Increasing Support for Health Care Workers' Mental Health and Well-being

00;00;01;00 - 00;00;39;10
Tom Haederle
Put your mask on first. That's especially good advice for doctors, nurses and other caregivers. It's another way of saying: you've got to take care of yourself before you can deliver your best effort to your patients. But self-care is not always a natural instinct or something that comes reflexively to our health care workforce. And that needs to change. Welcome to Advancing Health, a podcast from the American Hospital Association.

00;00;39;17 - 00;01;12;16
Tom Haederle
I'm Tom Haederle with AHA Communications. It's been widely reported for some time now that our health care workers are stressed out, stretched out, burned out, and leaving the profession in truly alarming numbers. It doesn't have to be this way. There are opportunities to make workplaces engines of mental health and well-being. In today's podcast, three experts to make the case that the physical and mental well-being of our workforce is best for patients makes good business sense and is actually a precondition for delivering topnotch medical care.

00;01;12;27 - 00;01;29;12
Tom Haederle
Rebecca Chickey, AHA'’s senior director of behavioral health, moderates our discussion. She's joined by Dr. Arpan Waghray, CEO of Providence Well-Being Trust, and her AHA colleague, Elisa Arespacochaga, AHA vice president of clinical Affairs and Workforce.

00;01;30;19 - 00;01;57;15
Rebecca Chickey
It's my honor today to welcome Elisa Arespacochaga from the AHA, vice president of Clinical Affairs and Workforce, as well as Dr. Arpan Waghray, who is the CEO of Providence Well-Being Trust. They are here to join me today to talk about a very serious situation, and that is the need to increase the support of health care workers, mental health and well-being.

00;01;57;21 - 00;02;25;20
Rebecca Chickey
Even prior to COVID, there were some challenges in this area, and COVID has taken that to another level. Dr. Waghray, at Providence and while at Wellbeing Trust, has been working diligently to improve access to services, to reduce job stressors, to reduce the stigma that many health care workers have in relating to seeking treatment for or even admitting that they might need mental health.

00;02;26;02 - 00;02;52;00
Rebecca Chickey
And Elisa Arespacochaga at the AHA has been leading this work, particularly focusing on what are the best practices to reduce physician burnout, and that has now expanded to the entire workforce. So it's my honor to welcome both of the speakers today. I'm just going to reiterate for the listeners a couple of the key facts that I indicated earlier.

00;02;52;20 - 00;03;24;11
Rebecca Chickey
First of all, the research shows that mental health challenges for our workforce has intensified, as I mentioned, since the onset of the COVID 19 pandemic in 2020. Health workers report that they've been stressed out, stretched too thin, as well as being emotionally and physically exhausted. In the fall of 2022, the U.S. Surgeon General, Dr. Vivek Murthy, shared a framework for the workplace, mental health and well-being to provide a foundation that workplaces can build on.

00;03;24;20 - 00;03;50;07
Rebecca Chickey
So this is not isolated to any one part of the country. We see this crisis happening across the U.S. As Dr. Murthy's stated, as we recover from the worst pandemic we have ever seen, we have the opportunity and the power to make workplaces engines for mental health and well-being. So I've got two questions to kick this off to Elisa and Arpan.

00;03;50;20 - 00;04;04;03
Rebecca Chickey
The first one is why is it important for employers, but particularly hospital and health system leaders, to focus on mental health and well-being? Dr. Waghray I'll give that first one to you.

00;04;04;14 - 00;04;22;03
Arpan Waghray
Sure. Well, thank you so much for having me, Rebecca, and for allowing me to be a part of this really important discussion. I also want to thank the American Hospital Association for a lot of stellar work that's happened. And hopefully we'll be talking about some of these things that have really made an impact. You know, it's a great question.

00;04;22;13 - 00;04;41;07
Arpan Waghray
And I'll start by quoting J.W. Marriott, because I think he captures the essence of this really well. He said once when asked, what's your business strategy? He said, Well, I take care of my people. My people take care of the customers, and the business takes care of itself. So to answer your question, I would say there are three parts to it.

