- The pandemic has put a spotlight on the issue of healthcare worker burnout.
- To address this issue, the Canadian Medical Association has built a plan to address three dimensions of wellness: physical, psychological, and cultural.
- For other healthcare associations, organizations or authorities looking to act on this issue, a plan is needed with well-defined metrics, leadership that prioritizes workforce wellness as a quality indicator, and thoroughly monitors progress against this priority.
The issue of healthcare worker wellness has been studied thoroughly over the last 20 years, providing plenty of evidence to prove there is a direct correlation between healthcare worker wellness and clinical quality and safety.1,2,3 The pandemic has put a spotlight on the issue of healthcare worker wellness, catapulting it into the public’s consciousness through news headlines describing workers leaving the sector due to burnout.4,5,6,7 According to the World Health Organization, COVID-19 has placed “extraordinary levels of psychological stress” on health workers globally.8
Traditionally, medical professionals have approached their jobs with a great deal of pride and passion, and in turn received society’s gratitude for improving the health and wellness of communities. Yet the pandemic challenged those notions. In many jurisdictions, including my home country, Canada, medical professionals are under immense stress as the pandemic disrupts their ways of working, limits accessibility to their patients, and has made them the targets for those against government public health measures.
Healthcare leaders are aware that action is needed. A recent KPMG International survey of healthcare CEOs in eight jurisdictions found that supporting workforce wellness is among their top concerns. It would seem that these leaders have come to the realization that meeting the challenges of COVID-19, addressing the elective care backlog, and making healthcare resilient to future shocks cannot be done with exhausted, demoralized staff. Given the global interest in this topic, I’d like to highlight the work the Canadian Medical Association (CMA) is doing in the area of physician wellness and offer practical advice to associations, organizations or authorities looking to address this difficult issue.
Well before the pandemic emerged in early 2020, the CMA had made physician wellness a flagship issue, believing that supporting physician health and wellness means addressing the physical, mental, and social factors that can help prevent illness. “Excellent patient care needs health providers who are working at their best, which means they are supported to work in safe and health-promoting environments. Put simply, we need a vibrant and healthy workforce to support a strong and healthy community,” says Dr. Caroline Gérin-Lajoie, psychiatrist and Executive Vice President, Physician Wellness and Medical Culture for the Canadian Medical Association.
In 2018, the CMA launched its inaugural Physician Health Survey to recognize that physician health and wellness was an important priority, to respond to growing concern within the medical profession, and to address a critical knowledge gap in Canadian data on key indicators of physician health. While results of the next survey will be released in spring 2022, the 2018 study revealed that female physicians, residents (doctors-in-training) and early career physicians were at the highest risk for mental illness.10 A further sub-analysis also found that occupational predictors (career satisfaction, work-life integration and presenteeism) were stronger predictors of psychological variables than behavioral factors (exercise, nutrition).11
Physicians have historically been individuals that tend to be perfectionistic, that focus on others’ needs before their own, and who care about how peers and patients perceive them. There is a fear of judgment or losing respect or credibility. Society also perceives physicians as superhuman or invincible, and that is simply not true. These dynamics make it harder for physicians to take care of themselves, especially when it comes to mental health.
Dr. Caroline Gérin-Lajoie
Executive Vice President, Physician Wellness and Medical Culture
Canadian Medical Association
Supporting wellness in the short and long term
In the first waves of the pandemic, frontline healthcare workers were experiencing emotional and moral distress from witnessing so many deaths, being unable to provide effective treatments, and having to comfort people who were dying without the presence of loved ones. And in the flurry of activity mid-pandemic, many healthcare workers experienced the additional distress of being redeployed to unfamiliar teams and having to acquire new skills with little support.11 In response to these challenges, the CMA is providing practical support to all physicians and medical learners through:
- The Physician Wellness Hub12, containing more than 400 resources for practitioners, leaders and educators, including articles, how-to guides, toolkits, videos, podcasts, and webinars on 27 topics such as burnout, resilience, and family matters. To-date, the CMA says user feedback on the hub has been overwhelmingly positive.
- The Wellness Connection13, a virtual safe space for physicians and medical learners to gather and discuss shared experiences, get support, seek advice and help each other. Since July 2020, almost 3,000 people have registered for these virtual peer support sessions.
