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Care for the Colleague: Bringing Encouragement and Support in Difficult Events by Kit Hoffman, PsyD | BESIDE Program Coach, Confluence Health

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Slides from a webinar on designing, implementing, and monitoring a successful Care for the Colleague program, presented by Kit Hoffman with first-hand experience of setting up such a program at Confluence Health.

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Care for the Colleague: Bringing Encouragement and Support in Difficult Events by Kit Hoffman, PsyD | BESIDE Program Coach, Confluence Health

  1. 1. BESIDE Bringing Encouragement and Support in Difficult Events Kit Hoffman, PsyD September 27, 2018 Northwest Patient Safety Coalition – Patient Safety Webinar
  2. 2. Outline • Brief Overview: Second Victim Phenomenon • Overview of Care for the Colleague • Psychologist’s Role in Care for the Colleague • BESIDE: Design, Implementation, and Evaluation – Future Directions • How to support a traumatized healthcare professional
  3. 3. Overview of the Second Victim Phenomenon
  4. 4. What is the Second Victim Experience? • Potential impact – Disrupted sleep – Guilt, anger, shame, depression – Self-doubt – Anxiety, worrying thoughts – Impaired judgment and concentration – Burnout – Decreased job satisfaction – leaving the profession – Increased likelihood of being involved in subsequent medical error – Other symptoms of trauma (e.g., nightmares, hypervigilance, physiological arousal, digestive upset)
  5. 5. Medical Errors All causes 2,597k Cancer 585k Medical error 251k COPD 149k Suicide 41k Firearms 34k Motor vehicles 34k Heart Disease 611k Causes of death, US, 2013 Adapted from Physician’s Weekly, 2016
  6. 6. Malpractice Lawsuits 2017 Medscape Report 4,000 Physicians Surveyed Levy & Kane, 2017 Named in a lawsuit
  7. 7. Mediators of Second Victim Experience Interaction between cultural and individual factors
  8. 8. What is Care for the Colleague? AKA Second Victim Support or Care for the Caregiver
  9. 9. The Case for Care for the Colleague
  10. 10. Potential Outcomes • Reduced risk for burnout • Retaining healthcare professionals in their role • Finding joy and meaning in work • Improvements in patient safety culture
  11. 11. Cost-Benefit Analysis: Cost Savings • RISE at Johns Hopkins Moran et al., 2017 • 1 year period • 1,000 bed hospital
  12. 12. Basic Structure
  13. 13. Clinician Support Model ForYOU at University of Missouri Healthy System Tier 3 Professional Resources Tier 2 Trained Peer Supporters Tier 1 Department Supports and Leadership Mentoring ForYOU Three-Tier Structure. (Hirschinger, Scott, & Hahn-Cover, 2015)
  14. 14. What is missing from the picture?
  15. 15. Andrew & Brenner, 2015
  16. 16. Seys at al., 2012
  17. 17. Tier 3 External Resources Tier 2 Trained Peer Supporters Tier 1 Psychologist – Support and Prevention Organizational Awareness and Support Confluence Health’s Care for the Colleague Model
  18. 18. Psychologist’s Role: BESIDE Coach • Coordinate Care for the Caregiver Program • Immediate psychological interventions—Individual and Group • Ongoing support, especially for litigation • Evaluate fitness for duty – Individual, supportive accommodations • Design and conduct Peer Supporter Trainings—Ongoing support • Organization-wide prevention • Evaluate program effectiveness
  19. 19. Defining and Designing
  20. 20. Design Considerations Program Component Program Component Program Component Needs of the Organization
  21. 21. BESIDE Program Structure Confidential Consultation and Support Peer Support Program Ongoing Workshops CRP & Incident Management
  22. 22. Designing and Implementing Care for Colleague • Clinician Support Toolkit for Healthcare via Medically Induced Trauma Support Services (MITSS) • Agency for Healthcare Research and Quality (AHRQ) Care for the Caregiver Program Implementation Guide found in their Communication and Optimal Resolution (CANDOR) Toolkit • Building a Clinician Support Program, Assessment Worksheet/Planner via Susan Scott at University of Missouri Health Systems • Second Victim Experience and Support Tool (SVEST) – Pre- and post-test
