healthcare workplace including those from COVID-19 • Describe systems-based and personal strategies to maintain professional well-being • Discuss ways to diffuse difficult and stressful situations with resilience
front line; not able to “save” a patient; bringing the virus to family Sustained stress workload, “no time” for basic self- care/usual stress reduction/ connection with family, protocol changes, media exposure “Traumatic“ stress exposure to death in large numbers, seeing patients die alone Challenges for Healthcare/Frontline Professionals
Anxiety % Stress/ Stress reactions % Sleep Problem % Distress New York * 48 33 57 45 China** 50 45 34 74 Italy*** 25 19 50 8 *Shechter et al, J Gen Hosp Psych, June 2020 **Lai et al. JAMA Open e-Pub, March 2020 *** Rossi et al JAMA Network Open, May 2020 Generally worse in nurses and frontline workers New York study: 61% increased meaning/purpose
to give, no pleasure lost energy • Depersonalization: cynicism, going through the motions, treating diseases instead of people with diseases lost enthusiasm • Decreased sense of personal accomplishment: never good enough, not worthwhile lost confidence Maslach C, Jackson S. Journal of Occupational Behaviour, 1981 Art: National Academy of Medicine: Expressions of Clinician Well-Being
JAMA, 2011 • Medical students (Nat’l survey N=4,287): 49.8% Dyrbye et al, Ann Int Med, 2008 • Nurses (Nat’l survey N=7,077): 38% Dyrbye et al, JOEM, Aug. 2019 • Similar among Physician Assistants Dyrbye et al. Perspectives, National Academy of Medicine, July 5, 2017 Art: National Academy of Medicine: Expressions of Clinician Well-Being
Reduced empathy and professional climate Brazeau et al. Acad Med, 2010 Unsolicited patient complaints Windover, JAMA Internal Medicine, 2018 Riskier prescribing Williams, Skinner. Health Care Management Review, 2003 Increased post- discharge recovery times • Halbesleben. Health Care Management Review, 2009 Impact Art: National Academy of Medicine: Expressions of Clinician Well-Being
et al. Am J Med, 2001; Shanafelt et al. Journal of Clinical Oncology, 2014 • Turnover disrupts patient care, affects remaining team Helfrich, J Gen Intern Med 2017 • Negative thinking, broken relationships Shanafelt, Mayo Clinic Proc, 2017 Art: National Academy of Medicine: Expressions of Clinician Well-Being
me to do my job Encourages me to suggest ideas for improvement Treats me with respect and dignity Provides helpful feedback and coaching on my performance Recognizes me for a job well done Keeps me informed about changes taking place at our institution Encourages me to develop my talents and skills Overall, how satisfied are you with your immediate supervisor? Shanafelt, T, Swenson, S Licensed by Mayo Clinic Shanafelt et al, Mayo Clin Proc. 2015;90(4):432-440 Each 1 point increase in leadership score strongly associated with: 3.3% decrease in likelihood of burnout (p<.001) 9% increase in satisfaction (p<.001)
yourself Propose solutions* Do not step on toes Set boundaries Cooperation Collaboration (win-win) Positive -Adapted from Speed et al, Clinical Psychology, 2018
manifested in a conversation in which two or more people's concerns appear to be incompatible.“ • Two people's thoughts, ideas or opinions trying to occupy the same space. • Concern? Anything people care about... money, resources, approach, speed, personal image, success, differing strategies or points of view, saving "face", etc.
trust building. • Disagreement on approach or strategies to accomplishing tasks or goals. • Differences in expertise, experience, motivation and capability. • Differences in values and style; assumptions about how things work and communication styles. • Lack of, or improper distribution of information, timing of information, and clarity of information. • Disagreement on risk assessment and importance of action. • The teaming process itself! Some of us don't like to work in a group setting or don't believe a team is the most effective way of getting work done.
behaviors that are difficult to manage, i.e. passive aggressive behaviors, defensiveness, withdrawal, poor commitment, low productivity and lack of accountability • "Stalemates“ or camps of disagreement • Others are "labeled" or seen as not being a team player • Conflict to go underground and "hidden agendas" abound • False agreement, i.e. "go along to get along", the "road to Abilene" • The team does NOT address the conflict but lets it "fester", which impacts productivity
and team change • Facilitates group cohesiveness/energy/ and alignment • Improves individual, group and organizational effectiveness and performance • Brings about a more constructive level of tension at the right times • Is the basis for creative dialogue, not debate • Creates resilience and adaptability in the team • Is recognized, addressed and used well as the source of innovative thinking • Creates better decisions made through consensus and synergistic problem solving
my wellbeing to have these groups.” • “I was grateful to have an impartial person outside of my department to talk to.” • “I learned so much about myself in a short amount of time.” • “I knew I needed to talk to someone but didn’t know how to go about finding someone who would understand.” • “We never got this kind of training in all of medical school or residency.” • “The seminar impacted each one of us in very different ways. I guess we all needed really this.” • “It is great to have a doctor who understands the stresses of medicine who is here to help us decompress.” • Where to go from here… • Rwjms surveys- targeted help • Code intervention- in the works • New employee orientation through faculty affairs- info given upfront
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