Intended for healthcare professionals

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Burnout in healthcare: the case for organisational change

BMJ 2019; 366 doi: (Published 30 July 2019) Cite this as: BMJ 2019;366:l4774

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Re: Burnout in healthcare: the case for organisational change

I read this piece with great interest. The existing inappropriate focus on the individual and unhelpful conceptualisation of burnout as a disease are critical points the consequences of which have been well-articulated by the authors. It could be argued that burnout is an occupational hazard protection from which is the employer's responsibility. In practice, of course, there are many factors to consider at an individual level when formulating burnout within a team including the spectrum of personality profiles, interpersonal styles, experience, staffing skill-set mix, responses to changes in work load, communication patterns, individual motivations and ambitions and so on. Despite this clear scope for immense complexity at the level of the individual, the widespread incorporation of employee-reported (and possibly supervisor and colleague-reported) metrics to capture features of burnout within teams could prove extremely powerful in supporting employers to anticipate and mitigate the likelihood of exposing an employee to burnout.

To use junior doctors as an example: over the course of five to ten years thousands in the UK will predictably progress from medical student to senior clinician (e.g., GP or consultant) gaining experience, confidence and indeed responsibility as they go. Within this period, they undertake multiple rotations typically at six-month intervals through a variety of teams, sites and specialities. These teams will inevitably have differing hierarchical structures. Sites and specialities will likely have differing work cultures. Data analytics of burnout metrics could potentially help to anticipate vulnerabilities for burnout or highlight damaging organisational dynamics particularly prevalent in certain specialities or at certain sites relative to the trainee's level. Moreover, the addition of such metrics into quality improvement projects could do much to raise the profile of the issue among doctors and hopefully diminish burnout stigma the impact of which is currently disproportionately shouldered by the individual.

Competing interests: No competing interests

13 August 2019
Owen P O'Sullivan
Specialty Registrar in Forensic Psychiatry
North London Forensic Service
Camlet One, Chase Farm Hospital, The Ridgeway, Enfield EN2 8JL, United Kingdom