COMPASSION, AWE AND GRATITUDE: REFLECTIONS FROM TWO U.S. CONFERENCES

Coach and doctor Linda Miller reports from the annual Institute of Coaching (IOC) conference on Coaching in Leadership and Healthcare (Harvard Medical School, McLean Hospital and Institute of Coaching), 16-17 September, 2016, and the International Conference on Physician Health (ICPH), (American Medical Association, Canadian Medical Association and British Medical Association) on 18-20 September, 2016

Compassion, awe and gratitude. How often do we experience these in our working lives? Psychology Professor Jennifer Stellar from Toronto, a plenary speaker at the ICPH conference in Boston on “Increasing Joy in Medicine” described her research in these three areas.

Having also researched the benefits of compassion over empathy, I was delighted to hear her conclusions that compassion ,awe and gratitude are positive emotions beneficial for mental health and well being.

Compassion is more “prosocial” than empathy. Together with concern for another, the focus is on action and what can change. It also leaves the person being compassionate with a positive affect (mood) compared with the negative affect of empathy .This is a crucial message for coaches and clinicians. If we wallow in empathy/sympathy, we and our clients (and patients) become disempowered and burnt out. Not surprisingly, positive emotions; joy, amusement, pride, contentment, love, gratitude, compassion and awe all have positive effects on wellbeing.

But what about awe? It struck me that in planning my trip to the conferences I had subconsciously sought awe inspiring experiences for my relaxation time; a whale watching trip, looking out for the autumn colours, and en- route seeking the Northern Lights and geological wonders of Iceland. Here was my own, admittedly anecdotal, evidence for this urge. Seeking out awe, whether it be natural beauty, art, music, the wonder of the human body or man -made achievements is good for mental health and well-being. Stellar found that regular doses of awe can reduce inflammatory markers associated with cardiovascular disease, diabetes and depression.

Stellar’s research on gratitude highlighted that expressing gratitude (for example recording five things to be grateful for in a weekly journal) has a beneficial effect on mental health. In my own practice as a GP, I have already seen the power of gratitude in action. I learnt several years ago from Roger Neighbour, an inspiring GP who wrote the consultation skills book The Inner Consultation,[1] that thanking the patients for key symptom information has a positive impact on the consultation. My experience has been that this makes the consultation more collaborative.

So how does all this relate to coaching and particularly coaching as applied to leadership and healthcare? For those of us coaching health care leaders in challenging times, compassion and encouraging self-compassion is essential. Coaches need compassion too, which is why supervision is so important as a safe space to address the inner critic and reflect. Supervision is normative, formative and restorative. Equally using a compassionate, coaching for health approach with patients, (avoiding being paternalistic, didactic and judgemental) definitely reminds patients they are resourceful and enables them to feel empowered. The transformational changes that people are able to achieve when given protected time and space to think, active listening ,belief and helpful questions, are awe-inspiring .This empowering approach also lightens the “burden” of care.

And the gratitude? Well I am truly grateful that I learnt coaching skills in 2008 and have been able to use them with patients and doctors and dentists for the award-winning, London Deanery Coaching and Mentoring scheme (now HEE Health Education England, Professional Support Unit,). I am also grateful for the amazing community of coaches from across healthcare (from surgeons to psychiatrists, anaesthetists to GPs) who share my passion for coaching and have coached hundreds of doctors and dentists since visionary Dr Rebecca Viney initiated the programme in 2008.The programme has inspired others internationally including in Vienna ,Ireland and Brazil.

Tragically, doctors are deciding to leave the UK because of the contract imposed by Jeremy Hunt. It is essential that coaching continues to be offered to them at this time of transition. It is very sad that the number of coaches is being cut. Fortunately these coaches are so committed they are trying to find other ways to continue to offer their skills.

I am also grateful that the value of coaching for health is now being recognised. At the IOC conference we heard the increasing research evidence for the health benefits in the keynote presentations from Carol Kauffman and Margaret Moore. The National Board of Medical Examiners and the National Consortium for Credentialing Health and Wellness Coaches in the US, recognising the importance of coaching are launching national standards in health coaching for 2017. In the UK, a coaching for health pilot in North West London is training multidisciplinary groups including social workers, doctors, paramedics, audiologists, physiotherapists, nurses and healthcare navigators. A new book by Jenny Rogers and Arti Maini is a good introduction; Coaching for Health why it works and How to do it[2] (reviewed in the March/April issue of Coaching at Work).

Recently Maureen Baker, the chair of the Royal College of GPs (RCGP) and the chair of the Royal College of Psychiatrists Simon Wessely spoke out about the disruptive impact of those in certain healthcare specialities being negative about other specialities e.g. general practice and psychiatry. Such “hidden curricula” can only worsen the recruitment crisis.[3] At the IOC conference, keynote speaker Amy Edmonson, Novartis professor of leadership and management at Harvard Business School presented her research on her book, Teaming. She studied psychological safety and the interdisciplinary prejudices, beliefs, values and biases in the silos in a smart city project, for example, what those working in software, construction or city government, architects and estate agents say about each other.[4] Her work demonstrates how coaching can play an invaluable “bridging” role in challenging such preconceptions and encouraging interdisciplinarity with a focus on the shared endeavour whether it be building a new city or patient care. Psychological safety underpins effective team working and is essential to having a sense of meaning and impact at work. It is also crucial to burnout prevention.

