Brief Stress-Reduction Training in an Academic Health Center

Dear Editor:

Stress is common among staff at academic health centers (AHCs). In a 2006 employee workforce survey at our institution (unpublished data), staff on the units with the highest turnover rates indicated that the institution was not meeting their stress management needs effectively. Mindfulness-based stress reduction (MBSR) can reduce staff stress and burnout, but it typically requires at least 20 hours of training, and may not be feasible in the most highly stressed settings. ^{1 –3} We were unable to find studies evaluating the impact of MBSR on absenteeism and turnover in AHCs. We therefore evaluated the impact of a brief meditation training program on staff stress and burnout and explored its impact on absenteeism and turnover in our AHC.

We recruited staff from inpatient units that had previously reported high rates of stress. The free, voluntary training was scheduled with 14 different groups scheduled over all work shifts to enhance convenience; staff were excused from work to attend.

The 6-hour training program was provided by a certified trainer using the Institute of HeartMath Transforming Stress Workshop curriculum (4 hours in one session, followed 4 weeks later by a 2-hour session). Training reviewed the prevalence, triggers, and consequences of stress. Training included several techniques including rhythmic breathing and intentionally activating a positive emotion (such as gratitude or compassion), using biofeedback to enhance learners' abilities to recognize and reinforce the desired state. ^4,5 Practice was neither required nor tracked. Nonetheless, participants were encouraged to use the biofeedback equipment installed on each unit to practice before the follow-up session 2–4 weeks later.

Outcomes included the 10-item Perceived Stress Scale (PSS) and the 22-item Maslach Burnout Inventory (MBI). ^6,7 They were assessed immediately prior to the initial training session and 2–4 weeks later at the follow-up session. Unanticipated absenteeism and staff turnover were measured for 3 months before the first intervention and 3 months following the last intervention for each unit by Human Resources staff. Turnover rates for all staff on participating units (not just the study participants) were calculated.

The project was approved by the Wake Forest University Health Sciences Institutional Review Board.

Of the 103 staff who signed up for the training, 83 (81%) completed attended the first (4-hour) session. Participation rates ranged from 13% to 27% of staff on the targeted units. Of the 83 participants, 87% were women; the average age was 39.6 years. Most (69%) completed both training sessions; completers and noncompleters reported similar demographic characteristics, stress, and burnout levels at baseline.

Among those who completed training, stress scores on the PSS fell from 19.2 (±7.4) to 16.8 (±6.5) (p = 0.003). The MBI burnout scales of emotional exhaustion and depersonalization improved by 16.1% (p = 0.02) and 12.5% (p < 0.001), respectively. Unscheduled absences decreased from 428.8 hours in the 3 months before to 359.4 hours in the 3 months following training (p = 0.22). In the 3 months after training, 2/83 participants terminated employment. The median turnover rate fell from 7.0% in the 3 months before to a median of 3.0% in the 3 months following training on the targeted units (p > 0.05).

Brief stress management training was associated with significantly decreased stress and burnout and nonsignificant improvements in unscheduled absences and employee turnover among inpatient staff at this AHC. These promising results suggest that it is feasible to assess economic outcomes such as absences and turnover and that comparative effectiveness studies for different types of stress management training are warranted. Larger sample sizes are needed to detect effects on rare outcomes such as staff termination or turnover. The relatively low participation rates on this AHC's highly stressed units and staff comments (not reported here) suggest that alternative training delivery strategies, such as brief online (e.g., webinar) training or individual, self-paced (e.g., CD or DVD) training should also be compared with standard training strategies. The promising research regarding the impact of meditation on physiologic changes and psychologic improvements should be matched by rigorous research on the most cost-effective strategies for disseminating training to different populations.