Facilities

This article by Porter et al. presents the experience of the Cleveland Clinic in utilizing an organizational-level team approach to address problems identified early in the COVID-19 pandemic and mitigate organizational crises, including avoiding many negative consequences experienced at numerous hospitals, such as layoffs, furloughs, and potential long-term workforce problems. The COVID-19 pandemic slashed hospital revenues across the nation as cancelled elective procedures severely reduced patient volume despite the simultaneous stress on hospital ICUs to manage surges in COVID-19 patients. Hundreds of hospitals and health systems applied cost-cutting strategies such as layoffs and furloughs that may have long-term consequences for health care workers (e.g., job insecurity, anxiety, depression) and more broadly for access to care in many communities.

There is significant literature on the importance of teams in the health care environment. This article contributes a focus on broader, organizational level teams (as contrasted with micro- or unit-level teams). The authors apply a social identity theoretical lens to assess the organization’s approach, with a focus on how individuals and groups define themselves in relation to each other. Strategies discussed include efforts to address:

• Key stakeholder engagement,
• Physical space and bed capacity,
• Re-deployment of workforce,
• Equipment challenges, and
• Communication strategy

Of course, not every hospital has access to the types of resources available to the Cleveland Clinic. Nevertheless, there are important lessons to be learned from the hospital’s approach that may be applicable to a variety of other hospitals and health systems in preparing for and responding to future crises.

Health Care Workers

 This article by Norful et al. addresses stress in frontline health care workers (HCWs) during the initial stages of the COVID-19 pandemic in the United States, including physical and psychological impacts of high stress clinical environments and contributory factors in burnout. Three major themes identified from interviews with HCWs were 1) fear of uncertainty, 2) physical and psychological manifestations of stress, and 3) resilience building. HCW stress flowed from shifting information, lack of personal protective equipment (PPE), and fear of infecting others. Effective responses to stressors included individualized stress mitigation efforts, social media, and organizational transparency. Qualitative responses from frontline HCWs explored in the article provide detailed insights into common sources of and responses to stress during the pandemic, with important insights into what organizations can do (well or poorly) in responding to unforeseen crises.

Issues of stress and clinician burnout are ongoing challenges that certainly predate the pandemic. Long-term exposure to stress manifests as high emotional exhaustion, high depersonalization, and low sense of personal work accomplishment that characterize burnout. The circumstances of the early stages of the pandemic unfortunately contributed heavily toward worsening these factors, as evidenced by the HCW responses assessed in the article. Of note, the study sample of HCWs included a high number of nurses and was predominantly female (75%) and African-American (49%), which may provide additional context of disproportionate burdens experienced by these groups. The long-term impacts of the increased stress experienced by frontline workforce during the pandemic are not yet known, including possible impacts of subsequent and repeated case surges. Among the most serious concerns, exposure to traumatic events and prolonged periods of stress can manifest in post-traumatic stress disorder and increased cardiovascular risk.