Ochsner Health Focused on Workforce Needs

The coronavirus pandemic has prompted the health system to address healthcare worker resiliency and mental health.

Ochsner Health has been awarded a $2.9 million federal grant to help support the New Orleans-based health system's multifaceted workforce well-being and retention efforts.

At health systems, hospitals, and physician practices, workforce issues have become paramount during the coronavirus pandemic. Healthcare worker burnout has risen to alarming proportions during the pandemic, and healthcare workforce shortages are being reported nationwide.

Ochsner Health's workforce grant was awarded by the U.S. Department of Health and Human Services through the Health Resources and Services Administration.

"We are trying to be more nuanced in how we reach our healthcare workers. No single initiative is going to be a cure-all for the future—we are in a time when we must experiment and measure. If some things are not working, we will eliminate them. If other things are working, we will scale them. That approach is part of what the workforce grant will allow us to do. This support will afford us an opportunity to implement many initiatives," says Nigel Girgrah, MD, chief wellness officer at Ochsner Health.

The workforce grant will help support seven programs over the next three years.

• Johnson & Johnson resilience training: "A company that probably has the best track record of workforce well-being is Johnson & Johnson. They have what is called a Human Performance Institute, and we have worked with them to create a four-hour virtual resilience course. We started this course last year; and over the long term, we will have to see whether the course makes a quantifiable difference in terms of promoting resilience," he said.
   
• Personal Leadership Program: PLP will support senior leaders, physicians, and advanced practice providers in their personal and professional wellness and growth. "Senior leaders are pulled off site for four days for intense workshops to help them better manage themselves. The idea is you cannot manage or lead others until you are effectively leading yourself. With help from the workforce grant, we will be scaling this program over the next two years," Girgrah says.
   
• Penn Resilience Program (PRP) and PERMA™ Workshops: PRP and PERMA™ Workshops are evidence-based training programs that build resilience, well-being, and optimism. "The PERMA™ Workshops are based on the positive psychology theories of Martin Seligman, and we are going to work with the University of Pennsylvania to fashion a similar workshop that we can offer to our frontline healthcare workers," he says.
   
• Institute for Healthcare Improvement (IHI) coaching: Nurses at eight Ochsner Health hospitals will participate in a 12-month coaching program followed by six months of reflection and feedback.
   
• Cabana by Even Health: Cabana is a virtual program that connects healthcare professionals from across the county to discuss shared issues and areas for self-care and self-improvement. "We were the first health system to pilot Cabana. It is group therapy led by a licensed healthcare professional. The unique thing about Cabana is it is anonymous. You create an avatar of yourself. You can disguise your voice," Girgrah says.
   
• Schwartz Rounds: This program offers healthcare workers a regularly scheduled time to openly and honestly discuss the social and emotional issues they face in caring for patients and families. "Healthcare workers have an opportunity to gather and discuss a specific case that has a high degree of emotional labor. They can work through their feelings as they talk about those sorts of cases," he says.
   
• Employee Assistance Program: Ochsner Health offers a traditional EAP that can help employees with common personal problems, such as family or marriage conflicts, job stress, financial worries, substance abuse, depression, loss of a loved one, and parenting concerns.  

Other well-being initiatives

Ochsner Health intensified its efforts to address burnout and employee retention in 2017, Girgrah says.

"We formed a wellbeing taskforce in 2017 and started to measure the state of our workforce and put together some recommendations. Originally, the focus on burnout and retention was aimed at practice efficiency and developing our leaders because we felt those were the two biggest drivers of professional fulfillment, especially among our physicians and advanced practice providers. We built some momentum in those areas, then the pandemic hit, which blew things up a bit," he says.

The pandemic required a focus on resilience, Girgrah says. "As an organization and the office that I lead—the Office of Professional Well-Being—we had to move quickly to crisis support. As we emerged from the first coronavirus surge, our efforts became all about resilience. I always knew that resilience was important, but I did not want to lead with that pre-pandemic. I did not want our workforce to feel that the organization was saying, 'If you just eat better and do some yoga, everything is going to be OK.' Clearly, as we emerged from the first surge, there was an appetite for resilience offerings. So, we had to experiment with different ways to reach our workforce. We developed a virtual course on resilience and some YouTube videos, which were adopted well, with high net promoter scores."

The pandemic also prompted the health system to step up efforts to address mental health among healthcare workers, he says. "As we continued into the pandemic, it became increasingly obvious that in addition to resilience we had to think long and hard about the mental health of our workforce. Our grant submission to the Health Resources and Services Administration reflects our interest in improving the resiliency of our workforce and encouraging a culture where mental health is promoted."

Addressing the stigma of behavioral health services among healthcare workers was a top priority, and Girgrah took a personal step to tackle stigma.

"In July and August 2020, I recognized in myself that I was languishing and struggling. I eventually reached out for help, and it made a big difference. I send out a quarterly chief wellness officer message that had historically been quite sterile. It was a report out. But in the summer of 2020, I shared information about myself and my own journey. Then I talked more broadly about mental health for healthcare workers. That was easily the most open executive communication at that point of the pandemic, with high engagement rates. People replied that they were going to seek help. That message helped with de-stigmatizing mental health services," he says.

In addition to the EAP, Cabana program, and Schwartz Rounds, which all play a role in addressing healthcare worker mental health needs, Ochsner Health has worked with a company called Happy. "It is basically an army of 2,500 empathetic support givers armed with a phone number or an app to proactively reach out to our frontline healthcare workers and check in on them. They can also arrange follow-up conversations. They can help address the epidemic of loneliness. Happy is the kind of on-demand offering that our healthcare workers have been requesting," Girgrah says.

To address burnout among healthcare providers, Ochsner Health has taken several steps to ease burdens associated with the electronic health record, he says. "We have been easing the strains of the EHR. One of the areas that has been the bane of a physician's existence is the EHR in-basket, where a physician can spend 45 to 90 minutes a day returning messages and doing various tasks in the EHR. We have launched initiatives such as a pharmacy refill clinic, which can take messages related to refilling medications away from our primary care physicians to give time back to the provider."

The health system has also been trying to limit "pajama time" in the EHR, Girgrah says. "We produce reports of our physicians and advanced practice providers who are struggling the most with pajama time—going home then logging back into the EHR to complete work. We can track the areas where providers are struggling the most such as doing notes or returning messages to patients from home. Then we can give them customizable help within the EHR to decrease the pajama time."