Build Your Own Fire Extinguisher Practical Ways to Reduce Faculty Burnout AAIM Week March 20, 2017 Shannon Boerner, MD Jennifer Harsh, PhD Sarah Richards, MD Shannon Boerner, MD sboerner@unmc.edu Jennifer Harsh, PhD jennifer.harsh@unmc.edu Sarah Richards, MD serichards@unmc.edu
Objectives 1. Utilize appropriate and validated tools to assess faculty burnout within your institution or program 2. Create and initiate a faculty wellness program 3. Examine ongoing effects of a faculty wellness program, and support its continued evolution Agenda Introduction Topical relevance GIM efforts at UNMC Review of assessment tools Audience desires 15 min 15 min Conclusions All audience desires addressed? Review Handouts Questions UNMC GIM Faculty Wellness Program 45 min Individual Wellness Strategies Practical Tips
Mackinnon & Murray, Academic Psychiatry (2017) Increase Preload i.e. Autonomy & Support Decrease Afterload i.e. Workload & EMR inefficiency Increase Contractility i.e. Resilience Analogy thanks to Tom Tape, MD
Maslach Burnout Inventory Emotional Exhaustion measures feelings of being emotionally overextended and exhausted by one's work. Depersonalization measures an unfeeling and impersonal response toward recipients of one's service, care treatment, or instruction. Personal Accomplishment measures feelings of competence and successful achievement in one's work http://www.mindgarden.com/117 maslach burnout inventory
Brief Resident Wellness Profile Keim, S.M., Mays, M.Z., Williams, J.M., Serido, J., Harris, R.B. (2006). Measuring wellness among resident physicians. Medical Techer, 28(4), 370 4. Share your Goals What has your institution utilized for wellness programming to date? What are your goals for this workshop what are you hoping to learn? What do you need that you do not yet have? How have you engaged leadership around wellness? What else?
Small Group Breakout UNMC GIM Faculty Wellness Program
How can we prevent burnout? Measure the problem Identify stress points Do something about it! Mark Linzer, MD, Hennepin County Medical Center What did we do to Measure the problem? Mini-Z Identify stress points? Guided group activity Do something about it!? Prioritize stress points and engage leadership to make real change Mark Linzer, MD, Hennepin County Medical Center
Mini-Z Survey Results Item Natl GIM NE 2015 Response Rate 47% 74% Overall satisfied with job 76% 70% Great deal of stress w/ job 67% 58% Symptoms of Burnout 38% 33% Control over workload 49% 40% Time for documentation 62% 58% Values aligned with leadership 65% 73% Teams work efficiently together 74% 83% Excessive time doing EMR at home 57% 40% Proficiency with EMR use 89% 95% Group Activity GIM Division meeting devoted to wellness Less than 1 hour prep time Providers grouped according to their primary clinical practice Interactive and solutions-focused Provided next steps and faculty resources
Small Group Instructions Brainstorm with group regarding your day to day activities and their relationship to your personal wellness What kinds of changes to your job/workplace/schedule/etc would make maintaining wellness HARDER? Examples: Complex new patient at the end of a clinic day No midlevel support on a hospitalist service Highlight (as a group) 2-4 top priorities Do not focus on finding solutions yet - IDENTIFY PROBLEMS first Potential Topics Workload Staff support EMR stress Leadership Clinic visit structure Work-home balance
Problem Solving Choose 1-2 priorities from your list to address What is needed for you to solve this problem? Identify barriers - people, locations, resources ($$, time) Identify key personnel who could take responsibility Feedback Process All written notes and verbal suggestions recorded and organized by theme Ideas presented and discussed with division and section leadership Ideas sorted into categories based on feasibility
Green Light ( low-hanging fruit ) Examples Streamlining EMR education for the ambulatory setting EPIC trainers will come to your clinic and work with you 1:1 Availability in the doctors lounge over the lunch hour Direct questions to our deputy Andy Ok to mail packages/usps mail Yes! details will be distributed via email Yellow Light ( a work in progress ) Examples Clarification of hospitalist roles/responsibilities Designated key leaders to provide clarity in the form of a document Fitbit competition John has agreed to lead this, stay tuned for details as he gets the group up and running
