The COVID-19 pandemic continues to challenge employers with strenuous and rapidly evolving workforce management issues. A panel of Mayo Clinic experts discusses strategic response to workforce management and regulatory compliance issues, as well as Mayo Clinic's continued core value emphasis on "the needs of the patient come first," and simultaneous support of a workforce in transition.
Moderator: Roshanak Didehban, chair, Department of Practice Administration; assistant professor of health care administration; instructor in health care systems engineering
Featured expert: Charles S. Bierman, J.D., consultant, Legal Department
Laura E. Breeher, M.D., M.P.H., interim chair, Occupational Health Services Executive Committee; consultant, Preventive Medicine; assistant professor of preventive medicine Featured expert: Samantha (Sam) K. Halverson, director, Human Resources, Mayo Clinic Health System in Eau Claire, Wisconsin
Featured expert: Mark A. Hyde, M.A., manager, Employee Assistance Program
Featured expert: Keri A. Slegh, SPHR, SHRM-SCP, chair, Division of Human Resources
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The views and perspectives shared in these resources are presented based on information available at the time of recording.
Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. All right, well, I'd like to welcome everybody today on behalf of the Mayo Clinic School of continuous professional development. Like to welcome you to the Mayo Clinic Cove in 19 webinar Siri's I'm Jeff. How are you going to be your host today on our topic is on responding to workforce management issues in the Cove in 19 Pandemic. Now, if you have a few house cleaning items as people are logging on here, this webinar is accredited by the A m A. For one credit. There are no relevant disclosures for today's discussion on. Of course, we'd like to thank Pfizer for their support of this educational activity. Now, before we get started, like to go over just a few details that will be helpful for today's webinar. First is you'll be able to claim credit for this Webinar. If you'd like to do that, you can see this link here. Visit us at c e dot mayo dot e. D u backslash Covic 09 to 8. What you want to do is when you go to this link, you'll need to log onto the site. If it's your first time visiting, we'll have you go ahead and register an account. Once you've done that, with this link, you'll see there's an access code box, and so you'll take in that box. You wanna enter the access code? Covad 09 to 8. This will allow you to access, of course, completely short evaluation, and then you'll be able to download or save your certificate. So a few things with this webinar what you'll see down below on your screen is you have a chat function and you have a Q and A function. Now if I could ask for the chat function, we'd like you to use that. If you're experiencing any technical issues, start support staff can help you. If you have questions for the panel today, we'd love to have to use that Q and a function eso a speaker's air talking. If you have a question right now, you can go ahead, open that box and go ahead and end to enter your question. You'll notice that when questions start coming in, they haven't up vote function. So if you see someone's asked a question that you also would like to see answered, go ahead and click that up. Vote in. Our Panelists will see that rise in the list, and we'll be able to prioritize and answering that for you. So in today's webinar, there's a few learning objectives. You will hopefully walk away. Really be able to determine rational contracting, tracing and monitoring processes for healthcare. Employees discuss the impact of Kobe 19. On the workforce. Identify resource is to assist employees during Kobe 19 pandemic identify permitted pandemic related medical exams and enquiries. Determined pandemic related accommodations, rights and obligations and, of course, be able to discuss protections for high risk employees. So with that, I'd like to introduce Are moderator for today? It is Roshi did Eban. She is the chair of the Department of Practice Administration at Mayo Clinic, an assistant professor of health care administration, and have also an instructor in the health care systems Engineering. With that, Rhoshii will pass it to you to introduce the rest of our panel. Great. Thank you, Jeff. And welcome everyone today We're really happy that you joined us for this discussion today. Our first Panelist, who I'm honored to welcome is doctor Laura Breer. Dr. Breyer is the chair of Employees Occupational Health Services Executive Committee, as well as a consultant within preventative medicine. We also are joined by Carrie Slay, who's chair of our division of Human Resource, is as well as Samantha Halverson, who's director of human resource, is within the Mayo Clinic Health System and oh, Claire, Wisconsin. We also have Mark Hyde, who is the program manager for our employee assistance program at Mayo Clinic in Rochester and also have significant expertise in leadership, employee motivation as well as performance issues. And lastly, we have Dr Sorry, we have Charlie Berman, whose legal counsel and senior director of our services at Mayo Clinic, and he has a significant experience in employment, disability absence management as well as occupational health services. And with that, I'll turn it over to our first Panelist, Dr Brewer. Thank you so much, Roshi, and it's a pleasure to be here. I'm looking forward to discussing just briefly a few of the things our group and employees occupational health has done in collaboration with the others on this call and their teams to support the health care workforce very early in the pandemic, we identified the need to create a 24 7 call line for healthcare workers. So we did this in collaboration with HR. Um, this call line is supported primarily by nurses, but there are options on the call line. Uh, if employees have questions about pay or other items that human resource is, could provide expertise on to route them to that team within our team and occupational health. The calls that primarily come to this number, our calls related thio personal Koven infection symptoms, um, personal exposures from household members air in the community as well as occupational exposure. So any time a an employee had breached and PPE when working with a patient, we would ask that they call us right away. And that 24 7 call line has continued to operate since spring of last year, and it's still available to employees Now. We get fewer calls after hours now, but it is still available for emergencies after hours as well as all