SPEAKER WILL BE TAKEN BOTH FROM
THE MICROPHONES IN THE AISLES AS
WELL AS ONLINE, THE VIDEOCAST
VIEWERS MAY SUBMIT QUESTIONS AT
ANY TIME DURING THE LECTURE BY
SCROLLING DOWN AND CLICKING THE
LIVE FEEDBACK BUTTON LOCATED ON
THE VIDEOCAST WEBSITE, QUESTIONS
WILL BE ANSWERED AS TIME
PERMITSA THE CONCLUSION OF THE
PRESENTATION.
SO TODAY WE'RE HONORED TO HAVE
OUR SPEAKER DR. LOTISSUING
TI DYRBYE, AN, LOTTED PROFESSOR
ON ENGAGE OF BURN OUT, SHE IS
THE SENIOR ASSOCIATE DEAN OF
FACULTY AND PROFESSOR OF THE
UNIVERSITY OF COLORADO SCHOOL OF
MEDICINE, SHE EARNED HEAR
DOCTORATE FROM THE UNIVERSITY OF
WISCONSIN MEDICAL COOL FOLLOWED
BY A RESIDENCY BY THE SCHOOL OF
WASHINGTON AND SCHOOL OF
MEDICINE IN SEATTLE.
SHE EARNED A MASTERS DEGREE IN
HEALTH PROFESSIONS, EDUCATION,
FOR THE UNIVERSITY OF
ELIMINATEDDIBLE AT CHICAGO
COLLEGE OF MEDICINE WHICH IS MY
ALMA MATER.
DR. DYRBYE, EARNED HER PRACTICE
AND LATER JOINED THE MAYO CLINIC
AS FACULTY.
SHE SERVED AS ASSOCIATE CHAIR OF
DEPARTMENT OF MEDICINE AND
SERVED INLET ROLES OF FACULTY
DIVERSITY AS IT RELATES TO
PROFESSIONAL SATISFACTION.
SHE STARTED RESEARCHING BURN OUT
AFTER WITNESSING DIFFICULTIES
THAT MEDICAL STUDENTS AND
RESIDENTS WERE HAVING DURING
TRAINING AND SHE BECAME GRADUATE
FOR THE MAYO EDUCATION.
HER PRESENT ROLE IS SENIOR
ASSOCIATE DEAN AS WELL AS CHIEF
WELL BEING OFFICER AT THE
UNIVERSITY OF THE COLORADO.
A DISTINGUISHED TEACHER AND
RESEARCHER, DR. DYRBYE HAS
RECEIVED FUNDING FROM THE NIH,
NHLBI, AND THE AMERICAN MEDICAL
ASSOCIATION.
SHE HAS MENTORED DOZENS OF
TRAINEES AND IS A CO AUTHOR ON
MORE THAN 150 PEER REVIEWED
STUDIES INCLUDING RANDOMIZED
CLINICAL TRIALS TO IIDENTIFY
PREVENT AND REDUCE BURN OUT IN
THE CLINICAL WORKFORCE.
DR. DISRKS YRBYE'S RESEARCH HAS
INCLUDED RESEARCH ON PHYSICIAN
WELL BEING ON THE SCORE CARD FOR
ORGANIZATIONAL LEADERS AND STATE
MEDICAL LICENSING BOARDS.
HER WORK WAS THE IMPETUS FOR THE
NATIONAL ACADEMY MEDICINE ACTION
ON WELL BEING AND RESILIENCE
WHERE SHE SERVES AND APPLIES
PRAGMATIC AND BROADLY
APPROACHABLE STRATEGIES FOR BUN
OUT.
SHE HAS ALSO CALLED TO THE FLOOR
THE THREAT OF SAFE QUALITY TO
CARE IS THE MOST DOWNLOADED N.
A. M. PAPER TO DATE.
IN HER ORGT WORK SHE OUTLINES
HOW HEALTHCARE ORGANIZATIONS CAN
BOTH MEASURE AND PRIORITIZE
IMPROVEMENTS IN CLINICAL WORK
ENVIRONMENTS TO MITIGATE
CLINICIAN BURN OUT AND FOSTER
WELL BEING AMONGST LEARNERS AS
WELL AS PRACTITIONERS.
DR. DYRBYE IS SOUGHT OUT AS A
LEADER IN THE BURN OUT SECTION,
AND SHE IS A SPEAKER THAT IS
SOUGHT OUT NATIONALLY AND
INTERNATIONALLY.
WE'RE SO HAPPY SHE IS JOINING US
TODAY.
TODAY'S TITLE IS TAKING ACTION
AGAINST BURN OUT.
PLEASE JOIN ME IN WELCOMING OUR
GRAND ROUNDS SPEAKER
DR. LOTTIE DYRBYE.
>> THANKS.
IT'S REALLY A PLEASURE TO BE
HERE TODAY.
I WILL NOT STAND BEE HIND THE
PODIUM, I HOPE THAT'S OKAY, SO,
I HAVE A DISCLOSURE, I WILL NOT
TALK ABOUT THE WELL BEING INDEX
BUT IT'S IN THE CME MATERIALS.
SO THESE ARE MY VERY WELL
WRITTEN LEARNING OBJECTIVES, SO
WHAT WE WILL DO TODAY TOGETHER
IS TALK ABOUT THE WHAT, THE SO
WHAT, BUT MOST IMPORTANTLY THE
NOW WHAT?
WHICH IS WHY I THINK YOU'RE HERE
TODAY WITH ME; SO THE WHAT, WHAT
IS BURN OUT, WE ALL HAVE OUR OWN
DEFINITIONS OF THAT FROM A
RESEARCH PERSPECTIVE.
IT'S AN OCCUPATION OF PHENOM
NANOG THAT IS CAUSED BY
UNMITIGATED LEVEL OF WORK
STRESS, WE THINK ABOUT IT IN
TERMS AT THE OF EMOTIONAL EXBE
HAWOF THION, LIKE I I'M THE END
OF MY ROPE, I HAVE NOTHING ELSE
TO GIVE, A SENSE OF BEING
CALLOUS OR DETACHED AND/OR A
VERY LOW ACCOMPLISHED PERSON AND
WE DON'T SEE THAT MUCH IN
MEDICINE BUT BURN OUT IS A
CONSTRUCT THAT'S BEEN STUDIED IN
ALL SORTS OF DIFFERENT
PROFESSIONS.
SO IN THEIR MOST RECENT NATIONAL
STUDY OF PHYSICIANS ACROSS THE
UNITED STATES, PRIVATE PRACTICE,
ACADEMIC GOVERNMENT, INDUSTRY,
WE SEE HERE IN 2021 THAT ABOUT
63% OF PHYSICIANS HAD REALLY A
HIGH PREVALENCE OF BURN OUT.
NOW I'M GOING TO TALK ABOUT BURN
OUT AS IF YOU HAVE IT OR YOU
DON'T.
AND THAT'S NOT REALLY THE CASE,
RIGHT?
IT'S A MATTER OF DEGREES, IT'S
CONTINUOUS AND VARIABLE, JUST
CONTINUE TO TALK ABOUT ODDS
RATIOS SO WE WILL TALK ABOUT
BURN OUT AS MORE OF A YES/NO
PHENOMENON EMPLOY AND WHAT WE
KNOW ABOUT BURN OUT IS THE MORE
YOU WORK, THE HIGHER YOUR RISK
OF BURN OUT, RIGHT?
THE WORK HOURS IS THE PRIMARY
DRIVER.
WE ALSO SEE KIND OF CONTRARY TO
COMMONLY HELD BELIEFS THAT
YOUNGER PHYSICIANS ARE AT HIGH
RISK FOR BURN OUT, SO IT DOESN'T
MATTER IF YOU LOOK AT GENERAL
INTERNISTS OR SURGEONS OR LOOK
AT PEOPLE IN PRIVATE PRACTICE OR
ACADEMICS OR THE GOVERNMENT, THE
YOUNGER YOU ARE, THE HIGHER YOUR
RISK FOR BURN OUT EVEN AFTER WE
CONTROL FOR WORK HOURS, AFTER WE
CONTROL FOR SPECIALTY IN A
VARIETY OF OTHER FACTORS.
THE GENDER STORY IS COMPLICATED,
YOU'LL SEE LOTS OF PUBLICATIONS
OUT THERE ABOUT WOMEN HAVING A
HIGHER RISK OF BURN OUT AND YOU
KNOW WOE IS ME, RIGHT, BUT THAT
ACTUALLY GOES AWAY AFTER WE
CONTROL FOR THINGS LIKE SEXISM
IN THE WORK ENVIRONMENT.
SO WE CAN TALK A LITTLE BIT MORE
ABOUT THAT.
BUT JUST BEING A WOMAN DOESN'T
SOMEHOW MAKE US MORE VULNERABLE
TO HAVING HIGH LEVELS OF WORK
STRESS AND GETTING BURN OUT
RELATIVE TO INDIVIDUAL WHO IS
IDENTIFY WITH MALE GENDER.
HIGHER PAID MAKES A BIG
DIFFERENCE, SO BEING A SALARY
MODEL VERSUS BEING EAT WHAT YOU
KILL MODEL WHERE IT'S BASED ON
BILLING FOR DOCS OUT IN PRIVATE
PRACTICE, MAKES A HUGE
DIFFERENCE AND THERE'S BIG
DIFFERENCES BY SPECIALTY.
SO YOU MAY REMEMBER THE DAYS FOR
THOSE OF YOU WHO ARE PHYSICIANS,
THE ROAD TO HAPPINESS WHEN YOU
THOUGHT ABOUT WHAT SPECIALTY TO
PICK, RADIOLOGY, OPHTHALMOLOGY,
ANESTHESIA, DERMATOLOGY, HASN'T
NECESSARILY PANNED OUT SO WE SEE
A BIG VARIABILITY IN THE BIG
PRESENCE OF PHYSICIAN BURN OUT,
DEPENDING ON SPECIALTY, I DON'T
KNOW WHAT'S GOING ON IN UROLOGY,
BUT THEY'RE RIGHT UP THERE,
EMERGENCY MEDICINE IS ALWAYS
RIGHT UP THERE, AND EVEN AFTER
WE CONTROL FOR WORK HOURINGS AND
ACADEMICS AND PRIVATE PRACTICE
AND A VARIETY OF OTHER FACTORS,
WE SEE THAT DOCS WHO WORK IN THE
EMERGENCY DEPARTMENT HAVE MUCH
HIGHER RATES OF BURN OUT,
RELATIVE FOR EXAMPLE TO A
GASTRONEUROLOGYIST OR OTHER TYPE
OF INTERNAL MEDICINE
SUBSPECIALIST.
WE ALSO SEE THAT THE
PEDIATRICIANS ARE ALWAYS HAPPY,
I DON'T KNOW IF IT'S THE CUTE
KIDS OR THE GREAT SCRUBS THEY
GET TO WEAR BUT WE SEE LESS BURN
OUT IN THE PEDIATRICIANS IN
GENERAL RELATIVE TO OTHER
SPECIALTY PRACTICES.
AND ALTHOUGH, WE FELT LIKE WE
WERE MAKING STRIDES, YOU KNOW
FROM OUR NATIONAL STUDIES OF
PHYSICIANS ACROSS THE UNITED
STATES, ALL SPECIALTIES, PRIVATE
PRACTICE, ET CETERA, DIFFERENT
PRACTICE SETTINGS, FROM 2014, TO
2020, WE SAW NATIONALLY THAT THE
RATE OF BURN OUT WAS GOING DOWN,
AND THEN THIS LITTLE COVID THING
HAPPENED, RIGHT?
AND COMPLETELY DERAILED THINGS
WE AND WE SAW DRAMATIC INCREASE
IN BURN OUT RATES ABOUT 20 OR SO
MONTHS INTO THE PANDEMIC, BUT OF
COURSE IT WASN'T UNIFORM RIGHT,
LIKE FOR SOME DOCS WE HAD LITTLE
TO DO, FOR OTHER DOCS WE HAD A
LOT TO DO AND WE SEE REALLY HIGH
RATES POST PANDEMIC IN DOC WHO
IS WORK IN THE EMERGENCY
DEPARTMENT, CRITICAL CARE, IN
THE HOSPITALS AND OBVIOUSLY IN
INFECTIOUS DISEASES, RIGHT?
