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Friedland burnout plenary 1

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TFME 2013 Organizational Professionalism Conference

TFME 2013 Organizational Professionalism Conference

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  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • 27 276 physicians who received an invitationto participate, 7288 (26.7%) completed surveys.When assessed using the Maslach Burnout Inventory,45.8% of physicians reported at least 1 symptom of burnout.Substantial differences in burnout were observed byspecialty, with the highest rates among physicians at thefront line of care access (family medicine, general internalmedicine, and emergency medicine). Compared witha probability-based sample of 3442 working US adults,physicians were more likely to have symptoms of burnout(37.9% vs 27.8%) and to be dissatisfied with worklifebalance (40.2% vs 23.2%)
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • As part of its commitment to foster physician health and well-being, the CMA gathered data on occupational stress andburnout in its 2003 Physician Resource Questionnaire (PRQ). The PRQ incorporated Boudreau’s Burnout Questionnaire, a30-item scale developed by Dr. Robert Boudreau, Professor of Organizational Behaviour in the Faculty of Management atthe University of Lethbridge. Boudreau’s Burnout Questionnaire examines three dimensions of burnout: depersonalization,lack of personal accomplishment and emotional exhaustion.The 2003 PRQ was sent to a scientific random sample of 8172 active Canadian physicians (including bothCMA members and nonmembers, excluding residents). The survey was in the field from February 2003 to June 2003;CMA received 2251 responses.
  • 27 276 physicians who received an invitationto participate, 7288 (26.7%) completed surveys.When assessed using the Maslach Burnout Inventory,45.8% of physicians reported at least 1 symptom of burnout.Substantial differences in burnout were observed byspecialty, with the highest rates among physicians at thefront line of care access (family medicine, general internalmedicine, and emergency medicine). Compared witha probability-based sample of 3442 working US adults,physicians were more likely to have symptoms of burnout(37.9% vs 27.8%) and to be dissatisfied with worklifebalance (40.2% vs 23.2%)
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of APA between July 21 and August 4, 2009, among 1,568 adults aged 18 and older who reside in the U.S., including: 729 men and 839 women.1,020 adults who identified as having one or more chronic conditions including high blood pressure, high cholesterol, overweight or obese, arthritis, depression, asthma or other respiratory disease, type 2 diabetes, chronic pain, an anxiety disorder, heart disease or heart attack, cancer, stroke, type 1 (juvenile) diabetes and 512 adults who do not have a chronic condition.504 Millennials (18 – 30-year-olds), 369 Gen Xers (31 – 44-year-olds), 464 Boomers (45 – 63-year-olds), and 231 Matures (64 years and older).235 adults who are parents of children aged 8 – 17.984 people who are employed and 584 people who are not employed. Among those who are not employed, 192 adults are looking for work. Overall, 256 adults are retired and 163 are stay-at-home spouses or partners (“homemakers”).820 White, non-Hispanic adults; 333 Black, non-Hispanic adults; and 311 Hispanic adults.By definition, anyone who indicated that they are employed full-time, part-time or are self-employed are included in the “employed” category, while everyone who did not indicate that they were employed are included in the “not employed” or “not working” category. Stress scale 1-10Extreme 8-10Moderate 4-7Mild 1-3
  • Is the professional satisfaction of general internists associated with patient satisfaction?Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA.SourceDivision of General Internal Medicine, San Francisco General Hospital, and the Institute for Health Policy Studies, University of California, San Francisco, CA 94143, USA. jhaas@itsa.ucsf.eduAbstractBACKGROUND:The growth of managed care has raised a number of concerns about patient and physician satisfaction. An association between physicians' professional satisfaction and the satisfaction of their patients could suggest new types of organizational interventions to improve the satisfaction of both.OBJECTIVE:To examine the relation between the satisfaction of general internists and their patients.DESIGN:Cross-sectional surveys of patients and physicians.SETTING:Eleven academically affiliated general internal medicine practices in the greater-Boston area.PARTICIPANTS:A random sample of English-speaking and Spanish-speaking patients (n = 2,620) with at least one visit to their physician (n = 166) during the preceding year.MEASUREMENTS:Patients' overall satisfaction with their health care, and their satisfaction with their most recent physician visit.MAIN RESULTS:After adjustment, the patients of physicians who rated themselves to be very or extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73-3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26-2.21). In addition, younger patients, those with better overall health status, and those cared for by a physician who worked part-time were significantly more likely to report better satisfaction with both measures. Minority patients and those with managed care insurance also reported lower overall satisfaction.CONCLUSIONS:The patients of physicians who have higher professional satisfaction may themselves be more satisfied with their care. Further research will need to consider factors that may mediate the relation between patient and physician satisfaction.
