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2/21/2016 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB Center for Palliative and Supportive Care [email protected] Page 2 Disclosures No financial disclosures but I am a part of the Studer Group Speakers bureau Acknowledge and thanks to members of the UAB Office of Patient Experience and Engagement for assistance with slides and content. Rodney O. Tucker, MD MMM Page 3 3 Identify and recognize signs of compassion fatigue and burnout Design and prepare an individualized plan for resiliency Objectives:

Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

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Page 1: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

1

Compassion Fatigue and Burnout:

Not If But When

Rodney Tucker, MD MMM

Chief Experience Officer

Associate Professor and Director

UAB Center for Palliative and Supportive Care

[email protected]

Page 2

Disclosures

No financial disclosures but I am a part of the

Studer Group Speakers bureau

Acknowledge and thanks to members of the UAB Office

of Patient Experience and Engagement for assistance

with slides and content.

Rodney O. Tucker, MD MMM

Page 3 3

Identify and recognize signs of compassion fatigue

and burnout

Design and prepare an individualized plan for

resiliency

Objectives:

Page 2: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

2

Page 4

•So why this topic and

why now?

4

Question One: The Why

Page 5

No one is experiencing more change

than physicians.

Page 6 6

Quint Studer

Founder of the Studer Group

Years of experience working with Healthcare systems

and physicians in culture change and making medicine a

better place

Shares personal side of his family healthcare experiences

and concerns about physician burnout

Page 3: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 7 7

December JAMA Article

Prevalence of Depression and Depressive

Symptoms

Among Resident Physicians

A Systematic Review and Meta-analysis

Douglas A. Mata, MD, MPH; Marco A. Ramos, MPhil, MSEd;

Narinder Bansal, PhD; Rida Khan, BS;

Constance Guille,MD, MS; Emanuele Di Angelantonio,MD, PhD;

Srijan Sen, MD, PhD

JAMA.2015;314(22):2373-2383

Page 8

Impact of Burnout on Self-Reported Patient Care

Among Emergency Physicians

Lu, Dave; Dresden, Scott; McCloskey, Colin, et al.

Volume XVI, No. 7: December 2015

8

Western Journal of Emergency Medicine

Page 9

Now is the time to engage and partner with

physicians

Change in Payment

System Change in Technology

Change in Employment

EXTERNAL ENVIRONMENT

W H Y ?

Page 4: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

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Page 10

• “Moving from volume to value is

monumental and the transition to

getting there is schizophrenic at

best.”

• R. Tucker, December 2015

10

Change in Payment System

Page 11

Acute Care Medicare Payment at Risk

Press Ganey Assoc.

Page 12 Press Ganey Assoc.

Page 5: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 13

Now is the time to engage and partner with

physicians

Change in Payment System

Change in Technology

Change in Employment

EXTERNAL ENVIRONMENT

W H Y ?

Page 14

Healthcare Consumers Want Choice

72% of US adult internet users who look for health

information online

35% of adults that have tried to diagnose a medical

condition online

60% of 18 – 24yo who prefer tele-health over an office visit.

71% of 18 – 24yo interested in using a mobile app

Page 15

The Digital Age of Review

Page 6: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 16

How Consumers are Choosing Their Healthcare

Page 17

Can we engage consumers and compete?

Page 18

How Consumers are Accessing Healthcare

Page 7: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 19

Beleaguered by Electronic Medical Record

Mandates, Some Doctors Burning Out

John Russell

Chicago Tribune

December 12, 2015

19

Chicago Tribune

Page 20

Now is the time to engage and partner with

physicians

Change in Payment System

Change in Technology

Change in Employment

EXTERNAL ENVIRONMENT

W H Y ?

Page 21

Providers (Physicians)

Healers

Crafts(people)

Guides

Counselors

Prescribers

Scribes

Billers

Managers

Coders

Most of all, leaders of

subcultures

Page 8: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

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Page 22

What Do Physicians Want?

Physician Drivers

QUALITY Physicians want to know their patients are receiving quality care and a great patient experience.

EFFICIENCY

Physicians want to work with team members who have the information needed at hand to discuss their patients. Over the course of a day this efficiency will save the physician 30 minutes or more.

INPUT

Physicians need a seat at the table to provide input when decisions are being made that affect clinical outcomes. Round on physicians and consistently ask them, “Do you have everything you need to provide excellent care to your patient?”

APPRECIATION Physicians value a “thank you” and acknowledgment when things are going well. They also want to see follow-up on their input in the form of tangible change.

Page 23

INTERNAL ENVIRONMENT

Source: Abraham Maslow; 1940; “Four Stages for Learning Any New

Skill””; Gordon Training International by Noel Burch; 1970

Unconsciously

skilled

Consciously

skilled

Unconsciously

unskilled

Consciously

unskilled

Page 24

•So what is compassion

fatigue and how does it

look?

24

Question Two: The What

Page 9: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 25

Associate Professor

of Medicine

Bellevue Hospital

Editor in Chief, co-

founder of Bellevue

Literary Review

Writes about life in

medicine

Page 26

• Grief

• Empathy

• Fear

• Guilt and Shame

• Disillusionment

26

What Doctors Feel

Page 27

• Considered a symptom, physical and/or mental

• Ranges from a general state of lethargy to a specific induced

muscle tiredness

• Reported by self rather than others

• Inability to continue functioning at the level of ones normal

abilities

27

Fatigue

Page 10: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 28

• “A more user friendly term for secondary

traumatic stress disorder which is almost

identical to Post-traumatic Stress Disorder,

except that it applies to those emotionally

affected by the trauma of another (usually a

client or family member)”

-Figley CR, ed. Treating Compassion Fatigue. New York: Brunner-

Routledge,2002.

