As environmental services workers get ready for their shifts at Salem (Ore.) Health, they take a moment to engage in positivity. They get sticky notes and pens, write down celebratory moments and put the notes on a wall in their break room.
The notes say things like: "My daughter just gave birth," "My son just got married," or "I beat cancer."
Salem Health CMO Ralph Yates, DO, said writing and displaying the notes are employees' way of expressing gratitude amid a devastating pandemic.
"It's a wall that celebrates joy and hope. So many sticky notes have gone up on the wall that some are starting to fall off," he said.
Hospitals and health systems are aware of the importance of steps like these to boost employee morale. In August, a $1 million gift to the University of California-San Francisco established a COVID-19 morale support fund for faculty and staff.
Other efforts reported this spring by healthcare organizations included mindfulness practice sessions via Skype, designating areas for employees to take refreshment and mental health breaks and a 24/7 phone support line for workers.
But with COVID-19 cases surging across the U.S. — and an exhausted workforce nine months into a pandemic — boosting employee morale may be even more challenging for hospitals and health systems as winter approaches.
Staffing has become increasingly difficult as healthcare workers miss work for coronavirus-related reasons, and flu activity this winter is likely to increase the strain on hospital staff.
To gain insight into boosting morale in these crises-filled times, Becker's asked health system leaders to share their do's and don'ts.
The do's
Label what you see. Dr. Yates said this means leaders should understand what burnout employees are experiencing reflects the constant change during the pandemic in this context of underlying fear.
"A friend said he likened the current pandemic to a fire that's fueled by fear, and the constant waves of change that are occurring is gasoline being thrown on the flames," he said. "I think that is an apt description. In context, fatigue we hear about is more change fatigue than COVID fatigue — being asked to do new things in a tighter period than I've seen in my 41-year career."
Focus on the strengths of each employee. The Menninger Clinic, a Houston-based specialty psychiatric hospital affiliated with Baylor College of Medicine, fosters a collaborative environment where team members work together on recommendations for patients.
Jonathan Stevens, MD, chief of child and adolescent psychiatry and chief of outpatient services at Menninger, said this approach involves all workers in a way they feel respected and draws on their strengths in hospitals and health systems.
"It engages our brains because you're challenged to bring out your best qualities," he said. "It also utilizes people's strengths to make them feel seen, connected and engaged, and that fosters a greater sense of community in our experience, connection and ability to make an impact, which is really empowering right now when many things in our lives feel stuck."
Schedule periodic, small, socially distant gatherings. These gatherings would preferably be outdoors. Dr. Stevens said Menninger leaders focus on engaging employees and showing gratitude for each of them at the gatherings. He advised making a game out of reading affirmations and having team members guess who is being referenced. Dr. Stevens said it's important to celebrate employees who have experienced significant life events, such as weddings or advanced education since the previous gathering.
"Those rites of passage, many have been put on hold, canceled or moved virtually, so if you have that in-person opportunity, make the most out of it and be really intentional as a leader that everyone is engaged and part of celebrating something positive," he said.
Ensure virtual employees have ample breaks in the schedule. Dr. Stevens recommends keeping in mind the new normal and allowing virtual workers to step out of the virtual office. This may be as simple as taking a walk in their neighborhoods.
Be mindful of Zoom fatigue. Dr. Stevens also encourages hospital leaders to be mindful to limit Zoom meetings among virtual workers to prevent Zoom fatigue. Sometimes he checks on virtual workers by phone or text, to ask how employees are doing outside of work.
Shore up worker resilience. Hospitals and health systems can do this by ensuring support is there, via mental health services, proper personal protective equipment and staffing, according to Philip Wilner, MD, senior vice president and COO of the NewYork-Presbyterian Westchester Behavioral Health Center and professor of clinical psychiatry at Weill Cornell Medicine in New York City.
"Those are foundational to providing outstanding healthcare and making sure workers can contribute at the highest level, despite the fact everyone is fatigued," said Dr. Wilner.
A study published in Academic Emergency Medicine backed this idea, finding that most emergency medicine physicians said increasing availability of PPE would relieve their pandemic-related stress.
