Mental Health for Healthcare Workers: Steps to Solutions
foreign my name is Claire Simpson and I’m the manager of alumni relations at the Leslie Dan faculty of Pharmacy I am delighted to welcome you to mental health for healthcare workers steps to Solutions tonight’s panel is brought to you by the Lawrence s Bloomberg faculty of nursing the factor in wentash faculty of social work and the Leslie Dan faculty of Pharmacy before we begin I would like to acknowledge the land on which the University of Toronto operates for thousands of years it has been the traditional land of the Huron when bat the Seneca and the mississaugas of the credit today this meeting place is still the home to many indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land tonight’s discussion will explore issues impacting our Healthcare Workforce in the hopes that we can make steps to meaningfully improve conditions for some of our most essential workers leading the conversation is Dr Rochelle Ashcroft associate professor factor in Winchester faculty of Social Work cross-appointed to the Department of Family and community community medicine at the temerity faculty of medicine Dr ashpop has 14 years of Social Work practice in health care including hospital and Community organizations as a health system researcher Dr Ashcroft has particular interest in nurturing organizational and policy contexts that support the delivery of team-based primary care patient-centered virtual care interprofessional collaboration and strengthening Social Work practice in primary care and other Healthcare settings over to you Rochelle thank you sir I’m so pleased to introduce our three panelists first we have Dr Jamie Keller who is the associate Dean and associate professor at the Leslie Dan faculty of Pharmacy Dr Jamie Keller’s clinical area of expertise is mental health and addictions she teaches in the neuropsychiatry and Health Systems courses at the Leslie Dan faculty of pharmacy at the University of Toronto Dr Keller has received numerous teaching Awards including the president’s teaching award and an early career teaching award from the University of Toronto and the national award for excellence in education from the association of faculties of Pharmacy of Canada her research is in the field of Health Professions education with a specific focus on professional identity formation next we have Dr Elizabeth Peter professor at the Lawrence s Bloomberg faculty of Nursing Dr Elizabeth Peter’s research focuses on examining the political dimensions of nurses ethical concerns and understandings with her scholarship reflecting her interdisciplinary background in nursing philosophy and bioethics recently she is she has examined the ethical concerns of nurses during the covid-19 pandemic and has ongoing research examining the ethical and social dimensions of the patient family and clinician experience as care transitions from hospital to home using new monitoring technology she serves as as an associate editor for nursing ethics the chair of the bioethics expert panel of the American Academy of Nursing and the chair of the ethics review board at Public Health Ontario prior to working at the University of Toronto she worked at the center for addiction and mental health as both a staff nurse and as a nursing coordinator and finally we are so pleased to be joined by Dr Javid aloud is a community family physician and educator on integrated physical and mental health at the center for addiction and mental health and Trillium health partners Welcome to our three panelists the purpose of the panel today is to explore issues impacting the mental health and well-being of our health care workers and steps that can be taken to work towards Sustainable Solutions today we are talking about people who are usually busy taking care of others yet the mental health and well-being of the healthcare workers themselves is so very important just to give you some context burnout which is characterized by emotional exhaustion depersonalization and diminished professional achievement is a real concern research published in 2021 on behalf of the Ontario Copa 19 science advisory table and mental health working group show that the prevalence of severe burnout in hospital-based health care workers was 30 to 40 percent in 2020 and by by Spring 2021 rates of burnout were greater than 60 percent in Canadian positions nurses and other Health Care Professionals as well a new study published in international Social Work by Dr Ramona elajia and Dr Esme Fuller Thompson who are both faculty members here at the University of Toronto demonstrates that social workers have experienced depression and anxiety at alarming rates during the pandemic four times higher than general population now let’s hear from our panelists who will help us better understand the problem to start I’m going to ask each of our panelists to uh tell us what some of the issues are that healthcare workers are currently facing Dr Peter let’s start with you recently you have been conducting research on nurses experiences of their ethical responsibilities during the covid-19 pandemic can you describe to us what ethical responsibilities means and talk to us about what you see as a key problem impacting the mental health and well-being of nurses okay well thank you so much for inviting me I believe this is such an important issue right now facing our Health Care system as a whole um and I think as as many of you would realize there are many different ways of conceptually conceptualizing mental health and also ethics my work is in ethics so in our work in in the recent studies during the pandemic we have used the work of vanillaire and gastmans who use the scholarship of Martha Nussbaum and others in Joan Toronto to really conceptualize what the ethical responsibilities of nurses are and to add some depth to this and we know in part this has to be about using the best knowledge skill and judgment but it’s also very much about the relational elements of care so when nurses are being ethical if you will they’re not only caring for people they’re also deeply caring about them which is a different orientation to people and their concerns and so on so when looking at ethical responsibilities I mean if we were going to just use a lay person’s term we could have just said standards of care but using a theoretical lens gave us some more depth so in terms of mental health however there are a number of related phenomena variously labeled there’s moral distress there’s sometimes termed moral stress and sometimes moral injury and all of these relate in one way or another to the kind of negative moral emotions like guilt shame and so on that people experience when they can’t meet their own standards when their integrity is violated and so on now moral injury is a term that has increasingly uh come into the healthcare literature its Origins are in the military so it’s a it’s a much more severe form of negative emotion if you will so in the military it normally refers to the kind of injury if you will that perhaps a soldier would experience coming back home after perhaps engaging in a war crime for uh to be straightforward perhaps witnessing something or feeling pressured by a commander or the group to do something they would not normally do and this is rather distinct from PTSD because it is has a distinct moral component and there has been some effort to bring this into the DSM which as far as I know has not yet happened but we also see this term coming into the healthcare literature but it refers to quite of the extreme end of this so all of these things in some ways are related and they’re related to burnout and they’re related to compassion fatigue as well but in ethics there has been the tendency to want a foreground if you will values and integrity and so on and how these are very important so if we look at nurses the one thing that has been commented on a great deal is that nurses tend to be in close proximity to patients residents clients depending on context setting and with that that normally tends to make people more compassionate but it also can be very very stressful when things when there’s trauma when things cannot go according to standard if you will so so the long and the short of it the challenges that we found in our work the the biggest stress factor if you will um was the was because these nurses felt that they could not meet their ethical responsibilities in the way they felt they should and that was deeply distressing and this is not something I believe that is unique to nurses but this is the group that we that we studied in nurses when there is not usually it’s the the root cause is a lack of Staff nurses 10 then to prioritize their care around things that are life-sustaining but they may miss fundamentals um you know fundamentals of care things like getting people up and walking Skin Care Health teaching and so on and so this diminished sense of care is something that deeply troubles nurses um some things that were specific to the pandemic and this is in a lot of other research is that nurses were very distressed that family members could not come in particularly during times of dying and death this was of great concern uh nurses in the community they also talked about Community Services not being open so their clients were without care that they required so there was that kind of isolation and with public health professionals legitimately focused on the pandemic we also had the opioid crisis so they’re all of those clients as well that they were concerned about um and finally the one study that we did we focused specifically on long-term care and we focused on registered practical nurses and long-term care during the height of the pandemic and they were by far our most uh distressed group um they were working under conditions where they had no family members coming in to support they witnessed an enormous number of people dying they couldn’t provide the kind of palliative care that they wanted and so many of them for lack of a better word were simply gutted by what they saw many have left the profession they felt terrible that they had betrayed themselves in the profession in their eyes even though they were doing all that they could they continued to go back into these nursing homes because of the commitment they felt to Residents and so on many of them became sick themselves and many of them now are living with some of the mental health consequences so that that