The COVID-19 pandemic continues to change the healthcare landscape. The destructive nature of the virus, lockdowns, delayed preventative care and increased infection rates have all placed immense pressure on healthcare providers around the world. Health workers have had to navigate a series of daily challenges with many unknowns and continually adapt both their efforts and mindset. While vaccine rollout has begun to accelerate in places such as the United States and the United Kingdom, many countries are in the midst of a third or fourth wave. We have collectively made strides forward from this time last year, but the pandemic and its toll on frontline workers around the world are still far from over. This article covers some of challenges health workers continue to face and strategies that leadership can adopt to help support their mental health and wellness.
The Impact of COVID-19 on Health Worker Mental Health
In January 2021, the number of COVID-19 cases continued to steadily increase globally, with the death toll surmounting two million. Limited personal protective equipment (PPE), overcrowded healthcare facilities and devastating loss of both patients and healthcare staff are all factors that have caused strain on the mental health and well-being of clinicians around the world.
An October 2019 report released by the National Academy of Medicine found as many as half of U.S. doctors and nurses experience substantial symptoms of burnout, resulting in increased risks to patients, malpractice claims, worker absenteeism and turnover, as well as billions of dollars in losses to the medical industry each year. Dr. Victor Dzau, President of the National Academy of Medicine affirms that these challenges have been compounded by COVID-19, stating, "There's lots of data to show that the burnout effect on clinicians is causing more medical errors [and] COVID-19 has made it worse."
The recent study, Impacts of COVID-19 on Health Care Workers: Infection Prevention and Control, indicated that that seven in ten health workers reported worsening mental health during the COVID-19 pandemic.
Research shows that since the start of the pandemic, the mental health of clinicians around the world has been negatively impacted. According to the International Journal of Emergency Medicine, studies found frontline health workers engaged in direct COVID-19 patient care are at a higher risk of depression, anxiety, insomnia and distress. The recent study, Impacts of COVID-19 on Health Care Workers: Infection Prevention and Control, indicated that that seven in ten health workers reported worsening mental health during the COVID-19 pandemic. The report concluded that participants in the initiative who worked directly with confirmed or suspected cases of COVID-19 and those who experienced restrictions associated with the supply of personal protective equipment (PPE) were more affected than others. In a separate study assessing anxiety, stress, depression and insomnia, researchers found that 63% of health workers reported mental disturbances.
The onslaught and severity of clinical staff’s mental health has been brought to the forefront of the pandemic. These effects can negatively impact caregivers as well as patients and their loved ones. When clinicians are experiencing burnout, grappling with severe emotional strain and working in a high-stress environment, this can result in increased risk of medical errors.
Bridget Duffy, MD, Chief Medical Officer, Vocera Communications, affirms this sentiment in the article, “Care for Caregivers More Important Now Than Ever,” stating, “Numerous studies have demonstrated how provider burnout is directly linked to quality and safety... Those who have emotional exhaustion, fatigue, and burnout have higher incidents of adverse events, medication errors, and bad outcomes in operating rooms.” Duffy goes on to emphasize that health workers’ experience is directly related to patient experience–– if a physician or clinician is experiencing burnout, this can negatively impact patient experience and satisfaction.
Promote Empathic Communication and Care for the Caregiver
It's increasingly important for healthcare organizations to be equipped with tools and programs that can specifically address and provide lasting solutions to the mental health challenges facing frontline staff.
In “Supporting Clinicians during Covid-19 and Beyond — Learning from Past Failures and Envisioning New Strategies,” Dr. Tim McDonald, Chief Patient Safety & Risk Officer, RLDatix, challenges healthcare leaders to implement organizational approaches to improve clinician well-being and suggests that these strategies are more effective than strategies focusing only on personal resilience.
Dr. McDonald explains that programs should be designed using a range of strategies, including peer support, as a way of framing emotional stress as an occupational hazard. Key aspects include incorporating processes that involve reaching out to clinicians and proactively offering support, as well as "reach-in” components that allow clinicians seeking help to easily obtain access to professional resources.
