PHYSICIAN WELLNESS AND ENGAGEMENT POTENTIAL SOLUTIONS FOR AN ORGANIZATIONAL CHALLENGE
DEFINITION OF BURNOUT • A work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment • The result of chronic stress associated with emotionally intense work demands for which resources are inadequate • Different than fatigue, occupational stress, depression or job dissatisfaction
RISK FACTORS: GOVERNMENTAL/NATIONAL • Inefficient work processes/environments (ANY task that does NOT maximize the time physicians spend working at the top of their licenses) • Meaning in work • Specialty • Payment models • Reimbursement structure
RISK FACTORS: ORGANIZATIONAL • Productivity targets/expectations • Work hours/part-time opportunities • Compensation models • Limited interprofessional collaboration • Organizational work flows • Limited advancement opportunities • Leadership behaviors • Time off
RISK FACTORS: INDIVIDUAL • • Recent graduate Values interface • • Work/home conflicts Meaning in both work/home • • Personal health and self-care Ability to delegate/say no • • Female Challenges with staying organized • • Family demands/discord Work expectations (productivity + work list)
IT’S ABOUT BALANCE Deconstructing Burnout to Define a Positive Path Forward Thomas H. Lee, MD; Deirdre E. Mylod, PhD
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MEASURE IT • Maslach Burnout inventory • Oldenburg • Mini-Z
CONCEPTUAL FRAMEWORKS
Individual Work Unit Organizational National Drivers Factors Factors Factors Factors Workload/Job demands Efficiency/resources Meaning in work Culture/Values Control/Flexibility Social support Work Life Integration
The American Journal of Medicine, Vol 132, No 5, May 2019
ASK YOUR CLINICIANS WHAT IS PREVENTING THEM FROM PROVIDING HIGH QUALITY HEALTH CARE
DRIVERS AND SOLUTIONS
DRIVERS AND SOLUTIONS • Physician trainers • Physician builders • EHR optimization • EHR • In-basket restructuring • Developing ways to identify providers who may benefit from early intervention. • Addition of bells and whistles
DRIVERS AND SOLUTIONS • Encourage members of your organization to • Self care/self awareness develop a wellness plan • Allow providers to implement department level processes that will improve their environment • Work inefficiencies/autonomy • Understand EVERYTHING that is involved in being able to get the work done • Excessive workload • Consider the overall impact (“Cobra Effect”)
LEADERSHIP EFFECTIVENESS SCORE • Leaders are graded on a 5 point Likert scale on each of the following questions: • • Provides helpful feedback and coaches me on my Holds career development conversations with me performance • Inspires me to do my best • Recognizes me for a job well done • Empowers me to do my job • Keeps me informed about changes coming • Interested in my opinion • Encourages me to develop my talent and skills • Encourages me to suggest ideas for improvement • Overall, I would recommend my supervisor • Treats me with respect and dignity • Overall I am satisfied with my supervisor
OTHER SOLUTIONS • • Holding both clinical staff and administrative staff Team based care to the same goals • Behavioral health integration into primary care • GROSS offices • • Include clinician well-being as a metric Health coaches/dieticians • Wellness day
OTHER SOLUTIONS • • Creating a culture of gratitude and kindness Education series • • Time banks Cultivating community @ work • • Concierge services No production based compensation
DEVELOP MEASURES • Clinician wellness as a health system metric • Quantify the work that has to be done and how onerous it is
FINAL NOTES • This list/presentation is not exhaustive • Organizational efforts to improve practice environments should accompany any personal well-being interventions • The organizational culture will make some things easier or harder to accomplish • The culture of your organization is very important
REFERENCES AND RESOURCES • Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level; Am J Med May 2019, vol 132, Issue 5, p556-563 • Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout; Mayo Clinic Proceedings, Vol 92, Issue 1, Jan 2017, p129-146 • Physician burnout: contributors, consequences and solutions, Journal of Internal Medicine; March 2018, Vol 283, Issue 6, p516-529 • Building a Program on Well-Being: Key Design Considerations to Meet the Unique Needs of Each Organization; Academic Medicine; Feb 2019, Vol 94, Issue 2, p156-161 • Clinician Well-Being Knowledge Hub: https://nam.edu/clinicianwellbeing/ • Video: Creating a Manageable Cockpit For Clinicians – A Shared Responsibility https://www.medicine.wisc.edu/video- recording/creating-manageable-cockpit-clinicians-shared-responsibility
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