Episode 13 | Dr. Julia Smith

Care2Listen Podcast | Season 2, Episode 1

I think there has been some learning done that can really take us forward and even help us now. We are thankfully not in the midst of the same type of pandemic, but our health system is in crisis.

Dr. Julia Smith:Author and Researcher, SFU

Content Warning:
This audio episode contains some sensitive content, such as discussions of addiction, the ongoing opioid crisis, suicide, grieving, and loss. As such, we recommend that you listen to it with caution.


In this episode of the Care to Listen podcast, host Sean Burke and Dr. Julia Smith discuss the impact of moral distress on healthcare workers, emphasizing the need for structural support and the importance of recognizing care work’s value to address health inequities and the mental health challenges faced by those in the healthcare sector.


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[00:00:00] Sean Burke: Welcome to the Care to Listen podcast. Today, I am joined by Dr. Julia Smith, an expert and researcher with over 15 years of experience in the healthcare field. In this episode, we discuss the impact of moral distress on healthcare workers, structural changes needed for support, And the role of women in healthcare with a focus on gender and health inequities.

Today’s episode is being broadcasted to you on the unseated and traditional territories of the Musqueam, Squamish, and SLE tooth nations. Welcome back to another episode of the Care To Listen podcast, dedicated to supporting caregivers mental health and wellbeing. I’m your host, Sean Burke, and today we have a special guest joining us, Dr.

Julia Smith. Dr. Smith is an expert in the healthcare field. She’s an assistant professor at SFU in the health sciences. and has an extensive background, um, when it comes to research and experience and understanding the impact of moral distress on healthcare workers. So we are so privileged to have you here today, um, Julia.

And, uh, I know that you were able to ride your bike in on a wet, cold, uh, winter day here in Vancouver. So thank you for taking the time out of your day to come and be here with us. 

[00:01:13] Julia Smith: Thank you so much for having me. It’s a pleasure. 

[00:01:16] Sean Burke: Well, we always like to kind of just get this show started, um, by giving an opportunity for our guests and hosts to introduce themselves.

So why don’t we start there and, you know, you can maybe share a little bit about who you are. 

[00:01:28] Julia Smith: Thanks so much. Yeah, I did ride my bike in. I live here in West Van on the unceded territories of the Squamish, Musqueam and Tsleil Waututh people. And as you mentioned, I work at SFU in the Faculty of Health Sciences where I conduct research on health policy and health systems, often applying a gender lens to look at how gender inequities structure our health delivery and work in the healthcare field.

I’m an interdisciplinary social scientist, so that means I draw from a lot of different fields, [00:02:00] um, to, to ask these sort of research questions. Uh, my background is in social and international studies. I studied in the University of Bradford in the UK previously, and I’ve also lived and worked in a number of different contexts in Europe and sub Saharan Africa.

But I’ve now been here at SFU for probably almost ten years now, and, uh, Yeah, I’m just really happy to be here today. We’ll 

[00:02:25] Sean Burke: also just throw in a little side note. Also a soon to be best selling author, but already the author. Um, and just, you know, I know from your experience and, and what you bring to the healthcare lens, in particular from that research perspective, there’s so much that we can, can gain from you here today.

You know, There’s so many different jumping in points, uh, don’t know where to, we can actually start today. So why don’t I put it back to you? Where would you like to focus on in terms of, you know, what you do and, you know, when it comes to just talking about the impact of moral distress on healthcare workers, um, maybe could you, let’s start with the book, um, and go from there.

[00:03:08] Julia Smith: Sure, I’d love to start there, um, since it’s not best selling yet, but, but one can hope. Um, so I recently published a book called Conscripted to Care, Women on the Front Lines of the COVID Response. And that book brings together the lived experiences and stories of almost 200 women who were engaged in frontline work during 2020 and 2021.

So that includes nurses, Doctors, also some of the folks we don’t always think about as frontline workers, such as childhood educators, midwives, and, and even parents who I count as frontline workers, because we all know parents do lots of care work. And that, that book came about almost by accident. What happened was in 2020, I started a project called the Gender and COVID Project, and that was actually a big international project looking at the gendered effects of the pandemic [00:04:00] across 12 different countries, including here in Canada.

