COVID-19 has taken a tremendous emotional and physical toll on clinicians. Throughout the pandemic, clinicians have grappled with daily changes in clinical knowledge, high volumes of patients, limited resources and anxiety about the health of their families, friends and themselves.
Becker's Hospital Review recently spoke to Heather Owen, MD, TeamHealth’s chief clinical officer for emergency medicine, about challenges clinicians continue to face and steps that healthcare leaders can take today to support their clinicians during the current public health crisis and beyond.
The pandemic has pushed the healthcare system to the brink in all regions
The COVID-19 pandemic has generated a variety of stresses. First and foremost, clinicians have been "learning on the job" about how to care for patients suffering from a novel, emerging disease.
"At times, it felt like we were sitting on the shore waiting for a tsunami," Dr. Owen said. "We knew it was coming and we recognized that it would be devastatingly overwhelming. Yet, our preparation seemed like it was really never going to be enough. Our clinical work became more stressful and the complexities of preparing for the unknown started to wear on us."
Simultaneously, the global sense of insecurity outside the hospital walls has been unrelenting. As a result, many healthcare professionals feel there is no reprieve from the stress they are experiencing. Although clinicians are trained to be resilient, the current situation has presented them with unimaginable circumstances.
"One of the things that is unique to this pandemic is an overwhelming sense of hopelessness as our healthcare system has been pushed to the brink in all regions," Dr. Owen said. "Nationally we’ve seen physician substance misuse increase by 18 percent during COVID-19, compared to 13 percent in the general public. Clinicians by nature want to help and feeling helpless is a very uncomfortable place for us."
Health system leaders know clinician wellness results in improved patient-clinician relationships, high-functioning care teams and an engaged workforce. The pandemic has highlighted that clinicians need improved balance in their lives and that each person reacts to stresses differently. In response, many healthcare organizations are trying to foster resiliency among clinicians more intentionally than they have done in the past. One of the challenges, however, is that clinicians don’t necessarily feel empowered to ask for help.
"Clinicians feel a greater sense of stigma about accessing mental health treatment and are much less likely to engage in counseling or therapy," Dr. Owen said. "There's a strong professional and business case to reduce physician burnout and to promote wellness. When leaders publicly address these issues, it’s very powerful and can lead to significant change."
Intentional, focused initiatives are needed to support clinician well-being
Even before the pandemic, TeamHealth took a proactive stance on clinician well-being. In early 2019, the organization created a Clinician Well-being Strategic Advisory Group with four subcommittees. Each subcommittee is tasked with developing initiatives to support clinicians. This structure has promoted open and transparent conversations about the importance of clinician wellness and has led to significant efforts to identify and reduce burnout.
"We quickly realized that you must provide a steady stream of communication around well-being and support resources," Dr. Owen said. "When clinicians need those, they know what’s available and applicable to them."
When TeamHealth started a dialogue around resilience and wellness, the responses across the board were powerful. Many of the experienced physicians had valuable insights to share. Meanwhile, some of the younger clinicians came out of their training with a different perspective on work-life balance.
"It's been rewarding to talk about these issues and to recognize that it's OK to struggle," Dr. Owen said. "It's just something that we need resources and support to get through."
Over the past year, as TeamHealth has navigated the pandemic, it has expanded its programs to support clinicians. The organization has addressed issues related to PPE and provided analytical summaries of newly released clinical information. In addition, TeamHealth has recognized the need for personal connection and regular touchpoints with clinicians.
"We expanded our best practice of wellness calls during hurricanes and other local or regional disasters nationally to every clinician in the organization to check on wellness throughout the pandemic." Dr. Owen said. "The power of that personal touch is so valuable. Those personal phone calls have had an unbelievable impact on morale within the organization."
TeamHealth has also recognized the importance of educating and empowering leaders. The goal is to provide leaders with the skills needed to identify when clinicians are struggling. Early discovery of warning signs leads to opportunities for early intervention. TeamHealth has trained every clinician leader on skills like well-being rounding and emotional intelligence, as well as the soft skills of leadership.
"We have educated leaders about peer support, critical conversations and the importance of providing support after critical incidents," Dr. Owen said. "If one of our facilities is struggling with a patient surge or loss in the healthcare community, we hold a webinar to debrief and share successful coping skills. Relating our stories about how to cope while maintaining a healthy work-life balance has been powerful." Additionally, one of TeamHealth's Resiliency Committee Group Chairs, Dr. Richard Juman, has been conducting regular wellness lectures with valuable education and insight on various topics.
In 2021, "breaking the stigma" is the main focus for TeamHealth's well-being program. The organization is investing significant time and effort to remove barriers and ensure clinicians have access to mental healthcare, counseling or therapy as needed.
"At a time when our focus could have wandered, TeamHealth has maintained a daily focus on supporting front-line healthcare professionals in an unprecedented way," Dr. Owen said. "I think we have touched every clinician in some way. I'm proud of the support that TeamHealth has provided and proud to be part of an organization that prioritizes wellness."
Organization-wide efforts can have a profound effect on physician well-being
Healthcare organizations have learned a great deal about clinician well-being during COVID-19. Although there is much more to learn, healthcare leaders can take action today to address clinician wellness.
The first step is to assess and acknowledge the need for support. "If you’re not recognizing the need, then you're not investing the time that it takes for improvement," Dr. Owen said. The next step is to empower leaders with skills like leadership rounding and techniques for personal connection.
With that foundation, organizations must create targeted interventions that address clinical well-being, cultivate community and strengthen a healthy culture. The goal is to harness the power of leadership and model the culture that the organization wants to cultivate. Attention from the highest levels of the organization is the key to making progress.
With that foundation, organizations must create targeted interventions that address clinical well-being, cultivate community and strengthen a healthy culture. The goal is to harness the power of leadership and model the culture that the organization wants to cultivate. Attention from the highest levels of the organization is the key to making progress.
Once the pandemic is behind us, the need for aggressive, sustained and intentional efforts to improve the well-being of healthcare clinicians will remain. The current heightened awareness about the need for clinician wellness, however, can be used in a productive manner moving forward.
"Clinician well-being is a shared responsibility for individual physicians and the organizations in which they work," Dr. Owen said. "Without an engaged physician workforce, healthcare organizations can't meet their institutional objectives, achieve their missions and promote workplace satisfaction."
Conclusion
Healthcare organizations that are committed to clinician wellness take a comprehensive view of clinicians' emotional and physical health and all the factors that influence those things. As Dr. Owen noted, wellness is one of those things that "you know it when you see it." It's easy to tell when someone is thriving, not simply surviving.
While COVID-19 has created massive healthcare challenges on many levels, it has also uncovered opportunities to innovate and address issues related to clinician well-being. "When I think about the impact of the pandemic, I feel that during this most challenging time, we’ve also seen some of the most amazing times in terms of collegiality among frontline healthcare workers, support from the community and hospital leadership and the efforts that hospital systems have put forth to innovate," Dr. Owen said. "It's been an honor and privilege to be part of that."