WORK FORCE I S SUE S
Peer-support programmes Stigma and isolation can be barriers to staff asking for help, as vulnerability can be seen as a sign of weakness. Therefore, programmes that rely on self-referral often fail because clinicians are understandably reluctant to admit they need help. Introducing a peer-support model into the healthcare organisation frames emotional fallout as an occupational hazard, rather than a mental health problem, thereby reducing the stigma associated with receiving support. A peer-support model recognises that most caregivers prefer to confide in and receive support from their colleagues,6
rather than
from mental health professionals, simply because peers understand their specific emotional stressors or ‘moral injuries’. Peer support also fosters a sense of camaraderie that is crucial to sustaining joy at work. Seeing that colleagues understand their emotional responses and have had similar experiences reduces the feelings of isolation and self-recrimination associated with distress. Funding for a peer-support programme should cover adequate training, marketing internally and externally to attract the attention of those that could benefit from the service and, ideally, deploying personnel who can lead, dedicate time and act as an important ‘go to’ liaison for the programme.
Safeguarding staff from moral injury In order to safeguard staff from moral injury, healthcare organisations need to focus on providing outreach to caregivers that may be in need of help and ensure that easily accessible ‘reach in’ services are also available. Regulators could help to make this happen with ‘duty of care’ type legislation.
Recent data from the BMA reveals that 45.69% of the 7,000 doctors surveyed are suffering far worse from depression, anxiety, stress, burnout or emotional distress than before the start of the pandemic, while 62.20% say they are overcome by far higher levels of fatigue and exhaustion.
Healthcare leaders can prioritise reaching out to staff who may benefit from receiving help by developing systems for offering support to clinicians rather than relying on self-referral. Even when emotional support programmes exist, caregivers may avoid them because of barriers including concerns about confidentiality, stigma and access. Good outreach initiatives have a robust component that involves proactively reaching out to staff, taking away the stigma of receiving support and facilitating easy access to the programme. Stressful events such as the occurrence of medical errors can be used as triggers for peer-support.7
Open
and honest engagement encourages staff to come forward for support. Outreach triggers specific to COVID-19 might include clinical service on a coronavirus ward or the death of a patient with COVID-19, particularly if the patient was the caregiver’s colleague. Although some emotional stress can be mitigated by means of preventive approaches, such as peer-support programmes, some caregivers will need professional mental health services. These supplemental services must be confidential and accessible at any time. In these cases, having peer supporters make initial contact
with affected caregivers has the advantage of normalising and facilitating connections to professional mental health resources in a discrete, sympathetic and constructive way.
Leadership accountability Emotional stress often comes from workplace issues that teams feel should be mitigated promptly and where leaders are not sufficiently sensitive to operations to effectively utilise the control invested in their role to reduce or mitigate these issues. These include the perception of inadequate or poorly distributed resources; unsustainable or unmanaged seasonal clinical volume; or even other colleagues’ unprofessional and problematic behaviour, including racist and sexist behaviour. Given that some situations cannot be simply or rapidly mitigated, such as the current situation with COVID-19, these need to be addressed by open and transparent communication with teams about the situation involving expert members of the team in informing the decision-making process and sharing details of what is being done and what can be achieved. Actions, even small actions, speak louder than words – statements from leaders about their desire to reduce burnout, in the absence of efforts to engage with staff in addressing its underlying causes, erode rather than build trust. Healthcare leaders can demonstrate accountability for caregiver wellbeing by showing they are taking realistic and meaningful steps to assess and address concerns in order to treat the causes of emotional stress rather than merely the symptoms.
Healthcare professionals shouldn’t suffer from the moral injury and long-term psychological damage that could result from having to make decisions on how limited resources are allocated.
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Systems can highlight the risk of moral injuries Leaders can empower clinicians to speak up about unsafe, highly stressful, or morally challenging workplace conditions and ensure that concerns are listened to and, wherever possible, acted on. As part of this effort, processes can be developed that actively solicit feedback and suggestions for improvement from caregivers on the frontline, as well as channels through which staff can safely and anonymously report concerns. Accountability among organisational leaders for support initiatives, with sufficient investment of resources, elimination of access
MARCH 2021
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