28

Compassion Fatigue

Page 29

“Progressive loss of

idealism, energy, and

purpose.”

“Physician Misery Index Survey,” Geneia, March 5, 2015,

http://www.geneia.com/news-and-events/geneia-survey/

Burnout

Page 30

Burnout Rates by Specialty

37% 38%

39% 41% 41%

43% 43%

44% 44% 44%

45% 45% 45% 45%

46% 47%

48% 49% 49% 49%

50% 50% 50% 50%

52% 53%

Dermatology

Psychiatry & Mental Health

Pathology

Gastroentrerology

Ophthalmology

Allergy & Clinical Immunology

Rheumatology

Anesthesiology

Oncology

Pediatrics

Plastic Surgery

Nephrology

Orthopedics

Diabetes & Endocrinology

Cardiology

Pulmonary Medicine

Urology

Neurology

OB/Gyn & Women's Health

Radiology

HIV/Infectious Diseases

General Surgery

Internal Medicine

Family Medicine

Emergency Medicine

Critical Care

The 2015 Medscape survey results reflect the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons

reporting burnout

Peckham, C., “Physician Burnout: It Just Keeps Getting Worse,”

Medscape Physician Lifestyle Report January 26, 2015.

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2/21/2016

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Page 31

Does Burnout Matter?

Medical Errors Medical Malpractice

Suits • Williams ES et al, Health Care Manage

Rev. 2007;32:203-212 • Firth-Cozens J & Greenhalgh J. Soc Sci

Med. 1997; 44:1017-1022 • Shanafelt TD et al. Ann Intern Med.

2002;136:358-67

• Jones JW et al. J Appl Psychol, 1988; 73:727-35

• Hickson, et al

Patient Compliance Patient Satisfaction

• DiMatteo MR et al. Health Psychol. 1993; 12:93-102

• Linn LS et al. Med Care. 1985;23. 1171-78

• Haas JS et al. J Gen Intern Med. 2000;15:122-128

Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for

Physician Resilience, Davidson, NC

Page 32 32

Compassion Fatigue and Burnout Syndromes

Cognitive

Emotional

Behavioral

Spiritual

Personal relations

Somatic

Work Performance

Page 33 33

Lowered

concentration

Decreased self

esteem

Apathy

Rigidity

Disorientation

Perfectionism

Minimalization

Preoccupation with

trauma

Thoughts of self harm

or harm to others

Cognitive

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2/21/2016

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Page 34 34

Powerlessness

Anxiety

Guilt

Anger and rage

Survivor guilt

Shutdown

Numbness

Fear

Helplessness

Sadness

Depression

Emotional roller

coaster

Depleted

Overly sensitive

Emotional

Page 35 35

Impatient

Irritable

Withdrawn

Moody

Regression

Sleep disturbance

Nightmares

Appetite changes

Hypervigilance

Elevated startle

response

Accident proneness

Losing things

Behavioral

Page 36 36

Questioning

meaning of life

Loss of purpose

Lack of self

satisfaction

Pervasive

hopelessness

Anger at God

Questioning prior

religious beliefs

Loss of faith in a higher

power

Greater skepticism

about religion

Spiritual

Page 13: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

2/21/2016

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Page 37 37

Withdrawal

Decreased interest in

intimacy

Mistrust

Isolation from others

Overprotection as a

parent

Protection of anger or

blame

Intolerance

Loneliness

Increased

interpersonal conflicts

Personal relations

Page 38 38

Shock

Sweating

Rapid heartbeat

Breathing difficulties

Aches and pains

Dizziness

Increased number of

medical maladies

Other somatic

complaints

Impaired immune

system

Somatic

Page 39 39

Low morale

Low motivation

Avoiding tasks

Obsession about

details

Apathy

Negativity

Lack of appreciation

Detachment

Poor work

commitments

Staff conflicts

Absenteeism

Exhaustion

Irritability

Withdrawal from

colleagues

Work Performance

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2/21/2016

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Page 40

•So how do we combat

compassion fatigue

internally and

externally?

40

Question Three: The How

Page 41

Organizational

psychologist

CEO of Healthy

Companies

International

Physical Health

Emotional Health

Intellectual Health

Social Health

Vocational Health

Spiritual Health

Page 42

New Culture Assumptions

Adapt to a new era of accountability,

engagement and communication

Adopt flexible practices of evidence based

leadership

Accept that the physicians and providers of

yesterday and today will not look the same as

those of tomorrow

Page 15: Compassion Fatigue and Burnout: Not If But When 1 Compassion Fatigue and Burnout: Not If But When Rodney Tucker, MD MMM Chief Experience Officer Associate Professor and Director UAB

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Page 43

• Individualized

• Consider where gaps or opportunities may exist (boost exercise,

examine diet and sleep habits, etc.)

• Clinically:

• Consider a step back in humanizing our patients before we

medicalize

• Set boundaries

• Work as a team in meeting patient expectations

• Reward and recognize; Celebrate positive feedback

• Debrief with colleagues

43

Designing a Personal Plan

Page 44

• Refocus on solutions rather than reiterating the problems

• Technology has to become friend not enemy; Volunteer for

enhancement teams around the EHR

• Couple process improvement with standardized communication

skills (AIDET)

• Round and engage colleagues differently:

• What is working well?

• Who is doing a good job and what is the behavior?

• Where can we improve policies or procedures?

• What resources do you need to take better care of our patients?

44

Personal Leadership Plan

Page 45

Rodney Tucker, MD MMM

Chief Experience Officer- UAB Medicine

[email protected]

205-975-4011

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