Insights Series Issue 17: "How to protect healthcare workers during and beyond the COVID-19 pandemic?"

This thought leadership paper hightlights concrete steps to mitigate the physical risk to healthcare workers and to safeguard their well-being.  

Insights Series Issue 17 transforming-care-delivery improving-patient-experience The New Normal .. . Protecting those who protect others Steps to ensure caregivers’ physical and mental health A thought leadership paper on how to “Transforming care delivery” and “Improving patient experience” SIEMENS Healthineers Preface The Insights Series The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. The Series explores emerging issues and provides you with practical solutions to today’s most pressing healthcare challenges. We believe that increasing value in healthcare – delivering better outcomes at lower cost – rests on four strategies. These four principles serve as the cornerstones of the Insights Series. Expanding Transforming Improving Digitalizing precision care patient healthcare medicine delivery experience The New Normal The New Normal is a special edition of our Insights Series focusing on the COVID-19 pandemic. This series provides recommendations on how to confront the current SARS-CoV-2 outbreak and its implications, as well as strategies and ideas on how to emerge from the current crisis stronger, more resilient, and better prepared to address the healthcare challenges that lie ahead. Please visit Executive summary The COVID-19 pandemic has served as a physical mental brutal reminder to the world that the safety of healthcare workers must be top of mind for jurisdictions, health systems and healthcare executives. We cannot protect patients if we cannot protect the people responsible for their care. This paper identifies two challenges in protecting healthcare workers – ensuring their physical safety and safeguarding their mental wellbeing. While achieving these two goals may require different approaches, they are inextricably linked because they work towards precisely the same ultimate objective: the safety and wellbeing of healthcare professionals. Protection Siemens Healthineers Insights Series · Issue 17 3 Physical Protection Mental Protection In September 2020, Amnesty International estimated In addition to their physical health being at risk, that at least 7,000 health workers worldwide had healthcare workers have also suffered mentally and died after contracting COVID-19.¹ Particularly during emotionally during the pandemic. The mental health pandemics, healthcare workers are always going to toll taken by COVID-19 has been considerable. Patient be among those who pay the stiffest price; they are care has suffered, and entire organizations have been the ones required to put their health on the line to care affected. Illness and absenteeism are prevalent, which for and comfort infectious patients. can drive up costs. Burnout and fatigue can contribute to mistakes, malpractice claims, and reputational This paper outlines several steps that health facilities damage. High-stress workplaces can lead to higher staff can take to mitigate physical risk to healthcare workers, turnover and low morale, as well as poorer outcomes while continuing to deliver care to patients. and diminished patient experience. • Restrict access to healthcare facilities to ensure that Protecting healthcare workers means protecting their only people who absolutely need to be there are mental health as well as their physical health. Just as allowed through the door. measures exist to safeguard people’s physical safety, • Distance potentially infectious patients in triage strategies and techniques are available to improve the locations by creating physically separated triage areas. environment in which people work, helping to safeguard • Set up dedicated spaces, equipment, and personnel their mental health. These are just as essential as the for infectious patients, reducing the need to move steps to protect their physical safety. them and ensuring that as few people as possible come into contact with them. • Support care teams in acute situation, helping front • Create safe care settings by building a good patient line workers with the physical and mental stress of and workforce safety culture and by repurposing working in dangerous situations. spaces and equipment. • Build care teams’ mental resilience with mind-body • Constantly monitor and test COVID-19 frontline staff techniques such as mindful breathing, active in order to identify potential infections early and meditation, biofeedback, and guided imagery. undertake appropriate measures. • Establish internal leaders to embed social support • Move staff behind the COVID-19 frontline, keeping and facilitate a feeling of being “all in it together.” them away from potentially infectious patients • Design healthcare facilities for a positive experience whenever possible. for the people who work there. • Provide natural spaces where employees can thrive, for example with natural light and elements of nature. • Build a remote culture by making it easier for patients and caregivers to connect virtually. 