by Jay Behel
Burnout, provider dissatisfaction, and attrition remain at near-epidemic proportions among healthcare providers. A 2017 survey found that 39% of physicians reported significant burnout, and nearly a third of physicians were contemplating leaving practice in a 2012 survey. Nurses seemed to be faring better in a survey released earlier this year with only 15% reporting burnout. However, 41% reported feeling disengaged from their work.
The myriad wellness programs launched to address these problems have disproportionately focused on private, individual aspects of wellbeing like diet, fatigue, and exercise offering similarly individual solutions like yoga and meditation.
Missing from the strategy to help healthcare providers is a coherent plan to address the systemic, communal factors underpinning the crisis, namely the disengagement and isolation fostered by our mechanized and monetized healthcare environment.
While they’re often reserved for use in criminal justice settings, community-building and conflict resolution practices rooted in the philosophy of restorative justice offer a remedy for the alienation of the contemporary healthcare provider and, perhaps, our entire healthcare system.
I began looking for ways to introduce RJ practices at Rush Medical College in Chicago after attending a training in California. While the whole experience had a powerful impact on how I think about my work as a healthcare leader, I was most struck by the flexibility of the circle practices—their ability to make space for the silly and the serious, for simple connection and complex problem-solving. I was also impressed by the speed and apparent ease with which participants, myself included, made themselves vulnerable and voiced hard truths.
Following this experience, I brought training to our campus, and our student leaders subsequently held a series of restorative justice circles to address tensions over a curricular transition. Participating students expressed their needs and, ultimately, reaffirmed their commitment to respect and care for one another. After the circles, the number of students reporting peer conflict and incivility dropped. Moreover, several students noted that the experience of sitting in circle completely changed their sense of the learning environment and their place in it. One student noted: “I feel that I have gained social capital knowing that there is a community of peers I can reach out to whenever I need support.“
Rooted in indigenous traditions, restorative justice (RJ) is a theory that emphasizes building community and repairing harm through cooperative processes that include all stakeholders. RJ practices convene groups of people to engage in meaningful dialogue about substantive issues that impact community and individual functioning. These processes can help a group identify and gain mutual understanding of both the personal and collective sources of disconnection, create the conditions that incentivize growth, and build or rebuild trust.
One essential RJ practice is the community-building circle. A circle is usually convened around a desire to both build connections and address tensions and conflicts disrupting the group’s ability to fully function as a community. Guided by a trained circle-keeper and structured around the use of a talking piece, community-building circles provide safe, inclusive space for the revelation of issues both large and small, personal and universal.
More fundamentally for the healthcare space, RJ, particularly circle practices foster the personal connection and humanistic values that brought most people to the field in the first place. Healthcare institutions in New Zealand and Australia are leading the way in employing restorative practices.
Integrating these practices certainly requires an up-front commitment of time and money, and RJ-driven culture change takes time and inevitably involves some moments of painful self-examination at both the personal and institutional levels.
Nevertheless, the pay-off over time, in reduced attrition, increased provider satisfaction, and better patient care, would greatly outstrip the initial investment. And, in an industry that has become so focused on efficiency and metrics, RJ may be key to building capacity.
While these practices alone cannot repair our fractured healthcare landscape, they do offer a roadmap by which providers can navigate the terrain with their souls intact.
Jay Behel, PhD, is Associate Dean of Student Affairs and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Rush Medical College in Chicago. He is a Public Voices Fellow with the OpEd Project.