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SPEAKER WILL BE TAKEN BOTH FROM

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THE MICROPHONES IN THE AISLES AS

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WELL AS ONLINE, THE VIDEOCAST

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VIEWERS MAY SUBMIT QUESTIONS AT

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ANY TIME DURING THE LECTURE BY

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SCROLLING DOWN AND CLICKING THE

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LIVE FEEDBACK BUTTON LOCATED ON

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THE VIDEOCAST WEBSITE, QUESTIONS

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WILL BE ANSWERED AS TIME

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PERMITSA THE CONCLUSION OF THE

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PRESENTATION.

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SO TODAY WE'RE HONORED TO HAVE

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OUR SPEAKER DR. LOTISSUING

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TI DYRBYE, AN, LOTTED PROFESSOR

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ON ENGAGE OF BURN OUT, SHE IS

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THE SENIOR ASSOCIATE DEAN OF

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00:01:21,991 --> 00:01:26,763
FACULTY AND PROFESSOR OF THE

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UNIVERSITY OF COLORADO SCHOOL OF

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MEDICINE, SHE EARNED HEAR

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DOCTORATE FROM THE UNIVERSITY OF

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WISCONSIN MEDICAL COOL FOLLOWED

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BY A RESIDENCY BY THE SCHOOL OF

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WASHINGTON AND SCHOOL OF

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MEDICINE IN SEATTLE.

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SHE EARNED A MASTERS DEGREE IN

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HEALTH PROFESSIONS, EDUCATION,

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00:01:40,276 --> 00:01:41,478
FOR THE UNIVERSITY OF

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ELIMINATEDDIBLE AT CHICAGO

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COLLEGE OF MEDICINE WHICH IS MY

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ALMA MATER.

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DR. DYRBYE, EARNED HER PRACTICE

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AND LATER JOINED THE MAYO CLINIC

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00:01:53,289 --> 00:01:53,723
AS FACULTY.

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00:01:53,723 --> 00:01:55,191
SHE SERVED AS ASSOCIATE CHAIR OF

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DEPARTMENT OF MEDICINE AND

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SERVED INLET ROLES OF FACULTY

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00:01:59,729 --> 00:02:02,098
DIVERSITY AS IT RELATES TO

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PROFESSIONAL SATISFACTION.

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00:02:03,800 --> 00:02:06,436
SHE STARTED RESEARCHING BURN OUT

40
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AFTER WITNESSING DIFFICULTIES

41
00:02:07,337 --> 00:02:08,571
THAT MEDICAL STUDENTS AND

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RESIDENTS WERE HAVING DURING

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00:02:11,141 --> 00:02:15,512
TRAINING AND SHE BECAME GRADUATE

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FOR THE MAYO EDUCATION.

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00:02:17,280 --> 00:02:18,548
HER PRESENT ROLE IS SENIOR

46
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ASSOCIATE DEAN AS WELL AS CHIEF

47
00:02:19,983 --> 00:02:21,017
WELL BEING OFFICER AT THE

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00:02:21,017 --> 00:02:23,520
UNIVERSITY OF THE COLORADO.

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00:02:23,520 --> 00:02:28,758
A DISTINGUISHED TEACHER AND

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RESEARCHER, DR. DYRBYE HAS

51
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RECEIVED FUNDING FROM THE NIH,

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NHLBI, AND THE AMERICAN MEDICAL

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ASSOCIATION.

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SHE HAS MENTORED DOZENS OF

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TRAINEES AND IS A CO AUTHOR ON

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MORE THAN 150 PEER REVIEWED

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STUDIES INCLUDING RANDOMIZED

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CLINICAL TRIALS TO IIDENTIFY

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PREVENT AND REDUCE BURN OUT IN

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THE CLINICAL WORKFORCE.

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DR. DISRKS YRBYE'S RESEARCH HAS

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INCLUDED RESEARCH ON PHYSICIAN

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WELL BEING ON THE SCORE CARD FOR

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ORGANIZATIONAL LEADERS AND STATE

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MEDICAL LICENSING BOARDS.

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HER WORK WAS THE IMPETUS FOR THE

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NATIONAL ACADEMY MEDICINE ACTION

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ON WELL BEING AND RESILIENCE

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WHERE SHE SERVES AND APPLIES

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PRAGMATIC AND BROADLY

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APPROACHABLE  STRATEGIES FOR BUN

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OUT.

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SHE HAS ALSO CALLED TO THE FLOOR

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THE THREAT OF SAFE QUALITY TO

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CARE IS THE MOST DOWNLOADED N.

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A. M. PAPER TO DATE.

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IN HER ORGT WORK SHE OUTLINES

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HOW HEALTHCARE ORGANIZATIONS CAN

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BOTH MEASURE AND PRIORITIZE

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IMPROVEMENTS IN CLINICAL WORK

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ENVIRONMENTS TO MITIGATE

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CLINICIAN BURN OUT AND FOSTER

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WELL BEING AMONGST LEARNERS AS

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WELL AS PRACTITIONERS.

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DR. DYRBYE IS SOUGHT OUT AS A

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LEADER IN THE BURN OUT SECTION,

87
00:03:53,476 --> 00:03:55,979
AND SHE IS A SPEAKER THAT IS

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SOUGHT OUT NATIONALLY AND

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INTERNATIONALLY.

90
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WE'RE SO HAPPY SHE IS JOINING US

91
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TODAY.

92
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TODAY'S TITLE IS TAKING ACTION

93
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AGAINST BURN OUT.

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PLEASE JOIN ME IN WELCOMING OUR

95
00:04:05,955 --> 00:04:10,293
GRAND ROUNDS SPEAKER

96
00:04:10,293 --> 00:04:10,860
DR. LOTTIE DYRBYE.

97
00:04:10,860 --> 00:04:11,160
>> THANKS.

98
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IT'S REALLY A PLEASURE TO BE

99
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HERE TODAY.

100
00:04:13,429 --> 00:04:15,064
I WILL NOT STAND BEE HIND THE

101
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PODIUM, I HOPE THAT'S OKAY, SO,

102
00:04:19,402 --> 00:04:20,703
I HAVE A DISCLOSURE, I WILL NOT

103
00:04:20,703 --> 00:04:22,305
TALK ABOUT THE WELL BEING INDEX

104
00:04:22,305 --> 00:04:25,074
BUT IT'S IN THE CME MATERIALS.

105
00:04:25,074 --> 00:04:27,310
SO THESE ARE MY VERY WELL

106
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WRITTEN LEARNING OBJECTIVES, SO

107
00:04:28,311 --> 00:04:29,679
WHAT WE WILL DO TODAY TOGETHER

108
00:04:29,679 --> 00:04:31,314
IS TALK ABOUT THE WHAT, THE SO

109
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WHAT, BUT MOST IMPORTANTLY THE

110
00:04:34,617 --> 00:04:35,485
NOW WHAT?

111
00:04:35,485 --> 00:04:41,491
WHICH IS WHY I THINK YOU'RE HERE

112
00:04:41,491 --> 00:04:43,192
TODAY WITH ME; SO THE WHAT, WHAT

113
00:04:43,192 --> 00:04:45,094
IS BURN OUT, WE ALL HAVE OUR OWN

114
00:04:45,094 --> 00:04:46,362
DEFINITIONS OF THAT FROM A

115
00:04:46,362 --> 00:04:47,397
RESEARCH PERSPECTIVE.

116
00:04:47,397 --> 00:04:48,998
IT'S AN OCCUPATION OF PHENOM

117
00:04:48,998 --> 00:04:51,668
NANOG THAT IS CAUSED BY

118
00:04:51,668 --> 00:04:52,602
UNMITIGATED LEVEL OF WORK

119
00:04:52,602 --> 00:04:54,804
STRESS, WE THINK ABOUT IT IN

120
00:04:54,804 --> 00:04:57,040
TERMS AT THE OF EMOTIONAL EXBE

121
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HAWOF THION, LIKE I I'M THE END

122
00:04:58,608 --> 00:05:01,077
OF MY ROPE, I HAVE NOTHING ELSE

123
00:05:01,077 --> 00:05:04,881
TO GIVE, A SENSE OF BEING

124
00:05:04,881 --> 00:05:06,516
CALLOUS OR DETACHED AND/OR A

125
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VERY LOW ACCOMPLISHED PERSON AND

126
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WE DON'T SEE THAT MUCH IN

127
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MEDICINE BUT BURN OUT IS A

128
00:05:10,153 --> 00:05:11,754
CONSTRUCT THAT'S BEEN STUDIED IN

129
00:05:11,754 --> 00:05:13,156
ALL SORTS OF DIFFERENT

130
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PROFESSIONS.

131
00:05:13,523 --> 00:05:15,692
SO IN THEIR MOST RECENT NATIONAL

132
00:05:15,692 --> 00:05:17,460
STUDY OF PHYSICIANS ACROSS THE

133
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UNITED STATES, PRIVATE PRACTICE,

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ACADEMIC GOVERNMENT, INDUSTRY,

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WE SEE HERE IN 2021 THAT ABOUT

136
00:05:25,902 --> 00:05:27,704
63% OF PHYSICIANS HAD REALLY A

137
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HIGH PREVALENCE OF BURN OUT.

138
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NOW I'M GOING TO TALK ABOUT BURN

139
00:05:30,440 --> 00:05:32,909
OUT AS IF YOU HAVE IT OR YOU

140
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DON'T.

141
00:05:33,309 --> 00:05:34,711
AND THAT'S NOT REALLY THE CASE,

142
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RIGHT?

143
00:05:34,911 --> 00:05:39,882
IT'S A MATTER OF DEGREES, IT'S

144
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CONTINUOUS AND VARIABLE, JUST

145
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CONTINUE TO TALK ABOUT ODDS

146
00:05:42,919 --> 00:05:44,220
RATIOS SO WE WILL TALK ABOUT

147
00:05:44,220 --> 00:05:46,923
BURN OUT AS MORE OF A YES/NO

148
00:05:46,923 --> 00:05:47,924
PHENOMENON EMPLOY AND WHAT WE

149
00:05:47,924 --> 00:05:50,793
KNOW ABOUT BURN OUT IS THE MORE

150
00:05:50,793 --> 00:05:53,062
YOU WORK, THE HIGHER YOUR RISK

151
00:05:53,062 --> 00:05:53,730
OF BURN OUT, RIGHT?

152
00:05:53,730 --> 00:05:55,531
THE WORK HOURS IS THE PRIMARY

153
00:05:55,531 --> 00:05:55,898
DRIVER.

154
00:05:55,898 --> 00:05:58,334
WE ALSO SEE KIND OF CONTRARY TO

155
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COMMONLY HELD BELIEFS THAT

156
00:05:59,869 --> 00:06:01,371
YOUNGER PHYSICIANS ARE AT HIGH

157
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RISK FOR BURN OUT, SO IT DOESN'T

158
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MATTER IF YOU LOOK AT GENERAL

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INTERNISTS OR SURGEONS OR LOOK

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AT PEOPLE IN PRIVATE PRACTICE OR

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ACADEMICS OR THE GOVERNMENT, THE

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YOUNGER YOU ARE, THE HIGHER YOUR

163
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RISK FOR BURN OUT EVEN AFTER WE

164
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CONTROL FOR WORK HOURS, AFTER WE

165
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CONTROL FOR SPECIALTY IN A

166
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VARIETY OF OTHER FACTORS.

167
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THE GENDER STORY IS COMPLICATED,

168
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YOU'LL SEE LOTS OF PUBLICATIONS

169
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OUT THERE ABOUT WOMEN HAVING A

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HIGHER RISK OF BURN OUT AND YOU

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KNOW WOE IS ME, RIGHT, BUT THAT

172
00:06:28,064 --> 00:06:29,365
ACTUALLY GOES AWAY AFTER WE

173
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CONTROL FOR THINGS LIKE SEXISM

174
00:06:30,700 --> 00:06:32,135
IN THE WORK ENVIRONMENT.

175
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SO WE CAN TALK A LITTLE BIT MORE

176
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ABOUT THAT.

177
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BUT JUST BEING A WOMAN DOESN'T

178
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SOMEHOW MAKE US MORE VULNERABLE

179
00:06:39,509 --> 00:06:41,210
TO HAVING HIGH LEVELS OF WORK

180
00:06:41,210 --> 00:06:42,245
STRESS AND GETTING BURN OUT

181
00:06:42,245 --> 00:06:44,180
RELATIVE TO INDIVIDUAL WHO IS

182
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IDENTIFY WITH MALE GENDER.

183
00:06:47,817 --> 00:06:48,951
HIGHER PAID MAKES A BIG

184
00:06:48,951 --> 00:06:50,920
DIFFERENCE, SO BEING A SALARY

185
00:06:50,920 --> 00:06:52,188
MODEL VERSUS BEING EAT WHAT YOU

186
00:06:52,188 --> 00:06:54,323
KILL MODEL WHERE IT'S BASED ON

187
00:06:54,323 --> 00:06:56,826
BILLING FOR DOCS OUT IN PRIVATE

188
00:06:56,826 --> 00:06:58,494
PRACTICE, MAKES A HUGE

189
00:06:58,494 --> 00:07:00,963
DIFFERENCE AND THERE'S BIG

190
00:07:00,963 --> 00:07:01,764
DIFFERENCES BY SPECIALTY.

191
00:07:01,764 --> 00:07:02,999
SO YOU MAY REMEMBER THE DAYS FOR

192
00:07:02,999 --> 00:07:05,068
THOSE OF YOU WHO ARE PHYSICIANS,

193
00:07:05,068 --> 00:07:06,936
THE ROAD TO HAPPINESS WHEN YOU

194
00:07:06,936 --> 00:07:09,539
THOUGHT ABOUT WHAT SPECIALTY TO

195
00:07:09,539 --> 00:07:12,375
PICK, RADIOLOGY, OPHTHALMOLOGY,

196
00:07:12,375 --> 00:07:13,476
ANESTHESIA, DERMATOLOGY, HASN'T

197
00:07:13,476 --> 00:07:15,878
NECESSARILY PANNED OUT SO WE SEE

198
00:07:15,878 --> 00:07:17,980
A BIG VARIABILITY IN THE BIG

199
00:07:17,980 --> 00:07:20,016
PRESENCE OF PHYSICIAN BURN OUT,

200
00:07:20,016 --> 00:07:20,883
DEPENDING ON SPECIALTY, I DON'T

201
00:07:20,883 --> 00:07:22,685
KNOW WHAT'S GOING ON IN UROLOGY,

202
00:07:22,685 --> 00:07:24,520
BUT THEY'RE RIGHT UP THERE,

203
00:07:24,520 --> 00:07:25,321
EMERGENCY MEDICINE IS ALWAYS

204
00:07:25,321 --> 00:07:26,956
RIGHT UP THERE, AND EVEN AFTER

205
00:07:26,956 --> 00:07:29,392
WE CONTROL FOR WORK HOURINGS AND

206
00:07:29,392 --> 00:07:30,326
ACADEMICS AND PRIVATE PRACTICE

207
00:07:30,326 --> 00:07:32,128
AND A VARIETY OF OTHER FACTORS,

208
00:07:32,128 --> 00:07:34,330
WE SEE THAT DOCS WHO WORK IN THE

209
00:07:34,330 --> 00:07:35,231
EMERGENCY DEPARTMENT HAVE MUCH

210
00:07:35,231 --> 00:07:37,433
HIGHER RATES OF BURN OUT,

211
00:07:37,433 --> 00:07:39,936
RELATIVE FOR EXAMPLE TO A

212
00:07:39,936 --> 00:07:42,305
GASTRONEUROLOGYIST OR OTHER TYPE

213
00:07:42,305 --> 00:07:45,708
OF INTERNAL MEDICINE

214
00:07:45,708 --> 00:07:46,142
SUBSPECIALIST.

215
00:07:46,142 --> 00:07:47,376
WE ALSO SEE THAT THE

216
00:07:47,376 --> 00:07:48,344
PEDIATRICIANS ARE ALWAYS HAPPY,

217
00:07:48,344 --> 00:07:50,246
I DON'T KNOW IF IT'S THE CUTE

218
00:07:50,246 --> 00:07:51,447
KIDS OR THE GREAT SCRUBS THEY

219
00:07:51,447 --> 00:07:53,816
GET TO WEAR BUT WE SEE LESS BURN

220
00:07:53,816 --> 00:07:55,051
OUT IN THE PEDIATRICIANS IN

221
00:07:55,051 --> 00:07:58,321
GENERAL RELATIVE TO OTHER

222
00:07:58,321 --> 00:07:58,888
SPECIALTY PRACTICES.

223
00:07:58,888 --> 00:08:00,490
AND ALTHOUGH, WE FELT LIKE WE

224
00:08:00,490 --> 00:08:02,325
WERE MAKING STRIDES, YOU KNOW

225
00:08:02,325 --> 00:08:04,827
FROM OUR NATIONAL STUDIES OF

226
00:08:04,827 --> 00:08:06,295
PHYSICIANS ACROSS THE UNITED

227
00:08:06,295 --> 00:08:08,564
STATES, ALL SPECIALTIES, PRIVATE

228
00:08:08,564 --> 00:08:11,300
PRACTICE, ET CETERA, DIFFERENT

229
00:08:11,300 --> 00:08:12,568
PRACTICE SETTINGS, FROM 2014, TO

230
00:08:12,568 --> 00:08:13,669
2020, WE SAW NATIONALLY THAT THE

231
00:08:13,669 --> 00:08:15,838
RATE OF BURN OUT WAS GOING DOWN,

232
00:08:15,838 --> 00:08:18,741
AND THEN THIS LITTLE COVID THING

233
00:08:18,741 --> 00:08:20,243
HAPPENED, RIGHT?

234
00:08:20,243 --> 00:08:21,677
AND COMPLETELY DERAILED THINGS

235
00:08:21,677 --> 00:08:23,813
WE AND WE SAW DRAMATIC INCREASE

236
00:08:23,813 --> 00:08:26,149
IN BURN OUT RATES ABOUT 20 OR SO

237
00:08:26,149 --> 00:08:28,284
MONTHS INTO THE PANDEMIC, BUT OF

238
00:08:28,284 --> 00:08:30,486
COURSE IT WASN'T UNIFORM RIGHT,

239
00:08:30,486 --> 00:08:32,555
LIKE FOR SOME DOCS WE HAD LITTLE

240
00:08:32,555 --> 00:08:34,590
TO DO, FOR OTHER DOCS WE HAD A

241
00:08:34,590 --> 00:08:37,460
LOT TO DO AND WE SEE REALLY HIGH

242
00:08:37,460 --> 00:08:38,528
RATES POST PANDEMIC IN DOC WHO

243
00:08:38,528 --> 00:08:40,263
IS WORK IN THE EMERGENCY

244
00:08:40,263 --> 00:08:41,230
DEPARTMENT, CRITICAL CARE, IN

245
00:08:41,230 --> 00:08:44,167
THE HOSPITALS AND OBVIOUSLY IN

246
00:08:44,167 --> 00:08:45,668
INFECTIOUS DISEASES, RIGHT?

247
00:08:45,668 --> 00:08:46,569
NO BIG SURPRISE.

248
00:08:46,569 --> 00:08:48,171
WE ALSO SEE REALLY HIGH RATES OF

249
00:08:48,171 --> 00:08:50,373
BURN OUTS IN DOCS WHO HAD

250
00:08:50,373 --> 00:08:51,607
ECONOMIC DISRUPTIONS BECAUSE OF

251
00:08:51,607 --> 00:08:52,875
COVID WHO DIDN'T HAVE ENOUGH

252
00:08:52,875 --> 00:08:54,710
ACCESS TO PERSONAL PROTECTIVE

253
00:08:54,710 --> 00:08:59,315
EQUIPMENT, AND WHO GOT SICK.

254
00:08:59,315 --> 00:09:01,717
SO IT ALSO KIND OF LENDS TO THE

255
00:09:01,717 --> 00:09:02,919
QUESTION RIGHT, ISN'T EVERYBODY

256
00:09:02,919 --> 00:09:06,622
JUST BURN OUT, IS THIS A

257
00:09:06,622 --> 00:09:08,524
PHENOMENA'S UNIQUE TO HEALTHCARE

258
00:09:08,524 --> 00:09:09,525
WORKERS OR UNIQUE TO PEOPLE WHO

259
00:09:09,525 --> 00:09:10,960
DO SCIENCE AND HEALTHCARE, WERE

260
00:09:10,960 --> 00:09:14,297
THE LAWYERS AND OTHER

261
00:09:14,297 --> 00:09:16,599
PROFESSIONALS, PILOTS, AREN'T

262
00:09:16,599 --> 00:09:18,868
THEY JUST BURNT OUT, TOO?

263
00:09:18,868 --> 00:09:20,937
ISN'T IT JUST A REFLECTION OF

264
00:09:20,937 --> 00:09:22,338
OUR SOCIETY, A 24/7 KIND OF

265
00:09:22,338 --> 00:09:22,905
SOCIETY.

266
00:09:22,905 --> 00:09:24,574
SO WE LOOKEDDA THE THAT,

267
00:09:24,574 --> 00:09:25,541
ACTUALLY, WE PARTNERED WITH A

268
00:09:25,541 --> 00:09:29,245
COMPANY THAT COULD GIVE US A

269
00:09:29,245 --> 00:09:30,346
SAMPLE, REPRESENTATIVE SAMPLE OF

270
00:09:30,346 --> 00:09:32,615
OTHER U.S. WORKERS TO SORT OF

271
00:09:32,615 --> 00:09:33,649
SEE, IS THERE SOMETHING UNIQUE

272
00:09:33,649 --> 00:09:36,219
TO BEING A PHYSICIAN IN

273
00:09:36,219 --> 00:09:37,887
PRACTICE, AND WE AJUSTED FOR A

274
00:09:37,887 --> 00:09:39,188
VARIETY OF DIFFERENT FACTORS,

275
00:09:39,188 --> 00:09:39,755
RIGHT?

276
00:09:39,755 --> 00:09:41,991
WORK HOURS, AGE, GENDER, ET

277
00:09:41,991 --> 00:09:45,294
CETERA, THINGS THAT WE COULD

278
00:09:45,294 --> 00:09:46,395
REASONABLY CONTROL FOR.

279
00:09:46,395 --> 00:09:48,464
AND WHAT WE FOUND IS IN THE

280
00:09:48,464 --> 00:09:50,032
UNITED STATES, IT DOESN'T MATTER

281
00:09:50,032 --> 00:09:51,734
WHAT YOU DO FOR A LIVING, THE

282
00:09:51,734 --> 00:09:53,536
MORE HOURS YOU WORK, THE HIGHER

283
00:09:53,536 --> 00:09:55,104
YOUR RISK FOR BURN OUT,

284
00:09:55,104 --> 00:09:55,871
SIMILARLY WE SAW THAT DOESN'T

285
00:09:55,871 --> 00:09:57,406
MATTER WHAT YOU DO FOR A LIVING,

286
00:09:57,406 --> 00:09:58,975
THE YOUNGER YOU ARE, THE HIGHER

287
00:09:58,975 --> 00:10:01,043
YOUR RISK FOR BURN OUT.

288
00:10:01,043 --> 00:10:05,047
BEING MARRIED IS PROTECTIVE, AND

289
00:10:05,047 --> 00:10:06,415
THEN WE SAW SOMETHING REALLY

290
00:10:06,415 --> 00:10:07,483
INTERESTING HAPPEN WITH

291
00:10:07,483 --> 00:10:07,883
EDUCATION.

292
00:10:07,883 --> 00:10:08,951
SO RELATIVE TO HAVING A HIGH

293
00:10:08,951 --> 00:10:11,621
SCHOOL EDUCATION, IF YOU HAD A 4

294
00:10:11,621 --> 00:10:12,755
YEAR'S BACHELOR EDUCATION, YOU

295
00:10:12,755 --> 00:10:15,491
WERE AT LOWER RISK FOR BURN OUT.

