Henry Ford Health System (HFHS) has been investing in the mental health and well-being of frontline employees. A five-step program was implemented to focus on the needs of frontline employees during COVID-19 and develop resilience throughout the organization.
A common challenge for health professions is neglecting personal needs due to the prioritization of patients’ needs. Frontline employees work tirelessly to provide the best care for patients while, often, their own physical health and mental well-being suffer. “As the pressure to react releases, the pressure to feel intensifies” became the emotional response team’s mantra as they developed the organization’s crisis response plan.
“We recognized that health care workers are well-trained to manage the intensity of a medical crisis, but we worried that they were not equally trained in managing the aftermath of the mental health effects,” explains Lisa MacLean, behavioral psychiatrist and director of wellness for physicians at HFHS.
At the beginning of the COVID-19 pandemic, HFHS’s emotional response team knew isolation, second-hand trauma, emotional stress, and fear would become areas of concern among frontline employees. After working long hours treating COVID-19 patients, frontline employees developed fears of bringing the virus home to their families.
Other common reactions during medical crises involve cognitive, emotional, behavioral, and physical reactions. Due to the nature of the medical field, these feelings are often suppressed, leaving the individual suffering in silence. When these feelings are ignored, they can develop further into burnout, anxiety, depression, absenteeism, physical illness, damaged relationships, and medical error.
The emotional response team developed a crisis response plan that focuses on five key areas to help employees develop resilience. Resilience is the ability to withstand, recover, and grow in the face of stressors and changing demands. The goals of the crisis response plan were:
- Protect and/or promote the psychosocial well-being and resilience of health care workers and providers.
- Prevent, mitigate, or treat the mental and/or behavioral health issues that arise in the context of the pandemic.
- Support health care workers willingness and ability to continue working.
- Improve health care workers support of and adherence to risk management measures.
- Augment the health care system’s capacity to respond effectively over time to the pandemic crisis.
Step 1: Basic Needs
The first step of the crisis response plan was to assess the personal safety of employees and their families. This includes dependent care, transportation, parking, and lodging:
- Community organizations donated hotel rooms to employees or families in need.
- Food stations were set up throughout the organization to provide employees with free coffee.
- The medical students from WSU-SOM created a Google doc with volunteer services including childcare and grocery shopping.
Step 2: Communication and Leadership
Communication is key when working to develop resilience throughout an organization. Twice a week, leaders were invited to participate in an online psychological first aid education program to ensure they can communicate effectively and share resources.
The psychological first aid program educates leadership on:
- Assessing needs and concerns.
- Listening, but not pressuring people to talk.
- Normalizing and validating feelings.
- Non-judgmental curiosity.
- Comforting employees.
- Helping direct employees to information, services, and social support.
Step 3: Assess Stress and Needs
Employees can’t perform their best, professionally or personally, if they are experiencing unhealthy levels of stress.
- Wellness rounds: Daily huddles, or wellness rounds, became critical for monitoring the emotional well-being of frontline employees. Daily check-ins between leadership and team members involve discussions around symptoms of burnout and secondary traumatic stress and allow for greater connectivity, support, and linkage to resources.
- Survey: HFHS’ experience team collected responses from over 500 physicians, residents, and Advanced Practice Providers (APPs) about what their fears and personal pain issues were.
“Is it fear they would bring the virus home to their families or were they in desperate need of childcare?” asks Dr. MacLean. The responses overwhelmingly confirmed the crisis response plan was on track with meeting employees’ needs.
Step 4: Mental Health Needs During the Pandemic
During the peak of the pandemic, HFHS implemented several resources into the crisis response plan to better support employees.
- 24/7 hotline: A group of psychologists managed a 24/7 hotline and received over 130 calls from across the organization.
- Zoom emotional support groups: These sessions are offered three times per day, seven days per week during the surge and focus on validation, coping, and referrals for further help if needed.
- Peer recovery coaches: Peer recovery coaches joined the emotional response team and began assisting employees who are treating COVID-19 patients and suffering from substance use disorders.
- Mindful moments: The health psychology team offers weekly virtual meditation sessions to frontline employees as well as those working from home.
- Frontline diaries: Frontline employees were encouraged to share their stories through frontline diaries, a narrative medical intervention published in the internal intranet platform and lead by Dr. Rana Awdish, HFHS’s medical director of care experience. Over 100 submissions ranging from essays, photos, and videos act as an archive of what frontline employees experienced during the COVID-19 pandemic.
“One of the greatest things we accomplished with this crisis response plan was so many groups working together to create these resources,” explains MacLean. “There was amazing communication and openness to new ideas amongst many teams who truly cared for the well-being of our employees.”
Step 5: Post-Pandemic Support – Recover and Heal
- Conversations for leaders: To ensure leaders would remain equipped to effectively provide support to their teams. This program meets three times per week and discusses best practices around managing team conflict, giving bad news, and resilience.
- Peer processing groups: Over 90 groups consisting of five to 10 nurses, physicians, and other frontline employees have been meeting consistently since June to share stories and provide peer support. These groups are facilitated by mental health professionals and clinical leads with the goal to:
- Process feelings about the pandemic.
- Relieve suffering.
- Validate feelings and normalize experiences.
- Teach about post traumatic growth.
- Reduce future traumatic reactions.
- Teach coping strategies that strengthen resilience.
- Provide tailored recommendations for unique teams.
- Burnout resilience workshop series: A designated Employee Assistance Program (EAP) therapist created a three-week resiliency workshop that is offered virtually or in person. The workshop teaches evidence-based skills to cope with stress and anxiety in and outside the workplace and improve quality of life to ultimately prevent burnout.
- After action reviews: An important component in the recovery and healing stage is reflecting on successes and lessons learned. Quality improvement is the focus of the after-action reviews.
“This intervention was designed to learn from mistakes made – so that we can be better prepared if we surge again,” said MacLean.
Henry Ford’s emotional response team has taken feedback from the crisis response plan and developed a “surge again plan.” The team is fully prepared to lead and implement organizational support for frontline employees if another surge of COVID-19 cases occurs.
Strategies for Employers
Whether you are in a health profession or not, there is much to learn from Henry Ford’s strategized response to the COVID-19 pandemic. MacLean outlines the top lessons learned to help employers support the mental health and well-being of their teams:
- A personal message has a strong impact.
- Transparent and frequent communication is key.
- Share the success of interventions and programs in messaging.
- Investment in leadership is critical.
- Everyone can help – students, colleagues, families, the community.
- Employees, especially health care workers don’t always reach out – create interventions that reach them instead.
- Reminding people of their strength, dedication, and determination, especially when they don’t feel they are doing enough, matters.