Lifting those around me, I of course have no disclosures, nothing to declare, no confessions, no conflicts of interest. I'd like to, we're here together for a short time, 20 minutes in this talk, and I'd like to be able to give you a little bit of direction of where we'd like to go. Start off with some background, a little bit of introduction, background of my work for context. And then I'd like to be able to look at things chronologically from two perspectives, pre-pandemic, recent past, up to 2019-ish, and then everything thereafter, intra-pandemic, post-pandemic if we think we are post, in fact. But really, these two different timelines. And let's try to look at the definitions and characteristics of our work during these times, as well as some solutions that were brought about for our challenges, and then some traits that our leaders, us as leaders and our leaders embodied during these times. You know, when I started thinking about this talk, lifting those around me, you know, I really thought certain terms came to mind. Burnout. Burnout was really the hot buzzword. And slowly, we said, you know what, let's turn that into something that has a little bit more of a positive slant. So we took burnout and started talking about wellness or well-being. And instead of combating burnout, we started talking about promoting well-being. And as I thought about this, I took a step back and I said, really, what are we trying to address? And another way I thought of looking at it is really morale, trying to address fluctuations in morale. Merriam-Webster defines morale as the mental and emotional condition of an individual or group with regard to the function or task at hand. So I am a PA. I'm the chief PA for advanced practice providers at Emory and Atlanta for the Emory Critical Care Center. A little bit about who we are and how we operate. We have 210 advanced practice providers. This is to include specifically acute care nurse practitioners, ACNPs, and PAs. We have 80 attending physicians, around 230 respiratory therapists, and 1,500 critical care trained nurses. And we do our work across 17 different ICUs across six campuses. These ICUs range from, we have medical ICUs, surgical ICUs, neurocritical care units, cardiac, cardiothoracic, cardiovascular ICUs, coronary care units. And then in some of our community hospitals, we have a mixed bag of come all sick. If you're sick, come to the ICU and we see a little bit of everything from the OR, from the ED, MICU, SICU, you know, all types. So my specific journey with relationship to leadership, I came into Emory in 2009 as a staff PA for the cardiothoracic ICU. My next move was to become a lead APP of a single ICU, a cardiothoracic ICU, which had seven APPs. And then I became the lead of two different ICUs with 14 APPs across the cardiothoracic critical care service line across two hospitals, and then became the chief APP for the entire center. And throughout my time, I thought it would be good to kind of expose some of the leadership roles and responsibilities that I had the pleasure of serving. So I am a manager. I am an educator. I'm also a representative for our APPs locally in the ICU with our nursing colleagues, with our physicians, with the various teams that come and touch the ICU. We're representatives of critical care within the hospital, various medical executive committees, peer review committees, and other places where we want critical care representation. Also have served as a mentor to our young up and coming advanced practice providers, our nurses, our young medical residents and fellows, and even some of our young attendings who are new out of fellowship. And just trying to mentor them into better ways of being able to work in the multidisciplinary team. And of course, the favorite part of my job, I don't think anybody can deny that being a master scheduler is probably the most satisfying role as a leader. And then of course, a colleague. A colleague is probably the most important. I placed it last, but I think it's probably one of the most important things. We never forget that we are actually colleagues with the people that we work with. We're friends, we are co-workers, and we really are team members trying to get the job done. So pre-pandemic, up till about 2019, let's examine and explore what were the characteristics, findings of trying to lift those around me, the bruised morale as it were. And really, we called it burnout, burnout syndrome. Let's talk about some solutions that we came up as leaders, and then let's talk about some of the traits that existed. So burnout syndrome was something that we coined, we identified that this was something that we need to tackle, address, define. And we noted that there were chronicity. Hang on one second. I want to see if I can get this up. Yeah. We noticed that there were a chronicity of symptoms. This is not something that happened overnight. This is something that took time. It came from just a, it was not acute, it was a slow buildup of challenges that we defined as burnout. There was gradual, steady loss of engagement, coupled with feelings of stagnation. Sorry for the heavily worded slide here, but we'll go through it together. So in 2018, we at Emory worked on a burnout project. We did a retrospective, prospective, comparative study, which examined the response rates to two burnout surveys. And what's interesting about this particular project is that we specifically were intentional in being multidisciplinary in our approach. So we worked, we surveyed the MDs, the advanced practice providers, RNs, respiratory therapists, pharmacy, as well as social work staff. And this was done across 12 ICUs, across three hospitals at Emory. Little bit of the detail, data was extracted from two surveys, the Mass Lack Burnout Inventory Survey, which measured an individual's frequency of feeling emotional exhaustion, depersonalization, and personal accomplishment. And then our collective group, the data was then compared to a general population of over 11,000 healthcare workers. This is not, this was not specific to critical care, but to 11,000 healthcare workers in total. The second survey was the Areas of Work Life Survey, and this focused on an individual's perceptions, as well as measured the impact of workload, control, reward, community, fairness, and values in an organization. And then that data was then compared to a population of approximately 20,000 healthcare workers around the United States. And the conclusions were that, although burnout is ubiquitous in most critical care environments, factors are not generalizable to all critical care providers. Different professions experience