Podcast Episode 49 | Rethinking Burnout and Why it is Important to Address it at the Organizational Level

with Paula Davis

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The Prosperous Doc® podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Full Transcript

Paula Davis (00:00):

But I think what the pandemic has done has simply ripped the band-aid off and exposed the fact that a lot of us, a lot of physicians, a lot of folks in health care were struggling prior to COVID even happening.

Intro (00:13):

From Spaugh Dameron Tenny, it's the Prosperous Doc Podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now, here's your host, Shane Tenny.

Shane Tenny (00:32):

Welcome back. Glad to have you with us. And today we're talking physician burnout again. Each year Medscape surveys about 15,000 Docs around the country on this topic, and their research report for 2021 came out a couple months ago, and it's even titled, Death by 1,000 Cuts. The results of this year's survey affirm the trends we've seen over the last decade with about 40% to 50% of physicians reporting symptoms of burnout, as you'd expect in the midst of COVID, the highest responses were among those in critical care specialties. But interestingly, at least to me, about 80% of respondents said their burnout started before COVID. And it's a topic that we've talked about a number of times on the Prosperous Doc Podcast, well covered in medicine, but we see it being acknowledged in other professions as well. And in fact, my guest today authored an article for The Washington Post two years ago titled, “From Moms to Medical Doctors, Burnout is Everywhere these Days.”

Shane Tenny (01:40):

I'm excited to have with me, Paula Davis, founder and CEO of the Stress and Resilience Institute. She is one of only a handful of lawyers in the world who have graduated from the University of Pennsylvania's Applied Positive Psychology program. She's been featured in Forbes, in New York Times, Oprah Magazine, Psychology Today. And her firm focuses on addressing burnout and resiliency at the organization or enterprise level, and has even worked in teaching resilience skills to army personnel. So I know we've got a great conversation in store for you today. Paula, thanks so much for joining me.

Paula Davis (02:17):

Thank you so much, Shane, for having me. I'm looking forward to digging into this topic.

Shane Tenny (02:21):

Yes, well, start high level with us. Of course, we're all living through, what, month 20 or 21 of COVID, what is the state of burnout that you're seeing across the country today?

Paula Davis (02:33):

Yes, so I think that one of the things that I usually try to tell my audiences when I speak to them is that COVID didn't start the burnout crisis, I feel like we're all becoming more aware of it because of COVID. But that's not to say that COVID hasn't certainly accelerated and amplified folk's state of overwhelm, exhaustion, overload, languishing, and certainly burnout. We know that burnout has been on the rise over the last 12 to 18 months or so. And I always frame it for folks in this way, so if I could give folks a simple definition or a simple formula for what causes burnout it's too many job demands and too few job resources.

Paula Davis (03:16):

And when you think about what COVID has done, it has ushered in a whole new set of job demands, things that take consistent effort and energy about our work and it's, for the most part, at least on the front end of when it hit, took away some or many of our resources. We weren't able to get together with people, we weren't able to be present in the same way and take those moments of recharge and rest that we needed to because gyms were closed and restaurants were closed and everything is different for a while. So it makes sense to me that burnout certainly has been on the rise simply because of that formula, I think about.

Shane Tenny (03:56):

Yes, I guess that's what we saw in at least Medscape's report from this year that there's a consistent percentage of health care providers who are acknowledging symptoms of burnout and the vast majority of those are, I guess, corroborating what your thesis is, and that is that it didn't start with COVID, it started long before.

Paula Davis (04:20):

Yes. And that's so interesting because I think the Medscape results don't surprise me, but they're also a little counterintuitive, because you would think that most would be responding, my burnout increased 500% in the last 12 to 18 months or so. But I think what the pandemic has done has simply ripped the band-aid off and exposed the fact that a lot of us, a lot of physicians, a lot of folks in health care were struggling prior to COVID even happening. And so the rates of burnout generally among healthcare providers prior to the pandemic, we were starting to see studies upwards of 50% plus of physicians and providers experiencing burnout.

Paula Davis (05:05):

And so that's extraordinarily high and then you take and add a pandemic to it where they are, or many of them are on the frontlines of care and just being exhausted and wiped out and dealing with all that they were dealing with, you can certainly see how that accelerated it. But they brought into and carried into the pandemic very high rates of burnout as well. So it sounds counterintuitive but it is not surprising to me that a lot of those physicians and folks reported that their burnout started pre-COVID.

Shane Tenny (05:34):

Mm-hmm (affirmative). Now, in your role at the Stress and Resilience Institute, you've had the privilege of working with folks in the army, tell me a little bit about that connection. It certainly seems like a different type of organization, enterprise than corporate America or a hospital system, what have you gleaned and what are those conversations like?

Paula Davis (05:55):

Just it was a fascinating four years of work for me on so many different levels. So I burned out during what became the last year of my law practice and decided to go back and just completely change careers. Actually, when you read my story, it seems like I pivoted and did a hard right turn, but I essentially came back to the things that I have really loved all along. My undergrad is in psychology, if you'd asked me what I wanted to be when I grew up in eighth grade I would have said I wanted to be a teacher. And so I ended up recrafting and coming back to what I had always wanted to do. And after I finished my Master's degree, the second part of my education or training really became staying on at UPENN to be part of the faculty teaching and training resilience skills to senior noncommissioned officers and officers in the United States Army.

Paula Davis (06:45):

And so it taught me so much. It taught me about how to teach adults, how to learn these types of skills, because I was a lawyer, I had no clue how to do that, it was a completely different skill set. But also I'm very keen to tell people, I wouldn't have the life or the business, quite honestly, that I have today had I not gone through that program. And I was so shut down about talking about my story, about talking about my experience with burnout, I was still recovering from it, I didn't really understand what had happened and how it started and I was really a mess with recovering from it.

Paula Davis (07:19):

And to hear soldiers tell their stories of obviously significant challenges that they experienced across multiple deployments, significant challenges they were experiencing with their families and just their ongoing work was really something that helped me start to think, wow, okay, if they're experiencing that level of challenge and they're able to talk about it or they're at least putting themselves out there to do so, it was very inspiring to me to, to really think inwardly about, what could I do? How could this influence or shape how I talk about my experience and other experiences going forward? And so that was amazing.

Paula Davis (07:58):

But I think it also really taught me very keenly about the science of resilience and how people view it and how it's applied to at least leaders and individuals. And I think it's one of those terms that we all hear about, especially in health care, but I think is largely misunderstood, because we equate resilience with making me tougher. And so I hear this a lot on Twitter when I'm engaging with physicians and nurses and other providers on social media is that, please don't tell me to be more resilient, and they're hearing it as, don't tell me to be tougher, and that's not at all really what the message should be or is about resilience, and it's helping.

Paula Davis (08:35):

Certainly I worked with many thousands of drill sergeants, I think many people would characterize them as pretty tough people. We don't need to make them tougher and we certainly didn't, it was about helping them recognize and understand how to navigate everyday challenges and significant challenges in a way that would help them just more quickly be able to assess and determine, yes, okay, Plan A or this course that I'm on makes sense, or no, I need to stop, I need to quit, I need to pivot, I need to pursue Plan B or Plan C. And so that's really an important message that I try to get across in my resilience work. So all of that really galvanized during my time with them.

Shane Tenny (09:13):

What's the difference or how do you define the difference between stress and burnout?

Paula Davis (09:19):

So it's hard because burnout is really the manifestation of chronic workplace stress, and so there's obviously a stress component to burnout. And so part of where we go wrong in this conversation is we think about stress and burnout as wholly interchangeable terms and they're not. And so the way I help people think about it is that, think about just your daily everyday stressors that you have, may exist on a spectrum or a continuum, right. We have days sometimes where we're like, whoo, didn't experience a ton of stress today. We have days where we're like, I am significantly stressed, I cannot wait for tomorrow to start.

Paula Davis (09:53):

Similarly, with burnout, burnout exists on a spectrum or a continuum too. So you can just enter burnout in certain ways, like you're rolling into work a little bit late, you're feeling moderately or mildly disengaged with your work, you're just a little ticked off today and you're annoyed at people, or you can be on the far end of the spectrum in experiencing significant mental health and physical health and other related consequences because of it. And so where I try to help people distinguish where you're crossing the line, where am I going from just my everyday stress, even if it's a significant, significant stress doesn't necessarily mean burnout, how do I know when I'm crossing that line?

Paula Davis (10:34):

There's really three big dimensions that people need to be thinking about, and it is chronic physical and emotional exhaustion. So oftentimes, when I ask people to come up with or say a word or a phrase that they think about when they hear the word burnout, 80% of people say something about being tired, being overloaded, overworked, exhausted, some flavor of that answer. So we oftentimes stop the conversation right there and make burnout, first of all, about individuals and then we make burnout about this syndrome of exhaustion. And we start to apply self-care and self-help strategies thinking that we're going to fix burnout when they're misapplied strategies at this point because we're missing the rest of the puzzle. So chronic, more often than not, physical and emotional exhaustion is very important, but there's more to it than that.

