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Burnout: Pitfalls & Prevention Burnout: Burnout: Pit Falls & Prevention for Academic Administrators in Psychiatry Charlene M. Dewey, M.D., M.Ed., FACP.

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Presentation on theme: "Burnout: Pitfalls & Prevention Burnout: Burnout: Pit Falls & Prevention for Academic Administrators in Psychiatry Charlene M. Dewey, M.D., M.Ed., FACP."— Presentation transcript:

1 Burnout: Pitfalls & Prevention Burnout: Burnout: Pit Falls & Prevention for Academic Administrators in Psychiatry Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration Associate Professor of Medicine Co-Director, Center for Professional Health Vanderbilt University School of Medicine Administrators in Academic Psychiatry National Meeting October 28, 2010

2 Burnout: Pitfalls & Prevention Acknowledgements & COI Center for Professional Health Previous Vanderbilt A New You! COI: –Charlene M. Dewey, has no financial conflicts of interest.

3 Burnout: Pitfalls & Prevention Women in Health Care

4 Burnout: Pitfalls & Prevention Women in Health Care Women make up the majority of the health care industry 4 Women physicians more prone to anxiety, stress, depression in the workplace 2,3 Women MD more likely to commit suicide 1 Women ≠ Men: 1.http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtmlhttp://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml 2.Health of Faculty in Academic Medicine, http://www.adaa.org/about-adaa/press-room/facts-statisticshttp://www.adaa.org/about-adaa/press-room/facts-statistics 4.U.S. Department of Labor, Bureau of Labor Statistics, Employment and Earnings, 2008 Annual Averages and the Monthly Labor Review, November 2007.

5 Burnout: Pitfalls & Prevention “If momma ain’t happy…. ain’t nobody happy!”

6 Burnout: Pitfalls & Prevention Reflection 1.Are you stressed at work? 2.Are you thriving or just surviving? 3.Would you like to see improvement in you current mental, physical, emotional or spiritual wellbeing?

7 Burnout: Pitfalls & Prevention Goals The purpose of this session is to: 1.Assist administrators with focusing on their wellness. 2.Review definitions of stress and burnout, risk factors for and symptoms of burnout. 3.Create an individual action plan to help reduce stress, prevent burnout, and improve overall health and wellness.

8 Burnout: Pitfalls & Prevention Objectives 1.Reflect on your current state of wellness, your stressors and if you are at risk of burnout. 2.Identify ways to prevent burnout. 3.List ways to enhance your physical, mental, emotional, and spiritual wellness.

9 Burnout: Pitfalls & Prevention Agenda 1.Introduction 2.Stress and Burnout 3.Professional Health and Wellness Spectrum 4.Individual Action Plans 5.Summary/Evaluation

10 Burnout: Pitfalls & Prevention 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 Burnout: Pitfalls & Prevention Self-Assessments What stresses you out? Measure your stress level on the stress-o-meter. Stress free Relaxed Calm Engaged Enthusiastic Ready to go Stressed out Ready to cave in Anxious Exhausted Overwhelmed At the breaking point

12 Burnout: Pitfalls & Prevention Stress & Burnout Stress and burnout occurs for different reasons in different individuals. Work load ≠ level of stress or burnout in all situations. Multifactorial

13 Burnout: Pitfalls & Prevention 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 stress ~Webster’s Dictionary

14 Stress & Productivity Declining Function Productive Stress No Prolonged Stress BurnoutStressed Situational Stress Non-Functional Prolonged Stress Reduced Cognition “Impairment” ???

