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Resilience Tools for the Front Line

Health visitor and a senior woman during home visit
Health visitor and a senior woman during home visit

At the Johnson & Johnson Center for Health Worker Innovation, we believe that sustainable improvements in the delivery of and access to quality primary care require a long-term commitment to enabling and supporting the well-being of the deliverer of care—the frontline health worker.

Over the past decades, investments to provide frontline health workers with innovative tools and programs that enable delivery of higher quality care to more patients have saved hundreds of millions of lives and must continue[1][2]. However, during this same period we have become acutely aware of the burnout that adversely impacts the health and well-being of the individuals who valiantly deliver the care.

Now is the time to prioritize the sustainable well-being of the caregiver, especially those working in resource-limited settings with overwhelming need—whether an overworked nurse in Mumbai who is balancing working 7 days a week with caring for her own children or a midwife in São Paolo with a passion for serving moms and babies who never has adequate time in the day to help every family who needs her services. The burnout of frontline health workers has never been more visible than today as COVID-19 impacts not only vulnerable patient populations across the globe but also the nurses, community health workers, midwives, doctors and others caring for the sick.

Attending to the mental, emotional and physical well-being of our healthcare providers is an essential priority for two reasons: (1) we should not passively accept that those who seek to help others should themselves become overwhelmed and exhausted by the stresses of their profession, and (2) there is already a significant gap—estimated at 18 million by the WHO—between the number of health workers in the field and the number needed to extend care to all; losing additional health workers to burnout, especially amidst the current pandemic, only expands this gap.

Our frontline health workers deserve a robust set of tools that meet them where they are and equip them with strategies that make it possible to experience moments of thriving and restoration. Even within unpredictable and intense environments like those in which health workers operate, research has shown that focusing on the well-being and resilience of the individual—even without changing the work ecosystem—can reduce feelings of stress and burn-out[3].

“Resilience Tools for the Front Line” will be free, globally relevant and accessible to any organizations that deliver training or content to frontline health workers. In developing the initial pilot Resilience tools, the Center for Health Worker Innovation team is partnering with The Johnson & Johnson Human Performance Institute (HPI) to leverage insights and learnings gained over decades at the cutting edge of these topics and then will co-create, test and iterate in real world environments with partner organizations.

Since 1995, HPI has scaled well-being solutions into employer environments within healthcare systems, governments and Fortune 500 companies. The scientific underpinnings of the HPI offerings include Cognitive Behavioral Therapy, Nutrition, Exercise Physiology, Performance Psychology and Sleep Science. These scientific disciplines are interwoven with human-centered design to ensure this vital knowledge connects emotionally with each individual. Their evidence-based, holistic wellness training has resulted in clinically measurable outcomes including sustainable improvements in well-being over periods greater than 12 months.

Given that the context of resource-limited frontline health worker settings differ from corporate HR training environments, the Center will co-create a tool set based on a human-centered design process with health workers around the globe. The Center will also benefit from the expertise of Thrive, a health and behavior change content creator with over 20 years’ experience in delivering effective messaging to 50M+ people in 40+ countries.

The core underpinnings of Resilience Tools for the Front Line are (1) Resilience is a skill that can be learned, and (2) as one improves one’s personal well-being, one’s capacity to perform grows. Other key elements include:

  1. Self-Awareness: Self-awareness and reflection are key to turning one’s attention to self-care. Health workers are often in the habit of selflessly serving others at their own expense. Empowering and enabling these individuals to devote time and attention to their own self-care does not detract from or diminish the positive impact health workers can have. Rather it enhances and increases their personal capacity and the quality of energy they bring to their work.
  2. Recovery: Stress or strain can be triggers for personal growth, but that growth can only come to fruition during the recovery phase. Constant exposure to stress wears us down physically, mentally and emotionally. Sleep, mindfulness, moments of gratitude and reflection... each of these rituals can be incredibly effective in aiding recovery, resilience and future performance if we are conscious of when and how to prioritize them into our daily rituals. Making recovery a priority enables growth and enhances future capacity to withstand stressors from a position of strength and health.
  3. Personal Purpose: Connecting self-care and resilience rituals to one’s personal purpose is critical to sustaining behavior change. Grounding these practices in the foundation of personal purpose allows health workers to conceptualize them as tools in service of their broader life mission rather than distractions or additional burdens.

It is our hope and intention to equip and enable those who tirelessly provide healthcare for others with a better chance to return home to their families each night with improved optimism, hope and personal health. This approach should have a multiplicative effect: as we equip individual health workers with strategies and tools to take care of their own well-being, the benefits of these learnings and behaviors may cascade to their patients and families.

This effort reflects the Center’s goal to serve as a gathering place for organizations like ours who recognize the essential role of health workers in strong, accessible health systems—because together we can make the most impact. If you share our commitment and want to join us in this effort, please reach out to me directly or drop the team a note at chwi@its.jnj.com.

[1] WHO Primary Health Care on the Road to Universal Health Coverage, 2019 Monitoring Report (Pg 1, SDG indicator 3.8.1 progressing from 45 to 66 from 2000 to 2017)
[2] https://www.globalcitizen.org/en/content/bill-and-melinda-gates-on-health-investment/
[3] https://pubmed.ncbi.nlm.nih.gov/29370014/ Resilience Training for Work-Related Stress Among Health Care Workers: Results of a Randomized Clinical Trial Comparing In-Person and Smartphone-Delivered Interventions