This CME course addresses mental health issues surrounding COVID-19. This one-hour program discusses leadership during challenging times, stress and anxiety management, and improving joy and well-being at work.
Click here to claim credit and view faculty disclosures. Select Register to begin the credit claim process. Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. Good afternoon and welcome to Internal Medicine. Grand Rounds. My name is John Cavernous, and I am chair of Mayo Clinic, Arizona's People and Culture Committee. I will be hosting you for the next hour or so for Internal Medicine Grand rounds today. Grand rounds will be devoted to joy and well being, reactivating staff and practicing during covert I, uh, Cove in 19. So our Mayo Clinic president, John Rico for Rusia made increasing joy in medicine. Mayo Clinic one of his top priorities when he took the helm over from John Nosworthy. Join Medicine can manifest in many ways, of course, but many believe that is getting. It is getting even harder to experience in these Kobe 19 times. At the same time, in this crisis, everybody at Mayo Clinic has come together for the common purpose but taking care of our patients together. So protecting our passion, getting out of the grind and exploring meeting and what we do every day has never been more important than now to discuss this. A special panel has been assembled. We have Dr Jonathan Lighten, Dr Cynthia Stonington, Dr Denise Milstein. All three are part of our Mayo Clinic Arizona Joint Task Force. Our first Panelist is Jonathan Layton, who will discuss how to lead during challenging times. I would like to remind everyone in the audience that you could post a comment or question at any time during the presentation. And if you have an idea for how to increase joy at Mayo Clinic, please write it in. Jonathan, please take it away. Thanks, Dr Caviness and welcome everyone. The I have two objectives for my talk this afternoon. The first is to recognize the five things employees need from leadership during challenging times. And then the second is to identify six strategies for successful leadership during a crisis situation. I want to start with this quote from John Lennon. Life is what happens to you while you're busy making other plans and how true this is. And it's means that you could make all the plans in the world you want for yourself. But life probably has a completely different set of plan, and I think the Cove in 19 Pandemic is a great example of that and can challenge any leader. Even great leaders confined the difficulty during challenging times, and the Centers for Creative Leadership reminds us of this. When faced with a crisis, leaders are often forced to think and behave differently and sometimes in ways that are completely unfamiliar. Plans may evolve quickly, and everything may be different. And this is particularly true as new information presents itself. And finally, it demands an emergency response plan with ability to adapt quickly a Z in the case of Cove in 19, and so you can imagine we first had to deal with the surge. Then we had to deal with reactivation of the practice to do it in a safe way for patients and its staff. And now we're having to look at ways of adjusting the practice because of another increase. In addition, I just want to mention that sometimes leaders have to deal with more than one crisis. At the same time, they're not mutually exclusive. So in addition to Cove in 19, we now have a second crisis. We must also recognize the senseless and tragic death of George Floyd, and we're reminded again of the painful and profound disparities that persists in our culture. So now more than ever, we have to unite around shared values and support each other to bring around positive change. And as the great Martin Luther King once said, in the end, we will remember not the words of our enemies but the silence of our friends. So it's time for all of us to speak up, and it's also time for action. But even during these difficult times, effective leaders have to remain calm and maintain perspective, particularly if they're going to be successful. And you have to remember that the goal is to reduce loss and keep things operating as normal as possible. I'm sure many of you have seen this picture before. This is Captain Sully Sullenberger, and he said that in many ways, as it turned out, my entire life up to that moment has been a preparation to handle that particular moment. I had to force myself to use my training and false Carm on the situation, so leaders have to stay car. Let's move to my first objective what employees need from leadership and I took this from the Gallup Workplace, which studies past crises. Toe learn what leaders can do during Cove in 19, based on employee feedback. And really, primarily, people need leaders to provide a path forward. But whether employees say, number one, my leader has a clear plan of action. Of course, this is critical. Number two. I feel well prepared to do my job. And really, during high stress times, leaders need to go back to the basics of clarifying expectations and also maybe even readjusting roles so that people can leverage their strengths in new ways. Number three, my supervisor, keeps me informed about what is going on, and if you think about this, the supervisor is really the key conduit. And on Lee, that direct manager can know each employee's situation, keep them informed and inspire high performance. So it's critical that leaders keep their managers informed of the situation. Number four. My practice cares about my well being. Boy, this is fairly relevant. Ah kee predictor of low worry and high confidence is whether each employee believes and experiences that the organization is looking out for their best interests and then number five. My workplace is very effective and practicing physical distancing. And leaders play a major role here as well, reinforcing what has proven toe work and flattening the curve and getting back to normal sooner rather than later. So if you think about it, effective leadership boils down to three things. Communication, clarity of vision and values and caring relationships. Because in the end it's all about people. So let's move to our second objective, how the lead through a crisis. So whether the best strategies and this remember applies to small practices, large group practices, academic practices and any challenging moments and through the Center for Creative Leadership and other sources, I've found six important