Caring for Those who Care for Others Balancing Work and Life

Transcription

1 Caring for Those who Care for Others Balancing Work and Life ACGME 2015 Shakaib U. Rehman MD, FACP, FAACH Professor of Medicine, University of Arizona College of Medicine- Phoenix Associate Chief of Staff for Education, V.A. Medical Center, Phoenix, AZ Jennifer L. Allie, PhD, MPA Assistant Dean, Office of Faculty Affairs & Development Assistant Professor, Bioethics & Humanism University of Arizona- College of Medicine-Phoenix

2 Disclosure of Financial Relationships All faculty have no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

3 Objectives Identify the barriers to balancing work and family. Explore strategies on how to prioritize to achieve balance. Discuss techniques, tools and skills to achieve balance and joy. Discover personal goals and learn skills to achieve those goals.

4 My Work

5 My Work

6 Employee of the Month

7 My Work

8 My Kids

9 My Family My wife

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11 Don t we feel like this every day?

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15 PREVALENCE Health Care Workers (HCW) burnout rates of more than 60%-80%. Chopra SS. Physician Burnout. JAMA, 2004;291:633

16 The Epidemic of Clinician Burnout

17 Burnout Emotional exhaustion Depersonalization Diminished feelings of personal accomplishment Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001; 52:

18 PREVALENCE 46% to 80% reporting moderate to high levels of emotional exhaustion 22% to 93% reporting moderate to high levels of depersonalization, 16% to 79% reporting low to moderate levels of personal achievement. Keller KL, Koenig WJ. Management of stress and prevention of burnout in emergency physicians. Ann Emerg Med. 1989;18: Lloyd S, et al. Burnout, depression, life job satisfaction among Canadian emergency physicians. J Emerg Med. 1994;12: Grunfeld E, et al. Cancer care workers in Ontario. CMAJ. 2000;163: Thommasen HV, et al, job satisfaction, and intention to relocate: opinions of physicians in rural. British Columbia. Can Fam Physician. 2001;47:

19 Consequences of HCW Burnout Loss of job satisfaction (Mirvis) Changing jobs or reducing work hours (Grunfeld). Associated with major depressive disorder (Shanafelt). 51% positive result on a depression screen 31% self-reported major depression Mirvis DM. J Health Hum Serv Adm. 1999;21: Grunfeld E, CMAJ. 2000;163: Shanafelt TD, ET AL. Ann Intern Med. 2002;136:

20 Consequences Suboptimal patient care practice Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:

21 Dissatisfied physicians have patients that are.. Less satisfied (Haas 2000) Less adherent with meds (DiMatteo 1993) More likely to leave MD (Keating 2002) Most likely to get questionable Rx

22 Effects of Burnout on Teams Low morale Impaired job performance decreased empathy increased absenteeism) Staff conflicts Maslach 2001, Vachon 1995.

23 Why is Balance important? For you? General health and well-being Career sustainability and satisfaction For your patients? Relationship with patients Quality of care and safety For your employer? Retention and Recruitment Cost-effective care For our profession? Changing health care environment The heart and soul of medicine

24 Staff who is sick

25 Coping Behaviours Sense of entitlement Belief on immunity to difficulties Failure of self recognition of mental problems Working harder and longer

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27 My Usual attitude: I ll scare you into change

28 Will scaring work???

29 So what should we do?

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31 Appreciative Inquiry Take a moment to think when you were at your best What was the situation? Who were the people? How did you feel? What made it so positive? What can you apply to other situations?

32 Exercise - Causes What is causing the burn out?

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34 What is Balance?

35 Essential Skills for Balance Awareness Reflection Conversation Plan & Act Linda Hawes Clever, MD, MACP

36 Burnout a long term stress reaction Predictors of stress well known (time pressure, lack of control, work home interference, lack of support, chaos, lack of values alignment) Burnout is predictable, and thus preventable Predictors Stress Burnout Interventions Linzer M, et al. JGIM 2014.

