Long-term care facilities & organizational healing
Welcome to Day 3 of our course, focused on resilience-building in the long-term care sector in the aftermath of the COVID-19 pandemic. Today, we explore how these institutions and individuals can heal after this crisis strengthening their adaptive, collaborative, and inclusive capacities. Long-term care environments, crucial for supporting one of society’s most vulnerable populations, faced immense challenges during the pandemic.
Many employees witnessed the devastating impact of the virus on their residents, whilst struggling with mitigation strategies that frequently involved complex ethical dilemmas. The crisis not only exposed existing vulnerabilities in this sector, such as overburdened healthcare systems and lack of protective equipment, but also subjected long-term care staff and residents to traumatic experiences. Now, in the aftermath of the pandemic, we can reflect on these many challenges experienced by this sector and additionally look into opportunities for creating paths to resilience and growth.
Our goal is to understand how crisis-related challenges can be transformed into strengths, fostering a healing-oriented culture. This transformation can be linked to the concept of “organizational healing,” which emphasizes recovery from trauma and growth within organizations.
We will explore various strategies that contribute to this healing process, including inclusive capacity-building, adaptive responses, empathetic leadership, and continuous learning. Meanwhile we highlight the importance of empathy and collective storytelling. Using examples from ethnographic research in Dutch care facilities, we will explore whether long-term care staff pursue “organizational healing” and how this helps them in recovering from COVID-19-related trauma and growing stronger.
We will concluse the day with a discussion session to reflect on implications for practice, policy, and the broader impact on community well-being. These strategies can be applied beyond the long term care sector to other contexts, helping to promote healing after crises and resilience. By doing so, they can cultivate more resilient and compassionate communities, in order to be better prepared to face future challenges.
Organizational healing in the long-term care sector as a response to the COVID-19 crisis
The COVID-19 pandemic has profoundly impacted the long-term care sector, revealing both its vulnerabilities and strengths. Nursing homes and other care facilities encountered numerous challenges, including high infection rates, severe staff shortages, and the emotional toll of isolation and death among residents. Consequently, nursing homes as organizations suffered, resulting in accounts of organizational trauma.
This article examines the concept of organizational healing, an academic framework designed to respond to trauma within organizations and help build long-term resilience enhancing the well-being of both staff and residents. Drawing on examples from Dutch nursing homes and research conducted after the pandemic, we explore how organizational healing remains relevant in 2024 and beyond, as long-term care facilities continue to face challenges in a rapidly evolving world.
Organizational healing: A framework for long-term resilience
Organizational healing represents a process through which institutions recover from trauma while simultaneously strengthening their adaptive, inclusive, collaborative capacities to face future challenges. Unlike traditional crisis management, which often focuses on returning to a pre-crisis state, organizational healing emphasizes continuous growth, learning, and resilience. In long-term care settings, where both staff and residents have endured significant trauma, healing involves intentional and ongoing efforts to rebuild trust, restore relationships, and enhance psychological and emotional health across the organization. Below, we explain several capacities and strategies that contribute to organizational healing, and reflect on how this may serve the long-term care sector in responding to their pandemic-related traumas.
Adaptive capacity: the need for flexibility
A first component that fosters organizational healing is adaptive capacity – the ability to adjust and respond flexibly to changing conditions. This is crucial in long-term care settings, and even more so in a post-pandemic era. The sector continues to navigate new challenges such as emerging diseases, workforce shortages, and evolving regulatory environments.
During the pandemic, care facilities had to quickly adapt to new guidelines and protocols to protect residents and staff. For example, some nursing homes swiftly created dedicated isolation units for COVID-19 patients, helping to contain the virus and protect other residents. These actions demonstrate how crises can accelerate decision-making processes, which are typically prolonged by bureaucratic procedures.
However, significant barriers to building resilience remain. Bureaucratic processes often delay critical decisions, and limited funding restricts access to essential resources and training. Systemic issues such as understaffing and inadequate mental health support for staff further complicate adaptation efforts. Moving forward, addressing these barriers is essential to enhance resilience and foster healing in a post-pandemic world.
Inclusive capacity: the strengths of empathy and empathic leadership
Secondly, empathy is fundamental to organizational healing, providing a foundation for trust, understanding, and support. In long-term care settings, empathy enables staff to connect with both residents and colleagues, fostering a sense of community and mutual respect.
A key strategy for building empathy is collective story-sharing, where staff and residents openly share their experiences of trauma and recovery. This process reduces emotional burdens, strengthens social bonds, and creates a more resilient community prepared to handle future crises.
In trying to foster empathy, leadership plays a vital role in fostering an environment conducive to organizational healing. Effective leaders create spaces where empathy and story-sharing are encouraged, recognizing the importance of acknowledging emotions and trauma. By showing their own vulnerability and empathy, leaders set a tone that breaks down hierarchical barriers that are often hindering open communication.