And as I started that research, some women physicians with the Equity, Diversity, and Inclusion Committee at Vancouver Physician Staff Association reached out and said, Hey, we’re doing these focus groups, trying to understand women’s experiences. Would you like to join? And I said, of course. Um, and so I started to do some research with them about women physicians experience.

And that snowballed. I ended up doing work with Safer Care BC, with the Hospital Employees Union, with the Nurses Union, just really trying to collect these experiences. Uh, that were so profound, so telling, um, so important at that time. And, you know, doing the academic thing of writing articles and that sort of stuff, but also, you know, trying to talk to a lot of people in the media, talk to policy makers, and get the stories out there to influence responses so that the needs of these women who are really carrying all of us through this pandemic, um, could be understood.

Um, so that book, so In sometime in 2021, I realized I talked to, you know, hundreds of women, health care workers and other care workers about these topics, and an editor reached out and said, Do you want to write a book? And I said, Sure. So I pulled them all together. And when I was writing that book, there were a number of themes that came out.

And one of the themes that came out, It’s really truly pronounced was around moral distress and I found that all of these healthcare workers were having very notable experiences of moral distress and moral distress is the experience of not being able to provide the care one feels ethically responsible to provide, um, because of structural constraints.

So, for example, when you work in long term care and you’re caring for so many patients, you cannot make sure that every patient has a regular bath, because you just don’t have time because you’re understaffed. That feeling of letting down [00:06:00] that patient or that resident would be a feeling of moral distress.

And so I started. That’s one component of the book. Um, and then even with the book, you know, kind of being finished and out there in the world, I still saw a lot of need to continue research in this field. And so we recently did a large survey of over 3000 healthcare workers also about moral distress, 

[00:06:23] Sean Burke: just a little bit of work.

Um, and so fascinating, obviously, the time of doing this research with, you know, so many of the unknowns, um, going through the pandemic, and you You know, I’d love for you to take us back to those days when you were doing those, that research, you were, you know, coming up with some of, I guess, the results of that research and then trying to find different sort of ways to take that research and, and put it out there, like you said, talking to media, um, sharing some of your findings, what was it like for you in that time, uh, to be able to, to go through that process?

[00:06:59] Julia Smith: That time, I think for all of us, was challenging in so many ways. I honestly wasn’t prepared for the, the emotion and trauma that I was going to encounter through these conversations. You know, in research at the university, you have to go through ethics review, and you have to come up with safe ways of doing your research, and we did all of that.

All our interactions were virtual. Um, and I started to interview women, healthcare workers, and um, hold focus groups. And I had to stop because every single interviewer, focus group, there was somebody in tears. And there were times when I got off the phone, or the call, and I was in tears because these were just Such profound stories.

You know, I can think of one nurse I was speaking to who recounted an experience. Uh, she was working in a COVID ward and somebody had, had crashed. So they needed like immediate life saving help [00:08:00] and she had to get on all her PPE before she could go into the room because that was the protocol. And it took her longer than normally, than normal.

And so when she got into the room, she didn’t get in fast enough. And she was telling me this story, and you could tell she had so much guilt. Um, and so it was those types of stories that really sat with me. Um, so we, you know, as researchers, we took the steps of making sure we always had a trained counselor present.

So if people were in an interview or a focus group, they could always go into another Zoom room and speak to a professional right away. As well as making sure they had connection to resources otherwise. Um, and that was really necessary, um, at that time. It left and because people were sharing these very personal and very challenging experiences with me, I did, you know, feel a responsibility to take those and do something meaningful with them.

People are so generous in sharing their lived experience with reason. lived experience with researchers like me. Um, so I really did want to share those, um, back to, to people making decisions to the community. I think though lots of us know healthcare workers, lots of us know caregivers, we don’t always fully understand what they go through in the day to day.

Um, so it’s, it’s been a privilege to be able to share some of these findings out. 

[00:09:18] Sean Burke: And part of the show really is to, to help. Caregivers, um, to to learn and to understand that it’s it’s not them alone, um, who may be experiencing some of the challenges, um, going through. You know, some of those different, um, mental health challenges.

And so, I’m curious, like, listening to some of those stories, um, being able to speak with over 3, 000, um, participants, was there anything that stood out, you know, beyond obviously the, the core title, um, and the impact of moral distress on healthcare workers, but was there anything that you were surprised by?

