We Need to Talk about the R-Word: The Problem with an Over-Emphasis on Resilience and What Xytal can do to Help
What do we mean by resilience and why has it become so popular?
In my broad work as a psychologist and the work that I do with Xytal, the term resilience and the need to become more resilient, particularly within the NHS has become commonplace. In an environment that has experienced increased patient demand, staff shortages and practices and procedures that have been aggravated by the Covid-19 pandemic, it makes good intuitive sense that it is helpful for a workforce to develop resiliency. Xytal often combines quality improvement (QI) methodology with other approaches, such as psychology (for example), to offer the people we support a practical and evidence-based blend of the what to do (improved processes and procedures) with the how to do it (psychology skills). This is perhaps a useful demonstration of how resilience has been understood over the years: as either a system or process that is strong and resistant to breakdown under pressure or a person who has developed the capacity to continue to perform well under pressure. For anyone reading this who either works for or with the NHS (or perhaps any complex organisation), framing resilience in these terms likely helps us to understand why resilience has been referred to as somewhat of a panacea for operating within a stressful environment. If the system, processes and people are resilient, we can deal with anything right? For this blog, we are going to explore more of the psychological aspect of resilience – the human part.
What’s wrong with being resilient – isn’t it beneficial to bend but not break?
Psychological resilience is perhaps best described as the mental capacity to adapt to stressful circumstances and recover from adverse events. The importance of increased resilience becomes more relevant when individuals are subject to environments and life circumstances that generate experiences of extreme stress. For our NHS colleagues then, it will come as no surprise that responding to the challenges that a global pandemic presents (alongside all those personal stressors outside of the workplace), calls for greater resilience. However, as with most things, context is everything and whilst resilience might be desirable during a crisis, it might not be as helpful in less stressful circumstances. If we only had a hammer in our toolbox, think about how limited we would be in the range of DIY jobs we might want to undertake.
Psychologists have typically framed the need to be resilient within the context of a single adverse and highly stressful (perhaps traumatic) life event. However, within healthcare, it is more typical that the need to be resilient is encouraged as something consistent – a ‘one size fits all’ approach to working successfully within a challenging environment. We hear so much about staff burnout and challenges with retention and often, the answer is that what’s needed is greater resilience! But can too much of a good thing be bad for you? If resilience doesn’t have an ‘off button’ what might be the consequences? Could it be that a constant commitment to the need for resilience could have the opposite intended impact and contribute to burnout? Interestingly, in a cross-sectional survey of non-clinical and clinical NHS workers, results have indicated that resilience may not be a mediating factor for health and wellbeing (Sull, Harland & Moore, 2015). Yet, we have seen a sharp rise in the offer of resilience and wellbeing support programmes for NHS staff. Mark Tan has captured the controversial emphasis on this somewhat ‘sticking plaster’ approach to supporting NHS staff in a recent publication:
“Resilience is a dirty word. It is an overused, poorly understood utterance which appears to consist of a blasphemous, hollow cacophony of yoga, coffee vouchers and mindfulness training” (Tan, 2022)
Perhaps what is implicit in Mark Tan’s thinking here is the lack of attention to cause and effect. Whilst we can manage the effect of working in stressful environments with some evidence-based approaches to mindfulness, relaxation and wellbeing-enhancing strategies, doing so without also addressing the causes/sources of stress seems meaningless. We can keep changing the tyre on our car but if it’s driving through nails and glass on the driveway that’s damaging them, wouldn’t it be better to also remove the nails and glass? At Xytal we recognise the importance of systemic and organisational factors that contribute to staff experience at work and therefore, our approach to supporting healthcare reflects this. Not just the what to do but the how to do it. Not just the effect, but also the cause. This often means acknowledging the vital role resilience has to play in supporting people to undertake challenging jobs in a way that is safe for patients and staff and also enhances wellbeing. However, we also acknowledge its limitations. Even if we work part-time, we spend a significant amount of our time at work - we might as well enjoy ourselves while we are there! 😊
Relatedness, Resilience and vulnerability
So, if a constant commitment to building resilience isn’t the answer, what is? Well, if we acknowledge that operating within the complexity of NHS systems, processes, patient demand and constant restructuring is multi-faceted, it makes sense that a single approach is poorly suited. There is also a risk that the over-emphasis on the need to be resilient within the NHS suggests that staff are somehow deficient in this way. Our experience of working alongside NHS staff tells us differently. Therefore, this is why Xytal’s individually tailored approach to supporting NHS staff and services is so important – one size does not fit all! The magic lies in authentically co-producing the blend that works for the staff that we are supporting within each team.
A very popular theory of motivation is Self Determination Theory (SDT) (e.g., Ryan & Deci, 2017). The theory proposes that three key factors influence our motivation: autonomy (how much choice and control we have), competence (how good we are at a particular skill) and relatedness (the need to feel connected to and belongingness with others). Our sense of motivation within the workplace is strongly linked to our sense of enjoyment and sense of purpose. We routinely see very high levels of autonomy and competence across both non-clinical and clinical teams. However, common frustrations include systemic issues that feel beyond control and time to connect with one another to share ideas about what’s working well, and not so well and create a safe space for solidarity. This is why across all our short course programmes (see here for details), we always work to elicit from attendees, through interactive discussion, what the current sense of autonomy, competency and relatedness is such that we can respond with support according to team needs. A critical part of the training experience is the safe space that we create for relatedness because our experience is that this is very much needed but fighting fires rarely allows the time for it! It really is amazing what happens when a group of multi-skilled and experienced people with a little facilitation can do when they get together to air frustrations and generate ideas.
If we are resilient, does this mean that we can’t be vulnerable? Might vulnerability be the opposite of resilience and therefore a weakness? The American Social Work researcher Brené Brown has a lot to offer in our understanding of vulnerability and resilience, particularly within the context of organisational leadership. Something that research and practice are helping us to understand more is that rather than being considered a weakness, there is strength in vulnerability. Indeed, it is through authentic and courageous, compassionate leadership that we might also experience vulnerability and that is what drives connection and our ability to relate and trust one another. So rather than build resilience as some sort of inflexible wall, it might be more helpful to consider as Sandburg and Grant (2017) have alluded to; resilience as something we flex and contract like a well-trained muscle. At Xytal our short courses in Enhanced Care Navigation, Person-centred Communication Skills and Wellbeing [CH1] help teams develop that muscle but we also blend it with additional skills appropriate to the needs of the team. This typically includes systemic, organisational multi-level cross-sectoral factors that we root in QI, psychology, compassionate leadership, open conversations and yes maybe a little bit of mindfulness and relaxation. 😊
References
Ryan, R.M. & Deci, E.L. (2016). Self-determination
theory: Basic psychological needs in motivation, development, and wellness.
New York, NY, US: Guilford Press.
Sandburg, S. & Grant, A. (2017). Option B:
Facing Adversity, Building Resilience, and Finding Joy. London: WH
Allen.
Sull,
A., Harland, N. & Moore, A. (2015). Resilience of health-care workers in
the UK; a cross-sectional survey. Journal of Occupational Medicine and
Toxicology 10(20), https://doi.org/10.1186/s12995-015-0061-x.
Tan,
M.Z.Y. (2022). Resilience is a dirty word: misunderstood, and how we can truly
build it. Critical Care 26(168).
https://doi.org/10.1186/s13054-022-04040-x
Xytal is one of the leading British consultancies in the health sector. If you found this article beneficial, you might also consider checking out our Care Navigation and Enhanced Communication Skills programme.