particular group was the one that I think we came away being the most concerned with personal support workers we did not study them but I I can assume that they would be equally distressed by the by those working conditions so that’s a nutshell and uh I’ll let you go to the next speaker great thank you Dr Keller you are a mental health champion in Pharmacy can you help us understand what occupational stress and burnout looks like in the pharmacy context sure thanks Rochelle and I think that many of the things that Dr Peter talked about are actually uh translate well into Pharmacy as a group however Pharmacy is understudied generally speaking in healthcare and certainly in this particular area there’s much less data looking at occupational stress and burnout in Pharmacy specifically that said there has been an increase of literature relative to the pandemic and so we do have data that is very much in line with many of the things that Dr Peter talked about in nursing I think that the pandemic has exacerbated a number of things that were happening in Pharmacy particularly Community Pharmacy for a long time and they’ve really just brought them to the Forefront and pharmacists over the last few years specifically have really had to step up to provide Frontline care which we’ve always done but in the absence of access to other health care providers and communities and that has been challenging pharmacists have been open longer and in person more than most other health care providers and so when someone needed something you know late in the evening access to a healthcare provider the pharmacy was there answering covid questions their phones were you know impossible to keep up with all of the vaccinations that pharmacists have stepped up to participate in and deliver covid testing as well as all of the the work that pharmacists are doing with managing medications and so some of the challenges around drug shortages and when Dr Peter talked about moral distress we’re seeing it in Pharmacy in ways that we’ve not actually historically talked about it trying to determine who to give medications to when you don’t have access to drugs and shortages and having to triage that on the spot and figure out which patients you can substitute and which you can’t and how you can access medications that are in short supply and and at various times come back and then disappear a lot of challenges right now with with robberies actually in Community Pharmacy and that is extraordinary really stressful and it really increases the amount of stress and burnout that folks are experiencing and a number of ethical challenges around how do you manage and how do you stock your narcotics in the in the environment that we’re currently living in that’s causing a lot of decisions and a lot of stress for for pharmacists as well in hospital settings certainly we saw stress and burnout as well but we saw it in different ways pharmacists often cover many units in hospital practices and have a variety of expertise however during the pandemic they were often being pulled to units where there were more patients or there were sick or patients and pharmacists were being moved into areas that they’d never worked particularly to the ICU where they may not have had training for a number of years and the stress associated with learning again new practices new team members all of that contributed significantly to the stress that pharmacists and their teams were experiencing so I think a number of different issues over the last several years including additional scopes of practice have really increased Pharmacy’s presence particularly in the media you certainly hear a lot about Pharmacy however it has been stressful we’re seeing more people retire we’re seeing shortages as well so I think it’s been a really rewarding time um to be a pharmacist on many levels but a very challenging time as well and I would say the workload right now is probably one of the biggest challenges that folks are trying to navigate that’s contributing significantly to stress and unfortunately we are seeing burnout we’re seeing it at again rates that are much higher than the general population and much higher than they’ve ever been if you look at some of the survey datas you’ve got 80 percent of Pharmacists reporting currently that they feel high levels of stress and or think they could be experiencing burnout so these are things we need to start to talk about but at a systems level so we can start to figure out how to move forward because it’s not feasible for individual pharmacists to solve this problem on their own nor should they be tasked with that great thank you Dr aldu you bring the perspective of a family physician leader can you please explain what you see as some of the key challenges currently facing Family positions sure and I’ll speak on October County physicians in the community but also what actually is the reality for a lot of other entertaining providers in the community as well and there’s a lot of commonality in our needs and the experience of the last number of years as well so we know the Canadian Medical Association did a really significant survey of filing Physicians and other Physicians um across Canada and what they found is more than half actually did qualify for having burnouts so we’re recognizing it’s not only we’re under distress but actually there’s a decompensation happening already by that stage and so you worry about what this means for efficiency of XC and sustainability of their work going forward and we know that it’s actually younger Physicians and Learners who are the most distressed female Physicians were under extra distress and demands as well and then final positions actually ranked significantly higher than other Specialties and that has to do with some of the isolation that we see that occurs in primary care and that applies to the nurses Nurse Practitioners primary care and the Pharmacists and all the other providers working in those contexts there’s a lot of relatedness and issues and the solutions also arise from recognizing the contextual issue issues that happen there and as Dr Keller spoke we we recognize there’s issues at individual organizational and systemic level leading to these conditions and also the solution will be found in that context so talking about the county position component we know that there’s a significant shortage of my position so in Ontario 1.8 million ontarians right now don’t have a family doctor we expect the number to be one in five so nearly double within the next two years and we’re also having a growing population we had the announcement today that there’s a million more Canadians 450 000 coming to Ontario will all need more care so there’s more demands than because of volume changes and when the system shut down during that lockdown phase of the pandemic all that Specialty Care basically stopped for the most part all that burden got shifted to Primary Care in the community to stabilize and maintain as the shortages and backlogs and work um the the wait list continue in secondary care all that work is still managed by primary care we also have the long covet adding on to that so the entire science table describe meeting 250 thousand excess Healthcare visits per year because of long covet probably an underestimate based on our data and that’s largely going to be a primary care again so there’s significant reduction in Workforce significant increase in population as well as significant increase in Acuity or complexity of population needs so you’re waiting for say the problem is just beginning to be seen as would describe it as so we also look at the isolation fragmentation I spoke about we know that when you’re looking at it’s not about being connected and talking to somebody it’s about actually having access to safety measures when PPE or clean air come came Acro in the beginning or even now it doesn’t exist in most Primary Care Community settings um so they don’t have the security as shannonfield talked about a lot in the papers on on wellness and safety of the last couple years hear me keep me safe let me work is actually the early phases of being able to do the rest of their work in a sustainable way and so we recognize these are areas their primary care and Community Care are really really disadvantaged in terms of going forward that will continue to add to their their distress Incarnation capacity limitations so I’ll stop here great thank you the next question is over to you Dr Keller some of your recent work has focused on focused on resiliency can you talk to us about what resiliency is why it is important and how we can cultivate resiliency within the pharmacist practice context well I think resiliency is just one tool that we have to help to combat stress and it’s certainly something that it’s I sort of think about like like a muscle that’s something that we all have but we can all continue to develop and grow over time and so individuals that are able to be more resilient and can build up their resiliency tend to be able to bounce back better from all sorts of things stressful work environments failures even positive changes and so resiliency is an important element to help combat or manage stress that we’re experiencing in in the healthcare Workforce broadly speaking not just in Pharmacy that said it on its own is not going to solve the problems that we’re we’re seeing and it’s certainly not going to be a solution for individuals that have moved into to burn out or are significantly past the point of just working in stressful environments and so it’s not a Band-Aid or a solution that’s going to fix many of the problems that we’re experiencing that said I still think it’s important and I think it’s another one of the things that we need to think about at an individual level as individuals we can build resilience but we need to think about organizational resilience and system level resilience and all of those things when coming together will help to ensure that we have a Health Care system that can continue to provide for the needs of Canadians and I think some of the key components around resilience relate to things like connection our ability to connect with others our ability to connect within our within our teams within our environment and thinking about how can you build connection as an individual that’s important to me the human and I connect with different people in my own personal and professional life but how do I build connection