COVID-19 is disrupting work, life and everything in between. When we pay attention to our wellbeing — the needs and experiences we all require in balance and combination to have health and hope and to weather challenges — we are more likely to succeed in times of rapid change. While leaders and employers can’t stop the progression of the virus, they can support staff wellbeing by adopting key strategies to mitigate the tradeoffs of change.
A Wellbeing Orientation is vital for helping people and communities cope with disruption. Some initial guidance is featured in our March 2020 newsletter. In the days to come, we will roll out a deeper dive into a Wellbeing Orientation in times of crisis.
At first, I wasn’t concerned at all about the spread of COVID-19. In fact, as the news started to roll in, I was a bit smug about the rising anxiety. But as the global community rushes to meet the challenge of this unforeseen health crisis, I’ve found myself chewing on a fundamental question: with all the threats that our communities face on a daily basis—the ravages of institutional racism, gun violence, addiction, rampant homelessness, pervasive domestic and sexual violence—what is it about this particular threat that feels different, more terrifying to those around me?
The anthropologist in me drew the easy conclusion. We’re contending with a basic instinct here: fear of the unknown. We humans have a well-cultivated, more-or-less successful strategy: fear what we don’t understand and overreact to unfamiliar information. This tendency is only amplified by our formidable ability to imagine so many unpleasant scenarios using our limited data.
But I’ve been at FFI for a few years now, and I’ve learned to dig down beneath fear, knowing that it is often driven by our need to hold on to our assets in the Five Domains of Wellbeing while we navigate the tradeoffs—big and small, voluntary and involuntary—that are required of us as we live our lives. FFI may be most well-known for demonstrating the ways that this operates on an individual and family level, but in the news I’m watching a live case study of how threats to our collective assets in the Five Domains of Wellbeing play out on the community level.
As I grounded myself in a wellbeing orientation, my perspective began to shift. Suddenly, my slightly smug dismissiveness was swept away by the realization of how deeply we will be impacted in each of the Five Domains:
Safety: Clearly, on the individual level, this is a direct threat to our lives and the lives of our loved ones. Will our friends, family, and co-workers of Asian descent be targeted by dangerous rhetoric? Is it ok to go to spaces that we have taken for granted as safe? Markets, places of worship, workplaces are all markedly more risky. Is anyone putting precautions in place to stop potential spread in these places with screening protocols or information on quarantine procedures? A casual cough by someone nearby now feels more dangerous. Can I trust other people to care for themselves appropriately if they start to feel ill?
Stability: An appropriate public health response on the scale required to stem the spread of a viral disease disrupts the patterns of our lives. If we’re required to work remotely to help flatten the curve, what will it be like to work in an unfamiliar space, to miss out on saying “hi” to our coworkers as we fill up our coffee, to establish new rhythms of work that we’ve relied on to keep our days on track? Will our travel options remain reliable? On any given day, what routines related to work will be disrupted? School? Childcare? If this escalates, will our bakeries and coffee shops open? Will our polling places be safe and accessible in November?
Social Connectedness: We are suddenly faced with the realization that even touch—a cornerstone of human social connection—is something that we should avoid. As we adopt various modes of social distancing, how will we stay in touch with our colleagues beyond an email, our friends outside of social media, or our faith communities as events and “extra” meetings are cancelled? Will we be able to give and receive care to our loved ones if the disease spreads to our doorsteps? And what if (may it never be so!) we contract COVID-19 and then recover—what stigmas might we face during our illness and upon recovery?
Meaningful Access to Relevant Resources: Our communities are not self-sufficient. We rely on trade–inter-city, inter-state, and international—for the goods and services that make our lives possible. It’s not just Baby Yoda toys and other mass-produced commodities that are at stake here. In the case of quarantine, will we be able to access food? Will we have access to the medical supplies we need to move through this? If we find ourselves scrambling to hoard supplies, are we protecting ourselves or are we exposing the most vulnerable people in our communities to increased risk? If public institutions scale back services or staffing, what segments of our populations will lose access to the help they need for housing, food, and other necessities?
Mastery: Are we collectively up to this? Are our systems strong enough, organized enough, resourced well enough to meet this challenge? Will testing kits and medical supplies be made available when and where we need them? Will public institutions that have so far struggled to produce clear guidance manage to do so in time? In the absence of this kind of guidance, do we feel like we can have an influence on our environment? If not, how might we act out individually and collectively to give ourselves even the illusion of that control—hoarding food and medical supplies; obsessively refreshing the news on our phones?