NO BIG SURPRISE.
WE ALSO SEE REALLY HIGH RATES OF
BURN OUTS IN DOCS WHO HAD
ECONOMIC DISRUPTIONS BECAUSE OF
COVID WHO DIDN'T HAVE ENOUGH
ACCESS TO PERSONAL PROTECTIVE
EQUIPMENT, AND WHO GOT SICK.
SO IT ALSO KIND OF LENDS TO THE
QUESTION RIGHT, ISN'T EVERYBODY
JUST BURN OUT, IS THIS A
PHENOMENA'S UNIQUE TO HEALTHCARE
WORKERS OR UNIQUE TO PEOPLE WHO
DO SCIENCE AND HEALTHCARE, WERE
THE LAWYERS AND OTHER
PROFESSIONALS, PILOTS, AREN'T
THEY JUST BURNT OUT, TOO?
ISN'T IT JUST A REFLECTION OF
OUR SOCIETY, A 24/7 KIND OF
SOCIETY.
SO WE LOOKEDDA THE THAT,
ACTUALLY, WE PARTNERED WITH A
COMPANY THAT COULD GIVE US A
SAMPLE, REPRESENTATIVE SAMPLE OF
OTHER U.S. WORKERS TO SORT OF
SEE, IS THERE SOMETHING UNIQUE
TO BEING A PHYSICIAN IN
PRACTICE, AND WE AJUSTED FOR A
VARIETY OF DIFFERENT FACTORS,
RIGHT?
WORK HOURS, AGE, GENDER, ET
CETERA, THINGS THAT WE COULD
REASONABLY CONTROL FOR.
AND WHAT WE FOUND IS IN THE
UNITED STATES, IT DOESN'T MATTER
WHAT YOU DO FOR A LIVING, THE
MORE HOURS YOU WORK, THE HIGHER
YOUR RISK FOR BURN OUT,
SIMILARLY WE SAW THAT DOESN'T
MATTER WHAT YOU DO FOR A LIVING,
THE YOUNGER YOU ARE, THE HIGHER
YOUR RISK FOR BURN OUT.
BEING MARRIED IS PROTECTIVE, AND
THEN WE SAW SOMETHING REALLY
INTERESTING HAPPEN WITH
EDUCATION.
SO RELATIVE TO HAVING A HIGH
SCHOOL EDUCATION, IF YOU HAD A 4
YEAR'S BACHELOR EDUCATION, YOU
WERE AT LOWER RISK FOR BURN OUT.
IF YOU HAD A MASTER'S DEGREE
RELATIVE TO A HIGH SCHOOL
DEGREE, YOU HAD LOWER ODDS OF
BURN OUT, IF YOU HAD ANOTHER
PROFESSIONAL DEGREE EXCEPT FOR
BEING A DOCTOR, LIKE A Y. D., A
Ph.D., A PSYCHE D, YOU HAD
ODDS OF BURN OUT LOWER RELATIVE
TO THOSE WHO WENT TO HIGH SCHOOL
ONCE YOU CONTROL FOR WORK HOURS
BUT IF YOU HAD A M. D. OR D. O.
OR EQUIVALENT BEHIND YOUR NAME,
YOU HAD INCREASE ODDS OF BURN
OUT RELATIVE TO U.S. WORKERS
EVEN AFTER CONTROLLING FOR WORK
HOURS AND OTHER FACTORS.
AND INDEED WE HAVE SEEN THIS IN
2011, 2014, 2017, 2020 THAT THE
RATE OF BURN OUT IS HIGHER IN
U.S. PHYSICIANS RELATIVE TO
OTHER U.S. WORKERS.
AND WHEN WE LOOK BACK, WE SEE
THE SAME STORY IN OUR RESIDENTS
AND FELLOWS AND IN OUR MEDICAL
STUDENTS.
SO THAT BEGS THE QUESTION, ARE
THEY LETTING THE WRONG PEOPLE
INTO MEDICAL SCHOOL, THEY'RE
LETTING ALL THE 1S WITH
RESILIENCY DEFICIENCY INTO
MEDICAL SCHOOL AND THAT'S OUR
SOLUTION EMPLOY I WAS ACTUALLY
ASKED THAT, BECAUSE PEOPLE HAVE
WRITTEN ABOUT THE DOCTOR
PERSONALITY.
I THINK THIS IS A PERSONALITY OF
MANY OF US, RIGHT, WE HAVE KIND
OF AN EXCESSIVE SENSE OF GUILTY
AND RESPONSIBILITY AND YOU KNOW
SORT OF DOUBT AND IN MANY WAYS
IT'S ADAPTIVE, IT'S A GOOD
THING, IT MAKES US THOROUGH,
MAKES US COMMITTED, MAKES US GO
TO GRAND ROUNDS, YOU KNOW, LIKE
WE'RE LEARNING THINGS ALL THE
TIME, WE RECOGNIZE THE
IMPORTANCE OF THE WORK THAT WE
DO, THE DECISIONS THAT WE MAKE,
RIGHT, WE'RE VERY RIGOROUS BUT
IT CAN BE MALADAPTIVE, WE CAN
HAVE A HEARD TIME SETTING
LIMITS, LETTING GO, DOING
IMPORTANT SELF-CARE PIECES LIKE
GET RECHARGED, RIGHT, TAKE OUR
VACATION AND NOT ACTUALLY WORK
ON OUR VACATION EMPLOY.
SO, YOU KNOW ARE WE LETTING THE
WRONG PEOPLE INTO MEDICAL SCHOOL
AND THE SOLUTION LIES IN FIXING
ADMISSIONS.
SO WE LOOK AT THAT RIGHT BECAUSE
I GOT TIRED OF BEING ASKED THAT,
AND IT TURNS OUT THAT
MATRICULATING MEDICAL STUDENTS
HAVE LESS BIRN OUT AND OTHER
QUALITY OF LIFE THAN OTHER U.S.
COLLEGE GRADUATES THE SAME AGE.
SO THE DATA WE HAVE AT LEAST
SUGGESTS THAT AT MA TRIBULATION
MEDICAL STUDENTS ARE VERY
SIMILAR TO THE U.S. POPULATION
AND MAYBE EVEN A LITTLE BETTER.
SO SOLUTIONS PROBABLY DON'T LIE
IN FIXING ADMISSIONS.
BUT SOLUTION CERTAINLY NEED TO
START EARLY, THINKING ABOUT
WHAT'S HAPPENING IN MEDICAL
SCHOOL, WHAT'S HAPPENING IN
RESIDENCY AND WHAT'S HAPPENING
OUT IN PRACTICE.
ALL RIGHT, SO THAT WAS THE FIRST
LEARNING OBJECTIVE, YOU NOW
KNOW, BURN OUT'S HIGH, IT'S A
BIG PROBLEM, IT'S AN
OCCUPATIONAL PHENOMENON, IT'S
NOT A MEDICAL DISEASE, IT'S
CAUSED BY HIGHER LEVEL OF WORK
STRESS, HIGHER ON DOCS THAN
OTHERS IN THE U.S. POPULATION
AND NOT BECAUSE WE'RE LETTING A
LOT OF PEOPLE INTO MEDICAL
SCHOOL, SO THAT'S WHAT YOU FIRST
LEARNED INLET FIRST 15 MINUTES
OR SO THAT WE WERE TOGETHER.
BEFORE WE CAN GET TO THE NOW
WHAT, WE NEED TO TALK ABOUT THE
SO WHAT.
BECAUSE YOU NEED TO BE ABLE TO
ARTICULATE WHY THIS MATTERS SO
YOU CAN GET SORT OF THE
INITIATIVE GOING AROUND THE NOW
WHAT.
WHAT ARE WE GOING TO CHANGE?
HOW ARE WE GOING TO ADDRESS THE
PROBLEMS?
SO IN THE NATIONAL ACADEMY OF
MEDICINE CONSENSUS REPORT WHICH
YOU CAN DOWNLOAD FOR FREE,
THEY'RE ALL CLIFF NOTES AND
THEY'RE ALL OVERWORKED AND TOO
BUSY, YOU CAN LOOK AT THOSE IF
YOU WANT.
OR YOU CAN LOOK AT THE SURGEON
GBL'S REPORT, SAME INFORMATION,
SAME CONTENT, INERED ONER TO
REALLY SUMMARIZE WHAT'S GOING
ON, WHY IS THIS HAPPENING AND
WHY IS IT IMPORTANT.
TO SUM IT UP, HERE'S THE SLIDE,
THAT SUMS IT UP WHY WE SHOULD
CARE, THE SO WHAT.
I'M GOING TO TALK A LITTLE BIT
ABOUT SOME OF THESE THINGS BUT
WE KNOW BURN OUT IS RELATED TO
MORE EXPENSIVE CARE THAT IT'S
RELATED HOW WE BEHAVE AND SHOW
UP AT WORK, WE'RE LIKELY TO BE
UNPROFESSIONAL AND WE'RE BURNT
OUT, WE HAVE A LOWER SENSE OF
ACCOUNTABILITY REPORTING
IMPORTANT COLLEAGUES AND
PROFESSIONAL, WE'RE MORE LIKELY
TO SAY WE'VE COMMITTED MAJOR
MEDICAL ERROR, TO BE INVOLVED IN
MEDICAL MALPRACTICE LITIGATION
SUIT, IT'S--THERE'S A
RELATIONSHIP BETWEEN BURN OUT
AND HOSPITAL ASSOCIATED
INFECTIONS AND THERE'S A COUPLE
OTHER THINGS I WILL POINT OUT.
SO HERE'S A DEEPER DIVE INTO
SOME OF THIS LITERATURE, RIGHT?
O THIS IS A COUPLE STUDIES OVER
2000 NURSES OR 5000 PHYSICIANS,
AND WE SAW VERY STRONG
RELATIONSHIP BETWEEN BURN OUT
AND SELF-REPORTED UNPROFESSIONAL
BEHAVIORS.
WE SAW A MUCH LOWER COMMITMENT
TO PRACTICING COST CONSCIOUS
CARE AND THE DOCTORS WHO ARE
BURNT OUT RELATIVE TO THOSE WHO
WEREN'T.
AND WE SAW AS I MENTIONED A
LOATER SENSE OF RESPONSIBILITY
TO PHYSICIANS AND NURSES IF THEY
HAD BURN OUT.
WE ALSO SEE IN LONGITUDINAL
STUDIES OF RESIDENTS, SO ALL
SPESHTS, WE FOLLOW THESE WITH
SECOND OR THERD YEAR THAT THERE
WAS A RELATIONSHIP BETWEEN BURN
OUT AND RACIAL BIAS.
SO IN THIS STUDY, WE SOUGHT
OVERALL BETWEEN THE SECOND YEAR
RESIDENCY AND THE THIRD YEAR
RESIDENCY, EXPLICIT BIAS TO OUR
BLACK PATIENTS WENT DOWN, GOOD
THING.
WE SAW THAT THE RESIDENTS WHO
DIDN'T HAVE BURN OUT AT EITHER
TIME POINT THAT THEY HAVE THE
LOWEST AMOUNT OF BIAS TOWARD OUR
PATIENTS.
GOOD THING.
WE SAW THAT THE RESIDENT WHO IS
RECOVERED FROM BURN OUT OVER THE
COURSE OF A YEAR, HAD THE MOST
REDUCTION IN THEIR BIAS TOWARD
BLACK PATIENTS.
IS WE SAW THAT THE RESIDENTS WHO
HAD WORSENING IN THEIR BURN OUT
DURING THIS TIME PERIOD HAD
DRAMATIC INCREASES IN THEIR BIAS
TOWARDS BLACK PATIENTS.
SUGGESTING AT LEAST THAT SOME OF
THE DISPARITIES WE CAN CONTINUE
TO SEE IN HEALTHCARE MAY VERY
MUCH RELATE TO THE LEVEL OF BURN
OUT IN OUR HEALTHCARE WORKFORCE.
OTHER STUDIES HAVE SHOWN THAT
WHEN SURGEONS ARE BURNT OUT
THEY'RE TWICE AS LIKELY TO SAY
THEY COMMITTED A MAJOR MEDICAL
ERROR.
