Speaker 1: Hi, I'm Candace Chen. I'm with the Tim Allen Institute for Health Workforce Equity at the George Washington University, and I'm really pleased today to be able to share our work, How Can Healthcare Organizations Address Burnout? A description of the Dr. Leonard Breen Act grantees that was in the AJPH February 2024 supplement. And of course, I am presenting on behalf of my co-authors and colleagues. First, a quick disclaimer. This program and this work was supported by the Health Resources and Services Administration, although all of the work that I'm presenting does not represent the official views of the government. Now, let's start with a little bit of background on health worker burnout. Before COVID-19, this issue was really rising, and studies showed that between 35 to 54% of health workers were reporting symptoms of burnout. But COVID-19 just added so much pressure to the workforce, and by 2021, over 60% of physicians and advanced practice clinicians were reporting symptoms of burnout. In 2022, 45% of nurses reported feeling burnt out, 51% reported feeling emotionally drained, and 56% reported feeling used up. And we know that burnout negatively affects workers and patients. For health workforce, the evidence tells us that burnout is associated with substance use, anxiety, depression, and suicide. And as well, burnout is associated with lower job satisfaction, greater intent to leave, higher quit rates, and higher rates of complete exits from the profession. For patients who are being seen by healthcare providers who are experiencing burnout, there are increased patient safety events, and there's decreased patient satisfaction. But maybe even more importantly is what happens when you have increasing turnover and increasing exits from the profession. This is the issue of health workforce shortages, and insufficient workforce both affects the quality of care, and it affects access, whether people even get a chance to experience healthcare and receive healthcare services. Following COVID-19, with the rising, I think, understanding of this issue of health worker burnout and how it was affecting both the workers and patients, Congress acted, in March of 2022, Congress passed the Dr. Lorna Breen Healthcare Provider Protection Act. That's a picture of the president signing the act and making it law. If you don't know who Dr. Lorna Breen was, Dr. Lorna Breen was an overseas physician who was present in New York City in March of 2020. In April of 2020, she died by suicide. And the Dr. Lorna Breen Healthcare Provider Protection Act came about in part because of her family's commitment to do something about this problem. Now, even before the act was passed, Congress provided about $140 million through the American Rescue Plan Act of 2021. And as a result, in January of 2022, HRSA awarded 44 grants to organizations to address suicide, mental health, improve resilience, address burnout, as well as one Technical Assistance Center award. And what I'm presenting to you is some of the work that was done by the Technical Assistance Center, which we renamed actually the Workplace Change Collaborative. And the Workplace Change Collaborative was asked to do two major things. One was to support the capacity of the 44 organizations working to improve their workplaces and their learning environments. And the second was to advance the thinking on burnout to share successful strategies with the larger community and to inform policy through the development of a national framework. And I just really quickly wanted to recognize our partners. While the Workplace Change Collaborative is based at the George Washington University, our major partners include the Institute for Healthcare Improvement, Moral Injury for Healthcare, and AFT. But the work that we're presenting is actually an early look at the 44 HRSA grantees at their strategies. And what we did is we asked the grantees to share their grant proposals with us. 43 out of 44 of the organizations shared their proposals with us. And then we proceeded to conduct interviews with 30 grantees. The HRSA grantees, they represent a range of different organizations from academic institutions, hospitals, health systems, community health centers, community-based organizations, national associations. And their work was focused on a number of different populations, physicians, advanced practice clinicians, nurses, dentists, behavioral health providers, pharmacists, social workers, the list kind of goes on, as well as specific focus in many of them with working with students and or other trainees. By reviewing their proposals, what we're looking for is these 44 organizations that were able to receive an award from the federal government, likely more advanced on the path of starting to address this issue. What work were they doing and what lessons could we learn from doing that? And what we found is that the 44 grantees, the organizations were working across a number of different levels. So they were working on changing the work and learning environment. They were working on doing things like providing individual supports. If you take a step up from them, they were also really working on changing organizations and changing organizations that would change how workers and learners experience the delivery of health care or the training for health care professions. In addition, organizations were working on what I might call leadership and management level changes. So how workers and learners not only experience the delivery of care, but how they experience the engagement with their leadership. And finally, a few of the organizations were doing things that were aimed at engaging with society and with culture, with health care systems and changing health care systems and the policies that were driving organizations to behave different ways. Now, the funding opportunity announcement had a bit of a focus on addressing suicide, addressing mental health, improving resilience, which as we talked to the grantees, many of the grantees pointed out that even for those who had stepped on to the path of addressing organizational well-being before COVID, COVID necessarily changed some of their focus to make sure that they were providing mental health supports, that they were providing stress trauma supports that were needed in ways that they hadn't fully seen before COVID. And so a lot of the organizations were doing things to increase mental health screening and services, and they were really grappling