Compassion and Suffering In Healthcare MARK ROSENBERG MD
Compassion and Suffering In Healthcare MARK ROSENBERG, MD AND BECCA HAWKINS, ARNP DIRECTORS OF COMPASSIONATE CARE PROVIDENCE ST JOSEPH HEALTH
Faculty Disclosures: o N s L IL flict T S on C ST Dis ILL clo No sur es Mark Rosenberg and Becca Hawkins have no disclosures or conflicts of interest
Objectives • Review the relationship between burnout, suffering and compassion • Describe how compassion in healthcare can be a source of resilience • Share “compassion infusions” that can be implemented for individuals or teams to strengthen resilience
“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet” Rachel Naomi Remen
Burnout in Healthcare Emergency Nurses 80% Journal of Emergency Nursing 2010 ICU (Nurses and RT) 54 % Ind. Journal of Critical Care 2014 Ward RNs 47. 3% Journal of Nursing Management 2009 PT/OT 58% Journal of Allied Health 2002 Chiropractors 40% Williams: Doctoral Thesis@Seton Hall 2013 Mental Health Workers 21 -67% Admin. Policy Journal of Mental Health 2012 Social Work 75% Journal of Social Service Research 2005 Chaplains 68% Pastoral Psychology 2011 Dentists 50% European Journal of Oral Science 2007
Burnout Rates In Hospice and Palliative Care Clinicians Physicians All Other Burnout Rates 62% 66% • Most suffered from emotional exhaustion • Factors associated with highest burnout • Smaller organization • Long work hours • Less than 50 years • Working weekends Kamal, 2016, J Pain Symptom Management
Organizational Wellbeing Suffering Burnout Compassion Resilience
People Organization Compassion Suffering & Burnout Teams Leaders
Compassion “A deep feeling of connectedness with the suffering of others, that results in caring that aspires to bring comfort to the sufferer” Dewar, 2013, J Comparative Effectiveness Research
Confusing Language f o r s o f g lin pity, e e F th une : i y w h d rt at e o f p g s n i Sym ess, ti se's m l n sad eone e som Em rec path the ogniz y: Ab fe ility e a elin to nd gs un de of r an oth stan d er Compassion: Deep connection with the suffering of another, that motives a desire to relieve that suffering
We Are Wired For Compassion Empathy network Insula Cingulate cortex Medial prefrontal cortex Motivation to act Medial prefrontal cortex Periaqueductal gray Caring Behavior Medial pre-optic area Oxytocin
Research in Compassion � Energizes � Connects � Contagious � Can Be Developed � Can Start With Self
Compassion: Not just a Religious Concept Press Ganey Schwartz Center IHI Cleveland Clinic • Connecting Compassionate Care • Compassionate Collaborative Care • Focused on safety • Encourage joy, meaning & respect • Empathy and Patient Experience
Compassion-Suffering Paradigm Suffering Less Resilience Less Compassion Avoidance Behaviors Less Renewal
Caregiver Burnout Impacts on the Quadruple Aim Decreased Quality of Care Loss of Meaning & Purpose in Work Caregiver Impacts Increase in Errors Increased Attrition & Cost of Recruitment Burnout Caregiver Depression, Addiction & Suicide Career Dissatisfaction & Attrition Quality & Cost Impacts Quality Rated Lower by Patients Decreased Patient Satisfaction Decreased likelihood to recommend Patient Impacts
Providence Caregiver Burnout Rate 2016 = 54, 700 Responses Executive 32 Supervisor 43 Clerical/Admin 45 Overall 48 Clinical Aide 50 RN 52 EVS 20 54 0 10 20 30 40 50 60 Employee Engagement Survey Oct, 2016 & 2017
Providence Caregiver Burnout Rate 2016 = 54, 700 Responses 2017 = 80, 000 Responses Executive 32 Supervisor 43 Clerical/Admin 45 Overall 48 Clinical Aide 50 RN 52 21 EVS 54 0 10 20 30 40 50 60 70 Employee Engagement Survey Oct, 2016 & 2017
Impact of Burnout Highly Sustainably Engaged Intending to Stay 92% Have a “positive” Safety Domain Score 84% 75% 69% 66% 57% 43% 20% Low Moderate High Burnout Burnout Low Moderate High Burnout PSJH Caregiver Survey Oct 2017
