Clinician Wellness: Building Resiliency in the Primary Care Home … · 2014. 2. 13. · 13....
Transcript of Clinician Wellness: Building Resiliency in the Primary Care Home … · 2014. 2. 13. · 13....
Clinician Wellness: Building Resiliency in the Primary Care
Home Team
Presented by: Patricia Robinson, PhD & Debra A. Gould, MD, MPH
February 18, 2014
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Patient-Centered Primary Care Institute History and Development
• Launched in 2012
• Public-private partnership
• Broad array of technical assistance for practices at all stages of transformation – Learning Collaboratives
– Website (www.pcpci.org)
– Webinars & Online Learning
• Ongoing mechanism to support practice transformation and quality improvement in Oregon
• Access to Care
– “Health care team, be there when we need you”
• Accountability
– “Take responsibility for making sure we receive the best possible health care”
• Comprehensive Whole Person Care
– “Provide or help us get the health care, information and services we need”
• Continuity
– “Be our partner over time in caring for us”
• Coordination and Integration
– “Help us navigate the health care system to get the care we need in a safe and timely way”
• Person and Family Centered Care
– “Recognize that we are the most important part of the care team – and that we are ultimately responsible for our overall health and wellness”
Read more: http://primarycarehome.oregon.gov
PCPCH Model of Care
Our Presenters
Patricia Robinson, PhD
Debra A. Gould, MD, MPH
Objectives
• Describe self-assessment tools and use them to determine:
1. Level of burnout
2. Sources and magnitude of stress
3. Level of psychological flexibility
• Describe 6 core psychological processes that support clinician resiliency and specific exercises designed to enhance resilience among the care team members
Primary Care Home
“Adaptive Reserve”
• Value their role
• Self-aware
• Balance and prioritize
• Manage a practice
• Support relationships
Resilience
Burnout
Wellness
Individual Organizational
ACT
Burnout
• Emotional Exhaustion
• Depersonalization
• Personal Accomplishment
Exercises
Maslach Burnout Inventory (MBI) Tool: Primary Care Provider – Stress Checklist (PCP-SC)
Burnout
• Over-eat, drink, work
• Substance abuse
• Isolation
• Depression, Suicide
• Leave Profession
• Relationship Problems
What do you think the burnout rate is for: Medical students? Residents - Family Practice & OB/GYN? Attendings?
Burnout Factors & Consequences
Work Conditions
Adverse workflow
Low control
Unfavorable culture
MD stress/burnout
MD/DO Reactions
Low satisfaction
High stress/burnout
Intent to leave
Quality of care errors
Linzer et.al, Working Conditions in Primary Care: Physician Reactions and Care Quality. Ann Inter Med 2009;151:28-36.
Tool: PCP Stress Checklist
• Interactions with Patients
• Practice Management
• Administrative Issues
• Education / Learning
• Relationships with Colleagues
• Balance between Work and the “Rest of Life”
Scoring: Higher scores indicates more stress (range 0-100)
Primary Care Provider Stress Checklist (PCP-SC)
NAME: __________________________________Date: _________________________
Below you will find a list of specific situations that may cause stress for people who work in
medical settings. Please rate the extent to which each of the situations is stressful for you at this
moment in time. Use the scale below to choose your response. For example, if you believe a
situation is highly stressful for you “Highly Stressful,” you would record a 5 in the Response
column and if it is “Not Stressful” for you, you would record a 0. To get a picture of what
stresses you the most, following the directions for scoring at the bottom of the form.
0 1 2 3 4 5 6
Not
Stressful
Very Mild
Stress
Mild
Stress
Moderate
Stress
Greater
than
Moderate
Highly
Stressful
Extremely
Stressful
I. INTERACTIONS WITH PATIENTS
Response Stressful Situation
1. Patients who don’t manage their chronic diseases
2. Patients who abuse or are addicted to alcohol or drugs
3. Patients who complain of chronic pain and are seeking narcotics
4. Patients who are angry and demanding.
5. Patients complaining of depression, anxiety and other common psychological
problems.
6. Patients who have unhealthy lifestyles (overeat, under-exercise, over-work)
7. Patients who perpetrate violence or abuse on children, domestic partners,
elderly relatives
Total (Sum of 1-7)
II. PRACTICE MANAGEMENT
Response Stressful Situation
8. My schedule is too tight to address more than one or two problems
9. Patients wait too long because of office work flow problems.
10. Chart and other important records information is not available
11. Lack of immediate access to information about clinical guidelines
12. Not enough time to address multiple medical and mental health problems in
complex patients
13. Dealing with interruptions and other annoyances during clinic/work day.
Total (Sum of 8-13)
Acceptance & Commitment Training (ACT)
“Utilizes various mindfulness and
acceptance processes in the service of enhancing people’s ability to pursue
personally valued life goals and actions.”
ACT Evidence – Healthcare Providers
• PCPs – Mindfulness Communication Training (US, before and after design ) – Improvements in burnout (EE, DP, PA), empathy,
emotional stability
• Substance Abuse Counselors – ACT (US, RCT) – Decrease in Stigmatizing Attitudes and Burnout in
Providers
• Psychotherapists – Mindfulness (US, RCT) – Positively influenced patients’ outcomes (decreased
symptoms)
Psychological
flexibility
Be Present
Connect with
Values
Acceptance
Defuse
Changing Self
Act on Values
Mindfulness
Resiliency – Core Processes
Psychological
flexibility
Be Present
Connect with
Values
Acceptance
Defuse
Changing Self
Act on Values
Values
Resiliency – Core Processes
Tool: Primary Care Provider Acceptance and Action Questionnaire (PCP-AAQ)
• 20 Items; sum equals total score (range 0-120)
– Higher indicates greater psychological flexibility
The Message: Values
• “Direction in life”
• Not a goal
• What’s important to you in how you live your life?
Tool: Values Clarification
If you were at your own retirement party, what would you like to hear other people say about what you stood for:
1. Practicing Medicine
2. Relationships with Colleagues
3. Relationships with Family/Friends
4. Personal Health & Well-being
My work life is totally consistent with my values
My work life is totally inconsistent
with my values
Studying/ Practicing Medicine
Relationships with
colleagues
Personal Health &
Well Being
Relationships with Family &
Friends
Tool: Bulls Eye Values
Assessment
Tool: Burnout Prevention Plan
Action Steps: 1. Practice of Acceptance - 2. Practice of Mindfulness - 3. Practice of Value Consistent Daily
Actions
Value Statement:
ACT Resources
• Handouts & Presentation - www.pcpci.org
• Association for Contextual Behavioral Science www.contextualpsychology.org/
• New Harbinger Publications www.newharbinger.com
Welcome!
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Thank you!
• Resources available online
– http://www.pcpci.org/resources/browse
– Search ‘Behavioral Health Integration’
• Please complete post-webinar survey