Episode Transcript
[00:00:02] Speaker A: Welcome to PG Pulse Press, Ganey's podcast on all things healthcare, tech and human experience.
[00:00:08] Speaker B: In this podcast, we'll be joined by.
[00:00:10] Speaker A: Some of the best and brightest minds.
[00:00:12] Speaker B: In the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
Good afternoon. I'm here with Jeremy Siegel. Welcome.
[00:00:27] Speaker A: Hi, Pat.
[00:00:28] Speaker B: Good to have you here. Let's start off. You have a very unique background. We've talked about it in other venues. Tell us about your background and how you ended up in healthcare in New York health and hospitals.
[00:00:41] Speaker A: Well, my mother was a nurse, so growing up, always heard about healthcare. My father was a master's in biology, is a veteran. I did a lot around the healthcare landscape as well. So I always felt it was very organic to how I grew up and the value system that was created in my home life. But it's a very nonlinear experience, if you will, to how I came to be who I am personally and professionally today. But I do believe it is a culmination of all my prior jobs or industries, if you will. So I do have a background in fine arts and drama therapy, but I think my finest art was struggling as an actor in New York City, working in food and beverage and bartending for many years to put myself through school. But it actually started with retail management. So I was a general manager of a music store when we had CDs.
[00:01:26] Speaker B: And we're going to get that H pinned down here pretty soon.
[00:01:28] Speaker A: Yeah, it's happening. They're pinning it as we speak. So there were cassettes still as well. So retail management into food and beverage while I was taking acting gigs here and there. But it was really by serving others, both in food and in retail services, that I learned how to humble myself and to really look at other people's needs and what they were seeking and how to deliver those services. And then obviously as an actor, to be able to empathize and literally put on someone else's shoes or walk in their existence and see the world through their eyes. As an actor, that really helped me understand that empathy is actually the best asset anyone can have, both personally and professionally. And then finally I said, I have to go back to school. I need to make sure that I'm practicing to the top of what ethics would say I need to know, morally speaking. And so I ended up going to the New School University. I got into NYU's grad program for drama therapy because I found my passion, which was creative arts therapies. And the minute I found my Passion. That's when the world really opened up for me. And then from there, it really just continued to cascade. I definitely have had to not kick doors down, but kick them open or crack them a little bit. But people have really been willing to open it along the way.
[00:02:39] Speaker B: This is more of a tell me about the journey you were on today and embracing that. It is a journey and there was not, you weren't bad at any period in time, or maybe you weren't as good as you thought at any period of time. Tell me how you convey that to an organization as large as the one you're working out right now.
[00:02:57] Speaker A: Well, one thing that I've learned throughout my adult and maturing life is that everything's complex. Everything's really layered and at times very complicated. You know, when I think about a staff member that might be acting out or playing the role of a victim or playing the role of the assertive one, and it's not playing out well or healthily with a clinical or non clinical team, we automatically say, oh, that's a bad employee, or oh, we know that one. But if you start to really look into the lived experience of that employee and try to ask true questions about what their challenges are, what their adversities are, how to give constructive and productive feedback that doesn't feel critical but helps the individual feel invested in and allows them to realize that they too are good somewhere. And even within some of those problematic behaviors, there is gusto, there's want and will to make a difference or to create comfort or to do a workaround or something of that nature. So nothing is all just one thing. It's how do you look at what is in front of us in action, in thought, in feeling and behavior and say, how do we take that? How do we mold it? How do we nurture it to help it grow into something greater than itself so that a difference can be made?
[00:04:13] Speaker B: So you go back and you get your degree and you find that you are a student, you just needed to find your passion and then you get your degree. How do you end up in a health system? And I do want you to go back a little bit to you mentioned your mom's a nurse. And I've always admired nursing. I'm humbled by the work they do. I think it has such a tremendous impact when you live and are around them to see really the heart that they bring to work every day. Tell me what impact that had on you. Did it tie you back into health systems when you got your degree?
[00:04:51] Speaker A: Well, first and foremost, to all my nursing friends and family, you are the backbone of all health systems. You could not have healthcare delivery without the nursing disciplines. My mom inspired me to be a healthcare worker. I heard all of her stories. She was an OBGYN nurse, inpatient in ambulatory care for 36 years. So of course that really inspired me. I loved hearing about how she was helping others, you know, living and working around Connecticut. Every time we'd go out to dinner, a patient would always stop her. I felt like she was the mayor at one point in time and it was just, thank you so much for making me feel comfortable during illness or injury or a life scare or crisis. So watching that happen so often growing up, I was like, I want to be that. I want to do that. And also I need that. And if I could inspire others to actually do the exact same thing through my modeling and if I get to actually apply myself to do something very similar for someone else, that to me was going to be very fulfilling.
[00:05:48] Speaker B: A lot of people would say that you can't get something done in a public health system the way you have. And fast forward to today. You're one of the few health systems in the country that has gone and looked at behavioral health and behavioral wellness and instituted a program. So take us through that journey from your first unit where obviously you got results because you don't continue to progress without results. And today where you are and how you've gotten there.
[00:06:18] Speaker A: Yeah. So ultimately, well, when I think about results. Right. Everything is a journey. You used the word earlier. Right. It's not about the destination, it's not about always the outcomes, it's about the process. Because the thing I've learned about healthcare is it's always about iterative improvement over time and the fluidity and flexibility that's necessary. So you spoke about NYC Health and hospitals, the largest municipal public healthcare delivery system in the nation. The largest safety net hospital system. So yes, we are at times resource limited or resource poor. But one thing we are very rich in is mission driven individuals. And if people are really willing to look at their own backyard, to plant seeds and water them and to really want to apply themselves, this is a rich foreground to allow people to really flex and to support our system because we need it.
