Surgeon General: Health System Overhaul Must Prioritize Worker Well-Being
System changes needed, not more worker resilience
Vaunted for its medical and technological prowess, the American healthcare system has a critical blind spot that has been widely exposed during the pandemic: Employee wellness, said U.S. Surgeon General Vivek Murthy, MD, MBA.
“Many of our healthcare workers operate in a culture that does not recognize the importance of well-being,” he said. “That makes seeking health a sign of weakness as opposed to what it truly is — a sign that we are human. It is kind of a strength to reach out and ask for help.”
Murthy spoke at a webinar hosted by the National Institute for Occupational Safety and Health (NIOSH), which is seeking input on how to protect the mental health of medical workers as burnout and resignations become prevalent in the COVID-19 pandemic.
Neither Murthy nor NIOSH are talking just about improving individual worker resilience. Work design and system changes are needed “because our healthcare workers are human beings — their well-being and health should matter to us,” Murthy said. “We have people who are sacrificing so much for the welfare of others. We need to be there, to show up for them. That is our moral obligation as a country.”
The deadline to comment and offer suggestions to NIOSH for mental health programs and interventions has been extended to Jan. 25. A comment to NIOSH from the Harvard-MIT Work and Well-Being Initiative (WWBI) said, “We view work as a social determinant of health, and work redesign initiatives as a critical lever to improve health and health equity. [W]e recently produced an employer toolkit2 that offers managers actionable steps and resources to modify their work practices in ways that improve employees’ well-being, including improving mental health.”
The WWBI toolkit outlines three critical work design principles:
- Give employees more control over their work;
- Tame excessive work demands;
- Improve social relationships in the workplace.
The Tragic Toll
Of course, beyond mental health, there is physical death. COVID-19 has taken thousands of healthcare workers’ lives. That these are measured in estimates reflects the lack of a national surveillance system for healthcare worker mortality due to SARS-CoV-2. This was another signal of lack of pandemic preparedness but coupled with the lack of PPE left the disturbing impression that healthcare workers were somehow expendable.
Although many of those who survived are vaccinated, they have weathered wave upon wave of COVID-19-infected patients. Yet nurses and physicians were reporting high levels of burnout before the pandemic.
“The pandemic made things worse, but we were already dealing with the burnout crisis before COVID-19,” Murthy said. “It was coming from multiple angles. It was not one single thing, one single policy that was driving the burnout.”
For example, many healthcare personnel were working in an environment where they spent far more time looking at computer screens or reviewing paperwork than they did with patients.
“We had healthcare workers who felt they weren’t able to do their jobs because of the administrative burden,” Murthy said. “We had healthcare workers who had profound mental health needs that were not recognized in the system they worked in. Their workload was not adjusted at all, and no support services were offered.”
Staff shortages now reported nationally aggravate the problem, with fewer workers trying to cover more patients. Understaffing and burnout clearly endanger patients.
“We know that burnout contributes to medical errors and patient safety issues,” Murthy said. “The pandemic has really highlighted that if we don’t take urgent action, then our healthcare workers will continue to suffer, and the entire healthcare system will be under threat.”
But the solutions must match the size of the problem, which has emerged writ large from a broken, overwhelmed healthcare system.
“Healthcare systems, educational institutions, public and private payers all will have central roles and changes they need to make,” Murthy said. “Doing all this is going to take investment, advocacy, and policy change. But we have the power to make these changes. Especially right now.”
Speaking directly to healthcare workers, Murthy said to those who are experiencing burnout, know it is not your fault, and you are not alone.
“We need systemic changes that are going to provide our healthcare workers with mental health support, with reductions in the administrative burden and the overall workload that is placed on them” he said. “Changes that ultimately involve building a healthcare culture that supports well-being.”
Restoring the Broken Bond
Murthy decided to become a clinician when his physician father and “healer” mother ran a clinic in Miami when he was a child.
“As a young kid, I didn’t understand a whole lot about the science,” he said. “What I did understand and what they taught me — sometimes through words but more often though example — was that real healing is about more than diagnoses and the medicines prescribed. It is about the relationships that you build with the patients and their families.”
The empathy and compassion that are formed in those provider-patient relationships can be mutually beneficial to the health of both parties.
“I wanted to be a part of that,” Murthy said. “It is this calling to heal that unites so many of us and brought us to this profession. For me this is a very personal conversation, as a physician myself and a member of the healthcare worker community.”
During this pandemic, healthcare workers have faced incredible stress and uncertainty for more than 20 months.
“Many times, it must have simply been hard to go to work, whether you are a doctor or a nurse,” Murthy said. “You bore the brunt of this pandemic in many ways that the public may never really understand.”
Although he is not often at the bedside as surgeon general, Murthy’s sister is a physician and his father still practices family medicine.
“Each day they go to work, I worry this will be the day they get sick,” he said. “That was true for many of you as well, but despite that risk, you went in to work. [You knew] that not only were you taking personal risk to your health, but [working] late nights, looking at the terrifying path of COVID, and [facing] the tough decisions you had to make on how to allocate limited resources.”
In later surges, primarily among the unvaccinated, healthcare workers have faced anger for not using non-approved treatments and other issues. Some patients have expressed surprise that it is too late to take the vaccine once they are seriously ill with COVID-19.
“Loss is something I think about a lot during this pandemic,” Murthy said. “We have lost so much. Not just the family members we knew and loved — we have lost so many lives this last 22 months. You have experienced loss time and time again at a level that has been truly extraordinary.”
The sheer mortality numbers can be mind numbing, but on Nov. 23, the U.S. was averaging more than 1,100 deaths a day due to COVID-19. A lot of these people died in hospitals with healthcare workers bearing witness. Overall, 776,000 Americans have died of COVID-19 since the pandemic began.3 That is greater than the population of Seattle (737,000).
“You know the names of some who have been lost,” Murthy said. “You know the stakes that have been on the table during this pandemic. The pain of losing a patient doesn’t go away, no matter how long you have been in our field. I still remember so clearly the patients that I have lost over the years. They will always be there with us.”
- Centers for Disease Control and Prevention. Interventions to prevent work-related stress and support health worker mental health; request for information. Federal Register. Sept. 27, 2021.
- The Work and Well-Being Initiative. Employer toolkit: Work design for health. 2021.
- Centers for Disease Control and Prevention. COVID data tracker. Updated Nov. 24, 2021.
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