The Complex Care Management Team was created to provide care to the Primary Care Center patients with multiple, complex medical, social and psychiatric problems, who as a result have repeated Hospitalizations, and ED visits. A team of a social worker, nurse care coordinator, patient navigator, pharmacist, medication health technician and a behavioral and medical advanced practice provider was formed to create individualized treatment plans to this group of patients.

The Bridgeport Hospital HealthCare Worker Support Group came together during the COVID-19 pandemic as a way to offer compassionate support, affirmation and recognition to employees. Through leadership communications, staff meetings, posters, and more, the group sought to support caregivers during this difficult period.

The Employee Wellbeing Check-In Program at Yale New Haven Health provides clinicians and staff with pro-active, scheduled check-ins to address coping, stress and mental health needs. The program was initially developed to address the mental health needs of those clinicians and staff impacted by direct patient contact during our the initial COVID-19. It has subsequently evolved into an ongoing effort to support the mental health needs of staff by providing them with proactive, opt-out scheduled check-ins. These are 30-minute screening appointments done by licensed mental health clinicians. The appointments are confidential and consist of a brief screening questionnaire (the validated Acute Stress Scale) followed by a discussion with the licensed mental health clinician. Individuals are then provided resources or referred to further counseling when appropriate.

The Family Meeting Support Group is weekly support group designed to answer intricate questions about aspects of care. The program is for anyone who has a family member or friend in the Intensive Care Units at Grady. Discussion and questions focus on what families can do for loved ones and how to emotionally navigate difficult health situations. Families and patients are also invited to come back after discharge to share their experiences with others.

The Center for Traumatic Stress, Resilience and Recovery (CTSRR) provides resilience, clinical, and educational services to support Northwell employees and their family members impacted by COVID-19. It is also engaged in research efforts to understand the impact of the stress of healthcare work on employees as well as the intersection of traumatic stress and health related outcomes. A centerpiece program of CTSRR is the adaptation and implementation of Stress First Aid.

The Annual Wellness Conference Series promotes open discussion about the difficulties all members of the healthcare organization face in the course of their work. The growing acknowledgement of the challenge of balancing patient care and staff self-care has led to the realization that more resiliency training is needed. In collaboration with organizational leaders, caregivers responded to this need by establishing a series of guest speakers. The speaker series has led to increased implementation of self-care techniques with support from the greater healthcare organization.

The Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team promotes wellness among the staff members on the hematology, oncology, and stem cell transplant units through a real-time nurse-driven, peer-to-peer education and support system. The program is designed to enhance staff resilience, create a healthier work environment, and improve team morale by offering an easily accessible on-site support program led by nurses.

The Resident Support Group at Boston Medical Center started as a biweekly meeting for family medicine interns and has since expanded to include separate groups for second- and third-year residents. Internship poses a number of challenges to new medical school graduates, including pressures from their supervisors and an ever-changing patient pool. This group gives them the opportunity to share experiences, to get perspectives on other rotations and interactions with supervisors, and to help each other navigate the difficulties of their new roles.

The Early Rehabilitation program allows the Henry Ford Hospital to provide superior care to patients admitted to the intensive care unit (ICU). It provides patient-centered care through focused physical and occupational therapy services in the ICU to improve the functional and cognitive outcomes of patients. In addition to being beneficial to the patients, staff have also been positively impacted by seeing improvements in their patients.

The John Peter Smith (JPS) Health Network had previous concerns with silos and duplication of resources and programs, so they developed the Caring for the Caregiver Team to support the psychological safety of employees. This team gathered like-minded stakeholders to create a comprehensive plan, brand Caring for the Caregiver initiatives, and create organizationally aligned initiatives to continue supporting all JPS employees. The Caring for the Caregiver team was able to conduct evaluations of all programs, determine the best course of action, present the plan to senior leadership and eliminate duplication of costs.

Helping Healers Heal is a system-wide initiative launched in 2018 that supports NYC Health + Hospitals staff who are second victims—healthcare providers and other staff members who were involved in an adverse event, a medical error, or a patient-related injury and feel traumatized or distressed by that event. The program offers three tiers of support based on an individual’s need, and uses trained peer supporters to offer support without judgment and recommend further assistance.

