by Susie Cymbor, MD
Physician Accreditation Advisor

Health care workers and support staff fighting the pandemic face something more than exposure to a virus. In addition to caring for critically ill patients, caregivers and support staff are battling changes to workload, shortages in necessary PPE and concern for the safety of their own families; all leaving them vulnerable to extreme stress. Not to mention that in times of stress, adherence to an organization’s safety culture may be affected, increasing the potential for human error that could result in diminished clinical performance and increased patient harm.  

According to the Centers for Disease Control and Prevention (CDC), some people may experience clinically significant distress or impairment, such as secondary traumatic stress (STS), which results from chronic workplace stress and exposure to traumatic events such as the COVID-19 pandemic. While stress may reveal itself in various ways and at different times, the CDC recognizes four distinct categories of STS: physical, cognitive, emotional and behavioral. Within the categories, associated symptoms can range from pain, visual difficulties and poor concentration to irritability, excessive alcohol consumption, and temporary loss or increase in appetite.

To ensure the well-being of all caregivers, as well as patients, it’s critical for organizations to identify and address potential manifestations of high stress early on. This can be accomplished by ensuring the following elements are in place.

  1. Encourage use of available resources.

The leadership message must be clear that each person has the opportunity to seek help. Some health care organizations have an internal network for help and now is a good time to raise awareness that these resources exist. Examples include a hotline, a walk-in counseling clinic or a ‘friend-2-friend’ call line for someone who is in trouble. Communicate when and how staff should seek help and how co-workers should communicate when they recognize signs and symptoms in themselves and their peers. Physicians practicing as independent contractors may need one-on-one counseling to reap the benefits of the resources available.

If your organization is struggling to maintain internal network resources, there are external services available, such as the toll-free, multilingual and confidential Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Helpline. For more information about coping with stress during an infectious disease outbreak, SAMHSA offers this guide

  1. Establish support networks within teams.

During times of stress, consistent and frequent communications can help provide support and avoid the fear and anxiety that sometimes results from a lack of knowledge or understanding of the topic. A culture of safety ensures that staff at each level are empowered and inspired to support one another. Each individual, or a team, may face a different set of stressors, whether it’s a scheduling issue or an obstacle hindering patient care, so teams need to identify a support network that fits their goals for success. A buddy system is a common technique used in disaster teams. Each individual is responsible for his or her own health and welfare and that of the buddy. If a team is small, the lead person could be responsible for checking in with each individual team member. This network starts at the staff level and then continues through the leadership teams.

In addition to front-line staff, remember to include those who may not necessarily have direct patient care when developing support networks. They are also vulnerable to high levels of stress and deserve assurance that they have access to support networks that fit their needs as well.

  1. Conduct regular evaluations to assess staff understanding.

The use of regular anonymous evaluations provide a valuable tool for leaders to gain an understanding of whether staff needs are being met from a communications, support and resource standpoint. They also help cement the safety culture into the values and attitudes of the organization, ensuring that your staff is providing safe, quality patient care. All of these endeavors satisfy accreditation mandates in leadership, human resources, medical staff services and performance improvement.

As the current environment evolves, the signs and symptoms of STS will continue to surface. Leaders must be vigilant in supporting and sustaining a proactive and robust network available to the health care workforce, both front-line and support staff, enabling all team members to recognize symptoms, promote wellness and seek help. 

Vizient provides a multifacted approach to help your organization comply with accreditation requirements, keep up with regulatory changes and manage the uncertainty of unannounced surveys. Learn more.

About the author. Dr. Cymbor uses her more than 20 years of experience leading patient safety and quality improvement programs in academic and private practice settings to provide accreditation and regulatory services to hospital, ambulatory and critical access member organizations. Prior to joining Vizient, she worked as a field surveyor for The Joint Commission. Board certified in anesthesiology and pediatric anesthesiology, she has provided care to all patients from the fetus to the donor, in the operating room, outside the operating room and in the perioperative clinic areas. Dr. Cymbor earned her medical degree at the Copernicus Medical Academy and completed her residency and fellowship at the University of New Mexico and Michigan. She also completed a medical education fellowship at the University of New Mexico and worked as a clinical research associate at the University of New Mexico Comprehensive Cancer Center.

Published: June 9, 2020