Discovering the ‘Bereavement Signature’
After the sudden loss of a beloved nurse, one of our hospital partners asked a powerful question: What can we learn to better support our colleagues during profound moments of loss? This inquiry wasn’t just about mourning—it was about understanding the unseen effects of loss and finding ways to support their team while preparing for future events.
With a significant portion of the partner hospital’s workforce participating in Arena Strive, including physicians and nurses, we analyzed anonymized data to gain deeper insights. To learn more about how Arena Strive functions, visit How It Works.
Grounded in established research on bereavement’s impact, we analyzed biometric data to uncover patterns among team members during this challenging time. We focused on three key metrics: Heart Rate Variability (HRV), Resting Heart Rate (RHR), and Bedtime Consistency.
HRV, which measures the variation in time between heartbeats, offers a snapshot into the nervous system’s balance and the body’s ability to manage stress and recover. Think of it as a readiness score—a higher HRV indicates greater ability to take on load. Complementing this, RHR provides a measure of cardiovascular health and can highlight acute stressors when tracked daily. Lastly, bedtime consistency captures the regularity of sleep onset times, offering insights into the stability of daily routines.
Learn more about HRV and Bedtime Consistency.
Key Findings:
On the day the team learned of their colleague’s passing, the physiological data of a subgroup in the cohort revealed a stark shift, marking one of its most challenging moments.
- HRV dropped the following day by an average of 30.68% (17ms), a decline associated with high levels of acute stress. According to data from WHOOP, a wearable fitness tracker, such a reduction is comparable to the physiological impact of consuming seven alcoholic drinks in one day (1).
- Resting Heart Rate (RHR) spiked by an average of 17.6%, increasing by 4.07 beats per minute (BPM) the following day.
Bedtime variability, which measures how much people’s sleep schedules shift from night to night, spiked to an average of 89 minutes per night during the week following the event. To put it simply, instead of maintaining a consistent bedtime, people were falling asleep at vastly different times—nearly an hour and a half apart on average—compared to their usual 60-minute deviation the week before.
Recovery was gradual: HRV took 8 days to normalize, while it required 3 weeks for weekly averages to return to baseline levels. This highlights how even a single day of intense stress or grief can have lingering effects on both the body and behavioral stability.
So what does that mean for leaders? These findings emphasize the importance of offering consistent, ongoing support after such events. While immediate interventions are helpful, the lasting impact on team members of certain events requires extended support. This can be as simple as showing up to check in regularly or providing the right resources, such as aids for better sleep and tools for recovery at home.
Recognizing these physiological markers, such as significant drops in HRV or disruptions to routines, allows leaders to implement more intentional, targeted support that aligns with employees’ needs. However, our goal is not to suggest that bereavement alone is the sole cause of such physiological changes. Rather, we assert that metrics like HRV and bedtime consistency should be leveraged more widely in everyday operational decision-making—before it’s too late – just as hospitals operationalize metrics like readmission rates, bed turnover times, and first-case on-time starts.
Physiological data points, while not definitive in isolation, can serve as invaluable early indicators of stress, fatigue, or impending burnout, prompting proactive interventions in high-stakes environments. Other industries, such as elite athletics (2, 3) and special operations (4) routinely use similar technologies to guide real-time decisions, balancing immediate action with ongoing research efforts. These sectors recognize that real-time data can inform critical choices—whether adjusting training loads, modifying schedules, or prioritizing recovery—while research works in parallel to deepen long-term understanding.
In the sections below, we will explore the broader implications of bereavement in healthcare, examine some of the scientific research that has looked into this issue, and highlight actionable strategies for leaders to better support their teams during times of loss.
The Overlooked Reality of Bereavement in Healthcare
When we lose a loved one—whether a spouse, family member, friend, or colleague—the aftermath feels like navigating uncharted emotional territory. This period, known as bereavement, reflects the reality of the loss itself, while grief encompasses the emotional, physical, and cognitive responses to that loss (5).
In the workplace, bereavement is often misunderstood—not only because of its complexity but also because it’s rarely studied. Managers may misinterpret symptoms like fatigue, distraction, or disengagement as performance issues. These challenges make it difficult to distinguish between grief and productivity concerns, often leading to inadequate support.
