We're going to speak about happy things. Yay! If you know it and you're happy, clap your hands. Hey, the audience is ready. Okay, I'm ready also, and I'm honored to be here. Really, I feel happy. So, I would like to know if you can describe, we have nothing to disclose, if we would like your participation. So, if you could define or describe happiness with a single word, what would it be, please? You can write it down. Please scan the QR code, please, and it will take you to a link, and you would be able to provide your answer, one single word, to describe what is happiness for you. We're very curious. Because what makes you happy probably is not the same for everyone, so see family, peace, content, fulfillment, smile, joy, purpose, peaceful, pets, satisfied, balance. Family, peace, are winning, creativity, satisfaction, lake, security, fulfillment, time, travel, life, smile, appreciation. A good cup of coffee? I agree with that one. Relaxed. Okay. So, the bigger the word means more people agree that that would be the word that describes happiness. So, it seems that family, peace, and love are synonyms for you about happiness. Let's see. We have time. Some people are coming. Let's see for the new participants. You can scan the QR code, and we would like your opinion about what makes you happy. A hundred responses. Awesome. We would like to hear some more answers, please. Bill, if you could, it's anonymous. You can write anything. You can write another word that you associate with happiness. So, scan the QR code and write a word that connects you with happiness. I have given this speech in several countries, several cultures, and when I make an exercise, I ask the participants to write a definition of happiness. Every definition is different, but there's one word that usually is present in everyone. That is connections, people, family, partner, spouse. I love it. A hundred and sixteen responses. Welcome, NASA. We have the doctor from NASA here. So, let's give one more minute for the new participants to scan the QR code and write the word that you associate with happiness. Let's see if dogs, scuba diving, I like that one, Starbucks, laughter, relationships, learning, warm, mountains, money. Money was included once in one of the workshops. Not many people included. One of the participants once that was in Saudi Arabia, he said high income. Maybe it doesn't sound very romantic, but we will see some relation between money and happiness. Value, forgiveness, that's a big one. A feel that you can share, appreciation, flight, together, dancing, a hundred and thirty-three responses. But still, love, family, and peace seem to be the bigger ones. Okay, I will continue. Thank you very much for your active participation. I have a very luxury VIP assistant. For Daniel Kahneman, he's an awesome writer. He was a winner of a Nobel Prize. He wrote a book that I highly recommend, Think Slow, Think Fast. He said for him, the definition of happiness for him was what I experience here and now, to be present. And that is associated with mindfulness. And it's so difficult for us to be here and now, to be present at this moment. We're sometimes, many, many times we're thinking about the future or regretting what we didn't do in the past. So, I like that one, what I experience here and now. Move, please. By the way, he died on March this year. When I was searching about the etymology of the word happiness, my mother language is Spanish, I live in Italy. So, in Spanish, it comes from felicitas, it's Latin. In Italian, felicita. In English, I mean, in Spanish, it's felicidad. So, felicitas was the goddess, god of good luck. And so, the meaning of the word has been associated with prosperity, success, and even fertility. In English, it comes from the word, old nurse term hap, that means luck and change. So, even language has been shaping and changing. So, the meaning of happiness has been changing in the future. Probably in 20 years, it would be associated with AI and robots and having like a good robot at home. We don't know. Everything evolves. So, when I, I think I need somebody's help to, it's not moving. When I was searching for the word happiness, it took me to the adjective happy in the Cambridge Dictionary that says, it's a feeling showing or causing pleasure or satisfaction. But, we need, like, that definition needs something else, don't you think? So, usually, the level of happiness for longer periods of time is more strongly correlated with levels of life satisfaction, subjective well-being, flourishing, and hegemonia. And it depends on different cultures. There was a meta-analysis that said that Muslim culture have a tend to be happier because they live in acceptance and gratitude. There's a definition that, oh, thank you, of health that we all know by heart. It's the state of complete, not partial, complete state of physical, mental, and social well-being and not merely the absence of diseases and infirmity. So, who is 100% healthy in this room? Nobody? Okay. So, Dr. Rodolfo Sarati, he said, he was like a critic of this definition of health. He said that this definition was written after World War II. So, and the takeaway of this discussion, of this paper, he said, the relationship between health and happiness is not fixed nor constant. Because in many surveys, when people have been asked what is happiness or a word that they associate with happiness, usually health is in it. But having a serious disease is likely to make us less happy. But not having a disease or not having cancer or not having any diagnosis doesn't make us happy necessarily. Here are some synonyms. When I did my search on literature, these are the words that are very much associated. There's not a universal definition of happiness. And the word that has been related, that appears in the literature most times is well-being. That's why when we find instruments to measure happiness, there are very few. Many measure job satisfaction or stress or