From Burnout to Belonging: Creating Flourishing Healthcare Cultures

In this inspiring season finale of The Symptom Media Podcast: Bridging the Divide in Mental Health, host Dr. Lindi van Niekerk sits down with Dr. Kim Garver, Dr. Jared Christensen, and Dr. Amy Young to explore how healthcare organizations can move beyond burnout toward cultures of genuine flourishing.

Drawing from their work at the University of Michigan and the Center for Positive Organizations, the trio shares how small, intentional acts of leadership such as listening with compassion, flattening hierarchies, and cultivating “relational energy”, can transform even the most toxic of workplaces. Together, they unpack what it means to build systems that care for the caregivers, translating research on positive organizational scholarship into real-world change.

Through deeply personal stories of loss, renewal, and courage, Kim, Jared, and Amy reveal how connection, transparency, and accountability can rebuild trust and meaning in medicine. This conversation is both a testament and a roadmap: that by starting human and ending human, we can create environments where clinicians don’t just survive the system — they change it.

This podcast is brought to you by Symptom Media - Mental Health Education & Training

For more information about the resources shared in this episode you can visit:

• Dr. Amy Young
• Dr. Jared Christensen
• Dr. Kim Garver
• MPowerD Coaching

To learn more about Symptom Media and its mental health resource library visit: https://symptommedia.com/

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Transcript

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Hello listeners, a quick note before we begin. One of our guests experienced some technical difficulties with their audio later in the interview. We apologize for the reduced sound quality and appreciate your understanding as you enjoy the important insights shared in this episode. Hello everyone and welcome back to the Symptom Media Podcast, Bridging the Divide in Mental Health. I'm your host, Dr. Lindy Faneckarck, and I'm grateful you've joined us for this meaningful and deeply personal conversation. Our mission here is simple but vital, to bridge the divide between the clinical and the experiential. In this final episode, we look at how we can practically build healthy workplaces, organizational cultures and environments that enable us to flourish as individuals and as teams. As healthcare professionals, we spend countless hours at work and those same settings often contribute to our distress. Yet as you will hear from three inspiring guests today, it is possible to create positive organizational cultures and environments that foster increased productivity, greater work satisfaction and supportive relationships. We all have a role in creating workplaces where we don't just survive, we thrive. Dr. Kim Garver is a physician, leader and coach and the founder of Empower D coaching. Drawing on decades in academic medicine and firsthand experience with burnout, stress, and life transitions, she helps physicians and teams create sustainable, people-first workplaces. Dr. Jarrett Christensen is the chief of operation for vascular and interventional radiology at Michigan Medicine and a faculty associate within the Center for Positive Organizations. His work examines how positive leadership and virtuous practices can drive culture change in healthcare. Dr. Amy Young is a teaching professor at the Ross School of Business at the University of Michigan and a core faculty member at the Center for Positive Organizations. Amy is also an adjunct research professor in radiology at Michigan Medicine. Her research explores how positive workplace environments improve wellbeing, reduce burnout, and enhance performance in healthcare settings. I'm confident this conversation with Kim, Jared, and Amy will leave you feeling energized and empowered. Let's dive in. Amy, Kim, Jared, welcome to the podcast. I'm really delighted that you're joining us today. And we're happy to be here. Thank you, Lenny. Thank you. So to frame our conversation today, this is the last in our season for this podcast. And we've over the last few months been having conversations with health workers, both here in the U S and in the UK. And three things that's just really struck me from these conversations. The first is how much health workers care about what they do. They genuinely care. Secondly, the pressure that they are under and how hard they're working to provide care, despite being in a system where they're not often receiving care themselves. And then the third piece that's really been interesting in all these conversations is the piece around agency and how there's this realization by so many health workers that they are the system and they are not the mercy of the system and so they can change the system. And I think that's what's really exciting. having the three of you be in this conversation today, because I feel we're coming full circle from discussing a lot of the mental health challenges that health workers are facing, but then showing that it is possible to even change these organizational environments that we do find ourselves in. And so I'm really excited to hear and for you guys to share the examples from your work. So Kim, I'd like to kick off with you. You've had a dynamic career in pediatric radiology, and after 22 years of practice, you also experienced burnout. And so I'm curious, how did that experience reshape your career path and how you thought about your work? Thank you very much. This is such an important topic. ah I was working in private practice for 22 years as both primarily a breast imager, ultrasonographer, and pediatric radiologist. And the intensity of the days, the speed, the pace, the intensity, continued to increase dramatically over my experience there. And add to that the fact that we We're now operating 24-7 shifts around the clock. So you were switching days, your day pattern between days, afternoons and nights, very difficult. So the pace, the speed, and often you were covering studies after hours that you didn't read during the day and were uncomfortable. So the stress of all those things, plus an aging body approaching menopause, a struggle with chronic migraines and raising four children. Finally, it took about a week of multiple ER visits and I was preparing to go to work the next morning after being discharged and it was my children that said, you're done. No more, we're going to lose you. And it was a real wake up call when they just finally made the call that you just can't keep going like this. I was lucky. I had an opportunity to change career paths and I was able to. back to the University of Michigan where I'd done my training and some of my initial work. And I had the privilege of being the first radiology director at an offsite major hub. So it was away from the complexity of a large academic practice. And I was just so excited to go up there, develop a new opportunity. And shortly after doing that, I was asked to come down and create a position called Department Life and Culture, where we would focus on the health and wellbeing of the 1,400 people in the department. That just gave us an incredible opportunity to do some really innovative things. Unbeknownst to any of us, it was