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BSI’s Kate Field, Global Head of Health, Safety and Well-being explores findings from a report published by BSI – Prioritizing People: how can hospitals protect the well-being of their workforce after COVID-19? Kate specifically sets out challenges and considers some ways forward to manage the fall-out following the pandemic.
Last month marked the third anniversary of the COVID-19 pandemic, which naturally prompted reflection on a time when hospital staff were on the frontline, responding to high levels of sickness and death from a new and unpredictable disease. They worked long hours, often in unfamiliar areas outside of their normal teams, and often putting their own health at risk. With no time to waste, they had to adapt fast to new ways of working.
Hospital staff were exposed to infection or at least an increased risk of this, for themselves and those they lived with, in some cases without sufficient personal protective equipment. Tragically, many contracted COVID-19 early on or saw colleagues and friends die from the disease. In fact, it was reported by the Office for National Statistics that 13,000 frontline health and social care workers died from the disease between March 2020 and February 2022.
Even three years on, the pressure on healthcare services from COVID-19 continues and now the same frontline workers face backlogs of patients who went untreated during the pandemic’s early days. According to official figures, almost 35,000 NHS workers resigned voluntarily during the first quarter of 2022. As our research found, healthcare professionals were choosing to leave their roles, in some cases as a result of long-term conditions caused by Long COVID, stress or anxiety.
With staff well-being a concern, what can healthcare employers do to support staff, manage this fall-out from the pandemic, and promote a culture of well-being?
What is well-being in the workforce?
Workplace well-being can have many meanings, from absence of harm to encouragement of healthy habits, to the fulfilment of the physical, mental and cognitive needs of a worker related to their work.
Mental health at work guidelines from the World Health Organization (WHO) and the International Labour Organization (ILO), published in September 2022, state that employers have a responsibility to provide ‘work that simultaneously prevents workers from experiencing excessive stress and mental health risks; protects and promotes workers’ mental health and well-being; and supports people to fully and effectively participate in the workforce, free from stigma, discrimination or abuse.’
These responsibilities go beyond basic health and safety measures, such as avoidance of injury or work-related illness. Well-being at work implies a psychological contract between employers and staff. Staff expect to work in a safe environment, to be supported in their work and career progression, to be paid fairly and respected. When this contract is not upheld, or trust in it is damaged, well-being can be damaged, and staff are at risk of burnout.
What are the challenges to well-being in the hospital workforce?
These guidelines apply to all sectors, not healthcare alone. But as our research found, there are specific challenges to the hospital workforce and there is a risk of burnout across the global healthcare community.
The International Classification of Diseases defines burnout as: a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is 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
While burnout is not classified as a medical condition, experts connect it with mental health conditions such as anxiety disorder and depression.
In the UK specifically, an NHS 20201 Survey revealed that 58% of 1,194 front-line health and social care workers showed symptoms of clinically significant anxiety, depression or PTSD during May to July 2020 and 34% of NHS staff said they felt burnt-out.
The survey also revealed that only 27.2% felt there were enough staff at their organization for them to do their job properly, nearly half (46.8%) had felt unwell because of work-related stress in the past 12 months and only 52% looked forward to going to work, down from 58.8% in 2020.
Hospitals are still dealing with high numbers of COVID-19 cases, as well as attempting to ‘catch up’ on the backlog of care that built up during the peak of the pandemic. In the UK, the backlog of people waiting for elective surgery rose to the highest ever at 6.7 million in June 2022, while in some cases patients have not been able to be discharged from hospitals into social care, putting more pressure on emergency care.
Variations of experience and outcomes
Not all hospital staff reacted in the same way to the pandemic. The overall figures mask variation. Some studies found that women and younger staff were more at risk of burnout, while older physicians were less likely to report the relevant symptoms. A study from one hospital in the UK linked the following variables to the likelihood of burnout, after adjusting for demographic characteristics:
- Differing roles
- Differences in ability to rest and recover between shifts
- Having concerns about personal protective equipment
- Lack of control over redeployment and working patterns
- Changes in workload
What initiatives can support well-being in the hospital sector?
Workplace well-being programmes are nothing new, but the need is greater now, meaning forward-thinking hospitals will be looking at ways to support people.
Initiatives that are short term or not well-thought through might put yet more stress on employees. For example, employers may offer resilience training, thus putting the onus on employees to become personally resilient to stress. Organizations that truly prioritize their people are those that understand resilience is about more than one individual.
The WHO mental health at work guidelines put it plainly: ‘a focus on individual stress management is unlikely to be effective on its own; critically, it can wrongly make people feel it is their own fault for experiencing understandable stress in response to difficult work circumstances.’
There are clear benefits from focusing on prevention, through routine management of workload and stress. Well-being starts with meeting people’s basic needs – for example, that they have access to drinking water and places to rest and eat – although of course it doesn’t stop there.
To support well-being in the hospital sector, BSI’s research has identified the benefits of:
- A strategic vision of an organization which prioritizes people
- A commitment to culture change from the top of the organization
- Data to reveal areas of concern that need tackling
- Support from every level of the organization
- Evidence-based tools and techniques to equip managers and volunteers
- A commitment to reduce unnecessary work and unhealthy practices
These approaches chime with the WHO’s recommendations.
Culture shift
There is a strong sense that people expect more of employers since COVID, and that employers have the opportunity to step up to create a culture that shows they value employee well-being.
For hospitals, the opportunity is to demonstrate to their people that they matter and shift the culture to increase trust and prioritise their well-being. Workforces are slow to grow, even if training and recruiting new healthcare workers starts now. So, hospitals with an eye on the future will want to make the most of the staff they have.
The international standard, ISO 45003 Psychological Health and Safety at Work, allows organizations to implement global good practice on managing psychological health and safety within their organization, wherever they are in the world. It provides a benchmark for organizations that want to show they are serious about delivering workplace well-being.
What needs to happen now?
The COVID-19 pandemic ‘took an x-ray’ of the stresses and strains within the hospital workforce, revealing fractures that were already causing problems but had long gone un-addressed. Hospitals face long-standing staff shortages at all levels. If the sector is to survive, taking good care of people and showing them they matter is an important first step.
A crisis in burnout is unlikely to be solved by short-term initiatives that rely on staff to ‘learn resilience’ or one-off ‘thank you’ gestures from employers. Real change will come from wholesale cultural shift – one of the hardest things to bring about, especially in organizations with hard-wired hierarchies and long-established cultures.
Change, embraced at all levels but led by senior management, will help show even the most junior member of staff that their well-being is important, not just to them but to their organization.
If we expect our healthcare professionals to thrive and rise to the challenges of the post-pandemic world, ensuring they are cared for, protected and prioritized is key. BSI’s Prioritizing People Model sets out a best practice framework on workplace well-being, and can allow
