How we can avoid burn-out at work
The nature of private healthcare has changed over the course of the pandemic and that has bought with it a host of new challenges and pressures. Dr Stephen Priestley outlines ways independent practitioners can sustain their physical and mental well-being and help the team perform at its best.
Doctors are humans first and have been exposed to the same feelings as others during Covid 19.
We doctors, too, have suffered feelings of anxiety, an acute sense of personal threat and a loss of control as the uncertainty of the pandemic continued to manifest and impact on both personal and professional lives.
Some private doctors have experienced financial pressures as the country went into lockdown, others had to divert their resources to support the NHS.
More than ever, the well-being and safety of your team members is critically dependent on the performance of those they work with.
Working together and looking out for each other will help keep all of us performing at our best, so that we can face these challenges together and maintain our performance for the long haul.
Prof Don Berwick, a leading authority in healthcare improvement and safety, states that ‘without a physically and psychologically safe and healthy workforce, excellent health care is not possible’.
Maslow’s hierarchy of needs
Maslow’s hierarchy of needs
In thinking about caring for others – and indeed self-care – as we face pressure and stress, we can draw on a concept developed by Abraham Maslow in 1943.
His ‘hierarchy of needs’ is a simple model that illustrates the range of human needs and how needs at a lower level have to be met before higher needs and aspirations can be addressed.
As Covid-19 threatens all layers of Maslow’s hierarchy, deficits across each of these core needs can have negative consequences for our physical and mental health.
1 Meeting the basic needs and ‘saying no for safety’
It is extraordinary that so many doctors downplay the importance of all team members attending to their basic physiological needs on a regular basis. Great performers know that this is fundamental to resilience.
In healthcare generally, we have not necessarily made it easy or acceptable to take a break, for a meal or a trip to the bathroom or a few minutes of rest. This is related less to individuals and more to the culture of our workplaces.
But, if we want to be at our best, we have to pay attention to those needs and make it easier for our team members to attend to their own well-being. This can be as simple as noting the needs of others and encouraging them to take a break.
There is evidence about the negative consequences of dehydration in doctors. A study by Lemaire from Canada compared an intervention of providing free healthy nutrition choices and enforcing nutrition breaks.
It found that the intervention group had greater nutrient intake and statistically significant reduction in dehydration.
Furthermore, cognition score testing indicated that dehydration can impair attention, short-term memory, visual perceptual abilities, psychomotor skills, alertness and increased fatigue.
So, at the basic needs level, we can think about simple things like providing access to things that we need at work such as showers, meditation or quiet rooms, healthy beverages and snacks, and safe transport home for team members and ourselves when fatigued.
The best idea of all may be to simply ask team members what they need.
Unsafe practice
Another principle that we firmly support at Medical Protection is the ability and responsibility of ‘saying no for safety’.
By that, we mean the right to say no to some form of work activity, or extension of hours or doctors carrying out tasks beyond their scope of practice and training because they believe it to be unsafe – for either their patients or themselves.
Saying ‘no’ often creates enormous anxiety. This anxiety comes both from within ourselves and external expectations. This ties up with the rescue model of healthcare.
When people ask for help, we often automatically rescue them. I know that most of us would miss a meal break or put our own needs aside to attend to a patient in need.
At the moment, for some, uttering a firm ‘no’ may require moral courage, but evidence suggests we promote safety more effectively by being clear and holding those boundaries.
We should validate to team members that saying no for safety is ultimately a professional action.
2Physical and psychological safety and support for habits/routines
Physical safety might seem an obvious priority; however, psychological safety is also vital to consider. A working definition of psychological safety is ‘If I make a mistake or ask for information or help, others will not punish me or think less of me’.
A psychologically safe environment can be created by supporting our team members’ right to contribute, by genuinely listening to them and by refraining from being judgemental. It is important to invite others to speak up or ask for feedback from them.
Additionally, when we show appropriate vulnerability and admit when we are wrong, this also creates psychological safety for others.
Supporting your team members in maintaining resilience is worthwhile, as habits and routines require very little cognitive effort; they can be protective in times of stress and overload.
We can actively develop habits that support both our performance and well-being. While initially requiring deliberate planning and action, positive behaviours eventually become subconscious, thereby reducing cognitive load and assisting you to maintain your performance in times of lower willpower and motivational energy.
Routines can also be powerful, as they can act as a ‘psychological inoculation’, giving us a sense of confidence, security and safety.
It is worth considering if there are routines or rituals that have been disrupted during Covid-19 that need to be re-instated or re-imagined.
3Sense of belonging
Enjoying workplace camaraderie and a shared sense of purpose are powerful protectors of well-being at work.
But this may have been much harder during the pandemic due to working with changing guidelines, perhaps reduced availability of communal space and time to speak to team members.
It is important to look creatively at how team members who may still be working in isolation can be supported and feel included, and ensure that all are treated appropriately when it comes to the sharing of tasks and resources, and rewards and recognition.
4Esteem and attaining self-actualisation
Civility at work is even more important during times of crisis. But courteous respectful communication in our workplace can be challenging because our emotional state can sometimes get in the way.
A useful phrase that is well supported by the literature is ‘civility creates safety’.
A growing number of peer-reviewed papers in health and safety literature support the conclusion that a civil and respectful environment is safer for patients, promotes better communication and enhanced teamwork. Indeed, the value and the contribution of all roles should be recognised and celebrated.
Psychologist Carol Dweck described in her book Mindset: The New Psychology of Success that showing appreciation encourages the development of a growth mindset, a valuable resilience factor.
Her research found that our personal growth can be encouraged when we recognise others – not simply with empty praise – but through articulation of not just the outcome but the effort and the process that the team member went through to get that outcome.
Caring for others also leads us to the very top of Maslow’s pyramid: self-actualisation. Many doctors may have been facing challenges in the area of professional fulfilment in the last 18 months as we are pressured to work in a different way.
So is there also an opportunity for creative or professional individual growth and to foster the potential of others? Remaining engaged in meaningful work is such a powerful well-being factor and warrants personal investment.
Medical Protection members can view the full webinar on this topic at https://prism.medicalprotection.org/course/view.php?id=1222.
Well-being support services are also available at http://medicalprotection.org/ireland/wellbeing.
Dr Stephen Priestley (right) is senior medical educator for Medical Protection’s Risk Prevention, and Cognitive Institute
