Presentation on theme: "Charlene M. Dewey, M.D., M.Ed., FACP"— Presentation transcript:
1 Burnout: Pit Falls & Prevention for Academic Administrators in Psychiatry Charlene M. Dewey, M.D., M.Ed., FACPAssociate Professor of Medical Education and AdministrationAssociate Professor of MedicineCo-Director, Center for Professional HealthVanderbilt University School of MedicineAdministrators in Academic Psychiatry National MeetingOctober 28, 2010
2 Acknowledgements & COI Center for Professional HealthPrevious VanderbiltA New You!COI:Charlene M. Dewey, has no financial conflicts of interest.
4 Women in Health CareWomen make up the majority of the health care industry4Women physicians more prone to anxiety, stress, depression in the workplace2,3Women MD more likely to commit suicide1Women ≠ Men:1 out of 4 U.S. adults (26%), 18 years of ageand older, suffer from a mental disorder.1 in 5 families are affected by mental illness.Only 7% of all health-care expenditures aredesignated for mental health disorders.10% of children and adolescents suffer from mental illnessthat is severe enough to cause some level of impairment.Depression ranks as the #1 cause of disabilityworldwide.The 3rd leading cause of death for thosebetween the ages of 15 and 24 is suicide.Health of Faculty in Academic Medicine, 2009U.S. Department of Labor, Bureau of Labor Statistics, Employment and Earnings, 2008 Annual Averages and the Monthly Labor Review, November 2007.4
6 Reflection Are you stressed at work? Are you thriving or just surviving?Would you like to see improvement in you current mental, physical, emotional or spiritual wellbeing?
7 Goals The purpose of this session is to: Assist administrators with focusing on their wellness.Review definitions of stress and burnout, risk factors for and symptoms of burnout.Create an individual action plan to help reduce stress, prevent burnout, and improve overall health and wellness.
8 ObjectivesReflect on your current state of wellness, your stressors and if you are at risk of burnout.Identify ways to prevent burnout.List ways to enhance your physical, mental, emotional, and spiritual wellness.
9 Agenda Introduction Stress and Burnout Professional Health and Wellness SpectrumIndividual Action PlansSummary/Evaluation
10 Self-Awareness“Self-awareness means having a deep understanding of one’s emotions, strengths, weaknesses, needs, and drives. People with strong self-awareness are neither overly critical nor unrealistically hopeful. Rather, they are honest – with themselves and with others.”“What Makes a Leader?” by Daniel Goleman, Best of Harvard Business Review (1998)
11 Self-Assessments What stresses you out? Measure your stress level on the stress-o-meter.Stress freeRelaxedCalmEngagedEnthusiasticReady to goStressed outReady to cave inAnxiousExhaustedOverwhelmedAt the breaking point11
12 Stress & BurnoutStress and burnout occurs for different reasons in different individuals.Work load ≠ level of stress or burnout in all situations.Multifactorial12
13 Definition - Stress Stress can be defined as: d : a state resulting from a stress; especially: one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium <job-related stress>~Webster’s Dictionary13
15 Work-Place Stress Reduce work-place stress by: Managing your energy Reducing distractionsPlanning appropriatelyManaging failures and successes15
16 Definition - Burnout Burnout can be defined as: a : exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration b : a person suffering from burnout.~Webster’s Dictionary16
17 Burnout“In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.”~Christina MaslachThe Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 199717
18 Six Sources of Burnout Work overload Lack of control Insufficient rewardUnfairnessBreakdown of communityValue conflictMaslach & Leiter, “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”18
19 Risk Factors for Burnout SingleGender/sexual orientation># of children at homeFamily problemsMid-late careerPrevious mental health issues (depression)Fatigue & sleep deprivationGeneral dissatisfactionAlcohol and drugsMinority/internationalTeaching & research demandsPotential litigationPuddester D. West J Med 2001;174:5-7Myers MJ West J Med 2001;174:30-33Gautam M West J Med 2001;174:37-4119
20 Symptoms of Burnout Chronic exhaustion Cynical and detached Increasingly ineffective at workLeads to:isolationavoidanceinterpersonal conflictshigh turnoverMaslach & Leiter, “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 1720
