Tag Archives: #OPResearch

Burnout in the NHS: what happens when doctors become patients?

Dr Kevin Teoh, Lecturer in Organizational Psychology, discusses burnout and mental health trends in NHS consultants – which is the subject of a new paper, co-authored with Dr Atir Khan, Dr Juliet Hassard, and Dr Saiful Islam.

Not many days go by where there isn’t any discussion on the current state of our National Health Service (NHS) – whether it is increasing patient demands and numbers, concerns around funding, patient safety, or Brexit. However, as one of the largest employers in the world, the changes across the NHS can have significant ramifications for its workforce. In the press, there is increasing concern about how healthcare staff are coping in light of these changes.

One of the main topics of discussion is burnout, which consists of three components – emotional exhaustion, depersonalisation, and reduced personal accomplishment.

Emotional exhaustion refers to being emotionally drained and exhausted in the workplace, while depersonalisation is a psychological withdrawal from relationships and the development of negative and cynical feelings towards people. Reduced personal accomplishment represents a lack of work effectiveness due to emotional exhaustion and depersonalisation.

But why is burnout in the NHS so important? And what are the factors in the work environment that precede it? We sought to examine these questions in a sample of NHS consultants drawn from England, Scotland and Wales. Consultants represent the most senior and well-trained doctors in the healthcare workforce. Through their role as supervisors and educators, they are also pivotal in the development of the current and future healthcare workforce. Far less is also known about the working conditions of consultants, when compared to their junior doctor and nursing colleagues.

We focused on two aspects of work – work-related pressure and autonomy. The first reflects the workload and pressure that consultants are under, with considerable evidence from other sectors that link it with the health outcomes of workers. The latter actually reflects a potential positive work aspect as high-levels of job autonomy may be beneficial to consultants (and workers more generally). This is because job autonomy gives consultants the flexibility to manage their workload, work on tasks which they find more interesting and problem solve.

In addition to the working conditions and burnout relationship, we also wanted to see how these linked in with staff outcome measures, including the levels of depressive and anxiety symptoms that consultants were experiencing as well as their intention to retire early from the NHS.

The results paint a worrying picture. Out of the 593 consultants who took part, about a third of NHS consultants had poor-levels of psychological health, including emotional exhaustion (38.7%), depersonalisation (20.7%), anxiety symptoms (43.1%), and depressive symptoms (36.1%). These figures not only highlight that our consultants are struggling; they also suggest that poor mental health among consultants has increased in the years since they were last measured.

As expected, both aspects of work that we measured – (high) work related pressure and (low) job autonomy – predicted adverse psychological health. But what are the implications of poor working conditions and burnout among consultants in the NHS?

Our findings suggest that the impact on both severe mental health issues (i.e. symptoms of anxiety and depression) and an intention to retire early. This means that when consultants in the NHS experience high work-related pressure and job autonomy, the subsequent development of burnout could lead to more severe downstream issues.

From a psychological perspective, this does make sense. Consultants struggling in an environment where they have little autonomy and high work-related pressure requires energy and coping resources. Continual exposure then takes a toll on consultants’ psychological resources, which leads to burnout over time, as doctors feel exhausted and they depersonalise from the people around them. When doctors burn out, it exacerbates even further this demand on their psychological resources. What then happens is the manifestation of further mental and physical symptoms, such as the development of depressive and anxiety symptoms. Also, consultants may choose to leave that difficult work environment to protect their remaining psychological resources – which is why we see that when consultants report higher levels of burnout they are also more likely to intend to retire early.

While it is important to note that we did not diagnose actual anxiety and depression in our sample of consultants, the measurement of symptoms is strongly associated with it. Consultants struggling with such symptoms are more likely to be impaired in their performance, which is consistent with the growing research evidence base linking poor mental health among doctors with lower standards of patient care. Should the prevalence of depression and anxiety among consultants go up, it would inadvertently increase the demands on the NHS as doctors become patients themselves.

The intention to retire early is something that should be of concern to us all, especially as the NHS is currently facing a shortage of healthcare staff, including consultants. If consultants do go on to retire early, this would not only reduce the number of doctors in the NHS but would lead to a skills gap in the healthcare service. This might then generate a continuous downward spiral where consultants experiencing poor working conditions burnout, leading to the development of more severe mental health issues and/or early retirement from the NHS. In turn, this further increases the demands on the health service that impacts the remaining consultants, thereby continuing this cycle.

Managers and policymakers need to be aware of the current state of poor psychological health of NHS consultants. They also need to recognise that decisions and changes made to the working conditions of doctors (and healthcare staff in general) not only impact their burnout levels. Where it is not feasible to alleviate some of the work-related pressures, then ways to increase the level of consultants’ job autonomy should be considered.

