Compassion Resilience Toolkit for Health and Human Services Leaders and Staff

In this toolkit we will explore ways to maintain a compassionate presence in our interactions with clients, their families and our colleagues. The rationale for this work, as described in the introduction, highlights the importance of compassion and resilience within the health care field and points to the many positive outcomes for clients, providers, and organizations as a whole. Our first focus in the toolkit is to ask: What is compassion, what does it look like in action, and what does compassion require of us?

Simply put, Compassion is concern for the wellbeing of others. It includes both the awareness of others’ distress coupled with a desire to alleviate it. At the same time that we desire to alleviate another’s distress, we also are confronted with the reality that we cannot always “fix” another person’s pain or suffering. Throughout this toolkit we will explore our professional role in alleviating client, colleague and other’s distress while maintaining our own well-being. In other words, we will focus on growing our compassion resilience.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Steps for Compassionate Action – Scenarios for Discussion

Compassionate Action Steps – Use this Visual and Display in Staff Break Areas

Moving Towards Stigma-Free Healthcare Discussion Guide for Stigma-Free Healthcare

Tips for Moving from Empathy to Discerning Best Action

Introduction to Staff Circles Agenda
This is a great place to start if your team is not use to receiving training in a circle format. Even if your team is use to circles, there are components of this agenda that would be helpful to include in your first Compassion Resilience circle, such as setting group agreements.  

Staff Circle Agenda

Additional Resources for Leadership

Conversations about Compassion – The Compassionate Instinct
This conversation guide outlines five different conversations related to compassion and gives the resources needed to facilitate these in small groups. Topic two on pages 12-14 of the guide focuses on compassion as a human instinct. Share pages 12-13 with the leadership team and/or other small groups within your organization and facilitate a conversation using the questions on page 13 or make up ones of your own related to the compassionate instinct in the health care setting.

Within this section of the toolkit:

Brene Brown Empathy video

Fetzer Organization Compassion Conversations Guide

In the first section we underscored that compassionate action requires intent and skill. This section of the toolkit provides further definitions that are foundational to all else found throughout the toolkit. We will be introduced to the wellness model we will use in the toolkit and the concept of compassion fatigue. Activities will help us explore our beliefs about self-care and self-compassion.

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Staff & Leadership Combined Activities

Fatigue and Resilience in the Wellness Compass – Reflection

What Were Your Childhood Messages About Self-Care?

Establishing New Self-Care Habits

Self-Compassion Self-Scoring Scale (Dr. Neff)

Self-Compassion – Use this Visual and Display in Staff Break Areas

Staff Circle Agenda

Additional Resources for Leadership

Conversations about Compassion
This conversation guide outlines five different conversations related to compassion and gives the resources needed to facilitate these in small groups. In section one you were asked to facilitate a discussion with the leadership team about the instinct humans have to be compassionate. For this section, facilitate a conversation with the leadership team and/or other small group or team within your organization on the third topic, self-compassion (beginning on page 15).  As a substitute, you can use the Kristin Neff article for the basis of your group discussion.

Within this section of the toolkit:

Self-compassion article, Dr. Kristin Neff

Conversations about Compassion – a facilitator guide

Additional Resources

Dr. Dennis Charney, MD, developed a 10-step “Resilience Prescription” that provides us with a way to think about our capacity to overcome challenges and retrain our brain to become more resilient: The Resilience Prescription

For the animal lovers among us, this blog provides a wonderful overview of compassion resilience in the context of those who work in animal rescue: Resources for people and animals affected by Hurricane Florence  

In this section of the toolkit we will delve more deeply into the concept of compassion fatigue; how it connects to our understanding of trauma, the stages that one might experience if compassion fatigue is not addressed, and how to assess our levels of secondary trauma, burnout and compassion satisfaction. As we grow in our understanding of the extent and impact of trauma on the clients we serve, their families and our communities, our ability to maintain an open and compassionate approach can be challenged. Compassion fatigue can develop slowly overtime and go unrecognized. This section gives us insights that can guide us to take proactive measures to prevent its progression.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Self-Assessment Tool
The ProQOL is a 30 question, self-administered, self-scored, free assessment. This is included in the document to distribute for this section. Facilitators should make time for participants to complete the assessment during their time together or ask them to complete ahead of time

It can be used on a regular basis as a self-check-in, offered in conjunction with supervisory or mentoring consultations, or as a basis for small group discussion. Please note that it is available on the ProQOL site in many languages.

