After two years of combatting a public health crisis, healthcare leaders say they have largely transformed from coping to building a culture of resiliency at their organizations.

But across the U.S., whether that tenuous tightrope is sustainable is up for debate – putting clinician well-being at the forefront of many conversations surrounding burnout and a system still plagued by COVID-19. The pressures on those who deliver care – and those supporting them – are greater than ever before, with a magnified spotlight on the social determinants of health and mental health woes.

athenahealth recently spoke with physicians and human resources professionals about what they’ve learned throughout the pandemic and the important role that quality of life has for those who deliver care – and its impact across the healthcare continuum.

Heather Sprague is the Chief Human Resources Officer at Adena Health System, which serves nine counties at four hospitals in south and central Ohio.

Dr. Kirsten Meisinger is the Director of Provider Engagement at Cambridge Health Alliance in Massachusetts, where she is also an instructor at Harvard Medical School.

Dr. Craig Summers is a managing partner and founder of Children's Medical Group in Hamden, Connecticut.

How do you define well-being?

Sprague says Adena has doubled down on focusing on “not just the physical component or the nutritional component, but spiritual, emotional, mental, career, financial” health of its 4,500 employees. “How we are supporting the whole person is a different conversation today than it was five or even three years ago.”

Meisinger also sees the answer as focusing on people holistically, and believes that despite the pandemic’s challenges, the crisis can be a catalyst to revisit some important conversations about “practicing what’s preached.” Flipping the U.S. “healthcare narrative” in terms of perspective, funding, and how wellness measures can prevent burnout is imperative, she said.

“The reason the healthcare system is difficult for us as people is that it doesn't recognize our humanity. It tries to divide us into pieces of what we think of ourselves, right? As patients, it tries to make our hypertension or diabetes one thing. So, you can talk to a nurse about your diabetes. But if you ask her about your foot pain, she says, ‘Oh, I can't do that.’ The system is set up for specialists. It’s set up for diseases, and episodes.”

Primary care is the “the only place you're allowed to talk about anything, and nothing's off the table,” said Meisinger. Those conversations – which have included a wide breadth of mental health woes and social determinants of health challenges during the pandemic – have exacerbated pressures within primary care. “If we don't start recognizing that [broadly], and addressing caregiver wellness, we won't understand why primary care is always burnt out,” she said.

For many organizations, burnout was already an issue going into the pandemic. What’s your perspective on COVID-19's impact on clinician well-being?

Beyond compartmentalizing, conversations about “we’re all in this together” need to extend beyond traditional hospital settings, Meisinger believes.

“There has been a mass experience of trauma that comes from caregivers navigating their own personal uncertainty, as well as redesigning care virtually every day, while being leaders for and reassuring their patients,” she said. “A lot of the energy you're seeing around trauma-informed care we need to apply to caregivers, particularly caregivers during a pandemic.”

At Cambridge Health Alliance, which has 14 community-based clinics, two teaching hospitals, one psychiatry hospital and three school-based health centers, the same wellness principles and sense of “collective alignment” apply at the higher and local levels, she said: “Psychological safety, community, conversations, trust — the antidote to that trauma is trust.”

For Summers, uncertainty about what was safe during the onset of the pandemic led him to take two months off to protect his own well-being. He says transparency about temporarily reduced patient volume – and thus, the financial health of the practice – created a sense of trust throughout his practice. He admits that having a smaller practice may be easier to address challenges collectively – but has ultimately led his organization to a stronger esprit de corps, Summers said.

At Adena, caregiver sentiment is measured in myriad ways, said Sprague. The system has anonymous pulse surveys that are 10 questions or less, health risk self-assessments for caregivers, and “check-in dialogue.” A “boots on the ground” approach to well-being conversations includes enhanced Schwartz Rounds, Employee Assistance Program rounding, and an expansion of pastoral care and chaplain support. (Schwartz Rounds give caregivers the opportunity to share their experiences, thoughts and feelings about patient cases or situations to make personal connections with fellow caregivers.)

