Good afternoon, and welcome to today's learning in action network event. Our topic today is burnout, building resilience. We are excited to welcome you today. My name is Victor Gonzalez, a quality improvement specialist for TMF. And I want to make sure that you're comfortable in today's event. We're gonna go over a couple of house keep issues and make sure you understand that this is going to be a collaborative event. We want your participation. Here is a couple of ways that you can do that. We certainly want to allow you to use the Q & A feature. You will find that on the right hand side of your event screen in that panel. If it's collapsed, just click on the share button. That's the little icon to the left of the Q & A, and it will expand. You will be able to type in your question and we will be happy to answer it or bring it into the conversation. We also have closed captioning in this event. You will see the Bea Young, my colleague, has placed it into the chat. If chat is not part of your panel, just go ahead and click on that and we will cover that in just a little bit. We will show you how to do that. Here is the other way you can participate. If you're not the shy type, raise your hand. You will find that icon next to your name. I will find your line, unmute you, and bring you into the conversation at the appropriate time. We welcome all of your questions and we think it's going to be a fantastic event and presentation today. So definitely participate. Here is that chat feature that I discussed earlier. This is a one way communication. We're gonna use this to send you lots of good information during this event. We have a big crowd today, so definitely encourage you to submit through Q & A. But watch out for chat. We're gonna send you lots of good stuff during our presentation. Well let's go ahead and get to the good stuff. We definitely want to get started very quickly here. We have got a lot of a lot to cover but it is definitely my distinct pleasure to introduce Vanessa Andow. Vanessa is our Project Director for the Hospital Quality Improvement Contractor initiative. Vanessa asked me to keep her intro brief because we have so much to cover and share with you today. And I know she's eager to take the focus off of her and dive fully into describing the exciting, transformative work we're undertaking with you and introducing our special guest speakers. If you recognize Vanessa's name, it's because Vanessa also heads up the community coalition task team that is part of the quality innovation network quality improvement organization contract with CMS. Vanessa, we originally had a very targeted group of select hospitals we were intending to share this event with, but this topic is too important and most beneficial not to expand this offering to our colleagues throughout the network. So thank you for allowing us to expand this event. We have a great crowd today. It's standing room only. A little bit about Vanessa. She holds an MBA in health care administration from Texas A & M University at Corpus Kristi. She holds a variety of professional certifications. Most noticeably, she's certified as a project manager with the project management institute, she holds a coveted certificate as a professional in health care quality from the national association of health care quality along with the prestigious certified professionals and patient safety credential. Vanessa, thank you for pulling this all together. It is exciting to be on the call with you today. Welcome. Vanessa: Thank you so much, Victor, and it's my pleasure to welcome everyone to today's event. As was mentioned, today's event is offered as part of the national CMS hospital quality improvement contract or HQIC. And it's for the idea that common liability begins with leadership in addition to developing a culture of patient safety and quality. It is now my pleasure to introduce our speakers from our partners, Safe and Reliable Health care. We have Mr. Jeff Dunaway who joined Safe and Reliable Health care in 2020 and has a primary focus of supporting the [indiscernible] journey in the VHA. He has practiced as a registered nurse for 25 years with the last decade dedicated to the performance improvement space. While working at Kaiser Permanente in California, he earned a lean green belt in 2009 and a black belt in lean six sigma from the [indiscernible] university in 2012. Jeff also holds a certification in change management. Jeff is passionate about helping health care at both a national and local level through the empowerment of front line workers and training of executives. He brings a servant leadership model to all of his engagements and has a deep understanding that culture eats strategy for lunch every time. It's also my pleasure to introduce you to Todd Krupa. He's a high reliability patient safety expert who develops evidence based content and facilitates comprehensive application of aero science principles, strategies and tactics for health care leaders, physicians, clinical and non clinical staff in an effort to reduce preventful harm to patients and those who care for them. Todd spent several years as an independent consultant and joined Safe, Reliable Health care in 2019. Todd has undergraduate degrees in communication and history from the university of [indiscernible], Pennsylvania, and a master's degree in journalism from the University of Missouri. And patient safety leadership from the College of Medicine at the University of Illinois, Chicago. Thank you, Jeff, and Todd for joining us today. The floor is yours. Jeff: Thanks, Vanessa. We appreciate it. So if we can advance