296
00:10:15,491 --> 00:10:18,361
IF YOU HAD A MASTER'S DEGREE

297
00:10:18,361 --> 00:10:20,296
RELATIVE TO A HIGH SCHOOL

298
00:10:20,296 --> 00:10:22,098
DEGREE, YOU HAD LOWER ODDS OF

299
00:10:22,098 --> 00:10:24,767
BURN OUT, IF YOU HAD ANOTHER

300
00:10:24,767 --> 00:10:25,501
PROFESSIONAL DEGREE EXCEPT FOR

301
00:10:25,501 --> 00:10:28,137
BEING A DOCTOR, LIKE A Y. D., A

302
00:10:28,137 --> 00:10:31,173
Ph.D., A PSYCHE D, YOU HAD

303
00:10:31,173 --> 00:10:33,142
ODDS OF BURN OUT LOWER RELATIVE

304
00:10:33,142 --> 00:10:34,844
TO THOSE WHO WENT TO HIGH SCHOOL

305
00:10:34,844 --> 00:10:36,279
ONCE YOU CONTROL FOR WORK HOURS

306
00:10:36,279 --> 00:10:39,415
BUT IF YOU HAD A M. D. OR D. O.

307
00:10:39,415 --> 00:10:41,450
OR EQUIVALENT BEHIND YOUR NAME,

308
00:10:41,450 --> 00:10:42,785
YOU HAD INCREASE ODDS OF BURN

309
00:10:42,785 --> 00:10:44,287
OUT RELATIVE TO U.S. WORKERS

310
00:10:44,287 --> 00:10:45,388
EVEN AFTER CONTROLLING FOR WORK

311
00:10:45,388 --> 00:10:48,557
HOURS AND OTHER FACTORS.

312
00:10:48,557 --> 00:10:53,896
AND INDEED WE HAVE SEEN THIS IN

313
00:10:53,896 --> 00:10:55,298
2011, 2014, 2017, 2020 THAT THE

314
00:10:55,298 --> 00:10:57,566
RATE OF BURN OUT IS HIGHER IN

315
00:10:57,566 --> 00:10:59,735
U.S. PHYSICIANS RELATIVE TO

316
00:10:59,735 --> 00:11:00,403
OTHER U.S. WORKERS.

317
00:11:00,403 --> 00:11:03,105
AND WHEN WE LOOK BACK, WE SEE

318
00:11:03,105 --> 00:11:05,608
THE SAME STORY IN OUR RESIDENTS

319
00:11:05,608 --> 00:11:08,511
AND FELLOWS AND IN OUR MEDICAL

320
00:11:08,511 --> 00:11:08,911
STUDENTS.

321
00:11:08,911 --> 00:11:11,113
SO THAT BEGS THE QUESTION, ARE

322
00:11:11,113 --> 00:11:13,616
THEY LETTING THE WRONG PEOPLE

323
00:11:13,616 --> 00:11:15,685
INTO MEDICAL SCHOOL, THEY'RE

324
00:11:15,685 --> 00:11:18,554
LETTING ALL THE 1S WITH

325
00:11:18,554 --> 00:11:19,188
RESILIENCY DEFICIENCY INTO

326
00:11:19,188 --> 00:11:22,391
MEDICAL SCHOOL AND THAT'S OUR

327
00:11:22,391 --> 00:11:23,926
SOLUTION EMPLOY I WAS ACTUALLY

328
00:11:23,926 --> 00:11:26,095
ASKED THAT, BECAUSE PEOPLE HAVE

329
00:11:26,095 --> 00:11:27,296
WRITTEN ABOUT THE DOCTOR

330
00:11:27,296 --> 00:11:27,596
PERSONALITY.

331
00:11:27,596 --> 00:11:29,098
I THINK THIS IS A PERSONALITY OF

332
00:11:29,098 --> 00:11:33,135
MANY OF US, RIGHT, WE HAVE KIND

333
00:11:33,135 --> 00:11:35,538
OF AN EXCESSIVE SENSE OF GUILTY

334
00:11:35,538 --> 00:11:37,306
AND RESPONSIBILITY AND YOU KNOW

335
00:11:37,306 --> 00:11:39,308
SORT OF DOUBT AND IN MANY WAYS

336
00:11:39,308 --> 00:11:40,343
IT'S ADAPTIVE, IT'S A GOOD

337
00:11:40,343 --> 00:11:42,011
THING, IT MAKES US THOROUGH,

338
00:11:42,011 --> 00:11:43,946
MAKES US COMMITTED, MAKES US GO

339
00:11:43,946 --> 00:11:45,414
TO GRAND ROUNDS, YOU KNOW, LIKE

340
00:11:45,414 --> 00:11:47,683
WE'RE LEARNING THINGS ALL THE

341
00:11:47,683 --> 00:11:49,118
TIME, WE RECOGNIZE THE

342
00:11:49,118 --> 00:11:50,619
IMPORTANCE OF THE WORK THAT WE

343
00:11:50,619 --> 00:11:53,889
DO, THE DECISIONS THAT WE MAKE,

344
00:11:53,889 --> 00:11:55,257
RIGHT, WE'RE VERY RIGOROUS BUT

345
00:11:55,257 --> 00:11:58,060
IT CAN BE MALADAPTIVE, WE CAN

346
00:11:58,060 --> 00:12:00,096
HAVE A HEARD TIME SETTING

347
00:12:00,096 --> 00:12:02,164
LIMITS, LETTING GO, DOING

348
00:12:02,164 --> 00:12:03,733
IMPORTANT SELF-CARE PIECES LIKE

349
00:12:03,733 --> 00:12:05,101
GET RECHARGED, RIGHT, TAKE OUR

350
00:12:05,101 --> 00:12:08,671
VACATION AND NOT ACTUALLY WORK

351
00:12:08,671 --> 00:12:10,239
ON OUR VACATION EMPLOY.

352
00:12:10,239 --> 00:12:11,674
SO, YOU KNOW ARE WE LETTING THE

353
00:12:11,674 --> 00:12:12,842
WRONG PEOPLE INTO MEDICAL SCHOOL

354
00:12:12,842 --> 00:12:18,013
AND THE SOLUTION LIES IN FIXING

355
00:12:18,013 --> 00:12:18,314
ADMISSIONS.

356
00:12:18,314 --> 00:12:19,815
SO WE LOOK AT THAT RIGHT BECAUSE

357
00:12:19,815 --> 00:12:21,684
I GOT TIRED OF BEING ASKED THAT,

358
00:12:21,684 --> 00:12:26,722
AND IT TURNS OUT THAT

359
00:12:26,722 --> 00:12:27,690
MATRICULATING MEDICAL STUDENTS

360
00:12:27,690 --> 00:12:28,791
HAVE LESS BIRN OUT AND OTHER

361
00:12:28,791 --> 00:12:30,893
QUALITY OF LIFE THAN OTHER U.S.

362
00:12:30,893 --> 00:12:32,661
COLLEGE GRADUATES THE SAME AGE.

363
00:12:32,661 --> 00:12:35,798
SO THE DATA WE HAVE AT LEAST

364
00:12:35,798 --> 00:12:38,033
SUGGESTS THAT AT MA TRIBULATION

365
00:12:38,033 --> 00:12:39,001
MEDICAL STUDENTS ARE VERY

366
00:12:39,001 --> 00:12:40,436
SIMILAR TO THE U.S. POPULATION

367
00:12:40,436 --> 00:12:43,906
AND MAYBE EVEN A LITTLE BETTER.

368
00:12:43,906 --> 00:12:48,411
SO SOLUTIONS PROBABLY DON'T LIE

369
00:12:48,411 --> 00:12:49,412
IN FIXING ADMISSIONS.

370
00:12:49,412 --> 00:12:51,580
BUT SOLUTION CERTAINLY NEED TO

371
00:12:51,580 --> 00:12:52,615
START EARLY, THINKING ABOUT

372
00:12:52,615 --> 00:12:53,649
WHAT'S HAPPENING IN MEDICAL

373
00:12:53,649 --> 00:12:55,484
SCHOOL, WHAT'S HAPPENING IN

374
00:12:55,484 --> 00:12:57,486
RESIDENCY AND WHAT'S HAPPENING

375
00:12:57,486 --> 00:12:58,053
OUT IN PRACTICE.

376
00:12:58,053 --> 00:13:00,389
ALL RIGHT, SO THAT WAS THE FIRST

377
00:13:00,389 --> 00:13:02,625
LEARNING OBJECTIVE, YOU NOW

378
00:13:02,625 --> 00:13:04,860
KNOW, BURN OUT'S HIGH, IT'S A

379
00:13:04,860 --> 00:13:07,163
BIG PROBLEM, IT'S AN

380
00:13:07,163 --> 00:13:09,198
OCCUPATIONAL PHENOMENON, IT'S

381
00:13:09,198 --> 00:13:11,066
NOT A MEDICAL DISEASE, IT'S

382
00:13:11,066 --> 00:13:12,802
CAUSED BY HIGHER LEVEL OF WORK

383
00:13:12,802 --> 00:13:13,836
STRESS, HIGHER ON DOCS THAN

384
00:13:13,836 --> 00:13:15,571
OTHERS IN THE U.S. POPULATION

385
00:13:15,571 --> 00:13:16,739
AND NOT BECAUSE WE'RE LETTING A

386
00:13:16,739 --> 00:13:18,374
LOT OF PEOPLE INTO MEDICAL

387
00:13:18,374 --> 00:13:20,843
SCHOOL, SO THAT'S WHAT YOU FIRST

388
00:13:20,843 --> 00:13:21,477
LEARNED INLET FIRST 15 MINUTES

389
00:13:21,477 --> 00:13:22,978
OR SO THAT WE WERE TOGETHER.

390
00:13:22,978 --> 00:13:24,280
BEFORE WE CAN GET TO THE NOW

391
00:13:24,280 --> 00:13:26,148
WHAT, WE NEED TO TALK ABOUT THE

392
00:13:26,148 --> 00:13:26,582
SO WHAT.

393
00:13:26,582 --> 00:13:29,218
BECAUSE YOU NEED TO BE ABLE TO

394
00:13:29,218 --> 00:13:30,419
ARTICULATE WHY THIS MATTERS SO

395
00:13:30,419 --> 00:13:32,922
YOU CAN GET SORT OF THE

396
00:13:32,922 --> 00:13:35,991
INITIATIVE GOING AROUND THE NOW

397
00:13:35,991 --> 00:13:36,225
WHAT.

398
00:13:36,225 --> 00:13:37,726
WHAT ARE WE GOING TO CHANGE?

399
00:13:37,726 --> 00:13:39,228
HOW ARE WE GOING TO ADDRESS THE

400
00:13:39,228 --> 00:13:40,196
PROBLEMS?

401
00:13:40,196 --> 00:13:42,998
SO IN THE NATIONAL ACADEMY OF

402
00:13:42,998 --> 00:13:44,333
MEDICINE CONSENSUS REPORT WHICH

403
00:13:44,333 --> 00:13:46,035
YOU CAN DOWNLOAD FOR FREE,

404
00:13:46,035 --> 00:13:47,636
THEY'RE ALL CLIFF NOTES AND

405
00:13:47,636 --> 00:13:50,673
THEY'RE ALL OVERWORKED AND TOO

406
00:13:50,673 --> 00:13:51,941
BUSY, YOU CAN LOOK AT THOSE IF

407
00:13:51,941 --> 00:13:52,274
YOU WANT.

408
00:13:52,274 --> 00:13:54,543
OR YOU CAN LOOK AT THE SURGEON

409
00:13:54,543 --> 00:13:55,845
GBL'S REPORT, SAME INFORMATION,

410
00:13:55,845 --> 00:13:57,213
SAME CONTENT, INERED ONER TO

411
00:13:57,213 --> 00:13:58,247
REALLY SUMMARIZE WHAT'S GOING

412
00:13:58,247 --> 00:14:00,382
ON, WHY IS THIS HAPPENING AND

413
00:14:00,382 --> 00:14:02,284
WHY IS IT IMPORTANT.

414
00:14:02,284 --> 00:14:04,987
TO SUM IT UP, HERE'S THE SLIDE,

415
00:14:04,987 --> 00:14:08,324
THAT SUMS IT UP WHY WE SHOULD

416
00:14:08,324 --> 00:14:09,725
CARE, THE SO WHAT.

417
00:14:09,725 --> 00:14:10,860
I'M GOING TO TALK A LITTLE BIT

418
00:14:10,860 --> 00:14:11,994
ABOUT SOME OF THESE THINGS BUT

419
00:14:11,994 --> 00:14:15,231
WE KNOW BURN OUT IS RELATED TO

420
00:14:15,231 --> 00:14:17,299
MORE EXPENSIVE CARE THAT IT'S

421
00:14:17,299 --> 00:14:18,634
RELATED HOW WE BEHAVE AND SHOW

422
00:14:18,634 --> 00:14:21,070
UP AT WORK, WE'RE LIKELY TO BE

423
00:14:21,070 --> 00:14:21,871
UNPROFESSIONAL AND WE'RE BURNT

424
00:14:21,871 --> 00:14:26,041
OUT, WE HAVE A LOWER SENSE OF

425
00:14:26,041 --> 00:14:26,542
ACCOUNTABILITY REPORTING

426
00:14:26,542 --> 00:14:27,276
IMPORTANT COLLEAGUES AND

427
00:14:27,276 --> 00:14:28,244
PROFESSIONAL, WE'RE MORE LIKELY

428
00:14:28,244 --> 00:14:30,212
TO SAY WE'VE COMMITTED MAJOR

429
00:14:30,212 --> 00:14:33,415
MEDICAL ERROR, TO BE INVOLVED IN

430
00:14:33,415 --> 00:14:35,484
MEDICAL MALPRACTICE LITIGATION

431
00:14:35,484 --> 00:14:36,185
SUIT, IT'S--THERE'S A

432
00:14:36,185 --> 00:14:38,287
RELATIONSHIP BETWEEN BURN OUT

433
00:14:38,287 --> 00:14:40,222
AND HOSPITAL ASSOCIATED

434
00:14:40,222 --> 00:14:41,657
INFECTIONS AND THERE'S A COUPLE

435
00:14:41,657 --> 00:14:44,026
OTHER THINGS I WILL POINT OUT.

436
00:14:44,026 --> 00:14:45,895
SO HERE'S A DEEPER DIVE INTO

437
00:14:45,895 --> 00:14:47,596
SOME OF THIS LITERATURE, RIGHT?

438
00:14:47,596 --> 00:14:50,232
O THIS IS A COUPLE STUDIES OVER

439
00:14:50,232 --> 00:14:51,667
2000 NURSES OR 5000 PHYSICIANS,

440
00:14:51,667 --> 00:14:53,402
AND WE SAW VERY STRONG

441
00:14:53,402 --> 00:14:57,406
RELATIONSHIP BETWEEN BURN OUT

442
00:14:57,406 --> 00:14:59,341
AND SELF-REPORTED UNPROFESSIONAL

443
00:14:59,341 --> 00:14:59,675
BEHAVIORS.

444
00:14:59,675 --> 00:15:01,944
WE SAW A MUCH LOWER COMMITMENT

445
00:15:01,944 --> 00:15:02,611
TO PRACTICING COST CONSCIOUS

446
00:15:02,611 --> 00:15:04,413
CARE AND THE DOCTORS WHO ARE

447
00:15:04,413 --> 00:15:07,550
BURNT OUT RELATIVE TO THOSE WHO

448
00:15:07,550 --> 00:15:07,783
WEREN'T.

449
00:15:07,783 --> 00:15:12,488
AND WE SAW AS I MENTIONED A

450
00:15:12,488 --> 00:15:13,255
LOATER SENSE OF RESPONSIBILITY

451
00:15:13,255 --> 00:15:14,990
TO PHYSICIANS AND NURSES IF THEY

452
00:15:14,990 --> 00:15:17,259
HAD BURN OUT.

453
00:15:17,259 --> 00:15:20,896
WE ALSO SEE IN LONGITUDINAL

454
00:15:20,896 --> 00:15:22,431
STUDIES OF RESIDENTS, SO ALL

455
00:15:22,431 --> 00:15:23,832
SPESHTS, WE FOLLOW THESE WITH

456
00:15:23,832 --> 00:15:25,100
SECOND OR THERD YEAR THAT THERE

457
00:15:25,100 --> 00:15:26,702
WAS A RELATIONSHIP BETWEEN BURN

458
00:15:26,702 --> 00:15:28,237
OUT AND RACIAL BIAS.

459
00:15:28,237 --> 00:15:31,006
SO IN THIS STUDY, WE SOUGHT

460
00:15:31,006 --> 00:15:32,608
OVERALL BETWEEN THE SECOND YEAR

461
00:15:32,608 --> 00:15:35,044
RESIDENCY AND THE THIRD YEAR

462
00:15:35,044 --> 00:15:36,345
RESIDENCY, EXPLICIT BIAS TO OUR

463
00:15:36,345 --> 00:15:39,281
BLACK PATIENTS WENT DOWN, GOOD

464
00:15:39,281 --> 00:15:39,481
THING.

465
00:15:39,481 --> 00:15:41,317
WE SAW THAT THE RESIDENTS WHO

466
00:15:41,317 --> 00:15:44,186
DIDN'T HAVE BURN OUT AT EITHER

467
00:15:44,186 --> 00:15:45,888
TIME POINT THAT THEY HAVE THE

468
00:15:45,888 --> 00:15:47,523
LOWEST AMOUNT OF BIAS TOWARD OUR

469
00:15:47,523 --> 00:15:47,890
PATIENTS.

470
00:15:47,890 --> 00:15:48,190
GOOD THING.

471
00:15:48,190 --> 00:15:49,325
WE SAW THAT THE RESIDENT WHO IS

472
00:15:49,325 --> 00:15:50,292
RECOVERED FROM BURN OUT OVER THE

473
00:15:50,292 --> 00:15:52,161
COURSE OF A YEAR, HAD THE MOST

474
00:15:52,161 --> 00:15:55,864
REDUCTION IN THEIR BIAS TOWARD

475
00:15:55,864 --> 00:15:56,231
BLACK PATIENTS.

476
00:15:56,231 --> 00:15:58,667
IS WE SAW THAT THE RESIDENTS WHO

477
00:15:58,667 --> 00:16:00,302
HAD WORSENING IN THEIR BURN OUT

478
00:16:00,302 --> 00:16:01,870
DURING THIS TIME PERIOD HAD

479
00:16:01,870 --> 00:16:04,773
DRAMATIC INCREASES IN THEIR BIAS

480
00:16:04,773 --> 00:16:05,441
TOWARDS BLACK PATIENTS.

481
00:16:05,441 --> 00:16:07,776
SUGGESTING AT LEAST THAT SOME OF

482
00:16:07,776 --> 00:16:09,545
THE DISPARITIES WE CAN CONTINUE

483
00:16:09,545 --> 00:16:11,080
TO SEE IN HEALTHCARE MAY VERY

484
00:16:11,080 --> 00:16:12,214
MUCH RELATE TO THE LEVEL OF BURN

485
00:16:12,214 --> 00:16:15,918
OUT IN OUR HEALTHCARE WORKFORCE.

486
00:16:15,918 --> 00:16:17,987
OTHER STUDIES HAVE SHOWN THAT

487
00:16:17,987 --> 00:16:19,688
WHEN SURGEONS ARE BURNT OUT

488
00:16:19,688 --> 00:16:21,123
THEY'RE TWICE AS LIKELY TO SAY

489
00:16:21,123 --> 00:16:22,925
THEY COMMITTED A MAJOR MEDICAL

490
00:16:22,925 --> 00:16:23,258
ERROR.

491
00:16:23,258 --> 00:16:24,960
THEY'RE ALSO TWICE AS LIKELY TO

492
00:16:24,960 --> 00:16:27,029
ACTUALLY BE INVOLVED IN THE

493
00:16:27,029 --> 00:16:27,863
MEDICAL MALPRACTICE LITIGATION

494
00:16:27,863 --> 00:16:28,063
SUIT.

495
00:16:28,063 --> 00:16:29,498
WE KNOW THAT THE LEVEL OF BURN

496
00:16:29,498 --> 00:16:31,734
OUT IN NURSES IS AN INDEPENDENT

497
00:16:31,734 --> 00:16:33,569
PREDICTER OF HOSPITAL ASSOCIATED

498
00:16:33,569 --> 00:16:33,869
INFECTIONS.

499
00:16:33,869 --> 00:16:35,404
WE KNOW THAT THE LEVEL OF BURN

500
00:16:35,404 --> 00:16:37,806
OUT, IN DOCTORS AND NURSES IN

501
00:16:37,806 --> 00:16:40,242
THE ICUs IS INDEPENDENT

502
00:16:40,242 --> 00:16:41,577
PREDICTOR OF PATIENT MORTALITY.

503
00:16:41,577 --> 00:16:43,545
AND THERE'S BEEN MULTIPLE

504
00:16:43,545 --> 00:16:44,380
SYSTEMATIC REVIEWS AND

505
00:16:44,380 --> 00:16:45,280
META,AINAL SIS THAT REALLY

506
00:16:45,280 --> 00:16:47,783
SUMMED UP SORT OF THIS

507
00:16:47,783 --> 00:16:49,418
RELATIONSHIP BETWEEN BURN OUT

508
00:16:49,418 --> 00:16:52,721
AND SUBOPTIMAL QUALITY AND

509
00:16:52,721 --> 00:16:53,288
SAFETY OF CARE.

510
00:16:53,288 --> 00:16:56,625
WE ALSO KNOW FROM LONGITUDINAL

511
00:16:56,625 --> 00:16:57,960
STUDIES WE CONDUCTED AT MAYO

512
00:16:57,960 --> 00:16:59,561
CLINIC IS THAT AS BURN OUT

513
00:16:59,561 --> 00:17:01,530
WORSENS OVER A TIME PERIOD, IT'S

514
00:17:01,530 --> 00:17:04,400
ASSOCIATED WITH DRAMATIC

515
00:17:04,400 --> 00:17:06,268
REDUCTIONS AND FTEs, SO IN

516
00:17:06,268 --> 00:17:07,870
TIME, TAKING CARE OF PATIENTS

517
00:17:07,870 --> 00:17:09,638
AND THIS STUDY FOR JUST 1 POINT

518
00:17:09,638 --> 00:17:11,140
INCREASE IN 1 OF THE DOMAINS OF

519
00:17:11,140 --> 00:17:13,442
BURN OUT, THERE WAS A 43%

520
00:17:13,442 --> 00:17:14,543
INCREASE ODDS THAT THAT DOCTOR

521
00:17:14,543 --> 00:17:15,778
WAS GOING TO REDUCE THE TIME

522
00:17:15,778 --> 00:17:19,915
TAKING CARE OF PATIENTS OVER THE

523
00:17:19,915 --> 00:17:20,616
NEXT 2 YEARS.

524
00:17:20,616 --> 00:17:23,986
AND IF YOU EXTRAPOLATE THE MAYO

525
00:17:23,986 --> 00:17:25,521
DATA NATIONALLY IT WOULD EQUIP

526
00:17:25,521 --> 00:17:26,955
TO 3 GRADUATING CLASSES OF

527
00:17:26,955 --> 00:17:28,257
MEDICAL STUDENTS SIMPLY NOT

528
00:17:28,257 --> 00:17:29,625
WORKING AND YOU ALL KNOW THAT WE

529
00:17:29,625 --> 00:17:31,093
HAVE A PHYSICIAN SHORTAGE, SO

530
00:17:31,093 --> 00:17:33,462
THIS IS NOT A GOOD THING.

531
00:17:33,462 --> 00:17:35,664
WE ALSO KNOW FROM LONGITUDINAL

532
00:17:35,664 --> 00:17:37,666
STUDIES WHERE PEOPLE HAVE DONE

533
00:17:37,666 --> 00:17:38,467
SURVEYS USING VALIDATED MEASURES

534
00:17:38,467 --> 00:17:40,436
OF BURN OUT AND THEN LATER

535
00:17:40,436 --> 00:17:43,005
LOOKED AT PERSONNEL RECORDS, WE

536
00:17:43,005 --> 00:17:45,307
KNOW THAT DOCS WHO ARE BURNT OUT

537
00:17:45,307 --> 00:17:47,476
ARE TWICE AS LIKELY TO LEAVE

538
00:17:47,476 --> 00:17:49,178
THEIR CURRENT JOB AND THAT

539
00:17:49,178 --> 00:17:52,848
OBVIOUSLY IMPACTS ACCESS AND IT

540
00:17:52,848 --> 00:17:53,382
COSTS GAZILLION DOLLARS.

