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JourneytoaResilient&ThrivingPharmacyWorkforce

KimberleeBerry,CAE

Outline• Explainwhyclinicianburnoutisapatientcareandhealthcareworkforceproblemthatneedsaddressing;

• Discusswhatisknownaboutburnoutinthepharmacyworkforce;

• DescribetheNationalAcademyofMedicineClinicianWell-BeingandResilienceActionCollaborative;

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Outline

• Identifystrategiestoimpactwell-beingandresilienceinpharmacists,pharmacyresidents,studentpharmacistsandpharmacytechnicians;and

• Describeclinicianburnoutasapatientcareandhealthcareworkforceproblem.

EngagedWorkforce:Whatitisandwhatitisn’tItis• Emotionalcommitmentto

theorganization• Workonbehalfofthe

missionandgoals• Discretionaryeffort• …thekeytoactivatinga

highperformingworkforce

ItIsn’t• Employeehappiness• Employeesatisfaction• Zeroburdensorstress

Forbes.Whatisemployeeengagement?Availableat:https://www.forbes.com/sites/kevinkruse/2012/06/22/employee-engagement-what-and-why/#2f96ddd37f37.AccessedAugust14,2018.

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Engagement:aWorkforceGoal“Towinthemarketplaceyoumustfirstwintheworkplace”

~DougConant,FormerCampbell’sSoupCEO

• Statistics:– 70%ofU.S.employeesreportfeelingunengaged– Inastudyofengagement&burnout(n=1000)

• Optimallyengaged(40%):highengagement&lowburnout– Highresources(support,recognition),self-efficacy,lowdemands(lowcumbersomebureaucracy),recoveryfromstress

• Engaged-exhausted(20%):highengagement&highburnout– Simultaneousexperiencesofhighengagement&burnoutriskhigherfrustrationandemployeeturnover

• Outcomes:– Greaterproductivity,higherqualityofwork,increasedsafety,

employeeretentionHarvardBusinessReview.1in5highlyengagedemployeesisatriskofburnout.February2,2018.

HealthcareWorkforceBurnoutasaPatient

CareProblem

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BurnoutisaPatientCareProblem

Bodenheimer T,Sinsky C.Fromtripleaimtoquadrupleaim:careofthepatientrequirescareoftheprovider.AnnFamMed.2014;12(6):573-6.

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Swensen S,Shanafelt,Mohta NS.Leadershipsurvey:Whyphysicianburnoutisendemic,andhowhealthcaremustrespond.NEJMCatalyst.December8,2016.Availableat:https://catalyst.nejm.org/physician-burnout-endemic-healthcare-respond/

Burnout MedicalError

Bi-directional relationship

• Higher levels of burnout associated with increased odds of reporting a medical error in subsequent 3 months

• Self-perceived medical error associated with worsening burnout & depressive symptoms

Shanafelt Ann Surg 2009; Balch J Am Coll Surg 213; West JAMA 2006, 2009; Jones J Appl Psychol 1988; Cimiotti Am J Infect Control 2012; Welp Front Psychol 2015; Welp Crit Care 2016

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BurnoutandPatientSafety:SummaryoftheEvidence• Introduction:Evaluationofassociationbetweenhealthcare

staffwellbeing,burnout,andpatientsafety• Methods:SystematicReview• Results:46studiesincluded

– Significantcorrelationbetweenpoorwellbeinginhealthcareprofessionalsandworsepatientsafety(n=16)

– Significantassociationbetweenburnoutandpatientsafety(n=21)

• Conclusion:Studiesshowcorrelationbetweenburnoutandlowerpatientsafety;morestudiesneededtodeterminecausality

HallLH,JohnsonJ,WattI,etal.Healthcarestaffwellbeing,burnout,andpatientsafety:Asystematicreview.PLoS ONE.2016;11(7):e0159015

HealthCareCosts

↑MedicalErrors↑Malpracticeclaims↑Turnover

– 1.2-1.3xsalary($82-$88,000perRNin2007)

– $500,000to>$1million

↑Absenteeism↓Jobproductivity↑Referrals↑Ordering

JonesJNursAm2008;FibuchPhysicianLeadershJ2015;BuchbinderAmJManagCare1999;Kushnir,FamPract2014;BachmanSocSciMed1999;ParkerJBehavMed1995,Toppinen-TannerBehavMed2005,HiltonJOccupEnvironMed2009

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PollEverywhereQuestion

• Howhaveyouseenburnoutimpactpatientcare?

