CEO Coalition News And Research
Here you will find news about the CEO Coalition and the great work its co-founders and members are doing to improve the safety and well-being of healthcare team members. Learn more about this national movement at www.CEOcoalition.com.
Health care workers understand that workplace violence, cognitive overload, and burnout have been challenging their safety and wellbeing long before COVID-19 added to their trauma. Bias and inequities in health care environments were also present well before this novel virus began making headlines. The time is now for us to determine what it will take to keep people in their chosen profession and then rapidly make these changes. Failure to do so will cripple our nation’s health care system.
The pandemic placed extraordinary stress on the health care system and its workers, exacerbating long-standing system issues that negatively impacted the physical, psychological, and emotional wellbeing of team members.
Safeguarding and retaining our health care workforce should be our nation’s top priority. It will require a new definition of safety and a renewed focus on care team wellbeing that makes emotional safety as important as physical safety. Health care leaders must uncover what changes are needed to keep people from fleeing their chosen profession and ensure that organizations take the steps to provide the systems, tools, technologies, and resources their team members need and deserve to feel safe at work and make them want to spend the rest of their careers doing what they once loved.
The CEO Coalition was launched because its founders understood that safety is at the heart of health care and that action is needed now to execute on a new definition to ensure a sustainable and safer future. The Coalition was founded by 10 U.S. health system CEOs, who share a mission to protect the physical safety, emotional wellbeing, and just treatment of all who work in health care.
The trauma is real
Physical and verbal violence at work, racial and ethnic biases, patients dying without loved ones by their side: these are only a few examples of trauma that healthcare workers have faced before and during COVID-19. For many frontline workers, what they have witnessed and experienced during the pandemic will have long-lasting effects, including PTSD.
In addition to battling a global pandemic, some health care workers must fight against bias and fight for health justice. A study from the University of California at Los Angeles found that the proportion of Black physicians in the U.S. has only increased by four percentage points over the past 120 years. The share of doctors who are Black men has remained unchanged since 1940. Additionally, many LGBTQ physicians have reported social ostracization in the workplace, including harassment by colleagues and patients. And since the start of the pandemic, Asian American health care workers have reported a rise in bigoted incidents.
Health care workers have suffered more psychological and emotional trauma since the start of the pandemic. According to 2021 survey findings from the Kaiser Family Foundation Washington Post Frontline Health Care Workers Survey, a majority of frontline health care workers (62%) reported that worry or stress related to COVID-19 had a negative impact on their mental health. More than half (56%) reported that worry or stress related to COVID-19 caused them to experience trouble with sleeping or sleeping too much (47%). Frequent headaches or stomachaches were reported by 31%, and 16% reported an increase in alcohol or drug use.
Violence against health care workers follows a similar storyline. A frequently cited survey from 2019 revealed that nearly 50% of emergency physicians reported being physically assaulted at work, while about 70% of emergency nurses reported being hit and kicked while on the job, according to the American College of Emergency Physicians and the Emergency Nurses Association. This type of violence has only intensified since the start of the pandemic.
Research published by the American Association of Occupational Health Nursing found that 44% of nurses reported experiencing physical violence in early 2020, while 68% experienced verbal abuse. According to the study, nurses who provided care for patients with COVID-19 experienced more physical violence and verbal abuse than nurses who did not care for these patients.
It’s time to redefine safety
Our health care workers deserve better. That is why health system leaders from across the country came together to write and sign “The Heart of Safety: Declaration of Principles.” The CEO Coalition is using the Declaration and its key principles to create more awareness about critical safety and wellbeing issues in healthcare and galvanize people to take action to retain and protect healthcare workers by providing them with the right equipment, technologies, support, and resources they need to be and to feel safe at work.
Importantly, the Declaration expands the definition of safety to include equity and antiracism as core components of safety and emphasizes a zero-harm program to eliminate physical and verbal workplace violence. Organizations that sign the Declaration are joining a national movement to accelerate policies and programs that advance these three essential pillars:
Safeguarding psychological and emotional safety. Participants pledge to invest in processes and technologies that reduce emotional and cognitive burdens on team members and restore human connection. This commitment involves creating practices that advance open communication between leaders and team members, so people feel safe to share their voice. It also means providing resources to assess and support team members’ emotional, social, and spiritual health, while at the same time alleviating the stigma and deterrents to seek support.