541
00:17:53,382 --> 00:17:56,418
SO IF WE LOOK AT TURNOVER AND

542
00:17:56,418 --> 00:17:57,920
LOSS OF FTE DIRECTLY

543
00:17:57,920 --> 00:17:59,988
ATTRIBUTABLE TO BURN OUT IN THE

544
00:17:59,988 --> 00:18:02,624
UNITED STATES ONLY IN

545
00:18:02,624 --> 00:18:04,560
PHYSICIANS, IT'S COSTING THE

546
00:18:04,560 --> 00:18:06,528
HEALTHCARE SYSTEM 4.6 BILLION

547
00:18:06,528 --> 00:18:07,296
DOLLARS A YEAR.

548
00:18:07,296 --> 00:18:10,999
AT THE LEVEL OF THE ORGANIZATION

549
00:18:10,999 --> 00:18:11,300
IT'S $7600.

550
00:18:11,300 --> 00:18:14,336
SO THIS IS EXPENSIVE AND THAT'S

551
00:18:14,336 --> 00:18:18,674
JUST THE DOCS, WE SEE THE SAME

552
00:18:18,674 --> 00:18:20,109
RELATIONSHIP WITH 26,000

553
00:18:20,109 --> 00:18:20,642
HEALTHCARE WORKERS, THIS

554
00:18:20,642 --> 00:18:22,144
RELATIONSHIP BETWEEN BURN OUT

555
00:18:22,144 --> 00:18:23,278
AND REDUCTION IN TIME TAKING

556
00:18:23,278 --> 00:18:24,980
CARE OF PATIENTS ISSUES RIGHT?

557
00:18:24,980 --> 00:18:25,848
DECISIONS ABOUT HOW YOU'RE GOING

558
00:18:25,848 --> 00:18:28,250
TO SPEND YOUR TIME, WHETHER

559
00:18:28,250 --> 00:18:30,486
YOU'RE FULL-TIME, WHETHER YOU'RE

560
00:18:30,486 --> 00:18:32,187
GOING TO .8, THE WHETHER YOU GO

561
00:18:32,187 --> 00:18:33,555
TO .6, ET CETERA.

562
00:18:33,555 --> 00:18:35,157
AND IF THE BUSINESS CASE DOESN'T

563
00:18:35,157 --> 00:18:37,025
HELP YOU WITH GETTING TO THE NOW

564
00:18:37,025 --> 00:18:39,328
WHAT, MAYBE THE MORAL CASE WILL

565
00:18:39,328 --> 00:18:40,462
GET YOU THERE.

566
00:18:40,462 --> 00:18:42,564
SO DOCS WHO ARE BURNT OUT ARE

567
00:18:42,564 --> 00:18:44,133
MORE LIKELY TO HAVE SUBSTANCE

568
00:18:44,133 --> 00:18:45,300
USE DISORDER PROBLEMS AND

569
00:18:45,300 --> 00:18:48,003
THEY'RE MORE LIKELY TO HAVE

570
00:18:48,003 --> 00:18:49,538
SUICIDAL IDEATION, AND WE KNOW

571
00:18:49,538 --> 00:18:50,806
FROM OUR LONGITUDINAL STUDIES IN

572
00:18:50,806 --> 00:18:52,307
MEDICAL STUDENTS THAT BURN OUT

573
00:18:52,307 --> 00:18:54,676
IS AN INDEPENDENT PREDICTER OF A

574
00:18:54,676 --> 00:18:55,778
STUDENT DEVELOPING THOUGHTS OF

575
00:18:55,778 --> 00:18:57,613
SUICIDE OVER THE COURSE OF A

576
00:18:57,613 --> 00:19:02,217
YEAR, EVEN AFTER WE CONTROL FOR

577
00:19:02,217 --> 00:19:02,751
SYMPTOMS OF DEPRESSION.

578
00:19:02,751 --> 00:19:05,053
ALL RIGHT, SO WHY IS THIS

579
00:19:05,053 --> 00:19:05,454
HAPPENING, RIGHT?

580
00:19:05,454 --> 00:19:06,855
SO WE KNOW THAT BURN OUT IS

581
00:19:06,855 --> 00:19:09,124
CAUSED BY HIGH LEVELS OF WORK

582
00:19:09,124 --> 00:19:09,458
STRESS.

583
00:19:09,458 --> 00:19:12,161
I THINK WE CAN ALL SIT HERE AND

584
00:19:12,161 --> 00:19:13,428
THINK ABOUT A GAZILLION THINGS

585
00:19:13,428 --> 00:19:16,498
THAT ARE CAUSING HIGH LEVELS OF

586
00:19:16,498 --> 00:19:17,466
WORK STRESS.

587
00:19:17,466 --> 00:19:21,770
WHAT WE KNOW IS THAT IT'S NOT A

588
00:19:21,770 --> 00:19:22,504
RESILIENCY DEFICIENCY, OKAY?

589
00:19:22,504 --> 00:19:23,772
WHAT WE KNOW IS THAT MUFFIN

590
00:19:23,772 --> 00:19:26,475
MONDAYS ARE NOT GOING TO FIX OUR

591
00:19:26,475 --> 00:19:26,875
PROBLEM.

592
00:19:26,875 --> 00:19:29,211
WHEN WE LOOK AT RESILIENCE IN

593
00:19:29,211 --> 00:19:30,813
PHYSICIANS, IT'S ACTUALLY HIGHER

594
00:19:30,813 --> 00:19:32,514
THAN IN OTHER U.S. WORKERS AND

595
00:19:32,514 --> 00:19:34,149
WHEN WE LOOK AT RESILIENCE AND

596
00:19:34,149 --> 00:19:35,417
BURN OUT, THERE'S ABOUT 29% OF

597
00:19:35,417 --> 00:19:37,553
THE PHYSICIANS WITH THE HIGHEST

598
00:19:37,553 --> 00:19:38,887
POSSIBLE RESILIENCY SCORE STILL

599
00:19:38,887 --> 00:19:39,354
HAVE BURN OUT, RIGHT?

600
00:19:39,354 --> 00:19:41,290
LIKE THIS IS NOT REALLY WHERE

601
00:19:41,290 --> 00:19:44,159
THE SOLUTION LIES, THE SOLUTION

602
00:19:44,159 --> 00:19:47,162
LIES IN ATTACKING THE REALLY

603
00:19:47,162 --> 00:19:47,896
COMPLICATED MULTIFACTORIAL

604
00:19:47,896 --> 00:19:49,031
DRIVERS THAT ARE CONTRIBUTING TO

605
00:19:49,031 --> 00:19:50,699
HIGH LEVELS OF WORK STRESS IN

606
00:19:50,699 --> 00:19:53,836
ALL FORMS OF HEALTHCARE WORKERS.

607
00:19:53,836 --> 00:19:56,538
SO A LOT OF TIMES WE

608
00:19:56,538 --> 00:19:59,341
CONCEPTUALIZE IT AROUND THESE

609
00:19:59,341 --> 00:20:02,044
DOMAINS THAT WAS PUBLISHED A FEW

610
00:20:02,044 --> 00:20:02,311
YEARS AGO.

611
00:20:02,311 --> 00:20:04,012
IT'S ULTIMATELY DRIVEN BY WORK

612
00:20:04,012 --> 00:20:05,447
HOURS, SO ALL THE THINGS THAT

613
00:20:05,447 --> 00:20:07,816
ARE DRIVING UP YOUR WORK HOURS,

614
00:20:07,816 --> 00:20:11,520
WOWR WORK LOAD BUT ALSO WORK

615
00:20:11,520 --> 00:20:12,588
EFFICIENCY, THAT'S A PIECE OF

616
00:20:12,588 --> 00:20:12,888
IT.

617
00:20:12,888 --> 00:20:14,590
IT'S NOT JUST WORK HOURS, IT'S

618
00:20:14,590 --> 00:20:16,625
ALSO OTHER DO MAINS WE WORKED

619
00:20:16,625 --> 00:20:19,928
ABOUT, LIKE CONTROL, STABILITY,

620
00:20:19,928 --> 00:20:20,729
AUTONOMY, DECISION LATITUDE,

621
00:20:20,729 --> 00:20:23,332
IT'S ALSO THINGS RELATED TO

622
00:20:23,332 --> 00:20:23,565
VALUES.

623
00:20:23,565 --> 00:20:25,400
IF YOU FEEL LIKE YOUR VALUES ARE

624
00:20:25,400 --> 00:20:26,902
ALIGNED WITH THE VALUES OF THE

625
00:20:26,902 --> 00:20:28,537
ORGANIZATION THAT YOU WORK FOR,

626
00:20:28,537 --> 00:20:30,405
HOW MUCH MEANING AND WORK YOU'RE

627
00:20:30,405 --> 00:20:32,808
ABLE TO GET, HOW MUCH SORT OF

628
00:20:32,808 --> 00:20:34,176
ALIGNMENT THERE IS BETWEEN WHAT

629
00:20:34,176 --> 00:20:35,577
YOU REALLY ENJOY DOING AND WHAT

630
00:20:35,577 --> 00:20:39,047
YOU'RE ABLE TO DO AT WORK.

631
00:20:39,047 --> 00:20:40,916
IT ALSO RELATES TO SUPPORTING

632
00:20:40,916 --> 00:20:41,917
CAMARADERIE AT WORK WHICH WE

633
00:20:41,917 --> 00:20:43,418
WILL TALK A BIT ABOUT, AND THEN

634
00:20:43,418 --> 00:20:45,888
THE ABILITY TO DO SORT OF WORK

635
00:20:45,888 --> 00:20:47,723
LIFE INTEGRATION, RIGHT IN WE

636
00:20:47,723 --> 00:20:51,994
DON'T CALL IT BALANCE DWOAR,

637
00:20:51,994 --> 00:20:54,363
ANYMORE, BALANCE IS OUT, WE'VE

638
00:20:54,363 --> 00:20:55,330
MOVED TO EPITHELIALIGRATION, WE

639
00:20:55,330 --> 00:20:57,299
CAN TALK MORE ABOUT THAT AND I

640
00:20:57,299 --> 00:20:58,734
DIDN'T WANT TO GO TOO MUCH INTO

641
00:20:58,734 --> 00:20:59,935
THE LITERATURE ABOUT ALL THESE

642
00:20:59,935 --> 00:21:01,336
DIFFERENT THINGS BECAUSE I THINK

643
00:21:01,336 --> 00:21:03,505
THEY'VE BEEN STUDIED MOSTLY IN

644
00:21:03,505 --> 00:21:04,840
PRACTICES AND HEALTHCARE

645
00:21:04,840 --> 00:21:06,909
SETTINGS VERY DIFFERENT FROM

646
00:21:06,909 --> 00:21:07,376
THEIR WORLD, RIGHT?

647
00:21:07,376 --> 00:21:12,214
IT'S A LOT OF TIMES THINGS

648
00:21:12,214 --> 00:21:15,050
RELATED TO LIKE THE INBASKET,

649
00:21:15,050 --> 00:21:17,052
HOW MANY MESSAGES, PHYSICIANS

650
00:21:17,052 --> 00:21:18,186
ARE GETTING EVERYDAY, IT'S

651
00:21:18,186 --> 00:21:20,322
RELATED TO THINGS LIKE ALTHOUGH

652
00:21:20,322 --> 00:21:22,357
YOU HAVE CHALLENGES WITH YOUR

653
00:21:22,357 --> 00:21:23,692
ELECTRONIC HEALTH RECORD, A LOT

654
00:21:23,692 --> 00:21:25,894
OF IS RELATED TO INEFFICIENCIES

655
00:21:25,894 --> 00:21:27,529
RELATED TO ELECTRONIC HEALTH

656
00:21:27,529 --> 00:21:27,896
RECORD, RIGHT?

657
00:21:27,896 --> 00:21:30,065
SO IT'S A LOT OF THESE VERY

658
00:21:30,065 --> 00:21:32,567
NUANCED THINGS BUT IT'S NOT JUST

659
00:21:32,567 --> 00:21:34,569
THAT, IT'S NOT JUST THE EHR,

660
00:21:34,569 --> 00:21:37,239
IT'S NOT JUST THE IN BASKET,

661
00:21:37,239 --> 00:21:42,311
IT'S THINGS THAT ARE HAPPENING

662
00:21:42,311 --> 00:21:43,645
WITHIN OUR CULTURE.

663
00:21:43,645 --> 00:21:45,514
FOR EXAMPLE IN OUR BIG STUDIES

664
00:21:45,514 --> 00:21:47,516
OF PHYSICIANS WE SAW THAT 20-30%

665
00:21:47,516 --> 00:21:49,718
OF THE PHYSICIANS IN THE LAST

666
00:21:49,718 --> 00:21:51,219
YEAR HAD EXPERIENCED OFFENSIVE

667
00:21:51,219 --> 00:21:53,255
RACIAL ETHNIC REMARKS FROM

668
00:21:53,255 --> 00:21:54,656
PATIENTS, SEXIST REMARK PRS

669
00:21:54,656 --> 00:21:57,092
PATIENTS, FAMILIES OR VISITORS,

670
00:21:57,092 --> 00:21:58,126
UNWANTED SEXUAL ADVANCES AND

671
00:21:58,126 --> 00:22:01,496
EVEN REFUSAL OF CARE, RIGHT?

672
00:22:01,496 --> 00:22:03,031
LIKE A PATIENT SAYING YOU CAN'T

673
00:22:03,031 --> 00:22:04,666
CARE FOR ME BECAUSE YOU KNOW THE

674
00:22:04,666 --> 00:22:05,300
WAY YOU LOOK?

675
00:22:05,300 --> 00:22:06,468
BECAUSE OF YOUR DEMOGRAPHIC

676
00:22:06,468 --> 00:22:08,770
BECAUSE OF YOUR RACE, BECAUSE OF

677
00:22:08,770 --> 00:22:11,206
YOUR ETHNICITY, BECAUSE OF YOUR

678
00:22:11,206 --> 00:22:13,208
DOT, DOT, DOT, PICK IT, RIGHT?

679
00:22:13,208 --> 00:22:15,243
AND THIS IS HAPPENING A LOT TO

680
00:22:15,243 --> 00:22:16,144
OUR HEALTHCARE WORKERS, IT

681
00:22:16,144 --> 00:22:17,746
HAPPENS MORE TO WOMEN, IT

682
00:22:17,746 --> 00:22:19,681
HAPPENS MORE TO RACIAL AND

683
00:22:19,681 --> 00:22:20,615
ETHNIC MINORITY PHYSICIANS, IT

684
00:22:20,615 --> 00:22:22,217
HAPPENS MORE TO OUR YOUNGER

685
00:22:22,217 --> 00:22:23,285
PHYSICIANS, IT HAPPENS MORE TO

686
00:22:23,285 --> 00:22:26,588
OUR PHYSICIANS WHO WORK IN THE

687
00:22:26,588 --> 00:22:28,090
EMERGENCY ROOM, AND THE MORE

688
00:22:28,090 --> 00:22:30,292
THIS HAPPENED, THE HIGHER THE

689
00:22:30,292 --> 00:22:31,927
RISK OF BURN OUT, RIGHT?

690
00:22:31,927 --> 00:22:34,062
THIS IS ANOTHER WORK STRESSOR

691
00:22:34,062 --> 00:22:36,498
THAT EVEN THE PERFECT EHR, IS

692
00:22:36,498 --> 00:22:37,299
NOT GOING TO AFFECT.

693
00:22:37,299 --> 00:22:38,734
THERE ARE THINGS THAT ARE GOING

694
00:22:38,734 --> 00:22:40,135
ON IN OUR CULTURE THAT ARE

695
00:22:40,135 --> 00:22:42,637
CAUSING A LOT OF STRESS AND

696
00:22:42,637 --> 00:22:49,678
DISTRESS FOR OUR HEALTHCARE

697
00:22:49,678 --> 00:22:50,045
TEAM.

698
00:22:50,045 --> 00:22:51,713
AND FRANKLY SOMETIMES WE DO IT

699
00:22:51,713 --> 00:22:52,481
TO EACH OTHER, RIGHT?

700
00:22:52,481 --> 00:22:55,150
WE DO IT TO EACH OTHER, WE SEE

701
00:22:55,150 --> 00:22:56,284
THIS PARTICULARLY IN OUR

702
00:22:56,284 --> 00:22:58,253
REZONING DEBTS THAT THE FEMALE

703
00:22:58,253 --> 00:23:00,889
RESIDENTS HAVE MORE, WE WILL

704
00:23:00,889 --> 00:23:02,324
CALL THEM SUBOPERATING GLOBALLY

705
00:23:02,324 --> 00:23:03,625
MALEXPERIENCES AT WORK WITH

706
00:23:03,625 --> 00:23:05,761
COLLEAGUES AND THESE NEGATIVE

707
00:23:05,761 --> 00:23:06,728
INTERPERSONAL EXPERIENCES, THEY

708
00:23:06,728 --> 00:23:08,964
PREDICT BURN OUT A YEAR LATER

709
00:23:08,964 --> 00:23:11,066
EVEN AFTER WE CONTROL FOR A HOST

710
00:23:11,066 --> 00:23:13,235
OF OTHER FACTORS ISSUES BASE

711
00:23:13,235 --> 00:23:13,935
LINE DEPRESSION, ANXIETY,

712
00:23:13,935 --> 00:23:15,303
QUALITY OF LIFE SCORES, BASE

713
00:23:15,303 --> 00:23:23,745
LINE BURN OUT SCORES.

714
00:23:23,745 --> 00:23:28,650
IT DOESN'T MATTER, WE SEE THEEN

715
00:23:28,650 --> 00:23:29,117
NEGATIVE INTERPERSONAL

716
00:23:29,117 --> 00:23:29,985
EXPERIENCES BETWEEN COLLEAGUES

717
00:23:29,985 --> 00:23:32,687
PREDIBTS BURN OUT AND ALL THIS

718
00:23:32,687 --> 00:23:33,955
DATA AROUND THE IMPLICATIONS TO

719
00:23:33,955 --> 00:23:35,357
QUALITY, SAFETY, ACCESS, YOU

720
00:23:35,357 --> 00:23:38,326
KNOW IT HAS REALLY CULMINATED IN

721
00:23:38,326 --> 00:23:39,461
LEADERS AROUND THE COUNTERRY

722
00:23:39,461 --> 00:23:46,368
SAYING HEY, WE HAVE A PROBLEM

723
00:23:46,368 --> 00:23:47,169
AND WHAT'S IMPORTANT ABOUT THIS

724
00:23:47,169 --> 00:23:48,503
IS WE HAVE A COLLECTIVE

725
00:23:48,503 --> 00:23:49,071
RESPONSIBILITY TO RESPOND.

726
00:23:49,071 --> 00:23:52,441
WHAT WE HAVE TO DO IS STOP

727
00:23:52,441 --> 00:23:53,175
OTHERRING, BLAMING OTHER PEOPLE

728
00:23:53,175 --> 00:23:55,010
ALL THE TIME FOR OUR WORK

729
00:23:55,010 --> 00:23:57,579
STRESS, OR FEELING LIKE THE

730
00:23:57,579 --> 00:23:57,879
VICTIM.

731
00:23:57,879 --> 00:23:59,781
WHAT WE NEED TO DO IS FIGURE OUT

732
00:23:59,781 --> 00:24:02,551
HOW TO LEAN IN, HOW TO DO WHAT

733
00:24:02,551 --> 00:24:04,052
WE CAN IN OUR SPIRIT OF CONTROL,

734
00:24:04,052 --> 00:24:06,188
HOW WE CAN BETTER INFLUENCE, AND

735
00:24:06,188 --> 00:24:08,256
HOW WE CAN BETTER ADVOCATE ON

736
00:24:08,256 --> 00:24:09,458
THINGS THAT ARE OUTSIDE THE

737
00:24:09,458 --> 00:24:12,360
CONTROL OF OUR EMPLOYER.

738
00:24:12,360 --> 00:24:14,963
SO THAT GETS ME TO WHAT I REALLY

739
00:24:14,963 --> 00:24:18,366
WANT TO TALK ABOUT WHICH IS THE

740
00:24:18,366 --> 00:24:19,267
NOW WHAT, BUT IT IS IMPORTANT

741
00:24:19,267 --> 00:24:20,702
THAT WE ALL HAVE A COMMON

742
00:24:20,702 --> 00:24:22,838
DEFINITION OF BURN OUT, IT IS

743
00:24:22,838 --> 00:24:25,407
BRNT THAT WE ALL UNDERSTAND ITS

744
00:24:25,407 --> 00:24:26,441
PREVALENCE AND ITS CONSEQUENCES

745
00:24:26,441 --> 00:24:28,110
SO WE CAN GET TO THE REALLY

746
00:24:28,110 --> 00:24:28,977
IMPORTANT WORK OF STARTING TO

747
00:24:28,977 --> 00:24:30,212
FIGURE OUT WHAT ARE POSSIBLE

748
00:24:30,212 --> 00:24:32,814
APPROACHES TO THINK ABOUT THIS.

749
00:24:32,814 --> 00:24:34,416
I WANT TO JUST BRIEFLY TAKE YOU

750
00:24:34,416 --> 00:24:36,118
A LITTLE BIT ON THE JOURNEY I'VE

751
00:24:36,118 --> 00:24:39,121
BEEN ON, SO I STARTED DOING THIS

752
00:24:39,121 --> 00:24:40,288
RESEARCH ABOUT 20-22 YEARS AGO.

753
00:24:40,288 --> 00:24:42,624
AND YOU KNOW WE DID A LOT OF

754
00:24:42,624 --> 00:24:44,126
STUDIES JUST DOCUMENTING THE

755
00:24:44,126 --> 00:24:45,127
PREVALENCE, STARTING TO SAY,

756
00:24:45,127 --> 00:24:46,461
WHAT ARE SOME OF THE

757
00:24:46,461 --> 00:24:48,864
ASSOCIATIONS WITH THINGS THAT

758
00:24:48,864 --> 00:24:49,698
PEOPLE CARE ABOUT.

759
00:24:49,698 --> 00:24:51,867
THE AMA STARTED TO GET ONBOARD

760
00:24:51,867 --> 00:24:53,602
AND THEY MADE THEIR PATHWAY, YOI

761
00:24:53,602 --> 00:24:55,904
IN MEDICINE PATHWAY TO TRY TO

762
00:24:55,904 --> 00:24:57,839
GET HEALTHCARE ORGANIZATIONS TO

763
00:24:57,839 --> 00:24:58,607
ENGAGE IN CHANGE.

764
00:24:58,607 --> 00:25:01,610
WE THEN SPENT A COUPLE YEARS

765
00:25:01,610 --> 00:25:04,079
GOING TO NAM AND GOING BACK AND

766
00:25:04,079 --> 00:25:06,281
FORTH COAST TO COAST AND HAVING

767
00:25:06,281 --> 00:25:13,522
MEETINGS AND READING 5000

768
00:25:13,522 --> 00:25:16,191
ARTICLES READING THINGS AROUND

769
00:25:16,191 --> 00:25:16,992
THE CONSENSUS REPORT.

770
00:25:16,992 --> 00:25:22,130
THEN WE GOT THE SURGEON GENERAL

771
00:25:22,130 --> 00:25:23,632
INVOLVED, KEN MURPHY IS GREAT

772
00:25:23,632 --> 00:25:27,502
WITH THIS WORK, THE INI GOT

773
00:25:27,502 --> 00:25:28,803
INVOLVED THE NATIONAL ACADEMY OF

774
00:25:28,803 --> 00:25:29,971
MEDICINE IS IN ON IT, THEY HAVE

775
00:25:29,971 --> 00:25:32,541
A PLAN FOR WORKFORCE WELL BEING

776
00:25:32,541 --> 00:25:33,808
TRYING TO GALVANIZE ACTION AT

777
00:25:33,808 --> 00:25:35,610
ALL LEVELS OF THE SYSTEM THROUGH

778
00:25:35,610 --> 00:25:41,883
THE UNITED STATES. 

