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- Creators: Barrett, The Honors College
Healthcare professionals across America are suffering from the inaccessibility of coping strategies that would help them to transform the excessive amounts of stress that they experience during each shift at the hospital or facility in which they work. Healthcare worker burnout, a disorder that manifests as physical exhaustion can be a side effect of a poor work-life balance. Other symptoms of burnout include problems with concentration as well as psychological disorders including depression and anxiety. Although it may seem odd, hospitals can start to implement programs utilizing alternative medicine in the form of mindfulness in combination with gratitude and vulnerability exercises that will not only create a positive corporate culture but also preemptively help these facilities save money by reducing rates of worker turnover, limiting the cost of employee treatment for burnout, and reducing the risk of employee accidents and poor quality of care leading to expensive patient lawsuits.
The goal of this project is to address resilience in children by designing mindfulness-based activities that incorporate and promote awareness of mind, being and mental health, and to integrate these resources into existing elementary curricula that focus on using school gardens as teaching platforms.
The objective of my honors thesis was to implement the mindfulness habit of journaling over the course of six months, then use the journal entries as a means to reflect upon observations of pre-selected metrics (connecting Zen teachings to my daily life, accessing my ability to rest, navigating relationships to others, and developing compassion for myself) in order to track how learning about Zen Buddhist philosophy impacts my life.
Through my academic career at Arizona State University, I have learned the importance of implementing mindful habits into one’s personal and professional life. Being introduced to mindfulness has changed my life for the better. My hope for completing this thesis is to inspire other college students and future social workers to embrace the present moment, while being aware of internal thoughts and feelings as well as external stimuli. While implementing mindful habits can seem daunting and complex, one must understand that being mindful is an ongoing life-long journey. Ultimately, we owe it to ourselves and the individuals and communities we serve to engage in mindfulness, and truly be at peace with our inner-being key words: mindfulness, social work, burnout.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
The purpose of this study was to determine the feasibility of a mindfulness-based intervention among pregnant women (12-20 weeks’ gestation) using a mobile meditation app, Calm. This study involved 100 participants who were recruited nationally due to the COVID-19 pandemic. This study was reviewed and approved by the Institutional Review Board of Arizona State University (STUDY STUDY00010467). All participants were provided an informed consent document and provided electronic consent prior to enrollment and participation in this study. This study was a randomized, controlled trial (trial registration: ClinicalTrials.gov NCT04264910). Participants randomized to the intervention group were asked to participate in a minimum of 10 minutes of daily meditation using a mindfulness meditation mobile app (i.e., Calm) for the duration of their pregnancy. Participants randomized to the standard of care control group were given access to the app after they gave birth. Both the intervention and control groups were administered surveys that measured feasibility outcomes, perceived stress, mindfulness, self-compassion, impact from COVID-19, pregnancy-related anxiety, depression, emotional regulation, sleep, and childbirth experience at four time points: baseline (12-20 weeks gestation), midline (24 weeks gestation), postintervention (36 weeks gestation), and follow-up survey (3-5 weeks postpartum). Data is currently being analyzed for publication.
