Leadership Development as an Antidote to Workforce Burnout in Integrated Behavioral Health (IBH)

1. Leadership Development as an Antidote to Workforce Burnout in Integrated Behavioral Health (IBH) Session #C4 Samantha Pelican Monson, PsyD Caroline Corrigan, PhD Jennifer Grote, PhD CFHA 18th Annual Conference October 14, 2016  Charlotte, NC U.S.A.

2. Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • List three practical leadership development strategies specific to integrated behavioral health. • Identify untapped leadership potential within their own workplace. • Discuss the benefits of leadership development for individuals, teams, and systems.

4. Current References (Complete List on Handout) • 1Fehr, R., & Gelfand, M. J. (2012). The forgiving organization: A multilevel model of forgiveness at work. Academy of Management Review, 37(4), 664-688. • 2Grandey, A., Foo, S. C., Groth, M., & Goodwin, R. E. (2012). Free to be you and me: a climate of authenticity alleviates burnout from emotional labor. Journal of occupational health psychology, 17(1), 1. • 3Grant, A. M. (2012). Leading with meaning: Beneficiary contact, prosocial impact, and the performance effects of transformational leadership. Academy of Management Journal, 55(2), 458-476. • 4Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352. • 5Rynes, S. L., Bartunek, J. M., Dutton, J. E., & Margolis, J. D. (2012). Care and compassion through an organizational lens: Opening up new possibilities. Academy of Management Review, 37(4), 503-523. • 6Skovholt, T. M., & Trotter-Mathison, M. (2014). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals. Routledge. • 7Wang, H., Sui, Y., Luthans, F., Wang, D., & Wu, Y. (2014). Impact of authentic leadership on performance: Role of followers' positive psychological capital and relational processes. Journal of Organizational Behavior, 35(1), 5-21.

5. What is Burnout?

6. Burnout Syndrome (BOS)8 • Burnout was first described in the 1970s, grounded in the real-life experiences of people in the workplace and developed into a conceptual framework. Three classic symptoms of burnout are defined that can be predictors of emotional stress and job-related disillusionment: • Exhaustion • Generalized fatigue related to spending excessive time at work or effort spend on tasks that are not perceived to be beneficial • Depersonalization/Cynicism • Indifferent attitudes toward work that may result in negative or cynical behaviors toward colleagues and patients, or an inability to express empathy when a critical incident occurs • Reduced personal accomplishment/Inefficacy • Devaluing the worth of one’s work, negative feelings about job performance

7. Symptoms of Burnout Syndrome8 Frustration Anger Fear Anxious Being unprofessional Feeling overwhelmed Disillusionment Hopelessness Lack of empathy Feeling insufficient at work Disengagement Insomnia Headache GI problems Muscle tension

8. Prevalence of Burnout in Healthcare Professions4,9 45% of ICU and ED Physicians report symptoms of burnout. 50% of mental health professionals cite burnout as an issue in their work. 86% of critical care nurses have at least one symptom of burnout. 1 in 3 physicians report burnout

9. Burnout Factors for Integrated Behavioral Health6, 10 • While the prevalence of burnout is high in other healthcare professions, IBH providers face other challenging factors: • Working in Medical Settings • Organizational Challenges (Department and Workforce Issues) • Healthcare Policy and Systems

10. Working in Medical Settings: Clinic Care Team and Workplace Dynamics • Training and educational differences amongst care team members • Medical hierarchy (covert and overt) • Role ambiguity amongst care team members • Isolation or loneliness as the only BH clinician on the care team • Shifting professional mindset from specialty practice to co-located and integrated care Burnout Factors Affecting IBH Clinicians and Leaders6,10

11. Organizational Challenges: Departmental and Workforce Issues Burnout Factors Affecting IBH Clinicians and Leaders6,10 Salary and Compensation Structure Work Hours Adequate time to provide case management and outreach EHR—integrated vs. co-located Productivity Expectations Availability of internal resources Quality Improvement Metrics and Outcomes

12. Healthcare Policy and Systems: Navigating Uncharted Waters30 • Federal policies • State rules and regulations • Reimbursement Rates • Grant Funding vs. Operationalizing Budgets • Insurance/payer mix • Availability of community resources • Support from local organizations/Public Health Burnout Factors Affecting IBH Clinicians and Leaders

13. What is leadership?

14. Leadership Types Fostering Resilience 3,11-14 • Inspirational motivation: Articulate the overarching vision • Idealized influence: Build respect and pride through charisma; communicate values and purpose; focus on collective interests • Intellectual stimulation: Question assumptions • Individualized consideration: Coaching, understanding Transformational Leadership: Organization Focus

15. Leadership Types Fostering Resilience 1,5,11-14 • Empower and develop followers • Interpersonal acceptance • Humility • Provide guidance/direction • Authenticity • Willingness to work for collective good Service orientation, mission-driven, long game Servant Leadership: Follower Focus

16. Leadership Types Fostering Resilience2, 7,15-22 Leader Focus • Self-awareness • Balanced processing • Relational transparency • Authentic behavior/action Authentic Leadership: Self Focus in Leader and Follower • Leader and Follower Focus • Self-awareness/introspection • Personal history and trigger events are relationally relevant to both parties • Follower leadership is cultivated as indicated, not prescribed

17. Leader (integrity + sustained performance) + Mutual Experience (developmental experiences + psychological safety + meaningful work) = Follower (engagement, well-being)

18. Other Relevant Leadership Models23-28

19. Development of IBH Leadership • A healthy work environment means a place where people have respect, autonomy, communication, shared decision-making, and meaningful recognition. These aspects foster emotional positivity… • BUT, even with the most well-intentioned leader or employee…change is hard! • So, what can you do? • Examine the environment in which you work • What is the level of change readiness… • In your clinic and care team? • In your organizational/department? • In the healthcare system and policies of your state?

20. How is leadership development a solution to burnout?

21. Multidimensional Model of Burnout4,6,8 BurnoutEngagement ExhaustionHigh Energy CynicismStrong Involvement InefficacyEfficacy

22. Our 7 A’s of Engagement and Leadership1-3,18-21,29-32 Engagement/Leadership Factor Self Reflection Prompt Accountability Acceptance Attunement Advocacy Attachment Authenticity Appreciation

23. Our 7 A’s of Engagement and Leadership1-3,18-21,29-32 Engagement/Leadership Factor Self Reflection Prompt Accountability “What do I/you think should happen as a result?” Acceptance “With what have I/you struggled?” “Am I understanding my/your experience Attunement correctly?” Advocacy “How can I further my/your cause?” Attachment “What would I/you do if I/you knew I/you could not fail?” Authenticity “What are my/your core professional values?” Appreciation “What I/you feel grateful for?”

24. Self Reflection Exercise: Fostering Leadership Potential Using the Self Reflection handout, make notes on 2-3 of the self reflection prompts, either for yourself or someone with whom you work or supervise.

25. Our 7 A’s of Engagement and Leadership1-3,18-21,29-32

26. Leadership Development Exercise: Fostering Leadership Potential Using the Leadership Strategies handout, select one strategy you are choosing to commit to within the next 30 days. Address a postcard to yourself, and it will be sent to you as a reminder of the way you will foster leadership within yourself or your organization.

27. Questions/Comments? THANK YOU! samantha.monson@dhha.orgcaroline.corrigan@dhha.orgjennifer.grote@dhha.org