Mike Ivy is not someone you would expect to contemplate taking his own life.

His experience and accomplishments communicate grit and resilience. A trauma, critical care and acute care surgeon by training, Dr. Ivy grew up in the U.S. Navy. His father was a submarine sailor; Mike joined the Navy to pay for medical school and served nine years active duty. Following the Navy, he completed a fellowship at Yale in surgical critical care then held a series of increasingly senior leadership positions at hospitals in Connecticut. Presently, Dr. Ivy is Deputy Chief Medical Officer for the Yale New Haven Health System, which comprises more than 26,000 employees, including 6,685 medical staff.

We first met Dr. Ivy in June 2019 when he was interim CEO of Bridgeport Hospital. After hearing us speak at Yale New Haven Health System’s Annual Directors Meeting, he brought us in that fall to lead a workshop on cultivating a culture of connection. Katie and I were inspired by the respect the Bridgeport Hospital leadership team had for Dr. Ivy and the connection they felt to him, and by his desire to enhance connection in the work environment so that each person could thrive and do his or her best work. Currently we’re working with Dr. Ivy and his colleagues on connection culture leadership training for a group of physician leaders and nurse leaders at Yale New Haven Hospital.

Dr. Ivy is an outstanding leader. He’s also an example to all of us that getting help when stress or adversity is taking a toll on your outlook on life is not a sign of weakness but rather a sign of wisdom, courage and strength.

In this podcast interview with Becker’s Hospital Review, Dr. Ivy recounts his experience. It happened during a period earlier in his career when his leadership responsibilities increased while fewer colleagues were available to help carry the load. He felt the ongoing stress of being stretched thin and not wanting to let others down. He began to burn out and so did his colleagues. Although he prided himself on being able to solve problems, he couldn’t see a way to address the people shortage given financial constraints facing the hospital. In addition, Dr. Ivy felt a sense of guilt from being away from home so much and missing important family events. Gone was a joy he previously experienced in life. Eventually, he lost hope that things were going to get better. He began to experience suicidal thoughts and developed a plan about how to do that.

At this critical juncture, Dr. Ivy recalled hearing in medical school that when someone begins to develop a plan to commit suicide, it’s time to get professional help. He reached out for help. “I started seeing a therapist,” he explained in the interview. “Therapy works. It worked for me. It helped me a lot… tremendously. It takes some time. I think you have to recognize that you are worth the time every week—whether it’s a few hours a week or an hour a week. If you stick with it and are open during the discussions, you can get better. And I did. I came out of it and have gone on and had a good career.”

Dr. Ivy’s experience is certainly relevant to people who work in healthcare today. The ongoing stress they experience during the pandemic makes them more vulnerable to emotional health issues. According to one recent research study, 51% of healthcare workers said their mental health has deteriorated during the pandemic and another 42% said their day-to-day lives have suffered during the pandemic. Because 1 in 5 individuals working in healthcare have quit their jobs during the pandemic, those who’ve remained are carrying a heavier workload. Dr. Ivy shares his story and encourages those in healthcare who are struggling with emotional health issues to seek therapy because he knows firsthand that it works.

Connectedness to reduce burnout and suicide

The last time I (Michael) wrote about the role that increasing relational connection can play in addressing burnout and suicide was in early 2020. In “Boost Connectedness to Reverse the Rise of Suicides in America,” I described the impact that having a lack of sufficient connection can have on us and shared how the Centers for Disease Control adopted “connectedness” as a strategic direction in its efforts to reduce suicides in America.

I included a personal story about a friend of mine who committed suicide and how the final time I had seen him, he had smiled and waved at me from across a crowded room. If there was something wrong, he would have shared it with me, or so I thought. Had I missed something?

I shared insights from Dr. Ted George, a neuroscientist and practicing psychiatrist. Suicidal individuals tend to feel lonely or isolated, and overwhelmed with emotions. On the outside, though, they may look like nothing is wrong, so people around them may be unaware of the emotional turmoil they are experiencing. Suicidal patients who managed to find a way to dig their way out of despair initially felt that talking was a waste of time. Yet they came to realize that talk therapy helped them “find new roads they never knew were there” and provided a “switch to turn on a light at the end of a dark tunnel,” replacing hopelessness with a vision for how to live.

A critical time for connection

According to research, physicians, lawyers, engineers and scientists tend to be the loneliest professions, and that makes them especially vulnerable to emotional health issues. But they are not the only ones. Loneliness is a subjective feeling; you can be surrounded by family, friends and colleagues and still feel profoundly lonely. Loneliness is a stressor because our brain perceives the lack of social support as a threat. And when our body shifts into a state in which it is on guard to react to a threat and stays on alert indefinitely, then our physical health suffers too.

Many people today are struggling. This is to be expected, given we are in the midst of a global pandemic that has dramatically altered our everyday lives, boosting stress, loneliness and social isolation. Unfortunately, the Covid-19 pandemic appears to be with us for the foreseeable future as the coronavirus continues to mutate into more transmissible and potentially harmful variants. As of Dec. 7, 2021, the number of deaths attributed to Covid-19 in the U.S. alone has topped 788,300 and more than 5,261,800 individuals have died worldwide.

Grief, trauma and considerable change have touched all of us in some respect at a time when our ability to connect with others in the ways we were used to has been curtailed. Enduring the pandemic has highlighted or reinforced how much we need connection and supportive relationships, especially during times when grit isn’t enough. None of us can get through life’s inevitable sustained times of adversity alone. And we shouldn’t want to.

This is a critical time to stay connected to others, for the sake of our own health, and so that we can effectively reach out to support others. Connection and resilience practices we’ve written about in the past, including sharing our weekly highs and lows, never worrying alone, serving others, staying physically active, engaging in prayer/meditation, and regularly taking time to think about what we’re grateful for, help us be our best selves so that we can thrive. These practices also help strengthen our emotional health so we can be a positive force in the lives of our families, friends, colleagues and community.

