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UTAH STATE UNIVERSITY – CASEY JUDD

EHDI 2019 – TOPICAL SESSION 4 & 5 – INTERNATIONAL F
MARCH 4, 2018
2:45 P.M. ET

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>> SPEAKER:  Thank you.  So, welcome.  This session I'd like to have is very informal.  I'd like to have it be a dialogue.  The leadership would like us to use microphones.  I think they're recording some of this, and there's some remote texting, or, um, scripting, so, um, I've got one microphone that works, there's another one up here, so for questions, I hope it doesn't intimidate you, but I will bring the microphone for you to use when you have a comment or question.  Allison will help in the facilitation and coordination.  One way we could start is to see if there are any reactions or reflections or comments or questions you had from the, um, morning plenary.  I did put up one slide as just a reminder of the five tactics that I briefly shared with you, so if there's one of those, commensality or job crafting to the five leader behaviors you want to learn a little bit more about or, um, reflect or share some experiences or thoughts with the group, that would be great.  This session would work best if it's all teach, all learn, and it works worse if you just listen to me for 60 minutes.  I already see a hand, which is wonderful.  It would be nice for the group, if you would introduce yourself with the, you know, your name and title and location or something, and then make a comment or a question.  That would be great.
>> SPEAKER:  I'll be the guinea pig.  I'm with the Centers for Disease Control and Prevention.  I'm a health scientist, but I was originally an EHDI coordinator and clinical audiologist.  So, I worked in a hospital for a long time.  Anyway, so, um, what I'm going to actually ask you is, maybe, you can expand or even clarify.  Um, I loved your presentation this morning, and one thought that I keep thinking about is self‑awareness, because, you know, there's always, you know, how your perceive yourself versus how other people perceive yourselves.  Sometimes, you may not be the best judge of your own approach.  You know, like, take, for example, some people might say that, oh, I'm very culturally competent, but other people might say, no, you have a long way to go kind of thing.  So, how does self‑awareness of, like, say, a manager, particularly in a powerful, in that power situation, authority situation, how does that play along in that dynamic?  Because if they have greater self‑awareness, I believe those five could be an easy approach, right?  What about if you don't have that self‑awareness?  Can you kind of elaborate that particular point for me?
>> SPEAKER:  That's a really great question.  So, there are two thoughts.  One, I'll share with you about the leader index, and the other is about emotional intelligence.  So, your basic premise, I think, is exactly right, is if the, anyone, but particularly leader, is not aware of his or her relationships and impact and how, what kind of power distance index they create, so the reasons, you know, a generation ago, we crashed so many commercial airlines was because the power distance index between the pilot, the captain, and the first officer and the navigator and the ground crew was so steep that people were uncomfortable speaking up, so there wasn't psychological safety, because the captain wasn't aware that he or she was creating that kind of environment, and in healthcare, um, all aspects of it, if we don't have psychological safety, um, members of the care team, in all spectrums, if they're not comfortable speaking up, if they see a patient about to be harmed, that patient is at higher risk for being harmed.  
So, I talk about leader index and emotional intelligence.  So, emotional intelligence is related to self‑awareness, and if you have emotionally intelligent leaders of your team or unit or department or division or, um, however you divide up your work life, higher levels of emotional intelligence on the team members protects against burnout.  It increases in engagement in joy and work.  It also increases the safety, because people are more comfortable in hand‑offs and communication and speaking up.  So, one of my careers at Mayo, Mayo is physician‑led, we partner full‑time with, the physicians are practicing, we partner with full‑time administrators and engineers and so on.  Um, one of my eight‑year terms, where we rotate, was head of leadership development, so Mayo has 65,000 staff, we have 4400 physicians and scientists, and we had 242 physicians in titled, formal roles.  Every physician that we hired, and there's a three‑year period from the first day that they joined our staff to three years before they were permanent, included onboarding for communication skills, Mayo sees patients from 152 different countries, all 50 states, they need to understand different cultural differences, different religions, different, um, orientations, so communication skills, professional skills, were, we spent a couple dozen hours on each of those, and at the end of the first year, every physician who we were about to make a formal commitment to underwent an emotional intelligence assessment.  At the end of the second year, every physician underwent a 360, so they would get feedback from nurses, administrators, students, other doctors, to understand, to be more self‑aware, to get that feedback.  