779
00:25:41,883 --> 00:25:44,719
WE HAVE LOR NA BREENE, DOING

780
00:25:44,719 --> 00:25:46,254
WORK FOR OTHER HEALTHCARE

781
00:25:46,254 --> 00:25:47,556
WORKERS AND U.S. NEWS AND WORLD

782
00:25:47,556 --> 00:25:50,225
REPORT AS EVEN GOTTEN INTO IT

783
00:25:50,225 --> 00:25:55,297
NOW THIS MAY NOT BE SUPER REEL

784
00:25:55,297 --> 00:25:55,530
 SUPER

785
00:25:55,530 --> 00:25:58,133
RELEVANT TO YOU BUT A LOT OF

786
00:25:58,133 --> 00:25:59,201
HOSPITALS ARE CONCERNED ABOUT

787
00:25:59,201 --> 00:26:00,502
THEIR RATINGS, YOU CAN ARGUE

788
00:26:00,502 --> 00:26:03,138
ABOUT THE PROS AND CONS OF THE

789
00:26:03,138 --> 00:26:04,439
RATINGS, HOW MUCH CAN YOU GAIN

790
00:26:04,439 --> 00:26:06,408
IN THE SYSTEM, BUT NONETHELESS,

791
00:26:06,408 --> 00:26:08,443
THESE MATTER TO THE CSUITE, AND

792
00:26:08,443 --> 00:26:10,645
AS NIEWZ AND WORLD REPORTS

793
00:26:10,645 --> 00:26:12,714
REPORT, THE RATING SYSTEM

794
00:26:12,714 --> 00:26:13,882
INCLUDES DO HAVE YOU ANYTHING

795
00:26:13,882 --> 00:26:15,483
GOING ON TO PROMOTE A POSITIVE

796
00:26:15,483 --> 00:26:17,052
WORK ENVIRONMENT AND TO

797
00:26:17,052 --> 00:26:17,752
ENCOURAGE WELL BEING?

798
00:26:17,752 --> 00:26:19,821
THEY ALSO HAVE A QUESTION ABOUT

799
00:26:19,821 --> 00:26:24,593
DO YOU HAVE ANYTHING GOING ON?

800
00:26:24,593 --> 00:26:27,329
SO IT'S STARTING TO GET ON THE

801
00:26:27,329 --> 00:26:29,064
AGENDA WHICH IS REALLY

802
00:26:29,064 --> 00:26:29,331
IMPORTANT.

803
00:26:29,331 --> 00:26:32,701
SO HOW IS THIS STUFF HELPFUL?

804
00:26:32,701 --> 00:26:34,302
WELL IT'S HELPFUL BECAUSE THE

805
00:26:34,302 --> 00:26:35,737
VERY OUTER CIRCLE OF THE THINGS

806
00:26:35,737 --> 00:26:38,273
THAT GIVE US WORK STRESS ARE NOT

807
00:26:38,273 --> 00:26:40,342
DIRECTLY IN CONTROL OF OUR

808
00:26:40,342 --> 00:26:42,310
EMPLOYER OF A HEALTHCARE

809
00:26:42,310 --> 00:26:42,644
ORGANIZATION.

810
00:26:42,644 --> 00:26:44,112
THEY RELATE TO THINGS THAT ARE

811
00:26:44,112 --> 00:26:47,148
GOING ON AT CMS, AT THE JOINT

812
00:26:47,148 --> 00:26:49,217
COMMISSION, AT STATE MEDICAL

813
00:26:49,217 --> 00:26:52,787
LICENSE BOARDS AT BOARD

814
00:26:52,787 --> 00:26:53,588
CERTIFICATION ORGANIZATIONS, AND

815
00:26:53,588 --> 00:26:56,891
IT'S IMPORTANT TO GET THIS OUTER

816
00:26:56,891 --> 00:26:58,126
CIRCLE ENGAGED BECAUSE ALL THE

817
00:26:58,126 --> 00:27:01,429
CIRCLES NEED TO PLAY TOGETHER TO

818
00:27:01,429 --> 00:27:02,697
REDUCE THE WORK STRESS.

819
00:27:02,697 --> 00:27:05,700
WE WILL ALSO TALK MOSTLY ABOUT

820
00:27:05,700 --> 00:27:06,768
HEALTHCARE ORGANIZATIONS BECAUSE

821
00:27:06,768 --> 00:27:09,037
I THINK THAT'S THE PIECE THAT

822
00:27:09,037 --> 00:27:10,071
MAYBE IS MOST TRANSLATABLE TO

823
00:27:10,071 --> 00:27:11,539
YOUR WORK HERE, AND THEN WE'RE

824
00:27:11,539 --> 00:27:12,941
GOING TO FOCUS ON THAT INNER

825
00:27:12,941 --> 00:27:17,245
CIRCLE WHICH HAS MORE TO DO WITH

826
00:27:17,245 --> 00:27:17,846
UNITS WITH TEAMS.

827
00:27:17,846 --> 00:27:21,249
SO IN ALL OF THESE EXPERT

828
00:27:21,249 --> 00:27:22,884
OPINIONS FROM THE NATIONAL

829
00:27:22,884 --> 00:27:24,286
ACADEMY OF MEDICINE, TO THE U.S.

830
00:27:24,286 --> 00:27:26,121
SURGEON GENERAL, TO THE AMA, TO

831
00:27:26,121 --> 00:27:30,125
THE IHI, TO THE CDC, NIASH,

832
00:27:30,125 --> 00:27:30,959
TOTAL HEALTH WORKER PROGRAM,

833
00:27:30,959 --> 00:27:33,395
THEY ALL HAVE THE SAME FRAMEWORK

834
00:27:33,395 --> 00:27:35,096
FOR HOW TO IMPROVE A WORK

835
00:27:35,096 --> 00:27:36,931
ENVIRONMENT.

836
00:27:36,931 --> 00:27:41,002
IT'S ALL THE SAME AND IT

837
00:27:41,002 --> 00:27:42,003
BASICALLY--1 TAKES LEADERSHIP,

838
00:27:42,003 --> 00:27:43,104
IT TAKES COMMITMENT FROM THE TOP

839
00:27:43,104 --> 00:27:45,640
AND WITHOUT THAT, IT'S REALLY,

840
00:27:45,640 --> 00:27:47,676
REALLY HARD TO GET ANYTHING DONE

841
00:27:47,676 --> 00:27:49,811
EMPLOY SO LEADERSHIP COMMITMENT.

842
00:27:49,811 --> 00:27:50,979
IT TAKES INFRASTRUCTURE, LIKE

843
00:27:50,979 --> 00:27:52,480
YOU HAVE INFRASTRUCTURE TO

844
00:27:52,480 --> 00:27:54,082
IMPROVE QUALITY AND SAFETY, YOU

845
00:27:54,082 --> 00:27:54,949
NEED INFRASTRUCTURE TO IMPROVE

846
00:27:54,949 --> 00:27:56,985
THE WORK AND LEARNING

847
00:27:56,985 --> 00:27:58,420
ENVIRONMENT.

848
00:27:58,420 --> 00:27:59,521
IT TAKES MEASUREMENT AS IN

849
00:27:59,521 --> 00:28:01,756
QUALITY, YOU NEED TO KNOW WHERE

850
00:28:01,756 --> 00:28:02,791
YOU'RE AT, WHAT'S CONTRIBUTING

851
00:28:02,791 --> 00:28:04,659
TO IT AND HOW AND IF WHEN YOU

852
00:28:04,659 --> 00:28:06,361
MOVE FORWARD, IT MAKES A

853
00:28:06,361 --> 00:28:06,795
DIFFERENCE OR NOT.

854
00:28:06,795 --> 00:28:09,464
AND THEN IT TAKES A SYSTEM LEVEL

855
00:28:09,464 --> 00:28:10,365
ACTION THATIME GOING TO TALK

856
00:28:10,365 --> 00:28:15,670
ABOUT AND GIVE YOU SOME EXAMPLES

857
00:28:15,670 --> 00:28:15,837
FOR.

858
00:28:15,837 --> 00:28:19,040
SO THERE NEEDS TO BE THIS

859
00:28:19,040 --> 00:28:20,208
ORGANIZATIONAL WEALTH, THERE

860
00:28:20,208 --> 00:28:21,609
NEEDS TO BE BUY-IN THAT THE

861
00:28:21,609 --> 00:28:23,611
LEVEL OF OF WELL BEING IN YOUR

862
00:28:23,611 --> 00:28:25,680
WORKFORCE MAKES A DIFFERENCE IN

863
00:28:25,680 --> 00:28:26,448
THE MISSION, RIGHT?

864
00:28:26,448 --> 00:28:28,583
THERE NEEDS TO BE THIS ALIGNMENT

865
00:28:28,583 --> 00:28:30,352
BETWEEN THE DECISIONS THAT TOP

866
00:28:30,352 --> 00:28:31,353
LEADERSHIPS MAKE AND THE VALUES

867
00:28:31,353 --> 00:28:34,689
THAT ARE ON THE STATIONARY,

868
00:28:34,689 --> 00:28:34,889
RIGHT?

869
00:28:34,889 --> 00:28:35,190
RIGHT?

870
00:28:35,190 --> 00:28:36,758
THAT NEEDS TO BE ALIGNED AND WE

871
00:28:36,758 --> 00:28:38,026
NEED TO MEASURE WELL BEING AND

872
00:28:38,026 --> 00:28:43,264
HAVE IT BE PART OF OUR ROUTINE

873
00:28:43,264 --> 00:28:43,798
ORGANIZATIONAL PERFORMANCE

874
00:28:43,798 --> 00:28:44,032
METRIC.

875
00:28:44,032 --> 00:28:46,000
LIKE WE HAVE FOR EXAMPLE, LENGTH

876
00:28:46,000 --> 00:28:47,001
OF STAY AND THINGS OF THAT

877
00:28:47,001 --> 00:28:49,938
NATURE IN THE PATIENT REALM.

878
00:28:49,938 --> 00:28:52,140
AND IT TAKES SOMEONE DRIVING THE

879
00:28:52,140 --> 00:28:54,909
BUS, RIGHT IN IT TAKES

880
00:28:54,909 --> 00:28:57,011
INFRASTRUCTURE LIKE WE HAVE FOR

881
00:28:57,011 --> 00:28:58,613
FINANCE, QUALITY, OTHER THINGS

882
00:28:58,613 --> 00:28:59,914
IN HEALTHCARE, IT DOES TAKE

883
00:28:59,914 --> 00:29:01,383
SOMEONE WHO'S LEADING IT AND IT

884
00:29:01,383 --> 00:29:03,385
CAN JUST BE 1 PERSON DRIVING A

885
00:29:03,385 --> 00:29:03,885
BUS ALIGN.

886
00:29:03,885 --> 00:29:05,520
THERE NEEDS TO BE OTHER PEOPLE

887
00:29:05,520 --> 00:29:09,591
ON THAT BUS WITH YOU WHICH IS

888
00:29:09,591 --> 00:29:13,461
CUT THROUGH THAT LENS OF

889
00:29:13,461 --> 00:29:14,329
LEADERSHIP DISTRIBUTEMENT.

890
00:29:14,329 --> 00:29:16,798
SO THIS IS OFTEN CONCEPTUALIZED

891
00:29:16,798 --> 00:29:20,235
AS LEADERS WITHIN WORK UNITS

892
00:29:20,235 --> 00:29:22,504
THEY CAN HAVE A VARIETY OF

893
00:29:22,504 --> 00:29:23,872
DIFFERENT ROLES, INCLUDING

894
00:29:23,872 --> 00:29:25,306
FINDINGS FROM SURVEYS, MOST

895
00:29:25,306 --> 00:29:26,207
IMPORTANTLY LEADING LOCAL

896
00:29:26,207 --> 00:29:28,710
IMPROVEMENT EFFORTS AND I WILL

897
00:29:28,710 --> 00:29:29,511
SHARE EXAMPLES OF THAT.

898
00:29:29,511 --> 00:29:31,312
THEY CAN ALSO DO WORK IN TERMS

899
00:29:31,312 --> 00:29:33,281
OF CULTIVATING COMMUNITY WHICH

900
00:29:33,281 --> 00:29:35,417
IS INCREDIBLY IMPORTANT, SHARING

901
00:29:35,417 --> 00:29:41,122
RESOURCES, FOR WHERE TO GET

902
00:29:41,122 --> 00:29:42,824
HELP, AND WE NEED TO MEASURE,

903
00:29:42,824 --> 00:29:44,526
RIGHT IN WE NEED TO MEASURE

904
00:29:44,526 --> 00:29:45,827
WHERE WE'RE AT SO WE KNOW IF

905
00:29:45,827 --> 00:29:47,462
WHAT WE'RE DOING IS MAKING A

906
00:29:47,462 --> 00:29:47,829
DIFFERENCE.

907
00:29:47,829 --> 00:29:50,598
SO WE CAN TALK SOME ABOUT

908
00:29:50,598 --> 00:29:51,733
POTENTIAL DIFFERENT TOOLS TO DO

909
00:29:51,733 --> 00:29:52,834
THAT, AND ULTIMATELY IT TAKES

910
00:29:52,834 --> 00:29:55,403
THIS MODEL OF DRIEWBTED

911
00:29:55,403 --> 00:29:55,904
LEADERSHIP.

912
00:29:55,904 --> 00:29:57,939
SO LET'S GET MORE PRAGMATIC,

913
00:29:57,939 --> 00:29:58,139
RIGHT?

914
00:29:58,139 --> 00:29:59,908
SO WHAT DO I MEAN BY ALL THESE

915
00:29:59,908 --> 00:30:01,709
THINGS, WHAT ARE EXAMPLES OF

916
00:30:01,709 --> 00:30:02,811
WHAT'S GOING ON OUTSIDE OF THE

917
00:30:02,811 --> 00:30:05,880
ISLAND OF THE NIH IN YOU KNOW TO

918
00:30:05,880 --> 00:30:07,215
HELP IMPROVE THE WORK

919
00:30:07,215 --> 00:30:07,515
ENVIRONMENT?

920
00:30:07,515 --> 00:30:09,818
SO THIS IS AN EXAMPLE FROM GROUP

921
00:30:09,818 --> 00:30:12,086
HEALTH AND IF YOU WORK IN THE

922
00:30:12,086 --> 00:30:13,154
OUTPATIENT SETTING AS ANY TYPE

923
00:30:13,154 --> 00:30:14,389
OF CLINICIAN, YOU ARE PROBABLY

924
00:30:14,389 --> 00:30:18,293
LIKE, OKAY, I WANT MOST OF THOSE

925
00:30:18,293 --> 00:30:18,793
THINGS, RIGHT?

926
00:30:18,793 --> 00:30:20,462
FOR ME, I'M A GENERAL INTERNIST,

927
00:30:20,462 --> 00:30:23,465
I TAKE CARE OF PATIENTS AT

928
00:30:23,465 --> 00:30:27,869
LOWRY, AN OUTPATIENT SETTING,

929
00:30:27,869 --> 00:30:29,637
I'M LIKE UH-UHH, I WANT ALL

930
00:30:29,637 --> 00:30:29,971
THOSE THINGS.

931
00:30:29,971 --> 00:30:31,739
O GROUP HEALTH IMPLEMENTED ALL

932
00:30:31,739 --> 00:30:34,843
THOSE THINGS AND THEN THEY DID A

933
00:30:34,843 --> 00:30:36,478
PRE-POST DESIGN AND SAW THE

934
00:30:36,478 --> 00:30:37,645
PATIENT EXPERIENCE WENT UP, THEY

935
00:30:37,645 --> 00:30:39,113
SAW THAT THE COST OF CARE WENT

936
00:30:39,113 --> 00:30:41,216
DOWN AND THEY SAW THAT THEIR

937
00:30:41,216 --> 00:30:44,652
BURN OUT AND HEALTHCARE WORKERS

938
00:30:44,652 --> 00:30:45,420
IMPROVED.

939
00:30:45,420 --> 00:30:45,854
SO IT'S POSSIBLE.

940
00:30:45,854 --> 00:30:49,290
THEY'RE EVEN GETTING INTO IT AT

941
00:30:49,290 --> 00:30:50,291
THE VA.

942
00:30:50,291 --> 00:30:54,062
THEY DID THIS INITIATIVE CALLED

943
00:30:54,062 --> 00:30:56,364
CREW, CIVILITY, RESPECT AND

944
00:30:56,364 --> 00:30:58,166
ENGAGEMENT, SO YOU MIGHT HAVE

945
00:30:58,166 --> 00:30:59,300
HEARD ABOUT HUDDLES, THEY GET

946
00:30:59,300 --> 00:31:00,301
EVERYBODY ON TRACK WITH WHATEVER

947
00:31:00,301 --> 00:31:01,836
WE'RE GOING TO DO WITH THE

948
00:31:01,836 --> 00:31:03,271
PATIENTS TODAY, THIS WAS KIND OF

949
00:31:03,271 --> 00:31:04,506
LIKE THAT, EXCEPT IT WAS MORE

950
00:31:04,506 --> 00:31:06,274
FOCUSED ON HOW ARE WE GOING TO

951
00:31:06,274 --> 00:31:06,741
WORK TOGETHER, TODAY.

952
00:31:06,741 --> 00:31:08,276
WHAT ARE THE THINGS THAT WE'RE

953
00:31:08,276 --> 00:31:10,245
TRYING TO IMPROVE TOGETHER TO

954
00:31:10,245 --> 00:31:12,947
CARE FOR OUR PATIENTS, RIGHT?

955
00:31:12,947 --> 00:31:14,649
AND THEY FOUND THAT WITH THIS

956
00:31:14,649 --> 00:31:16,284
SORT OF, YOU KNOW CREW

957
00:31:16,284 --> 00:31:18,052
INITIATIVE, THEY DID HAVE

958
00:31:18,052 --> 00:31:20,121
FACILITATORS, THAT THEY WERE

959
00:31:20,121 --> 00:31:21,589
ACTUALLY ABLE TO REALLY, TO MOVE

960
00:31:21,589 --> 00:31:24,125
THE NEEDLE ON SOME OF THESE

961
00:31:24,125 --> 00:31:25,226
IMPORTANT MATTERS.

962
00:31:25,226 --> 00:31:26,327
SO THE CANADIAN LIKE WHAT WAS

963
00:31:26,327 --> 00:31:28,863
GOING ON AT THE VA AND THEY

964
00:31:28,863 --> 00:31:30,198
IMPLEMENTED IT IN THEIR

965
00:31:30,198 --> 00:31:31,032
HEALTHCARE SYSTEM, AND THEY SAW

966
00:31:31,032 --> 00:31:33,034
THAT THEY WERE ABLE TO DECREASE

967
00:31:33,034 --> 00:31:34,702
CYNICISM WHICH IS THAT 1

968
00:31:34,702 --> 00:31:37,005
COMPONENT OF BURN OUT, BUT

969
00:31:37,005 --> 00:31:40,008
IMPORTANTLY THEY COULD INCREASE

970
00:31:40,008 --> 00:31:41,342
SATISFACTION WITH BEING EMPLOYED

971
00:31:41,342 --> 00:31:42,877
AT THE CANADIAN HEALTHCARE

972
00:31:42,877 --> 00:31:44,379
SYSTEM AND THEY REDUCED

973
00:31:44,379 --> 00:31:54,088
ABSENTEEISM WHICH WAS A BIG

974
00:31:54,088 --> 00:31:56,257
ISSUE FOR THEM.

975
00:31:56,257 --> 00:31:57,926
IN COLORADO WE HAVE SPRINT

976
00:31:57,926 --> 00:31:59,260
TEAMS, SO SO IT TAKES TRAINING

977
00:31:59,260 --> 00:32:04,165
ME AS A CLINICIAN TO USE THE

978
00:32:04,165 --> 00:32:04,866
ELECTRONIC HEALTH RECORD BETTER

979
00:32:04,866 --> 00:32:07,235
AND I'M A RELUCTANT LEARNER.

980
00:32:07,235 --> 00:32:09,237
IT ALSO TAKES BELLING THINGS

981
00:32:09,237 --> 00:32:10,638
WITH THE ELECTRONIC HEALTH

982
00:32:10,638 --> 00:32:11,806
RECORD WE CALL CONFIGURURATIONS

983
00:32:11,806 --> 00:32:13,975
SO THE SYSTEM WORKS BETTER FOR

984
00:32:13,975 --> 00:32:15,376
ME IN MY PRACTICE AND THEN IT

985
00:32:15,376 --> 00:32:17,378
TAKES SOME SORT OF SYSTEM

986
00:32:17,378 --> 00:32:19,080
DISTRIBUTION, YOU KNOW DOES THAT

987
00:32:19,080 --> 00:32:21,482
MESSAGE GO FIRST TO THE DOC OR

988
00:32:21,482 --> 00:32:24,986
THE MEDICAL ASSISTANT OR KIND OF

989
00:32:24,986 --> 00:32:26,287
THE WORK FLOW PIECES AND WHAT

990
00:32:26,287 --> 00:32:27,689
THEY WERE ABLE TO SHOW IN

991
00:32:27,689 --> 00:32:29,457
COLORADO WITH THE SPRINT TEAM

992
00:32:29,457 --> 00:32:32,260
SYSTEM THAT IT REDUCED BIRN OUT

993
00:32:32,260 --> 00:32:33,795
AMONG THE CLINICAL WORKFORCE BY

994
00:32:33,795 --> 00:32:34,462
INVESTING AND THINKING ABOUT

995
00:32:34,462 --> 00:32:36,230
WHAT CAN WE REALLY DO TO

996
00:32:36,230 --> 00:32:37,732
OPTIMIZE THE ELECTRONIC HEALTH

997
00:32:37,732 --> 00:32:40,268
RECORD WITHIN PRIMARY CARE,

998
00:32:40,268 --> 00:32:44,005
WITHIN GI, WITHIN PULMONARY AND

999
00:32:44,005 --> 00:32:45,306
CRITICAL CARE, OTHER HEALTH

1000
00:32:45,306 --> 00:32:48,142
SYSTEMS HAVE USED WHAT'S CALLED

1001
00:32:48,142 --> 00:32:49,978
GROWTH, IT WAS PUBLISHED IN THE

1002
00:32:49,978 --> 00:32:52,814
NEW LINE JOURNAL MEDICINE, YOU

1003
00:32:52,814 --> 00:32:54,148
WILL GET TO THE ARTICLE, NOW

1004
00:32:54,148 --> 00:32:56,517
PEOPLE ARE GOING, WE SHOULD CALL

1005
00:32:56,517 --> 00:33:00,121
IT GROW, WHATEVER, YOU KNOW,

1006
00:33:00,121 --> 00:33:02,357
IT'S CALLED IMROAGHTS, GETTING

1007
00:33:02,357 --> 00:33:03,558
RID OF TIEWP EDUCATIONAL STUFF.

1008
00:33:03,558 --> 00:33:04,926
SO THE SYSTEM HERE IS YOU ASK

1009
00:33:04,926 --> 00:33:06,694
EVERYBODY, BOOTS ON THE GROUND,

1010
00:33:06,694 --> 00:33:08,863
WHAT'S THE STUPID STUFF, YOU

1011
00:33:08,863 --> 00:33:10,031
SOLICIT ALL THESE COMMENTS AND

1012
00:33:10,031 --> 00:33:13,835
YOU PUT THE COMEBTS INTO 3

1013
00:33:13,835 --> 00:33:15,703
BUCKYS, THE BUCKET OF OH YEAH,

1014
00:33:15,703 --> 00:33:17,271
THAT'S STUPID AND WE SHOULD HAVE

1015
00:33:17,271 --> 00:33:18,272
FIXED THAT A LONG TIME AGO AND

1016
00:33:18,272 --> 00:33:19,974
WE SHOULD HAVE FIXED THAT.

1017
00:33:19,974 --> 00:33:21,609
THE SECOND BUCKET IS YEAH,

1018
00:33:21,609 --> 00:33:23,544
THAT'S STUPID BUT WE NEED A

1019
00:33:23,544 --> 00:33:24,812
COMMITTEE TO FIGURE OUT THE HOE

1020
00:33:24,812 --> 00:33:26,614
PROS AND CONS AND HOW WE WOULD

1021
00:33:26,614 --> 00:33:27,548
FIX THAT AND IMPLEMENT THAT AND

1022
00:33:27,548 --> 00:33:28,516
HOW IT WOULD WORK.

