This is part 3 of my guide to managing burnout in your staff. I'll link parts 1&2 at the bottom.

Today, I'll be concentrating on the longer term. This is the organisationally hard part as you'll be battling both internal inertia and finances.

The first two parts were:
1. Managing burnout today
2. Managing tomorrow

Each incremented up in organisational challenge, moving from operations to crisis planning, and now to future planning to help build organisational resilience

This follows the same format as before, I'll provide a skeleton for local plans with some suggestions on ways to do that.

The aim is to create an organisation capable of minimising burnout, and to provide structure to those who need help.

In part 1, I showed 5 ways to help today, these are the same for planning long-term:


They follow much the same principles, you just have a lot longer to get them right! These are suitable for all sizes of organisation.


This must have senior ownership, it's not acceptable to delegate this to a HR team, facilities/estates or lower level managers. If you're too important to manage your staff wellbeing then you're in the wrong job.

Let's start with information gathering:


Commission both subjective and objective reviews of staff working environments for how they can rest in a working day. Where can they get a break? Is there good quality food available nearby? Are your staff actually taking their breaks?


Start with a review of pre-COVID annual leave. Are there trends in who does/doesn't take leave? This is your baseline. Then do it from 1/3/20 until now.

Do the same for sick leave. Unless you've a perfect org, doing this by team will raise some flags.



Review your rota system. Is it hard and inflexible? Have you ever had any complaints about it? Do staff have to plan major personal events around you, or is there flexibility?

Your union shop steward will be your key ally in this if you're acting in good faith.


For the NHS, this is the hardest of all the tasks for a Board. Reserves cost money. The tool that's most in your control here is workforce planning: have you the right and safe skill mix? What do your team leaders say? What does your union say?



Do you have succession plans that go from Board to your lowest bands? Ask open questions to test attitudes as this will identify points of resistance for later.

Do you have crisis plans? Have people been keeping records of how they've done it in this pandemic?


This will test culture and organisational inertia. Every NHS org is different, but you have tools in your locker here.

One is training, give people a break to do training. Look at training time per staff grade and also staff leading peer-peer training.


I find the NHS is frankly decades behind the private sector in this. Can you show stats on how you identify burned out staff members, and once identified how you help them? Or, do you implement dry HR processes to protect your org?



Review your sickness policies. Are they dry and protective? Or do they give genuine staff support rather than leaving it to individual leaders?

Ask for proof of how you've reached out to people off sick to help them, with no ulterior mechanism.



Find out your stats on conversion to return to work of people off sick with mental health for more than a few days. How many return just before policy deadlines, whether better or not?

What in-work support to do you offer returners?



Do you offer professional support for mental health issues? How can your clinicians get mental health support without fearing (e.g.) a GMC report about their fitness? How do you openly stop unwarranted professional career detriment?


If you've done your data gathering robustly, you'll already have key themes for improvement. Treat it as a continuous improvement plan rather than a grand plan.

I won't tell you how to write a plan, you already know this.



Your key challenges are finding the money to fund this and getting over old-fashioned resistances to helping with mental health issues. Leverage everyone and everything you can, and encourage personal level leadership at all levels.


I find it inexcusable in 2021 to not treat burnout and mental health issues in the workplace seriously, yet many are reluctant to address it for historical reasons. Be brave, step up, lead and remember your duty of care as a leader.

(Personal note)

I hope you've found this three-part summary on burnout helpful. It is not aimed at individuals, helping with "resilience" or similar, there are far more qualified people out there to help with that!
p.s. here's the part 1 that I did on managing today:

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More from @CraigNikolic

12 Jan
This is part 2 on my guide to managing burnout in your staff. I'll link part 1 at the bottom.

Today, I'll be concentrating on the hardest bit: What happens when COVID starts to recede.

The third part will cover long-term plans.

When the vacc campaign gains momentum along with other measures, COVID will recede. One day you'll get to a point your COVID appointed staff start to see patient numbers drop off, people will start to think back on what they've seen.

You must start planning for this now.

This is where management will earn their pay, this is the most dangerous point for staff mental health as people will start to find the capacity to process all the trauma and moral injury of the last year.

Here's a skeleton plan for you to shape your local version:

Read 19 tweets
11 Jan
As promised, here’s my guide to staff burnout management during COVID. I’ll post over several days.

First though, the basics.

As a senior NHS leader, you must manage staff wellbeing. It's your primary job. If you don't do this, how on earth are you going to deliver?

Today’s thread covers the problem TODAY. Tomorrow, I’ll cover the mid-term problem

Today, you have a problem: your clinical and non-clinical staff are burning out. What tools do you have available to you?



This is a same day tool. Mandatory breaks, somewhere to go for a sandwich in peace, or with colleagues.

Walk through the working environment, where can staff go to escape for a while?

Does your lower tier management understand the importance of working day breaks?

Read 15 tweets
1 Jun 20
The NHS is trying to do many projects at speed now for all sorts of reasons, but doing them with the same processes that haven't exactly worked in the past.

Here's my 4 Tweet guide for those who manage project managers, or are clinicians on projects.
1. Show me the requirements

If you don't know what you're trying to achieve then you've failed before you start. This is the picture of what it'll look like once you finish.

This is the most often abandoned bit by those who don't really deserve to be called project manager.
2. Show me the patient impact

EVERY NHS project must show the patient, if it doesn't then you're wasting time and money.

How will this help the patient? This could be anything from reducing clinician burden (faster logins, etc.) to getting the right ratio of ITU/general beds.
Read 6 tweets
14 Feb 20
I was asked to facilitate a PCN planning session yesterday for next year's specifications and workforce. I thought I'd share the framework I used to help them work it through. Here it is, and I'll explain over a few more tweets.

1/ Image
Start bottom left with the patient experience, what are their needs, how you know and is everyone sharing this? Be brutal, keep it on patients.

This is critically important. How do you know those are the patient pain points? Have you asked them? Is that a shared PCN picture?

Then move onto the NHS people working with those patients. Be brutal, keep it on people, but keeping the patient context in mind.

Then move onto practices, what's the pain points they're suffering in this with the previous context in mind?

Then PCN, then CCG size, then up.

Read 8 tweets
25 Nov 19
Interesting but this is only half the story though. Some examples in a thread on the drivers of GP demand:
Long waiting lists in hospitals? Patients go back to their GPs for interim care. My rough rule-of-thumb is a two month wait creates a new GP contact for interim care.
Increased treatment thresholds. E.g. if the hip replacement threshold is increased, you have ill folk in serious pain who need intervention and they will need increasing GP time until they finally get over that threshold.
Read 13 tweets

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