Authors: A. M. Lawrence and F. N. Mwendia. First published in 2021.
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The health care industry is dynamic and full of continuous challenges in the delivery of health care services. As a result of the massive impact of COVID-19 on the health care system, it is necessary to develop an action plan to eradicate potential severe consequences. This study aims to determine how COVID-19 has impacted the mental health of employees and patients and how it has compromised various systems in hospitals. Specifically, it investigates the impact of mental health problems caused by COVID-19 on the Mayo Clinic network of hospitals. This study postulates that the mental health of employees and patients has impacted the following systems: Workforce (human resources), quality of care, workplace safety, and legal and ethical issues. The study incorporates findings from several studies that expound on the impact of mental health caused by the COVID-19 pandemic on the identified systems. Notably, Mayo Clinic can address these challenges by using evidence-based practices, such as the Schwartz Rounds, prioritizing workers’ mental health, supporting affected individuals, and providing a safe working environment.
Table of Contents
In 1864, Dr. William Worrall Mayo announced that he would be opening a private medical practice in Rochester, Minnesota. From humble beginnings, private practice thrived significantly. Later on, it grew exponentially when his sons, Dr. James Mayo and Dr. Horace Mayo, joined after graduating from medical school in 1883 and 1888, respectively (Olsen & Dacy, 2014). These partners to form a group practice that would become today’s popularly known Mayo Clinic, a private organization. Since then, this network has grown into an internationally recognized medical center, exemplifying an organization that has grown way beyond the lifetime of its founders.
This family partnership propelled the organization into today’s largest not-for-profit, private multispecialty medical practice in the world. The core value of Mayo Clinic is patients’ needs first (Olsen & Dacy, 2014). Generations of practitioners at Mayo Clinic have upheld this value, thus contributing towards the organization’s mission and vision. The unwavering commitment to patients’ health relies on a dynamic discovery of information and their eventual translation and adaptation to advance clinical care.
Mayo Clinic’s mission is “Inspiring hope and promoting health through integrated clinical practice, education and research.” Its vision statement reads, “Transforming medicine to connect and cure as the global authority in the care of serious or complex disease” (Mayo Clinic, 2020). These have enabled the organization to rise to its current international status and be associated with top-ranked quality services. The road to achieving its ultimate objective of transforming medicine gets crucial support from its value statements. These include respect, compassion, integrity, teamwork, innovation, excellence, and stewardship.
Mayo Clinic offers many minority health and wellness programs, including cancer prevention, healthy brain aging, community outreach, and community-engaged research programs. It is also involved in sponsoring programs intended to promote diversity. For instance, in its cancer prevention outreach and education program, Mayo Clinic aims to educate African-Americans about cancer and the significance of living a healthy lifestyle (Mayo Clinic, 2019). Most African-American communities experience high rates of death from cancer than other ethnic groups. The organization also engages in prenatal education in the department of Obstetrics and Gynecology at the Minnesota campus.
The categories of health care personnel include patient care, laboratory personnel, and support and administration personnel. The support and administration personnel include the central service technicians and other employees. The laboratory personnel has histology technicians, technologists, etc., and the patient care category has cardiac sonographers, trainers, child life specialists, physicists, and several others.
The funding for the medicine and health research program at Mayo Clinic is by grants from government organizations, foundations, and individual donors (see Appendix 1). There is also government funding from the National Institutes of Health – the National Center for Complementary and Alternative Medicine, National Cancer Institute, and National Institute on Drug Abuse. Each year, more than 1 million patients across the globe are treated at Mayo Clinic locations across Midwest and in Arizona and Florida. The hospital also offers services to international patients. For instance, it estimates that 8,000 international patients from over 150 countries travel to Mayo Clinic for medical care every year (Mayo Clinic, 2018). This number might have changed as a result of the dramatic effects of the COVID-19 pandemic.
The United States and the rest of the world remain afflicted by the COVID-19 crisis. In 2020 when the impacts of the disease started to show in various aspects of health care, the ultimate effects on health care personnel were largely unprecedented. For the last few months, the crisis has profoundly stressed health care systems and the ability of the nation to control the impact of the disease, more so because of the economic hardships, the need for social distancing, and limited freedom of travel and gatherings. Consequently, the COVID-19 has caused long-lasting mental health impacts on patients and health care professionals. The following paper section discusses the effects of the COVID-29 pandemic on the mental health of patients and employees (health care workers).
Covid-19 has presented health care professionals with unexpected, life-threatening experiences which they were inadequately or trained to handle. Although most health care professionals are used to witnessing trauma and regularly dealing with the loss of patients, the high mortality and morbidity rates during the pandemic have been overwhelming (Braquehais et al., 2020). This situation worsened because of the personal protective equipment shortage and the fear of getting infected or their family members getting the infection. Another variable was the absence of an effective treatment in the initial stages and restrictive public health policies. Consequently, the majority of health care professionals have experienced unpleasant emotions, including fear, hyperarousal, intrusive memories, and emotional exhaustion. The more they got exposed to this situation, the more mental distress they got predisposed to mental stress. However, because patients were equally affected mentally by the pandemic, health care professionals have continually prioritized care for these patients despite the risk to themselves and their families.
