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As a manager, you want to do right by your employees and support them through intense work periods so they don’t get burned out. But this can be a challenge when you’re feeling overly stressed yourself. How can you take care of yourself so that you have the time and energy to support your team? What steps do you need to take to reduce your stress level? And what actions can you take to improve your team members’ well-being?

What the Experts Say

It’s tough to find the energy you need to help others when you yourself are at your limits. Burnout — as opposed to more run-of-the-mill stress — can cause you to “feel utterly depleted,” says Susan David, a founder of the Harvard/McLean Institute of Coaching and author of Emotional Agility. And it “can permeate all aspects of your life. You are overtired and under-exercised; you’re not attentive to food and nutrition; and you’re disconnected from relationships.” But it’s not just you who suffers. “Your team is picking up on your stress, and it’s making everything worse,” says Whitney Johnson, the author of Build an A-Team: Play to Their Strengths and Lead Them Up the Learning Curve. So for the sake of both your health and the health of your employees, you need to summon all the resources you can to improve matters. Here’s how to do that.

 

Make your own health a priority

Before you can help your team members manage their stress, you need to manage your own. “Instead of hunkering down and concentrating” on your job, “you need to stop, look around, and figure out how you’re going to help your people get what they need,” says Johnson. A good starting point is to take care of your physical and mental health. Eat healthy, wholesome food; exercise regularly; get plenty of sleep at night; “try meditating, and find someone to vent to”— preferably “not your boss.” Taking care of yourself is not an indulgent luxury; it’s a matter of self-preservation. Johnson suggests sharing your tension-management techniques and rituals with your team. “Say, ‘here’s something I’m doing to manage the stress. This is how I cope.’”

Tackle the problem as a group

Even if you haven’t fully reigned in your stress, it’s helpful to demonstrate that you take the issue seriously. You can even suggest that you all take on self-care as a team — learning meditation as a group or sharing tips about what practices are working to reduce stress. You can make it a team goal to keep stress under control, says David. “Say to your team, ‘Even in the context of this change, how do we come together?’” This is helpful for the group but will also keep you accountable for taking care of yourself. Don’t force anyone into these activities though. A sense of autonomy can counteract the symptoms of burnout so you want people to feel they are making their own choices.

Exhibit compassion

Don’t be so hard on yourself or your team. “Burnout can often feel like a personal failing,” says David. But of course, that’s not true: We are all susceptible to it — and, in fact, our “environment precipitates” it. We are “living in an imperfect world, and yet we expect perfection.” Many organizations breed stress. “The ambiguity, the complexity,” not to mention the 24/7 nature of technology, leads many of us to feel “an extreme level of strain.” Be compassionate. Recognize, both inwardly and publicly, “that all of us are doing the best we can with the resources we have been given.” This doesn’t mean that you’re “lazy or letting yourself off the hook.” Rather, you’re “creating a psychologically safe place for yourself and others.” Johnson recommends talking your team through stressful periods in an honest but upbeat way. Yes, the workload is intense. And yes, big, high stakes projects are daunting. Tell your team, “‘We are in this together, and I know we can deliver.’”

Set a good example

You also need to “think about the [behaviors] you’re modeling” to your team, says David. “If you’re running from meeting to meeting and don’t have enough time in the day to breathe,” what message does that send? Set a good example by making downtime a priority. Show your team that you don’t always operate in full-throttle mode at the office. “Bring humanity back into the room,” she says. Johnson agrees. When “your people are completely overwhelmed,” you need to “encourage them to take regular breaks,” she says. “They need time to rest and rejuvenate and disconnect from work.” It’s also important to set limits on how much work encroaches on evenings and weekends. Whatever you do, “don’t send anyone on your team an email at midnight,” says Johnson. “You’re thinking, ‘I’ve got to get this out.’ But you’re also throwing a grenade into your employees’ peace of mind.” Instead, she recommends using Boomerang, or a similar program, that allows you to schedule emails.

