Session Information:

Creating a Culture to Promote Individual and Team Thriving, Resiliency, and Peak Performance

• Explore the rationale for changing the conversation from one focused on burnout and change initiatives to one focused on thriving and sustainable performance
• Understand the connection between emotional, thriving and emotional recovery to peak performance
• Discuss approaches that lead to sustainable change toward a work environment that enhances clinical team performance, professional well-being, and a culture of excellence
• Review outcomes on key performance indicators that organizations experience when using these approaches to create a culture of excellence, thriving, and performance

Session Transcript:

Our global audience from two of the greatest leaders of healthcare excellence. So, first, doctor maples, doctor William maples, is the founder, President and Chief Executive Officer of the Institute for Healthcare Excellence, a national organization supporting care, redesign, and cultural transformation in delivery systems across the United States.

Doctor Maples earned his undergraduate, undergraduate, and master's in Oncology and medical degrees at the University of wisconsin madison and completed his residency and fellowship in Medical Oncology at the Mayo Clinic Graduate School of Medicine.

He practiced medical oncology for 25 years at the Mayo Clinic and helped lead the Mayo Clinic Quality, Safety, inexperienced Journey, after which she has served as Senior Vice-president and Chief Quality Officer, Emission Health in Asheville, North Carolina, North Carolina, where he helped mission, health, navigate, cultural transformation and become a top ranked US Health system recognized for its impeccable, quality, and safety.

Thank you for being with us, doctor William maples.

We also have Jennifer ... with us. Jennifer ... is the Chief Experience Officer for the Institute for Healthcare Excellence. She's a graduate from the College of Saint Benedict in Minnesota with a Bachelor's degree in Liberal studies in communication. She's a fierce advocate for connecting people, concepts, seen and unseen that positively move the patient and employee experience forward.

Her ability to lead, inspire, manage, a mentor employees, providers in community made her perfect as the chief experience officer at the Institute for Healthcare Excellence. Jennifer, thank you for being with us. It's a real pleasure to have great leaders of healthcare excellence with us. Share your insights, and your knowledge on such an important topic for our global audience.

Good morning. Thank you.

Yeah, thanks, Joe, Jose, for the nice introduction and for your energy that you always bring to these presentations. Appreciate that.

And for highlighting what Jennifer and I are going to be talking about today, and that is, creating a culture to actually achieve what each of us really desires individual and team thriving, organizational, thriving, resiliency, the ability to bounce back and, and then to achieve our past, our peak performance.

And I think that's what we all and health care, come to work every day, hoping that we can do.

And the secret here is we didn't talk about what processes and policies and regulations Those are all important. You're going to have time to explore those in other talks today.

But this elusive culture, how do we actually create that and sustain that?

So hopefully Jennifer and I will share some some of our insights and thoughts with you, and then I'm happy to address any questions as they evolve. So Jennifer, if we can move forward.

Yeah.

And so when we think about creating this optimal experience for both the patient, the physician, the nurse, the health care team, what is that all about?

And I'd like to just share some, some thoughts with you from the patient's perspective, as well as the health care team perspective of what they believe is necessary to create that optimal experience.

And be mindful that this transcends generations. We always worry about does this generation need something different than this generation.

This comes from the last several generations have told us the same thing. So what do patients tell us?

They first tell us, Jennifer, if you can, but through here.

They first tell us they want to, you know, B, having that, the feeling that you're spending time with them, and, again, it doesn't have to be a lot of time, but just being there for them.

Next, just keep plugging Jennifer, that they want to know that you really, that means that you really, that you care about them and their health.

That you listen to them and take their concerns seriously.

That that year can be trusted, that you are easy to talk to, and last, that you really, they want to be treated with dignity and respect, and they want their sort of thoughts valued.

And respected, that's what patients have told us, and it's been elusive to actually achieve that over the last several decades.

On the opposite side is, Why do what a health care team members really say?

They really want to know that, that you care about them as a team member, So if you're in a leadership position, how do you show that.

That, um, But they have all the tools that they need to truly execute their job and be their best.

The next is that, that they're kept in form that, That leaders communicate to them, That team members communicate to them, and that there is a supportive environment, that being part of this team is very meaningful, that the work is meaningful and last, this sense of this need to be appreciated, the need to experience gratitude for all of the work that they do, and not for that to be taken for granted.

So, the key here is, how can we actually create an environment that will meet both of these needs, and provide the skills that are necessary to help create that environment?

