Tue Apr 12

Ashley Bloomfield's resignation highlights burnout on the COVID-19 front line

Written by Dougal Sutherland, Clinical Psychologist, Te Herenga Waka — Victoria University of Wellington

In Japan it’s known as karōshi. In China, guolaosi. The South Koreans call it gwarosa. The literal English translation is “death from overwork ^[1]”.

While we might hope this term wouldn’t resonate in New Zealand, the recent resignation of Director-General of Health Ashley Bloomfield and two of his deputies, citing stress and exhaustion ^[2], suggests otherwise.

Bloomfield has rightly received widespread praise for his efforts in combating the COVID-19 pandemic. But do we really want our leaders working 24/7 to the point of exhaustion and ultimately resignation?

Short term stress can often be a useful thing. It gets adrenaline and cortisol pumping around our body, increasing our alertness and energy levels, and potentially improving our performance ^[3]. But prolonged levels of stress without sufficient recovery can lead to burnout and exhaustion ^[4].

Unfortunately, organisations have not adapted to the prolonged stress associated with COVID-19. Consequently, many people are responding to the current situation as if it were a sprint, when we’re actually running an ultra-marathon.

Moral stress and injury

In 2019 the World Health Organization defined burnout as a syndrome caused by chronic workplace stress. Burnout is characterised by physical exhaustion, increased mental distance from work, increased negative or cynical feelings about it, and reduced productivity or difficulty focusing on work ^[5].

You may recognise these symptoms in your own life even if you’re not working in healthcare. Research shows increasing rates of burnout ^[6] across many sectors in Aotearoa.

Nurses, doctors and other healthcare workers have long expressed concerns about their huge workloads and associated mental burnout ^[8]. For many of these workers, burnout and fatigue have been an understandable response to years of being underpaid and under-resourced.

But COVID-19 has led to the adoption of a term previously used in military psychology, “moral stress and moral injury ^[9]”, to describe the heightened response of healthcare workers caught at the front line of the pandemic.

Director-General of Health Ashley Bloomfield speaking at a podium.

Director-General of Health Ashley Bloomfield announced plans to resign on April 6, after leading New Zealand’s COVID response from the start of the pandemic. Mark Mitchell/Getty Images)^[10]

Moral injury can occur when a person has to compromise or work contrary to their own moral beliefs or values, such as having to compromise on optimal care for patients due to insufficient resources. This dissonance can lead to complex emotions, including the feelings of guilt, shame or embarrassment, anger, contempt or disgust.

This sort of injury can affect a person’s social, psychological and spiritual ^[11] well-being and is linked to a range of poor health outcomes ^[12].

Understanding this concept can help make sense of why healthcare workers may oscillate between tears, exhaustion, angry outbursts and guilt.

Person in scrubs with head in hands. A second person has their hand on their shoulders.

Healthcare workers have faced a dissonance between their morals and how they have been asked to work. ER Productions Limited/Getty ^[13]

Combating burnout and moral injury

Efforts to reduce or prevent workplace burnout and moral stress start with employers meeting their responsibilities to protect their workers’ psychological wellbeing under the Health and Safety at Work Act ^[14].

Citing his own journey with stress and anxiety, Bloomfield shared the importance of switching off and setting boundaries with work. He gave his executive team an extra week of annual leave in 2020 and explicitly instructed them to rest during that time ^[15] – an example of how leaders can be role models of how to circuit-break cumulative stress by taking decent breaks.

But organisations need to go a step further.

As well as enabling employees to set good boundaries at a personal level (saying no, taking breaks, engaging in healthy habits), there should be an organisation-wide process for identifying and responding to work-related psychological risk factors.

The first global standard for psychological health and safety at work calls these “psycho-social risk factors ^[17]”. They include high workloads, exposure to emotional distress at work, tight deadlines, lack of control or role clarity, and poor support pathways.

Mitigation of psychological risks ensures they are effectively minimised and well-being prioritised. This in turn allows for the creation of high-performing teams who feel psychologically safe, are physically and mentally healthy, and are able to create, innovate and reconnect with the meaning behind their work.

Crucially, employees are also better protected against burnout ^[18], making them much more likely to stick around in their jobs.

Validation and appreciation

“Validating” might sound fluffy, but the science underpinning ^[19] this concept is sound. Emotional validation is recognising and accepting, but not necessarily liking or agreeing about, employees’ thoughts, feelings and behaviours.

When organisational leaders do this well, the validation helps to acknowledge and dial down strong negative emotions like anger, frustration or being overwhelmed, reducing the impact of these feelings.

Appreciation needs to be offered carefully, given the risk it may sound patronising or minimising. Research found that employers should praise and reward aspects of performance that are under an employee’s control ^[21].

Employers should also praise behaviour rather than the person, as well as recognising the effort, not the end results. It’s also important that employers ask their people what kinds of appreciation and recognition will be validating and meaningful, rather than assuming they know.

Bloomfield will leave a lasting legacy in New Zealand’s public health system. His departure also creates an opportunity to shine light on workplace psychological health and safety so we don’t lose more people to burnout.

Gaynor Parkin and Dr Amanda Wallis from Umbrella Wellbeing ^[22] contributed to this article.