burnout. But instruments that are exclusively to measure happiness, there are only few. So, why is happiness important? The World Happiness Report, and we will go in detail in a little bit, says that people that are happier are more likely to be healthy, productive, and socially connected. In 2015, with the agenda of sustainable development goals, they highlighted the importance of mental health. And after the pandemic, we understood how important that was. So, mental health has been conceptualized as a dynamic state. So, I would like, if possible, for you to, what do you use when you would like to write notes? I have a WhatsApp for myself. What do you use, like notes or? Okay, can you write on your notes the feeling you're having right now, the emotion that you're having right now? This is an emogram. So, I will explore your emotion while I speak. Because it changes like clouds on the sky. Our emotions are continuously changing. So, mental health is a dynamic state that manifests in everyday life through behavior and interaction, enabling individuals and groups to deploy their emotional, cognitive, and mental resources. So, it is very important. We cannot ignore the invisible world of emotions. They are there, even if we don't see it, or even if it's hard to measure them. So, the International Labor Organization recognizes mental health as a critical aspect of workplace safety and health. I don't say so. I'm glad that Ailo said it. Ailo acknowledges that mental health issues can have a significant impact on workers, employers, and the economy as a whole. And when there's money involved, people pay more attention, right? So, we have to focus on prevention and resources and strategies. We know that today we're facing a lot of challenges. Probably our teenagers, I have a teenager, probably our teenagers will have higher challenges. Isolation, I will show you a little bit. So, I would like to share with you some facts from WHO about suicide. More than 700,000 people die due to suicide every day. I have been working voluntarily in the Middle East, and I've learned that there could be some, not all the numbers maybe are published. In some cultures, suicide, if somebody attempt to suicide and it doesn't succeed, they can go to jail or they can be punished because it's against their religion. So, these are numbers we know. My statistician professor, he used to say, they're true, lies, and statistics. So, these are only a number. So, for every suicide, there are many more people who attempt suicide. Suicide is the fourth leading cause of death among 15 and 29 years old people. That's scary. Unfortunately, 77% of global suicides occur in low and middle income countries. Ingestion of pesticides, hanging, and firearms are among the most common methods of suicide globally. Please write your emotion right now on your notes, whatever you're writing, your emotions. So, when I was doing my research on the internet, like not very scientific, I just wanted to Google and see what was about, what information I would receive. I realized that there are webpages that teach people how to commit suicide. Scary. Write your emotion right now, please. And it was terrible. And in some nations, it's not, this webpage cannot be blocked. So, they have like a hidden IP number, and it's impossible to detect. And they say, it doesn't matter. If they block the webpage, we will create another one. So, they describe methods specifically and the doses. And people even post on social media when they're going to do an attempt, and what are they feeling when they're drinking. So, it's terrible. When I, I have feel goosebumps when I was reading, and I'm feeling it right now just to speak about it even in my face. This is a phrase from the Journal of Occupational Environmental Medicine that says suicides are highly significant, yet largely preventable public health issue. So, when we understand that suicide is a public health issue, and we have, we're here, we have many tools in our hands to prevent it. And the workplace is an important venue for health and safety, which includes concerns related to mental health and suicide prevention. Because we spend one-third of our life at work. One-third. If you live in the US, probably 50%. Because this meeting, I was going to propose that this meeting shouldn't start at 7. Now that I live in Italy with La Dolce Vita, they should start at 9. Come on, right? Don't you vote for that? And then, when you finish, you have like dinner events. So, you have like four hours of sleep every night. So, we have a lot to do in the workplace. Here are some statistics of ILO and WHO. Probably they are not very clear. But I want to, what I want to highlight is that exposure to long working hours has been the first cause of death. Can you believe that? Here is another graphic that we can see it. So, around 700,000 people have died because of working too much. But what is working too much? People from the US don't answer. Only people from Europe and Middle East. How many hours per week is working too much to become a high risk of cardiovascular death? 