[00:09:58] Julia Smith: There was a lot I was [00:10:00] surprised by. I was surprised by some of the conditions that people work within. Um, you know, when I think of, you know, I’ll give you one example that relates back to moral distress and long term care, and that was You know, uh, a long term care aide describing a situation where she was constantly understaffed.

So first, coming back to the issue of baths. So first, um, you know, residents were not getting baths every week, and then they weren’t getting baths every two weeks, and then they weren’t getting baths every four weeks. And the moral distress of knowing that people were living in those substandard conditions was, you know, extreme.

On the other hand, I was also just so amazed by the extra care that people took, the extra work they did, um, to overcome some of these situations. And it was Like, what we might refer to as little things, but are really big things. So, for example, long term care workers who took it upon themselves to hook up, um, Netflix, make sure Netflix was working in everybody’s room.

Um, other long term care workers who, um, assisted residents in getting onto Facebook and social media so they could communicate with others. And so it was those extra things that people were doing. To, to improve the situation that was just really also very inspiring. 

[00:11:20] Sean Burke: Like you said, it seems like it’s the, the simple things, the humanizing experiences of being able to support somebody and to care for them.

Um, in addition to all of the other work that, uh, healthcare providers and long term care workers, um, offer to their, their clients and patients. So, after, you know, Discussing and sort of identifying some of those challenges. Was there any, um, work that was done around identifying some of the coping strategies or ways that those health care providers were working through some of those challenges?

[00:11:55] Julia Smith: So in the survey we’ve recently did, we did ask about preferred coping [00:12:00] strategies. So We wanted to know when, when you’re dealing with moral distress, how, how do you cope? What do you feel is most effective? What’s most accessible to you? Most respondents commented that it, what they needed to cope and to deal with moral distress was more time.

So they, the answers were like more time with family, more time with friends, more time to exercise, more time in the outdoors. Um, more time with pets. Um, so that was definitely a key theme. Um, was that. people are really looking for more time. People also noted that peer support groups were quite helpful.

Mindfulness exercises, sort of in the immediate term, were seen as helpful. Um, one thing that’s I think is interesting and related is that we, we ask people about sources of moral distress. So what, what is it specifically? What kind of incidents cause moral distress? So lots of those were, um, you know, feeling like they had too many patients or residents to take care of, so they couldn’t provide quality care.

Um, but one of the ones that came out highest was lack of time for self care. So there was also this contradiction that people identified, um, the most effective strategies such as. You’re having time with family or friends, but they didn’t have the time. Um, and I think it’s really important for people to be able to do that or to take care of themselves, and they actually felt, um, like, distressed over that.

I remember one, um, care aide saying to me, like, people need to stop telling me to take care of myself. Like, taking a bubble bath is not going to fix this problem. And I think that’s really important, right, that, that it’s these bigger challenges, the sources of poor mental health and moral distress in this case, wasn’t that people weren’t taking time to relax, it was that they didn’t have the time to relax, that they were overworked, um, and working in really challenging situations.

[00:13:52] Sean Burke: And when I think about what potentially could be a solution to providing more time to healthcare providers, [00:14:00] I mean, Where do we start with that? That to me sounds like a foundational, a structural, um, change that needs to happen. Um, do you have any advice or any sort of work that was done around 

[00:14:13] Julia Smith: that? We have done, you know, a degree of policy analysis and we talked a lot to the healthcare workers as well as people in leadership positions about this sort of challenge.

You know, as we know, and we’ve seen in the media, our government and our health system leaders are very aware of staffing crises in, um, in the care sector right now, and they’re trying different strategies, um, to address that. Um, so that’s, I think there is a recognition of that problem already, and then at least.

Some effort, whether, you know, I think we have to wait and see how those government led efforts will play out. Um, one thing that I heard from participants was the need for more flexibility in work. So maybe even if it’s not about reducing shifts or hours in work, but having more flexibility. When we asked about moral distress, we also asked about moral distress related to unpaid caregiving.

Um, so Most healthcare workers are not just caregivers when they’re in a long term care facility or a hospital. They’re also caregivers at home. They’re taking care of children or elderly relatives or friends and family. Um, and this imposes a lot of moral distress and stress that can lead to other mental health challenges as well.

And so some of the solutions could also be to reduce that, those time burdens. So, for example, increased access to child care. And again, we’re seeing our governments make some positive steps to increasing access to child care, but still a lot of families in BC don’t have that access. And we definitely heard that this was a source of stress for many health care workers.