factors in a critical for success. Number one. Seek the best information Number two. Use effective communication number three. Keep your staff informed. Number four. Be present visible on available number five. Take care of yourself and number six. Prepare for the future, so let's start with number one. Always use the best information. It's critical to use up to date information, and it has to be reliable. Also, consistency of messaging is important, realizing that it could change from hour to hour and you have to anticipate that and let your staff know that. And then number three always stick with the fax and consult with state and local health services. And, in the case of Cove in 19, that might also include the World Health Organization as well as the Centers for Disease Control and Prevention. Jean Klahn, who wrote the book on Crisis Leadership, said that information is the oil that Greece is an organization and keeps it running smoothly and is especially true during a crisis. And if you think about it during a crisis, you can rarely over communicate. I think in fact, in most cases under communication occurs more often number to use appropriate communication strategies. We have to be transparent and honest. We have to keep our staff informed and you have to identify essential information and disseminate it. And information. If you think about it, is really powerful because it not only decreases emotional stress and reduces fear, but it provides guidance and it really shows that leadership is on top of the situation. Then you have to review, repeat and reinforce, because if information is only shared twice on Lee once, it can't be assumed that everyone has received it or if they did that, they understand it. So repeating and reinforcing information on a daily basis, or even more often this key. And then, in the case of Cove in 19, we all realize that face to face communication is difficult as it is today, and so emails, videos, live remote town halls all become the new way to do things. Number three. Explain what you're doing about the situation. Keep your staff informed during a crisis. Everything happens quickly, and there's little time for strategy and planning. Time is compressed, so you do have to act quickly. But if you're in charge, take charge and be proactive. Now you may have to act before you have all of the information and take more risks. But I can tell you that paralysis or over analyzing is even riskier. You just have to be truthful and honest and make sure everyone knows that the situation will likely evolve. Everyone has to know that the situation may change quickly, but you will keep them updated and remember, no one is gonna have a complete picture of what's going on. So as a leader, that's your job. Number four. Be visible and be available. This is critical. Leaders have to be accessible, so you have to let your staff know how they can reach you. Let them hear from you frequently and remember to keep your office door open. Leaders should be calm, concerned and knowledgeable. And when leaders appear in charge, workers not only feel encouraged, but they're more likely to have confidence that things are under control. And then you have to stay in the present. You have to show respect, treat people with genuine concern by paying attention, listening and being very responsive. And, you know, this is particularly true at this time with the murder of George Floyd and racial tensions. Make connections and be positive because ah, leaders attitude can be contagious. And we have a lot of heroes. Uh, this is a slide that I had thio include The friend of mine took this picture in New York City. We see heroes in Arizona and around the world, and our profession should be proud of what we've done. And this says I am proud of you. I hope you are proud of you too. Number five. Take care of yourself. Realize you're not immune. You have to stay in touch, and it could be with family, friends or other social networks. You have to get accurate information, but not too much. But if you think about it, staying well informed helps reduce the fear of the unknown. Also, take a breather. It could be deep breaths. It could be mindfulness techniques. It could be meditation or whatever helps you to relax. Also walk it off through exercise or stretching, and they remember to give and get support from colleagues. I like to call it a buddy system to help one another. Helping others is beneficial, and it reduces the stress but also asked for it. Accept help from your friends and colleagues and then care for yourself. A zwelling. You care for others, you have to know your limits. Remember, it's not selfish to take a break, and as a leader, it's okay to be vulnerable. And finally, you have to remember to get professional help if you need it. So you have to be mindful of your own cells of sense of well being or distress. This is one of my favorite quotes from Millie William McRaven. If you want to change the world start off by making your bed. And this quote reminds me that the little things in life matter during a crisis starting today can often be overwhelming or even impossible. But you have to start today, so start small, making your bed whatever you want to do. First thing in the morning sets the tone for the entire day. And for me, it's been getting up early, doing a short jog and doing some ab stretches, and that has helped me get the day started. Finally, number six plan for the future. As Yogi Berra once said, the future ain't what it used to be. And that can't be mawr from the truth. As the crisis transitions, we have to plan for recovery, reactivating the practice and now getting things back to normal or the new normal. Prepare your team for future crisis as best you can and set aside, resource is is needed. Consider team building exercises and the training program for similar events, and then finally take advantage. What you've learned innovate your practice, avoid simply going back to the old ways of doing things, and tell the medicine and video visits that we're all now learning more about are perfect examples of that. So in closing as leaders, remember to pay attention to your own emotions, needs and behaviors also be present for your staff. Contain the crisis and regain control. Minimize damage to your staff and your practice and really start planning for the new normal as quickly as possible. And I'll leave you with one more final quote from William James. Act as if what you do makes a difference. It does. Thank