[00:07:00] Speaker B: Talk about how you really brought your program to light in the organization.
[00:07:05] Speaker A: The thing that I think has worked really well for N was healthy health and hospitals and anyone that is willing to create purpose and meaning around themselves, their teams, and the opportunities that the system will actually hold and become a container for because we really do believe in our staff. We believe that our staff have the ability to encounter their own environments, to empower themselves, to speak up and to take charge. Everyone's a situational leader and I've seen that with my own two eyes and I'm an example of that. I did not have the background that most people have even as a Chief Wellness Officer. But with that said, if you are willing to speak up and make a difference and bring people together and be a conduit for cohesive group think and to really back the value system and the mission of NYC health and hospitals, you can really take anything off here. You know, we have a beautiful quality improvement infrastructure here that is frontline. Not just clinician, but ancillary operational support leader, manager driven in terms of how to improve what's happening and needs to happen in order for us to remain relevant in this healthcare field, to have that market share. Because the truth is we are dealing with very challenging, complex populations with lots of comorbidities. But our patient populations do have choice more than people realize. So we need to make sure that we are giving high quality, optimal, safe care. And the only way we can do it is empowering those that are doing the work to improve the work and to see how their passions can align to it and that they can actually make a difference not only in the life of a patient, their family members, the community that surrounds that site or service line, but even within themselves to know that they did a good job that day and did something that was meaningful to them in terms of their own life purpose.
[00:08:47] Speaker B: Yeah. You know, I'm sitting here thinking that I watch you in my office daily, being my life coach, I'm inspired by what you're saying. So if I were to. As we look at the viewer and they're watching this and they're thinking, you know, how do I take that energy and how do I bring it into my organization? What's the first step?
[00:09:06] Speaker A: I didn't make up this word, it's become much more popularized over the last few years, is just do your part to enhance psychological safety. The more that we can allow people to show up as their fullest, authentic self, to feel embraced from a diversity, equity and inclusion standpoint, but that they belong at a table to have and share their voice. The more that we will start to feel that things can be psychologically safe, to speak up when we see something, to say something without punitive measure or without it coming back to bite us in the butt, and so the more you can nurture that or foster that or build it even if it doesn't exist by modeling kind behaviors, generosity of spirit, dignity, integrity, follow through and accountability. The more that people truly create something that leaves the team better than when they found it. It is hard to be a human being right now, but it is hard to be a healthcare worker. And the more that we can embrace each other and support each other and model compassion and that if there is an error that the mistake is not going to be a scarlet letter, that we can come together as a team and problem solve together where we can remove blame and shame and actually say let's come together on the common goals here to make a difference. Then all of the malarkey, all of the politics and bureaucracy will one day melt away and shut away because we come back to what is the most important thing in healthcare, which is humanity and humility and just that humanness that I think we've forgotten over time.
[00:10:33] Speaker B: Talk about just the way in which you've taken this work and evangelically spread it throughout your organization and where you are today.
[00:10:43] Speaker A: So you know, for me it's about the platinum rule, right? Treat others the way that you want to be treated. It starts there. And to realize that that is not just something that's, you know, amorphous, it is something that you can actually strategically and systematically approach to create infrastructure around. The more people feel taken care of, the more that they're going to be willing to take care of another their team, the system at large. So helping Healer Seal, which is the brand name also known as H3 for our now holistic, proactive and preventative wellbeing program.
It's meant to ensure that our staff feel that they are at the center of all of what we do. We've put our people first. Ultimately, because I was already doing change management and transformational culture change through performance improvement, because I am a licensed behavioral health worker and because I like working with people, I was tapped to help spearhead this this program. At first it was meant to be more of a small scale. Second victim response initiative based on Dr. Susan Scott's 4U team. It was a three tiered approach to how can we build up peer modeling. The first is the groundswell of helping people understand that we as healthcare workers, clinicians and non clinicians, we're not robots. We are susceptible to all things, just like any population that we serve. Although people like to call superheroes since the onset of COVID we are humans and yes, we are heroes at times, we are human beings and we are fallible and Ultimately, how can we start to normalize that we too can have a tough day, that we too have those vulnerabilities and susceptibilities, and that we need help as well. And so how can you destigmatize that and encourage it and take the blame and shame game off of it so that it doesn't feel like it's coming back to bite you in the butt in terms of performance evaluations, in terms of court of public opinion, in terms of are you fit for duty or service. So building that up, normalizing it through action and behavior and communication and encouragement, second layer is really teaching people true concrete empathy skill building techniques so that they can actively listen to one another and to actually have a conversation. We practice this in our daily life, everywhere that we go. But somehow we come to work and we just direct it toward patients and their visitors, but we're not directing it to our peers and our colleagues. Where did we lose the art of that? And then the third tier, if you will, is an expedited internal and external referral network to say, well, if you need a heightened level of support, just outside of a compassionate collegial conversation between caregivers, how do we make sure that maybe we connect you to a risk manager or chaplaincy services or pastoral care or an employee assistance program? You know, I'm a licensed psychotherapist. I'm the first thing. Not everyone needs psychotherapy. We have to define what wellbeing is for us, what what wellness needs there are that I can fulfill with myself. But we may not all need therapy, but we all may need support one day. And so that's what really gave birth to it. The model really changed after the first year and change we started to really see that our peer to peer debriefs an emotional psychological encounter between colleagues that's non clinical. Actually a lot of it had nothing to do with patient delivery or the care that we were trying to deliver to others. It was more about what's going on in the world around us. This can't just be about when we're in the red zone of stress and things are boiling over. This has to be about proactive approaches and that health and wellness and maintenance of our own well being isn't just about crisis or trauma. It has to be about how do I get in front of it and stay good and not only be good, but be great one day. Not just to live in survival because we don't provide our best care and survival. It's when we're thriving that we Provide the best care. So what would it take for us to change? And so we expanded the model to now be about just general, everyday, biopsychosocial, spiritual stressors, what's happening around the environment. With us, we were no longer splitting ourselves from who we are personally, from who we are professionally, because we're one unit. You know, you and I talked about the roles that we play. I can play the role of executive, I can play the role of chief officer, but I can also play the role of brother and son. And all of those things come into who I am as a workforce, family member and individual. And so our model continued to expand. We aligned to the eight dimensions of well being, which I mentioned briefly before. So emotional, environmental, intellectual, financial, occupational, physiological, social and spiritual wellness programming. So that there was choice that we could push out to the system, but also have staff pull towards themselves in a confidential setting that allowed them to have anonymity if they needed it. But most importantly, for us to start saying wellness is okay, it's okay to not be okay, but it's not okay to not be okay alone. And the more that we could practice that together and preach it, the more that we showed it and modeled it, the more the staff were willing to utilize it. And we have some really incredible outcomes because of it. And it took a lot of time.
