Ep. 207: Pills to face burnout and the role of occupational health therapists

00:00:00: Welcome to EANcast, your weekly source for education research and updates from the European Academy of

00:00:17: Neurology.

00:00:35: Today, we're discussing a topic that resonates with many healthcare professionals.

00:00:40: I'm delighted to be joined by Professor Gay Kinman, Professor of Occupational Health Psychology at Birbwick University of London.

00:00:49: Thank you so much for being here today.

00:00:51: It's a pleasure, Alice.

00:00:52: Thanks for inviting

00:00:55: me!

00:00:55: So this start... Many of our listeners may not be familiar health psychology.

00:01:01: Could you tell us a little bit about your field and how it contributes to understanding, preventing burnout in healthcare settings?

00:01:10: Yes of course.

00:01:10: now occupational health psychology is relatively new discipline as the name really implies its kind Work psychology, but also health psychology as well.

00:01:24: So you know to find very broadly.

00:01:26: we examine how work affects people's health wellbeing and safety And How?

00:01:31: We can design workplace is took promote healthy productive and sustainable working lives.

00:01:37: so You don't really really key issues.

00:01:38: as he can say we provide evidence-based guidance two organizations But also individuals as well on how to remain healthy and also productive.

00:01:49: Now, in terms of burnout we're very interested in issues like how workplace cultures influence the well-being of employees?

00:01:57: How work related stress affects people's mental and physical health ?

00:02:02: And also their performance .

00:02:04: A particular issue is the occupational risks in different types of job because burn out can be caused by.

00:02:15: And very importantly, how can organisations promote well-being and put things in place?

00:02:23: Amazing.

00:02:23: That's very interesting.

00:02:24: that also provides us with a helpful framework then to walk through the questions of these episodes.

00:02:30: So as you mentioned burnout has become one.

00:02:33: they discuss challenges in healthcare but sometimes we hear this term used many different ways.

00:02:41: There is an issue in research too definition of burnout.

00:02:46: So from your perspective as an occupational health psychologist, how should we understand burnout today?

00:02:53: And what are the challenges that you're facing in defining burnout?

00:02:58: That's a really important issue Alice and I think it is very close to my heart actually because It's obviously important to raise awareness of these risks.

00:03:10: So talking about it and raising public awareness is very, very important because we need to understand how work affects people's well-being on performance... ...and how to reduce these risks.

00:03:23: but to be honest many us feel the term has become overused And I myself have been approached by various journalists, you know to talk about burnout and this.

00:03:35: that in the other.

00:03:36: We're really speaking.

00:03:37: people are seeing it as perhaps being a bit tired ,being a bit fed up .

00:03:43: Being a bit disillusioned with the job.

00:03:45: now This suggests That It can be A bit overused and Perhaps abused and we do need To Be very precise.

00:03:51: obviously In what were measuring?

00:03:57: So we see it as something a lot more serious than that.

00:04:02: And certainly, if we're talking about health care... We know obviously healthcare has particular risk factors for burnout and we would adopt Christina Maslach who first documented burnout in people working with the so-called human services That burnout is not an individual problem but it is a syndrome resulting from chronic workplace stress that has not been successfully managed.

00:04:29: And indeed, the World Health Organization has adopted this definition of being a work-plate syndrome and also an individual factor to be

00:04:39: treated.".

00:04:40: Now Christina Madelach's research was really interesting.

00:04:44: I was lucky enough to interview her few years ago.

00:04:47: you know she's one my absolute heroes.

00:04:50: She was very, very keen to emphasise this idea that burnout is not an illness and it isn't the individual.

00:04:58: It's the organisation which needs change.

00:05:01: essentially.

00:05:02: So she sees burn out as having these three facets And burnout being a cycle That doesn't actually happen overnight.

00:05:10: First of all people become emotionally exhausted Because you know Of emotional demands at their job Dealing with people in distress dealing with people who are families, etc.

00:05:24: It's a very emotional type of role and this emotional exhaustion obviously has the potential to overwhelm peoples' resources – peoples mental resources, peoples physical resources.

00:05:37: so what they do is put up an emotional barrier in place for self-protection And it really makes a lot of sense, doesn't they?

00:05:47: You know that if something is affecting us and hurting us we're going to put some barriers in place as a form of self-protection.

00:05:55: So what can happen then Is that we cease to actually engage emotionally with patients and colleagues.

00:06:03: To some degree That could cause a degree of cynicism and depersonalisation where We may see our patients like massive people who aren't individuals, who all want something from us.

