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1 Burnout: It COULD be you!!! Steve Alan Hyman, MD MM Professor of Anesthesiology Vanderbilt University School of Medicine Tune your texting device to Or PollEv.com/hymansa Burnout: It COULD be you!!! Steve Alan Hyman, MD MM Professor of Anesthesiology Vanderbilt University School of Medicine 1

2 Funding Source ASPAN Research Grant The presenter has no other disclosures. 2

3 Definition of burnout...burnout is used to describe a syndrome that goes beyond physical fatigue from overwork. Stress and emotional exhaustion are part of it, but the hallmark of burnout is the distancing that goes on in response to the overload... (Maslach, 1997) 3

4 Elements of Burnout Emotional exhaustion De-personalization (Lack of) personal accomplishment Maslach, C., Leiter, M. P., & Schaufeli, W. B. (2009). Measuring burnout. In C. L. Cooper & S. Cartwright (Eds.), The Oxford handbook of organizational well-being (86-108). Oxford UK: Oxford University Press. Maslach Burnout Inventory Human Services Survey (MBI-HSS) Situational Characteristics Individual Characteristics GOOD WORK-LIFE BALANCE BURNOUT AND DISENGAGEMENT OUT OF BALANCE BUT NOT BURNED OUT Differences in Burnout Among Medical Specialists Year of Study First Author Specialty Studied Moderate to High EE % (% High) Moderate to High DP % (% High) Moderate to Low PA % (% Low) Medium to High BO % (% High) 2001 Campbell Surgery 63 (32) 37 (13) 17 (4) 2005 Bertges Yost Xplt 61 (38) 49 (27) 40 (16) 1996 Ramirez X-ray Guntupalli CCM Lloyd ER 46 (29) 93 (61) 79 (16) 2007 Garelick Multi-spec Embraico CCM (30) 4

5 Pilot Study at VUMC MBI and Global Score Versus Role and Age Res Att CRNA RN Age Global Score Ref EE Ref DP Ref Low PA Ref Impact of Burnout On individual level High turnover Dissatisfaction with job situation Dissatisfaction with career in general Health Issues Contributes to poor physical/mental health Substance use/abuse On institutional level Decreased morale/contagious negative attitudes Lose best and brightest Increased cost due to recruitment and re-training The purpose of the webinar study The main components of an anesthesiologist s job (complex vigilance, monitoring, and dynamic decision making) are particularly susceptible to effects from a variety of factors including the work environment itself, human components and, and the human-machine interface necessary to the job. As part of a webinar dealing with the subject of burnout, we were asked to administer a survey to enhance the webinar experience The purpose was in part designed to assess the risk of burnout and its relationship to mental and physical health. We additionally studied the relationship of substance abuse, job satisfaction, and personal and professional support. 5

6 ASA Webinar Study Data gathered in 2011 Anonymous electronic survey Participants were attendees of a webinar on burnout co-sponsored by the ASA and ANESTHESIOLOGY Paper accepted for publication in Anesthesia and Analgesia Survey Design Variable length survey that reflected key burnout concepts using validated instruments o Modified Maslach-Burnout-Inventory-Human- Services-Survey o SF-12 (NEW) o Social-Support/Personal-Coping-Survey o NM ASSIST and National Survey on Drug Use and Health (select questions - NEW) Maslach Burnout Inventory Emotional Exhaustion (scored for low-med-high) De-personalization (scored for low-med-high) Lack of Personal Accomplishment (LPA) (scored for low-med-high) Valid and reliable tool with normative comparative data used since the 1980s 22 questions 6

7 SF 12 Health Satisfaction and Function Valid and reliable tool in use since the 90s 12 questions reliably measures satisfaction and function of an individual s health Covers physical and psychological health Social-Support/Personal-Coping- Survey Tool created to measure 4 components Work Satisfaction Personal support Work Control Professional support Original 22 questions included health questions Cut to 14 with the addition of SF-12 National Institute of Drug Abuse NM ASSIST Quick Screen Tool Asks select substances use in lifetime, in the last year and/or in last 30 days. For primary care physicians to screen for substances. Substances: Alcohol; tobacco; marijuana 7

