Caretia Silva, a licensed clinical social worker, is a labor improvement adviser with the Alliance of Health Care Unions in Portland, Oregon, and a member of OFNHP. As many nonclinical employees prepare to return to the office, she offered advice about ways to reduce stress related to the latest challenges of COVID-19.

Many employees will soon return to the office. What feelings might they experience?

For some folks, working from home has been wonderful; for others, it’s been very stressful. Many people were managing a lot of competing priorities with children at home, online schooling, sharing “office” space with partners at home and extended family concerns.

Some people may experience anxiety, grief, excitement, anticipation — and many other feelings as they encounter unknowns — with returning to the office. For folks who have already returned to the clinics, they’ve had a gradual reintroduction and the process has been slightly more paced, although it hasn’t been without stress.

What tips do you have for staff preparing to return to the office and send their children back into the classroom?

There are bound to be challenges as we work out new routines. Anything you can do the night before to prepare for the next day is a good idea — set out clothes, load backpacks, make lunches. It can also be beneficial to have a consistent and routine bedtime, not just for your children, but also for yourself. If you have trouble settling down at night, try the Calm app.

In the morning, set yourself up for success for the day by building in “transition time” — this is time to get people from the house to the car, including all the needed gear for the day. Building in transition time allows for any last-minute items and reduces the stress of being late. If you arrive early at school with the kids, take advantage of the one-on-one time with encouraging words to pump them up for their day. It only takes a few minutes to make a meaningful connection with your kids.

How can team members set each other up for success in the workplace?

Coming back to the office or clinic is a major change compared to working from home.

And some folks never left the clinic. Everyone had their own unique experience over the last year and a half. This transition will take some adjusting. Fatigue among workers may be common due to the increased social interaction. In the beginning, people may feel some nervous energy bouncing off each other as they acclimate to the new environment. It’s important to give people the time and space they may need to reacclimate to an in-person work environment.

How can unit-based team co-leads support their teams?

People will acclimate to the office environment at different times. When people seem fatigued, be aware that they might need some space.

Sometimes people need to take a break and disengage from the group. It’s a process that allows them to realign and center themselves. Have empathy for staff adjusting to this change.

How can unit-based teams use LMP tools to help them through this time?

The Partnership behaviors are a solid foundation for teams to ground themselves, and the Free to Speak tools are also good to foster a culture of trust and engagement. This might be a good time for a UBT to take another look at its ground rules and see if the rules need updating. Interest-based problem solving can also be useful for teams struggling with processes that have been adapted or need to change.

What advice do you have for managers during this transition?

The success I’ve seen with managers is when they are authentic with their staff and allow themselves to be seen. They don’t have to reveal personal secrets, but when anyone is sincere and approachable, there is more trust and engagement.

What else is important to consider?

The world has changed in ways we never saw coming. The pandemic was catastrophic and, on top of that, we also dealt with social justice issues and political unrest. It’s important to acknowledge how these and other challenges — such as financial insecurity and housing insecurity — have contributed to stress and anxiety for many people. Self-care is crucial now more than ever.

How do I recognize signs of stress?

If close friends, family or loved ones have mentioned that you seem different, consider what they are saying. Are you more emotional — quick to cry, jump to anger or experiencing mood swings? Have your eating or sleeping habits changed? Changes and impacts to your daily living habits are signs that stress may be affecting you. Reach out to the Employee Assistance Program, find exercise you enjoy, or check out emotional wellness apps like Calm or myStrength.

As we move toward the “next normal,” the Labor Management Partnership has played a key part in supporting COVID-19 vaccinations.

Frontline workers, doctors and managers have come together to get shots in arms. These fruitful collaborations point the way forward as Kaiser Permanente and the Partnership unions work to transform fear into confidence, confusion into clarity, and hesitancy into bold action.

Look at the data

A joint effort between SEIU-UHW and physicians pushed vaccination rates of the union’s members from less than 50% all the way up to 64% within 3 months. It began when union leaders crunched the numbers — and didn’t like what they saw.

At the beginning of February, less than half of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. For instance, only 40% of union employees were vaccinated in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. Union members were scared, confused and hesitant.

Building trust

At first, they considered joint physician-labor rounding. But they realized being in patient areas wouldn’t support those conversations, so they pivoted to huddles — short, informal team meetings.

Carol Ishimatsu, MD, a pediatrician with the Southern California Permanente Medical Group, was one of the first doctors to join a huddle in Downey.

“Vaccines are our most important intervention,” says Dr. Ishimatsu, who participated in the clinical trials for the shots when they were being tested.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line. “I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

“We did it in partnership,” says Montoya, the emergency medical technician. “The labor partners led the huddles and introduced the doctors.

I can’t imagine that happening in a nonunion hospital, or even a non-Partnership hospital.”

After learning more than a year ago that patients were having trouble getting doctors’ appointments, members of the Keizer Station Family Medicine team in Oregon began exploring ways to improve service and access. Their solution? Offer more video visits.

“What we didn’t realize at the time is that this work would put us in a unique position to be ready for the pandemic, which wasn’t on anyone’s radar in fall 2019,” says Ruthie Berrell, medical office director and management co-lead for the Family Medicine/Nurse Treatment Center unit-based team. 

Collaboration by the team’s frontline workers, managers and physicians has served as a partnership model for UBTs in the Northwest Region. It’s also earned the department applause for improving service and access at a critical time in health care, as teams across the enterprise adapt to the rise of virtual care. 

“It wasn’t always easy,” says Molly Maddox, RN, the team’s labor co-lead and OFNHP member. “This took a lot of working out the kinks and working together.” 

Overcoming resistance to change 

One of the team’s earliest challenges involved staff resistance to virtual care. Worried that patients would perceive virtual visits as a “takeaway,” some staff members pushed back. 

“The culture of how we delivered care was in the medical office, and people had different levels of acceptance across the spectrum,” says Caroline King-Widdall, MD, team co-lead and physician in charge. 

So, team members educated their peers on the benefits of virtual care and developed scripting to help them feel at ease offering video appointments to patients.

“People are more comfortable now taking the lead and scheduling appointments,” Berrell says. Others feared that older patients were less tech savvy and would have difficulty accessing their virtual visits. In response, team members posted informational fliers in exam rooms and emailed instructions to patients before their appointments. 

Building team engagement

Key to the team’s success was engaging everyone, including physicians. Medical assistants and nurses partnered with providers to review physician schedules and flag appointments they could convert to virtual visits. 

Also, UBT members participated in weekly huddles “where we brainstormed new tests of change and talked about what worked and what didn’t work,” says Maddox. The team’s efforts paid off. 

Patient satisfaction scores for ease of scheduling appointments jumped from 53% to 85% between August 2019 and December 2020. And because members access video visits through kp.org, website registration among the department’s patients increased by nearly 10% during the past year. 

The hard work has not gone unnoticed. This past fall, the team received the region’s UBT Excellence Recognition Award for improving service and access. 

Maddox attributes the team’s success to strong relationships rooted in partnership. “We know that we would not have had this success if our team didn’t work together.”