Feature Article:

The Role of Resilience in Practice Success

By Shelley Simon, RN, DC, MPH, EdD
Founder, Beyond Practice Management

If you?ve been following this series of articles, you?ll remember that the January issue focused on making resolutions, setting goals, taking first action steps, and developing competencies and skills necessary for sustainable change. In February we turned our attention to resistance — recognizing, reframing, and working with internal and external resistance. In this issue we address resilience — the final variable in the successful change process. (If you missed the first two articles in this series, click here to read them now.)

It?s March. Spring is on the way. Depending on where you live, buds may already be breaking through, revealing their innate hardiness. Those little buds were dormant all winter — resting, waiting for spring. You were, most likely, not resting all winter. Intent on getting 2007 off to a good start, you were busy — making resolutions, setting goals, addressing resistance, and getting your staff on board. You made significant progress. And you?d like to continue making progress, except that you?re tired. You want to keep pushing forward and see the efforts from the past couple of months pay off, but you feel unmotivated, uninspired, and perhaps frustrated because you?re not seeing results as quickly as you?d hoped. You?re lacking resilience. Your ?get up and go? has gone on spring break — which is exactly where you?d like to be. But there is still work to be done.

At times like this, it?s helpful to review your plans and goals, assess what you are working on, acknowledge the progress you?ve made, and remind yourself why your efforts are important. Keep in mind that you do have resilience — it may just be temporarily in hiding. This article includes nourishing food for thought and practical suggestions on how to enhance your resilience. As you?re reading, consider your own resilience. In what areas of your life are you naturally resilient? When does resilience not come so easily? Are there certain times when you feel as though you have almost no resilience? Why is that the case?

As a self-employed practitioner, you know all about the incessant ups and downs, the constant stress, and the new challenges that crop up with each passing year. Resilience is the attribute that helps you manage change, overcome challenges, and endure setbacks — often described as the capacity to cope with stress, or even catastrophe. This ability to bounce back after being physically or emotionally stressed increases self-esteem, which in turn helps build resilience so that you can bounce back the next time something stressful happens. So you might say that resilience builds and thrives on . . . resilience.

Resilience helps you view apparent problems from more than one angle, recognizing both the risks and the opportunities in challenging situations. Resilience boosts confidence, stress hardiness, emotional strength, and hopefulness. It also combats exhaustion, depression, and burnout so that you can manage your practice with greater ease and produce better outcomes.

Developing resilience is not a quick-fix proposition or a relief-oriented strategy. It?s not as though you?ll read this article, make the decision to be resilient from this day forward, and be done. There is a little more to it, and in a moment you?ll read about the characteristics of resilient individuals and learn six things you can do to anchor yourself in this way of being. Healthcare practitioners — particularly when they find themselves stressed, fatigued, or dissatisfied — are well served by learning to build their resilience.

Whether resilience is an innate capacity or a habit that must be developed presents an interesting question. What enables some individuals to bounce back and keep on going despite adversity, stress, and kryptonite, while others fall apart at the first sign of difficulty?

Resilience is not a genetic trait, rather it is our ?inborn capacity for self-righting and for transformation and change? (Lifton, 1993). Knowledge that everyone has innate resilience can ground change efforts in optimism and possibility. The development of resilience is none other than the process of healthy human development — a dynamic process in which personality and environmental influences interact in a reciprocal fashion.

So, is it nature or nurture? Probably a little of both. Developmental studies following children born into seriously high-risk conditions have shown that at least 50% overcome the odds and go on to lead successful lives. While some people are naturally more resilient than others, even they must work at times to maintain their optimistic mindset. For individuals who struggle to muster up resilience, the good news is that it can indeed be developed and strengthened.

Whether they are born resilient or have to work at it, what is it about certain people that make them seemingly immune to becoming discouraged or pessimistic? Research shows that individuals who have high levels of resilience share some common characteristics. These include:

• Caring relationships. Resilient individuals enjoy support and encouragement from people in their lives who believe in their ability to succeed. They also have caring relationships with themselves — that is, they treat themselves with kindness and compassion.
• High expectation for success. They have a belief in themselves — in their competence and in their ability to influence outcomes. This belief helps counter the negative self-talk and feelings that arise in all of us. The resilient person has an optimistic outlook and is able to keep even the most negative situations and challenging problems in perspective.
• Meaningful participation and contribution. Healthcare practitioners have this opportunity on a daily basis. However, feeling drained or frustrated, many have lost their way and feel that practicing has little meaning for them. Instead of seeing the value in providing services, they question their worthiness or career choice. Resilient practitioners keep in mind why they do the work they do and how their contributions are meaningful to the patients they serve and to themselves.
• Clear boundaries. Resilient individuals know when and how to say no. They balance giving with receiving and have consistent guidelines and expectations with the people in their lives.
• Life skills. They typically communicate well, have competent business practices and skills, and are able to make plans and take appropriate action to execute their plans.

A number of these conditions and characteristics are likely present in your life. Acknowledge your strengths and resilience builders and recognize how they provide you with hope, enrichment, satisfaction, and meaning. If some of these characteristics are not present to the degree you?d like, you can devote attention to improving self-care, rebalancing your time and priorities, developing new competencies, working on EQ, or revisiting your professional and personal goals.

Your mindset shapes how you view and interpret the events in your life. It determines the kinds of stories you tell yourself about what is happening around you, and what your actual influence may or may not be in a situation. In work and in life, setbacks and resistance are inevitable. How you choose to view these inevitabilities determines your outcome.

When faced with a significant problem, the viewpoint you adopt can mean the difference between success and failure in resolving the situation. Although it may sound like semantics, simply reframing a ?problem? as a ?challenge to be managed? makes a difference. What can take the place of telling yourself things like: I have too much to do. This doesn?t work. It?s too hard. No one will cooperate with me. I?m not motivated. I can?t afford it. Developing resilience requires turning this self-talk around so that you begin to see more right than wrong and feel more in control.

