Beyond PPE: a mixed qualitative-quantitative study capturing the wider issues affecting doctors' well-being during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has brought unprecedented challenges to the medical workforce. This has put them at increased risk of burnout at a time when levels are already worryingly high in the profession, with recent studies consistently showing that around half of doctors meet the validated criteria for burnout.

Objectives: To understand the wider factors influencing and impacting upon hospital doctors' well-being during the COVID-19 pandemic in England.

Design: Cross-sectional survey and mixed quantitative-qualitative analysis.

Setting: Acute National Health Service (NHS) Foundation Trust in England.

Participants: An online survey was circulated in early June 2020 to all 449 doctors employed by the Trust. 242 doctors completed the survey (54% response rate).

Primary outcome measures: Questions assessed occupational details, self-reported changes in physical and mental health, satisfaction with working hours and patterns, availability of personal protective equipment (PPE), medication and facilities, communication and sought to identify areas seen as having a significant effect on doctors' well-being.

Results: 96% of respondents requiring PPE were able to access it. Nearly half of the respondents felt that their mental health had deteriorated since the start of the pandemic. Over a third stated that their physical health had also declined. Issues identified as having a negative impact on doctors included increased workload, redeployment, loss of autonomy, personal issues affecting family members, anxiety around recovery plans, inadequate access to changing and storage facilities and to rest areas that allow for social distancing. Doctors appreciated access to 'calm rooms' that were made available for staff, access to clinical psychology support, free drinks and free car parking on site.

Conclusion: The emerging themes are suggestive of increased burnout risk among doctors during the COVID-19 pandemic and encompass factors well beyond shortage of PPE. Small organisational initiatives and the implementation of changes suggested by survey respondents can have a positive impact on doctors' well-being.

Keywords: COVID-19; mental health; occupational & industrial medicine.

Figure 1

Demographics by grade of doctors responding to our survey and across the Trust at which the survey was undertaken (N=242). GP, general practice; LED, Locally Employed Doctor.

Figure 2

Demographics by specialty of doctors responding to our survey and across the Trust at which the survey was undertaken (N=242). AAU, acute assessment unit; ED, Emergency Department; GP, general practice; ITU, anaesthetics/intensive treatment unit.

Figure 3

Self-reported decline in physical and mental health among respondents; specialties are listed here by alphabetical order (N=210; the question was not made compulsory in the survey). AAU, acute assessment unit; GP, general practice; ITU, anaesthetics/intensive treatment unit.

Figure 4

Causes of anxieties and stress, as identified by the nominal (quantitative) question: ‘Within the past 2 weeks, have any of the following caused you additional worry or anxiety?’ (N=219; the question was not made compulsory in the survey). PPE, personal protective equipment.

Figure 5

Manual qualitative analysis of the free-text answers to the survey led to the identification of seven major themes, many of which overlap with the factors relevant to burnout as identified by Leiter and Maslach (see text).