Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership

Abstract

Managing stress, burnout, and vicarious trauma is a long-standing issue for the health and behavioral health workforce, including those in case management. Yet, the recent novel coronavirus pandemic has amplified routine burnout to record levels. Practitioners and patients are amid a new dynamic of collective occupational trauma (COT). In this realm, health and behavioral health workers (HBWs) experience the same reality as their patients, families, and support systems; professional boundaries become blurred, leading to heightened levels of emotional vulnerability that can prompt the development of more pervasive psychopathology. This reality has put the Quadruple Aim in peril, with increased workforce turnover, staff shortages, costs, and quality challenges. Purpose/Objectives: This article: Identifies the incidence and costs associated with COT for HBWs; Distinguishes among terms associated with HBW burnout; Describes the occupational stress–trauma continuum; Defines COT; Explains the connection between COT and health care quality; Identifies why trauma-informed care (TIC) is relevant to address COT; Applies TIC to leadership and supervision strategies Identifies how established resources of guidance address workforce health, mental health, and professional self-care. Primary Practice Setting(s): Applicable to all health and behavioral health settings where case management is practiced. Findings/Conclusions: Organizational cultures must shift from a “process and roll” mindset to one that is trauma-informed. Implementation of TIC has yielded successful outcomes for the workforce via enhanced patient engagement, treatment adherence, and successful outcomes. In tandem, TIC leadership and supervision models have had promising results and should be more readily utilized; they acknowledge and address workforce trauma while prioritizing staff health, mental health, and wellness. Failure to shift the culture will result in an ongoing exodus of practitioners, leaving insufficient numbers to render safe, cost-effective, efficient, and patient-centered care. Implications for Case Management Practice: The case management workforce comprises professional disciplines across health and behavioral health, employed in every setting. The expanding workforce presence has put them at risk of COT. Leadership strategies must shift to acknowledge workforce exposure to occupational trauma, address mental health and wellness, and address professional self-care. This shift is key to mitigating retention, sustainability, and quality challenges.

Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers

“…The events from 2020 related to COVID-19 and racial reckoning were traumatic for individuals across the globe, and many HCWs worked diligently to provide trauma-informed care, which ensures empathetic and sympathetic patient care by promoting a culture of healing, safety, and empowerment (Fink-Samnick, 2022). However, to provide this support to its workforce, healthcare organizations must embrace trauma-informed leadership.…”

“…Koloroutis and Pole (2021) gathered five requests from HCWs for their trauma-informed leaders: (1) to be heard; (2) to be protected; (3) to be assisted in preparation; (4) to be supported; and (5) to be cared for. These requests show the need for adequate trauma-informed leadership in healthcare organizations, which can result in physical, psychological, and emotional safety, trust, choices, collaboration, and empowerment for all HCWs (Fink-Samnick, 2022).…”

“…In fact, more than half of HCWs in the United States reported feelings of burnout, anxiety, or depression from working during the first year of the pandemic (Murthy, 2022), all of which increase the risk of developing PTSS following a traumatic event (Williamson et al, 2021). Additionally, PTSS, burnout, compassion fatigue, and moral distress are well-recognized occupational hazards of HCWs (Cavanagh et al, 2020; Fink-Samnick, 2022).…”

Wholistic Health Equity's Quality Conundrum

“…Existing metrics continue to silo health or behavioral health. Insufficient focus has been on industry-vetted quality models addressing population-focused, concordant, and trauma- and equity-focused interventions (Fink-Samnick, 2022).…”