day, seven days a week. The other thing that we did that was a little bit different in response to the pandemic was that we shifted the scope of the, um, individuals that we serve typically employees. Occupational health very much focuses on employees, and we identified that for safety reasons as well as's for ease for our health care workers and non employees on campus, it was important for us to provide kind of a one stop, um, number for them. So our employees Occupational Health team is serving employees, volunteers, students, contractors, essentially anyone who's on our campuses, um, working amongst our teams. We want them to call us if they're having any symptoms if they have an exposure, if they have any sort of concern so that we can have standard safety practices and standard restrictions for who should be on our campus and who shouldn't amongst those teams. And that's worked very, very well and I think alleviated um, any confusion that could have come from disparate recommendations for those non employees that they may have received from others. Another area that we were very heavily involved in was medical clearance for respirator use, and we continue to be involved in that. But the surge with clearing our employees and health care workers for use of respirators was really in March in April of this year, in a typical year, we clear about 1500 employees, and those employees go through fit testing for respirators like 95. So those will be people working in high risk areas where they may encounter potential respiratory pathogens. This year in Rochester, on our Rochester campus alone, we've cleared nearly 14,000 employees for respirators, and 11,000 of those were in March and April. So that was a lot of a lot of work for our occupational safety colleagues to actually do the fit testing, but also for our employees. Occupational Health Services to review all of the Occupational Safety and Health Administration question years that are required to ensure someone is safe to where a respirator. So we created a digital question here to apply some AI behind the scenes to help us with that and expedite expedite that process so that employees with no medical conditions that would prevent clearance could get that response immediately after submitting the question here. Our team is also very focused on return to work, so any time and employees out due to symptoms of co vid um kobane infection themselves or, if they have an exposure, were assessing before they returned toe work in determining restrictions early on for those that had covert infection were doing PCR testing. But as the knowledge has evolved and we've identified, the employees may remain positive with PCR. For a long time we've shifted those practices as well in response as several health care institutions have done. And then the final thing that I just wanted to touch on was the contact tracing work that our team has done. So it was identified early. The need for centralized contact tracing, um, was important. We centralized that exposure, investigation process and contact tracing, um, within our Rochester practice in collaboration with all of our enterprise partners. And we evaluate every single health care worker with covert infection to determine, um, how they may have acquired that any exposures they had collaborating with public health. And we also do active symptom monitoring of any exposed employees whether they were exposed, um, in the workplace, at home or in the community. Next line. The contact tracing process is one that I could probably talk about for a long time, so I wanted Thio share with you that we did put many of the details of our model that we developed in writing in a paper that was published in the Mayo Clinic proceedings, um earlier this summer to share that with other health care institutions and businesses. But just like public health and other health care institutions, the contact tracings focused on early detection, thoroughly evaluating anyone who may have been exposed so that no one has missed including evaluation of personal protective equipment. And one of the things that we were very thankful that are public health partners supported us in doing was Thio not only evaluate our health care workers for occupational exposures, but also thio be a resource for them and proactively in our contact tracing, ask about exposures at home. And it worked on. By doing that, we've been able thio, make decisions about the safety and returning to work much more quickly. Theun. We would have been able thio had we not been delegated that ability to do that. So with that, I'm going to hand it over to my colleague Kerry Slay in a charge, talk about some of the Kobe 19 workforce impacts their group has been working on. Okay. Thank you. Dr. Greer, Um, if you want to advance, advance applied. So my colleague Sam Halverson, I are gonna talk a little bit about the impacts Thio our workforce. Um, really, starting in March all the way up to kind of presence. Um, like many employers across the country, we moved Teoh a rapid state of remote work for many of our staff. Um, some in nontraditional remote or tele work roles. Um, then we went into a pay protection period for the most the most of the month of April, where we maintained pay but also moved staff to critical areas. Um, to our labor pools on other needed roles in order to really one learn and Thio really set us up for the future. Um, we deferred some work, so we had certainly priority projects and others, like everyone else who put things on pause. Beginning April 29th, we implemented several actions, uh, to help secure financial stabilization for the months coming. Um, so we looked at our workforce. We looked at priorities. Andi looked at What roles will be critically needed. Andi implemented furloughs both fixed and flexible. Um, six meant it was a fixed period of time flex moment. It might be a rolling one week on one week off type both situation. We also implemented reduction. So reductions in FTE or our scheduled during that time. So that began April 29th. Um, the furloughs, which we called workforce programs, lasted up until August 31st, and there was varying times. Some were a short period of time somewhere a long period of time. Um, it really depended on the role of the work they perform. Um, there's two pieces of that one. We continue to pay benefits. So even if they were not working three employer, you know, paid benefit pieces were still were continued. Um, we also did not allow PTO use during that time, mainly to maximize unemployment benefits, but also to preserve cash flow for the organization. You could go to the next line. We