One of the most important lessons learned during the COVID-19 pandemic is the critical nature of strong, well-established organizational systems that provide academic, emotional, spiritual, environmental, social and financial well-being supports. Research into the topic of organizational systems reveals that multiple factors are involved in making these systems successful and effective.^1,2 When looking at networks as systems, strong and effective leadership is critical, networks must be fluent, and how communication is dispensed is of the utmost importance.1 Top-level organizational support and leadership involvement are indispensable to the perception of organizational support.2 Multiple research articles document the need for broad change in the area of emotional wellness for physicians, especially those on the front lines.^3,4

The Medscape Physician Burnout & Depression Report for 2022 showed that 60 percent of emergency physicians surveyed were burnt out.^5,6 More females were affected, and almost half of the physicians surveyed admitted to using isolation as a coping technique.⁵ Our own study of emergency physicians within the Northwell Health system showed that the COVID-19 pandemic had a greater impact on the well-being of female physicians and those with less than 11 years of practice.⁷ Prior studies have also concluded that female physicians and those in practice less than 20 years are at higher risk for burnout.⁸

To maintain the well-being of our physicians, the walls of stoicism that health care has built must be torn down. Long-term organizational support is critical in dealing with the crisis in health care workers’ mental health that has resulted from the COVID-19 pandemic. Resources should be shared throughout organizations, with the focus on evidence-based interventions.⁹ This especially applies to building staff resilience. Organizational systems must promote open discussion and support for emotional wellness, with administrators leading by example.

The Bohlsen family emergency department entrance.

Prior to the pandemic, the Northwell Health system offered multiple wellness offerings that encompassed many well-being categories. An Employee Assistance Program and Physician Resource Network that offered emotional support for employees was in place prior to the pandemic. Options like WW (formerly known as Weight Watchers) and smoking cessation support were also available. For years, a health risk assessment tool has been offered to employees as an incentive to receive financial credit on paychecks. Various support groups also have been available, long before the pandemic ever started. Northwell also had a Center for Integrative Medicine, where employees could partake in yoga, Pilates and guided meditation classes at a discount.

During the pandemic, Northwell’s Wellness division expanded its services. An emotional support call center was established with 24-hour support available. On-site and telephone access to spiritual leaders was created. Tranquility tents were constructed to create a space where hospital staff could decompress and obtain information on emotional resources. The Center for Traumatic Stress, Resilience and Recovery was created. It offers therapy and resilience skill building for both the individual and groups. The Center for Integrative Medicine offered free online classes, and access to multiple exercise videos was available to all employees. Multiple free or discounted apps like the Clinician Experience Project and Headspace were also offered. Several days of childcare were paid for by the system for those with young children. A well-being support survey was sent out to all employees to determine what services were needed and what barriers, if any, existed in relation to accessing those services. The Governor’s Board Physician Well-Being group made calls to almost all physician partners to check in and see if they needed any information on available supports. An easy-to-access Well-Being Resources page was created to facilitate access to multiple wellness platforms, including the Virgin Pulse app. The last wellness survey showed an 80 percent gain in awareness of benefits, and there has been an increase in the use of Northwell’s Employee and Family Assistance program since 2020. Of equal importance to our wellness support was the open stream of information with the latest data regarding the treatment of COVID-19 patients.

One of the most important things to mitigate stress during the pandemic was having enough personal protective equipment. We never were placed in the situation that our colleagues in New York City experienced. We had gowns, gloves and shields to help protect us. We had access to free coffee, healthy snacks were delivered to our departments, and scrubs were accessible around the clock. In the cafeteria, a mini market was put into place with fresh produce, small take-home meals and vital supplies like toilet paper that the local stores did not always have in stock. Without strong organizational and local support systems to promote wellness, the resilience needed to survive the COVID-19 pandemic would not have been possible. Organizational wellness systems must continue to grow as emergency physicians prepare to tackle the next pandemic.

References

1. Best A, Berland A, Greenhalgh T, et al. Networks as systems. J Health Organ Manag. 2018;32(1):9-24.
2. Grossmeier J, Castle PH, Pitts JS, et al. Workplace well-being factors that predict employee participation, health and medical cost impact, and perceived support. Am J Health Promot. 2020;34(4):349-358.
3. Hendrickson R, Hoerster K, Neville T. Health care workers’ suffering goes far beyond burnout. Self-care isn’t the cure. Stat. 2021 Dec. https://www.statnews.com/2021/12/16/health-care-workers-suffering-goes-far-beyond-burnout-self-care-isnt-the-cure.
4. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146.
5. Kane L. Medscape physician burnout & depression report for 2022: stress, anxiety and anger. Medscape. 2022 Jan. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664.
6. Chesak SS, Cutshall S, Anderson A, et al. Burnout among women physicians: a call to action. Curr Cardiol Rep. 2020;22(7):45.
7. Levine H, Baranchuk N, Li T, et al. An emergency medicine physician well-being survey focusing on gender differences and years of practice during the COVID-19 pandemic. Am J Emerg Med. 2022;55:84-88.
8. Linzer M, Stillman M, Brown R, et al. Preliminary report: US physician stress during the early days of the COVID-19 pandemic. Mayo Clin Proc Innov Qual Outcomes. 2021;5(1):127-136.
9. Søvold LE, Naslund JA, Kousoulis AA, et al. Prioritizing the mental health and well-being of healthcare workers: an urgent global public health priority. Front Public Health. 2021;9:679397.

Dr. Garg is director of emergency medicine research at South Shore University Hospital/ Northwell Health and associate professor of emergency medicine at the  Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York.

Dr. Levine is an attending emergency physician and assistant professor of emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York.