Um, there could be some innovative solutions about on site child care at health facilities or close to health [00:16:00] facilities, and specifically child care that corresponds with shift work. Again, in BC, we have very, very few options for shift workers when it comes to child care. So addressing the child care gap could increase the time that health care workers have.

to then, you know, take part in those activities that help them cope with the challenging situations. Um, another change that came up was that many, you know, when we asked about coping strategies, we noticed that accessing counseling services was actually quite low on preferred strategies, which surprised us.

But there were a number of comments that noted that They didn’t have adequate access to mental health supports, that their benefits programs only were for a certain number of visits per year, um, Or that they didn’t have access to in person mental health supports when that’s what they preferred. And so I think increasing those mental health supports, access and coverage for mental health supports would be another key step that could really help improve mental health in the short term while we try to address some of these bigger structural issues within our health system.

And what 

[00:17:11] Sean Burke: I love about that is the fact that You know, from your perspective, you’re doing this research and we’re seeing, okay, there, there are some challenges, but at the same time, you know, here are some of the, the steps that we can take in the interim, while some of the more foundational and structural changes are, you know, being tried to be dealt with.

Um, I know that so many of our listeners here are probably like, Oh yeah, that’s me when it comes to childcare. Um, you know. I’m somebody who myself, I know that, you know, if, even if there’s something as simple as a snow day, um, which happened a couple of hours last week, uh, you know, the scrambling, trying to figure out what are we going to do, um, and I know from your perspective, when it, when you talk about some of the, you know, the lens or the focus on gender and some of those health inequalities, [00:18:00] I’m curious if some of those research, you know, you might be able to elaborate on, on what some of those 

[00:18:04] Julia Smith: findings were.

Yeah, definitely. So as I mentioned, the first bulk of research we did during 2020 and 2021 was specifically with women, and we selected Um, women as the group we are working with, because we know that in Canada, 70 percent of health care workers are women. We also know that women in Canada, on average, do two to three times more unpaid care compared to men.

So that’s the care work of children, elder care, taking care in the home, that type of work. And during COVID, women faced disproportionate impacts in terms of Lots of income as well as stress and anxiety. So Oxfam Canada did a survey in the summer of 2020 where they found 70 percent of women they surveyed experienced increased stress and anxiety due to increased care burdens because of COVID.

And all of that comes down to lots of You know, the gender roles and norms that are dominant here in Canadian society. So we decided to focus specifically on women to better understand those inequities and those experiences. And The themes, those themes really have come out in that research, a lot, a lot of healthcare workers, you know, spoke about the moral distress not just related to their professional work, but their unpaid care work and the relationship between the two.

So, for example, when they’re working in a long term care facility that’s experienced an outbreak, and at home, they’re also taking care of an elderly relative. They were living with this constant fear. of bringing the virus to somebody who’s going to be extremely vulnerable. Following that research, we then did our large survey, and in that survey, we, um, interviewed, or we surveyed people of all genders, um, to look at, to see if there were differences in moral distress, um, [00:20:00] amongst genders, and that was interesting, too.

We found some small differences, um, One interesting finding actually that was that when it comes to unpaid care work in the home, men were experiencing more moral distress than women. And that was tied to feelings of feeling unqualified to provide care, which I think again comes back to this gender norms and how we assume that this is some, you know, that caring is something women do naturally.

Um, and then therefore men don’t do naturally. Um, which obviously is, you know, a perception and a social construct. Um, So there’s been some very interesting findings there, but I think women’s, so we often talk about women in Western, um, settler culture having a double or a triple burden. So, women do the work, most, most women are now in the care, like in the career, um, sector and in paid employment.

They also do the majority of care work at home. And then they take on sort of household and family management responsibilities, so the tasks of like remembering somebody’s birthday and checking in on neighbors and those sort of tasks. Um. Um. And so this puts an added burden on them, especially in times of crisis, which we saw during the COVID pandemic, but also in times like of challenges within the health system as we’re experiencing right now.

[00:21:24] Sean Burke: And I’m wondering, you know, based on that research that was done during that period of time and the magnification around the impact or the burden that was placed on women, was there, well not was, it sounds like there’s a need for men obviously to step up and this is a societal, um, shift that needs to be made.

