When there is no map, you become both the mapmaker and the navigator of uncharted daily life experiences.

For many, resilience, or the lack thereof, has moved into the spotlight since COVID-19 entered our realities. This article draws on the lived experience of interviewees in the healthcare system who work at a private hospital in a medium sized town to shed light on what supported their resilience when working under extraordinary conditions. It offers insights for HR practice by exploring what supports a resilience response in people and the organizations.

Resilience – the concept and the lived experience

There is no universally accepted definition. According to Ungar and Theron (2020), to fully understand human resilience we must consider biological, psychological, social and ecological factors.

However, there are a variety of indicators used to measure resilience (Valiente, et.al., 2021).

These include:

• Appropriate functioning in everyday living
• Stability and/or recovery over time despite adversity
• Absence of problems or symptoms associated with mental health
• Patterns of behaviour in response to stressors
• Presence of positive aspects of functioning.

When the question was posed to healthcare professionals and others working in the healthcare environment, “How do you manage from day to day?” The answer was generally based on two factors – “there is no-one else available to do my job”; and, “I have to support my co-workers”.

Health-care workers have a strong sense of responsibility, and the second wave of the pandemic illuminated their response to a stressed system.

The health professional’s role became more expansive according to Gerard Joubert, manager of Hermanus Mediclinic (personal communication, 2021).

Organograms and even protocols were ignored in the quest to be of service and to support a failing system. These spontaneous actions raised questions for HR about job roles, performance management, accountability and more. The potential for a professional workforce at odds with the managerial and support staff began to develop.

Concern for, and duty to family became a ripple across a system accustomed to individuals who could be relied upon to put work first, and home life second. The pandemic created an ethical dilemma for the system

– how to support essential workers in managing their duty of care to patients versus duty of care to their families and their own health?

The interviewees were selected from across the system in the hope of offering a multi-faceted view of how the experiences of individuals co-create and contribute to the resilience of a complex adaptive system during times of disaster risk (Coetzee, van Niekerk and Raju, 2016).

The experience of a physician

40 years of good quality experience didn’t prevent a sense of overwhelm

He identified the factors that contributed to his resilience and healthy COVID-19-free status:

1. Self-care

Partnering with a professional coach highlighted physical care measures like not touching his face at any time, rigorous hand-washing and regular mask changes in the hospital and at home. He established a pace of work which included regular breaks outside the hospital building. A stable home environment contributed to a sense of calm and normality.

2. Mindset

The mindset of “sieketrooster” is to focus on care for the patient as a person when nothing else could be offered to save the patient’s life.

3. It will be finite – this too shall pass

Science and experience from all over the world had shown sharp peaks of very active spread of COVID-19 for a limited period of time.

The experience of a hospital manager

Resilience lay in surrender to what I could not control, and teamwork

According to Jennifer McCrikerd (2000), a hospital is not seen as a “manufacturer of health”. Hospitals are places that provide a functional economical structure to meet the needs of the patients, create a functional space for various health professionals and health workers to work together and achieve economic goals for the organisation.

The hospital manager described his strategy as follows:

1. • Talking to people every day and asking about their wellbeing
   • Creating forums for conversation and voicing problem areas
   • Building reliable team structures and trusting team leaders
   • Encouraging employees to make use of the Employee Assistance Programme (EAP)
   • Evaluating operational support required every day.

His own way of coping was to make peace with those issues that he had no control over. He focused on successes. He acknowledged his own vulnerability. And he stressed the value of having a stable family environment so he could return to where he found nourishment for body and soul.

The experience of a nursing professional

“The ward has no laughter anymore”

According to a nurse unit manager, the biggest impact on nurse’s role in the hospital setting during the acute waves of the pandemic was the energy shift from ‘nursing to make better’ to ‘palliative care nursing’. This shift caused many of the nurses to feel traumatized.

Cox (2020) and Khan, et.al. (2020) argue that the title of hero, used by the media in good faith to highlight the role of the health worker, added to the stress of an already over-strained environment. Self-sacrifice – as implied by heroism – suggests unlimited personal risk without reciprocal structural support by the system and community and could have negative psychological effects. Khan et.al (2020) raise the concern of implied military voice which can lead to anti-science and xenophobic actions. This diminishes the humane care of the health workers and for the patients.

The nursing professionals found courage when:

1. Knowing that the community was noticing and appreciating their daily presence, gave rise to feelings of being cared for.
2. Leadership included spiritual care, a positive message after a shift, individual attention and praise, checking in when in quarantine, providing physical nourishment, holding the space for sharing personal experiences, and guiding end of life in patient care.
3. They adopted a mindset of “I’m doing the best I can for today”. This required prioritizing levels of patient care, being patient and tolerant with one another, exhibiting a forgiving attitude towards others and themselves, sharing duties, and self-forgiveness when testing positive for COVID-19.