burnout at different rates for different reasons. Burnout is lower in providers with a stronger sense of community, fairness, and value. So we found this out, and we said, okay, what do we do next? We have the data, we've learned that people suffer from burnout in different ways, different professions, different amounts, and different degrees. What can we do about it? What are the solutions that we're going to work on? So our solutions were individual and personal. We tried to identify, we got together locally within units. We encouraged folks to say, you know, come together. Who are you concerned about? Who is, okay, if we know that this profession is experiencing burnout more than others, let's talk to people, let's identify folks, and let's talk about, first of all, who's undergoing burnout, and what can we do about it? So then we tried to do some very personalized local changes. Let's change a shift. If you're working nights, maybe you need to come off nights for a bit. If you're working weekends, why don't we bring you to weekdays? Let's change the location. You know, if you're going to one hospital, why don't we try another hospital to try to change your environment? New faces, new colleagues, new patient population. Pathophysiology. If you want, if you are working in a, this is, for example, if you're working in a cardiothoracic ICU for the last X number of years, why don't we mix it up a little bit? Why don't you try the medical ICU? Why don't you try neurocritical care? Just to offer some sort of variety to try to combat whatever specific stresses are existing in a particular situation. And it was all geared toward changing an environment and hopefully trying to encourage some sort of evolution of change. From a departmental, local point of view, food. Who doesn't love food? I don't think anybody has refused a donut. You know, coffee, pizza, bagels. Somebody, we even had leadership, senior leadership, coming through the ICUs with fruit because it's healthy. Fruit and granola bars. And it gave people a chance to, I mean, again, who doesn't love food, right? And that became something that, you know, perceptions and optics, we saw leaders coming through the units. Pet therapy. I must confess, I am a first time new pet owner. Gosh, I love this. And this was right about the same time, I'm one of those, you know, COVID pet puppy people. And this was in tandem during that time. And it was amazing. Now, I'm talking about pet therapy for staff, not just for patients, but for staff. And we brought this in and we actually saw, it elicited tears of joy from staff. I've seen that myself. So we started getting, you know, kind of inventive about what are some of the solutions, pet therapy, food, social gatherings, happy hours, brunches, breakfasts, lunches. Not in the unit, obviously outside, on campus, off campus. Bringing people together to be able to talk about everything they were going through. It was a potpourri, it was a variety of options where people could say, listen, we see that the leaders are identifying burnout and they're creating potential venues for us to be able to come together and talk about how we're feeling and ask about how someone else is feeling. It was a team approach. It wasn't just, you know, in addition to leadership, it was local ICU leader teams, you know, infusing this as a part of the conversation, the weekly, the monthly conversation. Okay, how are we doing on burnout? Who are we talking about? How are we identifying things? How are we identifying, how is pet therapy going? You know, when are we doing the next, you know, donut run? We identified ICU burnout champions. This was kind of a volunteer thing, people who wanted to get involved from any profession, nurses, MDs, APPs, physical therapists, RTs, any and all who came to the ICU. If somebody had an interest in saying, you know what, either I have an interest, I have a proclivity, I have an experience and I want to get involved as an ICU burnout champion, we said, great. Let's try to identify somebody in the unit that has an interest and then highlight them such that people can come and speak to them and engage in whatever type of individual conversation they want to be able to try to tackle it one at a time. Essentially mitigation strategies focused around communication with the team and collaboration across the disciplines. This is the general health of the entire team. This is now no longer a nursing thing or an APP thing or an MD thing. This is burnout, it's ubiquitous, it's everywhere and we need to be able to find strategies to mitigate. So what were some of the traits of us as leaders and our leaders during the pre-pandemic time again? Empathy. I had an attending come up to me and said, you know, Vish, I'm not burned out. I don't believe in burnout. Yeah, you celebrate every, you have this week, you have a doctor's week, you have a this week, you have a that week, I don't need a week. I'm not burned out. To which I said, you know what, that's fantastic. I want you to bottle it, put it in a jar and then share it because what I need you to do as a leader is identify that even though you're not burned out, people around you are. And we don't want to come across as saying, I'm not burned out, therefore you shouldn't be. Let us be empathetic. Let's identify the fact that certain people for whatever reasons are suffering whatever they are suffering through. So let's try to be empathetic to what they're going through. So we were very in tune with, because it came down from our leaders. Senior leaders all of a sudden were stopping people in the hallway and saying, hey, how are you doing? What do you think of burnout? We started talking about it as a subject in conversation. How do you think about the burnout thing? How are you going? How are you doing? How are your colleagues? And when we saw this from the top down, this became a talked about subject. Available when available. This is interesting. Critical care is 24 seven and our leaders are often expected to be available all the time. We have leads, we have issues that happen only during the day. No, we have things that happen all the time. But we were encouraged to say, you know what? From eight a.m. to six p.m. feel free to call me whenever. However, respectfully, after six p.m. if you need me, please send me an email unless it is an emergency and then by all means call me. This was different from before. We never really thought about this. Your expectation as a leader was you pick up the phone. But then we started thinking about the health of our leaders and we started saying, you know what? If we're talking about burnout, what about the burnout