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From Burnout to Engagement: Strategies to Promote Physician Wellness and Workplace Satisfaction

Slides from a Modern Healthcare presentation.

http://www.modernhealthcare.com/article/20150225/INFO/302259999/webinar-from-burnout-to-engagement-strategies-to-promote-physician

Faced with long hours, unrelenting administrative burdens and the pressure to treat patients quickly, a growing number of physicians are experiencing burnout, a condition characterized by loss of empathy, exhaustion, and a low sense of accomplishment. According to a Mayo Clinic survey from 2012, nearly one in two U.S physicians reported at least one symptom of burnout, up from 22% in 2001. For hospitals with stressed caregivers, the stakes are high. Burned out, dissatisfied physicians are far more likely to make medical errors and are less able to communicate effectively with patients and co-workers. They're also at a higher risk for substance abuse and are more likely to leave clinical practice altogether.

From Burnout to Engagement: Strategies to Promote Physician Wellness and Workplace Satisfaction

  1. 1. WEBINAR WELCOME! Dr. Colin West Physician and researcher Departments of Internal Medicine and Health Sciences Research Mayo Clinic Dr. Michael Krasner Professor of clinical medicine University of Rochester Maureen McKinney Editorial Programs Manager Modern Healthcare During today’s discussion, feel free to submit questions at any time by using the questions box. A follow-up e-mail will be sent to all attendees with links to the presentation materials online. Dr. Ted Hamilton Vice president of medical mission Adventist Health System Panelists: FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction
  2. 2. WEBINAR HOUSEKEEPING
  3. 3. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction Maureen McKinney Editorial Programs Manager Modern Healthcare
  4. 4. NOW SPEAKING WEBINAR FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction Please use the questions box on your webinar dashboard to submit questions to our moderator Dr. Colin West Physician and researcher Departments of Internal Medicine and Health Sciences Research Mayo Clinic
  5. 5. What is Burnout? Burnout is a syndrome of: depersonalization emotional exhaustion low personal accomplishment leading to decreased effectiveness at work.
  6. 6. Burnout among Practicing Physicians National Data (Shanafelt et al., Arch Intern Med 2012) Burnout: 45.8% Emotional exhaustion: 37.9% Depersonalization: 29.4%
  7. 7. Burnout by Specialty (National) 0 10 20 30 40 50 60 70 Prev Med/Occupat Med/Enviro Med Dermatology Pediatrics - General Pathology Radiation Oncology Other Pediatric Subspecialty Neurosurgery Psychiatry Urology General Surgery Subspecialty Ophthalmology Internal Medicine Subspecialty General Surgery Average Burnout All Physicians Participating Physical medicine and Rehab Radiology Obstetrics and Gynecology Anesthesiology Orthopedic Surgery Otolaryngology Family Medicine Neurology Internal Medicine - General Emergency Medicine % Reporting Burnout Emergency Medicine General Internal Medicine Neurology Family Medicine Otolaryngology Orthopedic Surgery Anesthesiology OB/GYN Radiology Physical medicine/Rehab Average all physicians General Surgery Internal Medicine Subspecialty Ophthalmology General Surgery Sub-specialty Urology Psychiatry Neurosurgery Preventative/Occupational Medicine Pediatric Subspecialty Other Radiation Oncology Pathology General Pediatrics Dermatology Shanafelt et al. Arch Intern Med 2012
  8. 8. Consequences of Physician Burnout • Medical errors1-3 • Impaired professionalism5,6 • Reduced patient satisfaction7 • Staff turnover and reduced hours8 • Depression and suicidal ideation9,10 • Motor vehicle crashes and near-misses11 1JAMA 296:1071, 2JAMA 304:1173, 3JAMA 302:1294, 4Annals IM 136:358, 5Annals Surg 251:995, 6JAMA 306:952, 7Health Psych 12:93, 8JACS 212:421, 9Annals IM 149:334, 10Arch Surg 146:54, 11Mayo Clin Proc 2012
  9. 9. Physician Burnout: Key Drivers • Excessive workload • Inefficient environment, inadequate support • Loss autonomy/flexibility • Problems with work-life integration • Loss of meaning in work
  10. 10. Intervention Trial • RCT testing if an established, portable, low-cost curriculum administered during regular work hours can promote meaning and reduce burnout – Arm A (Intervention): • meet 90 minutes (12:30-2) every other wk (60 mins protected time, ~1% FTE) • 9 months • Facilitated curriculum, small groups of 6-8 physicians – Arm B (Control): • Receive 60 minutes every other week for professional/administrative tasks (~1% FTE) • Outcomes assessed quarterly, 3 months post, 12 months post West et al., JAMA Intern Med. 2014:174:527-33
