6

Priority Area: Institutionalize Well-Being as a Long-Term Value

Ensure COVID-19 recovery efforts address the toll on health worker well-being now and in the future, and bolster the public health and health care systems for future emergencies.

“I felt forgotten about by upper-level hospital management, family, friends, neighbors, etc. This affected my personal mental health because I felt like I was fighting this invisible war every day, watching people die all the time, dealing with a very sick patient whose family doesn’t believe COVID is real.” - Frontline Health Worker¹

Health care teams and public health workers experienced extraordinary fear, fatigue, isolation, and moral distress and injury during COVID-19, and recommendations for resilience often place the onus on the individual rather than the system. The nation must acknowledge that the health workforce will require recovery from the trauma of the pandemic, and that stress and distress are long-term issues that must be addressed with longitudinal, long-term solutions. In addition, the health care delivery system will face other challenges after the pandemic, including the demand for delayed and deferred care for non-COVID-19 patients, as well as emerging long-term side effects of COVID-19 for patients and health workers. The public health response to the pandemic may continue for

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¹ For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/.

years via surveillance programs, contact tracing, and other monitoring and evaluation efforts.

Understanding that burnout among health workers was a significant challenge prior to COVID-19, and the extent of the traumatic stress and injury from this period is yet to be determined, it is essential that well-being is institutionalized as a key priority at all levels of the health system. Furthermore, policies and protocols should reflect the dynamic nature of responses and prioritize health worker well-being. At the organizational level, leaders and health workers need to understand that health worker well-being is essential for safe, high-quality patient care. Leaders should use a systems approach for appropriate work system redesign and implementation, and health workers must be equipped with the required commitment, infrastructure, resources, accountability frameworks, and culture that supports well-being.

As seen during the pandemic, an underfunded public health system, including federal agencies and local, regional, and state health departments, has negative implications for the health of people across the country (Farberman et al., 2020). It is important that public health and health care systems guard against “active forgetting,” emphasize lessons learned from the pandemic, and address emerging questions on how the nation might prepare for the next pandemic or national emergency. Investing in infrastructure and institutionalizing well-being as a value are long-term approaches to growing a culture that provides the health workforce with the necessary supports to recover from the trauma of serving during the pandemic, and to bolstering a system committed to supporting well-being for the long-term.

Goal 6.3.	A strong and coordinated national public health infrastructure has a thriving public health workforce.
Actors		Academic Institutions, Clinical Training Programs, and Accreditation Bodies
		Federal, State, and Local Governments
		Health Systems
Actions	6.3.A. Invest in cross-cutting foundational public health capabilities, including threats assessment and monitoring, all-hazards preparedness, public communication and education, community partnership development, and program management and leadership.
	6.3.B. Re-invest in the public health workforce through training and education opportunities.
	6.3.C. Modernize surveillance and data systems.
	6.3.D. Provide full-year funding for federal agencies that is not disease-specific.
	6.3.E. Increase investment in the U.S. Department of Health and Human Services (HHS) Prevention and Public Health Fund (authorized as part of the Affordable Care Act).
	6.3.F. Increase funding for the Centers for Disease Control and Prevention (CDC) community health emergency preparedness programs.
	6.3.G. Use available data and science to inform decisions, priorities, and policies.

NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being.

RELATED RESOURCES² 1

Cultivate a Culture of Connection and Support

• Guide: Conversation and Action Guide to Support Staff Well-Being and Joy in Work during and After the COVID-19 Pandemic (Institute for Healthcare Improvement)
• Guide: Well-Being Playbook 2.0: A COVID-19 Resource for Hospital and Health System Leaders (American Hospital Association)
• Guide: Building Bridges Between Practicing Physicians and Administrators: Improve Physician-Administrator Relationships and Enhance Engagement (DeChant, 2021)
• Organizational Best Practices: At the Heart of the Pandemic: Nursing Peer Support (Godfrey and Scott, 2021)
• Organizational Graphic: Psychological PPE: Promote Health Care Workforce Mental Health and Well-Being (Institute for Healthcare Improvement)
• Overview of COVID-19 Resources by Roles: COVID-19: Stress and Coping Resources (American Hospital Association)

Advance Organizational Commitment

• Guide: A Guide to Promoting Health Care Workforce Well-Being During and After the Pandemic (Institute for Healthcare Improvement)
• Guide: Creating the Organizational Foundation for Joy in Medicine: Organizational Changes Lead to Physician Satisfaction (Sinsky et al., 2017)
• Guide: Wellness with COVID: Contagious Strategies to Promote Pharmacy Well-Being (American Society of Health-System Pharmacists)
• Brief: A Call to Action: Improving Clinician Well-Being and Patient Care and Safety (Schmidt and Aly, 2020)
• Discussion Paper/Guide: Healing the Professional Culture of Medicine (Shanafelt et al., 2019)
• Fact Sheet: Prevention and Public Health Fund Fact Sheet (American Public Health Association)

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² For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/.

Strengthen Leadership Behaviors

• Compilation: Leading Through Crisis: A Resource Compendium for Nurse Leaders (American Organization for Nursing Leadership)
• Guide: Well-Being Playbook: A Guide for Hospital and Health System Leaders (American Hospital Association)
• Guide: Appreciative Inquiry Principles: Ask “What Went Well” to Foster Positive Organizational Culture (Frankel and Beyt, 2016)
• Guide: Cultivating Leadership: Measure and Assess Leader Behaviors to Improve Professional Well-Being (Swenson and Shanafelt, 2020)
• Strategies: Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout (Shanafelt and Noseworthy, 2017)
• Discussion Paper: A Call to Action: Align Well-Being and Antiracism Strategies (Barrett et al., 2021)
• Guide: Grief Leadership: Leadership in the Wake of Tragedy (Uniformed Services University)

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