Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
Burnout:
Pit Falls & Prevention for Academic
Administrators in Psychiatry
Charlene M. Dewey, M.D., M.Ed., FACP
Associate Professor of Medical Education and Administration
Associate Professor of Medicine
Co-Director, Center for Professional Health
Vanderbilt University School of Medicine
Administrators in Academic Psychiatry National Meeting
October 28, 2010
Acknowledgements & COI
• Center for Professional Health
• Previous workshops @ Vanderbilt
• A New You!
• COI:
– Charlene M. Dewey, has no financial
conflicts of interest.
Women in Health Care
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
Women in Health Care
•
•
•
•
1.
2.
3.
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
http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml
Health of Faculty in Academic Medicine, 2009
http://www.adaa.org/about-adaa/press-room/facts-statistics
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
4. U.S. Department of Labor, Bureau of Labor Statistics, Employment and Earnings, 2008 Annual Averages and the
Monthly Labor Review, November 2007.
“If momma ain’t happy….
ain’t nobody happy!”
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?
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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.
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.
Agenda
1. Introduction
2. Stress and Burnout
3. Professional Health and Wellness
Spectrum
4. Individual Action Plans
5. Summary/Evaluation
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
Self-Awareness
“Self-awareness means having a deep
understanding of one’s emotions,
strengths, weaknesses, needs, and
drives. People with strong selfawareness are neither overly critical nor
unrealistically hopeful. Rather, they are
honest – with themselves and with
others.”
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
“What Makes a Leader?” by Daniel Goleman, Best of Harvard Business Review (1998)
Self-Assessments
• What stresses you out?
• Measure your stress level on the
stress-o-meter.
Stress free
Stressed out
Relaxed
Ready to cave in
Calm
Anxious
Engaged
Exhausted
Enthusiastic
Overwhelmed
Ready to go
At the breaking point
Stress & Burnout
• Stress and burnout occurs for different
reasons in different individuals.
• Work load ≠ level of stress or burnout in all
situations.
• Multifactorial
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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 <jobrelated stress>
~Webster’s Dictionary
Stress & Productivity
No
Prolonged
Stress
Prolonged
Stress
De
e
cli
tiv
ni
c
ng
du ess
Fu
o
r
r
t
P S
nc
ti
Burnout: Pitfalls & Prevention
Situational Stress
Stressed
Burnout
Reduced
Cognition
“Impairment”
???
on
Non-Functional
Work-Place Stress
Reduce work-place stress by:
– Managing your energy
– Reducing distractions
– Planning appropriately
– Managing failures and successes
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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
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
Burnout: Pitfalls & Prevention
The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It.
Maslach & Leiter pg 9; 1997
Six Sources of Burnout
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.”
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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
Burnout: Pitfalls & Prevention
Puddester D. West J Med 2001;174:5-7
Myers MJ West J Med 2001;174:30-33
Gautam M West J Med 2001;174:37-41
Symptoms of Burnout
1.Chronic exhaustion
2.Cynical and detached
3.Increasingly ineffective at work
4.Leads to:
1.
2.
3.
4.
isolation
avoidance
interpersonal conflicts
high turnover
Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do
About It.” pg 17
Figure 1
Spectrum of Disruptive Behaviors
Aggressive
Inappropriate anger,
threats
Passive
Passive
Aggressive
Hostile notes, emails
Yelling, publicly degrading
team members
Intimidating staff,
patients, colleagues, etc.
Derogatory comments about
institution, hospital, group,
etc.
Inappropriate joking
Pushing, throwing objects
Swearing
Outburst of anger &
physical abuse
Sexual
Harassment
Chronically late
Failure to return calls
Inappropriate/
inadequate chart notes
Avoiding meetings & individuals
Non-participation
Ill-prepared, not prepared
Complaining,
Blaming
Swiggart, Dewey, Hickson, Finlayson. 4/09
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Administrators in Academic Psychiatry National
Meeting
Two systems interact
The internal system
The external system
Functional &
nurturing
Good skills
Work Environment
Individual
Dysfunctional
Poor skills
Burnout: Pitfalls & Prevention
“The Perfect Storm”
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 health
Burnout: Pitfalls & Prevention
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.
