We've moved from stress to trauma. Here's what that means for leaders.

Healthcare professionals are a tough group. Healthcare, while rewarding, also involves heartbreaking work. Healthcare providers are always dealing with change, uncertainty, and upheaval. The external environment has always been chaotic. But now, COVID-19 has turned up the heat even higher. Many healthcare professionals report feeling chronic stress and burnout. The scope, duration, and intensity of what we’re facing is moving beyond stress and into something more serious. We're now entering trauma territory — and this can take a toll on even the toughest individuals.

Trauma is fundamentally different from stress. While stress upsets our balance in the moment, we can get through it and move on with our lives. Trauma sends people into survival mode. It makes a person feel their life, or at least their livelihood, is threatened, and it changes how one sees the world. With stress, there is the belief that things can get back to normal, or close to normal. With trauma, there is the realization that things may never get back to the way they were.

Moving from stress to trauma has a profound impact on individuals and organizations. Trauma is hard on humans. It unleashes a cascade of biological reactions — the "fight, flight, or freeze" survival mechanism — that can make people behave in uncharacteristic ways. People might become aggressive, or resist change, or resort to self-destructive behaviors. There may be blame and finger-pointing. People may divide into factions. Eventually, deep and damaging polarization may occur.

The first step to breaking (or, better yet, preventing) this fear-based chain reaction is to "name" trauma. This may not come easily. People typically think of trauma as a single horrific event (like a workplace shooting), but it can also happen gradually, like the frog in the pot of water that’s slowly turned up to the boiling point. Being willing to label a crisis as trauma (rather than ordinary stress) sets us up to take it seriously and approach it in a different way. Being aware that we have transitioned from stress to trauma helps everyone in the organization better understand how to move forward.

Treating trauma in the same way we treat stress doesn't work. Resilience training, while vital, is only the beginning. We also need a road map that allows us to intervene early in future crises and move people through trauma in a healthy and productive way. And we need leaders to take a strong, highly visible role in the process.

It is necessary for leaders to be immersed in the responsibility of managing all that COVID brings to the organization: securing personal protection equipment, managing capacity demands, educating the community, addressing the media, and at times eliminating elective procedures and dealing with the increased staffing complexities. It is like putting 15 pounds of beans in a 10-pound bag. Something will give.

Over the years, organizational leaders have spent a great amount of time and resources building cultures of high employee and physician engagement. COVID-19 is taking a tremendous amount of time and energy from everyone in the organization. When COVID first hit healthcare, employees responded quickly like they always do. In the crisis, employees’ adrenaline kicked in, teamwork was high, and collaboration was strong, which contributes to a high level of energy. What was unknown was how long COVID would last. With the unknowns of COVID-19 and the fact that it is lasting longer and the impact is wider than most imagined, what started out as stress on an organization may have transitioned into trauma.

The balance of life and work has never been tougher. A person feels a need to be at work to take care of their patients and support the organization, but now has their child at home because of virtual school or because the daycare center is unavailable. Extended family cannot be counted on as they once were because of the fear of COVID. Staffing is now a greater challenge because so many people are unavailable due to quarantining and other family commitments. On top of this, the person in healthcare may be looked upon as a resource for friends, family, and others.

Similar to a pain threshold with a patient, what was at one time a 5, 6, or 7 is now moving into the 8, 9, or 10 range. This means an organization must continue to address stress and resiliency, while also implementing a toolkit for dealing with trauma.

In 2020 there have been lots of "withdrawals" from the emotional bank account that the organization has built up with employees and physicians over the years. The majority of these withdrawals are from external factors that leaders and organizations have had little or no control over. With the pain threshold moving to an 8, 9, or 10, here are some recommendations that will help replenish the emotional bank account:

Super-focus on communicating. In times of trauma, people benefit from hearing from leaders often. If not, employees may fill in the blanks. Or, communication may be inconsistent with a range of messages shared. Either way, there may be uncertainty and anxiety. This is the time to lean toward the side of overcommunication. While we always want finite answers, this is almost like taking care of a patient. With a patient, you narrate the care you are providing even when there are no definite answers. Leaders almost need to daily and weekly narrate to employees what’s happening. You continue to communicate even when you don’t have all the answers and even when you have to share bad news. People want to know what to expect. At times it’s important to let them know they are hearing everything you know.

Round physically and virtually to stay connected with your employees. Rounding — where leaders regularly touch base one-on-one with employees to ask questions designed to get specific feedback — can help. Due to COVID, it is natural that physical rounding could be reduced, but we can always round virtually. This can reduce the communication gap, take the temperature of the organization, discover what is working, and identify opportunities for improvement.

Reward and recognize. It is more vital now than ever. Healthcare workers have always been heroes. We see this heroism every day, and it’s now apparent to everyone. It is normal, due to all the other demands on our time, to subconsciously back off on reward and recognition. We have had to cancel employee outings, employee celebrations, and large group gatherings that have at times been the threads that have kept our cultures together. So now we have to replace these events with increased use of virtual communication, personal touches, notes, and constant storytelling to bring all of our heroes to light.

Realize that we have the opportunity and responsibility to destigmatize mental health. Healthcare people have a "stiff-upper-lip" mentality. They have to. My (Quint's) first grandchild was a full-term stillborn birth. Ella was her name. My son and daughter-in-law received this devastating news from healthcare workers who had to leave this sad and tragic situation, walk into another room, and enter a completely different birth experience. Very few professions, if any, have to deal with the range of emotions that healthcare workers experience. Healthcare professionals are strong, stoic, and empathetic. They have to put feelings into emotional silos. However, there are unintended consequences.

If these emotions and situations are not addressed, depression and other emotional and even physical issues may surface. Suicide among physicians has never been higher. When you look at your benefits package, you may see that one of the biggest items is antidepressant medication. These have a place, but other types of therapies have a place as well. If you look at the EAP use among employees, it is relatively low. We need to be as aggressive with helping people with emotional issues as we are with physical ones. Now, more than ever, is the time to bring mental health to the forefront.

The pain scale throughout life varies depending on what is taking place. Most of the time, you would probably find it at the lower numbers. Many things outside of our control will increase that pain number, whether it is an accident, a personal loss, or a professional loss. Today, organizations, similar to people, have been impacted by many issues outside of their control. This has moved the organization from "stress" numbers (like 5, 6, or 7) to "trauma" numbers (like 8, 9, or 10).

The good news is, once healthcare leaders diagnose the problem, they move quickly into the solutions. Today, the solution is understanding the difference between organizational stress and trauma and treating both of these in the workplace.

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Quint Studer is a well-recognized and respected name in healthcare. Many credit Quint for increasing healthcare’s focus on patient experience, as well as employee and physician engagement. After years of working in hospitals, Quint founded Studer Group in 2000. Studer Group received the Malcolm Baldrige Quality Award in 2010. In 2014, Modern Healthcare presented Quint with its first Healthcare Marketing Visionary Impact Award.

His book Hardwiring Excellence is among the most read books ever published in healthcare. During these years, Quint founded a not-for-profit called the Studer Community Institute. It focuses on early brain development, entrepreneurship, and civic engagement, all of which support its mission of improving the quality of life in communities. This work is published in the book Building a Vibrant Community. His latest book is Wall Street Journal bestseller The Busy Leader’s Handbook. Quint currently serves on the board of directors of TriHealth, Hazelden Betty Ford, and CAHME.

For more information, please visit www.thebusyleadershandbook.com, www.vibrantcommunityblueprint.com, and www.studeri.org.

Dr. Diana Hendel is an executive coach and leadership consultant, former hospital CEO, and author of Responsible: A Memoir, a riveting and deeply personal account of leading during and through the aftermath of a deadly workplace trauma. She is also the coauthor of the soon-to-be-released books Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD and Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side.

As the CEO of Long Beach Memorial Medical Center and Miller Children’s and Women’s Hospital, Hendel led one of the largest acute care, trauma, and teaching hospital complexes on the West Coast. She has served in leadership roles in numerous community organizations and professional associations, including chair of the California Children’s Hospital Association, executive committee member of the Hospital Association of Southern California, vice chair of the Southern California Leadership Council, chair of the Greater Long Beach Chamber of Commerce, board member of the California Society of Health-System Pharmacists, and leader-in-residence of the Ukleja Center for Ethical Leadership at California State University Long Beach.

She earned a BS in biological sciences from UC Irvine and a Doctor of Pharmacy degree from UC San Francisco. She has spoken about healthcare and leadership at regional and national conferences and at TEDx SoCal on the topic of “Childhood Obesity: Small Steps, Big Change.”

For more information, please visit www.partnershipadv.com and whycopewhenyoucanheal.com.

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