Promoting health justice. Equity and antiracism must be considered as core components of safety. Organizations that truly want to protect their team members must have focused policies and practices that advance diversity, inclusion, and belonging. Health care team members deserve to work in environments free from bias and discrimination so they can bring their full selves to work without fear.
Ensuring physical safety. Workplace violence is an epidemic. Health care leaders must commit to implementing zero-harm programs for care team members to eliminate both physical and verbal violence at work, whether from a team member, patient, family, or visitor. The CEO Coalition encourages organizations to provide evidence-based personal protective equipment, technology, tools, and processes that health care team members need to safely do their jobs and care for patients.
As the next COVID-19 variant hits our country, I feel a renewed sense of urgency. We need to move faster to invest in an infrastructure that protects our nation’s health care workforce before we lose more nurses, doctors, and other care team members. Every day they risk their own safety for ours and our loved ones. It is time to reimagine safety and take action to make lasting change. That means investing in new policies, processes, resources, and solutions that ease the burden of team members and safeguard their physical, emotional, and psychological wellbeing. It means coming together as a nation and recognizing that health care is an essential infrastructure and that the people who work in health care are national assets and that their safety and wellbeing matters. We cannot afford to lose another nurse, physician, or frontline care team member.
When I donned my white coat and took the Hippocratic Oath to “First Do No Harm,” I would leave for work every day and pray that I didn’t hurt anyone that day.
My biggest fear was that some decision or action on my part would cause harm to my patients. Never did I have to worry that my own safety or the safety of my family would be at risk because of my career choice. Never did I have to be concerned that I might not have the equipment or technology to keep me safe as I provided care for my patients.
Unfortunately, with the COVID-19 crisis, today’s care team members have had to face that very reality. The consequential mental and physical toll on them will profoundly impact our nation’s healthcare system and the workforce of the future. My colleagues on the frontlines today have had to deal with a novel virus for which we were little prepared, leaving professionals whose whole sense of purpose comes from healing and “helping” feeling unable to help.
Many have had to become ‘doulas for dying,’ providing a loving presence at the bedside and connecting with patient’s loved ones who couldn’t be by their side due to safety restrictions.
COVID-19 exposed flaws in our health system and national health care infrastructure. Not only did we experience shortages of PPE and expose supply chain inadequacies, but we also discovered that our definitions of PPE (gowns, gloves, masks) failed to ensure that frontline care team members could communicate effectively with their teammates and with patients and families without the risk of infection.
That meant more contamination risk in donning and doffing PPE that hands-free communication tools could have prevented.
We also saw broad systemic inequities exposed as COVID-19 disproportionately impacted Black and brown community members, both from a mortality and economic perspective. We learned that racial injustices were also being experienced within our healthcare systems by many of our colleagues. Remarkably, our essential but too often “invisible” workers in housekeeping and food services – disproportionately people of colour – still put their lives on the line every day to care for patients and team members.
A movement to redefine safety for healthcare team members
As a physician whose career has been centered on making sure every human being has access to humane, compassionate, and competent care, and working for a company whose mission is to simplify and improve the lives of healthcare professionals and patients, I saw the need for a new movement in healthcare – one that broadens the definition of workplace safety and elevates team member safety and well-being to a top strategic priority for the nation.
With the support of the senior leadership at Vocera, my team and I quickly assembled a coalition of CEOs from leading health systems, diverse in background, geography, gender, and system type. It didn’t take any convincing. These leaders were seeing the same challenges we were and knew that the future of the nation’s healthcare systems depended on making physical and psychological safety and health justice our nation’s top priority.
Together, we drafted a Declaration of Principles that expands the definition of safety to include safeguarding psychological and emotional well-being of team members, promoting health justice by declaring equity and anti-racism as core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence, both physical and verbal. This Declaration extends to all team members, from frontline clinicians to environmental services workers and back-office employees.