Dr. Wilner said NewYork-Presbyterian ensures employees receive support at home by offering expanded child care resources to help those whose children are learning virtually or in a hybrid model. The health system also is trying to help out some employees with food.
"Because one family member lost a position, and there are problems meeting family needs, and we're trying to help with issues of that sort," said Dr. Wilner. "So, you have to stay vigilant at high levels to make sure the workforce is strong so they can come to work and do everything at the highest level and not succumb to some of the fatigue we're all experiencing."
Be transparent with information. At the beginning of the pandemic, there was a lot of good, open communication between leaders and employees, said Dr. Wilner. He recommends continuing that as much as possible in the winter. For example, NewYork-Presbyterian has leadership video presentations weekly and does a lot of routine email communication.
"I believe we all have to push ourselves to keep doing that, because even leaders may be feeling some of that fatigue, especially because everyone is pulled in many directions to try to help restabilize health systems that have suffered a very significant financial loss as a result of the pandemic and other needs of patient care that are everyone's responsibility," Dr. Wilner said.
Eric Cole, corporate senior vice president of human resources at San Diego-based Scripps Health, agreed. He said leaders should continually communicate with their staff from a system perspective about happenings on the employees' unit, during their shift and on their team.
"We've learned that our managers feel they need to solve issues for employees," said Mr. Cole. "We're finding that's not necessarily true. "We're trying to remind leaders to be there as a listening post for staff, and you don't always have to solve the problem at hand."
Survey employees. Scripps did an employee survey in August to examine how the health system was doing with respect to its workforce earlier during the pandemic. Scripps learned from the survey that workers feel most engaged when they feel they belong in the organization; when they feel like the health system provides high quality care; and when they feel the organization takes every step to deliver safe, error-free care to patients, said Mr. Cole. He said Scripps is using the survey findings as the foundation for anything it does to boost employee morale.
Understand different workforce segments. Mr. Cole said: "We know what they have felt and will continue to feel is going to be different based on each segment. We've segmented the workforce to direct and indirect patient caregiver and support roles, such as environmental services, food and nutrition staff, and by work environment. We segment those because things that may work on the hospital unit may not work in our clinics and may not work with those who are remote or hybrid. We have done some things from a global approach."
Ensure employees have tools to ease stress. Scripps Health offers psychologists on site at different facilities for short-term counseling, as well as virtual mindfulness classes and virtual music therapy. Mr. Cole said the health system also is in the process of deploying a peer support program from Baltimore-based Johns Hopkins Medicine, which pairs employees and allows them to confide in each other about what they're going through. Scripps has deployed the program at two facilities and will ultimately expand it across the organization.
Recognize employees. Leaders should recognize employees in a personal way, according to Mr. Cole.
"Sending out a global email to everyone in the department and an impersonal message probably isn't the best thing to do," he said. "Making it as personal as possible is what we're seeing. We've said, 'Express your appreciation in spoken word and then follow up in written word. That spoken word will help alleviate stress in the immediate, but that written recognition is something they can carry with them to make sure they understand the recognition over the long term."
The Don'ts
Don't disregard employees' problems. An employee having a problem on a unit should not be disregarded, Mr. Cole said. Their concerns should be listened to and understood to ensure they are not overloaded with work for long periods. They should also be assured that there's a plan to ease a short-term increase in work, he said.
Don't disconnect. Mr. Cole also recommends not disconnecting with employees. He said he has a lot of staff working from their homes, making it harder to connect, but he continues to meet routinely with them .
He said there may not even be a topic on the agenda, "just how are people feeling."
Don't take away hope. Dr. Wilner said leaders should not take away hope that the pandemic will end.
"I think it's wrong to say, 'This is the new normal, and we have to simply adjust,'" he said. "There's nothing normal about this, and I think it's our responsibility to infuse people with hope that this will pass, and we will get back to a situation that's more manageable for everyone. We have to talk up vaccinations, we have to talk up therapeutics — that there will be ways us as a society will move past this."
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