So we'll get started. Thank you for coming. This is a session on the role of the chief wellness officer and how that interacts with occupational medicine. There has been an explosion of interest by employers in hiring chief wellness officers. And I don't think there's always been a lot of thought given to how that position, which is meant to be a potent position, interacts with all of the other elements that influence employee health. So this session is going to be about that. We hope to explain the role of the chief wellness officer and its relationship to the other aspects of occupational health. We're going to outline the opportunities and challenges of the multiple leaders engaged together in protecting and advancing the health of employees and their dependents. And we're going to describe one approach from a team that comes from the same institution about how to put all of this together. So I am Robert McClellan. I am a professor emeritus, or I should say semi-emeritus maybe, at the Geisel School of Medicine at Dartmouth. With me is a team from Yale. Mark Roussey, who is a professor of medicine and epidemiology at Yale, and the medical director of the employee health, safety, and well-being of the Yale New Haven Health System. And with us as well is Christine Olson, a fairly newly minted chief wellness officer who has been working with these guys to try to figure out how to do this. Craig Thorne, unfortunately, could not be with us here in person. But he's going to zoom in, and hopefully all that will work. If not, we've got other plans. And Craig is the chief medical director for occupational medicine and business health services for the Yale New Haven Health System. And then we have a trainee, Romero Santiago, who is a clinical fellow in the OCMED program at Yale. So the approach to worker health, safety, and well-being has been evolving during our careers, with some historical exceptions going back quite a ways. OCMED and employee health and safety has traditionally focused on work exposures, traditional work exposures that you read about or you have to know about to pass the boards, and resulting in compensable injury and illness. And then, of course, there's also, and we're very used to now in OCMED, working with behavioral health, wellness, and welfare silos, in most cases, in most institutions. These might be EAPs, could be the benefit program. It's all the HR policies and programs and the health promotion programs. Very often have kind of sprung up over time and frequently not integrated in any real way. Well, certainly within my career, maybe the last 20 or so years, as health care costs have exploded and the burden of disease, chronic disease, has also exploded, employers have taken notice. And they've taken notice of the health promotion literature and the fact that lifestyle, in fact, has a big impact on these chronic diseases. So with that, we have seen a rise of employer-sponsored health promotion, most often focused on individual lifestyle, like you should lose weight, you should exercise, you should stop smoking. But there's a lot of evidence coming out that that kind of approach doesn't really work. And you can see, every time when I was still at Dartmouth running these programs, every time the HR or the CFO, one of these articles would come out in business magazines frequently, or Rand has published. He said, do you really think what you're doing is making any difference? So it turns out that you can do it wrong and you can do it right. And Ron Goetzel, in particular, but also Dr. Enger, has looked at this a different way of doing things, where there is opposed to this individually-oriented, siloed health promotion effort focused on changing individuals' lifestyle. Then instead, you take a comprehensive attention to the attributes of work and how work factors, many factors, all those factors we were talking about, affect lifestyle, the incidence, and management of chronic disease and well-being. And that health promotion's effectiveness really depends on comprehensive programs that incorporate systemic-level interventions, as well as health coaching. And even more recently, employer-sponsored programs are more effective when integrated with interventions to address worker safety. I will never forget, certainly during I think many of the people's careers in this room, when asbestos was just becoming a real big issue in the United States. And some asbestos manufacturers were focusing on telling their employees to stop smoking without necessarily doing all that they could do to protect them from the asbestos exposure. So without incorporating safety protection in comprehensive efforts to improve the health, the general health of a population, that group of employees may not take on a employer-sponsored advice. So this has been the genesis of what now NIOSH is calling the total worker health approach to addressing the health, safety, and well-being of unemployed populations. They define it as all of those policies, programs, and practices that integrate protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being. So this hierarchy of control, we're very familiar with. This is putting that into the total worker health perspective, that lens. You can see that the individual admonishment for personal change is at the bottom, where PPE oftentimes sits. And at the top is eliminating those working conditions themselves that threaten safety, health, and well-being. So this guy named Studs Terkel, a fantastic interviewer, wrote this wonderful book about work. And if you haven't read it, it's very digestible in like two to three pages on each particular job. And what he got from talking to every possible kind of worker that's out there is that people want to be safe, but it's not just about safety. It's about the dignity and value of work. He said that work is about a search, too, for daily meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short, for a sort of life rather than a Monday through Friday sort of dying. So I was at Kent's presentation yesterday on resilience, in which he said that Maslow maybe didn't have it all right, that he shouldn't have put this as a pyramid, but rather as a circle. I don't know if I completely agree. I agree that they're all related. But the point here with this slide, for me showing Maslow's pyramid, is that we have had this experience, even within our own industry of health care, that health care workers who have a mask on all day have a hard time hydrating. They have a hard time knowing where to eat without eating with other people who don't have their masks on. Break rooms is where people were getting sick in health care. Safety, the beginning of the COVID pandemic, you saw people who were wearing N95s, if they had them at all, for a week or more at a time, and were wearing garbage bags for gowns, et cetera. And people who were segregated from their family because of fear of bringing disease home and were living separate, et cetera, that not having their belongingness met, et cetera. And so as we begin to think about well-being in the absence of this foundation, I am concerned that we're not going to get there. We need to figure out how to integrate all these things. So Dame Carol Black, from the UK, said in a very strong statement in her position of influencing the health service system in the UK, said, there is strong evidence that work, health, and well-being are closely and powerfully linked and need to be addressed together. Well, the health care sector has not done this well. 18% of health care workers have quit during the pandemic. And another 29% are considering quitting. And I read just recently, 20% of physicians are thinking of quitting. So it's clear that clinicians are not well. And the NAM has taken this on as one of their highest priorities to respond to this epidemic of clinician burnout, depression, and suicide. And if you haven't read it, I commend their consensus study to you. Came out two or three years ago. And in that, along with some editorials, they make the case for the chief wellness officer in America's health systems. They say, it should be the standard to have a designated and empowered senior leader overseeing clinician well-being efforts on behalf of an organization. And this individual should facilitate system-wide changes. The CWO would have the authority, the budget, the staff, and the mandate to implement an ambitious agenda and reside within the executive suite alongside the analogous CIO, CQO, et cetera. So I say, dear chief wellness officer, please, first of all, keep me safe. Are you just promoting health by another name in the way that hadn't worked? I am concerned that NAM has not actually addressed the risk that advancing the role of a CWO may result in yet another siloed effort parallel or even superseding occupational health and safety. We need to get this right. We need an intentional build of a multidisciplinary integrated system to advance health, safety, and