View
220
Download
3
Category
Preview:
DESCRIPTION
TFME 2013 Organizational Professionalism Conference
Citation preview
Navigating Stress and Burnout
in Health Care
Daniel Friedland, MDMedical Director, Barney and BarneyFounder & CEO, SuperSmartHealth
© 2012 SuperSmartHealth
Roadmap & Objectives
1) Factors predicting burnout
2) Recognizing burnout
3) The 4 in 4 Framework™to navigate burnout
Burnout
Prevalence of Burnout
• Approximately 50% of students experience burnout and 10% experience suicidal ideation during medical school1
• Between 25-75% of medical residents experience burnout depending on the specialty2
• Approximately 1 in 3 doctors (both medical and surgical) are experiencing physician burnout at any given time3
1. Dyrbye LN, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334.2. Ishak WW, Lederer S. J Grad Med Educ. 2009 Dec;1(2):236-42.3. Shanafelt T, et al. JAMA. 2009;302(12):1338.
Prevalence of Burnout
• Survey of 27,276 U.S. physicians, 7288 (26.7%) completed surveys.
• 45.8% of physicians reported at least 1 symptom of burnout.
• Compared with a sample of over 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%).
Shanafelt TD et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population.
Arch Intern Med. 2012 Aug20:1-9.
Effects of Physician Stress
• 1200 practicing physicians surveyed• 6 in 10 have considered leaving medicine• 77% experience fatigue• 67% experience burnout• 33% depression & family discord
ACPE Survey 2006 November-December The Physician Executive
© Lee Lipsenthal 2009
Effects of Physician Stress
• 1200 practicing physicians surveyed• 6 in 10 have considered leaving medicine• 77% experience fatigue• 67% experience burnout• 33% depression & family discord• Contributing causes;
– Low reimbursement– Low autonomy– Patient overload– Lack of respect
ACPE Survey 2006 November-December The Physician Executive
© Lee Lipsenthal 2009
Factors Contributing to Burnout
Work-related stress:• Excessive workloads• Balancing personal and professional life• Deterioration in work conditions• Autonomy• Meaning in the work
Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.
Factors Contributing to Burnout
• Cross-sectional national survey of 2,000 randomly selected physicians in the U.S. with 935 respondents
• The strongest predictor of burnout was having little control over schedule and hours worked (P<.001)
Keeton K, et al. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007Apr;109(4):949-55.
Results from Canadian Medical Association Physician Resource Questionnaire (PRQ) November 2003http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/PhysicianHealth/news/pdf/Burn-out.pdf
Burnout by Specialty
Shanafelt TD et al. Arch Intern Med. 2012 Aug20:1-9.Copyright © 2012 American Medical Association.
Personality and Burnout• Escape-Avoidance (Self-directedness & Cooperativeness protective)1
• Low sense of stability and increased vigilance and anxiety traits2
• Low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others3
• Higher levels of neuroticism and introversion and lower levels of agreeableness4
• (Higher self-rated Emotional Intelligence protective)5
1. Pejušković B, et al. Burnout syndrome among physicians - the role of personality dimensions and coping strategies. Psychiatr Danub. 2011 Dec;23(4):389-95.
2. Cebrià et al. Personality traits and burnout in family doctors. Aten Primaria. 2001 Apr 30;27(7):459-68.
3. McCranie EW, Brandsma JM. Personality antecedents of burnout among middle-aged physicians.Behav Med. 1988 Spring;14(1):30-6.
4. McManus IC, et al. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004 Aug 18;2:29.
5. Weng HC, et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ. 2011 Aug;45(8):835-42.
Maslach Burnout Inventory
1. Emotional exhaustion
2. Depersonalization
3. Reduced personal accomplishment
Maslach, C. & Jackson, S.E. The measurement of experienced burnout. Journal of Occupational Behavior. 1981;2:99-113.
Freudenberger’s 12 Phases of Burnout
1.The compulsion to prove oneself
2.Working harder
3.Neglecting one’s needs
4.Displacement of conflicts
5.Revision of values
6.Denial of emerging problems
7.Withdrawal
8.Obvious behavioral changes
9.Depersonalization
10.Inner emptiness
11.Depression
12.Burnout Syndrome
Freudenberger H.J. & North G. Women's Burnout: How to Spot It, How to Reverse It, and How to Prevent It. (1985). New York: Doubleday.