Please, if you are considering suicide or someone you know is, don’t stay silent. Call the National Suicide Prevention Hotline at 800-273-TALK (8255) or reach out to your physician or an emotional health professional.

If your organization is seeing signs that people are struggling, let’s talk. In recent years, we have been contacted by several organizations in healthcare, education and the U.S. armed services that were specifically concerned about suicides in their ranks. We have helped train their leaders on how to cultivate relational cultures of connection that help people become smarter, happier, more productive, and more resilient to cope with stress. You can reach us at mike@connectionculture.com or 203-422-6511.

This article was co-authored by Katharine P. Stallard.

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By Michael Lee Stallard and Katharine P. Stallard

It is customary for your doctor to ask you how you are doing when he or she enters the exam room. We’ve come to expect it. Typically, it is the opening question in a conversation to assess how you are really doing. But how often do you ask your doctor the same question?

A Heavy Load

Practicing medicine these days is stressful. Demands of productivity drive increasing numbers of patient visits or procedures on a given day. In addition to caring for patients in the exam room or operating suite, physicians face challenges of navigating the reporting requirements of new payment models. Electronic medical records add extra work hours to most physicians’ days due to unfriendly user interfaces and lack of interoperability, putting information management on the list of their responsibilities. It can be disheartening to work in a broken healthcare system where patients still struggle to have coordinated care and basic needs met. Finally, in the internet era, physicians have experienced decreased societal regard for hard-won professional knowledge and experience.

The medical professionals we either know personally or as patients are well-intentioned and work very hard. Still, knowing what we do about the impact of stress, we’re concerned for all those who run the risk of lacking sufficient social connections to maintain good health for themselves. Despite all of the time spent interacting with patients and staff, a recent article in Harvard Business Review cited physicians as among the loneliest professions. The combination of chronic stress and loneliness is contributing to the epidemic of physician burnout which research has shown may be the primary cause of medical errors.

Social connection is a primal human need, as research has borne out. Biologically, it appears to improve the cardiovascular, endocrine and immune systems’ performance. Lacking sufficient levels of connection is associated with poorer cognitive performance, impaired executive control and self-regulation, lower levels of self-rated physical health, substance abuse, depressive symptoms and suicidal ideation.

This excellent article in The Atlantic, “Physicians Get Addicted Too,” provides a cautionary tale of what can happen when under pressure. It unfolds the poignant story of Dr. Lou Ortenzio, a beloved family practitioner in West Virginia who was seeing 40-50 patients a day and working from 9:00 a.m. until 9:00 p.m. or even later. His desire to serve his patients well and an unrealistic work schedule squeezed out time for family and friends. (When we saw those clues, we knew trouble was ahead.) The high stress of a demanding work schedule plus low social connection combined to make Ortenzio vulnerable to the emotional and physical consequences of stress. He began to have trouble sleeping and he gained weight. His first step on the slippery slope into unintended addiction came one evening in 1988 when he reached for a sample he had in his office of extra-strength Vicodin (which has acetaminophen and hydrocodone, an opioid) to relieve a tension headache so he could finish seeing patients on that day’s schedule. It helped. As his addiction grew overtime to taking 20-30 pills a day, he turned to writing prescriptions in his children’s and friends’ names to feed a growing habit. His life took a turn in 2004 and he “managed to taper off the drugs.” Shortly after, the prescription fraud was discovered and it led to the loss of his medical license in 2006. Today, Mr. Ortenzio heads his church’s ministry, Celebrate Recovery, to help addicts.

Effects of Trauma

Another factor that those of us on the receiving end of medical care don’t often think about is the emotional toll of caring for sick people and those with chronic conditions or a terminal diagnosis. To begin to appreciate the emotional demands people in healthcare routinely face, read this eloquent article by oncologist Dr. Martee L. Hensley, “What Do You Say When She Is No Longer Living with Cancer.” Recognizing the role of her entire team in the care of her patients, internist Dr. Holly Dahlman established a bereavement practice.  When a patient or close family member passes away, the whole staff team will sign a card of condolence for the next of kin. They will pause for a moment of silence at staff meetings after patients have died.

The effects of trauma also factor into burnout, which progresses from emotional exhaustion to depersonalization to a diminished sense of personal accomplishment. Trauma makes people more vulnerable to stress and feeling threatened. People who are traumatized may suffer damage to part of the brain that can lead to emotional shutdown, as described in the insightful book Untangling the Mind: Why We Behave the Way We Do by Dr. Ted George, a neuroscientist and psychiatrist.

In Finding Heart in Art: A Surgeon’s Renaissance Approach to Healing Modern Medical Burnout, Dr. Shawn C. Jones shared how trauma experienced in his practice as a board-certified otolaryngologist-head and neck surgeon led to experiencing alexithymia. He described the condition this way: “… [I] was completely unable to identify or feel anything in the way of happiness or sadness, anger, or calm. I felt no connection to anything —myself, my family, my associates, my patients. I felt completely disconnected from the world around me.” Given the isolating effect of alexithymia, feelings of loneliness are exacerbated. Fortunately for Dr. Jones, he didn’t merely carry on in that state of “emotional numbness.” He sought professional help, recovered and returned to practicing medicine. He went on to become president of the Kentucky Medical Association and in 2016 was honored with the association’s Distinguished Service Award.

A Simple, Memorable and Actionable Model

In our work to raise awareness of the need for connection and how to infuse it in a work setting, we present leaders with a simple, memorable and actionable model that captures the important elements: Vision + Value + Voice. Put simply, communicate a Vision that inspires and unites people, Value people as human beings and not just means to an end, and give people a Voice to express their opinions and ideas. We explain how these elements meet universal human needs in the workplace for respect, recognition, belonging, autonomy, personal growth, meaning and progress.