  23. 23. How the BESIDE Program Works Ongoing education and prevention workshops At any time, staff and providers can self-refer Safety Event or Commission Complaint is Reported Outreach to providers and staff Staff and providers can self refer Staff or provider meets with BESIDE Coach and/or Peer Supporter and plan for support is devised As needed, ongoing consultation with BESIDE Coach and/or referral to higher level of care Group debriefings for crisis events, as needed
  24. 24. Activities: Inputs Program Development -Protocols for Inclusion in BESIDE Program Marketing/Outreach Efforts Recruiting and Training Peer Supporters Activities: Outputs (Products and Services) Individual Coaching/Ongoing support Peer Support/Crisis Intervention Workshops Short-Term Outcomes (Specific to BESIDE) Organizational support (e.g., work accommodations made) Return to baseline functioning Increased perception of social connection Increased Knowledge (e.g., self-care, burnout) Long-Term Outcomes: Culture of Safety Reduced rates of burnout/increased resilience Decreased “culture of shame”/increased “Just Culture” Improved work/life balance Feels valued as an employee Effective Teamwork
  25. 25. Implementation
  26. 26. BESIDE Implementation Progression Marketing and Outreach (Ongoing) Phase One: Provide Confidential Coaching and Support -Offer and provide education workshops by request Phase Two: Implement Peer Support Program -Recruit, Select, Train Peer Supporters Phase Three: Ongoing education and prevention workshops -Expand support to include leadership training -Build Future Directions Current Phase of BESIDE
  27. 27. Evaluation
  28. 28. Activities: Inputs Program Development -Protocols for Inclusion in BESIDE Program Marketing/Outreach Efforts Recruiting and Training Peer Supporters Activities: Outputs (Products and Services) Individual Coaching/Ongoing support Peer Support/Crisis Intervention Workshops Short-Term Outcomes (Specific to BESIDE) Organizational support (e.g., work accommodations made) Return to baseline functioning Increased perception of social connection Increased Knowledge (e.g., self-care, burnout) Long-Term Outcomes: Culture of Safety Reduced rates of burnout/increased resilience Decreased “culture of shame”/increased “Just Culture” Improved work/life balance Feels valued as an employee Effective Teamwork
  29. 29. Input: Marketing and Outreach Efforts • Tracking outreach • Routinely asking, – “How did you hear about BESIDE?” -COMPARE TO- • Overall calls/identified needs • Interest in being Peer Supporter Calls for all BESIDE Services Requests September 2017 through July 2018 0 1 8 5 12 24 15 15 22 18 12 8 0 5 10 15 20 25 30 Referrals and Requests for all BESIDE Services Total, n=140
  30. 30. Services Not Provided, 66, 47% Initial Services Provided After 24 Hours, 47, 34% Initial Services Provided Within 24 Hours, 24, 17% Pending Services, 3, 2% Outcomes of Referrals And Requests For All BESIDE Services Total, n=140
  31. 31. Products and Services: Number of Services Provided • 94 sessions • 43 individuals Individual Coaching • 12 debriefings • 95 individuals Group Crisis Debriefing • 14 trained Peer Supporters • 6 more will be trained this fall Peer Supporters • 20 workshops • 238 attendees Workshops
  32. 32. TrackingPeerSupportServices
  33. 33. Short-Term Outcomes: Workshop Survey
  34. 34. Mean Workshop Scores 4.79 4.66 4.7 4.89 4.63 1 2 3 4 5 Satisfaction with Presentation Presenter's Ability to Maintain my Interest Learned One Thing I Plan to Use Presenter's Ability to Answer Questions Likelihood to Recommend BESIDE Responses from 11 workshops; 127 attendees 5-Point Likert Scale Questions
  35. 35. Future Directions
  36. 36. Activities: Inputs Program Development -Protocols for Inclusion in BESIDE Program Marketing/Outreach Efforts Recruiting and Training Peer Supporters Activities: Outputs (Products and Services) Individual Coaching/Ongoing support Peer Support/Crisis Intervention Workshops Short-Term Outcomes (Specific to BESIDE) Organizational support (e.g., work accommodations made) Return to baseline functioning Increased perception of social connection Increased Knowledge (e.g., self-care, burnout) Long-Term Outcomes: Culture of Safety Reduced rates of burnout/Increased resilience Decreased culture of shame/Increased “Just Culture” Improved work/life balance Feels valued as an employee Effective Teamwork
  37. 37. Long Term Outcomes
  38. 38. Lessons Learned: Barriers • Raising awareness about the program • Managing unidentified needs • Shame/stigma
