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What would happen if every five out of five employees leave your healthcare organization? And, what if two out of five leave the healthcare profession altogether? 

In our national study on Canadian healthcare providers’ (HCPs) mental health during the COVID-19 pandemic, ~300 survey respondents reported just that! Data collected from HCPs during the pandemic revealed that approximately three in five HCPs are more than 50% likely to leave their organization and approximately two in five HCPs are more than 50% likely to leave their profession. Further, two in three HCPs felt they did not have access to adequate extended benefit coverage for mental health.

There’s more to this story…

A CALL TO ACTION: The following recommendations have been developed for healthcare organizations to foster positive change within the healthcare sector. By offering implementation strategies based on our research, we provide practical steps to address the mental health of employees and improve workplace culture.

Beginning in February 2021, the Trauma and Recovery Research Unit at McMaster collected both survey and interview data from HCPs across Canada. A range of HCPs providing direct and indirect care have participated so far including respiratory therapists, nurses, physicians, personal support workers, occupational therapists, and more. Data collection remains ongoing and reveals myriad psychological difficulties and workplace challenges that accumulated through years in the healthcare workforce.

Across the globe, HCPs are part of the largest segments of labour markets. Research on the importance of the three main conditions of healthy healthcare—quality of care, workers’ wellbeing, organisation of healthcare—reveal it’simperative to focus on the care of HCPs to achieve optimal health system performance. The cascading effects of taking responsibility and accountability for the well-being of HCPs within organizations will impact a range of outcomes including quality of care, recruitment and retention of employees, resource efficiency, and overall performance. Furthermore, it appears that younger HCPs may be at greater risk of burnout and mental illness than older HCPs. It is especially concerning when experienced cohorts retire early or leave the organization while younger cohorts are more vulnerable and at higher risk of adverse outcomes, which increases their likelihood of leaving the profession. Our healthcare system is in peril. 

Our research demonstrates that HCPs do not currently have what they need to feel supported in a way that allows them to adequately care for either their patients or themselves. HCPs described negative working conditions, such as inadequate resources, staffing, autonomy, and mental health support, which led to poor mental health and ultimately decreased the perceived quality of care provided to patients. HCPs who felt that their organization did NOT value their contribution or care about their well-being also endorsed significantly higher symptoms of post-traumatic stress disorder, dissociation, burnout, depression, anxiety, stress, moral injury, and functional impairment. Similarly, our preliminary analyses suggest that higher perceived organizational support and spirituality/religiosity were significantly associated with lower self-reported moral injury symptoms, even after accounting for childhood adversity and mental health diagnosis. Perceived organizational support not only impacts HCPs’ mental health, but also their relationship with their organization and/or profession. For example, HCPs described that persistent pressure from their organization to prioritize work over family led to many HCPs’ to consider leaving their organization and, at times, their profession altogether. Organizations need to take responsibility and accountability for the health and psychological wellbeing of their employees given the various work-related barriers (e.g., increased work hours/ workloads, inadequate mental health funding, etc.) that impede on HCPs’ capacity and ability to seek out individual coping strategies to deal with occupational stress Without such action, staff retention will remain at risk.

The following recommendations are based on interview findings from 123 Canadian HCPs, approximately 300 completed surveys, and a comprehensive literature review. Our recommendations can be grouped under four broader themes: leadership, formal organizational supports, communication, and team. 

  • The leadership theme encompasses the roles of all levels of leadership, including any individual who oversees other employees. HCPs expressed that they do not feel adequately supported and acknowledged by their leadership for the work that they do. 
  • The formal organizational supports theme addresses higher level decision-making surrounding topics like benefits, staffing, policies, and procedures. HCPs described inefficient mental health resource communication and service availability to support mental health in the workplace. 
  • The communication theme refers to processes through which changes in policies and procedures are communicated to staff, as well as how staff communicate feedback on such policies and procedures. HCPs expressed that current communication methods are ineffective, unclear, and inconsistent. 
  • The team theme discusses the frontline staff collaborating on daily tasks, interacting with patients and their families, and leaning on one another for social support. Social support and encouragement received from colleagues during the COVID-19 pandemic were described as positive contributors to the workplace environment where the organization can play a role in enabling the development of strong teams.

A supportive workplace where employees feel valued and equipped to carry out their job requirements must be established at all levels of the organization. The themes and recommendations discussed in this document are interrelated and require cohesive action to facilitate an overall positive work environment, which provides the potential for increased employee wellbeing and, consequently, optimal health system performance. Each recommendation is accompanied by a list of suggested strategies for implementation. Individual organizations will need to determine which strategies will be most appropriate to address the unique challenges that exist within their workplace. There is no one-size-fits-all approach. While some of these strategies may already exist in an organization, there may be a need to adjust current practices to meet the specific needs of employees.