OSH I ssue s fa c ing Physic ia ns a nd Nurse s: Burno ut a nd Oc - - PDF document

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OSH I ssue s fa c ing Physic ia ns a nd Nurse s: Burno ut a nd Oc - - PDF document

11/20/2018 OSH I ssue s fa c ing Physic ia ns a nd Nurse s: Burno ut a nd Oc c upa tio na l Stre ss CAMI L L E NAPI E R, MD, MPH ME DI CAL DI RE CT OR, NY HOT E L T RADE & COU NCI L ADJU NCT ASSI ST ANT PROF E


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OSH I ssue s fa c ing Physic ia ns a nd Nurse s: Burno ut a nd Oc c upa tio na l Stre ss

CAMI L L E NAPI E R, MD, MPH ME DI CAL DI RE CT OR, NY HOT E L T RADE & COU NCI L ADJU NCT ASSI ST ANT PROF E SSOR, I CAHN SCHOOL OF ME DI CI NE AT MOU NT SI NAI NY NJ OCCU PAT I ONAL SAF E T Y & HE AL T H CE NT E R 39T H ANNUAL SCI E NT I F I C ME E T I NG NE W YORK , NY NOVE MBE R 20, 2018

Disc lo sure

 I ha ve no fina nc ia l re la tio nships to d isc lo se .

Ob je c tive s

 T

  • d e sc rib e the prima ry te c hno lo g ic a l ha za rd s fa c ing physic ia ns

a nd nurse s a nd ho w tha t c o ntrib ute s to b urno ut a nd o c c upa tio na l stre ss

 T

  • und e rsta nd wha t po lic ie s c a n b e c re a te d a nd imple me nte d tha t

impa c t sa fe ty a nd he a lth o f the physic ia ns a nd nurse s a t a n institutio n

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So urc e : US Bure a u o f L a b o r Sta tistic s, US De pt o f L a b o r

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OSHA pro g ra m

 5 a re a s:  Slips, trips, a nd fa lls  Pa tie nt ha ndling  E rg o no mic issue s  Wo rkpla c e vio le nc e  Blo o db o rne pa tho g e n e xpo sure

I n a dditio n to the se

  • c c upa tio na l ha za rds

wha t ro le do e s te c hno lo g y pla y in the he a lth o f he a lthc a re wo rke rs?

So c ie ta l Pre ssure s Pro fe ssio na l Re a lity O CCUPAT IO NAL ST RESS

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Oc c upa tio na l Stre ss

 T

he Na tio na l Institute fo r Oc c upa tio na l Sa fe ty a nd He a lth d e fine s Oc c upa tio na l Stre ss a s "the ha rmful physic a l a nd e mo tio na l re spo nse s tha t o c c ur whe n the re q uire me nts o f the jo b do no t ma tc h the c a pa b ilitie s, re so urc e s, o r ne e ds o f the wo rke r"

Pro fe ssio na l Burno ut

 Cha ra c te rize d b y lo ss o f e nthusia sm fo r wo rk, fe e ling s o f c ynic ism,

a nd a lo w se nse o f pe rso na l a c c o mplishme nt

F la g s o f impe nd ing b urno ut. Ad o pte d fro m I n pursuit o f the F

  • urth Aim in He alth Care , Me d ic a l

Clinic s o f No rth Ame ric a 101 (2017) 1031-1040.

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Pro fe ssio na l Burno ut

 46% o f US physic ia ns e xpe rie nc e sympto ms o f b urno ut in

2011

 By 2014, b urno ut ra te s ha d e sc a la te d to 54% a mo ng

physic ia ns e ve n tho ug h ra te s a mo ng o the r wo rking US a dults re ma ine d ste a dy

 E

spe c ia lly a mo ng E R physic ia ns, inte rnists, ne uro lo g ists, F P

 34% o f ho spita l nurse s, 37% o f nursing ho me nurse s re po rt

b urno ut c o mpa re d with 22% o f nurse s wo rking in o the r he a lth se tting s

Ho w T e c hno lo g y Co ntrib ute s to Burno ut

 E

R physic ia ns spe nd 44% o f the ir da y do ing da ta e ntry, o nly 28% o f time is spe nt with pa tie nts

 Whe n in the e xa m ro o m with pts PCPs spe nd fro m 25% to 50% o f

the ir time a tte nd ing to the c o mpute r

 At a VA d uring a o ne ye a r pe rio d , PCPs spe nt 49 minute s pe r d a y

re spo nd ing to inb o x a le rts in a d d itio n to d o c ume nta tio n. One ha lf o f suc h a le rts ha ve little c linic a l sig nific a nc e , o ve r 80% o f the te xt in the a le rts we re unne c e ssa ry

 Physic ia ns re po rte d up to 2 ho urs o f a fte r-ho urs wo rk e a c h nig ht,

mo stly d e vo te d to E HR ta sks

 A 2013 surve y o f 30 physic ia n pra c tic e s fo und tha t E

HR te c hno lo g y ha s wo rse ne d pro fe ssio na l sa tisfa c tio n thro ug h time c o nsuming d a ta e ntry a nd inte rfe re nc e with pa tie nt c a re

Quo te s o n Burno ut

 “I

a m no lo ng e r a physic ia n b ut the da ta ma na g e r, da ta e ntry c le rk a nd ste no g irl… I b e c a me a do c to r to ta ke c a re o f pa tie nts. I ha ve b e c o me the typist.”