Paula Davis (11:26):

So burnout is also chronic cynicism. So everyone and everything annoys you, bothers you, bugs you, rubs you the wrong way, and especially in healthcare, what this translates into is how you interact with your patients. So it's like, here we go again, I have to answer more questions, I know this person is going to be upset or angry at me. And you're carrying this predictability around and you've detached from what gives you a lot of meaning in terms of wanting to help your patients, and so they become just this other person that you're dealing with and that obviously doesn't translate into really good patient care where your patient is feeling that they're truly being taken care of.

Paula Davis (12:10):

So there's that detachment piece, that cynicism piece, which then the third big warning sign or the third big dimension for folks to think about is a sense of what the research calls inefficacy, I call it the, why bother? Who cares? Right. Am I really getting any meaning or a sense of impact in my work? I'm not really seeing how my work is really contributing. I don't think I'm really doing or at least don't see how I'm doing a good job at work, I'm starting to disengage and detach. And I think about it again as the, why bother? Who cares? It's like, why am I doing this? It's just becoming everyday is just on repeat and I'm just putting one foot in front of the other hoping to get through the day. So in order to earn the term or the word burnout, it's all three of those things. It's the combination of chronic physical and emotional exhaustion, and chronic cynicism, and also then feeling this sense of detachment.

Paula Davis (13:05):

And what's what's really interesting is I've had a chance to really measure this or look at this with some health care groups, and what's interesting is that in one group, it was a group of ophthalmologists that I worked with and it was interesting because this is the only time I've ever seen this, they gave perfect responses to some, if not all of the exhaustion and cynicism questions on the burnout inventory that I used. That is not a good thing. So a perfect answer is like a six, and it means that I'm experiencing these particular things every single day. So I had yet to meet, or assess, or work with a group who is saying that they are experiencing being checked out and being cynical and all that literally every single day.

Paula Davis (13:50):

And the one thing that really saved them from being officially classified as burned out is they had extraordinarily high efficacy scores. They were easily able to see how they were making a difference, where their sense of meaning and impact was. And so that third component can be an extremely important bomb, source of protection for folks who are feeling strongly exhausted and cynical. So it's all three of those things and that's how you know you're traveling closer to where you now into burnout.

Shane Tenny (14:23):

That's a super helpful definition. Thanks for laying it out in that way. And given your work with organizations, whether huge like the army or small like practices or smaller employers, what is the difference between approaching burnout as an individual issue, which of course it is, I mean, ultimately, and addressing it at a corporate level or systematically at the enterprise?

Paula Davis (14:53):

This is such an important question. And I think about burnout as the individual manifestation of a workplace system or cultural issue. And so that's a way to marry the two because, as I mentioned, this is another place where we go wrong in the burnout conversation, we think of it as purely an individual experience or purely an individual problem to be solved by individuals, to be solved solely by self-help strategies and wellbeing strategies and things of that nature. And so I tend to try and educate organizations that we need to take a me and we approach because oftentimes what I will hear from frontline workers is all of the angst, and the anger, and the cynicism, and the frustration about how we need more personnel, all of the systemic teams leader factors. And then when I talk to the leader and teams and the folks who run organizations, they complain that people, the individuals, aren't doing enough to just care for themselves and what have you. And they're missing all of the systemic factors that are driving burnout.

Paula Davis (16:03):

So we really have to talk about it being both pieces of the equation, both pieces of the puzzle become really important. Where we have gone wrong is, again, we over promote and over identify and just think it's the individual side of the equation. And so there's been a lot of education that I have had to do and that folks who are talking about burnout in this space have to do with leaders to help them realize that it is a little bit about my individual stress management style, and my personality traits, and how resilient I am, and my coping strategies and things like that, it is much more about the rest of the system and the rest of the puzzle. And we have to start looking at that and looking at it through that lens as well if we're going to have any hope of making any type of inroads with dealing with this problem.

Shane Tenny (16:53):

And it sounds like part of the work when you're retained by an organization or healthcare system or something like that, then clearly there needs to be some level setting or data, and that's where you have questionnaires or surveys or things to go and compile information to share with the leadership and the executive.