“Burnout is the index of the dislocation between what people are and what they have to do.
It represents an erosion in value, dignity, spirit, and will – an erosion of the human soul.
It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it’s hard to recover.”
Maslach, C. & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey Bass.
In summary…
Swank and Marchland 1946; redrawn from Mind-Body Medicine, Watkins 1997
0 10 20 30 40 50 60
Deg
ree
of
com
bat
Days in combat
Soldier becomes"battlewise"
Period ofmaximum efficiency
Combat exhaustion
Hyper-reactivestage
Emotional exhaustionstage
Period ofoverconfidence
Vegetative phase
Battle Stress / Efficiency and Exhaustion
© Lee Lipsenthal 2007
Consequences of Burnout
• Increased medical errors• Decreased empathy• Plans to retire early• Job dissatisfaction
Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat tosuccessful health care reform. JAMA. 2011 May 18;305(19):2009-10.
Physician satisfaction matters
• Strongly linked to patient satisfaction1
• Affects patients’ perception of quality of care1
• Enhances patient confidence2
• Enhances patient adherence with therapies3
1. Haas J, et al. “Is the professional satisfaction of general Internists associated with patient satisfaction?” J Gen Intern Med. 2000;15:122-128.
2. Grembowski D, et al. “Managed care, physician job satisfaction, and the quality of primary care.” J Gen Intern Med.2005;20:271-277.
3. DiMatteo MR, et al. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993 Mar;12(2):93-102.
Ten factors enhancing physician satisfaction
• Relationships with colleagues
• Relationships with patients
• Relationships with staff • Community involvement.
• Autonomy• Income• Resources• Administrative support• Free time away from work• Intrinsic satisfaction
Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182.
© Lee Lipsenthal 2009
• Relationships with colleagues
• Relationships with patients
• Relationships with staff • Community involvement.
• Autonomy• Income• Resources• Administrative support• Free time away from work• Intrinsic satisfaction
Ten factors enhancing physician satisfaction
Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182.
© Lee Lipsenthal 2009
• Relationships with colleagues
• Relationships with patients
• Relationships with staff • Community involvement.
• Autonomy• Income• Resources• Administrative support• Free time away from work• Intrinsic satisfaction The nature of the work Achievement Recognition Responsibility Growth
Ten factors enhancing physician satisfaction
Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182.
© Lee Lipsenthal 2009
Values, Workload and Efficacy (in women)
Leiter MP, Frank E, Mathison TJ. Canadian Family Physician December 2009 vol. 55 no. 12 1224-1225.e6
‘‘If all of the knowledge and adviceabout how to beat burnout could be summed up in one word,that word would be balance – balance between giving and getting, balance between stress and calm, balance between work and home.’’
Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall;1982.
- Christina Maslach
If burnout involves exhaustion,
depersonalization and decreased personal efficacy,
how can we become more resilient to better navigate stress and reengage so that we can
experience greater vitality,more fully connect with others, ourselves and our source of
inspiration, as well as thrive with peak performance?
Performance
Arousal/Stress
?
Yerkes–Dodson Law
Performance
Arousal/Stress Yerkes RM, Dodson JD (1908). Journal of Comparative Neurology and Psychology 18: 459–482.
The Foundation
Neuroplastic Transformation
Performance
Arousal / Stress
The 4 in 4 Framework™
IntegratingMental Emotional Social Spiritual
Intelligence
Make the Turn intoWhat’s Truly Important
Cultivate Creativity By Reflecting on
What’s Truly Important
Reappraise Stress and Self-Doubt
Recognize Reactivity
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
1 2
34
Recognize Reactivity
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
1
Recognize Reactivity:
1. Physical Sensations
2. Feelings
3. Thoughts
4. Behaviors
1
Is it doing more harm than good?
Recognize Reactivity:
1
Reappraise Stress and Self-Doubt
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
2Recognize Reactivity
Is it doing moreharm than good?
