Physician: Empowering healthcare workers starts with removing 'shackles'

Tina Shah, MD, has spent her career dedicated to supporting the well-being of healthcare workers. 

Now, in her work as principal of TNT Health Enterprises, a consulting business, and as a consultant to the U.S. surgeon general, she likes to think of healthcare workers as elite athletes.

"They go to school, they train and train, whether it's nursing school or medical school or occupational therapy school. They're basically elite athletes," Dr. Shah told Becker's. "Then once they come out, we [those who are part of the healthcare workplace environment] put them on the track, but we slow them down."

"We put shackles on their legs, and then we say, 'Go run the race,'" she added. "And no surprise — they can't do the best job possible. The track is the hospital, clinic or other healthcare workplace. My life's work has been about, how do we redesign the healthcare delivery environment to take those weights off? Because these are elite athletes, and they just need to be able to be empowered to do what they know how to do."

It is this life's work that prompted her to co-lead an initiative to identify five actions healthcare leaders can take in the next three months to support the emotional, psychological and on-the-job demands for nurses, physicians and other employees. She convened a group of healthcare experts, in collaboration with the National Academy of Medicine, to identify the five actions. 

Dr. Shah said the idea came from conversations with many leaders in the industry. 

"I've had many conversations, and one thing that's popped out is leaders are really getting bombarded," said Dr. Shah, who is also a longstanding member of the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience. "If you look at health system leaders, they're getting a lot of information from a lot of different sources when it comes to thinking about how to address burnout among their workforce and deal with these workforce shortages, and it's just not clear. How can we expect a hospital leader who has millions of priorities right now, that is probably burned out themselves, to be able to know what to do when they're getting information that's really discrepant?"

About a month ago, Dr. Shah and other experts began work to create the five tactical steps. The experts included: 

  • Heather Farley, MD, chief wellness officer for Newark, Del.-based ChristianaCare
  • Elisa Arespacochaga, vice president of workforce and clinical affairs at the American Hospital Association
  • Robyn Begley, DNP, RN, senior vice president and chief nursing officer at the American Hospital Association
  • Liz Boehm, executive strategist for Vocera
  • Corey Feist, president of the Dr. Lorna Breen Heroes' Foundation
  • Jessica Perlo, senior director for the Institute for Healthcare Improvement
  • Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association 

"Within a month, we, [in collaboration with the National Academy of Medicine], were able to come to consensus on five top actions that we felt would give the most meaning to those in the field to help support them. It's not about physicians. It's not about nurses. It's about everyone. It's about your food service worker, your environmental services worker, all the way up to the top. That was the process. We convened, used a rigorous process to come to consensus," Dr. Shah explained. 

The steps, part of a 2022 Healthcare Workforce Rescue Package released Feb. 4, are: 

  • Allow more flexibility and autonomy for clinicians
  • Work with clinicians to remove low-value work via a rapid improvement process
  • Help take strain off front-line staff
  • Appoint an executive to be responsible for and align clinician well-being efforts
  • Ensure adequate mental health resources for workers

Dr. Shah said the fourth step is about having someone be the well-being czar in the organization and allowing them to have operational authority and ability to make that influence as necessary so they can implement the organization's well-being efforts.

"Or, if you have a COVID-19 command center, or an operations command center as you're in a surge, that you appoint one person to be responsible for driving this work," she said. "Because it's so cross-cutting, we often find that it's well-intended but sometimes business goals or compliance concerns will almost undermine your ability to support your healthcare workforce, even though that's what we're all trying to do to ultimately take care of our patients."

Regarding the second step, experts provide examples such as reducing EHR clicks for common workflows; limiting inbox notifications; and getting rid of unnecessary mandatory training requirements.

"It boils down to what we all know how to do as leaders, which is walk the wards, talk to people and find out what's not working and how can it be fixed because your people know how to fix it," Dr. Shah said. "Pull up that Excel file if you want to start simple, and write down all the things that need to be fixed, get solutions from your front lines and tackle them and celebrate the wins with your front lines as they come."

Overall, she said the actions are designed to help both the long term and short term. 

She advised that healthcare leaders review the list, celebrate efforts they've already made and then think about what else can be done.

"This is definitely the time to just do, and not to worry about being perfect," Dr. Shah said. "I suspect ... focusing in on these actions and starting with just one additional [part] of the list will get us really far because at this point, we know our health system, our hospitals and clinics are already in the process of breaking down. Providing that urgent support to the front lines is a must."

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