Dr. Kieran Steer

BEEP BEEP BEEP – my pager squawks at an hour of the night that no human eyes should know. I pull away from the gummed-up keyboard tied to admission notes to answer the page. I return to my note. Another page rings, “we have a new admission, can you get to it ASAP.” This renowned cycle of the on-call junior resident physician pounds through the night – soothed only by the comfort of stale saltine crackers and vending machine diet Coke. But, as the smiling sunlight rises and the new welcomed workday floods the hospital halls, I handover the travails of the 26-hour shift and depart. As I rest my head at home, I close my eyes against the beams of morning sun and attempt to reclaim my night.

I imagine this anecdote (saltines and all) is not-so-dearly familiar to many of my colleagues. It’s no wonder that workplace wellness has become such a huge topic over the past decade. The impact that workplace conditions have on mental health is being increasingly recognized and “burnout” has even recently gained official recognition on the International Classification of Diseases-11 (WHO 2019). Health care workers are particularly faced with an uphill battle with workplace wellness: long hours, stressful conditions and nighttime work, against a litany of other factors (Brand 2017, Brady 2018). The problem is known. Now what to do about it?

Unsurprisingly, the answer seems as multifaceted as the problem. Occupational health literature has shown an explosion of research on initiatives to improve workplace wellbeing, especially among health care workers. A promising sight, these interventions are consistently effective (Gray 2019). But figuring out how to consolidate and use this research often feels like canoeing through a tumultuous ocean of study designs, interventions and frameworks. While journeying through the literature, one needle that seems to always point North is looking beyond the individuals and towards higher-level system factors. There clearly isn’t a broadly inherent factor about health care workers themselves that is leading to wellness issues. The issue lies in the system that so crucially needs to support them. I spend a lot of time thinking about this very point: what changes in the system’s structure can improve wellness?

Indeed, a maze of trials, tasks and tribulations lies between our current societal state and the golden chalice of a truly effective system. Many of these barriers are mountains that years of advocacy and policy change will gradually erode. But I can’t help but wonder what hills we may not be seeing. While fighting the good fight, what simple things could we be doing to improve the wellbeing of those around us?

One seemingly neglected area of workplace wellness initiatives seems to be supporting interpersonal interactions. Policy and complex organizational interventions will pave the ultimate path to the chalice, but substantial ground may be achieved through harvesting the fruit of what we encounter most often: our day-to-day interactions with our colleagues. Findings ways to enrich the common experiences we share and spreading these benefits may be a potential piece of the workplace wellbeing puzzle.

Scientists have investigated how positive interpersonal interactions can influence our behaviours, mood and actions. One of the most studied forms of positive interpersonal interactions is in witnessing acts of kindness. And yes, you guessed it: that warm fuzzy feeling we get from an act of kindness does have an unnecessarily esoteric scientific name, “moral elevation”. Experiments attempting to understand moral elevation have shown fascinating neural responses. When witnessing a virtuous act, the body experiences a relaxing parasympathetic response but also a paradoxical arousing sympathetic response (Piper 2015). This combination of physiologic changes translates into feelings of inspired optimism and impetus to act altruistically towards others (Haidt 2005). It seems that kindness appears to cause a measurable positive reaction in our bodies that spreads like the virtuous contagion that we deserve in 2021.

Therefore, there’s reason to believe that interpersonal interactions may be an important and overlooked component of organizational wellness initiatives. Alongside the massive institutional overhauls and policy rewriting, simple efforts that empower people to enrich their day-to-day collegial interactions may be an effective and simple method to improve workplace wellness. Importantly, these interpersonal interventions would be virtually instantaneous in creating change, unlike the years of work behind policy revamps. Likewise, the financial and logistical requirements are pea-sized and easy to adapt, in comparison to the gym constructions and lifestyle benefits packages often proposed in the occupational health literature. The feasibility of interpersonal interventions in terms of time, budget and resources is powerful.

Armed with incredible feasibility, these interventions are limitless in the specific method used to empower and promote interpersonal well-being. Raising awareness, providing tokens of recognition for acts of kindness or opening up resources to carry out acts are all beautifully simple but effective aspects of wellness worth exploring and advocating for. And further innovative ideas beyond this little list should be explored. In summary, a focus on interpersonal wellness may be bite-sized organizational intervention that pays handsome dividends in its ability to propagate better workdays for numerous people. From the science, one may even reasonably conjecture that an act of kindness could give a bigger buzz to the junior resident physician on-call than the 4 a.m. vending machine diet Coke did.

Definition and Measurement. Acad Psychiatry. 2018 Feb;42(1):94-108. doi: 10.1007/s40596-017-0781-6. Epub 2017 Sep 14. PMID: 28913621.

Gray P, Senabe S, Naicker N, Kgalamono S, Yassi A, Spiegel JM. Workplace-Based Organizational Interventions Promoting Mental Health and Happiness among Healthcare Workers: A Realist Review. Int J Environ Res Public Health. 2019 Nov 11;16(22):4396. doi: 10.3390/ijerph16224396. PMID: 31717906; PMCID: PMC6888154.

Haidt J. Wired to be Inspired. Greater Good Magazine. 2005 March. Accessed February 5, 2021. URL: https://greatergood.berkeley.edu/article/item/wired_to_be_inspired

Piper WT, Saslow LR, Saturn SR. Autonomic and prefrontal events during moral elevation. Biol Psychol. 2015 May;108:51-5. doi: 10.1016/j.biopsycho.2015.03.004. Epub 2015 Mar 23. PMID: 25813121.

World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. 2019 May. Accessed February 5, 2021. URL: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

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