  • Med Care. 1999 Nov;37(11):1174-82.Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M, Schwartz MD, Scheckler WE, Van Kirk J, Rhodes E, Douglas J.SourceCecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. bob_konrad@unc.eduAbstractBACKGROUND:Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffection, possibly improving health care.OBJECTIVE:To document conceptual development, item construction, and use of content experts in designing multidimensional measures of physician job satisfaction and global satisfaction scales for assessing physicians' job perceptions across settings and specialties.DESIGN:Using previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel, distinct job facets and statements representing those facets were developed.RESULTS:Facets from previously validated instruments included autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status. New facets included intrinsic satisfaction, free time away from work, administrative support, and community involvement. Physician status items were reconfigured into relationships with peers, patients, staff, and community, yielding 10 hypothetical facets. Global scales and items were developed representing satisfaction with job, career, and specialty.CONCLUSIONS:A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests.
  • DESIGN National mailed survey.SETTINGCanada.PARTICIPANTS A random sample of 8100 Canadian physicians (response rate 40%, N = 3213); 2536 responses (from physicians working more than 35 hours per week) were analyzed.MAIN OUTCOME MEASURES Levels of burnout, values congruence, and workload, by sex, measured by the Maslach Burnout Inventory—General Scale and the Areas of WorklifeScale.RESULTS Results showed a moderate level of burnout among Canadian physicians, with relatively positive scores on exhaustion, average scores on cynicism, and mildly negative scores on professional efficacy. A series of multiple regression analyses confirmed parallel main effect contributions from manageable workload and values congruence. Both workload and values congruence predicted exhaustion and cynicism for men and women (P = .001). Only values congruence provided a significant prediction of professional efficacy for both men and women (P = .001) These predictors interacted for women on all 3 aspects of burnout (exhaustion, cynicism, and diminished efficacy). Howevever, overall levels of the burnout indicators departed only modestly from normative levels.
  • First provide you some facts about stress to show you you are not alone and look at its tremendous impact and consequences on health, productivity and the bottom lineWe will then set a foundation to effectively navigate stress by providing you with a solid understanding how your brain functions under stress and at peak performanceThis understanding of the brain together as well as drawing on the fields of psychology, mindfulness, emotional intelligence, evidence-based medicine and the findings of a study I conducted in 2000 at San Francisco Intl Airport on the stress around self-doubt will serve as the foundation of a 4 step framework I will provide you to effectively navigate stress, uncertainty and self-doubt and show you in very simple and practical ways it can be used to improve decision making, enhance communication (whether with family, friends, colleagues or clients) and take healthy wise and productive action to achieve peak performance in times of high stress. If you are in a leadership position, I’ll also show you how to use this framework to facilitate the positive changes in others.
  • First provide you some facts about stress to show you you are not alone and look at its tremendous impact and consequences on health, productivity and the bottom lineWe will then set a foundation to effectively navigate stress by providing you with a solid understanding how your brain functions under stress and at peak performanceThis understanding of the brain together as well as drawing on the fields of psychology, mindfulness, emotional intelligence, evidence-based medicine and the findings of a study I conducted in 2000 at San Francisco Intl Airport on the stress around self-doubt will serve as the foundation of a 4 step framework I will provide you to effectively navigate stress, uncertainty and self-doubt and show you in very simple and practical ways it can be used to improve decision making, enhance communication (whether with family, friends, colleagues or clients) and take healthy wise and productive action to achieve peak performance in times of high stress. If you are in a leadership position, I’ll also show you how to use this framework to facilitate the positive changes in others.
  • Transcript

    • 1. Daniel Friedland, MD Medical Director, Barney and Barney Founder & CEO, SuperSmartHealth © 2012 SuperSmartHealth
    • 2. Roadmap & Objectives 1) Factors predicting burnout 1) Recognizing burnout 2) The 4 in 4 Framework™ to navigate burnout
    • 3. Burnout
    • 4. Prevalence of Burnout • Approximately 50% of students experience burnout and 10% experience suicidal ideation during medical school1 • Between 25-75% of medical residents experience burnout depending on the specialty2 • Approximately 1 in 3 doctors (both medical and surgical) are experiencing physician burnout at any given time3 1. Dyrbye LN, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334. 2. Ishak WW, Lederer S. J Grad Med Educ. 2009 Dec;1(2):236-42. 3. Shanafelt T, et al. JAMA. 2009;302(12):1338.
    • 5. Prevalence of Burnout • Survey of 27,276 U.S. physicians, 7288 (26.7%) completed surveys. • 45.8% of physicians reported at least 1 symptom of burnout. • Compared with a sample of over 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%). Shanafelt TD et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012 Aug20:1-9.