two months before COVID hit. So all of a sudden, I reached out to my dear friend, Amy, at the business school and said, help, how do you do this? And we... Got Jared in because he's another one of us. We call ourselves the culture junkies. And we just all have a passion for this work. And the three of us have been a team ever since, creating change within our organization and helping to improve the lives of our people at work. Well, it sounds like your children didn't just save your life, but likely the lives of the 1400 people that you've been caring for as well. We're not good at taking care of ourselves. That has been a common thread throughout all our conversations. Jared, how about you? I know you've also had quite a few pivotal moments that led you to leave a career in private practice, to change where you work, but really also to put your energy on not just supporting your patients, but also your fellow clinicians. Can you tell us a little bit about what that journey was like for you? Yeah, absolutely. And as you said, I've had a number of pivotal moments in my career that have led me to where I am today. Shortly after my residency, I was in a private practice in Oregon, Southwest Oregon, and was thriving there. I was really enjoying my time there. But I was affiliated with a number of different hospital systems, et cetera. And one of my good friends, another practitioner there, he was just not happy. He had had a number of experiences that had really jaded him and was very burnt out. Just kind of a lot like what Kim had said. was not feeling very well, had had multiple episodes where he had presented with some health problems. And one of those times was that he came in to me at the end of a weekend and said, hey, Jared, I was shoveling snow up over the weekend and I had some blood in my urine. Would you be willing to look at my CT scan this afternoon and let's take a look and see what's going on? We popped him onto the CT scan and ran him through the CT. And as the images are coming across into the control room, I could tell that he had uh an invasive urethelial or urinary cancer in his bladder. He came out and his wife was there and all I could think of was, oh crap, this is a very challenging thing for him. And a few weeks later, I got a phone call from the president of my group saying that he had passed away and had passed away suddenly, unfortunately, from a large pulmonary embolus in the post-operative period. Hmm. I knew that he had been unhappy for many months, even years at that point and really died in the saddle as a very unhappy person. And I realized at that point, you know what, I am not going to stay in a position where I am also becoming unhappy. That made me go back into an additional fellowship and then came back out into another private practice in Denver and had another pivotal moment where I had one of my friends and fellow practitioners who was in the room next to me. who unfortunately, unbeknownst to us, was really struggling with major depression and committed suicide. And I remember that day again, my practice partner called me up and said, hey, so-and-so has committed suicide, passed away last night. Well, this was again very impactful to me because like Tim, I was in a high volume radiology practice. It was click, click, click, stay in your own little room and just dig through the day as hard as you could. And so even though this friend of mine, had been in a room next to me many times, I had not even been able to see that he was struggling with this burnout or challenge. So I realized at that point that I needed to make a change and I needed to figure out a way that I could connect with the people around me. And what I did was I realized that my passion was for taking care of all of the people around me. I love taking care of patients, but I especially love taking care of my team. And that's the technologist, that's the nurses, that's the staff, that's the other faculty, that's all of the people around me. And so I started looking and that's what brought me here to the University of Michigan where there was an opportunity to join an organization and a department that was focused on taking care of people. Our department chair here is very engaged in that and passionate about that and he sold me on coming back. And now I have over the last five years worked with Amy and Kim in developing a flourishing organization and ah I love it. And what a privilege it is to be able to care about our staff as well. And I kind of resonate with your journey, both Jared and Kim, because I think I quickly realized in my medical career, I cared more about the people who I was working with day to day than just the patients. em And no one really is there to look after them. And so it is very rewarding to be able to give them the care as well and ourselves at the same time. Amy, I'd like to ask you as well. So throughout this podcast series, we've heard countless stories of health environments that are just not causing people to flourish, where mental health is the only thing, or mental health challenges are flourishing, but not people themselves. Incivility is common, burnout is widespread, the resilience of people are generally low. and you've really studied these dynamics through a psychology and an organizational lens. What inspired you to want to collaborate with people like Kim and Jared and look specifically at healthcare organizations? So I will say originally I got interested in this area when I realized if you change an organization you impact so many people's lives and it was a way to sort of up the impact. So that's really how I got involved with the Center for Positive Organizations housed at the Ross School Business and so I was exposed to it. I was very, very lucky to be where I am. But I would say with this particular project, it really was when I met the chair of their department. I'm really selective in who I work with because this type of work, it's not necessarily easy, it takes a long time. And if it doesn't work out, people become cynical and you're just making it harder for the next person to come along. So that's why I was convinced to work with this department. And then I met Kim and Jared quickly and I mean, they're so much fun. They are so much fun to work with. I get lifted up every day. So that's how I ended up working with them. I haven't heard people mentioning fun of working together so far, so that's really great. Kim, you've made mention of the satellite facility that you got a role in at the University of Michigan and also that this was really a blank slate for you. Yes. And what did it feel like for you to actually work in a culture where you could shape the culture and what made it possible for you to create a different environment there, especially before COVID? Yes. It was just an extraordinary opportunity. None of their academic radiologists really were comfortable doing this position and I had come from a practice where we had multiple off-sites. So I saw this as great opportunity and not a burden. It was tremendous to create the culture from the ground up. was lucky to have three young male physicians who were gung-ho about doing it differently. A hundred committed staff that wanted something different as well and actually wanted to be at this facility. That was a great basis. And then the managing director there was fantastic, is still there. And we started out with Everybody contributes to this team. I think the key was that we flattened the hierarchy of the organization. We took away the silos. were close and proximate and geographical area with each other, just a couple hallways. So every day I would do walking rounds in the morning and walking rounds in the afternoon. And it would be what we call start human and inhuman. We did that with everybody from the janitorial staff to the physicians that were staffing. And we had extracurricular activities of golfing and painting programs and pictures and parties. they just to bring us all together as one team. It was really tremendous. It was a living laboratory about how to create great culture with very willing, amazing participants. Jared Kim just described this amazing environment of flat hierarchies where everyone wanted to participate and had so much positive momentum. Was that the same that you found when you joined the Division of Radiology at the University of Michigan? Or how would you describe the culture at that time? So that's a very interesting question. When I joined my division, our culture was very different. It was very toxic. The previous division leadership had created a very challenging, confrontational, and tense environment and culture there. So that had happened over a number of years. And so what ended up happening then is all the people that could tolerate kind of a behavior ended up staying, and all the people that couldn't tolerate it or wouldn't tolerate it left. And so we had a very challenging environment in the Division of Interventional Radiology when I came on. And that created a lot of problems. Like Kim said, lots of silos, lots of hierarchy, lots of challenges, lots of people undermining one another. And it just seemed like the best description is a toxic, difficult, and draining workplace. Amy, so I'd like to ask you to help us give a framing on how we think about organizations. Our general framing in healthcare is always to look for the negative, look for problems and try to fix those. And I think for years, people have almost seen organizations with the same view. Organizations are these vehicles of efficiency that has to produce and the people in them too. And then this wonderful new movement started, which I know you're basing your work in, that really said, well, organizations can do more than just that. They can flourish. They can be virtue. They can be positive. elements within them and as a result of the positive things people start being productive in. So how does that positive lens reframe how we look at healthcare organizations? I'd like to give you the opportunity to teach us a little bit. Sure, I don't think medicine is that different from other industries. I think that is the traditional approach, look for the problems and help an organization get back to just being functional. You know, was my colleagues who were the founders of the center about 25 years ago had this really novel idea. What would happen if instead of looking at those organizations that are typical or looking at an organization that is having problems, what if we went to organizations that were really doing well? You know, they were very productive. If you're looking at all the different outcomes that you want a company to have, they have that, but they also are great places to work. Physically, it supports them. Psychologically, it supports them. And it also brings out the best of humanity, character virtues. They really promote compassion, kindness, and all that. So they go to the organizations that are really doing well in all three categories and they study those. And lo and behold, new things came to light. We were not learning the old things. And so I think the lesson there is really what takes us from a failing organization to a functional organization. That's not gonna get you to flourishing. You have to do different things. It's not about doing more. You have to do something different. And really the whole area of research that has blossomed out of those original studies, we've been able to document through research all the different practices that help you get to there. The biggest difference is you're not looking to just solve problems. You're also very purpose-driven. And that's kind of a broad category that covers practices that are really supporting our soul. And what I mean by that is they're promoting positive meaning. They're promoting positive connection. They're promoting positive emotions. And those really renew us. And that's why those companies are successful. Typically we're thinking well-being, employee well-being gets in the way of productivity. That's the traditional way of thinking of it. This is employee well-being is the driver of productivity. It's a whole different concept. And we've developed a lot of research that really supports it. think that is important for people to know that there is real research behind backing this different approach of organizations. It's not just feel good, because I've heard that... And we really stick to that the research is so important because otherwise we're not going to be believed. The quantitative research is really the cornerstone of the center. So Kim, how have you taken these concepts that Amy have spoken about and introduced and applied them within your hospital setting? So as the, was the first associate chair for department life and culture and really had to get my head around, this is a big bucket. How do you even start thinking about this, this challenge, this opportunity? So there is a model. It's if you take a, like a big circle, like a pie and you divide it into three pieces. One piece is a third of the pie is taking care of yourself. Now, We never lead with this in discussions with staff members or physicians. It is still really important to pay attention to your individual health, nutrition, exercise, sleep, all those things. Cause if you're not doing that, it reduces your own resilience. But if you lead by telling healthcare workers, they have to do more by, you know, practicing meditation, doing yoga, eating granola, you know, that type of thing. They just get really angry. Although important, you acknowledge it's important, you basically let them figure that out. And so you don't start your interventions there. The other two big pieces of the pie. One is what we call organizational efficiency. And Amy and I call this pebbles in your shoes. If you are trying to walk 10 miles and you've got rocks in your shoes, that is really going to slow you down and make you crazy. So whatever we can do to make those. practical logistical workflow issues better, using your quality teams to improve workflow processes, creating structures like meetings and having meeting minutes and having good agendas and good structure so you have places to put problem solving, good communication tools. We developed a physician scheduling tool that was more nimble, more fair, had better record keeping. And most importantly said, you know, if you have 15 sick days a year, we don't want you to wait till you get sick. We want you to use those as health days. Go get your colonoscopy, go get the dentist, go take care of your kids at the pediatrician. So we really tried to flip in some of those logistical