Abstract
One of the great privileges of being an editor for JICS is the contact it generates with members of our profession around the world. On occasions their work and opinions reinforce that which is familiar to us but, on others, new perspectives are presented that challenge the status quo and provide contemplative and compelling reading. This edition of JICS opens with two such perspectives. Peter Brindley’s editorial on psychological burnout highlights what has, in recent years, become an increasingly worrying issue within our specialty and profession. There are those who question whether intensive care staff are at greater risk from burnout than any other specialty or profession; however, Peter’s insightful article allows you to make a personal assessment and reach your own conclusions; its publication is timed well with the UK’s Intensive Care Society’s work on this important area.
A contributing factor in the development (or not) of burnout is the environment in which we work, an issue that is central to Massimiliano Polastri’s eloquent editorial on the paradigm of ‘meritocracy’. Work environment is an important factor in our professional self-worth; at best it can encourage a sense of reward and highly valued contributions, at worst it is a major contributor to the evolution of burnout. Mr Polastri’s article highlights, however, that we can and should influence this environment for the better. To strive for a better work environment is to strive for a better work life. There was a time not long ago when all I strived for professionally was early retirement; however, I am fortunate enough to work in a Trust which scores highly in the questionnaire provided in the editorial, and I currently feel valued and supported. This environment has been invigorating and energising and I now find myself seeking and rising to challenges I had been eager to avoid previously; most importantly, it has put the joy back into my clinical work. Not everyone is in such an enviable position, however, and I have experienced closely the impact of trusts that score poorly. The difference is having the right people in the right posts. In the past I have vilified clinical colleagues who have ‘sold themselves’ to management. In hindsight, this view was wrong; we should, in fact, be celebrating the fact that amongst our number are likely to be individuals with the perfect attributes to become an exceptional medical manager. I am fortunate enough to work with such individuals and, far from ‘losing touch with their roots’ by towing the corporate line, they are leading corporate strategy and keeping patient care at the heart of it. There will always be ‘management moments’ when bizarre targets and paper-exercises are required to keep our ministerial puppet masters happy; but in a top-down organisation such as the NHS, such moments will always exist. What is important it to be able to laugh them off while delivering the desired output in order to protect the Trust from whatever draconian punitive measure awaits in the event of ‘failure’. Of course, if we become the puppet masters then we can eradicate more of the nonsense and put patient care at the heart of government – a place in which it seems to have been absent for too long. This utopian world can only exist if the individuals occupying pivotal roles are doing so because they are the best person for the job – not the only applicant for the job, or the easiest person to put in the job. From trust management to government, the concept of meritocracy is appealing. The only way we will know if it is a key to success is if we start appointing into pivotal jobs based on merit alone. To do this, we first need to identify the key attributes needed for each role; then, we need to identify who possesses those attributes and encourage (rather than vilify) them to take on these positions. Will it happen? Probably not – but it is empowering to contemplate the difference it could make if it does!
This issue of the Journal, as always, contains a broad and fascinating mix of opinion, original articles, reviews and reports. It is a reminder of how complex the intensive care environment is and how far our influence is felt and needed within (and outwith) the hospital environment. As always, my sincere thanks to all who have contributed; the result, I hope you will agree, is an engaging and informative read.