Ep#209 Why Caring Leaders Create Better Outcomes

This Christmas Day episode is a quieter, more reflective conversation about leadership that actually works — especially in high-pressure environments like healthcare.

Dex is joined by Dr Joshua Hartzell, retired US Army Colonel, physician, and author of A Prescription for Caring in Healthcare Leadership.

Josh has spent 25 years in military medicine and leadership training. His message is simple and deeply relevant at this time of year:

Take care of your people. They will take care of the mission.

In this episode, we talk about:

• Why caring leadership is not “soft” — it’s effective
• What military leadership gets right about standards and support
• Burnout as a leadership systems issue, not a personal failure
• Why psychological safety improves outcomes
• How small human interactions create powerful ripple effects

If you’re a leader who genuinely cares — but feels stretched thin — this conversation will meet you where you are.

Resources:
A Prescription for Caring in Healthcare Leadership https://www.amazon.com/dp/B0DSQ4276K
Dr Joshua Hartzell  https://joshuahartzellmd.com/

-----------------------------------  Resources:
Leadership Performance Coaching https://dexrandall.com
LINKEDIN: @coachdexrandall
YOUTUBE: @dexleadercoach

See https://linktr.ee/coachdexrandall for all links

Transcript

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Introduction and Guest Welcome

Dex 0:09

Hi everyone. My name's Dex Randall, and this is the Burnout Recovery Podcast where I teach professionals to recover from burnout and get back to passion and reward at work. Hello my friends. This is Dex, and today I'm delighted to welcome our special guest Josh Hartzell MD, a retired army colonel who spent 25 years in military medicine. He's just written a book: "A Prescription for Caring in Healthcare Leadership, Building a Culture of Compassion and Excellence". And if you've ever listened to me before, you'll know how I love to support doctors who are doing it tough at work. So it should be an interesting session. Dr. Hartzell works now as a speaker, coach, and teacher on leadership development and an internal medicine physician. I discovered him on LinkedIn, because he writes a really standout post and I do tend to gravitate towards anybody who's promoting caring leadership. So I've been looking forward to this topic very much myself today. Hi Josh. How are you today?

Dr Josh Hartzell 1:13

Great, Dex, thanks for having me. I'm definitely looking forward to this discussion and really appreciate the work and your just man positive energy, which I feel like I get from your posts and I can already get from our little discussion before we became live. So looking forward to this.

Dex 1:30

I like to put a bit of warmth on the internet time to time because not everybody does.

Dr Josh Hartzell 1:35

We could use a lot more of it.

Dex 1:36

Especially in healthcare. We'll come to that in a minute. We're recording on the 22nd of December here in Australia, and the show's gonna go out on Christmas day as it happens. So thank you Josh, for showing up a couple of days before Christmas.

Dr Josh Hartzell 1:51

Ah thanks. Yeah, I'm looking forward to, this is actually the start of my Christmas vacation. Today was my last day of work for the next couple weeks. So I'm excited to, have some off time and spend some time with family.

Dex 2:04

Is wonderful to hear. You are the third American I've spoken to today, and the other two are working straight through, because Americans are legendary for not taking enough time off!

Dr Josh Hartzell 2:18

Yes.

Dex 2:20

Oh, you've gotta spend time with your family this time of year, for sure. So anyway, this is the special festive edition. I think we're gonna kick it outta the park. But I do promise not to sing. I'm not gonna sing any carols, I dunno about you.

Dr Josh Hartzell 2:33

I was gonna say, a good Christmas Carol might not be, might not be bad.

Dex 2:38

You haven't heard my singing voice! If that's coming on, you are very welcome to do it.

Josh Hartzell's Career Journey

Dex 2:52

Alright, so I'd like to ask you, I'm sure it's a boring question for you, but it looks like you've had a really interesting career journey. So can you just tell us a little bit how you got into the whole military medicine thing in the first place?

