This section below summarizes best practices for addressing health care worker (HCW) burnout following intense professional commitments. Additional details on preventing and addressing HCW burnout are provided in the Appendix.

Scientific Evidence

Addressing HCW Burnout 

• Several systematic reviews, meta-analyses, and single studies evaluated organizational-, system-level strategies, and individual-level strategies and interventions for supporting HCWs during a pandemic, and preventing or reducing burnout.
  • Organization-directed Interventions: A 2017 systematic review and meta-analysis on physician burnout reported that organization-directed interventions (i.e., rescheduling hourly shifts, reducing workload, structural changes) were associated with higher treatment effects compared with physician-directed interventions (e.g., mindfulness-based stress reduction techniques, educational interventions, exercise, or a combination of these features).
  • Mindfulness-based Stress Reduction: Two systematic reviews reported that brief mindfulness interventions may be effective in improving provider well-being (e.g., reductions in stress, anxiety). One of the included studies (2006) involving nurses and nurse aides reported that a brief, four-week mindfulness-based stress reduction intervention improved burnout symptoms. Larger studies are needed to assess an impact on clinical care.
  • Communication Skills: A 2019 review reported that communication skills training with e-mental health interventions, and psychiatric interventions were the most effective interventions for improving burnout among hospital physicians and nurses in the Netherlands, US, and England.

Research Gaps

• A 2020 systematic review on the mental health of frontline health and social care professionals during and after a disease outbreak, epidemic, or pandemic reported that no evidence reported on the effectiveness of interventions aimed at supporting HCW resilience.
• A 2016 review reported that additional research is needed to clarify categories of beneficial interventions to reduce physician burnout, which interventions or combinations of interventions might be most effective, and optimal approaches to development and implementation of these interventions.

Addressing Burnout Among Women

• A 2020 systematic review on burnout reported that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic; however, few studies discuss potential interventions to support them.
  • Preferred Resources: One of the included studies (2020) on the mental health of medical and nursing staff in Wuhan during COVID-19 suggested that women HCWs favoured psychological resources available through media (i.e., online push messages of mental health self-help) and self-help books, over counseling or psychotherapy.

Proposed Strategies for Supporting HCWs

The research most commonly proposed the following individual- and organizational- interventions for supporting HCWs:

• Individual Methods: Research focused on health promotion strategies that included: 1) healthy diet and adequate water intake; 2) physical activity; 3) recreational and relaxation activities (i.e., yoga, mindfulness activities, focused attention); and, 4) emotion-focused coping (e.g., compassion practices, emotional skills).
• Organizational Approaches: Research focused on organizational interventions that include: 1) improving work schedules; 2) providing counseling support meetings that promote self-management; 3) supporting HCWs financially; 4) provision of rest areas for sleep and recovery; 5) training programs to improve resiliency; 6) information on protective measures; 7) duty hour limitation policies; and, 8) physician debriefing sessions.

Barriers and Facilitators to Implementing Interventions

• The 2020 systematic review on the mental health of frontline HCWs during and after a disease outbreak, epidemic or pandemic, suggests barriers and facilitators to implementing interventions:
  • Barriers: Two factors were barriers to intervention implementation:
    • Frontline workers, or the organizations in which they worked, not being fully aware of what they needed to support their mental well‐being; and
    • A lack of equipment, staff time or skills needed for an intervention.
  • Facilitators: Three factors were facilitators of intervention implementation:
    • Interventions that could be adapted for local needs;
    • Having effective communication, both formally and socially; and
    • Having positive, safe and supportive learning environments for frontline workers.

International Scan

Supports for Health Care Workers in Hospitals

• The Policlinico of Milan Hospital (Spain) used a ‘modular’ approach to provide a stress-relieving strategy among health care workers during the pandemic. These included: establishing rest spots; therapy-based booklet; mindfulness exercises; psychological phone hotline. Priority was given to those easily deliverable over the intranet or accessible by phone at the health worker’s convenience. The program is currently under evaluation.

Guidelines and Recommendations for Addressing COVID-19 Burnout Among HCWs

• Guidance documents from Canada (e.g., Canadian Medical Association), the US (i.e., Cleveland Clinic, Centers for Disease Control and Prevention [CDC]), and studies from other international jurisdictions, suggest individual, departmental, and organizational actions to alleviate moral distress and the mental, physical, and financial impacts of the COVID-19 crisis. For example:
  • The Cleveland Clinic (US) recommends a seven-step process for addressing caregiver moral distress. Steps include: 1) see and seek moral distress; 2) understand moral distress; 3) pay attention and assess workplace climate; 4) promote a receptive environment and engage team members; 5) open opportunities for dialogue: 6) reflect, evaluate, and revise; and, 7) transform negative environments 

Canadian Scan

Supports for Health Care Workers in Hospitals

• The Centre for Addictions and Mental Health (CAMH) has developed two as-yet-unevaluated programs to support hospital-based health care providers and residents, and other frontline responders during COVID-19: the ECHO Coping with COVID; and a hub for evidence-based resources that will support health care workers manage their own mental health and support their patients and families. The ECHO Coping with COVID includes live virtual one-hour ECHO sessions occur weekly through multi-point videoconference technology. Topics include:
  • Overview of Self-Care & Wellness During COVID-19;
  • Managing Information Overload During COVID-19; and
  • Managing Stress in the COVID-19 Era.

Ontario Scan

Supports for Health Care Workers in Hospitals

• The 2003 severe acute respiratory syndrome (SARS) outbreak in Mount Sinai Hospital in Toronto (Ontario) prompted an administrative and mental health response in the first four weeks and afterward, including:
  • Provision of clear, succinct information and appropriate equipment and supplies;
  • Development of pamphlets that identified signs of anxiety and stress and information about support resources;
  • Informal contacts between psychiatric staff and colleagues in medicine, surgery, and administration;
  • Offering staff time with psychiatrists they did not have working relationships with;
  • A drop-in support centre; and
  • A confidential telephone support line staffed by inpatient psychiatric nurses.

Individual peer-reviewed articles were identified through PubMed and Google Scholar. The search was limited to English sources and therefore may not capture the full extent of initiatives in non-English speaking countries. Full-text results extracted were limited to those available through Open Access or studies made available to the Ministry by our partners. Jurisdictional information was identified using Google and on relevant government websites.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following member of the Network developed this Evidence Synthesis Briefing Note:

• Evidence Synthesis Unit, Research Analysis and Evaluation Branch, Ministry of Health. June 11, 2021.