ACEM Wellness Week 2021

You could say that we, Emergency clinicians: doctors, nurses, clerks, orderlies, cleaners, everyone that make up our team in ED, have never lived in more challenging times. The pandemic, access block, climate change, the list goes on. So you could argue that there has never been a more important time to think about looking after ourselves as well as our colleagues and our patients.
 
Of course “wellness” and “wellbeing” are not positive terms to some people – yoga and cupcakes do not suddenly right the ills in the world and these are in fact toxic concepts for some, kind of like blaming you for not being happy when you should be. None-the-less I will push on and try to put down some of my thoughts on wellbeing, connection, and compassion.
 
Over the years I have gathered some tips and tricks from a variety of sources.
 
On professional level: Emergency medicine is a marathon, not a sprint. You have to deal with uncertainty, grief, failure & disappointment. But we can gain a lot of satisfaction from the camaraderie, working shoulder to shoulder in a horizontal hierarchy that are all ED staff, sharing the stress, the laughter, the grief and celebrating our many victories of good patient outcomes. I love our emergency medicine tribe – don’t forget we are the most exciting 15 minutes of every speciality.
 
A Japanese concept of Ikigai – something that gives your life meaning: doing what you love, something you are good at, something that you get paid for, and that benefits society. It is a privilege to be able to line all of these up.
 
Build: a safe system, achievable goals, workforce growth & retention, resilience, conflict resolution, trust, and a safe and just culture
Peer: connection, support, belonging, engagement, a career portfolio and plan (in 5-yr segments), of course our College is a great example of this
Enjoy: Wellness has physical, emotional and spiritual components, all of which are different in everyone, life balance, interests outside medicine, exercise, a good diet, family time, alone time, show kindness, and learn to look up. And you cannot be happy all of the time.
 
We need to accept imperfection. The enemy of good is better. Excellence is possible, perfection is not. Learn from your mistakes and move on. “There is a crack, a crack in everything, it is where the light gets in” (Leonard Cohen)
 
And finally, look after yourself first, and you will be in a better place to look after others. Never forget the compassion: for your patients, your colleagues, and for yourself.
 
Kia kaha – be strong
John Bonning

The theme for ACEM Wellness Week 2021 could not resonate more strongly with me as connection and belonging are fundamental to my wellbeing. Working in Emergency Medicine, we see the human condition up close. It is a privilege to meet people on their worst days, to listen to their stories and hear their intimate concerns. Connection is at the heart of all that we do.

It was human connection that drew me to Emergency Medicine. From my first moments working in the Emergency Department, I loved the teamwork, the flat hierarchy, and the sense of being part of the ED family. I felt valued, working beside experienced doctors and nurses, with first names all round. They were generous with their skills and their time. I felt like I was learning fast and making a real difference. The ED soon came to feel like home. I now strive to create that feeling in my own workplace and in my college role.

The EDs I have most enjoyed working in have all fostered a strong culture of belonging. In my experience, team members who feel secure and valued make better clinical decisions. They are also more likely to speak up about problems and to engage in innovation to drive positive change. The emotional support that is available in highly connected ED teams is protective too.

We need to be mindful that true belonging cannot exist unless there is cultural safety and genuine inclusion. We must make conscious efforts to ensure that everybody feels part of the team.

With increasing presentations, worsening access block, and the ongoing uncertainty of the pandemic, times are difficult in Emergency Medicine. It is reassuring to share problems, discuss solutions and to celebrate the good things, no matter how small. I am making more deliberate efforts than usual to stay connected this year. I encourage you all to reach out and have conversations with colleagues too.

There is something different, something special about working in an ED. It is the people you work with and the bonds that you build. The work is hard. It is stressful. It has incredible highs and lows. But it is the connections to your team which allow you to get through this; to absorb and deal with the traumas, the sadness and the pain, but also share in some of the victories, those moments where you have all made a difference in someone’s life.