 

Focus on the why

A common symptom (and cause) of job-related burnout is a “disconnect between a person’s values” and the work at hand, says David. “You feel stressed and tired, and yet you continue to work and work and work,” all the while forgetting what drew you to your career and organization in the first place. “It can be toxic.” As a leader, you need to “develop a shared sense of why” — as in, why are we driven to accomplish the mission? As a boss, it’s your job to galvanize your team. Remind them of the objective and why it’s important to the organization and your customers. When people have shared values and connection they are more likely to feel positively about their work.

Advocate for your team

If you and your team are suffering under a heavy workload, it might be time to ask your boss for a reprieve. It is your responsibility “to advocate for your team within the context of your organization’s goals,” says Johnson. She recommends talking to your boss about the effect stress is having on morale and performance. “Say, ‘My team is fully committed to this project, but people are tired. And we all know the law of diminishing returns.’” Convey the consequences of burnout and describe how it is in your boss’s best interest to take action. “There are going to be mistakes and slippage. And those will be costly.” Explain that you’re worried you might lose people who are valuable to the organization. Then ask, “can this deadline be pushed back? Or can this assignment be curtailed?” Think, too, about what you can “put in place within your team that can help,” says David. Perhaps certain meetings can be discarded or at least shortened. It’s “important that leaders go to bat” for their employees.

Be a source of optimism

Whenever work is frenzied and frantic, make a concerted effort to promote positivity, says Johnson. This is hard to do when you are stressed out but “look for the good,” she says. “Smile at people. And be kind.” Make sure you regularly acknowledge, recognize, and thank people for their efforts. “Say, ‘I notice you did X. Thank you. I appreciate it.’” Cultivate a feeling of community and social support. When your team hits a milestone or when a particular crunch time is over, celebrate. Acknowledge the accomplishments — yours and the team’s.

Principles to Remember

 

Do

 

• Encourage your team to take regular breaks and seize opportunities to rejuvenate.

• Support your team with inspiring language. Your message should be, “We are in this together.”

• Go to bat for your team. If the workload is too heavy, ask your boss if deadlines can be moved or tasks reassigned.

Don’t

• Neglect your health and well-being. Take good care of yourself and share your favorite stress-reducing strategies with your team.

• Consider burnout a personal failing. Recognize, both inwardly and publicly, that people are doing the best they can with the resources they have.

• Get bogged down in negativity. Be a source of optimism and try to cultivate positivity in the ranks.

 

Let’s talk about your business challenges today.

Our fresh perspectives, experience, and specialized skill sets will get your practice where you want it, and with far less stress.

(833) 764-0178

https://hbr.org/2019/03/how-to-help-your-team-with-burnout-when-youre-burned-out-yourself

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According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when …

• … The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.

• … Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.

• … Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
  The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

• … Opioids are prescribed for pain. 
  Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with nonopioid therapies, such as physical therapy.

• … Pain lasts 90 days.
  At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

“Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

 The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management.

 

Let’s talk about your business challenges today.

Our fresh perspectives, experience, and specialized skill sets will get your practice where you want it, and with far less stress.

(833) 764-0178

https://www.moveforwardpt.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica

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JAMA Study: ‘Multicomponent’ Exercise Interventions During Hospital Stay Can Reverse Functional Decline Among Patients 75 and Older

The potential for hospitalization to have damaging, long-term effects on function and mobility among patients who are elderly is well-known. But does functional decline have to be a given? New research from Spain says no, and points to the possibility that those effects can be blunted—and even reversed—through the addition of an exercise intervention that goes beyond ambulation-only.

The study, published in JAMA Internal Medicine (abstract only available for free), focused on a single hospital and tracked 370 patients in who were hospitalized between 2015 and 2017, all of whom were 75 years or older (mean age, 87.3). Most participants were admitted for acute illnesses by way of the hospital’s accident and emergency department; all wound up in the facility’s Acute Care of Elderly (ACE) unit. Median length-of-stay was 8 days.

Over the 2-year study period, researchers divided participants into 2 groups: the control group received “usual care” consisting of “standard physiotherapy focused on walking exercises for restoring the functionality conditioned by potentially reversible abnormalities,” while a second group received twice-daily exercise interventions that included progressive resistance, balance, and walking training exercises adapted from the Vivfrail exercise program. Researchers then compared patient scores on several tests administered at admission to the ACE unit and again at discharge. Tests included the Barthel Index of independence, the Short Physical Performance Battery (SPPB), the Mini-Mental Status Examination, and a quality of life (QoL) scale.

