4/18/2018 Disclosure Journey to a Resilient and Thriving • All planners, presenters, and reviewers of this Pharmacy Workforce content report no financial relationships relevant to this activity. Jennifer M. Schultz, Pharm.D., FASHP ASHP Board of Directors Clinical Pharmacy Supervisor/ Residency Program Director Bozeman Health, Bozeman, MT April 20, 2018 Poll Everywhere Instructions • Text RXRESILIENCE to 22333 to join the conversation • All responses will appear to the audience in a “word cloud” after submissions are gathered Outline • Explain why clinician burnout is a patient care and healthcare workforce problem that needs addressing. • Discuss what is known about burnout in the pharmacy workforce. • Describe the National Academy of Medicine Clinician Well-Being and Resilience Action Collaborative. • Identify strategies to impact well-being and resilience in pharmacists, pharmacy residents, student pharmacists and pharmacy technicians. 1
4/18/2018 Burnout is a Patient Care Problem Bodenheimer T, Sinsky C. From triple aim to quadruple aim: care of the patient requires care Swensen S, Shanafelt, Mohta NS. Leadership survey: Why physician burnout is endemic, and how health care must respond. NEJM Catalyst. of the provider. Ann Fam Med. 2014;12(6):573-6. December 8, 2016. Available at: https://catalyst.nejm.org/physician-burnout-endemic-healthcare-respond/ American Society of Health-System ASHP Vision & Strategic Plan Pharmacists • Strategic Priorities and Goals Vision • – Our Patients and Their Care Medication use will be • • Goal 4: Improve Patient Care by Enhancing the Well- optimal, safe, and Being and Resilience of Pharmacists, Student effective for all people all of the time Pharmacists, and Pharmacy Technicians – Our Members and Partners • Membership – Our People and Performance Organization Established 1942 • 45,000 members • Quality and Safety Our Patients and Their Care: Goal 4 • Medical Error • Key Objectives – Engage in major national initiatives on clinician well-being – ~8000 surgeons Medical Burnout • Medical Malpractice and resilience Error Litigation – Facilitate the development of education aimed at helping – ~7000 surgeons pharmacists, student pharmacists, and pharmacy technicians • Health-care associated address and effectively cope with the stress and burnout Bi-directional relationship associated with demanding patient care environments infections – Seek opportunities to improve the well-being and resilience – Mean burnout hospital nurses Higher levels of burnout associated with increased odds of reporting a independent predictor of pharmacists participating in postgraduate residency medical error in subsequent 3 months • Patient mortality ratios training. Self-perceived medical error • Teamwork scores associated with worsening burnout & – Foster research that addresses well-being and resilience depressive symptoms – Mean EE physicians & nurses issues of pharmacists, student pharmacists, and pharmacy ICU technicians Shanafelt Ann Surg 2009; Balch J Am Coll Surg 213; West JAMA 2006, 2009; Jones J Appl Psychol 1988; Cimiotti Am J Infect Control 2012; Welp Front Psychol 2015; Welp Crit Care 2016 2
4/18/2018 Health Care Costs What is Stress? ↑ Medical Errors ↑ Absenteeism • Stress is a physical, mental, or emotional ↑ Malpractice claims ↓ Job productivity factor that causes ↑ Turnover ↑ Referrals bodily or mental – 1.2-1.3 x salary tension. ↑ Ordering ($82-$88,000 per RN in 2007) • Stress can be external or internal – $500,000 to >$1 million Jones J Nurs Am 2008; Fibuch Physician Leadersh J 2015; Buchbinder Am J Manag Care 1999; Kushnir, Fam Pract 2014; Bachman Soc Sci Med 1999; Parker J Behav Med 1995, Toppinen-Tanner Behav Med 2005, Hilton J Occup Environ Med 2009 https://www.medicinenet.com/script/main/art.asp?articlekey=20104 What is Burnout? • Syndrome of: depersonalization • emotional exhaustion • low personal • accomplishment Leads to decreased • effectiveness at work Attributed to work-related • stress Maslach, C., S. E. Jackson, et al. (1996). Maslach Burnout Inventory Manual. Palo Alto, CA, Consulting Psychologists