In the presidential address of the London Vet Show 2022, Malcolm Morley, president of the British Veterinary Association (BVA), reiterated the need to invest in people and create good veterinary workplaces as a means to tackle the mental health and recruitment and retention crises the profession is facing. Indeed, burnout, depression and compassion fatigue are all topics the veterinary industry has become well-versed in over the past few years.
But how can we move beyond the rhetoric? And what practical steps can we take, personally, as a veterinary team and within veterinary practices to “reignite the passion”? Beckie Mossor, RVN and programme director at the Gurnwick Academy of Medical Arts, attempted to answer these questions during this year’s conference.
What is compassion fatigue?
Compassion fatigue is often referred to as “vicarious traumatisation” or “secondary traumatic stress” (Figley, 1995). It is a condition characterised by the emotional and physical exhaustion often linked with exposure to working with those suffering from the consequences of traumatic events. Compassion fatigue can co-exist with burnout; however, they can be distinguished, as burnout may not be trauma-related, and those suffering from compassion fatigue often try to continue to provide care, while those with burnout will actively disengage.
“Compassion fatigue is like congestive heart failure – a slow decline; they don’t realise anything is wrong until it’s wrong – that’s us,” says Beckie. “Until we hit rock bottom, we don’t fully realise […], and it’s going to be a slow climb back up.” However, “ethical fatigue is where we [vets] live,” says Beckie. “[Ethical fatigue] is an emotional distress, where we say, ‘I know I can do better and I can provide better care, but I am at the limitation of my client’s financial ability and emotional capacity’.” So, we can no longer act in a way that is consistent with what we believe is the right thing to do.
‘Compassion fatigue is like congestive heart failure – a slow decline; they don’t realise anything is wrong until it’s wrong’
Added to this is the amount of pressure veterinary professionals face. As mentioned across numerous sessions at the London Vet Show, veterinary professionals are among the most trusted professionals, with 94 percent of the public either completely (34 percent) or generally (60 percent) trusting veterinary surgeons (RCVS, 2019). This places veterinary surgeons above general practitioners and dentists but behind opticians and pharmacists. However, vets are somewhat at the mercy of the client, with many facing abuse while navigating the increasing rates of pet ownership and the unprecedented impacts of COVID-19 and Brexit, not to mention the cost-of-living crisis.
Focus on compassion satisfaction
So, the question remains, what can we do to change this? “Words matter, and our mindset matters. Language matters. As long as we’re really focused on compassion fatigue, we aren’t thinking about the other opportunities we have and other mindsets we can have”, argues Beckie. She attests that the veterinary industry needs to focus on “compassion satisfaction”, which can be defined as the pleasure you derive from successfully doing your work or “the feeling you get when you have a simple case, and the client goes home happy”, she says.
‘As long as we’re really focused on compassion fatigue, we aren’t thinking about the other opportunities we have and other mindsets we can have’
Appreciative inquiry and the four Ds
Compassion satisfaction finds its basis in the theory of appreciative inquiry (AI). AI is not new – it was first coined by Cooperrider and Srivastva in 1987 – and has been widely applied in organisational change across a variety of industries, including human healthcare.
With a strong theoretical base in positive psychology, AI takes a strengths-based approach to achieve emancipatory change and learning rooted in the experiences of stakeholders. Essentially, every individual, team or organisation has strengths that work well and can be elaborated or expanded to co-create a reality (Arnold et al., 2022).
AI applies a four-step model or “four D” process to identify a problem, analyse the cause and suggest or trial solutions (Figure 1). The process starts with discovering and appreciating the best experiences (discovery), imagining the ideal – how it would be if those valued experiences happened most of the time (dream), defining the dream more clearly and discussing steps towards realising it (design), to wide-ranging actions, improvisation, learning and adjustments (destiny) (Arnold et al., 2022).
Embedding the four Ds into veterinary practice
There are several practical steps individuals, team managers and practice managers can take to build on the foundations of the AI change process (Figure 2).
Although these steps are well known – define the areas where you thrive and where you don’t and create and implement solutions for this – the key to success is making space for reflection. In this process, setting dates for check-ins to revisit the plan and adjusting the course of action is essential, and managers should schedule these in advance. However, individuals also have a responsibility to make sure these are in place and encourage their set-up if they are not.
Although these steps are well known – define the areas where you thrive and where you don’t and create and implement solutions for this – the key to success is making space for reflection
Becky emphasises that “do less of what we don’t like and do more of what we do like” is the essence of AI. Of herself she says, “I hate surgery […], but there is someone in your clinic who loves and thrives on surgery.” One of the key assumptions of AI is valuing differences: rather than focusing solely on democracy and equality, there is space to leverage what individuals enjoy. “There is someone in your practice for every single thing that you need. Everyone brings something unique to the table, and [this is] how they can thrive in the practice”, Beckie continues. “Practice managers can leverage what individuals in the team enjoy, where they want to be, and doing more of that helps increase our satisfaction.”
However, as individuals and managers move through the process outlined above, there will inevitably be activities that no one wants to do. For the audience attending Beckie’s session, it was the initial consult. Noting issues in staffing, Beckie suggested leveraging the veterinary nurse team, where appropriate and feasible, to accommodate this. Other examples to offset “what we don’t love” included: moving to a four-day-week shift pattern, changing shift patterns and setting up regular team-building events within work time.
Understandably, there will be limitations. For example, “in an emergency department, you may not have time for regular breaks, and there is little you can do to avoid this. So you could cater lunch for the team so at least they know they have food”, says Beckie. Change-making can be difficult in corporate practices; however, changes only need to be small and can be flexible. Beckie suggests focusing on “the 1 percent change. Ask yourself, what is your 1 percent change, and how can you support your team in the clinic to achieve this?”
The personal level
On a personal level, we need to recognise our emotional capacity to take things on. The search for compassion satisfaction acknowledges the importance of boundaries in what we do, to avoid overburdening ourselves or forcing ourselves to be perfect. Perfectionism is at the core of the problems the veterinary industry faces.
Beckie does concede that “there isn’t going to be 100 percent answers” to the search for compassion satisfaction. However, there are practical steps that can be taken as individuals, teams and as a whole practice to minimise stress and enable “percent increases in satisfaction to get a little bit closer” to reigniting the passion.