Managing Healthcare Workers During the COVID-19 Pandemic and Beyond

INTRODUCTION

Healthcare workers are on the frontline to confront a medical crisis, especially when the nature of the crisis is strongly related to total societal well-being. They put themselves in the line of duty and spare no efforts to save lives and minimize human suffering. The coronavirus disease (COVID-19) pandemic is the perfect example of the dedication shown by healthcare professionals and their sacrifices to help others at such a critical time. Although healthcare workers are exposed to many job-related risks under normal circumstances, these risks are more prominent during a medical crisis. These risks include infections, exhaustion, mental and physical health, and social and family pressures. However, the two main risks of major concern during a pandemic are the exposure to infection and mental health.[1–3] Studying these concerns and potential solutions to prevent or alleviate them has been a subject of interest to many investigators[4,5]; however, there is no comprehensive plan to address the issues in totality. Such a plan should guide healthcare workers and management on how to manage services during a medical crisis while keeping in mind the well-being of staff as well as the quality and safety of patients receiving healthcare services.

HOW TO MANAGE HEALTHCARE STAFF DURING A CRISIS

The healthcare staff management plan should have a dual aim: the first is to protect the staff physically and mentally, and the second is to enable them to do their job well. This dual aim can be achieved by answering three specific questions. Each question drills down with further questioning to identify the specific components of each intervention. The Table summarizes actions that can be taken to address these questions and can be used as a checklist. The questions that need to be asked are as follows:

Table.

Healthcare workers management options

Category	Actions
Protecting staff from risk
Staff screening	All staff should be screened regularly for symptoms and/or exposure and act accordingly.
Staff education	Train staff on cardinal symptoms, disease transmission, infection prevention, and control including personal protective equipment donning and doffing.
Staff protection	Fit staff for N95 mask with instruction on when to use. Have enough supplies and equipment, such as masks, gloves, gowns, and respirators. Apply strict rules to eliminate unnecessary visitors to hospitals or clinics. Apply traffic control bundles[2] (designate zones based on infection status such as confirmed infection, suspected cases, and clean cases), with strict rules for patient and staff flow to prevent transmission. Safe working space structure: drive-through screening for patients. Release and/or allow immunocompromised and susceptible employees to work remotely. Establish a clear policy of safe return to work.
Social distancing	Work from home as much as possible. Apply six-feet rule. Avoid crowding in certain areas (e.g., cafeterias). Switch to virtual meetings using a Web-based meeting platform.
Staff clustering	Minimize number of staff working. Minimal or no overlapping in duties that require physical presence in same area or dealing with same patients. Same minimal team members see the same patients.
Enabling staff to do their job well
Communication	Clear transparent communication with frequent updates on the status of the disease and expectations of staff behavior. Avoid flooding staff with too much information at one time. Have a central link or Web site that employees can access to get timely updates at times most convenient for them. Have clear Web sites with required resources.
Essential requirements	Ensure adequate stock levels of essential materials, equipment, and medications.
Staff shortage	Cancel all nonemergency leave in the early phase of crisis, then ration leaves according to the situation. People off duty remain on standby. Minimize nonclinical meetings. Use virtual technology for meetings. Seek external staffing from less affected areas.
Adaptation of roles	Work from home, if feasible. Use virtual technology for care and communications. Adjust care model to provide more care outside the healthcare facility. Incorporate infection control measures into work process.
Supporting staff to maintain their well-being
Adherence to infection prevention and control practice	Establish a policy related to the safe return to work. Vaccination (flu vaccination). Hand hygiene. Personal protective equipment (PPE). Same intervention in first category which all aim to protect staff from getting exposed to infections.
Staff well-being	Provide emotional support by: Support hotline Online support In-person support •Raise self-awareness through education and teamwork.
Acknowledgment	Recognition and appreciation from leaders to staff. Listen to staff and keep them involved. Ensure a no-blame culture to reduce feelings of guilt from any staff who have been infected or unable to work due to pregnancy or being immunocompromised.

1. Are staff protected from the risks posed by the crisis?

   To answer this question, we must answer the following questions:

   • Are healthcare workers equipped with reliable up-to-date knowledge pertaining to the disease, routes of transmission, and how to protect themselves?

   • Do they have the personal protective equipment (PPE) they require?

   • Are strict precautions implemented and enforced to prevent their exposure to the risk?

   It is important to prioritize the protection of the healthcare workers by providing the appropriate PPE to ensure they are not exposed to infection themselves or transmit the disease to patients, other healthcare workers, or even their own family members.

   Healthcare workers should self-screen and expect to be actively screened by other staff upon entry to work. Any healthcare worker suspected of having contracted the infection should be quarantined by the set guidelines. Healthcare workers should have adequate training to use PPE properly and implement all infection control recommendations including social distancing, traffic control, clustering, and any other evidence-based rules.[5]

2. Are staff able to do the best job possible?

   The meaning of this question is as follows:

   • Do they have a clear planned approach as to what is expected of them?

   • Is there a clear communication plan to keep everyone updated on the situation?

   • Do they have all the resources (equipment, medications, and materials) to manage their patients?

   One of the golden rules of crisis management is to provide transparent timely communications to update staff on the situation, set expectations, and share the vision and strategy on how to contain the crisis.

   The second rule is to make sure that staff have what is needed to provide the best care to their patients. One concern during a crisis is critical staff shortage; because the workload has sharply increased, the staff has been reduced by illness or quarantine, or both. Plans to prevent or minimize staff shortage should be implemented proactively, including canceling nonemergency leaves, adapting the roles, working remotely, and workload rebalancing, thereby enabling the work to be covered by a fewer number of staff with specific priorities.

3. Are staff supported to maintain their own well-being?

   • Is there an effective mental health support program for healthcare workers?

   • Are there mechanisms to help the healthcare workers overcome the challenges they are facing?

   Emotional disturbances are prevalent in major crisis situations, and serious steps should be taken to prevent, minimize, and manage them effectively. These interventions should be proactive, feasible, reliable, and consistent. These interventions should incorporate innovative ideas to face the new emerging challenges.

   To address the issue of protecting healthcare workers' mental health, proactive preventive measures such as early recognition, easy access to help, early intervention, and maintenance support should be available to all staff. In the Chinese experience, a set of proactive interventions consisted of the establishment of a psychological intervention medical team to provide online courses to guide medical staff on how to deal with common psychological problems, offer a psychological assistance hotline team, and offer practical psychological interventions, such as various group activities to release stress. Staff reluctance to seek help was a major obstacle when it came to the proper utilization of these services. It is critical for these interventions to be timely, feasible, and easy to access; this is why online support and a telephone hotline are good choices to provide convenient support to the healthcare workers.[5,6]

Funding Statement

Source of Support: None.