Burnout

Hello good afternoon and welcome to today's call. My name is Victor Gonzalez. I am a TMF health, quality improvements, and specialist and, uh, I am honored to be your host today before we begin I want to welcome everybody. We, thank you for joining our call today.

If you've had the opportunity to experience one of these presentations, uh, with us in the past, uh, you know, that we cover some housekeeping details. This is a very important topic. You may see some additional, uh, friends colleagues in the audience and that's because we've extended the invitation to other folks within our quality improvement network. Uh, this is a topic that is near and dear to us, and certainly 1 that we wanted to have an opportunity to share across our quality improvement organization.

Today we're going to cover the common reason among health care professionals for medical error which is burn out, even though the title of this call is.

Caregiver wellbeing, uh, we certainly want to talk about this topic as an outcome measure and how is it is a statistically significant predictor of patient harm.

So, we appreciate everything you do, we appreciate the support that you give to your healthcare organization, your colleagues, your patients, everybody within your healthcare system.

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Pleasure to introduce our friends from safe and reliable, uh, sharing their expertise today on this very important topic we're joined by is an, and experienced health care and patient safety expert who's spent her clinical career in pediatrics in the emergency department she spent the last 15 years dedicated to quality and patient safety and held several operational leadership roles where she designed developed and implemented patient safety programs.

Using high reliability concepts for both freestanding and academic children's hospitals in Connecticut in Donna’s most recent role as director of patient's safety and quality for the Connecticut hospital association.

She implemented a large scale state, wide improvement projects in all of acute care hospitals across Connecticut. She received her bachelors of science in nursing at Sacred Heart University, and her masters of science and nursing from Yale University. Currently. She lives in beautiful Sandy hook.

With her family, and she's experiencing some phenomenal weather today she's joined by Dr Don, a physician leader who has focused half of his 40 year career on improving the quality and safety of patient care after medical school in residency.

He was a full time faculty member in internal medicine at University of Texas, Southwestern Medical Center, where he taught students, and residents did basic science research, and implemented a patient centered disease management program for 20,000 patients with asthma.

Seeing both the power and failings of health care led to executive work at the bailer health care system where he developed patient safety program across its 10 hospitals and many outpatient clinics, he developed and published methods to measure patient injury and let other improvements as chief quality officer after leaving executive work Dr Kennedy has spent the last 6 years sharing lessons learned with consulting clients committed to, into delivering care that we all would want for our own family.

Is published 50 papers or book chapters received a variety of national awards and grants and help found 2 patients centered nonprofit organizations. It is a pleasure to have you both on and welcome to today's call. And Dr, Kelly, you're on mute. I do that way more often than I should. Um, thank you for that.

Very nice introduction, Victor and it's really a pleasure to have a chance to, um, to be with you today.

Uh, we are going to be talking about burnout and what we want to do is to also be moving towards the idea of what do we do to promote well, being a year ago.

We spoke about this topic and it was more about understanding causes and its frequency. Um, and now we know more about it and we know more about things to do about it.

So, we're going to be sharing with you some specific evidence based practices. That are ones that, uh, you can do and that are not difficult.

But 1st, what we'll do is the next slide. We'll just recap. What burnout is. It is, it really is the impaired ability to experience positive emotions. We all have a mixture when we're healthy about positive and negative emotions. We can see the good and the bad.

But what happens is that we become so exhausted and discouraged and, uh, and, and sort of withdraw from caring that we really lose our ability to stay connected with those positive emotions next slide.

So, what's the process of a person becoming, uh, burned out again? Uh, the definition is here. That includes emotional exhaustion and de personalization and most much of this work comes from.

Christina. Dr. Christina. Uh, who is a social psychologist? Who's really done some tremendous work as it relates to burn out and, ah, it begins by being.

Frustrated entire, and ultimately that fatigue becomes exhaustion, and as in a protective way, we people begin to not care as much about their work, and they sort of pull back from it. They cut corners. It's not that they intend to, but they're just so tired.

And so, um, wiped out that they just can't do is the kind of job that they'd like to be able to do.

And so they become progressively more ineffective and ultimately, they rather than 1 of the protective mechanisms we all have is, when we get to a spot like that we go into something called the personalization, which means it just doesn't feel like us. We don't see ourselves as actually doing these negative things. What we do is we just too sort of think that that can't we.

Sort of push away that reality if you will. And many of us really have a contributing factor of something called moral distress.

And what that has to do with in the middle of this progression is when you can't deliver the care that, you know, you'd like to be giving because you just simply don't have the energy or the resources to be able to do it.

Remember those times in the beginning of the Pandemic when there wasn't enough around, and it was just incredibly difficult for everyone. So the next slide will begin to.

