Issue link: https://beckershealthcare.uberflip.com/i/1446606
21 PATIENT & CAREGIVER EXPERIENCE by COVID-19, nurses and staff faced threats from patients to a degree that left government officials pleading with the public for a return to civility. Hospitals mobilized and took out full-page ads in local newspapers, begging adults with ample access to COVID-19 vaccines to accept them. When the willfully unvacci- nated landed in the hospital with COVID-19, they turned to the same people they spurned to care for them. Healthcare workers' exhaustion doesn't unfold in a vacuum, but in an ecosystem where goodwill, trust and support from the public is on the decline. e public's growing appetite for a return to normal, or some semblance of such, is apparently at cross-purposes with compassion for healthcare workers' experience right now. "The thing about burnout is not only are healthcare workers burned out, but the public is, too," says Dr. Arora. "We don't see the public outpouring of support for healthcare workers left behind with the aftermath of our pandemic response as a nation, which is, 'Let the cases and hospitalizations rise.'" Most healthcare professionals will tell you the reason they went into medicine is simple: to help people. This is an extraordinary commitment worth protecting. We would be sorely mistaken to assume it runs in endless supply, that healthcare workers' ability to endure is limitless. Omicron's proximity to the holiday season has certainly put healthcare workers' goodwill to the test. Ahead of the holidays, healthcare leaders began to see omicron's wave approaching. "It was the most frightening experience to see the trajectory of the number of new cases," says Dr. Pronovost. Hospitals sent messages to staff, encouraging them to avoid holiday gatherings and do all they could to not get sick. When people did get infected with COVID-19 despite their best efforts, colleagues were called to the front lines. During a season people rely on for restoration, healthcare workers were reminded there is no slack in the system. "ere was a lot of personal responsibility placed on healthcare workers to do their best to serve their communities," says Dr. Arora, speaking on behalf of friends and colleagues at hospitals in various regions of the U.S. "at goodwill is on top of two years of exhaus- tion and accusations and demoralization. People are spent." Dr. Arora says she picked up on something in private conversa- tions with physicians and healthcare workers during omicron's incoming wave that stands out compared to other surges: a quiet solitude. "There was just this sense of, 'I can't control this anymore. I'm not going to say anything. I'm just going to focus on self-preservation. Instead of asking for anything, I'm going to focus on my family and myself and try to get through this.' That's where a lot of people are right now." If this is the stretch of the hellish rollercoaster ride where people begin to fall quiet, that's a troubling sign for everyone — healthcare professionals, their employers and, most importantly, patients. Good leaders know silence is scary and can kill a company. It goes beyond fraud and malfeasance. "All too oen, behind failed products, bro- ken processes, and mistaken decisions are people who chose to hold their tongues rather than to speak up," wrote authors of the 2003 article "Is Silence Killing Your Company?" published in Harvard Business Review. Here's where authentic, courageous leaders come in. Between social, governmental and business problems, leaders are up against an awful lot. But at this point on the ride, honest leadership in U.S. hospitals and health systems is more noticeable and needed than ever. Good leaders seek solutions "The healthcare systems I've seen weather this best are those where leaders get in the trenches with the front lines," says Dr. Ranney. "Those that have had the most difficult experience are where leaders do not understand the hard issues." Most every leader would likely claim to be in the trenches with their front lines at this point, two years in. That's management 101. But healthcare workers feel the difference between lip service and real effort. They always have; now they're just more sensitive to it. "When problems are hitting the fan, are you only showing up at 10 a.m. on a Tuesday to take a look? Or are you willing to really sit down with folks and either help out, or be present, and work on solutions when the problems are actually there," says Dr. Ranney. "Not in a 'let me be here and show my face' way, but in a way of 'let me help the team, brainstorm and get the solution they need and not let off until we've gotten through the other side of it.'" The first half of 2020 was surely difficult for hospital leaders, but there was also a high-gloss coating over those days where leaders acknowledged the difficult circumstances, but pointed to possi- bilities. The spirit of innovation was rich and hopeful. Leaders pointed to the pre-pandemic version of healthcare we'd never go back to and pointed ahead to healthcare with less bureaucracy, red tape, burden, waste. Never let a good crisis go to waste was a mantra repeated time and time again. And while the pandemic hasn't given leaders much time to make the sweeping system changes they identified as necessary, physi- cians said it is crucial for workers to see their leaders advocating for change, pushing for improvements and courageously going to bat to make work fundamentally better for their employees. This goes beyond employee wellness efforts or greater pay. "One thing that strikes me: We have increased the number of patients staff have to care for, for the most part. But we have done nothing to reduce the work per patient," says Dr. Pronovost. "There are many things we can do." They range from the tactical to the broad. Technology can auto- mate vital signs and pour them into the EHR, reducing burden on clinicians. Solutions can track lost supplies, saving up to 20 percent of nurses' time on the job. Insurers can get realistic about prior authorizations for expensive but potentially lifelong medi- cations that keep patients out of crowded ERs during COVID-19 surges. Policymakers can step into the fray, working with The Joint Commission to waive documentation requirements that add no value. (Dr. Pronovost has been asking UH clinicians for the top five to 10 things they are required to document where the burden exceeds the benefit of documenting it; he wants to assem- ble a list put forth from clinicians across the U.S.) It's about time health system leaders quit touting yoga or medita- tion as a cure-all. Workers are looking at them now, at this point of the ride, to take far bigger swings on their behalf. "Now it's the extreme with burnout," says Dr. Pronovost. "If the message is yoga, self-care or a raise to think we solved the prob- lem, it's really misdirected. We need authentic leadership, the balance of hopeful and humble. Hopeful that we will get through this. But also the courage to confront our current reality: It sucks. Let's not pretend this isn't really hard. Now how can we make your work better?" n