with how do we provide these, the screening and the services in ways that health care workers will really be able to engage with it. And sometimes that meant providing services in ways that people could engage in a completely anonymous way so that they didn't have to be worried about implications for their job and for their employment, providing them virtually so that they could join at any time. A lot of the organizations were also grappling with this issue of the stress and trauma that health care workers were experiencing during COVID, and that are a part of the job of delivering health care. They're oftentimes taking care of people in the most difficult times of their lives. And so we're doing things like peer training, psychological stress, mental health first aid, providing critical crisis supports, critical incident response, Schwartz rounds. And many were also doing things around resilience and mindfulness and well-being, providing training, providing resources, changing the physical environment. And along with all of those, whether it's mental health, stress, trauma, or resilience and well-being, there was intentional efforts to change culture, not only to provide the services, but to change how the environment perceives these issues to one that is supporting individuals who are experiencing this, providing places where people can get support. Beyond that, though, we saw many of the organizations really engaging in organizational change. And this range from providing practice support. So, for example, training for non-escalation in the case of workplace violence, training in patient communication to address relationships with patients, and also to address the rising workplace violence that healthcare organizations have been seeing. Engaging in issues of diversity, equity, inclusion. So recognizing that healthcare workers from different groups may have been experiencing different things. And a core component improving the work and learning environment is to ensure that all healthcare workers are experiencing an environment that is supportive, that is not discriminatory, not biased. And that can be both in addressing the relationship with the workers and their peers, the workers and their managers and supervisors and leaders, as well as workers with patients and families. Many were also starting to engage in issues of looking at work environment and policies, issues of workload, grappling with staffing, with teams, with scheduling and flexible scheduling to allow people to balance their work life, but also to have some control over scheduling. Grappling with issues of workflows and administrative burden that might be seen through the electronic or how health workers are being engaged to ensure that patients can get the necessary care that they need. Addressing things like prior authorization and how to decrease the burden. Addressing issues of payment and incentive structures in the workplace. Work-life integration, working on leave policies, enhancing employee assistance programs, even addressing worker social determinants. So that recognition that workers are people and they don't come into existence as they walk in the door, but that the workers themselves might have issues of transportation challenges, housing challenges, food security challenges, making sure that career developments are in place so that people have opportunity and also know that their organization is willing to invest in that. And then working on, again, issues of teamwork and camaraderie, which has to be intentional, as well as creating meaning and purpose. So communicating organizational values. But if we take one step up, even from there, we saw that a lot of our grantees were starting to work on what we call big picture organizational change. So in some cases, developing the organizational infrastructure, and that might be well-being champions, staffing committees, offices, plans, to ensure that well-being and addressing well-being becomes an integrated part of an organization. Along with that, recognizing that leaders oftentimes need additional support, leadership training to be able to address these issues and to engage with workers in different ways. And then from there, starting to engage in policy and program review. Aligned with that was a move towards increasing worker engagement. So how do you build in processes by which you're engaging workers to provide feedback? And lots of the organizations were doing things like establishing focus groups, establishing town halls, so that they were creating opportunities for workers to have voice. And along with that, starting to change the way that the organization works to institutionalize all that and to advance things like participative management and shared governance models. Along with all of that also is the need to measure. And all of the organizations were establishing measurement, annual employee surveys, but then many were working beyond to move towards pulse surveys and also using measures to inform their interventions, not just to track maybe on an annual basis what is happening with worker burnout. And then finally, what we were seeing is many, many of the grantees were leveraging their process improvement, quality improvement units to turn towards well-being. And so using quality improvement really as a mechanism for worker engagement, engaging workers, again, through quality improvement, PDSA, and other cycles to create the process by which workers can identify the problems, identify potential solutions, and then be part of the implementation and the testing of those solutions. And finally, along with leadership training was also the need to train supervisors and managers. And like I said, just a few were also moving towards that, what happens beyond the, I think, walls of our organization and engaging in things like advocacy training and social justice training. And so this gives you a first look at the work of the PERSA grantees. And finally, what I wanted to share with you, if you wanted to learn more about that as part of the work of the Workplace Change Collaborative in developing a framework and providing resources to the community, we have a website, wpchange.org, where you can find both an expanded framework for the drivers, both burnout and moral injury, connected to the outcomes, as well as actionable strategies for healthcare organizations, for government, for individuals, as well as links to resources that can just help get organizations a little bit farther.