Category: HFT Tools

This post was originally featured in ARRS InPractice.

“This pandemic is really getting me down… I’m not sleeping well… Small things worry me constantly… My concentration drifts while interpreting studies… Antacids are taking care of my epigastric symptoms… Alcohol has become a necessary crutch to help me sleep… Everybody seems so needy around me… The media is driving me insane… The sense of loss overwhelms me at times… I cannot bear the thought of more Zoom meetings…”

Resilience. It’s a concept that predates the pandemic and one that we’ve heard about in personal development books, TED Talks, and leadership courses many times before. The word conjures a sense of unshakeable inner strength that’s impermeable to outside forces, like a giant African baobab tree—also known as the continent’s “tree of life”—during a torrential storm. You might define resilience as the capacity to recover and bounce back from adverse circumstances, such as those many of us are currently experiencing, as illustrated by the sampling of comments above.

It often feels like the pandemic swiftly derailed the pre-2020 tools and strategies we had introduced to our organizations to identify and combat employee burnout and support the collective health and wellness of our teams. While stressors have expanded and amplified, the concepts that were leading us on a path to healthier workplaces are still valid and valuable, particularly when it comes to resilience. With intention, practice, patience, and persistence, resilience can be learned, sustained, and strengthened; with resilience, we can emerge from our proverbial emotional basements, even during the most turbulent of weather.

Opening the Cookbook

While it’s not quite as simple as following a step-by-step recipe for your favorite meal, several key ingredients can help you develop resilience. Let’s explore 10 of them here.

1. Take care of yourself, first and foremost: If you’re a leader, remind yourself of the airline analogy to put on your own oxygen mask first. Learn to practice mindfulness to slow down and reduce anxiety. Learn to focus on being intensely aware of your senses and feelings in the moment, without interpretation or judgment. Be mindful, too, that you may be using unhelpful coping solutions. Try to eat healthily, sleep to rejuvenate, and exercise as best as you can, wisely. Doing so should boost your capacity for physical resilience. Consider strategies to boost your mental resilience, as well. How do you reignite your energy and creativity after challenging situations? Are you able to effectively disconnect? Build time into your schedule to recharge. Develop coping skills to help you manage stress, so that it doesn’t compound. One example of a valuable coping mechanism is laughter, which can reduce anxiety and increase our intake of fresh oxygen. Try to find ways to laugh each day, as part of your self-care practice. You can even find laughter yoga exercises on YouTube.
2. When something is not quite right, recognize, acknowledge, and call it what it is: Stress. Anxiety. Overwhelm. Depression. PTSD. Whether it is a formal diagnosis from a care provider or a gut instinct that you have, it’s OK not to be OK. The pandemic is amplifying our national mental health crisis. Recognize and mourn your losses, no matter how big or small you think they are. Communicate openly and honestly about your current state of mind; don’t minimize or ignore your symptoms until they become intolerable. Share your concerns with your primary care provider, a licensed therapist, a trusted family member or friend, or a 24/7 hotline. If you are in a potentially life-threatening situation, call 911, or go to your nearest emergency room. Opening up and asking for help can be terrifying, but you are worth it. No one is alone here. Seek the support and care that you deserve and need.
3. Find your sense of purpose: Develop your personal W-H-Y? Find intentional ways to connect to your larger life purpose and learn to savor them. What are your volunteer efforts? What does your charitable giving list look like? Altruism drives a sense of purpose and is a recognized trait of resilient individuals. Try to integrate your work and life effectively for you. Strive to be a realistic optimist and, rather than focusing on the negative, hone in on what you can contribute to your community, region, state, or country.
4. Get connected: Establish and nurture a supportive social network. Who comprises your safety net? Whose safety net are you in? Help others to support and nourish you by building a social resilience community. Never be afraid to lean on your support systems, even if virtually. How did you build your support group? Do you have an online community? Develop positive and trusting relationships in which you can work together to endure and recover from stressors. By listening and hearing, we can be kind and compassionate to others when they need it most. Do a proverbial mitzvah!
5. Find your resilience role models: On a personal level, I derive such joy and inspiration experiencing the resilience of my immediate family members. As a South African, it will also never cease to amaze me when I consider the remarkable resilience shown by Nelson Mandela. His endurance and persistence in the face of severe adversity were coupled with his ability to show emotional regulation, empathize, build connections, demonstrate self-efficacy, and stick to his guiding moral compass through authenticity. His favorite poem was “Invictus,” written by William Henley, which ends with the powerful line, “I am the master of my fate / I am the captain of my soul.”  
6. Seek to constantly learn and improve: Be coachable and seek feedback that you learn from and act upon. Seek this feedback from those sources most likely to be helpful to you. Recognize that change can be good, however inconvenient or uncomfortable. View so-called “failures” as learning and improvement opportunities and embrace them; activate your action plan, rather than dwelling on what might have been.
7. Know what emotional intelligence looks like: Practice self-awareness by knowing your stress levels and noticing your emotions. Train your brain—build emotional intelligence, moral integrity, and physical endurance. To boost your emotional resilience, work on understanding, appreciating, and regulating your emotions, while consciously choosing your feelings and responses to avoid being reactive. Learn to become self-aware. This includes recognizing what drives your stressors. What pushes your buttons? Finding and sticking to your moral center may aid this journey.   
8. Find ways to relax and decompress that work for you: Some examples include spending time with friends, pursuing hobbies, cooking, meditating, and listening to music. Each of these can be enjoyed in groups or individually, depending on what you prefer. As one example, photography is an art that can be practiced in mindful ways, shared with colleagues, and even used as a communication and connection tool. It might even influence your choice of travel locations and online connections. Surround yourself with positive energy. Misery doesn’t love company—find new ways to manage or even avoid adversities and adversaries. Have an executable plan to eliminate your blockages.
9. Practice gratitude and self-compassion: Hardwire this into your daily activities list; it will help you to feel content. This might simply include journaling things that you are grateful for. You already possess a series of resiliency tools and have likely overcome adverse situations that you learned from. Your journey has already begun, and you have endured 100% of your worst days. Congratulate yourself for this.
10. Reflect: This can go hand-in-hand with journaling. Simply put, sit quietly with the events and feelings of the day and see what comes up. Committing to creating the time for reflection allows one to build and increase self-awareness (an important component of emotional intelligence), encourages learning, and opens doors to being more adaptable. For events that occur, consider what happened, how it made you feel, and what lessons or new approaches you learned from the experience.

