Supporting the Mental Health & Well-Being of Yale Healthcare Workers During the COVID-19 Pandemic

June 28, 2021

Information

This presentation will describe the supportive sessions provided to front-line medical and nursing leadership teams during the first wave of COVID in the spring and summer of 2020. A combination of workshops and individual coaching support sessions were offered to help leadership teams with acute challenges presented by the rapid adjustments in care and staffing required by the pandemic. Many lessons learned also apply to hospital care after COVID.

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00:32Welcome to supporting the mental health
00:34and well being of Yale health care
00:37workers during the COVID-19 pandemic.
00:38There will be time for Q&A after
00:41each of the panelists presentations.
00:43Please use the Q&A function
00:44at the bottom of your screen.
00:47This event will be recorded. Thank you.
01:04Welcome everyone to this webinar on
01:07supporting the health care workforce
01:09during the COVID-19 pandemic.
01:12What a year it's been.
01:14The COVID-19 pandemic presented
01:16a unprecedented medical crisis
01:18for health care workers.
01:20Within weeks of dramatically changed the
01:23healthcare and pushed healthcare workers
01:26to their limits of their resilience,
01:28frontline workers worked long,
01:30exhausting hours in rapidly
01:32changing healthcare sent settings,
01:33often in settings in which
01:36they weren't familiar.
01:38In an era that's relied on
01:41evidence based medicine,
01:42they treated critically ill patients
01:44without evidence based interventions.
01:46They manage patients who seemed to
01:48be doing well one minute and shortly
01:51thereafter would be gasping for breath,
01:53requiring immediate intervention.
01:55They worked with often inconsistent
01:58guidelines about personal protective
02:01equipment and inconsistent supplies of PPE.
02:04Frontline workers made life and
02:06death decisions about who would
02:08be into baited or providing
02:11other lifesaving interventions.
02:12By battling a poorly understood new virus,
02:15they themselves and their cohabiting
02:18family members were put at risk
02:21for infection in the service of
02:24caring for the desperately ill.
02:27They were socially isolated
02:28from friends and family,
02:30often staying in separate apartments or
02:33or or separate quarters of their homes
02:36and and isolated from their families.
02:38Young frontline workers,
02:39particularly those in training,
02:41were exposed to death and dying
02:43patients at an unprecedented rate.
02:45As patients were not able to be sent
02:49to nursing homes or Hospice care.
02:52Some health care workers were pushed
02:54to the limit caring for patients.
02:56Others were sidelined by the closure of
02:59outpatient facilities and operating rooms,
03:01leading to diminished opportunities
03:02to serve and to earn a living.
03:06Covered uncovered significant
03:07health care disparities with some
03:09COVID units filled exclusively
03:11with black and brown patients,
03:13and this coincided with a national
03:16conversation about racism in the
03:19wake of the murder of George Floyd.
03:22And lastly,
03:23over the past year there's been a
03:25tumultuous political climate in an election,
03:28including claims that doctors were
03:30overcounting COVID-19 patients
03:32to make more money.
03:34During this pandemic,
03:35some likened health care delivery
03:38to fighting a war about it was
03:40front at the front lines to save
03:42lives and just as in other wars.
03:44The war against the pandemic put
03:46frontline workers at risk for stress
03:49related symptoms including anxiety,
03:50depression and post traumatic
03:52stress disorder symptoms in today's
03:54session will describe elements of
03:56our community's response to the
03:58stress experienced by members of
04:00the Yale School of Medicine and
04:02the Yona Haven Hospital community.
04:04We look forward to hearing from you
04:07about your experiences and ways in
04:09which you found support from the
04:12institutions that that do you work at.
04:14We're joined by three liters of support
04:17efforts for health care workers,
04:19and I'll introduce each of them
04:21before they make their presentation.
04:24First is John Crystal John graduated
04:26from Yale School of Medicine in 1984.
04:29He's the Robert L McNeil junior
04:31professor of Translational Research and
04:33professor of psychiatry and neurosciences,
04:35and he's chair of the Department of
04:38Psychiatry and Chief of Psychiatry
04:40at the Yale New Haven Hospital,
04:43John take it away.
04:46Thanks Bob, I since this is alumni
04:49and alumni event I can't but help
04:51reminisce to our days in Harkness Storm.
04:54I think it was the nineteen 8081.
04:57Year and it's a pleasure to join
05:01all of you today to talk about this
05:03tremendous challenge that we have
05:05faced for the past year and a half.
05:07And let me share my screens
05:09and bring up my slides.
05:14Today I'm going to be talking about
05:17efforts to support health care workers
05:20here at Yale School of Medicine,
05:23Ann, Yale, New Haven Hospital.
05:25We came together as a community to
05:28try to provide support and throughout
05:30the Community for staff for trainees.
05:33Ann for faculty.
05:38We came together as a single
05:41entity hospital and medical school
05:44leadership in a task force that for
05:47much of the past year and a half,
05:50met three times a week to organize a network
05:53of support services and the participants.
05:56In this task force include
05:58some of the speakers today,
06:00Doctor Robert Rohrbaugh, RR,
06:02Moderator Doctor Jack Tibs,
06:04who will be talking about his experience
06:07with the stress and resilience town halls.
06:10Doctor Linda Mays,
06:11who with charter about led the
06:13leadership Initiative Parenting
06:15Initiative in child care initiatives.
06:20So let me let's.
06:23Talk a little bit about the context.
06:26This picture is a picture of my local
06:29grocery store from March 2020 when
06:32literally the shelves were picked
06:34clean and and very limited resources
06:37were available in our community
06:39for the basics like toilet paper
06:42and paper towels and disinfectant.
06:45At the peak of COVID out of the 1500 beds,
06:49roughly 1500 beds at Yale,
06:51New Haven Hospital. 500 patients,
06:54500 beds were filled with COVID patients.
06:58We maxed out our utilization
07:00of intensive care unit beds,
07:02creating additional intensive care unit
07:05spaces and expanding the pool of ventilators.
07:086 units were converted to
07:11care for COVID patients.
07:13In non ambulatory, non urgent,
07:15ambulatory services were closed as mentioned.
07:20Faculty staff throughout the hospital were
07:24redeployed from settings quite distinct
07:27from the urgent care of COVID patients.
07:30Now playing new roles, leading clinical
07:33programs and caring for patients.
07:36With this initially unknown, not well.
07:42So what I'm going to talk 1st about
07:44are the stress levels in doctors and
07:46nurses and then about the support
07:49interventions that were offered.
07:51And if you'd like to read
07:54more about about this,
07:56I refer you to the website care
07:59for the caregivers website at
08:01medicine.yale.edu or to a paper
08:04that we published in 2021 in
08:07General Hospital psychiatry
08:09that describes our efforts.
08:14One of the first.
08:16Things that we realized that our
08:18community needed was a way to
08:20take their own stress temperature.
08:23In other words, people were
08:25under enormous stress.
08:27They had little time to devote
08:30to getting a sense of their own
08:33level of stress and and paying
08:36attention to their own self care.
