Caring Greatly™ Podcast

Danielle Ofri, MD, PhD, is one of the foremost voices in the medical world today, shining an unflinching light on the realities of healthcare and speaking passionately about the doctor-patient relationship. She writes about medicine and the doctor-patient connection. Her writing appears in the New York Times, The New Yorker, and the Atlantic, as well as the Lancet and the New England Journal of Medicine. Dr. Ofri is a founder and Editor-in-Chief of Bellevue Literary Review, the first literary journal to arise from a medical setting, now an award-winning, independent nonprofit literary arts organization. She is a primary care internist at Bellevue Hospital and a clinical professor of medicine at NYU. Dr. Ofri has given TED talks on Deconstructing Perfection and Fear: A Necessary Emotion, and has also performed stories for the Moth. She is featured in the documentaries “Why Doctors Write” and “White Coat Rebels.”

In this episode, Dr. Ofri and I talk about an article she recently published in the New Yorker titled, “The Curious Side Effects of Medical Transparency.” We delve into how the act of exposing medical notes to patients necessarily changes their purpose and their content, and how that, in turn, changes the thinking processes of clinicians. We talk about how art and expression are both integral to and separate from the art and science of medicine. Finally, Dr. Ofri offers advice to rising clinicians about how to separate their responsibilities from their identities to support sustainable practice.

Links related to Dr. Ofri’s podcast episode:

• Dr. Ofri’s website, which includes links to her books, articles, TED talks, and the Bellevue Literary Review

Jonathan Fisher, MD, FACC’s personal mission is to help others train the mind and heal the heart. Dr. Fisher is a cardiologist, certified mindfulness teacher, and well-being and resiliency leader at Novant Health, supporting a team of 38,000. He is also the founder of Mind Heart Now, LLC, delivering keynotes and workshops on mindfulness, stress mastery, total well-being, and heart-centered leadership for teams and organizations globally. In 2020 he co-founded the Ending Physician Burnout Global Community and organized the world’s first global summit dedicated to ending clinician burnout, with over a thousand participants from 43 countries. Dr. Fisher completed his medical training at Mt. Sinai School of Medicine in New York City and Harvard University. His first book “Just One Heart: A Cardiologist’s Guide to Healing, Health, and Happiness” will be released in early 2024.

In this episode, Dr. Fisher and I talk about how he came to medicine and his experience of burnout, depression, and disillusionment in his early career. That experience led him to take a deep dive into ancient wisdom traditions, but with a scientist’s mind. We look at the seven traits of the heart (steadiness, wisdom, openness, wholeness, courage, lightness and warmth) and how bringing these into healthcare practice creates presence, connection, and, ultimately, healing.

Links related to podcast:

• Just One Heart: A Cardiologist’s Guide to Healing, Health, and Happiness presale page
• Dr. Fisher’s Linkedin

Cynda Hylton Rushton, PhD, MSN, RN, is the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, and co-chairs Johns Hopkins Hospital’s Ethics Committee and Consultation Service. In 2016, she co-led a national collaborative State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing and co-chaired the American Nurses Association’s professional issues panel that created A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice. She was a member of the National Academies of Medicine, Science and Engineering Committee that produced the report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being. She is a member of the American Nurses Association Center for Ethics & Human Rights Ethics Advisory Board and American Nurses Foundation Well-Being Initiative Advisory Board. She is the editor and author of Moral Resilience: Transforming Moral Suffering in Healthcare. Dr. Rushton is a Hastings Center fellow and chair of the Hastings Center Fellows Council and a fellow of the American Academy of Nursing.

In this episode, Dr. Rushton and I talk about the concept of values discordance, and what happens when a person perceives their personal or professional values to be out of alignment with their organization’s values. We look at the ways values play out in an organization – through leadership, decision making, and budgeting. We dig into the link between values and moral injury, and how ethics considerations need to be a central component of leaders’ wellbeing and leadership strategies. And Dr. Rushton lays out a structure for how leaders can safeguard ethics and values through leadership and safety infrastructure to support expectations and accountability, practice integration, continuous improvement, and competency building.

Links related to Dr. Rushton’s episode:

• Nursing Management article, Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic: secondary analysis
• Journal of Internal Medicine article, Working in value-discrepant environments inhibits clinicians’ ability to provide compassion and reduces well-being: A cross-sectional study

Paul DeChant, MD, MBA, is a leadership coach who works with organizations to reduce clinician burnout and create a culture of organizational wellbeing. Prior to becoming a coach and consultant, Dr. DeChant worked in multiple direct care roles, including as an ER physician and primary care physician. As a leader, he has orchestrated clinic and system growth, overseen mergers, supported EHR optimization, and chaired compensation committees at systems including Geisinger Health System and Palo Alto Medical Foundation. Dr. DeChant also served as the CEO of the Sutter Gould Medical Foundation. In that role, he oversaw transformation work focused on returning joy to practice.

