Getting the Best Out of Medical Groups: Deepening Neurosurgeon and Team Engagement and Resilience. Wayne M. Sotile, PhD. Davidson, North Carolina

Transcription

1 Getting the Best Out of Medical Groups: Deepening Neurosurgeon and Team Engagement and Resilience Wayne M. Sotile, PhD SOTILE CENTER FOR RESILIENCE Davidson, North Carolina The Two Most Important Questions Who are you to the ones you love and work with How happy are you? 1

2 Toxic Stress High Demand Low Control Low Support 2

3 Getting the Best Out of Your Group Drive Effective Governance Apply Lessons from the Science of Motivation Respect the Psychology of Change Honestly Assess Yourself Be a Safe Space Hero A hero is someone who creates safe spaces for other people The Resilient Physician. Sotile & Sotile,

4 The Most Pervasive, Unchecked Risks to Safety, Quality and Satisfaction: Burnout & Psychosocial Distress Emergency Medicine Internal Medicine - General Neurology Family Medicine Otolaryngology Orthopedic Surgery Anesthesiology Burnout by Specialty Obstetrics and Gynecology Radiology Physical medicine and Rehab Average Burnout All Physicians Participating General Surgery Internal Medicine Subspecialty Ophthalmology Shanafelt, Boone, Tan, Drybe, Sotile et al. General Surgery Subspecialty Urology Psychiatry Arch Intern Med. 2012; 172(18): Neurosurgery Pediatric Subspecialty Other Radiation Oncology Pathology Pediatrics - General Dermatology Prev Med/Occupat Med/Enviro Med % Reporting Burnout 4

5 Does Physician Burnout Matter? Burnout adversely affects quality of care Wallace JE et al. Lancet. 2009;374: Medical Errors Williams ES et al. Health Care Manage Rev. 2007;32: Firth-Cozens J & Greenhalgh J. Soc Sci Med. 1997;44: Shanafelt TD et al. Ann Intern Med. 2002;136: Medical Malpractice Suits Jones JW et al. J Appl Psychol. 1988;73: Patient Compliance DiMatteo MR et al. Health Psychol. 1993;12: Patient Satisfaction Linn LS et al. Med Care. 1985;23: Haas JS et al. J Gen Intern Med. 2000;15: Medical Family Discord Sargent MC, Sotile WM, Sotile MO, et al. J of Bone and Joint Surgery ; Getting the Best Out of Your Group Honestly Assess Yourself Be a Safe Space 5

6 High Low Small Group Commitment Organ. Cohesion & Governance High Low Tuckerman,

7 Psychological Style Inventories Pros and Cons Myers-Briggs Type Indicator (MBTI ) Fundamental Interpersonal Relations Orientation (FIRO ) Key Thoughts On Interpretation 1. We all have gifts 2. We all have preferences 3. We all have different ways to take in information 4. There is strength in diversity all types are equally valuable 7

8 Dr. X Admin Dr. Y Dr. Z Dr. Z Dr. Y Dr. X Admin Admin Dr. Z Dr. Y Dr. X Admin Dr. X Dr. Z Dr. Y Constructive Use of Differences Identify your biases Reframe: Difficulties come from not understanding another type Irritation and hurt come from others person failing to match your type Move toward acceptance Embrace diversity 8

9 360 Evaluation: Pros and Cons 61 items 12 categories of workplace behaviors: Decision Quality Relationships with Authority Action Oriented Time Management Composure Patience Compassion Interpersonal Savvy Listening Integrity and Trust Perseverance Perceived Work/Life Balance Self Management Self-Awareness Self-Regulation Motivation Relationship Management Empathy Social Skills Influence Skills 9

10 Getting the Best Out of Your Group Respect the Psychology of Change Honestly Assess Yourself Be a Safe Space The Biggest Paradox & Our Ultimate Challenge The Yeanotreally Mentality 10

11 Getting the Best Out of Your Group Apply Lessons from the Science of Motivation Respect the Psychology of Change Honestly Assess Yourself Be a Safe Space Why Do People Change? Consequences Model Identity Model Who am I? What kind of situation is this? What would a person like me do in this situation? 11