If you are burning out or disengaged at work, you can use the 3V model as a diagnostic tool to examine your experience. Where is there a breakdown? What might you do, individually,to turn it around? Dr. Jones’ practical advice to fellow medical personnel based on his own journey includes these exhortations: “Take some time to remember what led you to choose medicine as a career and develop a way to tap into that meaning. It seems easy for that to get lost in day-to-day minutiae.” [Vision]; “Develop a cadre of friends with whom you can be real.” [Value]; and “Start a discussion group on [the issue of burnout] at whatever level you serve. That will help to build a sense of community.” [Voice].

The Need for Cultures of Connection

It’s important for those in the medical field to understand the positives of connection and the negatives of disconnection, and to act to improve and safeguard their own health. That said, there is a related piece that needs to be addressed: Healthcare is an industry that desperately needs to improve the cultures of its organizations, big and small.

The high rate of physician burnout and suicide are signs that the cultures in many healthcare organizations are not healthy cultures of connection. Instead, you’ll find cultures that tend to isolate people through unrealistic work demands combined with overcontrolling attitudes, language and behavior, or cultures that are indifferent to our human needs for connection. (It should be noted that data show that nurse burnout rates are extremely high, too.)

According to Dr. Jones, “Medical institutions are in dire need of physicians who are willing to take a stand and demand that the medical work environment improves for the good of the patient, the caregiver, and the healthcare system. It is imperative that physician well-being becomes a principal concern. It is a public health crisis that needs to be addressed now.”

Encouraging Signs

We recently spoke about our work and book, Connection Culture, to more than 300 leaders at Yale New Haven Health’s Annual Directors’ Meeting. In conversations we had with several people it was encouraging to see how many leaders at one of America’s top-rated healthcare organizations are intentionally cultivating a culture that will enable physicians and staff to perform their very best work, and ultimately help maximize patient outcomes in the battle against sickness and disease.

We are also encouraged to see that education of rising professionals in healthcare is beginning to include the importance of human connection and connection culture. The new medical school at Texas Christian University, where we work as consultants to the TCU Center for Connection Culture, is intentionally developing empathic scholarsTM using an “interdisciplinary curriculum designed to build skills in awareness, listening, inquiry and engagement to foster exceptional connections between physicians and their patients, their teams and their communities.” Incorporated in the education is a Physician Development Coaching program which pairs each student with a coach and other student team members. The coaching relationship will “assist in the development of resiliency, collaboration, communication and continuous improvement for personal and professional development.”

There is evidence that it may take well over a decade for healthcare research to be applied in clinical settings. We’re hopeful that the lag time will be far shorter in the case of connection — for the sake of those who work in healthcare and for our sake, as their patients.

About the Authors

‍Michael Lee Stallard, president and cofounder of Connection Culture Group, is a thought leader and speaker on how effective leaders boost human connection in team and organizational cultures to improve the health and performance of individuals and organizations. He is the primary author of “Connection Culture” and “Fired Up or Burned Out.” A three-time cancer survivor, Katharine Stallard is a partner of Connection Culture Group and a contributing author of “Connection Culture.”

Photo by Online Marketing on Unsplash.

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Much has been written about America’s loneliness epidemic, including in the workplace. The word “loneliness” in the work context is a misnomer. It doesn’t capture the whole story.

What about all of the individuals who might not think of themselves as lonely and yet the demands of work and task-oriented activities such as time in front of screens have crowded out time for anything more than superficial relationships? Many people lack sufficient, positive human connection (or social connection) and may be unaware of the ramifications. Left unchecked, the deficiency of connection today presents widespread risks not just to individuals but to organizations.

From a biological standpoint, social connection is a primal human need. Its presence appears to improve the cardiovascular, endocrine and immune systems’ performance. In contrast, studies have shown that “disconnection” is unhealthy for individuals:

• Loneliness is associated with poorer cognitive performance, including poorer executive function and social cognition.
• Loneliness may impair executive control and self-regulation, including with respect to greater smoking and alcohol consumption.
• Social disconnectedness is related to lower levels of self-rated physical health.
• Loneliness is associated with substance abuse, depressive symptoms and suicidal ideation.

Given these findings, it follows that researchers found greater employee loneliness leads to poorer task, team role and relational performance. One might assume that the higher up the organization you go, the more connected you feel, but that isn’t necessarily the case. Research reported in Harvard Business Review found that half of CEOs report feeling lonely and 61% of those CEOs believed it hindered their performance.

Prevalence of Social Disconnection

A considerable amount of evidence suggests that social disconnection is prevalent today. Based on its research findings, Cigna reported data in 2018 that chronic loneliness in America has reached epidemic levels. This is consistent with an earlier analysis on the potential public health relevance of social isolation and loneliness.

Looking forward, it would appear that over the next decade the workforce may become even more disconnected. Since 2011, research on adolescents has found they spend more time interacting with electronic devices and less time interacting with each other, while also experiencing declining well-being. As artificial intelligence further increases the presence and role of machines in people’s day-to-day lives, an unintended consequence is that technology may diminish people’s ability to connect.

The Role of Chronic Stress

Why is social disconnection problematic in the workplace? In answering this question one ought to address the topic of stress. While it is a term we often hear, it is difficult to fully comprehend the far-reaching psychological and physiological consequences associated with stress.

In measured amounts, stress serves to ready the nervous system for the task at hand. Here, odd as it sounds, stress can be a good thing. However, as Dr. Ted George of the National Institutes of Health describes in his book “Untangling the Mind,” stress can have negative effects. With increasing levels of stress, the nervous system processes the stress as a threat. In extreme circumstances, stress moves the individual from being guided by rational thought processes to the instinctual responses characterized as “fight,” “flight” and “shutdown.”

When people experience chronic stress, they don’t feel well and often resort to ingesting substances or engaging in behaviors that provide temporary relief. The danger is that this may lead to developing addiction. In a review of 83 studies on addiction with at least 500 subjects, Sussman et al. (2011) found that nearly half the adult US population suffers from one or more addictions that have “serious negative consequences.” The addictions studied included substance addictions (alcohol, eating disorders, mood-altering legal and illegal drugs, and tobacco) and process addictions (dependence upon busyness and work, exercise, gambling, online gaming or social media, shopping, love and sex).