THEY'RE ALSO TWICE AS LIKELY TO
ACTUALLY BE INVOLVED IN THE
MEDICAL MALPRACTICE LITIGATION
SUIT.
WE KNOW THAT THE LEVEL OF BURN
OUT IN NURSES IS AN INDEPENDENT
PREDICTER OF HOSPITAL ASSOCIATED
INFECTIONS.
WE KNOW THAT THE LEVEL OF BURN
OUT, IN DOCTORS AND NURSES IN
THE ICUs IS INDEPENDENT
PREDICTOR OF PATIENT MORTALITY.
AND THERE'S BEEN MULTIPLE
SYSTEMATIC REVIEWS AND
META,AINAL SIS THAT REALLY
SUMMED UP SORT OF THIS
RELATIONSHIP BETWEEN BURN OUT
AND SUBOPTIMAL QUALITY AND
SAFETY OF CARE.
WE ALSO KNOW FROM LONGITUDINAL
STUDIES WE CONDUCTED AT MAYO
CLINIC IS THAT AS BURN OUT
WORSENS OVER A TIME PERIOD, IT'S
ASSOCIATED WITH DRAMATIC
REDUCTIONS AND FTEs, SO IN
TIME, TAKING CARE OF PATIENTS
AND THIS STUDY FOR JUST 1 POINT
INCREASE IN 1 OF THE DOMAINS OF
BURN OUT, THERE WAS A 43%
INCREASE ODDS THAT THAT DOCTOR
WAS GOING TO REDUCE THE TIME
TAKING CARE OF PATIENTS OVER THE
NEXT 2 YEARS.
AND IF YOU EXTRAPOLATE THE MAYO
DATA NATIONALLY IT WOULD EQUIP
TO 3 GRADUATING CLASSES OF
MEDICAL STUDENTS SIMPLY NOT
WORKING AND YOU ALL KNOW THAT WE
HAVE A PHYSICIAN SHORTAGE, SO
THIS IS NOT A GOOD THING.
WE ALSO KNOW FROM LONGITUDINAL
STUDIES WHERE PEOPLE HAVE DONE
SURVEYS USING VALIDATED MEASURES
OF BURN OUT AND THEN LATER
LOOKED AT PERSONNEL RECORDS, WE
KNOW THAT DOCS WHO ARE BURNT OUT
ARE TWICE AS LIKELY TO LEAVE
THEIR CURRENT JOB AND THAT
OBVIOUSLY IMPACTS ACCESS AND IT
COSTS GAZILLION DOLLARS.
SO IF WE LOOK AT TURNOVER AND
LOSS OF FTE DIRECTLY
ATTRIBUTABLE TO BURN OUT IN THE
UNITED STATES ONLY IN
PHYSICIANS, IT'S COSTING THE
HEALTHCARE SYSTEM 4.6 BILLION
DOLLARS A YEAR.
AT THE LEVEL OF THE ORGANIZATION
IT'S $7600.
SO THIS IS EXPENSIVE AND THAT'S
JUST THE DOCS, WE SEE THE SAME
RELATIONSHIP WITH 26,000
HEALTHCARE WORKERS, THIS
RELATIONSHIP BETWEEN BURN OUT
AND REDUCTION IN TIME TAKING
CARE OF PATIENTS ISSUES RIGHT?
DECISIONS ABOUT HOW YOU'RE GOING
TO SPEND YOUR TIME, WHETHER
YOU'RE FULL-TIME, WHETHER YOU'RE
GOING TO .8, THE WHETHER YOU GO
TO .6, ET CETERA.
AND IF THE BUSINESS CASE DOESN'T
HELP YOU WITH GETTING TO THE NOW
WHAT, MAYBE THE MORAL CASE WILL
GET YOU THERE.
SO DOCS WHO ARE BURNT OUT ARE
MORE LIKELY TO HAVE SUBSTANCE
USE DISORDER PROBLEMS AND
THEY'RE MORE LIKELY TO HAVE
SUICIDAL IDEATION, AND WE KNOW
FROM OUR LONGITUDINAL STUDIES IN
MEDICAL STUDENTS THAT BURN OUT
IS AN INDEPENDENT PREDICTER OF A
STUDENT DEVELOPING THOUGHTS OF
SUICIDE OVER THE COURSE OF A
YEAR, EVEN AFTER WE CONTROL FOR
SYMPTOMS OF DEPRESSION.
ALL RIGHT, SO WHY IS THIS
HAPPENING, RIGHT?
SO WE KNOW THAT BURN OUT IS
CAUSED BY HIGH LEVELS OF WORK
STRESS.
I THINK WE CAN ALL SIT HERE AND
THINK ABOUT A GAZILLION THINGS
THAT ARE CAUSING HIGH LEVELS OF
WORK STRESS.
WHAT WE KNOW IS THAT IT'S NOT A
RESILIENCY DEFICIENCY, OKAY?
WHAT WE KNOW IS THAT MUFFIN
MONDAYS ARE NOT GOING TO FIX OUR
PROBLEM.
WHEN WE LOOK AT RESILIENCE IN
PHYSICIANS, IT'S ACTUALLY HIGHER
THAN IN OTHER U.S. WORKERS AND
WHEN WE LOOK AT RESILIENCE AND
BURN OUT, THERE'S ABOUT 29% OF
THE PHYSICIANS WITH THE HIGHEST
POSSIBLE RESILIENCY SCORE STILL
HAVE BURN OUT, RIGHT?
LIKE THIS IS NOT REALLY WHERE
THE SOLUTION LIES, THE SOLUTION
LIES IN ATTACKING THE REALLY
COMPLICATED MULTIFACTORIAL
DRIVERS THAT ARE CONTRIBUTING TO
HIGH LEVELS OF WORK STRESS IN
ALL FORMS OF HEALTHCARE WORKERS.
SO A LOT OF TIMES WE
CONCEPTUALIZE IT AROUND THESE
DOMAINS THAT WAS PUBLISHED A FEW
YEARS AGO.
IT'S ULTIMATELY DRIVEN BY WORK
HOURS, SO ALL THE THINGS THAT
ARE DRIVING UP YOUR WORK HOURS,
WOWR WORK LOAD BUT ALSO WORK
EFFICIENCY, THAT'S A PIECE OF
IT.
IT'S NOT JUST WORK HOURS, IT'S
ALSO OTHER DO MAINS WE WORKED
ABOUT, LIKE CONTROL, STABILITY,
AUTONOMY, DECISION LATITUDE,
IT'S ALSO THINGS RELATED TO
VALUES.
IF YOU FEEL LIKE YOUR VALUES ARE
ALIGNED WITH THE VALUES OF THE
ORGANIZATION THAT YOU WORK FOR,
HOW MUCH MEANING AND WORK YOU'RE
ABLE TO GET, HOW MUCH SORT OF
ALIGNMENT THERE IS BETWEEN WHAT
YOU REALLY ENJOY DOING AND WHAT
YOU'RE ABLE TO DO AT WORK.
IT ALSO RELATES TO SUPPORTING
CAMARADERIE AT WORK WHICH WE
WILL TALK A BIT ABOUT, AND THEN
THE ABILITY TO DO SORT OF WORK
LIFE INTEGRATION, RIGHT IN WE
DON'T CALL IT BALANCE DWOAR,
ANYMORE, BALANCE IS OUT, WE'VE
MOVED TO EPITHELIALIGRATION, WE
CAN TALK MORE ABOUT THAT AND I
DIDN'T WANT TO GO TOO MUCH INTO
THE LITERATURE ABOUT ALL THESE
DIFFERENT THINGS BECAUSE I THINK
THEY'VE BEEN STUDIED MOSTLY IN
PRACTICES AND HEALTHCARE
SETTINGS VERY DIFFERENT FROM
THEIR WORLD, RIGHT?
IT'S A LOT OF TIMES THINGS
RELATED TO LIKE THE INBASKET,
HOW MANY MESSAGES, PHYSICIANS
ARE GETTING EVERYDAY, IT'S
RELATED TO THINGS LIKE ALTHOUGH
YOU HAVE CHALLENGES WITH YOUR
ELECTRONIC HEALTH RECORD, A LOT
OF IS RELATED TO INEFFICIENCIES
RELATED TO ELECTRONIC HEALTH
RECORD, RIGHT?
SO IT'S A LOT OF THESE VERY
NUANCED THINGS BUT IT'S NOT JUST
THAT, IT'S NOT JUST THE EHR,
IT'S NOT JUST THE IN BASKET,
IT'S THINGS THAT ARE HAPPENING
WITHIN OUR CULTURE.
FOR EXAMPLE IN OUR BIG STUDIES
OF PHYSICIANS WE SAW THAT 20-30%
OF THE PHYSICIANS IN THE LAST
YEAR HAD EXPERIENCED OFFENSIVE
RACIAL ETHNIC REMARKS FROM
PATIENTS, SEXIST REMARK PRS
PATIENTS, FAMILIES OR VISITORS,
UNWANTED SEXUAL ADVANCES AND
EVEN REFUSAL OF CARE, RIGHT?
LIKE A PATIENT SAYING YOU CAN'T
CARE FOR ME BECAUSE YOU KNOW THE
WAY YOU LOOK?
BECAUSE OF YOUR DEMOGRAPHIC
BECAUSE OF YOUR RACE, BECAUSE OF
YOUR ETHNICITY, BECAUSE OF YOUR
DOT, DOT, DOT, PICK IT, RIGHT?
AND THIS IS HAPPENING A LOT TO
OUR HEALTHCARE WORKERS, IT
HAPPENS MORE TO WOMEN, IT
HAPPENS MORE TO RACIAL AND
ETHNIC MINORITY PHYSICIANS, IT
HAPPENS MORE TO OUR YOUNGER
PHYSICIANS, IT HAPPENS MORE TO
OUR PHYSICIANS WHO WORK IN THE
EMERGENCY ROOM, AND THE MORE
THIS HAPPENED, THE HIGHER THE
RISK OF BURN OUT, RIGHT?
THIS IS ANOTHER WORK STRESSOR
THAT EVEN THE PERFECT EHR, IS
NOT GOING TO AFFECT.
THERE ARE THINGS THAT ARE GOING
ON IN OUR CULTURE THAT ARE
CAUSING A LOT OF STRESS AND
DISTRESS FOR OUR HEALTHCARE
TEAM.
AND FRANKLY SOMETIMES WE DO IT
TO EACH OTHER, RIGHT?
WE DO IT TO EACH OTHER, WE SEE
THIS PARTICULARLY IN OUR
REZONING DEBTS THAT THE FEMALE
RESIDENTS HAVE MORE, WE WILL
CALL THEM SUBOPERATING GLOBALLY
MALEXPERIENCES AT WORK WITH
COLLEAGUES AND THESE NEGATIVE
INTERPERSONAL EXPERIENCES, THEY
PREDICT BURN OUT A YEAR LATER
EVEN AFTER WE CONTROL FOR A HOST
OF OTHER FACTORS ISSUES BASE
LINE DEPRESSION, ANXIETY,
QUALITY OF LIFE SCORES, BASE
LINE BURN OUT SCORES.
IT DOESN'T MATTER, WE SEE THEEN
NEGATIVE INTERPERSONAL
EXPERIENCES BETWEEN COLLEAGUES
PREDIBTS BURN OUT AND ALL THIS
DATA AROUND THE IMPLICATIONS TO
QUALITY, SAFETY, ACCESS, YOU
KNOW IT HAS REALLY CULMINATED IN
LEADERS AROUND THE COUNTERRY
SAYING HEY, WE HAVE A PROBLEM
AND WHAT'S IMPORTANT ABOUT THIS
IS WE HAVE A COLLECTIVE
RESPONSIBILITY TO RESPOND.
WHAT WE HAVE TO DO IS STOP
OTHERRING, BLAMING OTHER PEOPLE
ALL THE TIME FOR OUR WORK
STRESS, OR FEELING LIKE THE
VICTIM.
WHAT WE NEED TO DO IS FIGURE OUT
HOW TO LEAN IN, HOW TO DO WHAT
WE CAN IN OUR SPIRIT OF CONTROL,
HOW WE CAN BETTER INFLUENCE, AND
HOW WE CAN BETTER ADVOCATE ON
THINGS THAT ARE OUTSIDE THE
CONTROL OF OUR EMPLOYER.
