Healthcare staff burnout and its effect on workplace culture has continued to be a major challenge for health systems. Studies have found that peer support programs can successfully effect change, providing both proactive outreach and the structure to make improvements.
During an executive session of Becker's 10th Annual CEO + CFO Roundtable, sponsored by RLDatix, Tim McDonald, MD JD, Chief Patient Safety and Risk Officer at RLDatix, led a discussion on the effectiveness of peer support programs.
Three key takeaways were:
- The healthcare environment is filled with long hours and high stress, which takes a toll on workers. High levels of stress and burnout among healthcare workers have driven higher rates of depression, drug and alcohol abuse and other mental health issues as staff struggle to cope with low staffing levels, increases in workplace violence, and the enhanced stressors of COVID. When staff are left unsupported, the impacts of burnout can affect patient experience, patient safety, staff morale and the overall quality of care. For these reasons, more and more clinical and non-clinical staff are leave the profession before the cumulative trauma becomes too much.
Utilizing peer support programs as part of the solution. Effective peer support programs have three tiers of intervention and include processes to effect real change. "Tier one is at the local level," Dr. McDonald said. "For example, there's an unexpected death in the operating room, and you support each other through it. Tier three is a formal referral to psychological services, which for many organizations is structured as an Employee Assistance Program. Almost all organizations have Tier 1 and Tier 3 support structures in place, but many are missing the middle tier, Tier 2 Support. Tier two involves trained peer supporters, most commonly volunteers, who manage support outreach requests, and who will proactively reach out to groups or individuals after a serious event has occurred. Tier 2 support breaks down many of the common barriers to accessing support and is able to connect those needing support with those who can provide support in a more expedited fashion. A participant pointed to the importance of addressing the initial triggers of stress. "The thing that comes to mind is what are we doing to fix the problems that we're seeing?" she said. "I think it's twofold. It's important to have support in place and also to change the things we're experiencing." Insights into your peer support data is key to identifying and eventually addressing the systemic challenges which are driving staff to seek out support.
- A wide range of peer support-related strategies and tactics have proven successful. Dr. McDonald and several roundtable participants shared innovative solutions that have helped:
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- Multidisciplinary root case analysis. After workplace violence events, one health system conducts a root cause analysis that includes physicians and nurses as well as techs and other staff. All disciplines and functions discuss what occurred, what was learned and how things can be done differently and better moving forward.
- Software support. "Imagine having a button you can click on to ask for peer support or request that someone check on a colleague who has been suffering," Dr. McDonald said. RLDatix offers a solution that allows the peer support team to reach out to staff in a very organized and proactive way.
- Behavioral nurse team. A participant shared that her organization has behavioral health nurses who round every day throughout her 1,000-bed hospital. Daily rounding gives the team the awareness they need to rapidly identify opportunities to support individual staff members and teams who are struggling, and it also reinforces the organizations commitment to staff safety and wellbeing. Positive executive walkarounds. Dr. McDonald cited a study showing that positive executive walkarounds had a significant impact on staff burnout and resilience. "Essentially, you start by focusing on what's going really well in a specific department so it can be shared," Dr. McDonald said. "Then, you balance it with learning what's not working quite so well so it can be improved."
- Peer support programs can really help to reduce burnout, increase staff retention and improve workflows and efficiency. "If your staff feel supported by a peer support program, they have half the burnout rate, higher retention and much better patient safety," Dr. McDonald said. He shared the experience of Judy Davidson, DNP, RN at UC San Diego Health, which reported that 59 percent of staff had symptomatic workplace stress. "The peer support program was helpful for 100 percent of participants and all participants said they would recommend it to others."
Dr. McDonald went on to share an example of a process improvement that reduces burnout. "We need GROSS, a formalized process to Get Rid Of Stupid Stuff," he said. Nurses at one health system asked about eliminating the inordinate number of screens they need to click through in the EHR related to clinical assessments. "When the organization got rid of that, they saved 1,700 hours of time and energy, while improving care.”
Peer support programs can effectively help health systems reduce burnout, improve morale and identify areas ripe for efficiency and improvements.
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