By Bridget Duffy, MD
The COVID-19 pandemic put a spotlight on the fierce dedication and commitment of healthcare workers as we watched them run into the fire, during surge after surge, to care for their patients and support their colleagues. The pandemic also put a spotlight on the psychological, emotional, and physical trauma they endured due to system inefficiencies and supply and staffing shortfalls.
For the first time in my career, I witnessed colleagues not only live in fear for their own personal safety, but also worry about going home and infecting their families. They also were forced to become “doulas for dying” as they witnessed death after death while serving as surrogates for family members so that no one died alone. They risked infecting themselves while donning and doffing their PPE to try and communicate with their colleagues or to obtain the supplies and support they needed. They were faced with moral and ethical dilemmas in care decisions due to shortages of staff and supplies. And they witnessed people on the margins, members of Black and Brown communities, be disproportionately impacted by COVID-19.
Age-old problems exacerbated by the pandemic
Racial disparities and bias, workplace violence, cognitive overload, and burnout existed long before the arrival of COVID-19. For example, a 2019 survey by the American College of Emergency Physicians found that almost half of emergency physicians reported being physically assaulted at work, while about 70% of emergency nurses reported being hit and kicked while on the job.
Similarly, a quick glance at published medical literature reveals that journals have been extensively discussing the problem of healthcare worker burnout for well over a decade, and that burnout affects frontline workers in many nations across the globe. The consequences can be far-reaching, including threatening patient safety and care quality when depersonalization leads to poor interactions with patients and when burned-out physicians suffer from impaired attention, memory, and executive function, according to the Agency for Healthcare Research and Quality.
These factors are contributing to an alarming increase in nurse and physician shortages, which is expected to continue. For example, a report from the Association of American Medical Colleges projects that the U.S. will face a shortage of between 54,100 and 139,000 physicians by 2033. Similarly, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new nurses to avoid a nursing shortage, according to the American Nurses Association.
In addition, tragically, we are losing nurses and physicians from suicide. Physicians have one of the highest rates of suicide among all professions in the U.S. An estimated 300 physicians die by suicide each year, and rates may be rising. Researchers at University of California San Diego School of Medicine and UC San Diego Health’s Department of Nursing found that nurses are at higher risk of suicide than the general population. The results of the longitudinal study were published in the February 3, 2020, online edition of WORLDviews on Evidence-Based Nursing.
Unfortunately, the pandemic also exacerbated the factors that contribute to violence against health workers, adding significant stress to the work environment and exposing the impact of systemic inequities and racial injustice on the well-being of healthcare team members. In addition to cognitive overload, many healthcare workers are struggling against racism and bias from multiple sources. Many LGBTQ+ physicians still report social ostracization in the workplace, as well as harassment by colleagues and patients. Asian American healthcare workers have reported a rise in bigoted incidents since the pandemic started. And a new UCLA study shows the proportion of Black physicians in the U.S. has increased by only 4 percentage points over the last 120 years, and the share of doctors who are Black men remains unchanged since 1940.
New definition of safety needed to protect healthcare workers
After seeing so many gaps in our health system and watching my colleagues suffer through patient surges, limited PPE, visitor restrictions, and death after death, I felt a sense of urgency to do more to protect the physical, psychological, and emotional safety of the nation’s healthcare workforce. With support from the leadership team at Vocera, we started a movement to galvanize people and organizations around this mission. I reached out to a few influential CEOs from my personal contacts. They were immediately on board and recommended other CEOs to join.
Together, we launched the CEO Coalition and pledged a commitment to improving physical safety, emotional and psychological well-being, and health justice for all who work in healthcare. These 10 CEOs from across the country wrote and signed the Heart of Safety: Declaration of Principles to create more awareness about critical safety and well-being issues in healthcare, influence policies to protect healthcare workers, and ensure care team members have the resources, equipment, and technologies they deserve to feel safe at work.
Importantly, the Declaration expands the definition of safety by declaring equity and antiracism as core components of safety and including a zero-harm program to eliminate physical and verbal workplace violence.
The Declaration of Principles commits participants to adhering to and accelerating policies and programs that support three essential pillars:
- Safeguarding psychological and emotional safety
- Ensuring physical safety
- Promoting health justice
Safeguarding psychological and emotional safety: The CEOs who have signed the Declaration have committed to invest in processes and technologies that reduce emotional and cognitive burdens on team members and restore the human connection to the healthcare experience. This will involve creating practices and policies that advance open communication between team members and leaders, so people feel safe to speak up for themselves and their colleagues. Signees of the Declaration also will provide resources to assess and support team members’ emotional, social, and spiritual health, alleviating the stigma and deterrents to seeking support.
Ensuring physical safety: Member organizations commit to implementing a zero-harm program for care team members to eliminate workplace violence, whether from team members, patients, families, or community members. Additionally, CEO Coalition leaders call on all healthcare organizations to provide evidence-based PPE, technology, tools, and processes that healthcare team members need to safely do their jobs and care for patients.
Promoting health justice: The CEO Coalition has declared equity and antiracism core components of safety and requires explicit organizational and health equity–focused policies and practices to advance diversity, inclusion, and belonging. Healthcare team members deserve to work in environments free from bias and discrimination so they can bring their full selves to work without fear. They need to know they can advance to any position for which they are qualified and work in a system committed to dismantling structural inequities. And they need to see their systems evolve to produce equitable outcomes for all patients.
To turn words into actions, the CEO Coalition is collaborating with the Institute for Healthcare Improvement (IHI), which is identifying evidence-based practices to support the three pillars of safety outlined in the Declaration.
This crisis has helped healthcare leaders and policymakers see that protecting the physical, emotional, and psychological safety of nurses, physicians, and all healthcare team members is critical to the resilience of our nation’s healthcare system. Retaining, engaging, and recruiting the next generation of qualified healthcare professionals depends on us doing so. No one should have to sacrifice their personal health or safety, or their family’s well-being, to do their job of caring for others. Together we must go faster to make needed change now, so the lives of your loved ones are not impacted by the shortage of qualified professionals. On behalf of the CEO Coalition, we encourage all healthcare CEOs to join this movement of protecting our nation’s healthcare workforce.
Bridget Duffy, MD, is the chief medical officer of Vocera and a founding partner of the CEO Coalition.