Articles publiés dans La Revue vétérinaire canadienne

Moving from compassion fatigue to compassion resilience Part 6: Building organizational resilience

Having previously covered the significance of compassion (1), understanding compassion fatigue (2), the sources of compassion fatigue (3), the signs and consequences of compassion fatigue (4), and the ways to build personal resilience (5), this article focuses on the approaches, strategies, and practices that can build organizational resilience, thereby reducing the risk of compassion fatigue. Although building resilience on a personal level is unquestionably vital — even a professional ethical imperative — the research is clear that interventions at the organizational level have greater impacts on promoting health and wellbeing than those at the individual level (6). As Maslach (7) aptly asserted, “We need to pay greater attention to the social and organizational environment in which individuals work, and to be more creative about solutions at those levels, rather than just at the individual one.” Thus, the imperative to build organizational resilience is equally clear. Although the risk of compassion fatigue can never be eliminated, with the implementation of a variety of organizational measures, great gains can be made. These measures lead to healthy organizations with healthy people who can meet their mandate, achieve their goals, and remain resilient. From reducing workplace stress to promoting social support, and beyond, each measure will be discussed in turn.

Reduce workplace stress

Chronic, unresolvable workplace stress can lead to burnout, and in due course, compassion fatigue. Thus, it is very important to critically evaluate the sources of stress and identify ways to reduce them. There are a number of approaches to reduce workplace stress, starting with a review of workloads, working hours, and work processes (8–11), paying specific attention to schedules, staffing, administrative support, and on-call and overtime policies as well as flextime and vacation. Since excess demands reduce well-being, the key is to ensure that the demands are realistic, reasonable, and manageable.

Stress can be further reduced by ensuring that the resources to “do the job well” are readily available (9). These resources range from maintenance to medical supplies, and include up-to-date equipment and technologies. Variety in routines, novel experiences, and continuing education, all of which are rejuvenating, counter stress. Learning opportunities are especially important when the lack of job-related skills may be generating stress (9,11,12). Mentorship, which is gaining traction in practice, can also reduce stress. New graduates, those transitioning from one subspeciality to another, and those expanding their skillsets can benefit from learning within a safe, supportive social environment. Mentorship, coaching, and guidance promotes engagement and job satisfaction.

A participative — as opposed to hierarchical — management style reduces stress. It enables workers to have a voice in their workplace, increases their control over their work, and widens their decision latitude (i.e., professional autonomy), all of which boost morale and job satisfaction (8–10,12). Supportive and considerate supervision can further reduce stress, along with clear job expectations, equitable policies and practices, and a sense of job security (8–10).

Assessing communication practices and offering tips, techniques, and training, to better manage the challenges that inevitably arise, is a “not to be missed” opportunity to reduce stress (10). Much of the stress in practice can be directly linked to less-than-optimal communication practices and the subsequent outcomes — compromised patient care, damaged client relations, and conflict in the workplace. Upholding skilled, professional, and collegial communication practices prevents stress and reduces the risk of compassion fatigue.

Minimize euthanasia stress

With the endless complexities — the patient, the people, the circumstances, the rationales, the ethics, and the emotions — euthanasia is a considerable source of stress. As a key risk factor for compassion fatigue, finding ways to reduce this stress can be of substantial benefit. There are several ways to minimize the stress of euthanasia.

One way to minimize it is to create criteria (i.e., standards) and identify in advance the conditions under which euthanasia would be recommended — and refused (13). This provides clear, communally agreed upon boundaries upon which to navigate the oftentimes complex morally challenging circumstances that would otherwise prove to be subjectively distressful. Another way is to divide the euthanasia workload, dividing, therefore, the stress, distress, and grief that can accompany it — the emotional workload (13). This load can then be further divided by taking the time to debrief, as needed, with trusted colleagues or others who “understand.” Informal sharing can reduce the burden and calm the mind. Having a safe place or “sanctuary” within the workplace, to decompress, can also be helpful, particularly after intensely emotional experiences (9). In sum, the value of a social environment that sets standards, recognizes the emotional load, encourages open dialogue, and offers safe spaces cannot be overstated.

The option to opt out of euthanasia, in particular the euthanasia of a patient with whom an especially strong bond has formed, should be made available. Having a trusted colleague step in, and returning the favor in turn, enables each worker to avoid becoming overwhelmed and optimally meet the challenges (14). Lastly, providing resources for relatively minor medical or behavioral issues (13), offering incremental care, and identifying options for families of limited income are vital to avoid unnecessary euthanasia and the distinct kind of stress, distress, and grief that goes with it.

Provide interventions for stress

Interventions for stress can be both upstream and downstream. Upstream interventions help the person become less prone to stress and more capable of managing stress, whereas downstream interventions help the person to recover from stress. Both have a role in facilitating compassion resilience.

