Background & Introduction
Workplace wellness is an important focus for businesses but it is even more important in healthcare work environments where staff model health behavior. What activity can be offered to employees within the workplace at a low cost and provide participants with the opportunity to fully engage body-mind-spirit components of a workplace wellness program?This holistic activity has been around for thousands of years, and it's called yoga.
At Mayo Clinic in Rochester, Minnesota, the Departments of Radiology and Surgery sponsored a "yoga at work" activity. These departments have collaborated to develop an innovative RadSurg LiveWell program focused on providing a variety of health promotion activities for employees. The program derives part of its title from an institutional program. LiveWell is the name of Mayo Clinic's health promotion program aimed at helping employees find the right programs, tools and support to make or continue with healthy lifestyle choices.
An important component of the LiveWell health promotion program at Mayo Clinic in Rochester is its employee health facility, The Dan Abraham Healthy Living Center (DAHLC), through which members have access to a wide range of activities, training, and programs, including yoga classes. The RadSurg LiveWell wellness program extends the outreach of DAHLC by bringing activities into the workplace and offering additional options for employees who may be intimidated by a health club setting or are unable to fit it into their schedule (Jasperson 2010).
An overarching goal in planning a yoga workplace activity was to meet participants where they were on their own personal journey of health, wellness and self acceptance. Hence, the yoga activity was entitled Self Acceptance Through Yoga: A 40-day commitment to nurturing acceptance and inner peace (SATYA).
Engaging the Mind, Body and Spirit
A previously conducted yoga-based study at Mayo Clinic in 2009 provided the impetus for the RadSurg LiveWell program's eventual collaboration on a yoga activity. In this study, 58 generally healthy individuals ranging in age from 24 to 76 years participated in a six-week yoga study, in which pre- and post-study measures were taken. These were self-selected employees, with existing membership to the DAHLC, who were invited to participate in the study.
During this six-week study, participants practiced yoga daily, documented food intake, responded to personal reflection questions, and maintained a meditation practice. Comparison of baseline and final measurements revealed notable improvements in physical attributes (weight, flexibility, etc). Quality of Life measurements showed statistically significant improvement overall which included physical, mental, emotional, and spiritual markers. This pilot study suggests that a yoga-based wellness program is both feasible and efficacious. (Thomley et al 2011).
The RadSurg SATYA Activity
The SATYA planning team wanted to design an activity involving both the physical and non-physical aspects of yoga. Although the eight limbs of yoga (social behavior, inner discipline, postures, breath control, inward attention of the senses, concentration, meditation, and absolute bliss) are not tied to any one religion or culture, considerations of autonomy, religious sensitivity, perceived social propriety and unwritten company rules can make traditional Western companies wary of integrating anything other than the physical postures of yoga into their workplace culture.
It was decided that the limbs of social behavior (Yamas), inner discipline (Niyamas), postures (Asana), and breath control (Pranayama) would be both palatable and transferable to a business setting in a small, self-selected group of activity participants. A six-week activity was developed for a self-selected group of employees in the RadSurg LiveWell program with the hope that it would be sufficient time to develop a habit in some participants.
Prior to the start of the activity, registrants were encouraged to attend an orientation where introductions were made, journals were handed out, and frequently asked questions about yoga were proactively addressed. Individuals were asked to set intentions (similar to, but more forgiving than goals) for their time in the program, a daily home yoga practice was encouraged, and the components of the activity were explained.
When an employee enrolled in the activity, they were sent a confirmation email that contained a link to an electronic survey (Harris et al 2009). The survey collected general demographic information, as well as prior yoga experience. It also asked respondents to assess their current state of mental, physical, emotional and spiritual well-being, as well as overall quality of life and level of social activity. Participants were asked to rate these aspects again after completing the SATYA activity (Figure 1).
Each week, a new Yama/Niyama was articulated through e-mail and emphasized in the sessions via formal readings and informal education during class. The journal, with room for daily entries throughout the program, was designed with quotes and probing questions highlighting the week's focus (Figure 2). While nutrition and diet were not intended to be a primary focus of the program, it is common that people associate themselves with their body shape and eating habits.
For this reason, a portion of each day's journaling space was also dedicated to recording items that participants were proud to claim they ate, and ones that they were less proud of, but still willing to claim. The rationale behind this approach to nutrition self- assessment was to minimize self-judgment and instead encourage participants to simply observe. Through observation and mindfulness, people may begin to make healthier choices.
Classes were designed to minimize perspiration and enable a smooth transition between the program and the work day. Each class began with a brief reading or discussion of the week's Yama/Niyama, followed by a calming component that encouraged participants to focus on their breath and the present moment. Gentle stretches to increase flexibility were followed by a series of standing poses to increase strength and balance -the challenge of all these postures increased gradually over the six-week program.
Each session ended with twists, stretches, and a final resting/meditative period. Instructors were focused through their teaching and verbiage to support emotional and physical safety for all attendees. This process progressed throughout the six-week duration of the activity.
Collaboration
A key factor in the success of this program was the multi-departmental collaboration in its design and conduct. By bringing together varying types of experience and expertise, the planning team was able to design a robust program that supplemented other workplace offerings. The RadSurg LiveWell program receives input and guidance for program ideas from a group of Wellness Champions.
These Champions are employees from the work units of both departments who help to "champion" program activities and events and meet monthly as a group. Several Champions have experience with yoga and agreed that a robust yoga program in the workplace would be innovative. A series of meetings were initiated to explore the possibility of a yoga activity. Meetings included two participants from the 2009 yoga study, one of the 2009 Yoga study co-leaders, and two RadSurg LiveWell leaders.
