Heroes of Healthcare
Heroes of Healthcare

Episode · 1 year 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're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to the heroes of healthcare podcast. I'm your host, Ted Wayne. Today I'm joined by Dr Jonathan Rip. Dr Rip serves in a dual role. He is Mount Sionized Dean for wellbeing and resilience at the ICON School of Medicine at Mount Sinai and it's the cheap wellness officer for the Mount Sinai Health System. A graduate of Yale undergraduate and Medical School, Dr Rip has been passionate about clinician wellbeing and burnout prevention for many years. At the heroes of healthcare we want to continue to focus on mental health and couldn't be happier to have Dr Rip joined the show today. Welcome, Dr Rip. Thanks so much. It's great to be here. I'm excited to get into this because, you know, we talked a lot about covid and what's going on in the market place and we're talking about vaccines and so much of it and as we had one of your colleagues on, Heather 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 all interested in the physiological aspects of Covid and all, but I love your background, your passion in terms of clinician wellbeing and just looking forward to diving into that learning a little bit more today. But before we jump, and if you don't mind, always loved to start with a little bit about your background, where you come from, grew up and what led you into the wonderful world of medicine. Sure, yeah, great, thanks for the opportunity. So, yeah, yeah, well, it's some extent. You know, it's funny because I was born at the hospital that I that I work at, which was so yeah, so some people, you know, they talked about how long they've been at an institution. You know, they say their life first, right. I really am. Yeah, so, you know, definitely, back then it was just the mount side of hospital. Now it's a health system, but you know, it's basically, you know, always been a presence in my life. I grew up in New York City, on the upper west side of Manhattan and you know, really had a very, you know, really great childhood. I loved growing up in New York City, two older brothers and you know really became a city kid and didn't know much else outside. My family was was very urban and so, you know, both parents also from New York City. So, you know, in terms of doing things that are not in an urban setting, and 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 you know, perhaps not surprising that I that I ended up where I am. Just, you know, like so many kids as they're exploring discipline, some resonate more than others. I actually had an opportunity in I think in my either level, I think eleventh grade, between eleven and twelve grade, to do sort of a summer, I guess, internship at Mount Sinai so so again the life or theme there and spent that summer actually in the operating rooms as sort of hanging out with the anesthesiologists and sort of functioning as like a sort of like a tech, 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 and that's sure. Yeah, so, you know, I definitely expanded my world a little bit after high school and I ended up going to Yale for college and medical school and really loved my time there. That exposed to lots of interesting people and disciplines and became pretty interested in the humanities and writing and so so that that resonated to in fact, we tell academic physicians, you know, one of the one of the things you can really if you really want, to help your career early on is, you know, develop your skills as a writer, because it's really such a critical skill set. Spend a lot of time in my college years and medical school years traveling and developed a love for the for the outdoors, and that's still, I would say, is you know, when we talk about self care and what does it for you, what recharges you? Anytime I can get outdoors and and into nature, I find that...

...that always kind of is the you know, helps me press the the reset button. So, even though I still a sort of in between in between worlds, because I'm very much urban than my parents are still in the same apartment. I grew up in wow and yeah, so, but ultimately came, you know, after medical school, sort of you know, did a lot of this sort of soul searching and decision making that that so many young doctors make and realize that I, you know, I wanted to be back in New York and it really wasn't much 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, kind of close family. So I wanted to be the near my family and it really wasn't much of a decision. Of that point. I knew it was Mount Sana that I wanted to come to my training and eternal medicine. I'm still a practicing internets. I'm part of a home based primary care program where I see a homebound patients in their homes and make house calls to see them. But I that's that's kind of how things got started. I came as a resident back, you know, over twenty years ago now. Completed my residency with the exception of one year that I was not at Mount Sana. I've been there ever since and really kind of just got interested in that. You know, I sort of tell people a little bit I I kind of picked a winner in a way, because I got interested in this subject of. At the time I was interested in resident physician wellbeing because I'd probably because I was so close to being a resident when I was a first year faculty, and I thought kind of almost on a Lark, you know, this seems like an interesting thing I can explore. What do I do a little survey studying on that, and that was really the beginning of where I am now. My story is one of sort of slowly expanding, you know, scope and interest and I just had the good fortune to pick an area to focus on and develop some expertise in. That was that kind of tracked some national momentum around the recognition of the importance of physician, now clinician wellbeing and sort of all the implication thereof. And so happy to talk more if you like, but that's that's kind of my story now. Well, thanks for sharing that. I would assume your parents have one of those highly coveted rent control departments that everybody would love to have they've been there so long. Yeah, and not not rank control, but they were living