The ‘burnout’ of health-care providers exists in many countries of the world, but poses a greater risk for patients in lower and middle-income countries like Jamaica, where there is a severe shortage of staff to provide the required health-care needs of the population.

Burnout refers to psychological exhaustion due to stressful demands over an extended period and puts health-care providers like doctors and nurses at risk for poor mental health, decreased productivity and sometimes abandonment of their chosen careers.

Burnout may progress through various stages, beginning with emotional exhaustion (‘I feel burnt out from my work’), followed by depersonalisation towards others (‘I have become more callous towards people since I took on this work’), and eventually ending in the loss of professional achievement with a subsequent desire to leave the health-care profession.

Prevalence

Burnout is generally more prevalent in the public sector (government hospitals and clinics) than in the private sector. In the public sector, doctors and nurses have virtually no control over the number of patients they are required to attend to daily and are unable to turn back the numerous patients who turn up for care, particularly with the perception of ‘free health care’ currently prevailing in Jamaica. In the private sector, health care providers are more in control and able to stop working or limit patients at their discretion.

While there has been no funding to conduct such research in Jamaica, in a recent survey in the United States (published in the January edition of the New England Journal of Medicine), 42 per cent of doctors reported suffering burnout. The response rate was 67.8 per cent (2,069 responses out of the 3,051 doctors surveyed). Further, family physicians who had been working for only three years reported high rates of emotional exhaustion and depersonalisation.

Medical errors

The full cost of burnout was computed, and consisted of medical errors, poor clinical outcomes (patients receiving sub-standard health care that resulted in dire consequences), high turnover, and low job engagement. However, in that country, the article reported that health-care organisations and advocacy groups were beginning to take corrective action. This requires a great concern and agreement regarding the urgency and severity of the crisis, and the willingness to act to rectify.

Further, addressing the problem requires the systematic gathering and analysis of the data on burnout in health-care professions. Then there should be the coordination and synthesising of all efforts to rectify the identified causes, with a generated momentum of all collective efforts to bring about a resolution.

A wide array of stakeholders in health care and the health care industry currently exists, and they all should be involved in the effort to rectify burnout and reduce its short-and long-term harmful consequences on health-care providers, their families and patients, by providing sustainable solutions. These include the Ministry of Health, allied health-care organisations, the health insurance industry, doctors, nurses, professionals supplementary to medicine, policymakers, and patients.

Important goals

Research in North America 20 years ago had also linked high rates of medical errors with burnout by doctors. The resulting report spurred system-wide changes that led to improved safety and quality of care. To accomplish this, the following important goals were set:

1. Increase the visibility of the stress and burnout of health care professionals;

2. Improve health-care organisations’ baseline understanding of the challenges to health professionals’ well-being;

3. Identify evidence-based solutions; and

4. Monitor the effectiveness of the solutions’ implementation.

The evidence in the USA was that burnout was largely driven by external factors such as inefficient work processes, long work hours, heavy workloads, work-home conflicts, and specific organisational culture. Successful resolutions to these issues led to a restoration of the moral imperative that had led many health-care professionals to work in the field – providing the very best care to patients!

Reducing burnout

Many health-care systems have begun conducting testing programmes to reduce burnout among doctors in the US, and Stanford University’s School of Medicine has pilot-tested a ‘time banking’ programme to compensate doctors for some of the time they spend on work-related activities that fall outside of their care-giving duties, and which contribute to their feeling overburdened.

In exchange for the time they spent on tasks such as serving on committees, mentoring, and covering shifts for other health care providers, the pilot programme allowed health-care personnel to receive work or home-related services such as meal delivery, cleaning services, or grant-writing and similar career development support.

The initiative was very successful, particularly among female health-care providers. Further, Stanford became the first medical institution in the USA to create an executive-level position that focused specifically on the well-being of individuals working in clinical care.

The Ministry of Health in Jamaica and all similar employing bodies therefore need to constantly measure the well-being of health-care providers and implement research-based interventions to address the factors that contribute to burnout and suffering among health-care professionals. Otherwise, burnout will irrevocably erode the ‘soul’ of our health-care services.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)