Heroes of Healthcare
Heroes of Healthcare

Episode · 8 months ago

Battling Physician Burnout: The Role of a Chief Wellness Officer

ABOUT THIS EPISODE


We’re in the business of helping people with their health...

But it’s a job that can take a toll on our own wellbeing.

How do we ensure wellness in the people spending every day making others well?

I can think of no one better to ask than Dr. Jonathan Ripp, Chief Wellness Officer at The Mount Sinai Hospital, who joined me in the latest episode of Heroes of Healthcare.

What we talked about:

  • Tackling burnout in healthcare
  • Taking a data-based approach to wellbeing
  • The concentric circles impacting wellness

Check out these resources we mentioned during the podcast:

Heroes of Healthcare is hosted by Ted Weyn. To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

You Ere listening to heroes ofhealthcare. The podcast that highlights bold selfless professionals in thehealthcare industry focused on transforming lives in their communities.Let's get into the show, welcome to the heroes of HealthcarePodcast, I'm your host Ted Wayne Today, I'm joined by dtor Jonathan Rip. Dr Ripserves in a Duel Role. He is Mount sianised deem for a well being andresilience at the icon school of Medicine at Mount Syani and is thechief wellness officer for the Mount Sini Health System. A graduate of Yaleundergraduate and medical school dor rip has been passionate aboutClenishian well being and burnout prevention for many years at the hearsof health care, we want to continue to focus on mental health and couldn't behappyer to have doctor ripp join. The show today welcome Dr Rib thanks. Somuch it's great to be here excited to get into this, because you know we talka lot about covid and what's going on in the marketplace and we're talkingabout vaccines and so much of it and as we had one of your colleagues onHeather recently and talked about mental health, and I just don't think,there's enough really kind of covered about that. Of course we're allinterested in the physiological aspects of Covid and all. But I love yourbackground, your passion in terms of clinish and well being and just lookingforward to diving into that and learning a little bit more today, butbefore we jump in, if you don't mind, always love to start with a little bitabout your background where you come from grew up and what led you into thewonderful world of medicine, sure yeah great thanks for the opportunity, soyeah. Well at some extent, you know it's funny, because I was born at thehospital that that I work at which Wa so yeah. So some people, you know theytalk about how long they've been in an institution. You know they say theirlife Erds right. I really am yeah, so you know definitely back. Then it wasjust the Mountsana hospital. Now it's the health system, but you know it'sbasically, you know always been a presence in my life. I grew up in NewYork City on the upper west side of Manhattan and you know really had avery you know really great childhood. I loved growing up in New York City, twoolder brothers and you know, really became a city kid and didn't know muchelse outside of my family was was very urban, and so you know both parentsalso from New York City. So you know in terms of doing things that are not inan urban setting it. I really didn't explore much until I guess adolescence,but you know, grew up always kind of had an interest in the sciences. So youknow perhaps not surprising that that I ended up where I am just you know, likeso many kids as they're exploring discipline some resonate more thanothers. I actually had an opportunity in I think in my either eleven I thinkoleventh grade between eleventh and twelth grade to do sort of a summer. Iguess internship at Mount Sini. So so again the life wer theme there andspent that summer actually in the an operating rooms as sort of hanging outwith the andostysilogists and sort of functioning as like a sort of like aatteck. I guess- and you know it really just just- was an incredible experience.As you can imagine a seventeen year olds. You know watching surgeries andthat's short yeah, so you know I definitely expanded my world a littlebit after high school and I ended up going to Yale for college and MedicalSchool and really love my time there that exposed to lots of interestingpeople, N and disciplines and became pretty interested in the humanities andwriting, and so so that that resonated to. In fact, I wes toll academicphysicians. You know one of the one of the things you can really. If youreally want to help your career early on, is you know, develop your skills asa writer, because it's really such a critical skill set spent a lot of timein my college years and medical school years, traveling and Developd te lovefor the for the outdoors, and that's still, I would say, is you know when wetalk about self care and what does it for you? What recharge is you any timeI can get outdoors and into nature? I...