4 Issue 17 · Siemens Healthineers Insights Series Introduction Protecting Healthcare Workers is Imperative The COVID-19 pandemic has wrought many changes, “Caregivers and health one of the most important being renewed recognition care professionals around the world of the critical role played by health- care workers and the imperative that they be kept as will regain social safe as possible. recognition as noble As the pandemic began to take hold, jurisdictions everywhere emphasized the importance of “flattening and valuable members the curve.” For most people, the COVID-19 experience of society, no longer came to be defined by a vague and frustrating feeling of imprisonment, with the solitary safety of home treated like service replacing office work, group activities and most types of socializing. But for healthcare workers, particularly workers or as a those on the frontlines, the COVID-19 experience has been quite the opposite as they supported the sick, commodity.” dying, and contagious. Tomislav Mihaljevic, Healthcare workers were also forced into new and unfamiliar roles. They rapidly had to modify workflows MD, CEO and President, within hospitals and other facilities, to increase capacity Cleveland Clinic² for COVID-19 patients and ensure the safety of others. They had to act as substitutes for family members who were not allowed to visit the ICU, holding the hands of infected patients. At the same time, they had to grapple with their own personal challenges, including shortages of supplies and fear of possibly bringing the virus home to their own families. The protection of healthcare workers encompasses two equal challenges – protecting both their physical health and protecting their mental and emotional wellbeing. Only by focusing on both, in relatively equal measure, will providers around the world be able to adequately protect those on whom we depend to protect others. Siemens Healthineers Insights Series · Issue 17 5 The challenge Because of the nature of their work, frontline care- An early survey of approximately 1,300 healthcare givers were often exposed to SARS-CoV-2, and in workers in China (60% of survey participants from many locations, particularly early on, this risk was Wuhan), showed that more than half reported symptoms exacerbated by shortages of personal protective of depression, 45% symptoms of anxiety, 72% symptoms equipment (PPE). The World Health Organization of distress, and 34% of insomnia.⁴ In the U.S., after two said that healthcare workers accounted for around emergency workers committed suicide, New York’s 14% of global COVID-19 infections.³ Mount Sinai Health System opened a Center for Stress, Resilience and Personal Growth to focus on early As bad as any single infection can be, the infection of interventions, screening for depression symptoms and a healthcare worker can have an exponential effect resiliency training.⁵ Researchers with that program have on capacity within any hospital or medical center. estimated that 25% to 40% of first responders and At best, the infection of a healthcare worker can be healthcare workers will experience Post-Traumatic Stress managed through timely quarantine measures, Disorder (PTSD) as a result of the COVID-19 pandemic.⁵ resulting in the temporary loss to the organization of Symptoms of PTSD can be disabling, and include anxiety, an essential team member. At worst, the infection can irritability, difficulty sleeping and concentrating, as well spread rapidly among staff, threatening to bring a as persistent emotional numbing and social withdrawal. hospital to its knees. COVID-19 also poses a significant threat to the mental health and wellbeing of healthcare workers. Stress and burnout are common amongst healthcare professionals. According to the National Academy of Medicine, as many as half the doctors and nurses in the U.S. have experienced this, resulting in increased risk to patients, malpractice claims, absenteeism, and turnover costing the medical industry billions of dollars every year. During the COVID-19 pandemic, the emotional and mental stress of these workers intensified, as they were forced to deal with overcrowded ICUs, frantic family members and sick patients, while having to make unthinkable life and death decisions in settings that were often overcrowded and overwhelming. 6 Issue 17 · Siemens Healthineers Insights Series Global COVID-19 infections Symptoms shown in healthcare workers Healthcare workers Rest of population Early survey among healthcare workers from China 14% Distress 72% Depression 50% Anxiety 45% Insomnia 32% Siemens Healthineers Insights Series · Issue 17 7 Recommended strategies Physical Protection As the pandemic intensified, health system and In order to safeguard the physical safety of doctors, organizations quickly began to adopt strategies to nurses and other healthcare workers, a number of address these twin challenges. While the threats strategies have been developed and refined in to caregivers’ mental and emotional health were organizations around the world. What made this work often overlooked during the early months of the particularly challenging in the early days was that basic pandemic, it is now clear that both challenges must information about