Change the Culture, Build Resilience

By Carrie Barron, David Ring and Matt McGlone

People choose medicine because they want to help.  It takes hard work, intelligence and altruism to become a doctor.  Helping others in a time of need is fulfilling. It might be argued that there is no higher form of meaning and purpose than helping others get and stay healthy.  So it’s sad that an average of 45% of doctors report experiencing limited joy in their practice. In some specialties such as Emergency Medicine the rate is close to 70%.

Some of the things that take joy from medical practice include increased work hours, decreased pay, increased administrative work associated with electronic medical records, pressure to see more patients each hour contributing to less meaningful time with patients, and lack of supportive relationships at work.  While resiliency training and even workplace wellness spaces are increasingly common, it seems to us that one of the best ways to maintain joy in practice is to create a healthy, supportive work environment. When the professional setting supports doctors and medical teams, they — and their patients — are more likely to flourish. How do we create such an environment?

We have all had moments where colleagues supported us after mistakes, stood together in times of trouble and brightened our days with their positivity. But most of us have also at times been bullied, shamed or scapegoated. To err is human, but we aren’t yet naturals at tempering the human tendency to react to error as a personal failing. In the medical milieu people who misstep often feel blamed and disgraced. Pinpointing one individual creates consternation for all and can compromise the camaraderie that facilitates high-quality care.  

Absorbing insults — attributing them to a personal failing — instead of addressing them as a barb perpetuates the undermining atmosphere. Though stoicism is often a virtue and a first impulse, thickening skin may not serve the greater good. The opportunity to improve human relations for the betterment of all is lost. Even if some people derive self-esteem from withstanding a tough or even toxic superior or colleague, the overall impact of harsh criticism is dangerous. 

For example, in a study of intensive care unit training exercises, medical teams exposed to incivility made more diagnostic and treatment errors due to less effective collaboration and communication. A workplace culture rooted in dedication, compassion, empathy and kindness is safer, more comfortable and more enjoyable. There are ways to offer critique that motivate and facilitate growth.    

Perhaps we can start with a rigorous self-inventory. Do our organizations have a culture that values these aspects of a fulfilling and meaningful practice? Are we doing all we can to foster enriching relationships with our team members and the people that seek our care? Beyond training doctors in how to be more resilient, do we create a supportive environment that demands less resiliency? Strengthening the individual without altering the culture only goes so far. It’s important to get enough exercise, nutrition and downtime — time with loved ones in particular. Meditation, self-awareness, time for reflection and shared experience also help.  But do these positive actions treat the symptom or the disease? Optimizing the culture addresses the root of the problem.

The original goal of the workplace wellness movement was to foster a “culture of wellness” at work. But many organizations at the forefront of this movement now articulate their goal as cultivating a “culture of purpose,” in which workers are encouraged to treat their health as intrinsically linked to their professional goals. University of California, San Francisco Professor of Medicine and workplace wellness expert Ken Pelletier, PhD, MD, sums up the shift as “moving from a goal of increased ROI (return on investment) to one of pursuing ROV (return on value).” In other words, organizations should view workplace wellness efforts as a strategy not just for reducing loss of joy in work, but for improving workers’ quality of service. The available evidence supports Pelletier’s claim, in that service and productivity gains created by workplace wellness programs typically far outpace the cost reductions they also yield. Importantly, the culture of purpose producing these dividends hinges on stable, supportive social structures in the workplace in concert with health and resiliency programs.     

In the medical milieu, supportive social structures for a culture of purpose derive from civil professional relationships, sensitive speech and awareness of body language. When people feel safe, motivation for growth and receptivity to suggestions ensue. Decorum protects people, fosters freedom of mind and instills deeper dedication to one’s professional purpose, such as saving lives. A set of values embodied and modeled by leadership can create a sense of mission, community and belonging. A supportive work setting that protects doctors protects patients.  Let’s change the culture to build resilience.

Doctor-Patient Photo info: Creative Commons Dr. Lisa Marie Cannon|Doctor-Patient Relationship| Image Source: www.spacecoastdaily.com |Taken 7/3/2014