Abstract
Introduction: Globally, health and care systems are experiencing a workforce crisis which has been exacerbated by the COVID19 pandemic. Numerous reports have documented a deterioration in health and care workforce wellbeing, with burnout being called the new pandemic. Burnout is defined as a state of exhaustion in response to chronic organisational stress, which results in feelings of work-related exhaustion, depersonalisation, and reduced personal accomplishment. Research has shown that Rehabilitation Medicine Physicians, often the gatekeepers to accessing specialist rehabilitation services, are among the most likely specialties to experience burnout. According to the United Nations Commission on the Rights of Persons with Disabilities, access to rehabilitation is basic human right and an essential component in the post traumatic and illness integrated care pathway. However, many patients fail to access the services they require. Anything that impacts on access to appropriate expertise will exacerbate this problem. Research has shown that it is the experience of healthcare staff that shapes patient experience of care positively or negatively, not vice versa and evidence shows a strong association between staff wellbeing and organisational performance. Global and national policies and strategies have recognized the importance of ensuring staff wellbeing in health and care organisations and recognised it as a moral, social, and economic priority.
Although there have been many publications on interventions focusing on wellbeing, these have been directed mainly at personal rather than organizational factors. Maslow’s hierarchy of needs, an integrated hierarchy of human needs, has been used to good effect as a framework to assess wellbeing in doctors but not heretofore in Rehabilitation Medicine. Maslow hypothesized in his hierarchy of needs theory, that there exists a hierarchy of five needs within each human being. These include psychological, safety, social, esteem, and self-actualization needs. To enable human flourishing, any organisation needs to understand what level of the hierarchy an employee is currently on and focus on fulfilling those needs at or above that level.
Study Aim: Recognizing the importance of Rehabilitation Medicine Physicians as gate keepers in accessing specialist rehabilitation services, we sought to explore the status of Rehabilitation Medicine Physician wellbeing in a National complex specialist rehabilitation hospital.
Methods: Using the approach of qualitative deductive content analysis (an approach to reanalyzing existing data in a new context) and Maslow’s hierarchy of needs as the categorization matrix, qualitative data from three different data sources was systematically analysed.
Results: Using Maslow’s five needs (psychological, safety, social, esteem, and self-actualization needs), the analysis demonstrated that Rehabilitation Medicine Consultants’ needs were not being met at any of the five levels. The data revealed what constitutes relative deprivation and organisational injustice.
Learning: In order to enable the flourishing of the Rehabilitation Medicine Consultants, the organisation needs to focus on satisfying not just basic needs but creating the conditions for them to function at the highest level. This applies to other health and care organisations as well. The adapted Maslow framework provides a scaffolding for interventions to support such flourishing.
Next steps: Interventions are being investigated to address the issues identified.