with my team My Healthcare team the folks that I work with every day so in pharmacies those can be our Pharmacy teams assistants technicians but also other healthcare providers that we work with in primary care and in hospital settings as well and how do we build relationships and find ways to have a connection to provide care to patients we can also think about Wellness Wellness falls into resiliency and the more we are able to to build our Wellness the better able we are to be resilient and again self-care falls into this but I’m always reluctant to talk about self-care when we’re talking about occupational stress and burnout because I’ve certainly been a participant in things where when we’re talking about this the easiest solution is well just let you know work on some self-care and everything will be better well self-care is important for all of us to be able to to find and promote our own wellness it’s not the solution for systemic problems though and so although I advocate for folks to focus on themselves and to find time to do things that fill them up it’s not on its own going to be enough for us to to solve the problems that we’re experiencing particularly in healthcare I like the example that Christina maslok who’s one of the big researchers in in Burnout she uses the example of a canary in a coal mine and she you know describes this beautiful yellow canary that enters the coal mine and it’s singing and it’s happy and then it comes out black and covered in in coal and soot and it can no longer sting and nobody ever asks why the canary made itself sick well because we all know that it was the mind and the environment that it worked in that made the canary sick yet when we work in organizations and folks are stressed we often ask well what’s wrong with that person why can’t they manage the stress why can’t they figure it out everyone else can and so we’re quick to blame individuals and I think we really need to move away from that and we really need to think about how does individual resiliency contribute to overall organizational resiliency and what do resilient systems look like and how do we start to move towards that by improving communication systems by improving Staffing levels adjusting workload and those are hard conversations that take resources but I think moving forward that’s the resiliency that we really need to focus on and it has to move beyond the individual though that piece I still think it’s valuable to discuss thank you it’s a perfect uh perfect connection to my next question for you Dr ALU I’m wondering drawing on your system level level expertise how can we cultivate organizational practices where family physicians and other healthcare workers are well supported that’s a great question perfect leadoff from Dr Keller as well so recognizing exactly what you described them Jamie was the reality you’re looking at it’s going to be organizational level that measle level which is almost the perfect place to start intervening on issues like this um because we’re actually working both upwards anchoring the environment for people working individually in that context um so are we actually doing efforts as Senator scholar described to actually make work easier to do which is the hope when people are coming in every single day and Nova Scotia there’s an article in the newspaper just yesterday describing a 10 reduction administrative burden commitment that they had within three years and they’re already well on their way to doing that um in many areas of care that they’re doing for Primary Care so I think recognizing there are ways of duplication and workflow so process mapping is exactly what organizations do our process is we know are incredibly cumbersome way more than they need to be and I think the investment would be in about process Improvement for efficiencies that actually reduce duplication on staff because our limited resource is the people working not our computers not our process not the rest of it and I think if we want to see sustainability because we know we’re having attrition at massive rates we’re not going to meet our safety quality targets if this trend continues and so if an organization wants to see itself meeting a Target within six months or a year it needs to invest now in methods to enable their staff to be able to continue doing their work and so there’s a good business case argument to be made for why reviews are processes to reduce duplications efficiency can be done now um and as as um talked about the connections part is critical organizations either Foster Community amongst their team as well as amongst their peer organizations or they hope that magically these things occur and it’s a systems problem to solve it and they wonder why people don’t feel connected organization or why they’re not working in collaboration with their partner organization in primary care or in community care or in hospital care and so there’s opportunities to look at duplications we’re all suffering largely imagine every single day each worker spends how much time trying to connect to somebody else a different relation to get their job done this is created work by barriers that we’ve erected it’s actually not a natural issue of care and so we actually can look to see can we streamline and that’s nothing the individual should solve which is happening right now the social workers know stitching together this broken system is how much of the work this is part of organizations can play a role one by one with their lead primary partner to get the job done for patients and clients and that’ll actually make people feel fulfilled field of agency and extend their efforts of the part that came through them to this profession because it was not sitting on the phone all day or not paper pushing that Drew them to do this work and so you can actually make me feel accomplished and and valuing their work addressing them the core issues being unborn I was not feeling professionally satisfied I know in the um the culture part is a big part of the conversation and body the reality of needs so when I helped the entire College of time positions create their new educational program at the start of the pandemic on Mental Health Services and chronic pain it was designed initially for educating clinicians on how to support patients care in those areas and and that’s what we were funded for but we recognized that burnout was critical we knew that you could not get people to learn new things that were demanding a stressful um could have been trying for 20 years to do that unless we addressed it differently and so we did things differently so every month we’d have hundreds of Physicians Gathering Together the Virtual Technology helped that but the conversation was explicitly different we drew in people from different stages of practice rural and urban bringing them all together to help themselves be seen in their work and value in their work in different worlds but also Not only would they speak about clinical content but every one of every single topic we had whether it was alcohol use disorder or anxiety or chronic pain we’d invite the panelists to speak about their live experience with a disorder as well so they spoke about physician talk about their alcohol use disorder when they were teaching but how they care for patients with it now when it was anxiety we had Physicians talking about their anxiety as they learned to manage it in the process so there was no separation of Wellness from Clinical care and learning it was one entity and we presented on this at the International Conference position health was held around last year as well because this was a unique embodied honest way of representing the culture and supporting our Learners and our practitioners in their work so I’ll stop there and hand it over to the next question for Dr Peters great thank you Dr Peter what have you learned in your research about the sources of support and the types of social connections and collaborations that are important to improve nurses mental health and well-being well thank you and I think I’m going to be doing a lot of repeating from Dr Keller and Dr ALU because I’m going to be saying some very similar things so even before I get to what our participants told us I mean I think the real solution is prevention I think half of the mental health issues and half of the ethical issues would go away if there were there was adequate Staffing um it’s it there’s it’s a huge problem and it’s it’s just self-perpetuating if you will so but in saying that we did ask our participants what they found most helpful well they found each other most helpful so and the team most helpful so it was that connection which the other panelists have talked about by far hands down even in scoping review each other the team um they talked about family and friends being helpful as well but they also said family and friends don’t entirely understand what they’re going through and also a hesitation not to come home if you will and burden those family and friends with their issues so that was huge um we asked them about how helpful it was to receive some of the mental health supports that were put in place during the pandemic and we received some mixed reviews some said okay that wasn’t it was okay but they felt that that what they were going through was was very specific so somewhat helpful some spoke about some of their own therapists they had seen in the past that was useful um they also found it very helpful when leaders and managers made a point of going directly to the site of care so whether it was the unit or the community organization they found that very valuable to have that leader or manager there to share in some of the issues so that was useful um they also talked about some of the things the self-care again and I have the same anxiety around the self-care because we don’t want to place the the problems of the system on individuals to solve but some of them did talk about the usual list of exercise and distraction and meditation and television and so on so there were those things as well um but it was the big one was the team I should also add there is some evidence there are people who have studied various interventions to lower moral distress there isn’t a strong evidence base for anything but what they have found is some educational interventions are helpful where people can learn how to label what they’re feeling uh reflect on what they’re doing to find strategies to speak