60, 50, 55. Right answer. How much is 55 divided by 5? I don't know how to multiply or divide. So, we're in a high risk being at this event. We are, we are having a high risk because we're working 12 hours. What is it about the long working hours? Is it like the mental health aspect or is it the injuries at work? Or what, what is it? Yeah, the increase of cardiovascular risks. But this is, this is a tricky statistics. There's a Lancet publication. Probably I cited somewhere. If not, I can share the link at the end. It's not the same working 55 hours a week in a construction in Oman, in Qatar, or in Egypt under 50 degrees in the shadow than working in an office setting or working in an event like this. So, there are like protecting factors. When we're studying burnout, we know like engagement is a very protective factor. So, if people are engaged and they're working a lot, like we are, probably all of us, we will not have the risk. So, it's associated with increased cardiovascular risks. And that brings me to the next slide, Karoshi. Anybody from Japan here? So, Karoshi can be translated literally as overworked death. The first time I learned about it was in South Korea and when I was speaking with the minister of Japan, he said there are three types of Karoshi. Stroke, heart attack, and suicide. And when there's a suicide and it's work related, usually the worker leaves a suicidal note. Or, of course, to classify Karoshi is very difficult. In most countries, it's not included as a cause of death. It's very complex. Once I was in front of a case that most likely was Karoshi, it was very difficult to classify. So, it was not classified. This person had six years without taking vacation. He was working even Sundays. He was working 11 hours a day. And I remember him. He died on February 2nd. And I remember I saw him on Thursday and he was overwhelmed. And I said something that I regret. I said, well, God doesn't give us burden that we cannot take. And he died on Monday. So, that was pretty scary for me when I did the research about Karoshi. Because this gentleman didn't have any previous risks. He didn't have hypertension, obesity. Actually, he was athlete. He was very healthy looking. So, we're learning and learning and learning about these new emergent issues and risks. And I'm not speaking about plastic happiness. I have been working for many years with Cochrane, so evidence-based medicine. And when I started learning and sharing about happiness, I perceived that people look at me in a different way. Like, you're not scientific. This is, happiness is not very scientific yet. Because we don't have any systematic review in Cochrane yet. But one is coming. There's a protocol, not specifically about happiness, but about well-being. So, we're building more and more evidence. And I'm not speaking about having a chief happiness officer. Probably you have heard, like, Google was the first. Is anybody from Google? Like, the doctor from Google? Probably he should be somewhere around here. So, some companies are hiring the concept of a chief happiness officer. But I think there's a misconception. What I have seen, for example, I remember once on Mother's Day, in a Venezuelan rich company, they were having a nail bar. I didn't know what that was. So, a nail bar, you go and you do your nails. And they put little things on it. And we had, at that point, an outbreak of hepatitis C. And we didn't have money for the vaccines, but we had money for the nail bar. So, we have to prioritize. We have to, the origin first. So, we have to take care of occupational safety and health risks, and then take the next steps. It's like the Maslow Pyramid. So that's why our reputation is changing, I think. I think the happiness reputation is changing because sometimes people, I love human resources, but sometimes human resources hire somebody without the advice of an expert. So having a massage once a week or having snacks is not a synonym of providing happiness and well-being at work. So that's the confusion there. So please look at me as a respectful scientist, not like I'm sharing plastic happiness, because I truly believe we have to take care of occupational risks first, and then focus on the invisible, which is really important as well. But if we have an imminent risk, chemical, physical, we have to take care of that if we have few resources, and that's a reality in the majority of the countries of the world, because the majority of the countries of this planet are low and middle-income countries. I come from one, by the way. So here's the map that shows the World Happiness Report. This report is controversial, but it has some interesting numbers that I would like to share with you. So what is interesting, most relevant, is that Finland has been seven years in a row. Finland has been the happiest country for seven years consecutively. I used to remember when this report started, people would say, but suicide in Finland, they have a lot of suicide. Is anybody from Finland here? So yes, they did have a high suicide rate, and they do have long winters. In the north of Finland, they have six months of snow, and it's dark, but guess what? Weather is not included as a parameter. Probably if we include weather, it would have some difference there. Jan-Pierre. Well, I live in Kuwait, but Ian was from Finland, so we keep asking him about being number one over seven years period. So when he did it, he said, well, yeah, you take your pills, and then when they ask if you're happy, you're happy. So, you know, they take medications. I mean, according to him. You know what I mean? We all take the same medication. Can you please give us the name? Exactly. Can you tell us the name? Can you tell us the name of the medication so we can go and get it? Yes. I had to go back and send him a message about it. We take medication. Okay, I have a comment about that. I'm very curious. Actually, I would like to live there at least for three months to explore, but I heard from Finland, as from somebody that was married with a Finnish lady, he said, if they're not depressed, they will answer they're happy. So I'm not here to judge, but it's interesting because every culture, every religion is different. So the same parameters can be interpreted in a different way. Somebody had raised, okay. If their rate of completed suicides is that high, then those people are not reporting their happiness level. So, you know, you have a shorter- You have the healthy worker effect bias. No, but they did have a high suicide rate, but then the government, you know, I came from an oil company, so they are an oil country. They're a rich country, so the government started to implement a lot of measurements to increase the well-being of the citizens. So yes, it has changed. Now they don't have such a high suicide rate. And we see that