WELL MEASURED

MATT SHAND, JOURNALIST

Jo Sinclair is working to see greater recognition, and measurement, of the mental health of clinicians at Te Whatu Ora.

Dr Joanna Sinclair, the interim National Clinical Lead for Employee Wellbeing at Te Whatu Ora, says New Zealand is “decades behind” where it needs to be in terms of the mental wellbeing of doctors and medical staff.

This lack of care is contributing to a growing rate of burnout and exacerbating issues such as depression.

Sinclair hopes to be part of the change helping move things forward to avoid further losses.

“Year after year we see that burnout and stress are issues,” she says.

“It is my ‘why’ and it’s why I am here despite the challenges of trying to effect change. I want to make mental health a priority for all staff because this story is sadly not new, and people are left wondering why.”

Sinclair wants to see a system where clinicians and all health employees put their mental health and wellbeing first.

“That is the most important thing we can do for our patients. We have to put our own oxygen mask on first. There is abundant evidence that, aside from the personal benefits, clinician wellbeing is associated with better quality care and patient safety.

“[As an anaesthetist] we get made aware quite early on in our training about some of the issues our speciality is more prone to,” she says.

“Things like substance abuse, suicide and burnout. I’ve always carried a sense of injustice about the lack of attention paid to managing the inherent stress of the job.

“You put so much of yourself into becoming a doctor and establishing your career that it tends to be a bit later before you think about having a family. You might get behind on the property ladder, many rack up student debt and then you end up in a highly stressful job where the expectations on you to be ‘excellent’ are high. Yet you increasingly feel like the system is working against you.

“It seems really unfair. We can see other businesses understanding the value of ensuring their workforce can thrive, but we haven’t experienced that in our health care organisations.”

Sinclair spent a lot of her continuing medical education leave looking into mental health issues within a medical workforce context.

“I conducted a survey of SMO groups at Counties Manukau and presented a paper to the CMO and HR director at that time.

“The survey showed high levels of burnout and distress. Previously the bulk of work in staff wellbeing had been in the ‘people and communications’ space not in the hands of clinicians. We championed the importance of clinician voice at Counties and started to shift the dial towards a collaborative approach.

“This was pretty novel at the time. When the health reforms happened, my colleagues and I proposed including of clinicians in the planning of a national workforce wellbeing programme. That is how I find myself in my current role.

“As part of my role at Counties, we introduced the Well-Being Index developed by the Mayo Clinic as a tool to measure health care worker wellbeing.”

While it is a small step forward, she encourages clinicians to consider the Index and conduct regular self check-ins using the Well-Being Index app, an internationally validated tool that is being rolled out nationally later this year to help Health New Zealand employees track their mental health and identify when stress or burnout is affecting them.

“It is not the be-all-and-end-all tool for mental health but it is a start,” Sinclair says.

“This two-minute check-in is akin to getting your blood pressure checked regularly or having age-appropriate cancer screening. A personal dashboard helps you understand your results, see how you compare to your peers, and gives you access to a locally curated catalogue of resources.

“Over time it allows you to notice things about your mental health, like ‘what occurs when I take a holiday?’, or ‘are there dips due to a period of high workload?’”

Sinclair wants to make it clear that this is not a substitute for addressing the systems issues that are at the front of everyone’s minds.

“Eighty per cent of our wellbeing at work is tied up in workplace issues. That’s what I want to work on at a national level.

“But we need to keep looking after ourselves, because many of those workplace issues are not quick fixes.

“The data from the Well-Being Index app is 100 per cent anonymous. The value to my role is in the de-identified aggregate data that is collected.

“I’ve seen some powerful examples of the weight this data can add to our stories. The data shows it is not just one person’s story.

“There is a huge body of research that shows the impact our wellbeing at work has on patient safety, patient satisfaction, retention of our workforce, engagement… the list goes on.”

One initiative Sinclair is working on is encouraging the medical workforce to connect and talk to each other.

“There is a culture that rewards stoicism,” she says.

“Those who suck it up, do extra shifts and contribute when things are behind, are rewarded. Those who cannot are seen as lesser, even when they have valid reasons. We have this ‘it’s how it was done in my day’ mentality.

“This culture means issues are often missed because people may not feel safe to speak up.

“Some hospitals have started introducing Schwartz Rounds where people talk about the emotional impact of providing care. These are open to all staff, from surgeons to cleaning staff, as health care impacts everyone. At these Schwartz Rounds a lot of people voice things for the first time having support around them to talk about it.

“Whilst I continue to advocate for systems change, I want to acknowledge change is slow. Sometimes the best thing we can do to create change is to look out for the person standing next to us.”

Sinclair is also working on a peer-to-peer ‘stress first aid’ programme and she will be running a discussion group at ASMS’s annual conference in November.

To learn more about how you can engage about workplace wellbeing, contact Joanna.Sinclair@tewhatuora.govt.nz