One of the best-known means to cope with stress is to increase positive social connections. Being in an environment that fosters supportive relationships and human connection serves to stabilize the responses of the nervous system, preventing it from processing the stressor as a threat.

Cultures of Connection

UCLA neuroscientist Matthew Lieberman describes social connection as a “superpower” that makes individuals smarter, happier and more productive. Leaders at all levels of an organization would be wise to assess workplace culture through the lens of connection. Are attitudes, uses of language and behaviors drawing people together and connecting them? Or are they creating a stressful and/or relationally-toxic environment that pushes people apart?

In our research, we found that cultures of connection are best for individual well-being and for helping organizations thrive too. Specifically, cultures of connection convey several performance advantages upon organizations including higher employee engagement, tighter strategic alignment, superior decision-making, greater innovation and more adaptability to cope with rapid change taking place in the world today. These advantages add up to a powerful competitive advantage.

World’s Best Hospital Has Connection in Its DNA

The power of connection is on full display at Mayo Clinic, America’s top-ranked hospital and arguably the best hospital in the world. From the time of its founding in 1889, Mayo Clinic has been intentional about cultivating connection and community. Will Mayo, one of the earliest leaders, communicated an attitude that valued connection and warned about the dangers of isolation when he stated: “Our failures as a profession are the failures of individualism, the result of competitive medicine. It must be done by collective effort.”

One of the ways this is manifest is in Mayo Clinic’s practice of compensating physicians through paying a salary rather than by an activity-based system. Not only does this promote collaboration for the good of the patient but it also alleviates the financial and time pressure of trying to see too many patients in a day, which often serves to diminish the physician-patient connection.

Mayo Clinic’s stated mission and values point to being guided by the intent of its founders, the original Mayo physicians and Sisters of St. Francis. Mayo Clinic’s mission is “To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research” (italics mine). The language used to describe its values includes the following:

• “Compassion … [that treats] patients and family members with sensitivity and empathy,”
• “Healing [that nurtures] the well-being of the whole person, respecting physical, emotional and spiritual needs,”
• “Teamwork [that values] the contributions of all, blending the skills of individual staff members in unsurpassed collaboration,”
• “Innovation [to] infuse and energize the organization, enhancing the lives of those we serve, through the creative ideas and unique talents of each employee,” and
• “Excellence [that delivers] the best outcomes and highest quality service through the dedicated effort of every team member.”

Notice that words and phrases that reflect and enhance connection are woven throughout: sensitivity, empathy, treating the whole person (including emotional and spiritual needs), teamwork, blending skills of the team, unsurpassed collaboration, each employee and every team member.

Mayo Clinic’s belief in the importance of connection goes beyond attitudes and language to practical steps taken to see that connection is infused in the culture. Mayo Clinic’s onboarding process for physicians and scientists includes extensive training in professionalism and communications, and assessments to help them develop emotional intelligence which is instrumental to connecting with others.

Physician leaders are selected, developed and assessed based on their ability to connect, which includes listening, engaging, developing and leading other physicians. Informal opportunities for connection among colleagues is encouraged by providing dedicated meeting areas for physicians to gather in.

Mayo Clinic’s intentionality and commitment is evident in a program called COMPASS (COlleagues Meeting to Promote and Sustain Satisfaction). Under this initiative, self-formed groups of 6-10 physicians get together for about an hour every other week, usually over breakfast or lunch, with up to $20 provided to each participant to cover the meal cost.

During the meal, physicians spend at least 15 minutes focused on discussing assigned issues related to the physician experience, such as resiliency, medical mistakes, work-life balance and meaning at work. Mayo Clinic’s research has found that participants in COMPASS experience statistically significant improvements in multiple domains of well-being and satisfaction that will help reduce the risk of physician burnout and reduce medical errors.

Conclusion

For-profit organizations can develop cultures of connection, too. Consider the connection culture of Costco, which Forbes and Statista research has consistently recognized as among the best large company employers in America, or the connection culture Alan Mually cultivated when he led the turnaround of Ford.

Our current epidemic of social disconnection has arisen from multiple avenues including loneliness, social isolation and the busyness and increased screen time of modern life crowding out time for face-to-face human connection. Social disconnection is making people more vulnerable to the negative effects of stress. After one considers the prevalence and effects of social disconnection throughout an organization, it can be argued that social disconnection presents a systemic risk.

Connection matters. Organizations should be intentional about developing and sustaining cultures of connection that provide the structures and needed psychosocial support to foster inclusion and teamwork, minimize stress and reduce error — all of which will promote superior organizational outcomes. The net benefit amounts to better employee and organizational health, resilience and performance.

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This article was originally published by SmartBrief. Photo by Alex Kotliarskyi on Unsplash

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Kathy Bloomgarden, CEO of Ruder Finn, wrote a compelling article in Fortune about how the healthcare industry is slowly losing the very essence of healthcare: human connection.

Like Ms. Bloomgarden, we’re concerned about the decline of human connection in the patient experience. We’re also concerned that a decline of doctor-patient connection is contributing to alarming rates of physician burnout which research has shown is associated with medical errors.

For these reasons, we’ve been working with healthcare organizations for more than a decade to boost human connection by creating Connection Cultures.  Read more about it in articles we’ve written for Becker’s Hospital Review including “Creating a Life-Giving Connection Culture in Healthcare Organizations,” “3 Practices to Protect Your People from Toxic Stress and Burnout,” and this podcast on improving cultures in healthcare organizations that we did while speaking at The University of Texas’ M.D. Anderson Cancer Center.

The post Danger in Healthcare Losing Its Very Essence: Human Connection appeared first on Michael Lee Stallard.