The emotional intelligence assessment was not a pass/fail, but it was a chance for them to see their score and to reflect on what that meant for them as a team member, and if they were low on that, they should come to the understanding that the coaching and the discussion groups that we had for all of them, that they would not be as good of a physician for their patients and a team member, and eventually, at the end of the third year, we came to a mutual understanding that they were, could be a great fit or they wouldn't be a great fit based on their 360, based on emotional intelligence assessments, all sorts of things.  So, the self‑awareness you talk about is so very important that we've institutionalized it, so we measure it formally before we make a commitment to a team leader, like a physician, that has huge, um, you know, risk, upside and downside, for the welfare of patients.  The second part of the self‑awareness is this leader index.  So, um, when I was head of leadership development, we started with physicians, and then we scaled it to all 3300. of care leaders; nursing leaders, audiologists, sociologists, social workers, and accountants, every supervisor or manager or leader was assessed.  So, every year, we serve a all 65,000 colleagues at Mayo, and the answer, a dozen questions about five behaviors of their boss.  We don't use the term boss, of whoever is the leader of the group, and those five behaviors tracked, like I said this morning, with, um, much better outcomes of staff morale, teamwork, camaraderie, engagement, lower rates of turnover, um, and the five behaviors are very simple.  
We can get you, at the end, all the slides from this morning will be available, and at the end, or all the references, and, so, everything that I shared with you is published and peer‑reviewed literature, including the leader index, so the five behaviors relate to self‑awareness, and they're, because the, this is the feedback from all the people that are on my team, and, so, if I wasn't aware that I was being, wasn't communicating transparently or wasn't being appreciative or wasn't interested in their ideas or in their career or wasn't inclusive of everyone on the team, then I would get that information from that survey, and, um, and would help with self‑awareness, and most people, including most doctors and our staff, were surprised, if they didn't get the score that they wanted, because that's a sign that they weren't self‑aware, and the vast majority of them wanted to get better and could get better.  There were a few that either didn't want to get better or weren't capable of getting better, so we moved them out of the leadership position, because they were hurting patients, because the staff morale was lower.  So, those are two formal ways that we tried to get at, um, self‑awareness of leaders, and we spent a lot of time and energy doing it, because it mattered for the performance of the team, the joy of the team, that absolutely relates to outcome, safety, experience, and cost for patients.  Burned‑out physicians order a bunch more tasks, they make more errors; so do the nurses.
>> SPEAKER:  Hi.  My name is Allison.  I have a follow‑up question to Winnie's.  So, I can see the benefit of using the leader index and the emotional intelligence assessment.  We just got to talking a lot about control in situations, right, and you were coming from a place where you had some sort of administrative, higher‑up control over working with the leaders to get them to take these assessments.  I would venture to guess that a lot of these people, the people in this room wouldn't necessarily have the control.  Like, I would like to go to my boss and say here's this self‑assessment to see how aware you are.
(Laughing.)
>> SPEAKER:  But I'm just wondering, like, for people that aren't in that position, what approach, I mean, how could we, maybe, identify some pieces of self‑awareness from the positions that we're in?
>> SPEAKER:  Well, voodoo dolls work real well.
(Laughing.)
>> SPEAKER:  So, I think, um, so, the extreme end of the spectrum is you measure it and manage to it, and you have to have a lot of infrastructure and intent to do that, and you're right, that's either not within the bandwidth or interest or capability of a lot of organizations, particularly smaller ones.  So, um, these behaviors, um, are not rocket science, right, and they're basically things we all learn in kindergarten, right, from mom and dad and whatever.  So, it's a cultural element, and culture is a collection of behaviors, and you change culture one behavior at a time.  So, if the person, the head of your organization models those behaviors and is interested in your career and appreciates you and so on, then you see that that works to bring you joy in work and want to perform and succeed for the team and for your leader, that you do those as well.  So, even without formally measuring and racking and stacking, you can model those behaviors, you can talk about those behaviors, you can have workshops where people reflect on, well, what is it that I really like about, what would be the most effective way to be a leader at this organization, and I think it would come down to a lot of those, you know, same five behaviors, and I'm not sure I got exactly what you were asking about, Allison.
>> SPEAKER:  Oh, I think that gives us a little bit more of an idea.  I guess I'm, like, I like the example piece, so maybe bringing it up as, like, a conversation and in general terms and almost, maybe, hypothetically presenting a situation and trying to open the discussion that way, but, yeah, we're good.
>> SPEAKER:  And, so, each of us could go back and ask ourselves about those five behaviors, and is there one that we could do a little bit better, and then, um, and if you're doing them perfectly, great, then you're an example, so when you move to a higher position or another position or retire, you've left this legacy of those behaviors, that your colleagues said he was a wonderful leader, and she was so good, I want to be like that person who's my role model.  So, if you look at leadership development, um, it's a 70/20/10 combination that Lombardo's work from a generation ago, basically, 70 percent of leadership development is actually being in a leadership position and doing the real work and then learning from that.  20 percent is what you get from role models and coaches and examples in your life, on television, government, not in government, in your work life, that those leaders are people that I admire, they're charismatic, they're inspirational, only 10 percent is going to a course and doing your MBA and whatever.  So, most of it is role models, coaches and, you know, being a leader yourself, and that's where you can be, um, a wonderful developer of other people on your team, by living, you know, having the video match the audio, that what you say and do sync up, and that speaks to your authenticity.  So, other questions about, um, joy in work or esprit de corps?  Professional burnout?
