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Author's Note: The structures and strategies outlined, though specifically written for managing stress and conflict in an allied/mental health organization, have applicability for a variety of organizations, departments and team.

Does Your Organization Practice Safe Stress?

Q. Any stress survival strategies for folks in mental health organizations battered by work pressures, managed care, increased competition among providers, a world full of intractable problems, and a pay scale that is less than generous?

A. Whew! I'm on the edge of exhaustion already. Budget cuts, reduction in resources and reimbursements, loss of patients and key personnel...managed scare tactics. Today, an increasing number of allied health professionals must "do more with less." Can anyone say "frightsizing" and "lean-and-MEAN"? Take heart. Have no fear (well, maybe a little)...the Stress Doc is here with his Seven Highly Effective Organizational/Professional Strategies for Practicing Safe Stress.

1. Engage in Group Grieving. I'm going to assume almost everyone these days is occasionally flirting with burnout; too many, I fear, still engage in casual stress. While I'll close the article with individual stress management strategies, let's start with a systems intervention for helping the community of employees grapple with the above-mentioned stressors and losses. And it's not just loss of funds, fees and familiar faces. Cynicism and despondency can build when we feel the organization, the profession, the health care industry and the larger society devalue our services and a once cherished mission. Workshops that allow departments, if not the entire organization, to gather and grieve, that enable folks to see the tragedy and comedy in an absurdist world, that encourage the working through of sadness and vulnerability, while focusing justified anger and helping staff regain a sense of purpose, play and control...rebuild the commitment fire.

2. Insure Your Pros with "The Triple A." The basic formula for runaway job stress is simple: a work situation having high demand and/or high professional responsibility paired with little authority or low control over work process and outcome. It's not just a heavy workload that's the culprit. People can thrive on reasonably high volume if they have some impact on timing, scheduling and flow. But, for example, when corporate, headquarters or the main office are making global, top down decisions that are fairly out of touch with local needs and operational realities the consequences are often demoralizing.

In these volatile times, here are two philosophical and policy pillars for supporting employee integrity: a) Encourage and Integrate The Triple 'A' of Professional/Organizational Responsibility: Authority, Autonomy and Accountability. Remember, management must let professionals exercise reasonable independence and individuality in thought and practice. Professionals must understand that accountability to clients and professional management, i.e., effective and ethical management, supports autonomy and credibility. Also, the accountability process legitimizes the need for and strengthens the quality of service delivery. b) Question the notion of customer as king. During my years as a stress consultant to the US Postal Service, customer service was top priority. However, the USPS realized that resentment and depletion build when an operation is customer-driven and employee negligent. To challenge an organizational ambience where "client is king" and staff are withered and weary peasants, consider my Basic Law of Safe Stress: "Do know your limits and don't limit your 'no's!" Clearly, I'm not saying slam the door shut on your client population. I do mean practicing "N & N" -- the ability to say "no" and to "negotiate," for example, the number of clients in a caseload or people seen in a day.

Closed door time is also vital for paper work, individual reflection and colleaguial bantering and nurturing. And speaking of nurturing, some private time and space allows for my favorite - brief, restorative power napping; highly preferable to caffeine overloading.

3. Make Task and Process Meet. "Not another meeting." "Who has time for meetings?!" These can become familiar, plaintive cries in a downsized, pressure-packed setting. Drastically reducing organizational, departmental or team meetings is only a formula for isolation and confusion; making community time meaningful is the key.