Touch on the issues of well, let's go to the next 1 after that we're going to talk a little bit about how much it happens and in 2021 just a year ago. 7 out of 10 nurses said that they were burned out and that's so only 3 and 10 felt that they weren't and there is substantial data, and we won't spend a lot of time on this.

And Victor has mentioned it that caregiver burnout leads to. Caregiver burnout leads to sites to mistakes handoffs that don't go. Right.

The assumed kind of mistakes that where you assume someone else is going to do it and they assume you are and there are higher rates of injuries infections, and even patient deaths.

In addition to these professional outcomes of our work, it also affects our personal life and there are much higher rates of depression, divorce and personal injury.

And today, I saw something that said that physicians are beginning to catch up to nurses in terms of the frequency of burnout in the early part of the pandemic.

It wasn't as difficult for physicians, but it's become progressively more. We have a.

A link for you, if you're interested against that, you can go to learn more about this if you're interested.

But clearly bad things happen to people individually and addressing this by moving towards, doing things that promote.

Well, being will improve the outcomes of care as well as the personal outcomes.

Let's go to the next slide picture, so let's take a look at some H, quick data these are data from nearly 5,000 respondents and 25 facilities that participated in the score survey this year.

And you can see, and this is, we're not separating them out into individual hospitals and so what's being shown there is just the aggregate of all of them. So your hospital. Your hospital might look a little better. It might look a little worse but what's notable here is just how.

Incredibly prevalent. This issue is now 1 of the things you see here there are these are horizontal bar graphs and you can it being in.

The green is good and you can see that for example in the top. 1 is the percent positive means.

That's the percentage of respondents who answered disagree or slightly disagree when they were asked events in this work setting.

Affect my life in emotionally unhealthy ways.

Okay, so what we're doing here is it's negatively rewarded. We want people to disagree and that's considered a positive response, but you can see that fully 1 out of 4. People are feeling.

That, in fact, this is a big problem and about 20% are sort of in the middle, uh, on the fence if you will. And so I think the. The tendency here is for a lot of people to be experiencing this and if we were to be asking the questions, and I won't share those with you right now, if you ask these questions in a more global way about asking about their people on the unit the responses are about 10 percentage points worse and the tendency for individuals who respond to this survey is to sort of say, I can tough it out. But boy, my colleagues are getting.

Hammered and so we think it's somewhere probably closer to that number, but you can see that there is a huge number of people who have been really affected by burn out in the last few years.

Now, 1 of the things that's notable here is, you see this column called that's a year over year. And that means that things are appearing to get better in the in the quick group.

Those percentages are 3 to 5%, and those are perhaps not statistically significant, but all 5 of them are heading in the right direction. And so that's promising.

It's also promising that, in fact, the percentile is between the 62nd and 81st percentile, which means it's being managed better or in your hospitals.

And that may well be because many of them are smaller.

It's easier to sense the caring that other people have when people are hurting and in larger hospitals that maybe have a little harder time expressing caring.

People are affected more. So again above the 50th percentile. So that's a good thing.

Okay, let's, uh, let's move on to the next slide.

So, what we're, we're going 1 of the things to think about, is the idea of this, being a process that we want to get into recovery, not just describing the symptoms, not describing how we got there and how bad it is.

But how we're going to be working on recovery and I think it's, I had a total knee replacement about 7 or 8 years ago after my knee just got terrible.

And I had a significant amount of time where I had rehab and in order to get that knee working the way everybody thought it could but it took intentional effort.

So, what we're going to be talking about today and Donna’s going to focus on the specifics are the things that, in effect are involve things you can do for others as well as things you can do for yourself.

And this is really kind of a rehab. Process so I like this quote here that the opposite of depression isn't happiness.

The opposite of depression is hope because the idea is that you want to be able to experience these emotions again. Ah, acts of kindness, gratitude, self-compassion often were our worst critics and humor and hope is incredibly important to that recovery. So, 1 of the things that we want to be doing is to really be emphasizing looking at things in a different way. Next slide.

So, the first thing we want to do is to eliminate contributing factors to burn out.

I don't know how many of, you know, I've heard of will Rogers quote when you're in a hole and burn out is like a whole the 1st thing you do is stop digging.

So, the 1st thing that what we do is try to make sure we're not doing things to make burn out worse for each other, or the people who work for, or with us.

And I think 1 of the things that I've always felt was true is that there wasn't enough. Thank you in healthcare.

Spent time thinking people who did these remarkable things and gave them awards, but everybody who just comes to work every day and does a solid job. Those people deserve. Thank you too.

And that helps them to feel valued in the organization losing voice. That is no longer being able to have input into professional work is a major contributing factor, because it's a loss of control.