COVID-19 feels like a different type of threat because the best practices that are needed to stem the spread of the pandemic require us to make major tradeoffs—all at once—in each of the Five Domains. Taken individually, these may seem like minor inconveniences or small adjustments. Taken together, it’s overwhelming.
I feel like I can at least wrap my arms around the fear I see now.
So I’m not as smug about the rising panic. I’m approaching it with less eye-rolling and more hope: hope that when we stop and view this crisis—and our response to it—in the full-frame, we open up new pathways for a strong community response. Hope that as our public health officials issue guidance and move into action they will consider the tradeoffs that people will have to make, in order for that guidance to be successful. Hope that we’ll design a response that protects the people at the margins of our society just as much as the people at the center. Hope that we can find the path forward that preserves our collective wellbeing–and even contributes to our wellbeing after we successfully contain this microscopic terror called COVID-19.
This staff perspectives blog was written by Matthew Leger-Small, Special Assistant to the CEO on Tuesday, March 10, 2020.
Hungry to learn about how a focus on wellbeing can help transform patient care in our health care systems? Don’t miss the Center for Health Care Strategies’ Q&A with Tanya Tucker, FFI’s Chief of National Partnerships and Outreach.
Check out the October 2019 issue of FFI’s newsletter featuring voices from the field, thoughts on the importance of centering wellbeing in our healthcare system and much more!
Before coming to FFI, I spent most of my career practicing medicine in a small and privileged corner of the field that provides highly coordinated care to older people with frailty, complex illness, and chronic mental health issues. This system represents the best we have today, the gold standard of high-quality integrated and coordinated care. And yet. And yet, there is something else that was happening in this setting that was making people better that was more than the coordination of services and improved transitions between hospital and home. Over my last years in this work, I became extremely curious about what this “special sauce” was. Did it have a name, a language? Could we shine a light on it, scale it, build systems around it? These questions are what led me to the Full Frame Initiative.
I now believe that we do have a language and structure for this work, for what was happening in our clinic almost as a side effect of our work, and yet had powerful positive repercussions for the people in our clinic. This is the language and framework of a wellbeing orientation.
Let me share another story. Dr. Atul Gawande wrote in his Hot Spotters article about a patient who Dr. Jeffrey Brenner was able to work with who helped shape Dr. Brenner’s work with the Camden Coalition. This patient was receiving thousands of dollars of medical care and was not getting better. Was it bad care? Or the wrong care? This patient had heart failure, diabetes, morbid obesity, a history of alcohol and cocaine use and had been in the hospital a full half of the last three years. Why? Dr. Brenner spent time with this man, getting to know him and learning his story. As the story unfolds, we see that eventually, this patient gets better. His diabetes and heart failure are controlled, he stops using substances and he loses 200 pounds. What magical medicines or advanced technological interventions did Dr. Brenner use? None. He attended to this man’s wellbeing: the set of needs and experiences that we all require for health and hope.
Dr. Brenner’s team encouraged stability and routine in this man’s life, which included moving from a welfare motel to an apartment, as well as attending church and AA meetings regularly. They watched him reconnect with his girlfriend and children and benefit from the increased safety in his new apartment, as compared to his previous neighborhood. His team encouraged him to return to his prior trade, cooking. Over the next two years, there is no one magical intervention but this gentleman increased his assets in all areas of wellbeing—safety, stability, social connectedness, mastery and meaningful access to resources—and his health improved. It was attention to his wellbeing that led directly to improved health outcomes. He did not return to the hospital. This is almost miraculous. Except that it is so simple. It reflects the deep truth of what we all need and acknowledges that certain groups in this country have greater or lesser access to wellbeing.
We all know that our healthcare system, while so powerful in some ways, is failing us in others. This widespread acknowledgment has led to a welcome imperative for innovation, especially around addressing the social determinants of health. The time is ripe for exploring new models and new approaches. Healthcare is also in the midst of shifting payment structures to allow for funding of services, communities, and people who are supporting wellbeing. We have an opportunity right now to build something that addresses more than care coordination. We can build networks that support wellbeing and equity in our communities
I deeply believe that if we in healthcare attend to wellbeing, if we truly focus resources, innovation, and creativity in building access to wellbeing for all of us, individually and in communities, we will reap significant rewards in improved health outcomes. Let’s build a movement for wellbeing, a movement for increased access to wellbeing for all of us, and let’s put it at the heart of our work in health. I’m in, are you?
Rachel joined FFI having made a leap from medicine to systems and social change. After some time working from the outside in, Rachel has chosen to return to practicing medicine to create change from the inside out. FFI will be recruiting a new Director of Healthcare Transformation. Look for the job announcement and posting towards the end of the year.