up in organizations sometimes clinical ethicists that are embedded in various places that has been found to be helpful as well building what we would call moral Community helpful where there’s a shared ability to talk about moral issues and so on again it’s not a strong evidence base partly because context varies so much and moral distress has been defined in many different ways but there is that as well but I I lean heavily on the prevention side to be the most important great thank you very much bringing the social work perspective one of the challenges highlighted in a survey of more than 2 000 social workers conducted by the Ontario Association of Social Workers and published in the British Journal of Social Work was the heightened level of isolation experienced by social workers after shifting to working virtually from home during the pandemic so very similar to what the others have said and some of the recent work that I’ve been doing some social workers and Primary Care teams have noted that this isolation continues which is a bit concerning and really emphasize the need for regular and meaningful collaborative interactions with other members of the team and for social workers across different Healthcare settings clinical and peer supervision is an important source of support and capacity building so I’m going to shift and ask a few questions about the role of Technology Dr ALU what role do you see technology having in helping to alleviate some of the strain that family physicians are currently facing and are there any uh examples from your experience where technology is helping to bridge this Gap sure and so technology is always one of those things like any tool that both hurts and helps and so we see that very much in healthcare as well so we know the rise of Zoom right so connected providers isolated in small clinics able to discuss cases with each other um and with patients um who couldn’t come in far better yet far less no shows for difficult mental health and substance issues using technology that you have without it so efficiency was improved in certain ways their accessibility has improved for patients that they couldn’t actually get to see otherwise but it also made it easier for them to add hours which was good when there was a demand so they could say I’m working from home I’m not spending tours commuting I’m getting the work done and setting those two hours but it also meant the boundaries were blurred and so their separation of their self-care time and their working time also got reduced in that process and we also know what what Zoom overload feels like all of us right now in this process so there was good and bad in that process we know um that um these issues around patient portals and email Communications also improve connectivity with patients and with our co-workers again with extra volume and burden but the main issue we know is that the EMR systems are not designed for actually supporting care it’s more of a documentary system for the most part which creates more workload and more medical legal risks largely but without actually improving outcome sufficiently for the burden we’re facing so we know there’s a need and opportunity to improve the efficiency there right what I think we most want technological to do we’re actually beginning but it’s not a mature state is to connect us to each other to get our work done to connect patient care for example knowing who’s available how long to get them seen and when we need help these are things that we know our efforts in in the Ontario Health Team and other methods of Engagement but we know these are not there yet so right now technology allows a channel for connecting volume is a big demand that it places on us the returns for that we haven’t yet been able to show at scale rely is usually the individual connection that helps solve problems over the most part um so I think there’s challenges but opportunities with technology um going forward there’s also as we know like you know self-care apps for both patients and providers that definitely have some that really have good evidence basis that we would use and recommend but I think the biggest opportunity technology is our Paradigm of how we provide care fundamentally we’ll need to shift so increasing Health Workforce will certainly be a part of it but our assumptions were also a pretty old system which is you know we’re the experts on care we provide care to patients I think that the Paradigm is going to shift the technology where it’s about patients and people living their lives and how do we as a system in different ways support them in getting the care and quality they want which is a lot about using technology to connect with them and form them and help them do self-care and and adherence and all the rest in care where we come in where needed and don’t fulfill what gaps of Technology are actually forcing us to fulfill right now so I’ll stop there and hand it over because I know there’s a lot more to add to the conversation as well great thank you Dr Peter next question is for you you based on the research you have done what are the benefits of providing virtual care to people in their homes to improve both patient and nurse satisfaction okay yeah thank you for the question I’ve been involved in a couple of major studies as the person looking at patient experiences some some clinical trials looking at people discharged home post surgery and what their experiences are with virtual care and so these um trials involve people going home wearing monitoring equipment and they connect with specially trained nurses usually on a on a daily basis by video to talk about their ongoing needs they often take photos of their their wounds their incisions and so on so and in these we have found that there’s very very high patient satisfaction and family satisfaction I think it mainly because they feel there’s always a point person if there’s a problem they can contact the nurse the nurse is working with a number of Physicians and so when they things need to be changed orders need to be changed or some other aspect of their care needs to be changed that can happen very very quickly so as opposed to being at home and feeling anxious and not knowing whether to go to the ER or not there’s a point person and for anybody who has taken care of someone at home you’ll realize it is it is absolutely confusing who to call normally and when the first point of care is the ER that is just not ideal so there was a very high satisfaction with this uh and during the pandemic of course many of the clients at home they were happy not to have to come into a hospital so that they wouldn’t you know perhaps become more ill when they were there um the nurses and the Physicians by and large were quite satisfied as well they felt it was a great way to work as a team the I know the nurses felt that their expertise was being well used and so forth I mean there were some complications more with uh remuneration of Physicians which is not clear with virtual care it was easier situation with the nurses who were paid on an hourly basis I mean there were some issues as well uh you know not everybody has internet but by and large people were very able to use the tablets and they were they were very happy with this kind of care and so it was sort of a mutual win-win if you will with um people out in the community living at home they liked being at home as opposed to being the hospital and not coming in and having that point point of care being done virtually so um and again this this kind of satisfaction goes both ways patients and families are happy and the nurses tend to be as well so by and large those results have been very positive okay thank you Dr Keller um do you have any recommendations on how technology might might be used to better support pharmacists yeah I think there’s obviously a technology as Dr Lou said can be certainly beneficial and it can also be problematic and so I think there’s Pharmacy already leverages a number of things that I think have improved efficiencies for a number of technical related elements of the work and I think we’re quite good at utilizing a number of automated dispensing services and all of those things that we’re quite used to but there’s a lot around the patient care aspects that are not yet supported well by technology from a pharmacy perspective thinking about documentation systems particularly in community and Primary Care Pharmacy settings where pharmacists are really reliant on their their systems within their Pharmacy that aren’t necessarily connected to anything else they’re not connected to Physicians they’re not connected to other pharmacies and so there’s a lot of duplication and work being done in getting Med histories and asking questions there’s no easy way to document care provided within the pharmacy system so that other parts of the team can see it let alone the other care providers and so finding ways to connect Pharmacy into the the bigger Health Care system at a primary care level I think would be one of the biggest um aids to to Community Pharmacy practice specifically because right now pharmacists do a lot of work and not a lot of that is easily captured I think it’s fascinating that in 2023 the main mechanism of communicating with Physicians and nurse practitioners is the fax machine like there’s no Pharmacy that doesn’t have one and if it’s not working it’s a crisis and there are a number of better ways to communicate that again have not been easily worked into the pharmacy workflow and I think we need to spend some time at a system level thinking about how can we improve communication between providers and how can we easily transfer information um better than the fax machine more efficiently and more effectively as well and so I think those pieces also need to be factored in but I think that technology is actually going to really shift over the next 10 years if you think about what Healthcare is going to look like in 2030 it’s going to be much more consumer driven than it already is and I think one of the biggest shifts you’ll see is the notion of patients being consumers of health and they’re looking to have an active voice and be part of their care but we’re also going to have a lot more technological devices like we all wear watches that tell us everything that we’re doing including if our heartbeat is not normal or whatever the case may be we need to train healthcare providers that are going to work in the