...find that that always kind of is theyou know: helplly press the the reset button. So, even even though I stillsort of a in between in between worlds because I'm very much urban Han, myparents are still in the same apartment. I grew up in mow and yeah. So but itultimately came, you know, after medical school sort of you know, ID dida lot of this sort of soul, searching a decision making that that so many youngdoctors make and realize that I you know I wanted to be back in New Yorkand it really wasn't much of a of a decision that at that point in my life,you know if I was thinking that I wanted to be back here. You know C of aclose family so wanted to be the near my family and it really wasn't much ofa decision of that point. I knew whos, not SONA, that I wanted to come to mytraining, an enternal medicine, I'm still a practicing internist, I'm partof a homebased primary here program where I see homebound patients in intheir homes make house calls to see them, but I that's that's kind of howthings got started. I came as a resident back. You know. Over twentyyears ago now completed my residency with the exception of one year thatthat I was not at Mount. Sani have been there ever since and really kind ofjust got interested in that you know I sort of tell people a little bit. Ikind of picked the winner in a way because I got interested in thissubject of at the time. I was interested in resident physician wellbeing because I had probably because I was so close to being a resident when Iwas the first year faculty and I thought kind of almost on a Lark. Youknow this seems like an interesting thing. I can explore what an I do. Alittle survey studyn on that, and that was really the beginning of where I amnow. My story is one ond sort of slowly expanding. You know scope and interest,and I just had the good fortune to pick an area to focus o and develop someexpertisin. That was, that kind of Tractd, some national momentum aroundthe recognition of the importance of physician, now, Cuinishan well beingand sort of all the implications thereof and so Havin to talk more ifyou like, but that's that's kind of my story. No well thanks for sharing that.I would assume your parents have one of those highly coveted rent controldepartments that everybody would love to have they've been there so long,yeah n t not not rent control, but they were living in the city at the timewhen everything was amazingy, there was a lot of apartments which people wholive here now can't remember, because rents are so high and yeah and the costof buying apartments were so high, but there was a time where they actuallycouldn't sell apartments in New York Niss as like the S, so they kind oflocked it in at the time and brought the apartment at that. I grew up inyeah. That's that's great yeah! Being from New York Myself Too, I'm familiarwith the all those settings and tol those opportunities so yeah. So let'sgo in. If you can, I think, what's very unique about your background and yourcurrent role. Is You currently play a role as the chief wellness officer forthe Mount Sin I health system, but yet you're also academic on the icon schoolof Medicine for Mountsy, and I- and so you really share these dual roles. Canyou expand upon that and just how do they work together? How are theydifferent? How does this come together? Be because it's Li, it literally Ab. Iguess you have two jobs and and how do they work together, yeah? So you know,the truth is, is not really two jobs and you know ACADEMICC, medical centersare complex and the relationships between schools of medicine andhospitals that are connected with them are, you know, tha if you've seen oneyou've seen one they're all a little bit different and you know my job. Isit in the school medicine. I report to the deve of the school medicine, and sothat's kind of my initial charge is to address the needs of that community andon the one- and you might say well, isn't that a little bit unfair, thatyou're K, ow you're, addressing all this focus to a segment of you know theforty plus thousand employees of the of the health system and he learners inthe health system. On the other hand, roles like mine are very new. I've onlybeen at it for three years and when I started I was the fourth cheef wellnessofficer in the country now, there's probably thirty, plus growing by themoment. So on the one end you can say well shouldn't there be one person thatoversees all the needs of everybody in...

