PREVENT CLINICIAN BURNOUT IMPROVE CLINICIAN RETENTION AND ENHANCE

PREVENT CLINICIAN BURNOUT, IMPROVE CLINICIAN RETENTION AND ENHANCE PATIENT CARE Faith L Polkey, MD, MPH, FAAP Chief Clinical Officer Beaufort Jasper Hampton Comprehensive Health Services, Inc. Crystal A. Maxwell, MD, MBA, FAAFP Chief Medical Officer Sandhills Medical Foundation, Inc.

OBJECTIVES • Identify symptoms of burnout • Identify causes of burnout • Describe how burnout impacts clinician retention • Describe how burnout impacts patient care • Review ways to prevent and address burnout

PHYSICIAN BURNOUT SURVEY RESULTS Medical Economics 2019 https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisismedicine

https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

• What percentage of doctors said they had ever felt burned out during their career? A. 43% B. 62% C. 75% D. 92% https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

• What percentage felt burned out at the time of the survey? A. 47% B. 55% C. 68% D. 82% https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

• Rank these contributors to burnout A. Too much paperwork B. Lack of autonomy C. EHRs D. Poor work/life balance https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

https: //www. medicaleconomics. com/news/2019 -physician-burnout-survey-results-show-growing-crisis-medicine

WHAT IT LOOKS LIKE This Photo by Unknown Author is licensed under CC BY-SA-NC

SYMPTOMS • “[Job burnout is] a psychological syndrome in response to chronic interpersonal stressors on the job. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment. ” * Family Physician Burnout, Well-Being, and Professional Satisfaction (Position Paper)https: //www. aafp. org/about/policies/all/physician-burnout. html

PHYSICAL AND EMOTIONAL EXHAUSTION • Experiences physical and emotional exhaustion • • • Feels tired or drained most of the time Difficulty sleeping Difficulty focusing, experiences increased forgetfulness May experience physical symptoms – chest pain, GI symptoms, Has More frequent illness Decreased appetite Anxiety Depression Anger The Tell Tale Signs of Burnout…Do you have them? https: //www. psychologytoday. com/ca/blog/high-octane-women/201311/thetell-tale-signs-burnout-do-you-have-them

CYNICISM AND DETACHMENT • No longer enjoys activities • Glass is half empty • Talks negative regarding self • Becomes a loner • No longer participates in celebrations or lunches • No longer feels connected The Tell Tale Signs of Burnout…Do you have them? https: //www. psychologytoday. com/ca/blog/high-octane-women/201311/thetell-tale-signs-burnout-do-you-have-them

INEFFECTIVENESS AND LACK OF ACCOMPLISHMENT • Feels hopeless • Why bother, that patient will never change! • More irritable • Dr. X is in a mood today, you better watch out! • Not productive or has poor performance • Turning away patients • Poor quality scores • Difficulty completing charts or reviewing labs/documents The Tell Tale Signs of Burnout…Do you have them? https: //www. psychologytoday. com/ca/blog/high-octane-women/201311/thetell-tale-signs-burnout-do-you-have-them

MASLACH BURNOUT INVENTORY (MBI) http: //www. houstontx. gov/ldc/pdfs/Burnout_Self_Test_October_2018. pdf

CONSEQUENCES • Personal • Strain on family relationships • Health complications • Suicide • At work • • Difficulty with effective supervising/collaborative relationships Getting behind in charting, document/lab review Missed diagnoses Lack of participation

TURNOVER • 30% of primary clinicians do not work in the same primary care system after 2 – 3 years after reporting burnout* • 61. 7% of surveyed clinicians by the Association of Underserved Clinicians (ACU) indicated their job was a significant source of stress • In rural areas, 71. 4% of surveyed clinicians indicated their job was a significant source of stress • On a scale 1 -4, the rural clinicians scored 2. 33 (somewhat likely) when asked how likely they’d be at their current organization in 3 years. • Rural clinicians scored 3. 27 (very likely) when asked if they would remain in the field of work in 3 years • 70. 6% of full-time clinicians indicated their job was a significant source of stress *http: //www. annfammed. org/content/17/1/36. abstract

