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Essentials for Enhancing
Professional Resiliency
Speaker: J. Bryan Sexton, Ph.D.
Thursday, March 5
9 a.m. – 3:40 p.m.
Sponsored by:
J. Bryan Sexton, Ph.D. Associate Professor Director of Patient Safety Research and Training Duke University Health System J. Bryan Sexton, Ph.D., is a psychologist member of the Department of Psychiatry at Duke University Hospital, and he is the Director of the Patient Safety Center for the Duke University Health System. He has captured the wisdom of frontline caregivers through rigorous assessments of safety culture and teamwork. His research instruments have been used around the world in over 3000 hospitals, in 30 countries. He has studied teamwork and safety practices in high risk environments such as the commercial aviation cockpit, the operating
room, and the intensive care unit, under funding from NASA, AHRQ, Robert Wood Johnson Foundation, Swiss National Science Foundation, and the Gottlieb Daimler and Karl Benz Foundation. With specializations in organizational assessment, teamwork, survey development, and quantitative methods, he spends his time teaching, mentoring, conducting research, and finding practical ways of getting busy caregivers to do the right thing, by making it the easy thing to do. He has found that the teamwork and safety culture results across industries, work settings, shifts, professions, and countries highlight a great deal about reliability in high risk environments – specifically, “you are better off changing the situation, than trying to change human nature.”
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While you are waiting for us to start, perhaps you could send a quick text to someone important to you, to send a kind thought their way.
Thriving vs. Surviving during times of change: Science of Enhancing Resilience
J. Bryan Sexton, PhDDirector, Duke Patient Safety Center
www.dukepatientsafetycenter.com
Ask the kids…
• National Study of the Changing Workforce– children (age 8-18) of working
parents • 65% worried about parents• Wish parents were less stressed and
less tired
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In the past week, how many of you…
• Skipped a meal?
• Ate a poorly balanced meal?
• Worked an entire shift without any breaks?
• Changed personal/family plans because of work?
• Arrived home late from work?
• Drank too much coffee?
• Slept less than 5 hours in a night? – Over 40% of Americans regularly sleep less than 5 hours
a night• 2X as likely to die of heart disease
• 1.7x as likely to die of all causes (Cappoccino, 2007)
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Each bar = 1 DUHS Clinical Area
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Sleepy at Work:“Slept less than 5 hours in a night:3 or more nights in the past week.”
Each bar = 1 DUHS Clinical Area (n=258)
TeamworkClimate = 66.7
TeamworkClimate = 61.2
TeamworkClimate = 65.2
TeamworkClimate = 76.3
SafetyClimate = 70.6
SafetyClimate = 60.8
SafetyClimate = 67.3
SafetyClimate = 77.8
% Resilient= 45.8
% Resilient= 32.9
% Resilient= 36.3
% Resilient= 51.6
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Redefining Quality
• How we take care of our patients
• How we take care of each other
• How we take care of ourselves*
*Leaders have a responsibility to protect the work-life balance of their employees.
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Resilience is a function of your ability to cope, and the availability of resources related to health and well-being.
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After controlling for pt severity and nurse and hospital characteristics, only nurse burnout was associated with the clinical outcomes
Example of impact on critical care nurses
• half are emotionally exhausted (burned out)
• 2 out of 3 have difficulty sleeping
• 1out of 4 are clinically depressed
Sexton, et al. (2009). Palliative Care.
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What is burnout?Do you experience feelings of:
Emotional exhaustion?
Tiredness?
loss of sense of humor?
Irritability at work?
Progressively cynical attitude toward others?
Inability to concentrate or listen to others
Tendency to dehumanize others?
Suspicion and mistrust of others?
Am I burned out?• You try to be everything to everyone
• You get to the end of a hard day at work, and feel like you have not made a meaningful difference
• You feel like the work you are doing is not recognized
• You identify so strongly with work that you lack a reasonable balance between work and your personal life
• Your job varies between monotony and chaos
• You feel you have little or no control over your work
• You work in healthcare
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Burnout ≠ Lazy
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Are they burned out?
A brief tour of prevalence…
Burnout is common among physicians in the United States, with an estimated 30% to 40% experiencing burnout.
