The Children’s Hospital of Philadelphia (CHOP) cares for some of the world’s sickest children and does everything in its power to keep them from getting sicker. It is tasked with stopping viruses and bacteria from moving between patients, as well as with keeping them from entering the hospital in the first place.
Finding all of the potential sources of these germs is a challenge, and getting people to change their behavior is harder still. In working with parents and community members on policies for limiting contact between patients and sick visitors, CHOP realized it needed to have a similar conversation with another group that came to the hospital while ill: healthcare workers themselves.
Julie Szymczak, a postdoctoral researcher in CHOP’s Division of Infectious Diseases, and Julia Sammons, an assistant professor of clinical pediatrics at the Perelman School of Medicine and CHOP’s medical director of Infection Prevention and Control, wanted to know why.
Along with their colleagues Sarah Smathers, Cindy Hoegg, Sarah Klieger, and Susan Coffin, Szymczak and Sammons anonymously surveyed more than 500 CHOP clinicians about the circumstances and motivations behind working while sick.
The survey’s findings, recently published in JAMA Pediatrics, suggest that a sense of professionalism—not wanting to burden colleagues or let long-waiting patients down—was often at the heart of the decision.
“The motivation behind this research was to help healthcare workers make the decision to stay home when they’re sick,” Szymczak says. “Before we could do that, we knew we needed to ask them directly why they might come to work while sick.”
“In terms of adherence to policy and getting people to do the right thing, so much of what we’re trying to do involves figuring out the barriers involved,” Sammons adds.
Of those clinicians surveyed, 83 percent reported coming to work sick in the previous year even though 95 percent said they believed it was a risk to patients. This was in line with previous studies, which showed that working while ill was common, but left the reasons behind this apparently self-contradictory behavior as an open question.
With backgrounds in both sociology and infectious diseases epidemiology, Szymczak and Sammons were uniquely qualified to investigate.
“In patient safety, we frequently think of problems as stemming from lack of knowledge or resources. We educate healthcare workers and give them tools, but then the performance needle still doesn’t move as much as we’d like,” Szymczak says. “My research interest is in the gap that is left. That's where the complex social aspects come in.”
In addition to logistical concerns and some ambiguity about what constituted “too sick” to work, responses to the survey indicated that working while sick was simply understood as part of the “culture” of medicine. Doing so was a way for physicians to show dedication to both colleagues and patients, something demonstrated to them, consciously or not, by their peers and mentors.
The research team provided their data to CHOP’s department of pediatrics and helped develop strategies for dealing with the day-to-day idiosyncrasies and existing policies within its various divisions. Knowing that respondents were particularly averse to asking a colleague to cover their patients while sick, a common suggestion was to have a third person arrange for coverage when necessary.
“The follow-up included the development of guidelines that were flexible, given the needs of each division,” Sammons says. “The divisions really took it upon themselves to craft these guidelines with the expectation that it would make it easier for people to call out sick when they were supposed to.”
This grass-roots approach, the researchers say, is a way of tackling a complex problem that has both social and logistical causes.