Since launching the Declaration in May, we have collaborated with the Institute for Health Improvement to ensure that we can identify and spread evidence- and experience-based practices that advance the six Principles, as well as the metrics that allow us to gauge progress.
I am profoundly grateful to our 10 founding CEOs who are making team member safety one of their top priorities as we rebuild from COVID-19. And I invite others to join the movement to ensure that no healthcare team member will have to sacrifice their personal safety, health, identity, or well-being to do their jobs and care for patients.
Kedar Mate, MD, is President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), President of the IHI Lucian Leape Institute, and a member of the faculty at Weill Cornell Medical College. His scholarly work has focused on health system design, health care quality, strategies for achieving large-scale change, and approaches to improving value. Previously Dr. Mate worked at Partners In Health, the World Health Organization, Brigham and Women’s Hospital, and has served as IHI’s Chief Innovation and Education Officer.
In this episode, Dr. Mate and I talk about research IHI recently completed into a broadened definition of team member safety and well-being put forth by the CEO Coalition, a group of US-based healthcare CEOs who see team member safety and well-being as an essential component of healthcare efficacy and sustainability. The CEO Coalition’s Heart of Safety Declaration of Principles expands the definition of safety to include protecting psychological and emotional well-being, promoting health justice by declaring equity and anti-racism core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence, both physical and verbal. Dr. Mate shares what he and his team learned through the research process and how improvement science is critical to advancing safety and well-being. He also shares a long-term vision for healthcare in which the traditional locations and relationships of care expand, requiring a renewed focus on adaptive leadership competencies.
For many leaders, concern for workforce safety has focused on physical safety — a health care environment with no lift injuries, slips, trips or falls, and sound infection control with appropriate personal protective equipment (PPE). Yet, the COVID-19 pandemic has highlighted the need for a more holistic notion of workforce safety — one that builds on physical safety as a foundation, but also encompasses psychological and emotional safety, including an equitable work environment free of bias or discrimination.
This concept of workforce safety is consistent with the National Action Plan to Advance Patient Safety, and other national efforts to prioritize the safety of the health care workforce. Of note is the vision offered by the CEO Coalition, a group led by Vocera Communications with support from the Institute for Healthcare Improvement (IHI) that includes leaders from prominent health systems, including Intermountain Healthcare, Providence, and others. The CEO Coalition offers six key principles that fall under three domains to address workforce safety holistically: safeguard psychological and emotional safety, promote health justice, and ensure physical safety. The following domains and principles can form the foundation for a workforce safety agenda for health systems:
Domain 1: Safeguard Psychological and Emotional Safety
This domain and its accompanying principles acknowledge the emotional, mental, and cognitive health needs of health care workers:
Principle 1: Invest in processes and technologies that reduce emotional and cognitive burdens on team members and restore human connection to the health care experience.
Principle 2: Create practices and policies that advance open communication between team members and leaders so people feel safe to speak up and bring their full selves to work.
Principle 3: Provide resources to assess and support team members’ emotional, social, and spiritual health, and alleviate the stigma and deterrents to seeking support.
Learn More About Leadership & Innovation at the IHI Forum 2021
During the height of the COVID-19 pandemic, many health systems provided increased mental health services to their staff, acknowledging that health systems have a role in alleviating the psychological toll experienced by their workers. In addition to robust mental health services, some hospitals are also working to reduce the burden of the electronic health record (EHR) by limiting notifications. The time saved has allowed health care workers to spend more time with patients and helped them to feel greater work
Domain 2: Promote Health Justice
Principle 4: Declare equity and anti-racism core components of safety, and require explicit organizational and health equity-focused policies and practices to advance diversity, inclusion, and belonging.
