Editor's note: A previous version of this story incorrectly referred to Children's Health as Children Health. The error has been corrected.

Health care staff are at the front lines of addressing the Covid-19 epidemic. Many are stepping far outside of their clinical specialty to meet patient needs, with fewer resources at their disposal. And, on top of their day-to-day work, many are concerned about their personal safety and that of their loved ones.   

Starter list: How you can support frontline staff during the Covid-19 crisis

While clinicians are already an especially resilient workforce, they are at high risk of burnout as the epidemic stretches on for weeks or months. With the peak surge still on the horizon for most of the United States, it's important that organizations proactively introduce or reinforce support structures now to maintain staff well-being.

To learn about how organizations are ramping up support for staff, we turned to one of the nation's leading organizations in frontline resilience and engagement: Children's Health. Read on to see how they are proactively bringing their staff together to have critical conversations about Covid-19—and their advice about how others can do the same.

How Children's Health approaches staff well-being

Children's Health uses their RISE framework, which stands for Resilience, Integrated Ethics, Staff Support and Engagement, to guide their system’s approach. Stacy Smith, senior director of integrated ethics and conflict transformation at Children's Health, leads the RISE Program. The program's team includes Elaine Beardsley (Resilience), Jessica Roumillat (Integrated Ethics), and Leslie Leach (Staff Support). When the Covid-19 epidemic started to take hold in the United States, the RISE leaders converted their ongoing work—including their on-demand moral distress consults—to a virtual format. And, to ensure resilience remains a top priority for the system, the RISE team is in regular contact with the organization's senior leaders.

Recognizing the impact Covid-19 would have on their clinical and non-clinical staff, the team bolstered their current offerings by facilitating virtual Covid-19 forums tailored to specific small groups throughout the health system. These forums were designed to create a virtual space for employees to collectively process their emotions during this time and re-connect with their internal resilience.

As Smith said, “Moral distress will be there. We can’t take it away, however, we can create spaces for staff to talk about it and mitigate it.”

The Covid-19 forums

The team created Covid-19 forums with three goals in mind: give staff a safe space to process their thoughts and feelings; connect staff to their own internal resilience factors; and surface potential system barriers to resilience. Below, are the central tenets of their approach:

1. Proactively schedule time to debrief with teams. Forum sessions last between 30-60 minutes and are led by the RISE team's trained facilitators. For organizations without a dedicated staff support team, RISE leaders recommend tapping employees with trained facilitation skills: mental health clinicians, social workers, trained ethicists or chaplains.
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3. Lead with open-ended questions. The goal of the facilitator is help staff discuss moral distress, their personal challenges with the epidemic, and grief. The facilitator's job isn't to eliminate those feelings, but to create a space for staff to talk about them. If staff would like more support, they are referred to the organization's Employee Assistance Program or for a virtual visit with a mental health clinician.
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5. End with a resilience-building exercise. Facilitators finish each session with a mindfulness exercise designed to connect individuals to their internal resilience. RISE leaders also created videotaped versions of these exercises, which are available on-demand via the organization's intranet.
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7. Communicate organizational barriers to resilience to senior leaders. Facilitators elevate the system-level barriers to resilience to the RISE Program leader, who is charged with communicating updates on staff resilience to senior leaders who are managing the organization's Covid-19 response.

What Children's Health wants other organizations to know

Leaders are understandably focused on supporting frontline clinician's immediate emotional needs related to Covid-19. The Children's Health RISE team recommends organizations keep a few blind spots in mind to create a holistic resilience strategy:

• Acknowledge and address moral distress unrelated to Covid-19. Amid the epidemic, staff are still managing challenging cases and adverse events. It's important for leaders to still recognize those feelings and the toll they have on clinicians.

• Don't forget about leader resilience. Leaders are doing an unprecedented amount of emotional labor to support staff well-being—in addition to constantly processing and disseminating new information. To support leaders, the Children's Health RISE team facilitates leader-specific Covid-19 forums, including dedicated mindfulness exercises in leadership meetings, as appropriate.

• Non-clinical staff will experience moral distress, too. As organizations prepare to make difficult trade-offs in Covid-19-related care, clinician moral distress is top of mind. The RISE team notes that all staff, including non-clinicians, may experience Covid-19-related moral distress. Ensure your organization is investing in channels for all staff to access the support services they need.

• Be innovative. Ask leaders questions to better understand what their teams’ needs are and what they are struggling with. Customize forums based on expressed needs and provide them in a way that maximizes participation for all staff (multiple sessions, off-hour sessions, virtual meetings, etc.)

Questions for the RISE team? Email stacy.smith@childrens.com.