So from your perspective and then again following some of the research, knowing that, you know, the impact on moral distress was, So how do we ensure that that’s when brown color is again, that that’s when anything is greater with men there? Does that show that some change is happening? Or, [00:22:00] you know, what, what more?

I mean, these are two very different questions, but what more needs to be done to to shift that thinking and, you know, maybe balance the load a little. 

[00:22:10] Julia Smith: So we COVID did lead to men taking on increased caregiving responsibilities during that time period. So we, especially when schools were closed, child care was closed, we did see men taking on more child care related, um, activities than women.

Um, so that’s interesting, and I haven’t seen any research to note if that’s been sustained or not, but I think we are generally seeing a shift, which is really positive in, um, many of our homes and communities. Um, I think there is still so much farther to go, and I think some of this is about societal norms and perceptions.

You know, um, Supporting men who want to take on caregiving roles. There’s been some interesting research around mandatory paternity leave, or improved paternity policies, and how that has trickle on effects throughout, um, like over decades, actually. So I think that’s part of it. I think we also need, and this is, I mean, this is sort of philosophical, but, we need to shift how we think about care work, whether it’s paid or unpaid.

We tend to undervalue care work, and that’s partly because it’s feminized. It is something that We, uh, we don’t see as a skill or something that’s really hard. It’s something that we think, Oh, well, all women do this. So it must be easier. It comes naturally. Um, but anybody who works in long term care or in hospitals can tell you that this is incredibly hard work, right?

There’s more WorkSafeBC claims in long term care than any other sector because it’s so physical. Um, And so we know it’s one really physically hard work, but it’s also very intellectually hard and emotionally hard and all these other aspects. And so I think we need to change how we value care work. I think it’s devalued because it’s feminized.

And if we can [00:24:00] increase how we value it and challenge those norms around feminizing care work, I think We might be able to attract more men into caring professions for one thing, which would be great. Um, but also, you know, address some of those inequities in our families and communities. 

[00:24:16] Sean Burke: And even just thinking about some of our previous conversations in terms of having, you know, a lot of health care workers being female.

And then when we do often see some of, um, you know, their male colleagues, the, the level or, you know, the,

Um, and then when it comes to having decisions that are being made that ultimately affect, um, you know, the opposite gender, I’m curious how, you know, from a lot, again, some of your research, how does that show up? 

[00:24:57] Julia Smith: There was a lot of. You know, findings around those power imbalances in my research. We, in our, the conversations with healthcare workers, we heard again and again about how they wanted input into decision making.

And this actually comes back to the theme about what do we do about moral distress now? So one of the sources of moral distress is feeling powerless. And providing opportunities for people aren’t doing frontline work to engage in decision making and have a voice and have meaningful input can reduce moral distress and improve.

Their mental health. So I think that’s one thing that’s really important right now. Health leadership does tend to be male dominated. If you look at the pay scale in health professions as well, you see that men on average make more than women. We see the health professions that tend to be valued and paid higher, like physicians to be male dominated, where community health workers, for example, tend to be more women and lower paid.

Um, so that’s a major inequity that. [00:26:00] I think, you know, truly needs to be addressed.

And the reason that needs to be addressed is that we do know that when we have more diverse decision making, and that would include more women in decision making, more people of, um, different genders as well, trans people and gender diverse people in decision making. It would also include more racialized folks and also perhaps younger healthcare workers.

Um, their needs are going to be heard better and policies will hopefully, therefore, be more responsive. When we don’t have that, we see gaps, um, and they can have really, like, direct effects. I can give you an example, um, from the first year of COVID, when I was speaking with the women physicians I mentioned earlier.

And one woman physician explained how, when the schools closed in March 2020, Male colleagues sent out an email to the female colleagues and said, Hey, if you have to give up your shifts, don’t worry, we’ll take them, like, we’ll handle this for you, because we know you’re going to have to go take care of your children.

And the women physicians were furious about this, because they thought, why are you assuming we have to give up? Why are you assuming we will do that? We also have to earn an income, many of us are the breadwinners in our families. Uh, and then the colleagues that had put out this call were in return offended and thought they were being very, like, enlightened men that they were trying to help their female colleagues, um, by making this offer.

