Friday, November 22, 2019

Paths to Practice Interview: Dr. Annie Budhathoki, DAOM, LAc of Huntsman Cancer Institute

keywords: interview series, paths to practice, integrative oncology, research, metrics, wellness center, Huntsman Cancer Institute integrative oncology, hospital practice acupuncturist

The Hospital Practice Handbook Project Interview Series: Paths to Practice
Focus on Dr. Annie Budhathoki

Interview recorded on March 1st, 2019
Go to our YouTube Channel to watch the video.

This Paths to Practice interview is with Dr. Annie Budhathoki, DAOM, LAc, doctor of acupuncture and Oriental medicine, and licensed acupuncturist at the Linda B. and Robert B. Wiggins Wellness and Integrative Health Center, Huntsman Cancer Hospital and Clinics, the University of Utah, Salt Lake City, Utah.

video interview minute 0 - 5  
Annie Budhathoki, DAOM, L. Ac. is the wellness education and training coordinator at Huntsman Cancer Institute’s Linda B. and Robert B. Wiggins Wellness and Integrative Health Center.
Her clinical specialty is treating cancer-related side effects. She helps patients maintain wellness and longevity after a cancer diagnosis. Dr. Budhathoki is a research investigator on the use of acupuncture in the oncology setting. Her areas of interest include oncology, integrative medicine, pain management, geriatrics, and neurological disorders. 

Since 2012, she has worked full time as an integrative oncology clinician at Huntsman Cancer Institute in Salt Lake City, Utah. Dr. Budhathoki spends about 10% of her time in teaching and outreach. She is adjunct faculty for the University of Utah where she teaches in the medical school’s integrative medicine program.

Dr. Annie Budhathoki

Dr. Annie Budhathoki’s Path to Hospital-Based Practice
See minutes 07:55—14:00 for the related section of the video interview
Dr. Budhathoki attended Pacific College of Oriental Medicine (PCOM) San Diego where she obtained her master’s degree in acupuncture and oriental medicine. Then, she studied healthy aging and longevity at Yo San University in Los Angeles, CA, where she received her doctorate degree in the field.

In November 2009 she opened a private practice in Salt Lake City, Utah, where she enjoyed working as part of a patient’s healthcare team. She started work at Huntsman Cancer Institute pro re nata (PRN), in the summer of 2012 and by October 2012 she was a full-time employee there.

A Doctoral Degree in Healthy Aging & Longevity: Everything at Huntsman is a Longevity Prescription
minute 16:00
Megan:  So, you said your doctorate was in healthy aging and longevity.  What are some things you love about your work at Huntsman?

Annie: So, getting that doctoral degree in healthy aging and longevity my goal was to marry the ancient concepts of longevity with life after cancer and with cancer.  So that our patients can get the very best results they have possible. I see everything in our hospital as a longevity prescription.  So, our entire goal as a hospital is about patient care and about allowing a patient to get those best days as long as possible to be increasing their quality of be with family, to be doing what they want to do, to be enjoying their days.

And that’s really empowering to me to be able to take these ancient pieces…, integrate [them] into what Huntsman is doing at large with treating cancer and giving patients these really amazing and sustainable results.

And that gives me goosebumps because I think patients feel that when they come to Huntsman, we are focused on them and their priorities of quality of life and improving their life for as long as possible. At Huntsman, we treat patients and caregivers. 

What is your favorite thing to do in hospital practice?
Annie: Working with patients at the wellness center. The Wellness Center helps patients regain their own power. The patients can work on themselves while the oncology teams work on their cancer.
Acupuncture helps these patients with their stress and improves their sleep. Acupuncture is empowering for them during a difficult time. We reach the patients where they are. Often offering them hope in a unique way.

