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How hospitals can improve the well-being of their workers


John Howard of the National Institute for Occupational Safety and Health and Stefanie Simmons of The Dr. Lorna Breen Heroes’ Foundation talked with us about a new resource for health systems and the steps hospitals should follow.

Hospital leaders have frequently described the well-being of their workforce as one of their top concerns.

Conversely, many workers have said their mental health and wellness needs to be a higher priority.

Undoubtedly, the mental health of clinicians and other healthcare workers is gaining greater attention, and hospitals that are looking to make improvements now have another resource at their disposal.

The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, has teamed with the Lorna Breen Heroes Foundation to produce a new guide outlining steps to improve the wellness of the workforce. The guide was released March 18.

Dr. John Howard, director of NIOSH, and Dr. Stefanie Simmons, chief medical officer of the Lorna Breen Heroes' Foundation, spoke with Chief Healthcare Executive® about steps hospitals can take to help their workers. They offer insights on how health systems can help their clinicians and other vital staff members.

They both stressed one key point: The issue isn’t improving the resilience of workers.

Howard notes that even well-intentioned efforts to help workers become resilient are insufficient.

“Sole reliance on that has not worked,” Howard says. “It does not solve the problem at all, because there are these organizational issues, which differ, really differ, between each institution, that the workforce is really interested in.”

“Healthcare workers are intelligent, talented, resilient people,” Simmons says. “Trying to make them more resilient is not going to fix them.”

(See part of our conversation with Dr. Howard and Dr. Simmons. The story continues below.)

Six steps for hospitals

The new guide outlines six critical steps for hospitals and health systems to improve their well-being.

  • Review hospital operations to see how they support the well-being of staff
  • Assign a team to support wellness
  • Make it easier for staff to get assistance, including eliminating intrusive questions on credential applications
  • Develop methods of communication to tell staff about the hospital’s progress in improving well-being
  • Integrate well-being measures into an ongoing quality improvement project
  • Create a 12-month plan to continue progress in the hospital’s professional well-being

CommonSpirit Health worked with NIOSH in testing the steps in the guide at six of the system’s hospitals. Simmons notes CommonSpirit has a robust well-being team, but the different hospitals have their own unique environment.

“What we found during the pilot was that going through the Impact Well-being Guide, really prepared the hospitals that participated, to benefit from the resources that the health system had developed,” Simmons says.

‘Address the source of the bleeding’

Hospitals need to take a system-wide approach to improving the wellness of workers. An emergency physician, Simmons likens improving the well-being of the hospital workforce to treating a patient with severe bleeding.

“When you have somebody in front of you with a bleeding wound, you need to hold pressure or that patient will bleed to death,” Simmons says. “And holding pressure is what individual resilience-related interventions does. It helps individuals in the moment get through the awful wound that they've experienced. But if you don't then address the source of the bleeding, the patient still dies.”

Health systems must "go past that individual support to the source of the bleeding, the drivers of burnout, the administrative burden, the leadership focus, and the causes, the barriers to receiving mental healthcare," she says.

Hospitals would do well to create teams to examine well-being, but those teams should include diversity in gender and racial groups. The teams should also feature members with different roles in the organization, Howard says.

“If you're going to have a meeting start off and you look around the room, and it looks like a bunch of managerial types, as opposed to frontline types, regardless of racial, ethnic, and gender diversity, that's a big problem,” Howard says. “So diversity writ large, I think, is extremely important.”

Many clinicians struggle with burnout but say they’re reluctant to get help, and one of the leading concerns is the perception that they could hurt their career or risk their license for seeking help for their mental health.

The Lorna Breen foundation has been leading the charge to get state licensing boards and health systems to drop invasive questions about the mental health of employees and applicants. The foundation is named in honor of an emergency physician who died by suicide early in the COVID-19 pandemic.

“These intrusive questions prevent many healthcare workers from seeking help,” Simmons says.

Hospitals engage in a variety of quality improvement efforts, and as they seek to improve patient care, they should also be mindful of the impact on workers.

Simmons says health systems should look at interventions that can lead to the best possible outcomes for patients, without adding “unnecessary work to the healthcare workforce in order to get that outcome.”

“There is something wrong with the way that we're providing patient care when we are spending time doing unnecessary work, instead of caring for the patients in front of us, especially when there's unmet need,” Simmons says. “And we know people are waiting while we're doing this unnecessary step.”

Health systems also need to communicate the steps they are taking to improve well-being, and how they are incorporating feedback from staff on necessary improvements. Howard stresses that hospitals shouldn’t just rely on written communications.

Instead of posting a notice on the bulletin board, “the well-being team could come around and talk to each shift,” Howard says. Even as teams report to the next shift, there could be discussions of issues related to well-being.

“There's all sorts of ways that you can communicate,” he says. “It's a challenge in a hospital setting. And I think that what we want people to do is think through how you could, in your institution, take advantage of some of the ways that work is done to be able to take a minute or two to communicate with frontline healthcare workers.”

‘A living document’

Many hospital leaders have expressed concern about the well-being of their workers, and with good reason. Many doctors, nurses and other workers have said they are worn down and are considering career changes. One in five healthcare workers switched jobs in a 12-month period, according to a report from Press Ganey.

Six out of 10 doctors report feelings of burnout, according to The Physicians Foundation’s 2023 Survey of America’s Current and Future Physicians. That’s up from four out of 10 doctors in 2018. Women physicians and residents are more likely to struggle with burnout, according to the foundation.

In recent years, nurses have said they are struggling with burnout and have urged hospital leaders to take measures to improve the workplace. The American Nurses Foundation surveyed more than 7,400 nurses last May, and the majority of nurses (56%) said they are experiencing burnout. Roughly 2 out of 3 nurses (64%) said they feel “a great deal of stress” at work.

Howard says he hopes the guide can be a valuable resource for hospitals, but he says it can also be refined. He refers to the guide as “a living document.”

“Now it's really out there for a lot of facilities to see,” Howard says. “So that's one thing that I'm really interested in seeing is when it's out there in the larger world, how can we make it better?”

Coming tomorrow: How smaller hospitals and systems can take steps to improve the well-being of their workers.

Getting help

988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.

The American Foundation for Suicide Prevention offers resources for healthcare professionals.

NAMI: The National Alliance for Mental Illness offers “frontline wellness” resources for healthcare workers and public safety employees.

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