in the city at the time when everything was amazingly, there was a glot of apartments which people who live here now can't remember because rents are so high. And Yeah, and the cost of buying apartments are so high, but there was a time where they actually couldn't sell apartments in New York cities. was like the s. So they kind of locked it in at the time and bought the apartment that I grew up in. Yeah, that's that's great. Yeah, being from New York Myself Too, I'm familiar with all those settings and all those opportunities. So yeah, so let's go and if you can. I think what's very unique about your background and your current role is you currently play a role as the chief wellness officer for the Mount Sinai Health System, but yet you're also academic on the icon school of Medicine for Mount Cy and I, and so you really share these dual roles. Can you expand upon that and just how do they work together? How are they different? How does this come together, because it's like literally have, I guess 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, academic medical centers are complex and the relationships between schools of medicine and hospitals that are connected to them are you know, the if you've seen one, you've seen one. They're all a little bit different. And you know, my job. I sit in the school medicine. I report to the Dean of the school medicine and so that's kind of my initial charge, is to address the needs of that community. And on the one hand you might say, well, isn't that a little bit unfair that you're you're addressing all this focus to to a segment of, you know, the forty plus thousand employees of the of the hell system and learners in the health system? On the other hand, rolls like mine are very new. I've only been at it for three years and when I started I was the fourth chief wellness officer in the country. Now there's probably thirty plus growing by the moment. So on the one hand you can say, well, I shouldn't there be one person that oversees all their needs, of everybody in a...

...house system? And there are some sheep phone those officers that do have that role, that that perview. But certainly three years ago it was a very expansive role that I was that in terms of the scope of the population, that that my responsibilities were directed towards. You know, there's sort of May in name and in practice as it relates to school, school and hospital, and we saw that in covid more than ever. Once, once covid hit, it became clear, as all of us sort of pivoted our scope of work and directed everything towards dealing with this pandemic, that I would you know, anything that I could offer was going to be for everybody. Prior to that, you know, I never said No. There was a group that I interfaced with that was not strictly in the in the confines of the school based population, but you know, I try to navigate that that line a little bit. Now, in the wake of Covid, I would say, you know, talk about silver linings from all this. You know, we're still a relatively new health system. It's about six or seven years old. So the pandemic really served to make us tighter because we had we had to figure out how to serve the needs of the patients in all the hospitals and if one hospital got really stressed, we had to figure out how to unload them and in so doing, their lessons learned that could help the system function really more as an integrated system. So one hospital could offload the burdens of another if need be. And likewise, as we were thinking about a response to Covid by way of the wellbeing support of a workforce in crisis, you know clearly everything we were thinking about would be directed to everybody and that there wouldn't be one, you know, one group or another that we focused our concerns are. And you know, obviously, when we had DR KNAPP on our podcast to and he talked about the stresses to the system. You know, back in the what seems now like a long time ago, right, but we're coming up on the year, th year of this. But so let's back up a little bit in terms of so three years ago, either you said I was one of three wellness officers. Now there's probably forty. What was some of the early findings, some of the early observations that said, Hey, there's a need here, we're seeing this, we're seeing that these are things, things that's are causing us that we really need to dedicate more time into the wellbeing, the wellness of the clinicians, as well as making sure that there's not burn out. What were some of the things that were becoming obvious that made you guys start to jump into this area. Yeah, well, you know, the way I would answer that is by saying that sort of there's been national recognition, even, are you international recognition, around the issue of clinician wellbeing, employee wellbeing, and sort of why, sort of the consequences perhaps of not paying attention to that and just how significant that is and that that's been a growing literature, you know, growing a body of evidence to support the importance of addressing the issue. You know, I just when I first did that survey study that I spoke of when I was, you know, first year faculty member over fifteen years ago. If you were to go search, you know, the medical sort of database, you could find, you know, and you looked at resident physicians and Burnout, which was the area I was interested in, there were probably a hundred or maybe a hundred fifty papers total in the history of, you know, anything that's been written about the subject, and it feels like, you know, we're seeing that many come out each month now, and so the explosion of the lit of the evidence to support attention to the issue nationally, I think, is in large part what has driven the attention at a local settings. And then every system or hospital that decides to commit in the way that we have, you know, probably also has some very real kind of individual, you know, some some reasons that are that are unique or individual to that to that system, that's kind of prompting them to act. What I would say is the main things and that the literature showed. You know, it is first of all that we've got a problem here, that it's you know, the majority of clinicians experience burn out, as measured by a well...

