This Stress Awareness week, Health Innovation Network Head of Content Claire Portsmouth reflects on whether the nature of work in health and care means that stress is just part and parcel of the job.
I can see why International Stress Awareness week is the first week of November. The nights are getting darker and vitamin D is in short supply. But if you work in health and care, you are likely to have always dreaded winter time for additional reasons. The festive cheer and social events that the rest of us look forward to are yet another flu season and increasingly busy emergency departments and GP surgeries for the frontline. Winter every year in the NHS is not just hard, it’s exhausting. And here we are another winter in the same pandemic that has engulfed the last 20 months of our lives.
There’s no denying the NHS and social care have borne the brunt of Covid-19, so it’s not surprising that in the most recent staff survey, 44% of health and care workers said they had felt unwell as a result of work and 46% said they had gone to work in the last three months despite not feeling well enough to perform their duties.
But this is not news. NHS staff surveys have long given a desperate picture of a stressed and overworked workforce and even before the pandemic one third of the doctors who responded to a survey published by the BMJ in January 2020 were described as burned out, with those in emergency medicine and general practice most impacted. The pandemic has simply worsened the situation.
The same NHS staff survey found that 55% of workers admitted to working unpaid hours and the recent House of Commons Health and Social Care Committee report into Workforce burnout and resilience in the NHS and social care found that “Discretionary effort is the rocket fuel that powers the NHS, effectively. If staff worked to contract and worked to rule, we simply would not be able to provide anything like the quality of care that we need to.”
Whilst this is a terrifying prospect at an organisational level, there is also a personal cost to NHS staff. Like any calling or vocation, caring about your job too much can mean a lack of personal boundaries and mental down time, but the King’s Fund written submission to the Committee stated that NHS staff were 50% more likely to experience high levels of work- related stress compared with the general working population. The nature of many medical roles has historically meant that flexible working patterns that might support a better work-life balance have been hard to come by and long shifts without breaks to sit down, let alone get a meal, are commonplace. But is this just the nature of working in health and care, particularly on the front line?
When it is, or at least could be, the difference between someone’s life and death, can healthcare workers simply decide to go home on time? If the difference is them being the person to break bad news to the family they’ve built a rapport with, is it really a choice? When the emergency cord is pulled, is any health worker’s response ‘I have five more minutes on my break’? Of course it isn’t. The nature of health care means that workers are always required to put others before themselves.
Covid has compounded this issue. Dramatically more people to care for meant an insurmountable increase in workload but on top of this, as a country we actively asked our health and care teams not to put themselves and their families first. Instead, we asked them to head into work at a time when social anxiety was through the roof and press conferences announcing death rates were daily. Those who were parents or carers had the difficult choice of still sending their children to nursery or school despite other parents being told to keep their children at home, and many stories have since emerged of people who moved out of their homes to avoid spreading Covid to loved ones. Once again, they were choosing to put patients first.
The old adage, ‘you can’t pour from an empty cup’ comes to mind. So how do you look after a staff base who time and time again forget to look after themselves? It is exactly this altruism our OnlyHuman campaign sought to harness.
Based on behavioural insight, the campaign embraced the fact that healthcare professionals seem conditioned to put others first. Using nudge theory instead it calls on staff to check in on each other more proactively and intentionally. It prompts a start to the conversation.
In their training, health and care workers are supported to find ways to put their own feelings and emotions aside and focus on those of the patient. Beyond a coping mechanism for the truly serious topics and situations they deal with, this is imperative to ensuring the best patient experience possible. So even if a space for conversation is created, how do you get a workforce trained to keep calm and carry on to open up about their feelings? OnlyHuman gives a language and a framework. It supports teams to balance bringing their whole selves to work and keeping it together for their patients.
We recently recorded a podcast with deputy Chief People Officer at Maidstone and Tunbridge Wells Foundation Trust Ainne Dolan, who implemented OnlyHuman at King’s College Hospital in south London and is in the process of implementing at her current Trust. Ainne discussed how wellbeing is not a deliverable but an outcome that culture shifts create. OnlyHuman supports this by bringing together leadership and management techniques with policy, so frameworks can be put in place to ensure that the approach becomes part of the job, not in addition to.
With 92% of Trusts telling NHS Providers they had concerns about staff wellbeing and burnout following the pandemic, the overwhelming backlogs and ongoing staffing crisis, the fight is far from over for health and care teams. And whilst stress may be inevitable when the stakes are so high, dealing with it needs to be a priority. After all, NHS staff are absolutely super, but they are also only human.
You can hear the full Looking After the NHS podcast discussing the OnlyHuman campaign here.