00;04;41;07 - 00;05;11;20
Arpan Waghray
There are three reasons that come to mind. I mean, first, I hope that you would want to care for your people primarily because you love the people who work for you or work with you. Second, it makes a lot it makes good business sense. The impact, absenteeism, presenteeism, retention, so on, so forth. Third, and this is more pertinent to health care, the mental health and well-being of the workforce is a precondition to delivering excellence with compassion, not just a priority.

00;05;11;28 - 00;05;21;04
Arpan Waghray
So I would say that these are the top three reasons in my mind to make sure that every employer, every CEO starts paying attention to this.

00;05;21;21 - 00;05;25;24
Rebecca Chickey
Thank you. Great points. What would you like to add to that?

00;05;26;15 - 00;05;51;22
Elisa Arespacochaga
Thanks so much, Rebecca. And as you mentioned, I've been working on this issue for quite a while, starting with physicians, but across the workforce. And I think one of the things that physician and physician leaders who've been studying this work and studying burnout and the impact of their own well-being and mental health on their patient care have really been able to pinpoint is a direct correlation between their own well-being and the well-being of their patients.

00;05;52;03 - 00;06;23;04
Elisa Arespacochaga
And there is a close connection. You cannot provide the best care if you yourself are not well. And so creating those opportunities for everyone on the clinical team to support their own well-being is, as Arpan mentioned, is good business sense. It's also why they're there. They're there to care for people. So giving them those tools to be able to take care of their own well-being, their own mental health, not only allows them to reconnect to their purpose, to why they're there.

00;06;23;13 - 00;06;50;08
Elisa Arespacochaga
It also gives them the gas in the tank, if you will, to be able to think about how to innovate, how to drive the next type of care, the next care delivery system, because they have that, you know, well, that they can keep refilling of their own well-being. So I think there are a lot of different areas. But the supporting the mental health and well-being of our own team members is probably, you know, one of the paramount challenges that came out of the pandemic.

00;06;50;18 - 00;07;05;12
Elisa Arespacochaga
We have a team that's very, very dedicated. They are the ones who run into the fire, but they they're exhausted. As you mentioned, they've been doing this for three years. So creating more opportunities to support them and support their wellbeing is a huge requirement for our field.

00;07;05;28 - 00;07;25;16
Rebecca Chickey
Thank you. I'm going to quote someone. It's not quite as eloquent as what Arpan said, but that is summarizing part of what you said, Elise, and that is put your mask on first. I don't know if I should credit United, American, Southwest Airlines, but all of them tell you, put your mask on first and then you can take care of others.

00;07;25;16 - 00;07;48;17
Rebecca Chickey
And that's one of the key messages I heard from both of you. Unfortunately, sometimes, though, that's not a natural instinct to put your mask on first, right? Particularly if you're caregivers, if you're someone who has gone into the health care workforce, that's more than likely part of your motivation, if not your key motivation, to being in that field is to help others, as both of you mentioned.
00;07;48;20 - 00;08;15;05

Rebecca Chickey
And so we want to put it off. We want to help others first is often what I hear. Unfortunately, in addition to that natural instinct to take care of others before you take care of yourself, there's the stigma that surrounds psychiatric and substance use disorders, or even just that tipping point between burnout and feeling stressed out.

00;08;15;20 - 00;08;29;03
Rebecca Chickey
And so I'm wondering, and Elisa I'm going to kick this to you first - how has the stigma surrounding addressing mental health issues in the workplace shifted since the COVID pandemic? Have you seen any change?

00;08;29;17 - 00;08;57;11
Elisa Arespacochaga
Thanks, Rebecca. We certainly have. I think, as part of a an overall wave and change in the social comfort with addressing mental health issues, we've also seen a certain level of openness and comfort with addressing some mental health issues. You know, sort of broadly across health care. But we still have so many situations where addressing your own mental health is stigmatized as a caregiver, as a provider of care.