also implemented salary reductions. Eso There was a 7% salary reduction from 4 29 or April 29th through June 23rd. So for about eight weeks, there was a 7% salary reduction for Allied health exempt staff. There was a 10% reduction for our consulting staff. Andan administration had 15% reduction during all similar time period. We did not impact the base rate of non exempt staff. So hourly staff did not have a base rate or a pay reduction. They may have had hours or furloughs, but they did not have a pay reduction. We also paused 403 B and 41 K match contributions. Um, during that period and that was just restored just recently. Way also paused our tuition reimbursement. So we did not expand or pay any tuition reimbursement during that time. All of that was then re implemented as our finances stabilized. Um, and we could project out that those types of actions could be, um unp awes. Andi, We're now in a period where all of those actions have been restored and we're actually looking at now going back, um, in the particularly the salary reductions Andi paying those back with you want to call it that, um, we're also making some changes to our pension program, particularly the fourth through being the 41 k match. Um, to return, um, those and look at a whole year of contribution. So if someone stopped contributing, um, during a furlough, for example. Obviously, they're not getting paid or reduced hours. Um, they have a chance to contribute more of this fall in order to get that maximum match and go to the next slide. A few other things that we implemented in order to help hardships for employees. So we were balancing not only financial stabilization for the organization but looking at financial stability for our staff. Eso are paid time off program. Currently, we allow staff to go into the negative or borrow against future A cruel. Typically, they couldn't go below zero in their bank. We do allow that for any covert related absence. Or if there's a staffing low staffing needs on. They want to use PTO, they can use our flexible PTO program. We have a spirit of carrying funds where staff can apply for a grant of dollars from the organization, the fourth for being 41 K withdrawals. Those were allowed up 200,000 that was really across the country. That wasn't necessarily male specific, but we did amend our plan to allow on a short term disability benefit. Uh, cove in a zoo of itself is not a serious health condition. Um, however, we did allow short term disability, um, to be used and we waive the waiting period. So if someone went on leave due to Cove, it then tested positive, they could use their short term stability benefits without a waiting period while they were out. Um, I'm now gonna hand it off to Sam Holverson, who's going to talk a little bit about accommodations and other things that we've been doing for staff. So, beyond the financial hardships that employees may have experienced, we wanted to use our values to guide us on helping employees through some personal challenges. We had employees who were pregnant or had serious health conditions, or maybe have a family member with a serious health condition that could be complicated by cove. It we instituted in partnership with leadership in our legal colleagues what we called a C 19 request for accommodation. We did this at the onset of what we were experiencing in our geographical areas of cove. It and, um stopped it. We did a recall of employees come June 10th. So while we were accommodating employees who had those serious health conditions in many cases, we were allowing them to tell a work to stay outside the environment. We redeployed them to areas, work units that maybe didn't experiences many covert positive patients, or we approve them to be on a leave. And then if we had employees who didn't want to go home after caring for covert positive patient, we provided respite housing options so that they didn't feel like they were bringing home anything that they were exposed to into their family or homes. And then, um, once June 10th came, we felt like we were in a better position. We knew enough about Cove it to have instituted some protocols in our environment such Azaz, robust cleaning, masking screening of patients and visitors and employees that we minimized our workplace exposures and felt like it was safe for these employees to return. So we did a recall. And then if we had employees who remained concerned about coming back into the work place, we did an A d A assessment and worked with him through that formal process that we had pre established as employees were experiencing some school changes for their Children. Back in March, we had many schools go, Ah, 100% virtual. And then this fall, many of our employees Children are returning into a blended school situation where there have virtual on half in person. And so we group together to try to support them with their newly experienced child care needs. We increased our backup daycare options. We connected employees to many community. Resource is, we helped support Community Resource is such as Boys and Girls Club Y M. C. A s, and we provided some sitter tutor matching programs by enhancing as some of the day care child care options that we had in place next line and then our workforce reactivated quickly. And this was a good thing. Eso we started to recall are furloughed employees early and then because obviously our financials recovered as our practice reactivated, we were able to restore those pain benefits earlier than we had anticipated. And Kerry had spoke to those individually. That said, I'll turn it over to our next presenter, Mark and Mark, You may be on mute Thank you for that three employee assistance program. Here at man. We provide short term guidance and counsel problem solving, uh, council for employees, wide variety of family life emotional concerns, substance, any any issue that impacts any one of us in the community or and are and our work environment. So we provide swift access to people. So during Cove it we saw a number of interesting kinds of trends. I mean, the one thing that we'd see prior we saw prior to Cove. It was all the issues that we normally would have people coming in, whether it's E. A. P or community counseling center, they come in primarily with family relational issues, large in volume filed usually by emotional mental health concerns, anxiety, depression and then a wide variety of work concerns, maybe performance or or career and them. There's a lot of sub categories in each one of those dealing with substance abuse issues, dealing with grief loss issues and mostly a P s across the country colleagues that