The world is facing a viral pandemic, and news coverage has reflected public anxiety and confusion. Some of the largest health care conferences in the country have been cancelled this year, and we are still not sure what the new normal will be. I was planning to meet with leaders in physician burnout at those conferences, but found myself like a deer in headlights confused about the way forward.
Even prior to the coronavirus pandemic, the American health care system had rising rates of physician burnout and a physician shortage. Now, we also are expecting a surge and overload of our care capacity. I reached out to Bridget Duffy, MD, to ask her insight about the current state of physician burnout. (We were going to meet at HIMSS in person–so with that cancelled, I called her on the phone.) Dr. Duffy believes that in the face of crisis, physicians will show up for their patients. Her prediction? Physicians will work at the peak of their licenses, the peak of their efficiency, and the peak of their humanity.
Human Centered Leadership in Crisis
The stress that people are feeling now is a concentrated picture of the stress physicians and nurses feel regularly. Our instincts and procedures become more important, and a well organized system will have better outcomes.
? you can check in anytime you like but you can never leave ?
Anyone else facing required or voluntary quarantine away from family(elderly, kids, etc) while treating patients with Covid? Don’t know if it’s necessary or what I’d do but I am worrying. #covid4MDs pic.twitter.com/cejERLtMr9
— Lakshman Swamy (@laxswamy) March 18, 2020
What do systems need to do to nourish the needs of employees during a pandemic? We need to protect employees and their families. We need to keep them safe. Liz Boehm spoke to me about the need to acknowledge physicians and health care providers and the difficult decisions they will face. “For every bit of personal stress we are feeling, medical professionals are feeling that as well. While we get to social distance, they need to bridge the distance between themselves and the sickest people in the community.” Most of the directives from organizations such as the WHO and the CDC have been about avoiding other people. Providing support to those individuals who are helping the sickest among us is imperative. But, questions also arise: Should physicians and nurses go home to their families after they have been exposed? Do doctors need quarantine?
Plan for Emotional, Spiritual, Physical, and Cognitive Support
We need to couple effective clinical care with effective communication and caring. Human-centered leadership recognizes the humanity of medical providers and explicitly offers support in four areas:
If your health care system does not have a plan for each of the 4 areas, the pressure of care will overwhelm providers and we will see some of the outcomes Italy has seen, with health care providers walking out. The areas that leadership needs to support do not change in crisis, but the weaknesses in our current system will splinter and fail when overloaded. It is estimated that we are facing a problem of infrastructure- not enough beds and not enough physicians to counter the panic. Physicians have spoken out online about personal protective equipment (PPE). Is your hospital system working to protect the lives of physicians, nurses and front line providers?
— Esther “STAY HOME” Choo (@choo_ek) March 17, 2020
When communicating about physician mental health, I’ve often tried to appeal to the idea that supporting employees is good for business. Boehm pointed out that I was thinking about this incorrectly. We cannot treat people well just for productivity; we need to protect physicians and health care providers humanity in and of itself. If money is all that matters, she counters, we will fail in an emergency situation. Boehm recounts the importance of humanity in a ceremony wherein they recognize the importance of the work physicians are doing; the ceremony is called “The Blessing of the Hands.” Physicians and hospital workers take a moment to recognize the important life and death decisions that they are being asked to make. This is pastoral care outside any specific religion. Who gets a ventilator when they are in short supply? A simple ceremony acknowledges the weight of decisions physicians and other providers will have to make, not in a religious way, but with reverence for our shared humanity.
If our hospital system becomes overloaded like other countries, and we do not have the supplies or hospital beds or manpower to provide ventilators or support to every patient, physicians and health care providers will be making life and death decisions. We should recognize the gravity of that work.
Technology Can Help
If a system is overloaded with too much information, it can shut down. I’ve crashed my computer by taking up too much bandwidth. People are similar. Technology needs to step in to decrease the amount of noise in times of crisis. Technology can play a role in cognitive burden, either to free physician time or create more stress. Voice-activated technology can enable physicians to work more efficiently and safely. A hands-free, voice-activated system allows a physician to call for help when alone with a patient, such as in an isolation room. A hands-free system can also help to ensure that protective equipment such as gloves and masks are not wasted, by eliminating the necessary un-gloving and un-gowning that would have previously been necessary for a physician seeking another pair of hands while in the isolation room. Duffy and her team at Vocera are perfecting the communication with their hands free devices for hospitals internationally. They have released a resource page about setting up communications around Covid19. In a time when masks and other safety equipment are in particular shortage, the value of protecting those resources goes up.
Companies that have monitoring and recording of encounters will also be in high demand. This way higher volumes aren’t buried under a sea of paperwork. With a surge of care the system is overwhelmed, voice technology can help.
“In the midst of the current COVID-19 related crisis, Voice AI technology plays a critical role by providing physicians with a hands-free, friction-free charting experience. Voice AI technology equips physicians with the ability to examine patients in the shortest amount of time possible. By off-loading high volume, repetitive data entry tasks in the EMR, physicians can devote 100% of their energy to saving patient lives.” Harjinder Sandhu
Saykara has a voice powered ambient assistant that they are offering free of charge for Covid19 Visits. Any technology that protects physician time is crucial when a system is overloaded. It will not be just saving minutes and avoiding too many clicks in health records, it will be a life or death decision.
Cognitive Overload: Communication is Key
Duffy and her team have worked with organizations that are setting up tents to deal with capacity. Drive-through testing centers are faced with difficult decisions and lack of tests. Capacity issues abound. At the heart of every command center, what is most needed is an intelligent point of communication. If you have a surge of people use intelligent communication to help with triage. Get them out of the emergency room or into treatment as quickly as possible. Communication technology will be critical to how our country helps mitigate and contain the spread of this virus. Leaders need a solid plan and clear procedures so no time is wasted.
Dr. Duffy is working the long hours of someone coordinating a health care system that knows its capacity will be exceeded. When I asked her what advice she had for health care leadership at this time, Duffy pointed out:
“The surge capacity will inundate our system. Do we have the capacity to care and treat people with competence and compassion in the face of a pandemic?” Bridget Duffy, MD
How do we show up and lead in the face of a capacity and needs crisis? More than ever there will be cognitive overload. The anxiety and stress, given the unknowns around this virus, will call for a different style of leadership. We will all be pushed in different ways. She pointed out something important: The relevant conversation right now might not be directly about burnout, but the principles of leadership are the same. The importance of humanity and protecting health care workers is the same. This crisis will highlight weaknesses in our system and show how leadership and organization matter. The principles of leadership that strengthen us during this crisis are relevant in all times.