‘To be honest, I felt that I had established a good balance in my life prior to this,’ says Louise*. She had always managed to set aside quality time to spend with her family and was also able find time for herself and to explore her other professional interests.
But last year, Louise says, she began to feel unrelenting pressure from high clinical acuity and extremely high access block. She felt there was uncontrolled clinical risk in her department and started to contemplate the viability of emergency medicine as a career.
‘I wasn’t sure I would be able to keep working in an environment that was so stressful for reasons that felt outside of my control,’ Louise says.
‘After many years working with a group of colleagues I respected and liked, I was wondering if I should look to move to another department, or if I could remain as an Emergency Physician in the longer term.’
Her turning point was a presentation at the 2018 ASM in Perth, where she saw Canadian-based EP Dr Ken Milne (known as ‘BatDoc’) talk about burnout.
‘He delivered a very thought-provoking session on his personal experience of burnout, and it reinforced to me that this was the path on which I was headed if something didn’t change.’
From that session, Louise headed to one on wellbeing conducted by Associate Professor Andrew Dean and members of the Wellness, Resilience and Performance in Emergency Medicine (WRaP EM) group, which had been nominated for the inaugural ACEM Wellbeing Award and which outlined to her ‘some fantastic strategies’ being used in emergency departments to manage and improve wellbeing in emergency department staff.
‘I realised I needed to take action rather than just hope things would get better.’
Her first step was to quantify her problem using a burnout self-test. The test comprises a series of statements for users to respond to about particular situations and feelings and asks how often those situations or feelings occur.
‘Some of the questions focused on my personal behaviours and experiences, but it was also validating to see the questions that asked about workload and organisational issues.’
Those statements reinforced to Louise that her work environment was a significant contributor to how she was feeling and led her to wonder what effect the environment might be having on others in her department.
‘I was concerned enough about my own results to share both my results and the link to the tool with my colleagues.’
The discussion and activity that followed found that Louise was not alone. She compiled the responses from her colleagues and presented them as a graphic to the leaders of her organisation.
‘This gave me a powerful and objective measure that enabled frank and informed discussion’.
She was able to frame the discussion as being about ‘personal KPIs’, and the risks the current work environment posed to the clinicians in her department. She says it was not a difficult conversation to have.
‘I felt as though I was advocating for a group of colleagues who I valued highly which made it very important to me.’
‘I think the conversation personalised for management the human impact of the KPI numbers they were seeing in a way that has catalysed change.’
‘It meant I could discuss it as an occupational health and safety issue, while still being able to talk about my own personal experience.’
An important step, she says, was to be prepared. When she was asked about practical solutions to improve wellbeing within the department, she pointed to resources by WRaP EM, which offer steps for individuals, teams and organisations.
‘There was a real shift in the way my hospital focuses its attention. Multiple strategies were quickly introduced to address our access issues. There was a noticeable increase in senior management presence on the floor, and they were really proactive trying to improve patient flow.’
‘I felt clearly heard when I raised these issues,’ she says. ‘There was no animosity or resistance to the information I was sharing.’
Although she thinks it is too soon to objectively judge the longer-term impact of these conversations within her department and organisation, Louise says that personally she is focused on ensuring that these matters are an ongoing priority for her department.
Her advice for others is that the stress points in each department will be different. ‘It is useful to understand your own. When you start the conversation, be able to suggest solutions for the issues you identify within your department.’
Loiuse recommends WRaP EM and the episode ‘How to say no’ on podcast The Tim Ferris Show as resources to manage and strategise wellbeing. Other wellbeing resources are available via the ACEM Wellbeing Network.
*Name has been changed at request of the FACEM