Amid the unprecedented amount of stress the Covid-19 pandemic has put on the health care workforce over the past year, how do leaders develop a culture of resilience among their staff? In this episode of Radio Advisory, host Rachel Woods talks with Advisory Board's Katherine Virkstis and Anne Herleth about what resilience actually means, dismantling "I'm fine culture"—and identifying the "14 pound mental medicine" that can help keep your team together.

Lessons learned from adverse outcomes on clinician resilience

Read a lightly edited excerpt of the interview below, then download the episode for the full conversation.

Rachel Woods: So let's get into what leaders, and I think particularly clinical leaders, should actually do about improving resilience among their staff. Where do you recommend folks start?

Anne Herleth: The workforce is tired and they need recovery. They need physical recovery and they need emotional recovery. So in the coming months, as we hopefully continue to see Covid-19 cases decline, the workforce needs physical and emotional recovery.

And then from there, I think we start talking longer term, how are you going after those cracks in the foundation? How are you ensuring safety? How are you ensuring staffing so that your workforce feels they can deliver safe care? So going directly after those foundational cracks so that staff can not use so much resilience, day in and day out, in the months and years to come.

Woods: I also get this feeling that the workforce, maybe they've just lost some trust in the system. Maybe even trust in their leadership. And it can be hard to ask people to keep showing up every day under the conditions we've described, without personal protective equipment, when you have to make compromises, when those cracks in the foundation are present.

So if you are a leader who feels like you need to rebuild some of that trust, how do you do that?

Katherine Virkstis: One of the things that I think is really important right now is being really honest with staff. Don't sugarcoat what's happening right now. Don't make false promises. I think you should be kind of a vulnerable leader and share that you might not have all the answers. The future is uncertain and none of us knows what's going to happen. I think the more you can be honest with staff, the more they'll trust you right now.

Measuring physician burnout

Herleth: Yeah. I would just emphasize everything Katherine said. And vulnerability can be such an important tool to use. Vulnerability, and transparency around some of these hard decisions and what is coming down the pipe for your workforce. But it can be hard to do, particularly on the vulnerability piece.

I think we just as humans, and many leaders, haven't really practiced that skill. So really being open and honest and showing your humility and your human side can go a long way.

Woods: Even beyond showing your human side, Anne, you mentioned recovery. I imagine leaders need to take a break, too.

Herleth: Yes.

Woods: But as a leader, that feels especially difficult to do. How do you recommend clinical leaders go about taking their own break?

Herleth: Well, one of the things we say often here is, "Put on your own oxygen mask first," to use an airplane analogy. If you don't put on your own oxygen mask, if you don't take care of yourself, take that time off. Recover. You cannot truly help your staff. So I think many clinical leaders forget to take care of themselves first and that's step one.

Woods: I also feel like one reason why folks don't give themselves a break is because they feel like they are responsible to show up for their team. But actually, I want to challenge that assumption, because if you take a step back, you are giving your team permission to do the same, right? You're modeling the behavior that you would want them to do.

Katherine, you mentioned earlier that one mistake that leaders might be making is that they're focusing on engagement instead of resilience. They're focused on the top of the pyramid instead of the foundation. Are there other, maybe well-intentioned mistakes that you see leaders making?

Presentation: Strengthening your team's resilience

Virkstis: Yeah. One that I see right now is, we're all so busy, right? And a lot of organizations are understaffed or trying to come up with the right complement of staff, and people are sprinting, right? People are working long hours and stepping up and doing a lot. But the problem is, this pandemic is a marathon. It's not a sprint, and it's not over yet; we still have a ways to go. And the problem is, if you keep sprinting, you won't make it till the end. So we need to kind of reframe the way we think about this. How do we prepare ourselves for a marathon and not a sprint?

Woods: And I think that makes sense in theory, the idea that this is a marathon, not a sprint. But it is a lot harder to then make changes in practice. What do you actually recommend clinical leaders do?

Virkstis: First and foremost, it's sounds really simple and common sense, but you need to refuel yourself. You need to connect back to the things that energize you. And one of those ways is to connect with your coworkers, with your colleagues, with other leaders or other staff or whoever they may be.

We looked at the story that a lot of people will know about, called The Endurance. It was a book and a movie, and it was about the explorer named Ernest Shackleton from the 1800s, and he wanted to be the first to cross the Antarctic. Long story short, the ship got caught in an ice floe and it became very clear that they weren't going to cross. And immediately Shackleton's focus shifted to, how do I get every one of my team members out alive?

When it became clear that the ship was going to sink, they went back onto the ship to do a reconnaissance mission. And he said to each member of his team, "You can take no more than two pounds worth of your personal goods, or something that you want to bring back with you." With one exception—the ship's weatherman had a banjo. And the banjo was bulky, it was big, it weighed about 14 pounds, but he required that they bring it with them.

Rebuild the foundation for a resilient workforce

It was the thing that brought them together every night. They sat around and they played the banjo and they sang, and it was the way they connected to each other. And later, after they had survived this mission, and by the way, every single one of his team members did survive. He was asked what was the key? And he had said it was the banjo. He called it the team's mental medicine.

Woods: Wow. So what's the equivalent of the banjo today? What is the 14-pound mental medicine that you are going to bring to your team every single day?

Virkstis: Our initial thought was, it's storytelling, but we do lots of storytelling in health care. And we do a great job telling patient stories, but we're really terrible at sharing our own stories with each other. And that I think is the key.

How do we create the space for time and connection to share our own personal stories with each other? What it's like to be on the front lines, to have to be with a patient taking their last breath, who's not allowed to be in the same room as his or her family member. Those are really tough shoes to walk in. And only the person who walks in those shoes really understands and can help you connect on that level.

Woods: So far, we've been talking about our advice for clinical leaders, right? Those who are going to be managing a team of nurses or physicians. But I'm wondering if you have advice for frontline clinicians. Anne, let me start with you.

Herleth: Well, I think first I would say that it is okay to feel tired, to feel burned out, to feel worn down. And that doesn't mean that you're not resilient. I think just recognizing that is so important.

Woods: That's such a good point, because when we use those other terms, like burnout, it feels like such a bad thing. It's like, I'm admitting defeat to say, "I'm not engaged. I'm burned out," rather than making it okay to be tired.

Herleth: Right. It is okay. You showed up, you continue to show up. We all owe you so much for that. And you should feel okay with where you are and the fact that you just kept showing up.

Woods: Katherine, what's your message to frontline clinicians?

Virkstis: You know, I'm a clinician myself. We all often default to saying, "I'm fine." Right? We call it, we have a name for it. We call it the "I am fine culture."

And sometimes it's about being stoic. But I think usually it's because you think you're fine when actually you're not, and you don't realize it. So one of the things we need to do for frontline staff is think about emotional support and not waiting for frontline staff to raise their hands, to opt in to emotional support. We actually need to bring it to them. You need someone to say, "Here, this is something that you're going to do, unless you tell me you want to opt out."

Woods: And by the way, that's another excellent behavior for leaders to model. To not say, "I'm fine. My weekend was fine." But instead to say, "I'm really tired. I'm really exhausted. I feel like I'm on the hamster wheel." Whatever it is, to make it okay for your team. And you can only do that if you admit that to yourself.

Herleth: Right. That's vulnerability right there. And like we said earlier, we struggle with that. So showing that vulnerability is so important, and not just tomorrow and next week, but forever, because some of the clinicians might actually be fine now and not be fine in six months, in a year, in 18 months, when something else happens that sort of triggers some of that trauma that they felt.