In this episode, Dr. DeChant and I talk about what’s different about workplace transformation in the trailing edge of the COVID-19 pandemic. We look at the need to rethink workload as an antidote to burnout, digging deeper than the concept of exhaustion into the causes of cynicism and inefficacy. This means delving into concepts such as respect, values, and community connection. Dr. DeChant talks about management concepts such as LEAN and what it takes to apply these in ways that solve for burnout rather than contributing to it. We touch on leadership burnout and how leaders can care for their own resilience and wellbeing and then lead others on a path toward joy and wellbeing at work.

Links related to Dr. DeChant’s episode:

• Dr. DeChant’s website

J. Corey Feist, JD, MBA is a Co-Founder of the Dr. Lorna Breen Heroes’ Foundation, an advocacy and action foundation created in memory of his late sister-in-law, who died by suicide early in the COVID-19 pandemic. The Foundation’s mission is to reduce burnout among healthcare professionals and safeguard their well-being and job satisfaction. The Foundation leaders envision a world where seeking mental health services is universally viewed as a sign of strength for healthcare professionals. Mr. Feist has more than 20 years of experience as a healthcare executive and recently served as the Chief Executive Officer of the University of Virginia Physicians Group, the medical group practice of UVA Health comprised of 1200+ physicians and advanced practice providers. Mr. Feist has authored numerous publications on the need to support the well-being of the healthcare workforce. He has served as an expert in multiple forums including providing formal testimony in the United States Congress.

In this episode, Mr. Feist and I talk about the factors that led to Dr. Breen’s death by suicide in 2020. Chief among these was a fear of losing her medical license if it became known that she had needed mental health support. This legacy is what has led the Foundation to launch a campaign to eliminate intrusive mental health questions from healthcare professional licensure and credentialing processes, a change that will help reduce the stigma that currently exists in healthcare around seeking mental health support. This change is beginning to happen at healthcare institutions and in state licensing boards across the country and represents a simple yet meaningful change to creating safer healthcare workplaces for team members and patients alike.

Links related to Mr. Feist’s podcast episode:

• Dr. Lorna Breen Heroes Foundation’s licensure and credentialing campaign and toolkit
• U.S. New article: Give Healthcare Workers the Mental Health Support They Deserve
• The Physicians Foundation 2022 Physician Survey

Lisa Bukovac, DO, is Senior Vice President of Clinical Operations at OB Hospitalist Group (OBHG). She is an advocate for women’s reproductive rights and believes all women should have access to quality healthcare. Prior to joining OBHG in 2014, she served as the section chief for Augusta Health Center in Virginia. In 2018, Dr. Bukovac was the recipient of an OBHG Excellence in Clinical Leadership award.

In this episode, Dr. Bukovac and I talk about the factors in obstetrics that lead to physician burnout – especially the way that clinical practice is structured in a way that creates conflicts of time, attention and clinical expertise. Dr. Bukovac advocates for a fundamental restructuring of obstetrics training and operations that encourages physicians to specialize in office care, hospital care, or surgery. She believes this will not only lead to better clinical outcomes, but also a more manageable and sustainable practice model for clinicians. Dr. Bukovac shares her own journey from burnout to a practice that sustains her passion for medicine and allows her to balance work with her other life pursuits.

Links related to Dr. Bukovac’s podcast:

• OBHG study: The Future of Obstetrics Industry Survey Report (submission of personal information required)
• Chief Healthcare Executive article: When Outcomes Matter: Outsourced Providers Versus Outsourced Partnerships

Cynda Hylton Rushton, PhD, RN, FAAN is the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, and co-chairs Johns Hopkins Hospital’s Ethics Committee and Consultation Service. In 2016, she co-led a national collaborative State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing and co-chaired the American Nurses Association’s professional issues panel that created A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice. She was a member of the National Academies of Medicine, Science and Engineering Committee that produced the report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being. She is a member of the American Nurses Association Center for Ethics & Human Rights Ethics Advisory Board and American Nurses Foundation Well-Being Initiative Advisory Board. She is the editor and author of Moral Resilience: Transforming Moral Suffering in Healthcare. Dr. Rushton is a Hastings Center fellow and chair of the Hastings Center Fellows Council and a fellow of the American Academy of Nursing.

In this episode, Dr. Rushton and I talk about the current divide between advocates of system change to improve clinician well-being, and those promoting personal resilience and well-being training. We look at the challenges of managing polarities as leaders embrace a both/and approach to team member well-being. Dr. Rushton shares the specifics of a personal resilience training that equips nurses at Hopkins to stand firm in their ethics and values, and to act as advocates for system improvement without sacrificing their personal well-being. Finally, Dr. Rushton paints a picture of leadership in which clinicians gain empowerment to manage their own well-being while acting as advocates for both their patients and their profession.

