How to leave work at work: Psychological Debrief for Primary Healthcare staff

Many Primary Care leaders talk about their work-life balance. Working late and taking work home, in terms of stress, rumination, problems and patient experiences.

In this chapter, we will share a tool that helps high-pressure workers to leave work at work.

The Psychology of Transitioning

Humans evolved from tribal lifestyles into what are now highly complex social, technological and performance environments. The level of pressure and complexity common to Primary Care staff is a lunar leap from the tribesmen and women we were only a baby step back in the evolution of our species.

Whilst our worlds have exploded in complexity and responsibility, our base biology and Psychology is in many ways much the same. We have been successful in exploiting our psychological resources in creating the world we now occupy.

It is important to pause and think about what life was like for humans pre industrialisation and even pre-agriculture. The idea that our brains would be juggling thousands of tasks a day, interacting over digital media, making 100s of complex decisions an hour and all of this embedded in a team of individuals all with similar workloads — it would have been beyond imagination. Yet this is how we live and it is the norm for many of you.

But this is not our entire life. In between these 8–12 hour shifts, we are meant to de-role and return to our lives where we live again like our ancestors — our small tribes (families and friends), with household tasks and social hobbies.

On a rapid daily cycle, we are tasked with picking up this complex identity and then putting it down and being emotionally, socially and perhaps romantically available.

Needless to say, this is a challenge and one that we did not really evolve well for.

We are better equipped to hold stress, ruminate about the day and to take the tension home and release it there at the distress of our tribe or hold it in until we become ill or isolated, or both.

Punctuating work and home

There is much to be done about work stress and approach, addressed in this book.

Here I want to introduce a task that helps us to drop work and to become available for our lives outside of work. A task I have taught 100s of professionals and shared with 1,000s of NHS staff via online videos etc. A debrief.

This is a task that supports us to Psychologically draw a line between work and home — and is surprisingly powerful. I worked with many terminally ill young men in my NHS role and found this an essential part of my role, to enable me to arrive home without those experiences in my mind.

The debrief task

1. When work is over, create a symbolic exercise that signals an end. Take off your work badge and put it in a draw. Put your diary or notes in a draw. Take off your work blazer or jacket and replace it with your home jacket. Make this an intentional act in which you are either putting the day in a draw or taking off your ‘uniform’ and replacing it with your ‘true identity’.
2. End work in reality: Laptop and phone off and away until the next day (yes, this can be done — even in primary care!)
3. Journey home: Consciously notice that you are moving away from work and towards home. Consciously invite positive thoughts about home and what it has in it that you love and look forwards to.
4. For remote workers: take a walk and engage in the same task. Create a sense of a commute.
5. Ground: When you arrive home, engage in a grounding exercise. Inform your family that you need 5 minutes to settle in before all of them descend on you — or if you live alone, give yourself 5 minutes before trying to engage in your home life. Undertake an activity that has a sensory component. Take a shower, get changed, drink tea, light a candle with a smell, hug a teddy… whatever appeals. Breath easily and notice that this sensory sensation is nice and you like it. Notice that it is a sensation common to your home and not work. Invite more of it. Invite yourself home.
6. Arrive home: Now you are home. Work is over. The laptop is away, the phone is off and you are present. Enjoy it!
7. (Optional) Panic rescue: Something comes to mind that you realise you need to remember or attend to. Write it down, stick it in your laptop or work diary and promise yourself to get to it as soon as you are ‘back’ at work.

Summary

Leaving work is a psychological task but one we can learn.

This task, when practised daily, becomes powerful on the days when we are most challenged and stressed. We build a practice that can rescue us and always make us available for the recharge that our home lives can bring.

It is not easy when we are starting from a life where work is not contained — but it is a clear route to changing that.

Put Away

Walk Away

Arrive