well-being. And I am thoroughly delighted to have my colleagues here talk about, not that they are all the way there, but they are really working at it. They're really working at it. And you're going to hear today kind of the story of how they've gotten to where they are, some of the successes, some of the not successes that they've had, and all the work yet to be done. So I'm hoping you leave today. You're going to hear from a big academic health system. I hope you don't leave today and say, oh my god, this is just too much. We could never do this here. Because there's some warts. There's some warts. And I hope that you poke at them as we talk about and learn together how really we can get this right. So I'm going to turn it over to you now, Mark. Thanks. Thanks, Bob. And it's great to see everyone. So what I like to do in the first 15 minutes is sort of kind of describe the ecosystem, to tell you the infrastructure we have put in place over the past 10 years around wellness, around safety. We have hired a number of people to talk to us around wellness, around safety. We have hired 25 professionals dedicated solely to our employee population. We have seven disease management nurses. We have six health coaches for primary prevention and a pharmacist for medication needs. We have seven professionals who are employee safety specialists on the front line, and then a few other folks, and then an extension of our counseling services to 20 or 30 counselors we contract. This is just a picture of the web page. Folks can go here as kind of a first stop to get information, whether it's about wellness programs or about what's going on with employee safety, resources, numbers, and services they can access. Each of these takes you to various different pages. They have links, which link to links. And so that's just sort of a central repository. So let me describe one of the first things we did. This was 10 years ago. And we decided that we needed to do something about all of our folks who were struggling with chronic diseases. And we began with those with diabetes and set up one-to-one counseling for those folks. And over the years, we have integrated that more and more with the primary care practices, where those employees get their care. We've done various things to outreach to them. And obviously, as we've gone along, we have tracked our data. In the first two years, we saw some pretty encouraging results, both in terms of the health indices and the per member per month costs. And it looked as though we had probably decreased those costs by about $10 million over those two years. It's developed into a program that extends across our health system. Now we have more than 30,000 employees, mostly in Connecticut, a little bit into Rhode Island and New York. This is just an example of a page that tracks some of those activities, outreach to folks at different risk levels, degrees of engagement, et cetera. Right now, we have about 1,200 people who are doing these one-to-one meetings with the disease management nurse. That has waxed and waned over time. You can see for a while during the first waves of the pandemic, a little bit lower numbers of new members. And right now, we have about 75% of those folks doing disease management. We have another 25% doing health coaching around primary prevention. We are constantly sort of looking at how they're doing. This is just a look with folks serving as their own controls prior and post-enrollment. And we generally are able to show pretty good impact with these folks. Lots of them are diabetics. We have folks who are doing the best to manage hypertension and then a few other chronic diseases. So at the same time, we wanted to look at primary prevention. And I think there's so many wellness interventions that are just not rocket science. And the trick is just to sort of get people to engage with them. And we felt that if we could have one-to-one, face-to-face conversations with people at the very moment when we have just visited them with what might be kind of disturbing information to them, like, hey, your systolic blood pressure is 146, and then link them up at that very moment with health coaches, disease management nurses, let them know what resources are available for some of them just in getting them enrolled in primary care. So we began doing biometric screening in 2013. And so folks would come in, get their blood drawn. They would sit down immediately afterwards with someone who would go through those results and then point them in the direction of resources. And we actually had health coaches and disease management nurses at those sessions who were available to begin those relationships immediately. We have paired the biometric screening each year with a number of other activities that support health. You can see some of those there. And it has seemed as though $500 was about the sweet spot. It was enough to motivate people to do it. And lots of participation in this over the years. Obviously, we have followed these data as well. In the first year, we saw a really nice impact on the proportion of individuals with high risk blood pressure. This was just analysis we did about four years in. These were folks who had participated in four biometric screenings. And we had about a 25% decrease in the proportion of individuals in that group with systolic hypertension. Essentially, these are individuals serving as their own controls. This isn't new people coming in and bringing in better numbers. The diastolic, even a little better, about a 40% decrease in high-risk diastolic. Some impact with higher-risk HDL as well. Aggregate data we're constantly looking at. And by and large, we see numbers that are better than average numbers in the US population. 15% here with higher risk blood pressure compared to 30% across the country. Cholesterol, high risk, and about 6% versus 11% nationally. And low, or rather, a high or borderline LDL, you can see about 10% versus 30% nationally. There's been a lot of activity around emotional well-being support. We used to have our own in-house EAP. And as we've gotten bigger, we've contracted outside with that, with kind of a hybrid model where we have inside folks who do counseling and coordination, and then we have 20 or 30 counselors who are outside. We track this. There's a fair amount of participation in it. One of the things that we have wanted to do most with this is de-stigmatize the activity. An example of that was a program that we started several years ago where every incoming member of the house staff is enrolled with a counselor immediately. So we were always concerned that residents would just sort of keep their noses to the grindstone, that they would regard it as a sign of weakness if they ever had to go get counseling. So every single one of them meets with a counselor when they come in. That gives us a chance to familiarize them with resources we have in case they start having trouble. And hopefully, it lowers the threshold for their seeking help when they need it. And we have done surveys of the residents. They have accepted this very well. They like it. Many of them have actually engaged in counseling afterwards. And we have, in some ways, leveraged that in some of the activity that we've done during the COVID pandemic with well-being check-ins rather than counseling visits. It's essentially the same sort of thing, but it's a well-being check-in. And I think that that has helped folks to accept that sort of intervention a little more easily. We have many web-based resources. I think those are important. I don't think you really touch people with them. I think they're good sources of information. But we have tried to do everything we do with a very sort of human, face-to-face, high-touch kind of activity, whether it's counseling someone on risk factors for disease, whether it's counseling them about their chronic illness, or whether we are trying to help them with employee safety issues. These are just a few other things. Dr. Olson may mention some of these in her talk. Lots of activity. Phone meditations, and we've tried to leverage telehealth for a lot of this stuff. We have a very active, engaged mindfulness teacher, and mindfulness programs have been brought to lots of people across the health system. Dr. Olson spearheaded some work here with quiet and reset rooms, which are particularly helpful during the pandemic. And I want to finish with this, because as Bob mentioned, nobody is going to feel well unless they feel safe. And we have invested in this considerably. And I will say that just during the pandemic, just in all of the daily work that we did, we did our best. We never had to default to face masks. We were able to keep everyone in respirators. We were generally exceeding the guidance that was out there. And we have these seven individuals with boots on the ground who, every day, are out there meeting with employees. They follow up every single incident report. They're out