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The COVID-19 surge that hit New York City (NYC) in March of 2020 changed everything. The annual quality improvement (QI) agenda NYC Health + Hospitals had so thoughtfully co-created just months before was quickly shelved. As the largest public health care system in the United States, we quickly pivoted tremendous staff and resources to address the unprecedented clinical challenges and needs of the NYC communities.
Now, as NYC and some other communities around the world push past the initial surge of the pandemic, we must contemplate what QI and safety initiatives make sense to address while also maintaining vigilance for a second wave of COVID-19 cases. This post-surge, pre-vaccine phase necessitates a new way of thinking where we honor the tremendous psychosocial impact of the pandemic on the health care workforce and harness the lessons learned from our experiences.
One approach to mitigate a “parallel pandemic” of emotional harm is to ensure that patient and workforce safety and QI initiatives explicitly ensure psychological safety and promote empathy. “Psychological safety,” according to Harvard Business School professor Amy Edmondson, PhD, is defined as “a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.” Across a wide spectrum of industries, the thread that links high-performing teams is the presence of this crucial belief.
Empathy helps connect one person to emotions that another person is feeling.The absence of empathy due to burnout can lead to lower staff engagement. We must express empathy for what our frontline health care workers have been going through during the COVID-19 crisis as we utilize QI and patient safety assessments on how to do better in future surges. Without offering empathy and emotional and psychological support, health care systems risk eroding trust, destroying psychological safety, and alienating the doctors, nurses, and other frontline health care workers who risked and sacrificed so much to save lives.
The COVID-19 crisis meant that time was compressed. Process optimization decisions that normally take weeks needed to be made in real-time. Though we used the essential tools of QI and safety initiatives, such as the Plan-Do-Study-Act (PDSA) cycle, urgency required that the test-to-spread was immediate. For example, as critical care needs rapidly expanded beyond existing capacity, the insights on how to safely repurpose one room to deliver a significantly higher level of care were immediately applied to an entire unit.
Priority matrices are another common QI tool used to help determine where best to put effort and scarce resources. Figure 1 is a 2 x 2 prioritization matrix that tightly links psychological safety/empathy and the more traditional goal of maximal clinical/operational benefit. Using this matrix can help identify the “must do” quality and safety initiatives that both strongly promote psychological safety/empathy and have substantial clinical/operational benefit.
Figure 1 – Prioritizing Healthcare Quality & Safety Initiatives During/After COVID-19 matrix
Here is a three-step approach to explicitly link psychological safety and empathy to quality initiatives during and after the COVID-19 pandemic:
- Actively seek feedback on what went well and what to change for the future from staff in all areas and at all levels via electronic and paper surveys.
- Share identified feedback themes widely and seek out further details and clarifications as needed.
- Prioritize projects using the 2 x 2 matrix to ensure that resources are spent working on activities that promote psychological safety and empathy along with clinical and operational impact.
The best of the innovations that have surfaced during the last few months need to be hardwired for the future beyond this pandemic. Health care (and health care quality) should not simply return to “normal.” We have a real opportunity not just to change how we deliver health care, but also how we feel while delivering care. How will you make psychological safety and empathy a core part of your quality improvement work?
Komal Bajaj, MD, MS-HPEd is Chief Quality Officer at NYC Health + Hospitals/Jacobi. Michael J. Zinaman MD is Chief Medical Officer at NYC Health + Hospitals/Jacobi. Eric K. Wei MD, MBA is Chief Quality Officer at New York City Health + Hospitals.
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