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I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta.

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Presentation on theme: "I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta."— Presentation transcript:

1 I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program Keeping the Igloo Warm (A Canadian Perspective)

2 Handouts Evaluations How we will spend our time Door prizes Housekeeping

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4 3.3 million (2006)

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6 Alberta Physicians PFSP Involvement 2010 total physicians in province 10, 738 new contacts (overall) (6.7%) 719 physicians 410 residents 200 medical students 109 total physicians in province 10, 738 new contacts (overall) (6.7%) 719 physicians 410 residents 200 medical students 109 College of Physicians and Surgeons of Alberta 2010

7 The Current Situation in Alberta

8 Physician Engagement Survey 218 physicians (169 urban, 49 rural) 218 physicians (169 urban, 49 rural) Gallup 11question poll Gallup 11question poll U-shaped demographic U-shaped demographic Covenant Health 2010

9 Physician Engagement Survey concerns about patient care not good communication with Senior Staff engagement does NOT equal trust rural hospitals do NOT equal urban hospitals (within same administrative system) Covenant Health 2010

10 Province of Alberta Staff and Physician Engagement: 26% (Overall Engagement Score) (2009/10) Alberta’s Health System Performance Measures November 30, 2010 Alberta’s Health System Performance Measures November 30, 2010

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12 Developments Recent Developments 2011 Health Quality Council of Alberta 2011 Health Quality Council of Alberta Review regarding emergency services accessibility, cancer treatment waiting times, and intimidation within the system Review regarding emergency services accessibility, cancer treatment waiting times, and intimidation within the system Economic restraint and resource constraints Economic restraint and resource constraints

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14 The Alberta Approach Historically

15 Organizations Involved College of Physician and Surgeons of Alberta (licensing body) College of Physician and Surgeons of Alberta (licensing body) Universities (teaching institutions) Universities (teaching institutions) Hospitals Hospitals Alberta Health Services (gov. admin.) Alberta Health Services (gov. admin.) Alberta Medical Association (professional association) Alberta Medical Association (professional association)

16 Timeline pre PFSP expertise in developing case coordination on case-by-case basis pre PFSP expertise in developing case coordination on case-by-case basis now AMA PFSP case coordination process now AMA PFSP case coordination process CPSA/AMA/other stakeholders CPSA/AMA/other stakeholders guideline for all guideline for all impact of disbanding of regions impact of disbanding of regions 2010 PFSP starts Healthy Workplace Initiative 2010 PFSP starts Healthy Workplace Initiative

17 Landmark Documents Quality Worklife Quality Healthcare Collaborative - Within Our Grasp. A Healthy Workplace Action Strategy for Success and Sustainability in Canada’s Healthcare System(2007) Quality Worklife Quality Healthcare Collaborative - Within Our Grasp. A Healthy Workplace Action Strategy for Success and Sustainability in Canada’s Healthcare System(2007) PFSP team- Intervention Manual for Physicians with Disruptive Behavior (June, 2009) PFSP team- Intervention Manual for Physicians with Disruptive Behavior (June, 2009) CPSA - Managing Disruptive Behavior in the Healthcare Workplace (October, 2010) CPSA - Managing Disruptive Behavior in the Healthcare Workplace (October, 2010)

18 Prior Emphasis ‘disruptive’ vs. distressed behavior ‘disruptive’ vs. distressed behavior individual focused individual focused ‘sharp end of the stick’ analysis ‘sharp end of the stick’ analysis punitive or remedial in nature punitive or remedial in nature

19 Circumspect Exploration 1. importance of physician health issues 1. importance of physician health issues 2. importance of the systemic nature 2. importance of the systemic nature 3. importance that all parties agree 3. importance that all parties agree 4. importance of mentoring 4. importance of mentoring

20 ‘Working’ Documents letters of understanding letters of understanding behavioral agreements (including patients/office) behavioral agreements (including patients/office)

21 Code of Conduct Components List of unacceptable behaviors List of unacceptable behaviors Identified channels of reporting Identified channels of reporting Identified process of response Identified process of response Response guidelines Response guidelines Authority from, and mentioned in, medical staff bylaws Authority from, and mentioned in, medical staff bylaws Promulgated, acknowledged, and honored Promulgated, acknowledged, and honored

