By Sue Coons
As healthcare worker stress and burnout spiked during the pandemic, organizations searched for ways to alleviate the burden, including finding new uses for technology. On Sept. 13, panelists on the Healthcare Workforce Stress and Resiliency: The Role of Technology webinar discussed best and promising practices and examples of using technology address provider stress and promote healthcare workforce resiliency.1
The pandemic has brought additional fatigue and stress, staff upheaval, a continuing focus on the bottom line instead of nursing support, and verbal abuse from patients, said moderator Kimberly Patton, PsyD, public health analyst for the Health Resources and Services Administration’s (HRSA) Office of Intergovernmental and External Affairs in Denver. Stress can cause anxiety, depression, and physical ailments, which can affect decision-making and motivation.
To help healthcare workers adjust to these significant sources of stress, health systems can build and enhance resiliency, Patton said. This is the intrinsic ability for a system to adjust its functioning during and after changes or disturbances so it can sustain required operations.
COVID-19 turned up the pressure cooker on the issue of HCW burnout, said panelist Candice Chen, MD, MPH, an associate professor in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. She spoke about the tactics used by the Workplace Change Collaborative (WCC), an HRSA-funded center, to support 44 Health Professional Workforce grantees as they worked to improve mental health, ease burnout, and address “moral injury” — experiences that contradict a person’s values or expectations. For example, some healthcare workers found themselves making suboptimal treatment choices during the pandemic due to staffing or resource shortages.
Many grantees are creating initiatives to address mental health and to improve screening for their workers while recognizing the need for privacy, Chen said. One way is through telehealth or through creating virtual environments. For example, people can use an app or online virtual space to seek additional training and support for resilience and well-being. This way, people can access resources at their convenience and in a way that will support mindfulness, resilience, and well-being not only in their work life, but in their everyday lives as well, she said.
However, the effect on healthcare workers always should be considered when developing and implementing technology. These solutions should support better patient care and health worker well-being and not create inequities within a team, Chen said.
IHS Leverages Telehealth
The Indian Health Service (IHS) found telehealth services to be a tremendous help during the pandemic, both in reaching patients in remote areas and in increasing caregiver satisfaction, according to panelist Chris Fore, PhD, director of IHS Telebehavioral Health Center of Excellence in Albuquerque.
In November 2020, the Telehealth Workgroup conducted a survey for IHS providers with experience in telehealth. Most respondents either agreed or strongly agreed telehealth improved access, improved the health of patients, and gave the impression patients were satisfied. When asked what types of telehealth services would be valuable, the respondents primarily noted behavioral health, specialty care, and primary care.
The respondents also reported they were struggling with the telehealth platform and infrastructure. Telehealth visits with the IHS had increased from about 5,000 a month to more than 45,000 a month during the pandemic, but many of the visits were audio only because of patients’ lack of internet access. Putting technical staff and processes in place quickly to support the telehealth visits was a challenge, Fore said.
The IHS also set up a listserv where providers could ask questions to gain support and share information, such as best practices. The organization created a telehealth website as well. To help with infrastructure, the IHS contracted with a company for a telehealth tool that will work on any internet-connected devices and is designed for low-bandwidth environments. The IHS also released a telehealth toolkit and held training for IHS and tribal partners about how to pivot into telehealth.
Telehealth opportunities addressed resiliency and soothed provider burnout, Fore said. Some providers who needed to quarantine still chose to see patients through that platform. One IHS psychologist reported telehealth visits helped with her attention span. “Being in my own space, being able to have that distance and to interact through this modality, I feel like I have more stamina. I am more resilient and provide better care across the day than I was able to in person,” she said.
Some IHS providers who have moved out of the communities also follow those same patients through telehealth visits. That is another great way of helping with provider burnout and connection while supporting communities that need care, Fore said.
Pilot Program
A pilot program at the Medical University of South Carolina (MUSC) in Charleston is using digital health tools and telehealth to ease the burnout and mental health distress of critical care workers, such as those who work in ICUs. Typically, critical care practitioners rate higher on issues of burnout and mental health distress, and this has worsened during the pandemic, said Dee Ford, MD, MSCR, professor of medicine in the division of pulmonary, critical care, allergy, and sleep medicine at MUSC, and program director of the Telehealth Center of Excellence. Instead of just saying “we’re done and exhausted, let’s try to move on,” Ford and colleagues created a pilot program to improve the mental health of ICU workers. They built the pilot around two existing programs at MUSC, one of which was the MUSC Resiliency Program.
The program did not include a telehealth component, so they tied in a digital health component through the HRSA-funded Telehealth Center of Excellence. Ford wanted the program to be proactive in contacting people on the individual level rather than on the group or unit level. They followed the model of the MUSC Telehealth Resilience and Recovery Program (TRPP), a digital and telehealth-enabled program that educates and enrolls patients with traumatic injuries at the point of hospitalization.
In the TRPP, comprehensive mental health assessments are conducted for enrolled patients who may need higher levels of care, and the program provides best practice treatment based on individual needs, Ford said. The program adoption rate is high, with the most patients preferring the telehealth approach.
The initial screening includes contact information, 61 screening questions, and six demographic questions. The program screens for sleep disturbances, depression, anxiety, PTSD, resiliency, alcohol use, and burnout. Back-end analytics take the healthcare worker responses and tailors the individual scores in these different areas.
Longitudinal check-ins are conducted at 30, 60, and 90 days, with weekly abbreviated check-in calls in between. At each phase, a respondent can request a one-on-one session with a resiliency counselor.
The program began with medical ICU participants. Of the 178 workers who were presented with the program, 52 completed the screener, and 19 requested a telehealth appointment. The pilot is in its initial 90-day phase.
Generally, the participants in the first screening have stayed with the program, Ford said. Her mental health colleagues have indicated more people are seeking support. “I’m cautiously optimistic that we may be identifying and actually helping individuals who need [it].”
REFERENCE
- Arizona Telemedicine Program. Healthcare workforce stress and resiliency: The role of technology. Sept. 13, 2022.
As healthcare worker stress and burnout spiked during the pandemic, organizations searched for ways to alleviate the burden, including finding new uses for technology. To help healthcare workers adjust to these significant sources of stress, health systems can build and enhance resiliency.
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