Abstract
This paper is a look into the organizational structures that support mindfulness in the workplace. The healthcare system is notorious for burnout and low well-being amongst healthcare professionals so the need to find solutions is imminent. The research on Mindfulness Based Stress Reduction (MBSR) and adaptations of MBSR indicate that healthcare professionals who engage in a mindfulness program have improved stress levels, and lower burnout rates, however many of the existing programs and their structures are not sustainable. Using the success of Google’s mindfulness program, Search Inside Yourself, as a case study, this paper looks at how the organizational structure that the tech industry uses to support mindfulness could be applied within the healthcare setting. Specifically, this paper examines the structures within the Mayo Clinic that could theoretically support a mindfulness program such as Search Inside Yourself.
Keywords: Mindfulness, Organizational structure, SIY, Leadership,
Mindfulness in the workplace has become an increasingly popular employee offering to support the well-being of individuals and the organization itself. The benefits of mindfulness transcend industries ranging from social care, higher education, finance, media, government, healthcare, and tech (Chapman-Clarke, 2017). Mindfulness’ popularity has soared with the advances in neuroscience and the evidence that resilience and burnout decrease with the practice while well-being, cognitive flexibility, and creativity increase. (Schaufenbuel, 2014; Muller, Gerasimova, & Ritter, 2016). Antanaitis (2015) found in her research, “A surge of medical and psychiatric research supporting the benefits of secular mindfulness practices is fueling innovative ways to manage stress and improve production in the workplace. Companies such as General Mills, Google, and Aetna have effectively decreased their health care costs by integrating large-scale mindfulness-based programs into their workplace” (p.39). A quick internet search on “mindfulness in the workplace” reveals in popular magazines such as Forbes, Fast Company, and Business Insider, that tech companies across Silicon Valley are implementing workplace mindfulness, with Google being the archetypal organization. Google successfully developed and popularized mindfulness amongst their employees while becoming one of the most successful companies in the world. Google’s landmark mindfulness program, Search Inside Yourself (SIY), after growing esteem on Google’s campus, is now offered to any organization and is a strong example of how principles of management, cultural adaptation, and organizational values support a mindfulness program (Giang, 2015). Without an organizational structure that is congruent with the needs of the population, mindfulness programs lack stickiness or long-term engagement (Wasylkiw, Holton, Azar, & Cook, 2015). In other words, teaching or offering mindfulness meditation is not enough to garner success in an organization, there must be a thoughtful structure to support the practice.
While the peer reviewed literature for the SIY program is limited, it is clear by the testimonials, books, magazine articles, widespread adoption, and website (www.siyli.org), the mindfulness program is here to stay and continuing to reach individuals via their workplace organizations. As a Mind Body Medicine Ph.D. student, the author’s curiosity lies beyond the science of why mindfulness works, and into the organizational structure that supports it and how these structures can be translated into the healthcare system. Healthcare systems that are meant to heal the sick are plagued with low morale, burnout amongst nurses and physicians, resulting in decreased patient care and perpetuating un-wellness (Kemper, Mo & Khayat, 2015). The Mayo Clinic, a renowned scientific and medical institution, is a unique organization that has progressive and innovative structures that could potentially support mindfulness for their employees (Swensen, Gorringe, Caviness & Peters, 2016). The theoretical success of SIY in the Mayo clinic can be a model for how other healthcare systems sustain mindfulness, and more importantly improve employee wellness and patient care.
Structures That Support Mindfulness in Healthcare
The following section is an overview of various mindfulness programs adapted from Mindfulness Based Stress Reduction (MBSR) to provide stress relief, reduction of burnout, and improved well-being of healthcare workers. The programs examined in this literature review were chosen for their unique organizational structures.