I've talked with. Another's the same kinds of issues that we see for many decades After Cove it hit in the early stages of covert. We saw an awful lot of increase in primary is anxiety so emotional? Mental health became one of the primary concerns late March all the way through April that people were seeking some short term council, some help or medication with the anxious physiological and emotional issues. As time has gone on, it's become kind of a mixed because everything shows to be interdependent. So we see so many different life challenges now. But everything is kind of mixed together. So what we see is, of course, the prior issues to covert the issues just became more severe and complex once covert hit. So if you had a relationship issue a parenting issue finance issue dealing with grief, bereavement loss or any emotional issue, it became much more severe and complex. Because now we added on a number of things could be financial issues. It could be the daycare issue, incredible strain over daycare distance setting up initially for employees across the country, of course. And so we saw too many issues merged together at once, and people really feeling kind of paralyzed where to go. So the AP tried to provide short term guidance and problem solving for each piece at a time that we could. So normally you see 12 issues that stand out. Now you have 34 or five a day care issue, emotional issue, maybe a substance issue, maybe a work change issue and very unsecure about the new kind of task or role that they're playing. We try to provide services in all those areas individually, with people in a week to week basis, in some cases for brief check ins. 2030 minutes, even to try to do something a little different than a traditional our session to try to hit the most acute issue. Another area, the third bullet on both for manage those in management and employees. A tip for the workplace is really important here that if you're in management or employees, we must move from why the change? There have been so many changes, and sometimes we have different views about those changes. Very diverse ideas about different roles, different task, different hours and shifts. At some point after we tried all of us to give the best explanations. We have two movie. There's a manager is an employee to how to be effective or efficient and whatever the change or the task is that I'm doing now. So for leaders, it's wonderful when they can move beyond the Y discussion and move into. We have to do this But here, here's what I can do to help make your job even a little more easy, or at least less complicated, can remove unnecessary barriers that are preventing employees from doing the job is effective the right task and efficient doing those jobs. Those tasked with least amount of disruptions. Um, and when employees make that change as well, they can get stuck with the why. And it's really good for a mental health to be able in the midst of that crisis, to change to How can I do this in the most efficient way possible with the least problems for me and others? And the last thing that I'll say is, um, this is for all of us what we find our staff and we work with hundreds of employees a month on. We talked to people outside of organization as well. The Keith is really how to manage and adapt really comes down to for me, a couple of things. We have to have expectation, flexibility, people support and problem solving. The expectation flexibility means in this new time that we're in, we almost have to expect to get that phone call like many have recently that your school is gonna be quarantine. Pick your child up and you must figure out how you're distant learning starting tomorrow. So we have toe have this new mindset, this new mental model that doesn't become shocked and overwhelmed but goes into problem solving mode and expect that today it could go this way. The only way that people do that with relatively effective kinds of solutions is when they have people support, so trying to provide as much support to our employees and the workforce as we possibly can. But they need people support to help them think through all of these various struggles, we need neighbors, co workers, family friends, Um, and then the key to all of our quality of life is really problem solving. And as e. A. P s move to even a stronger problem solving, where can we guide and think out loud with people how to solve that day care issue? What are what are the services by the employer? What our services in the community? How can they? How can we help them address a short term financial? What? What do they do with their relationship issues that have really taken a hard hit during this time. Trying to solve so many issues all at once creates many more challenges and certainly domestic issues for all. So problem solving is just the key to be able to see something in the future and having somebody come alongside that someone in the workplace or a friend or family member or an e, a P counselor or a provider, Um, and in the benefits program that help people think through how to solve a number of these issues or at least start to have this steps involved in trying to solve. The last thing I'll say is that the issue that makes all of our emotional lives more challenges is when we don't see an end and so cove. It has been very unique in that aspect where we normally can go through a week, two weeks, a month, two months. But now all of our key categories, sometimes about even our job roles to our day to day structure at home, a daycare issues, online learning shift changes and we don't seem tohave. Many people just don't seem to have an end in sight, especially with some of the school issues on top, so that makes it harder. And we must have the small winds daily with people support and some joy that people do daily in order to manage when we haven't indefinite kind of, you know it's not. It looks like it's indefinite, indefinite kind of end to the stress of all these different juggles that people are trying to juggle in life. I will end with that and turn it over to Charlie. Thanks, Mark. My topic today is the impact of Cove in 19 on the Americans with Disabilities Act. The Equal Employment Opportunity Commission oversees that law. The Americans With Disabilities Act is a federal law in the United States and addresses employees with disabilities. What are their rights? What are the employer obligations in the pandemic? Out of pretty large impact in this area? There were some unanswered questions. The E e o. C. Very early on issued reissued its pandemic guidance from 2009 but that didn't answer everything. There have been several