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Transcript of Burnout: Pitfalls & Prevention Burnout: Burnout: Pit Falls & Prevention for Academic Administrators...
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Burnout:Burnout:Pit Falls & Prevention for Academic
Administrators in Psychiatry
Charlene M. Dewey, M.D., M.Ed., FACPAssociate Professor of Medical Education and Administration
Associate Professor of MedicineCo-Director, Center for Professional Health
Vanderbilt University School of Medicine
Administrators in Academic Psychiatry National MeetingOctober 28, 2010
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Acknowledgements & COI
• Center for Professional Health
• Previous workshops @ Vanderbilt
• A New You!
• COI:– Charlene M. Dewey, has no financial
conflicts of interest.
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Women in Health Care
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Women in Health Care
• Women make up the majority of the health care industry4
• Women physicians more prone to anxiety, stress, depression in the workplace2,3
• Women MD more likely to commit suicide1
• Women ≠ Men: http://www.youtube.com/watch?v=P77JnDHUw6g
1. http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml 2. Health of Faculty in Academic Medicine, 20093. http://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.
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“If momma ain’t happy….ain’t nobody happy!”
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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?
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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.
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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.
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Agenda
1. Introduction
2. Stress and Burnout
3. Professional Health and Wellness Spectrum
4. Individual Action Plans
5. Summary/Evaluation
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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)
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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
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Stress & Burnout
• Stress and burnout occurs for different reasons in different individuals.
• Work load ≠ level of stress or burnout in all situations.
• Multifactorial
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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 Dictionary
Stress & Productivity
Declining Function
Produ
ctiv
e Str
ess
No Prolonged Stress
BurnoutStressedSituational Stress
Non-Functional
Prolonged Stress
Reduced Cognition
“Impairment” ???
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Work-Place Stress
Reduce work-place stress by:– Managing your energy– Reducing distractions– Planning appropriately– Managing failures and successes
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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
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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
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1.Work overload
2.Lack of control
3.Insufficient reward
4.Unfairness
5.Breakdown of community
6.Value conflict
Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”
Six Sources of Burnout
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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;174:5-7Myers MJ West J Med 2001;174:30-33Gautam M West J Med 2001;174:37-41
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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, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17
Aggressive Passive 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, emails
Derogatory comments about institution, hospital, group,
etc.
Inappropriate joking
SexualHarassment
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
“The Perfect Storm”
IndividualWork Environment
The external system The internal system
Two systems interact
Good skills
Poor skills
Functional & nurturing
Dysfunctional
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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 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):121-43.
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Stress Management
• Seven Key Areas Help Manage Stress:– Sleep– Balanced meals– Physical activity– Socialization– Vacations/down times– Spiritual engagement– Have a physician
Mind Body
Soul Emotion
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Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50
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
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Protective Factors
– A supportive spouse or partner– Engage in religious or spiritual activity– Hobbies– Mentor (s)
Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50
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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
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“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.
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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.
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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 emails 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?
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• Examples:– Check emails only twice a day – planned checks– Define blocks of time 60-120 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
Individual Approach Organizational ApproachStarts 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
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“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
Dewey’s Professional Health & Wellness Spectrum
High FunctioningHigh Productivity
Fair FunctioningDecreasing Productivity
Fair FunctioningReduced ProductivityRelationships Suffer
Fair-Not FunctioningFair-Not ProductiveInstitution & Family Loses
Burnout
Coping MechanismsFailing
Risk of MH issues and suicide
No Coping Mechanisms
Professionally Healthy& Well
Stressed
Coping Mechanisms Strong
Physical
Mental
Emotional
Spiritual
Work &
Family
Relations
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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” = lazinessDewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.
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The greatest strength of any institution is it’s people!
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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.
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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.
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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?
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“The first wealthis
health.”~ Ralph Waldo Emerson
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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
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Vanderbilt ResourcesAbbrev. Program Focus Contact Number
FPWC Faculty and Physician Wellness
Committee
All issues of professional
health
Charlene Dewey x6-0678
FPWP Faculty and Physician Wellness
Program – Work/Life
Connections EAP
Treatment & counseling for
faculty and employees
Mary Yarbrough X6-1327
CPH Center for Professional Health
Training physicians
Bill Swiggart x6-0678
VCAP Vanderbilt Comprehensive
Assessment Program for
Professionals
Fit for duty assessments and treatment
Reid Finlayson X2-4567
CPPA Center for Patient and Professional
Advocacy
Identification and assistance
Jerry Hickson X3-4500
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Resources
• Primary care provider• Private counseling services• Institutional employee programs• Substance services: AA, NA, etc• 1-800-273-TALK: suicide prevention
hotline• Other:
– YMCA/YWCA, Massage envy, wellness programs– Center for Women in Medicine
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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 clear Plan/Timetable
Behavior not attitude What are your personal barriers?
Something you can count When will you start?
References1. ACP Ethics Manual 2. AMA Code of Ethics3. The 2007 Physician Charter4. Stern, D. “Measuring Medical Professionalism” Oxford Press 2006.5. Cole, T. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success.” Humana
Press 2009.6. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich &
Gritz, 2009.7. http://www.aamc.org/members/gwims/statistics/stats09/start.htm8. Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.
JAMA 254(19):2775-82. 9. 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 2006 81(1):27-34.10. “High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 200811. 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):121-43. 12. Faber et al. “Physician’s Experiences with patients who transgress boundaries.” J Gen Int Med 2000;15:770–
775. 13. Swiggart, Dewey, Hickson, Finlayson. “Identifying, Treating and Remediating the Distressed Physician.” 4/0914. Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of
Success.” Humana Press 2009; pg 7. 15. The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter
pg 9; 199716. Puddester D. West J Med 2001;174:5-717. Myers MJ West J Med 2001;174:30-3318. Gautam M West J Med 2001;174:37-4119. Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-5020. Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.
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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!
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“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