08:39And so our group created something
08:41called the Yale Stress Self Assessment
08:45and made it available through the
08:48website that I just mentioned.
08:50That questionnaire that stressed
08:53self assessment was accessed over
08:5625,000 times with over 17,000 fully
09:00completed surveys and what I'm showing
09:03you are here in this figure are are
09:07the number of times these assessments
09:10were assessed from October to April.
09:13Although this the assessments actually
09:16began back in May and you notice that they.
09:21Are in bursts because these
09:24bursts represent times in which
09:26our community was invited and
09:29reminded about the availability
09:31of the stress assessment tool.
09:34So as you can see,
09:36there wasn't a steady utilization,
09:39but when reminded about the
09:42availability that these.
09:44Questionnaires and surveys
09:45were highly utilized.
09:49These are some of the themes that
09:52doctors and nurses identified when they
09:55completed this stress self assessment.
09:57Think these themes in both
10:00groups include family life,
10:02the threats of COVID.
10:05The political upheaval.
10:07The impact of COVID on schools,
10:11children, parents.
10:14The health concerns the anxiety,
10:16the high level of stress and and
10:19the you know the general themes
10:22that that people described.
10:26What I'm going to show you across the
10:28next couple of slides are predominantly
10:31the overall stress levels and nurses,
10:33which are generally similar
10:34to those reported in doctors,
10:36but a little bit higher and you can see that.
10:41If the all group in this slide represents
10:45all healthcare workers from from staff,
10:49people, support staff, faculty,
10:51trainees, students and here
10:53on the right are the nurses,
10:57and so you can see that.
11:02That in October,
11:03about 1/3 of of overall staff and
11:06nurses reported not feeling confident
11:09about their ability to manage work and
11:13family that nurses reported a higher
11:16overall level of exposure to death.
11:19And that high rates a little bit
11:23higher rate of feeling out of control.
11:28Or feeling guilty or ashamed
11:30and blaming others.
11:32And these are whether they had these
11:36experiences fairly often or very often.
11:39And then what you can see is that overall,
11:43and among the nurses,
11:44that there was a relatively high
11:47and sustained level of stress.
11:49From October all the way through this March.
11:54And that applies across all of these
11:57different categories of symptoms.
11:59So so,
12:00a lot of people were feeling a lot of
12:03stress related to the challenges that
12:06they faced in managing both their work
12:10life and their family life through COVID.
12:16If we look at at again nursing staff
12:19overtime and now look at the levels of
12:23different kinds of stress related symptoms,
12:27we see that the most commonly reported
12:30symptom was a feeling exhausted or tired,
12:33and that these rates approached and even
12:37surpassed 80% of nurses in the hospital.
12:40The doctor rate of of exhaustion
12:43was a little bit lower,
12:45more in the low 70s.
12:48But still very very high.
12:51I'm at a slightly lower rate where
12:54symptoms that we would associate it
12:57associate with the experience of stress,
13:01anxiety, tension,
13:02irritability,
13:03and sleeping difficulties and these
13:06levels of of symptoms were fairly
13:09sustained from October to March as well.
13:13The next level of symptoms that we
13:16saw were symptoms that reflected
13:18the functional impact of all of
13:21these stress related symptoms.
13:24Having difficulty focusing on work,
13:26forgetting things, being distracted.
13:29In experiencing headaches,
13:32these symptoms were present in
13:36in about mid 30s to mid 40% as
13:40high as 50% of nurses.
13:45Perhaps the most concerning where the more
13:49severe depression and PTSD like symptoms,
13:52feeling distant cut off from others,
13:55having racing or slow thoughts.
13:58Feeling cut off are lonely.
14:01Reminiscing,
14:02having negative thoughts about the past.
14:05Becoming losing interest in one's activity.
14:10In increasing alcohol use.
14:13These symptoms were present
14:15in about 20 to 40% of nurses.
14:20And persistently present throughout,
14:22these are not just the presence of symptoms,
14:26but rather an increase in the
14:29level of these symptoms relative
14:31to their pre COVID life.
14:34So people were these nurses like
14:37all elements of our community,
14:41were experiencing substantial levels
14:45of symptoms of anxiety stress.
14:49And PTSD like symptoms.
14:54So in summary, what I've shown you is some
14:58evidence about the significant mental health
15:01impact of being engaged in the COVID.
15:04The war on COVID. If you will, symptoms
15:08of exhaustion, functional impairment,
15:10depression and trauma symptoms,
15:13and increased alcohol use. Surprisingly.
15:18You might say that even though the particular
15:22stresses might wax and wane overtime.
15:26That the level of stress and stress
15:29related symptoms was maintained overtime.
15:31And there was a sort of subtle shift.
15:34From the acute experience of stress.
15:37To them or persisting.
15:41Stress and depression like symptoms
15:43that we might associate with burnout.
15:47And this was also accompanied by
15:49rising levels of alcohol use.
15:54OK, so let's talk a little bit
15:57about what we tried to do in
16:00our Group of of volunteers.
16:03So some of the challenges that we
16:05face right from the beginning.
16:07Was related to engaging the people
16:09who needed our help the most.
16:12Simply offering services didn't
16:14always get people engaged in in
16:17the support efforts and partly
16:19this was because people were
16:21exhausted partly because they were.
16:24They did not feel that he had the time
16:28to step away from their responsibilities.
16:33Some of this, though,
16:34turned out to be a lack of appreciation
16:37of what stress related symptoms were
16:39that they needed to pay attention.
16:42Some of them,
16:43some people described not being
16:45aware of the support resources that
16:48could were already available to them.
16:52Also, there was a need to build
16:54trust in the in the.
16:56Both in the the effectiveness of
16:58the support services that were
17:00offered and in the confidentiality.
17:03And then there are a number of
17:05typical barriers that were faced.
17:08Stigma associated with mental
17:10illness and its treatment.
17:12Stoicism,
17:12usually an admirable trait
17:14among health care workers,
17:16but sometimes a barrier
17:18to seeking needed help.
17:20Concerns about privacy.
17:22And also feelings of hopelessness
17:25and exhaustion that,
17:26as I mentioned.
17:29What we developed overtime was
17:32the safety net strategy and we
17:34appreciated that different people
17:37could be most effectively reached.
17:39By providing an array of
17:42different services that might be
17:44particularly attractive to them.
17:47And so we created a web of
17:51services that I'll describe by
17:53redeploying our our faculty,
17:56and trainees,
17:57mobilizing over 200 volunteers from
18:00mental health experts in our community.
18:06The notion was that we created
18:09a tiered support system.
18:11With services oriented to the
18:14individual support services,
18:16targeting the clinical team or department
18:19or section and then services open to the
18:23entire community at the individual levels,
18:26the employee employee Assistant
18:29assistance programs of Yale and Yale.
18:32Even hospital were available.
18:34We highlighted the available 24/7 hotlines
18:38and we created a one to one support service.
18:42Uhm? And I'll come back to
18:44this in just a little bit.
18:46We provided Wellness checks.
18:49Quiet rooms close to high acuity error
18:52areas where people could get a break.
