Barbara Chandler, health at work
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This document discusses workplace health and well-being. It covers topics like stress, burnout, and what individuals and organizations can do to promote well-being. Some of the key points include: defining burnout and its symptoms; research finding high levels of burnout among UK doctors; interventions for burnout like CBT and relaxation; and recommendations for individuals like connecting with others, learning new skills, and practicing mindfulness, as well as organizational changes. The document emphasizes the importance of addressing stress and burnout for the health of both individuals and the healthcare system.
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Barbara Chandler, health at work
- 1. Health at Work Dr Barbara Chandler Consultant Rehabilitation Medicine NHS Highland 13th November 2017
- 2. Learning outcomes • Health in the workplace • Stress and performance • Burnout • What I can do for myself • What I can do for others • Organisational change Anything else?
- 3. A life without stress??? • What if … • Too much stuff • Too little stuff • Doubt • Reduced anticipation of enjoyment • Low mood • Feeling of being ignored • “no one understands” • Every time Resolution • Identify stress • Exacerbating factors • Perpetuating factors • Consequences • Resolution • Learning points
- 4. Human performance curve (Yerkes Dodson 1908)
- 5. Can you think of a situation in which you have felt stressed How did it affect you? What was the cause(s)? What did you do about it?
- 6. Burnout (Maslach 1986) •High emotional exhaustion •High de-personalisation •Low personal accomplishment
- 7. Burnout • EXHAUSTION • Over-extended • Depleted of emotional and physical resources • DEPERSONALISATION (cynicism) • Negative, callous, excessively detached response to aspects of the job • REDUCED EFFICACY or ACCOMPLISHMENT • Feelings of incompetence; lack of achievement and productivity Self evaluation Inter-personal context Individual stress dimension
- 8. Burnout in GP’s (Orton et al 2012) N= 564 general practitioners in Essex • 46% had high levels of emotional exhaustion, • 42% had depersonalisation and • 32% had low levels of personal accomplishment
- 9. Personal and Practice Risk Factors • Personal risk factors • Male • < 20 years GMC registration • Practice risk factors • Group practice • Seeing more “usual” patients ‘Whatever the reasons, a significant proportion of doctors are in trouble.’ Burnout levels indicate personal distress
- 10. Cochrane review 2015 • No apparent cultural difference • Approaches to treatment using CBT or relaxation applicable across cultures • No significant differences between different groups of health care workers • Intervention studies difficult to interpret, what is the aim of the study
- 11. Cochrane review 2015 ctd • Interventions • CBT – new ways to feel think and act • Relaxation – diverting attention away from unpleasant thoughts and building resilience • Organisational interventions – adjusting work practices
- 12. “Being a physician today is not good for your health” “Specialists know more and more about less and less; doctors treat diseases not people; medical schools teach the science but ignore the art of medicine; medical technology has outpaced moral understanding; hospitals have become cold, impersonal mazes” Cole and Carlin The Lancet 2009
- 13. “Burnout is the index of dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit, and will – and erosion of the human soul” Maslach and Leiter
- 14. “Burnout is the index of dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit, and will – and erosion of the human soul” Maslach and Leiter • Have you noticed when colleagues are “not themselves”? • Were you able to approach them? • How did they react? “Being a health care professional today is not good for your health”
- 15. What can be done? • Business in the community Workwell model of wellbeing • Wellness action plans MIND • Five steps to mental wellbeing NHS Choices • Mindfulness • Mentoring • CBT • VBRP (Values based reflective practice)
- 16. On Looking after yourself: a survival guide Psychiatrists Support Service RCPsych • Monitoring your own health and stress levels • Healthy living • Monitor your own coping strategies including alcohol and substance use • Discuss with family and friends • Informal discussion with colleagues • Formal discussion with colleagues • Make changes to your work/life balance • Supervision/mentoring • Seek help for health problems • Don not ignore the early warning signs of stress
- 18. Five ways to wellbeing (New Economics Foundation; MIND; NHS Choices) 1. Connect 2. Be active 3. Keep Learning 4. Give to others 5. Be mindful www.neweconomics.org www.mind.org.uk www.wellbeing.bitc.org.uk www.nhs.uk
- 19. 1. Connect • Talk in place of email • Speak to someone new • Ask someone how they are and LISTEN • Make 5 minutes to ask how someone is getting on • Walk or travel with someone • VBRP
- 20. Values Based Reflective Practice • We reflect on the past, in the present, to improve the future • To improve clinical outcomes • Values the worker as well as the work TOOLS - 1 • What do you see • What do you wonder • What do you realise