- The Wellness Support Line14 providing confidential, 24/7 access to counselling and psychological services to provinces that did not already have a similar service. In its first year in operation during the pandemic, almost 500 physicians, medical learners, and their families accessed this service.
- The Pandemic Wellness Toolkit15 which includes a self-assessment tool and evidence-based wellness supports to encourage physicians to check their emotional and physical health and access the appropriate resources.
- The Sound Mind Podcast series offers conversations about physician wellness and medical culture.16 In 2021, these podcasts were downloaded more than 5,000 times.
But singular tactics to support physician wellness will not be enough to make a difference to the system structures and culture that drive stress and burnout in healthcare workers. In May 2021, the CMA launched Impact 2040,17 an ambitious 20-year plan that calls on physicians, medical learners, other health providers, patients, and policymakers to co-create a better future of health. A key pillar of this strategy is supporting the healthcare workforce, through which the CMA aims to build a new medical culture focused on physical and mental wellness and embracing equity and diversity.18 “A key strength of Impact 2040 is that it sees physical, psychological and cultural safety as equal dimensions of overall health. Each dimension requires clear language and criteria, standards, accountability, and research at the national level,” says Dr. Gérin-Lajoie.
With regard to the equity and diversity aspect of Impact 2040, the organization recognizes that creating a more inclusive culture contributes to fostering improved wellness. “We need to acknowledge the unique dynamics of learners and physicians from diverse cultural backgrounds who suffer from harassment. This takes extra cognitive effort to scan their environments for “safety”. They also feel they have to perform at an even higher level to prove themselves,” says Dr. Gérin-Lajoie.
The CMA wants physicians and those in training to thrive in learning and practice environments that are physically, psychologically and culturally safe, ensuring they have access to resources and supports to promote and maintain their health and wellness. A critical part of this ambition, the CMA realizes, is that physicians must be able to seek help without fear of reprisal. With this strategy in place, the CMA is now acting on it to drive change.
Armed with evidence on the impact of healthcare worker wellness upon patient outcomes, and in the face of workforce shortages, and attempting to keep up with increased demand, the time is now for healthcare systems and organizations around the world to act on this issue and put concrete plans in place to care for healthcare workers.
Practical advice in taking action to support workforce wellness
While the approach is Canadian-inspired, I think these lessons are universal – so here I offer some practical advice based on my observations and learning:
Find your starting point: The first step towards supporting workforce health and wellness is to have the courage to know your starting point. Listen to the experiences of healthcare workers and care teams. Create the space for conversations about the current state of workers’ wellness — seek to understand the challenges and appreciate their strengths. Undertake a workforce wellness survey to collect baseline data and commit to a measurement plan that focuses on moving the dial on a few key metrics that matter.
Build your wellness vision in reality: How can you think differently about your workforce wellness journey? Make the connection to the realities of the workplace environment, its systems and culture. Take a holistic view that considers many different factors: from workload, supports and flexibility to a sense of belonging, empowerment, and trust. Build a vision for wellness that acknowledges that levers of change exist at many levels, including the organization, leadership, team and individual.
Co-design a plan and prioritize action: Meaningful change can be achieved through collaborative design. Let the ideas and solutions of healthcare workers guide and power their wellness action plan and help shape a workplace environment that is safe, inclusive and health-promoting. Co-design efforts can also involve patients, who can be very powerful allies themselves in its design and prioritization.
Lead by example: In every institution, improving workforce health and wellness requires determined, visible leadership. The pandemic has driven home the message that every board and leadership team should have its people as its highest priority. Boards need to continuously monitor outcomes of workforce wellness plans and leaders need to be accountable for a culture of caring. As health providers surface their plans and priorities, encourage new, innovative thinking and be ready to invest and implement the priorities. The time is now for action.
Alongside institutional action, teams and staff need to think about their own behavior and values. The attitudes and behaviors that new healthcare workers see from more seasoned professionals will not only play a substantial part in determining their personal health and wellness decisions, but also influence their attitudes and behaviors for the rest of their careers.
Put simply: start somewhere, demonstrate leadership, think differently, execute well and measure clearly.
The wellness competitive advantage
Beyond prioritizing workforce health and wellness because it is the right thing to do, it also makes business sense. Given the global shortage of healthcare workers19, the toll of the pandemic, and the expected support of workforce health and wellbeing, it will be the institutions that can deliver on this that will likely win in the war for talent by improving their recruitment and retention20, elevating staff pride, and ultimately delivering better outcomes for patients.