future how to actually analyze the data that all of us are getting in huge amounts like we’ve never seen before Healthcare data is everywhere and patients want it but they need folks to help them make sense of it we need to be able to analyze it we need repositories for it there’s cool technology now with mirrors that when you breathe on them they can tell you if you have strep throat the FDA has approved 3D printing for medications and you can now print multiple medications into a single pill once that technology and you know the the tech Giants start to see Health Care Tech take off we’re going to need an entirely different skill set as Healthcare Providers and I’m not sure as Educators and I say this as an educator at a large institution I’m not sure that we’re really thinking about the impact of AI and where technology is going we’re barely managing in the current state which is a bit dated but I think we need to start to think about where is technology going to take us and how are we going to train Healthcare Providers of the future and I don’t know that we’re doing that well and I think we need to really think about how we’re going to change their programs because we’re going to get further and further behind if we don’t really start to think about how all of this comes together to improve care and patients are going to start to demand it of us and it won’t be a nice day when we can’t actually facilitate and really lead that conversation and so I think there are bigger issues than what technology can do right now before moving on to our next Quest and I’m just I see you nodding uh Dr Ellie I’m just wondering if you want to jump in and add anything yeah a great Point um that’s exactly what I’ve been worried about for a very long time is we’re definitely not training Health Providers to actually even work in this current year um we’ve already had several years of patients telling us well this is possible one isn’t this working for my health care and it’s not even new technologies existing technology we actually still don’t email or text or communicate with patients in that way I wouldn’t want to do that individual as a clinician because of the volume but the system could actually facilitate to support in some of the ways but less complicated than what Dr Peter described for home care for example um most hospital care so the reality is that um when we actually have this mismatch we talk about burnout and that moral distress it’s when what we want to accomplish in support of our patients the system does not enable us to do we are creating the circumstance for further burnout for further moral injury because we’re not actually keeping up with What patients and the community needs from us as Healthcare Providers and so as a system but also organizationally beginning to create changes to meet the current needs of the people coming to us for care becomes a critical piece to reduce the burnout and distress of the workers that we have because otherwise we’re actually forcing them to pull back into our archaic state which is not meeting the needs of of the um of the consumers or what they use on their own and they realize which they know this is not artificial in a construct and so I think there there’s a real need to to work ahead to plan ahead and to recognize change I think one big thing that I hope and I see we change so we know the demand for care will dwarf our ability to provide it with systems going there’s no maybes we’re already there we’re just seeing more we’re getting worse all of us will need to do more work in our Scopes and expanding over time to fulfill the need the one of the challenges that we’re seeing right now um is is the competitive process looking at it as led by one or led by the other profession and I think this is a critical weakness the worst flaw we could say because that’s good for businesses that want to compete all of us working together still can’t meet the need and our desire to work Independence was creating those silos by structure by competition that’s actually burning out our employees and our staffers and so we actually need to find ways of working together to reduce his stress to accomplish the goal and not look to lead individually in fact if anybody’s leading it’s got to be patients and their family members because that’s where why we exist as get a care system at all and we’re here to support the need and how do we do that together this more than enough work for all of us and no more enough change for all of us to struggle through to get there we can support each other in that process yeah Dr Peter why yes I would like to Echo the the my two fellow panelists a colleague of mine Charlene Chu who who’s very up on every technology was always saying the same thing we’re behind in nursing education on technology uh in its various forms and the other thing that is so important is when these Technologies are being developed to really bring in um the providers to make sure that the Technologies are useful and and meaningful and not just another thing to learn that’s not quite right so I’ve learned a lot from her um talking about various Innovations and so on and I mean I totally agree uh we’re behind as well and the ideas of working collectively make ever so much sense so excellent points well I have one last question before we move to the our audience questions and um I’m going to ask for some you know final recommendations as well as any final thoughts that may have percolated during this panel discussion to close out I’m going to ask each of you to share one resource as well as any other Reflections that you think has been particularly good in supporting healthcare workers uh related to mental health and well-being and we’ll start with you Dr Peter foreign but I happen to click on the world happiness report for 2023 and I found it fascinating because the one thing in the course is an Ethics person uh the findings show that when people are virtuous they’re happier so people who are altruistic who are providing care and so when they’re happier which makes a lot of sense that’s why Healthcare professionals get into the work that they do however they have one very important caveat and they talk about how caregiving is also difficult and needs caregivers need support so I founded the report excellent in a variety of ways and so this this notion of going back to perhaps why many of us entered into our fields and how rewarding it can be but needing that kind of support to do the kind of work that we do is this essential to mental health so if fascinating report I’ve only started reading some of it but there are lots of insights there thank you and uh Dr Keller that report I’m going to take a look at now I have not seen it but it sounds great I think there’s you know tons of resources sometimes I get overwhelmed by the number of resources and uh that’s a bit paralyzing I think that for me thinking about places that you can go for that connection I think connection is huge and so you know it’s not necessarily a resource that you need to go to the Internet for sometimes leaving the technology is is refreshing and so thinking about ways to connect with your team or the folks that you work with on a regular basis to build those connections I think are really valuable whether that’s at the start of a shift whether that’s at lunch or the end of a shift I think those things are really important I also like a lot of there’s a really um nice positive psychology website that has some cool exercises that I think you can do as individuals and as teams I think it feeds into what Dr Peter was talking about from the happiness report around values and altruism and it’s not the notion of toxic positivity we hear a lot about that if you just pretend you’re happy you know everything is good it’s not embracing that it’s thinking about even in a bad situation where is there a silver lining or how can I reframe this cognitively speaking to to see that there was a learning or a growth or something I could do differently next time and taking time to slow down and actually reflect on those things to find the positive or a nugget that comes out of even the worst patient encounter or the worst day at work I think those reframing exercises over time help you move from constantly seeing the negative as your first response which happens in in healthcare and in busy environments you sometimes forget why you chose to do the work when the work gets hard we all joined a health care profession because we wanted to give back to to our communities we wanted to care for people and to help but when it gets busy and in the current state of the world where patient incivility where people are being mistreated by folks in the health care setting when work is busy and you’re making difficult decisions when you feel like you can’t do the work that you’re trained to do and you can’t do all of the things that you know are important that’s a heavy load to carry every day and so I think just finding ways to reframe that even amongst the chaos or even amongst the volume there’s still some really great work that’s being done and to take time to reflect on those positive moments because they can help to rewire the neural networks and over time you’ll see those positive things before you get entrenched in all of the things that went wrong and over time I think those are really important to keep us doing the hard work that everyone’s doing every day so again headspace meditations the resources around reframing exercises I like the Silver Lining exercise personally but there’s a number there that you can find whatever resonates with you there was thank you and uh Dr ALU okay it’s actually built off of what Dr Peterson Keller were talking about as well there a lot of that had to do with meaning that we ascribed to our experiences in that process right so what is significant what is the purpose what is the outcome what is our context um of giving that care and the distress we’re experiencing along the way um so I think there’s an opportunity in this process to actually reflect and ask teams about it and speak to the values and ask about that early on to organizationally and asking why people do things look for ways of context that allow that to happen as those approaches there’s educational context that actually bring that up very much I know that when we do the um the intricated physical Mental Health Care workshops at the Children’s Hospital looks at the human centered