Emotional resilience in the NHS – by Beth Stout

beth-150Beth is project manager of Diabetes UK’s Clinical Champions programme which drives improvement in diabetes care across the NHS.

How do you remain emotionally resilient working within the current demands of the NHS? At Diabetes UK, we’re always amazed by the healthcare professionals we work with. Overstretched, overtired and overworked, they somehow manage to also be hugely committed to making positive change happen around them. How do they stay emotionally resilient? Or do they?

Recent reports have brought the scale of this problem into sharp focus. Our DSN workforce survey 2016 report, launched in November, showed that 78% of diabetes specialist nurses (DSNs) surveyed have concerns that their workload is impacting upon patient care and safety. One survey respondent told us, “patient safety is maintained at a cost to myself. This is seen in me working overtime and stress in trying to manage my caseload.”

November also also saw the publication of the BMA GP survey 2016 highlighting similar concerns amongst GPs. In this survey, 84% of respondents said that unchecked and growing workload pressures are undermining their ability to provide safe and quality care.

With these challenges in mind, we arranged a session on emotional resilience as part of our Tomorrow’s Leaders programme. It’s a two-day leadership programme for diabetes specialist nurses (DSNs) and dietitians, which we run in partnership with Leicester Diabetes Centre and TREND-UK. Participants often tell us that a real advantage of taking part in the programme is time ‘off the hamster wheel’ to focus on the changes they want to make in their diabetes service, as well as talking to others who are feeling the same pressures. So emotional resilience seemed like a really important topic to cover.

The session was led by Laura Willcocks, a fantastic Senior Research Associate at Leicester Diabetes Centre. When I spoke to Laura in the weeks leading up to the training day, she told me how hard she was finding it to fit the basics of emotional resilience into an hour’s session. This topic deserved a full day of study.

At the session, Laura highlighted the scale of the problem for the Tomorrow’s Leaders participants. The challenges of staff burnout, retention and turnover. The impact on employers – and why they need to do something about it. We talked through the differences between stress and pressure. Participants felt that pressure was what was put upon them by the external environment, while stress was their own response to that pressure. The mental and physical impact of stress can be huge – how could they avoid this?

Balancing stress

One of the most important things Laura highlighted was the stress performance curve. Perhaps unsurprisingly for a group of people who are pushing for improvement in diabetes care, participants quickly identified the benefits of a healthy level of tension, which made them feel motivated and focused rather than inactive and bored. Positively, many identified themselves as being at just the right point on the stress performance curve: just enough stress to facilitate peak performance. We began to see stress not just as a negative, but as a driver of these high-performing clinicians.

The curve also helped participants identify times where they had moved too far to the right of the stress curve: past peak performance and into fatigue, anxiety and burnout. Laura worked with them to establish techniques to deal with this level of stress. How we interpret events that activate our stress is key to our emotional resilience. Participants gave examples of how their own perceptions and responses had created additional stress: focusing on one piece of negative feedback when the majority of feedback was positive. Assuming that one negative conversation was a sign of a bad relationship with a boss or colleague.

Focusing on what can be changed

Another tool Laura highlighted was Stephen Covey’s spheres of influence and concern. Participants identified issues that were areas for concern, and issues over which they had influence. Laura encouraged them to spend their time focussing on their circle of influence – what they have control over. Stephen Covey tells us that those who focus on their circle of influence will see it grow over time as they gain more and more influence. Spending time on your circle of concern (on issues you may have no influence on or control over) will see your circle of influence shrink as you dedicate less time to the changes you can make.

As Laura predicted, many participants wanted to spend longer talking about resilience – something we’ll factor in to future Tomorrow’s Leaders sessions. Observing the session however, I saw that even with a basic understanding of their own responses to stress, participants had much more agency to manage it.

Laura finished the session with the following quote from William James: “The greatest weapon against stress is our ability to choose one thought over another.” Can clinicians choose to remain emotionally resilient? Recent reports would suggest resilience isn’t a choice: it’s an imperative.

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