Marianjoy Rehabilitation Hospital, a part of Northwestern Medicine, is an elite performing healthcare organization in terms of patient satisfaction, employee engagement and financial performance. Marianjoy is composed of a network of 500 inpatient medical acute/sub-acute beds and outpatient rehabilitation services delivering a full range of multispecialty services to adults and children in the greater Chicagoland area. More than 50,000 patients receive care within the Marianjoy service network annually.

Marianjoy is led by Kathleen Yosko, its president and CEO. A life-long learner, Ms. Yosko, in addition to being a nurse by background, has earned M.B.A. and Ph.D. degrees. Ms. Yosko is a source of inspiration to the people she leads. She is an example of a leader who communicates an inspiring vision and lives it, as can be seen throughout her remarkable career.

Overcoming Obstacles to Serve Patients Well

As a relatively new nurse during the height of the Vietnam War, Ms. Yosko was assigned to work with paraplegic and quadriplegic former solders at a Veterans Administration Hospital in Pittsburgh. She noticed the regular “cat calls” and comments from male patients about the attractiveness of women. While others chose to overlook this behavior, Ms. Yosko realized it was a sign the men were longing for sexual intimacy and stressed about that aspect of their lives going forward, given the nature of their injuries.

Historically, this particular need of returning veterans was ignored by healthcare practitioners. To Ms. Yosko, it was a problem to be solved that would help her patients. She went on a mission to learn about male sexual function and anatomy, even though her medical colleagues discouraged her from talking with patients about sexual intimacy. Undeterred, she read books and sought advice from experts, eventually becoming an expert herself and going on to counsel scores of veterans and their wives.

Serving the Poor in Chicago’s Gang-Infested Westside

Not one to back down from a challenge, from 1978 to 1998, Ms. Yosko became the president and CEO of Schwab Rehabilitation Hospital and Care Network on the west side of Chicago. Schwab faced many challenges because it catered primarily to the poor, including gang members who required rehabilitation following injuries from gun violence.

Under Ms. Yosko’s leadership, Schwab Rehabilitation Hospital’s performance improved across the board and it experienced extensive growth. During her tenure, a replacement hospital was completed. Schwab now operates eight satellite facilities in the Chicago area. Ms. Yosko’s success transforming Schwab caught the attention of officials at Marianjoy Rehabilitation Hospital who in 1998 recruited Yosko to be its president and CEO.

Building the Best

In her early years of leading Marianjoy, which is based in the suburb of Wheaton about 30 minutes west of downtown Chicago, Ms. Yosko found people were afraid to speak up so she encouraged them to share their ideas and opinions in order to find opportunities to make the organization more effective. Over time, she gained people’s trust that she truly does want to hear their points of view. And speak up they did! One year the report of Marianjoy’s annual employee engagement survey included 80+ pages of optional comments, even though its engagement scores were near perfect. Typical of Yosko, she read every comment, looking for patterns that would reveal a problem or an opportunity to improve.

Yosko is a straight-talking, open-minded leader. When revenue was down one year due to changes in Medicare reimbursement, she explained to the people who worked at Marianjoy why she had to freeze salaries. This announcement was followed shortly thereafter by the organization’s employee engagement survey. Yosko feared that engagement scores would plummet from the stellar 98^th percentile she was accustomed to seeing. To her surprise, engagement scores for the first time hit the 99^th percentile among healthcare organizations nationwide.

Under Ms. Yosko’s leadership, Marianjoy continuously strives to be a leader in improving the state of rehabilitation medicine. For example, the organization launched AbilityLinks.org, an award-winning website that matches jobseekers who have a disability with businesses seeking to hire qualified workers. The program has increased employment opportunities for people with disabilities. More recently, Ms. Yosko secured philanthropic gifts to fund the cutting-edge Tellabs Center for Neurorehabilitation and Neuroplasticity.

National Leader and Advocate for the Disabled

Throughout her career Ms. Yosko has been active nationally in the field of rehabilitation. She has served as the chairperson of the American Medical Rehabilitation Providers Association, a nonprofit trade organization representing freestanding rehabilitation hospitals, rehabilitation units in general hospitals, outpatient rehabilitation facilities, several skilled nursing facilities, and home health agencies. Ms. Yosko has also served as the chairperson of the Commission of Accreditation of Rehabilitation Facilities (1997), and as the chairperson of the American Rehabilitation Association (1994), a Washington, D.C.-based organization representing providers of rehabilitation services.

Living the Vision

Marianjoy’s vision is to be recognized for superior and compassionate patient service, clinical excellence, and as the health care employer of choice and the preferred partner of physicians in each community it serves. From helping wounded warriors with disabilities to leading the improvement and expansion of two rehabilitation hospitals, and becoming a national leader and advocate for people with disabilities, Kathleen Yosko’s career journey shows that she lives this vision.

In many organizations, excellent leaders lead well, even though they haven’t lived the vision of the organization they lead. When a board of directors is fortunate to find a leader who lives the organization’s vision, like Kathleen Yosko does when it comes to rehabilitation medicine, it can provide an additional powerful boost to lift the organization’s performance even higher.

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The post When Leaders Live the Vision appeared first on Michael Lee Stallard.

In his excellent TED Talk titled “Doctors make mistakes. Can we talk about that?,” physician Brian Goldman describes the first medical mistake he made, how he made mistakes “over and over again,” and how the culture he worked in made him feel “alone, ashamed and unsupported.” The culture Dr. Goldman describes contributes to widespread burnout in medicine today and it makes future medical mistakes more likely.

Over the years, I’ve taught at, consulted to, or analyzed and written about many technically-oriented organizational cultures where the cost of mistakes and accidents is high, not just financially but in human terms. These organizations include hospitals, cancer centers, medical device makers, the armed forces, military contractors and NASA. Organizations such as these do extremely important work that is of great value to society.  Their employees know their work is important and they feel a sense of pride about it that has a positive effect on motivating them to strive to achieve performance excellence. Stated another way, the Connection Culture element of Vision is strong. I’ve observed that the frequent weakness, however, is that the Connection Culture elements of Value and Voice are less than ideal. These weaknesses make the organizations and their employees vulnerable.