During and after the pandemic, leaders who demonstrated compassion and transparency helped their organizations navigate uncertainty more effectively. These qualities remain crucial outside of crisis times, as they promote a culture of openness and trust that supports both recovery and ongoing resilience-building.
Collaborative capacity: the continuous and collaborative process of trauma distillation
Whilst these elements of organizational healing can be found within the COVID-19 crisis, the prolonged and unpredictable nature of the pandemic exposed the limitations of traditional approaches to organizational healing. Where previous approaches focus on acute crises with clear beginnings and ends, the pandemic constitutes a creeping, slow-burning crisis characterized by a prolonged incubation time, an unclear beginning or end, and rapid
escalation towards tipping points. For these prolonged crisis periods, the concept of trauma distillation offers a more nuanced approach, suggesting that healing involves a continuous process of collaboratively revisiting and reflecting on deep-seated organizational wounds.
This line of thinking acknowledges that trauma from long-term crises is complex and multi-layered, requiring sustained efforts to address underlying issues. By keeping the healing process active and open-ended, organizations can build resilience over time, preparing them to face future challenges more effectively.
In the photo exhibition that will follow after this article, we explain how we used the concept of trauma distillation to foster and study organizational healing within the long-term care sector in the aftermath of the pandemic.
Overcoming barriers and building resilience
Despite the many lessons learned from the pandemic, several institutional barriers continue to impede resilience-building in long-term care. Bureaucratic red tape, limited funding, and systemic issues like understaffing present significant challenges. On a larger scale, streamlined regulatory frameworks, financial incentives for innovation, and policies encouraging community engagement can help organizations adapt more quickly and effectively. In the absence of such large-scale changes, investing in the mental well-being of staff through in-house counseling services, stress management programs, and other support initiatives can potentially increase organizational resilience.
To build a resilient long-term care sector that is better prepared for another future pandemic or other similar crises, institutions should focus on strategies that support organizational healing:
Creating Safe Spaces
Develop environments where staff feel comfortable expressing their feelings and experiences without fear of judgment. This can be achieved through regular check-ins, support groups, and open forums.
Empathy Training
Offer training for caregivers and leaders on practicing empathy effectively, utilizing workshops, role-playing exercises, film screenings, and mentorship programs.
Encouraging Story-Sharing
Facilitate platforms for collective storytelling, such as narrative sessions, written reflections, or multimedia projects, to build a sense of community and shared understanding.
Supportive Leadership
Leaders should actively engage in the healing process by demonstrating empathy, vulnerability, and a commitment to resilience-building efforts.
Continuous Learning and Adaptation
Promote a culture of continuous learning and adaptation, encouraging staff to acquire new skills and strategies for resilience, including access to ongoing training, resources, and professional development opportunities.
The framework of organizational healing remains a vital strategy for building resilience within long-term care facilities, not just as a response to past traumas but as a proactive approach to future challenges. By fostering empathy, encouraging collective story-sharing, and promoting supportive leadership, these institutions can create a strong foundation for sustained well-being and preparedness. The concept of trauma distillation underscores the importance of continuous healing efforts, recognizing that resilience is a dynamic process built over time. As the world continues to change, long-term care facilities can leverage these practices to emerge stronger and more capable of facing future challenges, ensuring they are not merely responding to past traumas but actively cultivating a more resilient future.
Photo exhibition: organizational healing in COVID-19 aftermath
Building on the framework of organizational healing and the concept of trauma distillation, we put theory into practice by organizing workshops aimed at fostering organizational healing and therefore resilience among employees of an Amsterdam-based long-term care organization.
Methods
The workshops began with a screening of Loose Ends, an ethnographic film about the hot phase of the pandemic and associated crisis response in Dutch nursing homes. This ethnographic film combines documentary storytelling with in-depth qualitative research to provide insights into the experiences of nursing home employees during the pandemic. For participants, watching this film was like stepping into a time machine; it transported them back to the height of the crisis and offered a shared point of reflection on their collective experiences.
Following the screening, nursing home employees participated in an arts-based workshop where they created personal artworks representing their emotions and experiences during the pandemic. During this process, they engaged in conversations, discussing the thoughts and feelings that arose. The session culminated in a symbolic ritual: each participant presented their art work to the group and placed it into a “Shelf of Memories.” This act served as a tangible representation of the healing process, allowing individuals to externalize and share their emotions in a supportive environment. The Shelf of Memories became a physical embodiment of their collective journey toward healing.