...e house system and there are some cheapon those officers that do have that role that that perview, but certainlythree years ago it was a very expansive role that I was that in terms of thescope of the population that that my responsibilitieswere directed towardsyou know, they'r sort of made in Mame and in practice as it remates to school,school and and hospital, and we saw that in covid more than ever once oncecovid hit, it became clear as all of us sort of pivoted our scope of work anddirected everything towards dealing with this pandemic. That I would youknow anything that I could offer was going to be for everybody. Prior tothat, you know. I never said No. There was a group thatI interfaced with that was not strictly in the confines of the school basepopulation, but you know I try to navigate that that line a little bitnow in the wake of Covid. I would say you know en talk about silver liningsfrom all this. You know we're still a e, a relatively new health system, it'sabout six o seven year years old. So the pandemic really served to make ustighter, because we we had to figure out how to serve the needs of thepatients in all the hospitals, and if one hospital got really distressed, wehad to figure out how to unload them and mean so doing their lessons learnedthat could help the system function really more as an integrated system, soone hospital could oftload the burdens of another if need be in. Likewise, aswe were thinking about a response to coid by way of the well being supportof a workforcein crisis, you know clearly everything we were thinkingabout would be directed to everybody and that there wouldn't be one. Youknow onee group or another, that we focused our concerns. Ore and you know,obviously when we had DR NAP onor podcast too, and he talked about thestresses to the system. You know back in the what seems now like a long timeago right, but were coming up on the year that year O that yea. So, let'sback up a little bit in terms of so three years ago, either you said I wasone of three wellness officers now, there's probably forty what was some ofthe early finding some of the early observations that said, Hey, there's aneed here, we're seeing this we're, seeing that these are things thats arecausing us that we really need to dedicate more time into the well beingthe wellness of the clinicians, as well as making sure that there's not burnout what were some of the things that were becoming obvious. That made youguys start to jump into this area yeah. Well, you know the way I wouldanswer that is by saying that sort of there's been national recognition.AEVEN argue international recognition around the issue of Clinitian well,being employee, well, be and sort of. Why sort of the consequences, perhapsAF? Not Paying attention to that and just how significant that is and thatthat's been a growing literature. You know growing a body of evidence tosupport the importance of addressing the issue. You know I just when I firstdid that survey study that I spoke of when I was a you know first yearfaculty member over fifteen years ago. If you were to go search, you know themedical sort of database. You could find you know en you looked at residentphysicians and Burnout, which was the area I was interested in. There wereprobably a hundred or maybe a hundred fifty papers total in the history ofyou know anything that's been written about the subject and it feels like youknow, we're seeing that many come out each month now, and so the explosion ofthe of the evidence to support attention to the issue nationally, Ithink, is an enlarge part. What has driven the attention, an local settingsand then every system or hospital that decides to commit in the way that wehave you know, probably also had some very real kind of individual. You knowsome some reasons that are that are unique or individual to that to thatsystem, that's kind of prompting them to act. What I would say is the mainthings in that the literature showed you know is, first of all that we'vegot a problem here that it's you know the majority of conitions experienceburn out as measured by a well...

...established. You know validated tool,so we know that even of itself they're sort of the moral imperative to addressthis issue, because so so many are experiencing it. You know there's alsogrowing recognition that if you want to run a health system I mean it makesintuitive sense, but the data you know boar it out that if you want to run ahouse system, you know your most important asset is your workforce andif you don't take care of the workforceyou're not going to befunctioning optimally, and we see that by virtue of the link between measuresof wellbeing and quality of care, medical errors, patient satisfaction,productivity of the workforce, turnover people leaving their jobs. So, there'sa lot of evidence now that you know actually it makes it makes goodbusiness sense. It makes good, you know, sense in terms of quality occare to ourquality quare and just as adhe has any business any corporation wants toturnovers expensive rehiring as expensive. You want to keep thecontinuity of care, you know. So. Having that you know, minimizing burnout obviously has not only a real humanitarian aspect of it. You know,but it also has a very strong, just good business sense aspect of it, so itworks on both levels. Exactly I usually talk about. You know if you're makingthe case for it. I usually talk about the moral imperative and the businesscase. There's actually there's also yeah, there's also growing regulatory.You know burden, I wouldn't say burden but regulatory case, because nowthere's because there's so much recognition, there's actuallyregulations, particularly around resent physicians. The last thing I'll say isthat T at's. So that's kind of the you know what is the National Neleu? If youwill, that kind of was driving things forward and Mousindi, because I justhappened to develop an interest in this and then was able to you know many waysI kind of was able to help craft the job, because I was, I was slowlyexpanding, the scope of which I was advocating to work at. So I was alreadyin a role where I was overseeing the well being the responsibilities aroundthe wel being in issues for all of the residet positions, a group of abouttwenty five hundred at the Mounsana health system, so that was already inplace when a decision was made to kind of expand, and you know into my role soin the case of Mount Sana, there was already a large amount of attention toit. Prior to my coming on board. There's certainly other examples whereyou know there are large house systems that are hiring recruiting seat. YouKnow Chep ONS officer CWS right now, and what I'm delighted to see is thatsome of those are doing it just because they see. Oh, we, you know there'sthirty of them. These are our. You know our competitors, these are, you know,really top Notch Medical Center, so we need to have we need to have one to is.Is this is how you run? You know, Standard Standard Business Yeah nowclearly and I'm sure it even be starts to become a recruiting attraction thingto know that the the health system is investing back into the well being ofthe clinitions that they're bringing into the system is important. So muchthat they've got a chief wellness officer, so it make sense on Ait makessense on a lot of levels. To me this might sound very basic, but what is acouple of the top contributors that you are that you see within a practice?Inclination, that's causing burn out what causes them to start to burn outor not feel like they're working optimally, yeah! Well, you know so burnout. It is one measure of well being it's commonly reference than referredto, because there's a well established survey based instruments. You can havepeople fill out a survey that will you know, sort of churn out whether the ascore and tell you whether they're burnt out or not, and so because it'sbeen around for a long time. A lot of us use it, and so it's not necessarilythe only way to measure Worldbein, but it's away and it's well studied, andwhat we've seen is that it's very complex, as you might imagine, theworld being of individual clomitions of individual groups. So you know the wellbeing of the Guga anasthesiologist and...

