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:
- how is the concept of psychological resilience perceived by healthcare
professionals within the context of healthcare practice?
- how do healthcare professionals perceive and respond to the novel
intervention being tested?
- how relevant do participants perceive the intervention to be for them
and their roles?
- how do participants perceive their ability to cope with error?