Pulse surveys have also been important temperature checks throughout the pandemic, and going forward her organization will transition to Press Ganey surveys to measure activation, Sprague said. “Activation means that I understand my role. I understand my calling. It's a higher calling. I work for meaning and purpose. That really links back to our mission statement, ‘called to serve,’” she said. “The other piece of that is decompression, which means when I'm not at work, I don't have to think about work all the time. I can enjoy my family. I can enjoy my friends. I get a good night's sleep. I have things that bring me joy in my life.”

“Those temperature checks are all part of well-being, because they’ve led to us giving people more tools, apps, and resources to help them shut their minds off,” Sprague said. “What are some tools and resources to be able to sleep at night? Are we putting the screens down? Sometimes it's as easy as reading a book, versus being on your iPad or phone or watching TV.”

After-hours work is among top factors contributing to burnout. What innovative approaches have you taken to stave that off, and to promote wellness?

One of the biggest takeaways from an Adena physician survey last year led to a well-received update for 2022 – the “wellness week” is an entire work week away from the office. “You can’t just take off a Friday, Monday or random Wednesday – you need a whole week off to renew your mind and renew your spirit,” said Sprague.

Based on feedback, Adena has reconfigured some physical spaces to enhance the at-office experience, too. Rooms with spa chairs mean caregivers can take a break from clinical environs and get a mini massage, have a free snack, listen to music, or even try their hand at adult coloring books. The organization has also listened to feedback and enacted new workflows to prevent excess documentation time during the peak of the pandemic. Adena installed additional technology in patient rooms so that clinicians didn’t have to take away time from those encounters to document. The new equipment also ensures carts aren’t moved from room to room and is more sanitary.

For Summers, preventing burnout isn’t so much about after-hours work but maintaining independence – which correlates with athenahealth research about satisfaction surrounding organizational size and structure. Children's Medical Group clinicians have scheduling flexibility and can opt to provide longer appointment times – typically not an option with larger organizations. Delivering the type of care he thinks is best on his own terms gives Summers and those on his team a more satisfying clinical experience, he said.

Children's Medical Group has also made several investments. One is employee education, which increases morale. Others are upgrades to the human resources technology, which “allows us to be more attentive to the staff to listen to them better and be a little bit more proactive” so that well-being concerns don’t in turn manifest as burnout, Summers said. Ultimately, the pandemic “became a way to turn adversity into opportunity” and identify new workflows and ways to better use their EHR. “We use technology now to be more attentive and up to date with our patient care. I communicate more efficiently with my staff. We’re able to assign roles more effectively. And we all collaborate better,” Summers said.

How has your approach helped you manage the staffing woes that are so common across the healthcare continuum today?

Summers says having an “attentive” approach that demonstrates to staff that the “quality of life” ethos he built his practice on encompasses both patients and his workforce. A lot of those conversations revolve around retention. “We’ve spent a lot of time talking about how our staff are like gold. They are part of the entire encounter, more so than ever before, because technology has enabled them to be part of that team,” he said. “There is actually a happier spirit in the office.”

Both Meisinger and Sprague say the conversation today at their organizations about reframing expectations around traditional roles – and nomenclature – unites their staff and gives patients a different perspective.

“We really need to define ‘caregiver,’” says Meisinger. “Our culture likes to have crystallized roles, and that’s not reality. Primary care providers are not all doctors. And all of us really had to be caregivers (during the pandemic).…We have MDs, DOs, nurse practitioners, and PAs working alongside each other, in a very harmonious way. Just because you have different letters after your name, doesn’t mean that this isn’t your life’s work.”

At Adena, everyone from physicians to nurses and recruiters are referred to as “caregivers.” The hospital system enhanced its Schwartz Rounds – which involve traditional clinical roles and others like social workers, psychologists, and chaplains – during the pandemic. Dialogue shared between those roles is an important component of employee retention, said Sprague. “It gives the opportunity for our caregivers to hear from one another and realize they’re not alone – they all have the same mission."