Health systems are uniquely positioned to advance health equity by ensuring that their own workers are well, supported, and equipped to deliver high-quality care. The COVID-19 pandemic has shown how work environments in health systems affect the well-being of workers, whose capacity to deliver safe, patient- and family-centered care plays a central role in achieving health.

Healthforce Center Director Sunita Mutha and colleagues undertook a study this year of trends and opportunities with the potential to promote health worker well-being strategies, and to strengthen systems that advance equity in health care. A report on the findings is now available.

A literature scan confirmed the need to prioritize multi-pronged organizational interventions over individual interventions to achieve worker wellness. Conversations with national stakeholders underscored that the broader context in which health workers live and work affects their well-being. The effects on work and work climate of the COVID-19 pandemic, unmet social needs, recent social upheaval around racial inequities, and larger policy issues around payment, reimbursement, and wages were emphasized as particularly profound.

"The pandemic has shifted expectations of health care. It’s proved that we can work remotely and that will be a norm. [These] small variations will focus on convenience and flexibility. Well-being will move from ‘good to have’ to ‘must have.’ Well-being will be an expectation and demand of young people in training. And, there will increasingly be inclusion of well-being measures in organizational dashboards." — Health system leader

The pandemic’s disproportionate effect on middle-skill workers (such as clerical, nutrition, facility services, etc.) highlights differences in the nature of their work as well as differential access to skills, training, and social supports. There are knowledge gaps in the factors that affect the well-being of middle-skill workers; this understanding is essential for designing effective interventions. The report highlights areas that would benefit from investment and strategies to prevent and ease burnout, improve diversity, and inform how to better promote progress toward health equity for a diverse workforce.

The greatest immediate need for improving health workers’ well-being is mental health supports to address increases in depression, anxiety, and stress. Acknowledging that important policy (such as payment reform) and cultural (such as reducing stigma) issues must be addressed, but which exceed the initial scope of this effort, the report identifies five priority recommendations to pursue. The report speaks to these five areas in detail:

• Strengthen and expand worker resources to address mental health challenges, especially those that are culturally and linguistically concordant. 
• Address secondary trauma experienced by workers, such as burdens of increased workloads, risk of job loss, and the pressures of dependent care. 
• Support development of comprehensive organizational approaches to improve worker well-being among safety-net entities, where worker diversity might further health equity broadly. 
• Grow the knowledge base and tools for improving worker well-being to advance health equity broadly by investing in the large and often overlooked middle-skill workforce.
• Reduce stigma for workers seeking mental health services and supports by normalizing outreach and ensuring confidentiality. 

Health systems in the United States are in a precarious position as they grapple with how to ensure an adequate and healthy workforce. While the pandemic has underscored the vulnerable state of health workers, it offers the opportunity to reimagine and invest in strategies for supporting worker well-being and to make progress toward health equity. Individual health systems differ enormously — as do health workers — which means there is no simple, one-size-fits-all solution. No health care system should have to decide either to care for the individuals that make up their workforce or to meet the health needs and goals of the communities they serve. Health care systems should be equipped to do both. The report’s recommendations reflect the need to use different levers for sustainable systems change and for strategies that can be put into action now and for those that require planning, coalitions, and partners.

See the complete report, “Advancing Health Worker Well-Being: Trends and Opportunities,” with detailed findings and investment recommendations. 

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