18:55Provided meals to caregivers and as noted,
18:58housing when necessary at the team level,
19:02we provided support meetings for
19:04debriefing meetings for town halls.
19:07We had a body system we had drop
19:10Inns on literally every unit in the
19:13hospital nearly every day of the most
19:17urgent phases of the COVID pandemic.
19:21And then for units like the
19:24palliative care areas,
19:25the ICU's,
19:27we reinstated support meetings like
19:30palliative care debriefing meetings to
19:34help people manage the stress of the work.
19:38You will also hear about the leadership
19:41initiative that provided support and
19:43guidance to newly formed clinical teams.
19:45Another onsite consultations at the level
19:48of the at the Community we provided town
19:51hall meetings open to the entire community.
19:54At the beginning we had town halls
19:57every morning and every afternoon,
19:59every day of the week.
20:01On those tapered off over time,
20:04as as they as utilization declined.
20:07Also,
20:07mindfulness education from
20:10the stress centers.
20:12So let me begin first by describing the
20:14one to support one to one support program
20:16which worked from the Zoom platform,
20:19and the idea was that that access to this
20:21program was built into the stress survey.
20:24As people completed the stress self
20:26assessment and got their stress stores
20:28all they had to do was click a box and
20:31be taken to the website where they
20:33could sign up for one to one support.
20:36Everyone who signed up was then
20:40contacted within 24 hours for.
20:44A kind of debriefing, support,
20:45therapy,
20:46and clinical referral for long
20:48term treatment if needed.
20:50The treatment was provided by doctoral
20:53level traders and all cheaters
20:55were trained on a evidence based
20:58trauma focused brief intervention
21:01that was developed and validated
21:03within the Child Study Center.
21:07And they received two to four sessions
21:10and referrals were made as needed.
21:13The major challenge here was that
21:16we created an infrastructure that
21:19was not utilized as much as we would
21:22like and and which remains a bit of
21:25a mystery to us in a way but but also
21:29a reflection of how challenging it is
21:33to engage the healthcare community.
21:36In such a challenging work environment.
21:40This unit level support,
21:42as mentioned provided by a doctor
21:44Mazin Rohrbough.
21:45I'm going to let them talk about
21:47that in more detail.
21:51Frontline nurses received drop
21:53in support from from a group,
21:56including our Psychological
21:58Medicine service at Yale,
22:00New Haven Hospital and Doctors
22:02Capo from palliative Medicine,
22:04and Ariana for a from psychiatry
22:08or psychological medicine service,
22:10participated in huddles in icy
22:12with ICU and COVID unit staff.
22:20Doctor teams is shortly going to describe
22:23the stress and religion resilience.
22:26Town halls that enabled people
22:28to engage in support session.
22:31Some very general about the
22:33stresses and resilient strategies
22:35that they were uncovering.
22:38Some very focused on on various.
22:43Particular issues in particular
22:45groups targeting a variety of
22:48positive resilience strategies.
22:53So in summary, the COVID stress in our
22:57health community resembled that reported in
23:00health care communities around the world.
23:02We did our best to create a safety
23:05net of both individual team based and
23:08community based services to identify
23:11and support our health care community.
23:14And with that I will.
23:16I will stop my slides and I'd be happy to.
23:22Answer any questions.
23:25If there's time.
23:28Thanks so much John for that overview.
23:32Just a reminder, if you do have
23:34questions to to use the Q&A function
23:37and type those questions into the
23:39into the chat, that's down there.
23:47Perhaps Will will go right
23:48onto to doctor teams,
23:50and if there are questions,
23:51will catch those at the end of
23:54the of the web and R. Thank you.
24:00It's a pleasure to introduce Jack Tibbs,
24:03who's professor of psychiatry
24:04professor in the Child Study Center
24:06and Professor of Public Health.
24:08He's director of the Division of
24:10Prevention and Community Research
24:11for the Department of Psychiatry
24:13and is chief psychologist for the
24:15Connecticut Mental Health Center,
24:16and he'll tell us more about the
24:19stress and resilience town halls.
24:20Thanks so much, Jack.
24:24Thank you Bob. Come. You see the way.
24:36My slides are not coming up,
24:38so let me just get a minute here.
24:48Give me one second. Had a
24:49little bit of a glitch here.
24:56We can get them up there we go.
24:59We got it alright thank you.
25:02So I'm happy to be here today to
25:05talk to you about some of our
25:07work in the stress and resilience.
25:10Townhalls as John had spoken about
25:12earlier today, I'll be describing.
25:16Little bit of an overview on
25:18traumatic stress and resilience
25:19in the aftermath of COVID.
25:20What we've learned about that in
25:22the Yale stress and resilience,
25:24townhalls and then share some
25:26tips and resources that we did
25:28during the pandemic in the town
25:30halls for building resilience.
25:31Uh, we know that stress involves
25:34an event or series of events
25:36that places a demand on us that
25:38requires some adaptive response
25:41will experience stress physically,
25:43perhaps emotionally, cognitively,
25:44or behaviorally physically.
25:46We may experience bodily tension
25:48that may also be experienced
25:50emotionally as fear or anxiety.
25:52Cognitively,
25:52we might have trouble concentrating or
25:55have some impairment or decision making
25:58and behaviourally it may cause us to overeat.
26:01Drink alcohol to excess or withdraw socially.
26:04It's important to track these these
26:06different ways in which we experience stress.
26:08'cause as we introduce
26:09ways to reduce our stress,
26:11we can see how well we're doing.
26:14We know that COVID is been a traumatic
26:17stressor because it provides for
26:19adverse effects on our functioning
26:21and well being and often overwhelms
26:24our ability to adapt effectively.
26:26It's resulted in more than 600,000 US deaths.
26:29Health disparities for individuals who
26:31are black, Latin X American Indian,
26:33or Alaska native.
26:35There's an increase in hate crimes,
26:37Tord individuals,
26:38or Asian American or Pacific Islander
26:41recent studies have shown there's
26:43been at least a $16 trillion impact.
26:45On the economy just through 2020,
26:47with millions of people unemployed
26:49and it's revealed a national
26:51childcare and schooling crisis that
26:54we're now starting to address.
26:56Each year, the CDC, on a regular basis,
26:59tracks symptoms of anxiety or
27:01depressive disorder through a
27:03mental health pulse survey.
27:04You may be familiar with that survey.
27:07Last year,
27:08the tracking of those symptoms.
27:10There's two anxiety symptoms
27:12of anxiety disorder and two of
27:14depressive disorder over here.
27:16On the left,
27:17you can see in the spring of last year 2019,
27:21eleven percent of individuals reported
27:23symptoms of anxiety and depressive disorder.
27:26A year later,
27:27after the pandemic had arrived in the US,
27:30that was tripled to 30,
27:32almost 34%,
27:33and what I've done here is I've tracked
27:36that across time pretty much to the present.
27:39Using that survey.
27:40And as you can see,
27:42roughly 40% of individuals until
27:45very recently reported symptoms of
27:47anxiety or depressive disorder with
27:49a drop over the last several months.
