Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Resilience Is the New Black

3/26/2015 4:43:22 PM | 1 comments

Welcome to Mindfulness Based Leadership Quarterly, a column by renowned leadership and mindfulness expert and author Dawa Tarchin Phillips, intent on providing valuable insight and perspective on excellence in leadership, conscious high performance, meaningful professional impact and enhanced work-life balance in your field.
Mindfulness Based Leadership is an in-demand leadership objective that thrives on high levels of emotional intelligence, focus and attention skills, professional engagement and effective decision-making, culminating in increased leadership effectiveness, joy and overall job and life satisfaction.
In hospitals around the country, there is a growing awareness that the intense, on-the-job demands on healthcare providers too often exceed their personal resources.
To illustrate the problem, consider that: In many settings, provider burnout is becoming not the exception but the new baseline of workplace functioning. It's so pervasive that it threatens the efficacy and sustainability of our healthcare industry. We are well advised to address this debilitating epidemic if we hope to meet the growing demand for accessible, high-quality healthcare services and effective leadership.

What Is Burnout? Why Does It Matter?

Given the high incidence of burnout among providers, hospital and clinical leaders should become familiar with its signs:
  1. Emotional exhaustion. Depleted emotional resources to meet work-related demands.
  2. Depersonalization. A growing sense of emotional distance from one's patients or job.
  3. Low personal accomplishment. A diminished sense of self-worth or efficacy related to ones challenges and responsibilities.
While burnout appears to be increasing across all industries, certain changes in healthcare exacerbate the problem. For one, a shift toward value-based reimbursement is forcing hospitals to provide more and better care on a fixed budget. Providers' workloads are increasing as they strive for greater productivity in the face of workforce shortages. At the same time, job duties are expanding. (For example, many providers are now required to enter extensive documentation into an EHR.)
Additionally, many providers report feeling that new laws and regulations have eroded their autonomy and that government agencies and insurance companies are intruding into their clinical decisions. This perceived loss of control can increase the risk of burnout.
Finally, cultural factors can influence providers' stress levels. Some teams emphasize achievement, productivity and professional infallibility over mental and emotional health. Highly engaged providers may find themselves struggling to juggle the demands of clinical practice, teaching, administration, research and personal life.

Resilience: The Other Side of Burnout

There are many good reasons to address provider and leadership burnout, but perhaps the most compelling is the impact on patient care. Studies suggest that both physician and nurse satisfaction are highly correlated with patient satisfaction. What's more, patients of satisfied physicians are more likely to adhere to treatment, including medications and lifestyle changes.
So how can healthcare providers and their leaders foster greater job satisfaction? The first step is to define the issue in a way that resonates with the workforce. Warm, fuzzy catchphrases like wellness, mindfulness, stress management and work-life balance sometimes rub busy providers the wrong way. (They're doing serious work after all!) But there's one idea that seems to pique our collective curiosity: resilience.
People of all walks of life like the idea of being resilient. But what exactly does that mean? In objective terms, it's the capacity of individuals to access psychological, social, cultural and physical resources to sustain their well-being. Resilience is not about avoiding negative emotions or situations. On the contrary, it's the ability to thrive in the face of real-life stressors and uncertainties.
What makes a mind resilient? And what are some of the tools and techniques you can use to increase your resilience? You might start by reading about the elements of resilience defined by the American Psychological Association. In addition, the following habits of thought have been shown to be helpful:
Take full responsibility. Resilience means taking full responsibility for yourself, your behavior and your current circumstances. You must accept that no one but you can change your lot in life. Thinking of yourself as a victim not only disempowers you, it actually intensifies the problems you face.
If you want to thrive and lead in challenging circumstances, taking responsibility for your experiences is non-negotiable. Only you can be the change you wish to see in the world. Victims are not resilient. Survivors are.
Build on your strengths. Fostering resilience in the workplace might seem like a novel idea. However, you are already resilient in many areas of your life. If you can identify these strengths, you can use them as a springboard for growth. In other words, you can channel your existing resilience into new contexts.
For example, if you are resilient when it comes to standing in the operating room for hours on end, see if you can transfer that resilience into claiming regular short breaks during your workday. Purposefully carve out time for short walks in the fresh air, healthy snacks or mindfulness practice. If you are resilient when it comes to speaking your mind about team conflicts, try transferring that resilience into acknowledging team members' positive contributions.
Persevere. Resilience requires you to keep moving forward, even if steps are small and progress hardly measurable. It requires the capacity to get back to the drawing board at the end of each day, to acknowledge victories and defeats and to recommit to doing better tomorrow.
Persevere not only in striving toward your goals but for the sake of perseverance itself. When it becomes a habit of mind, you will be better equipped to handle setbacks and weather change and ambiguity.
Cultivate honesty. It is much easier to persevere at something that you can genuinely and authentically support. Therefore, be honest with yourself about what you are involved in, how you may or may not be contributing to its creation and to what degree you can wholeheartedly support it.
Nurture your sense of authenticity at work. Be willing to have “real” conversations. Work on eliminating the root causes of problems, not just their outward signs and symptoms.
Embrace transformation. In order to be a resilient leader, you have to allow yourself be changed and transformed by your experiences. You have to be willing to grow. So relax your self-imposed rules and explore new aspects of yourself and your leadership, even if they scare you or make you uncomfortable.
Most of all, keep an eye out for your joy. To sustain yourself on the path to resilience and personal growth, you need to find ways to enjoy the journey.
By accepting responsibility for yourself, building on your strengths, persevering, being honest with yourself, and embracing transformation with an eye for your joy, you will see your resilience grow. And soon you'll be ready to add this important trait to your portfolio of leadership skills.

Anne Bruce
I thoroughly enjoyed Dawa's article, "Resilience Is the New Black." Well done! His comments early on that in many settings, provider burnout is becoming not the exception but the new baseline of workplace functioning, is a reliable measurement of where we might be heading and what we can do about it. Discovering ways to "enjoy the journey" as Dawa says here, is critical thinking for shifting the paradigm from feeling or acting like a victim of the system. Thank you for these insights!
3/27/2015 12:12:42 PM