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Leadership should be visible to staff because it creates a sense of sharing the risks of frontline care. Research indicates strong visible leadership and support, especially from senior levels, can improve the health and well-being of HCPs. Leaders can demonstrate support for employee health by engaging HCPs in discussions. When leaders visibly express concern and support mental health efforts it can enhance employee perception that leadership is on their side and contribute to the destigmatization of mental health to develop a more resilient system.

Our research shows that HCPs were aware that healthcare leadership was overwhelmed by their own challenges during the pandemic. One respondent noted: “[Leadership is] also tired because they had the abundance of workload as well, trying to figure out what’s the right thing to direct our team with. Where do we get… the PPE when we don’t have unlimited resources… And they’re under the same stress, just not dealing with the frontline patients” (35HCP). HCPs recognized and empathized with these challenges but felt that leaders often prioritized patient care and COVID-19 protocols over employee well-being. In participant interviews, several opportunities were identified related to improving healthcare leaderships’ ability to mitigate and address employee mental health.

Research insights and recommendationsHCPs’ reportsStrategies for implementation
Explain the rationale for decisions and demonstrate your understanding of the impacts of decisions on your teams. 

HCPs explained that they struggled to understand the decision-making processes of leadership regarding protocol and policy changes. Many HCPs stated that they wanted leadership to be more forthcoming about how and why decisions were made, especially when changes contradicted HCPs’ professional values.
Most HCPs expressed concerns about policy/protocol changes at some point duringthe pandemic. However, their main concern was not being provided rationale for decision-making, which led to distrust in leadership.

“How do you build trust again with your staff…People weren’t sure the reasoning behind [changes in protocol] so there was maybe a little bit of non-transparency with what was happening or why things were happening. It was, ‘Well, don’t change your mask and it will be OK.” And they were like, “Well why do we not change our masks? This is a disease. You’re just trying to save money and save resources.’” (61RT)
Explain how policy and protocol changes were informed and why they were necessary. A lack of information often leads to negative interpretations. 

To reduce negative impact on staff morale when difficult decisions need to be made and help them see that you recognize the potential impacts:

• Keep equity in mind. 

• Offer as much choice as possible

• (E.g., in cases of redeployment, share needs and invite volunteers as a first step. Then allow people to select shifts in order of seniority if they’re required to take on different responsibilities and spread redeployment requirements equitably. Wherever possible, allow for alternative options to accommodate life circumstances and reduce stress).
Professional autonomy and respect are important values to demonstrate at all levels of the organization.

Hierarchical structures within healthcare organizations make it difficult for all HCPs to have equal levels of autonomy over their work, which leads HCPs to feel that leadership does not respect them. During the pandemic, HCPs reported communication only occurring from the top-down with no opportunity to provide feedback or input.
Many HCPs felt they had little professional autonomy and their expertise was often overlooked. This led HCPs to feel like they didn’t have a voice.

“Just having that voice of what actually happens at the bedside when [leadership is] making decisions [is important] because we’re always shut out of those decisions. And decisions come to us instead of [leadership] coming and asking for what we need or what makes sense.” (06HCP)
Implement shared decision-making models to  enhance bidirectional communication and build respect for expertise of the interdisciplinary team.

Establish regular communication processes like town halls or informal meet and greets to communicate directly with senior leaders. 

Communicate your response to staff recommendations and suggestions made in meetings/town halls so HCPs feel heard. 
Be a visible accessible presence to demonstrate support of and interest in your employees’ work 

HCPs felt that leadership, especially senior leadership, was absent and inaccessible during the pandemic. As a result, many HCPs felt that leadership did not fully understand the reality of the challenges HCPs were facing and the stress associated with these circumstances. Policies and orders coming from higher up the chain of command reflected a lack of understanding of working conditions on units.
“I remember a night when a Staff Support Specialist did rounds and actually came by so that we could feel validated, like “Can I talk to you about what’s going on here?” And, “Can I talk to you about what we’re witnessing or what we’re experiencing?” To have someone who is actually checking in with us…I wish that my boss did that too.” (116HCP)Demonstrate a genuine and personal concern for HCPs. This can influence employees’ perceptions of leadership and their work environment.

Engage in conversations with HCPs about mental health and how they would like to be supported. This destigmatizes mental health and demonstrates caring.

Build a culture of “being in this together” by encouraging respect, inclusion, and support. This improves team identity and trust in leadership. 

Ask for feedback and provide opportunities (e.g., meetings, debriefs, huddles, etc.) for staff to voice concerns without fear of being reprimanded.
Create ongoing and regular opportunities for staff collaboration and feedback regarding leadership decisions.Integrate that feedback where possible.

In many cases, HCPs stated that they were reprimanded for voicing concern or providing input on changing protocols and policies, despite the organization officially encouraging them to share their opinions. This created distrust between employees and leadership and led to feelings of helplessness.
Several HCPs explained that they were often ignored or reprimanded when they brought forward concerns or questions. 

“I think it’s leadership and the organizational culture… They say that they want people to voice their opinions and their wants and their needs… but any time I’ve tried to it’s come with almost, like, punishment.” (99HCP)
Ask HCPs what the organization/leadership can do to help them feel comfortable raising concerns and providing constructive feedback to begin rebuilding trust.

Hold the organization/leadership responsible for implementing feedback received from employees in a timely manner.

Create safe spaces in the workplace for HCPs to provide feedback (e.g., huddles).

Whistleblower policies should explicitly state that individuals who bring forth concerns of malpractice will be protected.
Value your teams by regularly demonstrating your gratitude in ways that resonate with them.

Most HCPs felt their organization’s attempts to demonstrate appreciation (e.g., pizza parties) did not adequately acknowledge the extent and magnitude of the heavier workload, increased stress, and risk of infection they endured during the pandemic. As a result, HCPs reported feeling expendable, devalued, and like they were moveable pawns instead of individuals who made personal sacrifices for the continuity of healthcare. HCPs also felt there was a disregard for their basic human needs (i.e., lunch breaks, going to the bathroom, etc.)
Many HCPs felt that their organization’s attempts to acknowledge and express gratitude for their contributions did not adequately meet their needs. Many HCPs were also unable to benefit from the organization’s appreciation efforts (e.g., wellness activities) because of their heavy workload.

“All the emerg nurses put up an advertisement for a cart. It was called the colouring and tea cart so when you were stressed you could go get something to colour or make yourself a cup of tea… We’re just like, ‘You know where you can stick your colouring and your tea right now?’ We don’t even have time to pee like we’re going to go grab something to colour?” (225HCP)
Acknowledge HCP stress through actions, such as providing accessible mental health support to staff (e.g., in-service, benefits, etc.)

Follow up short-term mood boosters like free lunches with verbal thanks and acknowledgement for the challenges HCPs are dealing with. Ensure that any activities offered during the day shift are available to those on the evening and night shifts too.