Facilitators should be prepared to offer resources to staff whose ProQOL outcomes point to significant levels of burnout or secondary traumatic stress. Health care organizations typically have employee support protocols and resources, such as Employee Assistance Programs. Be sure you know those and remind staff that they exist and how to access them.

Stages of Compassion Fatigue – Use this Visual and Display in Staff Break Areas

Staff Circle Agenda

Additional Resources for Leadership

Conversations about Compassion

Research links organizational culture to staff experience of compassion fatigue¹. One strong predictor of compassion fatigue is lack of clarity about the vision and mission of the organization. Leadership’s ability to align staff toward an overarching goal is an important key to staff job and compassion satisfaction.

Creating a trauma-informed culture of support for staff enhances their ability to provide such a culture for the people they serve. The STSI-OA is an assessment of the organization’s culture related to preventing and minimizing secondary trauma. The score is calculated online for your organization. Discuss results with your leadership team and consider one action to improve your organization’s support for staff related to secondary trauma.

1. Condrey, Katherine M. The Relationship between Compassion Fatigue and Organizational Culture. Diss. George Fox University, 2015.

Within this section of the toolkit:

Center for Health Care Strategies

“Drowning in Empathy: The Cost of Vicarious Trauma”

Second Victim Syndrome Blog Post

Organizational Assessment 

Individual Assessment

Cultivating Compassion – Commonalities Practice

As we have discovered in the previous sections of this toolkit, the goal of compassion resilience can be reached with the application of personal skills and perspectives combined with organizational policies and practices. In this section we will focus on the systemic factors that can negatively impact our compassion resilience and explore our response and potential role in making positive change.

We all work in imperfect systems. When we look outside of our own system to those that we rely on to provide for the health and well-being of the people we serve, we find more imperfection. The first step in lessening the negative impact of the systems in which we live and work is naming what it is about the systems that contributes to our compassion fatigue. The second step is to discover which items on that list we can change, which ones leadership can and will address, and which ones we would best be served by letting go.

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This document is for Toolkit Facilitators and Leadership Team Only
The following is a review of system factors that lead to compassion fatigue and those that are protective. Keep these factors in mind as you facilitate the combined staff and leadership activity below, What Can I Control?, and if you are on the leadership team, use this information to prepare and respond to the activity.

Staff & Leadership Combined Activity

System Drivers – Use this Visual and Display in Staff Areas

What Can I Control?

What Can I Control (Demo Video)

Staff Circle Agenda

Additional Resources

The National Academy of Medicine’s all-encompassing conceptual model of factors affecting clinician well-being and resilience is a good resource for those wanting a deeper dive into the external and internal factors that can contribute to both compassion fatigue and resilience: A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience

Family and friends are important support systems as well. This article speaks to using that support to help protect against burnout in the health care field: Ask Your Family for Help with Burnout 

Many of us give the very best of who we are every day, yet all too often struggle to feel like our best is good enough. Understanding, and at times challenging our own expectations and perception of others’ expectations is key to identifying and transforming unrealistic expectations that compromise our ability to approach others with compassion and extend that compassion to ourselves. In this section, we identify the expectations we have for ourselves and for others and question whether these expectations are helpful for us or holding us back.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Clarifying Expectations (20-45 minutes)
The purpose of this activity is to examine whether our individual expectations are aligned with collective understanding.

Setting Helpful Expectations (20-30 minutes)
Many times, our expectations do not align with our own wants, needs, and values, but rather, represent things that are socially expected of us or things we are conditioned to believe. This exercise helps us set intentional expectations that are rooted in our values.

Expectations Discussion Prompts – Use this Visual and Display in Staff Break Areas

Handout with Tips for Clarifying an Expectation Concern
Assists staff in clarifying the what, why and how of an expectation across different levels of positional power.

