Week 7 Presentation: Health Professional Well-Being

Burnout

• A psychological syndrome that involves a prolonged response to chronic interpersonal stressors on the job that results in feelings of being over-extended and depleted of one’s emotional and physical resources

• Emotional exhaustion

• Depersonalization

• Cynicism

• Reduced sense of personal accomplishments

• Transaction between the characteristics of the work environment and the characteristics of the health care worker

• The cumulative stress of the job overcomes the person’s ability to cope and problem-solve effectively

Emotional Exhaustion

• Feeling overextended and overwhelmed by work demands

• Negatively affects the quality and safety of healthcare delivery

  • Medical error, health-care associated infections

• Higher health-care costs due to staff turnover and lower job productivity

• Significant personal suffering for health-care providers

  • Broken relationships, alcohol and substance abuse, depression, suicide

• Don’t have the empathy and compassion to treat patients

Depersonalization

• Detachment

• Indifference

Cynicism

• An inclination to believe that people are motivated purely by self-interest

• Skepticism

Reduced Sense of Personal Accomplishments

• Feelings of inadequacy, perceptions of failure, decreased confidence

Total Worker Health Program

• Policies, programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being

• Developed by the National Institute for Occupational Safety and Health

  • Through our national government

Issues Relevant to Advancing Worker Well-Being Through Total Worker Health

• Control of hazards and exposures

• Organization of work

• Built environment supports

• Leadership

• Compensation and benefits

• Community supports

• Changing workforce demographics

• Policy issues

• New employment patterns

Control of Hazards and Exposures

• Chemicals

• Physical agents

• Biological agents

• Psychosocial factors

• Human factors

• Risk assessment and risk management

Organization of Work

• Fatigue and stress prevention

• Work intensification prevention

• Safe staffing

• Overtime management

• Healthier shift work

• Reduction of risks from long work hours

• Flexible work arrangements

• Adequate meal and rest breaks

Built Environment Supports

• Healthy air quality

• Access to healthy, affordable food options

• Safe and clean restroom facilities

• Safe, clean and equipped eating facilities

• Safe access to the workspace

• Environments designed to accommodate worker diversity

Leadership

• Shared commitment to safety, health, and well-being

• Supportive managers, supervisors, and executives

• Responsible business decision-making

• Meaningful work and engagement

• Worker recognition and respect

Compensation and Benefits

• Adequate wages and prevention of wage theft

• Equitable performance appraisals and promotion

• Work-life programs

• Paid time off (sick, vacation, caregiving)

• Disability insurance (short & long-term)

• Workers’ compensation benefits

• Affordable, comprehensive healthcare and life insurance

• Prevention of cost shifting between payers (workers’ compensation, health insurance)

• Retirement planning and benefits

• Chronic disease prevention and disease management

• Access to confidential, quality healthcare services

• Career and skills development

Community Supports

• Healthy community design

• Safe, healthy and affordable housing options

• Safe and clean environment (air and water quality, noise levels, tobacco-free policies)

• Access to safe green spaces and non-motorized pathways

• Access to affordable, quality healthcare and well-being resources

Changing Workforce Demographics

• Multigenerational and diverse workforce

• Aging workforce and older workers

• Vulnerable worker populations

• Works with disabilities

• Occupational health disparities

• Increasing number of small employers

Policy Issues

• Health information privacy

• Reasonable accommodations

• Return-to-work

• Equal employment opportunity

• Family and medical leave

• Elimination of bullying, violence, harassment, and discrimination

• Prevention of stressful job monitoring practices

• Worker-center organizational policies

• Promoting productive aging

New Employment Patterns

• Contracting and subcontracting

• Precarious and contingent employment

• Multi-employer worksites

• Organizational restructuring, downsizing, and mergers

• Financial and job security

Injuries

• Prevention of injuries

  • Overexertion and bodily reaction

  • Slips, trips, falls

  • Contact with objects

  • Transportation incidents (higher on list than others- home health)

  • Violence (working with TBI, aggressive children, home health)

  • Exposure to substances (hospital setting)

• Nearly 69% of OT’s are at risk for injuries, with musculoskeletal injury a common risk

• Body mechanics to prevent injuries

Infectious Diseases

• Prevention

  • Education and appropriate use of safety supplies and equipment

  • Consistently reporting and reviewing data on infection rates at the institution, community, state, national, global levels

  • Hand hygiene

  • Secondary prevention- containment to avoid transmitting the infection

• Workers have the right to

  • Working conditions that do not pose a risk of serious harm

  • Receive information and training about hazards, prevention, and OSHA (occupational safety and health association)

