Moral Injury, Organizations, and Leadership Faux Pas…

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As of recent, I have been reading journal articles and other material to create a presentation on moral injury. I have begun to see the real toll that it can take on those in the healthcare industry. It really is an expansive subject with far reaching implications for organizations at all levels. Moral injury occurs when a person is forced to do something that is not in line with their conscience and/or how they see themselves morally. This dissonance causes a great deal of stress within the individual. An example of this would be a combat soldier who was forced to kill another person in a firefight in order to prevent their own death. Much of the study of moral injury began with returning service men and women, however, the subject of moral injury has implications that reach well beyond the bounds of combat and war. Some instances of moral injury are obvious, but others lurk beneath the surface inflicting ongoing harm to a person. Moral injury is not just limited to people who do something that they ultimately feel violates their morals. It can also be related to feeling the need to act according to one’s morals and having a distinct inability to do so. This is where organizational leadership can come into play. If one is placed into a role where one is responsible to assist others in their suffering, but is not empowered to do, they may experience a deep sense of moral injury and in their care and concern for others, this can cause a great deal of angst and emotional suffering. You see, moral injury can be a type of trauma. The element that makes it traumatic is the notion of helplessness that accompanies it. Initiatives are created, policies improvements are suggested, but things are not implemented or improved because those that hold the ultimate decision making power don’t have to bear the emotional brunt of looking daily into the eyes of people who are subjugated and in pain. They don’t see the day to day struggle of individuals who are stressed to the nines in their personal life and then expected to come a perform in an exemplary fashion at work. As a matter of fact, often there is an intentional barrier built into the organization to protect the upper echelon from having to experience the “unpleasantries” faced by those in the lower organizational levels. Sadly, the greatest cause of moral injury for staff is precipitated by not feeling supported. In this place of perceived “professional abandonment,” people don’t feel seen or heard. This lack of support often stems from the greatest detriment that any organization faces, and that is the settlement for “good enough.” “Good enough” is and always will be the greatest adversary to true greatness. For those who see things as “good enough” may not have to be the ones who must look those who are struggling in their eyes. They are able to live in the walled up safety of their organizational cocoons where they can choose to focus on everything positive and spin the negatives to align with the narratives of positivity and progress. People are not stupid though. Eventually they recognize spinned information for the bullshit that it is. Those on the front line who are invested and who care know the truth…the truth that things are not wonderful. Eventually with enough “spinning” they begin to feel a sense of being patronized until a precipice is reached where their sense of moral injury begins to evaporate… and this is bad. This evaporation is not due to any therapeutic healing process, but rather it manifests in an effort to preserve one’s sanity and overcome the internal dissonance and the moral injury that is threatening the very being of the person within the struggle. This evaporation of moral injury is not indicative of healing…it is indicative of apathy and burnout. Reaching this point is the kiss of death for an organization. People either begin to quit at an alarming rate, or perhaps worse, they become hollow shells going through the motions… no longer able to empathize or connect with others in any real or meaningful way. Reaching this point is also the place where people begin to become dehumanized and social atrocities become more frequent. You see, moral injury is a sign. It is a warning that we are in need of a course correction and without this course correction we run the risk of tearing the bottom out of our humanity and our organizations. So, you might ask, how do we fix this? Well, that is a tough questions. It depends how far along the organization is in its decline. It may be too late and if that is the case, the entire situation may need to implode and start over. Ultimately, the common denominator for any organization interested in healing is a return to the basic needs that all human beings desire. We all want to be seen, heard, and appreciated. If people receive and experience those things, then they are able to extend them to others. So for leaders, I would suggest the following: Listen when people bring you struggles. Hear them out. Even if you can’t fix things, have some type of venue or mechanism to hear people out. Secondly, do not feel like you have to create some answer or solution to the concern yourself, and above all, don’t bullshit people! For the best outcomes, invite those who are actually engaged in the difficult situations to assist in creating viable solutions. This contributes to people feeling seen, empowered, and heard. Another suggestion that I have is for people and leaders to grow comfortable with discomfort. If you are a leader, have the tolerance to listen empathically to the struggles of those who are entrusted to your care. Cowards avoid the struggles, difficulties, and the hard situations…leaders who are effective and courageous lean into the struggles and recognize that the greatest growth can often stem from the most painful experiences. This is the essence of shared organizational responsibility and the single greatest piece to being able to address moral injury within an organization. My final suggestion is more than a suggestion. It is a mandate. Never forget that your people are not a means to an end. Your people are the heart and soul of the organization and if the heart and soul of your organization is corrupted, the product or service your organization is offering will be corrupted as well. At the end of the day, people can only live so long in contradicting circumstances. They can only be pushed to engage in activities that they fundamentally disagree with for so long. Eventually they will be torn apart by the dissonance and since the individual is a microcosm of the organization, then the destruction of the organizational culture will begin to follow. As Abraham Lincoln once said: “A house divided cannot stand.” The same is true for an individual and an organization. One final thought: If you are in a position of leadership and you find yourself hearing the plights and struggles of those under your charge and you don’t feel a tinge of moral injury…well, then perhaps you should reconsider why you have sought to be a leader in the first place.-

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