...established, you know, validated tool. So we know that in and of itself, they're sort of the moral imperative to address this issue because so, so many are experiencing it. You know, there's also growing recognition that if you want to run a health system, I mean it makes intuitive sense, but the data, you know, bore it out that if you want to run a health system, you know your most important asset is your workforce and if you don't take care of the workforce, you're not going to be functioning optimally. And we see that by virtue of the link between measures of wellbeing and quality of care, medical errors, patient satisfaction, productivity of the workforce, turnover, people leaving their jobs. So there's a lot of evidence now that you know, actually it makes it makes good business sense. It makes good, you know, sense in terms of quality of care to our quality quare. And just as Eddie has any business, any corporation, wants to turnovers expensive, rehiring as expensive. You want to keep the continuity of care, you know. So having that, you know, minimizing burnout obviously has not only a real human maanitarian aspect of it, you know, but it also has a very strong, just good business sense aspect of it. So it works on both levels exactly. I usually talk about, you know, if you're making the case for it, I usually talk about the moral imperative and the business case. There's actually there's also, yeah, there's also growing regulatory you know, burden, and I wouldn't say burden, but regulatory case, because now there's, because there's so much recognition, there's actually regulations, particularly around resident physicians. Last thing I'll say is that ATS. So that's kind of the you know, what was the national meal, you if you will, that kind of was driving things forward and Mount Sinai because I just happened to develop an interest in this and then was able to, you know, many ways, I kind of was able to help craft the job because I was I was slowly expanding the scope of which I was advocating for to work at. So I was already in a roll where I was overseeing the wellbeing, the responsibilities around the well being in issues for all the resident positions a group of about twenty five hundred at the Mount San a health system. So that was already in place when a decision was made to kind of expand and and, you know, into my role. So in the case of Mount Sun I, there was already a large amount of attention to it prior to my coming on board. There's certainly other examples where, you know, there are large health systems that are hiring, recruiting seat, you know, chief Lem so, officers cwos right now, and what I'm delighted to see is that some of those are are doing it just because they see o we you know, there's thirty 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. Two is this is how you run, you know, standard, standard business. Yeah, I know. Clearly, and I'm sure it even be starts to become a recruiting attraction thing. To know that the fit the hell system is investing back into the wellbeing of the clinicians that they're bringing into the system is important so much that they've got a chief wellness officer. So it makes sense on all makes sense on a lot of levels. To me. This might sound very basic, but what is a couple of the top contributors that you are that you see within a practicing clinician that's causing burnout? What causes them to start to burn out or not feel like they're working optimally? Yeah, well, you know. So burnout is one measure of wellbeing. It's commonly referenced and referred to because there's a well established survey based instruments. You can have people fill out a survey that will, you know, sort of cheern out, whether there a score, and tell you whether they're burnt out or not. And so because it's been around for a long time, a lot of us use it and so it's not necessarily the only way to measure well being, but it's a way and it's well studied and what we've seen is that it's very complex. As you might imagine, the wellbeing of individual clinicians, of individual groups so, you know, the wellbeing of of a group of anesthesiologists and...

