Addressing provider and staff mental health amid COVID-19

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4/23/2020

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “Have you addressed your providers' and staff's mental health amid COVID-19?” The majority (53%) answered “yes,” while 47% responded “no.” For those who responded “yes,” some of the more frequent courses of action included mental health counseling/services (43%), check-ins/transparency (32%) and wellness program/room (9%).

The poll was conducted April 21, 2020, with 1,018 applicable responses.

Respondents who answered “yes” offered some specific examples:

“Communication is the key. People need to know as much as you can tell them about testing, PPE, PPP loan, compensation, etc. We also send frequent reminders that we appreciate them and how our role helps the overall healthcare system even though we don't see COVID patients. We have also done fun stuff such as virtual bingo, and since we are still open having everyone wear a certain color or design (plaid, stripes, polka dots) every day.”
“Partnered with our departments of psychiatry and social work to provide virtual discussion groups. Set up online meditations, created virtual gaming groups, coffee hours, etc. for colleague-to-colleague support. Repeatedly communicated resources for employee assistance programs and special hotlines.”
“My door is open for everyone as usual. I make gentle suggestions for walks in nature (living in Oregon that's easy enough) with usual precautions, to make one small improvement in their environment and to remember counseling is remote also and paid by our insurance. Give folks time off. Rotate staff from remoting to shifts at the clinic.”

Unprecedented, uncertain, fluid, stressed and stretched — these are just a few adjectives MGMA members have used to describe working and living during COVID-19. As Lorri Brown-Ominsky, FACMPE, practice administrator, Internal Medicine of Milford PC, Milford, Conn., said in an MGMA Member Community thread, the epidemic is the “toughest challenge I have had in my long medical practice career.”

As practices continue to address an abundance of issues prompted by the pandemic — staff teleworking, instituting telehealth, applying for financial assistance and navigating furloughs and/or layoffs, etc. — one of the most important to consider is the mental health of staff and providers.

Healthcare personnel’s well-being can be affected by many circumstances, including higher-than-normal care demands, risk of infection, patient distress, challenges with equipment and ultimately psychological stress. Here are some points to emphasize to help ensure that providers and staff are fully supported during this difficult time.

Download the Crisis Management Checklist for Medical Practice Leaders

Focus on emotional health and well-being

As Allison McCarty, MSW, LCSW, behavioral health care manager, Mountain Area Health Education Center for Psychiatry and Mental Wellness, Asheville, N.C., expressed in a recent MGMA Insights podcast, providers and staff are going to have their ups and downs, because most of us have never been through a pandemic. “I’m hearing from a lot of people that they'll have a day where it feels OK … Then the next day we wake up, and maybe we're in a heightened state of anxiety. And then maybe the next day, we're sort of checked out and a little disassociated.”

Given this roller coaster of emotions, it’s crucial for providers and staff to focus on their emotional health and well-being. According to the Centers for Disease Control and Prevention (CDC), the COVID-19 pandemic can be a catalyst for many stressful reactions, including fear and anxiety regarding your health and your loved ones’ health, problems sleeping, increased chronic and mental health issues, and more frequent use of alcohol and drugs, among others.

To help address these issues, the CDC recommends:

Taking breaks from the news, including social media; repeatedly hearing about the pandemic can be distressing.
Self-nurturing, including eating well-balanced meals, meditating, getting enough sleep, regularly exercising, and abstaining from alcohol and drugs.
Setting aside time to unwind by participating in your favorite activities.
Connecting with friends, family and co-workers to express your feelings and anxiety.

The American Medical Association (AMA) suggests that it’s just as urgent for providers to take care of themselves as it is for them to take care of their patients. In addition to taking breaks from news and social media, as the CDC recommends, the AMA suggests not shying away from how you are feeling during this time of tremendous stress; utilizing coping strategies such as those mentioned by the CDC; and observing symptoms that could be caused by stress, including depression, sleeplessness and extended periods of sadness. Providers and staff should be continually reminded of the significance of their work and the sacrifices they are making for the good of the whole.

When focusing on retaining practice infrastructure, the AMA recommends that leaders zero in on a few key aspects of support:

Review and adjust schedules — When legal and possible, ensure that you rotate providers and staff from high-stress to low-stress roles.
Address your team’s well-being — Regularly check in with providers and staff to assess how they’re coping and acknowledge their needs as necessary.
Provide psychosocial assistance to your team — Psychological support is just as important as physical support; make sure your providers and staff have access to practical resources.

