Professional Health: Workplace Stress and Burnout

1. Professional Health:Workplace Stress and Burnout Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration Associate Professor of Medicine Co-Director & Chair William H. Swiggart, M.S.,LPC/MHSP Assistant in Medicine Co-Director Center for Professional Health & Faculty and Physician Wellness Committee, Vanderbilt University School of Medicine

2. Can you relate?

3. Stress free Relaxed Calm Engaged Enthusiastic Ready to go Stressed out Ready to cave in Anxious Exhausted Overwhelmed At the breaking point Self-Assessments • What stresses you out? • Measure your stress level on the stress-o-meter.

4. Purpose • Introduce the concept of workplace stress and how to manage it. Outline the symptoms of burnout and how to take an active role to prevent it or improve it once it occurs. • Outline resources available at Vanderbilt.

5. Participant Objectives • List 6 sources of burnout in the workplace. • Describe risk and protective factors for burnout. • Compare and contrast the role of individuals and organizations in reducing risk of burnout. • List resources available at Vanderbilt.

6. Agenda • Review Stress and burnout • Risk factors • Preventive factors • Individual & organizational options for improvement • Resources

7. Is Balance Possible? • What is balance? • If individuals work 50 hours a week or less, then they will have the option of good balance between work, sleep and home life. • But peaks and troughs come in most of our lives – so planning for the ups and downs is important.

8. Fair Functioning Reduced Productivity Relationships Suffer Fair-Not Functioning Fair-Not Productive Institution & Family Loses High Functioning High Productivity Fair Functioning Decreasing Productivity Professional Health Spectrum • When we are well – our productivity and function is well. • When we are not well – the impact can affect personal and work lives.

9. Professional Wellness • Self-care: • Mind • Body • Soul • Work-place stress: • Manage energy • Reduce distractions • Plan appropriately Mind Manage Energy Body Reduce Distractions Planning Soul

10. Professional Wellness • Self-care issues: • Sleep • Balanced meals • Physical activity • Socialization • Vacations/down times • Spiritual engagement • Have a physician

11. Introduction: Stress & Burnout • Stress and burnout occurs for different reasons in different individuals. • Work load alone does not define an individual’s level of stress or burnout. But several factors including work load may play a role in creating workplace stress or burnout.

12. Definition - Stress • Stress can be defined as: • d: a state resulting from a stress; especially: one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium <job-related stress> Webster’s dictionary

13. Stress • Stress can affect our physical being, mood/spirit, mental functioning and emotional stability. • Coping with stress and stress management is essential in our profession. • Some stress can make us more productive but too much stress will result in reduced productivity.

14. Stress • “As life’s pressures mount and your burdens increase, the resulting stress can have catastrophic impact on your health and physiology.” ~Robert S. Eliot, M.D. From Stress to Strength: How to Lighten Your Load and Save Your Life. Eliot, RS. 1994.

15. Stress While leaving for work one day, there is an accident and you are stuck in traffic. You have an early meeting of which you are the key presenter. You are watching the time click ever closer to the meeting start time and it just happens that your cell phone is dead. • Would you be stressed in this situation? • What type of stress is this? • How would you manage it?

16. Stress • This situational stress causes an “alarm reaction” – also the basic flight or fright scenario – your anxiety goes up but once the situation resolves itself, you relax to your more calm self. • You would probably scenario plan and think how could you get message to your team or what other ways might you take to cut off some time.

17. Stress • If the situation changed and you didn’t have a meeting, you might remain fairly calm and wait through the traffic by keeping your self relaxed – listening to music or the news. • If you take this approach – you are “coping.” If you calmly think through the situation you are coping well.

18. Stress • If you are sleep deprived or otherwise concerned you may loose your job, you may not be able to cope as well. • If you begin yelling at other drivers; hitting the steering wheel or perhaps yelling at your kids in the back seat – you probably are not coping well.

19. Stress • It takes effort to cope and your resiliency is key in helping you cope with stress. • You can improve your resiliency by the following: • Having a good night sleep • Being healthy – eating well and exercising • Understanding/recognizing when you are stressed • Focusing on your spiritual strength • Logically thinking through the situation • Keeping your opinion and view open • Finding ways to cope and keep the stress down

20. Stress • Another form of stress reaction is the “vigilance reaction” – this involves your ability to deal with prolonged stress. • The body responds by releasing cortisol which can result in higher blood pressures, irritability, and increased gastric acid production.