Sharing the Recipe

As a leader, your resilience impacts your performance, as well as the performance and engagement of your teams. Stressed leaders engage in fewer positive leadership behaviors, such as enunciating optimistic visions, setting and overseeing goals, communicating confidence, clarifying roles, showing genuine appreciation, and recognizing performance. Stressed leaders can become passive—they step in only when needed, tend to avoid decision-making, and can be emotionally absent. These attributes get noticed and impact teams. Resilient leaders can keep calm under pressure and develop additional skills (a component of posttraumatic growth) in the face of adversity. Through self-reflection and feedback, resilient leaders have a keen sense of the main components of emotional intelligence.

Resilient leaders can also regularly assess their leadership effectiveness and styles, more readily responding to change and unexpected situations. Striving to learn and grow continuously, resilient leaders are often purpose-driven individuals—they can visualize their work effort as being meaningful. Resilient leaders cultivate relevant and helpful relationships in their internal and external work environments that support them through tough times.

Why Is Resilience at Work Important?

Resilience shapes the way employees respond to the stress of change. It also relates to work engagement, job satisfaction, and organizational commitment. Resilience is inversely related to the frequency and manifestations of burnout and can improve organizational and employee performance.

How Do We Recognize Resilient Behaviors in Others?

A spectrum of characteristic behaviors and skills is recognized under the resilience rubric. Many of these are also included under a larger umbrella of effective leadership behaviors. A person who manifests resilient behavior communicates clearly, thoughtfully, and consistently. Moreover, effective leaders may design a strategy for communicating and managing change that accounts for different stakeholders and their communication preferences. Resilient individuals are coachable, regardless of their position in a hierarchy, and many seek opportunities for learning and improvement. They are willing to embrace change, and, ideally, they’re skilled at managing it. Resilient individuals are comfortable saying, “I don’t know” (and “I would like to learn”). They know how and when to take bold risks or when to initiate new ideas. Similar to effective leaders, resilient individuals are willing to and do invest in the development and advancement of others.

Those with high levels of resilience are better equipped to cope with stressful situations. They tend to see change as an opportunity, are optimistic, adaptable, and realistic about realities, and engage colleagues for support. Resilient individuals possess emotional regulation skills and don’t allow stress to impede their functioning. They practice self-compassion to reduce harsh self-criticism, soothe difficult emotions, and find sources of motivation. Resilient individuals show cognitive agility, a difficult skill to develop, which entails shifting how one thinks about negative situations.