When the Connection Culture Element of “Value” Is Weak

The Connection Culture element of Value exists in an organization when everyone understands the needs of people, recognizes their unique contributions, and helps them achieve their potential. This state makes people feel valued by their supervisor and colleagues.

When Value is weak, people are more likely to feel unsupported, left out, lonely and disconnected. They lose motivation to give their best efforts, align their behavior with organizational goals, proactively communicate, collaborate and cooperate. In extreme cases, they work against the interests of their organization as a form of retaliation for not feeling appropriately valued. This leads to more mistakes and accidents, and it increases enterprise risk from fraud.

When the Connection Culture Element of “Voice” Is Weak

The Connection Culture element of Voice exists in an organization when everyone seeks the ideas and opinions of others, shares their opinions honestly, and safeguards relational connections. It’s evident that Voice is at issue in the culture Dr. Goldman describes in which he felt that it was unsafe to speak up about mistakes.

Cultures that are weak in Voice are breeding grounds for knowledge traps, i.e. forms of relational dysfunction that trap knowledge within an organization so that it doesn’t get to the individual who needs it in order to make optimal decisions. Knowledge traps come in several forms, including a lack of humility to routinely seek the ideas and opinions of others, rivalries, a lack of safety and honesty in a culture, and departmental silos and fiefdoms.

The culture Dr. Goldman describes creates a knowledge trap by failing to openly address the conditions that led to the medical mistake. When Voice is weak, others may never learn how to mitigate the risks that contributed to a colleague’s mistake that might have been avoided. They miss the opportunity to learn and put safeguards in place to make future mistakes less likely.

Connection Culture Contributes to Performance Excellence

The best culture is a Connection Culture. Connection is a bond based on shared identity, empathy and understanding that moves individuals toward group-centered membership. A Connection Culture is created and maintained when leaders communicate an inspiring vision, value people and give them a voice. Few leaders naturally do this well.

Leaders who intentionally create and maintain a Connection Culture can expect to see five benefits that minimize mistakes and accidents: 1. Employees give their best efforts, 2. Employees align their behavior with organizational goals, 3. Employees communicate better information to improve the quality of decision-making, 4. Employees actively engage in efforts that lead to innovation, and 5. Employees are smarter, happier and more productive. Together, these five benefits of connection add up to a powerful source of competitive advantage.

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Could something as simple as regularly having a meal with colleagues to discuss work experience-related issues help reduce burnout? It seems too simple doesn’t it? Although several factors contribute to burnout, there is good reason to believe connection practices such as taking time to talk with others over lunch or dinner provides a measure of protection. It is certainly having that desired effect at Mayo Clinic.

In recent years the Mayo Clinic recognized that the increasing complexity of medicine made physicians feel more isolated, which is known to be a factor contributing to burnout. While lower than the national rate*, a 2015 Mayo Clinic survey showed 40% of its physicians reported at least one sign of burnout. To reduce isolation and burnout, Mayo Clinic began experimenting with programs that brought physicians together in groups to discuss issues related to their profession. Results were promising so they’ve continued to experiment and improve upon what they’ve learned.

The most recent program is named “COMPASS” (Colleagues Meeting to Promote and Sustain Satisfaction). COMPASS brings self-formed groups of 6-8 physicians together for meals every two weeks and provides $20 to each participant to cover the cost of the meal. The terms of COMPASS require participants to begin the time together with a 15-minute discussion on assigned issues related to the physician experience, such work-life balance, medical mistakes, meaning at work and resiliency.

After studying a control group of 61 physicians and comparing it to the results of an intervention group of 64 physicians, the study’s authors, Colin P. West, MD, Ph.D, et al, concluded study participants experienced statistically significant improvements in multiple domains of wellbeing and satisfaction. Dr. West recently shared with me that 1,100 of Mayo Clinic’s 3,700 physicians and staff scientists presently participate in COMPASS. He said 97% of participating respondents have indicated that COMPASS is valuable.

Wired to Connect

In Connection Culture, I lay out the scientific evidence that connection makes us smarter, happier, healthier and more productive. Amy Banks, M.D., author of an excellent recent book titled Wired to Connect, uses the acronym “C.A.R.E.” to summarize the relational benefits of connection. Dr. Banks is a former instructor of psychiatry at Harvard Medical School and is presently the director of advanced training at the Jean Baker Miller Training Institute at the Wellesley Centers for Women.

C.A.R.E. summarizes four parts of the neural pathway for connection, with each pathway representing an aspect of relationships. The four pathways are as follows:

• Calm – Helps people feel calm via the smart vagus nerve.

• Accept – Helps people feel accepted via the brain’s dorsal anterior cingulate cortex.

• Resonate – Helps people resonate with others via the brain’s mirroring system.

• Energy – Helps give people energy via the brain’s dopamine reward pathway.

Using Dr. Bank’s C.A.R.E. framework, it’s easy to see why physicians participating in Mayo Clinic’s COMPASS program would report fewer signs of burnout. Regular meals with colleagues help meet the physicians’ need for connection which makes them feel calm and accepted, helps them resonate in conversations with their colleagues and gives them greater energy to tackle the considerable workload physicians have today, especially given the changing landscape of healthcare reform and the added administrative burden required to convert the industry to electronic medical records.

Changing Cultures to Promote Connection

The decades-old push for productivity in organizations has had unintended consequences. Workloads in most professions have increased at a time when attitudes have changed to effectively squeeze out time to connect with colleagues. The result is that greater workloads and less connection is making people more vulnerable to disengagement, burnout, anxiety and depression.

Ask yourself: Does my team’s culture promote connection, including going out for lunch to catch up with colleagues, or does it pressure people to eat lunch at their desks while continuing their work? If an individual goes out for a social lunch, do people brand him or her as a slacker?

