The Mandate for Workforce Recovery

Across the pandemic, organizations quickly created and expanded supports for their teams. At this point, most organizations have a variety of one-off initiatives in place to support staff. But to achieve the scale and effectiveness that’s needed to support staff recovery, a more organized/centralized approach is needed.

Start designing a recovery strategy by auditing the emotional and physical supports your organization has in place to determine their effectiveness and applicability to all staff. Now is the time to review the investments made in staff’s emotional and physical well-being to determine what to carry forward and what to discontinue. Gather input on how leaders across the organization have been supporting staff’s physical and emotional needs either through a survey, your HR business partners, or in an all-leader meeting. Do not limit input to clinical teams; all staff need to recover in some way even if they were working from home. Ask leaders to share what supports they provided to staff (centralized or their own), what changes they made to workflows or processes to accommodate the team’s needs, how they communicated with their teams, and what they did to bolster team morale and engagement.

As you evaluate existing supports, consider the following questions to gauge utilization, identify gaps in support, and pinpoint opportunities to scale support across the system.

• How many staff utilize this resource now? If few, why?
• Is this resource available across the entire system? If not, should it be?
• Which staff can use this resource? Is it applicable to any other groups?
• Who owns deploying these supports? Is there coordination with other teams?
• How are we triggering the support? Is there a way to make it easier for staff to access it?
• Is there a need that we can’t meet today with our current supports?

Throughout this process, leaders will likely uncover more resources than are needed or sustainable to continue offering. Consider tapping into the knowledge of existing teams focusing on burnout and engagement, or convene a small group of invested stakeholders to edit your list of offerings. Considering utilization data and effectiveness, decide which resources to extend that are currently offered in silos. Discontinue offerings that have a limited return on investment to free up resources for more effective, scalable recovery strategies. Pressure test your final list with staff through rounding or existing staff forums to uncover gaps, get feedback on making existing resources more effective, or to provide new recommendations.

Building upon the audit results, begin investing in the resources your organization currently lacks to address staff needs and experiences. To synthesize the varied experiences of staff, Advisory Board identified the top five experiences that organizations should focus on: fear, exhaustion, isolation, distress, and trauma. We developed this list by talking with health care executives and reviewing the current literature. While the list is not exhaustive, most staff have experienced each of these feelings at some point across the pandemic to varying extents, and often at the same time. Organizations should ensure their recovery strategy addresses these different experiences so that all staff (even those not on the “front lines”) can heal and restore their emotional and physical well-being. Below is guidance on how to help staff address each of these five experiences. For each experience, consider having two to three options available for staff.

Throughout the remainder of this section, hyperlinks will lead you to the resources to help implement these strategies.

Staff experience 1: Fear

Common staff experiences

Some staff fear for their own lives and health, job security amid layoffs, and patients’ lives and comfort.

What staff need from leaders

Staff experiencing fear need transparent communication and vulnerability.

• Overcommunicate steps the organization will take to keep staff safe going forward and execute those steps. Tap into a variety of communication channels such as regular newsletters, targeted listservs, virtual brown-bag conversations, and weekly executive office hours to keep staff informed on how the organization is addressing their top fears. Across each of these channels, vulnerability and transparency is critical to make staff feel like their concerns are heard and validated.
• Don’t sugarcoat the challenge ahead. The workforce will know if leaders under-sell the challenges that health care organizations face. Staff who already perceive challenging realities will become even more stressed if the leadership team issues only rosy outlooks—because they will begin to feel that leaders "don't get it." To bring down stress levels, leaders must demonstrate that they do understand the challenges and that they are willing to act, even when those actions are hard.

Questions to identify biggest opportunities

• How does my organization create space for conversations that let staff express how they’re feeling?
• How do executives at my organization model vulnerability to their teams?
• How does my organization ensure that staff receive critical organizational updates and information?
• How does my organization routinely surface—and then address—questions and rumors circulating among staff?