you. Thank you, Jonathan. That was that was very stimulating indeed. Next will be Dr Cynthia Stanchions presentation entitled Managing Stress and Anxiety During Corbett 19. Cynthia, please take it away. Thank you so much. So we have all shared in a this roller coaster of emotions and experience of the past few months and the right isn't over. So I am really grateful to Dr Leighton for suggesting this grand rounds now because it gives us a moment to take a couple collective pause and be intentional about how we are rich, ramping up this hour practices and coping in a way that is not just to survive, but actually to thrive. Okay, so we I don't need to remind you that we came into this pandemic with high levels of burnout, and now we are dealing with increased threat related to Kobe 19 and uncertainty about the future. And we've We've had missing connections and the support of networks that sometimes we're really very important. We've had a lot of economic hardships and people on on furlough. And, of course, as we've been ramping up our practices, we've also experienced, um, an increase in covert cases and the potential for more second victim experiences. So what do I mean by that? Those second victims or healthcare workers who've involved in an unanticipated adverse event or medical error or, ah, patient related injury? And then they become traumatized by that event. This is something I'll talk about a little bit later. But I want to just emphasize that it's very easy to sort of understand then, with all of these threats and the other things that are going on, that it's easy to get into a reactive mode and think that we don't potentially have the luxury to sort of take a moment and take a pause. But in fact, what I'm going to challenge you to think about is that Maybe this is the opportunity we need. And as Dr Leighton says, we want toe leverage, some of the lessons that we've learned already through this crisis. Now we're all doing video visits and helly health, and we recognizing how, what a positive experience that is for our patients sometimes not have to come in all the way, but also for us, because we can now maybe leverage that so that we have more flexible schedules. Um, can do more work like integration in a way by doing some of that from home and also recognizing how much we are valued in what we're doing and and the meaning of everything that we're doing. So, um, I think it's important that we try to use thes things as a way to actually address some of the earlier burn out that we were experiencing before. So in orderto book, really be resilient. In the current environment, we need good leadership. As Dr Leighton said, I'm gonna address individual and individual responses as well as community support for the rest of my so regarding individual responses. I just want to emphasize that we were, um, evolved to and and survived as a species by having an incredibly finally tuned threat response system, so that, really, um, that what happens then is that when, particularly in times like this, when we have a lot of unpredictability and uncertainty, it's very easy than for us. Toe have false alarms. And so, for instance, like in your home where you have a smoke detector, you'll have a big alarm go off whether or not it's a fire or burnt toast. And so it is our job to really kind of take that pause and recognize well, we don't want to necessarily always react in the way that we would, of course, toe a fire when we need to think about it as burnt toast. And so we do have a very adaptive system in places to really be able to go into action in acute threat. Where we its stimulus driven we're using over learned behavior is very fast. These air, these air, very important things that we do but it is important to recognize in that mode were also very much prone to implicit bias because we're using those over learned kind of behaviors. It's during those times that we don't want to be processing your emotions. We want to compartmentalize them and just deal with the acute situation. But if the stress continues much longer, then it's very, um, then we have to be careful not to get stuck in that stress response. People who have a high, um, who have a prior history of trauma or maybe have a genetic risk for anxiety or depression or who are in or who have prolonged exposure to high stress or trauma are more likely to get stuck in that response. And here is where we want to think about what the kinds of things we do when, when, when, when we're in a predictable or safe environment. We use kind of the goal directed proactive prospective types of responses. Thes are what will allow us to kind of minimize that chronic of effect of that, um, false alarm system, we can, um, one very simple way to get out of that reactive mode is simply observing our reactions, because when you observe them, you don't you're no longer reacting to them, so that's really important to realize. And so when another way of putting it is that, for instance, when you're triggered your amygdala is popping, and when that happens, it often short circuits are prefrontal cortex. Now that is a part of our brain that we need when we're thinking about our values are being empathetic to others. Professionalism when we're making good decisions when we're planning another way that we can short circuit those types of actions is to just be overloaded with other tasks for our prefrontal cortex. So having to deal with the Elektronik health record, having lots of negative thoughts, having lots of worries. Now we're dealing with always having to be mindful of being having correct PPE and cleaning. So these air things that can make it harder a swell. So we try to take either a top down or bottom up approach. Thio minimize that chance of those false alarms and really be our best self. So a top down approach, of course, is having good leadership who maybe can help us with making sure that we do. We do have a safe environment and that we don't necessarily have to be doing all of the tasks, Um, that that kind of are unnecessary. Um, but another way is through our own abilities individually, to be able to monitor our thoughts and to recognize when our thoughts air helpful and when they're unhelpful. So these air top down approaches Bottom up. Approaches are ways thio decrease the chances of our Magdala popping in the first place. And that can be as simple as just doing something like breathing. So, um, you can you can download an app. Exhale, um dot com to just learn how thio pace your