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Introduction

This book is the work of healthcare professionals and allied health professionals who have made the psychological wellbeing of their colleagues a part of their working lives. They are all, in one way or another, involved in the culture change which we know is needed in healthcare in order to keep staff safe and allow them to work in jobs that they love for as long as they want to. There are chapters written by psychologists, paramedics, general practitioners, anaesthetists and others; some are very personal stories of transformation, some are about interventions, some are traditional research and all focus on making spaces for those working in healthcare to be heard and find ways of managing the pressures of the job. Since starting work in a medical school it has become increasingly clear to me that there is a battle for the words to describe the experiences of staff as they deal with the trauma that they witness and also the day to day difficulties of understaffing, and the pressure to perform. There is certainly much more to say, and I see this book as the beginning, rather than the end, of the conversation.

I originally gave this book the title ‘borrowed words’ because I noticed how much words like resilience, burnout, compassion fatigue and so on were being used, all of which were developed in and borrowed from fields other than medicine. It has become increasingly common in medicine to borrow from other fields, probably the most well‐known example is the borrowing of learning about human factors and safety from the field of aviation. Certainly this has been extremely useful in improving patient safety and developments in this area continue, always looking to develop more effective safety cultures in healthcare. (Chapter 13 of this book refers to such culture change.) Other borrowing is perhaps less useful, the wholesale dissemination of terms from other professional areas such as psychotherapy or social work will not apply in medicine and the uncritical adoption of these terms leads only to further resistance. The term resilience is an excellent example here. It originally describes the quality of materials to return to their original shape after being subjected to stressors such as bending or stretching, it was later applied in the field of child and developmental psychology in order to understand how children adapted to, and perhaps flourished despite, adversity. Its adoption in popular psychology has seen it applied in many different areas, perhaps without appropriate rigour. In healthcare it came to be seen as an entirely individual feature, and there was an emphasis on intervening to create more resilient staff. Such an endeavour was bound to fail given that not all members of staff would have started from the same baseline of stress and distress, or with the same individual traits, and that healthcare is not a system based on individuals but on teams. In fact, the research on resilience states that while there are individual traits which might be useful, they hinge largely upon the ability to enlist appropriate support when things are hard. So, while the ability to regulate one's emotions is an aspect of resilience, seeking a friend or colleague to talk to is an excellent way to regulate emotions. Failing to engage in sufficient depth with psychological concepts which might have been useful has meant that some concepts, such as resilience, have become buzzwords for management failure to properly support staff, seeming only to put the burden of coping back in the shoulders of staff rather than providing appropriate support and commitment to structural change.

It is true that what is needed is both structural change, team training and a focus on individual support and wellbeing. The chapters in this book focus on the ways in which staff experiences can be understood, in order to inform intervention; and the ways in which individuals have come together to create grassroots change.