Researchers found that not only did the exercise group register better scores than the control group on the Barthel index (a 6.9 difference on the 100-point scale), they tended to record improvements over their own baseline scores. The control group, meanwhile, lost ground, averaging a 5 point drop from baseline. The same basic pattern was found in the SPPB scores, as well as scores that assessed cognitive function, QoL, and depression.

“Our study shows that an individualized, multicomponent exercise intervention including low-intensity resistance training…can help reverse the functional decline associated with acute hospitalization in older adults,” authors write. “Acute hospitalization per se led to impairment in patients’ functional ability during [activities of daily living], whereas the exercise intervention reversed this trend.”

The exercise intervention itself consisted of 2 daily 20-minute sessions through the duration of the patient’s stay in the ACE unit. The first session, in the morning, included individualized supervised progressive resistance, balance, and walking exercises. The resistance exercises centered around 2 to 3 sets of 8 to 10 repetitions of a load equivalent to 30%-60% of the patient’s maximum; walking and balance exercises progressed in difficulty, and included semi-tandem foot standing, line walking, stepping practice, walking with small obstacles, exercises on unstable surfaces, and weight transfer. The 20-minute evening session consisted of “unsupervised exercises using light loads” such as anklets and handgrip balls, and daily walking in facility corridors.

While authors note that the study focused on patients who possessed “a high level of functional reserve and cognitive capacity high enough to allow them to perform the programmed exercise interventions,” the research did not automatically exclude patients with dementia or an inability to walk unassisted. Moreover, the entire population was markedly older than most previous studies on the effects of hospitalization, with about 30% of the study group being 90 or older.

“Our results indicate that, despite its short duration, a multicomponent exercise approach is effective in improving the functional status … of very old adults,” authors write, describing their findings as results that “open the possibility for a shift from the traditional disease-focused approach in hospital acute care units for elders to one that recognizes functional status as a clinical vital sign that can be impaired by traditional (bed rest-based) hospitalization but effectively reversed with specific in-hospital exercises.”

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association’s PTNow website.

 

 

Let’s talk about your business challenges today.

Our fresh perspectives, experience, and specialized skill sets will get your practice where you want it, and with far less stress.

(833) 764-0178

http://www.apta.org/PTinMotion/News/2019/01/11/HospitalExerciseJAMA/

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A well-conceived clinical space can improve the care experience for patients and staff alike.

 

Tara Jo Manal, PT, DPT, FAPTA, has no training whatsoever in construction, architecture, or interior design. She is, however, a seasoned physical therapist (PT), and she knows from experience how a physical therapy clinic should be built.

Manal, director of clinical services and residency training in the physical therapy department at the University of Delaware, led the total overhaul in 2013 of the department’s 10,000-square-foot outpatient clinic. Initially, she recounts, the department turned to a local architectural firm to draw up a set of plans. “We told them what we wanted to accomplish, and what we needed in terms of rooms, offices, and places for equipment,” she says. “When I looked at the plans, it was clear that they’d tried to incorporate everything we’d asked for. But it also was obvious that the design was never going to work.”

The problem primarily was sight lines and distances between the spaces the practice’s clinicians would use the most. “One thing they did was put all the offices around the perimeter so they’d have windows that looked outside,” Manal recalls. “The center of the clinic would be wide open. That sounds nice, but we need to watch our patients, not look out the windows. And walls are important, because without walls to place things against, you have nowhere to put everything.”

Manal asked the architects what structurally had to stay and what could go. They told her that the building’s 4 interior columns were structural, so moving them was out of the question. Beyond that, “We could do what we wanted,” Manal says. “So I chopped what they gave us into pieces. We then rearranged the parts to make it work.”

As they did, the architects and Manal mapped out exactly where equipment would go, adding outlets and data ports as needed. They segmented the space with a series of half-walls—high enough to define treatment areas and pathways but low enough to provide PTs with clear sight lines. “Functionally, it’s perfect now,” she says. “When you’re standing at certain spots you can see across the entire clinic, but you still have the needed space and privacy to do your work.”

Deciding to Design

Chances are there isn’t a PT in the country who hasn’t dreamed about ways to improve his or her clinical space. Most practices, after all, could use some sort of upgrade, whether it’s a fresh coat of paint or better flooring or lighting. And more than a few could stand to start from scratch—whether by packing up and moving to a new location or by tearing down walls for a custom rebuild. Growing practices start to burst at the seams, forcing owners to weigh the merits of expanding to meet demand. Or, there’s mounting pressure from nearby facilities: When competitors decide to invest in flashy remodels, it’s only natural to think it may be smart to do the same.

 

There are, of course, potential drawbacks to renovating: expense, disruption, questionable returns. And while studies conducted primarily in hospitals have shown that high-quality facility design can lead to better patient privacy, decreased risk of infections and injuries, shorter stays, and lower costs, other research indicates that patient satisfaction is unlikely to be swayed by aesthetics alone.1,2

“You can’t just assume that by opening up your clinic and flooding it with daylight, your patients will love it and clinical care will improve,” notes Deborah Franqui, health care market leader at the design firm Leo A. Daly and coordinator of health care design programs at the University of Miami School of Architecture.

Whether you intend to build a facility from the ground up or renovate your current clinic, it’s important, Franqui says, to base design decisions on information gathered from all stakeholders. “You have to involve all of your clinicians and, in fact, everyone in your organization, because they all use the space,” she notes. “They know what works and what doesn’t. You also should engage your patients, if you can, because their perspective may be different—and that may affect the decisions you make.”

Joe Latozas, an architect and senior associate with Designhaus Architecture in Rochester, Michigan, agrees that thoughtful collaboration can be the key to successful health care facility design. Latozas, who has several physical therapy offices in his clinical-space portfolio, says the first thing he does is sit down with clinicians and ask about their process: “What happens when a patient comes in?” “Where’s your staff, and what’s their routine?” Then he spends a half-hour or so “just observing what happens as everyone does their thing.”

As he watches, Latozas says, he considers his own experiences as a physical therapy patient and tries to put himself in the shoes of those he sees in the clinic. “Physical therapy can be a strenuous process,” he observes, “so I’m always looking for ways to make it easier on the patient—to create an environment that patients will enjoy visiting, and hopefully will want to return to.”

From there, Latozas typically will produce a rough schematic floor plan, then meet with the clinical team to get their input. “That’s where everything hopefully comes together—during that process of reviewing and revising,” he says. “You start tossing around ideas and thinking things through, and you eventually get to a design that yields the outcomes you want to achieve.”

Putting Patients First

One PT who is quite familiar with that creative process is Jeff Leatherman, PT, DPT, MS. He’s program director of the physical therapist assistant (PTA) program at South University in High Point, North Carolina. Leatherman, who also works part-time with patients at Pivot Physical Therapy in nearby Greensboro, has been involved in the design or redesign of 3 different practices, beginning in the late 1990s.

The first, he recalls, was a small satellite clinic that his then-employer built from scratch in a strip mall. A few years later, as a private practice owner himself, Leatherman led the “up-fit” development of a 2,000-square-foot clinic attached to a much larger sports performance and fitness facility. Finally, there was his most recent project: the complete overhaul of a former automotive center to create the space that now houses Pivot.

“We’d outgrown our previous location,” he says, “and were searching for something that might fit us better. I came across this old tire-service place. It was kind of odd but also ideal.” The 9,000-square-foot facility included 3 wide-open bays, 22-foot ceilings, and a storage area in the back that Leatherman imagined as a gym. The renovation, he says, “was nasty work” but ultimately was well worth the effort.

 

“We knocked out a bunch of walls, built a couple others, and had a lot of fun getting it into shape,” Leatherman recounts. Much of the work was completed by Leatherman’s brother, a contractor. They didn’t use an architect because they already had a clear vision of what they wanted to do.

Still, “there was a lot to consider,” Leatherman says, and it took time to get things off the ground. “We had to deal with permits, accessibility requirements, and so on. And we had to make sure that we’d thought of everything”—from office locations and treatment room placement, to lighting and storage needs, to where to put the gym equipment. “But the biggest thing all along was taking a patient-centered approach,” he says. “We wanted it to be a place where our patients felt special—where their experience was positive the second they walked in the door.”

