A conversation about Personal Resilience with Alex Hunter

How can a resilience training intervention cut dropout rates among newly-qualified midwives cut the dropout rate over their first year in clinical practice from over 60% down to just 2%? In this conversation, Alex Hunter describes the steps and process he uses in his Personal Resilience course.

Gerard O'Dea:

It's Gerard O'Dea here. I'm with Alex Hunter, one of our most popular and experienced trainers here at Dynamis.  Alex works with many of our school clients who book our training through (www.positivehandling.co.uk)  Today though, I specifically want to talk to him about the personal resilience course that he delivers, and the reasons behind it, what kind of content he covers on it. Welcome, Alex.

I know that you've had really good results from this course, but maybe we could start at the beginning. How did you get to a place in your training career where you're delivering a personal resilience course?

Alex Hunter:

If we look back to my career as we go through the military and the security, a lot of high-impact events which is par for the course as the job. And then culminating at that point when it comes to the training with a murder, a venue I was looking after. And then having to keep 30 staff reasonably on track and give them some coping strategies to be able to move forward.

I've been interested in psychology since about 2005. It was one of those things where I've just gone down the rabbit hole and just kept going and kept going and kept going. The interesting part for me was we teach conflict management to people who are front facing, who are public facing, who are dealing with service users, clients. But what we don't do is equip them for the conflict within themselves - personal resilience.

We talk about social contract all the time, about how we behave amongst others. But what we don't talk about enough is a self contract, where we set some standards and boundaries with ourselves of what is acceptable. Where we're going to draw the line on getting help, and who we're going to go to get that help from.

One of the things about, especially western culture, is there's a lot of embarrassment around going to get help. So it's trying to break down that so people have a coping strategy where they can feel good about making themselves feel good, if that sounds all right.

Why not listen to the interview on YouTube? https://youtu.be/--LuAfos-p4

Gerard O'Dea:

Somebody might be a real giver, a real caring personality. Like we see all the time in healthcare, and we see it in social care. We see it in all the allied professions around that as you have people who really want to look after other people. And sometimes they just forget that they need to put as much energy and thought into how they look after themselves, especially when they're dealing with difficult situations.

Alex Hunter:

When we do health and safety training, one of the key things we talk about is that your first duty of care is to yourself. But by their very nature, people who care will externalize and care about others first. The issue I find with that, is a phrase that I was always taught was "to take care of others, you must first take care of yourself".

And if you don't do that, then eventually, you're probably not intentioned that way, but if you've not taken care of yourself and you have issues that then spill across to the people you're caring for; whether they're children, foster children, children in school; certainly, patients in a hospital. Then all that's going to happen is your ability to deliver what you would feel good delivering as a service, is going to diminish.

Then you enter these spirals; these psychological traps where you feel bad for having done something. Then that just keeps going and keeps going and keeps going. So you erode performance.

One of the things I have found with clinicians, especially those coming in to the medical field, having spent years studying, is that their study doesn't give them the specific tools to be able to cope with that transition from being a student who goes out and practices with a mentor, to suddenly being a clinician.

And the massive pressure that's heaped upon them, which happens in many different professions. But certainly when it comes to healthcare, you are essentially in charge of someone else's life. Specifically, with midwives, you're in charge of two lives. And they're not given the skill set to be able to cope with that to remain true to themselves in a way; that's one of those phrases quite bandied about these days, but "If I can't take care of myself away from work, then that will eventually, no matter how professional I am, spill over into work."

And when someone has a balance between their life outside of work and inside work, then you tend to see them chop away the work first. "This job's doing this to me, so I'm going to quit," sort of thing.

Gerard O'Dea:

Interesting. So when we teach conflict management skills to staff, we're generally trying to help them to feel that they can cope in difficult situations with others.

That they have tools that they can apply and make their workplace safe in that respect; in respect to other people. But I'm sure there's so much that we could be doing to help people to deal with their own internal dialogue about what's happening to them as well, right?

To see the Learning Outcomes for this course and request a callback, please visit: www.dynamis.training/personal-resilience

Alex Hunter:

Well, absolutely, because if I don't have a self contract to set standards that I see for myself as to how I'm going to behave; how I'm going to behave with certain people; what I'm willing to accept in certain circumstances and what I'm not.