Kootenai Health created a free Lung Cancer Screening Program to provide eligible patients the opportunity to obtain recommended testing. This program has shined a light on a vulnerable patient population that now feels more included and valued. The program also helped bolster the confidence of providers by ensuring that all patients were receiving the best available care. The ability to provide follow-up scans in subsequent years gave the providers the confidence to recommend undergoing initial screening to their patients with the understanding that future scans would be performed free of charge. This confidence helped to engage patients who have previously been skeptical of the healthcare system.

The Dying, Death, & Bereavement Worship workshop was created to help new graduate nurses in the residency program at Memorial Hermann Northeast Hospital feel more comfortable caring for dying patients and their families. Later, more experienced nurses also expressed interest in the training, as they also felt discomfort with dying, death, and bereavement. Participants in this program have reported higher levels of comfort and competence in caring for patients during challenging end-of-life scenarios.

New York Presbyterian/ Lower Manhattan Hospital created the Purple Butterfly Project to alert team members to the presence of patients on comfort care measures prior to entering a room. The goal was to better prepare all team members to perform job duties in a compassionate, patient-centered fashion that is supportive of this patient population. Since the initiation of this project, there have been overwhelmingly positive responses not only from the clinical and non-clinical staff, also from the family members of patients who are on comfort care. They feel it offers an additional layer of support for their loved one.

Compassion, Peace and Renewal: CPR for the Soul was designed to create a caring infrastructure that provides opportunities for the inter-professional healthcare team to be acknowledged for the often difficult, demanding, and emotionally charged work of caring for seriously ill children. The goals of the program are to prioritize clinician well-being, address moral distress in care teams, and provide a safe space to gather, share and reflect on the work of caring for the very sick. Employees have reported that the program has helped them deal with stress and burnout.

The “Exploring Ethics” program was created to address the fact that clinical staff did not know when or how to request an ethics consultation, or have the confidence to do so. The program is structured to provide ethics content and education within a framework of real-time patient care concerns. This approach shows promise for supporting clinicians of all disciplines to build more cohesive teams, to reduce professional distress and to mediate communication conflicts.

The Enhanced Recovery After Surgery (ERAS) program was developed and implemented to improve collaboration between departments, to break down departmental silos, and to improve the experience of both patients and providers, giving the former a strong sense of comfort that their providers are all on the same page and giving the latter a strong sense of teamwork. Both patients undergoing surgery and providers working to prepare for, perform, and follow the patients after surgery are involved in the team.

Code Lavender is a mechanism to initiate support for staff after unexpected or adverse patient outcomes. The goal is to provide timely emotional, psychological and spiritual support. Team Lavender members (which includes nurses, physicians, and social workers in addition to chaplains and psychology staff) provide respite for those involved with a three-tier response. The program also provides monthly meetings for Team Lavender members, faculty and residents that focus on personal wellness, including therapy dogs, breathing exercises, guided imagery, and reiki therapy.

Conversations with Patients is an opportunity for caregivers to talk with patients in real time about their experiences, hear their stories, learn what is important to them, and then enhance their care based on the shared information. To date, the team has held more than 4,000 conversations with patients and their families. A conversation guide is used, and a summary of the conversations is entered into an electronic tool that enables the information to be made available to the larger healthcare team

The goal of the Food for Health program is to care for patients more than just medically. The team aims to provide the resources needed for long-lasting health and wellness. Caregivers screen for food insecurity and provide a free box of healthy food to the families who screen positively. In addition to the pantry boxes, every positive screening also receives a social work consult and a list of resources for food and other needs (such as utilities, transportation, etc.). The team has also augmented various meal programs for patients still in the hospital. Studies have shown that food is medicine and that food insecurity has significant implications for admission and readmission to the hospital.