  39. 39. Lesson Learned: Balancing Act Author: Leandro Inocencio
  40. 40. Future Directions • Educating leaders across the organization – What is 2nd Victim? – What is BESIDE? – What is leadership’s role in 2nd victim event? • Increasing Peer Supporter presence • Meeting identified needs – Moved BESIDE from Incident Management to Behavioral Health Department
  41. 41. How to Support a Traumatized Healthcare Professional
  42. 42. Providing Support to a Traumatized Person: General Guidelines for Anyone • If in crisis – Are basic and safety needs met? – Remove from stressful environment – What resources are available? – 1-800-273-8255 Suicide Prevention Hotline – Text to 741-741
  43. 43. Providing Support to a Traumatized Person: General Guidelines for Anyone • Following a crisis – Trauma-informed conversations – Use active listening—don’t jump to problem solving right away – Offer realistic support—don’t make promises you can’t keep • ALWAYS make sure the person has natural supports in place – Connect with resources or become their support, if able
  44. 44. 4. Maintain Routine 5. Talk with Trusted Friends, Family, Supports 3. Sleep/Rest 2. Physical Activity 1. Water and Healthy Foods FiveEssentialSelf-CareSkills
  45. 45. Providing Organizational Support following a Safety Event • Develop a process for organizational support 1. Who will connect with healthcare professional? – Managers, supervisors, etc. 2. A supportive statement – e.g., “We value and trust you as a member our team.” or “We care about how you are doing.” 3. Help with next steps – Offer help with documenting and reporting event, if needed – Offer to call in flex staff, if possible 4. Provide ongoing support – Provide local resources (e.g., peer supporters, EAP, etc.) – Check-in with staff member on ongoing basis (days, weeks later) until resolved
  46. 46. Questions? Kit Hoffman, PsyD 760-622-9674 Katharine.Hoffman@confluencehealth.org
  47. 47. References • Andrew, L. B., & Brenner, B. E. (2015). Physician suicide. Medscape Drugs & Diseases. • Burlison, J.D., Scott, S.D., Browne, E.K., Thompson, S.G. & Hoffman, J.M. (2014). The second victim experience and support tool: Validation of an organizational resource for assessing second victim effects and the quality of support resources. Journal of Patient Safety. • Christensen, J. F., Levinson, W., & Dunn, P. M. (2006). The Heart of Darkness: The Impact of Perceived Mistakes on Physicians. Neonatal Intensive Care, 19(7), 48. • Edrees, H., Connors, C., Paine, L., Norvell, M., Taylor, H., & Wu, A. W. (2016). Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ open, 6(9), e011708. • Gold, K. J., Sen, A., & Schwenk, T. L. (2013). Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry, 35(1), 45-49. • Headley, M. (2017, October 4). Creating a Culture of Caregiver Support . Patient Safety & Quality Healthcare. • Hirschinger, L. E., Scott, S. D., & Hahn-Cover, K. (2015). Clinician support: five years of lessons learned. Patient Saf Qual Healthc, 12(2), 26-31.
  48. 48. References • Levy, S. & Kane, L. (2017). Medscape Malpractice Report 2017. Medscape. Retrieved from https://www.medscape.com/slideshow/2017-malpractice-report- 6009206 • Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the U.S. BMJ: British Medical Journal (Online), 353. • Moran, D., Wu, A. W., Connors, C., Chappidi, M. R., Sreedhara, S. K., Selter, J. H., & Padula, W. V. (2017). Cost-benefit analysis of a support program for nursing staff. Journal of patient safety. • Physician’s Weekly. (2016). Medical errors officially the third leading cause of death in U.S. Physician’s Weekly. Retrieved from https://www.physiciansweekly.com/medical-errors-officially-the-third- leading-cause-of-death-in-u-s-study-finds • Prins, J., van der Heijden, F., Hoekstra-Weebers, J., Bakker, A., van de Wiel, H., Jacobs, B., & Gazendam-Donofrio, S. (2009). Burnout, engagement and resident physicians' self-reported errors. Psychology, Health & Medicine, 14(6), 654-666. doi:10.1080/13548500903311554 • Scott, S. D. (2015). Second victim support: Implications for patient safety attitudes and perceptions. Patient Saf Qual Healthc, 12(5), 26- 31. • Wu, A. (2000). Medical error: the second victim: the doctor who makes the mistake needs help too. BMJ: British Medical Journal, 320(7237), 726. Continued

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