Adopting a personalised approach to resilience building in pharmacy

The wellbeing of the healthcare workforce is a concern for employers, politicians, professionals and — perhaps most of all — for the patients that rely upon practitioners^​1​. The quality, safety, cost-effectiveness and efficiency of healthcare systems are directly related to the strength of the workforce — a depleted, dispirited and demoralised workforce suffering from occupational stress and burnout cannot function to the best of its ability^​2​.

Within community pharmacy, there is growing recognition that a focus on resilience is needed^​3​. Resilience is the ability to adapt well to adversity or stress, as well as ‘bounce back’ from difficult or unexpected experiences. It is usually described in terms of adaptability, self-regulation, flexibility and having a positive approach to change^​4​.

According to research published in 2021, which explored resilience in community pharmacy practice and its findings were outlined in this series of articles, two types of resilience were described: individual responses and workplace adaptations^​5​. Traditionally, we have thought of resilience as either a personality trait or a skill that can be learned and developed. It was seen as a function — and responsibility — of the individual. Rather than merely enduring a difficult situation, individuals were expected to demonstrate grit and tenacity, as well as learn to thrive in challenging times. Inability or reluctance to take this kind of stance is viewed by some as a personal deficit. When another person is somehow able to adapt and thrive, an individual’s inability to do so may be viewed and labelled as failure.

We are now realising that personal resilience is only part of the story, while workplace resilience is perhaps even more important. This series of articles has explored several important aspects of workplace resilience: the positive impact of scheduling practices that favour shorter shifts or team-based schedules^​6​, or workflow that supports a uni-tasking rather than multi-tasking orientation^​7​.

Building workplace resilience requires conscious and intentional management decisions that recognise the financial and business benefits associated with a strong and healthy workforce. Investing time, thought and resources into building a resilient workforce that supports mental health and wellbeing pays dividends in terms of quality, safety, customer loyalty and corporate reputation.

Some community pharmacists may view this framing as somewhat idealistic — to the point of unrealistic. Most front-line pharmacists would accept that “you are better off being an unresilient individual working in a resilient workplace, than being a resilient person with the bad fortune of working in an unresilient practice”^​5​. However, our day-to-day experience is that many — perhaps most — workplaces are, in fact, unresilient. 

Tip 1: When improvements in workplace resilience are slow, focus on personal resilience

Managerial change is possible, but it may be slow and incremental. In the meantime, how can pharmacists do their best to flourish under the circumstances? The answer is to focus on personal resilience.

Techniques including mindfulness, exercise, yoga, journaling, socialising and intentional gratitude have been proposed to build personal resilience and maintain mental health and wellbeing^​8​. There is an implicit assumption that individuals have the wherewithal and energy to enact these techniques, if enacted properly, psychological strength will improve. However well-intentioned, such ideas can come perilously close to ‘blaming the victim’ of burnout, and suggest that failure to properly perform these types of activities are the root cause of the burnout or explain lack of improvement. 

Tip 2: Identify which resilience practices work for you before you need them

When organisations propose or facilitate wellness activities, there is a natural tendency to prescribe one-size-fits-all interventions and presume everyone benefits equally from them. For example, a training provider might be brought in to do a breathing or meditation workshop, or access may be provided to an online mindfulness app. However, the results of a study of pharmacy students coping with the reality of living and learning under social-isolation constraints during the COVID-19 pandemic illustrated an important point: personal resilience is highly individualised^​8​. While jogging may work for some people, mindfulness may be more effective for others. This research also found that students — particularly those experiencing burnout — found it difficult to understand their own needs and what might work best for them. The takeaway from this is that the time to determine what technique works best for us individually is when we are already psychologically strong and well — not when we actually need to use these techniques to rescue ourselves in the middle of a crisis.

Tip 3: Identify your emotional intelligence type to better understand your coping strategies

There are many ways to reflect on what methods of self-support might be useful. One option explored in the study mentioned^​8​ was self-assessment of one’s emotional intelligence during a time of mental equilibrium and psychological strength. In that time of strength, using tools such as the Myers–Briggs framework, Strengths Finder or the Health Professionals Inventory of Learning Styles (HPILS) can help individuals determine their own unique emotional intelligence. In addition, individuals can identity strategies for managing burnout that are more likely to be helpful^​9​.

