The Secret to Achieving Joy and Avoiding Burnout at Work! Evelyn Clingerman, PhD, RN, CNE, FNAP Executive Director, The Bonnie Wesorick Center for Health Care Transformation Kirkhof College of Nursing Grand Valley State University clingere@gvsu.edu
Disclosures I have no conflicts of interest or relevant financial support to disclose. Evelyn Clingerman, PhD
Objectives: After attending this session, you will be able to maintain momentum in your transformation experience by: 1. Identifying signs and effects of burnout in individuals and organizations, 2. Identifying three strategies to use to achieve joy in work, and 3. Identifying three strategies to avoid burnout in work.
A three dimensional syndrome that involves: 1. emotional exhaustion, 2. cynical treatment and negative thoughts towards patients and the healthcare team (depersonalization); and 3. a low sense of personal accomplishment. What is Burnout? (Maslach & Jackson, 1981)
Prevalence of Burnout at Work Clinician burnout, stress, depression, compassion fatigue & emotional exhaustion levels are a national epidemic (National Academy of Medicine, 2017).
Burnout Prevalence increased 9% physicians (2011-14) For RNs ranged 33-44%(2002-11) 1 400 physicians die by suicide annually No national suicide data for nurses. 2 1 Davidson et al. (2018) 2 Kishore, Dandurand, Mathew, & Rothenberger, 2016
In the last 30 days, 14% of nurses report falling asleep while driving
Nurses and Health BMI Sleep Nutrition Stress Nurses 28 7.0 13% 60% Average American 26.6 7.8 hours 23% 29% Body Mass Index: BMIs in the 25-29.9 range are classified as overweight. Sleep: Number of hours of sleep in a 24-hour period. Nutrition: % eating recommended servings of five fruits and vegetables daily. Quality of Life: % reporting high levels of stress. American Nurses Association, 2018, Analysis of the Healthy Nurse Survey.
Impact of Burnout Clinic Clinicians Personal: Physical health; Emotional health: Exhaustion: Sadness, Depression Suicidal Ideation Professional: Turnover Lack of Engagement Depersonalized care, Substance abuse, poor quality relationships Patients Provider becomes less vigilant with patients Greater medication Lower Patient Satisfaction Poor clinical outcomes (infections, safety) Organizations Poor working relationships and social interactions Low quality scores Increased turnover rates(physicians & Nurses) Workplace violence Employee Assistance Dismissal Rate
Factors Affecting Clinician Well-Being (NAM, 2018) EXTERNAL Factors Society & Culture Societal Expectations Culture of Safety Patient expectations Social Determinants Rules & Regs Accreditation Licensure Certification Policies Reimbursement type HR Compensation Organizational Bureaucracy Power Workload & Time pressure Scope of Prt Mission Values profit emphasis Data collection Harassment Inclusion LearningPractice Environment Autonomy Collaborative? Health IT interop EHRs Mentoring Team structure Workplace Safety Health Care Responsibilities Admin Resp Clinical Resp Career Development Patient population Specialty Issues Teach Research? Individual Factors Personal $ Stressors Family dynamics Flexible to change Purpose, Meaning in work; values? Personality Work Life Balance Skills & Abilities Competency clinical & tech Communication Coping Delegation Empathy Resilience
What Are We Doing About Burnout? Bodenheimer & Sinsky (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annuals of Family Medicine, 12(6): 573-6
Where are we on the river? Upstream Parable
Restoring and Finding Joy in Practice
Management s aim should be to create a system in which everybody may take joy in his or her work. Why Focus on JOY? W. Edwards Deming (Perlo et al., 2017)
Institute for Healthcare Improvement (IHI) Model Involve the clinicians: What matters to you? What are the pebbles in your shoes? (barriers) Commit to Shared Goal: JOY in Work Use best methods & measures for aim. Dialogue Sessions: Listen & Learn (skilled facilitators) Prioritize Concerns Identify your champion? Ensure all voices are heard; huddles Pause for joyful moments, bright spots Best Evidence Knowledge Hub IHI
National Academy of Medicine s Action Collaborative Join the Collaborative and Stay Informed Take advantage of the Knowledge Hub https://nam.edu/clinicianwellbeing/ Causes Effects Solutions Conceptual Model Join the Listserve
Improve Raise Advance Improve baseline understanding of challenges to clinician well-being Raise the visibility of clinician stress and burnout Advance evidencebased, multidisciplinary solutions that will improve patient care by caring for the caregiver. https://nam.edu/clinicianwell-being
Return to Joy in Work: Individual Level Encourage Healthy Behaviors Encourage Connections with Family, Friends, & Co-workers Set Aside Compliment Time or Compliment Wall; Gratitude Time Have Debrief Time Take mandatory breaks Off duty means off duty Avoid email when off duty
To Achieve Sustainable Transformation: What We Measure gets our Attention Identify metrics: What gets measured gets our attention. Why? Quantify shortcomings & follow improvements; Measure What? Varies by level: Patient AND Provider Satisfaction Safety & error Data Turnover/Retention Rates Work-Life Balance for all Hassles Inventory; Safety Inventory Maslach Stress Inventory Measure When or Frequency (stay vigilant) hand on the pulse; track over time How to measure? Scorecards Keep it on the table at meetings/discuss findings Real time feedback Podcasts How to Intervene: Engage HCPs in solutions Best Evidence (NAM; IHI frameworks) No single answer: Both AND approach
Vaccinate HCPs for Exposure to Stressors (Nedrow et al., 2013) Burnout is linked to four values: service, excellence, curative competence & compassion but excess is unhealthy Training: mindfulness, self-compassion, gratitude, reframing Relax, Restore, Recharge and Wellness Events; Social gatherings, especially for newbies Use of Support Services & consider redistributing or sharing tasks Pleasing Environment Education: mindfulness, sleep, resilience
Organizational Interventions to Advance Joy (Barnett, 2017) Peer Support Networks and Resilience Networks Address personal emotions (+ emotional first aid) Build healthy stress management behaviors Organizational Re-design + Infrastructure Huddles Flexibility & Control with Hours Well-being Days (Cleveland Clinic) Protected time to attend Mindfulness Creative Arts Visual, Written, and Music
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as it is to be able to walk through water without getting wet. Rachel Naomi Remen