Moral Injury of Healthcare

Health care workforces in the United States and Europe are struggling and shrinking at unsustainable rates, write the authors of a new Perspective. One in five doctors and one in four nurses may leave the profession in the next 3 to 5 years. Many observers ascribe this exodus to burnout, which increased during and after the Covid pandemic. Burnout arises when demands surpass worker resources and has proved stubbornly resistant to interventions. In failing to consider the roles of compromised values, ethics, and existential meaning as drivers of distress, however, “burnout” offers an incomplete account of the health workforce crisis. By contrast, “moral injury” describes the values-based distress inherent in forsaking the foundational principle of the healing professions: the covenant of care. This experience is rooted in relational ruptures and ethical dilemmas that reflect the significant personal meaning people ascribe to perceived transgressions and betrayals. Such “meaning attached” experiences are distinct from the “transactional imbalance,” or demand–resource mismatch, of burnout, though they often coexist with that imbalance. Understanding the common drivers of moral injury in various types of health systems is vital for identifying effective solutions to ensure a thriving workforce and optimized patient care.    Continue reading the Perspective “Moral Injury and the Global Health Workforce Crisis — Insights from an International Partnership” by W. Dean et al., from Moral Injury of Healthcare and elsewhere: https://nej.md/4dY99CA 

Out today in NEJM Group: "Moral Injury and the Global Health Workforce Crisis — Insights from an International Partnership" coauthored with Simon Talbot, and valued collaborators in the UK and France: Deborah Morris, Pierre-Michel Llorca, Guillaume Fond, Antoine Duclos, and Laurent Boyer. https://lnkd.in/esjxEcSF Occupational distress needs new framing, to include #moralinjury. And it is not only about corporatization and profiteering. It is about how we, as societies, choose to distribute our resources - the structural determinants of health. We don't have the luxury of another half century to assess and address these challenges. The stakes are too high, and demand is about to explode. We cannot afford any amount of unnecessary attrition. So let's set about implementing new solutions based on an updated understanding of the crisis. - "As the French and British health care systems become increasingly privatized and financialized, mirroring the U.S. system, the potential for moral conflicts and moral injury among administrators, clinicians, patients, payers, and vendors will grow." - "Leaders of health care systems, professional societies, and national agencies need to acknowledge moral injury as an experience separate and distinct from burnout, which therefore cannot be effectively redressed within the burnout framework." - "Skirting public conversations about resource allocation leaves weighty and morally fraught decisions to either policymakers or individual clinicians, increasing the risk of moral injury to clinicians." - "Only through dialogue, mutual respect, and a collective commitment to ethical care can we lay the foundation for health care systems that are resilient, equitable, and truly morally centered."

Focusing on improving organisational cultures to create ethically centred healthcare organisations is a key goal to improve the wellbeing of both the workforce and the 'health' of healthcare services. Healthcare experiences avoidable and unavoidable moral and ethical dilemmas in the context of operating in highly regulatory frameworks, which can foster blame cultures, scapegoating and a focus on the 'violations of rules'. The 'Just and Learning Culture' model is gaining traction as an approach that refocuses organisational values, culture and practice around responding to incidents, patient harm and complaints. Its outcomes suggest that this approach enhances the wellbeing and growth of individuals, teams and organisations. The video below gives an overview of the model and Mersey Care's experiences with implementing it. https://lnkd.in/eTA5k545 Mersey Care NHS Foundation Trust have led the way in implementing, and learning from, the 'Just and Learning Cultures' model in the UK and we are delighted that Joe Rafferty CBE will be speaking about Mersey Care's experiences in implementing this model at the 4th International Occupational Distress and Moral Injury conference on the 15th October. This online event is co hosted with Centre for Developmental and Complex Trauma, The Crisis, Disaster and Trauma Section of the British Psychological Society, and the Moral Injury of Healthcare. The conference will offer 10 live papers from UK and international speakers exploring how we can restore, recover and repair healthcare organisations, through focusing on systemic drivers. Tickets start at £25 and can be booked here: https://lnkd.in/eqfJsk4r Wendy Dean, MD, Dr Annette Greenwood,St Andrew's Healthcare #moralinjury #occupationaldistress #healthcare #conference

