The Evolving Role of the Chief Wellness Officer in the Management of Crises by Health Care Systems: Lessons from the Covid-19 Pandemic

Clinician Well-Being Assessment and Interventions in Joint Commission-Accredited Hospitals and Federally Qualified Health Centers

BACKGROUND

Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being.

METHODS

This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited FQHCs. Outcomes of interest included the proportion of hospitals and FQHCs that assessed the prevalence of clinician burnout, established a chief wellness officer position, established a wellness committee, made clinician well-being an organizational performance metric, and implemented other activities/interventions that target clinician burnout.

RESULTS

A total of 481 (21.5%) organizations responded to the survey (hospital n = 396 [20.0%], FQHC n = 85 [33.2%]). Response rates did not differ by organization size, type, teaching status or urban vs. rural location. Approximately one third (34.0%) of the organizations in the sample conducted an organizational well-being assessment among clinicians at least once in the past three years. Although nearly half of responding organizations reported implementing some kind of intervention to address clinician burnout, only 28.7% of organizations had adopted a comprehensive approach to address clinician well-being/burnout. Only 10.1% of hospitals and 5.4% of FQHCs reported having an established senior leadership position responsible for assessing and promoting clinician well-being at the organization level, and less than half (29.3% FQHCs, 37.6% hospitals) of organizations reported having an established wellness committee. Among 500+ bed hospitals, 61.2% had surveyed, 75.6% had established a well-being committee, 78.0% had implemented interventions to promote clinician well-being, and 26.8% had established a chief wellness officer.

CONCLUSION

Although half of Joint Commission-accredited hospitals and FQHCs reported taking steps to improve clinician well-being, a minority are measuring clinician well-being, and few are taking a comprehensive approach or established a chief wellness officer position to advance clinician well-being as an organizational priority. Organizational clinician well-being improvement efforts are unlikely to be successful without measurement and leadership in place to drive change.

Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic

BACKGROUND

Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations.

METHODS

We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning (N = 246) and end (n = 94) of the SFA program and a subgroup (n = 11) completed qualitative feedback interviews.

FINDINGS

Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress.

CONCLUSIONS AND APPLICATIONS TO PRACTICE

While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.

Lessons From the Northeast COVID-19 Surge: Well-Being of the Health Care Workforce

The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic

Purpose of review

In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.

Recent findings

Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.

Summary

A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.