These findings, along with some of our other research in this area, emphasise the need to address the systematic issues within the work environment that influence the working conditions of NHS consultants. Although more individual-focused interventions, such as resilience training, may have a role to play, on its own this is clearly insufficient. In the UK, there has been limited research looking at interventions to manage the working conditions of doctors. Nevertheless, growing research from elsewhere in the world provide some examples that may be relevant to the NHS here.

Ultimately, as potential users of the NHS, the mental health state of consultants and their working conditions really should be of concern to us all.

The full study, Psychosocial Work Characteristics, Burnout, Psychological Morbidity Symptoms And Early Retirement Intentions: A Cross-Sectional Study Of NHS Consultants In The UK, is published by BMJ Open.

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Examining the class system in British museum employment

Sam Evans, a PhD researcher at the Department for Organizational Psychology, is leading a series of focus groups which will ask participants to reveal what it takes to get in and get on in the museum sector, and how social class shapes career chances and experiences.

I’m interested in how inequality is reinforced in the workplace. Class, until recently, has been surprisingly absent from the debate. Research into diversity or equality, often overlooks class, as does occupational psychology in general. Part of the reason for this absence is that class is not a legally protected characteristic, like age or gender, but also it is argued that there has been a more fundamental ‘individualisation’ of Western culture.

Class identities have become more difficult to see or express in the workplace. Our careers are thus seen as our responsibility, and we don’t often think or talk about the structural inequalities that might frame this. However, there is research suggesting inequality at work is increasing, professions are becoming more not less exclusive, and social mobility is declining.

I want to explore these issues in-depth in my research project, The Museum of Them and Us; I am interested not just in how people are classed, but also occupations, roles and organisations. I am particularly interested in why some careers and types of work favour some groups of people and not others. We assume anyone can get in and get on, no matter how tough, given they have the right personal qualities. But what is this really like for people from different backgrounds? I have chosen to look at museums, partly because I am familiar with the field, but also because visiting and working in museums is described as middle class. But why is this, does this account for all types of work, and what does this mean for people who might not be from middle-class backgrounds.

I don’t have a fixed definition of the term ‘class’ (this is a subject that has been debated for 150 years and most researchers recognise there is no one single definition), but am using Pierre Bourdieu’s concept of capital of class. This involves looking at the types of economic, social or cultural capital that are valued within different types of museum work and how this relates to the type of capital people actually have, or are able to acquire. Cultural capital is particularly important as this relates to accent, dress, education and knowledge of particular types of culture, and is often highly valued in cultural work.

I have already conducted interviews with representative bodies, trade unions and membership bodies as well as analysing reports and websites to look at how ‘getting and getting on is described’. I have found that, as with other research, museum work has become less secure and more competitive. The onus seems to be on the person to develop themselves as specialist and professional, and yet also flexible and versatile. This potentially makes it riskier and less beneficial for anyone entering the field. Class was talked about but was often described as difficult to see or measure, and most diversity initiatives were aimed at developing the individual to fit the required ways of working, rather than look more closely at how ways of working might be creating inequalities.

With the focus groups and interviews, on the one hand, I am asking people to talk about their work – what it takes to get in and on, how this might have changed, how this might be different for different roles, are some roles held in higher esteem than others and why. On the other hand, I want to talk about social class – what does it mean to people, do they think class matters and if so, how? I am also asking people to contribute images or photos that they think represent their work.

Take part in the focus groups:

If you have worked or volunteered for a museum you can take part in a focus group or an interview. If people think that class has mattered to them in particular, I am also conducting private interviews.

Taking part is confidential, enjoyable and you will be helping the sector. To take part in a focus group or an interview and for further information, please contact me or visit my website.

Thursday 5 April
6PM – 7.30PM, Birkbeck Main Building, Room MAL 420, Malet Street, WC1E 7HZ  

Wednesday 11 April
6.30PM – 8PM, Birkbeck Main Building, Room MAL 420, Malet Street, WC1E 7HZ.

Thursday 26 April
6PM – 7.30PM, Museums Association Offices, 42 Clerkenwell Close, London, EC1R 0AZ

Friday 18 May
2.30PM – 4PM, Birmingham Museum and Art Gallery, Chamberlain Square, Birmingham B3 3DH

Wednesday 23 May
6PM – 7.30PM, Museums Association Offices, 42 Clerkenwell Close, London, EC1R 0AZ

Thursday 7 June
4PM – 5.30PM, Whitworth Gallery, The University of Manchester, Oxford Road, Manchester, M15 6ER

Thursday 14 June
5.30PM – 7PM, M Shed, Princes Wharf, Wapping Road, Bristol, BS1 4RN

Or schedule an interview:
If you think social class has mattered to you personally in your work or career then you can take in part in an individual interview, by email, Skype or face to face (depending on your location).