Dr Josh Hartzell 3:06

Sure. Yeah for me, it really started at, I actually, when I was a kid I didn't have a lot of family who was in the military. My dad had served like a couple years in the Air Force and I had a couple uncles who were in the military. But when I was growing up, I really loved history and spent a lot of time reading history books and then also just other military autobiographies or biographies and just was drawn to the topic. I grew up in a really small town in the state of Pennsylvania here in the United States. I graduated with 63 people in my class. Part of joining the military was to, I don't wanna say necessarily get out, I love my hometown, but to go and see more of the world. And, I had the opportunity for, in the United States they were gonna pay for my college 'cause I had gotten a scholarship. And from there I did my four years in college and, during college, decided that I wanted to be a physician. And was able to fortunately apply to the Uniform Services University, which is the United States' Military Medical School. And so I was able to take that military and combine two things that I really loved, which was serving in the military and all the sort of interesting things that was going to bring but also being a physician where. I loved science and my mom had breast cancer when I was in high school and then again in med school. So I definitely was drawn to the medical field from personal reasons. But yeah, I was fortunate to be able to combine both of them into to a career.

Dex 4:48

Sorry to hear about your mom.

Dr Josh Hartzell 4:51

I appreciate it. Thank you. Yeah, that was definitely a impactful part of my life.

Dex 4:59

Yeah, an interesting journey has unfolded from there, though?

Dr Josh Hartzell 5:06

Yeah, definitely. And as I look back at a lot of things that shaped me, certainly my parents, both my mom. It was interesting I just posted today about Walmart because my mom had worked at Walmart when I was growing up. She was a stay at home mom until I think probably when I was maybe late middle school, early high school, and then went to work at Walmart. I would talk to her about all these experiences. Looking back a lot of the lessons she was telling me were leadership lessons about how they were dealing with conflict at work or how they were taking care of a associate who maybe had an illness or somebody had a family problem, and what were they doing to jump in and support that person. And, the older I got, I would find myself leading in a particular way. And I would draw back and be like, oh, those were lessons my mom taught me from Walmart. And then similarly, my dad who had a variety of jobs when I was growing up also was the guy in the neighborhood who was always helping people. I think that part of our roles in life, society, as humans is to help people who need it. Anytime somebody needed something at their house or fixed or whatever, he would be going to do it. And that was just the norm. And we did other service as a family. I remember we used to have this like roadside pickup day. It was like once, maybe once a year, and you would just go pick up trash along the highway and. That was the thing. And I think it was that constant idea of service, which was also probably part of what led me to the military. That idea of, look, you can go and serve others. And then obviously as a physician, it's a very service oriented career as well.

Dex 6:50

Wow, that's a great way to grow up.

Dr Josh Hartzell 6:54

I feel very blessed. And now with two, two kids of my own who are, 15 and 13, how do you instill those values and give them those experiences that help ground them and help them see that life is about service and helping others. Hopefully we all make an impact and make it a little bit better for each other and also for the next generation.

Dex 7:16

Yeah, old-fashioned values that it's hard for many youngsters to even connect with these days because of the internet and so on.

Dr Josh Hartzell 7:26

Yeah. And I think that's partly though, it's, it is true, but that's probably why, you just mentioned spending time with family over the holidays and stuff. That's why these interactions are so critical. Both my kids play sports, so we spend a lot of time with the teams and for me, some of that is just... how do you treat your teammates? How do you show up for practice? All those lessons that then they can hopefully knock on wood will carry into their professional lives as well.

Dex 7:53

That's almost the dead opposite of the way that I grew up unfortunately. I grew up in England and my family, for reasons best known to themselves, were not very outgoing or supportive or connected. I'm slightly envious, when I'm listening to you having that kind of training ground and giving that training ground to your kids is so wonderful to hear.

Dr Josh Hartzell 8:17

Thanks. That's interesting though that you say they weren't outgoing or connected because now you're hosting a podcast and you're connecting to people all around the world through LinkedIn and other venues. It's like, where did that come from?

Dex 8:30

Hard to say really. But I do love people and I find people endlessly fascinating. Lte me just come back to your job. I've got a burning question about the jobs that you've

Challenges in Healthcare Leadership

Dex 8:39

had during your career, the roles that you've had. What was your favorite?

