Abstract
Although job satisfaction remains high, Medical Laboratory Technologists (MLTs) and Medical Laboratory Assistants (MLAs) are experiencing increased levels of burnout and emotional exhaustion as a result of the COVID-19 pandemic. Stress levels have increased by nearly 10% since 2018, and emotional exhaustion has increased by 14%. We are seeing a rise in non-specific serious psychological distress contributing to a reduction in capacity to perform work. Staff capacity being critical as laboratory testing resumes normal operations in the wake of the global pandemic. Herein, we discuss our findings and efforts to address these challenges. We emphasize the need to increase domestic training program capacity, including clinical placements, and work to create sustainable programs for international, foreign-trained MLTs to join our workforce to ensure a manageable level of workload and reduction in stress.
Introduction
Since 2016, on a biannual basis, the Canadian Society for Medical Laboratory Science (CSMLS) has gauged and compared the level and impact of mental health issues, including stress and burnout, as well as mental illness of medical laboratory assistants, technologists, and other related professionals.
We do this to develop strategies to mitigate these mental health challenges as faced by our members, including Medical Laboratory Technologists (MLTs) and Medical Laboratory Assistants (MLAs). Our previous studies indicated several areas of improvement between 2016 and 2018. Reductions in anxiety and stress were observed, as well as increased trust in management and job security. Most notably, a 56% reduction of unemployment caused by mental health related issues was achieved. However, we also observed two areas which declined between 2016 and 2018, namely, the feelings of personal accomplishment and positive effect (vide infra). Our continuation of this study not only helps us ensure the gains prevail in areas already improving but also allows us to gauge the effectiveness of new strategies employed since 2018.
We take pride in the fact that our work began prior to the increased public awareness of these concerns brought on by the COVID-19 pandemic. However, like many others in the healthcare profession we were concerned with the effects of the pandemic. Once again, we decided to assess the mental health experiences of our members, and drew upon our pre-existing survey instrument to compare it to the results obtained pre-pandemic to gain a deeper understanding.12,13 We share the idea that, through the survey, we are able understand and therefore offer recommendations to promote well-being among laboratory professionals. 14
Questions are extracted from the National Institute for Occupational Safety, 1 the Maslach Burnout Inventory (General), 2 Mental Health Inventory, 3 and the Kessler Psychological Distress Scale (K6). 4 At the same time, we also determine the overall level of job satisfaction and quality of work-life in relation to the specific climate/culture defined within an associated subsection of the NIOSH Quality of Work-life Survey. This combined approach allows us to identify any relationships between the workplace and mental health indicators.
In addition to collecting and examining the mental health data for medical lab professionals for the current year, we are also able to compare with past results. In most instances, we separate the data within our organization to specific professional groups; however, in some instances, the data is and aggregate of all responses.
All current CSMLS members at the time of survey distribution were invited to participate in this study. There were no exclusionary criteria based on membership type, professional group, employment status or title, gender, or any another demographic categorization as the study is intended to determine and examine mental health issues associated with the entire population of members. At the time of this survey, there were 11,838 active CSMLS members, and we received a total of 1,366 complete responses. This provided a margin of error slightly below 2.5% with a 95% confidence interval. In 2018, the active member count at the time of the survey was 12,604, and we received 1,679 responses, providing a margin of error of 2.0%. Thus, when making comparisons to past results, if the data is within ± 2.5%, the values are considered essentially the same or similar. 5
The majority of our members are MLTs and this is represented by the 955 respondents who are a part of that demographic group. This is followed by MLAs, which make up the second largest group of respondents at 235. However, there are numerous others in various stages of their career, with a very broad span of roles. Our research also includes input from students and educators, researchers, managers, supervisors, directors, and consultants.
Shared experience of medical laboratory professionals
In some instances, we are able to look at the shared experiences of our members as there are common themes regarding job prospects quality and satisfaction. Employment prospects have been very good both before and throughout the pandemic. On average, 92% of our members are employed, and for MLTs it is up to 95%. In general, it is only the student members with lower levels of employment. The sense of job security has also remained consistently high at 92%. A number of our findings with regards to job quality have remained consistent between our 2018 and 2021 studies. These include the sentiment that our members have jobs that let them utilize their skills and abilities. Their trust in management, the sense that the safety of workers is a high priority with management, and that there are no significant compromises or shortcuts taken when worker safety is at stake have all remained consistent. This was an unexpected finding, given the need during the pandemic to change laboratory services and implement new COVID-19 testing.
The sentiment of respect in the work place remains consistent with previous years. In 2021, 79% of our respondents felt they were being treated with respect at the place of work. In this regard, we have also started tracking instances of reported discrimination, and note, the balance of 21% indicate that they have experienced some form of discrimination at their workplace. At 26%, the MLA subgroup is more likely than average to experience discrimination, whereas supervisors, managers, and directors are slightly less likely at 20%. However, supervisors, managers, and directors have significant influence on implementing policy at the workplace. Thus, awareness that discrimination can affect many people in the workplace, and the relation to this common experience between leadership and workers, may help guide effective communication and subsequent strategies to help eliminate this issue. 6
Overall, job satisfaction also remained fairly consistent between 2018 and 2021, with 77% of respondents indicating they were satisfied. Surprising though is that despite relatively consistent quality of work-life results between the two study years, there was a notable rise in the number of people who will make a genuine effort to find a new job in the coming year. This increased from 34% in 2018 to 42% in 2021.
Workload and stress
We observed an increase in stress levels for all Medical Laboratory Professionals (MLPs) since 2018. Two thirds (67%) of respondents agreed with the sentiment “I have too much work to do everything well” (Figure 1), a 9% increase since 2018. This affects 76% of the supervisor/manager/director subgroups, followed by MLAs at 75% and then educators at 74%. In this regard, MLTs are slightly below average at 66%. We can corroborate this when asking the question “How often are there not enough people or staff to get all the work done?” and 87% “sometimes” or “often” (Figure 2). On a positive note, awareness of stress reduction programs has increased. In 2018, 60% of respondents were unsure or did not have access to these programs, whereas in 2021, this number has dropped to 47%. CSMLS current advocacy efforts include raising awareness, in particular, to those who are in leadership roles and yet remain unsure of the status of stress reduction programs in their workplaces. Current data indicates 15% of supervisors, managers, and directors and 17% of educators remain in this “unsure” category. We encourage them to seek out this information and to share it with their coworkers. This is especially important for them because they are in a better position to provide guidance to others. Likert ranking of “I have too much work to do everything well” by professional group. Frequency for which there are there not enough people or staff to get all the work done by profession.
Maslach burnout inventory
Maslach Burnout Inventory—a 5-year comparison.
To determine a respondent’s level of emotional exhaustion, they are asked how frequently the following situations arise at work. The values are then combined to determine the overall emotional exhaustion score. • I feel emotionally drained by my work. • Working with people all day requires a great deal of effort. • I feel like my work is breaking me down. • I feel frustrated by my work. • I feel I work too hard at my job. • It stresses me too much to work with people. • I feel like I'm at the end of my rope. • I feel tired when I get up in the morning. • I have no patience by the end of my work day
In 2021, we saw a 14% increase in emotional exhaustion levels in comparison to 2018 on average. However, for the MLA subgroup, this value was even higher at 22%. Taken together with the perception of increased workload during the COVID-19 pandemic, we can start to develop a better understanding of how the added stress is affecting our members.
For Depersonalization, respondents are asked how frequently the following situations arise. • I feel I look after certain patients impersonally as if they are objects. • I have the impression that my patients make me responsible for some of their problems. • I really do not care about what happens to patients. • I have become more insensitive to people.
Unlike the findings for Emotional Exhaustion above, average Depersonalization values remained consistent between 2018 and 2021, and MLT responses indicated some improvement in this area. However, MLAs experienced an 11% increase. This experience is at odds with the other demographics in our organization, and also of important note because they are the most likely of our members to interact directly with patients, since their job often requires them to collect samples from the patients.
Personal accomplishment remains a challenging area for CSMLS members. Historically, MLPs have a reduced sense of Personal Accomplishment in comparison to the healthcare professions that we collaborate with. We assess this by asking respondents asked how frequently the following situations arise at work. • I accomplish many worthwhile things in this job. • I feel full of energy. • I am easily able to understand what my patients feel. • I look after my patients’ problems very effectively. • In my work, I handle emotional problems very effectively. • I feel that I have a positive influence on people. • I can easily create a relaxed atmosphere with my patients. • I feel refreshed when I have been close to my patients at work.
Our theory is that a large group of CSMLS members, the MLTs, have limited direct interaction with patients in comparison to our partners (medical radiation technologists and sonographers) and MLAs and it is these interactions that can nurture the sense of accomplishment. Since MLTs are removed from the people they help, this reduced sense of Personal Accomplishment manifests itself. Even when comparing MLTs to MLAs, we see that MLAs are 16% more likely to feel a sense of Personal Accomplishment. Since MLAs are more likely to interact with patients, this can be taken as evidence to support our theory.
Mental health inventory
Mental Health Inventory questionnaire.
Each of these four metrics is fairly consistent between the professions within our organization (Figure 3). Educators and people in leadership positions tend to fare a little bit better, and student members tend to show they are facing greater challenges in terms of their emotional function. Of note, MLPs have experienced an increase in feelings of anxiety and depression since 2018. However, the data obtained indicates an overall improvement since 2016 in these fields (see Table 3).12-13 At this time, it is difficult to assess the trajectory of these trends, due to the influence of the pandemic and the increase in workload and stress levels. On average, feelings of “behavioural control” and “positive affect” have increased by 10% and 14%, respectively, since 2018. This is a positive correlation indicating a fairly large improvement in these areas. We find these results particularly interesting because they contrast our initial hypothesis of how people would feel during the pandemic. Summary of Mental Health Inventory results. Respondents’ anxiety and depression scores.
Psychological distress
In this part of our study, the participants indicated how often they have had six different feelings or experiences during the 30 days prior to the survey. A 5-point Likert scale is used and then the responses are converted to numerical values associated with the likelihood of having a diagnosable mental illness severe enough to cause functional limitations and to require treatment,
8
and referred to as non-specific serious psychological distress.
9
The feelings and experiences are the following: • Nervousness? • Hopelessness? • Restlessness or fidgety? • So depressed that nothing could cheer you up? • That everything was an effort? • Worthlessness
Our findings indicated 29% of CSMLS members are experiencing incidences of non-specific serious psychological distress 10 —nearly double since 2018 (16%). Furthermore, 57% of respondents perceived increases in psychological distress in the month prior to the survey, indicating that negative effects on mental health are still accumulating approximately a year after the onset of the COVID-19 pandemic. 11
A further note of concern, respondents reported that the feelings associated with psychological distress affected their ability to work 4 days per month on average. This includes 1.5 days they were totally unable to work, and an additional 2.7 days they spent doing only half or less of what they would normally have been able to do. Taken together with the increased workload and challenges like the positive affect faced by MLPs, inability to work due to psychological distress can exacerbate MLP stress levels.
Discussion
We see that the stress, anxiety, and depression of our members have been elevated since the onset of the pandemic, and this is a sentiment that is shared by other healthcare professionals across North America. A study on MLTs in the United States, for example, drew very familiar conclusions. “While job satisfaction is high and well-being is rated fair to good by most respondents, feelings of anxiety or worry about work, high levels of stress, and burnout are prevalent among laboratory professionals.” 14
Currently, we are attempting to raise public awareness of the important role MLPs play in our healthcare system through the Indigo Lab Coat campaign, 7 and it is our hope that this will help improve their sense of Personal Accomplishment as well. Our intention is that future iterations of the study will help us assess the effectiveness of this campaign.
CSMLS will continue advocacy efforts on behalf of members and will continue providing resources for members in the form of the Mental Health Toolkit, available in both official languages and free. Information and insight into the mental well-being of our members will be shared with employers and educators to address and help with concerns about burnout in the workplace. Our continued advocacy efforts include raising awareness of the need to increase capacity in domestic training programs immediately, and work to create sustainable programs for internationally trained MLTs to join our workforce, to ensure a manageable level of workload and reduction in stress.
During our study, we noted that 20% of respondents saw a doctor or other health professional about feelings of distress, with an average of two visits each. One of the ways CSMLS can responds is to create a safe, facilitated space with a mental health professional, to consider issues like identity, stress, burnout, and resources available. CSMLS will pilot a brief program in 2022, to assess the interest and viability of this support method. We will also continue to run the study on a biannual basis to ensure our efforts are helping to mitigate negative influences on mental health. We will continue to compare the current year to past years, to assess the overall impact of our efforts. In particular, the study scheduled for 2023 will help identify what findings can be thought of transient or due to the pandemic versus persistent.
We encourage other health leaders to take a proactive role in the mental well-being of the healthcare workers they represent and hope that our efforts in this regard will serve as an inspiring model in how to assess concerns and implement methods in their alleviation.