Ukraine is the least country, the country in Europe with the least happiness record. And since I've been following this map for a long period of time, they were already unhappy for the war. Their rate was very low. In South America, unfortunately, Venezuela seems to be the least happy. And, but the least happy of the whole world is Afghanistan. So the U.S. is right here with, where's the U.S., 6.9. So this is the scale. One is least happy and eight is the most happy. So Afghanistan has 1.9. What, how do they measure that well-happiness report? So, oops, okay, sorry. I will show you the parameters that they have. So 10% of the global population still live in extreme poverty, surviving on less than $1.9 per day. And why I'm showing this? Because the majority of the countries are low, middle-income countries. And when I was living in Caracas, Caracas is very wild, I experienced this survival mode. In fact, when I speak about this, it's very hard, so I will go quickly, otherwise I will cry. So you would ask, there was a period of time that you would ask people, how are you? Como estas? And they would say, Sobreviviendo, surviving. It was part of their vocabulary. And then it was a moment of my life that I said to myself, I don't want to survive, I want to thrive. And it was hard, but that transition, it was very painful. So when people are in the survival mode, you can now think about writing poems and self-realization. You need to have water that day. You have to get out and be careful that you don't get killed on the streets. So it's very complex. So that's why I was supporting a lot of people in my job, doing intervention programs, and that's why this idea of writing this book came up, and it made me happy. Actually, it makes me happier to speak about happiness than to speak about problems. When I was writing about depicting the reality in Venezuela and South America and poor countries and seeing all the indicators and hyperinflation, devaluation, poverty, mortality rates, scarcity, I felt so bad. So now I'd rather speak about things that make me feel better because I realize nobody's going to come and save me. Every one of us have to do things for yourself. Nobody can eat healthy for you. Nobody can work out for you. Nobody can read for you, sleep more hours for you. So you are the only one who can take care of you. So here are the parameters that are being used in the World Happiness Report. Positive effect, negative effect, social support. That's a huge, huge thing. Probably you have heard the TED talk about longevity made by Harvard. So they found out that connections are so important, and having strong connections or not having strong connections is equal to smoking cigarettes. So having friends, usually when I'm doing workshops, I provide a homework to my students, and that is to connect at least with 15 people on LinkedIn before the event finish. So having connections really increases your probabilities of feeling better. Freedom, the ability to make choices. So when I was doing the last, the previous workshop in Riyadh we mentioned religion. So is religion a voluntary choice? Sometimes. Sometimes. Why? I would like to know. We were speaking about this. Why sometimes? I mean, some religions you are not able to leave the faith safely, depending on the interpretation of the religion, right? In some religions you are not able to leave the faith. It's not allowed. So it's borderline. In some countries can be, so why? Why I'm saying this? Because there's Seligman, the father of positive psychology. He has a distribution of the elements that can make us happy. So voluntary choice decisions like selecting your partner, selecting your work, selecting the country where you live at, which is not always easy. It's borderline also. In some countries you cannot leave the country because you don't have the money. You don't have the passport. You don't have the green card, the visa. You don't have. So corruption, generosity, GDP. Again, money seems to be associated with happiness. I'm sorry, it doesn't sound romantic, but you can put some hearts on it. So it seems that, but the interesting thing is that the richest country or the country with the highest GDP, which is Luxembourg, is not the happiest. And the country, South Sudan, which is the country with the lowest GDP, is not the unhappiest. So that's a good news, I think. That's good news. Our happiness does not depend on our GDP, but it helps. Healthy life expectancy. So this is a publication. We are planning to upload it as a handout, the science behind happiness at work. When we did the research, we wanted to make a review of the last 18 months. So there were like 22,000. That was last year. Today, this is today, this screenshot. There are 24,541 results in PubMed. And we see that there's an increased interest on the topic. So we're building more and more evidence. So in less than one year, 2,000 new publications arrive. That's pretty interesting. And loneliness, what, 14,000. So there are many publications now about loneliness. This is a definition of workplace well-being. Let me see. I enter in a flow state and I forget about time, so I have to watch. Workplace definition, the workplace well-being, that is, take a note about this. This definition is very much associated with happiness at work. Some literature is almost like take it as a synonym. So they say, it's very radical, the same as complete state as the definition of health. Here, workplace well-being relates to all aspects. So 100% of aspects of working life, from quality and safety of the physical environment to how workers feel. So subjectivity, perception is taken into consideration. That's very interesting. So the aim of measures for workplace well-being is to complement occupational safety and health measurements. To complement, not to substitute. We don't want to give a massage or hair salon or something and not take care of occupational safety and health measures. So this is a systematic review, I highly recommend it. Happiness and health, the biological factors, it's very interesting. It shows the relation between work, health and well-being. It's a both way. So everything, everyone touches each other in a positive or negative way. So here's the happiness formula by Seligman. He said that happiness is equal to a set range of happiness, neurotransmitters, circumstances of life, factors under voluntary control. So this is the proportion. He said, the set range, genetics, are 50% of our happiness. The rest is on the pharmacy in Finland. 