Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
The NIH Clinical Center is the world's largest hospital totally
dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
OUR PRESENTER TODAY IS
DR. DEBORAH SNYDER WHERE SHE
WORKS AS THE SENIOR ADVISOR FOR
THE CONSULTATION LIAISON SERVICE
TEAM.
MISS SNYDER RECEIVED HER
BACHELOR OF ARTS IN PSYCHOLOGY
FROM - DUKE UNIVERSITY AND A
MASTERS DEGREE IN SOCIAL WORK
FROM THE UNIVERSITY OF MARYLAND.
SHE HAS BEEN AT THE NIH SINCE
1992, STARTING OFF IN THE
CLINICAL CENTER DEPARTMENT OF
SOCIAL WORK AS AN INTEGRATED
MEMBER OF THE BREAST AND OVARIAN
CANCER TEAMS.
IN 2000, SHE MOVED TO NIMH TO
JOIN THE PSYCHIATRY CONSULTATION
SERVICE AND ASSISTED WITH
RESIDENCE EXPE FELLOWSHIP
TRAINING SINCE THAT TIME.
MISS SNYDER CONDUCTS
COLLABORATIVE RESEARCH IN
SUICIDE RISK VENING IN MEDICAL
SETTINGS INCLUDING HOSPITALS,
IN-PATIENT AND OUT-PATIENT
SETTINGS, SHE HELPED DEVELOP THE
ASK MEDICAL SUICIDE TOOL FOR THE
MEDICAL PATIENTS AS WELL AS TOOL
KIT TO HELP GUIDE INSTITUTIONS
ON THE IMPLEMENTATION OF SUICIDE
RISK SCREENING.
ANOTHER MAJOR FOCUS OF HER
CAREER HAS BEEN ON TOPICS AT THE
INTERFACE OF MEDICAL ILLNESS AND
MENTAL HEALTH.
SHE IS REGULARLY CONSULTED BOO
IA A WIDE VARIETY OF CLINICAL
STAFF AT THE NIH INCLUDING
PHYSICIANS, NURSES, SOCIAL
WORKERS AND GENETIC COUNSELORS
FOR HER EXPERTISE IN
FACILITATING PROFESSIONAL
DEVELOPMENT AND CASE BASED
DISCUSSION GROUPS.
SHE'S AN ORGANIZATIONAL LEADER
ON THE TOPIC OF ENHANCED STAFF
AND TRAINING WELL BEING AND
SERVES AS THE DEPUTY CHAIR OF
THE GRADUATE MEDICAL EDUCATION
SUBCOMMITTEE ON RESIDENT
WELLNESS.
IN ADDITION TO ALL SHE DOES, SHE
WAS RECENTLY RECEIVED AN NIH
DIRECTORS AWARD FOR HELPING TO
SPEARHEAD THE NIMH TELEPHONE
SUPPORT LINE FOR STAFF DURING
THE COVID-19 PANDEMIC.
THE TITLE OF HER PRESENTATION
TODAY IS BUILDING AN INTEGRATED
WELL BEING PROGRAM, A PATH
FORWARD FOR RESIDENTS AND
FELLOWS.
PLEASE WELCOME TODAY'S SPEAKER
DEBBIE SNYDER.
>>THANK YOU SO MUCH DR. CHUNG
FOR THAT LOVELY INTRODUCTION, I
ALSO WANT TO THANK DR. BURKLOW
FOR INVITING ME TO BE HERE TODAY
AND FOR THE LOGISTICS.
THE TOPIC IS NOT NEW ON THE
HEALTHCARE SCENE, WHRA'S NEW IS
THE AWAKENED ATTENTION REALLY TO
THE PROBLEM, OBVIOUSLY DUE TO
THE COVID-19 PANDEMIC.
IT IS GOOD NEWS ABOUT THAT IS
THAT IT'S CATAPULTED HOSPITALS
AND HEALTHCARE LEADERS AROUND
THE URGENCY TO ACT, HOWEVER,
THERE REALLY REMAIN MANY
QUESTIONS THAT I AM HOPING WILL
BE ABLE TO ELUCIDATE AND TALK
MORE ABOUT TODAY.
SO THERE REMAIN MANY QUESTIONS
THOUGH ABOUT THIS LARGE TOPIC
BUSINESS, FOR EXAMPLE, HOW DO WE
UNDERSTAND BURN OUT AND WELL
BEING, ARE WE SPEAKING THE STAIM
LANGUAGE WITH WE TALK ABOUT THE
TOPICS, AND WHO'S THE WE THAT
WE'RE TRYING TO HELP ANYWAY, ARE
THEY HEALTHCARE CLINICIANS,
ADMINISTRATIVE STAFF, AN CELLARY
STAFF, 40,000 EMPLOYEES HERE AT
THE NIH AND WHO'S IN THE
DRIVER'S SEATED WITH REGARD TO
CHANGE?
WHILE THIS TALK IS GEARED
TOWARDS CLINICIANS AND
SPECIFICALLY I MEAN RESIDENTS,
FELLOWS AND FACULTY, MANY OF THE
UNDERLYING CONCEPTS ARE BROADLY
APPLICABLE.
GO TO THE NEXT SLIDE, PLEASE.
I HAVE NO FINE ARNL CONFLICTS TO
DISCLOSE.
NEXT SLIDE.
SO AS A GENERAL OUTLINE WHAT I
HOPE TO DO TODAY IS OFFER A
MODEL OF CLINICIAN BURN OUT
INCLUDING DEFINING DRIVER'S OF
BURN OUT THAT RELATE TO 3
DOMAINS THESE INCLUDE PERSONAL
RESILIENCE, CULTURE OF WELLNESS
AND EFFICIENCY OF PRACTICE.
I WANT TO TRY TO MAKE THE CASE
FOR WHY INVESTOR NOTHING WELL
BEING MATTERS WITH A SPECIFIC
FOCUS TODAY ON THE REGULATORY
CASE.
THIS WILL OFFER TIPS FOR BOTH
RESIDENTS AND FELLOWS AS WELL AS
FACULTY ON THE ROLE YOU WILL
HAVE DURING CLEAR VISITS WITH
REGARD TO WELL BEING, A SHARED
MODEL WILL HELP AS WE WORK
TOGETHER, TOWARDS OBTAINING
MEDICAL STATUS HERE WHICH HAS
BEEN A MAJOR UNDERTAKING WITH A
NURSING AT THE HELM.
WE AND I WILL SHARE INFORMATION
ABOUT A TRACKING AND DECREASING
BURN OUT INITIATIVE THAT WAS
INITIATED IN 2020 BY THE GMEC
SUBCOMMITTEE ON WELLNESS TO HELP
DEFINE A PATH FORWARD FOR
ACCESSING AND MONITORING AND
MEANING AROUND DRIVERS OF BURN
OUT IN RESIDENTS AND FELLOWS
HERE AT THE CLINICAL CENTER, WE
WILL LEAVE THE IDEA FOR
AFFECTING MEANINGFUL CHANGE AND
FOR THOSE THAT ARE INTERESTED,
THE GOOD NEWS IS THAT THIS
PROJECT CAN BE EASILY SCALED TO
OTHER CLINICAL GROUPS.
NEXT.
THE THINGS THAT CARRIED WRITTEN
BY TIM O'BRIANAEN WHO SURVIVED
HIS TOUR OF DUTY IN VIETNAM TO
BECOME A WRITER DETAILS THE
STRUGGLES BY AMERICAN SOLDIERS,
THE MEN OF ALPHA COMPANY DURING
THE VIETNAM ROLE.
THE PRIMARY THEME IS THE
EMOTIONAL AND PHYSICAL BURDENS
AS THEY MARCHED, THE GUNS, THE
GEAR, THE PHOTOS, THE
LETTERINGS, THE CANDY, THE HOPE,
THE FEAR, THE MEMORIES, THE
GUILTY.
NEXT IT CARRIED THE SKY, THE
WHOLE ATMOSPHERE, THEY CARRY
TODAY, THE HUMIDITY, MONSOONS,
STINK OF FUNGUS AND DECAY, THEY
CARRY GRAVITY.
NEXT.
THE HARD THING TO SPLIEN TO
SOMEBODY WHO HASN'T FELT IT, AT
THE PRESENCE OF DEATH AND DANGER
AS WAY OF BRINGING YOU FULLY
AWAKE.
IT MAKES THINGS VIVID, WHEN
YOU'RE AFRAID, REALLY AFRAID,
YOU SEE THINGS YOU NEVER SAW
BEFORE, YOU PAY ATTENTION TO THE
WORLD, YOU MAKE CLOSE FRIENDS,
YOU BECOME PART OF A TRIBE AND
YOU SHARE THE SAME BLOOD, YOU
GIVE IT TOGETHER AND YOU TAKE IT
TOGETHER, NEXT.
THEY CARRIED ALL THEY COULD BEAR
AND THEN SOME INCLUDING A SILENT
AWE FOR THE TERRIBLE POWER OF
THE THINGS THEY CARRIED.
NEXT.
YOU HAVE ALL CARRIED THINGS OVER
THE LAST FEW YEARS NONE MORE
PUBLIC THAN THE TRAGIC STORY OF
DR. LORNA BREEN WHO IS WAS
DIRECTOR OF EMERGENCY DEPARTMENT
AT THE NEW YORK PRESCRIBING BI
TERRION HOSPITAL.
IN THE SPRING OF 2020 AND IN A
PERIOD OF JUST A SHORT 3 WEEKS
DR. GREEN FOUND HERSELF TREATING
COVID PATIENTS AND THEN
CONTRACTING THE ILLNESS HERSELF
AND THEN PUSHING HERSELF TO
RETURN TO HER COLLEAGUES IN ARMS
AT THE FRONT LINE SO SHE COULD
HELP THE PATIENTS.
SHE HAD MADE IT HER LIFE'S
MISSION TO CARE FOR.
THIS ALL HAPPENING DURING THE
TIME OF LIMITED PPE, LIMITED
SUPPLIES, LIMITED BEDS, PATIENTS
DYING IN WAITING ROOMS AND IN
HALLWAYS, MEDICAL TEAMS DECIDING
WHO WOULD GET VENTILATORS, LIKE
THE SOLDIERS AND THE THINGS THEY
CARRY, EXPERIENCE IS ENOUGH TO
BREAK ANYONE.
HER BROTHER-IN-LAW COREY FEISS,
WHO CONFOUNDED THE DR. LORNA
GREEN FOUNDATION ALONG WITH
DR. GREEN'S YOUNG OF THE SISTER
SPOKE IN A RECEIPT NATIONAL
ACADEMY OF MEDICINE WEBINAR
SAYING SHE ANSWERED THE CALL FOR
COUNTRY, FOR CITY BUT WHEN SHE
NEEDED TO MAKE A CALL FOR
HERSELF SHE COULDN'T PRIORITIZE
HER WELL BEING ABOVE HER
COLLEAGUES AND HER PAIBTS
BECAUSE STHEE WORRIED IT WOULD
END HER CAREER, HER PROFESSIONAL
REPUTATION.
