Wellness Champion Retreat: - PowerPoint Presentation

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Wellness Champion Retreat:

burnout from a systemic approach

November 6, 2019

Wellness Steering CommitteeSaint Louis University School of Medicine GME

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Wellness Champion Mission Statement

Mission:  Psychological, emotional, spiritual and physical well-being are critical for a competent, caring, and resilient health care professional. Saint Louis University School of Medicine will foster a culture of well-being and self-care through its Wellness Champion Program.Vision: The Wellness Champion Program will facilitate wellness activities in Graduate Medical and Graduate Research Education through the personal and collaborative activities of the Wellness Champions and will support the development of wellness initiatives within programs at the School of Medicine.  

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AgendaReflectionWhy focus on the system? Discussion Personal writing exercise

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Reflection: Pastoral Care

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Wellness & well-being definedwellnessnoun

well·​ness | \ ˈwel-nəs  \Definition of wellness: the quality or state of being in good health especially as an actively sought goal

well-being

 noun

well-be·​ing | \ ˈwel-ˈbē-iŋ  \Definition of well-being: the state of being happy, healthy, or prosperous

 

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Burnout Defined

”Loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment" As defined by Mayo Clinic/AMA studyA syndrome of emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment

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Resilience defined

Resilience is one’s capacity to cope with stress and stressors within his/her environment and the ability to interact in a manner to promote personal well-being. Attainment of effective coping skills as a powerful survival method is a defining characteristic of a resilient individual.

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“When we talk about individual-level psychological interventions like Headspace, we’re really putting the onus on the person to reduce their stress levels,” said Crosswell. “A lot of times the conversation ignores the fact that there are systemic changes that need to happen—in particular in the medical community—that reduces stress levels for everyone.”

Feeling stressed? Overloaded? There's an app to help with that. Sara Berg, AMA. OCTOBER 14, 2019

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Burnout contributorsChange in work environmentRapid changes in knowledge and technologyProduction pressure

Work compressionFinancial pressureEHRStudy found each intern spent: < eight minutes with each patient per dayTotal work time with direct patient contact: 12% indirect patient care activities (orders, communicating with other physicians, and writing/reading progress notes): 66%

Kuhn, C.M. & Flanagan, E.M. Can J Anesth/J Can Anesth (2017) 64: 158.

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Burnout & medical culture

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Burnout consequencesAffect professional developmentContribute to medical errors and adverse eventsIncrease substance useSuicidal ideation**Physicians who report high levels of burnout report more medication errors than their counterparts with a lower risk of burnout.

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Depression in Physicians

Medical student/resident depression rates are 15-30% despite equal prevalence at the beginning of med school.Overall, depression rates are 12% in male and 19.5% in female physicians, similar to general population. Bright & Krahn, 2011

Suicidal ideation pre-intern year 4%Suicidal ideation intern year 25%Sen, et al 2010

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Physician wellness as an acgme focus

201220152016

2017

2011

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Physician Well-being national perspective"Honestly, as I see it, the system has asked us as psychiatrists to weigh in on how to promote “physician (or resident) wellness”.  This is a complete distractor.  This isn’t about physician wellness.  Problems with physician wellness is a downstream effect of inefficient, ineffective, and at times toxic working conditions.  Focusing on physician wellness (as if that is the problem) allows systems to continue the status quo.  In our respective roles we have to push back on this.  We have to demand accountability in the systems where we work.  To the extent we have leadership roles, we need to leverage that for change. We also need to figure out how we leverage our collective voices as a group because individually we aren’t going to get very far."

--Melissa Arbuckle, MD, PhDVice Chair for Education, Director, Residency Training, Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute. *Copied with permission.

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Strategy for Improving wellness in physiciansAttention to the physician as an individualAddress the stressors of the particular work setting (e.g., clinical unit or department) Institutional approaches

National policies and strategies addressing physician wellnessKuhn, C.M. & Flanagan, E.M. Can J Anesth/J Can Anesth (2017) 64: 158.

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Reflection We are creative, resilient individuals. How can we lead in our department, institution, system, nationally?

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summaryPhysicians complete suicide at alarming rates, more so than any other professionStrategies to improve physician well-being are going to requires us to look at: Individual resilience, burnout, identification and treatment of depression/mental illnessDepartment- and institution-level strategies to improve work-life balance and work environment/expectationsNational advocacy with physician representation in the business of healthcare

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DiscussionSmall groupsWhat have you done to make change at SLU? What are the reasonable goals for small change in your everyday culture? Larger goals from an institution level?

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GoalsWriting exercise

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Thank youCONFIDENTIAL Behavioral Health Program 314.977.1066 Appointment Scheduling/ 24-hour Clinician On-Call

National Suicide Prevention LifelineCall 1-800-273-8255Available 24 hours everyday