We encourage institutions to utilize the Press Ganey “Caring for the Caregivers” wellness checklist as it provides a comprehensive framework to address wellness initiatives while allowing for adaptation as we did with our HOMERuN institution evaluation. Broad implementation of this checklist will also allow for the creation of benchmarks and comparisons across institutions.

While the checklist was published in response to COVID-19, it is important to note that institutions may experience variable success in developing and implementing these recommendations based on their pre-existing infrastructure. For example, most institutions have to newly develop the suggested physical protective strategies in response to COVID-19 (i.e., workload redistribution, use of telehealth), while some institutions may only need to augment existing emotional support networks (i.e., employee assistance programs).

We advise institutions to focus initially on physical protective strategies as these are the foundational pillars necessary to promote wellness. We argue that some of these protective strategies should have near 100% availability, which was not observed in our assessment. Specifically, 23% of responding sites reported inadequate access to PPE – a number we hope has changed, but which is likely still not near 100%. Similarly, 20% of sites reported absence of baseline triage and quarantine protocols. Although we recognize that the resources needed (financial and other) to fully implement these initiatives likely contributed to our observed findings, we advise that moving forward, institutions target 100% implementation of these crucial protective wellness strategies.

We recommend that institutions perform direct assessment of the emotional support wellness needs at their sites through surveys or focus groups. Only 31% of responding institutions performed a direct assessment of provider stressors. Direct assessment of provider needs will allow institutions
to best target emotional support wellness initiatives. Our findings demonstrate that those initiatives that are most resource-intensive (i.e., those that require time or money to implement) are less likely to be offered. Having data to support the need for specific emotional support offerings or initiatives will allow clinical leaders to better advocate and negotiate for the resources necessary to help their workforce.

Additionally, providers’ needs will differ during different phases of the pandemic.⁶ When American providers first recognized that the pandemic would likely spread to all parts of the United States early this year but had yet to see any cases, fear and uncertainty were the cause of most distress and addressing emotional wellbeing was more pressing than addressing physical wellbeing. We are now past the first phase of the pandemic with ongoing increasing cases in most parts of the country, paired with low levels of optimism and high levels of stress and exhaustion leading to the disillusionment phase of the pandemic. Emotional and physical wellbeing programs that may have been less impactful in early phases of the pandemic are now essential. Assessments performed serially will allow clinical leaders to assess uptake and impact of wellness offerings and how provider needs may change as the pandemic continues to evolve.

Finally, we encourage institutions to build wellness offerings that support providers in their caregiving roles. Healthcare workers report distress around issues surrounding family responsibilities, even more so than with issues related to the workplace.⁷ Notably, only 55% of institutions offered increased access to child or eldercare resources and fewer than 30% of institutions developed initiatives to address the burdens of families of providers. There is already evidence that the pandemic is disproportionally affecting women faculty due to their caregiving roles.^4,5 The addition of creative initiatives to address caregiver wellbeing will be necessary as the pandemic continues.

Future directions: Our next steps will include purposeful sampling of 10-15 HOMERuN sites to gather more detailed qualitative information regarding provider wellness offerings in order to address some of the identified gaps above. Included in this evaluation will be: a more detailed description of provider wellness offerings in response to COVID-19; at what level programs are being offered (i.e., by hospital, department, or division/section); uptake and, perhaps most importantly, actual impact of these offerings on provider wellness; differential impact of provider wellness offerings by age, gender, other factors; correlation of provider wellness offerings and impact with other factors, including institution-specific COVID-19 patient burden and pre-existence of provider wellness infrastructure; institutional management of longitudinal evaluation of and response to provider wellness over the varying phases of the pandemic; among others. Additionally, we hope to focus on several topics identified as high-yield in examination of COVID-19 impact on provider wellness, and how institutions are managing these, including: How institutions are managing the impact of institutional financial burden on provider wellness; and, provision of child/eldercare resources with the uncertainty of school/eldercare openings, decreased hours, increased cost for clinicians to pay for these resources, etc.