there meeting with managers and either identifying local solutions, or when we recognize that there is a problem with a device or an educational system or a policy, solutions that essentially extend across the health system. One of my gauges for whether this is working or not is when I walk around with one of these guys. I mean, not too long ago, I was in the basement of the St. Rayfield campus of one of our hospitals, and it was an environmental service issue. Everywhere I went with Brian, who's the employee safety specialist there, everyone was, hey, Brian, Brian, hey, Brian. Everyone knew him. And I sort of say, that's the kind of success we're looking for, where people feel supported, where they feel like they matter, where they feel like they know with whom they can speak if they have an issue. And we're doing our best to engender that sort of culture. So what does it come from? Essentially, we have broadly targeted biometric screening and sort of primary prevention work where we've seen some success. We've seen certainly some success with the disease management program, particularly around diabetes and hypertension. We want to make sure that there is good availability of counseling services, lots of resources that people have which are web-based and also not web-based for counseling and peer support. And I think I'll just sort of finish with, and I think Bob alluded to some of this, but wellness is sometimes criticized as disingenuous fluff, where you put a Band-Aid on someone's left elbow while you were braiding their right elbow because you're not doing enough about the quality of their work day. And I think in the case of clinicians, there is certainly a lot about the intrinsic quality of the work that still needs work. We need better electronic health records. We need to make sure that our clinical spaces are adequately staffed so that people aren't completely overworked. And we need to make sure, while ensuring quality of care, that we are preserving physician autonomy. These are important issues that we can work on. All of that said, there are elements of working in health care which are just intrinsically, emotionally stressful. When you've cared for a patient for three weeks who's 41 years old with COVID, who went from being proned to being intubated to being on ECMO, and then dies with three young children at home, that's emotionally stressful. And when something like that happens the next day, that's emotionally stressful. So everything we're trying to do is to try to just give people the emotional well-being, the physical health, and to make sure that they know where to turn when events like that happen. So that has been the spirit of it. Again, it's been a very high-touch, people-intensive program. Lots more to do, but that's where we are at this point. So I will hand over the podium to my friend and colleague, Dr. Craig Thorne, who has done wonderful work with our clinical occupational health services across the entire health system, with telehealth, and I think can share some good information, particularly how he led that effort through the pandemic. So how does this work with Craig coming in? There you are. He's there. Craig. Good afternoon. Good morning. And can we show the slides too? OK. So Craig, we are advancing to your slides. Wonderful. Can you see them? I appreciate it. I can. So good morning there. Good afternoon from here in Connecticut. I'm sorry I can't join you, but I've got this nuisance infection called COVID, but I'm working through it and cared for, and I'm glad to join you. I just want to begin with a motivational quote. I reflect on a lot of quotes, and I've repurposed this particular one. Alone, we can do so little. Together, we can do so much. And that really attests to the team approach that my care team in occupational medicine have carried forward throughout COVID to take care of each other. Next slide, please. So we know that COVID has changed our world, both professionally and personally, and we've gained a lot of tremendous new perspectives and ways to lead our teams and practice our specialty. And so in preparation for this particular session, I reflected on perspectives that I've gained throughout the COVID pandemic in terms of how I have attempted to lead my clinical teams successfully over the past couple of years so that we could deliver for our employees, namely to learn and adapt quickly, to continuously survey the troops, both individually and collectively, to overly communicate, particularly changes in guidelines, to innovate, to expand the team so that we could care for over 32,000 employees throughout the system, to look for technological solutions and get really good at that really quickly, and above all, as a leader, to model the way for our team members. Next slide. I would recommend this article, The Practice of Adaptive Leadership. The reference is at the bottom of the slide for reading material. I recall that at the beginning of the pandemic, I was furiously looking to read around crisis leadership, et cetera. And some of my colleagues in the Yale School of Public Health led me to this particular article. It really is interesting. It's moving continually between the dance floor, which is on the left-hand side, and to the balcony on the right-hand side. And what that means is that as leaders, particularly in stressful times like the pandemic, we are on the dance floor. That's where the action is. That's where we roll up our sleeves and we provide our usual care and our COVID-related care to deserving employees. But we also need to get to that balcony to look across and to keep perspective on what we're doing as leaders. Very interesting concepts. Next slide, please. This next slide then talks about continuously surveying the troops individually and collectively. And what we did throughout the COVID pandemic is what we do daily in our clinics, morning huddles. Of course, these were virtual, 15 minutes. And we always have begun, and we've had one again this morning, with praise and honest appreciation for the work that was done the day before. I have been taught to do one-on-one check-ins very routinely, at least weekly, with all of our team members, including people that don't necessarily report to me but are providing clinical services within our system, including physician assistants, nurse practitioners, and very importantly, the rest of the team members, the nurses and the clinical support teams. Very precisely, we monitor PTO and time away during the COVID pandemic for all of our clinicians and staff. And we report on that to our internal leaders that provide this PTO on a monthly basis so that we can balance time away from work to rest. I recall the summer before last reaching out to one of our younger physicians who had not taken PTO for about four months and encouraged that. And he was able to take a week of PTO to rejuvenate and spend time with his family. Obviously, we want to always be accessible and encourage questions of our team members. And any regulation of distress on the team was very critical, people questioning their schedules, et cetera. And to really address that proactively, reduce conflict, and to assure fairness was very important and built trust and loyalty. And obviously, by listening to people, we kept bringing knowledge of the pandemic forward and technological and innovative solutions to how we served our employees. Next slide, please. This next slide really is key, overly communicate. Daily mass updates, we kept circulating an updated slide deck with slide number two being the most advanced guidance around how we're managing time off work and care for our employees with COVID exposures or COVID, and certainly then later into the vaccine mandate. Updated frequently asked questions across all of our clinics because our clinic staff were getting called. An ongoing Skype chat daily for those that were assigned to the call center for our employees. Very disciplined attention to the guidance, early morning reviews and sharing amongst many leaders across the health care system, and certainly celebrating milestones and instilling a lot of team pride to keep the troops energized. Next slide, please. Very proudly, we were honored with the American Hospital Association's Quest for Quality Prize. And during the interview from the reviewers for this prize, we were asked specifically what we did for employees across the system. And innovatively, the same team that Dr. Rusci mentioned, the Living Well Cares chronic coordinator teams had already reached in and asked how they could help and actually volunteered to send out pulse oximeters to employees and family members diagnosed with COVID and also to reach out and do daily check-ins with those employees. And that really helped tremendously and definitely saved lives as some employees were steered towards emergency care. So we celebrated widely this prize and certainly paused in all of the work that we were doing to support our employees