The epidemic of burnout in the health and social sectors
In the health and social sectors, our business is about creating change. Change in the life of individuals, families, communities and society through our spectrum of work across all stages of life, with people from all walks of life.
We apply our skills (technical and interpersonal) to provide care, relief and hope, and to prevent ill health and suffering. This may occur in a variety of ways: in direct frontline roles as allied health professionals, nurses and doctors; indirectly, through research into ways to reduce the burden of ill health and social disadvantage; as champions in the charity sector who advocate addressing gaps in the system and providing needed responses to unmet needs; as leaders, policy makers and change makers across the many parts of these sectors.
The choice to work in the health or social sectors is often associated with a passionate personal drive — a sense of vocation, even. As human beings, we are fundamentally makers of meaning and when we engage in work that is intrinsically linked to our core purpose, it can bring great fulfilment and meaning to our lives. However, as we go about this work, the passion and heart that we put into it, that are essential to our effectiveness, also leave us at risk of burnout.
The growing problem of burnout
First characterised in 1974, burnout was formally recognised in 2019 in the International Classification of Diseases as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed — and, in the health and social sectors, chronic stress is the rule, not the exception.[i] Unhealthy social and cultural norms can work against meaningful efforts to prevent or reduce stress. Demand for our services, and unmet health and social needs, are growing. Healthcare practice is becoming increasingly complex — and the many, often competing, demands on our time and energy, coupled with relentless resource constraints, are simply and devastatingly wearing us down.
Prior to the COVID-19 pandemic, burnout was reported by around 30% of healthcare workers across Australia, the United States and the United Kingdom, across disciplines, and in direct and indirect roles. Rates reported ranged from 17 to 52%.[ii]; [iii]; [iv]; [v]; [vi]; [vii]; [viii] Job stress and fatigue rates were far higher, and people working in healthcare and social assistance roles were the second highest occupational groupings in relation to claims for mental health conditions in Australia.[ix]
Alarmingly, more than one in five doctors in the United States reported having had suicidal thoughts, and more than one in 100 had attempted to take their own life. In fact, the rate of suicide among American doctors was double that of the general population.[x]; [xi] In Australia, one in four doctors reported having suicidal thoughts in the past year, and one in 50 reported that they had attempted suicide.[xii]
Reports on burnout during the COVID-19 pandemic are even more sobering, with more than 51% of healthcare professionals from 60 countries reporting burnout in a recent global study, which aligns with a series of single-country studies reporting rates over 50%.[xiii]
Why burnout matters
For the person going through it, the psychological and physical consequences of burnout are significant. They can range from insomnia and other sleep disturbances to a range of physical manifestations that can mimic serious illness. Burnout impairs our capacity to sustain our professional work, with many contemplating leaving their workplace or even their profession. The spillover effects into our personal life can be significant, and lead to strains and conflicts in personal relationships, relationship breakdowns and worse.
In our workplaces, burnout can impact negatively on our colleagues, have damaging flow-on effects on the health workforce and have a negative influence on workplace culture and functioning. Toxic behaviours and workplace cultures can precipitate, and the growing impact of staff absenteeism and turnover can take a heavy toll on the system. This further compromises the quality and continuity of care, adding significant resource burdens to an already over-stretched system.
The experiences of our patients, carers and communities — those who we are here to serve directly and indirectly — are also affected. Burnout compromises patient or client experiences, and impacts on the quality and safety of care. Ultimately, this can negatively influence outcomes, working in contrast to the very reason that we chose to do the work we do.
A health hazard we cannot afford to ignore
The sustained physical, emotional and psychological demands of our work are literally destroying lives.
Burnout is a serious issue that requires action at many levels. It compromises the capacity of our systems, organisations and workforce to go the distance and to make meaningful change in the lives of those we seek to serve. It also compromises the health and wellbeing of all who choose to work in the health and social sectors.
This is a health hazard that we need to take very seriously, now.
References
[i] World Health Organization (2020). Burn-out an “occupational phenomenon”: International Classification of Diseases. Available at: https://www.who.int/mental_health/evidence/burn-out/en/
[ii] Kane L. (2020). Medscape national physician burnout and suicide report 2020: The generational divide. Available at: https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
[iii] Kane L. (2019). Medscape national physician burnout and suicide report 2019. Available at: https://www.medscape.com/slidshow/2019-lifestyle-burnout-depression-6011056
[iv] Imo UO. (2017). Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsych Bulletin, 41:197-204.
[v] Beyond Blue (2019). The National Mental Health Survey of Doctors and Medical Students. Available at: https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web
[vi] McHugh MD, Kutney-Lee A, Cimiotti JP et al. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signals problems for patient care. Health Aff, 30(2): 202-210.
[vii] Hansen V and Girgis A. (2010). Can a single question effectively screen for burnout in Australian cancer care workers? BMC Health Services Research, 10: 341-345
[viii] Girgis A, Hansen V and Goldstein D. (2008). Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer, 45(3): 393-399.
[ix] Safe Work Australia (2020). Available at: https://www.safeworkaustralia.gov.au/topic/mental-health#snapshot-of-claims-for-mental-health
[x] Kane L. (2020). Medscape national physician burnout and suicide report 2020: The generational divide. Available at: https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
[xi] Kane L. (2019). Medscape national physician burnout and suicide report 2019. Available at: https://www.medscape.com/slidshow/2019-lifestyle-burnout-depression-6011056
[xii] Beyond Blue (2019). The National Mental Health Survey of Doctors and Medical Students. Available at: https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web
[xiii] Morgantini LA, Naha U, Wang H et al. (2020). Factors contributing to healthcare professional burnout during the COVIs-19 pandemic: A rapid turnaround global survey. PLoS ONE, 15(9): e0238217. Available at: https://doi.org/10.1371/journal.pone.0238217
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