Next slide.

When we look at how we've done, over the past, you know, 12 plus years, we have made some improvement.

This is on the basis of H CAHPS, in terms of the overall rating of our healthcare systems, our inpatient healthcare systems, but we've spent billions of dollars and, and on ending time, achieving these, rather, I would say, mild improvements over this period of time.

So, we have not truly met the needs of the patient, if we just look at the data that stares in front of us every day. Next slide.

When we look at from the caregiver side and here using burnout as a surrogate for that optimal environment practice, then if we truly optimize that and met the needs of the caregivers, and on that first slide that I showed, we really should not be seeing the rates of burnout that we have. And so here's a slide from 20 11 to 20 14.

The blue line shows that the incidence of burnout was actually increasing.

Where it the gold line Is the general population was was relatively flat.

So you can say well, maybe we got better with all of the focus in the last 5 to 10 years on burnout.

Unfortunately, When we look at where we're at in 20 20, we are now and this is in the midst of the pandemic, we are now physician burnout is approximately 60%.

So we've actually have an additional challenge on our hands and from the consequences of the pandemic.

and I don't have it on the slide here, but nurse burnout is as high as 70% right now.

And what are the consequences of that?

This is no longer just a feel good sort of thing there. Everything that we show up to work for every day is at risk, patient satisfaction, satisfying the needs of our patients, are at risk.

Infections go up, medication errors go up, and actually, mortality rates, patients dying actually, go, go up, they deteriorate. The mortality rates deteriorate with the rise and burnout. That's with at risk.

Next slide.

What do you think about?

This quadruple aim, we.

We want to make certain we do deliver patient centered care about optimal experience, we want to make certain we deliver the highest quality of care the most efficiently, but we also have this fourth dimension of restoring joy to the practice of medicine.

It's all about creating an optimal experience for both patients and for our caregiver team. Next slide.

When we think about what we want, I think every healthcare organization can pretty much list those things that you see on the right side of the slide there.

And we, we truly would like to visit, to deliver on all of these.

When we think about what we've tried, and most organizations have tried, know, a series of different interventions, high reliability strategies, Some organizations focus on just culture, TeamSTEPPS.

It just hasn't gotten us to deliver all those things that we want on the right.

They're all good interventions, but by themselves, they are insufficient to truly drive the outcomes that we want.

So, we then have to ask the question, what's missing?

And it is this culture piece that's missing.

And we need to think about, how do we invest in time and resources and efforts to truly start, and, you know, at a level where we can evolve the culture to create that optimal environment. Next slide.

George X nicely outlined to us that if we want to improve, and the only way that health care organizations can survive in this ever changing environment is to be on a continuous improvement journey.

But, if we want to improve, we need to have technical capabilities, the EMR, other technical things that, that are, that sort of make up our entire healthcare environment.

But we also need cultural capabilities to truly drive the improvement, And the improvement capacity is equal to the technical capacity, multiply by the cultural capacity.

So, simply investing a lot of time effort, and dollars in the technology of medicine will not drive improvement.

And oftentimes, we, since there's a lot more quote, hard science behind the technical capabilities, we find ourselves drifting and spending resources in that category.

The last I learned, in my math, anything times the 0 is 0, and, and I'm not saying that there isn't some cultural movement with the technical work being done, but it is not sufficient to truly drive the improvement. Next slide.

When we look at some results from doctor Michael Leonard from Safe and Reliable Health Care, he looked at how important is culture in driving preventable harm or safety within health care organizations.

And here, in the end, this is several units and one hospital, same leadership team, Same policies, same as same startup procedures.

The, the units in green had high teamwork climates, their scores, the units in orange had lower teamwork climate scores.

And when you look at how those units perform, their H CAHPS scores were nearly double.

That is a surrogate for patient experience, maybe not the best surrogate, but it is a surrogate, nearly double medication errors per month.

One third less days, between C difficile infections, three, fold higher, days between three, Stage three pressure ulcers three fold higher, so you can see the probe gig.

Being able to really create the optimal teamwork culture really drove outcomes in all of these arenas and safety. Next slide.

This also is applicable to employ outcomes. So, again, same thing.

Green units, high teamwork, sparse orange, lower team, climate scores, employee satisfaction. About half in the units that had lower teamwork climate climate, score's injuries, absenteeism, and nurse vacancy rates.

nine fold difference and this is really becoming a challenge across the country in terms of nursing shortages, but nurses usually don't leave because of money and benefits they leave because of the environment that they're working in. They may say they leave for other things, but in if you take a deeper dive and peel back the onion, it really is about the the work climate.