CAUSES • Insufficient resources for my patients • Family responsibilities/work-life balance • Workload • Turnover in staff • Insufficient resources for my organization • Organizational structure • Time to complete tasks • Sufficient team support to get my work done • A strong base of referral networks for patients • Culturally appropriate resources for my patients Stress and Provider Retention in Underserved Communities. Hayashi. Journal of Health Care for the Poor and Underserved 20 (2009): 597 -604

https: //news. cuna. org/articles/116275 -engagement-is-more-than-benefits

ENGAGEMENT • Engage (https: //www. merriam-webster. com/dictionary/engage) Ø to attract and hold by influence or power Ø to arrange to obtain the use or services of : HIRE engage a lawyer Ø to provide occupation for : INVOLVE engage him in a new project Ø to induce to participate: engaged the shy boy in conversation Ø to hold the attention of : ENGROSS her work engages her completely

RESPECT • Provider vs Clinician • Provider: • Hospital - business • Clinic - business • Pharmacy - business • Clinician: • • Physician – person Physician Assistant - person Nurse Practitioner - person Behavioral Therapist – person

https: //www. midlevelu. com/blog/md-vs-np-vs-pa-heres-how-number-clinical-hours-compare

ACKNOWLEDGE • Be positive • Something good can be found in almost everything • Every encounter should not be negative or for reprimand • Be caring • Always remember Clinicians are people first • Clinicians are expected to care about our patients. Administrative staff should be expected to in turn care about the Clinicians • Be intentional • Every person is different. • Purposefully individualize your approach

OBJECTIVITY • Avoid subjective language • You have poor performance • He/she doesn’t care • Be Data Driven • What are the goals? • What are the nuances? • What are the numbers? • Individual, Site, Organization • Be Transparent • How did you arrive at the numbers? • Patient lists • Lists reviewed for accuracy

EMPOWER • Use objective language • 40% of your patients were screened for cervical cancer last year. What barriers do you think caused it to be less than goal? How can we reach more of your patients? • • Facts/data: 40% YOUR patients: Ownership Request insight/feedback (ENGAGE) How can WE reach more: Support not dictate • How do you feel about what your quality results show? • Opens the door to seeing where the Clinician’s values and priorities are (you don’t have to assume or guess) • ENGAGE

ADDRESS Assess the barriers • Assess + Address = Success Assess workflows Assess effectiveness of the team + Address the barriers Address workflow disruptions Address ineffective of the team • An assessment is only as good as how it is addressed.

IDEAS TO CONSIDER • Safety net funds • Contract with local specialists, hospitals, other centers • Assess ways to reduce paperwork and data entry • Encourage activities such as exercise • Provide admin hours to address paperwork, np/pa chart review • Have sufficient support staff and use them at the top of their license • Practice team based care • Expanding roles – teaching, quality • Flexibility of work schedule Stress and Provider Retention in Underserved Communities. Hayashi. Journal of Health Care for the Poor and Underserved 20 (2009): 597 -604 Charleston doctors blame physician burnout on endless paperwork and data entry. Floyd. 9/12/19. https: //www. postandcourier. com/features/charleston-doctors-blame-physician-burnout-on-endless-paperwork-anddata/article_28665282 -c 9 a 1 -11 e 9 -833 c-d 78161106 cf 0. html

EXEMPLIFY • Engage: to attract and hold by influence or power • Why do Administrators do what they do? • Why do Clinicians do what they do? • 0 Clinicians + 1000 Patients = 0 Encounters • “Coming together is a beginning. Keeping together is progress. Working together is success. ” – Henry Ford

QUESTIONS? This Photo by Unknown Author is licensed under CC BY-NC