Among the many who work hard to maintain the welfare of their colleagues in the medical workplace, Prof Phua Ghee Chee is a notable figure. Prof Phua, Deputy CEO of Singapore General Hospital (SGH), shares with SMA News his efforts and insights in the ongoing work of well-being in his role as the Chief Wellness Officer (CWO) at Singapore Health Services (SingHealth).
Speaking up on wellness and burnout
How did your role as CWO come about?
My appointment as CWO two years ago in 2022 came as a surprise, even to my family. Many of my colleagues had no idea what a CWO was. Even my daughter, who is a medical student, asked me what my "fuzzy new job" was about.
Before taking on this role, I led the SingHealth pandemic ICU response and oversaw clinical care and operations. These experiences gave me a profound understanding of the challenges faced by healthcare professionals and the importance of taking care of their well-being.
During the pandemic, like many of my colleagues, I experienced emotional exhaustion and burnout. The recurrent waves of COVID-19, relentless demands and uncertainty of the situation took a heavy toll on the physical and mental well-being of myself and my healthcare colleagues. The experience underscored the importance of having robust support systems in place for healthcare workers (HCWs). When I was asked to take on the responsibility of taking care of staff well-being at SingHealth and SGH, it resonated deeply with me and I agreed to take on this challenging role without hesitation.
Why is burnout so prevalent in healthcare?
Burnout in healthcare is common due to the high demands and pressures associated with the profession. Healthcare professionals often work long hours, deal with life-and-death situations, and face emotional strain from caring for patients and their families. This can lead to emotional exhaustion, depersonalisation and a reduced sense of accomplishment.
As a former internal medicine residency programme director, I recall speaking with many residents who felt overwhelmed during their residency and struggled to find joy in their work. At SingHealth, studies have shown that approximately 40% of doctors, nurses, allied health professionals and healthcare administrators have experienced some symptoms of burnout.1
How can we foster well-being among healthcare professionals?
I believe in the importance of 3 "Cs": Community, Control, and Connection to meaning.
Community – Being part of a supportive community of colleagues, friends and family helps us cope with challenges and increases our resilience.
Control – Having some degree of control over our present and future fosters a sense of stability and empowerment. For example, by having opportunities for professional growth and development, and participating in committees and projects to positively influence our work environment and policies.
Connection to meaning – Remembering the meaning and purpose of what we do helps us stay positive and withstand challenges. For example, by appreciating our colleagues and sharing heartwarming stories of the impact of our work on our patients' lives.
What are the staff wellness priorities at SingHealth?
At SingHealth, we have established these five pillars of staff wellness to guide our efforts:
- Physical health – Ensuring that staff have access to resources and support to maintain their physical health, including providing access to fitness facilities, encouraging regular exercise and optimising workplace ergonomics.
- Mental health – Providing mental health resources and creating an environment where mental health is prioritised and not stigmatised. This includes providing access to counselling and mental health services, building peer support networks, providing education on stress management, self-care and resilience, and fostering a culture where it is okay to seek help.
- Community building and people engagement – Fostering a sense of community and encouraging engagement among colleagues to build strong and supportive relationships. This includes organising and participating in social events, team-bonding activities and interest groups.
- Career and workplace wellness – Providing opportunities for professional growth and advancement, training and development, and ensuring that staff have access to the resources and support they need to succeed. We are also committed to protecting staff against abuse and harassment in the workplace, enhancing staff wellness spaces, and putting into practice the principles of the "Getting Rid of Silly Stuff" movement, an itiative aimed at reducing the volume of unnecessary tasks and processes at work.
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Culture and values – Building a culture that supports staff well-being through shared values and supportive practices. This includes promoting a culture of psychological safety, mutual respect, inclusivity and positivity.
Our junior doctors' challenges
What are your insights into the challenges faced by junior doctors?
Having been a residency programme director for many years, I gained close insights into the challenges that junior doctors face and empathise deeply with them. The landscape of healthcare is evolving rapidly and with it, the expectations placed on junior doctors. Today, they navigate more complex processes, including administrative tasks, documentation, information technology systems, and patient and family expectations, while keeping up with a constant flow of new knowledge and a rapid pace of work and life. The cognitive load on junior doctors is high, and providing support and resources to help junior doctors cope with these demands is crucial.
What are some initiatives in place to support junior doctors?
Junior doctors face unique challenges, and we have implemented various initiatives to support their well-being and career development:
- Post-call handover – Encouraging junior doctors to hand over their duties promptly and go home earlier after a call to ensure they get adequate rest and recovery time.
