Emergency Medicine Australasia (2020) 32, 706–708 doi: 10.1111/1742-6723.

13571

PERSPECTIVE

Safer coalmines, happier, healthier and more engaged

canaries
John BONNING,1,2,3 Didier PALMER,1,2,4 Clare SKINNER2,5 and Andrew MACDONALD6
1
ACEM Board, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia, 2Council of Advocacy, Practice and Partnerships,
Australasian College for Emergency Medicine, Melbourne, Victoria, Australia, 3Emergency Department, Waikato Hospital, Hamilton, New
Zealand, 4Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia, 5Emergency Department, Hornsby Ku-ring-gai
Hospital, Sydney, New South Wales, Australia, and 6Communications and Media Division, Australasian College for Emergency Medicine,
Melbourne, Victoria, Australia

Abstract advocacy work around the chal- the fact that the overall health of the
lenges of burnout and wellbeing systems in which emergency physi-
Addressing and limiting burnout and shows that this principle strongly cians work and operate is a key con-
its significant impacts on emergency informs its efforts. tributor to individual health and
physicians is an important and ongo- As Douros acknowledges, the wellbeing.
ing challenge, requiring much more issues of burnout and wellness are The American College of Emer-
than a focus on individual resilience. not new. They have been important gency Physicians, as part of Emer-
This is a key understanding which areas of focus for ACEM since its gency Medicine Wellness Week, has
guides and informs the Australasian foundation. These are not uniquely accentuated the holistic approach
College for Emergency Medicine’s Australasian issues, a fact acknowl- with a focus on a ‘wellness wheel’3
holistic approach and advocacy efforts edged in a joint statement released model which lists emotional, physi-
when it comes to the wellness of emer- earlier this year,2 co-authored by cal, occupational, financial, spiritual,
gency physicians and the health sys- ACEM and its equivalent colleges in social and intellectual as the seven
tems in which they operate. the USA, Canada and the UK. spokes of wellbeing.
The statement acknowledged the In highlighting some clearly con-
Key words: advocacy, burnout, significant risks associated with cerning statistics in relation to feel-
engagement, leadership, resilience, burnout syndrome (BOS) among ings of emotional exhaustion and
wellbeing. physicians in general, and emergency intentions to reduce professional
physicians in particular, calling for, hours among members and trainees,
An article in the previous edition of among other things: ‘Better under- Douros referenced the 2016 ACEM
this journal Burnout is the canary in standing and mitigation of the key Workforce Sustainability Survey.4
the coalmine; the solution is not underlying causes of BOS in Emer- The same survey also found that
stronger canaries1 discussed issues gency Physicians, including systemic overall, respondents felt supported
linked with burnout among our factors which are remediable, such by their immediate ED work col-
emergency medicine workforce. as access block and violence in leagues, and they most commonly
We agree with much of what was the ED’. reported that peer support
presented, particularly the assertion As understanding of the complex programmes and networks and men-
that in order to decrease burnout, it factors and components contributing toring programmes and networks
is crucial to address the key underly- to burnout and wellness has evolved, can best support their careers.
ing causes and not just have a focus so too have approaches to addressing ACEM has welcomed the emergence
on individual resilience. A compre- the many challenges. of grass-roots, clinician-driven initia-
hensive analysis of Australasian The College’s awareness and advo- tives, for example the WRAP EM5
College for Emergency Medicine’s cacy efforts have now advanced to online community, and encourages
(ACEM) significant, ongoing the point its work is underpinned by members and trainees to engage with
such initiatives.
Correspondence: Dr John Bonning, Australasian College for Emergency Medicine, 34 Respondents to the survey also
Jeffcott Street, West Melbourne, VIC 3003, Australia. Email: president@acem.org.au suggested ACEM’s role in supporting
John Bonning, BHB, MBChB, FACEM, President, Emergency Physician; Didier the specialist emergency medicine
Palmer, MBBCh, FRCS, FRCP, FRCEM, FACEM, Council of Advocacy, Practice and workforce was through stronger
Partnerships Chair, Director of Emergency Medicine; Clare Skinner, BSc, BA (Hons), advocacy, member health, wellbeing
MBBS, MPH, FACEM, Council of Advocacy, Practice and Partnerships Deputy Chair, and support, ED accreditation and
Director of Emergency Medicine; Andrew MacDonald, BA, DipJour, Media Relations training, workforce planning, provi-
Manager. sion of support resources, awareness
Accepted 8 June 2020 raising and professional development.

© 2020 Australasian College for Emergency Medicine

ADVOCACY AND ENGAGEMENT, SOLUTIONS TO BURNOUT
The College does offer a range of
resources and support services on its
website and portal. This support also
extends beyond the online domain;
ACEM membership and culture staff
are tasked with supporting members
and trainees through many resources,
initiatives, communications and events.
Acknowledging that system health
has such a bearing on individual
health and wellbeing, the College
has a proud history of advocacy in
support of members and trainees, on
the issues affecting emergency medi-
cine. This includes:
• Extensive and ongoing work on
the need to address access block
bi-nationally and jurisdictionally;
for example the 2008 Access Block
Summit and numerous other activi-
ties and political advocacy since;6
• Significant advocacy to address
the long ED waits faced by people
in mental health crisis including
mental health summits in Australia
(2018) and New Zealand (2019).
This issue has been a significant
stressor for ACEM members and
trainees over recent times;
• Health system reform work, includ-
ing revisiting time-based targets, as
part of efforts to ensure they play a
role in driving meaningful systemic
reform to address access block;
• Work with Swinburne University
researching leadership challenges
for ED Directors, and develop-
ment of ED leadership develop-
ment programmes;
• Significant work in relation to the
emergency medicine workforce to
promote sustainability and best
practice; and
• Rapid development of clinical
guidelines in response to COVID-
19 to support emergency physi-
cians with the management of the
pandemic.
While many of these issues are
ultimately beyond the College’s con-
trol, resting with hospital and
healthcare system executives and
government, it continues to advocate
via its various mechanisms of influ-
ence on the workplace.
Further evidence of this can be
found in the College’s comprehen-
sive range of position statements,
policies, action plans, steering groups,
strategies, standards and resources
© 2020 Australasian College for Emergency Medicine
addressing issues including access
block, patient safety, diversity and
inclusion, alcohol and drug harm,
mental health, healthcare equity for
Aboriginal and Torres Strait Islander
and Maori peoples; occupational vio-
lence and ED design. Details on these,
and more, are available within the
Advancing Emergency Medicine,7
and Emergency Medicine Standards8
sections of the College’s website.
One point of contention contained
in Douros’ article is the suggestion
that ACEM’s workforce plan for
burnout has been to ‘churn-out’
FACEMs. This is not the case; the
College has taken steps to balance
trainee intake with workforce require-
ments, while also ensuring Fellows
are trained properly, and have ongo-
ing support for the greatest possible
chance of success in their careers.
Accreditation to train emergency
medicine trainees is withdrawn from
EDs which have systemic issues that
contribute to burnout such as access
block, insufficient workforce or bul-
lying culture.
The College acknowledges organi-
sational and individual approaches
to addressing burnout and wellbeing
must consider a full range of factors;
from the individual (characteristics,
qualities, skills, training) to the sys-
temic (industrial, rosters, corporate cul-
ture, resourcing, professional support).
Exactly what works will be differ-
ent for everyone, but clearly agency
is important. The often-referenced,
Whitehall Studies9,10 – which exam-
ined the health of British civil ser-
vants – highlighted that a sense of
control over work was an important
determinant of health, with situa-
tions of high demand and low con-
trol predictors for a range of
illnesses. Engagement is an antidote
to burnout; building individual and
system resilience, as well as promot-
ing engagement to ‘fix the system’.
Individuals need to be able to
choose a life balance that works for
them. For some this may be yoga
and mindfulness, or control over
working hours. Some want to exer-
cise, or sing in a choir or be an edu-
cator, a mentor, or finding reward in
writing policy and shaping the future
of the specialty. For many it will be
a combination.
707
Diversity is important, and it is a
diverse range of voices and opinions
which shape the College’s approaches
to burnout and wellbeing. Most
important are the voices of members
and trainees. The College exists
because of, and for them. If there is
something they would like to see or
change, they have agency, through a
range of mechanisms to advance
those objectives. The tangible sense of
achievement and reward achieved
through that may in turn contribute
to wellness.
In line with the College’s Core
Values of Equity, Respect, Integrity
and Collaboration, it strives to
embrace and advance compassion
(particularly self-compassion), engage-
ment, civility, connection and kindness,
as it grapples with the challenges of
burnout and wellbeing. Civility saves
lives. It reduces errors, cynicism, burn-
out, absenteeism, presenteeism and
improves teamwork, patient safety and
patient outcomes.
Perfect wellness initiatives are hard
to find, and some can seem to blame
the individual, inferring the problems
lies with them. But with genuine
wellbeing meaning both individual
and the system are well, the College
remains committed to striving
towards that balance.
Acknowledgements
The authors wish to acknowledge
ACEM employees Nicola Ballenden,
Executive Director of Policy and
Strategic Partnerships and Andrea
Johnston, Membership and Culture
Manager for their participation in
writing and editing the manuscript.
Competing interests
None declared.
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