Dr. McDonald explains that programs should be designed using a range of strategies, including peer support, as a way of framing emotional stress as an occupational hazard. Key aspects include incorporating processes that involve reaching out to clinicians and proactively offering support, as well as "reach-in” components that allow clinicians seeking help to easily obtain access to professional resources. Additionally, it’s important for leadership to take accountability to mitigate workplace stressors, allocate resources to support these initiatives and assess program outcomes.
Provide Consistent Opportunities for Staff to Share Safety Concerns
Healthcare teams are balancing a variety of tasks throughout their shifts. Between caring for patients, complying with necessary hygiene and COVID-19 guidelines and communicating with patients’ families, it can be challenging for staff to find time to communicate safety concerns with their teams and leadership. Safety huddles serve as dedicated time for staff to share ongoing safety issues and call attention to situations that could potentially cause harm to other patients, staff or families.
Relying on a local Excel sheet or paper files to manage safety huddle information can result in the loss of critical safety information. An automated safety huddle system helps centralize all safety huddle information into one place, supporting streamlined communication between teams. Leveraging an electronic system also equips huddle facilitators and leadership with a tool to quickly access information and collect feedback to improve future meetings.
Safety huddles will likely look different depending on the team and organization. What matters most is that leaders and their teams work together to create a safe space and time for staff to communicate safety concerns impacting them, their fellow team members and patients. These meetings can help leadership better understand the challenges that staff are facing and develop strategies to best support them.
Adopt a Just Culture and Empower Staff to Speak Up
As health workers continue to work in high stress environments, compounded by the impact of COVID-19, adopting a Just Culture has never been more important.
A Just Culture does not seek to absolve healthcare organizations or individuals’ errors, rather it aims to implement fair treatment of staff and support a culture of fairness, openness and learning. Staff shouldn’t feel afraid to speak up when something goes wrong–– instead, they should feel empowered to speak up and report incidents without fear of punishment.
In the context of COVID-19, health workers are working under unprecedented levels of stress, so it is increasingly important that they feel empowered to identify and report unsafe conditions, understand that when errors are made, those who are responsible will be treated fairly and equitably and trust that leadership will then implement necessary process changes. These steps play an important role in an organization’s journey to high reliability and a just culture.
Ultimately, healthcare leaders help shape an organization’s culture. Leaders who adopt a just culture lead with compassion, make time to understand what challenges staff are facing and implement lasting solutions that support the safety of staff and their patients.
Putting it All Together: Continued Support for Health Workers and Patients
Burnout, anxiety, depression and post-traumatic stress disorder (PTSD) are all serious mental health concerns facing health workers amidst the COVID-19 pandemic. Research conducted by The King’s College London and University College London found that, in England, approximately half of intensive care unit staff working during the pandemic may be suffering from challenges related to their mental health including severe anxiety and PTSD.
In the introduction to the newly released international patient safety report, “The Overlooked Pandemic: How to Transform Patient Safety and Save Healthcare Systems,” Jeff Surges, CEO of RLDatix, highlights the mental and physical wellbeing of health workers as key components of building back our global communities and economies following the pandemic.
The report also addresses a study published in the International Journal of Nursing Studies specifically aimed at understanding the impact of the pandemic on the nursing workforce. The study found that without appropriate support for mental and physical stress, nurses are at an increased risk for experiencing negative psychological effects that can eventually lead to burnout and significant loss from the nursing workforce. When looking toward the future, the patient safety report concludes with a strong call to action for efforts to improve both patient and health worker safety “given the indelible relationship between staff, working environments, patient safety and occupational safety.”
As healthcare organizations work to support the mental health of frontline staff, promoting empathic communication and Care for the Caregiver, providing consistent opportunities for staff to voice their concerns and adopting a Just Culture are key strategies to support leaders as they look to effectively address emotional stressors and moral injuries and improve patient and health worker safety during COVID-19 and beyond.