Disclosures. From Burnout to Resilience: Building Capacity to Thrive at Work. Arif Kamal MD, MBA,

Transcription

1 From Burnout to Resilience: Building Capacity to Thrive at Work Arif Kamal MD, MBA, Disclosures 1

2 Objectives Learners will be able to describe the current prevalence and predictors of burnout in palliative care Learners will understand the personal and systems related contributors to burnout Learners will identify practical techniques to build resilience staying til 8 every night being the only one around who can facilitate a family meeting I just don t know how much longer I can do this. -a palliative care clinician you know talking to the daughter from California (again) convincing my colleagues that I don t take away hope seeing another 30-year old patient dying of melanoma 2

3 Definitions Working at a job you can t be successful at Professional Burnout % Professional Burnout Shanafelt JCO 2013 Shanafelt Arch Int Med 2012 Presented by Arif Kamal MD: 3

4 What s happening in medicine asymmetrical rewards, when mistakes are highlighted far out of proportion to successes; loss of autonomy, for example when clinicians cannot exercise judgment about how much time a particular patient and family need; and cognitive scarcity, which occurs when clinicians must continually manage their time under conditions of high complexity. Hospice and palliative may be different: 1. Being there vs. fixing 2. Unique core values 3. Focus on sacred life transition 4. Empowering patients & families, supporting choices 5. Requires unique worker qualities 6. Uniqueness of (hospice) work climate 7. Opportunity for personal growth 8. Hospice enchantment DiTullio M. et al. Am J Hospice Pall Med

5 Burnout Question %who said Once a week % who said Few times per week %who said Everyday I feel used up at the end of the workday 14% 19% 7% I feel I m working too hard on my job 11% 22% 13% I feel frustrated with my job 13% 20% 8% Presented by Arif Kamal MD: Burnout Severity Low Moderate High 67%* 62% 60%* EE DP Overall MD/DO Non-MD *P<0.01 Presented by Arif Kamal MD: 5

6 Multivariate risks of burnout Leaving >50% Work >50h Work weekends >4 colleagues MD/DO >50 y/o Presented by Arif Kamal MD: 6

7 The Burnout Crisis in PC 70 Professional Burnout % All physicians Oncology fellows Radiation oncologists Surgical oncologists Medical oncologists Palliative Care 7

8 Resilience: The capacity to meet challenges, recover from difficulties, & thrive at work; built from skills, not reflective of traits Sustainability depends on improving 2 areas 8

9 Individual skills Working from strengths Tracking activation Healthy boundaries Regulating emotions Recognizing distortions Reasonable expectations Finding meaning Commitment to long term Workplace factors Enabling control Structuring rewards Building community Promoting fairness Recognizing values Calibrating workload Six Areas of Work life Enabling Control Structuring Rewards Building Community Promoting Fairness Recognizing Values Calibrating Workload Maslach C, Schaufeli WB, & Leiter

10 Enabling Control Insufficient control over resources needed Can also be too high a level of responsibility Related to the inefficacy aspect of burnout Control of time Approaches Late start clinician each day Maslach C, Schaufeli WB, & Leiter 2011 Structuring Rewards Financial Reward Appreciation Recognition Intrinsic Reward Approaches Shout outs at division meeting Maslach C, Schaufeli WB, & Leiter

11 Building Community Sense of positive connection with others in the workplace Most destructive to community is chronic and unresolved conflict Approaches Training for giving feedback in the workplace Maslach C, Schaufeli WB, & Leiter 2001 Promoting Fairness Perceived fairness = respect and self worth Fairness of workload, pay, evaluations, promotions Approaches Rotations for high value weeks Maslach C, Schaufeli WB, & Leiter

12 Recognizing Values Doing something one considers unethical Mismatch between personal aspirations &that of organization Discrepancy between mission statement and actual practice. Approaches Team exercise to develop core values and mission statement Annual evaluations based on division core values Maslach C, Schaufeli WB, & Leiter 2001 Calibrating Workload Excessive work Wrong kind of work Most often related to the exhaustion aspect of burnout Approaches Part time work options, program development time Maslach C, Schaufeli WB, & Leiter

13 What s a resilience skill? Is this you? 13

14 A skills based approach 1. Working from my strengths 2. Tracking my activation 3. Finding healthy boundaries 4. Regulating my emotions 5. Reframing cognitive distortions 6. Using reasonable expectations 7. Discovering meaning everyday 8. Committing to ongoing work Self Awareness Strategies Examine your HOOKS denial, helplessness, anger & fear related to death and loss need to be in control to cure and to save - to do good over-helping and under-helping behaviors how personal feelings may contribute to inappropriate diagnoses or treatment assumptions about a good death dignity & hope at end of life 14

15 This is what MY mind often looks like! Mindfulness Raises provider consciousness of their inner reality and pf the external reality Teaches is to develop a kind, objective witnessing attitude Develops empathy for others Self compassion helps to protect us against anxiety and promote psychological resiliency Neff, KD, Kirkpatrick KL,, Rude, SS. Self-compassion and adaptive psychological functioning. J Res Pers. 2006;41:

16 Mindfulness Evidence mindfulness courses and activities help burnout Mindfulness practices, including the body scan, mindful movement, walking meditation and sitting meditation, as well as discussion focusing on the application of mindfulness at work resulted in significant improvements in burnout. Participation in a mindful communication program was associated with improvements in well being and attitudes associated with patientcentered care. *Int J Psychiatry Med. 2012;43(2): A mindfulness course decreases burnout and improves well-being among healthcare providers. Goodman MJ1, Schorling JB. JAMA Sept. 23, Vol. 302 No. 12 Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes Among Primary Care Physicians. Krasner, M., Epstein, R. 16