Health care systems in the United States are beginning to emerge from the devastation of the pandemic. Since the existential threat of COVID-19 first hit in March of 2020 and the waves kept rolling across the country, doctors, nurses, and other clinicians put themselves and their families at risk to save others.
Clinicians were thrown into situations for which neither they nor their institutions were prepared. Like combat, the pandemic created a VUCA environment in health care.
VUCA is an acronym from the military that describes the situation in combat. It stands for:
Volatility – the situation is changing rapidly, often more rapidly than one can absorb
Uncertainty – there is a lack of clarity about the risks, which are great
Complexity – there are a multiplicity of variables
Ambiguity – there is no “right answer” to any problem that develops
This unprecedented situation drove innovation in care delivery at a pace no one had previously thought possible.
Some organizations and their leaders rose to the occasion to collaborate with and protect their clinicians as much as possible. Others struggled. These challenges continue to this day.
Now, as we are beginning to recover, health care leaders are contemplating what to do next. While the immediate threats to health and safety of individuals are diminishing, the threat to health care organizations is growing.
Doctors and nurses have been through hell — and many are ready to quit.
As reported recently in the Washington Post, 3 in 10 health care workers are considering leaving the profession. Some face PTSD after dealing with the personal toll of exposure to the human tragedy of previously healthy patients suddenly struggling to breathe, their loved ones unable to be by their side while they suffer, and eventually succumb to the virus.
Other clinicians are questioning whether their sacrifice is worth it. They watch too many members of the public refuse to wear masks or get vaccinated, claiming the right of personal freedom, ultimately forcing the clinicians who are their neighbors to continue unnecessarily risking their lives while the pandemic lingers and new waves wash through our communities. Clinicians see these people as selfish while they themselves have performed so selflessly day after day.
And still, others question whether they are willing to work for the hospital or health system that did not seem to care about them. Some health system leaders rose to the occasion right along with their clinicians, giving their all. Others did not.
Too many leaders failed to respond appropriately to the needs of the moment. They failed to protect their caregivers with adequate PPE and with creative solutions to help their clinicians deal with the overwhelm:
- The physical overwhelm of too much work, no time for rest or nourishment or caring for basic physical needs
- The emotional overwhelm of the toll of human suffering they experienced daily with no end in sight
- The personal overwhelm of fearing for the health of their families, of bringing the virus home to their spouses or children
- The overwhelm of loneliness, not being able to commiserate with their colleagues after hours
Some leaders even took action against their clinicians, punishing some who complained about the lack of support they felt they needed to deal with the chaos. Many clinicians who were not practicing in hospitals were furloughed or lost their jobs altogether as health care institutions struggled with financial upheavals.
How should health care institutions respond to their clinicians’ needs and concerns? What changes will it take to stem the tide of clinicians looking to leave your hospital or medical group or to leave clinical care altogether?
This is not just an issue for the physicians caring for patients, for medical directors, chiefs of staff or chief medical officers.
This is a serious issue for those in the top leadership roles in all health care organizations — for members of boards of directors, for CEOs and for all the CEOs’ direct reports.
While the personal health threat of the virus is diminishing, the existential threat to health care organizations of losing their clinical workforce is growing.
Just as clinicians responded by rapidly changing and innovating how they cared for patients, health care leaders must now respond by rapidly changing and innovating how they care for their caregivers.
If you are a health care leader, what should you do?
In the heat of the pandemic, clinicians dedicated themselves to saving their patients, going above and beyond expectations, and when things were not working, innovating on the fly to meet their patients’ needs in extreme circumstances.
As a health care leader, you have the opportunity to be dedicated to saving your workforce, going above and beyond expectations, and innovating on the fly to meet your clinicians’ needs.
How do you do this? Keys to effective innovation include personally experiencing the challenges of shadowing clinicians in patient care settings, involving all stakeholders in developing solutions, maintaining rapid cycles of implementing ideas and adjusting as you learn from the outcomes, and visibly and actively leading the effort.
Here are some specific actions you can take to lead your group, whether you lead an entire health system, hospital, service line, medical group, department, or your local office:
- Make your commitment to your caregivers clear – communicate this in multiple ways multiple times
- Learn from your caregivers – Spend time directly with them in patient care settings, survey them so you can reach everyone and pay attention to the answers in the surveys, especially those that express anger and frustration
- Make it clear to those who report to you that this is your priority, and thus it should be theirs as well – set explicit expectations that they too should be spending time directly among the clinicians, especially if they have a non-clinical role. Their work impacts clinicians in one way or another.
- Invest in learning new ways to care for your caregivers – Whether that be process redesign to reduce work overload, management system redesign that clarifies caregivers’ needs are being addressed and change happening or both.
- Move quickly – When the existential threat of the pandemic hit, health care delivery changed overnight, converting med-surgery wards into ICUs and moving 90 percent of in-office visits to telehealth in a week. Caregivers are looking for leaders who can quickly address the existential threat of burnout and PTSD.
These are extraordinary times. Leaders have the opportunity to seize the day, to lean into this turning point in health care delivery, to drive organizational transformation, and to emerge from the devastation of the pandemic with an organization in which patients and clinicians thrive.
You simply have to ask yourself, are you willing to change? Are you willing to dive into the fray and adapt to save your clinicians with the same commitment that your clinicians have demonstrated throughout the pandemic?
If you are, your organization will succeed beyond what you think is possible.
Paul DeChant is a family physician and health care consultant.
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