>> SPEAKER:  Let me think about how to ask this question.  Oh, I'm Nicole.  I am, I'm an EHDI coordinator, and I work in the state health department, and I know there's bureaucracy everywhere, but, yes, there is bureaucracy in state government, and, so, I'm, as, um, as a manager, a team lead, um, I'm wondering how to, um, help my team become innovative and take chances in an environment where that is not, um, easy to do, where, um, from, you know, I've filled out my share of naughty forms, and the culture is of that where you, it teaches you not to try new things, right?  Like, you don't want to go outside the lines, because you're going to get in trouble, or you got the contract in place after somebody started work, you know, things like that, right?  So, how do you, as a supervisor for a team, how do I help create the culture, at least in our own team, of having people be innovative?
>> SPEAKER:  Thank you.  That's a good question.  So, I think I would start with, um, the spirit of your work, so what's the purpose of what you're doing.  Is it about these young children?  Is it about supporting, so, start with the warm, aspirational, um, statement of what success would look like, what's the purpose of your work and connecting it to, you know, that meaning and purpose, and then I would look at, once you have that vision, what are the outcomes you're looking for.  Not filling out these forms, not this process, um, but the, so, have it be outcomes‑based for your work, and then, as the leader of your team, you go in there, um, listening to understand, even if you think you know the answers, and you probably do, you'll be a much more effective leader if you, um, listen and talk based on the ratio of your ears to your mouth, at least two to one, so you're interested in their ideas, those leader behaviors.  It's participated management, so it's the team looking at, um, how do we get to these outcomes.  If we're not prescribed by certain pathways or policies, but, um, and then, as a team, moving forward, um, not doing it for them, but doing it with them, and all of us live in, I think the vast majority of us live in organizations that have rules and bureaucracies and, um, and overhead, and the best leaders, that never slows them down, so the best teams and people can accomplish wonderful things in spite of the organizational structure or bureaucracy, and others in the same system can step back and learn to be helpless, or choose to be helpless and say, well, we've got all these rules, all this bureaucracy, um, our boss is a, you know, micro‑manager, and then decide that we're going to be a middle manager and just do what we're told, as opposed to saying, um, let's do something really good for these families and children, in spite of the infrastructure, in spite of the bureaucracy, because, you know, you set your outcomes, your goals, and then the team figures out tactics to get there.  
So, you would have to be a really bad boss, and we have some bad bosses out there that would fault you for failing or struggling or stumbling, if your hearts were in the right space and you were doing something for the goals of the organization and the mission and the vision of the organization that wasn't self‑serving.  So, um, you know, the vast majority of places, you wouldn't get in too big a trouble for doing it, if it was the right spirit and the right intent and you had the team together on it.
>> SPEAKER:  I'm Ellen.  I have, um, a question about the, oh, Indianapolis.  Um, the 360, like, surveys or evaluations that you talked about, were those something that were just for, um, like, the leaders or the bosses, or did everyone take them?  And have you seen pros or cons to having, like, an entire staff take, like, an evaluation like that?  Does that make sense?
>> SPEAKER:  So, the question is about the 360s that we did, and I think what we did at Mayo is, um, we did two different kinds of 360s, 1 where, you know, actually, we did three.  So, the leader index is a way to get a 360.  On our annual staff survey, every member, all 65,000 of us answered questions about our immediate direct report leader, and that's part of a 360 that was embedded in the process.  The second type of 360 is where it's a formal, um, you're the leader of a group, and we will formally ask people that work for you, a couple people that you relate to horizontally, the person you report to, of different disciplines, nurses, audiologists, doctors, students, administrators, whatever, and then tabulate it, and, um, and the third, I think is probably the most effective, was a live 360, where we would have someone from our staff, um, visit person‑to‑person, face‑to‑face, with five or six people with whom you worked, and, so, if you're a leader, where, oh, you're from Mayo Clinic?
(Off mic.)
>> SPEAKER:  Yeah, that would be great.  You do that next.  I was just going to pick on you, but, so ‑‑
(Laughing.)