It’s time for leaders to encourage people in the workplace to take time to connect. Individuals and organizations perform better when they do. I applaud Mayo Clinic for its initiatives such as COMPASS that strengthen culture and protect people from burnout. It’s intentional efforts like this to improve culture that have made Mayo Clinic the #1 rated hospital overall in the nation.

* Medscape and Mayo Clinic/American Medical Association national studies show more than 50% of physicians report one sign of burnout.

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Burnout is on the rise in healthcare. Increased stress and complexity, and the demands to achieve higher productivity are taking a toll. Each year nearly 400 physicians commit suicide, more than double the rate of the general population. Healthcare workers are also susceptible to anxiety, depression and addiction. What can be done?

One of the most effective ways to address rising pressure on healthcare workers is to foster a life-giving culture of supportive relationships that benefits all, including patients and their family members. The best practices of leading healthcare organizations and recent scientific research provide evidence that an organizational culture which fosters connection among people positively affects human productivity, wellness, wellbeing and overall performance.

Sloan Kettering’s Connection Culture

My wife, Katie, was diagnosed with advanced ovarian cancer in 2004, a year after being treated for breast cancer. While she was in the midst of six rounds of chemotherapy at our local hospital that spring, we chose to go to Memorial Sloan Kettering Cancer Center in New York City for a second opinion on her treatment plan.

I expected Sloan Kettering would be a bleak environment that reeked of death and dying. It was anything but.

I’ll never forget our first visit. As we came within eyesight of the building’s entrance a doorman named Nick Medley locked his eyes on Katie and greeted her like a returning friend. This surprised me, given that people on the sidewalks of New York City rarely make eye contact. Nick was intentionally reaching out to connect with Katie and others whom he recognized were cancer patients.

The security and administrative people we encountered were friendly and helpful, and our oncologist was informative, upbeat and optimistic.I already knew that Sloan Kettering was among the best at treating ovarian cancer. By the end of our visit, I also knew they cared.

Katie went on to do further surgery and chemotherapy at Sloan Kettering. The feeling of connection we experienced made me more optimistic about Katie’s prognosis. Earlier this year we celebrated her 12th year of being in remission for ovarian cancer.

Research supports that the medical care she received helped her survive. In addition, research has established that the psychosocial support that came from feeling connected with our family, friends and the healthcare workers we interacted with also helped Katie survive. Observing Sloan Kettering’s Connection Culture first-hand and discussing it with a wide range of employees, I know that it is helping healthcare workers too.

Creating a Connection Culture

In the context of an organization’s culture, “connection” is a bond based on shared identity, empathy and understanding that moves individuals toward group-centered membership. Organizations with greater connection experience five benefits that add up to a powerful source of competitive advantage:

1. superior cognitive and physical performance of employees,
2. higher employee engagement,
3. tighter employee alignment with organizational goals,
4. better communication that helps improve decision-making, and
5. greater employee participation in efforts to innovate.

Certain collective beliefs and behaviors promote this bond of connection among people. There are three distinct elements in a Connection Culture that can be summarized as the 3V Leadership Model, with the 3V’s being Vision, Value and Voice. Each V provides a practice that protects people from stress and burnout.

1. Communicate an Inspiring Vision

Vision exists when people in an organization are motivated by the mission, united by the values, and proud of the reputation. The M.D. Anderson Cancer Center has a strong vision summarized in the phrase “making cancer history” that appears as part of its logo. M.D. Anderson has a reputation for being one of the leading cancer research centers in the world. Its vision provides an enormous source of pride to its employees and it helps connect them.

Vision also includes an organization’s values–its core beliefs about the ways it goes about doing its work and, by inference, the ways it deems as unacceptable. For example, many healthcare organizations embrace the values of excellence, integrity, respect, and caring and compassion for patients and their families. Leaders are responsible for making these values clear. They do this by articulating them in word and deed. Because Vision leaks as people get caught up in the day-to-day tasks and lose sight of it, leaders must regularly communicate the Vision.

Most healthcare organizations are strong when it comes to Vision because workers see they are making a difference in the lives of people. Unfortunately, because of the stress on people in healthcare organizations, most are not very strong at embracing the next two elements of a Connection Culture.

2. Value People

Value is the heart of a Connection Culture. Value exists when everyone in the organization understands the needs of people, appreciates their positive, unique contributions, and helps them achieve their potential. People in a Connection Culture value others as human beings and treat them as such rather than being indifferent to them or treating them as means to an end.

Dr. Herbert Pardes is a great example of a leader who promoted Value in a healthcare culture. When he was president and CEO of the not-for-profit New York–Presbyterian Hospital, Dr. Pardes devoted time to make bedside visits to patients, something that other senior leaders might dismiss as inefficient. He understood that walking the talk influenced his colleagues.

Dr. Pardes valued employees. He put practices in place to assure that people who worked at New York–Presbyterian were caring individuals and that they would be engaged at work. He advocated that everyone should have personal and professional mentors, and he strived to help the people he led balance their personal lives and professional growth. To extend the feeling of connection outward beyond the staff, he encouraged members to memorize the names of patients as well as their family members.

By combining Value in the culture along with sound management practices, Dr. Pardes and his leadership team turned around the hospital system. New York–Presbyterian’s revenue rose from $1.7 billion in 1999 to $3.7 billion in 2011. Although most hospitals were scrambling to attract and retain nurses, New York–Presbyterian’s vacancy rate for nurses was less than one-third the national average. The New York Times observed that while “most urban hospitals have struggled, New York–Presbyterian has thrived.”

3. Give People a Voice

The third element of a Connection Culture is Voice. This element exists when everyone in the organization seeks the ideas of others, shares their ideas honestly, and safeguards relational connections. In a culture with Voice, decision-makers recognize that they don’t have a monopoly on good ideas so they are intentional about keeping people in the loop on matters that are important to them, and seeking their ideas and opinions to get different perspectives.

