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Creating Health Within the Berkshire Health Systems Community

August 15, 2016

By Ruth P. Blodgett, MBA

As health systems across the nation focus on moving from volume to value to improve health and quality as well as reduce the cost of healthcare, one health system decided to adopt mindfulness for its employees as a key strategy to improve the health of its community.

With an initial goal to utilize the principles of integrative health to help transform the health of our community, the Berkshire team quickly realized that we needed to start the change from within each of us and our own organization. But this effort is not an employee wellness program, rather it is a leadership and organizational culture agenda to improve performance as well as enhance health and wellbeing.

Background

Berkshire Health Systems (BHS) is the leading provider of healthcare for the 130,000 residents and millions of visitors of Berkshire County. After the closure of a neighboring health system in 2014, BHS became the sole health system caring for this western most county in Massachusetts, with underlying poor health status often seen in both inner city and rural areas. Despite these socio-economic and health status challenges, BHS has a strong track record of clinical excellence at Berkshire Medical Center, its community teaching hospital, and Fairview Hospital, a critical access hospital in South County as evidenced by recognitions such as Healthgrades 100 Top 100 Hospital and Leapfrog Top Rural Hospital award, to name a few. Given the longstanding BHS mission “to improve the health of all residents of the Berkshires, regardless of ability to pay,” we also adopted the ambitious vision to become the healthiest community in the country. To attain this goal, we believe that we must work with our community to create health, not just take care of illness and disease.

BHS has had a comprehensive employee wellness program for over 10 years, which has reduced the cost of healthcare for our employees and earned several honorable mentions from the C. Everett Koop Workplace Wellness Award. Wellness at Work is also offered to many client companies throughout the Berkshires, in addition to a robust community health outreach program. In 2012, under the leadership of our CEO, we began a partnership with Canyon Ranch Institute’s Life Enhancement Program to bring an integrative health, lifestyle change program free of charge to residents with limited resources. The core team for the program included many key leaders at BHS and this direct experience informed and inspired the possibility that we could transform our health system so as to be more effective in transforming individual and community health.

Framework for Change

We began our work with the premise that we should adopt a strategy based on the principles and evidence of integrative health (IH). The overarching goal was to create a strategic plan for integrative health services at BHS. Specifically:

We seek to explore the application of IH principles and services throughout the health system as a means to help transform BHS and facilitate our effectiveness in achieving the quadruple aim to create a healthier population and community. Creating a strategic plan for integrative health at BHS will formalize and strengthen our focus and enhance our current effort to achieve our mission and strategic goals.

By following a proven change strategy framework, including being open and willing to modify direction, we began by focusing internally.

While there were many sources of information and evidence, we utilized three key resources to inform our model for change.

  1. Leading Change, by John P. Kotter
  2. The Execution Premium; Linking Strategy to Operations for Competitive Advantage, by Robert S. Kaplan and David P. Norton
  3. Finding the Space to Lead, by Janice Marturano

Defining the Problem and Forming the Team

Following Kotter’s eight-stage change process, we first established a sense of urgency through our guiding coalition (stages one and two). This was an iterative process, which ultimately led to our change in direction. We also avoided a near miss in forming our team. The initial team was comprised of knowledge experts and champions for integrative health, but with the guidance of Jeremy Petranka Associate Professor of Economics at Duke University, the team was quickly changed to include key operational leaders who would lead any significant organizational change.

Members of the guiding coalition included: COO, CNO, Medical Director for Population Health, Chairmen Behavioral Health, several VPs, Director of Wellness, Integrative physicians in primary and cancer care, program leader of IH for cancer and pain, educational specialist, SVP Planning/VP Physician Services, and most recently, the Director of Patient Safety.

Recognizing that clarifying the problem and opportunity was a crucial, foundational step, we dove into understanding the problem. Highlights included:

The Problem:

  • No one can afford the cost of health care today in the U.S.
  • And where is the value as measured by life expectancy, quality of life, and health status measures?
  • US Healthcare system based on fixing disease vs. creating health
  • From the Centers for Disease Control, 2009:
    • As a nation, more than 75% of our health care spending is on people with chronic conditions.
    • 7 out of 10 deaths among Americans each year are from chronic diseases.
    • In 2005, almost 1 out of every 2 adults had at least one chronic illness.
    • About one-fourth of people with chronic conditions have one or more daily activity limitations.

The Opportunity:

  • A staggering 75% of all health care spending in the US can be traced to obesity, physical inactivity, smoking, alcohol consumption, poor diet, insufficient sleep and poor stress management.
  • The good news is that these illnesses can be avoided, reduced and even reversed by making healthier lifestyle choices.
  • Integrative Health approach can transform health.
  • Payment reform and business models of healthcare are shifting towards value and population health which will provide new vehicles for proving care.