SO THAT GETS ME TO WHAT I REALLY
WANT TO TALK ABOUT WHICH IS THE
NOW WHAT, BUT IT IS IMPORTANT
THAT WE ALL HAVE A COMMON
DEFINITION OF BURN OUT, IT IS
BRNT THAT WE ALL UNDERSTAND ITS
PREVALENCE AND ITS CONSEQUENCES
SO WE CAN GET TO THE REALLY
IMPORTANT WORK OF STARTING TO
FIGURE OUT WHAT ARE POSSIBLE
APPROACHES TO THINK ABOUT THIS.
I WANT TO JUST BRIEFLY TAKE YOU
A LITTLE BIT ON THE JOURNEY I'VE
BEEN ON, SO I STARTED DOING THIS
RESEARCH ABOUT 20-22 YEARS AGO.
AND YOU KNOW WE DID A LOT OF
STUDIES JUST DOCUMENTING THE
PREVALENCE, STARTING TO SAY,
WHAT ARE SOME OF THE
ASSOCIATIONS WITH THINGS THAT
PEOPLE CARE ABOUT.
THE AMA STARTED TO GET ONBOARD
AND THEY MADE THEIR PATHWAY, YOI
IN MEDICINE PATHWAY TO TRY TO
GET HEALTHCARE ORGANIZATIONS TO
ENGAGE IN CHANGE.
WE THEN SPENT A COUPLE YEARS
GOING TO NAM AND GOING BACK AND
FORTH COAST TO COAST AND HAVING
MEETINGS AND READING 5000
ARTICLES READING THINGS AROUND
THE CONSENSUS REPORT.
THEN WE GOT THE SURGEON GENERAL
INVOLVED, KEN MURPHY IS GREAT
WITH THIS WORK, THE INI GOT
INVOLVED THE NATIONAL ACADEMY OF
MEDICINE IS IN ON IT, THEY HAVE
A PLAN FOR WORKFORCE WELL BEING
TRYING TO GALVANIZE ACTION AT
ALL LEVELS OF THE SYSTEM THROUGH
THE UNITED STATES.
WE HAVE LOR NA BREENE, DOING
WORK FOR OTHER HEALTHCARE
WORKERS AND U.S. NEWS AND WORLD
REPORT AS EVEN GOTTEN INTO IT
NOW THIS MAY NOT BE SUPER REEL
SUPER
RELEVANT TO YOU BUT A LOT OF
HOSPITALS ARE CONCERNED ABOUT
THEIR RATINGS, YOU CAN ARGUE
ABOUT THE PROS AND CONS OF THE
RATINGS, HOW MUCH CAN YOU GAIN
IN THE SYSTEM, BUT NONETHELESS,
THESE MATTER TO THE CSUITE, AND
AS NIEWZ AND WORLD REPORTS
REPORT, THE RATING SYSTEM
INCLUDES DO HAVE YOU ANYTHING
GOING ON TO PROMOTE A POSITIVE
WORK ENVIRONMENT AND TO
ENCOURAGE WELL BEING?
THEY ALSO HAVE A QUESTION ABOUT
DO YOU HAVE ANYTHING GOING ON?
SO IT'S STARTING TO GET ON THE
AGENDA WHICH IS REALLY
IMPORTANT.
SO HOW IS THIS STUFF HELPFUL?
WELL IT'S HELPFUL BECAUSE THE
VERY OUTER CIRCLE OF THE THINGS
THAT GIVE US WORK STRESS ARE NOT
DIRECTLY IN CONTROL OF OUR
EMPLOYER OF A HEALTHCARE
ORGANIZATION.
THEY RELATE TO THINGS THAT ARE
GOING ON AT CMS, AT THE JOINT
COMMISSION, AT STATE MEDICAL
LICENSE BOARDS AT BOARD
CERTIFICATION ORGANIZATIONS, AND
IT'S IMPORTANT TO GET THIS OUTER
CIRCLE ENGAGED BECAUSE ALL THE
CIRCLES NEED TO PLAY TOGETHER TO
REDUCE THE WORK STRESS.
WE WILL ALSO TALK MOSTLY ABOUT
HEALTHCARE ORGANIZATIONS BECAUSE
I THINK THAT'S THE PIECE THAT
MAYBE IS MOST TRANSLATABLE TO
YOUR WORK HERE, AND THEN WE'RE
GOING TO FOCUS ON THAT INNER
CIRCLE WHICH HAS MORE TO DO WITH
UNITS WITH TEAMS.
SO IN ALL OF THESE EXPERT
OPINIONS FROM THE NATIONAL
ACADEMY OF MEDICINE, TO THE U.S.
SURGEON GENERAL, TO THE AMA, TO
THE IHI, TO THE CDC, NIASH,
TOTAL HEALTH WORKER PROGRAM,
THEY ALL HAVE THE SAME FRAMEWORK
FOR HOW TO IMPROVE A WORK
ENVIRONMENT.
IT'S ALL THE SAME AND IT
BASICALLY--1 TAKES LEADERSHIP,
IT TAKES COMMITMENT FROM THE TOP
AND WITHOUT THAT, IT'S REALLY,
REALLY HARD TO GET ANYTHING DONE
EMPLOY SO LEADERSHIP COMMITMENT.
IT TAKES INFRASTRUCTURE, LIKE
YOU HAVE INFRASTRUCTURE TO
IMPROVE QUALITY AND SAFETY, YOU
NEED INFRASTRUCTURE TO IMPROVE
THE WORK AND LEARNING
ENVIRONMENT.
IT TAKES MEASUREMENT AS IN
QUALITY, YOU NEED TO KNOW WHERE
YOU'RE AT, WHAT'S CONTRIBUTING
TO IT AND HOW AND IF WHEN YOU
MOVE FORWARD, IT MAKES A
DIFFERENCE OR NOT.
AND THEN IT TAKES A SYSTEM LEVEL
ACTION THATIME GOING TO TALK
ABOUT AND GIVE YOU SOME EXAMPLES
FOR.
SO THERE NEEDS TO BE THIS
ORGANIZATIONAL WEALTH, THERE
NEEDS TO BE BUY-IN THAT THE
LEVEL OF OF WELL BEING IN YOUR
WORKFORCE MAKES A DIFFERENCE IN
THE MISSION, RIGHT?
THERE NEEDS TO BE THIS ALIGNMENT
BETWEEN THE DECISIONS THAT TOP
LEADERSHIPS MAKE AND THE VALUES
THAT ARE ON THE STATIONARY,
RIGHT?
THAT NEEDS TO BE ALIGNED AND WE
NEED TO MEASURE WELL BEING AND
HAVE IT BE PART OF OUR ROUTINE
ORGANIZATIONAL PERFORMANCE
METRIC.
LIKE WE HAVE FOR EXAMPLE, LENGTH
OF STAY AND THINGS OF THAT
NATURE IN THE PATIENT REALM.
AND IT TAKES SOMEONE DRIVING THE
BUS, RIGHT IN IT TAKES
INFRASTRUCTURE LIKE WE HAVE FOR
FINANCE, QUALITY, OTHER THINGS
IN HEALTHCARE, IT DOES TAKE
SOMEONE WHO'S LEADING IT AND IT
CAN JUST BE 1 PERSON DRIVING A
BUS ALIGN.
THERE NEEDS TO BE OTHER PEOPLE
ON THAT BUS WITH YOU WHICH IS
CUT THROUGH THAT LENS OF
LEADERSHIP DISTRIBUTEMENT.
SO THIS IS OFTEN CONCEPTUALIZED
AS LEADERS WITHIN WORK UNITS
THEY CAN HAVE A VARIETY OF
DIFFERENT ROLES, INCLUDING
FINDINGS FROM SURVEYS, MOST
IMPORTANTLY LEADING LOCAL
IMPROVEMENT EFFORTS AND I WILL
SHARE EXAMPLES OF THAT.
THEY CAN ALSO DO WORK IN TERMS
OF CULTIVATING COMMUNITY WHICH
IS INCREDIBLY IMPORTANT, SHARING
RESOURCES, FOR WHERE TO GET
HELP, AND WE NEED TO MEASURE,
RIGHT IN WE NEED TO MEASURE
WHERE WE'RE AT SO WE KNOW IF
WHAT WE'RE DOING IS MAKING A
DIFFERENCE.
SO WE CAN TALK SOME ABOUT
POTENTIAL DIFFERENT TOOLS TO DO
THAT, AND ULTIMATELY IT TAKES
THIS MODEL OF DRIEWBTED
LEADERSHIP.
SO LET'S GET MORE PRAGMATIC,
RIGHT?
SO WHAT DO I MEAN BY ALL THESE
THINGS, WHAT ARE EXAMPLES OF
WHAT'S GOING ON OUTSIDE OF THE
ISLAND OF THE NIH IN YOU KNOW TO
HELP IMPROVE THE WORK
ENVIRONMENT?
SO THIS IS AN EXAMPLE FROM GROUP
HEALTH AND IF YOU WORK IN THE
OUTPATIENT SETTING AS ANY TYPE
OF CLINICIAN, YOU ARE PROBABLY
LIKE, OKAY, I WANT MOST OF THOSE
THINGS, RIGHT?
FOR ME, I'M A GENERAL INTERNIST,
I TAKE CARE OF PATIENTS AT
LOWRY, AN OUTPATIENT SETTING,
I'M LIKE UH-UHH, I WANT ALL
THOSE THINGS.
O GROUP HEALTH IMPLEMENTED ALL
THOSE THINGS AND THEN THEY DID A
PRE-POST DESIGN AND SAW THE
PATIENT EXPERIENCE WENT UP, THEY
SAW THAT THE COST OF CARE WENT
DOWN AND THEY SAW THAT THEIR
BURN OUT AND HEALTHCARE WORKERS
IMPROVED.
SO IT'S POSSIBLE.
THEY'RE EVEN GETTING INTO IT AT
THE VA.
THEY DID THIS INITIATIVE CALLED
CREW, CIVILITY, RESPECT AND
ENGAGEMENT, SO YOU MIGHT HAVE
HEARD ABOUT HUDDLES, THEY GET
EVERYBODY ON TRACK WITH WHATEVER
WE'RE GOING TO DO WITH THE
PATIENTS TODAY, THIS WAS KIND OF
LIKE THAT, EXCEPT IT WAS MORE
FOCUSED ON HOW ARE WE GOING TO
WORK TOGETHER, TODAY.
WHAT ARE THE THINGS THAT WE'RE
TRYING TO IMPROVE TOGETHER TO
CARE FOR OUR PATIENTS, RIGHT?
AND THEY FOUND THAT WITH THIS
SORT OF, YOU KNOW CREW
INITIATIVE, THEY DID HAVE
FACILITATORS, THAT THEY WERE
ACTUALLY ABLE TO REALLY, TO MOVE
THE NEEDLE ON SOME OF THESE
IMPORTANT MATTERS.
SO THE CANADIAN LIKE WHAT WAS
GOING ON AT THE VA AND THEY
IMPLEMENTED IT IN THEIR
HEALTHCARE SYSTEM, AND THEY SAW
THAT THEY WERE ABLE TO DECREASE
CYNICISM WHICH IS THAT 1
COMPONENT OF BURN OUT, BUT
IMPORTANTLY THEY COULD INCREASE
SATISFACTION WITH BEING EMPLOYED
AT THE CANADIAN HEALTHCARE
SYSTEM AND THEY REDUCED
ABSENTEEISM WHICH WAS A BIG
ISSUE FOR THEM.
IN COLORADO WE HAVE SPRINT
TEAMS, SO SO IT TAKES TRAINING
ME AS A CLINICIAN TO USE THE
ELECTRONIC HEALTH RECORD BETTER
AND I'M A RELUCTANT LEARNER.
