10/13/2019 Disc lo sure sta te me nt I ha ve no fina nc ia l A Stor y of inte re st/ a rra ng e me nt o r a ffilia tio n with a ny Joy & Me a ning o rg a niza tio n(s) tha t c o uld b e pe rc e ive d a s a re a l o r a ppa re nt c o nflic t in Me dic ine o f inte re st in the c o nte nt o f this e duc a tio na l JOHN CHUCK , M.D. a c tivity RE GIONAL CHAIRPE RSON, PHYSICIAN HE AL T H & WE L L NE SS L E ADE RS GROUP T HE PE RMANE NT E ME DICAL GROUP OAK L AND, CA T ha nk yo u fo r b e ing he a le rs 1
10/13/2019 T he re le ntle ss pursuit o f pe rfe c tio n in Ame ric a n Cha pte r 1: A Ne w Dire c tio n me dic ine ha s ha d uninte nde d c o nse q ue nc e s Me tr ic s & T he MSCI T riple Aim Qua lity Outc ome s Burnout & Depression Burnout & Depression Multiple Simulta ne o us Co nflic ting I mpe ra tive s (MSCI ) Amo ng U.S. Physic ia ns 2011-2017 Ma yo Clin Pro c . 2019;94(9):1681-1694 Of 30,456 physic ia ns who re c e ive d a n invita tio n to pa rtic ipa te , 5197 (17.1%) c o mple te d surve ys. Whe n a sse sse d using the Ma sla c h Burno ut Inve nto ry, 43.9% (2147 o f 4893) o f the physic ia ns who c o mple te d the MBI re po rte d a t le a st o ne sympto m o f b urno ut in 2017 c o mpa re d with 54.4% (3680 o f 6767) in 2014 ( P <.001) a nd 45.5% (3310 o f 7227) in 2011 ( P =.04). T he pro po rtio n o f physic ia ns sc re e ning po sitive fo r d e pre ssio n sho we d a mo d e st b ut ste a d y inc re a se b e twe e n 2011 a nd 2017 (2011, 38.2% [2753 o f 7213]; 2014, 39.8% [2715 o f 6818]; 2017, 41.7% [2022 o f 4854]; P <.001). Burno ut a nd sa tisfa c tio n with wo rk-life inte g ra tio n a mo ng US physic ia ns impro ve d b e twe e n 2014 a nd 2017, with b urno ut c urre ntly ne a r 2011 le ve ls. Physic ia ns re ma in a t inc re a se d risk fo r b urno ut re la tive to wo rke rs in o the r fie ld s. 2
10/13/2019 Burno ut re duc e s q ua lity a nd sa fe ty B P e r for mance U R ZE RO nosoc omial Pe rfe c t staffing infe c tions and no ratios antibiotic r e sistanc e N Summary: We found small to medium-sized relationships between burnout and both decreased quality of care and decreased safety. Of the burnout components, emotional exhaustion had the strongest relationship with quality, followed by depersonalization and reduced personal accomplishment. In terms O of quality, burnout had a medium-sized relationship with lower perceived (provider-reported) quality and a weaker, but still significant, relationship with reduced patient satisfaction. provider burnout may contribute in part to real-world outcomes for patients, putting them at higher risk of an error or adverse event. In addition to the obvious implications for patient health and well-being, a greater number of U errors also leads to greater liability for healthcare organizations. Moderator analyses for safety suggest that the impact of burnout might be greater for nurses than for physicians or mixed provider samples. This finding is consistent with research showing that nursing care is more predictive of patient ratings of Se amle ss E MR ac ross R e ady supply of World c lass quality than physician care. As noted by Leiter and colleagues in one of the first studies linking nurse de partme nts and T burnout with patient satisfaction, nurses have more direct patient contact and perform more of the daily me dic ations and supplie s quality re porting care activities than other healthcare professionals such as physicians, which may have a more central he alth syste ms impact on patients. 3
10/13/2019 • Jo y is a c ho ic e Joy • “Jo y is ha ppine ss fo r no g o o d re a so n” • Jo y is inse pa ra b le fro m suffe ring • T he g re a te st jo y is to b ring jo y to o the rs = c o mpa ssio n = a c tive e mpa thy T he pro g re ss in JAMM is ite ra tive a nd Me a ning re q uire s a te a m e ffo rt to re a c h its full po te ntia l T he de e p sa tisfa c tio n o f kno wing tha t yo ur e xiste nc e ma tte rs a nd tha t wha t yo u do ma ke s a po sitive diffe re nc e in the live s o f o the rs. 4
