A new campaign launched by the National Institute for Occupational Health and Safety (NIOSH) provides resources for hospitals to improve policies and practices that will reduce healthcare worker burnout and improve their mental health.
The campaign, Impact Wellbeing, is designed to help hospital leaders make improvements and determine new ways to support staff dealing with stress.
“This is a longstanding issue in healthcare,” says Casey Chosewood, MD, MPH, director of the office of Total Worker Health® at NIOSH. “This is not a quick fix…It’s going to take effort at all levels.”
The program provides the following resources:
- NIOSH Worker Well-Being Questionnaire (WellBQ), to help hospital leaders understand how the workforce is doing and identify ways to improve worker well-being
- Leadership Storytelling Guide, designed to help hospital leaders talk publicly about seeking help for their own mental health issues and encourage staff to do the same
- Total Worker Health® Strategies, which can be used to train frontline supervisors how to help their staff balance work and home responsibilities using supportive supervision
“We’re focused on the decision makers,” adds Chosewood. The program will provide guidance to hospital leaders who in turn can then provide their staff with ways to ease the working conditions that lead to burnout.
Another focus area of the campaign is removing intrusive mental health questions on hospital credentialing applications. The Dr. Lorna Breen Heroes’ Foundation developed three steps hospital leaders can follow to improve this situation.
“Some of these invasive questions are a challenge, and I think that’s another important message of our campaign,” Chosewood says. “Let’s fix those credentialing questions so they’re not harmful and intrusive. There’s no evidence that they improve outcomes, and they certainly can disincentivize people from getting the help they need.”
In addition to keeping workers from leaving the profession, the campaign also hopes to attract younger people to become healthcare workers.
Asked what hasn’t been working to prevent burnout, Chosewood notes that while there has been much focus on patient safety in the past, the same can’t be said for providers. Referring to the Triple Aim framework that calls for improving care for individual patients, populations, and organizations, he adds that something was missing.
“We’re pushing now for a Quadruple Aim, focused on improving the health and well-being of providers,” he says. “We don’t believe the other three are possible without the fourth leg.”
To chart progress for the campaign, Chosewood recommends that organizations talk to employees about their concerns.
“To me, the most important way that health organizations can measure their progress is to frequently check in and ask to do employee engagement surveys, to do listening sessions to measure their own reports of well-being amongst their workers,” he says.
The NIOSH Worker WellBQ can be used to measure well-being pre- and post-intervention.
“A regular once-a-year check in the good news with the well be queue is not only will it allow you to track well-being, but it will allow you to prioritize where you intervene because it breaks it down into five different areas where you can intervene to actually improve well-being outcomes,” says Chosewood.
Currently, organizations aren’t surveying their workers enough.
“We need to be tracking this more aggressively in real time so that we can better gauge our interactions and our interventions with this important workforce,” he adds.
A health system under strain
A recently released CDC Vital Signs report illustrates the mental health struggles of healthcare workers and says supportive workplaces can help. Among the findings in the report are the following:
- The number of healthcare workers reporting harassment at work more than doubled in 2022 compared to 2018.
- Forty-six percent of healthcare workers reported often feeling burned out in 2022, up from 32% in 2018.
- Forty-four percent of health workers intend to look for a new job in 2022, up from 33% in 2018.
“That’s a critical issue for a health system already strained under a shortage of the skilled workers needed,” says Chosewood. “To me, that’s a huge incentive for organizations to act…It’s expensive when there’s turnover, they can’t operate smoothly and efficiently with just a revolving door of staffing.”
The Vital Signs report says workers reported fewer mental health issues when they said they work in supportive environments. The following factors may make workplaces more supportive:
- Participation in workplace decisions
- Trust between management and workers
- Proactive and helpful supervisors that promote stress prevention, psychological health, support for productivity, a harassment-free workplace, and enough time to complete tasks
Chosewood says he was surprised the survey findings weren’t worse.
“I think that specifically speaks to the tremendous resiliency of our health workforce,” he says. “They see their profession as a calling, not just a 9 to 5, not just punching a time clock.”
The issue of harassment is a “wakeup call, a red flag for the system that we have to change the culture of our workplaces,” Chosewood notes.
We need “less harassment, both from patient to worker, from worker to worker, from supervisor manager down to their team members,” he says. “There is too much of that along the continuum and there are strategies that are working in health organizations to fix that and also to create that culture of trust.”
These issues began before COVID-19, but they were amplified by the pandemic. “The pandemic introduced this sort of continuous level of nonstop stressors that really fell on the frontline health worker to manage the frontline provider and all their support staff as well,” says Chosewood. “And that’s an important takeaway here, where we’re not just focused on physicians and nurses. Really, everyone in the health system has been challenged.”
In addition, Chosewood notes another concern that emerged. “There was also the concept of moral hazard, moral distress, moral injury that health workers reported to us,” he says. “That’s basically when they inside feel this tremendous pain and burden because they’re not able to give the care they know they could give if the resources and circumstances were different. So every day they go to work saying, ‘I can’t do the things that this patient needs done.’ That’s tremendously painful, the guilt that comes from that.”
Since the campaign was announced in late October, Chosewood says the reaction from healthcare organizations has been enthusiastic.
“We also have heard from organizations that they’re ready to act, that they have been looking for the right approach here and that they’re ready to take action,” he adds. “So we’re really pleased to hear that we’re getting feedback too from workers and worker organizations, and they’re telling us what we’re getting right, and they’re also telling us what we need to do more of.”
The Impact Wellbeing program will evolve as NIOSH receives more feedback about it, but there are additional resources that will be released soon, says Chosewood.
“We have a number of resources that are going to be rolling out soon and an action guide that will give people step-by-step approaches that’ll be due out in early 2024,” he says.
Going forward, Chosewood says, “we’ll be monitoring through our evaluation process on a regular basis, at least getting quarterly inputs and uptake, utilization, and regular feedback from users of the program… We see this as a long-term commitment, though. This is a not a quick fix.”