...what drives that, their wellbeing is going to be different than the group of pediatricians from, you know, a group of obstetritions. Right. So there's also kind of group drivers and then there's kind of larger system drivers, almost concentric circles, starting with the individual and going out and then and then, quite frankly, what we would have a struggle with is, you know, what do you do when the major source of Burnout is external to your institution? You know, what if it's attention to racial injustice? What if it's, you know, the events that are happening in politics and and sometimes that that comes back to us and we sort of grappling with you know, this is really outside of our control, outside of our sphere of influence. But I would think about the answer your question in terms of sort of concentric circles, and it's important for chief wellness officers to remember that because you don't want to construct kind of a one size fits all approach to alleviating burnout, because you might help one group and not another. But you know, in terms of what what kind of drivers might sit in each of those circles. You know, we really focus on the systems like the healthcare system, not like the national healthcare system, but the drivers within an individual healthcare system. Those are likely to have the greatest impact and usually it fits into a couple of big buckets. One would be the efficiency of the workplace and the other would be the culture of the workplace. So but in the end it's really it's how well you are enabled to do your work and whether you work in a place that you feel supports and cares about you. That that's that, in my view, is the upshot as it relates to kind of the system factors. So if you're working somewhere where you know you're incredibly frustrated by all the clicks on your computer you got to do just to order an x ray or, you know, the the inefficiencies of the workflows in your clinic, or the number of notes you need to the amount of time you're spending, you know, typing notes in the computer, that's going to really impact your wellbeing. In fact, you might, as we've seen, you might take that home with you and spend hours at night finishing up, and that's just no good. And likewise you could work in the most efficient setting and a great workflows and you can have really, you know, superb it and electronic health records. But if you feel like like the people there don't value, you, don't respect, you don't care about you don't take an interest 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 other drivers are there's a number of other drivers that are kind of more individual. You know sort of what's what your support network is like. You know what your home, you know, work home issues are. You know, if you're in the midst of Covid for example, if you're young parent and all of a sudden your child care closes down and now you have to go to work and you have a four year old, you know all of a sudden you don't have a lot of wellbeing 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 think about all of those things and construct an approach that addresses all that and not honestly get overwhelmed ourselves with trying to take on too much. If we're going to be effective. Yeah, your world, although tell a medicine has increasing. I really can't work from home and I'll you know, especially for a lot of clinicians. So, as you said earlier, you've got the young child. School shut down. It's not like, okay, well, I'll just work from home. Right. A lot of people have that luxury. You have to get somebody to take care of your child and you've got to get to work because your hands on. So it does added a level of stress. Right. So when we just say Oh, that's great, now we all have zoom, we can all work from home, there's a lot of industries and businesses, and healthcare being one of them, says I don't have that luxury, I can't do that. Yeah, and we certainly saw that and it was 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 a position. She's an infectious disease physician, so she was there. Her specialty was was, you know, in high demand. The exactis and high demand and, you know, fortunately, as opposed to the case, I just you know, scenario, but four year old, my eleven and thirteen year olds. I mean pretty much one school went to virtual platforms. It wasn't it was definitely...

...not ideal, but there were times when they were they were plugged in and we would go take care of covid patients, you know, and they were kind of you know, they kind of grew up quickly, you know, and actually my son speaks about this. How, you know, you learned Adam fix himself, you know, lunch at home and you know, but to actually look after his younger brother. So there's, you know, there's some really great lessons, but it was it was stressful for sure, remains stressful and it's very individualized. Yeah, so tell me about what are some of the things? I know you have a you know, you really look at this, not only for the Mount Si and I health system, 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 little bit of kind of what's happening on a national basis, what are come of what our organization starting to look at? What are they trying to do? What are some of the preemptive measures are trying to take? And then maybe layer in. How are you guys feeling in the midst of a surge which you and I just said to each other is probably is bigger in the ends for some people that or in different ways than it was in the spring. We're all kind of used to it, so we're a little numb about it, but obviously it's still stressing and taxing the system. So I know that was a very broad thing, but let's how things happen nationally. What are some of the big initiatives going on? And then how is it relating to what your guys are up against right now? Sure, yeah, and just to make that question even more complex, you know, it's what are we doing, what's happening nationally? And then how do you think about that in the context of Covid and not covid right and so it's like anybody, it's really hard to think about anything right now that is not in the context of Covid, although even though right now, you know, we're here, we are in the middle of January and perhaps folks will be listening to this, you know, in a few weeks, and the experience we're having now is it's likely going to be different than it is changes fast change is fast. Yeah, and you know what I would say is so let me answer that by telling you how what life was like at Mount Sinai in terms of our overall approach to address these issues before and after, and then speak to how that might have informed what other other groups are doing nationally and then kind of what the way forward looks like professionally. Yeah, so, you know, before the pandemic we were really trying to organize our approaches based on addressing those those drivers at the system level that I spoke of. So, you know, while at the same time having a comprehensive approach that incorporated ways to think about the individual and perhaps some of the individual the issues that affect individuals, as well as a focus on on mental health for when folks are really in crisis to make sure that that robust resources are there. So our approach before covid was, as it relates to the efficiency of the workplace, we had developed sort of an organizational structure whereby we identified, in partnership with departmental leaders and chairs of departments, we identified individuals who would serve as sort of the wellbeing point person. We call them wellbeing champions within departments. In keeping with that theme that you know they're the issues of one department are likely going to be very different from others. And and we worked with these individuals, these champions, meeting with them monthly and giving them a framework to build their kind of departmental approach to address well being, keeping in mind the kind of the spears that they are likely to have greatest influence, so the cultural spheres and the efficiency of workplace spheres. And we provide them with some of the tools to measure that. We actually measured it and then gave them some data and and some know how around the types of things that have been studied and work. And we even created a granting mechanism to provide some pilot funds for groups to apply for. So not all the champions got this, but some did because they put together really robust proposals through a grant mechanism to come up with innovative ways to unload some of the burdens around inefficient systems or...

