6 ways a health system attacks stress during the COVID-19 crisis

The commitment to well-being at ChristianaCare in Wilmington, Delaware, began long before the COVID-19 pandemic. However, that dedication enabled the health system to build a robust well-being infrastructure that has helped to rapidly pivot and scale up available support resources to meet the needs of physicians and other health professionals during this crisis.  

Leaders at ChristianaCare—a large health system that includes two hospitals in Delaware and one in Maryland with more than 1,200 beds, which ranks in the top 25 nationally in both admissions and emergency department visits—performs daily rounding on all shifts with a heavy emphasis on the COVID-19 units and the emergency departments. These offer basic well-being needs, including food, drinks, lotion to help moisturize hands that get washed all day long, anti-fogging wipes, lip balm and ear protectors because people are wearing masks all the time that irritate their ears. All of these are nice touches, but the well-being work of the health system extends far beyond that.  

“It’s really less about what’s on the cart that we’re rolling around and more about being there with people in the midst of the crisis and proactively reaching out to them and providing that in- the-moment support and a direct pathway for those who need more intensive support,” said AMA member Heather Farley, MD, chief wellness officer at ChristianaCare. “It also gives an opportunity to elicit what needs and concerns require escalation and that has led to countless system level changes.” 

Those system-level changes follow the five ways that health care organizations can effectively address physician anxiety during COVID-19, which was highlighted in the JAMA Viewpoint article, “Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic.”  

Transparency is an important component during times of crisis. To do this, ChristianaCare sends daily COVID-19 email updates, which includes talking points for team huddles that are completed throughout the health system.  

“We want to make sure that information trickles down or is sent out to all of our caregivers,” said Dr. Farley. This includes sharing regular video recaps from higher-level meetings to keep everyone up to date with important information.   

Adding to that, a COVID-19 census dashboard—updated every six hours—is available for the entire health system. This dashboard shares the number of patients with COVID-19 at ChristianaCare, where they are and the trends. Providing that real-time data is key, Dr. Farley said, “because if there is a lack of information, sometimes people fill that in with their worst fears.”  

The Center for WorkLife WellBeing—this center provides resources for physicians and other health professionals to reduce stress and enhance wellness—also has an entire new section on COVID-19 wellness topics to serve as a “centralized resource with a listing of all the applicable well-being resources, including access to peer support and mental health resources, caregiver well-being tips, free exercise resources, pet care, elder care, childcare, tips on  surviving quarantine at home, spiritual resources, and gratitude offerings,” she said. 

A big source of stress and anxiety for caregivers has been how to keep their families safe after providing COVID-19 care.    

Heather Farley, MD

“They’re obviously concerned for their own health and well-being, but also that of their families,” said Dr. Farley, adding that there have been “heroic efforts on the part of our operations folks to procure adequate personal protective equipment” (PPE) and they have been “very fortunate for the outpouring of support from the community, industry and our state to make sure that we have adequate PPE.”  

Every day, educators complete rounding to perform PPE training to ensure everyone knows how to properly don and doff their equipment. Physicians and other health professionals can also access FAQs to learn how they can keep their homes and families safe.  

Specifically, ChristianaCare has been paying for “hotel accommodations for any caregiver who is working with COVID-19 patients as some of them are very concerned because they have high risk people in their home and they want to effectively self-isolate,” said Dr. Farley, adding that there is also a disposable scrubs service and scrub-changing areas, which allows health care workers to change scrubs and have them disposed of properly. 

For those who have underlying medical conditions, pregnancy or other special considerations, the team works to keep them as safe as possible by reassigning them to other areas.  

Throughout the pandemic, a lot of health professionals have been redeployed from non-COVID-19 areas to other areas caring for patients with COVID-19 as needed. To ensure these individuals are ready to help, ChristianaCare has developed care standardization, evaluation and treatment protocols. 

“There’s so much information flying around out there regarding how to evaluate and treat patients with COVID-19,” said Dr. Farley. “We are really trying to provide that information in a streamlined fashion.”  

