Well, good morning. I'm Dr. Mary Ann Orszag, and I'm a leadership and wellness consultant, and I'm retired from the military where I did aerospace and occupational medicine. And I'll probably be maybe even asking some questions, and if you have any questions, use the microphone in the center or the handheld one up here, because it's being recorded. And if you don't use the microphone, then they're not going to be able to hear it. And welcome. And I have no relevant disclosures. So the learning objectives for this presentation is we're going to be looking at the signs and the symptoms of psychological stress, because we're looking at how do we optimize provider well-being and using communication skills. So learning what is the signs and symptoms of psychological stress, what are the roadblocks to human connection, and how do we overcome them? And also discuss some of the techniques to effectively communicate so we can build working relationships that are effective, that can support the workforce, but also how do you individualize the support to the health care workers so that we can move from burnout to wellness. Now my first assignment out of my Air Force residency in aerospace medicine at San Antonio, Texas, was at Kunsan Air Force Base. This was actually going to be my first field assignment, or field clinical assignment, because I had been working at Wright-Patterson Air Force Base doing research on ejection systems. And I had requested to go to a fighter squadron. So I was assigned as the chief of aeromedical services at Kunsan Air Force Base. And the squadron flight surgeon for an F-16 squadron. And actually that was my dream, because I saw many of the shows of the Thunderbirds at the Cleveland Air Show. But it's essential for the flight surgeon to really be able to connect with the air crew and the pilots. Because if you don't, they're not going to come to you if they're ill, and you're not going to be effective to keeping them healthy, as well as flying safety. Now during an annual physical exam, one of the pilots came to me. And this was the first time I met him, and I had not been flying with him. He had an abnormality on a test. So I was going to schedule him for follow-up for a procedure at the hospital in Osan. And I explained what was going to be happening in terms of the follow-up, arranged for the procedure that would be performed in the next week. Now the pilot didn't have any questions at that time. That should have been my first clue. This was because a few days later, one of the Air Force officers came to me and told me, Marianne, you are in danger of losing credibility and trust from the fighter squadron. I was shocked. I had not really used the human connection skills, and I had not really sensed at that time the fear of going for a workup. And I had not been that empathetic ear. I was actually in transactional mode for doing a medical diagnosis, but I had forgotten that fear of if there's a health issue with air crew, am I going to be able to fly again? Am I going to lose my career? And the fear, again, of a workup. And sometimes as physicians, we take for granted that abnormal tests and follow-up. But for that patient, the uncertainty and fear is really palpable. I had not really been using my human connection skills of active listening and asking questions, thoughtful questions. So I went and knocked on the door of this pilot and asked if we could discuss some of these issues. I wanted him to know that I really wanted a more authentic and deeper relationship, and I wanted to answer his questions. So I answered his questions and assured him that I would be on him in this journey of the workup. So fortunately, the procedure cleared him, and he was able to be returned to flying status. But more importantly, I learned that the vital role of human connection in creating and trusting that patient-doctor relationship, that was central to his recovery. And it really changed the dynamic of our relationship. And I also regained the trust of the fighter squadron. I now provided the medical support when they go on deployments to the Philippines, and I actually was able to fly in the backseat of that F-16 during one of these deployments. And it was six hours long, but it was fun. So the squadron now trusted me, and I would now be able to do everything. And I wanted them to know that I was going to do everything possible to meet their medical needs and to keep them flying safely. I was there to support their mission and them. Now, this was an important interaction from the patient perspective, but also from the doctor's perspective, because I was really at risk for burnout. And I was at risk for burnout if I had not used human connection skills. I was single. I was in a foreign country. I was in a new leadership position. And I was going to set up for isolation. But I knew instinctively that I needed to make connections and develop human connections. So I did that. And also for me, flying was a de-stressor. And imagine flying an F-16 and flying that fun. And also I was challenged with new things and a new position. I was curious. And I loved the field of aerospace and occupational medicine. But also I had a meaning. I had purpose. And I knew I was going to have a positive impact. So now is the time to move from instinct to human connection skills. I will be presenting the human connection skills of storytelling in the service of others, active listening, and thoughtful questions. So we have actually been in a gathering storm