Next slide.

So when we think about what sorts of things do we need to do to create this culture and move from being burnt out on the left-hand side of the slide to thriving on the right-hand side of the slide?

This is work that's been done by all of the individuals listed here. Christina ...

was really important, Christine, since skiing team and then Brian Sexton from Duke University and Marcus Buckingham.

When we think about taking this journey from being burned out to not being burned out and then moving beyond that, too, I'm thriving, I really, really think I'm making a difference in my work. And I love coming to work.

Burnout at its core is the impaired ability to experience positive emotion.

That was an aha moment for me as as, as I thought about, how are we going to approach this, reading that and thinking about that. Again, burnout at its core is the imperative ability to experience positive emotion.

Think when you've been burnt out the days you go home with a bad tired, It is almost impossible to experience any positive things that happen that day, And it's sort of goes in a, in a circle that keeps repeating itself.

What we need to do is find ways to create an outstanding culture, which, at its core, is the cultivation of positive emotion.

Frequently and small doses throughout the day.

How can we tap into positive emotion because that will actually move us from burned out, thriving.

Next slide.

The emotions that we're talking about are all listed in the center of the slide here. Joy, Gratitude, Inspiration Interest amusement pride. Serenity love.

These happen repeatedly throughout the day in a health care environment.

Our job as leaders and team members is to figure out how can we tap into these emotions frequently in small doses?

Because when we do, it creates a tiny engine that keeps us going.

It keeps us engaged, it keeps us motivated, and it also on does all of the things that have negative consequences when we experience negative emotions. And those frequently can happen at work, too. So we have to find a way to undo those.

So I'm going to turn this over to Jennifer to actually just demonstrate one of these positive emotions, pride, and how it can come to life and the impact that has.

So Jennifer, you can guide us through that.

Thank you, doctor ..., So, I hope you all have a piece of paper and a pen, in hand, because we're gonna do a little exercise of cultivating one of those positive emotions, And today, we're gonna focus on cultivating pride. And pride is something that we're proud of, something that, perhaps, you experienced at work at home. It can be something way back in the past, or something recent are present. Or, that's something you're experiencing today. So, first of all, I would really like you just to jot down in 3 or 4 sentences, something, a peak experience that you would describe what we like to call as a fridge, where the moment, something that you would be proud of, and that you would potentially pulse on your refrigerator, either at home or potentially at work.

So, I'm just gonna give you a moment or two to jot down, and think about what that that peak experience was for you.

Could be something that you did at work.

A proud moment that you really think about with the smile on your face. So, that you would just really happy about the things that you experienced recently.

It can be anything.

And as you're writing that peak experience down, I'd like you to think about, as you're doing that.

What kind of feelings, emotions, what kind of, I guess, Positive emotions come up when you think about that experience.

Um, maybe you're going back in time and thinking about the people you were with.

Or um, maybe you were outside, when it happened, What day it was.

Um, Where you were, Maybe how old you were.

Um.

What impact you are having on others, perhaps, maybe the pact on yourself, maybe include some of those thoughts in your sentences.

Now I'm going to ask you to just go a little step further.

You don't have to be an artist.

Because we said this is a French worthy moment. We'd like you to actually go the next step and draw a picture. What would this look like if you would, when you hang this on your refrigerator at home or at work?

Could be a stick figure, could be anything.

You can chat with words, um, but what did the peak experience come come up to us? What did it feel like, what it looks like? Maybe you recall it was such a great experience. Maybe you remember what you were wearing or who you were with.

Take a moment and just draw with what that peak experience look like. Maybe it was just a simple moment that happened yesterday, and you can recall exactly where you were at that time.

Maybe the sun was shining. Maybe it was raining, You could try raindrops or sunshine.

Um, just take a few moments to do that.

Yes.

When we've done this exercise with other organizations, and friends and family, things that happen, when we cultivate pride, and hopefully when you've done this exercise just now, it has offered you a time to just simply pause for a few minutes, and reflect on a job well done. Something that you've experienced as perhaps a good day, a good experience, and it just allows you to reflect on some of those positive emotions.

It also can tap into some vulnerability, as you think about posting that vigilantly moment on a refrigerator where your family may see or your colleagues may see.