Offer resources to providers and staff

Beyond making it a point that everyone is in this together, practice leaders can provide resources to help teams work through adversity. As Shane Lunsford, MBA, CCT, CST, administrative director, Mountain Area Health Education Center for Psychiatry and Mental Wellness, noted, “We’re trying to make sure that our employees know the resources that are available to them, even if they aren't directly being affected by this situation … they have places that they can reach out to.”

Such resources include support groups, therapy, meditation and yoga, checklists and forms and childcare. Also, some larger organizations, such as Kansas City’s Children’s Mercy Hospital, have created wellness support teams. Composed of psychologists, clinical social workers, hospital leaders and chaplains, the hospital’s support team has established virtual support groups and services, one-on-one therapy sessions with mental health professionals, guided meditation and wellness rounds, among other offerings.

Share your stories and find peer feedback in the MGMA Member Community

Be intentional when leading

During a crisis, staff and providers look to their leaders for support. Intentional leadership, which emphasizes mission, culture, empathy and appreciation, is critical because it helps bring teams closer. According to the University of Colorado School of Medicine, intentional leaders should:

Allocate necessary resources to their leaders and their teams
Support reactive decisions
Provide advice regarding appropriate responses
Make certain that the organization and individuals rebound
Rethink the organization’s future, if necessary

In a recent MGMA Insights podcast, Dan Diamond, MD, observed that a disaster or emergency offers a chance to emphasize the good in the midst of stress, classifying it as a wonderful opportunity “to reach out to people and express kindness … to serve my team at work, to bring encouragement and hope.”

Diamond says that leaders should make it a priority to find out what individuals are working on, the resources they have to accomplish their goals and how they can be supported. “It's amazing what you can get done if you don't care who gets the credit,” Diamond added.

Communicate effectively and frequently

In uncertain times, clear communication is vital for curbing stress. As medical practices adapt to new workflows due to COVID-19, organizations need to keep lines of communication open. “We have to be careful about having a united voice; it makes people feel safer,” Christi Siedlecki, chief executive officer, Grants Pass Clinic, Grants Pass, Ore., said in a recent MGMA Insights podcast.

Many MGMA members are emphasizing this in their day-to-day interaction with their staff and providers. For example, Renee DeGroat, practice administrator, Ascension Texas Medical Group, Round Rock, Texas, said that she has “called associates to check in on how they and their families are doing and to make sure they have information and resources they need.” She’s also snail mailed thank you notes to their homes.

In addition, Meredith Hirsh, MBA, co-founder and vice president, The Hirsh Center, Delray Beach, Fla., said that she sends “twice-a-week email newsletters titled ‘Life in the Time of Corona.’ “This provides our team with updates from our practice's perspective, shows empathy and provides answers to questions received,” she said. Furthermore, the practice has a weekly raffle in which team members can earn raffle tickets by accomplishing tasks such as scheduling a telehealth visit, suggesting a cost-saving solution or putting a smile on a patient's or team member's face.

Keep staff and providers busy

Finally, having purpose and conviction is vital during stressful times. Dawn Andrews, administrator, Cardiovascular Associates, PC, Mobile, Ala., said that staff members are catching up on projects they haven’t had time to work on in the past. For example, “all office staff helping the insurance department — digging up old claims, updating bad addresses, no-insurance patients, etc.”

David L. Smith, FACMPE, executive director, United Imaging Consultants, LLC, Mission, Kan., said that extra time could be put to use by catching up on continuing education, as well as compliance and safety training. Moreover, he noted that if you work in a larger organization, it can be “very helpful to have folks from one department show others what they do and how they do it. It could be strictly informational, or actual cross training that might be handy in the future.”

By perceiving this as a chance to grow, rather than a reason to grow apart, Dan Diamond believes we all have a unique opportunity: “Healthcare was difficult before COVID-19, and all the more so now,” he said. “We need to show up with each other and bring kindness, openness and curiosity and ask great questions on how we can support each other.” By providing this support, healthcare leaders can become better attuned to their providers’ and staff’s needs, while strengthening their organizations.

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.