Valerie Neff Newitt
March 2021—A focus on workplace well-being is worthwhile all the time but never more so than now.
“Everyone knows health care worker fatigue is amplified during the pandemic,” says Sarah M. Bean, MD, professor of pathology and pathology medical co-director of the dermatology/pathology clinical research unit, Duke University School of Medicine. “Lab workers may not all be affected equally, but those involved with COVID-19 testing, ensuring there are adequate PPE supplies and supply chain for tests, and securing and validating platforms, are certainly feeling it.”
Luke Perkocha, MD, MBA, a pathologist with the Permanente Medical Group in Northern California and a member of its physician health and wellness committee, says burnout, technically, is not the issue at hand.
“Burnout happens when someone becomes apathetic about their job, career, or life’s mission because of chronic stresses related to the job itself, such as feelings of loss of control, chronic frustration or overwork, or a clash of values with the employer or leadership. But much of the stress we’re seeing today is related to living in our society at this point in time. We are seeing increased depression, unhappiness, and other kinds of social and emotional pathologies. Some may be contributed by the work environment, but a lot originates in the outside world or at home and is brought into the workplace.”
For laboratory leaders, it’s a time to reach out to help their colleagues, in addition to patients. “This can’t be solved only by offering yoga classes, meditation, or soothing music,” Dr. Perkocha says. “People are already busy and overwhelmed. Some may take advantage of and benefit from such things, but many cannot, and they see them only as added demands on their time and attention.”
[dropcap]D[/dropcap]r. Bean is chair of the newly formed well-being committee of Duke’s Department of Pathology. “The stakes are really high,” she says. “When well-being is suboptimal, we see increased medical errors and decreased productivity and effort. We see turnover in staffing. And that’s just on the professional side. On the personal side, individuals are at risk for having broken relationships, alcohol and substance abuse, depression, and suicide.
“The most important thing we can do,” she continues, “is ensure that individuals, as well as departments, divisions, practices, or whatever your work unit might be, have healthy behaviors in place to fall back on in times of stress. Leaders who don’t recognize that need a wake-up call.”
To get the well-being committee rolling last October, Dr. Bean asked for volunteers from the Department of Pathology to join the committee, the mission of which is to provide all members of the pathology department (and the broader Duke community) with tools to nurture a state of happiness and health in their emotional, physical, social, and workplace well-being. “Right now we are putting our greatest emphasis on the workplace aspect,” Dr. Bean says.
The committee’s 15 members are drawn from all corners of the pathology department, ensuring a variety of perspectives. “My goal was to have at least one representative from each of the different work roles within the department,” Dr. Bean explains. “We have the chief administrator, administrative assistants, post-sophomore fellows, med students, residents and fellows, PhD students, students from our pathologist assistant program, various program coordinators and directors, clinical faculty, and research faculty. We want everyone to feel included.”
The committee’s “culture,” she says, is one in which “everyone has a voice, all ideas are welcome, and thinking outside the box—while staying within the reality of budget constraints—is encouraged.” Also important is a spirit of “keeping it fun,” says Dr. Bean, adding that if the committee becomes arduous it may not thrive.
At quarterly meetings (using Zoom during the pandemic), the members plan and implement three well-being interventions per quarter. Progress is discussed at every meeting.
The first intervention for Q1 this year is called “Pawthology Post,” a PDF created with photo and text submissions from pet lovers in the pathology department. “One of the post-sophomore fellows created this venue for people to share their beloved animals,” Dr. Bean says. “Essentially, it is a way to demonstrate our lighter side, have fun, and strengthen the team at the same time.”
The second intervention for the first quarter is the creation of a walking club. “Our administrative assistants were already walking together, so we expanded that idea to the rest of the department,” Dr. Bean says. Two or three walking sessions are offered per week to accommodate different people and different shifts. “The Sarah P. Duke Gardens are a stone’s throw from our department’s back door, so it’s easy for us to walk through the gardens or the undergraduate campus where we can be inspired by art and gothic architecture,” she says.
