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Dr Stephen Priestley, Senior Medical Educator for Medical Protection’s Risk Prevention and Cognitive Institute, suggests ways to support doctors to sustain their own physical and mental wellbeing and support their colleagues during the pandemic
While Ireland has begun to flatten the curve of Covid-19 transmission, the thought of another wave is probably looming at the back of your minds. Many healthcare professionals have ‘flat batteries’ and in any downtime you have, you are just surviving rather than positively recharging and recovering. Doctors are humans first and clinicians second. During the pandemic, doctors have been exposed to the same feelings as others – feelings of anxiety, an acute sense of personal threat, and a loss of control as the uncertainty of the Covid-19 disease continued to manifest. Many have also worked on the frontline, resulting in an additional degree of risk, both individually and to their loved ones.
More than ever, your wellbeing and safety is critically dependent on the performance of those you work with. Caring for each other will keep all of us performing at our best, so that we can face these challenges together and maintain our performance for the long haul. Prof Don Berwick, a leading authority in healthcare improvement and safety, states that “without a physically and psychologically safe and healthy workforce, excellent health care is not possible”.
Wellbeing through the lens of Maslow’s hierarchy of needs
In thinking about caring for others (and indeed self-care) as we face the pressure and stress from increasingly complex work throughout this pandemic, we can draw on a concept developed by Abraham Maslow in 1943. His hierarchy of needs is a simple model that illustrates the range of human needs and how needs at a lower level have to be met before higher needs and aspirations can be addressed.
Because Covid-19 stands to threaten all layers of Maslow’s hierarchy, deficits across each of these core needs can have negative consequences for our physical and mental health.
- Meeting the basic needs and ‘saying no for safety’
It is extraordinary that so many doctors downplay the importance of all team members attending to their basic physiological needs on a regular basis. Great performers know that this is fundamental to resilience.
In healthcare, we have not necessarily made it easy or acceptable to take a break, for a meal or a trip to the bathroom, or a few minutes of rest. This is related less to individuals and more to the culture of our workplaces. But, if we want to be at our best, we have to pay attention to those needs and make it easier for our colleagues to attend to their own wellbeing. This can be as simple as noting the needs of others and giving permission to take a break.
There is evidence about the negative consequences of dehydration in doctors. A study by Lemaire from Canada compared an intervention of providing free healthy nutrition choices and enforcing nutrition breaks. It found that the intervention group had greater nutrient intake and statistically significant reduction in dehydration. Furthermore, cognition score testing indicated that dehydration can impair attention, short-term memory, visual perceptual abilities, psychomotor skills, alertness, and increased fatigue.
Thus, at the basic needs level, we can think about simple things like providing access to things that we need at work, such as showers, meditation or quiet rooms, healthy beverages and snacks, and safe transport home for our colleagues and ourselves when fatigued. The best idea of all may be to simply ask your colleagues what they need. Another principle that we firmly support at Medical Protection is the ability and responsibility of ‘saying no for safety’. By that we mean a clinician’s right to say no to some form of work activity, or extension of hours, or carrying out tasks beyond their scope of practice and training because they believe it to be unsafe – for either their patients or themselves.
Saying ‘no’ often creates enormous anxiety. This anxiety comes both from within ourselves and external expectations. This ties up with the rescue model of healthcare. When people ask for help, we often automatically rescue them. I know that most of us would miss a meal break or put our own needs aside to attend to a patient. At the moment, a firm ‘no’ may require moral courage, but evidence suggests we promote safety more effectively by being clear and holding those boundaries. As colleagues, we need to validate to our colleagues that saying no for safety is ultimately a professional action.
2. Physical and psychological safety and support for habits/routines
Physical safety might seem an obvious priority in a pandemic, where there has been an emphasis on infection control and the correct use of personal protective equipment.
However, psychological safety is also vital to consider. A working definition of psychological safety is: ‘If I make a mistake, or ask for information or help, others will not punish me or think less of me.’ A psychologically safe environment can be created by supporting our colleagues’ right to contribute, by genuinely listening to them and by refraining from being judgmental. It is important to invite others to speak up or ask for feedback from them.
Additionally, when we show appropriate vulnerability and admit when we are wrong, this also creates psychological safety for others.
Supporting your colleagues in maintaining resilience is worthwhile as habits and routines require very little cognitive effort; they can be protective in times of stress and overload. We can actively develop habits that support both our performance and wellbeing. While initially requiring deliberate planning and action, positive behaviours eventually become subconscious, thereby reducing cognitive load and assisting you to maintain your performance in times of lower willpower and motivational energy.
Routines can also be powerful as they can act as a ‘psychological inoculation’, giving us a sense of confidence, security and safety. As colleagues and healthcare leaders, it is worth considering if there are routines or rituals that have been disrupted during Covid-19 that need to be reinstated or reimagined.
3. Sense of belonging
Enjoying workplace camaraderie and a shared sense of purpose are powerful protectors of wellbeing at work. But this may have been much harder during the pandemic due to working in high pressure situations with changing guidelines, reduced availability of communal space and time to speak to colleagues. As colleagues, we need to look at how we can provide support to our co-workers who may be working in isolation or in unfamiliar environments. This will require deliberate and creative action to ensure that everybody is included and that all colleagues are treated appropriately when it comes to the sharing of tasks and resources and rewards and recognition.
Extensive literature supports that formal and informal peer support networks are important and effective in promoting wellbeing. If you have not already done so, now might be a time to try something new such as a peer support responder system, or another means of social support at work, which could continue beyond the pandemic.
4. Esteem and attaining self-actualisation
Civility at work is even more important during times of crisis. But courteous respectful communication in our workplace can be challenging because our emotional state can sometimes get in the way. A useful phrase that is well supported by the literature is ‘civility creates safety’. A growing number of peer-reviewed papers in health and safety literature support the conclusion that a civil and respectful environment is safer for patients, promotes better communication and enhanced teamwork.
For those who are not working in frontline roles, directly engaging in the care of patients with Covid-19, it may seem there is less recognition and value when compared with staff working directly with patients. As colleagues, it is important that we recognise and celebrate the value and the contribution of all roles, regardless of their position or duties. Psychologist Carol Dweck described in her book Mindset: The New Psychology of Success that showing appreciation encourages the development of a growth mindset, a valuable resilience factor.
Her research found that our personal growth can be encouraged when we recognise staff – not simply with empty praise – but through articulation of not just the outcome, but the effort and the process that the staff went through to get that outcome. Caring for others also leads us to the very top of Maslow’s pyramid: Self-actualisation. We have all been facing challenges in this area of professional fulfilment in the last year as we are pressured to work in a different way, or when we are taking on unfamiliar roles.
Many of our plans for professional development have been delayed and, in many cases, abandoned. Trainees have seen their training programmes halted or changed in such a way that they cannot get the experiences they need to successfully complete training. So is there also an opportunity for creative or professional individual growth and to foster the potential of others? I urge you to consider how you might derive professional fulfillment during this time and equally how you might help colleagues in doing the same. Remaining engaged in meaningful work is such a powerful wellbeing factor and warrants personal investment.
Medical Protection members can view the full webinar on this topic at https://prism.medicalprotection.org/course/view.php?id=1222. Wellbeing services are also available at http://medicalprotection.org/ireland/wellbeing