Todd Schemper, PT, DPT, partner and chief operating officer of Kinetic Edge Physical Therapy and a board-certified orthopaedic clinical specialist, took a similar approach to recent renovation of the clinic he manages in Des Moines, Iowa. His team didn’t employ an architect but did rely on the goodwill of their artistic landlord, who financed the work and helped design the new space. “We’d been here for about 10 years, and all we’d done when we originally moved in was put carpet on the floor and paint the walls,” Schemper recalls. “We finally reached the point where we needed to spruce it up—to modernize and make it more patient-friendly.”

Toward that end, Schemper says, they shifted the position of their front office and moved the patient fitness area so their clients could see outside as they exercised. They tore down several walls to make the clinic feel more open but added Plexiglas panels in certain places to delineate areas and block noise. Finally, they added LED lighting (planning to pay for it through savings in their energy bill) and finished the space off with an uplifting color scheme. “It feels more exciting now,” says Schemper. “It makes it easier for us to nail that first impression. Our patients come in and see that it’s updated and well-kept. That makes a difference in how they experience their care.”

Best Practice for a Better Clinic

Back at the clinic at the University of Delaware where Tara Jo Manal leads her team of clinical faculty and students, there also is the sense that the recent renovation has had a real impact on patient care.

“We did so many things that I would describe as ‘best-practice’ kinds of initiatives,” Manal says. “These changes have helped us do our work more efficiently and have improved our ability to serve our patient population.”

 

For example, she says, they created a station where patients check in to record their pulse and blood pressure and calculate their body mass index. “We used to be inconsistent about getting those measures, because on the floor it always was hard to find a spot to get it done. Now it’s automatic because it’s part of the process when patients come in.”

Similarly, Manal says, her group designed “touch-down stations” throughout the clinic that contain protocols, rehabilitation guidelines, checklists, and other reference documents that PTs typically need as they work with patients. “Often it’s much easier to see something on paper than it is to have to look it up electronically,” she notes. “This way, everything is in 1 place, and it’s never more than a few steps away.”

There are other functional improvements, too. At every bed, for example, a metal basket built into the half-wall contains equipment a PT might need—a pair of scissors, a new roll of tape, a goniometer, an electrical stimulation machine. Walls used by patients during certain exercises are covered in a special plastic wallpaper that is easy to wipe down and is more durable than drywall. (“In our old clinic we’d wear grooves in the cinderblocks,” Manal notes.)

Standard measurement lines for movement and agility testing have been incorporated into certain areas using stickers on the floor. There are permanent tracks, including one with a harness system, that patients follow around the clinic for their timed walking tests. “We even built a training bathroom and kitchen,” Manal says. “There’s a refrigerator, stove, sink, shower—everything you’d expect to see in a patient’s home.”

One addition that she particularly likes is 1-way mirrors throughout the space that allow her to watch the action from almost anywhere in the clinic. “When I’m in my office, there’s only a 10-by-20-foot span that I can’t see, even when I’m sitting down,” Manal notes. It’s a feature that would benefit any facility, but it’s especially nice, she says, to have in a space meant for teaching: “We have students here who are learning and practicing new skills, so it’s great to be able to keep an eye on everyone and know how things are going at all times.”

Looking back, Manal is glad to have worked with a design firm that was receptive to her and her colleagues’ feedback and open to modifying its plans to suit their needs. At the time, she recalls, she’d been at the clinic for 22 years and for the most part was satisfied with her workplace as it was. But she also felt the space could be better with tweaks here and there. “I knew there were things that we could do to make this clinic function exactly the way we wanted,” she says. “What I wasn’t sure about was how we could get there—what rules we had to follow or square footage was required.”

The architects, Manal says, knew those rules, even if they weren’t that familiar with physical therapy. “That was the beauty of this project: We came together from our different backgrounds and perspectives to create a design that works.”

 

 

Let’s talk about your business challenges today.

Our fresh perspectives, experience, and specialized skill sets will get your practice where you want it, and with far less stress.

(833) 764-0178

http://www.apta.org/PTinMotion/2017/10/Feature/ByDesign/

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