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Going to work to make people feel better should be the best job in the world – so why doesn’t it feel like it? Thank you to both Dr Matthew (BMJ 2021;374:n2148) and Dr Oliver (BMJ 2021;374:n2164) for raising the uncomfortable but very necessary notions that our places of work are not always joyful with well enforced mission statements. This does not sit easily with the recent media narratives of “superheroes” and of the healthcare sector as a whole pulling together.
We are all familiar with the term “Moral Injury”, particularly with reference to being aware of the vast unmet healthcare need. What is less commonly discussed is the moral injury caused to healthcare workers from barriers within the workplace.
Healthcare workers are remarkable - motivated, skilled, academic high achievers who care and want to make people feel better. There is a moral obligation to duty and a need to Get It Right First Time. We are used to assuming responsibility for big decisions, but it can be hard to distinguish where the boundaries of precisely what we are responsible for lie. Hence we find ourselves apologising for and assuming responsibility for things beyond our control in a system which did not enable us to succeed. Moral injury stemming from barriers within the workplace takes many forms; the prevailing focus on changing healthcare worker behaviour as opposed to system change in root cause analysis findings, the zero tolerance policy to worker abuse that never quite materialises, when raising concerns about culture feels like speaking into a void – the list goes on. The message received is that any failures and changes are down to you not the system.
We are subjected to increasing bureaucracy and management which can feel at odds with the autonomy which comes from years of experience, skill and knowledge necessary in our profession. Targets, flow and performance statistics frequently manifest in interruptions to our clinical work. The message received is that we are not trusted to manage our own workload.
The result of these in house moral injuries combined with regular traumatic clinical experiences is described by Dr Matthews. A meaningful job with highly skilled individuals but a noticeable lack of joy. Barriers to being able to use your skills and knowledge in the way you see fit and a nagging sense of lip service being paid to mission statements makes people feel very unhappy. Unhappy workers communicate with less compassion and less professionalism and we enter Chris Turners arena of “Civility Saves Lives”. Civility isn’t just essential for patient safety, it is essential to our safety and wellbeing also. We thrive when we treat each other with compassion and professional courtesy but become physically and mentally ill when these are lacking.
I think we will see more joy in the workplace when we start “Looking After Our Own”, not in a nepotistic fashion but in a compassionate professional way which respects autonomy and difference.
Re: Rammya Mathew: Building compassionate and joyful workplaces
Dear Editor
Going to work to make people feel better should be the best job in the world – so why doesn’t it feel like it? Thank you to both Dr Matthew (BMJ 2021;374:n2148) and Dr Oliver (BMJ 2021;374:n2164) for raising the uncomfortable but very necessary notions that our places of work are not always joyful with well enforced mission statements. This does not sit easily with the recent media narratives of “superheroes” and of the healthcare sector as a whole pulling together.
We are all familiar with the term “Moral Injury”, particularly with reference to being aware of the vast unmet healthcare need. What is less commonly discussed is the moral injury caused to healthcare workers from barriers within the workplace.
Healthcare workers are remarkable - motivated, skilled, academic high achievers who care and want to make people feel better. There is a moral obligation to duty and a need to Get It Right First Time. We are used to assuming responsibility for big decisions, but it can be hard to distinguish where the boundaries of precisely what we are responsible for lie. Hence we find ourselves apologising for and assuming responsibility for things beyond our control in a system which did not enable us to succeed. Moral injury stemming from barriers within the workplace takes many forms; the prevailing focus on changing healthcare worker behaviour as opposed to system change in root cause analysis findings, the zero tolerance policy to worker abuse that never quite materialises, when raising concerns about culture feels like speaking into a void – the list goes on. The message received is that any failures and changes are down to you not the system.
We are subjected to increasing bureaucracy and management which can feel at odds with the autonomy which comes from years of experience, skill and knowledge necessary in our profession. Targets, flow and performance statistics frequently manifest in interruptions to our clinical work. The message received is that we are not trusted to manage our own workload.
The result of these in house moral injuries combined with regular traumatic clinical experiences is described by Dr Matthews. A meaningful job with highly skilled individuals but a noticeable lack of joy. Barriers to being able to use your skills and knowledge in the way you see fit and a nagging sense of lip service being paid to mission statements makes people feel very unhappy. Unhappy workers communicate with less compassion and less professionalism and we enter Chris Turners arena of “Civility Saves Lives”. Civility isn’t just essential for patient safety, it is essential to our safety and wellbeing also. We thrive when we treat each other with compassion and professional courtesy but become physically and mentally ill when these are lacking.
I think we will see more joy in the workplace when we start “Looking After Our Own”, not in a nepotistic fashion but in a compassionate professional way which respects autonomy and difference.
Competing interests: No competing interests