Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors

Abstract

ObjectiveTo identify priority interventions for the prevention and reduction of work stress and burnout in hospital doctors through analysis of (1) doctors’ experiences of work stress and burnout and (2) their preferences with respect to interventions.DesignQualitative design using semistructured interviews analysed with deductive thematic analysis.SettingHospitals in Ireland.Participants32 hospital doctors (16 practising consultants and 16 doctors in training) from a range of specialties, career stages, hospital types and locations.ResultsPractical, system-focused interventions were found to be most needed. Challenges with basic entitlements, that is, accessing statutory leave, knowing in advance when leave can be taken and being adequately covered when on leave were identified as requiring urgent attention. Other priority interventions identified were the integration of psychological support in the everyday working environment, time and training for clinical line managers to perform key management activities such as debriefing and education interventions which highlight work stress risks and care pathways, teach self-care and train doctors in how to support one another.ConclusionsHospital doctors are feeling the effects of greater demand and fewer resources. What they most urgently need is adequate staffing levels, access to statutory leave and adequate cover when on leave. Doctors do not receive the support they need from their clinical line managers, who lack the skills and time to excel as people managers. Organisations should focus on developing clinical management skills across the system. The culture of medicine needs to change from stigmatisation and competitiveness to compassion and collaboration. Organisations, medical schools and professional bodies can steer this change through education.

Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

“…Although 15% indicated that their staffing levels were at or above 75% recommended levels, most (n = 22, 50%) had services operating at 50% staffing levels, with one service having only 20% of recommended resources. However, unlike in other studies, respondents operating with lower than recommended resourcing levels did not report higher BO levels 28. Certain perceptions rather than resourcing were associated with higher BO levels.…”

“…The Medical Council of Ireland Intelligence Report and the Royal College of Surgeons Ireland (RCSI) Health Workforce examined reasons for emigration among Irish medical graduates in 2015. They identified ‘push’ factors to include ‘stressful conditions’ compounded by low staffing and ‘lack of designated and supervised training’,36 37 findings which have been echoed in other studies 12 28. If clinical standards are to remain high, and children and families are to receive expert quality care, then urgent attention needs to be given to both work conditions and physicians’ mental health.…”

“…These were all factors outside of the control of the consultant. In a qualitative study of Irish consultants, Walsh et al found that the top three concerns contributing to BO, again extrinsic factors, were ‘quick fix’ management planning, staff shortages and inadequate resources 28…”

“…Certain perceptions rather than resourcing were associated with higher BO levels. These included not having confidence in either the HSE’s ability to manage the services effectively (n = 37, 71%) or the government’s commitment to invest (n = 38, 73%), also reflected in other research 28. These results resonate with the words of author and doctor, Rachel Clarke’s in her book ‘Your Life in My Hands’, with reference to a ‘a desperately overstretched workplace that breeds corner-cutting, indifference and excessive haste’ 29.…”

“…The CPI has now mandated participation of all trainees in Balint groups and support to attend such interventions, even on line, might well be considered for consultants. However, when asked, doctors opt for primary-level interventions aimed at bringing about system and cultural change, rather than focusing at the individual level 28. Avoiding ascribing blame to the clinician for being responsible for their own ill-health is paramount.…”