buckets, how to take care of people better. But the biggest area that we focused on is what we call the culture of care, the other third of the pie. And that's where leadership training is so important. Leaders that understand and practice positive organizational principles are critical to the well-being of their employees. And there are studies that prove there is a direct correlation between burnout and leadership behaviors. And also, are you inclusive? We had a DEI office. Inclusion is critical to what we do. and then also communicating positively. So that's where we put our focus and positive communications. know, people when they don't know what's happening, make up stories and those stories are never positive. So let's tell the stories first. Let's make sure people have the information. Let's make sure people understand what's happening, even if you can't do anything about it. It's really critical. So that's where we focused on leadership behaviors, leadership training programs, positive communication, and then inclusivity, recognizing the value of a diverse workplace. And Gemma, I'd like to follow up and ask you, said you started all this two months before COVID. So it could have been easy to implement all this. So just practically, how did this happen? Well, they're still trying to figure out how COVID happened. So, I mean, I was brand new in the role. The chair was new. Amy and I's relationship was new. And we had all of a sudden our people couldn't work because we didn't have patients except for emergencies. So what are we going to do with all these very anxious people that where there's no wind in sight, there's so much uncertainty. We brought them together. and we brought them together over a brand new platform that we turned on overnight. Believe it or not, we did not have Zoom. So we turned this on. We got everybody on camera once a week to have weekly personal connection. So we circled the wagons to support each other and we had a talent show on Zoom. And then we had a virtual art show. We had a Kentucky Derby day. We had a small group. discussion support. So we quickly pivoted and used what we could to connect people in a time of uncertainty. And that was helpful. And then all of a sudden, we kind of got back to work and we continued some of those practices, but not quite at the intervals that we had been doing. But it was a way to ground people and bring people joy. And can I jump in there for real quick? You know, really what Kim is talking about is this concept called relational energy. it is, you know, positive interactions can create relational energy and that renews us. And so really what was happening, even though people were depleted during COVID, having those moments actually energize you. So that's one of the fundamental principles that we're focused on. We really were tested on whether it's going to work, you know, with COVID. But it did. It did. I'd just like to ask before we move on, would you say that relational energy is even more so important during a crisis? Because usually during a crisis, that's when all that goes out the door and we just focus on being highly efficient and effective. Yeah. Well, you know, if you think about the way that communities respond to an earthquake or some other tragedy, they come together and they're all working together and that's how you get through. that relational energy is very closely related to resilience. Yep. Jared, can you share more about what you did within your setting and how you started implementing these principles and what it did for your setting? Yeah, absolutely. So as I described before, my setting was very toxic, very challenging, very tense. I felt like everything was just about out of control every single day. The way that I would, I guess I would describe it as you were at the crossroads of crisis and chaos and at the precipice of disaster. Everything felt like it was going to just fall off the tracks at any given time. And so what we quickly decided to do is we needed to figure out what schools did we need to use to help us to bring everybody back from the brink? And so what I did with Amy is created a survey together. We submitted that out to all of the staff, faculty, and we really were very intentional at the questions we asked. We wanted to know how people were feeling, why they were feeling that way. We wanted to know how engaged they were, how they felt at work, and why they felt that way. And so the results of that survey, we got a very high response rate up in the almost 90 And that survey told us the biggest challenges we had were in our leadership. People didn't trust the leadership. They felt like the leadership was dishonest. They felt like the leadership was not sharing with them the things that needed to be shared. They felt like the leadership wasn't focused on what needed to be focused on. What we elected to do was really then focus closely on the positive leadership principles. that Amy and the Center for Positive Organizations has developed and espoused. And those are things like character attributes of leaders, right? Honesty, transparency, empathy. Those are things that were really important to us. And so we ended up needing to reconfigure our leadership team because we needed people, the right people in the right place. And so we brought in a new leadership team and then we aligned that leadership team. And we spent many weeks just as a leadership team coming together and deciding these are the rules that we're going to play by. We're not going to allow silos in our unit. We are all going to be aligned. We're not going to allow people to create conflict between these different job responsibilities and job classes. That for example, if a technologist came to me, I am not the leader of the technologists. I am the leader of the physicians. And so if a technologist came to me with a problem, I would point them back to their leader. and that we would do that all with that, the technologists, with the nurses, with the administrators, and with all of the different leadership roles that we had. We instituted a leadership meeting that we continue to have every Wednesday morning, and in that meeting, that is the meeting where we can really hash out all of the difficulties, all the challenges, all the good things, as well as the bad things that are happening. And we do that, and then we are very intentional about leaving that meeting aligned with one another. If there's anything that comes up, we discuss it first before communicating it to the teams, and then we are very transparent and very honest and open with our teams. We share, share, share. And in that way, we were then able to develop trust in our leadership teams, and then we were able to start making the changes that were needed in the organization and the system itself, then to then flatten the hierarchy, bring people together, decrease the silos. make some impactful change that then allowed us now to start to move from that failing model of chaos and crisis, then to the functional model where now we're doing pretty good work and we're pretty happy with that and we're working well together and now we're starting to move towards the flourishing area where we're now being able to not just do good work and be happy with it but feel like we are making a big impact for the