Staff Circle Agenda

Additional Resources for Leadership

The recommended activities provide ways to make workplace expectations more transparent and encourage healthy expectations among staff. Provide staff with access to Caregivers’ Bills of Rights, which provides affirmations that help combat negative self-talk and expectations; bonus point for creating your own version with staff. Here are two examples from workplace and family perspectives:

Example 1

Example 2

Read the following article entitled “How to communicate employee expectations effectively” and after doing so, answer the following questions:
— What efforts can you undertake to encourage regular and ongoing conversations with staff regarding expectations?
— How can you more clearly communicate expectations to staff?
— How can you affirm what you, others, or your team are doing well to meet expectations?
— How might you encourage mentoring relationships and collaborative relationships among staff at your school?

Additional Resources

To find out more about the negative consequences of “shoulding” on ourselves (and how to avoid doing so), check out this resource from the author of “The Positively Present Guide to Life.”

To think about some strategies for how to approach managing the expectations of clients, and the importance of communication, consider reading this article.

“Without boundaries, you will act, sleep, work, groan, feel used and fulfill basic responsibilities rather than make choices to live and love fully, to work hard and nobly, to fulfill your purpose and to contribute passionately to your world.” (Black, J. and Enns, G, Better Boundaries: Owning and Treasuring Your Life. Oakland, CA. Raincoat Books)

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Helpful Adult Behaviors (20-40 min)
This activity is a highly valuable activity to do with teams or agency wide at a staff meeting. It will also prepare you for the Staff Culture section of the Toolkit.

Compassionate Boundaries Reflection (15 min)

Types of Boundaries – Use this Visual and Display in Staff Break Areas

Staff Circle Agenda

Additional Resources for Leadership

Leadership Support for Boundary Setting – Guided Discussion (15-30 min)
The leadership team will address key questions after participating in the Helpful Adult Behaviors activity with the whole staff or a small group of staff members.

Within this Section

Self-Help Alliance, Building Better Boundaries, 2010

Brené Brown video on boundaries and empathy

Additional Resources

In provider-client interactions it can sometimes be easy to cross boundaries and blur the lines between a professional and personal relationship. The University of Wisconsin-Oshkosh and Wisconsin Department of Health Services’ Professional Boundaries for Caregivers provides examples of boundary crossings and offers tips for staying in bounds in specific situations.

One way to maintain professional boundaries is to have a clear line between your professional and personal life, and setting those work/life boundaries is important to building and maintaining compassion resilience and job satisfaction. One strategy is to establish a boundary “ritual” or routine. To explore see more.

“The only thing we have is one another. The only competitive advantage we have is the culture and values of the company. Anyone can open up a coffee store. We have no technology, we have no patent. All we have is the relationship around the values of the company and what we bring to the customer every day. And we all have to own it.”  Howard Schultz, CEO, Starbucks

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Create a Positive Staff Culture Contract (15-30 minutes in small group and 15-30 min in large group)

Support Begins With Empathy! (10-15 min)

What Do You Want to Say About the Culture of Staff? – Use this Visual and Display in Staff Break Areas

Example of Staff Culture Agreements

Staff Circle Agenda

Additional Resources for Leadership

How to Avoid the Contagion Effect of Sharing Tough Stories between Colleagues
Read the information about low impact debriefing strategies and decide how to share with staff.

Additional Resources

For those in leadership positions, an insightful article that talks about the importance of and elements to a positive staff culture and what you can do as a leader to foster those elements: Proof That Positive Work Cultures Are More Productive

See how DaVita HealthCare Partners created a community culture that dramatically enhanced the wellbeing of the organization, its staff and their clients: It Takes a Village

If you want a deeper dive, the American Medical Association developed an in-depth module on creating positive team culture in your practice, including 10 steps for building a stronger, healthier team culture: Create Healthy Team Culture

“Our fatigue is often caused not by work, but by worry, frustration, and resentment.” – Dale Carnegie 

“The calm and balanced mind is the strong and great mind; the hurried and agitated mind is the weak one.” – Wallace D. Wattles

The four sectors of the compass model -Mind, Spirit, Strength and Heart- not only contribute to our overall wellness, but also provide guidance on strategies to help build our compassion resilience. Before delving in further, you may want to take a self-assessment of your current wellness practices (attached). Hold onto this and notice any that you marked as “this never occurred to me” as you encounter the next four sections of the toolkit.

