Supporting ‘whole-heartedness’ in clinical supervision

1. Supporting ‘whole-heartedness’ in clinical supervision 2013 CSSP Masterclass Series Conversations that change

3. 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”

4. “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.”

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

6. 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

7. 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

8. Consequences….. • Personally • Distress/sadness • Recurring memories • Reduced confidence • Isolation • Increasing difficulty speaking up as no-one else is

9. Consequences…. • Patient safety • Tired staff • Impaired thinking • Poor decision-making • Reduced technical proficiency • Poor team work

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

11. Acknowledging the challenges • ANZCA Welfare of Anaesthetists Special Interest Group • Examinable resource documents • Part 0 course

12. Understanding when to speak up When we think we could harm a patient or client Hungry Angry Late Tired Sick

13. Understanding when to speak up When we think someone else could harm a patient or client

14. Understanding the barriers to speaking up Professor Dan Raemer – Harvard Medical School/Massachusetts General Hospital “Responding to (very) challenging cases”

15. Barriers to speaking up Relational Content Self Climate

16. Relational hurdles Perceived hierarchy Respect for territory Respect for experience Value of the relationship Familiarity with the individual

17. Content hurdles Uncertainty about the issue Uncertainty about the consequences Confidence about being able to deal with the consequences

18. Self Perception of limited responsibility Avoidance of potentially embarrassing situations Fear of being wrong Personal reputation Protection of physician autonomy Natural obedience

19. Climate Not an environmental norm Waste of time Fear of repercussions Absence of a rubric/tool

20. The 2-challenge rule • Question with curiosity • Question with concern • Bring in a third party CHALLENGE TWICE THEN CALL FOR ASSISTANCE

21. “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’