15 Burnout: Pitfalls & Prevention Work-Place Stress Reduce work-place stress by: –Managing your energy –Reducing distractions –Planning appropriately –Managing failures and successes

16 Burnout: Pitfalls & Prevention 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 Dictionary

17 Burnout: Pitfalls & Prevention 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 Maslach The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

18 Burnout: Pitfalls & Prevention 1.Work overload 2.Lack of control 3.Insufficient reward 4.Unfairness 5.Breakdown of community 6.Value conflict Maslach & Leiter, “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” Six Sources of Burnout

19 Burnout: Pitfalls & Prevention Risk Factors for Burnout Single Gender/sexual orientation ># of children at home Family problems Mid-late career Previous mental health issues (depression) Fatigue & sleep deprivation General dissatisfaction Alcohol and drugs Minority/international Teaching & research demands Potential litigation Puddester D. West J Med 2001;174:5-7 Myers MJ West J Med 2001;174:30-33 Gautam M West J Med 2001;174:37-41

20 Burnout: Pitfalls & Prevention Symptoms of Burnout 1.Chronic exhaustion 2.Cynical and detached 3.Increasingly ineffective at work 4.Leads to: 1. isolation 2. avoidance 3. interpersonal conflicts 4. high turnover Maslach & Leiter, “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17

21 Aggressive Passive Aggressive Figure 1 Spectrum of Disruptive Behaviors Inappropriate anger, threats Yelling, publicly degrading team members Intimidating staff, patients, colleagues, etc. Pushing, throwing objects Swearing Outburst of anger & physical abuse Hostile notes, s Derogatory comments about institution, hospital, group, etc. Inappropriate joking Sexual Harassment Complaining, Blaming Chronically late Failure to return calls Inappropriate/ inadequate chart notes Avoiding meetings & individuals Non-participation Ill-prepared, not prepared Swiggart, Dewey, Hickson, Finlayson. 4/09

22 “The Perfect Storm” IndividualWork Environment The external system The internal system Two systems interact Good skills Poor skills Functional & nurturing Dysfunctional

23 Burnout: Pitfalls & Prevention Work Environment Powerful model how practice environment can impact physician health –Stress: physician, environment, patients –Environment was the only sig predictor of stress –Job stress predicts job satisfaction –Job sat is positive predictor of positive mental health –Perceived stress was a stronger predictor of both poorer reports of physical and mental health –Therefore, environment influenced health Williams 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 Burnout: Pitfalls & Prevention Stress Management Seven Key Areas Help Manage Stress: –Sleep –Balanced meals –Physical activity –Socialization –Vacations/down times –Spiritual engagement –Have a physician MindBody SoulEmotion

25 Burnout: Pitfalls & Prevention Spickard, Gabbe & Christensen. JAMA, September 2002:288(12): Protective Factors Personal: –Tend to self care issues first –Address Maslach’s 6 sources of burnout –Influence happiness through personal values and choices –Adapt a healthy philosophy/outlook –Spend time with family & friends

26 Burnout: Pitfalls & Prevention Protective Factors –A supportive spouse or partner –Engage in religious or spiritual activity –Hobbies –Mentor (s) Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):

27 Burnout: Pitfalls & Prevention Protective Factors Work: –Address Maslach’s 6 sources of burnout –Gain control over environment & workload –Find meaning in work –Set limits and maintain balance –Have a mentor –Obtain adequate support systems

28 Burnout: Pitfalls & Prevention “Natural abilities which come easily, are enjoyable to do, and result in a sense of inner satisfaction and meaningfulness.” ~Nick Isbister Dewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.

29 Burnout: Pitfalls & Prevention Managing Energy at Work Listen to your body Identify your own needs Define limits - Just Say NO! Create your work environment Eliminate distractions Take breaks Plan ahead Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.

