Clinician Wellness—Self-Care for Staying Healthy: Implementation of a Wellness Calendar and Programming for Health Care Workers in Response to COVID-19

Tip

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving over 9 million veterans and employing approximately 335,000 staff nationwide. ¹ Beginning in March 2020, VHA frontline workers and leaders quickly developed innovative methods to ensure high-quality health care remained available to veterans during the COVID-19 pandemic. ² Although the pandemic propelled the development of innovative health care methods for patients nationwide, it also impacted the physical ³ and emotional ⁴ well-being of frontline health care workers. The demonstrated physical and emotional toll is concerning as health care worker wellness impacts patient safety, continuity of care, and control of any illness outbreak. ⁵ As such, recent research recommends that support be available to safeguard the well-being of health care staff and, ultimately, of patients. ³

Practice

Soon after the onset of the COVID-19 pandemic, facilities within the New England region of VHA (VISN 1) recognized the imperative need to address staff well-being. At the time, VISN 1 facilities independently developed staff well-being programs to address this need while maintaining the principles of high reliability organizations. ⁶ For example, Boston Veterans Affairs Healthcare System focused on deference to expertise, translating existing in-person staff well-being offerings to a virtual platform. VA Bedford exhibited sensitivity to operations, conducting a rapid needs assessment of individual staff preferences for wellness. VA Connecticut focused on commitment to staff resiliency through consistent leadership endorsement of the employee assistance program COVID-19 team and wellness programming. VA Central Western Massachusetts and VA Maine focused on the principle of “preoccupation with failure,” anticipating upcoming urgent staff wellness needs, and developing problem-specific solutions within their facilities in collaboration with VA medical centers nationwide.

Despite these efforts, the number of offerings at individual facilities remained low, and additional programming was necessary to address the comprehensive staff well-being needs. This shared need became apparent during facility-based educational needs assessments conducted with VISN 1 sites in April 2020. These meetings were intended to focus on education goals and needs at each facility. Conversation quickly shifted to the impact of COVID-19 on staff well-being across VISN 1. Consistently, the necessity for a collaborative approach to staff well-being to maintain day-to-day functions and to support the added crisis management duties was emphasized. A small group of staff across VISN 1 organized the facility-based offerings and developed a comprehensive regional calendar for staff well-being, including offerings from four sites. This group consulted with regional and national VHA leaders in veteran and staff well-being to ensure appropriate language and ethical considerations were addressed.

The calendar was then introduced to all of the VISN 1 facilities and disseminated by designated facility-specific contacts. The first month served as a pilot, and other VISN 1 facilities were invited to contribute additional offerings for the subsequent month. Daily offerings are live, facilitated by VA staff volunteers, and vary with respect to level of interaction. Platforms used to deliver content include WebEx, Microsoft teams, and VA meeting software. Offerings range in content, focusing on self-care and well-being (e.g., coping with COVID-19, weight management, tobacco cessation, mindfulness, physical activity, poetry readings, and yoga).

Continuous tracking and follow-up surveys were conducted within at least one facility to ensure staff needs were met, and to identify necessary further actions. The calendar has since been modified and assessed each month by a VISN 1 facility representative to ensure accuracy of the dates, times, call-in information, and content. A single VISN 1 staff member reviews the final comprehensive calendar before broad distribution. To date, the VISN 1 calendar development team continually assesses wellness offerings for variation and equal distribution to accommodate staff across all shifts. In April, additional prerecorded offerings were added to accommodate staff unable to join for the live meetings. Modification of live or prerecorded platforms was executed based on objective participation and subjective feedback.

Over the course of calendar development, many lessons became apparent for organization and distribution. Initially, each facility representative made individual changes and submitted separate updates to a single team representative. This process resulted in hours spent organizing and coordinating the monthly calendar outside of regular work duties. Contributors are now contacted regularly each month and asked to complete their facility-specific modifications by a designated date to ensure adequate time to coordinate with facilitators and make necessary changes. Calendar organization was further optimized with the introduction of Microsoft teams at VHA in the fall of 2020. Facility organizers can now modify a single calendar document on a shared platform and confirm completed modifications in a separate document. The final draft is reviewed, organized, and distributed to facility contacts by a single team member. Multiple individuals have been trained in this coordination effort to avoid delays in distribution.

Currently, the VISN staff well-being team's efforts have become streamlined with regular meeting times and agendas set to assess the ongoing needs for staff wellness and integration of wellness into facility culture. This collaborative effort has achieved recognition by the VISN 1 network director, and the calendar is distributed and advertised in network director email updates, a VISN 1 website accessible only to staff, and distributed broadly within each facility.

Benefits

The national COVID-19 pandemic response highlighted the need to better attend to health care workers' well-being, with one survey indicating 69% of employees feel that the COVID-19 pandemic has been the most stressful time of their professional career. ⁷ Some of the VISN 1 wellness offerings are well attended (e.g., weight management support) while some are not (e.g., mindfulness practices). The reasons for discrepancy in attendance remain unclear, though surveys suggest that permission to participate during work hours, workload, protected lunch hours, and collateral duties could play a role.

To have successful work–wellness programming, research suggests the need for strong organizational support and immediate supervisory support. ⁸ Thus, next steps in the VISN 1 employee wellness domain will include concerting our efforts with national VHA employee health directives, and aligning our goals with those of high reliability organizations. On a larger scale, ongoing research and program evaluation are underway to address potential barriers, prevent health care employee burnout, increase employee resiliency, and reduce compassion fatigue. The VISN 1 employee well-being calendar will incorporate lessons learned from these programs as part of ongoing program enhancement activities.

Surveys of staff with higher involvement scores in wellness activities were significantly correlated with overall job satisfaction, decreased burnout, and work satisfaction. ⁹ Mindfulness techniques specifically improve reliability by encouraging creation of context-appropriate solutions with clear minds and attention to tasks. ⁶ These techniques are aided by many Complementary and Integrative Health modalities, and foster an organizational culture of wellness.▪