The Senior Products Serious Illness management program provides comprehensive, team-based and integrated health services that serve to improve the quality of life of members and families, living and coping with life-limiting and end-stage chronic illness. An interdisciplinary palliative care model aims to provide members with high-quality education, coaching and care to achieve optimal health. The program was designed to help members express their wishes regarding their own medical care.

For over 15 years, the UAMS-Health Tiny Hands and Love Lives Programs have supported patient- and family-centered care in the neonatal intensive care unit (NICU). Tiny Hands originated from community and staff donations to provide support for overnight stay rooms, meal cards and parking for families that had extensive stays with their babies in the NICU. It has expanded its scope to include items such as motion devices, music recorders, developmental items, books, and food. The Love Lives Bereavement Program was developed to promote movement though the stages of grief after the loss of an infant. Together, the programs ensure that families are supported through any circumstance of normal or complicated birth as well as loss.

The main goal of the Healer Education Assessment & Referral (HEAR) Program is to prevent suicide and burnout among UCSD’s health science staff (physicians, nurses, pharmacists, residents, fellows, and other clinicians). It was built to provide compassionate, confidential, free and anonymous care for caregivers by supplying ongoing therapeutic support, bridge care, referral resources, and emotional process debriefs after critical incidents. The HEAR program has made a difference by shedding light on the undeniable fact that caregivers suffer and need compassionate care themselves. The program has also impacted the overall culture at UCSD by creating an environment where staff feel heard, valued, and recognized for the work and struggle they deal with on a regular basis.

Caregivers at Virginia Mason Medical Center partnered with a local playwright to host a series of five short plays about grief and loss from the viewpoint of the healthcare worker. Two of the plays were written after meeting with the hospital’s team and hearing their stories. Following the performances, the team hosts a facilitated discussion inviting the audience to share their experiences and what they felt after watching the plays.

The Schwartz Rounds have been a catalyst for a cultural change across Alfred Health. Schwartz Rounds encourage an open conversation among staff and allows for a safe forum to express thoughts and feelings about patient care with colleagues. As a result, feelings of isolation are reduced, and participants are left feeling better prepared to handle tough or sensitive patient situations.

The mission of the Communicating for Engagement program is to provide trainings in empathic engagement across many aspects of the health system, and is available to medical residents, physicians, nurses, and support staff. Training has also been developed for organization managers, with the goal of teaching them how to bring empathic communication into their relationships with their supervisees. This curriculum in empathy training connects participants with essential knowledge, tools and skills to relate more effectively to each other and to those they serve.

The Music Therapy program at Boston Children’s Hospital has implemented the Pacifier Activated Lullaby (PAL) to serve the youngest NICU patients and their families. PAL creates clinical applications of music with the help of current technologies; this device allows access to the power of music in the most individualized way as mothers, fathers and caregivers are encouraged to take active part in singing to their children. In this therapeutic process, caregivers serve vulnerable patients and their families by supporting them in a natural and non-pharmacological way during their most difficult and challenging trials. The PAL device is one of many music therapy interventions used at Boston Children’s Hospital.

The Carilion Clinic began the Schwartz Rounds program in 2013 with the aim of mitigating moral distress and fostering moral resilience. Since its inception, the program has impacted thousands of caregivers. In conjunction with the Clinic’s educational department, the program is promoted to all staff to help improve communication and encourage empathy.

The I’m Fine workshop was developed by Beads of Courage and was launched as a collaborative effort with Dr. David Sadker and Children’s Healthcare of Atlanta (CHOA). The Beads program at CHOA has received strong support at all levels and has been embraced as a transformational learning experience. By practicing open reflection in a safe space, CHOA has seen staff grow in their understanding of the value of reflective practice, the importance of sharing personal experience for self-growth and resolution of traumatic stress, and the impact of this on interpersonal empathy between staff and with patients and families.

The RISE team is an interdisciplinary team trained in understanding the impact of moral distress and moral residue, pediatric bioethics, conflict transformation, caregiver grief, and resiliency practices. The RISE team integrates ethics into daily practice by creating a workplace environment that recognizes the impact of moral distress, fosters resilience, and encourages discussion and collaboration among teams. Through the RISE consult service, which creates readily available moral spaces in the midst of challenging situations and facilitated ethics discussions, the team aims to broaden perspectives, improve patient care, empower moral agency and enhance team communication.

