AMEDD Center & School Dept of Preventive Health Services Soldier & Family Support Branch

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


MAJ Bicknell (210) 221-6073 (DSN XXX) / [email protected] UNCLASSIFIED/FOUO

BRIEFING OUTLINE

• Brief History

• Methodology

• MEDCOMProQOL Findings

• Provider Resiliency Training


www.googleimages.com

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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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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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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.


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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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.


I feel “bogged down” by the system. 0 Never < 5 Very Often

I am a very sensitive person. Reverse coded

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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.


I think that I might have been “infected” by the traumatic stress of those I help.


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.


I avoid certain activities or situations because they remind me of frightening experiences of the people I help.


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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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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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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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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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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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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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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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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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)







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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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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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)









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

******

******

**

**

Burn Out

CompassionFatigue

CompassionSatisfaction

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Cautions

• Social desirability bias.

• Assumption of 1 in 4.

• Use of cutoff scores.

• Size of the dataset, www.googleimages.com

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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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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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Questions?????

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