When Life Impacts Work: Finding Work/Life Balance

Written by on November 29, 2013 in Practice tips - No comments

The cost of replacing a physician is estimated at anywhere from $150,000 to $1,000,000 and a nurse $40,000 to $60,000—but how does one calculate the cost of a physician or nurse who’s physically present in the exam room but mentally miles away?  Personal problems—from marital or relationship issues, to children in crisis or elderly parents in need of care, to financial investments gone bad— often have impact the quality and quantity of patient care that a physician or nurse is able to offer.

Heathcare providers tend to believe that they are immune to stress.  The reality is they are often unaware of the toll that personal stress is taking on themselves and their work.  It’s important for healthcare organizations to take steps to help their providers recognize when this is happening—and for physicians and nurses to become more self-aware about how their personal struggles may be impacting their work and job performance.

Common Stresses, Uncommon Costs

All employers pay a toll for distracted employees:

  • Relationship-related stress costs employers about $300 billion annually (Velasquez-Manoff, 2005)
  • A 2010 MetLife Caregiving Cost Study estimated that that an employee caring for an elderly parent costs his or her employer 8% more per year in increased healthcare costs alone, not counting absenteeism, presenteeism and work interruption-related costs.[1]
  • Employees dealing with major financial problems cost businesses an estimated $15,000 per affected employee per year[2]

These are average costs—at healthcare organizations, considerations such as the potential cost in dollar and human terms of adverse events make the cost of normal life distractions exponentially higher.  Given the stress of their profession, physicians and nurses also experience more stress in their personal lives.  For example, various studies have shown that the rate of divorce among physicians is estimated to be 10-20% higher than in the general population, and even higher for nurses

Clearly, it benefits healthcare organizations to intervene quickly and compassionately when they see that a physician’s or nurse’s personal problems are beginning to affect on-the-job performance.   Sometimes, relatively simple steps can be taken to help the provider and ameliorate the effects in their work.

Extreme Distractibility:  A Case in Point

A primary care physician referred to us had been going through a particularly difficult divorce while at the same time struggling with an adolescent daughter who’d been in and out of treatment for a variety of behavioral health issues

He was so concerned about his daughter that he dropped everything to accept cell phone calls from her and her siblings, no matter what he was doing.  Patient feedback about the distractions was reaching not just his colleagues, but also the organization’s CEO.

In addition to distracted patient care and disruptions in the schedule, the physician had also fallen deeply behind in case management and record keeping.  The organization was concerned, but very much wanted to retain the physician, whose contributions were highly valued and whose performance, until recently, had been above reproach.  Working with the physician and referring practice, a thorough evaluation of the situation resulted in a performance improvement plan for the distracted doctor that included:

  • An agreement that his cell phone wouldn’t be taken into the exam room
  • A temporary reduction in administrative duties and clinical load to give him time to catch up on his cases and medical records
  • A therapist to help the physician work through his marital and parenting issues
  • A physician peer coach to work with the physician on more effective ways to balance his work and life issues
  • An evaluation and coordination of the family counseling and behavioral health resources being provided to the physician’s family (at the request of the physician and with full permissions)

In this instance, the physician was unaware of how his behavior was affecting patients, colleagues and staff.  He actually appreciated the heads up and the support the organization was willing to extend.  The referring organization was able to see immediate and noticeable improvement and was kept apprised of the physician’s progress on a regular basis for a year, at which time it was agreed by all parties that the performance issue had been resolved and the ongoing family issues were being appropriately handled.

Clear Performance Issues, No Clear Cause

In smaller practices or medical groups, colleagues often know the underlying causes of a change in behavior: “He’s going through a divorce,” or, “Her father’s in the hospital.”  However, staff at a hospital may have no idea why a surgeon suddenly becomes bullying or dismissive every time he or she makes rounds, or a nurse who is normally impeccable in her charting starts to forget things.

