Supporting Clinicians During the COVID-19 Pandemic
Authors: Charlene Dewey, Susan Hingle, Elizabeth Goelz, Mark Linzer
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions20 March 2020Supporting Clinicians During the COVID-19 PandemicFREECharlene Dewey, MD, MEd, Susan Hingle, MD, Elizabeth Goelz, MD, and Mark Linzer, MDCharlene Dewey, MD, MEdVanderbilt University School of Medicine, Nashville, Tennessee (C.D.), Susan Hingle, MDSouthern Illinois University School of Medicine, Springfield, Illinois (S.H.), Elizabeth Goelz, MDHennepin Healthcare and University of Minnesota, Minneapolis, Minnesota (E.G., M.L.), and Mark Linzer, MDHennepin Healthcare and University of Minnesota, Minneapolis, Minnesota (E.G., M.L.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1033 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The coronavirus disease 2019 (COVID-19) pandemic has upended clinicians' sense of order and control. Such disruption may lead to substantial stress in the short term and higher risk for burnout over the long term. While natural disasters, such as Hurricane Katrina, demonstrated the effectiveness of short-term emergency planning (1), the COVID-19 pandemic poses unique long-term stressors and risks to clinicians' physical, mental, spiritual, and emotional well-being. Leaders and front-line clinicians need to proactively protect the well-being of themselves and their colleagues to avoid adverse outcomes for clinicians and adverse effects on quality of patient care (2). We provide practical suggestions to encourage a culture that will sustain the clinician workforce during the pandemic. Regardless of practice location or size, everyone must commit to supporting the well-being of those involved in patient care.First and foremost, organizational leaders should provide clear messages that clinicians are valued and that managing the pandemic together is the goal. Front-line clinicians must individually and collectively identify concerns that arise while facing the reality of the pandemic. Leaders must communicate current best practices clearly and compassionately, manage expectations, clarify work hours, and provide sufficient resources and effective personal protective equipment. To better enable clinicians to maintain personal well-being and resilience throughout the pandemic, leaders should aim to monitor clinician wellness and proactively address concerns related to the safety of clinicians and their families.Leaders should aim for work schedules that promote physical resilience by enabling adequate sleep and providing access to call rooms for hospital-based clinicians working long or multiple shifts. Leaders should also take initiatives to provide basic provisions during work hours, such as easy access to water, healthy snacks, chargers for phones and other devices, and toiletries. Leaders must also designate times for clinicians to take breaks, eat, and take medications. It may also be helpful to advise clinicians working such shifts to bring at least 3 days of their own medications to work and designate a source for emergency refills. Clinicians should also continue using wellness activities that have worked for them in the past and make efforts to support each other during this challenging time.Reduction of noncritical work activities may help to promote mental well-being. Examples include rescheduling preventive and routine patient follow-up visits and eliminating nonessential administrative tasks. Anxiety can be reduced by providing a central source for updated information and clear communication of well-defined protocols, expectations, and such resources as childcare via e-mails, tweets, and automated calls. When an individual clinician feels well but cannot be present in the clinical setting because of mandatory isolation or childcare, hospitals and practices should aim to redistribute work and have these clinicians participate in computer- and phone-based care while home.During the pandemic, clinicians should be encouraged to openly discuss vulnerability and the importance of protecting one's emotional strength. Health care organizations can provide information on managing stress, reducing burnout, and identifying mental health professionals available to support clinicians (3). Deploy designated wellness champions in health care systems and practices to field clinicians' concerns, advocate for clinicians, and distribute messages of gratitude and support.We also suggest fostering spiritual resilience through distribution of positive messaging that emphasizes appreciation for clinicians' dedication and altruism. Disseminating strategies for connecting with colleagues to share stories of success, rather than focusing on failures and stresses, can help clinicians find joy amidst chaos (4). Helping clinicians recognize what they can and cannot control helps to balance expectations with realities.A supportive work culture is vital to maintaining the resilience of clinicians during a crisis such as COVID-19. We suggest developing an evidence-based menu of interventions, to be carefully selected from, and tailored to various workplace settings. For larger health systems, wellness committees and employee assistance programs are the logical resources to organize these interventions. In smaller settings, appointing a wellness champion could help to elucidate colleagues' needs and implement solutions. Surveys to assess stress points, fears, and concerns can inform leaders and provide insight into areas requiring attention. We also suggest developing plans to back up, cross-train, and rotate leadership to avoid leader burnout.Sharing challenges and successes will help to meet urgent needs during the evolving pandemic. Examples of settings for such sharing include the American College of Physicians Physician Well-Being and Discussion Forum (5), the Society of General Internal Medicine GIMConnect (6), and the American Medical Association Physician Health (7) resources that members can access. Other professional organizations, or organizations with access to community discussion boards, could develop similar venues for highlighting best practices in wellness.Emphasizing clinician wellness during the COVID-19 pandemic (8) is necessary to enable them to provide high-quality care. We propose some preliminary, common sense steps toward this goal and encourage colleagues to share strategies they find successful. How we meet the wellness needs of our clinicians may determine how well we survive the COVID-19 pandemic and future public health crises.References1. DeSalvo KB. New Orleans rises anew: community health after Katrina. Ann Intern Med. 2016;164:57-8. [PMID: 26502034]. doi:10.7326/M15-2284 LinkGoogle Scholar2. Tawfik DS, Scheid A, Profit J, et al. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med. 2019. [PMID: 31590181]. doi:10.7326/M19-1152 LinkGoogle Scholar3. Linzer M, Poplau S, Grossman E, et al. A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. J Gen Intern Med. 2015;30:1105-11. [PMID: 25724571] doi:10.1007/s11606-015-3235-4 CrossrefMedlineGoogle Scholar4. Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open. 2019;9:e022695. [PMID: 30898795] doi:10.1136/bmjopen-2018-022695 CrossrefMedlineGoogle Scholar5. American College of Physicians. Physician Well-Being and Discussion Forum. Accessed at www.acponline.org/forums/physician-well-being-and-professional-satisfaction on 18 March 2020. Google Scholar6. Society of General Internal Medicine. GIMConnect. Accessed at https://connect.sgim.org/home on 18 March 2020. Google Scholar7. American Medical Association. Physician Health. Accessed at www.ama-assn.org/practice-management/physician-health on 18 March 2020. Google Scholar8. Center for the Study of Traumatic Stress. Sustaining the well-being of healthcare personnel during coronavirus and other infectious disease outbreaks. Accessed at www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Personnel_during.pdf.pdf on 18 March 2020. Google Scholar Comments 0 Comments Sign In to Submit A Comment Charlene Dewey MD, Mark Linzer, MD, Susan Hingle MD, Elizabeth Goetz MDHennepin Healthcare, Vanderbilt University, Southern Illinois University26 March 2020 Authors' Response to Sinsky We applaud the AMA for developing the invaluable resource page provided and resonate with the emphases on childcare, mental health, PPE and providing healthy food and adequate rest for clinicians. Great ideas will continue to evolve. Each institution, organization and practice will find what works best. Supporting clinicians, nurses and all employees can take several forms.1,2 Everyone wants to feel valued and supported, and anyone can send supportive messages. Here’s a few examples recently discovered. Colleagues/teams are encouraging each other via emails and text messages. Leaders in a hospital in Glasgow KY emailed supportive messages to physicians, while our leaders at VUMC send us video messages that demonstrate a clear plan and caring. For a more formal or scheduled approach to encouraging employees, consider the EncourageX® program.3 This program sends personalized encouraging comments to all employees on a scheduled basis for a low cost. Senders choose from a variety of pre-made comments or create his/her own. Find incentives – even little ones. Our community is offering discounted meals for front-line providers in Nashville and several restaurants/businesses are taking part in this initiative as a thank you to providers. We need examples of creative, modified schedules and workload redistributions. For