The Linda B. & Robert B. Wiggins Wellness and Integrative Health Center at Huntsman Cancer Institute
Dr. Pamela Hansen began the Wellness Center in 2005 with the “power exercise” program. This grassroots program out of an auxiliary bathroom helped patients with exercise and movement while they were undergoing cancer treatment. This wellness center is one of the few wellness centers inside an academic cancer hospital. It has grown to include over 36-39 programs depending upon the season. And, the Wellness Center publishes a quarterly catalog for patients, caregivers, and staff.
In 2005-2007 the wellness center program was very small. Just an afternoon session, once a week.  And it had a big waiting list.  So, in 2012, they decided to bring acupuncture on full time.

This year, the wellness program has 4 acupuncturists and 9 massage therapists. The Wellness Center’s clinical services are available from 7AM to 7PM most days Monday through Friday. In the wellness center, acupuncture and massage have a daily treatment average of 20-25 patients per day for each program.  Last year, in 2018 the whole wellness center saw over 25,000 patients in our more than three dozen programs. [minute 13 of the video interview]

The Wellness Center is an outpatient acupuncture practice inside the cancer hospital.  The acupuncturists treat the side effects and symptoms of cancer and cancer treatment [such as] neuropathy, pain, nausea, insomnia, and hot flashes. Dr. Annie Budhathoki also does inpatient acupuncture for hospitalized oncology patients.

Wellness Center Funding and Revenue Streams
Annie: The Wellness and Integrative Health Center at Huntsman Cancer Hospital is a budgeted program supported and directed by our patient-centered administration. Most of our programs are low-cost to no-cost; programs with a fee are generally reduced costs similar to a copay. Acupuncture is a fee-for-service program and the cost to the patients, caregivers, and staff is $40. Additionally, Huntsman has a financial assistance program that supports persons living on a low income and our wellness center offers a sliding scale within this program. Currently, very few of the insurance providers in the state of Utah cover acupuncture, so we don’t have insurance billing set-up for our acupuncture services.  

The Wellness Center is a Place Where Patients Regain Their Power 
minute 22
Annie: You know, the Wellness Center [is amazing; ] we have all this programming. At Huntsman, we have a supportive oncology team.  Dr. Anna Beck is the director of supportive oncology; when she came to Huntsman [she reshaped] the models for integrative medicine. 
This wellness center is a place where people are empowered to take charge of their health while going through cancer treatment and beyond into survivorship.
As providers, we have the opportunity to support people affected by cancer to overcome various health and wellness obstacles. We ensure each person feels empowered to improve and maintain their individual health despite their cancer diagnosis or former health status. When championing the best care of each specific symptom, we work together as an integrative team supporting the goals and betterment of each patient. Often this includes referring them into various programs that also support their needs, knowing that this is how they can continue to regain their power.
In the Wellness Center, we are supporting the basic health needs and daily quality of life issues which affects a person’s ability to function.  We manage symptoms like nausea, fatigue or sleep while their physicians are working on the cellular level to attack their cancer or on a surgical level to get things taken care of.

[In oncology the side effects of chemotherapy, radiation, surgery can be disempowering] for a patient because medicine takes over. And rightfully so in many cases so that those specific diseases can’t become chronic illnesses or can be cured if you will.  But in wellness and integrative health and especially acupuncture and massage, fitness, nutrition—this is where patients really get a chance to shine on their own; to regain their power. 

Dr. Annie Budhathoki

Advice for those of you working in integrative oncology 
Annie: As you practice in a hospital setting, keep that in mind: how do the patients remain empowered with their own health care as they go through that? 

The Inpatient Acupuncture Program at Huntsman Cancer Institute
Annie:  We started the inpatient acupuncture program with an Imagine Perfect Care grant from the University of Utah.  The inpatient acupuncture program began in September 2018.
We started that program on the oncology floor, working with symptoms like nausea or constipation or ir-retractable vomiting.  [Any] symptoms that would keep a patient in the hospital and extend their stays and prevent them from going home. [Eventually the program] moved into the surgical ward and into other parts of the hospital.  But the initial work was symptom-based, treating any issues that would keep a patient in the hospital too long.

What is the goal of integrating acupuncturists at Huntsman?
Megan:  So, you’re using acupuncture as a complement to ongoing care to help people have shorter inpatient stays?