These moments build those connections. These moments bring you back to work, to be with your ED team and do the things that we do.

Good leaders, the best leaders, will build those connections with their team. A vital part of being an ED Director…being an ED leader…is being prepared to get “on the tools” and do the hard yards…come in and help when an extra set of hands in needed, see the patient that others seem to avoid…make the hard calls, back your team. They see that you care for them, care with them and will go into bat for them at any time.

This may require you to work harder or longer than you sometimes want to, but you will be paid back in spades….the connections will be strong and staff will then back you up and back you in…

Being “isolated” as a leader, means that you will not be able to lead. You may try to manage, coerce and demand, but without the connections, the team, it will become a stress…it will impact your wellbeing and that of your staff.
 
Wellbeing for ED staff means more that all the usual things ( work life balance, exercise, sleep, good diet etc). In the environment in which we work, wellbeing also means having the capacity and supports to deal with some very streesful events. So, knowing that they have an ED which will support them in those times, the times where they and mentally and emotionally vulnerable, is a significant part of wellbeing in ED’s.
 
My ideas of leadership have been shaped by observing others, but also my own personal experiences. Good leaders will actually care about me and my wellbeing, my work, my career and my family life. I have felt that and I have felt what happens when that is missing. I don’t what anyone on my team to feel that loss of connection and the burn-out that can bring.

Everyone in a leadership position continues to learn, from the people they work with and reflections on their own experiences, good and bad. If you think you have it sorted, then you have a lot to learn. If you think you are a good leader, then you need to reflect on what you can do better. Leadership is a huge responsibility. People need you to be the best you can be…a good leader will ensure their team can be the best that they can be...you create connections and positive feedback loops and enhance your wellbeing and that of your team.

So leadership, effective, caring, inspirational leadership creates connections, supports and enhances wellbeing and elevates an team from good to great….

Connection and belonging is personal but derived from shared experiences. A sense of belonging to a place comes from the connections made with people and the events one lives though in that place, together. Although connection and belonging is often linked to a place, like an Emergency Department, for me it is more about the people. Connections are forged working as a team in a difficult resuscitation, dealing with difficult clinical challenges, or in the discussion afterwards. Friendship, collegiality, support, and jokes - especially black humour - allow personal connections to develop into a sense of belonging to a group. It’s not just about work, though, a strong sense of belonging needs connections beyond just the clinical realm: for me the regular Tuesday morning bike ride with colleagues and the “Lolly Vollies” (ED volunteers who fed us mountains of lollies each week) reinforced connections and belonging.

The reason I got the emergency medicine "bug" was because I felt part of a team, fighting the world. I was working at Western Footscray and there were large numbers of incoming and an under-resourced hospital. The nurses and doctors there were amazing and I felt like we were almost an underground movement helping these people access care. There was much dark humour, plenty of bad things happened, but the team stuck together and watched each other's back. The patients were appreciative and felt at home. I look at EM now and think about the stress, burnout, the unmet expectations and how our juniors somehow seem to have missed that sense of team and connection that makes all the bad stuff go away...

Clearly we do need to improve expectations of emergency care, but we also need to admit that nothing in EM is perfect and our job is to make the most of what we have got. 

For emergency teams to work, leadership must enable free and easy communication between members. there must be mutual respect, accountability and pride to be part of the team. In our field, it is not hard to feel pride in the work, we just have to remind ourselves every day, just how important our work is.

