I’m lucky in my role that I work remotely behind a computer screen. The same can’t be said for frontline health care staff – especially during a global pandemic. Not only do doctors, nurses, porters and the like run the risk of contracting the virus, they do so in the face of so many other challenges that office workers would struggle to comprehend. My back aches after thirty minutes of navigating the aisles of a supermarket. The prospect of standing motionless holding a retractor for hours at a time fills me with utter dread.

And yet, that’s the kind of thing medical staff up and down the country do on a daily basis. They put in the long hours, they look after others ahead of themselves. If anything, it’s surprising that burnout rates for health care staff aren’t closer to 100%.

Instead, burnout rates were reported by the Harvard Business Review to be approaching the 50% mark:

“With 100+ hour weeks common throughout training, treating work as the only priority was seen as a badge of honor. (The common joke in surgical training goes: What’s the problem with being on overnight call every other night? You miss half the surgeries.) However, increased recognition of the negative impact of these draconian schedules on personal health, mental wellness, and patient safety, combined with pressures from the Occupational Safety and Health Administration (OSHA), resulted in internally enforced work-hour restrictions and the emergence of wellbeing programs.

“These changes have paralleled a wider movement in medicine seen in the greatly increased number of burnout-related publications. In 2003, 307 scientific articles with the term 'burnout' were indexed by the National Library of Medicine. By 2009, that number was 560; by 2019, it was 2,137.

“This newfound interest led to two pivotal developments in various health care organizations: 1) increased measurements of wellbeing, including both drivers of distress (organizational leadership, lack of professional fulfillment, low engagement) and its sequelae (burnout, turnover, medical errors); and 2) structural changes that included the creation of formal wellbeing programs and the hiring of chief wellness officers.”

The article continues:

“In recent years, the health care sector has become increasingly aware of the drivers of burnout beyond long work hours. For example, the ability to engage in work that health care providers find most meaningful for just 20% of the week appears to protect against burnout.

“With this in mind, many physician wellbeing programs are incorporating professional development into their arsenal of initiatives to prevent burnout and consider professional fulfillment as a primary outcome. As a result of these multifaceted efforts, recent large multi-specialty national studies point to an overall decrease in physician burnout and an improvement in work-life-integration in recent years.”

It makes sense. If I were in a position to dedicate 20% of my working week to the projects I found most meaningful and fulfilling, I’d feel all the better for it. Recalibrate the split to 10% / 90% and I’d begin to feel overwhelmed. At 5% / 95%, I’d be wondering what the point of it all is. And my day job is sat at a desk. 

For doctors and nurses on the COVID wards, such disproportionate ratios would surely have catastrophic consequences on both their physical health and mental wellbeing.

A successful wellbeing programme relies on a solid infrastructure - one where interventions are both reactive and proactive. Prevention is better than cure, as the adage goes, especially when the lasting effects of burnout impact far more than just your ability to work. The Harvard Business Review suggests establishing wellbeing as an organisational priority akin to optimising finances and operations, as well as creating space for it at the decision-making table. The article further points to the importance of an organisational framework:

“As with all strategic endeavors, a clear vision for success requires a framework and guiding principles. In our institution, the use of the professional fulfillment model has helped shape our goals, initiatives, and establish organizational alignment by delineating three core wellbeing priorities. However, other frameworks, such as the Job Demand-Control-Support Model or internally developed alternatives, can be implemented.”

The professional fulfilment model in question was shared by Stanford Medicine in 2016, with the three “wellbeing priorities” listed as:

1. Culture of Wellness

Organizational work environment, values and behaviors that promote self-care, personal and professional growth, and compassion for ourselves, our colleagues and our patients.

2. Efficiency of Practice

Workplace systems, processes, and practices that promote safety, quality, effectiveness, positive patient and colleague interactions, and work-life balance.

3. Personal Resilience

Individual skills, behaviors, and attitudes that contribute to physical, emotional, and professional well-being.

The key success factors for Personal Resilience include:

• Self-care assessment and support systems

• Safety net systems for crisis interventions

• Worksite evidence-based health promotion

• Encouragement of peer support

• Financial management counseling

• Life-needs support mechanisms (e.g. Child and Elder Care, After hours meals etc.)

My concern is how such measures work in practice. Not through lack of effort or inclination “from the top” (although this will undoubtedly be the case in many a toxic workplace), but through a lack of uptake. I know from experience that asking for help is hard. And it doesn’t get any easier. 

Only a generation or so ago, Brits talked of a “stiff upper lip” as if it were a badge of honour. Speaking to a therapist about your thoughts and feelings was seen as a weakness, or something “only Americans would do”. Indeed, in 2010 there were only 127,600 therapists in the UK. In 2020, that number had risen to 211,300.

But times are changing. With each passing day, the stigma around mental health is waning and more and more sufferers are seeking professional help. According to the NHS:

“1.60m referrals were made to talking therapies for anxiety and depression in England during 2018-19 – up 11.4% from the previous year (1.44m in 2017-18).

“1.09m referrals started treatment during 2018-19, which is an increase of 8.3% from 1.01m in 2017-18.”

But burnout doesn’t just pertain to mental health.