presented by rosalie lo, psyd senior clinical psychologist ...1. impair personal well-being burnout...

Presented by

Rosalie Lo, PsyD

Senior Clinical Psychologist

Certified Traumatologist

Corporate Clinical Psychology Services (CCPS)

Hospital Authority,

Hong Kong

They experience higher level of stress when compared to the

general population

Challenges Facing HCWs

1. Job related Workload

Times pressure

Administrative duties

Sleep deprivation

No regular meals

Make errors

Threat of malpractice suits

3. Interpersonal Patient’s expectations and demands

Staff conflicts

Bullying

Professional isolation

Level of support from friends and

family

2. Organisation Career structure

Career uncertainties

Inadequacy of resources and staff

Lack of senior support

Culture and climate of organisation

4. Personal Personality

(e.g. perfectionistic, Type A)

High demands on self and others

Dealing with death and dying

Confrontation with emotional and

physical suffering

(Firth-Cozens, 2003; Wong, 2008)

A statutory body

Hong Kong's public hospitals services

42 hospitals and institutions

47 specialist out-patient clinics (SOPCs)

73 general out-patient clinics (GOPCs)

27,440 beds

NTWC

KCC

1. New Territories East Cluster (NTEC)

2. New Territories West Cluster (NTWC)

3. Kowloon West Cluster (KWC)

4. Kowloon Central Cluster (KCC)

5. Kowloon East Cluster (KEC)

6. Hong Kong East Cluster (HKEC)

7. Hong Kong West Cluster (HKWC)

KWC

NTEC

KEC

HKEC HKWC

70,132 HA staff

23721

19946

13665

6891 5910

0

5000

10000

15000

20000

25000

Nursing Others Supporting(Care-related)

Allied Health Medical

No. of Staff

No. of Staff

(28 February 2015)

Others: Chief Executive/Director/Deputy Director/Head, Cluster Chief Executive/Hospital Chief Executive, Chief Manager/Senior

Manager/Executive Manager/General Manager, Other Professionals/Administrator, Systems Manager, Analyst Programmer,

Other Supporting Staff - Clerical, Secretarial, Workman, Artisan, Property Attendant

1996 2015

Critical incident stress

Workplace violence

Mental well- being

Infectious diseases etc….

1. Impair personal well-being

Burnout

Mental health problems and self-harm behaviors

2. Lower quality of patient care

Medical errors

3. High cost for the organization

Increased sick leave, absenteeism

Increased long term treatment cost

High Staff turnover

Poor work performance

Decreased sense of commitment

(Dowell et al, 2000; Ho, 2012; Howard, 2008; Khairat & Gong, 2010; Mangiameli, 2012; National Clinical Assessment Services of United

Kingdom, 2009; Ratanawongsa et al, 2012; Siu et al, 2012; Weingart et al, 2000)

Study on Medical Errors

Purpose: studying the emotional impact of medical errors on physicians

Results: Increased anxiety about

Study on Litigation

The most severe work-related stressor

Major life trauma

Results: Two clusters of emotional symptoms :

‘major depression’ : 39%

‘adjustment disorder’: 20% .

(Waterman et al, 2007; Schattner, 1998; Martin et al., 1991)

• Future errors (61%)

• Loss of confidence (44%)

• Sleeping difficulties (42%)

• Reduced job satisfaction (42%)

• Harm to their reputation (13%)

Buffer against mental disorders

Reduce suicidal ideation and rates

Reduce burnout

Increase empathy

Improve communication

Increase job satisfaction

Improve staff cohesiveness

Reduce staff turnover

Reduce medical errors

Increase attentional control

Reduction of defensive medicine is an outcome of better patient

communication

(Beckman et al, 2012; Beddoe & Murphy, 2004; Cohen-Katz et al, 2005; Galantino et al, 2005; Irving et al, 2009;

Jain et al, 2007; Krasner et al, 2009; McCabe & Mackenzie, 2009; Mackenzie et al, 2006; Praissman, 2008; Rosenzweig et al, 2003; Shapiro et al,

1998; Shapiro et al, 2005; Shapiro et al, 2007; Sibinga & Wu, 2011; Young, 2001)

Resilience is the ability to:

Bounce back

Take on difficult challenges and still find meaning in life

Respond positively to difficult situations

Rise above adversity

Cope when things look bleak

Tap into hope

Transform unfavorable situations into wisdom, insight, and

compassion

Endure

http://www.rihope.ri.gov/documents/pdf/Reslience.pdf

The capacity to make and carry out realistic plans

Communication and problem-solving skills

A positive or optimistic view of life

Confidence in personal strengths and abilities

The capacity to manage strong feelings, emotions,

and impulses

American Psychological Association http://www.rihope.ri.gov/documents/pdf/Reslience.pdf

