Burnout Intervention and Prevention Strategies for the Health Workforce during COVID-19

Background and Purpose: Since March 2019, the U.S. has grappled with how best to navigate the daily and lasting impacts of COVID-19. The nature of this global emergency has strained healthcare systems and the capacity of the frontline health workforce, including social workers. Unrelenting conditions have placed the frontline health workforce at high risk for burnout— the emotional, physical, and mental exhaustion caused by excessive and prolonged stress. This study focused on identifying specific interventions health systems implemented during COVID-19 across the micro (individual), mezzo (organization), and macro (community) continuum to address burnout among the health workforce.

Methods: This study involved a two-pronged concurrent approach: (1) Expert interviews with health system administrators involved in COVID-19 burnout prevention efforts (N= 5), and (2) A scoping review of published literature on burnout interventions implemented for healthcare workers in the U.S. from during the pandemic. Scoping review protocol included a priori inclusion criteria, search terms, database selection, and data abstraction. Strategies identified in the review were abstracted and categorized into micro, mezzo, and macro-level interventions by two study investigators independently. Expert interviews were recorded and transcribed. A thematic content approach was used for qualitative analysis and transcripts were independently coded by two investigators.

Results: Title and abstract screening was conducted on 986 articles; full-text review was completed on 191 articles, resulting in 20 articles included in the scoping review. Nearly 86% of the articles described interventions that took place in academic medical centers and 40% were based in New York City. Based on scoping review findings, study team categorized eight types of interventions; spanning individual, organizational, and community systems. Micro-level interventions included increasing behavioral health support through individual counseling, often supported by social workers. Mezzo-level interventions included morale building activities for units such as virtual town-hall meetings or wellness initiatives like “recharge rooms.” Macro-level interventions included coordinating physical supports such as accommodations or working with external state- agencies to assist with childcare. Almost all of the described articles burnout-interventions that were new efforts in response to COVID-19 and reflect how little was formalized in preventing burnout prior the pandemic.

Qualitative data supported scoping review findings and uncovered themes related to the importance of leadership communication, role shifting and importance of workplace flexibility, wellness initiatives as forms of prevention and burnout reduction, and the need to develop interventions specifically for higher-risk groups (i.e., caregiving demands, workers of color simultaneously experiencing trauma or racial discord in the U.S.).

Conclusion/Implications: As the COVID-19 pandemic continues into 2021 so too will health worker stress, burden, and burnout. Health systems have worked quickly to address the mental health needs of the workforce through strategies that mitigate and prevent burnout. However, more work is needed to sustain these interventions over time, provide support to those supporting others-such as social workers, and evaluate the effectiveness of burnout-prevention efforts now and into the future. The effects of COVID-19 will continue to impact how those on the frontline manage their work and the stress of being a frontline worker in health settings.