Paradigm Shift From What's the Matter to What Matters to

Paradigm Shift From "What's the Matter" to "What Matters to You" Conversations: Creating Resilience by

Improving Joy at Work

Letha M. Joseph, DNP, APRN, AGPCNP-BCDurham VA HealthCare System

Duke University School of Nursing, Durham, NC

114th Annual ConventionConcord, NC | September 23-24, 2021

Objectives

• Define burnout and discuss signs of burnout• Describe the mechanism of burnout and its

impact on patient safety• Develop individual strategies to promote

resilience• Apply "what matters to you" conversation

strategy in creating resilient teams

Quadruple Aim

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From Triple Aim to Quadruple Aim

• Improved patient experience• Population focused approach• Cost effective use of resources • Joy and wellbeing of the workforce

Take care of your employees and the employees will take care of your patients

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Joy and Meaning

MEANINGFUL CONNECTION

PURPOSE IMPACT PRACTICEENVIRONMENT

A Narrative Analysis of Meaning and Joy in Nursing Practice, Institute of Health Care Improvement http://app.ihi.org/FacultyDocuments/Events/Event-2930/Posterboard-5781/Document-5495/Nurse_Stories_of_Meaning_and_Joy.pdf

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Through the eyes of the workforce

• Lucian Leape Institute. 2013. Through the eyes of the workforce: creating joy, meaning and safer health care. Boston, MA: National Patient Safety Foundation.

• National Academy of Medicine discussion paper 2017-Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care

Burnout

Emotional exhaustion

leading to

depersonalization and

low sense of personal

accomplishment at workThis Photo by Unknown Author is licensed under CC BY-SA-NC

Burnout- Occupational Phenomenon

“Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

Feelings of energy depletion/exhaustion Increased mental distance from one’s job, or feelings

of negativism or cynicism related to one's job; and Reduced professional efficacy”.

ICD-11 Definition

Burn-out an "occupational phenomenon": International Classification of Diseases (who.int)

Audience Response Question

Which of the following is the best tool to evaluate burnout in healthcare workers?

1. PHQ-92. Maslach Burnout Inventory 3. Health-Related Quality of Life Questionnaire4. World Health Organization Quality of Life Instrument

Audience Response - Answer

Which of the following is the best tool to evaluate burnout in healthcare workers?

1. PHQ-92. Maslach Burnout Inventory 3. Health-Related Quality of Life Questionnaire4. World Health Organization Quality of Life Instrument

Am I suffering ?

Maslach Burnout Inventory

Captures three dimensions of burnout

-emotional exhaustion,

-depersonalization &

-personal accomplishment

https://www.mindgarden.com/315-mbi-human-services-survey-medical-personnel

NAM Report- Burnout in Physicians

• >50% of US physicians report substantial symptoms of burnout

• Highest risk- in ED, family medicine, general internal medicine, neurology

• 2011-2014, the prevalence increased by 9%

National Academy of Medicine discussion paper 2017- Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care

NAM Report- Burnout in Nurses

High degree of emotional exhaustion

35 % of hospital nurses 37 % of nursing home nurses 22%of nurses working in other settings

National Academy of Medicine discussion paper 2017- Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care

Burnout in Nurses

Nurses who left their Jobs owing to burnout

2018 National Sample Survey of Registered Nurses.Prevalence of and Factors Associated With Nurse Burnout in the US JAMA Netw Open. 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021 https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456

Burnout - Factors

▰ Workload▰ Control▰ Reward▰ Community

▰ Fairness▰ Values▰ Job–person incongruity

Audience Response Question

What are some of the contributing factors of burnout? (Check all that apply)

1. Workload & long work hours2. Lack of respect from other professionals3. Lack of respect from patients 4. Too many regulatory requirements5. Computerization & Electronic Health Record6. Lack of autonomy7. Insufficient compensation8. COVID-19 9. Others

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

•“My batteries are just run down”.

•“I am not sure how much longer I can go like this”!

•“Thank goodness it’s Friday. I made it through another week.”

