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A strategic focus on doctors’ health

The Workplace Health and Wellbeing Unit (WHWU) within the HSE was established last year and is currently finalising its new Healthy Doctors Strategy document.  The strategy is part of the wider Healthy Ireland (HI) push within the HSE, according to WHWU Clinical Lead Dr Lynda Sisson.

 “We are hoping to have a launch date in the summer, probably July,” Dr Sisson, a specialist in occupational medicine, told the Medical Independent (MI).

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Dr Lynda Sisson, Clinical Lead, HSE Workplace Health and Wellbeing Unit

As the strategy is still under development, its precise contents cannot yet be confirmed.  However, Dr Sisson said that the concerted focus on completion of this document reflects the importance that the WHWU places on doctors’ health.

The WHWU has a role within the HR section of the HSE, confirmed Dr Sisson. “We sit on the HR portfolio and our guidance strategy is the Health Services People Strategy 2015-2018. So we are set up under the People Strategy, under the standards of staff engagement.”

Key work areas for the WHWU include “comprehensive and streamlined supports” for employees in the health service; development of standards for occupational health services; providing a safe working environment; standardisation of counselling services and approaches for staff needing support, including resilience programmes and the Critical Incident Stress Management (CISM) programme; and promoting positive health and wellbeing for all staff.

“One of my priorities when I came into this job was to look at the general health and wellbeing of doctors,” Dr Sisson told MI.

“Obviously I am looking at the general health and wellbeing of all staff, but there was a particular concern about doctors.” It was decided to examine the issue of doctors’ health first but similar strategies are planned for other staff.

Currently, there is a core working group developing the strategy, while a number of working parties have been established.  Each working party is exploring the challenges and opportunities around optimising health and wellbeing for doctors throughout their working lives, from medical school to retirement.

Over the past decade, there has been an increasing amount of research and policy focus on doctors’ health. Dr Sisson said the WHWU has been keeping abreast of developments in international research.

Stress

“Most of the developed countries are looking at stress among healthcare workers and looking at ways of addressing it,” explained Dr Sisson.

“As we develop the standards of occupational health medicine, which will be available in May, we will be standardising support services for all healthcare staff. Developing standards includes a broad literature review of international practice. The same applies to the development of standards for doctors for the Healthy Doctors Strategy.

“So for example, at the moment we are looking at guidelines from the WHO [World Health Organisation] and guidelines for medical education from the World Federation for Medical Education to inform this strategy.”

The WHWU is working closely with postgraduate medical training bodies and the Practitioner Health Matters Programme (PHMP), said Dr Sisson, and these organisations are represented on the body drafting the Healthy Doctors Strategy.

“There is a lot of work around doctors’ health going on in various different areas in the training bodies, in the colleges, in the medical schools, and then obviously with the RCPI research [on doctors’ health and wellbeing] and the Practitioner Health Matters Programme,” said Dr Sisson. 

“We have representatives from all those groups sitting around a table at the moment, looking at the working life of doctors and looking at how to optimise their health and wellbeing in every area of medical working careers, starting with medical students and going through to retiring or retired doctors.”

The available resources and ways of developing opportunities to optimise doctors’ health and wellbeing are all being examined. 

RCPI

In 2014, the RCPI launched a national study to assess the wellbeing of hospital doctors across Ireland and to get a deeper understanding of what it is like to work as a hospital doctor today.

“To date, there has been a lack of research into the health and wellbeing of doctors in this country, including the challenges posed by stress, mental ill health and addiction,” the RCPI noted on its website.

“The evidence is clear,” stated the College. “Doctors who enjoy good mental health and are ‘engaged’ achieve better patient outcomes. The wellbeing of an individual doctor, aside from being desirable in its own right, is essential in maintaining high standards and safety in medicine.

“Doctors are not immune to illness and mental distress. Some studies even suggest that doctors are more prone to mental ill health than the general population. In Ireland, doctors are becoming more vocal about the high prevalence of mental health disorders in the profession and the challenging working conditions that contribute to this.”

Dr Sisson noted that the Medical Council has been examining levels of stress among doctors in training and that a number of organisations have been engaged in improving doctors’ health.

GP Dr Íde Delargy has been working with doctors who are in difficulty for a number of years, initially though the Sick Doctors’ Scheme and subsequently as Clinical Lead of the PHMP.

 “In a faculty capacity, I happen to be on the clinical advisory group for the PHMP and we have good relations with Dr Delargy,” said Dr Sisson.

“She is involved directly with the Healthy Doctors Strategy and has also been involved in assisting and developing some of our policies. And it’s the same with the RCPI, where I am the Vice-Dean of the Faculty of Occupational Medicine.”

Uptake

The WHWU already runs a resilience programme and a Critical Incident Stress Management (CISM) programme. However, Dr Sisson said the evidence shows that current uptake among doctors is low.

“We don’t have statistics currently [for uptake of the current CISM programme], and this will be addressed once we have established national standards,” said Dr Sisson. 

“Anecdotally, we feel there is a need to increase awareness of the CISM programmes among doctors and encourage them to participate.”

She is hopeful that this trend will change soon, especially with the assistance of a new collaboration that the WHWU is undertaking with the State Claims Agency.

“We are also working closely with the State Claims Agency with their Work Positive programme… we will be rolling out a Work Positive programme as part of a critical incident stress management programme throughout healthcare, so obviously we will be including doctors in those programmes,” said Dr Sisson.

“We already have a critical incident stress management programme in the HSE, but we will be linking with the Work Positive programme. We will be making sure that we will be covering all areas of the health service and trying to increase the awareness of availability of these programmes for staff.”

The Work Positive programme, led by the State Claims Agency, involves a new online framework for protecting the psychological health and safety of workers in occupational groups likely to be exposed to critical incidents at work. The framework provides feedback on workplace stressors, employee psychological wellbeing and critical incident exposure in the workplace. It also provides structured guidance, enabling organisations to develop an action plan to mitigate against these stressors.

It is the first psychosocial risk management framework to be introduced in Europe that is specific to critical incidents and incorporates a free, easy-to-use, innovative, confidential online process.

Standards

Meanwhile, on other work ongoing at the WHWU, Dr Sisson commented: “One of our focuses is that we are also looking at setting standards for employee supports. We are developing and authorising accreditation standards for occupational health services. We’re setting standards for employee assistance and counselling services.

“We have 27 people on the Future Leaders programme with the RCSI looking at seven major organisational development programmes right across the system. There are transformational programmes that are looking at areas like improving staff wellbeing and measuring fatigue, amongst others.

“We will be showcasing the outcomes of these year-long projects on 19 May at a conference in Tallaght Hospital, Dublin, when we will also be launching our new Occupational Health Standards for implementation.”

For more information:

www.hse.ie/eng/staff/workplacehthwellbng/

www.rcpi.ie/physician-wellbeing/

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