So, whatever you can do to restore, or to preserve. Whatever levels of control are possible for people working on the front line is important and I think being feeling a sense of support and their and their work making sure that those of you who are leaders are visible and asking questions. How are you today? You know, what can I do? Those are really important things and when you do that kind of thing, it really creates a buzz around the organization, and for sure. Having the tools that people.

People need to be able to get their get their work done at least adequately again. This isn't about having all the cool bells and whistles, but make sure everybody has what they really need in order to get their basic work done.

Next slide. So, what we're going to do is we're going to be spending some time, um, sharing with you a program that, um, we're very pleased to, uh, to be able to share.

It's a program that Maureen fry who works in. Um, it's safe and reliable Vizient received a grant from Pennsylvania to be working with, uh, long-term. Care facilities to try to be reducing turnover, burn out in enhancing resilience. And she, and a number of others came up with 10 really cool ways that are easy approaches to be able to help with.

Getting people to have that sort of restore there, restore their hope feeling better about themselves being reminded about the good things in life.

Those are really important things. And so you can see on the right is sort of a, a long list of things. That are part of this program we're only going to share a few of those today in partner because we're trying to withhold from you, but what we're trying to.

Trying to do is to sort of help you to focus on a few things to get started. And these are things that we can talk more about another time if you're interested.

So, what we're really hoping is to introduce them in general, and to be able to then talk in more detail about a few of them to get you started and that's what Donna is going to be spending some time on it. And just a few more minutes here. So if we could go to the next line.

So, what kind of things can leaders be doing 1st, is to be getting whichever tools you choose to work in terms of well, being again, this is like, physical therapy, only it has to do with well, being it's not. So, when I spend time working on my knee, I had stretching exercises, I had strengthening exercises, I had balance of exercises, and I didn't try to.

Running or doing really ambitious things I started with small things and ultimately, it all it got better every day slowly and this is what winds up happening here too.

This is sort of therapy, if you will for all of us when we're in a tough spot.

So, again, making sure that the tools are readily available to everyone, they're not things that needs a lot of specific training. So just get them out and get them into the hands of people and to get to know them yourself, you'll see the information in the slides here and there'll be some videos as well. That can take you to more detail.

That will, let's do become even more familiar. With them and probably help you to be a better teacher with those who work with you. And working as a team, um, think about a couple of things 1 is is having a be thinking about this program as being something that is just not a 1 person kind of thing and you can have a resilience or well, being a champion that's worked out. Really well, in some hospitals that have the resources for that, and it's not like they stopped doing other things, but they become just a champion for well.

And encourage people in cheerleading and help to educate along the way, and to have a team of people who then support a champion, or who themselves are championing all of this.

And make it fun if you can, we're going to suggest that you start with something called 3 good things, which is really noticing the positive and donna's going to tell you a little bit more about it. But it's the thing that's been around for a long time and is a very effective approach. And having more gratitude for the things that we do have, when we're having troubles, we often think, look at the cup as being half empty, rather than half full.

And so noticing what is still working, what is good and meaningful in our lives again I'm not trying to be Pollyanna here, trying to pretend the other things aren't there, but just be sure not to miss the things that are still there in our lives.

That are good things and sleep is incredibly important, because it is really without getting adequate sleep. People are just don't get a good. In the day and things go from.

Bad worse so again, there are some other things that are ideas that can help spread within your organizations, or you might want to start in 1 place and then see how that goes and spread it in others for if you're in a larger organization. So, just to be thinking about designating a day, that's a wellness Wednesday.

What are we going to do today to work on wellness? Because we really are we're committed to this so we're going to take some.

Time to be working on this and to have ambassadors or champions, as I mentioned, and they have Tim team meetings that start with the wellbeing tool, you know, something that's gone.

Well, and there are a number of tools that Donna’s going to be sharing in more detail in just a moment. So, uh, next slide please. So this is really again, just to kind of summarize what we're going to be doing here is that it's the goal is to be shifting perspective, you can be looking at the pavement there and not be seen very much but if you miss the crack in the pavement that has a flower in it, which I think is easy to do when, you know, your head is you know, sort of in a different place, you're not prime to be seeing the good things.

The joy, the serenity of just looking at nature, being able to hope and feel proud of what you can accomplish.

Not thinking about what you can't accomplish, but think about what you have accomplished and so really your focus is what you're is really crucial to how you feel about.

And if you spend a little bit more time, and you can do this incrementally, this is not like, just turning on a light switch. This is about a dimmer where you just sort of turn the light up slowly and to be able, then to be able to experience good things more and more because you're noticing them and they tend to be get into a virtuous cycle, rather than the vicious cycle.