...what drives that their well being isgoing to be different than the group of pediatricians from you know, a group Oobsatritians right so there's also kind of group drivers and then there's kindof larger system, drivers, almost concentric circles, starting with theindividual and going out and then and then, quite frankly, what we woald havea struggle with. Is You know? What do you do when the major source of Burnoutis external to your institution? You know what, if it's attention to racialandjustice? What, if it's you know the events that are happening in politicsand and sometimes that that comes back to us and we sort of grappling with youknow. This is really outside of our control outside of our spiritofinfluence. But I would think about the answer. Your question in terms of sortof concentric circles and it's important for cheap wellness officersto remember that, because you don't want to construct kind of a one. Sizefits all approach to alleviating burnout, because you might have onegroup and not another, but you know in terms of what what kind of driversmight sit in each of those circles. You know we really focus on the systemslike the healthcare system, not like the national healthcare system, but thedrivers within an individual health care system. Those are likely to havethe greatest impact, and usually it fits into a couple of big buckets. Onewould be the efficiency of the workplace and the other would be theculture of the workplace. So, but in the end, it's really it's how well youare enabled to do your work and whether you work in a place that you feelsupports and cares about you that that's that, in my view, is the upshot,as it relates to kind of the system factor. So if you're working somewhere,where you know you're incredibly frustrated by all the clicks on yourcomputer, you got to do just to order an Xray or you know the theinefficiencies of the work flows in your clinic or the the number of notes.You need to be Moun of time, Youre spending, you know typing notes in thecomputer. That's going to really impact your well being. In fact you might, aswe've seen you might take that home with you and spend hours at nightfinishing up and that's just no good, and likewise you could work in the mostefficient Setyan, a great workflows, and you can have really a you know:Superb it and electronic health records. But if you feel like, like the peoplethere don't value, you don't respect, you don't care about! You don't take aninterest in your career. Then you're also likely to experience some burnout,so there needs to be attention to both of those major levels. The otherdrivers are there's a number of other drivers that are kind of moreindividual. You know sort of what's what your support network is. Like youknow what your Howne, you know, work work home issues. Are you know ifyou're in the midst of Covid, for example, if your young parent and allof a sudden, your child care quoses down and now you have to go to work andyou have a four year old, you know all of a sudden. You don't have a lot ofwell being and you might be pretty burned out and it's a very personal.You know individual level kind of issue, so our job is actually to try to thinkabout all of those things and and constructed approach that addresses allthat and not honestly get overwhelmed ourselves with trying to take on toomuch. If we're going to be effective, yeah your world, although tell amedicine his increasing, I really can't work from home and ill. You know,especially for a lot of clinition, so, as you said earlier, you've got theyoung child school shut down. It's not like okay, well I'll, just work fromhome right. A lot of people have that luxury. You have to get somebody totake care of your child and you've got to get to work because your hands on.So it does add a a level of stress right. So when we just say Oh hat'sgreat now we all have zoom. We can all work from home, there's a lot ofindustries and businesses and healthcare being one of them says Idon't have that luxury. I can't do that yeah and we certainly saw that- and itwas a little bit different for everyone. So you know kind of on a personal note.I have an eleven year old and a thirteen year old and my wife's, aposician she's, an infectious disease physician. So she washer specialty was,was you know in high demand, an yeah, xams and high demand, and you know,fortunately, as opposed to the case. I just you know, scenario F, a four yearold, my eleven and thirteen year olds. I mean they pretty much. Once schoolwent to to virtual platforms, it wasn't.