approach we actually bring in patients and providers of different disciplines to have a discussion around the challenges that they’re having discussing a particularly fragmented or not functioning process but how do we come to it together in solving it so getting people on the same side of the table look into some of it is actually one of the first matches coming together but how you come together to have the conversation stations and I think there’s ways to validate and then bring people together because they are shared value there is share of humanity that drives the process of seeking care and giving care and organizing care and so I think there’s a way to to support that conversation early on um in the process I mean as as Dr talked about staying just connected um there’s a WhatsApp thread that started before the pandemic um which has like 500 Physicians on it that literally pings non-stop all day long and I keep it on mute because it pings too much but when I need to I dive in it validates the community and the context and the solutions that we find for sure all the time and each of us can do this in our small team in our large teams as we go forward systemically have added actually in the chat you’ll see some resources from the Canadian Medical Association which is the wellness resource Hub particular tools and so there’s Pierce forwards model on social fairs programs that are now um in Pilot phases in Ontario from the Ontario medical association as well as other programs um that actually are there to support you and even at the level of distress that somebody’s having different sports that are there but I think a lot of it boils down to mindful self-reflection mindfulness of compassion which are courses which again bring together your Humanity with the work you do and allow you to experience that that that um that production the dichotomy that we’re experiencing which causes stress as well so there’s opportunities for learning operations for connection that bring in the meaning of self-reflection just as much as it does the skills you’ll learn to become better what you do great thank you and I’m not sure um Claire just to make note of some of those resources that Javed had put into the chat if we could share them with the audience I’m not sure if that’s possible um I’ll also just mention some of our work fabulous thank you worked with social workers in understanding their experiences around burnout and distress has been related also to long wait lists difficulties accessing particularly Mental Health Resources and communities for clients and as a result seeing their own wait list grow and their own inability to respond how they previously responded to in timely fashion to people’s concerns as well as just the heightened complexity of issues that their clients are facing since the pandemic and one of the rich sources of research Rich resource here in Ontario is the Ontario Association of Social Workers for social workers as well as other healthcare workers I would really encourage you to just take a look at the educational resources that provide a source of connection as well as a source of broadening capacity so um so fabulous before we move on to audience questions I just want to thank our panelists and thank the rich discussion that we’ve had here thus far we’ve had some wonderful questions I see coming through in real time to our audience we also had some questions submitted earlier in advance from audience members so to kick us off um one of our audience questions I’m going to ask uh I’m going to open up throw it out to any of any of you what evidence-based activities can be done to prevent burnout after working long hours and during working hours at home and at work anybody want to respond to that one I think you’d actually mention some of the evidence basis and the weakness earlier yeah and those were more specific to World distress um so and in those situations there are some educational strategies and becoming more of a team and so on those are helpful in in that regard burnout is something a bit specific and it’s not something that I have studied but I I think Dr Lee you were talking about finding meaning in work which I would imagine is you know focusing on that would be helpful um and I and also see Dr Keller has her hand out so she may have a good answer to this one yeah Dr Keller go ahead I’m gonna start the good answer but it’s the start of an answer I guess I think when you think about occupational stress and burnout there are actually a number of areas that have been studied to be predictive of improving outcomes and there are six big ones that are associated with reducing occupational stress and the likelihood for Burnout the biggest one particularly in healthcare’s workload um and so thinking about the workload and I think Dr Peter talked about this as well resourcing is a big issue and so really thinking about how we can fix some of the challenges around resources and how we can manage workload and in Pharmacy this is a significant challenge it has been for a long time um but it’s certainly getting worse as we see volumes increase in coming out of the pandemic and so when you’re thinking about workload you know we don’t have an infinite number of resources and and that’s the reality but thinking about how you can look at times that are more busy how you can improve workloads at various times or over various periods can help um and so there are some Creative Solutions around workload that’s not just about hiring more people when that’s not necessarily practical if there are no people and sometimes economically it’s not feasible as well so there are some things around workload thinking about um value and reward are also areas that are very predictive of Occupational stress and burnout and reward we often think about financial compensation and that comes up and it’s important everyone needs to be compensated for the work that they do in in a fair and Equitable way but there are other ways that you can reward people that again goes back to producing meaning in the work and so thinking about within your own teams and systems how do you reward work that’s being done how do you recognize contributions from team members those things all go a long way to building connection within your team thinking about values what are the values of the organization what are the values of the of the work and you as an individual how do they connect to your organization and the more aligned your personal values are with the workplace values the more resilient and the less likely you are to have stress and burnout so there’s a number of different ways that you can think about this and autonomy is actually a really big one the more control people have over their work environment the more likely they are to be able to be resilient to the stressful environment and again we all have to work for somebody it’s not that everyone can control all aspects of their day but finding ways to make your own decisions or to prioritize the workflow in a way that works for you or to take five minutes and I’m speaking as a pharmacist to the other pharmacist and I imagine this is true in other Health Professions as well a Community Pharmacy can be really busy there are people there all the time the phone rings all the time we often joke that we never get to use the washroom or take a lunch break or do anything that’s not got a phone attached to us and we’re standing you actually can you can go to the bathroom for three minutes and take deep breaths or listen to a song and dance it out if no one’s watching you I mean whatever brings you Joy but you can take a breath so that you can go back and reconnect and recalibrate with the work and we need to give ourselves permission to have the autonomy to do that when we need to because ultimately the worst case scenario from occupational stress and burnout is related to individual mental health and also errors we know that the more stressed individuals are and the more they’re working through burnout the higher the likely for errors medication error specifically and those can have grave consequences to patients and so taking the time to slow down and to really prioritize the work and let people know that you’re doing the best that you can is actually okay and we need to normalize those things within our work environment so that we can all continue to perform high quality work in very stressful environments great and I can continue after you want granted this exactly I think what I was hoping that that Dr Scott would have to speak about as well as exactly that aspect of what you have control over what you don’t have control over so recognizing the workplace there’s limitations of what you can do but there’s still things you can do to have agency and choice and that’s probably the most critical piece you have whether it’s in your work environment or after your work environment in terms of keeping yourself able to be stable and work um and well outside of your workout as well is the choices you make so some of the choices they’re defining what matters most both in your work what needs to get accomplished and what actually is less important in recognizing when there’s a resource constraints what actually will be the first thing you do and what things might not get done today and communicating that with your team and with your patients and clients as well and recognizing you know people obviously want everything done and we understand this but actually sharing this and the rationale and context and the pathway toward getting things done can help you get on the same side of the table when you’re looking with a difficult situation otherwise both on the blanks with what they believe is going on and isolates you from dynamically it’s complex and distrust you as well and that’s the consequences we all worry about in healthcare’s complaints as well so sharing information up front can help you make the difficult rationing decisions that happen at times and the planning decisions that happen at times but hopefully keep you together with your team and with your patients in clients um and looking at what you do with your time afterwards as well um so one of the things that’s come up more recently just published actually this week was the phenomenal evidence for example for exercise in treating even depression and depressive symptoms so recognizing we’re feeling overwhelmed there actually is value in that physical self-care for ourselves as