The past 18 months have placed seemingly unending physical and emotional strain upon physician anesthesiologists, CRNAs, and allied health care workers. As clinicians, we've seen care protocols for COVID patients evolve. We have repeatedly adapted our practice to the latest surge. In a specialty that prides itself on reliability and the ability to respond immediately at all times, we've managed enormous swings in day-to-day OR volume as well as widely fluctuating demands for our services to acutely ill patients in unexpected ways. Our resilience has been tested. The inherent normalcy of daily life has been turned upside down. Perhaps it is best summed up with a quote I heard frequently over the past year: “There's no right way to feel right now.”

When there is no “right way to feel,” it is imperative that organizations take notice and prioritize the mental health and well-being of their employees.

Historic trends have demonstrated that professional satisfaction among physician anesthesiologists has eroded due to a variety of factors, including increased administrative burdens in care delivery, perceived loss of autonomy, and increasing daily productivity demands. These factors have been further compounded by the tumult brought about by the pandemic, and the strain on mental health and wellness is significant (JAMA Intern Med 2017;177:1826-32; Healthcare (Basel) 2016;4:37-46; Lancet 2016;388:2272-81).

Recognizing the unique challenges of the pandemic, our first task at NorthStar was to alleviate immediate stressors. A cross-functional COVID task force composed of anesthesiologists, CRNAs, and leaders from the corporate and executive teams identified acute needs that could be addressed immediately.

  1. Given the shortage of PPE in the initial months of the pandemic, we quickly procured and shipped PPE to locations where clinicians reported supply limitations and/or a high burn rate (

  2. We announced there would be no furloughs and that employees would be kept whole on their compensation, regardless of case volumes.

  3. Our HR team handled the entire paperwork and filing process for managing paid time off and leaves of absence when a clinician was exposed or became ill.

  4. We implemented a back-up care option by partnering with a nationwide care organization that provided both center-based and in-home care options.

Once we had policies and processes in place to handle those immediate stressors, we quickly pivoted our primary focus to the mental health and well-being of our clinicians. Given NorthStar's large and varied footprint, clinicians serve in facilities that covered the gamut from front-line hospitals receiving patients requiring immediate ventilatory support, to surgical centers that all but shut down due to the elimination of elective cases. Each had unique stressors, ranging from fear of getting COVID through occupational exposure, or passing COVID to others for the front-line providers, to the fear of severe economic loss for clinicians who were unable to work for an indefinite period of time.

Recognizing the diversity of circumstances, we felt our best approach was open and transparent communication from NorthStar leadership. This included:

  1. Daily email updates with information and resources.

  2. A dedicated COVID website providing real-time updates of clinical best practices.

  3. A secure forum where clinicians could bring questions regarding the care of COVID patients, share stories from the field, and acknowledge heroic individual and team efforts.

  4. Creation of employee resource groups promoting diversity, equity, and inclusion across the organization.

These efforts were supplemented by anonymous guided counseling sessions available to all employees.

We assessed the impact of our efforts by conducting a brief engagement survey with our employees focusing on NorthStar's COVID-related communication and response. Results were compared with those from an engagement survey conducted a year prior (see Table).

Table: Engagement Survey

Table: Engagement Survey
Table: Engagement Survey

As we adjust to a new normal, we've maintained our COVID task force, which meets regularly to address the ongoing mental health needs of our clinicians and to provide immediate support as the pandemic trajectory continues to evolve. Despite the challenges we've faced, feedback from our recent annual engagement survey suggests that employee engagement remains at its highest level.

There are many lessons to be learned from this pandemic, with undoubtedly more to come. One of the most significant lessons learned is the heightened recognition of the importance of mental health and wellness and the role it plays in our ability to deliver safe, high-quality patient care. As an organization committed to providing the best patient care, we know – now more than ever – that we have an ongoing responsibility to support the mental health and wellness of our clinical and corporate employees. As a community of health care providers, we all must continue to build awareness around the importance of equipping our colleagues with the tools and resources to strengthen wellness and resiliency.

Josh Lumbley, MD, MBOE, FASA, Chief Quality Officer, NorthStar Anesthesia, Columbus, Ohio.

Josh Lumbley, MD, MBOE, FASA, Chief Quality Officer, NorthStar Anesthesia, Columbus, Ohio.

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