It was just that they hadn’t fully understood the situation because that wasn’t their lived experience. Um, And so that’s an example of why you really need people with that lived experience in the room, talking about, okay, how are we going to handle the allocation of shifts now that we know, you know, everybody’s kids out of school?

How do we do this in an equitable way? 

[00:27:56] Sean Burke: And having those open conversations, you know, bringing [00:28:00] diversity into the room and ultimately making those decisions with an informed, um, and holistic view on, You know, the, the total impact I think is, is key and something that I know from your research perspective, you know, like you’re alluding to, um, starting those conversations, moving them forward, um, being part of some of those societal changes.

So as I’m listening to so much of, you know, what you’re saying, the facts that you’re providing, I’m sitting here being like. Well, this is a lot, um, especially being a male and, and having sort of that new perspective on, you know, some of the data that came out of your research. So how, you know, from a perspective of somebody who cares and wants to, you know, have a better world for not only, you know, my family and others, and also the next generation, like what can men do right now to be part of the solution?

[00:28:58] Julia Smith: You know, in 2020 and 2021, when I was doing this research, there was a lot of media. I’m going to get to your question, but there’s a lot of media interest in in the research. And so I did over 500 interviews at that time. And every single time people asked me this question, like what can be done? And especially, you know, in the height of COVID there, I always said, men can help with care work at home.

They can like do the laundry and cook and clean and like, and really think about if they’re doing the equitable, you know, portion of work. Um, and it was like never quoted in any of like the print articles and it was always cut. Um, so please don’t cut that. But I think like more broadly thinking about our, our healthcare system.

I mean, I think there, there is a call for leadership and for all leadership to change. How They address some of these issues and we do see, you know, EDI [00:30:00] initiatives in all of our health authorities and health systems and lots of employers have them. But I think there needs to be really meaningful change.

For example, I remember a story from somebody I interviewed who was a woman in sort of middle management in a hospital in 2020. And she was talking about how she was getting these directives about COVID protocols from above. And she was told, okay, you need to change, you know, the mask rules this day. No, no, now we’re doing this.

And everything was constantly changing and it was really hard on her and her staff. And so one time the person from above said, you know, you have to make this change. And she said, okay, it’s Friday afternoon, everyone’s exhausted. Can I implement that change tomorrow morning, first thing Saturday morning?

And the person responded, if sure, but if people die, it’s your fault. And this, this woman actually, um, It’s, it’s, uh, a really tragic story, because she ended up having a heart attack. She was okay. Um, she’s okay now, but she went through quite a health crisis, and when she spoke to me, she said, this was caused by moral distress.

She said, I’ve never had a heart issue before in my life, it was caused by moral distress, and then she gave me that example. And so, I think we do need to change how, We communicate how decisions are passed down, particularly during times of crisis, because that’s when we see more of this sort of command and control style approach.

I also spoke to numerous, um, health care providers who told me that they were accused of caring too much when they made suggestions like, oh, well, can we change this instead, or my staff are overworked, or my patients are struggling because we can’t let in visitors. The feedback they got was you care too much, leave your heart at home, which I think is really troubling because as a person who, you know, has loved ones who need health care, who will need health care, and sometimes needs health care themselves, [00:32:00] like, I want the people who take care of me to care too much.

Like, I want them to care as much as possible. Um, but that is seen, or that was treated as a negative attribute. And again, that’s a really Feminize critique. And we often critique women for being too emotional or caring too much. And somehow they’re supposed to be able to separate their emotional feelings from the work they’re doing, caring for an elderly resident or somebody who’s come into the hospital and labors, whatever the situation is.

And, and they don’t separate those things, you know, they’re, they’re, they have an emotional reaction to it. And I think we need to recognize that as a positive and a strength. Um, and again, that comes to shifting how we think about care and how we think about these attributes that we often feminize, um, to value them and say, caring too much is a good thing.

We want our physicians to care too much. We want folks to care too much. And then having leadership and people in decision making value that. And tap into that as a resource, as opposed to making it a weakness. 

[00:33:04] Sean Burke: And some of these examples and stories that I’m hearing, you know, I’m, uh, immediately I’m thinking back to leadership.

And, you know, what makes and constitutes a great leader. Um, and having people who want to follow and, you know, work hard with you. So that’s something you know, as I’m thinking about here is how do we provide that support for leaders who are open to listening? Who aren’t, you know, directing blame or putting unnecessary burden on their staff?

