Beth Engelbrecht (UCT School of Public Health, IHI Faculty),


The global COVID-19 pandemic challenges health care organisations with unprecedented disruption, uncertainty, complexity, and rapid change. High levels of burnout in healthcare workers prior to the pandemic are exacerbated due to severe, sustained workplace pressure. There are positives, however. Amidst the pressure, many leaders learned quickly, communicated effectively, and found ways to support staff. These successes suggest that there are opportunities to build more resilient systems for the long term that will enhance satisfaction with work now and in the future.

Purpose and main ideas

#StaffCare emerged in the Western Cape as an attempt to strengthen the capability of the health care system’s leaders to actively support the workforce. #StaffCare co-created a Sense-making Framework (SF) of three key action streams and associated ideas for change:

(1) effective leadership and management,

(2) prevention and management of harm to health care workers, and

(3) preservation of mental and physical health of health care workers.

The SF emphasized the need for an authorising context to test ideas and take action, and an enabling culture that encourages innovation with less fear of failure.

Sense-making Framework

#StaffCare became part of a learning health system on a digital platform, via a catalytic innovation community (the Focus Group of mid-level leaders) and the large-scale spread community (CoLab).

A SteerCom guided the learning agenda, and pursued partnerships in and beyond the health system to deepen organisation-wide learning by connecting to frontline experiences, academic inputs and international learnings.

The paper by Shanafelt et al (2) structured the intervention content, by highlighting six requests from health care workers: hear me, care for me, protect me, support me, prepare me, honour me.

Principles and values that underpinned #StaffCare included respectful engagement, alignment with system priorities, relational perspectives, collaboration and co-creation

What we learned

COVID worsened healthcare worker burn-out by adding VUCA (Volatility, Uncertainty, Complexity, Ambiguity). The novel disease caused fear and anxiety, a sense of being overwhelmed, and dissociated feelings.  Traumatic exposure resulted from caring for large numbers of very ill patients, and the deaths of patients, colleagues, friends and family without time to process trauma or exit stress cycles. Changes in workload and shift patterns resulted in long, stressful hours, often in unfamiliar care areas. Home life stresses were due to lockdown restrictions, children not at school, partners losing jobs. Moral injury resulted from inadequate resources for the care need, violating moral codes.

Better care for HCWs requires system level transformation. The foundations of system resilience are established in good times and requires long terms investment in leadership capabilities, across the system and distributed to the frontline. A learning network should be inclusive and highly connected and make use of both internal and external partnerships.

The learning that takes place must be flexible and non-hierarchical in safe spaces for engagement system-wide, co-designed with participants and adaptable to rapid change. The group of innovators energises a stressed system. External partners bring agility, diversity, and connectedness overcoming hierarchies and silos.

Conclusions and recommendations

Staff burn-out is a neglected global problem requiring multidisciplinary interventions. Transformational system level action require strong senior and mid-level leadership distributed throughout the system, a relational, learning culture, and safe learning spaces. External partners add agility and connectedness helping to break down unhelpful hierarchies and silos. These partners require connection to the senior leadership and a funded mandate.

In recognition of the contributions by Gareth Kantor (UCT Dept of Anaesthetics, IHI Faculty).


  1. Engelbrecht et al, March 2021, Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID-19 pandemic. International Journal of Health Planning and Management
  2. Shanafelt et al, April 2020. Understanding and addressing sources of anxiety among healthcare professionals during the COVID-19 Pandemic. JAMA.