institution, for the patients that we serve and for one another. Can I just add one thing about that? Because it seems like it's a small point, but it is really critical. So when we did that survey and we got the results that were pretty, it didn't look so good. What we ended up doing, and I say we, I mean, Jared, sort of like a royal we, him and I were actually in Florida and we were online supporting him, but afar. Jared went to the whole unit and really said, here's what we heard. and it was fully transparent. And so then you can have an honest conversation. And that's not easy to do. I mean, Jared, for you to go to that room and there's really some harsh news, that's how it starts. You have to be really open and courageous as a leader. And if that meeting didn't happen, I don't know whether anyone would have believed that there were gonna be changes. Jared, can I ask, Amy just said you have to be brave. It is a scary thing as a leader to go out to ask people how they're feeling, especially if you're suspecting there's gonna be a lot of negative feelings and anger coming out and how did people react when you walked back into the room and you told them what you've heard? Did it erupt as like an angry mob or were people quite open to that? So we have about 150 people and so the responses are all varied, right? I have some that are always angry and always vocal and I have others that just sit back in the seat and seed. And so we had all of those different reactions at the time. However, once we put the results up on the board and were very transparent again about them, so we didn't just do the survey, we did listening sessions. We wanted to make sure we knew everything that people were heard. It was cathartic for people. to be able to say, yes, this is what I've been saying. This is how, you know, this is how our unit is. See, I told you so. And so it was really cathartic for the vast majority of people to be able to see it all in black and white and color up on this board and show them, yes, this is what I feel and this is why I feel that way. And then we did not make any promises at the meeting. We didn't make any excuses. We were very careful not to make excuses, not to be defensive, that this is why we have to do this. This is what we heard. and we're going to find ways to change. And that was it. And I'm curious, did you involve them in the, in as part of the change or did you promise that you would change and they just sit back and wait for it? Because I've, mean, that's a common response. My colleagues want someone else to drive the change. The manager, the leader. No, so thank you for clarifying that. So the conversation really was, we need to find ways to change. This is our goal, is to have a flourishing, fulfilling job for us. We want everybody to feel fulfilled and happy at work and at home and everything else that they do. And the conversation was, we need your help and we will involve you in that change. And then what we did was then we went out with those listening sessions, we went out with each individual and we really empowered them to make those changes in our unit. Too often I think we look at the system as this unchangeable thing that has been imposed upon us and we don't look for the things that we can change within our small systems. And so what we did was we went to the energizers of the unit, we started looking at how, or started incorporating them in some of these change initiatives and then that really snowballs into a much brighter future. And then they start talking with their peers that, I'm involved in this change initiative, this is what we're thinking. And then, again, starts to spread throughout the team. And it's a bit contagious. Amy, could you reflect on both these experiences? I mean, you were involved with Kim, with Jared. What is the main learning around which positive practices or principles really are important for health care organizations? Well, I think what Jared was just talking about is a really good example. It really starts with the leader, the leader opening up. And when he went into that session and said, here, is what we're looking at. So is the actions of the leader that can open up and invite participation, the way that they're communicating with the team sets the stage and determines whether you're going to move forward with a positive change or not. And that's really why I said that it was so important when I met the chair, why does he care about this? Is it about a career move or is it because it's the right thing to do? And people who make great leaders will say, it's the right thing to do because I care about my people. And I do believe that's the very same thing with Jared and Kim. They are driven not for a career move, but they're driven because they care about the people and it's the right thing to do. And Amy, I mean, we spoke earlier about the importance of relationships and I heard Kim also mentioning positive communication. And I wonder, can you explain a little bit more what that really means? I don't think many of us know what would positive communication look like within the context of organizations. So there are very specific behaviors, communication behaviors that you can do that will open up connection, open up meaning, open up positive emotions. And so a simple one is just greeting. When you go down the hall, do you say hello to people? Do you look people in the eye? Give them a genuine hello, or do you walk right by them? So what you're doing when you greet is you're recognizing the humanity of the person in front of you. It's a simple act, but it has so much impact on us. When you have someone who gives us a genuine greeting, it actually changes how you feel inside at a physiological level. Positive communication really is making a difference in how you feel psychologically, but also physically how you're doing. And there are different behaviors that we can teach. It's a lot of what our leadership class is about and just how can you interact with people in a more meaningful way. and the slight changes you can make in the way that you're communicating with them. And before we move on, and Jared, I mean, I'd love to ask you both as well. What do you feel really made a difference within your organization? What no cost behavior change really did you feel? Wow, this is shifting the culture. For me personally, the answer is actually always the same. Listening, listening fully, not listening for how you want to respond, but truly listening to the person in front of you, taking notes, listening with compassion, with empathy, and like they are the expert of the work they do, empowering people. There was nothing more powerful I did as a leader than just walking around morning before work closed, just to touch base, to listen to people, to find out about their personal lives, and to make sure I knew everybody's name. That was so important to work hard and use, I use picture flashcards to memorize people's names, because that says you care enough to know their name. So simple in many ways. How about for you? What do you feel as a leader really made the change? Yeah, so that is a very challenging question because, you know, it really is. I have a mantra that says I have to do everything, everywhere, all the time. So for one person, it's one thing. For another person, it's very