Staff experience 2: Exhaustion

Common staff experiences

Many staff are physically exhausted after months of long hours in full PPE, volatile volumes, short staffing, or even being confined working at home with their family.

What staff need from leaders

Staff experiencing exhaustion need meaningful time away from work to disconnect and decompress.

• Encourage staff experiencing exhaustion to use PTO or take time away from work. This is difficult in practice, but staff who are extremely exhausted may become flight risks if they’re unable to recover and continue feeling exhausted. Consider how to encourage PTO usage in a phased or systematic way to ensure appropriate coverage at the hospital.
• Remove administrative or nonessential tasks from staffs’ plates to allow more time and space for breaks throughout the workday. This strategy is not as impactful as longer-term time away from work. But many staff don’t have the time to have lunch, take a walk, or mentally recharge for 30 minutes during the day.
• Move clinical staff who work in high-acuity or high-volume areas to units that are less physically demanding for certain shifts to give them a break. Identify locations within the organization that need additional support and match those open shifts to staff who are feeling exhaustion.

Questions to identify biggest opportunities

• What tasks and meetings were removed from staff’s plates in the heat of the crisis? Which don’t need to come back?
• Where does my organization have the opportunity to protect staff time for the work only they can do?
• What steps could my organization take to make it feasible for staff to take time away from work?
• Are staff able to take breaks in the day to care for their basic needs?
• How do I model pausing and stepping away when I need to?

Staff experience 3: Isolation

Common staff experiences

Staff are feeling isolation after a lack of connection with loved ones and peers while also feeling like they’re “alone in the fight” as many communities move on from Covid-19.

What staff need from leaders

Staff experiencing isolation need a renewed sense of shared purpose and connection with one another.

• Reconnect staff to the team and each other. Consider implementing storytelling as a standing agenda item for certain meetings or huddles to allow staff to share experiences and foster a sense of community. This option requires no investment and is a simple, scalable way to reconnect staff.
• Reconnect staff to the mission. Remind staff how their contributions help the organization fulfill their mission. Consider implementing reward structures based on organizational goals or automatically triggering positive feedback when staff do something that aligns with the mission.
• For staff experiencing high levels of isolation, offer opportunities to build peer-to-peer support networks. Consider developing a peer-to-peer support model to connect staff with trained peer volunteers when they need empathetic support.

Questions to identify biggest opportunities

• Do staff and leaders have a formal way to connect with one another to discuss challenges?
• Are there existing meeting structures that that are suitable for embedded time for connection or confidential discussions?
• Do staff have a shared purpose in their work and the organization’s mission?

Staff experience 4: Distress

Common staff experiences

Staff are experiencing distress as a result of the daily emotional stress of their roles, feeling helpless or overwhelmed by their day-to-day work, moral dilemmas, or organizational resource constraints.

What staff need from leaders

Staff experiencing distress need easy-to-access emotional and psychological support.

• All organizations should reframe the purpose and value of their employee assistance program (EAP) to make it more appealing for staff. Make sure that the EAP adapts to respond to real staff challenges and that leaders talk about and push the EAP in an enticing way.
• Provide confidential forums for staff to discuss their experiences. Consider implementing moral resilience rounds or moral distress consults for staff to join virtual or in-person sessions to talk about their experiences in a safe environment.
• Bring group reflection directly to staff. Embed routine reflection into the workday or week to hardwire the opportunity for staff to share their experiences. This makes it easier for staff to cope with minor distress and helps the team recognize when somebody is struggling more deeply.
• Equip staff to check in on each other routinely. Utilize the power of peer relationships to make sure that all staff receive the support they need. Peers should be about to talk to their peers when in need or refer them to additional services if they deem it appropriate.