Self Assessment & Seeking of Help 1: 16 Surgeons bothered by suicidal thoughts in last 12 months Standardized Physician Well Being Index 100 90 Of physicians scoring in bottom 30%. . . 80 70 60 50 40 Only 26% sought help 30 20 10 0 Archives Surgery 2011 } 70. 5% believed their well-being was average or above Shanafelt et al. Ann Surg 2014
Burnout & Resilience Community Workload Cynicism Values Congruence Rewards Exhaustion Control Lack of Accomplishment Fairness
Levers of Burnout Gregory et al J Healthcare Management March 2015 Emotional Exhaustion [CATEGORY NAME] Cynicism Workload & Control [CATEGORY NAME]
Compassion in Healthcare: It Really Matters Intending to Stay Feel Safe if I were a Patient Highly Sustainably Engaged 91% 86% 67% 59% 44% Less Than 3% 3% Able to Give Compassion Not Able to Give Compassion Supervisor Promotes Compassion Supervisor Does Not Promote Compassion Organization Supports Does Not Compassion Support Compassion PSJH Caregiver Survey Oct 2017
Compassion and Patients’ Rating of Quality 92. 3 89. 3 93. 5 94 100 % 90 R A T I N G 80 Q U A L I T Y (9/10) 70 60 Compassion =5 50 40 30 20 10 0 ED Inpatient Medical Group Home Health
Compassion and Patients’ Rating of Quality 92. 3 100 % R A T I N G Q U A L I T Y (9/10) 94 93. 5 89. 3 90 80 70 53. 2 48. 2 60 56 Compassion =5 50 Compassion <5 40 19. 2 30 20 10 0 ED Inpatient Medical Group Home Health
What To Do?
Compassion Infusions • Affinity Groups • Compassion Curriculum • Compassion Cornerstones • Compassionate Leadership • Connecting Conversations
Compassion Affinity Groups
What are Compassion Affinity Groups? • A multi-disciplinary group that forms to create compassion infusions for the area that they serve (hospital, clinic, ED, etc) • Role is to brainstorm ideas, implement, and sustain compassion infusions
Creating a Compassion Affinity Group § Funding: $5, 000 Innovation Grant § Identified leadership support (COO) § Solicited Project Manager § Affinity Group Participants § Employees of the Month § Multidisciplinary composition § Meet once monthly with provided lunch
Compassion Affinity Groups • Compassion Bouquets • Compassion Carts on nights and weekends • Compassion Card to all Surgical Patients • Festival of Trees Compassion Basket
Affinity Group: Key Learnings • Energizing and growth inducing for participants • Create small successful projects at first • Crucial to have facilitator and project manager functions covered • Incorporate professional development for participants
An Infusion For Clinic Based Teams “Strengthening Compassion in Outpatient Practice”
Providence Medical Group Study: Brief Overview Randomized, controlled non-blinded study; all clinic staff participated • Multi-faceted curriculum to encourage personal and team well being • Evaluation Process: • Evaluation Timing Session Feedback Ending of each session Curriculum Impact End of Curriculum Attitudinal Impact Baseline, 6 & 12 months Quality/Business Outcome Baseline, 6 & 12 months
Individual Session Structure Session Focus 1 Beginning the Adventure 2 Strengthening Compassion in PMG 3 Self-Compassion 4 Reflection Rounds: The Difficult Patient 5 Bringing Compassion to Our Patients 6 Reflecting on Our Patients 7 Building Teams Together 8 Reflection Rounds: Challenges of Teams 9 Holding Hope and Fear 10 Bringing your Best Self Forward 11 Reflection Rounds: Joy in the Clinic 12 Bringing it all Together • 12 sessions offered • Each 80 minutes in length • All sessions include Mindfulness • Sessions facilitated by clinic staff • Facilitators trained and supported by program, networking calls and materials
Reduced Burnout 60 MBI Subscales: 55 50 46 40 Reduced Total Burnout p=. 02* Reduced Emotional Exhaustion =. 03* Reduced Depersonalization p=. 05* Improved Accomplishment p=. 2 30 20 P<0. 05 10 0 Control Intervention
