Part Four: Where are we headed?
By Françoise Mathieu, M.Ed., CCC.
It turns out that wellness practices are probably a great idea for everyone – therapists, circus acrobats and accountants alike. During the past year, I had to research and write this lengthy piece while juggling a busy work and family schedule. I am a writer, a consultant, keynote speaker, business owner and a parent. I travel extensively and have a heavy workload. And so, to cope with this busy time I made sure to exercise daily, practiced yoga several times a week, meditated, ate greens, drank lots of water, avoided excess alcohol and caffeine, tried to get enough sleep, connect with others and have some leisure time. I find that these practices are essential to my well-being. Sure, I can go a few days without them, but I start feeling unwell fairly quickly and that would also be true for many of my overextended civilian friends. Self-care and work-life balance are wonderful tools to manage the pressures of life, and perhaps live a little longer, and it is likely that they are particularly important for those of us who work in high stress, high trauma settings, but it is now clear that these strategies alone cannot compensate for unsustainable caseloads, excessive trauma exposure, toxic work environments and lack of training.
After seven years working as a crisis counsellor in a busy clinic, I quit. I left a permanent position with full benefits to work in private practice with no job security and no pension fund. Although I was definitely suffering from vicarious trauma from the thousands of terrible stories I had heard, my main reason for leaving had more to do with burnout and moral distress: inadequate pay, insufficient supervision and inadequate referral resources – those are the things that wore me down, over time.
It turns out that for me, and research shows for many others in the field, the clincher was regaining control over my schedule. I can say without a doubt that this was the single most important factor in reducing my burnout and compassion fatigue. The fact is that in my new job, I was still doing high trauma work, perhaps even more than before, as I had been given a contract to work with soldiers from our local military base. But I was the one setting my schedule. If I wanted to see four clients in a row and then go for a run, I could do that. If I wanted to take every Friday afternoon off to do groceries and work on a Saturday instead, that was completely my choice. I also felt relieved to no longer have to contend with office gossip and naysayers, something I had always found incredibly draining. Of course, not everyone can (or wants to) work in private practice. In fact it’s not a very sustainable model for an entire health care system. So we need to find ways to bring that kind of flexibility to our workplaces.
Is there a Google of Mental Health Services?
Over the past decade, Silicon Valley has led the way to crafting what seems to be the optimal workplace: beautiful work environments, flexible schedules, plenty of leisure time, free healthy food in the cafeterias, and, it seems, happy and productive employees. No wonder Google gets over a million job applicants per year. Wouldn’t it be wonderful to do the same in health care? Unfortunately, the helping professions lack the tech leader’s deep pockets. We also have to contend with a uniquely complex work environment – one that includes regular exposure to trauma and high stress. Organizational health expert Dr. Patricia Fisher has a solution, but to attain it, she argues, agencies need to be willing to invest in attracting and training strong leaders.
When things go terribly wrong in a prison, hospital or a child welfare office (such as a prolonged labour dispute, a mass casualty event, or the death of a child in care), senior management often turns to Dr. Patricia Fisher for help. Fisher is a clinical psychologist and trauma specialist with many years of experience working in workplaces with high stress and trauma exposure. In a recent conversation, Fisher, who is a close colleague of mine, explained that in order for real change to occur at an organizational level, it is essential to understand that not all workplaces were created equal: those with high stress exposure need a specialized approach. “Trauma exposure has immense consequences for organizational health and capacity. This is such a fundamental problem and yet it is typically invisible.” Based on her vast experience, Fisher argues that it is a mistake to try and use garden-variety human resource strategies with high stress, high trauma workplaces. Working in a trauma-exposed workplace is nothing like working in an IT department, so why would we try to apply the same employee health solutions to both?
In fact, Fisher’s research shows that organizations are often trying to solve their HR problems in completely the wrong order: “we need to understand that we are working with complex human systems, not machines”. Fisher argues that one of the key elements for a healthy organization is strong leadership – the healthier the manager, the healthier the team as a whole: “Leadership is critically important, but we need to remember that leaders are people too and are often themselves struggling with stress effects and require support and training to help them meet their mandate and keep their staff engaged and well.” Another crucial area of focus must be on attracting and retaining good quality staff, something that is proving to be a significant challenge these days, with Boomers retiring and Millennials unwilling to sacrifice their health to the job.
Patricia Fisher has developed one of the only comprehensive organizational health models that address the very complex needs of helping professionals. She brings a whole new way of seeing organizations, and her success rate is impressive. At the end of the first year of a recent contract with a province-wide corrections division, Fisher was able to see a significant increase in workforce engagement, respectful environment, improvement in staff management relations and a marked rise in job satisfaction rates. But to achieve this, Fisher needed senior management on board. In fact, she argues, you will not find a success story that does not have strong leadership as its base.