27:52Those symptoms vary by gender and age.
27:55With women it's reporting slightly
27:57higher symptoms of anxiety or
27:59depressive disorder than men
28:01and younger individuals.
28:03Younger adults 18 to 29,
28:05the highest percentage of symptoms
28:07of anxiety or depressive disorder,
28:09some hovering close to 60%,
28:12but holding pretty steady during
28:14the pandemic at around 50% of young
28:17people experiencing those symptoms,
28:19the least symptoms reported were
28:21by the oldest groups.
28:23Those in their 70s and 80s
28:25reporting around 20% of the
28:27population reporting symptoms.
28:28Other age groups were
28:30somewhere in the middle.
28:32Now the pandemic a curd in the
28:35back draft backdrop of racial
28:37violence that occurred in our
28:39country and that was emphasized
28:41through the murder of George Floyd.
28:43That happened at the end of May in 2020,
28:47and what I've listed here is these
28:49symptoms of anxiety or depressive
28:51disorder for different racial and
28:53ethnic groups through the present.
28:55The loss of George Floyd
28:57preceded by Brianna Taylor,
28:59Ahmad Arbury, and so many others.
29:03Led to a spike in anxiety or
29:06depressive disorders the week after.
29:09George Floyd's death,
29:10particularly among Asian American and
29:12Pacific Islander blacks and American Indian,
29:15Alaska native individuals,
29:17and then several months later that
29:20elevation persisted for all other racial
29:22ethnic groups until only recently.
29:25Again since January 20,
29:262021,
29:27did those numbers start to come down?
29:32Now, taking a step back of the
29:35consequences of trauma we can,
29:37we can think about trauma in a broader
29:41population perspective in that most of us,
29:43virtually all of us 94% are likely to
29:46experience some trauma in our life,
29:48and that will translate in our lifetime
29:51to a rate of PTSD of about 9% as a result
29:55of that exposure in any given year,
29:58it's about 5%.
30:01Good research has done has shown us though,
30:04that it's not just PTSD,
30:05but it's other mental health challenges
30:08and substance abuse challenges that people
30:10will experience following trauma from
30:12exposure and data has shown that about
30:15one in three individuals will report
30:16some mental health or substance use disorder,
30:19including PTSD in response to trauma,
30:21and that may vary based on a prior
30:24history of a disorder, persons,
30:26childhood trauma, history,
30:27the type of trauma it is with their
30:30other secondary traumas result.
30:32Or if you belong to a particular
30:35social identity group,
30:37important thing to recognize, though,
30:39is that the response to trauma,
30:42the normative response to trauma,
30:44is resilience.
30:46Most people are resilient
30:48despite experiencing trauma.
30:50And so one way to think about that
30:52is that will experience the trauma.
30:55We will have a stress reaction.
30:57And then,
30:58although a portion will experience
30:59symptoms and problem behaviors,
31:01the majority of individuals will overtime
31:03report no substantial permanent change
31:06or even growth or transformation.
31:07And that's how we define resilience.
31:10Successful adaptation despite adversity
31:11either continued development or
31:13enhanced development when well being.
31:14It's important to note, though,
31:16that resilience is multi dimensional.
31:18It's not an all or nothing thing.
31:20It includes indicators of well
31:22being as well as dysfunction,
31:24so individuals the presence of well
31:26being the absence of dysfunction is
31:28one way to think about resilience.
31:30But it also can vary in the
31:32same person in overtime,
31:34so that you may be doing a good
31:36job taking care of patients.
31:39But then come home have trouble sleeping
31:41or have difficulty in relationships.
31:43That's why because there's
31:44it's not all or none in covers.
31:47All aspects of 1's life.
31:49It's important to have multiple strategies
31:52and pathways towards building resilience.
31:54So is John had mentioned,
31:56but one of the parts of Yale's
31:59institutional response to COVID
32:01was to create a tiered approach.
32:03The community approaches with the stress in
32:06town halls have been emblematic of doing.
32:08We begin with the core belief
32:11that everyone experiences stress
32:12and everyone can be resilient.
32:14And So what we do is these 45 to
32:17one on one hour interactive zoom
32:19town halls that facilitated by a
32:22psychiatrist and or a psychologist.
32:25To support yell affiliated health
32:26care workers in Connecticut,
32:28Rhode Island, and Westchester County,
32:30New York and all the different hospital
32:32systems and healthcare systems that entails,
32:34as well as family members and other yell
32:38affiliated group in the Tri State Community.
32:41We'll do a single town hall or a
32:43series of two to four town halls
32:47across several weeks,
32:48begins with a brief presentation
32:50and then followed by participants
32:52sharing their own stresses and resilience.
32:55Strategies and facilitators job is to
32:57affirm evidence based strategies and
32:59provide online resources to participants.
33:01This combined psychoeducation about
33:03stress and resilience with mutual support,
33:05both of which are evidence based strategies
33:08to help people cope with stress.
33:11As you can see listed here,
33:14there have been many types of town halls that
33:18we've done focusing on anxiety or sleep,
33:21breathing, relaxation,
33:22managing stress, using routines,
33:24poetry and pandemic loss.
33:26Family challenges dealing with
33:28race related trauma and parenting
33:30stress through the pandemic.
33:32Thus far over 4000 people
33:34have attended 140 town halls.
33:37I've been privileged to work with
33:39a dedicated group of faculty,
33:42psychiatrists, psychologists.
33:42That have volunteered their time
33:44during this pandemic.
33:45We're diverse in terms of discipline,
33:47age, race, ethnicity, academic rank,
33:49and we're also supported by a team
33:52behind the scenes to make all of this work.
33:54One of the things that we do is
33:57we take notes at each town hall.
34:00That's anonymous.
34:00That allows us to see what people
34:03are experiencing in terms of stress
34:05as well as resilience.
34:07Here we've identified 6 core stresses
34:10that have been reported in the town halls.
34:13Work stress,
34:14family stress and stress signs and
34:16symptoms are three of those six.
34:18About 1/3 of individuals in the town
34:21halls reports some kind of work stress.
34:23Worry about getting sick at work.
34:25Maybe bring it home to the family feeling
34:28guilt about not being on the front lines,
34:31managing the changes that occur
34:34through service lines.
34:35Staying up late and getting up
34:38early to meet deadlines for work.
34:40For those who are working remotely
34:42for those reporting,
34:43family and parenting stress.
34:45This quote comes from a participant
34:47that was really characteristic
34:48with so many in the town halls.
34:51Person talked about feeling
34:52ineffective as both a parent and
34:55a professional because demands on
34:56both fronts are so high and part
34:59that's due to lacking childcare,
35:01balancing work and family,
35:02elderly loved ones,
35:03needing assistance,
35:04managing schooling during the pandemic.
35:06A lot of challenges that families had
35:09and then others to almost 20% report
35:12stress signs and symptoms that are not
35:15really tide to any particular problem.
35:18They're just reporting those symptoms,
35:20feeling of doom, feeling exhausted,
35:22angry and irritable, guilty,
35:24craving, comfort foods.