sets of Q and A's that have been issued to help guide employers to remind them what their obligations are and to address a few issues that are new in a big area, and the first slide addresses it are permitted medical examine enquiries. Under normal times, there are certain things we can do during the pandemic that we normally wouldn't be able to do and that the E. E. O. C. Is recognized. They need to give employers and flexibility, given the public health issues, and develop the need to develop infection control, uh, standards, especially in a health care setting, you know. So now, during the pandemic, you know, we can ask employees, you know, do they have any symptoms associated with the virus? We way, look to the C. D. C and are experts in our health to come up with that and we can restrict employees from working. You know, we want to err on the side of caution. In normal times, you can't take an employee's body temperature before they report toe work, you know, But this is new during the pandemic. You could do that. Some employers are doing that, and in their employees, their body temperature is taken before they come on site. I remember some of the meat packing facilities when they have big problems. Early on, they quickly implemented that another new item is Colvin. Testing you contest for the active virus is a condition of coming in tow work. You know, what you can't do is require the antibody. Tests have been very clear on that, but testing for the active virus before someone is allowed to come back to work after they've been out ill with symptoms associated with the virus. That's okay. Next time, please. High risk employees was a big, big topic at the early on. Sam already covered this male early on, went beyond what the laws required for three months or Maurin terms off. What do we do with the high risk employees? And by high risk, I mean, you know, three of the sub bullets on this slide address, you know, the high risk areas, potential high risk areas. And when I say high risk, I mean an individual as an underlying medical condition or even their age, you know that they place them at higher risk. Should they contract the Corona virus? That's what we're talking about with high risk individuals. We got this question early on the first bullet, you know, can we refuse to allow high risk individuals from working? Can we just put him on leave paid leave in the you know, the E E. O. C. Says no. If an individual wants toe work, if there's 70 years old and they wanna work, we can't bar them from working the other. The other issue that has come up, though, is even though the individual made disclose to you there at high risk. Or, you know, there there are high risk. You can ask whether or not there's a reasonable accommodation they need. So teleworking moving a lot of employees to teleworking early on was away. We dealt with this situation, and many employees were required to tell the work. But, you know, when we reactivated all of our services, the issue came up about certain individuals. Can they continue to tell the work? You know? Can they get in accommodation in that regard? You know the issue is, can they perform all the essential job functions next slide? So there's just general pandemic related accommodation issues, and early on questions came up whether or not an individual at high risk, even though an employer could be more generous than the Americans With Disabilities Act, the question came up. What are we legally required to do. And the e e. O. C. In some of its sub regulatory guidance indicated that if an individual has an underlying medical condition that places them at high risk, you do need to consider accommodation. So again, teleworking is one of the obvious examples. Uh, it's certain individuals asked to not do hospital service. They wanted to just work in the clinic setting or they wanted to work intel in telemedicine mawr. And we've worked through all those issues as best we can, balancing the rights of the employees. Yet we do need to keep our doors open on a temporary basis. You can eliminate essential job functions, But the trick with the pandemic waas You know, four months ago, five months ago, we realized this could go on for a year or two, and you know, what are we going to do? And we struggled with those issues, and Sam indicated early earlier on in this presentation, you know, for about three months we went way beyond what the law required, You know, come June, we started to get more in line with what the law, um, sets forth because again we reopened our doors, and we were back up running the business a little in more normal times, with obviously the use of PPE and all the other safety measures. One issue that's come up is the individual employee is fine, but they have a family member at home. Was a high risk medical condition under the law under the A D A. Were not required to accommodate them. We did have a program where we could help the person find different housing. And but, you know, across the nation, employers in general, if the individual has a high risk family member at home, the employer has no legal obligations. You know, teleworking has a knob v ISS accommodation choice by employees with at high risk. But that raises new issues for employers. Normally, you don't want to say, well, that's going to be too expensive. But with the economic devastation that the pandemic has caused for a lot of employers, you know, providing certain types of accommodations, two employees, the economic factors, you know, it might be a basis to deny a certain requested accommodation, and you can always try other things. But it's one thing that employers need to keep in mind that, you know the economic impact of the pandemic can be considered. And that's all I have. And I'll turn it back to Roshi for the Q and a session. Great. Thank you, Charlie. And thanks to all of our Panelists, um, for really that incredible information, um, getting through a very difficult time this year. And it's really incredible to see the summary points of the decisions that had to be made and how we managed through this complex period. Um, I'm gonna welcome everyone joining to please use the Q and A function on your screen. Thio either add questions for our Panelists today or to up vote the questions that are already there. Um, maybe we'll go ahead and get started with our first question. Um, how do we differentiate, assess and classify risk off other emergent diseases against the severity of covert 19 in patients when they come into the er, the outpatient setting? I'm wondering, Dr Breyer, if you could comment on this, and you might be on mute doctor