As Mayo Clinic remained of the networks dedicated to caring and providing necessary information on COVID-19, its employees have experienced numerous effects that have affected ordinary operations. During the COVID-19 crisis, many infected health care workers and patients have either been quarantined or hospitalized (Braquehais et al., 2020). Those quarantined tend to become more anxious, frustrated, helpless, and isolated than non-quarantined. The main fear among these people is infection risk to those close and themselves, especially if children are involved. Such employees or patients feel powerless and guilt as they cannot help their peers. It has affected hospital activities, including reaching out to those that record higher rates of absenteeism.
The big concern today, not only in Mayo Clinic, is that health care professionals may not ask for help if needed. People use either self-treatment, denial, or rationalization as the initial defense mechanisms in stressful situations (Braquehais et al., 2020). But, this tendency seems to have changed during the COVID-19 pandemic. The social recognition that most hospital workers are receiving today, paired with mass and social media diffusion of their testimonies, could reduce the psychological barriers to seeking help. Yet, self-stigmatizing attitudes may persist with severe mental disorders. Consequently, many hospitals, including Mayo Clinic, have extended psychological assistance provided to Healthcare professionals for cases at higher risk of having mental disorders.
In a study on the impact of the COVID-19 crisis on physician stress and mental health, Linzer et al. (2021) found that almost two-thirds of physicians throughout the United States were afraid of infection or transmission of the virus to loved ones. Around 30% responded of being anxious or depressed, and 29% felt overloaded by work. Most physicians at risk of higher mental health disorders caused by the pandemic include; women, those in early- and mid-career practices, inpatient physicians and specialists of critical care, hospital medicine, and emergency medicine. As Linzer et al. states,
“Previous work in the United States links work conditions to burnout. In particular, lack of control of work and chaotic work conditions are well-known stressors associated with burnout, as is time pressure during work activities (worsened in COVID care because of protective equipment donning and doffing, absence of family visitors, and extreme anxiety by patients)” (p. 131).
This situation has affected several systems in health care, impeding the delivery of essential medical services, as evident at Mayo Clinic. Mayo Clinic serves a wide range of diseases and millions of patients from within and outside the United States. After the first few months of the COVID-19 outbreak, the demand for telehealth increased gradually. It is a relatively unpopular technology in some places when compared to traditional physical treatment. As hospital staff became overwhelmed by these trends, there was a massive impact on hospital operations.
Throughout the COVID-19 pandemic, workers at Mayo Clinic have operated for long hours in high-pressure environments. They have gotten exposed to trauma and faced severe moral dilemmas, many of which came from a lack of sufficient staffing levels or experience in similar situations (Greenberg, 2020). These have all impacted their mental health in one way or another, presenting a potential impediment to health care service delivery. Undoubtedly, it is the reality in almost all hospitals throughout the United States.
These unprecedented circumstances will possibly increase the risk of mental disorders, such as post-traumatic stress disorder (PTSD) or depression, or other anxiety disorders, substance misuse, and suicide (Greenberg, 2020). These will further affect the quality of care in many ways. The employees or health care professionals caring for patients with COVID-19 are also at risk of getting the infection. They must also come to terms with the fact that there is a risk of infecting their loved ones or families. In this way, their expected service delivery is impacted mainly because of such a critical barrier.
This impact on the quality of care is not restricted only to the first responders. Greenberg notes that “The risk of psychological harm is not restricted to frontline HCWs; in fact most HCWs, regardless of their specialty, are likely to have experienced notable challenges since the pandemic began, including changes to the way they work and, at times, being unable to deliver the quality of care they would normally” (2020, p. 425). Although some health care workers can thrive in such circumstances and deliver quality care in stressful situations, the same scenario might become a barrier to the accessibility by the patients due to mental health issues. The potential high prevalence of burnout among health care professionals at Mayo Clinic is a cause for concern because it could affect the quality of care and performance of the entire health care system. Strategic efforts are required to address this growing problem and must rely on evidence-based practices.
Worker productivity has possibly decreased as they are required to work in highly challenging conditions. Throughout the COVID-19 pandemic, many Health Care Staff have operated for long hours in high-pressure environments (Greenberg, 2020). As a result, most of them have gotten exposed to trauma and moral dilemmas relating to the challenges of delivering quality care. For large organizations like Mayo Clinic, the effects might be profound. For instance, work overload and burnout as more patients report to the clinic for medical care reduce the quality of care given at each time. At the same time, the hospital and many other health care organizations have experienced a rise in the ratio of patients to medical professionals, decreasing the ability to provide quality care to pre-pandemic levels.