22 PFSP Role (clinical) Case Coordination Case Coordination Triage Triage Referral Referral Mediation Mediation

23 The AMA PFSP Experience

24 ‘Primary’ Occupation Issues 153/774 physician contacts 153/774 physician contacts 82/153 primary problem 82/153 primary problem 15/82 referred to Case Coordination (CC) 15/82 referred to Case Coordination (CC) (22/85 active CC participants had this as primary problem) (22/85 active CC participants had this as primary problem) AMA PFSP 2010

25 Who They Were 52/426 physicians 25/225 residents 5/123 medical students 82/774 total group 52/426 physicians 25/225 residents 5/123 medical students 82/774 total group

26 Issues Identified (1) Canadian Physician Health Network Common Indicators Canadian Physician Health Network Common Indicators perpetrator/disruptive behavior (4.4) 3 supervisor dealing with behavior (4.5) 3 workplace relationships (4.7) 13 patient boundary violations (other) (4.9) 2 occup. stress/burnout (4.10) 15 perpetrator/disruptive behavior (4.4) 3 supervisor dealing with behavior (4.5) 3 workplace relationships (4.7) 13 patient boundary violations (other) (4.9) 2 occup. stress/burnout (4.10) 15

27 Issues Identified (2) Canadian Physician Health Network Common Indicators Canadian Physician Health Network Common Indicators occupation/job change (4.11) 9 retirement (4.12) 2 other occupational issues (4.13) 28 regulatory complaint (4.15) 5 occupation/job change (4.11) 9 retirement (4.12) 2 other occupational issues (4.13) 28 regulatory complaint (4.15) 5

28 Issues Identified (3) Canadian Physician Health Network Common Indicators Canadian Physician Health Network Common Indicators professional boundary issues (4.16) 1 other regulatory issues (4.17) 2 civil suit related to practice(4.19) 1 professional boundary issues (4.16) 1 other regulatory issues (4.17) 2 civil suit related to practice(4.19) 1

29 Associated Problems all contacts AMA PFSP service

30 All contacts PFSP

31 Services Provided (not all needed to be ‘under microscope’)

32 Case Coordination other occupational issues (4.13) 9 perpetrator of disruptive behavior (4.4) 8 workplace relationships (4.7) 4 subject of emotional abuse (4.1) 3 occupational stress/burnout (4.10) 3 other occupational issues (4.13) 9 perpetrator of disruptive behavior (4.4) 8 workplace relationships (4.7) 4 subject of emotional abuse (4.1) 3 occupational stress/burnout (4.10) 3 (most common reasons for referral) Canadian Physician Health Network Common Indicators Canadian Physician Health Network Common Indicators

33 The New PFSP Approach

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35 Global Approach office hospital PCN office hospital PCN

36 Health Workplace Initiative Recognizing ‘disruption’ is intrinsically neither good or bad (and necessary for change) Recognizing the ‘components’ of a distressed workplace (and that structure can drive behavior) Recognizing the ‘skills’ needed to build a stronger team (including acknowledging the primary importance of the emotional issues*) Recognizing ‘disruption’ is intrinsically neither good or bad (and necessary for change) Recognizing the ‘components’ of a distressed workplace (and that structure can drive behavior) Recognizing the ‘skills’ needed to build a stronger team (including acknowledging the primary importance of the emotional issues*) * and not just problem-solving

37 Recognizing ‘components’ the components of a healthy workplace (physical*, cultural, ‘internal’ environment) the components of a ‘distressed’ individual the components of a physician’s mental and physical health the components of all the ‘support structures’ in the system the components of a healthy workplace (physical*, cultural, ‘internal’ environment) the components of a ‘distressed’ individual the components of a physician’s mental and physical health the components of all the ‘support structures’ in the system * incl. patient-initiated aggression

38 ‘Skills’ Needed leadership(recogniz ing different leader types and roles) engagement trust (use of appreciative inquiry) leadership(recogniz ing different leader types and roles) engagement trust (use of appreciative inquiry) “ Everyone plays their part”

39 ‘Skills’ Needed Civility Communication Collegiality Collaboration Conflict Resolution Civility Communication Collegiality Collaboration Conflict Resolution the 5 “C”s “ Healthier workplaces, Healthier doctors, Healthier patients.” “ Healthier workplaces, Healthier doctors, Healthier patients.”