breathing use slowed diaphragmatic breathing de increase that exhale breath and that will increase our parasympathetic nervous system and again allow us to be a little bit less calm. Are more calm, I should say. And, um, another very, very effective way to be to decrease that stress response is community connections. It's amazing how quickly that supportive environment their shared experience can really be. Call me so, um, just so that, you know, everybody's stress responses is different, so it is important for us to take a moment and reflect on the way we have our smoke alarm come off. So is it through worrying, or is it through feeling sad or various emotional responses? Or is it through headaches and stomachaches or feeling really wobbly or lightheaded? Or is it behavioral responses? Maybe being more isolated or becoming more irritable? Or maybe drinking more alcohol or eating more, um, food? You know these or or is it cognitively? Is it through kind of becoming more scattered or having a hard time focusing, remembering or or not able to get things done as efficiently as possible? Take a moment to think about that, because what that will do then is allow you to view those kinds of responses, um, as your sympathetic response, and not one that you need to sort of rush away and get get worried by but as a signal to prepare for action and then rise to the challenge by using other resilient techniques, such as seeking comfort with others, focusing on what is right with what What is wrong? I'm just remembering what it is that we're doing here. Another way to really help reinforce that is a very simple app that's been developed by the the V. A. It's a free app gives you a lot of stress management techniques, allows you to monitor your mood and then, if need be, get help when need be. So for the rest of time I just want to focus on community and pure counseling. And really, um, as I mentioned, community connections air so important. The problem is that we as healthcare professionals, tend not to seek help Ourself. We tend to try toe be quote unquote strong. And yet and so only about 15% of us proactively will seek help when we need it. Where as, um, 85% may actually hint and hope for it. And when they when they get help from or get support from colleagues, they very much welcome it. One of the things that is very traumatic for people after a second victim experiences, they tend to really second guessed themselves. They feel responsible for everything they feel like they start to question their own abilities and maybe even to the point of feeling like they need to leave the profession. So it's incredibly helpful that we, um, respond to people who've been through some very difficult our colleagues who've been through difficult or situations to really just remind them that these are normal responses, toe abnormal events, that it is completely, um, expected, and that they are incredibly valued and respected as colleagues. So this is something that we don't need any particular training to do. And in fact, 60% of second victims will really just benefit from just having your peers or supervisors reach out to you in that way. Now, um, many, um, institutions across the country have now developed a more formalized, trained peer support system, and that is helpful because it builds on that very first tier. And we and Mayo have one called Help is feeling the emotional lives of peers. And this has been something that was spearheaded by Robin Finney, who is a P A in the anesthesia department in Rochester. And now it's been expanded across the enterprise, and any of it you can can sign up to do pure support training. Um, it's about a four hour training, and it's a way that you can just get a little bit more skilled in inattentive or active listening and learning that, um, to provide that proactive support to our colleagues, Period. Counselors don't interrogate. They provide a safe place. They don't try to fix the situation. They really are there to be a supportive listener and to a foster kind of emotional expression. Um, so we can. Now on, then if if that is not enough, and then they can follow up with your to put their colleagues. And if that is not enough, then, um, offer referrals for professional counseling. Um, the As I said, the key messages that we want to hear is that we're respected, were trusted and that we have confidence in our skills and, um, at Mayo. If you you can access to help program by just looking for groups on under eight, you can see help program. And then starting July 1st, we will go live in Arizona. Um, and so in Arizona, if you wanted to activate support for either yourself or a colleague, all you would do is click on the Arizona tab. And in fact, already more than 20 peers, whether it be nurses, physicians, a PPS and others have already been trained here in Arizona. And we have another workshop planned June 30th from 7 a.m. To 11 that you can still sign up for. And if you don't know how to do that, just email me, and we will have more workshops in the fall. So besides that active more structure program again, just simple recognitions and thank you's are so important having supportive networks, mentorship, being willing to tell your story and and normalize help seeking. And of course, we still do have our warm line that is staffed by our fantastic chaplaincy and social workers and mental health resource. So in closing, I just want to say, um, remind us from There was a recent opinion piece in the New England Journal. I thought it was really important, he says. Although Cove in 19 presents a monumental excuse, now is not the time to divert resources from clinician well being or delay the establishment of new activities. And how true is that? So just to just toe finish up stress responses are entirely normal. But we can mitigate future risk by simply caring for yourself, caring for each other and retaining some of those positive lessons that have emerged from this prices. Um, and thanks to and thanks to inspired leadership, thank you. Since that was that was wonderful. And thank you for mentioning a big deal of popping, you know, nothing very, very important from my perspective, but but you also mentioned community connection, and we had a comment, uh, during a present during the presentation today that mentioned that Dr Levante and Community Carol Medicine has a 10 minute virtual huddle with their team every day. And this has been that has been very, very useful. So their exam example of community connection, if you