As the last of the summer warmth starts to fade, the sky still has a warm orange tinge and the dusks become perceptibly darker- we in the health service prepare for the arduous winter ahead. Normally, in the olden days the health service at least in the UK and other temperate lands would have a period of summer respite, when workload would be low, hospital or GP attendances lighter and people would get their batteries recharged. Winters have always been challenging and hard for all. However, for some years now, there has been nothing normal. The new normal, as we have learnt to describe this chaos as, has been one never-ending stream of patients, movement from one crisis to another and every day has presented a new challenge. Many in the UK NHS (and I am sure across the many similar health services around the world) are reporting exhaustion and burn-out. The common question, ‘How are you today?’ is no longer met with a sprightly, ‘Great’ or ‘Fantastic’ but with a nonchalant ‘fine’ or sometimes with a blank stare. This is a sign of deep fatigue both of mind and body, one of imminent burn-out and manifests itself in many ways.
September 17, also happens to be a day dedicated to ‘patient safety’ worldwide and for ‘prevention of physician suicide’. It is not at all ironic that both of these initiatives happen to coincide. We know that happy staff lead to better outcomes for our patients and clients.
We know that stress, job satisfaction and workload are directly related to burn-out in any industry or profession. Health service is not isolated from this phenomenon. Health service professionals are highly motivated, not shy of working hard, certainly don’t work to time but to the need of the service and come to the profession with strong ideals of selfless service as well as empathy. However, there are other factors such as environment, interactions, team behaviours, opportunities for progress and culture which have a significant influence on their experience and negative energy in these areas leads to a cycle of worsening experience- outcomes.
While many organisations are aware of the risk of burn-out, there is also learned helplessness for organisation leaders who are faced with the demands on the service and insurmountable workforce challenges. There is recognition of the inevitable causative links between workload, stress, dissatisfaction and workforce turnover or reduced recruitment. What can be done?
There is no clear or easy answer. One of the education leaders in a London organisation suggested something rather simplistic and profound. Since it is accepted that workload (in the NHS) is persistent, constant and incessant – we should force ourselves to focus on education and wellbeing within the stressed environment but not only on targets and arbitrary time-stamps (such as 4h targets in Emergency departments), even though these are often argued to be clinically driven. When taken out of context, the suggestion that we should even focus on staff wellbeing/ education in addition to clinical challenges – may sound controversial in the light of the ‘patient-centred safety ethos’. However, anyone who has even a few minutes to contemplate the causative interconnectedness of workforce wellbeing with patient outcomes will know how true this suggestion is.
The rising incidence of physician self-harm is alarming at any time, but now more than ever. Even though we do know that the majority of medical professionals are traditionally averse to reporting the impact on their physical and mental health. Anonymised surveys demonstrate that the majority of healthcare professionals including doctors have experienced enough stress to consider self-harm or at risk of self-harm. Data from Practitioners Health service has reported on the rising tide of mental and physical health deterioration.
Many organisations have introduced interventions for self-care, mindfulness, healthy living and strategies to improve work environments. Unfortunately, this is often too late and too little. There is much that professional organisations, voluntary or third sector organisations can do to help the formal health service employers. BAPIO is a health and well-being forum which hosts regular sessions for yoga, meditation and self-care online. Some sessions are offered pro bono and some require a small contribution. These are slowly gaining in popularity, which is encouraging. However, there needs to be a confidential helpline, access to psychological support and increased investment in formal occupational health resources which will allow these departments to be proactive, preventive rather than reactive, when a crisis has occurred. Higher educational institutions and education/training bodies also have a responsibility to support research on effectiveness of initiatives and help the employers in provision.
Ultimately, happy and well supported staff will lead to less self-harm and better outcomes for our patients. So in September, let’s pledge to dedicate airtime to improve awareness and support for healthcare staff.
By- Dr Indranil Chakravorty