This is always an interesting thing, because most people don't articulate that to themselves. They just carry on in life and just carry on with this whole, "Well, it's just me, it's who I am," et cetera.

But when you get them to actually look at their behavior and response to the stress of work today and what they've done as a coping mechanism when they go home, was it a healthy one? Did they go home and eat a whole cake? Because that gave them pleasure taste buds, calorie rush, raise their sugar levels? Then six weeks down the line, they say they're feeling depressed because they gained a lot of weight.

If I don't have that stated self contract, and I'll step outside of what I should and shouldn't do. And then before anything else, I'll probably do myself some harm. Maybe not physiologically, but certainly psychologically. Because guilt and regret are those two things that keep hitting you all the time. I like to call it a woulda-coulda-shoulda.

Especially as an overthinker, there are things running through my head from last year. There are things running through my head from 10 years ago. When I could have said something or done something. It's not always the most serious context, either. Because people do this all the time.

And as they're doing it, especially if they have a high-pressure job that means they have lives in their care, that woulda-coulda-should have can repeat and repeat and repeat.

When we look at it, certainly from a chemical level, we have to deal with people and talk about adrenaline a lot. If you've got constant bursts of adrenaline because you're over-analyzing things, you get this thing called analysis paralysis, where you just keep going over and over. You're essentially torturing yourself.

Gerard O'Dea:

I think you've worked with that particular section of staff (newly qualified midwives) quite consistently. The staff who are coming into clinical practice, they spend a lot of time in academia, and maybe being mentored. Now they're doing clinical practice themselves, and they're starting to feel that pressure.

What are the specific things that you help them with? What models do you give them to start helping them deal with their stress and so on? I mean, you just mentioned that self contract. I'm sure that is pretty important.

Alex Hunter:

Well, the first thing to do on this Personal Resilience course is to acknowledge that everyone in the room needs to be fully honest with themselves. I certainly like to remove any embarrassment by telling a few stories that embarrass me, because it takes away the tension in the room. I like to discuss things that have happened to me as well, where I've had to cope afterwards, and I've had to form a strategy.

Also I cover the darker stuff, where I have had issues in the past. And it's taken certain things to get me out of it. One particular one [inaudible 00:08:22], I mentioned the murder already. Was my daughter. Again, how my daughter essentially dug me out of the pit of depression. Simply because she had enough of seeing Daddy sad.

I talk a lot about self discipline. The whole day starts with physical health.

Because when we look at how it slips across, a lot of people think that mental health problems don't affect physical, and physical health doesn't affect mental health. Of course they do. They go hand in hand. It's a circle.

If you've got staff members who are expected to perform a physical task, certainly under pressure, then there has to be an element of physical release as part of a coping strategy. The interesting thing, certainly in working with midwives, is you get the whole demographic. You get people who are dedicated training half an hour a day, no matter what; and that's probably their strategy that just burns everything through.

Then you get people who just walk to work, and that's their exercise for the day. But it's a similar thing. It's a constant repetition with a goal. It's physical. It's benefiting them. It's burning calories. It's working the cardiovascular system. Certainly one is strength training is always a good analogy; I'll come to that in a minute.

I think the interesting part is you've got to start with the physical. And without shaming anybody, which is an interesting one, because again, you can start a guilt spiral where you could have someone go, "Well, I used to run in school, and here I am, 24 and I haven't run in four years while I was doing my degree."

The thing there is to get them to understand that where they are now is the starting point. Good enough is good enough. Any step forward is a good thing, because they can build habits really fast.

When we look at habits, certainly in dealing with behaviors, the interesting thing is a habit could start after two occasions where you have a reward for it. And that reward is as simple as a little squeeze up there [in the brain], a bit of dopamine to say, "That's good."

The issue is, when you have one bad habit, the chocolate cake, or you have a good habit, but it bites into other things so you then feel guilty for not doing it enough, right? Certainly with that one, understanding good enough is good enough is a major part. Getting people to give themselves a break is a major part as well.

To see the Learning Outcomes for this course and request a callback, please visit: www.dynamis.training/personal-resilience

Gerard O'Dea:

People do burn out. They do give too much, and they forget to do those things that help them to get through. And physical health is one of those. But there's also that psychological and emotional kind of wearing down that happens over time.  Their Personal Resilience is starting to break down.

Alex Hunter:

Certainly, with someone who cares, anyone who works in a caring profession, has a degree of empathy. Otherwise they shouldn't be there, or they wouldn't be there. What we see is that over prolonged periods of time, because they're repeating their responses to the certain behaviors, not constantly, but certainly in large periods of time; if I go on a 13-hour shift, and I'm two months in, then potentially I've done 24 13-hour shifts.

When you break it down into time scales, how many times have I helped someone go to the toilet? How many times have I dealt with someone who's irate? Upset? All these different factors? Before you know it, they stack up into large blocks of time.

Anytime you have that repetition of just dealing with the same behaviors, then the potential's there for you to care from the very start, and care less as time goes on because it's happening all the time.

Gerard O'Dea:

It's almost like a callus, isn't it?

Alex Hunter:

Exactly. That's a really good analogy.

What do you do to a callus? You file it down. That's the thing to do if you want to keep the skin intact. But what do we see if ... an analogy for a behavior, certainly where someone spends a month working really hard, and then goes out, say, drinking, and then poisons themselves for three days and can't go into work and stuff?

That's akin to ripping the callus off.

So they've got to a point where it's there, and they need to do something about it. They let off steam, and the way they do that is through a behavior that means that then they suffer later.

Both physically and psychologically, because hangovers are terrible.

And if you've got woulda-coulda-shoulda going around in your head while you've got a hangover, then all that's going to happen is you catastrophize the hangover. You attach it to what's going on in your head. And you're on these spirals, these down days.

That's not to say that you shouldn't have them, because they are a natural process. But the thing is, if we're expecting ourselves to be professional; and certainly in any provision of care, keep our standards high; everyone needs to understand that you will have the highs and the lows. They need to forgive themselves for the lows. And they need to reward themselves for the highs.

It's always an interesting thing. I always find it fascinating when people talk about, "Oh, well, work's just work." Okay. Have you had a success at work today? What's the reward for the success? It only needs to be a tiny thing. But that'll keep you going forward. It keeps you positive.

Gerard O'Dea:

Interesting. Just yesterday, I think you and I both saw it on Facebook or on LinkedIn. I posted this excerpt from Fred Lee's book "If Disney ran your hospital"

Alex Hunter:

Yeah.

Gerard O'Dea:

I love that book so much. But that one piece of the book, is about a page of the content says, we hire people and we teach them how to be courteous and competent. But the real leaders in any space where we're delivering care are the ones who are truly compassionate.

And to be compassionate, you have to be inspired by something. I think when you meet somebody who says, "Oh, it's just work, isn't it?" You feel, or you sense in that person that they've lost that inspiration somehow. I think it goes full circle back to what you described as a self contract.

What I would probably talk about with a group is the values base off which they springboard in to action. What values are you bringing to this activity you call work? And if the values base is intact, then it's not cracked or creaking, or leaking, then things should be good. And you have an inspired person delivering compassionate care. I think it's really interesting, what is your perspective on that?

Alex Hunter:

Certainly, self contracts is one way of looking at it. Goal setting is another way. Another thing it's called, because it's not just the negative; it's not just what I'll put up with. The issue is also what I won’t put up with.

And certainly, we were talking about goal setting again earlier in the resilience course. We need to get people to understand that small goals lead to large goals. It's kind of a chunking things down approach, if you want to use the NLP language.

But interestingly, people don't tend to do that.

I use a ladder analogy a lot, because skill ladders work really well when you just go up a rung and then up a rung and up a rung. And before you know it, you've climbed the ladder.

The interesting thing is, when we look at compassion fatigue, it's the same process. They experienced the bad behavior. Then the next shift they experience a similar behavior. The brain is a pattern-recognizing machine. So it clumps the two together. Then three shifts in, it's three. Then it's four; then it's 10; then it's 24.

So what the brain does is it essentially goes, "Ah! Well, this is what's going to happen all the time." And it doesn't differentiate between each time. Every human interaction is unique. But they don't allow themselves to have that. It's very easy; I mean, I've certainly experienced in my own career in security. To feel mired in the 3% of your work life which is bad, because you let that define the whole. You know?

That was another thing that certainly came across from the midwives I was training. It's five years now. The first day I was there; that was again, a real test for me because I was delivering some [inaudible 00:17:20] research for just over two years. And was standing in front of a room full of people who were essentially going, "Well, if you do well, then we're going to stay here. And if you don't, we'll quit."