In an effort to address the stress of their practice environment in the division at Cohen Children’s Medical Center, the Helping Our Peers Endure Stress (HOPES) team was developed. This is an all-volunteer multidisciplinary peer-support team that includes physicians (faculty and trainees), nurses, nurse practitioners, social workers, psychologists, clergy and child life specialists. The team responds to critical incident stress in real-time, are available 24/7, and are trained by the International Critical Incident Stress Foundation to conduct individual and group interventions. The program has been perceived as an effective means of addressing the previously unmet needs of staff to process and learn to adaptively cope with critical incident stress, and has significantly increased staff cohesion, communication and inter-professional support.

The Center for Resiliency supports physicians, medical residents, medical students, advance practice providers and all associates in the pediatric setting, including some who work with families in the adult setting. Over 90% of the active medical staff at the Dell Children’s Medical Center have participated in at least one experience with the Center for Resiliency; some have participated in multiple, including retreats, a six-session resiliency course, monthly Resiliency Rounds, resiliency research (four IRB studies are currently running), the Professional Boundaries and Burnout course, individual counseling or coaching, and Schwartz Rounds. The Center addresses not simply the personal practices of mindfulness or self-care, but hospital-wide processes around difficult conversations, conflict management, and considerations around 24/7 coverage for resource-limited practice groups; resiliency is not limited to individual transformation but is a systemic transformation that supports the whole person, team and community.

No One Dies Alone (NODA) is a program at Inova Fairfax Medical Campus that supports the core value of caring for people and the community by radicalizing end-of-life care in the hospital. NODA volunteers are available to comfort dying patients in their final hours, and these Compassionate Companions provide a reassuring presence, whether it is verbally assuring them they are not alone, sitting silently by their bedside, holding the patient’s hand, playing music, singing, or praying with them. The program’s volunteers include hospital employees and members of the community who work with the support of the hospital staff to provide the most valuable gift: a dignified death.

The Debriefing After Your Day program aims to address residents’ and faculty members’ emotional needs and to decrease the burnout and depression rate associated with being a physician-in-training. In addition, the program serves as social outlet for residents, students and staff, and is vital in reenergizing all participants to achieve a sense of belonging, meaning and shared purpose and vision in their work.

Compassion, Peace and Renewal: CPR for the Soul was designed to create a caring infrastructure that provides opportunities for the inter-professional healthcare team to be acknowledged for the often difficult, demanding, and emotionally charged work of caring for seriously ill children. The goals of the program are to prioritize clinician well-being, address moral distress in care teams, and provide a safe space to gather, share and reflect on the work of caring for the very sick. Employees have reported that the program has helped them deal with stress and burnout.

In an effort to collect alternate viewpoints, particularly from patients using patient-family advisor (PFA) volunteers, Catholic Medical Center created the volunteer rounding program. PFA volunteers visit patients at their bedside during their hospital stay and collect data that will authentically improve the experience, safety and quality of care for all patients. This program was created by former patients to serve current patients.

Code Lilac at Children’s Memorial Hermann Hospital helps treat debilitating emotional distress among caregivers following a traumatic patient event. When a Code Lilac is called, affected caregivers are provided with a safe space to meet with their peers and specially trained colleagues who help them gain clarity and perspective. Seventy-five staff members have completed extensive training on emotional diffusing – the same training used by the Red Cross, firefighters and police to help their team members return to a functional level of service – and volunteer to facilitate Code Lilac sessions for their colleagues.

Danbury Hospital created this program for the palliative care team to be able to address and treat the patient as a whole person. In addition to alleviating suffering, the teams are experts in symptom management and communication skills that are necessary to elicit “what matters most” from patients and families to align their medical treatment with their preferences. This program promotes an inter-professional palliative care team to provide the best patient experience.