That we get into and we're frustrated, angry annoyed at our leaders. Not giving us what we need having other people have never saying, thank you or those sorts of things we want to get into that virtuous cycle of appreciating our colleagues, what they do for us, how they do support us. And the good things that you can do for your colleagues, and that they can do for, you.

Next slide, so we're making them small and not gigantic making them easy. And so what we want everybody to be able to do is to get back to where they were before this sort of rehab, if you will with hope, as a catalyst is going to help people to be able to see the good and the bad across all situations and again, it's not this is not trying to be sort of.

About things, this is about being able to actually be mindful of the good things in life and the bad and being able to handle both because we've gotten to a spot where we're kind of out of the hole.

We're not looking up at that narrow top of the hole, but we've gotten up and now we can see the things that are around us in ways that we really had trouble doing.

So, next slide. So, I'm going to turn this over now to Donna, to be going through some of the specific things done or what else would you like to add about the topics that I've covered so far? You know, Donna, I think you did a really nice job of sort of summarizing and talking sort of contextually about, you know, the idea of caregiver. Well, being the 1 thing I do want to say is I want to validate and acknowledge that it's been a rough. Couple of years, uh, we've all gone through it. I think it was, you know. Uh, really difficult to be a caregiver in the hospital during the, the time of the, you know, really the sort of the, the height of the pandemic.

But I think we also need to sort of acknowledge that, uh, you know, we're kind of in this new norm that we have to get sort of re, adjusted to and that, you know, everybody needs to be kind to themselves. It's, um, you know, I think, as caregivers were really programmed to just give a lot. I mean, that's kind of what.

People are attracted to health care, they want to help others and give a lot and I think we need to acknowledge that in order to do that. You have to have that energy inside yourself. You have to feel good about.

Who you are, and personally, and, um, I think 1 of the things done referenced earlier is really important to acknowledge that these things bleed over into our personal lives and it complicates it makes it harder.

So, we're going to come at this from the point of view of all of you deserving to be good to yourself and re, energizing yourself. So that you can be good to others to your patients to your colleagues to your families, to your friends. And it all starts with sort of re, energizing.

So, Don, if you are all set with your portion, I'm going to go ahead and get started on 3. Good things. Okay. So, can we go to the next slide? Please.

All right, so, as John mentioned earlier, 3, good things is this super simple, uh, strategy that actually really, truly works. It's been sort of scientifically proven that this works.

Um, and it's a thing that we actually use internally at, um, at safe and reliable. And I've used as a strategy when I worked in the hospital as well. Which is really focusing on the positive and these aren't like, these don't have to be like, you know, grant. Giant gestures, like, oh, I'm, you know, I'm grateful for whatever. Some big thing.

This is like, literally looking at your life and your, um, your world and finding 3 good things about it. It helps you really shift your thinking from the negative to the positive. So, um, an example of, um.

An idea about how you would think about things is, I would say that 1 of the 3 good things for me today was, um, that I got to spend a little more time than usual with 1 of my sons who's, um, in college. So just thinking about that and having feeling grateful and feeling positive about that, um, really helps shift my perspective.

And if you do this with practice, it's a little hard at 1st. Like, wake up, and you're like, oh, I don't feel like anything's positive, but you can find small little things like, you know, I'm grateful for, um, you know, taking a nice long hot shower this morning or whatever it is like little things it really starts to shift how you see the world so I'd like you to go to the next slide. Please. And we're going to talk a little bit more about this. All right so noticing the positive.

How do you start? So, you can do it every night before going to bed you can do it. When you wake up, it's sort of how you want to sort of structure it going doing it before bed helps. You reflect on your day, and you think back to 3 things that happened and you write them down.

Literally write them down have a pad of paper. And write them down and you do this, we're going to ask you would ask your teams to commit to doing this. For 15 nights, so just over 2 weeks and, I mean, this may be something that like as a leader you want to try 1st, and then sort of spread that to your team, um, but you're going to actually honestly around day, 4 or 5, you'll start to notice that it becomes easier.

To identify those positives and there is science, science and evidence that shows that once you do it for 15 days.

Um, it'll, it'll last that that positive feeling actually goes well, beyond the 15 days, and there is a video link here that we can put in um.

In the chat that will you can watch sort of the full webinar on it but I want what I want now is for everybody to put in the chat. 1, good thing about today. I want you to reflect right now and add to the chat 1, positive thing about today and I'd like B, to do that and whoever else? Um, on the line I'd like to see, um. List 1, good thing about today that you can reflect on.

Uh, brandy says having enough stuff. That's a positive awesome. What else? Nancy cooler weather. Uh, Maria says that I am alive.

Beautiful Martha has a positive conversation with a patient. Emily is like, having time to visit with staff. Look at all these rolling in you guys are awesome. My grandson’s dogs. These are great connecting with an old friend.