[00:15:38] Speaker B: I want to come to those, but I want to pause for a second on burnout. I just literally came from another health system where they were talking about burnout. And the physician who was talking is a senior executive, longtime executive, said, you know, I never believed in burnout, but the reality is it's there and it's real. And my clinicians and really the workforce, we talked about the security force in the health system, which is at the front line, standing at the front doors, maybe sometimes receiving some of the more challenging patients and what's happening there and the turnover there. And so as you think about that organization and programs around reinvigorating the heart of what these clinicians do, what specifically would you say to organizations if you were traveling with me over there later today? What advice would you give them? Because everyone's trying to get to the bottom of this thing called burnout.
[00:16:40] Speaker A: When you pareto out all the reasons why people leave healthcare, it's because the stressors are linked to burnout, which is acting as a veil for them to really be able to remember why they fell in love with healthcare in the first place, why healthcare chose them or they chose it and continue to do so. Why to have those intentions to Stay working for an organization. It's burnout that acts as that lead box where you can't see in or out that gets in the way of reminding them why the stress is even worth it. To not be able to see the intrinsic and extrinsic rewards that we have each and every single day to make a difference in the life of someone like you or I, someone that has walked in similar life path as myself, to be able to care for those individuals, our own stress, our own burnout begins to isolate us and we just get further into that, you know, blinding tunnel vision viewpoint that ultimately one day takes us out of being able to have the legacy or the legend that we can parlay into any organization. My advice to healthcare organizations is especially if people really don't believe in wellness, which by the way, that exists in every healthcare organization. You might have someone that comes from a specific culture that doesn't even believe in mental health. So there has to be an equity lens even in the discussion at start about wellness and engagement with others, but first to really ask the questions, to help them look in the mirror themselves. So we have to really start taking a look at wellness as an operational imperative to keep our doors open and lights on and patients cared for. Because if we don't see this as a quality metric, as an operational metric that needs to be strategically and systematically approached, then we're going to be in danger in the next nine, 10 years.
[00:18:22] Speaker B: So you talk a great deal about safety in organizations, and it's far more than just physical safety. And we think about it at Press Ganey is that if you do not feel safe at work, both physically and psychologically, then you cannot deliver or you cannot be engaged in the way in that you would want to be engaged at work. And therefore you cannot deliver the care, experience and quality that you would hope to deliver. And so talk a little bit about safety, the role it has and how you address it at New York health and hospitals and think about it.