WRaP EM has developed guides on some wellness projects to help you with the logistics of starting projects in your ED such as:
“’How to” – Staff resus trolley
“How to” – Brain breaks
“How to” create a wellness interest group (WIG)
“How to” build a mindfulness program in your ED
“How to” perform a Wellness Needs Analysis in your ED
“How to” – Support and retain staff during parental leave

https://www.youtube.com/watch?v=iUbfRzxNy20
Ted Talk - Every doctor makes mistakes. But, says physician Brian Goldman, medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve. Telling stories from his own long practice, he calls on doctors to start talking about being wrong.

https://dontforgetthebubbles.com/changing-workplace-culture/
Don't Forget the Bubbles - Emergency Trainees brainstormed and shared a few of their ideas to change workplace culture. This is a summary of their list.

https://www.racp.edu.au/pomegranate/view/episode-30-being-human
RACP Podcast - This podcast examines how the system might be shaped to improve physician wellbeing.

https://www.stemlynsblog.org/st-emlyns-hierarchy-of-wellbeing/
St Emlyn’s article - Iain Beardsell talks about an alternative hierarchy of wellbeing which could form the basis of a departmental wellbeing plan.

https://www.stemlynsblog.org/lead-yourself-through-the-covid-19-pandemic-st-emlyns-with-joke-van-kerkhoven/
St Emlyn’s article - St Emlyn’s article with Joke Van kerkhoven is based on Joke’s work on how we perform and lead in the clinical environment (which is related to her PhD work, but with a special focus on the difficult circumstances we currently face during the pandemic).

https://wrapem.org/2021/06/03/the-why-and-how-of-organisational-wellness/
WRaP article – A informative piece by Dr Sam Bendall and Dr Bethan Richards outlining the three reasons to focus on wellbeing in EDs, top tips when bringing a wellbeing optimisation proposal to your hospital executive and their two top concepts form Well MD.

https://www.bmj.com/content/364/bmj.l690.full
The BMJ article - In front of patients or colleagues, or hidden in the toilets, is it appropriate—or maybe even a good thing—for medics to shed a tear on the job? Fran Robinson investigates

https://www.annemergmed.com/article/S0196-0644(17)30059-8/fulltext
ACEP article - Andrea Austin, MD shares her personal story and five strategies that have positively affected her shifts

https://onthewards.org/goodbye-2020/
onthewards article - onthewards contributors and team reflect on the year that was, and tell share about what they’ve learnt, the challenges faced and positive perspectives to come from the year.

https://onthewards.org/language-emergency-department/
onthewards article - James talks to Dr Dane Chalkley about the language in the Emergency Department and the terminology used within the ED.

https://www.ted.com/talks/brene_brown_the_power_of_vulnerability?language=en
Ted Talk - Brené Brown studies human connection -- our ability to empathize, belong, love. In a poignant, funny talk, she shares a deep insight from her research, one that sent her on a personal quest to know herself as well as to understand humanity.

https://thehug.exchange/
The Hug Generator will share with you a hug in words described by another human somewhere in the world. It might be a story, a memory, a poem, a feeling or a description of a hug.

https://www.mentate.org/post/issue-1-connection
Mentate article - Australian trauma authority, Psychiatrist Dr Richard Benjamin, explores how connection mitigates the effects of trauma.

Healthy Debate – COVID-19 has put enormous stress on physicians but even in normal times, one in three experience burnout or depression and one in five have suicidal thoughts. The fear and shame of making clinical errors is a major cause of this psychological turmoil.
 

Institute for Healthcare Improvement – IHI is partnering with experts around the world to offer new thinking and resources around joy in work — to share principles and techniques that enable the workforce to truly thrive, not just persevere.
 

15 Secs 30 Mins – a social movement to reduce frustration and increase joy in work.
 

Josh Bersin – diversity is a strategy; inclusion is a goal; belonging is a feeling; and a feeling of belonging is the most important goal of all.
 

Anita Sands – if diversity is the seed and inclusion is the crop, belonging is how you harvest them.
 

Ted Talk – Fiona talks about how part of understanding and valuing the dynamics of human interaction is knowing when it offers advantages over the technology-based interaction which is becoming pervasive in human society. She will ask, what is getting in the way, and how do we ensure we connect?
 

The Mind Full Medic Podcast – Dr Yumiko Kadota, Doctor and Author of Emotional Female on values, the power of lived experience and addressing toxic culture in Medicine.