1 / 54

I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program

Keeping the Igloo Warm. (A Canadian Perspective). I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program. Housekeeping. Handouts Evaluations How we will spend our time Door prizes. 3.3 million (2006).

chyna
Download Presentation

I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Keeping the Igloo Warm (A Canadian Perspective) I. Bennett MB.BS. M. Cherniwchan MD FRCPC Alberta Medical Association Physician Family Support Program

  2. Housekeeping • Handouts • Evaluations • How we will spend our time • Door prizes

  3. 3.3 million (2006)

  4. Alberta Physicians PFSP Involvement 2010 • total physicians in province 10, 738 • new contacts (overall) (6.7%) 719 • physicians 410 • residents 200 • medical students 109 College of Physicians and Surgeons of Alberta 2010

  5. The Current Situation in Alberta

  6. Physician Engagement Survey • 218 physicians (169 urban, 49 rural) • Gallup 11question poll • U-shaped demographic Covenant Health 2010

  7. Physician Engagement Survey • concerns about patient care • not good communication with Senior Staff • engagement does NOT equal trust • rural hospitals do NOT equal urban hospitals (within same administrative system) Covenant Health 2010

  8. Province of Alberta • Staff and Physician Engagement: 26% (Overall Engagement Score) (2009/10) Alberta’s Health System Performance Measures November 30, 2010

  9. Recent Developments • 2011 Health Quality Council of Alberta • Review regarding emergency services accessibility, cancer treatment waiting times, and intimidation within the system • Economic restraint and resource constraints

  10. The Alberta ApproachHistorically

  11. Organizations Involved • College of Physician and Surgeons of Alberta (licensing body) • Universities (teaching institutions) • Hospitals • Alberta Health Services (gov. admin.) • Alberta Medical Association (professional association)

  12. Timeline • pre - 2006 PFSP expertise in developing case coordination on case-by-case basis • 2006 - now AMA PFSP case coordination process • 2008 -2010 CPSA/AMA/other stakeholders • guideline for all • impact of disbanding of regions • 2010 PFSP starts Healthy Workplace Initiative

  13. Landmark Documents • Quality Worklife Quality Healthcare Collaborative - Within Our Grasp. A Healthy Workplace Action Strategy for Success and Sustainability in Canada’s Healthcare System(2007) • PFSP team- Intervention Manual for Physicians with Disruptive Behavior (June, 2009) • CPSA - Managing Disruptive Behavior in the Healthcare Workplace (October, 2010)

  14. Prior Emphasis • ‘disruptive’ vs. distressed behavior • individual focused • ‘sharp end of the stick’ analysis • punitive or remedial in nature

  15. Circumspect Exploration • 1. importance of physician health issues • 2. importance of the systemic nature • 3. importance that all parties agree • 4. importance of mentoring

  16. ‘Working’ Documents • letters of understanding • behavioral agreements (including patients/office)

  17. Code of Conduct Components • List of unacceptable behaviors • Identified channels of reporting • Identified process of response • Response guidelines • Authority from, and mentioned in, medical staff bylaws • Promulgated, acknowledged, and honored

  18. PFSP Role (clinical) • Case Coordination • Triage • Referral • Mediation

  19. The AMA PFSPExperience

  20. ‘Primary’ Occupation Issues • 153/774 physician contacts • 82/153 primary problem • 15/82 referred to Case Coordination (CC) • (22/85 active CC participants had this as primary problem) AMA PFSP 2010

  21. Who They Were • 52/426 physicians • 25/225 residents • 5/123 medical students • 82/774 total group

  22. Issues Identified (1) • perpetrator/disruptive behavior (4.4) 3 • supervisor dealing with behavior (4.5) 3 • workplace relationships (4.7) 13 • patient boundary violations (other) (4.9) 2 • occup. stress/burnout (4.10) 15 Canadian Physician Health Network Common Indicators

  23. Issues Identified (2) • occupation/job change (4.11) 9 • retirement (4.12) 2 • other occupational issues (4.13) 28 • regulatory complaint (4.15) 5 Canadian Physician Health Network Common Indicators

  24. Issues Identified (3) • professional boundary issues (4.16) 1 • other regulatory issues (4.17) 2 • civil suit related to practice(4.19) 1 Canadian Physician Health Network Common Indicators

  25. Associated Problems all contacts AMA PFSP service

  26. All contacts PFSP

  27. Services Provided (not all needed to be ‘under microscope’)

  28. Case Coordination (most common reasons for referral) • other occupational issues (4.13) 9 • perpetrator of disruptive behavior (4.4) 8 • workplace relationships (4.7) 4 • subject of emotional abuse (4.1) 3 • occupational stress/burnout (4.10) 3 Canadian Physician Health Network Common Indicators

  29. The New PFSPApproach

  30. Global Approach • office • hospital • PCN

  31. Health Workplace Initiative • Recognizing ‘disruption’ is intrinsically neither good or bad (and necessary for change) • Recognizing the ‘components’ of a distressed workplace (and that structure can drive behavior) • Recognizing the ‘skills’ needed to build a stronger team (including acknowledging the primary importance of the emotional issues*) * and not just problem-solving

  32. Recognizing ‘components’ • the components of a healthy workplace (physical*, cultural, ‘internal’ environment) • the components of a ‘distressed’ individual • the components of a physician’s mental and physical health • the components of all the ‘support structures’ in the system * incl. patient-initiated aggression

  33. ‘Skills’ Needed • leadership(recognizing different leader types and roles) • engagement • trust (use of appreciative inquiry) “ Everyone plays their part”

  34. ‘Skills’ Needed • Civility • Communication • Collegiality • Collaboration • Conflict Resolution “ Healthier workplaces, Healthier doctors, Healthier patients.” the 5 “C”s

  35. Two Approaches • Information and education to make physicians aware of the components of: • a healthy workplace • how to recognize challenges early • Refining an approach for when ‘dysfunction’ occurs that: • returns a physician to health • restores, and ensures, ongoing workplace health through an ‘engaged’ team approach

  36. Information and Education • Creating promotional materials/promulgate new bylaws • Including this topic in a comprehensive patient-centered undergraduate curriculum • Holding workshops to important stakeholders • Gathering a repository of materials to benefit a wide variety of group needs • Publishing articles educating the AMA readership on aspects of the program • Networking and colloborating to benefit from collective experience

  37. Typical Organizational Flowchart ‘Nightmare’

  38. ‘Refined’ PFSP Process

  39. Measurement and Evaluation • Outcome measures include: • participant feedback • client satisfaction/tracking surveys • workshop requests/evaluations • electronic tracking of information access • Review of: • expenditure against budget • timeline and outcomes on prevention logic model

  40. Problems Encountered • ‘well-defined’ environments (ie. OR) vs. loosely-structured workplaces (ambulatory clinic) • dealing with subtle long-term irritants ( vs. personal contributions) • differing levels skills/training among the ‘players’

  41. The AMA PFSP Healthy Workplace Survey • n = 155 • 5 survey venues (incl. resident input, hospitals and clinic settings) • n = 13 questions

  42. The AMA PFSP Healthy Workplace Survey • level of satisfaction: • 18% (5/5), 53% (4/5), 25% (3/5), 4% (2/5), 0% (5/5) • most enjoyed (patient care), least enjoyed (paper work) • 3 most important factors: • civil, professional, respectful relationships (28%), collegiality and collaboration (23%), availability, flexibility of coverage (15%)

  43. The AMA PFSP Healthy Workplace Survey • violence experienced in the workplace (n = 45%) • policies in place (PIA, violence) n = 57%, 54% note: physicians who don’t know n = 21%, 24% • impacted personal health: • yes = 70%, no = 30% • impacted personal/family life: • yes = 65%, no = 35%

  44. The AMA PFSP Healthy Workplace Survey • visit own physician • yes = 62%, no = 38% • Fatigue Management Plan (organization) • yes = 03% no = 97% • Fatigue Management Plan (self) • yes = 44%, no = 56%

  45. Building a WarmerIgloo

More Related