Q&A: Academia lacks structures to support health care professionals in times of grief

Additional support and flexibility in academia following a loss can foster recovery and may help reduce burnout among health care professionals, according to an opinion piece published in JAMA.

Krista Harrison, PhD, a faculty member in the division of geriatrics at the University of California, San Francisco, and a researcher in systems of care for older adults with serious illnesses like dementia, called for a change in “the norms and expectations around loss and bereavement” in academia.

“Academia rewards those who can make hardship invisible, who can be productive amid and despite crisis,” she wrote.

In the paper, Harrison detailed her recovery process following the deaths of loved ones while juggling her professional responsibilities and mental health.

“After each death I went back to work within a few days. Practicing normalcy, being back at work, was both reprieve from grieving and access to examples,” Harrison wrote. “Colleagues cautiously began to share their own stories of loss. I desperately needed these maps for grieving, especially the proximate stories: of sudden loss, of navigating loss as a new parent. Yet the hazard of my research focus meant that every meeting, every conference, every manuscript threatened to trigger my grief.”

To avoid burnout, Harrison began her own grief recovery process, which included exercising, therapy, journaling, meditating, crying and more.

In hindsight, Harrison said the academic space could have been better constructed to support her grieving process.

“Every grief experience is unique; no single policy could suit all situations,” she wrote. “Yet much like parental leave policies and norms are increasingly substantial and customizable, similar supports are needed for the bereaved.”

Healio Primary Care asked Harrison to discuss the importance of bereavement and self-care among health care professionals.

Healio Primary Care: How does a lack of support for loss and bereavement contribute to burnout?

Harrison: I am not an expert in burnout research, but I think of burnout as an accumulation of injuries. Some talk about the moral injuries of having to provide clinical care in ways that feel suboptimal because of the way that our health care system is set up. I think that is one set of injuries. Another set of injuries are ways in which we encounter hardship throughout our lives and careers just by virtue of what life throws at us, especially in the pandemic. And so, if we don’t have jobs that have sufficient flexibility and supports to make time to process hardship and get a sense of restoration — and it gets worse when you have combinations of things, such as already being behind on your clinical work or your research, your home life and then you also get hit with this big loss — you get to a point where you just don’t know how to get out of it. Everything accumulates and exacerbates each other, thus the overall sense of burnout. At some point, if you don’t have ways, if you don’t have examples, if you don’t have directions, if you don’t have people saying, ‘No, seriously. You’re going to have your job tomorrow or next week. We need you to take this time off and get yourself in a little better headspace for everyone’s wellbeing,’ then people get in a situation where they think there’s nothing else to do but quit. That is a major loss to society, not just to employers, the individual themselves or their families, to have to go through that major change after society invested in training health care professionals.

Healio Primary Care: Have you and your colleagues discussed the challenges of juggling familial and professional responsibilities during loss?

Harrison: Yes, in many different stages of their career or formulations. I think what I have heard most commonly is that whenever we are in situations where there isn’t an ability to take a break, whether that’s real or if it’s self-imposed, there’s a degree of compartmentalization and ignoring the need for processing. It doesn’t make the emotions go away; it just makes them out in strange ways. And ultimately, it means that we’re not bringing our balanced professional selves to the workplace, because we can’t. I’ve heard stories of people who are able to take time off, a week here, a week there, a day here, a day there. After my losses, I went back to work immediately and was in the office full time, in part because my child’s daycare was right by my office and my spouse worked from home. My child certainly saw me cry plenty, but my grieving was changed by needing to care for him and his presence, not least his propensity, to make me laugh. The combination of professional and familial responsibilities made my grieving process much longer, I think. A few colleagues have taken longer leaves to travel and help family after a loss, or in anticipation of loss. There are people who end up switching jobs. It’s probably a version of burnout in a way, of finding a different way to use their professional expertise.

Healio Primary Care: What interventions can be put in place to better support health care professionals?

Harrison: I have observed that my colleagues who are in palliative care in particular seem to create regular rituals for honoring the loss of their patients, because of course that happens more frequently in palliative care. Having those safe spaces in the workplace to honor grief is an example that would be beneficial if it was to be implemented into normal practice. It depends on the culture of groups or organizations whether or not that is an acceptable use of time or an acceptable place to express emotion. But I think a lot can be learned from that practice of my palliative care colleagues.

Also, I was very surprised a grief support group wasn’t a built-in service within my university. I still haven't heard of any. I’ve just started to form one with the people who I’ve encountered who have similar stories and seemed like they’d be interested. It was something that I wish I had early on. Instead, I found different road maps for how to grieve and how to make space for these things over time. Having those sorts of structures and leaders who can provide information on where to find these support groups or mental health and grief support from experts, while also not putting you at risk of losing your job, is important.

Healio Primary Care: How has the pandemic impacted you and your colleagues?

Harrison: I’d be surprised if anyone was not incredibly impacted by the deaths of so many people because of the pandemic and the pandemic-related downstream effects such as levels of distress from clinicians. In our group, we're hearing it particularly among our trainees who are trying to learn, amid encountering all this loss and all this change. They are at a more vulnerable stage in their career. I was in some ways fortunate enough to be as far along in my career as I was while experiencing my own devastating losses. If it had been earlier, there’s a decent chance I would have dropped out of research, out of academia. I think the next generation of clinicians are important to protect and support. There’s been a lot of talk in palliative care about how burnout rates are incredibly high. The downside is you lose both your institutional knowledge and the people who can train, support and help protect the new trainees. If you lose both your trainees and your long-term experts, who’s left?

Frankly, we learn from our colleagues how to protect ourselves. In fact, in bits and pieces by asking my colleagues, I found out about things like scheduling time for grieving: in a professional workday, I’m going to have this hour and I’m going to cry as hard as I can and then I’m going to move on with my day. I had no idea that was a way that some of the more senior clinicians coped with all the loss that they witness. That is yet another example of professional knowledge that gets handed down over time. And if we lose our experienced clinicians who have developed healthy methods to cope with the losses, our trainees are even more at risk.

Healio Primary Care: Anything else to add?

Harrison: One of the things I’ve been thinking about is how in a number of institutions the leaders who are setting policy can’t, by definition, have experienced all the range of things that their employees are going through. I wish that there was an opportunity for a model where our leaders could be informed by, say, a board of people who are at different stages of their careers and lives and people from different walks of life, and to give them a voice in policymaking. I hope that we are able to move towards more innovative practices that allow for creative possibilities that are not just prioritizing making money, but prioritizing the wellbeing of the patients, the clinical workforce and the myriad of people of different disciplines who support our clinical colleagues.

Reference:

Harrison KL. JAMA. 2021;doi:10.1001/jama.2021.13539.