of the health system. Next slide, please. This next slide talks about innovation. A lot of this conference over the past day and going forward is about innovations learned through COVID, how we've had to expand our teams. We called for clinicians throughout all disciplines, had a lot of hospitalists volunteer to help us. Telehealth tools, work-from-home tools for extended shifts to support telephonically and by video employees that were sick. Obviously, our vaccine campaigns and then a lot of transformation into nurse telehealth services. And probably we're going to be presenting some of that information following this session later this afternoon. Next slide, please. Creating technological solutions, self-scheduling of COVID tests. We learned from the EMR lecture earlier today, creating in-basket for all the test results, automating reports and work assignments, et cetera. Not being overly paternalistic during the time when so much work had to be done, but instilling trust and automation in how we operate as occupational medicine practitioners. And then a daily leadership dashboard so that we could keep senior leaders updated and also call for more resources as we needed them. Next slide, please. I think very importantly, we have to model the way. And this particular slide is from an amazing book called The Leadership Challenge. And the authors, Jane Kouzes and Barry Posner, the reference is at the bottom. And I would recommend this reference, another easy read. If you haven't practiced these five models, and there's two sub-factors within each to give you 10 key ideas, I would recommend that you reflect on them. Modeling the way is particularly important and something that I've learned to do and continue to learn through my career. And I'm gonna show you the next slide in terms of how we did it. This next slide shows, I'm gonna just ask yes, on the left-hand side, something that's very familiar. So when you fly on an airplane, the flight attendant instructs you to put on your oxygen mask first before helping others. Because if you run out of oxygen, then you cannot help others put on their mask. And I think this is such an important metaphor for us as we as care providers need to replenish ourselves, our energy and our reserves. And I'm sure many of you have had to take that time throughout the pandemic to take care of yourselves. On the right-hand side, a beautiful sunset of the coast here in Connecticut. And daily or near daily, I would take a walk early morning, late afternoon, just to reflect and get my perspective in order and replenish. And I recommend that we continue to balance our own wellbeing as well as the wellbeing of our teams. Next slide, please. Final lesson, keep your mind healthy always. Another very good reference that I've leaned on the four agreements by Don McGuell-Ruiz. And importantly, there were a lot of lessons learned throughout COVID. Things are imperfect. We are imperfect as leaders. It takes some time to get things right. And every day we got better. Number two, don't take things personally. Get the advice and counsel of others and move things forward. If you make a mistake or you admit to do something, correct that and move forward. And number four, going back to Boy Scout days, always do your best. And every day, again, get a little bit better about what we do. So those are the lessons that we've learned and applied throughout the pandemic. And I hope some of them are helpful as we move forward into this talk. I can go ahead and get the slides up, if that's okay with you. Okay. Get started. First of all, I'm... Can you just advance the slides on your own? Can you advance the slides? Thank you. Is that working now? Yeah. My clicker's not working, but you can advance the slides. You just say, next slide. Sure. So I'll let you know. Hi, I'm Christine Olson. I'm the Chief Wellness Officer at Yale New Haven Hospital, and I'm so glad to be here with my colleagues from Occupational Health, who have always been so good to me, and to be with so many like-minded people looking at how to make work well for people across this country. And I think Dr. Jung had me pegged yesterday. I did medical microbiology and philosophy and ethics as an undergrad. Then I went on to Peace Corps. I worked with USIS. I see our military officers here on tropical medicine, traveler health and disaster preparedness, med school, and then med-peds double boarded there, and then went on to do two years at the School of Management and then health services research and epidemiology as an NIH ARC fellow, looking at particularly the professional well-being as an indicator of health policy effects and how it affects their ability to perform and the organizational performance. So I think I'm kind of typical according to Dr. Jung. But it also goes to show, I think, when I heard that presentation yesterday of how much training we get, I think it's, one, not only to get the skills that we need to work in a really complex health care system, but also to be included and have a seat at the table to participate and have a voice in shaping our profession. And so sometimes you need to have those credentials just so you can participate, and I think that's a lot of it, the root of what we're talking about here. So today I'm going to talk a little bit about what raised the alarm and created chief wellness officers, the root causes, how chief wellness officers emerged to meet the need, and some of the strategies and tactics that are used and how we collaborate with our stakeholders. So I'm going to go briefly here, but when we talk about advancing the work-life well-being, personal and professional for individuals, teams, and our medical community in support of the quadruple aim, coined by Dr. Sinskey and Dr. Bodenheimer, building on Don Berwick's of the IHI, on how we get professionally fulfilled people to be accessible, to provide high-value, high-quality care for patients, and to give them a great patient experience, and that how we use, how we look at that and look in these three domains, and I see Dr. Brian Bowman's right here, the author of the three-domain model out of Stanford, looking at the culture and climate, the practice efficiency and personal resiliency and work-life balance, and how we're able to do that. And when I put here the vision, you'll see a little more how this vision of being professionally fulfilled, absorbed in meaningful work, done masterfully, done together with pride and vitality, is based on models of thriving. And we'll talk a little bit about that. First, let's look a little bit about the background of why we call it an occupational hazard and why it's relevant to occupational health, and then how we work together to move this whole agenda forward for work-life well-being. So Dr. Schoenefeld and all with the AMA through the AMA master file have been doing these triennial surveys looking at burnout among American physicians, and it peaked in 2014 with 54% of American physicians having symptoms of burnout, which raised the alarm, compared to 28% for the general population. Their work-life satisfaction was at 40%, where the general population was at 60%. We saw that this change to burnout happened at the time of entering medicine because the work by Dr. Deerby and Brezzo and others showed that physicians that had a higher quality of life, lower depression, less burnout prior to entering medicine, and then something changed as they entered medicine. So we know that there was a temporal relationship. We also know there was a dose relationship because Schoenefeld and others showed that with the amount of FTE exposure you were having a higher burnout, and you could decrease burnout by limiting your exposure and taking more time to decompress. We also saw that this was dynamic across the industry where static across the general population. It was across all states, all disciplines, going up and down, so we knew that it was something happening in the industry in the milieu of practicing medicine. We also know that traditionally higher education is protective against burnout, as Schoenefeld and others have shown, but for physicians compared to other professionals, we had a higher risk of being burned out. So then others did meta-analysis to systematic review and meta-analysis and found that organizational interventions were more effective than individual interventions at decreasing burnout, improving work-life well-being. So we saw that that was an important component. It wasn't just what we could do for individuals, that we had to actually change how the medical industry and the medical environment actually worked. And so we know that when people are burned out, they will physically withdraw. They will retire early. They will reduce their work effort. They will relocate. They will restrict their scope of practice. They will resist work. We have to incentivize them. And then we know psychologically they will also withdraw. They will withdraw with