IT ALSO TAKES BELLING THINGS
WITH THE ELECTRONIC HEALTH
RECORD WE CALL CONFIGURURATIONS
SO THE SYSTEM WORKS BETTER FOR
ME IN MY PRACTICE AND THEN IT
TAKES SOME SORT OF SYSTEM
DISTRIBUTION, YOU KNOW DOES THAT
MESSAGE GO FIRST TO THE DOC OR
THE MEDICAL ASSISTANT OR KIND OF
THE WORK FLOW PIECES AND WHAT
THEY WERE ABLE TO SHOW IN
COLORADO WITH THE SPRINT TEAM
SYSTEM THAT IT REDUCED BIRN OUT
AMONG THE CLINICAL WORKFORCE BY
INVESTING AND THINKING ABOUT
WHAT CAN WE REALLY DO TO
OPTIMIZE THE ELECTRONIC HEALTH
RECORD WITHIN PRIMARY CARE,
WITHIN GI, WITHIN PULMONARY AND
CRITICAL CARE, OTHER HEALTH
SYSTEMS HAVE USED WHAT'S CALLED
GROWTH, IT WAS PUBLISHED IN THE
NEW LINE JOURNAL MEDICINE, YOU
WILL GET TO THE ARTICLE, NOW
PEOPLE ARE GOING, WE SHOULD CALL
IT GROW, WHATEVER, YOU KNOW,
IT'S CALLED IMROAGHTS, GETTING
RID OF TIEWP EDUCATIONAL STUFF.
SO THE SYSTEM HERE IS YOU ASK
EVERYBODY, BOOTS ON THE GROUND,
WHAT'S THE STUPID STUFF, YOU
SOLICIT ALL THESE COMMENTS AND
YOU PUT THE COMEBTS INTO 3
BUCKYS, THE BUCKET OF OH YEAH,
THAT'S STUPID AND WE SHOULD HAVE
FIXED THAT A LONG TIME AGO AND
WE SHOULD HAVE FIXED THAT.
THE SECOND BUCKET IS YEAH,
THAT'S STUPID BUT WE NEED A
COMMITTEE TO FIGURE OUT THE HOE
PROS AND CONS AND HOW WE WOULD
FIX THAT AND IMPLEMENT THAT AND
HOW IT WOULD WORK.
AND THEN WE HAVE THE YEAH,
THAT'S TIEWP EDUCATIONAL ABOUT
YOU THAT WILL TAKE A GAZILLION
DOLLARS, WE WILL PUT THAT IN THE
PARKING LOT AND HOPE THAT AI
SOLVES IT, RIGHT?
AND SO THIS KIND OF STRATEGY HAS
BEEN SHOWN IN DIFFERENT MULTIPLE
ORGANIZATIONS TO ACTUALLY LEAD
TO MEANINGFUL INPROVEMENT
PARTICULARLY WITH RESPECT TO THE
ELECTRONIC HEALTH RECORD SO
GETTING RID OF STUPID CLICKS AND
GETTING RID OF OTHER THINGS THAT
ARE DRIVING US NUTS, THE 10,000
PAPER CUTS.
BUT SOMETIMES WHEN PEOPLE HAVE
DONE THESE SORT OF GROWTH
INITIATIVES, AND YOU GO TO
ADMINITRATION WITH YOUR GREAT
IDEAS, ADMINISTRATION SAYS,
THERE'S A RULE, THERE'S A
REGULATION, WE CAN'T POSSIBLY
CHANGE THAT.
SO DON BERWICK IN HIS GREATNESS
ASKED A BUNCH OF HEALTHCARE
ORGANIZATIONS TO COME UP WITH
RULES AND REGULATIONS THAT ARE
GETTING IN THE WAY OF THE
PATIENT CLINICIAN EXPERIENCE.
HE THEN TOOK ALL THESE RULES AND
REGULATIONS AND ACTUALLY WENT TO
CHECK IF THEY WERE REALLY RULES
AND REGULATIONS.
AND WHAT THEY FOUND IS THAT 80%
OF THESE WERE NOT RULES AND
REGULATION OUTSIDE OF A SPECIFIC
ORGANIZATION, THEY DID NOT
RELATE TO JACO OR CMS, THEY WERE
PURELY MADE UP OR HISTORICAL.
AND ONLY, YOU KNOW ABOUT 1 IN 5
WERE REALLY STATUTORY REGULATORY
REQUIREMENTS.
SO WE HAVE SOME MYTH BUSTING TO
DO IN MEDICINE ABOUT WHAT ARE
REALLY RULES AND REGULATIONS.
AND THE AMA, YOU DON'T DO A
MEMBER OF THE AMA, TO ACCESS ANY
OF THESE SORT OF RESOURCES, BUT
THEY HAVE A WHOLE PAGE THAT THEY
KEEP BELLING ABOUT REGULATORY
MYTHS AND HOW TO DEBUNK THEM AND
WHAT THE BACKGROUND IS THAT ARE
REALLY WELL VETTED SO IT MIGHT
BE A USEFUL RESOURCE FOR SOME OF
YOU.
AND THEN WE NEED TO CONTINUE TO
ADDRESS THIS MISTREATMENT THAT'S
GOING ON.
RIGHT?
THE MAIORITY OF MISTREATMENT
THAT HAPPENS TO HEALTHCARE
WORKERS IS COMING FROM PATIENTS,
FAMILY ANDS VISITORS, SO WE NEED
TO MAKE SURE SHOULD CLINICAL
SPACES THAT WE HAVE THE RIGHT
TYPE OF PROCEDURES AND POLICIES
IN PLACE, AND THAT ALL OF US ARE
EDUCATED IN HOW TO BE AN
UPSTANDER AND BY STANDER AND HOW
TO TOW THE LINE WITH PATIENTS
AND HOW TO UNDERSTAND THOSE
CONVERSATIONS WITH THE WORK
ENVIRONMENT AND THERE'S LOT OFS
OF WORK GOING ON IN THIS NATION
IN THIS FIELD BECAUSE IT'S ABOUT
BECOME A VERY BIG ISSUE.
WE ALSO KNOW THAT LEADERS MATTER
AND THIS IS ANOTHER REALLY
IMPORTANT PART OF THE STRATEGY,
SO HOW I RATE MY IMMEDIATE SUPER
VISOR IS A PREDICTER OF MY BURN
OUT AND MY SATISFACTION WITH MY
EMPLOYER.
THAT'S ALSO TRUE WHEN WE ASK
42,000 NONPHYSICIAN HEALTHCARE
WORKERS, IT'S ALSO TRUE WHEN WE
ASK RESIDENTS AND FELLOWS TO
RATE THEIR PROGRAM LEADERSHIP
BEHAVIORS ACROSS THE SAME
LEADERSHIP DIMENSIONS.
AND IT'S NOT JUST CROSS
SECTIONAL, WE HAVE LONGITUDINAL
DATA THAT HOW I RATE MY
IMMEDIATE PHYSICIAN SUPERVISOR
TODAY PREDICTS MY BURN OUT AND
SATISFACTION WITH THE
ORGANIZATION 2 YEARS LATER AND
IT'S A VERY STRONG RELATIONSHIP
WITH A SIGNIFICANT EFFECT SIZE.
SO ORGANIZATIONAL APPROACHES
ISN'T ONLY TO DO THINGS LIKE
GROW, SORT OF SPRINT TEAMS OR
YOU KNOW FIXING THE CLINICAL
PRACTICE, IT NEEDS A LOT OF
FIXING, BUT IT'S ALSO THINGS
THAT AS TIMES CAN BE EASIER TO
MOVE LIKE IMPROVING LEADERSHIP
BEHAVIORS.
AND THAT'S WHERE FACULTY,
LEADERSHIP DEVELOPMENT CAN
REALLY COME IN, THESE ARE NOT
HARD LEADERSHIP BEHAVIORS BUT IT
TURNS OUT OUR LEADERS DON'T ALL
EXHIBIT THESE BEHAVIORS TO THE
SAME DEGREE AND THAT THERE'S
OPPORTUNITY FOR ALL LEADERS TO
CONTINUE ON THEIR LEADERSHIP
JOURNEY.
ANOTHER IMPORTANT PIECE OF
LEADER SYSTEM TO HIGHER THE
RIGHT PERSON FOR THE YOB CORPS
AND TO HELP PEOPLE JOB CRAFT.
SO THERE'S ALL THINGS THAT WE DO
AT WORK, SOME OF WHICH WE LIKE
BETTER THAN OTHER THINGS, SOME
OF WHICH GIVES US BETTER
MEANING, VALUE AND PURPOSE THAN
OTHER THINGS AND THEN WHEN WE
ASK DOC SIMPLY THE QUESTION,
ABOUT WHAT ACTIVITY DO YOU FIND
THE MOST MEANINGFUL AT WORK, AND
THEN HOW MUCH TIME DO YOU SPEND
DOING THAT ACTIVITY AT WORK, WE
SEE A VERY STRONG RELATIONSHIP.
IF YOU CAN JUST SPEND 1 DAY A
WEEK, BASICALLY 20% OF YOUR WORK
EFFORT, DOING WHAT YOU FIND MOST
VALUABLE, MOST MEANINGFUL, YOU
HAVE A LOWER RISK OF BURN OUT.
O THIS IS SOMETHING LEADERS CAN
DO THROUGH CAREER DEVELOPMENT
CONVERSATIONS, THIS IS SOMETHING
ALL OF US CAN DO, JOB CRAFTING.
WE'VE DONE A FEW OTHER RCTs
THAT I WILL TALK BRIEFLY ABOUT,
1 IS LOOKING AT PROFESSIONAL
EXTERNAL CREDENTIAL COACHING,
WE'VE SHOWN IN 2 RCTs THAT
THIS IS VERY EFFECTIVE IN
PHYSICIANS IN SURGEON PHYSICIANS
AS WELL, AND THAT IT HELPS
IMPROVE MULTIPLE METRICS.
NOW YOU CAN SAY, WOW THAT SOUNDS
EXPENSIVE, RIGHT?
THESE RCTs IT WAS 6 HOURS OF
EXTERNAL EXECUTIVE COACHING OVER
THE COURSE OF 6 MONTHS IT COSTS
ABOUT $1500 WHICH IS A LOT
CHEAPER THAN WHAT IT'S COSTING
BY DOING NOTHING, RIGHT IN IF WE
THINK BA BEING TO THAT
7600-DOLLAR PER PHYSICIAN PER
YEAR COST.
OTHER SCALABLE MODELS HAVE BEEN
MORE WEB BASED GROUP COUCHING SO
THIS HAS BEEN A TRIAL AT
UNIVERSITY OF COLORADO WITH
RESIDENTS VERSUS A SINGLE
INSTITUTION INSTEAD OF A
MULTIINSTITUTIONAL STUDY AND
THEY'VE BEEN ABLE TO SHOW THAT
IN RESIDENTS GROUP COACHING AND
A WEB BASED MODEL, SCALABLE, AND
AFFORDABLE CAN ALSO DECREASE
BURN OUT IN RESIDENT ANDS
FELLOWS.
INTERESTINGLY THOUGH, IT'S
APPEALING MOSTLY TO WOMEN
PHYSICIANS MOSTLY WOMEN
RESIDENTS, MAYBE IT'S THE
VULNERABILITY OF BEING GROUP
COACHED ON A WEB BASED PLATFORM
BUT WE DON'T KNOW WHY YET.
THEY HAVE MALE COACHES, THEY'RE
TRYING TO REALLY CRACK THAT NUT
AND ULTIMATELY TELL BE DIFFERENT
THINGS FOR DIFFERENT PEOPLE BUT
IT'S WEIRD THAT IT'S FOLLOWING
ALONG DEMOGRAPHIC LINES.
WE ALSO KNOW THAT SOCIAL SUPPORT
IS INCREDIBLY PROTECTIVE, RIGHT
IN IF YOU TAKE FOR EXAMPLE, YOU
KNOW A GROUP OF PEOPLE WHO ARE
EXPOSED TO A TRAUMATIC EVENT,
NOT EVERYBODY DEVELOPS PTSD AND
THE SINGLE MOST PROTECTIVE
FACTOR FROM WHAT I UNDERSTAND IS
ACTUALLY YOUR PERCEPTION AND
SOCIAL SUPPORT AND THERE'S BEEN
LOTS OF STUDIES IN MEDICINE
ABOUT THE ROLE OF SOCIAL SUPPORT
IN MITIGATING HIGH WORKPLACE
STRESS.