Mindfulness Based Stress Reduction
Jon Kabat-Zinn and his colleagues are responsible for their landmark studies on an evidence based secular mindfulness program called Mindfulness Based Stress Reduction (MBSR). MBSR has been shown to help patients with self-regulation to improve both physical and psychological suffering (Kabat-Zinn, 1982). Since its inception, MBSR has expanded in popularity and is offered to individuals and organizations around the world. In the Standards of Practice Document found on the University of Massachusetts’s website, Kabat-Zinn (2014) opens with, “Mindfulness-Based Stress Reduction (MBSR) is a well-defined and systematic patient-centered educational approach which uses relatively intensive training in mindfulness meditation as the core of a program to teach people how to take better care of themselves and live healthier and more adaptive lives” (para 1). The structures and methods are clearly laid out:
a) Group Pre-program Orientation Sessions (2.5 hours) followed by a brief individual interview (5- 10 minutes)
b) Eight-weekly classes 2.5-3.5 hours in duration
c) An all-day silent retreat during the sixth week of the program (7.5 hrs)
d) “Formal” Mindfulness Meditation Methods: Body Scan Meditation - a supine meditation Gentle Hatha Yoga - practiced with mindful awareness of the body Sitting Meditation - mindfulness of breath, body, feelings, thoughts, emotions, and choiceless awareness Walking Meditation
e) “Informal” Mindfulness Meditation Practices (mindfulness in everyday life): Awareness of pleasant and unpleasant events Awareness of breathing Deliberate awareness of routine activities and events such as: eating, weather, driving walking, awareness of interpersonal communications
f) Daily home assignments including a minimum of 45 minutes per day of formal mindfulness practice and 5-15 minutes of informal practice, 6 days per week for the entire duration of the course
g) Individual and group dialogue and inquiry oriented around weekly home assignments including an exploration of hindrances to mindfulness and development and integration of mindfulness based self-regulatory skills and capacities
h) Incorporation of exit assessment instruments and participant self-evaluation in Class 8
• Total in-class contact: 30+ hours
• Total home assignments: minimum of 42-48 hours
•Total group Orientation Session time: 2.5 hours (para 4)
While the MBSR structure has proven to be highly successful, the demand on time and in person meetings is not congruent with the lives of busy professionals, leading to many adaptations designed for the workplace. This author chose a few examples of peer-reviewed structures in Table 1 designed for health care professionals based on the originality of their structure and lineage from MBSR. Google’s Search Inside Yourself program, designed for the tech industry is also included for comparison.
Table 1. Comparison of MBSR derived programs for the workplace
Organizational Structure, Leadership and Culture Matter
While MBSR, tMBSR, MIM, and Mindful Moment have positive outcomes on the participants in the study, long-term engagement is unknown. In a study of mindful awareness on leaders in health care settings (Wasylkiw, Holton, Azar & Cook, 2014), the authors were surprised that despite such positive results on leadership effectiveness during the mindfulness intervention, a sustained practice was found in only one of eight people (p.905). Wasylkiw et al., 2014) conclude that, “While leadership development is an espoused priority in many health care organizations, research suggests the ineffectiveness of leadership development initiatives are poorly implemented and that do not provide sufficient time for personal change” (p.908).
Perhaps each of these structures reviewed could find greater sustainability with the tips from workplace practitioner-generated evidence distilled into ten useful points (Chapman-Clarke, 2017, p.2):
1. Find the business reason to implement mindfulness
2. Determine the desired outcomes
3. Who will act as a “mindfulness champion” from within the organization?
4. Identify key stakeholders and their needs
5. What measures will be used?
6. Identify if you need to demonstrate return on investment
7. Keep language secular and deal with misperceptions head-on
8. Use research and evidence to support mindfulness in the workplace
9. Aim for progress not radical change
10. Embody the change and mindfulness you want to see in others
These tips suggest that for a mindfulness program to be successful, organizational considerations beyond the actual mechanisms of the mindfulness must be thought through. This paper will look at Google and Mayo Clinic as case studies for how the organization’s structure and leadership can determine the success of a mindfulness program.
Research Question
What do healthcare organizations need in their organizational structure to be successful in implementing a mindfulness program?