Let’s face it: It’s really difficult learning to become resilient. It takes time, persistence, effort, commitment, energy, and a drive to succeed. We do know that resilient teams are best served by resilient leaders. Now more than ever before, we need our imaging teams to function effectively. Our teams should be equipped with resilience to face ever-changing challenges and unanticipated adversities, and whether they are or not begins with us as leaders.

About the Author

This post was originally featured in ARRS InPractice.

Some days, it’s hard to recall what prepandemic life was like. Things have forever changed in light of this historic global event, and it’s vital to reflect and process these last three years. We’ve endured some of the most trying times of our careers, but we also have a bright future as a medical community ahead. You’re wondering what that might look like and how we can collectively “skate to where the puck is going to be, not to where it has been,” as Wayne Gretzky famously said.

COVID-19 precipitated a fundamental change in clinical service delivery, teaching, research, staff retention, employee wellness initiatives, and communications strategies. We amended workplace safety standards and practices, stood up and resourced remote teams, recruited trainees virtually, and transformed in-person grand rounds programs into digital ones. These are just some of the many efforts that we as a specialty undertook to protect our people, uphold our missions, and keep our teams employed. And while not all changes were novel ones, the pandemic catalyzed their implementation. We now have tremendous momentum to continue innovating, especially as we begin to emerge from crisis mode together.

Accelerating Change

Here at Beth Israel Deaconess Medical Center, we simply couldn’t have managed this public health crisis without our highly effective, efficient, and resourceful operational surveillance systems and teams. Some of these teams were in place before the pandemic started; they rapidly responded to the initial phases of COVID-19, then swiftly transitioned into a multidisciplinary incident command structure to assess, rethink, reinvent, iterate, and communicate our health care systems and strategies on a daily, hourly, and minute-by-minute basis. This collaborative structure operated in real time and kept our trains running, on schedule and on the tracks, far more often than not. Light started to appear at the end of the tunnel, and then, the alphabet of variants arrived. It soon became clear that we would never return to prepandemic normalcy. A fundamental shift had taken place in the way we delivered our services, and some of this change represented the necessary digital transformation many had envisioned long before COVID-19 struck.

So, what are our next steps? How can we effectively shift from a reactionary mode to one that is deliberate and purposeful? What structure will best support the necessary regrowth phase that will support our medical practices and organizations? Now is our time to be accelerators rather than incubators, to reinvent and rebrand our skills and clinical contributions, and to be thoughtful and strategic in the process. This is where the most strategic, imaginative, and operationally agile teams will lead the way and define our recovery. Those who embrace change and progress will be the best positioned to thrive. Lead the change. Be the change.

Building COVID Recovery Hubs

Let’s be the disruptive thinkers our field will be proud of. Define, then communicate your future radiology vision. Do this in an inclusive manner that involves all role groups. For such plans to be adopted and successful, leaders will need to continue to create forums for staff to weigh in, ask the right questions of their teams, listen to feedback, barriers, needs, and ideas, and provide other ways to share input, such as through short pulse surveys in a departmental newsletter or real-time polls during meetings. Ensure everyone’s voice is heard and incorporate major common themes into your plans.

We suggest constructing and resourcing a formal COVID recovery hub, which can house your postpandemic mission, vision, and recovery playbook. Appoint and support a multidisciplinary team to lead and own these pioneering transformation efforts. Who have you appointed to lead your radiology recovery, reinvention, and reengineering transformation? What does your “r⁴” portfolio look like? By answering these questions, you will help your practice continue to keep its staff and patients safe, deliver exceptional care, manage ongoing people and supply chain shortages, support staff morale and wellness, nurture remote teams, and effectively communicate and engage with a multigenerational workforce.

Reimagining Administrative Functions

As part of your COVID recovery hub, consider the roles, responsibilities, and constituents of your leadership team. Are you best positioned for your recovery? Now might be a great time to reimagine these elements and challenge the traditional hierarchy, as we work to flatten authority gradients, build diverse, inclusive, and multigenerational teams, and ensure that form follows function. Additionally, these roles have likely transformed out of necessity during the pandemic and might need to evolve to meet your practice’s future needs.  