Undoubtedly, the COVID-19 pandemic has caused a substantial decline in the productivity of health care workers. It has been mainly because most health care workers have had to deal with almost triple the number of patients they help compared to pre-pandemic. Under normal circumstances, this increase in demand for health care services reduces an individual’s commitment to quality. For Mayo Clinic, the high number of affected health care workers significantly is associated with an overwhelming decline in performance in many departments.
There was a massive decline in health service output in many organizations. The crisis has placed the health care system under pressure that has led to significant changes in service provision during the year, and there is a possibility of long-lasting effects. For instance, there was a substantial decline in non-COVID-19 service provision of all kinds within the hospital immediately after the outbreak. The decline in activity has had a long-lasting effect on health outcomes through reduced screening, late diagnosis, delayed treatment, and increased incidence of mental ill-health.
Mental health issues caused by the COVID-19 crisis have caused more legal and ethical problems than before the pandemic. As indicated in the earlier sections of this paper, many health care workers have had to deal with new experiences that they were possibly unprepared to address. In many instances, the situation presented scenarios that touched on both legal and ethical issues. Without adequate preparation on the side of management to employees and ensuring there are mechanisms to address such issues, employees and specifically health care workers have had to rely on intuition and their understanding of the scenarios in making vital decisions. Take, for instance, an elderly come to the hospital with a need for a ventilator. At the same time, a young patient reports to the unit with an urgent care need. Given that the number of available ventilators cannot satisfy the demand at a time, the health care worker must make a decision, and a critical one for that matter to save either or both of these lives. These kinds of situations present legal and ethical implications which can significantly impact the operations.
The choice to prioritize treatment for patients who have the best chance to survive with those with a higher chance of dying represents one of the most popular issues that every health care organization has had to deal with during the COVID-19 pandemic. At the same time, keeping the morbidity and mortality rates as low as possible in many communities within the country remained a major priority for policymakers and health care organizations. However, the efforts to contain the number of infections and reduce the pressure on the hospitals rely on societal and exceptional measures that at times present ethical issues.
Outpatient practices and health care services got substantially limited at Mayo Clinic. This effect includes ordinary hospitalization and elective surgery that have either been canceled or postponed. This scenario is recurring even currently because of the increase in infections. Subsequently, patients with physical or mental disabilities who require continuous care have had to deal with difficulties at scheduled follow-up in the hospital. The challenging decisions during the emergency phase may include the need for criteria for admission to Intensive care Units whenever there is a bed shortage.
The risk of harming a patient during the crisis remained high among health care workers after the outbreak of COVID-19. It has been a period of high need for informed consent to treatment and research. As an institution focused on improving patient care through research and innovation, issues about informed consent have dominated the system at Mayo Clinic. The anxiety and pressure associated with the pandemic exposed health care workers and patients to challenges that often need irrational solutions.
During this emergency period, a perception of unfair health care policy and non-ethical allocation of resources can create tension among practitioners and expose health workers and administrators to malpractice claims. Ferorelli et al. state that “Implementing the hospital’s novel care pathways and all proactive measures in response to mitigate COVID-19 spread, starting from the admission of untriaged patients in Emergency Departments up to safety recovery in a dedicated ward will guarantee the standard of care to all citizens, and avoid malpractice being part of the magnitude of indirect health effects due to the pandemic” (2020, p. 4). A health care policy based on an ethical framework and which adheres to regulations is the only way to promote the equity of patients during the crisis and avoid ethical and legal implications.
There is a need to address the increased risk in vulnerable working populations such as the frontline workers at higher risk of contagion. The workers at Mayo Clinic get exposed to conditions that threaten the safety of the entire hospital, more so, those directly providing services where they are most needed. Many factors interact to predispose the employees to psychological distress and peri-traumatic symptoms (Giorgi et al., 2020). Possible stressors include the risk of getting infected when dealing with sick patients and the possibility of acting as vectors, pre-existing physical problems like tuberculosis, psychosocial factors like the absence of supportive families, and the inability to receive psychiatry support promptly. The financial constraints associated with loss of jobs and the suspension of workplace safety and basic laws related to occupational risks aggravate this vulnerability.
Mayo Clinic can rely on evidence-based practices to deal with mental health problems on workplace safety, the workforce, and quality of care. The value of adapting characteristics of high-reliability organizations to health care is to reduce the likelihood of adverse events for patients and employees. Organizations must ensure the work environment is free of stressors and that every employee feels protected by the safety measures (OSHA, 2020). For hospitals such as Mayo Clinic that operate around the clock, they must tackle many challenges in meeting workplace staffing demands. While it has continuously faced staffing challenges due to its demanding operational schedule, several trends including worker shortages in the more recent times have influenced the hospital’s management practices. This influence is also associated with the outcomes for employees’ well-being and performance that include fatigue and exhaustion, sleep deprivation, slowed reaction time, occupational injuries, and increased incidence of errors. Research suggests that protecting health care workers requires consideration of identified elements that Mayo Clinic could use to address the challenge.