00:06:19: And obviously that can be a big problem because people would go into healthcare to make a difference and they need to feel this sense of personal accomplishment in what they do now.

00:06:32: if they stop making genuine emotional connections with people They stopped getting what they should out to the job.

00:06:42: you know, that can go on all the time.

00:06:45: But of course it isn't trivial.

00:06:47: we know that the impact of burnout in health and performance can be very serious so it is not a short-term problem requiring a quick solution.

00:06:57: You also mentioned something about measurement.

00:07:00: Yes now...that can be an issue because although The Maslatch Burnout Inventory, which was first developed by Christina Maslach a long time ago and has been extensively validated across different occupational groups.

00:07:15: There's many different measures out there you know?

00:07:18: There are even single item measures that is pretty much how burned-out are on the scale of one to five.

00:07:25: now they can be useful, but of course what can happen is that we get lots of different types of measures being used.

00:07:34: Different sub-scales, different threshold levels as well.

00:07:39: so it's very difficult to compare findings across studies and what we often find then are inconsistent classifications suggesting an individual could actually be classified as burnout using one measure than not another.

00:07:55: And this is a bit of challenge for both research and practice, so I would certainly encourage people if they are measuring burnout in any way to use consistent measure.

00:08:08: To use the valid threshold scales because that's key issue.

00:08:15: Absolutely!

00:08:16: We see also other fields when you don't have shared scales that you use or shirt cut off.

00:08:24: That makes it very hard to study the subject, but also as mentioned too compare different studies and have a clear idea of.

00:08:35: I was reading the papers in this field.

00:08:37: And as you mentioned, like there was a paper that was published in JAMA few years ago that looked at the literature and they were at least one hundred fifty ways of defining burnout is imagine.

00:08:47: so we really need to have more clarity and to ever consensus among researchers in the fields just to use As You Mentioned The Same First The Same Scale.

00:08:56: Yeah

00:08:56: We Do Because We Need To Know What We're Made Of And We All Need To Be Made Of The Same Thing.

00:09:00: But That's Not To Say but we can't be open to change and being a bit flexible, you know because there are different ways of looking at things.

00:09:08: But I would say to your listeners as well if they're interested in the Maslatch Burnout Inventory i've recently published A Review Of The Scale Itself In The Journal Occupational Medicine.

00:09:21: so um...I'd Be Happy To Provide A Reference For That.

00:09:26: Absolutely We Could Share With Our Listeners In Spotify.

00:09:30: You Brought Up Another Topic another aspect of burnout that is really close to my heart as well, the fact that it's not only an individual problem.

00:09:39: Is this actually a structural and organizational problems?

00:09:43: As you mentioned we also see consequences of.

00:09:47: burnouts are affecting individuals but also organizations and how patients receive care which is something very important and clear for any healthcare professionals.

00:10:01: So we also, coming back to the title of this podcast, Pills To Face Bernat.

00:10:08: We wanted to be with Luca Cuffaro... The person at home who designed these podcasts.

00:10:14: Wanted it a little bit provocative because as you mentioned in some ways there is this culture and common tendency for individual solutions or individual weaknesses when people are struggling.

00:10:25: But as you mentioned, it is also an organizational problem.

00:10:28: So how can we approach burnout not only as an individual problem but also as an organization or a problem?

00:10:37: What are the suggestions that you would have for individuals and organizations to on one side identify very early burnouts And so... We wish to prevent this

00:10:48: Absolutely.

00:10:51: Part of the problem is that burnout can manifest itself in lots of different ways.

00:10:56: So, you know it doesn't appear overnight although strangely enough there is evidence now that medical trainees are starting to experience burnout very early on in their training and this is longitudinal research by The British Medical Association.

00:11:13: so its kind of legitimate And It's been tracked over time since the pandemic.

00:11:19: So that is a cause for concern.

00:11:21: The people so early in mercury are starting to show signs of burnout, and generally speaking evidence shows it doesn't appear suddenly but over time.

00:11:33: as people move from manageable stress to more chronic stress then go through the cycle.

00:11:38: you know exhaustion detachment reduced effectiveness looking at ways can manifest itself we do.

00:11:47: Organisations need to be aware of this, but individuals need too as well because they should be aware their own early warning signs.

00:11:56: So if we see burnout is a cycle it means that we can intervene at any stage.

00:12:01: But prevention –as all know-is much better than cure.

00:12:05: It can manifest itself as emotional splines.

