At several points during the workshop, participants gathered to discuss the presentations and to reflect on how to move forward in their own organizations with the ideas presented. This chapter summarizes these discussions, and includes a “to-do list” in which individual participants identified quick actions they could take to improve well-being in their own lives and for others at their organizations.
REFLECTIONS ON THE WORKSHOP
Siddharth Shah summarized what he heard at the workshop in four points. First, while helping individuals cope is worthy of time and attention, health professionals must put more focus on changing the system itself. He said, “The system itself seems to be getting off easy and deserves more heat.” Second, he heard ambivalence about the term and concept of resilience, particularly when it devalues human experiences or “gets us off the hook through opportunities to support people.” Third, there are several ways in which leaders can use their positions of power to facilitate change toward healthier systems. Leaders can lead by showing opposition to a negative status quo, having healthy but difficult conversations, being role models, demonstrating courage by displaying vulnerability, and pointing out policies that are being ignored. Fourth and finally, the discussions about race and equity demonstrated that “we are not in a postracial society, but instead our systems reinforce historical trauma unless we are deliberate about cultivating a more healing and equitable system.”
Moving from Idea to Systems Change
Susan Scrimshaw, a forum member, reminded the audience of all the wonderful case studies and program examples they heard and discussed at the workshop, but she remarked on the absence of conversation on “the harder question of scaling-up.” While it could be relatively easy to implement a small initiative or policy, she said, these types of changes are unlikely to significantly alter the culture at a large organization. Additionally, Scrimshaw continued, the forum members and workshop participants need to look at how to implement programs across entire systems that are sustainable over time.
Crewe agreed with Scrimshaw that a number of great ideas were presented but cautioned that such ideas should not be simply transplanted into another organization—“the promising practices for one organization may not work for another organization.” The constituents, stakeholders, and needs of organizations may be very different, even if they share the same professional and general goals. In social work, she said, “We talk a lot about starting where the client is.” This same philosophy applies to systematic change, “We have to get in touch with our particular organizations and the systems and then respond appropriately.” J. Eliot concurred and said that even when two organizations seemingly have the same symptoms of stress and burnout, the root causes may be very different, and thus the solutions should be different. From a global perspective, said Talib, the definition of well-being may be very different between Kenya, Pakistan, and the United States, and initiatives and plans need to reflect these contextual differences.
The Costs of Change
“When you implement something to try to improve or make a difference,” said Brenda Zierler, representing the American Academy of Nursing, “there is a de-implementation that is going on at the same time.” She explained that when a new program is introduced to the workplace, workers will have to adjust and may even lose something. For example, adding a 1-minute moment of mindfulness at the beginning of every meeting means changing people’s routines, and there is 1 less minute for other things like working, eating lunch, or socializing. Zierler further commented that such a de-implementation process needs to be considered when trying new programs, and one should not expect change to “happen quickly or easily.” This notion came as a shock to Kenya McCrae who was surprised that not everyone would be open to or excited about change, even when the change is designed to make things better in the long term.
Change the System
Aviad Haramati briefly discussed the training system for health care providers, and how it may be contributing to stress, burnout, and lack of both mental and physical well-being. He said, “Medical students come to medical school better adjusted than their college-matched peers, but within 1 year, that changes and never comes back.” Then referring back to the comments of Maryanna Klatt (see Chapter 3), radiology technicians, he said, suffer from back pain and shoulder pain—these problems start during training. Among students training in radiology, 36 percent have pain when they finish their training, and “they haven’t even started working yet” (Lorusso et al., 2010). “Our training environment is making people sick,” he determined. “We cannot simply ask people to be resilient or mindful, when the system itself is causing problems.” Ballard agreed and added that we should not be training people to “withstand a terribly dysfunctional, negative, toxic work environment.” Rather, there is a need to change the environment itself. He quoted Krishnamurti (1895–1986), the renowned Indian philosopher, who said, “It is no measure of health to be well-adjusted to a profoundly sick society” (Ballard, 2003). Haramati interjected that this perspective holds true for both societies and organizations. After agreeing, Ballard then added that individual-level interventions are unlikely to be effective unless there are policies in place to support well-being and well-being is prioritized at a systems level by the organization and the community.