the infection, including about its be addressed. Techniques and strategies to do both, transmission, often simply didn’t exist. As a result, often simultaneously, have been developed and changes had to be introduced, modified, and monitored shown to be effective. on an ongoing basis. “Health care systems can, and will, improvise even in suboptimal environments. Heroic teams have rapidly adapted by reconfiguring older buildings to increase hospital beds, finding alternative ventilator sources and respirators, and implement protocols to protect their staff.” Gianrico Farrugia, MD, President and CEO, Mayo Clinic² 8 Issue 17 · Siemens Healthineers Insights Series 1 Restrict access to healthcare facilities 2 Distance potentially infectious patients The first step that needs to be taken is to better manage, in triage locations and if necessary restrict, access to healthcare facilities. Within medical centers, potentially infectious patients Only people who absolutely need to be there should be should be isolated from other patients and providers allowed through the door. This includes non-urgent whenever possible. Patients are most likely to come into patients, family members, vendors, suppliers, and back- contact with one another in triage locations, so this is office employees. where separation efforts should be focused. Clearly, the first step should be remote triage, via phone or video In the case of urgent patients, preventing healthcare conference. The creation of additional, physically workers from seeing them is clearly not an option. In separated triage locations is also helpful. In some those cases, it is critical to assess the risk of infection and instances, containers and tents have been used to use mitigation measures, particularly PPE. For non-urgent provide this badly needed additional space. Spare patients, however, various telehealth solutions not only rooms within a hospital are obviously a simpler option. allow for self-monitoring at home, but also provide for These discrete locations allow for separate workflows, video consultations with physicians. Particularly during advancing safety and increasing capacity. events such as the COVID-19 pandemic, these solutions allow physicians to connect with patients who are Within these locations, as well as in regular healthcare quarantined at home, monitor their progress on an settings, maintaining as much distance as possible ongoing basis, and take appropriate action if needed. between potentially infectious patients and caregivers should be a priority. While a certain amount of contact Many institutions have also established virtual touch- is inevitable, there are innovations that can minimize points with suppliers and vendors. Most business of this, for example tools that allow medical devices such this type does not need to be conducted face-to-face. as CT scans to be controlled remotely. Service technicians sometimes must do their work on site, but in many cases technology is available to maintain equipment and to support clinical personnel remotely, or to schedule preventative maintenance for off-peak hours. Others Covid-19 infection Visitors and relatives Yes Non-urgent patients Urgent patients! Unclear ? No V Siemens Healthineers Insights Series · Issue 17 9 3 Establish dedicated spaces, equipment and 4 Create safe brick and mortar care settings personnel for infectious patients The importance of viewing every action and decision Once the triage process is complete, care must be taken through the lens of infection control is essential. to ensure that potentially infectious patients do not For non-COVID-19 patients, creating safe brick and infect healthcare workers or other patients. For patients mortar care settings imbued with a culture of safety is who are known to be infectious, the first priority must vital in preventing infection. The key to building a good be to set up dedicated, separated and shielded spaces, patient and workforce safety culture is to establish high such as pop-up hospitals, in order to effectively isolate standards for infection prevention and control, focus them. Within these spaces, it is critical to ensure that on migrating from inpatient to outpatient consultation, proper PPE is available for both patients and their and repurpose spaces and equipment as much as caregivers. In addition, providing dedicated equipment possible. For example, CT scanners in Radiation Therapy for use in contaminated spaces helps to reduce the risk departments or PET/CT and SPECT/CT scanners in of infection, as neither patients nor the equipment need Nuclear Medicine can be used as standalone CT scanners to leave the designated area. Portable ultrasound systems to serve as back-up for non-COVID-19 patients, in the and mobile X-ray machines can support this effort. event of a backlog. 10 Issue 17 · Siemens Healthineers Insights Series 5 Monitor COVID-19 frontline staff As noted earlier, the threat from healthcare workers The first is remote work. The COVID-19 pandemic has becoming infected and passing the disease on to their shifted the transition to remote work into overdrive. colleagues and families is serious and must be mitigated. TIME magazine called the emerging phenomenon “the Close monitoring of COVID-19 frontline staff is key to world’s largest work-from home experiment,” pointing identifying potential infections early on and undertaking out that as a result of the coronavirus outbreak, working appropriate measures. Contact tracing should be from home is “no longer a privilege, it’s a necessity.”