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Digest 3 - Strategies to support HCWs and frontline managers during COVID-19
Written by Ermin Erasmus on 21 April 2020 .
Strategies to support health care workers and frontline managers during the COVID-19 pandemic –
Digest 3
We conducted a very rapid scan of websites and some academic literature to answer the question, 'what key lessons can we learn about how best to support frontline health workers and managers during the COVID-19 pandemic'? We draw from early experiences in other countries and from experiences with other epidemics (such as Ebola, SARS, etc).
The literature we found consistently emphasises that the high degree of uncertainty and need to find rapid solutions in constantly changing conditions requires openness, compassionate leadership and attention to attenuating the enormous strains health care workers and managers already find themselves under. These will increasingly get worse, and will potentially include stigma and (self-) isolation:
"…… they cope with the societal shifts and emotional stressors faced by all people, health care professionals face greater risk of exposure, extreme workloads, moral dilemmas, and a rapidly evolving practice environment that differs greatly from what they are familiar with"(Shanafelt et al., 2020).
The literature is fairly unanimous that key themes to pay attention to are:
Adequate equipment (PPE etc) and training (including on prioritization and triaging)
Care and self-care, psycho-social support
Frequent and full communication.
We found six documents from India, the US and the UK particularly succinct and helpful, and are sharing these here:
Shanafelt, T., Ripp, J., & Trockel, M. (2020). Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. Jama, 2019, 2019–2020. https://doi.org/10.1001/jama.2020.5893
This 2-page viewpoint piece reports on results from "listening sessions" held with a variety of healthcare providers in the US in the early weeks of the pandemic, asking: what healthcare workers were most concerned about; what messages and behaviors they needed from their leaders; and what sources of support they believed would be most helpful to them. The results are summarised in a table, with 5 key requests: "hear me, protect me, prepare me, support me, care for me".
The George Institute in India conducted a rapid evidence review on "the roles, issues, barriers and enablers for frontline health workers (FLHWs) in the prevention and control of COVID-19" – focusing on community health workers and similar cadres rather than nurses and other professional cadres. They provide 5 key policy considerations in a one-page summary, as well as a list of recommendations, downloadable from the same website. URL: https://www.georgeinstitute.org.in/frontline-health-workers-in-covid-19-prevention-and-control-rapid-evidence-synthesis.
The Kings Fund in the UK has a number of blogs, short videos and documents focusing on leadership during the COVID-19 pandemic (https://www.kingsfund.org.uk/topics/covid-19). We found three of these particularly useful:
A blog by Suzie Bailey and Martin West, entitled COVID-19: why compassionate leadership matters in a crisis (https://www.kingsfund.org.uk/blog/2020/03/covid-19-crisis-compassionate-leadership)
A two-page Guidance for planners of the psychosocial response to stress experienced by hospital staff associated with COVID: Early Interventions, compiled by a COVID Trauma Response Working Group, comprising of psychological trauma specialists from the NHS: https://www.kingsfund.org.uk/audio-video/stress-hospital-staff-covid-19
A linked diagram summarising and illustrating do's and don'ts of Responding to stress experienced by hospital staff working with Covid-19: guidance for planning early interventions: https://www.kingsfund.org.uk/audio-video/stress-hospital-staff-covid-19
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