37 Demand-control/Support model of stress Demands balanced by control and support Stress increases if demands rise or control diminishes Support can facilitate impact of control Bottom line support and control prevent stress Demands Control Support Karasek et al. Am J Public Health 1981;71:

38 What are the types of control?

39 Control and Support

40 Self Talk Activating Event Consequences David Stoop, PhD

41 Self Talk A C David Stoop, PhD

42 Self Talk A B C David Stoop, PhD

43 Activating Event Failure to return my phone call Belief System They don t want to talk to me They don t like me anymore They are too busy to care about me Obviously, there are a lot of other things in their life more important than me Consequences I feel hurt and rejected

44 Mindsight

45 Mindsight

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47 Power of Questions! Anthony Robbins. Lessons in Personal Mastery

48 Ask Right Questions! Brain is built to answer questions Only we can decide what question to ask Right questions will get you right answers Wrong questions will lead to wrong answers Anthony Robbins. Lessons in Personal Mastery

49 I have come to realize that people are about as happy as they make up their minds to be (Abraham Lincoln)

50 What Makes People Happy? Wealth? Education? Youth? Marriage? Sunshine?

51 What Makes People Happy? Wealth? Education? Youth? Marriage? Sunshine? 8% of one s well being

52 What Makes People Happy? POSITIVE PSYCHOLOGY Wealth? Education? Youth? Marriage? Sunshine? 8% of one s well being Social Support Meaningful life Martin Seligman

53 Exercise Name Miss Universe for the last 2 years. Name Olympic triathlon champions for the last 2 years. Name the top 5 richest people on the planet Earth.

54 Beautiful and Rich Paulina Vega (2014) Gabriela Isler (2013) Bill Gates (net worth $76 billion), Carlos Slim Helu (net worth $72 billion), Amancio Ortega (net worth $64 billion), Warren Buffett (net worth $58.2 billion), Larry Ellison (net worth $48 billion).

55 What you value the most? Can you name 3 family, friends, teacher, mentor, coach who helped you on the way to be successful? What are the reasons you remember them?

56 Olympic Triathlon Champion

57 Miss Universe

58 What you value the most?

59 One of the best ways to enhance your own life is to enhance somebody else s. Dr. Oprah Winfrey Duke Univ, May 12, 2009

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62 It is better to light a candle than to curse the darkness (Eleanor Roosevelt)

63 Home Work Exercise: What is "success"? Write your obituary, place it in your night chest drawer and look at it on your every birthday (or electronic storage with annual reminder. Since your obituary will be written by other folks (family, friends, co-workers etc.) Think hard that what you want them to say about you and act accordingly now so they will say what you want them to say. (Visualization)

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65 Whole Person Body Spirit YOU Mind Heart Stephen Covey. The 8 th Habit. New York, Free Press, 2004

66 Whole Person Body NEED/TALENT Discipline Spirit Conscience YOU Mind Vision Heart Passion Stephen Covey. The 8 th Habit. New York, Free Press, 2004

67 Whole Person Body TO LIVE Survival Spirit TO LEAVE A LEGACY Meaning and Contribution YOU Mind TO LEARN Growth and Development Heart TO LOVE Relationship

68 Plan-Do-Study-Act Cycle Rejuvenates a Marriage. Ann Intern Med. 2008;149: PDSA Act What actions will we take? Abandon, adjust, adopt Next Cycle Study Reality vs. predictions New knowledge Plan Objective Predictions Do Who, what, when, where? Unexpected events

69 Exercise - STRATEGIES What are the ways YOU are resolving/addressing stresses/challenges and competing demands?

70 EQ

71 Emotional Intelligence Self-Awareness Self-Regulation Motivation Empathy Daniel Goleman. Working with emotional intelligence. New York, Bantam Books, 1998

72 Emotional Intelligence Self-Awareness: the ability to recognize and understand your moods, emotions and drives and their effects on others Self-Regulation: the ability to control disruptive impulses and moods, to suspend judgment, to think before acting Motivation: a passion to work for reasons that go beyond money or status; to pursue goals with energy and persistence Empathy: the ability to understand the emotional make-up of other people; skill in treating people according to their emotional reactions

73 Two Types of Intelligence Intellectual Learning Lectures Problem Analysis Critical Thinking Reading Writing Emotional Learning Appreciative Inquiry Reflection Journaling Feedback Coaching Relationships Reading Writing

74 Essential Skills for Balance Awareness Reflection Conversation Plan & Act Linda Hawes Clever, MD, MACP

75 Can we? Can we follow our dreams? Can we live a healthy live? Can we live a happy live?

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77 How ready are you to make changes in your life to achieve balance on a routine basis?

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79 Can we? Can we follow our dreams? Can we live a healthy live? Can we live a happy live?

80 Committment to Goal What one or two change(s) you will make to improve your well being and the well being of others (family, colleagues, trainees, students) Choose a partner and text/ him/her your goal. She/he will do the same. She/he should text/ you in 4 weeks to check on the status of your efforts.

