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Introduction, Industry Disruptors, and Interprofessional Practice

by Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP on 02/11/18

I could easily begin my blogging career with hefty content on health and behavioral health care industry disrupters, and there are many; from bullying to workplace violence, proficiency with digital technology, as well as the impact of workforce burnout on medical errors. Each one poses grand ethical challenges for professionals and their client populations. Yet, I also value the importance of relationship building. So, let me start with a brief introduction, before diving into the deep end of the pool. 

I’ve been kicking around the health and behavioral health industry for almost 35 years. I have a Masters’ Degree in Clinical Social Work from the University of Buffalo ,with most of my career spent as a hospital-based Professional Case Manager in line staff and administrative roles. 14 years ago I made an intentional choice. I was concerned how worn, torn, and tired my colleagues presented and the impact of this level burnout on two key areas; patient care quality and workforce sustainability. I realized that in order to have quality health and behavioral health care, a quality workforce was required. However, sustaining this level of quality was rapidly becoming a problem, particularly with organizations drastically cutting professional education benefits for their employees. As a result I created a company, EFS Supervision Strategies, LLC where every contract I take, every publication and presentation I develop, every student I educate, and each professional I train allows me the unique opportunity to empower the workforce.

What else do you need to know about me? I believe deeply in the power and intentionality of interprofessional team practice. The definition put forth by the World Health Organization (2010) rings true:

“Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”

This valuable construct is being actively implemented across the industry, from the professional gateway of academia across every practice setting and program. I find myself envious that this model was not formally taught when I was in college, some 35 years ago. Current outcomes tout the value of interprofessional teams in working through the most complex client circumstances to date, including social determinants of health, co-occuring physical and behavioral health, and opioid dependence. Yet, I was weaned on this concept before it had a name by a physician father and a mother who was a discharge planning coordinator for over 40 years at a community hospital. Their mentoring afforded me poignant messaging; the expertise and perspective of each professional matters.

The benefit of interprofessional teams was further reinforced by my colleagues across practice disciplines who valued one important mantra; the outcome of any team effort is only as good as the individual efforts of each member. To this end, I view any care team as one big interprofessional village. We together serve on the front lines of the care process for individuals, their families, and communities. We must consider the impact of disrupters on the health and behavioral health workforce overall as opposed to segmenting the impact by profession only.

For example, I greatly value how nurses have the traditional reputation of eating their young, which contributes to a high incidence of bullying. I am extremely concerned about the rapidly escalating rate of burnout for physicians and the concern this evokes across the profession. Social workers, as helping professionals can be viewed as helpless and thus more vulnerable to bullying by those individuals who have greater power in an organization. However, the rising incidence of suicide for any professionals who have fallen victim is alarming, whether to burnout and/or bullying. From my lens, these disrupters are not specific to only nursing, medicine, or social work. Every professional working in the industry today is potentially at risk. A few numbers to chew on:   

  • Healthcare is among the highest incidence of bullying, with 37% of American workers affected: roughly 54 million people                                                                      
  • Bullying by leadership has been associated with a number of physical and behavioral health issues for targets, inclusive of:

o   Cardiac problems ( > 60%),

o   Posttraumatic stress disorder ( > 30%), and  

o   Suicidal ideation ( > 30%).

  • 70% of physicians know at least one colleague who left the practice due to poor morale, with rapidly increasing incidence of suicide among the profession.
  • 50% of nurses worried their job was affecting their health, with 35% wanting to resign from their current position
  • 60% of individuals in health care report burnout, with over 34% actively looking for new job
  • Therapy professionals and healthcare professionals have among the highest suicide rates in men and women

(Bodenheimer & Sinsky, 2014; Falzoi, 2016; Graham, 2016; Morgan, 2014;  Sikka, Morath, & Leape, 2015; Tencer, 2017)

Some might argue that a focused, if not compartmentalized discipline specific approach to addressing the disrupters of workplace bullying and professional suicide can yield more tangible resolution. However, I fear that the more the industry works to silo how it addresses each industry disrupter, the harder it will be to shift to the interprofessional culture that is the reality of health and behavioral health care today. There must be efforts to resolve the disrupters from a system-wide approach, for what impacts one impacts all. Otherwise the problems will surely continue for future generations to come. Based on the numbers, I don’t think the workforce can endure it without serious compromise to the patients, clients, members, and consumers we care for, as well as itself; Do you?

Here are several resources and references to empower your ethical energies with the disrupters of Bullying, Workplace Violence, and Workforce Sustainability:

Bullying

Read The New Age of Bullying and Violence in Health Care

            Part 1: The Interprofessional Impact

            Part 2: Advancing Professional Education, Practice Culture, & Advocacy

            Part 3: Managing the Bullying Boss and Leadership

Learn about The Workplace Bullying Institute

Explore The Healthy Workplace Bill

Interprofessional Teams 

Read about the Interprofessional Education Collaborative  

Read: The Importance of Interprofessional Practice and Education in the Era of Accountable Care

Burn-out

Read: Professional Resilience Meets the Quadruple Aim: Ethical Mandate, Professional Imperative

Read: Who’s Really to Blame for Physician Burnout? 

Thoughts about this post? Add your comment below

Future blog topic recommendations? Feed free to add them below 

Stay Resilient,

Ellen

References:

Bodenheimer , T. , & Sinsky , C . ( 2014 ). From triple to quadruple aim: Care of the patient requires care of the provider ; Annals of Family Medicine, 12 (6), 573-576.

Falzoi, D. (2016). New study shows that prolonged expo­sure to workplace bullying can lead to suicide—And it can happen to anyone. MA Healthy Workplace Bill

Graham , J. ( 2016, July 21). Why are doctors plagued by depression and suicide? A crisis comes into focus 

Morgan, T. (2014). The organizational challenge of workplace bullying. Workplace Answers

Tencer, D. (2017, May 11,) The Jobs with the Highest and Lowest Suicide Rates, Business, Huffington Post

World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization

 

Comments (4)

1. barb leach said on 2/14/18 - 04:56PM
Hey Ellen, you do so much to make a difference in this crazy healthcare world. Thank you
2. Judith R. Sands said on 2/15/18 - 02:58PM
Thank you for highlighting the significance of the issue in healthcare and the physical implications to healthcare workers. Timing is everything, just as sexual harassment is finally being openly discussed, so should bullying.
3. Audrey said on 2/21/18 - 11:28AM
Ellen and can verify what you say. As an RN and now Case Manager I have witnessed the internal demise of bedside healthcare with increase burnout. Self medication of professionals to try to make another day. It's not just one or two factors it is a negative culture undercurrent that needs to come to light. Refocus on the patient outcomes and work together as a team supporting each other. Talking to each other as a collaborative team. Thank-you for your insight and support of us in the trenches.
4. Ellen said on 2/21/18 - 11:38AM
Audrey, you are so right! The front lines of health and behavioral healthcare are a tough place! All the disrupters contribute to a traumatized and burnt out workforce. This is a big focus of why the Institute for Healthcare Improvement has promoted the evolution of the Quadruple Aim. While the individual initiatives of professionals are applauded, to address the disrupters for the long haul takes a concerted interprofessional effort. I wrote an article last year, The Professional Resilience Paradigm Meets the Quadruple Aim in the Professional Case Management Journal that might have appeal. You can access it at https://journals.lww.com/professionalcasemanagementjournal/Citation/2017/09000/Professional_Resilience_Paradigm_Meets_the.8.aspx. Thank you for taking the time to comment and support! Stay tuned for more!


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