40% voluntary control and 10% circumstances. So when we see circumstances and we take less weight to circumstances, we see that there are a lot of things under our control. So what is controller happiness? Here are the, I will go quickly because you are experts about it. So we have the amygdala, hippocampus and the limbic system, the structures in our brain and neurotransmitters such as dopamine, serotonin and norepinephrine and endorphins. Here are some of the genes, effects of genes of happiness neurotransmitters. So I wish we all have all these good genes. If not, we can go to the pharmacy. Really, because there's a lot of people that are against, like there's people now that are against formal education. They say, oh, you can find everything on YouTube or you can fix your state with meditation and breathing. I do meditation. I breathe, I think positive. But I do believe if somebody needs serotonin, they have to buy it on the pharmacy. It's a deficit. And when somebody has depression, it's like telling them, it's like telling somebody, oh, you have a fever, come on, go to 37. 37 is nicer. I'm speaking about Celsius, by the way. So you cannot ask or somebody that feels depressed to feel better because life is beautiful. It doesn't work that way. They cannot control it. And we are physicians. I know I always prefer natural things. When my daughters have fever, I leave them with that. I don't give medication. I wait because the temperature will kill, but never kill. So at the end, I have to provide something if they have a virus or a bacteria. But I always go through the natural first and then the medication. But we're physicians and we know if there's a deficit of a neurotransmitter, we have to support them. But we have to know the roots. And I'm glad that melatonin is here because melatonin is not famous for being a happiness hormone. Usually, melatonin is associated with as a sleep hormone, but in reality, it's not a sleep hormone. Circadian, melatonin controls the regulation of darkness and daylight. There was a study that melatonin only helps seven minutes, increases only seven minutes of sleep during the night. So melatonin is not for sleep, but it's great for us, an immunomodulator, and also increases our happiness levels, and you can get it in Walmart. Oxytocin is the lung hormone. We already know that. When mothers hear, I think that has been the highest peak of oxytocin ever, and endorphins. So on our publication, we described 34 factors. I will not go in details, but you can read the publication. Here are some of them. Many are associated with happiness, and I would highlight that the most important relationship at work is with your supervisor. Of course, with your colleagues, but your supervisor plays a huge role on your well-being. Here are other factors, and why we made this, this is the daughter of the, that's me when I was 24. So when we made this publication about the science of happiness at work, we realized that most of the publications were made on healthcare workers. That's why we made a second publication after that. Here it is. It's free. You can get it. So here's my family and things that make me happy, because healthcare workers, the majority here are healthcare workers, and work-life balance, having the opportunity to share with the family and have an interest and have a hobby has been a great issue for healthcare workers. Flexibility, this is a Cochrane Review, very old, before the pandemic, and they associate this flexibility in terms of schedule, location, and days, like negotiating, having this flexibility was really highly associated with happiness. Here, shorter, kind of shorter work week make us happier. What do you think? Okay. We all agree. I'll continue. But here, for example, Mexico, we have some friends here from Mexico. They have a long working hours, long working week, and Germany seems to have the fewer, 317 hours fewer than the average. So I would like to introduce my dear colleague, Professor Ahmed Abba Al-Badri. He's a chief happiness officer, but he will share with us his experience implementing a wellness department. Yes, thank you very much. Good afternoon, everyone. Always when I attend to Yohama, I am happy, and everyone in the organization is happy, but I am a social professor of incubation medicine in Mansoura Faculty of Medicine in Egypt, and I am based in Saudi Arabia for 10 years now, and we starting in the wellness from 2019. Five years now, we wanted to make a solvent, the problem of the wellness and the well-being in our hospital. So we starting with happiness safe organization. Our wisdom today, as taught in Japan, say your age is a measure of wisdom, but rather the awareness and the knowledge you have. This is me in 2014, when we first met Christina Maslach. You know Christina Maslach? The founder of the science that's called Burnout, and the first Burnout name coined in 1937, before I born, and she have this name, a phrase which used by poverty lawyers to describe the loss of inhuman feeling for their clients. And when we search about the dimension of the Burnout, emotional exhaustion, depersonalization, reduced personal accomplishment, we found a great framework that's called IHI, the Institute of the Healthcare Improvement, framework for solving the problem of the Burnout, and they name it the IHR framework for joy at work. And in this framework, they indicate that they are working