Participant demographics
Out of 15 total coaches, 13 participated in interviews: 9 psychiatrists (70%), 2 mental health nurses and 2 non-clinical hospital staff (15% each). Eight coaches self-identified as female (62%) and 5 self-identified as male (38%).
Coaching frequency and attendance
The frequency of coaching sessions varied considerably depending on the clinical area and perceived level of stress amongst staff, which often correlated to spikes in hospital or community case counts. As an example of frequency, from January to March 2021, which was one of the most acute phases of the pandemic in this region, 12 coaches reported running 168 sessions across the two hospital sites.
Staff attendance at coaching sessions varied considerably, and seemed to depend on a variety of factors, including: the format of delivery, departmental culture, subject of the session, and status of COVID-19 infections in the area. For some units, virtual coaching was more popular, and for others, in person was preferred. Moreover, preferences and attendance shifted throughout the pandemic. Units with established large meetings often offered coaching sessions as part of these meetings, which were often well attended; however, during times of increased infection counts, virtual coaching sessions often became more popular, because they could provide more opportunities for quiet reflection. These factors are discussed in more detail throughout via examples from the participating coaches.
Most frequently, staff attendance was reported in the range of 1–8 people at a session.
Resilience coach interview themes
Three main themes emerged from the analysis: A) Motivations and rewards, B) Challenges, and C) Coaching strategies and techniques.
A) Motivations and rewards
Coaches described their experience as rewarding – providing satisfaction, connection, and a meaning. They frequently reported feeling honoured to support colleagues during a difficult time. One said it was a privilege for people to “open up and share their real accounts…and let me in in that way.” (C1). For another, providing support “feels helpful and useful.” (C2). Another reported it was “beautiful to bear witness to the teamwork and to the resilience of the units” and that “there aren’t enough pots and pans in the world to recognize what nurses are doing” during COVID-19 (C3).Footnote 2
Delivering Resilience Coaching also provided some coaches with a deeper understanding of life within their hospital. One said Resilience Coaching helped her “feel connected to everybody in a different way,” that “there are a group of people that get it,” in contrast to people outside whose professional lives had not been as severely affected in the same way (C4). Another noted that providing Resilience Coaching to the unit they supported, where they also have professional connections, improved their understanding of challenges experienced by that team. They noted this improved understanding was proving helpful in their regular role on the team, where they worked with the team providing the mental health component of “collaborative care” for their patients (C5). Another coach commented that delivering Resilience Coaching made them more aware of “power and privilege” in the hospital, especially related to discrepancies between nurses and physicians (C3); several others expressed this idea as well. For these coaches, it was personally and professionally meaningful to have a deeper understanding of the realities of working lives of their colleagues, and renewed their initial desire to help.
B) Challenges
i. Role tensions
Coaches described challenges in their role that included uncertainty about their roles and questions about the scope of their expanded role within their organization. One coach noted feeling uncertain about delivering sessions that were not explicitly requested by staff: “No it’s not easy and natural…I don’t offer my service unless people ask me [laughs]. So, I feel like I don’t want to force this on people who are so busy already” (C6). Another noted that perceived power imbalances influence sessions; they felt an “odd tension” because they didn’t “want to be the doctor in the room.“ (C2). For this coach, Resilience Coaching became challenging over time:
I feel increasingly uncertain about the sessions. I thought at the beginning that our role was really…a responsive role and that…I just had to show up and help deal. And that's the role I can do, that's OK. With time going on, there's less fires, but the temperature is still hot. And I keep wondering [about what we should do]…(C7).
Another key challenge was a role tension about maintaining boundaries between clinical care and Resilience Coaching. One coach articulated the difference: “operationally, clinical care requires identifying a patient, opening a chart, keeping notes. You bill for that, and you have a regulatory responsibility to your college…So the nuts and bolts of that are is really clear…[But] why we choose that for one person…and [not] for someone else…is less clear” (C8). Another noted they experienced a “blurring of…what it means to provide support” and felt a need to “constantly [be] evaluating…at what point does this conversation…need to become clinical care?” when working with staff (C3). Another coach reflected on the fact that with one staff member, they had not defined their role as distinct from clinical care. The coach described writing a letter advocating for the staff member which led them to personally question “where does the role [of the coach] actually end?” (C9).
