Partnering during the Pandemic: HAP’s Series of Resources for Hospital Leadership, Management, and Staff

Originally published in HAP Update

Week 1

HAP Update, January 25, 2021

The entrance of COVID-19 into our lives may seem like an eternity ago, but our health system clinicians, management, leadership, and staff have been there for every step, providing thousands of patients with life-saving care as they meet the challenges of this singular public health crisis. Nearly a year into the pandemic—and with the full-scale distribution of the COVID-19 vaccine still months away—it is critical to prioritize the well-being and resiliency of staff during these challenging times and beyond.

This week, HAP debuts its month-long series, Partnering during the Pandemic, which provides weekly resources for hospital leadership, management, and staff. This weekly series builds from HAP’s Resources for a Resilient Workforce and focuses on ways hospital leadership, management, and staff can partner to build resiliency.

Our first edition of the series focuses on walking rounds, communication, and self-care.

For Leadership: Follow up walking rounds with feedback and next steps

Walking rounds provide an opportunity for hospital leadership to meet with staff to discuss safety and to receive direct feedback from workers on the frontline of care. This form of engagement allows leadership to identify issues surrounding workplace safety and to establish a culture of care from leadership to staff.

Sexton, et al. discusses how walking rounds with feedback are associated with an improvement in a range of metrics including:

• Higher workforce engagement
• Lower personal burnout and burnout climate
• Identification of patient safety and quality improvement opportunities

For Managers: Communication during the pandemic

Hospital managers face a constant flow of information during this public health crisis. More than ever, it’s critical for managers to identify and prioritize strategies for effective communication that establish trust among staff.

When it comes to communication, the American Organization of Nursing Leadership has identified methods to establish and maintain trust:

• Be Transparent: Managers should be transparent when sharing information with staff, even when acknowledging they don’t have all the answers. Reassure staff you will follow up on questions and concerns as quickly as possible
• Be Vigilant: Misinformation and rumors can spread wildly during periods of crisis. Establish a hotline or designated email space where staff can feel free to ask questions
• Be a Resource: To help ward off rumors and misinformation, reinforce the go-to locations for staff to receive relevant information from trusted resources

For Staff: Identify opportunities for self-care

Encouraging self-care among staff can improve team cohesiveness and resilience, and lower stress.

HAP has created infographics to help support this mission. The Staff Supporting Staff infographic provides a quick look at simple ways staff can engage in brief moments of self-care and support each other. In an era that requires constant multitasking and complex decision-making, encourage staff to take mindful moments throughout the day. 

Hospitals can support the importance of self-care among staff by:

• Encouraging staff to pair up with a colleague or mentor
• Posting reminders in staff lounges about the importance of self-care
• Communicating and sharing resources for staff about stress, burnout, and behavioral health

Week 2

HAP Update, January 31, 2021

HAP’s month-long series, Partnering during the Pandemic, provides weekly resources for hospital leadership, management, and staff. This weekly series builds off HAP’s Resources for a Resilient Workforce and focuses on the ways hospital leadership, management, and staff can partner to build resiliency.

The second edition of this series focuses on the benefits of psychological first aid and how positive psychology practices can benefit leadership, management and staff.

For Leadership: Psychological First Aid (PFA)

While training to protect hospital staff from sudden physical injuries has become the norm, it’s just as important for hospital leaders to protect employee mental health.

As the pandemic moves through multiple surges, it has and will continue to take a toll on everyone, even the most resilient staff. In addition to employee assistance programs, hospitals have added another layer of protection against the relentless stressors related to the pandemic.

PFA offered through a peer-responder system can identify staff at risk, provide immediate support, and connect staff to additional resources to overt a crisis. The World Health Organization (WHO) defines PFA as “humane, supportive, and practical assistance to fellow human beings who recently suffered a serious stressor.”

Hospitals and large medical centers have implemented psychological first aid training across systems and equate it the CPR of mental health.

PFA training may have several important potential benefits for your staff and creates a culture that prioritizes employee mental health.

The WHO outlines three core action principles of PFA:

• Look:  Check on individuals experiencing distress and identify their basic health needs
• Listen:  Hear an individual’s concerns and help them feel calm
• Link:  Connect the individual with resources and support to address their basic needs and provide professional assistance when needed         

Free resources are available to learn more about providing PFA and different models of care.

