The Impact of a Program in Mindful Communication on Primary Care Physicians

Beckman, Howard; Wendland, Melissa; Mooney, Christopher J.; Krasner, Michael S.; Quill, Timothy E.; Suchman, Anthony L.; Epstein, Ronald M.

doi:10.1097/acm.0b013e318253d3b2

Cited by 232 publications

(225 citation statements)

References 7 publications

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“…There is emerging literature about interventions that individuals can undertake to better combat the tendency to burn out. 24,25 Our study complements this work by showing that organizational change may also lead to reduced stress and improved clinician outcomes. Our most powerful intervention was workflow modification, such as reassigning clinic staff work and changing call schedules.…”

Section: Discussionsupporting

confidence: 63%

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

et al. 2015

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BACKGROUND: Work conditions in primary care are associated with physician burnout and lower quality of care. OBJECTIVE: We aimed to assess if improvements in work conditions improve clinician stress and burnout. SUBJECTS: Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study. STUDY DESIGN: This was a cluster randomized controlled trial. MEASURES: Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12-18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites. INTERVENTIONS: Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects. ANALYSIS: Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement. RESULTS: Of 166 clinicians, 135 (81.3 %) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8 % vs 7.1 % less burned out, p=0.01) and satisfaction (23.1 % vs 10.0 % more satisfied, p=0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p=0.02], and with targeted QI projects than in controls (OR 4.8, p=0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p=0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p=0.06). LIMITATIONS:We used heterogeneous intervention types, and were uncertain how well interventions were instituted. CONCLUSIONS: Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.KEY WORDS: burnout; primary care; quality improvement; work conditions.

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Section: Discussionsupporting

confidence: 63%

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

et al. 2015

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“…We present it as a discrete early stage as it was an early experience reported by most participants and appeared to be a necessary building block for subsequent experiences. A sense of reluctance and/ or guilt for engaging in self-care has been reported in many mindfulness studies in diverse contexts and countries (Beckman et al 2012;Irving et al 2014;Morgan et al 2015). The modelling of self-care in the group appeared to help our study participants.…”

Section: Discussionmentioning

confidence: 90%

“…Group effects in MBSR-based interventions are expected, and reported, as vicarious learning, normalisation, cohesion, empathy, compassion and reduced professional isolation, and are therapeutic in stress reduction in and of themselves (e.g. Beckman et al 2012;Dobkin 2008;MacKenzie et al 2007). Irving et al's (2014) model of change, based on healthcare practitioners, similarly positioned group experiences as an intervening factor, whereby peer endorsement of the intervention's application to working life improved the intervention's credibility and acceptance.…”

Section: Discussionmentioning

confidence: 99%

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How Is Stress Reduced by a Workplace Mindfulness Intervention? A Qualitative Study Conceptualising Experiences of Change

et al. 2017

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Mindfulness-based interventions are effective as curative and preventative approaches to psychological health. However, the mechanisms by which outcomes are secured from such interventions when delivered in the workplace, and to a stressed workforce, are not well understood. The aim of the present study was to elicit and analyse accounts from past participants of a workplace mindfulness intervention in order to generate a preliminary model of how positive benefits appear to be secured. In-depth, semi-structured interviews were completed with 21 employees of a higher education institution who had completed an eight-week intervention based on Mindfulness-Based Stress Reduction, adapted for the workplace. Interviews invited participants to recount their experiences of the intervention and its impact, if any, on their work life. Aspects of the interview data that pertained to intervention experience and positive benefits were analysed using a version of grounded theory, leading to the generation of a provisional model of how positive change occurred. The model suggests that discrete, temporal experiences build on each other to generate multiple, positive benefits. As anticipated in mindfulness-based interventions, enhanced attentional capacity was important, but our provisional model also suggests that resonance, self-care, detection of stress markers, perceiving choice, recovering self-agency and upward spiralling may be central mechanisms that lead to positive outcomes. Understanding mechanisms of change may help support participant engagement and trust in work-based mindfulness programmes, and enhance participants' ability to apply mindfulness in their work life.

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“…55,56 The effect of education in mindful communication has been examined in physicians in a structured training program, which produced 4 main themes of feedback from participants: (1) participants felt a decrease in sense of personal isolation; (2) mindfulness training helped physicians listen more deeply and attend to the patient' s concerns more effectively; (3) adaptive reserve was increased; and (4) participants experienced a feeling of greater selfawareness that proved, in many cases, to be transformative. 57,58 Mindfulness may also support more thoughtful decision-making and can enhance empathic communication. Precedent in the use of mindfulness exists in law and business, where it is used to reduce reactivity in stressful situations.…”

Section: New Frontiers Of Wellness: Mindfulness In Medicinementioning

confidence: 99%

Physician Health and Wellness

McClafferty¹,

Brown²,

Vohra³

et al. 2014

Pediatrics

138

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Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training.Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training.Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted. Pediatrics 2014;134:830-835 INTRODUCTIONPhysician health and wellness is an issue garnering national interest because of the high prevalence of burnout in medical practitioners and trainees. Burnout takes a steep toll on physicians and has negative effects on patients and health care systems. 1 Research advances detailing the detrimental effects of chronic stress, including impaired immune function, inflammation, elevation of cardiovascular risk factors, and depression, 2-9 are directly relevant to pediatric practitioners and create a need for organized efforts to address physician health and well-being in the pediatric community. The purpose of this report is to provide an update on the issue of physician health and wellness with regard to how they relate to pediatricians. Rather than reviewing programs already in place to address substance abuse and other serious conditions in distressed physicians, this report focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Although specific recommendations are beyond the parameters of this report, examples of positive progress and national programs to promote physician health and wellness will be reviewed. BURNOUT: THE ANTITHESIS ...

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The Impact of a Program in Mindful Communication on Primary Care Physicians

Abstract: Interventions to improve the quality of primary care practice and practitioner well-being should promote a sense of community, specific mindfulness skills, and permission and time devoted to personal growth.

Cited by 232 publications

References 7 publications

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

How Is Stress Reduced by a Workplace Mindfulness Intervention? A Qualitative Study Conceptualising Experiences of Change

Physician Health and Wellness

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