It was definitely not ideal, but therewere times when they were they were plugged in and we would go take care ofcovid patients. You know, and they were kind of you know they kind of grew upquickly. You know, and actually my son speaks about this sow. You know helearned how to fix himself. You know lunch at home and you know what to and actually lookafter his younger brother. So there's you know, there's some really greatlessons, but it was, it was stressful for sure remain stressful and it's veryindividualized. Yeah. So tell me about what are some of the things. I know youhave a you know you really look at this, not only for the Mountsi and I healthsystem and you're involved with a lot of things on a national level. So again,as you look over the kind of the years and and maybe you can give us a littlebit of kind of what's happening on a national basis, what are c what Aurorganization starting to look at, what are they trying to do? What are some ofthe preemptive measures they're trying to take, and then maybe layer in? Howare you guys feeling in the midst of a surge which you and I just said to eachother is probably is bigger in e n for some people that or in different waysthan it was in the spring, we're all kind of used to it, so we're a little anumb about it, but obviously it's still stressing and taxing the system. So Iknow that was a very broad thing, but let's Haw Tho things happen nationally.What are SOM the big initiaves going on and then how is it relating to whatyour guys are up against right now sure yeah and just to make that questioneven more complex? You know it's. What are we doing what's happeningnationally and then how do you think about that? In the context of COVID andnot covid right, and so I it's like anybody- it's really hard to thinkabout anything right now. That is not in the context of COVID. Although eventhough right now you know 're here we are in the middle of January, andperhaps folks wil be listening to this. You know in a few weeks and theexperience we're having now is likely going to be different th than it ischanges fast, changes fast yeah, and you know what I would say is. So let meanswer that by telling you how what life was like at Mount Sini in terms ofour overall approach to address these issues before and after and then speakto how that might have informed what other other groups are doing nationallyand then kind of whith. The way forward looks like professionally yeah, so youknow before the pandemic. We were really trying to organize ourapproaches based on addressing those those drivers at the system, level thatI spoke of. So you know, while the same time, having a comprehensive approachthat incorporated ways to think about the individual and perhaps some of theindividual, the issues that a affect individuals, as well as focus O onmental health, for when folks are really in crisis, to make sure thatthat robust resources are there. So our approach before covid was as it relatesto the efficiency of the workplace. We had developed sort of an organizationalstructure whereby we identified in partnership with department, AL leadersand chairs of departments. We identified individuals who would serveas sort of the well being point person. We call them well being championswithin departments ind. Keeping with that theme that you know there, theissues of one department are lifely going to be very different from others,and- and we worked with these individuals, these champions meetingwith them monkly and giving them a framework to build their kind ofdepartmental approach to address well, be keeping in mind the kind of thespears that they are likely to have greatest influence, so the culturalspheres and the efficiency of workplace severes, and we provided them with someof the tools to measure that we actually measured it and then gave themsome data and and some know how around the types of things that have beenstudied and work, and we even created a granting mechanism to provide somepilot funds for groups to apply for. So not all the champions got this, butsome did because they put together really robust proposals, Tho a e Gratmechanism to come up with innovative ways to unload some of the the burdensaround inefficient systems or ways of...

