Leadership Challenges in Maintaining Staff Engagement and Motivation During Covid-19

This article is the second of the IHF Young Executive Leaders’ subgroup, working on Leadership issues in times of Covid-19. Since the working group members bring in professional experience in hospital management, healthcare leadership and nursing management, they quickly defined the most urgent issues that they, as leaders, wanted to work on, using their different perspectives and personal experiences. They will discuss what makes a good leader in a special situation such as this pandemic, and what – people-centered – actions have proven to be effective and indispensable to keep a hospital going. Which are the challenges and lessons learned for hospital leaders? What to focus on and what precautions and changes in leadership should be taken for/in the future? To keep responding to these questions, this second article explores how to Maintain Staff Engagement and Motivation in times of Covid-19.

Authors: Alhammadi, S. (UAE), Bartolo, A.M. (Portugal), Braga, V. (Portugal), Castela, E. (Portugal), Lahuerta-Valls, L. (Spain), Obwaka, Ch. (Kenya), Rodriguez, O. (Spain), Trummer, F. (Austria), Ulrich, K. (Germany), Edited by Bogues, R. (UK)

 

 

Introduction

The 21st century has already seen many severe pandemics including Ebola, SARS, MERS, H1N1 and most recently COVID-19. All of them have challenged healthcare workers as they never thought before, as well as required constant adaptations through this hard time around the world. For those who are at the frontline of healthcare services, taking care of patients and – at the same time – fighting the spread of the virus is accompanied by a toll on healthcare workers’ physical, mental and psychological health. Long and exhausting working hours in layers of Personal Protective Equipment (PPE) with very few breaks, significant mental stress and anxiety and little social contact for weeks – this is the reality for millions of healthcare workers in pandemic times. Therefore, in this special situation of extreme stress and physical strain, a state of demoralization or burnout is inevitable without sufficient support as they need by their superiors and leaders.

Moreover, in some regions of the world, doctors and nurses had and still have to work under very resource-limited circumstances and they have been exposed to deadly infections including SARS-CoV-2. Many healthcare workers lost their lives or members of their families as a result of hospital acquired infections – not because they were careless, but because those who were meant to ensure their safety failed. This is absolutely not acceptable.

In this article, we will discuss the responsibility of leaders in hospitals for taking care of the employees and will highlight some helpful and some mandatory actions to maintain staff engagement and motivation during the COVID-19 crisis. Our experiences reflect different impacts of COVID-19 in each of our countries and hospitals, different types of hospitals (public and private), as well as different roles in our organizations. Our conclusions summarize the “best practices” from our experiences as leaders in various hospitals.

Leadership Challenges

First and foremost, leaders have to protect and take care of their staff. Leaders are responsible to create a workplace for every employee that offers physical and mental safety at all times.  If leaders don’t look after their teams and respond to their needs, staff motivation and engagement will quickly get lost and the drop-out-numbers (e.g. sick leaves) will rise. So, how do leaders maintain and encourage motivation and engagement in special times such as during the COVID-19 pandemic?

Since COVID-19 started to spread around the globe, even before science could find out how exactly this virus worked, within only a few weeks in some countries, there were vastly more patients than the regional healthcare system could absorb. Some regions of the world (e.g. Italy, Spain, …) rapidly ran out of hospital beds. Additionally, the healthcare staff soon was getting ill too.

A variety of factors such as the (predicted) total number of patients; the speed at which that number hit the healthcare systems in some countries; the daily news (and rumors) about the virus; and the never-ending political and public discussions concerning the best way to fight the pandemic,  led to uncertainty and anxiety among the healthcare professionals. So, hospital leaders face(d) the challenge – beside others – to ensure safety in the workplace to their staff. This needs a good strategy as well as great personal commitment of the leaders.

In multiple hospitals, various steps have been taken regarding the organization and structure to keep the hospital functioning and different institutional strategies to encourage the commitment, satisfaction and engagement of the health professionals, in a period as complex as the COVID-19 pandemic, have been adopted. Many hospitals, e.g. the Jewish Hospital Berlin, tried to find and employ more staff even if it meant calling on retired or resigned members of staff or medical students to reinforce the human capital. Apart from working conditions, some hospitals granted an extra pay or so-called hardship allowance for putting one’s life on the line when dealing with a pandemic. This extra remuneration can serve to motivate staff to keep up the momentum. But key factors for supporting and keeping up motivation and engagement also include:

  • Protection & Well-Being
  • Education & Training
  • Communication
  • Guidance & Personal Encouragement

 

Let’s take a closer look at each of them.

