The anesthesiologist’s beeper goes off — it’s an emergency call to place a breathing tube in a patient critically ill with coronavirus, a dangerous procedure due to the risk of viral transmission. Because of Covid-19, these calls are increasingly frequent; the intensity level in the hospital is like nothing she’s ever imagined. She barely has time to register her ever-present concern for critically ill patients, her anxiety at so many unknowns, her fears around her own personal safety and that of her family, or her grief at so much loss. As her beeper goes off, her training kicks in. She dons her personal protective equipment, feeling fortunate that she has it.
Even when the procedure is over, the emotional challenge it presents is not. Not for her, or the many doctors, nurses, technologists, cleaning staff, and others on the front lines of healthcare, or their leaders. The effects linger on beyond their time on the job, and can manifest in real ways, including insomnia, difficulty concentrating, and decreased energy. The risk of burnout in healthcare was already high before coronavirus, and the crisis has only exacerbated it.
From our experience working with healthcare professionals before and during this crisis and our combined 29 years of research in the world of emotional intelligence, we’ve learned that it’s critical for healthcare professionals pay attention to their emotional lives in order to remain effective and healthy themselves — especially in times of crisis. The payoff from this higher emotional intelligence among physicians and other health care workers has been suggested by several research studies: outcomes include more trust among patients, higher levels of patient satisfaction and less physician burnout. This tracks with research with executives in other areas, such as finance and manufacturing, which finds that greater emotional intelligence creates better results ranging from productivity to job satisfaction.
Emotional intelligence can be categorized into four areas of particular importance for healthcare workers and leaders today: self-awareness, self-management, social awareness, and relationship management.
If you’re a healthcare worker, emotionally intense moments are guaranteed in these days. And knowing what you’re feeling and how you’re reacting to those feelings — and how that’s affecting your performance — is the first step to managing them.
But given the focus on the patient, it’s often hard for healthcare workers to diagnose themselves. Medical school, residency, fellowship, and all of medical training are focused on patient care rather than self-care. And when the need is so great and your skills can help, it’s too easy to dismiss your own needs; doctors and nurses can neglect eating, sleeping, and yes, even using the bathroom. For our anesthesiologist this can mean that during the day she gets wound tight, though she doesn’t give herself a moment to think about it. She might snap at someone when she gets home. And even when she’s safe in bed at night, she still can’t relax and has trouble sleeping. She struggles the next day at work.
Far from being self-indulgent, self-attention and self-care are essential so that healthcare workers can continue so help and serve.
Journaling and other reflective activities can help you become more aware of what you’re going through. Use common activities such as hand washing as an opportunity for a moment of mindfulness, and a self-care check in: “Am I hungry, thirsty, or exhausted?” In whatever form you choose to do it, naming your emotions shifts the activity in your brain from the emotional center to the higher order prefrontal cortex; it’s there that you have access to insight, creativity, and reframing of issues. “Name it to tame it” as UCLA School of Medicine professor of psychiatry Dan Siegel coined. Even the words you choose to describe your experiences to yourself — your self-talk — can begin to change your emotional state. Looking around and saying “This is crazy!” will leave you in a more distressed mental space than asserting, “We can meet this challenge.”
Self-awareness is especially important for leaders, since they set the emotional tone for their people; a stressed and reactive service chief in a hospital will likely lead to more frazzled physicians, nurses, and technologists. Ask yourself: Am I bringing calm, steady energy to the situations I’m a part of? Is my personal anxiety, fear or stress being transmitted to those around me?
- Am I aware of my emotions?
- Am I aware of how I am expressing them and impacting others?
- What is the tone of my self-talk?
- Are my basic human needs being met?
Becoming more aware of your emotions and how you’re expressing them gives you the information you need to better manage your responses. This usually doesn’t come naturally. When you stumble across an emotional trigger, it can result in an “amygdala hijack” — your emotions take control. You may unexpectedly lash out at someone, start crying in response to a seemingly minor event, or start yelling at your computer out of all proportion with its slowness.
It can help to remember the maxim that “our power to make a better choice lies in the space between a stimulus and our response.” Awareness of that space is the first step; then we can expand the space, and make a healthier choice. When you notice you’re being triggered, take a break to allow your physiology and nervous system to settle. Deep breathing, movement, and music can also shift your emotional state toward more calm.
Focusing on what’s in your zone of control can also help — the patient in front of you, the decisions you need to make today. By narrowing of the scope of your attention and focus, you can replace seemingly unsolvable issues with doable items. You’ll feel relief and satisfaction as you accomplish them.
