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The Secret to Achieving Joy and Avoiding Burnout at Work!
Evelyn Clingerman, PhD, RN, CNE, FNAPExecutive Director, The Bonnie Wesorick Center for Health Care Transformation
Kirkhof College of NursingGrand Valley State University
Disclosures
I have no conflicts of interest or relevant financial support to disclose.
Evelyn Clingerman, PhD
Objectives: After attending this session, you will be able to maintain momentum in your transformation experience by:1. Identifying signs and effects of burnout in individuals and
organizations,
2. Identifying three strategies to use to achieve joy in work, and
3. Identifying three strategies to avoid burnout in work.
What is Burnout?
A three dimensional syndrome that involves:1. emotional exhaustion,2. cynical treatment and
negative thoughts towards patients and the healthcare team (depersonalization); and
3. a low sense of personal accomplishment.
• (Maslach & Jackson, 1981)
Prevalence of Burnout at Work
Clinician burnout, stress, depression, compassion fatigue & emotional exhaustion levels are a national epidemic (National Academy of Medicine, 2017).
1 Davidson et al. (2018)2 Kishore, Dandurand, Mathew, & Rothenberger, 2016
Burnout Prevalence• increased 9% physicians
(2011-14)• For RNs ranged
33-44%(2002-11)1
• 400 physicians die by suicide annually
• No national suicide data for nurses.2
• In the last 30 days, 14% of nurses report falling asleep while driving
Nurses and Health
BMI Sleep Nutrition StressNurses 28 7.0 13% 60%Average American 26.6 7.8 hours 23% 29%
Body Mass Index: BMIs in the 25-29.9 range are classified as “overweight”.Sleep: Number of hours of sleep in a 24-hour period.Nutrition: % eating recommended servings of five fruits and vegetables daily.Quality of Life: % reporting high levels of stress.
American Nurses Association, 2018, Analysis of the Healthy Nurse Survey.
Impact of Burnout
Personal: Physical health; Emotional
health: Exhaustion: Sadness, Depression
Suicidal IdeationProfessional: Turnover
Lack of EngagementDepersonalized care,
Substance abuse, poor quality relationships
• Poor working relationships and social interactions
• Low quality scores• Increased turnover
rates(physicians & Nurses)
• Workplace violence• Employee
Assistance• Dismissal Rate
Clinic
• Provider becomes less vigilant with
patients• Greater medication
• Lower Patient Satisfaction
• Poor clinical outcomes
(infections, safety)
Clin
icia
ns
Org
aniza
tions
Patie
nts
Factors Affecting Clinician Well-Being (NAM, 2018)
EXTERNAL Factors
Society & Culture• Societal
Expectations• Culture of Safety• Patient
expectations• Social
Determinants
Rules & Regs• Accreditation• Licensure• Certification• Policies • Reimbursement
type• HR • Compensation
Organizational• Bureaucracy • Power• Workload &
Time pressure• Scope of Prt• Mission Values
profit emphasis
• Data collection• Harassment• Inclusion
LearningPracticeEnvironment• Autonomy• Collaborative?• Health IT
interop EHRs• Mentoring• Team structure• Workplace
Safety
Health Care Responsibilities• Admin Resp• Clinical Resp• Career
Development• Patient
population• Specialty
Issues• Teach
Research ?
Individual Factors
Personal• $ Stressors• Family dynamics• Flexible to change• Purpose, Meaning
in work; values? • Personality• Work Life Balance• Social Isolation
Skills & Abilities• Competency
clinical & tech• Communication• Coping • Delegation• Empathy• Resilience• Teamwork skills
What Are We Doing About Burnout?
Bodenheimer & Sinsky (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annuals of Family Medicine, 12(6): 573-6
Where are we on the river? Upstream Parable
Restoring and Finding Joy in Practice
(Perlo et al., 2017)
“Management’s aim should be to create a system in which everybody may take joy in his or her work.”
W. Edwards Deming
Why Focus on JOY?
Institute for Healthcare Improvement (IHI) Model
• Dialogue Sessions: Listen & Learn (skilled facilitators)
• Prioritize Concerns• Identify your champion?
Involve the clinicians: What matters to you?
• Ensure all voices are heard; huddles
What are the pebbles in your
shoes? (barriers)
• Pause for joyful moments, bright spots
Commit to Shared Goal: JOY in Work
• Best Evidence• Knowledge Hub• IHI
Use best methods &
measures for aim.
National Academy of Medicine’s Action Collaborative• Join the Collaborative and Stay Informed• Take advantage of the “Knowledge Hub”
https://nam.edu/clinicianwellbeing/• Causes• Effects• Solutions• Conceptual Model
• Join the Listserve
Improve
Improve baseline understanding of challenges to clinician well-being
Raise
Raise the visibility of clinician stress and burnout
Advance
Advance evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver.
https://nam.edu/ClinicianWell-Being
Return to Joy in Work: Individual Level• Encourage Healthy Behaviors• Encourage Connections with
Family, Friends, & Co-workers• Set Aside Compliment Time or
Compliment Wall; Gratitude Time• Have Debrief Time• Take mandatory breaks• Off duty means off duty• Avoid email when off duty
To Achieve Sustainable Transformation: What We Measure gets our Attention• Identify metrics: What gets
measured gets our attention.• Why? Quantify shortcomings &
follow improvements; • Measure What? Varies by level:
• Patient AND Provider Satisfaction Safety & error Data
• Turnover/Retention Rates• Work-Life Balance for all• Hassles Inventory; Safety Inventory• Maslach Stress Inventory
• Measure When or Frequency (stay vigilant) hand on the pulse; track over time
• How to measure? • Scorecards • Keep it on the table at meetings/discuss
findings• Real time feedback • Podcasts
• How to Intervene: • Engage HCPs in solutions• Best Evidence (NAM; IHI frameworks)• No single answer: Both AND approach
Vaccinate HCPs for Exposure to Stressors (Nedrowet al., 2013)
• Burnout is linked to four values: service, excellence, curative competence & compassion but excess is unhealthy
• Training: mindfulness, self-compassion, gratitude, reframing
• Relax, Restore, Recharge and Wellness Events; Social gatherings, especially for newbies
• Use of Support Services & consider redistributing or sharing tasks• Pleasing Environment• Education: mindfulness, sleep, resilience
Organizational Interventions to Advance Joy (Barnett, 2017)
• Peer Support Networks and Resilience Networks• Address personal emotions (+ emotional first aid)• Build healthy stress management behaviors
• Organizational Re-design + Infrastructure• Huddles• Flexibility & Control with Hours• Well-being Days (Cleveland Clinic)• Protected time to attend Mindfulness
• Creative Arts• Visual, Written, and Music
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as it is to be able to walk through
water without getting wet.Rachel Naomi Remen