Let’s be a little provocative: how can we identify the best person to be our “knowing exactly where the puck will be in 2030” portfolio leader? Actually, this is not a task for one person—and this is precisely why building and sustaining high-performing diverse and inclusive teams will become paramount and essential. Proudly establish your recovery hub, appoint a vice chair of recovery and reinvention to lead this effort, then establish and resource new portfolios to signal just how serious you are about recovery, regrowth, and reinvention. For example, have you considered the future of your remote teams? Based on national employee preferences, it’s clear that some level of remote work is here to stay. Perhaps, as part of a practice’s new digital innovation and transformation lab, it could create a remote workplace and team-building portfolio. Will your organization continue producing short video messages, digital newsletters, social media content, and academic webinars? What will your postpandemic communications strategy look like? Perhaps it’s a question for a newly formed digital communications and connections team. While these structures might not be novel in a large, digital-first corporate setting,they would be a progressive leap forward for many of our major academic medical practices.

Additionally, we all know that health care delivery has progressed to incorporate population health, cost reduction improvement efforts, care coordination and integration, and customer experience, among other important factors. Simply put, our aim is to deliver the highest-quality, safest possible care and experience at the most sustainable costs. This boils down to value, and who better to drive it than an effective chief value officer?We’ve certainly been talking about this value proposition for quite some time already. On a different but equally important note, we must think about how we will continue to support the health and wellness of our staff postpandemic, especially during our nation’s mental health crisis. Is there an influential and compassionate leader on your team who could become your chief wellness leader and drive these vital efforts to aid your entire team?

The structure of a leadership team should primarily relate to its intended function and purpose. Once you have reconfirmed your foundational core purpose, reimagined your vision and mission, and defined your annual goals, then form the team (and define their precise roles) that will help you reach your ideal future state. Energize your teams by including them in strategic brainstorming and planning sessions, imagining an exciting and successful future together.Designing a newoperational landscape is not a task for one person, which is why building and sustaining high-performing, diverse, and inclusive teams will be paramount.

The interesting exercise that we are all engaged in now is to define that future state. Has anybody considered a leader of a recovery and reinvention portfolio? Your entire team wants to contribute! Be inclusive and build diverse teams.

Mapping New Pathways

This is an era of posttraumatic regrowth. Reimagining your pathway should be an inclusive, aspirational, and even inspirational process. Be thoughtful and strategic when redefining your path forward toward the new normal you and your team aspire to achieve. Reengage and revitalize your most precious resource, your workforce. Recommit to safe practices, wellness initiatives, and high-performing team building. Reconnect your teams, and work to sustain these connections. Reimagine and rethink your strategic plan and goals, and start your new journey today. Those who will flourish and thrive will do this effectively, thoughtfully, and strategically; consider the long-term goals, map out your route, and take action. As you shift from managing operations to imagining the future, try to shift your focus from keeping the trains running to considering where new rails could be built. Periodically, it’s important to pause and ponder—to consider not only how trains can be better engineered, but also to contemplate whether train travel will be a safe and efficient customer choice in the future. That’s strategic thinking.

Let’s try to simplify. You’re done with reacting, reflecting, and responding. You’re starting to see some light at the end of this tunnel. You’re hoping that omicron is the last symbol of this pandemic alphabet. Now, more than ever before, is the time to look forward, plan your recovery strategy, and focus on building and sustaining innovation. The practices that are most likely to thrive are already thinking outside the traditional administrative oversight box. And they are moving ahead right now.

And, finally, find ways to share your experiences of this journey. We’re all traveling new paths and learning as we go. We must learn from each other’s successes and missteps, and there will be plenty of both. As we build our departmental COVID recovery hubs, we also need to design and build collaborative teams to communicate and interact with institutional, regional, and national COVID recovery hubs, to the extent they exist. These new systems must be capable of redefining and reimagining the future, so that we can all travel along the path of progress together.

It’s now time to be intentionally inclusive, as we commence this new journey.

About the Authors

This post was originally featured in ARRS InPractice.

Feeling stuck, joyless, or “meh?” You, like many others, might be languishing. In fact, it might be the dominant emotion of 2021.

Sociologist Corey Keyes describes mental health as a continuum: ranging from flourishing, that state of wellbeing we all seek to achieve, to languishing, the absence of wellbeing, and a lower state of mental health. Languishing is distinct from depression, yet individuals who are languishing are at a higher risk of future mental illness (such as depression and anxiety disorders), as shown by Keyes et al..

Simply put, languishing is a series of emotions, rather than a mental illness. Adam Grant, writing in the New York Times, refers to languishing as “the neglected middle child of mental health” and “the void between depression and flourishing.” Given the negative impacts on productivity, morale, innovation, team building, retention, and engagement, nonprofit organizations and corporations alike must take this widespread state seriously.

