Many workplaces are being described as stressful, and this certainly the case in healthcare fields.  To address these concerns, some organizations implement a form of workplace wellness program (WPP) that typically contains a host of activities and resources to help employees manage and cope with stress.  But what is it about these programs that make them successful or not?  Actually, much of the past research evaluating their success has questioned their usefulness.  To learn more about the challenges, UT researchers studied a wellness program in a medical residency program, and here we share the findings that were published in Management Communication Quarterly in 2019. 

In the past, our team has worked with a host of human resource professionals and others tasked with finding ways to make their workplaces healthier. We have seen that there are well-intentioned people who often work on a limited budget, and they come up with some pretty creative ideas!  That was certainly the case in this study of a medical residency program.  The program organizers created peer-mentoring programs, had monthly social activities, created an ongoing wellness scavenger hunt, and had weekly 1-hour lunchtime sessions aimed to provide creative, social, and therapeutic outlets to help residents manage stress.  There were painting and creative writing activities, yoga classes, and 24/7 access to a hospital gym. 

Yet the findings from this study revealed that the medical residents were still very stressed and many of them felt the wellness activities did not fit their stress-coping needs.  Actually one third of the residents said they never used any formal resources, and most others used them rarely or occasionally.  Why is this?  First, the medical residents believed that the wellness activities did not really address the causes of their stress.  They were stressed for two primary reasons:  1) they felt overloaded by tasks and communication, and 2) the expectations they had of themselves, and that others had of them were not healthy.    

A second year resident explained this well by saying, “You’re always pulled in a thousand directions. You have to upset parents who want to talk to you. You have to go see this child who’s in ten-out-of-ten pain and give them some medicine. Meanwhile, your other child is seizing, and a nurse keeps calling because this kid has a rash… Oftentimes, nobody is happy with you because you’re just trying to do so much and feel like you can’t do anything well because you’re doing too many things.” (p. 11)

The majority of the reasons for the mismatch between wellness opportunities and coping with stress seem to be structural.  By structural we mean that rules and practices in this residency program, along with the perceived culture of medicine, created clear barriers when the residents tried to cope with their stress. 

Specifically, they worked 12-hour shifts, 6 days a week.  By the time they got off work, they could not get to a doctor/therapist/drycleaner to take care of their personal needs.  Many of them did not get full lunch breaks, so when attending a wellness activity—like painting—it actually caused them even more stress because their work load was continuing to build while they took their break.  They felt a strong need to prioritize anything academic over taking care of themselves, and academic activities often conflicted with scheduled wellness events.  Finally, there was a consistent belief among the residents that they are expected to be tough, and that means there is something wrong with them if they can’t handle the stress. 

As third-year resident explained, “There’s no way to change the work hours, or how many patients you’re carrying, or what the culture of coping in medicine is.”

You might be wondering what was most helpful as these residents coped with stress.  They said that having each other as a form a support was the best resource possible.  The residents also said that even though they only used the wellness activities at a minimal level, knowing there was a program in place communicated a sense of care.  They also appreciated having private spaces to retreat, even if they only had a few minutes to catch their breath. 

It is well-documented that burnout, stress, and serious health concerns are growing in the healthcare field.  While many medical schools and residency programs are committed to making their culture healthier, it might be time to determine how to make wellness an integral part of their work.  Medical residents have the inherent stress of being responsible to care for others, combined with feeling overloaded with too many tasks, receiving constant calls, text messages, and pages, trying to exceed the expectations of others, and working 12-hour shifts six days a week.  This study found that they don’t have time to add another task: wellness.  Providing them space to privately share experiences with one another, time to take care of their personal needs, and sending messages that self-care is valued, might be the best way to create wellness-in-practice and take steps to communicating these new values. 

To learn more, please read the entire article: Wellness in Medical Residency An Opportunity for Structural Changes.