1. AMEDD Center & School Dept of Preventive Health Services Soldier & Family Support Branch Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Graeme Bicknell, PhD, LISW MAJ Sheila Adams, PhD, LCSW, BCD UNCLASSIFIED/FOUO 12 August 2009

2. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO BRIEFING OUTLINE Brief History Methodology MEDCOMProQOL Findings Provider Resiliency Training MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO www.googleimages.com Slide 2 of 23

3. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO History Walter Reed Incident 2007,MG Pollick’s assessment SAMMC Institutional Review Board 30NOV07 Mandated by FRAGO 34 (to Implementation of the Army Medical Action Plan) 27JUN08 Data collection www.googleimages.com Slide 3 of 23

4. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Methodology Professional Quality of Life Scale (ProQOL) (Stamm, 2005) https://www.us.army.mil/suite/page/200013 –ProQOL –Demographics –Video training qualitative questions “Protected” Data maintained at Ft. Detrick, transferred to Soldier Family Support Branch, FSH, FEB09 Slide 4 of 23

5. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO ProQOL Compassion Satisfaction is about the pleasure you derive from being able to do your work well I get satisfaction from being able to help people.0 Never < 5 Very Often I feel invigorated after working with those I help.0 Never < 5 Very Often I like my work as a helper.0 Never < 5 Very Often I am pleased with how I am able to keep up with helping techniques and protocols. 0 Never < 5 Very Often My work makes me feel satisfied.0 Never < 5 Very Often I have happy thoughts and feelings about those I help and how I could help them. 0 Never < 5 Very Often I believe I can make a difference through my work.0 Never < 5 Very Often I am proud of what I can do to help.0 Never < 5 Very Often I have thoughts that I am a “success” as a helper.0 Never < 5 Very Often I am happy that I chose to do this work.0 Never < 5 Very Often Slide 5 of 23

6. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO ProQOL Burn Out is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively. I am happy.Reverse coded I feel connected to others.Reverse coded I am losing sleep over traumatic experiences of a person I help.0 Never < 5 Very Often I feel trapped by my work as a helper.0 Never < 5 Very Often I have beliefs that sustain me.Reverse coded I am the person I always wanted to be.Reverse coded Because of my work as a helper, I feel exhausted.0 Never < 5 Very Often I feel overwhelmed by the amount of work or the size of my case work load I have to deal with. 0 Never < 5 Very Often I feel “bogged down” by the system.0 Never < 5 Very Often I am a very sensitive person.Reverse coded Slide 6 of 23

7. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO ProQOL Compassion Fatigue is about your work-related secondary exposure to extremely stressful events. I am preoccupied with more than one person I help.0 Never < 5 Very Often I jump or am startled by unexpected sounds.0 Never < 5 Very Often I find it difficult to separate my personal life from my life as a helper. 0 Never < 5 Very Often I think that I might have been “infected” by the traumatic stress of those I help. 0 Never < 5 Very Often Because of my helping, I have felt “on edge” about various things.0 Never < 5 Very Often I feel depressed as a result of my work as a helper.0 Never < 5 Very Often I feel as though I am experiencing the trauma of someone I have helped. 0 Never < 5 Very Often I avoid certain activities or situations because they remind me of frightening experiences of the people I help. 0 Never < 5 Very Often As a result of my helping, I have intrusive, frightening thoughts.0 Never < 5 Very Often I can't recall important parts of my work with trauma victims.0 Never < 5 Very Often Slide 7 of 23

8. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Demographics General Demographics –Gender –Ethnicity –Age –Rank MEDCOM Specific –Medical specialty –Medical treatment facility –Deployment history –Time in position www.googleimages.com Slide 8 of 23

9. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO What are we comparing to? MEDCOM Population ProQOL Norming Sample MEDCOM Sub-Samples MEDCOM Population MEDCOM Sub-Samples All of us against them All of us against some of us Some of us against some others of us Us against the future us MEDCOM Standard Slide 9 of 23

10. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Bottom Line Overall MEDCOM has less Burn Out and Compassion Fatigue than the ProQOL norming population both statistically and substantively Within MEDCOM Physicians report more Burn Out than MEDCOM Overall Within MEDCOM, Enlisted Direct Care Respondents consistently reported having more Burn Out, Compassion Fatigue and less Compassion Satisfaction. Slide 10 of 23

11. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Bottom Line Within MEDCOM, Civilians consistently report less Burn Out, Compassion Fatigue and more Compassion Satisfaction. Within MEDCOM Military Only, those who report having deployed report more Burn Out, Compassion Fatigue and less Compassion Satisfaction than MEDCOM overall. Slide 11 of 23

12. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Population Versus MEDCOM ONE SAMPLE T-TEST Burn Out t-Test -86.8, p<.001, Compassion Fatigue t-Test -70.83, p<.001 Compassion Satisfaction t-Test 29.26, p<.001, CAUTION: MEDCOM RESPONDENTS RECEIVED A 20 MINUTE “PROVIDER RESILENCY TRAINING” INTERVENTION PRIOR TO TAKING THE PROQOL. THE PROQOL NORMING POPULATION DID NOT RECEIVE ANY TRAINING PRIOR TO RESPONDING TO THE SURVEY Population Versus MEDCOM MEDCOM RESPONDENT DEMOGRAPHICS MEDCOM All50,478 SpecialtyPhyscian4,387 Nurse10,495 Other Credentialed Provider8,670 Enlisted Direct Care6,475 Admin or Support Staff20,451 Civ/MilCivilian28,065 Military22,168 DeployedYes14,606 No35,872 RMCNARMC13,162 GPRMC15,757 SERMC9,048 WRMC5,196 PRMC3,957 ERMC3,358 Slide 12 of 23

13. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Population Versus MEDCOM Chi Square Tests between MEDCOM Observed Frequencies and ProQOL Expected Frequencies: Burn Out Chi-Square 4002.587 p<.001, Compassion Fatigue Chi-Square 18258.1, p<.001, Compassion Satisfaction Chi-Square 6670.19, p<.001 Slide 13 of 23

14. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO MEDCOM Demographics Note: Percentages less than 1 not graphically displayed Slide 14 of 23

15. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO MEDCOM Respondents by Specialty Burn Out Compassion Fatigue Compassion Satisfaction Chi Square Tests between Specialty Observed Frequencies and MEDCOM (mean) Expected Frequencies by ProQOL construct: Burn Out 18%, Compassion Fatigue 14%, Compassion Satisfaction 24% * Denotes statistically significant difference from MEDCOM mean with a p value <.01 ** Denotes statistically significant difference from MEDCOM mean with a p value <.001 ** * Slide 15 of 23

16. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO MEDCOM Deployment Note: Percentages less than 1 not graphically displayed. There were no respondents deployed in the 37 to 48 month bracket. Slide 16 of 23

17. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO MEDCOM Versus MEDCOM Sub Samples Chi Square Tests between MEDCOM All Observed Frequencies and ProQOL Expected Frequencies: Burn Out Chi- Square 4002.587 p<.001, Compassion Fatigue Chi-Square 18258.1, p<.001, Compassion Satisfaction Chi-Square 6670.19, p<.001 Chi Square Tests between MEDCOM Sub Samples Observed Frequencies and MEDCOM ALL Expected Frequencies by ProQOL construct: Burn Out 18%, Compassion Fatigue 14%, Compassion Satisfaction 24% ** Denotes statistically significant difference from MEDCOM mean with a p value <.001 ** Burn Out Compassion Fatigue Compassion Satisfaction Slide 17 of 23

18. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Cautions Social desirability bias. Assumption of 1 in 4. Use of cutoff scores. Size of the dataset, www.googleimages.com Slide 18 of 23

19. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO AMEDD C&S Training Opportunities Train the Trainer Course –Regional Medical Command (RMC)/MTF PR Trainers/Leaders –Guidance on developing, implementing and sustaining an organizational Commander PR program at the RMC/MTF level, –Understanding research –Key concepts and theories –Resiliency building skills/practices using effective intervention training strategies Slide 19 of 23

20. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO AMEDD C&S Training Opportunities The Professional Resiliency Resident Course –Targets professional medical staff i.e. Doctors, Nurses, Ancillary Staff GS11 & above and E7 & above –Focuses on the most advanced research, concepts, and theories as it relates to self care management. –Attendees will have the opportunity to participate in various experiential learning self-help techniques. Using personal introspection, participants will focus on internal and external stressors that contribute to burnout and compassion fatigue. The PRT also conducts Mobile Training as requested. Slide 20 of 23

21. Data Analyses on Provider Fatigue & Burnout in MEDCOM MAJ Bicknell (210) 221-6073 (DSN XXX) / graeme.bicknell@amedd.army.mil UNCLASSIFIED/FOUO Questions????? Slide 21 of 23