The management must thank the health care workers appropriately. Appropriately acknowledging the challenging work undertaken during such crucial times could foster resilience (Greenberg, 2020). It should include recognition of potential psychological difficulties and offer necessary information on the available support options which both patients and hospital workers can use.
Avoidance is the key symptom of traumatic stress, and that such behavior could show up through distressed staff staying away from the hospital (Sorokin et al., 2020). For this reason, it is paramount to contact and reach out to those that do not turn up at work. Understanding the cause of absenteeism could be a key to unlocking potential incidences of mental health disorders.
As the pandemic begins to recede, Mayo Clinic has to provide ‘return to work interviews to all staff. It might be late already because the government relaxed its restrictions a few months ago, but it could unlock mental health problems among the workers (Dawson, 2021). This should happen as the workers begin to transition from crisis response roles back to the ‘new normal’ and should be performed by experienced supervisors who can confidently speak about mental health. This practice could offer a significant opportunity for the supervisors to understand staff members’ experiences, ultimately helping to reduce absences caused by sickness.
Mayo Clinic should pay greater attention to the health care workers in high-risk positions, especially those that attend to outpatients. Additionally, the above-mentioned ‘return to work’ interview could be critical in this period because it could help identify the presence of pertinent stressors like feelings of being overwhelmed or bereavement by those left by loved ones. Specific attention should also get directed to the staff who, during the COVID-19 pandemic, have worked beyond their usual role (Huang et al., 2020). These could include, for instance, outpatient nurses who may be required to care for ventilated patients during the crisis. Evidence suggests that additional stressors could have a profound impact on already emotionally distressed people.
This element follows the recommendation made by the UK National Institute for Health and Care Excellence. It states that anyone exposed to a potentially traumatic experience should get active monitoring by relevant authorities within the care system, especially those with a high risk of developing mental health problems (Greenberg et al., 2020). Mayo Clinic could achieve this by employing an anonymous online self-check tool with a wide range of mental health measures providing a bit of tailored advice, for example, by describing how the person can access professional care. With anonymous approaches, there is a high possibility that the affected employees will use the self-check tool.
Managers should help all workers make sense of their experiences. Undoubtedly, the health care workers got exposed to morally distressing circumstances during the pandemic. Being able to relieve themselves of the blame and develop a meaningful narrative for what happened during the pandemic could potentially reduce the risk of them suffering psychological harm (Buheji & Buhaid, 2020). In this sense, the hospital should encourage the use of the evidence-based model, the Schwartz rounds.
Schwartz Rounds are interdisciplinary reflective groups that encourage staff to share their personal experiences and vulnerabilities so that they can support their colleagues and patients (Farr & Barker, 2017). The Rounds standard procedure begins with a discussion of a diverse panel about a patient or work-related theme. These Rounds use an evidence-based model and rely on trained facilitators, supposed to act as moderators of the group discussion. The impacts of using this method include staff reported feelings of empathy and compassion towards the affected patients, improved teamwork, feeling more supported, and building shared values and openness in the work environment.
The purpose of this phase is to build resilience among workers. Mayo Clinic needs to know the needs and strengths of its workforce. There must be clarity of triggers for stress and personal coping strategies to manage distress. The hospital leaders must evaluate whether its workforce members are more vulnerable to mental health problems than others. For instance, it might pay greater attention to those with existing needs, those who have been caring responsibilities in their home lives, and those who might have recently survived a traumatic experience.
The workers should be able to tackle one task at a time, trying not to become preoccupied with future threats. Everyone should be encouraged to manage their mental well-being. The organization might also use Schwartz Rounds at this phase to discuss the present moment experiences.
During this phase, workers should focus on enhancing their self-compassion, being mindful, grounding, balancing home and work, ensuring a social connection, and adopting healthy living strategies. Additionally, communication is crucial at this stage. The hospital must provide accurate, timely, and evidence-based information about the virus and its response, including worse case scenarios.
Once the pandemic has passed, there is a need to reflect on what has occurred and the overall response. Workers should remain connected with their colleagues throughout to share their experiences. The hospital must look to thank, acknowledge and reward the workforce for their efforts during the crisis and reflect on lessons learned using the Feelings, Evaluation, Analysis, Conclusion, Action plan model (Tomlin et al., 2020). The management and executives at Mayo Clinic must maintain close contact with all staff to check in and see if anyone requires further support.
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Appendix 1: Mayo Clinic Funding – Not available in media.