81 Emotional Intelligence Self-Awareness Self-Regulation Motivation Empathy Daniel Goleman. Working with emotional intelligence. New York, Bantam Books, 1998

82 What is Empathy

83 Wife Me Me Wife

84 Empathy Goes a Long Way 48 percent of the men never used (empathy) continuer Versus 20 percent of the women never used (empathy) continuer Kathryn Pollak, et al. Journal of Clinical Oncology, Dec 2007

85 What is anti- Empathy?

86 Skill Interruptions Male physicians Average time before interruption: 4 seconds Female physicians Average time before interruption: 37 seconds

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89 The happiest people don't have the best of everything.

90 They just make the best of everything.

91 My Family

92 Light at the End of Tunnel

93 Thank You!

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95 Strategies to Prevent Burnout Influence happiness through personal values and choices Spending time with family and friends Religious and spiritual activities Personal Self-care (nutrition, exercise) Adopting to healthy philosophical outlook A supportive spouse or partner Spickard A. Et al. JAMA 2002;288:

96 Strategies to Prevent Burnout Work Control over environment: workload Finding meaning in work and setting limits Having a mentor Having adequate administrative support systems Spickard A. Et al. JAMA 2002;288:

97 Bibliography Bickel J, Brown AJ. Generation X: implications for faculty recruitment and development in academic health centers. Acad Med. 2005;80(3): Brown, Judy, (Cone in the box)a Leader s Guide to Reflective Practice, Trafford Publishing, Epstein RM. Mindful practice. JAMA 1999;282: Goleman D. Emotional Intelligence. New York: Bantam Books, Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the Physician Worklife Study. J Gen Intern Med 2000;15: Skilled listening, inquiry, advocacy; and the Ladder of Inference reference is: New York, Currency/Doubleday, Linzer M, Gerrity M, Douglas JA et al. Physician job stress: results from the physician worklife survey. Stress and Health 2002;18: McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K, for the SGIM Career Satisfaction Study Group. The work lives of women physicians; results from the Physician Worklife Study. J Gen Intern Med 2000;15(6): Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med. 2000;342(6): Novack DH, Suchman MD, et al. Calibrating the physician: personal awareness and effective patient care. JAMA 1997;278:

98 Bibliography Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Int Med 1990;150: Redman S, Saltman D, Straton J, et al. Determinants of career choices among women and men medical students and interns. Med Educ. 1994;28: Senge, Peter, Roberts,Charlotteools, Ross, Richard, et. al, The Firth Discipline Fieldbook: Strategies and Tools for Building a Learning Organization, Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136: Sobecks, NW, Justice AC, Hinze S, et al. When doctors marry doctors: a survey exploring the professional and family lives of young physicians. Ann Intern Med. 1999;130(4): Spickard A, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA 2002;288: Suchman AL, Ramamurthy G. Physician Well-being. In Feldman MD, Christensen JF (Eds.). Behavioral Medicine in Primary Care: a Practical Guide. Appleton & Lange, Tresolini, CP and the Pew-Fetzer Task Force. Health Professions Education and Relationship-centered Care. San Francisco, CA: Pew Health Professions Commission, Warde C, Allen W, Gelberg L. Physician role conflict and resulting career changes. Gender and generational differences. J Gen Intern Med. 1996;11(12): Weiner EL, Swain GR, et al. A qualitative study of physicians own wellness-promotion practices. West J Med 2001;1745: Williams J. Unbending Gender: Why Family and Work Conflict and What to Do About It. New York, NY: Oxford University Press; 2001.

99 Organizations and Websites Northwest Center for Physician Well-Being The Foundation for Medical Excellence 4000 Kruse Way Place, Bldg. 2, Suite 100 Lake Oswego, OR (503) MD CareerNet Boston, MA (617) Website: Center for Professional Well-Being Durham, NC (919) Website: cpwb.home.mindspring.com Menninger Clinic s Professionals in Crisis program Topeka, KS (800) Website: Center for Professional and Personal Renewal Palo Alto, CA (800) Website: pmoskowitz@batnet.com Physician Wellness Foundation Los Osos, CA (805) Website: WellDocs@aol.com Center for Physician Renewal Bellevue, WA (253) MDRENEW@aol.com The Center for Professional Health Vanderbilt University Medical Center 1107 Oxford House Nashville, TN (615) Website: cph@mcmail.vanderbilt.edu Personal-Professional Balance Interest Group Society of General Internal Medicine Website: Institute for Health and Healing California Pacific Medical Center San Francisco, Cal Phone: Website:

100 Tips to Help Stress and Burnout Increase sense of control Hope Relationship skills Attitude change challenge, control, commitment Time management Self-protective choices Be a team builder Be honest about stress Seek feedback Balance leave work at work

101 Exercise For Body You have just had a massive heart-attack What are your reactions, thoughts, feelings? What do you care about now? What would you change in your life if you could go back before the heart attack?