The health inequities exposed by the COVID-19 pandemic and increased attention to racism in our societies have highlighted the need for health systems to take a firm stand on racial justice and health equity. Health systems must look at their own internal practices to ensure they are creating an anti-racist and equitable environment for both patients and staff. An example of this includes incorporating equity into existing practices, such as root cause analyses conducted after workplace injury or harm. Some health systems have begun to include questions specific to equity, such as whether the incident suggests any possibility of biased behavior on any individual’s part, or whether the incident suggests system-level barriers to an equitable workplace, such as impediments to transportation, childcare, or other supports.
Domain 3: Ensure Physical Safety
Principle 5: Implement a zero-harm program for care team members to eliminate workplace violence, both physical and verbal, whether from team members, patients, families, or community members.
Principle 6: Ensure that all health care organizations can procure and provide evidence-based PPE, technology, tools, and processes that health care team members need to do their jobs safely and care for patients.
While important progress has been made to protect the physical safety of workers, recent events have shown the need to scale up efforts related to workplace violence and injury prevention. This includes implementing the US Occupational Safety and Health Administration (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, forming a behavioral response team to de-escalate workplace violence events, and implementing safe patient handling protocols.
The CEO Coalition now includes a learning community where system leaders can understand evidence-based practices in areas such as workplace violence prevention and reducing the mental burden for health care providers.
Other Efforts to Expand the Scope of Workforce Safety
Multiple national initiatives are converging to broaden the understanding of workforce safety:
Safer Together: A National Action Plan to Advance Patient Safety makes several recommendations for health systems that go beyond physical safety, including:
Assume accountability for physical and psychological safety and a healthy work environment that fosters the joy of the health care workforce and
Develop, resource, and execute on priority programs that equitably foster workforce safety.
The National Action Plan authors also developed an organizational assessment tool and implementation resources.
IHI’s Joy in Work Results-Oriented Learning Network (ROLN) has highlighted interventions that go beyond typical notions of employee satisfaction. These changes encompass physical safety, improved communication, and reducing unnecessary work and workarounds. In the coming year, the Joy in Work ROLN will also benefit from IHI’s efforts to more explicitly incorporate equity into the joy in work change package.
In the coming year, IHI’s Leadership Alliance — a dynamic collaboration of health care executives — will assemble a workforce well-being workgroup after convening a year-long workgroup in 2021 focused on physical safety.
IHI’s overall efforts to advance equity increasingly focuses not only on patients, but also on health care staff. Examples of changes introduced by leading health systems include workforce diversity targets, implicit bias training for all staff, and executive coaching to ensure C-suite leaders have personal goals to promote equity for their system.
How to Take Action Now
Health systems can address workforce safety more holistically in a number of ways:
Create robust measurement and reporting systems that prioritize workforce safety but go beyond physical safety.
Regularly report incidents of physical injury, workplace violence, and verbal aggression experienced by the workforce to the C-suite and board level (e.g., as part of an executive dashboard).
Make workforce safety one of a small number of strategic system priorities, and adopt an investment mentality. This means allocating the time, equipment, and staffing necessary to promote workforce safety. These investments pay off in lower turnover and other avoidable costs.
Stratify workforce safety data by race, ethnicity, gender, age, and specialty, and also survey the workforce on whether they perceive leadership as prioritizing equity across initiatives.
Focus on creating a safety culture. As the Joint Commission and others have recognized, the foundations for workforce safety — such as psychological safety, transparent and regular reporting, a focus on identifying root causes and structural factors, as well as working to build a just culture — are much the same as the foundations for patient safety. Leaders must commit to these foundations to make workforce safety sustainable.
Commit to listening to frontline workers to understand their needs, what matters to them, and what would make them feel safe when thinking about physical safety, psychological safety, and an equitable work environment.
The safety of the health care workforce is essential for safe, high-quality patient care. Yet, harm to the workforce remains a challenge across all settings. The solution, according to an increasing number of organizations, is to take a wider view of workforce safety to include the physical and psychological safety and well-being of workers, including equitable work environments free of discrimination and bias.
Nurses, doctors, and other healthcare team members deserve working environments that protect their physical, emotional, and psychological well-being. They also deserve equitable support and access to resources and tools to care for themselves and the patients they serve. At the heart of safety is a commitment from hospital leaders to build cultures that empower employees with essential equipment, technologies, and protocols that protect their well-being and enable them to work at the highest level of their skills.
