Molyn Leszcz, Julie Maggi, Heather Flett and Robert Maunder are psychiatrists and professors at the University of Toronto’s Temerty Faculty of Medicine.
Every day, Canadians are confronted by a health care system experiencing enormous strains. Millions of Canadians have no family doctor and emergency rooms are shutting down with regularity due to lack of staff. Last year, Ontario ERs shut their doors nearly 1,000 times.
Valourized as heroes in the initial stages of the COVID crisis, health care workers are now leaving their honourable professions in droves, feeling profoundly abandoned, invalidated and diminished by their work. Their departure creates a vicious cycle, worsening a dire situation by increasing the demands on those who remain.
Driven by an ethos of personal self-sacrifice, amplified by an all-too-common organizational attitude of “pedal to the metal,” the culture of health care has exploited its workers’ dedication and acutely neglected their well-being. This has long been a problem, but COVID has blown this up in ways that are now impossible to deny. Protecting health care workers’ well-being is a reliable, proven and accessible way to maintain the standard of care Canadians expect. It is also what health care workers deserve. Guided by research, evidence and our experiences as physicians and psychiatrists, we argue that our health system urgently requires a culture change.
Consider the alarming evidence. Rates of health care worker burnout are skyrocketing. Burnout severely compromises these workers’ ability to provide meaningful, responsive and empathic care. The moral distress created by the agonizing gap between personal ethics and the actual ability to provide patients with proper care continues to mount, fuelling the exodus. Many feel betrayed by, and mistrustful of, their leaders, and psychologically unsafe in their workplaces. Some are deeply wounded with feelings of grief, loss and helplessness due to the enduring consequences of the pandemic. Four years later, that impact persists, and for too many, continues to grow.
If the suffering of health care workers is insufficient to warrant action, consider the economic impacts. Ontario and Quebec spent more than $1.5-billion last year on agency nurses to fill vacant roles left by experienced and talented, but undervalued, nurses who have either moved to the private sector or left health care entirely. The continued practice of paying private agencies for access to nurses is scandalous.
Health care workers deserve a system that invests in their well-being. We need to engage health care leaders in understanding strategies and interventions that promote the well-being of their colleagues and trainees. Providing support and coping strategies, mental health care, expressing appreciation and mindfulness training have brought value no doubt, but are woefully insufficient by themselves. Recent research demonstrates that interventions at the structural level itself are what’s needed – not efforts to help people cope with fractured systems. Worse yet, some interventions inadvertently fault individuals for not being hardier, while ignoring organizational practices that are hostile to health care workers’ well-being. We need leadership that invests in organizational well-being rather than shaming those who seek the basics of self-care.
At the Temerty Faculty of Medicine, we are creating Leading for Wellness Communities of Practice (COPs) that train and support leaders to prioritize health care workers’ wellness. To date, more than 75 interprofessional faculty leaders have participated in a year-long course of facilitated group support, with a curriculum of scholarly articles and meaningful discussion. The COPs’ main objective is to change health care culture by promoting leadership that bolsters and protects a key resource: the human capital of our colleagues.
COP participants report that they feel better supported, better connected and more impactful as leaders. They are better able to advance beyond nice ideas about health care workers’ well-being, and move on to evidence-based and implementable practices that reduce burnout, manage moral distress and improve psychological safety in the workplace, which is ever more important in addressing workers’ concerns about identity, diversity, equity and inclusion.
Health care providers need three things to flourish: strong connections to their patients, colleagues, and professional communities; greater control in their work life; and a stable sense of clinical competence. The most effective leaders embed these elements in their policies and behaviours throughout the organization.
Health care leaders require training to support wellness. Support, coaching, professional development, timely feedback and accountability are essential for leaders to promote the well-being of their colleagues and trainees. Culture in health care changes slowly, but it does so with proper attention, advocacy and investment. Forty years ago, it was common to see physicians smoking in their hospital offices, a once acceptable practice that is now unfathomable.
Fostering the well-being of health care providers protects their capacity to deliver the outstanding care we all seek and deserve. In the wake of the pandemic’s terrible destruction, let us seize this enormous opportunity to create a better health system in Canada.