Physician Wellbeing | Family Medicine | School of Medicine

Support for Psychological Self-Care and Protection from Moral Distress in the Workplace: Facilitators and Barriers

Principal Investigator: Colleen Grady, DBA

Co-Investigators: Angela M Coderre-Ball, Francis Maisonneuve, Mary Martin, Bruce Knox, Sophy Chan-Nguyen, Denis Chenêvert

Psychological health and safety in the workplace is directly tied to our well-being. It is integral to our capacity to be effective, to feel significant, and to find meaning in our work. Those in health care face many challenges to being well at work, challenges that have increased exponentially during the COVID-19 pandemic. In this light, Canada’s health-care leaders and policy makers have an ethical responsibility to support health-care workers in their psychological self-care and protect them from moral distress.

To better understand the facilitators and barriers related to these two psychosocial factors, we surveyed and spoke to hundreds of health-care workers from several disciplines and workplaces across the country. Before doing so, we set out to build on what is known about psychological self-care and moral distress in Canadian scholarly and grey literature. We also sought to understand how individual health-care workers, teams, and organizations contribute to safer workplaces, including the barriers that make doing so more difficult.

We can now say, unequivocally, that addressing the well-being of the health-care workforce is of paramount importance, one that leaders and policy makers can no longer avoid.

Read the full report from the MCSS here.

Mitigating occupational stressors: project design by family physicians

Principal Investigator: Colleen Grady DBA

Co-Investigators: Mary Martin MSc, Dave Pinkerton MD CCFP, Laura DiQuinzio MD CCFP

Context: Burnout among Family Physicians (FP) has a significant personal impact (exhaustion, disengagement, and relationships) and can also lead to issues related to patient safety and access to care. Though the sources of burnout among FP are known, gaps in knowledge remain regarding solutions that may be implemented within organizations.

Objective: To explore the top two occupational stressors leading to burnout among FPs (patient expectations and administrative obligations) and to design a project in collaboration with FPs to test an intervention which will address one of these stressors and measure the impact on workplace stress.

Study Design and Analysis: Qualitative study involving focus groups and interviews with FPs using an appreciative inquiry (AI) framework. Analysis uses an iterative, grounded theory approach.

Setting: Family health organizations (FHOs) in the Kingston, Frontenac, Lennox and Addington (KFLA) region.

Population Studied: Practicing FPs recruited using an emailed invitation in conjunction with the lead physician at each FHO, as well as mailed paper invitations.

Instrument: Focus group script was developed by research team based on review of literature and consistent with the AI 4-D cycle (Discovery, Dream, Design, Destiny).

Outcome measures: Experiences of burnout; potential interventions to inform long-term solutions to workplace stress; critical elements to include in a subsequent study

Results: One focus group with 4 participants, and 4 interviews were conducted (n=8). Though FP felt their work was meaningful, burnout was common. FP agreed that unrealistic patient expectations was the most significant source of workplace stress but that an intervention to address administrative obligations was more feasible. Scribes, IT (EMR) solutions and system-level regulations were proposed interventions.

Conclusion: Burnout at work was common among FP. Though unrealistic patient expectations were identified as the top source of stress, many felt that an intervention to address this would not be successful. Next steps include developing a study to test an intervention which addresses the burden of administrative obligations in partnership with FPs.

Mitigating psychological stress in the workplace for family physicians: The role of peer support

Principal Investigator: Colleen Grady DBA

Co-Investigators: Mary Martin MSc, Dave Pinkerton MD, Laura DiQuinzio MD, Amber Holmes, Robyn Brown MD

Context: Physician burnout has contributed to a shortage of practicing family physicians (FP) in Canada. This issue has directly impacted physician well-being and the quality and accessibility of health care for their patients. Peer support has been shown to be a valuable tool in reducing moral distress and burnout among healthcare providers. If individuals are unequipped to provide such support, however, a partial adoption of the initial sufferer's stress can result. Peer Support Training aims to provide individuals with the knowledge and skills required to safely support their peers. It can reduce the vulnerability of those aiming to act as supporters and lead to healthier outcomes for both individuals.

Objective: This academic-community partnership explores the efficacy of a peer support intervention to address psychological stress in the workplace for FPs and assesses the sustainability of peer support in family health organizations (FHO).

Study Design and Analysis: This study will utilize a qualitative iterative approach to data collection and analysis, including pre/post intervention surveys, as well as post-intervention semi-structured interviews. Qualitative thematic analysis of transcripts will be completed in NVivo.

Setting: One practice site of FHO in Kingston, Ontario, Canada.

Population: Practicing Primary Care Physicians at the FHO site.

Intervention: An experienced FP facilitator will provide two 90-minute peer support training sessions to up to 7 FP participants. Next, participants will attend and co-facilitate four monthly peer support sessions with the facilitator and additional FPs not enrolled in the study.

Outcome Measures: Participant feedback on content, format and value of training, challenges and future recommendations for peer support implementation, and the perception of the feasibility of long-term implementation of peer support in family health organizations.

Results: Four family physicians took part in the intervention. Participants felt the benefits of Peer Support Training included feeling less alone, being heard and the opportunity to share workplace challenges. Training was highly rated among participants who felt their experience was valuable, noting they learned a new way to interact as well as practical skills to support their peers. Feasibililty considerations included a need for ongoing funding as well as clearly outlined materials for prospective and new participants.

Conclusions: Peer Support for FPs is a viable intervention to decrease stress within an FHO. A training program that includes a mix of didactic and practice sessions and led by an expert can expand capacity of FPs through increased knowledge and confidence. Ongoing implementation within an FHO will be contingent on internal supports (funding, uptake), however, this intervention is promising, feasible, and relatively low-cost in its capacity to decrese stress among FPs.