Having served in the Army in Bosnia and in Iraq after the 9/11 attacks, Dr. George Brandt has seen his share of people experiencing combat stress. There are parallels, he says, for healthcare staff grappling with stress and anxiety as they work through the coronavirus pandemic. A psychiatrist hospitalist at Porter Adventist Hospital, part of Colorado-based Centura Health, Brandt says it is critical that leaders support the mental well-being of their entire workforce. Brandt spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You’ve drawn a parallel between the situation today and what you’ve seen from your time in the military.
Brandt: I did about 15,000 miles of convoy operations and flights throughout south central Iraq—going out to see the soldiers where they were, their forward operating bases and taking care of my troops who were in the same areas. You would have preparation and a briefing before every convoy, every operation about what to do and how to plan and how you were going to manage your safety.
(What’s happening now is) like going off the base—what’s your strategy for managing risk? I’m going to be wearing masks, using gloves, being very smart about where I go and what I do and try to not bring anything home to hurt my family.
MH: What kind of tactics and strategies are you recommending leadership start to deploy as they talk to front-line staff and manage their anxiety?
Brandt: It starts with listening to safety (announcements) and doing your job. Another thing is, we’re in a bit of a marathon more than a sprint, so I want to make sure that people have a good sustainment strategy, that they’re getting plenty of rest, they’re getting plenty of sleep.
Many people working in intensive-care settings are not spending as much time with their families. They’re socially distancing within their own homes to protect their family from a potential exposure. So there’s a bit of a challenge with not having their support system … or their support system needs to be a bit more than at arm’s length, just to protect everyone in the home.
MH: What can leaders do for staffers who have to remain an arm’s length away from their personal support systems?
Brandt: Make sure basic needs are being taken care of. Make sure that they get breaks. Make sure that the overall fatigue isn’t too great. Make sure they get fed. Make sure that they’re getting information at the beginning and end of shifts and be transparent about what’s going on. If someone develops a fever or symptoms, it’s time to stay home and get tested. And make sure that testing is available for people.
I was active duty during 9/11 and in the recovery phase afterwards. The psychiatrists stationed at the Pentagon didn’t set up as many formal debriefings, but they found about every coffeepot they could in the building. You would deploy your support staff to those places (in that situation). I would want chaplains checking in at every coffeepot in the hospital and making sure people are supported. Go where the people are and make sure that they see you and know that you’re concerned and have a presence and an ear for them and are able to respond to any of their concerns.
MH: Thinking back to 9/11, were those check-ins planned, or did they happen more organically?
Brandt: It’s a bit of both. The military gets very regimented … every group of soldiers, firefighters and other support staff who went in the building would have an opportunity for a debriefing as they left. We would sit down and I would ask, “What did you see today? What did you do today?” That check-in time and having regular support seemed to help people do well.
MH: Equipment shortages have been a challenge across the industry, and we’re seeing a lot of stress from front-line staff talking about it. Are there ways just to deal with that from an emotional, psychological aspect?
Brandt: Part of it is trying to make sure there’s really good communication from command about what the supplies are, what’s coming in and when it’s coming in and how (leadership) plans to protect (staff).
Giving good information (helps) allay some of those fears.
MH: You also think using humor can help during these times. How?
Brandt: There are those moments every day; they just happen. The ability to laugh and share a laugh is very preserving; it relieves tension. It’s a little refresh for people as well.
MH: Stress was a factor for clinicians before the pandemic started. What do industry leaders need to think about now since those stress levels are only going up?
Brandt: Pay attention to your inbox and how many things are still coming in related (to the pandemic). It’s not over the day the last patient is discharged. It goes on for a while. (Look at) how you assess people’s needs. That’s when I’d really look at the coffeepot follow-up, where you’re physically present in the building and collecting people’s stories. “What did you do? Where were you?”
Collecting stories, getting multiple perspectives about events, getting good information to people, those will be very helpful in helping them digest this experience.
I’ve been in medicine 34 years and I haven’t had days—other than some combat days—where I’d had multiple deaths. That’s something people haven’t seen for a while. Being able to talk about that will be important.
MH: Managers and executives are dealing with their own form of stress, too. Are there self-care tips you recommend for them?
Brandt: They need to get good information, get it to people, but then they also need to have times where they shut down. There are only so many hours of news I would want one to consume. Make sure that they’re talking about processes and executing their leadership tasks … but also making sure that they take care of themselves with some downtime.
You have to have some days you turn off the phone and try to get a good night’s sleep and let somebody else take the hospital call that night.
MH: That’s hard to do for a lot of people though.
Brandt: You’ve got me thinking back to Bosnia in the 1990s and there was a particular place where there were just great sunsets and then stopping and reflecting for a moment.
I love the personal reflections that our CEO at Porter Adventist Hospital (is doing). Today’s was about the polio epidemic in the 1950s and how that rippled through families and the changes that came from it. This reflective capability about where we are today and in the historical context can be helpful.
Doctors are some of the most resilient people (because of their) education and training. Sometimes I worry more about the clerk on the unit who may not have seen people die before and that person might be the most vulnerable person in the organization from a lack of training and experience standpoint.
MH: How do you help those people?
Brandt: That’s the person I want talking to folks before they go home.
I’m thinking about a young woman in Bosnia with one of our fatalities there. It was quite the shock for her. She was a medical record specialist, so not having a great deal of medical training but being right there, gathering information in the middle of a very traumatic event was quite an exposure for her. (But) helping (her and her team) understand what we were doing and why they were doing it and thanking them for their presence and (understanding that the) paperwork being done right was important.
MH: On a different front, what’s been the impact on your patients and practice?
Brandt: I am busy with telepsych.
MH: Do you see continuing with telepsych when we return to more normal operations?
Brandt: It is a very useful way to do business. It does impact the emotional distance with people and the emotional intensity. I find it more fatiguing than having patients in the office, but it’s reaching people where they are.
MH: Why is it more fatiguing?
Brandt: You can see the whole person in your office. You get a sense of their presence by reading the body language.
(With telehealth you are) moving through multiple programs. I use one program to get my staff to check the client in. I use another program to do the clinical encounter. We use Zoom, as well. And then sometimes my phone in addition to that.