Psychological Fitness Foundations, Part 7 - Relatedness

This week, we are finally moving on in our series to the second key component for physicians' psychological health. Relatedness - a sense of belonging and connection - is critical, not only in team relations but in your personal mental fitness. Brené Brown has described belonging as the feeling of security and support when there is a sense of acceptance, inclusion, and identity. It is connected to positive, lasting, and significant interpersonal relationships.

Relatedness involves feeling respected, valued, receiving care and concern in the face of challenges, a sense of warmth and inclusion, and opportunities to genuinely contribute and that contribution being recognized.  When we as physicians don’t feel we belong or aren’t connected at work, we don’t engage or make the most impact. It can also affect relationships outside of medicine. And all that combines to diminish our own mental health.

“True belonging doesn’t require you to change who you are; it requires you to be who you are,” is an excellent Brené Brown quote. Fitting in is the opposite of belonging because it causes you to feel you need to change. And when others accept the edited version of you, well, it's not really you. Belonging means you’re in a safe place where you can be your authentic self and share your opinions without negative consequences. Trusting relationships and shared values underpin that connection.

Brené offers ways to cultivate a culture that provides belonging that I’ve tried to apply to our medical world leadership:

- Recognize the physician’s efforts and accomplishments (public vs. private based on individual preference)

- Give them opportunities to express their opinions

- Encourage physicians’ contributions in team meetings and validate them by actively listening and showing genuine appreciation for the input

– Foster open, honest environments, so they feel comfortable being themselves. I personally like the phrase “Who can offer a different perspective?” that my friend and mentor, Dr. Kelly Derbin, once offered me. It is a non-threatening invite to those who may not feel their opinions matter since it is not what the louder voices or even consensus sound like.

– Host a lunch or an informal chat about subjects that may make people feel unsafe in a larger environment.

-Use transparency via communication of organizational plans and developments. This conveys to the physicians that they matter enough to be included in what’s coming down the road and even invites opinions that may remove blinders from leadership to ensure a solid plan.

-Let the individual physicians know that the office, residency, or organization cares about the person as an individual.

-Communicate and allow physicians to align with the values of the organization.  It’s interesting how health systems allow this to play out. In one organization I worked for, part of my annual evaluation included my ability to recite the five values of the system. And I did. I was never asked what those words meant to me, what they meant to the organization, how they aligned with my values (or not), or even where I felt the hospital system was negligent in those areas.

Amanda Bonilla expands DEI work to include belonging. “Diversity is having a seat at the table, inclusion is having a voice, and belonging is having that voice be heard.” It’s not hustling for approval or acceptance, which offers only a “belonging knock-off.”  It involves compassion, suspension of judgment, and accepting that others have different lived experiences and perspectives that are valid and important. When connection is broken, which is often- because we are all human, trust can be damaged. However, with good communication – it can be rebuilt stronger as we learn and grow.

Ideas for Organizational Leadership In addition to the ideas above, organizations can model and teach other leaders:

Create room for various voices and perspectives and appreciate what each brings.

Encourage mentorship – formal or informal.

Seek out individuals' opinions and how they are experiencing work in the organization.

Express genuine happiness when seeing the individual – smile, say, “Hi.” Use their name (Read their name badge or just ask, “I know we’ve met before. Please remind me of your name.”)  

Make sure they have their own space. When I can hang photos of my family and spread out my folders as I want them, I feel like I have a space and belong.  In my opinion, devaluing office space for physicians is a short-sited money-saving trend.

I appreciate when the “C-suite” personnel avail themselves for lunch and town-hall meetings where we feel truly seen, heard, and valued.

Inquire of ways an individual may want to contribute and ensure you recognize their contributions. Help them celebrate wins. 

Provide safe spaces for physicians to gather with and without staff.

Support and encourage physicians' involvement in outside connections (community, family, etc.)

It can take time to craft the environment and time for an individual to feel they belong. Create a sustainable work environment, so they’re there long enough to gain a sense of connection and relatedness. Encourage team-building with some autonomy on what that can look like.

Our leadership used an Alaska Native tradition by utilizing a Talking Circle. It gave us insight into each other’s worlds. It also gave us a glimpse into some of our patients' cultures - increasing our sense of connection. (Please note I was true to my nature when I fought to participate in this initially – however, it was actually a fantastic experience.)  

The healthcare organization in Alaska that I am still working for as on-call faculty opens meetings with a reflection. It’s been more enriching when each person takes a turn – you get to see what each member values and get a glimpse through their lens.

Help the teams ask, “What does each member bring that is different?” Make it safe for people to say, “Let me give you the perspective from a father of a neurodivergent child.” “Let me give you a perspective from someone who has faced blatant racism along with years of microaggressions.” “Let me share with you the perspective of someone with my faith.” - A rural low-income family. - A highly privileged and educated upbringing. -Someone who experienced health-care trauma. Basically – storytelling. It’s a centuries-old practice that connects through the shared-human experience.

I recently coached faculty members who talked about various personality types not being welcomed or valued in their institution. There was a story of a shy but incredibly bright resident being excluded by colleagues and other attendings. After talking through things, one attending started to conclude that “some seeds just do better in different soil.” I offered her another perspective - what of the organization? What’s their responsibility to their soil? Do we just move all young saplings away from them? Or can they be open to hearing, changing, and leading a culture shift that genuinely values diversity enough to tend to the soil?

