Psychosocial risk in healthcare: progress is built one practical change at a time
At a recent psychosocial risk in healthcare event co-hosted by Duncan Cotterill and Clearhead, leaders from across New Zealand’s public, primary and palliative healthcare sector explored what practical steps healthcare providers can take to create safer, healthier and more sustainable workplaces.
The discussion reinforced an important point: healthcare providers are already aware that their people are under pressure. The more challenging question is what providers can practically do about it.
The emerging answer is not a single wellbeing programme, an annual survey or greater individual “resilience”. It is a deliberate, organisation-wide process of identifying what is causing harm, making achievable changes and showing people that their concerns lead to action.
There is no finish line. But there are practical steps every healthcare provider can take now.
Move beyond support after harm has occurred
Employee assistance programmes and mental health support remain important, but they generally respond after someone is already struggling. Managing psychosocial risk requires organisations to look further upstream.
As Dr Angela Lim, co-founder and Chief Executive of Clearhead, explained, the defining difference is who is expected to act. Traditional wellbeing initiatives often place responsibility on the individual to seek help. Psychosocial risk management places responsibility on the organisation and its leaders to identify the causes of harm, introduce appropriate controls and check whether those controls are working.
Treat leadership as a psychosocial risk control
The quality of day-to-day leadership can either reduce psychosocial risk or compound it. A supportive leader can identify pressure early, adjust work, encourage people to speak up and connect staff with appropriate support. Conversely, a leader who lacks the skills, confidence or support to lead well can turn manageable pressures into much more serious problems.
Healthcare providers should invest deliberately in the skills leaders require, including listening, workload management, conflict resolution, psychologically safe conversations and responding appropriately when concerns are raised. Training alone, however, is not enough. Lisa Ryan, Chief People, Capability & Culture Officer at Tāmaki Health emphasised the importance of alignment at executive level about what good leadership looks like, which behaviours will be celebrated, and which will be challenged. At Tāmaki Health, this includes acting quickly when leadership behaviour does not align with the organisation’s values or its expectations for staff health and wellbeing.
Organisations also need to measure and reward the right things. If leaders are assessed only on budgets, productivity or clinical delivery, there is a risk that insufficient attention will be paid to how those outcomes are achieved and their impact on staff wellbeing.
Healthcare providers cannot prevent every difficult encounter, particularly in patient-facing environments. Lisa Ryan described Tāmaki Health’s focus on developing leaders who can recognise when an incident has occurred, intervene early and check in with the staff involved. The aim is not to suggest that every difficult situation can be avoided. Rather, it is to ensure employees are supported, experiences are discussed and lessons are carried forward.
Listen in smaller, faster cycles
Many organisations invest significant time in annual wellbeing surveys. The risk is that, by the time results have been analysed and an organisation-wide response developed, the issues have changed or staff have forgotten what they were asked.
A more useful approach is to listen regularly at a team or service level and respond quickly.
Dr Angela Lim described the value of short pulse checks that allow an organisation to identify the hazards affecting a particular team, agree on a priority and test a practical response. If shift work hours and fatigue are the most pressing hazard, for example, the team might trial a different rostering or split-shift arrangement and then measure whether it has helped. If it has not, the response can be adjusted rather than left in place despite limited evidence that it is working.
This continuous improvement approach also helps rebuild trust. The organisation can say:
- This is what we heard.
- This is what we can address first.
- This is what we are going to try.
- This is what we learned.
- This is what we will do next.
Not every concern can be resolved immediately. Staff are generally realistic about that. What matters is being able to see that an issue has not disappeared into a report.
Build support into the working day
Support is less effective when it sits outside the practical realities of healthcare work.
Offering a voluntary debrief or supervision session at the end of a demanding shift can help mitigate the effects of psychosocial strain. However, a stronger control is to address the source of that strain by building support into rosters and normal working arrangements.
Dr Angela Lim gave the example of monthly group supervision being rostered for teams working in emotionally demanding areas, including paediatric oncology. This recognises that exposure to distress and difficult clinical situations is a predictable part of the role. The organisation may not be able to remove that exposure, but it can put protective structures around it.
Other practical options can include:
- structured debriefs following traumatic events;
- peer support arrangements;
- risk huddles where concerns can be raised early; and
- access to external coaching or specialist support.
For smaller healthcare organisations, this does not necessarily require a large internal wellbeing team. Emma Maddren, Chief Executive of Mercy Hospice, described using a fractional leadership model to bring in specialist expertise when needed. This gives the organisation targeted guidance and coaching without requiring a full-time internal resource.
Create everyday opportunities to raise risk
People are more likely to identify risks early when doing so is part of normal work, rather than a formal process used only when something has gone badly wrong.
At Mercy Hospice, regular cross-functional risk huddles have helped people become increasingly comfortable raising concerns. Emma Maddren described an important turning point when staff began saying, “I don’t know if this is a risk, but I thought I’d raise it.” That willingness to speak before people are certain is exactly what enables an organisation to identify emerging issues and act early.
The same principle can be applied in a small clinic, community provider or large hospital service. A risk conversation could be included in an existing team meeting and focus on three straightforward questions:
- What is making it harder for us to do our work safely and well?
- What is within our control or influence?
- What is one change we can test before our next meeting?
Joanna Sinclair, Chief Wellbeing Officer at Health New Zealand, described this as identifying the “pebbles in our shoes”. The issues may appear small, but addressing them can demonstrate that change is possible and build confidence to tackle larger systemic risks.
There is no finish line
Psychosocial risk in the health sector will not be “solved” through a one-off project. Healthcare work will continue to involve emotional demands, difficult decisions and interactions that organisations cannot completely prevent.
The goal is not to eliminate every pressure. It is to create a system that notices risks earlier, responds consistently and learns from what happens.
Dr Joanna Sinclair connected this work to the idea of whakapapa, drawing on Owen Eastwood’s exploration of belonging in his book Belonging. Today’s healthcare professionals stand in a long line of people who were trained by those who came before them and who are now responsible for those who will follow. This is our opportunity to make a lasting contribution, not because we can complete the work, but because we can shape the system into something better than the one we inherited.
That is the opportunity for healthcare providers now. There may be no finish line, but sustained, visible progress can make healthcare safer and more sustainable for both the people providing care and the people who depend on it.
Disclaimer: The content of this article is general in nature and not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose.