  11. 11. Conclusions • A small amount of protected time during the workday resulted in improved meaning from work and reductions in burnout – Effects larger in facilitated small group arm than in “free time” control arm, particularly in promoting meaning and reducing depersonalization. – Follow-up study data found sustained benefits at 1 year after the close of the study. West et al., JAMA Intern Med 2014:174:527-33
  12. 12. Second Intervention Trial DOM faculty N=550 Volunteers N=125 Non- volunteers N=425 Intervention N=64 Waitlist Control N=61 Current Practice
  13. 13. Conclusions • Compared to the wait-listed control group, the facilitated small group intervention improved: – Depersonalization – Personal accomplishment – Overall QOL – Depression – Meaning from work – Social isolation at work – Job satisfaction – Likelihood of leaving in next 2 years • Initial intervention shows benefit with sustained changes over subsequent 6 months.
  14. 14. Individual Strategies • Identify Values • Debunk myth of delayed gratification • What matters to you most (integrate values) • Integrate personal and professional life • Optimize meaning in work • Flow • Choose/focus practice • Nurture personal wellness activities • Calibrate distress level • Self-care (exercise, sleep, regular medical care) • Relationships (connect w/ colleagues; personal) • Religious/spiritual practice • Mindfulness • Personal interests (hobbies)
  15. 15. What Can Organizations Do? • Be value oriented • Promote values of the medical profession • Congruence between values and expectations • Provide adequate resources (efficiency) • Organization and work unit level • Promote autonomy • Flexibility, input, sense control • Promote work-life integration • Promote meaning in work
  16. 16. Burnout: Key Drivers • Excessive workload • Inefficient environment, inadequate support • Loss autonomy/flexibility • Problems with work-life integration • Loss of meaning in work
  17. 17. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction Dr. Michael Krasner Professor of clinical medicine University of Rochester
  18. 18. Medicine in Crisis Crisis of meaning Crisis of identity Crisis of purpose Crisis of role
  19. 19. Sir Luke Fildes, The Doctor 1867 Oil on canvas, The Tate Britain, London
  20. 20. Toll , B. JAMA June 20, 2012
  21. 21. HYPOTHESES: Resilience is a capacity that can be grown
  22. 22. Lower quality of technical care Riskier prescribing practices More medication errors Lower patient adherence to treatment More unsafe behaviors (e.g. needlestick injuries, not following protocols) Lower patient satisfaction Erosion of altruism and empathy Unprofessional conduct Poor relationships with staff and patients Higher attrition and job turnover higher recruitment costs Fahrenkopf et al. 2008; DiMatteo et al. 1991; Williams et al. 2009; Shanafelt et al. 2005; Dyrbye et al. 2010; Haas et al 2000; Sundquist et al 2000; Krasner et al. 2009; Buchbinder et al. 2001
  23. 23. Clinician resilience (well-being – burnout) Quality of care (safety – errors) Quality of caring (compassion - detachment) Shanafelt, T. D., et al. (2002). Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med, 136, 358-367; Shanafelt, T. D., et al. (2005). Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med, 20, 559-564.
  24. 24. Three components: Emotional exhaustion I just can’t do any more Depersonalization (cynicism) Every good deed gets punished Low personal accomplishment No matter how hard I work, nothing improves
  25. 25. The ability of an individual to respond to stress in a healthy, adaptive way such that personal goals are achieved at minimal psychological and physical cost; resilient individuals not only “bounce back” rapidly after challenges but also grow stronger in the process. Epstein & Krasner 2013 Howe A et al 2012
  26. 26. Burnout Resilience Withdrawn Present Emotionally exhausted Energized Defeated Bouncing back Going through the motions Fully engaged Brittle, rigid Bending, not breaking Cynical, hopeless Capacity for positivity Hypercritical A light touch Feeling ineffective Becoming stronger Treading water Moving forward AFGO Welcoming change
  27. 27. Optimism More and more I have come to admire resilience. Not the simple resistance of a pillow, whose foam returns over and over to the same shape, but the sinuous tenacity of a tree: finding the light newly blocked on one side, it turns in another. A blind intelligence, true. But out of such persistence arose turtles, rivers, mitochondria, figs -- all this resinous, unretractable earth. ~ Jane Hirshfield ~
