Restoring Joy in Work and Preventing Burnout: An IHI Framework for Joy

Transcription

1 29th Annual National Forum on Quality Improvement in Health Care Workshop A/B Restoring Joy in Work and Preventing Burnout: An IHI Framework for Joy Stephen J. Swensen, M.D. and Jessica Perlo, M.P.H. December 12, 2017 The presenters have nothing to disclose

2 Objectives 2 Share IHI s experience making Joy in Work a strategic priority Identify the key changes in the system for joy in work and to assure staff experience meaning, choice, camaraderie, and equity Describe key leadership behaviors that raise staff engagement and restore joy

3 Deming and Joy Management s overall aim should be to create a system in which everybody may take joy in his work. Dr. W. Edwards Deming

4 Welcome to IHI

5 The Burning Platform 60% respondents of MD survey are considering leaving practice 70% knew at least one MD who left practice due to poor morale 37% of newly licensed RNs are thinking of leaving their job 13% vacancy rate for RNs Few CEOs have taken up the challenge to transform their organizations Health care work force injuries are 30x greater than other industries Lucian Leape Institute Through the eyes of the workforce: creating joy, meaning and safer health care. Boston, MA: National Patient Safety Foundation.

6 Joy is more than absence of burnout

7 Joy as a Strategic Priority Innovation Cycle 1: Research Engagement, Burnout, Satisfaction, Joy, Wellness

8 Joy as a Strategic Priority Innovation Cycle 2: Expert Interviews How do you think about joy in your organization? Where does joy fit with mission, strategy or priorities? Do you measure joy? How and how often? Have you seen improvement or cost resulting in your joy in work improvement efforts?

9 Joy as a Strategic Priority 9 Innovation Cycle 3: Prototyping Outpatient Kaiser Permanente Erwin Street Medical Offices Charleston Area Medical Center Glen Cove Hospital, Northwell Health Organizations and Trusts Institute for Healthcare Improvement imatter NHS Scotland Imperial College Healthcare Trust NHS Highland Inpatient Mount Auburn Hospital Labor and Delivery Floor Nemours/Alfred l. DuPont Hospital for Children Pediatric Intensive Care University of Michigan Cardiac ICU Academic University of Virginia School of Nursing Penn State Altoona School of Nursing

10 How do you improve Joy in Work? 10

11 Swensen, Pugh, McMullan, Kabcenell. High-Impact Leadership. Institute for Healthcare Improvement; 2013.

12 Swensen Pugh McMullan Kabcenell High-Impact Leadership. Institute for Healthcare Improvement 2013.

13 Real Time Measurement Wellness Resilience Daily Improvement Camaraderie Teamwork Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Camaraderie & Teamwork Happy Healthy Productive People Participative Management Participative Management Physical & Psychological Safety Meaning & Purpose Recognition & Rewards Autonomy & Control Physical Psychological Safety Meaning Purpose Autonomy Control Recognition Rewards

14 Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, et al. Changes in Burnout and Work-Life Balance in Physicians. Mayo Clinic Proceedings: (12) MFMER slide-14

15 exhausted detached callous cynical unsure Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, et al. Changes in Burnout and Work-Life Balance in Physicians. Mayo Clinic Proceedings: (12) MFMER

16 substance abuse medical errors car accidents depression divorce Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press Shanafelt, Noseworthy. Executive Leadership Physician Well-being. Mayo 2013 ClinMFMER Proc

17 Gonzales-Morales, et al. Perceived collective burnout. Anxiety Stress Coping 2012;25:43 Bakker et al. Burnout Contagion. J Advanc Nurs. 2005; 51:276

18 Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Education Counseling. 88(3).

