In Desert Waters’ signature course “From Corrections Fatigue to Fulfillment™” (CF2F), we repeatedly emphasize that wellness interventions designed to move staff from a place of work-related Fatigue to a place of Fulfillment are a two-way street in a correctional organization. That is, to maximize the probability of successful outcomes, interventions must be BOTH bottom-up AND top-down.

By bottom-up, we mean self-care and other health-promoting activities and behaviors that individual staff can practice on their own, independently of anyone else, on and off the job.

By top-down, we mean programs, resources, and system-wide policies instituted and implemented by the organization to promote employee wellness.

Bottom-up, individual-focused activities are about what employees can do themselves—and that no one else can do for them. They and only they can make these behaviors happen, and often only they know if they have disciplined themselves enough to follow through with these activities.

Individual, bottom-up, activities include good sleep hygiene; healthy nutrition; regular physical exercise; avoidance of substance abuse; engaging in breathing, stretching and other types of relaxation and mindfulness exercises; applying anger and anxiety management techniques; practicing effective interpersonal skills; and engaging in social and/or spiritual types of activities that give them joy and inner peace, and that confer positive meaning to their lives.

Organizational, top-down activities are those most directly accomplished by agency leadership through a broad variety of system-wide approaches. Examples of these are strategic well-being initiatives, messaging about and recognition of Fatigue issues, specifically-targeted training courses, intentional role modeling, new policies that address Fatigue issues (such as mandatory overtime, caseload size, and the ever-present exposure of staff to traumatic stressors), management performance objectives and evaluation criteria, budget and resource allocations, creation of new positions—such as wellness coordinators, staff psychologists or staff chaplains, and as always, increased staffing levels.

In other words, organizational, top-down activities require giving employee well-being the policy-level decision-making status equal to such traditional concepts as safety and security.

This could happen by measuring staff well-being programs in a pre-post manner to ensure return on investment; by requiring that staff training and literature on self-care and resilience-promoting behaviors be added to an agency’s employee development catalog; by offering confidential peer support, Employee Assistance Programs and other mental health and wellness services (if they don’t currently exist, or improving access to them if they do); by training supervisors to interact with subordinates in supportive ways, especially in relation to traumatic exposure and mental health issues; by carefully designed programs that increase family member understanding of the challenges of the job, and ways to cope effectively with such challenges; by changes in policies and procedures, where possible, to mitigate the impact of inherent stressors (such as creative staff-focused work scheduling emphasizing a reduction in mandatory overtime or constantly expanding caseloads); and by advocating for the notion that staff well-being is as crucial to agency effectiveness as are successful offender programs.

And this is where a good offense becomes the best defense. In some ways, several of the bottom-up approaches can be considered “defensive” maneuvers—figuring out ways to cope with the negative effects of exposure to inevitable work-related stressors, after the fact.

Top-down, organizational strategies, can be both “defensive”—such as, for example, the provision of a protocol for staff support following exposure to traumatic incidents—but, very importantly, they can also be “offensive.” This happens when the organization proactively puts in place policies and procedures to lessen the presence or negative effects of anticipated work stressors. When such policies and procedures are used effectively, staff do not have to expend (as much) energy trying to recover from the negative aftermath of workplace stressors, simply because there were supports already in place that they could recognize and count on, and perhaps even that they were not exposed to them in the first place or were exposed to a lesser degree. That is, organizational strategies can be preventative, and as such they can be invaluable. As the folk adage goes, “an ounce of prevention is worth a pound of cure.”

We at Desert Waters maintain that both these approaches are important and necessary. When contrasted with one another, effective top-down organizational strategies would seem to carry more weight—be even more critical than individual ones (ALTHOUGH BOTH ARE NEEDED), simply because of the energy-savings and the reduction (or even prevention) of damages. It makes sense to focus on fixing the leaky faucet, instead of just continually mopping up puddles on the floor. And it makes even more sense to check faucets periodically, proactively, to make sure they remain in good working condition.

Interestingly, we find reinforcement for this top-down/bottom-up strategic solution approach in research into the burnout of medical professionals. burnout among physicians seems to be a rampant reality, frequently measured in terms of emotional exhaustion, depersonalization, and reduced sense of accomplishment. Physician burnout can be seen as referring to the combined outcome of what we at Desert Waters call organizational and operational stressors. (Physician burnout studies do not typically address traumatic stressors—which is the third group of stressors that we propose contributes to Corrections Fatigue.) That is, there is abundant evidence that physician burnout is a commonly occurring outcome to the challenges of the medical profession—just as Corrections Fatigue is for corrections staff.

Two meta-analysis studies of the tools used to mitigate physician burnout address the same dynamic.1,2 (A meta-analysis study is research that combines and analyzes data of multiple other selected studies.)

The first paper1 concluded that both individual-focused (bottom-up) and organizational (top-down) strategies were successful in reducing burnout. However, only organizational, top-down strategies lowered the overall (total) burnout score to a statistically significant degree—10%.  That is, for reducing overall burnout, top-down interventions were more effective.

For this population, individual-focused (bottom-up) interventions were similar to those presented in Desert Waters’ signature CF2F course:

  • facilitated and non-facilitated small group curricula,
  • stress management and self-care training,
  • communication skills training,
  • a “belonging” intervention to emphasize connections with others, and
  • mindfulness-based approaches.

Top-down, organizational interventions included:

  • shortened attending rotation length,
  • clinical work process modifications,
  • shortened resident shifts,
  • changes in duty hour requirements, and
  • changes in practice delivery.

