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Wayne M. Sotile, Ph.D.
Real Talk, Inc. and Sotile Psychological Associates Winston-Salem, North Carolina
Clinical Assistant Professors Dept. Orthopaedic Surgery
Tulane University School of Medicine New Orleans, LA
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Overcoming “Yea, Not Really” and other Psychological Barriers to Changing for Good
Email: [email protected]
Resilience Defined
The ability to get through difficult times and come out stronger
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What Drives Physician Dissatisfaction?
Lack of Time Role Stretch Disparate Expectations
Zuger, A. Dissatisfaction with medical practice. NEJM.2004;350(1):69-75. h
Yes!
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0 10 20 30 40 50 60
Prev Med/Occupat Med/Enviro Med
Dermatology
Pediatrics - General
Pathology
Radiation Oncology
Other
Pediatric Subspecialty
Neurosurgery
Psychiatry
Urology
General Surgery Subspecialty
Ophthalmology
Internal Medicine Subspecialty
General Surgery
Average Burnout All PhysiciansParticipating
Physical medicine and Rehab
Radiology
Obstetrics and Gynecology
Anesthesiology
Orthopedic Surgery
Otolaryngology
Family Medicine
Neurology
Internal Medicine - General
Emergency Medicine
% Reporting Burnout
Burnout by
Specialty
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Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population Arch Intern Med. 2012 Oct 8;172(18):1377-85 Shanafelt T, Boone S, Tan L, Dyrbye L, Sotile W, Satele D, West C, Sloan J, Oreskovich M.
Why Physician Burnout Matters
á Medical Errors Williams ES et al. Health Care Manage Rev. 2007;32:203-212 Firth-Cozens J & Greenhalgh J. Soc Sci Med. 1997;44:1017-1022. Shanafelt TD et al. Ann Intern Med. 2002;136:358-67.
á Medical Malpractice Suits Jones JW et al. J Appl Psychol. 1988;73:727-35.
â Patient Compliance DiMatteo MR et al. Health Psychol. 1993;12:93-102.
âPatient Satisfaction Linn LS et al. Med Care. 1985;23: 1171-78 Haas JS et al. J Gen Intern Med. 2000;15:122-128
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áMedical Family Discord Sargent MC, Sotile WM, Sotile MO, et al.
J of Bone and Joint Surgery. 2009. 91;2395-405.
Does Physician Wellness Matter?
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Physician’s Fat Consumption Below median fat score 30.2% Median fat score 22.6%
Physicians’ Exercise Complies with ACSM rec. 46.1% Doesn’t comply with ACSM rec. 39.6%
Physicians’ alcohol consumption < 2 drinks per week 41.7% > 2 drinks per week 31.9%
Physicians’ cigarette smoking Non-smoker 63.4% Current smoker 47.8% *p<0.01 Frank, et al Arch Fam Med, 4/2000; Res Q Ex Sport, 6/2004
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Physician’s Health Behavior % Counseling Pts on Issue at Least 1x/year**
Physicians’ Personal Health Practices vs. Her Counseling or Screening Patients at Least 1x/yr
Screenings for Cancer Sunscreen Use Breast Self-Exam Receive Flu Shot Cholesterol Testing Blood Stool Testing Skin Exam Post Menopausal HRT
Frank, et al Arch Fam Med, 4/2000; Res Q Ex Sport, 6/2004
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The Challenge: Constant Change
High Demand Low Control Low Support
Toxic Stress
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8 Steps to Transformation
Kotter JP. Harvard Bus Review. March-April, 1995:59-67.
1. Establish a Sense of Urgency 2. Form a Powerful Guiding Coalition 3. Create a Vision 4. Communicate and Get Buy-In 5. Empower Others to Act on the Vision 6. Create Short-Term Wins 7. Don’t Let Up; Drive More Change 8. Create a New Culture ..
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The Biggest Paradox & Our Ultimate Challenge
The
“Yeanotreally” Mentality
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Lessons from the Psychological Underbelly
of Changing for Good
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Respect the Pain of Changing
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Overcoming "Yea, Not Really"
What Holds Us Back?
Mental Maps We grossly overestimate the importance
of what we do know – the familiar, and underestimate the importance
of what we don’t know – the unfamiliar.
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Overcoming "Yea, Not Really"
“To what do I attribute this?” Beware the Attitude:
“When people don’t change, it’s because they
don’t want to change” www.Sotile.com
Crucial Question
Don’t Let What You Know
Limit What You Can Imagine
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Overcoming "Yea, Not Really"
William C. Taylor. Practically Radical.
J. Black & H. Gregersen. Leading Strategic Change, 2003
Done Well
Done Poorly
Old Right Thing
New Right Thing
Believe
Achieve
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Conceive
See the Familiar In Unfamiliar Ways
Practice “Seeing the Familiar in Unfamiliar Ways”
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Overcoming "Yea, Not Really"
Beware of Cajun Logic: “Right Concept;
Wrong Application” and/or “Ignoring the Obvious”
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Overcoming "Yea, Not Really"
Why Do People Change?
