In a far-reaching podcast interview with Professor Ciaran O’Boyle, Director, Centre for Positive Psychology and Health at The Royal College of Surgeons, Ireland we covered some of the topics he will be discussing as keynote speaker to the Nurse Leadership Forum Middle East on Monday, October 12th (3pm-5pm GST) in which he will share further thoughts and lead the discussion with 200+ nurse leaders from across the Middle East on the event. He will be joined by Associate Professor Jane Griffiths, recent Chief Nursing Information Officer at the Dubai Health Authority, who will provide a regional perspective on the strategies employed with their staff and in their hospitals during this COVID-19 crisis.
Professor O’Boyle explains the two themes to be explored.
“The first is to provide what I hope is helpful advice for health professionals – for themselves, for dealing with their own psychological well-being in this COVID time and particularly in leadership roles.
“The second is to talk about leadership and how we think about leadership. I sometimes think people are put off leadership because they think there's one way of leading, that they have to be charismatic and they have to be a particular type. Whereas we know there are as many ways of leading as there are types of people. One of the things we’ve learned in the Institute of Leadership over the years is it's wonderful to see the light go on in people's heads when they realized they could actually lead while still being the person they are. There’s a way of leading quietly – in fact, some of the best leaders lead quietly, they're effective, they're approachable – so one of the things I'd like to come out of this session is for people to maybe reflect on their own leadership styles and see what's good about it, see what might need to be developed and then perhaps come away with a model for compassionate leadership, which allows them maybe to tweak how they themselves lead, but also, more importantly, to develop their own people into leadership roles. To help their own people develop into leadership.
“The mark of a true leader, in my opinion, is somebody who develops leaders.”
Professor O’Boyle has a CV that demands notice, based on 40+ years of senior experience in the health sector, all of which brings an extra sense of urgency for his message. The discussion started with a key point, which is that “stress and burnout have always been problems in the healthcare professions. It's a demanding job anyway and COVID has introduced a whole new set of stressors for health professionals, particularly for those who are working at the frontline dealing directly with patients who have the virus infection.
We asked for his perspective on the scale and severity of the problem in recent months, and building on his initial thoughts he went on to make a statement about the mental concerns at the workplace for healthcare workers, saying “many have concerns about getting infected themselves and carrying that infection home to their families. Then, because of the workload, particularly in ER/A&E there are basic stressors like lack of food, rest and poor sleep quality. But you also have the stressors such as the changing nature of having to cope with death, especially for young newly trained health professionals. And then there's a concern about what's called moral injury. Moral injury is the damage done to us when we see something or experience something that challenges us ethically and challenges our values.
“Internationally I'd summarize by saying that mental health challenges are ubiquitous. We're seeing reports from many countries, many different cultures, all saying very similar kinds of things about the added impact of COVID on the mental health and well-being of health professionals.”
The scale of COVID took most by surprise, but it's not the first time the world has experienced major health outbreaks, so we asked Professor O’Boyle why weren't these concerns anticipated sooner and why wasn't there anything in the system to proactively address these problems?
“There's a significant issue in the way healthcare systems are structured and operate. Health professionals give and give and give of themselves, driven by altruism and by their vocational desire to help. That happened here and is absolutely fantastic. The problem is it’s not sustainable. You really need support in place to allow people to continue to operate in situations that are that challenging.
Mental health for professionals
In terms of how health care professionals are dealing with effectively, he suggests it falls broadly into two approaches.
“One concerns the personal and the second is in their organizations, and the kinds of organizational strategies needed to support health professionals.
“When it comes to the personnel, we have some research on this, and there are a number of things that seem to be helpful. The first is relying on your training is really helpful in terms of dealing with the day to day stresses of dealing with COVID patients. The second is by taking a proactive, problem-focused approach. That involves seeing events as challenges to be dealt with rather than catastrophes that cause you to go under. We call that adopting a growth mindset which is a very specific kind of psychology. People who adopt a growth mindset say, ‘I'll do my very best, learn from it so the next time I know better how to deal with this’.
“The third [approach] is people do better if they maintain very good social supports; friends, family, colleagues. The team huddle is a fantastic example of that in hospitals where at the end of a difficult shift, the team comes together briefly, has a huddle and there's a sense of mutual support there.
“Taking personal responsibility for one's health with diet, exercise, timeout, good sleep hygiene etc are also important factors that help set the tonal level of coping.
“Organisationally we should start with the idea that there is a duty of care in all stressful situations. The more enlightened have, for example, policies around how shifts work. They try to put people together in the same teams over long periods, encourage buddy systems for new people, open communication support in terms of restroom places where people can take time out from the immediacy of the situation. Some organisations use Schwartz rounds, which is a type of an emotional debrief for a staffer to look at a situation that's occurred and talk about their feelings and their emotions in relation to that.
“Leaders need to monitor their staff, watching for signs where people might not be doing so well and be aware of the stressors they're dealing with, and not just stressors occurring within the facility setting but also additional stressors at home like managing young children, elderly parents and so on. And then I think there's a third layer, which is where there should be an employee assistance program for people who need additional care.”
Leadership and compassion
Leading on from organisational support we asked what empathy and leadership looks like, and how can leaders take a greater interest in the well-being of a staff?