00;08;57;19 - 00;09;30;18
Elisa Arespacochaga
We have had the privilege of working with the Dr. Lorna Breen Foundation for a number of years and been a founding member of their all in for well-being efforts. And there is still a very clear in some cases misconception in some cases not, but belief that based on many of the licensing and credentialing and application forms, that admitting on paper to seeking help for a mental health disorder, that they are, you know, somehow going to jeopardize their careers.

00;09;30;26 - 00;09;59;13
Elisa Arespacochaga
So we are working with the foundation and others to try to address some of those challenges, to try to really correct some of those stigmatizing language and questions that are in some of our applications, both at the hospital and health system level, at the credentialing level, at the state licensing level, trying to move forward beyond that stigma that if you need support for your mental health or did at some point in the past, that somehow that changes your ability to provide care to your patients.

00;09;59;24 - 00;10;10;11
Elisa Arespacochaga
So while we've seen it moving slowly, unfortunately, and particularly in the case of Dr. Lorna Breen, not fast enough. So we're continuing to push forward.

00;10;10;26 - 00;10;23;10
Rebecca Chickey
Thank you, Elisa. And just for the purpose of the listeners, can you say the name of the foundation again? So if they'd like to Google that, they can go there to find some of the resources that AJ has contributed as well as others in this effort?

00;10;23;19 - 00;10;33;08
Elisa Arespacochaga
Oh, absolutely. The Dr. Lorna Breen Foundation,  as well as "all in for health care well-being" are two phrases you can Google to find these resources.
,
00;10;33;26 - 00;10;54;08
Rebecca Chickey
Wonderful. Dr. Waghray, what's your perspective? Because as a geriatric psychiatrist, really working in the field and on such a strong, large system as Providence Health, along with your work at the Wellbeing Trust? What's your perspective on the impact that COVID has had on stigma?

00;10;54;22 - 00;11;15;18
Arpan Waghray
Yeah, I mean, I love the way Elisa called out the core issues over there. I mean, and I think you started us off that way too, Rebecca. You think about it. Help seeking behavior doesn't come naturally to those in health care, right? So they suffer in silence. And unfortunately, we see the tragedies that Elisa described. And there's so much more to be done.

00;11;16;04 - 00;11;44;24
Arpan Waghray
Now, come back to your question. If I reflect on this and look at the last few years of the pandemic, if there was a silver lining, for me it was that the conversations around mental health started to become more normalized at every level of the organization. And I think that was a refreshing change. You know, if we think about it, in the past, there was a culture in health care where you were always told that if you can't take the heat, get out of the kitchen.

00;11;45;05 - 00;12;04;05
Arpan Waghray
Well, that's been flipped on its head. And now we're intentionally asking us asking ourselves the question, does the kitchen really need to be that hot all the time? So there's a fundamental shift in how we're approaching these things. So I do feel more hopeful. There's a lot more way, you know, ways for us to go, though.

00;12;04;23 - 00;12;30;21
Rebecca Chickey
Absolutely. I sometimes call it the sliver of the silver lining of the COVID epidemic. And that is that more people realize that depression, anxiety, substance use disorders just doesn't happen to that person over there. I often say to people, you know, it is one in four or one in five Americans, depending upon which research you look at that in every year has a psychiatric or substance use disorder.

00;12;30;21 - 00;12;48;10
Rebecca Chickey
So if you're in the room listening to this with a group of colleagues, look around the room, some of your colleagues or maybe even yourself may be struggling. I'm going to move now to which we pointed out some of the problems, the big changes that have happened, the impact that stigma can have. So let's get down to the nitty gritty.

00;12;48;11 - 00;13;05;08
Rebecca Chickey
What are some of the small changes, or large changes if you want to go down that route, that a health care or health system leaders can implement to start making the mental health and well-being of their employees and their workforce a priority? Dr. Waghray, I'll pitch that to you first.

00;13;05;27 - 00;13;35;07
Arpan Waghray
Sure. Thanks, Rebecca. I would say that it starts with building on our prior comment of normalizing the conversation and setting a tone from the top. And I can now probably pivot to an example of how we approach this at Providence, and hopefully that will help your listeners. We did two things. So when I started the pandemic, as you're aware, we admitted the very first COVID positive patient to one of our hospitals in Everett, Washington, and our leaders recognized that we need to be prepared.