 “I

re a lize d tha t my b e lo ve d pro fe ssio n wa s b e ing turne d upside do wn b y te c hno lo g y.”

 “I

t c o uld b e wo rse . . . I c o uld b e yo ung e r.”

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Co sts o f Burno ut

 De pre ssio n (pre va le nc e in

physic ia ns 39%)

 Anxie ty  E

mo tio na l e xha ustio n (pre va le nc e in nurse s is 23-31%)

 Alc o ho l a b use / d e pe nd e nc e

(12.9% ma le , 21.4% fe ma le )

 Suic id a l id e a tio n  De c re a se d q ua lity o f

inte rpe rso na l re la tio nships

Co sts o f Burno ut

 Physic ia n a nd c a re te a m b urno ut ma y c o ntrib ute to o ve ruse o f

re so urc e s a nd the re b y inc re a se d c o sts o f c a re

 Unha ppy physic ia ns a re 2 -3 time s mo re like ly to le a ve the ir pra c tic e  Mo re E

HR func tio na litie s- e ma ils with pts, physic ia n o rd e r e ntry, a le rts a nd re mind e rs- a re a sso c ia te d with mo re b urno ut a nd inte nt to le a ve pra c tic e

 Re pla c e me nt c o sts pe r physic ia n 500 K

to 1 mil

 T

he a ve ra g e c o st o f turno ve r o f a nurse ra ng e s fro m $37,700 to $64,000

Physic ia n Sa fe ty Nurse Sa fe ty Pa tie nt Sa fe ty

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Burno ut links to Pa tie nt Sa fe ty

 Dissa tisfie d physic ia ns a nd nurse s a re a sso c ia te d with lo we r pa tie nt

sa tisfa c tio n

 Dissa tisfie d physic ia ns a re mo re like ly to pre sc rib e ina ppro pria te

me d ic a tio ns whic h c a n re sult in e xpe nsive c o mplic a tio ns

 Physic ia n b urno ut is a sso c ia te d with re d uc e d a d he re nc e to

tre a tme nt pla ns, re sulting in ne g a tive ly a ffe c te d c linic a l o utc o me s

 Burno ut a lso le a d s to lo we r le ve ls o f e mpa thy, whic h is a sso c ia te d

with wo rse ne d c linic a l o utc o me s fo r pa tie nts with d ia b e te s

 Pa tie nt sa fe ty is thre a te ne d b y nurse d issa tisfa c tio n; ma ny nurse s

re po rt tha t the ir wo rklo a d c a use s the m to miss impo rta nt c ha ng e s in the ir pa tie nts’ c o nd itio n

 A re vie w o f 29 studie s fo und po sitive a sso c ia tio ns b e twe e n ho spita l

wo rk e nviro nme nt a nd nurse -se nsitive pa tie nt o utc o me s

Wha t sho uld b e the g o a l?

Ad a pte d fro m the Ame ric a n Me d ic a l Asso c ia tio n: Cre a ting the Org a niza tio na l F

  • und a tio n fo r Jo y in Me d ic ine , 2017

Wha t po lic ie s c a n b e c re a te d a nd imple me nte d tha t impa c t sa fe ty a nd he a lth

  • f the physic ia ns

a nd nurse s?

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I nte rve ntio ns

 Ind ivid ua l  Use d to b e individua l fo c use d-”b la ming the vic tim”  Re silie nc e tra ining  Mindfulne ss me dia tio n  Institutio na l  I nte g ra te d he a lth c a re wo rke r he a lth a nd pa tie nt sa fe ty pro g ra ms

Ad o pte d fro m: Me rc ha nt J, L ind D, Ke lly K, e t a l. An E mplo ye e T

  • ta l He a lth Ma na g e me nt-Ba se d Surve y o f Io wa E

mplo ye rs. J Oc c up E nviro n Me d. ;55(12 0):S73-S77.