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Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001)
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a person’s future level of cognitive vulnerability was significantly affected by his or her roommate’s baseline
level of cognitive vulnerability (and vice versa)
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The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses.Depress Anxiety. 2009;26(12):1118‐26.Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M.Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado 80045, USA. [email protected]
18% (61/332) met diagnostic criteria for PTSD86% (277/323) met criteria for BOS
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Burnout and Suicidal Ideation among U.S. Medical Students
Dyrbye et al., 2010
50% of medical students burned out
10% have suicidal ideation
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Although the groups (surgeons & internal medicine physicians) in these 2
studies were disparate, the same 3 factors (hours worked per week, work/home conflict in the last 3 weeks, and resolving the last work/home conflict in favor of work) remained independent factors associated with burnout in multivariable models in both samples with strikingly similar odds ratios.5 These findings suggest that work/home conflict and how that conflict is managed may be central factors for physician burnout in a variety of practice settings.
In conclusion, burnout is highly prevalent among US Physicians (32%), more so than among other US workers(23.5%).
…(3) physicians wcork longer hours and have greater struggles with work‐life integration than other US workers, and (4) after adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine, whereas a degree in medicine (MD or DO) increases the risk.
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Lies.ALL LIES.
From First to Worst
Those with tenacity, dedication and a strong sense of responsibility are vulnerable to burnout
Burnout Lead Weights: work hours, night shift, conflicts with colleagues, fiscal debt, poor boundaries between work/home life
Burnout Band-aides: spending time with spouse, social support, positive learning environment, having a clinician as a parent, being a parent, and getting satisfaction from conversations with others, control over days off, quality of working relationships
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Random acts of Kindness:
Doing a kindness produces the single most reliable momentary increase in well‐being of any exercise that has been tested
Find one wholly unexpected kind thing to do tomorrow and just do it. Notice what happens to your mood.
‐‐Marty Seligmann, 2011Page 38
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Recipe for Longevity: No Smoking, Lots of Friends
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v
more‐frequent tension was associated with greater risk of infection when hugs were received infrequently but not when received frequently
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Page 43FriendBest Friend
4 a.m. Friend:
Is there someone in your life whom you would feel comfortable phoning at four in the morning to tell your troubles to?• If so, you are likely to live longer than those who say
“no.” Discovered by George Vaillant (Harvard psychiatrist) and called the capacity to be loved.
• Conversely, loneliness is such a disabling condition that it suggests the pursuit of relationships is a fundamental to well-being.
Page 44-- Marti Seligmann, 2011
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Attachment
An abundance of research shows that the perception that one has supportive others to turn to in times of stress (i.e., perceived support) buffers against the harmful effects of stress (e.g., Cohen, 1992; Collins & Feeney, 2000; Sarason, Sarason, & Gurung, 1997).
But if things go right, and you are there for me, does that have an
independent impact on relationship functioning?
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Active Constructive Listening
…79 dating couples…Both self-report data and observational codes showed that 2 months later, responses to positive event discussions were more closely related to relationship well-being and break-up than were responses to negative event discussions. The results are discussed in terms of the recurrent, but often overlooked, role that positive emotional exchanges play in building relationship resources.
Toxicity of Insincerity
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Buddy Upoptimizing oxytocin and serotonin ‐ which boost mood and promote bonding ‐ hold a handshake for at least six seconds.
Active Destructive Responding
Finding the bad in the good: where you find the cloud in the silver lining
Passive Destructive Responding
Not caring at all about their news
Passive Constructive Responding
Not making a big deal out of it
Active Constructive Responding
Reacting positively, being interested and caring about their news.
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Active Constructive Responding
05:0004:0003:0002:0001:0000:3000:00
Maintain eye contact / smile / touch / laugh• Don’t overdo the praise and positive feedback (it can
make people feel uncomfortable/patronized)
• Concentrate on asking questions which encourage the person to talk about their good news/ savor their positive emotions.
• If this type of active and constructive response does not come easily to you try to ask at least three questions.
Three Good Things
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led to increases in positive affect, as well as reductions in negative affect, mediational analyses showed that gratitude was uniquely responsible for the effect of the intervention on positive affect. In addition, the gratitude intervention improved people’s amount of sleep and the quality of that sleep. Furthermore, the effects on well‐being were apparent to the participants’ spouse or significant other.
