Leading through crisis - Advisory...Leading from the center of the storm Advisory Board interviews...

Presented by

Post-Acute Care Collaborative, Nursing Executive Center, and HR Advancement Center

Supporting the workforce and shoring up resiliency

during an emergency

Leading through crisis

© 2020 Advisory Board • All rights reserved • advisory.com

Today’s Research Expert

Carol Boston-Fleischhauer, JD, MS, BSN

Chief Nursing Officer and Managing Director

Ms. Boston-Fleischhauer has over 30 years of progressive

health care experience in patient care practice, operations,

management, education and consultation in academic medical

centers, community hospitals and clinics, multi-hospital

organizations, and integrated health care systems.

She serves as a global spokesperson for Advisory Board’s

research in key areas including clinical and operational

leadership, human resources, and quality.

[email protected]

http://www.advisory.com/



7

Numbers you already know

Source: “2011 ANA Health and Safety Survey,” American Nurses Association, 2011,

http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/2011-

HealthSafetySurvey.html; Masterson L, “Nurses are burnt out. Here's how hospitals can help,” Healthcare Dive, May 12,

2017, https://www.healthcaredive.com/news/nurses-are-burnt-out-heres-how-hospitals-can-help/442640.

1. N = 4,614; 2011.

2. N = 93; 2017.

3. N = 600; 2017.

More stress

and overwork

Number of nurses that report

concern about stress and overwork1

3 in 4

Increased

burnout

Percentage of nurses that

report feeling burned out3

70%

Growing work-

related fatigue

Percentage of nurses who

report feeling tired all the time2

49%

Sample evidence of frontline nurse stress and burnout

Advisory Board interviews and analysis.



http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/2011-HealthSafetySurvey.html

https://www.healthcaredive.com/news/nurses-are-burnt-out-heres-how-hospitals-can-help/442640


8

Source: “Are You Way Too Stressed Out? Survey Results,” The Vickie Milazo Institute, 2014; “Listening

to Nurses: Dissatisfaction and Burnout on the Job,” AFSCME; “More Than One Third of Employed

Health Care Workers Plan to Look for a New Job This Year,” CareerBuilder Healthcare, April 30, 2013.

Burnout a pervasive problem in health care

It’s not just nurses


Workforce

60% Health care workers who

have felt burned out

Physicians

50+%Physicians

burned out

Nurses

43%Nurses severely

burned out

75%“I find it hard to do

something fun after

work due to stress”




9

Far beyond the norm: the COVID-19 crisis continues

96 million cases

4.8 million hospitalizations

480,000 deaths

Estimate of possible effects

At least 33,018 cases

50 states reporting cases

At least 428 deaths

Current COVID-19 cases

Current as of March 23, 2020


Source: “Coronavirus Disease 2019 (COVID-19) in the US,” CDC,

March 11, 2020. “One slide in a leaked presentation for US hospitals

reveals that they’re preparing for millions of hospitalizations as the

outbreak unfolds,” Business Insider, February 27th, 2020.




10

A delivery system poorly equipped for the coming trauma

Atlanta: 77.4%

San Francisco: 55.1%

New York City: 74.6%

Los Angeles: 59.2%

Chicago: 57.4%

DATA SPOTLIGHT

U.S. aggregate hospital

occupancy

60.7%

Variation in occupancy from

least (WY) to most (NY)

heavily occupied state

36.8%-73.4%

Common heuristic for full

occupancy

80%

Average hospital occupancy by state





11

Nursing homes are especially vulnerable

Source: Post-Acute Care Collaborative Turnover Benchmarking Initiative.


Factors making SNFs and long-term care facilities particularly vulnerable to COVID-19

High-risk, elderly patient population

Fewer staff per patientHigh turnover rates, nearly 52%

as opposed to 15% in hospitals

Predominantly unlicensed staff




12

Understanding stressors: Maslow’s Hierarchy of Needs


• Self-actualization: The need to achieve one’s

full potential, including creative activities

Self-fulfillment

needs

• Esteem: The need to feel respected, including the need to have

self-esteem and self-respect

• Social belonging: The need to feel a sense of belonging and

acceptance among social groups, including friendships and family

Psychological

needs

• Safety needs: The need to feel physically safe, including

personal, financial, health, and adverse events

• Physiological needs: The physical requirements for human

survival, including air, food, and water

Basic needs

Summary of Maslow’s Hierarchy of Needs

Source: McLeod S, “Maslow's Hierarchy of Needs,” Simply Psychology, 2017, https://www.simplypsychology.org/maslow.html.



https://www.simplypsychology.org/maslow.html


13

Two sets of needs are urgent concerns amid the outbreak

Staffing Equipment

Child care Ability to protect family

Training

What do I need to feel safe at work?


Psychological and logistical barriers promote fear

What do I need to feel safe going to work?

Transportation




14

Leading from the center of the storm


“During a time of crisis, leadership is a matter of having

people look at you and gain confidence; seeing what you do

and how you react. If you are in control; they are in control.”

Tom Landry




15

1. Care for yourself as you care for others.

2. Be sensitive to the emotional needs and fears of those around you. Project compassion.

3. Listen.

4. Be honest; avoid blind optimism.

5. Employ confident, nimble decision-making.

6. Be present.

7. Provide meaningful connections at all levels.

8. Communicate.

Ground Rules for Leading through Crisis


Crisis leadership starts with you




16

Typical communication pitfalls make a crisis worse


Legacy communication missteps

Staff already inundated with

information; overly abundant

change communication just

compounds sense of “noise”

Difficult for staff to distinguish

the truly important if too many

messages marked as urgent

Messages focusing on big

picture give requisite context,

but lack critical details staff

need about next steps

Unclear action stepsExcessive urgencyOverwhelming amount

Communication challenges during acute crisis

Increased stress and

emotional pressure on staff

responding to outbreak

Potential for misinformation

from external communication

channels

Difficult to convene

frontline staff to deliver

messages




17

Five tips for executives

Establish clear COVID-19 communication channels for staff


Field and respond

to rumors

Give staff a

consistent source

of COVID-19 truth

Minimize non-

essential emails

Make yourself

virtually accessible

Share your gratitude

personally and often

• Send messages

from the same

person/email

address

• Send messages at

a consistent

cadence – even

when there’s no

“new” news to

report

• Link to centralized

page of resources

on intranet

• Centralize the

decision to send

any org-wide

emails that

aren’t about your

COVID-19

response

• Consolidate

any essential

non-COVID-19

messages

• Establish regular

virtual office

hours

• Hold virtual

town halls

• Set up a channel for

fielding staff rumors.

Options:

– Dedicated phone line

or survey where staff

can share rumors

anonymously

– “What’s the buzz?”

council with frontline

staff representatives

from across the org

• Regularly publish

answers to FAQs

• Acknowledge the

challenges and

uncertainty staff are

navigating

• Recognize the

sacrifices team

members are making

• Emphasize staff

health and safety as

much as patient/family

health and safety

1 2 3 4 5




18

No-regrets leadership moves in times of crisis


Build your organization’s

“stop doing” list

• Press pause on as many

initiatives as possible. Ask:

– Can we push this out 8 weeks?

– If not: what’s the bare minimum

we must do? Who absolutely

has to be involved – and who

can we release?

• Tell staff what is okay to

de-prioritize

Be ready to capture and share

moments of greatness

• Ensure leaders know where to

send stories about how staff

are rising to the challenge

• Share these stories every

chance you have

Double-down on supporting the

emotional health of managers

• Remember: frontline managers

have a disproportionate impact

on both daily operations and the

emotional health of their staff

• Make sure you have:

– A dedicated forum for managers

to share concerns

– The list of things managers can

stop doing so they can better

support their teams

Ensure leaders and staff at all levels know where to share their questions and concerns.




19

Remembering Maslow’s Hierarchy of Needs


• Self-actualization: The need to achieve one’s

full potential, including creative activities

Self-fulfillment

needs

• Esteem: The need to feel respected, including the need to have

self-esteem and self-respect

• Social belonging: The need to feel a sense of belonging and

acceptance among social groups, including friendships and family

Psychological

needs

• Safety needs: The need to feel physically safe, including

personal, financial, health, and adverse events

• Physiological needs: The physical requirements for human

survival, including air, food, and water

Basic needs

Summary of Maslow’s Hierarchy of Needs

Source: McLeod S, “Maslow's Hierarchy of Needs,” Simply Psychology, 2017, https://www.simplypsychology.org/maslow.html.



https://www.simplypsychology.org/maslow.html


20

Working to support basic staff needsExamples of ongoing initiatives to support clinicians’ ability to work

Source: “Elassar A, “Medical students launch program to offer child care to hospital workers fighting coronavirus,” NBC, March 18, 2020,https://www.kcra.com/article/medical-students-launch-program-to-offer-child-care-to-hospital-

workers-fighting-coronavirus/31761560#; Catoura C, “Medical workers to get childcare help during coronavirus outbreak,” CBS News, March, 19, 2020, https://www.cbs46.com/news/medical-workers-to-get-free-childcare-during-

coronavirus-outbreak/article_061f0fa8-694b-11ea-9bf2-b7ea0e243878.html; Weisman R, “Nursing homes fear coronavirus could aggravate severe staff shortages, ”The Boston Globe, March 10, 2020,

https://www.bostonglobe.com/2020/03/10/nation/nursing-homes-fear-coronavirus-could-aggravate-severe-staff-shortages/; “Short Term Elder Care,” University of Washington Human Resources, https://hr.uw.edu/elder-care/short-

term-elder-care/; Post-Acute Care Collaborative interviews and analysis.

Child and elder care

• YMCA of Metro Atlanta is providing low-cost

child care to frontline health care providers

• UW Medicine is helping staff access backup

eldercare services through its Back-Up Care

Advantage Program

• Medical students at the University of

Minnesota and Ohio State University

College of Medicine are offering child care to

medical professionals

Transportation

• Can you use existing vans or buses to offer

staff a way to get to work?

Housing

• Can you pay for hotel rooms near the facility

to reduce commute time and protect staff

members’ families from exposure?



https://www.kcra.com/article/medical-students-launch-program-to-offer-child-care-to-hospital-workers-fighting-coronavirus/31761560

https://www.cbs46.com/news/medical-workers-to-get-free-childcare-during-coronavirus-outbreak/article_061f0fa8-694b-11ea-9bf2-b7ea0e243878.html

https://www.bostonglobe.com/2020/03/10/nation/nursing-homes-fear-coronavirus-could-aggravate-severe-staff-shortages/

https://hr.uw.edu/elder-care/short-term-elder-care/


21

Emergent situation worsens existing cracks in the foundation


Psychological

Needs

Four cracks in today’s care environment

Point-of-care safety threats are now

commonplace in health care settings1

Staff bounce from traumatic experiences

to other care activities with no time to recover

2 Staff feel they have to make

compromises in care delivery

3

4 New technology, responsibilities, and care

protocols cause staff to feel “isolated in a crowd”




22

1. Disruptive behavior

algorithm

2. Security-driven

unit rounding

3. Frontline de-escalation

team

4. Behavioral health

emergency response

team

Reduce response

time to routine

point-of-care threats

1

7. Manager-triggered

psychological

first aid

8. Embedded emotional

support bundle

2Make emotional

support “opt-out” only

5. Staffing assumptions

leadership exercise

6. Frontline moral

distress consult

Surface and address

frontline perceptions

of “compromising care”

3Reconnect staff

through storytelling

4

Best practices to repair the cracks in the care environment

9. 90-second storytelling

10. Routine clinical

reflections


Rebuild the foundation for a resilient workforce




23

Pandemic piles on to existing stressors

Regular sources of stress

haven’t gone away…

…and emergent needs have the

potential to push staff over the

edge.

• Documentation

• Staffing ratios

• Policies and protocols

• Challenging patient and

family dynamics

• Equipment shortages

• Media and public scrutiny

• Worries about personal safety

• Daily spikes in COVID-19 cases

and new hot spots

• Bed capacity limits





24

Source: Jameton A, Nursing Practice: The Ethical Issues, Englewood Cliffs: Prentice-

Hall, 1984, Pg. 6; Whitehead P, et al., “Moral Distress Among Healthcare

Professionals: Report of an Institution-Wide Survey,” Journal of Nursing Scholarship,

47, no.2 (2014):117-125, http://onlinelibrary.wiley.com/doi/10.1111/jnu.12115/full.

1. A 2014 study of 395 nurses; Data from

a Moral Distress Scale-Revised survey.

Moral distress

“When one knows the right thing to do, but

institutional constraints make it nearly

impossible to pursue the right course of action.”

Number of

surveyed nurses

who indicated intent

to leave their

current role due to

moral distress1

1 in 5

Andrew Jameton, 1984

American Philosopher

Moral distress undermines Nightingale Pledge


Nurses feel they must make compromises in care

DATA SPOTLIGHT



http://onlinelibrary.wiley.com/doi/10.1111/jnu.12115/full


25

Clinicians’ “I’m fine” culture


Representative scenario

Extended leave

RN shows signs of

depression and

takes extended leave

Patient death

7-year-old patient

goes into respiratory

arrest; dies in the ED

Adverse Outcome

RN worries she may have

transmitted coronavirus to

a fragile patient

“I’m fine”

RN shifts attention

to next patient,

accidentally touches the

outside of her gloves

”[Following a traumatic experience] typically the clinical people will say,

“No, we’re good.” Because they think they’re supposed to be fine.”

SVP and Chief Nursing Officer

US HEALTH SYSTEM




26

Lack of recovery time taking a toll

Source: Mealer M, et al., “The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses,” Depression and Anxiety,

26, no. 12, 2009:1118-26, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919801/; Missouridou M, “Secondary Posttraumatic Stress and Nurses’

Emotional Responses to Patient’s Trauma,” Journal of Trauma Nursing, 2017, 24(2):110-115, https://www.ncbi.nlm.nih.gov/pubmed/28272184.1. N = 1,171 nurses.

2. N = 332 nurses.

Factors contributing to reduced

clinician recovery time

Increased patient turnover

Increased patient churn and decreased

length of stay means clinicians care for

more patients in less time

More care activities

Higher risk of infection and more

documentation means clinicians have

more to do per patient

9%

18%

Other U.S. Workers Nurses

Rates of depression in other U.S. workers versus nurses1


Number of nurses displaying symptoms

of post-traumatic stress disorder21 in 5

DATA SPOTLIGHT

Quickly changing situation

Rapid evolution in COVID-19 spread,

restrictions, and constant news updates

creates fatigue and stress



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919801/

https://www.ncbi.nlm.nih.gov/pubmed/28272184


27

Source: Carchietta GA, “Five steps to increasing utilization of your Employee Assistance Program,”

Workplace Health and Safety, 63, no. 3 (2015): 231, https://www.ncbi.nlm.nih.gov/pubmed/25994979.


Waiting for them to ask for help isn’t enough

Average utilization rate of Employee

Assistance Programs in the U.S. 3-5%

DATA SPOTLIGHT

Employee Assistance Program utilization rates



https://www.ncbi.nlm.nih.gov/pubmed/25994979


28

Make emotional support “opt-out” only

Two types of emotional support to make “opt-out” only

Immediately following an especially

traumatic event

For individuals who witness a traumatic

event, including death, overcrowding,

threat, or violent attack

During times of high stress

For individuals or units

experiencing a heavy load of

pandemic-related stress





29

Advocate Children’s Hospital emotional support building blocks

Chaplain-led recovery time

On-unit guided conversations between nurses and

chaplains; focused on managing routine daily stressors

Bounce back kits

Pre-made kits staff can give to each other during times

of high stress; include reflections on themes, including

acceptance, letting go, anger, gratitude, and rest

Moment of silence

Moment of reflection at the beginning of meetings and

huddles, or at dedicated times throughout the day

Code lavender carts

Equipped with materials to help staff ground and center

themselves during moments of heightened stress

Source: Advocate Children’s Hospital, Oak Lawn and Park Ridge, IL.


Introducing Advocate’s emotional recovery bundle




Case in brief

30

• Recipient of The VitalHearts: Secondary Trauma Resilience Training grant from the

LIVESTRONG foundation in 2013, which provides specialized resiliency training for

nurses, physicians and other clinicians

• As part of this work, Advocate rolled out several emotional support mechanisms,

including chaplain led support sessions (2015) and bounce back kits (2017)

• Chaplains round regularly with individual clinicians and managers and respond to

manager requests during times of high stress; managers can also send select staff to

attend series of hour-long sessions hosted on-site at end of shift

• Bounce back kits are take-out style boxes that contain small objects and a reflection

exercise related to specific theme; example themes include: acceptance, letting go,

anger, gratitude, keep perspective; kits are stored in centralized location and can be

activated by managers and peers on someone else’s behalf or directly by individual

• Additional supports have helped managers be more perceptive and aware of their team’s

emotional state, proactively assessing and addressing their own and team members’

emotional wellbeing

421-bed pediatrics hospital in Oak Lawn & Park Ridge, IL

Advocate Children’s Hospital

Source: Advocate Children’s Hospital, Oak Lawn and Park Ridge, IL.