Change in Focus: the BHS Community

We had to be open to the leadership of the guiding coalition as we defined the problem and opportunity which ultimately lead to a refocusing of our strategy and effort. So why the BHS Community?

The Problem:

  • All of Berkshire County is too big.
  • We are a reflection of our community—same health needs.
  • We care about our employees’ health.
  • If we can start something internally, we can spread to our friends and family.
  • How can we educate our patients if we don’t practice healthy living ourselves?
  • People are stressed and have limited coping skills.
  • Our staff is facing economic, social, environmental pressures.
  • Signs of stress, burnout.
  • Culture is left-brained and often judgmental.

The Opportunity:

  • If we feel better and have more energy and focus we will do our jobs better, and be a greater help to our patients.
  • Integrative health approach will improve wellbeing and performance.
  • If we can become a kinder, gentler place it might help others and improve results.
  • Decrease distractions, presenteeism, absenteeism.
  • Create a virtuous cycle of staff health, leading to staff engagement, leading to patient health.
  • Embrace the quadruple aim*: care of the provider/staff wellbeing as a key driver of the triple aim* for the health of the population, experience of care, and cost of healthcare.

The Vision and Strategy

With the problem and opportunity defined, we moved on to the third stage of change to create the vision and strategy, which resulted in the adoption of the following:

Why Embrace Integrative Health for the BHS Community?

To become the healthiest county in the country where every individual can thrive, we will need a critical and foundational strategy to create a healthy community within BHS, to allow us to transform our own health, culture, environment and models of care so that we can lead the community in the journey towards increased health and wellbeing.

The drive to thrive…..

Our Integrative Health Mission for our BHS Community:

To lead and foster healthy living and a healthy BHS community starts with each of us in our self-care, and includes our relationship with each other, our partnership with the people we help, and our friends and family.

Fostering healthy living and a healthy BHS community starts within each of us and includes our self-care, our relationships with each other, our partnership with the people we help, and our friends and family.

Our vision is to create an environment that builds the capacity for all to thrive as individuals, colleagues, caregivers, parents, friends and neighbors.

Values and Principles

The BHS values of compassion, respect, excellence, stewardship, trust and diversity are aligned with the philosophy of IH, and we believe the adoption a few additional elements will enhance our efforts to foster a healthier BHS community. These include:

  • Self-care
  • Partnership and empowerment
  • Mindfulness and presence
  • Holistic approach and attention to the integrated elements of mind, body, spirit (purpose and meaning), and emotional health

Value Proposition:

Employees will have:

  • More energy, resiliency, and coping skills as they face the normal stressors of work and life
  • More focus, clarity, creativity and compassion
  • Better health and sense of wellbeing
  • Less resources spent on sickness, chronic disease
  • Less distracted coworkers

BHS will have:

  • Improved results and performance for the triple aim
  • Best workforce, workplace and improved recruitment and retention

Patients will have:

  • More engaged partners for their health
  • Role models for health
  • More support for their mind-body-spirit needs

Community will have:

  • Ripple effect from the energy and knowledge emanating from the BHS community

To support the vision and strategy we developed a strategic development case statement, a strategic change agenda, strategy map, implementation plan, and leading and lagging metrics. Embracing mindfulness was identified as the primary and foundational initiative to lead this change. Close attention was paid to build upon key linkages to align efforts within this strategy with what might be considered “other” initiatives. Examples include leadership development/education and medical education/CME, employee engagement, crew resource management, patient safety, patient experience, and wellness.

Communicating the Change Vision

A day-long retreat attended by over 150 physician and management leaders in June officially launched our vision and change strategy. The day was intentionally experiential, giving people the opportunity to have firsthand exposure to mindfulness and meditation, followed by an overview of the strategy to increase both performance and wellbeing through specific initiatives. As some early initiatives had begun back in the fall of 2015, we were able to share some early successes as well. The feedback and evaluations were overwhelming enthusiastic about the day itself and the hopefulness and helpfulness of the future direction.

In late June we introduced the mindfulness agenda to our employees through our quarterly around-the-clock employee forums. Over 1000 people — nearly ¼ of our workforce — attended and heard about our vision for our BHS community and the benefits of mindfulness with a sampling of upcoming programs.

Empowering Broad Based Action

Since we began this journey almost a year ago, we have embraced an inclusive philosophy, and engaged and empowered champions and their efforts throughout the health system. We are fortunate to have several patient care programs with an integrative health component in areas such as cancer, pain, and our wellness programs. As caregivers are often more focused on the wellbeing of their patients over themselves, seeing the positive patient experience has helped people see the benefits of IH for others and simultaneously, opens the door for thinking about one’s own self-care.