Annie:  Our goal, long-term is to show the efficacy of acupuncture in an inpatient oncology clinic in a hospital and to show feasibility as far as reducing costs.
We believe acupuncture is a cost-saving measure for the hospital overall.  Whether that’s a reduction of opioid use, whether that’s reduced hospital stays, or reducing re-admission rates; that’s really our goal.

Integrating Clinical Outcome Measures Seamlessly in a Clinical Research Environment
Megan:  Are you doing ongoing research studies related to either of these programs? 

Annie:  So, Huntsman is a research institution.  [Research is] a foundational force of Huntsman alongside our clinical care. Research is really embedded throughout the hospital. In the wellness and integrative health center, we have a number of research projects.

[Related to] the acupuncture program we currently have a mindfulness acupuncture research study with Dr. Eric Garland who [is] a leading mindfulness researcher.

We also have a chemotherapy-induced peripheral neuropathy (CIPN) study. Which employs an fMRI to [measure] the implications of acupuncture on CIPN.  And we have an inpatient acupuncture research study in the works.

Teaching and Outreach with Medical Students at the University of Utah
minutes 6-8 and minutes 25-26 of the video interview

Annie: The University of Utah has a very strong collaborative approach to medicine.  Recently, Dr. Amy Locke created and developed an integrative medicine pathway.  Prior to that, we had an integrative medicine elective for our medical students. I teach in both [the elective and the pathway].

What is the University’s Integrative Medicine Elective?
Annie: It’s an elective for medical students to [shadow] integrative medicine practitioners and [observe] integrative medicine in action.  So, they come and spend about 1-2 weeks with us here in the wellness center [where they follow me] in the acupuncture clinic and [other] practitioners in their clinical work.

What is the Integrative Medicine Pathway?
Annie: In the integrative medicine pathway, we [have several learning structures]. We do panel discussions about integrative medicine.  We’re developing a modalities class.  There are different ways in which we work together to educate medical students. [The vision is] to develop their [knowledge base on integrative health] and [improve their ability and confidence] in referring to integrative medicine and utilizing it in their future [healthcare workplaces].

minute 25:50
Megan:  So, as an instructor in the medical school and as a clinical observation site you are shaping the future of healthcare integration and help the physicians be informed and feel comfortable referring to different integrative medicine services.

Annie: I really love that. I think, you know, spending a day with a student, a medical student is very powerful. A whole day together in an acupuncture clinic where they can ask all the questions they have in the world. And they can try the needle and they can explore the ideas on how to find an acupuncturist; “what could I use it for in my specialty?”. For me, that also gives me goosebumps for the future. Because I think that being a template or a first impression on acupuncture for their field is very rewarding.

Advice for future and current hospital acupuncturists
minute 14:10
Megan: What do you see as the biggest work-related challenge or learning experience for acupuncturists?

Biomedicine Communication, Conventional Medicine Literacy, and Practicing Research Literacy
Annie: “I think when it comes to work-related challenges, I think that our education [programs] as a whole need to do a better job at the literacy of speaking with elite oncologists, amazing world-class surgeons, nursing staff, and then, of course, patients.”

Annie recommends you learn and practice research literacy, study your hospital-based specialty whether it is oncology or OB/GYN. When you do this, you are better prepared to be “at the table [and] present our profession in the very best way possible”. The key factor in good communication with someone is language. Integrate both the practices and languages of TCM and Western medicine to “create a synthesized dialog that medical professionals can understand.” 

Annie: “Many of the ancient tools we were given are amazing. But [you need to] bring those to the table and translate [their usefulness] in a way that makes sense for the medical professions at large and ultimately [how these tools] benefit the patient [by giving] them the very best results in their care.”

minute 18:00
Dr. Annie Budhathoki’s Advice for Students and Professors of Acupuncture Education Programs
The educators at acupuncture programs could do better at informing students about research literacy and how it relates to growing the acupuncture practice field. The language of research is essential to know and hone for communication with your hospital practice team, your physician advocates/physician champions, and your hospital administrators. Dr. Budhathoki’s doctorate degree, she says, helped her build and grow research in the field.