“When I'm feeling empathy for another, I’m feeling their pain and feeling their suffering; I have a sense of what they're going through. That's terribly important, particularly in health care. The problem is if it stops there, I'm left feeling the pain but there’s nothing I can do about it.
“Compassion adds another dimension. Compassion is action. I feel the empathy and understand somebody's suffering, but compassion means that I actually take action to alleviate that.
“When we come to leadership, the first challenge is what do we mean by leadership? I subscribe to the idea that the best kind of leadership is transformational leadership, which sets out to develop and transform the follower into the best that they can possibly be. KPI’s and the ‘system & process’ approach is management. I make a distinction between leadership and management.
In the Institute of Leadership at the RCSI thousands of people are trained and developed in leadership with a model called Authentic Leadership, which encourages people to bring their life experiences to bear and helps create a natural moral centre, with people then operating from an ethical base.
“It involves creating an organization that supports care for the people working within it.”
He poses the question “Who would not want to be led by somebody who is trustworthy, knows their values, has worked on themselves, takes into account a variety of views, is open to input and who treats people as individuals?”
Technology also brings very large opportunities as we move away from an almost exclusively curative approach to a preventative approach. He states “We simply can't keep going with the current healthcare systems where people develop diseases and we try to cure or alleviate. That approach needs far more investment [than we have].”
The future resides in prevention lifestyle medicine and he sees very big shifts coming, as a result of which he sees different kinds of healthcare leaders.
Education and change
“It is important very early in the early stages of educational development of health professionals right across the spectrum that we start developing their management and leadership skills. This doesn't happen at the moment, and I think it's a pity.
“We seem to be educating health professionals for a healthcare system that currently exists, but not for one that will exist in 5- or 10- or 15-years’ time. I don't think we've adapted our educational systems quickly enough to develop health professionals for the future of health care.
We asked his thoughts about the role generally of governments in healthcare, and to what extent they need to drive much of this change.
“I've always been fascinated by the emphasis that governments put on GDP, as an indicator of how well a country is doing. There was a wonderful speech by Robert Kennedy where he talks about all of the things that GDP doesn't capture in a society. GDP is basically an economic indicator, but some countries have started to look very closely at this. Bhutan did away with GDP as an outcome and they've used a gross happiness quotient. Jacinda Ardern in New Zealand started to look at wellness and happiness as an indicator of how well the country is doing.”
This thinking has positive results. In the GCC the UAE launched the National Programme for Happiness and Wellbeing in 2016 and now has a government Minister of State responsible for this initiative.
“To give you an[other] example, in Australia they're teaching school children about their strengths. It's an idea that has emerged from positive psychology where you can identify what your key strengths are, and the evidence is if you're working with your top five strengths, and you're using those every day, your sense of well-being and happiness just goes up and up and up. Academic studies show how children as young as 4- or 5-years of age increase their emotional and physical well-being, and that translates into better academic performance. It makes sense as happy kids learn better.
“There's an example of an idea that could be applied in education systems worldwide, and one of the outcomes of that would probably be a decrease in the levels of eating disorders, of depression, suicidal ideation and so on in young people in the teenage years.
“Darwin didn't say it was the strongest that survive; rather it was the most adaptable that survive. In fact, he went on to say that it was the most sympathetic who survive. Which brings us back to compassion. We can see how compassion as a human characteristic in early humans created a very strong evolutionary advantage, so I think we've got to a point where we need to think very differently about health and healthcare.
“For me as a psychologist, it is really interesting to look at the main approaches needed, which is physical activity. It’s diet. It's alcohol, drugs, smoking. It’s sleep. Those are all behaviours. We're coming into an era where health psychology, just like public health medicine, which were Cinderella subjects until about a year ago, are now suddenly the most important subjects."
“COVID is an idea-accelerator because COVID has taught us we are personally responsible for our own health in this situation, and that our own approach to risk is important. The strategies for preventing the spread are our own behaviours. We are learning, and we are adapting, and we're starting to understand that, yes, it's challenging, but there are things we can do as individuals which demonstrate solidarity and concern for the common good and demonstrate to ourselves that our own behaviours have significant consequences for our health.”
Professor O’Boyle joins Assistant Professor Jane Griffiths, recently Chief Nursing Information Officer with the Dubai Health Authority, on 12th October at 3pm-5pm Gulf Standard Time online.
The moderator is Brandy Scott, well-known journalist, co-presenter of the Business Breakfast on Dubai Eye 103.8FM and the Steering Group for the Nurse Leadership Forum, comprising 28-CNO’s and leaders from across public and private hospitals in the region will all be on the event, along with their available nursing staff and executive leadership teams.
This initiative comes from OBIX Middle East, regionally headquartered in Dubai. The OBIX system starts from the moment an expectant mother attends hospital for the first-time. OBIX provides complete central, bedside and remote electronic fetal monitoring data for clinical workflow enhancement, patient record integrity, and continuity of care. Additionally, the high level of system performance and reliability includes full-screen surveillance and alerting, strip annotations and comprehensive charting modules. OBIX provides healthcare professionals easy access to mother & baby data in any location chosen by the hospital including at the bedside, nurses’ stations or remote office; and delivers same time/data between hospital, PHC facilities and off-duty locations directly into the electronic health record (EHR). The system operates to high standards of care.
From small hospitals to large, multi-facility enterprises, OBIX is easily scaled through its modular features to meet needs and seamlessly integrates with the hospital’s existing EHR of choice.