Red Light ( Not now, but here s why ) Examples Hire billers to appropriately bill for us, save time Limited resources (detailed response provided) Centralized credentialing, save time Systems differ and unfortunately this can t be done for these reasons. Personal workspace near patient care location, more private, set aside for provider Space is very limited (detailed response provided) Sustainability All written notes and verbal suggestions recorded and organized by theme Ideas presented and discussed with division and section leadership Updates at each division meeting (standing agenda item)
Mini-Z Survey Results Item Natl GIM NE 2015 NE 2016 Response Rate 47% 74% 62% Overall satisfied with job 76% 70% 80% Great deal of stress w/ job 67% 58% 42% Symptoms of Burnout 38% 33% 18% Control over workload 49% 40% 82% Time for documentation 62% 58% 64% Values aligned with leadership 65% 73% 78% Teams work efficiently together 74% 83% 87% Excessive time doing EMR at home 57% 40% 29% Proficiency with EMR use 89% 95% 87% Conclusions? Measure the Problem Identify Stress Points Do Something
SMART goals Specific Measurable Achievable Realistic Time bound I will speak to institutional leadership about assessing faculty in [specific area]. I will set this meeting within the next month. If approved, I will obtain [assessment tool] and identify a leader to distribute and administer this tool.
Shannon Boerner, MD sboerner@unmc.edu Jennifer Harsh, PhD jennifer.harsh@unmc.edu Sarah Richards, MD serichards@unmc.edu References Mackinnon & Murray. Reframing Physician Burnout as an Organizational Problem: A Novel Pragmatic Approach to Physician Burnout. Academic Psychiatry, published online Feb 2017. DOI 10.1007/s40596-017-0689-1.
Biopsychosocial-Relational Wellness Interventions Biomedical Exercise o Activity scheduling- act according to schedule rather than mood Eating Well o Make a plan for eating well- easier to follow than I ll grab something healthy when I can. o Engage an exercise (and healthy eating) buddy to help with accountability Sleep o Sleep Hygiene Tips No screen time one hour before bed Create a bedtime ritual Hide the alarm clock https://www.sleepassociation.org/wp- content/uploads/2014/08/top-sleep-hygiene-tips- Handout.pdf Psychological Meaning-finding o What is meaningful in your work life? Personal life? o Are you dedicating time and mental effort to these things? Gratitude o Consistent practice Journal Built in time for reflection E.g., Following clinic before arriving home
Diaphragmatic breathing o Deep belly breaths- blow stomach up like a balloon o http://my.clevelandclinic.org/health/articles/diaphragmaticbreathing Progressive Muscle Relaxation o Slowly tense and then relax each muscle group o http://www.mayoclinic.org/healthy-lifestyle/stress- management/in-depth/relaxation-technique/art- 20045368?pg=2 Learn about colleague s difficult experiences o Helps to normalize stress, emotional exhaustion, and burnout. Social/Relational Prioritize time with friends and family o Stick to scheduled events even if you don t feel like attending in the moment Relational health promotion o Communicate o Plan time to spend with partner and family members o Mindful during interactions o Validate experiences and feelings o Seek help for relationship distress Find at least one person with whom you can be vulnerable to discuss difficulties and successes o Partner? Friend? Family member? Colleague? Practice above self-care activities with family members or friends
AAIM Week March 2017 Workshop Build Your Own Fire Extinguisher Practical Ways to Reduce Faculty Burnout Shannon Boerner, MD sboerner@unmc.edu Jennifer Harsh, PhD jennifer.harsh@unmc.edu Sarah Richards, MD serichards@unmc.edu Micah Beachy, DO mbeachy@unmc.edu (unable to attend) Notes from Small Groups: SMART Goals Specific Measurable Achievable Realistic Timebound