Paula Davis (17:10):

Yes. And when I have a chance to really dig in and work with smaller teams or more targeted teams work within the larger organizational system, I'll oftentimes start with my resilient teams inventory. So it's an inventory that I created that, that I share in the book, and it's a real simple 10 question assessment that helps me start to understand, where are the problem areas with teams? And I usually use that in combination, not only problem areas, but what our teams are doing well? Because every team is doing things well that needs to be leveraged and identified and called out to.

Paula Davis (17:45):

But then I also use, there are a couple of wonderful empirically based burnout assessment tools, one gets at more around measuring rates of burnout and getting at helping people understand, what is the rate of that exhaustion, cynicism and professional efficacy within the context of teams? The other one though that I think is even more important is really start to address the root causes, helps to assess what we know are the core job demands or causes that tend to drive burnout at an organizational level. And so I find that, that is super helpful because we don't need to spend time addressing or dealing with anything that isn't truly a factor or something that isn't really giving cause to burnout with a team, let's be more targeted and focused in talking about those things, those challenges, those demands that are specifically giving rise to burnout in teams and organizations.

Shane Tenny (18:44):

And so, now I'm dying to ask, what are the six core areas on the team resilience inventory?

Paula Davis (18:50):

Yes, so this is more of the burnout research versus the resilience inventory. But the core six, I call them, job demands or causes of burnout that are universal across industry, so every industry, healthcare has other ones that are more specific or unique to them, but the core six are lack of flexibility. So I think we've seen in the pandemic how much folks crave having some sense of, where can I work? How do I work? Can I say yes or no to things? Can I set my own hours? Don't yell at me if I'm doing my laundry at 2:00 in the afternoon, because I work better from 8:00 until 10:00 At night. We need that sense of flexibility and so not having it as a really big driver of burnout.

Paula Davis (19:35):

High unmanageable workload. So I think this is universally the one when I have a chance to either talk with leaders or measure this in teams, almost always is the top one are among the top two that I see. And certainly, obviously, in health care, especially during the pandemic, I mean, just so many frontline providers were just working 16 hours, going home for a few hours, coming back and doing 16 hour. Just the unmanageable workload piece is huge.

Paula Davis (20:06):

Lack of community. So that lack of connection, lack of leader and colleagues support, I don't feel like or I don't understand if my leader has my back, I'm not feeling that sense of belonging or support in the team that I'm working on. unfairness is another big one. So lack of transparency, favoritism, closed door meetings, lots of red tape. I need a simple answer to something and I have to ask 18 people, and it takes three weeks for me to get a basic answer for something. Values disconnect. So what I think brings me meaning and impact into my work, what I want from my work isn't something that I'm receiving from the workplace environment, so there's a disconnect.

Paula Davis (20:50):

And then lack of recognition. This probably, I would say, bubbles up is number two and then sometimes is number one among the core six when I have a chance to measure. But it's not hearing thank you at all, it's not understanding the positive impact that I'm making. In more of the corporate environment, it is I feel like I'm working at a particular level but my job title doesn't match, or it's irritating to me that I'm not being invited into key meetings because I have the expertise that's needed to advance whatever topic is being talked about in the meeting. And so it shows up in all of those ways. So those are the big ones for leaders and teams and organizations to really be paying attention to.

Shane Tenny (21:29):

Super interesting. I'm thinking about the team I run and our own firm, and I'm pretty sure we don't have burnout on the issue, but I think I want to have my antenna for them. I know one of the larger health care organizations that you partnered with was Mayo Clinic, can you talk a little bit about just that project and the results of what they've been working on with you?

Paula Davis (21:48):

Sure. Yes. So this was more of an anecdotal experience. And just I've always been interested in the research that has been coming out of Mayo Clinic and what they have been doing to address burnout, because they have been one of the few health care systems and organizations that has noticed, they've been able to lower rates of burnout. And the studies that I talked about in my book were pre-pandemic and so it'll be interesting to see if there's any nuances or layers that the pandemic has added to this. But it's because they've implemented more of a holistic model, again, to address burnout. So they're taking it out of just the individual lens and really putting it into a leader type of focus where they've created focus groups to discuss and really understand these core six and other drivers of burnout. What are leaders really seeing in their teams in terms of what is causing burnout?