Take time, on a regular basis, to read the research in your field and related fields and discuss it with your colleagues.
Megan: This skill, research literacy, is one of the “5 ingredients” noted as essential in the HH Project resource booklet, Getting Your Foot in the Door of Hospital-Based Practice: First Steps.

Advice for the Student: Know Your Dream; Allow Your Dream to Grow & Expand
Annie: “Allow [your] dream to be as big as possible.  Thread every piece of [new] information you have into that dream as you learn.  So, as you attain that dream and those pieces come together, your dream then expands. And then, once you get that dream job, you [then] see all the professors, all of the people… that guided you and mentored you.  And, like in my case now I am guiding and mentoring.  And so, the dream expands.”

Dr. Budhathoki’s advice for the New Hospital Practitioner
Hone your patient care skills. “Sharpen your diamond”, Dr. Budhathoki says. “Become a masterful practitioner” in your facility, for your specialty, for your patients. Ways to hone your skills may include: completing a doctoral degree, practicing your research literacy skills, and reading acupuncture books written by physicians to better understand their perspective.

Patient Care First 
minute 19:50
On Gloving During Clinical Care: “Always Wear Gloves”
Dr. Budhathoki wants all her hospital-based practice colleagues, especially those working with immune-compromised patients to think about where the microbes are. Keep infectious disease at the forefront of your mind. Hand washing is extra important with immune-compromised patients.

Annie: Keep the patient in the forefront of your mind. Think about what is best for them and the risks involved. Align the safety of the patient with meeting their needs for symptom/condition. Keep the patient is as safe as possible. Always wear gloves. Hospital gloves are very thin and there are some good tricks to getting them to fit you well. Once you get used to them, it will not interfere with your palpation skills.
I never want to bring what I have from my life into a patient’s internal environment. So, as a protection for myself and as a protection for the patient, gloving is my number one [priority in my hospital practice environment]. Get to know your infectious disease nurse.  Get to know your infectious disease team.  [Contemplate] where things live and how they live on you and others so you are not putting a patient at risk any time, ever, including yourself.

Collaborate & Connect with your Champion 
minute 21:20
Dr. Budhathoki believes the collaborative connection to colleagues in the workplace are important.
Annie:  “So, who do you know who really loves acupuncture in your hospital? Who can become your physician champion?  And, as you find a champion, you know, what is their dream for your dream?”
Allow them [your physician champion] to help you grow and [expand your work/your program]. 
Find your physician champion. This is your advocate to help you grow and connect with others.
Ask your hospital champion what you can do for them. Don’t email your champion too frequently.
Be concise, courteous and respectful of their time. For example, when communicating with them, use three bullet points, no more. They are very busy and get hundreds of emails a day.

Luckily at Huntsman, we have had a number of physician champions through the years that have… really allowed acupuncture to become a very integral part of their oncology practice or surgical practice.

Megan’s note on “physician champion”:
Sometimes we talk about them as our “change agents” or our “advocates” or “hospital sponsors”. There are different terms for this. In the Project, I call them our “hospital sponsors” because sometimes they are not a physician, sometimes they are a nurse practitioner. Basically, a sponsor or champion is someone very established in the system who wants to advocate for you. This is a very important connection. More on this subject here.

Metrics and Integrative Oncology
How do you define success for an integrative health program within a mainstream oncology/cancer care clinic and/or wellness program?
Look at programs that have acupuncturists integrated as part of the treatment team. It is important to measure patient results, such as patient outcome measures and patient satisfaction. You should have research projects in place.

What are meaningful metrics for a patient-centered oncology program?
The website has an extensive set of oncology issue-specific questionnaires. It includes the following types of questions: pediatric oncology-specific, general adult functional assessments, metrics specific to the type of cancer, metrics specific to cancer therapy, specific to symptoms, specific to treatments, for patients receiving enteral nutrition and feeding, for non-cancer specific measures like dyspnea in chronic illness and palliative care.

