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Opinion

Why Australia needs a systemic response to burnout


Tammra Warby


24/08/2022 3:30:00 PM

Healthcare workers are under strain more than any other time in history. A strategic approach is needed, not tokenistic wellbeing advice, writes Dr Tammra Warby.

Healthcare worker taking time outside to de-stress
Nearly 71% of healthcare workers have suffered from burnout during the COVID-19 pandemic.

Burnout is not just an individual problem. It is an organisational issue, affecting turnover and intention to leave, as well as the ability to deliver quality healthcare.
 
But even though organisational factors contribute far more to burnout than individuals, many of the ‘solutions’ tend to emphasise individual interventions, such as clinician resilience or mindfulness training.
 
In my experience, these changes make a smaller contribution and run the risk of ‘victim blaming’ healthcare workers for burnout factors out of their control. 
 
For this reason, I believe the relentless, sustained effort from Australian frontline healthcare workers throughout the COVID-19 pandemic demands a systems and government response. Otherwise, it is highly likely that existing and predicted workforce shortages will collide with a mass burnout problem in the not-too-distant future.
 
To give some context, in 2021, 58% of Australian GPs reported that managing fatigue and burnout was one of their top challenges, while nearly 79% of primary care nurses who participated in a February 2022 survey reported having felt burnt out during the pandemic.
 
The trend is not limited to primary care, with a study investigating the severity and prevalence of mental health issues experienced by Australian healthcare workers during the COVID-19 pandemic uncovering high rates of anxiety (59.8%), burnout (70.9%) and depression (57.3%) among what was characterised as a ‘highly resilient’ workforce.
  
As mentioned by US physician Associate Professor Victor Tseng, burnout is part of a conceptualised fourth wave of the COVID-19 pandemic, which includes psychological trauma, mental illness, economic injury, and burnout.
 
It has also been defined by the World Health Organization (WHO) as an occupational phenomenon 
resulting from ‘chronic workplace stress that has not been successfully managed’.
 
According to the WHO, burnout is characterised by three dimensions:

  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • A sense of ineffectiveness and lack of accomplishment 
How the tokenistic advice received by the frontline in the past two years – including ‘Drinking more water’ (have you tried while wearing PPE all day?) and ‘Dancing in the kitchen’ – is supposed to address these feelings is laughable, bordering on offensive.
 
My guess is that whoever came up with these ‘tips’ did not have to wear PPE all day, or completely change and shower after an exhausting 12-hour-plus shift before even considering hugging loved ones for fear of infecting them with a highly contagious, potentially deadly disease.
 
That’s not even taking into account that healthcare workers have worked through all phases of the pandemic, including before vaccinations, and often in unsafe conditions without access to adequate PPE. In addition to the incredible load placed on hospitals, there has also been the shared burden of the vaccine rollout, delays in preventive elective and outpatient care, and an explosion in mental health care.
 
And while COVID-19 is ‘over’ for many, the avalanche of Omicron cases is still generating a huge caseload for GPs, including vaccine administration and antiviral prescribing.
 
These problems are compounded by inadequate staffing due to sickness, increased cognitive load, rapidly changing guidelines, cancellation of leave and occupational aggression and abuse.
 
The situation has deteriorated to such a point that healthcare leaders have called for burnout prevention to be a priority issue going forward.
 
In Australia, the National Workplace Initiative has released some resources on managing fatigue and burnout during COVID-19, but these are not specific to the healthcare workforce.
 
Instead, the Federal Government must recognise this crisis and establish a taskforce to
develop universal national guidelines and policies for organisations to address and protect against healthcare worker burnout.
 
In turn, healthcare organisations need to be accountable for the burnout of their workforce and acquire data on the benefit of any interventions applied via adopted burnout guidelines.
 
Feedback in the taskforce should be led by healthcare worker representative organisations such as the RACGP, AMA, Royal Australian College of Physicians, and the Australian Nursing and Midwifery Federation.
 
This taskforce could also be incorporated as part of the National Medical Workforce Strategy 2021–31, which only briefly mentions support for work–life balance as a means to reducing burnout, but does not go further than this.
 
Part of this plan requires urgent action by public health leaders to promote everything we can to reduce COVID-19 transmission in order to decrease the pressure on the healthcare system across all levels, from aged care, to general practice, to hospitals, and the additional backlog of work it has created. 
 
Otherwise, without a systematic response to COVID-induced burnout in healthcare, we run the risk of losing thousands of essential healthcare workers without any real plan to replacement.
 
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Dr Ian   25/08/2022 6:05:19 AM

Increasing the Intake into Medical Schools is worthy of a trial to ease the future Primary Care Shortage .
There has been an increase in availability of antivirals and P2 and P95 masks which is encouraging and mask innovations for greater comfort we are looking forward to.
Medical Surgeries need to be improved with larger waiting rooms and consulting rooms with fresh filtered air through partly open windows with screens sound proofed and with tinted glass for privacy a better working environment builds morale .
The Webinars are good giving knowledge too much maybe but also support .
Non blame for Error unless malicious or grossly incompetent in the MedicoLegal Insurance System but with generous compensation still is also able to reduce pressure .


Dr Vijai Gupta   25/08/2022 6:07:07 AM

Yes it further delays the access for the patient to seek some help


Dr Peter James Strickland   25/08/2022 12:33:00 PM

Burnout can last a lifetime after an event. In a major national disaster in Australian history I worked from 6am to 9 pm , 7 days/week for about 10 weeks without any decent accommodation, meals or support later to recover. No lives were lost with my management and decisions, but this total lack of support left me with permanent anxiety and fear of being the cause of ANY patient's demise for the next 50 years. That is what is happening to all our doctors and nurses, and it is caused by TOTAL reliance on policies around saving dollars in health care, and NOT quality of lives in the whole damned system here in Australia from Federal to State level in hospitals, nursing homes and private practices! Cause --too much bureaucracy, and too little positive decisions.