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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’