Team identification supports health care worker wellness during COVID-19 pandemic

Clinicians and researchers at the Yale Department of Emergency Medicine (DEM) and Yale School of Management tracked frontline health care worker well-being during the first wave of the COVID-19 pandemic and found evidence that identifying as part of a team can reduce stress and burnout. The findings were reported Oct. 28 in the journal BMJ Leader.

The authors wrote that understanding what can help protect the mental health of staff and supporting health care worker wellness is fundamental to ensuring that communities are prepared for further waves of COVID-19. Health care worker burnout already was a critical issue in medicine long before this pandemic, particularly emergency medicine, which has some of the highest rates of burnout. Early reports from countries that experienced COVID-19 surges suggested this would only get worse. "Finding ways to gather frontline worker feedback on pandemic response is important to inform operational changes but also get a pulse on the department," said Arjun Venkatesh, MD, MBA, MHS, associate professor of emergency medicine.

For the study, the clinicians in the emergency department (ED) collaborated with Marissa King, Ph.D., professor of organizational behavior at Yale School of Management. King's team developed short surveys that were sent via text message to ED staff exploring burnout, stress, and operational problems. The survey was sent to all staff, ranging from nurses to physicians to clerks. Surveys were linked to staff schedules, so an individual would only receive a survey every six shifts. Data were shared regularly with the ED COVID-19 task force to help inform changes.

All staff roles were represented, and 76% of staff responded. Staff who reported higher levels of team identification, or feeling part of a team at work, reported lower levels of work stress and burnout despite COVID-19 case volume increasing. These relationships held true in forward-looking analyses. First author Rohit Sangal, MD, a second-year administrative fellow in the DEM, stated, "we found that these relationships held true across a variety of health care workers—whether analyzing responses from nurses, techs, or physicians, we consistently identified the importance of belonging to a team."

King underscored the significance of the findings, "For health care organizations this is an important opportunity. Too often, the burden of reducing stress and burnout is on the workers themselves. Our work shows that organizations have a key role to play. Keeping teams together, promoting a shared sense of mission and purpose, and providing opportunities for everyone on the team to speak up can help health care workers feel as if they are not alone, and reduce stress and burnout."

The authors provide strategies that other departments can use to promote wellness for their staff. Using huddles to connect with staff and communicate supportive messages and align mindsets is one step that is already in effect for the emergency department. Other steps include workload sharing, keeping teams together, and seeking out and raising the voice of the entire health care team to ensure that team members such as techs and environmental service workers who provide essential services in the care of patients are also included in team conversations.