00:12:09: Now often people feel increasingly overwhelmed and sometimes start feeling almost emotionally and physically paralyzed, you know when they have the chance to make things better for themselves or improve their circumstances.

00:12:26: They become so paralysed that they can't actually make any changes at all even though they may be good for them.

00:12:35: Feeling emotionally drained etc.

00:12:37: but also irritable frustrated.

00:12:39: thats very common.

00:12:41: people can then be alienated from even their families, from their colleagues etc.

00:12:48: and as we know social support is one of the best buffers of any kind of stress.

00:12:55: so when you feel alienated from others that can only cause difficulties.

00:13:01: There are cognitive signs now clearly a major issue in medicine because people are relying very heavily on their cognitive abilities difficulties concentrating, increased forgetfulness etc.

00:13:17: and in decision where you know people I've worked with have struggled even deciding which brand of washing powder to buy because any kind of decision becomes too much.

00:13:29: Persistent worry about work is a very key sign and an inability to switch off from it.

00:13:35: You may well be with your family or friends enjoying your leisure but from work.

00:13:43: There are often behavioural signs, reduced engagement in activities outside work where people may grudge spending time on anything else apart from work and we often find that even when people maybe signed off sick from work they will be very reluctant to take time off or keep on coming back and coming back.

00:14:07: Staff medication is another behavioural sign as well.

00:14:11: they know that we need to be aware of where people may engage in excessive drinking, alcohol etc.

00:14:18: as a way of sweetening off.

00:14:20: Physical signs, persistent fatigue but cannot be alleviated by rest no matter how much you sleep and increased susceptibility to illness because of course as we know chronic stress can cause down-regulation of the immune system So people may pick up all kinds of problems.

00:14:40: It is very important for individuals and organisations to be aware, isn't it?

00:14:46: Of these signs that we can put things in place because although the causes are organisational... ...the signs are individual.

00:14:58: so I think its very important you know..to be aware

00:15:03: Absolutely, and then as you mentioned before they can at a certain point when many individuals suffer from this condition.

00:15:12: Then develop to become also organizational science where he have dysfunction in much more evident dysfunction other level of the team and in the care of the patient.

00:15:21: so As you mention The best step is to prevent this conditional tool first being aware of the signs, early signs of burnout but even advanced signs to tackle them and face them.

00:15:34: And I think there is also another aspect a cultural aspects.

00:15:40: what i've seen in my experience that medicine traditionally values endurance self-sacrifice pushing through despite difficulties and difficulty circumstances And I was reading a few months ago, the twenty-five report of The European Agency for Safety now at work and outside also from medicine.

00:16:00: There were forty eight of the individuals who replied to their questionnaire mentioned that disclosing mental health condition or any issues at work could have actually an negative impact in our career.

00:16:14: so How do you see culture playing a role in burnout and how can we actually tackle this aspect as well to prevent burn out?

00:16:25: That's really, really interesting important point Alice.

00:16:28: And I think i remember a few years ago reading the Really Interesting article on it was medical students.

00:16:37: basically finding showed that these medical students were much more likely If they were experiencing signs of stress, burnout mental health problems.

00:16:47: They would more likely to make up a physical health problem because it didn't want it on their own accord and I think that's extremely worrying.

00:16:57: but of course there is the reality.

00:16:59: often working in medicine as you say There are very strong cultural self-sacrifice where its normalised isn't it?

00:17:10: put patients' needs before your own.

00:17:13: And self-compassion, you know I'm very keen on the idea of cultivating self compassion because self compassion encourages self care and cultures often discourage it.

00:17:25: and also self care is not normalized.

00:17:29: see a little bit like an extravagance or luxury that perhaps we don't have so its way down there.

00:17:37: stigma It's also a key concern, you know that we know despite it being so-called caring profession.

00:17:47: Healthcare and social care more generally people can feel very reluctant to engage in...to ask for help.

00:17:56: And I think certainly research that i've done myself and others perfectionism is A big problem Very, very common indeed.

00:18:07: Isn't it in medicine?

00:18:09: Absolutely

00:18:10: forced selected for to some degree and It can be reinforced over time.

00:18:16: You know in cultures where there may be individual blame High standards etc.

00:18:22: are needed.

00:18:23: So you know people maybe much less likely To speak out when they're experiencing problems because of that.

00:18:31: so about is a big problem.

00:18:33: And certainly an Another piece of research with general practitioners in the UK suggested that although, and general practices are a very big risk factor for burnout.