the slide? So My colleague and friend, Todd Krupa and I back up just one. Today really want to give you some better context of burnout and how it's affecting health care. If you have ever flown, the safety information is to put your mask on first and then help others. The same concept applies to the work we're doing today. We must understand our level of burnout before we can help others. As we move through the discussion today, apply the learnings in that context whether you're a health care worker or not we're all supporting patients by supporting those who are caring for patients. Next slide. So here we see some of the numbers. Greater than 50% of physicians report that they feel burned out. Greater than 30% of nurses are feeling burned out, and 33% of the nurses are leaving the profession within the first two years of graduation. These numbers can and do ebb and flow, and probably today in the midst of the delta variant surge, we might even expect this data to be even a lot higher than that. Next slide. So what is burnout? What do we mean when we use the term "burnout"? Here we see a definition. Burnout is the psychological syndrome involving emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment that occurs among professionals that work with other people in challenging situations. In the boxes below, we can see some of the ways that burnout is manifested. Do you ever experience any of these? For those of us who are process thinkers, we can really think of burnout as the root cause and the items in the boxes as the symptoms. Frustration, exhaustion, cynicism, depersonalization. If we were to think of COVID as the root cause of the illness, then we would think of fever and tiredness and respiratory difficulty as the symptoms or the way the disease is manifesting itself. In the next few slides we will see that burnout can have many names and it can be manifested in many different ways. Thanks, Todd, for advancing the slide. As we see burnout get worse, we see that there are affects downstream such as there is an increased incidence of medical errors directly associated with burnout. Being involved in malpractice suits, hospital transmitted infections could be linked back to burnout. We see that there is a decreased sense of altruism among the medical students, we see work efficiency suffer, we see decreases in patient satisfaction. Often times when we start to think about these outcome measures, we don't often link it back to burnout but it's one of the key variables to consider when starting to work on these type of outcome measures. Let's look at our next slide. So here we see many different names for burnout. PTSD, moral injury, compassion fatigue, clinician distress. Todd is going to walk us through some of these and the nuances of each, but they all really tie back to what we are calling burnout. Todd? Todd: All right. Thanks Jeff. And very much appreciate the chance to stand in for our colleague and friend, Don, who often speaks with you. This concept of burnout is real, and we feel it in a variety of different ways. So compassion fatigue is really the syndrome that we experience or the physical exhaustion that we experience as professionals and caregivers. And it takes that energy, that emotional energy, to provide care. And that energy is usually returned to us in positive feelings of doing good. But when we're exhausted from providing that care, we tend to withdrawl. And it's a bit of a it truly is a protective mechanism that we undertake to take care of ourselves because our tanks begin to empty and our bodies are actually telling us not only physically but also mentally that we have hit a point where we're truly fatigued. So as that fatigue progresses, we begin to develop distress. And, you know, distress has multiple manifestations. In this case, we're distressed or distress by itself nature is the feeling we get when we're prevented from doing something that we think is the correct thing to do. Moral distress actually preceded COVID when nurses saw less than adequate care being made available and delivered by colleagues and others throughout that period of in the early days of COVID. Seeing people doing what isn't the correct thing is painful, and actually accelerates our withdrawl because we don't align with the professionalism that we would typically see and it reduces our empathy for those who feel like they're being let down. So, you know, we begin to see this erosion of esteem in ourselves and we actually witness it in the environments around us. So this idea of so we have moral distress but we also have moral hazard. And, you know, thinking about what that is is that really gets down to: when we're in a position where we're controlled or others control and limit our access to resources, we have moral distress. And that grows into anger that begins to obviously show up more regularly. Additionally, that anger is viewed as callused and then actually leads to feelings of betrayal. The perceived betrayal of those who are in power basically keeping me from having the things I need, the perception of that, leads to what's called moral hazard. And this is really severe. And we saw evidence of this throughout. And in some instances, much more limited today than earlier, but we continue to see it when professionals are put at risk. In other words, in this example using or not having the proper PPE in place, for example. So that loyalty then, to organizations, and then specifically to leaders becomes not only tested, trust is lost, and, of course, the frustration and the anger becomes further amplified. And, honestly, we move