Compassion and Suffering In Healthcare

Compassion and Suffering In Healthcare

Compassion and Suffering In Healthcare MARK ROSENBERG, MD AND BECCA HAWKINS, ARNP DIRECTORS OF COMPASSIONATE CARE PROVIDENCE ST JOSEPH HEALTH Faculty Disclosures: No s LL ic t I ST nfl Co ST Dis ILL N clo o su re s Mark Rosenberg and Becca Hawkins have no disclosures or conflicts of interest Objectives

Review the relationship between burnout, suffering and compassion Describe how compassion in healthcare can be a source of resilience Share compassion infusions that can be implemented for individuals or teams to strengthen resilience The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet Rachel Naomi Remen Burnout in Healthcare

Emergency Nurses 80% Journal of Emergency Nursing 2010 ICU (Nurses and RT) 54 % Ind. Journal of Critical Care 2014 Ward RNs 47.3% Journal of Nursing

Management 2009 PT/OT 58% Journal of Allied Health 2002 Chiropractors 40% Williams: Doctoral [email protected] Hall 2013 Mental Health Workers 21-67%

Admin. Policy Journal of Mental Health 2012 Social Work 75% Journal of Social Service Research 2005 Chaplains 68% Pastoral Psychology 2011 Dentists

50% European Journal of Oral Science 2007 Burnout Rates In Hospice and Palliative Care Clinicians Burnout Rates Physicians 62% All Other 66% Most suffered from emotional exhaustion Factors associated with highest burnout Smaller organization

Long work hours Less than 50 years Working weekends Kamal, 2016, J Pain Symptom Management Organizational Wellbeing Suffering Burnout Compassion Resilience People Organizatio Compassion n Suffering & Burnout

Teams Leaders Compassion A deep feeling of connectedness with the suffering of others, that results in caring that aspires to bring comfort to the sufferer Dewar, 2013, J Comparative Effectiveness Research Confusing Language of s g n i l ee ith F :

hy ed w lse's t a g e p n i e t m n , y o s S s e e m n sad , for so e pity ortun

f s i m Em rec pat un ogn hy: A i fee ders ze a bilit yt lin tan nd o gs dt h of an e oth er Compassion: Deep connection with the suffering of another, that motives a desire to relieve that suffering

We Are Wired For Compassion Empathy network Insula Cingulate cortex Medial prefrontal cortex Motivation to act Medial prefrontal cortex Periaqueductal gray Caring Behavior Medial pre-optic area Oxytocin Research in Compassion Energizes Connects Contagious Can Be Developed Can Start With Self

Compassion: Not just a Religious Concept Press Ganey Schwartz Center IHI Cleveland Clinic Connecting Compassionate Care Compassionate Collaborative Care Focused on safety Encourage joy, meaning & respect Empathy and Patient Experience Compassion-Suffering Paradigm Suffering Less

Resilience Less Compassion Avoidance Behaviors Less Renewal Caregiver Burnout Impacts on the Quadruple Aim Decreased Quality of Care Loss of Meaning & Purpose in Work Caregiver Impacts

Increase in Errors Burnout Caregiver Depression, Addiction & Suicide Career Dissatisfaction & Attrition Increased Attrition & Cost of Recruitment Quality & Cost Impacts Quality Rated Lower by Patients

Decreased Patient Satisfaction Decreased likelihood to recommend Patient Impacts Providence Caregiver Burnout Rate 2016 = 54,700 Responses Execu... 32 Superv... 43 Clerical/A... 45

Ove 48 Clinical ... 50 RN 52 EVS 0 20 54 10 20 30

40 50 60 Employee Engagement Survey Oct, 2016 & 2017 Providence Caregiver Burnout Rate 2016 = 54,700 Responses 2017 = 80,000 Responses Execu... 32 Superv... 43 Clerical/A... 45