- 21. VBRP TOOLS – 2 • Whose needs were met / left unmet • What does this tell us about my / our capabilities • Whose voice was heard / ignored in the decisions and actions • What was valued / under- / or over-valued • What does this say about you / me /us
- 22. 2. Be active •Exercise for health •“23 and half hours” •Stairs not lift •Walk - steps •Stretching
- 23. 3. Take notice • Be mindful • Aware of the present “knowing what is going on inside and outside ourselves moment by moment • Sights, sounds, tastes, smells, feelings of the present moment Mindfulness NHS Choices Moodzone www.palouseminfulness.com
- 24. 4. Learn •Learn something new •Find out about colleagues •Book a study day/course •Learn something outside work
- 25. Mentoring and Coaching Mentoring and coaching are learning relationships which help people: 1. Take charge of their own development 2. Release their potential 3. Achieve results which they value “…the learning relationship is at the heart of change” Connor and Pokora 2012
- 26. The skilled helper model Egan 2010 • What’s going on? • Story; new perspectives; value point • What is my preferred picture? • Possibilities; change agenda a specific goal; commitment • What is the way forward? • How do I get what I need / want; best fit strategies; PLAN Within the seeds of wild ideas may be the germ of a realistic possibility
- 27. 5. Give •Make a coffee •Ask how someone is •Complement someone •Thank someone •Remind someone that it is time to go home!
- 28. Final thoughts • What can I do individually to enhance my work life • What can we do as a group to influence work life • How will this affect life outside work? • What organizational changes may help? • What (small or large) organisational changes can I make that will improve wellbeing at work?
Editor's Notes
- Think of an example of a stressful situation – not too serious and not work related Mine – holiday How do you deal with it? Do you resolve it What changes can you make to self others environment
- Can delegates identify with this Where do you think you are on the curve and does it vary from day to day? Can you think of a situation in which you have felt stressed How did it affect you? what was the cause(s)? What did you do about it?
- Concept of burnout was introduced in the late 1970’s to describe a negative reaction of workers in client oriented occupations such as social workers and doctors Burnout occurs when three criteria are met Interpreting the three dimensions is also open to discussion – some consider it a developing phenomenon others suggest it is a state of being
- Bottom up and not taken entirely seriously at first as it came from the ”shop-floor” experience of workers up to developing academic theory rather than the other way round from scholarly thought into investigation of the workplace. What has emerged is the conceptualization of job burnout as a psychological syndrome in response to chronic interpersonal stressors on the job Depersonalisation represents the inter-personal dimension Symptoms – fatigue, poor memory, poor concentration, guilt, anxiety, insomnia. May manifest to others as someone who is uncooperative, frustrated, irritable, indecisive, apathetic. Further consequences – increasing social isolation, dependency on alcohol or drugs, reduced work ability, depressive illness Doctors and often nurses are not good patients
- A study amongst GP’s in Essex found that of 564 GP’s 46% had high levels of emotional exhaustion, 42% had depersonalisation and 32% had low levels of personal accomplishment. Not sure how to interpret these numbers Interestingly those with high depersonalisation or cynicism were not more criticised by patients and did not demonstrate adverse inter-personal relationships Personal risk factors were
- In relation to women working – more work part time and stress is 12%–15% more likely for each additional 5 hours per week worked. McMurray et al 2000 Study in industry in Switzerland found the best predictor of poor work related health was work-life conflict – inter-role conflict between work and family Hammig & Bauer2013
- Studies across continents except Africa
- Chinese relaxation like Qigong equally applicable in europe and CBT effective in Japanese nurses similar to US nurses Qigong is holistic system of breathing; posture movement meditation for health and spirituality
- The Lancet Perspective
- About 25% or 1:4 health care workers are considered “burnt out” Lancet 2009 quoting other work
- Business in the community model Outer wheel – the cycle of business benefits that come from promoting wellbeing – compelling business model Inner grey wheel – employee led element based on five ways to wellbeing framework developed by the New Economics foundation
- New Economics Foundation was commissioned by the Government’s Foresight project on Mental Capital and Wellbeing to develop a set of evidence based actions to improve personal wellbeing.
- Generate ideas then bring in ideas Social relationships are critical for promoting wellbeing and acting as a buffer against mental ill health
- Fitbit