by Dr Anna Baverstock and Dr Jess Morgan
Dr Anna Baverstock is a consultant community paediatrician at Somerset Hospitals Foundation Trust and lead for senior doctor wellbeing @anna_annabav
Dr Jess Morgan is a paediatrician and Dinwoodie RCPCH Clinical fellow @doc_bipolar
The workplace experiences of doctors in the UK continue to be very concerning. Data from successive years demonstrate an overwhelming workload, persistently high levels of burnout and exhaustion, and doctors continuing to leave UK practice. [1,2⦎ There is now much evidence linking burnout to adverse patient safety outcomes, as well as data revealing the financial benefits and efficiency savings when colleagues are well and able to offer more compassionate care [3,4⦎ So whatever your driver is, a thriving, mentally well workforce results in better patient care by all metrics.
With that in mind, how do we ensure that the last patient of our shift gets the same kind, compassionate, safe, high-quality care as the first? This is only possible, by making staff wellbeing a system and organisational level priority. Here, we offer a simple model, highlighting five key priorities. Join us on X and LinkedIn over the next few months as we explore each of these points in more detail, consider the barriers to change and how we can collaborate to overcome them.
Basics Needs
Whether it’s access to food, somewhere to park or simply a safe place to store your belongings, getting the basics right is key. Hungry, angry, late, tired doctors cannot and do not provide the same quality of care for patients.
We were reminded of the Van Halen tour in the 80s. In and amongst the detailed safety instructions about equipment and hospitality was a specific clause about the availability of backstage M & M sweets, with the added detail that there were to be “absolutely no brown M&Ms”. Failure to adhere to this instruction suggested the venue had not paid full attention to, or adequately valued the wellbeing and safety of the band.
In a similar way, tending to and valuing the basic needs of healthcare staff is paramount to patient safety. This includes access to hot food 24/7, appropriate sleep facilities, lockers, tea and coffee, car parking etc.
2. Protected rest time
The relentless and often overwhelming workload is well evidenced across the NHS. Doctors are leaving work exhausted and often feel insufficiently rested when they return.[1,2⦎ Ensuring that rest is both prioritised and respected is essential. Not only does this mean access to rest and sleep facilities at work, but also rotas which protect and respect non-working days, annual leave and less that full time working patterns, giving staff sufficient time to reset before their next shift.
3. Communication and civility
There is an ever-increasing awareness of the fundamental need for psychological safety for good team functioning. This is about creating environments where people feel able to speak out without fear of judgement, punishment or humiliation.[5⦎
Many of us will have been on the receiving end of uncivil behaviour at work, be it eye rolling, tutting, rudeness, shouting, swearing… the list goes on. Incivility quite clearly impacts our own personal wellbeing but it also has a knock on effect on the efficiency of the team and, in turn, ramifications for patient care. This is demonstrated by the work of Civility Saves Lives and Learning from Excellence, grass roots organisations that have been set up to raise the profile of how our behaviour impacts the care we deliver.
To support our diverse teams, we need system and organisational adaptations to welcome and accommodate all colleagues. The recent NHS staff survey highlights that those from black and ethnic minority backgrounds are more likely to be on the receiving end of harassment, bullying and abuse alongside colleagues with other protected characteristics. [6⦎
With this in mind, we encourage organisations to lead by example, modelling compassionate, psychologically safe working environments with a focus on training staff to challenge incivility, racism and discrimination as well as putting in place mechanisms to protect victims and address perpetrators when behaviours are ongoing or discriminatory. It is not enough to just talk about it, we need to take action.
4. Reflective spaces
Just like we cannot expect people to walk through water without getting wet, it is unrealistic to think we can bear witness to the pain and suffering of our patients without being touched by it emotionally. [7⦎ We need organisations to recognise this inherent humanity and prioritise supporting healthcare staff in processing the inevitable emotional burden of care-giving. Though some of this can be achieved through informal chats with colleagues or more formal reflective spaces with trained facilitators, such as Balint groups, Schwartz Rounds and peer support groups like those run by Doctors in Distress, we advocate that these conversations need to become part of our standard clinical care. This means allocated funding and incorporation into job plans and rota coordination making them part of the day to day work of a doctor.
5. Expert psychological support
Sometimes, despite our best efforts, all of the above may not be enough. In those circumstances, we need staff to feel able to reach out for help. This means addressing the undercurrent of stigma around mental illness in medicine and ensuring easy-access to expert emotional and psychological support. It is therefore imperative that organisations not only provide specialist wellbeing services, but also train leaders and supervisors on how to spot, support and signpost colleagues in distress.
This model of organisational wellbeing offers 5 priorities for leaders to focus their endeavours on meaningful, evidence-based changes which will result in staff feeling valued, improve satisfaction, reduce burnout and improve patient care. Join us on Twitter for ongoing conversations about how we can take action together to improve the wellbeing and working lives of our colleagues.
@anna_annabav @doc_bipolar
1. GMC State of Medical Education and Practice in the UK, Workplace experiences 2024 https://www.gmc-uk.org/-/media/documents/somep-workplace-report-2024-full-report_pdf-107930713.pdf [accessed 08.08.24
2. GMC National Training Survey 2024, https://www.gmc-uk.org/-/media/documents/national-training-survey-summary-report-2024_pdf-107834344.pd [accessed 08.08.24
3. Garcia C, Abreu L, Ramos J, et al. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019 Aug 30;55(9):553. doi: 10.3390/medicina55090553. PMID: 31480365; PMCID: PMC6780563.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780563/ [accessed 08.08.24
4. Dyrbye, L.N., T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers. 2017. Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington
5. Edmondson, AC. . The Fearless Organization. New York, NY: John Wiley & Sons, 2018
6. 2024 NHS National Patient Survey https://www.nhsstaffsurveys.com/ [accessed 08.08.24
7. Remen, R. Kitchen Table Wisdom: Stories That Heal. New York: Riverhead Books, 1996