Research

How Ochsner Health's structured debriefs promote recovery during a crisis

    Overview

    Over the last year physicians have been at the forefront of unrelenting change—and unimaginable challenges. And even with vaccine rollouts well underway, many of the experiences providers have encountered over the last year can have a lasting psychological toll. Data from past experiences with viral diseases, such as SARS, shows that affected health care workers experienced significantly higher levels of burnout, psychological distress, and posttraumatic stress for up to years after the fact. And perceived adequacy of support—through actions like unpacking traumas—has been found to be preventative of these negative posttraumatic effects.

    To learn about how organizations can create a space for physicians to reshape traumatic narratives, we spoke with Ochsner Health's Nigel Girgrah, MD PhD, the Chief Wellness Officer, and John Sawyer, PhD ABPP-CN, Medical Director of Professional Staff Experience, about its structured debrief model—and their advice for how leaders can help their teams unpack the experiences of the last year.

     

    Reshaping traumatic narratives and promoting posttraumatic growth

    During their unit-based rounding in early 2020, Girgrah and Sawyer recognized a need for a space where clinicians could debrief their experiences with their peers.

    Girgrah and Sawyer knew the research: Promoting posttraumatic growth can result in significant positive psychological changes after challenging life experiences. And with a large-scale stressful event such as the pandemic, how individuals remember the event can impact their development of anxiety or trauma.

    As Sawyer put it, "part of PTSD is getting sucked into inaccurate and extreme narratives. For instance, if you tell yourself things like ‘it was all my fault’ or ‘nothing is safe anymore’ or ‘leaders never cared about me’ then personal and organizational growth becomes very difficult.” And by unpacking the experiences, people can have more balanced and accurate thinking in retrospect; they acknowledge the traumatic experience and feel acknowledged by their organizations, consider the organizational realities and multiple perspectives along with their perceptions, and allow themselves to also identify what can be learned now.

    According to Girgrah and Sawyer, that dual focus on unpacking traumas and encouraging posttraumatic growth is critical to ensuring that individuals don't remain "stuck" on inaccurate, extreme, and harmful stories. Rather, they're able to discuss their experience, realize there are others who've shared in their pain, feel fully validated, and reflect on what they can do going forward.

     

    Ochsner's structured debriefing model

    To help physicians engage in this kind of reflection, Girgrah and Sawyer established structured debriefs, safe spaces where physicians can talk about challenging experiences, normalize those feelings, and connect with their peers.

    Sawyer said the sessions—which are typically about an hour long—are generally limited in size. Although he and his team have facilitated conversations for groups as large as 25 people, he said he prefers aiming for six to 10 participants to allow plenty of time for individual sharing and group reflection. To encourage candor, leaders do not participate in the sessions unless they are explicitly invited by their teams.

    Each session also has a trained mental health professional serving as a facilitator. That facilitator opens each session by explaining confidentiality and manages the conversation with a focus on empathetic listening. As participants share difficult experiences, facilitators first a create a space to hold and validate the awful and scary experiences. Often, participants feel a sense of universality or shared experiences between each other. Next, facilitators carefully, but purposefully challenge participants to also consider and potentially reframe experiences with an eye toward growth. Again, this isn’t about overly chipper and pollyannish positivity. Instead, it challenges participants to process both the pain and proactively point to growth to promote healthy healing.

    The sessions are designed to have an element of fluidity, so it doesn't feel like any one person is forced to speak for a specific amount of time or as if the facilitator must quickly pivot the conversation. If possible, Sawyer said he prefers to have these sessions in person, as it allows for a more "felt sense"—however, Covid-19 realities dictated that they conduct some of the sessions via Zoom.

     

    5 considerations for implementing structured debriefing sessions

    If interested in establishing debriefing sessions at your own organizations, Girgrah and Sawyer caution against rushing recovery; even as vaccination rates continue to rise, it's important to help your team process the experiences they've had over the last year. The sessions, if done poorly, can do more harm than good, they said.

    Below, we've highlighted five foundational components for establishing successful debriefs at your organization:

    • Make sessions opt-out: An essential component of Ochsner's sessions is that they are opt-out rather than opt-in. This approach can help overcome the "I'm fine" culture and normalize that everyone participating has experienced similar challenges.
    • Adapt scheduling to each team’s need. Girgrah and Sawyer explained that they don't have a standard approach to scheduling. Some units prefer to have sessions on off days, some prefer after hours, etc. Connect with leaders to determine what times work best for each team so it's more likely that everyone can attend—and consider offering other enticements, such as lunch or dinner.
    • Be intentional about who is in the room. It can be challenging to be vulnerable—especially in front of coworkers. To create a safe space, limit the list to peers (unless they specifically request that a leader be present), recruit a trained facilitator, and reiterate confidentiality among participants at the beginning and end of the conversation.
    • Orient—and reorient—the conversation around growth. A critical component of the debriefs is reframing a traumatic narrative in terms of growth. Otherwise, the conversation can run the risk of amplifying trauma, which can leave participants feeling resentful, powerless, or burned out.
    • Err on the side of overcommunication. Ochsner's leadership frame debriefs as "preventative medicine," Sawyer said, as a way to recognize the importance of talking about these experiences and acknowledge that people rarely do. To promote a broader conversation around wellbeing, leaders are encouraged to express their own vulnerability so as to create a culture where "it's ok not to be ok."

    Recognizing that resources are limited, you may need to prioritize rolling out debriefs with the groups that are at highest risk. If so, consider consulting with clinical leaders to gain a better understanding of groups with the most immediate need. And since trauma can have a long tail, even if an event took place earlier in the year, it's important to create the space for teams to unpack their experiences.

     

    The impact of structured debriefings

    In the early days of March and April 2020, physicians were more reticent to engage in structured debriefs, but today more than 1000 individuals have been involved systemwide. After attending, many have said they were glad they went—and some even said the sessions have completely transformed how they engage with their work. Plans are to continue offering debriefings this year as teams continue to ask for them on a weekly basis.

    Providing care during Covid is an unprecedented challenge in many ways. As Girgrah and Sawyer noted, reactions to trauma are to be expected—and they're human. What's key is to make a space for those reactions that not only acknowledges and unpacks that trauma, but also gives providers the tools to transform that experience into growth.

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