It has become imperative that we discuss the issue of mental health in doctors and other healthcare staff. The mental wellbeing of a healthcare staff forms the bedrock of patient safety. It takes a safe and supported person to deliver safe healthcare and we must give this attention as we try to find ways to improve the quality of care within our healthcare systems.
Ehi Iden, hub topic lead for Occupational Health and Safety, OSHAfrica, reflects on the increasing workload and pressure healthcare professionals face, the impact this has on patient safety and why we need to start 're-humanising' the workplace.
In March 2017 in Nigeria, we had two very shocking incidents which left everyone saddened and disturbed. The first case was Emmanuel Ogah, a medical doctor, who stabbed his 62-year-old mother to death in Lagos. Then, whilst we were all trying to come to terms with that incident, on the 19 March 2017 Allwell Orji, another medical doctor, asked his driver to stop in the middle of the popular ‘The Third Mainland Bridge’, got out of his car and jumped into the lagoon where he drowned before help could come. The loss of these two medical professionals happened within a space of one week.
As an occupational health consultant and a patient safety advocate, this got me thinking about how it further increases the risk exposure to the patients. These were both doctors who were trained to care for patients. Could they have been overworked? Were there issues surrounding their personal lives, their family lives and other very personal issues that were responsible for these acts? Nigerians were not known to commit suicide, but we cannot boast that any more, we are fast losing our resilience and coping capabilities. The World Health Organization (WHO) 2016 report revealed that Nigeria had the highest suicide rate among African countries, ranking sixth globally. This is concerning and needs urgent actions to stem the tide.
Let’s look at healthcare professionals being overworked as a key example. According to the Premium Times Report published in November 2015, the population of Nigeria was 173 million people in 2013. Going by that report, Nigeria needed a minimum of 237,000 medical doctors to care for the Nigerian population, in line with the WHO ratio of 1 doctor to 600 people within a population group. But from all reports available at that time, there was only 35,000 doctors actively working as medical doctors in Nigeria. According to this ratio there is no way that doctors will not be overworked. Using these figure, this meant 1 doctor to 4,960 people. Although, the Nigeria Medical College train more than this number of doctors, many move into other professions. Using these figures, we might conclude that workload could be a strong contributing factor to suicide or death amongst doctors and other healthcare workers in Nigeria.
So the question is, how does this impact on patient safety?
It is sad that mental health was not included amongst the list of occupational health diseases or illness in the International Labour Organisation list of occupational diseases until much later when the toll of mental health issues became so obvious. Psychosocial hazard has become a huge issue within the healthcare work environment leading to burnout, fatigue, exhaustion, stress, tiredness and sleep deprivation amongst healthcare workers, and these outcomes impact negatively on the safety and quality of care when treating patients. The need to keep healthcare workers safe and look after their mental health is something that needs our collective actions and commitment. It takes a safe healthcare worker to deliver safe healthcare to patients.
We should be looking at the workload – the duration and frequency of duty shifts within the healthcare sector – which has long changed over the years, making healthcare professionals work longer hours per shift, dealing with a workload that is beyond their coping capacity. We all agree that in healthcare we deal with lives and any mistake within healthcare delivery is always a costly one which innocent people pay for with their precious lives. Work overload is a critical issue surrounding daily patient harm in the hospital. It hurts the patient as much as it hurts the healthcare workers. This workload, if allowed to persist for too long, alters the mental wellbeing of the healthcare worker leading to avoidable mistakes, irrational behaviour, lack of co-ordination and a disrespect to the right and dignity of patients. This is never in anyone’s best interest.
There are many doctors, nurses and other healthcare staff who love their jobs and keep giving all they have, giving mutual support to colleagues when they perceive them to be overwhelmed with work, which sometimes leads to collective burnout within a team. which leads to patient harm. Such healthcare staff are seen as trusted by everyone and tagged 'MR FIX IT' because of their willingness and availability to always show up to help or assist. They become a victim of patients' and colleagues' continuous demands; they never say NO but instead are always there to help, but over time they become emotionally overdrawn and this can lead to patient harm.
The mental health of doctors and other healthcare professionals should be taken seriously owing to new and emerging conditions and disruptive behaviour noticeable amongst healthcare workers. The two doctors cited at the beginning of this write-up were managing patients entrusted to their care. Any doctor that has suicidal thoughts is a risk within the healthcare environment, no matter the department or unit he or she works in.
I really think this is where we must look more closely at human resources, management and leadership in the healthcare environment. These are not roles that should be assigned to a newcomer, but a role carried out by very experienced professionals with a strong analytical background in human psychology and a big heart for employees’ wellbeing. We cannot rule out the fact that the two doctors cited earlier never displayed violent or suicidal behaviours that would have attracted the attention of co-workers, or even the human resources managers who would have been expected to have a meeting with such an employee with obvious suggestive indicators. We need to start engaging our colleagues, we need to start setting up Employees Assistance Programs (EAP) and we need to start looking beyond work – taking an interest and asking what happens in the home of our employees and colleagues. Are there issues? Are there smart ways we can help out? This should be our thinking. It will save both the patient entrusted into the care of the healthcare workers and the healthcare workers themselves and maintain a good reputation for the healthcare facilities.
We must understand that healthcare workers are human beings just like us all; they are not super men and women, and they are fallible like every one of us. We need to start re-humanising our workplaces. Let’s start reviewing the workloads, timelines and deadlines, let’s once again treat healthcare professionals the way we would want them to treat our patients. Let’s bring dignity of labour back to healthcare, let’s again work like one big family where we all continuously watch each other’s backs, let’s rebuild the lost confidence while having the patient at the centre of these thoughts.
Losing more doctors from healthcare, seeing others behind bars due to homicide, and seeing others incapacitated and feeling invalid when we know the work pressure and work environment contributed to these conditions and states is no good to any of us. We can change it.
It takes a HEALTHY doctor to offer a SAFE healthcare.
About the Author
Ehi Iden is an Occupational Safety, Health and Wellness Consultant with over 20 years’ work experience spanning through healthcare management, patient safety improvement and Occupational Health and Safety Management.
He is the founding CEO of Occupational Health and Safety Managers (OHSM), a Head of Faculty at OSHversity and President, OSHAfrica.