AND THE LAST 2 PLUS YEARS ALL
STAFF IN HOSPITAL SETTINGS HAVE
GONE ABOVE AND BEYOND THEIR
ORDINARY OBLIGATIONS TO RESPOND
TO A THREAT TO NATIONAL AND
GLOBAL WELL BEING, A HUMAN
BEINGS ARE NOT INEXHAUSTIBLE.
NEXT SLIDE.
THIS OF COURSE LED TO ALL THE
WRITINGS WE'VE READ ABOUT THE
GREAT RESIGNATION INCLUDING
HEGHT CARE WITH OVER A HALF
MILLION REGISTERED NURSE
ANTICIPATED TO RETIRE BY THE END
OF 2020, THE U.S. BURRO OF LABOR
STATISTICS PROJECTS THE NEED FOR
1.1 MILLION NEW RNs ACROSS THE
COUNTRY WITHIN THE NEXT 5 YEARS,
THE COUNTRY FACES A PROJECTED
NATIONAL SHORTAGE OF MORE THAN
3 MILLION LOW WAGE HEALTHCARE
WORKERS AND THE AAMC, OCCASIONER
OF AMERICAN MEDICAL COLLEGES
PROJECTS THAT PHYSICIAN DEMAND
WILL CONTINUE TO GROW FASTER
THAN SUPPLY, LEADING TO A
SHORTAGE OF UP TO 139,000
PHYSICIANS BY 2033 WITH THE
ALARMING GAPS OCCURRING IN
PRIMARY CARE.
MEDICINE IS AT A RISK OF AN
AVISITINGERATING DEPARTURE OF
HIGHLY TRAINED HARD WORKING
CLINICIANS.
THE TRICKLE DOWN EFFECTS ARE
ENORMOUS, SIGNATURES 95 IMPACT
ON PATIENT CARE, TRAINING ON
CAREER PROGRESSION AND THE WORK
LOAD OF THE COLLEAGUES REMAIN.
PANDEMIC FELL ON A WORKFORCE
THAT WAS ALREADY UNDER STRESS
FROM THE BURDENS OF WORKING IN
ENVIRONMENTS LADEN WITH CLINICAL
RISKS, TO THE MEASURES OF BEING
UNABLE TO DELIVER CARE TO THE
HIGH STANDARDS TO WHICH THEY
HAVE BEEN TRAINED AND THE
FRUSTRATION OF CHRONIC
UNDERRESOURCING, UNDERRESOURCING
AND SYSTEM SYSTEM FAILURES THAT
HAVE RESULTED IN PATIENT ARMS.
NEXT.
THERE'S BEEN A GROWING MOVEMENT
UNDERWAY AND THAT'S THE GOOD
NEWS, THE ORGANIZATIONS LIKE THE
INSTIEWT IN HEALTHCARE AND
IMPROVEMENT BEGIN TO INDGREAT
PHYSICIAN WELL BEING AND TO
THEIR CALL FOR ACTION, MOVING
FROM THEIR TRIPLE AIM OF BETTER
POPULATION HEALTH, BETTER
EXPERIENCE OF CARE AT LOWER
COST, PUBLISH INDEED 2007 TO
RECOGNIZE THIS TRIPLE AIM COULD
NOT BE DONE WITHOUT ADDING
PHYSICIANS, I'M GOING TO BROADEN
THAT TO CLINICIANS WELL BEING IN
2017 AS AN IMPORTANT COMPASS FOR
OPTIMIZING HEALTH SYSTEMS
PERFORMANCE.
I WANT TO EMPHASIZE THE POINT
THAT VALUES BASED CARE MUST
INCLUDE THE CLINICIANS.
NEXT SLIDE.
THE NATIONAL ACADEMY OF MEDICINE
CREATED THE NATIONAL ACTION
ALLIANCE ON CLINICIAN WELL BEING
AND RESILIENCE.
COMMISSIONING A CONSENSUS STUDY
TO EVALUATE AVAILABLE EVIDENCE
ON CLINICIAN BURN OUT AND WELL
BEING, EVIDENCE OF PREVENTIVE
LANCE VARIES BUT MAN REFERENCES
THAT 35-54% OF NURSES AND
PHYSICIANS AND 45-60% OF MEDICAL
STUDENTS AND RESIDENTS
EXPERIENCE SUBSTANTIAL SYMPTOMS
OF BURN OUT AND THIS WAS ALL
WELL BEFORE COVID.
THIS CONSENSUS STUDY REPORT
IDENTIFIES CLINICIAN BURN OUT AS
SIGNIFICANT QUALITY OF CARE AND
HIGHLIGHTS THE NOTION THAT
MOUNTING SYSTEMS PRESSURES
WITHIN THE U.S. HEALTHCARE
SYSTEM HAVE CONTRIBUTED TO AN
IN-BALANCE WHICH THE DEMANDS OF
THE JOB ARE GREATER THAN THE
RESOURCES AND SUPPORT AVAILABLE.
SINCE AND DURING THE PANDEMIC
THE CLINICIAN WELL BEING
COLLABORATIVE HAS DOUBLED DOWN
ON THEIR EFFORTS WITH CONTINUED
EMPHASIS ON THE NATIONAL PLAN
FOR ACTION OFFERING A ROADMAP
FOR CHANGE.
IN FACT THEY HELD AN ONLINE
EVENT JUST A MONTH AGO CALLING
FOR PUBLIC INPUT.
NEXT.
THE CONSEQUENCES OF CLINICIAN
BURN OUT FOR VAST AND WELL
DOCUMENTED AND I WON'T GO INTO
THESE IN MUCH DETAIL, THIS WAS
LISTED WELL BEFORE THE PANDEMIC
HIT, AND IT'S INCLUDED TO YOU,
INCLUDING QUALITY ERRORS QUALITY
PROFESSIONALISM AND REDUCED
PATIENT SATISFACTION, TURNOVER
IN STAFF, REDUCED MORAL AND ITS
IMPACT ON PRODUCTIVITY,
THREATENED ORGANIZATION
REPUTATIONS AND ALL THE
INDIVIDUAL PROBLEMS THAT COME
WITH LIKE MOTOR VEHICLE
ACCIDENTS, NEAR MISSES
DEPRESSION AND SUICIDAL
IDEATION, MORAL INJURY AND SO
FORTH.
THIS IS NOT NEW TO OTHER
HEALTHCARE PROFESSIONALS.
NEXT SLIDE.
ON MAY 23rd, CERTAIN MEDICAL
FOWBD THE MOST RECENT ARK LARM
HIGHLIGHTING THE NEED TO ADDRESS
BURN OUT CRISIS ACROSS THE
COUNTRY AND YET AGAIN THERE ARE
REAL QUESTIONS THAT EMERGE FROM
THIS TOPIC LIKE WHAT DOES IT
MEAN TO ADDRESS THE PROBLEM AS
BIG AND HUGE AMORPHIC AS BURN
OUT AND STRESS AND WELL BEING.
IS IT OUR JOB TO MANAGE THESE
ISSUES FOR OUR STAFF AT WORK,
WHAT PARTS ARE PRIVATE AND WHAT
PARTS SPILL INTO THE WORKPLACE,
WHAT PARTS ARE FOR SUPER VISORS
AND COLLEAGUES TO ACT ON AND
WHAT PARTS ARE FOR THE
INDIVIDUALS.
OUR HEALTHCARE SYSTEMS
INTERVENING WHERE THEY SHOULD BE
OR JUST ON THE LOW HANGING
FRUIT.
WHAT SHOULD BE OFFERED AND TO
WHOM, AND WILL 1 SIZE FIT ALL,
NEXT SLIDE.
FOR SURE THIS TOPIC FEELS LIKE A
3 LEGGED BEHEMOTH, TERMS LIKE
WELL BEING AND BURN OUT CAN BE
AMBIGUOUSLY DEFINED, THEY ARE
LIMITS TO WHAT THEY MEAN, THERE
ARE LIMITS TO WHAT WE CAN
CONTROL AND WHAT WE CHANGE THE
THERE ARE MANY SYSTEMS IN PLACE,
1 OF THE PRIMARY CHALLENGES
THOUGH IS IN GETTING A READOT
PROBLEM, SORT OF PULSEOX
IMPEDIMENTSITTER NOT JUST FOR
THE INDIVIDUAL BUT FOR THE WORK,
UNIT, TEAM, DEPARTMENT, THE
ENTIRE ORGANIZATION, WE NEED
SYSTEMATIC AND RIGOROUS WAYS OF
MEASURING WHAT I CALL
ORGANIZATIONAL VITAL SIGNS.
THE EASY CASES ARE EASY, WHERE
THERE'S PULSE OX ON THE LOW 80S,
IT'S CLEAR WE HAVE A PROBLEM BUT
WHAT ABOUT THE TOUGH CASES, WHAT
ABOUT WHEN WE'RE NOT SO SURE?
FOR EXAMPLE WITH THE CHIEF
RESIDENT WHO EXTERNALLY LOOKS
LIKE HE'S COMPLETELY GOT HIS ACT
TOGETHER BUT SOMETHING UNTWARD
HAPPENS AND WE SAID WE HAVE NO
IDEA, EVEN THOUGH WE WORKED
CLOSELY WITH HIM EVERY DAY AND
JUST BECAUSE WE KNOW ABOUT A
READING IN THE LOW 80S HOW DO WE
GO ABOUT UNDERSTANDING THE
DRIVERS OF BURN OUT IN A
MEANINGFUL WAY, IN AN EVIDENCE
INFORMED WAY.
NEXT.
SO THERE ARE 5 CASES TO BE MADE
FOR WHY HEALTHCARE ORGANIZATIONS
SHOULD INVEST IN A WELL BEING
PROGRAM AND I WILL NOT GO INTO
THESE IN DEPTH, I'VE ALREADY
MADE THE CASE FOR A TRAGIC CASE,
1 DEATH OF SUICIDE IS 1 TOO
MANY, THE MORAL CASE, WELL IT'S
JUST THE RIGHT THING DO TO TAKE
CARE OF OUR OWN.
THIS CASE IS REALLY AN
INTERESTING 1 AND MORE SO WITH
THE GREAT RESIGNATION, ON ARE
RETURN ON INVESTMENT ASTRIGZ IS
DOUBLE AMONG PHYSICIANS
EXPERIENCING PROFESSIONAL BURN
OUT AND COSTS AVERAGE BETWEEN
HALVING A MILLION AND 1 MILLION
TO REPLACE A PHYSICIAN, CAN YOU
CALCULATE THE COST FOR NURSES,L
FORM CYSTS, SOC WORKERS AND
THE LIST GOES ON.
