Presentation
Adaptive Resilience Team Training (ARTT): Addressing Burnout in Healthcare Teams
DescriptionIndividual-level resilience, defined as continued self-regulated goal-striving despite adversity (King et al., 2022); can be adaptive (i.e., taking a short break after a successful surgery) or maladaptive (i.e., continuing to work despite feeling ill) (Jean-Baptiste et al., 2023). Adaptive resilience can be observed when the individual’s goals are aligned with success and well-being – while maladaptive resilience is often only aligned with success (Jean-Baptiste et al., 2023). In healthcare, resilience is sought out, because as a unidimensional concept, it is a protective factor against burnout in nurses and physicians (Guo et al., 2017; West et al., 2020). Notwithstanding – the literature still finds that even highly resilient healthcare workers are at risk of burnout (West et al., 2020). Moreover, the empirical distinction between adaptive and maladaptive resilience has yet to be made in the healthcare context (see Owen et al., 2023, for a discussion on maladaptive coping, note resilience is unidimensional).
In healthcare settings, the picture becomes increasingly complex as teamwork is the norm (Lemieux-Charles & McGuire, 2006), and yet, resilient individuals do not necessarily make a resilient team (Alliger et al., 2015). On top of this, teamwork leaves individuals open to other variables that may affect their resilience capabilities, such as negative emotional contagion; with findings that physicians and nurses absorb anger from their colleagues, which may contribute to exhaustion and/or cynicism (Petitta et al., 2016; see Booth, 2010 for anger in nurses). Another variable is collective allostatic load (CAL), the “wear and tear” that groups accumulate over repeated stress and strain, linking to negative performance outcomes (Davaslioglu et al., 2019; Rosen et al., 2023). Therefore, we posit that in order to improve team-wide healthcare outcomes (such as simultaneously improving patient safety and reducing clinician burnout), we must promote adaptive team resilience. In this presentation, we build on Alliger et al. (2015)’s work and definition of team resilience– “the capacity of a team to withstand and overcome stressors in a manner that enables sustained performance [and well-being]” (see Alliger et al., 2015, p. 177 for original definition; Traylor et al., 2023, for the addition of well-being), by distinguishing this as adaptive resilience. By making this distinction, we seek to integrate literature on how teams can use group-level concepts (i.e., emotional contagion) to their advantage, increasing performance but not at the expense of other important outcomes (i.e., team member mental health).
Our presentation has three key takeaways. Firstly, our presentation seeks to inform teams that persevering through stress above all will lead to negative outcomes (Adler, 2013). Another takeaway of this presentation is the introduction of adaptive resilience team training (ARTT), using emotional contagion theory as the main point of guidance in aiding to increase adaptive strategies in healthcare teams. Lastly, ARTT seeks to teach teams that whether they use emotion (i.e., joy/anger) adaptively or maladaptively will result in either burnout or well-being, instructing them on how to take the adaptive route. By introducing ARTT, we answer a call to further understand how the shared experience of teamwork can enhance or dampen collective resilience (see Raetze et al., 2021, p. 889).
Extant research has established resilience is important for teams that experience challenges, both chronic and acute (Alliger et al., 2015). Healthcare is widely recognized as a workplace setting that if anything – consists of overcoming such challenges – such as the chronic shortage of nurses (Haddad et al., 2023), chronic underfunding of the U.S. public health system (Faberman & Kelley, 2023), healthcare workers’ burnout (U.S. Surgeon General, n.d.); and globally, half of the world lacking the healthcare resources they need (World Health Organization, 2017). It is clear healthcare is under strain, and developing adaptive resilient teams is needed.
Emotional contagion theory as a basis for team resilience
Emotional contagion theory states emotions can spread from individual to individual because of our ability to emphasize – and it is a two-way street, with both negative (i.e., anger) and positive (i.e., joy) emotions being contagious (Barsade, 2002; Hatfield et al., 2009). One study found that nurses’ moods were associated with the collective mood of their teammates (Totterdell et al., 1998). Over time, teams develop group-level affect, defined as “a function of individual team member mood, emotions, and sentiment” (Tee et al., 2015, p. 661); which has the capability to affect collective action and team-level performance (Barsade & Knight, 2015; Tee et al., 2015) via emotional contagion. Findings in the literature are conflicting, with some studies linking emotional contagion to emotional exhaustion (Pettita et al., 2016 found both joy and anger contributes to exhaustion and cynicism in doctors); and others recognizing that overall, team members’ negative mood has a negative effect on team performance (Jordan et al., 2006; Wart & Nielsen, 2018).