Another tension was a lack of clarity about whether they were perceived by staff as colleagues providing support or as representatives of the hospital itself. One coach used a wartime metaphor to describe this: “I always wonder…is my role as a coach to make people…good soldiers, so that they carry on the mission of the hospital?” (C5). Another observed this tension arises when the organization’s requests and what staff are able to do are not aligned. The coach described feeling “in the middle…to figure out…is there a role for us to do something, or do we just focus on the…coaching aspect of things?” (C10).
ii. Logistics
Coaches noted several logistical challenges in the delivery of Resilience Coaching, often related to scheduling or finding a space for sessions. In one situation, a coach noted one group had a private space, but it was “also a medication room, and there's pharmacy delivery that's always in the middle of [the meeting].” For their other group, there was no private room, so they used the staff lounge. The coach reflected “usually, we have to kick people out of the lounge,” which felt uncomfortable (C4). Night shift workers and physicians, in particular, were noted as challenging to schedule. Some coaches also described a limitation on being able to arrange sessions to meet staff needs, due to constraints of their own clinical work. Additionally, many coaches reported setting meetings that were unattended or rejected. Rejection happened during summer months, and during COVID-19 outbreaks. These experiences raised for some a question about how much their time to offer, when, as one coach noted “every hour we spend with a group coaching is an hour we could spend doing a patient group” (C11).
Most coaches were interviewed approximately one year into the COVID-19 pandemic, and described a range of personal life stressors that they too experienced during that time. As HCWs themselves, they were not immune to the pressures and stresses experienced by those that they supported as Resilience Coaches.
iii. Coping with burnout
Most coaches were interviewed approximately one year into the COVID-19
pandemic, and described a range of personal life stressors that they too experienced
during that time. As HCWs themselves, they were not immune to the pressures and
stresses experienced by those that they supported as Resilience Coaches.
Coaches recounted experiencing considerable fear and anxiety in the early pandemic, but at the time of interview, it was more common for them to describe coping with those feelings. Exercise and cooking were common coping strategies described, as well as spending time with loved ones, and taking time alone to decompress when needed. While generally appreciative of their privilege, coaches also noted difficulties, such as using alcohol more frequently, and struggling to maintain a boundary between work and home life.
A common source of strain among coaches related to the impact of the pandemic on family life. Several Resilience Coaches described stresses of pandemic parenting, as in this individual who noted “it just feels like I've let my kids down…I just keep reminding myself that in March whenever they announced the first shutdown, I was like how are we going to survive…? And I just keep reminding myself that at that point three weeks felt impossible and now it's been much longer.” (C4). At the other end of the life cycle, some Resilience Coaches had elderly parents in their care, as in this example:
I talk to my parents every day which is both, you know, a plus and a negative because I worry about them a lot. They’re quite elderly… they’re fortunately not in long-term care, they’re in their own apartment but it feels scary for them. And my father is having declining health and so that all feels difficult. But I would say talking to them is more helpful in remaining resilient that not. (C5)
This coach noted that while they felt privileged and grateful for the experience of their immediate family, the pandemic was still a strain, resulting in feelings of burnout affecting their clinical work: “I think I just feel tired. I think my tolerance for patients is really low. So, I feel like that’s where probably the biggest impact has been which is that…I just don’t have the capacity to deal with really needy patients…like it gets under my skin and irritates me.” (C2).
Some coaches explicitly highlighted the challenge of providing support while experiencing burnout. One described, “there is some pressure to be well, because we are the ambassadors of resilience…And that’s tricky, too, right?…we can’t always give an answer about what we’re personally doing around resilience, because we’re not always doing it” (C10). Another stated they found leading coaching sessions sometimes magnified their personal difficulties: “I would also say that my own experience of the pandemic…makes it very hard to be a coach to other people. Because most of the time I'm in a very negative place in terms of what's going on for me personally. And when I'm in the session I just actually feel like even more terrible for what other people are going through.” (C4).