In the UK, Dr Henrietta Hughes, the inspiring London medical director with a challenging new role as NHS guardian for “whistle blowers” spoke to the media recently about the need for happiness in the NHS.[5] Her plea for more oxytocin, one of the “feel good” hormones, was controversial and hit the headlines. The tendency to attribute complex emotions to one hormone, neurotransmitter or one localised area of the brain “lighting up” on fMRI scanning has been critiqued by Raymond Tallis as reductionist, “neuro mania”.[6] The neurophysiology and neuropharmacology of emotions is complex .However, despite the criticisms, Dr Hughes is quite right, whatever they are mediated by, we do need more positive emotions in healthcare. Managing workload and Increasing psychological safety in teams is essential to nurture these positive emotions. Professor of psychology from the University of California, Riverside, Sonja Lyubormirsky described research demonstrating how acts of kindness to colleagues and gratitude can enhance happiness and well- being.[7]

A model encouraging “Deliberately Developmental Organizations” (DDOs) was presented at the IOC conference by Matthew Miller. Examples demonstrated how DDOs have a culture in which support of all employees’ development is a key aim in the day to day working of the organization.[8]

At the ICPH there were several workshops on burnout and mindfulness. The keynote speech by Jon Kabat –Zinn, who sat cross-legged on the platform, on the power of mindfulness was refreshing. Mindfulness is definitely a useful practice but as one delegate said “If one more person tells me to take a deep breath I will scream” .There are critics of “Mc mindfulness” as a panacea to mask understaffing and workload. Mindfulness, without a strong institutional ethical foundation behind it, can only go so far in building resilience.[9] Compassionate coaching to enable individuals find a good work-life balance, with a manageable workload, is transformative and staff are happier and more effective.

In addition to workload management, the most important factors for preventing burnout are feeling we are doing an important job well (meaning and impact) and hearing from colleagues who understand our role, that we are valued and appreciated. Our workshop using Graphic Medicine[10] to reflect on “Sparkling Moments” achieved these objectives and received very positive feedback from attendees, many of whom resolved to take the process back to their institutions. The workshop used narrative methods to capture individual’s stories. We are all natural storytellers and repeating stories of positive experiences in our work (rather than just the negative ones that our inherent negativity bias encourages) demonstrates our compassion and provokes awe. The small group appreciative enquiry evokes gratitude and peer recognition. Participants left feeling happy and we were grateful for their enthusiasm. We are collating the stories donated into an anthology and my colleague Niro Amin and I welcome invitations to share the workshop with coaches, supervisors and those working in healthcare. We are grateful to Robin Shohet and Eric De Haan, inspirational coach supervisors, for their “sparkling moments” concept.

I was shocked to hear from Andrew Gurman, the president of the American Medical Association, that 400 physicians commit suicide in the US each year. Physician suicide figures in the UK are equally shocking (and rarely talked about), but this number, 400, is equivalent to a whole year class at a medical school. Compared with other occupations, doctors have the highest rates of depression, drug and alcohol dependence, divorce and suicide. A combination of interventions is needed to address this. NHS workforce planning needs better leadership. We have a history of repeated inadequacies in this area with little institutional memory or learning from the 2007 Medical Training Application Service (MTAS) debacle which also left many disillusioned and emigrating. Adequate recruitment and staffing is essential for patient safety. Flexible working needs to be embraced across specialities to enable clinicians to have a family life as well as career without feeling guilty. Singer, songwriter, cardiologist Susie Brown with her plenary at the ICPH; “My Life as a Guitarologist” demonstrated how rewarding it is to have a portfolio career, something that coaching can facilitate. Part time medical careers are even less common in the US than the UK. Individuals also need supervision with protected time to reflect on their work with colleagues and build psychological safety. This can be facilitated using the humanities as in “sparkling moments” sessions.

I was grateful for the opportunity to attend these two conferences and would highly recommend them. Many of the speakers inspired awe, in sharing their compassion and their efforts to improve things for those working in healthcare. I appreciate the work that went into the organisation of these conferences which were effective in bringing together those with a shared passion for this.

 

Dr Linda Miller is a portfolio GP in London. She is an experienced coach, coach trainer, coach supervisor (Coaching Supervision Academy CSA), medical educator, GP appraiser and writer. her academic interest is clinician well being and the medical humanities.

  • lindamiller@doctors.org.uk

 

 

[1] Roger Neighbour, The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style, 1987

[2] Jenny Rogers and Arti Maini, Coaching for Health why it works and How to do it, Maidenhead, Open University Press, 2016

[3] Maureen Baker, Simon Wessely, Daniel Openshaw, Not such friendly banter? GPs and psychiatrists against the systematic denigration of their specialties BJGP DOI: 10.3399/bjgp16X687169, 1.10.2016

[4] Amy Edmonson and Susan Salter Reynolds, Building the Future: Big Teaming for Audacious Innovation, Oakland, CA, Berrett- Koehler Publishers ,2016

[5] Chris Smyth, Happiness is the Best Medicine Grumpy Doctors and Nurses Told, The Times 10.10.16

[6] Raymond Tallis, Aping Man-Kind : Neuromania, Darwin-it is and the Mis-representation of Humanity, Oxon, Routledge, 2011

[7] Sonja Lyubomirsky, The Myths of Happiness: What Should Make You Happy but Doesn’t What Shouldn’t Make You Happy But Does, N.Y ,Penguin 2014

[8] Robert Kegan and Lisa Laskow Lahey, An Everyone Culture; Becoming a Deliberately Developmental Organization”, Harvard, Harvard Business Review Press, 2016

[9] Ron Purser and David Loy, Beyond McMindfulness 7.1.2013, Huffington Post

[10] http://www.graphicmedicine.org/

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