[00:18:56] Speaker A: First and foremost, I just want to say I appreciate what you just stated, because a lot of times people think that when we're talking about safety, that it's just physical safety. And while that is of the utmost importance, we have to remember that the holistic experience of the staff is not just physical safety. It's about social safety and the belongingness that fits into that. It's about spiritual safety and intellectual psychological safety and even at times financial safety. You know, we have a lot of healthcare workers across the United States and even in New York City that are living below the poverty line. And so we have to be thinking about safety more holistically and to be able to specifically target interventions and programs or projects to enable our staff to feel more seen and heard and respected, honored and celebrated for who they are and what their lived experiences are. And how we've done that at NYC Health and Hospitals is a multitude of different initiatives, all under the umbrella of Workforce Wellness, again known as helping healers heal H3. So I already spoke about debriefs, individualized and group debriefs, not just about sentinel events or adverse patient outcomes or events, not just about second victimization. But you know, when Roe versus Wade was overturned, whatever side of the aisle you're on in viewpoints or politics, how is that impacting you? Especially if you were working on a labor and delivery unit or in a prenatal service area or women's health ambulatory medical practice? What happened when George Floyd was murdered and the many other countless black and brown unarmed folk that continue to see murder day in and day out on social media outlets, in the news, in written form? How do we make sure that what's happening economically, globally, with unrest and wars, how do we make sure that we create spaces that are safe and facilitated and that allow people to not prove someone else wrong or to be shut down, but to feel as though that their voice is encouraged to be heard, but ultimately to come together about our commonalities and the universal truths of who we are as human beings, that we all deserve to be cared for. And that's our mission here at NWASE Health and Hospitals. Outside of debriefs, we have wellness events. Since 2020 to current date, we're almost over 6,000 wellness events. And wellness events are not just diversional ice cream socials or, you know, acknowledgement or honorary days in terms of like international Women's Day celebration. Our wellness events are focusing on what we are learning from staff's input, crowdsourcing, the sharing of ideas, looking at the trends, the experiences of their service area and setting, to be able to tie it together in psychoeducational or psychodynamic approaches for them to process their own experience. One thing that I, as a creative arts therapist, again licensed psychotherapist using creative mediums, is how can you use the healing powers and effect of art? Because when you're creating, you're not destroying. And when you are using art to express, it doesn't always have to be through word. It can be what we call aesthetically distanced or socially distanced in a way that Feels safe to them. So how do you use art practices? So many licensed creative arts therapists, expressive arts therapists, allied professionals like arts and medicine practitioners are all using their skill sets to create these events, to allow staff to come together, to create something together individually to then process and hold on to and allow that process to live on its own as part of their well being journey. In addition to wellness events, we have proactive unit or team based wellness rounds. So during the peak of the pandemic, yes, we opened over 31 wellness rooms. We now as of last week have 20 permanent wellness rooms co designed by employees. The colors they wanted, the naturescapes that they wanted, how to utilize that space. So very proud of NY south and hospitals for using space which is a commodity these days, but capital space that ultimately one day could have been transformed for patient care delivery. To say no. The message is the staff have a place to go and it is solely for them. It is our commitment to workforce well being and helping healers heal programming. But at the peak of the pandemic, we were opening up wellness areas anywhere that we could. Sometimes it was a nook and cranny, but ultimately we realized that people couldn't come off the floors to go to those spaces where we were outfitting them with peer support champions or people that were doing those debriefs as I was talking about. So we were like, let's go to them. So we've always heard about leader rounding or patient rounding. We're actually doing some other kind of rounding now which is called kindness rounding, which I can talk about at a later time. But ultimately wellness rounding is the litmus test of how is the area feeling, how do we take the temperature check, how do we check in with each individual? And again, this could be in health information management, it food and nutrition, our environmental service workers. So it doesn't have to live in a physical area or you go to an ICU and you plant yourself on the unit itself ultimately to connect with staff. And what's really special about that is it begins to normalize their experience. Because the two biggest barriers to wellbeing and the willingness to engage or to utilize wellness services, number one is stigmatization, socialized, systemic or individualized stigma. Saying that it's not safe to utilize services, whether that's within themselves, that the narrative and the personal dialogue that they have kept throughout their entire lives. Because let's be honest, healthcare workers are usually the hardest people to treat or to support, no matter what discipline or department or walk of life. Something about the helping Humanities. We want to help others, but let's not help ourselves. Right?
[00:24:17] Speaker B: I come from the generation of stiff upper limbs.
[00:24:19] Speaker A: You know what? Yes. Let's be stoic, Everything's okay. With that said, it was our ability to say it's okay to use the services. So that's the number one thing. Stigma as the barrier. The second is access. So the more we were going out into their own areas.
Wow. I could teach you about all the multitude of free or subsidized services that are available to you not only as part of your benefits package, but what we've built organically at your own site or service line or facility or at the system at large. We have a lot of community partners we've really brought in. We're doing pet therapy for our staff, not just our patients. Now we're doing aromatherapy. We're working with Swedish massage institutes. So everyone needs those direct client or clinic hours. Right. To touch someone else. So it's, how can you partner with others to really bring it in. So even as a safety and hospital system, and I have a zero dollar operating budget, everything that I've been able to accomplish has been through innovation, ingenuity, the buy in and support of our executive leadership team, our C suites at the sites and service line level, but the staff themselves, that's an important point.
[00:25:26] Speaker B: So you're managing this process through influence and having others see the impact. And it's almost viral within the organization because you do not have the dollars. So you're using other people's budgets to get this done and they're willing to spend money to do that. So the value is being realized across the organization.
[00:25:47] Speaker A: Well, I think at this point in time we were talking about advice you would give to other healthcare executives or other systems. It's, let's not see wellness as something else to do or in addition to wellness has to be part of the way that we work. Just like quality improvement many years ago, before we saw chief quality officers take off across the nation, which wasn't a role, you know, six, seven, eight years ago. It's part of the work. It has to be seen as operational standards. And so wellness should be part of the budget. And again, we don't have very big budgets. But what we've been able to do is to really tap into just human connection. You know, we talked before about listening and how the art of that has really died down, if you will. We no longer ask people a question to hear the answer. But the truth is, is that listening is asking someone to actually want to Hear the answer, but to start asking different kinds of questions, right. The more we feel listened to, the more we can not just be listened to, but we can be heard. And when we're heard, that is what creates change. That is what creates people being willing to join a mission or a movement because they had a voice in it, which then creates skin in the game. And so listening is that goes to retention as well.
[00:26:59] Speaker B: Because retention is the other issue and we find that it's not generally about money. And it is about money. Sometimes every time I say that I'll have people respond, well, we've got travelers and things of that sort. But long term retention is about much more than money. It's about feeling part of the society, being listened to, being heard, having impact on your work. You've done a great job of that. And as you think of tactically, for those who we're talking to today on this podcast, how do you get that feeling? Part of the organization? What, what would you recommend they focus on early on?