...promoting culture of support. And sothat's in broad strokes. Some, you know very much what we were focused onbeforehand. As I said, we did other things to enhance tools that anindividual might avail themselves of either to build their own resilience orto seek out mental health support if needed, but use the word s I just waltt say so. Essentially you were building the tools to enable people toselfadminister to self. Through these programs you can't yea the the systemis so large and is so many people fortyhosand. You know your group inability to administer it that way, so you had to give in a sense each of theareas in the groups a tool box so that they could monitor it and administeritself. That's that makes sense, yeah yeah GR great. I really glad you madethat clarifying point there, because I often will tell a chief oness officerwho's a little. You know I've only been add ID three years, but someone who'snewer than me. You know I'll say you you can't possibly. This is a. This isan oil tanker, that's moving across the ocean and you can't possibly steer thatship. Without you know, without the different ane trying to get thepersonon that's running t you know, if there's four engines, you know you gotto try to partner with the folks that are operating those engines, whetherit's sure you know, initiatives that promote culture or initiatives thatpromote efficiency. So and that's that's part of what we enbable ourchampions to understand, and then we work closely. So it's not our job asChiaf wellness officers or my t to fix the electronic health record, forexample, or to improve operational workfrows or to do what's needed tochange the culture ourselves specificy. We need a partner with those that canmake it happen and at any large institution, there's going to bethere's going to be those you know those drivers, those hose those folksare running those engines that you can kind of steer this tanker in thedirection towards towards. Well being so t, that's an important point yeahand so just to take it even like a little more grenular. So so, in a sense,your team's ability to say to your technology group we've identified thatthe inefficiency in a certain system is actually a huge contributor to thestress of our physicians, their feeling of inefficiency, their feelings of thatthey can't get to the patient care levels that we want is has beenidentified in this area so that they can address it fix it, make it betterand having worked in big organizations providing all the other factors, alllineup, it's in the budget, it's that when we can get to it all those things.But essentially that's it right identifying that going to that partnergroup and saying this is an area that you can really help us out. It. That'sexactly right. So you know my team. We meet monthly with the IT leads and wemeet monthly with operational leads, and so that's the work of the chiefwellness officers to make sure that all those groups understand how what theydo influence the well being on the workforce. And then we work on the on ayou know, sort of smaller level, which is still can be very large, but at thedepartmental level. So through the data we collect, we might say: Oh, thesefour departments have the highest burden of time spent on the electronichealth record or the highest burden of messages that they deal with, and so weneed to really think about those groups. We need to shine a spot lige on thosegroups, encourage thes groups to come up with novel ways and maybe apply forthe grants, and you know use the dat that we've collected to make the casefor it, so that that's kind of been our model and our approach before covid. Soif you like, I can speak to how we pivoted ONC'E Co. Let's, let's do that.You know I mean I'm sitting here. I got like fifteen more questions that I wantto ask you, and but the the podcast doesn't go for two hours, so Irecognize that we don't have the time. So let's talk about that. Let's talkabout the pivot in terms of distresses, that covid did some of the things thatyou did and then I'd love for us to just you know, maybe finish off on kindof. What do you to say is a mental health challenges that are going tocome out of this. You know: We've had severl conversations with some otherclinitions and obviously there's a lot of expectation that, for lack of abetter term PTSD or the mental stress, that's going to come out up. COVID willbe big. So, let's talk about, as you said, the pivot coming into coder andwell, we'll close out wet just talkng...

