Allow space for the team to pause
Fiona Day, medical and public health leadership coach and chartered coaching psychologist, says, “Extreme events in healthcare can leave lasting psychological scars on team members and those around them. It’s important to understand evidence based approaches, both in the moment and in the longer term, and for team leaders to resource themselves to lead effectively through a challenging period.
“Each person reacts differently to occupational trauma. It’s not possible to predict who will have more adverse reactions, and team leaders are advised to seek advice from their occupational or psychological health services at work before planning any individual or team specific interventions.
“NICE has recommendations regarding helpful and unhelpful actions following acutely traumatic ‘disaster’ events as well as general prevention identification and treatment of post-traumatic stress disorder.
“Team members exposed to extreme events may blame themselves or others, leading to high levels of shame—which can be detrimental to psychological health. The team needs to be able to pause, support each other, and learn together in a ‘no blame, no shame’ way. This calls for skilled and effective leadership from the team leader.
“Post-traumatic growth is a possible outcome of exposure to occupational trauma. A person (or team) can transform their negative experiences into positive internal cognitive changes and ways of working together. This includes positive impacts on psychological resilience, esteem, outlook, and commitment to the team and its values, as well as improved communication and sense of purpose, individually and collectively.
“Leading a team that has been involved in an extreme event will challenge the team leader. It takes a village to raise a leader—if you’re called to lead a team following an extreme event, don’t try to do it alone.”
Debrief as soon as possible
Stacey Killick, consultant paediatrician, Glan Clwyd Hospital, says, “Fortunately, traumatic events are not frequent. That being said, they catch us off guard and sadly it never gets any easier. When such events occur, we tend to go into autopilot, driven by adrenaline. It is when the adrenaline dies down that we start to process our thoughts.
“In medicine, we talk about hot and cold debriefs—hot occurring straight after an event and cold later. Many of us have other roles and responsibilities to continue with, so hot debriefs can be missed. It’s important to try to ensure they occur straight after the event and in a safe space so that everyone can process their emotions. We are all human and need to work through our thoughts so that we can process them in the healthiest way possible.
“Moving forward, feel free to reach out and speak to others. Make the time for this. Over our careers, many of us need additional support. Don’t fear seeming weak or feeling judged. Seek help without shame, encourage those around you to do the same, promote an environment that allows for the recognition of self-care, and be the colleague and friend that you always wanted for yourself.”
Accept that things will never be the same
Lucy Easthope, professor in practice at Durham University’s Institute of Hazard, Risk, and Resilience and adviser on disaster recovery, says, “Healthcare services are both an epicentre for traumatic events to occur and the first port of call when tragedies hit. But they can be ill equipped to respond to either. It’s important to recognise how fundamentally destabilising these events can be.
“The first thing to do—after the initial response—is to give these moments the respect and standing they deserve and not try to brush them under the carpet. The world will never be quite the same again for your team. There is a life before the events and a life after. Acknowledgment of that is vital but it’s a difficult message to accept.
“It’s important to access bespoke trauma support early and to take it to staff—don’t expect them to hunt down a phone number. Hold an all-staff event, using an external facilitator, to explain how staff can support themselves, and what it’s normal to feel. There is incredible support out there. I’m also a big fan of the ‘agenda-less’ meeting for an early debrief about what people are feeling.
“Plan for the honeymoon period when staff and communities can feel euphoric and closer than ever. And be prepared for this to last a couple of months at best, before it gives way to fragmentation, disillusion, and anger. This can be a low point for managers because more and more personnel problems will be brought to your door. Think about the timing of usual HR events—such as whether performance reviews can be delayed slightly—and again consider the use of external help to facilitate discussions with staff.
“For events that hit your community, such as flooding, terrorism, fires, or community tension, it’s important to talk to all staff about what happens next. Patients don’t always articulate what has happened to them but you may see an increase in the reporting of somatic symptoms that accompany trauma, such as gastric disorders, insomnia, rashes, and behaviours such as increased drinking and family breakdown.”