oneEd–a staff wellness case study

The day we think we don’t have time to do this, is the day we need this the most.

Dr Shahina Braganza, oneED, Queensland Health

In the lead up to Mental Health Week, the Public Service Commission took time to chat with Dr. Shahina Braganza (emergency physician) from the Gold Coast Hospital and Health Service to chat about oneED and the great work being done within the Emergency Departments at the two Gold Coast Hospitals to create a sense of community and connection through a simple wellness program.

What is oneED?

oneED is a wellness program at the Gold Coast Emergency Departments – both at Robina Hospital and Gold Coast University Hospital.

There are a few structured activities within the program, but oneED in its early stages was simply about trying to shift the tone and the comfort around having a conversation about wellness and struggle amongst healthcare professionals.

Once a week during our handover on a Thursday morning, we pause for 4 minutes and do various activities.

The activity itself focused originally on mindfulness practice, but has now broadened to general wellness promotion.  The activity itself - the detail of it - is less important.  What is more important is that we do something to raise awareness and to start conversations between our team members.  Giving them an opportunity during their shift to trigger a mindset that may help them to feel more comfortable to talk to each other about their experiences, particularly those in the workplace, and hopefully try to foster connections between team members – this is the crux of it. 

The more I think about what keeps us well, the more it crystallises for me that the bottom line to one’s sense of wellness is a sense of connection, belonging and community.  That feeling that you are never alone goes a long way towards getting out of struggle and despair when it occurs.

Why was oneED established?

The tangible trigger (for establishing oneED) was moving from the old hospital in Southport, to a brand-new facility.  There was an unspoken recognition whilst it was great that we were in these new facilities, there was a risk we were going to become so big and specialised that we might lose our connectivity with each other. 

We are an exceptional department in that we have very strong ties with each other, and we are very cohesive.  We didn’t want to lose that. 

The landscape of working in healthcare and particularly in an emergency department is high stress and high stakes.  We do have extremes of emotional experiences, mostly at the difficult end of the spectrum, because people don’t come to see us when they’re well!  The emotional burden is huge.  The cognitive burden is also huge – aside from having to keep a stable emotional keel, you also need to be able to maintain that awareness, presence of mind and attention focus, retrieve knowledge and conduct procedures; and, quite simply, get the job done. 

Frame of delivery matters. Marrying the wellness concept to the performance concept allowed us to engage our staff more readily.  If you rock up in the morning and say ‘We are now going to take 5 minutes out to pay attention to our wellness’, you will undoubtedly receive a few eye rolls. 

Whereas if you say ‘Ok, we are now going to take 5 minutes to just think and talk about how we can do our job better’; you are much more likely to get buy in.  We are dealing with a largely scientific audience; we are not great at ‘touchy-feely’.  If you can give science, data, evidence-based strategy and outcome, then the team are much more likely to say ‘Ok, I see some value in this. This resonates with me’.

oneED was built organically, and it is still evolving four years later.  We took a risk, got started, and we were very open to feedback and doing things differently.  We continue to do that now.

Is oneED valued amongst the team?

I’d like to think so! The gain and value are difficult to measure, but the investment is really small.

About six months into the program, there was one morning at handover when I arrived, and the place was heaving – as usual.  I could sense that the team was antsy, and keen to get out onto the emergency ward floor and simply get started.  As I asked the team if we could pause for four minutes, I could sense that a couple of my colleagues were not keen and there was subtle resistance.  But my Deputy Director said ‘Yes Shahina, definitely.  The day we think we don’t have time to do this is the day we need this the most.’  

I could have hugged him because he managed to profoundly encapsulate why this investment of time is so worthwhile!

To have a senior doctor say those words in that room, filled with 40 health professionals - to have someone of his calibre and credibility - make that statement is so powerful.  The statement he was making was that we need to pay attention and take time to attend to our own wellness – that it is important. 

Has oneED reduced the stigma around mental illness?

It would be an over-reach to say that oneED has achieved this, however I would like to think that it has made some impact – just by starting conversations.