>> SPEAKER:  So, Angie, you're a leader, in fact, you're from the islands, right?  So, what we do is we want to evaluate Angie as a leader, and we would then find three or four people that work with her horizontally, a couple that reported to her, and then whoever she reported to, and someone from our HR staff would then visit with them face‑to‑face, ask them a handful of questions about how Angie interacts with them, respects them, um, her ideas, etc., etc., and then that would be tabulated and then shared with Angie by the person she reports to.  So, it would be, it's a richer way than just checking boxes on a form, you know, it's a little more, um, labor‑intense.  So, we wouldn't do those for all members of the team, they were just people in titled leadership positions, and the spirit is always not to find out who we should fire or replace, the spirit is to make you a better leader, and, so, a lot of people get a little concerned when they hear people talking about leader indices and scoring how you're doing, but if you go in with the intent, um, we're doing this so you can help patients and families better, by having better staff morale.  I didn't even know you were from Mayo, so if you want to ‑‑
>> SPEAKER:  I've been there almost 30 years.  I know, like, what?  Um, so, my name is Lee, and I am an audiologist at Mayo Clinic, and that whole evaluation process has changed a lot over the years.  When I first started, it came from our administrator, and they would collect information, maybe from two or three people, um, that did the same thing that I did and put it together and reviewed it, and we don't do a 360 every year now, we do, maybe, a 360 every couple of years, and we'll ask anybody I work with, so it could be the desk attendants, it could be assistants, it could be, you know, anybody that I work with, and then they all get a chance to review and three things she does well, three things that could be areas for improvement, um, and then that information, it's constructive, it's not anything, you know, unless I did something really dreadful, you know, it's just to help me be better at what I do, so.
>> SPEAKER:  Thank you.  So, we can talk about leadership all you'd like.  The other potential areas, actually, there's no limit, and all of us would love to hear, if you have stories from your organization, um, that have worked or you struggle with for building morale or enjoying work, but the pronoun test, job crafting, commensality is that fancy word for sharing a meal with someone, um, we talked about those five leadership behaviors, the ask, listen, empower is a way to have, um, people on a team identify the pebbles in their shoes and then stratify them about secures for control and then start removing the ones that you can, so it's a wide open conversation about anything related to professional distress or professional burnout or joy in work, if you like that positive language.
>> SPEAKER:  Good afternoon.  My name is Ruth, and I am from Pittsburgh, Pennsylvania, and I'm going to take, since you said anything, I'm going to the other end of the continuum, and the topic is, um, compassion fatigue, because I find that many of our staff care so intensely for the families that they serve that they forget the boundaries, and they're just going to keep going and do whatever, but they tend to lose focus on their role is not the parents' role, and you can't should the parent, you can't tell the parent, the parent has the right to choose, so do you have any advice as to how to, it's such a delicate topic, because they care, you want them to care, but there's that balancing act that has to happen.  Do you have any insights on that?
>> SPEAKER:  Yeah.  Thank you.  So, the question is about, um, compassion fatigue in that space.  So, maybe, one thought would be about, um, self‑compassion, and I'll mention that in a moment.  So, compassion fatigue is one of the, is a major driver of professional distress and professional burnout, and, so, maybe, there are two elements I'll talk about, the affair and just accountability, and the second would be self‑compassion.  So, if you look at the people in this room who went into this profession compared to the general population, we have, in general, we are more resilient and have better, um, self‑care practices as professionals than the general population, with one exception, and this is work that's coming out of Stanford now.  The one exception is self‑compassion.  So, we are less compassionate with ourselves than we would be with colleagues for an adverse event or a challenge with patients or families, and, so, part of that is what you're getting at, we're more prone to distress and burnout from, um, these, you know, from interactions and occurrences and observations with families that create this cognitive dissonance between what the world should be like and what it is like, and, so, um, there are ways you can prove your self‑compassion, you know, mindfulness meditation is actually one that's been proven to do that, and there are others, but we should at least acknowledge that we're not as good as doing that for ourselves as we are for, um, people with whom we work.  
The next thought relates to this, um, engagement, and, so, in general, engagement is a positive attribute of workers, but particularly in healthcare, and in the broad sense, including all the work that you do, engagement, higher levels of it can actually cause professional burnout, because you don't know when to stop, and you care so much about the families and their kids that your work life integration gets messed up, and you overcommit, and this good thing of empathy and caring and compassion for the work you're doing gets you in trouble, because you don't have the boundary of when to stop and shut it off.  The last piece of this, this is something, it would be wonderful to have any of you reflect on or share your thoughts on, um, I'll share one more thought, and then we'll see if someone wants the mic to respond here, is, um, one of the things we have challenges with in the big healthcare/medical care space is fair and just accountability, so we, the vast majority of, um, errors and patient adverse events are related to system issues, not to, um, individuals who didn't study hard enough or work hard enough or pay attention, but our society and our profession tends to treat them in, um, as personal failings, and we tend to treat ourselves, when there's an adverse event that was purely, I'll tell you about a person I know who is from the state of Ohio, he's a pharmacist, name is Eric Crop, and he was involved in the preventable death of a young child, the chemotherapy solution was, um, put together by his assistant and him with a ten‑fold higher saline content than was safe, and the child died.  He and his assistant were competent, conscientious, hard‑working, they followed every protocol, every procedure, they had a good night's sleep the night before, but they were in a system that was flawed, that didn't protect patients from the frailties of human beings, and human beings doing a repetitive task, a hundred times, will make an error one to two times out of a hundred.  
That's as good as we get, and so we need systems and redundancies and checks, but the hospital system and the state legal system in Ohio didn't recognize that this was a systems issue and would happen to any one of us in that same work environment, and they put him in jail and took away his license.  So, that adds to some of this compassion fatigue, where we feel like we're not being treated fairly for the limitations of human beings.  I know a lot of what we're talking about is not adverse events, but that's one aspect of the self‑compassion.  So, I will pause to see if there are any, did you have any response to that or observations yourself?  Because it's a really good question.
>> SPEAKER:  It is just such a delicate balance, because the fact that they care so much is what makes it successful, what makes their work happen, but they also bristle when you say, oh, come on, you know, you have to see this from a longer view, and it's as if their supervisors are not as connected as them, and you just don't know all these details, where the supervisor's in a role where they can give you a longer view, but it's that short sightedness that often takes them a step closer to a failure or a misstep or something that we now have to go into a recovery plan for that, but I just wondered if you had any, and it is just an interesting dilemma we face.
>> SPEAKER:  I am Ann from Pennsylvania.  So, my thought is, sometimes, one person will try to take on the roles that, perhaps, should be shared and have a teaming situation, where you maybe bring in a different person to work with that same family who's supposed to wear the hat, to do what, perhaps, your educator is going above and beyond their job, when, in fact, we could have a team member join in and work together, and one of my team's roles is to teach parents to have capacity to do that which they don't believe that they can, so that would be a good partnership, I think, for a teacher who is going above and beyond their role.
>> SPEAKER:  I'm Allison.  I'm from Colorado, and I work, um, at Children's Hospital Colorado, and there's been a lot of emphasis and focus on two things, resiliency and leadership training, and particularly the leadership training, I've just transitioned into a management role, and I've been really pleasantly surprised, I just want to share just a little bit about what we go through.  It's a year‑long process, and the first 90 days is a leadership assimilation, where we have peer‑to‑peer feedback, as well as team assimilation, so whomever is on your team that reports to you also gives you feedback, and it's the idea that before you get into that daily grind of your day‑to‑day job and you're still fresh and new and excited about what you're doing, you get that information and feedback, um, how they view you as a leader and also a counterpart in that peer‑to‑peer.  So, I've found that process to be very helpful, and that's sort of just speaking to that self‑awareness piece.  The second thing I want to talk about just briefly is we're doing a lot of work surrounding resiliency, particularly there's, you can join, um, this program is called Caritas, and it's the science of caring, and it's big for nursing, and, so, I would encourage people to look at that.  It's Caritas.  Just Google it.  It's a program that really helps you understand the science of self‑care, and the idea is to prevent burnout in health profession fields, and we also have access to other Caritas‑like resiliency tasks, something called heart math and the understanding of just taking a breath when you have that event that really rattles you, but you know you have to go right to your next case or see your next family, and the importance of just releasing all that stress and trauma that's happened and going into your next case.
>> SPEAKER:  Thank you.  So, that reminded me, I think, um, what you're doing there sounds really excellent and effective.  One of the best, um, ways to grow immunity to professional distress is having this social network, and it could be your intact team, or it could be a group that you get together, so the commensality, one of the reasons that's so effective in decreasing burnout and lowering cortisol levels and Reactine levels is there's a small group of people that has a meal together and talks about these things, and it's a safe haven for them.  So, we still need safe havens without stigma of professionals, for counseling and discussions of challenges, but the best one is the one that's, um, of your peers in an established group of one kind or another, and, um, and this whole professional distress piece is, there's a balance of what we need to do for self‑care and what we need to do for all the drivers of burnout.  
So, um, in the healthcare, most of us, before we went into healthcare, had above average emotional health.  All pre‑med students have above average emotional health, and yet within a half a dozen years, the burnout rate is 54 percent of doctors.  So, self‑care is very, very important and has to be part of the balance, but the reason that we, the burnout rates are so high is largely because of the systems issues that we have control over as leaders and organizations, to look at, well, what actually are we doing to cause this to be over twice that of the general population.  Other thoughts or comments?
>> SPEAKER:  My name is Lindsey.  I'm from Indianapolis, and I kind of wanted to go back to the compassion fatigue for just a minute, and I, um, feel like, sometimes, I've seen in our field where people care so much, and they pour so much of their energy and their emotions into dealing and helping these families and their children, and then, maybe, something happens and the families fall short or the outcomes with the kids don't really go as well as they had hoped or what they wanted for these children, so over, like, 20 years of having this happen, they end up a little bit jaded and already kind of predict the trajectory for other children that they see in similar situations like that, where, maybe, someone with not as much experience would assume that the kid is going to end up that way.  Does that make sense?  And I just kind of wonder how, um, to be compassionate towards those people or coworkers or colleagues, when you don't necessarily see something happening the way that they do, because they've had a lot of experience, and they think, they're maybe just a little bit more jaded, because they've been letdown.
>> SPEAKER:  So, I'd love to hear people's thoughts about this.  This is a common situation in the work of our profession and all that you're doing, and what have you done in your organizations or on your teams to address this?
>> SPEAKER:  Hi.  This is Elizabeth.  I'm from Oregon.  Um, this is really specific to early intervention, deaf and hard of hearing, um, and EHDI work, but being that I am a hard of hearing adult, one of the things that I find is that whenever I'm on a team, that team, um, has less of that perspective of the child being limited, because they have a constant reminder of what can be possible, so I would just throw that out as a benefit of having deaf and hard of hearing adults on your staff.
>> SPEAKER:  Excellent.  Thank you.  Any other stories?
>> SPEAKER:  I would just speak to, this is where it's really important, you have to start setting boundaries too.  I think we are all naturally pretty empathetic, and we tend to take on more than we really need to, and we have to be a little bit selfish in that light, and, so, and it's not to say that you certainly wouldn't support your coworker who's starting to have those thoughts or you see that they're jaded, but just the understanding that it's not necessarily your responsibility to pull them along either.  So, I know it's hard to hear that, but for your own protection as well.
>> SPEAKER:  And jadedness and cynicism are part of the syndrome of professional burnout, so it's possible that colleagues who are expressing that, um, those emotions and concerns have distanced themselves and are experiencing some sort of professional distress.  The syndrome is, um, depersonalization, where, um, professionals relate to patients more as objects, or families more as objects than as people, and cynicism, jadedness, emotional exhaustion, are the characteristics of that one piece of personal distress called burnout.  This is great.  About half of the room is at least introverts, so I think we may have broken the glass ceiling, and the extroverts are enabling some of us.  I'm an introvert too.
>> SPEAKER:  I'm Carolyn, I'm an audiologist, and I have an audiologist that works with me, um, that is so empathetic that she believes anything the family tells her, so she will come back with, well, you know, at school, they just kicked the kid out, blah, blah, blah, and I have the ability, since I'm her supervisor, that I can say to her, well, let's try to look at this from another perspective, and let's try to contact the school, because, you know, that may not be the case, or that may not have been what happened at the last audiologist office, but it's difficult, because she cares so deeply, but she will believe anything the family tells her, and trying to manage her behavior, because by the time I know it, she's already reacted to the mom or to the family, and it's difficult, and it's because she cares so much, but finding that balance of don't believe everything you read or see, so it's a challenge, to kind of keep people on task.  I think the best thing for us is that I tend to try to call her on it every time it happens, so that it doesn't build up to this point where, you know, okay, this has happened ten times now, and we need to talk about it.  I don't know, for us, that's the best strategy, to try to hit it head‑on, which is hard sometimes, because, sometimes, it's little stuff.
>> SPEAKER:  Thank you.
>> SPEAKER:  Hi.  I'm Corey.  I work with Nevada Early Intervention Services.  I just had a comment.  I think one of the things that my organization has done, um, a practice they've instituted, which I have found super helpful, is once a month, they have a meeting, and it is for compassion fatigue, it is for emotionally supporting our employees.  We all get together, we case conference about difficult, um, cases, difficult families that people may have, may be experiencing, you know, they offer us support, they try to help us find resources, you know, and some of it's pretty emotional.  We have people coming in because there is abuse in the home, there is, there are all these of these things, and I think that that has really helped combat the tendency that a lot of us have to sort of internalize this and to ruminate on it and to stress about it and not know how to reach out or how to, um, find people to, maybe, help us or give us another perspective.  So, I don't know, I think that's been a super helpful practice in my own organization.
>> SPEAKER:  That really sounds like a best practice.  So, it's not unit or team‑based, it's more organization‑based, where professionals get together and, ahead of time, you know about a case that's going to be presented, then you talk about it?
>> SPEAKER:  Generally speaking, um, if there is a case, I mean, they will sort of present and say, hey, we're going to talk about this, but for the most part, it's not mandatory.  Most of us come, there's just a time setup once a month, and we all go in, and they sort of open the floor, and then the supervisors also bring, um, resources, and they bring in, you know, meditation techniques, or we, they just sort of try to address, um, the whole person, you know, in our profession and the things that we face, I think.
>> SPEAKER:  I like that it's more team‑based and group instead of individual.  I think we need both, but it sounds like a wonderful practice.  The, um, there are many peer support programs, um, that, and maybe you have them at your organizations, some of them, most of those are more individual‑based, when someone is struggling, so at Mayo, we have an Office of Staff Services, and, um, that offers everything from peer support for grief or bad bosses or relationship issues or my kid's on drugs or whatever, and over 80 percent of the staff use that for some of the services, like income tax and finances and so on and scholarships and college funds, and 7 percent of us every year use it for some sort of emotional challenge, from compassion fatigue to some challenge that we're, some interpersonal deal.  That's a stigma‑free place, because the door you go into is the same whether you go into a counselor or whether you're going to a, um, you know, someone dealt with your income taxes, and no one knows, you know, what that conversation is about, and it's, um, it's firewall protected from electronic health records, so it's not discoverable, so it's a very safe haven for those kind of discussions on an individual basis.  What you're describing sounds a little bit like Schwartz rounds, you know, where you talk about adverse events, and there's a community to support and acknowledge, but it sounds like yours is maybe more specific for the profession than that, but the idea is similar, where you're, there's a shared conversation about we're here as a team to support you, because we understand, we've been there.
>> SPEAKER:  My name is Lee.  I'm an audiologist from Mayo, and, um, one of the things that was really, really difficult for me, um, is finding a work‑life balance.  So, most of my colleagues who are my age are, we work differently than my younger colleagues, and I have learned a lot about stopping and taking the time for myself and going to the gym or going home and just spending time with my pet or, you know, whatever, where I wouldn't have done that before, I would have sat and read a journal or, um, you know, I would have done something more work‑related than what the younger kids do, people do, and they, you know, they'll say, okay, my patient, you know, my calendar is finished for the day, and all my reports are wrapped up, I'm going home or doing whatever, and it, you know, at first, I looked kind of down on it, thinking, what?  It's 4:15, how can they walk out the door?  And now, it's like, well, you know, maybe there's something to it, they seem a lot happier.
(Laughing.)
>> SPEAKER:  They've got youth on their side.
>> SPEAKER:  I'm Justin from Wisconsin.  I just was wondering if you could repeat, um, what you said earlier today about what the triad of burnout is, the three words there.
>> SPEAKER:  So, this was originally described back in the 70s by Freudian Berger and then Christina Maslock put together a system for professional burnout, so it's been described and measured for decades, and it's a subset of professional distress, so distress includes compassion fatigue and, um, moral injury and, um, post‑traumatic stress disorder and clinical depression, but professional burnout is a very important piece of that distress area, and the three, um, characteristics are emotional exhaustion, depersonalization, which is, um, so, depersonalization and, um, and that relates to the jadedness and the, um, cynicism.  Those are the two main drivers, and then social isolation.
>> SPEAKER:  Hi.  I'm Megan.  I'm an audiologist, and on the flip‑side of Lee's comment, um, I don't know if this is an advantage or a disadvantage, but for the most part, in my career, um, the oldest immediate colleague I've had has been late 30s, and that same respect of being able to walk away, you know, you mentioned your colleagues who finish up and leave at 4:15 and not being shamed or dissed by management because our stuff was taken care of and we left, so that, too, you know, we don't want to be seen as lazy just because, you know, we barreled through and got it done so we could go home and just be.
>> SPEAKER:  Thank you.
>> SPEAKER:  Just really quick, to add to that work‑life balance, at Children's, we added that to our list of interview questions, so that we can identify team members who do understand the value of work‑life balance, but also let them know that's part of our culture.  So, just something to think about.
>> SPEAKER:  I'm Melissa from Arizona, and this all sounds lovely, sounds like you all work for wonderful organizations.
(Laughing.)
>> SPEAKER:  And I continue to hear you say we're all management, so we have control over this, but I go back to what Allison was saying, what if we don't have control over this?  What if we are that middle management type position, and I feel like I do all this for my team, you know, those who work for and with me, I give them that, I know how to support them, but what if we're not having that support?  How do we support each other or make changes?  Can we? 
>> SPEAKER:  So, I love that you are being the example in your organization by relating to your team or group like you are, so that's, congratulations.  To control the person that you report to or the overall organizational culture, that's a big ask, and, maybe, it's something that you just take a deep breath and say, well, I can't control that.  Sometimes, when leaders that people like you report to see your success and see how you relate, that can be contagious.  Not often, but it can be.  Sometimes, there's a horizontal connection in your organization, where there are people in leadership positions, um, I don't like calling it middle management, um, because you're behaving like a leader, even though you're in the middle of an organization, but there are other leaders in horizontal positions doing similar things that you could connect with, one for commiseration, and it could be your commensality group to your support group, your, you know, that group of, um, close friends at work that help bridge the boundaries that we artificially put between organizations, within them, and that could be helpful for you emotionally, and it could be helpful for them emotionally, and it could be helpful for some mutual learning, and it could be a way that's easier to spread your wonderful practices that are making a difference for your team, um, because the power distance index between you and colleagues doing similar work in the organization should be pretty flat as opposed to your boss, who, or the leader to whom you report who's performing and behaving like a boss, and if things were mutually disrespectful, so if the leader you reported to was doing things that were out of line culturally and, um, disrespectful, well then that shouldn't be tolerated, and then it would be a matter of talking to the person, you know, um, so we shouldn't tolerate that.  If it's just kind of a neglectful, misfit leader who's not doing his or her job, that's a little bit different than where they've crossed the line with some behaviors, but, maybe, I'd explore some of the horizontal connections, and you may have a big influence in improving the culture and spreading your, um, learnings and practices and learning from that, and I think we're getting, we have about 5 minutes left, is that right?  So, um, we have time for several more comments or questions. 
>> SPEAKER:  Hi.  I'm Melena.  I'm a researcher from Colorado.  I had a question, maybe more, a lot of these have been organizational questions, within an organization, but when we talk about EHDI, we're talking about an early intervention agency, um, government people, um, pediatricians, physicians, ENTs, health departments.  We're talking about big systems.  What's your advice beyond our individual agency we work at, um, facilitating, um, ideal work environments across an EHDI system rather than just within an organization?
>> SPEAKER:  That's a really wonderful question.  I'm going to go to the front, just to be respectful of everybody in the room.  I think what I would do, and then I'll, I'm sure someone in the room has a better answer than mine, I would look at who are the stakeholders that you need to have on your multidisciplinary team for you to be successful, and some of them may be in your organization, some may be, um, people you report to, some may be in social services or at the university, so if you look at who is on the dream team for you to do the best possible work for families and children, and then I would look at building those relationships, and I would start not with e‑mails or phone calls, I would start one‑on‑one with those people, and can you build this coalition, can you build relationships across all of these boundaries, and the best way to breakdown boundaries is with a face‑to‑face conversation, looking at something aspirational, the dream that you have for the care that you want to deliver, and, so, you're, that's the theme of boundarylessness.  So, even though some are government, some are private, some are, you know, university, that you say who are the people, who are the stakeholders, let's get them together and, um, see how we can, um, can have this dream come true.  Now, I know a lot of people in this room have worked on this very same challenge, because it's not easy to do.  Any, who has a better answer to that?  Or another answer to that.  Do you work across all those boundaries to get teams working as an orchestra instead of different sections of the symphony? 
>> SPEAKER:  Hi.  This is Allison again.  So, I work with, um, the National Center for Hearing Assessment and Management, and I think, you know, I'm not saying I have an answer, but I know that there's a lot of people trying.  Um, I think, um, awareness of the other agencies that are working toward a common goal is a good first step, and then reaching out, I mean, I even think about, um, we had the state stakeholder meeting this morning, and that's such a great opportunity to identify common goals or themes that you're all working toward.  I know that all state EHDI programs, not always in their Department of Health, but, um, you know, either out of their health department or a university, um, have to, um, you know, have either an advisory committee, or some have both an advisory committee and a learning committee, where they're trying to bring other stakeholders in and do work specifically with one another.  So, it's, that doesn't necessarily mean that it makes it seamless and that you work together as an orchestra, but, um, I mean, you have to start somewhere, and, so, if you, um, what state did you say you're from?
(Off mic.)
>> SPEAKER:  Colorado, okay, and, so, if you do need connection with, um, some other organizations in your state, we'd be happy to help you get connected.
>> SPEAKER:  We'll give you the last word, and then we'll adjourn.  Otherwise, Princess is going to turn off the microphone.
>> SPEAKER:  I'm Cathy from Massachusetts.  A couple of years ago, after the stakeholder meeting happened here, one of the parents that came with us said, well, when do we do this at home?  Now, other states might do this as well, but a couple of years ago, we started having stakeholder meetings within our own state, um, so we do them three times a year, and the director of our EHDI program, Sara Stone, spearheaded this, and, so, one is here every year, and then the other two are in different parts of our state, and the way, it's only happened three times, I think, and what we've done is, each time, it's been held in a different agency, so it's been at one of the schools or one of the hospitals.  All of the same people are invited, and the list goes out to more than the people that were just here, and everybody doesn't get to all of them, but it gives people an opportunity to see where the work is being done in different places, um, and it gives people an opportunity to talk about how, what we're going to do with those learning communities and some of the things that all of the EHDI programs have to do, and it's really been a great opportunity for people to come together, and people have formed smaller work groups out of that, found a lot of, um, mutual interests that they've then partnered with, and, um, it's been, it's really been effective.
>> SPEAKER:  Very cool.  Thank you for sharing that.  I think we are out of time.  I just want to end by, um, thanking you.  I'm in awe with the work you're doing, and in spite of all the barriers and challenges and obstacles, you're doing it extraordinarily well.  I love your passion, and I love your dream, and thank you for the opportunity to spend the day with you.  Appreciate it.
(Applause.) 

This is being provided in a rough-draft format. Communication Access Realtime Translation(CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.