2020 has stretched every one of us to our limits, but perhaps of all sectors, it has been the healthcare practitioners at the frontline of fighting the pandemic who’ve been most impacted. Dr. Stephanie Costa shares her experience as an OBGYN applying learnings from the 2017 Robert Wood Johnson Foundation and Reos Partners Healthcare Systems Scenarios to her work coaching healthcare professionals.
As an obstetrician gynecologist, I am familiar with transformation; the transformation of a sperm and an egg into a human being; the progression from a baby girl through adolescence to adulthood, to a woman wise in her years. I routinely witness the transformation that occurs when an eager nursing student starts his first IV, when a physician assistant transitions from first days as a new grad to an experienced practitioner, and when a doctor in training conducts their first physical exam or makes her first incision with a scalpel.
Having practiced for over twenty years, I am called to serve my female patients, but I also feel drawn to support healthcare providers. For the past three years, I have had the privilege of coaching healthcare professionals in the areas of leadership development, career fulfillment, work-life balance, effective communication, and delivery of care. It has been extremely rewarding to help facilitate the change that these dedicated providers seek, and to witness improved delivery of healthcare by empowering them to enhance their effectiveness, confidence and overall well-being.
A shift in coaching
As the pandemic began to impact our country this past spring, coaching engagements took on a completely different focus. Providers were no longer interested in setting goals and working to achieve them, instead, they were working to survive the high-risk situations and long hours required of them. During coaching sessions, they were seeking a compassionate and sympathetic ear. They needed to express to someone in medicine what their lives were now like. Many were relieved to realize that they were not alone when feeling completely overwhelmed and uncertain as they cared for very ill patients. Prior to the pandemic, at least half of healthcare providers in the country were overworked and burned out, but now they were being asked to navigate situations that were completely unfamiliar, to work even longer hours, and to see even more patients, all while putting themselves and their families at risk of contracting COVID.
In the midst of the pandemic, the US was also experiencing escalating civil unrest and nationwide activism. Those in healthcare were taking a stand, participating in marches and affirming that racism is a public health crisis. The pandemic has highlighted the disparities in health outcomes for BIPOC (black, indigenous and people of color) – not just relating to coronavirus, but in almost any disease studied. As I watched things unfold, I recalled the RWJF and Reos’ Healthcare Scenarios project I had done in the spring of 2017.
Health Systems Scenarios 2017 – 2027
Throughout 2017, Reos Partners worked with a diverse team from across the American health system to co-create the Health System Scenarios. Throughout the process, we listened, we questioned, we reflected and eventually we developed three scenarios exploring the question: How will the United States improve health outcomes?
• Will it reduce the role of government and rely on the Marketplace?
• Will it bring national stakeholders together in the Conference Room?
• Or will it organize change from the bottom up, around the Kitchen Table?
The scenarios offer an opportunity to engage many diverse voices across the country in drawing attention to the opportunities, risks, and choices we face regarding the future of health and health equity. More than a product with a single message, the scenarios were intended as a catalyst to spark reflection, discussion, and action relevant to the diverse social, political, and environmental contexts of different regions of the US.
While the scenarios looked ahead to the year 2027, just three years later, in a pandemic which none of us foresaw, we were thrust into a health crisis that magnified the disparities in how healthcare was delivered. I was seeing first-hand how companies and manufacturers capitalized on opportunities to sell critically needed product primarily to those who had access, as in our Marketplace scenario. I saw state and local governments and agencies trying to provide for their citizens as best they could with the information they had at the time, as in the Conference Room scenario. I saw the Kitchen Table scenario play out with activists from grassroots movements demanding justice and equality, not only for issues pertaining to healthcare, but for all areas of disparity.
The ripple effect on community
I observed distress and exhaustion in the healthcare providers I encountered each day. I began to grow concerned about the ripple effect that the strain our healthcare workers were undergoing would have on the community and on patients, especially people who have been under-resourced, marginalized or ignored. As the summer went on, many healthcare providers were feeling increasingly powerless to help the patients who needed them most. There were inefficient workplace processes, and providers were unable to deliver or connect patients to much needed medical or social resources. Clinicians were beginning to lose their sense of professional efficacy and this, in turn, resulted in higher rates of burnout and “compassion fatigue” – not what is needed during a major global health crisis!
Coming together in central Ohio
What could I do to assist the caregivers and patients? I wanted to provide support, but the need was immense. I reminded myself that I had a skill set and life experiences – not least of all stemming from the scenario process – that I could use to foster awareness and change, even if only on a small scale.
A conversation with a friend and mentor led to an invitation in my inbox, and soon I found myself meeting at a “virtual kitchen table”. Several of us involved with the Physician Leadership Academy of the Columbus Medical Association began gathering via video meetings in the evenings, hopeful that in some way we could make a difference in central Ohio, not just during these difficult times, but for future generations. We met with members of the healthcare community and conducted interviews to hear stories and better understand issues of race and inequities, not only in healthcare delivery, but in the recruitment and training of healthcare professionals. It was so rewarding to collaborate with members of our healthcare collective, both to do something impactful and positive, and also to connect as human beings in a deeply personal and profound way.
Healing with empathy and understanding
The work is ongoing, and we are eager to harvest the themes and identify what wise actions our community can take going forward. I hope that as the pandemic continues, and as our country moves toward healing and understanding, we can continue to gather people together, even if virtually. By reflecting on the scenarios and identifying what is currently happening, we feel empowered to create empathy, understanding, and change that will improve the health of those we serve, as well as those who serve them.
For further reading:
• Flip the Clinic is a previous project spearheaded by Reos Partners together with the Robert Wood Johnson Foundation to address healthcare burn-out and improving the sector as a whole.
• For further information on coaching and support for healthcare workers and the systems in which they work, see www.whol.co .