How can we tackle healthcare staff burnout?

A previous post looked at the negative impact of staff burnout on patient care. But how can we tackle this problem? In this post I will consider the evidence for the effectiveness of interventions for reducing burnout.

Types of interventions
Interventions to tackle burnout are often broadly split into those which are targeted at the ‘individual-level’ and those which are targeted at the ‘organization-level’. Individual-level interventions are context independent; they view employees as people who are suffering from poor mental wellbeing and aim to treat this. They may include stress management workshops, one-to-one cognitive therapy or the provision of support phonelines for staff. Organization-level interventions on the other hand are ‘context dependent’; they view employees as workers being impacted by difficult work circumstances. They may include the changing of shift-patterns or rostering practices, improving canteen facilities or the provision of job training.

Are organization-level or individual-level interventions most effective?
There is debate as to which type of intervention is most effective. Three recent meta-analyses have found somewhat conflicting results.

  1. In a meta-analysis of 15 randomised trials and 37 cohort studies in doctors, West et al. (2016) found that while organization-level interventions were more effective than individual-level interventions for overall reducing overall burnout, there was no difference when the outcome was either of the specific facets of burnout (emotional exhaustion and depersonalisation).
  2. In a meta-analysis of 20 randomised controlled trials in doctors, Panagioti et al. (2017) found that organization-level interventions were significantly more effective than those which were targeted at the individual-level.
  3. In a meta-analysis in mental healthcare professionals, Dreison et al. (2018) found that individual-level interventions were more effective than those targeted at the organization-level.

Why the difference?
These conflicting results could partly be due to different interpretations of what the categories of ‘individual-level’ and ‘organization-level’ interventions include. For example, whereas West et al. (2016) included communication training interventions in with individual-level interventions, Dreison et al. (2018) regarded these as training interventions, which they included in with organization-level interventions. The lack of clear findings could also be an artefact of how broad these categories are; when Dreison et al. (2018) broke down the category of organization-level interventions into training interventions and non-training interventions, their results differed again; training interventions were actually more effective for reducing overall burnout scores than individual-level interventions. It is possible that the categories of ‘organization-level’ and ‘individual-level’ interventions are so broad as to be useless.

Take home message
Despite the confusion over organization-level vs. individual-level interventions, the clear message is that overall, interventions ARE effective. DO SOMETHING and there is a good chance your staff will benefit.

Helping staff to love their work
A first step in developing any effective burnout intervention should be to look at the causes of why this burnout has developed in the first place. This may sound obvious but it is often overlooked. Studies into the causes of burnout have identified several contributors which interventions could seek to address, including poor staffing ratios on wards, lack of time for patient-facing work, inadequate IT facilities and lack of training or professional development opportunities. The unifying theme here is that we need to help staff to love their work – we need to help make the difficult aspects of their work more manageable and support them to maximise and capitalise on the parts of the job they love. A recent example of this is the introduction of a caseload-carrying model of care to midwifery in Australia. Caseload-carrying midwives follow the same women up throughout their pregnancy, rather than simply attending to women who arrive at a clinic when they are working (who will likely have their other appointments with different midwives). There were concerns that carrying responsibility for a caseload may increase the burnout levels of midwives, but in fact the opposite has been found. A study by Dawson et al. (2018) found lower rates of burnout and more positive work attitudes in caseload-carrying midwives than those working in the traditional model. If we consider the causes of burnout, we could hypothesise that caseload-carrying midwives enjoyed stronger relationships with the patients that they had and were able to employ and develop a greater skill-set due to working with women at all different stages of pregnancy.

I work in healthcare. What can I do to help myself?
Research suggests that making changes at the level of the organization is a key to targeting healthcare staff burnout. However, if you are a healthcare worker keen to improve your own self-care, there are things you can do:

  1. Help yourself get good sleep. A recent study suggests that people who get better sleep are less likely to report burnout three years later (Elfering et al., 2018). If you work night shifts, getting good sleep may be particularly difficult for you. The BMA have recently published tips for managing these. Amongst other things, they suggest taking naps of 10-20 minutes during the early part of night shifts, avoiding caffeine and nicotine in the final few hours of night shifts, and wearing sunglasses on your journey home in the morning, even on a cloudy day.
  2. Put in boundaries. Nurses who have clear boundaries between their work and home lives have higher wellbeing (Oates, 2018) and psychotherapists who put in boundaries on an emotional level between themselves and their clients (Simionato et al., 2018) have lower burnout.
  3. Spend time relaxing, listening to music and being out in nature. Nurses who do this report higher wellbeing (Oates, 2018).
  4. Look into training opportunities you can access via work. The budgets for Continuing Professional Development have been squeezed in recent years, but research suggests that healthcare staff who get more workplace learning have higher job satisfaction (Iliopoulous et al., 2018), and training could be one of the best ways to tackle burnout (Dreison et al., 2018).
  5. See if there is a way you can get more time to do aspects of the job you think are important. Carefully consider the parts of your work that give you the greatest sense of satisfaction. Is it building positive relationships with patients? Is it contributing to service level improvements? Is it learning about recent advances in your area and seeking to apply this knowledge to your own patients? Whatever it is, see where there could be scope to spend more time on this. Research suggests that doctors believe having adequate time for key tasks is the most important thing to reduce burnout risk (Fortenberry et al., 2018).

This blog was written in conjunction with a talk given at the Practitioner Wellbeing Conference in Manchester on 14 June 2018. To download a copy of the slides, click here.

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