Gerard O'Dea:

With all these clinicians getting really good education and mentoring for a couple of years; several years.

Alex Hunter:

It's a degree course. It's a full degree course to become a midwife, because you're an independent practitioner.

Gerard O'Dea:

Then, though, we're seeing this huge dropoff in the first year or two of clinical practice.

Alex Hunter:

The First year. First year, 60% drop-off.

Gerard O'Dea:

My goodness.

Alex Hunter:

And looking at it organizationally, if you had an organization where 60% of your new staff left in the first year, then that would be such a massive red flag that you'd tear apart your recruitment process and everything involved with how you get people into the job.

Again, it was flipping the perspective that was the key there. I stood in front of this room full of ladies who, and one gentleman, who essentially were doing the "should've had this years ago, so let's see what you've got." So the expectation was very high. At the end of the day, the feedback on the initial personal resilience course was very very good. And at the end of the year, the rate was 2%.

Gerard O'Dea:

Their new dropout rate for new clinicians was 2%, after they'd had a single Personal Resilience intervention from you?

Alex Hunter:

A single day, yes.

Gerard O'Dea:

Wow.

Alex Hunter:

I think ... it helped on that first Personal Resilience course to have members of line management there, to have people from different departments there as well, who just essentially popped in. If you've ever seen a training day at a hospital, you know that people just come in and out. At some point, someone goes, "Oh, that's interesting. I think I'll sit in on that."

But again, perhaps it's because I don't do an exclusionary attitude towards that. "Oh, you're here? Well, just come and join in." The good thing for that is you also get that extra perspective.

That extra perspective is so important any time you're having a discussion, which is what all training is. You're having a discussion and trying to lead it.

Gerard O'Dea:

I think if you've got a senior member of hospital staff who decides to take even 20 minutes out of their day to sit in your session, there's probably a really good reason for that. And it has to be respected. If they do want to input, it's going to be important input.

To see the Learning Outcomes for this course and request a callback, please visit: www.dynamis.training/personal-resilience

Alex Hunter:

Absolutely. That builds trust. Trust between management and staff is one of those key things that we have to address when we look at organizations. To have someone from management in on a personal resilience course was brilliant, because obviously everyone's in it together and learning together.

I've always found it fascinating when you have two-tier systems of training, where management don't attend with their frontline operators or carers or whoever it is. Because the issue comes in that, "I don't trust what you've been taught, because I wasn't there." They don't trust what I've been taught, because they weren't there. Then you almost get a them and us, which happens.

On a fostering course recently, there was social workers and foster care was in the room. Because it was day two of their training, it was as it was, they went, "Ah, we've developed a good them and us." I went, "Okay, well, I'm going to break that down by the end of the day. There'll be none of that."

Again, a little bit of humor there. But we got those broken down. Different perspectives is always interesting to mix in with that one. Certainly having someone in the room who had been a midwife for 30 years say to me, "I wish I'd had this, because it would have saved me a lot of stress over the years."

And when I talk about stress, again, you essentially have two kinds of stress. You have the detrimental kind of stress, which eats away at you. That constant drip-drip-drip of adrenaline that burns you out. And then you have transformative stress. The difference between the two is how you appraise it to yourself.

It truly is. I mean, working with all sorts of people over the years, had some people who have survived horrific things in single events or been in relationships that have been abusive in the longterm, coercive or physically abusive. The thing that normally is the sea change that turns that stress from the thing that's eating them to the thing that causes them to have action and sort something out, is how they see it.

Certainly, when we look at the longterm stress, if I'm in a profession where I have passion in what I'm doing, and then I start to feel compassion fatigue; which is wearing away that passion; then I need to reframe it and re-examine why it was there. And then hopefully re-ignite that passion, so the compassion comes back.

There is also ... it's a fascinating thing, this, the 2%. Because of the course, 2%, which is one person for that intake, have re-appraised and decided, "This isn't for me. Because what is essentially happening is my mental health is suffering. I can make a clean decision to move on and do something else.

So you facilitate both sides. You can't always have it one way. Certainly, when it comes to a group of people who have spent a long time studying, which in itself is very stressful, and places burdens on home life and your finances and everything else. Then there has to come a time where you have to be realistic with yourself. And if that has set in, if the compassion fatigue is in, and it has eaten away, then the coping strategy absolutely lets you inform yourself, "I need to let this go now. I need to move on."

