Burnout in Healthcare: A Dual Systems Approach

July 24, 2019

     Alarming statistics across Australian healthcare highlight the need to improve physician and nursing well-being.  85% of doctors have reported experiencing a mental health issue over the past 12 months [1], with 1/3 of doctors experiencing burnout at some stage in their career [2].   More than 50% of Australian nurses feel that work-related stress has affected their health,[3]  in addition to negatively impacting their performance.  Research also reveals that the prevalence for depression amongst physician residents is more than 4 x higher in comparison to the general population;[4]  Suicidal ideation and attempts are also significantly higher for medical doctors, estimated to be 1.5-4 x above the average.[5] These statistics have been acknowledged and steps have been taken to address the challenges that have led to this crisis, but more support for healthcare professionals is needed.  Further, support that contributes to cultivating well-being across healthcare will not only benefit those working within healthcare, but also the patients experiencing care within the system. 

 

    Burnout seems to be pandemic within healthcare settings and can lead to decreased productivity and engagement, depression and adversely impact overall well-being.  It has been estimated that 40% of surgeons meet the criteria for burnout,[6]  yet little is done to acknowledge or address the problems within the healthcare environment.  There are 3 phases of burnout have been identified, which individuals progress through when they perceive workplace demands exceed workplace resources and personal traits: [7]

 

  1. Emotional exhaustion: manifested through extreme mental or physical fatigue

  2. Cynicism: critical of workplace environment and disengaged

  3. Reduced professional efficacy: perception of inability to successfully complete tasks

 

   Excessive workloads, poor work climate and greater emotional demands have been identified as the key culprits contributing to burnout.  Changes in the healthcare landscape related to decreases in autonomy and funding and increases in bureaucracy have only heightened the risks associated. 

 

   It’s safe to say that the general population have similarly felt the symptoms of burnout however, healthcare workers are also contending with the ongoing responsibility of managing others’ suffering and are often unable to switch off.  Encountering another’s suffering can elicit both empathic concern and empathic distress.  Empathic concern is when there are feelings of concern for another which lead to altruistic and prosocial behaviour, resulting in positive feelings, good health and the desire to help.[8]  The alternative response to managing another’s suffering is empathic distress, which is when one imagines and internalises someone else’s pain and has been associated with negative emotions, poor health and burnout.[9] Empathic distress leading to burnout is something doctors, nurses and carers regularly face due to the nature of their roles.  Fortunately, through taking proactive, positive and consistent action, the self-sacrifice doctors and nurses bestow each day, will likely not come at a personal cost. 

 

System 1: Approaching Burnout from a Personal Perspective

 

     According to the latest research, well-being is when our physical, psychological and social resources can cope with the physical, psychological and social challenges we face each day.[10]  Concentrating on building these resources is one of the keys to managing and avoiding burnout. Physical well-being can be enriched through a brain friendly diet, regular exercise and appropriate sleep hygiene.  Psychological well-being can be promoted through increasing positive emotions, finding meaning in daily activities, practicing mindfulness, having positive relationships and achievements.  Social well-being may be developed through maintaining close friendships, social integration and community involvement.  In addition to improving overall well-being, each of these endeavours builds internal resources that protect individuals from empathic distress and ultimately burnout. 

 

System 2: Approaching from an Organisational Perspective

 

   An imperative step to avoiding burnout will be to make changes to the environment which is leading to burnout, specifically the healthcare/hospital setting.  Identify the contributing factors that are placing individuals at risk for burnout and make some positive changes.  Make workloads manageable, take action to reduce the stigma of associated mental health issues, create a culture of support and mentorship and leadership. 

 

   Through a supportive organisational framework, healthcare workers must be given the time and the resources to start focusing on their well-being for their own benefit and the benefit of those they support.   They must also be provided with an environment that is conducive to cultivating and reinforcing well-being, one that drives a balance between the daily challenges and the resources developed to manage those challenges.  Change is warranted from both perspectives. 

 

Kirsten works with individuals, teams and organisations through initiatives in well-being, performance and leadership.  Contact her today to support you on your journey of developing your potential. 

 

    

 

References

 

 

[1] Miller, M. N., & Mcgowen, K, R. (2000). The Painful Truth: Physicians Are Not Invincible. Southern Medical Journal, 93(10). 32.

 

[2] West,  (2006)

 

[3] Southern Cross University Survey, 2013.

 

[4] National Mental Health Survey of Doctors and Medical Students (2013). Beyond Blue, Roy Morgan Research. Retrieved from https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web

 

[5] as above

 

[6] Dimou, F. M., Eckelbarger, D., & Riall, T. S. (2016). Surgeon burnout: a systematic review. Journal of the American College of Surgeons, 222(6), 1230.

 

[7] Taylor, N. Z., & Millear, P. M. R. (2016). The contribution of mindfulness to predicting burnout in the workplace. Personality and Individual Differences, 89, 123-128.

 

[8]  Eva, A., (2017).  How to stay empathic without suffering so much.  Greater Good, UC Berkely.

 

[9]  as above

 

[10] Dodge, R., Daly, A. P., Huyton, J., & Sanders, L. D. (2012). The challenge of defining wellbeing. International journal of wellbeing, 2(3).

 

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