over the last quite a few years of health care worker wellness. And also we had the storm of the pandemic. And you may be in different boats. But you really are navigating that same storm. Because a lot of the issues that we are having are really very common. But they're just different situations and in different places. But also one solution does not fix all. You have to also look at there's some things in common. But things also are unique. And now we're in the aftermath. The cleanup of a disaster. We now have health care workers that are retiring, that are leaving medicine. You can't fill the hospitals, wards, because of lack of staff. ERs are filled. And so we really need to wind up looking at what are some of the solutions. We also are navigating uncharted waters. Looking at what's below that iceberg. And what's below it is the emotional exhaustion. There's anger. There's fear. There's lack of skills in how do we handle this situation. And there sometimes is also lack of leadership. In terms of the leadership that maybe is needed in this time to get us through crisis that is not transactional. But that is actually looking for human connection. And developing those relationships. Now when I was at Wright-Patterson, I love flying. And so I was able to fly in the T-37. It's a two-seat aircraft. And the pilot was the one flying. But I was seated next to him. These were side by side. And in Wright-Patterson, in the winter, we really had instrument-rated conditions. But I liked instrument-rated conditions. I thought it was kind of interesting. Because we had to fly by instruments. You had to trust your instruments. And that is also what we need to be doing now, too, is that in this post-pandemic cleanup and navigating ourselves forward, we also have to trust the instruments. And the instruments is what I am here to be talking to you about. And that is the instrument of human connection. So human connection in a crisis. You actually have to go and work on that human connection before the crisis to build that trust. But if you are in the midst of a crisis, you go through the tough times together, and you really do come out, can come out on the other side where you will be standing up strong with new levels of connection with our colleagues and the people we lead. And that can sometimes turn post-traumatic growth. And there really is hope. So the signs and symptoms of stress and burnout, we've seen them in many articles before. But there's that depersonalization, the emotional exhaustion, and that low personal accomplishment that leads to decreased effectiveness at work. And in a study in 2021, they found that with physicians, there's a high emotional exhaustion in around almost 39 percent, depersonalization, 27 percent, and at least one symptom of burnout in 44 percent. And we've heard that. And so it's something we really need to be dealing with. So what did our healthcare workers experience during this pandemic? A big part of the trauma in some individuals is really that there's too much death and loss. There was much loss. And we could not save everyone. There's the loneliness and isolation that comes from being masked, from the physical isolation, away from families, disconnected, fatigue, and fatigue also, too, from providers who had to go back to work, and they were not completely recovered from their illnesses, especially from COVID, and maybe some of the chronic symptoms of COVID. You had the lack of sleep, lack of resources. And the effect of burnout on performance, again, we know, if we have sleep-related issues, there's going to be impairment of interpersonal engagement, work exhaustion, overall burnout, because you also know when you're fatigued, you can't always be that sympathetic ear that you normally are. And this can be unprofessional behavior. There's the anger, irritation, reduced motivation, oh, I don't want to get up now to go to work this morning. Suboptimal communication with patients. Friends of mine who are patients, other providers, have told me they really miss, again, having that connection and that physicians really talk to them about what is really happening, to really provide the answers and not just, oh, give them a prescription and not really go into detail. So we, again, also are seeing that in doctor-patient relationships. And that's hard to do when you only maybe have 15 or 20-minute time to see the patient. And then that provider's sense of lack of control over the environment. And you know, the roadblocks, the answer is right in front of us, but we don't really see it, because we're distracted. We're on, we may be on the computer with the medical record, we're on our phones, we're on our iPads. Disengagement, and also sometimes we say, oh, I already know that. I don't need any more training. And yeah. Also, nothing will help. This is the way it's always been done. We haven't been able to change anything. And then there comes in that sense of hopelessness. And the culture. Because the culture is sometimes very difficult to change, and especially if we don't have a culture that maybe has some psychological safety. And we don't practice the skills that we've learned. We've gone to training, we maybe practice it for a day, then we go back to our old habits. So what moves us along this stress-trauma continuum? Because there's stress in our days, every day, as health care providers. But we're able to deal with that. But if it becomes chronic, if we're tired, if we're sick, it can become a toxic stress