Turning the tide on doctors' wellbeing: perspectives and lessons from the UHB Doctor Wellbeing Group

Low levels of morale and wellbeing amongst doctors represent serious concerns for both staff health and patient safety.1 At University Hospitals Birmingham (UHB), the 'Bewick Report' was commissioned in response to the tragic death of a colleague and growing concerns about safety.2 This report, in combination with the National Training Survey,3 revealed a pattern of falling aggregate training benchmarks, along with high levels of staff sickness and dissatisfaction. In response, a trainee-led survey was conducted to identify and quantify factors affecting the working lives of non-consultant doctors at UHB. Subsequently, the 'Doctor Wellbeing Group' (DWG) – trainee-led and supported at executive level – was established to target areas of concern, champion the cause, and generate measurable change. The initial QIP cycle aimed to: quantitatively measure risk of burnout and level of wellbeing amongst non-consultant doctors in UHB; identify key factors affecting wellbeing; audit rest and wellbeing provision against national, regional and locally accepted charters;4-6 identify key areas for urgent intervention; and influence change using robust evidence presented directly to key stakeholders at the trust. Data was collected via an anonymous online survey between Mar – Apr 2023. 176 responses were recorded. 95% of respondents were aged 25-45, 50% female, 29.1% international medical graduates. A range of training programmes and all grades from FY1 to ST5+, as well as locally employed doctors, were represented. An aggregate Oldenburg Burnout Inventory Score was calculated and compared to previously published risk stratification in healthcare workers.7 This showed 38.3% of respondents were at high risk of burnout, 57.4% at medium risk and only 4.3% at low risk. Issues were identified with lack of adequate facilities (73% of responses); rota management (70%); and workplace culture (40%) including widespread unacceptable behaviours and perceived barriers to raising concerns. Following the survey, initial direct interventions included: raising awareness of survey findings through presentations to key stakeholders; improving rest/mess facilities and making them more accessible; employing extra Junior Doctor Wellbeing Officers; and arranging medical workforce and study leave drop-in sessions. The DWG has subsequently supported non-consultant doctor 'Members' to run a series of QIPs, supervised by consultants on a 'Senior Supervisory Board.' QIPs relate to working conditions, with topics such as increasing use of exception reporting, supporting locally employed doctor training opportunities, developing mentorship schemes, out of hours hot food access, and Civility Saves Lives campaigning.8 Through this work, the DWG promotes importance of wellbeing, supports portfolio requirements, and aims to implement measurable, sustainable change. Regular reports to the Trust Board are in progress. A trust-wide rep forum has also been established, to identify common issues and escalate concerns to Medical Education teams and Hospital Medical Directors. A repeat survey will be performed in May 2024 to re-assess and identify both improvements and continued challenges. Embedding the DWG within the Trust structures should continue to support positive change in the years to come.