Dr Judith Ancer: Strategies for Leaders and Health Care Workers for optimal coping during the pandemic (Webinar 1) Dr Thriya Ramasar: Leader and HCW Self-Care/ Stress Management (Webinar 2)

Below is a consolidation of the key notes from both Dr Ancer and Dr Ramasar’s presentations on the role of leaders during the pandemic.

What happens to teams during Pandemics/ crises?

Internationally, hospital leaders reported that in Covid-19 treatment facilities and ICU’s as admissions start increasing, team hierarchies get flattened, shifts change, increased staff absences become a reality and its “all hands on deck”, so traditional roles can get diffused.

We see increased levels of stress and burnout and old conflicts between staff may flare-up and new ones emerge. This is why it’s imperative that teams are able to work together in collaborative and supportive ways and why effective leadership is essential.

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There is also strong evidence to show that psychologically savvy team leaders play a critical role in supporting the health of their team members (Greenberg, 2020). The right team ethos allows members to function even in the most difficult of circumstances. Leaders also play a vital role in reducing stigma and promoting help seeking behaviours.

“The underlying principle, based on substantial evidence, is that supportive managers foster better mental health. Proactive, evidence-based team leadership can minimize risk of mental illness and maximize opportunities for psychological growth in the wake of trauma.” (Lancet Psychiatry May 2020 https://www.thelancet.com/action/showPdf?pii=S22150366%2820%2930224-8)

For every phase of the mental health wave, there are four key principles for an effective leader response.

The key principles are:

#1 Visible and Authentic Leadership

Be their calm centre in the storm: People look to leaders to be calm and deliberate in their decisions and actions, especially in times of crisis. Leaders who react to crisis in highly emotional ways can add to people’s stress and anxiety. However, the answer is not in hiding your feelings from others; that negates the earlier point about authenticity. The answer lies in slowing down, taking stock of your anxiety and stress and understanding what is causing an emotional reaction. Identify tools to help you truly manage your emotions so that you can provide leadership that is authentically calm and in control. And when you make a mistake, admit it, talk about it and use it as a learning opportunity that will give others the psychological safety to also be candid about their mistakes and emotions.

Be visible: Ensure you are visible – actually on the floor with them. Be available and demonstrate your support.

Be real: Employees need to face that this is a time of loss. There will be deaths; the systems and protocols are imperfect and there will be flaws and problems. This will inevitably lead to failures and frustrations and a sense of moral injury. Anticipating and naming this can reduce the negative impact.

Be vulnerable: We shouldn’t be afraid to show our vulnerability. It helps create connection and trust.

#2 Honest, Clear and Consistent Communication

Employees want to feel heard and they want to feel that they are being taken seriously. Make time to listen (and learn).

·  Set up regular meetings and direct communication channels (eg. dedicated team or unit WhatsApp groups).

·  Communicate clear, concise information in ways that staff can assimilate. Focus on the facts, beware of information overload. Express your opinion in simple ways and check if the other person understood correctly. Share your frustrations and reflect together on solutions. Searching for solutions together is more helpful than focusing on problems only.

·  Clarify treatment protocols and institutional plans with staff as they are communicated to you.

·   Actively listen and demonstrate empathy: Ask “How can I help?”

· Adopt a balanced and fact-based tone when communicating

·  Clarify what your team knows and that they are accessing accurate information and not fake news and rumours

Don’t underestimate the value of spending time with your team -“Time spent in meetings with your team show a 35% improvement in productivity in studies and overall improves the wellbeing of team members.”

#3 Promote Employee Wellbeing

As a leader, it is important that you act as container for anxiety, striving for compassionate, capable calm and modelling appropriate self-care.

Share your own tips for coping with stress and anxiety.

Acknowledge and normalise their feelings: it is appropriate, and not in any way unprofessional, to have fears of getting infected or transmitting the virus to families. Common symptoms can be mistaken for COVID-19 symptoms.

Talking about these worries in contained ways can reduce levels of panic or despair and create an invaluable sense of shared humanity.

Show appreciation by giving regular praise for their hard work and sacrifices. In fact, proper, personalised thanks by someone senior acknowledging the specific challenging work undertaken by an employee is one of the four key elements identified for recovery post-COVID.

Check in with them regularly to see if anyone is struggling. Pay particular attention to any employee that may be experiencing difficulties in their personal life, has a history of poor mental health or who lacks social support. Ask them how they are doing and what they need to feel better. Facilitate access to, and ensure staff are aware of where they can access mental health and psychosocial support services. 

When they return to work after being ill, a discussion about their mental health with a psychologically savvy supervisor, is the second key element identified. Ask “What can I do to get you back to work in a safe manner?” Find out about their direct and secondary stressors – secondary stressors impact on the risk of getting PTSD.

