The COVID-19 pandemic led to a significant increase in reports of unprofessional conduct by health care workers, with anecdotal evidence now backed up by a retrospective study.
A comparative cohort study in The Joint Commission Journal on Quality and Patient Safety examines the impact of COVID-19 on professionalism in the surgical environment at a single medical center in Houston, Texas. The results show a significant increase in reports of unprofessional behavior during the pandemic.
According to William O. Cooper, M.D, M.P.H., professor of pediatrics and health policy at Vanderbilt University Medical Center and a study co-author, professionalism-related incidents rose from a mean of 1.1 per month before the pandemic to 4.5 per month during the pandemic, as measured from March 2020 to May 2022.
Following that rise, the numbers remained at a mean of 2.9 per month through March 2023.
Cooper led another recent cohort study published in JAMA Network Open that found fewer than 10 percent of physicians ever receive a coworker report about unprofessional behavior.
A national collaborative program directed by the Vanderbilt Health Center for Patient and Professional Advocacy identified surgeons as more likely to receive reports than other specialties.
“It’s possible that surgeons practice in more stressful environments than the other specialties, resulting in interactions during high-stakes events that increase the likelihood of a coworker reporting a concern,” Cooper said.
Empathetic Intervention Model
At VUMC, Cooper said, anecdotal evidence indicated early surges in COVID-19 brought small waves of peer complaints, then waned as colleagues gave each other the benefit of the doubt during interactions. Within six to eight weeks, the overall numbers returned to baseline, with some elevated rates lingering in ICUs and in a few patient units.
Implementation of the previously developed Vanderbilt Professionalism Escalation Model led to further improvement.
“We encouraged coworkers to engage in empathetic conversations. This feedback put an end to 97 percent of unprofessional behavior.”
“We encouraged coworkers to engage in empathetic conversations,” Cooper said. “This feedback put an end to 97 percent of unprofessional behavior. Our intervention model from earlier studies at VUMC shows peer-to-peer feedback helps tremendously.”
Staff Burnout
The single-center study during COVID-19 also found professionalism-related incidents rose with increased staff turnover, which stood at 15.5 percent during the pandemic, compared to 8.3 percent prior to the pandemic. Staff turnover rates had dropped to 6.7 percent four months after the pandemic ended.
Cooper said at VUMC staff turnover was also faster than normal during the pandemic, mostly due to burnout and disengagement. Those issues eased over time.
“Once we gave them a chance to share and address their issues, retention improved,” Cooper said.
Luckily, VUMC has a strong employee assistance program to support its staff.
“After the COVID-19 pandemic, we had a thoughtful review to identify system challenges or why staff may have acted out,” Cooper said. “We found ways to fix scheduling, room set up, and patient flow to help the overall health care environment.”
He emphasized the importance of collaborative leadership, clear communication and consistent messaging. Based on learnings from the COVID-19 pandemic, crisis leaders should:
- Recognize that everyone is under stress.
- Provide resources during a crisis to alleviate sources of stress, such as meal cards, a place to sleep, counseling and other mental health resources.
- Commit – to patients and to each other – to provide high-quality care.
- Increase use of telehealth and virtual conferences to save time.
Boosting Morale
Promoting personal accountability, addressing wellness concerns, and providing models of resilience can enhance workplace culture and potentially cultivate better employee retention rates, the single-center study concluded.
“It means something to work at VUMC. We commit to take care of each other and hold each other to high standards, no matter what.”
The ongoing emphasis on workplace culture helps to limit lapses in professionalism at VUMC, Cooper believes.
“It means something to work at VUMC. We commit to take care of each other and hold each other to high standards, no matter what,” he said.