21 Spectrum of Disruptive Behaviors AggressivePassiveFigure 1Spectrum of Disruptive BehaviorsInappropriate anger,threatsYelling, publicly degradingteam membersIntimidating staff,patients, colleagues, etc.Pushing, throwing objectsSwearingOutburst of anger &physical abuseHostile notes, sDerogatory comments about institution, hospital, group, etc.Inappropriate jokingSexualHarassmentComplaining,BlamingChronically lateFailure to return callsInappropriate/inadequate chart notesAvoiding meetings & individualsNon-participationIll-prepared, not preparedSwiggart, Dewey, Hickson, Finlayson. 4/0921
22 Two systems interact The external system The internal system Functional & nurturingGood skillsWork EnvironmentIndividual“The Perfect Storm”DysfunctionalPoor skills
23 Work EnvironmentPowerful model how practice environment can impact physician healthStress: physician, environment, patientsEnvironment was the only sig predictor of stressJob stress predicts job satisfactionJob sat is positive predictor of positive mental healthPerceived stress was a stronger predictor of both poorer reports of physical and mental healthTherefore, environment influenced healthWilliams et al. Physician, practice and patient characteristics related to primary care physician physical and mental health: Results of the physician’s work-life study. Health Services Research, 2002; 37(1):
24 Stress Management Seven Key Areas Help Manage Stress: Sleep Balanced mealsPhysical activitySocializationVacations/down timesSpiritual engagementHave a physicianMindBodySoulEmotion24
25 Protective Factors Personal: Tend to self care issues first Address Maslach’s 6 sources of burnoutInfluence happiness through personal values and choicesAdapt a healthy philosophy/outlookSpend time with family & friendsSpickard, Gabbe & Christensen. JAMA, September 2002:288(12):25
26 Protective Factors A supportive spouse or partner Engage in religious or spiritual activityHobbiesMentor (s)Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):26
27 Protective Factors Work: Address Maslach’s 6 sources of burnout Gain control over environment & workloadFind meaning in workSet limits and maintain balanceHave a mentorObtain adequate support systems27
28 “Natural abilities which come easily, are enjoyable to do, and result in a sense of inner satisfaction and meaningfulness.” ~Nick IsbisterDewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.
29 Managing Energy at Work Listen to your bodyIdentify your own needsDefine limits - Just Say NO!Create your work environmentEliminate distractionsTake breaksPlan aheadSchwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.29
30 Managing Energy: Case Discussion Ms D is a 46 yo female with 2 kids and a spouse with significant travel/work schedule. She is a mid-level administrator for a psychiatric department chair and is involved in several community activities. Ms D finds s and other interruptions distracting and is feeling stressed due to changes in the department, a grant, and several other submissions and activities in the office that are due in the next 6 weeks. She has cut down on sleep and exercise to meet the deadlines.What are her risk factors for burnout?Will this lead to burnout?What changes could we suggest to control energy at work?30
31 Managing Energy: Case Discussion Examples:Check s only twice a day – planned checksDefine blocks of time min eachWalk, stretch and bathroom breaksDefine grant writing periods – block out on calendarSchedule vacations in advanceCoordinate with spouse/familyContinue self-care and socializing/spirituality31
32 Preventing & Resolving Burnout Individual ApproachOrganizational ApproachStarts with personBecomes group projectConnects to organizationOutcomes affects related mismatchesOutcome is a processStarts with managementBecomes organizational projectConnects to peopleFigure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 19973232
33 The Truth About Burnout “The twin goals of preventing and building engagement are possible and necessary in today’s working world. These goals cannot be easily achieved by an individual. Rather, people have to work together to make them happen. And if we all commit ourselves to the long-term process of organizational progress, we will be rewarded with workplaces that are more productive and resilient as well as humane.”~Maslach & Leiter, pg 12733
34 Dewey’s Professional Health & Wellness Spectrum High FunctioningHigh ProductivityFair FunctioningDecreasing ProductivityReduced ProductivityRelationships SufferFair-Not FunctioningFair-Not ProductiveInstitution & Family LosesBurnoutCoping MechanismsFailingRisk of MH issues and suicideNo Coping MechanismsProfessionally Healthy& WellStressedCoping Mechanisms StrongPhysicalMentalEmotionalSpiritualWork &FamilyRelations34
35 Professional Messages Expressing need = weaknessPretend you’ve got it all togetherSuck it up!For the greater good.More, faster, bigger, better!Your selfish if you take time for yourselfSaying “no” = lazinessDewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.