Dr. Annie Budhathoki’s Recommended Reading for the Prospective or Current Hospital-Based Practitioner interested in Oncology and Wellness Center Work
minute 27:00
Annie likes reading material that helps her better understand other perspectives, such as the patient’s perspective and the oncologist’s perspective.

Annie: “I love to read books by physicians and patients about my specialty on cancer and oncology as a lay book or as an easy reading. I like to go outside of our box and get into the physicians’ minds. I really love reading books that are written by physicians about acupuncture and oriental medicine or integrative medicine.”  

Kitchen Table Wisdom: Stories that Heal

Book that Annie recommends to everyone reading this article or watching the interview is Kitchen Table Wisdom: Stories that Heal by Rachel Naomi Remen, MD. This is a gathering of short stories the author compiled as she learned to practice compassion in her oncology practice.

Annie: “These types of books inspire me every day to become a better provider. [They help me keep a patient-centered] focus. And they help me see the physician's perspective and the conventional medical perspective. [I like] reading material that helps me put [myself] in the shoes of a physician [or the] shoes of the whole team. And, [books that put me] into the shoes of [my] patients, of course.”

Megan: I love that idea… for perspective, to read what physicians write about what we (acupuncturists) do so to better understand their perspective. And so, improve our communication with them.

Closing Notes
What else do you want the hospital-based acupuncturist community to know about integrative oncology and acupuncture?
Annie: Please wear gloves and work alongside with your infectious disease nurse to develop patient safety protocols in your hospital.
I really love integrative medicine and acupuncture. I am excited to see the research move forward. We are right on the cutting edge of integrative medicine. It is a powerful place.

Want to learn more?

Video editing acknowledgments
Thank you to Albert Stern, MSAOM, for editing this video. 
You can review his Chinese Herbal Medicine formulas at his TCM Picture Book YouTube channel 

Definitions of terms used in this article
PRN = “pro re nata” or as the situation arises aka “as needed”. 

Related blog posts
Other Program Interviews
Oncology and Acupuncture 
Research Literacy and Hospital-based Practice, some Resources
Recommended Reading Lists
Dr. Budhathoki recommended this book in her interview: Kitchen Table Wisdom: Stories that Heal by Rachel Naomi Remen, MD.

If you follow the Amazon links from this blog and make a purchase within a few hours, a few pennies from your purchase will go toward supporting the Hospital Handbook Project at no extra cost to you.
OverDrive and Libby

You can request reading materials from your public library in person or through the Overdrive and/or Libby app.

More Reading & Listening Lists from the HH Project Community
Related tags and search terms to consider finding more subject matter information in this blog: research and metrics, hospital employee, leadership and workplace, interview series, integrative oncology, wellness programs, paths to practice, interview series

HH Project Resources by Practitioner Type

To help offset the cost of this work and make it possible for me to do more work like this, please do one or more of the following:
Thank you!

Monday, November 18, 2019

Embedding Social Determinants Into Healthcare: A Resource Review for the Community

keywords and phrases:
Health equity, biopsychosocial model, integrated healthcare, social determinants of health (SDOH), data, telehealth, technology, electronic health record (EHR), interprofessional work, leadership and workplace, precision healthcare, reimbursement, health policy, public health, Lunchtime Listen recommendation

Resource Review: CHC’s interview on Embedding Social Determinants Into Healthcare System Process

Guest post by Steven Mui, MSOM, CAc

Resource reviewed: CHC Radio episode
Resource reviewed for this post was the podcast episode, “Addressing Upstream Causes of Poor Health: UCSF’s Dr. Kirsten Bibbins-Domingo on Embedding Social Determinants Into Healthcare” from the ongoing podcast Conversations on Healthcare®, published October 7th, 2019
An audio recording of this episode is about 25 minutes and available at this link.
Target audience: Hospital-based acupuncturists, social workers, community health workers, healthcare system leadership, those interested in research


Dr. Kirsten Bibbins-Domingo, Chair of the Department of Epidemiology and Biostatistics at the University of California at San Francisco discussed a report from the National Academy of Sciences on ways to incorporate social care into health care. She shared examples of what shifts are occurring in the American health system in managing upstream causes of disease. These upstream determinants include where we live and work and what we eat. She also shared how healthcare organizations can integrate and what components are needed to make it a reality.