Take for example, in 2015, a New York Times article, “Inside Amazon: Wrestling Big Ideas in a Bruising Workplace,” revealed cases where employees reported facing backlash for personal tragedies (6). One employee described being placed on a performance improvement plan during a time of immense grief following a stillbirth. While Amazon’s leadership denied these practices, the broader discourse—fueled by media coverage and internal conversations—highlighted a critical gap (7,8): Effective leadership requires a deep understanding of the personal impact of significant events on team members to provide the right support at the right time.
While the challenges in the technology sector provide one example of how leadership can falter in addressing personal crises, the healthcare sector presents its own distinct and complex set of obstacles. Unlike tech, where the focus is often on productivity and innovation, healthcare workers face unique emotional burdens that are deeply tied to the nature of their work. Consider the relentless challenges faced by those in specialties like oncology or emergency medicine, where micro-grief moments are a daily reality. These repeated, profound experiences of patient loss or trauma—whether sitting with a patient through their final days or performing CPR on a father while his children watch—take an undeniable toll. Unsurprisingly, these high-stakes environments are associated with some of the highest rates of burnout in the field (9).
Dr. Teresa Gilewski, an oncologist affiliated with Memorial Sloan Kettering Cancer Center, captures this challenge in her article “Encountering Grief in Patient Care. (9)” She explores how grief extends beyond a patient’s immediate family to impact physicians and other members of the healthcare team. Dr. Gilewski emphasizes the delicate balance that healthcare professionals must maintain: the need to empathize deeply with patients without becoming so emotionally overwhelmed that it hinders their ability to care for others. The very nature of their work—caring for people on some of their worst days—takes an inevitable toll over time.
When the death of a colleague or a personal loss is added to this daily reality of micro-grief events, it amplifies the emotional burden, raising a critical question: how can we better support healthcare teams and individuals as they navigate these layered and profound experiences of grief?
What the Literature Says
While bereavement has been explored through cultural and workplace perspectives, what does the scientific literature reveal about bereavement’s impact?
Bereavement has been extensively studied for its emotional, physiological, and behavioral effects, shedding light on its profound complexities (10). Among the leaders in this field is Dr. Mary-Frances O’Connor from the University of Arizona, whose work explores the neurobiological and psychological mechanisms underlying grief and bereavement, along with Dr. Christopher Fagundes’ lab at Rice University, which has conducted research on the intersection of loss, trauma, and physiological responses (11, 12).
Key findings from scientific research include:
- Heart Rate Variability (HRV): Bereavement is linked to lower HRV, reduced stress resilience, and impaired emotional regulation. Higher HRV can potentially facilitate faster recovery (13, 14).
- Resting Heart Rate (RHR): Elevated RHR during early bereavement correlates with anxiety and increased cortisol levels (15).
- Sleep Disturbances: Grief significantly disrupts sleep. About 22% of bereaved individuals experience insomnia, with sleep disturbances persisting for months (16).
- Broader Health Risks: Bereavement has been associated with weakened immune responses, heightened stress hormones, and increased risk of heart disease, depression, and anxiety (10).
Despite these valuable insights, research on how bereavement manifests in workplace settings—especially in high-stress environments like healthcare—remains scarce. This gap highlights the urgent need for focused studies to better understand and address the unique challenges faced by healthcare professionals coping with grief.
What Might Be Interesting for Leaders?
What are the takeaways for leaders? Bereavement doesn’t just affect emotions; it has measurable physiological impacts that can include drops in heart rate variability (HRV), spikes in resting heart rate (RHR), disrupted sleep, and overall emotional dysregulation. These insights provide a foundation for understanding how grief manifests in the body and for developing more effective, informed approaches to supporting employees during difficult times.
While standard workplace protocols often emphasize empathy, active listening, or providing access to chaplains and support lines, these approaches frequently miss the physiological toll of grief.
Tailoring Support Based on Biometric Insights
Recognizing these physiological markers, such as significant drops in HRV or disruptions to routines, allows leaders to implement more intentional, targeted support that aligns with employees’ needs. By leveraging biometric data, organizations can move beyond generalized support and provide tailored interventions that address specific challenges faced by grieving employees. For instance, monitoring HRV trends or sleep consistency could signal when employees need extra support, whether through adjusted schedules, targeted wellness programs, or increased flexibility.