Ruling out mental health and substance abuse issues, or medical problems, when there are clear performance problems is critical in any workplace, but especially in healthcare settings.  Once other causes are ruled out, it’s important that organizations delve for potential underlying issues in an employee’s personal life that might be impacting what is being observed in the workplace.

Sometimes this can be a challenge.  While a provider may be struggling with a personal issue, most healthcare organizations also struggle to balance compassion and respect for privacy with concern about how a their behavior will affect not only patient care, but also the organization’s liability and bottom line.  Healthcare organizations can provide physicians and nurses the help they need to become or remain productive without getting into the nitty-gritty details of the their personal lives in a variety of ways.

Restoring Work/Life Balance:  Ways Healthcare Organizations Can Help Providers

A 2010 article in American Medical News stated, “An unmanageable work schedule and out-of-control home life can lead to depression, poor performance at work, conflict with family and a feeling of burnout that can lead physicians to question whether to stay in medicine at all.” A 2006 paper in Research in Nursing & Health found “52% of nurses reported episodic family interference with work, and 11% reported chronic family interference with work.”

The reality is that ensuring a healthy work/life balance for physicians and nurses increases physician retention and productivity, improves patient care and reduces risk.

Sometimes it’s a matter of freeing up time so that physicians and nurses can attend to personal issues on their own time and at a more realistic pace:

  • Offering flexible hours and, for physicians, a period of no call or reduced call
  • Offering concierge-type services to assist with daily tasks, especially those that must be done during normal business hours that make it especially difficult for healthcare providers
  • Encouraging use of EAP services, which can provide confidential assistance and resources around family and relationship issues, financial struggles and legal problems
  • Allowing temporary changes in work schedules, practice assignments or duties
Helping Providers Help Themselves

Having organizations assist in making accommodations for providers is one approach to helping them more effectively address personal issues.  However, a longer-term approach is equally helpful in encouraging physicians and nurses to take a more constructive approach to dealing with problems in their personal lives.

There are three major areas where taking a different approach can make a big difference in approaching personal issues—and preventing them from spilling over into the work sphere to begin with:

1.       Better time management—this can be a challenge due to many demands that may seem conflicting.  Here are some ways to manage time more effectively:

  • Sit down with spouses or partners to discuss and negotiate relationship expectations.
  • Better align priorities and values between home and work.
  • Look for areas where limits can be set on boundaries and time—both at home and work—and stick to them.
  • Seek mentors who model good time management and ask for their advice and guidance.

2.       Stronger relationships—relationship problems can be a great drain on both time and emotional energy.  Some ways to strengthen relationships both at work and at home include:

  • Engage in necessary conversations regarding conflict. Addressing conflict and moving beyond it can make an enormous difference in your feelings and perceptions.
  • Set regular times to get together with family and friends, and stick to them.
  • Find time for regularly scheduled family meetings and meals together. Everyone may have to give a little to make this happen, but it will be worth it.
  • Give people the benefit of a doubt and avoid jumping to conclusions. Work on identifying obstacles to trust.
  • Be open to reasonable feedback.
  • Ask for help and delegate responsibilities and duties when possible.

 3.       Better self-care–practicing good self-care establishes a solid foundation for coping.  Some ways to do this include:

  • Build “down” time in schedules to take restorative breaks throughout the day.
  • Enroll in a yoga, Pilates, or mindfulness meditation class to reduce stress.
  • Read fiction, write in a journal, or meditate.
  • Identify more ways to integrate exercise into daily life.
  • Improve nutrition by sitting down to breakfast, taking a break for lunch, bringing healthy snacks to work, and being there for family dinners.
  • Take care of mental and emotional needs.  Acknowledge losses and take time to grieve.
  • Identify workplace and personal challenges that create stress, and develop an action plan for addressing or coping with them.

[1] “The MetLife Study of Working Caregivers and Employer Health Care Costs,” February, 2010
[2] Journal of Employee Assistance, 1st Quarter, 2009, January 1, 2009

By Liz Ferron, MSW, LICSW
Physician Wellness Services

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