into dangerous situations. Not only personally, professionally, but also in a community sense. So we move on to moral injury. And moral injury is is the idea that you have this continuing distress that's going on and that leads to this psychological damage. The progressive loss of our ability to have self respect, honor, and professional pride is at the heart of moral injury. When we lose hope for something that is a better day or, you know, a better week or a better month, we begin to feel like we're running to stand still and then actually we stop running. And the quote at the bottom of this, I think, is really powerful. A moral injury is a deep soul wound that pierces an individual's identity, sense of morality, and relationship to society. So we're actually disenfranchised from those ideas and those people and those communities that we have invested in so heavily to the point where we become apathetic and completely remove ourselves from participating in that. And that leads, then, to I think I a condition that we have heard much more about in the last two decades: post traumatic stress disorder. The mental health problem that some people develop after experiencing, witnessing a life threatening event like combat, a natural disaster, a car accident, a sexual assault. And we know that that list becomes rather significant over time. So you saw suicide rates as noted in this story in the lower right corner. Suicide rates increased by medical professionals during that time. Those that progression was really, in a way, to use a metaphor that we commonly use in aero science, the Swiss cheese model. That activity was lining up. Those activities were lining up through a process of erosion that really contributes to the burnout that we have witnessed and experienced during this time. And there are a lot of there are a lot of contributors to burnout, but there are also a lot of results that occur because of burnout. And Jeff's going to speak to those next. Jeff: Thanks, Todd. Yeah, so we all recognize it in ourselves often. And even if we don't recognize that we are burned out or nearing burnout, then we often recognize the symptoms in ourselves. And we might ask ourselves, okay, so what? Well, you who are working at hospitals and often in the quality departments, this is the "so what". So let's make the correlation of burnout to our outcome measures. You may have seen a slide like this before, and it's very relevant when we really start to work with hospital leaders to affect outcomes. Whether we want to work on infections, patient satisfaction, medication errors, medical errors in general, or even standardized mortality rates, there is a root cause that should not be overlooked as a starting point. Burnout has a statistically significant correlation to each of these patient outcomes. So if one of these patient outcomes is an area of opportunity for you and your hospital, then understanding the burnout rate for your team is one of the best places to start. You don't necessarily think about your team and the resilience and their wellness and their degree of burnout as it relates to infections. But, again, we have done the statistical analysis and the research and it's got a very strong correlation. Todd, feel free to add anything you like at that point. Todd: No, Jeff. You're right on. And, actually, as the data as we continue to grow the datasets, we're looking at a number of different outcome that we're going to see effects of truly in many instances preventable situations. Jeff: Thanks, Todd. So, now that we have a common understanding of what burnout is and some of the many faces that it looks like, along with some of the outcome measures that it effects, what are the elements that either lead to or magnify burnout? And here we see some of them. Helping ward off or prevent burnout. If your staff could answer this question: do I feel valued and respected by my team and my organization? For staff that are able to answer in the affirmative strongly, then they have a much lower understanding or a much lower incidence of burnout. For those that can't answer that question positively, if I'm answering that question and I say I don't feel valued, I don't feel respected by my team, by my organization. If I say I don't feel like I have a voice to be able to speak up. If I answered the question I don't feel supported in the work I do. If I answered the question, I don't feel like I've got all the tools and the resources to do my job, this is a combination of answers that if I'm not burned out today, I'm heading in that direction. So if your team can't answer all of these in the affirmative, there is a good chance that there is an increased incidence of burnout in your organization and you can expect if you're not seeing the outcome measures moving in the positive direction, that this could be a really good root cause and understanding of a point and place to start to look at for those things. And not just clinical best practice, but truly the burnout of your staff and your team. Let's look at the next slide. There we go. So if you could read through these bullet points and each one resonates with you, if you feel like they apply to you, you have a good chance of avoiding burnout or catching it early. You know, if you have if you're thriving from an emotional point of view: I have a chance to use my strengths everyday. I feel like I'm thriving at work. I feel like I'm making a difference. If I have the emotional recovery or resilience that I can recover quickly after I have a difficulty, I can adapt to events in my life. My mood reliably recovers after