00:18:47: But it's suggested that these general practitioners were actually able to hide these signs from their patients, from their colleagues

00:18:57: etc.,

00:18:59: for quite a long time.

00:19:01: nobody really had any idea until the signs became much more obvious.

00:19:06: And of course that takes a huge amount of energy and effort, contributes again to health breakdown over time.

00:19:15: but you know people can be very good at hiding these things because perhaps culture etc.

00:19:21: personal expectations as well have themselves being kind of superhuman.

00:19:28: really this is the phrase.

00:19:33: Agree, I just agree.

00:19:34: And there is as you mentioned the aspect of personality trait so being a perfectionist.

00:19:39: but i feel that it's also cultural pressure.

00:19:43: So few years ago I read an essay from Björn Chulhan who wrote The Burnout Society and he basically says in our society There was this shift with internalization of the imperative to perform.

00:19:59: internalize these needs to continually surpass the previous achievements always get better until.

00:20:06: To a point where they exploit themselves without, without realizing that this system is pushing them

00:20:12: absolutely.

00:20:13: and I think another issue there is you know part of perfectionism terms if you like.

00:20:19: it's excessively high expectations for other people.

00:20:24: So, you know it's very common in burnout for people to seek colleagues has not been as dedicated As them is not working.

00:20:31: It's hard as then and of course You know going back the culture.

00:20:35: but culture often rewards behaviors that actually contribute to burn out too, you Know Christina much would say they're kind of badges of honor Really almost like?

00:20:47: You know I'm burned out so i must have worked really really hard so That something we do need to be very careful off

00:20:54: And something that shows us there is still a lot of work to do from the cultural point-of view.

00:21:01: The last points I wanted to touch upon, always on this area with regards... You mentioned at certain stages of burnout you cannot really saturate your personal life or working life and new technologies.

00:21:16: so having access for example to emails also aside form work records, electronic health record so that you can check when you're at home how your patient is doing.

00:21:28: This isn't really helping us in having distinct and very clear boundaries.

00:21:34: So maybe this something... there's evidence I guess with regard to that about possible measures we could put into place.

00:21:45: That's a really important issue Alice And of course it has long standing interest separate and work in personal life.

00:21:53: Now it's a lot easier, isn't it?

00:21:55: When we go into the workplace physically... We do our work even though we may work for long hours but then when we go home It is our sanctuary!

00:22:03: We're home..we can relax ..we can spend time with friends ...we can switch off etc.

00:22:08: But you know The IT Can be a double-edged sword as we know And it takes a lot of effort I think For individuals to create these Habits and boundaries to separate work from personal life.

00:22:25: And certainly, you know if we go back and look at the culture that encourages old-work perhaps a degree of perfectionism and also A very strong interest in the work that you do You know so people may be less likely wanted this engage from it anyway.

00:22:43: But of course we know that having recovery mental recovery from work, physical recovery is absolutely essential.

00:22:51: Because although people may function for a fairly short period of time their health and lack of hormones will break down over time.

00:22:59: so creating some sort of rules yourself engagement it's really important certainly but i think alot this comes from above.

00:23:13: Leaders in organisations are very, very powerful role models for burnout risks.

00:23:19: For work-life balance or self care for self compassion.

00:23:24: so certainly changes need to be from the top down and it's no good leaders saying off you go home take time off etc.

00:23:35: relax at the weekend if they're going to continue into work themselves.

00:23:41: So it's really, really important to model a healthy work-life balance and to prioritise self care.

00:23:48: And also I would call rules of engagement with technology and stick to them.

00:23:55: The other thing is that we know from psychology We know at home should be seen as the place of sanctuary.

00:24:05: Often...I do a lot of work with child protection social workers And certainly when they're working at home and dealing with some quite emotionally disturbing issues in their homes, it can feel a little bit like your place of sanctuary can be invaded.

00:24:24: So that's something we need to be very aware.

00:24:29: Yeah, thank you so much for giving us also some tips on how to protect ourselves and have quite clear boundaries with our sanctuary.

00:24:39: Our home and work in places.

00:24:43: So continuing having powerful role models working on the organization.

00:24:50: if you were advising a hospital department that wanted to prevent burnout rather than react to it Where would you recommend they start?

00:25:01: Right.

00:25:01: Now, number one I think is to treat resilience programs with great suspicion because individuals are very wary now of programmes that aim to encourage people to cope with stress better Because essentially That isn't what causes burnout.

00:25:23: It's not a lack of coping ability It's these untenable working conditions.

