1. Adjust expectations during pandemic

Healthcare leaders should give clinicians more flexibility and autonomy during the pandemic, the rescue package says.

“We know from the literature that control is an important burnout lever,” says Jessica Perlo, MPH, a director at the Institute for Healthcare Improvement (IHI) who helped craft the rescue package.

An important way to provide clinicians with more flexibility is through alternative scheduling, she says. “For example, Hennepin Healthcare in Minneapolis worked on eliminating mandatory early morning and late afternoon meetings, and they allowed clinicians to flexibly schedule patients during the first and last hours of their day. Clinicians were able to maintain their productivity while decreasing conflicts with commuting and picking up kids. That kind of change is good because it does not impact patient access or total patient visits, but it does improve burnout scores and turnover.”

Focusing on autonomy gives staff the freedom to determine the conditions that best support their well-being, Perlo says.

“The misconception is that autonomy somehow negates the importance of collaboration, integration, and teamwork. It does not—it allows for individuals to use discretion, judgment, and the full scope of their degrees to make management decisions that best serve a patient’s needs. A good question to ask is, ‘Do people feel like they have some choice in how they execute their daily responsibilities or a voice in the way things are done?’ This is where quality improvement can be especially helpful because it empowers people to have sufficient authority to improve how the work gets done and can be an effective lever to help work to distribute leadership in a way that promotes autonomy,” she says.

2. Identify and remove low-value work

Healthcare leaders should collaborate with clinicians to limit low-value work such as reducing electronic health record clicks for common workflows and decreasing inbox notifications, the rescue package says.

Perlo says there are two helpful tools to reduce low-value work—Get Rid of Stupid Stuff and Breaking the Rules for Better Care. “With the Breaking the Rules for Better Care tool, leaders ask their staff if they could break or change any rule in the service of better care, what would it be? The IHI’s Leadership Alliance members found that asking this question enabled their organizations to identify areas where they could take direct action to eliminate habits and rules that cause harm without benefit,” she says.

3. Make radical changes to address workforce shortages

Healthcare leaders should get creative to make sure frontline care teams are adequately staffed such as sending executives to the bedside and initiating voluntary redeployment of non-clinical staff to care settings, the rescue package says.

One of the most immediate steps healthcare leaders should take is Agemba, Perlo says. “This is an approach we borrowed years ago from lean manufacturing to have leaders see an actual work process. They can understand the work, and they can learn and show respect to those who are experiencing workforce shortages firsthand. The objective is for leaders to understand problems, rather than viewing problems and making recommendations from their offices.”

Optimizing the efforts of care team members is also critical, she says. “We also talk about allowing all staff to work at the top of their licenses and getting serious about team-based care. This can include nurses and medical assistants taking verbal orders, performing computerized order entry, doing medical reconciliation, and assisting with visit note documentation. The idea is alleviating some of the workload of clinicians.”

4. Appoint a well-being executive

Healthcare organizations should designate an executive such as a chief wellness officer who has operational authority and resources to align and execute clinician well-being efforts, the rescue package says.

A chief wellness officer is a key member of any healthcare organization’s executive team, Perlo says.

“A chief wellness officer does things such as regularly monitoring and reporting on outcomes, as well as supporting a culture of well-being. It is important for the chief wellness officer to report to the CEO, president, or the dean. This individual should also work closely with the chief equity officer or take up the goal of addressing inequities in the system. The odds of burnout are greater in female physicians, and we know that burnout is higher among people of color. So, a chief wellness officer needs to identify and address the gaps in experience across these demographics. For example, at Henry Ford Health System, Kimberlydawn Wisdom is the chief wellness and diversity officer. She ensures that the staff has the resources to impact workforce equity,” she says.

5. Foundational programs to support mental health

Mental health counseling, a peer-support program, and psychological first aid training for leaders are helpful to maintaining well-being at healthcare organizations, the rescue package says.

“Providing quality mental health counseling, creating peer support programs, and offering psychological first aid training to healthcare organization leaders normalize distress and encourage help-seeking behaviors. Peer support programs can be effective at creating formal systems for non-mental health clinicians to offer support to their colleagues after adverse events or any professionally stressful experience,” Perlo says.

Offering psychological first aid training to healthcare organization leaders helps overcome stigma and identify staff members who need help, she says. “Right now, many healthcare workers are experiencing mental health sequelae related to the pandemic. We have had multiple waves of the pandemic, and people are experiencing a lot of trauma and stress. So, making sure people are equipped to identify when their colleagues are experiencing distress is an important part of supporting our caregivers.”