03. How are hospitals and health systems providing emotional support to hospitalists during COVID-19?

a. HOMERuN institutions

Although most HOMERuN sites had adopted communication strategies to address provider wellness, fewer sites had implemented or enhanced new emotional support programs or improved support for faculty families. Few sites assessed provider wellness needs directly, with only 30% of responding institutions reporting having performed a direct assessment of provider stressors to determine highest yield targets for wellness initiatives. Notably, most of these programs were developed or supported by the HOMERuN hospital or health system rather than the Hospital Medicine groups themselves.

1. Communication strategies. Almost all respondents reported their institution had transparent and frequent communication about COVID-19. Examples included regularly scheduled emails and webcasts with transparent communication about COVID-19 impact within the hospital/community. Many institutions also reported regular communication and/or easy access to information about sick leave/time off policies, e.g., via dedicated policy websites generated by the institution in response to COVID-19. Notably there was somewhat less communication about financial impact of COVID-19 on the institution/health care worker, with 70% of responding sites reporting regular communication on this topic.
2. Emotional support initiatives. Some institutions noted the formation of peer support groups such as weekly wellness check-ins and the development of buddy systems and virtual group gatherings. Over 80% of institutions provided tools to support health and wellness practices through methods such as webinars, hotlines, and wellness resource pages. More than 80% of institutions ensured providers received information about wellness resources and anxiety reduction resources with programs such as free membership to wellness apps, webinars, and mindfulness techniques practiced during meetings. Approximately 75% of institutions increased mental health resource availability (e.g., employee assistance programs).
3. Support for provider families. Overall, respondents reported variable availability of initiatives aimed at supporting provider families. 90% of respondents noted their institution gave guidelines to reduce family exposure. Examples included free hotel room housing for workers if desired, free parking for workers to minimize exposure via public transport, increased availability of scrubs and showers in the hospital, and guidelines for changing of attire prior to leaving the hospital to minimize home exposures. However, only 55% of respondents noted increased availability of childcare/eldercare resources at their institutions. Examples included subsidized on-site and/or in-home childcare. Less than 30% of respondents noted their institutions gave support for the families of providers such as counseling or support groups.

b. What is known:

There was much more variability in implementation of the emotional well-being strategies recommended to address provider wellness across HOMERuN sites. Although communication strategies were common, direct emotional support programs and provisions were less frequent, as were directed support for provider families. Communication strategies are largely less resource-intensive to implement (i.e., lower cost), whereas other emotional support initiatives and initiatives to support provider families may require more resources to develop and implement. There were also practical considerations, particularly early in the pandemic when shelter-in-place orders were strictest, around how and whether additional childcare programs were safe to develop and implement. Supporting emotional support initiatives for providers and their families may also have been dependent on infrastructure available before the pandemic.

It is worth noting that providers caring for children or aging parents have faced new challenges while attempting to maintain their workplace schedules and deadlines. Younger faculty members and women are projected to see long-lasting effects on their career trajectory due to the impact of COVID-19 on their caregiving roles^4,5. Thus, we argue that a focus on support for provider families, though likely more resource-intensive, is an important target for wellness initiatives.

Additionally, very few sites performed a direct assessment of contributing stressors, which is likely important as geography and local culture may impact wellness at individual sites and would likely help to target limited resources to the most needed interventions.

c. What is not known:

Though data was collected on what emotional support strategies were offered by responding institutions, we do not know which of these emotional support strategies were most or least effective at addressing provider wellness, or how the impact of these strategies was affected by the burden of COVID-19 patients at the responding institutions. Presumably, provider wellness offerings may differ by institution based on a number of factors, including any pre-existing provider wellness infrastructure (e.g., existing hospital/department/division leadership in wellness, allocation of funds/resources to address provider wellness, etc.) and the burden of COVID-19 patients at the institution, among other factors. How these factors relate to varying wellness offerings, how these offerings were utilized by providers, and then how they impacted provider wellness, remains unknown.