  • Review records of work-related injuries and illness

  • File a complaint with OSHA

  • Exercise rights under law without retaliation

Stress

• Exposure to infectious diseases

• Productivity demands

• Insufficient staffing

• Role ambiguity

  • Knowing who needs to do what

• Complex authorization

• Management system

• Ethical dilemmas

• Moral distress

Moral Distress

• Tension that arises when a practitioner is unsure of the best course of action to take or encounters a barrier that prohibits doing what is known to be right

  • Being expected to obtain as many billable units as possible per client regardless of individual client needs

  • Being unable to provide optimal therapy because of limited insurance coverage

  • Being expected to treat and/or documentation for more clients than time allows

Stress Risk-Reduction Strategies: Organizational Change Interventions Examples

• Address work-related stressors such as inadequate work space, unreasonable workload, lack of readily available resources, inadequate and unsafe equipment

• Recognize and take action on legitimate concerns regarding overbearing physicians and supervisors

• Establish employee assistance programs and organizational change programs

• Provide greater flexibility with job assignment, hours, alternative job arrangements

• Develop and implement training for supervisors on techniques to reduce worker stress

Stress Risk-Reduction Strategies: Stress Management Interventions

• Educate employees about job stress

• Establish and maintain stress management programs

• Provide readily available counseling from a nonjudgemental source

• Provide group therapy for specific job-related stressors

• Use of relaxation exercises and biofeedback until stress source is lifted

Improving the Well-Being of Health-Care Professionals: Resilience

• Protective against compassion fatigue

• Can be learned

• Mutual trust and connectedness to colleagues has a significant impact on resilience and protects against burnout

• A resilient health-care professional has the ability to maintain personal and professional well-being in the face of ongoing work stress and adversity

Resilience Protective Factors (Can All be Learned)

• Supportive relationships

• Healthy coping strategies

• A sense of purpose

• Positive parenting by caring adults

• Emotional self-awareness

• Safe environments and stable finances

• The willingness to seek help

• Problem-solving skills

Protective Factors to Face Challenges

Compassion Fatigue

• An emotional state with negative psychological and physical consequences that emanate from acute or prolonged caregiving of people stricken by intense trauma, suffering, or misfortune

• A direct result of a caregiver ignoring the symptoms of personal stress combined with inattention to personal emotions over time

• Attacks the OT’s empathy and ability to show compassion

• Very important to address these symptoms of personal stress

1st Stage of Burnout

• A compulsion to prove oneself

2nd Stage of Burnout

• Working harder to meet one’s own high expectations

3rd Stage of Burnout

• Neglecting basic personal self-care needs

4th Stage of Burnout

• Displacement and the inability to recognize and deal with the source of one’s distress

5th Stage of Burnout

• Revision of values and the dismissal of once-important relationships and activities

6th Stage of Burnout

• Denial of emerging problems

• Intolerance

• Cynicism

• Aggression

7th Stage of Burnout

• Withdrawal

• Isolation

• loss of hope or direction

• Escape through alcohol or drug use

8th Stage of Burnout

• Behavioral changes obvious to family and friends

• Increasing feelings of worthlessness

9th Stage of Burnout

• Depersonalization

• A loss of emotional connectedness to self and others

10th Stage of Burnout

• Pervasive feeling of inner emptiness that may lead to addictive behaviors, such as gambling, overeating, compulsive sexual behavior, and drug and alcohol abuse

11th Stage of Burnout

• Depression

• Loss of meaning

• Apathy

• Hopelessness

12th Stage of Burnout

• Burnout

• Total mental and physical collapse

• Potential for suicide

• A need for immediate medical and psychological attention

Clinician Well-Being Model

• Relationship between patient, clinician, and the complex interaction of factors that affect professional well-being and thereby have an impact on patient care

Prevention: Microsystem (Individual)

• Care for your mind/body/spirit

• Engage in behaviors that increase energy, lower stress, and contribute to health and well-being

  • Sleep, nutrition, physical activity, social support

• Active coping

• Mindfulness

• Yoga

• Gratitude

• Self-compassion

Prevention: Mesosystem- Worksite/Organizational

• Programs, policies, benefits, environmental supports, and links to the surrounding community designed to meet the health and safety needs of all employees

• Target interventions to each specific workgroup based on needs

• Cultivating community at work

• Promoting flexibility and work-life integration

• Providing resources to promote professional self-care and resilience

Prevention: Macrosystem

• Federal and state agencies, legislatures, accreditation organization, third-party payers, etc.

• Productivity expectations, certification requirements, quality metrics, documentation requirements, electronic health records

Compassion Fatigue Symptoms

• Trouble sleeping/exhaustion

• Increased emotional reactivity/hypersensitivity to emotional material

• Hypervigilance or heightened sensitivity to potential threats to self

  • Become reactive when something comes at you that is too much

• Diminished interest to feel empathy

• Anger and irritability

• Absenteeism (work, family, social) or poor work skills

• Difficulty separating work life from personal life

• Emotional exhaustion