8 Demographic Data Survey Respondents (n=221) Entire ASA Membership a Demographics Attendings Residents Item N # Responses % % % Age Gender Job Title Work Area 20 to to to to and above Female Male Physician (Attending) Physician (Resident) RN Other Hospital (Community) Hospital (Teaching) Surgery Center Office Based Practice MAJOR FINDINGS MBI-HSS MBI-HSS vs Gender Item EE DP LPA Burnout Total (95%) (95%) (95%) Coefficient (95%) p Coefficient p value Coefficient p value Coefficient p value value Participant Age a vs ( ) ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) 0.40 Participant Gender and Role Male vs. female ( ) ( ) ( ) ( ) 0.03 Resident vs. Attending ( ) ( ) ( ) ( ) 0.42 Other vs. Attending ( ) ( ) ( ) ( ) 0.26 Substance Use Use tobacco ( ) ( ) ( ) ( ) 0.57 Use alcohol ( ) ( ) ( ) ( ) 0.37 SF-12 Use cannabis ( ) ( ) ( ) ( ) 1.00 PCS ( ) < ( ) ( ) ( ) <0.01 SSPC-14 MCS ( ) < ( ) < ( ) < ( ) <0.01 Work Satisfaction ( ) ( ) ( ) ( ) 0.06 Personal Support ( ) ( ) ( ) < ( ) 0.67 Work Control ( ) ( ) ( ) ( ) 0.94 Professional support ( ) ( ) ( ) ( )

9 MBI-HSS vs Physical/Mental Health EE DP LPA Burnout Total Item Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value Participant Age vs. vs ( ) 0.05 aa ( ) ( ) ( ) vs. vs ( ) ( ) ( ) ( ) vs. vs ( ) ( ) ( ) ( ) 0.40 Participant Gender and Role Male vs. vs. female ( ) ( ) ( ) ( ) 0.03 Resident vs. vs. Attending ( ) ( ) ( ) ( ) 0.42 Other vs. vs. Attending ( ) ( ) ( ) ( ) 0.26 Substance Use Use tobacco ( ) ( ) ( ) ( ) 0.57 Use alcohol ( ) ( ) ( ) ( ) 0.37 Use cannabis ( ) ( ) ( ) ( ) 1.00 SF-12 PCS ( ) < ( ) ( ) ( ) <0.01 MCS ( ) < ( ) < ( ) < ( ) <0.01 SSPC-14 Work Satisfaction ( ) ( ) ( ) ( ) 0.06 Personal Support ( ) ( ) ( ) < ( ) 0.67 Work Control ( ) ( ) ( ) ( ) 0.94 Professional support ( ) ( ) ( ) ( ) 0.08 MBI-HSS vs SSPC Item Participant Age EE DP LPA Burnout Total Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value vs ( ) 0.05 a ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) 0.40 Participant Gender and Role Male vs. female ( ) ( ) ( ) ( ) 0.03 Resident vs. Attending ( ) ( ) ( ) ( ) 0.42 Other vs. Attending ( ) ( ) ( ) ( ) 0.26 Substance Use Use tobacco ( ) ( ) ( ) ( ) 0.57 Use alcohol ( ) ( ) ( ) ( ) 0.37 Use cannabis ( ) ( ) ( ) ( ) 1.00 SF-12 PCS ( ) < ( ) ( ) ( ) <0.01 MCS ( ) < ( ) < ( ) < ( ) <0.01 SSPC-14 Work Satisfaction ( ) ( ) ( ) ( ) 0.06 Personal Support ( ) ( ) ( ) < ( ) 0.67 Work Control ( ) ( ) ( ) ( ) 0.94 Professional support ( ) ( ) ( ) ( ) 0.08 SF-12 Comparison With Original Study 9

10 MBI-HSS vs Substance Use Item Participant Age EE DP LPA Burnout Total Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value Coefficient (95%) p value vs ( ) 0.05 a ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) vs ( ) ( ) ( ) ( ) 0.40 Participant Gender and Role Male vs. female ( ) ( ) ( ) ( ) 0.03 Resident vs. Attending ( ) ( ) ( ) ( ) 0.42 Other vs. Attending ( ) ( ) ( ) ( ) 0.26 Substance Use Use tobacco ( ) ( ) ( ) ( ) 0.57 Use alcohol ( ) ( ) ( ) ( ) 0.37 Use cannabis ( ) ( ) ( ) ( ) 1.00 SF-12 PCS ( ) < ( ) ( ) ( ) <0.01 MCS ( ) < ( ) < ( ) < ( ) <0.01 SSPC-14 Work Satisfaction ( ) ( ) ( ) ( ) 0.06 Personal Support ( ) ( ) ( ) < ( ) 0.67 Work Control ( ) ( ) ( ) ( ) 0.94 Professional support ( ) ( ) ( ) ( ) 0.08 What Else About Substance Use Survey Question Survey Response N # Responses % Used one or more substances Used tobacco Only used tobacco Used alcohol Only used alcohol Used cannabis In your life, which of the following Only used cannabis substances have you ever used? No substance use Prefer not to answer Used tobacco and alcohol Used tobacco and cannabis Used alcohol and cannabis Used all three substances Have you used any of those substances Yes within the last year? Daily Frequency of substance use within the Frequently last year to manage job stress Occasionally Never ASPAN Study American Society of Peri-Anesthetic Nurses Sent to 15,000 members s successfully sent to 13,429 members 5,000 members opened the ultimate participants 10

11 Differences from and similarities to the Webinar study Similarities Hobby questions SSPC questions Differences Almost no men We asked if they were burned out or were every burned out (New questions) Included marital status questions (New questions) Used NSDUH instead of NM ASSIST for substance use questions (New questions) National Survey on Drug Use and Health NSDUH Asks select substances use <30 days, 30 days-1 year, >1 year Normative comparative data going back decades We limited questions to: Alcohol; tobacco; cocaine; marijuana; pain prescriptions, tranquilizers, and sleeping pills not prescribed for individual; and inhalants. ASPAN Member Participants Burnout 47% 18% 35% Current Forme r Ne v er 11

12 Survey Data (Normative Control) = median normative data Emotional Exhaustion 80% 70% 60% 50% 40% 30% Current Forme r Ne v er 20% 10% 0% EE-low EE-medium EE-high Distribution of Burnout 90% 80% 70% 60% 50% 40% 30% Current Forme r Ne v er 20% 10% 0% All 3 high (EE, DP, L PA ) One or more high 12

13 I can easily understand how my patients feel about things. 80% 70% 60% 50% 40% 30% 20% 10% 0% Ne v er Every day Current Forme r Ne v er Burnout Indices Compared to Burnout History (ASPAN) Burnout (N-493) Former (N-981) Never (N-1,329) MBI Emotional Exhaustion MBI Depersonalization MBI Lack of personal accomplishment MBI overall Select SSPC Work Support Questions 7 6 current 5 4former 3 2never 1 0P value Advancement oppurtunities superv isor values my sk ills superv isor Control over provdes social workload support Current Forme r Ne v er P<0.001 on all 13

14 General Health Implications 30% 25% 20% 15% 10% 5% Current Forme r Ne v er 0% Excellent health Physical/ emotional health interfers quit a bit with social activities Pain interfers with normal social activities quite a bit 70% 60% 50% Hobbies/Activities & Burnout 40% 30% 20% Current Forme r Ne v er 10% 0% No strenous/moderate activitites P<0.001 No distraction activities No creative activities Personal Support and Burnout 70% 60% 50% 40% 30% 20% Current Forme r Ne v er 10% 0% No Support 1-3 people 4-6 people 7-10 people 14