00;13;35;15 - 00;14;09;23
Arpan Waghray
There was a sense of urgency to ensure that people are in care. I mean, we, of course, focused on the physical PPE, but very quickly we also started thinking about what's the psychological equivalent of the PPE, that what do we do to ensure that people are well. So we did two things. One was making sure that any one of our workforce and we have 120,000 caregivers across our seven state region, anyone raises their hand and wants help for themselves, that we have a process to seamlessly guide them to the support and help they need based on their needs and preferences.

00;14;09;29 - 00;14;32;27
Arpan Waghray
So this doesn't mean that everybody is referred to a psychiatrist or therapist. It's really based on what their needs and preferences. Sometimes it's self-help, sometimes it's spiritual help, sometimes it's therapy, sometimes it was child care. There could be so many different things. But having a process that seamlessly gets people to what they are, that was job number one and I can share a little bit more about how we've gone through that and and the successes.

00;14;32;27 - 00;14;52;02
Arpan Waghray
And it's been something that she then took on and and helped build something even more robust than what we had done. So that was one part. The second part builds on the prior comments that we had that many of those in health care who might need the help the most are probably suffering in silence. So how do we create a proactive.

00;14;52;07 - 00;15;21;09
Arpan Waghray
So in addition to the responsive reactive approach, how do we create a proactive approach to lean in and support those who might be suffering in silence? So this is where we partnered with the American Foundation for Suicide Prevention, a program that was built out of UCSP and created a process where it started with the top. So Dr. Rod Hochman, our president and CEO, started by talking about why mental health is important, why he cares about his mental health and what he is going to do about it.

00;15;21;15 - 00;15;41;27
Arpan Waghray
And that set the tone and almost gives permission for leaders to start thinking about this differently. Then what we did is, you know, people are used to annual dental checkups, annual physicals. We said, well, how do we proactively send an annual mental health checkup that's anonymous, confidential, that touches different domains that people can can understand what they're doing in the comfort of their home.

00;15;42;06 - 00;16;06;23
Arpan Waghray
And on the backend, these are reviewed by our therapists and a personalized response is given to people. And when people need higher levels of support that they're connected to, to a higher level of care. So these were two big approaches. The front door to seamlessly guide people when they need help and they're raising their hands and then creating a process that's built in to support those who need the help the most.

00;16;07;19 - 00;16;29;19
Rebecca Chickey
That's fantastic. Truly. Thank you, first of all, for taking on all that extra work when you were in the midst of dealing with and on the front end or the bleeding edge, as I sometimes call it, of the COVID pandemic. Miind you, to the listeners, this was all work that was being done prior to any of the vaccination, and that came a year, year and a half later.

00;16;29;21 - 00;16;50;26
Rebecca Chickey
So thank you for doing that. Alisa, what are some small changes that health care leaders can take? I know that AJ has done some research lately with the Centers for Disease Control on preventing suicide, obviously in the health care workforce, but tell the listeners what are a few things that they can take back to their own organization.

00;16;51;22 - 00;17;17;06
Elisa Arespacochaga
Absolutely, Rebecca. And we have a an entire series of resources from the front end of how do you create a wellbeing program, which I strongly believe has to be at the system level, at the organizational level, you have to bring in and understand that you need to create supports across the system. You also need to talk with your frontline teams about what it is that they need.

00;17;17;21 - 00;17;39;20
Elisa Arespacochaga
And as Arpan mentioned, you have to have multiple approaches. One approach will not work for every single member of your team. You have to have different ways to reach them. But from that, all the way to the research that you really led around, what are those interventions that can most help hospitals and health systems prevent suicide in their own workforces?

00;17;39;20 - 00;18;04;06
Elisa Arespacochaga
And as a result of that work, you published a report with 12 interventions. And I know you're leading a great collaborative now this year to really understand what works and what doesn't work. Again, you have to have a suite of resources that people can pull in what works for them. The other piece I want to mention is some great work that started at Providence, and that is the stress meter.

