By Dorothy Brooks
In 2017, leaders at Houston Methodist Hospital began to see culture of safety surveys indicating burnout was an issue, particularly in some of the hospital’s higher-intensity areas, such as the ED. This led to the implementation of resources directed toward staff well-being, which put the facility in a good place when the COVID-19 pandemic began.
“We saw that the presence of things such as teamwork and communication between departments ... appeared to offer big opportunities to mitigate burnout and also to provide a safe work environment,” says Stephanie C. Jones Wood, MPH, CPHQ, director of system provider engagement and resilience for the broader Houston Methodist health system. “We were also working on a strategy around high reliability.”
While many hospitals have initiated well-being efforts through their human resources departments, Houston Methodist looks at the issue through a quality and safety lens, directly connecting worker well-being to the organization’s efforts to improve patient safety. Thus, from the start, the hospital’s efforts in this area have been strongly data-driven.
For instance, the hospital uses validated tools that measure levels of burnout in the workforce. Also, leaders rely on data collected from employee surveys that help administrators identify specific work settings that may be at risk for low resiliency. This enables Wood’s team to target interventions toward departments or teams that are most in need.
One tactic the hospital began to use liberally at the height of the pandemic was what Wood refers to as comfort rounds. “The aim of this practice is influenced by our quality and safety background,” Wood says. “[Health system leaders] are not the bedside professionals. It was important during the peak of the COVID-19 pandemic and even now ... to experience [what is going on] side by side with frontline personnel.”
During the fourth COVID-19 surge, leaders began to pick up some concerning new signs from the workforce. “We started to see that healthcare workers — not just those at Houston Methodist, but everywhere — were irritated,” Wood recalls.
Critically ill patients continued pouring into Houston Methodist with COVID-19, even though effective vaccines were available. By this time, exhaustion and frustration had set in. “It felt like the surges were unnecessary,” Wood notes. “Earlier on in the pandemic, dealing with the surges was part of being in this line of work. We didn’t have a tool, and we were waiting for vaccinations and other public health measures.”
The sheer exhaustion and irritation were so manifest Wood and her colleagues believed they had to try something new to bring support and comfort to the frontlines, which sparked the comfort rounds idea. “We weren’t satisfied with just going through and saying ‘hi’ to whoever was on shift at our convenience,” Wood says. “We made sure that for every unit, we were visiting for the day shift, the night shift, and covering the weekend shifts as well.”
Often, Wood or other leaders would round with a mental health professional and provide every person in a unit with the opportunity to relay how they were doing, share needs, and communicate anything that was on their mind. “Rounding is not unique. It is actually how we audit,” Wood says. “But if you shape the way that rounding happens, the safety culture and the resiliency of the workforce is enhanced.”
While rounding traditionally has been used as a way to observe what techniques are effective in a given work setting, the comfort rounds at Houston Methodist are focused on supporting frontline staff. “The only script was to ask [frontline staff] how they are doing,” Wood says. “I just saw it as a crack in the door, and it was really humanizing because there was no hierarchy; it was just having a conversation.”
Others making comfort rounds might include hospital executives, mental health professionals, spiritual care professionals, case managers, or even music therapists. While there were many hard conversations with frontline staff, in many cases such employees voiced simple needs that were provided easily.
For example, Wood recalls a frontline worker on a COVID-positive unit who indicated she needed help delivering lunch trays. “We literally had the vice president of operations helping the nutrition staff deliver the lunches,” Wood shares. “We saw a couple of staff members who were in crisis, and we were able to pluck them up and put them on a pathway for mental health support.”
Other evidence suggests staff have responded positively to comfort rounds. “We first piloted this in three units. After we visited with [staff], we asked them ... if they would welcome more [comfort rounds] and would they recommend that we continue this process with other units,” Wood says.
The results were overwhelmingly positive, with 95% of respondents answering “yes” to both questions. When asked what more could be done on the comfort rounds, respondents generally indicated a preference for more chocolate or more snacks.
Beyond comfort rounds, when the pandemic started, Houston Methodist was working on applications for mindfulness training and positive psychology that can be accessed virtually. Wood says out of 28,000 employees at Houston Methodist, there are more than 19,000 active users of the positive psychology application. She is confident these offerings are helping frontline staff let go of certain resentments and effectively process difficult emotions.
