The Science of Burnout Define compassion fatigue, secondary - PowerPoint PPT Presentation

12/15/2014 Roadmap • Define burnout and discuss its impact • Describe risk factors and protective factors The Science of Burnout • Define compassion fatigue, secondary traumatic stress, and compassion satisfaction What Is It, What Causes It, and What • Discuss strategies for preventing burnout and Makes It Go Away promoting compassion satisfaction Diana Coffa, MD Residency Program Director, Family and Community Medicine UCSF, San Francisco General Hospital Herbert Freudenberger’s original Herbert Freudenberger’s original conception of burnout conception of burnout 1. Compulsion to prove oneself 7. Withdrawal 2. Working harder 8. Obvious behavioral changes 3. Neglecting needs 9. Depersonalization 4. Displacement of conflicts 10.Inner emptiness 5. Revision of values 11.Depression 6. Denial of emerging problems 12.Burnout syndrome—physical and emotional collapse 1

12/15/2014 The concept was refined by Christina Impact of Burnout Maslach, developer of the Maslach Burnout Inventory • 25-75% of practicing physicians have burnout • Emotional exhaustion at any given time. • Over a career, periodic episodes of burnout • Cynicism and depersonalization are virtually inevitable • Loss of sense of efficacy Impact of Burnout Adverse impacts spread Increased rates of Increased • Depression • Errors, both medical and surgical • Anxiety • Patient dissatisfaction • Suicidality • Postoperative recovery times • Increased inflammatory markers • Wound infections • Possible association with cardiovascular • Patient nonadherance disease • Increased sick calls • Attrition from medicine 2

12/15/2014 Risk Factors and Protective Factors Work Related Risk Factors Work Personal • Lack of control Risk • Heavy workload • Exposure to trauma Protection Work Related Protective Factors Risk Factors and Protective Factors • Shared mission Work Personal Risk Lack of control • Flexible schedule Heavy workload • Teamwork Exposure to trauma • Work friends • Supportive culture Protection • Teaching and administrative roles – Opportunity for sense of effectiveness in the short to mid term 3

12/15/2014 Risk Factors and Protective Factors Personal Risk Factors • Temperament and personality features Work Personal – Alexithymia Lack of control Risk Heavy workload Exposure to trauma • Life stress • Personal history of trauma • Approach to work Shared mission Protection Flexible schedule Teamwork Work friends Supportive culture Teaching and administrative roles Approach to work • Surface organized – Must be “just so” • Surface disorganized – Overwhelmed • Deep approach – Interested and engaged by complexity, problem solving McMannus IC et al. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine 2004. 2:29 4

12/15/2014 Personal Protective Factors Risk Factors and Protective Factors Work Personal • Relationships with patients Lack of control Temperament and personality Risk • Relationships with colleagues Heavy workload features Exposure to trauma Alexithymia Life stress • Social support Personal history of trauma Approach to work • Empathetic concern Shared mission Relationships with patients Protection • Openness to new experience Flexible schedule Relationships with colleagues Teamwork Social support • Deep approach to work Work friends Empathetic concern Supportive culture Openness to new experience Teaching and administrative Deep approach to work roles Self-care practices Meditation • Increased attentional control • Meditation • Increased ability to notice and accurately label • Exercise emotions • Decreased impulsive reaction to negative emotion • Outside interests • Shift from “brooding” or perseverative style to • Psychological practices “compassionate noting” style of awareness • Therapy • Increased positive affective states – Happiness, joy, love, gratitude, contentment, hope, • Special training interest, amusement, awe • Micro-breaks • Increased internal resources: • Vacations – greater purpose in life, improved resilience, enhanced optimism, greater mindfulness, more self-acceptance, more hope 5

12/15/2014 Psychological Practices Micro-breaks • Short, dispersed throughout day • Gratitude list • Work-related • Taking in the good – Conversations with colleagues • Perspective taking • Physical • Deep breath – Walk down the hall • Visualization – Stretch • Relaxing – Deep breath – Visualization – Words Vacations Other Models • Reduced work related stress and burnout for Secondary 1-2 months Traumatic Stress • Shorter if high workload upon return Compassion • Consider shorter, more frequent vacations Satisfaction Compassion Fatigue 6

12/15/2014 What is Compassion Satisfaction? The Impact of Compassion Satisfaction The satisfaction derived from being able to help • Studies on the impact of emotional others. attunement and engagement – Higher adherence to medications and recommendations – Increased patient satisfaction – Increased placebo response “Incentivizing with money is a self-fulfilling prophecy of cynicism. We must promote compassion, courage, and wisdom among our physicians before we make a sordid business of this high and sacred calling.” Describe a time when you felt Your assignment compassion satisfaction at work • Notice the moments when you experience compassion satisfaction. • What were the conditions that promoted it? • Feel it when it happens. • Can you build those conditions in to your work more? • Look for ways to build more in. 7