example, like hospitalists, providers work a few days on-site for patient care (3-5 days) and then cycle off to a home-based role (1-2 days) followed by off days (1-2 days). Some are already creating work pools to gather all non-clinical personnel and redistribute work based on priority areas. (E.g.: an administrator would use his/her skills in several areas based on institutional need.) Enlisting capable retired providers (MD, RN/APRN, PA) to care for non-COVID-19 patients or senior students (last year medical, nursing, PA students) to volunteer for non-clinical essential activities as outlined by the AAMC.4,5 Because knowledge is power, physicians seek knowledge. We can reduce the burden of providers staying abreast the changes with the pandemic or within the work area by keeping physicians updated through one source. Daily clinical updates on best approaches can eliminate physicians from seeking information from various sites or organizations, and getting sucked into the virtual, never-ending web content. (E.g.: VUMC created an app for this purpose.) As this situation continues to evolve, we are best positioned as a profession and a country, if we work together and share best practices that include attention to our clinicians. We look forward to others joining the conversation. Thank you. 1. John Hall. 11 Simple Ways To Show Your Employees You Care. Mar 10, 2014 at: https://www.forbes.com/sites/johnhall/2014/03/10/11-simple-ways-to-show-your-employees-you-care/#69ce72ae450e - Last accessed March 25, 2020. 2. Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak at: https://www.samhsa.gov/sites/default/files/tips-social-distancing-quarantine-isolation-031620.pdf - Last accessed March 25, 2020. 3. EncourageX at https://encouragex.com/encourage - Last accessed March 25, 2020. 4. AAMC: Read guidance on medical students’ voluntary participation in direct patient contact (PDF) – at https://www.aamc.org/coronavirus-covid-19-resource-hub#services – Last accessed March 25, 2020. 5. Emma Goldberg. A Medical Class ‘Minted by the Pandemic’. New York Times at: https://www.nytimes.com/2020/03/24/health/medical-school-coronavirus-students.html?referringSource=articleShare – Last accessed March 25, 2020. Christine SinskyAmerican Medical Association 25 March 2020 Crowdsourcing Ideas for Caring for Clinicians during COVID 19 Do you have ideas or experiences for how your organization is or could be caring for clinicians during COVID 19? (i.e. enhanced access to mental health care, rooms for naps, physicians at home working other's inboxes and doing telehealth....). Medical students making a difference deserve special shout out!We've begun crowdsourcing these ideas, posting and regularly updating on the AMA website here: https://www.ama-assn.org/delivering-care/public-health/caring-our-caregivers-during-covid-19?fbclid=IwAR0RFyQlS6YXR1D1XRoVm7aGzfmEsf7PhxogcBsBe8r-yJdzj0uty7nobG4If you have an idea or an implementation plan please email [email protected] .or add directly to our Google doc here: https://docs.google.com/document/d/18VwDA0ozaEUMG-jr4iNkg1F4kHh38ahZtXeQ2MCsrw8/edit Author, Article, and Disclosure InformationAuthors: Charlene Dewey, MD, MEd; Susan Hingle, MD; Elizabeth Goelz, MD; Mark Linzer, MDAffiliations: Vanderbilt University School of Medicine, Nashville, Tennessee (C.D.)Southern Illinois University School of Medicine, Springfield, Illinois (S.H.)Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota (E.G., M.L.)Disclosures: Dr. Linzer reports grants from the American Medical Association and the American College of Physicians outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1033.Corresponding Author: Charlene M. Dewey, MD, MEd, Center for Professional Health, Vanderbilt University School of Medicine, 1107 Oxford House, Nashville, TN 37232-4300; e-mail, Charlene.dewey@vumc.org.Current Author Addresses: Dr. Dewey: Center for Professional Health, Vanderbilt University School of Medicine, 1107 Oxford House, Nashville, TN 37232-4300.Dr. Hingle: Southern Illinois University School of Medicine, 913 North Rutledge cHOP, Mailcode 9623, Springfield, IL 62794-9623.Dr. Goelz: Hennepin Healthcare, 701 Park Avenue, (P5), Minneapolis, MN 55415.Dr. Linzer: Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, (G5), Minneapolis, MN 55415.Author Contributions: Conception and design: C. Dewey, S. Hingle, E. Goelz.Drafting of the article: C. Dewey, S. Hingle, M. Linzer.Critical revision of the article for important intellectual content: C. Dewey, S. Hingle, E. Goelz.Final approval of the article: C. Dewey, S. Hingle, E. Goelz, M. Linzer.Administrative, technical, or logistic support: C. Dewey, S. Hingle.This article was published at Annals.org on 20 March 2020. 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