Donor Alliance launched their Schwartz Rounds® in 2016 to support staff wellness and combat fatigue. The program has been well-received and well-attended by staff. They are creating an evaluation tool to track their goals of supporting staff health and well-being, increasing compassion among staff, improving resiliency and reducing fatigue.

When dealing with clients, it is imperative to focus on client-centered language to drive their care. A course was taught to improve nursing staff’s recovery-based language practice, which would be reflected in client-focused care. An eight-month program was implemented with five levels of tasks to be mastered: learning language, hearing and speaking, writing, application to clients, and an ongoing recovery-language group for clients. Pre- and post-test surveys were administered to all staff who participated, which validated the anecdotal reports of success.

Emerson Hospital’s Coping Kit Program was started to help children cope effectively with their hospital experience. Coping Kits are colorful, toy-filled bags given to pediatric patients who enter as inpatients in the emergency department. The toys are carefully selected by members of the Pediatric Intervention Team to support universal coping and stress reduction. Used together, these items empower a child to become a more active participant in his or her healthcare and help transform the intimidating medical world into an environment that a child can understand and master.

As the first hospital in Massachusetts to use Orchid-CipherHealth’s rounding application, Emerson Hospital’s inpatient nurse managers use an app on iPads to round on patients utilizing best practice evidence based questions. The process supports the ability to set patient expectations, send immediate complimentary comments to staff, and provide notifications to other departments such as dietary and environmental services for service recovery. The tool not only helps Emerson improve on patients’ experiences during their hospital stay, it also has a positive impact on HCAHPS scores and provides important trends and data that can be used to enhance patients’ overall hospital experiences immediately, as well as over time.

Through various campaigns, Genesis’ program promotes the recognition and use of compassion as the key driver of customer experience and focuses on the mutually beneficial nature of the patient-caregiver experience. Through posters, newsletters, videos and a caregiver recognition program, over 100 skilled nursing centers and assisted living communities have participated in compassion campaigns. Its supplementary video series defines compassion and was accompanied by a discussion guide for managers to easily help staff integrate and apply the information.

Le Bonheur’s comprehensive bereavement program was created in an attempt to ease grief for families who have lost a child as well as for the staff who cared for them. For families, it offers physical presence at the time of death, invitations for multidisciplinary review in the weeks to months after the death of a child, counseling resources as needs are identified on phone calls and an annual Celebration of Remembrance. Personalized cards on significant dates are sent and for those who reside within 30 miles of the hospital the team offers home bereavement visits. For staff, bereavement boxes are placed on the units where a child has died so the staff may also write personal cards to the family. This provides staff members with an outlet for their feelings and an opportunity to share heartfelt condolences with their patients’ families. Within days after a loss, the team also provides food, listening and a safe place for staff to process the loss of their beloved patients.

Loyola’s pet therapy program provides compassionate love and support through weekly rounds to the clinical caregivers on units. Every Wednesday, Zoey, an eleven-year-old national pet therapy partner and her pet partner and director of pastoral care and chaplain, Marie Coglianese, round the patient care units, blood bank, core lab, pharmacy, GI lab, radiology and emergency departments. True to Loyola University Health System’s tag line, “We also treat the Human Spirit,” health system president Wendy Luetgens also joins rounding on “Zoey Wednesdays,” which speaks to the hospital’s commitment to the compassionate care of the staff’s spirits.

McLean Hospital’s mental health public awareness and anti-stigma campaign showcases a series of larger-than-life photographs and interviews with people from across the United States who have been affected by mental illness. Told through the eyes of its participants, the campaign aims to tear down the misconceptions of what those with mental illness look like. Its initial 235-foot physical installation opened in December 2016 at Boston’s Logan International Airport. The installation, website and companion book serve to capture the complexity of living with a psychiatric disorder, seeking treatment, navigating insurance and healthcare systems and facing stigma.

A monthly staff oncology support group was implemented to combat compassion fatigue among the oncology nurses and the associated healthcare team in the MSKCC Urgent Care Center and Clinical Decision Unit. The nurse-led group, which is structured as a safe place to share experiences, focuses on a variety of therapeutic techniques based on a monthly theme. The purpose is to promote healing of the mind, body and spirit as well as to enhance team-building.