Virginia O’Hayer, PhD, is the director of the Jefferson Center City Clinic for Behavioral Medicine in Philadelphia. As a member of the wellness committee at Thomas Jefferson University Hospital, O’Hayer has worked with colleagues to prepare a range of well-being-related offerings before the pandemic. By March 2020, they had heard from healthcare workers in New York and New Jersey about the massive crisis that was coming. However, no one knew what would work to help ease the burnout and mental distress their frontline healthcare workers would face.
Thus, several interventions went into place, everything from group and individual mental health sessions to safe spaces where clinicians could come to vent their frustrations and receive support.
The problem with these approaches became clear quickly and did not let up despite repeated efforts to pivot and adjust. Few healthcare workers were taking advantage of any of these offerings. “I was running daily group support sessions and would only get one or two people to show up,” O’Hayer recalls.
O’Hayer and colleagues realized they should not put the onus on workers to come in and ask for help. Rather, they realized it could be better to give the responsibility of recognizing the need for help to team leaders, and then deliver this needed support to the entire team. “We are still here two-and-a-half years later, and I still get a ton of requests for these sessions,” O’Hayer reports.
When interventions are delivered this way, no one feels singled out, which can lead to team camaraderie and bonding, according to O’Hayer. Nevertheless, while O’Hayer still offers individual sessions to those who do seek help, healthcare workers tend to be reluctant to go this route.
“There is still such a hospital culture of stiff upper lip, keep calm and carry on, don’t be the weak link, and don’t show that you are struggling,” O’Hayer says. “That, unfortunately, still exists in our hospital culture despite all of our efforts to promote well-being.”
For the team-based approach to work, leaders need guidance on when to intervene with their workers. In the early days of the pandemic, this guidance typically was delivered during executive-level trainings that were happening weekly and sometimes twice a week to go over the latest COVID developments.
“Those of us on the wellness committee would often get a section of that meeting to go over how you identify if someone on your team is struggling and how you identify if your whole team is struggling in terms of burnout,” O’Hayer says.
Some include rising anger, disconnection, and expressions disgruntlement. “Also look for signs of people feeling depressed or withdrawn,” O’Hayer adds. “[Be aware] of people whose emotions are closer to the surface at work with crying or angry [outbursts].” Other signs might include absences that are not health-related or employees uncharacteristically arriving late to work.
The mechanisms to request team-based interventions remain in place. While requests typically still come from leaders, O’Hayer stresses she and her colleagues on the wellness committee want members to point out when their whole team could benefit.
“We have a kind of backchannel where a team member, even if it isn’t the leader, can also request an intervention for their whole team,” O’Hayer says.
O’Hayer’s advice to leaders looking to address worker well-being is to begin their efforts at a practical level. “If there is a morning meeting or a start-of-shift huddle, get a wellness check-in during that time,” she suggests.
“If there is a time when [staff] typically come together as a team to plan for the day or review what has gone down that day, that can be a really great time to have a mental health check [and ask] how everyone is doing.”
Regularly emphasizing mental health during daily huddles or team meetings is a great way to underline the importance of well-being. “This is a big change, particularly in the ED where there can be such a hospital mentality of just keep pushing, don’t show weakness, and keep moving no matter what,” O’Hayer says. “That’s what we are trying to swim against, to encourage people to take care of themselves.”
If leaders want to run a mental health or worker wellness workshop, ensure this session is conducted while intended participants are scheduled to be at work. “Do not expect people to come in early, stay late, or give up their lunch hours,” O’Hayer stresses.
Wood’s advice to colleagues is to gather baseline data to understand the problem.
“Leverage things like employee opinion surveys and any of the validated instruments that are out there, many of which are in the public domain,” she says. “Then, set a modest of goal of where you would like to go.”
Another must-have is support for well-being programming from every leader in the system. “Resiliency is one of those things like quality and safety that should be the responsibility of every leader, not just the wellness director or your quality and safety director,” Wood says. “Resiliency and workforce well-being should be the standard work of every leader.”
There also should be an executive-level individual who makes it clear to the organization that workforce well-being is a priority.
“There should be a strong director, and surely a champion, but an executive-level sponsor is necessary to give the effort visibility, and to communicate the importance of this work,” Wood says.
A Texas-based health system looks at employee well-being through a quality and safety lens, directly connecting worker well-being to the organization’s efforts to improve patient safety.
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