Inspired by a friend struggling to get their child in crisis access to services, Allina Health President and CEO Penny Wheeler, M.D., recognized there often is a gap between the care medical professionals aspire to provide and what actually is delivered. With her support an internally-focused, anti-stigma initiative was designed to shift the mindset of the Minnesota health system’s 27,000 employees, helping them become more aware of the stigma they carry and the stigma their patients face on a daily basis.
“She candidly asked, ‘What do we need to do to close the gap? And what can we do to make care better?’” recalled Paul Goering, M.D., Allina Health’s vice president of clinical care, mental health services.
Wheeler asked employees via an email in which areas Allina Health could improve the most and how they could do it. It went viral. Word spread quickly in the Minnesota health community that Allina Health was asking the tough questions, looking within itself to do better and inviting participants to respond.
“It was really amazing to see how quickly that spread and [how] impactful it was,” Goering said. “We saw pick-ups in our mental health recruiting efforts as people thought, ‘I want to work for a company that asks questions that mean something.’”
In Wheeler’s note to employees, she gave out her own email asking for feedback and received more than 200 responses. The most notable, Goering recalled, is one that said, “If we want to improve patient and employee health, we need to start by addressing stigma.”
To discuss solutions, Goering said they invited employees from different parts of the organization, as well as patients and other community partners, to a meeting.
“We thought it was going to be about 12 people,” he said. “We had a room that was maybe big enough for 15, and about 50 showed up. It was moving, to say the least, to hear every person say not only ‘yes,’ but ‘hell yes, we should do this.’”
After meetings and discussions, Goering said it became clear that they wanted a stigma elimination effort that would be different than others taking place in the surrounding community. They would have to tailor the new program to the unique needs of their organization, employees and patients.
Before Allina Health formally launched its “Be the Change” initiative, it sent out an employee survey to gauge attitudes and perceptions of mental health stigma internally. Initially, it saw 2,300 respondents offer insight. Survey questions included:
- I know where to find resources if I had a mental health or addiction condition;
- At work, I feel prepared to interact with people who have/had a mental health or addiction condition; and
- Employees at Allina Health are generally caring and compassionate toward people with mental health and/or addiction conditions.
In a survey one year later, Allina Health saw a statistically significant improvement in all questions.
At the same time these conversations were happening, the National Alliance on Mental Illness launched its “Make It Okay” initiative to stop the stigma around mental illness. Allina Health took this imperative to heart and turned inward first, said Joe Clubb, Allina Health’s vice president of operations, mental health services.
In order to build a sustainable program they could be proud of, Clubb said, they had to ask how it was important to patients’ experience and how it was important to the organization. But they also needed to give employees a platform to discuss it.
“Prior to this and to Dr. Wheeler’s entrance into leadership, I’d say mental health was pretty invisible within the organization,” he said. “So giving us permission to speak was extremely important.”
Furthermore, he said it was clear that this effort had to be employee-led, and they landed on a “champion” model. They reached out to the people who responded to Wheeler’s initial survey inviting them to be champions. Clubb said they were hoping to get 200 people; instead, 500 came forward asking to help change the culture.
Champions receive training, give presentations, and engage employees one-on-one. Allina also developed a toolkit to arm champions with the resources they need to advance their work.
“We initially focused on language, which is often created out of our thoughts and how we are all trained to think about individuals with mental illness and addiction,” Clubb said.
As part of the curriculum, champions also engage in adult-learning activities and discussion. After some time, champions now offer their own ideas for new activities and contribute to the model’s success.
Aimee Pappenfus, manager of community partnership at Allina Health, said the effort touches all employees throughout the organization because they all have the potential to bring stigma into an interaction with patients.
“This was across all efforts in the organization to provide better care overall,” she said.
Pappenfus, who plays an essential role in maintaining the program, said she continues to send biweekly correspondence to champions asking them to track their presentations and provide updates.
“We’ve been very intentional about developing new materials, getting new patient stories and asking how we continue to engage our champions and the broader organization,” Pappenfus said.
The Allina Health leaders emphasized that this program model is replicable with the right mindset, willingness to examine closely your internal culture, leadership buy-in and motivated employees.
“People gave discretionary energy in ways they don’t [normally],” Goering said. “And I’m sure your organization is like ours, in that, when you ask for people to volunteer, the same 100 people raise their hands. This group was not that same group. They brought energy that had not previously been accessed.”
The AHA offers a full suite of resources to support your efforts to address patients’ behavioral health needs and combat stigma. Visit AHA.org/BehavioralHealth for toolkits, webinars, videos and other resources.