Learning from coaches in conversations with healthcare professionals

Interviews were conducted with ICF Professional Certified Coaches. In reflecting on their work during the past year, they reported that the coaching conversation space provided healthcare professionals with

1. • a safe environment to talk about emotional issues
   • a communal space outside the hospital where they could talk about difficult decisions, ethical issues and the experiences of the day
   • a space where they could release stress before meeting with their families
   • support for first signs of burnout, loss, grief and conflict
   • an accountability partner for self-care
   • experiencing appreciation.

Healthy system for resilience – where are the touchpoints?

In a recent Forbes magazine article, Eric Friedman (2020) discussed the top five challenges for HR professionals in healthcare. These range from focusing on employee wellness to improving operational efficiencies.

If we consider the range of coaching skills and the availability of team coaching, professionally credentialed ICF coaches can assist managers and HR professionals in offering support and mentoring for:

1. • wellbeing and wellness of employees
   • adjusting to the pandemic world of work
   • supporting leadership during times of uncertainty and difficult decision-making
   • supporting HR departments with operational solution finding.

Cultivating a coaching culture integral to the support structure in the healthcare environment is important. Stress is not only a ‘fight and flight’ response; stress also invites the ‘tend and befriend’ response which is a biological state created to reduce fear and increase hope and motivates physical action.

A resilient healthcare culture focuses on:

1. • introducing gratitude practices for healthcare professionals and workers
   • strengthening the neural pathways to resilience through specific exercises, breathing practices and evoking self-compassion
   • introducing trauma-sensitive mindfulness practices to help face fears, change the narrative, and cultivate forgiveness
   • building positive networks that are culturally sensitive
   • appropriate acknowledgement and appreciation

1. • providing certainty of support and care during a period of uncertainty.

With the pandemic currently in its third wave in South Africa, continuing to support the healthcare workers through compassionate coaching and HR practices is of the utmost importance.

In 2020, the International Coaching Federation (ICF) celebrated 25 years as the global organisation for coaches and coaching. ICF is dedicated to advancing the coaching profession by setting high ethical standards, providing independent certification and building a worldwide network of credentialed coaches across a variety of coaching disciplines. Its 39000-plus members located in 146 countries and territories work toward the common goal of enhancing awareness of coaching, upholding the integrity of the profession, and continually educating themselves with the newest research and practices.

ICF South Africa is a Chartered Chapter of ICF with 483 members (June 2021 figures). Contact us at: [email protected]

Article references

Coetzee, C. van Niekerk, D. and Raju, E. (2016). Disaster resilience and complex adaptive systems theory.

Disaster Prevention and Management, 25 (2): 196-211.

Cox C.L. (2020). ‘Healthcare Heroes’: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic. Journal of Medical Ethics, 46:510–513.

Friedman, E. (2021). Top Five Human Resources Challenges In 2021 (Forbes.com)

Joubert, G. (2021). The expansion of the helper role in the healthcare sector – observations from the frontline / field. Personal communication.

Khan Z, Iwai Y, DasGupta S. (2020). Military metaphors and pandemic propaganda: unmasking the betrayal of ‘Healthcare Heroes’. Published Online First: 16 December 2020. doi: 10.1136/medethics-2020-106753

McCrickerd, J. (2000). Metaphors, models and organisational ethics in health care. Journal of Medical Ethics, 26 (5): 340-345.

Ungar, M., & Theron, L. (2020). Resilience and mental health: How multisystemic processes contribute to positive outcomes. The Lancet Psychiatry, 7(5): 441–448.

Valiente, C., Vázquez, C., Contreras, A., Peinado, V. & Trucharte, A. (2021). A symptom-based definition of resilience in times of pandemics: patterns of psychological responses over time and their predictors.

European Journal of Psychotraumatology, 12:1.

Annabe Tredoux is a Professional Certifed Coach by the ICF (PCC).  Annabe’s focus on supporting clients in various stages of transitioning is based on her background in pharmacy and observing the impact of health or ill-health on a person’s behaviour. She observed clients ease into difficult decision-making when mind and body blended to create mindset shifts. This encouraged her to start integrating decades of yoga study and practice with the Solution Focused Approach. She added team coaching to her coach specific training.  Annabe’s clients are individuals and teams (healthcare and education) who strive to adapt to change in a meaningful and sustainable way.