I mean, I've seen fall colors, done. Nice. These are all.

Things that if you do this at tacos me too. I'm actually in a place that has really good talk with right now Christie so I'm crystal. I'm feeling you on that. 1. Um.

These are all things I mean, you guys just filled this chat in a matter of seconds if you can sort of discipline yourself to do this every night choose 3 things.

It's pretty simple that we've got things from everything from word to personal life here. That's the beauty of this. It doesn't cost anything. It's very simple to do. And it really you will be amazed at how this changes. It changes your mindset. Can we go to the next slide? Please.

So, you know, how does this work um, and I think we talked about this a lot.

I talked about it in my opening when you have a prolonged period of, you know, really difficult times to handle, uh, both personal and at work, you know, your brain just gets wired because of the stress to see the negatives and 3 good things is actually literally rewiring how we think how we generate our feelings.

And how, you know, doing this together as a team is 2 fold really is 1, is that it is great for teamwork to share this experience together. But while you're doing it, you're also feeling better about.

Yourself about others um, there's an example over to the right here that just is like, what someone is grateful for. So a central department, um, you know, a full, uh.

Fruits and veggies and the fridge you could see these are all very, like, just simple things. Um, so I would love if everybody on this webinar could commit to doing this for themselves, trying it out. And, um, and really kind of thinking about, would this work with your teams and doing this together with teams? Um, 1 of the things. 1 of the strategies that I used for 3 good things is that when we did our Huddles. I would. Wrap it into a huddle a morning huddle and or shift change or however, you're structured, but to just have your team members each 1 team member volunteer to say, 1, good thing that they were grateful for that day, or from the day before and sort of make it a part of how you start your day and kind of wiring your brains to be like, okay, we're good. We have good things to think about. We have we have a good team here. We were taking care of each other. Um, so that is a very simple strategy that you can use once you sort of.

Make your plan around implementing 3 good things. Um, next slide please. Um, so here's a ways to really kind of dive into this activity again. Timing it, right? If this feels right to you as a strategy for right now we're going to talk about a couple others. But if this 1 feels good to you, um, you know, just make a decision on, you know, on when you're going to implement with your shift, which, uh, which team rather that you're going to implement with, you can use the post it notes on the board. You can do the morning huddles or meetings.

You know, there's, we have videos a very brief. I think it's a 3 minute video. You can share with your staff members.

I'm always asking where the video is up. There. You go B's, right on that. Boy be. You're awesome. Um, you can actually do this at home and I did this with my kids over the pandemic.

Um, we had, um, my husband and I had 3 kids in college at the same time, and they were all home during the pandemic. And, um, you know, it was a stressful time. And so, every night when we sat down at dinner, we did 3 good things. And it and it really works, um. So, you can do this at home you could do it at work. I think it's just a very simple strategy. That's quite effective. Next slide. Please. Um, before we get off of the 3, good things, topic, I want to just ask Don, if he has anything you'd like to add to that segment of the presentation. I think you've done a really nice job and I think it's, it's, um, it may feel a little. Silly for you to, to start with, but if you just decide you're going to do it for again, just. 2 weeks just do it and it's I do it.

I've continued to do it and I do it before I go to sleep because it helps me to get to sleep and, uh, the day is filled with challenges but the day also is full of some pretty wonderful things and people. So, just to.

You know, it just it, it's a great habit. I'm so glad I know about it. Thank you Dan and I just want to point out that you guys who are listening and participated in the chat. Totally. Get it. And you're and the chat. It makes me I'm grateful when I look at that chat and see all the beautiful things. That you guys are able to see that gives me hope, um, something as simple as, you know, walking your dog or looking at a picture of a, a family member. If you can look at that and recognize. The gratitude and not well, you guys are, you guys are in a good spot like you're in, you're really in a good spot to start really doing this work. Um, so I, I love that. Thanks. Thank you. I'm grateful to all of you for doing that.

We're going to now move on to, um, gratitude, um, and we're going to go to the next slide. Please. So, um, I had someone in who I is in my life who's a good friend who's had a really, um.

You know, I would say very difficult time over the last, several years and they said to me, um, gratitude is the purest form of happiness and boy did that. Really speak to me. Um, and I think, uh, when you look at the science of gratitude, its people who express gratitude who can recognize it and express it are generally happier. I think you probably all know someone in your life who's really good at this right? Who can not only experience gratitude?

But express it, and if you look at that 2nd tile, it says feeling gratitude and not expressing it as, like, wrapping a president, not giving it which when you share your gratitude, it, it feels good to you.

And it feels good to the person receiving the gratitude. Um, and it's contagious, it truly is contagious. Um, again, there's another video here that we're going to, um, to share the link with, um. But, you know, as a leader sharing gratitude to your team is critical and this.

