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Posted July 24, 2018

The Resilience Challenge

By Wayne Sotile, PhD

For over forty years, I have counseled, coached, researched and consulted with medical professionals, their families and their organizations. And these days, I spend much of my time speaking to groups of physicians and healthcare leaders across the country. Through that work, I've come to understand the definition of paradox: a situation, person or thing that combines contradictory features or qualities. Among the more than 25,000 health professionals, including 11,000 physicians, my group and I have coached or counseled over the decades, there exists a major defining paradox. Healthcare professionals are at once at high risk of burnout and highly resilient. Let’s define our terms.

Burnout is a state of physical, emotional and mental exhaustion and results from intense involvement with people over long periods of time in emotionally demanding situations. Burnout is signaled when the energy it takes to cope with people at work and home is depleted and not rejuvenated by typical recovery strategies.

Resilience, on the other hand, is the capacity for getting through difficult times and coming out stronger. It’s bouncing forward, geared with renewed energy and purpose, and with a deeper wisdom than you had at the start of the journey.

In recent years, it has been heavily reported that between one-third and one-half of health professionals suffer from burnout. The causes of burnout are well-documented: staff shortages, relentless demands from patients, their families and regulators of healthcare, and lessened autonomy and decision-making freedom. All this “stuff” is what too often keeps healthcare professionals from working in  their “sweet spot.” That is, spending time doing things professionally for which they have both high passion and high skill.

In the early 2000s, I noted that working in healthcare seemed analogous to standing amid a traffic-congested intersection and dodging traffic throughout your shift. Of course, if this is what you do for a living, you will inevitably get smashed by a speeding vehicle. Too often, health professionals are mandated to seek resilience training to “learn how to bleed less.” Focusing on teaching health professionals “bleed less” strategies borders on blaming the victim. Learning to relax, reframe, stay mindful and take a deep breath right before the next speeding truck smashes you to smithereens is not what’s needed. Collectively, we must work to revamp the medical workplace and “redirect the traffic.” Creative organizations are doing just that: revamping workflows, re-allocating resources to improve efficiencies, and more.

In the meantime, the good news is that somewhere between one-half and two-thirds of persons working in healthcare are also resilient. These people face the same coping challenges as those who suffer from burnout, but do not blame others for their suffering. These complaints typically have to do with what the proverbial “they” are doing or not doing, both at work and home. “At work, they…regulate me too much, work me too hard, pay me too little and do not appreciate me enough; and, when I go home, they do not love and understand me enough.”

In my most recent book, “Thriving Physicians: How to Curb Burnout by Choosing Resilience Throughout Your Medical Career” my co-author Gary R. Simonds, MD, and I issued the resilience challenge:

Even if they are 90 percent of the problem, what 10 percent am I willing to own?

Asking yourself this question regularly can help you to control yourself, even during the most uncontrollable times. Fill that 10 percent (or more!) with evidence-based resilience strategies and tactics, like the following:

  • Respect the topic. This is not a frivolous matter. Resilience correlates with quality of work, quality of family life and personal health and happiness. Simply put, resilient people tend to be more happy and successful in life. They are deemed by others to be better leaders, family members, and team members. Resilient health professionals perform better on every workplace metric than those who are not resilient. They also cope better with setbacks that demoralize others. Think of elite performers in any field. One of their shared characteristics is the ability to “forget” about setbacks, focus on the next coping challenge, muster the perspective of realistic optimism (i.e., acknowledge the challenges facing them, but maintain an attitude of hope), and continue moving toward their goal.
  • Honestly assess yourself. Do not ignore symptoms of physical and emotional distress. Commit to regularly engaging in psychosocial self-checks. Focus particularly on the three sub-syndromes of burnout:
    • Emotional Exhaustion is signaled by complaints about the routine demands that come with your roles, or, it can be a general loss of passion for your roles.
    • Depersonalization manifests as failure to behave in harmony with your inner values of compassion and concern for others. As time progresses, depersonalization results in appearing more calloused toward the needs of others.
    • Diminished Personal Accomplishment is signaled by the subjective sense of failing to attain “good enough” in any arena – work or life.
  • Disrupt maladaptive coping patterns. What do poor quality of life, lousy relationships and burnout tend to have in common? Answer: All can result from a pattern of small choices that seem inconsequential in the moment. Similarly, resilience comes from small choices about how you think, manage yourself and relate to others. The sooner you substitute healthy self-nurturing and relationship-nurturing choices for damaging self-neglect and relationship-neglect, the better. Avoid staying emotionally “numb,” and plowing onward.
  • Counter daily hassles with daily uplifts. Psychologist Barbara Frederickson found that a 3:1 ratio of uplifts-to-hassles assures personal resilience, regardless of the number of hassles you face. Practice seeing the familiar in unfamiliar ways as you are harvesting moments of joy, gratitude, hope, serenity, interest, humor, pride, awe, inspiration and love. Doing so requires mindfulness and commitment. The hassles of life jump up and grab our attention automatically. We must intentionally develop the habit of noticing and harvesting the uplifts. There is great wisdom in doing so, not only in your own quiet, individual ways, but also as a leader of your team and/or your family.
  • Accept that good work is good for resilience. Good work is good, both for individuals and for families. “Good work” is defined as work that matches your values, that you can do to the best of your abilities, is done with people you enjoy collaborating with, and begets support from your loved ones.
  • Deepen your relationships. As go your relationships, so will go your resilience. Quality of relationships at home and work is the most powerful predictor of resilience. Here are two facts worth remembering: The leading cause of marital distress is a loss of friendship, and a leading cause of turnover among medical professionals is the sense that “my contributions are not appreciated here.”

