Part Five: This isn’t About Perfection

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By Françoise Mathieu, M.Ed., CCC.

Mount Sinai: A Success Story and a Work in Progress

Nestled between several much larger health care facilities, Mount Sinai hospital is a 450-bed acute care teaching institution located in the heart of Toronto’s downtown. Like many Jewish hospitals in North America, Sinai was originally created nearly one hundred years ago in response to anti-Semitic discrimination and a lack of services for Jews and other vulnerable groups. Since its inception, Mount Sinai has aimed to stay true to its heritage of offering care to those who need it most, and filling a void for those who have nowhere else to turn. This philosophy has also influenced their approach to staff well-being. Sinai has high rates of employee engagement, and a leadership structure that believes in a culture of employee health at all levels, from the cleaning staff to the CEO. The hospital has developed a series of programs and initiatives such as a stress resiliency course called the “Stress Vaccine”, an online module that is now available to health-care workers worldwide. The hospital has a poet in residence, an active wellness committee, and many initiatives aiming to turn Sinai into a magnet hospital for new staff. They also have a commitment to reviewing the efficacy of their programs regularly, based on employee feedback.

Social worker Christine Bradshaw, a Mount Sinai staff member, speaks glowingly about the initiatives implemented by senior leadership. In the emergency room, the hospital has a social worker who covers nights and weekends, allowing Bradshaw to work Monday to Friday and to leave at 4pm each day: “Knowing that someone is coming to take over when I leave for the day is huge in reducing my stress.”

To make this work, there is no one magic pill, explains Melissa Barton, the hospital’s director of occupational health and wellness. Barton explains that in order to succeed in implementing effective CF and VT reduction initiatives, flexibility is key: “We stick with the program when it’s working, but sometimes you have smatterings of programs and they lose relevance, or stickiness. So we spend a lot of time thinking about our strategy to bring in new initiatives. Basically, we have an overarching strategy: what do we want to do? What holds them all together? Everything that we are offering to staff is about improving our reflective capacity on the emotional wellbeing side of things.” Last winter, Barton was instrumental in having a compassion fatigue workshop delivered to over 400 Sinai employees, with pre and post measures to assess the effectiveness of the training (which, in the interest of full disclosure, I must tell you I delivered). A firm believer in capacity-building, Sinai also secured funding to hire me to bring an intensive Compassion Fatigue Train the Trainer course to the hospital. 20 specially selected members of staff were trained as CF educators and are now equipped to deliver this workshop across the entire institution.

What makes a real difference, social worker Christine Bradshaw says, is that senior management at this hospital walks the talk on employee health and wellness:  “At Sinai, leaders don’t just talk about workplace stress – we have permission to vent or have a bad day or feel impacted by the work, because STS and CF are acknowledged, they are discussed from the very first day of staff orientation. It feels like we are allowed to say that some stories will affect us, so we aren’t afraid to speak up when we need a debrief, or a break.”

For Melissa Barton, the roots of Sinai’s success is embedded in the institutions priorities: “our agency is really committed to building leaders at all levels, to foster leadership at all levels, to provide a world class patient experience. In order to do that, we need to have caregivers who are healthy, who are able to reflect – not just react. We want staff who respond to patients in a thoughtful way.”

Asked to provide words of advice to other institutions, Barton says that “anyone trying to have a healthy workplace initiative in a hospital needs to be able to link it strategically. If you don’t, then you will be alone in trying to hold a torch on your own, and that is not sustainable.” Bradshaw concludes: “this isn’t about a perfect hospital, but it’s about a hospital that doesn’t just pay lip service to CF and VT, they value they staff, and their patients.”

In her excellent 1999 book on work life balance, Take time for your life, Cheryl Richardson said that we should not “confuse difficult choices with no choices.” As individual practitioners, we may be called on to do some painful self-assessments about the choices we make, about the cost of staying in an unhealthy workplace. Difficult choices are still filled with possibility, if we dare.

Trauma Stewardship author Laura Van dernoot Lipsky concluded our interview by throwing down a challenge to all of us:  “The leaders that I trust are those who have had deep personal process and can make changes on a very large scale. Archbishop Desmond Tutu spent a lot of time praying and meditating, as did the Dalai Lama. They have some big practices.” Each of us, Lipsky argues, has a responsibility to do the same if we are to remain healthy while working in this profoundly challenging field, and also to ensure that we are not causing harm to those who turn to us for help and support.

Compassion Fatigue’s eminence grise Dr. Charles Figley has long argued that it is an ethical duty for us to ensure that we are grounded and healthy so that, in turn, we can be present and able to provide the best possible care to our clients. Knowing what we know now, we could also argue that it is an ethical responsibility for organizations to provide a healthy working environment for its staff.

Vicarious Trauma specialists Pearlman and Saakvitne sounded the alarm bells twenty years ago when they expressed concern about agencies putting dollars ahead of clients: “When an organization serving trauma survivors focuses solely on revenue, to the exclusion of quality of care for its clients and quality of life for its employees, it supports vicarious traumatization.”

“Patient-centered care” has become a common buzzword over the past decade. But we need to ask ourselves whether we can truly offer patient-centered care without ensuring that our staff has all the tools available to do their work in a way that is sustainable for them, for clients and for the institution as a whole. If we are serious about addressing the problem of CF and VT among helping professionals, we need to get leaders on board, and we need to combat staff’s resistance and skepticism. But the final piece of the puzzle is equally important: we need to take ownership of our own personal contribution to the climate we work in and the culture we are creating.


Françoise Mathieu is a mental health professional and a compassion fatigue specialist. She is the author of The Compassion Fatigue Workbook (2012) and co-author with Leslie McLean of a book chapter entitled: Managing Compassion Fatigue, Moral Distress and Burnout in a context of patient-centered care in Walton, M., Barnsteiner, J., & Disch, J. (eds) Patient/Family Centered Care – Patient and Care Provider Considerations, Sigma Theta Tau International, 2014. She is also the author of several magazine articles.

Françoise is chair of the annual CARE4YOU Conference on Compassion Fatigue

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