1- Protection & Well-Being

The COVID-19 pandemic – just as any pandemic – posed several threats to the hospitals’ employees: the virus itself and the workload due to the new work situation. Keeping people healthy, protecting the staff from infections and from burnout was and still is an essential leadership task, even in the best of times. The constant adaptation, fear for themselves and their families can have a huge impact on the employees’ well-being. Leaders need to support and strengthen healthcare workers’ resilience, taking into account the physical and psychological well-being along with social and financial elements. To involve the occupational health service can be very useful.

Shifts need to be structured in a way that the employees get regular breaks for hydration, food, hygiene and socialisation. Furthermore, they must have enough time to tend to their mental health, personal lives and to get the proper rest needed. Providing the opportunity to swap shifts or changing the shifts patterns (6h or 12h instead of 8h shifts, depending on the unit and activity) can help to reduce the burden felt and to keep up motivation. Telemedicine/virtual consultation also became an instrument to protect healthcare workers.

Moreover, assuring PPE is fundamental and it was a global challenge. At the beginning of the pandemic, hospitals faced a PPE shortage and health professionals got positive COVID-19 tests. In many countries the supply chains broke down in almost no time and prices for PPE went up enormously. Stockpiling and providing PPE for all employees were central leadership topics.

Supplies need to be managed carefully and enough to make employees feel secure. Otherwise their engagement and motivation to do their work will drop abruptly. On the other hand, employees are aware that the resources such as PPE or even medical equipment are not unlimited. A discussion between representatives of each group of health workers (doctors, nurses, different technicians and auxiliary health professionals) and the infection/hygiene commissions of the hospital about which is the right PPE for each activity and unit will ensure equity and a general commitment.

In many hospitals, PCR testing (polymerase chain reaction) has been performed sequentially every 10 – 14 days, favoring the detection of positive COVID-19 cases. This has made it possible to isolate infected professionals and to prevent outbreaks in the hospital. Many hospitals also offered free PCR-tests to the staff to reduce worries about infection.

Keeping contact and telephone monitoring of professionals in quarantine or on sick leave is also a key factor for peace of mind and trust. These calls can be done by non-healthcare professionals who might be working at home, as they did at Sant Joan de Déu Hospital in Barcelona. This will lead to and support a climate of trust, empathy and understanding among the institution’s workers.

It is imperative to have mental health specialists on call at all times to enable the staff share their psychological burden. Regular psychological support sessions with healthcare professionals are a good way to give a space to reflect and share situations related to sensations and experiences. These sessions can be done virtually, on a weekly basis. This is a good service for professionals as they can express feelings and share difficult stories and experiences. Assuring psychosocial support to the employees is an important issue as well. Hospitals must ensure that all their staff and their immediate families can access high quality healthcare – at no cost – during the pandemic. Social support and volunteers organizing donations, like houses and hotel rooms for health professionals and their families to stay, or food and self-made masks to the hospital staff contributes to keeping up motivation and engagement.

2- Education & Training

Pandemics are often characterized by an initial lack of scientific knowledge about the virus itself, its way of transfer or how it affects the body and the extents of its damage. There is no cure or vaccination, at least for some months until medical sciences and pharmaceutics come up with new effective medicine. Therefore, the focus is on protecting the healthcare professionals from infection and learning as much as possible about the new virus and disease. The challenge for leaders is to find and to identify the right and important information and to make sure the organization and all its staff is always up to date.

At the same time, daily it is available a huge amount of new information from multiple sources and with different evidence levels. In order to avoid distress and uncertainty, which might result from unclear communication, leaders have to find a good balance and the best way to deliver as much information as needed to keep everyone updated without “overloading” people with too much news.

