Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J....
Transcript of Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J....
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Thriving vs. Surviving: Bite-sized Coping During
Times of Uncertainty
J. Bryan Sexton, PhDDirector, Duke Center for Healthcare Safety and QualityDuke University Health System
twitter.com/dukehsq | www.hsq.dukehealth.org
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Ask the kids…
National Study of the Changing Workforce
worried about parents
wish parents were less stressed
and less tired
65% of children (age 8–18) of working parents:
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Examples•Institutional Resources
– Schwartz Center Rounds
– Just Culture Training
– Positive Rounding
– Safety Rounding
– Second Victim Support
•Resources for individuals:– Gratitude Letters: bit.ly/grattool
– Cultivate Hope: bit.ly/fwdtool
– 3 Funny Things: bit.ly/start3ft
– Cultivate Confidants: bit.ly/1goodchat
– Cultivate Awe and Wonder: bit.ly/awetool
– Random Acts of Kindness: bit.ly/kindtext
– Cultivate Mindfulness: bit.ly/3goodminutes
– Cultivate Interest & Curiosity: bit.ly/inttool
– 3 Good Things: bit.ly/start3gt
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Why do we need individual and
institutional resources in the first place?
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MD Burnout is
expensive: $4.6 billion
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workplace wellness RCT: no
differences in clinical
measures of health, spending,
utilization, or employment
outcomes after 18 months
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hospitalizations for
conditions with
prevention potential in
primary care are
influenced by GP well-
being
(dose–response pattern
across several well-
being indicators)
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Expensive
Traditional countermeasures not working
Impact on clinical quality
Quick recap of burnout so far:
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In the past week:
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Burnout ICC .26
“Burnout is a team sport”
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Burnout is contagious, but so is resilience…
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Psychology of BurnoutYour focus and reflections
determine your reality
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Psychology of Burnout
Your determines your
reality
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Notice anything unusual about this lung scan?
Harvard researchers found that 83% of radiologists didn't notice the gorilla in the top right portion of this image.
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What the burned out eyes are able to
see is limited:
Eye-tracking of attention of burned out
and depressed participants was the same:
more focus on dysphoric stimuli /
less focus on positive stimuli
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Analogy:• Noticing something about the world
• Commenting on it briefly through your mobile phone
• Seeing what other people commented on
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For the latest on our research,
courses and tools, connect with
us on Twitter
@JBryanSexton1
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Higher Standardized
Mortality RatiosWelp, Meier & Manser. Front
Psychol. 2015 Jan 22;5:1573.
Burnout is associated with:
Medication ErrorsFahrenkopf et al. BMJ. 2008 Mar 1;336(7642):488–91.
InfectionsCimiotti, Aiken, Sloane and Wu.
Am J Infect Control. 2012 Aug;40(6):486–90.
Lower Patient SatisfactionAiken et al. BMJ 2012;344:e1717 Vahey, Aiken et al. Med Care. 2004 February; 42(2 Suppl): II57–II66.
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Christina Maslach, PhDauthor of the
Maslach Burnout Inventory (MBI)Professor Emeritus, Berkeley
MBI 3 Pillars of Burnout:
• Emotional Exhaustion (overwhelmed, drained, unable to meet
demands)
• Depersonalization (callousness, seeing others as objects)
• Inefficacy (diminishes sense of accomplishment)
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Burnout Scores by Role
(SCORE results) over 200,000 healthcare workers
0
5
10
15
20
25
30
35
40
45
50
55
60
Technologist(e.g., Surg.,Lab, Rad.n=9723)
Technician(e.g., PCT,Surg., Lab,EKG, Rad.n=11510)
Nurses Aide(n=5669)
Pharmacist(n=2637)
Physician(n=12015)
Nurse(n=57877)
% e
moti
onal
exhaust
ion
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Burnout is what happens when it gets really hard to notice something funny, interesting, or amazing…
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Burnout, at its core, is the impaired ability to experience positive emotion.
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Gratitude
Serenity
Awe
Interest
Pride Amusement
Joy
Hope
Love
Inspiration
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Through Positive Emotions…
Positive Emotions Recharge your
Batteries…
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How to make positive emotions more accessible, when the negative are so prevalent? A simple intervention called 3 Good Things…
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Three Good Things
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Three Good Things
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55
60
65
Pre-test
Post-test
Oneweek
Onemonth
Threemonths
Sixmonths
Happin
ess
Placebo control (n = 70)
Three good things (n = 59)
Three Good Things
Seligman, Steen, Park & Peterson, 2005
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8
12
16
Pre-test
Post-test
Oneweek
Onemonth
Threemonths
Sixmonths
Depre
ssiv
e S
ym
pto
ms
Placebo control (n = 70)
Three good things (n = 59)
Three Good Things
Seligman, Steen, Park & Peterson, 2005
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Effect Sizes
Baseline to
1-Mo Follow-up
Baseline to
6-Mo Follow-up
Burnout 0.25 0.34
concerning
threshold sub-group0.61 0.68
Depression 0.41 0.52
concerning
threshold sub-group1.57 1.38
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Adair, Kennedy & Sexton 2020Provisional acceptance at JOPP
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Interested in more?
bit.ly/welldukeWebinar Series
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#1 We are hard-wired to remember the negative.
The negative screams at
you, but the positive only
whispers…
—Barbara Fredrickson
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#1 We are hard-wired to remember the negative.
#2) Enhanced recall of material reviewed during last 2 wakeful hours.
#3 With practice (by day 4 or 5) reflecting on the positive leads to noticing more positive.
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`
We’ll send you a text or
email link…
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DUH Exposure to 3GT associations with Safety Culture and Well-Being
77%80%
45%51%
64%67%
37%
47%
0%
20%
40%
60%
80%
100%
TeamworkClimate
SafetyClimate
Resilience Work-LifeBalance
Perc
ent
Posi
tive
3GT Yes (N=1944) 3GT No (N=4890)
t=13.24
p<0.0001
t=14.04
p<0.0001
t=5.91
p<0.0001
t=3.58
p<0.0001
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Evaluation from Participants of 3GT
96% said that they would recommend the 3 Good Things exercise to a friend
86% said that they have encouraged others to try 3 Good Things
93% said they would like to participate in 3 Good Things again next year
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3GT on demand (start anytime)
Choose email or text format
Share with your colleagues
(bit.ly/start3gt)
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Please get your mobile phone….
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Please use your mobile browser to go to:
bit.ly/start3gt
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bit.ly/start3gt
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Negative is like Velcro,positive is like Teflon
3GT enhances your ability to see the positive that is there
scalable from individual to work setting levels
bit.ly/start3gt
![Page 64: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/64.jpg)
Time to enroll: 2–5 minutes
Time each evening: 2 minutes
Time to finish: 2 weeks
bit.ly/start3gt
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bit.ly/3gtdemo
3-Minute Video
![Page 66: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/66.jpg)
“So how are we going to kill the next patient
around here?”
Traditional Patient Safety Rounding Frame:
![Page 67: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/67.jpg)
“What are three things that are going well around here, and one thing that could be
better?”
Positive Rounding Frame:
![Page 68: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/68.jpg)
0
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50
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70
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% Y
es
Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?
![Page 69: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/69.jpg)
0
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50
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% Y
es
Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?
1st
Quartile2nd
Quartile3rd
Quartile
4th
Quartile
This
Quartile –
low Positive
Rounding
This
Quartile –
High
Positive
Rounding
![Page 70: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/70.jpg)
0
10
20
30
40
50
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ImprovementReadiness
LocalLeadership
TeamworkClimate
Safety Climate EmotionalExhaustion
BurnoutClimate
Work-LifeBalance
4th (fewest PosWR) 3rd 2nd 1st (most PosWR)
Mean o
f th
e w
ork
sett
ing s
core
s
t=6.32,
p<.001
┌┴┐
t=3.65,
p<.001
t=5.50,
p<.001
┌┴┐
t=7.69,
p<.001
┌┴┐t=-4.32,
p<.001
t=-5.07,
p<.001
┌┴┐
t=6.39,
p<.001
┌┴┐
Safety Culture & Well-Being by Positive Rounding Quartiles
┌┴┐ ┌┴┐
![Page 71: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/71.jpg)
Pausing and Reflecting
• Large survey of workplace norms (n = 10,496) included three items on positive reflection:
• The learning environment in this work setting
allows us to gain important insights into what we
do well
• The learning environment in this work setting
allows us to pause and reflect on what we do well.