After nearly two years, COVID-19 continues to wreak havoc on exhausted nurses, doctors, and others frontline workers. The pandemic, causing needless death and elevated stress levels, has burned out many of our caregivers. Some are retiring early, some are changing professions, and others are leaving the workforce entirely. The cognitive burden that healthcare workers are carrying, and have been carrying even before the pandemic, is extremely heavy. The emotional toll is unimaginable.
We must find ways to protect and support every care team member or we risk losing more of them too soon. The future of our healthcare system depends on what we do now.
To start, we must identify the root causes of staff shortages. Let’s call out what is harming the physical, emotional, and psychological well-being of healthcare workers. COVID-19, cognitive overload, and burnout are not the only things threatening their well-being.
Workplace violence, racial disparities, and bias are also contributing to the trauma healthcare workers must endure. While these threats existed well before the pandemic, the last 24 months have put a spotlight on the urgent need to protect the safety of our nation’s healthcare workforce who have risked so much to protect us.
Several health system CEOs from across the country have signed The Heart of Safety Declaration of Principles to redefine safety in healthcare and drive action for meaningful change. The three pillars of the Declaration highlighted below are helping galvanize support by other healthcare leaders, technology companies, policy makers, and more.
Safeguard psychological and emotional safety. We must eliminate stigmas associated with seeking mental health support and advance a culture of open communication, so people feel safe to speak up and are empowered as equal and valued members of the care team. The Dr. Lorna Breen Health Care Provider Protection Act is an excellent start.
Promote health justice by declaring equity and anti-racism core components of safety. Healthcare team members deserve to work in environments free from bias and discrimination. A recent UCLA study showed the proportion of Black physicians in the U.S. has increased by only four percentage points over the last 120 years. Focused policies and practices are needed to advance diversity, inclusion, and belonging in healthcare environments, which in turn enables more equitable care delivery.
Ensure physical safety. Healthcare workers are five times more likely to suffer a workplace violence injury than staff in other industries. Zero-harm programs must be implemented to eliminate workplace violence, both physical and verbal.
Policies, protocols, and training staff how to handle a violent situation are important, but they are not enough. Hospitals and health systems need to give nurses, doctors, and other team members the ability to easily and quickly call for help when a situation escalates.
Many hospitals have equipped employees with wearable communication devices that enable emergency communication, such as a dedicated panic button, and understand simple voice commands while wearing the device under personal protective equipment (PPE).
Intelligent communication technology can also help safeguard team members from mental and emotional distress. All day long, clinicians are overloaded with complex processes, competing priorities, and interruptions by calls, texts, and alert and alarm notifications from nurse call systems, patient monitors, ventilators, and more. These communications are often not actionable, causing clinicians to feel lost and overwhelmed, spending valuable time looking for information or a colleague to help.
A unified communication and collaboration solution can reduce distractions, noise, and stress, which have increased during the pandemic. It can eliminate loud overhead paging and help organize and prioritize notifications so they only go with contextual information to the person or team who needs them and can act. Managing alerts and alarms creates a quieter healing environment, while helping reduce the cognitive burden on the healer.
There are many ways to help protect and connect team members. Together, with more collaboration and a renewed commitment to safety, we can accelerate the adoption of these solutions to safeguard our nation’s healthcare workers for a brighter future of caring.
The Joint Commission continues its long tradition of focus on health care worker
safety in its accreditation standards and offers additional resources to protect
health care workers on its Workplace Violence Prevention Resources and its
Coronavirus (COVID-19) Resources portals. In addition, The Joint Commission
and Joint Commission Resources have held a long-standing partnership with the
US Occupational Safety and Health Administration through an alliance designed
to address health care worker safety. As concern for the safety and well-being
of health care workers continues to grow with the ongoing COVID-19 pandemic,
efforts to develop and implement programs to protect workers are gaining
momentum across the health care industry.