Our presentation will seek to establish a framework of adaptive and maladaptive resilience strategies based on emotional contagion theory. Booth (2010) recognized that anger can be approached both positively (i.e., expressing one’s anger without personally attacking anyone) and negatively (i.e., internalizing or displacing anger). Likewise, joy, whether approached as emotional labor (i.e., faking a smile to appear approachable) or as emotional work (i.e., giving a patient a smile to make their day better) can also lead to differential outcomes (Pisaniello et al., 2012). ARTT will seek to inform teams how to use positive emotional contagion to build adaptive resilience within the team, whilst informing them on how to reduce negative emotional contagion. Alliger et al. (2015) stated that resilient teams are those that minimize, manage, and mend challenges. For example, they may minimize a challenge by discussing risks beforehand; manage the challenge by continually providing status updates to team members; and mend outcomes of the challenge by conducting a debrief (Alliger et al., 2015). When it comes to positive affect, research has shown that when nurses were reminded of their occupational calling, they performed better (Zhu et al., 2021). Moreover, prosocial motivation was associated with occupational calling (Zhu et al., 2021). Therefore, ARTT will seek to inform teams on the pipeline of these behaviors and how positive affect, such as prosocial behavior, can help everyone perform. Notwithstanding, emotions have the capability to either build or decay team adaptive resilience. Teams that are capable of expressing negative emotions constructively were found to be more likely to experience knowledge creation within the team (Stephens & Carmeli, 2016). ARTT seeks to inform teams on how to use anger constructively, in order to manage it, moving away from using maladaptive anger strategies, such as internalization (i.e., anger-in, Evcili & Demirel, 2022; Felblinger, 2008), and externalization (i.e., anger-out, Satar et al., 2005).
Team training has been associated with positive performance outcomes in the healthcare context (Hughes et al., 2016). However, while existing medical team training programs (i.e., TeamSTEPPS, King et al., 2008) address providing team-based competencies, they do not focus on building resilience, and more so, they do not address maladaptive vs. adaptive behaviors. In light of existing individual-level resilience training techniques, such as HardiTraining, which includes videos, examples, and applied exercises over small group sessions (Khoshaba & Maddi, 2001); ARTT integrates these techniques into one session. ARTT will first teach teams the concept of resilience and its connection to burnout. ARTT will also inform participants on the concept of emotional contagion. Then, using videos and situationally-relevant examples, the ARTT instructor will go over adaptive and maladaptive emotional contagion strategies. Lastly, ARTT seeks to actively include participants by having them use role play, where teams have to model a) using anger maladaptively, and b) using it advantageously.
References available upon request.
In healthcare settings, the picture becomes increasingly complex as teamwork is the norm (Lemieux-Charles & McGuire, 2006), and yet, resilient individuals do not necessarily make a resilient team (Alliger et al., 2015). On top of this, teamwork leaves individuals open to other variables that may affect their resilience capabilities, such as negative emotional contagion; with findings that physicians and nurses absorb anger from their colleagues, which may contribute to exhaustion and/or cynicism (Petitta et al., 2016; see Booth, 2010 for anger in nurses). Another variable is collective allostatic load (CAL), the “wear and tear” that groups accumulate over repeated stress and strain, linking to negative performance outcomes (Davaslioglu et al., 2019; Rosen et al., 2023). Therefore, we posit that in order to improve team-wide healthcare outcomes (such as simultaneously improving patient safety and reducing clinician burnout), we must promote adaptive team resilience. In this presentation, we build on Alliger et al. (2015)’s work and definition of team resilience– “the capacity of a team to withstand and overcome stressors in a manner that enables sustained performance [and well-being]” (see Alliger et al., 2015, p. 177 for original definition; Traylor et al., 2023, for the addition of well-being), by distinguishing this as adaptive resilience. By making this distinction, we seek to integrate literature on how teams can use group-level concepts (i.e., emotional contagion) to their advantage, increasing performance but not at the expense of other important outcomes (i.e., team member mental health).
Our presentation has three key takeaways. Firstly, our presentation seeks to inform teams that persevering through stress above all will lead to negative outcomes (Adler, 2013). Another takeaway of this presentation is the introduction of adaptive resilience team training (ARTT), using emotional contagion theory as the main point of guidance in aiding to increase adaptive strategies in healthcare teams. Lastly, ARTT seeks to teach teams that whether they use emotion (i.e., joy/anger) adaptively or maladaptively will result in either burnout or well-being, instructing them on how to take the adaptive route. By introducing ARTT, we answer a call to further understand how the shared experience of teamwork can enhance or dampen collective resilience (see Raetze et al., 2021, p. 889).