00:25:30: So see it as an organizational, not an individual issue although clearly we do have to treat any kind of uncomfortable symptoms that may arise.

00:25:41: so move beyond this individually focused programs and think about the aspects of work environment which is actually causing chronic stress what they can do change them.

00:25:54: So the idea is that you start off by thinking about what can do to prevent it, not treat and help individuals cope with.

00:26:03: Number one is listen your staff because they are experts in their working lives.

00:26:09: so tell them what's causing problems often give some useful information or solutions which aren't very costly.

00:26:20: So listen to staff, make sure that you listen to people from different backgrounds and who are doing different types of work.

00:26:29: Assess the psychosocial risks using validated surveys.

00:26:34: Now in the UK we use health & safety executive management standards.

00:26:39: look at things like job demands support autonomy role in the organisation change management So that can help.

00:26:48: you then create a baseline where you can assess whether any interventions work over time.

00:26:56: Make sure we create a culture of psychological safety, now psychological safety.

00:27:02: for those who are unfamiliar with the term it really means staff feel safe in speaking out when they're struggling and making suggestions etc... They don't feel like their going to be targeted as individuals.

00:27:16: Also, make sure that self-compassion and self care is normalised.

00:27:19: As I said from the top down focus on workload staffing levels to make sure people have manageable workloads now.

00:27:29: People don't mind stepping up today On occasion if there are genuine emergencies but when it becomes a day-to-day reality That can then cause problems.

00:27:43: Ensure supportive and compassionate leadership.

00:27:45: Now some really interesting research out there on Compassionate Leadership, how it's important in healthcare and lots of guidance out there.

00:27:57: Treating... And I think this is a key issue, treating staff well-being as patient safety issues sometimes.

00:28:05: that makes sure you know they are prioritised then because I mean people who are burning out, although they may be struggling to preserve their levels of performance.

00:28:21: They won't be able do it for a while over time and will worry And make mistakes or forget or make prescription errors.

00:28:31: You know there's evidence for healthcare professionals in terms of accidents with patients physical accidents etc.

00:28:41: So, you know it is really very much a patient safety as well.

00:28:44: As an individual issue.

00:28:47: so I think but reiterating making sure that you are listening to the staff because they will know much more.

00:28:58: Thank You so much Gail.

00:28:59: i think this all The points that he raised really resonates with me and I hope That there Will also resonate With leaders And managers in the healthcare setting.

00:29:10: looking ahead What development in occupational health research give you the most optimism about tackling burnout?

00:29:19: Well, I think what gives me the most optimism is to shift away.

00:29:26: The gradual recognition that burnout isn't an individual lack of resilience.

00:29:32: doing a bit of mindfulness will make a huge difference.

00:29:36: Obviously, it's a skill perhaps that we can use to help us cope on a day-to-day basis but it isn't going to waive the magic wand and reduce these risks.

00:29:45: so its seeing as an organisational and occupational health issue And this is very heartening in lots of ways because It places greater emphasis on prevention than what organisations can do you know To reduce these harmful working conditions.

00:30:04: So I think that's probably my greatest cause for optimism.

00:30:09: Yeah, and it is also important that individuals are aware of this organisational aspect... ...and they request from their leaders or managers to have these types of sensibility attention... ...an organisational structure to support them as you mentioned?

00:30:26: Yes!

00:30:27: That's a key issue because what can happen if people who were burning out withdraw from others and don't really want to talk about it, they can feel that they're the only ones.

00:30:38: And it could be quite a lonely place so having conversations being open de-stigmatising you know is very important indeed.

00:30:49: thank you so much again.

00:30:50: this is like definitely food for thought for everybody working not only in the healthcare sector.

00:30:56: So Thank You so much for joining us today and sharing your insights.

00:31:03: So as we've heard today, burnout is far more than an individual challenge.

00:31:07: It's shaped by the environment in which healthcare professionals work.

00:31:10: recognizing early warning signs fostering a supportive workplace cultures and addressing organizational factors are essential if you want to protect well-being of clinicians and quality of patients care And I really hope that this conversation has encouraged our listeners not only on their own wellbeing but also how they can create it healthier and more sustainable healthcare systems together.

00:31:33: Thank you for listening to the INCAST Weekly Neurology, we look forward to welcoming.

00:31:54: You can also listen to this and all of our previous episodes on the EAN campus, E&Cast weekly neurology is your unbiased and independent source for educational and research-related neurological content.

00:32:31: Although all the contents are provided by experts in their field, it should not be considered official medical advice!