rear. No, um, maybe we will. Um I figured it out. I permitted on my handset. Alright. Um, so I will I'll, um, answer that so one of the things that we have done is we've put precautions in place so that all of our health care workers are protected, you know, regardless of whether we know the patient has Kobe, 19 or not all of our health care workers working in direct patient care where face masks and eye protection if an aerosol generating procedures performed, they wear a respirator. And we also have testing processes in place, um, to test our patients before they come in for surgeries or procedures. However, I think that this question is alluding to the fact that when someone comes into the ER, there's not that time to test them ahead of time. So, you know, we do have all of those precautions in place. Our health care workers have been trained to suspect that anyone could have cove it, even if they have no symptoms at all. So from that standpoint, we feel like our workforce is very protected from the patient's standpoint. You know, this is one of the things that we're looking at as we're approaching flu season because Kobe 19 symptoms overlap with so many other um infections and so you know, for our upcoming flu season. We're developing and implementing some protocols such that patients that had symptoms that are very characteristic of both Kobe, 19 and influenza would, um, receive a swab. And it would be tested for both diseases, as well as evaluation for other diseases that also overlapping symptoms like RSV. Um, so I think that that's likely the background of this question. But the other thing I want to mention is just that early on in the pandemic we found we found that people weren't coming into the ER with, um, diseases that weren't related to co vid. So you know, someone might have a bowel obstruction or, um, symptoms of a heart attack, and they wouldn't come in because they were worried about exposure to co vid and that I think had a pretty significant impact on the health of the population. So we did a lot of things to try. Thio encourage those people to come in, reinforce the safety precautions that we have in place, which are very strong, and I think that that helps to with some of those emergent diseases that are not Cove in 19 because those things keep happening during a pandemic. Thank you, Dr Brewer. That's very helpful. And of course, we want to continuously encourage both our staff. Acela's, our communities toe get the influence of vaccine this year a za critical step to try to maintain the safety across health care organizations and communities. Um, I think the next question also relates to contact Tracing. The question is, how large is the team at Mayo Clinic in Rochester? And how maney exposures are they able to handle per week? And it might also be interesting just to hear, um, kind of the ebb and the flow that we went through during the pandemic and where we started and where we are today. Um, absolutely. So the size of the team also kind of ebbs and flows in response to what we're dealing with. I think one of the great things about the model that we put in place right now is I do feel like we could expand that Teoh be able to serve any number of exposures that would come our way. Um, we have a pretty big trained panel of providers. We have over 20 providers right now, um, that are that are trained to do some of these exposure investigations calling employees to the risk assessments. Um ah. Large panel of nurses to assist with restrictions and symptom assessment. Um, I think that the last that I the last numbers that I heard were that we had over 130 people across all of our multidisciplinary teams. Um, but that is ebbing and flowing, and we're constantly looking at How do we use those? Resource is very efficiently. Um, looking ahead to what? The models, Maybe in terms of numbers per week. Um, you know, I think that the biggest numbers we had were actually very early on in the pandemic before implementation of universal masking. And then I protection. Um, because we do have patients that don't have symptoms at all, that we don't suspect that they could have cove it, and then they would later test positive for Cove it. And so that was in during those early times when, across the nation and across the world, we were learning about co vid, um, and there were a few surprises in patients that had been cared for. So, you know, it's I think that at our peak, we evaluated 50 exposures per week. Um, but those may be anything from an individual PPE breach where someone, um, you know, wasn't wearing Ah, respirator in an emergent situation. Like administering CPR to ah, larger exposure where there may have been a patient, um, that had cove it. It wasn't known, and people have been taking care of him for or that patient for a day or two. So, um, I do think that one thing that's important for us to know in terms of our contact tracing is actually that we have many more non occupational exposures than we do occupational exposures. The vast majority of our employees are being exposed outside of work. And so while we aren't, um, well, we aren't doing the frontline contact tracing for those if their source was not a Mayo Employees, Um, our contact tracing team is involved and collaborating with public health very closely on that. Thank you, Dr Blair. I'm going to go toe two of our other Panelists, Kerry and Sam. The question is around Tuition reimbursement, Um, how it will be restored for employees. And I think it will also be helpful Thio here. How we're thinking differently about tuition reimbursement as we look to the future Potentially. Yeah. So this is Carrie. I can e could take a shot at that one. So, uh, the pause, um, was fairly short. And so staff were able to go back and request reimbursement. Um, it just essentially was delayed. Eso they're still able to get reimbursement, um, for courses that they took this spring. Um, we are pausing on any new programs going forward because we want to put more emphasis on developing careers on, especially in critical areas. And so that's on DTA have tools kind of at the ready for staff to use versus, um, maybe going into ah, career. That isn't necessarily something they would do it male in the future, we've had a fairly open process in a fairly open benefit, trying to refocus that going forward. So thank you, Carrie. Sam. Anything you'd like to add? No, she said it very well. Thank you. Perfect. Thank you. Uhm, Mark, I'm wondering if you could share with us. Um, what kind of increased we've seen in e a p utilization since the start of the pandemic. And you're on you. Sorry. So, um, we were extremely busy