Caregiver Redeployment During COVID-19: Keeping Staff Safe

Added on Apr 10, 2020

By Tejal Gandhi, MD, MPH, CPPS, Chief Safety and Transformation Officer

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Health care staffing shortages are a critical emerging concern in the COVID-19 pandemic. Organizations are responding by redirecting physicians, nurses, advanced practice providers, and even trainees to work in areas or perform tasks that are typically outside their domain. For example, outpatient nurses are being redeployed to acute care units, surgeons are being assigned to medical floors, hospitalists are updating their ventilator training to help in ICUs, pediatricians are being tapped to provide non-COVID-related adult care, and the list goes on.  

Given the urgency, many of these approaches are being deployed quickly, but bringing new care models into an already stressed system introduces vulnerabilities that can compromise safety. When we put clinicians into new roles with new situations and conditions to manage, the risk of knowledge-based human error is high. In other words, although these staff may be highly trained and experienced in the own roles, they may have insufficient skills and experience in their new roles and may not feel comfortable asking for guidance. Estimates suggest that in this kind of circumstance, the chance of making a mistake may be as high as 60%.

This does not mean we shouldn’t cross-train and engage these clinicians in these new ways. We should, and we must. However, we can also mitigate the risks of knowledge-based errors when making these and any drastic practice changes, and leaders must be at the forefront of this effort by instilling and consistently reinforcing a culture of safety that allows staff to feel comfortable, competent, and safe in these new roles. Defining characteristics of such a culture include clear and transparent bidirectional communication and staff willingness to voice concerns and ask questions without fear of repercussions or blame.

During the COVID-19 crisis, leaders must prioritize a culture of safety and adopt the key high reliability behaviors and practices shown in the following figure.  Additional insights into the application of high reliability operating principles during a crisis are available through this on-demand webinar. These leadership behaviors are essential to reduce the risk of patient harm and ensure an emotionally and physically safe workplace for all caregivers.

High Reliability Concepts for Leaders

Behaviors

Leadership commitment to patient and workforce safety

Safety First in decisions: Put safety first in every decision about patients and staff. Encourage leaders to say, “Before we do this, let’s consider the safety of the patients and of our people.”

Strong safety culture, emphasized by leadership, in which staff feel empowered to speak up and to escalate concerns without fear of repercussions or judgment

Safety moments: Start every meeting with a short safety moment providing a balance of COVID-19 wisdom, describing the why, how, and what of safe practices.

Safety huddles: Use unit and team safety huddles every shift to communicate with staff and listen to staff concerns.

Daily safety check-in: Use a housewide safety check-in to coordinate with unit safety huddles. This facilitates moving resources to units that need the most help.

Learning boards: Use these to bring forward immediate needs such as supply shortages and problems such as insufficient staffing for quick resolution.

Clear communication methods to ensure things are heard correctly and understood accurately

Repeat-backs and read-backs with clarifying questions: The use of repeat-backs and read-backs coupled with one or two clarifying questions is essential for ensuring information has been received and understood.

 

Visit our dedicated COVID-19 webpage for additional resources.