Questions to identify biggest opportunities

• What types of support does my organization currently offer to staff immediately following a traumatic event?
• Are there any existing trained staff at my organization we could recruit for a psychological first aid team?
• Does my organization have the resources and infrastructure to train additional staff in psychological first aid?
• How does my organization currently connect staff with ongoing emotional support services?
• How has my organization acknowledged the collective trauma experienced by the health care workforce?

Staff experience 5: Trauma

Common staff experiences

Staff are experiencing trauma from seeing patients die from Covid-19 in isolation, living through a pandemic, and seeing friends, family, and peers suffer or die from Covid-19.

What staff need from leaders

Staff experiencing trauma need opportunities for collective and individual recovery.

• All organizations should create a standardized, structured debrief process that follows traumatic events. The process should be focused on on reshaping the narrative for growth. The key to making this strategy work is creating a safe space, without leaders present, that is facilitated by a trained mental health professional.
• Deploy trained staff to provide psychological support after traumatic events to help staff get the support they need immediately. Create a team of designated psychological first aid responders who are automatically deployed following a traumatic event. Consider creating standardized triggers for referrals like a patient death or harassment by the patient or family.
• An overlooked but critical tactic is to recognize the collective toll of a crisis and commemorate providers’ role in protecting their communities. Use moments like organization-wide meetings to acknowledge what staff are going through and show the organization’s unwavering commitment to supporting staff.

Questions to identify biggest opportunities

• What types of support does my organization currently offer to staff immediately following a traumatic event?
• Are there any existing trained staff at my organization we could recruit for a psychological first aid team?
• Does my organization have the resources and infrastructure to train additional staff in psychological first aid?
• How does my organization currently connect staff with ongoing emotional support services?
• How has my organization acknowledged the collective trauma experienced by the health care workforce?

Recovery efforts will not fulfill their needed purpose if staff don’t use them. Staff may not utilize these resources for many reasons including: believing that they are OK, not knowing about the services, or the difficulty (perceived or real) of accessing them.

First, make some resources opt-out.

Select some support services that can be opt-out only to address the long-standing “I’m fine” culture in health care. Consider which supports are globally applicable to all staff and will be offered without being requested (e.g., embedding 90-second storytelling in weekly team huddles, reducing unnecessary administrative work, offering moral distress consults, etc.). Also decide which specific events will automatically trigger support. Prioritize high-impact events like verbal or physical assault by a patient or family, or a patient death. These events should automatically trigger a connection to resources that will help staff cope with the event.

Learn more about how to build services to break down health care’s “I’m fine” culture in our recent publication on emotional support.

Second, make sure all staff know what resources are available.

Create a system-wide awareness campaign to ensure staff know what support is available and over-communicate, often. Leaders across all ranks must know exactly what the organization is doing and share that information with staff through formal and informal channels. Consider spotlighting recovery resources in existing communication channels like newsletters, creating a centralized place on your intranet to store all information, or deploying leader rounding to specific units or departments to provide information and answer questions.

Third, embed supports into staff workflow.

Staff and leaders alike know the importance of emotional wellness but often feel they don’t have the time to take a moment for themselves. To encourage widespread utilization of emotional well-being resources, make sure there are options that are quick, accessible, and able to fit into staff workflow. If possible, bring those services to staff directly rather than them having to schedule time to access them. Staff may also find it easier if the supports are simplified. Having too many resources is simply too difficult to navigate.

Take extra precautions to ensure overlooked populations are accessing recovery resources. One overlooked group are leaders. They often put on a brave face for their staff but don’t carve out space for their own recovery. Organizations must encourage leaders to put on their metaphorical oxygen mask first, before they can truly help their workforce. Another overlooked group is nonclinical staff. These staff aren’t the obvious targets for recovery resources but are critical members of the workforce who experienced the pandemic in different ways.

Managers are often the critical communication links who make sure staff are aware of organizational resources. Ensure that managers understand what staff are experiencing and the resources available to support them. Host a required training session for all staff in leadership positions or provide a detailed one-pager that highlights each available support.