frustrations and I could always regain a positive outlook despite what happens. If you can say that, if your team can say that, then you're in a really good position to see burnout when it's coming. To be resilient and avoid it and keep it at bay. Todd's going to focus for us on the very easy and quick and tangible activities that leadership can do to help counteract burnout in your organization. Todd: Jeff, I will point out in the in the nuance between and you hit it on emotional thriving and emotional recovery. When we thrive, we feel better about ourselves after a great experience at work. We feel like, hey, you know, that was a really tough day but I feel better. Like I achieve something. Recovery, you know, we have to pick ourselves up after those tough days. But when we're able to recover, that actually adds fuel to our tank for tomorrow. And when we start to get burned out and we're relying on ourselves for that emotional recovery, at some point we run out of the ability to generate our own fuel. And that's why these leader tools are really important. Because this can be fuel for emotional recovery, it can be a stageset truly for emotional thriving and ultimately satisfaction and growth in our team. A couple of tools here. 5 to 1 feedback. 5 to 1 feedback is relationship science, actually. A guy named John Gotman [phonetic] about 20 25 years ago did some rather extensive and seminal research on how relationships two people, a couple got along. And what he found is the most appreciative and successful relationships had a ratio of 5 positives to 1 negative. And significant success rates for those relationships where that ratio was at that at that level. So kind of reflect on what gets in the way of us providing more appreciation. Sometimes we take it for granted. Sometimes we don't see it. Sometimes we're focused in an inverse way, so the opportunity to treat our team members and each other better peer to peer appreciation is just as valuable. It gives us an opportunity, then, to build a fuel bank, if you will, for our team members and or ourselves. Giving compliments feels good too, so we give that back to ourselves. Rounding. Rounding is huge. Rounding with purpose. And, you know, there are several we see several iterations and ideas around what rounding is. But really what I'm referring to is getting out, being present, listening. You know, the LOL moniker. Lots of listening or listen a lot. Whatever which way you want. Think about how we, during difficult times, need to display empathy for the challenges that people are experiencing. Appreciation for what's happening. Appreciation also for imperfection and showing humility in that. And the key to good rounding is when you hear something that you can take on or take back to get back to the individual or the team that brought it to you. What we see is the improvement and a strong correlated improvement to reductions in burnout, increases in satisfaction, and stronger clinical outcomes. Leaders who follow through or rounding take care of some of that business that Jeff talked about a little bit earlier, simply by rounding and doing it frequently. And then finally, town halls are often town hall style activities are often missed chances for us. Simple updates, that's one thing. But when there is more transparency, sharing of concerns, taking live questions, you know, having a list of or having exercises where people can contribute to the greater good and share accountability for their outcomes creates dynamics where people feel better about their position and their ability to affect the organization in a way that, goodness, that's, you know, what being a professional is about. So just take a little moment and talk about a couple of these items a little bit. So tailored these tailored walkrounds. Just so you have a leader who is rounding here in our picture. There are four or five folks in there. Just think about how many people a leader can interact with rounding by seeing people in smaller groups than you can in one on one situations. One on one is really important, obviously. But you can be personal with these four folks in a really structured way and also in a lighter way too, by simply being present and human with them. So we're looking at, you know, understanding a little bit more about what's going on, listening, and also looking for opportunities to provide follow up. We look at different types of rounds. So that being a listening round. A resilience round is: how can I help you find more time? What are the things that are pebbles in your shoes or boundaries that you're experiencing? And what are you doing, you know, as a group to help each other make it better and that gives you an opportunity to spread? Of course you have safety rounds. You know, what's your biggest threat today? What's in the way of you having a safe day? What keeps you up at night and that we need to really take a look at and address quickly because it's a threat to a patient or a team member? And always, you know, keep in mind you never know what you're going to hear. But what you do know for sure is that the better you listen the more likely you are to be viewed as a genuine leader and provide sympathy and empathy and appreciation which will go a long way. Not only to giving but also receiving grace in those situations where no one is perfect but we're all on the same team and there is great appreciation for the genuineness that leaders who round well and frequently have among their teams. So there is also this, you know, really simple thing that we learned as kids. And that was to say "thank you". And sometimes