Building a new 430-bed hospital with all private rooms in the Midwest as the tertiary medical center and Level II trauma center within a 7-hospital system was an opportunity of a lifetime. In 2008, in the midst of a failing economy and the uncertainty of future healthcare needs, it was also a risk that required courage, conviction, and vision. This was more than a hospital—it was an entire campus focused on innovative ideas and technologic breakthroughs to improve the health and well-being of the region. The vision was to create a welcoming place of hope, healing, and confidence, with each person receiving the best care experience not only for the community we serve, but also for the well-being of clinicians and coworkers. Additionally, the vision was to distinguish the healthcare system as a world-class health and workplace destination where not only patients, but also staff members are a central focus of the structure and work design.
With this in mind, the new tertiary hospital was a pilot/proving ground for a hypothesis that architectural design and a mindful approach to employee well-being would transform the healthcare system. Nursing played a pivotal role in the cultural transformation and well-being vision that transcends care for staff members and patients through the development of a healing environment, a dedicated focus on well-being, and the implementation of a holistic nursing program and response team.
To achieve our well-being vision, the leadership team developed a set of guiding principles to keep at the forefront, with the understanding that the new tertiary hospital would have to sustain the vision for generations to come:
- be a healing environment focused on quality, safety, and patient and physician preference
- provide excellent care to every person every day
- be an employer of choice with exceptionally talented people
- be a tertiary hospital with a community spirit
- apply knowledge using the latest technology
- be a destination for healthcare, reflecting the heritage of the region.
To create a healing environment with a focus on health and well-being, features were incorporated to decrease stress and anxiety.1 The design included natural light, calming waterfalls, soft architectural curves, live plants, and an emphasis on healing art. The artwork throughout the facility is a blend of the work of local artists, as well as employee-created murals and images of local settings. This artwork embraces the community and the environment surrounding us. The family park, walking paths, and many outdoor spaces give employees and families the opportunity to unwind.
Throughout the planning process, clinical nurses and their coworkers had an active role in design, workflows, and the incorporation of technology into their practice. Recognizing that innovation is essential to success, the assembly of 40 multidisciplinary teams encouraged clinicians to stretch their thinking about the ways they practice and to dream of what the best place to practice in would look like. One such innovation is the inclusion of respite rooms throughout our clinical spaces. These private rooms within nursing areas have the sole purpose of providing a safe respite for nurses and clinicians who need a few moments away to reflect and refresh mind, body, and spirit. The respite rooms include dimmable lighting, a comfortable recliner, a side table with a basket containing aromatherapy, relaxing music, stress balls, scalp massagers, and written affirmations and reflections, and a small water feature. Our vision and culture support elements of compassion and humanity to provide excellent care to every person, every day.2
According to Hector De La Torre and Ron Z. Goetzel, “A successful health promotion program starts with a commitment from company leaders, and its continued success depends on ongoing support at all levels of the organization. Leaders at companies with successful programs establish a healthy work environment by integrating health into the organization's overall vision and purpose.”3 And according to the Gallup Organization, leadership creates the vision for culture, makes it a priority, and sets the example for everyone else to follow.4 A strategic, intentional approach that moves forward with the purpose of supporting staff members in their total well-being can positively impact turnover and retention.5
Focus on well-being
Well-being is a competitive strategy to attract the best and brightest talents and keep them from burning out or leaving. Well-being programming has increased in the corporate world over the last few decades, and organizations are recognizing the importance of this trend. Few competitive companies neglect the well-being movement. According to the Gallup Organization, “Effective well-being strategies focus on more than employees' physical health, programs, or contests. [They] need an integrated strategy that accounts for everything that helps people lead a life well-lived and execute a job well-done.”6 Well-being encompasses all that impacts employees' ability to show up and be their best every day. It explores beyond healthcare costs and demonstrates investment in the employee as an individual; if an individual is feeling at his or her best, he or she will come to work at his or her best, with increased engagement and productivity. Those who are more engaged in work tend to be healthier through connecting socially, mentally, and emotionally.7 Those who are disengaged are twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease.8
Our well-being program allows individuals to be their best selves by truly designing an environment where this is possible and encouraged. Even the most strategic programming won't be effective in a workplace culture that disallows choices promoting maximum well-being. Staff members who are thriving in their well-being not only reduce healthcare costs and absenteeism, but also increase productivity.9 Employees who feel supported and engaged in their company don't typically leave, resulting in lower turnover. Although establishing an intrinsically motivated culture takes time and investment, it's crucial to organizational success.
Attracting the best and brightest candidates for upcoming positions and retaining them through an intentional well-being strategy will help an organization stay strong and vibrant. Well-being efforts supported by leadership, created and evaluated in a strategic manner, and truly role-modeled by organizational culture can greatly impact the organization. Not only can focusing on well-being decrease healthcare costs, absenteeism, and presenteeism, it can guide staff members toward self-efficacy in their own health, empowering them to live a healthy life and take care of their total well-being.10 In turn, this produces a workforce and workplace where people can thrive.
Looking at well-being through another lens, the lack of focus on one's own optimal well-being may lead to employee injuries. For example, fatigue, lack of proper and regular nutrition, and insufficient stress management play an important role in employee injuries. With the belief that employee safety and patient safety go hand in hand, staff education was developed and implemented on the importance of appropriate equipment, proper stretching, recovery exercises, and body breaks to increase performance and decrease health risks.11 The implementation of these programs provides accountability and support to ultimately reduce employee injuries.
