How teams can help prevent stress and burnout among healthcare workers

In the early days of the COVID-19 pandemic, an emergency room doctor and three Yale SOM experts in organizational behavior launched a study to look for ways to protect the well-being of overwhelmed healthcare workers. They found that feeling like part of a team reduced reported stress and burnout—an insight with implications for how any kind of organization can weather a crisis.

During the COVID-19 pandemic, healthcare workers have been subjected to an extraordinary level of sustained stress. A Yale study conducted at the height of the pandemic identified one factor that can help ease stress and the longer-term burnout that can result: a strong sense of identification with a team.

The study began, like much COVID-era research, as an effort to grapple with a pressing problem: the well-being of technicians, doctors, nurses, and other healthcare workers facing a crisis with no end in sight. In the first weeks of the pandemic, Dr. Rohit Sangal, an emergency department doctor and a member of Yale SOM's MBA for Executives Class of 2021, contacted three of his professors: Amy Wrzesniewski, Julia DiBenigno, and Marissa King, who are experts in organizational behavior.

"When the pandemic was first declared, we had so many unknowns about COVID," Sangal says. "It became very clear that uncertainty was going to be a stressor on staff. I reached out to Marissa, Julia, and Amy and they helped put together a framework of how we could go about studying this, getting real-time feedback to optimize our operations to help support staff."

Sangal, Wrzesniewski, DiBenigno, and King assembled a larger team including Yale SOM doctoral students Alexandra Bray, Elisabeth Yang, and Eunice Eun as well as Eleanor Reid, Andrew Ulrich, Arjun Venkatesh, and Beth Liebhardt of the Yale School of Medicine. Based on previous research, the researchers hypothesized that workers who felt that they were part of a team might be more resilient during a crisis like COVID. Over two months from April to June 2020, they surveyed emergency department workers in a large health system, sending regular text messages asking about their levels of stress, their level of team identification, and, later in the process, about burnout.

They found that respondents who agreed more with the statement "I feel part of a team where I work" reported lower levels of stress and burnout. For lower-status workers, including nurses, residents, and technicians, team identification provided even stronger protection against burnout. One nurse wrote, "Look[ing] around, everyone is overwhelmed, exhausted, and stressed. With that said, I have never felt more like a team…everyone has really stepped up and is working together better."

For Wrzesniewski, an expert in how people experience work, the results were not surprising, but it was "really meaningful that something as seemingly simple as the degree to which you feel like you're a part of the team, that you're a member of something bigger than just your own role, ended up being highly impactful of people's experiences of this time."

The results are also heartening, she added, in that they give healthcare organizations a path for helping to protect their workers. "It points to a lot of things that organizations can do to try to feed a sense of belonging to a team or being part of something bigger, particularly given that it helps to shield people from some of the negative effects of an event like this."

The authors write that healthcare organizations will benefit from taking concrete action to bolster team identification—for example, gathering team members for a huddle at the beginning of each shift to create a shared understanding of the situation. In addition, they suggest, organizations should promote a sense of inclusivity on teams, by asking lower-status or new team members for input. They may also need to adjust their staffing practices to help keep teams more stable during a crisis.

"One of our recommendations was around the extent to which leaders can keep teams intact so that people can develop that familiarity and comfort working with one another, to go through a journey together supporting one another," says DiBenigno. "People who are assigned to one another as buddies, to be checking in on one another's mental health—things like that can create a sense of cohesion and identification with the people that you're working with."

A larger takeaway, says King, is that making mental-health resources available to individual workers isn't a sufficient response to a crisis like COVID. Mental health needs to be addressed on the organizational level as well.

"If you think about what it means to weather a crisis and how people think about stress and burnout," she says, "far too often the responsibility is put with the individual. While it's certainly helpful to have meditation, it's helpful to have counseling, one of the things that we wanted to highlight in our work is that there are many important things that organizations can do that don't necessarily rely on asking more of the individual."