Presented by Rosalie Lo, PsyD Senior Clinical Psychologist Certified Traumatologist

Presented by Rosalie Lo, PsyD Senior Clinical Psychologist Certified Traumatologist Corporate Clinical Psychology Services (CCPS) Hospital Authority, Hong Kong

Challenges Facing HCWs They experience higher level of stress when compared to the general population 1. Job related Workload Times pressure Administrative duties Sleep deprivation No regular meals Make errors Threat of malpractice suits 2. Organisation Career structure Career uncertainties Inadequacy of resources and staff Lack of senior support Culture and climate of organisation 3. Interpersonal Patient s expectations and demands Staff conflicts Bullying Professional isolation Level of support from friends and family 4. Personal Personality (e.g. perfectionistic, Type A) High demands on self and others Dealing with death and dying Confrontation with emotional and physical suffering (Firth-Cozens, 2003; Wong, 2008)

A statutory body Hong Kong's public hospitals services 42 hospitals and institutions 47 specialist out-patient clinics (SOPCs) 73 general out-patient clinics (GOPCs) 27,440 beds

1. New Territories East Cluster (NTEC) 2. New Territories West Cluster (NTWC) 3. Kowloon West Cluster (KWC) 4. Kowloon Central Cluster (KCC) 5. Kowloon East Cluster (KEC) 6. Hong Kong East Cluster (HKEC) 7. Hong Kong West Cluster (HKWC) NTEC NTWC KWC KCC KEC HKEC HKWC

70,132 HA staff 25000 23721 No. of Staff 20000 15000 19946 13665 No. of Staff 10000 5000 6891 5910 0 Nursing Others Supporting (Care-related) Allied Health Medical Others: Chief Executive/Director/Deputy Director/Head, Cluster Chief Executive/Hospital Chief Executive, Chief Manager/Senior Manager/Executive Manager/General Manager, Other Professionals/Administrator, Systems Manager, Analyst Programmer, Other Supporting Staff - Clerical, Secretarial, Workman, Artisan, Property Attendant (28 February 2015)

1996 2015

Critical incident stress Workplace violence Mental well- being Infectious diseases etc.

1. Impair personal well-being Burnout Mental health problems and self-harm behaviors 2. Lower quality of patient care Medical errors 3. High cost for the organization Increased sick leave, absenteeism Increased long term treatment cost High Staff turnover Poor work performance Decreased sense of commitment (Dowell et al, 2000; Ho, 2012; Howard, 2008; Khairat & Gong, 2010; Mangiameli, 2012; National Clinical Assessment Services of United Kingdom, 2009; Ratanawongsa et al, 2012; Siu et al, 2012; Weingart et al, 2000)

Study on Medical Errors Purpose: studying the emotional impact of medical errors on physicians Results: Increased anxiety about Future errors (61%) Loss of confidence (44%) Sleeping difficulties (42%) Reduced job satisfaction (42%) Harm to their reputation (13%) Study on Litigation The most severe work-related stressor Major life trauma Results: Two clusters of emotional symptoms : major depression : 39% adjustment disorder : 20%. (Waterman et al, 2007; Schattner, 1998; Martin et al., 1991)

Buffer against mental disorders Reduce suicidal ideation and rates Reduce burnout Increase empathy Improve communication Increase job satisfaction Improve staff cohesiveness Reduce staff turnover Reduce medical errors Increase attentional control Reduction of defensive medicine is an outcome of better patient communication (Beckman et al, 2012; Beddoe & Murphy, 2004; Cohen-Katz et al, 2005; Galantino et al, 2005; Irving et al, 2009; Jain et al, 2007; Krasner et al, 2009; McCabe & Mackenzie, 2009; Mackenzie et al, 2006; Praissman, 2008; Rosenzweig et al, 2003; Shapiro et al, 1998; Shapiro et al, 2005; Shapiro et al, 2007; Sibinga & Wu, 2011; Young, 2001)

Resilience is the ability to: Bounce back Take on difficult challenges and still find meaning in life Respond positively to difficult situations Rise above adversity Cope when things look bleak Tap into hope Transform unfavorable situations into wisdom, insight, and compassion Endure http://www.rihope.ri.gov/documents/pdf/reslience.pdf

The capacity to make and carry out realistic plans Communication and problem-solving skills A positive or optimistic view of life Confidence in personal strengths and abilities The capacity to manage strong feelings, emotions, and impulses American Psychological Association http://www.rihope.ri.gov/documents/pdf/reslience.pdf

The ability and capacity of a workplace to withstand potential significant systemic risk/ disruptions by adapting, recovering, or resisting being affected and resuming core operations or continuing to provide an acceptable level of functioning and structure. Companies and organizations: able to rebound from potentially disastrous changes. http://www.rihope.ri.gov/documents/pdf/reslience.pdf

In-depth psychological services Staff Clinic (Psychological Services) Clinical Psychologists Corporate Clinical Psychology Services HA Staff Emotional First Aid Critical Incident Support Teams (CISTs) Peer support

Build Resistance immunity Enhance Resiliency rebound Speed Recovery Treatment & rehab Kaminsky,et al, (2005) RESISTENCE, RESILIENCE, RECOVERY, Johns Hopkins.