⁶ conducted for clinical personnel, patients, and Today, remote work in a healthcare context can equipment, in order to understand contact trails in effectively connect care teams, allowing for collaborative confirmed cases. Radio frequency identification (RFID) decision-making, remote planning, and team coordination. tags are one way of doing this. Moreover, remote solutions can connect caregivers with patients for remote monitoring, diagnosis, and therapy. Finally, testing is critical. Establishing regular and reliable testing routines for clinical personnel is Just as important, assisting COVID-19 frontline staff by essential in preventing the spread of COVID-19 telephone and video is an effective measure that helps throughout hospitals, clinics, and other medical protect clinical personnel. Remote scanning is often centers. possible, with imaging personnel able to perform their functions from almost anywhere they can plug in a laptop. Virtualizing tasks that previously required 6 Move staff behind the COVID-19 frontline close proximity to potentially infectious patients is an A final strategy for physically protecting the healthcare emerging opportunity that can play an important role workforce is to identify ways of moving clinical in protecting clinical personnel. personnel behind the COVID-19 frontline. What this means is keeping them away from potentially infectious patients whenever possible. There are several ways of accomplishing this. Work remote Protect and test Healthcare hygiene Social distancing Siemens Healthineers Insights Series · Issue 17 11 ”Essential and frontline Mental protection workers are making an impossible choice every day, risking their health As noted earlier, protecting healthcare workers means protecting their mental health as much and their family’s health. as their physical health. In order to do this, it is important to explore immediate and long-term Saving lives. Keeping society ways of creating healthier and more positive work afloat. They are making environments. Of equal importance is addressing mental health management, helping workers build such a tremendous sacrifice the mental resilience they need to handle the stress they encounter. for our communities. I expect many of them will experience higher rates of depression, anxiety and post-traumatic syndrome disorder.” Renee Schneider, Vice-President of clinical quality, Lyra Health⁷ 12 Issue 17 · Siemens Healthineers Insights Series 7 Support care teams in the acute phase 8 Build care teams’ long-term mental resilience Healthcare workers are never as vulnerable as when with mind-body techniques they are on the frontlines, responding to natural It is important that healthcare leaders ensure that all disasters, pandemics, or other emergencies. It is staff have the skills they need to be mentally as well as critical that the healthcare organizations who send physically healthy and resilient. This will help ensure that these workers to deliver acute care in acutely they are able to provide the best care possible for their dangerous situations implement measures to support patients, and that they are able to enjoy relatively normal and protect them, both physically and mentally. lives away from work. Mind-body techniques such as When the Red Cross mobilizes for major disasters, mindful breathing, active meditation, biofeedback and its response includes spiritual care, for patients and, guided imagery have helped millions of people develop just as important, for the people helping them.⁸ self-awareness, self-care, and self-expression skills, and are proving effective in doing the same for healthcare Many hospitals have already creatively explored short- workers. term immediate solutions for care teams who are under high pressure either physically, mentally or from changed factors at home. During acute situations, leading institutions have implemented care team support such as 24/7 psychological support call centers, options to allow caregivers working long hours to sleep on-site, and in some cases even childcare. Many institutions offer training in critical incident stress management, a way of helping first responders or care- givers process a traumatic event soon after it happens. Adrienne Boissy, MD, MA, Chief Experience Officer of Cleveland Clinic Health System, has noted that “health care will never deliver the healing we want if patients are having great experiences and outcomes, but clinicians and employees are exhausted, disconnected, and burned out.”