“The ability and capacity of a workplace to withstand

potential significant… systemic risk/ disruptions by

adapting, recovering, or resisting being affected and

resuming core operations or continuing to provide an

acceptable level of functioning and structure. “

Companies and organizations: able to rebound from

potentially disastrous changes.

http://www.rihope.ri.gov/documents/pdf/Reslience.pdf

HA

Staff

• In-depth psychological services

• Staff Clinic (Psychological Services)

• Clinical Psychologists

• Corporate Clinical Psychology Services

• Emotional First Aid

• Critical Incident Support Teams (CISTs)

• Peer support

Build Resistance

“immunity”

Enhance Resiliency

“rebound”

Speed Recovery

Treatment & rehab

Kaminsky,et al, (2005) RESISTENCE, RESILIENCE, RECOVERY, Johns Hopkins.

Intensity of Services


Service planning, treatment protocols/ guidelines, supervision, training

High Intensity Services

Clinical Psychologists

HKEC KCC KEC HKWC KWC NTEC NTWC

Staff Clinic

(Psychological Services)

In-depth Psychological

Treatment

Psychological assessment

Individual & group

intervention

Professional consultation

Corporate Clinical Psychology Services

Staff Clinic (Psychological Services)

HO Staff Clinic

(Psychological

Services)

Triage

Emergency

Services

Crisis Response

Team

Professional

Consultation


Cluster Staff Clinics

(Psychological Services)

Crisis Intervention Services

High risk staff

Critical incidents

Types of services: • Critical Incident Management Planning

• Group Crisis Intervention

• Individual Crisis Intervention

• Family Crisis Intervention

• Grief Support Service

Treatment Guidelines/ Protocols

24

Assessment tools Workflow


(CCPS)

Service planning, supervision, training






Medium Intensity Services

Social Workers


Critical Incident Psychological Services Center




KEC

CIPS

center

KWC

CIPS

center

KCC

CIPS

center

NTEC

CIPS

center

NTWC

CIPS

center

HKEC

CIPS

center

HKWC

CIPS

center

Social Workers

Triage

Counselling services

Liaision & coordination

Support to Critical Incident Support Teams (CISTs)

Psychoeducation (e.g. talks, resource library)

Resource Corner Assessment Station

Interview Room

NTEC CIPS Center

Reception Area

Group treatment/

Multi-function Room

NTWC CIPS Center







Social Workers


Low Intensity Services

Staff Volunteers (>500)

Direct Supervision

Support

Peer support teams

Provide timely support to staff who have experienced critical

incidents

(e.g. workplace violence, sudden death/ severe injury of co-

workers, medical incidents, mass causalities)

Staff from different disciplines

(e.g. physicians, nurses, allied health professionals,

administrative, support services)

Hospital based

Voluntary participation

Critical Incident Support Teams (CISTs)

Emotional first aid

Network in hospitals

Critical Incident Support Teams



Service planning, treatment protocols/ guidelines,

supervision, training

KEC

CISTs

KWC

CISTs

KCC

CISTs

NTEC

CISTs

NTWC

CISTs

HKEC

CISTs HKWC

CISTs

6 teams

61 members

6 teams

88 members

1 teams

32 members

5 teams

85 members

1 teams

46 members

3 teams

46 members

7 teams

107 members Over 500 CIST members

Intensity of Services

Category Topic

Psychological

Preparedness for Crisis

Enhancing Workforce Resiliency for Manager

Mental Health First Aid

Coping strategies in face of crisis

Critical incident management

Staff support after critical incidents

Positive Psychology Building resilience through positive psychology

Mindfulness

Mindfulness- Combating burnout

Mindfulness- Responding to critical incidents

Cultivating Emotional

Balance

Transforming Anger

Emotion regulation

Positive emotions

Medical

incidents

Workplace

violence

New staff

induction &

orientation

Infectious

disease Primary care

Quality

&Safety

Occupational

Safety and

Health

Human

Resources,

Central

Nursing

Division

Infection

Control,

Emergency

Contingency

(IEC), CICO

Staff Clinic

Protocol

Working

Group/

Committee

/ Response

Team

Training

Psycho-edu

Materials/

Psy

Support Kit

Screening

Tools





Social Workers


Low Intensity Services

Staff Volunteers (>500)

Direct Supervision

Support

Comprehensive

Integrated

Timely

Proactive

43

Thank You

presented by rosalie lo, psyd senior clinical psychologist ...1. impair personal well-being burnout...

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