The third intervention is to conduct a needs assessment. “When working on any project, the first thing I ask is, ‘What does the data show?’ So we will send out a survey to the department. Based on responses, we’ll follow up with focus groups and one-on-one discussions with people who are section heads and various stakeholders who feel they might benefit from interventions from the group. We will try to distill common themes that are easy to implement and not too resource-intensive.”
One idea for Q2 is a departmentwide expression of gratitude of some type, “because gratitude has been shown to have a strong positive effect on both the giver and receiver. It’s something we think our department could use more of,” Dr. Bean says. “For example, in May and June when we have trainees, we hope to launch a ‘Thank a Mentor’ program. We want to come up with a way that expressions of thanks can be publicly displayed within the various units so that people might get an infectious feeling of gratitude.
“That’s the goal,” she says.
[dropcap]N[/dropcap]ow is a good time, Dr. Perkocha says, to go back to the basics of promoting well-being as they’re understood from accumulating research. “This will go a long way to mitigating routine stresses as well as the additional stresses specific to 2020 and 2021,” he says.
“There has been fear for one’s safety, particularly earlier when we knew little about the virus and had insufficient PPE,” he says. “Phlebotomists, in particular, had great concern because they were going in and out of patients’ rooms constantly.” Add to that the fears of spreading disease to family members, losing loved ones, possibly losing financial security, or having to cope with the needs of children suddenly at home, perhaps also with a spouse out of work or working from home.
“And still there’s more,” says Dr. Perkocha, noting the need to develop and learn new protocols at work and the restricted travel and quarantining, which limits the emotional benefit of vacation time taken. He cites, too, the divisive 2020 election and the social media and news cycle, describing it as toxic. “The point is, there is a lot of emotional stress being brought into the workplace. People may appear to have no specific problems, and smile as if everything is okay. But that’s not always the case. Things may not be as happy under the surface, and lab directors and pathologists need to be adequately tuned into that fact.”
With guidance drawn from standards of cognitive behavioral therapy and growing research on wellness, Dr. Perkocha suggests strategies to help leaders and their staffs create an environment conducive to well-being. Primary among them:
- Maintain perspective. “It matters how you frame something,” he says. “It helps to step back and get a perspective on what is unfolding. Is the glass half empty or half full? Right now we could say, ‘Not enough vaccine is available yet and the rollout is too slow.’ Or we could say, ‘It is still a miracle we were able to develop a vaccine—something that normally would take a decade—and get it through the regulatory process in under a year.’”
- Connect with others. “Connect with people in and out of the workplace as much as possible,” he advises. “It is particularly important now because social isolation is one of the hidden damages that the virus, the lockdowns, and distancing have caused.” Even simple acts can be powerful: “I made it a point to write a personal note to every staff member in our anatomic pathology lab on my Christmas cards this year. It was very meaningful to them—I got a number of amazing notes back.”
- Express gratitude. “Research on stress and wellness shows that expressing gratitude to another person provides a double benefit because it helps you as well as the person you direct it to,” Dr. Perkocha says. “In fact, research shows that buying and giving a gift to another has a more sustained well-being benefit for the gift-giver than spending the same amount on themselves.”
- Talk about successes. Positive discourse works in tandem with framing a positive perspective and expressing gratitude. “I try to point out good work and express thanks for it with the clinical lab staff whenever I get the opportunity,” he says. “For example, we have a new PA working here. I made it a point to tell her that her descriptions are amazing, so accurate and with an economy of words. It makes a lot of difference to people to be seen and appreciated.”
- Forgive and empathize. “Practicing forgiveness and believing in redemption means that even when things don’t work out, we should begin with the assumption that everyone is doing the best they can under difficult circumstances,” Dr. Perkocha says. “Perhaps someone didn’t perform exactly as they should have on the job. You have no idea what is going on at their home or what they may be dealing with. Keep that in mind before reacting.”
