Curbside Consult with Dr. Jayne 5/17/21

Last week, the US Centers for Disease Control and Prevention (CDC) dropped new recommendations covering the need for mask use for individuals who have received COVID-19 vaccinations. To be honest, Thursday was overly busy and I headed out of town on Friday, so I didn’t have time to read the primary source documents before my inbox started blowing up with questions from family and friends as well as updates from businesses I frequent.

As always with the CDC, the devil is in the details, and there were footnotes to the recommendations for educational institutions. Guidance for youth summer camps and activities is still forthcoming. Unfortunately, most people just latched onto the sound bites and it was off to the races.

I spent the weekend alternating sleeping on the ground with canoeing in the rain, which was actually a lot better than it sounds. Floating through the wilderness with one of my besties is always a good time. She’s a nurse who has been run into the ground during the pandemic and definitely needed a break. Even though things are easing, her hospital is chronically understaffed and nurses are being asked to continue to give more and more when their reserves are spent. COVID-19 cases in our area are at an all-time low and her unit is no longer a pandemic overflow unit, but case mix doesn’t really matter when you don’t have enough staff to properly care for patients.

The hospital is offering bonuses for people to pick up extra shifts, but I can’t help but wonder if increasing base pay and adding additional perks would keep people from calling in sick. Creating a dedicated float pool or paying people to be on call are also options, but those cost money up front, so I guess they would rather spend it on the back end and have burned-out staff instead.

It is in this context that most healthcare providers are listening to the CDC recommendations, which were dropped on states with little notice and effectively turned small businesses and community organizations into the vaccination police overnight. The way the recommendations were released stressed the system and did not give frontline providers enough time to digest the science behind them before being hit with loads of patient questions.

Anyone with any change leadership experience knows that consensus and communication are key to effectively managing change, and both were lacking. For healthcare providers who have been exhausted caring for COVID-19 patients over the last few months, an overwhelming sentiment involved the idea that maybe we could have just waited a little bit and given clinical caregivers a break. Would it have been so bad to allow six or eight weeks so that a good chunk of the 12- to 15-year-old crowd could become fully vaccinated? Could we have had just a little more time to recharge before throwing open the floodgates nationwide? Many of us have significant concerns about potential summer spikes and the growing body of information that shows that the long-term impact of COVID-19 is going to be more significant than initially thought.

The bottom line is that very few people seem to care what healthcare providers in the trenches actually think. Frontline clinical staff have become a commodity and there’s a sentiment that we can all be easily replaced even though in reality we can’t. You can’t just replace registered nurses with patient care technicians and expect things to turn out OK. Similarly, letting your seasoned physicians walk away and replacing them less experienced (and often cheaper) resources probably isn’t the best long-term play either. The idea that happy clinicians make for happy patients seems to be lost on most medical administrators these days.

The healthcare IT industry has significant focus on patient satisfaction and patient engagement, but there aren’t a lot of tools out there for care team satisfaction or engagement. There has been plenty of conversation about the usability of EHRs for years, but it’s not just that – it’s all the different systems that we have to engage with on a daily basis.

Take scheduling systems, for example. If it is difficult and annoying for employees to schedule their shifts, does that add to their satisfaction? If the learning management system doesn’t make it easy for you to complete required training, that certainly isn’t a win, either. At my last employed position, I had to use one system to submit my schedule requests and access another system to see how my schedule actually turned out. We had three different systems for employee education – one true learning management system, one intranet site, and then random text messages distributing critical information. It made it difficult to feel like you were in command of all the information.

Our EHR was a poorly configured version of a product that I know can do better, but that had been tweaked to support our particular (or peculiar, depending on how you look at it) workflows and policies. The CPOE for in-facility medications was beyond clicky and borderline unsafe, but we were expected to just deal with it. Our PACS went down on a daily basis because it wasn’t fit for purpose given the exponential growth of the organization, but no plans were made to replace it. When concerns were surfaced, we were essentially told to just deal with it, because replacing either would be too much of a hassle “and would distract us from our patient care mission.” We were also told that they couldn’t afford to upgrade the systems, but eventually organizations reach a point where they can’t afford not to upgrade the systems. I see these same concepts played out at organizations across the US, so I know it wasn’t unique to our situation.

Knowing how burned out everyone is from the pandemic, I can’t imagine what healthcare organization employees are going through when their employer is hit by a ransomware attack. It’s hard enough to care for patients today as it is without that added stressor. We’re all suffering from compassion fatigue and have little tolerance for things that make our lives harder. Many of us are also experiencing significant moral injury from having to make ridiculous decisions that shouldn’t happen in a large, industrialized nation in the 21st century. But that’s where things have landed, and at many organizations, we are told that we should be grateful to have a job.

I’m not sure what the answer is, but I think we need a greater dialogue around how healthcare organizations care for their employees. We need more exposure to the public about what the staffing pool looks like, and the potential negative impacts on care when the caregivers are still suffering. And maybe we need some fancy new technology to put the sexy back in employee satisfaction.

Got any ideas on how to rejuvenate the healthcare workforce? Leave a comment or email me.

Email Dr. Jayne.