RECRUITMENT AND RETENTION IS AT
THE FOREFRONT OF EVERY HOSPITAL
LEADERS MINE, AND WHAT ARE WE
DOING TO ADDRESS THE BEST AND
BRIGHTEST TO KEEP THEM HERE, 8%
OF HOSPITALS AROUND THE CASE
HAVE MAGNET STATUS, REALLY SMALL
NUMBERS AND NURSING HERE HAS
DONE A YOMAN'S JOB UNDER THE
LEADERSHIP OF DR. BARBARA JORDAN
AND RACHEL KOOMS AND THEIR TEEM
AND MANY OTHERS INTEGRATING WELL
BEING INTO THE VERY FABRIC OF
THE WORK BUT I'M HERE TO TALK
ABOUT THE REGULATORY CASE.
NEXT.
IN TWEBT 15 AND 2016 THE
ACCREDITATION COUNCIL FOR
GRADUATE MEDICAL EDUCATION, ALSO
KNOWN AS TD ACGHE ORGANIZED
THEIR FIRST AND SECOND SYMPOSIA
ON PHYSICIAN WELL BEING.
ON JULY 1st 2017, THE ACGME
PROVIDES SECTION 6 C OF A COMMON
PROGRAM REQUIREMENT TO ADDRESS
WELL BEING MORE COMPREHENSIVELY.
THAT'S A FANCY WAY OF SAYING,
THEY BAKE THIS IN AS A
REQUIREMENT, NOT JUST FOR
PHYSICIAN TRAINEES BUT
INTERESTINGLY ALSO FOR FACULTY.
AND THEY DID THAT BECAUSE
RESIDENTS AND FACULTY AS I'VE
SAID HAVE INCREASED RISK FOR
BURN OUT WHEN COMPARED TO THE
GENERAL POPULATION.
PROGRAMS HAVE THE SAME
RESPONSIBILITY TO ADDRESS WELL
BEING AS THEY DO TO EVALUATE
OTHER ASPECTS OF RESIDENTS
COMPETENCE LIKE MEDICAL
KNOWLEDGE AND PATIENT CARE, AND
PERSONAL COMMUNICATION AND
SYSTEMS BASED PRACTICE AND SO
FORTH MPLET I WANT TO HIGHLIGHT
FACULTY HERE BECAUSE THIS
REPRESENTS AN AREA OF
OPPORTUNITY HERE AT THE NIH AND
WE'RE CONSTANTLY LOOKING FOR
PARTNERS SO I WILL DO A FEW
PUBLIC SERVICE ANNOUNCEMENTS TO
GET YOU ALL ON BOARD, NEXT
SLIDE.
AS OF 2021, ALL SPECIALTY
PROGRAMS HAVE ROLLED OUT FORMAL
MILESTONES FOR WELL BEING UNDER
PROFESSIONALISM AS A HEADER AND
I WANT TO USE THIS EXAMPLE FROM
INFECTIOUS DISEASE WE FOR SURE
KNOW THEY HAVE BEEN WORKING HARD
OVER THE LAST 3 YEARS.
SO FROM LEVEL 1 TO 5 AND I'M
GOING TO SAY NEXT YEAR RITA CAN
POP THOSE OUT, LEVEL 1 IS
RECOGNITION OF THE PROBLEM.
LEVEL 2 IS IDENTIFYING LIST OF
RESOURCES, THAT'S A BIT OF A
CHALLENGE HERE BECAUSE WE'RE
BOTH AN EMBARRASSMENT THE OF
RICHES, WE IS A LOT OF PEOPLE
DOING GREAT WORK IN THIS SPACE
BUT THERE ARE SIGNIFICANT
CHALLENGES KNOWING WHERE TO FIND
NRGZ.
LEVEL FREE IS PROPOSING A PLAN
TO PROMOTE PERSONAL AND
PROFESSIONAL WELL BEING, LEVEL 4
DESCRIBES INSTITUTIONAL LEVEL
FACTORS THAT AFFECT WELL BEING,
AND LEVELS 5 DESCRIBES
INSTITUTIONAL PROGRAMS DESIGNED
TO EXAMINE SYSTEMIC SCRIEWBTORS
TO BURN OUT, SO IF YOU'RE HERE
FOR THIS TALK, I CAN SAY THAT
YOU WILL BE ABLE TO GET TO AT
LEAST A LEVEL 4 IN TERMS OF YOUR
UNDERSTANDING AROUND WHAT THIS
TOPIC IS ALL ABOUT.
BUT THESE MILESTONES OFFER A
BASIC GUIDANCE, THEY OFFER BASIC
GUIDANCE, THEY DON'T OFFER A
PATH FORWARD.
THAT MEANS IT'S BEEN UP TO OUR
PROGRAMS INDIVIDUALLY TO FIGURE
OUT HOW TO OPERATIONALIZE THIS.
THAT'S NOT A VERY EFFICIENT WAY
OF MEETING THESE CHALLENGES,
NEXT SLIDE.
THE ACGME ESTABLISHED THEIR
PROGRAMS IN 2017 TO PROVIDE
GRADUATE MEDICAL EDUCATION
COMILTEES AND EXECUTIVE LEADERS
OF HOSPITAL MEDICAL CENTERS AND
OTHER CLINICAL SETTINGS TO GET
FEEDBACK AIMED AT IMPROVING
PATIENT CARE WHILE OPTIMIZING
OUR CLINICAL LEARNING
ENVIRONMENT IN 6 IMPORTANT CROSS
CUTTING AREAS AND THOSE ARE
IDENTIFIED ON THIS TABLE OF
CONTENTS THERE.
THOSE IMPROVE THINGS LIKE
PATIENT WELL BEING, AND THEY
DON'T INCLUDE PEOPLE IN
HOSPITALS BUT THEY INCLUDED WELL
BEING AND I HIGHLIGHTED 6 WELL
BEING PATHWAYS AGAIN HERE WHICH
AMRI TO RESIDENTS AND FACULTY AS
WELL, WHEN CLER DOES A VISIT
THEY KNOW WHAT WE'RE DOING HERE,
WE ARE MAINTAINING WELL BEING
WHILE FULFILLING PROFESSIONAL
OBLIGATIONS TO DEMONSTRATE
SPECIFIC EFFORTS TO WELL BEING
AND RESIDENTS FELLOW FACULTY AND
DEMONSTRATE SYSTEMS BASED
ACTIONS AND SO FORTH.
DEFINING OUR TERM SYSTEM AN
IMPORTANT FIRST STEP IS A BIT OF
A CHALLENGE.
LET'S GO TO THE NEXT SLIDE.
BURN OUT, WELL BEING,
SELF-VALENTINEDDUATION,
COMPASSION FACAS FEEING,
ENGAGEMENT, SATISFACTION,
MEANING, STRESS, EMOTIONAL
EXHAUSTION, MORAL INJURY, JOY,
DEPRESSION, WHAT EXACTLY ARE WE
SUPPOSED TO BE MEASURING IN
ORDER THAT WE KNOW, WE ARE
CAPTURING THE FUNDMENTAL DRIVERS
OF BURN OUT IN THIS PARTICULAR
SETTING, IN OUR PARTICULAR
CULTURE, THAT IS A FEDERALLY
FUNDED CLINICAL RESEARCH
FACILITY WITH A GIVING--YOU
NATIONAL LIBRARY OF MEDICINOUS
MISSION TO CURE ALL THAT AILS
PEOPLE IN THE CONTEXT OF
ENORMOUS INSTITUTIONAL
COMPLEXITY.
IT IS NOT A SMALL UNDERTAKING.
BURN OUT IS A TERM THAT'S BEEN
CHARACTERIZED SINCE THE NEEB
70S, HISTORICALLY HERBERT
FROYDENBURGER IS CREDITED OF
DEFINING BURN OUT IN THE CONTEXT
OF THE ORIGINAL WORKPLACE.
IN HIS 1974 ARTICLE, HE
DESCRIBES THE STATE OF BEING
BURNT OUT AS BECOMES EXHAUSTED
BY MAKING EXCESSIVE DEMANDS ON
ENERGY OR STRENGTH OR RESOURCES
IN THE WORKPLACE.
THE W. H. O. HAS DEFINED BURN
OUT AS A PROBLEM ASSOCIATED WITH
CHRONIC WORKPLACE STRESS, NOT A
MENTAL HEALTH DIAGNOSIS, IT'S
IMPORTANT TO NOTE HOWEVER, THAT
BURN OUT, DEPRESSION AND SUICIDE
IDEATION ARE SEPARATE BUT
RELATED ENTITIES.
BURN OUT LIKE OTHER STRESSORS
MAY CONTRIBUTE TO THE
DEVELOPMENT OF DEPRESSION IN
SUSCEPTIBLE INDIVIDUALS.
NEXT SLIDE.
DEPRESSION AND BURN OUT SHARE
SIMILARITIES AND ALTHOUGH THEY
SHARE OVERLAPPING SYSTEMS THEY
ARE NOT SIN OPEN MEETING NOWS,
BURN OUT IS AN OCCUPATIONAL
STRESS SYNDROME AND PSYCHIATRIC
DIAGNOSIS THAT IS GLOBALLY
PERVASIVE AS AN EXAMPLE, MOST
BURN OUT ASSOCIATIONS, IS
INCREASED RISK OF SELF-REPORTED
MEDICAL ERRORS AND DEPRESSION IS
NOT.
BURN OUT AND DEPRESSION MANIFEST
SIMILARLY AND MAY EVEN CO EXIST
AMONG SOME PHYSICIANS AND
CLINICIANS, HOWEVER, SINCE THEY
ARE SEPARATE AND DISTINCT
CONDITIONS, THEY REQUIRE
DIFFERENT INTERVENTIONS.
INTERVENTIONS TARGETING
OCCUPATIONAL BURN OUT ARE NOT
ONLY ON AN INDIVIDUAL LEVEL OR
MORE IMPORTANTLY ON A SYSTEM
LEVEL, TARGETING THINGS LIKE
LACK OF CONTROL AND AUTONOMY.
SO THINGS FOR EXAMPLE, PATIENT
NONCOMPLIANCE AND ON THE
PHYSICIAN WHO MIGHT HAVE MINIMAL
CONTROL OVER WHAT THEY CAN DO IN
THEIR DECISION MAKING, A LACK OF
INFLUENCE OVER SCHEDULING
PATIENTS, INCONGRUOUS VALUES
BETWEEN CLINICIANS AND
HEALTHCARE ADMINISTRATORS MPLET
BOTH BURN OUT AND DEPRESSION MAY
LEAD TO REGULAR USE OF ALCOHOL
OR OTHER SELF-MEDICATION, AND A
STUDY FOUND THAT WOMEN
EXPERIENCING BURN OUT ARE AT
HIGHER RISK OF ALCOHOL
COMSUMPTION THAN ARE MEN AS AN
EXAMPLE.