10/13/2019 Cha pte r 2: A Cha t with T he L ittle Ma n “We a r e our c hoic e s.” - J.P. Sa rtre Cho ic e is de stiny Vic to r F ra nkl – Man’ s S e arc h fo r Me aning K e lly Mc Go nig a l, Ph.D., He a lth Psyc ho lo g ist “Be twe e n stimulus a nd re spo nse , the re is a spa c e . In tha t spa c e is o ur po we r to c ho o se o ur re spo nse . In o ur re spo nse lie s o ur g ro wth a nd o ur fre e do m.” 1998-2006: Na tio na l He a lth Surve y o f 186 millio n a dults linke d to na tio na l mo rta lity da ta . Hig he r le ve ls o f re po rte d stre ss a nd the b e lie f tha t stre ss a dve rse ly a ffe c ts he a lth we re inde pe nde ntly a sso c ia te d with wo rse he a lth a nd me nta l he a lth o utc o me s. T ho se who re po rte d hig h stre ss a nd b e lie ve d stre ss impa c te d the ir he a lth ha d a 43% inc re a se d risk o f pre ma ture de a th o ve r a 9 ye a r fo llo w up pe rio d. T ho se who re po rte d hig h stre ss b ut did no t b e lie ve tha t stre ss a dve rse ly a ffe c ts he a lth sho we d no inc re a se d mo rta lity. - Ke lle r, L itze lman, Wisk, e t al. He alth Psyc ho l. 2012 S e p 31(5): 677-684 5
10/13/2019 I re c omme nd the following c hoic e s Choose to slow down on the me nu of life • Slo w do wn a nd spe nd mo re time in the swe e t spo t • Be g ra te ful • E mb ra c e lo fty va lue s a nd g o a ls • K e e p yo ur b o dy mo ving • Ada pt to c ha ng e a nd suffe ring a nd e me rg e a b e tte r pe rso n • Dia l b a c k b usyne ss • Inve st in re la tio nships • F o rg ive yo urse lf a nd o the rs fo r b e ing le ss tha n • Dia l up stra te g ic sla c king pe rfe c t T he swe e t spo t T he drive to suc c e e d is like Brylc re e m Ac c omplishme nt E a se 6
10/13/2019 Choose g ra titude I invite yo u to ma ke the tra nsitio n fro m . . . Woe is me WOW is me !!! Pa rtne r up a nd sha re o ne thing yo u Co mpa re yo urse lf to a re g ra te ful fo r to da y. the ma sse s le ss fo rtuna te , no t the fe w who ha ve T HE MASSE S mo re . 7
10/13/2019 Choose lofty va lue s a nd g oa ls “My o nly ho pe fo r yo u is tha t a t so me po int in yo ur life yo u will wo rk with o the r pe o ple fo r a c a use g re a te r tha n yo urse lf.” - Mr. Williams, Davis S e nio r Hig h S c ho o l Graduatio n spe e c h, 2013 Choose move me nt A big thought from Jack “ At the c o re o f the jo urne y must b e a fund a me nta l se nse o f who I a m, wha t I a m inspire d b y, a nd wha t I a m willing to c o mmit to in ma king a diffe re nc e fo r wha t I truly c a re a b o ut. ” - Ja c k Ro za nc e , M.D., Physic ia n in Chie f E me ritus, Sa c ra me nto 8
10/13/2019 Choose to a da pt to c ha ng e a nd suffe ring T he ma g ic o f mo ve me nt and e me rg e a be tte r pe rso n • K intsug i c e le b ra te s the fa c t tha t b re a ka g e a nd a lly T he wo rld’ s Move Na tur re pa ir a re e sse ntia l e le me nts o f who we a re . lo ng e st-live d pe o ple do n’ t pump iro n, run ma ra tho ns o r • “T he mo st b e a utiful pe o ple we ha ve kno wn a re jo in g yms. Inste a d, the y live tho se who ha ve kno wn de fe a t, kno wn suffe ring , in e nviro nme nts tha t c o nsta ntly nud g e the m into kno wn strug g le , kno wn lo ss, a nd ha ve fo und mo ving witho ut thinking the ir wa y o ut o f the de pths. T he se pe rso ns ha ve a b o ut it. T he y g ro w g a rde ns a n a ppre c ia tio n, a se nsitivity, a nd a n a nd d o n’ t ha ve me c ha nic a l unde rsta nding o f life tha t fills the m with c o nve nie nc e s fo r ho use a nd c o mpa ssio n, g e ntle ne ss, a nd a de e p lo ving ya rd wo rk. c o nc e rn. Be a utiful pe o ple do no t just ha ppe n.” - E lisabe th Kuble r-Ro ss E ve ryo ne a g re e s: it’ s a b o ut re la tio nships Choose to inve st in re la tionships Gra nt a nd Glue c k Study Gra nt a nd Glue c k Study o f Adult De ve lo pme nt o f Adult De ve lo pme nt "T "T he c le a re st he c le a re st me ssa g e tha t we g e t me ssa g e tha t we g e t fro m o ur 75-ye a r fro m o ur 75-ye a r stud y is this: stud y is this: Go o d re la tio nships Go o d re la tio nships ke e p us ha ppie r a nd ke e p us ha ppie r a nd he a lthie r. Pe rio d .“ he a lthie r. Pe rio d .“ -Ro be rt Walding e r -Ro be rt Walding e r 9
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