I’ve had a strong interest in physician wellness for a few years now. I am a self-confessed groupie to the thought leaders on the subject and have been known to travel the globe to meet them and hear them speak. I am in awe of these ordinary physicians achieving extra-ordinary things for their fellow doctors. The challenges that physicians face are well documented – burnout, compassion fatigue, vicarious trauma and mental health issues. However, despite more than 20 years of world-wide attention to the subject, we don’t seem to be making any significant inroads. It worries me.
Doctors with burnout are more likely to make a medical error and display unprofessional behaviour (Panagioti, 2017). Both factors can result in poorer clinical outcomes, reduced patient satisfaction and can even propagate the risk of further mistakes. The responsibility for addressing the issue of physician health MUST be shared between the organisation AND the individual. In fact it has been shown that organisational strategies to improve engagement are more effective than those aimed at individuals.
In a 2016 landmark article, Shanafelt and Noseworthy outlined nine organisational strategies to promote engagement and reduce burnout. The Mayo Clinic have better statistics regarding burnout and satisfaction than the rest of the United States, if not the world, so their strategies must be worth considering (Shanafelt et al, 2015). Despite having read all the literature on the topic, I still struggled to know where to begin in my own workplace. Using these steps as a guide, we have been at least able to take the first small steps.
(Shanafelt and Noseworthy, 2016)
Acknowledge and Assess the Problem
Shanafelt et al recommended to first acknowledge and measure the problem. In my organisation within Queensland Health (QH), we already do this in several surveys. Yep. Despite living on the beautiful Sunshine Coast, our staff demonstrate the same levels of burnout and dissatisfaction as the published literature. There were themes that emerged from our data relating to leadership and attention to staff wellbeing which helped us to know where to start to craft bespoke solutions to address the issues.
One of the most important factors that contributes to a healthy workplace is adequate resources. I’ve worked in the NHS and I know that from a resource point of view, Australia is the lucky country. Even so, many Emergency Departments are chronically understaffed which makes the creation of a healthy culture all the more challenging. Let’s leave staffing to the side for now, as it is largely out of the hands of an ordinary staff specialist like myself. Suffice to say that visible, relentless efforts by our leaders to advocate for additional resources is essential to reassure staff that help is on its way.
Harness the Power of Leadership
Culture – more than just “the way we do things around here” but at its best provides a safe, nurturing environment with transparency, inclusivity and lived values that start at the very top. The essence of a healthy workplace culture is the development and demonstration of compassionate leadership. It has been said that leadership is like beauty: hard to define but you know it when you see it. While it may be difficult to define, there’s evidence that there are specific physician leader behaviours that most definitely have been shown to affect burnout and satisfaction parameters. When a leader is respectful, interested in opinion, full of encouragement, provides coaching, feedback and recognition, staff engagement booms! (Shanafelt et al, 2015). In a presentation at the Sunshine Coast University Hospital in 2017, Dr John Wakefield (Deputy Director General, Queensland Health) stated that the first level leader is the most significant factor in setting culture. Selecting emotionally intelligent leaders and investing in their training is an essential step in setting and maintaining said healthy workplace culture.
At an organisational level, in response to the surveys reflecting suboptimal workplace satisfaction and with a new Chief Executive at the helm espousing an intent to make our health service a joyful one, an initiative called “Leading the Sunshine Coast Way – The SCHHS Leadership Culture and Capability Development Program” has been launched on the Sunshine Coast.
The SCHHS Culture of Care Program aims to provide managers with useful skills with workshops on topics such as “The Value of Leadership”, “Leading through Change”, “Courageous Conversations” and “How Culture Eats Strategy for Breakfast”. The proof will be in the pudding that will be future staff satisfaction surveys. It is my hope that emphasis will also be placed on accountability, so that our leaders will be nurtured and supported, but if they fail to perform, alternative clinicians will be offered an opportunity to lead.
Align Values and Strengthen Culture
On a smaller scale, our own Emergency Department is currently attempting a cultural revolution. The last few years have seen a major transformation in the local health care facilities and true to the expectations of organisational upheaval, we recently found ourselves at the nadir of the change cycle.
The motivation of one within our group, Dr Ashwini Amaratunga, saw the recruitment of a group of interested senior emergency medical staff to tackle the problem, focussing initially on their own niche, ostensibly the role models of the department. While the group adopted the formal name “The SMO Culture and Wellbeing Group”, it has affectionately become known as “The Culture Club”.
In addition to identifying issues and solutions surrounding SMO wellbeing and strengthening the relationships both within the SMO group and upwards with their leaders, it was decided that we needed to create a vision and then a plan for its broader communication. We needed to begin with identifying the primary values and behaviours that we wished to foster within our group and to which we would hold each other to account. The vision being the “what”, the core values being the “how”.
Naively, we thought that a couple of us could formulate an initial draft of the vision and values, to be circulated for comment and ultimately approval. With further thought and consideration, we realised that in fact developing the vision and core values was a responsibility for everyone. It became obvious that it will be the process probably even more importantly than the end product, that will bring our team together in the name of collegiality, wellness and ultimately patient care.
So we now find ourselves at the start of this journey, asking ourselves the miracle question, “If we could wake up tomorrow and our ED was exactly as we envisage it, what would it look like? What is one small thing we could do to work towards that place?”
And as Mark Twain once said, the secret to getting ahead, is getting started. Watch this space.
- Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., & Chew-Graham, C. et al. (2017). Controlled Interventions to Reduce Burnout in Physicians. JAMA Internal Medicine,177(2), 195. doi: 10.1001/jamainternmed.2016.7674
- Shanafelt, T., & Noseworthy, J. (2017). Executive Leadership and Physician Well-being. Mayo Clinic Proceedings,92(1), 129-146. doi: 10.1016/j.mayocp.2016.10.004
- Shanafelt, T., Gorringe, G., Menaker, R., Storz, K., Reeves, D., & Buskirk, S. et al. (2015). Impact of Organizational Leadership on Physician Burnout and Satisfaction. Mayo Clinic Proceedings, 90(4), 432-440. doi: 10.1016/j.mayocp.2015.01.012