[00:27:42] Speaker A: Well, number one, shared decision making, mutual decision making. How if you're going to build a workflow, could you do so without the input and investment of those that the workflow is meant to impact or affect? You know, at NYC health and Hospitals we are person centered, not patient centered, person centered. So it is about co designing experiences. So you know, there's a quote that Planetree uses for person centered certification, which is nothing for me without me. And it is something that I think we all need to more subscribe to ultimately is how do we invite the patient's voice in the community members voices in everything from how to outfit a lobby or a waiting area, how to enhance standard work, our workflows, how we even engage staff in saying what should really actually be in EPIC that makes the most sense for you. We need to ask people to be a part of the decision making and the change process. The more we do that, the more they will feel that they have a place to be because again, they belong. And home is where the heart is and health is where the home is. If you feel you're at home at work and so you have an opportunity to engage staff more and patients more in this process, you know, money does matter. You know, health care is a business. We can't just keep doors open. And yes, while thanks to New York City taxpayers we're able to do incredible work here and provide high quality safe care that really does compete with the for profits.
Ultimately, at the end of the day, money matters. And we know for a fact that turnover Rates and retention costs healthcare organizations millions of dollars a year. You know, just to replace one physician, one physician costs over $1 million because of lost wages due to patients that we can't fill census with, in addition to the marketing to bring them in the onboarding process.
Nurses, same thing. You're looking at almost 4, 5, $600,000 per rn just to replace. So think about how many were offloading and not able to bring in and then also the cost attributed to that. We know for a fact that burnout plays a large part in that. You know, before I was talking about the veil of burnout, right? So we know for a fact if you like the work that you do and you are reminded by what you like about it, that you feel that you're making a difference and can see that echoed and that it's resonating around you each and every single day. If you stand by the people that you work with day in and day out, and feel proud of the work that you and others are doing side by side for the care and the services that the patient populations are receiving, if you look at your organization and are able to keep people that look like you, that act like you, that have that common life experience, whether you are trans, whether you are gay or lesbian, whether you are black, whether you are Christian, if you have an opportunity to keep the people like you around you and also treat people like you, that are around you, you'll be more willing to stay. But burnout gets in the way of that and creates a wedge between that and then. We're not going to provide the high quality, safe care that ultimately is the scaffolding, the foundation for anyone wanting to stay working somewhere. So if it's not safe for me or for others, why would I, would I want to stay? But it is the reminders of the return that ultimately keep people working and working well.
[00:31:09] Speaker B: You know, we don't do well as an industry addressing burnout and fatigue and a number of things because of the stiff upper lip. And we're caring for others in the process. And when you think of other industries like airline pilots, et cetera, where they have rules around the work and they measure their psychological safety at different periods of time. And we've got this issue that again was just brought up in my last meeting before I came here, which is the loss of nursing and the exit of both ends of the spectrum, the one to three year nurses leaving early and those who are at the end of their careers are leaving a few years earlier than they would have. What advice do you give to a CNO who is struggling to keep that retention of that one to three. And they're worried about that attrition, visibility.
[00:32:05] Speaker A: You know, often our executives are dealing with so many things, but sometimes they're stuck in meetings, sometimes they're stuck with surveyors, sometimes they're stuck with labor partners, board meetings. Right. And all of that is necessary part and parcel to the job itself. But visibility, to be out on the floors and to ask the staff, how may I help you? What would be most beneficial to you? To be able to be your best personal and professional self while at work.
To truly lead by example. You know, generosity of spirit and kindness. It costs nothing. The sacrifice that we sometimes feel due to stress can sometimes harden us. But we cannot allow anything to reduce us, to no longer see the people that are doing the work and for us to be part of that work with them, alongside of them. I mentioned before, try to leave the team better than you found it. Provide others what you did not receive. You know, you talked about your generation, right? The stoism, the stip upper lip. And you know, there are generations that truly believe that I must rule with an iron fist because that's the way I was taught. I can't show emotionality. But the more that you allow yourself to be at ease with that, the more that you actually realize that different generations have different generational needs and that the younger workforce and it doesn't have to always be about even age of an individual, it could also be the generation of the years of experience that we need to be thinking about and using as an equity lens in terms of how we approach others. But ultimately how do you truly stand with and by another and start to realize that maybe your approach is what you were taught, but maybe that's not what the needs are today.
[00:33:59] Speaker B: Listening and observing. Doesn't it?
[00:34:01] Speaker A: It does, Absolutely it does. Being present here and now, connecting, meeting people where they're at, being person centered.
[00:34:07] Speaker B: Yeah, Rounding is not walking through the floor going hey, how you doing? How you doing? How you doing? Yeah, it's really being present and listening. You know, we've got chart upon chart with regard to data that if you're rounding and we're even talking about rounding now, is visiting because it sounds a little more personal. But if you're visiting on the floors and you're out and visible, the level of improvement in the engagements course is a hockey stick for organizations. And we just did work for one of the for profits that we'll be coming out with where their decision to fully Implement and systematize. Rounding has literally changed their engagement scores in a six month period of time. It's, it's remarkable when you're present and people can and can see you. The other thing I thought about that, you know, when you're rounding, social capital is like a $25 gift card. When you're out there rounding and engaging with people, you're, you're basically putting in their social Capital bank account $25 here, $5 there, and you're building that relationship with folks because it's meaningful to see the boss, it's meaningful to be listened to.
[00:35:24] Speaker A: So I love, I love that you called the social capital in the bank, right? Because there's something called the banking approach, right? It's how am I banking in another in terms of if I'm a CNO or if I'm a CMO or if I'm a cqo, a cxo, whatever C it might be all leaders, managers and supervisors should be rounding, but it's the banking method. It's if I'm willing to commit, to sit, to listen to you and to understand your experience and truly willing to listen, as you mentioned before, that I will learn something and I will have a whole new perspective potentially that could help me strategize, could help me improve it. But also I'm banking in you to see my perspective even as a leader. You know, we often have seen the breakdown of the bidirectional feedback loop and we have to really welcome that back in and invite it in and rounding and listening is part of it. The other thing I want to say is we're always so quick to solution, right? When you're an executive, you're like, I have to get this done, I have to get this done now. And it's often with the best of intention to support the staff and to enhance workflows for optimal and safe quality patient care.
But we are so quick even just to ask a question than to answer it ourself. You know, there's data right now that says, you know, a physician will interrupt a patient after asking them, they're presenting problem with their chief complaint and we'll cut them off within 13 seconds to tell them what really is the issue and what they need to do. And we do that as healthcare executives as well. And then we model that for others to just always feel like I need to save and fix and solve immediately and not sit with the dialogue and the problem solving and the richness that comes along with that. And Browning allows that.
[00:37:11] Speaker B: The other thing you brought up, which I want you to comment on.
I think vulnerability is an asset. As an executive, how do you see that?
[00:37:22] Speaker A: Okay, so first and foremost, I'm very sorry for your loss. The loss of a parent is unlike any other kind of loss.
And it's tough right when people want to project their experiences or their feelings or how they're receiving it back onto others. And I think that that's a learning lesson for executives as well. We don't always have to have all of the answers. People have the answers within themselves without a question. There is no answer. And we want to guide people to find their own. And that's even in performance improvement, in healthcare operation improvement. So we sometimes have to sit with the discomfort of someone else's emotion or someone else's experience. That differs from what I'm feeling in the moment. As an executive, we have to be able to sit and accept the mess. Sometimes that feels uncomfortable, even if it's wanting to share a condolence and make someone feel better. But that isn't necessarily what they needed to hear at that time.
In terms of listening, vulnerability is absolutely a strength and is an asset for any leader to be able to lead well, often people are said, don't show your emotion at work. But most of that comes from the fear that people are not going to still respect me or see me as a strong leader. But we know that vulnerability is the bridge to the authentic connection and communication. It's actually how people can greater empathize with your experience. Not sympathize, not pity, but ultimately see you as a human being. The more I see someone else being human, the the more I'm going to be able to feel and want to be human and relax and be comfortable around you. Which ultimately translates to even me saying, hey, I think I could have done that better, or admit to an error or a mistake and to realize that failure is not the option, but it's the first attempt in learning and moving forward together, because I felt comfortable enough to share that with you for guidance, for feedback, for operational, clinical, or even collegial support. Vulnerability often is shied away from because people are uncomfortable with their own experiences, sometimes because the environment has not reflected back that it's okay to do so. But what I have definitely seen with my own two eyes, especially since the onset of the pandemic, is that people are starting to realize that they have limits and that there's strength in identifying that I have limitations as a human being. I am not a superhero and I'm not perfect because nothing is Perfect and that humanity is beautiful and it takes the stakes out of things. Sometimes vulnerability ultimately for me comes from a place of being willing to actually be seen and to model that which therefore then gives permission and allowance to others. You know, I ultimately, when I first started working for Animacy Health in hospitals, did not feel very safe in terms of being an out queer male. Even though I would say I'm quite readable in this red suit. I would say that ultimately I had a bad experience where I was, I was unfortunately called a derogatory term my first day working on my unit by a staff member. And so I closed up. I was like, I don't know if this job is going to actually be for me. I said I was going to give it three months and I gave it three months and then I said no. I believe that there could be a difference and there could be a change now. NYC Health and Hospitals Allied Organization out and Proud LGBTQIA Affirming Services all of this beauty that has welcomed me as an individual.
Actually seeing leaders share when they made a mistake or talking about a project that didn't go well or as expected, but ultimately how they coped through it. I've seen this through Mitch's executive cabinet. My boss Eric Way, you know, actually share their toughest cases as clinicians. So all of a sudden, just by modeling it and sharing vulnerability, we saw a strengthening of community and culture and the value system of integrity and compassion and respect and excellence. But ultimately that that led to our own accountability to continue to keep going and to keep striving for an environment that felt more inclusive. And I've talked a lot about belongingness, but that really is a part of it. Vulnerability is the key to connection.
[00:41:43] Speaker B: I find the deeper you get to know someone, the more willing you're prepared to follow work with sit shoulder to shoulder through difficult times. And I think it's an important part if you're a young manager to understand that being vulnerable is a strength, as you say. And I think as executives, conveying that message to your teammates is critical.
Go ahead.
[00:42:09] Speaker A: Yeah, I don't mean to cut you up. You know, ultimately people are afraid to be vulnerable because they feel so different. You know, often what I found in workforce well being work for healthcare workers is people will often say, wow, that made me feel less alone.
I didn't realize that others had that experience. So there are universal truths, there are commonalities that break through every difference in diversity makeup of a healthcare organization. But ultimately, if we can just realize that we are similar in Certain ways, yes. People have different privileges. Absolutely. I am a white, cisgendered male in an executive role. I know I am privileged, but I do know that I can have a very similar human experience to someone else that might be going through something very different and looks different in their life, but that we can absolutely connect on. So if we can just find the fabric of human existence is hard sometimes and that we can actually connect within the differences to find those common interests or opportunities, ultimately, vulnerability allows us to focus more on recovery and coping. And that no matter who we are and the differences that we have gone through in our own life, our coping mechanisms, our coping strategies, how we got through something could become someone else's survival guide, even if they're from a very different walk of life. So if we can just remember that at the end of the day we're human beings and that human experience and existence is happening. And yes, there are very different struggles that people have, but at the end of the day, there has to be something that ties us together, which is we're trying to live and live our healthiest, best life in our own right, but that things get in the way and that we can actually find common ground along the way. That is what will breed greater willingness to be vulnerable.