19 You cannot give MFMER

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21 Wound Healing Trust Anxiety Pain LOS Readmissions ( Burnout) Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Ed Counseling. 88(3). Cosley, J Experimental Social Psychology 46.5 (2010) Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): 216. Barsade, et al.companionate Love. Admin Science Quarterly

22 Experience Outcomes Empathy Errors Tests Procedures Professionalism Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Ed Counseling. 88(3). Cosley, J Experimental Social Psychology 46.5 (2010) Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): 216. Barsade, et al.companionate Love. Admin Science Quarterly Bodenheimer, Sinsky. From the Triple to Quadruple Aim. Annals of Family Medicine, 2015 Shanafelt Noseworthy. Executive Leadership Physician Well-being.Mayo Clin Proc MFMER Cimiotti, et al. Nurse staffing, burnout and infections. Am Journal of Infection Control. 2012;40

23 McHugh. Widespread job dissatisfaction, burnout, frustration. Health Aff Feb;30(2): Compassion fatigue, Moral distress. Psychological safety, Hostile work environment, Practice inefficiency, Production, Erosion of meaning, Clerical work

24 10,000 per day x 19 years

25

26

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28 Swensen. Esprit de Corps and Quality: Making the Business Case for Eradicating Burnout. J Healthcare Mgmt. In Press. 2018

29 BUSINESS CASE pp. 3-7 Roughly 75 percent of penalty kicks at the elite level are successful. The goal is a mere 12 yards away; it is 8 yards across and 8 feet high. 80 miles per hour. If the keeper guesses wrong, your odds rise to about 90 percent. keepers jump left 57 percent of the time and right 41 percent which means they stay in the center only 2 times out of 100. A kick toward the center, as risky as it may appear, is seven percentage points more likely to succeed than a kick to the corner. While a penalty kick aimed at the center of the goal is significantly more likely to succeed, only 17 percent of kicks are aimed there. If you follow this selfish incentive protecting your own reputation by not doing something potentially foolish you are more likely to kick toward a corner. If you follow the communal incentive trying to win the game for your nation even though you risk looking personally foolish you will kick toward the center. IMAGINE YOU ARE A SOCCER PLAYER: The statistics in this section were drawn from: PierreAndré Chiappori, Steven D. Levitt, Timothy Groseclose, Testing Mixed-Strategy Equilibria When Players Are Heterogeneous: The Case of Penalty Kicks in Soccer, The American Economic Review 92, no. 4 (September 2002) Chiappori, et al. Testing Mixed-Strategy Equilibria The Case of Penalty Kicks in Soccer. The American Economic Review 92, no. 4 (9/2002)

30 Organization Citizenship Behavior Collaboration Productivity Accidents Turnover Stress Profit Harter. Relationship between employee satisfaction, employee engagement and business outcomes: a meta-analysis. J Appl Psychol 2002; 87: Swensen, Shanafelt.

31 2017 National Health Care Retention Report. NSI Nursing Solutions, Inc 2017 (14.6% - $7.86M)

32 The world is run by those who show up Eighty percent of success is showing up. Woody Allen Gallup: State of the Global Workplace Report 2013 (34/51/16)

33

34 Swensen, Shanafelt. Organizational Framework Joy in Practice. The Joint Commission Journal on Quality and Patient Safety 2017

35 Shanafelt et al. Arch Intern Med. 2009: 25;169(10): (+/- 20% ½ BO) 2013 MFMER

36 IHI Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Meaning & Purpose Camaraderie & Teamwork Recognition & Rewards Participative Management

37 True source of joy in work is a connection to purpose.

38 Grant. Impact and the Art of Motivation Maintenance: The Effects of Contact with Beneficiaries on Persistence Behavior, Organizational Behavior and Human Decision Processes. 05/2007; 103(1):53-67 (scholarships - $503.22, up from $185.94) 2011 MFMER

39 How we spend our days is

40 Hibbard, Greene, Overton. Health Affairs, Feb 2013: 32(2): Roter, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care Aug;36(8):

41 Isen. Influence of Positive Affect on Decision Making. J CONSUMER PSYCHOLOGY, 2001,11(2)75 85 (2x speed, 20% accuracy)

42 25 years? Ann Rhoades. Built on Values: Creating an Enviable Culture that Outperforms Chief People Officer of most profitable organization for 25 years ending 2002

43 Gittell, et al. (2008). Impact of Relational Coordination on Job Satisfaction and Quality Outcomes.Human Resource Management Journal, 18(2). Gittell, Medical Care Volume 28, Number 8: Gittell, Impact of relational coordination on quality of care. Medical Care, 2000;38(8):

44

45 Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20: Overtreatment Failures of care delivery Administrative complexity Failures of care coordination

46 Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20: Overtreatment Productivity Compensation Worklife Imbalance Values Dissonance Social Isolation

47 Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20: Failures of Care Compassion Fatigue Meaning & Purpose Moral distress Workload

48 Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20: Administrative Complexity Inefficient workflow Values Dissonance Loss of Control Workload

49 The purpose of quality improvement

50

51 James, Poulsen. Harvard Business Review Jul/Aug 2016(94) Swensen, Bolton, Dilling. Business Case for Quality Improvement. J Patient Saf, (1)44 $42m >$900m $688m

52 BUSINESS CASE pp. 3-7 Roughly 75 percent of penalty kicks at the elite level are successful. The goal is a mere 12 yards away; it is 8 yards across and 8 feet high. 80 miles per hour. If the keeper guesses wrong, your odds rise to about 90 percent. keepers jump left 57 percent of the time and right 41 percent which means they stay in the center only 2 times out of 100. A kick toward the center, as risky as it may appear, is seven percentage points more likely to succeed than a kick to the corner. While a penalty kick aimed at the center of the goal is significantly more likely to succeed, only 17 percent of kicks are aimed there. If you follow this selfish incentive protecting your own reputation by not doing something potentially foolish you are more likely to kick toward a corner. If you follow the communal incentive trying to win the game for your nation even though you risk looking personally foolish you will kick toward the center. IMAGINE YOU ARE A SOCCER PLAYER: The statistics in this section were drawn from: PierreAndré Chiappori, Steven D. Levitt, Timothy Groseclose, Testing Mixed-Strategy Equilibria When Players Are Heterogeneous: The Case of Penalty Kicks in Soccer, The American Economic Review 92, no. 4 (September 2002) Chiappori, et al. Testing Mixed-Strategy Equilibria The Case of Penalty Kicks in Soccer. The American Economic Review 92, no. 4 (9/2002)

53 Casadevall, Fang Rigorous science: a how-to guide. mbio 7(6):e doi: /mbio

54 Perlo, Balik, Swensen, Kabcenell, Landsman, Feeley. IHI Framework for Improving Joy in Work. IHI White Paper. Institute for Healthcare Improvement; 2017

55 Real Time Measurement Wellness Resilience Daily Improvement Camaraderie Teamwork Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Camaraderie & Teamwork Happy Healthy Productive People Participative Management Participative Management Physical & Psychological Safety Meaning & Purpose Recognition & Rewards Autonomy & Control Physical Psychological Safety Meaning Purpose Autonomy Control Recognition Rewards

56 Losada, (2004). The Role of Positivity and Connectivity in the Performance of Business Teams. American Behavioral Scientist, 47(6), MFMER slide-56

57 IHI Joy in Work Framework Real Time Measurement Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Daily Improvement Participative Management

58

59 Linzer. Cluster Interventions to Improve Work Conditions + Burnout. J Gen Intern Med. 2015;30(8):1105 Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61: March/April MFMER

60 Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System AJMQ Spheres of Influence Little or no control Influence Control

61 John McCracken, Naveen Jindal School of Management, 2011 UT-Dallas MFMER

62 Dr. Laurel Fedor Region Medical Director for Continuous Improvement 2011 MFMER

63 Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61: March/April 2016

64 Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System AJMQ

65 Swensen, Johnson. Mapping Value Into Radiology. JACR 2005;2:992

66 Swensen, Dilling, Harper, Noseworthy. Mayo Clinic Value Creation System AJMQ Purpose not to work harder

67

68 7 minutes

69 7 minutes

70 Swensen. Reliably Better, Faster, and Cheaper Soufflés. JACR. August 2006 Standardize when it creates value for patients and time for professionals.

71 217 Units (~11,000 staff) Morale +17% Burnout -21% Teamwork +12% Swensen, Kabcenell, Shanafelt. J Healthcare Management. 61: April 2016

72 IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management Participative Management

73 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

74 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

75 Nick Seybert Harvard Business Review June 29, 2013 Physician Leadership and Emotional Intelligence. J Grad Med Educ Mintz, Stoller

76 Five Leadership Behaviors (P<0.001) (P<0.001) Shanafelt Swensen. Mayo Clinic Proceedings. April 2015: 90(4);

77 Appreciation Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions. Mayo Clinic Proceedings. April 2015: 90(4);

78 Sood, Amit,, and Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, Enhance wellbeing Increase optimism Improve mood Boost energy

