Burnout Among Health Care Professionals

Transcription

1 Burnout Among Health Care Professionals NAM Action Collaborative on Clinician Well-being and Resilience Research, Data, and Metrics Taskforce Lotte Dyrbye, MD, MHPE, FACP Professor of Medicine & Medical Education Associate Director, Program on Physician Well-Being Mayo Clinic

2 What is Burnout? Syndrome of depersonalization emotional exhaustion low personal accomplishment Leads to decreased effectiveness at work Attributed to work-related stress Maslach, C., S. E. Jackson, et al. (1996). Maslach Burnout Inventory Manual. Palo Alto, CA, Consulting Psychologists Press.

3 High Prevalence of Burnout 2014, 6880 physicians, all specialties, all practice types 2012, 5521 medical students & residents 1999, >10,000 inpatient RN 2007, 68,000 nurses High Emotional Exhaustion Aiken JAMA 2002;288; McHugh Health Aff 2011;30; Dyrbye Acad Med 89(3): ; Shanafelt MCP 2015:90:1600

4 Greater burnout More work hours Younger physician Female physicians Specialty Pay based entirely on billing Child < 21 y.o. Dual career relationships Shanafelt et al. MCP 2016(7):836; Ann Surg 250; Dyrbye Arch Surg 2011;146(2):211

5 Quality and Safety Medical Error ~8000 surgeons Medical Malpractice Litigation ~7000 surgeons Health-care associated infections Mean burnout hospital nurses independent predictor Patient mortality ratios Teamwork scores Mean EE physicians & nurses ICU Burnout Medical Error 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

6 Patient Satisfaction Physician Job Satisfaction Nurse Job Satisfaction Burnout Physician DP Burnout Nurse EE Halbesleben Health Care Manage Rev 2008; Haas J Gen Intern Med 2000; DiMatteo Health Pscyhol 1993; McHugh Health Aff 2011; Leiter Soc Sci Med 1998; Vahey Med Care 2004l Shanafelt J Am Coll Surg 2011

7 Turnover & Reduction of Work Effort Intent to leave ~8,000 US Surgeons Burnout and depression independently associated with intent to leave on MV Nurses Burnout and job dissatisfaction associated with intent to leave current job or nursing Reducing FTE Prospective Study >2660 MD 1 point change in EE was associated with a 43% higher likelihood of reducing FTE over ensuing 24 months Controlled for age, sex, site, and specialty Loss of productivity at national level ~ eliminating graduating classes of 7 medical schools Shanafelt. J Am Coll Surg 212(3): ; MCP 2016;91; Leiter J Nurs Manag 2009; Spence Laschinger J Nurs Manag 2009; Dyrbye MCP 2013;

8 Jones J Nurs Am 2008; Fibuch Physician Leadersh J 2015; Buchbinder Am J Manag Care 1999; Kushnir, Fam Pract 2014; Bachman Soc Sci Med 1999; Parker J Behav Med 1995, Toppinen-Tanner Behav Med 2005, Hilton J Occup Environ Med 2009 Health Care Costs Medical Errors Malpractice claims Turnover x salary ($82-$88,000 per RN in 2007) $500,000 to >$1 million Absenteeism Job productivity Referrals Ordering

9 Key Drivers of Burnout Excessive workload Inefficient work environment Problems with work-life integration Loss of autonomy, flexibility and control Organizational culture and values Reduction of meaning in work Lack of social support at work Leadership behaviors Nurses: Moral distress Trainees: Learning environment, Educational debt Shanafelt. MCP 2016(7):836; Dyrbye et al. Arch Surg 2011; 146(2):211; Dyrbye et al. Arch Surg 147(10): ; Shanafelt Arch Intern Med 2009; Dyrbye Med Educ 2016;50: ; Shanafelt MCP 2016; Williams Health Care Manag Rev 2007; Aiken JAMA 2002; Hamric Crit Care Med 2007

10 Interventions to Reduce Burnout ~ 15 RCTs and 37 cohort studies Broad range of modestly effective interventions Benefits similar for individual-focused and structural interventions Limitations Convenience sampling Lack appropriate comparison group Short in duration Single discipline or organization Focused primarily on individual interventions rather than address root causes of burnout West el al. Lancet 2016; Panagioti JAMA Intern Med 2016

11 Three Major Areas for Future Research Organizational and health care system factors that contribute to distress and threaten wellbeing for HCPs Implications of HCP distress and well-being for health care outcomes Intervention research to improve the worklives and well-being of HCPs Dyrbye et al. NAM Perspective 2017