Being “nice”: A complex activity among health professionals following a critical incident

Abstract

This paper reports on an action research study to explore the underpinnings of outwardly unsupportive behaviour among health professionals in New Zealand after a critical event and to develop and evaluate a resource to help them recover through mutual care and support. It explores the dynamic nature of the support system, the feedback loops, nonlinearity, underpinning “rules,” and associated behaviour. The tenets of complexity theory are applied to identify characteristics of the system, which, in turn, provide insight into ways of achieving change. The study demonstrates that these health professionals were behaving in ways which they thought were expected, rather than being “nice” to each other: behaviour that was driven by the inherent interrelatedness within an organization or system. This finding not only has significant outcomes for practice but also contributes to a deeper understanding of the emergent nature of complexity theory.

Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event

“…The acknowledgment of this level of distress did not appear to be reflected in the organizational responses for some individuals. Following a significant event a participant stated, “no one from the service found me to check if things were alright until one of the consultants found me crying in the lifts…” (A) (Austin et al, 2020, p. 204). Along with the need for immediate emotional support, the organizational review processes seemed to not recognize the impact of a poor outcome on health professionals.…”

“…One person spoke of the “massive, long review process which, I’ve never seen any outcomes of results” (A). This was a process they found intensive while everything was being highly scrutinized, “but there’s no feedback from that” (A) (Austin et al, 2020, p. 205). It was not only the event itself but also the processes that followed that caused distress.…”

“…A core action group ( n = 13), working together with the lead author, met seven times throughout this period and were guided by the data from 20 interviews and additional content experts, making a total of 50 participants (Table 1). The detailed method and findings are published in a previous article (Austin et al, 2020). An additional fourth phase was subsequently undertaken within a mental health and addiction service in another organization to adapt the tool (October 2018–October 2020).…”

“…Participants observed that the collective development and introduction of the tool into the existing system resulted in changes to the way health professionals interacted with each other and the wider organization. The common and significant impact on individuals was made visible (Austin et al, 2020). The process of development (drawing on action research principles of collaboration, reflection, learning, and change), which enabled the eBook to be produced, was as much a key driver of the changes observed as the outcome of the eBook itself.…”

“…In the study by Austin et al, (2020), participants expressed the importance of any tool and advice developed for health professionals to be specific and relevant to those needing the support. The impact of the event was considered significant and very personal.…”