I am departing from my usual themes to review a program on CD entitled Make Yourself Unforgettable: The Dale Carnegie Class-Act System.  I especially enjoyed the information on resilience in the second half of the program, which I had thought of as the ability to bend without breaking.

The authors defined resilience as the:

• ability to recover from and adapt successfully to adversity, problems, and setbacks
• power to reinvent oneself as circumstances change

They felt that resilience is like a muscle that people can learn to strengthen over time by:

• making connections to people without judging them
• accepting the inevitability of change
• moving steadily toward accomplishing one’s goals despite adversity
• looking for self-discovery opportunities and being grateful for them
• keeping events in perspective, which they described as avoiding swimming against rip tides
• seeing the opportunity as well as the danger in crises
• obtaining adequate nutrition, exercise, emotional support, and laughter, especially during crises

The authors described the five inner foundations of resilience as:

• Trust: believing in and relying on others, setting an example of trustworthy behavior by following through on promises and protecting confidentiality
• Independence: making one’s own decisions, accepting responsibility for those decisions, and learning from one’s helplessness and mistakes
• Initiative: acting in a way that is detached from the outcome, being proud of one’s best effort and giving oneself and others a second chance
• Energy, arising from the complementary forces of inspiration and will
• Identity: seeing oneself as part of a larger, triumphant movement

They identified the following qualities to be highly associated with resilience:

• Sociability: the enjoyment of forming positive relationships
• Humor:  a comical perspective, which has more to do with flexibility than joke-telling
• Insight: an understanding of people and situations, that allows one to see things that others miss
• Competence: skills that reinforce one’s self-confidence and encourage others to follow
• Persistence: continued effort despite setbacks
• Adaptive distancing: the ability to remain apart from people with negative outlooks

The first time that I remember resilience described in a healthcare setting was during residency at the New England Deaconess Hospital. Dr. Francis Moore, Emeritus Chair of Surgery at the Brigham and Women’s Hospital, described surgical decision-making as the art of taking prudent risks.  He characterized reilience as the ability to get back in the saddle after being thrown off a horse.  He was referring to the duality of learning from errors and moving forward to care for patients in a self-assured manner.

As I wrote in Collaborative Stress:

I am not sure what “positive stress” means, but I think that it refers to our ability to put events in perspective and move from “Why is this all happening to me?” to “Let’s figure out what we need to do to care for patients.”  Our ability to cope, in my experience, requires a certain resilience, which those of us who have survived residency describe as, “This will make a great story if I survive this weekend on call.”  It is a little like surfing the edge of chaos, where one has the excitement of doing things that make a difference in patients’ lives superimposed on the fears of failure and harming people.:

What do you think?

• Do the current economic and political challenges that we face demand resilience
• Is resilience required to work collaboratively in healthcare settings
• What examples of resilience have you seen in your organizations
• Is resilience taught formally anywhere; if so, please share with us what you have learned

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn