Whole Health is part of collaborative effort by the Pacific Institute for Research and Evaluation, VA Office of Patient Care and Cultural Transformation, and University of Wisconsin Integrative Health Program to transform healthcare and help people live healthier, happier lives, and more purpose-driven lives. Learn more: https://wholehealth.wisc.edu/courses-training/whole-health-in-your-practice/

1. Whole Health in Your Practice
4. The Power Of You:
Your Healing Presence

2. “Me” at the
center is both
you as an
individual and
the Veterans
who you serve.

3. Why Are You Here?
Every hero has an origin story – what’s yours?
• With a Partner, Answer
these AS YOU PREFER
• Pause to reflect: Why are
you here?
– In health care
– In the VA
• What do you love about this
work? What’s challenging?
• Each person will share for a
few minutes
Photo: Zimio.com

4. How do you know when you
are successful in your work?

5. How do you know when you
are successful in your work?
When you are successful,
people’s lives improve.
That means something shifts for them...
How do we make that happen?

6. Non-Specific Variables
Specific Variables

7. You Have More Power
Than Pills!
Photo: Similima.com

8. McKay K, et al.. J Affect. Disord, 2006;92:287-90.
Practitioner Effects
For Depression:
Good Therapist + Placebo > Poor Therapist + Imipramine

9. Think of the Best Healer You Know.
Why did you choose them?
Photo: gphealth.org

10. What Non-Specific Variables
Can You Use to Promote
Whole Health?

11. Even When Time is Limited, You Can...
• Engage them
• Show empathy and
kindness
• Communicate well
• Help them gain
insight
• Use the power of
expectation
Photo: videoblocks.com
Photo: usnews.com

12. Quiz Time! Engagement
Question #1
What is engagement?
 A. Someone gives you a diamond ring
 B. You are British, and you are meeting someone
 C. You are fighting a battle, and you just engaged
the enemy
 D. The desire and ability to actively get involved in a
way that is uniquely right for an individual, in
cooperation with the care team, to optimize care
and outcomes.

13. Quiz Time! Engagement
Question #1
What is engagement?
 A. Someone gives you a diamond ring
 B. You are British, and you are meeting someone
 C. You are fighting a battle, and you just engaged
the enemy
 D. The desire and ability to actively get involved in a
way that is uniquely right for an individual, in
cooperation with the care team, to optimize care
and outcomes.
✓
✓
✓
✓
Higgins T et al. Patient Education and Counseling, 2017;100:30–36.

14. Quiz Time! Engagement
Question #2
On average, how much time do you have to interact
with a given patient each year?
 A. 0-1 hour
 B. 1-2 hours
 C. 2-3 hours
 D. 3-6 hours
 E. 6+ hours

15. On average, how much time do you have to interact
with a given patient each year?
 A. 0-1 hour
 B. 1-2 hours
 C. 2-3 hours
 D. 3-6 hours
 E. 6+ hours
✓
✓
✓
Depends on different factors...
• Inpatient/Outpatient
• Primary care or specialty
• Letters after your name
• Type of patients you see
...but the bottom line is,
we only have so much time!
Quiz Time! Engagement
Question #2

16. Question #3
What % of the time do you think your
patients follow your recommendations?
A. Never
 B. ¼ of the time
 C. ½ of the time
 D. ¾ of the time
 E. Always – like my family, they always do
whatever I say

17. Question #3
What % of the time do you think your
patients follow your recommendations?
A. Never
 B. ¼ of the time
 C. ½ of the time
 D. ¾ of the time
 E. Always – like my family, they always do
whatever I say
✓
✓

18. How Well People Follow Through
• Medications – 50% adherence1
–20% for chronic conditions
–We at least want to beat a coin toss
• Lifestyle changes – 30% (ish)2
–Medical Outcomes Study – 20%
–PT – 35%
–More with certain approaches
1. Brown MT, et al. Am J Med Sci, 2016;351(4):387-99.
2. Martin LR, Ther Clin Risk Manage, 2005;1(3):189 –199.

19. Question #4
What approach is most effective to
support behavior change?
 A. Fear...

20. How effective are threats
when it comes to making changes?
Statement A
“If you don’t exercise more,
you are going to have a heart
attack and die. Or have a
stroke. Or you will get
diabetes, and your legs and
kidneys and eyes could be
damaged. I want to see those
labs improve soon, or else...”

21. Back to Question #4
What approach is most effective to
support behavior change?
 A. Fear
 B. Outrage and indignation
 C. Relationships – desire to be there for others
(altruism)
 D. Focusing on what they value and want to do
 E. A clear understanding of the benefits
 F. Information/Education

22. Question #4
What approach is most effective to
support behavior change?
 A. Fear
 B. Outrage and indignation
 C. Relationships – desire to be there for others
(altruism)
 D. Focusing on what they value and want to do
 E. A clear understanding of the benefits
 F. Information/Education
✓

23. Which statement will get buy-in?
Statement A
“If you don’t exercise
more, you are going to
have a heart attack and
die. Or have a stroke. Or
you will get diabetes, and
your legs and kidneys and
eyes could be damaged. I
want to see those labs
improve soon, or else...”
Statement B
“I know your goal is to
dance at your grand-
daughter’s wedding.
Better sugar control will
help your body in many
ways, and there are a lot
of ways to work with that.
How can our team help?
Where do you want to
start?

24. Engagement: “The Blockbuster Drug”
• Concept analysis of 722 articles on engagement
• Identified 4 key elements (PACT):
1. Personalization
2. Access
3. Commitment
4. Therapeutic Alliance
(Environment came up as well)
Higgins T et al. Patient Education and Counseling, 2017;100:30–36.

25. Patient Engagement Research
• 2014 Review of 10 trials
n>3,000
– Multiple chronic diseases (DM,
CAD, HTN, COPD, asthma,
arthritis, etc.)
• Variety of interventions to
enhance engagement
(groups, in-person one-on-
one, web-based, telephone
visits)
• Improved clinical outcomes
(A1c, lipids, BP, depression)
and quality of life
Simmons et al. Genome Med, 2014;6:16.
Photo: Continuouscare.io

26. Power of You = Power of Us
What is Empathy
(versus Sympathy or Compassion)?
Photo: nextavenue.org

27. What is Empathy?
Definition:
• You can understand their
– Situation
– Perspective
– Feelings of another person
• You can show the other
person you understand
• You can act on this
understanding
Photo: Pinterest.com

28. Video – Brené Brown on Empathy
https://youtu.be/1Evwgu369Jw
29

29. Brené Brown – Empathy
https://www.youtube.com/watch?v=1Evwgu369Jw

30. The Good Samaritan Study
Darley, J Personality and Social Psychol, 1973;27:100-108.
Group #1
Group #2
Group #3
Extra
time
On time
Late

31. Empathy Research
2013 systematic review
• 7 studies
• Over 3,000 patients and 225
physicians
• Conclusion:
“There is a relationship between
empathy in patient–physician
communication and patient
satisfaction and adherence, patients’
anxiety and distress, better diagnostic
and clinical outcomes, and
strengthening of patients’
enablement.” Photo: Pinterest.com
Derksen F et al. Br J Gen Pract, 2013;Jan:376-84.

32. Video – Little Miss Sunshine
What did the girl in this video say
that was so powerful?
https://www.youtube.com/watch?v=GJT_pAYaWB8
34

33. Little Miss Sunshine - Video Clip
https://www.youtube.com/watch?v=GJT_pAYaWB8

34. Placebo Research
Good Clinician
“Standard”
No Clinician
✓
✓
 Missing✓

35. Acupuncturist Effects on IBS
Kaptchuk TJ. et al. BMJ, 2008;336(7651):999-1003.
IBS Patient Group % Symptom
Improvement
Wait list control 28%
Limited Visit 44%
Augmented Visit 62%

36. UW Cold Study:
Perception of Perfect Empathy
IL-8 Neutrophils
No Visit Standard Enhanced No Visit Standard Enhanced
Rakel, et al. Patient Ed & Counseling, 2011;85:390-7.

37. No Visit < Perfect Perfect P Value
Duration 6.75 days 7.0 days 5.89 days 0.003
Severity 262.19 270.58 223.38 0.04
Rakel, et al. Fam Med, 2009; 41(7):494-501.
UW Cold Study:
Effects of Perceived Empathy

38. Reduction in Empathy in Med School
Newton et al. Acad Med, 2008;83(3):244-9.
Women
Men
Clinical
Research
Year of School
Empathy Score
Clinical
Combined
Research
Clinical
Research
Combined

39. Video: Cleveland Clinic - Connection
Empathy
https://www.youtube.com/watch?v=cDDWvj_q-o8

40. https://www.youtube.com/watch?v=cDDWvj_q-o8
Cleveland Clinic Empathy Video

41. Reflecting on the Video
• What did you notice watching the video
(thoughts, feelings, body sensations)?
• If you were in the video, what would be written
over your head right now?
• When in your life has someone really listened to
you? How did you know? How did it affect you?
• When in your life have you really listened well to
someone? How did that feel?

42. Communication - Tips
• Generous listening – really hear them
• Reflective listening
– Repeat, paraphrase
– Infer meaning
– Appreciate emotion
– Go deeper
• OARS
– Open-ended questions
– Affirmations
– Reflections
– Summaries Photo: Homedepot.com
Photo: youtube.com

43. Talking about the Video
• What did you notice watching the video
(thoughts, feelings, body sensations)?
• If you were in the video, what would be written
over your head right now?
• When in your life has someone really listened to
you? How did you know? How did it affect you?
• When in your life have you really listened well to
someone? How did that feel?

44. Communication
Thought Experiment #1
Consider one barrier to
communication in your current
work.
Photo: kbo-pcob.nl

45. Communication
Thought Experiment #2
Consider one thing that goes well with
communication in your current work.
Photo: Medium.com

46. Communication
Thought Experiment #2
Consider one thing that goes well with
communication in your current work.
Photo: Medium.com

47. Communication
Thought Experiment #3
What is something you can do to make
communication at work better?
Photo: aconsciousrethink.com

48. Communication: Partner Exercise
• Now take a few minutes to communicate
with a partner about communication.
• As a listener, practice generous listening
–Avoid the temptation to “fix” a problem
–Avoid the temptation to advise
–Don’t interrupt!
• Pick a person to go first and then we’ll
trade

49. We have two ears and one mouth so we can listen twice
as much as we speak. -Epictetus
• 1984 study: The average
doc interrupts after 18
seconds
• 2002: 23 seconds
• How long will patients talk
with no interruption?
– Mean: 92 seconds
– Median: 59 seconds
– In all 335 sessions, the info
was rated as ‘useful.’
Photo: 1ohww.org
Beckman et al, Ann Intern Med, 1984;101:692-6. Langewitz et al. BMJ, 2002;325:682-3.
Listening

50. Listening
• We spend 70-80% of our waking hours
communicating in some way.
• The average person remembers only 25% of
what he/she hears.
• On average when we communicate, we speak
30-35% of the time.
• We listen about 45% of the time.
• We are NOT good at it...
Listening: Our Most Used Communications Skill https://extension2.missouri.edu/cm150
Photo: pmslweb.com

51. Listening
If we spend 4 hours in a lecture…
• We hear about 2 hours.
• We listen to about 1 hours worth.
• We understand about 30 minutes of that hour.
• We remember just 8 minutes worth.
-Managing Upward Hathaway and Schubert

52. Listening
Photojooinn.com
68% of us lose ability to listen when we are
naked in a hospital gown.

53. Listening Exercise
1. Find a partner.
2. Sit back to back.
3. One person guides and the
other listens.
4. The guide will draw a
picture while telling the
other person how to draw it
at the same time.
5. The other person can’t see
what they draw until after.

54. Video: Change Words, Change Worlds
https://youtu.be/a66Dj5iAnEM

55. https://youtu.be/a66Dj5iAnEM
Video: Change Words, Change Worlds

56. Mindful Awareness and Listening
Most people do not listen with the
intent to understand; they listen
with the intent to reply.
-Stephen Covey

57. Self-Focused Listening
• Formulates responses
• Multi-tasks, distracted
• Filters through past
experiences, history,
assumptions
• Focused on personal
stories, agenda, advice
• “What can I do about
this?”
Photo: rebelcircus.com

58. Other-Focused Listening
• Beginner’s Mind, Not-
knowing
• Attention to body
language, facial
expression, tone of voice
• Attuned to energy and
emotions behind the
words
• Allow for silence, space,
pause
Photo: rebelcircus.com

59. Mindful Awareness and Listening
(You’ve already practiced this
some)Paying attention, in the moment, on
purpose, non-judgmentally
–Beginner’s Mind
–Non-judgment
–Non-striving
–Patience
Photo: dogslife.com/au

60. Video – It’s Not About the Nail
Fixing Versus Listening
https://www.youtube.com/watch?v=-4EDhdAHrOg

61. It’s Not About The Nail - Video Clip
https://www.youtube.com/watch?v=-4EDhdAHrOg

62. Attention is the rarest
and purest form of
generosity.
Now, let’s talk a little about insight...

64. Your Brain on Insight
• fMRI: Medial right anterior superior
temporal gyrus lights up
• Different people have different
activity here at baseline
• People stimulated here can solve
puzzles faster
• Activity slows with depression
• Alcohol allows more insight, but
less logic and analysis (!)
Kounios, Ann Rev Psychol, 2014.;65:71–93.

65. http://www.shortlist.com/news/this-black-smudge-optical-illusion-is-messing-with-our-minds

66. A Cowboy’s Head

67. http://www.today.com/popculture/

68. Partner Exercise
Describe a time when you or a
patient has had an important
insight (a “Eureka” moment).
What happened?
Why did it happen?

69. Video – Trust Fall
Two girls learn the importance of details
when it comes to skill-building
https://www.youtube.com/watch?v=wPOgvzVOQig

70. https://www.youtube.com/watch?v=wPOgvzVOQig
Trust Fall – Video Clip

71. Simotas, et al. Arch Physical Med Rehabilitation, 2005;86:693-696.
Public = 10% Derby = 0.25%
Expectations
• Why don’t derby drivers get whiplash?

72. 10 mg
Morphine
10 mg
Diazepam
Colloca L, et al. Lancet Neurol, 2004;3(11):679-84.

73. The Power of Placebo
Graphic: TheOnion.com

74. Open-Label Pain Study
• Randomized Controlled Trial
– 2016
– 97 adults with chronic low back pain
• Compared open label placebo to usual treatment
– i.e., they knew it was a sugar pill, and those have been shown
to help
• 3 weeks
• Patients rated pain levels on a 10 point scale
• Dropped by 1.5 in the group with the open label
placebo
Carvalho, et al. Pain, 2016;16:2766-2772.
Photo: menshealth.com

75. Clinicians’ Expectations
Have Power Too
• Study of acupuncture for pain
• 9900 patients, 2781 different physicians
• Controlling for everything else, if a physician
had high expectations for acupuncture
– Pain intensity decreased
– Physical functioning improved
• Two patients, exactly the same had
different outcomes based on their
clinicians’ expectations
Witt, et al. Eur J Pain, 2012;16:1455–1466.
Photo: worldofdtcmarketing.com

76. Perception Shapes Reality
Cloud of
Probability Perception shapes outcome Reality
Observation,
Consciousness
Foter.com/CC0
What can you do to help a person shift their perception
in favor of Whole Health?

77. To Sum Up – Your Healing Presence
• Never underestimate the power of your presence to
heal!
• Use all of these elements to enhance what you can do:
– Engage Motivate and encourage them
– Empathize Humanize them
– Communicate Well Don’t interrupt. Listen deeply.
– Foster Insight Take time to reflect and explore.
– Expectation Power of the Mind matters.
– Role Model We’ll get to this in Module 6.
• These need not take extra time. In fact, they may save
you time!

78. Self-Assessment: How “Whole Health-y” is
Your Practice?
• Questions are in your Passport Book, pages 11-12.
• Take time to answer the 21 questions with the
following scale:
– 1 Never happens
– 2 Occasionally happens – a few times a month
– 3 Often happens – a few times a week
– 4 Frequently happens – a few times a day
– 5 Always happens – part of every patient encounter

79. Take a
Break!

80. Whole Health in Your Practice
5. Mindful Awareness

81. Mindful Awareness is Everywhere
Now
Photo: content.time.com
Photos: mindful.org
Photos: Scientificamerican.com

82. A Core Concept
Photo: Explore.va.gov
Paying more attention to my
body and mind helps me
make better decisions in my
self care

83. Definition of Mindful Awareness
• Way of being
• In the present
moment
• On purpose
• Non-judgmentally
• With kindness
Photo: dailywildlifephoto.nathab.com

84. Other Ways to Define it…
• Jack Kornfield: Loving awareness
• Sharon Salzberg: a special kind of awareness
characterized by openness, curiosity and
acceptance
• Ron Epstein: Remembering who you are and
what is important, every moment of every day.
• Paying extraordinary attention to ordinary
experiences…as if your life depended on it!

85. Some Clarifications Passport, Ch 4
• Mindful awareness is a general concept
• Mindfulness is often used as a synonym for
Mindfulness Based Stress Reduction, a course
that focuses on teaching approaches that can
help enhance mindful awareness
• Meditation comes in many forms. Some support
mindful awareness; others focus elsewhere

88. Mindful Awareness
We all have it...
the natural
capacity to pay
attention with
curiosity and
openness.
Photo: chuchutv.com

89. Mindful Awareness
We also have the
capacity for
mindlessness,
inattention, or
going on
autopilot.
Photo: callminer..com

91. Mindful Awareness Experience

92. Mindful Awareness Research
Photo: Nationalgeographic.com
What
research
findings have
you seen?
Passport,
Chapter 4

93. A Call for More Rigorous Research
Attention is more focused on:
• Clearer definitions – what is being
studied?
• Stricter study methods
• Being clear on what we really know
• Clinical relevance

94. An Early Study: Promega
• Two groups
– Mean age 36
– 25 in meditation group (took 8-week MBSR course)
– 16 in wait-list control group took course later
• Groups’ brain electrical activity was
different
– Meditators had more activity of the left prefrontal cortex
– Less activity of the right prefrontal cortex
Davidson, et al. Psychosom Med. 2003;65(4):564-70.

95. LEFT Prefrontal Cortex Activated
People have MORE
• Vigor
• Optimism
• Enthusiasm
• Buoyancy
• Meditators also have a better
response (antibody titer) to the flu
vaccine
Davidson, et al. Psychosom Med. 2003;65(4):564-70.

96. RIGHT Prefrontal Cortex Less Active
People have LESS
•Anger
•Fear
•Anxiety
•Depression
Davidson, et al. Psychosom Med. 2003;65(4):564-70.

97. Mindful Awareness and Physiology
Physiologic Effects
• Increases gamma wave oscillations
on EEG
• Lengthens time in a relaxed state
• Activates brain attention center
• Lowers chronic inflammation
• Lowers stress hormones
• Stabilizes CD4+ counts in HIV
• Enhances natural killer cell function
• Alters interleukin levels
Photo: Foter.com
https://wholehealth.wisc.edu/overviews/mindful-awareness/

98. Mindful Awareness and Telomeres
• Longer telomeres = longer life and
less chronic illness
• Review of 4 studies
– 190 people
– Each had a different approaches to
mindfulness meditation (MM)
1. Qigong
2. Mindful eating
3. Loving-kindness
4. Yogic meditation
– Subject meditation time ranged
from 11-560 hours
– Telomeres were longer in the
pooled meditation groups
Schutte, Psychoneuroendorinol, 2014;42:45-8.

99. QUERI Evidence Map
for Mindfulness
81 systematic reviews thru Jan 2015
• Y axis = size of the literature
• X axis = efficacy
• Size of circle = number of
reviews
• Color = type of mindfulness studied:
1. Green = mix
2. Pink = MBSR
3. Purple = MBCT
4. Blue = combo of both
= “unique interventions”
http://www.hsrd.research.va.gov/publications/esp/ca
m_mindfulness-REPORT.pdf
Passport,
Page 55
In your Passport (p.53, 2nd ed, p. 55 3rd ed

100. Research Highlights:
Healthy Individuals
• Reduces
– Stress and anxiety
– Depression, rumination
– Anger and distress
• Improves
– Quality of life
– Emotional intelligence, creativity
– Concentration
• And (per another study)
– Enhances spirituality and values
– Increases empathy
– Fosters self-compassion
Photo: Adam Rindfleisch
Khoury, J Psychosom Res 2015;78:519–528. / Chiesa, J Altern Complement Med, 2009;15(5):593-600.

