1. Mindfulness in the workplace
Dr Sanjay Suri
Consultant Paediatrician
Chantil Calvert
Wellbeing Nurse Advisor
Rotherham NHS Foundation Trust
HEE QI conference workshop
12 July 2018

3. Stress

4. Systems

5. Change

6. What is mindfulness? Jon Kabat Zinn
Mindfulness is the awareness that emerges through paying attention on purpose in the present moment with curiosity and compassion which leads to a deeper understanding of how to respond wisely
Jon Kabat Zinn

7. Two competing neural systems
The Bottom Up response of stress conditions
The Top Down system of non stress conditions or The Relaxation Response

8. Stress response The Bottom up response of stress conditions
Can be protective – it is the fight or flight response
The amygdala is activated first setting off a cascade of stress related changes throughout the body

9. Relaxation Response Two essential components-
An alert non thinking state
An open receptive attitude

10. fMRI results
Greater levels of mindfulness training practice predict increased dorsolateral prefrontal (bottom left), right anterior insula (top right), and medial–prefrontal BOLD (bottom right) recruitment during negative emotional processing.
fMRI results. Greater levels of MT practice predict increased dorsolateral prefrontal (bottom left), right anterior insula (top right), and medial–prefrontal BOLD (bottom right) recruitment during negative emotional processing. Post hoc analysis further revealed this effect to be driven by positive correlations in the MT group. Top left, For visualization purposes, BOLD signal was extracted from the peak voxel (left posterior insula) of this contrast and plotted against practice minutes within MT group. The color bar indicates the t statistic associated with each voxel. A whole-brain statistical parametric map (in yellow) is displayed superimposed on coronal, sagittal, and axial views of the SPM T1-weighted template, for group by time interaction on the negative > neutral contrast. pFWE < 0.05 corrected on cluster level. The voxel selection threshold is p =
Micah Allen et al. J. Neurosci. 2012;32:

11. Amygdala activation
Functional MRI (left) showing activation in the amygdala when participants were watching images with emotional content before learning meditation. After eight weeks of training in mindful attention meditation (right) note the amygdala is less activated after the meditation training.

12. Mindfulness effects

13. Evidence base – patient care
A multicentre study of physician mindfulness and health care quality
45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients with HIV who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States.
Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted β = 1.17; 95% CI, ).
Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, )
High overall satisfaction (APR = 1.45; 95 CI, ) with high-mindfulness clinicians.
Beach, Mary Catherine et al , Annals of family medicine, Sep 2013, vol. 11, no. 5, p (2013 Sep-Oct) Available from National Library of Medicine in Annals of Family Medicine

14. Evidence base – patient care
Effect of mindfulness training on mindfulness level in the workplace and patient safety culture
6 week Mindfulness Leadership Training was delivered to radiation oncology staff.
MAAS survey of mindfulness, and the Medical Office Survey on Patient Safety.
15 participated (10 completed immediate post-test and 8 the 60-day post-test)
96 relationships tested, 8 had statistically significant outcomes (p<.05) from the pre-test to the first post-test and 15 had significant outcomes between the pre-test and 60 day post-test.
All statistically significant outcomes differed in the direction of more mindfulness and increased patient safety parameters.
Near miss and incident reporting increased from 10 to 25 reports for the 60 day periods pre and postintervention (p = NS)
Mumber M. Effect of mindfulness training on mindfulness level in the workplace and patient safety culture as a part of error prevention in radiation oncology practice: A pilot study. International Journal of Radiation Oncology Biology Physics, September 2014, vol./is. 90/1 SUPPL. 1(S748), (01 Sep 2014)