Many organizations under a time and resource crunch become increasingly task-driven. After the proverbial status report, meetings are run somewhat like the opening to "Mission Impossible": hierarchical assignments are detailed and delegated, though folks usually aren't asked if they choose to accept. Kidding aside, often lacking is some balance between a task focus and a relationship-group process one. At some point, the meeting needs to connect with how well people are working together, how coordinated the communication, how is stress and conflict being managed, within the team and among various departments...Is the atmosphere one of "esprit de corps" or esprit de corpse? Three suggestions: a) Establish a Wavelength Segment. In an hour or ninety minute meeting, set aside fifteen or twenty minutes for processing, usually at the end of the session. Individuals and the team as a whole can check in and tune in with each other. b) Rotate Leadership. A common mistake is always having a supervisor or manager run the show. Rotating the facilitator can enhance group involvement and commitment, reduce hierarchical decision-making and strengthen team concept and team morale. Also, this procedural shift gives supervisors an opportunity to be a real member of the group, providing an observational vantage point for better grasping group dynamics. The biggest challenge, as always, involves control and competition issues: whether the supervisor and the staff can be comfortable with his or her (i.e., the supervisor) wearing two hats - being both formal authority in a primary role and peer in the team meeting. c) Try a Morning Quickie. Sometimes an alternative to a formal meeting can be a ten minute huddle at the beginning of the day. How about warming up the team by sharing a joke or funny story, with a prize for the best joke of the month. A quick gathering makes it easy for giving the troops a heads up and for affirming that all are on the same day game page.

4. Envision Mission and Goals. With the above policies, structures and procedures in place, hopefully, your organization is no longer a candidate for becoming the land-based version of the Titanic. Agency and staff will not be sinking and disappearing. Perhaps management by crisis can be replaced by proactive leadership and creative consensus. This is especially critical after a major restructuring or downsizing. Set aside some team building/staff training time. If you haven't already done so, consider bringing in a "Team Visioning and Goal Setting" consultant. For a mission statement to be viable and for action plans that realize goals and objectives there needs to both short term and long range planning and buy in from staff.

Of course, the danger of a big picture retreat is that people and perspective can get swept away by ideals and rhetoric. Remember, there's often a fine line between vision and hallucination. To preserve that boundary, integrate past, present and future with my "Four 'F' Model of Loss and Change": 1) examine honestly and openly the strengths and vulnerabilities of the familiar past, 2) collectively grieve any loss of face or organizational identity and pride, 3) recommit to a collaborative method of conflict resolution to nurture a diverse, participatory team focus, and 4) explore new problem-solving options and opportunities for a pregnant and expansive future. (Hey, what kind of imagery do you expect in an article on "Safe Stress?")

5. Manage Stress Carriers. Now for a delicate matter. Some folks, even after partaking in these potentially rejuvenating steps, will not be able to rebuild the fire; there's no renewing a genuine sense of individual and/or organizational purpose and commitment. At least not on their own. A percentage may respond to individual supervision and coaching. Others may benefit from Employee Assistance Program (EAP) counseling or, hopefully, will seek out private psychotherapy. However, there may be a few individuals just not able to function in the still demanding day-to-day environment. I can't emphasize this enough: when management does not set appropriate limits and boundaries on such professional "stress carriers," team morale and productivity are contaminated and compromised.

Sometimes employees have to intervene with a supervisor or management before decision-makers realize they are ignoring or covering up for an impaired colleague (who also may be a personal friend or, even, a high producer). Clearly, fair, effective ("do the right thing') and efficient ("do the thing right") grievance procedures must be in place. Engaging this troubled individual is essential for his or her sake as well as for others. Remember, stress carriers (including managers in denial) may not get ulcers but they certainly can give them!