35:26Three other stresses reported by
35:29a large percentages of people in
35:31the town halls is societal stress,
35:34social isolation,
35:34stress and self care stress.
35:37Societal stress has to do with the
35:39current toxic political environment.
35:41Our response to COVID as a government
35:44and in communities and the kind of
35:48the the racist and other responses to
35:51individuals of color during the pandemic.
35:54One of the things that people talked
35:56about is how the media was assigned
35:59stress during the pandemic and watching
36:01and feeling more stress as a result of that.
36:04Individuals are concerned,
36:05specially health care workers,
36:06had reported the difficulty of
36:08dealing with patients that thought
36:10COVID was a hoax and also the
36:13toxic political environment.
36:14Others describe social isolation
36:15stress being isolated,
36:17lonely, the lack of interaction
36:18with friends and family.
36:20The challenge of that posed,
36:22and finally, some individuals
36:23reported self care stress.
36:25The things that we usually
36:27do to take care of ourselves,
36:29such as go to the gym or find ways
36:32in which taking care of ourselves.
36:35Then involves others.
36:36Those were limited during the
36:38pandemic and made it more difficult.
36:41Despite those stresses,
36:42individuals also reported strategies
36:44of resilience during the conference.
36:46We identified 8 strategies
36:48during the town halls,
36:50the two most frequently used
36:52ones were practicing acceptance
36:54and using positive appraisal.
36:57By practicing acceptance,
36:58it's individuals focusing on
37:00what's possible right now,
37:02taking things one day at a time,
37:05accepting the situation,
37:06and accepting yourself using
37:08positive reappraisal involved.
37:10Keeping a positive mindset
37:12celebrating small winds.
37:14Seeking positive experiences to
37:16deal with those negative feelings.
37:18Practicing gratitude.
37:21Three other strategies that people
37:23have reported that high levels
37:25was building social connections,
37:26practicing self care,
37:28and engaging valued activities.
37:29Again, looking at some of the quotes
37:32in the responses in the town halls,
37:34building social connections,
37:35what we see is that both
37:37giving and receiving support.
37:39People reported being helped by and
37:42making sure to prioritizing the social
37:44connections as a way to deal with
37:47some of the stress is that people
37:49have a variety of self care skills.
37:51We're also described in
37:53practicing self care exercise,
37:55taking walks,
37:56managing nutrition and food intake,
37:58meditation and mindfulness of breathing.
38:01Prayer for some self care time,
38:03increasing control by doing by setting
38:06up routines that were stripped away
38:09in the early days of the pandemic,
38:12and then lastly engaging in
38:14valued activities.
38:15Things that bring joy to people's lives.
38:18Finding creative new experiences to try.
38:22New hobbies things a way to connect
38:24with with family members and others
38:26that you can during the pandemic.
38:29Three additional stress resilience of
38:31resilient strategies that were reported
38:33were making specific adjustments at work,
38:35making similar specific adjustments at home,
38:38and then limiting news media consumption.
38:42Typically around making
38:43adjustments at work involved,
38:45creating flexibility around a work schedule.
38:48And the same goes true for the
38:50home environment and limiting
38:52news consumption was critical,
38:54particularly before sleep as individuals
38:56wanted to decompress from the day
38:59rather than watch more news that may
39:01keep them up and reduce their sleep.
39:05What to note about these strategies
39:07as that two of the strategies are
39:10essentially cognitive strategies,
39:11things that we do in our in our
39:14heads that are source of reflection
39:16about what we're going through a
39:19way to get some distance from them,
39:21and then to either practice acceptance
39:24or use positive reappraisal
39:25to deal with that stress.
39:27Three of those strategies
39:28are behavioral strategies,
39:30like building social connections,
39:31practicing self care,
39:32engaging and valued activities,
39:34things that activate ourselves behaviourally.
39:36To do something about our stress and
39:38then three others are some combination
39:40of those depending on the context.
39:42Sometimes at work,
39:43it might involve talking to an employee.
39:45If you're a manager talking to someone
39:47that needs support during a time,
39:49other times it may involve not intervening,
39:51because that's the appropriate thing
39:53to have people work things out.
39:55Limiting news consumption might involve
39:56not turning on your phone before bed,
39:59for example,
39:59or not turning or turning off the
40:01TV or the media that sometimes
40:03so depending on context,
40:05it could be a cognitive or
40:08behavioral strategy.
40:09So what are some take home tips
40:11backed by research that we know of
40:13that as a result of the pandemic
40:15that we've learned in the tunnels?
40:18Well,
40:18some specific tips for using cognitive
40:20strategies is about practicing acceptance.
40:22Is using appraisal is thinking
40:23about yourself ways in which
40:25you can accept yourself.
40:26Perhaps talking to someone that
40:28will not be may be as judgmental or
40:30critical about the about yourself
40:32in your response to pandemic
40:34that you might be of yourself.
40:36And focusing on what you can do.
40:39Rather than what you can't do.
40:41Using a gratitude exercise
40:42on a regular basis,
40:43writing down what you're grateful
40:46for the things you've learned in the
40:49pandemic that will help you get through
40:51the next day or next several weeks.
40:54Behavioral strategies around
40:55sustaining connections,
40:56practicing self care and engaging
40:57valued activities are prioritizing
40:59one thing for valuing social connect.
41:01Building social connections
41:02is prioritizing relationships,
41:03making sure to reach out to others
41:06because it's not happening and are along
41:08the normal course of events and again,
41:11giving support can be as helpful to you
41:14as receiving support from someone else.
41:16One of the things that we heard many,
41:19many times in the town halls.
41:22So the importance of practicing
41:24kindness to others.
41:25And as you can see below
41:27around practicing self care,
41:28besides doing some of these
41:30things or trying them.
41:31People often talk to each other
41:33and support each other when
41:35they had a slip in their self,
41:37clear people were encouraging
41:39others to forgive themselves.
41:40When they don't meet their own
41:42expectations just to center
41:44yourselves and get back on to try
41:46on track to be able to practice
41:48your own self care and finally
41:50in engaging in valued activities,
41:52identify things that bring you joy
41:53and then try to do those things
41:56even in small ways for making
41:58adjustments at work or in the family.
42:00It depends on the context,
42:02but mostly. Focusing on flexibility.
42:05Taking advantage of of stress
42:07protocols at work at pandemic
42:09protocols that are put in place.
42:11Recognizing the need to build
42:13well being and connections in for
42:16children and extended family,
42:18and lastly reducing and minimizing
42:20media exposure is something
42:22forefront for many people.
42:24Less clearly mentioned in the town halls,
42:27but we know from research is dealing with
42:29our own responses to trauma and grief.
42:32Monitoring our own trauma
42:33and grief reactions.
42:34The triggers for those and then
42:37implementing resilience strategies to
42:39the extent that we can and reaching out
42:41to professionals and keeping up with
42:44professional help before giving them.
42:46John already talked about the
42:47care for the caregivers website.
42:49I encourage you to go there to see it.
42:52It's a very useful site.
42:53It also has that stress survey that
42:55you can take anonymously to kind of
42:58track your own stress and the VA put
43:00out a really terrific app called COVID Coach.