1023
00:33:28,516 --> 00:33:29,617
AND THEN WE HAVE THE YEAH,

1024
00:33:29,617 --> 00:33:30,284
THAT'S TIEWP EDUCATIONAL ABOUT

1025
00:33:30,284 --> 00:33:31,853
YOU THAT WILL TAKE A GAZILLION

1026
00:33:31,853 --> 00:33:33,054
DOLLARS, WE WILL PUT THAT IN THE

1027
00:33:33,054 --> 00:33:36,324
PARKING LOT AND HOPE THAT AI

1028
00:33:36,324 --> 00:33:37,058
SOLVES IT, RIGHT?

1029
00:33:37,058 --> 00:33:39,227
AND SO THIS KIND OF STRATEGY HAS

1030
00:33:39,227 --> 00:33:40,862
BEEN SHOWN IN DIFFERENT MULTIPLE

1031
00:33:40,862 --> 00:33:43,831
ORGANIZATIONS TO ACTUALLY LEAD

1032
00:33:43,831 --> 00:33:44,532
TO MEANINGFUL INPROVEMENT

1033
00:33:44,532 --> 00:33:46,668
PARTICULARLY WITH RESPECT TO THE

1034
00:33:46,668 --> 00:33:47,669
ELECTRONIC HEALTH RECORD SO

1035
00:33:47,669 --> 00:33:49,270
GETTING RID OF STUPID CLICKS AND

1036
00:33:49,270 --> 00:33:50,938
GETTING RID OF OTHER THINGS THAT

1037
00:33:50,938 --> 00:33:53,107
ARE DRIVING US NUTS, THE 10,000

1038
00:33:53,107 --> 00:33:53,408
PAPER CUTS.

1039
00:33:53,408 --> 00:33:54,342
BUT SOMETIMES WHEN PEOPLE HAVE

1040
00:33:54,342 --> 00:33:56,611
DONE THESE SORT OF GROWTH

1041
00:33:56,611 --> 00:33:57,945
INITIATIVES, AND YOU GO TO

1042
00:33:57,945 --> 00:34:02,784
ADMINITRATION WITH YOUR GREAT

1043
00:34:02,784 --> 00:34:04,619
IDEAS, ADMINISTRATION SAYS,

1044
00:34:04,619 --> 00:34:06,320
THERE'S A RULE, THERE'S A

1045
00:34:06,320 --> 00:34:09,624
REGULATION, WE CAN'T POSSIBLY

1046
00:34:09,624 --> 00:34:12,060
CHANGE THAT.

1047
00:34:12,060 --> 00:34:14,595
SO DON BERWICK IN HIS GREATNESS

1048
00:34:14,595 --> 00:34:17,198
ASKED A BUNCH OF HEALTHCARE

1049
00:34:17,198 --> 00:34:18,266
ORGANIZATIONS TO COME UP WITH

1050
00:34:18,266 --> 00:34:19,033
RULES AND REGULATIONS THAT ARE

1051
00:34:19,033 --> 00:34:21,235
GETTING IN THE WAY OF THE

1052
00:34:21,235 --> 00:34:22,036
PATIENT CLINICIAN EXPERIENCE.

1053
00:34:22,036 --> 00:34:24,906
HE THEN TOOK ALL THESE RULES AND

1054
00:34:24,906 --> 00:34:25,840
REGULATIONS AND ACTUALLY WENT TO

1055
00:34:25,840 --> 00:34:28,276
CHECK IF THEY WERE REALLY RULES

1056
00:34:28,276 --> 00:34:30,044
AND REGULATIONS.

1057
00:34:30,044 --> 00:34:36,317
AND WHAT THEY FOUND IS THAT 80%

1058
00:34:36,317 --> 00:34:38,553
OF THESE WERE NOT RULES AND

1059
00:34:38,553 --> 00:34:40,722
REGULATION OUTSIDE OF A SPECIFIC

1060
00:34:40,722 --> 00:34:42,990
ORGANIZATION, THEY DID NOT

1061
00:34:42,990 --> 00:34:45,193
RELATE TO JACO OR CMS, THEY WERE

1062
00:34:45,193 --> 00:34:47,762
PURELY MADE UP OR HISTORICAL.

1063
00:34:47,762 --> 00:34:50,531
AND ONLY, YOU KNOW ABOUT 1 IN 5

1064
00:34:50,531 --> 00:34:52,500
WERE REALLY STATUTORY REGULATORY

1065
00:34:52,500 --> 00:34:54,068
REQUIREMENTS.

1066
00:34:54,068 --> 00:34:55,770
SO WE HAVE SOME MYTH BUSTING TO

1067
00:34:55,770 --> 00:34:56,904
DO IN MEDICINE ABOUT WHAT ARE

1068
00:34:56,904 --> 00:34:59,107
REALLY RULES AND REGULATIONS.

1069
00:34:59,107 --> 00:35:00,575
AND THE AMA, YOU DON'T DO A

1070
00:35:00,575 --> 00:35:03,277
MEMBER OF THE AMA, TO ACCESS ANY

1071
00:35:03,277 --> 00:35:05,179
OF THESE SORT OF RESOURCES, BUT

1072
00:35:05,179 --> 00:35:08,249
THEY HAVE A WHOLE PAGE THAT THEY

1073
00:35:08,249 --> 00:35:10,118
KEEP BELLING ABOUT REGULATORY

1074
00:35:10,118 --> 00:35:12,320
MYTHS AND HOW TO DEBUNK THEM AND

1075
00:35:12,320 --> 00:35:13,688
WHAT THE BACKGROUND IS THAT ARE

1076
00:35:13,688 --> 00:35:15,757
REALLY WELL VETTED SO IT MIGHT

1077
00:35:15,757 --> 00:35:17,492
BE A USEFUL RESOURCE FOR SOME OF

1078
00:35:17,492 --> 00:35:17,792
YOU.

1079
00:35:17,792 --> 00:35:20,895
AND THEN WE NEED TO CONTINUE TO

1080
00:35:20,895 --> 00:35:22,296
ADDRESS THIS MISTREATMENT THAT'S

1081
00:35:22,296 --> 00:35:23,698
GOING ON.

1082
00:35:23,698 --> 00:35:24,165
RIGHT?

1083
00:35:24,165 --> 00:35:25,666
THE MAIORITY OF MISTREATMENT

1084
00:35:25,666 --> 00:35:26,601
THAT HAPPENS TO HEALTHCARE

1085
00:35:26,601 --> 00:35:28,703
WORKERS IS COMING FROM PATIENTS,

1086
00:35:28,703 --> 00:35:30,271
FAMILY ANDS VISITORS, SO WE NEED

1087
00:35:30,271 --> 00:35:31,372
TO MAKE SURE SHOULD CLINICAL

1088
00:35:31,372 --> 00:35:32,874
SPACES THAT WE HAVE THE RIGHT

1089
00:35:32,874 --> 00:35:34,575
TYPE OF PROCEDURES AND POLICIES

1090
00:35:34,575 --> 00:35:37,378
IN PLACE, AND THAT ALL OF US ARE

1091
00:35:37,378 --> 00:35:40,882
EDUCATED IN HOW TO BE AN

1092
00:35:40,882 --> 00:35:46,721
UPSTANDER AND BY STANDER AND HOW

1093
00:35:46,721 --> 00:35:48,556
TO TOW THE LINE WITH PATIENTS

1094
00:35:48,556 --> 00:35:49,624
AND HOW TO UNDERSTAND THOSE

1095
00:35:49,624 --> 00:35:50,591
CONVERSATIONS WITH THE WORK

1096
00:35:50,591 --> 00:35:51,826
ENVIRONMENT AND THERE'S LOT OFS

1097
00:35:51,826 --> 00:35:54,228
OF WORK GOING ON IN THIS NATION

1098
00:35:54,228 --> 00:35:55,763
IN THIS FIELD BECAUSE IT'S ABOUT

1099
00:35:55,763 --> 00:35:57,799
BECOME A VERY BIG ISSUE.

1100
00:35:57,799 --> 00:36:00,001
WE ALSO KNOW THAT LEADERS MATTER

1101
00:36:00,001 --> 00:36:01,803
AND THIS IS ANOTHER REALLY

1102
00:36:01,803 --> 00:36:03,504
IMPORTANT PART OF THE STRATEGY,

1103
00:36:03,504 --> 00:36:05,840
SO HOW I RATE MY IMMEDIATE SUPER

1104
00:36:05,840 --> 00:36:08,276
VISOR IS A PREDICTER OF MY BURN

1105
00:36:08,276 --> 00:36:12,180
OUT AND MY SATISFACTION WITH MY

1106
00:36:12,180 --> 00:36:12,580
EMPLOYER.

1107
00:36:12,580 --> 00:36:15,249
THAT'S ALSO TRUE WHEN WE ASK

1108
00:36:15,249 --> 00:36:16,450
42,000 NONPHYSICIAN HEALTHCARE

1109
00:36:16,450 --> 00:36:17,952
WORKERS, IT'S ALSO TRUE WHEN WE

1110
00:36:17,952 --> 00:36:20,822
ASK RESIDENTS AND FELLOWS TO

1111
00:36:20,822 --> 00:36:22,223
RATE THEIR PROGRAM LEADERSHIP

1112
00:36:22,223 --> 00:36:24,358
BEHAVIORS ACROSS THE SAME

1113
00:36:24,358 --> 00:36:25,126
LEADERSHIP DIMENSIONS.

1114
00:36:25,126 --> 00:36:26,928
AND IT'S NOT JUST CROSS

1115
00:36:26,928 --> 00:36:28,429
SECTIONAL, WE HAVE LONGITUDINAL

1116
00:36:28,429 --> 00:36:31,165
DATA THAT HOW I RATE MY

1117
00:36:31,165 --> 00:36:32,300
IMMEDIATE PHYSICIAN SUPERVISOR

1118
00:36:32,300 --> 00:36:35,436
TODAY PREDICTS MY BURN OUT AND

1119
00:36:35,436 --> 00:36:36,537
SATISFACTION WITH THE

1120
00:36:36,537 --> 00:36:37,438
ORGANIZATION 2 YEARS LATER AND

1121
00:36:37,438 --> 00:36:39,307
IT'S A VERY STRONG RELATIONSHIP

1122
00:36:39,307 --> 00:36:44,645
WITH A SIGNIFICANT EFFECT SIZE.

1123
00:36:44,645 --> 00:36:45,213
SO ORGANIZATIONAL APPROACHES

1124
00:36:45,213 --> 00:36:47,215
ISN'T ONLY TO DO THINGS LIKE

1125
00:36:47,215 --> 00:36:48,482
GROW, SORT OF SPRINT TEAMS OR

1126
00:36:48,482 --> 00:36:50,918
YOU KNOW FIXING THE CLINICAL

1127
00:36:50,918 --> 00:36:53,387
PRACTICE, IT NEEDS A LOT OF

1128
00:36:53,387 --> 00:36:54,522
FIXING, BUT IT'S ALSO THINGS

1129
00:36:54,522 --> 00:36:59,694
THAT AS TIMES CAN BE EASIER TO

1130
00:36:59,694 --> 00:37:04,632
MOVE LIKE IMPROVING LEADERSHIP

1131
00:37:04,632 --> 00:37:05,233
BEHAVIORS.

1132
00:37:05,233 --> 00:37:07,101
AND THAT'S WHERE FACULTY,

1133
00:37:07,101 --> 00:37:08,069
LEADERSHIP DEVELOPMENT CAN

1134
00:37:08,069 --> 00:37:10,071
REALLY COME IN, THESE ARE NOT

1135
00:37:10,071 --> 00:37:12,073
HARD LEADERSHIP BEHAVIORS BUT IT

1136
00:37:12,073 --> 00:37:13,374
TURNS OUT OUR LEADERS DON'T ALL

1137
00:37:13,374 --> 00:37:14,342
EXHIBIT THESE BEHAVIORS TO THE

1138
00:37:14,342 --> 00:37:16,244
SAME DEGREE AND THAT THERE'S

1139
00:37:16,244 --> 00:37:18,279
OPPORTUNITY FOR ALL LEADERS TO

1140
00:37:18,279 --> 00:37:23,818
CONTINUE ON THEIR LEADERSHIP

1141
00:37:23,818 --> 00:37:24,285
JOURNEY.

1142
00:37:24,285 --> 00:37:25,086
ANOTHER IMPORTANT PIECE OF

1143
00:37:25,086 --> 00:37:26,587
LEADER SYSTEM TO HIGHER THE

1144
00:37:26,587 --> 00:37:27,755
RIGHT PERSON FOR THE YOB CORPS

1145
00:37:27,755 --> 00:37:29,757
AND TO HELP PEOPLE JOB CRAFT.

1146
00:37:29,757 --> 00:37:31,859
SO THERE'S ALL THINGS THAT WE DO

1147
00:37:31,859 --> 00:37:33,628
AT WORK, SOME OF WHICH WE LIKE

1148
00:37:33,628 --> 00:37:35,329
BETTER THAN OTHER THINGS, SOME

1149
00:37:35,329 --> 00:37:37,031
OF WHICH GIVES US BETTER

1150
00:37:37,031 --> 00:37:38,299
MEANING, VALUE AND PURPOSE THAN

1151
00:37:38,299 --> 00:37:40,201
OTHER THINGS AND THEN WHEN WE

1152
00:37:40,201 --> 00:37:41,569
ASK DOC SIMPLY THE QUESTION,

1153
00:37:41,569 --> 00:37:43,437
ABOUT WHAT ACTIVITY DO YOU FIND

1154
00:37:43,437 --> 00:37:45,273
THE MOST MEANINGFUL AT WORK, AND

1155
00:37:45,273 --> 00:37:47,008
THEN HOW MUCH TIME DO YOU SPEND

1156
00:37:47,008 --> 00:37:48,409
DOING THAT ACTIVITY AT WORK, WE

1157
00:37:48,409 --> 00:37:50,611
SEE A VERY STRONG RELATIONSHIP.

1158
00:37:50,611 --> 00:37:52,780
IF YOU CAN JUST SPEND 1 DAY A

1159
00:37:52,780 --> 00:37:55,082
WEEK, BASICALLY 20% OF YOUR WORK

1160
00:37:55,082 --> 00:37:57,718
EFFORT, DOING WHAT YOU FIND MOST

1161
00:37:57,718 --> 00:37:59,186
VALUABLE, MOST MEANINGFUL, YOU

1162
00:37:59,186 --> 00:38:01,255
HAVE A LOWER RISK OF BURN OUT.

1163
00:38:01,255 --> 00:38:02,823
O THIS IS SOMETHING LEADERS CAN

1164
00:38:02,823 --> 00:38:04,959
DO THROUGH CAREER DEVELOPMENT

1165
00:38:04,959 --> 00:38:05,626
CONVERSATIONS, THIS IS SOMETHING

1166
00:38:05,626 --> 00:38:13,301
ALL OF US CAN DO, JOB CRAFTING.

1167
00:38:13,301 --> 00:38:15,403
WE'VE DONE A FEW OTHER RCTs

1168
00:38:15,403 --> 00:38:17,004
THAT I WILL TALK BRIEFLY ABOUT,

1169
00:38:17,004 --> 00:38:21,909
1 IS LOOKING AT PROFESSIONAL

1170
00:38:21,909 --> 00:38:22,877
EXTERNAL CREDENTIAL COACHING,

1171
00:38:22,877 --> 00:38:24,312
WE'VE SHOWN IN 2 RCTs THAT

1172
00:38:24,312 --> 00:38:26,981
THIS IS VERY EFFECTIVE IN

1173
00:38:26,981 --> 00:38:28,582
PHYSICIANS IN SURGEON PHYSICIANS

1174
00:38:28,582 --> 00:38:32,787
AS WELL, AND THAT IT HELPS

1175
00:38:32,787 --> 00:38:33,587
IMPROVE MULTIPLE METRICS.

1176
00:38:33,587 --> 00:38:38,526
NOW YOU CAN SAY, WOW THAT SOUNDS

1177
00:38:38,526 --> 00:38:41,095
EXPENSIVE, RIGHT?

1178
00:38:41,095 --> 00:38:43,264
THESE RCTs IT WAS 6 HOURS OF

1179
00:38:43,264 --> 00:38:44,365
EXTERNAL EXECUTIVE COACHING OVER

1180
00:38:44,365 --> 00:38:47,034
THE COURSE OF 6 MONTHS IT COSTS

1181
00:38:47,034 --> 00:38:48,469
ABOUT $1500 WHICH IS A LOT

1182
00:38:48,469 --> 00:38:50,371
CHEAPER THAN WHAT IT'S COSTING

1183
00:38:50,371 --> 00:38:52,139
BY DOING NOTHING, RIGHT IN IF WE

1184
00:38:52,139 --> 00:38:55,943
THINK BA BEING TO THAT

1185
00:38:55,943 --> 00:38:58,379
7600-DOLLAR PER PHYSICIAN PER

1186
00:38:58,379 --> 00:38:59,647
YEAR COST.

1187
00:38:59,647 --> 00:39:01,816
OTHER SCALABLE MODELS HAVE BEEN

1188
00:39:01,816 --> 00:39:03,317
MORE WEB BASED GROUP COUCHING SO

1189
00:39:03,317 --> 00:39:04,652
THIS HAS BEEN A TRIAL AT

1190
00:39:04,652 --> 00:39:06,420
UNIVERSITY OF COLORADO WITH

1191
00:39:06,420 --> 00:39:08,923
RESIDENTS VERSUS A SINGLE

1192
00:39:08,923 --> 00:39:10,958
INSTITUTION INSTEAD OF A

1193
00:39:10,958 --> 00:39:11,525
MULTIINSTITUTIONAL STUDY AND

1194
00:39:11,525 --> 00:39:14,328
THEY'VE BEEN ABLE TO SHOW THAT

1195
00:39:14,328 --> 00:39:15,663
IN RESIDENTS GROUP COACHING AND

1196
00:39:15,663 --> 00:39:18,566
A WEB BASED MODEL, SCALABLE, AND

1197
00:39:18,566 --> 00:39:19,333
AFFORDABLE CAN ALSO DECREASE

1198
00:39:19,333 --> 00:39:21,836
BURN OUT IN RESIDENT ANDS

1199
00:39:21,836 --> 00:39:22,136
FELLOWS.

1200
00:39:22,136 --> 00:39:24,672
INTERESTINGLY THOUGH, IT'S

1201
00:39:24,672 --> 00:39:26,240
APPEALING MOSTLY TO WOMEN

1202
00:39:26,240 --> 00:39:27,375
PHYSICIANS MOSTLY WOMEN

1203
00:39:27,375 --> 00:39:30,077
RESIDENTS, MAYBE IT'S THE

1204
00:39:30,077 --> 00:39:30,945
VULNERABILITY OF BEING GROUP

1205
00:39:30,945 --> 00:39:33,247
COACHED ON A WEB BASED PLATFORM

1206
00:39:33,247 --> 00:39:34,949
BUT WE DON'T KNOW WHY YET.

1207
00:39:34,949 --> 00:39:36,650
THEY HAVE MALE COACHES, THEY'RE

1208
00:39:36,650 --> 00:39:38,419
TRYING TO REALLY CRACK THAT NUT

1209
00:39:38,419 --> 00:39:39,553
AND ULTIMATELY TELL BE DIFFERENT

1210
00:39:39,553 --> 00:39:40,654
THINGS FOR DIFFERENT PEOPLE BUT

1211
00:39:40,654 --> 00:39:44,625
IT'S WEIRD THAT IT'S FOLLOWING

1212
00:39:44,625 --> 00:39:45,626
ALONG DEMOGRAPHIC LINES.

1213
00:39:45,626 --> 00:39:48,596
WE ALSO KNOW THAT SOCIAL SUPPORT

1214
00:39:48,596 --> 00:39:49,330
IS INCREDIBLY PROTECTIVE, RIGHT

1215
00:39:49,330 --> 00:39:51,298
IN IF YOU TAKE FOR EXAMPLE, YOU

1216
00:39:51,298 --> 00:39:53,267
KNOW A GROUP OF PEOPLE WHO ARE

1217
00:39:53,267 --> 00:39:55,503
EXPOSED TO A TRAUMATIC EVENT,

1218
00:39:55,503 --> 00:39:57,671
NOT EVERYBODY DEVELOPS PTSD AND

1219
00:39:57,671 --> 00:39:58,406
THE SINGLE MOST PROTECTIVE

1220
00:39:58,406 --> 00:40:00,508
FACTOR FROM WHAT I UNDERSTAND IS

1221
00:40:00,508 --> 00:40:01,475
ACTUALLY YOUR PERCEPTION AND

1222
00:40:01,475 --> 00:40:02,910
SOCIAL SUPPORT AND THERE'S BEEN

1223
00:40:02,910 --> 00:40:03,811
LOTS OF STUDIES IN MEDICINE

1224
00:40:03,811 --> 00:40:06,113
ABOUT THE ROLE OF SOCIAL SUPPORT

1225
00:40:06,113 --> 00:40:09,850
IN MITIGATING HIGH WORKPLACE

1226
00:40:09,850 --> 00:40:10,184
STRESS.

1227
00:40:10,184 --> 00:40:11,285
SO ORGANIZATIONS CAN ALSO REALLY

1228
00:40:11,285 --> 00:40:14,255
THINK ABOUT HOW CAN WE BUILD

1229
00:40:14,255 --> 00:40:15,589
SOCIAL SUPPORT AT WORK?

1230
00:40:15,589 --> 00:40:18,859
HOW CAN WE BUILD COMMUNITY AT

1231
00:40:18,859 --> 00:40:19,060
WORK?

1232
00:40:19,060 --> 00:40:23,764
AND THERE'S DIFFERENT WAYS TO DO

1233
00:40:23,764 --> 00:40:23,964
THAT.

1234
00:40:23,964 --> 00:40:27,134
SO 1 OF THE WAYS WE EVALUATE AT

1235
00:40:27,134 --> 00:40:30,571
RCTs AT MAYO WAS CALLED

1236
00:40:30,571 --> 00:40:31,138
COMMENSALITY GROUPS.

1237
00:40:31,138 --> 00:40:33,474
SO IN THE FIRST VERSION, WE GOT

1238
00:40:33,474 --> 00:40:34,575
THE DOCS TOGETHER OVER A LUNCH

1239
00:40:34,575 --> 00:40:36,310
HOUR AND THEY ALSO GOT A

1240
00:40:36,310 --> 00:40:37,211
REDUCTION IN THEIR CLINICAL WORK

1241
00:40:37,211 --> 00:40:40,681
LOAD TO MEET TOGETHER WITH A

1242
00:40:40,681 --> 00:40:41,515
TRAINED FACILITATOR MORE ALONG

1243
00:40:41,515 --> 00:40:42,817
THE LINES OF PROBLEM SOLVING,

1244
00:40:42,817 --> 00:40:44,552
RYE HOW DO YOU DEAL WITH MEDICAL

1245
00:40:44,552 --> 00:40:48,989
ERRORS, HOW DO YOU DEAL WITH

1246
00:40:48,989 --> 00:40:50,624
WORK, HOME, INTEGRATION, THAT

1247
00:40:50,624 --> 00:40:52,693
PROBLEM SOLVING DOMAIN AND WE

1248
00:40:52,693 --> 00:40:54,295
SAW IN THAT RCT, WE SAW ON

1249
00:40:54,295 --> 00:40:55,596
COMPANY TIME IT IMPROVED BURN

1250
00:40:55,596 --> 00:40:58,065
OUT AND RETENTION MARKERS IN

1251
00:40:58,065 --> 00:41:01,836
COMPARISON TO THE CONTROL GROUP.

1252
00:41:01,836 --> 00:41:03,671
SO, YOU KNOW WE WENT UP TO THE

1253
00:41:03,671 --> 00:41:05,873
POWERS THAT BE, RIGHT, TO SELL

1254
00:41:05,873 --> 00:41:07,174
OUR GREAT MODEL THAT EVERYBODY

1255
00:41:07,174 --> 00:41:10,711
NEEDED TO BE TRAIN INDEED GROUPS

1256
00:41:10,711 --> 00:41:11,779
WITH TRAINED FACILITATORS ON

1257
00:41:11,779 --> 00:41:14,115
COMPANY TIME AND IT WASN'T THE

1258
00:41:14,115 --> 00:41:15,015
FEDERAL GOVERNMENT BUT

1259
00:41:15,015 --> 00:41:16,717
NEVERTHELESS THEY SAID NO,

1260
00:41:16,717 --> 00:41:18,252
THEREY'S NO MONEY TO DO THAT.