Three Good Things
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Three good thingsSeligman, Steen, Park & Petersen, 2005
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Three good thingsSeligman, Steen, Park & Petersen, 2005
“The negative screams at you, but the positive only whispers…”
‐‐ Barbara Fredrickson
#1) We are hard‐wired to remember the negative.
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#1) We are hard‐wired to remember the negative.
#2) Enhanced recall of material reviewed during last 2 wakeful hours.
#3) With practice (by day 4 or 5)reflecting on the positive leads
to noticing more positive.
www.dukepatientsafetycenter.com
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• Thanks to the efforts of Drs. Jon Bae and Amy Zaas, as well as our Medical Student researcher Whitney Chadwick.
• Main Findings:
– Lower burnout, lower depression in the post
– Fewer delays
– Less conflict
– Better work‐life balance
• Residents enjoyed participating in the research
Duke Internal Medicine Resident Results
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Three Good Things (free)www.dukepatientsafetycenter.com
Duke Resilience Retreat(1 day or 3 day)
www.dukepatientsafetycenter.com
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www.dukepatientsafetycenter.com
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link
www.dukepatientsafetycenter.com
www.sotile.com
Specific Tools – so far…•Three Good Things•Active Constructive Responding•Deliberate Acts of Kindness•Cultivate Confidants•WISER•3 day Resilience Retreat in May & Nov •1 day Resilience Essentials January/April/Septwww.dukepatientsafetycenter.com
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The Story of the Two Monks
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grat∙i∙tude
ˈgratəˌt(y)o ͞od/
noun
noun: gratitude
the quality of being thankful; readiness to show appreciation for and to return kindness.
Gratitude definition:
Page 89
Robert A. Emmons, Ph. D., is Professor of Psychology at UC Davis.
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led to increases in positive affect, as well as reductions in negative affect, mediational analyses showed that gratitude was uniquely responsible for the effect of the intervention on positive affect. In addition, the gratitude intervention improved people’s amount of sleep and the quality of that sleep. Furthermore, the effects on well‐being were apparent to the participants’ spouse or significant other.
The Gratitude Letter
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The Gratitude LetterSeligman, Steen, Park & Petersen, 2005
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How to be grateful?
Paying attention is a form of love
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At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.
Albert Schweitzer(1875‐1965; Physician, Philosopher, Theologian and Nobel Peace Prize Winner)
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Gratitude
Think of someone who has done something amazing for you, this person can be alive or no longer with us. This person contributed to your well‐being in a big way. Spend the next few minutes writing a brief note, telling this person what they did, how it impacted you, and the benefits you have received.
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A hundred times a day I remind myself that my inner and outer life depends on the labors of others, living and dead, and that I must exert myself in order to give in the measure as I have received and am still receiving.
‐‐Albert Einstein
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Further Reading…
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DUHS Response Rates
• 352 Work Settings
• 72% Response rate: 9164/12716 respondents
SAQ Climate Scores by Work Culture Tier Level
The Just Climate and Safety Climate scores are the 2 biggest factors impacting the Power Item Score (Tier Score).Tier 1 units score 66% higher than Tier 3 units in Just Climate,
and 45% higher in Safety Climate.
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My Burnout vs. Burnout Climate
Please answer the following items with respect to yourself and then with respect to your specific unit or clinical area. Choose your responses using the scale below:
A B C D E X Disagree Strongly
Disagree Slightly
Neutral Agree Slightly
Agree Strongly
Not Applicable
My Burnout
Events in this work setting affect my life in an emotionally unhealthy way. A B C D E X
I feel burned out from my work. A B C D E X
I feel fatigued when I get up in the morning and have to face another day on the job. A B C D E X
I feel frustrated by my job. A B C D E X
I feel I am working too hard on my job. A B C D E X
Burnout Climate
Events in this work setting affect the lives of people here in an emotionally unhealthy way. A B C D E X
People in this work setting are burned out from their work. A B C D E X
People in this work setting are exhausted from their work. A B C D E X
People in this work setting are frustrated by their jobs. A B C D E X
People in this work setting are working too hard on their jobs. A B C D E X
How are things going so far? Any comments?
Think of a time when you felt a sense of awe. From beautiful scenes in nature to
witnessing an amazing accomplishment of another person to encountering
something vast in size, number, power, or complexity, many things can make you
feel awe. For the next 7 minutes, write about your awe experience as if you were
explaining it to a friend (on the back of this sheet).
Copyright © 2001, Sexton & Sexton
You at Your Best
Think of the most wonderful experience or experiences in your life, happiest moments, ecstatic moments, moments
of rapture, perhaps from being in love, or from listening to music, or suddenly “being hit” by a book or painting or
from some great creative moment. Choose one such experience or moment. Try to imagine yourself at that moment,
including all the feelings and emotions associated with the experience. Now write about the experience in as much
detail as possible trying to include the feelings, thoughts, and emotions that were present at the time.
Please try your best to re-experience the emotions involved.
Signature Strengths, Self-Rating Scale Everyone has a characteristic set of strengths and virtues, that is, things that they are “good” or “strong” on. Research in Positive Psychology suggests that there are (at least) 24 strengths and virtues that are recognized in most cultures. Please read the descriptions of the 24 strengths and virtues below. As you read them, write a “+” in the margin next to the ones that you think describe you well. Write a “-“ in the margin next to the ones that you think do not describe you well. Leave the rest unmarked. Then look through the ones with a “+” next to them and try to rank order your top 5. That is, place a “1" in the left-hand column for the one that you think best describes you, then a “2" in the next best one, etc. Finally, look through the ones with a “-“ in the margin and try to rank the five that are LEAST true or applicable to you. That is, put a “24" next to the one that is least like you, then a “23", etc., out to 20. These might be considered your “weaknesses.” But bear in mind that everyone has strengths AND weaknesses, and being honest about both will help you plan out a life that takes maximum advantages of your strengths.
Strength Description
1.Curiosity Rank_______
You are curious about the world and you strongly desire experience of it. You are flexible about matters that don’t fit your preconceptions. Curious people do not simply tolerate ambiguity but they like it and are intrigued by it. You seek out novelty, and you are rarely bored.
2.Love of learning Rank_______
You love learning new things, whether you are in a class or on your own. You always loved school, reading, museums - anywhere and everywhere there is an opportunity to learn. There are domains of knowledge in which you are the expert, and others value your expertise. You love learning about these domains, even in the absence of any external incentives to do so.
3.Judgment Rank_______
You think things through and examine them from all sides. You do not jump to conclusions, and you rely only on solid evidence to make your decisions. You are able to change your mind. You are very good at sifting information objectively and rationally, in the service of the good for yourself and others. You do NOT just think in ways that favor and confirm what you already believe.
4.Ingenuity Rank_______
When you are faced with something you want, you are outstanding at finding novel yet appropriate behavior to reach that goal. You are rarely content with doing something the conventional way. This strength is also called "practical intelligence" or more bluntly common sense or street smarts.
5.Emotional intelligence Rank_______
You are aware of the motives and feelings of others, and of yourself, and you can respond skillfully. You notice differences among others, especially with respect to their moods, temperaments, motivations, and intentions, and then you act upon these distinctions. You also have finely tuned access to your own feelings and the ability to use that knowledge to understand and guide your behavior.
6.Perspective Rank_______
You have a way of looking at the world that makes sense to others and yourself. Others seek you out to draw on your experience, and you are often able to help them solve problems and gain perspective. You have a good sense of what is really important in life.
7.Valor Rank_______
You do not shrink from threat, challenge, pain, or difficulty. Valor is more than bravery during physical threat. It refers as well to intellectual or emotional stances that are unpopular, difficult, or dangerous. The brave person is able to uncouple the emotional and behavioral components of fear, resisting the urge to flee and facing the fearful situation. Fearlessness, boldness, and rashness are not valor; it is facing danger, despite fear, that marks valor.
8.Perseverance Rank_______
You finish what you start. You take on difficult projects and finish them, usually with good cheer and minimal complaint. You do what you say will do and sometimes more, never less. Perseverance does not mean dogged or obsessive pursuit of unattainable goals. Rather you remain flexible, realistic, and not perfectionistic.
