By Nickolas Yu, Program Manager - Staff
wellness & Patient & Family-centred care.
Sydney Local Health District.
Presentation for NSW Innovation and
Health Symposium, November 2015
Acknowledge ...
•Dr Teresa Anderson, SLHD CEO
•Katharine Duffy, SLHD DONM
•Karen Bowen & Rachel McBride, SLHD NM SLHD
•Susan Pearce, Chief Nurse NSW
General Managers & Director’s of Nursing, NUMs & staff at participating
sites Canterbury, Royal Prince Alfred, Concord, & Balmain Hospitals, &
Tresillian.
Heart of Health Research Hub research collaborators: Dr Greg Fairbrother
(SLHD), Dr Anya Johnson & Dr Helena Nguyen (Usyd), Prof Felicia Huppert
& Dr Paul Atkins (ACU).
2
Cartoons illustrated by Simon Williams, designed by Nickolas Yu
2
TODAY’s PRESENTATION
A consumer story
How to support compassionate care
Preliminary research findings
A CONSUMER STORY
“By the book ..
but not in the book.”
HOW TO SUPPORT
COMPASSIONATE CARE
Patient & Family-centred Care Attributes
Compassion strategies
Experiential
Research &
Sound theory
Conversational &
Reflective
Values
Narrative &
Creative
Role modelling &
Leadership
Hard wiring
Meditation &
Contemplative
Mindful, compassionate
presence skills
Personalised
care skills
Compassionate,
Patient-centred
Respectful care
Wellness &
resilience skills
Coaching &
enabling skills
Support & specialised
programs eg:
Compassion ‘Think tank’
Research collaboration
ABOUT THE PROGRAM
Meditation-based compassion and mindfulness training
A form of mental & emotional fitness training
Science-based, Practical, Secular (non-religious)
Compassionate care
Staff wellness
Happy worker – Productive worker hypothesis
eg Parks and Steelman (2008); Harter, Schmidt & Hayes (2002).
Deep relaxation meditation
Informal
(on-the-go)
practices
Kindness meditation
Mindfulness meditation
Formal
(‘sitting’)
practices
Self-compassion &
Compassion meditation
PRELIMINARY RESEARCH
FINDINGS
STUDY 1:
Cross sectional
STUDY 2:
Pre-post test
(sustained)
STUDY 4:
Non-randomised
experiment
(waitlist design)
STUDY 5:
Qualitative
STUDY 3:
Pre-post test
(intensive)
Studies
(1-6)
Fairbrother*, Yu*,
Johnson, Nguyen,
& Wang (*SLHD &
Usyd Work & Org.
Studies).
STUDY 6:
Qualitative – Sankalpa
facilitators-in-training
STUDY 1:
What might a cross-sectional
analysis of baseline survey-based
self-report data indicate to us?
Independent variables measured
*Perspective-taking
(r=0.58)
Demographics:
*Gender (NS)
*Years of service (NS)
Intra-personal capacity:
*Mindfulness (r=0.31)
*Well-being (r=0.27)
*Flourishing (r=0.41)
*Self-compassion (r=0.38)
*Resilience (NS)
*Positive affect
(r=0.52)
Negative load:
*Stress (NS)
*Emotional labour (NS)
Workplace-specific:
*Core performance (r=0.27)
*Team performance (r=0.18)
*Job satisfaction (r=0.46)
*Compassionate climate (r=0.19)
Dependent variable of interest:
*Compassionate Patient and Family-centred Care
NS = Not significant at P<0.05 level
*Resources
available (r=0.33)
Preliminary conclusion (n=130)
Perspective-taking
capacity
Positive emotions
Compassionate,
patient & familycentred care
(CPFCC)
After stepwise multiple regression … A model consisting of positive affect
and perspective-taking yielded the best predictive model of CPFCC (adjusted
r2=0.47)
So, improvements on positive affect and perspective-taking might positively
impact on Compassionate, patient & family-centred care
STUDY 2:
What is the impact of meditationbased mental & emotional fitness
training (sustained dose) on staff
wellness and compassionate care?
Preliminary results (n=24)
Perspective-taking
capacity
Effect size: 0.5
Compassionate,
patient & familycentred care
Effect size: 0.8
Mindfulness
Effect size: 0.8
Climate of
compassion
Effect size: 0.4
Stress
Effect size: 0.4
Emotional safety
Effect size: 0.3
At P<0.05
STUDY 3:
What is the impact of meditationbased mental & emotional fitness
training (intensive dose) on staff
wellness and compassionate care?