40 Two Approaches Information and education to make physicians aware of the components of: a healthy workplace how to recognize challenges early Refining an approach for when ‘dysfunction’ occurs that: returns a physician to health restores, and ensures, ongoing workplace health through an ‘engaged’ team approach Information and education to make physicians aware of the components of: a healthy workplace how to recognize challenges early Refining an approach for when ‘dysfunction’ occurs that: returns a physician to health restores, and ensures, ongoing workplace health through an ‘engaged’ team approach

41 Information and Education Creating promotional materials/promulgate new bylaws Including this topic in a comprehensive patient- centered undergraduate curriculum Holding workshops to important stakeholders Gathering a repository of materials to benefit a wide variety of group needs Publishing articles educating the AMA readership on aspects of the program Networking and colloborating to benefit from collective experience Creating promotional materials/promulgate new bylaws Including this topic in a comprehensive patient- centered undergraduate curriculum Holding workshops to important stakeholders Gathering a repository of materials to benefit a wide variety of group needs Publishing articles educating the AMA readership on aspects of the program Networking and colloborating to benefit from collective experience

42 Typical Organizational Flowchart ‘Nightmare’ Typical Organizational Flowchart ‘Nightmare’

43 ‘Refined’ PFSP Process

44 Measurement and Evaluation Outcome measures include: participant feedback client satisfaction/tracking surveys workshop requests/evaluations electronic tracking of information access Review of: expenditure against budget timeline and outcomes on prevention logic model Outcome measures include: participant feedback client satisfaction/tracking surveys workshop requests/evaluations electronic tracking of information access Review of: expenditure against budget timeline and outcomes on prevention logic model

45 Problems Encountered ‘well-defined’ environments (ie. OR) vs. loosely-structured workplaces (ambulatory clinic) dealing with subtle long-term irritants ( vs. personal contributions) differing levels skills/training among the ‘players’ ‘well-defined’ environments (ie. OR) vs. loosely-structured workplaces (ambulatory clinic) dealing with subtle long-term irritants ( vs. personal contributions) differing levels skills/training among the ‘players’

46 The AMA PFSP Healthy Workplace Survey n = survey venues (incl. resident input, hospitals and clinic settings) n = 13 questions n = survey venues (incl. resident input, hospitals and clinic settings) n = 13 questions

47 The AMA PFSP Healthy Workplace Survey level of satisfaction: 18% (5/5), 53% (4/5), 25% (3/5), 4% (2/5), 0% (5/5) most enjoyed (patient care), least enjoyed (paper work) 3 most important factors: civil, professional, respectful relationships (28%), collegiality and collaboration (23%), availability, flexibility of coverage (15%) level of satisfaction: 18% (5/5), 53% (4/5), 25% (3/5), 4% (2/5), 0% (5/5) most enjoyed (patient care), least enjoyed (paper work) 3 most important factors: civil, professional, respectful relationships (28%), collegiality and collaboration (23%), availability, flexibility of coverage (15%)

48 The AMA PFSP Healthy Workplace Survey violence experienced in the workplace (n = 45%) policies in place (PIA, violence) n = 57%, 54% note: physicians who don’t know n = 21%, 24% impacted personal health: yes = 70%, no = 30% impacted personal/family life: yes = 65%, no = 35% violence experienced in the workplace (n = 45%) policies in place (PIA, violence) n = 57%, 54% note: physicians who don’t know n = 21%, 24% impacted personal health: yes = 70%, no = 30% impacted personal/family life: yes = 65%, no = 35%

49 The AMA PFSP Healthy Workplace Survey visit own physician yes = 62%, no = 38% Fatigue Management Plan (organization) yes = 03% no = 97% Fatigue Management Plan (self) yes = 44%, no = 56% visit own physician yes = 62%, no = 38% Fatigue Management Plan (organization) yes = 03% no = 97% Fatigue Management Plan (self) yes = 44%, no = 56%

50 Building a Warmer Igloo

51 Most needed identifying organizational ‘champions’ education from the ground (undergrad) up and across career spectrum hitting the pavement (CME) to physicians, administrators and staff (promotion and education) linking to other health promotion initiatives (fatigue management/nutrition in the wkplace/career transitions/adverse events/addictions) innovation by all identifying organizational ‘champions’ education from the ground (undergrad) up and across career spectrum hitting the pavement (CME) to physicians, administrators and staff (promotion and education) linking to other health promotion initiatives (fatigue management/nutrition in the wkplace/career transitions/adverse events/addictions) innovation by all

52 Finding Champions

53 Elizabeth Paice FRCP FAcadMed 30,000 physicians 30,000 physicians 400,000,000 pounds 400,000,000 pounds 45 hr. wk legislation 45 hr. wk legislation hospital-based change hospital-based change patient mortality down patient mortality down

54 Thank you


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