The program isn’t rocket science and we are dynamic and responsive with how we conduct it.  We try to keep it simple, because what we do is not as important as the team stopping and doing something.

A comment made by one of my colleagues sums up where the value of oneED lies. The comment is extra valuable to me because it was made by one of my colleagues, our Director of Research, who ressonably questioned the program in the first place:  ‘What is the problem you are trying to fix; how do we measure the problem; how do we measure the effect of the program?’.  

Two years down the track, he said ‘If you were to ask me what the positive impact has been, I can’t tell you that we are all better and we are all well now, but what I can say is that people are more comfortable to have these conversations in our department than they might have been some years ago.’

That, to me, is magic. That is the goal.

Apart from starting conversations in the workplace, in the evening when our colleagues might be at home, sitting on their own in the dark and experiencing whatever they might be experiencing, they know for a fact that there will be someone else on their team who might also experience – or have experienced - the same thing. Therefore they have this awareness that what they are going through is normal, that what they are feeling is not something they need to deny or hide, that they can talk to someone about it. Hopefully oneED is breaking down those barriers to recognising what they are experiencing – because we have opened up the idea that this is a normal part of our working lives.

I was at joint education session earlier this year, and a nurse I only know from a distance sat down next to me and said “You’ve changed my life, Shahina”. I was bewildered: “What? When? How did I do that?” She told me that she’d gone through a rough time, but then explored resources about emotions, etc, and that she was in a much better place now. So then I asked “So…er… exactly how did I help you?” She replied that it was from the sessions at work that she started to acknowledge how she was feeling, and that it gave her permission to do something about it. You can only imagine how gratifying that was!

The oneED program has taken minimal resource in a busy emergency department environment and opened up the opportunity for the team to connect, talk and, from this, build a community – one that provides a safe space for the team to feel supported through their struggles, as well as an environment where everyone can thrive.

Quiet time or active time?  How oneED take four minutes to enable workforce wellness.

oneED is a staff wellness program at the Gold Coast Emergency Departments – both at Robina Hospital and Gold Coast Uni Hospital. 

There are a few structured activities within the program; but oneED in its early stages was about trying to shift the tone and the comfort around having a conversation about wellness, and in turn, about struggle. 

Once a week during our handover on a Thursday morning, the team pause for 4 minutes and engage in various activities.

The four minutes typically consists of a few different things. 

  1. They might watch a YouTube video of wellness related concepts. 
  1. They might listen to a shared experience from a colleague.

For example, one of our team talked about how she always tries to find a rainbow in their shift – like rainbows reflecting in glass or windows.  Other colleagues talked about how they see joy in the day, regardless of what might be going on, or about practicing gratitude and how they try to be grateful at every juncture in the day. 

Making those statements is powerful, even if they are talking about how they get through their day, or how they remain functional, because what is inherent in their message is that ‘I need these strategies in order to remain functional’ and therefore ‘I experience struggle’.  Ultimately is conveys the point that it is totally fine for you to experience struggle as well. 

  1. They will do guided meditation for a minute or two. 

However, there is no one size fits all at oneED – there are always ideas being put forward.

Some ideas don’t connect, while others resonate more widely. 

When looking at other options to incorporate into the oneED program, a couple of nurses found the two-minute guided meditation to be quite jarring.  Knowing full well that they were going to enter the ED and it was going to be bedlam. 

After a bit of thought they decided ‘We just want to move and jump!’. Not long after, they posted videos of them doing the Macarena, the Nutbush, and Rocky Horror Picture Show; it felt more relevant for them to get active. 

The key to oneED, was that whatever we did, we did it together.  If a nurse was doing the Nutbush next to a colleague at handover, you might find that an hour later, when they find themselves doing a resuscitation on a critically ill patient, or they needed help with something, they are more than likely going to ask that person for help.  Because they have built a social bond and sense of psychological safety.

After seeing what oneED do in four minutes, what do you think you can do in four minutes to support your mental wellbeing, and the wellbeing of others around you?

More information

Read more about the oneEd  staff wellness initiative.