Photo by Dustin Belt | Unsplash
I shudder to remember it. When I trained as a doctor, I was on for some of my hospital rotations for 36 hours straight. It was 12 hours off, 36 hours on, and then 12 hours off again.
At the time, I felt proud of getting through it, but it was not a formula for excellence. Fatigue is an enemy of quality. It also was not a formula for sustainability and kindness. No matter how committed you are, it’s hard to remain tuned into the needs of others when you yourself are exhausted.
We’ve built a bit of a mythology into health care over the years about health care workers somehow being (or needing to be) heroic and self-sacrificing and unrealistically durable. The experience of COVID-19 is helping us to become more aware of the psychological needs of the health care workforce. We need to redefine strength to include the strength that it takes to ask for help, to say when you’re tired, or to say, “I can’t do this anymore” or “I can’t do this right now.” Strength is not the mythic view of endless reserves.
My daughter is a hospitalist in a teaching hospital. She works very, very hard. I talked to her recently about her day, and she said, “I got through it.” She explained that she and her team got overwhelmed. There was a patient who had immense demands and they didn’t know if they could meet all those demands. “I got through it because I know there’s a [support] system I can use if I need it,” she said.
My daughter can call someone to get relief if she needs it. She didn’t need to call last night, but knowing it was there helped her get through a tough time.
Mental health support is crucial for the health care workforce. Some people in health care will need counseling. Some will need support from behavioral health professionals. Leaders and their institutions need to make this support easily available and ensure that no stigma is attached to asking for this kind of assistance.
The Need for Leadership
Attending to the mental health, well-being, and joy of the health care workforce should be among the duties and obligations of the governors of health care systems and executives. In the pandemic, I’ve seen more of them talking openly about this part of their job, and that kind of ownership of these issues is welcome. We should also develop those listening and response skills at all levels of management, so they are capable of staying in touch with what’s happening with staff.
We should also make sure we’re caring for the mental health and well-being of the executives themselves. They’re no more supermen or superwomen than the rest of the workforce. Let’s make sure they’re getting the support that they need. Governing boards should keep this in mind as they supervise and assist executives.
Measurement — especially narrative measurement — is also important. We don’t need measurement to be onerous, but it’s important to have some way of listening to the workforce and learning how things are going.
For many of the problems that we have in health and health care, we don’t know what to do. Supporting the mental health and well-being of the workforce isn’t one of them. The sciences of social and psychological support and the experience of disciplined organizations offer reliable methods for executives, boards, and managers and leaders at all levels who want to understand how to support their workforce.
Donald M. Berwick, MD, MPP, FRCP, is President Emeritus and Senior Fellow, Institute for Healthcare Improvement.
Editor’s note: This article was adapted from remarks made in this video: Leadership Insights: Mental Health and Well-being in Public Health and Health Care.
Recommendations for further reading from Don Berwick:
Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being — A Consensus Study from the National Academy of Medicine
National Academy of Medicine - Clinician Well-Being Resources During COVID-19
Mayo Clinic Strategies to Reduce Burnout: 12 Actions to Create the Ideal Workplace by Stephen Swensen, Tait Shanafelt