This Photo by Unknown Author is licensed under CC BY-SA

Do we stop when our ‘battery’ runs out?

What is burnout?

Energy Accounts

Physical Energy AccountDeposit by exercise, physical care, rest, diet

Emotional Energy AccountDeposit by healthy relationships

Spiritual Energy AccountDeposit by connecting with your purpose

Negative balance-Exhaustion

Negative balance-Cynicism, sarcasm

Negative balance-“Do I do anything good?”

Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html

Energy Balance

▰ Withdraw energy for daily use

▰ Deposit energy by rest, positive experience etc.

▰ Negative balance leads to burnout symptoms

Full

Empty

Negative balance

Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes.Fam Pract Manag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html

Burnout Leads to:

Lower levels of empathy

Poor QoL for staff Alcohol, drug abuse,

depression High risk for suicide.

Reduced adherence to treatment plans Overuse of resources Higher staff turnover

Poor quality of care Medical error Lower patient satisfaction

Bodenheimer, T., Sinsky, C. (2015) From the Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine

“Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being”. National Academy of Medicine 2019

Create positive workplaces Address burnout in training and in clinicians’ early

years Reduce administrative burden

Improve usability of health Information Technology Improve burnout recovery services National research agenda on clinician well-being

Six-Goal

Approach

Joy at Work

IHI Frameworkfor Creating

Joyful & Engaged Workforce

www.ihi.org

Joy at Work

Joy Starts Here

https://www.simplypsychology.org/maslow.html

Pillars of joy at work - PERK

Purpose Engagement

Resilience Kindness

The Greater Good Science Center UC Berkeley https://greatergood.berkeley.edu/article/item/the_four_keys_to_happiness_at_work

Purpose

I became a nurse because . . . What makes me proud to work @-----because. . . What matters to me in my work is . . . What I do best is …… At the end of the day, I feel happy about …

Resilience

Ability to handle, adapt to, and learn from setbacks, failures, and disappointments

Successfully detach from work

Real-time, in-the-moment awareness: Mindfulness

This Photo by Unknown Author is licensed under CC BY-SA-NC

Kindness

• Orient thoughts, feelings & actions towards care for others

• Genuinely support social bonds• Treat others with dignity and respect,

empathy and compassion • Practice gratitude• Constructive management of conflicts

Gratitude Practice

Describe what that other person did for you. Describe

Acknowledge their effort and the quality of their efforts

Acknowledge

Explain how their actions helped youExplain

Gratitude Practice-Benefits

Engagement

Add some playfulness,

creativity& levity

More ownership over day-to-day schedule,

tasks, and professional development

“What matters to you” conversations

Audience Response System -Question

“What matters to you” conversation is an effective strategy for:

1. Employee engagement2. Coworker engagement3. Patient engagement4. All the above

Audience Response System - Answer

“What matters to you” conversation is an effective strategy for:

1. Employee engagement2. Coworker engagement3. Patient engagement4. All the above

What ‘s the matter ?

To

What matters to you?

Impact of “What matters to you” question

Culture change

How will you prevent burnout?

How will you improve engagement by promoting “what matters to you “ conversation?

Contact info: letha.joseph@duke.edu

Reference

• Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam PractManag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html

• Dyrbye, L.N., T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers. (2017). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-un-derrecognized-threat-to-safe-high-quality-care.

• Edwards et al. (2018) Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices. J Gen Intern Med 33(12):2138–46 DOI: 10.1007/s11606-018-4679-0

• Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry research, 191(1), 36–43. doi:10.1016/j.pscychresns.2010.08.006

• Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston, MA: National Patient Safety Foundation; 2013

• Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y. U., Anton, A., Sinclair, S., & Schmidt, S. (2017). Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job” program. BMC Palliative Care, 1–15. doi:10.1186/s12904-017-0219-7

• Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017

• Reith T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Cureus, 10(12), e3681. doi:10.7759/cureus.3681

Thank You!Questions?

Letha M. Josephletha.joseph@duke.edu