depression, higher risk of suicide. Physicians have among the highest risk of suicides. We know that they will withdraw from work, and we know that it will have professional consequences on their quality, their patient experience, and others. We don't have cause and effect, so we don't know if it's because they can't provide it or if being burned out is part of why they aren't able to live up to those expectations. And so when we look a bit about the root causes, we've seen in the health care industry changes over time. So prior to health care reform, we saw that physicians started moving from private practice into organizational practices because they were looking for administrative simplicity, work-life balance, let doctors be doctors, because the administrative complexity of health care was going up, and the cost and overhead of practicing medicine was also worsening. So they had already started moving. Health care accelerated that as stakeholders became more intertwined together with health care reform. And then with the pandemic, it also made it harder to continue practicing in private practice without the support of large organizations. So we've seen, again, integration into these large organizations. So as we see the vertical integration of physicians into large organizations, we also see that they have a less sense of latitude of control, professional agency, autonomy, and voice. And so a lot of the underpinning of this work has to do with how do you give people that sense of a professional home and well-being in their work. So that is just to give you a little bit of background. So then when it comes to a chief wellness officer mobilizing an organization, you're looking across these different wellness domains, you know, social, physical, emotional, career or occupational, intellectual, environmental, spiritual, financial. You can think about what we've done for several years leading up to me being chief wellness officer is through our clinician wellness council, we invited all of our stakeholders who had some hand and some we inventoried the whole organization to find out what was already available, what resources were there. We invited those stakeholders to come to meet our wellness leaders across the different departments and sections and to tell us what they're doing to improve wellness. We do not do anything redundant. What we do is we elevate the profiles and the work of those people doing those things and then where there are gaps, we fill in those gaps. But so wellness is kind of like the fascia that connects all of these wellness entities across the organization and helps to mobilize an organization. When it comes to some of these traditional things that you might see in occupational health, when it comes to environmental, a lot of times physicians are talking about, do I have an office where it's conducive to my work? Do I have rooming to do my work? Do I have the facilities? There's been a resurrection of the physician lounges also for a source of connection and community and things like that when it comes to environmental, but also light, noise, and access to healthy food and exercise. And when you're on call, do you have a place to lay down if you need to? Things like that. When it comes to emotional, we've worked with our human resources and our EHR, which provides such a safety net for us going forward because when we first started measuring burnout, the first thing people said, they wanted to talk about the pebbles in the shoes that's driving the burnout, but when we had so many people saying, this is how I feel, this is how I feel, it was suddenly safe to say that, the first thing we had to do was have a safety net. So the EHR, I mean the EAP, our employee assistance programs, and those things did provide our safety net, but then there was still the stigma and things that we need to do for our medical professionals who felt like maybe they needed something more and felt safer with peer support and things like that. With the emotional, we also worked with our Department of Psychiatry. We did our Yale stress self-assessment throughout the pandemic, pulsing our stress symptoms as they escalated, who was at risk for demographics, and also looked for trauma factors through the pandemic of how we would tie that to resources. So I'm going to, there are two slides in here where I'm going to spend a little more time and the others are kind of reinforcing the point. This one is about individuals, when we think about individuals. So in this model, I put the theories here on the side that you can read more about these in depth, and also the National Academy of Medicine will also describe these as well. But when you look at burned out, when someone is emotionally exhausted, depersonalized, cynical, not feeling accomplished, they have a sense of withdrawal. Their challenges are hindering challenges. They're challenges that make it harder to do their work, that they're not able to get that sense of accomplishment, and so they do get exhausted working against these challenges, and they start to withdraw their resources. In the job demands resource theory is when you have job demands, you need to have the resources to be able to manage those or it becomes frustrating. So the job demand theory is one of those things that help you to manage those demands when you have the professional agency to do that. So if you are moving against the frustration or the hindering challenges, you start to withdraw yourself in burnout. As we remove those hindrances, you can move into satisfaction, but where we ultimately want to be is where your challenges are those that have a lot of meaning to you, where you're curing cancer, you're helping people, and you're really living up to your own mission, and you feel a sense of engagement, commitment, you're absorbed, you're in the flow. You have meaning and purpose, and you get a sense of mastery, accomplishment, and pride in your work. You feel connected to your tribe, your peers, your colleagues, your mentors, your sponsors, your allies as you are participating in this, and that you also have a time to rest and rejuvenate to come back ready for another day with work-life balance. And that's also important because you don't want to overinvest with workaholism, which also can have its detriments if you go too far in overinvestment in work. So as we look at how do we lead ourselves in this, we do have some programs in our joy in job crafting where we use a resiliency framework for personal and professional mastery as you start to uncover some of your own personal values and things and how to accomplish the life that you want to have. And then we also have our True North groups where we also look at our paths and our crucible moments and our values in a collegial way in a colleague group, and Dr. Santiago is going to talk more about those later. So when you put these together, when you put Dr. Bowman's three domains, the culture, efficiency, and personal resilience, and Dr. Szynski's and Bodenheimer's quadruple aim together, we look at when you have professional fulfillment, the correlations with being able to feel like you're giving a great patient experience, high quality, you're retaining people and the people are willing to promote the practice is going to be much higher, whereas on the other side when there's burnout, there's association with not being able to do these things, losing people and people not being willing to promote the practice. We can talk more about that later as well, but this tradition kind of goes back a long time. Dr. Donabedian, who's known as the father of quality, talked a lot about the structures and process of doing this and that there's an interpersonal and a technical side. You can take really talented people, plug them in, and think you're going to get the great outcomes, but it has to go through this culture. And so physician satisfaction here, circled in the green, is very much associated with having that professional agency in medical decision making, practice management, in service to their patient in getting that quality result. And so what is culture and climate has to do with your value alignment with leadership, teams, colleagues, and a sense of belonging where you are and the reciprocity or the rewards or the recognition that you receive as well as a functional workplace. And we'll come back to some of these interventions in just a moment. But I will mention that this professional fulfillment, this is very similar to the nursing magnet model of professional well-being as well. It's about having a sense of voice and agency. And this is very similar to the Toyota, anybody can stop the line for quality, and everybody has a voice as well if you look at what people like to be able to thrive. So here I just put this AMA Joy in Medicine Health System Recognition Program as just another way of reiterating some of these points. And so right now the AMA Joy in Recognition model for chief wellness officers in a wellness program would be that you have the commitment, a chief wellness officer, you make an assessment of well-being, you work on those hindering challenges with practice efficiency, you have leadership traits that create that type of culture, that you create the culture and climate, and teamwork, you have people working top of license, team-based share the care, and you have support for distressed physicians, as was said earlier, that there's some inherent distress in the work of caring for vulnerable people, you're high-stakes complex decision makers. So when it comes to what does the CWO do is making that strategic plan for wellness. So we measure and track burnout and professional fulfillment. We create the actionable data. We orchestrate with the stakeholders across the organization and across the departments and sections. We facilitate that through our Clinician Wellness Council, which you'll hear more about, and we create those strategies and tactics. We create programs where there aren't programs. We elevate the programs that are there if people don't already know about them as we curate them. And we look at how to make an optimal work environment for our professionals so that they think that Yale New Haven Hospital, Yale New Haven Health is the best place to work. So how do we engage and empower them so they belong and believe? So with our annual wellness survey, what we do is we assess these three domains across the whole organization. So we have five delivery networks, seven hospitals. We have over 8,000 on medical staff. There are about three to four times as many nurses, and overall there are about 40,000 employees at Yale New Haven Health with the School of Medicine. So as you see here on the right-hand side, you'll see that each department or section will get their individual report in these domains and that they have a wellness representative who works with their chair or chief to operationalize these reports. And then I also look at these and the leadership also look at these when I put them all together so you can look at the hot spots of where everybody's doing and compare them to see who are the positive deviants, why are they different, because you can see here that the burnout scores and professional fulfillment scores will be very different. Sometimes you'll see green all across their report, but it'll be one red bar and they may have the worst burnout score, and then you go back to them and validate with them what's this about and they'll tell you exactly what it's about and it's complex and then that involves going back to a bunch of other stakeholders across the organization to be able to address those things and that is, that's pretty complex solving those because the reason why it isn't solved in the first place is because it involves so many people and project management and moving it forward. So the other thing we do is we put all these results in quartiles and then we take these hot spots in each domain, say it's for the electronic medical record and those scores will go in the quartiles to that stakeholder, that organizational stakeholder and they will say what are you going to do to address these things or this is what we hear are the issues of why this is the way it is and they will look into it, do further investigation and see how do they address the in basket or the call center or how the EHR is working for them and what we can do or whether that is practice efficiency, hustles and hassles or whatnot. So we'll take each of those domains, send that to the organizational stakeholder that's in charge of that domain and then mobilize the whole organization in that way. And then you can see here on the right that we try to empower individuals to be able to have some control themselves as much as possible to have the tools that they need to move through their hindering obstacles. At the work unit we have representation at our clinician wellness council across the departments and sections. At the organizational level we talk about how we mobilize the organizational stakeholders and then we also have representation on our policy and regulatory commission where everything gets approved so we have some input and to be able to say before policies are implemented instead of after the fact when we're trying to correct those. So we do have some voice there. So here I'll just talk, this is, as we're wrapping up here, I'm just going to talk a little bit. We talked about the individual and where the individual is at burnout versus coming to engage and here we talk about the evidence-based ways that we help to influence the organizational culture so that it is conducive to the type of wellness that we have. So here we have Dr. Bowman's three domain model and then we have what we measure in the assessments and then how we do that. Now let's look at culture and climate. Let's start at belonging. The sense of belonging and not in the narrow sense of diversity, equity, inclusion but in the broader sense of how people feel that they don't have to twist themselves into a pretzel to fit in or belong or to have a voice or to participate so that we create a sense of inclusion so people don't have to conceal their identities and which is very stressful if they can't be themselves at work. To the sense of teamwork with our allied health professionals of how we create psychological safety for teamwork so that we can have a growth mindset so that we can bring up ways that we can do better so that we don't triangulate and so we really create a sense of safety and teamwork. Same with collegiality, a sense of gratitude and appreciation for one another, a sense of self-compassion and compassion for one another in our work and a leadership style that also supports psychological safety whether that is transformational style leadership where you're inspiring a group to work in behalf of the organizational mission or whether you're working in a servant leadership style and you're taking people who you already know believe in the mission and you're in service to them in a joint shared mission. But in all cases it involves making people feel seen, heard, valued, developed and supported in participatory style leadership where people feel like this is their professional home and they have a voice, they're not a cog, they participate there. Practice efficiency where we look at that workload if we can't improve the staffing or decrease or decompress the workload that we're looking at efficiencies that we're getting people home on time and we're working at a decent pace that people have some control over work-life balance in their job crafting and a sense of personal resilience and support. And then finally we make sure that we have a centralized place for people to get that information and our care for the caregivers. So at home we make sure that especially in the pandemic that you have the provisions or loved ones are secured, provisions procured, ready and reassured so that you're calm in leaving your house in the middle of a pandemic and being able to come to work. We create at work in control and ready to go where we send you to all the latest of everything of what are the visitation rights, what's the changing algorithm, what are the masking requirements. All the information you need to feel in control at work and that information is transparent and that you feel everything's being done on your behalf that can be done. And resilience is how we stay connected and calm and that people can go back to their own ways of finding resilience and feeling connected with others. And we also say calm, control and connected in leadership. If you can cultivate calm and positive emotions, a sense of control and a sense of connectedness that helps people. And then healthcare harmonics in being able to orchestrate an organization in supporting wellness. Everybody's really included this, like our CMIOs have building against burnout, our care signature people have ways of incorporating these things to improve work life well being. So we've made it culturally a part of what everybody is doing. And so that's, and there are challenges and opportunities, I'm sure that will be part of what we can look at in the discussion section. But thank you so much for letting me provide this overview. And I look forward to the discussion afterwards. Dr. Santiago. Thank you very much, everyone. So I am Romero Santiago, a second year clinical fellow here at Yale's ACHMED program. And little did I know that coming into ACHMED training two years ago that I would be entering a pandemic period of training. At the start of the pandemic, I was just finishing out my residency training in family and community medicine in California, and had to make that transition to Connecticut for occupational and viral medicine. And despite the unprecedented challenges that were in place throughout these two years, there are definitely many silver linings from these two years that I'm grateful to have the opportunity to share with you and to really build upon what my faculty mentors have mentioned previously. So with that said... So the way that I'll lay out my experience, before I get into these points, a couple things I'll say is that entering training in July of 2020, it was really an all-hands-on-deck approach where essentially, on all angles, I was fortunate to have the opportunity not only for my training program, but to also help out with the larger health systems efforts in the pandemic, from the COVID-19 call center response team that Dr. Thorne had mentioned, to these entities, the Clinician Wellness Council that Dr. Olson was chairing, and our resident fellow wellness senate and group, and these other programs that I'll mention. So with the Yale resident fellow wellness council, this entity is from our GME office and our house staff, and there are two components to this that I was able to appreciate thus far through my experience. One of those being that, as Dr. Ruscio was mentioning before, the high-touch, one-on-one encounters are critical, and were all the more critical during this pandemic. And so through the Yale resident fellow wellness group, we have a call-a-friend program in place where essentially, us as fellows and senior residents were paired with interns, incoming first-year interns into our health system, to really help them navigate as they're making this big transition, they had to do it during the pandemic. And so this system was quickly put in place for all of us, where we had, across specialties, it was not limited by specialty, I had people of various specialties from emergency medicine to anesthesiology and so forth as my mentees. And so this was a program that was year-long, and still continues today. With that said, from the one-on-one interaction, a lot of our efforts culminate to this house staff appreciation week that happened in February. So every year in February, our health system recognizes all house staff. And what we did with this task as a council to really build upon it was, there were unprecedented challenges with things having to be moved to the virtual platform during this pandemic. And so we tried with Zoom and so forth, and with the call-a-friend one-on-one touch points, to look at well-being in a comprehensive way. And so, as you can see, we themed each day a certain way. So like environmental, self-care, nutrition from that standpoint, physical well-being, and then finally emotional and spiritual well-being, where we were able to really bring various disciplines together, from chaplains to social work and psychology, to really combine in discussion and with Dr. Olson also providing that health system update for our residents and fellows to ensure that there is that continuity and that there are many different touch points a resident or trainee can interface with as needed. So from the GME part of things, it really escalates then to the Yale Clinician Well-Being Council that Dr. Olson shares. And during the pandemic, we really quickly decided that it was going to be all the more important that from our resident and fellow wellness council, that there was a conduit to the larger health system effort, with this council being one, as Dr. Olson mentioned, having representation from various departments, from surgery, pathology, and lab medicine, to psychiatry. And so I was very grateful to have the opportunity to help as that conduit from the resident fellow wellness senate aspect, and of course bring the occupational and viral medicine lens to the discussions. And this council was very special, through my experience, I can really personally attest to that in terms of sharing best practices in that first bullet, really it was an opportunity every single time to hear from these various departments on what they're doing for their trainees and seeing that cross communication across disciplines on what's worked for them, what's not. And that was very valuable to have that forum to do so, and in the process, meet the stakeholders of these various departments. The other big principle that really this council was excellent about is really Dr. Olson's emphasis on the resiliency component, and that meaning creating an individual toolkit for all of us, really as ambassadors of well-being for the health system, to really share with our colleagues going forward. And examples of this toolkit include informing us about programs such as Schwartz rounds, compassionate care rounds that happens in the hospital system that brings people of different disciplines together, from social work to chaplains and psychologists, as well as another program called Brave Conversations that really is emphasizing on empowering individuals within our health system to talk about diversity, equity, and inclusion issues, which of course are all the more important during these times. So that's just a quick snapshot of some of the toolkit opportunities that we reinforced during these meetings. And overall, like I had mentioned in principle, a valuable forum to hear these updates, you know, regarding well-being and that cross communication like I mentioned. And then the other thing too that I had the opportunity to do was to really share the perspective as an occupational and viral medicine trainee as one of the sessions for our Clinician Wellness Council. And I still remember to this day that it really sparked a very lively discussion about what is occupational medicine's role in crisis situations when you have someone who's coding in the ER or ICU, a bad surgical outcome. One of the surgery chiefs had mentioned this. And I remember being really struck by that, really thinking about, you know, what is it that we can do beyond our clinic walls of the pre-placement exams and so forth that is part of crisis leadership, as Dr. Thorne had mentioned. And so that platform to really have different specialties come together, especially in this time of the pandemic, was just of paramount importance. In terms of the True North groups that Dr. Olson mentioned, this was another component that we decided was going to be important. And it was important for me too in my well-being personally as a trainee navigating through all these unprecedented challenges. And so this True North group, basically this principle was founded by Dr. Bill George who was a former CEO and Chairman of Medtronic. And essentially what we did for our health system is we brought our main campus at York Street with the Greenwich Hospital Wellness Council, brought them together, adapting it for healthcare in terms of these small groups, about 10 or 12 members at most. And we established 12 sessions every other week. It was a nice, you know, touch point for that small group to meet. And you can see the list of themes here, but we covered things anywhere from really going back into our journeys and thinking about those role models that shaped our life. And you know, what makes us tick is the perfect way Dr. Olson always mentions it, that, you know, it's about really understanding, you know, what drives us internally, that really, as Dr. Thornton had mentioned too, from keeping your cup full is just so important. And I personally will say it definitely helped me to keep my cup full through this journey. And so as you can see, it's a vast amount of topics that were discussed and it really felt, you know, for me as a trainee, this, the small group I was in was a pilot with senior faculty across these two hospital campuses. And with this, after this experience of the pilot group, really we're hoping now to take it to the next level to really see how we can bring in other groups such as HR, such as various departments to have their small groups in a similar way to really hash out, you know, what makes them drive and bring unity among various important stakeholder groups. And then on a system level, in terms of you have the Yale New Haven Health System, you also have Yale University, that entire, you know, ecosystem, the other thing that I had the opportunity to interface with was the Being Well at Yale program. And specifically, that was through a course called Mental Health First Aid that Yale had offered and I was notified about this through the Graduate and Professional Students Association. And as in brief, this campaign, you know, was started in the early 2000s in Australia that now is in many different countries, including the United States. And what was interesting to me about this whole concept, I know this was discussed during last AOHC virtual, there was a session on this, that, you know, not only is it making it such that it's a simple message of identify, understand, respond, but it also brings multiple stakeholders together, not just physicians or healthcare professionals, but also this can apply to correctional officers and other workers of various industries that are dealing with crisis situations, whether it's at the school or a workplace and so forth. And so what I liked also about this is that this