simply a tool to help us manage again five minutes what can you do in five minutes at home without equipment and there is a heck of a lot that is possible in that process as well other questions that are choices about what we do for each other and ourselves and that’s both in our personal lives as well as in our work lives so the question that we often asked Physicians to look at in their in their wellness and burnout sessions was well what could you do for some one of your years who actually is have struggling this in the next two days what small thing could you do that could make things better it could be sending a text could be asking how they’re doing could be leaving a muffin on their table and then the second question is what could you do to be open for somebody else doing that for you in the next two days as well because quite often we’re used to being so resilient holding tough and not showing the weaknesses we’re asking for help and I think as much as we reach out it’s an openness to receiving as well and that’s a decision that we make as Dr Cutler describe agency is a critical part we feel overwhelmed by such an helplessness system and that as to our burnout in distress one of the challenges is actually finding ways of having choice in the Spheres that are available to us and there’s a heck of a lot there that can open doors to our own wellness and those of our colleagues yeah yeah that was I think very helpful and building on what the two of you also said with respect to nurses there there’s some research that shows if they’re able to see someone get better it’s helpful but working in different places there are some nurses who never see someone discharged or improved so for for them to have some exposure to when things went well and how their efforts contributed to someone getting better so that is that has been a a huge part of the research and also gratitude uh and the Gratitude can be expressed by colleagues as well because some patients cannot express gratitude I mean they might not even be conscious or they may be you know too distressed and so on so gratitude expressing it and receiving it is also things that have been found to be very helpful to create meaning in work uh in the research that I’ve looked at I love the discussion great discussion um I’m gonna I’m gonna read a question from one of our audience members one of our live audience members so it says I recently attended a talk by Dr Rabia Khan a social scientist whose dissertation is on burnout in post-grad medical education where she explored the idea of taking an existential approach and seeing burnout as a part of the health practitioner experience as opposed to it being a state to avoid might and might this be a helpful reframe for addressing distress related to individual responsibility for mental Wellness and just curious what this panel’s thoughts on this perspective are anybody I think it’s a great perspective so recognizing that having moments of suffering which describes a mismatch of context um and where you’re coming to the person in the context and your expectations your beliefs is a natural part of growth um if we actually always were smooth sailing never felt that distress that means that means there’s no growth and change you’re already optimized for your system and there’s nothing that needs to change internally in your views your perception to adaptation to but human beings are built for adaptation where change is part of our living context and so we push against the edges of our previous ways of doing things and the environment’s needs that’s where we feel the distress and when it’s not fully compensated or adapted for we have the the kind of um occupational stressors that we experience and that’s normal it’s a chance to recognize what could change to make things better and so I think it’s important to one validate and recognize yes it’s difficult um yes you know we don’t want it to be perpetually in the state of a mismatch because it actually is very hard to exist and grow when there isn’t the nutrients to help you adapt to the environment is growing but I think it actually it’s parked this conversation today about what actually is the future of healthcare what’s the current needs of the system and how we relate to people when we’re giving care into each other who are giving care to others and I think that wouldn’t happen had there not been further distress and we learned through this process I think bringing it up and actually let and it’s almost what Dr Carlos talking about that’s Circle lining this is the good that comes with the Pandora’s box right you have the bad but you also had the good that came with it and this is definitely the game with it foreign this really intersects with your research and your scholarship area what are your thoughts on our audience members question oh and I can answer it more in terms of moral distress which is also seen as something that is a normal thing to experience occasionally um I mean I think last it was last week I was teaching a class and I gave an example of a colleague who never experienced any kind of moral distress um and it was concerning working with her because there were situations where she would not react and behave in a way that was supportive to either the patient or the team so moral distress is something again I think just as Dr Ella was saying it’s not something you want to be in an intense experience every day every moment but it’s a normal response to things aren’t as they could be what is it that I can help change what is a system change and so on so it is it isn’t something to not ever experience it’s something to work through and it should be motivating um so to normalize it as a part of being a healthcare professional just not on a heavy dose every single day so I I think that’s that’s the key Dr Keller what are your thoughts so I know gravia well we were research fellows at the Wilson Center and we both used fucody and critical discourse analysis as the methodology of our studies so we were part of the same team and had the same supervisor so I’ll put that out front so I’m familiar with Rabia and her work and it’s fascinating so I I’m a big fan in that I think that she provides an alternative way for us to think about burnout and she uses the idea around discourses and that we’ve created a discourse of burnout that historically has been present for many many years it’s just a new label and a new conceptualization which is how Foucault actually conceptualized mental illness as well over a historical period so I think what she’s done is provided ways of of normalizing burnout and helping us think about it as a discourse and within the different discourses of burnout there are power relations at play that legitimize certain ways of existing within the world in the context of burnout and so I think that her way of of thinking about it gives us a different angle and context to understand burnout and to then think about how you can shift or change or exist within the different discourses to enable ourselves to continue to work in the spaces that we need to work so I actually like her critical look at burnout because it’s not a common way that we explore it and I think it provides alternative ways of understanding it and thinking about how we can continue to move forward and provide care as individuals but also thinking about it in the context of education training and systems and so I I think it’s fascinating and I’d love to see more work looking at burnout from these particular particular social science lenses actually because I think it will add much more to the work that’s out there yeah Dr Peter go ahead and and to add to that point as well in the moral distress literature there is also deep concern about how often this comes up in nursing because implied within it often is this powerlessness and without a Critical examination of are you really this powerless are we really powerless as a profession do we have to swallow that up or can we look at that critically So within um the critiques of moral distress which are really really important we need to examine that feature to try to overturn it where it’s relevant so I mean I think that Echoes what you’re saying about burnout that we need to be careful about the the narratives or the discourses because they can go unquestioned uh when they really need to be critically taken apart well actually had one thing there could be very relevant to the points and we’re talking about the organizational and system effects so we know that there is a large pressure for organization to suppress dysfunction within the organization and all that that be actually expressed externally and even you know this employment concerns and legal threats brought to employers when they were Sublime about things that are not working right and I think they have to recognize how that actually is seeking to disempower people where their environment could actually help them engage in acting an improvement of the system so I think that’s something we would certainly keep navigating for the ability for empowering the ridership to change what’s actually not working so well so we have two questions that are very similar so I’m going to combine them uh one from uh current audience member and one that came in in advance so our question in advance for from an advanced uh audience member how can we engage employers to prioritize staff mental health beyond the focus of self-care and one of our audience members had sent in something similar that said um can you please Point me towards some research or policies that could help us in fighting that could fight for us to help alleviate our turnover when managers are hurting instead of helping anybody want to take a stab at that question images tournament so I think a lot of what I look at is implementation strategy and that’s a lot of the work they do in other areas too and so I think in the in the end it’s the business case and so I look at it from a very cold-hearted point of view so the reality is that if your system can keep on dealing with the churn and the volume and the error rates the way you’re going then there’s no no compelling reason for management organizations to change what they’re doing um so I think recognizing for organization is the current pattern sustainable um is this going to get them to their other goals so mapping more clearly what the effects of these things are to their Core Business mandates and I think and dealing