As the COVID-19 pandemic has evolved, so have the needs of the health care workforce. Tait Shanafelt, MD, Chief Wellness Officer, Associate Dean and Professor of Medicine at Stanford University School of Medicine, has seen this firsthand. Shanafelt and his team have held nearly 40 confidential and facilitated listening sessions (with seven to eight staff members in each group) since the first week of March of 2020. What his research has uncovered is important for any health care leader to understand.

“If I’ve learned anything through this pandemic,” Shanafelt said recently, “it is just how critical the listening aspect of our [COVID-19] response is.” Many health care organizations during the pandemic have rightfully focused on crisis communications, Shanafelt noted, “but I think most of us as organizations have not devoted equal attention to developing robust incoming communication.”

Shanafelt, a researcher focused on provider wellbeing, made these comments as the featured guest on a recent IHI Virtual Learning Hour Special Series: Understanding and Addressing Sources of Caregiver Anxiety, presented in partnership with Well Being Trust. He shared advice for health care leaders informed by his research, including the following:

• Continuously assess staff’s current priorities. Shanafelt and his team have noted a change over time in the tenor of what many people have been sharing, including the strain of “the chronicity of sheltering in place, being disconnected from support networks, or the challenges of back-to-school struggles.” He also described staff worrying about upcoming elections and social justice issues. As Shanafelt said, “These challenges are going to be with us for quite a while and we need to be thinking about how we support our folks with some of these dynamics.”
  
• Understand that health care workers may be hard on themselves. “There has never been a time when self-compassion has been more important than now,” said Shanafelt. His Stanford colleague, Mickey Trockel, MD, has studied self-compassion in health care workers. Trockel has found that, while health care professionals are generally more resilient than workers in other fields, they also have less self-compassion. “We tend to be harsh and self-critical,” Shanafelt said. This may result in unrealistic expectations for handling responsibilities at home and may contribute to those quarantining at home feeling guilty or frustrated because they’re unable to help their team at work.
  
• Normalize and acknowledge the need for mental health support. For example, in Shanafelt’s organization, a physician makes regular check-in calls when workers are quarantining at home. They know from experience that almost all of them will at first decline mental health support and say things like, “I’m fine. I appreciate you calling. I just wish I was able to go to the hospital and help my colleagues.” In about a week, however, many are experiencing more difficulties. About 85 percent, Shanafelt estimated, need a referral for a range of issues, including insomnia, anxiety, depression, PTSD, and relationship issues. For this reason, Shanafelt advocated for a multifaceted approach to “psychological first aid,” which includes providing safe spaces to share concerns and offer mutual support, one-on-one peer support, and access to an Employee Assistance Program or mental health professional.

Whether an organization is preparing for a surge of cases, amid a surge, or gathering lessons learned in the aftermath, listening to what matters most to health care workers has emerged as an essential practice at every stage of response. To learn more, watch the Virtual Learning Hour Caring for Caregivers recording or read the JAMA Viewpoint Shanafelt and his colleagues wrote on this topic. The IHI Virtual Learning Hour Caring for Caregivers special series was delivered in partnership with Well Being Trust.

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