The second paper2 compared the effects of physician-directed (bottom-up) and organization-directed (top-down) burnout interventions on the emotional exhaustion component of burnout. Individual (bottom-up) interventions included techniques such as mindfulness-based stress reduction, exercise, and educational programs focusing on improving self-confidence and communication skills, individually or in combination. Organizational (top-down) interventions included workload interventions (such as rescheduling hourly shifts and reducing overall workloads), teamwork, and leadership.

Both types of strategies (individual and organizational) led to small, but statistically significant reductions in burnout. However, treatment effects were greater with organization-directed, top-down, approaches, that is, with interventions which took into consideration the effect of the work environment.

These findings provide support for the view that burnout is inherently a problem of health care organizations, rather than only being a problem of inadequate individual adaptations to work stressors.

The similarities and relevance to the challenges built into the corrections environment should be obvious. Yes, some staff adapt better than others. That’s only to be expected. But it is the overall environment and workplace culture that are most influential, so much so, that their persistent negative impact can wipe out gains accrued through individual bottom-up coping strategies, and contribute to a universal condition of Fatigue in the profession.

The authors of this study concluded, in language that should be familiar to all corrections leaders, that “[o]rganization-directed [top-down] interventions…that combined several elements such as structural changes, fostering communication between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout.” (p. 203)

Two additional studies point to the powerful effects of top-down interventions. In an Australian fire and rescue service agency, training supervisors to be sensitive and supportive toward their subordinates regarding their mental health struggles resulted is a significant reduction of work-related sick leave use, compared to not training supervisors to employ such skill sets.3 In another meta-analysis of a wide variety of job types, occupational psychosocial stressors (such as low job control, low reward, and high psychological demands) were found to increase by 76% the risk of sick leave use due to a diagnosed mental disorder.4 The implication here is that top-down interventions that lead to reduction of occupational psychosocial stressors can be expected to lead to reduced sick leave use due to diagnosed mental disorders. The authors of this study concluded that “[p]sychosocial stressors at work are frequent and modifiable. Thus, efforts should be made by employers … to develop organizational policies supporting workplaces in reducing these psychosocial stressors at work and, therefore, reducing the risk of mental disorders among workers.” (p. 849)

And this is where the challenge lies for correctional leadership: what staff-focused supports can we design into our traditional corrections environment on a system-wide basis to reduce Fatigue and enhance Fulfillment? Where can we take the offensive and proactively create conditions for improved resilience in our workforce? What strategies and what resources are needed to combat what we all recognize as a long-standing condition? Which programs work? Which don’t? And for that matter, why do it? Indeed, why pursue ways to reduce burnout (and overall Corrections Fatigue) among corrections personnel?

The reason is simple and obvious, and once again supported by physician burnout data. Yet another meta-analysis of physician burnout showed that burnout was negatively correlated to a statistically significant degree with patient safety and quality of healthcare.5 That is, the higher the physician’s burnout score, the lower the patient safety (in terms of physician errors), and the lower the quality of care. Physician burnout is in fact mission-critical.

With this robust research-based evidence as support, it is not much of a leap to suggest that burnout and overall Corrections Fatigue could have adverse consequences among corrections professionals also; that Fatigue could negatively impact the quality of offender management, and increase the likelihood of errors or lapses, resulting in policy violations, and hence reduced safety—with ensuing increases in incidents, injuries, death, and litigation risks. In other words, it does not seem to be far-fetched to conclude that countering Corrections Fatigue is in fact a mission-critical issue. So much so, that if we are going to do for the public what we say we are going to do, then proactively attending to the well-being of our staff is a crucial matter for corrections leadership.

Where does one start?

An easy answer is, start with what you’ve already got in place.

At Desert Waters we do not assume that an agency has not thought of these concepts before, and that no one has taken steps to address this long-standing condition. Quite the opposite. It’s very likely that you already have related training programs in your catalog, or that after-action employee support is currently written into physical force policy, or that creative scheduling has long been an issue you’ve wanted to address. Maybe now is the time to proactively enhance those programs. Maybe even do that by reassigning some resources for the purpose of giving these programs a renewed jump-start towards success. Perhaps it is as simple as just measuring the effectiveness of what you presently have in place. Or maybe it’s bigger than that. Maybe it’s a system-wide initiative to uncover and address Fatiguing conditions wherever they are found, and then strategically and intentionally target them to enhance Fulfillment for each and every employee. You know your agency better than we do.

In any case, we urge you to recognize and benefit from the research: the best defense may indeed be a strategically targeted, proactive offense. We are here to discuss these mission-critical matters with you further, bringing to the table our various approaches to complement yours.

References

1West, C.P.;  Dyrbye, L.N.; Erwin, P.J., Shanafelt, T.D. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. First published online 28 September 2016. doi: http://dx.doi.org/10.1016/S0140-6736(16)31279-X

2Panagioti, M.; Panagopoulou, E.; Bower, P.; Lewith, G.; Kontopantelis, E.; Chew-Graham, C.; Dawson, S.; van Marwijk, H; Geraghty, K. ; Esmail, A. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Internal Medicine. First published online December 5, 2016. doi:10.1001/jamainternmed.2016.7674

3Milligan-Saville, J.S., Tan, L., Gayed, A., et al. Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trial. Lancet Psychiatry 2017; published online 11 Oct 2017. http://dx.doi. org/10.1016/S2215-0366(17)30372-3.

4Duchaine C.S., Aubé K., Gilbert-Ouimet, M., et al. (2019). Effect of psychosocial work factors on the risk of depression: a protocol of a systematic review and meta-analysis of prospective studies. BMJ Open; 9:e033093. doi:10.1136/ bmjopen-2019-033093

5Salyers, M.P., Bonfils, K.A., Luther, L., Firmin, R.L., White, D.A., Adams, E.L., Rollins, A.L. (2016). The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine. First published online 26 October 2016. doi:10.1007/s11606-016-3886-9