The growing emphasis on employee well-being is reflected in the rise of Chief Wellness Officer roles, which prioritize initiatives such as improving sleep, exercise, and recovery (17). However, the opportunity exists to make these resources even more impactful by integrating insights from biometric data. This data not only highlights where interventions are needed but also helps evaluate their effectiveness over time.
How Our Partner Leveraged the Data to Support their Team
What did our hospital partner do as a result? By using data from Arena Strive, they thought through expanding their approach to grief-related challenges in several impactful ways:
- Enhanced Education: Educating teams on the connection between sleep, human performance, and autonomic control to mitigate the effects of grief on both body and mind.
- Digital Guides: We proposed developing tailored digital resources for navigating significant events, such as the death of a colleague. These guides offered tools and team protocols designed to address both the short- and long-term impacts of grief on emotional and physiological health, such as sleep tools at home.
Putting People First: Redefining Support in the Workplace
Based on our understanding of various metrics that illuminate stress, recovery, and behavioral patterns, I ask leaders to challenge the status quo: How can we rethink the way we operationalize the well-being of our people? In high-stakes environments like healthcare, where emotional and physical demands are constant, there’s an opportunity to move beyond traditional approaches and integrate well-being as a core part of operational strategy, not just an afterthought.
If you’re interested in bringing Arena Strive to your hospital or learning more, reach out to us at hello@arenalabs.co.
References:
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- https://www.whoop.com/us/en/thelocker/how-alcohol-negatively-impacts-your-biometic-data/
- https://www.nytimes.com/athletic/5564250/2024/06/14/england-oura-ring-southgate/
- https://www.whoop.com/ca/en/thelocker/patrick-mahomes-the-data-behind-a-season-with-whoop/
- www.army.mil/article/278986/
- Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009 Jun;8(2):67-74. doi: 10.1002/j.2051-5545.2009.tb00217.x. PMID: 19516922; PMCID: PMC2691160.
- https://www.nytimes.com/2015/08/16/technology/inside-amazon-wrestling-big-ideas-in-a-bruising-workplace.html
- https://www.vox.com/2015/8/17/9166023/new-york-times-amazon
- https://www.geekwire.com/2015/full-memo-jeff-bezos-responds-to-cutting-nyt-expose-says-tolerance-for-lack-of-empathy-needs-to-be-zero/
- Teresa Gilewski Encountering Grief in Patient Care. Am Soc Clin Oncol Educ Book 32, e81-e84(2012). DOI:10.14694/EdBook_AM.2012.32.302
- Parkes CM. Bereavement in adult life. BMJ. 1998 Mar 14;316(7134):856-9. doi: 10.1136/bmj.316.7134.856. PMID: 9549464; PMCID: PMC1112778.
- https://maryfrancesoconnor.org/
- https://bmed.rice.edu/
- Chen MA, Suchting R, Thayer JF, Fagundes CP. Resilience to stress across the lifespan: Childhood maltreatment, heart rate variability, and bereavement. Psychol Aging. 2023 May;38(3):247-262. doi: 10.1037/pag0000738. Epub 2023 Mar 23. PMID: 36951695; PMCID: PMC10192121.
- Fagundes CP, Murdock KW, LeRoy A, Baameur F, Thayer JF, Heijnen C. Spousal bereavement is associated with more pronounced ex vivo cytokine production and lower heart rate variability: Mechanisms underlying cardiovascular risk? Psychoneuroendocrinology. 2018 Jul;93:65-71. doi: 10.1016/j.psyneuen.2018.04.010. Epub 2018 Apr 13. PMID: 29702444.
- Buckley T, Mihailidou AS, Bartrop R, McKinley S, Ward C, Morel-Kopp MC, Spinaze M, Tofler GH. Haemodynamic changes during early bereavement: potential contribution to increased cardiovascular risk. Heart Lung Circ. 2011 Feb;20(2):91-8. doi: 10.1016/j.hlc.2010.10.073. Epub 2010 Dec 13. PMID: 21147029.
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- https://www.aha.org/news/headline/2024-02-08-aha-podcast-growing-role-chief-wellness-officers-health-care