Babushka Service: Care Packages Delivered to Sick Residents

What?

The goals of this intervention are to:

• Assemble care packages for residents who are ill.
• Identify volunteer faculty/residents to deliver care packages.
• Implement a system for residents to request care package deliveries for themselves or others.[1]

Why?

Although 26% to 43% of American residents reported having health-related problems that required medical attention in the past year, most neglect seeking medical care.[2] Indeed, 83% of practicing physicians report working while sick, even though 95% acknowledge that they are putting patients at risk.[3] Furthermore, avoidance in seeking care tends to be associated with worse self-rated mental and physical health, and greater health concerns.[2] Barriers to seeking medical care include: inadequate time, limited flexibility in work schedules, insufficient access to basic supplies to alleviate their symptoms, and a surgical culture that tends to promote “toughness.” A Babushka service communicates that illness is not only acceptable, but expected and that caring for oneself and others is important.

Resident Camaraderie	The Babushka service is a way to create a sense of support and community in the program by encouraging residents to help and support each other in concrete ways.
Faculty Engagement	Having faculty deliver care packages to sick residents demonstrates that faculty understand and do not stigmatize illness. It also demonstrates that faculty care about their residents.
Organizational Culture and Values	This intervention communicates to residents that the program takes their physical health and wellness seriously and cares about their basic physical needs. This intervention challenges the culture of “toughness” in residents by normalizing illness, the idea that one should prioritize their own health, and asking for help. It encourages self-care and caring for colleagues.
Work-Life Integration	Surgical residents have limited time and flexibility in their work schedules to seek medical care and tend to their physical health. This intervention offers a simple and cost-effective solution to help tend to the physical health of residents experiencing acute illness. It also normalizes illness and the idea that one should prioritize their own health when sick.

How?

(adapted from the Babushka Service developed at the Stanford Department of Surgery)

Step 1. Identify a point person to coordinate the Babushka service

1.Identify a point person to coordinate the Babushka service and troubleshoot any departmental issues that may arise during implementation. After the service has launched, the time commitment should be fairly minimal.

1. Staff
2. Residents (ideally from a variety of training levels and those during research years, so as to maximize availability)
3. Faculty and spouses

Step 2. Purchase and assemble care packages

1.Consider the following items (~$7.00/bag) (itemized budget):

• 3-day supply of Ibuprofen (25 units/bag: $0.30)
• Acetaminophen (20 units/bag: $0.07)
• DayQuil (2 units/bag: $0.08)
• NyQuil (2 units/bag: $0.21)
• Airborne/Emergen-C (3 units/bag: $0.81)
• Cough drops (15 units/bag $0.75)
• A can of chicken noodle or vegetarian soup (1 can/bag: $1.99)
• Gatorade (2 units/bag: $0.93)
• Tea bags (4 units/bag: $0.63)
• Mask (1 unit/bag: $0.20)
• Encouraging note (1 per bag: $0.20)
• Ziploc bag (3 units/bag: $0.81)

Additional items to consider:

• Pepto-Bismol
• Pedialyte
• Imodium
• Inexpensive digital thermometer

2.Prepare an encouraging note/sheet of advice to include in each package that includes:

• The importance of care for oneself.
• Medication administration instructions.
• Expiration dates for each medication.

(You may use our template, based upon Stanford’s).

3.Organize a bulk purchase of supplies at defined time points throughout the year and assemble the packages. Estimate needing approx.1-2 bags per resident per year. Consider:

• Delivery to your education office (e.g., Amazon, Costco).
• A shopping trip/pick-up (e.g., Costco, CVS).

By:

• Your Babushka coordinator.
• Your volunteers or a subset of them, i.e., a shared responsibility that rotates between people.

Step 3. Identify volunteers to deliver care packages

1. Identify volunteers that deliver the care packages to residents who are ill. Consider a mix of:
   1. Residents
   2. Faculty
   3. Staff
   4. Spouses
2. Having a wide range of caregivers is important to maximize availability to deliver a package and to demonstrate that everyone in the department is willing to help each other out.
3. Provide each caregiver with a few packages.
4. Packages can be delivered face-to-face or dropped off for the resident by their doorstep, in a common area, etc.

Step 4.Create an email listserv and/or text message group for requesting packages

1.Create an email listserv and/or a text message group that residents can use to request packages for themselves and others when ill.

2.To request a package, residents send a message either to the email listserv or the text message group, indicating:

• To whom the package is to be delivered.
• The address where the package should be delivered (e.g., the resident’s home, the hospital).
• If requesting a package for a co-resident, the resident may volunteer to deliver the package.

3.All volunteers receive the email and/or text message and may offer to deliver. If no one offers, the coordinator will reach out individually and identify someone to deliver within a few hours.

4.The package should be delivered by the volunteer on the same day that the request is made.

Step 5. Advertise

1.Obtain support from departmental leadership and publicize the Babushka service, including leadership names on all communications.

2.Advertise the email listserv and text message group widely to residents (e.g., at orientation, email announcements, flyers).

Step 6. Follow-up

1.The volunteer should check in (by whatever method they prefer) on the resident over the next few days.

2.Seek input on the service either formally (e.g., send recipients a brief survey 1 week after delivery) or informally. (You may use this survey template, based upon Stanford’s).

3.Consider revisions as appropriate.

Helpful Resources

Webinars

Webinar recording available here

Coaches/Successful Implementations

Stanford University

Coach: Ioana Baiu, MD, MPH, General Surgery Resident

Contact: ibaiu@stanford.edu

Coach: Ashley Titan, MD, General Surgery Resident

Contact: atitan@standford.edu

Coach: Sue Fu, MD, General Surgery Resident

Contact: sfu87@stanford.edu

Coach: Carlie Arbaugh, MD, General Surgery Resident

Contact: carliea@stanford.edu

Coach: David Spain, MD, Program Director

References

1. Baiu I, Titan A, Kin C, Spain DA. Caring for Caregivers–Resident Physician Health and Wellbeing. Journal of Surgical Education. 2020 77(1): 13-17
2. Dunn LB, Green Hammond KA, Roberts LW. Delaying care, avoiding stigma: residents’ attitudes toward obtaining personal health care. Acad Med. 2009;84:242–250.
3. Szymczak JE, Smathers S, Hoegg C, et al. Reasons why physicians and advanced practice clinicians work while sick: a mixed-methods analysis. JAMA Pediatr. 2015;169:815–821.