Um, it was, was there anything else that sort of came out when it came to leadership in in the workplace and a little bit more around the organizational behavior of how teams were created through through these 

[00:33:47] Julia Smith: challenging times? Yeah, I mean, so When we think about COVID specifically, especially if you think about the first year, we saw, you know, that was a [00:34:00] very specific style of leadership, crisis response, and crisis response, even in the health system, it comes from a tradition that actually is built on Like military modalities and from the business crisis response word, crisis response world.

Um, and those traditions are very, very masculine. They’re very top down, um, very command and control. Um, they don’t provide opportunities for feedback and consultation and. That was a problem. And I heard that over and over again from the people I spoke to that we just want to have a voice. We want to tell people what it’s like here on the floor of this long term care facility because they don’t know.

Um, and without knowing that we can’t have an effective response. So there’s there’s alternative models, right? There’s, um, there’s carrying models of leadership. There’s there’s ways to have more consultation. And I think we do really need to see that that shift. And I think In turn, that will have knock on effects in terms of strengthening the health system and empowering healthcare workers, you know, to be able to take care of themselves better.

[00:35:06] Sean Burke: That reminds me so much of the conversation we had earlier around just the concept of ethics of care. Yeah. Um, and, you know, having you share a little bit about valuing the care and the caring aspect equally as we value that productivity and so often I’m, I’m hearing that, you know, there’s this need for productivity to try to get, you know, clients released as quickly as possible, free up beds and, you know, obviously that that’s an important part of the healthcare system, but equally the, the valuing the work that people are doing.

And caring for those people is really important in building up those really great work environments. So, was there something, you know, specific that stood out when it came to that ethics of care perspective that you were talking to? 

[00:35:56] Julia Smith: Yes, the ethics of care is, you know, it comes from [00:36:00] feminist philosophy and it recognizes that in most Western liberal societies, we tend to value individualism and production.

So when we look at what’s valued, it’s about my right as an individual to work, to vote, to go walk down the street. And we, what we count in terms of, you know, our, National income, for example, GDP is all financial. Where as from an ethics care perspective, It’s recognized that none of that is possible without caregiving, without relationships between people, without somebody to feed and clothe and care for everyone, so that we can then enjoy these individual rights, or so we can go out and contribute to society or the economy.

None of us can do that without care, whether it’s self care or the care of others, and usually it’s a combination of both. So from a feminist ethics of care perspective, it’s We want to value that care work the same way we value other aspects of our society and our economy. And that comes back to needing to really recognize that in leadership, from leadership.

Um, And recognize that that care work is both the care work that’s happening in health facilities, um, and care facilities, and the care work that’s happening outside of it. And this comes back to kind of our conversation about what happens when you have more diverse leadership. If you have people in leadership who have care responsibilities who are also going home to take care of grandma or have somebody in their family with a chronic health condition.

They’ll understand, okay, we need flexible work hours for caregivers, or we need to make sure there’s, you know, accessible child care for, Our staff, Um, and they’ll be able to understand that and value that. Um, but even, you know, I think anyone if they if they take a moment, it’s not hard to reflect on how important the people who take care of us are to our [00:38:00] own health and well being.

[00:38:02] Sean Burke: And, you know, I feel so fortunate and privileged to be able to have this opportunity to sit with you, um, to basically have like a private tutorial session. Um, and, you know, I’ve learned a lot from today’s conversation. I’m curious as you continue to do this work, one of the things that I’ve recently started hearing is, You know, we’ve talked a lot about COVID, COVID, COVID, COVID, and now, like, can we just forget about COVID, um, and, and move forward?

And in particular in the healthcare space, um, you know, I’m curious what sort of that thinking or, you know, if there’s been any new research that’s been done or is currently being done that, that talks about that shift from, you know, thinking of, like you said, that pandemic, uh, response to now, okay, more of moving forward.

[00:38:51] Julia Smith: I also hear a lot of like, let’s just move on and forget about COVID. I think that’s really, really dangerous thinking because we risk not learning from our experience. We have been through this profound experience, and we do need to learn from it. And that takes a lot of time and energy and reflecting on unpleasant memories and mistakes and admitting mistakes.