To achieve the goal of healthy and engaged employees, the organization dedicated resources to create a well-being program and department in 2014. This department offers a variety of well-being coaches, including one-on-one coaching, phone coaching, and group empowerment coaching to guide coworkers through behavioral change and accountability for those changes. The well-being department coordinates and collaborates with other system departments or outside partners to offer specialized programs to enable employees to recover from stressors and enhance the element of social connection/well-being.
Holistic nursing program
In a culture of appreciative and participative leadership, a group of clinical nurses brought a proposal to the chief nursing executive (CNE) to incorporate holistic nursing practice throughout the healthcare system. To implement the plan, nurses needed to be educated in holistic nursing. The nursing leadership team, alongside clinical nurses, began to review holistic nursing programs at other healthcare systems, as well as certification programs. The CNE invited the group to present the concept of holistic nursing to the nursing shared governance council, and the holistic nursing program was developed and implemented across the healthcare system in 2014.
A holistic nursing council was created and incorporated into the shared governance process. Clinical nurses with a passion and drive for holistic nursing, with the support of the CNE, were actively engaged in bringing national speakers to the organization to further their knowledge and become certified as holistic nurses. In 2015, 38 nurses were educated to take the holistic nursing certification exam and 20 of these nurses received further training to teach ongoing certification preparation classes. Currently, three certification classes are held each year. To eliminate the financial barrier of applying for and taking the exam, the organization incorporated a voucher system to enable nurses to take the exam without the upfront expense.
The concept of unit champions was initiated to provide additional education and a standard process to better disseminate education, information, and events to further holistic practice. It's our belief that to care for others, nurses need to care for themselves first.12 The holistic nursing program developed, coordinated, and facilitated quarterly lunch and learn events covering a variety of topics, such as mindfulness, anxiety and stress management, and nutrition. This program continues to evolve and grow to reach more nurses. Holistic nursing concepts were accepted and incorporated into the healthcare system's professional practice model in 2016, including the whole spectrum of mind, body, and spirit. (See Figure 1.) In a continued effort to enhance, support, and inspire the well-being of nurses, a holistic response team (HRT) was formed in 2017.
Holistic response team
Holistic response is an innovative way to promote well-being and resiliency in the workplace. The purpose of the HRT is crisis intervention and self-care promotion, serving nurses in need of intensive emotional and spiritual support.13 The HRT utilizes holistic modalities and interventions, including aromatherapy, therapeutic communication, massage, meditation, breathing exercises, prayer, healing touch, nourishment, and mindful movements such as yoga. A timely and individualized self-care plan is developed using these modalities. Follow-up occurs to check on how the involved staff member is doing and if he or she is utilizing the self-care plan.
This holistic response is an early strategy to address and potentially prevent nursing burnout and demonstrate that the organization cares for its employees.14 The intention is to promote a mind-body-spirit connection by authentic presence and nurture others to be mindful and model self-care. Nurses who take time for self-care are better able to teach their patients effective anxiety and pain management techniques.15 The HRT provides a holistic and dignified response to any staff member experiencing crisis and is a conduit to other resources in the healthcare system.
The HRT can quickly intervene, acting as a circuit breaker on stressful days, turning struggles into strategies, and improving well-being for nurses and, ultimately, patients. This program is set up for normal people having a normal reaction to an extraordinary event. It empowers the clinical nurse to develop authentic self-care and explore different modalities for addressing stress and anxiety. The HRT provides employees with a moment to pause to take a breath and care for themselves. A nurse who utilized the HRT stated, “I feel privileged to work for an organization that advocates for my well-being. HRT is a valuable asset in providing much needed moments of relaxation and refocus. HRT is one of the best things the organization has added for keeping us in the right frame of mind, body, and spirit.”
Although the HRT program was initiated to support nursing, it's grown to include all employees, helping to fulfill the well-being mission of the healthcare system. A physician who experienced the HRT remarked, “The holistic nursing program and, in particular, the HRT are an absolute gem in the crown of our health system. To have coworkers who are willing to attend to and support any staff member who's upset or in crisis is a tremendous resource within our hospital, especially when our staff and providers are so focused on the patients that it's frequently overlooked when the trauma of caring for other human beings hits too close to home. With stress and provider burnout being a huge issue within our industry, having this type of response team to help staff regroup is essential to a medical center of our size and scope.”
By introducing a healing environment, focusing on well-being, and cultivating a holistic nursing program and response team, our organization has furthered our goal to distinguish the healthcare system as a world-class healthcare and workplace destination. This is demonstrated by several outcomes and national recognitions, including:
- decreased overall nursing turnover by 33% (See Figure 2.)
- increased scores in the “my organization helps me deal with stress and burnout” category on the Advisory Board's employee engagement survey (See Figure 3.)
- reduced employee injuries by 30% (See Figure 4.)
- received the Advisory Board's Workplace of the Year Award in 2015, 2016, 2017, and 201816
- received Magnet® recognition in 2017 for the 7-hospital healthcare system, with an exemplar in the holistic nursing program17
- received the American Holistic Nurses Association's 2018 Institutional Excellence in Holistic Nursing Practice Award18
- listed among the nation's “best and brightest” in wellness by the National Association for Business Resources in 2017 and 201819
- named one of the nation's 15 top health systems by IBM Watson Health for 2017 and 2019.20
Being our best selves
The World Health Organization defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”21 Our healthcare system aligns with this definition in its vision for well-being—a holistic approach to improving and inspiring the mind, body, spirit, and community connections. Our focus on well-being provides an enabling environment for staff members to engage or recover in different areas that help them be the best version of themselves.