Staff retention, training and burnout in health ( and other areas)
Increased demand for health services is putting unprecedented strain on health systems and the workers within them. Many are experiencing burn-out, depriving health systems of their most vital resource.
The World Health Organisation is bringing attention to the problem of work-related stress. The group announced in 2019 that it is updating its definition of burnout in the new version of its handbook of diseases, the International Classification of Diseases — ICD-11 — which will go into effect in January 2022
The new definition calls it a "syndrome" and specifically ties burnout to "chronic workplace stress that has not been successfully managed."
Despite earlier reports to the contrary, WHO does not classify the problem as a medical condition. It calls burnout an "occupational phenomenon" and includes it in a chapter on "factors influencing health status or contact with health services."
According to WHO, burnout is characterised by "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."
Burnout was also included in the previous version of WHO's disease handbook, the ICD-10, in the same category as it now appears. But it was defined simply as a "state of vital exhaustion," Tarik Jasarevic, a spokesperson for WHO, wrote in an email.
Consider the fact that companies without systems to support the well-being of their employees have higher turnover, lower productivity, and higher healthcare costs, according to the American Psychological Association (APA). In high-pressure firms, healthcare costs are 50% greater than at other organizations. Workplace stress is estimated to cost the U.S. economy more than $500 billion dollars, and, each year, 550 million work days are lost due to stress on the job. Another study by the APA claims that burned-out employees are 2.6 times as likely to be actively seeking a different job, 63% more likely to take a sick day, and 23% more likely to visit the emergency room.
Obviously, this is a real problem. And it can feel like a herculean task for leaders to tackle perhaps because the concept seems too ambiguous or overwhelming. When experts still struggle to define burnout, how can we ask our managers to actually prevent it?
According to the foremost expert on burnout, Christina Maslach, social psychologist and professor emerita of psychology at the University of California, Berkeley, the new WHO classification in the IDC11. “Categorising burnout as a disease was an attempt by the WHO to provide definitions for what is wrong with people, instead of what is wrong with companies,” she explains. “When we just look at the person, what that means is, ‘Hey we’ve got to treat that person.’ ‘You can’t work here because you’re the problem.’ ‘We have to get rid of that person.’ Then, it becomes that person’s problem, not the responsibility of the organisation that employs them.”
To Maslach’s point, a survey of 7,500 full-time employees by Gallup found the top five reasons for burnout are:
- Unfair treatment at work
- Unmanageable workload
- Lack of role clarity
- Lack of communication and support from their manager
- Unreasonable time pressure
The list above clearly demonstrates that the root causes of burnout do not really lie with the individual and that they can be averted — if only leadership started their prevention strategies much further upstream.
Organisations have a chance, right now, to fix this type of thing. Burnout is preventable. It requires good organisational hygiene, better data, asking more timely and relevant questions, smarter (more micro) budgeting, and ensuring that wellness offerings are included as part of your well-being strategy. Keep the yoga, the resilience training, and the mindfulness classes — they are all terrific tools for optimising mental health and managing stress. But, when it comes to employee burnout, remember — it’s on you leaders, not them.
Clinical supervision can help reduce work stress and burnout by providing a mechanism of support for staff, debriefing, and managing stress. Supervision may also provide opportunities for professional development, skill enhancement, identifying new ways of working with clients, validating existing clinical skills, and increasing job satisfaction. Although definitions between workplaces differ, in general, clinical supervision means
- Quality assurance and clinical safety.
- A method of improving clinical practice, which involves the worker learning new skills, problem solving effectively, and obtaining suggestions for improving practice (not line management).
- Professional support.
- Workforce development.
Evidence indicates that mental health workers who receive quality supervision are better able to function across multiple domains, manage their stress more effectively, and are less likely to experience burnout. Some of the demonstrated benefits of clinical supervision include greater job satisfaction, confidence and self-capacity, reduced staff turnover, improved development of complex clinical skills and delivery of evidence-based practice, reduced stress and burnout, better communication between staff, and the transfer of newly acquired skillsfrom training into practice. Further, less experienced workers can benefit from clinical supervision by receiving feedback on their interpersonal style, counselling skills, and ongoing appraisal. As such, clinical supervision can improve the quality of client– worker relationships and enhance treatment outcomes.
In 2019, NSW Health updated their clinical supervision guidelines for services. These may also be useful for clinicians in other states. The guidelines are not prescriptive, but make recommendations for best practice. They are intended to be applicable across disciplines, to all workers in services who are responsible for providing services to clients. As such, the guidelines are designed to provide acomprehensive framework for local operations, and encourage some degree of consistency
Within mental health an exposure to a critical incident can lead to a stress response. A critical incident can be overwhelming and threatening and may lead to distress. This can be harmful when a person has demands and expectations that are out of keeping with their needs, abilities, skills and coping strategies. Distress can result in a decline in performance and in overall levels of wellbeing.
Involvement in, or exposure to, abnormal workplace incidents can lead a person to experience distress. It is normal to react emotionally to a critical incident. This may involve recurrent thoughts about the event, feeling uneasy or anxious, mood changes, restlessness, feeling tired and disturbed sleep.
Critical incidents may trigger a wide range of physical and psychological symptoms, including increased heart rate, high blood pressure and anxiety. Demobilisation (rest, information and time out) is a way of calming workers following a critical incident and ensuring that their immediate needs are met. A supervisor or manager who was not involved in the incident, or affected by it, carries out the demobilisation.
A debrief is vital and takes place before the end of a shift or before those involved in the incident disperse. Strategies include:
- Convene a meeting for those involved as soon as possible.
- Summarise the incident and clarify uncertainties.
- Invite questions and discuss issues of concern.
- Show care and support, including the provision of Psychological First Aid.
- Draw up a plan of action, taking into account the needs of the workers.
- Make short-term arrangements for work responsibilities.
- Offer information on defusing and debriefing.
Prevention strategies
- Provide clear expectations for all employees and obtain confirmation that each employee understands those expectations.
- Make sure employees have the necessary resources and skills to meet expectations.
- Provide ongoing training to employees to maintain competency.
- Help employees understand their value to the organisation and their contributions to the organisations goals.
- Enforce reasonable work hours, including, if necessary, sending employees without good boundaries home at the end of their regular work day.
- Help assess workload for those who feel pressured to remain working beyond normal business hours.
- Set reasonable and realistic expectations.Organisations should be clear as to which activities require the highest standards and when it is okay to lower the bar and still meet business needs.
- Encourage social support and respect within and among work teams.
- Support physical activity throughout the workday.
- Strongly encourage the taking of breaks away from the work environment.
- Consider how leadership approaches might impact employees at risk of burnout:
- Psychologically safe leader assessment helps assess and improve strategies related to psychological health and safety.
- Psychologically safe interactions workshop is a set of resources based on the premise that most of us, including those in management and union roles, do not intend and are not aware of how our behaviour may be experienced as harmful by co-workers and employees.
Leaders are not responsible for the results. Leaders are responsible for the people who are responsible for the results. If you nurture your people, they’re going to deliver for you.
References/ Useful websites
https://www.nmsupport.org.au/workplace/burnout
https://anmj.org.au/the-value-of-clinical-supervision-in-nursing-and-midwifery/
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642