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.
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From Burnout to Engagement: Strategies to Promote Physician Wellness and Workplace Satisfaction
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
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. 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. What is Burnout?
Burnout is a syndrome of:
depersonalization
emotional exhaustion
low personal accomplishment
leading to decreased effectiveness at work.
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. 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. 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. Physician Burnout: Key Drivers
• Excessive workload
• Inefficient environment, inadequate support
• Loss autonomy/flexibility
• Problems with work-life integration
• Loss of meaning in work
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. 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. Second Intervention Trial
DOM faculty
N=550
Volunteers
N=125
Non-
volunteers
N=425
Intervention
N=64
Waitlist Control
N=61
Current
Practice
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. 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. 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. Burnout: Key Drivers
• Excessive workload
• Inefficient environment, inadequate support
• Loss autonomy/flexibility
• Problems with work-life integration
• Loss of meaning in work
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
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. 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. 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. 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. 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. 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.
29. 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)
30. Why should mindfulness matter to
clinicians?
• Quality of care
• Empathy
• Avoids cognitive traps and resulting errors
• Clearer assessments
• Promotes a more participatory medicine
31. 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
34. 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
36. 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
39. 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
41. 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”
42. • 649 physicians
• 281 spouses / family members
• 10,249 total number of sessions
PHYSICIAN SUPPORT SERVICES
48. 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
49. 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