Have you been offered a “free” wellness workshop at your hospital or clinic?
Our guess is that you have. While the meditation session may have given you a brief respite and maybe the food even tasted good, neither did a thing for the pile of patient messages, prior authorizations, and forms waiting for you back at your desk. Nor did these interventions give you more time with your patients, offer your patients better access to medications or mental health resources, or hand you the N95 mask that you so desperately needed last year. And they certainly didn’t reduce the burnout that you and your colleagues experienced pre-COVID, during COVID, and—dare we say it—that will continue to endure post-COVID.
Neither wellness initiatives nor burnout among healthcare providers are new, but this past year feels different as well-intentioned initiatives were utterly eclipsed by the depth of the issues faced by healthcare professionals who witnessed the horror of their patients dying alone in a landscape beset by uncontrolled contagion. Working in health care has always entailed personal risks, but 2020-21 was a mortal outlier as more than 3,600 healthcare workers, dutifully going to work bedecked with a tenuous-to-nonexistent supply of adequate personal protective equipment (PPE), succumbed to COVID-19.1
The healthcare system’s response to these tragedies has been a relentless spate of resilience workshops, mental health resources, and meditation sessions to enhance our so-called wellness. The problem with trying to throw wellness initiatives at an existential threat such as COVID-19 is that these small gestures fundamentally miss the mark. By a lot. Healthcare professionals are already some of the most resilient people—a study of physicians showed that while they have above average resilience, they still suffer from burnout.2 This high level of resilience is no doubt also true of nurses, medical assistants, and all healthcare professionals who continue to care for patients in times of crisis. The marginal benefit, then, of squeezing more resilience out of a population with baseline high resiliency is likely to be small. And yet, the greater the distress, the more inexorably wellness program invitations fill our e-mail inboxes, as if obstinately yoked to burnout by the misconception that distress is due to the individual failings of healthcare professionals. In a truly bizarre mismatch of need and intervention, we were even offered ice cream during the 2020 fall surge in COVID cases and hospitalizations. Those “free” wellness sessions? They aren’t really free—no one is taking your hospital shift or seeing your clinic patients so that you can attend.
So, is increasing resiliency wrong? Well, it never hurts to become more resilient. There’s nothing wrong with mindfulness, building compassion, expressing gratitude, supporting one another, and furthering one’s personal resiliency. Institutional efforts to increase resiliency or express gratitude may indeed be helpful and we applaud our colleagues who work in these domains.3 But that cannot be our only set of strategies. Interventions that rely on building individual resilience reflect a misunderstanding of the problem, rather than what we so desperately need: structural and organizational change to prevent the normalization of the work environments that cause burnout in the first place.
What else, then, should be done?
First, consider why healthcare professionals are burnt out both now and before we ever heard of COVID-19. Studies have shown that the anxieties faced by healthcare workers in the COVID-19 era include uncertainty in being heard by leadership, access to equipment, training if deployed to other clinical areas, support for personal and family needs, and care if they are themselves infected.4, 5 These are in addition to the longstanding causes of stress (pre-COVID) for healthcare workers which include extensive hours spent on electronic health record data entry (usually done “after hours”), lack of autonomy, emotional exhaustion, and difficulty maintaining a work-life balance.
Second, we must take these factors into account when implementing a structural response. We need approaches that treat the causes, rather than the symptoms, of burnout. Rather than calling healthcare workers heroes, we should acknowledge that the need for heroism is a structural failure in our healthcare systems. For physicians, interventions to improve the workplace environment should be founded on the underlying principles of returning physicians to patient care, building autonomy, reducing uncompensated work, and reclaiming work-life balance. To achieve these goals, health system leaders can direct efforts and funds towards building team-based care, allowing for flexibility in scheduling, and decreasing the administrative burdens currently falling onto physicians. The relatively new position of Chief Wellness Officer (CWO) should be empowered to make structural changes.6 For example, when front-line healthcare workers required protection from loss of paid time off in order to appropriately quarantine, the CWO should work with human resources to craft emergency policies that incentivize doing the right thing. Similarly, instead of adding a wellness session that healthcare workers are too busy, stressed, or tired to attend, the CWO should advocate for adequate rest and time to participate.
When making decisions that affect patient care and the well-being of front-line healthcare workers, leadership should solicit input from those very workers whose own lives are affected and who see first-hand what patients need. If anything, the COVID-19 pandemic may have exposed just how disenfranchised rank-and-file front-line workers are from healthcare decisions in the first place—much has been written about crisis leadership and messaging, with relatively little attention paid to how to optimally involve those in the trenches.
Now that vaccinations, despite suboptimal uptake, have at least offered in some locations the potential for an end to the first phase of this pandemic, it may be tempting to just try to go back to the way things were. While we agree that even a return to pre-COVID norms is a victory after the devastation wrought by the pandemic, complacency now is a danger to ourselves and to our patients. As healthcare professionals, we are trapped by heroism, ensnared by martyrdom. Within these mythic confines, it appears unseemly for healthcare workers to advocate for better working conditions for themselves. But we urge you to reconsider—it is long past time that an actual reckoning took place in health care.
We need leadership that can rise to the unprecedented nature of these times. We need to meet crises with compassion and keep our morals and values straight. We need to not pretend that the dangerous combination of wellness and heroism is the solution to a broken healthcare system that requires structural change. This will require a careful examination of healthcare costs and financing in order to appropriately reallocate resources. So, no—free ice cream and a yoga mat won’t cut it. We cannot meditate our way out of this mess. We don’t want to be heroes—we want to practice with grace, energy, and humanity. We can’t do it with the system we have.
- Lost on the frontline. The Guardian. https://www.theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-covid-19-coronavirus-us-healthcare-workers-deaths-database. Accessed August 15, 2021.
- West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020 Jul 1;3(7):e209385. doi: 10.1001/jamanetworkopen.2020.9385. PMID: 32614425; PMCID: PMC7333021.
- Lenhart A, Furnari M, Roller K, et al. Creating an institutional wellness platform in under 30 days during COVID-19. SGIM Forum. https://connect.sgim.org/viewdocument/creating-an-institutional-wellness. Published December 2020. Accessed August 15, 2021.
- Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323(21):2133-2134. doi: 10.1001/jama.2020.5893. PMID: 32259193.
- Donroe JH, Rabin TL, Hsieh E, et al. A broader view of risk to health care workers: Perspectives on supporting vulnerable health care professional households during COVID-19. Acad Med. 2021 May 25. doi: 10.1097/ACM.0000000000004175. Epub ahead of print. PMID: 34039858.
- Ripp J, Shanafelt T. The health care chief wellness officer: What the role is and is not. Acad Med. 2020;95(9):1354-1358. doi: 10.1097/ACM.0000000000003433. PMID: 32324635.
Clinical Practice, COVID-19, Health Policy & Advocacy, Leadership, Administration, & Career Planning, SGIM, Wellness
Dr. Wong (email@example.com) is an associate professor in the Division of General Internal Medicine at the University of Washington. Dr. Powell (firstname.lastname@example.org) is an associate professor in the Division of General Internal Medicine at the University of Washington. Dr. McClintock (email@example.com) is an assistant professor in the Division of General Internal Medicine at the University of Washington
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