paradigm shift from what's the matter to what matters to
TRANSCRIPT
Paradigm Shift From "What's the Matter" to "What Matters to You" Conversations: Creating Resilience by
Improving Joy at Work
Letha M. Joseph, DNP, APRN, AGPCNP-BCDurham VA HealthCare System
Duke University School of Nursing, Durham, NC
114th Annual ConventionConcord, NC | September 23-24, 2021
Objectives
• Define burnout and discuss signs of burnout• Describe the mechanism of burnout and its
impact on patient safety• Develop individual strategies to promote
resilience• Apply "what matters to you" conversation
strategy in creating resilient teams
Quadruple Aim
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From Triple Aim to Quadruple Aim
• Improved patient experience• Population focused approach• Cost effective use of resources • Joy and wellbeing of the workforce
Take care of your employees and the employees will take care of your patients
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Joy and Meaning
MEANINGFUL CONNECTION
PURPOSE IMPACT PRACTICEENVIRONMENT
A Narrative Analysis of Meaning and Joy in Nursing Practice, Institute of Health Care Improvement http://app.ihi.org/FacultyDocuments/Events/Event-2930/Posterboard-5781/Document-5495/Nurse_Stories_of_Meaning_and_Joy.pdf
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Through the eyes of the workforce
• Lucian Leape Institute. 2013. Through the eyes of the workforce: creating joy, meaning and safer health care. Boston, MA: National Patient Safety Foundation.
• National Academy of Medicine discussion paper 2017-Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care
Burnout
Emotional exhaustion
leading to
depersonalization and
low sense of personal
accomplishment at workThis Photo by Unknown Author is licensed under CC BY-SA-NC
Burnout- Occupational Phenomenon
“Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
Feelings of energy depletion/exhaustion Increased mental distance from one’s job, or feelings
of negativism or cynicism related to one's job; and Reduced professional efficacy”.
ICD-11 Definition
Burn-out an "occupational phenomenon": International Classification of Diseases (who.int)
Audience Response Question
Which of the following is the best tool to evaluate burnout in healthcare workers?
1. PHQ-92. Maslach Burnout Inventory 3. Health-Related Quality of Life Questionnaire4. World Health Organization Quality of Life Instrument
Audience Response - Answer
Which of the following is the best tool to evaluate burnout in healthcare workers?
1. PHQ-92. Maslach Burnout Inventory 3. Health-Related Quality of Life Questionnaire4. World Health Organization Quality of Life Instrument
Am I suffering ?
Maslach Burnout Inventory
Captures three dimensions of burnout
-emotional exhaustion,
-depersonalization &
-personal accomplishment
https://www.mindgarden.com/315-mbi-human-services-survey-medical-personnel
NAM Report- Burnout in Physicians
• >50% of US physicians report substantial symptoms of burnout
• Highest risk- in ED, family medicine, general internal medicine, neurology
• 2011-2014, the prevalence increased by 9%
National Academy of Medicine discussion paper 2017- Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care
NAM Report- Burnout in Nurses
High degree of emotional exhaustion
35 % of hospital nurses 37 % of nursing home nurses 22%of nurses working in other settings
National Academy of Medicine discussion paper 2017- Burnout Among Health Care Professionals: A Call to Explore and Address This Under-recognized Threat to Safe, High-Quality Care
Burnout in Nurses
Nurses who left their Jobs owing to burnout
2018 National Sample Survey of Registered Nurses.Prevalence of and Factors Associated With Nurse Burnout in the US JAMA Netw Open. 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469
'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021 https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456
'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021
https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456
Burnout - Factors
▰ Workload▰ Control▰ Reward▰ Community
▰ Fairness▰ Values▰ Job–person incongruity
Audience Response Question
What are some of the contributing factors of burnout? (Check all that apply)
1. Workload & long work hours2. Lack of respect from other professionals3. Lack of respect from patients 4. Too many regulatory requirements5. Computerization & Electronic Health Record6. Lack of autonomy7. Insufficient compensation8. COVID-19 9. Others
'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021
•“My batteries are just run down”.
