Building resilience in healthcare workers

Healthcare professionals are under pressure like never before. What can leaders and their teams do to strengthen their personal and professional resilience, during and beyond the coronavirus pandemic?

The challenge for healthcare workers

The coronavirus pandemic has made huge demands on employees in all sectors, as the global event and its ramifications change and disrupt every aspect of life.

But perhaps its greatest toll has been on those working in healthcare fields, including frontline hospital workers like doctors and nurses, caring professions like healthcare assistants and palliative care workers, technical and support teams, and those in research and administration, who have been under unprecedented levels of stress as they work to create and maintain a response to the disaster.

In order to rise to the challenge, healthcare professionals need not only their skill and knowledge, but personal qualities like resilience, gratitude and emotional strength to help sustain them through the pandemic.

What is resilience?

Resilience is an ability to cope with change, especially change that brings negative consequences. The word resilience comes from a Latin root, resilire, which means to leap, spring or bounce back.

If someone is resilient, they are able to return to an essential sense of self after a setback or a difficult experience. Like a coiled spring, they can be pulled or pushed out of shape by something external, but still resume their previous form afterwards.

Researcher Brene Brown has discovered that resilient people tend to share a “tolerance for discomfort”, meaning that they are able to navigate difficult experiences and the emotions that come with them. In particular, she found that resilience was linked with an ability to feel difficult emotions and approach them with curiosity, without becoming consumed by them.

Advice from healthcare resilience experts

Susan Haufe, our Industry Advisor for Healthcare, spoke with healthcare leaders J. Bryan Sexton, Associate Professor and Director of the Duke Center for Healthcare Safety and Quality, Allan Frankel, Managing Partner at Safe and Reliable Healthcare, and Cecelia Herbert, Employee Experience XM Scientist at Qualtrics, on the subject of resilience in healthcare workers as part of a recent webinar series.

Watch their full conversation here

Here’s a breakdown of their resilience-building recommendations and advice for healthcare professionals and their leaders.

1. The dangers of burnout

A major concern for healthcare professionals is the risk of burnout, a state that begins with frustration and leads to emotional exhaustion, cynicism and detachment.

Burnout among physicians alone costs the USA around $4.6million per year, according to data from Duke. When other professional roles, and the added impact of Covid-19 are considered, this figure is likely to be much higher.

Burnout is also correlated with negative patient experience outcomes across the board, from patient satisfaction and mortality rates to disruptive behaviors and medication errors.

So what can be done?

2. Leadership communication

Good communication between leaders and the wider workforce is essential for maintaining morale and confidence. But according to data collected by the Duke team, 55-60% of 2 million health care workers surveyed felt unsure if the professional values they bring to their day-to-day work were the same values as those running their organizations.

That doesn’t necessarily mean there’s a discrepancy in values – what it does mean is that leaders aren’t able to communicate their values and sense of purpose throughout the organizations they’re heading up, and that they’re not having conversations with front line workers about what they’re doing.

It seems bi-direction communication, whether digitally or face to face, is essential. Leaders must be present among and engaged with the wider workforce, and be able to clearly communicate their vision and values across the organization. This becomes even more important in a crisis situation like Covid-19. It’s about honesty, building trust, and letting workers know that you care what they have to say.

3. Vulnerable role models

Healthcare workers need to feel heard, seen, prepared and protected by their leaders. And at the same time, leaders can strengthen connections by being emotionally vulnerable, showing honesty about what they are feeling and what they are doing to cope.

Humility, vulnerability and caring can become a catalyst for trust between leaders and the workforce. It affirms the fact that employee wellbeing is central to leadership decision-making. It can also make organizations feel more cohesive, as individuals understand that they are linked together by a common human experience.

4. Empathy and expectation

High expectations – and by extension, high professional esteem, mixed with emotional empathy are a powerful mix. Dr. Frankel’s work has shown that when leaders motivate their teams with high expectations, based on the confidence that the team has strength, skill and an ability to perform, but also temper those expectations with emotional compassion, the result is a team that will rise to the challenge of a crisis feeling supported and empowered.

When these two leadership skills are combined, people feel that they are highly valued as professional performers, and at the same time, that if they need emotional support to help them keep going, it will be available to them.

5. The social contagion effect

Predictive markers of burnout, like skipping meals, going home on time, and poor sleep, seem to emerge within 6 months of new employees starting at an organization.

What that indicates, say Frankel and Sexton, is that an employee may start out with good boundaries around work-life balance, but over the first six months they will be influenced by the prevailing culture of the workplace. Essentially, they will fall in line with what other people are doing, even if they know those things to be bad for them.

When it comes to burnout, social contagion has a substantial role to play. In a statewide study in Michigan, Duke’s researchers found that around 26% of an individual’s risk of burnout could be predicted by looking at burnout rates among their colleagues.

This social contagion effect can be seen across all sectors, according to Herbert, and is mirrored in employee engagement data, but it’s especially relevant in the high-pressure world of healthcare.

On the upside, the reverse is also true – when a positive, healthy workplace culture is in place, social contagion means the influence of colleagues will be a positive one and could have a protective effect against burnout.

6. “3 good things”

Burnout, like depression, creates a reduced interest in what’s happening around us and a lowered capacity to feel positive emotion. A powerful antidote, according to Sexton, is to practice behaviors which create positive emotion and a chance to recharge a person’s emotional batteries.

One of these is the “3 good things” method, a cognitive intervention that’s practiced on an individual level. Each day, a person lists 3 things that have gone well for them.

While the process is simple, the results are remarkable. Clinical trials have shown that over a week, the “3 good things” gratitude practice achieves results equivalent to or better than being on a moderate dose of SSRIs.

Extended to 2 weeks in studies with over 30,000 healthcare workers, the Duke researchers were able to show that the practice improves not only mood but burnout and work-life balance. What’s more, the positive results can be observed even a year later.

7. Employee listening

The importance of listening to employees and taking action based on their feedback cannot be overstated. As Herbert describes, the value lies not just in what you ask, but in how you ask and what the intent behind your questions is.

She sees great benefit in ad hoc or pulse surveys that use a “little and often” approach to keep an attentive ear open to employees, without burdening them with a large survey.

Another useful step is to ask about indicators, rather than self-assessments, of burnout. Signals like skipped meals and sleepless nights often prove more useful in empowering leaders to appraise the problem and take effective action.

Herbert emphasizes that it’s essential to build a system of action, not just a body of data.

Make sure that every response you collect is directly linked to an action you can take. The focus for leaders should be results, not curiosity. Data only matters if it helps employees build resilience and creates better outcomes for patients too.