Dr. Bibbins-Domingo identified two activities that must happen within a healthcare system to address social determinants of health: direct assistance to patients (i.e. vouchers for transportation and implementing telehealth options) and partnering with community organizations in alignment and advocacy to create policy. There was more emphasis on involving the community partners and participating in community-based settings as the key to success in these endeavors.

From a leadership standpoint, they must ensure that their interprofessional teams include experts in addressing social needs (i.e. social workers, community health workers, gerontologies), valuing what those areas of healthcare offered to the whole picture of health for the patient. All team members should be at least aware of the social determinants of health even if they are not directly treating that cause. Leaders should see the value in this type of focused care coordination for populations with complex co-morbidities.

When asked about major trends, Dr. Bibbins-Domingo spoke about a shift of reimbursement based on volume to value. This has forced healthcare systems to rethink their approach to these complex diseases and put the focus on the social factors of health. The other major trend is treating the adolescent population at high risk for disease by treating risk factors before the disease has a chance to take hold. As a researcher, Dr. Bibbins-Domingo also emphasized the importance of data in the efficacy of population health initiatives. She spoke about the need for diverse data in shaping healthcare strategies and providing new insights for population health. “Insights in biology comes from understanding the heterogeneity that exists in our population”, she said. These insights can then be used to create evidence-based policy by working with policymakers.

She finished the interview with a vision of more healthcare students who would be equally interested in research.

Keep building bridges!
photo credit Megan Kingsley Gale

This is important to hospital-based acupuncturists because…
Hospital-based acupuncturists can use this language when building relationships with other departments and specialties. Our medicine is grounded in the biopsychosocial approach to health and a significant portion of our patient population has complex co-morbidities. We can expand our roles out of the strictly “acupuncturist”, [we also teach self-care tools, such as] tai chi, qi gong, meditation, etc. To the teams we work with, I believe that we [have much to] offer.

Thank you to hospital-based practice colleague Steven Mui, MSOM, CAc for this resource review!

Related reading
More Blog posts related to Social Determinants of Health (SDOH) 

Did you find this information useful or interesting?
Subscribe to our email list for the latest updates and follow us on the public Facebook Page.

Saturday, November 16, 2019

Leadership and Workplace Mondays, The Autumn Summary

keywords:  leadership, workplace, workplace culture, being an employee, clinician burnout & clinician resilience, mindful leadership article reviews, EHR workplace article reviews

Inspiration for Employees and their Leaders 

Review of the "Leadership and Workplace Mondays" theme from the public HHP Facebook Page

Would you like a pdf copy of this article?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you. 

  • NAM publication on Clinician Burnout, Taking Action Against Clinician Burnout: A Systems Approach…
  • Positively engage your mind for the work ahead
  • Access your medical reference library and professional journals
  • Mindful leadership resources
  • EHR in the workplace

New publication from NAM on Clinician Burnout
The National Academy of Medicine has a new publication on clinician burnout, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. This is a consensus study report. The pdf download is free and available as of late October 2019. It will be available in paperback December 1st.
For more information and the pdf download, go to this NAM webpage.

Quotes from the NAM webpage:
"Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care."
"Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being and recommendations for the field."  -NAM webpage
National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press.

What is a NAM consensus study report?
Any "Consensus Study Report" from the National Academies of Sciences, Engineering, and Medicine is the documentation of the "evidence-based consensus on the study's statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee's deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task."

The National Academy of Medicine has a lot of resources on clinician burnout. In fact, their recorded sessions on the topic are a recommended Lunchtime ListenLearn more about these resources at this blogpost. 

