Even prior to the COVID-19 pandemic, physicians expressed dissatisfaction with their workload and experienced burnout and mental health issues. A 2016 survey of academic general internal medicine physicians—including about 600 hospitalists and outpatient physicians—found that 67% reported high stress, 38% were “burned out,” and 50% felt they had “low control” over their work. With the outbreak of COVID-19 pandemic, longer hours caring for sick patients, adapting to new practice structures and guidelines to cut down on transmission, and shortages of necessary medical equipment added increased stress to hospitalists. A recent Washington Post/Kaiser Family Foundation survey of 1,327 front-line healthcare workers in the United States during the COVID-19 pandemic revealed that an overwhelming 55% of front-line healthcare workers reported burnout (defined as mental and physical exhaustion from chronic workplace stress), with the highest rate (69%) among the youngest staff—those aged 18 to 29.
The COVID-19 pandemic poses unique long-term stressors and risks to physicians’ physical, mental, spiritual, and emotional well-being. Leaders and front-line clinicians need to proactively protect the well-being of themselves and their colleagues to avoid adverse outcomes for clinicians and adverse effects on patient care quality. To better enable physicians to maintain personal well-being and resilience throughout the pandemic, our institution leaders aimed to monitor physician and especially hospitalist well-being.
To date, few studies have been published of successful interventions specifically to improve academic hospitalists’ well-being.1 Masters, et al, formed the UCLA Hospitalist Wellness Committee and with the creation of the Hospitalist Well-being survey offered an opportunity to pause, reflect, and intervene. The committee was a quality improvement project with the aim to support physicians through uncertainty and identify ways to help hospitalists thrive and the Hospitalist Well-being survey was a qualitative study to address and understand how the continued changes across the spectrum of health care affect the lives of individual hospitalists.
The aim of our study was to determine the prevalence of academic hospitalist burnout during the pandemic and then develop and evaluate an intervention in our division to improve emotional well-being and stress management during COVID-19.
Using a survey, hospitalists at Loyola University Medical Center were asked to complete a survey job satisfaction, opportunities for professional growth, indicators of burnout and well-being, and their experience throughout the COVID-19 pandemic. Subjective well-being (SWB) refers to one’s own cognitive and affective evaluations of their life and is most often measured as happiness and/or life satisfaction.2 Various instruments to measure well-being are available, with a tendency internationally to use numerical scales, such as one that ranges from 0 to 10 (10 being the most positive well-being).3 Using this scale, the survey asked hospitalists to think back to pre-COVID-19 time and rate their overall well-being level on a scale of 1 to 10 when they were at work prior to COVID-19 and during COVID-19.
The response rate was 65% (n=21/32)—82% of respondents rated their subjective well-being greater than 7 out of 10 before COVID-19; during the pandemic, only 45.5% reported well-being greater than seven. Further, 57% of respondents reported that they “were satisfied with the opportunities for professional growth” and 76.2% reported that they “had opportunities to apply their talents and expertise.” However, 71.4% reported that they “were forced to weigh the clinical workload against their desire to have some other academic or administrative activities” and 52.4% felt that they “had an unsafe patient census during COVID-19, and that the workload negatively affected their patients’ care and their trainees’ educational learning.” Finally, 77.28% of the hospitalists rated their stress level at work during COVID-19 more than seven.
Opportunities for Improving Hospitalist Well-being
Survey responses inspired dialogue within the group that helped identify core values and key opportunities for intervention. The division director met monthly with the hospital medicine leadership team and used the survey results to identify two areas for intervention:
- Structural and process redesign
- Daily noon huddles.
Structural and Process Redesign
The division director implemented a rotation of workers from high-stress services (COVID-19) to lower-stress services (non-COVID-19), flexibility in scheduling by allowing hospitalists to have autonomy in selecting how many days they could work in the COVID unit and trading shifts with others to cover those days off. As elective surgeries were cancelled, we dissolved our surgical co-management service to better accommodate our hospitals’ needs and used cardiovascular surgery advanced practice providers (e.g., physician assistants and nurse practitioners) who released from their clinical duties to help with inpatient care. In the event of surge, our primary care doctors were willing on a volunteer basis to cover academic positions so hospitalists can focus on inpatient needs.
Daily Noon Huddles
Hospitalist leadership incorporated daily weekdays noon huddles via WebEx to ensure excellent patient care. Each 30-45-minute huddle, conducted by our division director, provided updates on the status of COVID-19 patients under investigation (PUI) and confirmed cases, updates in management of COVID-19 patients, boosting morale with updates on some small victories (e.g., a negative test, a patient with a good outcome) and create an open forum for communication and participation from hospitalists in decision making. Hospitalists introduced ways to navigate protocols and care pathways which eventually helped the group to make real-time changes. The regular daily huddle with our hospitalist team allowed our group to connect with colleagues at a personal level. Our director has made sure to set aside defined time for staff to discuss and reflect on their experiences. Doing so, has allowed our hospitalists to feel heard and acknowledge the difficulties faced in their clinical duties. When hospitalists were asked in a second survey to assess the daily huddles, 72.73% of the group felt that the daily noon huddle initiated by our division during COVID-19 helped with emotional well-being and stress management.
With a brief survey, we were able to open a dialogue and proceed with two simple interventions that seemed to improve well-being for our hospitalist group. Burnout during the COVID-19 pandemic is present at higher than pre-COVID-19 era rates among healthcare professionals. Physicians, such as hospitalists, who provide front-line care are at an even greater risk. Management of these demands with increased support for physicians and identification of areas that yield more control to the provider over his or her work can prevent burnout and foster engagement. Engaged, healthy physicians are best able to deliver compassionate care, which leads to value for patients, providers, and the health system as a whole.