Paula Davis (22:43):

They really empower physicians to be able to implement solutions and identify drivers. And they're specifically educating their physician leaders around specific leadership practices that we know when implemented behaviors that leaders can exhibit that when they do we see higher levels of wellbeing, and intrinsic motivation, and higher levels of resilience and lower levels of burnout. And so they really support that education and add coaching to it so that when physician leaders have issues or encounter challenges, there's somebody there who can help to troubleshoot some of those issues.

Paula Davis (23:21):

And so the coaching piece I have found is a very important component to this and one that I try to build into my work with organizations generally. But yes, so essentially, the physicians, they're educated, they're empowered, they are keen too. And the organization generally is very assessment focused, right, let's measure this, let's get a handle on exactly what's going on and what the problem areas are. They try things and then they assess again to see what's working. And so it's really this ongoing iterative process focused on leaders that I think has really made a difference and it was certainly something that struck me and I thought worthy of putting in the book.

Shane Tenny (24:00):

Yes, excellent scenario and exciting to see how they're paving the way for other leaders looking to change their culture and change the trajectory of burnout. When we come back from this break, I want to hear more about your story and of course your book that just came out earlier this year.

Shane Tenny (24:16):

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Shane Tenny (25:34):

All right, so before the break we were talking or I was talking with Paula Davis, CEO, founder of the Stress and Resilience Institute about burnout and some of the core factors involved in it. But Paula, I know that you didn't just come to this work academically, it's really part of your own personal story, I wondered if you might share that with us.

Paula Davis (26:02):

It is absolutely part of my personal story. And I burned out during what became the last year of my law practice. So I practiced law for seven years, so I jokingly call myself a recovering lawyer now for all of these years. But I burned out during what became the last year of my law practice and it was a very, very scary and frustrating experience for me because I didn't understand what was happening. If you had asked me what burnout was, I probably could have maybe defined it as some stress related something. But I didn't know exactly what was happening to me and I just knew that my personality was different, I wasn't managing my stress in the same way, I was frustrated and disconnected at work, I couldn't stand any of my internal business clients or my clients generally, which was so horrible, and so different from how I had practiced law and experienced my work in the past.

Paula Davis (26:55):

I couldn't have told you this in the moment, but reflecting back on it now, when I first entered what I know burnout to be, it was showing up at work 20 to 30 minutes later than I normally would, and as a lawyer I have an official start time. But it got to the point where I was the last person really most days coming into the legal department and people started to notice that. People started to notice that I wasn't going out to lunch as much, I wanted to just be in my office with the door shut, leave me alone, because again, that exhaustion, I just never felt like I had enough energy to really accomplish what I needed to accomplish. I was procrastinating a lot more. I was internally eye rolling a lot, so hopefully that was never seen as showing up in any external behavior. But I know there were instances where I was more short tempered with people and just annoyed that they would ask me questions and things like that, again, very opposite of my normal personality.

Paula Davis (27:53):

And then it was very much led to, what am I doing here? That, why bother? Who cares? Am I really doing what I set out to do in my career? And that started me thinking about, should I or could I be doing something different? And so we talked earlier about the spectrum of burnout, when I finished, when I ended my law practice, I was experiencing panic attacks almost every day. So I had a lot of anxiety issues that had resurface, and that was not pleasant for a whole host of reasons, physically it doesn't feel fun. But I had to cut meeting short because I could feel like a panic attack or an anxiety issue coming on, and so then that's embarrassing because you have to get yourself out of a situation and I needed to escape, which is what having panic attacks feels like you need to do. And then I was in the emergency room twice because I had really bad stomach ache from the stress that I was experiencing.

Paula Davis (28:50):

And so that's something that I'm always very keen to talk to physicians and providers about as well is that what happened is because I was experiencing physical consequences from burnout, I needed help to deal with those physical consequences. But I think I saw half a dozen doctors for different ailments and things during that period of time and no one ever said, how are you doing? No one ever said, how stressed are you? No one ever keyed in on, how's work going? Just I think sometimes we feel hesitant to ask those questions of people, but it was one of those moments where I was so on edge with the stress and the emotionality of what I was experiencing, if somebody like a doctor had asked me that question I would have burst into tears, which is probably why folks don't want to ask it because they don't want to deal with the emotions that might come with it or don't know how to process that.

Paula Davis (29:46):

And I literally would have just said, I don't know what I would have said, but I just would have been a spill of a whole bunch of like, this is so hard and I can't do this. I think folks would have helped me uncover the workplace root causes or association with what I was experiencing versus what can sometimes happen is we get so focused on fixing the physical and mental ailments, which are important, that we forget about what's truly driving it in the first place. So I always, when I talk to physicians and nurses and folks in healthcare, I always tell them to not shy away from asking those types of questions.