1261
00:41:18,252 --> 00:41:21,489
SO IN THE SECOND RCT, WE HAD

1262
00:41:21,489 --> 00:41:22,356
PHYSICIANS BASICALLY SELF-FORM

1263
00:41:22,356 --> 00:41:25,025
INTO GROUPS, GO OUT TO DIN OR

1264
00:41:25,025 --> 00:41:25,726
THEIR OWN TIME.

1265
00:41:25,726 --> 00:41:26,760
WE GAVE THEM A LITTLE BIT OF

1266
00:41:26,760 --> 00:41:28,429
MONEY TO PAY FOR THE MEAL AND

1267
00:41:28,429 --> 00:41:29,530
SUGGESTED A TOPIC FOR THEM TO

1268
00:41:29,530 --> 00:41:31,065
TALK ABOUT, WE HAVE NO IDEA IF

1269
00:41:31,065 --> 00:41:32,366
THEY ACTUALLY TALKED ABOUT THE

1270
00:41:32,366 --> 00:41:35,669
TOPIC BY THE WAY BUT WE GAVE

1271
00:41:35,669 --> 00:41:38,472
THEM A TOPIC, WE TOLD THEM WHY

1272
00:41:38,472 --> 00:41:39,807
THEY SHOULD TALK ABOUT IT, HOW

1273
00:41:39,807 --> 00:41:42,643
ARBITRATE IT WAS, WE DID

1274
00:41:42,643 --> 00:41:44,578
FACILITATOR TRAINING BUT IN THAT

1275
00:41:44,578 --> 00:41:46,814
LOWER COST PILOT, WE SIMILARLY

1276
00:41:46,814 --> 00:41:49,717
SAW BENEFIT IN OUR RCT, RIGHT?

1277
00:41:49,717 --> 00:41:52,386
SO HELPING PEOPLE GET TOGETHER,

1278
00:41:52,386 --> 00:41:53,287
BUILD SUPPORT, BUILD

1279
00:41:53,287 --> 00:41:56,657
CAMARADERIE, YOU KNOW DOES MAKE

1280
00:41:56,657 --> 00:41:56,991
A DIFFERENCE.

1281
00:41:56,991 --> 00:41:58,692
SO YOU KNOW THERE'S THINGS IN

1282
00:41:58,692 --> 00:41:59,927
THE OUTER CIRCLE THAT ARE

1283
00:41:59,927 --> 00:42:01,862
DRIVING US A NOTCH, THINGS IN

1284
00:42:01,862 --> 00:42:02,830
THEINER CIRCLE THAT ARE GIVING

1285
00:42:02,830 --> 00:42:04,532
US A LOT OF STRESS AND THIS IS

1286
00:42:04,532 --> 00:42:05,633
WHAT I'M GOING TO TALK ABOUT

1287
00:42:05,633 --> 00:42:07,535
NEXT WHICH IS WHAT I WILL CALL

1288
00:42:07,535 --> 00:42:09,003
LOCAL WORK UNIT, SO FOR ME AT

1289
00:42:09,003 --> 00:42:09,703
UNIVERSITY OF COLORADO, THAT

1290
00:42:09,703 --> 00:42:10,905
COULD BE MY DEPARTMENT, THAT

1291
00:42:10,905 --> 00:42:14,208
COULD BE MY DIVISION, THAT COULD

1292
00:42:14,208 --> 00:42:15,242
BE LOWRY CLINIC WHERE I PRACTICE

1293
00:42:15,242 --> 00:42:17,178
AND YOU KIND OF HAVE TO THINK

1294
00:42:17,178 --> 00:42:21,315
ABOUT WHAT IT FOR YOU AND YOUR

1295
00:42:21,315 --> 00:42:21,715
WORK ENVIRONMENT?

1296
00:42:21,715 --> 00:42:24,251
WHAT WE DO KNOW IS THAT LOCAL

1297
00:42:24,251 --> 00:42:25,753
INTERVENTIONS CAN MAKE A HUGE

1298
00:42:25,753 --> 00:42:28,088
DIFFERENCE, SO THEY WORK--IF YOU

1299
00:42:28,088 --> 00:42:30,291
HAVE SORT OF PARTICIPATORY

1300
00:42:30,291 --> 00:42:31,392
LEADERSHIP, RIGHT?

1301
00:42:31,392 --> 00:42:33,961
THEY WORK IF YOU HAVE CONTEXT

1302
00:42:33,961 --> 00:42:35,029
WITH SPECIAL INTERVENTIONS, THEY

1303
00:42:35,029 --> 00:42:36,297
WORK IF THE BOOTS ON THE GROUND

1304
00:42:36,297 --> 00:42:38,032
COME UP WITH THE INTERVENTION,

1305
00:42:38,032 --> 00:42:39,400
AND THEY DON'T WORK IF PEOPLE

1306
00:42:39,400 --> 00:42:40,668
LIKE ME COME INTO THE GROUP AND

1307
00:42:40,668 --> 00:42:43,537
TELL THEM WHAT TO DO, OKAY?

1308
00:42:43,537 --> 00:42:46,907
AND THIS IS FROM THE WORK

1309
00:42:46,907 --> 00:42:47,374
REDESIGN LITERATURE.

1310
00:42:47,374 --> 00:42:50,744
SO, WHAT ARE THESE SORT OF LOCAL

1311
00:42:50,744 --> 00:42:53,847
CHANGES, WHERE DO THEY MAKE A

1312
00:42:53,847 --> 00:42:54,515
DIFFERENCE?

1313
00:42:54,515 --> 00:42:56,150
THEY MAKE THE MOST DIFFERENCE IF

1314
00:42:56,150 --> 00:42:59,720
THEY CAN TACKLE WORK LOAD, OH,

1315
00:42:59,720 --> 00:43:01,822
HARDEST 1, RIGHT, HARDEST 1.

1316
00:43:01,822 --> 00:43:03,057
THEY MAKE THE SECOND MOST DRVES

1317
00:43:03,057 --> 00:43:06,594
IF THEY CAN ATTACK DECISION

1318
00:43:06,594 --> 00:43:08,596
LATITUDE, CONTROL, ECONOMY,

1319
00:43:08,596 --> 00:43:09,463
FLEXIBILITY, RIGHT?

1320
00:43:09,463 --> 00:43:10,598
MAYBE MORE IN SCOPE.

1321
00:43:10,598 --> 00:43:12,533
THEY CAN MAKE THE THIRD MOST

1322
00:43:12,533 --> 00:43:14,201
IMPACT IF THEY ADDRESS THINGS

1323
00:43:14,201 --> 00:43:15,369
WITHIN THE CULTURE LIKE

1324
00:43:15,369 --> 00:43:17,004
LEADERSHIP BEHAVIORS FOR

1325
00:43:17,004 --> 00:43:19,373
EXAMPLE, SOCIAL SUPPORT AT WORK,

1326
00:43:19,373 --> 00:43:22,743
SO THIS IS THE MODEL THAT WE HAD

1327
00:43:22,743 --> 00:43:23,877
AT MAYO CLINIC, THEY STILL HAVE

1328
00:43:23,877 --> 00:43:25,346
IT, THEY HAVE IT.

1329
00:43:25,346 --> 00:43:30,017
AFTER 20 YEARS IT'S HARD TO STOP

1330
00:43:30,017 --> 00:43:31,552
WITH THAT PIECE, THE PART, SO

1331
00:43:31,552 --> 00:43:33,220
THEY DO A SURVEY, THEY GIVE

1332
00:43:33,220 --> 00:43:34,655
EVERY WORK UNIT THEIR REPORT.

1333
00:43:34,655 --> 00:43:36,190
THIS IS WHERE YOUR BURN OUT HAD

1334
00:43:36,190 --> 00:43:37,625
IS, THIS IS WHAT WE THINK ARE

1335
00:43:37,625 --> 00:43:39,126
THE MAIN DRIVERS OF BURN OUT,

1336
00:43:39,126 --> 00:43:40,861
THEY TAKE THIS REPORT, THEY

1337
00:43:40,861 --> 00:43:42,263
SHARE TRANSPARENTLY WITH THE

1338
00:43:42,263 --> 00:43:43,264
BOOTS ON THE GROUND, THE BOOTS

1339
00:43:43,264 --> 00:43:44,732
ON THE GROUND SAY, HEY, THESE

1340
00:43:44,732 --> 00:43:47,067
ARE THE THINGS I THINK WE SHOULD

1341
00:43:47,067 --> 00:43:49,370
WORK ON, THESE ARE THINGS I

1342
00:43:49,370 --> 00:43:51,472
THINK ARE IN OUR SPHERE OF

1343
00:43:51,472 --> 00:43:53,440
CONTROL EMPLOY LEADERS EMPOWER

1344
00:43:53,440 --> 00:43:54,174
THE LOCAL TEAM TO IMPLEMENT

1345
00:43:54,174 --> 00:43:56,043
SOLUTIONS THAT ARE WITHIN THE

1346
00:43:56,043 --> 00:43:57,144
SPHERE OF CONTROL OF THE LOCAL

1347
00:43:57,144 --> 00:43:59,480
WORK UNIT AND OTHER ISSUES ARE

1348
00:43:59,480 --> 00:44:00,147
ESCALATED UPWARD.

1349
00:44:00,147 --> 00:44:01,682
DOES IT WORK ALL THE TIME, NO

1350
00:44:01,682 --> 00:44:03,117
NOT IN A WAY WE CAN MEASURE BUT

1351
00:44:03,117 --> 00:44:05,252
IT WORKS IN ABOUT HALF THE UNITS

1352
00:44:05,252 --> 00:44:09,990
IN A WAY WE CAN MEASURE, AND THE

1353
00:44:09,990 --> 00:44:12,559
MORE ENGAGED PEOPLE ARE, THE

1354
00:44:12,559 --> 00:44:13,927
MORE THE LIKELIHOOD THE THING IS

1355
00:44:13,927 --> 00:44:15,696
THAT PEOPLE WILL GET BETTER,

1356
00:44:15,696 --> 00:44:17,965
IT'S JUST NOT AT MAYO, WE SEE

1357
00:44:17,965 --> 00:44:20,034
THIS ELSEWHERE SO THIS IS AN

1358
00:44:20,034 --> 00:44:20,868
EXAMPLE FROM THE UNIVERSITY OF

1359
00:44:20,868 --> 00:44:24,238
COLORADO, WE HAD LOTS OF MEDICAL

1360
00:44:24,238 --> 00:44:26,840
ASSISTANCE, THE DOCS WERE

1361
00:44:26,840 --> 00:44:28,375
LEAVING, ADVANCED PRACTICE

1362
00:44:28,375 --> 00:44:29,376
PROFESSIONALS WERE LEAVING, SO

1363
00:44:29,376 --> 00:44:31,779
THEY SAID WOE WHOA, WHOA, WHOA,

1364
00:44:31,779 --> 00:44:32,579
WHAT'S GOING ON HERE?

1365
00:44:32,579 --> 00:44:34,448
SO THEY GOT EVERYBODY TOGETHER,

1366
00:44:34,448 --> 00:44:36,650
AND SAID WHAT CAN WE DO

1367
00:44:36,650 --> 00:44:37,017
DIFFERENTLY?

1368
00:44:37,017 --> 00:44:38,686
HOW CAN WE MAKE THIS WORK BETTER

1369
00:44:38,686 --> 00:44:39,119
FOR EVERYBODY?

1370
00:44:39,119 --> 00:44:40,654
AND THEY CAME OUT WITH AN

1371
00:44:40,654 --> 00:44:42,389
EXPANDED MODEL WHERE THE MEDICAL

1372
00:44:42,389 --> 00:44:43,357
ASSISTANT DID MORE BUT THE MORE

1373
00:44:43,357 --> 00:44:44,892
WAS THE STUFF THAT THE MEDICAL

1374
00:44:44,892 --> 00:44:47,194
ASSISTANT REALLY WANTED TO DO

1375
00:44:47,194 --> 00:44:48,162
AND FOUND VALUABLE, AND THEN

1376
00:44:48,162 --> 00:44:50,898
THEY WERE ABLE TO REEL

1377
00:44:50,898 --> 00:44:51,732
KEEPSAKESLY DO MORE

1378
00:44:51,732 --> 00:44:52,633
RELATIONSHIPS BETWEEN THE

1379
00:44:52,633 --> 00:44:53,867
MEDICAL ASSISTANTS AND THE DOCS

1380
00:44:53,867 --> 00:44:55,769
TO REALLY IMPROVE THE PRACTICE,

1381
00:44:55,769 --> 00:44:57,204
THE WHOLE FLOW AND THEY FOUND

1382
00:44:57,204 --> 00:44:59,673
THAT WITH THE EXPANDED ROLE OF

1383
00:44:59,673 --> 00:45:01,041
THE MEDICAL ASSISTANCE, THEY

1384
00:45:01,041 --> 00:45:03,243
IMPROVE QUALITY ACCESS AS WELL

1385
00:45:03,243 --> 00:45:04,511
AS CLINICIAN EXPERIENCE AND

1386
00:45:04,511 --> 00:45:07,614
THAT'S STILL IN PLACE TODAY.

1387
00:45:07,614 --> 00:45:09,183
AND HERE'S THE PAPER FROM

1388
00:45:09,183 --> 00:45:11,418
STANFORD, AND THEY DO THIS AND

1389
00:45:11,418 --> 00:45:13,087
HAVE DONE THIS FOR SEVERAL YEARS

1390
00:45:13,087 --> 00:45:14,988
WHERE EVERY WORK UNIT BASICALLY

1391
00:45:14,988 --> 00:45:16,190
GETS THEIR SURVEY RESULTS AND

1392
00:45:16,190 --> 00:45:17,224
GET INFORMATION ABOUT WHAT ARE

1393
00:45:17,224 --> 00:45:18,726
THE MAIN DRIVERS IN THAT

1394
00:45:18,726 --> 00:45:20,361
PARTICULAR WORK UNIT AND THEN IS

1395
00:45:20,361 --> 00:45:22,329
EMPOWERED TO DO LOCAL WORK UNIT

1396
00:45:22,329 --> 00:45:22,963
CHANGES.

1397
00:45:22,963 --> 00:45:24,565
ARE THEY FIXING THE ELECTRONIC

1398
00:45:24,565 --> 00:45:25,899
HEALTH RECORD, NO, ARE THEY

1399
00:45:25,899 --> 00:45:28,335
FIXING THE STAFFING PROBLEMS IN

1400
00:45:28,335 --> 00:45:28,936
THE HOSPITAL?

1401
00:45:28,936 --> 00:45:29,269
NO.

1402
00:45:29,269 --> 00:45:30,371
BUT THEY'RE FINDING THINGS

1403
00:45:30,371 --> 00:45:31,438
WITHIN THEIR SPHERE OF CONTROL

1404
00:45:31,438 --> 00:45:35,909
THAT THEY'RE WORKING ON AND THAT

1405
00:45:35,909 --> 00:45:37,344
PROCESS IS IMPROVING BURN OUT

1406
00:45:37,344 --> 00:45:38,712
AND PROFESSIONAL FULFILLMENT IN

1407
00:45:38,712 --> 00:45:41,949
EVERY SINGLE DEPARTMENT IN A WAY

1408
00:45:41,949 --> 00:45:42,850
THAT'S MEASURABLE.

1409
00:45:42,850 --> 00:45:44,918
SO LOCAL WORK UNIT ACTION IS

1410
00:45:44,918 --> 00:45:48,422
REALLY IMPORTANT AND IT DOES

1411
00:45:48,422 --> 00:45:52,126
TAKE ALL OF US FILL OUT 1 MORE

1412
00:45:52,126 --> 00:45:52,960
DAMN SURVEY, BUT IT IS IMPORTANT

1413
00:45:52,960 --> 00:45:53,994
JUST LIKE IT IS WITH QUALITY,

1414
00:45:53,994 --> 00:45:56,263
THAT WE SHARE THE RESULTS

1415
00:45:56,263 --> 00:45:58,132
TRANSPARENTLY AND THAT WE HAVE

1416
00:45:58,132 --> 00:46:00,134
LISTENING SESSIONS AND

1417
00:46:00,134 --> 00:46:01,001
COLLABORATIVE ACTION PLANNING.

1418
00:46:01,001 --> 00:46:01,835
COLLABORATIVE ACTION PLANNING

1419
00:46:01,835 --> 00:46:03,370
THAT HELPS US IDENTIFY WHAT'S IN

1420
00:46:03,370 --> 00:46:10,144
OUR SPHERE OF CONTROL, VERSUS

1421
00:46:10,144 --> 00:46:10,744
INFLUENCE, VERSUS CONCERN.

1422
00:46:10,744 --> 00:46:12,212
TO IEE, AUDIENCE DENTIFY WHAT TO

1423
00:46:12,212 --> 00:46:15,015
WORK ON AND FORTUNATELY THE WORK

1424
00:46:15,015 --> 00:46:16,116
RELINE LITERATURE TELLS US THAT

1425
00:46:16,116 --> 00:46:19,253
WHEN WE LEAN IN AND ENGAGE IN

1426
00:46:19,253 --> 00:46:20,387
WORK DESIGN, CHANGE, IT

1427
00:46:20,387 --> 00:46:21,655
IMPROVING OUR WELL BEING, SO YOU

1428
00:46:21,655 --> 00:46:23,390
MIGHT SIT THERE AND THINK I CAN

1429
00:46:23,390 --> 00:46:24,792
BE THE DO 1 MORE THING, I CAME

1430
00:46:24,792 --> 00:46:26,693
TO THIS MEETING BECAUSE I BURNT

1431
00:46:26,693 --> 00:46:28,729
OUT AND WAS LOOKING FOR

1432
00:46:28,729 --> 00:46:29,396
STRATEGIES, RIGHT, LIKE I CAN BE

1433
00:46:29,396 --> 00:46:30,864
THE DO 1 MORE THING BUT IT TURNS

1434
00:46:30,864 --> 00:46:33,600
OUT LEADING IN AND ENGAINLING IN

1435
00:46:33,600 --> 00:46:36,069
THIS PROCESS AROUND ROUND WORK

1436
00:46:36,069 --> 00:46:36,970
REDESIGN, AROUND IDENTIFYING AND

1437
00:46:36,970 --> 00:46:39,807
IMPRIEWING WHAT YOU CAN IN YOUR

1438
00:46:39,807 --> 00:46:42,576
SPHERE OF CONTROL, YOUR WELL IS

1439
00:46:42,576 --> 00:46:43,477
LIKELY TO MEASURABLY IMPROVE

1440
00:46:43,477 --> 00:46:45,245
EMPLOY HERE ARE SOME THINGS THE

1441
00:46:45,245 --> 00:46:47,214
WELL BEING LEADERS ARE WORKING

1442
00:46:47,214 --> 00:46:49,116
ON IN COLORADO, ARE THEY ALL

1443
00:46:49,116 --> 00:46:49,516
SYSTEM THINGS?

1444
00:46:49,516 --> 00:46:51,452
NO, SOME THINGS ARE VERY MUCH

1445
00:46:51,452 --> 00:46:53,821
RELATIONAL, SOME THINGS ARE VERY

1446
00:46:53,821 --> 00:46:55,322
MUCH FACULTY DEVELOPMENT, SOME

1447
00:46:55,322 --> 00:46:57,825
THINGS DO RELATE TO WHAT'S GOING

1448
00:46:57,825 --> 00:47:02,396
ON IN THE CLINICAL PRACTICE, IT

1449
00:47:02,396 --> 00:47:05,065
BEINGLY AROUND SCHEDULING,

1450
00:47:05,065 --> 00:47:06,333
ADVERSE EVENTS, THE INBASKET,

1451
00:47:06,333 --> 00:47:08,969
OUR NEW THING IS SECURE CHAT,

1452
00:47:08,969 --> 00:47:10,237
ALL SORTS OF GREATNESS IS

1453
00:47:10,237 --> 00:47:12,539
HAPPENING IN THAT SPACE.

1454
00:47:12,539 --> 00:47:14,508
AND I JUST WANT TO SPEND A

1455
00:47:14,508 --> 00:47:15,609
COUPLE SLIDES BEFORE I OPEN IT

1456
00:47:15,609 --> 00:47:17,344
UP ABOUT WHAT I THINK IS SORT OF

1457
00:47:17,344 --> 00:47:19,546
THE WORKPLACE OF THE FUTURE.

1458
00:47:19,546 --> 00:47:22,216
BECAUSE THERE'S FASCINATING

1459
00:47:22,216 --> 00:47:23,250
STUFF THAT'S GOING ON.

1460
00:47:23,250 --> 00:47:24,418
ONE THING THAT'S GOING ON IS

1461
00:47:24,418 --> 00:47:26,887
WE'RE TRYING TO FIGURE OUT IF WE

1462
00:47:26,887 --> 00:47:28,522
CAN PREDICT BURN OUT.

1463
00:47:28,522 --> 00:47:30,557
RIGHT NOW WE REACT.

1464
00:47:30,557 --> 00:47:31,992
RIGHT, SO WE REACT WHEN THE

1465
00:47:31,992 --> 00:47:34,561
SURVEY LOOKS REALLY BAD, WE

1466
00:47:34,561 --> 00:47:35,863
REACT WHEN TURNOVER'S REALLY

1467
00:47:35,863 --> 00:47:38,165
BAD, WE REACT WHEN THERE'S A LOT

1468
00:47:38,165 --> 00:47:39,066
OF PROFESSIONALISM COMPLAINTS

1469
00:47:39,066 --> 00:47:40,467
BUT WE REACT AFTER THERE'S

1470
00:47:40,467 --> 00:47:41,702
ALREADY BEEN HARM TO THE PATIENT

1471
00:47:41,702 --> 00:47:44,505
AND WHEN THERE'S ALREADY BEEN

1472
00:47:44,505 --> 00:47:44,771
TURNOVER.

1473
00:47:44,771 --> 00:47:46,173
WHAT IF WE COULD PREDICT IT,

1474
00:47:46,173 --> 00:47:48,442
WHAT IF WE COULD USE BIOMETRICS

1475
00:47:48,442 --> 00:47:49,843
AND PREDICT WHEN WORK STRESS IS

1476
00:47:49,843 --> 00:47:51,745
GETTING TOO HIGH SO THAT WE CAN

1477
00:47:51,745 --> 00:47:52,145
RESPOND.

1478
00:47:52,145 --> 00:47:55,282
SO THESE ARE COUPLE OF STUDIES I

1479
00:47:55,282 --> 00:47:56,717
HAVE GOING ON WITH

1480
00:47:56,717 --> 00:47:58,252
[INDISCERNIBLE] AT MAYO, SO WE

1481
00:47:58,252 --> 00:47:59,887
HAVE ACTUALLY SEVERAL COHORTS OF

1482
00:47:59,887 --> 00:48:01,321
NURSES WITH SMART WATCHES

1483
00:48:01,321 --> 00:48:02,422
FILLING OUT SURVEYS, WE'RE

1484
00:48:02,422 --> 00:48:04,291
TRYING TO FIGURE OUT WITH BIG

1485
00:48:04,291 --> 00:48:06,093
DATA SETS WE CAN PREDICT THEIR

1486
00:48:06,093 --> 00:48:08,862
BURN OUT, WE HAVE 180 PHYSICIANS

1487
00:48:08,862 --> 00:48:10,831
AND RESIDENTS AT MAYO AND AT

1488
00:48:10,831 --> 00:48:12,366
COLORADO THAT WE'RE CLICKING

1489
00:48:12,366 --> 00:48:14,902
BIOMETRIC DATA ON AS WELL, AND

1490
00:48:14,902 --> 00:48:16,770
DOING SOME FUN MATH TO SEE IF WE

1491
00:48:16,770 --> 00:48:17,971
CAN PREDICT IT, WE MIGHT NOT BE

1492
00:48:17,971 --> 00:48:20,741
ABLE TO BUT YOU DON'T KNOW UNTIL

1493
00:48:20,741 --> 00:48:20,974
YOU TRY.