Intensity of Services

Corporate Clinical Psychology Services (CCPS) Service planning, treatment protocols/ guidelines, supervision, training High Intensity Services Staff Clinic (Psychological Services) Clinical Psychologists HKEC HKWC KCC KEC KWC NTEC NTWC In-depth Psychological Treatment Psychological assessment Individual & group intervention Professional consultation

Corporate Clinical Psychology Services Staff Clinic (Psychological Services) HO Staff Clinic (Psychological Services) Triage Emergency Services Crisis Response Team Professional Consultation Crisis Intervention Services Cluster Staff Clinics High risk staff (Psychological Services) Critical incidents Types of services: Critical Incident Management Planning Group Crisis Intervention HKEC HKWC KCC KEC KWC NTEC NTWC Individual Crisis Intervention Family Crisis Intervention Grief Support Service

Corporate Clinical Psychology Services (CCPS) Service planning, supervision, training Treatment Guidelines/ Protocols Assessment tools Workflow 24

Corporate Clinical Psychology Services (CCPS) Service planning, treatment protocols/ guidelines, supervision, training High Intensity Services Medium Intensity Services Clinical Psychologists Social Workers HKEC HKWC KCC KEC KWC NTEC NTWC HKEC HKWC KCC KEC KWC NTEC NTWC

Corporate Clinical Psychology Services Service planning, Staff Clinic treatment (Psychological protocols/ guidelines, Services) supervision, training Critical Incident Psychological Services Center HKEC CIPS center HKWC CIPS center KEC CIPS center KWC CIPS center KCC CIPS center NTEC CIPS center NTWC CIPS center

Social Workers Triage Counselling services Liaision & coordination Support to Critical Incident Support Teams (CISTs) Psychoeducation (e.g. talks, resource library)

Assessment Station Resource Corner Interview Room NTEC CIPS Center

Reception Area Group treatment/ Multi-function Room NTWC CIPS Center

Corporate Clinical Psychology Services (CCPS) Service planning, treatment protocols/ guidelines, supervision, training High Intensity Services Medium Intensity Services Clinical Psychologists Social Workers HKEC HKWC KCC KEC KWC NTEC NTWC HKEC HKWC KCC KEC KWC NTEC NTWC Low Intensity Services Staff Volunteers (>500) Direct Supervision Support

Critical Incident Support Teams (CISTs) Peer support teams Provide timely support to staff who have experienced critical incidents (e.g. workplace violence, sudden death/ severe injury of coworkers, medical incidents, mass causalities) Staff from different disciplines (e.g. physicians, nurses, allied health professionals, administrative, support services) Hospital based Voluntary participation

Emotional first aid Network in hospitals

Corporate Clinical Psychology Services Staff Clinic (Psychological Services) Service planning, treatment protocols/ guidelines, supervision, training Critical Incident Support Teams HKEC CISTs HKWC CISTs KEC CISTs KWC CISTs KCC CISTs NTEC CISTs NTWC CISTs 6 teams 61 members 6 teams 88 members 3 teams 46 members 7 teams 107 members 1 teams 46 members Over 500 CIST members 5 teams 85 members 1 teams 32 members

Intensity of Services

Category Psychological Preparedness for Crisis Topic Enhancing Workforce Resiliency for Manager Mental Health First Aid Coping strategies in face of crisis Critical incident management Staff support after critical incidents Positive Psychology Mindfulness Building resilience through positive psychology Mindfulness- Combating burnout Mindfulness- Responding to critical incidents Cultivating Emotional Balance Transforming Anger Emotion regulation Positive emotions

Medical incidents Workplace violence New staff induction & orientation Primary care Infectious disease Quality &Safety Occupational Safety and Health Human Resources, Central Nursing Division Staff Clinic Infection Control, Emergency Contingency (IEC), CICO Protocol Working Group/ Committee / Response Team Training Screening Tools Psycho-edu Materials/ Psy Support Kit

High Intensity Services Comprehensive Medium Intensity Services Clinical Psychologists Integrated Timely Social Workers HKEC HKWC KCC KEC KWC NTEC NTWC Proactive Low Intensity Services HKEC HKWC KCC KEC KWC NTEC NTWC Direct Supervision Staff Volunteers (>500) Support

Thank You 43