43:03If you haven't seen it already,
43:05it's free in the App Store or
43:07wherever you get your your apps.
43:09It's very useful,
43:10has a lot of useful programs.
43:12It's helpful to track both the kinds
43:14of self care things you're doing.
43:16The social connections parenting
43:18issues that are going on.
43:19It's quite helpful.
43:21So with that,
43:22I'll take any of your questions or comments.
43:29Thanks so much, Jack.
43:31That's that's great.
43:32We have a question from a
43:34from an audience member.
43:37And it might be for both Jack and for.
43:40For John, you focused on stress generally
43:43and traumatic stress in particular.
43:45But what about burning out?
43:46Which is better than
43:48epidemic rate in physicians?
43:49Your strategies of engagement and
43:51support would seem to help that. Have you
43:54been measuring burnout?
43:55Mean in many ways, it's a very good question.
43:58It's one that we hear a lot
44:01frequently burnout is is a synonym
44:03for many health care workers.
44:05For things like depression,
44:06it's often feeling.
44:07Oppressed by work,
44:08and which then can make a person
44:10feel depressed because they feel
44:12unable to change their life in critical ways.
44:15And so we track burnout to the extent
44:18that people come to us in the town halls.
44:20They say I'm really burned out.
44:22I'm exhausted, I'm tired.
44:24What can I do?
44:25And what they hear is other people who've
44:28experienced some of those same things,
44:30but maybe are a little bit further
44:32along and dealing with them.
44:34Recommend some things like
44:35behavioral activation strategies
44:36or things around practicing
44:37acceptance of what they can.
44:39Control versus what they can't.
44:43Thanks, Jack. What will
44:46now move on to doctor Linda Mays?
44:49Doctor Mays is the Arnold Gesell
44:52professor of child, psychiatry,
44:53Pediatrics and psychology in
44:55the Yale Child Study Center.
44:57She's chair of the Child Study Center
44:59and his deputy Dean for professionalism
45:02and leadership at the Yale School
45:04of Medicine and she'll be talking
45:07to us about supporting leaders
45:09of health care teams and again,
45:11if there are questions that come
45:14up during the presentation.
45:16Please type them into the Q&A doctor Mays.
45:18Yes,
45:19thank
45:19you ma'am. Thank you very much
45:21and thank you for joining us
45:23this afternoon for this session.
45:25We look forward to a discussion with you.
45:28I'm going to talk about efforts that
45:29we did to bring together specific
45:32leadership consulting for the position
45:34nurse teams on the COVID floors.
45:36But I just want to begin by
45:38setting a context which you've
45:40already heard a fair amount about.
45:42And that is that Kovin brought a
45:46very strained healthcare system in so
45:48many ways by the volume of patients
45:51by the severity of their illness.
45:53By the demands on so many health
45:56care providers, long hours, long,
45:58long times of working in intensive
46:01settings an experiencing more loss
46:03and death that had happened before.
46:05So not only is it the strained
46:08healthcare system for the providers,
46:10nurses, physicians, and all staff.
46:13On the healthcare floors.
46:15But also that there is community
46:17and individual stress during
46:19COVID that you've also heard about
46:22and all of us experienced.
46:24Many,
46:24many nurses and physicians are parents
46:27and had children at home that they needed
46:31also to worry about their education.
46:34To worry about,
46:35would they bring COVID home
46:37to their families if they had
46:39elderly adults in their homes?
46:41Were they putting them at greater risk?
46:43How would they educate their children
46:46while they were at the same time working?
46:49For many families,
46:50for many individuals working
46:52in healthcare settings,
46:53one other member of the family might
46:56have lost their job and then they became
47:00the one the one source of income.
47:02So a host of stressors,
47:04not just in the hospital setting itself
47:07on these individuals and working in
47:10the units and leading the teams.
47:15The other piece that I would say was a
47:17tremendous dresser that Doctor Rohrbough
47:20mentioned in his introduction is that the
47:23COVID magnified in equities in the United
47:25States and across the world, it magnified
47:28racial in health and equities on both.
47:31In the response to the to the virus and in in
47:35the ability to seek and receive health care.
47:38And this is going to come up as we
47:41talk about the leadership teams
47:43as it became a clearly magnified.
47:47Moral dilemma for so many of the
47:50teams in the health in this hospital.
47:54So you've already heard from
47:56both my colleagues, doctor teams,
47:58and doctor Crystal that this brought together
48:01a combination of feelings of uncertainty.
48:04Living in all of us,
48:06living through the pandemic have
48:08lived through tremendous uncertainty.
48:10What was next when with the vaccine, come?
48:13How risky was it to get out in the community?
48:18Tremendously?
48:18Rapid change?
48:19From social distancing to opening
48:22up to when would that happen?
48:25Fear a climate of loss that has been
48:28across the country with nearly 600,000
48:31deaths and so many people sick every day.
48:34Tremendous concern for family
48:37and friends and neighbors.
48:39Fatigue on health care workers,
48:41especially tremendous fatigue.
48:43The moral crisis that I mentioned as you
48:47began to see the magnification of the
48:50inequities in our health care system.
48:52And I'll talk a little bit more
48:55about this at the end, but a sense,
48:58even as we celebrated often,
49:00healthcare professionals as heroes
49:01and working on the frontline,
49:03so many of them experiencing a loss of
49:06meaning and purpose to what they were doing.
49:09And I'll talk about why that was and is.
49:14So hospital realities of a
49:16rapidly unfolding crisis.
49:17Doctor Crystal spoke about this
49:19as well that there was a need to
49:22quickly convert hospital units to
49:24coated floors very quickly,
49:25and to do that often overnight,
49:28and to do that often without even
49:30the unit knowing that it was going
49:33to happen in the next 12 hours.
49:36Things were moving so fast to
49:38redeploy unit staff,
49:39even those that might have less
49:41acute care experience and sometimes.
49:44Even ambulatory staff individuals that
49:46worked in outpatient settings hadn't
49:48been in inpatient settings in along time,
49:51were called in to work in
49:54these inpatient settings.
49:56And to move and to redeploy the medical
49:59leadership teams to different floors.
50:01Different areas you all remember,
50:03I'm sure at the beginning of the
50:05pandemic the crisis on the getting
50:07personal protective equipment and
50:09just gearing up the country to
50:12manufacture it will not only where
50:14there's a manufacturing challenge,
50:15but it is a distribution challenge
50:18in the health system.
50:19How do you get it to where it's going to be?
50:24How do you work with more limited supplies?
50:27How do you predict how much longer
50:29you can have and how much longer
50:32your supplies will last?
50:33How do you help people use it properly?
50:37There was limited to have to limit
50:40exposure and thus lock down the hospital
50:42with no visitors and no families
50:44and for medical staff.
50:46That meant then that they had
50:48the families and all the family
50:50that individuals needs without
50:51the benefit of family around them
50:54and were attending to everything
50:56that that individual needed.