Dr Josh Hartzell 8:45

So hands down, my favorite position was when I was the program director for the Internal Medicine Residency Program at Walter Reed National Military Medical Center. Residency training or postgraduate training, which I think they call it, in other places outside the United States, you know that those years out of medical school. So these are very young, impressionable physicians who are really learning their craft. Medical school, you have general training, but when you get to residency, it's the most impactful part of your career. And it was the job I always wanted. Early in my career, I just I felt how much my program director had meant to me and my peers and others, and, how we all really wanted to, emulate him and be able to have that impact on others. Yeah it was a real honor and privilege to serve in that position for almost five years. Being able to guide not only educational development and professional development as a physician, but also just the broader context of, taking care of a team of people who were there not only to get their training, which obviously was one of their primary roles, but also to take care of patients and to do that, all at the same time. It's a phenomenal role and it's one of those roles I feel like as a leader still, you have a lot of freedom. There's obviously requirements and things you have to do, but there's a lot of ability to build and shape the culture the way that you want. We spent a lot of time focused on creating that environment where people could really learn and feel safe and, also feel challenged so that when they left they felt wow, I got so much out of this residency, or I feel so prepared for the next stage of my career. When I look at what really gives me energy, it's investing in people and helping them develop. When I'm teaching, that's what I get the most joy from. And that role is centered around teaching and leading and helping people develop. So yeah, it was far and away the best job I had.

Dex 10:58

That's interesting. 'cause my favorite job was the one where I had the best leader that I've ever had too. It's huge. The impact's incalculably large. I would agree with you.

Dr Josh Hartzell 11:10

Yeah. And it's also one of the things, I've been thinking about recently, and you may have some insights on this. Sometimes I'll talk to people about some of the leaders I've worked with, and they'll be like, wow, those were like really meaningful. I wish I had that. Sometimes I almost feel like I was blessed with all these great leaders, that showed me what effective leadership could look like. And I don't know that everyone has that and which I think why, like your work and the book, like others who are trying to help people figure out how to lead more effectively, but also lead in a humane way where people aren't driven into the ground and they're not burned out. I think having those types of leaders we're really lucky when we experience them and hopefully more people will have that ability to experience them over time.

Leadership Lessons from Military and Healthcare

Dex 12:02

Yeah, I think a lot of people ascend into leadership without being taught how to lead. That's one of the core problems. They're very competent in a technical capacity, a solo capacity. I've got a team and they all shuffle around under me and do stuff, but you thrust somebody who's been a solo player into leadership and you don't teach them how to do it, it's a disaster.

Dr Josh Hartzell 12:26

Yeah, and it's just different skills, right? I think your point about we're not trained and, I think in medicine we're getting better at this. We're recognizing that we need to train leaders., Just because you're the best researcher, or best physician, or even best clinician, doesn't mean that you're gonna be the most effective leader when you get in that position. And part of that is just, it's not that people don't have good intentions and want to lead effectively. They just, as you said, they haven't been trained. So really thinking holistically about how do we develop leaders from medical school forward, particularly in our field, is important. And, just as important if you're in other fields, there's really no profession or job where leadership doesn't matter, right? Go back to my mom, right? She worked at Walmart. My dad built railroad cars and all of those places need effective leaders.

Dex 13:22

Yeah, and I've met a lot of leaders in healthcare who've been doing it for 20 or 30 years, and still nobody's taught 'em how to do it, and they're halfway drowning, still. And dying do better as well. Really highly motivated to do better, but it's like how? How do I do this?

Dr Josh Hartzell 13:41

Yeah, it's always striking to me. 'Cause I do a fair amount of coaching or leadership development with, different organizations and yeah, we have people who are in pretty, mid-level or senior level positions who have had maybe some training, maybe not, maybe none. Certainly eager to learn. But yeah we definitely need to think about how do we make this routine? So that, 10 years from now, 15 years from now, by the time this generation of leaders becomes at that position. They've had leadership development, their whole careers. We need to make it a longitudinal training approach so that folks are better prepared. And then recognize that no matter where you get on the leadership spectrum, you're always gonna need more. 'cause you have new challenges, new context. We're gonna acquire different skills.

Dex 14:33

Yes, it really hurts to go from being at the pinnacle of your technical profession to be dumped into a leadership where you're floundering. Very painful!

Dr Josh Hartzell 14:43

In some ways, and you probably see this with people you coach too, it's almost like we push people into leadership

Dex 14:50

Yeah.

Dr Josh Hartzell 14:51

And some people maybe don't even want to be there, which is okay. You have to decide, I'm a really good surgeon or I'm a really good researcher. I don't really want to have to deal with all these other things. I just wanna be in the O.R. I just want to do my research. And then you have other people who really want to do those roles. We need more people to embrace that and be effective leaders. And even if you're not gonna be, a quote unquote titled leader, somebody who has a formal position, everybody in healthcare leads. We lead patients at the bare minimum, right? How do we lead patients and their families? For the most part, you're practicing in teams and how do you work with your nurse, your techs, your front desk? All of that requires leadership skills.

