Issue link: https://beckershealthcare.uberflip.com/i/1455714
41 FINANCE CMO / CARE DELIVERY on the decline. e public's growing appetite for a return to normal, or some semblance of such, is apparently at cross-purposes with com- passion for healthcare workers' experience right now. "e thing about burnout is not only are healthcare workers burned out, but the public is, too," said Dr. Arora. "We don't see the public outpouring of support for healthcare workers le behind with the af- termath 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. is is an extraordinary commit- ment 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 health- care 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 cas- es," said 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 responsi- bility placed on healthcare workers to do their best to serve their communi- ties," said Dr. Arora, speaking on be- half of friends and colleagues at hos- pitals in various regions of the U.S. "at goodwill is on top of two years of exhaustion and accusations and demoralization. People are spent." Dr. Arora said she picked up on something in private conversations with physicians and healthcare workers during omicron's incoming wave that stands out compared to other surges: a quiet solitude. "ere 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.' at's where a lot of people are right now." If this is the stretch of the hellish roller coaster ride where people begin to fall quiet, that's a troubling sign for everyone — healthcare profes- sionals, 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, broken processes, and mistaken decisions are people who chose to hold their tongues rather than to speak usp," 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 "e healthcare systems I've seen weather this best are those where leaders get in the trenches with the front lines," said Dr. Ranney. "ose 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. at's management 101. But healthcare workers feel the difference between lip service and real ef- fort. ey 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," said 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.'" e first half of 2020 was surely difficult for hospital leaders, but there was also a high-gloss coating over those days where leaders acknowl- edged the difficult circumstances, but pointed to possibilities. e spirit of innovation was rich and hopeful. Leaders pointed to the pre-pan- demic 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, physicians 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. is goes beyond em- ployee 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," said Dr. Pronovost. "ere are many things we can do." ey range from the tactical to the broad. Technology can automate vital signs and pour them into the EHR, re- ducing 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 surg- es. Policymakers can step into the fray, working with e Joint Com- mission 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 assemble a list put forth from clinicians across the U.S.) It's about time health system leaders quit touting yoga or meditation 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," Dr. Pronovost said. "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 Editor's note: is article originally appeared on Becker's Hospital Re- view's website Jan. 12. "e healthcare systems I've seen weather this the best are those where the leaders get in the trenches with the front lines." Megan Ranney, MD, Brown University School of Public Health