Resilience training puts chill on burn-out
Improved coping skills can reduce injury
The best thing you can do for patients may be to take care of your hardest working employees. Burnout not only affects the health and well being of health care workers, but it also leads to medical errors, higher infection rates, and injuries, says J. Bryan Sexton, PhD, associate professor of psychiatry at Duke University in Durham, NC, and director of the Patient Safety Center for the Duke University Health System.
Burnout is a common ailment in a time of constrained resources, sicker patients and constant change. One in every three nurses and physicians meets the diagnostic criteria for severe emotional exhaustion, Sexton says. One study found that almost half (43%) of nurses who reported high burnout said they planned to leave their jobs in the next year.1
Sexton is now leading a movement to bring resilience to health care. In workshops and webinars, he teaches health care workers how to use simple tools to improve their ability to cope in a stressful environment.
"When the resilience goes up, your needlesticks go down, your workplace injuries go down, turnover rates improve," he says.
Resilience also brings joy back into the caregiving professions, he says. That echoes a recent report on "Creating joy, meaning and safer health care" that was released by the Lucian Leape Institute at the National Patient Safety Foundation in Boston. (See HEH, June 2013, p.68.)
"The people who are your hardest workers are the most vulnerable to burnout," says Sexton. "If you make people more resilient, it's like adding staff. They're enjoying work more and getting a sense of meaning. Why wouldn't you do this?"
Training eases stress of change
In fact, that was the conclusion of the Minnesota Hospital Association — why not help hospitals and health care workers cope with change?
The MHA Hospital Engagement Network received a $4.5 million grant from the Centers for Medicaid & Medicare Services to improve patient safety. Some of the projects cover the usual issues, such as hospital-acquired infections and readmissions. But one goal is "creating a hospital culture of safety that fully integrates patient and worker safety."
New initiatives are often stressful, with checklists and data tracking and new protocols. "We were getting a strong sense from hospitals that they couldn't handle any more. We couldn't put one more thing in front of them," says Tania Daniels, MBA, PT, vice president for patient safety.
So the MHA sought a way to relieve some of the stress — and improve the capability to adapt to change. "We believe it starts with the culture," she says. "There's some evidence that shows that patient satisfaction is strongly correlated with units and hospitals that have strong employee safety and employee engagement and satisfaction."
The MHA launched a resiliency pilot project with 10 hospitals, but then opened the training up for all member hospitals. Sexton shared techniques in two and a half days of training, which was followed up with webinars.
"Some hospitals are targeting one or two units. Some critical access hospitals are going to train as many people as they can," says Nora Vernon, RN, MS, a patient safety/quality specialist at MHA.
The pilot hospitals will look at the impact of the program on injury rates, such as bloodborne pathogen exposures. The hypothesis is that resilience will improve attentiveness and teamwork — and reduce injuries.
Simple techniques lead to resilience
Sexton's work on resilience stems from his prior research into patient safety. He began to wonder why certain patient safety interventions were very effective in some, but not all, hospital units. High burnout inhibited teamwork and led to resistance to change, he says.
Just getting away to an offsite "retreat" to learn some simple skills can be very effective, Sexton says. His techniques are based on findings from the field of positive psychology. For example, in the "Three Good Things" exercise, participants receive a reminder email each evening to write down three positive things that happened that day. It could be a beautiful sunset, or a quiet moment reading to your child, or a successful outcome at work.
"If you do that every day for two weeks, we can actually measure marked improvements in your depression, happiness and work-life balance," Sexton says.
In "Strength Finders," participants use a tool to identify their greatest personal strengths, and then figure out how to use them in different ways.
Resilience can be enhanced through greater support in the workplace, he says. For example, the chief nursing officer at Duke established "meeting-free Wednesdays," so that everyone would have one protected day to focus on their work without interruption. Units also can add 15-minute resilience activities to staff meetings. Even doing it every other month — six times a year — makes a difference, he says.
"It shows employees that my leader cares about more than just the targets and volume. My leader cares about my well-being," Sexton says.
Resilience training is not a cure-all. Burnout often stems from budget cutbacks, high patient acuity, and other realities. But resilience training can help people cope, he says. "It will help people reconnect with purpose and meaning," he says.
[Editor's note: More information about the resiliency training at the Duke Patient Safety Center is available at www.dukepatientsafetycenter.com/.]
- Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout and job satisfaction. JAMA 2002; 288;1987-1993.