different. And that can seem a little bit overwhelming, but I think getting back to Kim's response, there are very simple behaviors that are really important to people. Communication and being present is really, really important, setting the expectation that I am not Dr. Christensen, I am Jared. Okay, so I am Jared with everybody. We have three janitors, janitorial staff that come into our area to clean the rooms. I know their names, I greet them in the morning, and I see them, and people see that, and that's important. In the operating room, when we do a timeout, I introduce everybody by name. So I say, is Jess, this is Tiana, this is, you know, John. and I go down that. So they know I know them personally as individuals. So being that kind of a person, being able to be approachable, flattening the hierarchy, and then communicating well with people. And then I think the other thing that was really, really important for us and for me was being able to develop high quality relationships with energizing people within the unit. needed to oh identify those people who were energizers. Now, when I say energizers, I'm talking about those people that I feel uplifted by. and that people, other people feel uplifted by it. Energizers aren't the people that are hankering for change. They're not the rabble rousers. So have to be careful that you don't involve those people because they're gonna get you in trouble. But the energizers are the people that I could connect with and I have a list of eight to 10 energizers that I connect with informally very, very frequently. And I just take the pulse. What's going on? How do you feel? How are things going? And those are people who I rely on. to help with change, help me understand how to do better, and to really spread the good news, if you will, throughout the entire division. I think it's so important that you're sharing these behaviors which does not cost money. And so often any change effort is... The response that I've gotten in hospitals is, we don't have money so we can't do this. And I think both of what you're sharing is none of this is costing any extra money to do. So again, Kim and Jared, could you tell me a little bit more how you've sustained these efforts? So it's one thing getting them started and then people are getting engaged, but how do you make sure this doesn't just die after a few months, but it keeps building? One thing I wanted to mention as a really important thing, listening with compassion and empathy, kind of on the other side of that is courage. Courage to absolutely not tell the gory truth, but to be transparent about what you can be transparent about. Of course, you never want to expose confidential information. To be transparent, to be courageous, to hear negative feedback and to take it as a gift and to practice. taking negative feedback as a gift. And then also to be courageous when you have one or two people within the unit and that's all it takes to make the unit feel toxic. You have to deal with that head on. You could not let somebody else do that. And when you become a new leader somewhere, you have to deal with that out of the gate because everybody's looking to see if you're gonna be courageous. or you're gonna let those people get away with continued negative behavior. So you may have to be a little tough to start and then you can always soften, but you really need to have people understand there is a new sheriff in town and we will treat each other from now on respectfully and appropriately. And for those people, you need to take it on. It's the hardest part of being a leader and our chair did that. Jared's done that and I've done that because you can't let one or two people harm the rest. So what are the three C's? oh C's are, this is where, you know, this is the implementation of that. So the first is coach. You know, people don't show up wanting to do stupid things or harmful things. So you really try to coach, find out what, what is the issue, send people to counseling, send people to coaching, of course, work with people to do anything possible, but sometimes that's not going to work. And when that doesn't work, then you contain. So you try to. Again, create an opportunity for that person to practice, continue practicing in a way that doesn't hurt other people. Either take them away from patients or colleagues or have them do something meaningful and important, but just limit the damage. And then the third thing, if all else fails, is to collect your things and be courageous about that. And of course, follow all the rules and the HR principles, but sometimes you have to, it's expensive. There can be lawsuits, but you still have to do it. It's what people are looking for when a leader steps in the room. Sherrit, how about in your situation, what helped sustain these changes that you were making and kind of grow them even more? So sustaining change is difficult when it takes a long time to implement it. Some people will say that the Soviet Union didn't die, it just got up and moved to Ann Arbor, Michigan and took up residence at the University of Michigan. So it's just slow and the bureaucracy is intense. What I have found has worked for us is that we have to maintain a very consistent vision of why. So the what is pretty easy and there's a lot of what that we do, but why are we doing it? And we have to continue to come back. this year, a good example of that is that our objective this year in our division is um that you work hard and you take care of your team. Those are the two things that we that we're doing this year. That's the focus that we have. And so everything we do is to help us one another work hard, take care of our team. And that's the why. And there's other why, of course, within terms of fulfillment and relationships and those kinds of things, which are also really, really important. But what we are able to do then is maintain that at the forefront. This is why we're doing what we're doing, because when change takes a long time, changes start to stack up. And so over time... when you're starting to make implementation or change or implement different workflows or other things like that, those changes start to stack up and it starts to become burdensome for people. And so you have to always come back to the why. And then it's consistent communication of the why and the what, the why and the what. And that helps us to move beyond that functioning uh organization to the flourishing organization because people then connect to the why. They know, hey, I do this and I take pride in what I'm doing. I enjoy what I'm doing and this brings meaning to my life. And that way, all those stacking tasks can start to feel more aligned with what they want to do instead of with what they have to do. Meekin, can expand a little bit more on this idea of moving from the functional to the flourishing organization as Jarrah just referred to? Yeah, and what helps you get there? You know, it's really interesting. you know, the center's been around for 25 years and really our focus has been on research, but all along we've been developing practices to do it. And if you go to the Center for Positive Organization website, you can find a lot of practices and it's really about how you're getting to flourishing. And, you know, a lot of it really does rest on how we are