- There is a direct correlation between healthcare worker wellness and clinical quality and safety; investments in staff result in better patient outcomes and experience.
- To take the first steps in the area of workforce wellness, healthcare organizations should consider undertaking a workforce survey to get a starting point, to identify and prioritize a few areas of focus — this should guide where leadership provides their support.
- Employers that are seen to support staff health and wellness will likely attract and retain talent and become a provider of choice to patients.
Throughout this website, “we”, “KPMG”, “us” and “our” refers to the global organization or to one or more of the member firms of KPMG International Limited (“KPMG International”), each of which is a separate legal entity.
1 Firth-Couzens, J. (2001). Interventions to improve physicians’ well-being and patient care. Social Science and Medicine, Volume 52, Issue 2, Pages 215-222, https://doi.org/10.1016/S0277-9536(00)00221-5
2 Wallace et al. (2009). Physician wellness: a missing quality indicator. Lancet. 374: 1714–21. https://www.academia.edu/18831138/Physician_wellness_a_missing_quality_indicator?from=cover_page
3 Harris et a. (2016 July 8). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One. 11(7). https://doi.org/10.1371/journal.pone.0159015
4 Yong, E. (2021 November 16, 2021). Why health-care workers are quitting in droves. The Atlantic. https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/
5 Favaro, A. (2021 September 12). Stress, staffing shortages brought on by COVID-19 causing nurses to leave the front lines. CTV News. https://www.ctvnews.ca/health/coronavirus/stress-staffing-shortages-brought-on-by-covid-19-causing-nurses-to-leave-the-front-lines-1.5582781
6 Campbell, D (2021 May 3). NHS faces exodus of doctors after Covid pandemic, survey finds. The Guardian. https://www.theguardian.com/society/2021/may/03/nhs-faces-exodus-doctors-covid-pandemic-survey
7 Cunningham, M. (2021 November 17). Pandemic triggers ‘mass exodus’ of critical care nurses. Sydney Morning Herald. https://www.smh.com.au/national/pandemic-triggers-mass-exodus-of-critical-care-nurses-20211116-p5998i.html
8 World Health Organization. (2020 September 17). Keep health workers safe to keep patients safe. News release. https://www.who.int/news/item/17-09-2020-keep-health-workers-safe-to-keep-patients-safe-who
9 Canadian Medical Association. (2018 October) CMA National Physician Health Survey: A National Snapshot. https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf
10 Canadian Medical Association. (October 2019). Physician health and wellness in Canada: Connecting behaviours and occupational stressors to psychological outcomes. https://www.cma.ca/sites/default/files/pdf/Media-Releases/NPHS_Report_ENG_Final.pdf
11 Skjerven, K, and Dove, N. (2021 November 4). COVID-19 briefing provides more details on resumed services, staff redeployment. Global News. globalnews.ca/news/8350602/saskatchewan-health-authority-resumed-services-covid-19/
12 Canadian Medical Association. (2022). Physician Wellness Huh: A new era in physician health and wellness. www.cma.ca/physician-wellness-hub
13 Canadian Medical Association. (2022). Welcome to the Wellness Connection. https://www.cma.ca/physician-health-and-wellness/wellness-connection
14 Canadian Medical Association. (2020 June 15). New Wellness Support Line launches to help Canadian physicians and medical learners. www.cma.ca/news/new-wellness-support-line-launches-help-canadian-physicians-and-medical-learners
15 Canadian Medical Association. (2022). Pandemic Wellness Toolkit. https://www.cma.ca/physician-wellness-hub/pandemic-wellness-toolkit
16 Canadian Medical Association. (2022). Podcast: Sound Mind. https://www.cma.ca/physician-wellness-hub/sound-mind-podcast
17 Canadian Medical Association. (2021 May 5). Impact 2040: CMA developing new strategy to build better health, post-pandemic. https://www.cma.ca/news/impact-2040-cma-developing-new-strategy-build-better-health-post-pandemic
19 World Health Organization. (2022). Healthcare workforce. www.who.int/health-topics/health-workforce
20 Wein, D. (2018 August 27). Win with wellness -- Attract and retain talent. Forbes. https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2018/08/27/win-with-wellness-attract-and-retain-talent/?sh=567b7d681648