The pandemic has impacted almost every structural framework of our lives, such as socializing, working, vacationing, traveling, and exercising—and, in turn, compromised our sources of joy. With no clear path as to when and how our “future state” will present itself, we continue to exist in an ongoing and indefinite interim state. As uncertainties persist and routines remain in flux, many people are being shuffled into a state of languishing.

You Might Be Languishing if You Are:

• overwhelmed or emotionally numb
• distracted and unfocused
• depleted, empty, and/or disinterested
• unmotivated or procrastinating
• not functioning at your full capacity
• unable to feel excited about upcoming events
• cynical about your colleagues and leaders

How Can We Shift From Languishing to Flourishing?

Below, I share a compilation of suggestions from the experiences of many. If the symptoms of languishing seem familiar to you, perhaps one or more of these strategies might help. If even one person finds solace in these ideas, it would bring me joy.

• Prioritize your health: Do your best to eat healthily, drink plenty of water, sleep well, and incorporate movement into your life. Schedule and keep your annual health appointments. Consider alternative medicine modalities, such as acupuncture and chiropractic medicine. Find moments to sit in silence and simply breathe. Use your personal time and plan vacations, including memorable “staycations.” Disconnect from work and social media during your time off. Set boundaries and learn how to respectfully say “no,” when needed. Take your first small step toward doing something you’ve always wanted to do for your health today.
• Protect your time: Manage your time intentionally and purposefully. Detach, disconnect, and learn how to engage your personal reset button. You might try scheduling uninterrupted time for yourself to recharge your batteries, even if this means “doing nothing.” Limit social media scrolling and email checking. Consider recapturing your prepandemic experiences; for example, create a virtual “commute” that includes a home spin class, podcast episodes, reading, music, or another element that helps you transition from the waking to working hours.
• Make positive connections: Reengage or recreate your personal and professional network. Recall who once might have lifted you up. Walk and chat, gather and eat, find and embrace, and explore commonalities with positive people. When possible, spend less time with those who drain your energy and spirits. Seek a peer support buddy with whom you can share your experiences and feelings. Look for authentic and uplifting connections to replenish yourself emotionally.
• Reflect on the current situation: Acknowledge the loss and anxiety and frustrations and grief. What have you lost? What have others lost? What has everybody lost? Recognize that you’re not alone here.
• And then, practice gratitude: Recognize what you do have, rather than focusing on what you don’t. Appreciate what is working, rather than focusing on what isn’t. Try keeping a daily gratitude journal or using a meditation app, like Calm or Headspace, for guided gratitude practices.
• Find flow and motivation: What’s on your music playlist, and when did you last update the content? Step out of your comfort zone by trying a new recipe, exercise, podcast, app, or online class. Get better at something, whether it’s dance, yoga, art, reading, writing, meditation, music, composting, or gardening. Explore mindful crafting, photography, collecting, and other hobbies. Reconnect with and walk barefoot in nature for additional grounding.
• Celebrate small successes: Rethink what constitutes success, however small. It may be someone else’s success or happiness that you contributed to. When overwhelmed, rethink your goal-setting strategy. Set simpler goals that are achievable, and enjoy the successes that you are contributing to. It’s OK to start small. Perhaps also schedule achievable self-care activities each day.
• Rethink your possessions: What would you like to keep or surround yourself with? These items might include things that bring you joy, inspiration, hope, confidence, or calm. Consider decluttering a room or maybe even your entire living space over a period of time. According to a recent Psychology Today article, decluttering can be very beneficial.
• Change your scenery: Breaking from a stagnant routine is challenging. I encourage all of us to find ways to get out of our emotional basement and head up to our proverbial sunroom. Take a stroll through your memory banks to recall what may have once ignited your passions. Learn the art of introspection—what does your perfect day look like?—and consciously do something new or different to refresh your spirits. Check out your local museum, gallery, or library with a friend. Sign up for an online class or enjoy a virtual comedy show. You never know what you may discover.
• Find joy in giving: When did you last wrap a small gift? Who can you help today? What causes would you like to reengage with? Have you discussed and explored different options with your friends and family? Try to get back to your talents and gifts. Learn to be a peer supporter. Research volunteer opportunities in your community. Contemplate your purpose and remember what truly drives you. Helping others can bring a tremendous sense of inner fulfillment.
• Activate your personal coping strategies: For some, the average workday may seem filled with one stressful encounter after another. Meetings may not go as planned. Your workflow may be interrupted. The dominant sentiment might be that this is just another tough day. Is it possible that you are being too hard on yourself and in your judgments? For example, while you may feel that a meeting, interaction, or event didn’t quite go as planned, perhaps that is from your perspective. Maybe others had a different perspective and felt more positive about the encounter. Activate your personal coping strategies to decompress, relax, boost your energy, stay focused, gain perspective, and reflect on the bigger picture.
• Explore therapy. It’s a strength to recognize when we need professional help. According to a recent Value Penguin survey of more than 1,300 US adults, “nearly 30% of Americans have seen a therapist during the coronavirus pandemic, and 86% say it’s helped them cope.” Psychiatrists, psychologists, social workers, therapists, and other licensed practitioners are trained to help patients construct a personal repertoire of coping strategies. There are many forms of therapy to consider, including psychodynamic, cognitive behavioral, dialectical behavioral, mindfulness-based, and art. One or more of these modalities could help you address and manage stressful life events.

