“I Shall Be Released.” Restorative Justice Techniques Can Address Healthcare Burnout & Attrition

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.

“You will be alright” – A Doctor’s Reflection on the Power of Hope

By Mahboobeh Mahdavinia

Alanna and Anthony are not yet ten years old, but they have been to the emergency room more times than most adults. Every few months since they were babies, their parents have raced them to the hospital for asthma attacks, superinfections of their severe eczema, or food allergy reactions. They each have been intubated twice in their precious few years of life.

But for the last year, Alanna and Anthony have not had to come to the ER in crisis. Instead, their parents have brought them to see me in my allergy clinic for scheduled medication shots and follow-up visits. I consider Alanna and Anthony a success story, or at least the start of one. But most hospitals would not – and neither would insurance companies.

The truth is, Alanna and Anthony have missed multiple appointments, and consequently missed almost half of their shots. Other patients I see have similar spotty records. Administrators who oversee my clinic have pointed out the large cost of no-show appointments. When inconsistent patients do come, their appointments often go overtime, creating conflicts with nursing and staff schedules. Some other hospitals and  clinic administrators would almost surely have come up with plans for dismissing Alanna and Anthony from the practice. However, we have all come to the agreement that we should do whatever it takes for them to stay as long as they choose. Read More »

“The Homeless Situation” – Reflections of a Neighbor and Doctor

by Suzanne Minor, MD, FAAP

The subject of the email read “MDC Commissioners Meeting to Address the Homeless,” the body asking me to attend the Commissioners Meeting to describe my challenges in dealing with the “homeless situation in our area” in order to force the Homeless Trust to allocate dollars to target the Miami homeless populations.  Common scenes in the nearby downtown Miami waterfront public park included all manner of dogs and owners frolicking in their respective packs, designer-clad joggers and boot campers, tourists snapping photos, parents hovering near toddlers, and men and women rolling out blankets or spreading out cardboard for the night.  This email started me to seriously reflect on the homeless living in the park.

I’ve lived in this area for 10 years now.  There are more homeless now than when we moved in, displaced to the local park by museum construction.  At first, it was awkward as the pristine park felt overrun with this new population.  For a time, I even avoided the park in the evenings, not wanting to be reminded of the poor after working to provide healthcare for them in the face of great obstacles in my professional life throughout the day.  Looking at the homeless in the park was painful, bringing up feelings of helplessness, hopelessness, failure – providing health care for the poor of Miami was so difficult.  For any patients in the county safety net system, subspecialty appointments might take 6-12 months patients and if homeless, those patients might not get the appointment notification at the shelter address they gave until after the appointment was actually scheduled.  Just to see me as a walk-in patient required them to spend hours in the waiting room to be fit in to the day’s census.  Work was like constantly climbing a steep hill without the necessary gear or support.  And seeing those patients at night reminded me of this defeat and wore at my reserves.Read More »

The Poetry of Dianne Silvestri, MD

Dianne Silvestri, MD, a retired academic physician, is author of the chapbook Necessary Sentiments. Her poems have appeared in Barrow Street, Naugatuck River Review, Poetry South, The Worcester Review, The Healing Muse, New Limestone Review, Zingara Poetry Review, The Main Street Rag, American Journal of Nursing, JAMA Oncology, and elsewhere. She is Copy-Editor of the journal Dermatitis and is founder and leader of Natick’s Morse Poetry Group in Massachusetts.

Hearts, Exposed – A Medical Student’s Reflection on Witnessing Their First Patient Death

By Erik Carlson

“Hospital’s on lockdown.”

The security guard didn’t even throw us a backward glance as he shouted the news over his shoulder before continuing on his brisk jog around the floor. I turned to the chaplain I was shadowing that Friday afternoon. A Dominican sister from the Dominican Republic, she called herself a “Double Dominican.”

“Why is the hospital on lockdown?” I asked, trepidation coloring my voice gray.

“That’s hospital procedure whenever they bring in a gunshot victim. Would you like to go? They’ll need a chaplain, so I’ll be going.”

During our first year, my medical school requires students to shadow a chaplain in the university hospital. These chaplains, who come from a variety of faith traditions and backgrounds, address the emotional and spiritual needs of patients, often liaising between the medical team and the patients’ families. Before entering the hospital that afternoon, I was determined to put aside any preformed notions about healthcare and spirituality and to approach the experience with as open a mind as possible.Read More »

Working on my MD and PhD degrees as a DACA recipient

By Cesar E. Montelongo Hernandez

Last week a federal appeals court upheld the ruling that blocks the Trump administration from ending DACA. This means the nationwide injunction that allows DACA to remain will stay in place. Despite this, the legal battle will continue and likely head to The Supreme Court of the United States. DACA recipients have been granted a few months of respite but their long-term outlook is still very uncertain.

I am currently in my fourth year of medical school. In total the combined MD-PhD program takes eight years to complete (an MD degree alone takes four years). Students begin by completing two years of the MD, switching over to the PhD for about four years, then coming back to complete the last two years of the MD. At present I have completed two years of the MD degree and I am in the second year of the PhD degree. Ideally, I will complete the PhD degree by 2021 and the MD degree by 2023.Read More »

A Response to Alumni Disappointed in Stritch’s Support for DACA

By Sunny Nakae

In May the Stritch alumni magazine published a cover feature article about our first cohort of DACA recipients admitted to the Loyola University Chicago Stritch School of Medicine and their impending graduation.  We received both positive and negative correspondence about this feature.  What follows is a compilation of complaints I received from some alumni and a summary of the responses I offered.

“As an alum I am disappointed in your policy to admit DACA recipients over US citizens.  Because you are admitting non-US citizens that means a US citizen will not get a seat. Supporting undocumented students violates Federal Law.  Did these DACA recipients get ‘affirmative action’ status?  Candidates should get admitted because of their credentials, not because they are minorities or immigrants.  What constitutes the right minority?  It seems like Japanese, Korean and Chinese are no longer considered minorities but smaller Asian groups like Hmong are? In my graduating class there are many of us who will no longer be supporting the school.”

Dear Stritch Alum,

Thank you, sincerely, for expressing your current views on our decision to accept MD applications from DACA recipients.  This happened in 2012 with the support of our then dean, Dr. Linda Brubaker, and our then president, Fr. Michael Garanzini, S.J  The inclusion of DACA recipients continues to receive full support from our current dean, Dr. Steven Goldstein, and our president, Dr. JoAnn Rooney.  It seems from your email that you might not have all of the facts for the situation, so I would like to open a dialogue and provide those facts for you and any colleagues with whom you wish to share this information.  I understand that at first glance this decision may appear to disenfranchise other applicants, specifically those of Asian descent or US citizens. Read More »