we get away from that. At some point we sort of guess off the bus. Maybe it's middle school. I don't know where it really is but it happens in life where we kind of lose our appreciation for the simple things. When we recognize each other frequently and appreciate each other, it gives us sort of, you know, a number of links into good, high reliability behavior. First of all, we get back to that 5 to 1 or 3 to 1. We appreciate. We provide positives to the people who are doing what they do all the day all the time. And sometimes get less than appreciative feedback for it because it's just what we do. But if you think about it in the terms if we all stopped doing what we just do everyday, it would break. Everything would stop. We would break. All of a sudden the supply chain didn't deliver products to us so we couldn't provide the care that we did because that we do because we don't have PPE or there is not something in the OR theatre that we need or there is no more oxygen in the tanks. If that just stopped, we would be in trouble, so appreciation for doing what we do everyday, very important. And we're not just thinking about sometimes these heroic actions. The heros are those who do what they do everyday in a reliable way to keep the ship going. And that appreciation is very valuable. Always an opportunity to have some physical appreciation activity, whether that's a board and I'm not talking about having, you know, parades and balloons. But just the smallest thank you or a quick note left in a locker goes a long way to express our gratefulness for our teammates and being part of their team as well. So a couple of additional evidence based activities to improve resilience and joy in work. And there is a lot of research on this. Caring for the caregiver is a program, Massachusetts program, that focuses on gratitude and well being. Hero health is and there are 118 of those throughout the world. You know, and there are things that you definitely need to ensure that how we take care of each other and ourselves. You got to get good sleep, exercise, rest, time away. The mental health of for us as individuals is very important in order to have that fuel that we need. So we need to get past the potential stigma of saying, hey, you know, I may need a little bit of help. I may need to speak to somebody who can help me be a better me. There is nothing wrong with that. That's a healthy activity and show case the work and attitudes of people who we want to model or be the model. So have that positive attitude during the toughest times goes a long way and that becomes contagious. Contagious over time. So the meaning and the purpose of our positive behavior leads to positive emotions, and that leads to being able to recharge that emotional thriving or emotional recovery reservoir of fuel that we have. And we can be we can get good at giving feedback and giving positive responses but we have to be good receivers of it too. Humility is sometimes, you know, overplayed but I think it's also it's hard for some people to appreciate being appreciated. And you have to understand that there are people who find that a little uncomfortable, so it goes back to: do you know your team? If you know your team, you know those who enjoy receiving that public recognition. But there are a number of people that throughout my career and many many more than I anticipated who have that sort of stand backness to them. And the little walking down the hall and a little nudge on the elbow says, hey, I'm really proud of you. It goes so much further than them than that public kind of situation that we sometimes turn to. So I think it's really important to think about burnout not as a condition, but as a process. Because burnout doesn't just happen. You don't get burnout dropped into burnout. It's a process, and the more that we potentially simplify it, we may put ourselves in a bit of risk to not appreciate all of the inputs. And Jeff's going to talk a little bit about some things that we can do to mitigate some of the realities that we experience in the process of burnout. Jeff: Thanks, Todd. So, yeah. What is a couple of the simplest, most effective things that we can do right now if we're feeling burned out? What do you do for yourself to bounce back from the day and be ready for tomorrow? To emotionally thrive and practice emotional recovery, we rest, we sleep, we might meditate, we might exercise, practice our faith. These are all examples of things that we do for ourselves. And on the next slide that Todd's got up for us, there is a very clear and simple individual activity that we can do. So let me just kind of walk you through that. And I do this myself quite often. Every night before I go to bed, I sit down and I reflect on my day. I think of not all of the bad thing that happened but three things that went well for me during that day. And I write them down. And then I go back and reflect on each of these. And three of the vital steps in this are writing it down. It's vital. It really helps you to focus on the event in a structured way when you write things down. When you really reflect back on what I did and it's essentially that it adds a sense of perceived control and well being to me. There were things that were off my control but I can think about these things in a way that gives me control. And then the timing is very significant for me. I try to do this everyday, but if you're just getting into it, think about trying to do it once a week for six weeks. This is really a way to train ourselves to see the positive by calling out the good things that happened in the day. The