will, the next presentation that Dr Milstein will be presenting joy and well being. Spread your jam. Denise, please take it away. Well, thank you. Good afternoon, everyone. I want to express my gratitude to Dr Isley in Stonington and Cabinets for inviting me to present here and also for involving me in this important work group and work my objectives air here. And really, what I'd like to do to cap off the hour is re energize us around initiatives for joy and inspire you to think about how you can bring this back to your own work unit. But first, let's talk about some of the science behind joy. So the Institute for Health Care Improvement has put out a white paper called a framework for improving joy at work. And for those skeptics of you out there, they even call themselves out to say Perhaps this seems like, ah, bit of a flaky topic at this important time, but it is in fact, not because it will impact how you care for your patients and perform your job. So even what is joy? Well, it could be boiled down to reconnecting to your meaning and purpose. Why do you do the work that you dio as a health care provider? And then to answer the question why and particularly in these days of a multiple issues going on between co vid and social justice and a number of different issues? Why now? Well, because joy is partially responsibility of the individual. But even more importantly, it's a consequence of the system. It's a consequence of the system in which we work, and we really need to investigate it in those terms. And, of course, joy is much harder to experience in times of perceived inequity or when there's a sense of unfairness. And we've had a lot of shifting times thes days, and finally, it's related to your patient's ability to feel hopeful for what they're facing, to feel confident and to feel safe in your care. So it matters how you show up. The H. I also gives us a number of steps for addressing joy, and the first is to tap into your group and ask them what matters to you. So maybe those 10 minute huddles are simply approaching that first step and then look at what's getting in the way. And this could be any number of things. But some of them are manageable. And then to commit to using the entire system, to make joy a shared responsibility, not on the shoulders of the individual or a single group but across the levels of the organization. There's also science of happiness. So in this book, The Myths of Happiness, which is written by Dr Sonya Lea Remorse Key. I'm sure I didn't do that quite right. Apologized to her. She's listening. It's called the midst of happiness. What should make you happy but doesn't what shouldn't make you happy but does. And we've all lived this experience, So a very common approach to joy and happiness is to think Well, I'll be happy when I'll be happy. When I finished that grant proposal, I'll be happy when I get funded. I'll be happy when I get that promotion. I'll be happy when, but the reality is that we often don't find persistent joy and those accomplishments, because once you get the grant proposal and finish the manuscript, there's always that next project that needs your attention. There's also the issue of hedonic adaptation, so we all remember being in training or in education and going Thio Ah, staff level salary. And it seemed amazing when we were starting and very quickly we settled into a lifestyle or responsibilities to which that seemed pretty normal. Tow us, even though it was remarkable just a short time ago. There's also the loss of novelty. We build new spaces and they seem shiny and new and within a couple of months were already complaining about different aspect of it or finding what's not exactly perfect about it as well. What was once special becomes a privilege. Maybe you're granted things like time for travel or academic projects, and we set an expectation that we should be getting that, not realizing that it's actually a privilege of ours. And, of course, those daily hassles. Those multiple clicks messages, even pages through the pager system at Mayo Clinic never stopped. There's also journals regarding happiness studies, So there's an entire journal called the Science of Happiness studies. In addition, several journals public published in this area. So when there's one article where they surveyed 2000 family medicine physicians, they were trying to assess not rates of burnout. But what was correlated with their happiness And they found it to be a sense of career, meaning that they were accomplishing things and their ability to manage their workload was acceptable. But it was not, and this will be no surprise related to how many hours they worked each week. So there are books, books, books, and they seem to be even contradicting each other. Lots of books on how to be successful in your work place just how to be happy at work. Deep work. Just take a pause and dig in. You can start with Why? What's your purpose? Find your why? If you could just find that, then you'll have more joy at work. Or it could just be a simple is washing your face and picking yourself up and getting back at it or being a badass, I hope that's okay to say on Finally, Cheryl Sandberg encouraged us to lean in and very shortly after other professionals encouraged us to lean out, but we always listen when the chair of the Department of Medicine sends a book our way. So I'd like to spend some time with my comments. Talking about Bruce Days lays it Sleep work. Repeat subtitled 30 Hex to bringing Joy to your job, Mr Days Lee is an executive at Twitter, and he has given us a framework for thinking about how toe hack into that joy half back into that joy that we all had at some point with being health care providers. So the first bucket is to recharge. You cannot be joyful at work if you are worn out those times when you've had a number of shifts in a row and you're just exhausted, you must recover from them. We have to give people manageable workloads. If you're double and triple booked with patient after patient, you aren't going to be able to recharge. It's important to think about recharge hacks when you're having the thought in your head. Boy work used to be a lot more fun, and then finally, we know that physicians are more likely to make mistakes at four o'clock in the afternoon than at eight o'clock in the morning, so addressing your energy is important for the safety of your patients. The second bucket is to sink, and this is about connecting to each other, not just to each other on your