00;18;04;16 - 00;18;39;09
Elisa Arespacochaga
So we took that front door, as you called it, and really created a resource that organizations in hospitals across the country can access and download for their own organizations to have access to. What are those immediate potential resources that could support someone who is having distress? And those options give everyone, you know, the option from everywhere, from, you know, I just need to talk to someone, a peer, a colleague, to, you know, what are the resources that might be available to me when I need something a little more advanced.

00;18;39;18 - 00;18;57;28
Elisa Arespacochaga
So I think there's sort of a suite of resources that have really been curated to put that opportunity in front of health system leaders to address the broad spectrum of activities, but also to pick and choose those that will most help their workforce.

00;18;58;28 - 00;19;20;09
Arpan Waghray
Rebecca If I may build a little bit, because I think I want to emphasize this so the listeners can understand the amazing work that the American Hospital Association has led here. You know, there are some health systems that have a lot of resources and they're able to allocate financial resources to this. But that's not the luxury that many of our small, smaller hospitals have.

00;19;20;21 - 00;19;52;23
Arpan Waghray
And what the American Hospital Association has done over here is so powerful that there is a process that allows every hospital, every system, irrespective of what your resources are, to be able to do something that is meaningful for your workforce by leveraging this this beautiful tool. And it has the best science. You know, a lot of research that the AHA team led to really understand and make sure that these are vetted best practices and they're all free resources.

00;19;53;01 - 00;20;12;22
Arpan Waghray
So I think it's it's just so powerful. And one more thing that I wanted to call out was, you know, when we think about what can health systems do? You know, when when I reflect back, I think everyone in health care is used to CPR. They recognize that when you know somebody is on. Well, you know, that's a familiar approach that we take.

00;20;12;22 - 00;20;36;01
Arpan Waghray
And what we did was we said, well, if one of your colleagues is struggling, how do we give you the tools, the emotional equivalent of CPR and can we build in that training so that you're comfortable identifying people, your colleagues, when they're struggling, ask them questions around, you know, suicidality. And so which can be really hard if that's needed, and then guide them and support them.

00;20;36;10 - 00;20;57;29
Arpan Waghray
And I see this because no matter how many resources we put out there, many people who need the resources might not ever get to that point where they're able to avail them. And when we did this and we put this out there, you know, voluntarily, we had 40,000 of our caregivers complete the training and be prepared. I mean, it just tells you how health care workers think.

00;20;57;29 - 00;21;07;25
Arpan Waghray
I mean, what if you called that out? You know, you go ahead. This is your calling. When you go into this field, you want to help others and you want to help ypur own. So I just wanted to make sure that we were calling that out as well.

00;21;08;08 - 00;21;28;01
Rebecca Chickey
Know our pain. And thank you so much for that. And I want to just reiterate what Alisha said a little bit earlier, not only the suicide prevention guide, that if you want, you can Google HRA Suicide Prevention Guide for Health Care Workforce, and it will take you right there. This is free and available to all, as is AHA's stress meter.

00;21;28;07 - 00;21;57;16
Rebecca Chickey
That is a tool that Lisa mentioned that was earlier created at Providence. We took that fabulous idea of centralizing some key vettted resources that can be anyone can use the stress meter to check in every day on themselves and really determine where they feel. Are they good today? And if so, keep going or are they having a moderate struggle?

00;21;57;16 - 00;22;22;06
Rebecca Chickey
This is not a diagnostic tool, but it's a way to quickly access resources that may help any individual. I actually gave the stress meter link to my niece, who's in her first year of medical school. So it's anyone who can access this and hopefully keep the stress at a manageable level. But if not, it also takes you to resources when you're in a crisis.

00;22;22;14 - 00;22;51;24
Rebecca Chickey
So thank you for the compliments, Arpan, and thank you for sharing and being a part of both of those products. And one thing I also want to reiterate, the message ... actually two things. One, size does not fit all. You know, one of the key reasons I think this question said small changes in employer can make is because if you start small in that way, you can build on your success instead of trying to put it off with a big project.