Preliminary results (n=36)
Positive affect
Wellbeing
Effect size: 1.3
Effect size: 1.2
Mindfulness
Effect size: 1.7
Resources
Effect size: 1.0
Stress
Effect size: 1.0
At P<0.0001
“Very needed for our type of work dealing with all types of people in
community – reminds us we need to look after ourselves to look after others
…” RN ED
“Sankalpa helps me a lot to relax, refresh, and revive. I feel so happy to be
part of this program. Thankyou NSW Health for organising this wonderful
program for us.” RN Recovery
“The program allows me to take a moment and look after myself and to
reflect on the things that I need to improve.” RN Oncology
“I look forward to Sankalpa. At first I liked the acknowledgment from my
hospital – now I like the acknowledgement I have myself. It is nice to slow
down, calm down, forgive and be kind to myself …” RN Oncology
Preliminary overall conclusion
• Highly significant (P<0.0001) short-term Sankalpa effect shown
among leaders during intensive format;
• Significant (P<0.05) sustained Sankalpa effect shown among staff
during sustained format;
• Positive affect and perspective-taking shown to be important
correlates of CPFCC
• Empirical support for key program assumptions is emerging (eg PA
& PTC)
• Sankalpa appears to be an effective strategy for supporting
compassionate, patient & family-centred care + staff wellness
Appendices
Lindy Collins, NUM
Canterbury Emergency Dept.
*Impact
Clinical leader
Culture
*Key success factors
Staff wellness
Compassionate care
Relaxation & Stress relaxation, Mindfulness, Kindness, Self compassion, Compassion skills
What is compassion?
Definition
Latin: “to suffer with”
“a deep awareness of
the suffering of another
coupled with the wish
to relieve it.” Chochinov 2007
Elements of compassion
Head
(noticing +
appraising)
… seeing
Heart
(emotional experience)
… feeling
Hands
(action to diminish
suffering)
… acting
An understanding, a feeling, a motivational state, and an action.
SITUATIONAL MAP FOR COMPASSION IN CONTEMPORARY HEALTHCARE
Healthcare
Rising consumer expectations
Excellence
Risk management
Positive care
outcomes
Positive care
Experiences
(safe n sound)
(caring & responsive)
Patient &
Family-centred
care
Compassion
Bigger perspective on quality
Leaders’ vision
$ effectiveness & funding models
High performance cultures
MF, compassion, SR skills
(Attention & Emotional
Fitness training)
Happy worker-Productive worker
Humanistic/Sustainable cultures
Employee of choice, War for talent
Healthcare
A social good
Broader systemic influences
What else?
Intensive format science-based, meditation program (Sankalpa)
improves positivity, stress, wellness, mindfulness: Preliminary
results
Nickolas Yu1, Greg Fairbrother 2 Anya Johnson3, Helena Nguyen4
Manager
Staff
Patient &2,Family-centred
Care, Sydney
Local Health District
1, Anyaand
3
Nickolas
YuWellness
Johnson
& Helena Nguyen
2Clinical Nurse Consultant - Patient & Family-centred Care Research, SLHD
1*Nickolas to(SLHD),
2-3
add correct title and other collaborators**, University of Sydney Business School
3-4University of Sydney Business School.
1Program
Introduction
Method
Patient & family-centred care is a
key priority in modern healthcare.
The Sankalpa Program consisted
of five core
meditation practices:
Research has found that patient
and family-centred care is
characterised by collaboration,
continuity of care, consideration of
patient needs and preferences,
comfort (physical and
psychological), candid information
sharing, courage, caring workplace
environment, and compassion
(Blewitt et al, 2015).
Compassion is “a deep awareness
of the suffering of another coupled
with the wish to relieve it.”
(Chochinov 2007). Elements of
compassion include understanding,
appraisal, empathy, motivation and
responding (Atkins & Parker 2012).
Aim
A number
of studies
haveof
found
To
investigate
the impact
a 2-day
that meditation
trainingworkshop
can
meditation
residential
on
increase compassion
(Seppala
et
participants’
stress, wellness,
positive
affect
al, 2013;
Fredrickson et al, 2008).
and
mindfulness.
