Debra A. Gould MD, MPHMichael J. Aquilino MS, LMHC

Patricia Robinson PhD

Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.

Session # A3 in Period 3Friday, October 16, 2015

Transforming Burnout Using ACT

Faculty Disclosure

The presenters of this session currently have the following relevant financial relationships during the past 12 months:

New Harbinger Publishing Inc.Authors: Debra A. Gould MD, MPH

Patricia J. Robinson PhDSpringer Publishing Inc.Authors: Patricia J. Robinson PhDGuilford Publishing Inc.Authors: Patricia J. Robinson PhDMountainview Consulting Inc. - Patricia J. Robinson PhD

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Understand current research on burnout and impact on healthcare workforce.

• Define mindfulness and the ACT specific

psychological processes associated with mindfulness.

• Learn how to use specific ACT-based exercises and tools focused on the processes of acceptance, present moment awareness, defusion and perspective-taking.

Learning Assessment

1. What is the potential impact of burnout on the primary care workforce?

2. Name 2 of 4 specific ACT processes that cultivate mindfulness?

3. Name 1 ACT-Based Mindfulness exercise you will use at your practice/teaching site for cultivating Resiliency?

Quadruple Aim

From triple to quadruple aim: care of the patient requires care of the provider. Bodenheimer T, Sinsky C. Ann Fam Med. 2014 Nov-Dec;12(6):573-6. doi: 10.1370/afm.1713. PMID: 25384822

“Improving the Work Life of Clinicians and Staff”

BurnoutAdverse workflow Low MD

satisfactionLow control High

Stress/BurnoutUnfavorable culture Intent to leave

(Linzer et.al, Working Conditions in Primary Care: Physician Reactions and Care Quality. Ann Inter Med 2009;151:28-36.) 6

Conditions Costs

$236,383

Psychological Toolbox

Be Present

Defuse

Acceptance

Observer Self

ACT ACT

Values

Act

ion

Psychologicalflexibility

Acceptance and Commitment Training (ACT)

Be Present

Connect with Values

Accept

Defuse

Observer Self

Act on Values

Mindfulness Values

Evidence

The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout. Lloyd J, Bond FW, Flaxman PE. Work & Stress, 2013, 27(2):181-199, http://dx.doi.org/10.1080/02678373.2013.782157

Population: Employees UK govn’t Department

Intervention: 3 ½ day sessions of ACT to increase psychological flexibility.

Comparison: Wait list

Outcomes: ACT arm - Emotional Exhaustion

Depersonalization

Neuroscience of Mindfulness

Resonance Circuits

Executive Function

Plasticity

The Mindful Brain, Reflection and Attunement in the Cultivation of Well-BeingSiegal, D. W W Norton & Company, New York, 2007.

MindfulnessObserving one’s private experience:• Present moment awareness• Accepting of unwanted thoughts and

feelings• Openness toward self

Goal: Self-RegulateRespond not ReactAct according to your Values

TEAMS Skill Training: Think about a difficult situation with a your clinic administration or a

patientTEAMS Element What comes up?

Thoughts

Emotions

Associations

Memories

Sensations

(Exercise)

Case - Difficult Situation – New EMR

You are a clinician and you have been working at a federallyqualified health center for the past 10 years. Your organization has used a locally produced electronic medical record (EMR) for the past 5 years; it is relatively user friendly and you use it well.Some of the functions actually work pretty well - sending prescriptions (safer patient care), inserting your dictations (patient’s narrative), and it has a sort function that you can use to find key information (efficient).However, it cannot produce reports for meaningful use measures.

Your clinic administration makes a decision to implement a new EMR. The new EMR requires you to click boxes for data entry. It does not have a sort function for quick retrieval of information. It has no dictation component so you now have to type your notes.

Bottom line: You’re spending up to 2 hours after clinic getting your notes done.

TEAMS Skill Training: Think about a difficult situation with your clinic administration or a

patientTEAMS Element What comes up?

Thoughts

Emotions

Associations

Memories

Sensations

De-brief – Observer Self, Defuse, Be Present, Acceptance

Mindfulness

Thought

Reminds me of….

I’m going to fail……

Anxious

Anger

De-brief – Defusion, Observer Self, Acceptance

Observer Self

Racing heart beat!

Feeling

(Exercise)

• Breath deeply and slow down• Observe your TEAMS• Listen to your values• Decide on action & do it

Mindful WarriorStruggling

(Tool)

(get out of your mind & into your life for teens, Ciarrochi JV, Hayes L, Bailey A. New Harbinger Publications, 2012.)

SummaryPsychological Flexibility builds

Resilience…

Acceptance and Commitment Training

Accept

DefusePresent

Observer Self

ValuesAction

1. From triple to quadruple aim: care of the patient requires care of the provider. Bodenheimer T, Sinsky C. Ann Fam Med. 2014 Nov-Dec;12(6):573-6. doi: 10.1370/afm.1713. PMID: 25384822

2. Estimates of costs of primary care physician turnover. Buchbinder SB, Wilson M, Melick CF, Powe NR. Am J Manag Care. 1999 Nov;5(11):1431-8. PMID:10662416

3. Effectiveness of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. Asuero AM, Queraltó JM, Pujol-Ribera E, Berenguera A, Rodriguez-Blanco T, Epstein RM. J Contin Educ Health Prof. 2014 Winter;34(1):4-12. doi: 10.1002/chp.21211. PMID: 24648359

4. The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout. Lloyd J, Bond FW, Flaxman PE. Work & Stress, 2013, 27(2):181-199, http://dx.doi.org/10.1080/02678373.2013.782157

5. To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice. Lamothe M, Boujut E, Zenasni F, Sultan S. BMC Fam Pract. 2014 Jan 23;15:15. doi: 10.1186/1471-2296-15-15. PMID:24456299

References

Learning Assessment

1. What is the potential impact of burnout on the primary care workforce?

2. Name 2 of 4 specific ACT processes that cultivate mindfulness?

3. Name 1 ACT-Based Mindfulness exercise you will use at your practice/teaching site for cultivating Resiliency?

Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!