National Plan for Health Workforce Well-Being (2022)

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6 Priority Area: Institutionalize Well-Being as a Long-Term Value Ensure COVID-19 recovery efforts address the toll on health worker well-being now and in the future, and bolster the public health and health care systems for future emergencies. “I felt forgotten about by upper-level hospital management, family, friends, neighbors, etc. This affected my personal mental health because I felt like I was fighting this invisible war every day, watching people die all the time, dealing with a very sick patient whose family doesn't believe COVID is real.” - Frontline Health Worker1 Health care teams and public health workers experienced ex- traordinary fear, fatigue, isolation, and moral distress and injury during COVID-19, and recommendations for resilience often place the onus on the individual rather than the system. The nation must acknowledge that the health workforce will require recovery from the trauma of the pandemic, and that stress and distress are long- term issues that must be addressed with longitudinal, long-term solutions. In addition, the health care delivery system will face oth- er challenges after the pandemic, including the demand for delayed and deferred care for non-COVID-19 patients, as well as emerging long-term side effects of COVID-19 for patients and health work- ers. The public health response to the pandemic may continue for 1 For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/ clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/. 51 

52 | National Plan for Health Workforce Well-Being years via surveillance programs, contact tracing, and other moni- toring and evaluation efforts. Understanding that burnout among health workers was a sig- nificant challenge prior to COVID-19, and the extent of the trau- matic stress and injury from this period is yet to be determined, it is essential that well-being is institutionalized as a key priority at all levels of the health system. Furthermore, policies and proto- cols should reflect the dynamic nature of responses and prioritize health worker well-being. At the organizational level, leaders and health workers need to understand that health worker well-being is essential for safe, high-quality patient care. Leaders should use a systems approach for appropriate work system redesign and implementation, and health workers must be equipped with the required commitment, infrastructure, resources, accountability frameworks, and culture that supports well-being. As seen during the pandemic, an underfunded public health sys- tem, including federal agencies and local, regional, and state health departments, has negative implications for the health of people across the country (Farberman et al., 2020). It is important that public health and health care systems guard against “active forget- ting,” emphasize lessons learned from the pandemic, and address emerging questions on how the nation might prepare for the next pandemic or national emergency. Investing in infrastructure and institutionalizing well-being as a value are long-term approaches to growing a culture that provides the health workforce with the necessary supports to recover from the trauma of serving during the pandemic, and to bolstering a system committed to supporting well-being for the long-term. PREPUBLICATION COPY - Uncorrected Proofs 

Institutionalize Well-Being as a Long-Term Value | 53 Priority Area: Institutionalize well-being as a long-term value. Health worker and learner well-being are prioritized, Goal 1 reflected in, and operationalized in strategic plans and core values. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Actors Health Systems Health Workers Insurers and Payers 1A. Define the organization’s ideal future state, guided by a culture that institutionalizes well-being as a core value. 1B. Communicate that health worker well-being is essential for safe, high-quality patient care. 1C. Commit to infrastructure, resources, accountability, and a culture that supports well-being. 1D. Ensure a systems approach for appropriate work system redesign and implementation. Actions 1E. Provide training for health workers and learners that offers interactive, engaging formats that build communication and collaboration and goes beyond mandatory e-learning. 1F. Provide coverage and compensation for direct care workers to engage in meetings and other decision-making forums. 1G. Develop hybrid work policies to enable health workers to complete their work from home. 1H. Plan for sufficient reserves of personal protective equipment (PPE) and other resources in preparation for future emergencies. PREPUBLICATION COPY - Uncorrected Proofs 

54 | National Plan for Health Workforce Well-Being The effects of COVID-19 on the well-being of the Goal 2 health workforce are addressed. Federal, State, and Local Governments Health Systems Health Workers Actors Insurers and Payers Private and Non-Profit Organizations Professional and Specialty Societies 2A. Appropriate funds for the National Health Workforce commission (authorized as part of the Affordable Care Act) to gather real-time workforce data. 2B. Secure long-term funding to treat and support those who experience acute physical and mental stress and long-term effects from providing care in response to COVID-19. 2C. Facilitate adequate time off and provide mental health resources without stigma or punishment. 2D. Establish a national platform or network that can rapidly share, implement, and test models or solutions for transi- tioning from acute COVID-19 care to institutionalizing long- Actions term well-being. 2E. Streamline the discharge planning Condition of Par- ticipation (focusing on the most pertinent information to discharge patients to post-acute facilities), in recognition of health workforce shortages and administrative flexibilities allowed during COVID-19. 2F. Grant relief on timeframes related to pre- and post-ad- mission patient assessments and evaluation criteria-both to ensure patients are treated in a timely manner and to allow health care settings and health workers to better manage an influx of non-COVID-19 patients returning for care, in rec- ognition of health workforce shortages and administrative flexibilities allowed during COVID-19. PREPUBLICATION COPY - Uncorrected Proofs 