Just gratitude of like, hey, you know, thanks for coming today and really showing up here and being positive. That goes a long way with someone who is worked really hard over the past couple of years, or saying, hey, you know,

I really appreciate that when we do huddle you're always 1 of the people that is really engaged and really participates little things like that. It is an expression to your staff that you're paying attention to your team that you're paying attention. It makes people feel.

Good it makes you feel good to express that. Um, so it is a very again simple strategy. Gratitude is easy. It is an easy way to feel good. Um, Don, did you want to add anything. Yeah, I would commend some of these videos are done by Brian Sexton.

Dr. Brian, who is at Hopkins and he is really 1 of the national, if not international experts on a burnout and self-care and resilience. And, uh, and these are, uh, some of them are long, but you can listen to them in little bits and pieces. And, uh, but he is terrific. And he, he really knows this stuff. So I didn't. Encourage you to, uh, take some time to, uh, to watch those yeah, absolutely. I mean, you watch those videos and you feel like you want to hug somebody. That's how good they make you feel. They, they just are. They're just they're really valuable.

And, um, you know, I think our goal today was to sort of get this information out to you as leaders, you know, watch these, um, watch the videos, glean what you can from them share in a way that works for you and your units. Um.

You know, I mean, I had my kids watch the 3 good things video, so you can really use these in many different sort of. Facets of your life, but I think they're really they're wonderful next slide please. So, I think we talked about this already, but, um, you know, gratitude is super important to having a good perspective on life. Um, you know, it helps it helps you rediscover, meaning the meaning in your life, which is, I think something that, when you're burned out is hard to see. Um, and so really feeling gratitude and expressing gratitude is a way of healing and.

Again, I would, I would love for all of you today pick 1 person to express gratitude to and, uh, just try it out. I think it, um, you know, I, I actually would like to express my gratitude to Don, who's been a wonderful partner and mentor and a great person to work with. He's fun.

He's helpful and I just love being in, um, you know, in the same space with him virtually. Um, he's been, um, awesome to work with. That's expressing gratitude. And that's an easy thing to.

Do so I challenge you to do that today with 1 person, whether it's at home, or at work um, again, we have more videos here. Um, 1 of the other sort of exercises is writing a letter, or a note of gratitude, this also can go a long way if if this you feel like this might be something you can do with your team little, just little tiny note cards with hey, you know, I'm grateful for this about you and leaving it for folks. Um, also is a very nice. Personalized touch, um, and a way to really connect with your frontline teams.

Next slide please. So we've talked about, you know. Perspective 3, good things gratitude. And, um, this next piece I think is.

Really important, and very sort of under emphasized in terms of, uh. Wellness, so we're going to talk a little bit about the science of sleep, and I can almost guarantee everybody on this line is probably like, yeah, I don't get enough of it. So, let's go to the next slide and let's talk a little bit about how important sleep is.

So, you know, there's, um, there is science around how important sleep is for your ability to cope and have resilience. And, um, and there's a quote here from Matthew Walker, um, that sleep is the single, most effective thing to reset brain and body health and, uh, you know, to don's point doing that sort of exercise of 3, good things before bed sort of helps reset your brain before you go into rest mode, um, that, you know, brains interpret, prolonged stress and fatigue, which you all have had for.

Couple of years now, um, with releasing hormones that make it more difficult to sleep. So, um, you know, the reason you're not sleeping. And the reason it's hard to fall asleep at night is the reality of sort of. The work that you all are doing, and sort of being able to kind of.

Diminished those feelings when you're trying to rest and get sort of get good sleep is really important in terms of physically, and physiologically being able to sleep in a healthy way. Um, less than 6 hours of sleep. I, I want you guys to put in the chat. How many of you get.

Less than 6 hours of sleep at in general a night. Um, if you can just add there that that, uh, yeah, so, um. Angela saying, yes, Martha says sometimes so it's 1 of those things that I think, uh, lots of us, um, are kind of.

Unfortunately, in the mode of, you know, having this happen and I think it's an important thing to try and shift if possible consistent sleep patterns improves health mood and weight and that is, um, you know, really significant. And I think if you think about how important we, we think about sleep for our kids, when you have little kids, how important it is for them to sleep, it's that is the same for an adult. Really? You know.

Cranky because you haven't slept is going to be very hard to look at your day through positive lens. And again we can see there's a video link here for the science of sleep. I also recommend if you have trouble falling asleep doing the 3 good things using there's tons of apps out there. Now there's the calm app calm and you could actually.

Use that before you go to sleep, there's got all different strategies on there for sleep, whether it's listening to music listening to a bedtime story. They have a really interesting actually stories to listen to looking at, um, thinking about and listening to calming music. There's different things.