- Reducing multiple pre-rounds – Reducing unnecessary workload by eliminating the need for multiple pre-rounds before consultant rounds.
- Clear communication and expectations – Ensuring that the timing of morning and exit rounds are clearly communicated to help junior and senior doctors plan their day more effectively.
- Avoiding routine early morning tests – Advising against routine early morning blood tests, X-rays and other investigations to ease the burden on junior doctors, nurses and allied health colleagues.
- Weekend offs and reduced calls – Providing some weekend offs and reducing the number of calls to help junior doctors maintain a healthier work-life harmony.
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Facilitating career development – Offering various opportunities for junior doctors to develop their careers, including excellent postgraduate training programmes, courses, workshops, mentorships and job opportunities.
How can we overcome viral negativism?
One issue that often affects HCWs is viral negativism – a pervasive sense of negativity that can spread through teams and professional groups. This negativism is particularly detrimental to medical students and junior doctors who are still finding their footing in the workplace. It is important to acknowledge and remember that while challenges are inherent in our roles, we as HCWs hold privileged positions. We have the unique opportunity to make a significant difference in the lives of our patients and their families. Embracing this perspective can help counteract the spread of negativism and reinforce the meaningful impact of our work.
Moreover, it is crucial not to compare ourselves to others. Each and every one of us will have a unique and personal journey. Comparing ourselves to others can lead to unnecessary dissatisfaction and stress. Instead, focus on our personal growth, celebrate our small successes, and learn from our experiences.
A personal perspective
Could you share some personal reflections from your time as a junior doctor?
I remember clearly the importance of teamwork, especially while on calls. One rule we had was that nobody ate until everyone ate, and nobody slept until everyone had their work "under control". Senior residents would often buy supper for us and check in on residents and interns to ensure that we were managing well. The camaraderie was a lifeline during those long exhausting nights.
Peer support was also extremely important. Having a listening ear or a shoulder to cry on during tough times made a world of difference. Seniors taught juniors and the juniors paid it forward. Finding mentors who had the wisdom and breadth of experience to reassure us that everything would be okay was invaluable. They provided not only guidance but also the support needed to navigate the challenges of my early career.
Looking back at my own experiences, a career in healthcare is undoubtedly challenging. It involves sacrifices and trade-offs, trials and tribulations. Resilience is crucial to navigate these difficulties. However, it is also a career filled with immense meaning, satisfaction and personal growth. The friendships forged and the differences made in the lives of others are immensely rewarding.
I know how challenging the life of a junior doctor is. However, with the benefit of hindsight, I can see that the phase of being a junior doctor is transient and relatively short in the span of a much longer career. Looking back, it was one of the most challenging periods of my life, but also one of the periods that shaped me, trained me and benefitted me tremendously. The memories and friendships formed during this time were some of the best experiences and bonds in my life.
How did you balance your personal and professional life as a junior doctor?
Balancing professional responsibilities with my personal and family life was challenging. As a junior doctor, I was perpetually tired, especially when I became a parent. Managing night shifts, long hours, postgraduate examinations and the responsibilities of parenthood required a level of resilience and support that had to be learnt and built over time.
My children are now medical students themselves and will soon be junior doctors. Seeing their experiences and hearing their stories and perspectives remind me of the importance of having a supportive system. We need to ensure that as a healthcare community, we care deeply not just for our junior doctors, but also our nurses, and allied health and healthcare administrator colleagues, and strive to create a supportive, inclusive and positive culture of well-being.
Why is individual responsibility for well-being important?
While organisational support is crucial, well-being is also a personal responsibility. Each healthcare professional must proactively manage their own physical, mental and emotional well-being. I often talk about the concept of the "emotional cup" – taking proactive steps to keep it filled is crucial for our well-being and enables us to remain empathetic towards those who rely on us. Simple actions are important, such as taking breaks, engaging in physical activities, practising mindfulness, seeking support and asking for help. Understanding that resilience is built over time through consistent self-care and self-management practices is vital. By recognising when one's emotional cup is being drained, junior doctors can take proactive steps to replenish their cups regularly, whether through social connections, sleep, rest or simply taking time for self-renewal.
What is the path forward?
Staff wellness is an ongoing journey, and requires the collective effort of the entire healthcare community. By working together and prioritising the well-being of our colleagues, we can create a more resilient, energised, empathetic and joyful community of HCWs – and ultimately, this would benefit both our patients and the wider society.
SingHealth Staff Wellness Council