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Importance of a Culture Committee for Boosting Morale and Maintaining a Healthy Work Environment in Radiation Oncology

Open AccessPublished:July 18, 2020DOI:https://doi.org/10.1016/j.adro.2020.07.002

      Abstract

      During the unprecedented workplace disruption from the corona virus disease 2019 (COVID-19) pandemic, health care workers have been particularly vulnerable to increased work-related stress and anxiety. This may have a negative effect on job performance and personal well-being. Personal safety, job security, and childcare needs are essential concerns that must be addressed by health care organizations to ensure stability of its workforce. In addition, workplace morale is also damaged by the many daily changes brought about by social distancing. Thus, opportunities exist for departments to address the loss of social bonding and cohesiveness needed for successful team building. In this report, we describe the efforts of our departmental workplace culture committee during this pandemic.
      With the new challenges introduced by the COVID-19 pandemic, health care workers have been subject to enormous additional stresses, both physically and mentally, added to an already stressful work environment. Despite the slowdown or stoppage of routine and elective medical services, cancer therapy remains an essential treatment.

      Rivera A, Ohri N, Thomas E, Miller R, Knoll MA. The impact of COVID-19 on radiation oncology clinics and cancer patients in the US [E-pub ahead of print]. Adv Radiat Oncol. https://doi.org/10.1016/j.adro.2020.03.006. Accessed June 29, 2020.

      As the number of administrative and health care staff working from home increases, the burden of patient care increases on those continuing to work in clinic. In particular, radiation oncology requires daily interaction and coordination among physicians, radiation therapists, physicists, dosimetrists, nurses, and other health care staff to run a successful and safe clinical operation. Stress and anxiety associated with working in areas with potential for the spread of COVID-19 are amplified.

      Jun J, Tucker S, Melnyk B. Clinician mental health and well-being during global healthcare crises: Evidence learned from prior epidemics for COVID-19 pandemic [E-pub ahead of print]. Worldviews Evidence-Based Nurs. https://doi.org/10.1111/wvn.12439. Accessed June 29, 2020.

      Furthermore, the effect of working from home due to shelter-in-place orders and social distancing efforts for many staff members carries the additional burden of isolation, lack of separation between work and personal lives, disintegration of daily routine, and potential guilt about not being on the frontline.
      Thus, measures taken by individual departments are necessary to mitigate work-related burnout, particularly in the current health climate where the threat of COVID-19 lingers. In the department of radiation oncology at Stanford University, a committee of dedicated staff members was created in 2017 to address work-related wellness, burnout, and morale. Many initiatives are focused on facilitating departmental communication, improving camaraderie through relationship building and social bonding, and fostering a supportive environment through employee recognition and acknowledgments. We identified a tremendous opportunity for this committee to take on an integral role in addressing the new tensions and mandates brought about by this pandemic. We outline our process of improving morale and emphasize the importance of supporting employee wellness.
      The culture committee consists of approximately 15 members across various working groups in radiation oncology, including physicians, physicists, residents, radiation therapists, nurses, and other health care staff. Subcommittees focus on appreciation, communication, social events, and website and media. The committee convenes monthly to discuss current events occurring in the department, subcommittee updates, and ideas to improve the wellbeing of department members. Funding is provided through the hospital as part of a broader quality initiative incentive program for improving clinical care for patients with cancer. A portion of the incentive payout may be used for social and team-building purposes.
      The first pandemic response initiative taken by the culture committee in the early period of surge preparation was to show support for the essential health care staff, particularly the radiation therapists, nurses, physicians, and staff who remained on site. Committee members created care packages consisting of vitamin C packets, hand lotion, cough drops, mint candies, and snacks. Owing to the difficulty of obtaining hand sanitizer, individual spray bottles of hand sanitizer were made in-house according to World Health Organization guidelines

      World Health Organisation (WHO). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care [E-pub ahead of print]. World Health. https://doi.org/10.1086/600379. Accessed June 29, 2020.

      and also distributed to protect our staff. In another initiative to mitigate the initial shortage of personal protective equipment for our health care workers, committee members successfully obtained 200 reusable masks as a charitable donation from a local company that had dedicated its production to manufacturing personal protective equipment. Additionally, outreach to foreign and domestic companies led to donations totaling >1000 single-use surgical masks.
      Acknowledging the continued work of our frontline health care workers, the committee purchased and distributed grocery store gift cards. Additional funding was allocated for regular meals and snacks. Finally, a committee member obtained large donations of meat products that were used to host 2 barbecue lunches. These lunches were distributed to frontline workers in the radiation oncology, nuclear medicine, diagnostic radiology, respiratory therapy, and emergency departments. Thank you notes from department leadership were attached to the gift cards and boxed lunches.
      In an effort to address potential social isolation and disconnect as a result of social distancing, the culture committee created opportunities for virtual social gatherings and interactions. First, members created a weekly podcast through Zoom (Zoom Video Communications, San Jose, CA). Each week for 8 weeks, selected department staff were interviewed as guests and asked about how they were coping and adapting to changes made to their work and personal routines, observations they noticed in the clinics or at home, and personal hobbies and activities they usually enjoy. In addition, the culture committee created virtual Zoom breakrooms to allow staff to “drop-in” and have conversations with colleagues in an effort to restore some of the social interactions they relied on to stay connected. The committee has also organized more formal and scheduled virtual “meet-ups” for casual social interactions. Finally, through a regular monthly department newsletter, affectionately titled “Breaking Rad” and originally designed to communicate work-related issues and developments from department leaders, the committee dedicated its most recent issue to social bonding by inviting and soliciting material from department members. This ranged in topics from the working-at-home experience, interesting photos, humorous stories, and uplifting moments, to stories happening around the department and local area.
      Boosting and maintaining morale throughout departments, particularly during this unprecedented time, is essential for work productivity and institutional success.

      Weakliem DL, Frenkel SJ. Morale and workplace performance [E-pub ahead of print]. Work Occup. https://doi.org/10.1177/0730888406290054. Accessed June 29, 2020.

      The goal of these initiatives (Table 1) is to address stress and anxiety related to workplace safety, support and acknowledge staff, and facilitate social bonding to improve morale and maintain employee engagement and clinical performance. Fifty-four members of our department, including radiation therapists, nurses, dosimetrists, physics and medical faculty, residents, and clinical staff were surveyed on the effect of our culture committee’s efforts to boost morale. In total, 36 (67%) individuals agreed that the activities were effective in increasing department morale during the pandemic. Thirty (56%) responded that the activities were “just right” rather than “not enough” or “too much.” The gift cards, provision of snacks and meals, and care packages had the greatest number of ratings as “extremely helpful” (Table 2). Thirty-two (59%) found the weekly podcasts to be “very helpful” or “extremely helpful.” These Zoom podcasts consistently drew ~25-30 department members each week, with some members requesting it to continue. Department members rated the Zoom breakrooms as the least helpful, likely owing to lack of facilitation and coordination among working group team members. Respondents suggested that facilitation of virtual games and contests could also be useful for bringing department members together to improve morale. Owing to varying work shifts in the midst of the pandemic, members also mentioned that some individuals did not experience the committee-held events.
      Table 1Culture committee initiatives addressing the needs of health care workers
      NeedInitiative
      Worker safetyDistribution of care packages
      Obtaining donations of reusable masks and PPE
      Creation of individual hand sanitizer spray bottles
      Worker acknowledgmentGift cards to grocery stores
      Provision of snacks and meals
      Obtaining donations of food
      Social interactionsDepartmental podcast
      Departmental newsletter
      Zoom breakrooms
      Virtual gatherings for members of various working groups
      Abbreviation: PPE = personal protective equipment.
      Table 2Rating of helpfulness of culture committee initiatives for boosting morale and maintaining a safe workplace during the COVID-19 pandemic
      NeedInitiativeRating (n = 54), %
      Not helpfulSlightly helpfulSomewhat helpfulVery helpfulExtremely helpfulDid not answer
      Worker safetyCare packages1 (1.9)2 (3.7)9 (16.7)8 (14.8)30 (55.6)4 (7.4)
      Worker acknowledgmentBarbecues2 (3.7)4 (7.4)4 (7.4)13 (24.1)25 (46.3)6 (11.1)
      Gift cards1 (1.9)1 (1.9)2 (3.7)13 (24.1)34 (63.0)3 (5.6)
      Lunches and snacks1 (1.9)2 (3.7)7 (13.0)8 (14.8)32 (59.3)4 (7.4)
      Social interactionsDepartmental newsletter3 (5.6)3 (5.6)8 (14.8)17 (31.5)20 (37.0)3 (5.6)
      Podcast5 (9.3)5 (9.3)10 (18.5)16 (29.6)16 (29.6)2 (3.7)
      Zoom breakrooms15 (27.8)7 (13.0)11 (20.4)3 (5.6)9 (16.7)8 (14.8)
      Abbreviation: COVID-19 = corona virus disease 2019.
      As facilities begin to ease restrictions to transition back to more “normal” workflows, some of the committee events will likely evolve to fit the changing needs of the department. Some working groups may never fully return to the workplace; for example, our dosimetrists found that their team works well from home and can perform effectively from outside the office. Thus, although some of our committee’s initiatives, such as the Zoom breakrooms, will likely not continue, they may evolve into more structured virtual events for those who may continue to work from home. As in-person breakrooms continue to reopen for regular use, precautions and physical distancing will continue to be essential. Thus, the implementation of wellness initiatives may be focused on facilitating department member interactions, whether virtually or at a distance, as well as working to ease some of the burdens of daily life. In addition, we recognize the importance of mentorship, education, and career advancement, which are fundamental factors in determining overall job satisfaction and burnout, and we continue to develop initiatives to address these areas. We emphasize the importance of paying attention to the needs of employees and the implementation of measures to improve department culture.

      References

      1. Rivera A, Ohri N, Thomas E, Miller R, Knoll MA. The impact of COVID-19 on radiation oncology clinics and cancer patients in the US [E-pub ahead of print]. Adv Radiat Oncol. https://doi.org/10.1016/j.adro.2020.03.006. Accessed June 29, 2020.

      2. Jun J, Tucker S, Melnyk B. Clinician mental health and well-being during global healthcare crises: Evidence learned from prior epidemics for COVID-19 pandemic [E-pub ahead of print]. Worldviews Evidence-Based Nurs. https://doi.org/10.1111/wvn.12439. Accessed June 29, 2020.

      3. World Health Organisation (WHO). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care [E-pub ahead of print]. World Health. https://doi.org/10.1086/600379. Accessed June 29, 2020.

      4. Weakliem DL, Frenkel SJ. Morale and workplace performance [E-pub ahead of print]. Work Occup. https://doi.org/10.1177/0730888406290054. Accessed June 29, 2020.