asco’s quality training program...quality training program project title: impact of burn- out...
TRANSCRIPT
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Quality Training Program
Project Title: Impact of Burn-Out Syndrome in Oncology personnel and its improvement through specific interventions
Presenter’s NameAlberto Cunquero TomásInmaculada Ortega Ruiz
Institution: Consorcio Hospital General Universitario de Valencia
Date: 14 – April - 2019
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Problem Statement
Burn-Out Syndrome
• 78% Oncology-related workers (doctors, nurses,…)• Characteristics
– Emotional and physical exhaustion– Cynicism and depersonalization– No Personal nor professional fulfillment
• Repercussions– Decrease in patient attention quality– Decrease in the quality of institutional processes
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Problem Statement
Burn-Out Syndrome
• Few experiences reported about its incidence and impact in Medical Oncology
• Lack of resources for its diagnosis and management
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Institutional Overview
Consorcio Hospital General Universitario Valencia
- University Public Hospital- Potential patients: 356000 patients- All specialties available- Medical Oncology Service
- 12 Medical Oncologists- 9 Medical Oncology Residents- 30 nurses / nursing assistant- 2000 new patients per year
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Consorcio Hospital General Universitario Valencia
- Hospitalization room- 30 beads 10 double rooms + 8 single rooms- Nurse / patient ratio 9 patients / nurse- Doctor / patient ratio 8 patients / doctor
- Clinic- 20 seats + 2 beads- 5 seats / nurse 45 treatment administration / day- Symptom control office 1 nurse assigned
Institutional Overview
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Team Members
• Sponsor: Dr. Carlos Camps (Medical Oncology Chief)• Coach: Dra. Ana Gómez• Leaders
– Alberto Jacobo Cunquero Tomás– Inmaculada Ortega Ruiz
• Collaborators– Teresa Fernández (Nurse Chief)– Sonia Blasco (Clinic)– Eva Peral (Hospitalization area)– Teresa Bosque (Clinic)– Ana Sánchez (Hospitalization area)
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Process Map
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Cause & Effect Diagram
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Diagnostic Data
DATA COLLECTION METHOD
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Diagnostic Data
Chart Clue
1 Yes
2 No
99
Lost Data
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Diagnostic Data
DATA COLLECTION METHOD
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Diagnostic Data
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Diagnostic Data
Range Exhaustion Depersonalization FulfillmentLow 30% 55% 30%
Medium 35% 15% 25%High 35% 30% 40%Total 100,00% 100,00% 100,00%Risk
(Medium + High) 70% 45% 55%
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Diagnostic Data
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Diagnostic Data
0
10
20
30
40
50
60
E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 E-10 E-11 E-12 E-13 E-14 E-15 E-16 E-17 E-18 E-19 E-20
Run Chart Burn-Out
Exhaustion Depersonalization Fulfillment
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Aim Statement
• Endopint: decrease in 20% de percentage of Medical Oncology nurses who suffer or are at risk of suffering from Burn-Out Syndrome
• Expected achiving date: May 2019
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Measures
• Measure: variation in the questionnaire results (Maslachquestionary)
• Objective population: Nurses and Nursing assistant working in the Medical Oncology Service
• Calculation methodology: Maslach index calculation according to questionnaire data
• Data source: questionnaire fulfillment by objective population
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Measures
• Data collection frequency• Previously to planned interventions• Every 3 months since after• Total follow-up time 1 year
• Data quality limitations– Questionnaire fulfillment subjectivity– Available time to fulfill questionnaire– Risk of subject lost due to vacation, workers turn-over,… among others
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Prioritized List of Changes (Priority/Pay –Off Matrix)
Ergonomy tips / lessons
Provide tools to manage Transference
Contratransference
Continuous training
Psico-Oncologist
Job stability
Group Cheer-leader
Exercise tips
Family and work cociliation
Hire more workers
High
Impa
ct
Low
Easy Difficult
Ease of Implementation
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PDSA Plan (Test of Change)
Date of PDSA Cycle Description of Intervention Results Action Steps
12 – 23 / Nov / 2018 Burn-Out Syndrome Questionnaire 1º Round
Base-line data Analysis of obtained data
13 / Dec / 2018 Brainstorming Plan of action Ergonomy tips
1 – 8 / Mar / 2019 Ergonomy tips Evaluation of results
20 – 27 / Mar / 2019 Burn-Out Syndrome Questionnaire 2º Round
Improvement data (5%)
Analysis of obtained data
1 – 5 / Apr / 2019 BrainstormingPlan reevaluation
Plan of action Leadership Sessions
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Materials Developed
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Materials Developed
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Re-Evaluation
DATA COLLECTION METHOD
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Change Data
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Change Data
1º round 2º round
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Change Data1º round 2º round
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Change Data
RangeExhaustion
Round 1Exhaustion
Round 2Low 30% 35%
Medium 35% 15%High 35% 50%Total 100,00% 100,00%Risk
(Medium + High) 70% 65%
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Change Data
0
10
20
30
40
50
60
E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 E-10 E-11 E-12 E-13 E-14 E-15 E-16 E-17 E-18 E-19 E-20
Run Chart Burn-Out
Exhaustion Round 1 Exhaustion Round 2
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Change Data
• We have achieved an improvement of 5% lowering the risk of suffering Burn-Out Syndromeamong our workers
• Complex measure due to answer subjectivity– We have healthier workers (GHQ-12)– Levels of Exhaustion have decreased mildly, but those
who were already exhausted are worse than before(Maslach Index)
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Change Data
• Possible causes of these findings– Renovation work on the Clinic
• Changes may be happening too fast• Normal workflow is altered
– Labor instability• Very competitive public job offer• Uncertainty about future jobs• High worker replacement
– Recent local holidays dificulties with family and work cociliation
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Next Steps/Plan for Sustainability
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Next Steps/Plan for Sustainability
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Conclusions
• We have achieved an improvement of 5% lowering the risk of suffering Burn-OutSyndrome among our workers, althoughresults might be incoherent and may needdeeper analysis
• New brainstorming should bring up new opportunities of improvement
• Reevaluation of our next activity will be definitory of its success
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Quality Training Program
Project Title: Impact of Burn-Out Syndrome in Oncology personnel and its improvement through specific interventions
Presenter’s NameAlberto Cunquero TomásInmaculada Ortega Ruiz
Institution: Consorcio Hospital General Universitario de Valencia
Date: 14 – April - 2019