Throughout the COVID-19 pandemic, frontline healthcare workers around the globe provided exceptional patient care despite fears of infection, shortages of staff and supplies, and the frustrations of trying to treat a novel pathogen. At the same time, COVID-19 exposed deep and systemic risks to healthcare team members’ physical, psychological, and emotional safety driving burnout to crisis levels. Burnout is arising not only from the emotional toll of caring for sick and dying patients, but COVID-19 also exposed flaws in our health system and infrastructure. Systemic inequities were amplified as COVID-19 disproportionately impacted people of colour and Indigenous community members. A renewed and expanded definition of safety is needed to restore trust, recruit, and retain individuals to the healing professions, enable care to be provided with the greatest skill and humanity, and ensure the well-being of every person working in healthcare. In collaboration with CEOs of a diverse group of health systems in the United States, the author drafted a Declaration of Principles that expands the definition of safety to include safeguarding psychological and emotional well-being of team members, promoting health justice by declaring equity and anti-racism as core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence, both physical and verbal. We invite Canadian leaders to embrace these concepts and commit to supporting team member safety and well-being as an essential foundation for public health. We must humanize healthcare and the time to act is now.
Throughout the COVID-19 pandemic, healthcare workers around the globe exhibited courage, compassion, and resilience in the face of an invisible enemy. Frontline team members have come to work and provided care for patients despite fears of infection, shortages of staff and supplies, and the frustrations of trying to treat a novel pathogen. They have held the hands of the sick and the dying, and orchestrated video calls for final farewells between patients and their loved ones who were not allowed to visit in person. Day after day, care team members face the reality that just doing their job means they could place their own safety and the safety of their families at risk.
All of this is happening on top of a system that was already struggling with access, financial strains, and clinician burnout before the pandemic. The tug between public and private sector healthcare services, with their differences in wages, schedule flexibility, and autonomy, was already putting pressure on Canada’s critical public health sector. And differences in healthcare access and outcomes for the most vulnerable and those with historic reason to distrust government services were only heightened by COVID-19.
These and other challenges are taking a toll on frontline healthcare team members, from doctors and nurses to environmental services and food services professionals. A study conducted at the University of New Brunswick found an elevated level of depressive symptomology among Canadian healthcare workers1 substantiating other research that found healthcare professionals working in the first wave faced pandemic-related stressors including depression, anxiety, and Post-Traumatic Stress Disorder (PTSD).2-5
If Canadians do not act collectively and swiftly to redefine and restore safety and well-being for healthcare team members—at the local, provincial, and national levels—our healthcare system will be the hardest hit casualty of the COVID-19 pandemic.
COVID-19 exposed deep and systemic risks to healthcare team members’ physical, psychological, and emotional safety driving burnout to crisis levels. In a UBC study of 302 internal medicine physicians working at Vancouver General Hospital and St. Paul’s Hospital from August to October 2020, more than two-thirds experienced burnout. Rates were highest among female physicians, younger physicians, and visible minority physicians.6 This is even higher than levels of burnout among US physicians.7
The same study exposed burnout levels among nurses and allied health professionals at levels of 78% and 73%, respectively. Issues such as forced overtime, violence, and poor working conditions are causing new nursing graduates to leave public sector positions for private sector jobs in which they have more control and better pay.8
Burnout is arising not only from the emotional toll of caring for sick and dying patients struggling against a novel pathogen for which treatment protocols are still emerging. COVID-19 also exposed flaws in our health system and infrastructure. Not only did we experience shortages of Personal Protective Equipment (PPE) and expose supply chain inadequacies, we also discovered that our definitions of PPE (gowns, gloves, and masks) failed to ensure that frontline care team members could communicate effectively with their teammates and with patients and families without risking infection. That meant more contamination risk in donning and doffing PPE that hands-free communication tools could have prevented.