and can even be a point of trauma, which we especially saw during the pandemic. So there's, again, that loss of control, overwhelm, a relentless exposure. And that is where we're again seeing with the pandemic. And a lack of support and resources, feeling no one's listening to us. And it's uncertainty and inescapability. Things aren't going to change anymore. The lack of sleep, rest. And again, that isolation, loneliness, and disconnection. Because when we are tired and fatigued, we will often feel lonely. And that we're the only one experiencing it. So we need to break that continuum from stress to trauma. And human connection can be one of the answers. So connection really mitigates trauma. And connection disrupts that toxic stress. So actually the best stress disruptor and trauma mitigation tool is really you. And we are really fighting for the person to our right and to our left. To keep them loving medicine and staying in the game. But if we're going to do that, we have to have leadership. And leadership that matters. And it has to be leadership at the organizational level. At the team level. And also leadership at the individual level. Because we also have responsibility to take care of ourselves. So again, we've all kind of, we've maybe even said, I'm fine. And then the person listening to us said, really? And I'm sure you also maybe even had the same thing. Because we don't really want to admit we're having any issues. But if you're going to have the person give you an authentic answer, then there needs to be a psychologically safe environment. And that has to be built. And purposeful storytelling, active listening, and thoughtful questions can help build that psychologically safe environment. Now there's a continuum in human connection. We can go from transactional to relational. And oftentimes we've been really very transactional. Especially because we have computers, we send emails, we may text. But we need to go, and also that what was missing, and I think we saw that during the pandemic, is really the relationships and connection. We really do need that human touch. And the author, Shan Felt, he wrote an article about the wellness-centered leadership. Which is, I think, a very interesting concept. And he had three elements of this wellness-centered leadership. It was caring about people always, cultivate individual and team relationships, and inspire change. And I'll be really dealing with human connection. We're going to be going, and it'll affect the first two elements. But leadership matters. And leadership needs, especially at the organizational level, to adopt a well-being as a strategy. And to really mean it, and setting the resources to do that. Another article had about leaders and employees to explore meaning and connection at work as an antidote to burnout. So looking at, are we really helping the individuals really have meaning and connection in the workplace? Now, none of this is really new. But we're not always ready to implement it. We sometimes don't have the resources, and sometimes we don't really want to invest in the resources, because we have other priorities, and we're making other things as a priority. We don't have the skill set. We may be able to do it instinctively, but you can also learn. And also, what programs really work? And one size does not fit all. You have to start, we have to individualize things. For instance, in some wellness programs, take yoga, do exercise. But that may not be for a particular individual. There's need to find, what is it that is going to help them in their wellness journey? So building working relationships is very important. And relationship management, it will move people to action. It's a powerful social capital, and it really is a strategic asset. And sometimes in organizations, they have, oh, our people are our greatest asset. But are you really showing it, or is it just words? You're going to have to take action. And building relationships even becomes more important during the time of crisis, but you need to develop that trust before the crisis. And putting relationships above transactions, and this is a team sport. But how do we show up? We need to be able to give grace when people need it. And also that self-compassion when we need it. Give ourselves a break when we don't have all the answers, and we don't. Sometimes the best answers and solutions may come from our staff, or the people that we work with. And we need better systems and policies that support mental health. We need to go deeper into human connection skills. And there now is some courses on trauma awareness. And even though the pandemic provided, again, a large amount of, can provide a large amount of trauma, people in their individual lives may also have trauma that they have not resolved. For instance, from a type of abuse, it could have been emotional, verbal abuse. And they bring that into the workplace. So we need to also be aware of that and help them to be able to resolve those issues by finding out what really is bothering the individual. And then we can go to post-traumatic growth and storytelling, the listening, and the questions. It's one group of skills that can help us through that. Now about organizational characteristics to promote connection. You really have to have that environment to go and connect. And so it can be trust, transparency, inclusion, and that feeling of connection and belonging. Psychological safety, curiosity, power sharing. And this is maybe how we feel at the end