Mind is the first sector we will explore. Being resilient in this area is exemplified by being well-organized, engaging in meaningful work, and being fully present in the moment. As we learned in Section 1, mindfulness is a contemplative practice of being intentionally aware in the present moment. We have practiced strategies to enhance our mindfulness in various sections of the toolkit. Mindful self-awareness is a key skill for the Mind Section area as well as those that follow: Spirit, Strength, and Heart.  

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Mindsets – Use this Visual and Display in Staff Break Areas

Appreciative Inquiry Reflection on Competence (15 mins-45 mins)

Power of the Positive Word (15 minutes-30 minutes)

Practicing Mindfulness – The Body Scan and Pause (3-10 minutes)

Wellness Compass Practices Assessment

Staff Circle Agenda

Additional Resources for Leadership

Name and Celebrate Staff Competence

Showing appreciation to your staff and fellow co-workers is a part of a healthy, productive, and encouraging work culture. Here are some options to encourage appreciation and focus on the specific competencies of staff or staff teams that combine to produce your school’s positive outcomes.

1. Create a process where staff can nominate each other for staff appreciation
2. Create and maintain an ongoing list of assets of your team or workplace — Something everyone can add to and see in the teachers’ common gathering space
3. Develop a gratitude board, or employ other strategies to foster a workplace attitude of gratitude, such as the ideas provided here

Additional Resources

Link to resources, videos, and tools to learn more about and develop a growth mindset.

A popular and reliable time management approach, “Five Simple Steps That Apply Order to Chaos”

A toolkit from AMA on using appreciative inquiry to foster positive culture, including how to incorporate it into daily work to maintain positivity in your organization.

Spirit is one of the four sectors of the compass model for self-care. Each area contributes to and helps build our compassion resilience. Spirit encompasses connecting to our sense of purpose with intentionality, exposing ourselves to resilience in those we serve, and recreating ourselves through rest and play.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Book study (30-60min)

Sharing Stories of Resilience (5-10 min)
Institute the regular practice of sharing stories about current and past clients’ resilience.

Developing Your Professional Mission Statement (15-30 min)

Rest and Play Reflection – Use this Visual and Display in Staff Break Areas

Staff Circle Agenda

Additional Resources for Leadership

Mission and Vision Statements — Making Them Meaningful (30-40 min)

Within this Section

“Creating a Meaningful Vision Statement”

“5 Ways to Put Meaning Behind Your Hospital’s Mission, Vision and Values”

“Developing a Vision and a Mission”

Rogers InHealth Video Library, Stories of Recovery

“An Oath for New Physicians”

Additional Resources

5 Elements of a Powerful Company Mission Statement

In the compass model the four sectors, Mind, Spirit, Strength and Heart, not only contribute to your overall wellness, but also provide guidance on strategies to help build your compassion resilience. Strength is one of the sectors. Strength encompasses stress resilience and care for the body. Stress resilience allows us to maintain a non-anxious presence as we encounter the inevitable stressors of our job. Developing our ability to care for our bodies and listen to the signs that our bodies give us supports our whole health and minimizes any unhealthy responses to stress. Becoming stress resilient and caring for our bodies often require assistance from others. Help seeking is a key skill for both of the areas in the strength section of the Wellness Compass.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities 

Listening and Responding to Your Body’s Stress Alarm (10-15 min)

Writing and Sharing Staff Resilience Stories (30-60 min)
Ask staff to write a short story about an obstacle they faced and overcame. Have them submit the stories anonymously and share them randomly with other staff. The next day, lead a community-building circle to talk about what staff heard in the stories and what it meant to them.

Identifying Nourishing vs. Depleting Activities (15-30min)

Choose Nourishing vs. Depleting! – Use this Visual and Display in Staff Break Areas

Care for Body – Develop Your Plan (10-15 min)

Staff Circle Agenda

Additional Resources

This article discusses the stages of change applied to emotional resilience. The website offers many brief articles on topics included in this toolkit.

