How mindfulness can help tackle healthcare’s burnout crisis
One effective way employers can combat burnout among in the healthcare sector is by implementing mindfulness-based interventions for staff
Healthcare workers globally are reporting high levels of burnout, a chronic stress reaction caused by an imbalance in work demands and support. The issue of burnout was further exposed and exacerbated by the COVID-19 pandemic, which put additional pressure on vulnerabilities in healthcare systems.
In Australia, healthcare workers have reported reduced emotional wellbeing and increased anxiety, depression and burnout following the onset of the pandemic. “In healthcare, burnout is allied with detrimental wellbeing and human functioning, resulting in higher staff turnover, team stresses and workforce shortages, as well as increased risk of patient harm and poor-quality care,” according to Dr Bradley Hastings, Insights Associate at the UNSW Business Insights Institute.
Addressing the burnout crisis first requires understanding the factors that lead to this phenomenon, said Dr Hastings, who spoke recently with BusinessThink about an industry engagement partnership between the UNSW Business Insights Institute and a local health district to reduce staff burnout.
A growing crisis in healthcare
Burnout is an occupational phenomenon caused by a chronic imbalance between work resources and demands. According to the World Health Organisation, employees experiencing burnout feel exhausted, have increased negativity toward their jobs, and have reduced professional efficacy.
Burnout also has impacts at the organisational level, leading to decreased productivity, increased absenteeism, higher turnover rates and reduced employee engagement, according to NSW Health. A related concern in healthcare is compassion fatigue, which limits one’s sensitivity to suffering or distress.
Moreover, research shows employees experiencing burnout are 63% more likely to take sick days, 2.6 times as likely to be actively job searching, half as likely to discuss performance goals with their manager, 23% more likely to visit a hospital’s emergency department and 13% less confident about their performance, according to a 2020 Gallup report.
Dr Hastings said the problem is particularly acute in healthcare, pointing to recent surveys showing 87% of physicians, 79% of nurses and 28% of psychologists in Australia reported concerns about burnout.
According to Dr Rosalind Foster, Sexual Health Staff Specialist at the South Eastern Sydney Local Health District (SESLHD)’s Sydney Sexual Health Centre, burnout occurs when there is an imbalance between the demands of a job and the resourcing available to do that job. People experiencing burnout report feeling energy depletion or exhaustion, increased mental distance from or feelings of negativity towards their job, and reduced professional efficacy.
“Burnout leads to a decline in an individual’s overall wellbeing and significantly impacts their performance, job satisfaction and overall quality of life,” Dr Foster said.
A closer look at burnout
In 2022, the NSW Public Service Commission measured burnout across the public sector for the first time as part of its People Matter Employee Survey. The results, which covered the SESLHD, showed that only 30% of respondents did not feel burned out by work, while just 58% reported that their wellbeing was favourable.
As part of an industry engagement partnership, in 2022, the UNSW Business Insights Institute and SESLHD undertook a project to improve reported wellbeing among the 230 staff of SESLHD’s Sexual Health and Blood Borne Viruses (SHBBV) services. “We did not have specific data on wellbeing for SHBBV at this stage, but anecdotally, managers were reporting features of burnout in their staff, particularly post-COVID where people had been redeployed or had been working with reduced staffing numbers,” explained Dr Foster, who led the project.
According to Dr Hastings, the project studied the effect of mindfulness-based interventions on indicators of burnout among the staff of the SHBBV sexual health clinic in Sydney. The goal was to generate insights that would inform health policy and practice on the effectiveness of such interventions.
The key drivers of burnout for public sector workers are a lack of time and support to do one’s job well and a lack of access to adequate organisational resources to support wellbeing, Dr Hastings explained. “The Business Insights Institute looked at decades of organisational research on these themes. Time is out of our control, but what is in the control of health workers is their perception of time, the support they can provide each other and the resources they can provide,” he said.
Mindfulness-based education, positive mindsets
There is no single indicator of burnout, but commonly used measures include reduced team effectiveness, individual wellbeing and resilience.