Most of these programs run
progressively over a 2 month
period or more. Less is known
Model
about theMindfulness
effectiveness of Compassionate
care
compassion
and mindfulness
•Attention
•Compassion
•Acceptance
training delivered in a brief,
behavioural
•Awareness
intensive
format.
•Present
focus
Sankalpa
Staff wellness
•PANAS
•DASS (Stress)
•Mental wellbeing
Patient-centred care
•Collaboration
•Person first
•Relationship-based
Results
• mindfulness training,
• relaxation and stress reduction
training
• kindness training,
• self-compassion training,
• compassion training.
Where to next?
The 2 day residential program
comprised of 12 hours of
compassion and mindfulness
training.
Pretrainin
g
T1=
0
•Strengthen research design in
next study by:
•Using a cohort, waitlist control
36 clinical leaders (managers,
Posteducators and seniortrainin
clinicians)
g
participated
in the program.
Sankalpa
Days
A within person repeated
T2 =
measures design was3
used. A questionnaire was used to
collect data at
two time points.
•Testing the longer
Contact
Effect sizes were calculated for each
of the five outcome variables of
interest:
Nickolas Yu
d=
Mindfulness
Pre/post data was analysed via
SPSS using the paired-t test.
Dependent variables canvassed
were: Positive affect, Mindfulness,
Stress, Well being & Resources
(physical, mental, emotional).
Gender and years in the
profession were also measured
as independent variables.
term effects of the
intervention.
Effect Sizes
1.7
Positive affect
1.3
Stress
Program Manager, Staff
Wellness and Patient & Familycentred Care, Sydney Local
Health District.
E:
nickolas.yu@sswahs.nsw.gov.au
Note
This is a research project of the Heart of Health
Research Hub which is a collaboration between
academics and practitioners from Sydney Local
Health District, University of Sydney and
Australian Catholic University. The focus of
research projects is staff wellness and
compassionate care.
1.0
References
Well being
1.2
Resources
Atkins, P. & Parker, S. (2012). Understanding individual
compassion in organisations: The role of appraisals and
psychological flexibility. Academy of Management Review.
Blewitt L, Wang K, Nguyen H, Johnson A, Pidial K, Yu N
(In press) Mindfulness: Creating the space for
compassionate care. Industrial Org’l Psychology Review
1.0
Chochinov, H. (2012). Dignity therapy.
Impact of compassion
• Compassionate individuals show ↑ helping behaviour, moral
reasoning, connectedness & stronger interpersonal relationships, as
well as ↓ depression, moodiness & mental illness (Cameron 2003)
• Within org’s compassion influences and individual’s sensemaking
about the org, resulting in ↑ org commitment, > frequent org
citizenship, and ↑ quality relationships (Boyatzis et al 2013; Lilius et al 2012; Lilius et al 2008)
• May use time & energy (Kanov et al 2004)
Receiving compassion
• Manage pain (Lilius et al 2012), Supports change (Huy 2002), Express suffering &
grieving (Hazen 2008), Legitimates suffering (Lilius et al 2012), Potential to trigger
vulnerability, recovery & org reengagement, commitment, +ve r/ships,
demonstrate supportive behaviours towards others (Dahl & O’Connor 2015)
Witnessing compassion
• Elation (Haidt 2003; Lilius et al 2012), Promotes org virtuousness which may
amplify org performance (Cameron et al 2004), Compassion satisfaction and
positive prosocial identity (Grant et al 2008), Openness to receiving help from
others, less stress (Cosley et al 2010), Work connectedness ... org
commitment, lower turnover, org citizen (Lilius et al 2012)
Acknowledgement O’Connor* and Dahl (2015). *Heart of Health Research Hub
Compassion in defined in terms of four elements: compassionate noticing,
appraising, feeling and acting (Atkins and Parker 2012)
Self/goal relevance or shared group belonging, deservingness and coping
self-efficacy (Goetz et al. 2010)
If lack coping self-efficacy … aversive and anxiety provoking (Lazarus & Folkman, 1984).
Faced with such personal distress, the observer is more likely to act
defensively rather than compassionately (Bandura, 1988).
Emotion regulation linked to compassion (Eisenberg et al., 1994); secure
attachment is linked to compassion (Mikulincer, Shaver, Gillath, & Nitzberg, 2005).
An important aspect of coping self-efficacy appears to be the self-compassion