SO ORGANIZATIONS CAN ALSO REALLY
THINK ABOUT HOW CAN WE BUILD
SOCIAL SUPPORT AT WORK?
HOW CAN WE BUILD COMMUNITY AT
WORK?
AND THERE'S DIFFERENT WAYS TO DO
THAT.
SO 1 OF THE WAYS WE EVALUATE AT
RCTs AT MAYO WAS CALLED
COMMENSALITY GROUPS.
SO IN THE FIRST VERSION, WE GOT
THE DOCS TOGETHER OVER A LUNCH
HOUR AND THEY ALSO GOT A
REDUCTION IN THEIR CLINICAL WORK
LOAD TO MEET TOGETHER WITH A
TRAINED FACILITATOR MORE ALONG
THE LINES OF PROBLEM SOLVING,
RYE HOW DO YOU DEAL WITH MEDICAL
ERRORS, HOW DO YOU DEAL WITH
WORK, HOME, INTEGRATION, THAT
PROBLEM SOLVING DOMAIN AND WE
SAW IN THAT RCT, WE SAW ON
COMPANY TIME IT IMPROVED BURN
OUT AND RETENTION MARKERS IN
COMPARISON TO THE CONTROL GROUP.
SO, YOU KNOW WE WENT UP TO THE
POWERS THAT BE, RIGHT, TO SELL
OUR GREAT MODEL THAT EVERYBODY
NEEDED TO BE TRAIN INDEED GROUPS
WITH TRAINED FACILITATORS ON
COMPANY TIME AND IT WASN'T THE
FEDERAL GOVERNMENT BUT
NEVERTHELESS THEY SAID NO,
THEREY'S NO MONEY TO DO THAT.
SO IN THE SECOND RCT, WE HAD
PHYSICIANS BASICALLY SELF-FORM
INTO GROUPS, GO OUT TO DIN OR
THEIR OWN TIME.
WE GAVE THEM A LITTLE BIT OF
MONEY TO PAY FOR THE MEAL AND
SUGGESTED A TOPIC FOR THEM TO
TALK ABOUT, WE HAVE NO IDEA IF
THEY ACTUALLY TALKED ABOUT THE
TOPIC BY THE WAY BUT WE GAVE
THEM A TOPIC, WE TOLD THEM WHY
THEY SHOULD TALK ABOUT IT, HOW
ARBITRATE IT WAS, WE DID
FACILITATOR TRAINING BUT IN THAT
LOWER COST PILOT, WE SIMILARLY
SAW BENEFIT IN OUR RCT, RIGHT?
SO HELPING PEOPLE GET TOGETHER,
BUILD SUPPORT, BUILD
CAMARADERIE, YOU KNOW DOES MAKE
A DIFFERENCE.
SO YOU KNOW THERE'S THINGS IN
THE OUTER CIRCLE THAT ARE
DRIVING US A NOTCH, THINGS IN
THEINER CIRCLE THAT ARE GIVING
US A LOT OF STRESS AND THIS IS
WHAT I'M GOING TO TALK ABOUT
NEXT WHICH IS WHAT I WILL CALL
LOCAL WORK UNIT, SO FOR ME AT
UNIVERSITY OF COLORADO, THAT
COULD BE MY DEPARTMENT, THAT
COULD BE MY DIVISION, THAT COULD
BE LOWRY CLINIC WHERE I PRACTICE
AND YOU KIND OF HAVE TO THINK
ABOUT WHAT IT FOR YOU AND YOUR
WORK ENVIRONMENT?
WHAT WE DO KNOW IS THAT LOCAL
INTERVENTIONS CAN MAKE A HUGE
DIFFERENCE, SO THEY WORK--IF YOU
HAVE SORT OF PARTICIPATORY
LEADERSHIP, RIGHT?
THEY WORK IF YOU HAVE CONTEXT
WITH SPECIAL INTERVENTIONS, THEY
WORK IF THE BOOTS ON THE GROUND
COME UP WITH THE INTERVENTION,
AND THEY DON'T WORK IF PEOPLE
LIKE ME COME INTO THE GROUP AND
TELL THEM WHAT TO DO, OKAY?
AND THIS IS FROM THE WORK
REDESIGN LITERATURE.
SO, WHAT ARE THESE SORT OF LOCAL
CHANGES, WHERE DO THEY MAKE A
DIFFERENCE?
THEY MAKE THE MOST DIFFERENCE IF
THEY CAN TACKLE WORK LOAD, OH,
HARDEST 1, RIGHT, HARDEST 1.
THEY MAKE THE SECOND MOST DRVES
IF THEY CAN ATTACK DECISION
LATITUDE, CONTROL, ECONOMY,
FLEXIBILITY, RIGHT?
MAYBE MORE IN SCOPE.
THEY CAN MAKE THE THIRD MOST
IMPACT IF THEY ADDRESS THINGS
WITHIN THE CULTURE LIKE
LEADERSHIP BEHAVIORS FOR
EXAMPLE, SOCIAL SUPPORT AT WORK,
SO THIS IS THE MODEL THAT WE HAD
AT MAYO CLINIC, THEY STILL HAVE
IT, THEY HAVE IT.
AFTER 20 YEARS IT'S HARD TO STOP
WITH THAT PIECE, THE PART, SO
THEY DO A SURVEY, THEY GIVE
EVERY WORK UNIT THEIR REPORT.
THIS IS WHERE YOUR BURN OUT HAD
IS, THIS IS WHAT WE THINK ARE
THE MAIN DRIVERS OF BURN OUT,
THEY TAKE THIS REPORT, THEY
SHARE TRANSPARENTLY WITH THE
BOOTS ON THE GROUND, THE BOOTS
ON THE GROUND SAY, HEY, THESE
ARE THE THINGS I THINK WE SHOULD
WORK ON, THESE ARE THINGS I
THINK ARE IN OUR SPHERE OF
CONTROL EMPLOY LEADERS EMPOWER
THE LOCAL TEAM TO IMPLEMENT
SOLUTIONS THAT ARE WITHIN THE
SPHERE OF CONTROL OF THE LOCAL
WORK UNIT AND OTHER ISSUES ARE
ESCALATED UPWARD.
DOES IT WORK ALL THE TIME, NO
NOT IN A WAY WE CAN MEASURE BUT
IT WORKS IN ABOUT HALF THE UNITS
IN A WAY WE CAN MEASURE, AND THE
MORE ENGAGED PEOPLE ARE, THE
MORE THE LIKELIHOOD THE THING IS
THAT PEOPLE WILL GET BETTER,
IT'S JUST NOT AT MAYO, WE SEE
THIS ELSEWHERE SO THIS IS AN
EXAMPLE FROM THE UNIVERSITY OF
COLORADO, WE HAD LOTS OF MEDICAL
ASSISTANCE, THE DOCS WERE
LEAVING, ADVANCED PRACTICE
PROFESSIONALS WERE LEAVING, SO
THEY SAID WOE WHOA, WHOA, WHOA,
WHAT'S GOING ON HERE?
SO THEY GOT EVERYBODY TOGETHER,
AND SAID WHAT CAN WE DO
DIFFERENTLY?
HOW CAN WE MAKE THIS WORK BETTER
FOR EVERYBODY?
AND THEY CAME OUT WITH AN
EXPANDED MODEL WHERE THE MEDICAL
ASSISTANT DID MORE BUT THE MORE
WAS THE STUFF THAT THE MEDICAL
ASSISTANT REALLY WANTED TO DO
AND FOUND VALUABLE, AND THEN
THEY WERE ABLE TO REEL
KEEPSAKESLY DO MORE
RELATIONSHIPS BETWEEN THE
MEDICAL ASSISTANTS AND THE DOCS
TO REALLY IMPROVE THE PRACTICE,
THE WHOLE FLOW AND THEY FOUND
THAT WITH THE EXPANDED ROLE OF
THE MEDICAL ASSISTANCE, THEY
IMPROVE QUALITY ACCESS AS WELL
AS CLINICIAN EXPERIENCE AND
THAT'S STILL IN PLACE TODAY.
AND HERE'S THE PAPER FROM
STANFORD, AND THEY DO THIS AND
HAVE DONE THIS FOR SEVERAL YEARS
WHERE EVERY WORK UNIT BASICALLY
GETS THEIR SURVEY RESULTS AND
GET INFORMATION ABOUT WHAT ARE
THE MAIN DRIVERS IN THAT
PARTICULAR WORK UNIT AND THEN IS
EMPOWERED TO DO LOCAL WORK UNIT
CHANGES.
ARE THEY FIXING THE ELECTRONIC
HEALTH RECORD, NO, ARE THEY
FIXING THE STAFFING PROBLEMS IN
THE HOSPITAL?
NO.
BUT THEY'RE FINDING THINGS
WITHIN THEIR SPHERE OF CONTROL
THAT THEY'RE WORKING ON AND THAT
PROCESS IS IMPROVING BURN OUT
AND PROFESSIONAL FULFILLMENT IN
EVERY SINGLE DEPARTMENT IN A WAY
THAT'S MEASURABLE.
SO LOCAL WORK UNIT ACTION IS
REALLY IMPORTANT AND IT DOES
TAKE ALL OF US FILL OUT 1 MORE
DAMN SURVEY, BUT IT IS IMPORTANT
JUST LIKE IT IS WITH QUALITY,
THAT WE SHARE THE RESULTS
TRANSPARENTLY AND THAT WE HAVE
LISTENING SESSIONS AND
COLLABORATIVE ACTION PLANNING.
COLLABORATIVE ACTION PLANNING
THAT HELPS US IDENTIFY WHAT'S IN
OUR SPHERE OF CONTROL, VERSUS
INFLUENCE, VERSUS CONCERN.
TO IEE, AUDIENCE DENTIFY WHAT TO
WORK ON AND FORTUNATELY THE WORK
RELINE LITERATURE TELLS US THAT
WHEN WE LEAN IN AND ENGAGE IN
WORK DESIGN, CHANGE, IT
IMPROVING OUR WELL BEING, SO YOU
MIGHT SIT THERE AND THINK I CAN
BE THE DO 1 MORE THING, I CAME
TO THIS MEETING BECAUSE I BURNT
OUT AND WAS LOOKING FOR
STRATEGIES, RIGHT, LIKE I CAN BE
THE DO 1 MORE THING BUT IT TURNS
OUT LEADING IN AND ENGAINLING IN
THIS PROCESS AROUND ROUND WORK
REDESIGN, AROUND IDENTIFYING AND
IMPRIEWING WHAT YOU CAN IN YOUR
SPHERE OF CONTROL, YOUR WELL IS
LIKELY TO MEASURABLY IMPROVE
EMPLOY HERE ARE SOME THINGS THE
WELL BEING LEADERS ARE WORKING
ON IN COLORADO, ARE THEY ALL
SYSTEM THINGS?
NO, SOME THINGS ARE VERY MUCH
RELATIONAL, SOME THINGS ARE VERY
MUCH FACULTY DEVELOPMENT, SOME
THINGS DO RELATE TO WHAT'S GOING
ON IN THE CLINICAL PRACTICE, IT
BEINGLY AROUND SCHEDULING,
ADVERSE EVENTS, THE INBASKET,
OUR NEW THING IS SECURE CHAT,
ALL SORTS OF GREATNESS IS
HAPPENING IN THAT SPACE.
AND I JUST WANT TO SPEND A
COUPLE SLIDES BEFORE I OPEN IT
UP ABOUT WHAT I THINK IS SORT OF
THE WORKPLACE OF THE FUTURE.
BECAUSE THERE'S FASCINATING
STUFF THAT'S GOING ON.
ONE THING THAT'S GOING ON IS
WE'RE TRYING TO FIGURE OUT IF WE
CAN PREDICT BURN OUT.
RIGHT NOW WE REACT.
RIGHT, SO WE REACT WHEN THE
SURVEY LOOKS REALLY BAD, WE
REACT WHEN TURNOVER'S REALLY
BAD, WE REACT WHEN THERE'S A LOT
OF PROFESSIONALISM COMPLAINTS
BUT WE REACT AFTER THERE'S
ALREADY BEEN HARM TO THE PATIENT
AND WHEN THERE'S ALREADY BEEN
TURNOVER.