Extant research has established resilience is important for teams that experience challenges, both chronic and acute (Alliger et al., 2015). Healthcare is widely recognized as a workplace setting that if anything – consists of overcoming such challenges – such as the chronic shortage of nurses (Haddad et al., 2023), chronic underfunding of the U.S. public health system (Faberman & Kelley, 2023), healthcare workers’ burnout (U.S. Surgeon General, n.d.); and globally, half of the world lacking the healthcare resources they need (World Health Organization, 2017). It is clear healthcare is under strain, and developing adaptive resilient teams is needed.
Emotional contagion theory as a basis for team resilience
Emotional contagion theory states emotions can spread from individual to individual because of our ability to emphasize – and it is a two-way street, with both negative (i.e., anger) and positive (i.e., joy) emotions being contagious (Barsade, 2002; Hatfield et al., 2009). One study found that nurses’ moods were associated with the collective mood of their teammates (Totterdell et al., 1998). Over time, teams develop group-level affect, defined as “a function of individual team member mood, emotions, and sentiment” (Tee et al., 2015, p. 661); which has the capability to affect collective action and team-level performance (Barsade & Knight, 2015; Tee et al., 2015) via emotional contagion. Findings in the literature are conflicting, with some studies linking emotional contagion to emotional exhaustion (Pettita et al., 2016 found both joy and anger contributes to exhaustion and cynicism in doctors); and others recognizing that overall, team members’ negative mood has a negative effect on team performance (Jordan et al., 2006; Wart & Nielsen, 2018).
Our presentation will seek to establish a framework of adaptive and maladaptive resilience strategies based on emotional contagion theory. Booth (2010) recognized that anger can be approached both positively (i.e., expressing one’s anger without personally attacking anyone) and negatively (i.e., internalizing or displacing anger). Likewise, joy, whether approached as emotional labor (i.e., faking a smile to appear approachable) or as emotional work (i.e., giving a patient a smile to make their day better) can also lead to differential outcomes (Pisaniello et al., 2012). ARTT will seek to inform teams how to use positive emotional contagion to build adaptive resilience within the team, whilst informing them on how to reduce negative emotional contagion. Alliger et al. (2015) stated that resilient teams are those that minimize, manage, and mend challenges. For example, they may minimize a challenge by discussing risks beforehand; manage the challenge by continually providing status updates to team members; and mend outcomes of the challenge by conducting a debrief (Alliger et al., 2015). When it comes to positive affect, research has shown that when nurses were reminded of their occupational calling, they performed better (Zhu et al., 2021). Moreover, prosocial motivation was associated with occupational calling (Zhu et al., 2021). Therefore, ARTT will seek to inform teams on the pipeline of these behaviors and how positive affect, such as prosocial behavior, can help everyone perform. Notwithstanding, emotions have the capability to either build or decay team adaptive resilience. Teams that are capable of expressing negative emotions constructively were found to be more likely to experience knowledge creation within the team (Stephens & Carmeli, 2016). ARTT seeks to inform teams on how to use anger constructively, in order to manage it, moving away from using maladaptive anger strategies, such as internalization (i.e., anger-in, Evcili & Demirel, 2022; Felblinger, 2008), and externalization (i.e., anger-out, Satar et al., 2005).
Team training has been associated with positive performance outcomes in the healthcare context (Hughes et al., 2016). However, while existing medical team training programs (i.e., TeamSTEPPS, King et al., 2008) address providing team-based competencies, they do not focus on building resilience, and more so, they do not address maladaptive vs. adaptive behaviors. In light of existing individual-level resilience training techniques, such as HardiTraining, which includes videos, examples, and applied exercises over small group sessions (Khoshaba & Maddi, 2001); ARTT integrates these techniques into one session. ARTT will first teach teams the concept of resilience and its connection to burnout. ARTT will also inform participants on the concept of emotional contagion. Then, using videos and situationally-relevant examples, the ARTT instructor will go over adaptive and maladaptive emotional contagion strategies. Lastly, ARTT seeks to actively include participants by having them use role play, where teams have to model a) using anger maladaptively, and b) using it advantageously.
References available upon request.
Event Type
Oral Presentations
TimeTuesday, March 264:10pm - 4:30pm CDT
LocationSalon A-4
Simulation and Education