Dex 15:36

Yeah. What do

The Importance of Caring Leadership

Dex 15:38

you think are the differences, 'cause you've been immersed in both worlds, between the military leadership style, which is very particular, and the healthcare leadership?

Dr Josh Hartzell 15:49

To me it's actually interesting. I did a fair amount of Army. The US Army has leadership training and then there's healthcare training. I will say it's actually similar than I think a lot of times people think and I guess I'll just give you a couple examples. So when I was doing reserve Officer Training Corps, which is the training I got when I was in college and I had classes on leadership and we did field exercises and other things. The whole point was to teach you leadership. Some of those lessons that are not really different are: you need to have high standards. In the military, if you don't have high standards, like people get hurt, right? In healthcare, if you don't have high standards, there are patients we're taking care of. So I think, it started there. Like the ability to give people feedback and do that effectively. We need it in both places. I will definitely say some of my military feedback is probably less kind delivery than maybe what would be acceptable in a hospital setting. But there's certainly the need for feedback. The primary thing that I took from the military training is that our job as leaders, or in my case an officer in the military, was to take care of my soldiers. And when I was working in a joint environment, take care of my soldiers, sailors and airmen. And it was really that emphasis that, look, you can't accomplish the mission if you're not taking care of your people. At the end of the day, generals, admirals don't win wars. They create great strategy and great plans, but if there aren't soldier, sailors, airmen and marines to carry out those missions, it's not gonna be effective. The same for healthcare. You really need to have leaders who understand that if we don't take care of the healthcare team and the healthcare team is large, right? Physicians, nurses, physical therapists, pharmacists, front desk, techs, the people who sterilize our equipment. All of these folks are part of our healthcare team that if we don't do a good job taking care of all of them, then we're potentially jeopardizing the ability to provide the best patient care that we possibly can. And that lesson was a direct carryover from many of the things I learned in the military. One thing that really stood out to me was when we were doing our training exercises, they would always say at the end of a road march or during a road march, Hey, check your people's feet. Make sure they don't have blisters. If they have blisters, take care of their blisters so that they can finish the road march. The other lesson that was pretty constant in the Army, was, look you don't eat until all your people have eaten. Make sure that, your soldiers have been fed, they've gotten food, and then you can eat. But to me, those lessons really stuck in that, hey, my job is to take care of them so that they can do what they need to do to take care of the mission.

Dex 18:48

Well, it's a pretty high stakes game. Every time I think about military leadership, I haven't read up very much on it, but Jocko Willink springs to mind and he talks so much about the psychology and science of how they operate: how they think, how they plan and execute. And the whole setup seems to me from the outside to look like a cut above what other people think of as leadership because there's such high stakes.

Dr Josh Hartzell 19:19

It's definitely high stakes. And I think the other thing that's maybe somewhat unique about, it's just how much emphasis we put on leadership development in the military and it's not just the courses and the different trainings that we have, but it's the mentoring and the micro interactions. We're actually working on a study now looking at some different leadership stuff. And one of the things we've seen is just how much the individual leaders benefit from the informal mentoring and coaching above of people above them and how that's just been passed down from generation to generation. Within the military, your job is to help that next level below you be prepared to take your job. Because you're always cycling, right? Our careers are infinite. I want to go back to the point you made about Jocko Willink, who he is written several good books. He's a great speaker. One of the things I love about Jocko is if you look at Jocko like he's a pretty tough looking guy. He does mixed martial arts. But he talks a lot about caring and how you have to care for people as a leader. It's not what you would expect when you see him, right? You like this guy would be espousing caring. But he has one quote in his book, and I think it's the book Dichotomy of Leadership, where he talks about: If you really care about your people, then you have to train them hard and prepare them because your real goal is that they can come home from war, come home from conflict alive. And that really resonated with me. One for my army role but also for the healthcare role because if we really care about our patients. Which, I've really never met a physician or someone who doesn't deeply care about their patients. Then we need those high standards and we need to help people be able to achieve them. But we need to do that in a caring way. In a way that allows them to do that. Because what we know is that if people don't have psychological safety. If we, work people crazy shifts, it creates environments where they really can't thrive. So we have to be able to create these cultures where people, are challenged. Absolutely. But the level of support equals the level of challenge. Ultimately that leads to better patient care, but also hopefully leads to the healthcare team not being as burned out as we really have been probably for the last, I don't know, several decades when you look at the data on burnout in healthcare.