MANY FACTORS CONTRIBUTING TO
BURN BURN OUT AMONG MEN AND
WOMEN PHYSICIANS BY THE WAY ARE
SIMILAR, PREVENTION AND
INTERVENTION STRATEGIES AIMED AT
MITIGATING THESE FACTORS SHOULD
BENEFIT ALL, HOWEVER SOME
EXTERNAL FACTORS DIFFERENTIALLY
IMPACT.
NEXT.
THAT SAID, THE PANDEMIC HAS
SINCE AFFECTED THE MENTAL HEALTH
OF HEALTHCARE WORKERS NATIONWIDE
WITH MORE THAN 50% RECORDING
SYMPTOMS OF AT LEAST 1 MENTAL
HEALTH CONDITION SUCH AS
ANXIOUS, DEPRESSION AND
INCREASED LEVEL OF PROAOF THE
TRAUMATIC STRESS DISORDER, NEXT
SLIDE.
GIVEN THE CURRENT EVIDENCE BASE
AND PHYSICIANS, IT IS DIFFICULT
TO KNOW WHETHER THERE ARE REAL
OR PERSISTENT GENDER RELATED
DIFFERENCES IN THE RATES OF BURN
OUT, THEY ARE NOT CONSISTENTLY
ADDRESSED IN STUDIES OF
PHYSICIAN BURN OUT, MOST STUDIES
DO NOT ADDRESS GENDER IDENTITY
OR SEXUAL ORIENTATION, FURTHER
MORIT IS NOT CLEAR IF BURN OUT
AND MORE CLEAR AMONG WOMEN OR IF
GENDER BASED DIFFERENCES IN ITS
EXPRESSION MAKE IT EASIER TO
IDENTIFY AMONG WOMEN.
SO EVEN IF WOMEN AND MEN REPORT
THE SAME SOURCES ON QUANTITATED
SURVEYS, THEIR QUALITATIVE
EXPERIENCES OF BURN OUT MAY
DIFFER.
IN 1 STUDY BY [INDISCERNIBLE]
AND COLLEAGUES WOMEN WERE MORE
LIKELY TO IDENTIFY EMOTIONAL
EXHAUSTIAN AS THEIR PRIMARY AREA
OF BURN OUT WHEREAS MEN WERE
MORE LIKELY TO DESCRIBE
CYNICISM.
BOTH MEN AND WOMEN REPORT THAT
CHALLENGES AND WORK LIFE
INTEGRATION CONTRIBUTE TO BURN
OUT HOWEVER THEY DEFINE THIS
DIFFERENTLY.
JOLLY AND COLLEAGUES LOOK AT
GENDER DIFFERENCES IN TIME SPENT
ON PARENTING AND DOMESTIC
RESPONSIBILITIES BY HIGH
ACHIEVING YOUNG PHYSICIAN
RESEARCHERS AND NOTE THAT WOMEN
ARE MORE LIKELY THAN MEN TO HAVE
PARTNERS WHO ARE EMPLOYED
FULL-TIME.
WOMEN EMPLOYED FULL-TIME SPENT
AND AND HALF ADDITIONAL HOURS
PER WEEK ON CHILD CHAIR AND
OTHER DOMESTIC ACTIVITIES: ON
AVERAGE WOMEN WHO ARE EMPLOYED
AND WHOSE PARTNERS ALSO WORK
PERFORMANCE ARKSZ DITIONAL 2
HOURS OF WORK AT HOME PERDAY AND
INCREASE 3 TIMES HIGHER THAN
THAT REPORTED BY MEN WHO PARTNER
WORK, MEN IN THESE CIRCUMSTANCES
NOTE THEIR DOMESTIC WORK
INCREASE BY AN AVERAGE OF 40
MINUTES.
THE INTERSECTION OF BURN OUT AND
GENDER AGE, RACE, ETHNICITY AND
RELIGIONS LIMITED BY SURVEY SIZE
RESPONSE RATES AND UNDER
REPORTING AND THESE FOR SURE
REQUIRE FURTHER INVESTIGATION.
NEXT SLIDE.
LET'S GET BACK TO THE DEFINITION
OF SURN OUT, WITH WELL BEING ON
THE LEFT AND STRESS?
THE MIDDLE AND OCCUPATIONAL ON
THE RIGHT.
NEXT, YOU CAN GO NEXT, THERE WE
GO.
THE INVENTORY IN MEASURING BURN
OUT DEFINES IT AS THE TRIAD OF
EXHAUSTION, CYNICISM, FEELINGS
OF DIMINISHED ACCOMPLISHMENT ON
THE WORK ENVIRONMENT.
OT LEFT SIDE YOU SEE WELL BEING
AS DEFINED AGAIN, IS THAT
PROFESSIONAL FULFILLMENT,
SATISFACTION, ENGAGEMENT OR
MOANING BUT THAT'S THE GENERAL
IDEA, ALTHOUGH BURN OUT IS A
SIGN OF CLINICAL STRESS AND A
BARRIER TO WELL BEING, IT'S
ABSENCE IS NOT CONFER A SAFE
WELL BEING, IT'S BURN OUT IS 1E
MORE NOTABLE CONDITIONS.
LET'S GO TO THE NEXT SLIDE.
SO, IN THIS 2015 ARTICLE BY
[INDISCERNIBLE] AND COLLEAGUES
WE LOOK AT BURN OUT ALONG THE
X-AND Y AXIS AND I WILL HAVE YOU
HIT NEXT, RITA, THE X-AXIS IF
YOU CAN HIT NEXT RITA IS SHOWING
BURN OUT AND SATISFACTION IS ON
THE Y-AXIS WITH WORK LIFE
INTEGRATION OF THE Y-AXIS, THIS
SAY STUDY DONE IN 2014 BEFORE
COVID, CAN YOU SEE THAT VARYING
SPECIALTIES HAVE VERYYING
REPORTS ON THE PERCENTAGES OF
THOSE THAT ARE BURN OUT AND
THOSE THAT ARE SATISFIED WITH
THEIR WORK LIFE BALANCE.
OCCUPATIONAL MEDICINE IS WAY UP
THERE ON THE LEFT CORNER AND
SAFETY DOG IT WELL, NEUROLOGIC
SURGERIES HAVING A HARD TIME BUT
THIS WAS 2014 DATA BEFORE COVID.
SO THE TAKE HOME HERE IS THAT
THERE ARE VARYING STRESSORS
ACROSS SPECIALTIES, MAKING THE
POINT THAT WHAT AILS DIFFERENT
GROUPS ARE DIFFERENT AND THEY
NEED TO BE MEASURED EFFECTIVELY
AND THEY NEED TO BE INTERVENED
DIFFERENTLY AND THAT'S TRUE FOR
EACH GROUP.
LET ME GO MORE DEEPLY INTO THIS
WITH THE NEXT SLIDE.
SO IN THE BOOK, STRATEGIES TO
REDUCE BURN OUT MAKE THE POINT
THAT STRESSORS IMPACT HEALTHCARE
PROVIDERS AS I MENTIONED
DIFFERENTIALLY, THE BLACK
SECTION HERE IN THE CIRCLE
IDENTIFIES STRESS POINTS IN THE
SYSTEM SO FOR EXAMPLE, POORLY
FUNCTIONING CARE TEAM AND POOR
MANAGEMENT AND LEADERSHIP AND
INCONGRUENT VALUES COMPLEX CAN
IMPACT HEALTHCARE PROVIDERS
DIFFERENTIALLY.
NEXT, IF YOU LOOK AT THE OUTER
PART OF THE CIRCLE HERE THEY
HIGHLIGHT WHAT STRESSORS
INFLUENCE PARTICULAR HEALTHCARE
PROVIDERS.
THAT IS BLUE REPRESENTS STRESSOR
FORS PHYSICIANS LIKE MALPRACTICE
SUITS AND EXCESSIVE WORK HOURS
AND ACADEMIC PROMOTION AND THE
PURPLE REPRESENTS STRESSORS MORE
RELEVANT TO NURSES, LIKE
INADEQUATE STAFFING,
MISTREATMENT BY OTHERS ON THE
CARE TEAM AND SO FORTH.
IF WE GO IN THE NEXT SLIDE, IN
THIS 2019 ARTICLE, THEY MAKE A
POINT THAT 1 SIZE DOES NOT FIT
ALL.
IF YOU GO NEXT, AGAIN, IT'S
BROKEN DOWN BY VARYING
SPECIALTIES NOT JUST WITHIN
MEDICINE BUT I WANT TO POINT
WITH LITTLER DISCIPLINES CAN YOU
SEE WITH THIS REGARD, ALLIED
PROFESSIONALS, PRACTICE
PROFESSIONALS, AND NONCLINICAL
ALLIED STAFF, CAN YOU SEE THE
VARYING SPECIFIC EXAMPLES THAT
COME UP, AMBIGUITY AND LIMITED
OPPORTUNITY FOR PROFESSIONAL
DEVELOPMENT, SO DIFFERENT FOLKS
HAVE DIFFERENT STRESSORS, NEXT
SLIDE.
LET ME MAKE AN ANALOGY THAT
MIGHT BE MORE RELATABLE, SO
HUNDREDS OF YEARS AGO,
PHYSICIANS DESCRIBES FLUID
ABNORMALITIES NORMALLY
ACCUMULATING THROUGHOUT THE BODY
AS DROP C WHICH IS NOW CALLED
EDEMA, WHICH IS NOW AS A
DIAGNOSE IS THAT IT CAN BE
RELIABLE IDENTIFIED, THAT'S THE
PITTING WHEN THERE'S EXTERNAL
PRESSURE PLACED ON THE SKIN.
THE PROBLEM THOUGH S&P THAT IT'S
NOT A DISEASE BUT RATHER A
SYMPTOM WITH ANY NUMBER OF
CAUSES, THE CAUSES COULD BE
MOUNTAIN SICKNESS OR PROTEIN
DEFICIENCY, AND THAT'S IMPORTANT
BECAUSE DIFFERENT TREATMENTINGS
REQUIRE DIFFERENT MECHANISMS.
IT'S REALLY ANALOGOUS ON HOW WE
SHOULD CONCEPTUALIZE BURN OUT.
BURN OUT IS THE SYMPTOM OF
ANOTHER UNDERLYING PROCESS.
NEXT SLIDE.
SO DR. LORNA GREEN HEROES FOWBD
AIGDZ WHO JUST PARTNERED UP WITH
INTERESTINGLY WITH THE SCHWARTZ
FOUNDATION AND THAT'S AT GROUP
FOR UNDERWRIEDING SCHWARTZ ROUND
WHICH I KNOW SOME OF HAVE YOU
COME FROM OTHER OUTSIDE
INSTITUTIONS THAT HAVE THESE.
THEY IDENTIFY TOP 5 ACTIONS TO
SUPPORT CARE TEAMS WELL BEING,
WHAT THEY CALL THE WELL BEING 5
AND THAT'S START WITH NONNORMAL
TIMES SO IT'S JUST YOUR
EXPECTATION, DOCTORS, NURSES AND
OTHERS ON THE CLINICAL CARE TEAM
SPENT A HUGE AMOUNT OF TIME ON
ADMINISTRATIVE FUNCTION.