Paula Davis (30:25):

So yes, so that was my year long process of really dealing with what I now understand to be burnout. I ended up having to really diagnose myself with it once I left my law practice, because I just really didn't understand what was going on in the middle of it. So yes, so I come to this experience not just from an academic perspective because I've lived it.

Shane Tenny (30:49):

Right, I think as the old saying goes, I'm not just the President, I'm also a former patient.

Paula Davis (30:54):


Shane Tenny (30:56):

So let me ask you about this point that you're bringing up at the end, which is you're coaching, and we've heard on this podcast and other places, just how valuable it is if you are observing a colleague or a subordinate that seems to be burned out or maybe is exhibiting symptoms, how valuable it is to ask. To the point you make, it requires a level of maturity and an emotional IQ to be able to step into that and risk asking someone a question you know might bring them to tears and then not knowing how to fix it.

Paula Davis (31:35):


Shane Tenny (31:35):

Which, of course, is one of the core psyches for those in medicine, which is we fix bodies, we fix people's problems, we fix these things. What do you say to leaders when you're coaching or hosting a workshop or things like that? What would you say? What do you do then? What happens if the person burst into tears or says, yes, I keep thinking about killing myself on my way into the office or driving my car into an overpass or those sorts of things?

Paula Davis (32:04):

100%. And you never know what you're going to get back when you ask those questions because there is a lot of intense emotionality around it a lot of times. I was finishing a workshop, this was probably six or seven years ago and it was a group of salespeople, and I had a salesperson come up to me afterwards and he didn't introduce himself, he literally just said to me, "If something doesn't change for me at work in the next six months, I'm going to have a heart attack." And so you have to be ready to hear where the ... Again, the cynicism piece shows up differently for people as well. You can be a level 10 angry, so the person may say back to you some version of, get out of my face, right? So there's a whole range of ways that this can express itself.

Paula Davis (32:52):

And so I think if you're concerned about a colleague, first of all, I think what I tell people is you have to have a trust check. Do you have the right relationship with the person to begin with to have this conversation? Because if you don't have an established relationship with somebody, and I would argue that if you are a physician patient, you do have an established relationship with somebody to ask the question, but I'm talking also thinking about outside of that interaction, if you're just concerned about a colleague, are you the right person to be having the conversation? Do you have enough of a rapport or relationship that's been built up such that makes you the right person to even go in and start this conversation for the exact reasons we're talking about?

Paula Davis (33:38):

You don't know what you're going to hear back and it could be some really deep stuff, and if you're not the right person, they're either not going to say anything to you about it and you could shut them down and make it worse or you're going to feel really awkward because you're going to not know or feel comfortable with how to deal with the information that you might get. So that's a really important piece.

Paula Davis (33:57):

The second piece is to be as intentional as possible. And I say that from both if you're the person who feels burned out and also the leader, what do you want to get out of this? If I'm burned out and I need to talk to somebody, do I need a sabbatical? Do I need an extended period of time off of work? Am I feeling sick to the point where some other thing has happened and I need employee resources? Do I need a reference to a psychiatrist or a mental health professional? Do I just need to get something off of my chest and just talking to somebody for a half an hour is significantly going to help?

Paula Davis (34:33):

So you have to be clear, and as a leader, you have to be clear about understanding and knowing what those resources are, because if you do need to help somebody and they say, you know what, I've developed a significant drinking issue and I need some help, which I have heard from folks who I've worked with, you have to be ready to offer up and know who to help them, who to refer them to and what those resources are. So it is much as you can educate yourself around, who would I refer somebody to? What are those pieces? What is our sabbatical policy here at the hospital or in the organization? Do we even have one? What can I say? What parameters do I have to help somebody who's telling me, I need to have an extended period of time off? So the more you can do that front end research as a leader, the less likely you will be caught off guard.

Shane Tenny (35:23):

Mm-hmm (affirmative).

Paula Davis (35:23):

Then that leads me to the third component, and that is activating a listen to learn and a listen to understand style of thinking. So I think about it as humble curiosity. We call it empathy but sometimes I think empathy sounds squishy and I think about it as humble curiosity. How can I simply just create an environment to allow the person to just be? To tell me their story and tell me what's going on, because as you suggested, physicians love to listen to fix. What can I do to fix it? Right. I'm going to go right into the treatment plan and I'm going to solve the problem. And in reality, a lot of the lawyers especially who I work with love to listen to win. So we love to listen to fix as leaders, we oftentimes love to listen to win, we have a harder time listening to understand, because it's hard for us to just sit there and not try to walk somebody through a treatment plan or to what we think the fix is.