Dex 21:51

Oh yeah, it's horrible. I work with a lot of physicians, but I'm glad you said what you just said. 'cause there's the first part of the book where it talks about how do we inspire caring. Why would you care? How can you care? Why don't you care? What do you care about? And I've never met a physician who didn't care, or a nurse or anyone else who worked in the healthcare industry. By and large, a lot of them are in it because they care.

Dr Josh Hartzell 22:16

Yeah. And so 100% agree, and to me, part of the impetus for the book is if we care this much. Which is core, it's foundational to who we are. Then what are the intentional actions that demonstrate that caring? You go back to the leadership I want to care as a leader, but maybe I've never seen it. Maybe I've just never had that experience of what it looks like or feels like. Here are the tangible behaviors that you can do if you wanna be a leader who leads with caring, somebody who places an emphasis on caring and taking care of your people.

Dex 22:55

Yeah. I think a lot of people in those positions have not had great leadership modeled to them because the people in the next layers up haven't been taught either. In your book there's a lot of information. It takes a lot of digesting, but I like the chapters set up and I like the prescription for caring leadership in each of the chapters with the self-reflective questions.

Dr Josh Hartzell 23:18

The book it's long. I will say it's funny when I turned it in my editor, she was like, is this a textbook? I'm like no, it's not. But I think what I have found valuable and what people have told me that have been reading it is certainly you can read it straight through, right? But really to the point you just made, which is, you know what, maybe I'm struggling at work with a particular area. Delegation. I feel like I'm just not being as effective as delegating as I would like to be. Let me read that chapter and then, okay, here's this prescription at the end of it, let me take one or two of these ideas and implement them. Or, Hey, you know what? I'm actually struggling with my own time management and my own self-care. What are some strategies so you can go to that chapter. Part of this for me too is having been in medical education for most of my career. Is that I really wanted there to be tangible action steps that people could take. While I hope the book is inspiring and gets people to think about it, I wanted someone who reads it to walk away and be like, oh, I can do that. That's a behavior I can start doing today. There's, 20 some chapters. Whatever area you feel like you need work on, or read that chapter and then dive in with some of the action steps.

Dex 24:40

And when you're talking about this, so I know you do a lot of speaking and training and all of that, but do you ever come into contact with HR, with your ideas and if you do, how does that go for you?

Dr Josh Hartzell 24:52

What do you mean by come in contact with HR?

Dex 24:54

I have worked with a lot of physicians who are on performance plans, for example and sometimes get ejected after a whole career and things like that. My perception from the outside is there's a lot of HR involvement in that process and I wonder if there might be some contentious content stuck in between you and them?

Dr Josh Hartzell 25:18

That's interesting. I mean it definitely comes up Just recently was talking to a group, and we were talking about a couple different groups and couple issues, both of which had HR involved. I think to me it can actually be complementary. In an ideal world, right? We and HR want the same thing. We want people to be high performing, to execute well, and to show up and not create problems with others at work. Be good team players. So we actually want the same things. To answer your question, how can some of the ideas in the book be partnered with HR? And sometimes they're part of a process. If we need to have maybe a little heavier hand in terms of getting someone to buy into a process. Or if you're having trouble with an employee and you just like, okay, what are we gonna do with this person? I often wonder though that if there's not an intermediary step, which is if we could implement some of these processes in a more caring way. If we wouldn't get more buy-in. One of my favorite things is this idea of compliance versus commitment. You probably have way more experience with HR than I do, but generally when we get to HR, I feel like we're getting to the compliance. Do this or else and we're really missing the, "What would it take to make this person feel more committed to this?"

Dex 26:43

If HR were motivated on reducing turnover, you would think they'd want to support the people that were there, rather than just waiting until they hit the wall and then just going, no, you're out. Oh, hang on. I haven't got enough staff. I've just fired two.

Dr Josh Hartzell 27:00

I think from a healthcare perspective, we're looking at this in terms of turnover, as you mentioned, it's expensive.

Dex 27:06

Super expensive. Oh my word. Expensive. Up to a million bucks per

Strategies for Preventing Burnout

Dex 27:12

operative.

Dr Josh Hartzell 27:13

One of the other things that I've been thinking about, partly because I'm a physician, is this idea of primary prevention. So instead of, having to deal with troubled employees or people who are leaving because they're burned out or whatever, how do we prevent that from happening? How do we help people thrive so that they never get to HR, they never get burned out like we need to do that primary prevention.

