Supporting ‘whole-heartedness’ in clinical supervision

2013 CSSP Masterclass SeriesConversations that change

Whole-heartedness

“a willingness to be vulnerable and to feel a sense of self-worth in the face of uncertainty and risk”

“We need courage, compassion and connection to be whole-hearted”

“I hated the way they handled Mum so roughly”

“They were just plain mean”

“A bunch of them came around this morning – I think they were doctors. They didn’t speak to me or let me know what was going on.”

• I was a 2nd year anaesthetic trainee on night duty in a large Sydney trauma hospital……

Let’s take a closer look

• Young woman dealing with the violent death of another young woman

• Unable to save her – did I do everything possible?

• Literally holding her life in my hands• Late at night, physically tiring• Required to keep working after• Follow-up regarding the technical side, no

follow up about how the team felt

How do we cope?

• Hide our feelings, numb our emotions • Stop asking patients how they feel so we don’t

have to deal with our emotional reactions• Inappropriate humour and other

unprofessional behaviour

• Become exhausted and burn out

Consequences…..

• Personally

‐ Distress/sadness‐ Recurring memories‐ Reduced confidence‐ Isolation‐ Increasing difficulty speaking up as no-one

else is

Consequences….

• Patient safety

‐ Tired staff‐ Impaired thinking‐ Poor decision-making‐ Reduced technical proficiency‐ Poor team work

I’m an anaesthetist – what can I do about it??

Acknowledging the challenges

• ANZCA Welfare of Anaesthetists Special Interest Group

• Examinable resource documents• Part 0 course

Understanding when to speak up

When we think we could harm a patient or clientHungryAngryLateTiredSick

Understanding when to speak up

When we think someone else could harm a patient or client

Understanding the barriers to speaking up

• Professor Dan Raemer – Harvard Medical School/Massachusetts General Hospital

“Responding to (very) challenging cases”

Barriers to speaking up

• Relational• Content• Self• Climate

Relational hurdles

• Perceived hierarchy• Respect for territory• Respect for experience• Value of the relationship• Familiarity with the individual

Content hurdles

• Uncertainty about the issue• Uncertainty about the consequences• Confidence about being able to deal with the

consequences

Self

• Perception of limited responsibility• Avoidance of potentially embarrassing

situations• Fear of being wrong• Personal reputation• Protection of physician autonomy• Natural obedience

Climate

• Not an environmental norm• Waste of time• Fear of repercussions• Absence of a rubric/tool

The 2-challenge rule

1. Question with curiosity2. Question with concern3. Bring in a third party

CHALLENGE TWICE THEN CALL FOR ASSISTANCE

“Me too”

• Sharing our experiences including our mistakes

• Showing we have felt the same way• Not just asking “What happened?” but also

“How did you feel?”

• Normalising ‘whole-heartedness’