And in turn, it can increase engagement as you think about sharing that story or sharing that moment of pride with others. And then it may build on Storytelling Shireen from other.

Team members are family members.

Cultivating these positive emotions, such as pride or gratitude, are really great ways to, like doctor Maple said, tap into these positive emotions. In tiny doses frequently throughout the day can really have a great impact on kind of decreasing your burnout and increase your striving. And we really encourage you to think about how you might take this back to your teams, and also, perhaps home to your family, at the dinner table and just practice these.

And encourage you to maybe find a way to, to put this into your meeting in your huddles, different ways to encourage these as team building exercises.

So thank you for walking through that skills practice and thinking about how you might cultivate pride more often tomatoes, I'm going to turn it back to you to take the next couple sections.

Thanks, Jennifer. Jennifer mentioned about taking this back to your teams and intentionally carving out a way to do this.

The reason this is important is that this is a team sport, 26% of your individual burnout can be predicted by the people around you.

So, all the things that hopefully, you experienced that, Jennifer, as you went through that exercise that Jennifer outline, hopefully, you could, by doing that in a team setting. You could really help those around you to create the optimal environment and move from being the burned out side to the thriving side as a, as a team sport. So thinking about how to do this as a team is really important. Next slide.

Uh, and the approach that we take to the what's missing question is, and to really evolve the culture, is what we, in the center of this circle call, relationship centered care. And there are six critical skills that are important to pull levers necessary to evolve the culture.

Those skills include presence.

Listening, how we gather information, and then how do we jointly set an agenda with patients and or colleagues?

How do we recognize emotion and connect to individuals meaningfully, to create trust, and then how do we actually spread appreciation and gratitude throughout our workday?

Next slide.

There are the six skills in the center when we pull these levers and really provide skills for our team members to execute these different levers, we find we, we create an enhanced emotional intelligence. Our teamwork scores are improved.

Depressive symptoms decrease and we reconnect to purpose, We have metrics actually demonstrating all of this as we engage organizations in and this work.

Next slide, an expert, please. It also helps us to connect with patients to really close the gaps from that first slide that I showed in terms of what the patients really want.

And it connects with our team feeling appreciated, feeling heard, feeling communicated with, and it helps us deliver patient centered care.

The next thing is it proves our resiliency, our ability to bounce back, even though there are things we can't control, that's our day in medicine.

Our efficiency, our outcomes and safety, all of these objectively improve when we truly execute these skills.

And last lastly, we have demonstrated our ability to in increase our empathy capacity and improve engagement and deliver an environment that breeds trust.

So, next slide.

The structure of the way we do this, we, we, we really leverage our, our, our own peers, our own colleagues, facilitating this work for their colleagues.

It's really important to decrease the, one of the barriers to learning.

We make certain that we, when we introduce a skill, everybody can practice that skill and apply it to their daily work.

That's the only way that we can truly embed these into our daily workflow.

And we reinforce the skills, it's very interactive and immersive into what a daily, what, what a daily work would look like in a healthcare setting.

And, the skills are listed below.

Next slide.

We take great.

Care to be certain that we address all of these principles, these four principles, on this slide.

Because one of the most disheartening thing is as you go to a session, you hear about something and it feels good for 24 hours, but it isn't sustained.

So we take great care to be certain that the participants can answer very quickly, why should I care, what's in it for me?

We, we use self discovery so people can decide, rather than us tell them what's in it for them, they actually can experience it.

We make certain that there is the opportunity to connect deeper to emotions, How does this impact their day?

And as I already mentioned, practicing the skills is a critical element if we have any hope of sustaining these skills moving forward.

Next slide.

And Jennifer, just if you could share your thoughts on, why does this work, because there has been other work that's been done over the years, that's been hard to stick. Why? Why do you think that this work, and this approach to evolving culture, can actually be successful?

I'd love to share, kind of my thoughts on that. And what I've seen over my five years of working around the country closely with this work is that this is really designed by clinicians, for clinicians. And I think it's really critical that, you know, it's, it's delivered by colleagues who walk in the shoes of, you know, people that do the work on a daily basis. And we also have the model of a train the trainer program, so that this work is delivered in the institution by people that work in the institution.

And so, it's, it's really important that that the people that are practicing and learning the skills are learning from people that work beside them. And I think that's, that's critical. And by this, this opportunity works for them. Also, that the clinicians have the opportunity to bring their own situations to practice with, and, therefore, they're able to then go back that afternoon and practice with something that's applicable to them.