⁹ Siemens Healthineers Insights Series · Issue 17 13 9 Establish internal leaders to embed 10 Design emergency spaces to alleviate social support emotional distress The feeling of being “all in it together” is one that most Designing and adapting physical spaces to respond people respond to. Such a feeling of togetherness and to the unique requirements of a crisis is, as discussed mutual support is particularly important during times above, essential for safeguarding workers’ physical of crisis. Being part of a facilitated group significantly safety. Yet, well-designed spaces should also help enhances participant outcomes, as all are able to benefit workers to feel safe, contributing to their feeling of from the sharing of skills and mutual support. security and wellbeing. Research-based mind-body medicine programs¹⁰ can also be of great value and can be conducted in small There are various ways of doing this, shaped by the online group formats, supporting staff and helping nature of the emergency and the circumstances them to relieve stress and trauma. surrounding it. What they have in common is that they provide an element of privacy and calm to The small groups described above can be led by leaders healthcare workers who are otherwise surrounded within the organization who have received training in by panic and distress. these techniques, allowing them to form and lead small groups of their own. In the long term, such a system A simple example would be something as basic as a allows healthcare organizations to create a culture of privacy partition, allowing for a moment of down time care within teams, one that promotes the valuing and and reflection. A more sophisticated take on this idea supporting of staff as an organizational principle, is what is known in emergency response situations as potentially easing stress and trauma and reducing a “coping corner”, a space that is private for care teams staff burnout. when they feel they need a break or some alone time.¹¹ This becomes especially important if symptoms of anxiety are heightened. It can include soothing light, soft blankets, comfortable clothing, and distractions such as art supplies and music. The purpose of this space is to tune out negative thoughts, distressing emotions, and difficult social stressors, and to tune in to being mindful and compassionate towards oneself. 14 Issue 17 · Siemens Healthineers Insights Series 11 Design healthcare facilities with natural spaces 12 Build a remote culture for a positive staff experience COVID-19 has taught the world that working from home The physical design of a facility can not only create a is not only possible, but in many cases preferable or even powerful healing environment but can also facilitate essential. This will likely continue to be the case post- effective communication among staff and between pandemic. Remote work has become a reality and has staff and patients. allowed many healthcare workers to deliver first-class care while remaining safe, secure and free of debilitating Hotels and restaurants have long understood that worry and stress. While this is not always possible in a physical spaces that are “nice to be in” will attract healthcare context, there are many ways for patients customers and help retain staff. It is now widely accepted and physicians to interact virtually, allowing patients to that healthcare facilities should subscribe to this experience a feeling of human connection. In addition, philosophy, with spaces designed around patients and healthcare teams can work with one another through their care pathways. Healthcare facility planners must virtual support networks, with all the empathy and now be focused on creating a healing environment that mutual support that would be available were they in optimizes every patient’s experience. This has a critical the same physical room. added benefit, because it is very much a situation where what is good for the patient is good for the provider.¹² A change like this should be supported by cultural adjustments to ensure that employees continue to feel Biophilic design is an increasingly popular concept within valued and integrated into their teams and workplaces. the building industry. It focuses on creating a connection This can be supported by embedding recognition, for between the people inside a facility and the natural example in team meetings, as well as informally. environment that would normally be found only outside. Coaching and mentoring on how to work digitally can This is accomplished through an emphasis on natural also be helpful. Measures to foster virtual collaboration light, as well as the incorporation of elements of nature are also important to support this cultural change. into the overall design of the space. Research has shown that biophilic design in the workplace increases creativity and reduces absenteeism. Some studies have reported an 8% increase in productivity and a 13% increase in employee well-being.¹³ Many healthcare organizations are rightly incorporating the biophilic design approach. Siemens Healthineers Insights Series · Issue 17 15 “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe”¹⁴ “We can’t stop COVID-19 without Conclusion protecting health workers first.”¹⁵ Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization This paper makes two basic assumptions about Late in Spring 2020, the Harvard Business Review healthcare and healthcare facilities. The first is that published an article entitled Health Care Workers Protect a society that prides itself on keeping patients healthy Us. It’s Time to Protect Them.