Since the pandemic began, healthcare professionals have gone above and beyond the call of duty to care for their communities. Faced with uncertainty about the virus itself and the crushing demand it created, many risked their own health to keep the delivery system running. Healthcare leaders worked closely with frontline staff and had to act fast and adjust policies and practices, redeploy staff, and change the pace and channels of communication, all while the ground constantly shifted under their feet. The crisis offered lessons about how to lead, communicate, recognize, and tap into staff expertise, as well as the need to respond to the toll this crisis is taking on employees.
Survey respondent: “The effectiveness at our institution was driven by an overwhelming sense of collaboration and coordination. All staff, especially those on the frontline, rose to the call and went above and beyond to support the needs of the hospital.”
KEY FINDINGS
The right people must be involved in decision-making.
Early in the pandemic response, healthcare organizations and governments faced the impossible choice between making decisions efficiently to maximize impact or applying the same rigor to due diligence as they do in less dire circumstances. This trade-off was managed with varying levels of success – sometimes prioritizing speed, sometimes prioritizing inclusiveness, sometimes achieving neither. As a result, certain policies failed and had to be adjusted or dropped entirely, creating confusion within organizations and the community. Getting to the right level of speed and inclusiveness requires both long-term strategies for planning and engagement, and thoughtful management in the heat of the crisis. This includes ensuring the representation of frontline workers, operational experts, and health equity leaders. In a similar vein, provider organizations may want to bring community perspectives into their emergency planning processes.
Cross-sector knowledge transfer for crisis planning and response has become commonplace, with many national examples proving its benefits. However, this type of collaboration has unmet potential – for example, the potential for healthcare providers to partner with technology leaders and tackle the growing cybersecurity threat.
Transparent, frequent communication is crucial.
Healthcare communications adapted to better combat crisis-induced confusion and misinformation. To communicate the magnitude and frequency of change to their employees, organizations established a single voice of authority and moved beyond email and into mediums like virtual CEO town halls, Facebook groups, SMS messages, and specialized webpages. This apprised staff of change; fostered structured, predictably-timed content; provided employees an open forum to offer feedback and suggestions; and maintained morale. However, information overload was recognized as an active concern. Lastly, the increased internal use of translation and interpretation services is here to stay and should be considered in emergency planning.
Employers had no choice but to get creative.
Systemic and worsening workforce shortages, exacerbated by a multitude of factors – including illness, family obligations, and travel employment opportunities – occurred in parallel to the creation of pandemic-specific roles, such as drive-through testing attendants and vaccination staff. While some of these new roles were filled by volunteers, much of this workload fell to frontline workers with existing responsibilities. For those more traditional roles, solutions like pre-credentialing, activating retired and foreign-trained clinicians, and deploying medical and nursing students as appropriate were essential for temporary relief.
While staff shortages necessitated cross-role flexibility within the provider setting, not all roles could be flexed. Still, continually cross-training staff and keeping a current record of employee skills for redeployment when needed was widely recognized and adopted as a best practice. To reach that goal, many providers deployed surveys to inquire about past and current skills and experience in clinical expertise, nursing expertise, and support services.
Burnout and turnover were exacerbated.
Healthcare workers are known for their resilience. However, more than two years and counting of nonstop demands and the emotional strain of caring for and losing so many COVID-19 patients, all compounded by pandemic-related home life and family well-being stresses, have taken an enormous emotional toll on personnel at every level of the organization. Providers have accelerated initiatives to address the resulting increase in employee burnout and turnover. Some measures, like removing all non-essential activities during surges, were adopted widely. Other initiatives include stress first-aid programs, resilience carts, peer support programs, group sessions, childcare support, and individual support sessions with behavioral health clinicians with an opt-out model to remove the stigma often associated with seeking such care.
While much attention is deservedly placed on frontline workers, it is import ant to recognize administrative and clinical leaders for their contributions. Leadership talent is at a premium in the field, and healthcare needs to remain a desirable career path for young leaders in Massachusetts.
Survey respondent: “The ongoing capacity and workforce challenges pose real threats to our ability to respond to the next public health emergency. These require a commonwealth-wide assessment and discussion as these issues are not limited to any single institution.”
RECOMMENDATIONS
Identify ways to quickly expand the healthcare workforce to meet surge needs and expand the pipeline for the future.
The state’s healthcare system needs to build a structure and reserve capacity for staff through provider coalitions or partnerships with institutions of higher learning to better prepare for public health emergencies. While caregiver reserves are likely to be prioritized, this structure should also include other roles that power the care continuum, including behavioral health and transportation professionals. To the extent possible, triggers for activation of reserve staff, along with the logistics of their deployment, should be codified within statewide emergency planning and drilling activities for both general and specialized roles.
These efforts should include the identification and mitigation of regulatory barriers to staffing flexibility across the care continuum and state lines. Examples include enabling paramedics to deliver certain types of home care and creating a single credential that allows doctors to provide telehealth services across the continuum.
The regulatory enablement of digital health capabilities must be prioritized to increase caregiver flexibility and improve the staffing efficiency of care delivery. Where needs remain, provider organizations should sustain their relationships with third-party staffing partners and work with federal partners to address significant flaws within the travel staffing model.
Reimagine how to support and deploy a limited workforce.
Healthcare was experiencing a concerning shortage of healthcare workers before the pandemic. The problem has only worsened and is now spreading to non-clinical roles, such as administration, information technology, transportation, and environmental services. The workforce is foundational to every aspect of the healthcare system — its resilience should be recognized by committing to priorities like flexible staffing models, having caregivers working at the top of their licenses, and offering easily accessible behavioral health services and childcare support.
Since progress to grow the workforce pipeline will not happen overnight, organizations need to optimize workflows and use technology where appropriate to increase providers’ patient care capacity. At the same time, healthcare organizations need to train employees in advance of disaster scenarios in competencies such as PPE use and surge care.
Alleviate employee strain.
The enormous toll the pandemic is taking on employees has driven burnout and staff shortages. To address the problem, healthcare organizations should continue to evolve expectations of an appropriate work-life balance for employees by allowing them to “unplug” from work in their off hours. Other measures include offering flexible scheduling and wraparound services like child care, family care support, and financial guidance. Additionally, using a team-based care delivery model places less burden on any single healthcare worker.