This is a series about how taking better care of their employees, hospitals can take better care of their patients.
A lot of the issues found at any healthcare facility are the exact same issues all organizations face, just magnified by a giant X-factor especially during the pandemic. Whether it’s stress, burnout, employee retention or customer satisfaction, for hospitals it all plays out at the level of life or death.
I recently attended a Healthcare Conference in Baltimore sponsored by Planetree International. Planetree is a hospital-based organization that promotes “patient centered care.” One of this organization’s guiding principles is: if you want to have good patient care you must FIRST “care for the caregiver.” In other words, to put it in language of non-healthcare folks: if you want your clients to feel well cared for, you better make sure your employees are well cared for, too.
So how did hospitals care for their employees, given the challenges brought on by the pandemic during the last three years?
That’s a lot of what the conference focused on: reports back from what truly was the trenches in the battle against Covid 19. Problems such as burnout and stress challenged healthcare workers before the pandemic, but they increased dramatically during the pandemic: Frontline hospital workers could forget about working remotely! They could forget about minimizing their exposure to the virus. They could forget about having ANY spare time for self-care. And they could forget about working a normal shift. Shifts of 12 to even 24 hours long, were not uncommon, with employees only able to catch short catnaps in chairs at work, day after day, week after week, month after exhausting month.
One can only imagine what it must have been like for doctors and nurses to have to take on this heavy workload and fear for their lives while doing it. Often times, they couldn’t see their families and had to stay in hotels or, at the very least, stay in separate areas (like the basement) set aside in the furthest corner of their own homes where meals would be left on trays in order to minimize contact between themselves and their OWN family. Now fold in the added job of being the SOLE caretakers for their dying patients during that first year of the pandemic, when no family members were even allowed into hospitals and you can easily see what an overwhelming task these healthcare workers faced.
These caregivers had to make difficult triage-like choices every day as to who needed their attention most with a patient load that was double, triple or quadruple, what they were normally accustomed to. Sometimes they’d call family members on their own phones so that these grieving loved ones could say goodbye to a dying mother or father. This kind of care was up to the caregiver to voluntarily deliver, and imagine the guilt they felt, when through no fault of their own, they were simply unable to provide it.
Eric Wei, M.D., Chief Quality Officer for NYC Health & Hospitals, talked about the guilt that caregivers feel in a keynote presentation where he kept referring to the caregiver as “The Second Victim.” Wei explained, “at the beginning of the pandemic, every time we would intubate a patient, we knew that in many cases, it was only a matter of time before that patient would pass away. It was so demoralizing. So, whenever we would extubate a patient, we decided to celebrate that event. We had a rock song that we would play, and we would dance to that song for a minute or two to lift our spirits through the darkest hours of the pandemic.”
“During the pandemic, we could barely even address the very bottom of Maslow’s pyramid of needs,” explained Dr. Kimberly Barrieault, a psychologist who works for Planetree and who I interviewed by phone after the conference. “Safe breathing supplies like N-95 masks, home cooked meals, and sleep and even safe shelter were all in short supply during the first year of the pandemic.”
Barrieault remembers hearing one doctor say: “I’m burned out and a massage chair is not going to fix it.” Dr. Barrieault’s doctoral dissertation was on burnout. Burnout is at an all time high right now for doctors and nurses, and it was already high before the pandemic. For organizations like Planetree, coming up with solutions to Burnout – which leads to high levels of turnover - is one of their top priorities.
“If we want to prevent burnout,” Barrieault explained, “we have to address all the levels of Maslow’s hierarchy of needs, not just the bottom of the pyramid. Employees want to feel involved, respected and appreciated. Burnout is more an emotional problem than a physical one. If employees feel like a cog in a wheel, everything they do feels like drudgery. Now that the pandemic is waning, we need to figure out how to address the very top of the pyramid and not just the bottom.”
In future installments we will look at exactly what these Planetree hospitals did for their employees to survive the pandemic, and how they hope to improve treatment and care of both employees and patients moving forward from here.