“Do This in the Morning for a Better Workday”, an article on Mindful, reviews how to gear up your mindset to start your day off on a good path and keep positive momentum through your workday.
“Taking time to reattach to work helps our work goals to become more salient, which energizes us to focus. When we consider how to achieve our goals, we become more aware of our autonomy to accomplish them, as well as the resources and people we have supporting us. All of these factors contribute to feeling more inspired and engaged at work—which, other research suggests, is important for productivity.”
How to positively engage your mind and attitude for the day ahead:
1.       Why does the work I do matter to me? How does my work impact the lives of others?
2.       Who are the people—both at work and in my personal life—who support me and my professional success?
3.       What would I like to focus on today?

Do you know how to access your medical reference library?
Did you know, as a hospital employee who is a health care professional, that you have free access to peer-reviewed journals?

Learn more about this common hospital employee benefit in this blog article. It also includes tips on how to request a peer-reviewed journal your medical library does not have in stock. 📚

The 5 Abilities of Mindful Leaders” from the Mindful Leader blog.
  1. Build your personal mindfulness practice 
  2. Build Your Ability to be Mindful Toward Yourself Throughout the Day
  3. Build Your Ability to be Present with and for Others
  4. Build Your Ability to be Present with a Group
  5. Build Your Ability to Mindfully Shift your Focus and Attention

For more relate-able reading on Leadership and Mindfulness, I recommend the resource booklets from the Duke Integrative Health Leadership Program. The following are their two white papers/booklets about leading change in health care: 

The Mindful Leader “Best of SummitTalks”. Mindful Leader rotates their free access to talks. This is the landing page for what is currently accessible.

Electronic Health Record (EHR) design and the Workplace
EHR Design--there’s room for improvement.
“Many a clinician has cursed as they click through multiple screens to enter information. Workflows are getting better at being simpler and faster, but still they add hours to a clinician’s day, taking away valuable time spent interacting with and caring for patients. As the caretakers for people’s health, every interaction a clinician has with an EHR system should provide a clear benefit to their patients.“Patients are still entering the same information on multiple forms and repeatedly explaining symptoms. In some cases, information scrawled on paper patient questionnaires may not be inputted into their digital chart. Deeper interoperability could help patients avoid these frustrating, repetitive interactions and also lead to better, more coordinated care by including more historic information.“Having payer data, such as coverages and reimbursement rates, available at the point of care can give patients and providers more information to make informed decisions. This is especially helpful for patients to understand out-of-pocket costs on treatments outside of their plan coverage.“However, one factor that currently erodes trust is that different functions—administrators, nurses, doctors and payers—may not see the same data set. They each have different views that restrict them from seeing the whole picture, which is an issue especially for value-based partnerships dependent upon more risk sharing.” [emphasis/underline added]
Read more in this article on Health Data Management, "How to Get the Data Right to Advance Collaboration and Build Trust"

Epic’s initiative, Cosmos, and the new frontier of data mining EHR for clinical research.

Want to see more resources related to the workplace for hospital-based integrative health practitioners?

If you enjoyed this, check out our public Facebook Page and subscribe to our email list. 

For more recommended reading (books and audiobooks) on leadership, see our Reflecting on Leadership post.

More posts on Leadership

If this was useful, please support this community work.  
You can buy me a coffee, sponsor a newsletter, or sponsor a project via the website.

Self-Care Saturdays: The Autumn Roundup

keywords: self-care, practitioner resilience, wellness, mindfulness practices

The Autumn 2019 Self-Care Roundup

Some inspiration from the Self-Care Saturdays theme over at our public Facebook Page

"Training your brain to learn resilience", an article by Linda Graham in Mindful.
“Resilience—the capacity to bend with the wind, go with the flow, bounce back from adversity—has been pondered, studied, and taught in tribes and societies, in philosophical and spiritual traditions, and through literature for eons. It is essential to the survival and thriving of human beings and human societies.“We now also know that resilience is one behavioral outcome of a mature, well-functioning prefrontal cortex in the brain. Importantly, whether we’re facing a series of small annoyances or an utter disaster, resilience is teachable, learnable, and recoverable. It takes practice, and it takes awareness, but that power always lies within us."

