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Table 2 Key recommendations and principles for refining/developing strategies to reduce mental ill-health

From: Optimising strategies to address mental ill-health in doctors and medical students: ‘Care Under Pressure’ realist review and implementation guidance

Key recommendations and principles for refining/designing strategies to reduce mental ill-health in doctors
For policy makersPolicies that aim to secure the future of the NHS workforce must foster a supportive work culture in which individuals can thrive. Policies and interventions that target the individual in the absence of a supportive work culture are unlikely to succeed. CMOCs 1–3, 7–9, 12–14, 16, 19.
For employersEnsure influential nominated Board-level responsibility for the wellbeing of staff. This should include regular immersion in practice settings, as well as regular reports on progress against key performance indicators (e.g. absenteeism might be detected by sickness absence, rota gaps and vacant posts; presenteeism might be detected by complaints and errors; workforce retention might be detected by staff turnover; general staff wellbeing might be detected via annual staff surveys, markers of overwork and occupational health referrals). CMOCs 12–13, 16–19.
For team leadersActively look out for behaviours that may be potentially stigmatising and encourage help-seeking. In performance reviews, emphasise the positive as well as the negative and ensure the doctor knows their hard work in often challenging circumstances is valued. Make clear that prioritising own health is important for patient care. CMOCs 12–15.
For doctorsRecognise when you are working under pressure and, even when your workload is high, prioritise your relationships at work. CMOCs 7–11.
For other healthcare team membersRecognise that the whole team may, at times, be providing care under pressure. Try to normalise discussions of struggle in the context of challenging work. CMOCs 7, 8, 11–13.
For patientsKnow that doctors and other health professionals are usually doing the best job they can in difficult circumstances. A thank you when things go well will always be appreciated! CMOCs 4, 5, 7, 12.
For researchersUse research syntheses and stakeholder involvement to target your research to the areas of greatest need. Research of all kinds will be needed to develop theory and interventions, and design appropriate outcome measures, approaches to evaluation and implementation, in relation to doctors’ mental ill-health. CMOCs 1–19.
For those refining/designing interventionsAdopt our 10 Care Under Pressure principles (see below). CMOCs 1–19.