Ove 48 Clinical ... 50 RN 52 21 EVS 0 54 10 20 30

40 50 60 70 Employee Engagement Survey Oct, 2016 & 2017 Impact of Burnout Highly Sustainably Engaged Intending to Stay Have a positive Safety Domain Score 92% 84% 84% 75%

69% 66% 57% 43% 20% Low Moderate High Burnout Burnout Burnout Low Moderate High Burnout Burnout Burnout Low Moderate High Burnout Burnout Burnout PSJH Caregiver Survey Oct 2017 Self Assessment & Seeking of Help 1:16

Surgeons bothered by suicidal thoughts in last 12 months Standardized Physician Well Being Index 100 90 Of physicians scoring in bottom 30%... 80 70 60 50 40 Only 26% sought help

30 20 10 0 Archives Surgery 2011 } 70.5% believed their well-being was average or above Shanafelt et al. Ann Surg 2014 Burnout & Resilience Community Workload Cynicism Values

Congruence Rewards Exhaustio n Control Lack of Accomplishment Fairness Levers of Burnout Gregory et al J Healthcare Management March 2015 Emotional Exhaustion Community & Fairness Values Cynicism

Work Load & Control Community & Fairness Workload & Control Values Compassion in Healthcare: It Really Matters Intending to Stay Feel Safe if I were a Patient 91% 86% 67% 44% Able to Give Compassion

Highly Sustainably Engaged Not Able to Give Compassion 59% Less Than 3% Supervisor Promotes Compassion Supervisor Does Not Promote Compassion 3% Organization Organization Supports Does Not

Compassion Support Compassion PSJH Caregiver Survey Oct 2017 Compassion and Patients Rating of Quality 100 % 90 R A T I N G 80 Q U

A L I T Y (9/10) 50 92.3 89.3 93.5 94 70 60 40 30 20 10 0

Compassion =5 Compassion and Patients Rating of Quality 100 % 92.3 90 R A T I N G 80 Q U A

L I T Y (9/10) 50 89.3 93.5 70 60 48.2 20 10 0 56 Compassion =5

Compassion <5 40 30 53.2 94 19.2 What To Do? Compassion Infusions Affinity Groups Compassion Curriculum Compassion

Cornerstones Compassionate Connecting Leadership Conversations Compassion Affinity Groups What are Compassion Affinity Groups? A multi-disciplinary group that forms to create compassion infusions for the area that they serve (hospital, clinic, ED, etc) Role is to brainstorm ideas, implement, and sustain compassion infusions Creating a Compassion Affinity Group

Funding: $5,000 Innovation Grant Identified leadership support (COO) Solicited Project Manager Affinity Group Participants Employees of the Month Multidisciplinary composition Meet once monthly with provided lunch Compassion Affinity Groups

Compassion Bouquets Compassion Carts on nights and weekends Compassion Card to all Surgical Patients Festival of Trees Compassion Basket Affinity Group: Key Learnings Energizing and growth inducing for participants Create

first small successful projects at Crucial to have facilitator and project manager functions covered Incorporate professional development for participants An Infusion For Clinic Based Teams Strengthening Compassion in Outpatient Practice Providence Medical Group Study:

Brief Overview Randomized, controlled non-blinded study; all clinic staff participated Multi-faceted curriculum to encourage personal and team well being Evaluation Process: Evaluation Timing Session Feedback Ending of each session Curriculum Impact End of Curriculum Attitudinal Impact Baseline, 6 & 12 months Quality/Business Outcome

Baseline, 6 & 12 months Individual Session Structure Session Focus 1 Beginning the Adventure 2 Strengthening Compassion in PMG 3 Self-Compassion 4 Reflection Rounds: The Difficult Patient 5

Bringing Compassion to Our Patients 6 Reflecting on Our Patients 7 Building Teams Together 8 Reflection Rounds: Challenges of Teams 9 Holding Hope and Fear 10 Bringing your Best Self Forward 11

