Wellbeing (eBook)

Contents 6
Part I: Introduction 8
Chapter 1: What Is Wellbeing? 9
1.1 Origin of Wellbeing Concepts 10
1.2 Concept of Wellbeing 11
1.3 Definition of Wellbeing 14
References 15
Chapter 2: Why Focus on Wellbeing? 17
2.1 Personal Losses 17
2.1.1 Loss of Physical Health 18
2.1.2 Loss of a Healthy Lifestyle 18
2.1.3 Loss of Mental Health 20
2.1.4 Loss of Relationships 21
2.1.5 Loss of Employment 21
2.1.6 Loss of Life 21
2.2 Institutional Losses 22
2.2.1 Loss of Employees 22
2.2.2 Loss of Productivity 23
2.2.3 Loss of Patient Satisfaction, Quality and Safety 23
2.3 Societal Losses 23
2.4 Loss of Meaning and Purpose 24
2.5 Conclusion 24
References 25
Part II: Maintaining Wellbeing as a Surgeon 26
Chapter 3: Important Terms in Wellbeing 27
3.1 Introduction 27
3.2 Factors Positively Associated with Wellbeing 28
3.3 Factors Negatively Associated with Wellbeing 29
3.4 Individual Characteristics to Combat Burnout and Support Wellbeing 30
3.5 External Strategies to Promote Wellbeing 31
References 33
Chapter 4: Conceptual Framework for Wellbeing 35
4.1 The National Academy of Medicine Action Collaborative on Clinician Wellbeing and Resilience 35
4.2 Conceptual Model of the Factors Affecting Clinician Wellbeing and Resilience 36
4.3 Intervening on Physician Wellbeing 39
References 41
Part III: Individual Factors of Wellbeing 43
Chapter 5: Healthcare Role 44
5.1 Introduction 44
5.2 Administrative Responsibilities 45
5.3 Alignment of Responsibility and Authority 45
5.4 Clinical Responsibilities 46
5.5 Learning and Career Stage 48
5.6 Patient Population 49
5.7 Specialty Related Issues 49
5.8 Student and Trainee Responsibilities 50
5.9 Teaching and Research Responsibilities 51
5.10 Conclusion 51
References 52
Chapter 6: Personal Factors 55
6.1 Introduction 55
6.2 Intrinsic Personal Factors 55
6.2.1 Personality Traits 55
6.2.2 Flexibility and Ability to Respond to Change 56
6.2.3 Personal Values, Ethics, and Morals 57
6.3 Extrinsic Personal Factors 58
6.3.1 Relationships and Social Support 58
6.3.2 Family Dynamics 59
6.3.3 Work-Life Integration 59
6.3.4 Financial Stressors/Economic Vitality 60
6.4 Work Environment Personal Factors 61
6.4.1 Inclusion and Connectivity 61
6.5 Conclusion 62
6.5.1 Physical, Mental, and Spiritual Well-being 62
6.5.2 Sense of Meaning 62
References 63
Chapter 7: Meaning/Purpose in Work 64
7.1 Background 64
7.2 Empathy, Meaning, and Empathetic Distress 65
7.3 Enhancers of Enjoyment and Meaning in Work 66
7.4 Elements That Detract from Meaning in Work 69
7.5 Net Meaning 71
References 73
Chapter 8: Skills and Abilities 75
8.1 Introduction 75
8.2 Clinical Competency 75
8.3 Mentorship 77
8.4 Management, Delegation, Leadership, Communication, and Teamwork Skills 77
8.5 Optimizing Workflow, Organizational Skills, Mastering New Technologies 78
8.6 Resilience and Grit 78
8.7 Coping Skills, Empathy, and Emotional Intelligence 79
8.8 Conclusion 80
References 80
Part IV: External Factors of Wellbeing 83
Chapter 9: Sociocultural Factors of Wellbeing 84
9.1 Economic and Political Climate 84
9.2 Alignment of Societal Expectations and Clinician’s Role 86
9.3 Media Portrayal 87
9.4 Patient Behaviors and Expectations 88
9.5 Culture of Safety and Transparency 89
9.6 Discrimination and Overt and Unconscious Bias 91
9.7 Stigmatization of Mental Illness 95
9.8 Conclusion 96
References 96
Chapter 10: Regulatory, Business, and Payer Environment 102
10.1 Introduction 102
10.2 Regulatory and Business Factors Affecting Surgeon Wellness 103
10.2.1 Regulatory Environment 103
10.2.2 Clerical Burden and Electronic Systems 105
10.2.3 Financial Reimbursement 107
10.2.4 Litigation 108
10.2.5 Shifting Practice Patterns 110
10.3 Conclusions 112
References 113
Chapter 11: Organizational Factors 117
11.1 Introduction 117
11.2 Congruent Organizational Mission and Values 118
11.3 Leadership, Culture, and Staff Engagement 118
11.4 Professional Development 121
