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1. Resilience Workshop (in latin, resilience refers to the pliant and elastic quality of a substance) Angela Davey Behavioural & Social Science Dundee Medical School p Add text

2. AIM: • To build on the GMC’s outcomes for ‘Good Medical Practice’ & patient safety  • Objectives: • to define resilience • to appreciate one’s ability to adapt to changing circumstances, e.g. adversity, trauma & stress, without experiencing stress related problems or threats to performance • to appreciate the risks and threats that affect wellbeing and performance • to understand how to get the better of negative emotions • To understand what factors contribute to resilience • To appreciate the importance of raising concerns & acting on concerns that limit patient safety

3. Definition – in pairs • Turn to the person next to you. • What does resilience mean to you? • 2 minutes each

4. One definition • The ability to adapt to changing circumstances, even when the circumstances are discouraging through adversity, trauma, tragedy, threats, or even significant sources of stress -- such as family and relationship problems, serious health problems, or workplace and financial stressors

5. Why is Resilience important? • Most organisations face the challenge of workers who are not performing at their best because of events at home or at work • “Psychological presenteeism” accounts for 1.5 times the combined costs of sickness absence and staff turnover • It incurs a massive cost to many organisations including the NHS that is largely preventable • THIS WILL APPLY TO YOU AT TIMES!

6. Pairs exercise Vulnerability factors • Resilience is the capacity to tolerate excessive demands and stresses without experiencing stress related problems or threats to performance • Discuss some reasons why we sometimes find it difficult to cope in the face of adversity (think of yourself and also of a patient) • 2 mins each and feedback

7. Elements of Resilience

8. Response to events

9. Risks and threats that affect wellbeing and performance Tertiary threat Conflict Harassment and bullying Discrimination Autocratic leadership Intimidation Job insecurity Poor performance Isolation Excess demands Loss and bereavement Accidents Illnesses Secondary threat Culture Organisation issues Changes Transitions ‘Rules’ Procedures Ambiguity Impact Increased costs Underperformance High sickness and absence High staff turnover Poor quality Recruitment difficulties Negativity PrimaryThreat Senior staff Colleagues Patients

10. Risks and threats cause stress Primary Threat Secondary Threat Tertiary Threat ATTITUDE

11. REACTION TO EVENTS • We go through processes in reacting to an event • Who am I? – personal features inform our attitude towards the event • What does the event mean to me? Based on an evaluation which gives it meaning • What will be the outcome? Depends on personal skills, attitudes and actions

12. Getting the better of negative emotions • Strengthening resilience is a process that moderates our feelings, thoughts and behaviours to enable us to react effectively and grow and develop

13. Does everyone have the ability to bounce back? • Research has shown that resilience is ordinary, not extraordinary. • People commonly demonstrate resilience • One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals' efforts to rebuild their lives.

14. Resilience through self discovery What kinds of events have been most stressful for me? How have those events typically affected me? To whom have I reached out for support in working through a traumatic or stressful experience? What have I learned about myself and my interactions with others during difficult times? Has it been helpful for me to assist someone else going through a similar experience? Have I been able to overcome obstacles, and if so, how? What has helped make me feel more hopeful about the future?

15. Pairs exercise • Think of a recent stressful time you have experienced • On reflection did you deal with it well? • How did you know you had resilience? • What qualities do people need in times of difficulty?

16. What factors contribute to Resilience? Having caring and supportive relationships within and outside the family. The capacity to make realistic plans and take steps to carry them out A positive view of yourself and confidence in your strengths and abilities Skills in communication and problem solving The capacity to manage strong feelings and impulses

17. Is resilience a denial of emotion? Becoming more resilient is likely to involve considerable emotional distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts, and actions that can be learned and developed in anyone.

18. Exercise - groups of 4 – 5 mins • Think of examples where you may need to build on your resilience as a doctor • (types of problems that you may face) • Write down some categories that these include – e.g. time constraints, patient complaints etc.

19. Ten ways to build Resilience(American psychological association) • Make connections. • Avoid seeing crises as insurmountable problems. • Accept that change is a part of living. • Plan and develop some realistic goals. • Take action rather than ignore the problem

20. Building resilience (ctd) • Look for opportunities for self discovery • Nurture a positive view of yourself • Keep things in perspective. • Maintain a hopeful outlook. • Take care of yourself.

21. What else may be helpful to reduce stress? • Writing things down • Meditation and spiritual practices • Good diet • Exercise • Me time

22. Summary • Resilience is the capacity to mobilise personal resources to tolerate, cope with and overcome adverse events without experiencing stress, and to grow and develop as a consequence of such events. • Resilience features aspects of personality and experience • All elements can be learnt and strengthened.

23. Resilience Questionnaire From the Oganisation of Health Psychologists Questionnaire has 32 questions It includes questions using dimensions of Self assurance, Personal vision, Adaptability, Organisation, Problem solving, Interpersonal Competence, Social Connectiveness and Active Response skills

24. Resilience Questionnaire • Read each of the 32 statements • For each, use scale of 1-5 to indicate how the statement applies to your perception of yourself

25. Examples of questions

26. RQ scoring

27. Meaning of Scores Highest score =141-160. You are very resilient. You are consistently able to deal with and even thrive on change. You have effective mechanisms in place that give you direction, structure, support and self-confidence. Lowest scores = 32-60. You are not very resilient. Change creates major challenges for you. Look to your lowest scoring dimensions as a place to start and then develop your development plan.

28. Resources • Management Advisory Servcice • http://www.mas.org.uk/uploads/articles/Resilience_and_strengthening_resilience_in_individuals.pdf • American Psychological Association • http://www.apa.org/helpcenter/road-resilience.aspx