79 Ideas Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

80 Listen to understand.

81 Transparency Root of the tree is trust. Michael C. Bush

82 Shanafelt et al. Arch Intern Med. 2009: 25;169(10): (+/- 20% ½ BO)

83 The study by Cecilia Rouse, an associate professor in Princeton's Woodrow Wilson School of Public and International Affairs and the economics department, and Claudia Goldin, a professor of economics at Harvard University, seems to confirm the existence of sex-biased hiring by major symphony orchestras and illustrates the value of blind auditions, which have been adopted by most American symphonies. Their report was published in the September-November issue of the American Economic Review. "This country's top symphony orchestras have long been alleged to discriminate against women, and others, in hiring," Rouse said. "Our research suggests both that there has been differential treatment of women and that blind auditions go a long way toward resolving the problem." Florence Nelson, director of symphonic services at the American Federation of Musicians, described the research as a "very important statement, especially to those of us who have done auditions both ways -- behind a screen and without the screen." She has played flute and piccolo in major orchestras. Traditionally, new members of the great symphony orchestras were handpicked by the music director and principal player of each section. Most contenders were the male students of a select group of teachers. To overcome bias, most major U.S. orchestras began to broaden and democratize their hiring procedures in the 1970s and 1980s, advertising openings, allowing orchestra members to participate in hiring decisions and implementing blind auditions in which musicians audition behind a screen that conceals their identities but does not alter sound. Of the "Big Five" symphonies -- the Boston Symphony Orchestra, the Chicago Symphony Orchestra, the Cleveland Symphony Orchestra, the New York Philharmonic and the Philadelphia Orchestra -- only Cleveland still does not hold blind auditions. Use of the blind auditions varies among the other orchestras, with some holding them only in preliminary rounds. In their study, Rouse and Goldin examined lists of personnel from 11 major orchestras, including the Big Five, and actual accounts of the hiring process maintained by personnel managers in eight major orchestras. Among musicians who auditioned in both blind and non-blind auditions, about 28.6 percent of female musicians and 20.2 percent of male musicians advanced from the preliminary to the final round in blind auditions. When preliminary auditions were not blind, only 19.3 percent of the women advanced, along with 22.5 percent of the men. Using data from the audition records, the researchers found that blind auditions increased the probability that a woman would advance from preliminary rounds by 50 percent. The likelihood of a woman's ultimate selection is increased several fold, although the competition is extremely difficult and the chance of success still low. Inclusion As a result, blind auditions have had a significant impact on the face of symphony orchestras. About 10 percent of orchestra members were female around 1970, compared to about 35 percent in the mid-1990s. Rouse and Goldin attribute about 30 percent of this gain to the advent of blind auditions. "Screens have been a very important part of the whole audition process," Nelson said. "My sense is that blind auditions have made a tremendous difference in the amount of hiring discrimination women face." Chua. Costs of Ambient Cultural Disharmony. Academy of Management. 2013, 56(6)545. Nelson recalled how sensitive she was to the gender issue while auditioning. She remembers being told in the 1980s to remove her shoes while walking to center stage behind a screen, so the judges would not hear the "clickety-clack" of a woman's high heels. Rouse. Blind Auditions. September-November. American Economic 2013 MFMER Review. slide-83

84 subjected to differential treatment that often is demeaning and pointedly directed to their status as women David Wahlberg. November 6,

85 Coaching Mentor Culture Elephant and baby Engagement = Leading Indicator What is the best way to succeed at Mayo? 12 Dimensions Career Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development 2013 MFMER Vol. slide (4) 2016

86 the best way to succeed

87 2013 MFMER

88

89 Signature Size Shanafelt, Menaker, Buskirk, Gorringe, Swensen. Leadership Dimensions. Mayo Clinic Proceedings. 4/ (4) Shanafelt, Swensen. Using the Annual Review to Reduce Burnout and Promote Engagement. American J Medical Quality 2017

90 IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Autonomy & Control Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management

91 Intrinsic Motivation and Employee Attitudes: Public Personnel Admin Dec

92 Paul Zak. Center for Neuroeconomics Studies Trust Factor the science of creating high-performance companies 20% pay cut

