Practical solutions for managing NHS system burnout

Much like long-COVID syndrome, burnout is a ramification of the pandemic that needs attention and management.

There can be little doubt that we face a system-level burnout problem caused by the pandemic. There is a current Parliamentary Health & Social Care Committee inquiry into it, it has been all over the news, HR reps, membership bodies, trade unions and individuals across many sectors have raised it, while think tanks and policy units have been meditating and writing on it.

The impact of the pandemic on workers has been most acutely felt by the NHS. In an NHS Confederation survey of trust leaders in October 2020, 99% expressed concern over staff burnout—and not far behind them by all of the other key workers on the frontline. And a BMA survey found that more than half of UK doctors are suffering from burnout, depression or anxiety.

Burnout has also affected the many who have gone from, as the expression goes, working from home to living at work. In our work with boards across the public, private and third sector during the pandemic, staff burnout has been a visible and regular feature in risk registers.

Burnout also brings with it the danger of a significant exodus from critical professions; one of the most common responses is for sufferers to leave their jobs.

The size of the burnout challenge and how we’re rising to it

The first step in solving any problem is recognising that it exists.

In May 2019 the World Health Organisation (WHO) officially classified burnout as a syndrome resulting from workplace stress that has not been successfully managed.

That definition, from the 11th edition of WHO’s International Classification of Diseases (ICD-11), predates one of the most exceptional human challenges in recent history.

COVID-19 has created circumstances in which stress and pressure have reached unprecedented levels for many. Burnout has gone from being more of an individualised issue to an increasingly collective one, creating substantial challenges and consequences for society.

The important part of the ICD definition is the agency it implies. Burnout, even at a more systemic level, can be managed. However, more needs to be done—and soon. Much like long-COVID syndrome, burnout is a ramification of the pandemic that needs attention and management.

What is burnout? Why is a precise definition important?

The second step to solving any problem is understanding it.

As organisational psychologist Adam Grant says, it is important to be precise about burnout and distinguish it from ordinary stress or anxiety. The key is its longevity. He says: “Don't confuse stress with burnout. Feeling overwhelmed sometimes is normal—it signals responsible engagement in meaningful work. Burnout is persistent, impairing emotional exhaustion. It stems from too many demands—and too little control and support.”

The NHS definition of burnout corroborates this: a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. It occurs when an individual feels overwhelmed, emotionally drained and unable to meet constant demands.

The key element of burnout is a prolonged sense of stress due to environmental factors, making meeting demands increasingly difficult and resulting in feeling persistently overwhelmed. If longevity is key, so too is efficacy.

ICD-11 describes burnout as an occupational phenomenon characterized 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
• reduced professional efficacy.

As well as neatly defining burnout, this summary provides an effective roadmap for how to manage it. Tackle these three sources of burnout and you will go a long way towards addressing it.

Agency: what leaders can do about burnout

There are three key areas to this, each of which should be strategically discussed, prioritised and addressed.

1. Tackling exhaustion - perhaps by providing additional time off and encouraging and supporting staff to take it. Not only does this provide staff with additional time to rest and get separation from work but it also formally recognises their efforts and the strain on them. Additional wellbeing checks and support mechanisms also make sense. Some organisations are investing in wellbeing schemes such as Uplift, an online stress-busting programme jointly funded by technology organisation MindLife UK and Rotherham Doncaster and South Humber NHS Foundation NHS Trust (RDaSH).

2. Creating conditions for staff to be effective - at times of severe systemic stress, any shortcomings in working conditions are amplified. Setting boundaries by, for example, introducing no-meeting Fridays or discouraging out-of-hours emailing will help. So will being clear on workload prioritisation and making full use of technology to improve flexibility. Staff who feel empowered and part of the decision-making process will feel less out of control - Nottingham University Hospitals NHS Trust’s shared governance approach is a great example of this in action. Acknowledging and responding to the inequality of experience between different groups is also crucial. We know that non-white people have been hit harder by the pandemic, for instance, so organisational responses to burnout should be considerate of this. This Harvard Business Review article summarises a few tactical measures that managers should consider.

3. Helping staff to reconnect with their purpose - applying the basic rules of good employee engagement will help to remind the people in your organisation why they chose the careers they did. That means celebrating successes and ensuring that regular gestures are made, no matter how small, to demonstrate that staff are valued. It means focusing on the outcomes of their work, through data and human impact stories, and being vocal about them. And it means ensuring that the internal and external communications about your organisation’s purpose and values are strong and effective.

Illuminations

• Acknowledge and discuss burnout with staff to consider possible new or innovative solutions appropriate for the individual – for example by removing some of their tasks but not all of them for an agreed period of time.
• Understanding burnout is important. Be clear what it is and what it means in your organisation; create an open dialogue with your staff and use the understanding this provides to tailor solutions.
• Addressing staff burnout effectively and systemically will tackle the very real threat of significant staff loss and boost staff retention and wellbeing.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.

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