01. What frameworks or approaches for addressing provider wellness in response to COVID-19 have been suggested by professional societies?

The Press-Ganey “Caring for the Caregivers: A Leadership Checklist,¹ released on March 20, 2020, emphasizes the difference in strategies to prevent physical harm versus emotional harm. The checklist is as follows:

Physical Harm

☐ Develop robust protocols for triaging, quarantining, and distancing to minimize exposure.
☐ Minimize contact with patients by using telehealth when possible and cutting back on schedules.
☐ Provide sufficient access to personal protective gear.
☐ Ensure the availability of and easy access to hand hygiene products.
☐ Communicate and enforce guidelines for reducing risk of transmission.
☐ Communicate and enforce return-to-work guidelines for infected workers.

Emotional Harm

☐ Communicate frequently and empathically to build trust.
☐ Consistently employ universal leadership skills such as communication, awareness, honesty, and transparency.
☐ Organize peer support groups.
☐ Promote and support health and wellness practices around nutrition, sleep, exercise, and social connections.
☐ Offer and suggest anxiety-reduction strategies and opportunities such as mindfulness exercises and buddy systems.
☐ Provide professional counseling and mental health services through employee assistance programs.
☐ Establish and communicate clear policies around time off, sick time, and pay.
☐ Design solutions for providing childcare coverage.
☐ Develop and communicate clear guidelines to minimize family exposures.
☐ Offer support for families of caregivers.

The Society of Hospital Medicine (SHM)³ held a webinar on April 22,2020, and recommended the following strategies:

1. Transparent and frequent communication from leadership
2. Increase collaboration within/between groups to reduce patient loads and increase time for self-care
3. Build partnerships between the group/institution and the local community to address personal stressors
4. Provide resources to help with stress management; increase access to optional counseling sessions
5. Create opportunities to recognize and share positive news and success

The American Medical Association (AMA),² on June 17, 2020, updated their recommendations to include the following strategies for health care leadership to support staff:

1. Assess physician stress and identify specific drivers
2. Build a resilient organization
3. Workload redistribution
4. Institutional policies – changes in paid time off and sick days, ensure no expense for COVID-related illness
5. Meals – providing access to meal delivery
6. Providing childcare and pet care
7. Adequate access to PPE
8. Paying attention to emotional and mental well-being
9. Providing adequate social support

All three organizations recognize the importance of addressing barriers to both the physical and emotional wellness of their providers during the pandemic. The Press-Ganey checklist provides a concrete list of goals that it recommends institutions achieve whereas the SHM and AMA provide broader guidelines for categories of initiatives that should be addressed, and examples of good practices.

While the Press-Ganey checklist provided an initial framework to address hospitalist well-being needs, it did not adequately address how to best support hospitalist workload through adequate staffing, nor how to appropriately assess stressors at individual sites–both of which we thought were fundamental to evaluate. For this reason, we developed a questionnaire based on the Press-Ganey checklist with modifications recommended by the AMA and conducted a directed assessment of how HOMERuN institutions addressed provider wellness during the pandemic. The questionnaire was sent to 26 sites.