¹⁶ The authors outlined a and safe not only has a moral imperative to also keep number of what they called “leadership imperatives” healthcare workers healthy and safe, but a practical for the healthcare industry if it is to take the safety of one as well – workers who are sick, scared or unhappy its workers seriously. The last of those was “Don’t use cannot provide the level of care that patients need. frontline caregiver heroism as an excuse not to act.” The second is that any infection suffered by a In other words, focusing on the courage and healthcare worker as a result of exposure to a patient commitment of caregivers who become infected should should be regarded as having been preventable. not be a way of letting the rest of us off the hook for the fact that they were in harm’s way in the first place. We should instead be focusing on how to keep them out of harm’s way. This paper presents a number of strategies and actionable techniques that support this objective. Particularly during a time like this, it would be advantageous for the healthcare industry to explore solutions that have not previously been considered as much as they should – specifically those involving remote technology that allows for the delivery of care from afar. A deeper understanding of caregivers’ mental and emotional wellbeing, combined with creative techniques to safeguard this wellbeing, is also essential. A stronger focus on these two interrelated objectives will play an important role in assisting individual healthcare workers, institutions, and society, to emerge from the current pandemic in good health. 16 Issue 17 · Siemens Healthineers Insights Series Suggested follow-up on • Insights Series, Issue 10: Remote work for healthcare professionals remote-work-in-healthcare • Insights Series, Issue 9: Managing the impact of caregiver stress and trauma in the COVID-19 era: a strategy toward resilience-building • Insights Series, Issue 8: Seven strategies for thriving in a market with COVID-19 Information: H. The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. It explores emerging issues and provides practical solutions to today’s most pressing healthcare challenges. All issues of the Insights Series can be found here: Contact: For further information on this topic, or to contact the authors directly: Dr. Christina Triantafyllou Vice President, Head of Improving Patient Experience [email protected] Dr. Herbert Staehr Vice President, Head of Transforming Care Delivery [email protected] Siemens Healthineers Insights Series · Issue 17 17 About the authors Dr. Herbert Staehr Vice President Dr. Ralf Meinhardt Global Head of Transforming Care Senior Global Marketing Manager Delivery at Siemens Healthineers at Siemens Healthineers Herbert Staehr serves as Global Head of Transforming Ralf Meinhardt leads Siemens Healthineers’ thought Care Delivery for Siemens Healthineers, driving the leadership activities related to Transforming Care company’s activities and messaging around delivering Delivery. Previously, Ralf worked in the pharmaceutical high-value care. In this capacity, he develops and industry, as well consulting and scientific research. executes programs and outreach strategies aimed at Ralf holds a Doctor of Economics and Social Sciences healthcare providers around the world, as well as degree from the University of Erlangen-Nuremberg. stakeholders in every branch of the healthcare industry. He holds a Master of Science degree in Management. In Before joining Siemens Healthineers, Herbert spent addition to his academic work at the University of several years with one of Germany’s leading private Erlangen-Nuremberg, he also studied at the Indian Insti- hospital groups, as head of the Corporate Development tute of Management, Bangalore (IIMB). His scientific department and serving as Managing Director of an background is in the field of corporate strategy, a subject acute care and a post- acute care hospital in Germany. on which he has authored several publications. He also spent several years with McKinsey & Company with their healthcare practice, providing strategic advice to a wide range of international clients. Herbert holds a doctorate in Healthcare Economics from the University of Hohenheim. Dr. Christina Triantafyllou Vice President Head of Improving Patient Experience at Siemens Healthineers Isabel Nieto Alvarez, MSc Christina Triantafyllou is Siemens Healthineers’ Global Senior Key Expert on Head of Improving Patient Experience, exploring ways in Improving Patient Experience at which this field can be enhanced and made more acces- Siemens Healthineers sible to healthcare providers. She develops strategic Isabel Nieto is passionate about innovating and approaches to deliver high value care, by providing transforming the experience of care to be human- patient experience focused solutions, best practices and centered. She is an expert in the Siemens Healthineers thought leadership content. Christina began her health- Global Innovation Network on mental and physical care career at Harvard Medical School, Boston, where she stressors in the experience of