Case Study

How ChristianaCare provides system-wide peer-to-peer support

10 Minute Read

Key Takeaways

The challenge

Directly following a stressful workplace event, it can be challenging for clinicians to access emotional support. Either there isn’t clarity about where to seek support, they have to go out of their way to access it, or they don’t trust that the support will address their challenges. Even when peer support programs exist, utilization can lag because they’re largely dependent on self-referrals and struggle to overcome the “I’m fine” culture.

The organization

ChristianaCare is a private, non-profit health system headquartered in Wilmington, Delaware. They are a major teaching hospital with four campuses, over 120 practices and locations, and more than 13,000 employees.

The approach

ChristianaCare developed a peer-to-peer support model as part of their Care for the Caregiver program. The program provides short-term emotional support from trained peer volunteers within 24-48 hours of a referral. Clinicians can access support via self-referral, a colleague referral, or in response to proactive outreach from someone in the Care for the Caregiver program following an adverse event.

The result

Since the program launched in 2015, there’s been consistent growth in the number of peer encounters per year. During the first wave of the pandemic, there was a two-fold increase in utilization of peer-to-peer support and more than four-fold increase in group support, with more than 500 encounters across 2020.

 

Solution

Care for the Caregiver program overview

ChristianaCare’s program was initially based on the University of Missouri’s forYOU Team, which teaches hospital leaders how to set up a multi-disciplinary team of hospital volunteers to support team members going through stressful workplace events. In 2015, ChristianaCare partnered with the University of Missouri to launch their Care for the Caregiver program, which offers one-on-one and group peer support.

Expanding access to short-term, peer-to-peer support

When leaders at ChristianaCare performed a needs assessment, they found that following an adverse event, clinicians’ overwhelming preference was for peer support, while resources like supervisor support and EAP were less popular. To provide one-on-one support, they set up a central program to connect peers to each other—all within 48 hours of a stressful event.

The goal of the program is to provide short-term peer-to-peer support. As a result, peers are connected with a trained peer supporter for one to two 15 to 60-minute conversations in response to a specific event—not a long-term mentorship or ongoing therapy relationship. The scoped number of encounters can make it less daunting for the participating employee, while also protecting the bandwidth of peer supporters. If a clinician needs additional support, the peer supporter or Center for WorkLife Wellbeing staff connects them to the appropriate internal or external resources.

Equipping peers to provide empathetic emotional support

ChristianaCare’s program includes over 70 volunteer clinical and non-clinical peer supporters representing a range of roles, departments, and levels of experience. The goal is to recruit a diverse team of volunteers who can identify with the high-stress nature of the work but can also empathize and provide confidential support to any employee across the organization.

To prepare for their role, peer supporters participate in training on how to provide emotional support in the wake of a stressful event, including adverse clinical events and other events that could cause distress such as violence in the workplace or racial injustice. Peer supporters participate in three hours of initial training through interactive web-based modules and simulation cases, as well as ongoing training at quarterly meetings. The focus of the training is on how to provide non-judgmental, empathetic emotional support, rather than problem-solving. And if a peer supporter runs into a challenging case, they can seek additional support through ongoing meetings and check-ins with the Center for WorkLife Wellbeing.

When it comes to matching peers, ChristianaCare aims to take each employee’s preferences into account. For example, one employee may prefer to connect with the same caregiver type (e.g., nurse to nurse) while another employee would prefer someone in a different role or department. To create a safe space for candid discussion, the program has no connection with the HR or legal department and ChristianaCare emphasizes confidentiality within the encounter, ensuring that there’s no identifying documentation of who receives support or what’s discussed.

How ChristianaCare overcomes the “I’m fine” culture

While peer support can be one of the most beneficial forms of emotional support, there can be utilization challenges because services are not easily accessible, or employees don’t feel comfortable disclosing their experience. ChristianaCare’s leaders took three steps to make their peer support program integrated, trusted, and accessible.

Hardwire peer support into existing processes. To identify employees who would benefit from peer support, the Center for Worklife Wellbeing embeds their program in quality and safety procedures such as post-event debriefs and CANDOR processes so they can proactively reach out following an adverse event. ChristianaCare also has a referral template in their secure messaging system that anyone can use to make a referral, on their behalf or for someone else. Referrals go to the Care for the Caregiver Program Manager, who triages the cases to the peer support teams to connect clinicians to a peer supporter. 

Emphasize colleague referrals to identify those who may fall through the cracks. Self-referrals comprise less than 20% of referrals into ChristianaCare’s program. All other requests come from a combination of colleague and manager referrals and the proactive monitoring mentioned above. The program is also embedded in their reporting system, so after an event like a patient fall, a colleague can submit a referral while reporting the event. The Care for the Caregiver Program Manager then connects the referred individual to a peer supporter who will offer support. And critically, the team underscores that referrals are optional and not punitive, so employees know they aren’t being singled out, mandated for support, or punished.

Market the program often—and through multiple channels. ChristianaCare advertises their program widely: sticking magnets and pamphlets in different break rooms, networking with leaders across the organization to spread the word, rounding on different topics related to peer support, and encouraging participants to share their own experiences if they’re comfortable doing so. Erring on the side of overcommunication helps normalize the need for support and fosters a culture of help seeking where clinicians know it’s ok to be vulnerable.

 

Results

In the first year of the Care for the Caregiver program (2015), ChristianaCare already had nearly 100 encounters—and they’ve seen sustained growth since then. During Covid, the peer support program has been a foundation element of their crisis response. Across 2020, they’ve had more than 500 peer encounters and during the first Covid surge saw a more than two-fold utilization increase in their individual support and four-fold increase in their group support.

As they continue the program, ChristianaCare is incorporating more holistic support to reflect the varied challenges facing employees—such as how to manage distress from widespread racial injustice. Anecdotally, program leaders report that there’s a growing acceptance of seeking peer support given employees’ positive experiences with the program. As the program’s manager, Katie Godfrey, noted: “We are seeing a shift toward a more supportive, help-seeking culture. Caregivers are looking out for their colleagues after difficult events and are much more comfortable now raising their hand and saying, 'I’ve been impacted by this event, and I’d like support.'"

Sources

Agency for Healthcare Research and Quality, https://www.ahrq.gov/patient-safety/capacity/candor/impguide.html#:~:text=The%20CANDOR%20process%20is%20an,or%20financial)%20to%20a%20patient; ChristianaCare Health System, Newark, Delaware; “Implementation Guide for the CANDOR Process,” ; “forYOU Team,” MU Health Care, https://www.muhealth.org/about-us/quality-care-patient-safety/office-of-clinical-effectiveness/foryou; Physician Executive Council interviews and analysis.

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