Burnout, emotional exhaustion, depersonalization and low personal accomplishment have been correlated with negative patient, professional and organizational outcomes. A team at Mount Auburn set out to engage a diverse group of employees to determine whether either of two brief mindfulness-based interventions could help to reduce burnout. Interventions were either a downloaded four-minute focused breath meditation that participants would listen to daily for 30 days at a time of their own choosing, or attendance at four weekly one-hour sessions of a facilitated small group held conveniently at the workplace. They found that both interventions were significant with the independent meditation having the greatest impact on emotional exhaustion and improvement in depersonalization.

The Second Victim Peer Support program centers on providing rapid emotional support for all staff who have experienced or been impacted in an unanticipated or adverse patient event. This is a peer support approach; members have been trained to provide support to their colleagues. Nationwide Children’s Hospital is now near the end of an 18-month research project to characterize the negative impact of errors or adverse events on healthcare providers, and evaluate the effectiveness of the second victim peer support program.

The Ken Hamilton Caregivers Center at Northern Westchester Hospital was created in 2006 to provide free emotional support and respite to family caregivers. Listening with a non-judgmental ear allows family caregivers to feel heard and can help ease their stress. A relaxing physical space allows them to rest and recharge. In 2016, a “Stay in Touch” program was launched to maintain an ongoing, supportive relationship with the family caregiver in the home. By periodically touching base, trained caregiver coaches will provide emotional support and referrals to community resources as appropriate. Support will continue for as long as the caregiver finds it helpful.

Northwell Health has been undergoing a cultural transformation grounded in Connectedness, Awareness, Respect and Empathy (C.A.R.E.). This framework supports their execution strategy focusing on culture, care delivery, hospitality and accountability pillars. It embodies a holistic approach to patient experience by leveraging innate passions, listening to the “voice” of their patients and families, designing with intent and caring for professional caregivers. Highlights of their approach include an emphasis on storytelling, the creation of a culture leader role that is tasked with executing the patient and customer experience strategy, staff education, first impression projects, humanism initiatives, holistic integrative medicine programs, Schwartz Rounds™, relationship-centered communication and leadership rounding.

ACCEPTS (Aware Compassionate Communication: an Experiential Provider Training Series) is a multimodal program designed to enhance provider resilience and communication. Didactic and experiential exercises are delivered in a group format over the course of eight weeks. Providers engage in discussion and value-clarification exercises, learn cognitive behavioral models of stress and coping, practice mindfulness and participate in a number of communication exercises.

To enhance bereavement services in the acute care setting, South Shore Hospital created their bereavement program, which adopted the initiative “No One Dies Alone (NODA),” — a bedside vigil program where volunteers are trained to play music, read and attend to patients as they move toward a safe and dignified death. Their program also includes the Bereavement & Resource Line, offering families and staff around-the-clock access to referrals for community support groups and counseling, grief materials and phone support. The Comfort Tote replaces the standard hospital belongings bag and allows families to take their loved one’s items home in a more dignified manner and contains a resource guide to help families cope after a loss.

During the organization’s stakeholder consultation for a quality strategic plan, patients, families and staff rated compassion and humane aspects of care as a top priority, equally as important as safety. Sunnybrook adopted the Schwartz Rounds program as an intervention and enabler to advance a culture of compassion. To show that modeling compassion starts with hospital leaders, the CEO introduced the first Schwartz Rounds session and the CMO closed the session.

The University of Washington Medical Center’s program improves and strengthens interprofessional collaborative practice among caregivers, patients and families. It provides an opportunity for patients and families to engage with the medical team, and to establish shared knowledge and goals. This team approach promotes patient safety and high-quality care through improved communication, with the goal of co-creating the best plan of care for the patient. Clinicians, educators, researchers, students and patient advisors collaborated to achieve the goal of implementing SIBR and improving “The Triple C” — compassionate, collaborative care.