36 The greatest strength of any institution is it’s people!
37 The Ethics of Self-Care “The medical academy's primary ethical imperative may be to care for others, but this imperative is meaningless if it is divorced from the imperative to care for oneself. How can we hope to care for others, after all, if we ourselves, are crippled by ill health, burnout or resentment?”Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.
38 The Ethics of Self-Care “…medical academics must turn to an ethics that not only encourages, but even demands care of self.”Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.
39 The Ethics of Self-Care Should you be ethically obligated to care for ourselves?Do you feel empowered to demand your own self care?
40 “The first wealth is health.” ~ Ralph Waldo Emerson 40
41 Professional Health & Wellness Share a story about a time when you felt you had achieved a good level of work-life balance. What worked for you?List several41
42 Vanderbilt Resources Abbrev. Program Focus Contact Number FPWC Faculty and Physician Wellness CommitteeAll issues of professional healthCharlene Deweyx6-0678FPWPFaculty and Physician Wellness Program – Work/Life Connections EAPTreatment & counseling for faculty and employeesMary YarbroughX6-1327CPHCenter for Professional HealthTraining physiciansBill SwiggartVCAPVanderbilt Comprehensive Assessment Program for ProfessionalsFit for duty assessments and treatmentReid FinlaysonX2-4567CPPACenter for Patient and Professional AdvocacyIdentification and assistanceJerry HicksonX3-4500
43 Resources Primary care provider Private counseling services Institutional employee programsSubstance services: AA, NA, etcTALK: suicide prevention hotlineOther:YMCA/YWCA, Massage envy, wellness programsCenter for Women in Medicine43
44 Individual Action Plan ReflectSelf-assess: stress level/burnoutList three self-care areas to improveList three ways to manage your energyIdentify a resource you will use if needed.Define your plan:Specific and clearPlan/TimetableBehavior not attitudeWhat are your personal barriers?Something you can countWhen will you start?44
46 References ACP Ethics Manual AMA Code of Ethics The 2007 Physician CharterStern, D. “Measuring Medical Professionalism” Oxford Press 2006.Cole, T. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success.” Humana Press 2009.“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, 2009.Lin et al Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA 254(19):Schindler et al. The Impact onof the changing Health Care Environment on the Health and Well-being of faculty at Four Medical Schools. Academ Med (1):27-34.“High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 2008Williams et al. Physician, practice and patient characteristics related to primary care physician physical and mental health: Results of the physician’s work-life study. Health Services Research, 2002; 37(1):Faber et al. “Physician’s Experiences with patients who transgress boundaries.” J Gen Int Med 2000;15:770–775.Swiggart, Dewey, Hickson, Finlayson. “Identifying, Treating and Remediating the Distressed Physician.” 4/09Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997Puddester D. West J Med 2001;174:5-7Myers MJ West J Med 2001;174:30-33Gautam M West J Med 2001;174:37-41Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.
47 Take Home PointsYou are valuable! Self-care is the foundation to your vitality at home and work.Look for and anticipate stress. Take action immediately to manage stress and energy.Recall the 6 sources of burnout and seek ways to prevent burnout in the workplace.Take advantage of resources when needed – esp MH!47
48 True thriving is… “Embracing the truth of who you are so that you can freely receive, give, and hope, regardless of your circumstances.” ~Debbie Smith, M.A. Center for Women in Medicine