Reflection Rounds: Joy in the Clinic 12 Bringing it all Together 12 sessions offered Each 80 minutes in length All sessions include Mindfulness Sessions facilitated by clinic staff Facilitators trained and supported by program, networking calls and materials Reduced Burnout 56 MBI Subscales: 55

Reduced Total Burnout p=.02* Reduced Emotional Exhaustion =.03* Reduced Depersonalization p=.05* Improved Accomplishment p=.2 54 52 50 48 46 46 44 42 40 P<0.0 5 Control Intervention Improved Engagement Highly Sustainably Engaged

60 52 50 50 50 41 40 Disengaged 14 12 12 13 P=0.0 2 10 8 8

8 30 6 20 4 10 2 0 2015 2016 Treatment Control 0 2015 2016 Treatment

Control Stabilized Intent to Stay 94 92 90 88 86 84 82 80 78 76 74 92 P<0.05 84 82 2015

Treatment 81 2016 Control Better Patient Experience* P=0.06 4 3 2 P=0.1 3.1 4 1.3 1 P=0.06 3.4 0.8

0 Control * 2.4 0.1 Intervention Top Box Score: 6 months prior vs 6 months post Increased Productivity 1000 Average Visits/Month* 500 P<0.0001 0 Baseline

During Trial -500 -1000 -1500 Control Intervention Post Compassion Curriculum: Key Learnings Support from executive leadership is critical Insure the intervention is a gift, not an add on

Facilitator choice and training is critical Evaluation is time consuming AND imperative 60 minutes is enough Mindfulness requires practice at home Compassion Cornerstones Finding Meaning SelfCompassion am Te

Connection s di In vi a du Wellbeing l Mindful Pause Gratitude Hawkins & Rosenberg, 2017 Compassion Cornerstones In Practice

SelfCompassion Mindful Pause Gratitude Finding Meaning Cornerstones for Leaders Help leaders find strength and resilience Develop authenticity, as a person and leader Practices that can be applied to personal and professional life

Create messages and practices to bring to your team Real Time: Mindful Pause When What Why Washing Hands 3 deep breaths Letting go of what came before Logging into Computer Notice rhythm of typing the log-in and password

Strengthening calm before EPIC Leaving for the Day Standing in doorway Express gratitude for three things that went well today Real Time: Gratitude When What Why Starting Your Day

Write 3 things you are grateful for Trigger the brain to look for positive Safety Huddles Express gratitude for work that has gone well Remind ourselves all of the goodness we do daily Team Meetings Create space for people to express gratitude for each other Improve team

unity and appreciation Real Time: Finding Meaning When What Why In Conversation Remember something that is important to the other person Noticing the outward connections that create meaning In Work & Play

Before an activity, reflect on why you are spending time doing it Connecting inwardly to our purpose and heart Every Day Search out a moment of awe each day Recognize, with humility, our place in the universe Real Time: Self-Compassion When What

Why You gained weight Stop the negative talk in your head Actively comfort yourself To practice Self Kindness, and stop the self critic Made a mistake Remind yourself that you are human Practice in recognizing your humanity Recognize our humanity, which means we are

imperfect Notice your feelings Had an of anger argument with a Feel your anger as loved one an emotion and not who you are Practice mindfulness so that you dont react Cornerstones for Self and Team Increased Team Cohesiveness Improved Individual Coping and Resilience Life Practices for Work and Home Facilitating Authentic

Connection Connecting Conversations Forum for authentic sharing Done in every setting No fixing, just listening Connection is key Connecting Conversations: Evaluation Results Find A Place of Rest In The Middle of Things Frank Ostaseski To Contact Us: [email protected] Compassion Team: Becca Hawkins, MSN, ARNP Director, Compassionate Care

[email protected] Laura Chun, MPM, PMP Manager, Compassionate Care [email protected] Mark Rosenberg, MD, FACP Director, Compassionate Care [email protected] Krista Nelson, MSW, LCSW, OSW-C Connecting Conversations Program [email protected]

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