Serena Rice, MS CPH-NEW UMass Lowell; Jeremy Weiland, LICSW, Worcester MA; Cesar Morocho MS, MPH, CPH-NEW UMass Lowell; Sundus Siddique MBBS, MPH, CPH-NEW UMass Lowell; Alicia Kurowski, ScD, CPH-NEW UMass Lowell; Laura Punnett, ScD, CPH-NEW UMass Lowell SHIFT Project Research Team
Describe engagement of a joint labor-management team of mental health workers in development of participatory intervention activities to address burnout.
Burnout is a well-studied consequence of high job demands and low resources. Its three dimensions are emotional exhaustion, disengagement, and low personal accomplishment. Burnout evolves over time in a vicious cycle; emotional exhaustion manifests first due to high demands and triggers depersonalization, which is followed by a reduced sense of accomplishment. Even before the COVID-19 pandemic, burnout already represented a pervasive issue for mental health workers in Massachusetts. Among other issues, mental health workers experience bullying and assault at work, and short staffing often prevents adequate recovery time between these incidents.
The Intervention Design and Analysis Scorecard (IDEAS), developed by the Center for the Promotion of Health in the New England Workplace, is a participatory process involving root cause analysis and intervention design. In 2018, this program was initiated in a public-sector mental health facility which formed a joint labor-management Design Team (DT) composed mostly of front-line workers (multi-union, multi-disciplinary). Two facilitators, one representing management and one labor, were trained by researchers in the IDEAS process. Meeting facilitation, status presentations, and utilization of outside experts originated in the DT, particularly from the facilitators. Research staff attended DT meetings and recorded group process and outcomes. A steering committee of senior managers retained decision-making authority. The DT identified burnout as a priority issue and worked on identifying the root causes of burnout and building three workplace intervention packages to address it.
The package of intervention activities presented by the DT and endorsed by the SC for implementation included enriched orientation of new staff, a preceptor program, policy for personnel leaves, leadership training, a post-incident decompression room, increased staffing, advancement opportunities, and access to on-site education.
The COVID-19 pandemic interrupted implementation of the selected interventions. In the fall of 2020, DT members initiated sporadic meetings to reinvigorate their earlier burnout reduction efforts. Several barriers made this work challenging. Meetings were often cancelled due to worker absences which often put extra workload on DT members. In spring, 2021, meetings were often postponed because most DT members were instrumental in administering the vaccine at their facility. Research staff were unable to attend meetings in person, so remote methods were developed for facilitation and documentation, although technology and social distancing guidelines made meeting evaluation difficult. During the height of the pandemic, members of the SC engaged workers in listening groups to provide an outlet for staff to discuss issues such as their daily hurdles, virtual schooling for parents, and racial justice. The labor unions representing our study partners helped the members win hazard pay as well as ensuring that productivity guidelines were not considered in yearly performance reviews.
DT members were also trained in focus group facilitation by the research coach during this hiatus. The DT now plans to conduct focus groups to learn how workers’ priorities were affected by the pandemic and obtain feedback on the original intervention plans. Upcoming analysis of theme frequency and relevance of the focus groups will allow us to determine whether the DT activities had any impact on burnout.
The DT members sought to reduce worker burnout among themselves and their co-workers. While the pandemic created many barriers to the implementation of their planned interventions, these workers have shown impressive commitment to continue addressing the problem. In addition to resuming meetings on their own, another testament to their commitment is that all nine DT members completed the virtual focus group facilitation training. Over the course of the winter and spring, the team wrestled with identifying and framing how they would conduct and evaluate their focus groups, continuing to develop their own skills and confidence while adapting their plans to a radically different situation.
Despite the obstacles, DT team members have remained committed to addressing the issue of burnout. The DT remains committed to working with their leadership team to determine what might be feasible in the post-pandemic environment, while also seeking new ways to address the pandemic’s impact on the burnout that they and their colleagues are facing.
The unique and effective leadership skills developed by DT members include group facilitation, nuanced communication at various organizational levels, and policy evaluation. These have been acknowledged by hospital leadership and have led to several promotions for individuals. These skill sets can provide significant opportunities for future union leadership roles, as well as an impact on the larger labor movement.