Challenges of working in clinical care

Better minds better living with Dr. Yansie Rolston Monday, July 24 2017

WHEN we enter a healthcare institution we expect to receive a high level of service, and anticipate that interactions with the people working there will be positive. Hence, when services are less than expected the staff is rightly held to account. However, we tend to overlook the effect that the work environment can have on the way the staff engage with patients.

Clinical environments are highly pressurised and healthcare professionals are constantly having to deal with life and death, pain, despair and grief. They are also susceptible to other occupational stressors such as poor management practices; unkempt physical spaces; substandard or malfunctioning equipment; fear of culpability for negligence of care –all of which will impact on the quality and standard of service provided.

I have witnessed serious shortcomings at various clinical care institutions both in the UK and in Trinidad and Tobago, and staff have lamented that even though they raise concerns with senior management their voices go unheard.

This deep-seated frustration with the systemic failures and their sense of disillusionment is notable by the impact it has on their overall well-being. To quote a healthcare professional, “it’s a case of shut up and put up with the mess and hope and pray for the patients because if not it will drive me insane”. Another asked: “How can we be expected to deliver a first-class service in a third-rate environment and it not affect us.” The fact of the matter is that healthcare personnel are psychologically, emotionally and cognitively diverse and as such will have different reactions to situations.

But, working in an environment where there are processes which are counter-productive to health and healing (even amongst the most resilient person) will eventually impinge on their ability to deliver the level of service expected.

Let me share some of the challenges raised by the staff at Port of Spain General, San Fernando and Mt Hope Hospitals: Lack of mandatory tools of the trade – equipment malfunctioning due to lack of maintenance Poor communication –illegibility of referral letters and prescriptions, language and cultural barriers Inefficient procurement processes for acquiring equipment, supplies and stationary Inadequate human resources and consequential overwork Occupational safety and health violations – exposure to unsafe situations with risks to cross-infections, receiving abuse, threats and physical violence Working in physical spaces with vermin infestations, broken air-conditioning and unusable furniture Ineffective organisational practices – management failings, nepotism, interpersonal conflicts, lack of training and development, low morale, incompetence Unrealistic patient demands and expectations –hostility, emotional exhaustion Sub-standard records management system – patient documentation, test results, and images consistently being lost Breaches of confidentiality – fear of disclosure of their own health status From discussions with personnel who have been shouted at, rushed off their feet, feel undervalued, are mentally and physically exhausted and in some instances are in a job where there is a mismatch between their personality, skills and the role they perform, it is evident that not only do these issues affect the quality of their work, but they have a bearing on their health and wellness.

Studies in the UK found that 61 per cent of healthcare professionals expressed feelings of stress most of the time, and that they are also prone to increased levels of depression, anxiety, suicide, and have greater rates of substance misuse.

Such findings ought not to be overlooked because all employers have a duty of care for their staff, and if the work environment is not conducive to staff wellness it should be addressed because staff is the most valuable resource within an organisation.

In TT there is a culture of non-disclosure when it comes to mental health mainly due to stigma and discrimination, but the reality is that health care personnel work in environments with heightened occupational and psychosocial stressors that increases their chances of physical and psychological distress and the knock-on effect of not addressing those stressors is the potential for life-threatening clinical errors to occur.

If healthcare institutions are serious about adhering to quality assurance standards and fulfilling their duty of care to patients and employees, then the voices of the staff who wish to discuss the challenges they endure should be listened to. The benefits of having a motivated and empowered workforce should not be underestimated, so taking account of their concerns will be a step in the right direction that can invariably boost morale, improve communication, reduce absenteeism/presenteeism and lead to improved job outputs and outcomes – a win/win situation for all.

Dr Yansie Rolston FRSA is a UKbased disability and mental health specialist advisor. She is a social strategist and trainer who works internationally at various levels of government, business and civil society.

Contact her at

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