...ways of promoting culture of support. And so that's in broad strokes. Some you know very much what we were focused on beforehand. As I said, we did other things to enhance tools that an individual might avail themselves of either to build their own resilience or to seek out mental health support if needed. But use the word so. I just would to say so, essentially, you were building the tools to enable people to self administer to self through these programs. You can't get, the system is so large and as so many people, Fortyzero, you know, your group, in ability to administer it that way. So you had to give, in a sense, each of the areas in the groups a tool box so that they could monitor it and administered itself. That's that makes sense. Yeah, yeah, great, great, really glad you made that clarifying point there, because I often will tell a chief wellness officer who's a little you know, I've only been added three years, but someone who's newer than me, you know, I'll say you, you can't possibly, this is a this is an oil tanker that's moving across the ocean and you can't possibly steer that ship without, you know, without the different you know, trying to get the person that's running. You know, if there's four engines, you know you got to try to partner with the folks that are operating those engines, whether it's sure. You know, initiatives that promote culture or initiatives that promote efficiency. So and that's that's part of what we enable our champions to understand and then we work closely. So it's not our job as chief wellness officers or my team, to fix the electronic health record, for example, or to improve operational workflows or to do what's needed to change the culture ourselves. Specifically. We need to partner with those that can make it happen. And at any large institution there's going to be there's going to be those, you know, those drivers, those are those, those folks running those engines that you can kind of steer this tanker in the direction towards towards wellbeing. So that that's an important point. Yeah, and 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 grew. We've identified that the inefficiency and a certain system is actually a huge contributor to the stress of our physicians, their feeling of inefficiency, their feelings of it that they can't get to the patient care levels that we want. Is it has been identified in this area so that they can address it, fix it, make it better. And having worked in big organizations providing all the other factors all line up. 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 partner group and saying this is an area that you can really help us out. That's exactly right. So, you know, my team we meet monthly with the IT leads and we meet monthly with operational leads, and so that's the work of the chief well this officers to make sure that all those groups understand how what they do influence the wellbeing of the workforce. And then we work on the on the you know sort of smaller level, which is still can be very large, but at the departmental level, so that, through the data we collect, we might say, Oh, these four departments have the highest burden of time spent on the electronic health record or the highest burden of messages that they deal with, and so we need to really think about those groups, that we need to shine a spotlight on those groups, encourage those groups to come up with novel ways and maybe apply for the grants and, you know, use the data we've collected to make the case for it. So that that's kind of been our model and and our approach before covid. So, if you like, I can speak to how we pivoted once come. Yeah, let's let's do that. You know, I mean I'm sitting here, I got like fifteen more questions that I want to ask you and but the have the podcast doesn't go for two hours, so I recognize that we don't have the time. So let's talk about that. Let's talk about the pivot terms of the stresses that covid did, some of the things that you did, and then I'd love for us to just, you know, maybe finish off on kind of what do you see as mental health challenges that are going to come out of this? You know, we've had several conversations with some other clinicians and obviously there's a lot of expectation that, for lack of a better term, PTSD or the mental stress that's going to come out of COVID will be big. So let's talk about, as you said, the pivot coming into cold sure, and we'll we'll close out with just talk more about what's coming down the road.