Gerard O'Dea:

t was interesting that you mentioned about the midwife who wished she'd had it, the training, 30 years ago. I think you were there when the training when we had somebody come up to us and say, "If I'd had this training 30 years ago, I wouldn't be on my fourth husband."

Alex Hunter:

That's right.

Gerard O'Dea:

That was pretty funny. So we give people these tools, and they take them away, and use some of the ideas that you've given them to refocus themselves and renew themselves in terms of how they're seeing their work.

Alex Hunter:

That's the first part of Personal Resilience. Because the issue you then find is that once you set goals and standards, and you understand that you're not going to allow yourself to slip into these patterns of behavior that are destructive, then you need to move forward.

And the only way to move forward is to build a system, which is always fascinating because people resist systems for their personal life massively. But if you say to someone at work, "Here's a check sheet for your day," they love it. Because it makes it easy to have a list.

So, first thing I look at is how they actually frame their day. Interestingly, a lot of stuff about affirmations over the years I've been looking at, some really wild stuff as well that's out there. [inaudible 00:26:29] about verses and verses and verses and verses.

But I think just making the decision that today's a good day when you open your eyes, is a good thing. No matter what your mood is. Mood comes into it a lot because mood channels into emotion, which channels into behavior. But it also works the other way.

I talk about the workplace and how the environment has to be conducive to wanting to be there. Certainly, with the midwives I was working with, having a staff of them was comfortable. Environment first. Having the facility to get a drink when they need a drink. I spoke to management, and we were talking about how difficult it is to schedule their breaks.

Well, okay. They need to get a break, and the way to build the trust between you and your team is for you to make sure that they get their breaks before you. Because they'll see you as a giving, caring person in leadership. And they'll follow you anywhere then.

The American thing that is used is leaders eat last, which is a U.S. Marine Corps maxim. At the queue of people at the canteen, the officers are in the very back.

They eat last. And that does help build respect and trust. Then you've got other factors going forward. Self discipline. Again, in the past, a prolific procrastinator is the phrase I like for that one. Someone who can procrastinate a lot, which is interesting.

You've got great standards and rest. You know? Yeah, what I like to do is get people to understand that the self-fulfilling prophecy with regards to how you're going to feel if you take one step, then another step, then another step.

Again, certainly with care, they can see it because they have literal physical examples in front of them. Certainly, with the process of birthing a child. Then everything that goes afterwards, it's one step after one step after one step. And it's small steps that lead to large changes. So that's the second thing.

Then I ask people to look at their own moral compass, because everything is driven by your moral compass. It's what you've decided is good for you, good for others, how much loyalty you place in certain relationships. Certainly, work relationships, home relationships, all this stuff.

How honest you are with yourself and others is an interesting one. I had a discussion quite a while back with some mental health professionals about therapeutic lying. Telling a lie to achieve a therapeutic goal, and the ethics discussion around that was about 45 minutes long. It was fascinating to be a part of.

Because the opinions across the room, and this was from one hospital. [inaudible 00:29:34]. Was so different, and so contrary to each other, that you could see the blood boiling in the room. And certainly with some people, "I never lie to anyone. I never, never, never lie to anyone."

And then of course someone will throw that "What if?" out. Okay? [crosstalk 00:29:54] One of them said, "What if your mum said, 'Do I look good today?,' and she didn't? Would you say to your mum, 'No, you look horrible'?

"What if your partner said, 'Do I look good today?' And she didn't. Would you be totally honest there?"

So it was a really fascinating conversation. Especially where it turned from about ethics of therapeutic lying to a whole broad spectrum moral discussion about honesty.

Gerard O'Dea:

I think that's really interesting. I had the great honor to teach quite a few students at the University of Edinburgh, where some of them were studying medicine. Every now and then we'd just talk about how they were getting on. And one I can remember, speaking with a young man who's now a doctor, somewhere in the world.

He said that they had actually started to tell patients that the medicine they were giving them was really new, really good; it had had great results with other patients similar to them. And really selling the patient on the benefits of the medicine. The reason they were doing that is that well, the placebo effect.

If I can convince this patient that the medicine's working, then scientifically, evidentially, that is very likely to have an effect on the patient. But, it trips up over that ethical question, quandary that you just discussed. Am I telling them the truth?

