Module 3 – Avoiding Burnout, Enhancing Resilience

Module 3 – Enhancing Personal Resilience: How Do I Keep Myself Safe?

by Dr Suzy Jordache

To thrive and remain resilient clinicians need to work in well run, efficient hospitals and clinics that understand and champion staff wellbeing. The key to ensuring stability over a working lifetime is personal resilience.

At Premium Medical Protection, we are keen to explore issues that affect you and your medicolegal risk and we believe that this is a key area of concern for many.

Aims

1. To challenge deeply ingrained habits and beliefs that lead to risky behaviours and burnout.
2. To consider three key personal strategies: to recognise human fallibility, ensure safer workloads and guard against loss of meaning, purpose and passion at work.

Learning outcomes

To gain confidence, courage and strategies to make necessary changes in the face of current imperfect systems to protect yourself against burnout.

Introduction

In the previous two webinars, we used the analogy of a three-legged stool to look at physician wellbeing. The first two legs of the stool concern practice efficiency and the culture of wellness in the workplace. To thrive and remain resilient, clinicians need to work in well-run efficient hospitals and clinics that understand and champion staff wellbeing.

However, the third leg of this stool is key to ensuring individual or personal stability and resilience over a working lifetime.

Personal resilience: A challenge

As explored in Spiegelman and Berrett’s book, Patients Come Second:
“The culture of medicine has been one of bravado and self-neglect. There is a need to challenge deeply ingrained habits and beliefs.”

The concept that patients should come second may create discomfort for many who have championed patient experience for years. Doctors are conditioned to put their own physical and emotional needs aside and have stoically developed habits and rituals that often lead to dehydration, hypoglycaemia and exhaustion on a daily basis. They struggle into work when ill or emotionally broken, determined not to let the patient or team down. Many doctors fail to take full annual leave entitlements and sign up for extra work to fill gaps when asked, and whilst the reasons for this might be complex, sometimes, putting patients first can lead to heartache for all.

Whatever the reason, the first step to protecting personal resilience is to admit that our resilience is finite and that there are times when we must prioritise our own needs.

Strategies for enhancing personal resilience

Strategy 1: Recognise human fallibility and develop safe habits

You need to ensure that you:

• get sufficient sleep
• take regular breaks
• stay hydrated and fuelled
• take time off when unfit
• accept that you will make mistakes.

This all sounds fairly straightforward, yet we all know we struggle to sleep, drink enough, eat healthily, take time off when necessary and often become defensive when things go wrong.

Many workplaces and systems make it extremely difficult to put healthy habits in place. It may require considerable courage and commitment to make changes and develop new habits. Relying on willpower is often disastrous.

1. Prioritise sleep and build in regular breaks at work.

• Manage fatigue throughout the working day. Building in 10-minute breaks or even briefer ‘Power Pauses’ every two hours can transform performance and enjoyment at work.

2. Keep hydrated and fuelled throughout the day.

3. Take time off when unfit.

• Many doctors present or go to work when physically sick, emotionally unwell and exhausted. There is good evidence that repeated ‘presenteeism’ and burnout are intricately linked. Failing to build in cover to enable doctors to take time off when needed is a systemic failure that must be addressed. Please refer to the 2015 webinar by Dr Charlotte Chambers, “Superheroes don’t take sick leave.”

4. Accept mistakes and learn from them.

• All clinicians during their careers will make mistakes. These errors should be viewed as opportunities to learn and develop clinical practice. This ‘growth mindset’ is a fantastic anti-burnout strategy. Doctors who stay humble and curious (rather than furious with themselves or others) are less likely to burnout.

Strategy 2: Maintain strong boundaries around safe workloads

Having the courage and confidence to say “No” when asked to do more than is safe is a skill that can be taught and learnt. Some of your colleagues will have become extremely proficient in saying no to extra clinics, more patients and additional duties. Whilst there are many ways to say no, the wording that seems to work best in healthcare is around safety. Safety is everyone’s priority, and it is hard to argue against.

Practising this is key.

• Set and hold boundaries:
  • Say “No” for safety.
  • Get comfortable with repetition.
• Resist unhealthy perfectionism:
  • Live with less than perfect.
  • Delegate where safe and possible.

Strategy 3: Reconnect with meaning, purpose and passion

The third strategy recommends that doctors reflect on why they chose medicine as a career and if they still have a sense of purpose and mission. Many doctors find it useful to ask themselves two questions, as discussed in the study, “Association Between Physician Burnout and Identification With Medicine as a Calling” by Jager A J et al, in 2017:

1. Why am I doing this work?
2. Am I doing enough of what I am uniquely good at and passionate about?

Evidence suggests that to maintain resilience, it is important to spend at least 20% of work effort on activity that is personally meaningful. This will be different for everyone. Examples include research, education, management, or sub-specialisation. It is said that an individual can cope with whatever is required up to 80% of the time without much enjoyment if their passion can flow throughout the rest of the working day or week.

Remember that engagement is the opposite of burnout. Many employers now recognise the importance of working with individuals to craft a job mix that is personally meaningful. The mutual benefits are usually loud and clear.

Summary

PMP hopes that this final module in the series of Avoiding Burnout, Enhancing Resilience webinar series has provided you with new insights, food for thought, and some great ideas to work on your personal resilience to help prevent burnout.