You can do I think next slide please, but I think 1 of the things is to really think about how to improve sleep. So, some of the things avoiding caffeine, which is probably. Very hard for a lot of us, but even limiting it to, like, stopping caffeine at a certain point in the day, not using your shoes button. It's a bad idea. And it just prolongs the inevitable of you getting up. Um.

You know, trying to have a healthy diet, not eating close to your sleep time um, having a cool sleep space, um, exercise, of course.

Uh, always helps in sort of, in terms of healthy sleep. And again, it's really the best reset button for overall health. Um, so there are things you can do in terms of sleep. There's a video here that's like. Sleep tips and tricks, which I think you can, um, you know, be will put in there again. Um, but again using this using the idea of healthy sleep as 1 of the ways to reset caregiver. Well, being so picking from the menu that we've done here, um, like, uh.

You know, either, 3 good things, gratitude or improving sleep. We're going to go to the next slide. We'll talk about how some strategies to use that with your team. So, if you feel like, this is the sort of way to go with your team, you want to start with this um, you can do this in a sort of a bite sized activity. Um. Get people to commit to participating in, you know, working on getting their better, healthier sleep. Um, you can. Do this by putting, you know, like, even just tracking people like, how many of you come in in the morning and check a box if you've got more than 6 hours of sleep last night or um, you know, what have you done today to contribute to healthy sleep, um. So, there's things you can do to, uh, there's these videos you can show it meetings if you feel like that would be helpful.

And I think just having a dialogue with your staff about, and your teams about how healthy sleep affects work and home life is also very enlightening. I think people don't really recognize the importance of healthy sleep.

Um, Donna, I think this is the last sign on sleep. Can you just go to the next slide? Please. Yep, so Don, anything on sleep that you want to add. Yeah, I think I think you've done very well on this. Thanks, Donna.

And I, I would only add that, you know, I'm not going to get into the details of it, but there's a growing research that there are certain cells in the brain that literally clean out the debris of the brains hard work during the day.

And they only work when you're sleeping and, uh, there's growing evidence that people are more susceptible to dementia. If they haven't had, uh, enough sleep in a, in the past.

So, if you want to be, not only investing in a better day tomorrow, but investing in better years in the future. This is important. This is like, exercise. You have to make a plan to have that. And I think having a a unit leader, be able to say, well, we're going to talk about sleep on Fridays and we're just going to check in with everybody in a week or 2, and see what people have tried and just to make it intentional. That that. Important for the team members to work on this.

Thank you. All right and then finally we're going to talk about, um, cultivating on and wonder and you can go to the next slide. Please. So, I think 1 of the important things to think about, when you think about. When you think about cultivating well, being and using and wonder as a way to do, that is sort of channel your inner 6 year old. And if you can think about a time, when you were with a 6 year old child, and you are, and they see a caterpillar, and they're just fascinated.

And they want to look at the caterpillar and study it and ask questions about it and admire it. That's and that's how you cultivate on wonder in yourselves, right? Looking. At the world and really just looking at it and being amazed and being, um. Just, uh, you know, wondrous about how beautiful the sunset looks or, you know, how great you've been waiting for this flower to bloom in your garden. It finally bloomed and how beautiful it is those way the way that law and wonder. Work is it really gives you such a positive perspective on the moment. It, it dampens negative emotions. Um, it resets you to make you just feel better. Um. And I think again, if we can put some, like, if you can in the chat, put a time that you felt that you can identify a time in the last week or 2 that you felt or wonder in the chat I think I I believe you guys can do this because you did the 3 good things so great. And so quickly let's add to the chat and the last couple of weeks. Can you reflect on a time when you felt or wonder? And I'm going to say that.

Uh, the sunset last night. Beautiful. Uh, that's so beautiful. Seeing a child enjoy the sun in their face. The waterfalls in Norway. Beautiful. Drinking coffee on my porch. Oh, I love that though. See you guys are you guys are really? I'm actually in the state right now that has a lot of desert and, um, the desert night. Sky is amazing.

And I live in Connecticut, so I have a canopy over me of trees all the time. And to to see this the night sky sort of uncovered by, like, pollution. And the amount of stars was just amazing for me. Um, I'm seeing a blue heron, Don, I have a blue heron in my backyard that has a nasty. I love it. I love seeing the blue herons. Um, cooler evening walks. Uh, I mean, these are beautiful yoga on a mountain Emily. Wow. You got some. Good stuff going on for you. That's awesome. So, just reflecting on this. I mean, I feel better now just reading the things that you all wrote and how like, you know, appreciative and wondrous. You could be about beautiful, simple things in the world and that. Definitely. Resets how we see everything right?