SO THEIR SECOND RECOMMENDATION
IS GET RID OF STUPID STUFF, THIS
BEGS THE PROBLEM OF REFRAMING
QUESTIONS MAYBE WE DON'T HAVE A
HEALTHCARE WORKFORCE SHORTAGE,
MAYBE WE ARE WORKING ON THE
WRONG THING?
THE OTHER RECOMMEND
ANTICIPATIONS INCLUDE GETTING
RADICAL AND SHORE UP ON
STAFFING, DESIGNATE A WELL BEING
EXECUTIVE AND EMPLOYEE
ASSISTANCE PROGRAMS ARE NOT
ENOUGH, DO MORE AND THIS LAST
RECOMMENDATION MEANS 2 THINGS,
WE NEED MORE AND THE RIGHT KIND
OF MENTAL HEALTH SUPPORT,
INTHINKING ABOUT COMPLIMENTARY
MODELS FOR MANAGING STRESS LIKE
COACHING INTRODUCTIONS WHICH ARE
BEING EFFECTIVELY USED AROUND
THE COUNTRY FOR PHYSICIAN
FACULTY AND TRAINEES AS A MEANS
FOR FULFILLMENT.
WE ALSO NEED TO MOVE AWAY FROM
FRAMING THIS 1 AS ERNETAL DRIVES
OF BURN OUT ONLY.
LET ME EXPLAIN.
REJILLIENCE AND SELF-CARE HAVE
BECOME TRIGGERS TERMS BECAUSE WE
RECOUNT THEM, LESSONS ON
PSYCHOLOGY WELL BEING, LESSONS
ON RESILIENCE OF DOCTORS, THE
PROBLEM OF PHYSICIAN BURN OUT
AND YOU CAN GO NEXT RITA, THE
PROBLEM OF PHYSICIAN BURN OUT IS
GENERALLY NOT ORIGINALLY
DOCUMENTED.
RITA CAN YOU HIT NEXT.
THERE WE GO, SO THE PROBLEM OF
PHYSICIAN BURN OUT IS GENERALLY
NOT A RESILIENT SYSTEM.
AND BY THE WAY ON A DIFFERENT
BUT RELATED NOTE, 1 OF THE
REALLY IMPORTANT TAKE HOMES WE
HEARD AT THE NRIERKS H OVER THE
LAST SEVERAL YEARS IS THAT
LEADERS PARTICULARLY PHYSICIAN
LEADERS NEED TO MODEL
VULNERABILITY BETTER INCLUDING
THAT YOU DON'T HAVE TO BE
RESILIENT 24/7 AND DR. GILMAN
WAS AT THE HELM OF THAT WHEN HE
SENT E-MAILS STARTING EARLY ON
IN THE PANDEMIC THAT HELP SEEK
SUGGEST A SIGN OF STRENGTH WHICH
IS AN IMPORTANT MESSAGE.
BURN OUT IS NOT A PROBLEM WHO
DRIVERS LISTED SOLELY WITHIN THE
CLINICIANS CHARACTERISTICS.
PEOPLE ARE GREATER ON PHYSICIANS
ON ADDRESSING CHARACTERISTICS
WITH OF FACTORS AND EXTERNAL
ENVIRONMENTS THAT CONTRIBUTE TO
BURN OUT. THIS IS HIGHLIGHTED
FURTHER IN THE NATIONAL
ACADEMY'S FRAMEWORK, A SYSTEMS
MODEL OF CLINICIANAL WELL BEING.
GO TO THE NEXT SLIDE.
THIS IS A BUSY SLIDE SO YOU
DON'T HAVE TO FOCUS ON THE
DETAILS HERE.
I'M GOING TO POINT OUT A FEW
THINGS, THE NATIONAL ACADEMY
COLLABORATATIVE IN TBENT FLEEN,
SYSTEMS MODEL WHICH INCLUDED
SYSTEMS ENGINEERING WHO WANTED
TO POINT OUT HOW WORK SYSTEM
FACTORS PLAY A MAJOR ROLE IN
CLINICIAN BURN OUT.
AND THOSE THAT IF YOU GO NEXT,
RITA THIS IS WHAT I WANT TO
FOCUS ON, THOSE ARE DISTINCT
FROM THE INTERNAL MEDIATING
INDIVIDUAL MEDIATING FACTORS,
OKAY?
RESEARCH SUGGESTS THAT FOR
PHYSICIANS, EXTERBAL FACTORS
CARRY MORE WEIGHT TO CONTRIBUTE
TO BURN OUT THAN INTERNAL
FACTORS.
AGAIN, WHAT'S BROKEN?
THE SYSTEM.
AGAIN THEY'VE FOCUSED ON
INDIVIDUAL MEDIATING FACTORS
LIKE WORK, YOGA, MINDFULNESS
PRACTICE AND REALLY IMPORTANT
PROGRAMS LIKE PEER TO PEER
INTERVENTIONS.
AND DON'T GETNY WRONG, EACH THE
BEST EMPLOYEES ARE GOALS ARE TO
SUPPORT THEM AND RECOGNIZE THE
EMOTIONAL TOLL OF THE WORK AND
OFFER WAYS TO HELP AND THAT'S
BEEN GOOD AT RAMPING UP AND
HIGHLIGHTING ON HOW THESE THEMES
IMPACT BURN OUT BUT THESE ARE
NOT ENOUGH.
GO TO THE NEXT SLIDE.
SO THERE ARE 7 MAIN DRIVERS AND
OF BURN OUT DRIVEN BY THE
LITERATURE, EACH DRIVEN BY
NATIONAL ORGANIZATION AND THESE
INCLUDE WORK LOADS,
EFFICIENCIES, FLEXIBILITY AND
CONTROL, WORK LIFE INTEGRATION,
COMMUNITY AT WORK AND MEANING AT
WORK.
NEXT.
AND WE NEED TO LOOK AT BOTH
INTERNAL FACTORS LIKE ANXIOUS
WITHOUT COMPETENCY AND LOSS OF
POSITIVE CONNECTION IN THE
WORKPLACE AND SO FORTH, BUT
NEXT, WE ALSO NEED TO LOOK AT
THE EXTERNAL FACTORS, THINGS
LIKE EMRs, ADMINISTRATIVE
INEFFICIENCIES, UNREALISTIC WORK
LOADS AND SO FORTH.
NEXT.
I COMPLETED A REALLY WONDERFUL
STANFORD MD-Ph.D. WELL BEING
DIRECTORS COURSE LAST FALL,
THERE MOTTO FOR PROFESSIONAL
FULFILLMENT IS REALLY AMAZING
AND THAT'S 3 DOMAINS, CULTURE OF
WELLNESS,ENTIOUS FICIENCY AND OF
PRACTICE AND PERSONAL
RESILIENCE, 2/3RDS IN RED AND
ONE-THIRD IN BLUE, THAT'S
PURPOSEFUL, THE EMPHASIZE THE
NEED TO FOCUS NOT ONLY ON
PERSONAL RESILIENCE BUT EXTERNAL
DRIVERS.
SO I WANT TO DEFINE THESE
DOMAINS FURTHER AND HIGHLIGHT
THE EFFORTS AT THE NIH THAT HAVE
KNOW IMPLEMENTED HERE, MOSTLY BY
THE CLINICAL CENTER AND THE
GRADUATE MEDICAL EDUCATION AND
BY MANY OTHERS IN THIS SPACE WHO
HAVE BEEN HARD AT WORK.
SO THE CULTURE OF WELLNESS IS
THE DIMENSION THAT DESCRIBES THE
ORGANIZATIONAL WORK ENVIRONMENT
AND VALUE AND BEHAVIORS THAT
MODELED TO PROMOTE SELF-CARE,
PERSONAL AND PROFESSIONAL GROWTH
AND COMPASSION, AND LEADERSHIP
ALIGNMENT AND VOICE OF INPUT, IF
YOU GO TO NEXT, I WANT TO POINT
OUT THIS IS A SHORT LIST AND NOT
INCLUDES THISEM BUT THESE ARE
EXAMPLES THAT NIH TERMS OF THE
KULTDURE OF WELLNESS, INCLUDE
THE STAFF SUPPORT TELEPHONE LINE
THAT WE'VE HAD TWICE, DOCK SIDE
WHICH HAD A GROUP I WILL TELL
YOU ABOUT FOR FELLOWS, PEER TO
PEER, CODE LAVENDAR AND THOSE
COME FROM THE PATIENT SAFETY AND
QUALITY HERE AS WELL AS NURSING,
FROM BEREAVEMENT GROUPS THAT ARE
RUN OUT OF THE SPIR YIT
ULTIMATELY MINISTRY AND
HOSPITALITY OF MEDICINE, WE'VE
GOT WELLNESS AMBASSADORS AT THE
IC LEVEL AND OF COURSE HELP SEEK
SUGGEST A SIGN OF STRENGTH OUT
OF DR. GILMAN'S NEXT.
NEXT, EFFICIENT OF PRACTICE AS I
MENTIONED DEPENDS ON WORKPLACE
SYSTEMS AND PROPHECIES AND
PRACTICE, AND PRACTICES THAT
PROMOTE SAFETY, QUALITY AND
EFFECTIVENESS, EXAMPLES INCLUDE
SCHEDULES AND WORK FLOW IN OUR
ENVIRONMENT, IF YOU HIT NEXT,
DR. --JOHN AND COLLEAGUES AT
CCRI HAVE DONE A REALLY NICE JOB
ROLLING OUT NEW FEATURES IN THIS
THE EDITORS, CRSP, ET CETERA AND
THESE ARE AGAIN A SHORT LIST OF
EXAMPLES AT THE NIH AND FINALLY
NEXT, RETIRED ATHE PERSONAL
RESILIENCE DOMAIN WHICH REFERS
TO THE INDIVIDUAL SKILLS AND
BEHAVIORS AND ATTITUDES THAT
CONTRIBUTE TO PHYSICAL, ERKSZ
MOTIONAL AND PERSONAL WELL
BEING, IF YOU GO TO NEXT, THERE
ARE A LOT OF PEOPLE THAT ARE
WORKING AND HAVE PROGRAMS ON THE
SAME GME SIDE, WE HAVE BUDDY
PROGRAMS, INTRAMURAL COURSE
OFFERINGS, DR. SHARON HAS A TON
OF OFFERINGS ON THE OFFICE OF
INTRAMURAL AND EDUCATION ON THE
ORS, AND EMPLOYEE ASSISTANCE
PROGRAM HAS PROGRAMS, ET CETERA.
NEXT SLIDE.
