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Bill Klaproth: Welcome to the ASHRM podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ASHRM.org, that's ASHRM.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth.

Traumatic events impact people's lives in many ways. And it's not like you just get over it, take a couple of aspirins, go to sleep and wake up in the morning and you're fine. There's a recovery process and, left untreated, it can manifest in many negative emotional, physical, and psychological ways.

So let's learn about CISM, Critical Incident Stress Management, and how that is helping people through their traumatic events and helping healthcare provider wellbeing around the clock. With me is Amy Morrison-Maybee, a Critical Incident Stress Management Team Coordinator for Bronson Healthcare Group.

Amy, thank you so much for joining me. This is a great topic and we're looking forward to learning more about this. So first off, can you explain to us what the Critical Incident Stress Management or CISM team is?

Amy Morrison-Maybee: Of course. Our CISM team here at Bronson, we have about 60 people on our team. And it's a group of employees that have all been specially trained to provide support to their coworkers after a traumatic event occurs in the workplace. After something difficult happens, we come in and we provide comprehensive peer-based support. And we want to do that in an effort to try to mitigate. some of the psychological damage that's often associated to exposure to these kinds of traumatic or highly stressful events.

Bill Klaproth: Right. So you're talking about you have specially trained staff to help people that have experienced a traumatic event. So what kind of interventions do you offer to staff?

Amy Morrison-Maybee: Sure. We offer a lot of different types of interventions and we've learned to be very flexible over the last few years as well and maybe have even kind of come up with some hybrid interventions as well, because healthcare is so influxed at all times, that we have to be on our toes. But the primary CISM interventions that we use, one big one is pre-incident education. I feel like it's always better to prepare before a crisis happens. We want to try to be proactive rather than reactive.

A big thing that we do a lot in healthcare is group defusings. What that really is, is kind of a shortened version of a more formalized debriefing, which I'll mention in just a second. But the group diffusing is meant to bring a group together almost immediately after an event happens. And why it's so good in healthcare is because it can often be really difficult to bring the same team back together again that was involved in an event, especially if it's in one of our acute care settings. So we have a group, they come in and they just really talk about what happened. What are you feeling right now? Here's some things you might expect to feel when you go home and you start to unpack some of this. And here are some good ways to take care of yourself. It's really just like a 20 to 30-minute check-in just to give people the tools that they need to help decompress.

I mentioned the debriefing. That's probably our most formal intervention that we offer. It's a much longer process, so usually about an hour to an hour and a half. And we do that about 24 to 72 hours after an event occurs. Another intervention that we do, which is really probably actually what we do the most of, are one-on-ones. And I think there are a lot of reasons for that. Sitting in a group of your peers and being vulnerable can be difficult For people. In addition, what's traumatic for me might not always be traumatic for the next person. So offering these one-on-one interventions for staff members can just be a really good way to invite people into a space where healing can occur without some of the other barriers that might exist for them.

Bill Klaproth: Yeah, I could see where it might be more comfortable for someone to do a one-on-one, but I love what you talked about, the group diffusing, the formalized debriefing and then the one-on-ones. So, Amy, can you tell us what impact these three types of meetings have on the wellbeing of your employees?

Amy Morrison-Maybee: I think that there are a lot of benefits to it, honestly. One of the main things that I see often happen is the cohesion that it brings to a group. When there are a group of individuals who have gone through a really traumatic event together or really high stress incident, and they're able to come together and to process through it together in a healthy way, kind of that walking through the fire together oftentimes really can strengthen bonds as long as there's the ability to heal in a healthy way after that. And so that's where CISM comes in and we're able to facilitate that.

I think that it also offers people an opportunity to process the difficulties of this job. This is a very taxing industry to be in. Healthcare is not easy, no matter what your role is here. Just acknowledging and validating people and what they feel, really, I think, heightens their sense of feeling appreciated, it improves employee satisfaction. And when our employees are well taken care of and we're reducing things like burnout and compassion fatigue, which so many people on this field often experience, that translates into better patient care. So really, it's not only just a benefit for our employees. It benefits our patients and our community as well.

