Workload is a key causal factor for burnout in healthcare. When workload chronically outstrips capacity healthcare workers are at high risk of developing burnout due to emotional exhaustion. The Covid-19 pandemic was a perfect example of this, where the surge in demand meant people were having to work longer hours and over a long period of time, with little respite. Burnout levels have reached record highs.
(This is of course just one element of the challenges the pandemic brought for healthcare workers – the nature of the work, the need for PPE, risk to self, and disruption to normal life and social support all had a huge impact too.)
But we also know that demand has been outstripping resources long before the pandemic. The NHS has faced major recruitment and retention issues for a long time. Staff vacancies require longer hours, more shifts and lengthier caseloads from those still working – feeding the vicious cycle of burnout. And there’s no sign of this easing.
If I had a magic wand I’d conjure up all the health professionals we need so the load could be shared sensibly. But in the absence of magic (and a government committed to funding the NHS properly) what can we do?
Here are some ideas about tackling workload as a risk factor for burnout:
Get the data
Facts & figures can help both you and your managers to take stock of the situation. Presenting your manager with workload data can help them take your concerns seriously and enable them to take a detailed look at possible solutions. Do a time sampling study over a typical week, writing down what you are doing every 15 minutes. Next, categorise the data according to the type of task e.g. patient facing, clinical notes, meetings, CPD, breaks etc. This will help you to evaluate:
- How much time you are working compared to your contracted hours, and whether or not you are taking adequate breaks
- How much time you are spending on different tasks
- Whether this reflects your job description, job plan and priorities (and whether there are tasks you need to drop, de-prioritise or delegate)
- Whether you/management have a realistic idea about how long a task takes
- Whether you need more support/resources to complete certain tasks
- Where the inefficiencies in the system lie (e.g. slow/crashing IT, needing to travel long distances for meetings, meetings that don’t deliver on their purpose etc.)
This approach is especially useful when done across teams and can highlight how staff are papering over the cracks of poor resourcing.
Say no
This is, of course, easier said than done, but if you can start learning how to say no to extra requests you can start to put healthier boundaries in place. This is likely to bring a great deal of discomfort, often due to a fear of letting others down. Acknowledge this and be kind to yourself, but know that the costs of continuing to take on too much are high. Are you willing to make room for that discomfort, knowing it will pass, in the service of looking after yourself?
Reduce the administrative burden of EHR (Electronic Health Records)
This is not something individuals can do on their own, but would make a huge difference to burnout levels. In the most recent Medscape burnout survey, doctors cited administrative burden as the number one cause of burnout.
The introduction of EHR in recent decades has increased this burden due to the use of systems that aren’t purpose built, and that make it easy to continually add more data collection requirements (although it appears very difficult to take any away for some reason). One study found that ICU clinicians were spending as much as 86% of their time on admin. This was not due to staff being inefficient, but simply that there was too much to do.
Another study in primary care noted the cognitive burden of alerts generate by the EHR. The intrusive nature of the alerts and the fact that GPs did not have protected time to respond increased subjective workload. Interestingly subjective workload was predictive of burnout, but objective workload (i.e. number of alerts) was not. This relates to job control – being able to choose how to tackle work demands mitigates the impact of workload on exhaustion and burnout. Simply building in protected time for administrative tasks can go a long way to preventing burnout.
If you can, seek opportunities to be involved in reviewing your EHR and working to “get rid of the stupid stuff”. This is a complex process but should be given priority by healthcare leaders given the enormous burden it places on staff.
What if you can’t reduce your workload?
Workload is one key risk factor for burnout, but it’s not the only one. Let’s consider how workload interacts with the other factors (job control, reward, community, fairness, and values), and how you might be able to draw on these when your options for reducing workload are limited.
Job control
Studies show that a sense of job control moderates the relationship between workload and exhaustion. People feel less burdened by their work when they have a stronger sense of control over how they tackle it. When we can choose how we want to respond to work challenges and how we organise our time we are more able to manage a heavy workload.
This becomes more difficult in our hyper-connected culture where expectations to be online and available all the time can make it difficult to block out time and plan our own diaries. If you work shifts or are in a frontline role this can be even more difficult.
But managers can make relatively small differences that have a big impact on job control by e.g. allowing protected distraction-free time to complete work tasks; and supporting flexible working patterns.
Reward
No-one goes into healthcare for the financial reward, but feeling that you are being exploited or not being fairly paid will add to workload burden. You may wish to get more involved in union activity to address this, but it’s also worth considering how you can access a sense of reward in other ways. Make use of discounts offered by your employer/union. Are there other things that would be nurturing for you that you could seek out – training, coaching or other development opportunities? Take your annual leave and TOIL. Do not feel guilty about taking these rewards – you have more than earnt them!
Community
Draw on the support of colleagues. Talk to others about your struggles either informally and/or through reflective practice. Could you join forces with others to address workflow or IT issues? There are often times when others may have more capacity – can you ask for help? There may also be tasks that you find less burdensome, that others hate and vice versa – are there opportunities for sharing or swapping tasks to reduce the sense of burden?
Fairness
Feeling that work is unfairly distributed will increase workload burden. Talk about this – it may be that others haven’t realised that things are unfair, or it may be that there are (fair) reasons for differences. It may also be that discrimination needs calling out.
Values
When the values of frontline workers and management are aligned there can be greater agreement on task priority which can in turn reduce workload burden. It is vital that leaders are visible in seeking to truly understand the experiences of staff on the ground and that there are clear channels of communication. An example of this would be commitment from senior management to support clinical staff in reviewing EHR systems so that they serve clinicians and patients, and not the other way around.
If you’re recognising symptoms of burnout you might find my Burnout Toolkit helpful – it has loads of taregted evidence-based psychological strategies.