A recent New York Times op-ed entitled “Why you hate work” by Tony Schwartz and Christine Porath supports Fisher’s assertions: “Put simply,” the authors write, “the way people feel at work profoundly influences how they perform.” Schwartz and Porath identify “four core needs” in employees: physical, emotional, mental and spiritual. Improved productivity and employee satisfaction is a direct result of ensuring that those needs are addressed in staff: “physical, through opportunities to regularly renew and recharge at work; emotional, by feeling valued and appreciated for their contributions; mental, when they have the opportunity to focus in an absorbed way on their most important tasks and define when and where they get their work done; and spiritual, by doing more of what they do best and enjoy most.”
Schwartz and Porath argue that one of the main obstacles to implementing these changes is getting senior leaders to actually put them into place: “We often ask senior leaders a simple question: if your employees feel more energized, valued, focused and purposeful, do they perform better? Not surprisingly the answer is almost always Yes.” Next we ask, “So how much do you invest in meeting those needs?” an uncomfortable silence typically ensues.” Why are senior leaders often unable or unwilling to put in place the policies that are needed to ensure a healthier, more productive workplace? The authors suggest that we are challenging significant inertia and deeply rooted practices and beliefs: Creating such a large shift at the senior level of some organizations is not unlike getting a huge freighter to change its course. It takes time, and plenty of strong data to support the case of implementing change that may, in the short run, look more costly than business as usual. Once senior management is on side, you then need to obtain staff buy-in, which can be very difficult to obtain.
“Why are staff not coming to our lunchtime wellness sessions?” a manager in a busy Los Angeles legal clinic recently asked me, “we try to provide body breaks, staff appreciation days, and exercise classes, but our employees don’t attend. What are we doing wrong?”
It turns out that this well-meaning agency, and many others like it, may be putting the cart before the horse: recent studies have shown that obtaining employee buy-in requires a deeper understanding of workplace stress and that focusing exclusively on employee wellness may be a mistake. Conversely, some organizations have become highly vocal champions of employee health and wellness on paper alone, but the truth on the ground is far from rosy: I worked with a nursing group a few years ago who flat out refused to wear their agency’s new button pin which said something like “at this agency, we provide compassionate care” because they believed it was patently untrue – this organization had recently been drastically restructured, workload demands were unsustainable, positions had been abolished and rates of depression and anxiety were soaring among staff. It was evident that the problem was organizational, rather than insufficient yoga.
Like the Los Angeles legal centre, many agencies are genuinely concerned about the health and well-being of their staff and are anxious to provide quality client care and reduce sick leave and attrition. Unfortunately, economics play a significant role – organizations are trying to improve working conditions in a context of severe budgetary cutbacks and a dramatic increase in workload. So, how do we move forward and integrate the new compassion fatigue findings in our work so that we can become a healthier workforce?
Pat Baigent, a social worker and director of support and recovery services for a community mental health agency in Ontario has been working hard to implement strategies to reduce compassion fatigue in her agency. She agrees that getting staff to engage can sometimes be a challenge: “People have difficulty with change – even sometimes when the change is good. I’ve heard that it can take many years to change the culture of an organization so I am trying hard to be patient. Many staff view management efforts with suspicion and pessimism. It seems like some staff are afraid to hope. Even talk at my work about plans for home offices and flexible schedules (things that would have been viewed as a pipe dream under old management) are not well received. It can be really hard to continue to champion the positive changes whilst feeling disappointed with the negativity.”
Baigent observes that staff also sometimes experience “committee fatigue” and are fed up with having to fill out yet another survey, or take part in one more focus group. She adds: “negative voices can seem so much louder than the positive ones. It’s difficult to find ways to amplify the voices of the staff that are adapting and thriving in the changing culture. It often seems that most of our energy is spent trying to pull negative staff “along” with us as we change.” Baigent concludes that there is no quick fix, and that she and her colleagues need to be patient and hold steady: “We had to acknowledge that evidence of compassion fatigue is all around us and it will challenge both our staff and our organization for some time to come.”
Dr. Patricia Fisher agrees and emphasizes that it is important to remember that change takes time, and high stress, high trauma workplaces may be more mistrustful and reactive to new policies and initiatives coming from senior management, no matter how well meaning they are.
Tomorrow: Part five of five – This isn’t about perfection
Françoise Mathieu is a mental health professional and a compassion fatigue specialist. She is the author of The Compassion Fatigue Workbook (2012) and co-author with Leslie McLean of a book chapter entitled: Managing Compassion Fatigue, Moral Distress and Burnout in a context of patient-centered care in Walton, M., Barnsteiner, J., & Disch, J. (eds) Patient/Family Centered Care – Patient and Care Provider Considerations, Sigma Theta Tau International, 2014. She is also the author of several magazine articles.
Françoise is chair of the annual CARE4YOU Conference on Compassion Fatigue