Making an impact

LONG hours and heavy workloads seem to have become a fact of life for trainee doctors, with many suffering from low morale and burnout.

Results from the General Medical Council’s (GMC) latest annual national training survey found that three-quarters of trainees were working beyond their rostered hours each week to fit in additional duties, while 40 per cent rated the intensity of their work by day as “heavy” or “very heavy”. More than a fifth (22 per cent) of trainee doctors said they felt short of sleep while at work.

For the first time, the regulator asked specific questions about the impact of burnout and exhaustion in its 2018 survey in a bid to identify areas for improvement.

Sleep deprivation is a key problem that has not been far from the headlines. An inquest into the 2015 death of Suffolk doctor Ronak Patel found he had crashed his car after falling asleep at the wheel while driving home from a third consecutive nightshift. Despite this and other similar high-profile cases, a 2016 survey for HSJ magazine found many doctors were actively discouraged from taking naps.

But one new initiative from the Faculty of Medical Leadership and Management (FMLM) hopes to tackle low morale, high attrition and burnout with its report Eight high impact actions to improve the working environment for junior doctors. While the actions are designed to be implemented quickly, FMLM says: “Meaningful improvements will require engagement locally between trusts and doctors in training, along with support from senior clinicians and, in some instances, investment of resources.”

But it adds that “the benefits to staff engagement, performance, cost savings and most importantly patient care and reduction of harm will provide a worthwhile return.” The initiative, run in conjunction with NHS Improvement and NHS Providers, has received the backing of national medical bodies including the British Medical Association, the General Medical Council and the Royal College of Physicians (RCP).

RCP president Professor Jane Dacre says the actions are “incredibly useful for trainees and senior colleagues alike.” The action points are:

1. Tackling work pressure – the report encourages hospitals to reduce the burden on juniors of administrative and basic clinical tasks such as filling in request forms, blood taking and data entry. This would free up time for tasks that specifically require a doctor’s input.
2. Promoting rest breaks and safe travel home – sleep deprivation leads to increased clinical error and poor psychomotor abilities, the report says. It calls for moves to “foster a culture that supports staff in taking rest breaks to ensure they can provide safe, effective patient care” such as the HALT (Hungry, Angry, Late Tired) campaign at Guy’s and St Thomas’ NHS Foundation Trust which encourages staff to take frequent breaks.
3. Improved access to food and drink 24/7 – almost two-thirds of doctors (65 per cent) told the Royal College of Physicians they had worked at least one shift in the past month without eating a meal while 74 per cent had not drunk enough water. Water should be made easily accessible in clinical areas and 24-hour access provided to healthy, hot food or facilities to heat up food, ideally in staff-only areas.
4. Engagement between board and trainees – improving engagement between trainees and the board/ executive committees could lead to better staff recruitment, retention and productivity as well as improved safety outcomes. Solutions include board members shadowing juniors or attending junior doctor forums.
5. Clearer communication between trainees and managers – closer working between these two groups can help discover new perspectives and improve services, the report says. It suggests senior trainees and divisional managers use instant messaging apps to handle service pressures and raise issues (for non-patient information).
6. Work-life balance – rotas that force staff to choose between work and their personal responsibilities can negatively affect job satisfaction and retention. The report suggests involving juniors in designing and managing rotas and introducing flexible rostering practices such as those used in nursing.
7. Rewarding excellence – introducing formal structures to celebrate good practice should leave fewer juniors feeling undervalued.
8. Wellbeing, support and mentoring – a massive 80 per cent of doctors say their job causes them excessive stress which can lead to lower productivity and poorer patient outcomes. The report suggests appointing a dedicated pastoral lead to support doctors, peer-led coaching and mentoring schemes, tailored resilience and stress management training, and critical incident debriefs.

Link: Read the full report on the FMLM website

Joanne Curran is managing editor of FYi