Improved Engagement Highly Sustainably Engaged 60 14 52 50 Disengaged 50 50 41 40 12 13 12 P=0. 02 10 8 8 8 2015 2016 30 6 20 4 10 2 0 0 2015 Treatment 2016 Control Treatment Control
Stabilized Intent to Stay 94 92 92 90 88 86 84 82 P<0. 05 84 82 80 81 78 76 74 2015 2016 Treatment Control
Better Patient Experience* Recommend Provider Recommend Clinic 4 3. 1 3. 5 Sensitivity to My Needs 3 2. 5 2 1. 5 1 P=0. 06 1. 3 P=0. 14 P=0. 06 0. 8 0. 1 0. 5 0 Control Intervention * Top Box Score: 6 months prior vs 6 months post 2. 4
Increased Productivity Average Visits/Month* 1000 500 P<0. 0001 0 -500 Baseline During Trial -1000 -1500 Control Intervention Post
Compassion Curriculum: Key Learnings • Support from executive leadership is critical • Insure the intervention is a gift, not an “add on” • Facilitator choice and training is critical • Evaluation is time consuming AND imperative • 60 minutes is enough • Mindfulness requires practice at home
Compassion Cornerstones Finding Meaning Self- Compassion Connection Wellbeing Mindful Pause Gratitude Hawkins & Rosenberg, 2017
Compassion Cornerstones In Practice Self. Compassion Mindful Pause Gratitude Finding Meaning
Cornerstones for Leaders • Help leaders find strength and resilience • Develop authenticity, as a person and leader • Practices that can be applied to personal and professional life • Create messages and practices to bring to your team
Real Time: Mindful Pause When What Why Washing Hands 3 deep breaths Letting go of what came before Logging into Computer Notice rhythm of typing the log-in and password Strengthening calm before EPIC Leaving for the Day Standing in doorway Express gratitude for three things that went well today
Real Time: Gratitude When What Why Starting Your Day Write 3 things you are Trigger the brain to grateful for look for positive Safety Huddles Express gratitude for work that has gone well Remind ourselves all of the goodness we do daily Team Meetings Create space for people to express gratitude for each other Improve team unity and appreciation
Real Time: Finding Meaning When What Why In Conversation Remember something Noticing the outward that is important to the connections that other person create meaning In Work & Play Before an activity, reflect on “why” you are spending time doing it Every Day Search out a moment Recognize, with of “awe” humility, our place in each day the universe Connecting inwardly to our purpose and heart
Real Time: Self-Compassion When What Why You gained weight • Stop the negative talk in To practice Self your head Kindness, and stop • Actively comfort the self critic yourself Made a mistake • Remind yourself that you are human • Practice in recognizing your humanity Recognize our humanity, which means we are imperfect Had an argument with a loved one • Notice your feelings of anger • Feel your anger as an emotion and not who you are Practice mindfulness so that you don’t react
Cornerstones for Self and Team Increased Team Cohesiveness • Improved Individual Coping and Resilience • Life Practices for Work and Home • Facilitating Authentic Connection •
Connecting Conversations • Forum for authentic sharing • Done in every setting • No fixing, just listening • Connection is key
Connecting Conversations: Evaluation Results
Find A Place of Rest In The Middle of Things Frank Ostaseski
To Contact Us: PHS. Compassion. Program@providence. org Compassion Team: Becca Hawkins, MSN, ARNP Director, Compassionate Care Rebecca. Hawkins@providence. org Laura Chun, MPM, PMP Manager, Compassionate Care Laura. Chun@providence. org Mark Rosenberg, MD, FACP Director, Compassionate Care Mark. Rosenberg@providence. org Krista Nelson, MSW, LCSW, OSW-C Connecting Conversations Program Krista. Nelson@providence. org
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