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Monday 11 December 2023

Sick and tired: how can we stop staff burnout in the NHS?

By Rhys McKenzie

Burnout is a finally being recognised as a serious problem in the NHS and many other workplaces. But what is burnout, what causes it and how can we prevent it? Rhys McKenzie reports.

Man with head in hands against deep blue backdrop

Working in healthcare can be a rewarding experience. Most staff feel that their work is meaningful and makes a difference to patients even if they’re not directly involved in their care. But the demands of the job result in much higher levels of burnout than in other sectors. Why are such rewarding jobs prone to causing burnout and what steps can managers and employers take to prevent it?

Although the experience varies from person to person, burnout is defined as a psychological syndrome that involves physical, emotional and mental exhaustion. It is strongly associated with stress and linked with the symptoms of depression. If you suffer from burnout, you will usually experience a sense of hopelessness, and feel that you have lost your spark and motivation. Burnout can lead to serious mental health problems that affect your professional and personal life. What distinguishes it from similar mental health conditions is that burnout is primarily caused by work-related experiences.

The World Health Organization says that while burnout can be a catalyst for mental health problems, it’s a workplace issue rather than a medical condition. Burnout describes a developmental process brought on by a prolonged period of work-related stress, not a clearly-defined set of symptoms. Jobs that are demanding, require long hours and are highly pressurised are most likely to cause burnout. The intensity of working in the NHS and social care explain why burnout is so prevalent, so there is an onus on employers to address the early signs before they become more serious.

Risk factors

Most people working in healthcare will experience some degree of stress. But according to the 2022 NHS Staff Survey, 45% of respondents were so stressed at work that at some point in the year they felt unwell. In June 2023 (the latest available figures), 27% of all sickness absences in the NHS in England were due to stress and/or other mental health reasons. It’s consistently the most reported reason for sickness absence in the NHS, resulting in the loss of between five and six million working days each year.

When stress is allowed to fester and is not addressed, staff are at risk of burnout. In its recent report, Burnout in Healthcare, The Society of Occupational Medicine (SOM) suggests the best way to prevent burnout is to first tackle workplace stress. By identifying the risk factors for stress and establishing which jobs or groups of staff are most at risk, organisations can be proactive in supporting their staff and ensure that interventions are targeted effectively.

Workplace culture is also important. In a workplace where staff are not stigmatised for showing signs of vulnerability or asking for support, symptoms of stress can be caught and action taken before burnout sets in. Explaining the signs and symptoms of stress and signposting where support is available helps give staff the confidence to raise issues before they become overwhelming.

Supporting line managers

Managers have an important role to play in supporting staff wellbeing and preventing burnout, but they can only do that if they are looking after their own wellbeing. The NHS Staff Survey found that one in four managers and administrative staff reported feeling burnt out due to work last year. As the pressure mounts to fill vacancies, bring down waiting lists and drive improved performance with a beleaguered workforce, managers need the capacity to safeguard themselves from burnout if they are to support their own staff effectively.

Research also suggests that many line managers don’t feel they have the knowledge and tools to support staff experiencing stress and burnout. Only four in ten UK employees say they feel comfortable discussing their mental health with their supervisor. NHS case studies have shown that training managers to identify the changes in attitudes and behaviours that point to stress and burnout improves staff wellbeing, resulting in fewer instances of burnout.

Even when managers are trained, they need capacity and time to dedicate to supporting staff wellbeing. Employers must support managers to intervene in cases where staff are showing early signs of burnout. All too often, employers say tackling burnout is a priority but, when under pressure to improve performance, fail to support interventions because of the potential short-term hit to productivity. Employers need to recognise that through absenteeism, presenteeism and staff leaving their jobs, burnout always harms productivity in the long term. This why a systemic approach to tackling burnout is needed. Line managers alone cannot take full responsibility for implementing initiatives, they must be genuinely supported by their organisation.

No quick fixes

There is no one-size-fits-all approach to supporting staff with burnout; everyone experiences it differently. So it’s important to take a person-centred approach, actively listening to and involving your staff in shaping interventions. Using evidence-based methods to prevent, manage and deal with burnout is essential. It’s easy to reach for quick fix solutions in a highly pressurised work environment, but they usually fail. There is little evidence, for example, that wellbeing apps for phones have any impact. Talking to staff, identifying the stressors and making reasonable adjustments to remove them is much more effective.

While burnout is an organisational issue, individuals can take steps to avoid it. Research suggests that healthcare workers are particularly prone to ‘perfectionism’ — having excessively high standards and being overly critical of themselves and others when they’re not met. While high standards and diligence is expected in healthcare, research shows it’s unhelpful to hold yourself to unrealistic expectations about performance at work. Recognising this in yourself and colleagues and taking steps to reduce it will help to prevent burnout setting in. Practicing ‘self-compassion’ — treating yourself kindly rather than judgementally when you’re struggling — reduces the risk of burnout and can enhance your compassion towards others, helping to build better relationships with colleagues and strengthening your peer support network.

The last three years have been one of the most difficult periods for health and care in modern times. Despite coming through the worst of the pandemic, services are still a long way from recovering completely. With waiting lists rising, staff shortages throughout the system and no sign of politicians being forthcoming with new investment, the risk of burnout is not going away anytime soon. But by recognising burnout as an organisational issue that develops over time, rather than an ‘illness’ or a sign of individual weakness, we can begin to tackle it.

While individual interventions can be helpful, addressing the unhealthy organisational practices which cause burnout is a much more effective approach. By equipping managers to identify and prevent chronic workplace stress and talking to staff about the early signs and risk factors, we can minimise the impact it has. That will require cohesive action from the whole system. But by reducing absence, staff turnover and improving productivity, it will benefit the whole system too.

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