Agenda. Office of Clinician Support. Staff Responses to An Adverse Event. A Safe Place To Talk. Traumatic Stress Symptoms

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1 Office of Clinician Support: Caring for Children s Hospital Clinicians David R. DeMaso, MD Psychiatrist-in-Chief & Chairman of Psychiatry Children s Hospital Boston Professor of Psychiatry & Pediatrics Harvard Medical School

2 Agenda Office of Clinician Support A Safe Place To Talk Staff Responses to An Adverse Event Traumatic Stress Symptoms

3 OCS Premise Stress & Burnout Suboptimal Patient Care Attitudes & Practices Patient Safety Preventive Support System Self-Understanding Promotes Resiliency

4 What is the OCS? A safe alternative communication channel for anyone who does clinical work with patients. A place to assist clinicians with any problem that they may be having whether it be work-related or personal. Free onsite program (generally 1 3 meetings) Confidentiality of all parties is closely respected & information is shared only in unusual circumstances. Direct reporting to the CEO& President of the Hospital

5 What do we do? A place to voice concerns, evaluate situations, organize thoughts, assess feelings, & decide what is important according to a clinician s specific circumstances. Listen for trends impacting patient care and hospital culture. Ombuds Role Provide advocacy & intervention services including shortterm & intermittent counseling, referrals, information on system-wide operations, problem-solving, & help with decision-making. Employee Assistance Program Role

6 Individual Clinicians Consultations Consults Clinicians 34% MDs 26% trainees 74% attendings 41% RN s 25% Other clinicians Referral 75% self 22% recommend % mandated Year

7 Intervention Complexity Straightforward (phone, , fly-by ) 35% Low (office visit) 33% Moderate (office visit with follow-up or group meeting) 22% High (office visit & collaborative contacts) 9% Department intervention Hospital legal service Physician Health Service Outside professionals Others

8 Areas of clinician distress Patient and Family Re: patient/family 4% Patient safety 3% Personal & Own Family Personal Distress 40% Family/Friend Distress 34% Non-patient Work Concerns Re: another clinician 26% Performance 17% Interpersonal problem 11% Communication 10% Disruptive 8% Team conflict 8%

9 Staff Responses to An Adverse Event Staff perceived involvement in event Definite Uncertain No Work Environment High-volume, high-technology, & high-demand Caring for sick children Caring for stressed parents Safety & quality demands Common staff characteristics High expectations, altruism, sense of responsibility, & dedication

10 Staff Concerns & Symptoms Concerns Doubt practice Lose job Lose license Legal action What will others think? Traumatic Stress Symptoms The NIH Reaction Numbness Intrusiveness Acute Stress & Post Traumatic Stress Hyperarousal Subthreshold Disorder Re-traumatization in review

11 Interventions for Adverse Event Prevention Universal education re: adverse events Indicated intervention Gatekeepers alert to traumatic stress symptoms Impact on individual & those in close proximity Alert to re-traumatizing via investigation Intervention Peers/colleagues/leaders are major supports the modeling surprise Telling story leads to making meaning & self-understanding which leads to resiliency Measured debriefing correcting cognitive distortions Individual &/or group interventions No great studies on long term consequence most back to work more on guard more cautious time heals

12 Prevention & Wellness Efforts Pursuing education & training opportunities via group &/or educational venues in response to identified need as well as numerous requests for help in enhancing collaboration, increasing communication & reducing stress from across the hospital. During the year, over 1000 clinicians annually attended either a support group &/or educational program facilitated by OCS staff. Provided consultation/coaching on a number of occasions regarding difficult personnel & system issues that impact adversely on program management, staff morale, &patient care. Policy Statements & Guidelines Physician Behaviors & Enhancing Working Relationship with Families

13 OCS Satisfaction Survey 05, 06, & 08 Created & distributed a satisfaction survey to assess program quality & perceptions. Targeted only office visits. Cases deemed too acute & those no longer CHB employees were excluded. Send via inter-office mail in sealed envelopes marked Confidential. 74 (2005), 77 (2006), & 97 (2008) hospital clinicians sampled in one wave. No reminders & no second set of forms due to confidentiality & burden concerns. 5-point Likert scale with 1 being poor 5 being excellent. 36% response rate for all 3 years.

14 OCS Satisfaction Survey Results Item # and Text 2008 Mean 2008 SD 2006 Mean 2005 Mean 6. I understand the OCS is a place for either work-related or personal concerns My confidentiality was respected The OCS provided me with a safe place to talk regarding my concerns, organize my thoughts and feelings 13. If I were to seek help again, I would come back to the OCS. 12. If a colleague needed similar help, I would recommend the OCS Overall, my experience with the OCS was: The OCS helped me deal more effectively with my concerns or problems The OCS met my needs How would you rate the quality of the OCS service you received? 11. After my OCS consultation, there was a reduction in my level of stress

15 OCS Clinician Satisfaction Survey - '05, '06, & ' Rate service quality My experience Safe place to talk Confidentiality respected Work or personal Voice patient safety concerns Help deal Satisfied with help Met my need Reduced my stress Recommend colleague Would return Pattern of Meaning OCS Clinician Satisfactin Ratings 0 (unhelpful/disagreed strongly) (excellent/agree strongly)

16 A Safe Place To Talk Even a few minutes can help to reduce your distress. OCS can be a first step. David R. DeMaso, MD (Director) Lauren Coyne, RN, MS, LICSW Caitlin Bright (Coordinator)