15. Evidence base – patient care
Mindfulness, health, well-being and patient care of oncologists
American Society of Clinical Oncologists survey data
(N = 114, response rate 29%).
Male (76%), Caucasian (78%), and married (84%), mean age of 52 years, average work week of 58 hours.
Half (51%) reported sleeping 6 or fewer hours per night and the mean sleep duration was 6.3 hours.
35% not getting adequate sleep
57% believed that lack of sleep interfered with daily functioning.
Very good general health, high levels of trait mindfulness, and satisfaction with their lives and jobs.
They reported engaging in occasional suboptimal patient care practices and attitudes.
20% endorsed some degree of burnout, but only 12% were considering changing jobs in the next 5 years.
Mindfulness predicted greater SWL and less suboptimal patient care beyond the variance accounted for by general health.
Sleep problems predicted less SWL, whereas mindfulness predicted less suboptimal patient care, beyond the variance accounted for by sleep problems. Finally, mindfulness moderated the relationship between oncologists’ sleep problems and suboptimal patient care; as sleep problems increased for oncologists with low mindfulness, they reported that their patient care actually improved.
Kracen, Amanda C. Mindfulness, health, well-being and patient care of oncologists. Dissertation Abstracts International: Section B: The Sciences and Engineering, Jan 2011, vol. 71, no. 9-B, (2011)

16. The mindfulness initiative
The mindfulness initiative was discussed and a UK all-party parliamentary group on Mindfulness was launched in May 2014.
MBSR has been used to train CEOs, judges, members of the clergy, Olympic athletes and politicians.

18. Why does it matter? 10.45m sick days per year 2016
27% > public sector average
Direct cost of sickness absence £1.9 billion/year
£3.3 billion on locum and agency staff 2014/15
10,383 left NHS due to poor work–life balance
(5.5% total leavers)
3,819 people left due to ill health (2%)
1.1m Full Time Equivalent (FTE) staff within the NHS
NHS workers took on average 9.5 sick days last year. That is 10.45m sick days per year
NHS staff typically receive 35 days holiday per year (including bank holidays), resulting in 225 working days per year
Thus sick days account for 4.22% of the annual working days.
The average NHS salary is £41,570.  Based on this, sick pay costs the NHS £1, per employee per year
Sick pay costs the NHS a total of £1,929,675,000 per year.

19. NHS Staff Survey 2017
National Briefing Published: March 2018

20. 2017 NHS Staff Survey
Approximately 1.1million NHS employees in England were invited to participate in the survey between September 2017 and November 2017.
309 NHS organisations took part
Staff were sent a paper questionnaire or an containing a link to an online questionnaire.
The survey was administered by the Survey Coordination Centre, based at Picker, on behalf of NHS England.
487,727 staff responded
129,442 paper surveys
358,285 online surveys
Response rate:
45%
(up from 44% in 2016)

21. Health and wellbeing
58% of staff worked additional unpaid hours (q10c | 2016: 59%)
KF17 – 38.4% felt unwell due to work related stress in the last 12 months
KF18 – 52.9% of staff attended work in the last 3 months despite feeling unwell because they felt pressure from their manager, colleagues or themselves
68% say their immediate manager takes an interest in their health & wellbeing (q7f | 2016: 67%)
58% of staff worked additional unpaid hours (q10c | 2016: 59%)

24. Co-relations between staff surveys and inpatient surveys
staff and patients
Positive co-relations
Staff availability of hand-washing materials
Managerial support
Witnessing and reporting of errors
London trusts performed worse on patient experience than trusts outside London
Specialist trusts performed better than other acute trusts.
Negative associations
Working extra hours
Stress
Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England V S Raleigh,D Hussey,I Seccombe,R Qi BMJ Qual Saf Healthcare 2009

25. Benefits to the NHS
Attention and focus on task – less error – human factors
Care and compassion – Francis report 2013
Communication based on respect for one another – Intelligent kindness
Reduced sickness absenteeism – NHS staff survey
Better performance in the workplace – calmer, well thought out discussions