We also saw broad systemic inequities exposed as COVID-19 disproportionately impacted people of colour and Indigenous community members, both from a mortality and economic perspective. These community members often fill essential work positions, live in multi-generational households, or lack access to resources such as clean water that leave them more vulnerable to infection.9,10
The challenges outlined above are not unique to Canada. In the United States, my team and I are collaborating with CEOs of health systems across the country and other industry leaders to spark a movement to redefine safety in healthcare to include health justice and make psychological and emotional safety as important as the physical safety of healthcare team members around the globe.
After watching my colleagues suffer through patient surges, limited PPE, visitor restrictions, and death after death, I felt a sense of urgency to do more to protect the physical, psychological, and emotional safety of the nation’s healthcare workforce. With support from the leadership team at Vocera, we started a movement to galvanize people and organizations around this mission. I reached out to a few influential CEOs from my personal contacts. They were immediately on board and recommended other CEOs to join. I offered to put resources toward building a Coalition, creating a Declaration of Principles, and driving a plan of action. The result was 10 founding members—a diverse group of health leaders representing: clinical and operational backgrounds; a mix of genders, races, and ethnicities; institutions including academic medical centres, public safety net institutions, for-profit and non-profit organizations; and systems span urban and rural geographies.
To create the Declaration of Principles, my team and I conducted in-depth interviews with executive partners identified by the CEOs as having responsibility for team member well-being. Roles spanned medicine, nursing, quality, HR, technology, and team member experience. Some of the executive partners are still involved in frontline caregiving practice. Based on those interviews, we drafted the Declaration and then worked with the executive partners and convened the CEOs for collective feedback until all agreed on a final version.
We believe a renewed and expanded definition of safety is needed to restore trust, recruit, and retain individuals to the healing professions, enable care to be provided with the greatest skill and humanity, and ensure the well-being of every person working in healthcare.
The Declaration expands the definition of safety to include safeguarding psychological and emotional well-being of team members, promoting health justice by declaring equity and anti-racism as core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence, both physical and verbal. This Declaration extends to all team members, from frontline clinicians to environmental services workers and back-office employees.
We are working with the Institute for Healthcare Improvement and others to turn that Declaration into action so that we can ensure that healthcare team members are safe at work. If we don’t do this, we will face an exodus of healthcare talent and compassion that will cripple our ability to care for patients.
As a physician whose career has been centred on making sure every human being has access to humane, compassionate, and competent care I invite you, my Canadian colleagues, to embrace this movement and join us to broaden the definition of workplace safety to elevate team member safety and well-being as a top strategic priority so that the lives of healthcare workers around the globe will be improved. I believe this is the most important issue that healthcare will face over the coming decade.
Canadian leaders can get a start on protecting and connecting team members even as the delta variant brings a new surge of patients and challenges. To get started:
1. Rebuild trust. The pandemic has shaken the trust of team members—trust that they will be safe at work, and that they will get the support and resources they need. Leaders in the health services, government, and community need to focus on rebuilding that trust.
2. Redefine and recommit to team member safety. The pandemic amplified pre-existing issues such as injustice and workplace violence—and it introduced new safety concerns around infection and death. We are working on a new definition of team member safety that encompasses safeguarding team members’ emotional and psychological safety, promoting health justice, and protecting their physical safety. We need all leaders, as well as national and local governments to commit to healthcare team member safety and well-being or we will face a crisis in healthcare that will last for years if not decades to come.
3. Expand the definition of PPE to include communication tools. When team members had to adopt new infection prevention approaches to protect themselves and other patients from COVID-19, too many of them found that donning PPE left them cutoff from colleagues. They risked infection by using devices like cell phones in contaminated areas. We need to expand the definition of PPE to include communication technology so no team member has to risk contamination to communicate with their peers.
4. Embrace human-centred leadership. Put simply, human-centred leadership is leading people with humanity. More specifically, it is leadership that explicitly supports team members’ cognitive, emotional, physical, and spiritual well-being so they can maximize their human and healing potential.
5. Reimagine human connection. One of the lessons of the pandemic is that we need human connection to thrive. Never did we imagine a time when we would strip loved ones away from each other upon admission to the hospital. When in-person connection is not possible, we learned that purpose-built technology is essential to keep patients connected with their loved ones and their care teams. We need to reimagine human connection so that essential connections can happen via technology without disrupting nursing workflows or creating burdens on team members or loved ones.