Ideas for your local office or hospital team. Gathering, eating, and sharing help form connections within the setting.  Our office would get lunch and have some social time before and after our meetings. We also had twice-a-year off-campus gatherings. One right before the Christmas holidays and one mid-summer. We played games and ate and families were encouraged to come. My husband's office takes turns bringing and sharing various foods - (Hot Pot being the overwhelming favorite) and spending the lunch hour socializing. The physicians encourage it by participating in the cooking and eating and making sure groceries are paid for those who love to do the cooking. They also host an annual crawfish boil - flown in from Louisiana of course.  They celebrate the holidays at the office by closing for a 1/2 day and participate in a game-type gift exchange. These activities foster connection amongst the staff which improves engagement. Vocalizing and living out the shared goals/mission/values also goes a long way to enhance belonging. 

Ideas on the individual level. Based on our previous experiences, we may expect things just to evolve organically. I mean, that’s how it worked through school and even sometimes residency? And when they do, that’s amazing. Though, it often isn’t the norm.  No one told me – “Be intentional” in this setting until I was 45 years old. Invest - get to know your colleagues, staff, and patients from professional to personal goals, to their recent experiences, to shared experiences. What options are available to you to cultivate your (and others’) connection? How much time and energy is worth the trade-off to spend time with colleagues, staff, and patients? It likely will vary day-to-day and setting-to setting.

During my flaming burnout period (before I had the term to describe what I was experiencing), I thought cutting time spent chatting with colleagues and staff over lunch would help me get more work done and take less work home. Little did I realize; I was cutting out one of the key pillars supporting my mental fitness.

Consider helping others feel they belong. It likely will enhance your own relatedness. It’s essential here to communicate – what others desire may not be what we assume. I coached a new faculty member who had an older colleague drop an article on her desk that was of a personal nature. Her intentions were likely pure and kind. However, it didn’t make the new member feel welcomed; it made her feel awkward, embarrassed, and not fully understood.

So, be intentional, decide what that will look like, how you fit it in, and when it’s worth the trade-off and when it’s not.

A note about virtual connection: The Covid 19 pandemic will prove a treasure trove for social and behavioral scientists. Many are furiously collecting and processing data now. I heard the latest statistics that it takes three times the effort to feel a sense of connection over Zoom than in person.  (My take is even more than three times the effort is needed on Microsoft Teams). There are some tips others have given here to help. 

Inner dialogue/Thoughts

But you know me – I like to work on the thoughts. I’ve put in much effort on my part for the virtual connections. And alas, I now can even look at a black square or colored circle with a name or initials and feel connected to them. I just imagine the person on the other side as a unique, worthy human being trying to do the best they can with the hand they’ve been dealt. I ask questions that I choose to believe they will ponder in their minds and hearts to unlock their own best answers for their lives. It’s so much more effective than my initial tendency to imagine they have muted me and are doing all the other things. (Like I tell many of my clients if you’re going to make something up – at least make it positive). And wow, when the camera is on and/or they speak and engage – I am privileged to hold space for them. I’m invested – and my investment is not contingent upon their response. I believe the best of them, even when they don’t believe the best in themselves.  Okay, I’ve digressed. Back on track -

Now, let’s think of times you don’t feel you belong.

Think through all the circumstances – actual facts (no judgments, assumptions, loaded words).  List what you know for sure. Could your automatic thoughts in those situations be inaccurate? Many of us have natural cognitive errors in some spaces in which we utilize mind-reading, personalization, and jumping to conclusions which all involve assumptions toward the negative. These have likely been friends with our brains for so long that they’ve created large neuropathways in which we never pause and consider the accuracy.  We just accept them as fact.

In what situations are you playing small or hiding to fit in? What are your reasons? What is it costing you? (Mental and emotional energy or distress?). What are you afraid of? Is that really true? What’s a safe way to test the waters?

What if you felt you belonged? What would that feel like? What would you do differently? What would you allow for?

When you’re in places or situations where it has become apparent that you don’t belong, what do you do then? In those situations, our brains automatically like to offer “No one thinks I belong.” It’s easy for us to overgeneralize. Examine closely. Is it all the voices or just one or two? Can you give space to believe that maybe the quieter personalities accept you just as you are? What would you do differently if that were true?

What about when the voice is yours only – “I don’t belong”? Why is that? Is it based on good information and trusting your intuition? Do you want to belong in that situation? We want to feel connected, but not at the expense of transgressing our values. How can you engage in a way you are proud of? Where can you cultivate belonging for yourself – if not there, elsewhere?

And in the setting in which you have no capacity, no sense of safety, and no identifiable ally – what do you want to do? How do YOU want to show up anyway? How do you want to think of others? What can you do to change the system, whether by overhaul or via inch-by-inch? When do you decide the soil is inhospitable and take care of yourself by moving to more fertile ground? We often start at this last question because it seems like a quicker and less painful option. It’s too easy to think the grass is greener. So, I urge you to slow down and consider the previous questions before this one but make it back to this one if you need to. And then, do what you need to do for yourself. Your future patients and relationships outside of medicine, along with your mental health, depend on you taking care of yourself, no matter what that looks like.

Have a joy-filled and connection-investing week!  Tonya

Residency programs can benefit from our Flagship 6-session hybrid coaching course for resident or faculty groups. Learn more here.