prior Thio Cove it and kind of maxed out with our capabilities. Just about when Cove it hit the numbers dropped for the first several weeks, 2 to 3 weeks, easily because of probably the acuity in people's lives and trying to readjust. And so they came back up about three weeks later. Four weeks later, I started Come back. We're at the full rate, so I don't think we really have the capacity to do much more of an increase. But now we're back to where we were prior to cove it. So what we kind of tracked was not only the volume, so the volumes back to what it was before, extremely busy, probably just about five or 10% more, and we were before Cove it. But of course, the severity is what we've been tracking. The severity of the issues is dramatically kind of changed for our counselors, kind of coating on that. So So. And you get your one thing just to add thio. That and Thio sing the praises of e a p a little bit from an occupational health standpoint, um, they've also worked with us in oh hs thio develops. Um, resource is for employees that were proactively sending out toe every single employee who is put on isolation due to kobane infection or quarantine due to any exposure so that they have all those resource is right in front of them. Um, so I think that that impact from E a. P to support those employees kind of even before they develop um those issues or concerns is important. We noted that employees were seeming a little bit more anxious and having some questions, so we reached out to you happy to see what they could do, and they developed this fabulous resource. Thank you for that. I also wanna add There's so many rich resource is that male There was a well being group in a focus that an incredible amount of work across their institution enterprise wide. I'm providing a number of resource is and trainings and phone lines tow our employees. So we certainly were fortunate to have so much rich response to help our employees internally from a wide variety of groups. Thank you. I do think it's incredibly powerful. Thio really be proactive and recognizing the challenges that employees they're gonna have, especially when they're isolated or put on quarantine. And how can we help them through that period of time and make sure that they feel supported? Um, Dr Bear, the next question is related to those quarantining guidelines. What are our current guidelines for quarantining employees that are exposed outside of work? Um, so we are facilitating quarantine for 14 days from the last known date of medium or high risk exposure. Outside of work, we do ask that our employees call us Thio assess, um, that exposure because we assess for things like how close they were to the other individual. For what period of time were they both wearing masks, or were they unmasked? Um, uh, Thio ensure that we're quarantining appropriately, but not quarantine quarantining people unnecessarily. Um, and we've worked with our public health partners to ensure that that aligns with their recommendations as well. So we one of the things that we do is we we do monitoring for symptoms of our quarantine employees eso that if they develop symptoms, we can assist with testing right away to ensure they don't have co bid. And a related question. Dr Breyer, are we returning exposed employees back into the workplace during the quarantine timeframe. And under what conditions would we do that? Yeah. So this has been a topic that, um, that we thought very closely about, as did other health care institutions across the nation. Um, and we are returning some employees during co bit with with safety precautions in place. So this happened first on our southern campuses when there was a surge, Um, in those states and the risk benefit of keeping a symptomatic employees out of work versus having those employees there to care for the patients. We really didn't want to put our patients at harm by not having enough staff there. So we did start allowing those those employees to return as long as they had a negative cove. It PCR test, and they were asymptomatic. And then we do serial testing multiple times throughout the quarantine period. Thio make sure that they remain Covic. Negative. Um, that in conjunction with the safety precautions we have across all of our practices, like universal masking, um, we have not seen an uptick in transmission transmission of infection across our campuses with that, um, and in the Midwest, we're doing that on a select basis. If there's a critical healthcare staffing issue with those same precautions in place. Thank you. Um, Charlie, I'm wondering if I could ask you the next question. It's around 80. A requirements? Um, the question is, I have had a patient tell me that the A D A requirements cannot require a mask. He was a bit belligerent about it and wanted an excuse to not have to wear a mask. Um, can you speak a little bit? Thio An organization's ability to require masking in the workplace. So I'll admit my area of expertise on the a d. A. Is employer employee law Title one under the a d. A. This is a title. Three a. D. A. Question. Public accommodations. One of my colleagues handles those issues. I will say, for employees we can require them to wear a mask. And if they can't, we treat that as an essential job function now, and they're not allowed on site, and hopefully we can accommodate by writing teleworking or some other means. My understanding is in effect, the same rules apply to our patients, and they can seek health care elsewhere. Maybe there's some type of other accommodation, like telemedicine. Appointment generally speaking, given the public health hazard. And it's a and, you know, individuals rights are are, you know, subject to the public policy issues. So I think in general we can require the mask, and that's just the way it is right now. Thank you, Charlie. And I don't know, Dr Brewer, if you also maybe want to add the guidance we've provided our physicians, Um, when they're asked, Thio provide a reason why in individual doesn't need to wear a mask. I know our guidance has been very limited in that regard. Yeah, So these questions do come to our providers in clinic from patients asking not to wear masks. And that was, um, one thing that we felt very conflicted about because from, ah, public public health standpoint and even protection for that patient. If they have a medical condition, um, like a pulmonary condition that may make it difficult for them to wear a mask. It's also putting them at risk, not wearing that mask. So we have very much focused on connecting our patients to treatment that would allow them to safely wear a mask on DWI found that with our