program really, as I went through the training, its main mission is to really reduce that stigma of mental health and really show that just like CPR, we have to get annual routine certifications, that it's important for multiple individuals to have this mental health first aid training and really be called a mental health first aider. And so in my small group, I remember, for example, I had people from the various schools, from the Divinity School, from nursing, from engineering, and I just appreciated being able to see, you know, the vantage points of different people and including people who don't have as much of a touchpoint with healthcare. And so this program also is, I think, you know, really showed me that it's, in terms of the empowerment piece for an individual ambassador, this is also another tool that can be utilized for health system employees as a whole. And in terms of really acknowledging, so I have a training grant through CDC NIOSH for, you know, our training program, and it's truly an honor for me to share the stage with such esteemed faculty mentors here through the training program. And just to shine a light on all that they've shared just earlier in the presentation, Dr. Olson, in terms of her well-being efforts, really, you know, personally for me provided that voice, not only for my training experience, but also for occupational and viral medicine. And that discussion we had as a group was still memorable to this day. And so I thank her dearly for that. Dr. Rusci, for sure, in terms of my training, really emphasizing the intrinsic nature of work, I think really keeping those fundamentals strong was something that we consistently had the opportunity to talk about in, from workplace violence meetings that happened, all different types of health system meetings that I had the opportunity to go to, and just how everybody had to take this all-hands-on-deck approach and make things happen. And then Dr. Thorne, too, in terms of the COVID-19 call response, call center response team was really an invaluable opportunity for me because I can, there are countless times that we had one-on-one conversations with employees who were just lost and did not know what to do. And it's those moments, those crucible moments like Dr. Rusci mentioned about emotional well-being that really, I think, transform a trainee's experience. It definitely transformed mine. And so I think that program and being able to share with employees the different programs that they had outlined was a privilege. And of course, Dr. McClellan, in terms of always showing the bigger picture of, you know, you have the health system but now with the National Academy of Medicine and how all these pieces fit together. Coming into fellowship for me, I had heard of the AMA Joy in Medicine. I had heard of these various touch points through involvement in these organizations. But I definitely was really trying to figure out how they all come together, what we're trying to do today and reflect on the lessons learned. And I think COVID-19 definitely, although it was so many struggles to navigate through, there were definitely sort of alignings that I think helped me better appreciate, you know, with more learning to go of how these elements can really come into play. And so with that, I will hand the podium over back to Dr. McClellan for his final remarks. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. 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Thank you. Thank you. Thank you. Dr. Cadet, please. Thank you so much for the talk. My name is Dr. Cadet. I'm the employee health medical director at Loma Linda University. We have about 22,000 employees, and I love, love, love the idea of incoming residents are plugged in with some type of counselor. My question is, how did you get the funding to be able to do that? Because I can imagine if I bring that to my institution, that will be the first question. And then number two, you mentioned that one of the strategies for overcoming burnout is to perhaps cut back on your work hours, but physicians are kind of de-incentivized to do that because you're going to take a pay cut. So just wondering, how can we walk the line of trying to help physicians overcome burnout without having to take a pay cut when they have things like student loans and families that they're trying to take care of? You know, I have often been asked, how did you convince the C-suite to do this stuff? And I'm in the really fortunate position that we didn't have to convince them. There was an appetite for this. I mean, we had communicated enough that there was understanding and appetite for this sort of thing. Honestly, the resident program barely cost anything because we had in place already underutilized resource for counseling that wasn't utilized because it's stigmatizing and people didn't want to do it. And so we set it up, but it was relatively low cost. And it was kind of a hit with the residents. And to Kent's point before about things that we track, we looked at how many of them engaged in counseling later. We looked at their impressions from their encounters, et cetera, et cetera, so. Great. Thank you. So... I think he's going to answer that second one. Oh. Oh. Yeah. No. I would just, I'd reiterate that often there's a lot of capacity there with EAP for those wellness checks, and then it's getting the residency directors to proactively schedule them. And then they're given the option of going to those six free stress sessions off the record, off insurance. I think like less, like 9% opt to go on to get those. And then there's a smaller percentage that will get more comprehensive care. And then there's also ways that they'll do off-site care if they need off-site care for their privacy. And as far as burnout and workload, one, people are entitled to set boundaries for their health and well-being, and sometimes you absolutely have to because it's dangerous not to. We want people to work at full capacity. We want them to work full-time. We want them to have access to their full salary. We want to have a sustainable job. So that's when we look and put in the quartiles where the workload is really high and highly correlated with the burnout, and then we try to emphasize to the organization that please look at these entities. Please decompress the work, make it more efficient, or get more staffing. So we try to advocate on that, on their behalf that way. So thank you so much. You've heard the story of one academic medical system, large health system, and an approach they've taken, and a myriad of interventions. What is, I think, important to understand is not just their story, but kind of what's going on in our nation, in the globe, really. This is not unique to the United States, for sure. And I wanted to point out to you that the National Academy of Medicine, which has made this a priority, on May 20th is holding a public hearing, or not a hearing, but the launch, if you will, of a yet stronger call to action across the country for a collective voice, really, to help all of those of us who are out there who may not have a corporate suite with an appetite to recognize how, indeed, the existence of this health care economy is dependent upon the workforce, not on the drugs and the blades and the facilities, but on the workforce. We are in a crisis now like no other, not just because people are feeling bad, but people are quitting. And so I think there is a real opportunity now to take a look at the systemic issues that are affecting the health care workforce, and approaching this as a systems problem, not an individual problem, where there are many interventions that may be successful. Some are going to be successful in your particular setting, others not. But this approach to really listening on the ground and understanding the differences between orthopedics and the NICU and the ICU and the ED and the primary care is crucial to getting this right. So this cannot be a top-down kind of systems approach. The need to hotspot and listen to what the pebbles are and how, in fact, solving those pebbles at the local level oftentimes is within the control of that individual section before you can worry that, oh, I can never solve the big problem. We can never have enough staff. What's going to happen? So I hope that what you've gotten is a look at one journey to this where a new person came to a very large organization whose goal it was really to try to find that fascia, create that fascia that pulls together all the disparate pieces to create a systems approach full of many interventions but tied together with that fascia. And so with that, I think it's time for lunch, and I appreciate you coming. Thank you. Thank you.

chief wellness officer

occupational medicine

worker health

comprehensive programs

employee well-being

collaboration

integration

burnout

wellness programs

supportive culture

work-life balance

leadership involvement

occupational and environmental medicine