next slide builds on that. So whatever we use our brains for, we get better at. If we worry a lot, if we ruminate and we're upset and we're angry, we get better at being angry and it worrying. We train our brain. So the science of neuroplasticity tells us that we have to retrain our brains. I really like the next slide. If you practice complaining, you will get better at complaining. You practice gratitude, you will become more grateful. There is a scientific study that just simply supports what I just proposed to you. I won't begin to try to walk you through this is actually the research or this article. It is hard to read but the last line says to us that results suggest that conscious focus on blessings or on positive things do have positive emotional and personal benefits for us. Todd: Jeff, if I could throw in something here? Jeff: Yeah. Todd: And I think there is a there is always a little skepticism about the you know, this feels soft. You know people will say, well, you know, that's nice but the reality is that when you take the time to do whether it's three good things or something very similar and you practice it. On the days that you struggle, so long as you write it somewhere electronically or old school, you have a diary. You know, you have in your hands, all of the good things that have happened to you. So appreciation for the good things that have happened to you in a fashion or manner that you can actually put your hands on has a tremendous amount of emotional and interpersonal benefit because you we often forget about the good things because we have trained ourselves to focus in this negative or less than desirable phase. Which I think gets to exactly the content of this particular study which launched, by the way, a whole bunch of work that we benefit from today in looking at burnout. Jeff: Yeah. Thanks for bringing those points out, Todd. Sometimes the stuff does feel kind of soft and it's easily overlooked. But to understand the benefits, they really magnify themselves. This exercise is similar to the other one. I would encourage you to make a weekly practice of just expressing gratitude in a way. If I were to write Todd a note to basically just tell him I'm grateful for how you, you know, jumped in and brought forward these points. It positions me to think positively, to share my feelings. But for the receiver of it, there is equal benefits to it. You know, once measured and understood, we're also better prepared to approach the issue of burnout in a meaningful way. Todd's going to talk just a little bit more about how we measure burnout, you know, with a focused approach on specific burnout symptoms. And what you're seeing in your culture, you know, and that's just culture at large. But back to our slides, you know, physicians had a higher burnout rate than nurses. And that can vary from organization to organization. And to really better understand, you know, where you are, and where your organization is, I kind of look at it like trying to fly a plane through the fog and you don't have any instruments. You don't know your altitude, you don't know your speed. You don't know your direction. To have this type of data at your finger tips to make better, informed decisions and to understand, you know, just how far at risk or, you know, how stable your organization is. Todd, I will leave it there. Todd: Absolutely. And I say and, you know, as a leader, I think it's important that we appreciate a couple of things as we you know, as we go down this path. One is that we're not perfect and we do the best that we can, you know, in the moment. And if we're genuine with our team members, they know that. Providing the appreciative opportunities for them to for us to appreciate them is very important as well in making that time as part of our day. To me it's really important. And I actually put time into my day to make sure that I'm capturing that. And the third thing is what we're going to talk about here just briefly. It's how to look at score maybe a little bit differently. Score is a snapshot in time at numerous times. We have trends and we know how data works. But score is not a tool for judgment. It's to create curiosity about what the data might mean. So just to show you a little bit about, you know, how to read some of this and I know you guys have talked about this a bit. But on the left you see the donut diagrams that come from the summary report and you can see there is red in some of the survey items that show opportunity. In the center you have or closer to the center the horizontal graphs. Really look at the variation among particular work settings. And I look at these graphs from a data science perspective and an aero science perspective. But also the visual here is very important. I'm not worried about the red as much as I'm worried about the yellow. Because if I could turn the yellow into green, then that graphic looks much different than it does right now. And that's some of where you, you know, can have some curiosity about what it really means. And in the spider diagram in the right center, what you see: you obviously want to have more green. More dots in the green. But what is important here is to show that your local leadership has the opportunity here and the potential to create continued improvement. And you want to look at that's one of the ways that we definitely want to look into score. And we will just take a little quicker a few tactics. We will take a look at a few tactics on how to address burnout. So you see that you see your data a little bit. And you kind of you know, we get that moment of, oh, I'm