Focusing on improving organisational cultures to create ethically centred healthcare organisations is a key goal to improve the wellbeing of both the workforce and the 'health' of healthcare services. Healthcare experiences avoidable and unavoidable moral and ethical dilemmas in the context of operating in highly regulatory frameworks, which can foster blame cultures, scapegoating and a focus on the 'violations of rules'. The 'Just and Learning Culture' model is gaining traction as an approach that refocuses organisational values, culture and practice around responding to incidents, patient harm and complaints. Its outcomes suggest that this approach enhances the wellbeing and growth of individuals, teams and organisations. The video below gives an overview of the model and Mersey Care's experiences with implementing it. https://lnkd.in/eTA5k545 Mersey Care NHS Foundation Trust have led the way in implementing, and learning from, the 'Just and Learning Cultures' model in the UK and we are delighted that Joe Rafferty CBE will be speaking about Mersey Care's experiences in implementing this model at the 4th International Occupational Distress and Moral Injury conference on the 15th October. This online event is co hosted with Centre for Developmental and Complex Trauma, The Crisis, Disaster and Trauma Section of the British Psychological Society, and the Moral Injury of Healthcare. The conference will offer 10 live papers from UK and international speakers exploring how we can restore, recover and repair healthcare organisations, through focusing on systemic drivers. Tickets start at £25 and can be booked here: https://lnkd.in/eqfJsk4r Wendy Dean, MD, Dr Annette Greenwood,St Andrew's Healthcare #moralinjury #occupationaldistress #healthcare #conference

📢 We need proactive and ethically centred solutions to reducing and preventing occupational distress in healthcare- 📢 Today, in conjunction with the Crisis, Disaster and Trauma Section of the BPS and the Moral Injury of Healthcare, we are launching our 4th International conference exploring moral injury and occupational distress. This online event, taking place on the 15th October, will focus on how we can prevent occupational distress through attending to and improving our understanding and provision of support for the ethically and morally complex contexts of our work.  The conference consists of three symposia and a panel discussion of senior healthcare leaders ·     1️⃣  Symposium 1: Focuses on exploring (i) Moral injury and its roots, (ii) exploring the role of moral injury in accounting for clinician distress and (iii) stressing the need to adopt de pathologising approaches to moral injury and occupational distress ·      2️⃣ Symposium 2: Reviews the evidence base for ‘what works’ in reducing occupational distress, (ii) embedding ethics into professional and CPD programmes and normalising moral conflicts and (iii) re discovering the ethical basis of clinical practice ·      3️⃣ Symposium 3: Explores proactive approaches to (i) developing healthy systems by focusing on ‘just cultures’, (ii) the role of clinical ethics boards to support clinician decision making (iii) and supporting leaders and teams in crises ·     🤝  Panel Discussion: Barriers and facilitators for senior healthcare leaders to engaging in ethical behaviour We are very pleased that Professor Joe Rafferty CBE, CEO of Mersey Healthcare NHS Foundation trust, and a pioneer in the ‘Just cultures’ work, Professor Jill Maben Jill Maben OBE., a very respected nurse researcher in occupational support mechanisms, and Dr Tine Molendijk, a world class moral injury researcher, are offering keynote addresses at this event.  The event will be co-chaired by the author of 'If I betray these words', Wendy Dean, MD and a leading authority on moral injury in healthcare. The conference as a whole draws on speakers from the UK, US and Europe. As with all our conferences, there is an opportunity to submit an abstract for a poster presentation at the event. The submission form can be accessed on the link below.  Please contact us for an informal discussion to support submissions for this event (cdct@stah.org). Tickets can be booked here: https://lnkd.in/edMEFKfP? #moralinjury #conference #occupationaldistress #heathcare St Andrew's Healthcare Dr Annette Greenwood