See the opportunities and challenges organizations face in addressing the patient experience.
Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a
spark for further ideas on how we work to improve the patient experience.
Have a case study to share? Download Case Study Template.
Interested in receiving PX Weekly? Subscribe here.
Music in the Key of Hope: Music for Staff Wellness in a Metro-New York Pediatric Medical Center during COVID-19
At the epicenter of the COVID global pandemic, New York hospital staff have been experiencing a heightened level of stress, anxiety, and compassion fatigue.
Leveraging music interventions at Cohen’s Children’s Medical Center has been a strategic intervention geared to promote relaxation, resilience, and feelings of hope for patients, families, and staff members alike.
Music Therapists are critical to COVID recovery planning and work streams because they are adequately trained to address the unique needs of healthcare workers and use interventions such as environmental music therapy and community engagement to promote a more efficient and therapeutic work environment.
Experience Framework Alignment
What was the opportunity, issue or challenge you were trying to address and in what setting?
New York State quickly became a COVID-19 epicenter with unprecedented volume, acuity and mortality. Initially, CCMC had not seen an overabundance of pediatric cases for COVID-19. Our children's hospital, which was once blooming with various pediatric cases, soon became the adult overflow and surge units for our nearby adult hospital. Our nurses and critical care physicians became redeployed to work in the many overturned ICUs throughout the adult hospital and throughout our children's hospital. Some pediatric healthcare workers even volunteered to serve at other adult facilities in our health system.
It was quickly understood that this pandemic was taking on a storm of its own, growing larger by the moment and taking much of humanity away from us all. Shortly after the spike in adult cases, we found our medical/surgical and intensive care units crowded with positive COVID-19 pediatric cases. These cases seemed to involve a sense of mystery, as new symptoms were presenting in pediatric COVID cases.
The environment was one that contained limited familial/social supports to patients (only one visitor throughout the entire hospitalization allowed with little to no time allowed outside the room, other than discharge), and support from most psychosocial staff was limited to virtual means. The physical environment of the PICU and the medical/surgical unit, once fluttered with bright colors and decorated scrubs, slowly moved towards a blend of blue scrubs worn by every healthcare professional and masks, goggles, face shields, and scrub caps covering almost all of professionals’ faces. While these PPE precautions ultimately helped preserve and protect healthcare professionals, they left little humanism to the professional behind the mask.
Not only were healthcare workers seeing this trauma as they worked with adults (which brings its own set of insecurities and unfamiliarity), they were seeing it now in their home units in pediatrics. We found that as resilient as our healthcare team members were, there was still a lack of hope and positivity in what was once our very colorful and bright children's hospital environment. The collective trauma that healthcare workers were facing and living showcased a need for reinforcement through authentic and empathetic practice. We needed to find a way to help our healthcare workers cope with the ongoing pandemic. Our goal was to use music as a means to build community, strength, engagement, and resilience in healthcare workers.
What process did you use to develop a solution?
Our team of two full-time licensed and board-certified music therapists realized that there was a decrease of hope and warmth within the environment of the children's hospital, which was a stark difference of the typically colorful and bright energy pediatric healthcare workers typically exude.
The music therapists then explored the various strategies where music can be used within an environmental context to promote overall wellness in healthcare workers, which could then ripple down to patients and families.
These ideas were brought to fruition during mentor meetings, monthly creative arts therapies meetings, and in partnership and collaboration with the Child Life & Creative Arts Therapies team, site leadership, and interdisciplinary teams. This team shifted their schedules to work clinically within the hospital part-time and working remotely part-time.
What outcomes were you looking to achieve?
Enhance community and support for all healthcare workers. As there are many different roles within the healthcare environment, we were hoping that community engagement could instill a sense of togetherness. In addition, we hoped it would showcase that we are all working as part of a team, promoting the well-being of our patients and families and also one another as coworkers.
What specific steps did you take to address the problem?
Initially, our music therapists discussed the various needs that were addressed during daily rounding on various units. Nurses, doctors, and other healthcare workers often commented on the stressors of the environment, the feelings of hopelessness, and the overall chaotic nature of what the pediatric units have turned into. The use of PPE, which at first did not allow pediatric patients to see healthcare workers’ faces, was daunting on many professionals, as they felt a lack of connection and inability to build rapport with their patients.
Secondly, to address this immediate need of stress within the environment, the music therapists provided environmental music therapy on various units. This intervention and process includes the music therapist tailoring music to fit the needs of the environment, live and in the moment. It is important to stress that the music is live and re-created/improvised by the music therapist, as they are specifically trained to tailor the musical experiences in a productive and sensitive manner. It was interesting to note that each unit had a specific ‘flavor’ depending on the day and the unit census. For example, one of the medical/surgical units requested uplifting and inspirational songs that they could dance and sing along to, whereas the pediatric intensive care unit (PICU) did not request any particular music but wanted music that allowed them to take a moment to breathe. It is incredibly important to realize the nuances and sensitivities of meeting the culture and pace of each unit moment to moment.
Next, the music therapists created a “Positivity Parade,” which allowed all healthcare workers to gather in our atrium once a week at a scheduled and routine time. During this time, all healthcare professionals gathered to sing together, being mindful of social distancing and proper use of PPE. The music therapists would lead the group in song using guitar or piano, keeping true to the ideal of using live music to enhance community and a feeling of accomplishment. Each week, a different song with a theme of resilience, hope, and/or community was used to promote the aforementioned themes within the environment. Occasionally, the music therapists would reframe the lyrics or repeat phrases/choruses that seemed to resonate amongst coworkers. This was an opportunity for any healthcare professional, no matter their title, to gather and be together as one—promoting the efforts of "we're all in this together.”