Press. Maslach Burnout Inventory – Human Burnout is Not.. Services Survey Tool • Medical Personnel • Having a bad day at work – Emotional exhaustion • Feeling overwhelmed for a day or two • Measures feelings of being emotionally overextended and exhausted by one’s work • Experiencing a bad mood – I feel emotionally drained from my work – Depersonalization • Wanting time-off from work • Measures an unfeeling and impersonal response toward patients – I don’t really care what happens to some patients • Needing a beverage at the end of the day – Personal Accomplishment • Measures feelings of competence and successful achievement in one’s work – I have accomplished many worthwhile things in this job – Response options (frequency): never, a few times a year or less, once a month or less, a few times a month, once a week, a few times a week, every day 3
4/18/2018 High Prevalence of Burnout Burnout: Pharmacy Residents Study Overview Takeaways • Stress and negative affect • 10-item Perceived Stress levels surveyed in PGY1 & Scale is a free, validated PGY2s (n=524, 27.7% response) tool to assess stress among • Those working > 60 pharmacy residents hours/week reported higher • Hostility was highest in levels of perceived stress and Medicine elevated depression, hostility, PGY2 • 2014, 6880 physicians, all and dysphoria • When pressures of being • specialties, all practice types Perceived stress for pharmacy • overworked > resident’s 2012, 5521 medical students & residents was 19.06+5.9 – 14.2+6.2 in 18-29 year old residents ability to cope, well-being health adults Nursing is in danger – 20.3+7.4 in cardiology medical • 1999, >10,000 inpatient RN residents • 2007, 68,000 nurses Le HM, Young SD. Evaluation of stress experienced by pharmacy residents. AJHP.2017;74:599-604 Aiken JAMA 2002;288; McHugh Health Aff 2011;30; Dyrbye Acad Med 89(3): 443-451; Shanafelt MCP 2015:90:1600 Burnout: Clinical Pharmacists Burnout: Clinical Pharmacists, cont. • Jones and colleagues measured clinical pharmacist • Jones and colleagues measured clinical pharmacist burnout (n=974) burnout (n=974) – Many objective factors noted as increased in burned out – Nearly ¾ included respondents are certified by BPS individuals; however, no factors independently predict – More than half completed residency training burnout – 61.2% overall burnout rate; 52.9% high emotional exhaustion – Strong predictors: – Characteristics of burned out clinical pharmacists: 1. Too many nonclinical duties • Less likely to have children (p=0.002) 2. Inadequate teaching time • More likely to work more median hours (p<0.001) 3. Inadequate administration time • More likely to have attained BPS certification (p=0.005) 4. Difficult pharmacist colleagues – No difference observed in practice area, hospital setting 5. Contributions unappreciated Drivers of Burnout in Healthcare Burnout: COP Faculty Professionals • El-Ibiary and colleagues measured faculty burnout • Excessive workload • Reduction of meaning in • Inefficient work work in US College of Pharmacy (n=758) • Lack of social support at environment – 41.3% exhibited high emotional exhaustion scores work • Problems with work-life – Women had significantly higher emotion exhaustion and • Leadership behaviors integration lower personal accomplishment scores than men • Loss of autonomy, • Nurses: Moral distress – Faculty who had a hobby had significantly lower emotional flexibility and control • Trainees: Learning exhaustion scores, lower depersonalization score, and • Organizational culture and environment, Educational higher personal accomplishment scores values debt – Faculty working in newer Colleges of Pharmacy (est. < 5 years) were associated with lower depersonalization and lower personal accomplishment scores. Shanafelt. MCP 2016(7):836; Dyrbye et al. Arch Surg 2011; 146(2):211; Dyrbye et al. Arch Surg 147(10): 933-939; Shanafelt Arch Intern Med 2009; Dyrbye Med Educ 2016;50:132-149; Shanafelt Am J Pharm Educ. 2017;81(4):75 MCP 2016; Williams Health Care Manag Rev 2007; Aiken JAMA 2002; Hamric Crit Care Med 2007 4
Recommend
More recommend