21. Stress Affects - Productivity Productive Stress No Prolonged Stress Declining Function Prolonged Stress Situational Stress Stressed Burnout Non-Functional

22. Work-place stress: Manage energy Reduce distractions Plan appropriately Work-Place Stress

23. Definition - Burnout • Burnout can be defined as: • a: exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration b: a person suffering from burnout. Webster’s dictionary

24. Burnout “In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.” ~Christina Maslach The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

25. Burnout • “…the gap between people and the demands of the job is so great, this progress comes at a high human price.” • “…It represents an erosion in values, dignity, spirit, and will – an erosion of the human soul. It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it’s hard to recover.” The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

26. Six Sources of Burnout • Work overload • Lack of control • Insufficient reward • Unfairness • Breakdown of community • Value conflict Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”

27. Self-Assessment Select the option that best applies to you in the past 6 months? • I feel chronically exhausted. • I am more cynical and detached from my work. • I feel increasingly ineffective in my job. • All of the above • None of the above

28. Symptoms of Burnout • Emotional exhaustion • Feelings of cynicism • Impaired productivity • Isolation • Avoidance • Interpersonal conflicts • High turnover Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17

29. Single Gender/sexual orientation ># of children at home Family problems Mid-late career Previous mental health issues (depression) Fatigue & sleep deprivation General dissatisfaction Alcohol and drugs Minority/international Teaching & research demands Potential litigation Risk Factors for Burnout Puddester D. West J Med 2001;174:5-7 Myers MJ West J Med 2001;174:30-33 Gautam M West J Med 2001;174:37-41

30. Protective Factors • Personal: • Address Maslach’s 6 sources of burnout and your current role • Influence happiness through personal values and choices • Adapt a healthy philosophy/outlook • Spend time with family & friends • A supportive spouse or partner Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

31. Protective Factors (cont) • Engage in religious or spiritual activity • Maintain self-care (sleep, nutrition & PA) • Hobbies & mentors

32. Protective Factors • Work: • Address Maslach’s 6 sources of burnout • Gain control over environment & workload • Find meaning in work • Set limits and maintain balance • Have a mentor • Obtain adequate administrative support systems

33. Managing Energy at Work • Listen to your body • Identify your own needs • Define limits - Just Say NO! • Create your work environment • Eliminate distractions • Take breaks • Plan ahead Schwartz, T. & McCarthy, C. Manage Your Energy Not Your Time. HBR October 2007.

34. Dr D is a 46 yo female physician-educator with 2 kids and spouse with significant travel/work schedule. She wears 5 different hats on any given day and is involved is several community activities. Dr D finds emails, starpanel and other interruptions distracting and is feeling stressed due to a grant and several submissions that are due in the next 6 weeks. She has cut down on sleep and exercise to meet the deadlines. What are her risk factors for burnout? Will this lead to burnout? What changes could we suggest to control energy at work? Managing Energy: Case Discussion

35. Managing Energy: Case Discussion • Examples: • Check emails only twice a day – planned checks • Define blocks of time 60-120 min each • Walk, stretch and bathroom breaks • Define grant writing periods – block out on calendar • Schedule vacations in advance • Coordinate with spouse/family • Continue self-care and socializing/spirituality

36. Individual Approach Organizational Approach Starts with person Starts with management Becomes organizational project Becomes group project Connects to organization Connects to people Outcomes affects related mismatches Outcome is a process Preventing & Resolving Burnout Figure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 1997

37. The Truth About Burnout “The twin goals of preventing and building engagement are possible and necessary in today’s working world. These goals cannot be easily achieved by an individual. Rather, people have to work together to make them happen. And if we all commit ourselves to the long-term process of organizational progress, we will be rewarded with workplaces that are more productive and resilient as well as humane.” ~Maslach & Leiter, pg 127

38. Resources

39. Vanderbilt Internal Resources

40. Vanderbilt Internal Resources • Center for Integrated Health (CIH) • Health Plus • Go for the Gold program • Center for Professional Health Educational Resource web page/on-line classroom (in development) • Dayani center & ortho exercise facility

41. Other Resources • Primary care provider • Centerstone, Elam Center or other private counseling services • Cumblerland Heights & Evelyn Fry for issues related to substance use • 1-800-273-TALK: suicide prevention hotline • YMCA/YWCA

42. Useful Web-Based Resources • TipGuide: http://www.inspiredliving.com/stress/stress-busters.htm#Learn_Time_Management_Techniques • HelpGuide: http://www.helpguide.org/mental/stress_management_relief_coping.htm • WebMD: http://www.webmd.com/balance/stress-management/stress-management-relieving-stress • Girltalk-HealthiNation Video: http://www.healthination.com • GeneralStressManagement: http://www.aboutstressmanagement.com/stressrelief/

43. Individual Action Plan • Are you balanced? Stressed? Burnt-out? • What area needs focus/attention? • List three individual wellness pieces you will improve over the next 6 mo. • List three ways to manage your energy at work. • Identify a resource you will use if needed.

44. Faculty and Physician Wellness Committee

45. Q&A

46. Summary • Reviewed stress and burnout – RF and protective factors • Options for self and department. • Resources at Vandy • Please feel free to contact us: • Charlene.dewey@vanderbilt.edu • Wiliam.swiggart@vanderbilt.edu

47. “The first wealth is health.”~ Ralph Waldo Emerson