More generally, being compassionate with yourself is important here too. Sleep, good nutrition, and exercise will help you stay resilient. Call on your support network and share with them what brings meaning and purpose to your life and work. Research has shown that writing down three people, events, or things one feels grateful toward several times a week can also enhance your wellbeing. Finally, having a trusted colleague, friend, coach, or mental health professional to talk with can be invaluable in navigating everyday life; even more so in conditions like today’s.
- Do I have effective way to navigate emotional triggers?
- What is within my zone of control?
- Am I making time for sleep, nutrition, and exercise?
- Do I have a support network and do I give myself permission to lean on it?
- What brings meaning and purpose to my life?
Taking care of yourself is what allows you to take good care of others. Having empathy for your patients, your family, or the colleagues you need to work so closely with in these days can provide much-needed glue for those relationships.
The most fundamental way to do this is through listening to others — not just hearing what they’re saying but giving them what’s called “caring presence,” in which you’re fully attentive to understanding their needs in the moment. This kind of presence is a gift you can give and the resulting empathy strengthens the working alliance between physician and patient. The same applies to managers or leaders communicating virtually with direct reports working from home.
Other awareness can also include recognition of all those serving on the front lines — the cleaning staff, technologists, therapists, nurses, and everyone else. Some of these individuals are working in areas that they haven’t staffed in years and it’s important to see and celebrate their courage, poise, and dedication.
- Do I listen to others first to understand rather than rush to respond?
- Can I identify and name others’ emotions accurately?
- Whose work haven’t I recognized?
While social awareness is tuning into others, relationship management is using this awareness to have successful interactions with them. Given the added workload, anxiety, and grief due to coronavirus, relationship management can be especially challenging in healthcare settings. You may also be working with unfamiliar colleagues — individuals redeployed to new duties, or rotated in to give relief — and you need to cement new relationships quickly in order to maintain high performance. Meanwhile, good relationships with patients boost the likelihood that they will comply with medical directives; this is especially important now since so many virus patients are caring for themselves at home.
This is where empathy comes in: Once you tune in to the emotions others feel you can reach out to them in ways that fit them best. In interactions with patients, pay extra attention to your own vocal tone and facial expressions as you respond, as these can be very reassuring and comforting.
Patience should be a watchword in all of your interactions. Allow for more displays of emotion than you’d normally see, even in healthcare settings. This is particularly true for your colleagues: While healthcare professionals often have to break bad news like cancer diagnoses and the passing of loved ones, coronavirus has increased the intensity in many ways. Understandably, this can manifest as tears, decreased focus, and loss of patience. Now is a time for everyone — and especially leaders — to assume good intent and that all are doing the very best they can. Such an outlook can help to nurture the relationships that will move us all through this challenge and beyond.
Many healthcare leaders are also grappling with coronavirus’s impact on their institutions’ stability and tough decisions including possible layoffs or salary cuts. In this environment, transparent communication about the state of the business is of vital importance. If the nurses, technologists, and doctors who are putting their lives on the line think or feel their leaders are not being honest with them it could profoundly diminish their motivation. This information-sharing can be simple in form: For example, the University of Michigan health system (where David works) has been sending out daily coronavirus emails from UM’s leadership with updated tallies of hospitalized patients, unused bed capacity and employee safety data, as well as, the number of patients who have recovered. These messages all end with the line “If you have more questions, go here” with a link to a wealth of available resources.
Lastly, leaders at all levels should consider that research has shown that sometimes we need to slow down to increase our effectiveness, especially at key moments. You can defuse a tense conversation or ease the tension around a crucial decision simply by saying, “This is important, let’s go slow.” Such a strategy can aid a tense conversation, a key decision, and even those important moments of saying “Thank you.”
- Am I bringing extra patience, and assuming the best about others?
- As a leader, am I being transparent with information?
- Are my communications frequent, clear, and open to feedback?
- Am I going slow at key moments, including moments of thanks?
* * *
The anesthesiologist’s beeper goes off again. She takes a deep breath to calm herself before she moves quickly to the patient’s room, reminding herself of her deeper purpose. Once there, she reads the team’s vocal tone and body language for signs of stress, paying special attention because once again this is a team she’s never worked with before. After the tube is place and the patient stabilized, she slows down and personally thanks each of them. Beneath her mask and shield there’s a brief smile. The faces of the team are covered, but she imagines they are feeling it too — the warmth and connection of caring for patients, and each other.
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