in the three 90-day innovation project enjoying the work in 2015, 2016, with more than 30 experts, and with more than 11 health and healthcare system working to improve the joy in the work. And they have the four steps for leaders. The happiness and the joy in the work start by the leaders, and this is a problem. How many leaders here? Okay, wow. How many of us as a leader take a training program about wellness and happiness among our employee? No one, that's right? When we have Richard Safir speak about MBA, and he review the MBA curriculum, we know that the MBA is always a mandatory or it is complimentary for any leader to be leader. When he search in the curriculum of the MBA all over the world, he didn't find anything speak about the wellness and the employee health and the work culture. Also, only they teach them about the communication, about the marketing, about the finance, and everything else. So the leaders didn't know how to make wellness in the organization. And this is the first thing that we do in the IHI framework. We teach the leader to ask very stuff, what matters to you? Because if you hire a consultant, occupational medicine consultant, and say, told him, please make a wellness program for us. The first step that he must teach the leaders of the organization, how they ask their employee what matter to them. Every department is different from others. Every employee has a different aspect of wellness. The second step is to identify unique embedments to join the work in the local context. After the first step, the second step, every department has a list of the joy in the work and the wellness activity they can do. After that, commit a system approach to making the joy in the work a shared responsibility at all levels in the organization. I will show you now a video we do in our hospital and we make a training program. We make a training program and in this training program I make a portrait, a big photo and covered by sheet and I told them, this portrait of the person is responsible for the happiness in our organization. I will discover now the sheet. Guess who is the one? I put a mirror because every leader in this room is responsible for the happiness in the organization. It's not the responsibility of one leader. All the leaders, supervisor level, mid-level, even the unbelievers themselves are responsible for their happiness and wellness and joy in the work. Lastly, use improvement science to test approaches to improving joy in the work in the organization. And this is a video. We start our training program for the day I come, before I came here. This is in my hospital in Saudi Arabia. This is the leaders of the hospital and they are very happy to attend and first time to discuss this wellness program and happiness program and the steps. We make a work group and they start to study the steps of the happiness and how we can make improvement in the improvement in the culture of the work. And this is discovering of the mirror in front of them. All these are the head departments and supervisor level and the CEO of the hostel, medical director and all closed in one workshop for about four hours. We closed the door from outside and told them no one go from here except he study and know these steps. We have nine steps in the IHI forum work and if you see here, this is a responsibility for senior leaders. The co-leaders are responsible for the nine steps. The managers and the co-leaders are responsible mainly for these five steps and this is sole responsibility of them and the individuals manage or individually responsible for these three steps. The first step is physical and psychological safety. Everywhere we speak about physical safety and I think this is the first time to speak about physiological and psychological safety. Only do you know what means psychological safety as a leader? Always you have one employee in your department, he is a problem maker, that's right? This is the wrong definition of him. He is problem solver because he is the one detecting the problem and making the solving of this problem. So the justice culture and the speak up culture must be implemented in our hospitals or in our organization. Second one is the meaning and the purpose. Once upon a time, in front of our hospital, I stand and ask everyone come to the hospital, why you are coming to the hospital today? One question for everyone. If it came with you, what is the right answer? Why you go to every day for your work? Any HR people here? Finance? What is the ideal question for you? Why you going every day to your work? No answer? Change, that's right. Again, what else? Get paid. The meaning and the purpose, this means that you every day go to your work to realize the vision of your organization that aligns with your vision. This is the right answer. This is the meaning and the purpose in every employee. The choice and the autonomy. We have choice and autonomy in our department or not. We must institute choice and autonomy, recognition and rewards, participative management, decision making, not decision taking in the organization. All these are steps that we will do to reach happy, healthy, productive people in our organization. Camaraderie and teamwork. Daily improvement. Every day we must improve our culture in the organization. Wellness and resilience, and there is a big difference between the two. And lastly, the real time in measurements. And we have two types of measurement, either system level or local level. And this is my clinic leadership dimension of the assessment. The good point in this assessment is not to assess only your leader. It is a prescription for the good leader how to deal with their employee. How to be advocate of wellness and happiness in your organization. So you must ask your employee about that. Am I hold career development conversation with me? My leader. My leader inspire me to do my best, empower me to do my job, interested in my opinion, encourage employee to suggest