Wednesday 18/5/2016 Workshop 1: Self Care, Self Aware for Physicians Andrew Tresidder Patient Safety Lead, NHS Somerset Clinical Commissioning Group, Advocate in Somerset Clinician Support Service Ask a hundred people how they are, and they say FINE – fearful, insecure, neurotic and emotionally imbalanced (Denial). Ask a hundred physicians, and they cannot tell you – they are too busy looking after their patients (Denial and Displacement) Good health is harmony of Mind, body and spirit. Health is not taught at medical school. How then can physicians practice self-care and achieve good health? The factors of smoking, alcohol, fruit and vegetable consumption, and exercise are well known. Medical Mindfulness is becoming more widely practiced. However, the psychological aspects of health are simple yet not widely applied, possibly because they are not in the medical curriculum. Self Care, Self Aware explores such factors as basic physical, psychological and emotional needs, hardware body / software being, the physiology of how emotions flow, being a patient as a doctor, loss, grief and bereavement, breathing and environmental factors upon health. The Drama Triangle (Karpman and Edwards) is all about relationships and power – how we relate to others, and where the power lies. It frequently traps us in our lives, and exhausts our energy. In this workshop we first explore the health drivers noted above, then move on to the experience of Attention as an Energy Flow. We use role-play to experience the Drama Triangle, how it works, and how to analyse the dynamics. Next we look at the antithesis to the Drama Triangle – Ruiz’ Five Agreements as a guide to authentic living. We end with a reminder of Aasland’s Ten Top Tips for Physicians when Patients.
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Thursday Thursday 19 /5/2016 Roundtable 1: The European Association of Physical Health – Α contribution to enhanced medical well – being and patient safety? Convenor: Karin Isaksson Ro, Discussant: Karin Isaksson Ro Institute for Studies of the Medical Profession, Oslo, Norway Roundtable overview Aims: To discuss how the European Association of Physician Health (EAPH) can contribute to: - stimulating the implementation of health services for doctors and medical students in European countries - stimulating research on physicians´ and medical students´ health in and between European countries - stimulating research about the links between physician health, healthcare organization and quality of patient care, Rationale: Although the health and welfare of doctors and medical students, and the implications this has for the quality of patient care, is a fairly small field there are several organizations and conferences addressing some or all of these issues. It is therefore important that we know about each other, and that we discuss how the individual organization can contribute. Summary: The European Association for Physician Health (EAPH) will be introduced. The organization has a two-fold perspective: (i) to encourage and influence the development of health- and support services for doctors (ii) to stimulate, promote and undertake joint research on the health and wellbeing of doctors. Four short presentations will serve as a background for the discussion. We present experiences from a local support program for physicians and from international research co-operation about physician health. Plans for two new co-operative research projects will be presented. We would like to discuss the role of an organization like the EAPH for stimulating the development of support services for doctors and for international research on relevant topics. How can the EAPH co-operate with other organizations if and when necessary?
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Individual abstracts:
R1.1 Clinical significance of anxiety and depression in medical students Debbie Cohen cohenDA@cardiff.ac.uk Although we agree that there are different cultures across European countries there is a clear consensus that medical students struggle at different times throughout their training and there is a perception that they are more vulnerable (higher levels of anxiety and depression) than other types of students. However we do not have a strong evidence base that this is the case. It does look like medical students and doctors are more willing than their counterparts to self-report high levels of anxiety but whether this is clinically significant we do not know. How could the EAPH work together with organizations dedicated to medical students´ health and functioning in order to investigate this? R1.2 The relationship between organizational factors, doctors´ wellbeing and quality of care Karin Isaksson Rø karin.ro@legeforeningen.no Research on doctors´ health and wellbeing is highly motivated by the assumption that it has an impact on the quality of patient care. There is however little research documenting this relationship. Organizational factors can impact both doctors´ wellbeing and quality of care directly. In the transfer of patients from specialist in-patient care after cardiac incidents to follow-up care outside hospital there are often problems with patient compliance to medication and training. We want to study the association between organization, specialists´ and GPs´ work environment/wellbeing and patient outcomes before and after an intervention to enhance such follow-up care. We have established research co-operation with two centers in Sweden. R1.3 Group supervision for physicians in Finland Kristiina Toivola, kristiina.toivola@tyonilo.fi Successful work necessitates that everyone take responsibility for the success of the organization as a whole – not just for their own jobs or work area. Physicians are cultured to be lone-rangers. Group supervision with clear boundaries can create a safe place and time to reflect the professional role and its relationship to other professionals and the common primary task of the organization. Good enough organizational support and leadership, open dialogue and creating a protected thinking space in a supervision group can help the doctor find his new role in the healthcare system with constant turmoil. R1.4 International study on quality of care and professional autonomy and job satisfaction among doctors.
Reidar Tyssen, reidar.tyssen@medisin.uio.no To do cross-national research in the fields of physician work satisfaction and well-being, and also quality of care/patient safety, is very important because of increased globalization. Despite this, cross-national comparisons are quite few. Some difficulties and challenges that pertain to such work will be shortly mentioned, as well as possible solutions to this. In all, my experience is quite good as regards cross-national studies that compare Norwegian physicians with those in North America and Iceland, and this work has been a great pleasure.
Symposium 1: Connecting organizational health and health professional well-being Chair: Anthony Montgomery 1 , Discussant: Cristina Maslach 2 1
University of Macedonia, Thessaloniki, Greece
2
University of California, Berkeley, USA
S1.1 The relationship between work organization and occupational well-being: An observational study. Maxime Bellego Aix-Marseille University, France Background: This study is based on free observations and consulting work conducted as part of a project on organizational change in technical units. The objective was to assess the effects of organizational changes on the work relationships of technicians and the impact on their professional identity. This research explores technicians’ representations as both built and shared according to the social context, as well as adjustment strategies used by technicians. Methods: The study involves interviews with 54 technicians, and that were recorded and conducted in the Technical Units of organizations in Paris, Pays de Loire and Ile-de-France Sud. Data were analyzed with Interpretative Phenomenological Analysis (Smith et al. 1995) and thematic analysis. Observations were also conducted in situ during technical interventions. Findings: Results suggest that work relationships are based for a large part on the beliefs of the previous work organization of the company. As for professional identity, results show that the important elements for the client, colleagues and the technical people were rooted in a singular relationship to the hierarchy and the management of company. Discussion: The impact of the organizational culture and its impact on professional identity are discussed with regard to future research. S1.2 Intervening on burnout in complex organizations – the process of an Action Research in the hospital Patrícia Costa, Sara Ramos, Ana M. Passos, Sílvia A. Silva
ISCTE – InstitutoUniversitário de Lisboa, Lisbon, Portugal Introduction: Health professionals are known as being at high risk for developing burnout symptoms, with consequences for both their own mental and physical health, and the quality of care they are able to provide their patients. This paper presents the process of developing and conducting an action research intervention in a specific sector of a large Portuguese hospital. Directed at reducing the organizational variables impacting on professionals’ burnout levels, this process was developed within the scope of a broader European project (Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care – ORCAB), involving 9 different countries. Methods: The service involved in the action research has 59 doctors, 66 nurses, and 42 auxiliary professionals, divided by four sectors that share the same Director. The present intervention focused on one of those sectors, which receives mostly old, multi-pathological and terminal patients. First, problems were identified and defined. In order to do so, researchers conducted 11 interviews and one focus group with key persons (chief nurse, chief of sector) and with diverse professionals from the sector. Researchers conducted 20 hours of observation in loco, observing the daily routine of the service. Afterwards, results from the diagnose were shared with the service Director and the Chief Nurse, and possibilities for intervention were presented and discussed. Results: The sector is generally described as technically excellent and as having a high potential for teaching and scientific activities. However, organizational-level constraints create stress-inducing situations for professionals that compromise their well-being and put them at higher risk for burnout: for example a high work load, with a constant occupancy rate over 100%, lack of nurses or inadequate technology for registering processes or procedures. Sector-level specific difficulties were also reported and observed, such as a lack of information sharing or depreciation of auxiliary personnel. Therefore, professionals report both demotivation and the need to deal with the emotional part of their job. Nonetheless, the hierarchy blocked all of the proposed intervention possibilities. Discussion: The findings of the present study highlight two main aspects. First, the unequivocal role of organizational factors for the well-being of professionals, particularly in complex settings with emotionally charged interactions. Second, the pivotal role of the direct hierarchy in facilitating (or obstructing) organizational change, with consequences not only for the functioning of the service, but also for the (de)motivation of professionals, in a self-perpetuating negative spiral.
S1.3 Organizational culture and medical error reduction Adriana Baban Babes-Bolyai University, Cluj-Napoca, Romania The problem of errors in patient care is a critical issue facing hospitals today. Based on theoretical perspectives and of ORCAB project results, we reflect on how organizational culture can improve overall performance of medical departments and reduce the amount of suboptimal care behaviours of health providers. We will discuss a range of possible approaches to reduce the number of errors and adverse events as they were identified by medical staff, including cultural shift, partnership of all stakeholders, a climate based on trust and mutual respect, acknowledging errors without blame, using errors as learning opportunities, education and training programs. The understanding of the hospital as a complex organizational system and possible root-cause of medical errors should be used to develop a set of managerial practices that leads to the improvement of patient safety and quality of care. S1.4 Health professional emigration from Ireland: How do healthcare organizations care for health professionals and what are the effects? Anne Matthews 1 , Niamh Humphries 2 , Sara McAleese 2 , Ruairi Brugha 2 1
School of Nursing & Human Sciences, DCU.
2
Division of Population Health Sciences, RCSI.
Background: Lack of care for health professionals in their workplace has immediate effects on their well-being and may also influence longer-term decisions, such as those to emigrate. This paper presents findings from the Failure2Retain study of doctors, nurses and midwives who emigrated from Ireland, conducted in 2014. Methods: The use of Facebook elicited 372 completed responses to an exploratory mixed-method online survey. Results: Analysis of two open-ended questions, on health worker emigration (N=209) and health worker return (N343) shows that respondents emigrated because of poor working conditions in the Irish health system (long working hours, poor career progression). Specifically the themes of ‘work strain’ and ‘duty of care’ are examined in this paper.
Discussion: Difficult working conditions and a perceived lack of care for professionals’ well-being are major drivers of health professional emigration from Ireland. This paper demonstrates a connection between lack of care for health professionals and health professional emigration. S1.5 The working man - psychiatry's blind spot and challenge Dror Dolfin Geha Mental Health Center, Petach Tiqva, Israel Psychiatry, the medical field entrusted with the diagnosis, research and treatment of disorders of thought, emotion and behavior does not recognize or show an interest in the burnout syndrome Maslach has called "an erosion of the human soul", this in the face of decades of robust research that have defined and illuminated the concept of burnout and shown its nature as a psychiatric occupational disorder, exacting an enormous toll on the lives of working men and women, on their thoughts, emotions and behavior. It appears as though psychiatry actively shies away from engaging a disorder exposing not an individual's illness but the price men pay for a social choice. Reviewing the story of the invention of PTSD shows this to be not an isolated incidence but a deeply rooted stance. After suggesting reasons for psychiatry's position, ways of thinking about psychiatry's possible conceptualizations of burnout will be discussed.