BurnoutinthePharmacyWorkforce

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WhatisStress?• Stress is a physical, mental, or

emotional factor that causes bodily or mental tension.

• Eustress is moderate or normal psychological stress considered to be beneficial for the experiencer

– Motivates, focuses energy, is short-term, perceived as within our coping abilities, feels exciting, & improves performance

• Distress is extreme anxiety, sorrow, or pain

– Can be short-or long-term, feels unpleasant, considered outside of our coping ability, decreases performance, may lead to mental & physical problems

https://www.medicinenet.com/script/main/art.asp?articlekey=20104

CaringforPatientAvoidingHarmRespectingPatientAutonomyStrivingforJustice

GrowingDemandsBurdensomeTasksIncreasedStress

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Maslach, C., S. E. Jackson, et al. (1996). Maslach Burnout Inventory Manual. Palo Alto, CA, Consulting Psychologists Press.

WhatisBurnout?• Syndromeof:

• Emotionalexhaustion

• Depersonalization(e.g.,cynicism)

• Lowpersonalaccomplishment

IdentifyBurnout

https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-related-dimensions/

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Maslach BurnoutInventory– HumanServicesSurveyTool

• MedicalPersonnel– Emotionalexhaustion

• Measuresfeelingsofbeingemotionallyoverextendedandexhaustedbyone’swork

– Ifeelemotionallydrainedfrommywork

– Depersonalization• Measuresanunfeelingandimpersonalresponsetowardpatients

– Idon’treallycarewhathappenstosomepatients

– PersonalAccomplishment• Measuresfeelingsofcompetenceandsuccessfulachievementinone’swork

– Ihaveaccomplishedmanyworthwhilethingsinthisjob

– Responseoptions(frequency):never,afewtimesayearorless,onceamonthorless,afewtimesamonth,onceaweek,afewtimesaweek,everyday

HighPrevalenceofBurnout

Medicine• 2014,6880physicians,all

specialties,allpracticetypes• 2012,5521medicalstudents&

residentsNursing• 1999,>10,000inpatientRN• 2007,68,000nurses

Aiken JAMA 2002;288; McHugh Health Aff 2011;30; Dyrbye Acad Med 89(3): 443-451; Shanafelt MCP 2015:90:1600

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Burnout:PharmacyResidentsStudyOverview• Stressandnegativeaffect

levelssurveyedinPGY1&PGY2s(n=524,27.7%response)

• Thoseworking>60hours/weekreportedhigherlevelsofperceivedstressandelevateddepression,hostility,anddysphoria

• Perceivedstressforpharmacyresidentswas19.06+5.9– 14.2+6.2in18-29yearold

healthadults– 20.3+7.4incardiologymedical

residents

Takeaways• 10-itemPerceivedStress

Scaleisafree,validatedtooltoassessstressamongpharmacyresidents

• HostilitywashighestinPGY2

• Whenpressuresofbeingoverworked>resident’sabilitytocope,well-beingisindanger

LeHM,YoungSD.Evaluationofstressexperiencedbypharmacyresidents.AJHP.2017;74:599-604

Burnout:ClinicalPharmacists

• Jonesandcolleaguesmeasuredclinicalpharmacistburnout(n=974)– Nearly¾includedrespondentsarecertifiedbyBPS– Morethanhalfcompletedresidencytraining– 61.2%overallburnoutrate;52.9%highemotionalexhaustion– Characteristicsofburnedoutclinicalpharmacists:

• Lesslikelytohavechildren(p=0.002)• Morelikelytoworkmoremedianhours(p<0.001)• MorelikelytohaveattainedBPScertification(p=0.005)

– Nodifferenceobservedinpracticearea,hospitalsetting

JonesGM,RoeNM.FactorsAssociatedWithBurnoutAmongUSHospitalClinicalPharmacyPractitioners:ResultsofaNationwidePilotSurvey.Hosp Pharm.2017;52:11:742-51.

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DriversofBurnoutinHealthcareProfessionals

RiskFactorsAssociatedWithBurnoutAmJHealth-Syst Pharm.2017;74:e576-81

RiskFactor Example

Workload Jobdemandsexceedinghumanlimits;limitedtimetorest,recover,andrestore.

