Individual Strategies to Promote Resilience

WSRS/WSMAOctober 14,2017Claudia Finkelstein, MDCMDirector Faculty Wellness ProgramsUniversity of Washington School Of Medicine

Disclosures and Biases

> Financial-none

> Individual strategies are not enough

> Not either /or we need structural change AND

increased resilience

> Leaders matter

Agenda/Objectives

➢ Participants will define burnout syndrome and the

(increasing) incidence

➢ Participants will become familiar with some tools

used to assess and identify burnout and resilience

➢ Participants will learn strategies that promote

individual, team and institutional resilience

and prevent burnout

Define Burnout

➢Emotional Exhaustion

Being emotionally overextended and exhausted by

one's work

➢Depersonalization

Unfeeling and impersonal response toward recipients

of one's service

➢ Decreased Sense of Personal Accomplishment

Lack of feelings of competence and successful

achievement in one's work

Incidence and Trends

➢ Incidence

Changes in Burnout and Satisfaction With Work-Life Balance in

Physicians and the General US Working Population Between

2011 and 2014

FOR GENERAL USE

Tait D. Shanafelt MD, Omar Hasan MBBS, MPH, Lotte N. Dyrbye MD, MHPE, Christine Sinsky MD, Daniel Satele MS, Jeff Sloan PhD and Colin P. West MD, PhDMayo Clinic Proceedings, 2015-12-01, Volume 90, Issue 12, Pages 1600-1613,

From: Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US

PopulationArch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014

MBI vs Single Item Measure: Ask Yourself How Often?

➢ I feel emotionally burned out or emotionally depleted from my work

➢ I have become more callous toward people since I took this job —

treating patients and colleagues as objects instead of humans.

West CP, Dyrbye LN, Sloan JA, Shanafelt TD.J Gen Intern Med. 2009 Dec;24(12):1318-21 Single

item measures of emotional exhaustion and depersonalization are useful for assessing burnout

in medical professionals

Consider Measuring-Individual & System

➢ Physician well being index- 7 Items

➢ Mini Z Burnout Survey

➢ Professional fulfillment

➢ Sleep related impairment

➢ Meaning, Appreciation

➢ Mindfulness

➢ Pajama work/ clicks per day

➢ http://www.ihi.org/education/Conferences/Forum2017/P

ages/Joy-in-Work-Track.aspx

Define Resilience

➢ Bounce Back

➢ Push Through

➢ Regain Shape

➢ Recover Quickly From Difficulty

The capacity to respond to stress in a healthy way such

that goals are achieved at minimal psychological and

physical cost; resilient individuals "bounce back" after

challenges while also growing stronger. Resilience is a

key to enhancing quality of care, quality of caring, and

sustainability of the health care workforce. Yet, ways

of identifying and promoting resilience have been

elusive. Resilience depends on individual, community,

and institutional factors.

Epstein and Krasner Academic Med 2013 March 88(3) 301

Resilience

Resilience Scales With Best Psychometrics

➢ Conner-Davidson Resilience Scale

➢ Resilience Scale for Adults

➢ Brief Resilience Scale

➢ ?UW Scale

CD-RISC

1. Acceptance of Change and Secure Relationships

2. Personal Competence

3. Trust/Tolerance/Strengthening Effects of Stress

4. Control

5. Spiritual Influences

Based on Connor and Davidson’s operational definition of resilience, which is the ability to “Thrive in the face of adversity”.

RSA – Resilience Scare for Adults

➢ Personal Competence

➢ Social Competence

➢ Social Support

➢ Family Coherence

➢ Personal Structure

For Example 0-4 on 25 items

> 1 I am able to adapt to change

> 2 I have close and secure relationships

> 3 I believe that sometimes fate or God can help

> 4 I can deal with whatever comes

> 5 I remember past success and this gives me

confidence for new challenges

Levels of Resilience

➢ Individual

➢ Team

➢ Department

➢ “System”

➢ Infinite Levels

Individual Factors

> Self care

Eat, Drink, Sleep, Pray, Love, n-1

> Connection – Compassion – Empathy – Gratitude

> Meaning

> Learn from the past

Error as feedback

> Emotional Regulation

> Mindful (Tech, Self Compassion)

Individual Resilience Strategies: Support

➢ Family

➢ Friends

➢ Peers

➢ Groups

➢ PHP

➢ Coach/ Therapist /Psychiatrist

More on Reflection: Fearless Honesty

➢ Identify your core values (Exercises Online)

➢ Institution values and overlap?

➢ What do you really value?

➢ How do you spend your time and money?

➢ Legacy?

Resilience Connect With Purpose

Individual Factors: Common Threads

➢Attention➢Intention➢Nonjudgement

Sounds a lot like:

Paying Attention: Technology

Resiliency: Teams / Connection

Resiliency: Teams / Trust

Resiliency: Teams – Different Strengths/Styles

Resiliency: Teams / Empathy

Resiliency: Teams / Communication

Action Plan: Pick One

> Digital Sabbath – or Variation

> Time Alone: Between Work and Home

> Journal Daily x 20 minutes

> Try Meditating (Insight Timer)

> Gratitude Journal/Letter

> Track your Sleep, Fluids, or Foods

> Take a 10 minute walk 5 x per week

> Self Compassion Practice

Pull Out Your Calendar

> Put an activity on the calendar and check off each

day the activity is done

> Monday November 13th , Add up how many times

you “Did It”

> If you didn’t do much, be curious and kind with

yourself

> If you did, how do you feel?