And that everybody gets a chance to practice, like you said, mentioned earlier, it's one thing to listen, but it's another thing: to actually have the opportunity to practice in a safe environment.

Um, we also, you know, really want to address the gaps in creating that optimal experience that we've heard from patients and families, and fellow caregivers over the past 20 years. And, so, keep bringing those forward, and keep finding ways to address those gaps. We also have fun ways of engaging, and providing an educational experience.

Continually addressing what's in it for me, to the people are engaged, and can bring back the learning, and make it sustainable.

Then forming relationships across departments. So often, education and training are done within the same department, and this is really important that people are able to meet colleagues from across departments, and not just through the electronic health record, or e-mail.

Um, so, then, you might ask, so how do we support and sustain this, improve and scale it across large organizations.

We like to call it a slow IV infusion, so that's where we go in and, you know, work with it, with a group of people and then train them to can do the continuous training of a year's culture to culture. Work, is not a quick fix, and it takes a few years to really see that change happen.

Um, the skills, like we talked about, are useful immediately. They can go back that afternoon and practice, practice the skills, and we talk about those as accessing those tiny engines of how to positive emotions.

We do, as, as, doctor maples and I, work with organizations on a quarterly basis and review their work.

Course evaluations, we work with the organizational metrics, Provide insights into key metrics from across the country, and share ideas that we received from other organizations. We do go back about nine months after we do a refresher session, and Observe and Coach. We have electronic support via videos and mini modules. And then we do hold regional events to engage the site faculty there with Advanced Curricular.

So leaves, been able to really help sustain and launch an improvement scale across organizations around the country to help improve and enhance the work.

So doctor maples, I will send it off to you to talk about the outcomes.

Yeah, so in a few minutes, I just would like to highlight some of the outcome, as many of you may or may be, asking, you, know, really, what sorts of things can I expect if we engage in this work?

And to start with, many of you may be saying, this may not pertain to me, are practices to smaller practices too large, are at our practices academic network community in our military government?

Bottom line is that when executed in a thoughtful way that engages the team, this has worked in every single setting that that we have had the privilege of partnering with health care organizations, as you can see.

Next slide.

So, I just wanted to share some results in a couple of different buckets.

First of all, from the eyes of the patient, what, what, how did the, how the patients really responded to, to this, and organizations that have launched this work, you can see here. This is H CAHPS from a Michigan hospital. Prior to the left side of all of these curves, there was a typical, we did everything, we did, every evidence based medicine, and we can't move the curve.

You can see here, communication with nurses, communication with physicians, and the overall global rating all significantly move in a positive direction as the organization was launching this work. Next slide.

When we look at grievances, this is this grievances that actually come from patients and colleagues, and this I look as sort of a surrogate, to really, what is the climate and the environment like.

Because if we really create that optimal experience, there should not be a need for most grievances from, from wherever they are coming from.

So we look at the pattern of grievances. Next slide.

This is from the Washington, DC Community Hospital.

The red arrow is where they launched this program.

And you can see that about the grievances decreased by about 60% after they launched the program.

And every organization where we measured had the opportunity to measure grievances. This is the exact pattern that we've seen across the board.

This translates to, for this particular hospital, they did a cost analysis to about a million dollars in savings just on their decrease in grievances. And that's a conservative estimate.

Next slide.

When you look at various quality and safety metrics, next slide, you can see a couple things here. This is the culture of Safety, the AHRQ Culture of Safety, in a North Carolina hospital.

The dark blue is when the this organization began this work, the light blue is one year after, and you can see, for the most part, in every domain, this organization was in the lowest 10th percentile.

After year one, they were in the 25th, 50th plus percentile. Work, not done, but clearly, you can see the evolution of the one true metric that measures culture, which is the Culture of Safety Survey. Next slide.

When we look at engagement and well-being, engagement is always a challenge. You here are, how can I get my positions engaged? How can I get my team engaged in this work?

This is a Maryland hospital, and you can see the arrows related to pick where they launched a program.

Their overall engagement score was was rising before the work, but continued to rise.

But look, and look at the open communication throughout all levels of the organization, a significant change that was sustained over over a period of time, after launching the work.

This open communication throughout all levels of the organization, is key for safety, psychological safety, in particular. Next slide.

When we look at the ability to increase empathy, you can see this is the Michigan Hospital again, the green bar is where the organization started whispers right at about the 50th percentile.

three months after launching the program, they were improved to the 75th percentile, and that was sustained for one year that the Navy blue line on the top graph.