There have also been a lot of resources created for leaders to help support their team’s well-being during COVID-19. For example, there are FAQs for how leaders can talk to their teams if a caregiver tests positive for COVID-19. Additionally, Dr. Farley’s team created a biweekly leadership discussion forum; 130 leaders called into the first session.  

“It’s a protected space for leaders to share their experiences, exchange ideas and take away successful strategies for leading their teams during the crisis,” she said. “This is a very, very difficult time to be a leader and so in normalizing the things that they are experiencing, it can be very therapeutic for them.” 

“Tons of donations are coming in from the community, which is lovely,” said Dr. Farley. “We’ve got lots of food flowing for people and we’ve collated the available free virtual exercise resources so that people are able to maintain their physical health as well.” 

Physicians and other health professionals also have access to resources on sleep hygiene, which can be challenging for people to practice during this time. The resources ensure everyone is “supported in having the knowledge and the ability to get adequate rest,” she said.  

In addition, OASIS (Opportunity to Achieve Staff Inspiration and Strength) rooms—which were available before the COVID-19 pandemic hit—offer a space to rest, reset and reflect. The 10 OASIS rooms across the health system offer massage chairs, low lighting and inspirational information to create a peaceful escape. 

On the financial side, the human resources department provides support for caregivers by offering the ability to cash out personal time off without a penalty. For those who need a little extra help, ChristianaCare also offers a food pantry. And for any health professional with a child up to the age of 12, prepaid childcare is available. If a caregiver uses their own childcare, they can get reimbursed for that too. 

“There’s so much that we’re asking of our caregivers and we’re trying to do everything we can on the backend to support them and their families,” said Dr. Farley.  

“It’s interesting to watch the different phases of what our caregivers are dealing with. Initially there was a lot of anxiety resembling PTSD, not post-traumatic, but pre-traumatic stress of what’s coming, when it’s going to come, how bad is it going to be and it moving from that phase into the ‘what if I get it and what if my family gets it?’” said Dr. Farley.  

“This component that we’re seeing now is some of our caregivers, unfortunately but not unexpectedly, contract COVID-19,” she said, adding that having a “robust response and mechanism for caring for them if that does happen is really important.” 

Anyone who tests positive for COVID-19 has access to one-to-one peer support and 24/7 intensive mental health support. Group support is also available for teams who have had a caregiver test positive “because it’s really distressing to the team,” said Dr. Farley. 

Hotel accommodations are also available to caregivers with COVID-19 who believe they cannot effectively self-isolate or quarantine at home.  
 
“Finally, creating just-in-time resources for leaders so when a team member does test positive, how can they communicate that compassionately and effectively with their teams and making sure that they are also aware of those peer and group support resources,” she said. 

“There’s the phase of what we’re doing right now to meet the acute needs in the midst of the crisis, but as we start to move into the recovery phase, we have to think very carefully about how the needs of our caregivers will shift,” said Dr. Farley. “I suspect that we will have, unfortunately, a potentially large contingency of a traumatized health care workforce that will require ongoing support.” 

“Part of that is probably going to be giving our health care providers an opportunity to create their narrative around this,” she said. “There’s a tendency to just want to run away from this and put it in the past, but we risk really developing post-traumatic stress if we don’t process what we’re dealing with right now.” 

“We recognize that this is a stressful time. The fears that people are going through are real, but they know that we're here for them no matter how bad it gets, no matter how long it lasts and that we will get through this together,” said Dr. Farley. “Ultimately, at the end of the day, I think this will be our finest hour as an organization and I think that gives people hope.” 

The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic. The AMA also provides resources for health care leaders on caring for our caregivers during COVID-19. 

Additionally, the AMA is offering two free surveys to help health care organizations monitor the impact COVID-19 has on their workforce during this pandemic. The surveys can be used to track trends in stress levels, identify specific drivers of stress, and develop supportive infrastructures based on these drivers. Organizations that use the surveys will receive free-of-charge support from the AMA in launching the surveys and access to data through an easy-to-use reporting dashboard.