Leadership & Management

Promoting Belonging and Inclusivity: A Business Essential at McMaster’s Psychiatry Department

By Ana Hategan, Tara Riddell,  Karen Saperson (@KarenSaperson), and Nick Kates
Originally Published on August 17, 2020

Do you feel connected to your colleagues? Do you feel surrounded and supported by a collegial community of staff and leaders? Do you feel part of an inclusive environment that values your unique contributions? Take a moment to reflect on these questions. They refer to social connectedness, a sense of belonging, and of being valued and appreciated, which are not only fundamental human needs, but integral to clinicians’ well-being in the workplace.

Data on physician burnout (an occupational problem of epidemic proportions predating the COVID-19 health crisis) indicated that clinician well-being depended on whether physicians feel a sense of belonging at their organization [1]. This is unsurprising both because belonging is a strong psychological desire and there is a clear influence of social connections on our health and well-being [2, 3]. Yet, it is common for clinicians to work in isolation or in a fragmented team, experience mistreatment or exclusion, or be immersed within an environment that disregards one’s efforts or is unsupportive, all of which serve to impair vital social engagement and connection and are associated with burnout [4].

COVID-19 has only served to widen the divide between us. In a time in which we require social connection and support more than ever, this has become increasingly difficult as social distancing is mandated to reduce the risk of further spread, and typical work routines have been upended, with many clinicians transitioning to working virtually or by phone. As such, in the COVID-19 epoch, medical leaders and organizations should not just be concerned about exhaustion, detachment, and inefficiency (the three core elements of burnout) within the healthcare workforce, but also about clinician isolation and loneliness, which is likely endemic during this time.

Leaders also need to pay heed to diversity and inclusion in medicine, as this too can impact an individual’s sense of belonging, and perception of safety and acceptance within their workplace. Diversity encompasses differences in gender and sexual orientation, race, ethnicity, age, and thought processes, to name a few. An inclusive environment values the unique contributions of all its members. Teams with diversity of opinion would bring an extensive range of innovative ideas and creativity to effective decision-making processes and scientific medical discoveries, and drive excellence in patient care, trainee education, and even health care equity [5]. 

Fostering belonging and inclusion in medicine is of paramount importance, and requires not only commitment from leadership, but change at the system and organizational level. While there is still much work to be done, great progress has been made within the McMaster Department of Psychiatry and Behavioural Neurosciences. Below, we highlight some of the efforts and approaches to fostering connectedness, belonging and inclusivity in the hopes it may inspire further efforts elsewhere.

Early during the pandemic, a Wellness Working Group was formed within the Department, open to all staff, resident members, and faculty, with the dual goals of curating and sharing of vital resources, as well as assessing and responding to the Department members’ needs during this time of uncertainty and change. With an emphasis on the inter-professional collaboration, psychologist members in our Department provided expert contributions to local, regional and provincial initiatives supporting colleagues. A clinical psychologist and faculty member became the project lead of a provincial initiative designed to deliver support to healthcare workers. SJHH is one of five hospitals in the province chosen to partner with Ontario Health’s Mental Health and Addictions Centre of Excellence to offer confidential support for healthcare workers impacted by the pandemic-related stress.  

Others organized a virtual psychotherapy learning group for students, clinicians, and faculty, to share psychotherapeutic strategies and approaches, and stay connected, as well as developed a virtual women’s support group for the OMA. Support within the Faculty of Health Sciences was offered to managers and leaders, using a coaching model to guide and promote team morale and support. Members of the Department were involved in developing support programs for employees of SJHH and HHS, including managing support crisis lines.

Within the residency program, fostering connectivity and relatedness has been a longstanding focus even prior to the COVID pandemic. A formal wellness curriculum was designed by two senior residents, where trainees have the opportunity to engage in Balint-informed groups during protected time, and to participate in RESPITE Rounds during unprotected time, which are led by senior resident facilitators. Pre-pandemic, our residents already used to receive a local wellness newsletter, Concordia, provided to both residents and staff which offered personal stories of combating burnout and fostering resilience, exchange of gratitude, and tips for maintaining one’s well-being. Additionally, a number of our psychiatry residents in collaboration with colleagues from the department of family medicine contributed to a recent book entitled, “Humanism and Resilience in Residency Training.”

When the COVID-19 struck, a group of resident leaders rallied together to form a “COVID Resident Wellness Team” aiming to maintain resident morale and cohesion. Their efforts have included use of a Slack channel for residents to stay in touch and share positive notes and educational or wellness resources. This team also ran various virtual activities, including yoga, and peer-led coffee support groups. The team continues to work to ascertain residents’ needs and seek to adapt resident social events and retreats to social-distance friendly formats. For example, with the start of the new academic year, a couple of junior residents arranged for a virtual funhouse and a welcome drive-by parade for incoming residents.  

The Department is also working to promote unconscious bias training for all members this year, which further promotes diversity within the program. Recognizing the critical importance of promoting a culture of inclusivity, and highlighting the need to address systemic racism within the Department, two members championed an Anti-Black Racism Working Group.  Several senior residents joined the initiative, serving as organizers at the resident-level to ensure residents are also included in these discussions.

There have been initiatives and partnerships with local Indigenous communities to ensure equal and unimpeded access to culturally safe mental health and addiction services, especially during the COVID times. Indigenous cultural safety training and opportunities to learn more about the Indigenous experience, available to every member of the Department, further helps to ensure that Indigenous peoples are treated with dignity and respect within the health care system.

Members of the Department, faculty, staff and trainees alike, are routinely celebrated and acknowledged for their leadership, academic and research pursuits, and honorary achievements through the distribution of the bi-weekly Psychiatry Digest newsletters by the chairperson. This activity has enhanced recognition and appreciation among members, and further promoted a sense of pride in the workplace.

Plato is purported to have said, “Good actions give strength to ourselves and inspire good actions in others.” Therefore, it is the hope that our achievements inspire members from other departments and disciplines to learn more, do more, and become more; and for that, you are a leader!

In summary, in the practice of medicine, the antidote to occupational burnout is fostering a sense of community and belonging, connectedness and inclusion, and meaning and engagement [1, 2]. This requires leaders and clinicians to challenge their own thinking about the status quo, to be advocates, and to act with intention, care, and compassion. ​Clinician-centric healthcare organizations with an emphasis on belonging and inclusion are expected to be attuned to clinicians’ specific needs and feelings and to respond promptly to these. Creating and maintaining a sense of belonging and inclusion will motivate and empower physicians, enhance collaboration, and inspire innovation. 

As a final refection, consider the following: “What has my workplace or professional relationships given to me?” (receiving); “What did I return to my workplace or these professional connections?” (giving); “What can I or my organization do to further build an inclusive and supportive community?” (transforming). Engaging in such reflection may help to not only recognize and appreciate the value of our social connections, but promote a deeper exploration of how much one takes versus gives in social relationships within the workplace, and how we can do our part to promote and advocate for cohesive, inclusive and connected enterprises.

References

1. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516-529.

2. Hategan A, Riddell T. Bridging the gap: responding to resident burnout and restoring well-being. Perspect Med Educ. 2020;9(2):117-122.

3. Umberson D, Montez JK. Social relationships and health: a flashpoint for health policy. J Health Soc Behav. 2010; 51 Suppl():S54-66.

4. Southwick SM, Southwick FS. The loss of social connectedness as a major contributor to physician burnout. JAMA Psychiatry. 2020; 10.1001/jamapsychiatry.2019.4800. 

5. Fuentes-Afflick E. Promoting inclusion in academic medicine. JAMA Netw Open. 2018;1(4):e181010.