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
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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
Burnout: Pitfalls & Prevention
Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50
Protective Factors
– A supportive spouse or partner
– Engage in religious or spiritual activity
– Hobbies
– Mentor (s)
Burnout: Pitfalls & Prevention
Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50
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
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
“Natural abilities which come
easily, are enjoyable to do,
and result in a sense of inner
satisfaction and
meaningfulness.”
~Nick Isbister
Burnout: Pitfalls & Prevention
Dewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.
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
Burnout: Pitfalls & Prevention
Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.
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?
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
Managing Energy: Case
Discussion
• 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
Preventing & Resolving Burnout
Individual Approach
Organizational Approach
Starts with
person
Starts with
management
Becomes group
project
Becomes organizational
project
Connects to organization
Connects to people
Outcomes affects related
mismatches
Outcome is a process
Burnout: Pitfalls & Prevention
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
The Truth About Burnout
“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
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Administrators in Academic Psychiatry National
Meeting
Dewey’s Professional Health &
Wellness Spectrum
Work &
Family
Relations
High Functioning
High Productivity
Fair Functioning
Decreasing Productivity
Fair Functioning
Reduced Productivity
Relationships Suffer
Fair-Not Functioning
Fair-Not Productive
Institution & Family Loses
Physical
Mental
Emotional
Spiritual
Burnout: Pitfalls & Prevention
Stressed
Professionally Healthy
& Well
Coping Mechanisms
Strong
Burnout
Coping Mechanisms
Failing
Risk of MH issues and
suicide
No Coping
Mechanisms
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” = laziness
Burnout: Pitfalls & Prevention
Dewey, C & Smith, D. “A New You!” Vanderbilt University School of Medicine 2010.
The greatest strength of any
institution is it’s people!
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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?”
Burnout: Pitfalls & Prevention
Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the
Pressures of Success.” Humana Press 2009; pg 7.
The Ethics of Self-Care
“…medical academics must turn to an
ethics that not only encourages, but
even demands care of self.”
Burnout: Pitfalls & Prevention
Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the
Pressures of Success.” Humana Press 2009; pg 7.
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?
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
“The first wealth
is
health.”
~ Ralph Waldo Emerson
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
Vanderbilt Resources
Abbrev.
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
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
Administrators in Academic Psychiatry National
Meeting
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
Individual Action Plan
1.
2.
3.
4.
5.
Reflect
Self-assess: stress level/burnout
List three self-care areas to improve
List three ways to manage your energy
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?
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010
Administrators in Academic Psychiatry National
Meeting
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Burnout: Pitfalls & Prevention
Burnout: Pitfalls & Prevention
16.
17.
18.
19.
20.
ACP Ethics Manual
AMA Code of Ethics
The 2007 Physician Charter
Stern, D. “Measuring Medical Professionalism” Oxford Press 2006.
Cole, T. “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success.” Humana
Press 2009.
“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich &
Gritz, 2009.
http://www.aamc.org/members/gwims/statistics/stats09/start.htm
Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.
JAMA 254(19):2775-82.
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.
“High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 2008
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.
Faber et al. “Physician’s Experiences with patients who transgress boundaries.” J Gen Int Med 2000;15:770–775.
Swiggart, Dewey, Hickson, Finlayson. “Identifying, Treating and Remediating the Distressed Physician.” 4/09
Cole, Goodrich & Gritz. “Faculty Health in Academic Medicine: Physicians, Scientists and the Pressures of
Success.” Humana Press 2009; pg 7.
The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter
pg 9; 1997
Puddester D. West J Med 2001;174:5-7
Myers MJ West J Med 2001;174:30-33
Gautam M West J Med 2001;174:37-41
Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50
Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.
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!
True thriving is…
“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
Created by: Charlene M. Dewey, M.D., M.Ed., FACP
Center for Professional Health – Vanderbilt University School of Medicine
October 27, 2010