SO I WANT TO SHIFT HERE NOW AND
FOCUS ON THIS QUALITY
IMPROVEMENT PROJECT AS WE
UNDERTOOK ON OUR SUBCOMMITTEE OF
WELLNESS, IT'S BEEN A LONG
UNWINDING ROAD AND A PLEASURE TO
PARTICIPATE ON, DR. BOB WAS AT
THE HELM EMPHASIZING THE NEED TO
ACT AND DR. JENNIFER CHANG WHOO
IS THE CHAIR OF THIS COMMITTEE
HAS BEEN A WONDERFUL PARTNER AS
WELL AS DR. LIPSCLRKS ITZ TO DO
THE WORK AS WELL.
LET'S GO TO THE NEXT SLIDE.
I HAVE TO THANK MY COLLEAGUE
DR. HOROWITZ, DON'T LET
STRESSORS BE THE ENEMY OF THE
GOOD.
SO WE'VE TAKEN THIS AS AN
UNDERLYING ON MOTTO BUT THIS IS
A TIMELINE THAT I WILL ROLL IN,
THERE RITA IF YOU CAN GO NEXT,
IN 2017 THEY PUBLISHED THE
REQUIREMENT, NEXT, IN 2018,
CLEAR VISITSA THE CLINICAL
CENTER FOR THE FIRST TIME, NEXT
IN 2019 THE GRADUATE MEDICAL
EDUCATION SUBCOMMITTEE ON
WELLNESS WAS ESTABLISHED, AND WE
TRY TO ENGAGE STAKEHOLDERS AND
CHAMPIONS, AND STARTED THIS QIP
IN 2020, YOU SEE WE INITIATED A
SURVEY AND IN 2021 NEXT, NEXT
THE CLEAR CAME BACK TO VISIT US
AGAIN AND WE ROLLED OUT SURVEY
NUMBER 2.0.
NEXT SLIDE.
I WANT TO START WITH AND LET YOU
KNOW THAT WE LOOKED AT FELLOW
SURVEYS, THE ACGME HAS WELL
BEING QUESTIONS BAKED IN SO WE
CAN GET A PULSE ON HOW RESIDENTS
AND FACULTY WERE DOING AT THE
START OF THIS PROJECT.
NEXT.
OUR FIRST STEP AGAIN WAS TO
FIGURE OUT MEASUREMENTS, WHAT
TOOLS YOU CAN GO NEXT THERE
RITA, WHAT TOOLS WE WERE GOING
TO NEED, WE WANT TO PICK
VALIDATED TOOLS, WE CAN MEASURE
THE PROBLEM TO GET THE ACCURATE
READ AND THERE ARE MANY TOOLS AS
YOU CAN SEE IDENTIFIED HERE IN
THE ARLBY [INDISCERNIBLE], WE
WANT TO GET AN APPROACH FOR
WHERE WE HAVE A MINNAL BURDEN
AND SOMETHING THAT'S ACTIONABLE
AND WE HEARD LOUD AND CLEAR THAT
FOLKS DID NOT WANT TO DEAL WITH
LONG SURVEYS AND MASLOW'S BURN
OUT WAS IESHES DENTIFIED AS WAY
TOO LONG AND BURDENSOME, SO IF
YOU GO AND NEXT AGAIN, PHYSICIAN
WORK LIFE SURVEY WHICH IS THE
MINIZ AND A 1 ITEM AND SIMPLE TO
ANALYZE TOOL AND WAS FREE WHICH
WAS GOOD BECAUSE WE DIDN'T HAVE
ANY FUNDING, NEXT.
WHAT IS THAT QUESTION, WELL HERE
IT IS: OVER ALL BASED ON YOUR
LEVEL OF BURN OUT HOW WOULD YOU
RATE YOUR LEVEL OF BURN OUT SO
THIS IS I 5-POINT SCALE.
NO SYMPTOMS TO HAVE I HAVE A
LOT.
NEXT SLIDE SMGHT AGAIN, WE
MENTIONED IDENTIFYING DRIVES
FROM THE BURN OUT LITERATURE AND
THESE ARE THE DRIVERS I SHOWED
YOU EARLIER, WE ADDED
PROFESSIONAL DEVELOPMENT BECAUSE
WE THOUGHT THAT WAS IMPORTANT IN
THE SETTINGS AND IN OUR FEEDBACK
AFTER THE FIRST, THE SURVEY THAT
WENT OUT FOR 2 PBT 0, WE ADDED
DIVERSITY, EQUITY AND INCLUSION,
THIS IS AN IMPORTANT AREA AS
WELL AS OTHER FOR FEEDBACK GOING
FORWARD, NEXT SLIDE.
AND I WANT TO LET YOU KNOW THAT
WE TAKE THESE CATEGORIES AND
GIVE EXAMPLES THAT ARE SPECIFIC
IN OUR SETTINGS SO YOU WILL SEE
THIS IS WHAT OUR FELLOW SOFTWARE
SUPPORT TAKE, TAKE A READ ON
INCLUDING PRESSURES THAT YOU CAN
SEE AS AN EXAMPLE.
SO GO TO THE NEXT SLIDE SO WHAT
DID THE SURVEY LOOK LIKE WHEN
THEY WENT OUT, WELL THEY WENT
OUT TO THE ELECTRONIC PLATFORM,
LINE OF QUESTIONS, THAT BURN OUT
QUESTION AND THEN IDENTIFYING
THE TOP DRIVERS OF BURN OUT.
NEXT SLIDE.
SO IN TERMS OF THE PROJECT, IT
WAS A SIMPLE DESIGN, CREATED 2
QUESTION SURVEY TOOLS AND THEN
TALK WITH PRESENTLY DIRECTORS
ABOUT HOW TO ADMINISTER THE
TOOL, HOW OFTEN AND 1 OR 2 TIMES
A YEAR AND WHEN TO MEET WITH
TRAINEES AND WHY INCLUDING
NORMALIZING THE CONVERSATION,
OFFERING A FRAMEWORK IN A MODEL
AND DISCUSSING TOP DRIVERS SO
THAT, INTERVENTIONS COULD BE
SPECIFICALLY TARGETED TO THE
INDIVIDUAL TRAINEES COMING TO
THEIR OFFICES, SO OBVIOUSLY IT'S
NOT ANONYMOUS, WE DID THIS SO WE
COULD INTERVENE AT THE
INDIVIDUAL LEVEL NEXT SLIDE.
IN ADDITION WE CREATED AN
ALGORITHM AND CAN YOU GO NEXT,
FOR ACTIONS SO THAT ALL PROGRAMS
ACROSS THE BOARD WOULD HAVE
CONSISTENCY ABOUT HOW THEY
MANAGED THE DRIVERS OF BURN OUT
AND THE IMPACT THEY SEE, NO
INTERVENTION ON THE GREEN,
SCHEDULE FREQUENT CHECK-IN
SESSIONS, AND SO FORTH, CAN YOU
GO NEXT AND NEXT THERE, RITA.
SO THAT WHEN WE GOOT, IF THERE
WAS SOMEONE THEY WERE CONCERNED
ABOUT THEY COULD GET A CRITICAL
VALUE SEBT TO THEM IMMEDIATELY
AND YOU CAN ACT AS NEEDED.
SO OVER ALL WHRA ARE THE
RESULTS?
WELL OVER ALL WE HAD ABOUT 10
PROGRAMS, 10 PROGRAMS
PARTICIPATED IN OUR INITIATIVE
IN YEAR 1, THAT'S IN 2020, AND
2021 AND 9 ADDITIONAL PROGRAMS
JOINED FOR THE SECOND YEAR SO WE
ALMOST DOUBLED OUR ENROLLMENT
THERE, WE HAVE--IT'S THE
COUNTING ON OUR NUMBER OF ACGME
PROGRAMS HERE IS DIFFICULT, BUT
WE HAVE OVER 27 ACGME CREDIT
PROGRAMS AND ABOUT 31
NONACCREDITED FELLOWSHIP
PROGRAMS FOR A TOTE OF OF 260 OR
70 MEDICAL AND DENTAL FELLOWSA
THE TIME AND TO GO TO THE NEXT
SLIDE, WE HAD 7 OUT OF THE 10
PROGRAMS SO 70% RESPONSE RATE IN
THE INITIATIVE AND THIS IS WHAT
THEY IDENTIFIED AND THEY
IDENTIFIED AS TD TOP DRIVERS OF
BURN OUT, THOSE HAD TO DO WITH
WORK LOAD, JOB DEMAND,
PROFESSIONAL DEVELOPMENT, SOCIAL
SUPPORT AND WORK LIFE
INTEGRATION, I DON'T HAVE THE
NUMBERS OF INDIVIDUALS BECAUSE
AGAIN THESE ARE THE PROGRAMS
THAT SENT US INFORMATION ABOUT
THIS, AT THE INDIVIDUAL LEVEL.
IF YOU GO TO THE NEXT SLIDE, WE
INTEGRATED INTERVENTIONS
ACCORDING TO THE DRIVERS AND TO
EITHER EXISTING PROGRAMS OR WE
CO CREATED AND BUILT NEW 1S.
SO I WILL JUST POINT OUT A FEW
IN THE CLINICAL PROFESSIONAL
DEVELOPMENT AREA, THE YOMAN'S
JOB UPDATING THE 2021 HAND BOOK
WHICH OFFERS A LOT OF GREAT
INFORMATION, ON SOCIAL SUPPORT,
IN TERMS OF OUR WELL BEING
SUBCOMMITTEE WE STARLIGHTED AN
INTRAMURAL SUPPORT GROUP AND
INITIATIVE CALLED DOC SIDE FOR A
GROUP THAT STARTED OF FELLOW
THIS IS YEAR, TO GET TOGETHER IN
A HYBRID MODEL MONTHLY TO HAVE
DISCUSSIONS ABOUT THEMES AND
WORK LIFE INTEGRATION, WE
LAUNCHED SEVERAL BUDDY PROGRAMS,
AND RESIDENCY PROGRAM AS WELL AS
A PROACTIVE EAPP PROGRAM OUT OF
OUR GROUP.
NEXT SLIDE.
I WILL GIVE A SHOUT OUT TO
DR. [INDISCERNIBLE] AND
DR. [INDISCERNIBLE] FELLOW
SHARES FOR THE LAST YEAR, THEY
DID A TERRIFIC JOB IN TERMS OF
PROFESSIONAL DEVELOPMENT AND
CREATING AN UNDATED
INFRASTRUCTURE THAT IS AN
EXECUTIVE COMMITTEE FOR
ENHANCING PROFESSIONAL
DEVELOPMENT AND LEADERSHIP FOR
THEMSELVES WITHIN THE LARGER NIH
STRUCTURE AND THAT'S JUST A GOOD
EXAMPLE'VE HOW THIS IS ANOTHER
EXAMPLE OF HOW WE RAMP UP AND
ADVANCE PROFESSIONAL DEVELOPMENT
OPPORTUNITIES FOR OUR RESIDENTS
AND FELLOWS, NEXT SLIDE.