1494
00:48:20,974 --> 00:48:23,010
WE'RE LOOKING AT WAYS TO

1495
00:48:23,010 --> 00:48:24,978
OPTIMIZE THE CLINICIAN COMPUTER

1496
00:48:24,978 --> 00:48:26,747
INTERFACE, SO RIGHT NOW, YOU GET

1497
00:48:26,747 --> 00:48:28,081
A DRUG ALERT, USUALLY SAY

1498
00:48:28,081 --> 00:48:31,084
SOMETHING LIKE LIKE IF YOU GIVE

1499
00:48:31,084 --> 00:48:32,052
THIS DRUG TO THE PATIENT YOU

1500
00:48:32,052 --> 00:48:33,687
WILL KILL THEM T. DOESN'T GIVE

1501
00:48:33,687 --> 00:48:35,389
YOU ANY ALTERNATIVES AND YOU

1502
00:48:35,389 --> 00:48:37,658
TEND TO GET THE INFORMATION TOO

1503
00:48:37,658 --> 00:48:44,865
LATE AND WITH PHARMA CO GENOMICS

1504
00:48:44,865 --> 00:48:47,334
PERSON, HOW DO I DETERMINE WHAT

1505
00:48:47,334 --> 00:48:49,102
TO GIVE THIS PATIENT BASED ON

1506
00:48:49,102 --> 00:48:50,103
THEIR PROFILE, RIGHT?

1507
00:48:50,103 --> 00:48:51,605
YOU GOTTA BE KIDDING ME, RIGHT?

1508
00:48:51,605 --> 00:48:54,541
SO HOW DO WE DESIGN DRUG ALERTS

1509
00:48:54,541 --> 00:48:55,976
SO THEY'RE HELPFUL, IF YOU GIVE

1510
00:48:55,976 --> 00:48:58,412
THIS DRUG, YOU HAVE A 20% CHANCE

1511
00:48:58,412 --> 00:49:00,047
DEPRESSION'S GOING TO GET BETTER

1512
00:49:00,047 --> 00:49:02,182
BUT YOU GIVE THEM DRUG THAT WILL

1513
00:49:02,182 --> 00:49:06,086
COST LESS BUT YOU HAVE A 40%

1514
00:49:06,086 --> 00:49:07,688
CHANCE THAT DEPRESSION WILL

1515
00:49:07,688 --> 00:49:11,024
DECREASE, SO FIGURING OUT THAT

1516
00:49:11,024 --> 00:49:11,224
PIECE.

1517
00:49:11,224 --> 00:49:15,362
FIGURING OUT ALSO HOW CAN WE

1518
00:49:15,362 --> 00:49:17,097
OPTIMIZE STAFFING MODELS IN THE

1519
00:49:17,097 --> 00:49:18,298
HOSPITAL RIGHT BECAUSE THERE'S

1520
00:49:18,298 --> 00:49:19,666
ALWAYS GOING TO BE BUDGET CUTS

1521
00:49:19,666 --> 00:49:21,368
BUT HOW DO WE ACTUALLY FIGURE

1522
00:49:21,368 --> 00:49:22,636
OUT IN REALTIME WHAT STAFFING

1523
00:49:22,636 --> 00:49:25,005
MODEL LEADS TO THE BEST

1524
00:49:25,005 --> 00:49:26,573
FINANCIAL AND CLINICAL OUTCOME,

1525
00:49:26,573 --> 00:49:28,809
WHAT STAFFING MODEL LEADS TO THE

1526
00:49:28,809 --> 00:49:29,910
BEST RETENTION, WHAT STAFFING

1527
00:49:29,910 --> 00:49:32,312
MODEL LEADS TO THE BEST QUALITY

1528
00:49:32,312 --> 00:49:32,779
OF CARE.

1529
00:49:32,779 --> 00:49:34,948
SO USING APPS TO COLLECT

1530
00:49:34,948 --> 00:49:39,419
REALTIME DATA, KIND OF LIKE,

1531
00:49:39,419 --> 00:49:40,454
YEAH, ECOLOGICAL MOMENTARY

1532
00:49:40,454 --> 00:49:41,588
ASSESSMENTS BUT THINKING ABOUT

1533
00:49:41,588 --> 00:49:44,791
WORK DESIGN, WE CAN LOOK AT

1534
00:49:44,791 --> 00:49:46,760
EVERYTHING EVERYBODY DOES IF WE

1535
00:49:46,760 --> 00:49:48,862
CALL THE AUDIT LOG DATA, VERY

1536
00:49:48,862 --> 00:49:50,097
BIG BROTHER, KIND OF CARRY BUT

1537
00:49:50,097 --> 00:49:51,898
THEY CAN SEE HOW LONG I SPEND ON

1538
00:49:51,898 --> 00:49:54,301
EVERYTHING, WHAT I'M DOING.

1539
00:49:54,301 --> 00:49:57,237
CAN WE HARNESS THAT DATA TO

1540
00:49:57,237 --> 00:50:02,342
FIGURE OUT WHAT ARE BEST WAYS TO

1541
00:50:02,342 --> 00:50:02,709
DESIGN WORK?

1542
00:50:02,709 --> 00:50:03,710
SO THOSE ARE SOME OF THE THINGS

1543
00:50:03,710 --> 00:50:06,146
THAT ARE COMING ON THE HORIZON

1544
00:50:06,146 --> 00:50:09,783
AS WELL AS LISTENING

1545
00:50:09,783 --> 00:50:10,317
[INDISCERNIBLE], IT'S AI

1546
00:50:10,317 --> 00:50:11,852
TECHNOLOGY WHERE YOU HAVE A

1547
00:50:11,852 --> 00:50:13,086
DEVICE THAT'S RECORDING THE

1548
00:50:13,086 --> 00:50:14,254
ENTIRE INTERACTION WITH THE

1549
00:50:14,254 --> 00:50:15,355
PATIENT AND BY THE TIME YOU WALK

1550
00:50:15,355 --> 00:50:17,124
OUT OF THE ROOM, IT'S RECORDING

1551
00:50:17,124 --> 00:50:18,525
EVERYTHING WITH THE PATIENT AND

1552
00:50:18,525 --> 00:50:20,761
YOU JUST REVIEW IT AND SAY YEAH,

1553
00:50:20,761 --> 00:50:21,294
THAT'S RIGHT.

1554
00:50:21,294 --> 00:50:22,462
THAT STUFF IS COMING.

1555
00:50:22,462 --> 00:50:24,031
SO LOTS OF INTERESTING THINGS

1556
00:50:24,031 --> 00:50:25,932
BUT FOR ANY OF THIS TO WORK, WE

1557
00:50:25,932 --> 00:50:27,534
ALL HAVE TO BE WILLING TO LEAN

1558
00:50:27,534 --> 00:50:30,037
IN AND DO OUR PART, WHETHER

1559
00:50:30,037 --> 00:50:31,738
THAT'S FILLING OUT THE SURVEY,

1560
00:50:31,738 --> 00:50:33,840
WHETHER THAT'S ENGAGING IN LOCAL

1561
00:50:33,840 --> 00:50:36,243
ACTION PLANNING, WHETHER THAT'S

1562
00:50:36,243 --> 00:50:37,644
ADVOCATING WITH YOUR SOCIETIES

1563
00:50:37,644 --> 00:50:39,913
OR OTHER GROUPS AND SOME OF

1564
00:50:39,913 --> 00:50:41,014
THESE FACTORS OUTSIDE THE

1565
00:50:41,014 --> 00:50:42,182
CONTROL OF HEALTHCARE SYSTEMS

1566
00:50:42,182 --> 00:50:43,784
DIRECTLY BUT I THINK IT'S

1567
00:50:43,784 --> 00:50:45,085
IMPORTANT WE ALL HAVE A ROLE TO

1568
00:50:45,085 --> 00:50:46,753
PLAY AND THAT'S WHAT IT'S GOING

1569
00:50:46,753 --> 00:50:49,690
TO TAKE TO BEND THE NEEDLE AND

1570
00:50:49,690 --> 00:50:50,223
MAKE MEANINGFUL CHANGE.

1571
00:50:50,223 --> 00:50:51,425
SO THANK YOU VERY MUCH FOR YOUR

1572
00:50:51,425 --> 00:50:51,692
ATTENTION.

1573
00:50:51,692 --> 00:50:52,559
HAPPY TO TAKE QUESTION ANDS

1574
00:50:52,559 --> 00:50:54,127
WE'LL GO FROM THERE.

1575
00:50:54,127 --> 00:51:01,334
[ APPLAUSE ] 

1576
00:51:01,334 --> 00:51:02,369
>> SO IF PEOPLE HAVE
QUESTIONS

1577
00:51:02,369 --> 00:51:05,405
THEY CAN STAND UP.

1578
00:51:05,405 --> 00:51:06,807
GO AHEAD.

1579
00:51:06,807 --> 00:51:07,708
NHI, I ENJOYED YOUR TALK.

1580
00:51:07,708 --> 00:51:10,277
I HAVE A COUPLE QUESTIONS ABOUT

1581
00:51:10,277 --> 00:51:12,379
THE PHYSICIAN BURN OUT THAT YOU

1582
00:51:12,379 --> 00:51:13,313
SPOKE OF.

1583
00:51:13,313 --> 00:51:16,783
I WANTED TO KNOW IF ANY DATA WAS

1584
00:51:16,783 --> 00:51:18,552
FOUND BETWEEN THE RELATIONSHIP

1585
00:51:18,552 --> 00:51:19,953
BETWEEN BURN OUTS BETWEEN

1586
00:51:19,953 --> 00:51:23,156
PHYSICIANS AND PHYSICIAN

1587
00:51:23,156 --> 00:51:23,690
SCIENTISTS?

1588
00:51:23,690 --> 00:51:27,127
SPOKEN WITH MANY MD-Ph.D.s

1589
00:51:27,127 --> 00:51:28,095
WHO ARE UNSATISFIED WITH THEIR

1590
00:51:28,095 --> 00:51:32,466
LINE OF WORK OR HOW THEIR

1591
00:51:32,466 --> 00:51:33,400
RESEARCH AND HOW THEIR RESEARCH

1592
00:51:33,400 --> 00:51:34,601
AND PRACTICE TIME HAS BEEN SPLIT

1593
00:51:34,601 --> 00:51:36,369
SO I JUST WANTED TO KNOW IF

1594
00:51:36,369 --> 00:51:39,806
THERE WAS ANY RESEARCH DONE IN

1595
00:51:39,806 --> 00:51:40,173
THAT FIELD?

1596
00:51:40,173 --> 00:51:43,310
>> YEAH, SO, THERE'S A LOT
OF

1597
00:51:43,310 --> 00:51:43,744
OPPORTUNITY, RIGHT?

1598
00:51:43,744 --> 00:51:45,579
THERE'S VERY LITTLE RESEARCH IN

1599
00:51:45,579 --> 00:51:48,982
THIS FIELD ON SCIENTISTS IN

1600
00:51:48,982 --> 00:51:49,616
GENERAL.

1601
00:51:49,616 --> 00:51:52,753
AND ALSO ON SORT OF THE

1602
00:51:52,753 --> 00:51:54,755
MD-Ph.D. PHYSICIAN SCIENTIST

1603
00:51:54,755 --> 00:51:55,288
IN THAT SPHERE.

1604
00:51:55,288 --> 00:51:57,624
WE TRY TO LOOK AT IT A LITTLE

1605
00:51:57,624 --> 00:52:00,127
BIT AT MAYO BECAUSE WE'RE REALLY

1606
00:52:00,127 --> 00:52:00,994
CURIOUS, RIGHT?

1607
00:52:00,994 --> 00:52:02,963
AND IN COLORADO I'VE ALSO LOOKED

1608
00:52:02,963 --> 00:52:05,599
ATAUR DATA BY THE PRESENT OF FTE

1609
00:52:05,599 --> 00:52:08,268
IN THE CLINICAL PRACTICE VERSUS

1610
00:52:08,268 --> 00:52:09,803
PRESENTING FTE THAT YOU HAVE FOR

1611
00:52:09,803 --> 00:52:11,171
RESEARCH AND NOT FOR THE

1612
00:52:11,171 --> 00:52:12,639
RESEARCH PIECE, NOT REALLY

1613
00:52:12,639 --> 00:52:14,241
SEEING MUCH OF A RELATIONSHIP

1614
00:52:14,241 --> 00:52:15,842
BUT THE MORE TIME PEOPLE SPEND

1615
00:52:15,842 --> 00:52:17,144
IN CLINICAL PRACTICE, THE HIGHER

1616
00:52:17,144 --> 00:52:18,945
THEIR RISK IS OF BURN OUT, WE

1617
00:52:18,945 --> 00:52:20,147
DEFINITELY SAW THAT PIECE.

1618
00:52:20,147 --> 00:52:22,282
I THINK SOME OF IT COMES DOWN TO

1619
00:52:22,282 --> 00:52:24,050
THAT CAREER FIT PIECE, YOU KNOWI

1620
00:52:24,050 --> 00:52:25,786
LIKE THE MORE YOU'RE ABLE ON DO

1621
00:52:25,786 --> 00:52:28,155
WHAT YOU FIND MOST MEANINGFUL,

1622
00:52:28,155 --> 00:52:29,923
SORT OF THE LESS PROFESSIONAL

1623
00:52:29,923 --> 00:52:32,058
BURN OUT THERE IS, BUT THIS IS

1624
00:52:32,058 --> 00:52:34,394
DEFINITELY AN AREA WHERE WE NEED

1625
00:52:34,394 --> 00:52:35,462
MORE RESEARCH TO REALLY PICK

1626
00:52:35,462 --> 00:52:40,267
OUT, YOU KNOW WHAT ARE--WHAT'S

1627
00:52:40,267 --> 00:52:41,802
THE APPROACH AND THE SOLUTION

1628
00:52:41,802 --> 00:52:43,136
FOR SCIENTISTS OR WHAT'S THE

1629
00:52:43,136 --> 00:52:45,705
APPROACH AND SOLUTION FOR PEOPLE

1630
00:52:45,705 --> 00:52:47,107
WHO ARE STRADDLING THESE 2

1631
00:52:47,107 --> 00:52:47,874
WORLDS.

1632
00:52:47,874 --> 00:52:48,642
>> OKAY AND JUST 1 MORE

1633
00:52:48,642 --> 00:52:50,177
QUESTION, I WANTED TO KNOW IF

1634
00:52:50,177 --> 00:52:52,012
THERE WAS A CORRELATION BETWEEN

1635
00:52:52,012 --> 00:52:53,246
LARGER AMOUNT OF BURN OUT IN

1636
00:52:53,246 --> 00:52:55,782
AREAS WHERE THERE ARE HEALTHCARE

1637
00:52:55,782 --> 00:52:56,783
DESERTS OR WHERE YOU WOULD

1638
00:52:56,783 --> 00:52:58,919
DESCRIBE THEM AS HEALTHCARE

1639
00:52:58,919 --> 00:53:02,289
DESERT ANDS THEN AREAS WITH

1640
00:53:02,289 --> 00:53:03,223
DEMOGRAPHICS OF HISTORICALLY

1641
00:53:03,223 --> 00:53:05,091
FLUTED GROUPS FROM MEDICINE IN.

1642
00:53:05,091 --> 00:53:05,692
>> YEAH, GOOD QUESTION.

1643
00:53:05,692 --> 00:53:07,961
WE'VE TRIED TO LOOK AT, YOU KNOW

1644
00:53:07,961 --> 00:53:10,764
IS THERE A DIFFERENCE FOR CLIN 8

1645
00:53:10,764 --> 00:53:13,667
HOURSS WHO WORK IN FEDERALLY

1646
00:53:13,667 --> 00:53:14,801
QUALIFIED HEALTHCARE TRUSTEESS,

1647
00:53:14,801 --> 00:53:16,269
THEY ARE OFTEN UNDERRESOURCED

1648
00:53:16,269 --> 00:53:18,972
AND VERY MUCH OVERWORKED BUT SO

1649
00:53:18,972 --> 00:53:21,341
FAR OUR SAMPLE HASN'T REALLY

1650
00:53:21,341 --> 00:53:22,976
BEEN BIG ENOUGH LIKE WE NEED TO

1651
00:53:22,976 --> 00:53:24,344
FIGURE OUT HOW TO GET MORE

1652
00:53:24,344 --> 00:53:25,679
RESPONDERS FROM THAT GROUP.

1653
00:53:25,679 --> 00:53:27,781
YEARS AGO, I LOOKED AT THE

1654
00:53:27,781 --> 00:53:28,348
RELATIONSHIP BETWEEN SURGEON

1655
00:53:28,348 --> 00:53:29,649
BURN OUT AND THE SIZE OF THE

1656
00:53:29,649 --> 00:53:31,184
COMMUNITY THAT THEY WORKED IN,

1657
00:53:31,184 --> 00:53:31,551
RIGHT?

1658
00:53:31,551 --> 00:53:32,886
THINKING THAT IF THE SURMON IS

1659
00:53:32,886 --> 00:53:35,322
LIKE THE LONE SURGEON IN A

1660
00:53:35,322 --> 00:53:38,525
COMMUNITY, RIGHT, IS THAT A GOOD

1661
00:53:38,525 --> 00:53:41,361
OR BAD THING AND WE SAW NO

1662
00:53:41,361 --> 00:53:42,062
RELATIONSHIP BETWEEN THE SIZE OF

1663
00:53:42,062 --> 00:53:44,264
THE COMMUNITY AND THE SURGEON

1664
00:53:44,264 --> 00:53:44,998
BURN OUT.

1665
00:53:44,998 --> 00:53:47,667
IT DIDN'T GET AT YOUR OTHER

1666
00:53:47,667 --> 00:53:48,368
EXCELLENT POINTS RIGHT AROUND

1667
00:53:48,368 --> 00:53:50,103
SORT OF THE RESOURCES OF THE

1668
00:53:50,103 --> 00:53:51,404
COMMUNITY THAT YOU'RE TRYING TO

1669
00:53:51,404 --> 00:53:54,274
PROVIDE CARE FOR OR THE

1670
00:53:54,274 --> 00:53:55,675
DEMOGRAPHICS OF THE RESOURCES OF

1671
00:53:55,675 --> 00:53:56,743
THE COMMUNITY THAT YOU'RE TRYING

1672
00:53:56,743 --> 00:53:58,578
TO PROVIDE CARE FOR SO REALLY

1673
00:53:58,578 --> 00:53:59,880
IMPORTANT WORK, SO YEAH, MORE TO

1674
00:53:59,880 --> 00:54:02,749
COME OR MAYBE A PROJECT.

1675
00:54:02,749 --> 00:54:03,617
>> OKAY, THANK YOU.

1676
00:54:03,617 --> 00:54:04,751
>> THANK YOU.

1677
00:54:04,751 --> 00:54:04,951
YEAH?

1678
00:54:04,951 --> 00:54:06,887
>> THANK YOU FOR THE GREAT
TALK

1679
00:54:06,887 --> 00:54:08,622
EMPLOY I WAS WONDERING IF YOU

1680
00:54:08,622 --> 00:54:09,923
COULD TALK MORE ABOUT THE AGE

1681
00:54:09,923 --> 00:54:11,191
DIFFERENCES YOU SAW IN WHETHER

1682
00:54:11,191 --> 00:54:12,859
THERE ARE ANY DRIVING FACTORS

1683
00:54:12,859 --> 00:54:16,496
THAT HAVE BEEN IDENTIFIED OR

1684
00:54:16,496 --> 00:54:18,265
DIFFERENT THINGS THAT CONTRIBUTE

1685
00:54:18,265 --> 00:54:19,432
TO THAT?

1686
00:54:19,432 --> 00:54:20,100
>> YEAH, SUPER INTERESTING
RIGHT

1687
00:54:20,100 --> 00:54:21,935
BECAUSE WE ALSO SEE IT IN THE

1688
00:54:21,935 --> 00:54:25,272
POPULATION AND THEN WE SEE IT IN

1689
00:54:25,272 --> 00:54:31,378
PHYSICIANS, SURGEONS THAT THIS

1690
00:54:31,378 --> 00:54:32,078
RELATIONSHIP WITH AGE.

1691
00:54:32,078 --> 00:54:34,047
WHEN WE LOOK AT IT DIFFERENTLY

1692
00:54:34,047 --> 00:54:36,016
OR BY CAREER STAGE, WE SEE THAT

1693
00:54:36,016 --> 00:54:38,084
IT'S NOT THE SORT OF 10 YEARS

1694
00:54:38,084 --> 00:54:40,453
AND BELOW IN CLINICAL PRACTICE,

1695
00:54:40,453 --> 00:54:42,956
AND IT'S NOT THE 20 AND ABOVE

1696
00:54:42,956 --> 00:54:44,357
CLINICAL YEARS IN PRACTICE, IT'S

1697
00:54:44,357 --> 00:54:45,191
THIS MIDCAREER GROUP THAT SEEMS

1698
00:54:45,191 --> 00:54:48,929
TO HAVE THE HIGHEST LEVEL OF

1699
00:54:48,929 --> 00:54:51,298
BURN OUT AND MAYBE THAT'S

1700
00:54:51,298 --> 00:54:53,533
BECAUSE YOU KNOW THE YOUNGER

1701
00:54:53,533 --> 00:54:55,168
GENERATIONS MAKING DIFFERENT

1702
00:54:55,168 --> 00:54:56,536
DECISIONS OR MAYBE IT'S JUST

1703
00:54:56,536 --> 00:54:58,238
THEY'RE NOT READY IN THEIR

1704
00:54:58,238 --> 00:55:00,473
LEADERSHIP JOURNEY TO TAKE ON

1705
00:55:00,473 --> 00:55:01,274
BIG RESPONSIBILITIES AND MAYBE

1706
00:55:01,274 --> 00:55:02,976
IT'S THE SEEN KROR PEOPLE ARE

1707
00:55:02,976 --> 00:55:04,244
LIKE, I'M DONE WITH THIS, TIME

1708
00:55:04,244 --> 00:55:05,645
TO HAVE SOMEONE ELSE HAVE THE

1709
00:55:05,645 --> 00:55:07,180
OPPORTUNITY AND THEN THE

1710
00:55:07,180 --> 00:55:10,250
MIDCAREER PEOPLE ARE LEFT

1711
00:55:10,250 --> 00:55:11,918
HOLDING ALL THIS WORK SO THERE'S

1712
00:55:11,918 --> 00:55:13,353
A COUPLE DIFFERENT THINGS GOING

1713
00:55:13,353 --> 00:55:15,155
ON, THERE'S EVIDENCE BY CAREER

1714
00:55:15,155 --> 00:55:16,356
TAIJ, THAT MIDCAREER IS PRETTY

1715
00:55:16,356 --> 00:55:17,857
TRICKY AND THEN THERE'S SORT OF

1716
00:55:17,857 --> 00:55:20,093
EVIDENCE THAT KIND OF GETTING

1717
00:55:20,093 --> 00:55:25,098
STARTED IS TRICKY, RIGHT?

1718
00:55:25,098 --> 00:55:26,766
THERE'S NEVER A GENERATION THAT

1719
00:55:26,766 --> 00:55:28,568
HASN'T BARBED THE GENERATION

1720
00:55:28,568 --> 00:55:30,337
BELOW THEM, RIGHT?

1721
00:55:30,337 --> 00:55:32,005
LIKE MY PARENT BARBED MY

1722
00:55:32,005 --> 00:55:34,107
GENERATION AND I CAN BARB OTHER

1723
00:55:34,107 --> 00:55:35,842
GENERATIONS, RIGHT, BUT I DON'T

1724
00:55:35,842 --> 00:55:37,277
THINK IT'S LIKE THIS MYSTERIOUS

1725
00:55:37,277 --> 00:55:40,280
ALL THE SUDDEN WE HAVE THIS HUGE

1726
00:55:40,280 --> 00:55:41,648
GENERATIONAL DIVIDE OR ALL OF A

1727
00:55:41,648 --> 00:55:42,582
SUDDEN WE HAVE ALL THESE WHO

1728
00:55:42,582 --> 00:55:44,317
WANT TO HAVE A HEALTHIER

1729
00:55:44,317 --> 00:55:45,318
BALANCE, RIGHT?

