Resilience: maybe it isn't all bad?

In one of our first group sessions as a cohort of Scottish Clinical Leadership Fellows we set out some ground rules and goals for our future sessions. We agreed that the exact details of the resulting document would remain confidential, but I can reveal that one of my personal commitments was to be more open to new ideas and new perspectives on old ideas.

That commitment met its greatest challenge yet when I learned that the regional Faculty of Medical Leadership and Management (FMLM) conference in Scotland this March was entitled ‘Promoting Resilience’.  

The very word ‘resilience’ is enough to make me feel defensive, as it seems to be the latest fad to fix the morale of doctors in training. I graduated in 2008, and I cannot recall a single use of the word in the current fashionable medical training context before the last 18 months, a time when the NHS as a whole has struggled with ever greater challenges. A time for doctors in training which has encompassed the ‘introduction’ of a contract, the first strikes of medical staff in forty years and increasing pressures on the service for which we work with consequent impact on our training.

Image from Improving Physician Resilience, AMA 2017

In discussions about resilience, I have encountered unhelpful references to us weak, privileged millennials who just can’t cope with the difficulties of training and working as a professional because of our over-protected upbringings. It can feel like a stick to beat us with: the implication that things would be fine if we were just more resilient, that the problem lies solely with us and not the system around us. And it can feel like you’re trapped in the four Yorkshiremen sketch at times, when you raise these concerns to hear that what you’re experiencing was much harder ‘back in the day’.

And that is the well-rehearsed, supremely negative internal monologue that would have triggered, prior to my new, more open-minded persona. I won’t lie, when I heard the theme for the day my instinctive reaction was all of the above. But then I thought about it a bit more and reasoned that, if nothing else, it would be a good idea to go into the day with an open mind otherwise I was going to be in for a miserable eight hours.

Prof Rhona Flin, Professor of Industrial Psychology at Robert Gordon University and Emeritus Professor of Applied Psychology, somehow managed to link a Swedish ship disaster of 1628 to the managerial approach behind NASA’s safety culture. You do get to hear a lot about NASA and aeroplanes at leadership conferences – someday I will come up with a bingo card, though I’ve yet to decide on a prize for the first to get a full house. As Prof Flin describes, maybe the reason for the repetitive messages in these talks given to leaders and managers is that we just don’t learn.

It’s easy to isolate the human factors around the sinking of the Vasa (which, for those not in the know, was a Swedish warship which sank shortly after launch in Stockholm harbour in 1628): rapidly changing demands from the king regarding the design of the ship while it was being built, the death of the experienced shipwright in charge of the project during its construction, a test showing the ship’s instability prior to launch was ignored and so forth. What possible relevance can this have to sending rockets into space? A similar sequence of errors led to the Space Shuttle Challenger disaster in 1986, with members of the team who raised concerns being silenced, as the cost of failure was too high.

By MapMaster – Own work, CC BY-SA 3.0, Link

This led to further consideration of organisational and managerial resilience, terms which describe the ability to manage pressure and conflicts within an organisation while balancing safety and performance goals. In the context of healthcare, you would hope that you could be admitted to hospital safely and quickly while everyone else who attended hospital that day got the required treatment and care without ending up floundering in Stockholm harbour because of competing priorities. Flin also advocates a sense of chronic unease: a type of vigilance and ongoing suspicion that something might go wrong that you would hope leads you to spot issues early.

We were also addressed by two medical students, Miss Ilona Blee and Mr Jonathan Tsun, who are part of the group behind Humans of the NHS. This initiative seeks to promote the positive stories from the NHS, rather than the overwhelmingly negative impression you might get from the media and other quarters. They spoke brilliantly through the words of those they’d interviewed and it was really uplifting to hear the motivations, hopes and occasionally fears of others working in healthcare. Keep a note of those students’ names, they are going places.

And finally, to close the day, Dr Catherine Calderwood, Chief Medical Officer for Scotland, spoke about her second report, Realising Realistic Medicine. In its predecessor, Realistic Medicine, she set out her vision for an approach to healthcare, which is more holistic and less medicalised. Where doctors (or nurses, AHPs, dentists and anyone else responsible for patient care) and patients connect and have a proper discussion about what it is that they want from their treatment, rather than it just being assumed that they want what you propose to give them. The second report focuses on how this vision is going to be realised.

Realising Realistic Medicine; CMO Scotland’s report 2015-16.

I haven’t even covered half of what was squeezed into a fascinating day in either the main sessions or the workshops. Suffice to say, I know far more than I did at the start about kinds of resilience, international healthcare, the Ebola response and use of data in the NHS. And I’ve been persuaded that it is possible to promote resilience as a positive tool: one of building the strength to cope, being flexible, adaptable and strong. It can be used and developed as a supportive tool for doctors in training and it is compatible with the acknowledgement of our concerns. But I reserve the right to cling to my sceptical defence if anyone tries to tell me that junior doctors have never had it so good, we just need to be a bit more resilient.

This was originally published on the Scottish Clinical Leadership Fellowship (SCLF) blog.