11.5 Workload, Performance, Compensation, and Value Attributed to Work Elements 121
11.6 Bureaucracy and Scope of Practice 122
11.7 Level of Support for All Healthcare Team Members 122
11.8 Data Collection Requirements 123
11.9 Diversity, Inclusion, and Discrimination 123
11.10 Harassment and Bullying 125
11.11 Conclusions 125
References 126
Chapter 12: Learning and Practice Environment 129
12.1 Introduction 129
12.2 Autonomy 130
12.3 Collaborative vs Competitive Environment 131
12.4 Curriculum 131
12.5 Health It Operability and Usability/Electronic Medical Record (EMR) 132
12.6 Learning and Practice Setting 133
12.7 Mentorship 134
12.8 Physical Learning and Practice Conditions 135
12.9 Professional Relationships 135
12.10 Student Affairs Policies 136
12.11 Student-Centered and Patient-Centered Focus 136
12.12 Team Structures and Functionality 137
12.13 Major Domains of Teamwork 137
12.14 Workplace Safety and Violence 137
12.15 Conclusion 139
References 140
Part V: Improving Wellbeing 143
Chapter 13: Addressing Individual Factors 144
13.1 Healthcare Role 144
13.2 Personal Factors 146
13.3 Skills and Abilities 148
13.4 Conclusion 149
References 150
Suggested Reading 151
Emotional Intelligence 151
Mindfulness 152
Chapter 14: Addressing External Factors 153
14.1 Introduction 153
14.2 Conceptual Model 154
14.3 Socio-cultural Factors 154
14.4 Regulatory Business and Payer Environment 157
14.5 Organizational Factors 159
14.6 Learning Practice Environment 161
14.7 Summary 163
References 164
Chapter 15: Wellbeing Considerations for Medical Students 168
15.1 Introduction 168
15.2 The Impact of Student Demographics on Wellbeing 169
15.3 The Impact of Step 1 on Wellbeing 169
15.4 The Impact of Clinical Rotations on Wellbeing 171
15.4.1 Mistreatment and Wellbeing 171
15.4.2 Defining Mistreatment 172
15.4.3 Student-Centered Solutions 173
15.5 The Impact of Residency Applications on Wellbeing 174
15.6 Student Support Instead of Remediation 175
15.7 Concluding Remarks 176
References 177
Chapter 16: Wellbeing Consideration for Residents 179
16.1 Introduction 179
16.2 Life of a Surgery Resident 180
16.3 Burnout and Wellness in Residency 180
16.4 What to Do from Here? 182
16.5 Conclusion 186
References 186
Chapter 17: Approaches to Study Wellbeing 190
17.1 Observational Studies 190
17.1.1 A Note on Epistemology 190
17.1.2 Cross-Sectional Studies 192
17.1.3 Qualitative Methods 193
17.1.4 Mixed Methods Research 194
17.2 Correlational Studies 195
17.2.1 Cross-Sectional Studies 195
17.2.2 Case-Control Studies 196
17.2.3 Cohort Studies 196
17.3 Interventional Studies 197
17.3.1 Experimental Studies 197
17.3.2 Pseudo-Experimental Studies 198
17.4 Research as Intervention 198
17.5 Conclusion 199
References 200
Part VI: The Study of Wellbeing 201
Chapter 18: Tools of the Trade 202
18.1 Introduction 202
18.2 Burnout Assessment Tools 204
18.2.1 Maslach Burnout Inventory (MBI) 204
18.2.2 Oldenburg Burnout Inventory (OBI) 207
18.2.3 Copenhagen Burnout Inventory (CBI) 208
18.3 Wellbeing Assessment Tools 209
18.3.1 Short Form-12 Health Survey (SF-12) 209
18.3.2 Physician Wellbeing Index (PWBI) 210
18.3.3 Quality Work Competence (QWC) 211
18.4 Personality Assessments 211
18.4.1 Grit Scale (Grit-O)/Short Grit Scale (Grit-S) 211
18.4.2 Connor-Davidson Resilience Scale (CD-RISC) 213
18.5 Burnout + Wellbeing Interventions 214
18.6 Conclusion 218
References 218
Chapter 19: Evaluating Organizational Structures and Institutional Policy for Wellbeing 226
19.1 Introduction 226
19.2 Content to Evaluate 227
19.2.1 Exposures 227
19.2.2 Outcomes 228
19.3 Methods 229
19.3.1 Measuring Exposures 229
19.3.2 Measuring Outcomes 232
19.4 Future Directions 233
References 233
Chapter 20: Emerging Areas of Research 235
20.1 Organizational Interventions 236
20.2 Physician Interventions 238
20.3 Limitations 239
20.4 Implications for the Future 240
20.5 Conclusion 241
References 241
Index 244