31

Source: Ohio’s Hospice of Dayton, Dayton, OH.

Ohio’s Hospice of Dayton staff committees offer support in times of stress

Use staff-run committees to support frontline team members

Post-Acute Care Collaborative interviews and analysis.]

The Betty Schmoll Care Connections team allows staff to seek support on challenging situations

What it is

Goal

Attendees

Meetings

Example scenario

Meeting for frontline staff to debrief on difficult cases

Prevent burnout and equip staff to put “best foot forward”

Open to all patient-facing staff member

Monthly standing meetings and more as needed

Heart failure patient expresses

wish for LVAD to be discontinued

Staff feel uncomfortable

about the patient’s request

Staff are honest about their

discomfort at committee meeting;

learn tactics for managing stress




Case in brief

32

• Ohio’s Hospice of Dayton staff were suffering from burnout because of the

difficult patient and family situations they face. To ease this emotional burnout,

Ohio’s Hospice of Dayton formed two committees.

• Betty Schmoll Care Connections is a monthly meeting, with more held as

needed, open to all frontline staff to allow anyone to express the personal

impact they may have felt bearing witness to a challenging situation, and to

equip staff with tools to cope with emotional burnout.

• The Ethics Committee meets quarterly and as needed to help staff determine

appropriate next steps in an ethical dilemma. The team is made up of a

physician, nurse, social worker, chaplain, bereavement counselor

representative and a bioethics professor.

• These committee have reduced staff burnout by allowing staff to express their

emotional challenges and providing guidance on navigating difficult situations.

Inpatient and community-based hospice provider; Dayton, OH

Ohio’s Hospice of Dayton

[Insert program name interviews and analysis.]

Source: Ohio’s Hospice of Dayton, Dayton, OH.




33

Source: Children’s Health, Dallas, TX.

Key Goals of Frontline Moral Distress Consult

Expands Staff Perceptions

Fact-driven approach helps staff understand the bigger picture

Surfaces House-Wide Trends

Enables unit or organizational leadership to identify patterns of moral distress

Facilitates Staff-Driven Solutions

Staff identify solutions that address initial concerns

Provides a Platform for Staff to Share Concerns

Interdisciplinary discussion with peers to mitigate internalization of distress

Giving staff a channel to voice concerns





34

Representative Example of an Emergency Nurse’s Moral Distress

Asked To Do Something

That Feels Wrong Facilitated Group Consult

Facilitator Identifies

Trends and Next Steps

Nurse Requests Moral

Distress Consult

Nurse told by manager to delay

care for one patient in order to

attend to others

Nurse joins peer discussion on

prioritizing care; focused on root

causes and solutions

At end of shift, nurse calls to

request to moral distress consult

Recommends leaders provide

additional training on prioritization


Moral distress consult in action




Case in brief

35

• Children’s Medical Center implemented moral distress consults in 2015, which provide

frontline staff a way to spotlight and discuss situations causing moral distress

• The moral distress consult team is led by clinical ethicist with an additional core team of four

facilitators and 12 interdisciplinary team members; consists of RNs, advanced practice

clinicians, psychologists, socials workers, chaplains, bereavement counselors, etc.

• Staff initiate consult, as needed; each consult is facilitated by two team members who guide

conversations surrounding the case, asking staff to share facts surrounding the triggering

incident and identify organizational constraints causing moral distress

• Consults conclude with staff-driven solutions; next steps can include scheduling follow-up

consults, requesting an ethics consult, or escalating the case to executive leadership

• Differs from traditional ethics consult in which the Institutional Ethics Committee addresses

ethical conflicts in patient care, primarily focusing on recommending an ethical solution

rather than clinician distress

A 487-bed pediatric teaching hospital in Dallas, Texas.

Children’s Medical Center Dallas


Source: Children’s Health, Dallas, TX.




