How to Sustain the Health Care Team
Six Suggestions for System Resilience that Reclaim Empathy
This week I am precepting on the inpatient team. We had so many patients with COVID, many of them unvaccinated, patients who had come for other reasons testing positive in the hospital. The emotions from the members of the health care team and patients were variable and palpable: anger, frustration, exhaustion, and even no emotions.
Clad in our PPE, emerging from two adjacent patient rooms, the resident on another team asked me, “Dr. Panda, how will we know when we are in that place where everything is really going to be the end?”
Taken aback, pressed for time, I stopped and invited him to share what he meant. He shared how the ED felt like a homeless shelter with the overcrowding, (and these are not all homeless people, he explained). We took a few minutes to share our feelings. I offered how I try to find meaning in each encounter and we left with me inviting a continued conversation.
The next day we met at some lull time with a cup of tea, masked except when we sipped our tea, distanced, and had a conversation. We spoke about our journey thus far, what brought us to this vocation, what gives us meaning or frustrates us, our fears, joys and hope. We shared about what we can influence, how can we take one extra step to make somebody’s day. Maybe that is bringing a bag of ice for a patient, watching a silly video and laughing together in the resident lounge. I shared how we make intentional time to unpack our emotions and reflect on what gave us hope, inspiration or what surprised us. I left feeling connected, pride in the resident, his genuine care and concern and a desire to make a difference. I was touched by his insight, care and maturity. I left with with renewed energy and hope.
The overcrowding of EDs, the shortage of health professionals, the delayed effect of the COVID pandemic and the parallel pandemics has definitely stressed a stressed health care system even more.
I feel we have moved from relationship value unit to a throughput value unit, referring to a rapid turnover of patients. My intention is not to point fingers at ‘leaders’, although I view this as an invitation to reframe the purpose and review what is best for the greater good. It is going to require hard conversations of what can we give up, do without and what cannot be sacrificed.
Most would definitely agree that what’s paramount is the quality of care for the patients, the quality of education that the learners are receiving, and the quality of each and every member of that interprofessional team which is so vital for the first two. However, are healthcare systems surviving and sustaining at the cost of these?
I don’t want to make it sound easy, I know these are layered and complex issues, and require difficult decisions. However, these difficult conversations need to be had, these conversations will need a reframing, focusing not on personal resilience but on system resilience—more importantly the culture in the system. Only then can we actually talk about sustenance and even thriving.
I have likened our current times in healthcare to changing the wheels of a bus when it is going 200 miles an hour. Recently I’ve become resigned to the fact that we even have to try to learn how to drive this bus as we have no training or experience. Within this chaos, when these big decisions are being made, often times it feels like the needs and ideas of the people with boots on the ground, the healthcare team, are not considered or are the last to be given priority. This creates an ‘us versus them’ mentality and widens the already divided and fragmented system.
So how do we come back to what is important? I believe that each and every individual comes to work wanting to do their best. We are, however, in an environment that often feels insecure at so many levels and unsafe. We want to do our best. Do our work. We do not want to rock the boat. We have fear that if we speak up, we fear being labeled, not liked. We need and want to feel safe, a natural instinct, and when the environment around us is not safe, we feel powerless, so we don’t speak up. We are fearful that we would be either marginalized or ridiculed.
Because of this fear, we put everyone’s else’s voice above our own. We live in this constant moral tension of value conflict.
What can be done at this point with everything going on, which feels and is so chaotic? What can we all do, not individually alone but also collectively in our teams, programs and organizations?
The important thing is first just to be still, to pause and reflect, be intentional about reframing what is needed in this time. We cannot just react to the chaos, the need of today is different. We can learn from our past experiences, with the honest realization and acceptance that the same interventions have not solved the needs. Collective conversations around, what have we tried that has not worked, what are our realistic resources and what is needed to be sacrificed for the greater good?
Next is empathy, just being there, honoring and being witness to our own and each other’s feelings, emotions.
We must be intentional to create and invite open authentic conversations.
We need to highlight awareness, which will come by asking simple questions, such as How are you doing? What keeps you up at night? What do you need to do your job? How can I be of help?
Going back to the basic Maslow‘s hierarchy of needs—food, water, shelter—do we have that in the workplace for everybody? Do we have that for ourselves?
Let us be intentional about affirming our own feelings and those of others and acknowledging the hardships and even suffering that we feel, see and are unsure of what or how to address. Affirming and acknowledging that it’s ok to be not OK!
The words burnout and well-being may actually be counterproductive at this point. To be human is to be able to feel what is going on, to feel the helplessness and the powerlessness, rather than feeling compelled to share tools and resources.
What if we simply acknowledged and accepted that we are all feeling similar emotions, irrespective of our position in the health care team and system? This acceptance can then lead to forgiveness, forgiveness for self and overcoming feelings of guilt; forgiveness for the leaders. We move from the us versus them to ‘we.’ When we understand and accept and even trust that we are together, we can be open, vulnerable, speak truth to the power, and together identify the shared purpose. Developing these trustworthy relationships allows us to speak about each other’s strengths and even blind spots openly. We speak from and to the heart and the head. This is community, this is belonging!!!
As leaders, we can invite this culture of belonging by asking and affirming, acknowledging and accepting our own vulnerabilities and emotions. When we do so, we can feel connected in a caring community. These shared experiences and the sense of belonging renews and restores our sense of professional identity. We are connected in a community of trust and relationships committed to a shared purpose. Only then can we move to finding meaning and purpose—and well as solutions to the challenges we face.
What we need to survive, sustain and start thriving is belonging and empathy to promote a community of shared unity! Only then can we ensure that the dignity that exists in each of as a human is not smothered or allowed to fall to the wayside by a system that does not recognize affirm, appreciate and give voice, or hear and invite each other as a fellow valued human being and member of the health care team.
As 2022 unfolds, how do you tend to self-care, community and resilience? I will post reflections on these themes and invite you to join in the conversation here or on Twitter or Instagram with your thoughts or what you are doing for self-care and care of others. My book explores such ideas too: Resilient Threads: Weaving Joy and Meaning into Well-Being.