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H I L A R Y M C C L A F F E R T Y , M D , F A A PA M E R I C A N A C A D E M Y O F P E D I A T R I C S
2 0 1 7 P E D I A T R I C S I N T H E 2 1 S T C E N T U R Y
C H I C A G O , I L L I N O I S
S E P T E M B E R 1 5 , 2 0 1 7
The Culture of Health Care: Are We Making Ourselves Unwell?
McClafferty 2017
Faculty Non-Disclosure Information
In the past 12 months, I have had no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of
commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial
product/device in the presentation.
McClafferty 2017
Goals
1. Convey my sense of urgency.
2. Acknowledge complexity, and the short and long term impact of the culture we create.
3. Emphasize our connections, common mission.
4. Highlight opportunities to lead change.
5. Provide tools & resources for your immediate use.
McClafferty 2017
2017: Where is the Burnout Research Leading?
• The toll is significant. • At least 50% of physicians experience professional
burnout.• Between 2011 and 2014 burnout increased in all
medical specialties in the US.• Systems level, sustainable approaches are needed.
Mayo Clin Proc. Jan 2017;92(1):129-146. Shanafelt, NoseworthyMcClafferty 2017
Burnout Myths
� Too expensive to fix.
� Addressing burnout interferes with our organizational goals.
� Focusing on the individual physician is adequate to prevent or remedy burnout.
Mayo Clin Proc. Jan 2017;92(1):129-146. Shanafelt, NoseworthyMcClafferty 2017
Burnout Facts
� Acknowledgement is key.
� The stigma must lift before progress can be made.
� Candid, repeated dialogue with administration develops trust.
� Standardized benchmarks must be developed and measured.
Mayo Clin Proc. Jan 2017;92(1):129-146. Shanafelt, NoseworthyMcClafferty 2017
Are We Making Ourselves Unwell?
McClafferty 2017
Wellness, the Opposite of…
Burnout: the feeling of being overextended and depleted of one’s emotional and physical resources.
Early predictors of job burnout and engagement. Maslach C, Leiter MP. J Appl Psychol. 2008 May;93(3):498-512.
� Emotional Exhaustion� Depersonalization� Loss of a Feeling of Personal Accomplishment
McClafferty 2017
Yerkes-Dodson Curve (1908)
McClafferty 2017 Yerkes RM, Dodson JD (1908) The relation of strength of stimulus to rapidity of habit formation. J C0mparative Neurology and Psychology 18:459-482
Positive Trait In Exaggerated Form
Altruism Loss of sense of self, martyr
Compassion Compassion fatigue, loss of empathy, depression
Perfectionism Compulsiveness, self doubt, imposter syndrome
Competitiveness Isolation, alienation of peers
Resiliency Sense of invincibility, unsustainable pace, exhaustion
High Achievers Workaholic, burnout
Positive Traits or Risk Factors?
McClafferty 2017
Taking Stock: a Snapshot
Wheel of Life Exercise
McClafferty 2017
Wheel of Life
Co-Active Coaching (2nd ed.) © 2007 by Laura Whitworth, Karen Kimsey-House, Henry Kimsey-House, and Phillips Sandahl.McClafferty 2017
Wheel of Life Exercise
Co-Active Coaching (2nd ed.) © 2007 by Laura Whitworth, Karen Kimsey-House, Henry Kimsey-House, and Phillips Sandahl.McClafferty 2017
Where Are You?
• Take a moment for self-reflection.
• Ask yourself, what is going well?
• Where can you identify a strength?
• How do you cultivate this strength?McClafferty 2017
Wheel of Life
Co-Active Coaching (2nd ed.) © 2007 by Laura Whitworth, Karen Kimsey-House, Henry Kimsey-House, and Phillips Sandahl.McClafferty 2017
Why Do We Care?
Strengths *Healthy Resilience
McClafferty 2017
Emotional Resilience
Psychol Rep. 2016 May 18. pii: 0033294116649707.
Resilience: The ability to generate positive emotion and to recover from negative emotion is a modifiable factor
closely linked to burnout.
The ability to ‘bounce back’ after being psychologically challenged
McClafferty 2017
Resilience is:
• Teachable
• Learnable
• Measurable
McClafferty 2017
Common Traits of Resilient People
� Strong social connections � Emotional awareness � Strong sense of purpose � Openness to challenges � Flexibility, openness to
change � An internal locus of control � Identifying as a survivor,
not a victim
� Able to set reasonable goals � Able to ask for help � Take good care of themselves � Sense of optimism
Stress in America: Paying with Our Health. American Psychological Association, 2015McClafferty 2017
Common Traits of Resilient People
� Strong social connections � Emotional awareness � Strong sense of purpose � Openness to challenges � Flexibility, openness to
change � An internal locus of control � Identifying as a survivor,
not a victim
� Able to set reasonable goals � Able to ask for help � Take good care of themselves � Sense of optimism
Stress in America: Paying with Our Health. American Psychological Association, 2015McClafferty 2017
Resilience Associations in Physicians
• Sense of humor • Higher levels of intelligence• Attention to consistent exercise, healthy
nutrition, rest, play, relationships, and coping skills
• Spirituality/organized faith community• Most powerful predictor for physicians:
maintaining caring connection with others
Wayne/Mary Sotile- http://www.sotile.com/advice_articles.php?articleMcClafferty 2017
Healthy Resilience
Why should we care?