And, um, you know, even just taping a little picture of some of those things that you talked about, are writing a little note to yourself and sticking it on your computer. You know.

You have a bad day, like, glancing at that is going to make you maybe take you back to that moment and we'll really reset how you're feeling about things next slide. Please. Um, so, you know, again, we're kind of really trying to, uh, you know. Sort of emphasize the fact that when you feel burned out, you're stuck in the negative looking, like, intentionally looking for and wonder really depends those negative emotions and, and really very quickly flips them to positive emotions.

So, there's an odd tool that's here that you're going to get and I would like you all to commit to trying that go on and all walk. It sounds like you all have some.

Really butterflies migrating. How beautiful Martha. Um, so I think you all are really can under understand conceptually what you need to do.

It's the discipline of making yourself do this every day, or, uh, you know, at least a couple times a week. Um, making yourself really in the Headspace of.

Cultivating on, and wonder will really contribute to your outlook on life to your mood to how you are as a leader to the people around you again. This is another activity you can do with your team.

Can we go to the next slide? Um, so as we talked about the destination here is restoring resilience right? Feeling good about life every day understanding there are challenges, but really being resilient to those challenges and really being able to thrive emotionally.

And, um, if you look at these 2 columns, emotional, thriving and emotional recovery, and if you're reading through that emotional, thriving column, and you don't feel any of those things.

Then you're suffering from burnout, um, if you feel maybe some of those things, but not all of them or some of them sometimes and not all the time. Then you have an element of burn out and it would be. Really great to use these strategies to sort of move yourself out of that, um, out of that feeling, and into, uh, a healthier emotional state. Um, these are things you can work with your teams. Um, really I, I think those of you who participated in the score survey um, these are some of the, the topics that are covered in this core survey around emotional, thriving and emotional recovery. Um, and I think if you can get to a place of emotional, thriving, you'll see.

That things and that emotional recovery column happen very readily. So, if you feel like you're emotionally thriving, you can recover after difficulties pretty quickly. You can adapt to events in your life that you don't have control over.

But, no, you just need to kind of deal with. You can have a mood that reliably recovers. You can regain that positive outlook despite maybe a really bad day at work. So these are things that I think if you kind of focus on sort of where you're at, and where you want to.

Get to, um, that's on this slide here. That's where these 2 columns are all about. Next slide. Please.

So, um, I think if we look at next steps, Don, please feel free to interject here at any point.

I think you can, uh, it would be great for all of you to look at the 3 things we covered today the 3 strategies, and make a decision on, um, which 1 would work best for your team.

Um, I would say, you know, if you kind of have an opportunity to look at any of the videos, look re, look at the slides that we talked about today and think about which 1 would fit best for where you are. Um. Start with just 1 create some really excitement and buzz about it. It may be because you've already tried it, you can kind of share your success story. Um, but I think doing something is going to help, um, these are all, uh, things that you can do with 0 budget. Um, you can use in your personal life as well as your work life and, um.

I think that, you know, I would say, just pick 1 right now, and kind of really put all your energy into 1 and, um, you know, I would love if you could share back with your team at TMF.

Um, if any of these strategies are working and maybe share best practices, um, with your colleagues, if there's a venue to do that, um, that that would be great, um, done any, any last thoughts here because I think we're wrapping up for at 258. Yeah, no, I think I just wish everybody good luck.

Um, and I think this is really more about getting started the amount of work in this you've heard what these things are they're not complicated, but just choosing 1 and having, you know.

Trying to have enough energy just to do 1 regularly for a while, and then you'll have more energy. And so it's getting started is the most important part of this.

Thank you, I just want to say, thank you to everybody for your participation in this today and, um, for being here, this is like, step 1 for feeling like you want to work on it.

Um, and I know you guys can do it, your caregivers, your, um, you know, your your healers and I just want you to really take the time to sort of.

You know, be introspective focus a little bit about a little bit on yourself and I'm getting yourself going on some of these and then think about how you want to sort of implement this with your team. So, thank you. Everybody. This was a really great session and I'm grateful for all of you. So thank you.

And Victor, you want to finish up? Yes, thank you. Dr. and Donna for providing such wonderful insight. Unfortunately, each hour only has 60 minutes.

Uh, we, uh, or else, we'd have you for a little bit longer and we might get more sleep, but you've provided some, uh, additional techniques on how we might be able to accomplish that.

Some great insight and a lot of information here around, um, the wellbeing of the caregivers. So hopefully take, uh, some of this away from me today.

And utilize it in your space. We thank you for dropping in. We will send you a follow up as you disconnect from today's call. You'll be redirected to take a brief survey. We do appreciate you joining us and look forward to hosting you next time.

That does conclude our call for today and we wish you a wonderful week and we look forward to visiting with you again very soon.