Two Advisory Board leaders—Christopher Kerns and Rachel Woods— sat down to discuss one big idea for meeting the needs of an exhausted and traumatized clinical workforce on the heels of the Covid-19 pandemic. Here’s what they had to say:
Christopher: Rae, you recently wrote an article (editor’s note: published in Harvard Business Review) that focuses on the individual and collective trauma clinicians have experienced across the past year. How bad is the problem?
Rae: It’s bad. While many of us feel like we are standing in the light at the end of the tunnel, the physical stress and emotional toll on clinical workers is going to stick around for a while. In some cases, doctors and nurses are only just now starting to process a very real trauma. Concepts like “burnout” and “disengagement” are entirely inadequate for describing the current situation. For many, their tank is below empty. According to a recent poll from the Kaiser Family Foundation and the Washington Post, 62% of health care workers said worry or stress had a detrimental effect on their mental health.
Christopher: What does the industry risk if we don’t effectively address trauma in the workforce?
Rae: When clinicians are stressed, stretched too thin, traumatized, that poses a threat to their own well-being and the quality and safety of patient care. That threat could become significantly greater if we see a wave of departures from the workforce. One Washington Post and Kaiser Family Foundation poll from March 2021 showed that nearly 30% of health care workers have considered leaving health care altogether because of Covid-19. We’ve been talking about clinician supply shortages for years, and I worry that problem is about to get a lot worse. (Editor’s note: Advisory Board is currently surveying health care leaders about their own well-being. Please consider taking 3-5 minutes to fill out the questionnaire using this link: https://survey.alchemer.com/s3/6326493/Health-Care-Leader-Well-Being-Survey).
Christopher: What have you heard from leaders at health care organizations? Do they share your concern?
Rae: Absolutely, yes. I recently hosted a conversation with over a dozen executives at provider organizations, and I can assure you they’re worried too. Turnover and departures are already becoming a big issue. One person shared an anecdote about a nurse leader who left the organization to go into the landscaping profession. I mention that because it speaks to a real desire among some to just get out.
I was also reminded by this group that the year ahead is not likely to provide much reprieve for weary clinicians. Volumes are growing steadily, hospitals are full again, and many patients are returning with higher acuity needs after delaying care for so long. That’s to say nothing of the long list of new goals and initiatives many organizations are hoping to work through in the coming months.
Christopher: In your article, you recommend a recovery period for clinicians. What do you mean by that?
Rae: I mean that leaders at provider organizations need to relieve their most impacted clinicians of their duties, temporarily. I’m talking about providing workers with literal time to recover. That could take the shape of paid leaves of absence, modified working hours, short-term role changes, and the like. I don’t pretend to think that time off is a sufficient solution to emotional and psychological trauma, but it’s a necessary one. Providers need that space to access a more robust suite of tools to help them heal. It’s a somewhat simple idea in the abstract, not terribly different from the way military service members earn a reprieve following a combat tour. But I know that sometimes what seems simple on paper can be quite challenging to make happen.
Christopher: Yes, I agree, and I can already hear alarm bells going off in the heads of some leaders at provider organizations. Not that they’ll disagree with the premise that many clinicians are suffering, but doesn’t your suggestion make our system even more supply constrained than it already is?
Rae: Yes, that’s true, but I think we need to look at the big picture here. I’ll use another analogy. In forestry, we ignite small controlled burns in order to prevent larger uncontrollable fires in the future. That’s what this is. I worry much more about the long-term impact to clinician supply if we don’t take seemingly dramatic steps in the near term. One of those steps is to take some percentage of our health care workers “offline” for a little while.
Christopher: Practically speaking, how should leaders approach the concept of recovery? I assume they can’t give all their ER nurses a month off at the same time, so what should they do?
Rae: No, they can’t. And when I talk with leaders about recovery, this is where the greatest friction is. Everyone agrees that clinicians need emotional and physical support more than ever, but the practicalities of doing so make the task seem near impossible. Ultimately, every organization is going to have to figure out how to adapt this concept to their unique circumstances, but there are a few governing principles I recommend to all. First, they need to consider this an additional benefit on top of whatever already exists. It’s not going to work to simply tell nurses that they must use their existing paid time off. Second, they should assess which parts of their clinical community were most effected by Covid-19. Not every health care worker had the same level of exposure to Covid-19 patients, so it’s fair for organizations to set criteria for who’s eligible to use a recovery period. And third, organizational leaders should consider the proper ways to sequence recovery among eligible staff. It might take 12-18 months to give everyone the opportunity to step back.
Christopher: You said something just now about “emotional and physical support.” What does that mean in the context of a recovery period?
Rae: This is really important. What I’m recommending–literal time away from work–will only be effective it if it is paired with more holistic care for clinicians’ behavioral health needs. And I’ll be candid, leaders I’ve talked to have expressed concern about the potential for self-harm if clinicians take extra time away from work without additional emotional support resources. We can’t have one without the other.
Christopher: In addition to scoping who’s eligible, and staggering recovery periods across time, you write about other mechanisms for extending clinician supply to make room recovery. What are they?
Rae: For one, leaders should continue to apply the staff flexibility models they developed out of necessity last year. We saw a ton of creative approaches to moving people within and across sites of care. That kind of flexibility will make it a lot easier to plug gaps created by recovery periods. I also think this is a moment for organizations to lean into their technology. How much clinician time is spent on tasks that can increasingly be automated, or at least substantially supported by tech? I’d love to see this moment become a catalyst for a greater investment in tools that support clinicians’ ability to focus on the parts of their work that are most important.
Christopher: Rae, thanks for taking some time to talk me through this. In addition to reading your article on HBR, what else should leaders check out if they want to dig deeper into this concept?
Rae: My pleasure, Christopher. I do have a few recommendations. For those who enjoy audio content, check out Radio Advisory episode 77 to hear me talk through the need for clinician recovery, and what it takes to make it happen. I also suggest reading Three strategies to build baseline emotional support and The executive’s role in fostering resilient, adaptive leaders.