C) Coaching strategies and techniques
1. Relationship building, establishing trust and validation
Relationship building was a commonly described strategy used
by Resilience Coaches in running sessions. This coach describes creating a new
relationship with a team: “I often didn't know how to support them…I mostly
just tried to be visible. I wanted people to know that they weren't going to go
through this alone” (C11). This Resilience Coach used humour: “And the telling
a joke thing? I do that with my patients too, but I don't do it as much.
Because I think the coaching thing needs to feel a little bit more contained
for people. And I also feel like…they need to know this is a peer thing” (C8).
Other relationship building tools described include self-disclosure, and
helping the team where possible, even stepping outside of normal roles.
Coaches described being attentive to staff emotions as key to their practice, often to build trust. One described validation as a form of education:
…[I coach] to help people realize that negative emotions, negative reactions, are not necessarily a sign of failure, shortcoming, or lack of professionalism, but rather an occupational hazard of working…in healthcare at any time, [and] especially during COVID times. So, educating people to realize that there is an occupational hazard to working during COVID…it will affect you as a human being, and what you do with that feeling will help you be resilient or not…if we can talk about, and we can talk about why it’s OK to feel like that…it seems to help people. (C1).
For this coach, listening and validating were essential as well: “…a lot of the time it’s just about kind of asking a different question or listening in a different way, how can you listen in a different way that isn’t all about finding solutions, but it’s just hearing people and where they’re at.” (C12). This coach described that the practice can be “a lot of…listening, validating, reframing sometimes, where there’s room to think of things differently.” (C10).
ii. Psychotherapeutic techniques
Resilience Coaching is a form of collegial support, distinct from clinical care. However, coaches draw on principles of psychotherapy and psychological first aid in doing the work (1). This coach noted that: “it’s clear that [Resilience Coaching has] been informed by my psychotherapy…When it’s more on an individual level, it’s not the resilience building, it’s sort of – there’s a lot of listening, there’s a lot of…empathizing with what’s going on, and there is some intervention that goes beyond coaching, I think.” (C9).
Some coaches described specific principles derived from psychotherapeutic modalities (such as cognitive behavioural therapy (CBT) or dialectical behavioural therapy (DBT)) were useful to incorporate. This coach illustrates how this can be applied in coaching: “One of my favourite types [of therapy]…is dialectical behavioural therapy, which is the idea that two opposing things can exist at the same time. So, we spend a lot of time talking about…for example, I’m so burnt out and I’m so tired, and my job is important to me and this role has great meaning…” (C10).
Other coaches noted group therapy skills were ones they commonly used in conducting Resilience Coaching sessions. This coach was self-deprecating about their group management: “I actually have to call upon all of my meager group psychotherapy skills to try and contain…[some staff] so that the others can function as a group…” (C8). Another described the group management more broadly:
I would say that there's a lot of generalisation, a lot of normalisation, a lot of intra-group learning. Somebody raises a problem, anybody else faced that, anybody else got an idea how we can manage that? And a lot of, in a sense, encouraging the group to manage itself as opposed to offering specific interventions. That would be the stuff that feels like its psychiatric, feels like group therapy in that way…[but] they don't want therapy. They…see us as colleagues, not as therapists. (C2)
iii. Paired coaching
Many coaches reflected positively on the experience of delivering
Resilience Coaching with a partner. This coach noted being paired made it
easier to begin Resilience Coaching: “I was paired with [name]… everything he
says is smart and inspiring...Since that time, after the first meeting he’s no
longer doing it, but the first meeting was just made easier…” (C5).
One
coach noted working in pairs facilitated self-reflection: “Coaching in pairs…allows for the coach to have someone
who they can bounce ideas off of and ask, how did that land when I tried that exercise
with the group? Or what did you think of this.” (C3). This coach noted a possible value in working in pairs
may lie in the enhanced relatability of the coaches: “there’s also a clear
difference between, like, who will reach out to me versus who will reach out to
my colleague, and I think that’s because we are relatable to different groups
of people.” (C7). Another noted that pairs-based coaching allows for logistical
flexibility “to share days when one of us needs to be away or when there’s
other competing demands,” as well as echoing that having two facilitators is
helpful because “we pitch things at two different levels and I think that
appeals to different demographics.” (C10)