HPILS categorises individuals into four emotional intelligence types: divergers, assimilators, convergers and accommodators. One study identified that divergers are more vulnerable to social isolation, tend to ‘eat their feelings’ (engage in emotional eating) and are at higher risk for emotional paralysis. Divergers should be aware of this tendency and work to change this behaviour. Divergers are less likely to respond positively to isolated physical activity — for example, jogging or swimming as a technique to enhance their wellness. Instead, intentional socialisation and conversation with others was found to be more helpful^​10​. Divergers are highly affiliative and typically will draw psychological energy from positive, non-confrontational social interactions at work^​10​. Divergers also often experience distress in workplaces that are characterised by political intrigue, in-fighting, gossip or factions/cliques. When feeling overwhelmed by work, divergers frequently withdraw from social interactions. Stopping the downward spiral of coping by engaging in emotional eating can be difficult but ought to be a priority. In such times, divergers may find it helpful to erect firewalls between themselves and a toxic workplace or difficult colleagues. Finding other outlets for their interpersonal energy — for example, joining non-professional social activities or clubs, or attending professional continuing education events with others — can be helpful^​10​. 

By contrast, assimilators (the category most pharmacy students and pharmacists fell into), are more likely to experience burnout in terms of feeling psychologically overwhelmed with an associated loss of self-confidence^​10​. For them, effective resilience techniques typically focus on planning and subdivision of complex tasks into bite-sized, smaller activities that can be undertaken in a sequence. Bringing order to chaos — by for example, cleaning the house or organising a desk — has a relatively quick and immediate psychological benefit. These same activities had minimal to no positive psychological benefit for divergers^​10​.

Pharmacy technicians most frequently identify as accommodators^​10​. Accommodators tend towards action rather than reflection and prefer to be busy doing things rather than waiting for clarification. They also value pragmatic accomplishments and are generally not burdened by the need for perfectionism. Across health professions, other technical or technologically oriented fields — including respiratory therapists and perfusionists — also seem to attract large numbers of accommodators. Accommodators may experience occupational stress and burnout as a form of decisional or action paralysis, unable to accomplish anything or find the energy to be busy or stay in motion. When feeling overwhelmed, accommodators may feel incapable of literally moving, which can start a downward spiral towards burnout^​10​. In these times, accommodators might find it helpful to do any kind of physical activity that reminds them of their tendency to act rather than ruminate. Accommodators may also find physically intense work – such as gardening, home maintenance/DIY or athletic pursuits, including jogging – which has no connection to their job, jump-starts their energy and positivity. They typically don’t benefit from reflective activities, such as meditation, mindfulness or journalling.

Psychologists and social workers are often over-represented in the diverger category. Divergers are highly affiliative and typically will draw psychological energy from positive, non-confrontational social interactions at work. Divergers also often experience distress in workplaces that are characterised by political intrigue, in-fighting, gossip or factions/cliques. When feeling overwhelmed by work, divergers frequently withdraw from social interactions and may be particularly vulnerable to ‘eating their feelings’. Divergers should be aware of this tendency and work to change this behaviour. Stopping the downward spiral of coping by eating can be difficult but ought to be a priority. In such times, divergers may find it helpful to erect firewalls between themselves and a toxic workplace or difficult colleagues. Finding other outlets for their interpersonal energy — for example, joining non-professional social activities or clubs, or attending professional continuing education events with others — can be helpful. 

Conclusion

The research cited here^​8​ highlighted the critical importance of knowing oneself in terms of identifying wellness and resilience strategies that had a higher likelihood of success and ignoring well-intentioned advice to do things that might work better for other people. Importantly, the best time to invest in developing this self-awareness is during a period of psychological strength and stability. Inoculating oneself for a future episode of burnout is not an obvious or pleasant thing to do, but is an essential safeguard for what may be an inevitable future occurrence.

We all deserve and hope for workplaces that will evolve into resilient organisations, which prioritise and value the mental health and wellbeing of the health workforce. This is essential, and work to support this is ongoing by researchers, regulators, unions, professional associations and employers. As our understanding of workplace resilience has grown, incremental improvements have occurred and continue to evolve. In the meantime, we must accept the reality that there will continue to be circumstances and needs where we will need to find ways of coping in the midst of a crisis. The time to plan on how best to do that — taking into account our own unique needs, personalities, traits and experiences — is before we actually need to do so.