Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees
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This study evolves around the first part of Caritas Process 1 from Jean Watson’s Philosophy and Science of Caring (2008): Practice of Loving-kindness toward Self. The study evaluated the effect of performing centering moments on the happiness level of Kaiser Home Health employees.
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Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees
- 1. Kaiser Permanente, Northern California Caritas Consortium 2013 Comfort as Medicine: Integration of CAM into Bedside Care Caritas in Action How Caring Science informs and inspires KP caregivers and affirms our commitment to provide our patients and their families exceptional care
- 2. Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees Intent to Contribute Statement: This study evolves around the first part of Caritas Process 1 from Jean Watson’s Philosophy and Science of Caring (2008): Practice of Loving-kindness toward Self. The study evaluated the effect of performing centering moments on the happiness level of Kaiser Home Health employees in Oakland and Richmond, California. The single case experimental design B-A-B-A (Barlow et al., 2009) was used for studying the change on happiness level, during which period B represents one week of baseline without intervention, i.e., no centering moment, and A, a week with interventions or centering moments. During both types of week, each participant evaluated their happiness level once at the beginning of the workday, and once at the end, and that, for 4 days each week, for 4 weeks total. To do so, each participant circled a number from 0 to 10, where 0 is the least and 10 the most happiness experienced. During the “A” weeks, every hour of a workday, each participant’s phone rang softly to remind the employee to pause 20 seconds or less at their earliest convenience. During this pause, he or she performed a centering moment. Basically, the employee read a statement from The Philosophy and Science of Caring, (Watson, 2008). The statement aims at “cultivating the practice of loving-kindness and equanimity toward self” (from Watson’s Caritas Process 1). Employees chose among the 3 following statements: (1) With every moment’s light, may something beautiful be revealed to me, and become a part of who I am. (Mariann Williamson); (2) It is the tender heart that has the power to transform the world. (Jack Kornfield); (3) You can search the whole universe and not find a single being more worthy of love than yourself (The Buddha). In addition to the happiness levels, pre and post measurements of work satisfaction were performed before the first “B” or B1, and after the second “A” or A2 via a survey. Page 2
- 3. Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees … Continued Eight Kaiser home health employees participated in this study with 6 who completed it. The median was chosen over the mean as a measure of central tendency because the sample size was small. The median is less affected by extreme variations in the data than the mean. In general, Kaiser Home Health employees seem moderately happy in the mornings with median score of 6 for the first 3 weeks, that is, B1, A1, and B2, where Bs are baseline, and As are treatment weeks during which the centering moments were practiced. Only during the A2 did the happiness level increased to 6.5. It is possible that it took time for the training to occur, and during the first training week, A1, the subjects not accustomed to do the centering moments were not as effective as in the second training period A2. However, the standard deviation for the 4 training weeks was 1; which means the results reported here were not higher than the variability of the data. This limits our ability to infer the effects of the centering moments on happiness levels. Therefore, there seems to be only a trend of increase in happiness level at the 4th training week (A2). In the afternoons, Kaiser Home Health employees seem moderately happy as well, with median score of 6 for the first 2 weeks, that is, B1 and A1. It then increased to 7 during B2 and then 8 for A2. It is possible that collapsing the data across subjects might have eclipsed the treatment effect in A1. Alternatively, it is possible that the training effect might have been delayed, and noticeable only on B2. The happiness level went up to 8 for week A2. The standard deviation for B1 was 2, and for the 3 other weeks was 1. The increased happiness score for A2 is in support of the hypothesis that centering moments performed throughout the day can raise the level of happiness of Kaiser home health employees. Subjects also participated in a survey on work satisfaction. Page 3
