So, Karen, I think the first question that I have, and this is an issue that I've been really interested in for some time, is what is the single... If you were going to give a frontline clinician one piece of advice on something they could do for themselves, what would that one thing be? And if you could give them a piece of advice about one thing that they should advocate for in their institution, what would that be? I can start with the easier, because it's a summary of the lecture, really of what could they do in... It's just, I think, starting the discussion, or if there is an initiative, asking what that initiative is, because I can't tell you how many people in leadership I've talked to who said, nobody fills out our survey. And when there's no input that goes up to leadership, then there's going to be no action. I think on an individual level, I think self-reflecting, just... I tell you, I want to make this app. How often is the... We catalog our food intake and our exercise in that, but if you looked at how many decisions you make in favor of work and in favor of home, just catalog and see what that looks like. I'm wondering if you could comment a little bit on the relationship between burnout and depression, and particularly not thinking so much about ourselves, but as mental health clinicians, we often see colleagues throughout medicine or behavioral health that come to us. And if you have thoughts on what other things might be on our differential diagnosis, besides burnout, if someone comes in and says, I'm feeling really burnt out, are there other things we need to be thinking about? Well, that's a very important point. And I'm not trying to say everything's burnout and nothing's depression. That would be a mistake. We also... I saw someone who was working 80 hours and it just seemed unmanageable. She described it as a culture of blame and shame and her work environment. And she said to me, I think I'm depressed, but if I worked in a bookstore that had a slow pace and I was sleeping regularly, I don't think I'd feel this way. And so sometimes we're treating a depression and indeed it has all the hallmarks of depression, but what's so important and what was important for me to see what choices she could have in her life? Because I do think that there's a relationship between... Not that all burned out people are going to end up depressed, but we can't deny that there's a relationship between the two. There's a question that came in around the hidden curriculum. It says, I'm curious about the hidden curriculum that emerges. What happens if new staff enter an already burned out institution? Do we observe burned out behaviors without the subjective experience of burnout? And I guess in addition to the hidden curriculum, the idea of contagion and how that affects workplaces. That's an excellent question. I talked to someone from AAMC the other day and he said the major concern about the trainees were that their supervisors and mentors were often unhappy and cynical. So these were their role models and who they were learning care from. I think this just points to the negative consequences of not addressing burnout because it's hard to ask people to do what you can't even muster, collegiality, recognition rewards for your trainees. And I think what's impressive now is younger trainees are coming in and asking for something different. It's no longer the day where you come and you expect to work long hours and you're not going to say anything. And if you see something, it's going to be swept under the table. So it's not the responsibility of the trainee to change the hidden curriculum. That's not their responsibility. But I think their voice is propelling us to begin to look at this and take it seriously. Change is slow. But I think it is an exciting time. We're rethinking our models of health care. Well, one of the questions we have is from a certified peer support worker who feels as though one of the contributions to his or her own burnout relates to a hiring manager not taking him seriously. And so I'm wondering if you could comment a little bit about the, and you mentioned this a little bit in your talk, but comment further about the relationship between perceived value in an organization and how people can address feelings around self-efficacy within the work environment and the contributions that they bring into the workplace. There's a very good example of a situation where people can be left feeling like, I can't change this. This is a top-down organization. And just wonder from that individual, what would happen if they brought that forward and said, there are often times where I don't feel appreciated and my contribution is in the field doing this and this and this and this. And helping the team or having the leadership recognize that and the leadership then help the team interaction. I think we all can benefit from more situational awareness and emotional intelligence training. So if you were going to go back today to your institution and say, just like that nursing curriculum, communication skills, what would be the top items? And 9 times out of 10, it's improving communication and finding a way to really mobilize people to understand we're only as good as the whole organization and that each one has a vital role. That is just such an important part of value alignment in team building. We have another question. It says, when there's a hectic environment, what are the suggestions on the appropriate time of day to have discussions about burnout? Morning in the morning, after hours. I guess it speaks to a broader question around how do you bring up this topic within the workplace? Does it have to be brought up by leadership or can frontline folks feel empowered to raise and start these conversations themselves? And when and how should they do it? Well, I think in my experience, when people go to leadership and say we're burnt out, often they don't get the kind of response that they would hope. So those small stakeholder groups are very important. When people look at what's burning them out, and you have strength in numbers. And so if people can say the intake process or whatever really seems to drive the greatest inefficiency. And I wouldn't start with our caseloads should go from 50 to 25 because you're engaging leadership. But to start smaller and come together with a solution focused, we think one of the things could improve morale, could improve patient flow. Many of you are trained in the lean, the six sigma. And if it's practice efficiency that's driving, or maybe it's lack of culture and collegiality. So getting together and saying, we think we need, if you're not going to get a three day retreat, we need a one hour retreat. So where we all check in and check in with each other. There's small things that you can do. A friend of mine was a surgeon and she said it was just a really abrupt culture and lack of collegiality. And she started every staff meeting by the person checking in. And it was a very short check in. And what they found out was my dog died. My partner graduated from a training program. And just taking one minute to check in before a staff meeting can be impactful. Because we're so busy talking about the client, the patient, the other, having that moment of self-reflection built into the culture. Then sometime if you feel like someone's not carrying their load and you hear a bit about what's going on, then it's put into a different perspective.

burnout

frontline clinicians

mental health

work environment

organizational culture