View
3
Download
0
Category
Preview:
Citation preview
Physicians: Individual and Systemic Strategies to
Prevent Burnout
Florida Chapter of the American College of PhysiciansDecember 9, 2017
Kathleen Gibney, PhD, ABPP, LMHC, DirectorThe Center for Physician Wellbeing, Florida Hospital
Financial Disclosures
• No relevant financial relationships with any commercial interests.
Kathy Gibney, PhD, ABPP, LMHC
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
Dimensions:‐ Emotional exhaustion‐ Impersonal attitude toward patients & coworkers (depersonalization)
‐ Perceived lack of accomplishment
Can lead to:‐ Anxiety‐ Depression‐ Substance abuse‐ Addiction‐ Suicide
© 2014 Canadian Medical Association or its licensorsSource: Fralick, M. and Flegel, K. Physician burnout: Who will protect us from ourselves? CMAJ 2014; June 2 (Epub ahead of print).
Physician Burnout
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
1. 54.4% reported at least one symptom of burnout in 2014 as compared to 45.5% in 2011.
2. Satisfaction with work‐life balance declined from 48.5% to 40.9%
3. In comparison to the general population an increasing disparity exists in burnout and satisfaction with work‐life balance in physicians.
Shanafelt (2015) Changes in burnout and satisfaction with work‐life balance in physicians and US Working population between 2011 and 2014. Mayo Clinic Proceedings, Dec 90:12, 1600‐1613.
Out of 6,880 physicians surveyed using Maslach Burnout Inventory:
A look at the numbers
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.orgCarol Peckham | January 13, 2016. Medscape Lifestyle Report 2016: Bias and Burnout.
15,500 physicians participated
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.orgCarol Peckham | January 13, 2016. Medscape Lifestyle Report 2016: Bias and Burnout.
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
Consequences of Physician Burnout
‐ Medical errors1‐3
‐ Impaired professionalism5,6
‐ Reduced patient satisfaction7
‐ Staff turnover and reduced hours7
‐ Depression and suicidal ideation9,10
‐ Motor vehicle crashes and near‐misses11
1. JAMA 296:1071 2. JAMA 304:1173 3. JAMA 302:1294 4. Annals IM 136:358 5. Annals Surg 251:995 6. JAMA 306:952 7. Health Psych 12:93 8. JACS 212:421 9. Annals IM 149:334 10. Arch Surg 146:54 11. Mayo Clin Proc 2012
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
Essential skills are lost when burnout is present:
‐ Compassion‐ Patience‐ Empathy‐ Ability to listen
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
615 E Princeton St. Suite 410Orlando, FL 32803
thecenterforphysicianwellbeing.org
Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.
Richard Gunderson
•Excessive Work Load• Inefficiency and Clerical Overload•Loss of Control and Flexibility•Loss of Work & Life Integration•Loss of Meaning
Tait Shanafelt ~ Mayo Clinic
Bottom Line and Common Sense
• LET DOCTORS DO WHAT THEY DO provide support & improve EHR• WORK LOAD SHOULD REFLECT WHAT IT TAKES TO CARE FOR PATIENTS• MEASURE, TRACK AND BENCHMARK PHSYCIAN WELLBEING• LEADERS NEED TO INFORM, ENGAGE, DEVELOP, EMPOWER AND ACKNWOLDEGE THAT BURNOUT EXISTS
• TRUST PHYSICIANS eliminate intrusive regulations that do not improve care.
http://catalyst.nejm.org/videos/physician‐burnout‐stop‐blaming‐the‐individual/
National Academy of Medicine: A call to explore and address Burnout as an underrecognized threat to safe,
high‐quality careResearch is needed in Organizational, Practice, Financial, Regulatory and liability environments
Research on implications of professional distress and well‐being for health care outcomes
Intervention research to improve work‐lives and well‐being of health care professionals
NAM.edu/perspectives July 5, 2017Dyrbe, Shanafelt, Sinsky, et.al.
TRAIN ADMINISTRATORS
Manager and Physician Cultures Area Administrators Physicians
Basic Assumptions
Central Logic Rationalization, efficiency Collegial control, expertise
Values View of WorkPrimary loyaltyResponsibilityTolerance for ambiguityPatient focusTimeframe of actionView of resources
Make a livingTo the organizationSharedHighBroadMiddle‐longLimited
Work is livingTo the patientPersonalLowNarrowShortUnlimited
Artifacts Basis of KnowledgeExposure to “others” while trainingRelationshipsCareer DevelopmentVocabulary
Social/management sciencesLittleHierarchicalHierarchical advancementCost, benefit, revenue, patient satisfaction
Biomedical sciencesGreatCollegialAchievementQuality, patient outcomes
Change requires an understanding and appreciation of the differences on both sides Kaissi, 2014
There is no one/perfect plan
AMA: Steps Forward Program
• Seven steps to prevent burnout involving administrative functions
• Mini Z burnout survey to assess personal level of symptoms• Examples of positive practice changes including
• Workflow• Communication• Quality improvement
• chronic health management programs• synchronized prescription renewal
https://www.stepsforward.org/
A Thin White Line
Physician Training
90 hours/weeksleep deprived Survival mode – split off from
own emotions and needs
Evaluated 24/7
Profession’s Expectations
• High Degree of Integration(personal/psychosocial/spiritual)
• Highly Developed Interpersonal Skills
• Able to Maintain Balance
Profession’s Reality
• Trained to Split
• Cut off from Meaningful Interactions
• Pulled Toward Imbalance/Postponement
Behaviors and Living in the Present
• Slow Down ~ Radical!• Play• Be Aware• Be Intentional• Deliberately Feel• Notice Details• Share Experiences• Turn off Technology
Cease Not till death…
The real challenge isn’t what we are able to do with our eyes closed. It is to be more self‐aware in the crucible of our everyday lives, and to behave better as a result. That’s
mindfulness in action.
Tony Schwartz is the chief executive of the Energy Project
And…An Irish Blessing
Recommended