- 4. Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees … Continued The survey was conducted before the data collection (“pre”), and after (“post”). 8 subjects participated in the “pre” whereas only 6, in the “post” survey. The work satisfaction scores under “moderately satisfied” decreased by about 20%, while scores under “extremely satisfied” increased by about the same amount. This suggests by performing centering moments, Home Health employees might get more satisfaction in their work. To sum up, happiness levels of Kaiser home health employees seemed to increase both in the mornings and in the afternoons as centering moments were performed. Moreover, 20% of work satisfaction from these employees appeared to have shifted from moderately satisfied to extremely satisfied. These two findings are in agreement with Jean Watson’s theory about caring individuals committed to expanding their caring consciousness and actions to self. In other words, performing centering moments contributed to enhancing employees’ focus from a modern medical science work setting towards a truer caring-healing-loving model. Increased happiness levels and work satisfaction are in line with the true caring-healing-loving model in Jean Watson’s theory. This study must be replicated with a greater number of subjects to increase the generalisability of these results. Page 4
- 5. Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees Inspired Contributor(s) 1 : Violaine Hamel Robyn Dean -----Service Area: East Bay Medical Center: n/a Affiliation: Continuum -----Year Shared: 2013 Venue: Caritas Consortium Format: Poster, PowerPoint ID #: W08 1 Names as listed in Lotus Notes, otherwise personal e-mails indicated Keyword TAGs: Identifier Consortium2013-July, East Bay, , Podium, Poster, Home Health / Hospice Self Descriptor Caritas Consciousness, Centering, Self-Care, Research and Metrics
- 6. Exploring the Potential for a Centering Practice to Influence the Happiness Level of KP Employees Page 6
- 7. Page 7
- 8. Inspiration 1) 2012 Kaiser Caritas Consortium 2) Daily lessons from spiritual practice (***great support from managers) Page 8
- 10. CARITAS PROCESS # 1 CULTIVATING THE PRACTICE OF LOVING-KINDNESS AND EQUANIMITY TOWARD SELF AND OTHERS Page 10
- 11. EXAMPLE OF QUOTE “You can search the whole universe and not find a single being more worthy of love than yourself” (the Buddha) Page 11
- 12. EXPERIMENTAL QUESTION DOES PERFORMING SELFCENTERING MOMENTS DURING THE WORK DAY INCREASE THE HAPPINESS LEVEL OF HOME HEALTH EMPLOYEES? Page 12
- 13. METHODS • N= 6 Home Health employees completed the study 3 RNs 2 PTs 1 SLP Page 13
- 14. METHODS Page 14
- 16. METHODS EVERY HOUR OF WORK DAY, CELL PHONE RANG SOFTLY TO REMIND SUBJECTS TO READ AND CENTER AROUND A MEANINGFUL QUOTE Page 16
- 17. Page 17
- 18. Happiness Scale PM HAPPINESS RATINGS AS A FUNCTION OF TIME 10 8 6 4 2 0 N=6 PM SCORES MED Page 18 B-1 A-1 B-2 A-2
- 19. HAPPINESS RATINGS AS A FUNCTION OF TIME - SUBJECT 2 Happiness Scale 10 8 6 4 2 B1 A1 B2 A2 0 1234 1234 1234 DAYS Page 19 1234 AM PM
- 20. HAPPINESS RATINGS AS A FUNCTION OF TIME - SUBJECT 5 Happiness Scale 10 8 6 AM PM 4 2 B1 A1 B2 A2 0 1234 Page 20 1234 1234 DAYS 1234
- 22. WORK SATISFACTION SURVEY Are you satisfied with your job? PRE 100.0% 50.0% 0.0% Page 22 extremely satisfied moderately satisfied slightly satisfied
- 23. WORK SATISFACTION SURVEY POST Are you satisfied with your job? 100.0% 50.0% 0.0% Page 23 extremely satisfied moderately satisfied slightly satisfied
- 24. DISCUSSION • HAPPINESS LEVEL SEEMS TO INCREASE WITH CENTERING MOMENTS (TREND) • WORK SATISFACTION SHIFT FROM MODERATELY TO EXTREMELY SATISFIED Page 24
- 25. DISCUSSION QUESTIONS FOR FURTHER STUDY • ARE PATIENT OUTCOMES BETTER AS THE EMPLOYEES HAPPINESS LEVELS AND WORK SATISFACTION INCREASES? Page 25
- 26. DISCUSSION QUESTIONS FOR FURTHER STUDY • IS MEMBER SATISFACTION HIGHER AS THE EMPLOYEES HAPPINESS LEVELS INCREASE? Page 26
- 27. DISCUSSION QUESTIONS FOR FURTHER STUDY • ARE SELF CENTERING MOMENTS THE MOST EFFECTIVE WAY TO INFLUENCE HAPPINESS LEVEL OF HOME HEALTH EMPLOYEES? Page 27
- 28. ACKNOWLEDGEMENTS • HOME HEALTH SUPERVISORS AND COWORKERS • JEAN WATSON • MARY LUSH • MARGHERITA MCINTOSH • ROBYN DEAN Page 28
- 30. YOU CAN CHOOSE TO CENTER Page 30
- 31. AND RECONNECT WITH HAPPINESS, YOUR UNIVERSAL POWER Page 31
Editor's Notes
- I like to step back for a minute, and share with you the 2 sources of inspiration for doing this study. 1st : coming to the Caritas Consortium last year and 2nd, my personal spiritual practice; and of course I could not have done this without the great support from my managers.
- Going to the CC last yearwas an epic eye opener for me. I never heard of Jean Watson before, I got so moved by learning about her world-wide work on restoring the deep nature of caring-healing and by seeing how her work was bringing love and happiness back into health care systems. I heard Dr Larry Dossey who provided scientific evidence of how interconnected we all are and how my state of mind, your state of mind happy or sad, and every thing in between or beyond affects directly the whole community around us. I also had the chance to look at many posters, and I was amazed of the transformation that already took place in sooo many departments within Kaiser. During that day, at last year CC, I understood I had a mission:to help bring Jean Watson’s principles of caring in our very own Oakland/Richmond home health department.
- When we started, CP #1 seemed the natural way to start as nurturing ourselves would help deal with stress in the HH settings. So the question was how can we cultivate loving-kindness toward ourselves when we work? In reading Jean Watson’s “The philosophy and science of caring” I was drawn to performing centering moments as a mean to cultivate the practice of loving-kindness. I was also drawn to very meaningful quotes and I thought I would center around these quotes and use that in the study.