50:58And just as the last point on this,
51:01this line that especially nurses
51:03were caring for more severely ill
51:05and often dying patients and they
51:07were not always able to provide
51:10the care and the supportive care
51:12that they especially valued and
51:14that they were there was just
51:16too many people to take care of,
51:18and they had to be very careful
51:21themselves about their own exposure
51:23and how to really care for a
51:25patient severely ill when you have
51:27protective gear all around you.
51:29It's even a risk to hold their
51:32hand as they're dying.
51:35So. In the hospital and in the health system
51:40there is a model called ION leadership.
51:43That is very that is across hospitals
51:46across the country and the idea of
51:49that model is that a nurse, nurse,
51:51leader Anna, physician leader,
51:53or paired and that together they
51:55lead a unit in the hospital.
51:57I've just given you just a sample of
52:00articles that are about Diane leadership.
52:03And this is the model around which
52:06our health system is also based.
52:09But when you have a crisis that so
52:12rapidly emerging and changing so quickly,
52:14mom, as in the COVID situation,
52:17even that dyad model is a bit,
52:20is it as a bit challenged.
52:22So the leadership teams faced these
52:25challenges as their units were
52:27moved as they were shifted as they
52:29were deployed in different ways.
52:31They were often leading teams
52:34that they actually didn't know.
52:36That they were just encountering as they
52:39moved all new people onto a COVID unit.
52:43They were sometimes actually removed
52:46from their familiar unit setting and
52:49moved to another unit where their
52:51skills might be more aptly placed.
52:53Some leadership dyads,
52:54physicians and nurses were split up and
52:57they were paired with new partners,
52:59so they might they might work really
53:01well with their previous partner,
53:03but they had for a whole host of
53:06reasons to be working with site
53:08to one nurse parent 1/2 positions
53:10might be paired with four nurses and
53:13they were just different partners
53:15in different configurations.
53:17If we, the public,
53:19were experiencing tremendous changing
53:21communications around COVID in the
53:23health care system and on the units,
53:25this was an everyday every hour
53:28phenomenon that communications were
53:30changing rapidly and as a leader you
53:32needed to be able to convey what
53:35was the most up-to-date policies
53:37and communications to your team.
53:39But they were often changing so
53:42quickly that it was very hard
53:44to engender trust in a team,
53:47especially when things were.
53:48And especially if you didn't know
53:51all the members of your new team.
53:53And learning to read lead in a
53:56crisis while you're in the middle of
53:58a crisis can be quite a challenge.
54:00So these were the challenges that
54:02these leadership dyads faced.
54:04And So what we did,
54:06and I hope you also hear that
54:08there's a theme of volunteers here.
54:11Volunteers in what? Doctor Kristal presented.
54:13There's there's a tremendous number of
54:16volunteers coming together to do this.
54:19So we gathered a team of six volunteers,
54:22two of the physicians myself,
54:24and doctor Rohrbough,
54:25and another physician and three
54:28organizational psychologists.
54:28And we began by just bringing the group,
54:32nurses and physicians together,
54:33and two town halls to just ask them.
54:37What were the worries that they had as
54:40they were trying to lead their units.
54:43And these again were nurses and
54:45physicians leading their units.
54:47These are listed on the slide.
54:51They need a clear and consistent
54:54communication that they could clearly
54:56convey with confidence to their teams.
54:59They needed time and this is a
55:02part of communication
55:03to prepare their teams for changes.
55:05They needed support in how to engage a very,
55:08very stressed group of people.
55:10Very tired, very stressed,
55:11and also even how to recognize manifestations
55:14of stress in the team 'cause they
55:17were in a new world and we all were.
55:20And they had to understand,
55:22how do you keep to expectations of
55:24a work environment and working in
55:27a climate of fear and uncertainty?
55:29How can you expect someone who is just
55:31so stressed and so frightened about
55:34what might happen to their family?
55:36How do you still keep them to the
55:39specific expectations you need to have
55:42have for their working on the unit?
55:44And then how do you in this rapidly changing
55:47environment find space and time to support?
55:50Those individuals who are struggling on
55:52your unit and be able to help them while
55:56at the same time leading the whole team.
55:59So what did we do?
56:01So first I want to give you a
56:04sample of the communication.
56:05So this is just a brief sample of
56:08the many communications coming
56:09out every day every day,
56:11and we still continue to get this
56:14particular COVID status day by day
56:16and you can see the blue line here
56:18was the COVID inpatients and you
56:20can see this is the April peak.
56:22Then it went down in the summer and
56:25then began to peak again over the fall,
56:28never reaching quite as high as
56:30the April spring of 2020 times.
56:32But this white line will show you
56:35also just to give you a sense.
56:38So while we're talking about the COVID units,
56:41the hospital itself was was had was
56:43was full and I want you to notice
56:47here that actually then census of the
56:49hospital is is above even this hiest
56:52time here now as many more people are
56:55hospitalized even as COVID goes down.
56:58And why to make that point is that
57:00these are the same individuals caring
57:03for these patients that were actually
57:05working during the COVID time and
57:08they've been working almost without a break.
57:11Every day there was a system
57:13incident report that the team,
57:15the leaders of the team needed
57:18to process and present.
57:19There were signs and and various signs
57:22being created nearly every day in the
57:24crisis and those had to be placed properly.
57:27And again the leaders had
57:30to communicate about that.
57:33So what did we do?
57:35We brought together regular town
57:37halls because one of the requests
57:39of the leader leadership,
57:41dyads was that the noon time was was good.
57:44It was a time that they often had to
57:47get together in various settings.
57:50So we brought together noon town
57:52halls that would begin with very
57:55short presentations on topics that
57:57they had asked us to address.
58:00So the some of the topics are listed
58:02here on the slide. There were.
58:04How do you communicate to your
58:06teams during stress?
58:08How do you define roles and
58:10decision who makes decisions?
58:12Who can make decisions?
58:14How do you have difficult conversations
58:17and you manage conflict when again,
58:19everyone's very strengths.
58:20How do you think about change
58:22when you're living through it,
58:24and how do you think about your team and
58:27your unit as a small organization that
58:30you're trying to build and make change in?
58:34Rebuilding and repairing trust.
58:37Decision making under uncertainty.
58:40On this, the topic about addressing
58:43racism in the clinical setting came up,
58:46especially after the George Floyd murder,
58:49but was also coming up as the leadership
58:52teams were struggling with the all of
58:55their teams recognizing the in equities
58:58exposed by COVID and then recognizing
59:01stress and recognizing burnout.
59:03And then as a topic that we got.
59:06Into more Tord June and July,
59:09as this became as the teams
59:11they were leading,
59:12were so tired to begin to talk about meaning
59:16and finding meaning in your work, and how.
59:20How were the most satisfying and
59:23sustained work is work that has meaning.
59:27Besides the town halls and the town halls,
59:30I should say these presentations were
59:32brief and then encouraged a lot of
59:35discussion and as they went on on
59:37the participants did much more of
59:39the discussion than any of us as the
59:42facilitators the participants began to
59:44help each other and talk across their units.
59:47If you will,
59:48and supporting each other.
59:50We also offered individual coaching sessions
59:53with one of the six members of our team.
