Developing an Evidence-Based Approach to Support the Mental Health of Health Care Professionals

Why It Matters

In the last year, Pernille Cedergreen, MD, became increasingly aware of the impact that COVID-19 was having on health care professionals. As the Chief Physician for the Department for Anesthesia, Surgery, and Intensive Care at Herlev and Gentofte Hospital in Copenhagen, Denmark, she was keen to do something that went beyond a quick fix.

“As a leader of a multidisciplinary clinical team, I have always been aware of the psychological impact of delivering critical health care on the well-being of my team,” Cedergreen said. “However, during the COVID-19 crisis, I have seen how staff, who already work in highly challenging circumstances, have had an extra layer of complexity added to their work and their private lives. As a leader, I have tried to find positives, and look for opportunities.”

Cedergreen’s department is now collaborating with national research and implementation experts to test better ways to support the delivery of high-quality and safe care during challenging times. We’ve assembled a team of clinical, research, and improvement experts for an eight-month pilot project they are calling Mental sundhed for sundhedsprofessionelle (MeSu).

Though the direct translation of the project name means “mental health of health care professionals,” “mental health” in this context encapsulates a state of well-being in which individuals can develop skills to deal with stress and form healthy relationships. The team believes that having the psychological resources and abilities to cope with challenges are essential for good mental health.

The literature  indicates that health care professionals often express the need to talk with close peers soon after a stressful episode. Ideally, staff should also have access to evidence-based interventions such as debriefing and defusing, and their organization should actively support a culture of openness and learning.

The MeSu project team assembled a group of psychologists, doctors, midwives, nurses, and specialists in patient safety, cultural development, and work environmental medicine. The team aims to improve psychological safety, overall learning culture, and reduce the level of emotional distress among health care professionals. Although MeSu is a pilot project, the department has over 400 staff members, so its scale is relatively large.

We will put together a comprehensive program of theoretical learning on mental distress and psychological first aid, defusing, and practical training on having supportive conversations between peers. Supportive conversations are short discussions between close colleagues. They consist of three parts: 1) invitation to talk; 2) focus on emotions associated with the stressful episode; and 3) preparation to move on.

The goal will be to provide training using real cases. The team will also train some clinicians and leaders to deliver key evidence-based interventions for more significant events or experiences, such as the unexpected death of a child. For the most severe events, access to dedicated psychological services will be available. Building the skills and knowledge within the staff will contribute to the long-term goal of sustaining the program beyond the lifetime of the project.

A crucial element of the model is the lengthy implementation period. Over a period of six months, program managers and clinical leaders visit each team weekly to discuss progress and to support learning based on local experiences. So far, this process has helped to build interest in the project and motivation among the staff. “This has been especially notable among the leaders,” Cedergreen remarked. “It’s fair to say that some of them [originally] had doubts about the need to engage in this program.” The team believes the implementation process will also contribute to the prolongation of the program.

Importantly, the program uses improvement science methods. Data are gathered on each intervention, and incorporated into the collective curriculum iteratively to generate the basis for the next implementation cycle. The team collects qualitative and quantitative data through interviews, questionnaires, and by noting the topics covered during supportive conversations. The team also collects organizational-level data, including rates of absence due to illness and job turnover.

The MeSu project aims to share their results through internal papers, conferences, and peer-reviewed journals. The project web page provides detailed information and will be updated over time. If you have experiences or research you would like to share about staff well-being (especially during the COVID-19 pandemic), please feel free to contact project manager Jacob Nielsen, MD, at jacob.nielsen@patientsikkerhed.dk.

Jacob Nielsen, MD, is a project manager for the Danish Society for Patient Safety. Simon Tulloch is a psychologist and senior consultant for the Danish Society for Patient Safety. Doris Østergaard, MD, is a professor at the Copenhagen Academy of Medical Simulation (CAMES). Marlene Dyrløv Madsen is a specialist consultant at CAMES, Herlev Hospital. The MeSu project team is grateful for support and funding from Velliv Foreningen.

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