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Staff burnout is nothing new. But the levels of stress that healthcare workers are experiencing in the midst of the pandemic is. In spite of this, there can be – and are – positive shifts. We talk to Dr. Azhar Ali, ex Head of Middle East & Asia Pacific regions for Institute for Healthcare Improvement (IHI), who has just introduced ImproveWell to Scottish practice at the Forth Medical Group.

The IHI’s recent practical advice updates its 2017 framework that states reducing burnout in healthcare isn’t just about changing working hours or increasing rewards but is linked to enjoyment – a lack of which it describes as an epidemic. Burnout has tangible results including staff churn, diminished camaraderie and poorer patient outcomes. What’s needed is ‘psychological PPE’ and bold leadership.

How has Covid-19 changed the issue of burnout in healthcare? ‘We talk about equity in healthcare and how it’s probably the forgotten dimension of quality… It’s not just a case of the virus targeting certain people, but instead the pandemic highlights inequities that are already there in our system, in our communities and in our society’, says Dr Azhar Ali. ‘Similarly, from a burnout perspective, it’s not just a case of the Covid-19 pandemic creating it, but it has highlighted and exacerbated an existing issue. It’s a challenging time, the emotional pressures and burdens are significant.’ We talk about the “frontline”’. Some might say that’s dramatic and “at the point of care” might be more apt. ‘But during the pandemic, I think it really is a frontline because we’re fighting a war. It might be a war but in a different sense, but it is a war nonetheless – and healthcare workers have died.’

‘Added to that, some of the healthcare workforce have had to decide whether they go to work and separate from their family. Obviously decisions like that only exacerbate the burden. Tackling burnout and promoting Joy in Work needs leadership attention and needs to be tackled at a system level. That requires a better understanding of the sources of burnout and it may mean a redesign of the way that we work.’ 

The rewards of teamwork

What has it been like being on the frontline during this extraordinary time? ‘I left my role in IHI in April and became a frontline worker and leader myself as I’m managing a group of practices in Scotland. The highlight for me has been making sure that we manage the emotional aspects that everyone working in healthcare feels. We had staff who were shielding, and some who are high risk, so how do we minimise risk for staff? It was encouraging to see that staff who were shielding still wanted to contribute to efforts. So we found ways for them to support and help out using tools for working remotely. We put systems in place that supported us as an organisation and allowed them to stay safe as well. 

Nonetheless, times have been tough. ‘I think we see this as an opportunity to do things differently, to redesign the way we’re working and to say that while Covid-19 has had an impact, what can we take from this positively as well? There is a silver lining. With Covid-19, the adoption of technology has accelerated rapidly over the weeks and months since March. What would have taken years in healthcare – because we can be a little slow to adopt technology – has only really taken a matter of months and people are genuinely willing to try different things.’

Increasing the recognition

Burnout in healthcare is a global problem. Ali’s work abroad has given him a broad perspective on how different cultures adapt. ‘Every country, every region has its own, different experience of how burnout manifests,’ says Ali. Many of the challenges are common – such as high workloads – but how we adapt our working practice to better cope with that is what will make the difference. ‘One of the key things for me is that burnout is now increasingly being recognised as an issue and a priority, although there’s still a lot of work around the world needed to increase that recognition. We’re still in the early stages of understanding and managing burnout but it is definitely a high priority amongst many leaders. Some of the things leaders can do is create an organisational culture where people feel they have autonomy over the work they do, making sure there’s a camaraderie and feeling of teamwork.’ 

As a healthcare leader, Ali believes we need to keep learning, to raise awareness of the issue and to act differently. ‘It’s important to work collaboratively with staff – it’s not something we do to staff, but with them.

‘Working in a collaborative way leads to a greater chance of success as well. Leaders need to lead but we should be co-designing improvements to working practice.

‘We are currently going through a significant period of change in our organisation.  This involves implementing technology solutions but also aligning with redesigning our processes. We’re currently looking at how we optimise the back offices, how we look at hub working with admin teams but also thinking about how we can get people working together, and how we can increase variety in work. What’s very important is engaging the staff in our redesigns.’

Change at a system-level

‘It’s great that there’s a growing movement around attacking burnout in healthcare and increasing joy in work. Joy in work is about more than just tackling burnout – it’s about rethinking the system. It’s not just about having pizza parties or telling staff that it’s their individual responsibility and that they should be resilient but instead asking how we ensure that the system creates an environment that not only avoids burnout but also promotes joy in work. 

We’ve recently started using the ImproveWell platform and it’s really helping us to listen to staff and their ideas and then test them out – and we can do it collaboratively. It’s an exciting time and working closely with our staff is crucial. Covid-19 has made us more open to trying out new ways of working – and that’s a good thing. I really hope we can build on this to lessen burnout.’

Photo by Gabriel Lamza on Unsplash