In this third article in our series on clinician wellbeing, Dr Caitlin Weston discusses the need for a culture change in medicine and the practical steps organisations can take to support a program of clinician wellbeing.

Culture change in medicine is widely acknowledged as important, however implementation often languishes because of entrenched behaviours and beliefs. In my Churchill Fellowship report Burning out: International Approaches to Clinician Wellbeing, I highlighted the actions being taken by organisations that are prioritising clinician wellbeing and how this is influencing change in workplace culture.

Regardless of the level at which a clinician works, from student to senior management, healthcare is synonymous with a hypocritical “hidden curriculum” and “iron man” culture.¹ 

Laying responsibility solely at the feet of clinicians ignores the fact that clinicians are already incredibly resilient people. In my research I noted that:

Despite high prevalence of psychological distress, specific mental health diagnoses, burnout and suicidality among Australian doctors and medical students, it appears to have minimal impact on their work². Furthermore, a study of medical students in the USA showed that the individuals choosing to study medicine are in fact healthier and more resilient that their compared with matched peers entering other postgraduate courses, a pattern which is overturned after two years of study³.

To some degree, placing the onus solely on clinicians also absolves policy-makers, organisations, and managers from addressing dysfunctional systems and workplace cultures.⁴ It seems this only further heightens the cynicism felt by Australian doctors-in-training. A disturbingly low 24% believed that any action would be taken to support their wellbeing.⁵

All is not lost, however, with the concept of a culture of wellness gaining prominence. Thanks to the research efforts of Dr Patty de Vries from the Stanford WellMD Center, the bulk of responsibility for clinician wellness is being levelled at healthcare organisations, not the individual. Dr de Vries’ model, which has been taken up by multiple institutions around the USA and the world, focuses on the drivers of burnout and poor wellbeing. It divides drivers and solutions into three domains: Culture of Wellness, Efficiency of Practice, and Personal Resilience (refer to Figure 1 below). The model also aids organisations to design or select programs that address specific drivers within their context.

Stanford WellMD Center defines a culture of wellness as:

Organisational work environment, values and behaviours that promote self-care, personal and professional growth, and compassion for ourselves, our colleagues and our patients.

As mentioned in the second article in this series, leadership has been identified as a key contributing factor to the success of any program that supports clinician wellbeing. It is also paramount to fostering a culture change in healthcare when delivered through engagement and collaboration between leaders and clinicians.

Opportunities to support change are available through efficiency in practice and personal resilience, with the latter focused on three areas: training in skills of self-compassion, mindfulness, and positive psychology; education around optimal nutrition, sleep, and exercise for shift workers; and provision of access to truly confidential medical treatment and case management.

A culture change in medicine is needed now

Typically, culture change is relegated to the ‘too hard’ basket, however digital technology can ease the transition to a healthier workplace culture for all healthcare workers. Working with MedApps, we are developing new ways to help healthcare professionals feel capable, confident and efficient in their work. Together, we are supporting clinicians as they navigate a culture change in medicine by delivering meaningful and practical wellbeing content that is accessible  from any smartphone, tablet or desktop. For the wellbeing of all healthcare workers, it’s a worthwhile application of technology with the potential to improve, and even save, the lives of clinicians.

Is your organisation supporting clinician wellbeing? Learn how simple it can be when you download the app* or request a demonstration today? For more information, reach out via email at [email protected].

*Available on the App Store for iOs and Google Play for Android.

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1. Weston, Caitlin. Burning out: International Approaches to Clinician Wellbeing. The Winston Churchill Memorial Trust, Canberra, 2018.
2. Beyond Blue. National Mental Health Survey of Doctors and Medical Students Australia (2013) 
3. Brazeau, C.M.L.R., et al., Distress Among Matriculating Medical Students Relative to the General Population. Academic Medicine, 2014. 89(11): p. 1520-1525.
4. Montgomery, A., The inevitability of physician burnout: Implications for interventions. Burnout Research, 2014. 1(1): p. 50-56
5. NSWHealth, Your Training and Wellbeing Matters Survey Report. 2017, NSW Government.