12 Important Factors in a Desirable Practice for Young Physicians % Very Important Time for family/personal 71% Adequate support staff and services 43% Long term income potential 42% Practice income 39% Flexible scheduling 37% Health insurance coverage 35% No or very limited on-call 31% Adequate patient volume 30% Opportunity to advance professionally 28% AAMC 2006 Survey of Physicians Under 50 The Paradoxes of Human Motivation When money us used as an external reward..the Ss lose intrinsic interest for the activity.. Deci, Edward. Effects of externally mediated rewards on intrisic motivation. J Person and Soc Psych. 1971;

13 Overcoming "Yea, Not Really..." THE CRUCIAL BALANCE Intrinsic / Extrinsic Rewards Good Work Does the Work Match My Values? Can I Do it to the Best of My Abilities? Am I Enjoying Working with the People I Work With? Am I Getting Support from Loved Ones for Doing this Work? Sotile W & Sotile M. Letting Go of What s Holding You Back

14 How People Change Which is used most? Influence Strategies Do it. Actual performance Notice it Internal feedback Observe it..vicarious learning Learn it.. Verbal persuasion A. Bandura et al. Cognitive processes mediating behavior change. Cognitive Therapy and Research. 1977;1: Deepen Your Relationships Time Matters Who spends time with whom? Reflects affiliations O Connor EJ ACPE,

15 From Risk to Resilience.. Deepen Your Relationships Principal of Propinquity The frequency and quality of human interaction is largely a function of physical distance (proximity) Festinger L et al Social Pressure in Informal Groups, 1950 Make Frequent, Repetitive Contact with Everyone Involved 15

16 Focus on Your Respective Strengths Are We In This Together? Elsbach & Bhattacharya. Organizational Science. 2001;12: Low Passion Zone Apathetic Identification High Passion Zone Organizational Identification Non-Identification Neutral Identification Dis-Identification 16

17 Getting the Best Out of Your Group Drive Effective Governance Apply Lessons from the Science of Motivation Respect the Psychology of Change Honestly Assess Yourself Be a Safe Space The Seven Deadly Sins of Ineffective Governance (Orlikoff & Totten, 1999) 1. Representational Governance 2. Lack of Mission Focus 3. Resisting Change Rather than Leading It 4. Bad Governance Information 5. Reluctance to Remove Nonperforming or Dysfunctional Board Members 6. Bad Governance Structures 7. Lack of Job Descriptions 17

18 4 Ways to Promote Thriving at Work Incivility Decision-Making Discretion Share Information Performance Feedback Speitzer G. & Porath C. HBR. Jan-Feb, 2012 Performance Management Does the person know what needs to be done? Know how they are doing? (feedback) Incentivized to do this? Has skills/training necessary to do it? Has capacity? (mental, physical, etc.) Do they want to do it? 18

19 Aggressive Outbursts (90%) Intimidation (20%) Harassment (10%) Passive Aggressive Derogatory comments (5%) Refusals to do tasks (20%) Passive Chronically late or not responsive to calls (15%) Inappropriate or inadequate documentations (15%) Samenow CP et al. Phys Exec (1):32-40 The Scope of the Problem Disruptive Behavior Humiliating, Demeaning Treatment of Others Passive-aggressive Behavior Passive Disrespect (chronic tardiness, sluggish responses and charting, failure to participate in initiatives) Dismissive Treatment of Others Systemic Disrespect (normalizing discourteousness or a hostile work environment) Leape Ll et al. Academic Med. 2012;87(7):1-8 Federation of State Medical Boards,

20 Who Has the Problem? A Problem Person? A Person with a Problem? A Person in a Problem System? Getting the Best Out of Your Group Drive Effective Governance Apply Lessons from the Science of Motivation Respect the Psychology of Change Honestly Assess Yourself Be a Safe Space 20

21 Promoting Resilience You don t get what you want by focusing on what you don t want. Thank You! Wayne Sotile, Ph.D. Sotile@Sotil .com 336/