VALUE. DELIVERED.


Standards of conduct: Critical care for healthcare workers


by Karen Conway A


s we pass the two-year mark and more than 900,000 deaths in the U.S. from COVID-19, I pause to


refl ect on what the pandemic has taught us. Amidst the heartache and hardships, we have gained a much deeper appre- ciation for issues that we knew about (or should have) and which hold the keys to improving the health of society as well as our healthcare system. Those lessons range from the degree to which health inequities increase the prevalence of chronic disease and in turn hospitaliza- tions and death from the virus among the poor and communities of color to the incidence of violence against healthcare workers that has grown significantly worse during the pandemic. The pan- demic has also highlighted the frailties of a still primarily fee for service health system that is not designed for public health. To me, it has also underscored the importance of managing and safe- guarding the fi nite resources we have to do what healthcare is supposed to do: generate better health. Just as we work to ensure the quality of the medicines and medical devices used in patient care, so, too, should we protect the ability of our healthcare workers to do their jobs, with- out which our healthcare system would (and could) collapse. That’s why I was so moved recently by


the work of Medical University of South Carolina photojournalist turned nurse to document the journey of both patients and caregivers on COVID wards in pho- tos displayed on the hospital’s Facebook page. With permission from patients, families and healthcare workers, Alan Hawes began documenting their stories in hopes it would lead to more people being vaccinated. One of his subjects is a 37-year-old unvaccinated man who had to be intubated when he contracted COVID. Today, that same gentleman (who thank- fully recovered) now pleads with others to get vaccinated because, in his words, “We need to give [healthcare workers] a


break because eventually they are going to break.” While much of the news these days is


about the critical shortage of healthcare workers, and in particular the fi nancial strain faced by hospitals that must address attrition rates as high as 35 percent by hir- ing traveling nurses who make 2 to 4 times more than a staffed nurse, the more alarm- ing story is the rise in violence against an already burned out and stressed work- force. According to a National Nurses United survey conducted last fall, nearly one-third of nurses reported an increase in violence. Even before COVID, the U.S. Occupational Health and Safety Admin- istration (OSHA) declared hospitals to be one of the most dangerous places to work. The pandemic has only increased and shone a light on the threat. There is always heightened stress when people are sick, but nurses say even simple requests (to wear a mask) or questions (about vac- cination status) have ignited violence. And it’s not just nurses. While they bear


much of the brunt of the attacks given how closely they work with patients and families, a supply chain executive told me recently that members of her staff have also been physically accosted. The vast majority of the attacks lead to non-fatal injuries, and the real trauma comes when staff, already burned out by a relentless pandemic, do not feel safe at work. Beyond the signifi cant toll on these essential workers, studies show work- place violence can lead to more medical errors and turnover. According to a recent poll, 2 in 5 nurses and 1 in 4 physicians are considering leaving practice. Yes, it is hard to imagine the U.S. health system on the verge of collapse. After all, it is nothing compared to the plight of countries like Afghanistan where fi nancial sanctions have cut off funding for supplies and clinician salaries. There, the plight of the healthcare system and the families that depend upon it is being held hostage by geopolitical confl icts. In the U.S., as


56 March 2022 • HEALTHCARE PURCHASING NEWS • hpnonline.com


the line from the cartoon strip Pogo so aptly stated, “We have met the enemy, and it is us.”


Hospitals and health systems have


taken steps to protect staff from violence, including beefed up security, de-escalation training and panic buttons. These can be effective, but they do not address the underlying causes, one of which is the decline in civility and respect for others. That’s why I am so appreciative of recent messages posted by Northwell CEO Michael Dowling and Healthcare Financial Management Association (HFMA) CEO Joe Fifer. In his blog post, Fifer bemoans the lack of empathy for healthcare workers and notes how something as simple, yet authentic, as a thank you note from a school child can ease some of the pain. Dowling is more direct, placing blame on elected leaders who have modeled bad behavior and those on social media who have spread misinformation and gone as far as celebrat- ing deaths among the unvaccinated. Dowl- ing also offers several remedies, none of which are diffi cult, but all require a willing- ness to comply. His advice: Listen to others, ask questions, share your perspective and do not ridicule. Perhaps most importantly, he says respect diversity of thought, as well as of race, gender, religion, sexual orienta- tion and, yes, political persuasion. From my perspective, diversity of thought and appreciation for a range of perspectives is at the heart of innovation that has driven advances in medical science. Now, it may just be respect for diversity that saves our healthcare system. HPN


Karen Conway works to advance the role of the supply chain as a critical enabler in the pursuit of a value-based healthcare system. As Vice President, Healthcare Value for Global Health- care Exchange (GHX), Conway explores how the supply chain and improved data quality and visibility can support understanding of what increases value for patients and to those organizations that develop and deliver healthcare products and services.


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