COVID-19 AND BURNOUT IN HEALTHCARE: TWO ......Darryl Anka SIGNS YOU NEED TO CHANGE YOUR MINDSET You...

COVID-19 AND BURNOUT IN HEALTHCARE: TWO REALITIES THAT FEED OFF EACH OTHER

HCMS

Naim El-Aswad, MD, FACP

Chief Medical Officer

Vital Signs Vital Skills, L.L.C.

August 26th, 2020

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Live Activity:

Covid-19 and Burnout in Healthcare Two Realities that Feed off Each Other

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education, and the American Medical Association require that speakers and planners for continuing medical education activities disclose any relevant financial relationships they may have with commercial interests whose products, devices or services may be discussed in the content of a CME activity.

The planners/speakers/participants for this activity have NO relevant financial relationships to disclose.

Any new planners, speakers or participants will be verbally disclosed prior to the start of the conference.

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OUTLINE


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CHALLENGE OF HEALTHCARE

Healthcare

Standards

Burnout and

the healthcare

industry

Knowledge, tools,

skills, and practices

COVID19,

Burnout and the

healthcare

industry

NEW and DIFFERENT

Knowledge, tools,

skills, and practices

Physician/

HCP/HCO

Healthcare

Standards

www.vitalsignsvitalskills.com

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Physician/

HCP/HCO

SHIFTING LANDSCAPE. MANAGING THE NOW, PREPARING FOR THE FUTURE

1- We have not yet fully figured out how to deal with

the prior landscape

2- Our current landscape keeps changing

a- How do we maintain our balance?

b- How do we successfully navigate it?

c- How do we lead others and make sure they

do not fall?

3- We need to look ahead without stumbling in the

now

a- How do we do that?

b- What do we need and why?

c- What will the road look like later?

d- Will it ever be smooth and somewhat

predictable again?

e- What will be the new norm?www.vitalsignsvitalskills.com

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HONESTY

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REFLECTIONS

• Frustration

• Fear

• Anxiety

• Apathy

• Anger

• Exhaustion/fatigue

• Sadness/depression


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WHERE CHANGE NEEDS TO HAPPEN


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Healthcare Environment

Healthcare Organizations

Healthcare Individuals

BURNOUT DEFINITION

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It is now a DISEASE. (WHO: ICD 11)

“Syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. 3 dimensions:

1- Feelings of energy depletion;

2- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;

3- Reduced professional efficacy.

It is an occupational phenomenon.


STAGES OF BURNOUT

• According to the psychologists Herbert Freudenberger and Gail North, burnout goes through a 12-stage model:

• Compulsion to prove oneself

• Working hard - with an inability to switch off

• Neglecting basic needs - lack of sleep, lack of healthy eating, lack of social interaction

• Displacement of conflicts - problems are dismissed

• Revision of values - values are skewed, friends and family dismissed, hobbies irrelevant

• Denial of emerging problems

• Withdrawal - social life small or nonexistent

• Odd behavioral changes - changes in behavior obvious to friends and family

• Depersonalization - seeing neither self nor others as valuable

• Inner emptiness

• Depression

• Burnout syndrome - includes mental and physical collapse; medical attention required

BURNOUT CAUSES


12

Burnout

Unmet Expectations

Lack of Control

Insufficient Rewards

Leadership

Pressure

Personal characteristics

Purpose and Need

Self-care and wellness

BURNOUT CAUSES


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Burnout

Unmet Expectations

Lack of Control

Insufficient Rewards

What else was

added in the

Covid/Burnout

Realities?

-Lack of PPE

-“Did not sign up for this”

-“Putting our lives at risk”

-Cannot control the public

-Cannot control the virus

-Pay is less, jobs lost

-Risking our loved ones

-Physical, mental, and emotional

separations

EMR

Cog in a wheel

Too many hours at work

Insufficient monetary funds

Emphasis on profits not patients

Severity of illnesses

Acuity of situations

Increase physical, mental and

emotional demands

PURPOSE AND NEED

Engaged: Best MD-

patient

satisfaction/outcome


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E

B

P

C

PURPOSE AND NEED


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Connecting to Purpose

Physician’s Self

Determination Theory:

Empathetically Connected

Clinically Competent

Professionally Autonomous

Behavior

P

Cognition

Emotions

Behavior

P

Cognition

I-THOU I-ITMedical Training


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Emotions

In medical training and

medical practice,

empathy is gradually

eroded and lost. Patients

are viewed as liabilities,

not assets.

COGNITION


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Government

regulations

Insurance

companies

Lawsuits

Feedbacks,

evaluations

Business

demands. Non-

medical

responsibilitiesCognitive

Scarcity

Leads to

counter-

productive

behaviors

and mistakes

Draws cognitive

resources to

urgent demands

Induces

impairments

in other

domains

Behavior

P

COVID-19

Quarantine

Home school

Gathering supplies

Job losses

Economic, political, social

changes

Possibility of getting

infected and infecting

loved ones

BEHAVIOR

• In a single day, residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients.

• More and more physicians/nurses are graded based on their bed side manners, not their clinical skills.

• Physicians get evaluated/rewarded on communication and presentation skills rather than clinical performance and outcome


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P

COVID World:

Web-based conferences

Decreased bedside rounding

Decreased patient interactions

Doing our best with little impact

on outcome

“I have never felt so

useless and so needed at the same time”Jewel Jones, MD

PERSONAL CHARACTERISTICS

• Personal characteristics associated with burnout include:

• Being self-critical

• Matching the personality to the specialty

• Engaging in unhelpful coping strategies

• Perfectionism

• Idealism

• Certain personality types can affect positively or negatively


Patel S. et al, 2018. Factors Related to Physician Burnout and Its Consequences: A Review. Behavioral Sciences.

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COVID-19

PRESSURE VERSUS STRESS


Pressure is where the outcome is important

to you, it is uncertain, and you are

accountable and judged for the results. You

must deliver the goods or suffer dire

consequences.

Adversely impacts cognitive success,

downgrades behavioral skills, we perform

below our capability, often camouflaged

and is continually increasing.

Weisenger and Pawliw-Fry, (2015) Performing Under Pressure

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COVID-19

PURPOSE AND NEED

Engaged: Best

physician/patient


Burnout: Worst MD-

RN/patient



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E

B

P

C

The “old” world of burnout

and the “new” world of

COVID-19

The New Challenge

of Healthcare: THRIVE

WHERE BURNOUT IMPACTS: PREFRONTAL CORTEX


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From: Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences

Arch Surg. 2009;144(4):371-376. doi:10.1001/archsurg.2008.575Vital Signs Vital Skills, L.L.C.

50 % of MD’s are

burned out

Projections during and postCOVID-19:

More burnout

More moral injury

More will leave the work force

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BURNOUT AND PHYSICIAN/NURSE PERFORMANCE

• Observation, Reason, Human Understanding, Courage; these make the physician. ~Martin H. Fischer (1879–1962)

• Observation: Disconnected, unrealistic, can’t read clues and “checked out”

• Reason: Decreased ability to analyze, assess and think. Loss of clinical skills, and abilities.

• Human Understanding: Can’t understand or relate to others, loss of empathy

• Courage: Distant, insecure, blaming others, explosive, unpredictable and aggressive


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RELATIONSHIP BETWEEN COVID AND BURNOUT: MAACU EFFECT


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Burnout

PathophysiologyBurnout

Factors

Burnout Signs

and

Symptoms

COVID

MagnifiesAmplifies

Creates

Uncovers

Accelerates

THE IMPACT OF COVID• Created a sense of oneness

• Changed the public view of healthcare providers (Became Heroes)

• Altered our adaptive mechanisms/support systems (Family, exercise, social gatherings, …)


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MAACUBurnout

COVID-19

Focused

Efforts

Burnout

Moral

Injury

MORAL INJURY


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“Moral injury refers to an injury to

an individual's moral conscience

and values resulting from an act of perceived moral transgression,

which produces profound

emotional guilt and shame, and

in some cases also a sense of

betrayal, anger and profound

"moral disorientation“ “

AAA APPROACH

• A: Awareness

• A: ACKNOWLEDGEMENT and ASSESSMENT

• A: ACTION


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Maslach Burnout

Inventory

Mini Z

Mini-Maslach

Several online

BURNOUT AND PHYSICIAN/NURSE PERFORMANCE

• Observation, Reason, Human Understanding, Courage; these make the physician. ~Martin H. Fischer (1879–1962)

• Observation: Disconnected, unrealistic, can’t read clues and “checked out”

• Reason: Decreased ability to analyze, assess and think. Loss of clinical skills, and abilities.

• Human Understanding: Can’t understand or relate to others, loss of empathy

• Courage: Distant, insecure, blaming others, explosive, unpredictable and aggressive


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Intervention

BURNOUT MALIGNANCY MODEL

Environmental and Genetic

FactorsTime

Negative cumulative

Effects


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Lack of defenses and

ability to detect

Intervene:

Resiliency, coping,

EQ/Self-care mindset,

momentum

Use it to our advantage

Develop detection and

defense capabilities:

EQ/Self-care

Positive cumulative CHANGE

CREATE A NEW REALITY

GUIDELINE OF APPROACH


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• “In a battle all you need to make you fight is a little hot blood and the knowledge that it’s more dangerous to lose than to win.” George Bernard Shaw

MINDSET


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“A set of beliefs

or a way of

thinking that

determines one’s

behavior,

outlook, and

mental attitude”

Circumstances

do not

determine state

of being; state of

being determine

circumstancesDarryl Anka

SIGNS YOU NEED TO CHANGE YOUR MINDSET

✓ You continuously focus on what is wrong

✓ You mourn your failures without celebrating your success

✓ You don’t want to face the truth

✓ You get angry when your expectations are not met

✓ You feel unsatisfied or unhappy with everything you have

✓ You are constantly fighting with the ones you care about

✓ You think about what you have to do and not what you get to

do

✓ You see yourself as a victim

✓ You hold on to other people’s dreams

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God, grant me the

serenity to accept the

things I cannot

change, the courage

to change the things I

can, and the wisdom

to know the

difference… Serenity

Prayer

Stephen Covey(1989) The 7 habits of highly effective people: Powerful lessons in personal change.


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CLINICAL PERFORMANCE

Purpose

and

Need

Physician

Physician-Patient Interaction

Decision Making/Interaction/Skills

Engaged Burnout

Emotional Intelligence, Self-care and

Wellness, Resilience, Coaching

Institutional

Political

Social

Governmental

Professional

COVIDVital Signs Vital Skills, L.L.C.

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DEFINITION OF EMOTIONAL INTELLIGENCE

Understanding

ourselves,

managing

ourselves,

understanding

others, managing

others

www.vitalsignsvitalskills.com

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EMOTIONAL INTELLIGENCE IN MEDICINE

• Decreasing/diagnosing/preventing Burnout

• Needed for the skills of the 21st century physician

• Needed for personal and professional development

• Needed in the ACGME core competencies

• Tied to physician satisfaction and mission

• Tied to wellness

• Tied to patient satisfaction

• At the core of LEADERSHIP


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WELLNESS AND BURNOUT


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Wellness and

life/work

balance

protect

against and

treat burnout

https://www.google.ca/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjZp9TAi8XLAhUCyYMKHdZFA1gQjRwIBw&url=https://www.flickr.com/photos/61056899@N06/5751301741&bvm=bv.116954456,d.amc&psig=AFQjCNGaTUU3AdaKrJI_Jqyt8daRIZu0Hw&ust=1458213653017743

WITHOUT SELF-CARE AND WELLNESS

• Burnout

• Physician/Nurses/Executives morbidity and mortality

• Patient morbidity and mortality

• Poor leadership

• Healthcare industry failure


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WELLNESS/SELF-CARE40

• Rules of wellness:

• At the heart of wellness: Self-love, Self-compassion, and Self-care

• Four steps to successful wellness:• Deciding (Develop the mindset)

• Taking control

• Taking time

• Creating a habit


If you do not make time

for your wellness, you will

be forced to make time

for your illness.

RESILIENCE


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NICHOLSON MCBRIDE RESILIENCE

QUESTIONNAIRE (NMRQ)

• 0-37: A developing level or resilience. Your score indicates that, although you may not always feel at the mercy of events, you would in fact benefit significantly from developing aspects of your behavior.

• 38-43: An established level of resilience. Your score indicates that you may occasionally have tough days when you can’t quite make things go your way, but you rarely feel ready to give up.

• 44-48: A strong level of resilience. Your above average score indicates that you are pretty good at rolling with the punches and you have an impressive track record of turning setbacks into opportunities.

• 49-60: An exceptional level of resilience. Your score indicates that you are very resilient most of the time and rarely fail to bounce back –whatever life throws at you. You believe in making your own luck.