What resources, if any, did you engage - either internally or externally - to address the problem?
The music therapists partnered with their Child Life colleagues and the hospital's administrative Project Manager to promote the Positivity Parades. This collaborative effort allowed all hospital staff to engage in the music-making as well as having it promoted to all hospital areas, units, and departments. Zoom conferencing was used to promote the Positivity Parades to healthcare workers who were off-site that particular day, while a large monitor allowed all of those members joining in through Zoom to see the parade in real-time.
Within clinical practice, the music therapists primarily partnered with nurses to promote and enhance environmental music therapy practices on units.
What measures did you establish to determine the success of this effort?
While there have not been any formal metrics set to determine the success of this effort, true measurement can be found in the comments from various staff members and others. Each week when the Positivity Parade has finished, a video of the experience is uploaded to the health system’s internal Facebook page. From there, we are able to see the many positive and enlightening comments that are left. Among them are:
“There are so many beautiful scenes that are bringing tears to my eyes…I had to open another box of tissues! They sound like angels singing. Please, please, please keep posting. I love it!”
“Beautiful…Great job to all! Hope this time together lifted you up as much as you are lifting others up. Thank you for all you are doing.”
“Beautiful – music heals body, mind, and soul.”
In addition, healthcare workers who are present during the music-making are often fully engaged in the process. We have witnessed staff closing their eyes, using their full bodies to engage in the lyrics, and smiling throughout the time spent. At times, we have seen staff shedding tears and taking photos and videos of one another.
As mentioned earlier, the music therapists have noticed many valuable self-care practices taking place during environmental music therapy. The music therapists have witnessed deep breathing, moments of joy and clarity, and positive affirmations being shared. The nurses and other healthcare workers had moments to relax and recharge throughout their day, which could ultimately lead to a reduction of burnout and compassion fatigue.
What was the ultimate outcome of your effort?
Ultimately, we have found that the use of music is a transferable and emotionally-charged opportunity to provide comfort, create a sense of community, and promote resilience within the hospital environment. This information was collected by way of unprompted comments, smiles, tears, and the witnessing of deep breaths.
During environmental music therapy, nurses would often comment that it was beautiful to sing along and have an opportunity to feel free and relaxed throughout their shift. Comments would be discussed for days on end after the music therapist provided environmental music therapy, such as, “It was lovely to hear that song again,” or “I haven’t taken a moment to breathe; it felt so good to do that.”
From the eye of the music therapist, it was beautiful and emotional to witness the breaths, the moments that coworkers stopped to pause and listen, and the expressions of those that had previously appeared stressed and weary. The music allowed these healthcare professionals to be heard, validated, supported, and comforted all at the same time.
The Positivity Parades grew from only one team to many. It started with the Child Life & Creative Arts Therapy team. Soon after, Administration joined. Later, Environmental Services and Materials Management joined in. Eventually, almost every department in the hospital, from Nursing, to Pharmacy, to Concierge, to Respiratory Therapy gathered together in song to commemorate the work that they have accomplished and the overwhelming feeling of support within the environment. It has not been this writer's experience to have so many departments and units together for one common goal: support.
What lessons did you learn would that would share with others as they consider addressing a similar issue?
First and foremost, we learned that music therapy lends itself not only to patient care, but its boundaries can extend into staff wellness and community service. This is a time of heightened awareness of healthcare workers and their ability to formulate resilient practices for compassionate care. We have found that music therapy is a feasible and personal intervention with huge impacts to the wellness of healthcare workers.
We have learned that wellness is a team effort. Although these ideas were started by music therapists, these offerings quickly spread throughout the hospital and many other healthcare workers wanted to join in. It is helpful to understand the various strengths of employees’ talents and strengths so they can continue to use them as a means of resilient self-care.
Overall, it is important to note that these efforts were brought on by a traumatic event that seemed to affect most, if not all, healthcare employees. These efforts brought forth by the music therapists can serve healthcare workers and patients alike, not only in a time of need, but in a time of clarity and peace as well.
About Northwell Health:
Northwell Health is the largest integrative healthcare system in New York State, spread geographically in Westchester County, New York City boroughs and across Long Island. With 70,000+ employees, 23 hospitals and 750+ medical practice locations, our mission is to provide world class service and patient-centered care. Cohen Children's Medical Center (CCMC), Northwell’s hallmark pediatric specialty hospital, has been designed exclusively for children in the New York Metropolitan area, and comprises of just over 2,000 employees. CCMC is a 202-bed hospital with a Level 1 Pediatric Trauma Center, a Level IV NICU, and is the largest provider of children’s health services in the state. CCMC is rooted in its humanistic view of the pediatric patient, treating not only the biomedical needs of the patient but using the interdisciplinary team as a conduit to the treatment of the patient’s mind, body, and spirit. It has been ranked in 9 out of 10 specialties nationally by US News & World Report’s 2019-2020 Best Children’s Hospitals.
For more information contact:
Shawna Vernisie, MA, LCAT, MT-BC, Creative Arts Therapist, Cohen Children's Medical Center
Carly Caprioli, MS, LCAT, MT-BC, Creative Arts Therapist, Cohen Children’s Medical Center
New Hyde Park, NY, USA