Case Study: Google
Google is an iconic Silicon Valley based tech company and arguably one of the most valuable companies in the world, valued at over $200 billion dollars. Google is popularly known for their internet search engine and other wide-reaching tech innovations. They have a sprawling campus with state-of-the-art facilities and elaborate employee benefits that contribute to Google being one of the best places to work year after year according to Forbes and Fortune Magazine.
Google is a mission driven company with the focus to always innovate and “do no evil”. This mission expands beyond the product they produce and is embedded in their culture, leadership, and organizational structures. They employ a bottom up leadership model with a thin management layer that allows for individual innovation, group accountability, trust in employee driven projects (Google Grows on People, 2013). Googlers spend 20% of their day working on their own projects which allows for people to operate from inspiration (Boyce, 2010).
In 2006, an engineer named Chade Meng-Tan developed a mindfulness program that became known as Search Inside Yourself (SIY). It did not gain popularity amongst Googlers (a population of data scientists, engineers, and other data driven minds) until he demonstrated the neuroscience and research that mindful awareness has on the improvement of emotional intelligence because this population knows that EI is good for one’s career (Baer, 2014). SIY was founded as a data driven program to meet the employee cognitive culture. He quickly became known as the “Jolly Good Fellow, Which Nobody Can Deny” and Search Inside Yourself gained so much respect, the Dalai Lama endorsed it. An article published in an academic journal about the tech giant stated, “In 2010, only 12 years after it started, Google was generating almost $30 billion in annual revenue. By 2011, it was the world's most valuable brand. This success was based on a stream of new and innovative products ‐ some acquired, but many developed in‐house” (Google grows on people, 2013, p.16). In 2012 the SIY course expanded its offering to any organization and reached 20,000 people.
Google continues to be a flat leadership model that lends to a culture of nurturing new ideas and innovation on the individual and organizational level. Their culture is protected by how they hire and continue to attract talent with revolutionary employee wellness and benefit offerings. Within this environment, SIY has taken roots and is a popular course that has a history of a wait list (Baer, 2014).
Structures of SIY
The SIY website does not have a clear articulation for the structure of the program, likely because it is adapted to fit the culture of each organization that uses the model. There also are no peer-reviewed articles of the program which may be a limitation in being able to assess the clinical benefits of SIY. A Business Insider’s article on SIY states that, “it can be taken as either a two-and-a-half-day intensive course or in 19 hours over seven weekly sessions” (Baer, 2014. para 4) and there are two facilitators, one that provides scientific research and the other that gives practical instructions. According to an earlier article in Mindful:
SIY includes an introductory class, a full day of mindfulness practice, and six two-hour sessions, each a week apart. Class sizes range from twenty to fifty, depending on the time of year and whether an entire team or department has signed on for the course. The course begins with the “Neuroscience of Emotional Intelligence,” which shows participants that there is a growing body of scientific literature on the effects of training attention and emotion. In addition to basic mindfulness, the course includes instruction in journaling as a means of nonjudgmentally noticing mental content, mindful listening, walking meditation, mindful emailing, and a variety of other contemplative techniques. The latter stages of the course emphasize empathy using loving-kindness meditation, and social skills, including how to carry on difficult conversations. The word “Buddhism” is not used (Boyce, 2010. para 20).
It is clear from the countless interviews with Meng-Tan that can be found on the internet, that SIY is not intended to bring in any sort of religiosity or Buddhist thought, and strictly intended to help people find happiness through emotional intelligence (Baer, 2014).
Discussion: SIY Applied to Mayo Clinic
Swensen, Gorringe, Caviness & Peters (2016) case study on leadership in the Mayo Clinic offers detailed and valuable insight that informs much of the section of this paper. The Mayo clinic is a progressive and innovative place that has some of the lowest nurse and physician attrition rates in the healthcare system. They are a mission driven organization with the goal of providing the best patient care. Forbes has rated the Mayo as one of the top places to work in the country which can be attributed to an organizational structure that allows for a culture of collaboration, adaptation to change, high performance, and top patient care. Unlike other healthcare systems, the Mayo has thoughtfully and intricately designed a leadership model and culture that has a thin management layer and possesses many parallels to Google’s culture. The following paragraphs highlight the aspects of the Mayo that parallel Google, which could imply that mindfulness offered via the SIY structure could thrive in this particular healthcare setting.
