Lindsay T. Fazio, PhD Miranda M. Huffman, MD, MEd Getting to Faculty Engagement: Can Focusing on Community and Strengths Address Burnout and Improve Engagement? Lindsay T. Fazio, PhD Miranda M. Huffman, MD, MEd

Disclosures None

Objectives Upon completion of this session, participants should be able to: List evidence-based strategies for treating and preventing burnout in family medicine faculty members. Describe how positive psychology can be used to promote engagement amongst faculty members. Develop individualized learning plans for faculty members and use small accountability groups to promote implementation of plans.

About Us University of Missouri – Kansas City Family Medicine Residency 12-12-14 Program Truman Medical Center – Lakewood 25 faculty members Faculty development Tuesday from 12p to 2p

Project Part of Leading Change Fellowship Quality improvement project led by family physician and behaviorist

Baseline Data Range Group Average MBI Emotional Exhaustion 0 to 6 3.1   Range Group Average MBI Emotional Exhaustion 0 to 6 3.1 Depersonalization 1.7 Personal Accomplishment 4.9 AWL Workload 1 to 5 2.2 Control 3 Reward 3.4 Community 3.8 Fairness 2.9 Value 3.5

Emotional Exhaustion Depersonalization Personal Accomplish Admin 3.11 1.48 4.98 Not Admin 3.17 2.02 4.74 Hospital Hill Pavilion 3.1 2.05 4.75 Lakewood Pavilion 1 4.8 Family Medicine Center 3.31 1.2 Maternal Care Clinic 2.61 1.63 5 Sports Medicine 2.8 2 5.17 MedSurg 2.75 1.75 4.91 Labor and Delivery 2.52 1.56 L&D LW Pavilion FMC HH Pavilion L&D/MCC More Desirable Level Less Desirable Level

Control Reward Community Fairness Values Admin 3.38 3.67 3.77 2.97 Not Admin 2.44 3.11 3.9 2.69 3.19 Hospital Hill Pavilion 3.2 3.3 3.75 2.6 3.08 Lakewood Pavilion 2.91 3.74 2.86 3.91 Family Medicine Center 3.01 3.5 3.83 2.99 Maternal Care Clinic 2.47 3.17 4.03 2.77 Sports Medicine 2.93 3.7 3.87 3.03 MedSurg 2.75 3.29 3.78 2.65 3.39 Labor and Delivery 2.76 3.92 2.79 LW Pavilion HH Pavilion MCC

Other Data ACGME Program Survey Denison Cultural Survey Resident evaluations of faculty Student evaluations of faculty

Focus Groups 1. Faculty needed clarity on how they are paid 2. Faculty needed a venue to air their concerns about how they are paid 3. Faculty needed to know the plan for accomplishing things when they want to do something 4. Faculty needed to see how the strategic plan intends to improve primary care 5. TMC and UPA needed to show how they value primary care

Intervention StrengthsFinder tool Education on burnout Finding Meaning in Medicine Individualized Learning Plans Faculty development on identified areas of need

StrengthsFinder Completed on all faculty, administrative support staff, and residents Outside consultant educated faculty and administrative staff We educated residents Continuous exposure Door signs Meeting make-up Group discussions

Relationship Building Executing Influencing Relationship Building Strategic Thinking Achiever Arranger Belief Consistency Deliberative Discipline Focus Responsibility Restorative Activator Command Communication Competition Maximizer Self-Assurance Significance Woo Adaptability Developer Connectedness Empathy Harmony Includer Individualization Positivity Relator Analytical Context Futuristic Ideation Input Intellection Learner Strategic Ahern Debra   3 1 4 5 2 Arey Anne Barnett Angela Byler Mark Crumpecker Christina Dedon Jon Fazio Lindsay Gibson Margaret Griffith Steve Groner Jennifer Hempstead Laura Huffman Miranda Livingston Myrick Tim Nikel Carlie O'Dell Michael Otto Rachel Rosemergey Beth Sandri Kelly Jo Schultz Shaffer Todd Silvers Swade Kelly Vierthaler Stephen Voran David

Education on Burnout Review of data Discussion of the “usual” strategies Time management Boundaries Mindfulness

Finding Meaning in Medicine Groups Based on work of Rachael Naomi Remen Add website Two groups, approximately 10 per group Meet monthly

Individualized Learning Plans Shared the following: Strengths Resident evaluation Student evaluation Encouraged to do the following: Reflect on most meaningful parts of work Focus on times you felt appreciated

Individualized Learning Plans What aspect of your career is most meaningful to you? (patient care, teaching, research, administration, etc.) What do you do now that you would like to continue? What don’t you do now that you would like to do? What are you doing now that you would like to stop?

Individualized Learning Plan One thing you will do in 1 week One thing you will do in 1 month One thing you will do in 1 year

Greatest Assets Dedicated time for faculty development Support from the chair Financial Attitudinal Faculty leadership support Touchy-feely family doctors

Biggest Obstacles The non-participators The chronic pessimists Clinical demands Administrative support

Repeat Data Range Initial Average Repeat Average Percent Change MBI   Range Initial Average Repeat Average Percent Change MBI Emotional Exhaustion 0 to 6 3.1 2.5 -19.4 Depersonalization 1.7 1.0 -41.2 Personal Accomplishment 4.9 5.0 +2.0 AWL Workload 1 to 5 2.2 2.7 +22.7 Control 3 3.2 +6.7 Reward 3.4 3.7 +8.8 Community 3.8 4.3 +13.2 Fairness 2.9 +6.9 Value 3.5 +5.7

Lessons Learned Focusing on strengths and community decreased burnout and improved engagement amongst family medicine faculty You don’t need 100% participation to have an impact Changing culture takes time and effort

Phase 2 Trialing intervention in other programs OB/Gyn program at UMKC Oregon Health Sciences Family Medicine Clinic Expanding work to residents Switching measures used Physician Wellness Inventory Questions from Gallup – 12 Questions for Engagement Adding measures Empathy - Interpersonal Reactivity Index Resiliency – Brief Resiliency Scale Workload – NASA Task Load Index, ????

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