Bill Klaproth: Yeah. It's easy to see how your services can definitely help reduce the stress of trauma. I'm wondering though, have you ever received any pushback? Someone saying, you know, "I don't need your help. I got this." I'm just curious if there were any roadblocks or barriers that you faced in engaging staff and getting them to accept your services.

Amy Morrison-Maybee: Oh, for sure. Obviously, there's a huge stigma, especially in healthcare, regarding reaching out for help. I've spoken to a lot of physicians and nurses and just all kinds of frontline healthcare workers who often say, especially our physicians, that they were never taught that it was okay to show emotion. And so they really carry this internal feeling of, you know, that they have to remain stoic, that they can't show emotion to family and especially not to their teammates. So, it was very hard to get people to be comfortable with being vulnerable. Like I said before, when I was talking about those one-on-ones, it's not easy to do that.

So I think that just the stigma of reaching out for help is a huge roadblock, but we have moved mountains. And we have done so much work to help break down some of those barriers. I think that accessibility or just the lack of knowledge about resources like CISM. We would find a lot of times that staff and leaders would either have no idea that we existed, or they had no idea how to request our services. Right now, we have a lot of travelers that are in our inpatient settings. And they often are coming from other healthcare organizations who don't have something like CISM. So they're very unfamiliar with the concept. So they don't have any idea of what benefits we can offer and they kind of look at us strangely when we are there and providing the support. And I think right now, time is a huge barrier. Staffing issues continue to create challenges, and bringing groups of people together, or even individuals who are seeking that one-on-one support.

Staff often feel guilty, sometimes for taking time away from the workspace to take care of their own emotional and mental needs. And they don't want to be a burden to their coworkers. So if I'm leaving the floor for a half an hour to an hour, that puts more work my colleague and I don't want to do that.

Bill Klaproth: We are taught, "Don't show emotion. Tough it out. Stiff upper lip," that kind of thing. So it's interesting to hear you say that we're never taught that it's okay to show emotion. So I know you talked about one-on-ones and that's a kind of a safe place that people can share with you what they're going through. Do they worry about that conversation being kept confidential, like, "I don't want you to talking about this to anyone else" or "Is this going to go on my file?" or whatever? Is there confidentiality issues that people worry about? And I'm sure you do keep your interactions with staff confidential. Is that right?

Amy Morrison-Maybee: Yeah, absolutely. And I would say that concerns about confidentiality would be one of those barriers or roadblocks that you mentioned, and that we just talked about. We do a lot of work to make sure that staff feels safe. We do that by, at the very beginning of any type of intervention, we make a statement about confidentiality. Letting them know that anything that is shared in that space is protected information and won't be shared by others. And then if we're in a group debriefing, we will also ask for our participants, "Whatever you hear here, please don't go out and share that either. So I'm not going to share it as a facilitator. But I'm also asking all of you to uphold that value too." That's been a big thing.

But just in order to formalize that, we've put some other safeguards in place, and this has really helped a lot, especially with physicians. We actually have an internal policy that is very clear about any information being disclosed during a CISM is protected and it can't be used against anybody. But I think more importantly, we were able to go in in 2020 and help amend current state law that already protected confidentiality of CISM in other areas, it just didn't cover healthcare. So we were able to go and work with the Michigan Health and Hospital Association and the Michigan Legislature, and they were able to sponsor a bill that worked to revise that law. And now, it includes legal protections for healthcare professionals. So any communication made by a healthcare worker to a CISM team member while they're receiving some services is confidential and it can not ever be disclosed in any type of civil, criminal or administrative proceeding. Any records kept relating to this work that we're doing is confidential. It's protected. It's not subject to subpoena or discovery. And it can't be used as evidence in any kind of civil, criminal or disciplinary hearing.