Physician leadership
The mission of “the patient comes first” is the driver for how the Mayo Clinic developed leaders with robust skills and best practices. The value of Physician Leadership enables doctors to lead committees, coach other employees, collaborate across practices, share knowledge, and innovate in addition to the usual patient care. Just as Google designates time for employees to work on their own projects, the Mayo designates 10-40% of a physician leader’s time to leadership responsibilities. With a blend of Transformational and Servant Leadership (Lacroix & Verdorfer, 2017), physicians and administrators are constantly in alternating roles of learning and guiding each other. In other words, rather than concerning themselves as authority figures, they function in a way where they learn from everyone on the team regardless of their title or position. Just as Google hires individuals who can perpetuate their culture of Googlyiness and bottom up leadership (Google Grows on People, 2013), the Mayo clinic intentionally hires those that will perpetuate a culture of collectivism. With a shared structure of being a flat organization that promotes the individual as an innovator to enable the whole system to be innovative, it is likely that the Mayo’s leadership structure could support SIY.
Value of Emotional Intelligence
The Mayo Clinic places a strong value on Emotional Intelligence (EI) as part of an indicator of top performance. Gorringe et al., (2016) in their research found that regular performance feedback is given to leaders which is collected from patients and team members specifically assessing social and emotional intelligence of the physician leader. Additionally, “Each new potential permanent staff is assessed with an emotional intelligence tool at the end of the first year” (p.558). The value on EI is congruent with Google’s intentional use of SIY to develop EI in their own employees. Considering the Mayo Clinic is emphasizing the value of EI in their organization through multiple assessments, there is reason to believe that the Mayo would prioritize and easily adopt a tool that supports the enhancement of EI in their leaders.
Value of adapting to change
Gorringe et al., (2016) discuss the value of adapting to change at the Mayo with the design of their internal coaching program. Coaching is used as a leadership tool to help development, exchange of knowledge, increase transparency in decision making and ultimately execute rapid change in day-to-day operations. The Mayo invests in over 100 trained physician leader coaches that can serve as enablers and supporters for change amongst the employee population. Ultimately agile teams are stronger, more successful, and have better results (p.561). This “leader as coach” model and value placed on adaptation to change parallels Google’s leadership model where leaders are facilitators and coaches to support a culture of change. Google is a thriving company because of their ability to innovate and this is a regular phenomena because of their “ambidextrous organizations” and agility (Google Grows on People, 2013). In both organizations, the dual role of being a leader and coach perpetuates a value of change. This may be one of the organizational components that enables a mindfulness program to take root amongst the population.
Conclusion
This paper looked at best practices of how to implement mindfulness in the workplace, the organizational structures of Google and SIY, and the unique organizational structure of the Mayo Clinic as a healthcare structure that could theoretically support a mindfulness program. While there are limitations in understanding the true impact that SIY is having on an employee population, the widespread demand and engagement with the program indicates that people are finding success in this particular mindfulness structure. In examining some of the literature of the mindfulness structures in various healthcare settings, there is a clear need to find a way to increase employee engagement with the programs otherwise there is continued risk of burnout and attrition. It is not enough to have an evidence-based mindfulness program for employees; there must be structures within the program and within the organization that support a consistent practice. The parallels in leadership, values and culture that the Mayo Clinic has with Google suggest this is a healthcare setting that can support a mindfulness program such as SIY and other healthcare organizations can model. Returning to the research question, “What do healthcare organizations need in their organizational structure to be successful in implementing a mindfulness program?”, the healthcare industry needs to improve the environment of the workplace for their employees and ultimately the patients. Organizations need to be mission driven with some form of leadership that allows for collaboration and relative flatness (rather than hierarchical), a measure of emotional intelligence, and a value placed on organizational flexibility as well as personal agility.
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