Introduction
Health systems internationally face significant and escalating challenges to provide care that offers both value and quality in the context of rising costs of care, aging populations, complex conditions and comorbidities.(1, 2) Healthcare professionals at the clinical front-line have borne much of the burden, evident in consistent data demonstrating high levels of stress and burnout(3-5), while studies have shown consistent links between these negative psychological effects and healthcare safety and quality. (6-8) Strong evidence that psychological resilience factors can help minimise distress, coupled with the potential for low-cost opportunities to intervene, have given rise to interest in the development and application of resilience-based interventions to address psychological distress amongst health professionals.(6, 7) Resilience factors are those which statistically moderate the association between exposure to stressors and negative outcomes; those who have high levels of resilience are less likely to show negative reactions in the face of stress.(6) Resilience-based interventions therefore seek to develop individuals’ capacity to maintain emotional equilibrium in response to difficult experiences.(8)
Resilience-based interventions have faced substantial criticism as the wrong solution to address system inadequacies that create occupational suffering.(9) The misapplication of resilience-based interventions in an attempt to build capacity for enduring pervasive health system stress has led to such interventions being criticised for masking inherent system and organisational failings. For example, the application of resilience training in the UK health system, to enhance health professionals’ capacity for “absorbing any unacceptably and avoidably negative conditions”, has created distaste for the implementation of such training.(10) The potential value of resilience-based training in enabling healthcare professionals to prepare for burdens associated with clinical work is supported, but it is critical for such training to be applied only in the context of systematic solutions to tackle the burden on health professionals that is created by system inadequacies.(9, 10)
Since the late 1990s the impact of involvement in medical error for healthcare staff and associated psychological distress which often heightens potential for further unsafe care has gained increasing attention.(11) Despite extensive focus, few interventional approaches have been developed and fewer have been comprehensively evaluated for their effectiveness in addressing psychological distress.(12-14) To date, interventional approaches have been limited to programs that integrate a range of approaches to support healthcare staff following an error. However, despite a burgeoning commentary in the literature regarding the topic of resilience, we are unaware of any studies that have directly explored healthcare professionals’ views of the concept of ‘resilience’ following participation in resilience-based training interventions. Furthermore, there is little evidence of the experience of health professionals who undertake resilience-based programs regarding their acceptability and value.
A novel, prophylactic, resilience-based coaching intervention was developed by the authorship team to prepare healthcare professionals to mitigate the negative impacts of involvement in making an error. The intervention was evaluated using a mixed-methods design. The findings, which are published elsewhere, demonstrated that the intervention significantly increased resilience levels, confidence in coping with error and knowledge of resilience building strategies and their application amongst 66 health professionals in the UK from diverse professions. (15) The intervention comprised a 3.5 hour interactive, group workshop involving 4-12 participants and a follow up one hour 1:1 coaching phone-call with a facilitator that enabled participants to explore issues they did not feel comfortable discussing in a group setting and their application of the learning in practice. The workshop was theoretically underpinned by an evidence-based concept of resilience to failure events and drew on cognitive-behavioural therapy principles (16) to enable participants to identify and use evidence-based techniques for developing relevant traits and abilities.(7) Work-based case studies, tailored to stressful aspects of clinical practice and errors commonly experienced by the specific discipline groups, were used to facilitate learning and enhance perceived relevance. The facilitators were a Clinical Psychologist (JJ) and an Occupational Health Psychologist (RSE) with experience in CBT-based interventions. Eligible health professionals were employed in the target disciplines of midwives, doctors, paramedics, or completing an education programme leading to qualification as physician associates, sonographers or mammographers. Healthcare staff were invited to participate in the intervention via their employing organisations (qualified healthcare professionals) or programme leads (trainee healthcare professionals).
A qualitative evaluation conducted alongside the intervention answered the following research questions, designed to glean the knowledge required to optimise future implementation approaches: