Taking%20Care%20of%20You

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• Taking Care of You
• Becoming the CEO of Your Health

Michael Anderson, MDChief Medical Officer - UH
Case Medical CenterChief Medical Officer -
University HospitalsAssociate Professor,
Pediatrics - CWRU School of Medicine
Raymond Krncevic, Esq.Associate General Counsel
Shanna McIntosh MSN BSN RNSupervisor, Clinical
Applications Analyst IIIT Department -
Ambulatory EMR
Zachary Brott, BSN, RNIT Clinical Application
Analyst I
Roy Buchinsky, MD, ABIHMSenior Clinical
Instructor, Medicine-CWRU School of
MedicineDirector of wellness, Primary Care
InstituteRobert and Susan Hurwitz Master
Clinician in Wellness
Meghan M. Ramic, BSN, RN, CPHQManagerClinical
Risk ManagementUniversity Hospitals Case Medical
Center
Laurie Joyce BSN, RNSenior Quality Improvement
NurseQuality Institute University Hospitals
Case Medical Center
Susan Semrau BSN, RN, CPHQSenior Quality
Improvement NurseQuality Institute University
Hospitals Case Medical Center
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Disclosures

• Speakers in this presentation have no disclosures.

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Objectives

• Understanding the effect of the external
  environment on the internal environment
• Effect of lifestyle on disease causation
• Smoking, diet, nutrition, exercise, stress,
  sleep, and sex
• Understand the different modalities of stress
  management
• Discuss the Critical Incident Management Team
  (Second Victim) and available resources for staff
  
• Overview of the physician wellness committee
• Brainstorming of future growth for the program

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Self Care - Becoming the CEO of Your Health

• Roy Buchinsky, MD,ABIHM
• Director of Wellness, PCI
• Robert and Susan Hurwitz Master Clinician in
  Wellness

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Wellness Statistics Cost

• 75 of Health Care are spent on four chronic
  conditions
• Obesity
• Diabetes
• Cardiovascular Disease
• Cancer

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Wellness Statistics Cause

• 75 of Chronic Health conditions are due to
• Smoking
• Poor nutrition (choices and portions)
• Physical inactivity
• Unmanaged stress

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Behavior is a Powerful Determinant of Health
Outcomes
Schroeder SA. N Engl J Med 20073571221-1228.
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Optimal Health 3Fs 3 Ss
Sleep Stress Sex
Feet Fingers Fork
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Epigenetics

• Nature vs. Nurture
• Genes load the gun, but epigenetics pulls the
  trigger
• 30 Genetics
• 70 Lifestyle

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Reshuffling the Genetic Deck

• All genes do is make proteins or watch other
  genes
• Which genes are on or off are largely under OUR
  control
• 90 of genes are actually gene switches
• Epigenetic studies reveal that genes can be
  turned off and on

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Mechanisms of Changing Gene Function

• 1. Proteins production
• 2. Terrific telomeres

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Lifestyle and Cell Age

• Telomere length affects longevity
• Smoking, obesity and stress shorten telomeres
• Relaxation lengthens telomeres by 30

8/6/2019
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University Hospitals Ahuja Medical Center
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Why Physician Self Care Matters
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Why Now?
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Shakespeare on Self-Care
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Self-Care vs. No Self-Care for Self and Patients

• Self-care No self-care
• Satisfaction
  Fatigue
• Well being
  Weakened immune system
• Sense of purpose
  Interpersonal distress
• Mental clarity Burnout
• Emotional awareness Depression
• Social attunement Substance
  use/abuse

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The Exercise Prescription Frequency
Intensity Type Time
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Benefits of Exercise

• Lower risk of
• Early death
  High BP
• Colon cancer
  Metabolic Synd
• Coronary heart disease Abnormal
  Lipids
• Breast cancer
• Stroke
• T2 Diabetes
• US HHS, 2008 Physical guidelines activity for
  Americans

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Stress Management

• Between 60-90 of
• healthcare visits are related to
• Stress!!!!!!

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Effects of Stress on Performance
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Mindful Practice Mindfulness

• Paying attention with purpose to the moment at
  hand
• Being in the now with total acceptance
• Noticing your present experience-thoughts and
  feelings
• Being fully and totally aware
• Mind full, or Mindful
• Various breathing techniques

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Mindfulness
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Mindfulness Practice and Tools

• Breathe - the 10 count technique
• Notice five things in the moment
• Immerse yourself in sensation using an object of
  focus - chocolate
• Walk purposefully in meditation
• Practice mindful eating

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Stress Busters- No Single Prescription

• Diaphragmatic breathing
• Yoga classes
• Guided Imagery purposeful dreaming
• Take a walk/jog/spin/swim
• Look out the window watch the clouds/stars

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Out With the Old
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In With The New
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So, Lets Start At the Beginning

• The Confusion starts with Diets
• Low Fats
• Low Carbs
• High Protein/ High Fat
• High Fat(?)
• Vegan

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JUST TELL ME WHAT TO EAT!!

• Eat real food, mostly plants, not too much
• If it comes from a plant, eat it-If its made in
  a plant, avoid it
• If its white, its just not right( with
  exceptions)
• Balanced diet, incorporating ALL food groups
• Stop drinking your calories

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The Bottom Line
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Deep Sleep
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Sleep and Disease Risk

• Chronic medical conditions
• Obesity
• High blood pressure
• Diabetes
• Heart disease
• Depression

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Sleep Deprivation

• Focus, attention, and vigilance drift
• Reduced ability to access previously learned
  information
• Interpretation and decision-making affected
• Judgment becomes impaired
• Chronic fatigue poor performance, accidents and
  injuries
• Low quality sleep poor mood, reduced energy and
  learning

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Sex and Wellness- The Missing Link

• Sex is good for you!!!! ( DUH)
• One act of intercourse burns 180 calories
• Sexual hormones lower rates of
• Depression
• Anxiety
• Cancer
• Chronic medical illnesses
• Sexual hormones may boost immunity and promote
  longevity
• Release of oxytocin increase intimacy( bonding
  hormone)
• Krychmann M, Fall 2007 ISSWSH conference Dallas,
  TX

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Sex is Important in Overall Life
Moderately / Very / Extremely Important (3 to 5)
40-80 years of age
83
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Percentage of Respondents
Men
Women
5-point scale where 5 is extremely important and
1 is not at all important.
Laumann, et al. 2005
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How Frequently Have You Had Sex in the Past 12
Months?
Pfizer Global Health Survey
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Importance of Sexuality to QOL
Agreeing That Sex Is Important to QOL ()
Age (y)
Fisher L. AARP Survey. 2010.
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More Sex Longer Life- Maybe!!!

• Increasing orgasm frequency from one per week -
  three per week decreases risk of dying by about
  20 in males
• Increasing frequency to one a day or about 350 a
  year, decreases the risk by about 40 in males
• Not sufficient data on women to link frequency to
  longevity
• Quality of sex correlates positively with better
  health for women.

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Summary

• Genes are not your destiny
• Lifestyle factors account for 75 of chronic
  medical conditions
• Feet,fork,fingers, sleep, stress, sex( love) are
  the master levers of our medical destiny
• Behavioral patterns account for 40 of premature
  mortality
• Practice self care !!!
• Practice what you preach, and preach what you
  practice!!!

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Critical Incident Management Team (CIMT) Peer
Support Program

• Meghan Ramic, BSN, RN, CPHQ
• Clinical Risk Manager

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Agenda

• Overview of CIMT Program
• Review of CIMT model
• Review CIMT role
• Data for CIMT interventions from team

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Reason for the team

• We now believe that it is our moral
  imperative to design and deploy a readily
  accessible and effective support infrastructure
  for all health care providers beginning the
  moment that events causing anxiety and stress are
  discovered and extending through years of
  protracted litigation as necessary.
• Joint Commission Statement

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Ripped from the headlines
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Reasons for the team

• Their concerns related to the patient and family
  
• Is the patient/family ok
• Will I be sued
• Will I be fired
• Will I lose my license
• Peers
• What will my colleagues think
• Will I ever be trusted again
• What happens next?

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Types of events/incidents in Healthcare

• Death (coworker or patient)
• Downsizing
• Suicide (coworker or patient)
• Quality/Risk management issue
• Conflict
• Workplace Violence
• Sentinel Event/Critical Event

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Purpose of CIMT

• Minimize risk of harm to employees and patients
• Assessment of who benefits and who might be at
  risk from an abnormal event in the workplace
• Restoring balance and resilience to the workplace
  and employees
• Promoting safety and well being of others

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Roles of CIMT Responder

• Provide consultation, individual or group
  facilitation, and psycho-educator rather than
  counselor
• Promote recovery, return to work and function
• Consult with leadership when indicated to review
  information about the event and reactions
• Build group support
• Provide safe haven and promote confidentiality
• Provide/initial solutions to overcome immediate
  return to work and return to life obstacles

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Roles of CIMT Responder

• Triage movement toward immediate business as
  usual functioning or additional care
• Focus on the strengths and resources of the
  individual to return to adaptive functioning
• Normalize symptoms to reduce anxiety (normal
  reactions to an abnormal event)
• Focus on resilience and recovery, not pathology
• Identify strategies for self care and reentry to
  life and work

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3 types of CIMT interventions

• Individual
• Small Group Briefings
• Large Group

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Critical Incident Management Peer Support

• Volunteer physicians, nurses, LISW, EAP
• Educated in Critical Incident Management
• Respond to Colleagues Incidents
• Sentinel Events
• Litigation
• Adverse Patient Outcomes
• Referral if needed

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Legal and Management

• Confidentiality and Privilege
• Program Management / Oversight

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Current Goals

• Increase awareness of the team
• RMC
• Nursing education
• GME education
• Recruit new members
• Application process
• LMS education

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Promoting your own resiliency- Taking care of
yourself

• Check your readiness to respond before you go
• Understand nature of request
• Use support resources during response
• Discuss response afterwards
• Apply what you know about self care
• Be on guard for compassion fatigue, caregiver
  burden, or burn out

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UH Physician Wellness Building a Culture of
Support and Professionalism

• Michael R Anderson, MD MBA FAAPChief Medical
  Officer UH and UH Case Medical CenterAssociate
  Professor, Pediatrics - CWRU School of Medicine

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Self
UH
CIMT
Wellness Committee
Wellness and Self Care
Physician
A Culture of Professionalism
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UH Building a Culture of Support and
Professionalism

• Medical Staff Wellness Committee
• UH Center on Ethics and Professionalism

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UH Medical Staff Wellness Committee

• Support the Medical Staff
• Confidential Referral to Support Network
• Review of Sensitive Matters for Clinical Council
  (Med Exec)
• Work in conjunction w center on Ethics and
  Professionalism Center for Referrals
• Aid Chairs and UH Leaders in Supporting a Culture
  of Professionalism and Support
• Define new avenues to support medical staff in
  their important work

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UH Center on Ethics and Professionalism

• A foundation of the social contract for medicine
• Principles include patient welfare, patient
  autonomy and social justice
• Excellence in humanistic and patient-centered
  care

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From Cruess R., Cruess S., Professionalism.
CanMEDS Train-the-Trainer Program on
Professionalism. 2009
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What is Professionalism?

• Commitments
• - Professional competence/knowledge -
  Professional responsibilities (managing COI,
  etc.) - Professional communication honesty,
  confidentiality, etc. - Appropriate
  relationships

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What is Professionalism?

• Attributes - Primacy of the needs of the
  patient - Reflective practice - Altruism -
  Accountability - Respectfulness - Sensitivity
  (culture, age, gender, disabilities, etc.)

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UH Centers Mission and Vision

• Mission Provide readily accessible, practical
  and useful resources to all medical professionals
  at University Hospitals that improve and enhance
  providers' ability to deliver professional,
  compassionate and ethical care of the highest
  quality in the most collegial environment for
  employees to function as a health care team
• Vision University Hospitals will be an
  institution that is known and respected for
  excellence in humanistic and patient-centered
  care.

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Return on Investment in Professionalism
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Where are we so far?

• Two major Keynote speakers
• Michael Brennan, MD Director for Program for
  Professionalism and Ethics, Mayo Clinic
• Thomas Atchison, EdD Creating and Sustaining a
  Culture of Professionalism
• Medicine MM Conference The Curious Case of
  the Confounding Communication
• Presentation to Vascular Surgery on disruptive
  behaviors
• Developing Web presence UHDoctor.org
• Oct 27 and 28, 2015 Lawrence Smith MD (Dean,
  Hofstra)

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Elements of the Center

• Consultation to individuals and departments
• Website for resources and learning modules
• Partnership w CWRU in education and research
• Menu of programs for Grand Rounds, GME, CME,
  etc.
• Risk Management Strategies (e.g., prescribing
  controlled substances, management of medical
  mistakes, addressing disruptive behaviors)
• Communication Skills
• Management of Challenging Patients

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Self
UH
CIMT
Wellness Committee
Wellness and Self Care
Physician
A Culture of Professionalism
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I Will