The three yoga instructors had recently completed yoga teacher training and were excited to have a venue to develop their newly acquired skills and share their knowledge. Challenges & Barriers Several challenges were addressed prior to bringing this yoga activity to busy Radiology and Surgical practices:
- Selecting the length, frequency and time of day at which sessions were offered
- Identifying and securing acceptable space and locations for sessions
- Accommodating instructors' schedules and availability
- Managing preconceptions about yoga by potential participants
- Designing promotions that appeal to both men and women as well as varied body shapes and sizes
- Developing a program that would be appropriate for varying levels of yoga experience, including novices
Employees in the Surgery and Radiology departments work varied schedules so any activity would ideally have multiple times available for staff to attend. After meeting with RadSurg LiveWell Champions, it was decided to schedule an early morning session in one location (the main clinic location) and a later morning session at a different campus location (Saint Marys Hospital). Space used for the sessions needed to accommodate several yoga mats on open floor space.
Conference rooms with movable tables and stackable chairs were selected for ease of configuration and set up. Locations were the same for a majority of the sessions, but some had to be adjusted due to prior schedules for these rooms. Reminders about room changes were clearly communicated to all participants by e-mail. Along with the needs of the potential participants, the schedules of the instructors were considered when determining the frequency and timing of sessions.
The best schedule identified was three days per week, with morning and lunchtime sessions. Each session lasted 40 to-45 minutes. The three instructors worked out a schedule to accommodate all sessions and allow for backup for each other. The promotional posters emphasized that this program was "come as you are" with no special clothing or experience required. They also made an appeal to both men and women and focused on the stress management benefits of yoga (Figure 3).
RadSurg LiveWell Champions were utilized to help spread the word about the program throughout the departments. The simple enrollment form was linked on the RadSurg LiveWell website.
Results/Outcomes
The SATYA workplace activity achieved sustained participation over the entire six weeks from 24 of the 31 participants who completed the pre program survey, for a retention rate of just under 80 percent. As noted earlier, participants completed a questionnaire regarding aspects of quality of life and physical, emotional, social and spiritual well-being prior to the start of the workplace activity and after completion. The median rating on the multiple pre and post participation self-assessments showed positive increase for each of the measures.
Several participants shared personal stories with the yoga instructors. One participant, who sings at weddings, consciously used breathing techniques learned in the program to calm herself before her vocal performance. A grandmother who had been unable to get down on the floor and play with her young grandchildren gained the physical flexibility to do so after participating in the yoga sessions.
One woman found the program a "lifesaver" in handling her emotional and physical distress as she dealt with a terminally ill family member. Others remarked on the noticeable reduction in neck and shoulder tension created by their daily desk and computer work.
Anecdotally, participation in this workplace program provided benefits that extended far beyond the workplace and included elements of mind, body, and spirit. Comments below express a sample from three participants regarding what area of their life improved the most with this activity.
- "My physical self. I am motivated to continue regular exercise and continue with the things I have learned."
- "This program helped my emotional well being the most."
- "I have had an increase in my spiritual well being"
Several of the participants sought out experiences to continue their yoga practice after SATYA finished. A few, who were members of the DAHLC at Mayo Clinic, joined scheduled classes offered there. Others found yoga programs within the local area or purchased DVDs for use in their homes.
Conclusions and Recommendations
The SATYA yoga at work activity successfully engaged body, mind and spirit components of a workplace wellness activity and appears to have led to some sustainable life changes for several participants. In addition, this activity is an example of how collaboration among key individuals and departments can lead to an effective health promotion in the workplace. Based on the survey results and comments from participants, this yoga event had positive results for many.
Several people commented about wanting to continue with this activity beyond the pilot time. The SATYA results suggest that there are benefits to offering a yoga activity in the workplace to promote health and manage stress. Based on this experience, the RadSurg program will offer this activity on a yearly basis with discussion on what tips for yoga could be incorporated into everyday activities. Preliminary data suggests the potential for formal research protocols incorporating yoga into the workplace. Namaste.
Works Cited
Jasperson, David B. RadSurg Wellness Program: Improving the Work Environment and the Workforce Team. Radiology Management. January/February 2010: 48-53.
Thomley, Barbara S., et al. Effects of a Brief, Comprehensive, Yoga-Based Program on Quality of Life and Biometric Measures in an Employee Population: A Pilot Study. Explore. 7.1 (2011) : 27-29.
Harris, Paul A., et al. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 42 (2009) : 377-81.
Author Biographies
David B. Jasperson, MA is a Quality Improvement/Education Specialist for the Department of Radiology at the Mayo Clinic in Rochester, MN, and also serves as the Program Coordinator for RadSurg LiveWell. He can be contacted at jasperson.david@mayo.edu.
Lisa M. Schrader, MT, MBA is a yoga instructor trained at the 200-hour level in Rochester, MN, and an Operations Coordinator in the Mayo Clinic Center for Translational Science Activities. She can be contacted at schrader.lisa@mayo.edu.
Barb Thomley is a Coordinator for the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, MN and is a yoga instructor in the Rochester community. She can be contacted at thomley.barbara@mayo.edu.
Kathleen Sundt, RN, PMA-CPT, RYT-200, owns Gentle Pilates and Yoga in Boston, MA and teaches clients privately. She can be contacted at kathleensundt@gmail.com or gentlepilatesandyoga.com.
Susanne M. Cutshall, MS, RN, CNS is an Integrative Health Specialist for the Department of Surgery at the Mayo Clinic in Rochester, MN and is a wellness champion for the RadSurg LiveWell Program. She can be contacted at cutshall.susanne@mayo.edu.