- Open lines of communication. It’s vital that there is two-way communication, devoid of fear of reprisal, between leaders and staff. Communication with patients can also be stressful, he says. “Within our medical group there is one entire unit that focuses on communication skills for physicians. Pathologists working in institutions with consultants to help them with difficult communication issues should avail themselves of that service.”
- Identify and share resources. Institutional resources are sometimes undervalued or overlooked, so it is important for lab and departmental leaders to explore and share those resources. Dr. Bean points to an outstanding wellness program already in place at Duke, “so we don’t have to reinvent the wheel.” Duke’s Center for Healthcare Safety and Quality provides courses on burnout, resilience, well-being, and teamwork and communications, and it has developed a well-being ambassador program, which Dr. Bean has completed. Nominated for the program by their department or work unit, participants attend a two-day immersion course. “The ambassadors learn about tools, the basics of well-being, burnout, and more, and then take that information and implement some of these things within their unit.”
Kaiser Permanente also provides resources for physicians and staff. They address family and child care, financial needs, personal care, and assistance through crisis—with professional and peer-based programs. “A lab leader can be key in recognizing the need,” and helping a colleague or employee to access the resource, Dr. Perkocha says, “something those in crisis often cannot do on their own.”
[dropcap]W[/dropcap]hile the list of hazards to well-being is long, and made longer by the pandemic, the latter has forced workplace changes that aid well-being for some.
“There are benefits arising from this pandemic period that should be appreciated,” Dr. Perkocha says. “One that is striking is the further emergence of telemedicine. Before the pandemic, resistance was high and it was moving very slowly along the adoption curve. But now the use of telemedicine is pervasive, and that will likely have a long-term positive effect by lowering costs, improving access, and perhaps improving health outcomes.”
Dr. Bean, too, considers better use of technology an unanticipated positive—for example, using Zoom for committee meetings. “The pandemic forced us to implement technology rapidly. Pre-pandemic, there would always be a lot of resistance because it is human nature to avoid change. The pandemic has forced the issue upon us, and we are learning that change is not so bad. We’ve learned it is great to have a virtual meeting option; it has increased participation in the well-being effort.”
Pathologists at Duke have also benefited from expanded uses of the whole slide imaging platform. “The pandemic forced us to expand our use cases; now we are using it more for teaching and tumor boards,” Dr. Bean says. “Then a few of us said, ‘Is there any reason why these can’t be used for Saturday stats as well?’ The answer was no, and we were all thinking, ‘Yay! That just made our well-being scores shoot up.’ It means I no longer have to drive 30 miles to go to the hospital to look at one biopsy on a Saturday morning.”
Dr. Bean says her practice has started loaning out microscopes so pathologists can work from home. “We have come up with a system that allows slide tracking, case tracking, sign-outs, et cetera. We can take care of our patients, use the microscopes at home, then bring slides back and check them in. There are faculty members on lower-volume services doing that, and they find it to be a great benefit. We would never have conceived of this pre-pandemic.”
[dropcap]A[/dropcap]n aware and willing leadership and management team is a must in the drive for well-being, Dr. Bean and Dr. Perkocha say.
“It is up to leadership to create an environment of trust, integrity, and consistency, within which we all can thrive,” says Dr. Perkocha, stressing that staff must feel heard and appreciated.
Dr. Bean says pathologists and other leaders must take definitive steps toward a culture of well-being.
“We must role model well-being. We must walk the walk,” she says. “We must do what we say. We must recognize the importance of wellness, inspire people in our departments to embrace it, and demonstrate to those in our work teams that we care. Our staffs must know we see them and recognize the work they do. We must talk to people, find out what they are passionate about, promote their professional development, and help them reach their goals.
“Only then,” she continues, “can we engage people for input and have moments of humble inquiry where the goal is to learn what is on their minds and how that affects their workplace and their well-being. That’s the foundation of creating a culture of well-being.”
Valerie Neff Newitt is a writer in Audubon, Pa.