1
Reappraise Stress and Self-Doubt:
• SCARF1
• What if…• If only...• Judgment and Criticism• Rejection and Abandonment• Neglect and Abuse• Standards and Expectations• Loss• Transition
Triggers of Stress and Self-Doubt:
2
1. Rock, D., Managing with the Brain in Mind. Oxford Leadership Journal. 1(1): p. 1-10.
Reappraise Stress and Self-Doubt:
2
Appraise Reappraise
1) What happened (just the facts)?
2) What is my belief about what happened?
3) Is my belief true or what is the evidence this should be so?
4) How could I view this differently?
Adapted from Albert Ellis et al. Rational Emotive Behavior Therapy. Amer Psychological Assn; 3 edition 2011.
Reappraise Stress and Self-Doubt:
• What if…• If only…• Judgment and Criticism• Rejection and Abandonment• Neglect and Abuse• Standards and Expectations• Loss• Transition
Reappraising the Triggers:
2
In a survey of 314 people at San Francisco International Airporthow many acknowledged they experience doubts of self-worth?
a) 76b) 187c) 235d) 283e) 311
Reappraise Stress and Self-Doubt:
2
Friedland D, SFO Self-Doubt Study 2001, unpublished data
Self-doubt is nothing more
than psychic gas!
Reappraise Stress and Self-Doubt:
2
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
Recognize Reactivity
Is it doing moreharm than good?
1Reappraise Stress
and Self-DoubtIt’s nothing more than
Psychic gas!
2
Cultivate Creativity By Reflecting on
What’s Truly Important
3
Cultivate Creativity By Reflecting on
What’s Truly Important
What is your definition of
optimal health?
3
Cultivate Creativity By Reflecting on
What’s Truly Important
• Learning• Connecting• Expressing Potential• Being of Service• Creating Opportunity• Experiencing Significance• Leaving a Legacy
3
Cultivate Creativity By Reflecting on
What’s Truly Important
3
Health Relationships Productivity
V
S
I
R
V=Vision S=Strategy I=Implementation R=Results
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
Recognize Reactivity
Is it doing moreharm than good?
1Reappraise Stress
and Self-DoubtIt’s nothing more than
Psychic gas!
2
Cultivate Creativity By Reflecting on
What’s Truly ImportantLearning
ConnectingExpressing Potential
Being of ServiceCreating Opportunity
Experiencing SignificanceLeaving a Legacy
3
Make the Turn intoWhat’s Truly Important
4
1
3
Find
Frame
Apply
Evaluate
1
3
24
Make the Turn intoWhat’s Truly Important
4
Frame-Find-Evaluate-Apply Spiral of Growth™
Cultivate Creativity By Reflecting on
What’s Truly Important
Reappraise Stress and Self-Doubt
Recognize Reactivity
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
Is it doing moreharm than good?
It’s nothing more than Psychic gas!
LearningConnecting
Expressing PotentialBeing of Service
Creating OpportunityExperiencing Significance
Leaving a Legacy
Make the Turn intoWhat’s Truly Important
Frame
1
2
3
4
Apply
Evaluate
Find
1 2
34
Fight Flight Trigger
1 2
Fight Flight
Trigger
Give Receive
1 2
GiveReceive
Cycle of Reactivity
Cycle of Creativity
Cultivate Creativity By Reflecting on
What’s Truly Important
Reappraise Stress and Self-Doubt
Recognize Reactivity
ReactivityFight & Flight
CreativityFulfillment
STRESS & SELF-DOUBT
INSPIRATION
The 4 in 4 Framework™
Is it doing moreharm than good?
It’s nothing more than Psychic gas!
LearningConnecting
Expressing PotentialBeing of Service
Creating OpportunityExperiencing Significance
Leaving a Legacy
Make the Turn intoWhat’s Truly Important
Frame
1
2
3
4
Apply
Evaluate
Find
1 2
34
Achieve and Enhance Peak Performance
Performance
Arousal / Stress
Online Program
+
The 4 in 4 Framework™ to Achieve Peak Performance
Workbook• 1 Module per week for 8 weeks, each 45-90 minutes long• 30 minutes of workbook exercises per week• 10-20 minutes of mindfulness practice per day
For more information go to:
http://danielfriedland.com/programs
Contact Information
Daniel Friedland, MDMedical Director, Barney and BarneyFounder & CEO, SuperSmartHealth
daniel@supersmarthealth.comOffice: 858.481.2393 Cell: 858.229.0875
Recommended