    • 6. Effects of Physician Stress • 1200 practicing physicians surveyed • 6 in 10 have considered leaving medicine • 77% experience fatigue • 67% experience burnout • 33% depression & family discord ACPE Survey 2006 November-December The Physician Executive © Lee Lipsenthal 2009
    • 7. Effects of Physician Stress • 1200 practicing physicians surveyed • 6 in 10 have considered leaving medicine • 77% experience fatigue • 67% experience burnout • 33% depression & family discord • Contributing causes; – Low reimbursement – Low autonomy – Patient overload – Lack of respect ACPE Survey 2006 November-December The Physician Executive © Lee Lipsenthal 2009
    • 8. Factors Contributing to Burnout Work-related stress: • Excessive workloads • Balancing personal and professional life • Deterioration in work conditions • Autonomy • Meaning in the work Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.
    • 9. Factors Contributing to Burnout • Cross-sectional national survey of 2,000 randomly selected physicians in the U.S. with 935 respondents • The strongest predictor of burnout was having little control over schedule and hours worked (P<.001) Keeton K, et al. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007Apr;109(4):949-55.
    • 10. Results from Canadian Medical Association Physician Resource Questionnaire (PRQ) November 2003 http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/PhysicianHealth/news/pdf/Burn-out.pdf
    • 11. Burnout by Specialty Shanafelt TD et al. Arch Intern Med. 2012 Aug20:1-9.Copyright © 2012 American Medical Association.
    • 12. Personality and Burnout • Escape-Avoidance (Self-directedness & Cooperativeness protective)1 • Low sense of stability and increased vigilance and anxiety traits2 • Low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others3 • Higher levels of neuroticism and introversion and lower levels of agreeableness4 • (Higher self-rated Emotional Intelligence protective)5 1. Pejušković B, et al. Burnout syndrome among physicians - the role of personality dimensions and coping strategies. Psychiatr Danub. 2011 Dec;23(4):389-95. 2. Cebrià et al. Personality traits and burnout in family doctors. Aten Primaria. 2001 Apr 30;27(7):459-68. 3. McCranie EW, Brandsma JM. Personality antecedents of burnout among middle-aged physicians. Behav Med. 1988 Spring;14(1):30-6. 4. McManus IC, et al. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004 Aug 18;2:29. 5. Weng HC, et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ. 2011 Aug;45(8):835-42.
    • 13. Maslach Burnout Inventory 1. Emotional exhaustion 2. Depersonalization 3. Reduced personal accomplishment Maslach, C. & Jackson, S.E. The measurement of experienced burnout. Journal of Occupational Behavior. 1981;2:99-113.
    • 14. Freudenberger’s 12 Phases of Burnout 1. The compulsion to prove oneself 2. Working harder 3. Neglecting one‟s needs 4. Displacement of conflicts 5. Revision of values 6. Denial of emerging problems 7. Withdrawal 8. Obvious behavioral changes 9. Depersonalization 10. Inner emptiness 11. Depression 12. Burnout Syndrome
 Freudenberger H.J. & North G. Women's Burnout: How to Spot It, How to Reverse It, and How to Prevent It. (1985). New York: Doubleday.
    • 15. “Burnout is the index of the dislocation between what people are and what they have to do. It represents an erosion in value, dignity, spirit, and will – an erosion of the human soul. It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it‟s hard to recover.” Maslach, C. & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey Bass. In summary…
    • 16. Swank and Marchland 1946; redrawn from Mind-Body Medicine, Watkins 1997 0 10 20 30 40 50 60 Degreeofcombat Days in combat Soldier becomes "battlewise" Period of maximum efficiency Combat exhaustion Hyper-reactive stage Emotional exhaustion stage Period of overconfidence Vegetative phase Battle Stress / Efficiency and Exhaustion © Lee Lipsenthal 2007
    • 17. Consequences of Burnout • Increased medical errors • Decreased empathy • Plans to retire early • Job dissatisfaction Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.
    • 18. Physician satisfaction matters • Strongly linked to patient satisfaction1 • Affects patients‟ perception of quality of care1 • Enhances patient confidence2 • Enhances patient adherence with therapies3 1. Haas J, et al. “Is the professional satisfaction of general Internists associated with patient satisfaction?” J Gen Intern Med. 2000;15:122-128. 2. Grembowski D, et al. “Managed care, physician job satisfaction, and the quality of primary care.” J Gen Intern Med.2005;20:271-277. 3. DiMatteo MR, et al. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993 Mar;12(2):93-102.