For Management: Positive Psychology for Reducing Burnout

Throughout the pandemic, we have heard consistent concerns about clinician burnout. As our frontline health care staff continue their important work, managers must be on the lookout for feelings of emotional exhaustion, disconnection from patients (depolarization), and low-or-no feelings of accomplishment or rewards from work (inefficacy). 

Positive psychology focuses on the elements of life that provide meaning and fulfilment. Creating an environment that supports positive psychology may reduce the impact of burnout. Just like burnout, positivity is contagious.

During this challenging time, it’s important for managers to identify opportunities to provide positive messages for staff, such as:

• Utilize white boards for sharing positivity messages
• Encourage staff to post and share patient success stories
• Identify inspirational messages to share with your team

For Staff: Positive Psychology for Staff

We are neurologically wired to remember bad events as a way of self-preservation; however, in doing so, we may overlook the good things that happen. There are many ways to boost positivity and charge the resiliency battery whether in the midst of your work day or at home. 

Here are three strategies that may help staff improve wellbeing:      

• Three good things:  Take time to notice three good things before you go to bed, write them down, and focus on what your role was in them. Practicing every night for two weeks has demonstrated significant impact
• Positive reminiscing:  Thinking about a joyful event such as a vacation or celebration can bring in positive emotions. Take a minute or more and relive the event in as much detail as possible. Having pictures of the event may enhance your memory. Pay close attention to how you are feeling as you remember the event
• Savoring:  Try this simple, easy-to-do-anywhere moment when you slow down and pause to really enjoy a positive experience. Think of it like “smelling the roses.” The moment can involve one or more of your senses. Try eating something you enjoy slowly, even if it is just for a minute, or really enjoying your favorite song

Week 3

HAP Update, February 8, 2021

The Hospital and Healthsystem Association of Pennsylvania’s (HAP) month-long series, Partnering during the Pandemic, provides weekly resources for hospital leadership, management, and staff. This weekly series builds off HAP’s Resources for a Resilient Workforce and focuses on the ways hospital teams can build resiliency.

The third edition of this series focuses on strategies for well-being, leadership tips for managers, and methods to build staff resiliency.

Leadership: The Well-Being Playbook

There is a multitude of research, articles, editorials, and opinions on clinician well-being and strategies to create a healthy workplace culture. This growing body of literature emphasizes the importance of integrating clinician well-being into a strategic plan with shared accountability for success across all levels in the organization. Although helpful, there also is caution in only offering wellness programs that support the individual; this approach may send a message that burnout is solely the responsibility of employees.

The American Hospital Association has published a Well-Being Playbook that discusses the ways that burnout can impact quality, physical, and psychological health, worker productivity, and turnover. The playbook outlines the seven steps health care leaders can take to improve organizational well-being:

• Create infrastructure for well-being                
• Engage your team
• Measure well-being
• Design interventions
• Implement programs
• Evaluate program impact
• Create a sustainable culture 

Managers: A resource for team leadership and problem-solving  

Connecting well as a team facilitates engagement, cohesiveness, and improved problem- solving. The collective ability of a team grows exponentially when we work toward a common goal.

The Institute for Healthcare Improvement hosted a series of seven virtual learning hours, including a session focused on what effective leaders can do to help their team problem-solve and find joy in work. This resource highlights the ways leaders can support staff, such as:

• Taking an active interest in what gives staff purpose and meaning
• The importance of being present and engaging in conversations
• Building psychological safety

This connection and co-creation engages and empowers staff, and increases a sense of control, purpose, and camaraderie, all of which build resilience and decrease burnout.   

Staff: Tips for a Resilient Staff

Resiliency is the ability to successfully adapt to trauma, adversity, tragedy, or a significant threat. There are many benefits that stem from being resilient, such as improved longevity, well-being, and a sense of control. The good news is you can build resiliency. Taking care of yourself is one way to boost your resilience. However, there are other ways to build resilience, as well. Stanford Medicine has identified several strategies to build resiliency:

• Make connections
• Avoid seeing crises as insurmountable problems
• Accept that change is a part of living
• Move toward your goals
• Take decisive actions
• Look for opportunities for self-discovery
• Nurture a positive view of yourself
• Keep things in perspective
• Maintain a hopeful outlook
• Take care of yourself

Week 4

HAP Update, February 15, 2021

HAP’s month-long series, Partnering during the Pandemic, provides weekly resources for hospital leadership, management, and staff. This weekly series builds off HAP’s Resources for a Resilient Workforce and focuses on the ways hospital teams can build resiliency.

The efforts to promote resiliency and well-being are enduring challenges for health care organizations, and HAP is proud to work with hospitals and health systems across the commonwealth to address these important issues during the pandemic and beyond.

The fourth edition of this series focuses on the “Quadruple Aim” for health care improvement, supporting clinicians through listening, and peer support for staff.

Leadership: The Quadruple Aim

The Institute for Healthcare Improvement’s (IHI) “Triple Aim Initiative” has been widely adopted by many organizations as a standard to improve care. The IHI framework sets three clear goals to improve the patient experience, support better health outcomes for populations, and reduce the cost of care.

During the last decade, many organizations have added the clinician experience to this framework to create a “Quadruple Aim,” as it is impossible to achieve our goals for patients, populations, and cost containment without supporting our clinicians.

Reaching the Quadruple Aim requires a shift in culture and a commitment that permeates through all levels of the organization; it will not happen without intention. The National Academy of Medicine (NAM) offers a wealth of information, research, and resources, including a report that identifies the causes and consequences of clinician burnout and provides system-wide approaches to promote professional well-being.

The report highlights the following steps to take action against clinician burnout:

• Create positive work environments
• Create positive learning environments
• Reduce administrative burden
• Enable technology solutions
• Provide support to clinicians and learners
• Invest in research

In response to the parallel pandemic of clinician burnout, NAM recently announced a two-year extension of the work being done through the Action Collaborative on Clinician Well-Being and Resilience.

NAM is among multiple national organizations offering an extensive list of research and resources, including the IHI, the American Hospital Association, and the American Medical Association. Don’t reinvent the wheel. Utilize the resources to guide your organization’s initiatives for improving clinician well-being, remembering to tailor the work to the needs of your staff.

Management: Supporting staff through listening

The psychological impact of the pandemic is not isolated trauma. Moral distress is often a shared experience, increasing the toll on everyone involved.

Shanafelt, Ripp, and Trockel discuss anxiety among health care professionals during the pandemic. During a series of listening sessions with clinicians, the researchers note the drivers of anxiety include a mix of professional and personal concerns, such as the fear of COVID-19 exposure at work and the potential to spread the infection at home.

As the researchers note, the “best way to understand what health care professionals are most concerned about is to ask.” During the listening sessions, the researchers identified key the ways management can provide helpful support in five key categories:

• Hear
• Protect me
• Prepare
• Support me
• Care for me

Now and beyond the pandemic, understanding staff concerns serves as a foundation that is critical for mitigating fears as much as possible through visibility and clear communication. It also provides a first step to deliver solutions to address those anxieties and concerns.

Shanafelt and Swensen offer an in-depth look at reducing burnout in their book, Mayo Clinic Strategies to Reduce Burnout:  12 Actions to Create the Ideal Workplace.

Staff: Peer Support

Being engaged at work during a pandemic is like trying to squeeze water from a stone. Staff are physically and mentally exhausted. Now, more than ever, it is vital to ask for help. It is essential to you, your patients, and your coworkers. Camaraderie is one of the strongest bonds that pulls teams through a crisis. Expressions of gratitude can boost morale and make even the most difficult shift manageable, as well.

The Centers for Disease Control and Prevention (CDC) emphasizes the importance of communication among staff during this challenging time and recommends:

• Talking openly about how the pandemic is affecting your work
• Identifying factors that cause stress and work together to identify solutions
• Asking about how to access mental health resources in your workplace

As the CDC notes, “it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.” This important reminder remains critical for caregivers during the pandemic and beyond, as we begin to envision a “new normal” after COVID-19.

Last year, a peer-to-peer support group was established to help frontline workers during the COVID-19 pandemic.

For more information: Contact Beth Murray, HAP’s readmissions project manager, or Mary Marshall, HAP’s director, workforce and professional development.

 

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Topics: Workforce

Revision Date: 2/15/2021

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