key: cord-0876411-5nq2vtbr authors: Palamara, Kerri; Sinsky, Christine title: Four Key Questions Leaders Can Ask to Support Clinicians During the COVID-19 Pandemic Recovery Phase date: 2021-10-26 journal: Mayo Clin Proc DOI: 10.1016/j.mayocp.2021.10.015 sha: 0be3bbfd751cf516970bf9423546261b6975aa23 doc_id: 876411 cord_uid: 5nq2vtbr nan Individual clinicians are typically able to step up for a temporary crisis, but when crisis becomes steady state the stress can be unsustainable. As a nation, concerns about clinician burnout resulting from the stresses of the coronavirus disease 2019 (COVID-19) pandemic are rising. There is an increased focus on supporting clinicians during the pandemic recovery phase and beyond. This requires health care leaders to authentically and effectively develop strategies to address these stressors and support their clinicians. 1 In doing so, they may improve the organizational culture and promote post-traumatic growth in the pandemic recovery phase by showing their clinicians they are valued and appreciated. 2 This perspectives piece provides language and guidance for how to set the stage for honest and open conversations between organizations and their clinicians, and begin to strategize in response to what is shared in these conversations. Prior to the pandemic, clinician burnout had already been identified as a public health crisis. 3 Triennial national surveys over the past decade have demonstrated nearly half of all physicians experience some sign of burnout. 4 A fourth survey, launched in late 2020 will shed light on changes in the rates of burnout during the pandemic. Since March 2020, the American Medical Association (AMA) has surveyed clinicians and other health care workers as part of the COVID Caring for Caregivers initiative. In a cohort of 20,947 healthcare workers, those who moderately or greatly endorsed "I feel valued by my organization" had 40% lower odds of burnout, p < 0.001. 5 In a cohort of 2,373 physicians, those who answered the same question similarly had significantly lower summary stress scores (P <.001). Feeling valued explained 11% of stress summary score variance at the physician level and 31% of variance at the organizational Table 1 details potential examples one might expect to hear in response to these questions. We learned that simply asking clinicians "how are you" or "how can we help" did not generate much input or provide directionthe mental and emotional lift of coming up with ideas proved to be an unwanted additional burden, particularly when loss and grief seemed to cloud creative problem solving. In contrast, using this semi-structured approach framed with the 4 questions can help leaders connect with their workforce and walk clinicians through a process where they can articulate loss and impact of their experiences, identify what value feels like, what doing a job they feel proud of looks like, and what is getting in the way of that vision. The final step takes this new perspective and creates a space to provide recommendations for how leadership can respond. Acknowledging the many losses people have experienced is a first step in helping them feel seen and heard by leaders. Some losses may have gone unrecognized in the chaotic experiences of the J o u r n a l P r e -p r o o f workplace during crisis, and in fact, until this conversation many may not have realized what they were feeling was loss or grief. Naming those losses begins the process of grieving and can promote post-traumatic growth through development of one's narrative. 7 It also provides an opportunity for leaders to understand the areas of greatest need for resource development and support. Hearing directly from people what value and appreciation feels like will give leaders a clearer understanding of their needs and help to ensure values alignment. Guided by their responses, a mutually agreed upon vision for future success can be crafted and referenced back to in the future. Is it enough to "just try to survive" or even in crisis should leaders look for ways to help the workforce thrive? Providing space to focus on what an individual clinician needs to do a job they can feel proud of sends a message of being valued by leadership. It also creates a space to promote self-compassion rather than self-condemnation during a time when the workforce is overwhelmed, both at work and at home. This is the opportunity questionnow they have named their losses, the barriers to doing work that makes them feel proud, and how being valued at work looks, clinicians can make the ask of leaders for what they need. Consider a follow-up question of "what can we take off of your J o u r n a l P r e -p r o o f plate?" The AMA has developed a "De-implementation Checklist" as a resource to remove unnecessary burdens and improve clinician well-being through subtraction, rather than addition. 8 How leaders respond shows their investment. It is important to note that the asks that results from these conversations do not need to be realistic or well thought out. Rather, this is a brainstorming place where even the grandest idea that seems impossible may have something that can be drawn from to show value and appreciation. This is helpful to keep in mind as many healthcare organizations are operating in a resource constrained environment due to the impact of the COVID-19 pandemic. While this reality can be acknowledged during these conversations to identify areas that may be "off limits" (i.esalary, benefits, space, staffing, etc), to create a generative space, participants should be encouraged to not be hindered by financial constraints when sharing ideas, nor should leaders promise to be able to fulfill all the wishes shared. We recommend providing a range of opportunities for clinicians to engage with these questions and respond, including open listening sessions with skilled facilitators, 1:1 meetings with clinicians, hallway conversations during leadership walk rounds, or in qualitative surveys. Meeting clinicians where they are, such as typical practice meetings, rounds, or conferences can be particularly useful, so as not to ask "one more thing" of them or their time. Consider providing the questions in advance so people have time to consider their responses or consult with their colleagues. Following these discussions, it is important for leaders to share what they heard with those they listened to and those who are part of the leadership teams. These conversations should open an ongoing dialogue, not a one-time offering. Small working groups can be formed to J o u r n a l P r e -p r o o f engage those who are passionate and have ideas, which can serve to reinforce value and appreciation in these clinicians. Many resources exist and can be used to support the response to these discussions, particularly in the AMA's website 9 and the National Academy of Medicine's Clinician Well-being website. 10 Consider adding "value and appreciation" to a standing leadership meeting agenda to ensure you are not forgetting the importance of this issue. Finally, measuring value and engagement before and after this process can provide useful data on the impact of these efforts. Many clinicians readied themselves alongside their organizations in the first waves of the COVID-19 pandemic, but now worry about their resilience and rising burnout as a result. Healthcare organizations may find themselves struggling financially and focusing on the fiscal needs, but now more than ever, leaders must invest in their healthcare workforce to express their organizational values and individual appreciation to clinicians.  People cannot continue to do all they were doing before plus more, so things need to be removed from their plate, resources need to be built in, or expectations need to change  Leaders need to show more flexibility and grace in expectations and acknowledge that this time is not normal.  Need to adjust our expectations for ourselvesmy patients still need me, but I also may have kids screaming in the background. 4) What can be done to move forward and help you do a job you are proud of?  Rather than ask someone how they are doing, ask "how can I help make your day better?"  Meet 1:1 with clinicians to identify what they have lost academically or monetarily and help create an action plan to get that back on track (and check back in regularly!)  Create financial relief programs for those affected by unforeseen costs or who have suffered funding losses  Respect work and home boundaries  Encourage self-care  Encourage time off  Adjust clinical volume expectations and job descriptions to reflect post-COVID workload  Create opportunities for grieving and sharing loss Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic Pandemic-Driven Posttraumatic Growth for Organizations and Individuals Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study Preliminary Report: US Physician Stress During the Early Days of the COVID-19 Pandemic Radiologist Well-Being and Professional Fulfillment in the COVID-19 Era: Fostering Posttraumatic Growth AMA Steps Forward De-Implementation Checklist Caring for our caregivers during COVID-19 Strategies to support the health and well-being during the COVID-19 outbreak