At a time when health systems nationwide are grappling with persistent physician and care team burnout, workforce strain, and rising workplace stressors, Northwell Health is taking a structured, systemwide approach to support its care teams—one that begins not with diagnosis, but with connection.
Through its Center for Traumatic Stress, Resilience and Recovery (CTSRR), the health system has implemented Stress First Aid, a peer-support framework designed to help physicians and other health professionals recognize, respond to, and manage stress—both in themselves and in their colleagues.
This effort reflects a broader shift in healthcare, moving from reactive mental health care toward proactive, culturally embedded support.
Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
From fragmented support to systemwide strategy
The roots of CTSRR predate the COVID-19 public health emergency when leaders at Northwell began to recognize a gap in how stress and trauma were addressed across the organization.
“We lacked a structured, coordinated way to address stress and trauma across our communities—both internally and externally,” said Mayer Bellehsen, PhD, a clinical psychologist and assistant vice president within the behavioral health service line at Northwell Health. He is also the founding director of the center.
Even before 2020, localized issues—including burnout, workplace violence, and high-stress incidents—were surfacing across individual hospitals. But it was the COVID-19 public health emergency that transformed those signals into an urgent systemwide call to action.
“With the level of death and loss across New York—and the acceleration of burnout and other mental health challenges—the need for a more robust, systemwide approach became clear,” Bellehsen said.
What began as an emergency response—organizing volunteers to support physicians and other health professionals during the height of the public health emergency—quickly evolved into a more permanent infrastructure. That structure became CTSRR, which now anchors Northwell’s approach to workforce well-being.
One of its earliest and most scalable tools: Stress First Aid.
A different model for supporting care teams
Originally developed for the military and later adapted for first responders, Stress First Aid has been further tailored at Northwell for use in healthcare—where chronic stress, emotional fatigue and high-stakes decision-making are part of daily practice.
“It’s a peer-support framework focused on self-care and building resilience,” said Rebecca Schwartz, PhD, a clinical research psychologist and associate professor at Northwell Health. With Bellehsen, Schwartz is also a co-founder of CTSRR and is its senior director of research and evaluation.
Unlike traditional mental health services, which often begin after a physician or other health professional reaches a crisis point, Stress First Aid focuses on prevention and early intervention.
“Traditional mental health support often starts with seeing a clinician, receiving a diagnosis and beginning treatment,” Bellehsen explained. “This approach equips team members with the knowledge and tools to take action as stress begins to rise.”
At the core of Stress First Aid are three key actions:
- Recognizing stress in oneself or others.
- Understanding available resources.
- Taking appropriate steps to provide or seek support.
Northwell has implemented the program using a train-the-trainer model, beginning with foundational education and followed by an extended integration phase. During that time, teams incorporate Stress First Aid practices into daily workflows, making it less of a one-time training and more of a cultural shift.
One of the most visible elements in the Stress First Aid Program is the “color continuum,” which is a shared language for discussing stress levels.
“The continuum ranges from green for low stress to red for high stress, with yellow and orange in between,” Schwartz said. “It removes stigma by giving teams a simple way to check in—asking, ‘What color are you today?’”
The simplicity of that framework has helped normalize conversations about stress across teams.
“I’ll be in a meeting and hear someone say, ‘I’m really orange today’—even if I don’t know them. That shared language has really taken hold,” she added.
Embedding support into daily practice
Beyond language, Stress First Aid introduces structured practices that teams can use in real time. Daily pauses encourage brief moments of reflection and reset, while “orange huddles” provide a mechanism for teams to debrief after difficult events.
“It’s both preventive and responsive,” Schwartz said. “After an incident, for example, teams can hold an ‘orange huddle’ to talk it through, debrief and identify ways to ease the stress.”
Importantly, the program is not limited to a small group of trained responders. Instead, it is designed to empower all team members.
“This model provides specialized peer support, but just as importantly, it gives all team members tools and knowledge to support one another,” Bellehsen said. “As a result, it can help shift the culture in talking about stress, burnout and stress management.”
That cultural shift is central to the program’s design—and its potential impact.
