Caring for Caregivers: A Leadership Checklist

Added on Mar 20, 2020

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

T_Ghandi_SBIn these days of fear and uncertainty surrounding COVID-19, ensuring the physical and emotional well-being of the health care workforce must be a leadership priority. Front-line caregivers and staff are facing levels of stress that were unimaginable even a month ago. To help them bear this continuous burden and deliver the best care to patients, leaders must understand the potentially damaging impact these unique circumstances can have and consistently and deliberately work to mitigate it.

Caregivers’ physical safety is an area of intense focus, as it should be. Minimizing exposure risk, ensuring access to protective equipment, and mitigating exhaustion due to overwork are top concerns. But leaders must also focus on the emotional well-being of their workforce and themselves. This is a lesson we have learned over the past 20 years in patient safety. Health care providers who are involved in an unanticipated adverse event can be traumatized by the event. Multiple studies show that clinicians involved in these events report feelings of responsibility for patient outcomes, shame, anger, failure, depression, inadequacy, and loss of confidence. Some report symptoms of post-traumatic stress disorder (PTSD).

In the current crisis, emotional stress is incredibly high. The pandemic is spreading rapidly, and staff are caring for high numbers of patients with potentially bad outcomes. Workload pressures; personal safety concerns; anxiety about the well-being of family, friends, and colleagues; childcare challenges; and financial concerns exacerbate this emotional stress.

The following checklist is a starting point to help leaders address these issues. We plan to build on it as we hear from colleagues around the country who have developed additional strategies for caring for their caregivers.

Leadership Strategies for Workforce Protection against Physical and Emotional Harm

Physical Harm

☐ Develop robust protocols for triaging, quarantining, and distancing to minimize exposure.
☐ Minimize contact with patients by using telehealth when possible and cutting back on schedules.
☐ Provide sufficient access to personal protective gear.
☐ Ensure the availability of and easy access to hand hygiene products.
☐ Communicate and enforce guidelines for reducing risk of transmission.
☐ Communicate and enforce return-to-work guidelines for infected workers.

Emotional Harm

☐ Communicate frequently and empathically to build trust.
☐ Consistently employ universal leadership skills such as communication, awareness, honesty, and transparency.
☐ Organize peer support groups.
☐ Promote and support health and wellness practices around nutrition, sleep, exercise, and social connections.
☐ Offer and suggest anxiety-reduction strategies and opportunities such as  mindfulness exercises and buddy systems.
☐ Provide professional counseling and mental health services through employee assistance programs.
☐ Establish and communicate clear policies around time off, sick time, and pay.
☐ Design solutions for providing childcare coverage.
☐ Develop and communicate clear guidelines to minimize family exposures.
☐ Offer support for families of caregivers.

Because emotional consequences can often be invisible and enduring, leaders must also create strategies to monitor for intermediate and longer-term aftereffects of this crisis, such as PTSD and anxiety, and ensure that support services are available to the entire workforce, including themselves. Thinking about emotional impact is a major challenge, especially while trying to ensure day-to-day operations are safe and high quality. This checklist can help leaders develop robust strategies as part of their preparedness planning. 

Visit our dedicated COVID-19 webpage for additional resources.