A review of workplace interventions for burnout in healthcare professionals showed that these interventions generally occupy two levels, Dr Hastings explained. First-order interventions aim to eliminate causes of stress (such as redesigning work processes), while secondary interventions target behavioural responses to workplace stress (such as positive mindset training).
“Given that the workplace itself and associated systems had not changed pre- and post-COVID, it was decided to focus on secondary interventions (i.e., better prepare workers to cope with the workplace environment,” he said of the design of the SHBBV study.
Secondary interventions are generally individual-centred, aiming to minimise the effects of stress on participants through relaxation training and positive-mindset interventions, often applied as group activities that aim to change individual responses.
The researchers focused on mindfulness-based education and positive-mindset interventions, the most common intervention strategies. Mindfulness-based education interventions focus on stress management, emotional intelligence and resilience; positive-mindset interventions shift thoughts away from negativity and stress toward more positive assessments.
Both these intervention strategies have improved wellbeing and reduced burnout, but previous studies on the issue have taken a one-dimensional approach, with a focus on a single intervention and dependent outcome variable, and a lack of control group, said Prof. Hastings, who noted that this can make it difficult to replicate research-based findings in practice.
The study, therefore, featured both mindfulness-based education interventions (such as box breathing) and positive-mindset interventions (such as group positive-experience sharing). It also implemented a control group.
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‘Upward spiral’ of positivity
The SHBBV clinic’s 84-person staff undertook the intervention, which took place over eight weeks, with 47 staff members then volunteering to complete a survey about their experience. The interventions comprised three 60-minute face-to-face training sessions by an experienced facilitator from School of Management & Governance within UNSW Business School. This facilitator was assisted at clinic sites by a number of SESLHD staff, including Ruth Hennessy, Dee Holland, Wendy Machin, Isabel Fabian and Katherine Coote. In addition, participants engaged in daily positivity activities between training sessions.
The first session aimed to build “awareness of how our actions influence each other”, Dr Hastings explained. After completing a survey to gauge positivity levels, the intervention groups engaged in practical activities like dancing, listening and responding positively to others. “Then the survey was retaken, showing that these activities made a positive difference – helping everyone understand that how they interact with others matters,” he said.
The second session examined the actions people can take to improve their own mindsets and, thus, how they project onto others. “It explored the mind tricks that our minds play on ourselves – i.e., the stories that we make up of others – and some strategies to create space for ourselves to gain perspective, e.g. box breathing, positive thinking, growth mindset and remaining present,” he added.
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The third session focused on practical, everyday activities for participants to incorporate into their own lives, and teams devised lists of activities to help each other. “We tracked measures of stress, mindfulness and wellbeing before and after the intervention took place,” explained Dr Christian Criado-Perez, Insights Associate at the UNSW Business Insights Institute.
The scores showed that the centres allocated to the intervention groups improved, while the control groups got worse, he said. For the groups that underwent the intervention, mindfulness scores increased from 3.83 to 3.9 out of 5, while wellbeing increased from 3.75 to 3.78 out of 5.
The result illustrates the potential benefits of the intervention in mitigating the decline in mindfulness and wellbeing as indicators of burnout, Dr Hastings said. It showed teams with a positive mindset to be “more engaged, forward-thinking and cohesive,” with enhanced client outcomes.
“With the development of personal wellbeing resources, teams can be taught evidence-based interventions to increase their positivity, which in turn improves their team effectiveness. This tends to occur as part of an upward spiral of increasing positivity, resulting in benefits that last for months or years beyond the initial intervention,” he concluded.
The UNSW Business Insights Institute delivers economic and business insights, research, and methods to business and government. Using a program-based approach consisting of Knowledge Hubs and Research Labs, the Institute helps industry partners solve complex challenges by linking them to academics and providing them with access to novel research insights. For more information, please contact Dr Bradley Hastings or Dr Christian Criado-Perez, Insights Associates at the UNSW Business Insights Institute.