Control Roleconflict; absenceofdirectionintheworkplace

Reward Inadequatefinancial,institutional,orsocialrewardintheworkplace;lackofrecognition

Community Inadequateopportunityforqualitysocialinteractionatwork;inadequate developmentofteams

Fairness Perceptionofequityfromanorganization orleadership

Values Organizationalvaluesareincongruouswithanindividual’spersonalvaluesorbeliefs

Job-personincongruity Personalitydoesnotfitorismisalignedwithjobexpectationsandcopingabilities

NationalAcademyofMedicineAction

CollaborativeClinicianWell-Beingand

Resilience

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NationalAcademyofSciences§ FoundedinMarch,1863§ Private,nonprofitorganization

ofthecountry’sleadingresearchers

§ NationalAcademyofMedicine§ Formedin1970toadvisethe

nationonmedical&healthissues

§ Dr.VictorDzau isPresident

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Dzau VJ,Kirch DG,Nasca TJ.Tocareishuman– collectivelyconfrontingtheclinician-burnoutcrisis.NEJM.2018;378(4):312-314.

“Throughcollectiveactionandtargetedinvestment,wecannotonlyreduceburnoutand

promotewell-being,butalsohelpclinicianscarryoutthesacredmissionthatdrewthemtothehealingprofessions– providingtheverybest

caretopatients”

ActionCollaborativeGoals

NAM• Improvebaselineunderstanding

acrossorganizationsofchallengestoclinicianwell-being

• Raisevisibilityofclinicianstressandburnout

• Advanceevidence-based,multidisciplinarysolutionstoreversethesetrends,leadingtoimprovementsinpatientcarebycaringforthecaregiver

ASHP• Improvepatientoutcomes

throughoptimalmedicationuse

• Identifymechanismstoimproveandsustainpharmacyworkforcewell-beingandresilience

• Deploypharmacyworkforcetosupportmultidisciplinarysolutionsforimprovinghealthcareworkforcewell-beingandresilience

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ActionCollaborativeTimelineJuly2016 July2017Jan2017Sept2016

June2017

May2018

Sept2017

American Society of Health-System Pharmacists

• Vision• Medication use will be

optimal, safe, and effective for all people all of the time

• Membership Organization• Established 1942• 45,000 members

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ASHPVision&StrategicPlan

• OurPatientsandTheirCare– Goal4:ImprovePatient

CarebyEnhancingtheWell-BeingandResilienceofPharmacists,StudentPharmacists,andPharmacyTechnicians

• OurMembersandPartners

• OurPeopleandPerformance

Goal4:Objectives• Engageinmajornational

initiatives• Facilitatethe

developmentofeducation

• Improvethewell-beingandresilienceinpostgraduatepharmacyresidencytraining

• Fosterresearch

StrategicPlan

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CollaborativeComposition&Commitments• 36sponsoringorganizations,100network

organizations:– Professionalorganizations– Government– TechnologyandEHRvendors– Largehealthcarecenters– Payors

• 130commitmentstatements– Toprovideanopportunityfororganizationsacrossthecountrydiscuss

andshareplansofactiontoreverseclinicianburnoutandpromoteclinicianwell-being.

– https://nam.edu/initiatives/clinician-resilience-and-well-being/commitment-statements-clinician-well-being/

CreatingAnAll-EncompassingModelü Broadenoughtodefinetheissueacrossallhealthcare

professionsü Satisfactorilyencompassesmultipleenvironments

(education,practice)ü Satisfactorilyencompassesmultiplestagesofdevelopment

ofthehealthprofessionalü Satisfactorilyencompassessystemandindividualissuesin

waysthatarehelpfultowarddevelopingasolution(e.g.definingwithoutstigmatizing)

ü Lendsitselftobeingatoolfordiagnosis,explanation,treatment

ü Servesasataxonomyfororganizingotherelements/toolsdevelopedaspartofthisNAMCollaborative

BrighamT,BardenC,Legreid Dopp,A,Hengerer A.etal.AjourneytoConstructanall-encompassingconceptualmodeloffactorsaffectingclinicianwell-beingandresilience.NationalAcademyofMedicine,2018.

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StrategiestoImpactWell-Beingand

Resilience

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ClinicianWell-beingandResilience• Well-being

– Thepresenceofpositiveemotionsandmoods.– Theabsenceofnegativeemotions.– Satisfactionwithlife,fulfillmentandpositivefunctioning.

– Physicalwell-beingisalsoviewedascriticaltooverallwell-being.

• Resilience– Setofindividualskills,behaviors,andattitudesthatcontributetopersonalphysical,emotional,andsocialwell-being,includingthepreventionofburnout.