Alex Hunter:

Again, certainly, when dealing with clinicians in the personal resilience course, it was absolutely fascinating. Because the end goal in this case was to stop a patient having aggressive violent incidents. But it backfired in the end, because at a certain point, people will see through a lie. And that's the issue we have with that.

As long as either you're a really good liar or you are able to smooth it in a way so that is no longer a massive bump in trust, then you're okay. Interestingly, for me, I came down on the necessity and proportionality line a bit, to add some logical framework to it.

Then you had people considering all sorts of different options. Because if it was really necessary to save a life, and it was proportionate to the threat, which was their behavior becoming so bad they harmed themselves or others, then what's the problem in a fib?, was the general consensus. As long as it's not going to have a longterm effect on trust for the staff.

I found that fascinating because they still caveat. You do that with yourself. That's the interesting thing with resilience. You caveat yourself with your own self contract. You will accept a certain behavior from one person, because they are a loved one. But never accept it from someone else. You caveat your own contracts when it comes to your personal interactions with people. That's always fascinating as well, because there's an ethical framework behind that.

Again, if I've set a standard for myself and then I have exceptions to that standard, then I've got to justify it. Otherwise I will feel hypocritical, guilty. That's the other thing. Is getting people to framework things so they can understand what's going on. And then diminish.

You can't ever take it away totally, but diminish this effect of feeling bad afterwards. Or regret or guilt or ... one of the worst ones is when someone feels like they're a hypocrite because they're embarrassed to themselves, which is an interesting concept.

Because embarrassment in a normal framework is in front of other people. But you can be embarrassed in yourself. As in you feel ashamed for your behavior, but no one else is here to see it. Because you set a standard, you've broken it, and then you accept it.

Getting rid of that self embarrassment is a key.

Gerard O'Dea:

Yeah, that's what we've seen. I'm a big fan of Robert Cialdini. He's written extensively about persuasion. One of the things that you can trigger in somebody to help them to go along with one particular option or another, is you trigger their internal consistency.

If they've decided that they're a certain type of person, or they've decided that they're going with a certain brand, or they've decided on a certain course of action; then if you can trigger them to think about how consistent they are with themselves, then they'll probably go along with whatever's consistent, whatever they previously decided, whatever they see themselves as. Or whoever they identify themselves with.

So that self-embarrassment, that hypocrite problem is that inconsistency with myself, right?

Alex Hunter:

Exactly, yeah. Again, when we look at team dynamics in Personal Resiliency, which is the last part of the day; we look into interpersonal support and everything else that goes into being a cog in a machine, as it were, which is a horrible analogy, because it's humans. But you know where I'm going with that.

The thing I find fascinating about that is, again, that Joel Lashley (from Vistelar) phrase, "All behavior equalizes.

Unless you've got a team of people who have the same goals, who have a similar mindset when they arrive at work, and that if someone does arrive out of that mindset, its personal support kicks in so it gets dealt with, either by people at one level or moving up the chain. And dealt with in a way that's not a punishment exercise, but is a fix-the-problem exercise. I'm a massive fan of fix the problem, not the blame. Again, thousands of sound bites in a 10-minute conversation.

Fix the problem, not the blame means that people don't feel guilty for getting something sorted out. Whereas certainly, you've seen management styles; this is across the board, not just in healthcare; where the problem can't be fixed until someone is blamed. And all that does is make people feel bad.

That spirals, and then you're going to get all sorts of issues with people and their mental health purely going forward because they have made themselves feel bad because there's a problem that needed to be fixed.

Gerard O'Dea:

People feel great about fixing problems. As human beings, it ticks all the buttons, right? You see a problem, you fix it.

Alex Hunter:

Well, again, the sense of achievement you get from fixing something, from solving that issue, that's the reward. That's the first reward, is that little bit of dopamine that says, "You did good today."

It's getting that acceptance that that's my reward, and I want that to repeat. I want it to keep going, form a habit, and then pass the habit become a routine. Because once you get to that stage when something is a routine, then it's baseline behavior. And it's something that you want all the time as a norm, as it were. Normal's a horrible phrase, but baseline is what we're after.

Gerard O'Dea:

So towards the end of the day, you're talking with the team about how they work with each other. That's how you then leave Personal Resilience with them, as a program that they work with each other on?