Sure, sure. Yeah, so we recognized, you know, in early March that we were going to see something something really serious. You know, it became clear, like it like it has to all of us. And when it became clear to us, we, like everybody doing everything, they realized it. We have to put whatever we were doing on pause and and pivot towards addressing covid and in our case that was, you know, how do we address the emotional wellbeing of a workforce in crisis? I think by virtue of my being in the role that I that I'm in, and I know I've heard this from other chief wellness officers, we were poised to be able to, you know, make make that pivot and do something meaningful quickly because we had the infrastructure in place. Another case to be made is that, you know, having having folks like us involved, helps to respond in crisis. So we realize that the that the stressors had changed a bit. So some of the things that I spoke to you about earlier, about the drivers of wellbeing, were quite different, not surprisingly, in the midst of a crisis. Wen you know, prior to Covid, spend much time thinking about, you know, how people are going to you know, get to work, you know, and you know, transportation to work or just personal safety. That wasn't really an issue because, quite frankly, everyone, you know, took that for granted by way of you know, what risks you might experience at work. Right. So issues around how do I get my Ppe and how do I get to work safely? Where am I going to get my next meal? Basic needs, yeah, became an area that we needed to supports. Was One big area that we focused on and try to enhance what could be offered to people. And obviously the system did a lot of this, but so we did a lot of the packaging and and pushing out of the information, which is a critically important role of ours is sort of creating coherence and good messaging around resources. Perhaps that already exists, but basic needs was a big part of it. Uncertainty, he had settled in and that, in that Spring Surgey, remains a huge source of anxiety. Yeah, you know, just just, you know, dealing with who knows what, knows right, right, and certainly in the spring. You know, I think some of that's been alleviated because we we know that the PPE works, we know that patient you know how to take care of patients. We know that we can handle a surge, but we didn't know any of that back in the spring and so just you know, and folks were getting redeployed, would they be prepared? Would they be supported? Now, you know, just last week I was redeployed to the COVID units and and I felt much more, you know, sort of support. Well, I felt supported because I knew that that you know how it would be organized. We had an experience with it. So anything in life, right, the first time you do it you're so anxious about it and then the next yeah, it's it is the unknown, it's the uncertainty, as you said, that's run the next time. The first time you fly on an airplane, you're a little anxious about it. The next time you get on you're like, Oh, this isn't no big deal, but it has to go through it. Yeah, the fair of the unknown. And you know that that's emerged, and I mean I you know, I could have anticipated that would have been problem, but it really, it really has emerge as a huge source of anxiety. So, you know, when uncertainty is the cause of stress, then information is the source of relief. Right. So we put a lot of efforts and energies into pushing out information, both to and you identify what the questions people had were, so that this is, you know, to help the system in their communications efforts and you know, we were one one element in that. Obviously there's a huge communications effort underway, but also providing supportive, authentic, regular communications to is something that we could provide our expertise, and so that was another big area. And then, of course, what you spoke of as the psychosocial mental health support aspects. You know, in the midst of crisis a lot of people kind of hunker down and they don't process or have a desire to address their psycho social needs and there's some suggestion that it actually may not be helpful or even detrimental to do it in the moment, that you kind of need to do it at a little bit afterwards when people can take a breath and process. So we needed to make sure, yeah, we needed to make sure that all those resources were in place, and we did. We kind of create a coherence around we figured out everything that could be offered already and then ramped up again with partners, social workers and Department of Chiatry and spiritual parent so forth. We kind of put together a menu of resources we have were fortunate to have a...