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Resilience&CopingSkills

• Bouncebackfromadversity,uncertainty,riskorfailure,andadapttochangingandstressfullifedemands

• Hope,optimism,self-efficacy

• Perseveranceandpassionforlongtermgoals(Grit)

ReadyGoodtogo

Adapting/flexible

Excellingatjob

“Iamatthetopofmygameandadaptingwelltoallpressures”

ReactingMilddistress

Temporarysymptoms

Stillgettingworkdone

“StressisaffectingmebutIcanstillgetthe

jobdone”

InjuredNoticeablesymptoms

Personalitychange

Erraticfunctioning

“IhavechangedtothepointthatIamnotintotalcontrolofmybehaviororreactions”

IllSevere

impairment

Extremelyoverwhelmed

Possibledangertoself/others

“Thisworseningcondition

requiresfullattentionbeforegettingbackto

work”

SelfInterventions

SocialSupport

ProfessionalCare

RestNeeded*AdaptedfromUSNavy’sCOSCDoctrine

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MitigatingStress

Self-CareTechniques• Monitorpersonalstress

indicators(sleep,eating,agitation,etc)

• Decompresswithhealthytransitions(teatime,yoga,journal,breathwork,music)

• Recordthreegoodexperiencesfromtheday,savorthosepositivemomentsandplanforgoodexperiencestomorrow

• Speakwithtrustedpeople,maintainsocialconnections

ResiliencyCompetencies• Awareness

– Noticingtherightinformation• Sensations,thoughts,environments

• Regulation– Ofselfandothers’stress

reactionsandemotions

• Leadership– Towardmeaningfulpersonal

andteamactions

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StrategiestoAlleviateBurnoutinHealthcareProfessionals

RiskFactorsAssociatedWithBurnoutAmJHealth-Syst Pharm.2017;74:e576-81

RiskFactor StrategytoAlleviateRisk

Workload Permittingtimeattheworkplaceto recoverfromastressfulevent

Control Clearlydefinedrolesand expectationsfromorganizationalleadership

Reward Identifysuitablerewardsto recognizeachievements,provideopportunitiestoteachormentor trainees

Community Promoteparticipationin professionalorganizations

Fairness Transparencyindecision-making

Values Alignpersonalexpectationswith organizationalgoals

Job-personincongruity Evaluateandalignjob responsibilitieswithpersonalandprofessionalexpectations

ExecutiveLeadershipStrategies• Acknowledge&assesstheissue• Identifyimpediments• Harnessthepowerofleadership• Implementsystemapproaches• Cultivatecommunity• Userewards&incentiveswisely• Alignvalues&strengthenculture• Promoteflexibilityandwork-lifeintegration• Provideresourcestopromoteself-care• Useimprovementsciencetotest

1.Shanafelt TD,Noseworthy JH.Executiveleadershipandphysicianwell-being:NineOrganizationalStrategiestopromoteengagementandreduceburnout.MayoClinProc.2017;92(1):129-146.2.Perlo J,Balik B,Swensen S,Kabcenell A,LandsmanJ,Feeley D.IHIFrameworkforImprovingJoyinWork.IHIWhitePaper.Cambridge,Massachusetts:InstituteforHealthcareImprovement;2017.

DecreaseToxicity

DecreaseStress

EstablishMeaning

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LOOKINGAHEAD

EducateYourselfonBurnout

• Webinars– ExtinguishingtheBurnout:YourselfandYourTeam– TametheFlamesofBurnout:ToolsforBuildingResilienceinYour

Workforce– LeadershipBurnoutandStrategiesforBurnoutPrevention

• MoreResiliencesessionsplannedfor:– 2018NationalPharmacyPreceptorsConference

• CreatingaCultureofResidentWell-Being• BuildingResilienceinResidencyTrainingItTakesaVillage• FuelingYourFireIdentifyingandManagingPreceptorBurnout

– 2018ConferenceforPharmacyLeaders• WorkforceResilienceDevelopinganOpenandSuccessfulEnvironment

– 2018MidyearClinicalMeeting

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EducateYourself&JointheConversation

Followtheconversation:nam.edu/ClinicianWellBeing#ClinicianWellBeing

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NAMKnowledgeHub

nam.edu/clinicianwellbeing

Questions?Ideas?

Considerations?

ChristinaMartin AnnaLegreid Doppcmartin@ashp.org adopp@ashp.org