26. Evidence base
C Singleton, O., et al. (2014). "Change in Brainstem Gray Matter Concentration Following a Mindfulness-Based Intervention is Correlated with Improvement in Psychological Well-Being." Front Hum Neurosci 8: Farb, (2012). The Mindful Brain and Emotion Regulation in Mood Disorders Can J Psychiatry. February; 57(2): 70–77. Tang, YY and Posner, MI. (2013). Tools of the trade: theory and method in mindfulness neuroscience. Soc Cogn Affect Neurosci Jan;8(1): doi: /scan/nss112 Ch Keng, S-L, et al. (2011). Effects of Mindfulness on Psychological Health: A Review of Empirical Studies. Clin Psychol Rev August ; 31(6): 1041–1056. doi: /j.cpr Kerr, C. E., et al. (2013). "Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation." Front Hum Neurosci 7: Allen, M., et al. (2012). "Cognitive-affective neural plasticity following active-controlled mindfulness intervention." J Neurosci 32(44):

27. Resources (books)
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (Delta, 1991) , by Jon Kabat –Zinn
Mindfulness: A practical guide to finding peace in a frantic world,(2011) by Prof Mark Williams and Dr Danny Penman
Mindfulness For Dummies: Shamash Aladina, Mindfulness Consultant – Wiley Publications © 2012

28. Resources (apps/websites)
iphone apps –
Calm
Headspace
Insight timer
GPS4Soul
Guided Mind
Breathe2Relax
Websites

29. Resources (courses) 8 week MBSR course http://www.wellpresent.co.uk

30. Mindfulness – Colleague Wellness matters
Chantil Calvert
Wellbeing Nurse Advisor

31. What do we offer … Mindfulness Mondays: Open to all
Free – 30 minute mindfulness session
Five ways to wellbeing:
The concept is that are five steps to improve our wellbeing. These include – Be active, Connect, Give, Keep learning and Take notice.
Get active programmes
5 ways to wellbeing – RMBC led initiative Rotherham wide. Focusing on maintaining good mental health through 5 concepts.

32. Benefits of practising Mindfulness
Colleague feedback describes:
Reduce anxiety and frustration
Reported blood pressure reduction
Improve mental wellbeing – ‘cleared my mind’
Improved sleep patterns
Improved resilience
Techniques enabling individuals to address situations in real time

33. In the last year 2017/18 Mindfulness has proved very popular
56 colleagues attended the Mindfulness Lunchtime Lecture
167 colleagues attended the full day Mindful Compassion Course at Wentworth Woodhouse (5 courses)
250 colleagues attended the mindfulness Monday sessions
Feedback from attendees at these has been very positive with 87% of colleagues saying they are still practicing mindfulness after attending the Mindful Compassion Course.

34. Colleague Testimony
“Mindfulness techniques made me aware of making time to stop for a few moments (just a few minutes a day) and bring my thoughts and feelings together, and in perspective at that moment in time. It allowed me to think things through, to prioritise the most important things in my life, both at home and work.”

35. Colleague Testimony
“I went on the Mindfulness course last year at Wentworth. I found the day extremely useful and relaxing. Since then I have tried to use my findings of the course in my daily life, which I know have helped me in many ways.”

36. Future plans
We are committed to continuing to embed mindfulness in the workplace
Work with our partners to raise awareness of importance of good mental health
Mindfulness will be included as an option in our wellbeing services at the Trust for 2018/19

37. Angela Eyre – Macmillan Cancer Information and Support Manager

38. And finally… It is not about waiting for the storm to be over
It is about learning how to dance in the rain

40. Why mindfulness? Organisational change
Job and financial security not a given
Targets, Deadlines – Stress
Complaints; Serious Incidents; GMC/NMC; Claims
Personal circumstances (illness; bereavement; loss)
Pain (physical; psychological)
LOOKING AFTER YOURSELF

41. History Buddhist origins
Centre for mindfulness – University of Massachusetts Medical School – Jon Kabat-Zinn
Centre for mindfulness research and practice – Bangor University
Oxford Mindfulness Centre – Oxford
MBSR and MBCT

42. What it isn’t? A religious activity
Sitting cross legged and contemplating
Problem solving
Only meant for the mentally ill
Relaxed inattentiveness

43. Mind-lessness