Roundtable 2: Does effective clinical communication (and clinical communication teaching and learning) lead to increased health and well-being professionals? Convenor: Jonathan Silverman University of Cambridge, UK and president of the European Association for Communication in Healthcare Speakers: Cadja Bachmann, University of Brandenburg, Germany Katrien Bombeke, University of Antwerp, the Netherlands Jonathan Silverman, University of Cambridge Zoi Tsimtsiou, Aristotle University of Thessaloniki, Greece Eva Doherty, Royal College of Surgeons in Ireland Roundtable overview One of the key selling points of teaching and learning effective clinical communication is that, as well as improving patient outcomes and enhancing accuracy efficiency and supportiveness in the health professional interview, it also leads to increased health and well-being of health professionals. But how far does the evidence support this, what further research is required to establish these links and what are the challenges to sustaining effective clinical communication in practice? In this roundtable, we will: • review the evidence so far for a link between health/well-being of professionals and health professional-patient communication • explore new directions in research to further the exploration of this topic • consider what other challenges there are to enable the transfer of what we already know into clinical practice
Symposium 2: Is job burnout an operational issue? Chair: Anthony Montgomery 1 , Discussant: Cristina Maslach 2 1 2
University of Macedonia, Thessaloniki, Greece
University of California, Berkeley, USA
S2.1 Lean as preventive medicine for burnout in healthcare Paul de Chant MD, MBA Executive Director, Clinical Operations and Innovation Simpler North America This presentation will focus on Lean in healthcare settings as a way to prevent burnout. It will review how Lean addresses dysfunctional healthcare management systems and cultures and enables the transition to a healthy healthcare workplace that can significantly reduce the risk of clinician burnout. There are many programs that address ways that healthcare workers can reduce their susceptibility to burnout or treat the symptoms. A Lean management system and culture is the only approach that focuses on resolving the workplace conditions that drive burnout, essentially serving as preventive medicine for burnout. Drawing on real life examples from the Lean transformation at Sutter Gould Medical Foundation, this presentation will educate the attendees about how specific attributes of Lean can mitigate the drivers and impacts of burnout. It will also review issues specific to physician engagement in Lean transformation and its importance in addressing burnout. S2.2 Is resilience the antidote to doctor burnout? Yvonne McGowan, Niamh Humphries, Karen Morgan Royal College of Surgeons in Ireland, Division of Population Health Sciences Background: This study explores doctors’ perspectives on resilience and considers whether it is the antidote to burnout Methods: In-depth interviews were conducted with 40 doctors, including GPs, hospital doctors, and consultants working in Ireland in 2013 and 2014.
Results: Doctors’ felt that ‘resilience won’t last long in the face of the onslaught of difficulties’ (R1). Respondents expressed concern that you could be ‘too’ resilient, meaning ‘persevering past the point of burnout’ (R2). Respondents noted many individuals tend to distance themselves from aspects of the job in order to remain working. They believed these doctors were the least likely to affect positive change in the system. Conclusions: Doctors insights challenged the idea that cultivating resilience will provide the antidote to doctor burnout. They caution that promoting resilience may prolong doctors’ exposure to hazardous working conditions and promote the idea that individual (rather than organisational) solutions to burnout are required. S2.3 Burnout, Depression and Work Stress in Medical Doctors and General Population – Czech National Study Radek Ptacek, Jiri Raboch Department of Psychiatry, 1st Faculty of Medicine, Charles University Prague and General Teaching Hospital, Czech Republic Introduction: Medical professionals are exposed to numerous high intensity stressors related to their work. This may lead to increased occurrence of signs of burnout syndrome, depression eventually to further symptoms and problems. This phenomenon is further connected to higher probability of serious medical errors, lower attention to patients and other medically serious issues. Methods: We have conducted a national study to assess the level occurrence of burnout syndrome (SMBM scale) and depression (BDI-II scale) using standardized questionnaires. We have collected data from n=7428 medical doctors cross all specialties and types of medical institutions. Further we collected data from representative sample of the Czech general population n=1200. Results: The results of the study confirmed high occurrence of burnout syndrome and depression symptoms among Czech medical doctors. The comparison of the samples confirmed, that signs of depression and burnout syndrome are significantly higher (<0.001) in the medical doctor sample than in the general population. The study also brought information about specific risk factors as the type of specialty, age, marital status or educational level which influence the levels of burnout and depression syndromes at statistically significant levels (p<0,001). Conclusion: The study supports the hypothesis that medical doctors are highly endangered by development of burnout and depression symptoms and thus should get appropriate care.
S2.4 What do we know about organizational factors and job burnout in Norwegian doctors? Reidar Tyssen Department Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway Background: Several representative prospective studies have been conducted on Norwegian doctors over the last decades. This presentation aims to identify any organizational and contextual work-related factors that may predict job stress and burnout among them. Methods: Selective review of studies from the Norwegian Physician Survey, NORDOC, and Villa Sana that include organizational and work-related predictors of burnout, and that are amenable for preventive efforts. The findings will be contrasted to international findings. Results: The review identifies factors such as work-home stress, support from colleagues, sleep deprivation, and specialty work that may predict burnout. Some interventions that have been evaluated will also be presented. There are relatively few gender differences in studies among Scandinavian doctors. Discussion: Strengths of the studies are a prospective design and adjustment for confounding. Despite that working conditions are highly regulated in Scandinavia, some of these factors are possible risks of burnout also in other countries. S2.5 Effects of empathy and stress on job burnout in physicians Ewa Wilczek-RuĹźyczka 1 ,Irena Milaniak 2 1
Cracow University of A. F. Modrzewski, Faculty of Psychology and Humanities, Poland
2
John Paul II Hospital, Cracow Department of Cardiovascular Surgery Poland
Introduction: Generally speaking, professional burnout may be understood as the psychological reaction to chronic work stress. According to the model of Christina Maslach, burnout is the sequence of three dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment. Objectives: The aim of this study is to analyze the relationships between occupational burnout and specialized, demographic healthcare workers. Methods: The research was carried out in Poland and involved 1785 healthcare workers. 627 of whom were specialized in operation, 944 non-operation, and 213 worked in primary healthcare. The following research methods were used: - Maslach Burnout Inventory (MBI)
- Sociodemographic Questionnaire. Results: The surveyed from the operating wards showed the largest burnout on all the measures of MBI, and the displayed differences were of high significance (p<0,001). Men showed a higher DEP level (p<0,05),and age and work experience influenced the increase of the PAR scale results (p<0,001). Conclusions: The results of surveying physicians and nurses confirm the need of preventing occupational burnout as it lowers healthcare quality and affects the health of workers.
F riday 20/5/2016 Poster Session 1: Challenges in linking well-being and patient safety in clinical practice Chair: Lucie Byrne-Davis University of Manchester Medical School P1.1 Burnout and clinical practice among Danish primary care physicians Karen Busk Nørøxe University of Aarhus Background: The potential influence of physician burnout on clinical performance is important. We aim to examine associations between physician burnout and measures of clinical activity. Methods: Burnout is measured by Maslachs’ Burnout Inventory in a questionnaire survey addressed to all Danish general practitioners (GPs) (N ≈ 3,600). From national registers we retrieve data on patients’ redeemed prescriptions (proxy for quality of medical encounters) and GP rates of procedures, prescriptions and referrals/admissions. Associations are assessed on practice-level by regression analyses and adjusted for case-mix in patient populations. Expected results: Burnout is hypothesized to associate with patients not redeeming prescriptions (non-compliance) and higher rates of activities that may protect the GP’s internal resources by postponing clinical decision making or decreasing emotional involvement (e.g. high rates of referral and antibiotics prescribing). Current stage of work: The questionnaire survey will be accomplished during 2015, analyses and articles throughout 2016-2017. Discussion: The study has important implications for initiatives targeting resource-utilization and quality in health care.
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P1.2 Connectivity, time perspective and well being: Are doctors different from everybody else? Marianna Dalkou Medical School, Aristotle University of Thessaloniki Background: The aim of the present study was to investigate time perspective and levels of connectivity in comparison with health behaviours for both doctors and the general population as well as their within relations. Moreover, associations of health behaviours underpinning wellbeing status were examined and to further illustrate doctors’ levels of wellbeing, two dimensions of burnout were also investigated (emotional exhaustion and depersonalization). Methods: A cross-sectional designed was applied. Zimbardo’s Time Perspective Inventory, Maslach Burnout Inventory and questionnaires investigating ‘screen time use’ and connectivity were disseminated. Results: Results were analyzed with the appropriate statistical analyses (Independent t-test, Pearson’s Correlation and Linear Regression). Discussion: Connectivity was associated with health behaviours. Although time perspective was not directly associated with each of the examined health behaviours it was a strong predictor for internet addiction, which implies that there is a corresponding variable in terms of connectivity. Specifically, doctors who mainly adopted unhealthy behaviours were also burnt out. P1.3 A systematic review of factors that promote or impede the development of resilience amongst doctors Eleanor Balme 1 , Clare Gerada 2 , Lisa Page 3 1
Brighton and Sussex Medical School
2
NHS Practitioner Health Programme
3
Sussex Partnership NHS Foundation Trust
Background: Resilience is the ability to survive and thrive through adversity. Doctors constantly work in adverse conditions: it is perhaps surprising so few experience mental health problems or burnout. This study explores the factors contributing to resilience amongst doctors. Methods: Studies from Cochrane, EMBASE, Medline, PsychINFO and other sources were systematically reviewed. Results: 1560 records were identified, of these 10 were included in qualitative and quantitative synthesis.
Findings: Resilient doctors are characterised by high levels of interest and motivation, employing time-management skills to maintain professional practices and foster supportive relationships. Attitudes and mental strategies include: self-awareness; personal reflection; spiritual practices; acceptance & realism. Routines and behaviours include: taking time out for leisure activities and professional practices. Discussion: A shift from pathology focused research may enable insight into what structural changes are necessary to promote resilience. Enhanced resilience in doctors benefits not only individuals but ultimately the overall provision of quality patient care. P1.4 Senior clerkship medical students’ insight of their readiness on patient safety in five main domains Kyin Win, Davendralingam Sinniah, Moti Lal Department of Pediatrics, International Medical University, Malaysia Background: Five main domains of “patient safety” (5MDOPS) namely, safety culture, teamwork, error disclosure, professionalism & safety behavioural intent item have been recognized as vital to the training of International Medical University (IMU) senior clerkship medical students (MS) in preparation for internship in Malaysia. Feedback from MS on these aspects would be valuable in evaluation of continuing medical curriculum. The objective of this study is to ascertain the insight of IMU MS during training on 5MDOPS prior to work as house officers. Methods: The 32-item questionnaire developed by Liao et al for the survey on MS training was used with a 5-point Likert scale. The results were analysed to determine whether the training has accomplished anticipated outcomes. Results: 83 of 88 (94%) of IMU MS gave informed consent to participate in this study. 70% of MS had a positive perception of their training on safety culture; 74% on teamwork; 45% on error disclosure; 43% on professionalism and 75% on Safety behavioural intent item respectively. Discussion: IMU MS have a diverse positive perception of their training on the 5 MDOPS in preparation for future career as doctors. This spectrum of perception from feedback is valuable in guiding areas that need emphasis for current curriculum evaluation. P1.5 Burnout in medical students: A follow up Daniel Pagnin, Valéria de Queiroz, Erito Marques, Leticia Roberta Rodrigues, Luciana Tedeschi, Isabela Klein, Isadora Aurione, Mariana Moura, Rafaela Queiroz, Olívia Amorim
Fluminense Federal University, Institute of Community Health / Department of Psychiatry and Mental Health Background: Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. In this prospective study, in medical students of the Fluminense Federal University, we expect to determine the frequency, course and its correlation of with individual and environmental variables. Methods: We applied self-administered questionnaires: MBI-SS,PSQI, ESS, BDI and BAI in 277 medical students at the 2nd, 4th and 6th year of the course. Expected results: High burnout rates; burnout and sleep disorders have relevant bidirectional effects; students who apply for medical school motivated by illness/death experiences are at a great risk for burnout. Current stage of work: We are now analyzing the sixth year. Three articles have been published. Discussion: Burnout is correlated with significant consequences as dropping out, sleep disorders, depression, and suicide. We hope this study will help to understanding burnout and the factors associated with its development in medical students.