In the compass model the four sectors, Mind, Spirit, Strength and Heart, not only contribute to your overall wellness, but also provide guidance on strategies to help build your compassion resilience. Heart is one of the sectors. This section will take a deeper look at our emotions and our relationships—both with ourselves and with others. We will be invited to focus on our self-compassion as we seek to be compassionate in our relationships with clients, their families and our colleagues.

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Developing an Emotional Regulation Plan

Colleague Conversations – Use this Visual and Display in Staff Break Areas

A Self-Compassion Exercise (10min)

Self-Compassion Self-Scoring Scale (Dr. Neff)

Practicing Compassion with Those Who Mistreat Us

Staff Circle Agenda

Additional Resources for Leadership

Fostering Relationship Building among Staff

Additional Resources

Article discusses, from the perspective of nurses, workplace relationships, specifically trust and how it contributes to feeling accepted and valued by colleagues.

This article offers a brief introduction and tips for developing better communication skills through structured dialog and communicating your trust distinctions.  

Reflection questions to assess emotional health

“Engagement is often viewed as synonymous with involvement. Involvement in services is important, but real engagement goes beyond that. Families can be involved and compliant without being engaged. Engagement is motivating and empowering families to recognize their own needs, strengths and resources and to take an active role in changing things for the better. Engagement is what keeps families working in the sometimes slow process of positive change” –Sue Steib (2004).

Distribute this document to all participants to explore prior to the following application activities

Staff & Leadership Combined Activities

Compassionate Connections with Families or Caregivers 

Responding to Challenging Interactions with Families – handout and possible role-play activity

Communicating Difficult News to Clients and Their Families

Stages of Change Applied to Family Conversations

Adopting a Strengths-Based Approach

Additional Resources

Family members often become caregivers outside of the health care setting, and offering support is essential. The Schwartz Center offers various links to resources to help family caregivers.

The article “Few hospitals dedicate space for family caregivers, but that could change” discusses supporting family caregivers through dedicated spaces and other resources, and the importance of family caregiver well-being on client well-being.

The core concepts of Patient- and Family-Centered Care are used widely in efforts to better engage families in the delivery of care. To learn more about incorporating such an approach into your work in order to better engage with families consider visiting the Institute for Patient- and Family-Centered Care website.

An Introduction for Leaders

Provider Perspective Shift

Crisis Response for Significant Disclosures and Reactions

Whether we are growing our compassion resilience to prevent compassion fatigue or to address existing compassion fatigue, this intentional shift often includes changing attitudes and behaviors that no longer serve us well. The Stages of Change offers a model for people to understand the complex path towards successful change and how to support our own change efforts as well as the change efforts of colleagues and those we supervise. This model identifies effective action and responses at each stage to avoid the unintended negative consequences of mismatched efforts.

James Prochaska, John Norcross and Carlo DiClemente are the researchers and architects of the Stages of Change model. It is also known as the Transtheoretical Model. The model assesses an individual’s readiness to act on a new, healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance.

The Stages of Change Powerpoint provides an overview of the Stages of Change model. View the slides in the mode that allows you to read the notes for each slide or as pdf.

Leadership Activity

What’s the Stage? What’s My Response? This brief activity lists statements to practice identifying the stage they represent. It will build leaders’ ability to identify what stage someone is at so they can choose effective supports for that person’s desired behavior change. Pages two and three provide a chart that takes the statements from the What Stage activity and suggests helpful responses to support that person in their current stage of change.

Staff Activity

Navigating Your Way Through the Stages of Change handout that describes each stage and gives self-help hints for those looking at their own change behaviors and hints for how to help others as they navigate change.

Individual Reflection Worksheet The individual names a target change and goal behavior, identifies the stage of their current change, and completes questions based on their stage of change.

Support for Providers in Early Years of Career

References

Before facilitating Health and Human Services Compassion Resilience groups, please reference these tips for facilitating small groups and the engaging participants with questions resource.

Tips for Facilitating Small Groups

Engaging Participants with Questions Resource