Paula Davis (36:24):

And so I offer up some sentence starters to leaders in particular, ways to start a conversation that will activate more of that listening to understand or listening to learn style of listening. So it can be something as simple as, walk me through that, help me understand. Okay, you're telling me that you're stressed at different points during your day, walk me through that, help me understand how it shows up for you so that I can get a better picture of what this is. You could say, I'm wondering, right? When I say I'm wondering, that is a signal that I'm being curious about something and it shuts down defensiveness, so the person feels comfortable and they don't feel like they're being judged. So it's those simple ways of starting conversations that can really diffuse what could potentially be an awkward or weird or tense type of conversation.

Paula Davis (37:14):

And then once you get through the conversation it then becomes both people need to be very clear, what's the next step forward? Is it a referral out? Is it just, you know what, we're going to follow up every two weeks and we're going to see what's going to happen. Is it, okay, I'm going to refer you to so and so in human resources and we're going to talk about what does an extended period of time off look like for you? So it's a lot of intentionality at every point in the conversation.

Shane Tenny (37:39):

Yes, and I'm thinking of the point you made earlier about the core six, the third one I jotted down as you were talking, just the lack of community, at the very least, the person feels connected, heard, listened to, and they're not alone. And so even if you don't know all the resources then at least I'm with you and help you, or help explore, or help poke around, or we will journey through this together.

Paula Davis (38:04):

100%. I mean, that is so critical and it's so important. And I think it also points to the fact that I think we do a pretty bad job generally of setting that type of environment in a proactive way so that we're not dealing with it on the reactive side of the equation. So if I can proactively build a team environment that promotes trust, and psychological safety, and belonging, and community, and these things that become important, it makes it much more likely and it makes it much easier that people will feel comfortable then approaching with these topics, hopefully, way on the front end of when they're experiencing them versus me who's trying to figure out how to not have panic attacks and in the emergency room, very much a reactive approach where your options become more difficult and they become more limited. So I think there's a lot of work we can do on the front end of the equation to set the right environment and develop the right environment to begin with.

Shane Tenny (39:03):

Yes. Now, before we wrap up, we've got to take a minute and talk about your book published earlier this week, Beating Burnout at Work, by the way, shout out, it's on Amazon, if you're interested in this and for connecting with Paula's explanation of this topic, you've got to check out her book, again, Beating Burnout at Work. Talk a little bit about what you're approaching, in particular, some of the framework or paradigm that you're introducing there to leaders.

Paula Davis (39:30):

So for me, as we've talked about over the arc of our conversation is, how do we move from having or making burnout about an individual issue and addressing it in a systemic way? So that was really my challenge when I was thinking about writing this book. And it was hard for me to think about, where is the entry point? Because I have to think about, where can we truly honestly do something about this issue? Because it's not enough to approach it from just the individual side, it's also really hard to walk into an organization and say, hey, organization, you have to just change the way you're doing things, that doesn't really go far either.

Paula Davis (40:05):

And so where was my entry point in this spectrum? And for me, it became about teams and leaders. Really being able to educate leaders and help teams understand that there were practices that they could implement, there were behaviors that they could think about incorporating more, there were frameworks to consider such that if they even just imposed a couple of things more regularly, you would see, again, a proactive ability to bloom the type of environment that led to more resilience at the team level and leader level, that lead to more thriving, that lead to more wellbeing, that lead to more motivation and all of these good things that we want that slowed burnout down.

Paula Davis (40:46):

So once I zeroed in on the fact that teams and leaders are really my entry point, I just started to read as much research as they could about, what makes for a high performing team? What makes for a resilient team? Because there's great new research coming out now talking about resilience at that intersection. And so I read multiple dozens of studies and was able to really come to the conclusion that there were some themes that teams and leaders could implement, and that's my acronym in the book, it's PRIME. So each letter stands for a really important competency or set of skills or frameworks or tools that a team, that individuals, that leaders, the collective can implement to create this great type of environment and slow burnout from happening.

Shane Tenny (41:32):

Yes, excellent. So what is the acronym? You want to walk through it?