And like, it’s it’s hard work. But you know, when In March 2020, when COVID was declared a public health emergency here in B. C., colleagues and I wrote a paper about the gendered effects of pandemics in other contexts. So we talked a little bit about SARS that had been here, we talked about Ebola and Zika, um, and H1N1.

And we said, these are the lessons that were learned. There’s not very much, there wasn’t very much research or data at that point, but we had some, right? And, uh, we published that commentary in The Lancet. And it did get a lot of Um, interest and people responded to it. And that that was great. But I really didn’t feel like there was a lot of taking on those lessons and applying them to COVID.

We made the same mistakes again, basically. [00:40:00] And if you look back, um, to the reports after their SARS outbreak, you can see. In those reports data about nurses mental health and about how nurses struggled to manage care responsibilities at home and at work, and it’s all there. And we just saw the same thing happened with COVID.

Um, so unless we can meaningfully reflect on that and take it on board and deal with some like some hard truths about what happened. Um, I think we really risk making the same mistake. So that’s.

I think there has been some learning done that can really take us forward and even help us now. We are thankfully not in the midst of the same type of pandemic, but our health system is in crisis. We do. We are understaffed in all aspects of health care work. The long term care sector is still struggling and we have an aging population like there’s a lot going on now that can really, you You know, the lessons that we have learned can be applied and we can also take some of the methods and the questions we’ve been asking and continue to ask them in order to make sure these issues and like, and the needs of healthcare workers aren’t lost.

[00:41:16] Sean Burke: There’s so much there to unpack. Um, and even throughout this conversation, you know, I’ve been reflecting on my own personal life. Um, and responsibility and what that means to be, you know, a husband, a father, um, and, you know, how to be part of the solution, uh, and not to perpetuate the, the problem. When, when you think about, you know, and as we’re sort of signing off here, I’m curious, like, what, what Do you hope and would love to see over the next, you know, 10, 15 years, uh, when it comes to the healthcare profession and some of the changes that this, um, the industry could 

[00:41:59] Julia Smith: make?[00:42:00] 

That’s a great question. Um, you know, I think we really need to see sustained effort around addressing the staffing crisis. Um, and looking at how that relates to people’s lives. Um, and also we’re looking at, you know, whole lives and well being. So, for example, you know, as we mentioned before, um, you know, some of the quicker wins around having on site childcare and how that might help address staffing, right?

So looking beyond just health care, to look at how health care sits within our broader social economic structures. Because, well, I appreciate that, like, when I talk about women’s experiences, um, um, um, um, You know, it’s wonderful to hear, to hear men and fathers and brothers and, uh, others saying, okay, well, like, what can I do?

That’s, that’s such an important step, but the big changes are structural. They need to happen at the structural level. They need to happen, you know, in terms of government policies and at the leadership level. Um, and those like leaders could be of any gender, but it’s some changes like I think need to happen there in terms of how they value care work.

Um, I think our, you know, our long term care sector in particular needs a major structural changes. Um, and like the BC senior advocates and others have written a lot about that. But I think if we can address some of the inequities in care in that sector, that will make better working conditions for healthcare workers.

I’m really encouraged that there is so much increased awareness of mental health challenges amongst healthcare workers through like initiatives like this podcast and the work of lots of different great organizations. I think that’s really important, but then we need to see increased benefits so that people experiencing mental health challenges can then access care and support.

Um, so I’d like to see, you know, those changes. There’s other, you know, Simple but not simple changes around, you know, increased sick days for people, um, who work in, um, care professions. I think that’s really [00:44:00] important considering their increased risk, one of, of, of illness, but also increased risk of, you know, mental health stressors.

[00:44:07] Sean Burke: Well, so much, um, you know, hope and so much work to be done, definitely. But I think, you know, where do we start from? And so much of that is because of the work that you and your team are doing when it comes to the research, when it comes to discovering consistencies, um, challenges that, that a lot of healthcare workers are experiencing.

And I think opening up those, that conversation around this is a reality. How are we going to move forward? What are we going to do to take those steps to make those changes? And, you know, without that work, without identifying some of those, um, you know, having that data to support. What everybody is saying, seeing, feeling and talking about.

I mean, it really helps to start moving those conversations forward. So I wanted to thank you for, for coming on the show today, Julia, for sharing so much of your research, your passion, um, and for doing all the work that you’re doing, because it really is making a difference. Thank you so much. Thanks for listening to this episode.

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