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

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