Stress and Burnout in Healthcare delivery - Caring for caregivers

Presentation about stress and burnout for healthcare workers, as well as resources for assistance from the local hospital

1. STRESS
IDENTIFYING AND DEALING WITH

2. WHAT IS STRESS?
FIGHT OR FLIGHT BECOMES FULL TIME

3. THE STRESS PYRAMID
▸Everyday stressors - bills,
family, news, etc
▸Things we deal with when
we get home from work
▸May influence our daily
outlook at work
STRESSORS - LIFE

4. THE STRESS PYRAMID
WORK STRESS
▸Implicit vs explicit
stress
▸Care team
dynamics
▸Distractions -
internal & external

5. THE STRESS PYRAMID
IMPLICIT VS EXPLICIT JOB STRESSORS
▸Implicit Stressors are the underlying logistical stressors
associated with a job, including commute, productivity etc.
▸In terms of Anesthesia, the implicit stressor of productivity alone
may have consequences on a practitioners health
▸Explicit stressors center on the solving of a particular problem in
a work environment and are usually considered ‘eustress,’ in that
it is profession-focused
▸In Clinical Anesthesia, the ‘problem solving’ Explicit Stressor may
actually be a life threatening issue, and not a ‘eustress’ moment.

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Do waking salivary cortisol levels correlate with anesthesiologist's job involvement?
Klein M, et al. J Clin Monit Comput. 2012.
ANESTHESIOLOGY & CORTISOL

7. THE STRESS PYRAMID
THE STRESS APEX
▸Traumatic events and
memories
▸Acute traumatic events
▸Hostile interactions
▸Bad Outcomes

8. THE STRESS PYRAMID
STRESSORS - WHEN A BAD OUTCOME OCCURS
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9. THE STRESS PYRAMID
THE ‘SECOND VICTIM’ SYNDROME
▸Coined by AW Wu (2000)
▸‘The doctor who makes the mistake needs help too.’
▸Involvement in adverse pt outcome creates a condition
similar to PTSD - maladaptive behaviors may result.
▸High risk cases include pediatric cases, organ harvest, pts
with multiple comorbidities, trauma...
▸Respite and emotional debriefing outside of the M&M
setting are critical in mitigating
Wu, AW. ‘Medical error: the second victim. The doctor who makes the mistake needs help too.’ BMJ 2000 Mar
18;320(7237); 726-7

10. HEALTH CONSEQUENCES
Physical responses to chronic
cortisol secretion
Chronic health conditions
Sleep deprivation and
consequences
Chronic psychological response
to stress can contribute to
burnout...
http://infographicfacts.com/17-reasons-avoid-stress/

11. BURNOUT
‘WORK-RELATED PSYCHOLOGICAL SYNDROME CHARACTERIZED BY EMOTIONAL
EXHAUSTION, DECREASED SENSE OF PERSONAL ACCOMPLISHMENT AND
DEPERSONALIZATION; EFFECTS INCLUDE FATIGUE, SLEEP AND EATING
DISORDERS, EMOTIONAL INSTABILITY AND JOB PERFORMANCE’
Maslach et. al. ‘New Insights into burnout and healthcare. Strategies for improving civility and alleviating
burnout.’ Med Teach 2017 Feb;39(2):160-3

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‘Burnout Among Anesthesiologists,’ lecture by Dr. Bryan P. Mahoney. 72nd PGA NY NY Dec7-11 2018
ANESTHESIOLOGIST BURNOUT

13. BURNOUT
RISK FACTORS FOR BURNOUT — 2700 anesthesia residents surveyed
▸Age <30. (46% <30, 34% >30)
▸Female (46% vs 37% for men)
▸Single (52% vs 33% married)
▸No children (45% vs 31% with children)
▸>70 hrs worked / week
▸<5 days between calls
▸>5 alcoholic drinks / week
de Olivera et. al. ‘The prevalence of burnout and depression and their association with adherence to
practice and safety standards: a survey of [US] anesthesiology trainees.’ Anesth Analg Jul; 117(1):182-93

14. HELPING YOU
CARING FOR THE CAREGIVERS

15. JOHN MUIR - CARING FOR THE CAREGIVER PROGRAM
WHAT IS THIS PROGRAM?
▸This is a hospital - specific program
directed at all caregivers, from
maintenance staff to MDs.
▸When a Bad Outcome or traumatic
scenario occurs, the staff involved
may be experiencing significant
stress.
▸The goal is a rapid response by an
equivalent colleague to help
determine the level of stress incurred,
and offer support to the staff member

16. JOHN MUIR - CARING FOR THE CAREGIVER PROGRAM
HOW DOES IT WORK?
▸Ideally, the practitioner involved notifies the Caring for
Caregiver (‘Wellness rep’) as soon as they are able
▸If another care team member (RN, surgeon etc) is
particularly concerned about the case, they can call the
service, who then alerts the Wellness rep.
▸We talk. Or text, but whichever is most convenient
▸I can also offer you resources to seek further assistance.

17. JOHN MUIR - CARING FOR THE CAREGIVER PROGRAM
WHAT ARE THE LIMITATIONS?
▸Muir offers a vast array of resources
- to its employees only
▸One of the facets of the program is
to get the practitioner out of the
clinical environment to recoup.
With our schedule and setup, there
are times that this is not possible.
▸Depending on the rigors of the day,
the ideal 24hr activation window
may not be large enough - you can
text me any time.

18. EVHC WELLNESS
ADDITIONAL RESOURCES

19. ADDITIONAL RESOURCES
EVHC EAP
▸Employee assistance program:
Morneau Shepell -
1800-272-2727.
workhealthlife.com/us
▸Evhc Wellness Initiative

20. ADDITIONAL RESOURCES
WAYS TO ENGAGE IN A WELLNESS LIFESTYLE
▸Most difficult - get out of the clinical environment when
possible
▸Exercise
▸Mindful awareness - diet, interactions with others
▸Meditation / spirituality - mind + body connection
▸Social engagement - GroupMe activities stream