#4 Build Team Cohesion

·  Build cohesion through effective vertical (leadership) and horizontal (camaraderie) communication 

·  Encourage employees to acknowledge each other’s efforts

· Help staff remember the WHY of the job and honour the work.

·  Make an effort to notice and highlight staff efforts and be generous with compliments.

·  As the pandemic progresses also share stories of help and hope

· End of shift wellbeing huddles – not to psychologically debrief but to help employees make the emotional transition between work and home.

· Set up support structures – consider a “buddy system”. Pair up experienced employees, with good coping skills, with inexperienced employees or invite employees to identify someone on the team to take care of and support. Another set of eyes is helpful

Specific principles have been identified for responding after the crisis:

Resilience in the most likely outcome. However, we still need to remember that some HWCs will struggle.

The risk factors that have been identified as “strongly predictive of longer-term mental health outcomes” (Greenberg, et al, Lancet 2000) are:

1.     Post-trauma social support

2.     Stressors experienced during recovery (direct or indirect)

Greenberg et al provide specific elements for responding to HCW mental health post the Covid-19 peak:

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1.     Appreciate them by giving them appropriate thanks

A proper, personalised thank-you (written and verbal) by someone senior acknowledging the specific challenging work employees have faced. Consider letters to families too. This can develop individual resilience.

2.     Support them when they return to work

Interviews conducted by “psychologically-savvy” line managers who feel comfortable speaking about mental health. Find out about employee’s work during the pandemic and the direct and indirect impact on them. This can be an effective tool to create a better understanding of an employee’s experiences and in identifying secondary stressors - secondary stressors impact on the risk of getting PTSD. Ask, “What can I do to get you back to work in a safe manner?” Use the REACT principle:

 

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1.     Keep an eye on them and monitor their wellbeing

Keep an eye on individuals considered at higher risk of development mental health problems. Evidence supports active case-finding. We need to give help early on in order to reduce a worse outcome due to secondary damage – have a low threshold to intervene if no improvement 3 months after the trauma. Anonymous online self-check tools might also encourage honest and meaningful responses and provide useful feedback.

2.     Create space for reflection

These leader-led discussions are helpful in helping employees develop and meaningful narrative that can reduce the risk of harm. The leader sets the scene and makes it psychologically safe for the team members to talk. A meaningful narrative develops. There will be sorrow, but this at least does not equate to mental illness. The evidence-based Schwartz rounds is a useful approach

References: Dr Ancer

Harrison, J., Sharpley, J., & Greenberg, N. (2008). The management of post traumatic stress reactions in the military. Journal of the Royal Army Medical Corps154(2), 110.

Greenberg, N., & Tracy, D. (2020). What healthcare leaders need to do to protect the psychological well-being of frontline staff in the COVID-19 pandemic.

Tedeschi, R. G., & Calhoun, L. (2004). Posttraumatic growth: A new perspective on psychotraumatology. Psychiatric Times21(4), 58-60.

References: Dr Ramasar

Physician Suicide: Overview, Depression in Physicians, Problems with Treating Physician Depression. (2020). Retrieved 10 August 2020, from https://emedicine.medscape.com/article/806779-overview

Cole-King, A. (2020). Optimising staff preparedness, wellbeing, and functioning during the COVID-19 pandemic response [eBook] (1st ed.). Retrieved from https://d29e30c9-ac68-433c-8256-f6f9c1d4a9ec.filesusr.com/ugd/bbd630_48e96c3b5f394de89609c170ad4ec698.pdf

Li, W., Yang, Y., Liu, Z. H., Zhao, Y. J., Zhang, Q., Zhang, L., Cheung, T., & Xiang, Y. T. (2020). Progression of Mental Health Services during the COVID-19 Outbreak in China. International journal of biological sciences16(10), 1732–1738. https://doi.org/10.7150/ijbs.45120

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ, m1211. doi: 10.1136/bmj.m1211

Brooks, S. K., Dunn, R., Amlôt, R., Rubin, G. J., & Greenberg, N. (2018). A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak. Journal of occupational and environmental medicine60(3), 248–257. https://doi.org/10.1097/JOM.0000000000001235

The British Psychological Society. (2020). The psychological needs of healthcare staff as a result of the Coronavirus pandemic [Ebook] (1st ed.). Retrieved from https://www.bps.org.uk/sites/www.bps.org.uk/files/News/News%20-%20Files/Psychological%20needs%20of%20healthcare%20staff.pdf

Greenberg, N.,Brooks, S.,Wessely, S., Tracy, D. (2020). How might the NHS protect the mental health of health-care workers after the COVID-19 crisis? The Lancet Psychiatry,:https://doi.org/10.1016/S2215-0366(20)30224-8