When I hear leaders talk about resilience, I try to understand their reasoning: trying hold onto good staff, physicians, nurses, APPs, techs, and so on. Leaders face difficult challenges from boards and their superiors; maintaining a healthy operating margin; staying in the budget. Their toolbox is limited. And oftentimes, they are alone in these struggles, emotionally speaking.
I also ask, is the motive behind resilience training to retain staff so that the system can continue to stay revenue-positive, or is it an investment in the ultimate resource of medicine, the human one? Is this strictly business under the guise of workplace wellness? I don’t know; and I don’t think it’s as simple a dichotomy as my questions perhaps suggest. I say this with respect to both sides of the coin in terms of hospital leadership (leaders) and healthcare workers (HCW). And let me just say that I am not just being diplomatic, this is basic leadership: both sides need to be valued and listened to.
I also ask, is the motive behind resilience training to retain staff so that the system can continue to stay revenue-positive, or is it an investment in the ultimate resource of medicine, the human one?
But, in terms of physicians in the trenches, because that is how I will always identify my medical side, it’s really quite insulting to hear the notion of resilience training as a means for HCW retention: You can’t teach resilience.
And really, you cannot win me over with a break from the trenches with yoga, pizzas or a cute therapy dog.
It’s not going to work for me… ever… And by the way, I love pizza and dogs, and still want to learn yoga, but these do not help assuage the personal turmoil and anguish or build resilience that I have already painstakingly forged.
They are temporary salves at best… And weakly so.
And to me, these edicts feel like slights and insults. No decent human being can cope with, or much less accept, a broken system and all of the baggage that goes along with that.
Empathy and compassion are much preferred as ways to help rather than the pizzas and massages, or yoga and therapy dogs… If you are a RINO (registered nurse in name only) or DINO (doctor in name only), coming over to our area and actually helping with patient care in the middle of the storm can help.
It’s a good start to get buy-in from your staff.
By the way, I didn’t coin these acronyms and accept the fact that they can be perceived as derogatory and not really accurate, but full disclosure, they are used often in the trenches by HCWs. So prove them wrong.
Truly listening to staff and acknowledging their feelings that they cannot do a good job on an individual human – which is a moral injury – and coming up with real and tangible ways to solve it, will go a lot further. But, before doing any of this, please, please, just patiently listen to these people…
Truly listen and feel what these HCWs have to say. Try and feel their suffering.
Then use that to come up with – in like a Manhattan Project Tom Hanks Captain Sully Hudson River ass-kicking sort of way – realistic and tangible solutions.
The current toolbox for preventing physician burnout – and worse – isn’t cutting it.
The current toolbox for preventing physician burnout – and worse – isn’t cutting it.
A break like bagels or a massage during a shift is nice and often appreciated, as it should be (love lox by the way), but it doesn’t address the feces show confronting HCWs each and every day.
I never looked forward to getting back to the ER after having a vacation.
I mean I loved the patients, my colleagues and staff. But did I really look forward to violence in the ED?
The difficulty transferring sick patients for whom my critical access facility didn’t have the resources and whose best help came with an expeditious transfer to a tertiary care facility, for instance?
No, these things gnawed at my core. And then the pandemic came which was, to me, emblematic of just another major, albeit global, dysfunction, amidst this litany of others.
Think of the reactor personnel who stayed back when the nuclear plants at Fukushima Daiichi were in trouble and at least one was melting down.
The leaders, who were sitting in offices in faraway Tokyo, hurled directives without any real situational awareness or buy-in onto these operators at the nuclear plant, many of whom had accepted their fates of likely radiation exposure and possible death, and despite what these seemingly far away leaders inappropriately asked them to do, did what they had to do in order to cool the reactors.
This is no different than how many HCWs see the current challenge in healthcare: the existential threat for them is repeated moral injury.
Despite this craziness, most HCWs do not abandon their patients and will do what they need to do in order to care for a patient with absolute dignity and respect. At least that has been my experience.
Is it going to be easy? No, not at all.
My recommendation for leaders is to feel the pain of your people on a similar level and realize that your challenge is just as horrific and difficult to you as it is for them.
Small steps leaders can do may include rolling up your sleeves, removing your business coat, washing your hands and gloving up, and helping to move patients, as in the ER.
Really move patients: see them, assist in the cognitive and physical load, in a way that is appropriate for your training, until at least that small battle is won and a moment of end-of-shift reprieve has been realized.
That can help with buy-in by the way.
How do we as a system hold onto the caregivers and not use the tact of “you need to be more resilient?” Well, I have some simple suggestions for leaders:
#1 STOP USING THE TERM RESILIENCE! Please. Pretty please.
#2 Listen to your people – the HCWs – and be sincerely empathetic
#3 Be compassionate
#4 Do everything in your power after truly coming up with a good composite picture from the aforementioned sincere and full immersion in points #2 and #3 TO COME UP WITH REAL LASTING SOLUTIONS.
Not by mandatory courses to “get resilient in your own time”, bagel, pizza, or yoga mat…
So, medical leadership, I implore you:
Think Manhattan Project, “Kuhnian” paradigm shifts, Tom Hanks Captain Sully Hudson River, Apollo thirteen: whatever you need to do to shift the narrative, addressing the problem head on with real world solutions.
And maybe, together, we can forge a different path forward that actually keeps the ultimate healthcare resource – the human one – intact and thriving.