30 Burnout: Pitfalls & Prevention 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?

31 Burnout: Pitfalls & Prevention Managing Energy: Case Discussion Examples: –Check s only twice a day – planned checks –Define blocks of time min each –Walk, stretch and bathroom breaks –Define grant writing periods – block out on calendar –Schedule vacations in advance –Coordinate with spouse/family –Continue self-care and socializing/spirituality

32 Individual ApproachOrganizational Approach Starts with person Becomes group project Connects to organization Outcomes affects related mismatches Outcome is a process Starts with management Becomes organizational project Connects to people Figure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 1997 Preventing & Resolving Burnout

33 Burnout: Pitfalls & Prevention “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 127 The Truth About Burnout

34 Dewey’s Professional Health & Wellness Spectrum High Functioning High Productivity Fair Functioning Decreasing Productivity Fair Functioning Reduced Productivity Relationships Suffer Fair-Not Functioning Fair-Not Productive Institution & Family Loses Burnout Coping Mechanisms Failing Risk of MH issues and suicide No Coping Mechanisms Professionally Healthy & Well Stressed Coping Mechanisms Strong Physical Mental Emotional Spiritual Work & Family Relations

35 Burnout: Pitfalls & Prevention Professional Messages Expressing need = weakness Pretend you’ve got it all together Suck it up! For the greater good. More, faster, bigger, better! Your selfish if you take time for yourself Saying “no” = laziness Dewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.

36 Burnout: Pitfalls & Prevention The greatest strength of any institution is it’s people!

37 Burnout: Pitfalls & Prevention 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 Burnout: Pitfalls & Prevention 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 Burnout: Pitfalls & Prevention The Ethics of Self-Care 1.Should you be ethically obligated to care for ourselves? 2.Do you feel empowered to demand your own self care?

40 Burnout: Pitfalls & Prevention “The first wealth is health.” ~ Ralph Waldo Emerson

41 Burnout: Pitfalls & Prevention 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 several

42 Burnout: Pitfalls & Prevention Vanderbilt Resources Abbrev.ProgramFocusContactNumber FPWCFaculty and Physician Wellness Committee All issues of professional health Charlene Deweyx FPWPFaculty and Physician Wellness Program – Work/Life Connections EAP Treatment & counseling for faculty and employees Mary YarbroughX CPHCenter for Professional Health Training physicians Bill Swiggartx VCAPVanderbilt Comprehensive Assessment Program for Professionals Fit for duty assessments and treatment Reid FinlaysonX CPPACenter for Patient and Professional Advocacy Identification and assistance Jerry HicksonX3-4500

43 Burnout: Pitfalls & Prevention Resources Primary care provider Private counseling services Institutional employee programs Substance services: AA, NA, etc TALK: suicide prevention hotline Other: –YMCA/YWCA, Massage envy, wellness programs –Center for Women in Medicine

44 Burnout: Pitfalls & Prevention Individual Action Plan 1.Reflect 2.Self-assess: stress level/burnout 3.List three self-care areas to improve 4.List three ways to manage your energy 5.Identify a resource you will use if needed. 6.Define your plan : Specific and clearPlan/Timetable Behavior not attitudeWhat are your personal barriers? Something you can countWhen will you start?

45

46 References 1.ACP Ethics Manual 2.AMA Code of Ethics 3.The 2007 Physician Charter 4.Stern, D. “Measuring Medical Professionalism” Oxford Press Cole, T. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success.” Humana Press “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, http://www.aamc.org/members/gwims/statistics/stats09/start.htmhttp://www.aamc.org/members/gwims/statistics/stats09/start.htm 8.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): “High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, Williams 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– Swiggart, Dewey, Hickson, Finlayson. “Identifying, Treating and Remediating the Distressed Physician.” 4/09 14.Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; Puddester D. West J Med 2001;174: Myers MJ West J Med 2001;174: Gautam M West J Med 2001;174: Spickard, Gabbe & Christensen. JAMA, September 2002:288(12): Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.

47 Burnout: Pitfalls & Prevention Take Home Points 1.You are valuable! Self-care is the foundation to your vitality at home and work. 2.Look for and anticipate stress. Take action immediately to manage stress and energy. 3.Recall the 6 sources of burnout and seek ways to prevent burnout in the workplace. 4.Take advantage of resources when needed – esp MH!

48 Burnout: Pitfalls & Prevention 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


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