Being well and feeling well contribute to your wholeness as a person. But there’s an increasing recognition that the United States is a stressed population — with negative effects on both physical and mental health. To help alleviate consequences of stress, wellness programs are becoming popular in workplaces and in the healthcare system.
At Boston Medical Center, a large percentage of patients come from underserved populations, with unmet social needs and physical conditions that contribute to their daily stress. While healthcare systems play an important role in addressing patients’ social needs, they are not designed for treating population-level root causes of stress, such as a lack of affordable housing. The inability to fully address these issues, along with generally limited resources — whether that’s time, funding, or emotional bandwidth — can lead to higher stress levels, burnout, and low engagement for hospital employees and staff. These stress-related issues are linked to poorer quality of care for patients, as well as fatigue, depression, decreased performance and morale, and other mental health problems for physicians.
The Office of Equity, Vitality & Inclusion, Human Resources Department, and the Program for Integrative Medicine at Boston Medical Center saw a strong need for a focus on wellness and self-care to reduce stress among employees, leading to a pilot study to evaluate the impact of a mindfulness-based stress reduction (MBSR) program on clinicians, nonclinical leaders, and support staff at the safety-net academic medical center. Though the pilot sample consists of small groups of employees, the overall aim is to incorporate mindfulness into the culture of the entire BMC system, including patients, with this program being a first step in using mindfulness-based stress reduction as a low-cost, low-barrier method to systemically address issues of stress, burnout, and engagement and invest in the long-term health and wellness of both patients and employees.
Mindfulness is a practice that can be accessible to anyone, to wide-reaching benefit. It can be as simple as a three-minute breathing exercise with your hand on your heart and your hand on your stomach, while you just watch yourself breathe. As humans, our minds are constantly racing, but the tools of mindfulness have been shown to bring us into the present moment, cultivate mind-body awareness, reduce pain, and decrease stress. These benefits were borne out by the pilot program, which found consistent and positive effects on vitality, engagement, and interpersonal connection across cohorts.
MBSR study design
The pilot intervention included three cohorts of BMC employees — clinicians, nonclinical administrative leaders, and support staff — representative of a diverse range of daily responsibilities, stressors, and needs.
Each cohort underwent an adaptation of the traditional mindfulness-based stress reduction approach, which was designed in 1979 as a systematic course of eight 2.5-hour weekly group sessions, as well as home practice that teaches participants how to cultivate mindfulness in everyday life. The intervention at BMC adapted the curriculum to an eight-week course with a 1.5-hour session each week, led by an MBSR-certified instructor. Participants learned mindfulness techniques including yoga, narrative medicine, and meditations such as body scan, breathing, and lovingkindness.
Each week of the course had a theme, such as the present moment. It included a mindfulness exercise and a reflective question. For example, participants may be asked, “When’s the last time you felt you made a meaningful difference, either at work or at home?” Participants write or draw their responses to the question, an approach that took into account varying literacy levels and language barriers. Participants would then talk one-on-one to practice mindful communication. The course also incorporates home practice, including meditations, to help bring mindfulness into every aspect of participants’ daily lives, not just work.
The pilot course was initiated in March 2019 with a cohort of 26 clinicians from 14 departments. The second cohort included 21 nonclinical leaders from 18 divisions across the hospital, including Human Resources, Compliance, Development, and administrative leaders in clinical services. The third cohort represented support staff, including Transport staff and Environmental Services (housekeeping) staff.
Mindfulness-based stress reduction pilot program results
The impact of the eight-week program on stress was measured through reported burnout, professional fulfillment, and engagement. In physicians, reported burnout decreased from 52% to 26%, while professional fulfillment increased from 26% to 52% after the course. In leaders, employee engagement as measured by three nationally verified questions increased from 47% to 93%. Burnout among this group also decreased from 27% to 13%.
Qualitative data supports these results. Leaders noted the positive impact of the course on their capacity to be effective leaders, while participants across cohorts reported connecting more strongly to their colleagues at the end of the course. Participants reported feeling more confident in stress management and self-care, in both their personal and professional lives. For example, one participant provided the following feedback:
“Honestly, I did not think this course would help me in so many ways. I feel not only more present with my patients, I am now more present at home with my family. It has helped me disconnect work from my personal life, which gives me more energy in both.”
Appraising system-level value through wider use
The value of this program is not only in what it offers employees themselves, but also in what it could offer the hospital and the healthcare system. As more long-term data is gathered, researchers expect to see that employees who feel more engaged and fulfilled in their professional and personal lives through this practice will also be able to provide better care for patients, work more productively, create a more positive work environment, and stay in their roles at the hospital.
Because of its potential for improved performance and engagement, the plan is to expand the program to more employees, including through collaboration with the hospital’s residency program directors and colleagues at the Boston University School of Medicine. Soon, the team will begin an eight-week mindfulness course for patients. While some referral-based mindfulness programs already exist on campus to address specific conditions, such as pain, all patients would be welcome to attend this course.
The aim is to give each group a practice that they can easily integrate into daily life and create a culture that includes mindfulness based stress reduction to improve long-term health and wellness — for both patients and employees.