...lot of resources, including a new center for stress resilience and personal both dedicated to the mental health needs of our workforce now and beyond the crisis. So we have a lot of resources, but we you know, what my team did was identify the needs, identify what resources we had, what gaps we needed to plug, and then how to package it all and deliver it. I'd like to think that, in answer to your other question about how that helps nationally, I think we were early on to experience all this. So we were able to put together our covid nineteen pandemic wellbeing tool kit, which we pushed out and made available open access to other institutions, which I'd like to think hopefully they, you know, could learn from our experience. I'm happy to finish with sort of what the way forward, what we might expect. Let's do that and I want to also maybe get the information from you and we'll get it on the website for some of the listeners. If somebody hears and says we'd love to see that package, that tool kit that you guys are, you know, graciously sharing out there, you know we I'd love to make that available so that they can get that likens will get. Will follow up with you on that after yeah. So let's talk about the let's talk about the way forward. Yeah, so one of the things that we've done, you know, fortunately our De News and expert, Dean Charney, Dennis Charnese and expert and resilience. He recognized early on that this experience was going to have a significant impact and enable us to do some some real time research, which we've done a lot of. And the the upshot is that, you know, we looked at a sample of the forty plus thousand employees amounts on a health system through a survey based instrument that we developed. We sampled about six thousand frontline healthcare workers, doctors, nurses, social workers. Would have you got a response of a little over fifty percent. So threezero plus surveys completed, which we I you know, we basically analyzed and found that that thirty nine percent of that workforce who answered the survey that criteria for symptoms, not a diagnosis, but symptoms of depression, anxiety or PTSD. We just closed our second round of that survey, so we'll have a sense of how this is is continuing, but I'm sure our experience is mirrored in other places. So clearly this is having a dramatic impact on our on our workforce, and we do need to to kind of make sure we are sharing best practices. I do that through the collaborative that a Cochhare, called charm, the collaborative for healing and renewal and medicine. We have a network of chief illness office. There's those thirty s O chief illness officers I spoke of. We meet monthly and sort of share ideas and are learning from screaty. But the experience also have the experience. Yeah, the experience we have is is, you know, at not sun is not unique, and so I do think if anything, this is it's shown us, it's validated our roles by virtue of being able to make a difference in the time of crisis. And you know, I think that there's clearly we've identify find at the burden is real in terms of the impacts, and so it means that we need their partner with our mental health colleagues and continue to push forth and enable our folks to be efficient at work, to be a culture that they feel cared for, because it's clearly a something that we're going to be contending with for some time. Yeah, no, and I love that. And threezero were survey meaningful data. That's awesome, you know. You know sometimes you put these surveys out and hit it a couple hundred and that gives you a good indicator. But over threezero returns but unfortunately, at thirty nine percent it's showing itself. So obviously we're going to need to continue to do that. So it makes me believe that what I'd like to do is reserve maybe in the next six months I'd love to come back to you and maybe we can do this again, because I'd love to hear where what you guys are continuing to see and keep following on. I'm a big mental health advocate. I don't think I like the way it's come. We're more open to talking about it, we recognize it. The stigma is going around. Get you getting better? I wouldn't say we're there yet, but it's getting better. And if I probably just would summarize kind of the two things that I really you know, I obviously heard you know. Take away is from our conversations information and communication to remove uncertainty is really so critical. You just have to continue...

...to try to get that data out there and we kind of have a expression at our where I work, where we say seven times, seven ways. In order to communicate it, you got to say at seven times and seven different ways and then they start to get it right. You can't just love that put an email out once and assume that they're going to get it. So we say seven times, seven ways. So that's a big piece to remove that uncertainty. And I love the part about the concentric circles. It's not just a one size fits all and you have to start with, as you said, with the small part, and then keep working out and find out what of the nuances to eat. So those were two really neat takeaways. That that that I have. So Dr Rip, as you know, is we're wrapping up this episode. I always like to end asking each of our guests who their hero was. Who is somebody who had a big impact in your life, whether it be current or in the past? Thanks for that question. So who's my hero? Well, it's a tough one. Can Imagine so many people that might fit the bill, so many role 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 about someone heroic, I'd probably choose someone that you know. Perhaps it might be a little more trite to go with a family member, but I would say that my grandmother really is my hero. Her story is one in which she fled from Europe during wartime in the beginning of the Second World War, had the wherewithal to pick up her family, travel through dangerous areas and make her way to the United States. I can only imagine what kind of fear and challenges and stress she was going through and then all that she faced in a new world, establishing herself and her family here in New York, where I am now. I like to think that that I learned from her example, and you know this. This really resonates at a time like this one, where I had to come in and take care of patients with with Covid and obviously, you know it's a totally different type of example. But thinking through that, you know the fear, the real anxiety that myself and others no doubt experience when entering rooms of patients that are sick, knowing how many people have died from this that, you know, we just sort of have to do it, and I guess she, you know, taught me that lesson that she just she had to do what she what she did, and course I wouldn't be here had she not. So, yeah, my grandmother, thanks so much again for your time. I know that this is this is a busy time for everybody, especially in systems like yourself, and we appreciate you being part of this podcast and we look forward to getting feedback and, most importantly, I look forward to coming back to you down the road and let's get a let's touch base again and see and see how things are going and and what do you keep guys continuing to learn to share to the listeners would be great. Thanks so much. I'd love to do that. I really appreciate chance to speak with you and look forward to doing it again. We'll take you up on that. You've been listening the heroes of healthcare. For more, subscribe to the show in your favorite podcast player or visit us at heroes of healthcare podcastcom.

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