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A proactive, team-based, psychological solution to burnout

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Mental Health

Clarissa Chan, PharmD

Princess Margaret Cancer Centre, a tertiary teaching hospital in Toronto, Canada, might have a thing or two to share about preventing mental health distress and burnout. Members of the hospital’s psychosocial oncology division developed and implemented CREATE—Compassion, REsilience And TEam-building—to help support the mental health of health care staff during the COVID-19 pandemic. 

“We wanted to develop an intervention to support health care workers, which could be implemented across our institution, rapidly deployed, and integrated into workflow, while recognizing [health care workers’] time pressures,” said Mary Elliott, MD, a psychiatrist at the teaching hospital.

CREATE is a proactive, team-based intervention delivered at the point of care. It incorporates elements of psychological first aid, an evidence-based approach that provides support and practical assistance to reduce initial distress and build resilience in those who have experienced a serious stressor. It also incorporates adaptive coping, which helps individuals manage stress through problem-solving, relaxation, and support from others, according to Elliott.


Although the health care workers teams expressed anxiety, anger, and fear in the March/April early phase of the program, during the May mid-phase and June late phase, the teams felt committed, engaged, positive, and calm. Over time, the emotional tone from these teams became more positive, suggesting that CREATE helped teams cope effectively with stressors and become more resilient.

“The CREATE program has normalized talking openly about our mental health,” said Sabrina Bennett, a nurse manager at Prince Margaret.

Psychosocial coaches, health care workers, and hospital leadership see CREATE as a valuable model that can be replicated in other institutions.CREATE helped psychosocial coaches quickly disseminate information about mental health resources to those wanting or needing individual consultation, Elliott said.

“Generally, prescheduled sessions, support, and adequate break time with full work coverage will garner more participation from frontline [health care workers],” said Erin Knox, PharmD, BCPP, who is a psychiatric pharmacist and director of experiential education at University of California Irvine. 


Thirteen psychosocial coaches and clinical managers at Princess Margaret collaborated to support 27 health care worker teams in the implementation of CREATE. They collected qualitative and quantitative data during the first wave of the pandemic in Ontario, Canada, from March 27 to June 19, 2020, after each intervention with teams.

Psychosocial coaches addressed the needs of health care practitioners in four core areas: physical (14.5%), social (28.4%), psychological (46.2%), and spiritual (10.9%).

“The majority of psychosocial coaches did brief check-ins during safety huddles or team meetings and could respond to identified themes in real time,” said Elliott.

Going forward

“We must develop and evaluate interventions that support our frontline health care workers’ mental health. Ongoing research is needed to examine the long-term impact of CREATE on reducing distress and how to best support frontline workers during COVID-19,” said Gilla Shapiro, PhD, a psychologist and CREATE research lead.

As one of the most accessible health care professionals, “pharmacists are good listeners, so during the pandemic [they can] recognize domains of psychological first aid—establish safety, restore calm, cultivate connection, enhance efficacy, instill hope—and draw on these to support team members,” said Elliott.

CREATE team model components

  • Address emotional needs: Coaches help health care workers (HCWs) understand their emotional needs and connections so they can work through challenging emotions such as anger, moral distress, disappointment, and grief. Helping HCWs validate, normalize, and address these emotions enables HCWs to feel heard, cared for, and understood. 
  • Calming strategies: Coaches use techniques such as meditation, breathing exercises, and stress-monitoring tools to help HCWs reduce stress and build resilience. 
  • Institutional advocacy: Coaches encourage HCWs to speak up and express their concerns in a confidential forum, where issues are brought to management and hospital leadership anonymously to reinforce institutional supports. 
  • Providing resources: Coaches share mental health resources with HCWs, such as online exercises, creative arts projects, and relevant mental health reading materials to promote self-learning and general wellness.
  • Tripartite coping: Coaches integrate emotion-, problem-, and meaning-focused coping to help HCWs process and understand their emotions, solve practical issues, and reflect on their own motivating factors for becoming a HCW to help them persevere through challenging times, respectively.  
  • BRITE (Building Resilience within Institutions Together with Employees): Coaches built this system to help HCWs develop resilience in mindfulness micropractices in six different areas, including fundamentals, self-awareness, connectedness, self-regulation, perspective, and optimism.



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