42 Vital Signs Vital Skills, L.L.C.

Resilience Questionnaire Score1. In a difficult spot, I turn at once to what can be done to put

things right.

2. I influence where I can, rather than worrying about what I

can’t influence.

3. I don’t take criticism personally.

4. I generally manage to keep things in perspective.

5. I am calm in a crisis.

6. I’m good at finding solutions to problems.

7. I wouldn’t describe myself as an anxious person.

8. I don’t tend to avoid conflict.

9. I try to control events rather than being a victim of

circumstances.

10. I trust my intuition.

11. I manage my stress levels well.

12. I feel confident and secure in my position.

TOTAL

For each question, score yourself between 1 and 5,

where 1 = strongly disagree and 5 = strongly agree.

COACHING

SUCCESS


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Assessments:

BurnoutEQ

Personality

Resilience

GritOthers

WHERE CHANGE HAPPENS


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Stress/Burnout

Factors

Training

Practice of

medicine

Positive

Emotions/

Mood

Negative

Emotions/Mood

Mindfulness/Wellness/

EI training/Coaching

Hijack, loss of IQ, loss

of will power, Lower

EQ

Problem solving and

creativity

Institutional

Changes/Outside

Factors

Purpose/Need of

medicine

COVID

MAACU

WHERE CHANGE HAPPENS


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TAKE HOME TOOLS, MICRO INITIATIVES

• Mindfulness

• Three good things: Gratitude

• Name it to tame it: Bring the emotions up

• Connect

• Acknowledge goodness

• Highlight positivity

• Share experiences

• Focus on emotional intelligence

• Work on your self-care and wellness


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TIPS TO WORK ON YOUR EMOTIONAL INTELLIGENCE

•ACKNOWLEDGE EMOTIONS!!!!!!• Take an assessment test (EQi, MSCEIT,…). Find out where you are, where you

are strong and where you need help.

• Make a mental memory of your own reactions. Self analyze.

• Few times a day, STOP, and observe your emotions. Listen to your own mind.

• Know your positive and negative triggers. Enhance positive reactions, modify negative reactions.

• Identify the emotion: name it to tame it


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WELLNESS ACTIVITY: WHEEL OF WELLNESS

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• Use a scale of 0 to 10 (0 being the least and 10 being the most) to write down your personal wellness score for each realm using the wheel below.

• Identify one activity that you can do to improve your score along each realm.

• Set a plan of action to achieve that activity.

• Complete the activity.


PLANNING WHAT’S NEXT?

• Identify: Your burnout, your abilities, your assets, your limitations

• Mindset: Decide not only that you SHOULD change, but that you MUST and WILL change

• Enhance: Your EQ, self-care, and resilience

• Plan: With or without a coach, outline a plan of action based on your parameters

• Assess and adjust: “Adapt what is useful, reject what is useless, and add what is specifically your own.” Bruce Lee


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FOLLOWUP DATA THAT DR. EL-ASWAD SPOKE ABOUT IN THE CENTRAL BRANCH MEETING:51

• HAS DEMONSTRATED THE IMPORTANCE OF FRONT-LINE LEADERSHIP ON THE WELL-BEING AND PROFESSIONAL SATISFACTION OF PHYSICIANS.

• IT OBSERVED THAT LEADERSHIP RATINGS HAD A STRONG ASSOCIATION WITH BURNOUT AND SATISFACTION AT THE LEVEL OF INDIVIDUAL PHYSICIANS...

• FOR EVERY POINT UPWARD ON A 60-POINT SCALE, THERE WAS 9% GREATER STAFF SATISFACTION AND 3.3% LESS BURNOUT.

• AT THE DEPARTMENT AND DIVISION LEVEL, 11% OF THE VARIATION IN BURNOUT AND 47% OF THE VARIATION IN SATISFACTION WITH THE ORGANIZATION WAS EXPLAINED BY THE LEADER INDEX OF THE CHAIRPERSON.”

SHANAFELT, T., ET AL., IMPACT OF ORGANIZATIONAL LEADERSHIP ON PHYSICIAN BURNOUT AND SATISFACTION. MAYO CLINIC PROCEEDINGS. 4/2015 90(4): P. 432-440 4. SWENSEN, S., ET AL.

COVID-19 AND BURNOUT IN HEALTHCARE: TWO ......Darryl Anka SIGNS YOU NEED TO CHANGE YOUR MINDSET You...

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