of the day. We also have to make a workplace where, actually, make room for all who are suffering. Because we all suffer at different times. A place of encouragement and inspiration, a place where you can lay your head, and a place of nourishment of body and soul. And with one director of an urgent care clinic, he again, the people and his staff noticed that he again was probably having some issues because I think there was a medical illness in his family. And so they said, you know, we'll cover for you. Take a couple days off. And that's part of what these human connection skills is observing what is happening in our workplace and allowing people the time to be able to take care of some of those needs and recognizing and not have us having to be the martyrs that, because I remember, yeah, the, even reading, I think someplace where maybe a resident was sick and was even going and doing his rounds with an IV. And so this is, we need to get and look at the wellness culture that we have set up and being able to take care of them ourselves. And leadership matters. And this is something where you can actually look at implementing when you go back to your workplaces. Again, being an example, being a model of wellness behavior. If you really are, if you're sick, stay home. Allow your people to be able to do that. But also if you can, have sufficient capacity within your organization to be able to have someone be able to cover. Learn the names of the people that you are working with and align your systems with your mission and values. And personalized birthday cards, because then that shows people that, yep, they matter. And not just an email, actually, even if it's written, that's even better. Hold one-on-one meetings and doing daily rounds. When I was in the military, the wing commander actually went and spent a half day in a variety of different departments to see what are their issues and to get to know them. And that is really very effective, because if you're in the C-suite, or even if you are a director or even a team leader, if you don't go and see what's really happening at that grassroots level, the stuff that people tell you is their perspective, but there's also another perspective. So you really do need to go out and really find out what really is happening. And I'm one of those individuals that, actually, I do like to go do the visits, and that's one thing that was great with occupational medicine. We did site visits at the occupational hazard areas. But there, you see it in person, you can feel it, you can hear it. And that's why you need to be that human connection and doing it in person. And writing thank you notes, having staff meetings, and then also making sure that performance and results are really clear. And also attend the employee orientation. I've also heard that sometimes employees may go to the orientation, or they may not even have an orientation. A healthcare provider, they're so short-staffed, they almost put them at work immediately. They haven't really learned what is the medical record system, and a variety of things. Take the time and have the people do the orientation, and leaders should attend those orientations to find out, actually to give them what the mission and vision of the facility is, but also that they can see you. And don't be afraid to say, I don't know, and I'm sorry. We really don't know. And also, we as physicians sometimes want to go and think we have all the answers, but we don't. And allow your staff to figure out a solution. You don't have to be the one that has to have the burden of finding out all the solutions. And solicit feedback on your performance. It really is, you can really learn a lot now, and it's maybe, again, a person's perspective, but that still tells you something, but it also makes a connection. And now that person feels that they're heard. And tell people that their job is significant. And learning the art of storytelling, because that will help you develop those connections. Now going from burnout to wellness. And here again, we're looking at a variety of, getting social support systems, and making people feel that what they do matters. And here again is a list of some things that, again, are helpful in the path to wellness. And one of the new things is the chief wellness officer. And that wellness officer can really help with taking the burden off of the C-suite, and really doing and implementing some wellness. And can be the eyes and ears of leadership. Now the introduction to storytelling. Have you been around a campfire, and people are really having great conversations? So storytelling is really, can be very possible, or very powerful, because it's a powerful tool for human connection. And if you are sharing your scars and your struggles, that's really being very generous. And it can have high impact. And you can be the most relevant person in that room. But you have to set up conditions for that storytelling, that trust, and that psychological safety. And the power story, why does it work? Well, it's universal, and it leads to an action which we call narrative transportation. And what is that? And go back to the story I told you at the beginning of this conference. It puts an audience into a place where they're ready to listen. The movie playing in your head now is transferred to their head. They are transported into your story as if they lived it themselves. And they process their own issues in the safety of your story. And you experience, again, rapport with