An overloaded tree in Watson Lake, Yukon
Hi, I’m back! My blog has been quiet as I was on the road pretty much the whole month: I spent a week in the Yukon with Victim Services, a week in Cuba for a holiday with family, two days in Ottawa running a Train the Trainer session, what felt like ten minutes in Halifax for a workshop with Victim Services and finally three days of training in Kingston. Hectic? You bet. Rewarding and replenishing? Absolutely. I am often told “Françoise, you are a busy person” and I would agree that I tend to like things on the active side, but there is a tremendous difference between being busy and being overwhelmed. I think it really depends on the nature of what you are doing and how much support you have at home.
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I am posting a bit late this week – I was in Toronto yesterday, attending Dr. Gabor Maté’s workshop on stress. I will write more on this later as it was a very rich day of learning and Dr Maté deserves his very own post.
Last week, I had the privilege of sharing the podium with Dr David Kuhl at a conference hosted by the Elizabeth Bruyere Continuing Care Centre in Ottawa. Dr Kuhl is both a physician and a psychologist and he is the director of the Centre of Practitioner Renewal (CPR) at Providence Care in Vancouver. The CPR was created several years ago to offer support to staff members of the hospitals of the Providence Care network. At the CPR, Dr Kuhl and his colleagues offer counselling and education to health care workers and carry out research related to compassion fatigue and helper wellness. They work with individuals and also with entire teams to try and improve staff relationships and enhance the quality of care.
Dr Kuhl is a very erudite and skillful presenter and his session was inspiring and illuminating. I really appreciated the focus he puts on teams and the challenges they are facing in health care.
Conference participants had many questions for us about organizational challenges and expressed their frustration at the current state of affairs in health care. Their anger and exasperation towards the system was expressed strongly throughout the day. This is not an isolated case: I have the opportunity to meet hundreds of health care professionals each month from across the country and the evidence is overwhelming: physicians, nurses, allied health professionals and hospital managers are struggling. Health care workers all over Canada describe having to do more with less resources and trying to deliver quality of care when staffing has been cut beyond what is realistic. Last week, one nurse told me about mandatory overtime where nurses are not allowed to say no when the hospital calls. She talked about nurses who work in remote communities who get a knock at their door when they don’t answer their phone – in order to force them to come to work.
Taking a step back, how can quality patient care be delivered when you have been coerced to come to work for an additional shift? It simply does not make sense.
What happens, of course, is that we all suffer, patients and health care workers alike: we turn on our colleagues, we resent any extra time off they take (I call it the “must be nice phenomenon”), we blame our managers whom, we feel, “don’t understand”. Perhaps that is sometimes true, but I meet with different managers weekly and they say they feel like “the peanut butter in the sandwich”, squeezed between upper management, ministry demands, staff needs and concerns and patient care. A very difficult position.
So, what to do about all this? Sometimes we can try going the advocacy route, protesting to the upper echelon in various ways, not voting for a government that doesn’t value health care workers (and also doesn’t believe in a restorative justice system, but I digress). But sometimes we feel that we do not have a voice. We feel stuck.
In my opinion, to find our voice within this deeply flawed system, we need to gain a better understanding of organizational health. This is what my esteemed colleague Dr Pat Fisher does. Dr Fisher is an organizational psychologist as well as a trauma specialist and she has spent the last two decades working within our system. She has developed an approach to diagnosing and enhancing organizational health and the results are very convincing: a year after her interventions, agencies report a significant improvement in decreased absenteeism, productivity, decreased job stress and employee wellness. Pat has developed the 4 tier, 12 factor model of organizational health. I invite you to go read more on her important work.
Yesterday, (January 14th, 2009), the Globe and Mail published the results from the 5th annual survey of “the best small and medium employers in Canada” by Queen’s School of Business.
I was very curious to read more on the key elements that made these companies the best, and my hunch was confirmed: Among the top companies, the focus is on empowering employees, rewarding effort and encouraging growth among staff by supporting ongoing training. Flexible work hours are also encouraged and hierarchy discouraged (some of our hospitals a ways to go on some of these points…)
“At top-ranked Protegra [the company who won best employer award], employees are encouraged to participate in goal setting and decision making at monthly staff meetings. [...] At top companies, not only do employees have a say in setting direction, they are also given wide berth to run with their ideas.”
I am fascinated by these findings as they are exactly what we recommend to minimise compassion fatigue and enhance wellness among helping professionals. The top strategies for health care organizations wanting to mitigate the impact of compassion fatigue are related to offering flexible work hours, providing staff with positive feedback, supporting continuing education and genuinely inviting staff to contribute to the direction and manner in which the organization is progressing in the future.
So, I’m sure many of you are wondering who came in the top five? Here they are:
Number 1: Protegra Inc., Winnipeg (IT and business consulting)
Number 2: Miele Canada, Ontario (Appliance maker)
Number 3: Gibraltar Solutions Inc., Mississauga (IT and consulting)
Number 4: ISL Engineering and Land Services Inc. Edmonton (Engineering)
Number 5: Hood Group, Edmonton (Engineering, construction and environmental consulting)
More on this at globeandmail.com/smallbusiness
If you are interested in exploring this issue some more, I would highly recommend that you read the book “Maverick” by Ricardo Semler. Semler owns a large successful manufacturing company in Brazil and this book chronicles how he dismantled the entire corporate structure of his company and reaped the rewards tenfold. He also describes how he obtained the help of his staff to weather through a severe recession in Brazil in the early 90s. It’s a highly readable book, I would recommend it to any manager interested in exploring this further.
By Françoise Mathieu, 2008
“Helpers who bear witness to many stories of abuse and violence notice that their own beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material.” (Pearlman et al, 1995)
After a difficult session….
Are you sliming your colleagues? Are you being slimed? Can you still be properly debriefed if you don’t give all the graphic details of the trauma story you have just heard from a client? Would you like to have a strategy to gently prevent your colleagues from telling you too much information about their trauma exposure?
When helpers hear and see difficult things in the course of their work, the most normal reaction in the world is to want to debrief with someone, to alleviate a little bit of the burden that they are carrying. It is healthy to turn to others for support and validation. The problem is that we are often not doing it properly. The problem is also that colleagues don’t always ask us for permission before debriefing their stories with us.
To read more: click here for pdf.