THIS IS REALLY THE FOCUS OF
WHERE THINGS NEED TO BE IN TERMS
OF MAKING CHANGE IN HEALTHCARE
SYSTEMS AROUND THE COUNTRY.
THESE ARE GENERIC EXAMPLES OF
THE KINDS OF INTERVENTIONS THAT
WILL HELP US THROUGH AUTONOMY
AND THROUGH PUT AND REDUCING
INEFFICIENCIES, THESE ARE
EXAMPLES LIKE AGAIN, THE
DOCUMENTATION PROTOCOL, I WANT
TO POINT OUT MAXIMIZING PRIVACY
AROUND LICENSURE AND
CREDENTIALING, IT'S AN IMPORTANT
TOPIC AND AS YOU KNOW PHYSICIANS
ARE ENGAGED AS TO WHETHER THEY
HAVE HAD MENTAL TREATMENT IN THE
PAST AND THERE ARE VARYING
APPROXIMATELY SEES IN EACH STATE
AND PEOPLE ARE WORKING ACTIVELY
AT TRYING TO REDUCE THE
SIGNATURES STATE REGULATOR AND
WHAT EXTENT THIS NEEDS TO BE
CHANGED SO THESE ARE JUST
SUGGESTIONS FOR AREAS OF
CONTINUED WORK.
SO NEXT SLIDE, WAFTER IN HIS
2018 JAMA ARTICLE, OOPS I WAS 1
BEHIND IN HIS ARTICLE RESOLVING
THE PRODUCTIVITY PARADOX OF
HEALTH INFORMATION TECHNOLOGY,
SAID THAT ALTHOUGH EVIDENCE OF
HEALTHCARE DIGITIDESSATION HAS
LED TO IMPROVEMENTS IN QUALITY
AND SAFETY IS GENERALLY
POSITIVE, UNIVERSALLY, THESE
HAVE BEEN CONTACT DEPENDENT
RECRUITMENT AND HAVE BEEN
RELATIVELY SMALL, SO, THE BOTTOM
LINE HERE IS A COMPLAINT THAT
LITTLE USEFUL INTELLIGENCE IS
BEING DELIVERED BACK TO
CLINICIANS IN TERMS OF THINK
BEING THE PRESENCE OF THAT
COMPUTER AS A SEPARATION BETWEEN
CLINICIANS AND PATIENTS AND
OTHERS AND AS A WAY TO ENHANCE
COMMUNICATION,S BUT WHAT IT DOES
SAY IS JUST THE FLIP SIDE ON
SORT OF PRODUCTIVITY NEAR
INFORMATION TECHNOLOGY IS THAT
PRODUCTIVITY DOES NOT
IMMEDIATELY IPT GREATER CREASE
WITH THE INVESTMENT IN I.T. BUT
IT TAKES TIME SO IT TAKES 15-20
YEARS TO SEE THE FRUITS OF THAT
LABOR, IF YOU LOOK AT OTHER
INDUSTRIES LIKE IN THE LAB AND
THE CREATION OF THE MODERN
TELEPHONE, IT LOOK A LONG TIME
FOR PRODUCTIVITY TO IMPROVE AND
IMPROVEMENT OCCURRED AFTER THE
REDESIGN OF THE WORK ITSELF AND
THAT'S REALLY IMPORTANT BECAUSE
WHAT WAFTER SAYS IS THAT WE'RE
AT THE SWEET SPOT, THE RIGHT
SPOT IN TIME WHEN THESE AI, ML
TECHNOLOGIES ARE RAPIDLY
ACCELERATING SO THE GOOD NEWS IS
THAT I THINK WE HAVE MUCH TO BE
HOPEFUL ABOUT WHERE THIS IS
GOING IN THE FUTURE.
NEXT SLIDE.
SO IN TERMS OF OUR WELL BEING
COMMITTEE IT'S BEEN A LITTLE BIT
LIKE FEELING LIKE WE'RE THROWING
SPAGHETTI AT THE WALL IN TERMS
OF COMING UP WITH INTERVENTIONS
THAT MIGHT STICK BUT WE
REALLY--I THINK HAD QUITE A BIT
OF SUCCESS IN TRYING TO
UNDERSTAND BE SPECIFIC ABOUT
IDENTIFYING DRIVERS OF BURN OUT
AND CO CREATING SOLUTIONS WITH
OUR TEAM.
GO TO THE NEXT SLIDE, THIS IS
OUR WAY OF MEASURING KIND OF HOW
WE'RE DOING OUT OF THE ARTICLE
IN 2017, LOOKING AT THE TYPICAL
STEPS IN AN ORGANIZATION JOURNEY
TOWARDS EXPERTISE POSITION WELL
BEING AND AGAIN, WE COULD--WE
CAN PUT THE WORD PHYSICIAN AND
PUT IN CLINICIAN, ON THE Y-AXIS
IS THE IMPACT, SO, MINOR,
MODERATE, MAJOR TO
TRANSFORMATIVE AND ON THE X-AX
SIS STAGE FROM NOVICE TO
BEGINNING TO COMPETENT TO
BEGINNING TO EXPERT, SO WHEN OUR
SUBCOMMITTEE TOOK A LOOK AT THE
START OF OUR WORK TO WHERE WE
WERE, YOU SEE ON THE BOTTOM HOW
AND WHERE WE WERE AWARE OF THE
ISSUE, WE HAD THIS WELLNESS
COMMITTEE BUT WE WEREN'T--IT
TOOK USA IA WHILE TO GET FURTHER
ALONG, IF YOU GO TO THE NEXT
SLIDE, BY THE END OF 2021, HERE
WE ARE IN TERMS OF WHERE WE
THINK WE ARE NOW ON OUR JOURNEY
TOWARDS THAT PHYSICIAN WELL
BEING.
NEXT.
AND I WANT TO SAY THAT THE
NATIONAL ACADEMY OF MEDICINE
AGAIN AND THE SURGEON GENERAL
ARE TRYING TO IDENTIFY THESE
PRIORITY AREAS, THAT IS CREATING
AND SUSTAINING POSITIVE WORK AND
LEARNING ENVIRONMENTS, INVESTING
IN MEASUREMENTS, REDUCING
ADMINISTRATIVE BURDENS, ENGAGE
NOTHING EFFECTIVE TECHNOLOGY
TOOLS AND PROTECTING THE HEALTH
AND WELL BEING OF ALL HEALTHCARE
WORKERS, PRIORITIZING SOCIAL
CONNECTION AND COMMUNITY AS A
CORE VALUE, REPORTING MENTAL
HEALTH AND STIGMA, AADDRESSING
COMPLIANCE AND REGULATORY
BARRIER AND INSTITUTIONALIZING
WELL BEING AS A LONG-TERM VALUE
WITH MANY HOSPITALLING EMPLOYING
CLEAVE WELLNESS OFFICERS AS PART
OF THE CTC TEAM AND INCLUDIVE
WORKFORCES SO I WILL JUST WRAP
UP HERE IF YOU GO TO THE NEXT
SLIDE, ANYBODY WORKING IN
HOSPITALS IS THE 90S WILL
REMEMBER THE GREAT KD--SALLY
WHRA, WAS A METHODOLOGY THAT WAS
BROUGHT TO HEALTHCARE FROM THE
AUTOMOTIVE INDUSTRY AND THAT'S
HOW SORT OF PATIENT SAFETY AND
QUALITY PROGRAMS IN HOSPITALS
WERE LAUNCHED TO ERR IS HUMAN
AND CROSSING THE QUALITY CHASM
AND EVERYONE KNOWS WHAT YOU
CHECK IN TERMS OF QUALITY
IMPROVEMENT METHODOLOGY, WE HAD
PARTNERS ALL OVER THE COUNTRY,
CHIEF OFFICERS AND PATIENT
SAFETY IN CARE AND QUALITY AND I
THINK WHAT'S PATIENT AND SAFETY
QUALITY WAS IN THE 90S, IS
CLEARLY WHAT WELL BEING IS NOW
AND IS GOING TO BE GOING
FORWARD.
NEXT SLIDE.
SO I JUST WANT TO MAKE A PUBLIC
SERVICE ANNOUNCEMENT, DOCK SIDE
WILL BE LAUNCHED AGAIN AND OUR
SECOND FORM WHICH IS A DIFFERENT
INITIATIVE AND AGAIN, TELL BE
FOR PRESIDENTS AND FELLOWS IF
YOU'RE NEW HERE, TAKE A LOOK AT
YOUR INBOXES IN AUGUST OR
SEPTEMBER TO HEAR ANNOUNCEMENTS
ABOUT THEM, WE REALLY WELCOME
YOU TO JOIN THIS INITIATIVE
AGAIN, MONTHLY GROUP
SPECIFICALLY GEARED TOWARDS OUR
REZONING DEBTS AND FELLOWS AND
NEXT SLIDE, I JUST WANT TO
ENVIED THOSE THAT WOULD BE
INTERESTED TO JOIN OUR GRADUATE
MEDICAL EDUCATION WELLNESS
SUBCOMMITTEE, IT'S A WONDERFUL
GROUP.
WE HAVE A LOT OF CURRENT
PROJECTS WE COULD USE NEW IDEAS
ON AND WE'RE ALWAYS WILLING TO
START NEW PROJECTS.
OUR DOOR IS OPEN.
NEXT SLIDE, SO TO SUM IT UP,
UPSTART CLINICIANS ARE COMPETING
IN OPERATIONAL MODELS,
PHYSICIANS ARE CERTAINLY AT
INHERENT RISK CONDITIONALLING TO
THIS CALLING THAT'S OFTEN
ENORMOUS DRIVES TO SEE AND I
MEAN TO HEAL AND SECURE AND
CAUSE THE ADVANCE OF HELT IN ALL
SETTINGS AND WORKING
ALTRUISTICALLY AND OUR
RESPONSIBILITY ARE BAKED INTO
WHAT IT MEANS NOT ONLY FOR
SUCCESSFUL DOCTORING BUT ALSO
FOR SUCCESSFUL CLINICIANING
REALRY TO BE BROADER AND MAKE UP
A WORD, I MEAN EVERYBODY HERE IS
REALLY FOCUSED ON DOING THE SAME
THING THERE, BUT WE HAVE TO
UNDERSTAND THIS IS GOING TO
IMPROVE CERTAIN INHERENT RISK
GIVEN THE CURRENT CLIMATE, RISKS
AROUND THE THINGS WE ALL CARRY.
OVER THE LAST 2 YEARS IN
PARTICULAR, EVERYONE HERE NOT
JUST CLINICIANS BUT EVERYONE'S
WENT ABOVE AND BEYOND THEIR
ORDINARY OBLIGATIONS TO RESPHOND
THIS NATIONAL AND GLOBAL LET TO
THEIR WELL BEING, AND WE'RE
WAITING IN THE BALANCE THAT
PEOPLE RELY ON ALL OF YOU TO
CURE, TO HEAL, TO ADVANCE
SCIENCE, IT'S AN ENORMOUS JOB
AND WE NEED TO MAKE SURE WE TAKE
CARE OF OURSELVES.