Links related to Dr. Rushton’s podcast:

• Johns Hopkins research paper: Mindful ethical practice and resilience academy: Equipping nurses to address ethical challenges
• Nursing Management article: Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic
• Nursing Management article: An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic
• Journal of Professional Nursing article: Strengthening internal resources to promote resilience among prelicensure nursing students

Rosanne Raso, DNP, RN, NEA-BC, FAAN, FAONL, is the chief nursing officer of NewYork-Presbyterian’s Weill Cornell campus and the editor-in-chief of Nursing Management. She is a national leader in improving the practice environment for staff, enhancing patient safety, and advancing nurse leadership. Among other roles, Dr. Raso is an adjunct assistant professor for both the New York University Rory Meyers College of Nursing and Case Western Reserve University Frances Payne Bolton School of Nursing. She was the co-founder and past president of the Brooklyn Nursing Partnership, a collaboration of education and practice leaders focused on increasing nursing capacity in Kings County, NY. Dr. Raso was inducted into the American Academy of Nursing in November 2018 and as a fellow of the American Organization for Nursing Leadership in January 2021.

In this episode, Dr. Raso and I talk about her latest research looking at authentic leadership, healthy work environment, team-member well-being, and nurse retention. In it, she uncovered a remarkable resilience of nurse leaders to continue leading with authenticity and humanity, even as the work environment for nurses has diminished. We talk about the need to support nurse leaders with the same process and practice improvement, as well as well-being support that frontline nurses need and deserve. Dr. Raso lays out a hope-filled vision for a future in which the structures of support for nurses and nurse leaders emerge from the challenges of the pandemic stronger and more human-centered than ever.

Links related to Dr. Raso’s podcast:

• Study: Perceptions of United States Nurses and Nurse Leaders on Authentic Nurse Leadership, Healthy Work Environment, Intent to Leave and Nurse Well‐being during a Second Pandemic Year: A Descriptive Study
• Article: In the Eye of the Storm: Leadership Lessons from the Front
• Article: How Leadership Matters

Mike Woodruff, MD, is chief patient experience officer at Intermountain Healthcare. Intermountain’s Office of Patient Experience combines safety, quality, and experience of care under a single governance umbrella, recognizing that they are deeply interconnected. Dr. Woodruff and his team take a holistic approach to caring for patients, families, and healthcare workers. He is an emergency physician who is driven to alleviate suffering. He believes that listening is the most powerful diagnostic tool available to clinicians.

In this episode, Dr. Woodruff and I talk about the central role that trust plays in supporting team member safety and well-being. While trust is not an unusual concept in leadership, Dr. Woodruff takes an expansive view, connecting it to every process that an individual interacts with within a system. He believes that any process that isn’t explicitly designed to build trust – by showing respect and integrity – has the potential to erode trust, and that those small, daily interactions carry more collective weight than a single, positive, in-person encounter. He and his team use two questions to filter the trust factor on organizational processes: Does it support the mission? And, is it kind?

Links related to Dr. Woodruff’s podcast:

• Edward Deming’s red bead experiment
• Research paper, Human-Centered Leadership Mastery Model

Heather Farley, MD, MHCDS, FACEP, an emergency physician by training, is one of the nation’s foremost experts on healthcare worker well-being. Dr. Farley has personally experienced the trauma that impacts caregivers when a patient suffers an unexpected adverse event and the transformative power of supportive, evidence-based initiatives. She is passionate about advancing the professional fulfillment and well-being of health care providers so they can flourish at work and at home. In her role as Chief Wellness Officer at ChristianaCare, Dr. Farley oversees the system-wide programs that support caregiver experience and promote a culture of well-being.

Tina Shah MD, MPH is a practicing physician with more than 10 years of healthcare experience across digital transformation, healthcare delivery, and policy. She is the Principal of TNT Health Enterprises, a consulting company that advises public and private sector healthcare organizations on digital transformation, value-based care, and clinician wellbeing. She is also proud to serve her country most recently as Senior Advisor in the Office of the Surgeon General.

Drs. Farley and Shah recently spearheaded a collaboration with leaders from the AHA, AMA, CEO Coalition, Dr. Lorna Breen Foundation, IHI, and National Academy of Medicine (NAM) to create the 2022 Healthcare Workforce Rescue Package. The package was devised to help leaders zero in on the most impactful team member well-being efforts to undertake at the current stage of the pandemic. In this episode, we delve into each of the five practices outlined in the Rescue Package and look ahead to how these create a foundation for a transformed culture of well-being for all healthcare team members.

Links related to Dr. Farley and Dr. Shah’s podcast:

• Resources, The 2022 Healthcare Workforce Rescue Package
• Schwartz Center Webinar, Five Evidence-Based Actions Leaders Can Take Now to Support the Healthcare Workforce
• National Academy of Medicine, Resource Compendium for Healthcare Worker Well-Being