Developing resilience in

our workforce

Rebeca Baron and Shirley Remington

Definition of resilience

The Latin derivative,

‘resiliens’

…the pliant or elastic quality of a substance.

• …a capacity to absorb negative conditions, integrate them in meaningful ways, and move forward.

• Interactive concept- not characterlogical trait- not directly

measurable-Rutter 2012

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Plan is to share the evidence…

• Definitions

• Some of the science and neurology

• Practical things to do to help resilience

• Review of the literature of what has made a

difference

Evidence base?

• Child development and psychiatry

• Earliest publication ?1973 Garmazy

• How is it measured- issues with controls

• How are preventative interventions assessed

• US army programmes-PTSD down but suicides?

• Quality of research

• Prevention v interventions early when challenged

• Post event intervention

• Extension into organisations

NEUROSCIENCE ADVANCES

-why resilience training works

• Functional MRI

• Brain Plasticity

• Brain Training

• Changes to stress management

• Evolutionary Mal-adaptation

• Understanding of human behaviour-Chimp paradox

Transition cycle- Williams 1999

Dennis Charney Rx for Resilience1. Positive Attitude

2. Reframe – cognitive flexibility

3. Core beliefs, altruism, purpose

4. Resilient role model

5. Fear is normal

6. Active coping skills

7. Support network

8. Exercise

9. Practice

10.Develop Signature Strengths

Nicholson McBridehttp://www.testyourrq.com/my-rq/

r.baron@nhs.net s

Overall Resilience quotient

Optimism Glass half full

Solution orientation See problems coming and start to plan

Individual accountability Self worth and belief in own abilities

Openness and Flexibility Tolerate ambiguity and good learners

Managing stress and anxiety

Manage by distraction or resolution

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Flourish – Martin Seligman

• Research on positive psychology and resilience – flow and

the pleasant life

• Losada Ratio 3:1

• Post traumatic stress versus post traumatic growth

• Three Good Things exercise

• Signature Strengths

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Three Good Things

• Write three good things that happened

each day for a weekThen:

• Why did this good thing happen?

• What does this mean to you?

• How can you have more of this good thing in

the future?

• or PLEASED THANKFUL HAPPY ( PTH)

PERMA-Seligman

• Positive emotion - tunable by writing down, every day at bed time, three things that went well, and why

• Engagement -tunable by preferentially using one's highest strengths to perform the tasks which one would perform anyway

• Relationships – tunable:listen-respond

positive /negative

passive/active

• Meaning -belonging to and serving something bigger than one's self

• Achievement -determination is known to count for more than IQ

Sven Hansen – Inside-Out: The practice of resilience

• UPWARD SPIRAL

• Stress Mastery

• Energise Body

• Engage Emotion

• Train Mind

• Spirit in Action

• DOWNWARD SPIRAL

• Confused

• Disengaged

• Withdrawn

• Vulnerable

• Distress

• Depression

How to bounce backStep 1 – recognise it

• DOWNWARD SPIRAL

• Confused

• Disengaged

• Withdrawn

• Vulnerable

• Distress

• Depression

WHAT TO DO

• Prioritise/delegate

• Recognise/stretch/diet/ exercise/ go outdoors

• Talk/connect

• Sleep/ time away/ exercise

• Get help/mindfulness

• Get help/CBT/lifestyle/

meditation

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Research on Interventions

• Some interesting studies on what has worked –

Canadian study

• Concept of coping reservoir – highlights dynamic

nature

• The evidence shows importance of fostering

resilient environments and individuals

• Resilience training is seen as a potential solution -

consider balance between organisational versus

personal support

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Evidence outside of medicine

• Strong evidence in areas outside of medicine – both individual and

organisational, good summary from the chartered institute of personnel

development:

• Individual things - CBT, mindfulness, resilience regimes, reframing,

positive tracking (reframing), support, exercise, diet, team resilience.

(Sports has mentors)

• Organisational things – Understanding risk – “wicked problems”

appreciate challenges we face, good leadership, team working and

reflection

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Evidence from Medicine

• SMART (Stress Management and Resilience Training) One 90 min

group session and 2 follow up phone calls.

• Physician wellbeing coaching: 3-8 individual coaching sessions

focusing on: boundary setting and prioritization, self-compassion and

self-care, self-awareness.

• Medical Leadership course

• Mindfulness training (one-off intervention)

• Life coaching

• General Wellness programme

• Meaning in Family Medicine’ group: To give back meaning and

purpose to GPs to improve motivation.

• Effective Emotional Management: Learning to cope and how we cope.

Education to enhance resilience

• Content - ethical dilemmas, causes of error

• Process - building exposure to difficulties, simulations, increasing autonomy

• People - role models, patients, each other

• Understanding why - link to professionalism and leadership

• Reflective Practice - reduces risk burnout

• Understanding how we think - Thinking fast and Slow – Daniel Kahneman

Attitude and perspectivesvaluing what you do as a doctor, maintaining interest in the job, developing self-awareness and accepting your own limitations

Balance and prioritisation setting limits, work life balance and looking after and valuing yourself, taking effective approaches to CPD

Organisation of your work environment good management, having good staff, effective systems at work

Supportive relationships positive personal relations, effective professional relationships and good communicationJen

Resilience resources

On line resources

Free on line test for resilience quotient https://www.testyourrq.com/

Martin Seligman on resilience https://www.youtube.com/watch?v=e0LbwEVnfJA

Questionnaire for signature strengths https://www.authentichappiness.sas.upenn.edu/home

go to the VIA Survey of Character Strengths ( not the brief strengths test)

Short video about signature strengths https://www.youtube.com/watch?v=YC1HZqCbZ70

Sven Henson Resilience – slides http://www.slideshare.net/sfmardon/sven-hansen-elf-12-

resilience-presented-at-education-leaders-forum-2012

Sven Henson Leadership and resilience - https://www.youtube.com/watch?v=4UCuX-Y1jpk

Sven Henson longer talk on resilience https://www.youtube.com/watch?v=Ka0LeDubU3k

Developing resilience – CIPD guide for practitioners http://www.cipd.co.uk/hr-

resources/guides/developing-resilience-evidence-guide.aspx

Steve Peters on Chimp Management TED talks https://www.youtube.com/watch?v=R-

KI1D5NPJs Steve Peters speaking to Raj Persaud

https://www.youtube.com/watch?v=Z6_6aPWQMc8

Elaine Fox http://www.rainybrainsunnybrain.com/about-the-author/

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What can we take away from this

as educators…..

and what do we need to do….