59:57And and and those coaching sessions actually
01:00:00continued for for many of the individuals,
01:00:03continued from April to August of 2020.
01:00:08So what do we observe and what we did?
01:00:10Did we hear?
01:00:12The first thing we saw and heard is that
01:00:15the DYAD leadership model was fragile,
01:00:19especially under stress,
01:00:20and especially when you're actually
01:00:22asking diads to work in more units
01:00:25or work with people they don't know.
01:00:27But those diets who stayed together
01:00:30and had worked together well before
01:00:32the pandemic fared much better
01:00:34in this circumstance.
01:00:36They already had a working relationship
01:00:39and a strong relationship.
01:00:41We learned that the nursing leadership,
01:00:43even in a dyad model,
01:00:45carried the brunt of managing the
01:00:47team will cause the model had it that
01:00:50positions more often moved across units
01:00:53and went with different nursing partners.
01:00:55Whereas nursing leaders typically stayed
01:00:58with their unit so that they tended to
01:01:02carry the brunt of managing a team.
01:01:04That for all of them,
01:01:06however well functioning,
01:01:07they were that there's main struggle
01:01:10was managing fear and uncertainty
01:01:12on their teams and keeping them
01:01:14engaged together.
01:01:16And that they all were responding also to a
01:01:19moral crisis and a meaning and word crisis.
01:01:22So what was the moral crisis?
01:01:26Many nurses and physicians alike would
01:01:30describe scenarios such as this one.
01:01:35That they would be caring for a patient
01:01:38with COVID too was terminal not doing
01:01:41well at all and was was clearly going to die.
01:01:45Within a short period of time.
01:01:48That individual could not.
01:01:50Their family could not be there because of
01:01:54their stricted visiting in the hospital.
01:01:56And their most difficult experience was to
01:02:01realize that that person might die alone.
01:02:05It might die without human contact
01:02:07because they had tremendous caseloads.
01:02:09It wasn't that they might be able to
01:02:12stay by the bedside for the last half
01:02:15hour or last hour that that individual
01:02:18might be alone that they could not
01:02:21an be safe themselves or keep their
01:02:24other patients safe necessarily
01:02:26remove their gloves and hold a hand.
01:02:30That creates for those who go into
01:02:32the caring environment and caring
01:02:34profession and those who are leading
01:02:36others in a caring profession.
01:02:38A tremendous moral crisis.
01:02:40Are they doing the right thing?
01:02:42Are they providing the care that they
01:02:44went into the profession to provide?
01:02:46And many of our leaders as as the
01:02:49Pandemic War on were responding
01:02:51and caring for their teams,
01:02:53not just in the practical ways,
01:02:55warehouse the PPE and use of
01:02:57PPE and hours of working.
01:02:59But at this much more.
01:03:01Psychological level.
01:03:05So finding meaning is really these questions.
01:03:08Why did you become a nurse?
01:03:10Why did you want to become a doctor Anaz?
01:03:15If you will, behind the
01:03:16scenes on the tandem against,
01:03:18we celebrate these individuals
01:03:19who have done so much.
01:03:20These were the very deep questions
01:03:22that people were asking,
01:03:23and a number of our leaders,
01:03:25particularly our nurse leaders,
01:03:27talked about conversations they were having
01:03:29with the younger nurses on their teams.
01:03:30As the younger nurses were asking,
01:03:32is this what it's going to be like?
01:03:35This is not what I thought
01:03:36I wanted to be a nurse for,
01:03:39and trying to keep them in the profession
01:03:41and keep them and help them find the
01:03:44meaning of why they had entered it.
01:03:46In the first place.
01:03:49So as I indicated on the earlier slide, we.
01:03:53Did this intervention or this
01:03:55works between April and August,
01:03:57and as the pandemic began to in
01:03:59the summer slowdown and we all of
01:04:02course hoped that that would be
01:04:04the that would be the end of it.
01:04:06And then came the fall and winter surge.
01:04:09But how do we phase to a more support
01:04:11to a supportive structure that was
01:04:13in a more sustained model and a
01:04:16number of the individuals continued
01:04:18their coaching relationship even
01:04:19as we phased to another model?
01:04:22We fed back to the hospital leadership
01:04:25system system leadership about
01:04:26the structure of communications,
01:04:28about the importance of maintaining
01:04:30dyad stability even as you had to
01:04:33shift units but keep the dietze
01:04:36together and as much as possible,
01:04:38keep the unit teams together so that
01:04:40they take their working style and
01:04:43their working process before COVID
01:04:45into how they're working now and then,
01:04:48actually to provide ongoing leadership,
01:04:50training and support to Diane's
01:04:52to actually ask, they become Dyas.
01:04:55To give them basic training and
01:04:58leadership skills on many of the topics
01:05:01that we've provided in the in the town halls.
01:05:04The hospital brought to the health system,
01:05:07brought together a group called the Wellness
01:05:09Engagement and Leadership Task Force,
01:05:11and there's a number of CONTINUITY'S in that
01:05:14group with the members of our voluntary team.
01:05:17So there's a continuity of
01:05:18experience and information across,
01:05:20and also some of the nursing and
01:05:22physician dyads that were in our coaching
01:05:25and an works in town hall sessions
01:05:27are members of that Wellness Group,
01:05:30so there is a continuity of experience that
01:05:32we learn together and hopefully to take that.
01:05:36And then change some aspects of how the
01:05:39health system works so that we're not
01:05:42only are better prepared for another
01:05:45crisis and may there not be one,
01:05:47but that it works even better
01:05:51with day-to-day healthcare.
01:05:52And what I would say in closing
01:05:55is that justice COVID has been a
01:05:58magnifier of health inequities.
01:06:00It is also been a magnifier of many needs
01:06:03to restructure our health care system,
01:06:05not just in the supply chains.
01:06:08For PPE.
01:06:08Not not in all of those things
01:06:11that have been more in the news,
01:06:13but as we learned to actually begin to think,
01:06:16how do you create stable relationships
01:06:19among leadership teams so that they
01:06:21they are ready to meet any challenge?
01:06:23And how do you keep them together as
01:06:26any kind of challenge comes forward?
01:06:29So I'm going to stop there,
01:06:31and I'd be glad to take questions
01:06:32or even turn to my colleague Doctor
01:06:34Rohrbough who did this work with us.
01:06:36Thank you very much.
01:06:51Thanks so much Linda,
01:06:53who really appreciate that presentation
01:06:55and thanks to each of our speakers.
01:06:58And to the our audience,
01:07:00for your attention and participation,
01:07:02care of the health care workforce was
01:07:04obviously a hugely important component
01:07:07of responding to the COVID crisis.
01:07:09I'm sure that we all hope that
01:07:11some of the lessons learned will be
01:07:14incorporated into the ongoing system
01:07:15of support across the United States.
01:07:18I hope each of you enjoy
01:07:20the rest of alumni weekend,
01:07:21and particularly,
01:07:22there's a session that's just started with
01:07:26Doctor Braverman on the art of medicine.
01:07:29Thanks again.