We support key efforts that are aligned with our IH strategy, while being careful not to stifle other’s ideas but instead, to align them with the overall effort to ensure coordination and optimal reinforcement strategies. As an example, our nursing division was inspired to start a self-care committee after a session with the Birch Tree Institute in May of 2015. To link and leverage efforts, as well as to avoid fragmentation and silos, we supported their committee by joining it and embracing their efforts within the formal implementation plan of our IH agenda. We continue to identify and connect champions through the organization, as well as look for opportunities to insert this philosophy into other efforts and organizational culture in the organization. We recognize the need to remove barriers and work to modify behaviors which run counter to this philosophy as well.

Celebrating Short Term Wins

While we are just beginning on this journey, we do have some early short term wins, and we aim to learn from each of these to improve and build momentum. We have a deliberate focus on leadership during this first year, as we believe this is essential to changing our behaviors, culture and our environment to reinforce and uphold the vision of mindfulness, but we have also included many efforts for our whole organization as part of leading this change. Examples include:

  • Beginning many leadership meetings, including the weekly BHS Senior Team, with a short centering/mindfulness practice.
  • Day-long Leadership Retreat, with each recipient receiving a copy of “Finding the Space to Lead”, to reinforce the leadership benefits of focus, creativity, clarity and compassion, and to offer concrete guidance to build one’s practice and skills.
  • “Mindfulness, Medication, and Management” management workshop to reinforce the connection to performance and leadership, in addition to health and wellbeing. Other management classes under development.
  • A 10- week Mindfulness/Yoga class on campus for leadership. Completed 4 sessions thus far, with pre and post evaluations.
  • Four-Week Meditation class underway for leaders and managers.
  • Adding an additional dedicated resource by hiring a part-time master yoga teacher from Kripalu, a local yoga retreat with a national reputation.
  • Self-care Committee hosted a “Relaxation Fair” for all employees, conducted a self-care survey, and has promoted space and skills for meditation in the work space.
  • Meal Break Fair to promote the benefits and offer tips for taking a break during one’s shift.
  • Sound meditation sessions.
  • Wellness classes for all employees including 8-week workshop on tips for lifestyle change, summer outdoor yoga classes, and weekly group acupuncture for stress release.
  • Rounding on units to offer tips and techniques for handling stress by breathing, taking a pause, managing transitions, chair yoga, etc.

Next Steps

We have just begun. We are not even halfway through Kotter’s 8 stages. Our leadership team will need to stay focused and build upon these early efforts to create lasting change and results. This alone will call for discipline given the many competing demands at BHS and in the rapidly changing healthcare industry. It will be critical to continue to link this strategic initiative with the larger mission and strategies of the organization. Caring for our caregivers and integrating mindful leadership and practice into the way we work will produce better results for whatever challenges we face and goals we embrace. It will be critical to remember that this is not a “nice to do” side agenda, but a central and enabling strategy, aligned to support the achievement of mission-driven strategies, as articulated in the concept of the quadruple aim.

While efforts begin with education and training, we recognize the importance of hardwiring the mindfulness philosophy into the way we work with one and other, our systems, processes and initiatives to drive the organizational culture we believe will help transform the performance and wellbeing of our workforce. Ultimately, the change will be owned and driven by the individuals and culture of organization, and sustainable beyond the voices of the guiding coalition. Embracing mindfulness and integrative health within the BHS Community will lead to creating greater health with our patients and community.

References

Thomas Bodenheimeimer, MD and Christine Sinsky, MD, “From triple aim to quadruple aim: Care of the Patient requires care of the provider”. Annual of Family Medicine, 2014

Michael E. Porter, “What is Strategy”, Harvard Business Review. 1996

David J.Collis and Michael G.Rukstad, “Can you say what your strategy is?” Harvard business Review. 2008

John Kotter, Leading change

Janice Marturano, Finding the Space to Lead

Robert S. Kaplan and David P. Norton, The Execution Premium

Acknowledgements

Special thanks to the faculty at the Leadership Program for Integrative Healthcare at Duke University and Jeremy Petranka, Associate Professor of Economics at Duke’s Fuqua School of Management, for their guidance, expertise and passion and to the leadership team at BHS for their unwavering dedication and commitment to excellence and the health of the people we serve every day in the Berkshire community.

 

AUTHOR BIO

Ruth Blodgett, MBA, is the Senior Vice President, Planning and Development for Berkshire Health Systems in Pittsfield, Massachusetts

 

 

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