care. Isabel leads cross- worked as a medical physicist. At Siemens Healthineers, functional teams in innovative projects on patient she served as the Director of Global Ultra High Field MR experience. She is a biomedical engineer from Solutions, focusing on business strategy, KOL-based Universidad Ibero-americana in Mexico, holds a Master collaborations in innovation/clinical translation, and in Science on Mind and Body Medicine from Saybrook product management for the first worldwide clinical 7T University in California, and Certifications on Leadership MR system. Christina holds a PhD in Medical Physics from in Healthcare without Harm and Design Thinking. Kings College, University of London, UK. 18 Issue 17 · Siemens Healthineers Insights Series References 1. Amnesty International. Global: Amnesty 7. Perna G. Supporting COVID-19’s mental 12. Gordon JS, Miller AJ, Nieto Alvarez I, analysis reveals over 7,000 health health crisis for frontline providers Triantafyllou C. Managing the impact workers have died from COVID-19 [Internet]. Health Evolution. 2020 [cited of caregiver stress and trauma in the [Internet]. 2020 [cited 2020 Nov 20]. 2020 Nov 20]. Available from: heal- COVID-19 era: a strategy toward resil- Available from: ience-building. Siemens Healthineers news/2020/09/amnesty-analysis- covid-19s-mental-health-crisis-for- Insights Series [Internet]. 2020;(9). 7000-health-workers-have-died-from- frontline-providers/ Available from: siemens-healthineers. covid19 com/insights/news/managing-the- 8. Lewellen D. Spiritual Care When Disas- impact-of-caregiver-stress-and- 2. NEJM Catalyst. Lessons from CEOs: ters Strike. Health Progress: Journal of trauma.html Health Care Leaders Nationwide the Catholic Health Association of the Respond to the Covid-19 Crisis. NEJM United States [Internet]. 2019;100(6). 13. ANS Global. The Principles and Benefits Group Public Health Emergency Collec- Available from: of Biophilic Design [Internet]. 2019 tion [Internet]. 2020;1–22. Available tions/health-progress/article/ [cited 2020 Nov 20]. Available from: from: november-december-2019/spiritual- full/10.1056/CAT.20.0150 care-when-disasters-strike and-benefits-biophilic-design#:~:text =The effects of biophilic design, 3. World Health Organization. Coronavirus 9. Boissy A. Getting to Patient-Centered increase in employee well-being. disease (COVID-19) - Weekly epidemio- Care in a Post-Covid-19 Digital World: A logical update - 12 October 2020 Proposal for Novel Surveys, Method- 14. World Health Organization. Keep health [Internet]. 2020 [cited 2020 Nov 20]. ology, and Patient Experience Maturity workers safe to keep patients safe: Available from: Assessment. NEJM Catalyst Innovations WHO [Internet]. News release. 2020 source/coronaviruse/situation- in Care Delivery. 2020;1(4):1–26. [cited 2020 Nov 20]. Available from: reports/20201012-weekly-epi- update-9.pdf 10. Siemens Healthineers. How to create health-workers-safe-to-keep-patients- the healing environment of the future - safe-who#:~:text=“No country%2C 4. Lai, J et al. 2020. Factors Associated The human-centered approach to hospital or clinic,and the respect they With Mental Health Outcomes Among healthcare facility planning and design deserve.” Health Care Workers Exposed to Corona- [Internet]. 2020. Available from: virus Disease 2019. JAMA network 15. World Health Organization. Shortage open, 3 (3), pe203976. value-partnerships/asset-center/ of personal protective equipment white-papers-articles/healing-envi- endangering health workers worldwide 5. Mount Sinai. Mount Sinai Announces ronment [Internet]. News release. 2020 [cited Center for Stress, Resilience and 2020 Mar 3]. Available from: Personal Growth [Internet]. Press 11. Wheeler L. The 3 Pillars for Creating a news/item/03-03-2020-shortage-of- release. 2020 [cited 2020 Nov 30]. Safe Space: Managing Trauma Symp- personal-protective-equipment- Available from: toms During COVID-19 [Internet]. endangering-health-workers-world- newsroom/2020/mount-sinai- High Focus Centers. 2020 [cited 2020 wide announces-center-for-stress-resil- Nov 20]. Available from: highfocuscen- ience-and-personal-growth-pr 16. Segel KT, Toussaint JS. Health Care 3-pillars-for-creating-a-safe-space- Workers Protect Us. It’s Time to Protect 6. Banjo S, Yap L, Murphy C, Chan V. The managing-trauma-symptoms-during- Them. Harvard Business Review Coronavirus Outbreak Has Become the covid-19/ [Internet]. 2020 Jun 19; Available from: World’s Largest Work-From-Home Exper- iment. TIME [Internet]. 2020 Feb 3 protect-us-its-time-to-protect-them [cited 2020 Jun 26]; Available from: from-home/ Siemens Healthineers Insights Series · Issue 17 19 At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide benefit every day from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We are a leading medical technology company with over 120 years of experience and 18,500 patents globally. With about 50,000 dedicated colleagues in over 70 countries, we will continue to innovate and shape the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 Published by Siemens Healthcare GmbH · Printed in Country · 1220 · ©Siemens Healthcare GmbH, 2020

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