team, but also to why you're there and what your culture is or should be or could be. And then the final is buzz. Many people will call this flow when you're feeling energized by your work, and you find this most often when you find the combination of positive affect, also known as being in a good mood and psychologically being safe, being able to express your views and suggest changes. So recharge hacks. Let's go through a handful of them. The first one is to think about a monk mode morning. Remember, our ability to concentrate is better in the morning, and if we want to establish that as a normal, it might be a good idea to give a signal. Maybe you place headphones on, not ones connected to a microphone because you're on a zoom call, but ones that are really isolating you in your space or in the work unit where I work. We have a mandala that we all contributed Thio. And you can hang that on your door so that people know you prefer not to be interrupted. But of course you're in here and if need be, you could pay maybe thinking about using the meeting after meeting after meeting as a walking meeting. And this is particularly effective when you're trying to think of divergent thinking. So instead of convergent thinking where you're trying to come up with a protocol or come on the same page, if you're trying to really brainstorm and think of new ways to solve problems, walking could be the best way to do this. And you could do that virtually just like we did in pre, just like we did face to face and prick over days. And it doesn't take a lot of time. So even 7.5 minutes has been shown to be enough for these walking meetings to really get to a point. And then I love the concept of overthrowing the evil mill owner. So this is for the scorekeeper in all of us. If you find yourself in a work, you know where people are thinking, why weren't you here exactly at 8 a.m. Or Why am I the only person who still here at 6 p.m. That culture probably needs to be overthrown in order to create more joy in your work? Some sink hacks. So Doctors West and Shannon felt published a paper on physician engagement groups, pure engagement groups where they were trying to combat burn out. And what they would do is collect a handful of people between three and six to get together and just be connected to each other. It doesn't have to be something as formal. It could be a simple coffee break or a zoom T meeting where you can connect to your teammates. The department or division of gastroenterology under the leadership of Dr Tisha Lunceford actually got together a couple of weekends to get a go to Dio cooking cooking lesson with her. It was a social meeting for them. Ah, lot of fun and aligned to what they do, because you can't be a gastroenterologist without thinking about what and how people it sink. Hacks could also include doing less, so maybe we could have fewer meetings. Or maybe we could consider uninviting people to meetings if they don't need to be there so they can go and do other parts of their work. And maybe counterintuitively just knowing when to leave people alone can get you into better sync with one another. So the final bucket is buzz that energizing finding space for creativity, considering having a period of time where you call it a hack week that's inspired by, uh, this at Google, you have to have a theme. You have to draw borders around it. But let's say we challenged you to create an elefant without using the color gray. I bet you could do it if we gave you enough space to consider how to do it. There's also the idea of the pre mortem, so we're all familiar with looking how things went and seeing what went best and what could have gone better. But if you're about to roll out, say a letter to all of your patients, maybe a pause to think about what could the response be that we're about to get and being prepared for that will help you to be more energized when that starts to come your way? And then, of course, in this time it's critically important to talk about diversity. So in one study and psychology, they looked at a group of fraternity members. Solving a problem compared Teoh, a group of people who were strangers to one another. And what was reported was those people who came from a similar background felt much more comfortable with the experience. They felt much more confident with the experience. They were also right half assed much of the time. So the device diverse group solved the problem 70% of the time, where the non diverse group solved the problem around 30% of the time. So we want to think about that when we're considering diversity in our approach. So let's turn it back internally. The joy and well being workgroup, which I saw in the chat people were wondering if it had not been reactivated. It indeed has been reactivated, has a couple of priorities to approach in the near future. So the first we've already heard from Dr Stonington about the health program, I'll introduce you Teoh a potential way to end your day using a well being check list, and then we'll wrap up talking about spread your jam joy at Mayo and random acts of kindness. So the well being checklist was created across the enterprise toe. Ask you to finish your shift or the end of your day by taking a pause to stop and think about what went well, what didn't go so well. But to let that go to think about one person who you could recognize that day one person who might need a little attention just to say, Hey, I see you. I see you might be struggling with something, and then one thing that you did that was directly aligned toe Why you dio what you dio takes about two or three minutes. Random acts of kindness is something we're also rolling out. And here's a photo of Ah, bag of Carol's corn, which is a Rochester favorite with a plant and a card. Just to say to somebody, Thanks for taking the extra step. Thanks for being here and helping me out. I'm grateful to you, and this is something that we're making possible at the Arizona campus as well. But today we want to invite you to talk about jam joy at Mayo, so the joy and well being work group is soliciting proposals for this new initiative to bring more joy to your workgroup. Whether that's in the bucket of recovery, sinking or finding energizing buzz and our intent is to fund as many of these projects as possible. There'll be three buckets that we drop these projects into, so spread your jam will be funded by some generous money that we've been given for this. Just do it. If you ask us to do something that