employees to early on We had several employees that reported that they had claustrophobia or anxiety with usage of masks. And so we worked with our psychology and psychiatry department and help those employees essentially, um, desensitized themselves by starting to wear masks at home and on these early walks around the neighborhood so that they weren't isolated in their home, unable to go to the grocery store, toe healthcare, toe work to restaurants and things throughout the pandemic. So we we are if we do end up writing writing something for the employees. It's an accommodation suggestion to periodically allow that patient time in an environment where they can safely removed their masks for a bit where they're far away from others. Um, rather than just a blanket restriction that they couldn't wear masks. Thank you. Um, Carrie and Sam, I'm wondering if you could speak to the next question around teleworkers. Um, so have all teleworkers return to normal pre co vid set up. If not, have you needed to implement new policies for the longer term? And it may also be worth, you know, um maybe I'll just to start it off state that from a practice perspective, we found that getting individuals off of our campuses have really allowed us to reduce kind of the people density, um, within our buildings. And we believe that's really critical to ensure that we can continue to support social distancing and make sure that our lobbies and other areas are not overly full. And so, from a practice perspective, we really considered it a priority that if staff can work from home, they do work from home. But carry Sam, what would you add? Um, I would add that most of our tele work, um staff are stuff that moved to Tower are still fellow working. Um, there are some exceptions to that, but to your point, role shifts where they're really needed to be physically in the building in order. Thio, um, support the practice. Um, but we've rapidly, whether it's innovated, learned new tools in order Thio work with each other, um, in a virtual state. And we're now moving into a new phase where many of our administrative support, our shared service organization, will continue to tell a work or work remotely, um, for the foreseeable future. And we're making investments and changes in policies to support that, along with expanding technology options for those, um, teleworking. So, um, many of our staff who are teleworking today will continue to tell her work with the option of coming back on campus when needed, right? If the work dictates them to be there, they need to be collaborative and a collaborative space that they can't do virtually that they still have the opportunity to do that. So, Sam, anything you would add, The only thing I would add it's just information that my facility colleagues have said that you know, individuals who are returning to the environment. Um, they're really trying to focus on the social distancing. And they are putting up more cubicle walls just toe again, have more barriers of similar to how front line staff are using shields. Those that are behind the scenes have more cubicle walls just to keep that space and distance. So we have Maybe just one minute before we turn it back over to Jeff to close our session, I'm gonna put our panel on the hot seat a little bit and ask each of you to tell us what was kind of either the greatest lesson or the greatest challenge you overcame in the last several months. And how is that shifted? The way you think about health care moving into the future. Dr. Breyer, would you like to start? Um, sure. So I think that I think that one of the probably the biggest challenge that we have overcome was the need to think differently. We had done a lot of planning for a pandemic, specifically Ebola and had a lot of processes and protocols in place. And when cove it hit and it, um, ramped up significantly, it was humbling. And we realized that the plan we had in place that was very much, um, people power us making phone calls to every single one of our employees when they were exposed to notifying them. Um wouldn't work with these volumes. And we really need to think differently. So fortunately, we had Resource is in place to do that. And I think that it's turned out really well. But that was a little bit surprising. Thank you, Dr Brewer. So perhaps in quick succession, Sam. Yeah, I would say, um, the need for communication. Strong communication remained very important. We had so many workplace impacts that were happening to keep employees aware of that, instituted a lot of Q and A sessions the use of, um, different technology so that people could ask questions anonymously. And we have answered questions over and over again, which has provided the opportunity for employees to really understand where we're headed and how they're being impacted by all of this. Great. Thank you. Um, Charlie, you know, probably the most significant issue is the high risk workers. You know, you feel for them, they have a medical condition, their age, a combination and just, you know, they're they're your co employees. And I've taken a few calls from individuals who, you know, were they wanted Mayo to doom or for them. And it was just hard discussions tohave, you know, balancing. You know, the the employers need to get through this and the individual who may have been up here a long career Mayo Clinic. It's, you know, it's It's a hard discussion tohave Thank you, Charlie. So sorry. We can't get to carrier Mark, but I want to thank our Panelists again. This was a really exceptional time together. And thank you for sharing all this incredible information. And with that alternate back over to Jeff. All right. Thanks so much, Roshi. I'd like to thank our Panelists for joining us today as well as you all for being a part of this discussion on how Mayo Clinic is responding. Thio workforce management issues during this Kobe 19 pandemic. Uh, I want you to make sure that if you enjoyed this webinar and you're interested in joining us again with our Kobe 19 webinar Siris on October 14th, we're gonna have a discussion on Kobe 19 vaccine development. What's happening with that? And what that looks like? And then, of course, if you are interested in claiming credit for today's webinar, you can go to our website ce dot mayo di e d u backslash Kobe 09 to 8. You need to go ahead and log onto the site, access that code box and put that Kobe 09 to 8 into that access code box and you'll be able thio, complete this course and get your certification. Eso once again like to thank you for joining us today. And we hope you can join us for our upcoming covered 19 weaponize. Have a good afternoon