101. Research Highlights:
Specific Health Issues
Remember, mindfulness is not
merely a ‘therapy,’ but it has
shown benefit with some
conditions
• Especially responsive:
– Chronic stress
– Depression
– Somatization
– Various types of pain
– Anxiety disorder
– Psychosis
– Substance use
– Binge eating
– Insomnia
http://www.hsrd.research.va.gov/publications/esp/cam_mindfulness-REPORT.pdf

102. For More Information...
Passport, Chapter 4
(Resources at end of chapter)
Whole Health Education Website
https://wholehealth.wisc.edu/overviews/mi
ndful-awareness/

103. 115
Mindful Awareness:
How do you cultivate it?

104. Mindful awareness is an opportunity to be in the wholeness of life…
including suffering, joy, peace, unrest, creativity,
fullness, emptiness – everything…
It is not merely a technique for coping with a specific problem.
Photo: Dave Rakel, MD

105. Discussion
When are you at your most:
Aware Present Centered Focused Calm

106. Formal and Informal Practices
• Breath Awareness
• Seated Meditation
• Moving/ Walking Meditation
• Mindful Eating
• Compassion Practice
• Contemplative Prayer
• Mantram Repetition
• Body Scans
Photo: Dailyheal.com

107. 1. Beginner’s Mind
2. Non-judging
3. Patience
4. Non-striving
5. Acceptance
6. Letting go
7. Trust
Seven Attitudes of Mindful Awareness

108. Drop Beneath and ... Observe
Thoughts
Judgment
Emotions
Awareness

109. More
Mindful Awareness

110. Breath Awareness Practice
1. Find a comfortable position
2. Allow eyes to close if you like
3. Remember the seven attitudes
4. Let go of busy-ness or life concerns
5. Pay attention to your breath
6. When attention wanders to thought, sensation, emotion
etc. simply notice
7. Gently return focus to your breath
8. Practice as long as you wish

111. Mindful Awareness and Medicine

112. Meditation:
How much at a time, and is it safe?
–Safety
Very safe, and…
…If risk of psychosis or
flashbacks, should be
guided by a trained
professional

113. How can your clinical stool or chair
become your meditation cushion?
How can you integrate mindful awareness
in your daily life?

114. Mindful Awareness Wherever You Go
• Pause for a moment before every interaction
o Threshold exercise
o A few deep breaths
o While cleaning your hands
• Use a stethoscope or other object as a reminder
o Sitting in a chair or shaking hands can also remind you
• Join a group to practice
o Some PACTs do mindfulness before they start the day
• Try other daily practices
o You will experience several during this course
• Other ideas?

116. Take a
Break!

117. Whole Health in Your Practice
6. Resilience and
Clinician Self-Care

118. We start out...
Photo: pinterest.com
Photo: pinterest.com
Photo: insidehighered.com
Photo: umhs-sk.org
Photo: onstopsocial.co.uk

119. And...
Photo: Foter.com
Photo: AMSJ.org
Photo: healthsystemreview.com
Photo: jealth.usnews.com
Photo: DoctorCPR.com
Photo: likeateam.com
Photo: physicianlicensing.com

120. Burnout Indicators
Burnout effects half of
physicians, and even more
nurses.
Key indicators of burnout include:
1. Emotional exhaustion
2. Depersonalization & decreased
empathy
3. Lack of personal accomplishment
http://www.headington-institute.org/Portals/32/Resources/Test_Are_you_burnout.pdf
Photo: doctorgabby.com

121. Burnout in General Population vs
Physicians, 2011 to 2014
Shanafelt TD, et al. Mayo Clinic Proceedings, 2015;90:1600-13.