The journey from languishing to flourishing is of indeterminate length, and some of the “travel aids” listed above may be more effective than others. What we need is a means of sharing best practices—what worked well and what didn’t—multigenerational preferences and impacts, as well as other solutions that have been identified along the path. I can only wish each of you who may be experiencing a state of languishing a very safe, healthy, memorable, and rewarding trip back!

About the Author

This post was originally featured in ARRS InPractice.

The COVID-19 pandemic continues to exacerbate the pre-existing epidemic of stress, distress, dis-ease and burnout in our profession—and across the country. Contributors to workplace stress in radiology have been further compounded as we grapple to provide safe care to our patients, keep our teams healthy, uphold social distancing requirements, support, sustain, and engage remote teams, deploy effective communication strategies, and cultivate diverse and high-performing teams. People across the country are fighting silent battles against chronic anxiety, depression, and other mental health disorders during any given workday.

Prior to the pandemic, we heard frequent reference to the hamster wheel environment in which we work; expectations of ever increasing workloads and so-called quality metrics driving us to work faster and longer hours all while meeting ever increasing regulatory requirements. Not surprisingly, the consequences of just trying to keep up include burnout, and the field of radiology is still seeking solutions to mitigate our recognized high incidence.

However, in parallel with burnout is the growing focus on mitigating known stressors, those that establish a genuine conflict between our core values as care-providing physicians and our daily activities in the trenches. This is the reality of the so-called moral distress and injury, which is frequently associated with burnout. To me, this implies that we as individuals are unable to balance work expectations against personal resources—that, somehow, we are failing at what we “should” be doing and achieving. There is a growing school of thought that the symptoms of burnout simply reflect a healthcare delivery system in need of urgent repair. The moral insults and injury of healthcare is not being able to provide the high quality of care that we would want to, thus highlighting the opportunity to address what is contributing to this state. And the consequences are dire: physician suicide rates are now twice that of active-duty military members. Now more than ever, it is clear that we must reprioritize employee wellness efforts and implement additional strategies to protect and support our workforce.

Treating the Cause

To effect lasting change, we must reshift our focus and address the cause rather than the symptoms. While appreciated and beneficial in their own right, wellness programs, flexible schedules, extra time off, and other employee benefits oftentimes treat the short-term symptoms, not the long-term cause.

Relaxation practices, exercise, vacation, mindfulness activities and meditation might be extremely effective at resolving some symptoms on a temporary basis, at least until that time that we are back trying to balance on the hamster wheel. To address the causes, we need brave and effective leaders who are willing to question and confront the constellation of drivers, and who recognize and respect the fourth component of the quadruple aim of healthcare (care of the patient requires care of the provider). We must excavate the problem that is moral injury until its origins become clear.

Numerous factors detract from what we believe is our primary mission and contribute to such injury, including the profit-driven healthcare environment, electronic health records and productivity metrics, provider review sites, litigation concerns, turnaround time targets, and the ever-expanding regulatory mandates. Here I refer to practices mandated by regulatory agencies such as audits, documentation expectations, annual testing, and of course, the unpopular practice of peer review.

Let’s consider peer review as our low hanging fruit here. This is a process that in radiology is often known for being onerous, burdensome, distracting, divisive, resource-intensive, inefficient, and ineffective. In my experience, it can be difficult to use peer review as a driver for meaningful and impactful improvement.

