reframing wellness: it’s not a personal issue …...reframing wellness: it’s not a personal...

Reframing Wellness: It’s Not a Personal Issue AnymoreRita A. Manfredi, MD, FACEP | @Rita_Manfredi3 The George Washington University, Washington, D.C.

Arlene S. Chung, MD, MACM | @arlenesujinMaimonides Medical Center, Brooklyn, NY

“We know how to be well individually, but how do we do this in our department or organization?”

No disclosures

Objectives• Identify existing gaps in knowledge related to systems-based

interventions and programs that impact health care provider wellbeing

• Outline guidelines for departments and institutions that promote the wellness of health care providers from a system level

• Discuss exemplary strategies that departments and organizations have currently implemented and suggest innovative strategies for the future

3 Questions Each Day• Am I treated with dignity and respect every day?

• Do I have what I need so that I can make a contribution that gives meaning to my life?

• Am I recognized and thanked for what I do?

Why do we care about ?

Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction with Work Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.

900,000doctors

Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction with Work Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.

900,000doctors

500,000with burnout

Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction with Work Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.

900,000doctors

500,000with burnout #1

Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction with Work Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.

Linzer M, Harwood E. Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians? J Gen Intern Med. 33(6):963-965.

400doctors die by suicide

400doctors die by suicide

x240 days

400doctors die by suicide

x240 days

x 20 patients/day =

400doctors die by suicide

x240 days

x 20 patients/day =

1,920,000patients without care

“To our knowledge, this is the first study that links clinician burnout with increased standardized mortality ratios and subjective patient safety indicators ….

We have shown that patient safety and clinician burnout are dependent on one another…

Mortality adjusted for severity of disease is higher on units with high emotional exhaustion. Our results led us to the conclusion that clinician psychological health and patient safety could and should be managed harmoniously.”

Think system-wide, act locally

• Emotional• Occupational• Physical• Spiritual• Financial• Intellectual • Social

ACEP Wellness Wheel

20

Barriers

Communication

Work Overload

Culture $$$

Workload and Job DemandsEfficiency and Resources

Organizational Culture and ValuesSocial Support and Community at Work

Work-Life IntegrationControl and Flexibility

Meaning in Work

EngagementBurnout

Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-146.

Shanafelt TD, Gorringe G, Menaker R, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432-40.

“Employee wellness programs…viewed as a nice extra,not a strategic imperative. But the data show otherwise.

The ROI on comprehensive, well-run employee wellness programs can be as high as 6 to 1.”

Berry, Leonard and Mirabito, Ann M. and Baun, William B, What's the Hard Return on Employee Wellness Programs? (2010). Harvard Business Review, December 2010; Mays Business School Research Paper No. 2012-68. Available at SSRN: https://ssrn.com/abstract=2064874

Institutional Wellness

9 Organizational Strategies

Shanafelt TD et al. Executrive Leadership and Physician Well-being: Nine organizational strategies to Promote Engagement and Reduce Burnout, Mayo Clinic Proc Jan 2017

Louisiana’s State-Wide 7-Step Wellness Approach

Institute for Healthcare Improvement 4-Step Program

Multiple Approaches

The IHI 4-Step Program

1. Ask Staff: “What matters to you?”2. Identify unique impediments to joy in work3. Commit to a systems approach4. Test approaches to improving joy in the

system

Wellness Toolkits• The CDC has recognized wellness in the workplace and created

a guide in conjunction with the DOH• Healthiest Maryland Business Program, partnered with

“mental hygiene”• Breastfeeding friendlier in Arizona• Arkansas Healthy Employee Lifestyle Program• Healthy Vending in Hawaii• Montana Comprehensive Worksite Wellness

Measuring Organizational Wellness

30

“If you can’t measure it, you can’t improve it.” — Peter Drucker

Burnout● Maslach Burnout Inventory● Single-item emotional exhaustion and depersonalization

score● Jefferson Scale of Physician Empathy● Professional Quality of Life Scale● Utrecht Work Engagement Scale● Copenhagen Burnout Inventory

Resilience/Mindfulness● Connor Davidson Resilience Scale● Brief Resilience Scale● Five Facet Mindfulness Questionnaire● Cognitive & Affective Mindfulness Scale● Measure of Current Status of Part A● Self-Efficacy Questionnaire Scale

Mood/Personality● Myers-Briggs Type Indicator● Profile of Mood States● Thomas-Kilmann Conflict Instrument● Interpersonal Reactivity Index Perspective-Taking Subscale● Revised Life Orientation Test

Depression/Suicidality● Center for Epidemiologic Studies Depression Scale

Revised● Depression, Anxiety and Stress Scale● Hopkins Symptom Checklist● Patient Health Questionnaire● Primary Care Evaluation of Mental Disorders● Second Victim Experience Support Tool ● Columbia Suicide Severity Rating Scale

Stress● Perceived Stress of Medical School● Perceived Stress Scale● Ways of Coping Scale● The COPE Inventory● The Coping Inventory for Stressful Situations

Other● Epworth Sleepiness Scale● Satisfaction with Life Scale● Physician Wellness Inventory● General Self Efficacy scale

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative

Awareness of the issue

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative

Understands drivers of burnout and engagement

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative

Understands the business case for

well-being

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative Understands the impact of well-being

on key organizational

objectives

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Stage

Impa

ct

Novice ExpertBeginner Competent Proficient

Minor

Transformative Well-being influences key organizational decisions

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.

Summary• Existing gaps in knowledge: Joy in work is more than absence of

burnout

• Departmental and institutional policies: Stanford, Mayo Clinic, Mount Sinai promote provider wellness

• Exemplary strategies: Louisiana State-Wide Approach, Institute for Healthcare Improvement 4-Step Program, 9 Organizational Strategies to Promote Engagement and Reduce Burnout

• Focus on System changes to impact individual provider wellness

3 Questions Each Day• Am I treated with dignity and respect every day?

• Do I have what I need so that I can make a contribution that gives meaning to my life?

• Am I recognized and thanked for what I do?

Measuring Organizational Wellness

40

THANK YOU!QUESTIONS?

philritas@mindspring.com | @Rita_Manfredi3Arlene.Chung@gmail.com | @arlenesujin

References• Chuang C, Tseng P, et al: Burnout in the Intensive Care Unit Professionals - A Systematic Review. Medicine (Baltimore). 2016 Dec;

95(50):e5629• Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med.

2009; 84(2): 236-41.• Gold KJ, Sen A, and Schwenk TL. Details on suicide among U.S. physicians: data from the National Violent Death Reporting System.

Gen Hosp Psychiatry. 2013; 35:45-49.• Hemmerdinger JM, Stoddart SD, Lilford RJ. A systematic review of tests of empathy in medicine. BMC medical education. 2007;7:24.• Hemphill RR, Santen SA. The words your patients will remember. Academic emergency medicine: official journal of the Society for

Academic Emergency Medicine. 2011;18(1):96-97.• Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009. 1(2):236-42.• Jani BD, Blane DN, Mercer SW. The role of empathy in therapy and the physician-patient relationship. Forschende

Komplementarmedizin. 2012;19(5):252-257.• Linzer M, Harwood E. Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians? J Gen Intern Med.

33(6):963-965.• Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu Rev Psychol. 2001; 52: 397-422.• Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US

Population. Arch Intern Med. 2012; 172(18):1377-1385.• Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement

and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-146.• Shanafelt TD et al. Executrive Leadership and Physician Well-being: Nine organizational strategies to Promote Engagement and

Reduce Burnout, Mayo Clinic Proc Jan 2017 • Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-Being. JAMA Intern Med. 2017;177(12):1826-1832.