Research psychologist Carol Dweck, in her book Mindset: The New Psychology of Success, points out the difference between a fixed mindset and a growth mindset. The individual with a fixed mindset has an internal dialogue that is focused on judging — both self and others — good, bad, positive, negative — and they are overly sensitive about being wrong or making a mistake. Individuals with a growth mindset are monitoring what is going on, but without all the judgment. Typically more self-aware, they are apt to observe and learn from a situation rather than judge and invent worst case scenario stories. Additionally, someone with a fixed mindset is most focused on the outcome in a situation whereas someone with a growth mindset is interested in the process and learning potential, as well as the outcome.

Having read this far, you hopefully have a clear understanding of the benefits derived from building your personal reserves and resilience. But how do you actually go about becoming more resilient? Here are six actions you can take (or at least consider) today that will put you on a path toward greater resilience, stamina, and stress-hardiness.

1. Practice self care. You?ve heard it before but it bears repeating. Doctor, heal thyself. If you?re exhausted, out of shape, poorly nourished, and constantly stressed you can?t expect much resilience in your life. Do what you advise your patients to do: eat well, exercise regularly, practice work/life balance, maintain healthy boundaries, say no when you need to, and get enough sleep, rest, relaxation, and downtime.
2. Manage your time. Set aside time to work on projects that matter. Prioritize, delegate, follow through. Avoid wasting time (how many times have you checked e-mail today?).
3. Work on your emotional intelligence. Self-management and self-awareness are two key components of EQ. Both are closely linked to building resilience. For more information about EQ, click here to read the four-part series published last year.
4. Balance long-term goals with shorter-term ones. When working on a complex project or a long-term goal, sometimes just completing one or two small steps will give you the boost you need to do the next one or two steps the following day. Set big goals and complete them by taking baby steps, one after the other.
5. Maintain perspective and a sense of humor. Don?t take everything so seriously. The important projects and goals will bubble to the top and get done. Maybe not as quickly as you?d like, but if you?re patient with yourself and keep working — in small steps if needed — toward what is meaningful, eventually you will succeed.
6. Pay attention when resistance arises — because it will. Even with fairly high levels of resilience, especially when you?re working on something that it not especially appealing (marketing, for example), you?ll encounter resistance. It?s normal, it?s to be expected. How you choose to manage your own resistance will, in part, determine your level of resilience.

Practice any of these six actions until they become familiar, until they begin to deliver better outcomes, and eventually they will become habits.

The stories of those who have overcome adversity tell us that ?ultimately, resilience is a process of connectedness, of linking to people, to interests, and ultimately to life itself? (Bernard, 2004). Resilience is one more piece of the personal growth and development puzzle, one that will serve you in a variety of important ways over the course of your life. The good news is that you have — and can further develop — the capacity to renew and strengthen yourself so that resilience is available when you need to tap into it.

Whether you?re faced with a practice challenge, a family crisis, a financial setback, or a personal health problem, resilience will help you cope, manage, and ultimately thrive. Give yourself the gift of practicing self-care, developing healthy relationships and healthy boundaries, and managing yourself so that you can build upon your innate resilience and have a satisfying, sustainable practice.

Client's Corner:

Healing the Healer: A Case Study

Chiropractor Brent Bedford is a good example of someone who worked on building resilience and is now enjoying the results of his efforts. In practice for ten years, Brent experienced a major wake-up call two years ago in the form of a serious illness. Brent requested coaching on life goals and said he wanted to learn to be more gentle with himself, stop pushing so hard, and be less reactive in stressful situations. Brent said that the prior year facing a major health challenge was ?the most difficult year I had lived to date.? It was clear that one of the things Brent needed was more personal reserves and increased resilience.

We approached Brent?s goals with an internal rather than an external focus. As is the case with many clients, Brent discovered that what you manifest on the outside is closely tied to your internal motivation, intention, and way of being. Among other things, we addressed the need for him to pay more attention to self-care and to proactively mange his mindset.

I also coached Brent?s wife so that together they could better manage their busy family life. With both Brent and his wife, the attention was on fundamentals and they each had ?homework? between sessions, which included reflective exercises and body-based practices, mindfulness meditation, reading assignments, and applying new communication strategies.

?I have always strived and pushed hard to accomplish the goals I set for myself. I was very good at that, but I knew intuitively that I could not continue on that track without having it adversely affect my health,? says Brent. ?I am more relaxed with myself and the people around me. I no longer am striving for striving sake. There is an intent to how I make decisions and communicate . . . they are no longer knee jerk reactions.?

As Brent has become more relaxed it has impacted his practice in a positive way. To his surprise, Brent found that by working on himself and his personal goals he was concurrently working on his practice — even though that was not what he?d signed up for. ?One indirect benefit is that although I wasn?t working on my practice, it?s taken off to a new level,? says Brent. ?We?ve gotten extremely busy.?

Today, a year after he began the coaching process, Brent feels better physically, his practice is up 20%, and he works with ease. By taking time to heal and build resilience, both his personal capacity and practice have grown and are now being sustained with less stress and effort on Brent?s part.

Introductory Consultation:

Make 2007 Your Year for Success

Are you committed to taking yourself and your goals seriously this year? Focusing on developing and enhancing personal competence may be the most important thing you do in 2007. If you?re ready to move beyond short-term tactics and learn self-management skills that will to help you achieve your most important goals, then don?t wait — act now, while it?s on your mind. Click here to request a free consultation with Shelley Simon and get the support you need to have a truly great year.

Upcoming Issues:

April: Looking Ahead