Change is how we show health care workers real support
As Covid-19 cases rise at a dangerous pace throughout the country and hospitals start to fill up, health care workers are shouldering much of the burden. During the first wave, many drew attention to widespread burnout of clinicians and other hospital workers in Covid-19 hot spots. But with Covid-19 taking over nationwide the burnout has become “burnover,” write Dr. Wendy Dean and Dr. Simon Talbot, in a recent op-ed in Stat News.
Dean and Talbot were among the first to apply the term “moral injury” to health care. In the military, moral injury occurs when soldiers perpetrate or witness actions that go against their own moral beliefs. But this also happens in health care, when “clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their long standing, deeply held commitment to healing.” While burnout puts the onus on the individual patient to slow down, relax, and get better, moral injury identifies the root cause as a health care system that forces clinicians to put profits over patients.
In this Covid-19 wave, health care workers are experiencing multiple types of distress from moral injury, Dean and Talbot write. One is the demoralization and exhaustion of having to care for so many people who are so sick, day after day. The other is a feeling of betrayal because they feel their leaders are not fighting for them and are still putting profits ahead of their well-being. When hospital administrators call health care workers “heroes” it feels performative, not sincere, because the sentiment is rarely backed up with real protection or compensation.
Medical schools responding to COVID pic.twitter.com/0H4mtU6DEF
— Shailin Thomas (@shailinthomas) November 30, 2020
Some hospitals have responded to rising clinician distress with free water bottles and mandatory wellness programs. Clinicians need resources that help build their resilience, but these piecemeal initiatives alone won’t cut it.
Health care leaders need to show health care workers that they have their backs, that they aren’t “essential but disposable.” The first step for rebuilding trust is to “loudly and publicly” advocate for common-sense measures to reduce the spread of Covid-19, such as masking and physical distancing, Dean and Talbot write.
A guide to promoting health care workers’ well-being published recently by the Institute for Healthcare Improvement recommends that the first thing that health care leaders need to do is meet the needs of the workforce:
Leaders need to do everything within their power to ensure that the immediate needs of the workforce are addressed — whether that’s providing food, physical PPE, childcare resources, transportation support, ensuring the availability of a broad array of mental health services, or other types of support. Longer term, it’s imperative for leaders to ensure that all health care workers earn a living wage and have good health insurance that covers mental health services.
Another essential element is listening. Health care workers feel as though they are not being heard; administrators and other leaders should put themselves in the shoes of clinicians and try to feel what they are feeling. The IHI guide recommends establishing formalized listening sessions to give health care workers a safe space to share.
However, improving clinician wellness cannot end with Covid-19. The gap in trust between front-line workers and administrators did not start with Covid-19; it has eroded over many years of hospitals making decisions based on what was “good for business” rather than good for patients. Moving forward, health care leaders must commit to fixing the systems that make clinicians feel like cogs in a wheel; protecting them from hate and bias; reducing the enormous administrative burden; and eliminating incentives that push clinicians to do more tests and procedures on patients rather than spend time with them.
“Supporting health care workers’ mental health is not just about supporting individuals as they cope with unimaginable situations. It is also about improving the environment, processes, policies, and cultures of institutions and their communities.”
Wendy Dean and Simon Talbot
Now more than ever, hospitals need to be civic leaders in their communities. That not only means taking care of patients that need medical care, but taking care of their workers’ physical, mental, and emotion needs–now and after Covid-19.