C O L L E G E O F P O P U L AT I O N H E A LT H

August 18, 2020 | 4:00-5:00 pm ET

Spread the Science, NOT the VirusClinical Lessons from the Northeast Surge

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Jefferson College of Population Health

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Well-being of the Healthcare Workforce

Presented by

Sharon C. Kiely, MD, MPM, FACP

Moderated by

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Today’s Panelists

Heather Farley, MD, MHCDS, FACEP

Chief Wellness Officer

ChristianaCare

Susan M. Parisi, MD, FACOG

Director of Wellbeing & Practicing Physician

Nuvance Health

Jonathan Ripp, MD, MPH

Professor of Medicine, Medicine Education and Geriatrics and Palliative Medicine

Senior Association Dean, Well-Being and Resilience and Chief Wellness Officer

Icahn School of Medicine, Mount Sinai

Physician Well-Being: What’s Changed and What’s

More Important than Ever in the

Wake of COVID-19

Jonathan Ripp, MD, MPH

Chief Wellness Officer, Mount Sinai Health System

Senior Associate Dean for Well-Being+Resilience,

Icahn School of Medicine at Mount Sinai

Co-Chair, Collaborative for Healing and

Renewal in Medicine (CHARM)

The Pandemic Curve and Associated Stressors

6

Greatest Stressors

Time

Number of

Cases

Fear

for B

asic N

eeds

Uncertainty

Processing Experiences

1) Fear for Basic Needs

• When/what will I eat?

• How will I be kept safe and keep others safe?

• Who will care for my children?

• How will I get to and from work?

2) Uncertainty

• How long will this workload continue?

• Will I be able to do the job if redeployed?

• Am I doing enough?

• Will I be supported by my employer?

• Will I be able to make the difficult decisions?

3) Processing Experiences

• Grief and loss

• PTSD or PT Growth

• Catching my breath and time to reflect and facing the impact of societal upheaval around racial injustice

Shanafelt et al. JAMA. 2020; Ripp et al. Academic Medicine. 2020

The Pandemic Curve and Associated Stressors

7

Strategies to Address

Time

Number of

Cases

Fear

for B

asic N

eeds

Uncertainty

Processing Experiences

Time

Number of

Cases

Provid

e Bas

ic D

aily

Resourc

es

Communications

Mental H

ealth and

Psychosocial Support

1) Provide Basic Daily Resources

• Food (free and subsidized)

• PPE Clarity

• Childcare resource

• Transportation and Parking

2) Communication

• Weekly wellness messages

• Town Halls

• Transparency

3) Psychosocial & Mental Health

• Support Groups

• Phone Lines

• Telepsychiatry

• Mental Health “PPE”

• Frontline Relief

Shanafelt et al. JAMA. 2020; Ripp et al. Academic Medicine. 2020

8

9

Making the Case for Well-Being – Pre-COVID

10

Making the Case for Well-Being – In the COVID-19 Era

11

How ready is your employer to “buy in”?

12

Lessons Learned

▶ The approach to clinician well-being almost certainly requires a pivot in light

of the pandemic

– Be aware that we’ve all just experienced (are experiencing) a communal trauma.

– Shifting Needs and Drivers of Well-Being may lead to shifting priorities and

consideration of Societal Factors

– But, pre-COVID models can still apply in many respects…

▶ Uncertainty is a huge source of anxiety and stress during a pandemic

▶ Regular, authentic, transparent and supportive communications can’t be

overemphasized

▶ Trauma and Moral Distress will likely lead to significant long-term

consequences

▶ Everyone needs support, some will need treatment

– There are lots of resources to help for support

13

COVID 19-

Caring for Our Caregivers

HEATHER FARLEY, MD, MHCDS

CHIEF WELLNESS OFFICER

Center for Worklife Wellbeing

WHO

HOW

WHAT

WorkLife

Center for

WorkLife

Wellbeing

Rounding

Peer Support

“The solidarity of a

group provides the

strongest

protection against

terror and despair,

and the strongest

antidote to

traumatic

experience.”

–Judith Herman, MD (1997)

Meaning-Making

Caregiver Relief Fund

“The solidarity of a

group provides the

strongest

protection against

terror and despair,

and the strongest

antidote to

traumatic

experience.”

