“I can lose sight of my own well-being because I’m just so focused on them”: a qualitative investigation of eating disorder clinicians’ experiences in England

BACKGROUND: Work in eating disorder (ED) services presents unique challenges and rewards that may affect clinicians' work-related and personal wellbeing. However, research on ED clinician needs, views, and experiences is still sparse, despite major service changes since the COVID pandemic. This study aims to explore and conceptualise NHS ED clinicians' work-related experiences, challenges, and needs, in order to inform future clinicians wellbeing and service improvement strategies. METHODS: Clinicians working in ED services (N = 19) were interviewed using a semi-structured interview guide that probed their professional experiences, work-related needs, and views. Interviews were analysed using NVivo, following guidance from Braun and Clarke (2006) for reflexive thematic analysis. RESULTS: A holistic ecological systems framework for ED services was created, comprised of five levels of influence: intrinsic, intra-personal, departmental, systemic, and societal. These levels contain nine themes: [1] clinician motivation for working in ED services [2], complexities of ED management [3], clinician personality and emotional disposition [4], team dynamics [5], supervision, management, and organizational support [6], service-level concerns [7], macro-level systemic concerns [8], broader societal challenges in ED care, and [9] COVID-related challenges. Key concerns included the chronic nature and risk of EDs, growing service demands amid limited resources, and regulation through guidelines and commissioning targets. CONCLUSIONS: This presented framework illustrates the multifaceted array of complexities faced by ED clinicians. The interplay of personal, inter-personal, and systemic factors is explored, with clinicians' interest in and commitment to ED care at the core of the framework. These areas can be targeted to improve clinician job satisfaction and reduce burnout risk, with the goal to provide optimal patient care.