93 Journal of Applied Social Psychology 34 (2004).; Lancet Vol 337 (1991). J Pers Soc Psychol 1976;34(2): Baard, Deci, Ryan. Journal of Applied Psychology. 2004, 34, 10, pp

94 Pink, D. H. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhead Books. (revenue 2016 centers) MFMER slide-94

95 Seifter. The Conductor-less Orchestra. Leader to Leader, No Summer MFMER slide-95

96 Shanafelt, Sinsky, Dyrbye, West. Mayo Clin Proc. 2016;91(11): (When Where BO)

97 Brookings Institute. Barrington L, Silvert H: CEO Challenge New York: The Conference Board, August 2004.

98 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

99 Sinsky, et al. Ann Intern Med. 9/ Hill RG. Am J Emerg Med Nov;31(11):1591 Shanafelt, et al. Mayo Clin Proc. 2016;91(11):

100 Clerical Work Hill RG. Am J Emerg Med Nov;31(11):1591-4

101 Sinsky, et al. Ann Intern Med. 9/ Hill RG. Am J Emerg Med Nov;31(11):1591 -Necessary? Efficiency. Right person. --- (Nights: Clicks, 2011 Workflow, MFMER Multi-Task)

102 Organization Design Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61: March/April 2016 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

103 IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Participative Management Recognition & Rewards Recognition & Rewards

104

105 Swensen. Esprit de Corps & Quality -Caring for each other for our patients the case for eradicating burnout. Journal of Healthcare Management. In Press. January 2018 (revenue centers)

106 Hess. Circ Cardiovasc Qual Outcomes. 2012;5:

107 Swensen, Duncan, et al. Safe and Appropriate Imaging of Children J Patient Safety 10 (3) 2014

108 Daniel Kahneman, Angus Deaton. High income improves evaluation of life but not emotional well-being. Proceedings of the National Academy of Sciences (107) 38:

109 1. Camaraderie 2. Intrinsic desire 3. Recognition 4. Impact 5. Growth 6. Helping patients 7. Money Drzymalski, Gladstone, Troyani, Niu. TINYpulse Engagement Organizational Culture Report

110 Mellstrom, (2008) Crowding out in blood donation. Journal of the European Economic Association, 6(4):845. Pink. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhead Books.

111 Grant. Psychological Science Hand hygiene prevents you/patients from catching diseases 22(12)

112 IHI Joy in Work Framework Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Camaraderie & Teamwork Participative Management

113 Kniffin. Workplace Commensality and Performance of Firefighters. Human Performance, 28: , 2015 West, Dyrbye, Rabatin Shanafelt. Physician Well-being. JAMA Intern Med. 2014;174(4):

114 Bartolini et al. Decline in Social Connections. Social Indicators Research. Feb 2013, 110(3)

115 Holt-Lunstad (2010) Social Relationships and Mortality.

116 West, Dyrbye, Satele, Shanafelt. J Gen Intern Med. 2015;30:S89. Colleagues Meeting to Promote And Sustain Satisfaction

117 Meyer-Lindenbergh. December 7, 2005 Journal of Neuroscience

118 Hariri, Weinberger. NIMH. July 19, 2002 Science

119 Grant. Impact and the Art of Motivation Maintenance: The Effects of Contact with Beneficiaries on Persistence Behavior, Organizational Behavior and Human Decision Processes. 05/2007; 103(1):53-67 ($15m lunch break) 2011 MFMER

120 Camaraderie Money

121 Companionate Love Empathy Satisfaction Engagement Commitment Productivity Exhaustion Burnout Barsade, O Neill. What s Love Got to Do with It? A Longitudinal Study of the Culture of Companionate Love. Administrative Science Quarterly. May 29, 2014

122 IHI Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Happy Healthy Productive People Physical & Psychological Safety Meaning & Purpose Autonomy & Control Physical & Psychological Safety Camaraderie & Teamwork Recognition & Rewards Participative Management

123 Swensen, Dilling, Harper, Noseworthy. The Mayo Clinic Value Creation System AJMQ

124 Swensen, Dilling, Harper, Noseworthy. Mayo Clinic Value Creation System AJMQ

125 Emily Jenny

126

127 Fair Faulty design or lack of system? Fix System and Human Error (lapse, slip, mistake) Console Learn Just Culture Accountability not determined by outcome Risky (choice increases risk where risk is unrecognized or mistakenly believed to be justified) Reckless (choice to consciously disregard a substantial and unjustifiable risk) Coach Learn Corrective Action Leonard, Frankel. Patient Education and Counseling. 80 (2010) Reason J. Human error: models and management. BMJ Mar 18; 320: Marx D. (2001) Patient Safety and the Just Culture : A Primer for Health Care Executives. Columbia University, New York, NY.

