How smaller hospitals can improve the mental health of workers

Leaders of hospitals of all sizes should be concerned about the well-being of their workforce.

However, smaller hospitals and systems don’t always have the resources available to invest in some wellness initiatives, such as hiring new staff to focus on the well-being of workers.

The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, partnered with the Lorna Breen Heroes Foundation to produce a new guide on improving the wellness of the workforce.

The guide, which was released March 18, offers guidance for hospitals of any size, says Dr. John Howard, the NIOSH director.

“There are very small hospitals, rural hospitals that are basically hanging on from a financial standpoint,” Howard says.

Read more: How hospitals can improve the well-being of their workers

Larger hospitals may be able to hire additional staff to prevent clinicians from being overworked, or additional staff to focus on wellness efforts. But Howard adds that smaller hospitals can use the guide and make improvements in well-being without big financial investments.

“The smaller less resourced institution can take the guide," Howard says. "They don't need to spend a lot of money. They don't need to hire a bunch of staff. Because one of the important points that I think that the guide makes is in two-way communication, because that's how you build trust.”

Taking initial steps

The guide offers six 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
• Read more: Getting hospitals and state medical boards to drop invasive questions on mental health

Dr. Stefanie Simmons, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, says hospitals of any six can utilize those steps.

“I like to think of this guide as an enzyme,” Simmons says. “So when you have a chemical reaction, an enzyme lowers the activation energy, right and helps the physical reaction go. And so what we're really trying to do here is to accelerate the pace of change in organizations, regardless of what stage of development their professional well-being programs are in.”

Some hospitals and health system leaders may be intimidated by the task of beginning or expanding well-being programs, she notes.

“If you're at the very beginning stages of addressing this issue, the problem can seem overwhelming,” Simmons says. “You can feel like in order to improve the professional well being of your healthcare workers, you need to solve for the entire U.S. healthcare system, and on any given morning, that can really feel like a daunting task. So what we've done here is really provide some first steps, some actionable steps that are achievable with the existing resources within the organization.”

• Read more: Nurses in hospitals: Burnout by the bedside

An advantage in smaller hospitals

While smaller hospitals may not have the resources of larger organizations, they may have one advantage over larger hospitals.

In a smaller hospital, managers often have more direct contact with front-line workers, so the communication can be easier than in organizations where hospital executives are removed from clinicians and other staff, Howard says. Leaders and staff are more likely to genuinely know each other and talk on a regular basis.

“Because sometimes we see in a large institution, there's all that distance between the frontline worker and upper management,” Howards says.

“Sometimes for a large organization that even has a really great starting point, they may actually have a well-being program, sometimes there's problems there, because of the communication issues,” he adds.

Even very small hospitals have managers, and Howard says some efforts could begin by simply pairing one manager and one employee at the table and walking through the steps in the guide.

“I don't think the resource implication, whether it be time, personnel, etc., is that big of an issue really,” Howard says.

Simmons, an emergency physician, has worked in hospitals of all sizes, including rural community hospitals. She says the guide was developed to be useful to large and small organizations.

“When we were designing this guide, we were very thoughtful about making the steps to have utility in all of those settings, and to be accessible, regardless of the type of setting that someone is working in who wants to make change,” she says.

Both Simmons and Howard stress the importance of diversity on teams focusing on improving well-being, but Howard notes that a smaller hospital in a very rural area could have a largely white population.

But he says well-being teams should include members of different departments, including people outside the managerial ranks, to get a mix of views.

“Even at a rural hospital where you may have one particular type of ethnicity, you still want diversity in opinion, in perspective, in outlook,” Howard says. “I think those kinds of diversities are extremely important, too.”

• Read more: Doctors aren’t the only ones battling burnout. Many medical school students are hurting.