The Cleveland Clinic boosted Voice in its culture by holding Cleveland Clinic Experience workshops in which 40,000 physicians, nurses, environmental service workers, administrative and other staff sat together and had conversations on the patient experience they aspired to deliver.

The Science of Connection

Research shows that chronic stress damages telomeres, the caps at the end of chromosomes, by shortening them. This damage weakens the immune system and promotes rapid aging. Conversations in which people experience mutual empathy and emotional support release telomerase, an enzyme that heals damaged telomeres. A culture that fosters connection can play a role in healing the corrosive effects of stress, literally.

When the human body is in stress response it over-allocates blood, glucose and oxygen to the body’s fight or flight systems, at the expense of parts of the brain that affect memory, the digestive system, the immune system and the reproductive system.  Connection has been found to help keep the human body in a state of balance or homeostasis. Connection also helps prevent the “amygdala hijack,” in which brain activity shifts from the cortex (where we make rational decisions) to the midbrain (where there is a greater probability we will make rash decisions).

Other research studies support the positive effects connection has on organizational performance. Compared to organizations with connection/employee engagement scores in the bottom quartile, organizations with top quartile scores have been shown to experience 2.5-4.5X greater revenue growth, 21% greater productivity, 22% greater profitability, 10% higher customer service metrics, 41% lower quality defects, and 37% lower absenteeism.

Over the last decade, research studies by Gallup consistently show that two-thirds or more of employees in the U.S. are not engaged. They show up for the paycheck but don’t give their best efforts. While this may sound bleak to some, I see it as a major opportunity. Create a Connection Culture in your healthcare organization and watch what happens. You will likely see people in your organization experience greater productivity, prosperity, and joy, and your patients experience superior health outcomes.

To get started, download the free 28-page 100 Ways to Connect e-book. The attitudes, uses of language and behavior in100 Ways to Connect will help equip you to create a high-performance, life-giving culture in your healthcare organizations.

This article originally appeared on Becker’s Hospital Review. 

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At the 2015 World Business Forum in New York City, Aetna CEO Mark Bertolini laid out the most important vision at the conference: a vision to save healthcare. 

Bertolini’s message is that healthcare is broken and that he is committed to fixing it. Although his vision will be difficult to achieve, his resolve and thoughtfulness is evident.

He knows fixing healthcare is important. He knows it will have a positive effect on the length and quality of lives of millions of Americans.

Bertolini’s dedication to the cause of reforming healthcare and actions as CEO make him a clear example of a servant leader.

Servant Leadership Defined

The term “servant leadership” has been around since Robert Greenleaf coined it in 1970. Many leaders I’ve spoken with about servant leadership struggle with the word “servant” because of its link to Jesus’ words  “I came not to be served but to serve” and to the subservient nature of a slave.

Despite these concerns, I still find servant leader is an accurate description of the great leaders I’ve known and studied. These leaders serve a cause just as Mark Bertolini serves the cause of changing healthcare. Furthermore, they think of themselves and behave in ways that serve the people they are responsible for leading.

My friend Frances Hesselbein, chairman of the Frances Hesselbein Leadership Institute, once told me “to serve is to live” (now it’s her Twitter handle). There is a great deal of wisdom in this phrase.  Leaders who serve benefit from “helpers high,” an emotional state that research has found makes people healthier, stronger and more energetic. Leaders who serve also connect with the people they serve which leads to greater employee and customer engagement.

In short, a leader who serves a cause that serves others and who serves the people who serve the cause will be more effective than a leader who serves himself/herself.

Mark Bertolini is a wonderful illustration of this point.

Serving a Cause Greater than Themselves

Several experiences Bertolini had helped him develop greater empathy for people experiencing life-threatening healthcare problems. For a season, he worked as a paramedic in his native Detroit. In 2001, Bertolini’s son was diagnosed with incurable lymphoma. Bertolini took time off from work and moved into his son’s hospital room. Today, his son is alive, well, and working in Boston.

In 2004, Bertolini was seriously injured in a ski accident that fractured his neck in five places and left him struggling to recover his health. The painkillers doctors gave him dulled his mental acuity and diminished his ability to work. He gave them up for alternative medicines. Although he still experiences neuropathy in his left arm, he manages the pain with yoga and acupuncture.

Walking the journey of patients and their family members shaped Bertolini so that he has a passion and drive to reform healthcare. His vision is based on proactively making individuals healthy and productive rather than on eliminating disease (a reactive approach), as has historically has been the focus of healthcare. This mindset has also influenced how he leads people who work at Aetna.

Serving Those Who Serve the Cause

Bertolini appreciates people who work in healthcare. When Bertolini was out meeting people who worked on the frontlines of Aetna, he frequently heard people say it was difficult for them to afford the insurance Aetna offered. Bertolini asked Human Resources to look into it. When it was reported back that the employees’ comments were true, Bertolini took action. Earlier this year, he raised the Aetna minimum wage from $12 to $16 an hour.

Mark Bertolini is a CEO to watch. His mindset of serving the cause and serving those who serve the cause could very well make Aetna a catalyst for positive change in healthcare.

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Image courtesy of World Economic Forum under Creative Commons Attribution-Share Alike 2.0 Generic License. Image has been cropped. 

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Katie Stallard with daughters Elizabeth (left) and Sarah (right)

Ten years ago today, my wife’s surgeon told me she had advanced ovarian cancer.  Today Katie is cancer free and flourishing in every way.  The experience of spending more time with my family and friends during that season of supporting Katie while she underwent treatment opened my eyes to the power of connection.  I wrote about it in “Alone No Longer.”

Since the time Katie was diagnosed and treated for advanced ovarian cancer, research published in The Journal of Clinical Oncology by Susan Lutgendorf, et. al., has shown that connection provides a survival advantage to ovarian cancer patients.

The post Alone No Longer: Ten Years Later appeared first on Michael Lee Stallard.