Abstract
At the time of writing, the COVID-19 pandemic has infected over 75 million people resulting in over 1.6 million deaths. The standardized tabulation and reporting and monitoring of data on how the pandemic has impacted the lives of healthcare providers is between sparse and non-existent. Social media is flooded with accounts of personal sacrifice, compassion, and heroics in the delivery of care, but at the same time, there are stories of tragedy, exhaustion, and exasperation on the part of healthcare providers who look in horror at their communities that appear to give no regard for taking steps to minimize the risk of transmission of the virus. Providers around the globe are having their lives put at risk and their mental well-being compromised as some citizens choose to partake in risk taking behaviour in respect to spread of COVID-19. They are laying witness to the unnecessary loss of life and deteriorated health due to poor personal choices. They are working longer hours, extra shifts, and in uncomfortable personal protection equipment. This issue of Forum is focused on workplace mental health and what can be done to raise the awareness and understanding of how to improve the healthcare workplace both during the pandemic and after.
COVID-19 has levelled a devastating impact on the mortality and morbidity of the population, but it has also contributed to increasing the negative consequences of other health and social maladies. For example, we are witnessing an increase in domestic violence, suicide, mental health conditions, and illegal drug overdose deaths. Ungar and his colleagues describe three case examples which highlight how healthcare providers may fall victim to an implicit cognitive bias when treating a person with a mental health or behavioural health condition that leads to a negative outcome for the patient. As an aide to healthcare providers, the authors develop a visual model to help make explicit the clinical setting where this implicit bias may arise and to respond appropriately. The authors recognize the limitations of their approach and encourage further research to validate it for education and quality improvement purposes.
In March 2020, hospitals all across Canada prepared for an onslaught of demand for COVID-19 patients expected to require hospital care. Surgeries were cancelled to ensure that adequate beds, staff, and equipment would be available for COVID-19 patients. In the period between March and June 2020, the number of surgeries fell by 47% or 335,000 fewer surgeries compared to 2019. Reid and colleagues point to the recent attention being paid to team-based single-entry models (SEMs) as a way to cope with catching up on the pent-up demand for surgeries. They recognize the challenges associated with SEMs but argue that COVID-19 has opened up the space for a national conversation to share ideas and strategies around shared care models in surgery. The authors put forward a promising framework that has been tried and tested. Health leaders should welcome the opportunity to advance an innovative program such as this which encourages the building of trust between the patient, surgeon, and the team that facilitates the efficient reduction of waiting lists.
The complexity and challenges of delivering healthcare in today’s settings can be emotionally and physically stressful. Adams and Bryan point out the irony of healthcare being oriented toward compassion and caring but often overlooking the extension of that same consideration to fellow employees and colleagues. The authors bring attention to the need for health leaders to be constantly vigilant and identify workplace harassment and bullying when they see evidence of it. The authors identify approaches and techniques to guide leaders in promoting a safe workplace. Calling out inappropriate behaviour takes courage and resilience—your employees expect it of you.
Provider burnout, secondary traumatic stress, and compromised mental health were important concerns of health leaders before the COVID-19 pandemic. They are of greater concern during the pandemic and its expected aftermath. An unhappy or stressed staff will affect the care that is being delivered to patients. Knaak, Sandrelli, and Patten describe a training program for healthcare providers that addresses the transference and perpetuation of negative attitudes and behaviours toward people based on the principles of trauma-informed practice and care. From their evaluation of the program, the authors describe how embedding resiliency and self-compassion can be a promising step toward cultural transformation in the healthcare setting.
Pepler and her co-author tackle head on the disjuncture and negative consequences of police services in Canada being the first response to people in a mental health crisis. Mental illness is not, in and of itself, a police problem. Experiences from the summer of 2020 in which lives have been lost due to unhelpful interactions between police and an individual in crisis is a testament to this issue. The authors point to accumulating evidence that mental health and police services need a serious reset from reacting to immediate health and crime events and move toward holistic approaches that will result in improved individual outcomes to preserve public safety and reduce police involvement. Health leaders and policy-makers should take immediate note of the authors seven steps to action and remediate a broken service delivery system.
Follwell and her colleagues build on the HealthCareCAN and Mental Health Commission of Canada (MHCC) partnership to advance the psychological health and safety of Canadian healthcare workplaces and to promote quality mental healthcare. The result of that collaboration was the formation of the Quality Mental Health Care Network which developed the road map for improving quality mental healthcare in Canada. The authors describe the methods used to arrive at the framework and the dimensions of quality mental health services. Health leaders will find the comprehensive approaches delineated essential to aid the transformation of mental health services in the country.
Dealing with a global pandemic is testing the resilience of healthcare providers and systems around the world. Elliott and her colleagues define resilience as “the capacity to bounce back and respond to pressure, unpredictability, or adversity in an adaptive and effective manner that leads to learning and positive outcomes.” The authors describe the experience of their institution embarking on a journey to develop a program named “Building Resilience with Institutions Together with Employees (BRITE)”. Then COVID-19 happened. Drawing on the experience with SARS, the team implemented a pandemic readiness program to build resilience in the organization and employees. Health leaders would be well advised to become familiar with the BRITE experience as they think about how to prepare their organizations for the unexpected.
Brunet and co-authors provide a first-hand description and analysis of how their university health centre responded to the COVID-19 pandemic using an organic enterprise model. The model is centred on three pillars: a culture of creativity and innovation supported by leadership and communitarianism, an agile organization structure and processes, and an open innovation ecosystem and network. The authors describe how this approach was well suited for the three unexpected insults resulting from COVID-19: lack of knowledge of the virus, the fear of staff, and the need for continuous modifications in management of the crisis. Health leaders are strongly encouraged to read and reflect on the three essential lessons that the first wave of COVID-19 imprinted on the organization.
Healthcare delivery is going to the dogs! And it is about time. Studies have demonstrated the positive influences of dog-assisted interventions in high stress settings such as emergency departments and intensive care units. Caton and her collaborators explore the opportunity afforded by canine-assisted interventions for acute care staff. The P.A.W.S., Pups Assisting Wellness for Staff, pilot project is described in detail with a summary of results that show positive outcomes, with some limitations. Further explorations of how this approach might be an asset for the employee wellness program are presumed. One can only conjecture what comfort and joy a companion therapy dog might have brought to a patient isolated or quarantined during the pandemic.
We hope that this edition makes you think about your own environment and how the people who work in it might feel every day.