  28. 28. Mindfulness • Integral to professional competence • A quality of consciousness • Attends to the context in which the contents of consciousness are expressed • Can be cultivated, grown, expanded • Attentive observation, critical curiosity, beginner’s mind, presence • The awareness that arises out of paying attention on purpose, in the present moment, without judgment (Kabat-Zinn 1994)
  29. 29. Why should mindfulness matter to clinicians? • Quality of care • Empathy • Avoids cognitive traps and resulting errors • Clearer assessments • Promotes a more participatory medicine
  30. 30. Moment-to-moment purposeful awareness of one’s own mental and physical processes during every day work with the goal of practicing with clarity and compassion Epstein RM 1999
  31. 31. Resilience and well-being Quality of care Quality of caring Mindful practice
  32. 32. Participation in a mindful communication program was associated with sustained improvements (<.001) in: Patient-centered attitudes (empathy, psychosocial orientation) Physician well-being (burnout, mood) Personality (increased emotional stability). Associations were mediated by changes in mindfulness. Participants identified three themes: community, skills development, and giving oneself permission to take time for self-development Results replicated in Spain and North America
  33. 33. RESILIENCE = INTENTION + COMMUNITY + SKILLS + ENGAGEMENT + SUPPORT
  34. 34. Other programs Baystate Medical Center Boston University Brown University Dalhousie University Dartmouth Medical School Drexel University Duke University East Carolina University Georgetown University Göteborg, Sweden Hamilton Ontario Health Systems Harvard Medical School Hong Kong University Jefferson Medical College Mayo Medical School McGill University Monash University Oakland University Ohio State University Oregon Health Sciences University Universidad Autónoma de Barcelona University of Iowa Université de Montreal University of California, San Diego University of Massachusetts University of Rochester University of Toronto University of Wisconsin
  35. 35. www.mindfulpractice.urmc.edu
  36. 36. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction Dr. Ted Hamilton Vice president of medical mission Adventist Health System
  37. 37. WALL STREET JOURNAL American doctors are unhappy . . . and it’s hurting patients.
  38. 38. If you want to change the culture of an organization, you don’t have to get everybody…you have to get the square root of N. It will take on a life of its own and drive itself ahead. W. Edwards Deming “SQUARE ROOT OF N”
  39. 39. • 649 physicians • 281 spouses / family members • 10,249 total number of sessions PHYSICIAN SUPPORT SERVICES
  40. 40. 4 • Clinical burnout • Depression / mood disorders • Marital / relationship issues • Anger management / boundary issues • Addiction / substance abuse CLINICAL ISSUES
  41. 41. FINDING MEANING IN MEDICINE
  42. 42. SCHWARTZ ROUNDS
  43. 43. • Physician Support Service • Meaning in Medicine • Schwartz Rounds • Physician On-Boarding THE BIG FOUR
  44. 44. 8 forphysicianwellbeing.org
  45. 45. WEBINAR TODAY’S PANELISTS FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction During today’s discussion, feel free to submit questions at any time by using the questions box Dr. Colin West Physician and researcher Departments of Internal Medicine and Health Sciences Research Mayo Clinic Dr. Michael Krasner Professor of clinical medicine University of Rochester Maureen McKinney Editorial Programs Manager Modern Healthcare Dr. Ted Hamilton Vice president of medical mission Adventist Health System
  46. 46. Expect a follow-up email within two weeks with links to presentation materials and information about how to offer feedback. For more information about upcoming webinars, please visit ModernHealthcare.com/webinars WEBINAR THANK YOU FOR ATTENDING Thanks also to our panelists: Dr. Colin West Physician and researcher Departments of Internal Medicine and Health Sciences Research Mayo Clinic Dr. Michael Krasner Professor of clinical medicine University of Rochester Maureen McKinney Editorial Programs Manager Modern Healthcare Dr. Ted Hamilton Vice president of medical mission Adventist Health System FROM BURNOUT TO ENGAGEMENT: Strategies to Promote Physician Wellness and Workplace Satisfaction

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