IF WE SAY THAT CARE IS IMPORTANT
BUT WE DON'T MONITOR BOUNDARIES,
WE DON'T OURSELVES GO TO OUR OWN
DOCTORS IF WE SAY WE ARE
SUPPORTIVE IN OUROIN COMMUNITY
BUT WE CAN'T OPEN OURSELVES UP
IF WE FOCUS ONLY ON THE BOTTOM
LINE, WITH THE ASSOCIATED SPOT,
IF WE SAY TO ERR IS HUMAN, BUOY
THEN WE DON'T HAVE THE ALTRUISM,
THEN WE AREN'T WALKING THE
WALKER ENOUGH AND WE HAVE OUR
WORK OUT OUT FOR US IN THE WELL
BEING CASE.
I HOPE I MADE THE CASE ABOUT WHY
THIS IS IMPORTANT BUT HOW WE
MIGHT OPERATIONALIZE A NOVEL
PATH FORWARD AND THOSE WITH
OTHERS AND IF YOU GO TO THE NEXT
SLIDE, I WANT TO THANK SO MANY
PEOPLE.
IT TAKES A VILLAGE TO MAKE THIS
HAPPEN, THIS HAS BEEN A REAL
TEAM EFFORT.
I HAVE TO GIVE A SPECIAL SHOUT
OUT TO DR. MARILYN POWE SHE'S
BEEN AN INCREDIBLE SUPPORT HERE
AT THE NIMH AND ALONG THIS ROAD
AND AGAIN TO MY COLLEAGUES,
DR. JENNIFER CHANG AND
DR. [INDISCERNIBLE] AND MISS
EMILY GUINEE, AND DR. WEI AND
OUR MANY FELLOWS WHO HELPED IN
THIS SPACE.
THANK YOU.
DID EMPLOY.
>> THANK YOU SO MUCH FOR THAT
INCREDIBLE VISION AND TALK.
I WANT TO REMIND PEOPLE THAT
THERE IS A LIVE FEEDBACK BUTTON
ON YOUR LIVE VIDEOCAST SCREEN
THAT YOU CAN USE TO SUBMIT
QUESTIONS BUT BARS THAT I WOULD
LIKE TO ASK THE FIRST QUESTION
WHICH IS: ARE YOU AWARE OF ANY
STUDIES OR REPORTS ON THE COST
EFFECTIVENESS OF SUCH
INTERVENTIONS EITHER INDIVIDUAL
OR SYSTEMIC LEVEL?
BECAUSE SOME PEOPLE MIGHT SAY
WELL THIS IS EXPENSIVE TO OFFER
THESE SERVICES, IT'S EXPENSIVE
TO CHANGE OUR SYSTEMS OF HOW WE
PRACTICE, CAN YOU COMMENT ON
THAT AT ALL?
>> THIS IS A CHALLENGING
QUESTION BECAUSE IT'S REALLY
HARD TO MAKE A DIRECT STATEMENT
BETWEEN BURN OUT FOR EXAMPLE
TURNOVER RATE, WHY SOMEBODY'S
LEAVING TO MAKE THAT DIRECTLY TO
SAY THIS WAS THE SOLE CAUSE,
IT'S MULTIFACTORIAL AND IT'S
DIRTY SO IT'S VERY DIFFICULT TO
MAKE THOSE DIRECT LINKS.
I THINK THE COST IS TOO GREAT
NOT TO BEAR BUT THIS IS
SOMETHING THAT'S NATIONAL
LEADERS ARE TRYING TO GET THEIR
HANDS AROUND.
THERE IS A CONSORTIUM OF
ACADEMIC PROFESSIONALS, THAT
STARTED OUT AT STANFORD, THEY'RE
1 OF THE LEADERS IN WELL BEING
AS IS THE MAYO CLINIC AND WHAT
THEY'RE TRYING TO DO IS ENHANCE
THE RESEARCH IN THIS AREA,
COLLECTIVELY AND COLLABORATIVELY
TO LOOK AT EXACTLY THIS KIND OF
ISSUE TO MAKE THE ARGUMENTS FOR
WHY AND WHAT THE DATA AND
EVIDENCE IS ON THOSE FUNDS.
WE HAVE A WAYS TO GO ON THAT.
>> NOW A QUESTION FROM THE
FEEDBACK.
EXCELLENT TALK, THANK YOU VERY
MUCH, ANY UPDATE TO EXTENDING
THESE RESOURCES TO THE NIH STAFF
CLINICIANS OR MAYBE FACULTY IN
GENERAL, I KNOW NEXT WEEK WE
WILL HAVE A SPEAK TORE THAT BUT
YOU'VE BEEN FOCUSED MOSTLY ON
TRAINEES.
>> YES, THE FACULTY HAS BEEN
ASKING US FOR SEVERAL YEARS NOW
TO WEIGH INTO THIS AREA AND WE
NEED CHAMPIONS.
SO IF YOU'RE OUT THERE AND
INTERESTED IN WORKING WITH US I
KNOW WE DON'T WANT TO ADD TO
YOUR BURN OUT, IS ASKING FOLKS
TO DO MORE WITH LESS, AND SO MY
CALL TO YOU WOULD BE TO SIT IN
ON A MEETING OR TALK TO US, IT
DOES NOT MEAN YOU'RE OBLIGATED.
I WILL SAY WE'VE SPOKE TONE
DR. PARKER RULE AND DR. CURRY
RECENTLY ON HOW WE CAN WORK WITH
STAFF CLINICIANS SPECIFICALLY
AND WE ARE CURRENTLY TRYING TO
WORK ON SPECIFICALLY FOR THAT
GROUP.
I HOPE WE WILL BE ABLE TO AS LHE
HAS BEEN--SHE'S ALREADY INVOLVED
A LOT WITH OUR FELLOWS HERE IN
THE HOSPITAL AND WE'VE SPOKEN TO
HER AND HAVE MEETINGS SET UP
ABOUT HOW WE CAN BRING SOME OF
HER PROGRAMS WHICH ARE FULLY
FUNDED AND HAVE BEEN REALLY
EFFECTIVE DURING COVID AND BRING
THEM SPECIFICALLY TO OUR STAFF
CLINICIANS, PART OF OUR
CHALLENGE IS MAKING SURE THESE
OFFERINGS ARE GEARED FORWARD
AUDIENCES AND THAT'S PART OF THE
CHALLENGE.
>> OKAY, I DON'T SEE ANY OTHER
QUESTIONS.
DO YOU HAVE ANY OTHER CLOSING
STATEMENTS YOU WANT TO MAKE.
THERE WERE INCREDIBLE FINDINGS
YOU PRESENTED BI YOU I GUESS
WHAT I WOULD LIKE TO SAY IS
WHAT'S NEXT, YOU KNOW?
WHAT DO YOU HAVE ON THE HORIZON?
>> I THINK YOU HIT THE NAIL ON
THE HEAD DOCTOR, I THINK FACULTY
IS STAFF, IN TERMS OF THE
GRADUATE MEDICAL EDUCATION
COMMITTEE ON WELLNESS BUT ALSO
MORE BROADLY TO CLINICIANS, YOU
KNOW BROADLY IN THE INSTITUTION,
MY HOPE WOULD BE THAT NIH CAN
CONTINUE TO WORK TOGETHER TO CO
CREATE SYSTEMATIC WELL BEING
PROGRAMS, I THINK THAT COMMENT
THAT WE'RE AN EMBARRASSMENT THE
OF RICHES BECAUSE WE ARE VERY
RESOURCE RICH IN IN SOME WAYS
AND IN OTHER WAYS WE HAVE TO GET
MORE TARGETED AND DO A BETTER
JOB OF COMMUNICATING WITH EACH
OTHER SO THAT WE'RE AWARE OF
WHAT'S OUT THERE AND AGAIN I
WANT TO FOCUS ON DRIVERS OF BURN
OUT, THAT'S THE FOCUS TO NOW
DRILL DOWN TO WHAT THE
INDIVIDUAL DRIVERS OF BURN OUT
ARE FOR INDIVIDUALS, FOR
SPECIFIC LABS FOR SPECIFIC
DEPARTMENTS SO THAT YOU CAN
BUILD INTERVENTIONS THAT ARE
MEANINGFUL TO PEOPLE LOCALLY, 1
SIZE IS NOT GOING TO FIT ALL AND
LOCAL BATTERS ARE VERY IMPORTANT
AT THE SAME TIME WE NEED IT TO
COME FROM THE TOP DOWN AS A MAIN
PRIORITY SO TO MAKE WELL BEING
BETTER INTEGRATED AND BAKED INTO
EVERYTHING WE DO HERE.
>> OKAY, WITH THAT, I DON'T HAVE
ANYMORE QUESTIONS FROM THE
AUDIENCE--OH ACTUALLY MAYBE 1
MORE HERE.
HOW DO NATIONAL ISSUES THAT ARE
SO POLARIZING CONTRIBUTE TO THE
EROSION OF WELL BEING?
>> AS WE SAY IN PSYCHIATRY, IT'S
LIKE THE QUESTION ASKED WITH 1
FOOT OUT THE DOOR.
SO IT'S A SERIOUS TOPIC AND
REALLY IMPORTANT, THE
POLARIZATION IN THIS COUNTRY AND
WHAT'S GONE ON IN THE LAST MANY
YEARS, ON TOP OF ALL THE
SOCIOLOGICAL POLITICAL ISSUES,
ABSOLUTELY CONTRIBUTE TO WELL
BEING, AND IMPACT KIND OF I
THINK ARE FUSES AND ARE DISTRESS
TOLERANCE AND OUR ABILITY TO
CO-PUT 1 ANOTHER IN WAYS AND
IT'S A HUGE PROBLEM AND I THINK
ALL--ALL I CAN SAY ABOUT THAT IS
WE ALL TAKE A MOMENT TO SORT OF
BREATHE BEFORE WE FIND OURSELVES
EMOTIONAL DISREGULATED AND
REACTING AND JUST TAKE A BREATH,
WE CAN LEARN FROM MINDFULNESS
BASE AND STRESS REDUCTION BEFORE
WE RESPOND AND TRY TO GROUND
OURSELVES IN ANCHOR OURSELVES
AND TRY TO WORK CIVILLY WITH 1
ANOTHER BUT THAT'S A HUGE
IMPORTANT POINT AND 1 I HOPE WE
CONTINUE TO TALK ABOUT.
>> SO MORE POSITIVE COMMENTS
FROM THE AUDIENCE AND WITH THAT
I LIKE TO THANK OUR SPEAKER
DEBBIE SNYDER FOR A FABULOUS
TALK AND A SO TARGETED TOAUR
GRADUATE EDUCATION EFFORTS AND
BEYOND.
SO THANK YOU AGAIN.
AND GOOD DAY.