–Judith Herman, MD (1997)

Susan M. Parisi MD, FACOGDirector of WellbeingNuvance Learning Institute

Connecticut Statewide

Provider Wellness and

Resilience Collaborative

during COVID-19

August 18, 2020

23 Nuvance Health

Presentation Objective

Provide a statewide collaborative, replicable approach to developing a framework for Provider Wellness and Resilience during the COVID-19pandemic

– Connecticut Hospital Association (CHA) is an infrastructure that convenes member organizations for discrete purposes

– The CHA’s Safer Hospital Initiative recognized Worker Support as an important pillar

– CHA identified provider wellbeing as fundamental in addressing and supporting our caregivers during the COVID-19 pandemic

Background

The initial goal was expanded to include:

• Define guiding principles

• Develop a framework and toolkit for provider wellbeing

• Foster collegiality and sharing of wellness strategies across CT

• Recognize that all clinicians and staff members of the healthcare team would benefit from job-based approaches outlined for providers

• Ensure a thriving work force now and moving forward in CT

The Goal

Provide collective guidance based

on best practices and evidence for

how Connecticut hospitals were

responding to COVID-19 from a

Wellness standpoint

26 Nuvance Health

Nuvance Health27

Connecticut COVID-19 Statistics (May 6, 2020)

https://portal.ct.gov/-/media/Coronavirus/ctdphcovid19summary5152020.pdf

Nuvance Health28

Solving for “How to organize and discuss in a meaningful way”

Hospitals were at different stages of developing Wellness Programs pre COVID-

19 with different leadership structures and resources

Novice: traditional HR/EAP

Advanced: Chief Wellness Officer led Wellness Departments

How to create an accessible framework with common language to share with all

CHA members?

The Solution….

29 Nuvance Health

30 Nuvance Health

1. Hear me & Respond to me (Guiding Principles- multimodal,

bidirectional, timely and complete response)

2. Protect me (Guiding Principles- physical safety, psychological safety)

3. Prepare me (Guiding Principles-training, up to date & evidence-based

education, transparency)

4. Support me (Guiding Principles- holistic support of the individual in

the context of the community)

5. Care for me (Guiding principles- ensure basic needs are met

(Maslow’s hierarchy))

6. Honor me (Guiding principles- coordinated, inclusive, planned and

executed authentic appreciation and acknowledgement)

Connecticut Framework for Provider Wellness in COVID-19

31 Nuvance Health

Hear Me & Respond to Me(Guiding Principles- multimodal, bidirectional, timely and complete response)

Interventions to consider:

• Rounding: Walk rounds, GEMBA rounds

• Sharing stories: Schwartz Rounds, tell stories, Fifty Word Stories (JAMA),

• Communication: One Call support number, Intranet, dedicated Wellness

Intranet site, Daily communication; common messaging, Team huddles with

leadership, safe space, aligned with executive strategy and interests; 12

Leadership Traits re Wellness-(CITE); Virtual Town Hall, CEO Calls; identify both

low and high-level leaders to listen, GME newsletters, DIO forums

• Measurement: Pulse checks and other surveys: Maslach, Press Ganey, Internal

research, Mayo, mini Z, Stanford (PFI), AMA Survey specific to COVID.

• Equity: ensure safety to speak up across all levels including trainees

Challenges/ Barriers: mental, emotional and physical fatigue, exhaustion, extra

shifts and dealing with the long curve, trainees unique needs, cumulative impact on

healthcare workforce, attrition, unknown consequences of this pandemic, focus on

6-12 months and impacts on families and friends, isolation persists, disruption of

usual means of communication .

Takeaways1. Wellness of providers and staff was and continues to be a common and

prominent concern of CT hospitals during the COVID-19 pandemic

2. The COVID-19 pandemic presented an opportunity for CT hospitals to

collaborate on a developing situation impacting the healthcare workforce

3. Wellness is emerging as a critical skill set for healthcare systems and did not

need to be aligned with other initiatives for validation and importance

4. Wellness programming can be adapted based on this framework to the

individual hospitals’ needs

Next Steps in Connecticut- Present the Framework for Provider Wellness in COVID-19 to Safer

Hospital Initiative

- Continue provider wellness collaborative in CT moving forward

- Expand toolkit to include entire healthcare workforce wellness

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Questions?

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Spread the Science, NOT the VirusClinical Lessons from the Northeast Surge Series

Presented by the Healthcare Association of New York State

Featuring:

Noreen B. Brennan PhD, RN-BC, NEA-BC

Nicolette (Nikki) Fiore-Lopez, PhD, RN, CNEP

Courtney Vose, DNP, MBA, RN

Loretta Willis, RN

Weekly Webinar recordings can be found at Jefferson Digital Commons https://jdc.jefferson.edu/covid-19-ssnv

For more information or questions visit our website

or contact Mary.R.Cooper@Jefferson.edu.

Next Week:

Leading Patient Care during the COVID-19 Pandemic

August 25 at 4:00 pm ET | Register Here

| THOMAS JEFFERSON UNIVERSITY | COLLEGE OF POPULATION HEALTH

Thank You!