Beating burnout

says Liz Price

No one would dispute that NHS staff are under growing pressure due to multiple factors, from understaffing to rising patient demand. Research by a range of organisations is consistently finding increased rates of burnout across all areas of healthcare.

Burnout can be defined as a state of physical, mental and emotional exhaustion, usually occurring when someone experiences a lot of stress over a long period of time.

There is a well-established causal relationship between reduced clinician wellbeing and increased patient safety incidents. The rise in the incidence and severity of reported burnout is concerning for clinicians themselves and for the potential impact on their patients and colleagues.

Consequences

New evidence has revealed several groups of clinicians who are at high risk of burnout, that is those: working in remote areas or isolated roles; those with disabilities; those with care-giving responsibilities; and those working in specialties where there is an extreme backlog of work associated with the COVID-19 pandemic.

Furthermore, it is becoming clear that clinicians can experience burnout at any stage of their career, and that the personal consequences include a reduction in work satisfaction, a deterioration in health, and difficulty in empathising with and demonstrating compassion to colleagues.

Consequences at the team or organisational level for clinical and non-clinical leads include increased numbers of errors, reduced productivity and efficiency, and a reduction in measures of patient satisfaction. There may also be a reduction in the quality of care delivered and an increase in unprofessional behaviours, which is directly associated with the inability to empathise and demonstrate compassion. This also reduces the levels of both supportive and help-seeking behaviours, which are essential to ensure safe practice.

Individuals can adopt protective strategies against burnout on a personal level (see some tips below), but it is now evident that systems and organisational factors within healthcare settings are increasingly contributing to the reduced wellbeing and diminished resilience of clinicians.

Such factors include heavy workloads, challenging working environments – even at the level of basic needs, such as adequate hydration, rest and personal safety – normalisation of aberrant behaviour within teams and ineffective leadership styles.

Right: Burnout is on the increase throughout the healthcare sector

Below: Make sure you are supportive of your team

This is an extremely worrying trend. Clinical leaders may feel that there are some major factors beyond their ability to control or influence – for example, funding or staffing –but the following may be helpful.

CHECK-INS

Ask yourself: “Do I understand how my team members are doing?” Can you incorporate check-ins across their mental, physical and emotional wellbeing? These can be formalised at briefings or debriefings, or as straightforward as asking “How are you?” and really listening to the reply.

This can be daunting, as we often worry about opening a Pandora’s box. However, I often find that people will say: “I’m fine, thanks”, but non-verbal cues and delving a little deeper will reveal that things are not quite that fine.

You may need to consider the level of psychological safety you have in play if the team are not letting you know that things are challenging at times. People who don’t feel supported or properly listened to are less likely to raise concerns about themselves or others, and again this is problematic for patient safety and demonstration of professional responsibilities.

Positive Energy Management

There is growing evidence to support the concept of positive energy management – making sure that, as a leader, you always bring your best self to the team. Being able to step aside from the stuff that negatively drains your emotional capacity and convert it to a positive is important when leading others. It’s still important to recognise the negatives and their effect (particularly in front of the team), but being able to demonstrate you can move forward through anything in a positive way helps the team feel supported and provides reassurance.

Can you incorporate check-ins across your team’s mental, physical and emotional wellbeing?

BEING SELF-AWARE

My key tip here for all clinicians (including leaders) is to work on self-awareness. Starting to notice early warning signals is an important first step in managing your response. These are different for different people, but can frequently include:

• feeling tired or drained

• frequent illness (lowered immunity)

• lack of motivation

• memory loss

• changes in your attention span

• feelings of failure or self-doubt

• feeling detached or isolated.

You may also notice a reduction in the quality of your interactions with colleagues or experience increased negative emotions towards patients and/or colleagues. This requires increased levels of self-management and control: are they getting annoyed with you, are you getting more annoyed than usual with them, are you avoiding some colleagues as you don’t have the energy and are you cutting encounters short for that very reason?

Proactive Wellness

It can be helpful to reflect on things you can do proactively to manage your own wellness. For example, write down a wellness ‘plan on a page’ that includes activities that you could incorporate into daily life to support your own wellness across mind, body and spirit.

For me, these headings would include: mind – listening to music or reading; body – doing a mini strength workout twice a week, switching off my phone earlier before I try to get to sleep; spirit – walking the dog, making sure I connect with friends more often.

Challenging Encounters

Practise self-compassion when reflecting on challenging interactions with colleagues. It may be that your approach or response to a situation contributed to a negative outcome. However, just because you got one interaction wrong doesn’t make you a bad person. Just take the opportunity to be honest and apologetic the next time you see them.

Of course, if there is a pattern developing, it’s worth delving a little deeper to see whether there are actions you need to take to break the cycle.

Take Action

Take time to understand your own lived experience in relation to burnout. Ask for support if you are experiencing signs of burnout. Patient safety can be impacted and all clinical colleagues have a professional responsibility to provide a supportive response in these circumstances. Remember that clinicians in leadership roles have additional professional responsibilities in relation to creating safe, inclusive and health-promoting work environments.

No Easy Solution

It is important to acknowledge that all these issues present a complex challenge for health service organisations and individual clinicians, and there is much more to say on the topic of burnout.

At MDDUS, we have been lobbying UK governments on addressing workforce health and wellbeing issues.

We have also developed different courses for leaders on how to build conditions that support resilience and support for individual members to develop strategies to maintain wellness.