Esprit de corps (patient-designed care)

Transcription

1 Esprit de corps (patient-designed care) Stephen Swensen, MD, MMM, FACR Medical Director Professionalism and Peer Support Senior Fellow, Institute for Healthcare Improvement Nothing to Disclose

2 Esprit de corps Camaraderie Purpose Trusted Six Actions Two Measures Swensen, Shanafelt. Organizational Framework to Bring Back Joy in Practice. TJC Journal 2017

3 Baard, Deci, Ryan. Intrinsic Need Satisfaction. J Applied Social Psych, (10): 2045 Swensen, Kabcenell, Shanafelt. J Healthcare Management.61:2; Esprit de corps Human Needs Camaraderie Trusted Purpose

4 Leaders Pebbles Design Esprit de corps Second Victims Human Needs Commensality Resilience Swensen, Kabcenell, Shanafelt. Journal of Healthcare Management. 61: March/April 2016 Swensen Gorringe Caviness Peters. Leadership by Design. Journal of Mgmt Development Vol. 35 (4) 2016

5 Six Actions DESIGN: Design Organizational Systems to Address Human Needs LEADERS: Develop Leaders with Participative Management Competency PEBBLES: Remove Sources of Frustration and Inefficiency SECOND VICTIMS: Reduce Preventable Harm and Support Second Victims COMMENSALITY: Build Community and Camaraderie RESILIENCE: Bolster Individual Wellness

6 Professionalism 5 6 Medical errors Patient Satisfaction 7 14 Productivity Turnover 9 Suicidal Ideation JAMA 296: JAMA 304: JAMA 302: Annals IM 136:358 5 Annals Surg 251:995 6 JAMA 306:952 7 Health Psych 12:93 8 JACS 212:42 9 Annals IM 149: Arch Surg 146:54 11 Fahrenkoph Shanafelt West Beach Halbesleben 2008

7 Professionalism 5 6 Medical errors Motor Vehicle Accidents 16 Patient Satisfaction 7 14 Productivity Turnover 9 Suicidal Ideation JAMA 296: JAMA 304: JAMA 302: Annals IM 136:358 5 Annals Surg 251:995 6 JAMA 306:952 7 Health Psych 12:93 8 JACS 212:42 9 Annals IM 149: Arch Surg 146:54 11 Fahrenkoph Shanafelt West Beach Halbesleben Shanafel 2012 MCP

8 Shanafelt Noseworthy Executive Leadership Physician Well-being Mayo MFMER Clin Proc

9 Leadership Index (P<0.001) (P<0.001) Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions. Mayo Clinic Proceedings. April 2015: 90(4);

10 Five Leader Index Behaviors Appreciation: Express gratitude in a meaningful way to colleagues Transparency: Share what you know with the team Ideas: Consistently solicit input of coworkers Career: Support professional aspirations of staff Inclusion: Nurture a culture where all are welcome and psychologically safe

11 References Swensen, Shanafelt. Organizational Framework to Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety 2017 Sinsky, C.A., et al., In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices. The Annals of Family Medicine, (3): p Swensen, S., A. Kabcenell, and T. Shanafelt, Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. Journal of healthcare management / American College of Healthcare Executives, (2): p Johnson, J.V., et al., Long-term psychosocial work environment and cardiovascular mortality among Swedish men. American Journal of Public Health, (3): p Baard, P.P., E.L. Deci, and R.M. Ryan, Intrinsic Need Satisfaction: A Motivational Basis of Performance and Weil Being in Two Work Settings1. Journal of applied social psychology, (10): p Swensen, S., et al., Leadership by design: intentional organization development of physician leaders. Journal of Management Development, (4): p Thirioux, B., F. Birault, and N. Jaafari, Empathy Is a Protective Factor of Burnout in Physicians: New Neuro- Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Front Psychol. 2016;7:763. doi: /fpsyg Riess, H., et al., Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience- Informed Curriculum. Journal of general internal medicine, (10): p Krasner, M.S., et al., Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Jama, (12): p P a g e

12 References Scott, S.D., et al., Caring for our own: deploying a systemwide second victim rapid response team. Communication of Critical Test Results, Taris, T.W., Is there a relationship between burnout and objective performance? A critical review of 16 studies. Work & Stress, (4): p Swensen, S.J., et al., The Mayo Clinic Value Creation System. Am J Med Qual, (1): p Beckman, H.B., et al., The impact of a program in mindful communication on primary care physicians. Academic medicine : journal of the Association of American Medical Colleges, (6): p Kniffin, K.M., et al., Eating Together at the Firehouse: How Workplace Commensality Relates to the Performance of Firefighters. Human Performance, (4): p West, C.P., et al., Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med, (4): p Linzer, M., et al., A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. Journal of general internal medicine, (8): p Sinsky, C., et al., Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, (11): p Shultz, C.G. and H.L. Holmstrom, The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med, (3): p Wu, A.W., Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ Mar 18;320(7237):726-7.

13 References Shanafelt, T.D., et al., Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 91(4): p West, C.P., et al., Association of resident fatigue and distress with perceived medical errors. Jama, (12): p P a g e Williams, E.S., et al., The relationship of organizational culture, stress, satisfaction, and burnout with physicianreported error and suboptimal patient care: results from the MEMO study. Health care management review, (3): p Swensen, S.J., et al., The business case for health-care quality improvement. J Patient Saf, (1): p Ruotsalainen, J.H., et al., Preventing occupational stress in healthcare workers. The Cochrane Library, Laskowski, E.R. Walking Throughout Your Day Keeps Depression (and a Host of Other Health Problems) Away. in Mayo Clinic Proceedings Elsevier. Epstein, R.M. and M.S. Krasner, Physician resilience: what it means, why it matters, and how to promote it. Acad Med, (3): p Sood, A., et al., Stress Management and Resiliency Training (SMART) Program among Department of Radiology Faculty: a pilot randomized clinical trial. EXPLORE: The Journal of Science and Healing, (6): p Panagioti, M., et al., Controlled interventions to reduce burnout in physicians: A systematic review and metaanalysis. JAMA Internal Medicine, West, C.P., et al., Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 388(10057): p