interacting with each other in an organization. Also, how we are setting up the norms and the work roles. So they're all supporting positive engagement. For example, not having an efficient work system can actually create conflict in the organization because you don't know, why didn't this person do it this, you know. So if you have a very inefficient system, that will create conflict. So you have to take care of that. You have to have everything working towards building. positive interactions and building that positive momentum. There really is something to be said for positive emotional contagion. And so once you can get the wheels rolling in the right direction, it really helps. And I think, you know, Jared has pointed out, and I know this was true for Kim too, inviting people on from your unit to be part of the change. One of the things of, you know, all those listening sessions that we did, all the frontline workers had fantastic ideas of change. but they had never been asked. The idea that you're just asking them, but also inviting them to be part of the solution really does make a difference. So all of those things are really helpful. I'm glad you mentioned that because even in very low income, low resource hospitals in Africa and in Asia, I've seen the exact same thing. There's something magical that happens if you invite health workers to be part of the change and give them an opportunity to share their solution. Where that extra energy comes from, I don't know, but they will go above and beyond to be able to make a contribution and not be left on the sidelines. And so I think that's really beautiful. Well, we actually have a term for that. It's called discretionary energy. And this is something that one of the founders of the center really studied for a while, Robert Quinn. And the idea is that we actually have more energy to give, but we have to have a good enough reason. And leaders who have amazing cultures are creating a reason for people to bring that extra energy, because they really do want to be part of the solution. Kim, you looked like you wanted to add to that. One of the things that we've talked about is when people don't answer surveys. Organizations are constantly surveying their people. And this is a really great learning or teaching tool from Jared. People are not, do not have survey fatigue. The kind of fatigue they have is an action fatigue. And they get frustrated by the fact that nothing ever changes. So why should I bother contributing to the survey? And I think one of the important things that goes back to creating a positive culture is being accountable to your people to getting things done. And on top of virtuous practices and positive relationships, people have to see things changing. And you can start with small, but you have to celebrate wins. And it's actually pretty easy to do. You make sure you have the meeting structures in place. You have recorded notes. You have a... project management system, there's accountability to the team, and then most importantly, you need to find your person that will act as a dog with a bone. It's the most important. You find somebody absolutely committed to this, not because it's their job, but because they believe in it. And you have to empower that. person and if you find that person and given the right resources and the follow-up and the structure and the accountability, things will happen and then that becomes contagious when people see things actually happening. And then you celebrate it because it's a big deal. But accountability is really important. And I just like to add one thing. For both of the units that they're in, we would pick one thing that's getting to flourishing and one thing that's getting from failing to functional. Because if we were not doing that, it's as though we were not listening to them. And so the two of them work together. So the flourishing part is helping you create that energy to fix the problems. So it's really important that you're doing both at the same time. Jared, how did that work within your context? How have you kind of, I like the word contagious that was used. How have you used the sense of contagious and getting this to spread beyond just an immediate team, but maybe to a broader group of people? Getting the ideas and this to spread amongst the teams, the energy that Amy is talking about and Kim is talking about, this relational discretionary energy that we have, it really was important to find ways that we could move from functioning to flourishing and to identify things that people are already doing well, that they're already passionate about, and that was easy to then focus on those. And then they feel the energy that they need, the discretionary energy that they need to then move from failing to functional or from functional to flourishing in other components and other sections. And so that's really important. It's important as a leader who is trusted to then call that out and to empower them to succeed, right? And then to help them to feel that discretionary energy. And you can find pockets of people within your division or organization that are flourishing and do things exceptionally well. And you can use that to spread the discretionary energy to other people and... pockets within the organization. So that's how I've really utilized that is you use the relationships that you have, you use the things that people are doing well. Like Amy said, you find the function, find the things where people are flourishing and that gives people the discretionary energy that they need then to move forward. And there really is a cycle that moves upward and forward. Now that doesn't mean that you don't ever fall back, right? Because organizations, especially healthcare organizations, have a tendency to focus on functioning. I mean, we have all these JCO requirements and all of our accreditation and all this other stuff that we have to do. That's just functioning. And so we have so much to do. There's a deluge of clinical care. There's a deluge of administrative care priorities that we have and tasks that it's easy to just say, just clear the bar. That's all you need to do. Organizations tend to, unfortunately, push people. to the functioning, right, instead of the flourishing. And I think that that's where we need to just always keep our foot on the gas to push towards the why of flourishing and not just the why of functional. Or not just the why of functional. And Jared, I recall that you've said you've even expanded your leadership program to training a broader group of people, think, capacitating them with these skills. Could you share a little bit about that? Yeah, so as we've developed this leadership academy, other people have heard about it and have come and asked us to then spread this to other areas. So I just had a meeting with a person in charge of faculty development, and he'd like to have the new faculty who join every year have a short course for things like positive organizational scholarship, positive communication, three or four session course to help them in their early careers to do that. Kim is working actually tomorrow with our transplant teams. to do the same thing. And so people are hungry about this. They really are hungry for these positive practices that you can put into place in a environment where you don't