1730
00:55:45,318 --> 00:55:48,521
I THINK WE ALL WANT A HEALTHIER

1731
00:55:48,521 --> 00:55:51,591
BALANCE, SO I DON'T THINK IT SO

1732
00:55:51,591 --> 00:55:53,193
MUCH REFLECTS KIND OF GENERATED

1733
00:55:53,193 --> 00:55:55,128
RAITIONZAL DIFFERENCES, I THINK

1734
00:55:55,128 --> 00:55:57,597
IT'S ALSO REALLY HARD, RIGHT?

1735
00:55:57,597 --> 00:56:00,600
LIKE YOU THINK ABOUT IT 30 YEARS

1736
00:56:00,600 --> 00:56:02,068
AGO, PHYSICIANS HAD A AT A AT

1737
00:56:02,068 --> 00:56:04,104
HOME SPOUSE WHO MANAGED A LOT OF

1738
00:56:04,104 --> 00:56:06,239
THINGS, NOW MOST PHYSICIANS ARE

1739
00:56:06,239 --> 00:56:07,540
IN DUAL CAREER RELATIONSHIPS,

1740
00:56:07,540 --> 00:56:09,042
THERE'S A LOT OF WOMEN OBVIOUSLY

1741
00:56:09,042 --> 00:56:12,312
IN THE HEALTHCARE WORKFORCE

1742
00:56:12,312 --> 00:56:13,747
VERSUS, YOU KNOW 30, 40 YEARS

1743
00:56:13,747 --> 00:56:15,815
AGO BUT IT'S REALLY HARD TO

1744
00:56:15,815 --> 00:56:16,449
KNOW, RIGHT?

1745
00:56:16,449 --> 00:56:18,785
WE CERTAINLY KNOW THAT OUR

1746
00:56:18,785 --> 00:56:19,652
MEDICAL STUDENTS HAD TO LEARN

1747
00:56:19,652 --> 00:56:21,554
EVERYTHING WE HAD TO LEARN PLUS

1748
00:56:21,554 --> 00:56:23,356
EVERYTHING ELSE THAT WE HAD TO

1749
00:56:23,356 --> 00:56:25,091
LEARN SINCE WE WENT TO MEDICAL

1750
00:56:25,091 --> 00:56:27,527
COOL RIGHT IN LIKE HOW IS THAT

1751
00:56:27,527 --> 00:56:28,795
HAPPENING AND THEN PEOPLE WANT

1752
00:56:28,795 --> 00:56:31,264
THEM TO BE VALUE-ADD IN THE

1753
00:56:31,264 --> 00:56:32,832
CLINIC AND OTHER EXPECTATIONS

1754
00:56:32,832 --> 00:56:33,900
BUT IT'S WORTH LOOKING AT MORE

1755
00:56:33,900 --> 00:56:36,536
SO THAT WE CAN CRACK IT, I'M

1756
00:56:36,536 --> 00:56:37,771
ALSO WORRIED ABOUT SURVIVAL

1757
00:56:37,771 --> 00:56:41,374
BIAS, IS THE REASON WHY MY BIG

1758
00:56:41,374 --> 00:56:41,975
NATIONAL LONGITUDINAL STUDIES,

1759
00:56:41,975 --> 00:56:42,809
THAT IS THE YOUNG PEOPLE WHO

1760
00:56:42,809 --> 00:56:45,412
HAVE BURN OUT IS BECAUSE THE OLD

1761
00:56:45,412 --> 00:56:49,015
PEOPLE LIKE THEY LEFT, RIGHT AND

1762
00:56:49,015 --> 00:56:50,417
IT'S SURVIVAL BIAS, SO THERE'S

1763
00:56:50,417 --> 00:56:51,951
LOTS OF POSSIBILITIES.

1764
00:56:51,951 --> 00:56:52,585
>> DOCTOR, WE THANK YOU
VERY

1765
00:56:52,585 --> 00:56:52,886
MUCH.

1766
00:56:52,886 --> 00:56:54,087
THAT WAS A PHENOMENAL

1767
00:56:54,087 --> 00:56:55,688
PRESENTATION AND I HAVE TO SHARE

1768
00:56:55,688 --> 00:56:57,891
MY DISCOMFORT OF SEEING MYSELF

1769
00:56:57,891 --> 00:57:01,995
ON THAT SLIDES TOO OFTEN, I

1770
00:57:01,995 --> 00:57:04,097
THINK, BUT--BY THE WAY, WE HAD

1771
00:57:04,097 --> 00:57:05,598
OVER A HUNDRED VIDEOCAST VIEWERS

1772
00:57:05,598 --> 00:57:07,634
SO THIS WAS A VERY WELL RECEIVED

1773
00:57:07,634 --> 00:57:07,967
PRESENTATION.

1774
00:57:07,967 --> 00:57:09,869
MY QUESTION IS ABOUT IS THERE A

1775
00:57:09,869 --> 00:57:14,007
ROLE FOR LIKE NEAR PEER

1776
00:57:14,007 --> 00:57:14,307
MENTORING?

1777
00:57:14,307 --> 00:57:16,276
DOES THAT DO ANYTHING TO

1778
00:57:16,276 --> 00:57:17,877
MITIGATE BURN OUT?

1779
00:57:17,877 --> 00:57:19,512
AND ALSO WHO MENTORS THE

1780
00:57:19,512 --> 00:57:19,746
MENTORS?

1781
00:57:19,746 --> 00:57:22,682
BECAUSE SOMETIMES THEY GO INTO

1782
00:57:22,682 --> 00:57:24,851
THIS WITHOUT MUCH SUPPORT.

1783
00:57:24,851 --> 00:57:25,418
>> YEAH, GREAT QUESTION.

1784
00:57:25,418 --> 00:57:27,887
AND SO, WE KNOW AT LEAST IN

1785
00:57:27,887 --> 00:57:32,292
RESIDENCY PROGRAMS IF THEY HAVE

1786
00:57:32,292 --> 00:57:33,927
A STRUCTURED MENTORSHIP PROGRAM,

1787
00:57:33,927 --> 00:57:35,462
THEY'RE LESS LIKELY TO BE BURNT

1788
00:57:35,462 --> 00:57:35,762
OUT.

1789
00:57:35,762 --> 00:57:37,931
THE SAME QUESTION HAS NOT BEEN

1790
00:57:37,931 --> 00:57:39,399
ASKED OF ACADEMIA BUT IF YOU

1791
00:57:39,399 --> 00:57:40,733
THINK ABOUT IT MAKES SENSE IT'S

1792
00:57:40,733 --> 00:57:42,735
THE RIGHT THING TO DO AS PART OF

1793
00:57:42,735 --> 00:57:44,671
THE STRATEGY BECAUSE WHAT DOES

1794
00:57:44,671 --> 00:57:46,272
MENTORING DO, IT ULTIMATELY

1795
00:57:46,272 --> 00:57:46,906
BUILDS RELATIONSHIPS, IT BUILDS

1796
00:57:46,906 --> 00:57:48,374
SOCIAL SUPPORT, IT HELPS COACH

1797
00:57:48,374 --> 00:57:51,511
YOU THROUGH DIFFICULT

1798
00:57:51,511 --> 00:57:54,147
SITUATIONS, SO, INTUITIVELY,

1799
00:57:54,147 --> 00:57:55,281
MENTORING, MENTORSHIP PROGRAMS,

1800
00:57:55,281 --> 00:57:57,517
MENTORING COMMITTEES, THE WAYS

1801
00:57:57,517 --> 00:57:59,219
WE CAN BUILD SUPPORT FOR EACH

1802
00:57:59,219 --> 00:58:01,621
OTHER BY THEMSELVES IS REALLY

1803
00:58:01,621 --> 00:58:01,888
VALUABLE.

1804
00:58:01,888 --> 00:58:03,123
AND I THINK TO YOUR POINT AS

1805
00:58:03,123 --> 00:58:05,592
WELL, HOW DO WE TAKE CARE OF THE

1806
00:58:05,592 --> 00:58:07,026
MENTORS, RIGHT IN AND I WOULD

1807
00:58:07,026 --> 00:58:09,162
SUGGEST THEY NEED THEIR OWN

1808
00:58:09,162 --> 00:58:09,963
MENTORING CIRCLE WHERE THEY

1809
00:58:09,963 --> 00:58:11,397
SHARE THEIR EXPERIENCES AND

1810
00:58:11,397 --> 00:58:12,765
CHALLENGES AND THEIR TRIUMPHS,

1811
00:58:12,765 --> 00:58:15,301
AND DO THAT KIND OF, YOU KNOW IN

1812
00:58:15,301 --> 00:58:16,636
THE MOMENT LEARNING AND LIKE, OH

1813
00:58:16,636 --> 00:58:18,505
YEAH, I HAD A MENTEE TELL ME

1814
00:58:18,505 --> 00:58:19,973
THAT ONCE, TOO AND THIS IS HOW I

1815
00:58:19,973 --> 00:58:22,609
DEALT WITH IT, RIGHT IN I THINK

1816
00:58:22,609 --> 00:58:25,211
THOSE SORTS OF COMMUNITY THINGS,

1817
00:58:25,211 --> 00:58:27,046
YOU KNOW.

1818
00:58:27,046 --> 00:58:28,915
IT DOESN'T TAKE A COLOSSAL

1819
00:58:28,915 --> 00:58:32,285
EFFORT TO CHANGE IT, IT DOESN'T

1820
00:58:32,285 --> 00:58:33,353
TAKE A COLOSSAL EFFORT TO GET

1821
00:58:33,353 --> 00:58:35,321
NURSES INTO THE WARDS BUT THESE

1822
00:58:35,321 --> 00:58:36,990
OTHER PIECES AROUND BUILDING

1823
00:58:36,990 --> 00:58:37,857
COMMUNITIES WHETHER IT'S FROM

1824
00:58:37,857 --> 00:58:39,259
DINNER GROUPS TO FORMER

1825
00:58:39,259 --> 00:58:41,161
MENTORING PROGRAMS AND CIRCLES,

1826
00:58:41,161 --> 00:58:42,095
I THINK INTUMOR SPECTRUM LIVELY

1827
00:58:42,095 --> 00:58:45,665
AND BASED ON THE RESEARCH IS A

1828
00:58:45,665 --> 00:58:46,366
REALLY VALUABLE APPROACH.

1829
00:58:46,366 --> 00:58:46,966
NTHANK YOU.

1830
00:58:46,966 --> 00:58:49,002
I HAVE 1 QUICK QUESTION, TOO, SO

1831
00:58:49,002 --> 00:58:51,938
THE DATA THAT YOU PRESENTED ON

1832
00:58:51,938 --> 00:58:53,673
THE STANFORD MODEL WHERE THEY

1833
00:58:53,673 --> 00:58:54,674
ACTUALLY INTERVIEWED THEIR

1834
00:58:54,674 --> 00:58:56,843
ENTIRE WORKFORCE OF THE WORK

1835
00:58:56,843 --> 00:58:58,845
UNITS, HOW DOES AN INSTITUTION

1836
00:58:58,845 --> 00:59:01,281
GO ABOUT PICKING THE RIGHT--WHAT

1837
00:59:01,281 --> 00:59:02,849
ARE THE MEASUREMENT TOOLS THAT

1838
00:59:02,849 --> 00:59:03,850
AN ORGANIZATION SHOULD DEPLOY TO

1839
00:59:03,850 --> 00:59:07,520
TRY TO UNDERSTAND THIS BETTER

1840
00:59:07,520 --> 00:59:08,488
DATA WISE?

1841
00:59:08,488 --> 00:59:10,023
>> SO MEASUREMENT, I THINK
IS

1842
00:59:10,023 --> 00:59:10,890
KEY TO DRIVE CHANGE.

1843
00:59:10,890 --> 00:59:12,525
LIKE WHEN WE THINK ABOUT

1844
00:59:12,525 --> 00:59:13,326
QUALITY, RIGHT?

1845
00:59:13,326 --> 00:59:16,362
IF WE'RE TRYING TO YOU KNOW

1846
00:59:16,362 --> 00:59:17,263
REDUCE INFECTIONS WE FIRST

1847
00:59:17,263 --> 00:59:18,665
FIGURE OUT HOW MANY INFECTIONS

1848
00:59:18,665 --> 00:59:20,233
DO WE HAVE AND WHERE ARE THE

1849
00:59:20,233 --> 00:59:22,068
INFECTION HOT SPOTS AND THEN WE

1850
00:59:22,068 --> 00:59:23,369
DO INTERVENTIONS THERE, AND I

1851
00:59:23,369 --> 00:59:24,871
THINK IT'S THE SAME THING WITH

1852
00:59:24,871 --> 00:59:25,638
WORKFORCE WELL BEING, YOU KNOW

1853
00:59:25,638 --> 00:59:27,707
WE CAN LOOK AT THINGS OTHER THAN

1854
00:59:27,707 --> 00:59:28,074
SURVEYS, RIGHT?

1855
00:59:28,074 --> 00:59:29,742
SO WE CAN LOOK AT TURNOVER, WE

1856
00:59:29,742 --> 00:59:32,278
CAN LOOK AT WHAT WE CALL AUDIT

1857
00:59:32,278 --> 00:59:34,280
LOG DATA TO FIGURE OUT WHO'S IN

1858
00:59:34,280 --> 00:59:35,415
THE ELECTRONIC HEALTH RECORD,

1859
00:59:35,415 --> 00:59:37,383
OUTSIDE OF SCHEDULED TIME WITH

1860
00:59:37,383 --> 00:59:38,418
PATIENTS, BUT ULTIMATELY SURVEYS

1861
00:59:38,418 --> 00:59:40,286
DO HAVE A ROLE AND THEY'RE

1862
00:59:40,286 --> 00:59:41,554
REALLY IMPORTANT AND THERE ARE

1863
00:59:41,554 --> 00:59:42,689
MANY DIFFERENT MEASURES AND

1864
00:59:42,689 --> 00:59:45,425
TOOLS AND SERVICES OUT THERE.

1865
00:59:45,425 --> 00:59:46,960
I THINK THE MAIN THING IS IT'S

1866
00:59:46,960 --> 00:59:48,695
SUPER HELPFUL TO HAVE 1 MEASURES

1867
00:59:48,695 --> 00:59:51,097
THAT HAVE SOME AMOUNT OF

1868
00:59:51,097 --> 00:59:52,031
PSYCHOMETRIC PROPERTIES, RIGHT

1869
00:59:52,031 --> 00:59:54,200
AS SOME SERIOUS DEGREE OF

1870
00:59:54,200 --> 00:59:55,101
VALIDITY, THAT'S REALLY HELPFUL

1871
00:59:55,101 --> 00:59:57,337
SO THAT YOU KNOW WHAT YOU'RE

1872
00:59:57,337 --> 00:59:58,304
MEASURING MATTERS AND THEN THE

1873
00:59:58,304 --> 00:59:59,672
SECOND THING THAT I FIND REALLY

1874
00:59:59,672 --> 01:00:02,008
HELPFUL TO IS TO HAVE BENCHMARK

1875
01:00:02,008 --> 01:00:03,676
DATA BECAUSE LIKE WHEN I GO TO

1876
01:00:03,676 --> 01:00:06,279
MY CHAIR, OF LET'S JUST PICK ON

1877
01:00:06,279 --> 01:00:09,015
EMERGENCY MEDICINE, YOU KNOW, MY

1878
01:00:09,015 --> 01:00:09,882
CHAIR OF EMERGENCY MEDICINE SAYS

1879
01:00:09,882 --> 01:00:11,551
I HAVE THE MOST STRESSFUL JOB,

1880
01:00:11,551 --> 01:00:13,820
OF COURSE I'M GOING TO HAVE THE

1881
01:00:13,820 --> 01:00:15,188
HIGHEST BURN OUT RATES.

1882
01:00:15,188 --> 01:00:15,888
NATIONALLY EMERGENCY MEDICINE

1883
01:00:15,888 --> 01:00:17,223
HAS THE HIGHEST BURN OUT RATES

1884
01:00:17,223 --> 01:00:19,325
BUT WHEN I CAN THEN GO, YES,

1885
01:00:19,325 --> 01:00:20,893
CHAIR, THESE THINGS ARE TRUE,

1886
01:00:20,893 --> 01:00:23,463
AND YOUR BURN OUT RATES ARE

1887
01:00:23,463 --> 01:00:25,665
HIGHER THAN NATIONAL, THE IT

1888
01:00:25,665 --> 01:00:28,401
CHANGES THE CONVERSATION, RIGHT?

1889
01:00:28,401 --> 01:00:29,002
IT GIVES ME TRACTION.

1890
01:00:29,002 --> 01:00:31,871
SO BEING ABLE TO SORT OF COMPARE

1891
01:00:31,871 --> 01:00:34,107
TO BENCHMARK, IS REALLY VALUABLE

1892
01:00:34,107 --> 01:00:35,575
BECAUSE IT TELL HELPS ME

1893
01:00:35,575 --> 01:00:36,809
IDENTIFY THE DELTA RIGHT, THEN

1894
01:00:36,809 --> 01:00:37,977
IT'S NOT THE JOINT COMMISSION,

1895
01:00:37,977 --> 01:00:40,980
THAT IT'S NOT MEDICARE, THAT

1896
01:00:40,980 --> 01:00:42,915
IT'S NOT SOME RULE OR

1897
01:00:42,915 --> 01:00:43,716
REGULATION, RIGHT?

1898
01:00:43,716 --> 01:00:44,717
IT'S MANAGE THAT'S HAPPENING

1899
01:00:44,717 --> 01:00:49,422
LOCALLY SO, I WOULD--YOU KNOW

1900
01:00:49,422 --> 01:00:49,822
GETTING THE MOST

1901
01:00:49,822 --> 01:00:50,523
PSYCHOMETRICALLY STRONG TOOL YOU

1902
01:00:50,523 --> 01:00:52,759
CAN GET THAT HAS NATIONAL

1903
01:00:52,759 --> 01:00:56,229
BENCHMARK DATA IS WHERE THE

1904
01:00:56,229 --> 01:00:56,596
SWEET SPOT IS.

1905
01:00:56,596 --> 01:00:58,464
>> THANK YOU FOR YOUR
TALK.

1906
01:00:58,464 --> 01:01:01,234
IT'S BEEN VERY GREAT.

1907
01:01:01,234 --> 01:01:03,069
I'M AN ADVANCED PRACTICE

1908
01:01:03,069 --> 01:01:05,138
PROVIDER AND ON 1 OF YOUR

1909
01:01:05,138 --> 01:01:06,139
SLIDES, MAYBE THE INTERVENTION

1910
01:01:06,139 --> 01:01:08,541
WAS DONE IN COLORADO, AND YOU

1911
01:01:08,541 --> 01:01:10,510
KNOW AS AN ADVANCED PRACTICE

1912
01:01:10,510 --> 01:01:11,577
PROVIDER, YOU KNOW YOU'RE A

1913
01:01:11,577 --> 01:01:12,679
NURSE BUT YOU'RE ALSO A PROVIDER

1914
01:01:12,679 --> 01:01:17,383
AND IT JUST SEEMS LIKE THE

1915
01:01:17,383 --> 01:01:18,017
SUPPORT ISN'T THERE.

1916
01:01:18,017 --> 01:01:19,819
IT'S ALMOST LIKE IF THERE IS AN

1917
01:01:19,819 --> 01:01:22,255
EXTRA TASK, IT SEEMS LIKE IT'S

1918
01:01:22,255 --> 01:01:26,392
DELEGATED TO YOUR ROLE AND I SAW

1919
01:01:26,392 --> 01:01:28,961
THAT THE EXAMPLE IN COLORADO

1920
01:01:28,961 --> 01:01:32,365
THEY ACTUALLY HAD THEIR MEDICAL

1921
01:01:32,365 --> 01:01:33,433
ASSISTANTS ACTUALLY VOLUNTEER

1922
01:01:33,433 --> 01:01:34,434
AND ACTUALLY WERE EMPOWER

1923
01:01:34,434 --> 01:01:35,468
EXCLUDE FELT BETTER WHEN THEY

1924
01:01:35,468 --> 01:01:37,170
HAD DIFFERENT ROLES AND I'M LIKE

1925
01:01:37,170 --> 01:01:38,838
HOW DO YOU GET TO THAT

1926
01:01:38,838 --> 01:01:39,172
CONVERSATION?

1927
01:01:39,172 --> 01:01:40,073
BECAUSE THEY'RE LIKE, THIS IS

1928
01:01:40,073 --> 01:01:41,908
THE WAY IT'S ALWAYS BEEN DONE

1929
01:01:41,908 --> 01:01:43,109
AND THEY DON'T REALIZE THAT

1930
01:01:43,109 --> 01:01:44,944
THERE IS A PROBLEM.

1931
01:01:44,944 --> 01:01:46,279
NYEAH, IT'S A REALLY GOOD

1932
01:01:46,279 --> 01:01:47,013
QUESTION.

1933
01:01:47,013 --> 01:01:48,648
YOU NEED TO GET STAKEHOLDER

1934
01:01:48,648 --> 01:01:50,350
BUY-IN AND CREATE A SENSE OF

1935
01:01:50,350 --> 01:01:51,651
URGENCY, RIGHT?

1936
01:01:51,651 --> 01:01:54,253
SO THAT SOMETHING DOES HAPPEN

1937
01:01:54,253 --> 01:02:00,560
AND I CAN TELL YOU, IT IS A VERY

1938
01:02:00,560 --> 01:02:00,960
DIFFICULT JOURNEY.

1939
01:02:00,960 --> 01:02:02,362
BUT THE MORE YOU CAN INVOLVE

1940
01:02:02,362 --> 01:02:05,398
EVERYBODY FROM THE BEGINNING AND

1941
01:02:05,398 --> 01:02:06,866
THE CONVERSATION, THE MORE SORT

1942
01:02:06,866 --> 01:02:08,701
OF BUY-IN YOU GET, THE MORE SORT

1943
01:02:08,701 --> 01:02:10,803
OF IDEAS YOU GET SO THE MORE

1944
01:02:10,803 --> 01:02:12,004
TRACTION YOU GET WITH CHANGED

1945
01:02:12,004 --> 01:02:13,806
MANAGE AM BUT THERE HAS TO BE

1946
01:02:13,806 --> 01:02:15,575
INTEREST, THERE HAS TO BE

1947
01:02:15,575 --> 01:02:16,376
LEADERSHIP COMMITMENT, THERE HAS

1948
01:02:16,376 --> 01:02:18,010
TO BE THAT TONE THAT YOU KNOW

1949
01:02:18,010 --> 01:02:19,912
FOR US TO DELIVER ON OUR

1950
01:02:19,912 --> 01:02:20,913
MISSION, WE HAVE TO TAKE CARE OF

1951
01:02:20,913 --> 01:02:23,049
THE WELL BEING OF OUR WORKFORCE

1952
01:02:23,049 --> 01:02:24,917
AND THATTEN MEANS WE MEASURE AND

1953
01:02:24,917 --> 01:02:28,855
WE SHARE AND WE RESPOND.

1954
01:02:28,855 --> 01:02:30,923
AND WITHOUT THAT IT'S REALLY

1955
01:02:30,923 --> 01:02:31,124
HARD.

1956
01:02:31,124 --> 01:02:32,492
SO I THANK YOU VERY MUCH FOR

1957
01:02:32,492 --> 01:02:32,925
YOUR TIME.

1958
01:02:32,925 --> 01:02:35,895
I OWN FORTUNATELY HAVE TO RUN TO

1959
01:02:35,895 --> 01:02:36,829
CATCH A PLANE BUT PEOPLE FEEL

1960
01:02:36,829 --> 01:02:38,931
FREE TO E-MAIL ME AND I AM HAPPY

1961
01:02:38,931 --> 01:02:40,233
TO CONDITION IN THIS

1962
01:02:40,233 --> 01:02:41,067
CONVERSATION, RITA HAS MY TON

1963
01:02:41,067 --> 01:02:42,135
TACT INFORMATION AND THANK YOU

1964
01:02:42,135 --> 01:02:43,536
AGAIN FOR THE INVITATION AND THE

1965
01:02:43,536 --> 01:02:45,304
OPPORTUNITY TO PRESENT HERE.

1966
01:02:45,304 --> 01:02:46,372
>> THANK YOU FOR COMING.

1967
01:02:46,372 --> 01:02:56,616
[ APPLAUSE ]