If you are interested in finding out more, please contact Sam directly.

About Sam:

I studied History originally, and then spent about 25 years working in marketing in the museum, cultural and public sectors. A lot of my work was really about understanding people and organisational cultures as much as ‘doing’ marketing, hence my interest in studying organisational psychology.  I started studying part time about 8 years ago, first obtaining a degree in psychology at OU, then moving on to the MSc in Organisational Psychology at Birkbeck.

About the same time as graduating, I was made redundant, which forced a decision – stick to the marketing “battleship” I knew, or jump onto the less stable “raft” of psychology. I had already met some PhD students and Dr Rebecca Whiting who became my supervisor, and thought I would really like to study for a PhD here. So when I was offered a studentship, I took the leap. It’s been one of the best decisions I’ve ever made!

From Dr Rebecca Whiting, a lecturer in the Department of Organisational Psychology and Sam’s PhD supervisor:

Sam brings a wealth of experience to her research from working in this sector and an intellectual rigour from her academic training. Class is a challenging concept to research because of the many and sometimes conflicting ways in which its conceptualised and measured.

Many definitions reflect the relationship between class and socio-economic and cultural status. However, since class is not a ‘protected characteristic’ under the Equality Act 2010, it doesn’t always appear as an aspect of diversity in organizations, so is ripe for critical investigation. Museums are key locations of our socio-cultural heritage but are an under-researched context in organizational and occupational research.

This highlights the importance of Sam’s research which brings together this topic and context to explore how class impacts on museum work.

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Who knows wins: the validity of employee selection methods

Duncan Jackson, Chris Dewberry, Jarka Gallagher and Liam Close discuss the effectiveness of different candidate selection methods for businesses.

Photo by Nick Hillier on Unsplash.com

In our recent article published in the Journal of Occupational and Organizational Psychology, we were interested in how HR practitioners perceived the validity of employee selection procedures, and how their perceptions aligned with validity estimates published in academic literature.

We summarised the discrepancies between published validity evidence and the perceptions of those who reported holding:

  1. CIPD (Chartered Institute for Personnel and Development) qualifications
  2. HRM (Human Resource Management) qualifications
  3. OP (Occupational Psychology) qualifications
  4. and laypeople, who do not hold formal HR qualifications.

Our findings suggest that the responses of those with CIPD- and HRM-related qualifications did not differ significantly or substantially from the responses of laypeople.  However, those with OP-related training tended to respond in a manner significantly and substantially more aligned with findings reported in the research literature. What do these findings imply?

They could imply that those trained in OP have a better awareness of the research literature regarding employee selection than the other groups sampled.  This is consistent with the fact that research in this area is predominantly published in journals that are psychology-oriented.  Our findings might also imply that those with CIPD- and HRM-related training do not tend to access – or perhaps do not have access to – contemporary, high-quality research related to the validity of candidate selection methods.

Dr Chris Dewberry from the Department of Organizational Psychology and a co-author on this paper states:

‘For organisations, selecting the best job candidates is very important. To achieve this, familiarity with the results of high-quality scientific research on the effectiveness of different selection methods is vital. The results of the research presented in this article clearly indicate that practitioners without a background in organisational psychology are at a disadvantage here. The implication is clear: initiatives to familiarise practitioners with an HR background about the results of scientific research on personnel selection are urgently needed.

As a community of applied researchers and practitioners, perhaps we need to do more to make research findings available and to communicate those findings.  For example, occupational psychologists could work in conjunction with the CIPD to ensure that findings published in occupational psychology-related journals are shared in an appropriate format with HRM practitioners.

If practitioners do not hold an awareness of the latest and greatest vis-à-vis employee selection research, then they might not be using candidate selection methods optimally.  This could, in turn, affect the careers of individuals and the optimal function of organisations.  Dr Scott Highhouse from Bowling Green State University offers a related explanation and suggests that practitioners might not see selection research as being relevant to their practice.  This perspective suggests that it is important to educate about the importance of validity in selection and how it impacts on practice.  A clear example of where selection applies to the bottom line for an organisation is seen in utility analysis – a function which shows how validity relates to monetary gains for organisations on the basis of using valid selection procedures.

Practitioners should consider the following actions:

  • Ensure that the choice of selection method is guided by validity evidence as published in high quality, peer-reviewed sources
  • Understand that knowledge of validity is power in employee selection: practitioners need to take the time to familiarise themselves with the literature on the validity of selection methods
  • Know that the degree of validity makes a difference to the quality of selection decisions and to the bottom line for organisations

Further information:

  • For the original, peer-reviewed article, see:
    Jackson, D. J. R., Dewberry, C., Gallagher, J., & Close, L. K. (in press). A comparative study of practitioner perceptions of selection methods in the United Kingdom. Journal of Occupational and Organizational Psychology. doi: 10.111/joop.12187
  • About the authors: Duncan Jackson, Chris Dewberry and Liam Close are members of Birkbeck’s Department of Organizational Psychology. Jarka Gallagher works for Arctic Shores Ltd, where Liam Close also works.
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The proposed ‘right to disconnect’ after work hours is welcome, but not enough

This post was contributed by Professor Gillian Symon, member of the Digital Brain Switch project. Involving a multi-disciplinary team of UK researchers (including Birkbeck’s Dr Rebecca Whiting), the project explored the ways in which mobile communication technology  affects how we switch between different aspects of our lives. This article was originally posted on The Conversation on 23 March 2016.    

Changes proposed to France’s famously inflexible employment laws by French president François Hollande have prompted an outcry among students and unionists and even the barricading of schools by pupils. But among the raft of changes to working practices is the liberating notion that employees should have the right to disconnect: to ignore emails from employers during evenings and weekends so that time with friends and family is not affected by work distractions or feelings of guilt.

Limited interventions of this sort have been put forward in Germany and France before, but this is the first proposal that the right be enshrined in law.

There is much to like about it. First, it recognises the massive impact the widespread use of smartphones and tablets, Wi-Fi and high-speed mobile internet has had on our working lives. In as much as work emails, diaries and contacts are on a smartphone in our pocket, to some extent we are never truly “out of the office”. The proposal seeks to counter this in legislation, not to leave it to corporate custom and practice.

Second, the proposed legislation acknowledges the considerable research that suggests that we need to psychologically detach from work regularly, or risk becoming exhausted and losing our creativity.

Third and most importantly, it makes the employer at least partly responsible for managing this intrusive technology and its effects on employees. There is a recognised paradox, whereby technology allows flexibility over when and where we work, but at the same time acts as a leash that chains us to our (virtual) desks. For too long this has been seen as something employees themselves should manage.

The research into work-life balance my colleagues and I have conducted suggests that achieving the right balance has become another “life crisis”. It is one that is fed by endless media articles and self-help books, and one that is almost certainly unresolvable by the individual as so much of the pressure comes from bosses and colleagues at work. What we’ve found is that there needs to be respect for individuals’ chosen work-life boundaries at all levels within organisations.

So congratulations to the French for taking this particular taureau by the cornes. But is their proposed approach through new legislation the right answer?

It’s not easy, and often employers don’t make it any easier. wongstock/shutterstock.com

As far as it goes

There are three ways digital media and mobile technology have affected our lives that isn’t acknowledged by legislation, which is concerned only with time spent connected to work. In our research we’ve sought to highlight the creeping effects of “digi-housekeeping”: those endless technology maintenance tasks that we engage in – updating software, syncing devices, fighting technical problems – which often takes place outside of office hours and doesn’t appear on time sheets. None of this is accounted for by legislative approaches.

Nor does legislation address the way in which the use of social media for work may intrude into our privacy. When we blog and tweet for our employers, are we exploiting our personal identities for their ends? Are these additional tasks, and the need to maintain our digital presence online, causing us anxiety and increasing our workload without any formal recognition of the effort involved? These sorts of activities go beyond a concern with just maintaining a time boundary between work and life. They represent new tasks required to maintain our digital work lives.

What’s more, because the French legislation presumes an employee-employer relationship, it entirely ignores the anxieties of the self-employed, as those taking part in our research told us. While those working for themselves have always had to work hard, social media has put added pressure on them to be constantly online and accessible to maintain their business. We need more imaginative interventions that will address the needs of specific groups such as these.

What are 21st century working lives like?

The French legislation is important primarily because it makes clear the responsibilities of employers and organisations. However, it’s also rather a blunt-edged tool that doesn’t appreciate the intricacies of our online lives. Legislation like this enforces a strict work-life boundary that may be a thing of the past.

Read the original post on The Conversation

Read the original post on The Conversation

Our research collaborators kept video diaries that captured the complex circumstances of today’s workers in a more revealing way than traditional surveys can do. These video diaries suggest we might be making sense of our lives in radically different ways in the 21st century. We distinguish between online and offline lives rather than work and non-work hours, and we think more about how we prioritise time, rather than how we divide it.

To support flexible working, we may need flexible legislation that is based on other considerations than time alone, including where and how we work best. It’s very unlikely there will be a one-size-fits-all solution; researchers and policymakers are going to have to find more creative 21st century solutions for this very 21st century problem.

So the French government’s move to formally recognise the distraction caused by unfettered technology is welcome, but limited. To improve upon it, we need to understand much more fully the complexities of contemporary digital online lives, what boundaries people now find important, and how the law can best support them.

Find out more

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