have to spend any money. You just have to implement small, simple positive practices and they have a big outcome. Amy then I guess the proof is going to be in the data. What has your data found? You've been studying both these settings as well, looking like you said for quantitative data and what has been coming out of that? Because it sounds so good. Is it actually true? Well, have to wait a bit for the program that we're just running. We'll have to wait a bit to find out about that one. But we had the initial study from breast imaging that we had really good results, and that was during COVID. But I'm also relying, there's a lot of research at the center. It's coming from a lot of different industries. You know, we have an international group of scholars who just are in this field and contributing a lot of research that helps us identify the impact. And it is broad. You could just look at productivity, individual productivity, team productivity, or measuring at the organizational level. You could look at team cohesion. You could look at employee engagement, employee loyalty, and financial data. So you can look at organizational outcomes in terms of whatever key performance indicators you want. The data is really there. It's not studied as often in healthcare, but with other industries. And you know, that's what gave me lot of confidence that this was going to work in healthcare. Why would healthcare be different? Kim and Jared, based on what Amy said, what do you feel for yourselves personally? I mean, you started the conversation explaining your own journeys, coming into this work, having experienced burnout, seeing colleagues really struggle with suicide. And what makes this meaningful to you based on the changes that you're seeing around you? How do you know like your efforts are having an impact? For me personally, I think finding something that you really care about and then finding the people around it, just a couple like Amy and Jared and our chair, that feel equally passionate about it, it drives you without money, without status, without prestige, without papers. When you find like-minded people and you want to make an impact on that, it's just so powerful and it's energizing. And I think the other thing is to remember in big systems like ours, it's easy to get overwhelmed and throw up your hands, but small is all. And what can you do to make a tiny impact without any additional resources, any additional money or any permission? And that we can do. We can't fix the parking. We can't fix the salaries or the shortage of this or that. But if you just think about what is my 15 %? that I can do and even if it's just remembering people's names, huge difference. My in the past, it was hospitals in Pakistan or Cameroon, is when I saw shiny eyes. When people walk in with like dead eyes and suddenly there's life in their eyes again. Maybe not a measurable indicator, but it was always beautiful to see when that comes back, the hope and the enjoyment comes back for people in their work. You know, I will say, know, small wins, you the leadership group that we have been working with, ah you know, from where we start, I mean, they are very, very stressed, but those sessions are so much fun. We get work done, but there's so much fun that happens there. And you can see that energy and hopefully they're taking it to their teams. That's the hope. And I do think that that's going to happen. But that is, me, a small win to see those people at work really happy despite the fact that they're very stressed. Amy, I'd like to ask you, for someone listening today, and they may not be in a leadership position or they may be in some position, but of course there's always people above you. This is healthcare, the hierarchy stretches far. What could they do to convince their team, their manager above them to give this a go? Yeah, well, it all depends on the audience. So if you're speaking to someone that only listens to research, get some research and start with that. I mean, that's typically how I approach that group. I also try to approach it, you know, have the experience. So, you know, even attending some of our sessions, you can feel the energy. But if you don't have either one of those, then you really start by, you know, 1 % change that you are making. And so you can go to the website and learn about the positive communication behaviors. Each one of those you can learn and do. And if you're making one small change a day, one small act, that's gonna lift up you and the people around you. I really like that one small change. Kim, Jared, what would you advise or kind of guidance could you give to health workers who's feeling stuck, who want to see something shift within their organizations? I think it's just like when you board an airplane and you're taught you got to know how to put your own oxygen mask on first. I think that self-care is really important even though we don't tend to talk about it because it makes people feel responsible. But find your passion but also find a way to successfully say no in a way that you can be comfortable with to save yourself. Sometimes you just got to Hunker down, find a bunker and survive for a while. So having a good strategy to say no and say, like maybe it sounds great, maybe just not right now. But so self care, a healthy no, and then find your peeps. Find your passion and find your people. And if you can do that, you can do just about anything. Number one, think for me it is stay human, to understand that we are human and that part of that human experience is a very wide range of emotions. And I think it's important to intentionally and very carefully relate to the emotions that we have. I love the thought of start the day human, end the day human. Intentionally relate to your emotions and then be very intentional about finding your people and stay away from the ones that drag you down as much as possible. Amy, I'd love to give you the last word. Is there any other encouragement you could offer just for the healthcare community, but from all this research that exists, that it is possible for us to create positive organizations? It actually is, it really is, and I think that the work that we've done demonstrates that. It's a new approach that hasn't really been used in healthcare that much, but I really do believe that the research is showing that it does work. It's really about making sure that we have workplaces where we can be human, where we're renewed. things that uplift our soul, which really comes down to building positive connections, positive meaning, and positive emotions. Those three things are really at the cornerstone of creating a flourishing organization. Thank you so much to all three of you. I feel like if we walk away today with knowing that we should take care of ourselves as Kim have said, to remember that we're human and stay human like Jared said, and Amy like you've encouraged us to make one small change, it is possible to build different healthcare organizations. Thank you very much. Thank you so much for having us. Thank for taking the time to join us for this discussion. learn more about our guests and to access the resources mentioned, please visit the Symptom Media podcast page at SymptomMedia.com. We look forward to having you with us again for our next important conversation.