9 Lessons Learned From Pair of Healthcare Worker Well-Being Programs

The experience of two healthcare worker well-being programs implemented during the coronavirus pandemic generates recommendations.

The architects of two healthcare worker well-being programs launched at the beginning of the coronavirus pandemic share lessons learned in a new journal article.

Healthcare workers nationwide were already showing signs of distress and burnout before the pandemic. Earlier research showed that physicians experiencing at least one burnout symptom rose from 38.2% in 2020 to 62.8% in 2021.

The new journal article, which was published by JAMA Psychiatry, focuses on well-being programs launched by Columbia University Irving Medical Center (CopeColumbia) and the University of California-San Francisco (UCSF Cope).

CopeColumbia and UCSF Cope shared several characteristics such as being led by departments of psychiatry. CopeColumbia featured a model of peer support and education. UCSF Cope provided triage, assessment, and treatment services to all workers at the health system.

The new journal article offers nine lessons learned from the well-being programs.

1. Prepare for a future crisis: Healthcare organizations should prepare now for future crises, the journal article's co-authors wrote. "In addition to building a robust well-being program, healthcare systems must incorporate explicit plans for supporting mental health into future disaster preparedness. These plans require investment in a mental health workforce that has capacity and flexibility to respond during disasters."

2. Embrace structural change: Healthcare organizations should enact structural changes to boost well-being, the journal article's co-authors wrote. "Workplace well-being is largely dependent on structural factors. After the initial shock of managing the fear and uncertainty of a novel deadly virus, we found that sessions emphasizing individual well-being and coping strategies without adequately addressing (or at least acknowledging) structural barriers to wellness evoked negative responses. For example, the impact of lack of childcare resources clearly impacted healthcare worker experience of burnout during the pandemic."

3. Promote compassionate leadership: Healthcare organizations need compassionate leadership to achieve positive cultural change, the journal article's co-authors wrote. "The central role of leadership in creating a sense of safety and shared purpose was repeatedly highlighted—not only at the top but across all layers of administration. … We believe that leaders should obtain training in compassionate leadership following the principles of trauma-informed care: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and attention to culture, historical, and gender issues. We believe that leaders should be evaluated by their ability to prioritize well-being and mental health, in addition to productivity."

4. Deploy dedicated resources: Healthcare organizations need to have dedicated resources to address healthcare worker well-being such as financial and personnel resources, the journal article's co-authors wrote. "Both systems in the initial phase of the crisis mobilized clinicians eager to volunteer time to support their colleagues to rapidly create these programs. However, as our medical centers reopened, it became clear that meeting the varied needs of workers across complex health systems requires ongoing investment from the larger institution, rather than relying on individual volunteers or departmental resources."

5. Address equity and justice: Healthcare organizations need to address equity and justice to boost healthcare worker well-being, the journal article's co-authors wrote. "The disproportionate toll of the COVID-19 pandemic on historically racialized and economically marginalized populations is well documented. Clinicians caring for these populations are faced with the consequences of societal inequities that limit their ability to care optimally for patients and contribute significantly to moral injury. Within the healthcare workforce, the stresses of the pandemic were also unequally experienced. For example, productivity declined among women compared with men in academia."

6. Importance of psychiatry leadership: Well-being program leadership teams should include psychiatry professionals, the journal article's co-authors wrote. "We strongly believe that psychiatry should hold a formal role within any system-wide well-being effort in healthcare. Because well-being exists along a spectrum, our programs benefited from psychiatry leadership who could facilitate consideration of the range of mental health issues that often co-occur with significant work stressors and burnout, integrate evidence-based therapeutic approaches into well-being efforts, and facilitate access to clinical care."

7. Partnerships are pivotal: Well-being programs should be built on partnerships and trust, the journal article's co-authors wrote. "Human resources groups were key partners in both institutions and must be engaged early in any crisis response. Collaboration between departments and units, such as Faculty Affairs, the Office of Work Life, employee assistance programs, as well as between academic and hospital programs that have historically functioned in silos, were critical to our successful efforts to support well-being, build trust, and overcome stigma."

8. Craft worker-focused opportunities: In addition to individual treatment, well-being programs should offer a range of resources for self-help and stress management, the journal article's co-authors wrote. "To increase employee access to mental health services in ways that provide reassurance about confidentiality, institutions should consider contracting with insurance providers with robust mental health coverage and/or partnering with companies that have remote telemental health and facilitate care for employees and their family members to be delivered both within and outside the medical center."

9. Address mental health stigma: Healthcare organizations should strive to reduce the stigma associated with mental health support and treatment, the journal article's co-authors wrote. "Many interventions intentionally focus on burnout—rather than mental health—to avoid the stigma associated with mental illness. … We recommend that institutions launch mental health destigmatization campaigns to encourage all staff to seek treatment when needed, connected with scalable low-resource interventions. Hospital privilege processes should not include any questions regarding mental illnesses or treatment, but rather focus on current ability to perform occupational duties."

Related: The Business Case for Clinician Wellness