Bill Klaproth: Wow. That's really interesting. So there's an actual legal process in place for confidentiality. I didn't even think it went that far when I asked the question. So, wow, you really have thought all of this through. And it's interesting to say it sounds like it goes both ways. You're keeping confidential what you discussed with the patient or the person that you're working with. And you're asking them to keep confidential as well of your discussions.

Amy Morrison-Maybee: Absolutely. Yes.

Bill Klaproth: So I think this is big one, Amy. As we've been talking about and you brought it up, people are stoic, they're taught that, you know, "Don't show emotion," you know, "Stiff upper lip. Grind it out." You know, the old American way, "Grind it out. I'm just going to get through it." But people are afraid to talk about mental health. They don't want to bring it up. They don't want to be seen that way. There is a negative perception with that. So, how has your team work to combat that stigma?

Amy Morrison-Maybee: Yeah. It takes a lot of work erasing that kind of stigma that's really existed and been ingrained into the culture for so long, it doesn't happen overnight. But I think there were several key things that we did that really have helped. And I think one of those keys to breaking down that stigma is providing continuous education at all levels about the psychological effects and the impact of this work. So we've worked really hard to normalize conversations about emotional wellbeing, about stress, about burnout, about mental health and even substance abuse and suicide and just the difficulties of this job. It's no longer taboo to say you're having a bad day or that a case is really taking a toll on you emotionally. We've made it okay to not be okay sometimes.

I think another really important piece has been leadership buy-in, including executive leadership. So when you have your CEO or other high level leaders that are frequently mentioning or encouraging use of services or even calling them themselves, that really sends an important message, that this is the norm, that this is the expectation in our culture at Bronson, and that there isn't any shame attached to reaching out for help. And I think ultimately, making it a peer-based service with members that include nurses and providers and respiratory care and social workers and chaplains. And we have people from EVS, we have from all of our systems. So it really is a true peer-based service. And I think when people are receiving support from their peers, it can sometimes be a lot more comfortable. They don't think of it as therapy.

And we've had a really robust marketing and communication plan and we rely a lot on using staff testimonials. So we will share staff telling their story about how CISM was helpful for them. And so when staff see others are using our services, and they begin to realize that they're not alone in how they feel, it really does start to break down I think a lot of walls.

Bill Klaproth: Yeah, that is very, very well said. And thank you for saying all of that. And everybody, take your phones out right now. Tweet this out what Amy said, "We've made it okay to not be okay." That really kind of sums it up and I think is a beautiful way to put it. Amy, I bet you're very good at your job. You have such a soothing, calming voice and presence. I feel like could tell you anything at this point.

Amy Morrison-Maybee: Yeah. I'm a social worker too.

Bill Klaproth: We've only known each other for five minutes. Oh my goodness.

Amy Morrison-Maybee: You can call me anytime.

Bill Klaproth: Okay. I might do that. Amy, thank you so much for your time. Is there anything else you want to add about CISM and what we've been discussing today?

Amy Morrison-Maybee: I just would really encourage people to utilize whatever resources or support is available to them. Like I said, not every healthcare organization has things like CISM, but most do have it, an employee assistance program or if you just have a peer that you trust, making sure that you're checking in on each other. Making sure that you're taking care of yourself is so important. Just thanking everybody for continuing to do what they do.

Bill Klaproth: Yeah. check In on each other and make sure you take care of yourself. Again, very well said. Amy, this has really been great to talk with you and we've enjoyed really learning about CISM and all that it can do to help people that have gone through traumatic events. Amy, thank you again so much for your time. We appreciate it.

Amy Morrison-Maybee: Yep. Thank you so much.

Bill Klaproth: And once again, that's Amy Morrison-Maybee. And ASHRM celebrates National Patient Safety Awareness Week, March 13th through the 19th, 2022. And for additional activities and tools, please visit ASHRM.org/resources/patient-safety-week. I'll say it again. That's ASHRM. Of course, that's A-S-H-R-M.org/resources/patient-safety-week.

And the ASHRM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ASHRM.org/membership to learn more and to become an ASHRM member. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth. Thanks for listening.