    • 19. Ten factors enhancing physician satisfaction • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
    • 20. • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction Ten factors enhancing physician satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
    • 21. • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction  The nature of the work  Achievement  Recognition  Responsibility  Growth Ten factors enhancing physician satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
    • 22. Values, Workload and Efficacy (in women) Leiter MP, Frank E, Mathison TJ. Canadian Family Physician December 2009 vol. 55 no. 12 1224-1225.e6
    • 23. „„If all of the knowledge and advice about how to beat burnout could be summed up in one word, that word would be balance – balance between giving and getting, balance between stress and calm, balance between work and home.‟‟ Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall;1982. - Christina Maslach
    • 24. If burnout involves exhaustion, depersonalization and decreased personal efficacy, how can we become more resilient to better navigate stress and reengage so that we can experience greater vitality, more fully connect with others, ourselves and our source of inspiration, as well as thrive with peak performance?
    • 25. P e r f o r m a n c e Arousal/Stress ?
    • 26. Yerkes–Dodson Law P e r f o r m a n c e Arousal/Stress Yerkes RM, Dodson JD (1908). Journal of Comparative Neurology and Psychology 18: 459–482.
    • 27. The Foundation
    • 28. Neuroplastic Transformation P e r f o r m a n c e Arousal / Stress
    • 29. The 4 in 4 Framework™ Integrating Mental Emotional Social Spiritual Intelligence
    • 30. Make the Turn into What’s Truly Important Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 1 2 34
    • 31. Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 1
    • 32. Recognize Reactivity: 1. Physical Sensations 2. Feelings 3. Thoughts 4. Behaviors 1
    • 33. Is it doing more harm than good? Recognize Reactivity: 1
    • 34. Reappraise Stress and Self-Doubt Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 2Recognize Reactivity Is it doing more harm than good? 1
    • 35. Reappraise Stress and Self-Doubt: • SCARF 1 • What if… • If only... • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition Triggers of Stress and Self-Doubt: 2 1. Rock, D., Managing with the Brain in Mind. Oxford Leadership Journal. 1(1): p. 1-10.
    • 36. Reappraise Stress and Self-Doubt: 2 Appraise Reappraise 1) What happened (just the facts)? 2) What is my belief about what happened? 3) Is my belief true or what is the evidence this should be so? 4) How could I view this differently? Adapted from Albert Ellis et al. Rational Emotive Behavior Therapy. Amer Psychological Assn; 3 edition 2011.
    • 37. Reappraise Stress and Self-Doubt: • What if… • If only… • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition Reappraising the Triggers: 2
    • 38. In a survey of 314 people at San Francisco International Airport how many acknowledged they experience doubts of self-worth? a) 76 b) 187 c) 235 d) 283 e) 311 Reappraise Stress and Self-Doubt: 2 Friedland D, SFO Self-Doubt Study 2001, unpublished data
    • 39. Self-doubt is nothing more than psychic gas! Reappraise Stress and Self-Doubt: 2
    • 40. Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It‟s nothing more than Psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important 3
    • 41. Cultivate Creativity By Reflecting on What’s Truly Important What is your definition of optimal health? 3
    • 42. Cultivate Creativity By Reflecting on What’s Truly Important • Learning • Connecting • Expressing Potential • Being of Service • Creating Opportunity • Experiencing Significance • Leaving a Legacy 3
    • 43. Cultivate Creativity By Reflecting on What’s Truly Important 3 Health Relationships Productivity V S I R V=Vision S=Strategy I=Implementation R=Results
    • 44. Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It‟s nothing more than Psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy 3 Make the Turn into What’s Truly Important 4
    • 45. 1 3 Find Frame Apply Evaluate 1 3 24 Make the Turn into What’s Truly Important 4
    • 46. Frame-Find-Evaluate-Apply Spiral of Growth™
    • 47. Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Is it doing more harm than good? It‟s nothing more than Psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 4Apply Evaluate Find 1 2 34
    • 48. Fight Flight Trigger 1 2 Fight Flight Trigger Give Receive 1 2 GiveReceive Cycle of Reactivity Cycle of Creativity
    • 49. Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Is it doing more harm than good? It‟s nothing more than Psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 4Apply Evaluate Find 1 2 34
    • 50. Achieve and Enhance Peak Performance P e r f o r m a n c e Arousal / Stress
    • 51. Online Program + The 4 in 4 Framework™ to Achieve Peak Performance Workbook • 1 Module per week for 8 weeks, each 45-90 minutes long • 30 minutes of workbook exercises per week • 10-20 minutes of mindfulness practice per day For more information go to: http://danielfriedland.com/programs
    • 52. Contact Information Daniel Friedland, MD Medical Director, Barney and Barney Founder & CEO, SuperSmartHealth daniel@supersmarthealth.com Office: 858.481.2393 Cell: 858.229.0875

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