128 Scott, et al. Caring for Our Own: Deploying a Systemwide Second Victim Rapid Response Team. May 2010 Volume 36 Number Shanafelt. Ann Surg 2010 Jun;251(6): Burnout and medical errors among American surgeons. Kimberly Hiatt

129 Am J Psychiatry Dec;161(12): MFMER

130 IHI Joy in Work Framework Wellness & Resilience Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management

131 Hobfoll. Stress. Am Psychol. 1989;44:513. Maslach. Applied Psychol Workload & Environment.

132 social, physical, mental Hobfoll. Conservation of Resources - Stress. Am Psychol. 1989;44: MFMER slide-132

133 Romundstad. Sense of Humor and Causes of Mortality: The Nord-Trøndelag Health Study. Psychosomatic

134 Sánchez-Villegas. Mediterranean dietary pattern and depression: the PREDIMED randomized

135 Epstein, Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, (3): p Sood. Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

136 Blomkvist: Occup Environ Med 2005;62e1; Psychosomatic Med 67: 2005Ulrich: Science 224: 1984

137 Fidler MacCarty Swensen, et al. Feasibility of Using a Walking Workstation During CT Image Interpretation. JACR. 2008;5(11): Laskowski, Walking Keeps Depression (and a Host of Other Health Problems) Away. Mayo Clin Proc. August 2016; 91(8):

138 Epstein, Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, (3): p Sood. Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

139 Epstein, Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, (3): p Sood. Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

140 Shanafelt, Sinsky, Dyrbye, West. Mayo Clin Proc. 2016;91(11): ( hours BO)

141 Sood, Amit,, and Mayo Clinic. The Mayo Clinic Guide to Stress-free Living. First Da Capo Press edition. Da Capo Press/Lifelong Books, 2013.

142 Oberg, Frank. Physicians health practices strongly influence patient health practices. Journal of the Royal College of Physicians of Edinburgh. 2009;39(4):

143 Real Time Measurement Wellness Resilience Daily Improvement Camaraderie Teamwork Joy in Work Framework Wellness & Resilience Daily Improvement Real Time Measurement Camaraderie & Teamwork Happy Healthy Productive People Participative Management Participative Management Physical & Psychological Safety Meaning & Purpose Recognition & Rewards Autonomy & Control Physical Psychological Safety Meaning Purpose Autonomy Control Recognition Rewards

144 Losada, (2004). The Role of Positivity and Connectivity in the Performance of Business Teams. American Behavioral Scientist, 47(6), MFMER slide-144

145 pp. 3-7 Roughly 75 percent of penalty kicks at the elite level are successful. The goal is a mere 12 yards away; it is 8 yards across and 8 feet high. 80 miles per hour. If the keeper guesses wrong, your odds rise to about 90 percent. keepers jump left 57 percent of the time and right 41 percent which means they stay in the center only 2 times out of 100. A kick toward the center, as risky as it may appear, is seven percentage points more likely to succeed than a kick to the corner. While a penalty kick aimed at the center of the goal is significantly more likely to succeed, only 17 percent of kicks are aimed there. If you follow this selfish incentive protecting your own reputation by not doing something potentially foolish you are more likely to kick toward a corner. If you follow the communal incentive trying to win the game for your nation even though you risk looking personally foolish you will kick toward the center. IMAGINE YOU ARE A SOCCER PLAYER: The statistics in this section were drawn from: PierreAndré Chiappori, Steven D. Levitt, Timothy Groseclose, Testing Mixed-Strategy Equilibria When Players Are Heterogeneous: The Case of Penalty Kicks in Soccer, The American Economic Review 92, no. 4 (September 2002) Chiappori, et al. Testing Mixed-Strategy Equilibria The Case of Penalty Kicks in Soccer. The American Economic Review 92, no. 4 (9/2002)