often with this is what it is like your project is this you want to accomplish this what’s not going to happen if you do this um how can your yourself not only are they able to participate in the work you want in the way that you want them to do um and so I think recognizing with this this process they’re facing nutrition of healthcare staff they think there’s a more compelling reason you cannot do your core mandate for existing as an organization without enabling the staff to do x y and said so it’s a lot more of a mapping Solutions and it’s as we describe there’s many reasons how burnout and wellness stress is created in in healthcare workers but some of them are more clearly mapped to the processes that exist in organizations that are amenable to the organization to change what they ask their staff to do how they ask them to do things how they communicate and that’s more within the purview of what the organization can change we know we want them to bring Staffing that’s often not entirely within their own scope to some of you but not entirely and so I think if you’re looking to get on the same side as your organization which is what I think the question is about how do you help them work with you to solve the challenge it’s about identifying the the their goals how the current needs and the trajectory is taking them away from their goals and what can you do to get this in that you’re negotiating like you would in any sort of Labor negotiations to show how the goals can be aligned in going forward and I think that’s one of the easiest persons because in looking at the humanity people are there for good goals but when they’re not actually helping each other it’s because they don’t understand traditional needs or they haven’t seen how their needs are aligned yeah I would also add in very simple terms as well it’s very costly for people to be off sick and turnover and so on it’s very very costly to an organization and bringing home some of those facts and figures might be compelling as well and I think the reality is that we have to start to talk about it so as Frontline staff that might not be a manager you might be not somebody that feels like they have the ability to have control I think starting conversations with your team meeting with your manager and bringing the issues forward and bringing it I think to to javid’s point around from a business case perspective all organizations need to whether they’re not for profit or whether they’re for profit corporations everyone has a business goal and a mandate to deliver and I think we need to understand what those are as employees but I also think that understanding that helps to present the case and it’s not about you know meeting with your manager or your team with a laundry list of complaints it’s about working together to find Solutions around here are some of the challenges that we’re facing in here that the things that we’re doing well but here are the things we can’t get to or here are the things we’re struggling with that are impacting customer and patient satisfaction here’s where there’s risks of mistakes that can be really concerning here’s where you know we have the biggest Crunch and we could benefit the most from additional staff if we can’t have it everywhere and so we can’t necessarily get the ideal situation we live and work in a system that we know is is not fully resourced how all of us would like it to be we could always use more people um that’s true in our universities as well I think that’s the reality of how we do the work but finding ways to to meet in the middle and begin the conversation and to talk about stress and burnout and some of the the moral injury and moral distress that people are experiencing and having that start at the ground and moving up I think is really important because I think leaders as they learn more and really are more engaged and transparent you’ll start to see shifts over time but these things don’t happen overnight and also just one quick thing to add leaders and managers are struggling as well so I mean I think sometimes we think they’re not but they are as well and so having that commonality may also be a place to start [Music] I’ll ask one last question that seems to really tie into this conversation that we’re currently having and there’s so many wonderful audience questions so I hate just limiting it to one last one but I see your time the last question how to not be how do we not feel guilty for asking for time off or less work when one sees everyone working under intense stress and colleagues are recovering double workload because the Imposter syndrome is real particularly when we’re expected to continue to put Patients First work under difficult stressors be resilient through difficult times and basically have the answer to everything so how do we step away without being seen as selfish or not a team player I think we just have to empower each other we all know our own limits and working past them isn’t helpful and so I think it goes back to the culture of your team the ability to have these conversations but everyone needs to be able to take some time off and in fact if you can take time off and really disconnect you come back much more productive in the long run and so I’m not sure that it’s selfish I actually think it’s helpful and I think it’s about how we frame it and how we talk about it I think though one of the take-home messages for managers is and leaders and I say this as somebody who thinks about this a lot in in my role at The Faculty how do you encourage people to take their their time off how do you set an example and how do you make sure that you don’t ask the same people over and over to do the work because it’s easy as a leader to go to folks that you know will do it that will work extra time who say yes you do a good job but there has to be an equitable distribution of work amongst the team so that everyone can actually have those times off and so you really have to think of about it at a management and a leader level if you’re in that capacity so that folks are actually feel like they can take the time off and then you need to figure out what has to be done and what can wait sometimes we have to prioritize the work and and sometimes with somebody being off you can’t do everything and that’s okay so it goes back to normalizing having conversations and recognizing that arrested Workforce is a more productive and a safer Workforce and we we really need to have that empowerment within ourselves I think that’s great they can build our food that’s what I was talking about there as well I think a lot of that comes into a really radical honesty being recognizing the limits that we know we’re not going to meet all the needs to the fullest extent with the resource we have we simply don’t have the system capacity for it we’re trying to do the best we can individually in our team and sharing that information so I often talk about really saying it up front I know we all need this we know this will help us function better when do you need time when should I take time and working to negotiate that very openly and explicitly rather than being worried about doing it really and worrying what other people think of you otherwise because we haven’t had that open conversation so breaking down the barriers as much as possible with explicit honesty and sharing I think really helps and recognizing as Dr clear mentioned there will be needs that will not be met um and that’s actually normal but I think also as she described the need to reinforce for equal sharing of resources because not everybody is as comfortable stating their boundaries or their needs as everybody else and this is how we take care of each other that we talked about earlier and that can be support we give each other along the way yeah right and Dr Peter did you want to jump in and add just one one small thing and again as Healthcare professionals we’re so focused on the needs of other people which is very typical I think it it’s a matter of realizing that all everyone needs care and support uh and to continue to care for other people we need to do those things like take a day off which if someone else were doing it we would say well that’s completely reasonable well we should be using that same standard for ourselves and normalizing it so well before I turn over to Claire I just want to again thank you uh our three panelists it’s been a really rich discussion and we’ve covered a lot of ground in this in this hour and 10 minutes talking about culture of team and systemic challenges and funding and and the individual experience and organizational context so you’ve left me with a lot to think about and hopefully have also left the audience with with quite a bit to think about over to you Claire thank you so much thank you so much all of you uh doctors Ashcroft Aloo Keller and Peter for tonight’s incredible discussion to our audience for your thoughtful questions and your amazing participation in the chat uh and I would like to once again thank our presenting faculties the Lawrence s Bloomberg faculty of nursing the factor in wintage faculty of social work and the Leslie Dan faculty of Pharmacy for organizing this very important conversation which I am sure will continue so I hope everyone takes care of themselves and I wish you all a good night
In collaboration with the Factor-Inwentash Faculty of Social Work, Faculty of Dentistry, and Lawrence S. Bloomberg Faculty of Nursing, ‘Mental Health for Healthcare Workers: Steps for Solutions’ highlighted the issues impacting our healthcare workers and discussed what policies and practices need to be implemented to start taking care of the people who take care of us.
Original Stream Date:
Wednesday, March 22, 2023
7:00 p.m. to 8:30 p.m.
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Speakers:
– Professor Jamie Kellar, Associate Dean, Academic; Associate Professor, Leslie Dan Faculty of Pharmacy
– Dr. Elizabeth Peter, Professor, Lawrence S. Bloomberg Faculty of Nursing
– Dr. Javed Alloo, Clinical Lead for Primary Care Integration for Practicing Well, Ontario College of Family Physicians
– Dr. Rachelle Ashcroft, Associate Professor, Factor-Inwentash Faculty of Social Work, cross appointed to the Department of Family and Community Medicine, Temerty Faculty of Medicine (Moderator)
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If you have any questions on this session, or Pharmacy alumni events, contact alumni.pharmacy@utoronto.ca.