Hie ra rc hy o f Co ntro ls a pplie d to NI OSH T

  • ta l Wo rke r He a lth

Ad o pte d fro m: NIOSH T

  • ta l Wo rke r He a lth: https:/ / www.c d c .g o v/ nio sh/ twh/ le tsg e tsta rte d .html
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E limina te o r re duc e

 L

e a d e rship re spo nsib ility

 Stro ng e r a d ministe r/ physic ia n pa rtne rships with pa rtic ipa to ry

ma na g e me nt

L e a de rship re spo nsib ility

Ac tion Comme nt

Va lida te Suffe ring E mpa thy, va lida te fe e ling , re c o g nize impa c t; yo u will na vig a te with the m a s pa rtne rs Co mmunic a te K e e p physic ia ns & nurse s info rme d He lp physic ia ns & nurse s unde rsta nd the b usine ss He lp e duc a te o ur physic ia n & nurse pa rtne rs so the y b e tte r unde rsta nd why de c isio ns a re b e ing ma de Be I nc lusive I f yo u wa nt physic ia n & nursing suppo rt fo r ke y de c isio ns, inc lude the m in the re a l de c isio n ma king Re c o g nize the ne e d fo r symb io sis Re c o g nize the ne e d fo r ta nde m ro le s o f physic ia ns/ nurse s a nd a dministra to rs fo r q ua lity o f c a re a nd ma inta ining he a lth o f the b usine ss Be wa re o f T rig g e r issue s Be fo re e xe c uting so me thing ne w, unde rsta nd the mo o d o f the physic ia ns a nd nurse s a nd the e ffe c t the c ha ng e will ha ve

Ad a pte d fro m Me rlino J. Aug ust 19, 2015: www.b e c ke rsho spita lre vie w.c o m

Sub stitute

 Culture o f e ndura nc e fo r c ulture o f we llne ss  Ado p t physic ia n a nd nurse we ll-b e ing a s a n o rg a niza tio na l va lue  Sta ting it, inq uiring a b o ut it a nd mo re impo rta ntly, a c ting o n it se nds a stro ng me ssa g e to physic ia ns a nd sta ff a nd b o o sts pro duc tivity.  E

mplo ye e pro g ra ms

 We llne ss se mina rs (q ua lify fo r CME

  • r ma lpra c tic e re duc tio n)

 Mindfulne ss b a se d pro g ra ms in pe rso n, o nline , o r b y pho ne  We b b a se d CBT  E

AP- psyc ho the ra py, priva te psyc hia trist  Gym  Mo nthly so c ia l e ve nts, we ll-b e ing d a ys, re q uire d a nnua l physic a ls

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Re de sig n

Syste ms

I mpro ve E HR

 Bio me tric s to sig n in  E

HR c usto miza tio n

 Vo ic e re c o g nitio n  I

nc re a se d I T suppo rt 

Co lla b o ra tive c a re mo de l

Imple me nt te a m d o c ume nta tio n

Co -lo c a te te a ms so tha t physic ia ns wo rk in the sa me spa c e a s the ir te a m me mb e rs 

Wo rkflo w c ha ng e s

Pre -visit pla nning a nd pre -a ppo intme nt la b te sting

Sta nd ing o rd e rs so o the r te a m me mb e rs c a n a ssume re spo nsib ility fo r pre ve ntive c a re

Avo id shifting b urno ut fro m physic ia ns a nd nurse s to sta ff 

F le xib le wo rk sc he dule s

De dic a tio n o f mo re fina nc ia l a nd pe rso nne l re so urc e s

E duc a te & E nc o ura g e

 E

duc a te physic ia ns a nd nurse s a b o ut the da ng e rs o f o c c upa tio na l stre ss a nd b urno ut in re g a rd s to pa tie nt sa fe ty

 E

nc o ura g e physic ia ns a nd nurse s to se e k he lp (d e -stig ma tize )

T

ha nk Yo u!