of our leaders? So then we started introducing some soft parameters, guidelines and ideas about when I'm available, I'm available and I'm engaged. I'm communicative and I'm collaborative and I'm held accountable. You need something from me, I'm on it. And then what happened? Please forgive the simplicity of some of these findings and characteristics because all of you know this in greater detail than what I'm going to define here. But then the pandemic hit, right? And we all have amazing, intense stories about what the pandemic, how the pandemic affected each one of us. What were the findings? What were the characteristics? What changed? What happened to burnout? What were our solutions for addressing morale? What were our solutions for lifting folks around us? And then what were some of the traits of our leaders? What were some of the traits within us as leaders that were expected or what changed and what didn't change? So again, forgive the simplicity. Obviously, there were differences in magnitude and severity. Everything exploded. There was massive uncertainty of so many things. We didn't know about our own health. We didn't know where we were going. We didn't know about the health of our colleagues, of our bosses, of our patients, of our families. We were dealing with all sorts of uncertainties related to job, livelihood, and life. We all have stories of people who we know that were affected by the pandemic, by the virus. This led to feelings of isolation and loneliness. When we used to talk about these with people, not in the medical field, but close in our communities, we were the ones that were running into the building on fire while everyone else is running away. So there were very few people that we could really commiserate with, talk to. So what does this do to burnout? I mean, burnout is like a, now all of a sudden it becomes a tiny insignificant word compared to what was happening during the pandemic. We felt a loss of control. And we as critical care caregivers, we like control. We like the ability to be able to control the next move. We like an algorithmic approach. Thank you. So some of the solutions, what happened to some of the solutions around pandemic? We needed a quick turnaround. We needed to get things done immediately. And these things were system-wide. They were to be implemented system-wide. They were no longer local. We weren't talking about one person suffering from burnout. We were talking about system-wide implementation. We had to be innovative and inventive in our solutions. I remember a specific time in one hospital with five ICUs where on one night shift, I had a plastic surgery division, sorry, plastic surgery attending, an orthopedic attending, an ED, advanced practice provider, and a nurse anesthetist running four different ICUs with a critical care APP floating between all of them, making sure everything was okay. Crazy. Would have never thought about this in the past. Transparency, we created town halls. These are now, thankfully, once a quarter. We've scaled it down once a month. They were happening once a week. And in these town halls, we were telling people about staffing, resources, we're low on vents, we're low on CRRT. These are things that we were telling folks, sharing with whoever wanted to join. We had 1,500 people join, nurses, APPs, MDs, anyone who touched the ICU are welcome to join the critical care town hall, senior leadership. But we also invited stories. We said, please send us stories about wins, about losses, so we can be real. We're not going to sugarcoat anything. We need to tell people what's actually happening. And this is where we learned about the innovative, putting the baby monitors in the room so that the staff inside the room could talk to the staff outside. The iPads for FaceTime with families, et cetera, et cetera. This is where we were able to spread information that helped get people through. And accountability. Pandemic solutions, we wanted people to know that if you need something done, I'm the person to do it. If I'm not, I'm going to find the person who's gonna do it and going to get it done for you with the quick turnaround that's expected. We reached out past our walls and reached out to mental health professionals. We said, we need help from our experts. We created an office of well-being and wellness, understanding that this is something that really is system-wide. And our collaboration became on a broader scale with not only other professions in critical care, but outside of critical care. Some of the leader traits that we saw, of course, we were still empathic. That continued. But our availability changed. We had no choice. We had to be available 24-7 because we were literally dealing with acute life and death issues. But we got better at task designation. We had to. We had to, unless we, you know, to avoid being too overloaded, we decided to grab our resources and try to make sure that we were able to do that. We grabbed our resources and tried to get things done. And the transparency and the reliability continued. My last slide, this is off the cuff here. Whenever I do these conferences, you know, I will go to the source and I will talk to two people who give me as much clarity and honesty as I can expect. That is my 84-year-old aging Indian mother and my 12-year-old daughter. And they said, hey, what you doing? I said, hey, I'm speaking at a conference. They said, what's the topic? I said, lifting those around me. My daughter laughed and my mom rolled her eyes. I said, listen, this is about COVID. This is about the virus. What do you think? How can we lift those? What's expected from a leader when we do these things? My mom, who is a woman of few words and she's an expert on every topic. And if she's not an expert on every topic, it's not a topic that's important, so it doesn't matter. She's adorable. And I said, mom, how do we lift those around us? And she, of course, her first thing that she said is wear a mask. I said, okay. And then she said, don't talk, do. And again, the simplicity of everything she said, I just, I take it because it's lovely in its own right. And then my daughter, who's 12, who's obviously an expert on everything, she said, don't panic and be the one who motivates. I thought those were adorable words and I promised them I would somehow incorporate that into the talk. So I'll stop there. Again, encourage everyone to be as involved as possible. This is a small group and the more we chat and the more we get to know each other, the more we can get out of the sessions. Thank you so much.

burnout

healthcare field

well-being

COVID-19 pandemic

leadership

innovative solutions