Recently, I had the honor of speaking at Yale New Haven Health’s 2018 Inaugural Quality, Safety and Experience Conference. One of my favorite parts about presenting at conferences is the opportunity to attend and learn from the other presenters. This event was no different and it was a great day.
One of the most powerful sessions of the day involved two physicians discussing their experiences of harm and error. The focus of the conversation was not clinical and did not dwell on the details of the case—in fact, the patients discussed were clinically fine after an adverse event. Additionally, there was even some gray area about whether or not the physicians involved could have done anything differently to avoid the adverse event. This was not a conversation about clinical safety but, rather, emotional safety among colleagues.
Despite there being significant differences between the clinical elements of their experiences, the two physicians onstage shared many similarities in their experiences after the adverse event. They both considered leaving medicine; one physician confessed she wondered if she should make a career change to home renovation. Both struggled to sleep at night and both replayed the event over and over in their mind, seeking an answer to what could have been done differently. Perhaps most important, both physicians are haunted by the event to this day even though many years have gone by.
What I carried away from both of the stories shared that day was the deep sense of isolation both physicians experienced. When sharing their grief and trauma with collogues, they found they were met with responses that had good intentions but fell flat. “You did the best you could,” and “But the patient is alright, isn’t she?” didn’t sooth the deep, unrelenting self-doubt that had manifested within these dedicated doctors. The experience had not only caused them to question their worth as professionals but their worth as human beings. It seemed they had no safe place to turn. These two physicians made it clear that when mistakes happen the primary need for support goes to the patient and family. That does not mean, however, that support for the provider is not also needed.
Listening to these heart-wrenching stories, my mind went to an article I had read years ago. The article, “How the Babemba Tribe Forgives,” tells the story of a tribe in South Africa. In this community, when a person makes a mistake or does something irresponsible, everyone in the community drops what they are doing and circles around. For hours and sometimes days, the members of the tribe shower this individual with details of their good deeds, positive traits and strengths. Once they are satisfied that they have shared all of the good stories about the individual, the circle breaks and a celebration begins. I see this approach as “radical support” and is far from the standard way that most healthcare professionals receive support after a traumatic experience.
We live in a culture that often expects perfection of our healthcare professionals and, when a mistake is made, we don’t always have tools or skills to effectively support the person as they process and grieve. I can’t help but wonder, if the colleagues of these physicians had been given tools in order to react and provide support more effectively, might the physician wondering if she should move into home renovation see things differently? If, instead of replying with statements that invalidated the physician’s deep sense of insecurity, what would have happened if the response was to validate all of the physician’s strengths and good qualities as a person and a professional? What if the root of pain the professional is experiencing comes from an unconscious need for forgiveness and we offered that to them?
Assuming the “radical support” approach of the Babemba Tribe is philosophically intriguing, it may be challenging to imagine how it may translate into current systems and processes. For some teams, supporting a team member who is struggling with an adverse event may be a more informal conversation among leaders, staff and providers behind closed doors. Other organizations may benefit from a more formal approach that builds a new program or, ideally, integrates into an existing framework.
One potential framework that many organizations already use is Schwartz Rounds. Looking at The Beryl Institute White Paper, Schwartz Rounds: Supporting the Emotional Needs of Staff: The Impact of Schwartz Rounds on Caregiver and Patient Experience, it strikes me that both the spirit and the format would easily lend itself to a few adjustments in order to include “radical support.” A few highlights from this whitepaper quickly illustrate why one might connect the two:
- The Schwartz Rounds program, now taking place in more than 425 healthcare organizations throughout the U.S., Canada, Australia, New Zealand and more than 150 sites throughout the U.K. and Ireland, offers healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss the social and emotional issues they face in caring for patients and families.
- One of the primary goals of Schwartz Rounds Decreased is to reduce feelings of stress and isolation while fostering more openness to giving and receiving support.
- One Schwartz Rounds participant articulated, “The ability to find a safe venue for expressing our unrest was, to me, the most attractive feature of the Rounds.” Another participant stated, “The emotions we feel, the stress we feel, does need to be ventilated someplace…”
The Beryl Institute has an unwavering commitment to the human experience in healthcare and, it is evident, humans working in this challenging field need more avenues to hear how much they are valued. Perhaps the Babemba Tribe approach is one worth adapting to the complex world of healthcare; whether through Schwartz Rounds or another framework already hardwired into the organization. No matter what, we must find ways to address isolation and provide better support to those facing questions of their own worth after an adverse event.
Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute