As the former director of Physician Wellness for the department of Anesthesiology and Pain Medicine at the University of Alberta and a pediatric anesthesiologist at the Stollery Hospital, I was asked to write an article on physician wellness. A decade ago, I would have jumped at the opportunity to express my personal point of view on the topic. Yet now, I hesitate. It is difficult to simplify the topic of physician wellness, since it is as diverse and unique as each one of us. Of course, there are various resource lists, which include topics such as men’s mental health, mindfulness, cognitive behavior therapy for insomnia, and grief management¹ just to name a few. There is also professional help when needed, such as a program we offer in Alberta, Canada.² This program offers a variety of services including individual therapy, couples therapy, and treatment of substance use disorder.

Each one of us can contribute to psychological health and safety in the workplace.

However, social determinants of health have a profound influence on individuals.³ There are several social determinants of health such as gender, race, sexual orientation, and early life experiences. The workplace and working conditions are another social determinant of health. Psychological health and safety (PH&S) in the workplace is a domain to assess and quantify working conditions. The concept of psychological health and safety in the workplace is shown in a short video from the Mental Health Commission of Canada (MHCC).⁴ This video describes the importance of PH&S to the healthcare workplace. It emphasizes that it is not only an individual responsibility to care for their own mental health, but also an organizational responsibility to minimize burnout, compassion fatigue, and sleep deprivation. The MHCC stresses that attention to PH&S in the workplace will decrease organizational costs and mental health stigma, reduce burnout, increase productivity, and improve staff morale.

“Caring for Healthcare Workers” is a Canadian tool used to assess the level of psychological health and safety in the healthcare workplace, such as operating rooms.⁵ This tool measures the 15 psychological factors (PF) that comprise a psychologically healthy and safe workplace. It compares the organizational results (need 10 responses to get an anonymous report) to that of more than 5,000 working Canadians. The factors measured are:

PF1 - psychological support

PF2 - organizational culture

PF3 - clear leadership and expectation

PF4 - civility and respect

PF5 - psychological job fit

PF6 - growth and development

PF7 - recognition and reward

PF8 - involvement and influence

PF9 - workload management

PF10 – engagement

PF11- balance

PF12 - psychological protection

PF13 - protection of physical safety

PF14 - protection from moral distress

PF15 - support for psychological self care.

This tool also measures the level of discrimination, harassment, and mental health stigma participants experience in their workplace and compares this to IPSOS reference sample. In addition, “Caring for Health Care Workers” gives a toolkit to help an organization improve its level of PH&S in the workplace.

Psychological health and safety in the workplace is not only important for staff health but can further impact patient safety and innovation.⁶ Dr. Amy Edmondson describes four key areas that are improved in psychologically safe work environments – learning, risk management, innovation, and job satisfaction/meaning.⁶

Each one of us can contribute to psychological health and safety in the workplace. We can be mindful employees by, for example, actively engaging in open and honest communication, showing esteem and consideration for others’ opinions and culture, and seeking out opportunities to improve skills and competencies.⁷ It is important to recognize the behavior continuum.⁸ We need to understand which behaviors are considered respectful, disrespectful, harassment, or violence. We can strive to keep our own behaviors to others respectful. This is more essential than ever to build a supportive system in the workplace amid the COVID-19 pandemic. An increasing workload is expected from anesthesiologists performing daily aerosol-generating procedures, participating in COVID-19 airway teams, redeployed to intensive care units, covering for colleagues who are self-isolating, encountering information overload, and dealing with a backlog of surgical cases resulting from an operating room slow down. It has been shown that burnout and distress negatively impact physicians and the treatment they provide; a recent survey in a cardiovascular center of a quaternary hospital network in Canada showed a high well-being index indicating high distress amongst anesthesiologists, perceived inadequate staffing levels, or unfair treatment.⁹

To really improve psychological health and safety in operating rooms, or any workplace, we should use models of improvements.¹⁰ Models of improvement use data collection, plan-do-study-act cycles, and strong senior leadership support for the quality improvement activities. This work should involve front-line anesthesiologists as well as concrete system support from organizational, department, and team leaders. Ongoing quality improvement work is needed to improve and maintain PH&S in operating rooms. This work is never done.

Teresa Eliasson, MD, FRCPC, is a staff pediatric anesthesiologist at Stollery and former director of Physician Wellness at the Edmonton Anesthesia Zone and department of Anesthesiology and Pain Medicine at the University of Alberta in Edmonton, Canada.

References

1. Resources. Edmonton, Canada: University of Alberta. Available at: https://www.ualberta.ca/anesthesiology-pain-medicine/for-faculty-staff/staff-wellness/resources.html. Accessed March 26, 2021.
2. I need help now. Edmonton, Canada: Alberta Medical Association. Available at: https://www.albertadoctors.org/services/pfsp/i-need-help-now. Accessed March 26, 2021.
3. Social determinants of health. Toronto, Canada: Canadian Mental Health Association. Available at: https://ontario.cmha.ca/provincial-policy/social-determinants/. Accessed March 26, 2021.
4. Join the movement – Advancing psychological health and safety in healthcare settings. Ottawa, Canada: Mental Health Commission of Canada. Available at: https://www.mentalhealthcommission.ca/English/media/4098. Accessed March 26, 2021.
5. Caring for Healthcare Workers. Hamilton, Canada: Canadian Centre for Occupational Health and Safety. Available at: https://www.caringforhealthcareworkers.com. Accessed March 26, 2021.
6. Why is Psychological Safety so Important in Health Care? Boston, MA: Institute for Healthcare Improvement. Available at: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Amy-Edmondson-Why-Is-Psychological-Safety-So-Important-in-Health-Care.aspx. Accessed March 26, 2021.
7. Being a Mindful Employee: Balance. Ottawa, Canada: Mental Health Commission of Canada. Available at: https://www.mentalhealthcommission.ca/sites/default/files/2019-02/13_factors_posters_eng.pdf. Accessed March 26, 2021.
8. Behaviour Continuum: Worker-to-Worker. Alberta Health Services. Available at: https://www.ualberta.ca/anesthesiology-pain-medicine/media-library/eliassons-wellness-docs/healthy-enviro/dealing-with-conflict/worker-behaviour-continuum-poster-ahs.pdf. Accessed March 26, 2021.
9. Rubin B, Goldfarb R, Satele D et al. Burnout and distress among physicians in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey. CMAJ. 2021;9(1):E10-E18. https://doi.org/10.9778/cmajo.20200057.
10. Science of Improvement: How to Improve. Boston, MA: Institute for Healthcare Improvement. Available at: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx. Accessed March 26, 2021.