•“I am not sure how much longer I can go like this”!
•“Thank goodness it’s Friday. I made it through another week.”
This Photo by Unknown Author is licensed under CC BY-SA
Do we stop when our ‘battery’ runs out?
What is burnout?
Energy Accounts
Physical Energy AccountDeposit by exercise, physical care, rest, diet
Emotional Energy AccountDeposit by healthy relationships
Spiritual Energy AccountDeposit by connecting with your purpose
Negative balance-Exhaustion
Negative balance-Cynicism, sarcasm
Negative balance-“Do I do anything good?”
Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html
Energy Balance
▰ Withdraw energy for daily use
▰ Deposit energy by rest, positive experience etc.
▰ Negative balance leads to burnout symptoms
Full
Empty
Negative balance
Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes.Fam Pract Manag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html
Burnout Leads to:
Lower levels of empathy
Poor QoL for staff Alcohol, drug abuse,
depression High risk for suicide.
Reduced adherence to treatment plans Overuse of resources Higher staff turnover
Poor quality of care Medical error Lower patient satisfaction
Bodenheimer, T., Sinsky, C. (2015) From the Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine
“Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being”. National Academy of Medicine 2019
Create positive workplaces Address burnout in training and in clinicians’ early
years Reduce administrative burden
Improve usability of health Information Technology Improve burnout recovery services National research agenda on clinician well-being
Six-Goal
Approach
Joy at Work
Joy Starts Here
https://www.simplypsychology.org/maslow.html
Pillars of joy at work - PERK
Purpose Engagement
Resilience Kindness
The Greater Good Science Center UC Berkeley https://greatergood.berkeley.edu/article/item/the_four_keys_to_happiness_at_work
Purpose
I became a nurse because . . . What makes me proud to work @-----because. . . What matters to me in my work is . . . What I do best is …… At the end of the day, I feel happy about …
Resilience
Ability to handle, adapt to, and learn from setbacks, failures, and disappointments
Successfully detach from work
Real-time, in-the-moment awareness: Mindfulness
This Photo by Unknown Author is licensed under CC BY-SA-NC
Kindness
• Orient thoughts, feelings & actions towards care for others
• Genuinely support social bonds• Treat others with dignity and respect,
empathy and compassion • Practice gratitude• Constructive management of conflicts
Gratitude Practice
Describe what that other person did for you. Describe
Acknowledge their effort and the quality of their efforts
Acknowledge
Explain how their actions helped youExplain
Gratitude Practice-Benefits
Engagement
Add some playfulness,
creativity& levity
More ownership over day-to-day schedule,
tasks, and professional development
“What matters to you” conversations
Audience Response System -Question
“What matters to you” conversation is an effective strategy for:
1. Employee engagement2. Coworker engagement3. Patient engagement4. All the above
Audience Response System - Answer
“What matters to you” conversation is an effective strategy for:
1. Employee engagement2. Coworker engagement3. Patient engagement4. All the above
What ‘s the matter ?
To
What matters to you?
Impact of “What matters to you” question
Culture change
How will you prevent burnout?
How will you improve engagement by promoting “what matters to you “ conversation?
Contact info: [email protected]
Reference
• Drummond, D. (2015). Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam PractManag. 22(5):42-47. https://www.aafp.org/fpm/2015/0900/p42.html
• Dyrbye, L.N., T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers. (2017). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-un-derrecognized-threat-to-safe-high-quality-care.
• Edwards et al. (2018) Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices. J Gen Intern Med 33(12):2138–46 DOI: 10.1007/s11606-018-4679-0
• Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry research, 191(1), 36–43. doi:10.1016/j.pscychresns.2010.08.006
• Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston, MA: National Patient Safety Foundation; 2013
• Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y. U., Anton, A., Sinclair, S., & Schmidt, S. (2017). Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job” program. BMC Palliative Care, 1–15. doi:10.1186/s12904-017-0219-7
• Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017
• Reith T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Cureus, 10(12), e3681. doi:10.7759/cureus.3681
