Programme Director, Derby Speciality Training Programme for General Practice, Nottingham, UK
John Frain, MB ChB, MSc, FRCGP, DCH, DGM, DRCOG, PGDipCard, AFHEA Clinical Associate Professor & GEM Director of Clinical Skills, Division of Medical Sciences and Graduate Entry Medicine University of Nottingham, UK
Susanne Hewitt, MBE, MBChB (Hons), FRCS, FRCEM Consultant Emergency Medicine University Hospitals of Derby & Burton NHS Foundation Trust, UK
Carrie Krekoski, RDH, BDSc (Dental Hygiene), MEd Practice Education Manager Office of the Vice President, Health University of British Columbia, Canada
Sue Murphy, BHSc (PT), MEd Faculty of Medicine, Department of Physical Therapy University of British Columbia, Vancouver Campus, Canada
Lynn Musto, PhD, RN, RPN Assistant Professor School of Nursing, Trinity Western University, British Columbia, Canada
Sarah Nicholls, BSc, BMBS Junior Doctor, Emergency Department Queens Medical Centre, Nottingham, UK
Betsabeh Parsa, BEd, MEd Faculty of Medicine, Department of Physical Therapy University of British Columbia, Vancouver Campus, Canada
Carla Stanton, BMBS, BMedSci, MRCGP, PgDip, DPD General Practitioner Functional Medicine Doctor, Hertfordshire, UK
Victoria Wood, MA Strategic Lead, Health Systems Office of the Vice President, Health University of British Columbia, Canada
Preface
‘To err is human’ but so is to excel. Resilience recognises this. It is about bouncing back, regaining our shape – about not merely carrying on, but becoming more self‐aware rather than more self‐critical. Clinical resilience is not about standing apart from our patients but embracing the humanity we share and planning for the physical, emotional and cognitive effects our work has upon us. Our work is intense, and it is a paradox of modern healthcare systems that, despite the incredible treatment pathways and technological advances we have achieved, our most precious resource – those who deliver the care – report feeling increasingly burned out and unable to carry on.
We are human beings trying to help other human beings. Our professional role often requires us to be bigger than who we believe we are capable of being. When we fall short of this self‐imposed expectation, many of us feel we have failed, that we have let ourselves down as well as our patients and our colleagues. Though we must be aware of our limitations, we should not be bound by them.
A recurring theme of this book is the need in healthcare for greater kindness. Not kindness as simply an emotional feeling – important though this is – but intelligent kindness, the kindness that motivates us to be cooperative rather than competitive with one another; to feel connected, thoughtful and with a sense of kinship towards other people. This connectedness starts with thoughtfulness towards ourselves, and learning about the impact on our physiology and our cognitive performance of the stressful environments in which we are all working. The potential gains are substantial. First, there is our own well‐being, and a recovery of that ‘joy of practice’ which first alerted us to the attraction and fulfilment of working in healthcare. Secondly, greater safety and well‐being of staff means improved safety for patients and a reduction in the medical error related to staff burnout. There is a particular responsibility on healthcare regulators, leaders and providers to develop the intelligent kindness towards healthcare staff which has too often been absent, so that staff and their patients remain safe.
We are grateful for the contribution of our authors, all of whom committed to this project before the outset of the Covid‐19 pandemic, an event which has bought into much sharper focus so many of the themes we set out to explore in this book. They have shown resilience in completing their chapters in such a timely way despite the challenging circumstances. We work in Canada and the UK, and so this book inevitably reflects perspectives on resilience in our particular countries. However, from our professional conversations, we believe the themes we have explored reflect concerns in many countries and health systems worldwide.
We hope the individual reader will find this book of interest. With our emerging understanding of resilience and its importance to patient care, training programmes are increasingly considering how to incorporate resilience into healthcare education. We hope our work will be helpful to them as well.
Anna Frain
Sue Murphy
John Frain
February 2021
CHAPTER 1 Why resilience? Why now?
Anna Frain1, Sue Murphy2, and John Frain3
1 University of Nottingham, Graduate Entry Medical School, Derby Speciality Training Programme for General Practice, Nottingham, UK
2 Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver Campus, Canada
3 Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
OVERVIEW
Those entering healthcare professions are motivated by the potential ‘joy of practice’.
Healthcare practitioners are being harmed by the impact of the systems in which they work.
Burnout is an occupational hazard for all healthcare workers and increases the risks of both major and minor errors in caring for patients.
Equality and inclusion in healthcare are not only morally right but enables all to fulfil their potential to improve patient outcomes and maintain practitioner well‐being.
The Covid‐19 pandemic has brought into sharper focus the impact and current challenges of the working environment upon healthcare workers.
Organisations have a duty of care to protect patient safety by supporting healthcare workers with intelligent kindness.
Introduction
Healthcare workers are human beings trying to help other human beings. This invariably leads to a discussion of human frailty and shortcomings. Yet, the skills and abilities of practitioners are awesome, and we often have an insufficient sense of awe regarding them – to listen and to understand the effects of suffering on patients, to use our senses to examine and to diagnose, to provide comfort and support, to restore to health, to witness both the greatest joys in patients’ lives as well as their darkest moments. Undoubtedly, this work requires the full use of our talents and is rewarded by the joy of practice.
Alongside this, advances in treatments across the multidisciplinary spectrum of healthcare in the past century enables us to do more and achieve more for patients and to genuinely feel we are making a difference to peoples’ lives. Those entering healthcare training should be confident they are entering an occupation at the cutting edge of human endeavour and characterised by the sense of the well‐being and resilience of those working in it.
Yet, the reality for many practitioners is very different. Confronted by the uncertainties and ambiguities of practice
