Ian Nisonson, M.D., FACS Conference Director President of Baptist-South Miami Medical Staff (1997-1999) Senior Active Medical Staff, Baptist Hospital of Miami Adjunct Assistant Professor, Herbert Wertheim College of Medicine, Florida International University Miami, Florida Disclosure Neither I, nor my spouse, have relevant financial relationships with commercial interest companies. My presentation will not include discussion of off-label or unapproved product usage. 2 Objectives Recognize the magnitude of healthcare provider burnout. Explain the adverse impact of burnout on quality of care, patient safety, patient outcomes, patient satisfaction, and workplace satisfaction. Identify common contributors to stress in the changing healthcare environment. 3 1
The National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience July 14, 2017, Washington, D.C. first public meeting Burnout is nearly 2 times as prevalent among physicians as U.S. workers in other fields, after controlling for work hours and other factors. 1 Source: Action Collaborative on Clinician Well-Being and Resilience. (2017). National Academy of Medicine. https://nam.edu/initiatives/clinician-resilience-and-well-being/. 1) Shanefel, et al., 2013 4 NAM Action Collaborative on Clinician Well-Being and Resilience 400/year Physician suicide Rate > 2 Xs than that of the general population. 1 Females: 130% higher than that of other females in the population. Males: 40% higher than that of other males in the population. 2 39% Physician rate of depression. 3 23-31% Emotional exhaustion prevalence among primary care nurses. 4 35% Emotional exhaustion prevalence among hospital nurses. 5 24% ICU nurses post-traumatic stress disorder symptoms. 6 Source: Action Collaborative on Clinician Well-Being and Resilience. (2017). National Academy of Medicine. https://nam.edu/initiatives/clinician-resilience-and-wellbeing/ 1) Andrew and Brenner, 2015; 2) Canter, et al, 2003 3) Shanafelt, 2015; 4) Gomez-Urquiza, et. al., 2016; 5) McHugh, 2011; 6) Mealer, et. Al., 2007. 5 Physicians Facing Adverse Events or Medical Malpractice Reactions include: Sadness Shame Self-Doubt Fear Anger Isolation 6 2
The main characteristics of Burnout are: Emotional exhaustion. Depersonalization and cynicism. Reduced sense of accomplishment A negative perception of self-worth. 7 Other areas that are affected: PROFESSIONAL Poor judgement in patient care Poor decision making Hostility towards patients Medical errors Diminished commitment and dedication to productive, safe, and optimal events Difficult relationship with coworkers Disengagement 8 Other areas that are affected: PERSONAL Depression Anxiety Sleep disturbances and fatigue Broken relationships Alcohol and drug addiction Marital dysfunction and divorce Early retirement SUICIDE 9 3
This can lead to: Lower quality of care Lower patient satisfaction Lower patient compliance Increased medical errors Poorer outcomes 10 Scale 7 1 Causes of Physician Burnout 5.3 Too many bureaucratic tasks 4.7 Spending too many hours at work 4.6 Feeling just like a cog in a wheel 4.5 Increasing computerization of practice (EHRs) 4.1 Income not high enough 4.0 Too many difficult patients 4.0 Maintenance of certification requirements 4.0 Insurance issues 3.9 Too many patient appointments in a day 3.9 Threat of malpractice 3.9 Lack of professional fulfilment 7 = significantly contributes 1 = does not contribute at all Peckham, C. (January 11, 2017) Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout. Page 4. http://www.medscape.com/ features/slideshow/lifestyle/2017/overview#page=1 11 Resiliency - Defined The capacity to bounce back. Able to withstand hardship. Positive adaption in the face of stress or disruptive change. 12 4
What can be done? 1. Recognize this problem. 2. Reach out to the individual clinicians suffering. 3. Note that physicians will ONLY speak to other physicians. 4. Address these situations within Teams, e.g., ER team, ICU team. 5. Raise awareness - let them know that they are not alone. 6. Make certain there is NO shame and blame. 7. Teach coping mechanisms and techniques for self-care. 13 KEY MESSAGES 1. U.S. healthcare professionals report below-average levels of wellbeing relative to professionals in other industries. 2. Ensuring clinician well-being is a patient safety imperative. 3. If we act proactively, we have a golden opportunity to promote clinician well-being and improve patient care. 4. Clinician well-being is a challenge for every member of the care team. 5. Solutions are needed at the institutional level to support clinician well-being. 6. When clinicians are at their best, everyone wins. 14 Acknowledgements / References National Academy of Medicine, July 14, 2017 Webinar, Establishing Clinician Well-Being as a National Priority: Meeting 1. Marc Moss, M.D., Roger S. Mitchell Professor of Medicine in the Division of Pulmonary Sciences and Critical Care Medicine, and Vice Chair of Clinical Research, Department of Medicine, University of Colorado School of Medicine; President, American Thoracic Society 2017-2018 Cynda H. Rushton, Ph.D., R.N., FAAN, Anne and George L. Bunting Professor of Clinical Ethics, Berman Institute of Bioethics/School of Nursing; Professor of Nursing and Pediatrics, Johns Hopkins University Jo Shapiro, M.D., FACS, Director, Center for Professionalism and Peer Support, Brigham and Women s Hospital; Associate Professor of Otolaryngology, Harvard Medical School Entire Webinar: https://nam.edu/event/making-clinician-well-being-a-national-priority-barriers-research-promising-approaches/ 15 5
References National Academy of Medicine Establishing Clinical Well-being as a National Priority. (July 14, 2017) https://nam.edu/initiatives/clinician-resilience-and-well-being/ Konopasek, L., Bernstein, C. (July 13, 2016) Combating Burnout, Promoting Physician Well-Being: Building Blocks for a Healthy Learning Environment in GME. ACGME Summer Spotlight Webinar. Presbyterian NYU Langone Medical Center, New York. Medical University of South Carolina Health, Summer 2017 Progress Notes. (August 2, 2017) Loosening the Grip of Physician Burnout. MacDonald, I. (Nov 18, 2016) Mayo Clinic: 9 ways to engage physicians, prevent burnout. Fierce Healthcare. http://www.fiercehealthcare.com/healthcare/mayo-clinic-9-strategies-to-boost-physicianengagement-prevent-burnout. Peckman, C. (January 11, 2017) Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout. Pages 4 and 5. https://www.medscape.com/features/slideshow/lifestyle/2017/overview 16 17 6