...more about what's coming down the roadsure sure yeah. So we recognized you know in early March that a we weregoing to see something something of these serious. You know it became clearlike t like it has to all of us and when it became clear to swe likeeverybody doing everything they realized it, we have to put whatever wewere doing on cause D and pivot towards addressing covid, and in our case thatwas you know. How do we address the emotional well being of a workforce incrisis? I think, by virtue of my being in the role that that I'm in- and Iknow, I've heard this from other chief wellness officers- we were poised to beable to. You know, make make that pivot and do something meaningful quickly,because we have the infrastructure in place. A another case to be made isthat you know having having folks like us involved, helps you respond incrisis, so we realized that the that the stressers had changed a bit. Sosome of the things that I spoke to you about earlier about the drivers ofWellb we're quite different. Not surprisingly, in the midst of a crisiswe IDN, you know prior to Covid, spend much time. Thinking about you know howpeople are going to, you know, get to work. You know and ou K, owtransportation to work or just personal safety that wasn't really an issue,because, quite frankly, everyone you know took that for granted bout. By wayof you know what risks you might experience at work right so issuesaround. How do I get my Ppe and how do I get to work safely? Where am I goingto get my next MEL BASIC NEEDS? Y Ah became an area that we needed tosupport thams one big area that we focused on and try to enhance whatcould be offered to people, and obviously the system did a lot of this,but so we did a lot of packaging and and pushing out of the informationwhich is a critically important role of ours is sort of creating coherence andgood messaging around resources. Perhaps it already exist, but basicalleans was a big part of it. Uncertainty had settled in in that in that springsurge remains a huge source of anxiety, yeah. You know, just just you know,dealing with who knows what Ho knows right right and certainly in the spring,you ki think some of that's going to Leve Youtt, because we know that thePPE works. We know that patient. You know how to take care of patients. Weknow that we can handle a surge, but we didn't know any of that back in thespring, and so just you know and folks were getting reemployed woerd. They beprepared Woerd, they be supported. Now you know. Just last week I wasredeployed to the COVID units and I felt much more. You know sort ofsupportme. Well, I felt supportid because I knew t hat that you know howit would be organized. We had an experience with it, so anything in liferight the first time you do it you're so anxious about it and then the Nexyeait's it is the unknown. It's the uncertainty, as you said, that's Rugn,the next Tim First Time you fly on an airplane you're a little anxious aboutit. The next time you get on you like this is no big deal, but it has to gothrough it. Yeah the fear, the unknown, and you know that that's emerged and Imean you know I could have anticicipated. That would have beenproblem, but it really. It really has emerge s as a huge source of anxiety.So you know when uncertainty is, is the cause of stress. Then information isthe source of relief right. So we put a lot of efforts and energies intopushing out information both to an you know, identify whath the questionspeople had were so that the syste you know to help the system and theircommunications efforts, and you know we were one one element in that. Obviouslythere's a a huge communications effort underway, but also providing supportive,authentic, regular communications to in something that we could provide ourexpertise in. So that was another big area and then, of course, what youspoke of is a psychosocial mental health support aspects. You know in themidst of crisis a lot of people kind of hunker down, and they don't process orhave a desire to address their psychosocial needs and there's somesuggestion that it actually may not be helpful or even detrimental to do it inthe moment that you kind of need to do it a a little bit afterwards whenpeople can take a breath and process, so we needed to make sure yeah. Weneeded to make sure that all those resources were in place and we did wekind of created coherence around. We figured out everything that could beoffered already and then ramped up again with partner social workers andDepartment of psychiagry and spiritual pare and so forth. We kind of puttogether menu of resources. We have...

...we're fortunae to have a lot ofresources, including a new center for stress, resilience and Personal Proth,dedicated to the mental health needs of our workforce now and beyond the crisis.So we have a lot of resources, but we L, you know: Wamy team did was identifythe needs, identify what resources we had, what gaps we needed to plug andthen how to package it all and deliver it. I'd like to think that, in answerto your other question about how that helps nationally, I think we were earlyon to experience all this, so we were able to put together our covid nineteenpandemic well, being toolkit which we pushed out and made available openaccess to other institutions which I'd like to think. Hopefully they you knowcould learn from our experience. I'm happy to finish with sort of what theway forward what we might expect. Let's do that and I want to Galso, maybe getthe information from you and we'll get t on the website for some of thelisteners. If somebody hears and says we'd love to see that package thattoolkit that you guys are, you know graciously sharing out there. You knowI'd love to make that available, so that they can get that actually wellget he'll follow up with you on that after Yeh. So let's talk about thelet's talk about the way forward, yeah, so one of the things that we've done.You know, fortunately e Our d news and expertet Dean, Charney Dennis charneysand expert an resilience he recognized early on that this experience was goingto have a significant impact and enabled us to do some some real time,research H, which we've done a lot of, and the upshot is that you know welooked at a sample of the forty plus thousand employees, amount SANA healthsystem through a survey based instrument at that we developed wesampled about sixthousand, frontline health care workers, doctors, nurses,social workers- would have you got a respons of a little over fifty percent.So three sand, plus surveys completed, which we you know, we basicallyanalyzed and found that that thirty, nine percent of that workforce whoanswered the survey and Tet criteria for symptoms, not a diagnosis butsymptoms of depression, anxiety or PTSD. We just closed our second round of thatSurveye. So we'll have a sense of how this is is continuing, but I'm sure ourexperience is mirrored in in other places. So clearly, this is having adramatic impact on our on our workforce and we do need to kind of make surewe're sharing best practices. I do that through the collaboratove, a coachhaircalled charm, the collaborative for Heliam, renewal and medicine. We have anetwork of Chief ILMTHESS office, there's those thirty SOMOCHEEP OMISofficers. I spoke of we meet monthly and sort of sheer ideas and arelearning thats great, but the experience also a the experience. Yeah.The experience we have is is you know at not son is not unique, and so I dothink if anything, this it's shown us. It's valivated our roles by virtue F, of being able tomake a difference in the time of crisis, and you know, I think that there'sclearly we've identified that the burden is real in terms of the impacts,and so it means that we need their partner with our mental healthcolleagues and continue to push forth and enable our folks to be efficient atwork to be in a culture that they feel cared for, because it's clearlysomething that we're going to be conteining with for some time. Yeah. Noand I love that Nteain threehsand over survey, meaningful data- that's awesome,you know O. Sometimes you put these surveys out and hi it a couple hundred,and that gives you good indicator, but over three thousand returns, butunfortunately y thirty, nine percent, it's showing itself. So obviously we'regoing to need to continue to do that. So it makes me believe that what I'dlike to do is reserve, maybe in the next six months, I'd love to come backto you, and maybe we can do this again, because I'd love to hear wher what youguys are continuing to Seae and keep following on I'm a big mental healthadvocate. I don't think ID like the way. It's come, we're moreopen to talking about it. We recognize it. The stigma is going around, getgetting better. I wouldn't say we're there yet, but it's getting better andif I probably just would summarize kind of the two things that I really youknow obviously heard you know. Takeaway is from our conversations. Informationand communication to remove uncertainty...