“It is usually the invisible staff in an organization that actually make the place function,” said forum member Malcolm Cox. Many improvement initiatives focus efforts on the health providers, but there is a missed opportunity to involve and engage all of the people who make up an organization. In addition, leaders should be engaging the community members who are served by the health care organizations. Unfortunately, he said, aside from board members, “it is not a common practice” to solicit input and engagement from the people who make up the communities served. Ballard noted that stakeholders sometimes have differing perspectives and goals, and there may need to be trade-offs, but the ultimate goal should be “to get the best outcome possible for everyone.”
Learning from Other Sectors
Ruth Nemire, representing the American Association of Colleges of Pharmacy, commented on the similarities between the work environment of the current health care system and the work environment of a disaster relief team. For example, both environments involve stressful situations, time pressure, and the emotional burden of caring for others. However, she said, in disaster relief people are “always taking care of each other.” They look out for the needs of their colleagues, and there is usually a psychologist available to assist when called on. She wondered aloud why “we don’t do that for anybody in the hospitals or any of the workplaces” in health care.
Kreitzer brought up an intriguing project from Google known as Project Aristotle (Google, n.d.). The activity aimed to better understand what makes a perfect team knowing the enormous power of groups to innovate, to quickly identify errors, and to achieve better results with greater job satisfaction. After years of research involving statisticians, organizational psychologists, sociologists, engineers, and others, they found that what mattered most was kindness. The teams where people were kind to each other and expressed empathy were the most successful collaborations within Google. She then brought the example back to health care. “I share this with you because when I talk to organizations large and small and they’re facing sometimes great challenges like ‘How do we acquire the budget to make these sweeping organizational changes that need to happen?’” She responded by saying, “There are strategies like cultivating gratitude and cultivating kindness that can have huge impacts.”
The forum members briefly discussed how the forum itself could incorporate and act on the issues raised and lessons learned. Ideas included
- Integrate issues of well-being into other workshops topics (Coffey).
- Encourage cooperation between health care organizations and health care educators to better position students entering the workplace to learn from positive role models in resilient, adaptable organizations (Jeffries).
- Work with key stakeholders to develop common standards and a clear operational definition of wellness and resiliency (Mancini).
- Explore the creation of interprofessional guidelines that include self-care, resilience, health, and well-being, and encourage the educational programs and their accrediting bodies to include these areas in their guidelines (Goldblatt).
Workshop participants listed and discussed ways they could carry the lessons learned at the workshop to improve their own personal well-being as well as the well-being of their colleagues and organizations. These lessons include
- Implement a personal or organizational policy of no emails on weekends or after 5:00 pm. Put emails in a draft folder if you need to work outside regular work hours, but do not send them until morning (Gaudet).
- Once per day, walk over or call someone instead of emailing them (Skolchelak).
- Have compassion for people who think differently (Klatt).
- Do not borrow tomorrow’s problems by checking email late at night (Walker).
- Put a sign outside your door that says “Come back in 5 minutes, I’m breathing” (Haramati).
- Plant flowers on campus or the grounds of the workplace to spread cheer (Scrimshaw).
- Send notes to colleagues and their partners to thank them for their hard work and dedication (Jeffries).
- Check in with somebody every day to see how they are doing (Crewe).
- Take space for yourself to breathe, and communicate to colleagues that it is okay for them to take space to breathe (Nyirenda).
- Use the term work–life integration instead of trying to balance work and life that are really two separate efforts (Haramati).
- Find ways that your whole self can be present in both work and leisure time (Leary).
- Focus on facilitating joy and empowerment rather than removing the negatives of work (Merrick).
- Practice gratitude and kindness, both in your personal and professional lives (Kreitzer).
Ballard, D. W. 2003. Forest for the trees. gradPSYCH Magazine, September 2003.
Google. n.d. Guide: Understand team effectiveness. https://rework.withgoogle.com/guides/understanding-team-effectiveness (accessed July 7, 2018).
Lorusso, A., L. Vimercati, and N. L’Abbate. 2010. Musculoskeletal complaints among Italian X-ray technology students: A cross-sectional questionnaire survey. BMC Research Notes 3(1):114.
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