AMEDD Center & SchoolDept of Preventive Health Services Soldier & Family Support Branch
Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Graeme Bicknell, PhD, LISWMAJ Sheila Adams, PhD, LCSW, BCD
UNCLASSIFIED/FOUO
12 August 2009
Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
BRIEFING OUTLINE
• Brief History
• Methodology
• MEDCOMProQOL Findings
• Provider Resiliency Training
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
www.googleimages.com
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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 collectionwww.googleimages.com
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Demographics
• General Demographics– Gender
– Ethnicity
– Age
– Rank
• MEDCOM Specific– Medical specialty
– Medical treatment facility
– Deployment history
– Time in position
www.googleimages.com
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
What are we comparing to?
MEDCOM Population
ProQOL Norming Sample
MEDCOM Sub-Samples
MEDCOM Population
MEDCOM Sub-Samples
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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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.
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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.
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Population Versus MEDCOM
Mean Scores
2118
1210
37 38
0
5
10
15
20
25
30
35
40
45
ProQOL Burn Out MEDCOM Burn Out ProQOL CompassionFatigue
MEDCOMCompassion Fatigue
ProQOL CompassionSatisfaction
MEDCOMCompassionSatisfaction
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 All 50,478
Specialty Physcian 4,387
Nurse 10,495
Other Credentialed Provider 8,670
Enlisted Direct Care 6,475
Admin or Support Staff 20,451
Civ/Mil Civilian 28,065
Military 22,168
Deployed Yes 14,606
No 35,872
RMC NARMC 13,162
GPRMC 15,757
SERMC 9,048
WRMC 5,196
PRMC 3,957
ERMC 3,358
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Population Versus MEDCOM
Using ProQOL Quartile Scores to Compare Population Percentages to MEDCOM Percentages
24%
25%
50%
25%
37%
25%
36%
50%
36%
50%
45%
50%
39%
25%
14%
25%
18%
25%
0% 20% 40% 60% 80% 100%
MEDCOM CompassionSatisfaction
ProQOL CompassionSatisfaction
MEDCOM Compassion Fatigue
ProQOL Compassion Fatigue
MEDCOM Burn Out
ProQOL Burn Out
Good Medium Bad
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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
MEDCOM Demographics
Note: Percentages less than 1 not graphically displayed
Respondents by Gender(N=50,478)
Female55%
Male45%
Respondents by Specialty(N=50,478)
Nurse21%
Enlisted Direct Care13%
Admin Staff19%
Support Staff21%
Physician9%
Other Credentialed Professional
17%
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Percentage of MEDCOM Respondents that meet Cut Off Scores
73%83%83%
77%84%
85%86%88%
82%88%
76%82%81%
64%74%
27%17%17%
23%16%
15%14%12%
18%12%
24%18%19%
36%26%
0% 20% 40% 60% 80% 100%
Physicians (n=4,387)Nurses (n=10,495)
Other Cred Providers (n=8,670)Enlisted Direct Care (n=6,475)
Admin & Support Staff (n=20,451)
Physicians (n=4,387)Nurses (n=10,495)
Other Cred Providers (n=8,670)Enlisted Direct Care (n=6,475)
Admin & Support Staff (n=20,451)
Physicians (n=4,387)Nurses (n=10,495)
Other Cred Providers (n=8,670)Enlisted Direct Care (n=6,475)
Admin & Support Staff (n=20,451)
Below Cut Off Score Above Cut Off Score
MEDCOM Respondents by Specialty
Burn Out
CompassionFatigue
CompassionSatisfaction
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
**
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
MEDCOM Deployment
MEDCOM Deployment Length(N=14,639)
7 to 12 Months
35%
13 to 18 Months
25%
19 to 24 Months
10%
25 to 30 Months
7%
31 to 36 Months
3%More 48 Months
3%
6 Months or less17%
Medcom Deployed Status(N=50,478)
Non-Deployed
71%
Deployed29%
Note: Percentages less than 1 not graphically displayed. There were no respondents deployed in the 37 to 48 month bracket.
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Percentage of MEDCOM Respondents that meet Cut Off Scores
82%
76%
78%
86%
86%
81%
87%
89%
76%
69%
71%
81%
18%
24%
22%
14%
14%
19%
13%
11%
24%
31%
29%
19%
0% 20% 40% 60% 80% 100%
MEDCOM All (N=50,478)
MEDCOM Military Deployed (n=11,454)
MEDCOM Military Non Deploy (n=10,714)
MEDCOM Civilians (n=28,065)
MEDCOM All (N=50,478)
MEDCOM Military Deployed (n=11,454)
MEDCOM Military Non Deploy (n=10,714)
MEDCOM Civilians (n=28,065)
MEDCOM All (N=50,478)
MEDCOM Military Deployed (n=11,454)
MEDCOM Military Non Deploy (n=10,714)
MEDCOM Civilians (n=28,065)
Below Cut Off Score Above Cut Off Score
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
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Burn Out
CompassionFatigue
CompassionSatisfaction
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Cautions
• Social desirability bias.
• Assumption of 1 in 4.
• Use of cutoff scores.
• Size of the dataset, www.googleimages.com
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] 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.
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Data Analyses on Provider Fatigue & Burnout in MEDCOM
MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO
Questions?????
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