idea for improvement, recognize me at the job well. I would recommend working for this leader. And overall, how satisfied are you with this leader? This is very important to have the prescription of your leader. And also, as a leader, you have the right way to deal with your employee. And also, we use Maslach Burnout Inventory. And this is very important to have. In the Maslach Burnout Inventory, they have now the profile, engaged, ineffective, overextended, disengaged, and lastly, they burn out. And this is also how we make it with the area of work life survey, workload, control, reward, community, fairness, and values. Thank you very much. This is my contact information. Thank you. Thank you, Professor Ahmed. So, some conclusions. We're not here to share the truth. We're here to share what has been published. Because we know the definition of happiness. It's very individual, even from a collective perspective. So, there's not a standardized definition of happiness. This makes it challenging to approach the topic from a scientific point of view. There's an association between the working time and happiness and health. So, they reduce working hours. So, now we know long working hours increases the cardiovascular risk. So, it seems like we have to enjoy more and work a little less. Organizations have the power and responsibility to improve their workers' well-being. And we know that. It's like we are, the organization is like we parents. We have a big responsibility with our children. So, when leaders and managers cultivate the whole person at work, not just the employee, they promote the success of every individual organization. Again, the 34 factors, these are not the only one. These are the 34 factors that were found on this framework of 18 months. So, please, take in consideration that there are much more. There are several instruments that have been used specifically to measure happiness. Some of the 12 interventions have been identified that can be done, and there's some evidence that can improve the well-being. For example, having a gratitude journal, unbelievable. Some of the studies, they made their workers to write at the beginning of the workday what they feel gratitude for, grateful for. And also, there was a study that says that having a gratitude journal can increase your REM sleep and can reduce your glucose levels because of the reduction of cortisol. So, it's pretty interesting, all the research that is being done. Perceive, this is a good takeaway. Perceive stress is the most important happiness killer for healthcare workers. Most of the studies have been done in Asia, followed by the Americas, and they are not studies in the Middle East. So, we have opportunities also in Africa to collaborate and do some more research. Happiness at work is inseparable from other life dimensions. It's not like, okay, I'm super sad in my house, and I arrive to my job, and I woo-hoo, become happy. By the way, this is my older daughter and my little, but now they're grown up. They're, so stability in matrimonial, now we would say, partner, not only marriage. In Italy, for example, people are not getting married as much as they used to. So, having a partner seems to have a strong relation, as well as finance, involvement in leisure and religious activities. Complete, permanent happiness does not exist. And I like a discussion that we had, and I highlighted, and happiness is not a destination, it's a journey. So, I've heard from somebody that says that we don't have to let a negative thought last more than five seconds. So, if we have a negative thought, we have to immediately do something to change it. And we can do it also through music. Doesn't happen to you that when you listen to the music that makes you uplift, you feel much better? So, even though there's not a formula, there are things that we can have under our control to have a beautiful state. And we can use our work as a springboard to our happiness. So, I would like to finish this presentation with something that we used in Caracas when we were under a huge crisis. We have psychologists that were supporting after the earthquake in California or the earthquake in Chile. So, people that were like on life-threatening events, and this was the first time I learned about this serenity prayer that says, oh, what did I do? This is the end. Well, the serenity prayer, I don't know it by heart. Is anybody that can help me that knows the serenity prayer? It's a beautiful prayer. Lord, give me the wisdom to change the things I can change, to accept the things I cannot change, and to understand the difference. Thank you very much for being here. Fantastic presentation, both of you, Shoham and Ahmed, fantastic. I'm happy now. Oh, you are. I do have a question. My time with the international occupational medicine community, I've become aware when we were in Morocco just two weeks ago, and we learned that in countries like India, 90% of those people are informal workers. They're not employed. I'm wondering, have you done any sampling of the informal worker population and their happiness scales? Maybe something for future work, but they make up, informal workers are more than 50% of all workers. They don't have supervisors. They're their own bosses. Yes. And a lot of them live in terrible conditions. Yes. Is that future work for you, or do you have any insight on that? Thank you. Yes, I can answer that one. I was working with informal workers for more than a decade, and the reality is that only around 10% of the workers in the world have access to occupational and health services. So this group of population that is very huge in the planet, they're uncovered. So they don't have, when I have made some literature reviews, they have no access to the very basics. For example, they're exposed to noise, vibration, chemicals, many things. So many, many times they're in the survival mode. So we need research. I haven't searched, I didn't find any research on