Poster Session 2: New approaches in linking well-being and patient safety in clinical practice Chair: Adriana Baban Babes-Bolyai University, Cluj-Napoca, Romania P2.1 Medically unexplained symptoms in paediatrics: The paediatricians’ perspective Laura Wolpert, Mohammed Al-Nasiri, Kamal Patel Brighton and Sussex Medical School, Brighton, UK Background: Medically unexplained symptoms (MUS) are those for which there is no identifiable pathophysiological cause. They are typically complex and result in a high degree of functional impairment. This study examined paediatricians’ views of MUS, to gauge current level of training and to identify desire for further training. Methods: Questionnaires were sent by email to 855 paediatricians in five deaneries and two hospitals. Findings : Response rate was 10.2% (87 responses). All but one had encountered a patient with MUS. The majority (58.6%) thought that MUS were relatively common. Of paediatricians sampled, 61.6% had no formal training on MUS whilst 38.4% had training either at medical school, at postgraduate level or both. Irrespective of training, 95.6% of paediatricians felt that further teaching would benefit their future practice. Discussion : Paediatricians sampled consider MUS to be common. However most do not receive formal training on MUS and believe further training would be beneficial. P2.2 Empathy among greek mental health nurses: is there any association with depressive symptoms and dysfunctional professional attitudes? Maria Karanikola 1 , Maria Nystazaki 2 , Afroditi Zartaloudi 3 , Valentina Farah 4 , Fillipou Andri 4 , Kaikoushi E 4 1
Department of Nursing, Cyprus University of Technology
2
Psychiatric Clinic/ G.H.A “Agioi Anargyroi”, Athens
3
Athens Institute of Technology, Department of Nursing, Athens
4
Athalassa Psychiatric Hospital of Cyprus
Background: Phenomena such as fatigue or burnout may have significant effects on nurses’ professional and health status, including compromised empathic understanding. Moreover, health care professionals’ empathic understanding is associated not only with the quality of provided care but with their well being, as well. However, there are limited studies investigating the relationship between employees’ empathic understanding and the manifestation of mild psychiatric symptoms. Aim: To explore among Greek Psychiatric-Mental Health nursing personnel (MHNP): a) the level of empathic understanding, depressive symptoms, and professional satisfaction, b) potential associations between demographic /job related factors and the aforementioned variables, and c) the relationship among empathic understanding, professional satisfaction and depressive symptoms. Methods: A descriptive correlational design with cross-sectional comparisons was applied. A convenience sample of 206 members of Greek MHNP, employed in public and private hospital settings completed the JES, IWS, CES-D. The response rate was 69.8%. Results: Participants reported moderate to high degree of empathic understanding (5,00 ± 0,79, scale range/ item: 1-7) and moderate professional satisfaction [Mean(SD)= 3,93 ± 0,05, scale range/ item 1-7], whilst approximately 11% of the sample reported clinical symptoms of depression (Μean ≥22). The degree of empathic understanding was associated a) negatively mildly with the severity of depressive symptoms (r=-0.236, p<0.05), b) positively mildly with the satisfaction from i) professional status (r=0.280, p<0.0001), ii) professional relationships (r=0.279, p<0.0001), and c) negatively mildly with the satisfaction from pay (r=-0.290, p<0.0001). The workload, as described by the number of beds included in the work setting, was associated: a) positively mildly with the severity of depressive symptoms (r=0.233 p<0.05), and b) negatively weakly with the level of professional satisfaction (-0.190 < r < -0.288, p<0.003). Additionally, the degree of empathic understanding was positively and mildly associated with the length of clinical preoccupation (r=0,208 p˂0.05), whilst MHNP employed in private settings reported higher level of empathy compared to their colleagues of the public sector (95% CI -079,-010 p=0,030 t-test). Conclusion: Greek mental health nursing personnel reported relatively high degree of empathic understanding, which was related with their professional and psychological well being. Further qualitative and longitudinal studies are warranted, with special focus on particular aspects of this relationship. P2.3 Towards sustainable employability in health care: A systematic review of the effectiveness of interventions Sabrina W.Pit 1,2 , SJ Robroek 3 , D. Donoghue 2 , Vibeke Hansen 1
1
School of Medicine, University of Western Sydney, Lismore, Australia
2
School of Public Health, University of Sydney, Lismore Australia
3
Department of Public Health, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands Objectives: Industrialised countries face the challenge of an increased workforce participation need, particularly at older age. This systematic review aims to assess the effectiveness of interventions on sustainable employability amongst healthcare workers. Methods: MEDLINE, EMBASE, and CENTRAL were searched up to January 2015. Selection criteria were cluster randomized controlled trials (RCTs), RCTs, controlled trials, controlled before-after studies and factorial trial designs that evaluated the effect of interventions on sustainable employability amongst healthcare workers. Abstracts were reviewed. Relevant full-text papers were examined to determine whether it met the predetermined inclusion criteria. Suggested risk of bias criteria for EPOC reviews were used. Results: Three-thousand articles were identified, 1947 were screened, 350 full-text articles were assessed and 27 studies were included. There were nine health promotion, seven physical, four psychosocial, and seven organisational interventions. Two out of nine health promotion trials led to a reduction in sick leave. One intervention involved Tai Chi classes but had a small sample. The other intervention involved participants working reduced hours combined with increased physical activity. Also, one trial reported an increase in sick leave. Participants in two out of three health promotion studies reported increased productivity. Seven physical intervention trials incorporated sick leave. Only one small trial found a significant effect using a workplace-based physical workout program. Only one out of four studies trialling psychosocial/ organisational interventions measuring sick-leave, found that using Acceptance and Commitment Therapy led to a decrease in selfreported sick-leave.Five out of seven studies employing interventions at an organisational level assessed turnover. All but one reported significant improvements. The programs were generally designed in conjunction with staff. Overall, the risk of bias criteria were mostly not met or reported. Conclusion: Programs designed in conjunction with staff appear to lead to reduced staff turnover. There was inconsistency between studies, such as variations in intervention content and length of follow-up. Additionally, the results of several studies were potentially biased due to weak study designs. Policy makers, researchers and work, health and safety experts could consider including sustainable employability outcomes measures when evaluating strategies to promote sustainable employability amongst healthcare workers. P2.4 Meditation in health care settings â&#x20AC;&#x201C; An innovative approach to resolving clinical ethics disputes Evi Avlogiari
Mediation has long been used to resolve disputes. It is a private, voluntary, informal process in which an impartial third person facilitates a negotiation between people in conflict and helps them find solutions that meet their interests and needs. In the hospital setting, where health care providers, faced with intense demands on their time, are called on to explain complex information and deliver bad news to physically and emotionally vulnerable patients and their families, and where large numbers of physicians, nurses and other providers interact with one another and with the patient, it is not surprising that communication breaks down and disputes arise. Mediation services are now available for medical staff conflicts, difficult patient care decisions, employee disputes, medical malpractice claims and bioethics disputes. Mediation tools are also being used to aid in disclosure of adverse medical events. P2.5 The doctor, the patient and the disease Rebecca Jacoby The interaction between the physician, the patient and the disease critically depends on the perceptions, attitudes, beliefs and emotions held by both sides with regard to the disease and to each other. However, models of health and illness as well as psychological interventions have focused mainly on patients' cognitions, behaviors and emotions while confronted with a disease. Much less attention has been paid to physicians' models of health and illness and to their emotional state, all of which undoubtedly play a central role in physicians' decisions and the messages they convey to their patients. Although physicians can participate in Balint Groups, these are time consuming and not available everywhere. In my presentation I would like to offer a self-examination protocol to assist physicians in evaluating their perceptions, emotions and behavior towards the disease and towards their patients. This protocol may serve as a self- regulation tool for physicians and contribute to their decision making process. P2.6 "I feel pretty": Comparing preferences for cosmetic surgery of doctors to the general population Panagiotis Milothridis, Efharis Panagopoulou Medical School, Aristotle University of Thessaloniki N/A
Thematic session 1: Medical education in the spotlight Chair: Debbie Cohen 1 , Discussant: Chris McManus 2 1
Cardiff University
2
University College London
O1.1 Assesement of emotions and emotional regulation in medical studentsâ&#x20AC;&#x2122; most memorable experience Karolina Doulougeri, Efharis Panagopoulou, Anthony Montgomery Aims: The aim of the present study was to explore medical studentsâ&#x20AC;&#x2122; emotions and emotional regulation strategies elicited by memorable experiences. Methodology: Peer interviewing was used to assess medical studentsâ&#x20AC;&#x2122; memorable experiences. All interviews were transcribed and analyzed thematically. For the present study only memorable experiences including references to emotions were selected for further analysis (n= 55) Results: About two thirds of the experiences had a negative emotional content. The most prevalent emotion in the narratives was shock in the face of unexpected situation. Emotions of sadness, shame or embarrassment were also reported as a consequence of breaches of patient or their own dignity. Students reported several avoidance strategies, such as suppression, denial, focusing on clinical tasks as ways to cope with intense emotions. Discussion: Students should be offered the opportunity to reflect on the emotions associated intense experiences during medical school and develop adaptive regulation strategies. O1.2 comparison of self-report and clinical interviews: do students over report anxiety? Debbie Cohen 1 & Naomi Marfell 2 1 2
School of Medicine, Cardiff University
School of Medicine, Cardiff University
Background: Medical students report higher levels of common mental health disorders than the general population. This study investigated the suitability of the self-report Hospital Anxiety and
Depression Scale (HADS) as a screening tool for medical students and explored optimum cut-off points. Method: Phase 1 was the dissemination of two rounds of HADS to students at two UK medical schools. Phase 2 compared HADS with a structured clinical interview using ICD-10 diagnostic criteria. Findings :32.7% of students (round 1) and 39% (round 2) had total HADS score of 15 or above, indicative of psychological distress. Comparison of HADS with a clinical interview suggests revised subscale cut-offs ≥7 for HADS depression and ≥12 for HADS anxiety would give optimal sensitivity and specificity for the current sample. Discussion: Revised subscale cut off scores my be appropriate for medical students and provide more effective screening and support for students in reaching their maximum potential O1.3 Psychotherapy training repairs traumata of medical school and working life as physicians Chantal Meystre Background: Medicine uses the doctor’s self to relate. Medical identity forms by role modelling and surviving traumata. Not debriefing erodes empathy. Psychotherapy training, transforms from objective quantitative observers, to subjective, qualitative participants. The journey to psychotherapy trained physician was investigated. Method: Four psychotherapy trained physicians were interviewed. Interpretative Phenomenological Analysis supported the small sample size. Ethics conformed to UKCP practice Results: Rational choice of medicine was accompanied by unconscious hope of self-realisation. Good and bad role models and shocking initiations were left unvoiced. Vulnerability was disavowed. Defended personae replaced relating at work and home. Disillusionment led to personal therapy where expressing vulnerability relieved alexithymia. True- and professional-self integration increased empathy. Subsequent psychotherapy training resolved defenses. Changes benefitted patients, teaching and training roles. Discussion: The Cartesian split of bio-medical training obscures identity and develops defenses. Debriefing earlier traumata was beneficial to the doctors and improved relationships. Psychological training medical practice may be reparative and prophylactic. O1.4 Comparison of quality of life between medical students and young general population
Daniel Pagnin & Valéria de Queiroz Fluminense Federal University, Niterói - Rio de Janeiro, Brazil Background: Quality of life of students can decrease in medical school. Methods: This study assessed the quality of life (WHOQOL-BREF) among 206 medical students, which was compared with that of 199 young people from a normative population, using independent t-tests. The effects of medical school phase and gender on quality of life were also assessed by analysis of variance. Findings: Medical students showed worse psychological well-being and social relationships than young people. One-half of the students revealed a low quality of life in the psychological and social domains and one-quarter of the students showed a low quality of life in the physical health and environment domains. Medical school phase did not influence quality of life, however, gender had a large effect, where female students showed worse physical and psychological well-being than male students. Discussion: Future doctors with a low quality of life may translate into poorer performance, impairing patient care. O1.5 Influence of burnout and sleep difficulties on the quality of life among medical students Daniel Pagnin & Valéria de Queiroz Fluminense Federal University, Niterói - Rio de Janeiro, Brazil Background: Quality of life can be affected by burnout and sleep difficulties. Methods: Data were collected from 193 medical students through their completion of self administered questionnaires. This survey performed hierarchical multiple regressions to quantify the effects of burnout dimensions and sleep difficulties on the components of an individual’s quality of life. The influence of confounding variables, such as gender, stress load, and depressive symptoms, were controlled in the statistical analyses. Findings: Physical health decreased when emotional exhaustion and sleep difficulties increased. Psychological well-being also decreased when cynicism and sleep difficulties increased. Burnout and sleep difficulties together explained 22% and 21% of the variance in the physical and psychological well-being, respectively. On the other hand, physical health, psychological well-being, and social relationships increased when the sense of academic efficacy increased.
Discussion: To improve the quality of life of medical students, a significant effort should be directed towards burnout and sleep difficulties.
Thematic session 2: Work stress: Impact on well-being and risky behaviors Chair: Daniel Keith Border 1 , Discussant: Anne Matthews 2 1 2
University Hospitals Coventry and Warwickshire
Dublin City University
O2.1 Stress and anxiety-related sickness absence in UK-based junior doctors: An alarming problem Daniel Keith Border 1 , Lindsay Clare Muscroft 2 , Hannah Blakey 3 , Mehtab Ahmad 4 , & Petra Hanson 1 1
University Hospital Coventry and Warwickshire (UHCW), Coventry, UK
2
South Warwickshire Foundation Trust, UK
3
Warwick Medical School, Coventry, UK
4
University of Birmingham, Birmingham, UK
Background: A pilot study surveying foundation year trainees (n=35), revealed a significant number of participant-reported sick-days relating to anxiety/stress. Here, we surveyed junior doctors nationally to better ascertain the extent of this problem resulting in more extensive, and therefore reliable, data. Methods: An anonymous, online questionnaire was sent to foundation trainees in 142 hospitals across the UK. Participation was entirely voluntary. Participants were asked about sick-leave behaviour, using yes/no questions. 1363 doctors responded. Findings: Almost ten percent (8.90%; n=121) reported knowingly taking a day off due to anxiety or stress. Additionally, 13.28% (n=180) reported taking a day off which they later attributed to anxiety or stress. Taken together, the total number of participants taking sick-days relating to anxiety/stress, equated to 17.24% (n=235). Discussion: These findings have enormous economic significance, and future work is required on methods of reducing sickness absence due to anxiety/stress in junior doctors. O2.2 The relationship between job characteristics, well-being and risky behaviour: Insights from a survey of pharmacists
Denham L Ppipps 1,2 , Kieran Walshe 3 , Dianne Parker 1,2 , Peter R Noyce 2 ,Darren M Ashcroft 1,2 1
NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, United Kingdom 2
Manchester Pharmacy School, The University of Manchester, United Kingdom
3
Manchester Business School, The University of Manchester, United Kingdom
Background: The study aim was to examine the relationship between job characteristics, well-being and risky behaviour amongst pharmacists. Methods: We carried out a cross-sectional self-report survey of 517 registered pharmacists in a region of the United Kingdom. The survey measured respondents’ ratings of job characteristics, well-being, and engagement in risky behaviour during their work. The data were subjected to principal component and path analysis. Findings: A path model including job characteristics as the independent variables, and risky behaviour as the dependent variable, provided a good fit to the dataset [CFI = 0.95; TLI = 0.93; RMSEA = 0.05]; as did one with well-being measures as the independent variables [CFI = 0.95; TLI = 0.93; RMSEA = 0.05]. The path weights varied according to the type of risky behaviour. Discussion: Our findings suggest ways in which a healthcare professional’s work environment and well-being can influence his or her performance. O2.3 Physician distress and problematic sexual behaviors: Risk factors, prevention and management James C. “Jes” Montgomery 1 , Andrew C. Stone 2 , & Philip Hemphill 3 1
Pine Grove Behavioral and Addictions Services, Hattiesburg, MS, US
2
Discovery House, Woonsocket RI, US
3
Lakeview Health, Jacksonville, FL, US
Background: The primary objective of this study is to review the available information with regard to physician boundary violations, legal consequences and outcomes of these events in the U.S. Methods: A systematic internet search of public records using a Google key word(s) search found 900 physicians who were criminally charged for inappropriate sexual behavior since 1980 (704 since 2000). Information available from public sites including newspaper accounts, board documents and consent orders were abstracted for information including: Criminal characteristics of the behavior (contact crime, non-contact crime and internet related “cyber” crime). Determination as to whether or not the patient was the victim.Evidence of substance abuse, psychiatric diagnoses and
paraphilic disorders are identified (using board orders where available). Comparisons among groups who could be licensed versus those who were not. Statistical testing for using Chi Square analysis for significance. Demographic data is also abstracted from available online records. Findings: There have been an increasing numbers of physicians who have been charged with sexual offences over the last 35+ years. The rate of suicide among these physicians has increased over the years to an even larger extent. Of the 26 physicians who committed suicide in this cohort 18 have died since 2005. Despite the hopelessness that may drive some to suicide 1/3 of physicians in this cohort were able to regain licensure on average of 3 years after initial board action. With over 2500 practice-years since re-licensure only 30 individuals had subsequent disciplinary action, 6 were for repeat inappropriate sexual behavior. Discussion: The goal of this presentation is to discuss the significance of known sexual boundary violations in terms of its impact on the medical profession and the clinician. By looking at specific numbers, including a suicide rate roughly double that of the general population, risk factors and prevention strategies may be elucidated and discussed. In addition, the presenters will review the factors that help identify predatory behavior as opposed to self-destructive behavior and the various treatment components that have historically allowed safe reintegration into medical practice when appropriate. Reflecting on the interventions and successful reintegration as well as emphasizing the self-care aspects of maintaining boundaries will delineate the potential of prevention and treatment. O2.4 "Switch on" strategies before shift work in nurses: Effects on work performance and well being Georgios Manomenidis & Efharis Panagopoulou Department of Medical School ,Aristotle University Thessaloniki Background: Little is known about the "switch on" strategies nurses use before the beginning of shift work, in order to prepare for work. Methods: This behavioral diary study examined the impact of switch on strategies on performance and well being. Forty Greek hospital nurses completed behavioral diaries at the end of the morning shift. Diaries assessed switch on strategies, psychological strain, burnout, dissonance, mood and performance. Findings: The results of the study indicated an effect of mentally preparation strategies on nursesâ&#x20AC;&#x2122; performance and well being. Discussion: Psychological preparation for work is important for patient safety and health professional well being
O2.5 Stress and absenteeism in mental health nursing: Development and empirical test of a process model Kathryn Melling Bradford Institute for Health Research Background: Stress related absenteeism is costly to the NHS with previous research failing to explain the process of stress-to-absenteeism. We aim to address this gap with the use of a qualitatively driven study addressing the following questions: How is stress manifested, mediated & moderated? What process do individuals follow? Do quantitative data support factors & pathways in this process? Methods: Using a sequential mixed method design we interviewed 15 mental health nursing staff to develop a process model of the stress-absenteeism relationship using Grounded Theory analysis. We will then develop a questionnaire and survey 350 staff to validate this process model using structural equation modelling. Expected Results: Empirically tested process model of the stress-absenteeism relationship, associated contributory factors and outcomes. Current stage of work: Concluding qualitative analysis. Contribution: An empirical framework and practical tool in assisting NHS managers in tackling stress and absenteeism, enhancing staff wellbeing and quality of patient care.
Thematic session 3: Working in a healthcare setting: Demands and expectations Chair: Anna Schneider 1 , Discussant: Jennifer Bremner 2 1
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University Hospital 2
European Health Management Association
O3.1 An analysis of ‘free’ labour in junior doctors in the UK National Health System (NHS): “Goodwill Working” Daniel Keith Border 1 , Hannah Blakey 2 , Petra Hanson 3 , & Lindsay Clare Muscroft 4 1
University Hospital Coventry and Warwickshire (UHCW), Coventry, UK
2
Warwick Medical School, Coventry, UK
3
University Hospital Coventry and Warwickshire (UHCW), Coventry, UK
4
South Warwickshire Foundation Trust, UK
Background: We know anecdotally that doctors provide significant amounts of ‘goodwill hours’ (overtime for no extra pay). Here we studied foundation trainee (year 1 and 2 post-graduation) junior doctors’ behaviour, with respect to finishing time. Methods: An anonymous, online questionnaire was sent to foundation trainee junior doctors in 142 trusts nationally. Participation was entirely voluntary. Participants were asked, using Likert-scale questioning, about their behaviour relating to leaving work. 1363 doctors responded. Findings: A staggering half of doctors reported leaving work up to 1 hour late (50.81%; n=692). A further 24.60% (n=335) left work up to 2 hours late. Finally, 3.74% (n=51) of those surveyed reported leaving more than 2 hours late. Discussion: In already-stretched health services, these findings have great significance, both in terms of Junior Doctor well-being and health economics, and the benefit of extra hours worked should not be underestimated. O3.2 Burnout amongst physicians in palliative care in France: Impact of working conditions Soazic Dréano-Hartz, Marilène Filbet
Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon Background: Palliative care physicians have to deal with end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. This study aims to identify the impact of their working conditions. Method: A questionnaire including the Maslach Burnout Inventory, socio-demographic and professional data was sent to all the 590 physicians working in palliative care. Findings: The response rate was 61, 8%, 27 (9%) participants showed a high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalisation, 71 (18%) felt low personal accomplishment. Physicians working in Palliative Care Mobile Team tended (p=0,051) to be more likely to suffer from emotional exhaustion than their colleagues. They are working in smaller teams (fewer physicians (p<0.001) and fewer non physicians (p<0,001)). Discussion: The prevalence of burnout in palliative care physicians was lower than that reported in other populations. Loneliness could be a risk. O3.3 IMPACT of physicians work environment on physicians’ strain and perceived quality of care: A prospective study among hospital physicians Matthias Weigl, Tanya Krämer, & Anna Schneider Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University Hospital Background: Adverse psychosocial work conditions affect physicians’ strain. This may eventually also adversely influence care quality. However, prospective research on this potential causation is scarce. We aimed to investigate the causal relationships between work stressors, strain and perceived quality of care among hospital physicians. Method:Two-wave panel design (1year time lag) with N=95 hospital physicians (51.6% male, mean age 39.83 years) was established. Standardized questionnaires were applied. After testing for panel attrition, hypotheses were tested using structural path modelling. Results: Physicians work stressors predicted perceived quality of care over time. Additionally, we observed a reversed effect over time from quality of care to time pressure. Physicians strain did not mediate those relationships. Discussion:We observed reciprocal effects between physicians work conditions and diminished quality of care. Our findings emphasize that further understanding is required of how workplace constraints affect job demands and quality of care.
O3.4 Different causation in the Job Demands-Resources Model: A 9-year study in physicians across three waves Anna Schneider 1 , Matthias Weigl 1 , Severin Hornung 2 , Jürgen Glaser 2 , & Peter Angerer 3 1 Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany 2
Institute for Psychology, Leopold-Franzens-University, Innsbruck, Austria
3
Institute for Occupational and Social Medicine, Center for Health and Society, HeinrichHeine-University, Düsseldorf, Germany Background: Work life of physicians determines their well-being and performance. Our study tested different causal directions in the associations between challenge and hindrance demands, job resources, and employee mental well-being. Methods: Data originated from a panel study of N = 400 physicians over nine years in Germany with three waves (two plus seven year time lags). Study variables were assessed with standardized questionnaire scales. Causal, reverse, and reciprocal associations were estimated using structural equation modelling. Findings: Hindrance (organizational constraints) and challenge demands (time pressure) showed significant causal and reverse relationships with burnout and work engagement over time. However, observed relationships were ambiguous. Job resources (autonomy) at T1 positively predicted depersonalization at T2. Discussion: Our results show a dynamic interplay of physicians’ work life and well-being over time with a differential impact of challenge and hindrance demands on physicians’ well-being. Our findings may contribute to assessments and evaluations of hospital physicians’ work conditions. O3.5 Disclose or not to disclose? A qualitative study Debbie Cohen, & Sarah Winstanley School of Medicine, Cardiff University Aims: To understand the ‘tipping point’ for physicians in their decision to disclose mental ill health to the workplace. Method: A 3-stage study. Stage One (completed) was a questionnaire study (1% UK doctors) to understand the obstacles and enablers to disclosure of mental ill health. Stage Two reported here, informed by Stage One is a qualitative in depth study of 42 interviews with doctors recruited through multiple channels across the UK.. Thematic analysis was applied to data collected through face-to-face and telephone interviews.
Findings: A doctorâ&#x20AC;&#x2122;s decision to disclose is finely balanced by their confidence in local support structures, insight into their ill health and regulatory and employment policies. Discussion: Understanding the obstacles and enablers to disclosure and how to engender better decision-making will improve physician health and patient safety. Stage Three of this study will develop a simple shared decision-making tool to support earlier disclosure.
Thematic session 4: Medical stories Chair: Brian Stafford 1 , Discussant: Irina Todorova 2 1
WHO Patient for Patient Safety Champion; Director of Patient Affairs, ISCOME; Human Reserach Ethics Committee, Sir Charles Gardiner Hospital 2
Northeastern University
O4.1 O, death, where is thy sting? Using Grounded Theory analysis to unravel humans’ death beliefs Robin Lynn Treptow Fielding Graduate University Rationale: It is oft believed that bodily functioning—such as agility and muscle tone—inevitably declines with age. In contrast, exercise physiology and nursing data suggest disuse induces muscle flaccidity. What’s up? This physical therapy (PT) case offers rare insight to discern wherein the answer lies. Context: Pain-induced insomnia, restricted range-of-motion, impeded daily living tasks, “your body was ten years younger then”. I understood how people grow old. “Frozen shoulder” (adhesive capsulitis) held me captive. What to do? Seek a PT referral; do what she says. Circa half-a-dozen visits across six months later my shoulder functioned normally. Psychologist-participant mental data augments PT treatment records to grant unique access to physical/mental healing processes. Contribution to the field: This exemplar provides integral tacit knowledge about restored prior agility commensurate with PT intervention. It interweaves practitioner expectations—“You’re going to make me [the PT] look good!”—with a hopeful psychologist-patient’s regimen compliance. O4.2 The ‘Letters to No-One’ and the medical legacy of a Glasgow general practitioner Kenneth Collins University of Glasgow Family doctors must be flexible and resilient, able to deal with the pressures of medical bureaucracy, health service funding and a heavy workload while displaying a determined, positive and caring attitude. Retirement can mark a difficult transition from a respected and hectic
professional life to an uncertain and different future. The ‘Letters to No-One’, found after the death in 2007 of Glasgow general practitioner Dr. Hetty Ockrim and her highly innovative oral history project, conducted after retirement in 1989 form a medical legacy of dramatic significance. Together, the Letters and her interviews of over seventy former patients and practice staff tell a compelling story of the history of family practice over half a century prior to her retirement. Through illustrative vignettes this paper highlights the relationship between patients and doctor while indicating the personal skills which mark a conscientious, dedicated and empathic doctor. O4.3 A balanced partnership for better outcomes; for clinicians & for patient safety Brian Stafford WHO Patient for Patient Safety Champion; Director of Patient Affairs, ISCOME; Human Reserach Ethics Committee, Sir Charles Gardiner Hospital When issues of patient safety are considered it is imperative to take into account the patient’s experience. I was in of the speakers at a public forum in Switzerland where I represented the patient voice with a position that the patient had the right to know immediately a medical error occurred. I was struck with one patients’ story of experiencing unintended medical harm. 5 years after the event of the medical error the physical harm done had been corrected. However, the patient was left an emotional cripple. The emotional injury was a blight on her life and the lives of her family. Moving forward in the first instance would be to understand that when medical harm is experienced by the patient it can be such a violation to the integrity of the self that the emotional damage is greater that the physical harm done. O4.4 Physicians’ stress of managing hope with reality in caring for dying patients William R. Grace, Heidi Mandel, David Langer, & Steven Mandel Lenox Hill Hospital and North Shore-LIJ Health System Rationale: For patients with advanced disease, the determination of treatment goals and quality of care causes significant stress for the physician and family. A fine line exists between maintaining trust and unrealistic hope. Self-reflection insures that professional boundaries are not crossed. Context: An oncologist cared for an only child with advanced cancer for several years. The patient and her parents sought increasingly aggressive treatments, despite the poor prognosis. A dynamic developed between the parents and the oncologist in which the physician, despite ambivalence, accepted gifts from the parents, as the treatments proved more unsuccessful. After the patient’s death, the parents initiated a lawsuit against the oncologist for the death of their daughter.
Contribution to the Field: In caring for dying patients, the physician must be mindful of his own “rescue fantasy” which impacts the vulnerability of the family at the end of life. Self –reflection enables the physician to confront this. O4.5 Legal aid for health professionals - The “Legal Emergency Kit” Leopold-Michael Marzi Head of Legal Department, AKH Vienna Hospitals are open twenty-four hours and errors, especially malpractice, can happen day and night. But only bigger hospitals have a legal department and most of the others do not really need one for everyday life.Very often health professionals do not know how to react in case of malpractice or emergency from a legal point of view. Sometimes they make errors after the event which could be avoided easily. The patient or his family contact a lawyer immediately, but who helps the health professionals to cope with the case?The Vienna General Hospital is one of the biggest hospitals not only in Europe, but also in the world. I has an own legal department since 1989.In the year 2000 the project “Risk Management” was initiated by the head of the legal department in order to reduce the cases of malpractice. The aim at this time was: “Minus 50% concerning cases and more than 50% concerning costs in ten years (2010).”In the year 2010 the aim was reached, but how did it work?Every case was analysed by the legal department and also by the insurance company. If necessary and possible, amendments were made in order to avoid such errors and damages in the future.In the years 2005 to 2007 the legal department of the Vienna General Hospital in cooperation with the Vienna Insurance Group also created a totally new form of quick help: the socalled “Legal Emergency Kit”. It represents a handy plastic case, which is labelled accordingly and on which a paragraph is stamped. There are about 500 of these kits in all departments of the Vienna General Hospital and every employee must be able to access such a plastic case within one minute from the workplace. Like a Medical Emergency Kit it contains the most important information that is needed: What are the facts? Who has to be informed? What can be done to minimize the damage? How can I get the necessary legal support, even during the weekend? It is very well known that in dangerous situations there can be a second victim: one or more health professionals that are involved in the case, making errors after the event. In order to avoid negative consequences the Vienna General Hospital made it possible to get legal support even during the weekend and late in the evening. The legal practitioner of the Vienna General Hospital can be called at any time via mobile phone. If necessary he comes to the hospital, in most cases he tells the health professionals what has to be done over the phone. These measures taken by the hospital also were very well supported by the insurance company. There are about twenty calls during the weekend and in the late evening every year sine 2007. All reported cases could be settled out of court. Some events were reported to the legal department (and also to the insurance company)
before the operation was finished. Not a single case was mentioned in a newspaper or any other mass media, because the case was handled in a right way, even for the patients and their families.
Thematic Session 5: (How) can physicians influence patient safety? Chair: Hardeep Singh 1 , Discussant: Rebecca Lawton 2 1 2
Houston VA Health Services Research Center
University of Manchester
O5.1 The “safety architect” role of the attending physician on the wards Jane B. Lemaire 1 , Alicia Polachek 2 , Kristin Desjarlais-deKlerk 3 , & Jaya Dixit1 1
University of Calgary
2
W21C Research and Innovation Center, University of Calgary
3
Medicine Hat College
Background: Attending physicians are accountable for both patient care and medical education. In this presentation we explore the safety behaviors and duties embodied in this important role. Methods: To answer our research question, we used a modified ethnographic approach involving 93.5 hours of observations of 24 physicians. Following all observations, inductive thematic analysis was conducted by multiple experienced qualitative researchers. Findings: “Safety architect” was a dominant role dimension across sub-themes. Researchers observed attending physicians protecting patients by reviewing learners’ work with them and conducting solo background checks; promoting physical safety by using infection control protocols; safeguarding patient information by ensuring information exchange in private, confidential settings; using routines and rituals in patient care and teaching as virtual safety checklists; and fostering safe emotional environments for learners through adequate supervision and support. Discussion: The “safety architect” role dimension has a broad scope requiring additional training for attending physicians. O5.2 Emotional exhaustion: Outcome or antecedent of teamwork and patient safety? A longitudinal study Annalena Welp 1 , Laurenz L. Meier 1 , & Tanja Manser 2 1
Department of Psychology, University of Fribourg, Switzerland
2
Institute for Patient Safety, University Hospital Bonn, Germany
Background: Reduced occupational well-being in clinicians is often viewed as an outcome of ineffective teamwork that poses a threat to patient safety. However, these causal assumptions have not yet been tested longitudinally. Methods: Participants in this study were 2100 nurses and physicians working in 55 intensive care units. They answered a questionnaire on emotional exhaustion, cognitive-behavioral and interpersonal teamwork, and patient safety. Analyses were conducted using cross-lagged structural equation modelling. Findings: Analyses revealed that emotional exhaustion had a negative impact on interpersonal teamwork, whereas cognitive-behavioral teamwork exerted a positive effect on patient safety. In addition, we found a reciprocal relationship between interpersonal and cognitive-behavioral teamwork. Discussion: Clinician emotional exhaustion is thus a predecessor of interpersonal teamwork and connected to patient safety via the reciprocal relationships between interpersonal and cognitivebehavioral teamwork. Consequently, when managing teamwork and patient safety, it may be even more important to reduce clinician emotional exhaustion first. O5.3 Features of computer-based patient decision aids: Systematic review, thematic synthesis, and meta-analyses Ania Syrowatka 1,2 , Dรถrthe Krรถmker 3 , Ari N Meguerditchian 1,4,5 , Robyn Tamblyn 1,2,6 1
Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
2
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada 3
McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada 4
Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
5
Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
6
Department of Medicine, McGill University, Montreal, QC, Canada
Objectives: To identify features that have been integrated into computer-based patient decision aids, and to assess whether specific features improve quality of decision making. Methods: Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. A thematic analysis and meta-analyses with tests for subgroup differences were conducted to synthesize the data.
Results: 58 studies were included in the thematic analysis. A subset of 26 was used to conduct the meta-analyses. Overall, knowledge and decisional conflict improved when providing content control (p=0.008, 0.42, respectively), but were negatively affected by tailoring (p=0.08, 0.07, respectively) or patient narratives (p=0.26, 0.005, respectively). Results varied for explicit values clarification, feedback, and social support based on how the features were implemented. Conclusions: This study provides preliminary evidence for integration of specific features into patient decision aids. Future research can focus on clarifying independent contributions of features, and refining designs of features to improve effectiveness. O5.4 Healthcare staff wellbeing, burnout, and patient safety: A systematic review Louise Hall University of Leeds and Bradford Institute for Health Research Background: The primary objective is to determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. The secondary aim is to explore whether wellbeing or burnout is more strongly associated with patient safety. Methods: Four online bibliographic databases were searched on 20/07/2015 using both keyword and MeSH terms. 12031 articles were initially identified, with 34 meeting the eligibility criteria for inclusion in the final review. Findings: The majority of studies found that burnout and wellbeing were significantly associated with errors and/or poor patient safety culture (52% and 59% of studies, respectively). Discussion: This review illustrates the need for organizational change to provide safer work environments, along with interventions within the workplace to improve employees’ mental health, and subsequently improve patient care. Furthermore, the need for studies with prospective designs, and within Primary Care facilities is highlighted. O5.5 New issues on patient safety in relation to patient safety and medical education Karen Morgan RCSI Department of Psychology & The Faculty of Health Sciences, Royal College of Surgeons in Ireland Ensuring patient safety is a priority for healthcare professionals. However integrating this new discipline into medical education has been difficult, as highlighted by the recent UK General Medical Council report (‘First, do no harm’)1. The World Health Organisation (WHO) Multiprofessional Patient Safety Curriculum Guide2 highlights the importance of addressing the areas of
inter-professional working, governance and quality improvement as key priority areas for improving patient safety. The WHO guide also emphasises the need to understanding error and the role of the individual, as well as systems, in contributing to health error and adverse events. Medical schools have identified patient safety as a core competency for their graduates and are engaged in efforts to formal document patient safety training throughout the under and post-graduate curricula. RCSI have integrated patient safety to the Health Sciences curriculum over the past decade, incorporating the WHO curriculum on patient safety alongside inter-professional applied group work.
Thematic Session 6: When the glass is half full: Nurturing positivity in the workplace Chair: Renée Scheepers 1 , Discussant: Ana Margarida Passos 2 1
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 2
BRU-IUL, Instituto Universitário de Lisboa (ISCTE-IUL), Portugal
O6.1 Using positive organizational scholarship to promote interprofessional teamwork and foster clinician well-being Julie Haizlip University of Virginia Schools of Nursing & Medicine Background: Healthcare education and practice have a tendency tο focus on the negative: ruling out the worst-case scenario anticipating what could go wrong. While this way of thinking is essential to prevent bad outcomes, it predisposes us to focus on the negative and threatening in all aspects of life and can permeate interprofessional relationships leading to dysfunctional teams and burnout. New Idea: Creating interprofessional teams that are supportive and nourishing could buffer the effects of everyday stressors on clinicians. The discipline of positive organizational scholarship (POS) promotes the creation of high performance organizations through strategies such as developing high quality interpersonal connections, encouraging prosocial behavior, and fostering meaning and positive emotion. These principles could be used to stimulate interprofessional discussion and promote the formation of high functioning teams. Contribution to the field: High performing interprofessional teams can be created using POS strategies and could enhance individual clinician well-being. O6.2 Job resources, physician work engagement and patient care experience Renée A. Scheepers 1 , Lenny S. S. Lases 1 , Onyebuchi A. Arah, 1,2,3 , Maas Jan Heineman 1,4 & Kiki M. J. M. H. Lombarts 1 1
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 2
Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States
3
UCLA Center for Health Policy Research, Los Angeles, California, United States
4
Member of the Board of Directors, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Background: Physician work engagement is associated with better work ability and less medical errors. It is however unclear whether work-engaged physicians also perform better from the patient perspective. Work engagement is advanced by job resources, i.e. autonomy, collegial support, participation in decision making and learning opportunities, yet this is understudied for physicians. Objectives: This study investigates associations of physician work engagement with (a) patient care experience and (b) job resources. Methods: Patient care experience was measured with 9 validated items from the Dutch Consumer Quality index. Physicians reported job resources using 13 items of the Questionnaire on Experience and Evaluation of Work and work engagement with the validated 9-item Utrecht Work Engagement Scale. Results: 4573 patients (47%) and 192 (80%) of their consulting physicians participated. Physician work engagement was positively associated with autonomy (B = 0·34, 95% CI = 0·14 – 0·54, P value = 0·001), learning opportunities (B = 0·33, 95% CI = 0·10 – 0·56, P value = 0·006), yet not with patient care experience (B = 0·01, 95% CI = -0·01 – 0·04, P value = 0·361). Conclusions: Although work engagement previously showed to well affect patient care, physicians’ work engagement levels seem not to translate in better care according to patients. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From physicians’ perspective, autonomy and learning opportunities could safeguard or enhance their work engagement. These could be optimized in order to facilitate physicians’ coping with the challenging demands of modern patient care. O6.3 Job engagement in Bulgarian hospitals: Implications for burnout and quality of care Irina Todorova 1 , Elitsa Dimitrova 2 , & Anna Alexandrova-Karamanova 3 1
Northeastern University
2
Institute for Population and Human Studies – Bulgarian Academy of Sciences, Department of Demography, Sofia, Bulgaria 3
Institute for Population and Human Studies – Bulgarian Academy of Sciences, Department of Demography, Sofia, Bulgaria Background: Work engagement is an important for health providers’ wellbeing and effectiveness. We address the role of work engagement for burnout and quality of care in Bulgaria.
Methods: Healthcare professionals in the ORCAB study were physicians, residents, and nurses (N=403). We use a constructed scale for Work Demands - Physical, Emotional, Organizational and Cognitive; The Maslach Burnout Inventory - Emotional exhaustion and Depersonalization; Job Engagement (UWES) – Dedication and Vigor; and Quality of care (Shanafelt et al., 2002). Results: In multiple regression analysis, controlling for demographics, the direct predictors of burnout were organizational, physical and emotional work demands, and of suboptimal care - organizational and emotional work demands. Work engagement was a direct predictor of burnout and suboptimal care; it was also shown to mediate the effect of the relevant work demands on burnout and suboptimal care. Discussion: The Discussion expands on the role of engagement for burnout and quality of care. O6.4 Promoting team effectiveness in the Portuguese healthcare centers: Does leadership make a difference? Ana Margarida Passos 1 , Diana de Sousa Morais 1 , Patrícia Lopes Costa 1 , Catarina M. Santos 1 , & Pedro Marques-Quinteiro 2 1
BRU-IUL, Instituto Universitário de Lisboa (ISCTE-IUL), Portugal
2
William James Center for Research, Lisboa, Portugal
Background: Today, it is relatively consensual the team effectiveness is strongly influenced by a number of cognitive, affective, motivational and coordination processes and emergent states (e.g., Zaccaro, Rittman & Marks, 2001). Also in healthcare organizations teamwork has been emerging as a key component of quality of care and patient safety (Costa et al., 2014). However, the number of studies on team effectiveness in the healthcare context is still very low. Portugal is no exception. This study was run within a larger national project called “Health at the Center” and aimed to investigate how team explicit and implicit coordination processes affect the relationship between leadership processes and team effectiveness. Method: A total of 30 healthcare centers (245 individuals) participated in this study. We collect data through a questionnaire from doctors (30%), nurses (42%) and other health professionals (28%). Findings: To test our hypotheses all individual answers were aggregated to the team level. We computed Rwg(j) and ICC to justify aggregation. Globally, the results from mediation analysis support the hypotheses concerning the direct influence of leadership (b=.49, p<.05) and team implicit (b=.38, p<.05) and explicit coordination (b=.22, p<.05) on tem effectiveness. The results also support the hypothesis that the explicit coordination is mediating (partial mediation) the relationship between team leadership processes and team effectiveness. We did not find support for the mediation role of implicit coordination.
Discussion: Leadership and team coordination processes seem to be fundamental to the effectiveness of the health centers. However, while explicit coordination strengthens the leadership processes, implicit coordination mechanisms might works as substitute of leadership. These results underline the importance of teamwork in health centers and reinforce the need to promote leadership development and training within this context. O6.5 Dimensions of engagement for staff providing support for individuals with dementia and their caregivers Hope Turner, Irina Todorova, Carmen Castaneda-Sceppa, & David Young Northeastern University Background: The purpose of the study was to gain understanding of the dimensions of â&#x20AC;&#x153;engagementâ&#x20AC;? for nurses and care managers at a long term services and supports (LTSS) company, Caregiver Homes. The concept of engagement has been explored for different health professions, and its role in sustaining well-being has been well illustrated. Methods: We conducted semi-structured interviews with nurses and care managers (n=24). Interviews asked about staff experience, confidence, challenges and sources of fulfillment. They were recorded and transcribed verbatim; we used Thematic Analysis with a phenomenological lens. Findings: The themes of professional engagement were the relational skills of empathy, inclusiveness, and skillful communication; the attitudes of flexibility, self-reflectiveness, and enthusiasm; and the motivating factors of meaning, purpose, creativity, and dedication. We also address challenges to engagement. Discussion: Understanding the specifics of engagement in this context can support successful services to clients and caregivers; interactions between co-workers and professional growth.
Sa turday 21/5/2016 Thematic session 7: Towards integrative education in medicine Chair: Jo Hart 1 , Discussant: Mohammadreza Hojat 2 1
University of Manchester
2
Thomas Jefferson University, Sidney Kimmel Medical College
O7.1 Mindfulness for pre-clinical medical students Sarah C. Shepherd, Claire Mimnagh, Jo Hart , Mary Walsh University of Manchester Background: This study aims to evaluate mindfulness with medical students. Methods: Year 1 and 2 invited to 5 sessions of Mindfulness. Measures taken pre and post: Maslach Burnout Inventory Student Survey (MBI-SS), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and General Self-Efficacy Scale (GSE). Analysed using Wilcoxen signed rank test. Focus group run 1 month post, analysed using framework. Follow up measures collected October 2015, 6 months post. Findings: 33 participants, 22 completed both sets of measures. -MBI-SS: Pre-mindfulness 50% ‘burnt-out’ post-mindfulness 4%. -WEMWBS: Mental Well-being increased (z = -3.554, p = <.001, r = 0.55). -GSE: Self-efficacy increased (z = -2.274, p = < .023, r = 0.34) Themes from the focus group (n=7): -Verbalising ‘stress/pressure’ with colleagues was OK. -Felt more aware of thoughts and their impact on behaviours. -Acknowledgement of ‘stress’ from the Medical school important. Discussion: Positive experiences reported. Further study needed.
46
O7.2 Introducing narrative medicine to the scientific and clinical mind Evangelia Lazaris University of Utah School of Medicine The incorporation of Narrative Medicine into medical education has been sought out as a way to both establish a standard of narrative and cultural humility among health care providers and to present the providers with an option for their own selfcare. In 2014, I designed a series of writing workshops for medical students and worked toward the integration of Narrative Medicine into the pediatric residency curriculum at the Keck School of Medicine of the University of Southern California. Despite the scientific mind of the clinician, both groups clearly saw the benefits of narrative training in their careers. Most stated that critical analysis of literature and art was valuable in truly understanding their patients, and that the simple act of reflective writing significantly improved their mental health. Though it may be out of the scope of basic medical sciences, Narrative Medicine has helped the essence of medicine resurfaceâ&#x20AC;&#x201D;the personal narrative. O7.3 Narrative medicine for self-care and teambuilding in a dialysis unit Elizabeth J. Berger, Heidi Mandel, Alice Fornari, Kenar D. Jhaveri, Rita A. Charon North Shore-LIJ Health System and Hofstra North Shore-LIJ School of Medicine, NY Columbia University in the City of New York Background and Introduction: Burnout is considered prevalent among staff members in the highstress clinical setting of dialysis units. Narrative medicine employs facilitated close reading and reflective writing to deepen awareness and improve relationships in healthcare. A narrative medicine pilot was implemented to promote self-care and teambuilding in a single center dialysis unit. Methods: A three-month curriculum of weekly sessions (a.m. and p.m. offering times) accommodated work schedules of the interprofessional healthcare team. The intervention included presentation of literature, discussion, ten minutes of writing to a prompt and group sharing with stipulated confidentiality. Data collection was quantitative and qualitative: electronic survey; focus group and principal investigator interview transcripts. Findings: Pleasurable; increased cross-professional understanding. Stories inspired, motivated and were recalled during the clinical encounter. Precedence of patient care was a logistical factor affecting participation
Discussion: Quarterly narrative medicine sessions were identified as desirable, with positive implications for many stress-prone clinical settings. O7.4 Medical traineesâ&#x20AC;&#x2122; reflections on treating chronic pain: Implications for improved patient well-being through teaching empathy Kathleen Rice University of Toronto The importance of empathy for good clinical practice is widely recognized. While, a growing body of survey data suggests that medical trainees become less empathic towards chronic pain patients over the course of their training, the contextual factors that lead to this decline in empathy remain poorly-understood. As part of an Institutional Ethnography (IE) examining chronic pain care in Ontario, we interviewed thirteen Canadian medical students and residents about their experience treating patients with chronic pain, and their reflections on the importance of empathy for clinical practice. Our findings suggest that trainees find chronic pain patients challenging because the pain experience is subjective, and because chronic pain often cannot be cured. Moreover, a number of trainees reflected that teachers and preceptors had shielded them from exposure to chronic pain patients, and had implied that these patients are not valuable educationally. In this paper we suggest that trainees implicitly learn that chronic pain patients have limited educational value precisely because they often cannot be cured of their pain. As such, they are not useful in teaching the primary goal of medicine, which has historically been to cure. Drawing on both these interviews, and wider data set collected as part of the IE, we take issue with this assumption. Instead, we show that because the pain experience is private, and because pain cannot be cured, chronic pain patients present an excellent opportunity to teach empathy in clinical practice. O7.5 Improvement of empathy in undergraduate medical students in Japan Sayaka Kamio School of Medicine, Kyorin University, Tokyo, Japan Aim: This study researches improvement of empathy in Japanese medical students during undergraduate course. Background: Although previous studies indicated decreasing empathy during medical education, recent studies explored that Japanese medical students keep empathy throughout undergraduate study. However, it has not fully understood why the empathy in Japanese medical students have not decreased.
Methods: Japanese undergraduate medical student (N=101) participated in quantitative and qualitative researches. First, all participants answered a questionnaire with Jefferson Scale of Empathy. Second, their empathy in studying history-taking in English as second language (ESL) were assessed. Third, selected subjects (N=12) participated in semi-structured interview. The data were analyzed performing the structural equation modelling. Findings: Metacognition skill to manage anxiety in studying clinical communication in ESL positively influence on the improved empathy. Discussion: Developing metacognition skills throughout clinical communication in second language and managing anxiety in studying clinical communication contribute to improvement of empathy in undergraduate medical students.
Thematic session 8: Health professional well-being threats and challenges Chair: Margaret Kay 1 , Discussant: Jane Lemaire 2 1
Discipline of General Practice, School of Medicine, The University of Queensland
2
University of Calgary
O8.1 Caring for doctors – Listening to the doctor-patient narratives Margaret Kay Discipline of General Practice, School of Medicine, The University of Queensland Background: The medical literature holds many personal illness narratives published by doctors. Understanding these experiences can provide an evidence-base to improve the quality of health care provided to doctor-patients. Methods: A systematic review of the literature identified illness narratives written by doctors. The data were interrogated using critical discourse analysis. Information about the doctor-patients’ illness experiences were extracted. The patient-centred consultation method (PCCM) provided a framework for the interpretation of the findings. Findings: Over 260 narratives were identified and key themes included becoming a patient, the care delivered and impact of illness. Experiences were contexualised using the PCCM providing a rich understanding of the professional cultural issues influencing the care doctors receive. These findings are used to re-interpret current assumptions that underpin the literature’s representations of doctors and their health. Discussion: Though confronting for the medical reader, doctors’ narratives can provide insights that can inform the future training of doctors-for-doctors. O8.2 The role of self esteem in medical decisions: The god complex Evangelia Tsiga & Efharis Panagopoulou Department of Medical School, Aristotle University Thessaloniki Background: Physician personality is considered one of the individual characteristics that contribute, along with professional and organizational factors, to physician wellness. Self esteem is a personality characteristic which is involved in the process of choosing to become a doctor and
plays an important role during all the stages of a physician's professional development. However, not much is known about whether or not physician self esteem may affect physician wellbeing. The purpose of this study was to investigate certain physician personality characteristics, such as self esteem and professional self esteem and their determinants, as well as to see if there is a relationship between these personality traits and burnout. Methods: An on-line questionnaire was administered to GPs practicing across all (both public and private) primary care settings in Greece. An 8-item questionnaire was developed to measure GPâ&#x20AC;&#x2122;s professional self esteem while general self esteem was assessed using Rosenberg Self Esteem Scale. Burnout was measured with the Maslach Burnout Inventory (MBI). 135 GPs participated at this study, 66 (48.9%) men and 69 (51.1%) women. Results: Male doctors were found to have higher self esteem than their female colleagues (p<0.001), and GPs were found to have higher self esteem comparing residents (p<0.05). Self esteem was positively correlated with professional self esteem (RPearson= 0.284, p<0.01). Self esteem had a negative correlation with both emotional exhaustion (RPearson=-0.376, p<0.001) and depersonalization (RPearson= -0.376, p<0.001). Professional self esteem was also negatively correlated with emotional exhaustion (RPearson= -0.369, p<0.001), and depersonalisation (RPearson= -0.360, p<0.001), (table 5). Almost 30% of the sample scored high for both emotional exhaustion and depersonalization. Conclusion: General self esteem and professional self esteem were found to protect GPs from burnout. Since burnout has been related to medical errors there is need for further investigation in order to confirm if building self esteem could be a core dimension in physician resilience and patient safety programs. O8.3 On-call stress among Finnish anesthesiologists Pirjo Lindfors 1 , Kari Nurmi 2 1
Hjelt-Institute and Helsinki University Central Hospital, Deparment of Anesthesia and Intensive Care 2
Helsinki University
Background: Very little is known about physiciansâ&#x20AC;&#x2122; night duties and related health problems. We investigated on-call stress and its consequences among anesthesiologists. Methods: A double-mail questionnaire was sent in 2004 to all working Finnish anesthesiologists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. Results: The anesthesiologists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and
combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18% vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Conclusions: Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave. O8.4 Discrimination Bullying and Sexual Harassment (DBSH). Where next for medical leadership? Professor David J Hillis Chief Executive Officer, Royal Australasian College of Surgeons Background: Concerns about discrimination, bullying and sexual harassment have been long standing and despite significant legal reform remains prevalent in the health sector. The Royal Australasian College of Surgeons (RACS) undertook substantial consultation to develop a path of cultural change to address the issue. Methods: RACS undertook a prevalence survey of its members, organisational surveys of hospitals around Australia and New Zealand, collected individual narratives, provided online facilitated discussion forums and received submissions to a broadly distributed issues paper. Findings: 47% (3516 of 7431) responded to the prevalence survey, 33% (117 of 352) responded to the organisational survey, 414 individuals contributed individual narratives and 8% (646 of 8247) engaged with the online discussion. 49% of surgeons and 71% of hospitals report DBSH. Discussion: RACS is now responding to the forty two recommendations that have been made by the reference group. These aim to produce comprehensive and sector-wide change O8.5 Does Resilience support Positive Deviance within Healthcare? Lesley Dewhurst 1 , Laura Sheard 1 , Rebecca Lawton 1 & Lisa Pinkey 1
Bradford Institute for Health Research, Bradford NHS Teaching Hospitals
Background: Scarce resources and increased requirements in health and safety within healthcare require more than just workforce change. This research explores the role positive deviance has within elective hip and knee surgery wards and identifies that resilience is central to achieving outcomes.
Methods: A qualitative study of clinical practices involving 45 NHS staff from 2 NHS Trusts Focused ethnography; focus groups, non-participant observation & framework and analysis. Expected Results: Key issues at system, clinical and individual level where resilience is positively deviant in that it maintains or increase success within the system. Current stage of work: Analysis of observational data and follow up interviews Discussion: Findings will inform healthcare systems and service delivery, and support structures.
Thematic session 9: is formal education enough? Skills and competencies in clinical practice Chair: Karolina Doulougeri 1 , Discussant: Aneez Esmail 2 1 2
University of Macedonia
Institute of Population Health, University of Manchester
O9.1 What does it take to be a good doctor? The meaning of professionalism among hospital doctors. Tuva Kolstad Hertzberg 1,2 Helge Skirbekk 2 , Olaf Gjerlow Aasland 3 , Reidar Tyssen 2 , Karin Isaksson Ro 1,2,3 1
Modum Bad Hospital, Vikersund, Norway
2
Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway 3
Institute for Studies of the Medical Profession, Oslo, Norway
Background: There is an extensive literature on the ideals of professionalism but what does this imply for hospital doctors? Methods: 7 semi-structured focus groups and 3 in-depth interviews of hospital doctors (chief specialists/senior house officers, internal medicine/surgery/psychiatry, central/rural hospital) N=48, 56% women. Analyzed by systematic text condensation (Giorgi). Findings: “Professional dedication” demonstrated by “long hours at work” and “large work capacity” emerged as important themes on what it takes to be a ‘good doctor’. Work capacity defined as the willingness to extend oneself towards becoming more efficient and being more present at work. Discussion: The norm for being a good hospital doctor was more associated with long hours and sustained efficiency and less with content and performance. This could have implications both for quality of health care and the wellbeing of doctors. O9.2 Association between humanities exposure and medical students’ personal qualities: A multi-institutional survey
Salvatore Mangione 1 , Elizabeth Cerceo 2 , Chayan Chakraborti 3 , Megan Voeller 4 , Mohammadreza Hojat 5 , Wendy L. Bedwell 6 , Rebecca Harrison 7 , Keaton Fletcher 8 , Allan R. Tunkel 9 , Marc J. Kahn 10 1
Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia, PA United States of America 2 3
Cooper Medical School of Rowan University Camden, NJ 08103 United States of America
Tulane University School of Medicine New Orleans, LA United States of America
4
Institute for Research in Art University of South Florida Tampa, FL 33620 United States of America 5
Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia, PA United States of America 6
University of South Florida Tampa, FL 33620 United States of America
7
OHSU School of Medicine Portland, OR 97239 United States of America
8
University of South Florida Tampa, FL 33620 United States of America
9
The Warren Alpert Medical School of Brown University Providence, RI 02912 United States of America 10
Tulane University School of Medicine New Orleans, LA 70112 United States of America
Exposure to humanities may have important implications in the development of future physicians. To test this hypothesis we used a multivariate statistical model to study the relationship between humanistic interests and various psychosocial measures for 912 students of five US medical schools. Greater exposure to humanities was significantly associated with higher empathy scores, higher tolerance of ambiguity, higher emotional appraisal, lower indicators of burnout, and higher scores on a measure of wisdom. We also found a significant association between a higher degree of exposure to visual arts and scores in visual-spatial thinking. Research hypothesis was thus confirmed, indicating that interest in the humanities is linked to personal qualities conducive to physicians’ well-being and patients’ outcomes. Findings have important implications for admission decisions and professional development of physicians-in-training. O9.3 Effects of PRACTA intervention aimed at enhancing GPs’ competencies in activating the elderly Dorota Wlodarczyk 1 , Magdalena Anna Lazarewicz 1 , Miroslawa Adamus 1 , Monica Lillefjell 2 , Marta Rzadkiewicz 1 , Joanna Chylinska 1 , Gørill Haugan 2 , Geir Arild Espnes 3 1
Medical University of Warsaw, Poland
2
Sør-Trøndelag University College, Norway
3
Norwegian University of Science and Technology, Norway
Background: Addressed to GPs and evidence based PRACTA intervention was developed in two forms: e-learning and pdf article. Both focus on recognizing seniors’ needs, improving communication skills and building active attitude towards health but use other methods of teaching. Method: The study consisted of baseline examination, implementation of intervention and followup. Out of 199 GPs who agreed to participate in the whole study, 35 were in e-learning group, 83 in article group and 81 in control group. Findings: There were significant time x group interactions related to recognition of seniors’ needs (importance of disease explanation increased in e-learning group, F=5.14, p=0.007 but importance of emotional support dropped in article group, F=3.35,p=0.04) and GPs’ communication skills (selfrated communication skills dropped in article group, F=10.48, p<0.001)). Discussion: The results did not confirm direct impact of e-learning on GPs competencies but article intervention contributed to greater GPs’ criticism of their communication skills. 09.4 Skill mix and staff types for implementation of Community Based Rehabilitation Hasheem Mannan, Manjula Marella, Fluer Smith, and Vishal Gupta School of Nursing, Midwifery & Health Systems Health Sciences Centre University College Dublin Community Based Rehabilitation (CBR) focuses on enhancing the quality of life for people with disabilities and their families, meeting basic needs and ensuring inclusion and participation. This paper will present the optimal skill mix and staff types identified for implementing CBR in developing countries. Using the Critical Incident Technique this study sought community based rehabilitation workers in India to specify the core competencies that they possess to do their job successfully and effectively. Eighty critical incidents, 44 positive and 36 negative, were described by the 32 participants, with each participant sharing at least two critical incidents. All participants described skills and attributes that influenced the outcomes of the reported incidents. Thematic analysis of these skills and attributes identified nine themes and 13 subthemes that can be grouped into four components– (1) Responsibilities, Technical Skills and Personal Characteristics, (2) Family Factors, (3) Community Factors and (4) Organizational support. This paper outlines how the above skills and attributes enable human resource systems to select, train, and appraise personnel more effectively. In particular, it highlights key modules for inhouse training including continuous professional development of CBR personnel.
