wellbeing and resilience - nmshp final · 10/4/18 2 outline • identify strategies to impact...
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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 [email protected] [email protected]