Alex Hunter:

I'm a massive fan of the idea of getting people to email themselves a reminder. Because that way, you essentially set a longterm memory trigger that's going to, "Oh yeah, we did that Personal Resilience course last week, and there was this." That's a useful tool as a trainer.

But also, what I'm trying to do is I'm trying to get them to see a dynamic. Then we have to cover the toxic people that you're going to encounter. That includes patients, service users, clients, all the way through to management of the staff. And how dealing with toxic people is an essential part of your well being. Essentially, it's a very short conflict management course.

But it's goal focused. It's about keeping people on goal. Not trying to change their behavior. Let's say I'm a midwife booking someone in, then I'm seeing them at month three, and it's 25 minutes at half an hour, or maybe 45 minutes. I may not see them again until six months' time.

But if I don't set a standard right there of accepted behavior and social contract and get that understanding, then what's going to happen in the time in between in the appointments with other members of staff; and again, it's all on record, so you could have a member of your staff look back and go, "Who booked him in?" "Oh yeah, she never talks to anyone about."

Dealing with those sorts of issues is fascinating for me. Because in a team dynamic, you want a level playing field that's led by someone exceptional at the task.

Then because of their example, then you've matched their behavior. And if someone comes in to that team dynamic, so shift change is the most common thing we've looked at.

Or start work. Then it needs to be dealt with immediately.

Everyone has bad days. The issue is, people are made to feel bad about having a bad day. Whereas the constructive thing to do is to gain some support straightaway, bolster confidence, set the goal, and then move forward together.

Because everyone has a life. Everyone has bad days. But I find this blaming thing the worst part about it. If I've had a bad day and you make me feel bad for having a bad day, then that's a double bad day.

Gerard O'Dea:

Of course, yeah. And I think there, having observed that dynamic where that negative spiral starts in few workplaces, there's nothing worse than where that becomes normal.

And people complain about each other, then all of a sudden you're going back to the thing you discussed before, is that us-and-them.

Then you've got vertical conflict and horizontal conflict. At that point, everything's broken, and we really do need some kind of intervention to get this whole thing reset. We need to reset the social contract. We need to decide how we're going to treat each other, and how we're going to treat our clients and visitors.

And maybe, just renew the relationships and the way we're going to treat each other in the setting. It's so important.

So, I've got a question for you then, just to close things out. Which is, where do you see ... obviously you've worked with clinicians in the NHS and with people involved in that setting. Where do you see your personal resiliency course going?

Alex Hunter:

The key to me is to be able to get some kind of Personal Resilience training delivered to as many people as possible, so that they remain caring in their caring professions. A lot of stuff we've been talking about recently about compassion fatigue, is that unless you give people a skill set to start the process of letting themselves keep hold of their compassion, then we're going to see it more and more.

For me, the whole point is to get the idea of resilience out there, not just clinicians; everyone who needs it. For example, I had an interesting conversation with someone who works in retail the other night. She was saying that she has two jobs. She works a bar and she works in retail. The abuse she gets in the bar setting doesn't affect her at all. But the abuse she gets in the retail setting does affect her.

It's purely based on the context and the work environment. The team dynamic when she's on the bar is one where she's able to use humor to brush off incidents that would have normally affect her.

But the serious nature of the retail environment means that everything is said is taken seriously. You have this dichotomy of one work environment is humorous and fun. Therefore, things don't stick. The other one is really serious and prim and proper. And that everything that's said sticks. Every tiny terse word, everything that's outside of social contract, hits her really hard.

I had a little time with her to talk about reframing. Then I talked about interpersonal support with her. She said, "There is none.”

Okay. Well, that's interesting - because certainly, when we look at normalization of success, you want your staff to be happy, because they'll be passionate in their job. When we look at care, we want compassion to continue through our career. So the only way to do that is to give people a strategy that lets them enjoy what they do. And stop things that are bad, from sticking.

Gerard O'Dea:

Very good. Well, that's a really good introduction to your resieliency course - thank you for that.  No doubt, we will dig into some of those topics in more detail some other time.

To see the Learning Outcomes for this course and request a callback, please visit: www.dynamis.training/personal-resilience Further Reading: https://www.nursingtimes.net/news/workforce/trusts-called-on-to-do-more-to-support-stressed-nursing-staff-05-04-2019/ https://www.leadershipacademy.nhs.uk/blog/resilience-not-essential/