overwhelmed. What do I do? We gave you a number of ways to try to mitigate burnout. The ones on the left are most notably successful. Pretty, pretty consistently. And we will just walk through those a little bit. So quiet your or create organizational recharge groups. That's one that a lot of organizations began to develop during COVID. That's a place where you could go and be by yourself. Some folks would actually one organization that we worked with have worked with, people signed up for them and then they needed another room. So they had to create another room, which is a good problem to have. Create environments where you can talk about burnout. Very important to have open forums for that. Appreciate always that we need our fuel literally and you know, as in food emotionally. Make sure we have coverage for breaks and ensure that that occurs. The burnout buddy is a really fascinating one. And that's where you create a pair and you monitor and support each other. The consider a stop doing program is one that takes some courage but it also is something that happened naturally during COVID for us because we stopped doing some things in order to deal with the challenges of the pandemic. Interestingly, I wonder how many organizations will go back to doing those things that weren't so important in the moment and ask themselves the hard question of: should we continue or revive those activities that haven't been important for a period of time? And then, of course, you align with your patient's safety quality and efficiency goals and make sure people are supported in achieving them. On the right, a couple of ideas around rounding. Authentic thank yous for all, of the routine things. Make sure you find them. Put on a different lens, point of view. Find something that a leader can and will do to improve staff wellbeing. It could be the simplest thing like the quiet room or creating, you know, some appreciation and recognition activity where people can begin to refuel, again, in another way that compliments other things they're doing for themselves. And really talking with staff helps them process the tough times and providing them realistic hope for days that they can actually help occur and situations that they can help build as we move forward. So as we wrap up and before just a moment for questions, I want to point out a couple of measurements of burnout in this survey. So these are two questions, events, in this work setting affect the lives of people here in an emotionally unhealthy way. What you see here on the left is this is a burnout climate question. So what you see on the left remember green is good so being out in the red is less desirable. So people in this work setting are frustrated. I asked the question directly. People in this work setting are exhausted. People in this work setting are burned out. This, again, is a burnout climate question. So this is how we perceive the environment around us. It's not how we feel. It's how we see others in our work settings. Of course the example on the right is a much more healthy environment where we would have the scores closer to the green. Burnout's real and it's a process. And there are a number of things that we can do for ourselves but also as leaders to reduce the likelihood that burnout becomes pervasive. And always keep in mind as well that burnout is relative to the individual as he or she experiences it. But it's also very relevant to the work setting, and that can change it will change a little bit more slowly but it works through the same process that the people who are burned out are experiencing. So with that, questions? Jeff, I haven't been able to see the chat so I'm not really sure if there is anything out there that we can address or just in general from the crowd? I'm gonna lean on you to tell me what the format is. Jeff: Yeah. So far we haven't had anything come in through the chat. Victor, you said you can put your hand up or ask for time. We want to have a further discussion. We have just a few minutes left and I'm just gonna go out on a limb and say this topic is one that probably resonates with everyone that's listening to it. You probably either have seen burnout or seen symptoms of burnout in yourself, in your staff. If there is anything we can clarify. If there is any other questions you might have, we're here for you on that. And we're happy to stay. We're happy to stay in silence for a few minutes while you formulate those. But we will draw Vanessa back in to the conversation in preparation to close out this presentation. Vanessa: Yes, thank you Todd and Jeff for your great presentation. And really for highlighting the importance of communication and providing our hospitals some really good tactics to address burnout that they can take back to their facility and implement. I wanted to since we have some hospitals that may not be part of TMF HQIC program that the score survey is an offering for our TMF HQIC participants. And next year in 2022 we will do the second round of score surveys. If your facility did not participate in that this first round, we will have that available in 2022 so that your facility can also get this great information and some of the data that Todd highlighted in the document. Let's see if anyone raised their hand. I want to inform the audience that in order to find the hand feature, just locate your name. To the right of your name there will be a hand icon. Click it, we will find you and unmute the line and bring you into the conversation. Also as requested earlier on, if you would like to type in a question in chat we will certainly receive