Introduction
Each evening at 7:00 pm, Portlanders joined others in a symphony of shouts, applause, clanging pots, and pans. The cacophony of support was both recognition and encouragement for healthcare workers in the COVID-19 pandemic.
The first Oregon COVID-19 case appeared on February 28, 2020, followed in March by a shelter in place order and Oregon Health and Science University (OHSU) becoming the epicenter for the impending surge. Five institutional wellness leaders organized and formed the COVID-19 Wellness Task Force (CWT) in early March to develop, implement, and evaluate a plan to support the emotional and physical wellness of the OHSU community during the crisis. These leaders were incorporated in the Emergency Operations Center (EOC) to ensure that community wellness was part of the daily report.
CWT built programs quickly anticipating the surge. Each leader managed an interdisciplinary subcommittee: essential needs, wellness website, wellness resource phone line, psychological support, and feedback and evaluation. With regular meetings, thoughtful communication, and action-based plans, CWT was able to create a wellness platform to serve OHSU efficiently and effectively. They worked to amplify current programs, build new programs to address known gaps, create high-yield deliverables, and address community needs.
This article outlines the specific response and actions taken to support our healthcare workforce during the initial stages of the pandemic. Its intention is to guide other institutions as they enter a “new normal” and must build resilient communities in the face of immense health and economic challenges.
Adapting Roles: Creative Structure and Leadership
CWT used a collaborative leadership approach, alternating the team leader weekly to facilitate meetings and report to the EOC. Intentional check-ins started virtual meetings with a focus on relationship building and connection before diving into work. OHSU created a labor pool to re-assign those whose jobs temporarily waned during modified operations. The CWT acquired administrative support from the pool which allowed the CWT leaders to achieve maximum productivity by offloading the administrative burden. Subgroups were composed of experts from all over OHSU. Diverse points of view and rich dialogue in meetings capturing the temperature of the larger community, allowing the team to hear about wellness challenges early and work to address concerns quickly. Team success resulted from informed leadership, rapid mobilization, a budget support, and talented teams that brought innovations to life.
Where to Access Wellness Resources? Website, E-mail, and Grand Rounds
Resource accessibility and unified messaging is a challenge faced by academic institutions; however, during COVID order emerged from the usual communications overload. To provide clear messaging, a reporting structure was put into place with one daily email containing updated information and key resources from university leadership. Similarly, CWT designed a central wellness email address for the community to send ideas and concerns. In the first six months 145 emails were received. A wellness website was also launched with internal and external resources—it had 900 visits on launch day and 300 average visits per day in the following months. Resources were made visible and featured prominently in the daily email as the place to look for wellness support. CWT also gave 14 virtual Grand Rounds or department presentations over the course of three months, describing wellness programs and resources for the community.
First Things First: Essential Needs
The essential needs subcommittee focused on the fundamental needs highlighted in Maslow’s hierarchy: nourishment, shelter, rest and physical safety. It partnered with “Frontline Foods PDX,” a national charitable organization that uses donations to pay local restaurants to prepare and deliver meals to healthcare staff. To shelter healthcare workers, OHSU offered rooms free of charge. Employee parking was made free limiting exposure to public transportation and shortening commutes. Additionally, hospital respite spaces were created and offered snacks, beverages, and relaxation kits. Badge access data indicated 900 staff per week accessed the spaces in May.
The Importance of Human Connection: Wellness Resource Concierge Phone Line
Fear can diminish people’s ability to process information making it challenging to access support. Medical students collaborated with CWT to create a phone line which connected OHSU members to a student resource navigator who could provide tailored wellness resources. The phone line launched April 6 with a team of 10 medical students led by a CWT faculty leader. They collated the best institutional, local, and national wellness resources in concert with the wellness website. Resources included topics such as psychological support, crisis and suicide assistance, physical wellbeing, financial assistance, children and family resources, interpersonal violence, and housing challenges. Any psychological support call was asked safety questions in order to assess for urgent crisis support. Calls were confidential, daytime hours only, and averaged 3-4 per day during March and April with a focus on essential needs. In May, the volume decreased to 1-2 calls per day and the focus shifted to mental and financial health needs. Overall, the phone line gave the students an opportunity to serve by supporting frontline workers. In two months, the line had 60 calls from 23 different groups.
Beyond the Basics: Psychological Support
The psychological support subcommittee’s initial challenge was to map out needs, structures, and tools to prepare for and manage the psychological impact of the surge on the OHSU community. The members’ wide skill set included: trauma intervention, suicide prevention, critical incident debriefing, public psychiatry, tele psychiatry, wellness program leadership, organizational and clinical psychology. The team coordinated psychological support services across the institution and addressed gaps by creating new services. Of particular importance was the development of a psychological first aid webinar and QPR suicide prevention training, as well as a Psychological Resilience Consult Service for leaders. The consult service arose from recognizing leader’s significant impact on employee wellbeing, and leaders seeking coaching on how to support their teams. The service provided one-on-one and small-group listening sessions for leaders, resources on psychological first aid principles, organizational psychology practices for employee communication and support, and individual and team resilience building strategies. In six months, the team has completed 28 consults with 20 unique groups of leaders.
Listening to Our Community: Feedback and Evaluation
A feedback process is essential for any rapidly implemented wellness intervention to guide effective resourcing and iterations. The feedback and evaluation subcommittee goals were to assess psychological health and the use and efficacy of wellness resources and to create a platform for anonymous feedback. Multiple methods of feedback were deployed and a structure for escalation to top leadership was developed. Feedback mechanisms included a one-item survey about immediate needs, a comprehensive pulse survey to measure wellness, and recruitment of wellness advocates providing in-person listening and feedback on high-needs units (ED, MICU, and environmental services).
The one-item survey included the questions: “What do you need right now?” or “What feedback do you have for the wellness team?” The initial survey gave valuable feedback, however required individual initiative, thus was not effective in gathering all opinions. In May and in September, comprehensive pulse survieswere sent to the entire organization to measure wellbeing, psychological health, financial strain, and the effectiveness of wellbeing resources. The responses were used to inform the work of the task force.
Finally, CWT leaders regularly escalated relevant feedback to the EOC to identify gaps, find solutions, and allow leaders to get a sense of the day-to-day concerns. Feedback allowed leaders to focus resources where they were needed based on data rather than making assumptions.
Conclusion
The CWT elucidated issues facing OHSU, which allowed for rapid changes and new innovations. Prioritizing wellness initiatives, streamlining and centralizing resources, communicating with leadership, and institution-level wellness improved during the initial COVID-19 response. A clear leadership structure and mobilization of experts from across formal and informal community networks resulted in unprecedented inter-professional collaboration. The CWT increased wellness funding and brought new visibility to both previously existing and novel efforts. OHSU now provides centralized wellness resources for the entire community, bolstered psychological supports, a program to support resilient leaders, and a model of feedback for improving wellness programming.
The current and future impact of COVID-19 is unknown, the 7:00 pm cheer no longer occurs as COVID-19 becomes part of the “new normal,” but the newly established wellness platform continues to serve the community.
Acknowledgements:
The authors would like to acknowledge the following outstanding OHSU medical students for their significant contributions toward the wellness task force and help with the creation of this publication: Sarah Newhall, Nicole Santucci, Kate Rosen, and Alexandra Ninneman.