the listener. And the listener feels connected to you, and conditions are set for action by the listener. Now, the neuroscience of storytelling, it's 70,000 years old, then we are wired for that. We also make sense of the world through story. And also we use a metaphorical pattern matching things. And just like, that's why I used the metaphor of the storm in the beginning. And the story will provide your listener with meaning, context, and especially that emotional connection. Because people take action from not necessarily logic, but from also the emotional connection that they have. And now PowerPoint engages working memory so that the listener forgets 90% of what you said the last 30 seconds after you say it. And you probably will, but you maybe will remember the story. And storytelling engages, and it's really because it's engaging that long-term memory. And we are not machines or numbers. We use stories to create a wellness culture, and again, moving from transactional to relationships. And it also builds trust. Now active and meaningful listening, we're getting, to get ready to listen, you now need to be in a calm state, or a parasympathetic state. And you can develop this by through abdominal breathing, or taking a pause, and getting yourself grounded before a particular difficult conversation you may have. And you need to be grounded. And also if you can move, take a walk, that can relieve the tension. And being present in the moment is really very important, because an individual really wants you being present. And there are times when words don't work. We got to be still and present. But we can't forget about listening to ourselves and taking care of ourselves, and that is through meditation, mindfulness, and journaling. There's that gift of friendship. You can speak, and you can still be still. And then the powerful, thoughtful questions. And especially your workers want to find out, you know, how can I help you? What do you need? Then their voice is heard. You may not be able to solve that problem, but they know you heard them. And you can also say, we can't do that now, but we'll try to go see if we can get resources for that later. Then you can ask them, what's that biggest challenge that they have for today? So now we're going to be doing a human connection exercise. And this is, again, where if you can take about five minutes to write down your story about maybe a poignant moment that maybe you had during the pandemic. But nothing that, again, would be, again, building any type of trauma. And so that you, again, can go in, or an issue that maybe has been resolved. Because then you'll be sharing it with maybe two or three people, if you choose to. You don't have to share it. And the partner will actively listen to this person, and then you will switch. Because I want you to really experience the idea of writing a story, then sharing it, and that feeling of somebody really listening to you without interrupting you. And then, like I said, we'll be switching roles. And then we'll have a debrief of that experience. And so that you, again, can now experience that storytelling, which really, here, is a conversation. It's someone, again, expressing what they have experienced. And you don't have to really write it down. Also, you can just think about it, too. And then with that sharing. And then you can choose whoever you want as your partner. And as I said, you can do it in twos or threes, if you choose to share that. So why don't we start now? So if you, again, can think of an incident or a story for about five minutes. Now, if we can just start wrapping it up. It sounds like everybody is having a good discussion. Okay. And what I'd like now is if someone, again, can start sharing what they've experienced through this process. And the microphone is right up there. Now, is anyone willing to share how they felt through this process? Okay. Well, I guess what I'll do is also, can you put your hands up if you really felt that you were listened to? Good. Great. And did you find this process worthwhile, in terms of... Good. And so this is one thing you can do in terms of when you're interacting with your staff. And I have found it very helpful, because it really is great to feel listened to. And that's what one of my physician friends said, that when she really felt active listening and listened to, that that was really very worthwhile. Because she hadn't really experienced it. Now, what are some of the challenges that maybe you have faced in your workplace facilities in terms of human connection? And do you think you can use this process to help build that better connection? Anyone willing to go and answer? Good. Great. I'm very uncomfortable with silence, so that's what makes me the first one. I'm working on that. Yeah, as part of listening. Actually, I'm a portfolio coach for medical students. And they said we're supposed to be listening more than talking. So I am working on that. Yeah, so I have a new position at my medical center, where I'm now a supervisor. And so I have started having one-on-one meetings with all of the staff, just to learn more about what they do, and ideas for improvements. So I do feel like that is establishing a connection. But I do find it hard. And we celebrate. We have potlucks and things. But I do find it hard to translate that into their day-to-day, especially if they're doing data entry. You know, how to make them feel connected to me and to a larger purpose. I forgot what the question was. I'm