WHAT IF WE COULD PREDICT IT,
WHAT IF WE COULD USE BIOMETRICS
AND PREDICT WHEN WORK STRESS IS
GETTING TOO HIGH SO THAT WE CAN
RESPOND.
SO THESE ARE COUPLE OF STUDIES I
HAVE GOING ON WITH
[INDISCERNIBLE] AT MAYO, SO WE
HAVE ACTUALLY SEVERAL COHORTS OF
NURSES WITH SMART WATCHES
FILLING OUT SURVEYS, WE'RE
TRYING TO FIGURE OUT WITH BIG
DATA SETS WE CAN PREDICT THEIR
BURN OUT, WE HAVE 180 PHYSICIANS
AND RESIDENTS AT MAYO AND AT
COLORADO THAT WE'RE CLICKING
BIOMETRIC DATA ON AS WELL, AND
DOING SOME FUN MATH TO SEE IF WE
CAN PREDICT IT, WE MIGHT NOT BE
ABLE TO BUT YOU DON'T KNOW UNTIL
YOU TRY.
WE'RE LOOKING AT WAYS TO
OPTIMIZE THE CLINICIAN COMPUTER
INTERFACE, SO RIGHT NOW, YOU GET
A DRUG ALERT, USUALLY SAY
SOMETHING LIKE LIKE IF YOU GIVE
THIS DRUG TO THE PATIENT YOU
WILL KILL THEM T. DOESN'T GIVE
YOU ANY ALTERNATIVES AND YOU
TEND TO GET THE INFORMATION TOO
LATE AND WITH PHARMA CO GENOMICS
PERSON, HOW DO I DETERMINE WHAT
TO GIVE THIS PATIENT BASED ON
THEIR PROFILE, RIGHT?
YOU GOTTA BE KIDDING ME, RIGHT?
SO HOW DO WE DESIGN DRUG ALERTS
SO THEY'RE HELPFUL, IF YOU GIVE
THIS DRUG, YOU HAVE A 20% CHANCE
DEPRESSION'S GOING TO GET BETTER
BUT YOU GIVE THEM DRUG THAT WILL
COST LESS BUT YOU HAVE A 40%
CHANCE THAT DEPRESSION WILL
DECREASE, SO FIGURING OUT THAT
PIECE.
FIGURING OUT ALSO HOW CAN WE
OPTIMIZE STAFFING MODELS IN THE
HOSPITAL RIGHT BECAUSE THERE'S
ALWAYS GOING TO BE BUDGET CUTS
BUT HOW DO WE ACTUALLY FIGURE
OUT IN REALTIME WHAT STAFFING
MODEL LEADS TO THE BEST
FINANCIAL AND CLINICAL OUTCOME,
WHAT STAFFING MODEL LEADS TO THE
BEST RETENTION, WHAT STAFFING
MODEL LEADS TO THE BEST QUALITY
OF CARE.
SO USING APPS TO COLLECT
REALTIME DATA, KIND OF LIKE,
YEAH, ECOLOGICAL MOMENTARY
ASSESSMENTS BUT THINKING ABOUT
WORK DESIGN, WE CAN LOOK AT
EVERYTHING EVERYBODY DOES IF WE
CALL THE AUDIT LOG DATA, VERY
BIG BROTHER, KIND OF CARRY BUT
THEY CAN SEE HOW LONG I SPEND ON
EVERYTHING, WHAT I'M DOING.
CAN WE HARNESS THAT DATA TO
FIGURE OUT WHAT ARE BEST WAYS TO
DESIGN WORK?
SO THOSE ARE SOME OF THE THINGS
THAT ARE COMING ON THE HORIZON
AS WELL AS LISTENING
[INDISCERNIBLE], IT'S AI
TECHNOLOGY WHERE YOU HAVE A
DEVICE THAT'S RECORDING THE
ENTIRE INTERACTION WITH THE
PATIENT AND BY THE TIME YOU WALK
OUT OF THE ROOM, IT'S RECORDING
EVERYTHING WITH THE PATIENT AND
YOU JUST REVIEW IT AND SAY YEAH,
THAT'S RIGHT.
THAT STUFF IS COMING.
SO LOTS OF INTERESTING THINGS
BUT FOR ANY OF THIS TO WORK, WE
ALL HAVE TO BE WILLING TO LEAN
IN AND DO OUR PART, WHETHER
THAT'S FILLING OUT THE SURVEY,
WHETHER THAT'S ENGAGING IN LOCAL
ACTION PLANNING, WHETHER THAT'S
ADVOCATING WITH YOUR SOCIETIES
OR OTHER GROUPS AND SOME OF
THESE FACTORS OUTSIDE THE
CONTROL OF HEALTHCARE SYSTEMS
DIRECTLY BUT I THINK IT'S
IMPORTANT WE ALL HAVE A ROLE TO
PLAY AND THAT'S WHAT IT'S GOING
TO TAKE TO BEND THE NEEDLE AND
MAKE MEANINGFUL CHANGE.
SO THANK YOU VERY MUCH FOR YOUR
ATTENTION.
HAPPY TO TAKE QUESTION ANDS
WE'LL GO FROM THERE.
[ APPLAUSE ]
>> SO IF PEOPLE HAVE QUESTIONS
THEY CAN STAND UP.
GO AHEAD.
NHI, I ENJOYED YOUR TALK.
I HAVE A COUPLE QUESTIONS ABOUT
THE PHYSICIAN BURN OUT THAT YOU
SPOKE OF.
I WANTED TO KNOW IF ANY DATA WAS
FOUND BETWEEN THE RELATIONSHIP
BETWEEN BURN OUTS BETWEEN
PHYSICIANS AND PHYSICIAN
SCIENTISTS?
SPOKEN WITH MANY MD-Ph.D.s
WHO ARE UNSATISFIED WITH THEIR
LINE OF WORK OR HOW THEIR
RESEARCH AND HOW THEIR RESEARCH
AND PRACTICE TIME HAS BEEN SPLIT
SO I JUST WANTED TO KNOW IF
THERE WAS ANY RESEARCH DONE IN
THAT FIELD?
>> YEAH, SO, THERE'S A LOT OF
OPPORTUNITY, RIGHT?
THERE'S VERY LITTLE RESEARCH IN
THIS FIELD ON SCIENTISTS IN
GENERAL.
AND ALSO ON SORT OF THE
MD-Ph.D. PHYSICIAN SCIENTIST
IN THAT SPHERE.
WE TRY TO LOOK AT IT A LITTLE
BIT AT MAYO BECAUSE WE'RE REALLY
CURIOUS, RIGHT?
AND IN COLORADO I'VE ALSO LOOKED
ATAUR DATA BY THE PRESENT OF FTE
IN THE CLINICAL PRACTICE VERSUS
PRESENTING FTE THAT YOU HAVE FOR
RESEARCH AND NOT FOR THE
RESEARCH PIECE, NOT REALLY
SEEING MUCH OF A RELATIONSHIP
BUT THE MORE TIME PEOPLE SPEND
IN CLINICAL PRACTICE, THE HIGHER
THEIR RISK IS OF BURN OUT, WE
DEFINITELY SAW THAT PIECE.
I THINK SOME OF IT COMES DOWN TO
THAT CAREER FIT PIECE, YOU KNOWI
LIKE THE MORE YOU'RE ABLE ON DO
WHAT YOU FIND MOST MEANINGFUL,
SORT OF THE LESS PROFESSIONAL
BURN OUT THERE IS, BUT THIS IS
DEFINITELY AN AREA WHERE WE NEED
MORE RESEARCH TO REALLY PICK
OUT, YOU KNOW WHAT ARE--WHAT'S
THE APPROACH AND THE SOLUTION
FOR SCIENTISTS OR WHAT'S THE
APPROACH AND SOLUTION FOR PEOPLE
WHO ARE STRADDLING THESE 2
WORLDS.
>> OKAY AND JUST 1 MORE
QUESTION, I WANTED TO KNOW IF
THERE WAS A CORRELATION BETWEEN
LARGER AMOUNT OF BURN OUT IN
AREAS WHERE THERE ARE HEALTHCARE
DESERTS OR WHERE YOU WOULD
DESCRIBE THEM AS HEALTHCARE
DESERT ANDS THEN AREAS WITH
DEMOGRAPHICS OF HISTORICALLY
FLUTED GROUPS FROM MEDICINE IN.
>> YEAH, GOOD QUESTION.
WE'VE TRIED TO LOOK AT, YOU KNOW
IS THERE A DIFFERENCE FOR CLIN 8
HOURSS WHO WORK IN FEDERALLY
QUALIFIED HEALTHCARE TRUSTEESS,
THEY ARE OFTEN UNDERRESOURCED
AND VERY MUCH OVERWORKED BUT SO
FAR OUR SAMPLE HASN'T REALLY
BEEN BIG ENOUGH LIKE WE NEED TO
FIGURE OUT HOW TO GET MORE
RESPONDERS FROM THAT GROUP.
YEARS AGO, I LOOKED AT THE
RELATIONSHIP BETWEEN SURGEON
BURN OUT AND THE SIZE OF THE
COMMUNITY THAT THEY WORKED IN,
RIGHT?
THINKING THAT IF THE SURMON IS
LIKE THE LONE SURGEON IN A
COMMUNITY, RIGHT, IS THAT A GOOD
OR BAD THING AND WE SAW NO
RELATIONSHIP BETWEEN THE SIZE OF
THE COMMUNITY AND THE SURGEON
BURN OUT.
IT DIDN'T GET AT YOUR OTHER
EXCELLENT POINTS RIGHT AROUND
SORT OF THE RESOURCES OF THE
COMMUNITY THAT YOU'RE TRYING TO
PROVIDE CARE FOR OR THE
DEMOGRAPHICS OF THE RESOURCES OF
THE COMMUNITY THAT YOU'RE TRYING
TO PROVIDE CARE FOR SO REALLY
IMPORTANT WORK, SO YEAH, MORE TO
COME OR MAYBE A PROJECT.
>> OKAY, THANK YOU.
>> THANK YOU.
YEAH?
>> THANK YOU FOR THE GREAT TALK
EMPLOY I WAS WONDERING IF YOU
COULD TALK MORE ABOUT THE AGE
DIFFERENCES YOU SAW IN WHETHER
THERE ARE ANY DRIVING FACTORS
THAT HAVE BEEN IDENTIFIED OR
DIFFERENT THINGS THAT CONTRIBUTE
TO THAT?
>> YEAH, SUPER INTERESTING RIGHT
BECAUSE WE ALSO SEE IT IN THE
POPULATION AND THEN WE SEE IT IN
PHYSICIANS, SURGEONS THAT THIS
RELATIONSHIP WITH AGE.
WHEN WE LOOK AT IT DIFFERENTLY
OR BY CAREER STAGE, WE SEE THAT
IT'S NOT THE SORT OF 10 YEARS
AND BELOW IN CLINICAL PRACTICE,
AND IT'S NOT THE 20 AND ABOVE
CLINICAL YEARS IN PRACTICE, IT'S
THIS MIDCAREER GROUP THAT SEEMS
TO HAVE THE HIGHEST LEVEL OF
BURN OUT AND MAYBE THAT'S
BECAUSE YOU KNOW THE YOUNGER
GENERATIONS MAKING DIFFERENT
DECISIONS OR MAYBE IT'S JUST
THEY'RE NOT READY IN THEIR
LEADERSHIP JOURNEY TO TAKE ON
BIG RESPONSIBILITIES AND MAYBE
IT'S THE SEEN KROR PEOPLE ARE
LIKE, I'M DONE WITH THIS, TIME
TO HAVE SOMEONE ELSE HAVE THE
OPPORTUNITY AND THEN THE
MIDCAREER PEOPLE ARE LEFT
HOLDING ALL THIS WORK SO THERE'S
A COUPLE DIFFERENT THINGS GOING
ON, THERE'S EVIDENCE BY CAREER
TAIJ, THAT MIDCAREER IS PRETTY
TRICKY AND THEN THERE'S SORT OF
EVIDENCE THAT KIND OF GETTING
STARTED IS TRICKY, RIGHT?
THERE'S NEVER A GENERATION THAT
HASN'T BARBED THE GENERATION
BELOW THEM, RIGHT?