...is really so critical. You just have tocontinue to try to get that data out there and we kind of have a expressionat our where I work, where we say seven times seven ways in order tocommunicate it, you got to say it seven times and seven different ways, andthen they start to get it right. You can't just love th, put an email autonce and assume that they're going to get it so we say seven times, sevenways. So that's a big pase to remove that uncertainty, and I love the partabout the concentric circles. It's not just a one size fits all and you haveto start with, as you said, with the small part and then keep working outand find out what are the nuances to eat. So those were two really neattakeaways that that that I have so Dr Ripp, as you know, as we're wrapping upthis episode, I always like to end asking each of our guests who theirhero was. Who is somebody who had a big impact in your life, whether it becurrent or in the past? Thanks for that question, so whois my hero? Well,that's a tough one, can imagine so many people that might fit the bill, so manyrole models and mentors that I look up to and have influenced me along the way.But I guess if I were to really ask myself who is my hero and think aboutsomeone heroic? I probably choose someone that you know. Perhaps it mightbe a little more trite to go with a family member, but I would say that mygrandmother really is my hero. Her story is one in which she fled fromEurope during wartime. In the beginning of the Second World War, had thewherewithaw to pick up her family travel through dangerous areas and makeher way to the United States, I can only imagine what kind of fear andchallenges and stress she was going through and then all that she faced ina new world establishing herself and her family here in New York, where I amnow I'd like to think that that I learned from her example- and you knowthis- This really resonates at a time like this one, where I had to come inand take care of patients. W H with Covid and obviously you know it's atotally different type of example, but thinking through that, you know thefear, the real anxiety that myself and others no doubt experience whenentering rooms of patients that are sick. Knowing how many people have diedfrom this, that you know we just sort of have to do it, and I guess she, youknow taught me that lesson that she just she had to do, what e what she didand, of course I wouldn't be here, had she not so yeah my grandmother thanksso much again for your time. I know that this is. This is a busy time foreverybody, especially in systems like yourself, and we appreciate your beingpart of this podcast and we look forward to getting feedback and, mostimportantly, I look forward to coming back to you down the road and let's geta let's touch, base again and see and see how things are going and- and whatare you guys continuing to learn to share to the listeners would be greatthanks. So Much Ye' love. To do that. I really appreciate chance to speak withyou and look forward to doing it again, we'll take you up on that. You've been listening to heroes ofhealthcare for more subscribe to the show in your favorite podcast player,or visit us at heroes of healthcare. Podcastcom.

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