By Melinda Young

Hospital case management departments can anticipate increased levels of stress among their staff as the COVID-19 pandemic continues. This could cause employees to burn out and leave their jobs.

But before things reach a crisis point, there are practical and evidence-based steps leaders can take to help their employees shore up their resiliency to deal with pandemic-related stressors.

“There are things you can do at an individual level and at a system and unit level,” says Keith Doram, MD, MBA, FACP, adjunct associate professor of medicine at Loma Linda (CA) University School of Medicine. “Changes at the unit level and system level are the most challenging because now you have to get everybody on board. The easiest things to do are at the individual level.”

Doram describes these methods for building resilience at the individual level:

• Think of Three Good Things before sleeping. The Three Good Things intervention was tested among healthcare professionals and found to promote well-being and alleviate burnout.1,2

“Before going to bed at night, think of three things you did that day that you had responsibility for,” Doram says. “This could be making your favorite salad, taking a five-minute walk, or calling a friend.”

It does not matter what the three things are; just that the person thinks about them before going to sleep. “Do that for seven consecutive nights,” he says. “Researchers found that if you did that, then your happiness factor, well-being, and ability to sleep and rest were all more impacted than they were for people who were taking an antidepressant.” Practicing the Three Good Things intervention for a week positively affected people’s resiliency for six months, Doram adds.

The authors of a study about Three Good Things used popular social software as part of the intervention. The researchers concluded nurse managers should include Three Good Things into their management systems to improve nurses’ physical and mental health and long-term work performance.1

• Take a break. “Another thing in healthcare is doctors and nurses are running here and there with case after case,” Doram says. “They’re not taking in enough fluid and are not eating properly.”

Their overall health suffers, and they are not taking time for a quick daily recharge moment at work. “We recommend hitting the pause button during the day,” he says. “They need a state of mindfulness, just five or 10 minutes, to take a pause.”

They can take a short walk, look at a tree, or whatever they choose. This needs to be uninterrupted time, Doram adds. “It’s less important how much time it is than that you do it and you’re in control of doing it.”

Case management leaders can help their team members build resilience. Here are a few suggestions:

• Measure burnout. Survey staff to gauge their levels of burnout, Doram suggests. One reliable survey instrument to measure burnout is the Maslach Burnout Inventory — Human Services Survey for Medical Personnel, available at:

If the results show three out of five people on a unit are burned out, the unit will not be effective until this problem is addressed. “If you have a burned-out unit, they cannot take on more initiatives because they don’t have the capacity,” he adds.

• Empowerment. Employees experience more burnout when they feel as though they have no control over their working conditions.

For example, Toyota Production System discovered their factory workers were making too many mistakes, suggesting they had reached high levels of stress and burnout. The company put in a simple and effective solution: a big red button, Doram explains. Any worker could push that button and stop the entire assembly line if they noticed a quality problem. Assembly line workers were held responsible for pushing the button when they felt it was necessary. (More information is available at:

“What was amazing about that was the number of mistakes went down dramatically,” Doram notes. “Even more striking, hardly anyone pushed the button; it was just the fact that they had control if they needed to.”

• Reward. Leaders should commend their employees’ achievements and be specific in their praise.

“Don’t say, ‘Keep on doing a good job,’” Doram suggests. “Say, ‘I really like the way you talked with that family.’”

It is important to employees to be recognized for what they are doing. It matters to them, he adds.

• Support. Employees become more resilient when they have a supportive relationship at work.

For example, if a case manager comes into work after a stressful morning with a sick child or some other issue, a colleague might offer to let the case manager take the easier cases that day.

“It helps to have a sense of community and to know someone has your back,” Doram says. “It’s tremendously impactful.”

• Fairness. Employees are more content at their jobs when management gives everyone equal and fair consideration, Doram says.

“A lot of this has to do with perceptions, not the reality,” he notes. “Deal with things that are transparent and do not leave a person out.”

• Values. Employees experience stress and burnout when the organization outwardly expresses values with which they agree, but behaves differently in the day-to-day work environment.

For example, hospitals often express the value of caring for their patients and employees. But, during the pandemic, many hospitals did not provide their staff with as much personal protective equipment as was needed. This disconnect contributed to some staff burnout, Doram says.

“If a manager isn’t telling staff the exact truth about things, and employees discover that what they were told is not true, then they can’t count on what their [leaders] are saying,” he explains. “That’s what erodes the confidence in the worker that the value of the organization is not matching what they perceived it to be.”


  1. Guo Y-F, Lam L, Plummer V, et al. A WeChat-based “Three Good Things” positive psychotherapy for the improvement of job performance and self-efficacy in nurses with burnout symptoms: A randomized controlled trial. J Nurs Manag 2020; 28:480-487.
  2. Rippstein-Leuenberger K, Mauthner O, Bryan Sexton J, et al. A qualitative analysis of the Three Good Things intervention in healthcare workers. BMJ Open 2017;7:e015826.