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Re fe re nc e s

 Ba b b o tt S, Ma nwe ll L B, Bro wn R, e t a l. E le c tro nic me dic a l re c o rds a nd physic ia n stre ss in prima ry c a re : re sults fro m the ME MO Study. J Am Me d I nfo rm Asso c . 2014;21(e 1):e 100-e 106.  Bo de nhe ime r T , Sinsky C. F ro m triple to q ua druple a im: c a re o f the pa tie nt re q uire s c a re o f the pro vide r. Ann F a m Me d. 2014 No v-De c ;12(6):573-6.  F rie db e rg MW, Che n PG , Va n Busum KR, e t a l. F a c to rs a ffe c ting physic ia n pro fe ssio na l sa tisfa c tio n a nd the ir implic a tio ns fo r pa tie nt c a re , he a lth syste ms a nd he a lth po lic y. Ra nd Co rpo ra tio n 2013.  G e rg e n Ba rne tt KA. I n Pursuit o f the F
  • urth Aim in He a lth Ca re : T
he Jo y o f Pra c tic e . Me d Clin No rth Am. 2017 Se p;101(5):1031-1040.  Hill RG Jr, Se a rs L M, Me la nso n SW. 4000 c lic ks: a pro duc tivity a na lysis o f e le c tro nic me dic a l re c o rds in a c o mmunity ho spita l E
  • D. Am J
E me rg Me d. 2013;31(11):1591-1594.  Ho ja t M, L
  • uis DZ, Ma rkha m F
W, We nde r R, Ra b ino witz C, G o nne lla JS. Physic ia ns’ e mpa thy a nd c linic a l o utc o me s fo r dia b e tic pa tie nts. Ac ad Me d. 2011;86(3):359-364.  L
  • e ppke R, Bo ldrig hini J, Bo we J, e t a l. I
nte ra c tio n o f He a lth Ca re Wo rke r He a lth a nd Sa fe ty a nd Pa tie nt He a lth a nd Sa fe ty in the U S He a lth Ca re Syste m: Re c o mme nda tio ns F ro m the 2016 Summit. J Oc c up E nviro n Me d. 2017 Aug ;59(8):803-813.  Mc Hug h MD, Kutne y-L e e A, Cimio tti JP, Slo a ne DM, Aike n L
  • H. Nurse s’ wide spre a d jo b dissa tisfa c tio n, b urno ut, a nd frustra tio n with he a lth b e ne fits sig na l pro b le ms fo r
pa tie nt c a re . He alth Aff (Millwo o d). 2011;30(2):202-210.  Mo nta g ue E , Asa n O. Physic ia n inte ra c tio ns with e le c tro nic he a lth re c o rds in prima ry c a re . He alth S yst (Basing sto ke ). 2012;1(2):96-103.  Murphy DR, Re is B, Sittig DF , Sing h H. No tific a tio ns re c e ive d b y prima ry c a re pra c titio ne rs in e le c tro nic he a lth re c o rds: a ta xo no my a nd time a na lysis. Am J Me d. 2012;125(2):209.e 1-209.e 7.  Murphy DR, Re is B, Ka diya la H, e t a l. E le c tro nic he a lth re c o rd b a se d me ssa g e s to prima ry c a re pro vide rs: va lua b le info rma tio n o r just no ise ? Arc h I nte rn Me d. 2012;172(3):283-285.  Privite ra M, G o me z-DiCe sa re C, Be die nt T . Burno ut Re duc tio n fo r the I ndividua l Clinic ia n. MSSNY Ne ws o f Ne w Yo rk. Oc to b e r 2017. Ava ila b le a t: https:/ / www.mssny.o rg / Do c ume nts/ 2017/ Physic ia nBurno ut/ NONY_Oc t2017_Pg 6_7_12_13E xtra c tio ns_111517.pdf . Ac c e sse d No ve mb e r 4, 2018.  Privite ra M, Ro se nste in A, Ple sso w F . Physic ia n Burno ut a nd Oc c upa tio na l Stre ss: An inc o nve nie nt truth with uninte nde d c o nse q ue nc e s. Jo urna l o f Ho spita l Administra tio n. 2015 4(1): 27-35.  Sha na fe lt T D, Bo o ne S, T a n L , e t a l. Burno ut a nd sa tisfa c tio n with wo rk-life b a la nc e a mo ng U S physic ia ns re la tive to the g e ne ral U S po pula tio n. Arc h I nte rn Me d. 2012;172(18):1377-1385.  Sinsky C, Co llig a n L , L i L , e t a l. Allo c a tio n o f physic ia n time in a mb ula to ry pra c tic e : a time a nd mo tio n study in 4 spe c ia ltie s. Ann I nte rn Me d 2016;165:753–61.  Snitko ff L , Ata lla h F , Privite ra M, e t a l. MSSNY’ s Stre ss a nd Burno ut T a sk F
  • rc e . MSSNY Ne ws o f Ne w Yo rk. No ve mb e r 2017. Ava ila b le a t:
https:/ / www.mssny.o rg / Do c ume nts/ 2018/ Physic ia nBurno ut/ 011218.pdf. Ac c e sse d No ve mb e r 4, 2018.  U S Bure a u a nd L a b o r, Bure a u o f L a b o r Sta tistic s. E mplo yme nt Pro je c tio ns 2016-26. Ava ila b le a t: https:/ / www.b ls.g o v/ ne ws.re le a se / pdf/ e c o pro .pdf. Ac c e sse d No ve mb e r 2, 2018.  U S Bure a u a nd L a b o r, Bure a u o f L a b o r Sta tistic s. Surve y o f Oc c upa tio na l I njurie s a nd I llne sse s. Ava ila b le a t: https:/ / www.b ls.g o v/ iif/ o sc h0062.pdf. Ac c e sse d No ve mb e r 13, 2018.