For more on the self-care themes of movement, reflective reading, spending time outdoors, breathwork, nutrition, recreation time, and connecting to your community, see this HH Project blog article. 

A mindful meditation for dealing with the side effects of cancer and cancer treatment.

Community Health & Public Health
As an integrative health professional, East Asian medicine specialty, I know public health and community health are intrinsic to our paradigm of patient care.

  • The Blue Zones community certification is taking the basic tenets of what makes a healthy environment and community more accessible. Learn about how they are implementing this work in "Good Health is a Community Effort".
  • “Huge Study Confirms Purpose and Meaning Add Years to Life” from BlueZones
  • Blue Zones published books are available at your local library or on Amazon. If you follow the link on this post to Amazon and buy with a few hours, a few pennies of your purchase go toward the HH Project.
  • And, you can support your local library by checking out a physical item at your local branch. Or use your library card to access Overdrive and the Libby app for e-books and audiobook versions on your phone or other portable e-device.
  • More about Blue Zones in our “Practicing Philanthropy: Positives for You and Your Community”

Blue Zones Books

If you are interested in community health and nutrition, you may be interested in Teaching Kitchens. or Nutrition Learning with Your Family.

Review on "What is Self-care?"

Taking time for self-care in your day and week, from a few minutes here to 30 minutes to several hours at a time, are drops of water into your resilience bucket.  A full resilience bucket makes it easier to weather the storms of life and work.  A half-full or empty bucket provides little defense or support when the storms hit and make it easy to get swept away or feel like you are drowning.  Fill your bucket, minutes or seconds at a time. Make regular drops or cups of self-care into your bucket part of your daily and weekly routine (habits) to keep it closer to full.  Consider the following categories of self-care when you are filling your bucket:

  • Movement:  any movement from walking, hiking, dancing, tai chi, bicycling, swimming, or other forms of active movement and exercise
  • Mindset/inspiration and reflective reading:  any activity that encourages you to slow down and self-reflect.  Forms this may take include journaling, qi gong/nei gong (inner-work qi gong), several types of mindfulness practice, reading poetry, some forms of prayer.  
  • Spending time outdoors in nature:  going outside into fresh air and "green space" whether it is your backyard lawn, working in the garden, the local town park, pond, or creek, time at the beach, the botanic garden/arboretum/conservatory, doing chores at your friend's farm, or a trip to a state park or national park/federal lands.
  • Breathwork:  practice basic diaphragmatic breathing.  It can be a simple breathing exercise, like the one below. Or maybe your breathwork self-care practice takes the form of any of the following:  yoga, mindfulness meditation, qi gong, or tai chi
  • Nutrition/Food as fuel:  everything in moderation.  talk with your health care provider before making any major changes to your food intake (diet), especially if you have a chronic health care condition.
  • Time "having fun", socializing, connecting to your community.

    Breathwork exercise, "belly breathing"
      • Breathwork is the conscious control of your breath.  "Belly breathing" is practicing diaphragmatic breathing.  This type of breathing induces the "rest and digest" phases of our nervous system, the parasympathetic response.  This is an important practice because, in our modern world, we are often going about our day rushing, in a full or partial sympathetic (fight or flight) state.
      • Practice (self-care):
        • Take a few moments to check in our breathing.  One hand over your heart, one over your belly.  Practice belly breathing (where your belly hand moves more with each breath than your heart hand does). 
        • Breathe in for a count of 5 and out for a count of 7.  Repeat 20 times.
      • If you want, you can watch one of these videos while you practice:

    May you have some peace in your day.  Remember you can come back to this breath-centering practice at any time.

    Related blog posts
    More self-care resources at 

    If you enjoyed this post, check out our public Facebook Page and subscribe to our email list.