Institutionalize Well-Being as a Long-Term Value | 55 A strong and coordinated national public health Goal 3 infrastructure has a thriving public health workforce. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Actors Federal, State, and Local Governments Health Systems 3A. Invest in cross-cutting foundational public health capa- bilities, including threats assessment and monitoring, all- hazards preparedness, public communication and education, community partnership development, and program man- agement and leadership. 3B. Re-invest in the public health workforce through training and education opportunities. 3C. Modernize surveillance and data systems. 3D. Provide full-year funding for federal agencies that is not Actions disease-specific. 3E. Increase investment in the U.S. Department of Health and Human Services (HHS) Prevention and Public Health Fund (authorized as part of the Affordable Care Act). 3F. Increase funding for the Centers for Disease Control and Prevention (CDC) community health emergency prepared- ness programs. 3G. Use available data and science to inform decisions, pri- orities, and policies. NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being. PREPUBLICATION COPY - Uncorrected Proofs 

56 | National Plan for Health Workforce Well-Being RELATED RESOURCES2 1 Cultivate a Culture of Connection and Support • Guide: Conversation and Action Guide to Support Staff Well- Being and Joy in Work during and After the COVID-19 Pan- demic (Institute for Healthcare Improvement) • Guide: Well-Being Playbook 2.0: A COVID-19 Resource for Hospital and Health System Leaders (American Hospital As- sociation) • Guide: Building Bridges Between Practicing Physicians and Administrators (American Medical Association) • Organizational Best Practices: At the Heart of the Pandemic: Nursing Peer Support (Godfrey et al., 2020) • Organizational Graphic: Psychological PPE: Promote Health Care Workforce Mental Health and Well-Being (Institute for Healthcare Improvement) • Overview of COVID-19 Resources by Roles: COVID-19: Stress and Coping Resources (American Hospital Association) Advance Organizational Commitment • Guide: A Guide to Promoting Health Care Workforce Well-Be- ing During and After the Pandemic (Institute for Healthcare Improvement) • Guide: Creating the Organizational Foundation for Joy in Medicine (American Medical Association) • Guide: Wellness with COVID: Contagious Strategies to Pro- mote Pharmacy Well-Being (American Society of Health- System Pharmacists) • Brief: Call to Action: Improving Clinician Well-Being and Pa- tient Care and Safety (Ohio State University College of Nurs- ing/Health Policy Institute of Ohio) • Discussion Paper/Guide: Healing the Professional Culture of Medicine (Shanafelt et al., 2019) • Fact Sheet: Prevention and Public Health Fund Fact Sheet (American Public Health Association) 2 For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/. PREPUBLICATION COPY - Uncorrected Proofs 

Institutionalize Well-Being as a Long-Term Value | 57 Strengthen Leadership Behaviors • Compilation: Leading Through Crisis: A Resource Compen- dium for Nurse Leaders (American Organization for Nursing Leadership) • Guide: Well-Being Playbook: A Guide for Hospital and Health System Leaders (American Hospital Association) • Guide: Appreciative Inquiry Principles: Ask “What Went Well” to Foster Positive Organizational Culture (American Medical Association) • Guide: Cultivating Leadership: Measure and Assess Leader Behaviors to Improve Professional Well-Being (American Medical Association) • Strategies: Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout (Shanafelt and Noseworthy, 2017) • Discussion Paper: A Call to Action: Align Well-Being and An- tiracism Strategies (Barrett et al., 2021) • Guide: Grief Leadership: Leadership in the Wake of Tragedy (Uniformed Services University) PREPUBLICATION COPY - Uncorrected Proofs