UCSF Develops Program to Help San Francisco Workers Deal with Stress on the Job

Valerie Reichert talks to a library patron
Valerie Reichert (left), branch manager of the Bernal Heights Public Library in San Francisco, talks with Brian Shimdred, a community member and patron at the library. Photo by Susan Merrell

Each time a library patron comes up to the help desk, Valerie Reichert tries to take a deep breath. It’s a technique the Bernal Heights librarian learned through a stress-relief workshop for city and county workers who often work with the public.

"It was great because it relaxed the day’s interactions and made it easier to take care of the patron’s requests,” Reichert said.

Reichert is one of about 600 San Francisco city and county workers who’ve gone through workshops offered through a collaboration between UC San Francisco’s School of Pharmacy and the city over the last five years.

Any work with the public involves being present for each request, and no one is perfect at it, Reichert noted. “Resiliency tools gave me a couple extra seconds to figure out how to best serve each patron. As a result, I had a better day, too."

Collaboration Started with Muni Drivers

The collaboration between UCSF and the City and County of San Francisco started in 2011 with the San Francisco Municipal Transportation Agency (SFMTA), which oversees ground transportation in San Francisco, including the Muni system, which runs the buses and trains.

3 people discuss around a table at the library
Henry Kahn (left), MD, and Eleanor Vogt (center), PhD, RPh, developed and implemented the stress-relief program for San Francisco city workers. Photo by Susan Merrell

Eleanor Vogt, PhD, RPh, a professor in the Department of Clinical Pharmacy, initially talked with the city about Muni drivers’ high rate of diabetes. These discussions surfaced the significant job-related stress issues, and Vogt offered to help.

Laura Chalfant, development director of BackFirst, the provider for a health and wellness program for SFMTA employees called Road to Fitness, said she immediately saw the benefits of the UCSF Stress-Relief and Resiliency Medicine Training for Muni workers. More than 100 of them have since gone through the training.

“One participant said afterward, ‘I realized today that I create my own stress,’” Chalfant said. “I think many people think of stress as something that happens to them, but in reality you can use these tools to manage stress more effectively and to cope.”

Resiliency and Managing Stress

Mindfulness has become a buzzword in countless workplaces over the past few years.

Vogt began looking into the science 20 years ago while serving as a senior fellow at the National Patient Safety Foundation at the American Medical Association.

Her initial work was studying how stress and burnout contributed to medical error and patient risk. Vogt said that in addition to the growing epidemic of practitioner burnout, the research documenting the role of stress in initiating or complicating disease is growing daily.

The interactive workshop training is based on emerging science showing that our thoughts and feelings have more impact on us than ever thought possible, she said. The topics and techniques include a look at the emerging science and practice using the evolving tools, including visualization, mindfulness, heart-centered appreciation, storytelling and reframing mind-sets with “take-home” applications.

Just as we immunize for flu, we can immunize for stress.

Eleanor Vogt, PhD, RPh

At first glance, it may seem like an unlikely project for a pharmacy school to take on. “In fact, pharmacists are on the front lines, and patients see pharmacists more than any health care provider,” Vogt said. “With our coaching, counseling and caring, we are the ‘medicine’ too. Just as we immunize for flu, we can immunize for stress.”

Lisa Kroon, PharmD, chair of the Department of Clinical Pharmacy, noted that the UCSF School of Pharmacy is deeply involved in the community through health screenings, immunization programs and education for seniors. “This is an example of how pharmacists, who are on the frontline of health care delivery, can promote wellness through non-medication strategies and provide practical tools to manage stress to help improve the health of our San Francisco community.”

Inside a Workshop

During a workshop, the instructor plays a video depicting fast-paced urban scenes: taxis zooming by, gridlocked city streets, pedestrians rushing to their next commitment. For the first half of the video, jarring and discordant music plays. But in the second half, a symphony plays Pachelbel’s “Canon in D,” and workshop participants visibly relax at the change in tone.

“That shift shows that if you can find a way to take a step back, or listen to nice music or even remember Pachelbel’s ‘Canon,’ it can help calm you,” said Henry Kahn, MD, a clinical professor in the School of Medicine, who’s partnered with Vogt on developing and implementing the program.

Rx for Reducing Stress at Work

Try a 90-second exercise in the video above that's scientifically proven to alleviate stress, or check out the following tips offered by Eleanor Vogt, PhD, RPh, and Henry Kahn, MD.

For Rapid Relief
  • Notice and acknowledge what you are feeling.
  • Shift your attention onto your breath – or the space around your heart – and take three slow deep breaths.
  • Identify an aspect of your life for which you are grateful and feel appreciation.
For Sustained Relief
  • Radiate your feeling of appreciation to your co-workers and beyond.
  • Be ambassadors of kindness with random acts of acknowledging and recognizing others.
  • Schedule three-minute “breath breaks” for slow, deep breathing throughout your day.
  • In your workspace – or in a public space - post three things for which you are grateful for today.
  • Shift your mindset to tell yourself a more positive story – you are the scriptwriter.

Vogt then asks everyone to sit with their eyes closed, breathe deeply for a few minutes and then think of someone or something for which they are grateful. Research has shown that deep breathing combined with this kind of “heart appreciation” practice lowers levels of the stress hormone cortisol and may increase our immune response as well.

The workshop isn’t all about sitting quietly and breathing.

Vogt also talks about research indicating that body language and position can influence mood and stress, noting that sitting hunched over tells the body it feels smaller and needs protection, creating a feeling of powerlessness, which in turn increases cortisol levels. She asks everyone to stand up and try out “power poses,” with their hands on their hips like Wonder Woman, and then with their arms raised and expansive like an Olympic victor, and note their feelings.

Promising Results

Catherine Dodd, PhD, RN, director of the San Francisco Health Service System, which negotiates benefits for San Francisco public employees and retirees, said that once she saw the workshop for herself, she knew she had to bring it to more city workers. During that workshop, Vogt connected a burly SFMTA manager to a machine that tracked his heart rate and then told him to take some deep breaths, Dodd said.

“You could see his heart beat slow down as he thought of something he liked. And she said, ‘Send him love’ to the other participants and, sure enough, it slowed down more,” Dodd said. “It sold me.”

Then in the summer of 2015, the system launched a pilot program advertising the stress and resiliency training to all city human resource professionals. 

More than 270 city workers from the Department of Public Health, SFMTA, Human Resources, Health Service System, the Arts Commission and the San Francisco Public Libraries participated. Of that group, 79 percent said they found the training useful, with 86 percent recommending it to a friend and 83 percent reporting that they were likely to make a change as a result of the class. 

Training to Teach the Public

After several years of successfully training city employees in reducing their own stress, Vogt and Kahn are now turning to training city workers how to teach such workshops.

As part of the San Francisco Public Library’s ongoing training program to keep staff current with technology and skill updates, Reichert and Ann Dorman, manager of the Parkside Branch Library, will work with UCSF’s Vogt and Kahn to develop a resiliency training model for library use. Once tested, the librarians will be able offer these programs to one another across all 28 San Francisco libraries and to the general public.

“After taking the training twice, I am convinced this training is a powerful tool for the library,” Reichert said.