Roundtable 3: Patient safety in a globalized world; The virtuous circle of education and training Convenor: Jo Hart, Discussant: Lucie Byrne-Davis Manchester Medical School Roundtable overview Behavioural and implementation science have demonstrated that many factors influence whether a healthcare worker will carry out required practices (behaviours) and that many of these influences have little to do with knowledge and skills. Certainly, a healthcare worker must be capable of doing what is required but this capability is not sufficient to bring about sustained behaviour change and ensure patient safety. In his 2013 editorial “The 6 domains of behavior change: the missing health system building block”1 the Science Advisor for Global Health for the US Agency for International Development stated that behavioural expertise is needed to improve health systems globally. Building block four was “provider behaviour”. The most common intervention to change provider behaviour globally is education and training. However, education and training is often focused mainly or only on knowledge and skills i.e., capability, and misses the opportunity to intervene in other crucial determinants of behaviour i.e, opportunity and motivation2. Education and training is typically provided by high-income country (HIC) volunteers, often through health links or partnership schemes. The benefits of volunteering for the personal and professional development of HIC health professionals is a matter of some interest. Benefits that have been reported include increases in wellbeing, flexibility and adaptability. These are also linked to patient safety. In this symposium, we will outline a virtuous circle of activity in which HIC volunteers develop, deploy and evaluate interventions to improve practice in LMIC whilst they themselves benefit from the volunteering experience, improving their own practice upon return to the UK. Individual abstracts:
R3.1 To what extent is education and training in UK and LMIC behaviourally focused? Jo Hart
Manchester Medical School Educators often design training sessions, packages and resources from the perspectives of what participants need to ‘know’. When psychologists look at interventions they code behaviour change techniques and it is possible to look at education and training in the same way e.g., role modelling, social support, feedback. Psychologists and educators are then able to understand the active ingredients (behaviour change techniques) in education. Matching these techniques to what is known about the healthcare workers’ thoughts, beliefs and emotions makes practice change following education more likely. This discussant will present some examples of education to illustrate and challenge attendees to think about education and training of healthcare workers as a behaviour change intervention. When HIC engage in health systems strengthening there is always a focus on education and training of the workforce. This discussant will also describe UK health links with LMIC healthcare organisations and highlight some of the opportunities and challenges in developing and supporting healthcare workers through these partnerships. R3.2 Using behavioural determinants to evaluate education and training Jane Mooney Advanced Life Support Group & Manchester Medical School Despite the implicit focus of education and training often being practice change, education is rarely evaluated by change in behaviour. Even less common is evaluation by determinants of behaviour change. The pathway from education to change in practice is, therefore, not fully explored. This leads to lost opportunities. This discussant will describe the collaboration between a group of behavioural scientists and an international provider of healthcare professional education and training to create feasible, acceptable and informative evaluations, based on behavioural theory. R3.3 Evaluation for quality improvement and research: The benefits of volunteering for UK healthcare workers and increasing implementation in the global workforce Lucie Byrne-Davis Manchester Medical School Good acute illness management is crucial in LMIC. We have previously shown that short courses in acute illness management (AIM©) and maternal acute illness management (M-AIM©) can improve the knowledge of Ugandan healthcare workers3,4. We sought to understand the barriers and facilitators to implementation and this highlighted the need to look in detail at the elements of capability, opportunity and motivation that lead to behaviour change in this context. This work led
to extensive revision of AIMŠ and M-AIMŠ to increase their alignment with the experiences of the clinical staff in Uganda, specifically the low-resource nature of the setting and the frequently experienced lack of senior support. This discussant will describe the process of developing behaviour-focused evaluations and how these can be used by educators to improve education and by researchers to understand implementation of education. Additionally, the impact on the personal and professional development of the HIC volunteers has generated interest, particularly in considering how to make volunteering a sustainable activity in which the UK, and other HIC, can invest. This discussant will also report on the Measuring the Outcomes of Volunteering for Education (MOVE) study. Through metasynthesis and a Delphi study, 117 benefits and costs to individuals from volunteering in LMIC were found. This discussant will highlight the outcomes that would be likely to be associated with educational transformation and patient safety.
Workshop 2: Narrative medicine; Employing the power of story in clinical practice Catherine Rogers , Columbia University, Department of Narrative Medicine Narrative medicine, according to Rita Charon MD, PhD, founder and director of the Narrative Medicine program at Columbia University, is “medicine practiced with the narrative competence to recognize, absorb, interpret and be moved by the stories of illness.” When we humans want to better understand ourselves and others, we naturally reach for storytelling to help us make sense of complex events and situations. Narrative medicine fortifies clinical practice by building skills in giving and receiving stories. The practice of narrative medicine can help clinicians respond more effectively to the increasing challenges in medicine today: time constraints, rising healthcare costs, socio-cultural inequities, ethical concerns, professional demands, and self-care. This workshop will provide an introduction to the field of narrative medicine as well as hands-on experience in its practical applications. Objectives: The workshop will employ close reading, reflective writing, and active listening to explore and reveal affiliation with others and meaning in clinical practice. It will create a “clearing” where healthcare professionals can focus, reflect on, and share their own stories and the stories of others. It will equip participants with practical strategies for enhancing clinical practice and nourishing professional well-being. Relevance: Narrative medicine training emphasizes the imperative of self-care in order to effectively care for others in clinical settings. Dr. Charon points out, “Like narrative, medical practice requires the engagement of one person with another and realizes that authentic engagement is transformative for all participants. Physicians absorb and display the inevitable results of being submerged in pain, unfairness, and suffering. Indeed, it may be that the physician's most potent therapeutic instrument is the self.” Questions of well-being, effective performance, decision making and communication, therefore, inspire us to explore experientially how narrative medicine might help improve care for the caregiver and promote well-being in clinical practice. Activities: After an introduction to the history and concepts of narrative medicine, the group will engage in guided close reading and reflective writing around the themes of well-being and effective performance. Participants will practice giving and receiving accounts of self. The session will conclude with a discussion of strategies for employing narrative medicine techniques in clinical practice.
While designed primarily for healthcare professionals, namely doctors, nurses, psychologists, and social scientists, this workshop will also be useful to academics, scholars, writers, and artists with strong interest in medicine and healthcare. Maximum number of participants: 40
Thematic session 10: When coping fails; fatigue, grief and stress vulnerability Chair: Leeat Granek 1 , Discussant: Reidar Tyssen 2 1
Ben Gurion University of the Negev, Department of Public Health, Faculty of Health Sciences. 2
University of Oslo
O10.1 Psychiatric caregiver stress and compassion fatigue Francesco Franza , Neuropsychiatric Centre â&#x20AC;&#x153;Villa dei Piniâ&#x20AC;?. Avellino, Italy Background: People who work in health care can be exposed to the fatigue of care. The compassion fatigue (CF) is an occupational hazard specific to clinical work related severe emotional distress. Aims of our study was evaluated CF in psychiatric workers. Methods: We have evaluated CF in 52 psychiatric workers (psychiatrists, psychologists, social workers, psychiatric nurses, and healthcare workers) and its relationship with 264 psychiatric inpatients. At baseline and after one year administered the following rating scales: (in inpatients) PANSS; YMRS; HAM- D; in (psychiatric staff) sCFs and CBI. Findings: At baseline, were present Job Burnout (JB) and CF (39.28%, 28.57%) in psychiatric nurses; CF in psychologist group (36.36%); in psychiatrists, vicarious trauma (VT) (28.57%), but not JB. After a year, the psychiatric staff presented an overall reduction in total mean score [CBI: p :< 0.0000045; sCFs: (VT: p:0.0288; JB: p:<:0.000001)]. Discussion: Compassion fatigue causes concern among mental health professionals. O10.2 The Grieving oncologist: An overview of four studies on grief reactions using mixed methodologies Leeat Granek, Amos Toren Ben Gurion University of the Negev, Department of Public Health, Faculty of Health Sciences. Background: Between 2010-2016, I conducted a series of research studies on the grief of oncologists and how it affects their personal and professional lives.
Objectives: To explore the grief experience of oncologists from the perspective of physicians working in the field; To examine what interventions, educational programs, or strategies oncologists report as helpful in managing their grief and potentially identify ways to improve the grief experience of oncologists who have frequent exposure to patient death. Methods: Mixed methods: Sample included Canadian pediatric and adult oncologists and Israeli adult oncologists. Findings: This session will give an overview of the major findings from these studies with a focus on comparing pediatric and adult oncologists when it comes to expression, management, and impact of chronic patient loss on oncologistsâ&#x20AC;&#x2122; personal and professional lives. Oncologistsâ&#x20AC;&#x2122; grief was a unique, affective experience, resulting in feelings of self-doubt, guilt, failure, powerlessness, and sadness, and in sleep loss, and crying. The impact of the loss of patients on oncologists was manifested in burnout, compartmentalization, emotional exhaustion, and difficulties in maintaining emotional boundaries. The impact of oncologists' grief on their patients found expression in their focus on pursuing active treatment (e.g., aggressive chemotherapy, clinical trials, etc.) rather than on end-of-life comfort care, including their reluctance to refer patients to palliative care, their distancing themselves from dying patients, and their heightened motivation to improve care for their other patients. Discussion: I will conclude by discussing the implications of this research program and outline my new research projects focusing on developing interventions for oncologists. O10.3 Work-related fatigue among Armenian physicians Anna Margaryan Yerevan State Medical University After M.Heratsi Health state and safety are common attributes of human well-being. The purpose of the given research was studying a prevalence of work-related fatigue among physicians who are working in the different level of Armenian healthcare system. Methods: A cross-sectional study was conducted. The survey involved 2167 physicians (592 men and 1575 women). Results: It was found that only 10.5% of physicians never feel a sense of fatigue in the middle of the work-time. Every morning feel tired and have a reluctance to go to work 0.8% of physicians. The results showed that 4.5% physicians related to work stress more than once a week had a sleep problem. About Âź of the physicians are sleeping less than 6 hours per day and a third of physicians observed various forms of sleep disorders.
Conclusion: Our findings indicate that health care managers should develop strategies to address and improve the quality of working conditions for physicians. O10.4 Young physicians: Associations between intentions to leave the profession and psycho-social factors in a national representative sample Dina Van Dijk, Gabi Bin-Nun, Keren Holzman, & Talma Kushnir Background: Research on intention to leave the medical profession is scarce. Five recent European studies, found that adverse work conditions (e.g., poor working environment, high workload, long working hours) predict physicians' intention to leave. We aimed to examine four facets of job satisfaction (intrinsic, extrinsic, social and prestige) as predictors of intention to leave medicine among young physicians in Israel. Methods: A telephone survey among 845 Israeli physicians, 4 to 10 years after receiving medical license. Measures: Facets of job satisfaction, Intention to leave medical profession, Proactive steps towards quitting; linear and logistic regression analyses. Findings: Intrinsic job-satisfaction was the strongest (negative) predictor of intention to leave (β=.41, p<.01); Only intrinsic job-satisfaction (β=-.37, p<.01) and job prestige (β=-.25, p<.05) predicted active steps toward leaving. Discussion: Contrary to European studies, we found that job significance and challenges have a stronger impact than adverse physical working conditions on intentions and taking active steps towards leaving the medical profession.
Workshop 3: Different health professions: partners or rivals? A practical approach to pros and cons of cooperation with each other in clinical practice Csilla Jeszenszky, Maike Lippmann University Hospital Carl Gustav Carus Dresden, Germany
Human medicine is a unifying field of different health professions. Communication in clinical practice seems often complicated. The necessity to deal with these difficulties is high. The main purpose of the workshop is to sensitize the participants to the importance of communication in clinical practice between different health professions and to facilitate and motivate them to get involved in communication and cooperation with each other. Our goals are also to provide a platform for exchanging experiences in this topic and to bridge the gap between barriers and solutions. The idea of our workshop arose out of our everyday work experiences as psychologists dealing with doctors. We see a great opportunity to exchange substantial information and integrate our work into the mainstream of the congress. During the workshop both negative and positive experiences in communication and collaboration with doctors and other health professionals are to be collected in first place. Secondly a brainstorming is to be carried out in order to provide possible explanations on a meta-level for both the limitations and the successes. Discussions and role-plays in pairs or small groups of up to four participants are to be involved into the process. Also plenary discussion with the whole group is to be initiated. Thereafter a short theoretical input about the possible causes of complicacies - rooting among others in differences of training, ways of communication, means of treatment - and models of prosperous conjoint research will be provided. The workshop is to be completed by bringing together conclusions and implications for our practice. Subsequently we also aim to generate and to hand out a checklist about the discussed issues to every participant. o study, to date, has explored the experience of medical students who have, themselves experienced mental illness despite many demonstrating the increased prevalence.
Workshop 4: Guided imagery for healthcare professionals Shulamith Kreitler Tel-Aviv University Background: Guided imagery is a theoretically-based procedure with variety of possible functions. It is a kind of mini-hypnosis. Its major uses that are of interest for health professionals are changing to some extent physiological and in general bodily functions. Evaluation: Learning to do guided imagery properly may be of great use to health professionals both in order to control their own reactions as well as to help patients control their emotional and even physiological responses. Findings: There is a lot of evidence â&#x20AC;&#x201C; mostly anecdotal and some of it evidence-based â&#x20AC;&#x201C; concerning the benefits of guided imagery. Discussion: It is claimed that mastering guided imagery by health professionals may be of great help to them in their work and in their interaction with patients.