McClafferty 2017
Sobering Statistics
� Nearly half of all medical students report feelings of burnout by the third year of training.
� Strong associations have been identified between burnout and suicidal ideation.
J Grad Med Educ. 2014 Mar;6(1):78-84. Dyrbye et al McClafferty 2017
National Pediatric Trainee Data
Pediatric Resident Burnout - Resilience Study Consortium
McClafferty 2017 https://pedsresresilience.com
Pediatric Resident Burnout - Resilience Consortium
• Describe the epidemiology and relationships between burnout, resilience, empathy and confidence in providing compassionate care by pediatric and medicine-pediatric residents
• Test interventions that positively impact burnout, resilience, empathy, compassion and wellness and generate evidence that may be useful in addressing similar concerns in all residents and fellows.
McClafferty 2017 https://pedsresresilience.com
McClafferty 2017
Pediatric Resident Burnout and Resilience Consortium PHASE 1- 1693/2723 (62%) Residents, 34 Institutions
https://pedsresresilience.com
Professional’s Mental Health
Stigma, Stoicism, Consequences
J Grad Med Educ. 2014 Mar;6(1):78-84. Dyrbye et alMcClafferty 2017
• Competency• Professionalism• Quality of patient care• Career satisfaction • Substance abuse • Self prescribing• Motor vehicle accidents
Male physician: Relative risk ratio 1.4 to general male population
Female Physician: Relative risk ratio 2.27 to general female population.
300-400 medical students and physicians complete suicide annually, equivalent to 2 average sized medical school classes.
At the Extreme: Physician Suicide
Moutier et al, Acad Med. 2012 Mar;87(3):320-6.McClafferty 2017
Recognizing External Stressors
• Chronic elevated stress• Patient care demands, EMR• Environmental and infectious
exposures, excessive light, noise• Chronic fatigue, sleep disruption• Time constraints, strained
relationships – personal and professional
• Lack of exercise• Frequent exposure to conflict, yet
lack of conflict resolution training• Erratic meals, poor quality nutrition• Deferred gratification• Unprocessed emotional or spiritual
needs – grief, trauma exposure
McClafferty 2017
Immune system to brain signaling: neuropsychopharmacological implications. Capuron L, Miller AH. Pharmacol Ther. 2011 May;130(2):226-38. Epub 2011 Feb 17. Review.
Internal Effects of Stress: Highly
Pro-inflammatory.
McClafferty 2017
McClafferty 2017
Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and
unpublished data for 603,838 individuals.
Lancet. 2015 Aug 19. pii: S0140-6736(15)60295-1. Kivimäki, et al.
McClafferty 2017 Lancet. 2015 Aug 19. pii: S0140-6736(15)60295-1. Kivimäki, et al
Leadership is a Critical Predictive Factor, Distinct From:
• Salary • Culture• Specialty • Personality conflicts • Workload expectations • Strategic direction of the organization • Opportunities for professional development
Impact of organizational leadership on physician burnout and satisfaction Mayo Clin Proc. 2015 Apr;90(4):432-40. Shanafelt, et al.McClafferty 2017
Barriers to Seeking Help
� Denial
� Distortion
� Defensiveness
� Deference
“I’m fine”
“I’m the only one struggling”
“I’m worried about practice andlicense implications”
Subordinate in a culture that frownson weakness
Mayo Clin Proc. 2015 Apr;90(4):432-40. Shanafelt, et al.McClafferty 2017
Our Collective Goal Today
Mayo Clin Proc. 2015 Apr;90(4):432-40. Shanafelt, et al.McClafferty 2017
“If you do not change direction,
you might end up where you are heading.”
Lao Tzu
In Summary:
• Heighten awareness of the culture we have created.• Recognize the cost of unmitigated stress.• Build on your existing strengths. • Identify personal and professional obstacles to wellness.• Remain open-minded and identify useful resources. • Attitudes are changing, time to dispel the culture of silence.
McClafferty 2017
1. Create urgency
2. Form a powerful coalition
3. Create a vision for change
4. Communicate the vision
5. Empower action
6. Create quick wins
7. Build on the change
8. Make it stick
Creating the climate for change
Engaging & enabling the organization
Implementing & sustaining for change
Dr. John P. KotterProfessor EmeritusHarvard BusinessSchool8 Steps to LeadingChange
McClafferty 2017 Harvard Business School http://www.hbs.edu/
Thank youHilary McClafferty, MD, FAAP
University of Arizona, College of Medicine Tucson, Arizona
McClafferty 2017