However, the concept persists, in large part due to meeting accreditation and reimbursement requirements. As radiologists, we are expected to devote time to rank the diagnostic skills of our colleagues. During this process, targeting occurs, under-reporting is rampant, and job security might be impacted, yet challenging the status quo is difficult. Despite evidence that radiologists make errors almost 30% of the time, national peer review data reports fewer than 5% of these discrepancies. Is this practice truly an effective use of our time and skills?

Forging a New Path

Peer learning and improvement offers us an enormous opportunity to remove a mandated hurdle to our work-related distresses; it also allows us to embrace an emerging practice that will provide new learning and improvement opportunities. Today, I’d like to give a loud shout-out to the many peer learning trailblazers out there, including: David Larson, Richard Sharpe, Jennifer Broder, Nadja Kadom, Lane Donnelly, Mythreyi Chatfied, Andrew Moriarty, and Richard Heller. And this cohort is growing rapidly.

Now is an ideal time for the field of radiology to commit to taking the necessary steps to embrace peer learning in our practices. This will be a journey that many have commenced, along varied paths, influenced by practice patterns and cultures. In some practices, this will require cultural transformations, so that staff are willing to speak up safely in a Just Culture without fear of consequences. It will require hospital administrators to embrace all components of peer learning as meeting local OPPE requirements. It will require that the focus shift from scoring diagnostic discrepancies to identifying learning and improvement opportunities, and that participation is expected. In fact, willing participation could replace annual denominators altogether. Peer learning leaders could be identified and appropriately trained, and their work acknowledged as a vital part of our performance improvement processes. Most important, the American College of Radiology (ACR) has now approved a new pathway for ACR-accredited facilities to meet the Physician Quality Assurance program requirement, opening a path for practices to embrace this learning and improvement and non-punitive approach, thus no longer needing to use a score-based approach.

I started this column addressing the additive impacts of the pandemic on our preexisting stressors and burnout numbers. I highlighted the growing recognition that the so-called moral injury is an additional and major contributor to our current distress. Transitioning from retrospective peer review to prospective peer learning practices is one superb example of how we can mitigate a known contributor and provide what will, hopefully, be some major relief to our radiologists. This could allow our colleagues to participate in a process that is likely to positively impact our performance and the quality of care that we deliver. Because, ultimately, I believe that’s why we are all here.

About the Author

All members have a voice, that is heard

Getting your voice heard can give you so much, especially in the way of meeting others and exposing yourself to a greater audience of people, where you will have the chance to interact with a greater spectrum of culturally diverse people, much like, or different to yourself.

Wellness initiatives

Leaders of high functioning teams recognize the stresses inherent in our contemporary work environment, as well as their downstream impacts and the many manifestations of burnout. Efforts should be made to mitigate the many and ever-expanding factors contributing to stress and burnout. Recognized solutions include finding meaning in work, learning to be resilient, providing resources to support efficiency in work, and while not always practical, working less.

Additional Resources:

• A Call to Action – Our Radiology Chairs Are Burning Out
• The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at Work
• A Road Map to Foster Wellness and Engagement in Our Workplace
• Radiologist Burnout According to Surveyed Radiology Practice Leaders
• Burnout: Redesign the Work Process Rather Than the Person

Just culture

Just culture is a concept related to systems thinking which emphasizes that mistakes are generally a product of faulty organizational cultures, rather than solely brought about by the person or persons directly involved. In a just culture, after an incident, the question asked is, “What went wrong?

Additional Resources:

• How We Do It: Operationalizing Just Culture in a Radiology Department
• The Just Culture Framework
• Just Culture: Practical Implementation for Radiologist Peer Review

Speak up safely programs

Healthcare practitioners are expected to speak up about patient safety concerns to help intercept errors and avoid adverse patient outcomes. By ‘speaking up,’ we mean raising concerns for the benefit of patient safety and quality of care upon recognizing or becoming aware of a risk or a potential risk.

Additional Resources:

• Speak Up, Listen Up! Toolkit
• Help Prevent Errors in Your Care
• The Many Ways to Speak Up for Patient Safety

Codes of conduct

To assure a collaborative and inclusive culture, radiologists, interventional radiologists, radiation oncologists, and medical physicists should conduct themselves in a professional manner, respecting all individuals, including patients and colleagues, and advocate for those who cannot advocate for themselves.

Additional Resources:

• Professional and Inclusive Environment
• Professionalism and Quality Care

Environment of professionalism

Medical professionalism is a belief system in which group members (“professionals”) declare (“profess”) to each other and the public the shared competency standards and ethical values they promise to uphold in their work and what the public and individual patients can and should expect from medical professionals.

