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 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 o 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 o 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 1

11/20/2018 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 2

11/20/2018 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 o 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 Pro fe ssio na l Pre ssure s Re a lity O CCUPAT IO NAL ST RESS 3

11/20/2018 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 o urth Aim in He alth Care , Me d ic a l Clinic s o f No rth Ame ric a 101 (2017) 1031-1040. 4

11/20/2018 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.” 5

11/20/2018 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 Pa tie nt Nurse Sa fe ty Sa fe ty Sa fe ty 6

11/20/2018 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 o 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 o f the physic ia ns a nd nurse s? 7

11/20/2018 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 o 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 o ta l Wo rke r He a lth Ad o pte d fro m: NIOSH T o 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 8

11/20/2018 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 He lp e duc a te o ur physic ia n & nurse pa rtne rs so the b usine ss 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 o 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 9