Addressing ongoing stressors in healthcare
While the public health emergency may have subsided, the stressors facing physicians and care teams remain significant.
“Direct care providers face a high risk of burnout—even outside of a pandemic,” Schwartz said, noting that systemwide surveys continue to show elevated stress among physicians, nurses and nonphysician clinical providers.
Bellehsen pointed to the multifaceted nature of those stressors.
“Clinicians are managing complex cases, difficult outcomes, patient demands and documentation requirements—along with ongoing frustrations with the EHR—all within a fast-paced environment that can feel stressful at times,” he said.
Those pressures are compounded by broader trends in healthcare, including rising workplace violence and increasing complexity in care delivery. Against that backdrop, Northwell’s approach aims to meet physicians and other health professionals where they are—offering tools that can be used in the moment, rather than waiting until stress escalates into crisis.
Scaling across a large health system
Implementing a Stress First Aid program across a large, complex organization requires both strategic planning and flexibility.
Northwell began with a pilot at Zucker Hillside Hospital, its psychiatric campus, working closely with nursing leadership to refine the model. Feedback from focus groups helped shape training content and delivery.
From there, the program expanded across hospitals and is now moving into ambulatory and corporate settings.
A key driver of that growth? Leadership buy-in.
“Strong support from system leaders and local leaders made a real difference,” Schwartz said, “especially in building early momentum and introducing core concepts like the color continuum.”
Bellehsen emphasized the importance of engagement at every level, from executive leadership to frontline staff.
“The program’s success depends on how deeply leaders and teams embrace it,” he said.
At the same time, adaptability has been critical. Training formats have been adjusted to fit everyone’s schedules, and implementation strategies vary depending on the care setting.
“One of the strengths of Stress First Aid is its flexibility,” Schwartz said. “We can adapt it to fit the realities of different settings.”
Measuring impact and outcomes
From the outset, evaluation has been a central component of the program. Northwell uses both process and outcome measures to assess effectiveness, tracking everything from training participation to changes in stress levels over time.
“We measure confidence in recognizing stress, awareness of resources and knowing what actions to take—that’s our primary focus,” Schwartz said.
Surveys conducted at baseline and at regular intervals—three, six, nine and 12 months—have shown promising results.
“We are seeing significant improvements across most measures over time,” she said, “including decreases in stress and burnout.”
The program has also increased awareness and use of well-being resources, while strengthening perceptions of organizational support. Notably, similar trends have been observed among physicians.
“When we analyzed physician data specifically, we saw that Stress First Aid is making a measurable impact,” Schwartz said.
To date, Northwell has trained about 35,000 employees, including roughly 1,500 physicians, with plans to expand further.
Future evaluation efforts will examine broader organizational metrics, such as absenteeism and turnover, which are key indicators of long-term sustainability and return on investment.
Shifting culture and reducing stigma
Beyond quantitative outcomes, leaders say one of the most meaningful changes has been cultural.
“We’re seeing a shift—people are more comfortable acknowledging when they’re not OK and seeking support,” Schwartz said.
That shift includes reduced stigma around mental health and increased openness in discussing stress—critical factors in a profession where vulnerability has historically been difficult to express.
Bellehsen noted that Stress First Aid also functions as a shared communication framework.
“When everyone uses the same language to recognize stress and respond, it creates alignment across teams,” he said.
The result is a more connected workforce that is better equipped to support itself.
Aligning with the Joy in Medicine road map
Northwell’s efforts align closely with the AMA Joy in Medicine® Health System Recognition Program, particularly its emphasis on peer support and connection.
“When everyone uses the same language to recognize stress and respond, it creates alignment across teams,” Bellehsen said.
At its core, the program reinforces a simple but powerful idea: that connection is a key driver of resilience.
“Connection is a key pillar in reducing stress,” he said. “Stress First Aid strengthens that connection and helps create a culture of care, though it’s just one, albeit important, part of a broader well-being strategy.”
In an era when health systems are seeking scalable, sustainable ways to support their workforce, Northwell’s approach offers a compelling model—one built not just on resources, but on relationships.
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