Dex 27:37

Yeah, but even the costing of it or the profitability of it, if you do that is, is a huge return.

Dr Josh Hartzell 27:46

You mentioned the numbers, right? So the estimated cost is 500,000 to a million dollars to replace a physician. And there's a variety of things that go into that. Why not take part of that money and invested in more support staff for your physicians so that they don't have to write their notes at night, with pajama time. Or how about just hire another physician. Here's an idea for nurses, right? Nurse turnover is not quite as expensive, but there's many more nurses, so cumulatively it still costs a lot of money. Why not hire a couple extra nurses to decrease the nurse to patient ratio so that our nurses one, provide more, safer care, but also so that they want to stay in your organization so that you don't have to hire traveling nurses who cost three times as much.

Dex 28:40

Well also you don't have to keep breaking teams that are working. I can never quite get my head round why the system persists as it does, considering that the economics are against, nevermind all the other reasons.

Dr Josh Hartzell 28:59

It is the right thing to do no matter what, but if you're not convinced by just the right thing, it's the financially best move as well. I do think there's growing recognition of this because of the financial implications. I think as people are really looking at the data and realizing, wow, this is really expensive, that's starting to motivate people to think about, okay, how can we do this more effectively save money? The other thing we know from, again, the burnout literature is that when you have burned out healthcare providers, they provide less safe care, they have less patient satisfaction. There's all these other indicators that if we do a better job of taking care of the team, they would just naturally get better and it would lead to better financial outcomes, patient outcomes, and healthcare team outcomes. In terms of wellbeing,

Dex 29:59

Yes. In my mind that's the definition of a no brainer. But anyhow, let me ask you from this direction then, what are you most worried about in healthcare right now?

Dr Josh Hartzell 30:10

Most worried? That's a really good question. I think what I'm most worried about is that if we don't do something to fix some of the issues that we were just talking about that a lot of people who are mid to late career, so the core who I would consider the core body right now. You have like junior trainees, physicians who are coming up. Incredibly important, right? But they're just out of their training. And then you have this middle group, this is the group I'm talking about, and then you have the more senior people. What I'm worried is that if we don't fix some of these issues, they're just gonna keep leaving healthcare or they're not gonna leave healthcare completely, but they're gonna look for jobs that are gonna give them the work environment they want. And we already see this in some respects. We have, physicians who leave certain practices to go to environments that are better for a variety of reasons, or they work part-time for a variety of reasons. I think if we don't create better work conditions and change some of the culture of medicine, we're gonna have even more of a physician shortage than we already do. And I think you could say the same for nursing. I know nurses who are just like, I'm not gonna do this anymore. I can go get another job. I can make as much money and not have to deal with this. So my biggest fear or concern is that if we don't really embrace culture change, we're gonna have, significant shortages of healthcare providers as we have a, increasingly aging population, which is really a recipe for disaster. With those two things happening at the same time.

Dex 31:58

And you train a lot of physician leaders, don't you? When they come to you, what do they ask you for the most?

Dr Josh Hartzell 32:06

I think it's a variety of things. It depends on their roles. A lot of the topics we cover most are how to deal with conflict. Feedback is always a topic. I think people are really uncomfortable giving feedback. I think those are the interpersonal ones that we see the most of. And then the other thing, a lot of it is time management and how do you prevent burnout? And for me, part of that is a few things. One is reminding people, and I don't know if you've read the book, essentialism by Greg McKeown? Yeah. Like life changing book for me, but like this idea that we have choices. And really coaching people to understand that there's choices.

Dex 32:52

That must be a hard sell telling a physician they've got choices 'cause that's not their sensation of life. Usually, when I meet them.

Dr Josh Hartzell 33:00

Yeah. I think that's part of it, right? We're almost enculturated into this is what you do as a physician, or this is what you do as a nurse to step back and say no, these are choices. And there's everyday choices we make, but there's also career choices. So a lot of it is about that agency around making choices and also being okay with certain things. One of the things that I think I see a lot of is we do a lot of things in medicine because we think other people expect it of us. And that might be doing research or working crazy hours, all these things that we just do. And then part of that is just because we've agreed to do it and we don't choose or push back against the system that we're not gonna do it. Or you could just say for me it's not important. I don't need to do this to be fulfilled. What I really want to do in my career is this. So focusing on the fact that we have agency in choices, and then the other big one, on an individual level is that, that same idea, but giving people the permission to say no. People ask you to do certain things, that you can literally just say, no, I don't want to do that, or I'm not particularly interested.

Dex 34:14

Because that was the other thing I wondered how you teach them all of the self care personal health prioritization rules you put in the book. That'd be a tough sell to a physician in a hospital, for example.

Dr Josh Hartzell 34:29

You do a lot of coaching, right? For me that's when I start challenging assumptions and I say Why would that happen? What would it look like if you tried this? Really getting them to, either challenge that assumption or I'm a big fan of piloting things. Why don't we just try it once? See what happens, right? Did the world end? Did your, clinic collapse? But just getting them to, giving them that permission, challenging assumptions and then just try it once and see what happens. But I agree it's not easy because the other thing I think for physicians, we carry a lot of guilt. That if we don't do something, something bad is gonna happen to the patient, or I don't wanna let my coworkers down. Fully get it. And trust me, I should also say that I speak confidently about these things and I struggle with them all the time. So it's not like I have all these things figured out, but we're, we are all works in progress. But helping people understand that yes, you feel guilty but if we don't change some of these things, we're gonna continue to live in this world of burnout and not having the cultures that we want. We have to be able to push back against the system, for system and process changes, while at the same time ensuring that, no patient or family suffers from that. There, there has to be a balance. My concern is that for too long, some healthcare systems, organizations, departments, different levels have used physician altruism and nurse altruism to not fix the problems that need fixed.

Final Thoughts and Holiday Wishes

Dex 36:11

I'm gonna say anything about them. in any case we didn't get time to sing any carols or anything, but we're pretty much out of time. Was there anything else you wanted to talk about today?

Dr Josh Hartzell 36:21

The only thing I would say Dex, I think just, this is gonna air on Christmas, which is awesome. That's exciting for me. The thing I've really been thinking about is twofold. One is, on a daily basis we interact with a certain number of people, and that may be a few people, it may be a lot of people. But every one of those interactions is really an opportunity for us to think about how can I positively impact this person's life? And, it could be as simple as a smile. It could be as simple as holding the door for somebody who's walking out of the grocery store, carrying their groceries and looks like they, are gonna struggle. It could be having a mentoring conversation with somebody. But this idea that all of these interactions are opportunities for us to positively impact that person's life, which in and of itself is worthwhile and important and we should feel good. I feel good about these interactions, but then recognizing that each one of those interactions, that person then goes and interacts with somebody else. So these positive interactions can have this ripple effect throughout your team, your organization, your family, your community. So really as we think about, going into 2026, like, why don't we try to make this the year where all of us with what we can control, or trying to positively impact the lives of those closest to us that would make 2026 a banner year in my mind.

Dex 37:54

Yeah, I would agree. And that comes right back to the topic we started with in the beginning. How can we support our fellows?

Dr Josh Hartzell 38:03

Yep same thing.

Dex 38:07

Marvelous. Alright. If listeners were gonna remember only one thing from today, what do you wish that one thing would be?

Dr Josh Hartzell 38:16

To me, it's simple. It's take care of your people. They will take care of the mission. This idea that as leaders it's part of our job to help take care of others. And I think as humans, it's part of our job or should be part of our job to, to take care of others. So just that idea that if you take care of others, it's gonna lead to good things in your organization.

Dex 38:38

I love that you're out there making a big noise and supporting so many people to be that kind of person and be that kind of leader out in a tough workplace, really. I think you're doing a marvelous job, and I love your book.

Dr Josh Hartzell 38:51

Thank you and thanks for for having me on. I really appreciate it and having the opportunity to spread this message, which we, I think both agree is important.

Dex 39:00

Very important! And thank you so much for being here today, Dr. Josh Hartzell. It has been such a pleasure.

Dr Josh Hartzell 39:08

Thanks Dex.

Dex 39:11

Listeners, please don't forget to pick up a copy of Josh's excellent book, A Prescription for Caring in Healthcare Leadership, because it's packed with practical leadership advice and suggestions that everybody can use. The link will be in the show notes. And if you are heading into New Year's, feeling a little bit fried and strung out yourself, a little bit buried under this never ending workload. And if your leadership is suffering the strain, now would be a really great time to book a consult with me because I can help you make 2026 the year that you are proud of. One way your performance, leadership, and passion revive in a way you never thought that they could. So if you'd like that, you can book a time at dexrandall.com. And let's get 2026 started right. Now I just wish you and yours a wonderful holiday, whatever you are doing and all the very best for the New Year.