Using the analogy of a battery on a phone that drains and we need to recharge is how I like to think about each aspect of Wellbeing. We often are aware when our phone is on red and needs to be plugged in. How often do we do a battery check for our own reserves?
Traditionally we often think of ourselves as ‘draining’ reserves at work and ‘recharging’ at home. This however doesn’t enable us to function well for the whole of our working day. In reality we need to think about how we recharge through the working day to enable compassionate, high quality care from the beginning of our shift to the end. This is not well discussed in healthcare where we often try and continue to provide care when our own batteries are running low.
We also often think of recharging as being something we do as individuals or at home. I am interested in exploring how we recharge in teams and as wider systems. We are very good at recognising the impact of situations on the patients and families we look after. How good are we at prioritising our own Wellbeing or that of our teams during a usual day? There is increasing evidence that rest and regular breaks need to be prioritised.
Putting this together in the attached illustration recognises the wider evidence that is emerging. We want to be working in the ‘green zone’. How do we ensure that the last patient on the ward round or list or clinic gets the same quality of care, compassion and communication.
We need to become more self aware that as our reserves are drained we need to stop and recharge. This can be done in many ways. Mini recharges through the day can be as simple as a few informal mindful activities. My favourite is a mindful hand wash – takes no longer than a usual one but is probably more effective for infection control and certainly helps as a mini break from endless decisions. We spend so much of our time when working in a clinical role thinking, planning, deciding, filtering information and decoding. We ruminate over decisions made and worry over future conversations. I find a mindful hand wash simply focusing on water, soap and hands very stilling. There are other activities to try.
We also can recharge as teams. A good old cup of tea, a few biscuits and a natter often work wonders. How well do we know members of our team? We are often so busy we neglect the simpler, lighter conversations. We know that if we feel confident and comfortable in a team we function better. We are more likely to challenge potentially unsafe decisions or errors if we feel able to challenge or ask a question. If we take time to make each member of the team feel valued it can save time in the future. Sadly when we are busy we retreat to our clinical work, eat lunch hunched over a computer and tackle emails rather than pick up phone or have conversation face to face.
We need to be more creative with our system solutions too. IT often is the number one frustration when questioned. As medicine becomes more computerised we often see an endless stream of data to input or read. Can we be more creative? Can we find solutions that are time efficient. As organisations we could look at what we focus on and reward. Alongside incident reporting, excellence reporting is emerging. We have departments for PALS (patient advice and liaison service) and complaints some with compliments too. Our workforce is often one of the biggest costs. We need to invest to consider our Wellbeing as an important resource.
Looking at unneeded Drainers is also key. What would an organisation look like where staff wellbeing was considered as part of every decision, proposed change or development. Can we incorporate staff wellbeing into our incident reporting systems and Root cause analysis investigations. When we design new wards and clinical areas we could do much to improve things from a staff perspective whilst maintaining the needs of the patients we look after. We need to start to think about Staff Wellbeing as the very important resource it is rather than a dispensable luxury.
Working as part of a team is also often seen as a positive aspect of working in healthcare. We have to recognise however that working in a poorly functional team can be very draining. There have been some really interesting recent highlighted campaigns on bullying and undermining behaviours. These have helped to highlight the widespread and profound effects such negative behaviours can have on team and individual functioning.
Much is written about compassion fatigue and burnout. Over the last few years much has been written in newspapers and magazines alongside peer reviewed journals. Social media is awash with statistics on prevalence of burnout amounts health care staff. We planned our wellbeing month for every member of staff as we recognised that staff wellbeing was important for all. When the clinical staff are busy and hospital and community face Winter pressures every staff member is busy.
To prevent compassion fatigue leading to burnout we need to be aware of ourselves and our teams. Compassion fatigue can present in many different ways. We may recognise a colleague is struggling if upset and in tears. Harder sometimes to recognise are those who are angry and hostile or quietly retreat to their own office and suffer in silence. If unable to recharge after Compassion Fatigue you are at risk of burnout. The term first coined in the space industry to describe a rocket when it had run out of fuel it was ‘burnt out’. Recognition and prevention of an earlier stage of battery draining enables earlier recharge. Burnout can be described as a combination of emotional exhaustion, depersonalisation, cynicism, lack of personal accomplishment and lack of personal efficacy.
Dr Anna Baverstock
Consultant Paediatrician & Associate Director of Medical Education for Support.
Musgrove Park Hospital, Taunton