So, the ability to actually increase the empathy capacity of our caregiver team has been demonstrated in this work, as well as other studies across the country. Next slide.

When we look at the ability to move from emotional exhaustion, that burnout, and move burnout to lower percentile levels, this is the Indiana Medical Group when we, before we started the work, about 47% of their stack was burnt out and at completion of the work at one year later, that had improved to 11% significantly better. So they started about at the national average and improved and the top decile.

Next slide, then going beyond burnout, but to it ability to recover, when we started, about 77% said they were able to recover that improved at 89%, they started a pretty high level and actually even improve that. Next slide.

And finally, when you look at the ability to move from beyond burnout to that thriving state on the right-hand side of those slides, here, about 82% were thriving when we started, improve to 95% at one year. Again, they started the high functioning level, but even with that, we're able to sustain and improve that, this is all pre pandemic. Next slide.

So, when we think about the approach that Jennifer and I have outlined, we really have talked about ways to evolve the culture.

It takes time, doing, that, create safe environment, and we really focus on embracing the human connection, the human connection to the patient, the human connection to team members.

And we, we particularly focus on creating the connection to those positive emotions.

The inspiration, the gratification, and improving that empathy capacity, to truly drive the culture, to fill in that blank, of what's missing, and all the other great things that you're already organizations have likely attempted to date.

So with that, we'd love to entertain a few questions. And if there are any additional questions you have, we're always available to take a deeper dive with you.

And tastic, doctor William maples and Jennifer ..., what a great reveal of the importance of building A culture, like, you have describe of human, real human connections. Now, one can easily claim that this is true for all industries, not just health care. And I think healthcare is having especially covert, is having a very intense period of burnout.

And the one of the themes that has emerged in the questions has to do, with, How do you even get this conversation started in a time where everybody's going around so burnout, and they don't have time for anything? I mean, how curious about what are some of maybe hooks you can do to to get people's attention missed? So much change and disruption, that's happening right now.

Jennifer, you want to start?

But I think, you know, I think, one, acknowledging that, first off, this is a first step. That one, we're going home with that bad tired, and we'd really like to go home with a good tired.

And so, having the conversation at the leadership level about, how are we operating? How are we functioning? And do we need to take a pause to understand that a little bit more? And that would be the first 2 to 1, acknowledging that, that we do need that pause. And then second step is, how might we, as a leadership team, model that change, and then how do we, how do we ask for help, and how do we get help? so doctor ..., what else would you offer to that? You know, in addition to that, Jennifer, I think the almost every single organization is aware of the problem of burnout.

Leaders will talk about, yes.

It's something that we really have to address, but there is something that's getting in the way of actually, um, moving from talking about it to actually doing something meaningful about it. And a lot of times there's a, there's a lack of belief that there's any hard science around it. There is. So, sometimes sharing that is helpful.

And then there is talk among leaders, healthcare leaders, about the return on investment to this work.

It's no longer saw the return on investment.

In a very conservative way, it can be shown to be 2 to 1.

And it's probably more, like, 5 to 1.

And to really get leaders to understand that it has been a bit of a challenge, but, I think, spending a little bit of time there. Joe's AT your question is probably valuable, and helping an organization move forward.

That's very helpful.

one of the transformation lessons that we have heard that we have learned cross industry is that transformations are hard, because people and organizations resist what they most need to change.

So, on that respect, I'm curious about your perspective, as you look at the, kind of, the cultural formation of healthcare. Any, specifically, with doctors. It seems to me that doctors have build a culture over time of resilience that is associated with a badge of honor off. I don't burn out. Meaning that, you know, I go for med school, and I'm like, work in this crazy hours, I go for residents. I barely sleep. And people start wearing that as a badge of honor. And this seems to be straight against the grain of that culture. That was still over a long period of time, even during their formation. Curious if there is an outreach that goes all the way back to universities and how we match school is done with a program like this? Or maybe not, does it make sense to go earlier in the process with with this concepts?

Absolutely. And I think one of the that's a great question, Josie.

I mean, we, there is sort of this artificial, we don't are now, but I think there is becoming a reality that that's not the case anymore.

And, and really, individuals really, really want to have skills to really prevent that burnout and move to the thriving.

And then to your question about moving an earlier, It shouldn't be moved early, but with one caveat, it can't just be done early.

