Sixteen months into the COVID-19 pandemic, frontline clinicians continue to grapple with some of the greatest challenges of their careers, including insufficient safety protections, a lack of answers and training for treating a novel virus, and the loss of patients and even colleagues. And as the more infectious Delta variant spreads, some hospitals and health systems are once again being inundated with patients, most of whom are unvaccinated.

Even before the pandemic hit, a 2019 report from the National Academy of Medicine (NAM) found that the consequences of overworked, overwhelmed clinicians go well beyond their individual well-being. Clinician burnout is an occupational syndrome caused by stresses in the workplace environment, which can adversely influence the quality and safety of patient care. Recent reports have also projected that burnout may lead to some clinicians retiring early or leaving medicine altogether.

While health system leaders have focused on clinician well-being more intentionally in recent years, the pandemic has made clear that there is more work to be done in health care organizations, medical schools, and in the professional culture of medicine. Now is the time to reflect on lessons learned from system changes made during the pandemic, and build on what’s working and better prepare for the future.

Recently, NAM asked six health system leaders how they are making clinician well-being an organizational priority.

• Kirk Calhoun

• Thomas Priselac

• Jeff Gold

• Nancy Howell Agee

• Kevin Sowers

• Janice Nevin

Understanding the Burnout Problem

Health system leaders must ask the right questions and measure what matters when addressing clinician burnout and well-being, emphasized Kirk Calhoun, president of the University of Texas Health Science Center at Tyler and chair-elect of the Association of American Medical Colleges.

In addition to an annual physician satisfaction survey, the center has several forums for honest feedback, including in medical staff meetings, group practice meetings, and exit interviews.

“When a physician leaves the organization, we ask, ‘did we take actions to improve the quality of your experience, or do we still have negatives? Have those negatives entered into your decision to retire or go work elsewhere?’”

Improving clinician well-being should also be embedded in the organization’s annual goal-setting process, said Thomas Priselac, president and CEO of Cedars-Sinai Health System in Los Angeles. The health system revisits these goals at least quarterly. “It not only signals to the organization what our strategic priorities are, but it also creates an organizational accountability loop,” he said.

Building a Culture of Trust

Medicine suffers from a culture of silence, said Jeff Gold, chancellor of the University of Nebraska Medical Center. Few clinicians feel they are able to talk about their stresses without stigma or career repercussions.

“When I was a practicing surgeon, I remember it was a point of pride that you never talked about the way you were hurting after you lost a patient or after several difficult nights on call,” Gold said. “Yet we all have these stresses. I make it a point to talk about my own personal journey. The more we talk with each other and reach out, the better off we can be.”

Carilion Clinic, headquartered in Roanoke, Virginia, is finding new ways to break the culture of silence. The organization’s chief medical officer has championed supports for health workers who are traumatized by a patient event. These include a confidential “TRUST Team” of first responders: a support group of peers trained to talk to struggling employees and guide them to the help they need. Johns Hopkins Health System introduced a similar program, which also incorporates social workers and chaplaincy services.

“In April and May 2020, we found our nurses and physicians were calling on the TRUST Team more frequently,” said Carilion Clinic CEO Nancy Howell Agee. “We want that — to have a culture of ‘I’m concerned, and I can raise my hand. I can reach out, and it’s done confidentially.’”

Remembering Clinicians Are People First

Clinicians are people first, and they have to juggle the demands of work and home just like many others do. The work environment should support both their professional well-being and their needs outside of work, said Kevin Sowers, president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine.

“How do we normalize within our work culture that it’s okay to ask for help? We realized we need to take care of everything from the basic needs to the complex psychological needs of our workforce,” he said.

To support employees and their families during the COVID-19 pandemic, Johns Hopkins launched an employee food pantry. Employees use it for a variety of reasons, whether that is the loss of a partner’s income, or not being able to grocery shop due to work schedule demands.

Janice Nevin, president and CEO of ChristianaCare, said the Delaware-based hospital system has invested in initiatives such as implementing paid parental leave for new and adoptive parents and establishing a minimum wage of $15 an hour for service workers.

“Everyone at ChristianaCare is a caregiver, because you’re either directly caring for a patient or you’re caring for somebody who is caring for that patient. Whether you are a physician or nurse, if you work in food services, in pharmacy, if you’re in public safety, you’re a caregiver,” said Nevin. “Giving them the resources to feel engaged and confident in all aspects of their lives is really important.”

What Does Clinician Well-Being Look Like Post-COVID-19?

While the pandemic has exacerbated clinician burnout, for many clinicians, serving on the front lines reaffirmed why they chose medicine. When we emerge from the pandemic, health system leaders must recommit to building supportive environments that allow clinicians to thrive and feel valued — whether in times of crisis or not.

“We need to pay attention to the efforts that show we care about physicians,” said UT’s Calhoun. “That means providing a comfortable workspace and having electronic systems that don’t take away from care. It means open communications and minimizing conflict in how people go about doing their jobs.”

Health system leaders must also continue to listen to clinicians and deliver the mental health and wellness resources they need, and reform the culture and systems that contribute to burnout in the first place, said Carilion Clinic’s Howell Agee.

“This is about investing in health, investing in employees, and investing in clinicians for the joy and the love of health care. The health outcomes will follow,” she concluded.