122. Medscape National Depression and Burnout Report, 2018.
https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235#3

123. Why Does it Matter?
Burnout’s Effects
• Relationship problems
– Marital discord
– Conflicts with colleagues
– Poor patient relationships
• Accidents
• Poor decision making
• Less empathy
• Medical errors
• Poor communication
• Health problems
• Quitting, early retirement
Photo:marksdailyapple.com

124. What Leads to Burnout?
1. Lack of control over
office processes
2. Lack of control over
schedule
3. Excessive paperwork
4. Difficult and
complicated patients
5. Not enough time in
the day; not enough
for for self care
6. Lack of coping skills for
stress
7. Personal bad habits
(smoking, drug use)
8. Not enough time in
the day
9. Regret over chosen
career
10. Perfectionism*
Eckleberry-Hunt et al, Acad Med 2009; 84:269-277.
IndividualInstitutional
*Perfectionism, and other traits, need not be a liability.
And we can’t blame the victim!
Photo:juniordoctorblog.com

125. Key Drivers of Burnout
Shanafelt et al, Mayo Clin Proc. 2017;92(1)129-146.
Burnout
• Exhaustion
• Cynicism
• Inefficacy
Engagement
• Vigor
• Dedication
• Absorption
Meaning
in work
Social
support &
community
at work
Workload
& job
demands
Work-life
integration
Control &
flexibility
Organiza-
tional
culture &
values
Efficiency
&
resources
Less optimal
More optimal

126. The Quadruple Aim
1. Improve the health of populations
2. Enhance the patient experience
(quality and satisfaction)
3. Reduce cost per person
Bodenheimer, Ann Fam Med. 2014;12(6): 573-6.
4. Improve the work life of health care
clinicians and staff
www.Ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
Photo:centerfor resilientchilren.org

127. The Opposite of Burnout:
What is Resilience?

128. In general, what makes a
person more resilient?
What helps you be resilient?
What would help your team?
Discussion

129. Burnout  Resilience:
What Helps?
• Self-Care
• Meditation, relaxation,
massage
• Support groups
• Talking about feelings
• Professional counseling
• Sense of control over one’s
work conditions
• Time management
Eckleberry-Hunt et al, Acad Med 2009; 84:269-277.
Can also do a web search for
“The Resilience Prescription”
for a summary

130. Resilience Can Be Trained!
1. Think flexibly
2. Have a positive
attitude
3. Develop “active
coping skills”
4. Fine-tune your oral
compass
5. Have role models
Photo: valleybusiness report.com

131. Resilience Can Be Trained!
6. Face your fears
7. Have strong social
support
8. Maintain Physical well-
being
9. Train regularly (plan
ahead)
10.Recognize and foster
your strengths
Photo:HdFlowerWallpaper.com

132. Short Mindfulness Intervention:
Maslach Burnout Inventory Changes
Fortney, et al., Ann Fam Med, 2013;11(5):412-20.

133. Depression, Anxiety and Stress
Fortney, et al., Ann Fam Med, 2013;11(5):412-20.

134. Shifting Our Thinking –
Three Examples
1. All-or-nothing thinking
– Everything is either all good or all bad
– Can some things be in between?
– Catch yourself, and try to look at things in a new way
2. Self-blame
– “It’s all my fault.”
– Is it? Can you look at it in other ways?
– Can you be kind to yourself?
3. Filters
– Only seeing things one way (usually negative)
– What if you try a different filter?

135. Discussion:
Resilience Superstars
• At your table, each person chooses one of the
following to share about for for a minute or two.
1. Who do you admire for their resilience? Why?
2. When have you shown resilience in your own life?
How? What helped you succeed?
3. How can you cultivate more resilience in your life?
4. Share an example of when a patient or colleague
demonstrated strength and resilience.
5. How can you enhance resilience in your workplace?
Photo: positivepsychologyprogram.com

136. To Learn More:
Whole Health Education Library
https://wholehealth.wisc.edu/tools/burno
ut-part-1-origins/
https://wholehealth.wisc.edu/tools/burno
ut-part-2-solutions/

137. The Personal Health Inventory pp. 9-10
• What do you need to
take even better care of
yourself?
• The Brief PHI is one
example
• Several sections
– Vitality signs
– Big Questions
– Self/Professional Care
Ratings
– Vision of the Future
• One of many
assessments

138. Activity: Your Own PHI
• Complete the Brief Personal Health
Inventory on page 9-10
–It is 2 pages (don’t forget the back!)
–Takes about 5-10 minutes
• You will be discussing the inventory with
others throughout the rest of the course

139. What was it like to
complete the PHI?
What did you
notice?
Discussion
Photo: nga.gov

140. Closing, Pulse
Checks,
Homework

141. Thank You
And see you tomorrow!
Photo: fstoppers.com