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Caregiver crisis: 4 immediate interventions every leader should consider

This is the first blog in a five-part series on the state of the healthcare workforce. 

Blog #2: Tackling workplace violence and compassion fatigue in healthcare; Blog #3: How to reduce nurse turnover in first-year nurses; Blog #4: 3 steps to avert physician and nurse suicide; Blog #5: How to confront challenges to coordinated care

There is no question that we are in the midst of a caregiver crisis. Front-line clinicians are mentally, emotionally, and physically exhausted from the intensity of the pandemic response. Hospitals face rising turnover as nurses leave for roles away from the bedside or accept lucrative temporary contracts from competitors while physicians reassess the fit with their current employer or leave the profession altogether.

Just as hope was on the horizon, the Delta variant surged, and caregivers are once again entrenched in this intense battle. There are, however, a few key interventions that organizations can undertake to support employees, and Press Ganey has the tools to help. 

1. Shift staffing models to support employee and patient needs

The #1 concern we are hearing across the nation is staffing. Clinicians are overworked and often asked to step into unfamiliar roles, which means that their skills and expertise are not being leveraged in the best possible ways. This, in turn, may introduce safety, quality, and experience risks for patients, as well as well-being risks for caregivers. Leaders who are laser focused on ensuring that there is adequate and appropriate staffing are showing front-line clinicians that they are listening and responding, as well as demonstrating to patients that they are the hospital’s top priority. 

Many organizations are redeploying non-direct care clinicians into direct care roles as well as into supporting roles that take some of the burden off front-line caregivers. An example is Bon Secours Memorial Regional Medical Center, a facility in the Bon Secours Mercy Health system’s Richmond, Va., market. The hospital stabilized the night shift on the neurological unit by adding LPNs, who helped RNs distribute medication and assisted with clinical assessments.  

When addressing their own staffing issues, senior leaders should: 

  • Talk openly and honestly with employees about challenges 

  • Be transparent about planned interventions to ensure adequate understanding and readiness for changes  

  • Conduct engagement or pulse surveys (frequent and targeted listening tools) to identify teams with low engagement and key drivers for improvement 

  • Conduct a flight risk assessment, which uses your data to identify units at the highest risk of turnover and shows where changes to clinical or managerial roles will have a positive effect on engagement and clinical outcomes 

2. Instill confidence in your caregivers through high reliability techniques

The more you can ease the minds of caregivers and quell anxiety during periods of uncertainty, the safer they will feel. High reliability organizations follow a set of best practices, called the “ABCDs,” to prevent errors and set behavior expectations for a culture of safety. While leaders and staff alike are working hard to keep these top of mind, it’s also important to acknowledge that flexibility and adaptability are critical tools during a crisis.  

  • Assignments: When units are understaffed, it’s easy for leaders to feel overwhelmed by the decisions before them. Assignments should be driven by patient need and acuity, with routine or noncritical cases matched to clinicians who can quickly and accurately diagnose and treat patients, freeing up beds and resources.  

  • Behaviors: Attention to detail is central to error prevention. Saving hardworking employees from the emotional harm of an unforeseen safety event can be accomplished by helping them remember five behaviors:  

    • Preoccupation with failure, or actively thinking about what could go wrong and being aware of small signs that may signal problems  

    • Reluctance to simplify, or seeking full explanations of complex situations instead of a surface understanding  

    • Sensitivity to operations, or recognizing how operations are running and where they could be more efficient  

    • Deference to expertise, which places knowledge over role hierarchy in problem-solving  

    • Commitment to resilience, or the practice of rapidly assessing and responding to challenges  

  • Communications: The overwhelming onslaught from 24/7 news cycles and a constantly changing landscape can quickly sow confusion and distrust in teams. Sharing information in as transparent a manner as possible, and ensuring that information is cascaded, helps maintain trust and a safe environment for workers and patients.  

  • Double checks: Unease and apprehension are heightened when workers are thrust into new roles and responsibilities. It's up to managers to empower their employees to receive help, and provide oversight and coaching when needed. Peers can also provide feedback and checks when they notice a lapse in best practices. 

3. Recognize hard work in all its forms

Caregivers need their efforts acknowledged at both the staff and leadership levels. Recognition can take many forms but should start with understanding your workforce. Employee engagement surveys can shed light on what workers consider meaningful recognition. While awards and sharing of accomplishments are valued by some, others may consider ongoing perks like their favorite snacks or a weekly massage in the break room a better alternative. Consider forming a rewards and recognition committee to evaluate what best suits your organization, and how to show appreciation for caregivers on the front lines and in supporting roles. A few tactics that hospitals are using include: 

  • Incentivized submission programs for peer recognition 

  • Hospital-wide sharing of recorded testimonials from leaders 

  • Web page of community thanks 

  • Signage/words of encouragement from patients 

  • Thank-you videos submitted through social media 

  • Handwritten thank-you notes sent to employees’ homes 

4. Build trust by listening to caregivers and acting quickly on their concerns

Organizations must continually invest in building and re-earning the trust of their caregiving teams to reinforce their commitment to their well-being and to the overall mission. This starts with leaders being visible and accessible by routinely rounding on teams and units and seeking input via multiple channels to understand the specific challenges facing managers and the workforce. These include: 

  • Daily safety check-ins and tiered huddles, where everyone has a voice in raising safety and staffing problems as well as problem-solving 

  • Confidential employee surveys, so that all members have an opportunity to have their voices heard and not fear retribution. A regular cadence is key, with pulse surveying an especially effective tool for gathering input on common pain points and potential solutions. 

  • Focus groups, where those who are less comfortable in large groups can express their opinions and their colleagues’ opinions 

  • Town halls, which allow for employee participation in agenda formation and ample time for questions, creating a forum for the sharing of truly meaningful information 

The pandemic has taught us, as healthcare leaders, that we can implement rapid change without the usual months of planning. As you listen to your caregivers, it’s equally important that you respond to their concerns in a bold, meaningful, and timely way. You can start by incorporating innovative solutions from other organizations. Our Workforce Well-Being Collaborative brings new ideas and solutions to the forefront. Many hospitals and health systems are using data to inform creative and innovative problem-solving. It’s important to remember, however, that each situation and set of circumstances is unique, so you need to segment your data and perform comprehensive analytics to prioritize interventions.

Addressing the caregiver crisis is a full-team effort. Recovery begins only when all voices are accounted for, communication is open and transparent, and workers feel confident and appreciated in their roles. Press Ganey’s employee engagement surveys, pulse surveys, and flight risk analytics can help you get the data you need to overcome the crisis. We can also help you take action by gathering meaningful insights and quickly developing action plans.

About the author

As Chief Nursing Officer, Jeff leads Press Ganey’s focus on improving patient and caregiver experience and developing nursing leadership at healthcare organizations nationwide. He also plays an integral role in the company’s workforce initiatives, including Press Ganey’s Workforce Well-Being Collaborative, which focuses on supporting caregivers as they deal with the ongoing challenges of the pandemic. Prior to joining Press Ganey, Jeff served in various chief nursing officer roles at both community-based organizations and major academic medical centers throughout the US. In addition, he was the inaugural Vice President of the Magnet Recognition and Pathway to Excellence programs at the American Nurses Credentialing Center.

Profile Photo of Dr. Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN