Burnout: Pitfalls & Prevention Burnout: Burnout: Pit Falls & Prevention for Academic Administrators in Psychiatry Charlene M. Dewey, M.D., M.Ed., FACP.

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Burnout:Burnout:Pit Falls & Prevention for Academic

Administrators in Psychiatry

Charlene M. Dewey, M.D., M.Ed., FACPAssociate Professor of Medical Education and Administration

Associate Professor of MedicineCo-Director, Center for Professional Health

Vanderbilt University School of Medicine

Administrators in Academic Psychiatry National MeetingOctober 28, 2010

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Acknowledgements & COI

• Center for Professional Health

• Previous workshops @ Vanderbilt

• A New You!

• COI:– Charlene M. Dewey, has no financial

conflicts of interest.

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Women in Health Care

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Women in Health Care

• Women make up the majority of the health care industry4

• Women physicians more prone to anxiety, stress, depression in the workplace2,3

• Women MD more likely to commit suicide1

• Women ≠ Men: http://www.youtube.com/watch?v=P77JnDHUw6g

1. http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml 2. Health of Faculty in Academic Medicine, 20093. http://www.adaa.org/about-adaa/press-room/facts-statistics

4. U.S. Department of Labor, Bureau of Labor Statistics, Employment and Earnings, 2008 Annual Averages and the Monthly Labor Review, November 2007.

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“If momma ain’t happy….ain’t nobody happy!”

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Reflection

1. Are you stressed at work?

2. Are you thriving or just surviving?

3. Would you like to see improvement in you current mental, physical, emotional or spiritual wellbeing?

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Goals

The purpose of this session is to:

1. Assist administrators with focusing on their wellness.

2. Review definitions of stress and burnout, risk factors for and symptoms of burnout.

3. Create an individual action plan to help reduce stress, prevent burnout, and improve overall health and wellness.

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Objectives

1. Reflect on your current state of wellness, your stressors and if you are at risk of burnout.

2. Identify ways to prevent burnout.

3. List ways to enhance your physical, mental, emotional, and spiritual wellness.

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Agenda

1. Introduction

2. Stress and Burnout

3. Professional Health and Wellness Spectrum

4. Individual Action Plans

5. Summary/Evaluation

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Self-Awareness

“Self-awareness means having a deep understanding of one’s emotions, strengths, weaknesses, needs, and drives. People with strong self-awareness are neither overly critical nor unrealistically hopeful. Rather, they are honest – with themselves and with others.”

“What Makes a Leader?” by Daniel Goleman, Best of Harvard Business Review (1998)

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Self-Assessments

• What stresses you out?

• Measure your stress level on the stress-o-meter.

Stress free

Relaxed

Calm

Engaged

Enthusiastic

Ready to go

Stressed out

Ready to cave in

Anxious

Exhausted

Overwhelmed

At the breaking point

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Stress & Burnout

• Stress and burnout occurs for different reasons in different individuals.

• Work load ≠ level of stress or burnout in all situations.

• Multifactorial

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Definition - Stress

• Stress can be defined as:– d : a state resulting from a stress;

especially: one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium <job-related stress>

~Webster’s Dictionary

Stress & Productivity

Declining Function

Produ

ctiv

e Str

ess

No Prolonged Stress

BurnoutStressedSituational Stress

Non-Functional

Prolonged Stress

Reduced Cognition

“Impairment” ???

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Work-Place Stress

Reduce work-place stress by:– Managing your energy– Reducing distractions– Planning appropriately– Managing failures and successes

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Definition - Burnout

• Burnout can be defined as: – a : exhaustion of physical or emotional

strength or motivation usually as a result of prolonged stress or frustration b : a person suffering from burnout.

~Webster’s Dictionary

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Burnout

“In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.”

~Christina Maslach

The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

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1.Work overload

2.Lack of control

3.Insufficient reward

4.Unfairness

5.Breakdown of community

6.Value conflict

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”

Six Sources of Burnout

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Risk Factors for Burnout

• Single• Gender/sexual

orientation• ># of children at home• Family problems• Mid-late career• Previous mental health

issues (depression)• Fatigue & sleep

deprivation

• General dissatisfaction• Alcohol and drugs • Minority/international• Teaching & research

demands• Potential litigation

Puddester D. West J Med 2001;174:5-7Myers MJ West J Med 2001;174:30-33Gautam M West J Med 2001;174:37-41

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Symptoms of Burnout

1.Chronic exhaustion

2.Cynical and detached

3.Increasingly ineffective at work

4.Leads to:1. isolation

2. avoidance

3. interpersonal conflicts

4. high turnover

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17

Aggressive Passive Passive

Aggressive

Figure 1

Spectrum of Disruptive Behaviors

Inappropriate anger, threats

Yelling, publicly degrading team members

Intimidating staff, patients, colleagues, etc.

Pushing, throwing objects

Swearing

Outburst of anger &physical abuse

Hostile notes, emails

Derogatory comments about institution, hospital, group,

etc.

Inappropriate joking

SexualHarassment

Complaining,Blaming

Chronically late

Failure to return calls

Inappropriate/inadequate chart notes

Avoiding meetings & individuals

Non-participation

Ill-prepared, not prepared

Swiggart, Dewey, Hickson, Finlayson. 4/09

“The Perfect Storm”

IndividualWork Environment

The external system The internal system

Two systems interact

Good skills

Poor skills

Functional & nurturing

Dysfunctional

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Work Environment

• Powerful model how practice environment can impact physician health– Stress: physician, environment, patients– Environment was the only sig predictor of stress– Job stress predicts job satisfaction– Job sat is positive predictor of positive mental

health– Perceived stress was a stronger predictor of

both poorer reports of physical and mental health

– Therefore, environment influenced healthWilliams et al. Physician, practice and patient characteristics related to primary care physician physical and mental health: Results of the physician’s work-life study. Health Services Research, 2002; 37(1):121-43.

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Stress Management

• Seven Key Areas Help Manage Stress:– Sleep– Balanced meals– Physical activity– Socialization– Vacations/down times– Spiritual engagement– Have a physician

Mind Body

Soul Emotion

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Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

Protective Factors

• Personal:– Tend to self care issues first– Address Maslach’s 6 sources of burnout– Influence happiness through personal

values and choices– Adapt a healthy philosophy/outlook– Spend time with family & friends

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Protective Factors

– A supportive spouse or partner– Engage in religious or spiritual activity– Hobbies– Mentor (s)

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

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Protective Factors

• Work:– Address Maslach’s 6 sources of burnout– Gain control over environment &

workload– Find meaning in work – Set limits and maintain balance– Have a mentor– Obtain adequate support systems

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“Natural abilities which come easily, are enjoyable to do,

and result in a sense of inner satisfaction and

meaningfulness.”~Nick Isbister

Dewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.

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Managing Energy at Work

• Listen to your body

• Identify your own needs

• Define limits - Just Say NO!

• Create your work environment

• Eliminate distractions

• Take breaks

• Plan ahead

Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.

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n Managing Energy: Case Discussion

Ms D is a 46 yo female with 2 kids and a spouse with significant travel/work schedule. She is a mid-level administrator for a psychiatric department chair and is involved in several community activities. Ms D finds emails and other interruptions distracting and is feeling stressed due to changes in the department, a grant, and several other submissions and activities in the office that are due in the next 6 weeks. She has cut down on sleep and exercise to meet the deadlines.

– What are her risk factors for burnout?

– Will this lead to burnout?

– What changes could we suggest to control energy at work?

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• Examples:– Check emails only twice a day – planned checks– Define blocks of time 60-120 min each– Walk, stretch and bathroom breaks– Define grant writing periods – block out on

calendar– Schedule vacations in advance– Coordinate with spouse/family– Continue self-care and socializing/spirituality

Individual Approach Organizational ApproachStarts with

person

Becomes group project

Connects to organization

Outcomes affects related mismatches

Outcome is a process

Starts with management

Becomes organizational project

Connects to people

Figure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 1997

Preventing & Resolving Burnout

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“The twin goals of preventing and building engagement are possible and necessary in today’s working world. These goals cannot be easily achieved by an individual. Rather, people have to work together to make them happen. And if we all commit ourselves to the long-term process of organizational progress, we will be rewarded with workplaces that are more productive and resilient as well as humane.”

~Maslach & Leiter, pg 127

The Truth About Burnout

Dewey’s Professional Health & Wellness Spectrum

High FunctioningHigh Productivity

Fair FunctioningDecreasing Productivity

Fair FunctioningReduced ProductivityRelationships Suffer

Fair-Not FunctioningFair-Not ProductiveInstitution & Family Loses

Burnout

Coping MechanismsFailing

Risk of MH issues and suicide

No Coping Mechanisms

Professionally Healthy& Well

Stressed

Coping Mechanisms Strong

Physical

Mental

Emotional

Spiritual

Work &

Family

Relations

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Professional Messages

• Expressing need = weakness

• Pretend you’ve got it all together

• Suck it up!

• For the greater good.

• More, faster, bigger, better!

• Your selfish if you take time for yourself

• Saying “no” = lazinessDewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.

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The greatest strength of any institution is it’s people!

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The Ethics of Self-Care

“The medical academy's primary ethical imperative may be to care for others, but

this imperative is meaningless if it is divorced from the imperative to care for oneself. How can we hope to care for others, after all, if we ourselves, are

crippled by ill health, burnout or resentment?”

Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.

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The Ethics of Self-Care

“…medical academics must turn to an ethics that not only encourages, but

even demands care of self.”

Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of Success.” Humana Press 2009; pg 7.

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The Ethics of Self-Care

1. Should you be ethically obligated to care for ourselves?

2. Do you feel empowered to demand your own self care?

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“The first wealthis

health.”~ Ralph Waldo Emerson

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Professional Health & Wellness

• Share a story about a time when you felt you had achieved a good level of work-life balance. What worked for you?– List several

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Vanderbilt ResourcesAbbrev. Program Focus Contact Number

FPWC Faculty and Physician Wellness

Committee

All issues of professional

health

Charlene Dewey x6-0678

FPWP Faculty and Physician Wellness

Program – Work/Life

Connections EAP

Treatment & counseling for

faculty and employees

Mary Yarbrough X6-1327

CPH Center for Professional Health

Training physicians

Bill Swiggart x6-0678

VCAP Vanderbilt Comprehensive

Assessment Program for

Professionals

Fit for duty assessments and treatment

Reid Finlayson X2-4567

CPPA Center for Patient and Professional

Advocacy

Identification and assistance

Jerry Hickson X3-4500

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Resources

• Primary care provider• Private counseling services• Institutional employee programs• Substance services: AA, NA, etc• 1-800-273-TALK: suicide prevention

hotline• Other:

– YMCA/YWCA, Massage envy, wellness programs– Center for Women in Medicine

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Individual Action Plan

1. Reflect

2. Self-assess: stress level/burnout

3. List three self-care areas to improve

4. List three ways to manage your energy

5. Identify a resource you will use if needed.

6. Define your plan:Specific and clear Plan/Timetable

Behavior not attitude What are your personal barriers?

Something you can count When will you start?

References1. ACP Ethics Manual 2. AMA Code of Ethics3. The 2007 Physician Charter4. Stern, D. “Measuring Medical Professionalism” Oxford Press 2006.5. Cole, T. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success.” Humana

Press 2009.6. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich &

Gritz, 2009.7. http://www.aamc.org/members/gwims/statistics/stats09/start.htm8. Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.

JAMA 254(19):2775-82. 9. Schindler et al. The Impact onof the changing Health Care Environment on the Health and Well-being of faculty at

Four Medical Schools. Academ Med 2006 81(1):27-34.10. “High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 200811. Williams et al. Physician, practice and patient characteristics related to primary care physician physical and

mental health: Results of the physician’s work-life study. Health Services Research, 2002; 37(1):121-43. 12. Faber et al. “Physician’s Experiences with patients who transgress boundaries.” J Gen Int Med 2000;15:770–

775. 13. Swiggart, Dewey, Hickson, Finlayson. “Identifying, Treating and Remediating the Distressed Physician.” 4/0914. Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of

Success.” Humana Press 2009; pg 7. 15. The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter

pg 9; 199716. Puddester D. West J Med 2001;174:5-717. Myers MJ West J Med 2001;174:30-3318. Gautam M West J Med 2001;174:37-4119. Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-5020. Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.

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Take Home Points

1. You are valuable! Self-care is the foundation to your vitality at home and work.

2. Look for and anticipate stress. Take action immediately to manage stress and energy.

3. Recall the 6 sources of burnout and seek ways to prevent burnout in the workplace.

4. Take advantage of resources when needed – esp MH!

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“Embracing the truth of who you are so that you can freely receive, give, and hope, regardless of your

circumstances.” ~Debbie Smith, M.A.

Center for Women in Medicine