makes us think, Why haven't we been doing that all along? We're just going to roll it right out. And then if you ask us for bigger projects, we're going to escalate that toe leadership. Let me give you some examples. So the first are the joy at Mayo activities. So this would be things like finding an opportunity for non work connection. Maybe we could support those zoom cooking gatherings or group yoga or movement practice. We could also use this to recognize people on anniversaries or special events. We could even use it to get raffles for those nearby parking important at certain campuses or to engage with the community. There are a lot of people and a lot of need these days, and it could be energizing to come together to support others or could be just a simple assed keeping a list of your staff and what they're interested in outside of work. Maybe they're like hiking or dancing. And as you come on board as a new member of that division, it would be nice to know what people are interested in or when big meetings are canceled. Maybe we stop and pause and huddled together and think about how we can be more resilient and provide self care to our team. Some examples of Just Do It's that were approved immediately included having shuttles from the parking lots that were farther away during construction. It was also when people were asking about using their project time there category time, whether they could work from home, and that was approved even prior to the pandemic days and then also variable schedules with something we worked to approve pretty quickly. But if you ask us to adjust your compensation or to expand educational and developmental offerings to people like Allied Health Thio remodel your space, we're gonna have to escalate that toe leadership and even if you want us to replace those old pagers. That's something that is above the workgroups ability Thio address. So now it's your turn. I hope that you're already using the question and answer section Thio Give us some ideas to give us some thoughts in addition to asking the speakers. But if you don't have a chance to submit it right now or you don't know what you want to submit right now, there is an email a rz joy at mayo dot e d u and we're encouraging you to submit a proposal that has three features. Tell us what you want to dio estimate how much you think it's going to cost and then tell us how you're going to measure whether it was effective or not. It is really, really that simple. And we hope most of you will participate. Thank you. Thank you, Denise. Thank you very much. Excellent presentation and excellent job, Thio All all the panel. Thank you very, very much. So we'll turn to some questions in comments and Jonathan, I think the first one to probably directed towards you and it's, um, as a leader during this crisis, how do you deal with dissent and public criticisms of your actions as is occurring with the leadership of our country. So being how our public officials and leaders seem thio disagree on how to approach many of these things in in Kobe, how allies physicians, that Mayo Clinic do we, you know, deal with that and deal with our patients and their families on that account. Thanks, John. And great question. And I think the first thing is that you know, great leaders trust people with the truth and in return, you are trusted Mawr. And I think that, you know what we have to do is do the best that we can dio on day try to do it through consensus, ringing a group of experts together and hope that we make the right decision but realize that we don't always make the right decision. And as leaders, I think we have to be open to criticism. We have toe listen. Excuse me. The other points of views and, um acknowledge if we've made a mistake, and I think if you're able to do that, then again people trust what you do, and at least they understand that you're trying to do the right thing. Even if you do make a mistake. So thank you. Thanks, Jonathan. The next question or comment, I think for for you, Cynthia. One attendance of did the health program training this week and found that it was excellent. Recommends that all to sign up and be a help here supporter. So I guess part of that in terms of the question, is you know, now that the practice is pretty much back online and work as busy or busier than we were before, you know, how do we you know where where should this rise up in our priorities? And why should a person signed up to do it? Well, first of all, just so the first thing is that you've already heard from somebody that they thought it was worthwhile and excellent, so that's really so it's it is worth the four hours of time. I think he's I even as a psychiatrist who I thought would know all of those things, learned a lot and really found it to be helpful for me. And since I did the training, I found many opportunities where I was a little bit more alerted. I didn't you know it wasn't a formal alert, but I did. You know, make that extra effort. Thio, Just, um, reach out to a colleague or to be be supportive, and I and and it paid such dividends. So I think I think it's really critical, particularly now that we we turn our attention and make that extra time for it. Um, if it's a matter of not having literally time in the schedule or to do the training, you know, we are offering this in a few months. Eso you'll have timeto maybe put it aside. But also, it might be something if need be that you could even think about. Maybe this is ah, joy. Uh, spread your jam initiative that maybe would require, For instance, if you're a nurse and you don't have that time, maybe you could apply for some funding to take those four hours from our giant male initiative. So there's lots of different ways, but I really do want I think it would be so helpful if 10% of us went through this training because just think about that. If we've got that many people who are trained and can be activated and are in that mindset, what kind of a culture and a community we would have, um, on a day to day basis. And I and I and I really do think that the evidence is incredibly strong, based on other programs and other studies that have been using this for a lot longer. Thank you, Cynthia. Uh, Denise, we had won a suggestion for a joy at work initiative. This attendance says that we should eliminate tone the tone paging system. We don't need bursts of anxiety if need to communicate text page. So we know who was trying to get in touch with us. And so that also wonder if you could comment