Beating burnout in the NHS

• Employee wellbeing - Burnout can negatively impact mental and physical health and often results in presenteeism and absenteeism.
• Financial cost and waiting lists- absenteeism and presenteeism can have detrimental financial implications and can make it challenging to meet patient waiting-list targets.
• Patient care - How staff are feeling can impact on the quality of care provided to patients, and constant exposure to traumatic events associated with caring responsibilities can result in compassion fatigue, which can lead to staff becoming wary of giving and caring.
• Retention - Burnout can contribute to poor retention and make it harder to maintain safe staffing. 

Rising sickness absence levels, poor retention, and unsuccessful recruitment campaigns have contributed to staff shortages. Whilst there are often financial and practical barriers to achieving optimum staffing levels, employers can work to boost retention, strengthen recruitment efforts, and support staff off work to return to the workplace. See resources to help you improve staffing levels below:

• Our improving staff retention guide for line managers and employers in the NHS.
• Our sickness absence toolkit for NHS managers.
• The NHS Staff Council’s guidance on managing long COVID sickness absences.
• The NHS Staff Council's musculoskeletal guidance.
• Our inspire, recruit and attract toolkit, including resources and guidance to improve your workforce supply.
• Our case study showcasing how Wye Valley NHS Trust filled some of its hard to fill vacancies by upscaling and improving its international recruitment campaign.

Creating a supportive working environment where health and wellbeing is spoken about openly, staff feel able to seek support without fear of repercussion, and leaders role-model positive behaviours, is crucial to preventing burnout. 

Read how you can improve your organisational culture.

• Follow our guidance on embedding regular and effective health and wellbeing conversations.
• Ensure staff wellbeing is a priority across all aspects of your organisational strategy - health and wellbeing guardians can help influence leaders at board level to implement a culture of wellbeing.
• Regularly promote your health and wellbeing offers and celebrate national health and wellbeing campaigns.
• Challenge perceptions of ‘wellbeing hubs’ so staff know they are not only places they can go only when struggling but also spaces to help them to maintain good mental health and wellbeing.
• Create safe, open spaces where staff feel empowered to talk about their health and wellbeing needs, and use this information to shape your initiatives.
• Encourage senior leaders and managers to share their personal experiences and maintain an ongoing dialogue with staff on the importance of health and wellbeing, including stressing that staff should not feel pressured to constantly maintain a ‘hero identity’.
• Make sure your initiatives are as inclusive as possible, and put in place alternative support pathways for staff who are not comfortable with open discussion.
• Build psychological safety by identifying and resolving barriers to effective communication and collaboration, and use teambuilding exercises to harmonise and strengthen relationships.

It benefits both staff and service provision to put in place interventions to prevent burnout before it occurs. In addition, members of staff with mental health needs may benefit from regular support to prevent burnout. Below is a list of interventions we recommend you consider.

• Embed preventative wellbeing initiatives into all aspects of the employee lifecycle. You could start as early as your induction programme and continue to hold regular mandatory mental health maintenance sessions.
• Raise awareness of mental ill health using the information on our mental health in the workplace webpage.
• Ensure staff have access to the right equipment, training and development to do their jobs to the best of their abilities, and prioritise meeting their basic needs. This includes ensuring they can get adequate rest and good quality food when on shift. Read how Sherwood Forest Hospital Foundation Trust effectively implemented the Royal College of Nursing's rest, rehydrate and refuel initiative.
• Download our NHS staff wellbeing needs poster and read our supporting the wellbeing needs of NHS staff article to learn how you can make great health and wellbeing a lived reality.
• Make your health and wellbeing offer and resources relevant and accessible, and ensure they are regularly promoted through various channels. Read how introducing health and wellbeing champions into your organisation can support you with this.

Well_Lab shared research and evidence-based recommendations at one of our staff experience conferences on how trusts can address workplace burnout in the NHS. Read the session slides to learn more.

Recognising burnout symptoms and providing the right support early on can help to prevent problems from escalating and reduce the chances of staff absences. Research by Maslach & Leiter identified energy depletion, reduced efficiency and depersonalisation or cynicism as key symptoms. To combat this, organisations should consider the following interventions.

• Train managers and staff to spot burnout symptoms and signpost to appropriate interventions. Embed burnout into wellbeing conversations, encouraging a compassionate and personalised approach as there is no one-size-fits-all solution.
• Consider a rapid access service for staff to access therapies and counselling and address symptoms of burnout early.
• Ensure your interventions target a range of symptoms, as staff may be affected from burnout in different ways. For example, initiatives that moderate workload demands can help to address energy depletion, while interventions that target workplace civility though ensuring staff are treated with dignity and respect are more effective in decreasing cynicism. 

Research from NHS Employers and AgiLab has drawn attention to work indifference , a flat, emotionally detached feeling some people experience toward their jobs. It’s being recognised as a possible late-stage sign of burnout, especially in agile working environments. People who strongly identify with their roles might be more at risk. This is why it’s so important for managers to spot signs of disengagement early and respond with empathy. 

Workplace and external pressures both contribute to burnout. Upskill your managers to have effective wellbeing conversations with teams and provide the right support for any pressures staff may be experiencing. These can include:

• the rise in of cost of living – read how you can support the financial health of your staff on our cost of living hub
• caring responsibilities outside the workplace, including caring for disabled and/or elderly relatives and children – learn how you can implement agile and flexible working opportunities to allow staff the time to care for loved ones, increase productivity and reduce the chances of compassion fatigue
• physical or mental ill health – signpost staff to support in a timely fashion to prevent these issues from getting worse or hindering recovery.

• Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis
• Burnout in healthcare: risk factors and solutions
• Burnout in healthcare: the case for organisational change (requires log-in)
• Work indifference: a sign of burnout for agile workers