informal workers. Most of the research are on manual handling or biomechanical risk, other like hard risks, let's say, like classical, the classical fire risks. It would be very interesting to explore that. Thank you for sharing. What's the example of an informal worker in India? An informal worker could be from a babysitter or somebody who sells fruits on the street, somebody who does handcrafts, anybody that doesn't have like a formal employment. Thank you for that. Yes, Frank. Thank you for your talk. I'd like to know how wellness, which is what you do at your company hospital, how those efforts interface and overlap with employee assistance programs. So I'm still trying to formulate the question in my mind. Is there data to say that if there's greater efforts for wellness, there'll be fewer, less utilization of employee assistance programs? Does that make sense? Could you repeat the last part, please? So the question is, if organizations spend the efforts and put in the planning to encourage wellness and happiness, so to speak, does that reduce the utilization of employee assistance programs? The question is, the overall concept is, if we encourage happiness and well-being, will people end up being in a mental state where they can still function and not have the issues with absenteeism and presenteeism? So from my perspective, employee assistance program for solving the problem. But the initial state of any employee is happiness. Do you know Deming? Edward Deming? Edward Deming is the father of quality. He always has a workshop with the leaders and asks them a very famous question. How many dead wood do you have in your department? And they say, many, a lot. You hire them dead or you kill them? You are killers. So this is a problem. That if we have a wellness program and happiness program, reserving the initial status of the employee coming to our organization, we don't need the employee assistance program. Employee assistance program only in the risk, in the exposure, in accidents, but not in the happiness, not in the wellness, not in the psychological. We only need to maintain the initial status of happiness for the employee hiring in our organization. So I think if we institute and make a wellness program, it will decrease the number of the employee assistance program. Because employee assistance program, as you say, absenteeism or presenteeism coming from the wellness. He will not come to you, to your clinic and say, I am not good today. I am not happy. He will say, I can't work. I want to have a sick leave. He will tell a lie to take a sick leave. Okay. This is a problem. So employee assistance program will go down and there will be less utilization if we have wellness and happiness program, God willing. Okay. I would like to add on that. When I work with AIP, I learned that, is anybody from Argentina here? So in Argentina, almost everybody has their own psychologist. There's no prejudice about it. They say, oh, I have to go. I have my psychologist appointment. And they leave and they are very open about it. There's not such a taboo as there is in other countries. So EAP, if we have, let's contrast this information. If only 10% of the planet have access to occupational health services, what would be the percentage for EAP? I would say less than 1%, something like that. In my experience in Latin America with EAP services, most of the people were reactive about the service. So we would have, we could have access to six consultations about divorce, financial problems, problems with the kids, any problem. But people were only using EAP services when there was a problem, not as a preventive initiative. In fact, when I was transferring to Italy, I used the service proactively. And they say, what is your problem? I said, I have no problem. I just want to avoid a problem. I wanted to, because I knew about culture shock, I wanted to address the issue with my kids. So probably having wellness programs will reduce the EAP services. But we don't know yet. There's not statistics about it. I don't know if there's another presentation. If not, we can have take another question. Where is she based? Oh, no. I will search for it. Thank you for sharing. Yes, thank you. Any other questions, comments? Yes, please. Thank you very much. It was an excellent presentation. I think you've given us food for thought. We have EAP utilization by many organizations, and they experience it. It's very, very little changes from time to time. It was quite a bit during the pandemic. Again, it's come down. But I think we need to focus more on the happiness of employees, happiness quotient, happiness index, something like that, we should have for employees. So thank you very much. Let's give you food for thought. Thank you. Yes, please. I just wanted to say that when we asked our employees why they utilize it, so because we were really worried. We're like, hey, like everybody loves our well-being program. Our participation was like up to 50% with no incentives. We had like 500 volunteers. It was really loved at the organization level, but then when we got the EAP data, we were so shocked. We're like, why is our EAP utilization going up? So then we did a focus group with those people, and they said, we didn't realize we needed EAP, and we didn't feel psychologically safe to use EAP within the organization. So then we realized there's a lot of people with all these diagnoses walking around not getting the care that they need. So the point being is that even if EAP increases, it may be a proxy measure for something else. Great comment. Thank you. Let's connect. Let's connect on LinkedIn, and we can continue conversation virtually or continue thinking about it. Thank you very much for your participation.

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recognition in work environment

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mental health in informal workers

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