Anthony Montgomery: Connecting healthcare professionals’ wellbeing and clinical practice

The logic of connecting healthcare professionals’ wellbeing and the enhancement of clinical practice should be obvious when we consider the substantial evidence-base which shows that how we perform is symbiotically linked with how we feel. [1,2] The fact that this connection has received inadequate attention in medical curricula and professional development is rooted in the myth of the heroic physician who is resilient and expected to be a leader in healthcare.[3]

Today burnout and its associated mental health problems are reaching an epidemic rate among healthcare professionals. [5] The consequences for the health and safety of the population ripple outwards in all directions. No solution has so far been given at a national or European level. All interventions developed so far are at the margins of organisational functioning, have had limited effectiveness, and almost no sustainability. 

In order to begin to tackle some of these issues, we need to have a serious conversation about real organisational solutions in healthcare. There is considerable lip-service given to the idea that we should change work practices. However, these conversations are inevitably watered down due to the need to recognise the reality that work practices are difficult to change, and the fact that healthcare employees perceive such initiatives as yet another burden. Add to this the growing recognition that healthcare systems are under staffed and have “‘to do more with less”, [6] and the idea of changing work practices and organisational culture seems like a Sisyphean task. Happily, there are some bright spots on the horizon, with The BMJ’s push towards creating rest facilities for doctors. [7,8] However, such campaigns highlight the fact that there is a need to ensure that healthcare professionals have a space to rest, which tells us all we need to know about the norms in most healthcare settings.

We also need to have serious conversations about the experience of patients and the role of the general public in influencing healthcare delivery and healthcare policy. Meaningful input from patients, in terms of medical conferences and peer review, is developing in the right direction. However, we are not yet discussing the elephant in the room⁠—degraded health services will impact hardest on the most vulnerable sections of our communities

It should be no surprise that when the going gets tough, stressed healthcare workers will cope by skimming over the aspects of care that are the least likely to be measured and valued. For example, caring neglect (e.g., not showing compassion or maintaining the dignity of patients) is a phenomenon that is below the threshold of being proceduralised (and is unlikely to cause immediate harm), yet leads patients, family and the public to believe that staff are unconcerned about the emotional and physical wellbeing of patients. [9] Caring neglect is likely to “fall under the radar” of quality assessments. Regulations and targets are unlikely to reduce the phenomenon of caring neglect, even though it is the focus of patient complaints. [10]

Finally, we need to develop and test the first clinically embedded, organisational solution for burnout, the underlying cause of all mental health problems in health professionals. Our idea is to transform traditional clinical patient rounds into resilience forums in order to halt the spiralling decline of mental health of health professionals working in hospital settings. [11] The potential stigma, financial penalties, and licensing repercussions leading to reluctance to seek care clearly exacerbate mental health crisis in the health profession. Not surprisingly, healthcare professionals tend to self-diagnose and self-treat, and even self-prescribe. [12,13]

It is against this backdrop that the fourth meeting of WELLMED will take place in May 2020. The network conducts research aimed at exploring how burnout and wellbeing are related to different aspects of quality of care and patient safety, in terms of clinical decision making, communication in clinical practice, medical errors, civility at the workplace, and patient neglect. 

Addressing burnout is not a panacea for all the problems in healthcare, but it is the bridge that helps us link complex work relationships with poor health among both healthcare professionals and patients. [14] Burnout harms both healthcare professionals and patients in equal measure. The recent recognition by the World Health Organization that burnout is an occupational phenomenon (and not a medical disease) opens the way for policy makers to fund organisational strategies aimed at research and amelioration. [15]

Anthony Montgomery is a professor of work and organizational psychology at the University of Macedonia in Thessaloniki, Greece.
Twitter: @monty5429
Competing interests: None declared


  1. Ignacio J, Dolmans D, Scherpbier A, et al Stress and anxiety management strategies in health professions’ simulation training: a review of the literature BMJ Simulation and Technology Enhanced Learning 2016;2:42-46. 
  2. LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med 2009;84:S25–33. 
  3.  Montgomery A. Physicians as leaders: are we trying to fit square pegs into round holes? BMJ Leader 2018;2:128-131. 
  4.  Bureau of Labor Statistics, State Occupational Employment Statistics Survey, May 2018. Available at
  5.  European Commission (2012), EU Employment and Social Situation. Quarterly Review, Special Supplement on Health and Social Services, December 2012, Brussels. Available at
  6. Campbell D. NHS suffering worst ever staff and cash crisis, figures show. The Guardian. 2018 11 September. Available from
  9. Reader, TW, Gillespie, A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Ser Res2013;13:156.
  10. The NHS Information Centre for Health and Social Care: Data on Written Complaints in the NHS 2010–11. Leeds: The Health and Social Care Information Centre, 2011. Available from
  11. Panagopoulou E, Montgomery A. From burnout to resilient practice: is it a matter of the individual or the context? Med Edu 2019
  12. Hem E, Stokke G, Tyssen R etal. Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwides ample. BMC Medicine 2005; 3:16.
  13. Marshall EJ. Doctors’ health and fitness to practise: treating addicted doctors. Occupational Medicine, 2008; 58:334–340.
  14. Ahola K, Hakanen J. Burnout and health. In: Leiter MP, Bakker AB, Maslach C (eds). Burnout at work: a psychological perspective. London: Psychology Press, 2014:10-31.
  15. World Health Organization. Burn-out an “ocupational phenmenon”: International Classification of Diseases. 2019 May. Available from