The staff needs to be educated on a regular basis. Organizations and leaders can do so by implementing a weekly online course teaching the necessity and the proper way of wearing PPE, latest scientific publications about the virus, recent updates regarding the radiological/ laboratory findings, the latest testing policy, the best medical treatment for COVID-19 positive patients, and many more. There should also be personal trainings for those who are not familiar with PPE and how to use it correctly.

Hospitals might also benefit from forming a small group of executives, like a Task Force, and experts that gathers data to discover and implement knowledge and solutions that serve the best for the employees. Some parts of the group pursue actions outside regular business operations. Other parts of the data-team identify the crisis’ implications for routine business activities and make adjustments, such as helping employees to adapt to new working norms.

3- Communication

Good, direct and clear communication – top-down and bottom-up – is a core element of good leadership. It is the basis for trust and organizational identification. Communication skills and multiple communication channels are essential for challenging the pandemic successfully.

However, there is no good communication without good information. Thus, to keep staff motivated and engaged, a plan of action to handle the pandemic within a hospital must be developed and communicated. Leaders have to deliver meaningful and transparent information on the current situation and the steps taken and planned to manage the situation, however it is developing in the next weeks and months. The Hospital Fernando Fonseca (HFF) in Portugal for example defined a Communication Plan with the main information about COVID-19 risk, quality procedures, risk mitigation and level of individual protections. All employees need to know what is going to happen and what they are expected to do in different situations (e.g. a large number of COVID-19 patients, they get infected and isolated, PPE runs out …). Communication must be accessible and consistent. There should be regular memos, newsletters and meetings to keep everyone apprised of the situation and any changing dynamics. To ensure that the information finds its respective addressees, cascading communication at different levels of the organization, e.g. leadership memos, all employee memos, resources on the intranet, virtual meetings etc., might be a good way. The fears of the employees can be reduced by means of regular updates.

Communication should be a continuous process and both ways, as previously mentioned, as there is a possibility of resentment and negative emotions associated with only receiving orders from the top without being heard. The medical staff needs to be involved in decision-making as they are the frontline workers in response to the pandemics. Creating and sharing with professionals a timeline for the COVID-19 situation is important and helpful to ensure the professional trust.  Giving employees the opportunity to create some rules and guidelines (e.g. operation room guidelines during COVID-19) themselves and then of course implement them, is another highly motivational factor. Loyalty to superiors and the hospital increase significantly.

At the same time, healthcare workers need the opportunity to speak about their situation and concerns. There must be regular debriefs after every shift so that the employees have a chance to vent and discuss their daily challenges. Being an active listener to the employees as well as encouraging them to express their opinions and suggestions of policy action, helps reducing anxiety levels and build their invaluable trust by showing that they are crucial for the organization. Supportive and understanding leadership can make an immense difference. Empathy is another element of good leadership.

4- Guidance & Personal Encouragement

Healthcare workers at the frontline need their leaders to be with them, to be present in the unit and to collaborate, to know their situation and to listen and answer to their needs and worries. It is important for workers to see leaders present. Leaders must let their staff know they truly care and that, if the solution to a problem does not yet exist, you will do your best to find answers to the questions that the team is asking. It mitigates the negative effect of work overload and psychological distress of workers. This is leadership based on organizational support, meaning the employees believe their organization cares for their well-being, considers their goals and values, helps them when they have a problem, and trust that they will be treated appropriately. This has proved to be a successful strategy of different hospitals to encourage the motivation, productivity and engagement of healthcare workers.

Conclusion

Managing and leading in pandemic times has inherent arduous challenges, as hospitals have a significant challenge in balancing national, regional, business, employees and patients’ best interests. Our experiences highlight the importance of inclusivity at every step and of ensuring safety of all.

To keep a hospital running during a pandemic, leaders must take measures to foster an organizational culture based on motivation in order to encourage their employees’ involvement and efficiency. Besides, in an institutional level, leaders must respond to the patients’ needs, preserving the quality of their medical services by adapting to changing contexts.

Equally, leaders have the responsibility, not only to promote education and enhance communication with their teams, but also to support them personally. Organizing learning opportunities, creating communication channels and assuring the right resources for the staff as well as having an ear for the staff are essential points to engage and motivate health professionals in these difficult times.

In short, as Young Executive Leaders’ views, you must ‘take care of your staff, then your staff take care of the rest’.

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