it there as well. So, please, we encourage you to do that too. Sometimes this is a difficult subject to open up about but it's certainly one that I'm sure resonates with a lot of folks on this call. Vanessa: Absolutely. Thank you, Victor, for the reminders. We're waiting for folks to come on and ask their questions. I do want to just mention that all our resources are available on the TMFnetworks.org which will include this presentation and that will be available for our HQIC participants. And so that will be posted probably in a couple of weeks. We also have other programs going on at TMF under our CM S contracts which include projects for specifically for nursing homes, skilled nursing facilities, patient and family engagement, and quality payment programs. Our featured content today that we want to highlight: we do have several change packages to help with your QI initiative and journey. And today's feature package is our opioid change packet which, again, will help facilities with misuse across their continuum of care. So you can click on that link and that will take you to the change packets that you can use free of charge, of course. If you are not a member of our TMF quality innovation network, we encourage you to join us. Visit TMFnetworks.org, create a free account, and that will give you access to our LAN resource, events, and other materials that we post on the LAN. And then, of course, when we close up the call, you will be redirected to take a satisfaction survey. We please ask you to take that so that we can learn how we can improve our presentations and materials in the future. Let me do one last check. Victor, anything come in? I don't see anything in the chat. I don't see nun. We don't have anyone requesting to be unmuted at this time. If you would like to join the conversation, raise your hand, we will find you, unmute our line, and let you join the conversation. Or use the chat feature and send us your question there. We have a few minutes to let you contemplate what those questions might be. Vanessa: All right. Well Jeff and Todd, thank you so much for your time today. Any last closing thoughts? And then we can close up our call. Jeff: Thank you so much, Vanessa. We appreciate this opportunity. Thank you to everyone on the line. We know that you're going through a lot. We haven't walked a mile in your shoes. I hope that you really consider this content and how you can apply it. I know that there is evidence of burnout in probably every team that we would find across the country in hospitals right now. So it's real and it exists and we would love to be able to help you navigate your way through that. Jeff and Todd, don't disconnect too quickly. We have a question from Sarah. I would like to bring her into the conversation. Let me unmute her line. Sarah, your line's unmuted. Go ahead, please. Sarah, can you hear us? Yes. I can hear you. I was just gonna say I do see some questions in the chat. And one was about: will these slides be available somewhere? And another about ways to recognize and express gratitude to staff during the burnout phase. So I am seeing some questions in the chat. Jeff: Well thank you for bringing that to our attention. I appreciate that Sarah. Sarah is one of our team members as well. I will take the first one, Jeff. As Vanessa mentioned, all of our LAN events are recorded. There will be a copy of the presentation available to you. You will receive a follow up e mail with that information. So look out for that in the next couple of weeks. Jeff: Todd, do you want to take the second question. Todd: Yeah, sure. So if I heard it correctly, what are the things we can do for gratitude? Especially now. So, you know, for leaders, one of the things that we have learned I think and seen very consistently is leaders being present. And being present meaning available, accessible, and the experience has been important. It's a prerequisite then, in some ways. In not all situations is that possible for a variety of reasons. But in many ways that's a prerequisite for providing gratitude. And the presence is actually showing gratitude to begin with. So that's a start. And additionally what I would say is, you know, following up on being following up to being present is being empathetic. Listening and understanding. And also then closing with or closing or opening with depending how you approach it looking for opportunities to make even small changes or adjustments that would be rather significant, you know, even on the smallest scale. But because they were addressed would be greatly appreciated. So the appreciation for providing input, the appreciation for providing, you know, the care that the dedicated teams have been doing now for months on end in situations that and environments that we, you know, rarely would dream of or even imagine. But being present, being empathetic, listening and following through is the greatest act of appreciation that leaders can provide. And never and I would give this: you know, never under appreciate the small things because it's the small things that we all do everyday to keep it rolling. And, Jeff, please, pile on. Jeff: Yeah, completely agree, Todd. Leadership presence during these times is invaluable. Todd: I hope that helped. Vanessa: Thank you both so much. Perfect words to close out our presentation today. Thank you, again, for your time and to everyone that shared some of their time today during our event. Have a great rest of your day everyone. Thank you. Jeff: Thank you. Todd: Thank you. That does conclude our call for today. I appreciate your time. You may now all disconnect.