Organizational healing
The intention behind these workshops was to create a safe space where the elements of organizational healing—sharing experiences, expressing empathy, and supportive leadership—could be actively practiced. By engaging in creative expression and open dialogue, participants navigated the emotions they experienced during the pandemic and its aftermath. Discussing these emotions opened a platform for reflection, recognizing the trauma the organization endured and what they learned from the crisis, representing the underlying mechanisms of resilience-building and crisis recovery as a continuous process.
The workshops and the artworks that stemmed from them exemplify how trauma distillation can occur through the use of creative mediums, facilitating conversations that are less likely to come up in the everyday lived experience of an organization. By leaving behind these visualizations of the employees’ stories on the Shelf of Memories at the organization, conversations can be sparked among those who did not attend the workshops, continuing the process of trauma distillation beyond our involvement.
Results
We are pleased to share several works from these workshops in this photo exhibition. Each piece, regardless of artistic skill level, offers a glimpse into individual narratives. We invite you to engage with each artwork: first, interpret what you see and consider why the employee chose to express themselves in this way. Then, listen to a (translated and anonymized) audio clip where the creator discusses their piece. As you explore each work, reflect on the potential conversations they might inspire and how intentional healing practices can impact the journey toward a more empathetic and resilient future—not just in long-term care, but in any organization committed to social impact.
Photo 1
“The strings capture the deep emotions I experienced while watching the film: a sense of being torn and tangled. This feeling resonated with me then, and continues to echo within me each time I revisit it. On the one hand, I cherished my home and my family (1). During that time, I welcomed my second daughter into the world. It was a truly nurturing environment. The limited number of visitors didn’t diminish its warmth; rather, it created a safe haven, full of love and tranquility. This (2) refers to my job. The protocols. The reality of death. The presence of illness. Still, amidst it all, there was an abundance of love. Colleagues supporting one another, and the residents as well. However, there were moments when the weight of those rules felt overwhelming. Then there’s society, pictured here (3). Rutte 3. The chaos that accompanied it often drove me crazy. And lastly (4), there was social life. It felt so flat, so quiet. A torn, frayed life.”
Photo 2
“The first thought that crossed my mind was the one and a half meters. I just started working here and then, well.. [laughs]. Initially, nothing was permitted, but gradually, a little more activities were allowed. For instance, we would dance with residents, following social distancing rules by using one and a half meter long sticks. So I guess that is one way of looking at this piece. But you could also interpret it as ‘we do this together”, supporting each other, sharing the weight on our shoulders. However, I believe that everyone, in their own way, can derive their own meaning from it.”
Photo 3
“I have always found solace in the wisdom of tarot cards; they resonate deeply with me. Reflecting on that time, I pondered how to encapsulate it within a card. Instantly, the image of the Hanged Man came to mind. This card, striking in its imagery, depicts a figure suspended upside down. Upon first glance, the card’s meaning is pretty self-evident, an image of a man hanging upside down. So when given this card, it implies that your world is turned completely upside down. I believe this was a shared experience for everyone during the pandemic. Aside from this, I feel that this card embodies an essence of youth and disobedience: This is how the man finds himself in this position in the first place. Looking back, I realize how I was on a quest for understanding, acknowledging that the social distancing measures were necessary. However, I also felt a strong desire to challenge the status quo. I yearned for the police to confront me in the evening, holding on to that piece of paper, ready for the encounter. Catch me, for you cannot confine my spirit. I was determined to explore the boundaries of that system. Lastly, the Hanged Man discusses introspection: In that moment, you must pause, for you find yourself in a state of suspension. As you remain in that position, it compels you to view the world from a fresh angle. With your perspective inverted, there lies an opportunity for learning. What this card often represents, especially when turned upside down, is a call to release what you are holding onto. Embrace the present moment as it is. To me, this is a card that perfectly encapsulates my experience during that time.”
Photo 4
A slightly worn out letter, size A4, that acted as a parking permit for employees during the COVID-19 pandemic. Workshop attendees were asked to bring in objects that reminded them of the pandemic a week before the sessions took place.
Discussion
Finally, we encourage you to consider the profound effect that intentional healing practices can have on individuals and organizations alike. As social entrepreneurs, think about how you might adapt these ideas to address healing and resilience within your own contexts, using our workshops as an example. By integrating such practices, you can foster stronger, more empathetic communities that are better equipped to navigate future challenges.
- How do you recognize different aspects of organizational healing in the examples of the photo exhibition?
- What personal experience from your work would you contribute to a workshop discussion about reflecting on the COVID-19 crisis period? Why?
- What role does empathy, story-telling, and leadership play in your own work or studies during (a personal) crisis?
- How do you think the concept of trauma distillation can be expanded to address other types of crises beyond COVID-19?
- What strategies do you think can be implemented to overcome institutional barriers such as bureaucratic delays and limited funding in resilience-building efforts?