00;22;52;03 - 00;23;21;27
Rebecca Chickey
And you said the first things that Dr. Rod Hoffman did was to speak from the top to get leadership involved. And he took that leadership and he spoke out. It's only one step. I'm not in any way saying it was a small step, but it's one step and it probably reverberated across your whole organization. Let me turn to this situation, because I know there are probably people listening to this who are saying, well, I work in a workplace that's not supporting my mental well-being at all.

00;23;22;14 - 00;23;41;01
Rebecca Chickey
Do you have recommendations of, you know, what would you say? How would you guide that person? You know, they're frustrated. You're concerned about their mental health. Are there any ideas that you could share with the listeners to say, here's what they should do? Elisa, I'm going to hand that off to you first.

00;23;41;29 - 00;24;08;00
Elisa Arespacochaga
All right. Well, I think there are a number of different things I would point to. Certainly looking for resources in your community as well. But I think one of the challenges that organizations face in looking at implementing programs around well-being and around supporting your mental health is a paralysis of doing the wrong thing, of not creating a sufficiently robust program or or not creating the right program.

00;24;08;00 - 00;24;44;11
Elisa Arespacochaga
So I think looking for resources like those AHA has available to find opportunities to make those small changes. Start with, for example, what is the employee assistance program within your organization through HR? That may not be enough resources for what you need, but that's a place to start looking for those opportunities where we have most organizations may have some resource, but exploring what's available to start and then looking for ways to drive change in your organization and bring forward the conversation and bring it up.

00;24;44;11 - 00;24;58;09
Elisa Arespacochaga
It's sometimes a challenge, but I think we the more we can have our teams really raising the issues that are a challenge will help the entire organization move forward and really heal. But let me turn it over to Arpan.

00;24;59;02 - 00;25;17;07
Arpan Waghray
Oh, you said it so eloquently over there. I think it's those small things. I would say, you know, everything Elisa said, because first of all, you know, look, this is the number one health concern for most workers in health care, like musculoskeletal pain is the number one health concern for the employees of Amazon across health care, across the United States.

00;25;17;13 - 00;25;37;06
Arpan Waghray
Mental health concerns do remain the top one and two: depression anxiety. So being chronically unprepared is not a strategy, at least not a good one. So we have to do something. And I think not getting stuck in the analysis paralysis mode and doing simple things, I would say simplify everything you're doing and then lighten it. So you really need to make sure that there are things that you already have.

00;25;37;14 - 00;25;58;05
Arpan Waghray
Everyone does have something, and if you don't, there are resources like the American Hospital Association has made available to you for free. So you already have access to these things. It's just organizing it and making it accessible through through your intranet pages, through QR codes in the nursing stations, making sure that the word is out there and you're just presenting it to everyone.

00;25;58;06 - 00;25;59;16
Arpan Waghray
I think that would be an important first step.

00;26;00;09 - 00;26;35;02
Rebecca Chickey
Thank you both. I'm going to add one other resource that is easily to do, and that is AHA has created now six, almost seven posters. We call it The People Matter, Words Matter Posters. And I think often people struggle to talk about or speak about treatment, mental illness, because they don't have the right words to say. They don't know what might be offensive or even if they know something is offensive, they might not have the right words for something that is caring and understand.

00;26;35;17 - 00;27;00;08
Rebecca Chickey
And so we have developed a series of posters and it takes you through: How do you talk about substance use disorder? How do you speak about suicide? What's your perception of individuals with mental illness? And the reason I mention this is that they're free, they're downloadable and it gives you a workforce team, in this case hospital and health system workforce team members.

00;27;00;20 - 00;27;26;10
Rebecca Chickey
The ability to normalize, I think, is the word that you used early on Arpan, normalize how you speak about it. And in fact, CommonSpirit has taken these posters and is rolling them out across their various hospitals and states and helping their managers, encouraging their managers to sit down with their team members and feel comfortable talking about behavioral health disorders.