Additional Resources:

• Excellence and Professionalism in Radiology
• Radiologic Professionalism in Modern Health Care
• Professionalism in Radiology: Ideals and Challenges
• Professionalism in Radiology
• The Evolution of Professionalism in Medicine and Radiology
• Designing a Curriculum for Professionalism and Ethics Within Radiology

Dignity and respect

Dignity and respect in the workplace follows the “golden rule” of treating others the way you want to be treated. A workplace where everyone shows each other dignity and respect usually has plenty of laughter, a free-flow of ideas and clear policies on expected work results and behavior.

Additional Resources:

• Setting the Stage: Why Health Care Needs a Culture of Respect
• Office of Equity Diversity and Inclusion (EDI), POLICY ON “RESPECT AND DIGNITY IN THE WORKPLACE”

Collaboration and team science

Team science is a collaborative effort to address a scientific challenge that leverages the strengths and expertise of professionals trained in different fields. Although traditional single-investigator driven approaches are ideal for many scientific endeavors, coordinated teams of investigators with diverse skills and knowledge may be especially helpful for studies of complex social problems with multiple causes.

Additional Resources:

• Collaboration and Team Science: From Theory to Practice

A shared vision

Strategic planning is the process of documenting and establishing a direction—by assessing both where you are and where you’re going. The strategic plan gives you a place to record your mission, vision, and values, as well as your long-term goals and the action plans you’ll use to reach them.

Strategic planning

Strategic planning is an organization’s process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy. It is here that priorities are set. It may also extend to control mechanisms for guiding the implementation of the strategy.

SWOT analysis

SWOT analysis is a strategic planning technique used to help a person or organization identify strengths, weaknesses, opportunities, and threats related to business competition or project planning.

Team functions as a learning organization

Peter Senge stated in an interview that a learning organization is a group of people working together collectively to enhance their capacities to create results they really care about. Peter Senge’s 5 characteristics: systems thinking, personal mastery, mental models/open culture, shared vision and transform from individual to team learning approaches.

Additional Resources:

• Building a Learning Organization
• Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error
• Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit
• Is Yours a Learning Organization?

Scenario planning

Scenario planning is making assumptions on what the future is going to be and how your business environment will change overtime in light of that future. More precisely, Scenario planning is identifying a specific set of uncertainties, different “realities” of what might happen in the future of your business.

Provide effective feedback

Feedback is vitally important in the workplace. It helps individuals grow and projects stay on track, and in doing so, it helps companies progress. Yet many people find giving and receiving feedback in the workplace to be totally nerve-racking. Observe a specific behavior and then explain what you observed. Tell your colleagues what kind of impact that behavior had on you, the team, and/or the organization. Provide a suggestion or an expectation for future behavior (feedforward approach), or alternatively ask how the other person wants to move forward.

Running effective meetings

An effective meeting is one where it’s objectives where accomplished within the stated timeframe. Being prepared is the most effective way to have a successful meeting.

Additional Resources:

• How To Run a Meeting
• How to Run a More Effective Meeting
• Seven Steps to Running the Most Effective Meeting Possible

People first language

People First Language is a way of communicating that reflects knowledge and respect for people with disabilities by choosing words that recognize the person first and foremost as the primary reference and not his or her disability.

Imposter syndrome

Impostor syndrome (also known as impostor phenomenon, impostorism, fraud syndrome or the impostor experience) is a psychological pattern in which an individual doubts their skills, talents or accomplishments and has a persistent internalized fear of being exposed as a “fraud”.

Improving Communication

TeamSTEPPS^® is a teamwork system designed for health care professionals that is: A powerful solution to improving patient safety within your organization. An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.

Ethical behavior, practices and oversight

Examples of ethical behaviors in the workplace includes; obeying the company’s rules, effective communication, taking responsibility, accountability, professionalism, trust and mutual respect for your colleagues at work. These examples of ethical behaviors ensures maximum productivity output at work.

Inter-personal support

Ubuntu can best be described as an African philosophy that places emphasis on ‘being self through others‘. It is a form of humanism which can be expressed in the phrases ‘I am because of who we all are.’

Managing internal conflict

The role of an ombudsperson is to investigate and facilitate resolution of allegations by any staff member of perceived unfair, inappropriate, discriminating or harassing treatment (behavior) by faculty, staff, administrators, or fellow students.