As nations around the world begin to emerge from lockdown and assess the economic, social, and mental ravages of the COVID-19 pandemic, there is no doubt that some nations were more successful in limiting the spread and damage of the virus than others.
It has been a surreal experience, sitting in my home office in London and talking daily to my Cemplicity colleagues and family in New Zealand and Australia. It’s difficult to reconcile the news and statistics from Downunder with that of the UK, and the Cemplicity team is finding itself having very different conversations with clients in each of the countries we work in.
Australia and New Zealand are being globally praised for their early, aggressive approach and for the outcome you’ve achieved. Up here in the UK we are still grappling with high rates of infection, deaths, and further lockdown restrictions.
However, there is one common concern that continues to permeate every discussion regardless of which country our client is in: concern for the welfare of frontline staff.
People have no doubt heard about our weekly clapping in the UK at 8 pm on Thursdays. We all head to our front door, windows, and rooftops to participate in the mass applause. Some folks bang on pots and pans and others stick their fingers in their mouth and let out piercing whistles.
It’s hard to describe the overwhelming sense of unity as we all try to send love, acknowledgement, and support to the doctors, nurses, scientists, practitioners, emergency services, and more of the countless staff across the NHS and care homes who are risking their lives due to the pandemic. It’s even harder to believe this ritual will come to an end, and the pandemic will abate, but the news from Australasia gives us some hope.
As the pandemic subsides and we reenter a changed world, the reality is that healthcare staff worldwide will still be reeling from the physical and emotional blow of this crisis. Our clients in Australia and NZ are now asking us how they can best monitor and support their workers through the recovery process. One thing they are particularly worried about is staff burnout.
Burnout is described as a psychological syndrome induced by occupational stress in which one may feel physically, mentally, and emotionally drained at work. It is characterized by a feeling of cynicism or indifference at work, and inefficacy, or a lack of satisfaction with expectations. (West and Dawson)
Cases of staff burnout have been linked to an increase in absenteeism and turnover, as well as an increase in patient dissatisfaction. By monitoring staff burnout, the idea is that we can relieve the strain on an already stretched staffing level while improving patient health outcomes and overall experience. Frankly, it is also the right thing to do for those who dedicate their lives to the service of others.
In New Zealand, it was reported that two-thirds of female doctors and half of male doctors suffer from burnout. In one national mental health survey, known as Beyondblue, 32 percent of Australian doctors reported high levels of emotional exhaustion, and 35 percent responded with feelings of cynicism. These are shocking statistics with severe implications as burnout effects include depression, apathy at work, and negligence in patient care.
Burnout is not the same as depression. Burnout is strictly occupational— stress incurred from work. At lower levels, symptoms of burnout can subside over staff breaks or weekends. However, as burnout develops and becomes more severe, people begin to question their career choice and become indifferent and negligent of their work. Eventually, they resign.
This questioning of one’s career is particularly worrisome because figures suggest an already precarious shortage of staff in the healthcare sector continuing to plummet. WHO predicts an additional global shortfall of 18 million healthcare employees by the year 2030.
In a recent physician survey conducted in the USA, 60 percent of the participants claimed they were considering leaving their practice, and a staggering 70 percent of respondents knew of at least one staff member who had already quit their practice because of poor morale. More than 40 percent of American physicians experience symptoms of burnout, a massive contributor to the dissatisfaction and turnout of American healthcare workers.
It is imperative that we monitor staff engagement to prevent and pre-empt burnout so that we can maintain current healthcare staffing levels. We also want our staff to find meaning and joy in their work so that they inspire others to join this important profession.
In a blog post found at Nurse.org, an American website featuring voices and opportunities for healthcare nurses, one nurse described burnout as a blindsiding, gradual, cumulative process that led to her eventually needing a six-month break from the healthcare sector. “Gradually, my friends, family, and coworkers started noticing changes. Nothing had changed in my workload, my schedule, or my life at home — but there were definitely changes in me.” One slow-burn change was an increase in cynicism and a decrease in empathy. This nurse writes, “showing compassion and giving people the benefit of the doubt was something I no longer did.”
The fact that dissatisfied staff are unable to offer the best care is not just anecdotal. Analysis of the 2007 NHS national staff survey correlated with the NHS inpatient survey from the same year, showed over 12,000 correlations between staff experience and patient satisfaction. This suggests that burnout among nurses and physicians is linked explicitly to patient perceptions of poorer care and results in poorer health outcomes as stated in the West and Dawson Review of Staff Engagement (2012).
In a medical paper titled “Breaking the Burnout Cycle”, Doctors with burnout “were more likely to subjectively rate patient safety lower in their organisations and to admit to having made mistakes or delivered substandard care at work; they are less empathic, less able cognitively and can have a negative impact on colleagues, teams and the organisation.” The burnout epidemic in the healthcare sector can be fatal.
In addition to poor performance, burnout has also led to cases of poor physical health and depression among healthcare staff. In that same Beyondblue survey of Australian physicians, 6 percent reported a diagnosis of depression and 4 percent of an anxiety disorder, all caused by the onslaught of their work-stress. A recent article published by The Economist claims that doctors and nurses worldwide are at higher risk of suicide than the general population. According to Dr. Clare Gerada, Chairwoman of the British charity, “Doctors in Distress,” the problem is “a lack of time and space afforded to doctors and nurses to discuss the emotional impact of their jobs.”
All this data, with the added impact of the pandemic may make burnout feel like an avalanche that is impossible to avoid. The truth is that there is a way forward. By acknowledging its existence and closely monitoring staff for symptoms, we have the strategies to step in and support healthcare workers before contributing factors make the outcome inevitable.
What Cemplicity is doing is offering our clients a platform to keep their finger on the pulse of staff engagement, to identify teams that need greater support and to celebrate those that are doing well. This staff ‘check-up’ is not something that should be done once a year in a kind of ticking-of-the-box manner. Instead, we view staff engagement monitoring just like patient experience measurement – as an ongoing commitment that provides a panoramic view of how staff are coping every week and month.
As NZ and Australia see the pressure lifting and can refocus on strategic improvement projects, we are seeing our forward-thinking clients turn their attention to their workforce. By investing in their carers’ well-being, they are investing in their future generation of healthcare workers as well as great care for patients.
And there is no time more necessary to invest in staff well-being than now. In our current crisis of COVID-19, with a death toll of over 275,000 humans, it’s clear how essential and life-saving an efficient, valued, and tended to health workforce is.
It is also what the people who dedicate their lives to the care of others deserve.