• In this work setting local management regularly
makes time to pause and reflect with me about my
work.
• Chronbach's alpha: .863
![Page 72: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/72.jpg)
Relationship between
institutional resources and well-being after controlling for positive
reflections:
ZERO or nearly Zero
![Page 73: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/73.jpg)
Relationship between
institutional resources and well-being after controlling for positive
reflections:
ZERO or nearly Zero
![Page 74: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/74.jpg)
Examples•Institutional Resources
– Schwartz Center Rounds
– Just Culture Training
– Positive Rounding
– Safety Rounding
– Second Victim Support
•Resources for individuals:– Gratitude Letters: bit.ly/grattool
– Cultivate Hope: bit.ly/fwdtool
– 3 Funny Things: bit.ly/start3ft
– Cultivate Confidants: bit.ly/1goodchat
– Cultivate Awe and Wonder: bit.ly/awetool
– Random Acts of Kindness: bit.ly/kindtext
– Cultivate Mindfulness: bit.ly/3goodminutes
– Cultivate Interest & Curiosity: bit.ly/inttool
– 3 Good Things: bit.ly/start3gt
![Page 75: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/75.jpg)
Meeting Agenda Item
-One good thing so far this week
![Page 76: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/76.jpg)
Enduring Resources (for Pausing & Reflecting)
• Cultivate gratitude: bit.ly/grattool
• Cultivate positive emotions: bit.ly/start3gt
• Cultivate engagement: bit.ly/inttool
• Cultivate awe: bit.ly/awetool
• Cultivate hope: bit.ly/fwdtool
• Cultivate work-life balance: bit.ly/wlbtool
• Mindfulness: bit.ly/3goodminutes
• Self Compassion: bit.ly/selfcomptool
• Cultivate relationships: bit.ly/1goodchat
• Cultivate serenity: bit.ly/serenitytool
• www.hsq.dukehealth.orgResilience Ambassador Training in Durham, NC
Positive Emotion & calibrating to situation are keys to resilience
Frequency…not magnitude of positive emotion
![Page 77: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/77.jpg)
bit.ly/start3gt
Q&ATOOL
bit.ly/threegtContinuing
Ed Credit
bit.ly/welldukeWebinar
Series
![Page 78: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/78.jpg)
For the latest on our research,
courses and tools, connect with
us on Twitter
@JBryanSexton1
![Page 79: Thriving vs. Surviving · Thriving vs. Surviving: Bite-sized Coping During Times of Uncertainty J. Bryan Sexton, PhD Director, Duke Center for Healthcare Safety and Quality](https://reader035.fdocuments.in/reader035/viewer/2022070909/5f8ebc9aa1f93d1def6b4eef/html5/thumbnails/79.jpg)
Monthly Resilience Webinar series:—1 hour continuing education credit (MD/RN/other)—1 tool each month, recorded, with Q&A
JANUARY Prevalence & Severity of Burnout: Workforce Resilience as Care Quality
FEBRUARY Enhancing Resilience: The Science and Practice of Gratitude
MARCH Relationship Resilience: The Science of How Other People Matter
APRIL Enhancing Resilience: Three Good Things
MAY Enhancing Resilience: Practicing Safe Stress and the Science of Sleep
JUNE Psychological Safety: The Predictive Power of Feeling Supported When Things Go Wrong
JULY Science of Mindfulness
AUGUST Health Care Worker Resilience, Work-Life Integration, and Burnout
SEPTEMBER Collaboration vs. Dealing with Difficult Colleagues: Assessing, Understanding and Improving Teamwork in a Clinical Area Near You
OCTOBER Science of Wow: Cultivating Awe and Wonder as a Resilience Strategy
NOVEMBER Positive WalkRounds: Leader Rounding to Identify What is Going Well—Links to Quality, Culture and Workforce Resilience
DECEMBER Enhancing Resilience: Survival of the Kindest
www.hsq.dukehealth.org