- Here is an example of a quote. So we would have subjects (or Kaiser HH employees) center all throughout the day, by reading slowly a meaningful quote. Which led to the experimental question:
- “ “
- So the number of subjects is consistent with the exploratory nature of this study.
- Here we have a sample of happiness score data sheet. So every morning, subjects would circle their happiness level, before they started working, and at the end of the work day. Subjects also kept a diary.
- HERE IS A REPRESENTATION OF THE EXPERIMENTAL DESIGN: IT’S A SINGLE CASE EXPERIMENTAL DESIGN “BABA”, where B weeks are baseline ie datas are recorded without subjects performing centering moments and A weeks, treatment weeks where subjects performed centering moments.
- Every hour of the workday, each participant’s phone rang softly to remind him/her to pause for 20 seconds or less at the earliest convenience. During this pause, he or she read one quote that aims at cultivating the practice of loving-kindness and equanimity toward self, i.e CP#1.
- (1st I describe the axes, and that’s for the afternoon scores), overall happiness subjects remained around 6/10 for the first 2 wks, and went up to 7 on B-2 and to 8 on A-2.
- (1st I describe the axes, interpret day by day for B-1), subject 2 data show 2 main things: 1) variability within the week seems to decrease after B-1; happiness ratings seem to increase over time.
- Subject 5 behaved differently, with higher variability between the days but also within the day. For example, day 2 of A-2 rating was 3 in the morning and 7 in the afternoon. So the happiness level increased of 4 points that day, which is very important in a day of HH employee to be able to increase happiness so to have access to his/her intuition and creativity. In that subject diary, however, subject 5 had a headache that day and took some pain medicine. So this increase was probably affected by the pain med effect.
- WORK SATISFACTION SURVEY
- WORK SATISFACTION SURVEY PRE
- In the post satisfaction survey, although there was an increase of 5% in the slightly dissatisfied, most of the change in the moderately satisfied was transferred over to the extremely satisfied group, that is an increase of about 20%. This suggests that increasing meaning in the work place, increases work satisfaction
- So it seems centering moments performed during the work days help increase happiness level of Kaiser employees. How does it work? Well according to Jean Watson, everyone’s natural state of being has to do with abundance of loving-kindness. and that brings joy and promote healing around us. Unfortunately, our inner loving-kindness gets covered over with difficult stuff we deal with on a day to day basis. So Centering moments might help uncover the unhappiness, so we get in touch with our natural state of loving-kindness.
- I believe pt outcomes will be better. As happier employees, we become ready for caritas no 5 which is Being present to, and supportive of, the expression of negative and positive feelings. To my opinion, this is a major turning point as the Kaiser home health employee never know what he/she will walk himself/herself into. Sometimes we walk into homes with angry, anxious, or sad patients or family members. So we have to, so to speak, increase our happiness so to access our optimal healing influences via Caritas Field or Consciousness. Some of the brain research suggests that creativity and intuition is available to individuals only when they are happy. So if we are not happy with a 3, like subject no 2 I showed earlier, it will be hard to promote healing when we enter a house with a difficult situation. Let me quote Jean Watson : “what we do for ourselves benefits others and what we do for others benefits us. If one person is healed, it is helping to heal all. If others are healed, it helps us heal.”Here’s an example. One day, I visited a bedbound pt who started to cry and was repeating she would never walk again. If I was at happiness level of 3/10 I may have replied something like “don’t be silly everything will be fine.” But I was higher (maybe a 6/10) and i got inspired by the CP #5 and was able to be present to her expressing her feelings. After listening to her, she was willing to participate in the PT activities and in fact, she got up at the walker and walked about 3 or 4 steps. So it seems to make sense that pt outcomes will be better as employees happiness levels go up.
- SEEMS THAT PT OUTCOMES AND MEMBER SATISFACTION GOES HAND IN HAND
- I found difficult to explain to the subjects of the present study how to perform short self centering moments, and there were lot of variability on how to do it, and also, between subjects. In the future, we could look at techniques from the Institute of Heart Math. The Institute of Heart Math is a non-profit that helps people reduce stress for healthier and happier lives. Some of their techniques appear well defined and easy to teach and learn.
- HH SUPERVISORS: ALWAYS SUPPORTIVE OF THIS WORK: COWORKERS WHO PARTICIPATED AS SUBJECTSJEAN WATSON FOR HER AMAZING LIFE WORK AND DEDICATION MARY LUSH WHO TOOK TIME TO LOOK INTO MY DATA AND SAT DOWN WITH ME AND GAVE ME IMPORTANT FEEDBACK AND SUGGESTIONS I INCORPORATED MARGHERITA MCINTOSH HELPED ME A LOT WITH PRESENTING THE DATA, HOW TO DO THE SURVEY, AND MORE.ROBYN DEAN FOR SITTING DOWN WITH ME GIVING ME CLEAR FEEDBACK, IDEAS AND ENCOURAGEMENTS
- WHEN YOU ARE HAVING A ROUGH DAY
- YOU CAN CHOOSE TO CENTER YOURSELF AND TO QUIET YOUR MIND.