9.Integrity Rank_______
You are an honest person, not only always speaking the truth but also living your life in a genuine and authentic way. You are down to earth and without pretense. You representing your intentions and commitments to others and to yourself in sincere fashion, whether by word or deed.
10.Kindness Rank_______
You are kind and generous to others, and you are never too busy to do a favor. You enjoy doing good deeds for others, even if you do not know them well. Your actions are very often guided by other people’s best interests, even when these override your own immediate wishes and needs.
11.Loving Rank_______
You value close and intimate relations with others. You have deep and sustained feelings for others, who feel the same way about you. This strength is more than the Western notion of romance; it is about very deep ties to several or many people.
12.Citizenship Rank_______
You excel as a member of a group. You are a loyal and dedicated teammate, You always do your share, and you work hard for the success of the group. You value the group goals and purposes even when they differ from your own. You respect those who are rightfully in positions of authority, like teachers or coaches, and you identify with the group.
13.Fairness Rank_______
You do not let your personal feelings bias your decisions about other people. You give everyone a chance. You guided in your day-to-day actions by larger principles of morality. You take the welfare of others, even those you do not know personally, as seriously as your own, and you can easily set aside personal prejudices.
14.Leadership Rank_______
You do a good job organizing activities and seeing to it that they happen. You are a humane and effective leader, attending to getting the group's work at the same time as maintaining good relations among group members. You are additionally humane when you handle intergroup relations "with malice toward none and charity toward all."
15.Self- control
Rank_______
You can easily hold your desires, needs, and impulses in check when it is appropriate. It is not enough to know what is correct; you must also be able to put this knowledge into action. When something bad happens, you can regulate your own emotions. You can repair and neutralize your negative feelings, and generate positive emotions on your own.
16.Prudence Rank_______
You are a careful person. You do not say or do things you might later regret. You wait until all the votes are in before embarking on a course of action. You are far-sighted and deliberative. You are good at resisting impulses about short term goals for the sake of longer term success.
17.Humility
Rank_______
You do not seek the spotlight, preferring to let your accomplishments speak for themselves. You do not regard yourself as special, and others recognize and value your modesty. You are unpretentious. You see your own aspirations, victories and defeats as pretty unimportant in the larger scheme of things.
18.Appreciation Rank_______
You stop and smell the roses. You appreciate beauty, excellence, and skill in all domains: nature, the arts, science, and the wide range of abilities that other people possess. You often see or hear things cause you to feel profound feelings of awe and wonder.
19.Gratitude Rank_______
You are aware of the good things that happen to you, and you never take them for granted. You always take the time to express your thanks. Gratitude is an appreciation of someone else's excellence in moral character. We are grateful when people do well by us, but we can also be more generally grateful for good acts and good people. Gratitude can also be directed toward impersonal and nonhuman sources--God, nature, life – but it cannot be directed toward the self.
20.Hope Rank_______
You expect the best in the future, and you plan and work in order to achieve it. Hope, optimism, and future-mindedness are a family of strengths that represent a positive stance toward the future. Expecting that good events will occur, feeling that these will ensue if you try hard, and planning for the future sustain good cheer in the here-and-now and galvanize a goal-directed life.
21.Spirituality Rank_______
You have strong and coherent beliefs about the higher purpose and meaning of the universe. You know where you fit in the larger scheme. Your beliefs shape your actions and are a source of comfort to you. You have an articulated philosophy of life, religious or secular, that locates your being in the larger universe. Life has meaning for you by virtue of attachment to something larger than yourself.
22.Forgive-ness Rank_______
You forgive those who have done you wrong. You always give people a second chance. Your guiding principle is mercy and not revenge. Forgiveness represents a set of prosocial changes that occur within an individual who has been offended or hurt by someone else. When people forgive, their motivations and actions regarding the transgressor become more positive (e.g., benevolent, kind, generous) and less negative (e.g., vengeful, avoidant).
23.Humor
Rank_______
You like to laugh and bring smiles to other people. You can easily see the light side of life. You are playful and funny.
24.Zest Rank_______
You are a spirited person. You throw yourself body and soul into the activities you undertake. You wake up in the morning looking forward to the day. The passion that you bring to activities is infectious.
(Adapted by Jonathan Haidt, from M.E.P. Seligman, 2002: Authentic Happiness)