LIKE MY PARENT BARBED MY
GENERATION AND I CAN BARB OTHER
GENERATIONS, RIGHT, BUT I DON'T
THINK IT'S LIKE THIS MYSTERIOUS
ALL THE SUDDEN WE HAVE THIS HUGE
GENERATIONAL DIVIDE OR ALL OF A
SUDDEN WE HAVE ALL THESE WHO
WANT TO HAVE A HEALTHIER
BALANCE, RIGHT?
I THINK WE ALL WANT A HEALTHIER
BALANCE, SO I DON'T THINK IT SO
MUCH REFLECTS KIND OF GENERATED
RAITIONZAL DIFFERENCES, I THINK
IT'S ALSO REALLY HARD, RIGHT?
LIKE YOU THINK ABOUT IT 30 YEARS
AGO, PHYSICIANS HAD A AT A AT
HOME SPOUSE WHO MANAGED A LOT OF
THINGS, NOW MOST PHYSICIANS ARE
IN DUAL CAREER RELATIONSHIPS,
THERE'S A LOT OF WOMEN OBVIOUSLY
IN THE HEALTHCARE WORKFORCE
VERSUS, YOU KNOW 30, 40 YEARS
AGO BUT IT'S REALLY HARD TO
KNOW, RIGHT?
WE CERTAINLY KNOW THAT OUR
MEDICAL STUDENTS HAD TO LEARN
EVERYTHING WE HAD TO LEARN PLUS
EVERYTHING ELSE THAT WE HAD TO
LEARN SINCE WE WENT TO MEDICAL
COOL RIGHT IN LIKE HOW IS THAT
HAPPENING AND THEN PEOPLE WANT
THEM TO BE VALUE-ADD IN THE
CLINIC AND OTHER EXPECTATIONS
BUT IT'S WORTH LOOKING AT MORE
SO THAT WE CAN CRACK IT, I'M
ALSO WORRIED ABOUT SURVIVAL
BIAS, IS THE REASON WHY MY BIG
NATIONAL LONGITUDINAL STUDIES,
THAT IS THE YOUNG PEOPLE WHO
HAVE BURN OUT IS BECAUSE THE OLD
PEOPLE LIKE THEY LEFT, RIGHT AND
IT'S SURVIVAL BIAS, SO THERE'S
LOTS OF POSSIBILITIES.
>> DOCTOR, WE THANK YOU VERY
MUCH.
THAT WAS A PHENOMENAL
PRESENTATION AND I HAVE TO SHARE
MY DISCOMFORT OF SEEING MYSELF
ON THAT SLIDES TOO OFTEN, I
THINK, BUT--BY THE WAY, WE HAD
OVER A HUNDRED VIDEOCAST VIEWERS
SO THIS WAS A VERY WELL RECEIVED
PRESENTATION.
MY QUESTION IS ABOUT IS THERE A
ROLE FOR LIKE NEAR PEER
MENTORING?
DOES THAT DO ANYTHING TO
MITIGATE BURN OUT?
AND ALSO WHO MENTORS THE
MENTORS?
BECAUSE SOMETIMES THEY GO INTO
THIS WITHOUT MUCH SUPPORT.
>> YEAH, GREAT QUESTION.
AND SO, WE KNOW AT LEAST IN
RESIDENCY PROGRAMS IF THEY HAVE
A STRUCTURED MENTORSHIP PROGRAM,
THEY'RE LESS LIKELY TO BE BURNT
OUT.
THE SAME QUESTION HAS NOT BEEN
ASKED OF ACADEMIA BUT IF YOU
THINK ABOUT IT MAKES SENSE IT'S
THE RIGHT THING TO DO AS PART OF
THE STRATEGY BECAUSE WHAT DOES
MENTORING DO, IT ULTIMATELY
BUILDS RELATIONSHIPS, IT BUILDS
SOCIAL SUPPORT, IT HELPS COACH
YOU THROUGH DIFFICULT
SITUATIONS, SO, INTUITIVELY,
MENTORING, MENTORSHIP PROGRAMS,
MENTORING COMMITTEES, THE WAYS
WE CAN BUILD SUPPORT FOR EACH
OTHER BY THEMSELVES IS REALLY
VALUABLE.
AND I THINK TO YOUR POINT AS
WELL, HOW DO WE TAKE CARE OF THE
MENTORS, RIGHT IN AND I WOULD
SUGGEST THEY NEED THEIR OWN
MENTORING CIRCLE WHERE THEY
SHARE THEIR EXPERIENCES AND
CHALLENGES AND THEIR TRIUMPHS,
AND DO THAT KIND OF, YOU KNOW IN
THE MOMENT LEARNING AND LIKE, OH
YEAH, I HAD A MENTEE TELL ME
THAT ONCE, TOO AND THIS IS HOW I
DEALT WITH IT, RIGHT IN I THINK
THOSE SORTS OF COMMUNITY THINGS,
YOU KNOW.
IT DOESN'T TAKE A COLOSSAL
EFFORT TO CHANGE IT, IT DOESN'T
TAKE A COLOSSAL EFFORT TO GET
NURSES INTO THE WARDS BUT THESE
OTHER PIECES AROUND BUILDING
COMMUNITIES WHETHER IT'S FROM
DINNER GROUPS TO FORMER
MENTORING PROGRAMS AND CIRCLES,
I THINK INTUMOR SPECTRUM LIVELY
AND BASED ON THE RESEARCH IS A
REALLY VALUABLE APPROACH.
NTHANK YOU.
I HAVE 1 QUICK QUESTION, TOO, SO
THE DATA THAT YOU PRESENTED ON
THE STANFORD MODEL WHERE THEY
ACTUALLY INTERVIEWED THEIR
ENTIRE WORKFORCE OF THE WORK
UNITS, HOW DOES AN INSTITUTION
GO ABOUT PICKING THE RIGHT--WHAT
ARE THE MEASUREMENT TOOLS THAT
AN ORGANIZATION SHOULD DEPLOY TO
TRY TO UNDERSTAND THIS BETTER
DATA WISE?
>> SO MEASUREMENT, I THINK IS
KEY TO DRIVE CHANGE.
LIKE WHEN WE THINK ABOUT
QUALITY, RIGHT?
IF WE'RE TRYING TO YOU KNOW
REDUCE INFECTIONS WE FIRST
FIGURE OUT HOW MANY INFECTIONS
DO WE HAVE AND WHERE ARE THE
INFECTION HOT SPOTS AND THEN WE
DO INTERVENTIONS THERE, AND I
THINK IT'S THE SAME THING WITH
WORKFORCE WELL BEING, YOU KNOW
WE CAN LOOK AT THINGS OTHER THAN
SURVEYS, RIGHT?
SO WE CAN LOOK AT TURNOVER, WE
CAN LOOK AT WHAT WE CALL AUDIT
LOG DATA TO FIGURE OUT WHO'S IN
THE ELECTRONIC HEALTH RECORD,
OUTSIDE OF SCHEDULED TIME WITH
PATIENTS, BUT ULTIMATELY SURVEYS
DO HAVE A ROLE AND THEY'RE
REALLY IMPORTANT AND THERE ARE
MANY DIFFERENT MEASURES AND
TOOLS AND SERVICES OUT THERE.
I THINK THE MAIN THING IS IT'S
SUPER HELPFUL TO HAVE 1 MEASURES
THAT HAVE SOME AMOUNT OF
PSYCHOMETRIC PROPERTIES, RIGHT
AS SOME SERIOUS DEGREE OF
VALIDITY, THAT'S REALLY HELPFUL
SO THAT YOU KNOW WHAT YOU'RE
MEASURING MATTERS AND THEN THE
SECOND THING THAT I FIND REALLY
HELPFUL TO IS TO HAVE BENCHMARK
DATA BECAUSE LIKE WHEN I GO TO
MY CHAIR, OF LET'S JUST PICK ON
EMERGENCY MEDICINE, YOU KNOW, MY
CHAIR OF EMERGENCY MEDICINE SAYS
I HAVE THE MOST STRESSFUL JOB,
OF COURSE I'M GOING TO HAVE THE
HIGHEST BURN OUT RATES.
NATIONALLY EMERGENCY MEDICINE
HAS THE HIGHEST BURN OUT RATES
BUT WHEN I CAN THEN GO, YES,
CHAIR, THESE THINGS ARE TRUE,
AND YOUR BURN OUT RATES ARE
HIGHER THAN NATIONAL, THE IT
CHANGES THE CONVERSATION, RIGHT?
IT GIVES ME TRACTION.
SO BEING ABLE TO SORT OF COMPARE
TO BENCHMARK, IS REALLY VALUABLE
BECAUSE IT TELL HELPS ME
IDENTIFY THE DELTA RIGHT, THEN
IT'S NOT THE JOINT COMMISSION,
THAT IT'S NOT MEDICARE, THAT
IT'S NOT SOME RULE OR
REGULATION, RIGHT?
IT'S MANAGE THAT'S HAPPENING
LOCALLY SO, I WOULD--YOU KNOW
GETTING THE MOST
PSYCHOMETRICALLY STRONG TOOL YOU
CAN GET THAT HAS NATIONAL
BENCHMARK DATA IS WHERE THE
SWEET SPOT IS.
>> THANK YOU FOR YOUR TALK.
IT'S BEEN VERY GREAT.
I'M AN ADVANCED PRACTICE
PROVIDER AND ON 1 OF YOUR
SLIDES, MAYBE THE INTERVENTION
WAS DONE IN COLORADO, AND YOU
KNOW AS AN ADVANCED PRACTICE
PROVIDER, YOU KNOW YOU'RE A
NURSE BUT YOU'RE ALSO A PROVIDER
AND IT JUST SEEMS LIKE THE
SUPPORT ISN'T THERE.
IT'S ALMOST LIKE IF THERE IS AN
EXTRA TASK, IT SEEMS LIKE IT'S
DELEGATED TO YOUR ROLE AND I SAW
THAT THE EXAMPLE IN COLORADO
THEY ACTUALLY HAD THEIR MEDICAL
ASSISTANTS ACTUALLY VOLUNTEER
AND ACTUALLY WERE EMPOWER
EXCLUDE FELT BETTER WHEN THEY
HAD DIFFERENT ROLES AND I'M LIKE
HOW DO YOU GET TO THAT
CONVERSATION?
BECAUSE THEY'RE LIKE, THIS IS
THE WAY IT'S ALWAYS BEEN DONE
AND THEY DON'T REALIZE THAT
THERE IS A PROBLEM.
NYEAH, IT'S A REALLY GOOD
QUESTION.
YOU NEED TO GET STAKEHOLDER
BUY-IN AND CREATE A SENSE OF
URGENCY, RIGHT?
SO THAT SOMETHING DOES HAPPEN
AND I CAN TELL YOU, IT IS A VERY
DIFFICULT JOURNEY.
BUT THE MORE YOU CAN INVOLVE
EVERYBODY FROM THE BEGINNING AND
THE CONVERSATION, THE MORE SORT
OF BUY-IN YOU GET, THE MORE SORT
OF IDEAS YOU GET SO THE MORE
TRACTION YOU GET WITH CHANGED
MANAGE AM BUT THERE HAS TO BE
INTEREST, THERE HAS TO BE
LEADERSHIP COMMITMENT, THERE HAS
TO BE THAT TONE THAT YOU KNOW
FOR US TO DELIVER ON OUR
MISSION, WE HAVE TO TAKE CARE OF
THE WELL BEING OF OUR WORKFORCE
AND THATTEN MEANS WE MEASURE AND
WE SHARE AND WE RESPOND.
AND WITHOUT THAT IT'S REALLY
HARD.
SO I THANK YOU VERY MUCH FOR
YOUR TIME.
I OWN FORTUNATELY HAVE TO RUN TO
CATCH A PLANE BUT PEOPLE FEEL
FREE TO E-MAIL ME AND I AM HAPPY
TO CONDITION IN THIS
CONVERSATION, RITA HAS MY TON
TACT INFORMATION AND THANK YOU
AGAIN FOR THE INVITATION AND THE
OPPORTUNITY TO PRESENT HERE.
>> THANK YOU FOR COMING.
[ APPLAUSE ]