Rebecca Hoffmann: Maine's Emotional Health

And today I'm speaking again with someone who I kind of am beginning to believe. She's a friend. This is Rebecca Hoffman who is the director for the Maine Health Center for Trauma Resilience and Innovation. Last time we discussed things more on the patient and community side regarding innovation and resilience. And today we thought, wow, this is a really important topic. Let's bring you in and talk about clinicians and practitioners and how we help support the whole healthcare ecosystem. So welcome back. Thank you so much. Thanks for having me. So is mean. Obviously this is a huge topic right now. We know that clinicians going into this, and when I say clinicians, I mean people who interact with patients in the healthcare system. So this could be medical doctors, this could be advanced practice practitioners, like nurse practitioners. This could be front end staff, this could be medical assistants. So it's the whole range. But healthcare was never easy. Then we had Covid never really had a chance to kind of process and now we're back into it. And there's a lot of people who are trying to buffer the difficulties right now for a larger society. And that's put clinicians on the front line. Would you say that's true? Absolutely. I think it's put clinicians on the front line in multiple ways in the true sense of the word that they are the frontline of medicine or healthcare, but also they are on the front line of the impact of the stressors of the world and they're the ones soaking that in their position. So they're kind of getting attacked by stress and the burden of that from multiple angles. And I think for me, one of the things that's been really interesting is I've watched this evolution, particularly in the practitioner wellness space where we're talking about, well, let's give you tools to help with your resilience. And we start with things like yoga and meditation and exercise, all of which are wonderful. I love all of those things. And also it's a little bit like putting lipstick on a pig. So how can we actually get to the root of this without dismissing those as being really important for wellbeing for anyone? How do we get to the root of helping people be more resilient? I think that is the most important question because resilience is being able to not only take in what's coming at you but be able to land on the other side in a better place, maybe not in a worse place. And so the problem with this work and this idea of wellbeing and resilience, that is to me the most important thing is that we've always relied on the person to do it. So we call it self-care and I don't like that word. I don't even use it if I don't have to anymore because it is not the responsibility of that person to try to fit in meditation and yoga every day or even once a week because for some people they do not have time for that. It's the responsibility of the organizations that we work for our community to help create the mechanisms for wellbeing. And so that looks like opportunities for whatever works for that person, opportunities throughout the day sort of, I call 'em micro strategies. So the idea that someone may get a break if there's a break in the schedule in the emergency department is not going to work anymore. It's the idea that a human being needs a break to be functioning and healthy and that the organization needs to staff in a way that allows for that. And I know that's really easy to say because staffing is a whole other topic in healthcare and other fields, but it really, it's always fell on the person to fit in time for the manicure or the massage and that's not going to work anymore. The stress and the impact of the job is too great. It has to be built into the fabric of the organization and the job to say that these are vital to the success of our employees and our staff. So we are going to prioritize them and we are going to make those resources and supports available. And we also are going to begin talking about how important it's, so historically the field of healthcare, it was sort of like if you think about the first responder community of like you throw yourself in front of the grenade, you sacrifice yourself and we need to switch the way we look it. So you need to put your oxygen mask on first before you can help others. I mean, we could actually spend an entire session just talking about process on the one side and culture on the other. They're both huge and really important. I think I want to start with this idea of how do you think we got to the place specifically, and I'm going to say specifically physicians because this happens to be the group that I'm most familiar with. How do we get to the place where we decided, let's say physicians, firefighters, paramedics, that somehow we had to be the heroes. We have to be the ones who save the lives, sacrifice everything. And I guess I can broaden this out to nurses do the same thing. I mean law enforcement officers do the same thing. How did we get to the place that we felt as a society that this was an okay thing, that we're going to have the heroes be the interface and that they need to self-sacrifice to an extent where they get burnt out and maybe leave the profession early? I think it starts with image. So when we think back to when we were little kids and we watched medical shows on TV or TVs shows about police officers or we got to know police officers, they seemed, and that's just one example, it's true for healthcare providers. They seem sort of more than human right heroes. And when you think of a superhero, you don't think of that being someone that needs sort of the normal kind of care and support. And so it's this cultural belief as let's say the kid that wants to grow up and be the firefighter, they're thinking potentially like, I'm going to be a hero. And that culture continues to grow into the profession where it historically was almost seen as a weakness to have needs or to need support or a break or any of those things was really connected with weakness. And I think, I'm not a physician, I'm a mental health practitioner, so you can say more about this than I can, but I think historically, and I hope this has changed in medical schools or training for healthcare providers, there wasn't a lot of attention paid to sort of shifting the culture to say that you are not superhuman, you are human and it is expected that this job's going to affect you, it's going to be difficult and because you're a human and we want you to be a human, that's okay. We support that. It was more about how many hours could you work and how many difficult traumas could you see and continue to work. I think about certain scenarios where there's been a horrible loss, let's say in an OR and those staff have to turn right around and do it again. And so there's so much in the culture from childhood TV shows sort of this depiction of the hero right up through the training programs that train you to be tough. And somehow toughness doesn't equate with having needs or emotions or being impacted by the job. One of the things that I know a lot of us felt during Covid and by us, I meant people in healthcare or people who are protecting the public health, let's just say. So anybody that was interfacing as a frontline provider is there was this idea that there was, we were the heroes there, the banging of the pots and there's the posters and people were very grateful and that was all really wonderful. I think it's been especially painful now to come out on the other side where we're just showing up and trying to do our job and we're trying to interface with people who are understandably very stressed out about all the things in the world and very upset about healthcare because healthcare has a lot of problems and I'm not trying to make excuses, but it's been really hard I think to see that transition where we go from being the hero to being worthy of blame. And it also becomes that triangulation sort of the victim hero perpetrator. There's this whole thing that happens and that I think is the bigger they are, the harder they fall sort of idea. So how do we get back to a place where we don't actually want to be the heroes, we want to show up and do our jobs because we don't want to be the heroes on the other side When you've decided we're not the heroes anymore and now we're the villains, how do we move through That? Right. Well I think, and it reminds me very much in a different way, and so not comparing it sort of to say it's the same, but when Vietnam vets came back and they were heroes at war and then came back and people were spitting on them and that was like, wait, that dichotomy and that dissonance is so painful. It's a trauma, it's a traumatic experience. And I think that in medicine, people go into medicine because they want to help people. I mean there's some that go in because for a variety of reasons, they love science, whatever it might be. But a lot of people want to help and that's what they still wanted to do. They want to help. And so I think the first thing that needs to happen is acknowledgement that time during the pandemic was painful for healthcare workers and they were being asked to do more than humanly possible and put their selves at risk and their families at risk. And that's scary and painful and it's okay to have felt that, right? So this acknowledgement that that was really difficult and you deserve to feel badly about that. So I think just given permission to have feelings about that is the first step. And then the second step, which is really hard, and I have to say I haven't figured this out from my own sort of professional role, is that the next thing that always needs to happen after those traumatic experiences is healing. And part of healing from an experience like that has to include rest and recuperation. And so your body can't heal if it's continuously your nervous system's continuously in fight or flight. It's continuously onto the next really stressful thing your nervous system needs to settle. So I think that's why we are seeing healthcare providers that are burning out or leaving the profession completely to do something entirely different or just really struggling is because they haven't had the chance to heal and recuperate. And when you went from the pandemic of working constantly to then having staffing issues because so many people left and people saw how hard it was and maybe didn't want to go into the field, it's left us in a real conundrum of having the need for that recuperation without the need to sort of pause time. And so there are ways that we have to build that into the culture. How do we do that? I think some of the ways to build that into the culture, what I briefly mentioned before is this idea of it's up to not only the individual but the organization to say this is important. Your wellbeing and building your resilience are important and the responsibility of not only the person but to build opportunities for that. So giving permission and supporting the need for providers, let's say to take vacation. And that that's not only okay, but really it is vital to take a break and we are going to do everything we can to support that as an organization to make sure that you take your vacation time. And I know with some organizations we really look at, for example, I look at my staff how much vacation time they have and if theirs is getting too high, I know that they haven't taken a rake and I need to support them and say, listen, you've got to take some time off to care for yourself and to rest because I can see that you've got so much vacation time that you haven't. And so that's one of those, that's just a little example of an organizational way of supporting wellbeing. It's building in those tools during the day. It's having mindful breaks that are two minutes of breathing, not an hour of meditation. It's teaching staff. There's a method that's been used by the swat, used by SWAT teams called box breathing, which probably a lot of people know. And box breathing is a way to really settle your nervous system, which is what's healthy for our bodies and our bodies will go into, again, a fight or flight state and get really comfortable staying in there, but it's really toxic to your heart, your organs to stay in that state. And so we need to remind our bodies to come back into a centered state. And if you picture that physician running from code to the one thing after another, how can their nervous system be settled? And so there's some places where they put those reminders, let's say, of box breathing on the outside of patient rooms and really support their providers in doing that once before they walk into the room with a patient. So before you walk in that room, you get your nervous system a little settled. You'll not only be better for it in terms of your own biology or physiology, but you're also going to interact with that patient in a much more connected way when you are settled. And so that tool, just putting that on the outside of a patient door and reminding a provider to do it before they walk in is a MicroStrategy that can have great impact on the health of those providers. I do like Micro strategies like that. I know that when I see patients, I use strategies like the hand-washing, timeout because everybody has to wash their hands. So I come in and I say hello and I'm washing my hands and I'm just bringing myself back into the moment with that patient or the doorknob touch so that I really put myself in a place of being present. And I think that is so important because if you're not able to put yourself in the place of being present, then that's going to impact every new or ongoing relationship you have with every single person that you interact with over the course of a day. And maybe it's a patient, but maybe it's a medical assistant. And I think this is what sometimes people forget is if you don't bring yourself back to a place of being centered that whether you realize it or not or intend for it to happen or not, it does spill over into your interactions and then that just kind of creates its own set of issues. Absolutely. And I love that idea. I think that's an incredible strategy to use that handwashing as that moment because not only is it something you're going to do each time, but it's also a grounding strategy, touching your hands, you're feeling your body, you're reconnecting your mind to your body. You are feeling the sensation of the water, which is again a grounding. There's so many things about that that are a very incredible suggestion, but it's also something that I think one of the challenges is if we don't make it a practice that we do over and over again, like any behavior, we forget it. So what are those ritualistic? What are those ritualistic things we do throughout the day already that can provide opportunities for a micro strategy? So rather than creating something new, let's say what do we already do? Because the question is always are the common is I don't have time for for that. And it's true, you probably don't have any extra time in your day to add in a walk or whatever it might be, but what are you already doing that you could build in a MicroStrategy? I know one of the things that we talk in mental health care a lot about is what you hold at the end of the day. So what are you holding from that day and bringing home with you and what are the ways that you can leave those experiences at work and sort of shut the door on them so that when you come home to your family or your pets or whatever it might be, you come as a sort of centered, grounded person without the sort of ghosts of the day with you. And so for example, we talk about shutting the door on your office and having that be sort of a ritual of, okay, now I'm shutting the door on my workday and I'm transitioning away from myself as a worker into myself as a parent, spouse, partner, whatever it might be, or utilizing the commute and you're going to do it anyway. So what could you do in that commute to shed the day with the pandemic? Again, that was one of those things when everything kind of turned upside down for some people. So they didn't have commutes anymore, their work was in their home, even many healthcare providers doing telehealth, whatever it might be. And so we had to come up with new micro strategies and tools to do those things, to shed the workday to stop working at 5:00 PM rather than going back in the office and doing more. And so it created a challenge and an opportunity to think of new micro strategies. I think for healthcare, what happened was everything changed and even if you weren't working remotely or you still were commuting, everyone went into sort of response mode, right? No matter where you worked in the hospital, everyone was a responder and that we sort of threw out all the things that we did that were normal or typical in our days. So if we don't take the time now to come up with new micro strategies like the hand-washing one or for those that work in different sorts of setting, finding settings, finding those times that you do things anyway and saying, okay, how can I just add on a tool, quick breathing exercise, a gratitude moment of something I'm grateful for something, some movement, some stretch, something that reminds your body that it's there and that you're caring about it. It's like a moment of self-compassion and self-love, which is really important too. So I think one of the things we can all do now besides sort of organizationally saying how are we going to take care of those that work for us? Each of us can come up with some micro strategies throughout the day that can help resettle our nervous systems and care and take care of ourselves. I agree with all of the things that you just said. And I also know in talking to people who are in healthcare specifically, again physicians, because this just happens to be the group that I'm most familiar with, although I certainly have had a lot of interactions with other professions that it's almost as though, well, we shouldn't need to use those tools because we're the ones taking care of other people. Again, it's this idea that we're somehow more than human. And also this idea that if we show our own vulnerability, if we suggest that we might need to do things that other human beings need to do, then somehow we're not capable of taking care of other people. And there's almost a sense of secrecy around feeling vulnerable within medicine. So I'm working in our organization, as I mentioned to you before, we're trying to set up for the third time a peer support program three times it's taken our organization to enable practitioners to support one another. And the fact that it's taken this much and that even with something in place, it has never been fully utilized. Think to me, that's just a suggestion that I don't think we're actually giving people permission. We don't have the processes perhaps, but they also don't feel the permission to actually utilize things that are available. How do we help people understand that it's really okay to reach out and maybe preferable to reaching out before you actually get to a place of crisis? It's a great question and a great example. I think one of the things, and if folks are ever looking for really good reading about this, Brene Brown is an incredible author as you know about the power of vulnerability and the courage it takes as a leader to be vulnerable and what the impact, the positive impact that has on those that work for you. Because just like children, children are, children are going to do what we do not what we say, and it's true as a leader in an organization too, is that staff are looking to you to see what the standard is, right? What's the standard here? What's the norm? What's okay? And if they see somebody who's superhuman, they're going to think I'm supposed to be superhuman too. So the best and often hardest thing to do is to show your own vulnerability as a leader and for leaders to say, I have done this. I have reached out for support, or I really struggled in the pandemic with let's say stress or sleep and this is what I did about it. And to give permission to staff to be human. As soon as leaders do that, it's going to cascade down. But there's this old model of leadership, as you mentioned, of being superhuman and not being impacted by the trials and tribulations of being a healthcare professional that continue that myth that that's how you're supposed to be. And the quickest way to break that myth down is to show vulnerability and say, it's okay to be human, and I am too, and this is how I've struggled and this is how I've overcome it. And I think leaders aren't necessarily taught that, but it's really the quickest way to shift culture is from the top down that way. And if not, if it doesn't happen, it's going to seep up sort of from the bottom up, right? Staff are going to start struggling, leaving, asking for more because they need it. And leaders can get ahead of that by getting in front of it and saying, it's okay. It's okay. I've done this and it's okay that you need it too, and I'm going to make those resources available. I know for our organization, even the concept of having a chief wellness officer sets the standard that that's important, that your wellness is important and we are going to put someone in the position of overseeing or ensuring that wellness is addressed. I think what you're describing is so absolutely critical, this idea of modeling. And I think you're absolutely right that we still have leaders who end up being lauded essentially for working all the time. And in some ways I think we continue to give them a lot of a claim. We're so glad to have these leaders that literally work all the time. They're always available to us. It's so necessary to our own wellbeing to have somebody who is in that position. We don't necessarily see the long-term impact on those leaders, and then we strive to be those leaders ourselves. So then we're modeling it for the next generation down. One of the things that in the teams that I work with I try to suggest is why don't you aim for a very highly functioning team so that you can trade off so that if somebody's going to be on vacation, somebody else is there. You're not the only person who can do this work, somebody else can do this work if you bring them up to speed. And I think that if we could start looking at things as more of a group endeavor, whether it's the patient is in the middle of their own team, which includes many different people, or whether it's a leader is in the middle of their own leadership team, and that we don't have to be out there hiking the trails all by ourselves, but that also takes a set of skills to try to build a team and to the time and the collaboration and those sorts of things. Are you seeing any shift in in the work that you Do? I think it's such a good point because it's also just to add to it. It can feel threatening to say, oh, someone else can do my job. That feels a little bit, I don't know, somewhere deep inside us as those who thrive for leadership positions. It feels scary to say, oh, I could go on vacation and no one would even know I was gone. Not that that's what we're seeing, but that's sort of the fear that, but I guess I would turn the question back to listeners and to you to say, do you want a leader who you know can call at any moment or do you want a leader who says, I time away is important, rejuvenation is important. I am going to be on vacation and I'm not going to read my email, but this is who you can reach out to and modeling that for you as a staff member or on a leadership team, which one feels better? And I know in my own leadership model, I was always the one that was like, oh, I'll be checking my email or call me if you need anything. And still my staff, I hope, always know that they could always call me no matter where I was if they really needed me, but that there are other supports in place for the sort of day-to-Day things because for you as a leader to be able to completely shut off when you have even a little bit open, like you're checking that email once a day, your body never gets to just reset. And that's really important. It's a really important model for staff. So I think your point about building a team that can share in that responsibility is a model maybe newer to healthcare. I dunno. I was actually in a training all day yesterday on your team and how to create a team that has different talents but can be shared so that there isn't the one lone person doing this, that's the only one that can do it. And then one person that only does this. So in our organization, something happened that I watched recently and it just really stood out to me as a shift. And so our organization does these open door podcasts where leadership is interviewed and answers questions from staff. And so staff can write in or text or chat in questions and leadership will answer them. And it's a really transparent and wonderful way for staff to feel connected to leadership. And the question was about taking care of themselves. And I was so curious to hear how they were going to answer that because it was going to mark a shift in culture to me about, well, I work so hard so my staff can take time off, or whatever it might've been in the past. And the two leaders talked about, one talked, well, I'm taking vacation and I'm shutting my email off. And this was a senior leader who said, I've got team that can do this, and so I will not check email. And the other leader talked about how her own, they started talking about dopamine and the importance of dopamine and dopamine, building opportunities like walking, like laughing, all these things that we know bring us joy in the workplace. And so those were two things to me that were different than historically. One senior leader saying, I take vacation and I shut my email off. And sort of that hidden messages, you all have permission to do this too. And the other saying that they take walks during the day or both of those things were different than they would've been even I think five years ago. And so I felt really happy that there seemed to be a shift in culture of permission to care for themselves and that the organization supported that. I like that sign of hope. Well, it's been really a pleasure to have you back again today, and I hope we will have ongoing conversations on these very important topics because I'd love to, there's many different tentacles There are every time we get together. I know. I feel like there are so many tentacles to this one alone that we could talk about. So it's been great. Thank you so much for having me. Yes, thank you. I've been speaking with Rebecca Hoffman. She is the director for the Maine Health Center for Trauma Resilience and Innovation. Thank you very much for being here today. Thank you so much.