Consequences Model
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Climate Change
The New Normal
Regulation Reimbursement
Erosion
Changed Patient
Expectations
Enhanced Physician -Income Anxiety -Business Savvy
International Financial
Environment
New Definitions of
Quality Provider
Shortages
More Sophisticated Workplace Systems
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Increased Competition
ACOs
•Who Becomes a Physician? •What Motivated You to Enter Medicine?
•What Happened, Next? www.Sotile.com
The Crucial Balancing Act
Extrinsic and Intrinsic Motivation
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The Paradoxes of Human Motivation
“When money us used as an external reward..the Ss lose intrinsic interest
for the activity..”
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Deci, Edward. Effects of externally mediated rewards on intrisic motivation. J Person and Soc Psych. 1971; 114.
Important Factors in a Desirable Practice for Young Physicians
% Very Important Time for family/personal 71% Adequate support staff and services 43% Long term income potential 42% Practice income 39% Flexible scheduling 37% Health insurance coverage 35% No or very limited on-call 31% Adequate patient volume 30% Opportunity to advance professionally 28%
AAMC 2006 Survey of Physicians Under 50
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Important Factors in a Desirable Practice for Young Physicians
BALANCE Male Female Time for family/personal 66% 82% Flexible scheduling 26% 54% No or very limited on-call 25% 44% Minimal prac mgmt responsibility 10% 18%
CAREER / INCOME
Practice income 43% 33% Long term income potential 45% 36% Opportunity to advance 29% 27%
AAMC 2006 Survey of Physicians Under 50
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Maslow’s Hierarchy of Needs Self-actualization needs _________________________________________________________________________
Psychological needs ___________________________________________________________________________
Fundamental needs
The need to
fulfill one’s unique potential
Esteem needs: To achieve, Be competent,
gain approval and recognition
Belongingness and love needs: to Affiliate with others;
to be accepted and belong
Safety needs: to feel secure, safe and Out of danger
Physiological needs: to satisfy hunger, thirst, and sex drives
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What Drives Sustainable Motivation?
Drive to Acquire Drive to Bond Dive to Comprehend Drive to Defend
Nohria, Nitin. “Employee Motivation; A Powerful New Model,” Harvard Business Review, July-August 2008.
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Tie the Change to Identity, Not to
Consequences
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Overcoming "Yea, Not Really"
Why Do People Change?
Consequences Model Identity Model
Who am I? What kind of situation is this? What would a person like me do in this situation?
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What Motivates Physicians?
Inherent Factors Performance Factors
Lepnurum, Rein. “Cornerstones of Career Satisfaction in Medicine,” Canadian Journal of Psychology.V. 51, no. 8. July 2008.
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What Drives Physician Resilience?
Does the Work Match My Values? Can I Do it to the Best of My Abilities? Am I Enjoying Working with the People I Work With? Am I Getting Support from Loved Ones for Doing this Work?
Sotile W & Sotile M. Letting Go of What’s Holding You Back. 2007
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What Drives Sustainable Motivation?
Autonomy Mastery Purpose
Pink D. Drive. 2009
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We Must Work on How We are Working
Together
Drucker P.Harvard Business Review, Feb 1, 2006
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Are We In This Together?
Non-Identification Neutral Identification
Apathetic Identification
High Passion Zone
Dis-Identification
Organizational Identification
Elsbach & Bhattacharya. Organizational Science. 2001;12:393-413
Low Passion Zone
Deepen Your Relationships
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Overcoming "Yea, Not Really"
A hero is someone who creates safe spaces
for other people
—The Resilient Physician. Sotile & Sotile, 2002
Be a Hero
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Who Supports Your Faculty Physicians
and their Families?
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Overcoming "Yea, Not Really"
Where Do You Get Support?
I talk with colleagues informally about my concerns.
Residents Res Mates Faculty Fac Mates
Not at all 5.6% 26.7% 10.3% 40% A little 38.5% 46.1% 59.2% 48.5% Quite a bit 41.5% 18.1% 24.4% 8.5% A lot 14.4% 9.1% 6.1% 3.0%
Sargent, Sotile, Sotile et al. JBJS. 2009; 2009;91:2395-2405. www.Sotile.com
The Principal of Propinquity The frequency and quality of human interaction is largely a function of physical distance (proximity)
Festinger L et al Social Pressure in Informal Groups, 1950
Deepen Your Relationships
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The New Science of Building Great Teams
• Be a “Charismatic Connector”
• Focus on Strengths Gallup, 2008
Pentland A. HBR. April, 2012, 60-70.
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Achievements
Expectations
William James www.Sotile.com
Beware the False Hope Syndrome: Don’t Overestimate the Benefits
or Underestimate the Effort Required
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Overcoming "Yea, Not Really"
Polivy, J & Herman, P. Amer. Psychologist. 2002;Sept;57(9):677-89.
Overcoming “Yea, Not Really..”
1. Respect the Pain of Changing 2. Practice Seeing the Familiar in Unfamiliar
Ways 3. Beware of Cajun Logic 3. Appeal to Identity/Values, not Consequences 4. Deepen Relationships 5. Beware the False Hope Syndrome
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