Because when, when those positions and training our nurses and trying to enter into the workforce, if we don't change the environment that is so ingrained in our senior positions and our senior nurses, all of the work that's done with those in the early formation years can get completely extinguished. So we have to work at both, both of those environments simultaneously.

Thank you. That's an excellent perspective.

So if you're if you're, if you're starting you, let's say you're on a healthcare organization right now, there's a lot of burnout going on.

And the, and I have a vision, and I'll put this as, in the role as a leader, let's assume that I have a, I am a leader with some leverage in this organization, that I can implement certain things.

Um, what is the best way of, that you have found to influence those leaders? that may or may not be, again, initially, they don't know what they don't know, They're not sure if this is even an issue. How do, how have you, while you have found to be the best ratio influencing specifically healthcare leaders? You've talked a little bit about Roy, which is a language that several of them will talk. Is there anything else beyond Roy? and then that? and really, the question that I see from the front of the audience questions is about a bit of a hook, how do you even get a hook with certain leaders to start having these conversations with them?

Any practical suggestions on that?

Jennifer, you want to start with any thoughts?

I think it's a really good question, and I see a lot of leaders struggling with, What is the hook? A lot of organizations may come to us with, we've had a patient safety event, or H CAHPS scores are low, or burnout's an issue. You know, sometimes there's something that's happening in that organization. Where there's a desire, a need, or, as maybe some of the audience is Sterling with, we're not sure what that, what that hope kids are. What that need is. And I think, looking across your employee engagement, your patient experience scores. You know, what are those key metrics?

Because our work touches all of the key metrics, quality, safety experience grievances, Some, everything that doctor maples went through on the presentation are kind of touches all of those metrics and enhances where you're at with with those experiences, Because cultures is everything. So this work doesn't live in just one department in an organization that lives across all the departments. And so I think some organizations get stuck with this work, maybe belongs. in one organization, one department there for that. one. Leader needs to fair as possible. So, that might be one way, is getting a group of leaders together, to talk about how might we evolve this culture in a different different way than we're used to, because we're not getting the results that we've always wanted.

So, that might be one way to look at it differently.

The other thing that we've learned is that we're always focusing on the negative, on the deficits of our team, and on the results of other surveys that we've taken over and over again. So how might we change the focus to really look at how can we get our culture to the state of Maine and what does that look like in that. If we're changing the question. We're asking perhaps that's the hook.

Oh no, no, doctor Nicholas if you have anything else you want to, I think those are really great, and I haven't been on several leaders, healthcare leadership teams.

It's really not uncommon if you look at surveys that really what what health care leaders really would put on their priorities, almost always they have, we need to work on our culture, so.

So simply asking the question, what is it that you really want to achieve by working on your culture?

Will actually create the answer to what the hook should be for that organization. And those questions can be done internally by the team members asking Matt.

And that will help say, Oh, it's engagement. Oh, wait, No, it's patient experience on a wait.

No, it's, it's, it's our staff turnover and it will absolutely drive what the should be unaware. That focus should be for that particular organization.

And if an organization is having trouble actually answering that question, why is it that we want to work on culture?

or finding our real, you know, the one thing we want to work on.

Sometimes when we start our work, we do what we call an assessment. It's usually a day or two.

To really help that organization answer that question, what is it that's missing for you, what is it that you want to work on.

And then you can focus from there on that, That's the hook, that, that you can evolve the conversation and say, This is how this will work and, and move forward.

That is fantastic. Jennifer ..., doctor William April's thank you so much for sharing this incredible journey of cultural transformation. I mean, the The results and impact are tremendous. And we're so grateful for you to share that with our global audience today and we will keep following your journey and in this very again, or fly omission.

Thanks so much.

Thank you for the opportunity.

Thank you, Diana.

Ladies and Gentlemen, that was the Institute for Healthcare Excellence leadership, discussing the components of culture for a thriving healthcare organization. And the wonderful reveal, and insights and data they have shared with us on a mission, a very worthwhile mission that, that will definitely keep, keep falling, falling up on. We are going to take a break now, and we are going to continue the discussion on the healthcare industry, with a focus on.

culture and innovation. Next, we are going to bring Dave ..., who is the global vice-president for the Joint Commission International for Transforming Healthcare. And he's going to discuss the development and promotion of a culture of innovation in healthcare. So, you do not want to miss that last session for today, and we will have that directly with Dave Q at the top of the hour. Thank you.