From Burnout to Engagement: A Framework for Wellness in Critical Care Settings

Transcription

1 From to Engagement: A Framework for Wellness in Critical Care Settings Robert C. Johnson, Ph.D. Shoreline Partners, Inc. 10 April 2017 SHORELINE PARTNERS, INC. DELIVERING TEAM EXCELLENCE - GLOBALLY The Big Idea Work load 1

2 The Big Idea Work load Key Points A growth mindset for resiliency The field of positive psychology offers highly effective practices Resiliency is foundational to improving the health and well-being of individuals, families, and communities 2

3 The Practice of Critical Care Critical care as determinative Personality = Assertive, Competitive, Persevering, and Responsible/High Achieving Ability to make decisions in the face of uncertainty Loves for hands-on work with patients and the ability to help people immediately The Practice of Critical Care More people coming to the ER Doing more with less Meeting performance criteria vs. doing good medicine Reduced sense of control over the work environment 3

4 About Me Clinical Psychologist by Training Organizational Consultant Division Psychologist for 1 st Infantry Division, US Army Combat Stress Control Officer for 2BDE, 1ID, US Army Balad, Iraq Context for Imbalanced Job demands exceed resources Chronic Imbalances are enduring Conflict Between people, sources or authority, or values Leading to an environment characterized by continuous emotional tension and unrealistic expectations Maslach, C. and Goldberg, J. (1998) Prevention of : New Perspectives. Applied and Preventive Psychology, 7,

5 A psychological syndrome of: Exhaustion Cynicism Inefficacy.experienced in response to chronic job stressors Engagement A psychological state of: High Energy Strong Involvement A sense of Efficacy 5

6 Personal Experience A Model of Maslach, C. and Goldberg, J. (1998) Prevention of : New Perspectives. Applied and Preventive Psychology, 7, Demands Work Overload Conflicts Resources Control Support Skills Use Autonomy Involvement Exhaustion, Cynicism, Reduced Efficacy Impact Reduced Commitment, Turnover, Illness 6

7 Personal Risk Factors Recognition of Risk Professionals underestimate their vulnerability to burnout Perceiving risk for burnout is different than accepting those risks Fatigue makes for values congruent, quick decisions Beyth-Marom, R., & Fischhoff, B. (1995). Adolescents' decisions about risks: A cognitive perspective. In J. Schulenberg, J. Maggs, & K. Hurnelmans (Eds.), Health risks and developmental transactions during adolescence. Cambridge: Cambridge University Press 7

8 Cognitive Biases Under-accumulation bias The inability to understand the relationship between the risk from a single experience and the risk from multiple experiences Past experience predicts future experience Linville, P., Fischer, G., & Fischhoff, B. (1993). AIDS risk perceptions and decision biases. In J.B. Pryor & G.D. Reeder (Eds.), The social psychology of HIV infection. Hillsdale, NJ: Lawrence Erlbaum. Cognitive Biases Optimism bias Bad things are less likely to happen to us than they are to other people This is especially true for consequences of behaviors that are under our control Jacobs-Quadrel, M., Fischhoff, B.. & Davis, W. (1993). Adoles cent (in)vulnerability. American Psychologist,

9 Evaluation of Risks and Benefits Risky behaviors (e.g., working long hours week after week) are often also psychologically beneficial Seeing ourselves as someone who cares enough to go the extra mile Jacobs-Quadrel, M., Fischhoff, B.. & Davis, W. (1993). Adoles cent (in)vulnerability. American Psychologist, Situational Risk Factors 9

10 Risk Factors Workload Control Reward Community Fairness Values M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp Workload Job demands exceeding human limits Strong correlation to the exhaustion component of burnout Depleting the capacity of people to meet the demands of the job Critical point is when people can t recover from work demands M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp

11 Control Capacity to influence decisions that affect one s work Exercise of professional autonomy Gain access to necessary resources Role conflict multiple authorities with competing demands M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp Reward Rewards (monetary, social, and intrinsic) are inconsistent with expectations Lack of recognition is strongly predictive of feelings of inefficacy Being excluded from rewards of an organization heighten a personal sense of neglect and disconnection C. Cordes and Dougherty, T. W. (1993). A review and integration of research on job burnout.academy IJJ{!IJ:(/?.eyiett;,"]8, ; 11

12 Community Overall quality of social interaction at work Job settings can either isolate people from one another or make contact impersonal C. Cordes and Dougherty, T. W. (1993). A review and integration of research on job burnout.academy IJJ{!IJ:(/?.eyiett;,"]8, ; Fairness Extent to which decisions are perceived as fair and people are treated with respect Fairness of a process is more important than the favorability of the outcome Supervisors seen as fair and supportive reduce likelihood of burnout C. Cordes and Dougherty, T. W. (1993). A review and integration of research on job burnout.academy IJJ{!IJ:(/?.eyiett;,"]8, ; 12

13 Values Values are at the heart of people s relationship with their work The ideals and motives that attracted them to the work in the first place Gaps between organizational and personal values predict burnout C. Cordes and Dougherty, T. W. (1993). A review and integration of research on job burnout.academy IJJ{!IJ:(/?.eyiett;,"]8, ; Pulling it All Together 13

14 Risk Management Personal Risk Factors Risk Recognition Risk Estimation Risk Evaluation Situational Risk Factors Workload Control Reward Community Fairness Values Risk Management The Tools Maslach Inventory Areas of Worklife Survey The Process Transparency of results Quarterly meetings Develop risk-mitigation approaches based on group results 14

15 Workload Strategies for Engagement Opportunities to use and refine skills while also becoming effective in new areas A sustainable workload stops the cycle of exhaustion that is the driving force in the experience of burnout Landsbergis; P,A. '(1988). Occupational stress among health care workers: A test of the job dem. control model. Journal of Organizational Behavior, 9(3), : Control Strategies for Engagement Enhance conditions for personal experience of control Participative decision making Aligned sources of authority M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp

16 Reward Strategies for Engagement Intrinsic rewards are just as if not more important than extrinsic Day-to-day pleasure and satisfaction is what keeps people coming back M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp Community Strategies for Engagement Thriving is enhanced through community with people we like and respect This reaffirms our membership in a group with shared values Supervisor support predicts exhaustion Peer support predicts efficacy A live, attentive, responsive community is incompatible with burnout M. Leiter and C. Maslach. (2003) Areas of Worklife: A structured approach to organizational predictors of job burnout. In P. Perrewe, J. Halbesleben, and C. Rose (Eds) Emotional and Physiological Processes and Positive Intervention Strategies (Research in Occupational Stress and Well-being, Volume 3) Emerald Group Publishing Limited, pp

17 Questions 17