Post Burnout

By Ben Caesar
Consultant T&O Surgeon, Brighton

As the NHS faces another significant challenge in the ongoing pandemic, it is essential to remember that healthcare workers were facing a pandemic of burnout even before the COVID-19 virus struck. The stresses this has placed upon workers across the NHS has compounded the problem and brought it to the fore.

The drivers of burnout were described by Christina Maslach in her paper 'Job Burnout' (Maslach et al. 2001). The six drivers are excessive workload, lack of control, lack of reward, loss of community, lack of fairness and a mismatch in values. Therefore, when we discuss ways of managing burnout, we must not simply focus on workload alone. It is quite possible for people to tolerate a high workload, if they feel they have appropriate autonomy to get the job done and that they are appropriately rewarded for this work, which may not necessarily be financial. However, if the work is demanding and there is a perceived lack of fairness or a mismatch between the work and one’s moral or ethical values then this can drive burnout.

Medical education and career structure has within it a hidden curriculum that contributes to these drivers of burnout. It has been described by Dr Dike Drummond, a physician burnout expert, as the four horsemen of the burnout apocalypse. It manifests as the perfectionist, the workaholic, the lone ranger and the superhero. These compel us to overworking, isolation, and a belief in our own invincibility, when in fact what we should be looking to do for our own and our patients wellbeing, is working collaboratively and with compassion for each other.

There is a simple framework to help organisations mitigate the risk of burnout. Reduce the demands on your employees, increase the amount of control they have over the way they deliver their results, and support them through both formal and informal mechanisms. The training of all staff to recognise colleagues who are struggling with burnout and other emotional or mental health issues, and to give them the vocabulary and tools to support their peers is part of this strategy. It is essential to destigmatise these issues and allow open and caring dialogue in the workplace. This also provides the supporter an opportunity to act as a giver, within a set of boundaries. This has been demonstrated to decrease burnout, as described in Adam Grant’s book “Give and Take” and is called “otherish” giving.

I hope that as healthcare professionals, we can utilise this terrible pandemic to initiate real changes and post-traumatic growth in the way we learn, teach and practice medicine. I hope for a working environment where “otherish” behaviour thrives, small daily wins are possible, organisations put their people first which will improve that patient experience and outcomes, and that the courage to be vulnerable is encouraged and a just culture exists.

Reference

Maslach, C., Schaufeli, W. B., and Leiter, M. P. (2001), 'Job burnout', Annu Rev Psychol, 52.