also begs the question. Can enjoy initiative. The actually Thio get rid of something. Think that's an excellent point. And definitely something that should be that is welcome to come through the work group. As I said, I don't think the work group is going to be able to adjust the pager system, but we certainly can communicate it upward to leadership and see if there are possibilities and make the point that nobody needs additional stimulation of their fight or flight response. Uh, because of the tone, paging and Dr Cabinets, I might Also add the doctor. Furuya has emphasized the need to break down barriers, so I think suggestions like that would be great. Very good. Thank you, Denise. Thank you, Jonathan. So, another question, Azan employees not in the leadership position. Is there a way to assist our leaders in fulfilling those objectives? So maybe Jonathan, you could start with that, and Cynthia and Denise could could also coming. Yeah, well, you know, I think that it Mayo Clinic, I in one way or another think of all of us as leaders. So I think that we want to create an environment where anyone could step up if they're interested. So I would, uh, the highly recommend that that individual approach there call me or approach their chair or administrator or nursing lead on duh. You know, talk about what they would like to do. And hopefully there's always room for more leadership. Mayo Clinic. I would just add that as having just been a chair for almost 10 years. I would just be so welcoming when anyone would come up with would would suggest something or come up with something. It really is, um, a sign that you're engaged and If I were to be running a meeting and nobody has any kind of dissent or nobody wants to say something that's different or doesn't offer ideas, I would be incredibly deflated. I mean, the whole point of of of the really high functioning team is that we have that people can feel free to speak up. And of course, the leader will listen. But it's you can't be a good leader unless you don't have good ideas and and that, you know, I really depend on my team to offer up those ideas. Denise, did you want to comment? You're well, I'll just say that. I think this giant Mayo initiative is meant to invite not on Lee the people that you think of in leadership positions but anybody to put forward a proposal that they think will enhance our joy. Thank you, thank you. We had one comment in question. Aziz. We all know it's, uh, we have been told or have learned that there's certain populations that are disappear. A Porsche innately affected with the cove in 19 virus. What can we do as providers and employees to guard against that bias? I'll just open it up Thio any of our £3? Well, I'd say I mean, the first thing is we have Thio recognize that unconscious bias and all of us. And so, you know, that's something that is an organization we need to continually talk about. And if you at least take the time to recognize that potential for unconscious biased, it helps you deal with that as you talk about patients but o. R interact with patients. And, of course, I think Dr Milstein's and Stonington probably have more insight into this, you know? But I think that's extremely important. Is Toe acknowledge the issue? No, that it exists. And when you're more conscious about things like that, then I think you can mawr effectively approach those individuals in a in an improved way. I completely agree, and I would also add that it's really important to simply acknowledge that reality. So when inequities exist, or when you know one group is affected more strongly, there's nothing worse than somebody wanting to just deny that reality and say, Oh, no, no, we're all the same and everything's good. Um, there that that will definitely popular Magdala on DSO the thing to really be helpful is for us as a community to acknowledge those hard realities toe to acknowledge, um, Inconvenient Truth. And and that is the first step to making those those changes and addressing them in a very intentional and helpful way. So both acknowledging, of course, the unconscious bias, but but also be, in fact, the realities that exist that that aren't that we wish were different. I'll just reinforce what's been said and also say that we find more joy when we come together to work on these issues as well. So it would be appropriate if your group found an organization that they wanted to support as part of their joy initiative. And that helps bring some of the discrepancies and disparities toe life, toe light, Um, to make us more aware of it as an organization. Thank you. Thank you. Um, there's one, uh, question that kind of reflects on kind of how things have changed since March. Coming forward June on the leadership response to the Corbett crisis. Um, in the questioner is wondering if the panel could comment on you know how leadership could do better and kind of keeping the message in going. Yeah, I think that's Ah, great question, John. And and, you know, initially our response across Mayo Clinic was quite extreme because we were basing that on what happened in northern Italy and New York City. And we're very concerned about our health care systems being overwhelmed on. Then the curve was flattened and that extreme situation never occurred. Uh, but now, gradually, as we all know, Assauer society and economy opens up. We're having a slow increase in cove in patients. And I think, as I talked about in my talk, you know, leadership has to over communicate at times like this. And, you know, sometimes we don't always do it as well as we would like, But we certainly have kept our guard up in terms of monitoring the situation. And we never totally let the infrastructure of the hikes command just go away. And so we realized in the last, you know, 7 to 10 days that because of the hospital, was filling up, that we needed to then bring back that infrastructure on. We are doing that, but, you know, I think that it's critical that we continue to have a high level of communication with all our staff and that we do all the things that we can do to, uh, keep our hoste little safe. Keep our outpatient cracked. This is safe. And we are continuing to do that as much as we can. Thank you, Jonathan. And I think we need to close with that. So thank you to our excellent Panelists. Thank you to the audience, please. Uh, follow the instructions toe. Get credit for attending this wonderful brain rounds. Thank you. Stay well and let's let's keep joy at mail going. Thank you. Thank you.