In this pandemic crisis leaders are not only at war with the COVID-19 virus, they are also at war with the debilitating effects of "battle fatigue" among their healthcare heroes on the front lines. Reports from virus hotspots around the globe reveal that clinicians are dying not only because of infection but also because of cardiac arrest or other ailments due to overwork and fatigue. Fatigue must be carefully managed or the virus war may be won at an unacceptably high cost to clinicians.
From a former military and airline pilot with extensive alertness management and fatigue countermeasures expertise, here are six things leaders must do to ensure the alertness and well-being of their most important resources.
Act if Fatigue Really Matters
Because it does. People are Your Most Critical Asset - safe, high-quality, effective care in a crisis depends on your team performing well. Studies show fatigue causes:
The judgment and reaction time of someone with a BAC of .10
20% more errors & 14% longer to do clinical tasks
A doubling in the risk of making errors
A lapse in attention and vigilance
A higher-than-average risk of contracting COVID-19
Impaired decision-making and ability to assess risk and consequences
Implement a Fatigue Management Policy
All high-reliability organizations, including major military powers and U.S. airlines, have fatigue management policies that drive operations.
Military policies include titles like, "Fatigue Management During Operations: A Commander’s Guide"
To legally operate in U.S. airspace, U.S.-based airlines must have a Fatigue Countermeasures Policy and a Fatigue Risk Management Plan
Policies take a Systems Approach - both the organization and the employee have a responsibility to manage fatigue
Provide Fatigue Countermeasures Education
Education in Fatigue Countermeasures is required in high reliability organizations. Research has provided us with an arsenal of proven strategies for fighting fatigue. The question is not whether they work — they do — but whether clinicians know them and understand how to integrate them into their personal work lives. There are many "off the shelf" courses available, including those from the FAA. (LifeWings has one, too.) Topics should include:
Fatigue and its science-based countermeasures
Circadian Rythm disruption and its countermeasures
Actively Manage Duty Times
Time on duty is directly related to fatigue. For example, if you have an adverse outcome it is 1.7 times more likely that the team will have been on duty 12 hours & 5.5 times more likely they will have been on duty 13 + hours. Manage duty times accordingly. Science-based best practices include:
No more than 60 hours on duty in any 7-day period
No more the 3 straight night shift duty periods
No more than 9 hours of direct patient care in the daytime (duty time minus lunch, breaks, huddles, meetings, etc.)
No more than 8 hours of direct patient care during the night shift
9 hours of "protected" rest in any 24-hour period
30 hours duty-free in any 7-day period
Implement Fatigue Countermeasures
Fatigue has been extensively studied and science has given us proven countermeasures. Best practices that can be implemented quickly include:
Reward those that admit their level of fatigue and ask for a "crosscheck" during team meetings/huddles
Make caffeine immediately available - in close proximity to the workplace
Make water immediately available and encourage drinking it
Encourage napping (especially for the night shift) during breaks and make accommodations for it
Design menu and food choices (especially for the night shift) based on their "alertness factor"
Provide hotel accommodations for caregivers with families that are self-quarantining
Accept and Track Cost
Protecting your most precious resources through active fatigue countermeasures has a financial cost. It's not free. Failing to protect them has a cost as well. Recent studies of caregivers in COVID -19 hotspots reveal that they experience symptoms of depression (50 percent), anxiety (45 percent), insomnia (34 percent), and psychological distress (71.5 percent). Fatigue increases cost because of errors, risk management expenses, turnover, sick usage, and lower productivity. The good news is that there is a return on investment, And, by carefully tracking your increased costs due to managing duty times and implementing countermeasures, you may be able to reimburse most of those costs with government stimulus funds.
About the author: Stephen is the founder and CEO of LifeWings Partners LLC – a team of physicians, astronauts, nurses, pilots, and Lean experts that have helped over 220 healthcare organizations in the U.S. and abroad implement the best safety practices from aviation and other high-reliability industries. He is the author or contributing author, of three books on patient safety. Results of his patient safety work have appeared in over 35 publications and news outlets. A former professional pilot with 42 years of experience, Stephen was a captain for a major international airline. His expertise in the field of aviation safety training has garnered him seven awards for superior performance and Quality Achievement - including his work on a Fatigue Countermeasures course for his airline. He has also conducted workshops for the University of Southern California’s School of Aviation Safety. Harden is a graduate of the United States Naval Academy. He accumulated over 300 aircraft carrier landings during service with the U.S. Navy and was selected to be an instructor pilot at the Navy’s elite Fighter Weapons School (TOPGUN).
Steve, along with all of the LifeWings team, is deeply grateful for the heroic work you are doing on the frontlines. Together, we will prevail.