Upstream interventions focus on i) psychoeducation, which, in this context, refers to learning about compassion fatigue, and ii) providing opportunities for people to improve their personal resources and coping strategies. The latter can be achieved through initiatives that enhance self-awareness, reflection, relational skills, and relaxation techniques, but could be expanded to include any of the following: a sense of purpose, a proactive attitude, enabling self-beliefs, optimism, motivation, social and emotional competence, goal setting, problem-solving, resourcefulness, and help-seeking. Although research on the effectiveness of these interventions in the animal care community is limited, preliminary evidence suggests that they are beneficial, with reports of reduced stress, anxiety, and burnout (15). To date, psychoeducation is the predominant intervention for compassion fatigue. Surprisingly, simply learning about compassion fatigue can enhance health and well-being. Research has shown that it reduces stress, reduces the symptoms of compassion fatigue, and increases compassion satisfaction (16–18).

Downstream interventions focus on providing support. There are increasing opportunities for organizations to offer employee assistance programs (EAPs) (14,19). These programs assist workers (and their families) with personal and/or work-related problems that can impact their health, well-being, or job performance. Employee assistance programs offer confidential assessments, short-term counselling, referrals, and follow-up services. They also offer (upstream) resources to promote health and well-being (e.g., fitness, nutrition, and sleep hygiene), good parenting, financial stability, and more.

Provincial, state, and national professional associations and industry partners have an important role in offering resources on compassion fatigue and how to cope with the demands of compassionate work. Many organizations have stepped forward to provide continuing education opportunities and online resources, increasingly aware of the challenges and effects of occupational stress (19). So too have the veterinary and veterinary technician and technology colleges, offering a variety of educational opportunities to support health and well-being, and in this, the sustainability of the professionals who graduate and the profession as a whole.

Promote social support

Social support is recognized as crucial to minimizing workplace stress (20). Research has demonstrated that workplaces can reduce the risk of secondary traumatic stress and burnout, and in this, compassion fatigue, by building strong, supportive social networks (21,22). When workers feel socially connected, heard, and cared about, they tend to have fewer stress-related symptoms. This speaks to the importance of building cohesive teams and the imperative to set this as a high priority. Social cohesion reduces the effects of stress, reducing the risk of both burnout and compassion fatigue (23). Interventions that promote teamwork, including relational coordination, culture building, and social events, can enhance resilience.

Peer support, debriefing, and regular check-ins can also enhance resilience. They provide windows of opportunity for coworkers to safely discuss the impact of their work on them, both personally and professionally (11). The chance to share difficult experiences permits workers to let go of them, and in this, release the lingering effects. It also reduces the sense of isolation that so often accompanies these experiences and enables camaraderie. Alongside this, it offers the opportunity to generate and exchange ideas on how to manage the difficulties as well as the associated stress and risk of compassion fatigue, all in a safe environment (14).

Encouraging in-person and online support groups (also known as mutual aid or self-help groups) may also enhance resilience, engendering many of the benefits just noted. These groups often focus on stress, mental health, and wellness. Online support groups are becoming increasingly popular, practical, and economical.

Promote the initiatives that build personal resilience

There is one more measure that organizations can take to build organizational resilience, and that is to promote, within the workplace, the initiatives that build personal resilience. As previously noted, (5) the opportunities to build personal resilience can be promoted within community. Within community, people can support one other to achieve their goals and set shared goals, enhancing the potential for resilience.

Given the benefits, organizations can promote selfcare, sharing resources and encouraging their workers to develop personalized selfcare plans and achieve their selfcare goals (24,25). They can offer mindfulness training (e.g., information sessions or workshops) to foster the principles and practices of mindfulness in the workplace (24). With time and leadership, certain practices (e.g., taking a mindful moment prior to meetings or at times of stress) can become a cultural norm. Self-compassion and compassion training can likewise be offered, fostering a qualitatively kinder, more benevolent workplace culture as well as compassion resilience.

Lastly, organizations can develop initiatives to express appreciation for their people and celebrate the successes, which can go far in growing compassion satisfaction. There are many opportunities for organizations to support, within community, their peoples’ efforts to build personal resilience.

Where do we go from here?

There are so many ways to build organizational resilience that you may not know where to begin. That’s all right because it’s not for any one person to know. Building this kind resilience requires an inclusive approach. It requires bringing people together, asking what matters to them, and creating a shared vision for the future.

As Maslach said, we need to be more creative about the solutions (7). Creativity requires being willing to look at things in a different way, break out of established patterns, and try something new. Each of us can start with just one change, and often one change will inspire another which will inspire another within a natural unfolding. With each change tied to the other, the overall change is more sustainable. The key is to start somewhere. As Plato said, “The beginning is the most important part of the work.”

We can only benefit from acknowledging the reality of compassion fatigue and promoting measures that will reduce the risk. The “cost of caring” is a cost, and one that has farreaching implications, affecting all that we are and all that we do. Although compassion fatigue cannot be prevented, it can be mitigated — and that is through building compassion resilience.

Where do we go from here? Let’s join forces and make the move from compassion fatigue to compassion resilience… and see where we find ourselves.

It will be a better place.

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