[00:44:01] Speaker B: Yeah, you know, I want to underline that common ground, because society, and we all get wrapped into it, is putting people or things or situations in boxes and without the benefit of a deep knowledge. We had a week. We can sit here, different generations born in different communities, but we don't know each other's upbringing, experiences to this point in time, and the importance of digging deep to really find understanding. I believe that most people have much more in common than they do different. And as a society, we've got to break away from trying to separate what the differences are and talk about what we have in common. I think within companies, health systems, et cetera, continuing to highlight what we have in common makes a massive difference. I'm going to give you a wand right now. You're going to be able to solve the health systems of the future, the struggles of tomorrow, where we can flip the switch and it'll be fixed. What would you do if you had that power? And we'll wrap on that question.
[00:45:12] Speaker A: Yeah. So first and foremost, you know, I was just talking about privilege.
If I could fix healthcare systems at large, is to make sure that healthcare is not a privilege, it is a right, and that we all work together to remember the healing powers that we all have and to remember the common global goal of Healthcare is to heal and help others and for them to stay healthy and well so that they can love and respect and support others health and wellbeing.
If I could wave a magic wand to fix healthcare is to remember that we often talk about the patients and their loved ones and the communities and put them at the center, but that we need to put our people first and that we need to provide the same compassion to our colleagues, the same passionate support that we provide to patient populations, to provide to our peers and to really level the playing field to encourage that wellness is not just seen as something such as smoking cessation groups and pedometer challenges. That it can be strategically, systematically approached with actual framework around quality improvements. You know, we're doing performance improvement projects on wellness. That's reporting up to our system scorecard, the mayor's management report, to our governing body and executive boards. We are truly using QI and performance improvement principles to enhance, measure, monitor and that tracking to then create further improvement around wellbeing. That we have to see wellness as just an important metric as anything else like sepsis or a CAUTI or a Clabsi or anything else that we publicly report.
We have to realize that this is something that we can actually make a difference in and that it doesn't just have to be waving that wand and that it will fix itself, that it can really be organizationally approached with infrastructure to have true outcomes and to make a difference.
[00:47:14] Speaker B: Well, you know, you just highlighted a number of things that I want to add emphasis too. So you have a data strategy that drives your overall strategy in the organization. So you look at engagement with your workforce, engagement with your patients, and your overall wellness strategy from a metrics standpoint and measure it as operating data as important as your financial data, if not more important.
[00:47:47] Speaker A: It is up there with all of those metrics, including financial sustainability metrics, access to care metrics, culture of safety metrics, quality and outcome metrics, and we have care experience metrics and our workforce wellness helping healers heal metrics. We have outcome, process and balancing measures, we have scorecards at the site level, we have unit based data and we use it for performance improvement purposes at an enterprise level, at a service line and site specific level, team and individual level. So when I look at our process metrics, first and foremost it's about the global awareness of the program. We talked about one of the barriers being access, which is understanding what's even available. So I'm measuring awareness of programming and willingness to utilize it, which really gets to are we breaking through stigma? Are we stopping stigma to start healing. We are obviously looking at the infrastructural support mechanisms at a site and service line level of how many trainings are taking place to build the debriefers of the future and those future wellness champions. As peer support champions, we're taking a look at steering team meetings, how often they're taking place, to talk about the strategic plans of 2025 that we're already starting to build as organizations at a site level. Aside from that, when we think about other processes, it's about how satisfied are you with the initiatives. So taking a look at all the different projects and programs that you have and really listening not only the quantifiable evidence of how people are rating or recommending it, but really being satisfied by it, but ultimately what the qualitative feedback is and how do you steer that. To know what next year's priorities should be in terms of projects or programs, in terms of outcomes, you have to take a look at actionable causes. Right? We know for a fact that we can reduce stress and can create greater opportunities to de stress while at work. We measure stress and compassion fatigue, feelings of sadness or being depressed, anxiety, burnout on a scale. But ultimately we're not just measuring how often, we're also measuring the density of it. All of that is rich substance. To really look at strategy, to be able to create action plans and actionable improvement work to be had, we take a look at balancing measures. How long is a debrief really taking? Is that taking people really away from their duties of administering medications per se? And what we're learning is if you don't have seven minutes that can make the world of a difference in the eyes of an employee because they felt listened to, then we have a bigger issue at hand.
You know, with any good program, you can only be as good as your measurability of it and how well you measure it, but more importantly what you do with that information. So you know, a data point is a data point. At NYC health and hospitals, it's about the life behind the metric and what we believe we can make a difference in as we measure it.
Within NYC health and hospitals, we have purposefully made sure that we have aligned all of our quality reporting around helping healers heal and our employee engagement to our quality assurance performance improvement committed to the executive board up to the executive Board system scorecard as well as all the way up to the Mayor's management report. We've aligned all the reporting to also be mirrored at the site level to have strategic Scorecards that are balanced in terms of what we look at in terms of overall operations. But effectiveness without the measurement, you don't know the efficacy of the program. And so we obviously, as I mentioned, we have outcome, process and balance metrics, but it really is about the outcomes and what the outcomes are starting to tell you. And we take pride in that because even if we're not doing well, Right. It's an opportunity to reveal it, to heal it. Right.