15 Substance Use Substance Ever Within the last 30 days Tobacco products 43% 4% Alcohol 82% 60% Marijuana 29% 1% Tranquilizers 7% 0% Cocaine 7% 0% Hallucinogens 4% 0% Inhalants 1% 0% Prescription pain relievers 21% 1% Prescription sedatives or sleeping pills 21% 1% None 10% 38% Burnout in Subspecialty Anesthesiologists ASRA, SPA, and SCA. Largely the same protocol as ASPAN. These are data from ASRA. Now use RAND-12 instead of SF-12. ASPAN versus ASRA Self-reported burnout ASPAN ASRA Currently - 18% Formerly - 35% Never -47% Currently - 26% Formerly - 23% Never - 50% 15

16 ASPAN and ASRA Burnout risk compared to controls ASPAN ASRA EE DP LPA EE DP LPA Distribution of Burnout ASPAN versus ASRA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Self reported: Currently Burned out, Formerly burned out, Never burned out ASPAN 3 high ASRA 3high ASPAN 1or more high ASRA 1or more high Currently Formerly Never Review Burnout Indices Compared to Burnout History (ASPAN) Burnout (N-493) Former (N-981) Never (N-1,329) MBI Emotional Exhaustion MBI Depersonalization MBI Lack of personal accomplishment MBI overall

17 Burnout Indices Compared to Burnout History (ASRA) Burnout (N-107) Former (N-95) Never (N-203) MBI Emotional Exhaustion MBI Depersonalization MBI Lack of personal accomplishment MBI overall Subspecialty results Ø Ø Ø Ø Ø Ø Approximately 400 responses (Fairly low response rate-32.5%) Ø 71% male, 46% in teaching hospitals, and 82% attending MBI-HSS Ø 47% at least one high risk factor, 6% at risk in all three Ø EE & DP less and LPA the same as population values (Fig 1) Ø Age was associated with DP and LPA, but not EE. No association of burnout with tobacco, alcohol, or marijuana use SSPC-14 has four areas Ø Work satisfaction, personal support, work control, professional support Ø EE associated with all areas Ø LPA not associated with personal satisfaction Ø DP was not associated with any area Ø Respondents who feel currently burned out score lower in all areas RAND-12 Ø MCS highly correlated with all aspects of MBI-HSS Ø PCS only correlates with EE and DP Little overall correlation with extracurricular activities and burnout risk Adjusted for Age, Gender (Regression Analysis) Age appears protective (the older we are, the less likely to experience burnout) ASPAN-Tobacco & alcohol appear protective (Surrogate for increased social behavior or more likely to take a break at work to smoke?) 17

18 Limitations Response rate?bias in respondents Work status not captured Advanced degrees Vacation/time off Effect of Harassment Correct instrument for testing burnout/substance use Take Away Message Those experiencing burnout are less likely to engage with coworkers (fatigue and less trustful of colleagues)& feel unappreciated/unsupported by supervisors-so colleagues need to be mindful of this when communicating Burnout has physical and mental health implications (fatigue, pain) Strenuous and moderate activities can decrease fatigue Regardless of burnout status nurses maintain empathy for patients What can we do to reduce burnout? Individual level Be mindful of how those with burnout perceive their relationship with work Institutional level Offer support, opportunities for professional growth and recognition for our colleagues 18

19 8/22/18 Final Thoughts.. while having too much to do can cause stress, it doesn't necessarily cause burnout......more often, burnout happens when people feel out of control. If employees are working in a chaotic environment where it's not clear who is in control, they can burn out......other critical factors that contribute to burnout are a lack of recognition and reward, a lack of community and support in the workplace, or an absence of fairness... The biggest contributing factor in burnout, however, is a mismatch in values. "When there are value problems or conflicts, you see greater instances of burnout"... Excerpted from A mismatch in the workplace sparks employee burnout Review of The Truth About Burnout (Christina Maslach) elizabeth.b.card@vanderbilt.edu (615) steve.hyman@vanderbilt.edu 19