Remaining Resilient in Health Care

Tips from THA’s popular resiliency series help health care managers and frontline workers become more resilient against the common contributors of burnout.


We’ve all heard it: the perfunctory instructions given by flight attendants before a plane’s departure. Amid demonstrations of the aircraft’s safety features and what to do if there is a loss in cabin pressure, there is an order that stands out.

Secure your own mask before assisting others.

It’s a phrase reiterated so often it’s become a cliché for the importance of self-care. And, just like preflight instructions, it often goes ignored. Even if we understand the internal logic that care givers must care for themselves first, health care workers consistently experience burnout.

Since the pandemic, health care workers report alarming levels of burnout, which is broadly defined as a state of emotional exhaustion caused by chronic workplace stress. In a recent survey released by THA, which collected responses from 178 hospitals in Texas, 61% of respondents who left hospital employment cited burnout as one of their top reasons for leaving.

The burnout trend isn’t unique to Texas. According to a 2022 Morbidity and Mortality Weekly Report published by the CDC, nearly 53% of health care workers in the United States reported symptoms of at least one mental health condition, such as anxiety, depression and post-traumatic stress disorder, within the past two weeks.

From janitorial staff to nurses and executives, burnout is an existential crisis that everyone in the industry is at risk of experiencing. Like the real estate and banking industries after the Great Recession of 2008, the health care industry will be marked by the adversity of the COVID-19 pandemic for many years.

To help equip health care workers with tools to address this ongoing crisis, THA hosted a workplace resiliency webinar series in collaboration with the Texas Organization of Rural and Community Hospitals, made possible with funding from the U.S. Department of Health and Human Services Administration for Strategic Preparedness and Response (ASPR).

Facilitated by Cindi Baldi, Ph.D., founder of CEO of management science firm Culsure and Geoffrey Tumlin, Ph.D., president of On-Demand Leadership, the six-week series was offered to clinical and non-clinical managers within Texas hospitals and health systems.

All session descriptions, handouts, exercises, speaker information and recommended reading can be found here.

Understanding Resiliency

Resilience is broadly defined as a collection of qualities that enable a person to adapt and thrive in the face of adversity and stress. Like any characteristic, it can be developed with practice.

Resiliency is not a stable trait; it ebbs and flows depending on the individual and their circumstances. If someone isn’t regularly practicing self-care and “filling the reserves” during good times, it will limit their ability to meet adverse circumstances with resiliency. Additionally, everyone has a breaking point if too much adversity compounds without reprieve. Resiliency is a useful skill for everyone, but it’s especially useful for health care workers because they witness others’ adversity on a daily basis.

What to do before, during and after adversity

To prepare for adversity, follow the “3As” to better respond to the situation with resiliency:

  • Acknowledge and affirm the reality of the situation.
  • Adjust and reframe the situation from being a threat to being a challenge or an opportunity to grow.
  • Act

In the moment of adversity, practice scientifically proven techniques to de-escalate the internal stress response via ACT (Acceptance and Commitment Therapy):

  1. Stay in the moment and be mindful of the thoughts and choices you’re making.
  2. Don’t judge the thoughts you’re having. Embrace them rather than trying to avoid, deny or alter them.
  3. Return to your center by considering your personal values rather than quickly taking action. These values will allow you to take concrete next steps.

To reduce the likelihood of trauma after facing adversity, do the following:

  • Reflect on what you’ve learned from the situation and move forward with those lessons. Don’t ruminate on the experience beyond that.
  • Try to pull some significance from the experience.


Combatting Exhaustion and Leaning on Social Support Systems

You’re not you when you’re exhausted. Symptoms of fatigue, exhaustion and burnout manifest emotionally and physically and impair our ability to meet adversity with resilience. Identifying the early signs of burnout is crucial, particularly in health care because the best and brightest minds have the ability to save lives but might quit their work prematurely due to overexerting themselves.

Understand the difference between common terms:

  • Fatigue can be remedied with a few days of rest away from work.
  • Exhaustion requires more time away from work and is typically accompanied by lethargy once work resumes.
  • Burnout is characterized by a trifecta of professional depersonalization, cynicism and inefficacy. Its accompanying fatigue is not improved by prolonged periods of rest away from work.

To proactively prevent fatigue, exhaustion or burnout, try the following:

  • Invest in your work environment by creating a workspace that reflects the mood you want.
  • Plan a rest period every month for the next six months. This could be a three-day weekend or a vacation.
  • Regularly remind yourself of the purpose behind your work and why you’ve chosen to pursue the career you have.
  • Understand there is no substitute for regular, high-quality sleep. If your sleep schedule is disrupted, you will feel the effects of fatigue, exhaustion or burnout more acutely.

The importance of investing in relationships, particularly outside of work, cannot be overstated. If we have regularly scheduled meetings with colleagues, we should also have planned time with friends, family and acquaintances outside of work who can later help us through adversity. Even weak connections, people you know but not very well, serve a purpose in your social support system as they can provide an unbiased, objective perspective that is more difficult to get from close connections.


Resiliency at Home and at Work

Trouble at home easily transfers to the workplace and vice versa. When you interact with a colleague at work, you aren’t just interacting with them as a professional, you’re interacting with someone who is likely dealing with unseen circumstances at home. Because families are units, when one person within the unit is impacted by adversity, it usually impacts all members. Therefore, a significant component of equipping staff with resiliency training is to teach them how to be resilient at home.

Families are also a resource for one another, so when one member is resilient, they can model that behavior for other members of the family.

The five practices of resilient families:

  1. They are connected to each other and to a larger support system.
  2. They proactively care for one another.
  3. They have confidence that they can get through adversity.
  4. They are committed to each other and believe that the family unit matters.
  5. They take control and move through adversity together.

Four ways to improve resilient family responses:

  1. View your family as a system, not as individual parts.
  2. Put the adversity that your family faces in context.
  3. See adversity as potential for growth.
  4. Remember that families respond to adversity differently. Look at them with a positive framework rather than a negative framework.

While equipping individuals with resiliency tools at the individual level is important, hospitals and health care systems must model resiliency first.

Creating resiliency in the workplace is fairly similar to creating resiliency in the home. It begins with seeing your workplace as a system with a common thread that unites all individual contributors. Just like the family unit is a resource for its members, organizations should be a resource for its staff members.

The success of an organization is not just a reflection of the pooled talent, expertise and ability of its individual members. How the organization facilitates cooperation and communication amongst the individuals determines if the organization will be greater than the sum of its parts.

What resilient organizations do differently:

  1. They have routines;
  2. The value rest, self-care and the well-being of staff;
  3. They embrace the reality of circumstances; and
  4. They facilitate relationships and supportive communities.

Organizational agility is characterized by:

  1. Rehearsals: the organization emphasizes preparation, pre and post-mortems and contingencies;
  2. Reserves: the organization plans for cross-training and diversity of skillsets amongst its workforce;
  3. Reflection: the organization facilitates collaborative learning and innovation; and
  4. Responsiveness: the organization demonstrates agility in decision-making.