[00:51:31] Speaker B: You know what? I want to stop right there because we say to everyone, don't look at. It's a constant journey of improvement that no one should feel uncomfortable measuring. You take the information in, you study it, and you determine how to execute and improve.
Tell me how you get that philosophy around the organization so that people are anxious to see how they're doing as compared to, or excited, I should say, as compared to being anxious.
[00:52:03] Speaker A: I like that you said excitement. Right. We are so, you know, conditioned to be scared of red.
Right. But red is a compass. It's a guide to say, great, what can we be doing differently in the eyes of our workforce? Ultimately that then impacts patient care delivery. We want to stay excited by the greens, but if we can't keep an eye on it, then how do we know that the program is going to sustain and that ultimately is the most important thing right now. Sustain the workforce, sustain the wellness programming, and sustain a future vision of what wellness can be so that we can continue to strive for more and better at the nation at large for our healthcare workers. I always say if you don't have consistence and persistence, then you're not going to continue to stay relevant and relevant in the landscape of healthcare. But again, outcomes, we as a system had a large opportunity to grow in terms of wellness and engagement because we didn't really have it since 2018. And then the onset of 2020 is when we really became this full fledged, holistic, proactive and preventative workforce wellness model with helping healers heal. Really taking on a variety of different interventions and programs. But you know, we were able to decrease symptoms of burnout that wouldn't go away by 64% since 2020. 4% rate of change since 2020, we've increased staff feeling valued by 47%. We have decreased stress, anxiety, compassion, fatigue, as well as feelings of sadness or being depressed between 50 up to 65% decreased it over the last two years. So outcomes speak volumes, but it's the qualitative answers, it's the feedback, it's the compliments, and it's the constructive Commentary that has enabled us to continue to really look at this in a meaningful manner, to say what can we manage that's actionable to make a difference?
We've seen many other outcomes as well. I won't go into it, but the reality here is great. I'm so thankful that I get to say to our executive board and up through the Mayor's management report that NWASE Health and Hospitals is on the right side of history. Having Assistant Chief Wellness Officer and having wellness champions and wellness program directors and others across the organization all championing this. But ultimately it takes the village and NYC Health and Hospitals is willing to say we're the village at large, but we also have to look at ourselves sometimes and say where do we still need to go? For instance, we have two comparison groups. So we've got New York State looking at both the public and private healthcare delivery systems and the other comparison group being our America's Essential Hospital Safety Net members, if you will, that we compare ourselves to. And while we're seeing an overall national decline in engagement, NYC Health and Hospitals is seeing incremental statistical significant improvement over the last three surveys.
[00:54:57] Speaker B: That's amazing because it has been a tough period across the national database. Not broken out by safety net hospitals, broken out in total from an engagement standpoint. And what's interesting is our data shows that those organizations that had gone through high reliability training and stuck to their mission, vision and values during the pandemic, in other words, didn't do what it took, quote unquote, to get through the day, but continued to practice around, focused on the patient experience, focused on the wellness and engagement of their team members, continued to improve. And today we're seeing almost a have and have nots. There are a group of people who are improving much faster than the market and there's this separation in the data. So you're calling out to the industry to focus on wellness and look at really safety and the overall experience. It's coming at a critical time for the industry for the very reasons you mentioned in 2033. We're going to face a staffing crisis unless we do something about it.
[00:56:11] Speaker A: You know, what I'll say is even though I'm very proud of our outcomes, there's still so much more that we all can be doing as the global workforce collective that we are public, private, urban, suburban, whatever it might be. We all have an opportunity to be on the right side of history to stop the boiling point that you just spoke about and to not shy away from where we see we have improvement opportunities for growth and to really invest in that. You know, again, I'm very proud of our outcomes, but we have to do more. And we know for a fact that workforce wellness equals employee engagement, equals safety, equals patient experience that is high quality and safe and compassionate that meets their concrete needs. It's the proven premise.
[00:56:58] Speaker B: Well, Jeremy Siegel from New York Health and Hospitals stands behind his work. I had the opportunity to visit one of your facilities recently. I think the emergency room was stocked to the ceilings with patients.
It was quiet, peaceful. People felt cared for. So thank you for what you're doing for New York Health and Hospital. Thank you for what you're doing speaking to us in the entire industry. And I have a sense that the impact that you're going to have is going to be far beyond New York with time. So thanks for your work.
[00:57:36] Speaker A: Well, thank you, Pat, and thanks to Press Kaney for having me. And I want to say thank you to all of my site and service line stakeholders that they're the ones doing the hard work each and every single day to truly embody our mission and our vision. So I wouldn't be who I am today and where I am today without those really at the site level greeting you and aligning themselves to the greater good of what we stand for at NYC Health and Hospital. So thanks to you, Press Ganey, and of course, those at the sites and service lines.
[00:58:03] Speaker B: Thank you.
[00:58:04] Speaker A: That's a wrap.
[00:58:05] Speaker B: Thank you for joining us today and.
[00:58:07] Speaker A: Special thanks to our guests for sharing.
[00:58:09] Speaker B: Their time and insights.
[00:58:10] Speaker A: Stay tuned for our next episode, which.
[00:58:12] Speaker B: Will be released soon. In the meantime, visit our website where.
[00:58:16] Speaker A: You'Ll find more information on the human.
[00:58:18] Speaker B: Experience and a lot more.