sorry. Actually, it's experience with using these techniques. Yeah, good. And sometimes it can just be asking. Actually, that's when you just ask questions. And then see what answers you get. And it can be on their personal life. It also could be, what is the best part of your job? Because if you find that out, then you really want to go and then provide their workplace so that they can be doing that the majority of the time. Because we all have different things that we enjoy doing. Other things can drain us. We can do it for a period of time, but it drains you. Especially, I think, for physicians, or nurses, or health care providers. We like seeing patients. We don't like to do the data entry. That can be very energy drag on us. And so, it's finding out, what's your strengths? And what do you enjoy doing? And what excites you? Because if they're doing the majority of their job with really what excites them, they're going to stay there. They're actually going to be less burnout. Because a lot of times, if we're not doing what we really were made to do, or have something that has meaning, then we lose the interest, and then we become fatigued, tired, and we're drained. And we wonder why. And sometimes, it's just that we're not doing what we, maybe, our calling was, or made to do. Which, again, is seeing patients. But also, there's some people that really like data entry. So, those are the people you want to go and do that data entry. So, there's always somebody there. Somebody is willing to do something you don't like. So, allow them to do that. Because that's where they find their meaning. Good. Any other type of comments? So, I was glad to see you talk about the storytelling, and that, as clinicians, we should, it was a good idea to share that with our patients. Because I agree with that. One day a week, I'm the clinician coach for the providers in our network to help with patient communication and patient experience. And that's one of the things I advocate, is to share stories as you're building your personal connection with your patients. Share things that you're comfortable about sharing, where you're from, you're background. Even when neurologists had a history of vertigo and shared that with their patients, vertiginous patients, somebody would sleep happy, I had some clinicians sleep happy, I shared that. And so, one of the comments I'll get back from the clinicians is, you know, I was always taught or advised not to share personal stuff. And I disagree with that. And so, I'm glad to see this. You know, if you're not comfortable sharing that, obviously, don't do it or have your own boundaries, certainly. But I agree wholeheartedly. And I think that helps to form that therapeutic relationship with the patients and make it stronger and better. Because patients, and I think all of us, are now much more hungry for not having to transactional, but to have more relationships. Now, there's appropriate time for transactional, because that's where, again, the boundaries. So, this is a continuum. It's not one size fits all. And also, too, with the stories you tell, you also want to choose stories that you have resolved. You don't want to go and do a story where you still are feeling the trauma from that. It's choosing the appropriate stories. And patients, yeah, they want to know, yep, that you maybe experienced it. Because then, they can ask questions, and they know that you kind of now maybe have that empathetic ear. So, now, and we have to, as providers, have to be careful that we don't go and get burned out from compassion. So, there's a balance with all that. And that's where, again, learning the skills, and also having that support system within your provider network, where people understand this, and can go and be that listening ear, and to be a place where they can go and talk about issues that they're having, and then we can, again, then look at solutions that kind of have come up, so that we don't feel alone, and that there's not an answer. There really is. Okay. So, what, again, we have with Connection is, it liberates us from the prison of our own loneliness. Because sometimes, we just feel like we're the only one that are having these issues, because we, again, are concerned about not sharing, or that people will think less of us. They will think we're incompetent, but we're not. We're actually just human beings. And also, it can free us from the prison of unforgiveness and shame that kind of occurs when you're not feeling well, when you don't know the answers, if a patient dies, oh, I should have saved them. Nope, that doesn't, we can't save everyone. Also, the power of forgiveness. Forgiving yourself and others. That sometimes can be hard to do in particular situations, because there's a lot of trauma, but once you can get through the trauma, and get to forgiveness, it really is very freeing. And together, we can battle burnout, and win. Any questions? This is the question and answer period. Any particular situations that you have in your organizations, or that you experienced during the pandemic? Well, if there's no questions, I've put a list of the resources, and then there's my contact information. So, I'll be here, again, through the whole conference, and be interested, again, in hearing what you, again, have been experiencing through the pandemic. Well, thank you. Thank you.

psychological stress

human connection

provider well-being

communication skills

healthcare workers

burnout to wellness

leadership

storytelling