_{Published May 13, 2022}

Over the last few years, we have heard a lot about resilience. What does resilience really mean?  How can we develop resilient teams and organizations? Furthermore, how can we help our patients to be more resilient? Resilience is often defined as the capacity to recover quickly from difficulties. Some equate resiliency with toughness. Another definition of resilience is elasticity, the ability to spring back into shape. Psychological resilience is characterized as the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly [1].

While resilience implies bend-but-don’t-break properties, there are a couple of issues to consider:

1. We don’t always return to our exact pre-crisis or pre-stress configuration;
2. Resilience can allow for personal growth and help to catalyze the growth of others.

Regarding our return to our original forms after a jolt to the system, we will never be exactly the way that we were previously. We are older, maybe heavier, maybe hungrier, and maybe more tired.  Furthermore, we probably learned something from the stress that we just endured. What we learned can lead to personal growth and the ability to share our new knowledge with others. This process of sharing and helping others has the potential to lead to more resilient teams and to help our patients become more resilient.

Historically, we have thought of resilience in terms of personal resilience—at the individual level. There is no question that personal resilience is important, but resilience can also apply to groups and teams. It is important to consider teams, especially in radiology, as most of our activities are team-related. In fact, very few of our activities do not involve teams. Just think of the process on the front end of any imaging study, before it gets to the radiologist for interpretation: there are schedulers, front desk personnel, nurses, physicists, and technologists. How do we make our teams more resilient and more effective?

One of the drivers for engaged, resilient teams is relational energy. Leaders with relational energy create a positive environment with higher levels of engagement, lower turnover rates, and enhanced feelings of well-being [2]. On the other hand, there are leaders who drain energy from the group, and the team members loathe working with an idea-killing, energy-sapping leader. In the book Multipliers: How the Best Leaders Make Everyone Smarter [3], Liz Wiseman discusses two types of leaders: The first group are diminishers, draining intelligence, energy, and capability from the people around them, and the second group are multipliers, leaders who employ their skills to amplify the strengths and the capabilities of those around them.

Multipliers can have a major impact on our teams and organizations in radiology. In this ever-changing, peri-pandemic world, multipliers can make us all more resilient, by doing more with less, by attracting and developing talent, by creating a safe environment that allows for our best thinking, by challenging us to push beyond what we know, by debating decisions, and by instilling ownership and accountability. Furthermore, multipliers do not need to be great at everything. Rather, effective multipliers should have some very solid strengths and few major deficiencies. In addition, effective multipliers often choose to form teams with others who bring complementary strengths to the table [3].

As we navigate the challenges of our topsy-turvy world with a major war in Europe, political divisiveness and the great resignation in the United States, and rising inflation, and as we try to re-equilibrate in the peri-COVID world, we need to be resilient as we continue to move our field forward and deliver top-notch care to our patients. Our patients really need us, not just to read their images and do their procedures, but to advocate for them with empathy and dignity.

When we go to work, it may be a good day, a bad day, or a usual, non-descript day. Often, our patients are seeing us on what may be their worst day ever or what they fear will be their worst day ever. I recently spoke with a patient who was diagnosed with a cervical plasmacytoma in 1994. Soon thereafter, he was shown to have multiple myeloma involving several sites in the cervical, thoracic, and lumbar spine. Despite chemotherapy, radiation therapy, an autologous stem cell transplant, and experimental therapy, he was told that his chances for survival were less than 5%. With each imaging study came the dread that more disseminated disease would be found. Nevertheless, during those encounters, he found front desk personnel, technologists, and physicians to talk to. Even amidst a downward cycle of relapses and remissions, a radiation oncologist suggested that he consider sperm preservation (he was single at the time).

Let’s fast forward to 2022, when the patient is a 30-year survivor of multiple myeloma, leading a foundation to help multiple myeloma patients; he is happily married, and his son is a college graduate! The patient was in a “very dark place” 25 years ago, worried that he would never see or know his son, and now, miraculously, he is a long-term myeloma survivor.

There are countless patients who come to us every day on their journeys of resilience. We have an obligation to engage them, to treat them in a dignified professional manner, and, hopefully, what was anticipated as a very bad day may not be so bad for them.

As we think about building resilient teams and resilient enterprises, it is important that we promote and practice empathetic, patient-centered behaviors. We need to be multipliers for our patients. 

Recently, I performed a biopsy on a small right breast mass on a 44-year-old woman. The procedure went smoothly, and the biopsy showed evidence of a papilloma. A few days after the biopsy, the patient’s referring clinician contacted me, informing me that the patient had a 4th ventricle ependymoma resected at age 5 years, and that the patient had diminished mental capacity. Immediately after the biopsy, the patient’s mother had asked to speak to me, but she was told that I was busy and that she should check the electronic medical record. I do not know who communicated with the patient’s mother, but I certainly would have made myself available to talk to her. As we try to be multipliers for our patients, we need to do better each and every day.

As we try to be resilient in this ever-changing world and form resilient radiology teams, we should keep in mind these words from the Cadet Prayer at West Point: “Make us choose the harder right instead of the easier wrong, and never be content with a half-truth when the whole truth can be won” [4]. We need to choose the harder right; our patients are depending on us.

References

1. Psychological resilience. en.wikipedia.org/wiki/Psychological_resilience. Wikipedia website. Accessed April 26, 2022
2. Stillman J. Yale research: having this 1 trait makes leaders 4x more effective. www.inc.com/jessica-stillman/yale-research-having-this-1-trait-makes-leaders-4x-more-effective.html. Inc website. Accessed April 27, 2022
3. Wiseman L. Multipliers: How the Best Leaders Make Everyone Smarter. Harper Business (New York); 2017
4. Cadet prayer. www.west-point.org/academy/malo-wa/inspirations/cadetprayer.html. West Point Connection website. Accessed April 28, 2022.