Creating a Caring Workforce Culture: Practical Approaches for Hospital Executives

Within healthcare settings during COVID-19, staff have experienced increased adverse stress conditions, which have led to increased absenteeism and turnover, lower morale, and decreased productivity. This resource highlights workforce challenges that have emerged during COVID-19 and provides concrete practical approaches that hospital management and executives have utilized during COVID surges to support and retain their workforce. This resource provide common practices that can inform hospital management and executives in workforce retention and resilience strategies.

Healthcare executive in a conversation with a male and female medical staff

Stress associated with the COVID-19 pandemic has affected everyone, but the responses to stress have varied. An MMWR survey report in July 2021 found that 53% of the 26,174 public health workers reported symptoms of at least one mental health condition in the last two weeks, such as depression (32%), anxiety (30.3%), PTSD (36.8%), or suicidal ideation (8.4%).ⁱ These adverse stress conditions have been linked to an increase in absenteeism, increased turnover, lower morale and decreased productivity.

In healthcare settings, staff have experienced serious distress due, in part, to increased workforce responsibilities, grief related to COVID deaths, depression and anxiety regarding the impacts of COVID, and fear of contracting and/or spreading the virus. These stressors have led to higher staff turnover, new and/or exacerbated organizational/administrative issues (some new and/or exacerbated by COVID), and unaddressed industry and/or social issues (e.g., lack of sufficient and affordable childcare).

Hospital executives are uniquely qualified to support, model, and build a culture of workforce wellbeing and goodwill as a mechanism for promoting workforce retention and resilience. This resource highlights workforce challenges that emerged during COVID-19 and concrete practical approaches that hospital management and executives have utilized during COVID surges to support and retain their workforce.

Common Workforce Challenges:

Inadequate staffing levels
Focus on workforce recruitment versus retention of loyal staff
Use of a temporary workforce with significant pay levels for travel staff versus those in-house
Emphasis on performance and productivity metrics versus optimal patient care
Extended and imposed work schedules
Lack of basic support (e.g., breaks, time off; use of benefit time; time for hydration, nutrition and even brief rest)
Concern for 24/7 operations (daytime workforce and night shift personnel)
Rejection of requested time-off and inability to use PYO
Accommodation for aging nursing workforce
Financial stress and/or volatility (loss of family income)
Workplace safety (personal protective equipment [PPE]-related challenges; lack of effective air circulation; risk of working while exhausted)
Lack of temporary housing/ accommodations to help manage extended shifts and safety needs
Behavioral health challenges related to cumulative stress and trauma (e.g., pervasive grief, compassion fatigue, and even burnout)

Suggested practical approaches to support the workforce

Note: These are not prescriptive solutions, rather shared common practices by healthcare organizations that have shown positive outcomes in their effort of supporting the workforce.

Involve the workforce in identifying problems and solutions

Listening to staff and what they feel would be helpful is a critical component to guide support. Incorporate staff input in solutions.
Give staff opportunities to vent and process with emotional support staff (e.g., crisis counselors, trained peers, faith leaders, even a trained supervisor or manager, etc.) on a routine basis with guided conversations around normalizing and understanding distress symptoms and coping strategies.
Implement a process for confidential feedback, suggestions, and recommendations.

Maximize multiple and supportive communications strategies:

Maintain administrative communication during shift rounding as opportunities to convey urgent or at least timely communications
Keep staff informed regularly on progress of workforce support through situational reports and/or brief targeted staff meetings.
Identify internal channels (e.g., one internal email daily) and physical spaces to provide information and encourage staff feedback (e.g., break room white board) on challenges and potential solutions. When seeking feedback from staff, ask targeted questions like:
- What are your biggest work-related challenges?
- What have you done before that worked in addressing such challenges?
- How can we honor losses (e.g., a moment of silence at the beginning of each shift)?
- How can we celebrate successes (e.g., success wall highlighting patients who have been successfully discharged)?
- What else can our organization do to make you feel valued and safe?

Practice walk-around, direct communication and modeling

Executives and team leaders can connect with all staff throughout the hospital by being present, rounding, and creating an open communication style. Encouraging all disciplines of staff to talk to executives in an informal way sends the message to staff that the workforce matters to the organization.
Follow up purposefully and meaningfully regarding issues affecting the workforce.
Model and express the importance of taking designated comfort breaks to stretch, breathe deeply, hydrate, and grab a snack. Make water and nutritious snacks easily available to staff in ongoing emergency situations.

Provide space for staff physical fitness and wellness
1. Create space and promote opportunities for staff to walk/take regular breaks.
2. Encourage staff to take breaks after a difficult experience, or as part of a debriefing process.
3. Embed employed mental health support within high-stress units.
4. Have pictures of stretching and breathing exercises in the break rooms.
5. Provide cots for short rest periods.
6. Provide information on the common, expected stress reactions, and the cognitive, emotional, and physical benefits of body movement to help decrease their negative impact.
7. Ensure information for additional behavioral health and social support (e.g., flyers, wallet cards) is available in the break rooms.
Explore employee support strategies
1. Explore an embedded support model, where several team members are trained to recognize signs of stress and distress in staff and provide stress reduction tips and other forms of support.
2. Consider implementing a buddy system, where staff are paired during each shift (they don’t need to know each other) and remind each other to take breaks, maintain nutrition and hydration, flag problems when identified (e.g., exhaustion, dehydration, confusion), and communicate with loved ones as needed.
3. Use the Safety Officer (SO) model where one person each shift is designated to check on staff and make sure they are getting hydrated, snacks, and rest, even just for short intervals.
4. Partner with and include local Voluntary Organizations Active in Disasters (VOAD’s) in supporting staff. They may have volunteers looking to make sandwiches, raise donations, supply cots, charge staff cell phones, provide emotional support, and bring coffee!
5. Ensure there is enough coverage for staff to take breaks and feel like they are doing all they can for their patients.
Financial support
1. The hospital may have a fund (or fundraising capabilities) they could use to pay or subsidize certain staff expenses.
2. Employees may be able to donate personal time off to those in need.
3. Consider providing low/no cost child and elder care for staff working long shifts.
Offer free water and food for all health care workers
1. Keep cafeteria areas open 24 hours or extend hours, as much as possible.
2. Partner with local VOAD’s or community businesses who can provide nutritional support for staff.
Encourage recognition of grief and loss

Acknowledge and honor grief and loss of patients, loved ones, colleagues, and routine.
Organize memorial services and identify physical and/or virtual spaces to memorialize loss
Implement daily rituals (e.g., coming together to name those who have died in the past 24 hours, allowing a moment of silence once per shift). Refrain from over focusing on the losses.
Balance grief/loss with opportunities to celebrate survivors being discharged.

Promote existing support programs at the hospital, such as employee assistance programs (EAP), work-life and other stress management activities that can be brought on site (e.g. stretching, chair/standing yoga; short, focused meditation; trauma acupuncture, therapy dogs, etc.) that have been previously underutilized or not promoted. Explore EAP or other insurance supported teletherapy services and negotiate them being on-site, on the phone, or virtually accessible to staff for extended hours.

Offer Resources and Referrals as Appropriate
Provide messaging to staff that at any time if any of their distress symptoms are bothering them or seemingly out of control, that it is ok to seek treatment-destigmatize the concept that there is something wrong with them if they do and instead, suggest it is a good self-care action. Short term Cognitive Behavioral treatment is a best practice that can reduce symptoms in a focused, directed, limited number of sessions in person or via telemedicine.