6. Fireproof Life with IRAs and PUNCH. Despite, or because of, the future shock pace of change, some professionals will have "been there, done that" one too many times. (Organizational crisis often surfaces chronic individual frustrations.) Maybe it's the 300th couple counseling session or "not another sexual abuser." These folks may be experiencing what I call 'The Bjorn Bored Syndrome (BBS)," named for the late '70s-early '80s tennis great, Bjorn Borg. Borg, after a five year reign, dramatically burned out on the circuit. BBS has a simply elegant formula: when mastery times monotony provides an index of MISERY! The answer: Fireproof your life with variety. And for management and staff I offer two stimulating acronyms: a) Organizational IRAs. Provide "Incentives, Rewards and Advancement Opportunities" for employees. Merit bonuses, new training, conference attendance keep the mind, heart and soul supple and dynamic. I experienced LMR - Lateral Movement Revival - from doing EAP Orientation training and short-term counseling when the New Orleans Family Services Society started an EAP venture with a federal government agency. The move also laid the groundwork for a future training/consulting career path. b) Entrepreneurial PUNCH. More than ever, organizations must develop new clients and resources. Professionals need to springboard from the office into the larger community to market mental health services. The entrepreneurial spirit is calling. I've detailed how to embrace it. (See "Adding Entrepreneurial PUNCH to Your Career Path: Surviving the Managed Care Scare," Treatment Today, Fall 1996.) Here's a quick outline of skills and strategies for entrepreneurial evolution and rejuvenation, whether a professional chooses to stay with the organization or to move on: P. Public Presentation. Public speaking and workshop leading is both a powerful marketing vehicle and a most challenging, exhilarating and growth producing opportunity. So too meeting a wide variety of consumers and colleagues. U. User-Friendly. Avoiding psychobabble and communicating ideas and concepts with an expanded audience - face-to-face or through writing and the electronic media - in a lively and tangible, meaningful and memorable style is critical. For example, are you ready to help folks "Practice Safe Stress" or confront "The Intimate FOE: Fear of Exposure?" N. Networking. Make connections with a variety of consumer groups and professional associations, not only with therapists and clinical societies. Recently, in addition to social workers, two dentists and a marketer attended my public speaking/program marketing seminar. Two years ago, hobnobbing with self-employed business folks opened the door to the wonders of space travel. C. Cyberspace and (Mass) Communications. There's a whole new internet frontier rapidly being explored and developed with myriad possibilities for clinicians and organizations - from EAP assistance and specialty chat groups to distance learning and training. Go web young cyber-ite! H. Humor. You don't have to be a standup comic, just appreciate the absurdity in the world and laugh at and share your own imperfect humanness. Remember, people are more willing, even eager, to open and receive a serious message when it's gift-wrapped with humor. Every mental health organization needs at least one in-house "psychohumorist" (tm).

7. Develop Psychological Hardiness. While this article has especially focused on team strategies, a vital group and community requires healthy and hardy individuals. Here are some final stress management strategies based on a study with AT&T executives. During the break up of Ma Bell in the '80s, researchers discovered four factors that distinguished execs susceptible to physical and emotional illness from those who demonstrated "psychological hardiness." To survive and thrive in a turbulent transition, build in these "Four 'C's of Masterful Coping": a. Commitment. While invested in the company's reorganization, the hardy execs didn't just have a work life. They had a life...and were nurtured by family, friends, religious practice, recreation and hobbies. b. Control. Hardy execs had a realistic and less rigid sense of control; they avoided self-defeating turf battles. A swollen ego did not hinder their stepping back and reassessing the changing landscape. c. Change. Quickly dealing with feelings of loss, while not harboring false hopes and illusions about the future enabled these individuals to explore new options. Hardy players viewed change as a stepping stone not a stumbling block. d. Conditioning. Finally, the most hardy execs engaged in regular physical exercise. Thirty minutes of aerobic exercise - walking, jogging, swimming, bike riding, etc. - releases the body's natural pain killers and mood enhancers. Equally important, in times of stressful transition, exercise grounds us when everything else seems up in the air; there's a beginning and end point, providing a tangible sense of accomplishment and control.

In closing, in these tumultuous times organizations must help rebuild individual energy. Management and professionals must together cultivate conflict managing and harmonizing team structures along with healthy boundaries both within and with the outer environment. Organizations also need to encourage career and skill evolution and responsibility for professional productivity and personal integrity. It takes a systems approach and individual hard work to forge that elusive balance: giving to your organization, colleagues and clients as well as getting from others and giving to yourself. But when you create that balance, you definitely are...Practicing Safe Stress!

Mark Gorkin, LICSW, the Stress Doc, a psychotherapist and nationally recognized speaker, trainer, consultant and author, is also known as AOL's and the internet's "Online Psychohumorist" ™. Check out his USA Today Online "Hot Site" website - www.stressdoc.com  and his page on AOL/Online Psych, Keyword: Stress Doc

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