COVID-19 is a novel virus. Early on, we needed to determine how it was transmitted requiring the adjustment of process, technologies, and physical environments to mitigate infection spread. We learned our supply chains need to be more resilient to a global crisis to ensure that we have adequate access to personal protective equipment to keep members safe and to demand communication technologies be included so team members don’t risk contamination for communication.
We initially lacked treatment protocols so care team members who professionally identify with helping others were unable to help, unable to support healing of their patients, feeling isolated, and helpless. We learned that healthcare teams need greater emotional and psychological support than we had traditionally provided because of the inherent trauma in the system heightened by the pandemic.
There are countless stories of healthcare workers being heroes during the COVID-19 pandemic. Overcoming their own fear, we have seen how their dedication to their patients meant going into COVID isolation wards over and over again not sure how much they were endangering themselves or their families.
We have heard about nurses creating video calls between dying patients and their families and even more heartbreaking stories of nurses holding and comforting their patients so that they need not die alone. Healthcare team members have carried an enormous emotional burden as they experienced unprecedented levels of death and bearing witness to the passing of patients. But all this has taken a tremendous toll on healthcare workers.
We must ensure that we never are unprepared for future pandemics. We must ensure that we not miss this opportunity to redefine healthcare safety under the three pillars: psychological and emotional safety, physical safety and health justice, and strive for meaningful change. We must humanize healthcare. If we do not, we will witness an exodus of caring, compassionate, and exhausted team members who leave their profession and their calling. The time to act is now.
Declaration of principles
We witnessed selfless acts of courage, care, and compassion from our nation’s healthcare team members during the COVID-19 pandemic. Safety is at the heart of protecting our healthcare workforce, which means being safe from physical and emotional harm and free from all forms of inequity and racial injustice. Workplace violence, burnout, and disparities existed long before the outbreak of COVID-19. The pandemic has, however, exacerbated the factors contributing to workplace violence, created an environment of unprecedented stress, and exposed the impact of systemic inequities and racial injustice on the well-being of healthcare team members.
We believe a renewed and expanded definition of safety is needed to restore trust, recruit, and retain individuals to the healing professions, enable care to be provided with the greatest skill and humanity, and ensure the well-being of every person working in healthcare. We commit to:
Safeguarding Psychological and Emotional Safety
1. Investing in processes and technologies that reduce emotional and cognitive burdens on team members and restore human connection to the healthcare experience.
2. Creating practices and policies that advance open communication between team members and leaders so people feel safe to speak up, bringing their full selves to work.
3. Providing resources to assess and support team members’ emotional, social, and spiritual health, and alleviating the stigma and deterrents to seek support.
Promoting Health Justice
1. Declaring equity and anti-racism core components of safety, requiring explicit organizational and health equity-focused policies and practices to advance diversity, inclusion, and belonging.
Ensuring Physical Safety
1. Implementing a zero-harm program for care team members to eliminate workplace violence, both physical and verbal, whether from team members, patients, families, or community members.
2. Ensuring that all healthcare organizations can procure and provide evidence-based personal protective equipment, technology, tools, and processes that healthcare team members need to do their jobs safely and care for patients.
Our ability to build trust and provide the care patients require and deserve is dependent on the physical and emotional safety and the just treatment of all those who provide or support patient care. We commit ourselves to this new definition of safety to ensure that no healthcare team member will have to sacrifice their personal safety, health, identity, or well-being to do their jobs and care for patients.
Listen to the podcast with Dr. Bridget Duffy, moderated by Dr. Gurprit Randhawa, who has recently joined the First Nations Health Authority as the Director of eHealth & Virtual Care Innovation. Dr. Bridget Duffy, the Chief Medical Officer of Vocera Communications, discusses the Declaration of Principles designed to expand the definition of safety to include safeguarding psychological and emotional well-being of team members, promoting health justice by declaring equity and anti-racism as core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence.
By Bridget Duffy, MD