146 Berwick, Hackbarth. JAMA, April 11, 2012.Vol 307(14) Swensen, et al. British Med Journal Q&S. 2011;20:534-37

147 2011 MFMER

148

149 Swensen Pugh McMullan Kabcenell High-Impact Leadership. Institute for Healthcare Improvement 2013.

150 What s Next?

151 What s Next What will you do by next Tuesday? Can you commit to: Starting one conversation around what matters to your colleagues / staff? Testing one change to remove impediments to joy, contribute to institutional learning by spring 2018? Reassessing opportunities for interventions at the system level Our commitment to disseminate learning: IHI Joy in Work Whitepaper free download on IHI Joy in Work virtual learning system

152 Upcoming Program Begins March 1, week virtual training with video content, group calls, and options for added coaching Learn more and enroll:

153 Thank You! Please let us know if you have any questions or feedback following today s session. Stephen Swensen Stephen.Swensen@imail.org Jessica Perlo jperlo@ihi.org

154 References Cited Swensen, Shanafelt. Organizational Framework to Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety 2017 Sinsky, C.A., et al., In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices. The Annals of Family Medicine, (3): p Swensen, S., A. Kabcenell, and T. Shanafelt, Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. Journal of healthcare management / American College of Healthcare Executives, (2): p Johnson, J.V., et al., Long-term psychosocial work environment and cardiovascular mortality among Swedish men. American Journal of Public Health, (3): p Baard, P.P., E.L. Deci, and R.M. Ryan, Intrinsic Need Satisfaction: A Motivational Basis of Performance and Weil Being in Two Work Settings1. Journal of applied social psychology, (10): p Swensen, S., et al., Leadership by design: intentional organization development of physician leaders. Journal of Management Development, (4): p Thirioux, B., F. Birault, and N. Jaafari, Empathy Is a Protective Factor of Burnout in Physicians: New Neuro- Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Front Psychol. 2016;7:763. doi: /fpsyg Riess, H., et al., Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience- Informed Curriculum. Journal of general internal medicine, (10): p Krasner, M.S., et al., Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Jama, (12): p P a g e

155 References Cited Taris, T.W., Is there a relationship between burnout and objective performance? A critical review of 16 studies. Work & Stress, (4): p Swensen, S.J., et al., The Mayo Clinic Value Creation System. Am J Med Qual, (1): p Beckman, H.B., et al., The impact of a program in mindful communication on primary care physicians. Academic medicine : journal of the Association of American Medical Colleges, (6): p Kniffin, K.M., et al., Eating Together at the Firehouse: How Workplace Commensality Relates to the Performance of Firefighters. Human Performance, (4): p West, C.P., et al., Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med, (4): p Linzer, M., et al., A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. Journal of general internal medicine, (8): p Sinsky, C., et al., Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, (11): p Shultz, C.G. and H.L. Holmstrom, The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med, (3): p Wu, A.W., Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ Mar 18;320(7237): Scott, S.D., et al., Caring for our own: deploying a systemwide second victim rapid response team. Communication of Critical Test Results, 2010.

156 References Cited West, C.P., et al., Association of resident fatigue and distress with perceived medical errors. Jama, (12): p P a g e Williams, E.S., et al., The relationship of organizational culture, stress, satisfaction, and burnout with physicianreported error and suboptimal patient care: results from the MEMO study. Health care management review, (3): p Swensen, S.J., et al., The business case for health-care quality improvement. J Patient Saf, (1): p Ruotsalainen, J.H., et al., Preventing occupational stress in healthcare workers. The Cochrane Library, Laskowski, E.R. Walking Throughout Your Day Keeps Depression (and a Host of Other Health Problems) Away. in Mayo Clinic Proceedings Elsevier. Epstein, R.M. and M.S. Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, (3): p Sood, A., et al., Stress Management and Resiliency Training (SMART) Program among Department of Radiology Faculty: a pilot randomized clinical trial. EXPLORE: The Journal of Science and Healing, (6): p Panagioti, M., et al., Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, West, C.P., et al., Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 388(10057): p Shanafelt, T.D., et al., Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 91(4): p