36

How can you help?Addressing staff emotions and fear

• Have you adjusted your leader rounding strategy?

• What kinds of emotional support services are we extending to staff?

• What temporary resources can we deploy to help manage physical strain and

exhaustion? Can we create makeshift spaces for rest and even sleep?

• Will we adjust our benefits or offer any financial support mechanisms for staff

who are unable to work due to the virus?

• What kinds of policies can we implement to prevent health care worker fatigue?

• What channel should staff use for sharing feedback, questions, and concerns?

Who will respond and when?


Key questions for leaders




37

The silver lining: banding together to help each other

Examples of initiatives to support isolated seniors during the COVID-19 pandemic

Community volunteers deliver

groceries, supplies, and medicines

Local stores designate senior-

only shopping times

Grocery stores like Walmart,

Target, and Safeway are creating

senior-only shopping times

PACs creatively maintain social

connections amid isolation

• PruittHealth is providing video chat

options for family members and

residents to replace in-person visits

• Heart of Hospice-Acadania is

connecting school-aged children

with AL and SNF patients through a

letter writing and card campaign

• The Berkeley Mutual Aid Network

is a group of community individuals

who deliver groceries, medicine,

and supplies to seniors in need

• 1,300 Invisible hands volunteers

deliver groceries and medicine to

older and at-risk New Yorkers

Source: “Covid-19 pandemic prompts Berkeley neighbors to help one another”, Mar 16 2020, accessed at https://www.berkeleyside.com/2020/03/16/covid-19-pandemic-prompts-berkeley-neighbors-to-help-one-another;

“PruittHealth offers video chats for loved ones in nursing homes,” Mar 19 2020, accessed at https://www.walb.com/2020/03/19/pruitthealth-offers-video-chats-loved-ones-nursing-homes/;;“Stores designate shopping time for seniors

vulnerable amid coronavirus: Walmart, Target, Whole Foods and more,” Mar 18 2020, accessed at https://www.usatoday.com/story/money/2020/03/17/coronavirus-shopping-stores-introduce-time-for-vulnerable-elderly-

pregnant/5074064002/; Conklin A, “Amid coronavirus, hospice connects out-of-school kids with elderly residents in letter-writing campaign,” Fox Business News, accessed at https://www.foxbusiness.com/lifestyle/hospice-

coronavirus-students-elderly-letters; “Two NYC 20-Somethings Extend 'Invisible Hands' to Older, At-Risk Residents in Coronavirus Pandemic,” NBC, March 18, 2020, accessed at https://www.nbcnewyork.com/news/local/two-nyc-

20-somethings-extend-invisible-hands-to-older-at-risk-residents-in-coronavirus-pandemic/2333487/; Post-Acute Care Collaborative interviews and analysis.




https://www.berkeleyside.com/2020/03/16/covid-19-pandemic-prompts-berkeley-neighbors-to-help-one-another

https://www.walb.com/2020/03/19/pruitthealth-offers-video-chats-loved-ones-nursing-homes/

https://www.usatoday.com/story/money/2020/03/17/coronavirus-shopping-stores-introduce-time-for-vulnerable-elderly-pregnant/5074064002/

https://www.foxbusiness.com/lifestyle/hospice-coronavirus-students-elderly-letters

https://www.nbcnewyork.com/news/local/two-nyc-20-somethings-extend-invisible-hands-to-older-at-risk-residents-in-coronavirus-pandemic/2333487/


38

Resources for COVID-19


To access the top COVID-19 resources,

visit advisory.com/covid-19

CDC and WHO Guidelines

Coronavirus scenario planning

Managing clinical capacity

Learning from previous outbreaks

and disasters

Webconference: Make your COVID-19

communications to staff more effective

Things You’ll Learn:

• How to limit non-essential emails to

ensure the most important messages

stand out

• How to hear what rumors are

circulating among staff and then

set the record straight

• How to communicate gratitude to

staff authentically

Tuesday, March 31 at 1 p.m. Eastern time

Register here



https://www.advisory.com/Research/HR-Advancement-Center/Events/Webconferences/2020/Make-your-COVID-19-communications-to-staff-more-effective

655 New York Avenue NW, Washington DC 20001

202-266-5600 │ advisory.com

https://www.advisory.com/

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