Paula Davis (41:37):

Sure. Yes, I can walk through it. The acronym is PRIME. And so the P is two parts, it stands for psychological safety, which is that trust piece that we were just talking about, and it also stands for psychological needs. So I retranslate that when I talk about it into ABC needs, so we all need autonomy or that sense of flexibility, belonging, people have my back, I feel cared about at work, and competence, I'm growing and developing as a professional toward goals that matter to me. ABC, we need those, those aren't just nice to have, those are critical needs that we have in order to bloom this sense of motivation and wellbeing at work. So the P is really the foundational piece to all of it.

Paula Davis (42:23):

The R is relationships. So as we just talked about, that sense of community and relationships and how we interact with each other, and do I have one or two people who I can vent to at work? Even things as simple as that become important. The I is about impact. So again, impact, and meaning, and how can we start to promote conversations and activities around talking about and reinforcing that important sense of meaning and impact in our work? I always have to think in my head, where am I at in the PRI? The M is mental strength. So one of my favorite aspects about this model is, and I think a largely ignored aspect of good teaming and addressing stress is how we think under stress and pressure, and how counterproductive thinking can really waste a lot of energy. So I talk a lot about catastrophizing, so that worst case scenario thinking. And I'm a classic overthinker and my lawyer training doesn't help me with that. And so recognizing how our thinking can help and can get in our way.

Paula Davis (43:26):

The E is just I needed an E to work in my model, so the is energy. So that's my catch all for talking about things like positive emotions and other nuances of burnout and wellbeing that are important. And the D is design. So it's helping teams and leaders and individuals understand that there are proactive approaches and ways that we can actively reshape our environment in small ways that lead to really big outcomes and changes in either the way we perceive work or the way our teams and the way that our teams perceive work and how we lead in that environment. So that is the model.

Shane Tenny (44:08):

Excellent. Excellent. Now, Paula, as we wrap up, I know that you are really one of the people at the forefront of this work on addressing, acknowledging, improving burnout and culture within organizations, but you didn't get here alone. And so one of the questions I like to wrap up the show with is, who has been most impactful in your life? Is there someone that you'd like to shout-out here, give a little thanks to for their participation in bringing you to where you are today.

Paula Davis (44:47):

Yes. So one I've already mentioned, but I want to re-shout-out, and that is the soldiers who I worked with. So just seeing their courageousness and getting to know them and recognizing all of the challenges that they face was really inspiring and life changing for me and they helped me in so many different ways. So I'll just reiterate that shout-out.

Paula Davis (45:07):

The other person though that I definitely want to shout out as my dad. So I come from a very entrepreneurial family and my parents owned a plastic injection molding company for 15 years, so a business very different than the one that I have. But really being able to grow up in that environment and travel with my dad to business meetings and sales meetings and seeing how he interacted with everybody from the semi truck delivery driver, Lenny, who dropped off plastic material and resin and how he treated him the same way as he treated any CEO of a company, there were so many different lessons that he taught me about the right way to establish and run a business culture, I didn't realize that in my teens when I was going through working shifts in the plant in the summertime and things like that. But a lot of lessons he has taught me about creating a really vibrant and right type of culture and then also just how to be successful as an entrepreneur. So I could not have done this without [crosstalk 00:46:09].

Shane Tenny (46:09):

And what's his name?

Paula Davis (46:11):

His name is Bob, Bob Davis.

Shane Tenny (46:13):

Bob Davis, excellent. Well then, that's his 30 seconds of fame and the legacy lives on. Paula, thanks so much for your dedication, your expertise, and especially your time today that you've just shared with us. If you are listening to this and realizing that Paula's message would be so helpful to your organization you'd like to catch up with her, I know the website is stressandresilience.com, you can track her down there. Paula, any other way that you like to shout-out just for people to connect with you?

Paula Davis (46:50):

Sure, my email, folks can email me directly at paula@stressandresilience.com. And then I'm on LinkedIn as my social media of choice, so I'm always publishing and promoting things on LinkedIn.

Shane Tenny (47:03):

Excellent. Well, thank you again for your time. Thank you for listening, for those of you who are driving or working, or working out for joining us on The Prosperous Doc podcast. As always, we're so grateful if you subscribe, it not only helps our analytics you'll also know every two weeks when we roll out a new episode. And also welcome your feedback. Thank you to those of you who've emailed me with different folks who have stories or messages that we can share to help motivate, encourage and inspire you to wellness. We'll see you back here.

Outro (47:38):

This episode of The Prosperous Doc is over, but you're not alone on your journey, Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.