Every interaction you have with others either adds to or withdraws from the repository of positive energy that is at the core of the relationship or team. Deplete that energy by withholding uplifts or by being a constant source of hassles to those you lead or love, and you’ll lose team/family resilience.

Even amidst your busy schedule, find ways to establish and maintain rituals to help you fully focus on your family or team members. Work hard but create “islands” of time at home (a night off, a weekend each month) to fully engage with your loved ones. Similarly, at work, diligently pursue excellence, but also make time regularly to pause and celebrate what is good and right about your team, your performance thus far and each member of your group.

Research has also underscored that generating and harvesting team uplifts correlates with team performance. Again, Barbara Frederickson notes that leaders of low-performing teams drive “wins” discussions versus “problems” discussions at 1:1 ratio; middle performing teams have a 3:1 win-to-problem discussion ratio; and the highest performing teams discuss six wins for every problem discussed. Similarly, marital researcher John Gottman found that the most happily married couples tend to have a 5:1 ratio of positive comments to complaints or criticisms.

Remember the Meaning

Meaning is the talisman that heals much distress, and it is the secret sauce for sustaining resilience. Remember the sacredness of your work and your family journey. Doing so connects the current suffering you are enduring or overcoming to your inner values and commitments. Give meaning to the tasks that seem to be burning out others, and you will stay on a resilience path.

Find renewed meaning in the daily aspects of your work. This focus on meaning requires that you balance your achievements and your expectations. Remind yourself regularly why you do this job or entered the profession; or why you created this family or joined this personal relationship. And keep your behaviors aligned as closely to your values as possible. At the same time, realistically adjust your expectations. Like it or not, every profession (and every family) goes through upheaval regularly. If you worked in another setting or profession, or had another life mate or family, the specific demands you would face might be different, but they would probably remain substantial. Choose to focus on what is good and right in your work and life and pursue continuous improvement from that position of strength.

I believe that it is time for us to change our national dialogue. For the most part, we are ending “the conspiracy of silence” about the suffering of health professionals that many of us have lamented for the past four decades. We now acknowledge that healthcare is a challenging industry and healthcare professionals are to be admired, appreciated and helped to not only endure but to thrive. All this change requires focus and commitment of both individual and organizational resources. In a recent NEJM Catalyst article, Mayo Clinic CEO John Noseworthy observed: “We manage what we measure.”

Let’s focus on and measure the vital signs of resilience: joy in our work; camaraderie in our teams; what is good and right in our organizations, work teams, and families; and our overall satisfaction. At a minimum, that’s our 10 percent.

Wayne M. Sotile, Ph.D., is a national speaker and co-author of the book “The Thriving Physician How to Avoid Burnout by Choosing Resilience Throughout Your Medical Career.” He is the founder of the Sotile Center for Resilience and The Center for Physician Resilience in Davidson, North Carolina.

Dr. Sotile consults nationally with medical organizations and speaks internationally on keys to resilience for health professionals, medical families, and medical organizations. For more information, please visit his website www.TheResilientPhysician.com.

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