00;27;26;15 - 00;27;48;17
Rebecca Chickey
So that's one more small step that you can just start with one poster and see where it goes. So my last question that I asked focused on the challenges that a worker might have. I'm going to ask you now what challenges should an employer, a health care system leader, expect as they are implementing a new policy or program supporting mental health?

00;27;49;12 - 00;27;51;28
Rebecca Chickey
So Arpan, I'm going to let you lead this one.

00;27;52;11 - 00;28;14;01
Arpan Waghray
Sure. I think it's a really important question. It segueways nicely from the prior comments and questions and this is something we learned the hard way. Everyone is well-meaning and we want to come up with resources as that help our people and what we unintentionally do. And this is something that all health systems need to be thoughtful about is not create more confusion for your workforce.

00;28;14;11 - 00;28;36;04
Arpan Waghray
You know, we add programs. I mean, we got to a point where we kept doing more and more things and and adding and stuff, and people were not able to even access the simplest things because it was just the entire repository of resources itself became confusing or could become confusing for people. And there was a point where people said, Please, no more, just don't add any more programs to what we have.

00;28;36;09 - 00;28;56;09
Arpan Waghray
We already have. So so I would say that that's really important to, you know, simplify it and have, you know, an organized approach, not just adding more. The other thing I would say is that well-being needs to be something that becomes a part of your normal workday. It can't be this one other thing. If you just imagine how busy our nurses, doctors and frontline workers are.

00;28;56;09 - 00;29;21;28
Arpan Waghray
And if you ask them to take time out to do one more thing, even if it's for their own well-being, that'll never work. So it needs to be incorporated in the normal workday, understanding, you know, what matters to people, what are the pebbles in your shoes? And then having clear other ways to help that at every level, at every team level, at every unit level, so that you then now start building a culture where well-being is a part of who you are.

00;29;22;07 - 00;29;34;01
Rebecca Chickey
I love that. What is the pebble in your shoe? That's that is so relevant. I mean, seriously relevant. It's that what is that one or two things that are just so irritating. Elisa, to you.

00;29;34;23 - 00;29;56;13
Elisa Arespacochaga
Just building on that, I would say ask your front line team. They know what the pebbles are. They can outline that. They can describe in great detail every single pebble. I think the other thing that leaders especially need to think about is this is not for the faint of heart. It is going to take time, culture change takes anywhere from three to five to seven years to really take hold.

00;29;57;00 - 00;30;20;04
Elisa Arespacochaga
So don't be discouraged when the first five things you try only get you, you know, a tiny bit of a reaction or in fact, you know, you don't actually see your engagement scores change or some of your metrics moves because it's very hard to make the connection between the measurement and initial activities. Absolutely, you need to keep measuring.

00;30;20;05 - 00;30;40;23
Elisa Arespacochaga
I'm not advocating that you don't measure what you do or you don't track, but it's not you know, it's not one of those indicators that's just going to shoot up through the roof as soon as you set up your first program and you're going to have to stick with it. So I encourage everyone to have the patience and just keep focusing on what are the things that the team tells you they need?

00;30;41;29 - 00;30;53;13
Rebecca Chickey
Well, so as we wrap up this podcast, I'm going to ask each one of you to say one thing that you do to support your own mental health and well-being.

00;30;53;26 - 00;31;03;21
Elisa Arespacochaga
One of the best ways I've found to support my mental health and well-being is to focus on family time, separate from work time, and protecting that as strongly as I can.

00;31;04;16 - 00;31;06;00
Rebecca Chickey
Excellent. Arpan?

00;31;06;27 - 00;31;19;20
Arpan Waghray
For me, it's the practice of gratitude every day. I use the three good things. What are the three good things that happened? And and I think, though, that is really, really grounding for me and helps me tremendously.

00;31;20;05 - 00;31;52;16
Rebecca Chickey
Well, thank you both for sharing the tools and resources that are available and for sharing your time and expertise with us today and for encouraging others to help this movement to improve and enhance the way in which all employers, but particularly hospitals and health systems, support the mental health and well-being of our health care workforce. To learn more about the resources that AHA offers, visit AHA.org/behavioral health.