Speaker 1: You're listening to the Intermountain podcast with Dr. Mark Briesacher.

Dr. Mark Briesacher: I'm Dr. Mark Briesacher, the Chief Physician Executive at Intermountain Healthcare, today we have a guest host, Dr. Anne Pendo who is interviewing one of Utah's healthcare heroes.

Dr. Anne Pendo: My name is Dr. Anne Pendo, and I'm an internist by training, but I'm also the medical director for experience of care in the office of patient experience. Today we're going to have a conversation with Dr. Taki May who is a hospitalist at Logan, and we want to talk today about celebrating. I just would like to start by sharing a little bit of how we got to sitting in this room together.

Taki and I have met a couple times up here at Logan, and then we had the opportunity to sit next to each other at the Intermountain Medical Group Board retreat. During a conversation around resilience and burnout and finding joy in work, there was a lot of discussion about what wasn't right. What the problems we're facing, and you could feel the energy sucking out of the room.

People may be slumping over more in their chairs, and Taki raised your hand and said...

Taki May: I wanted to introduce a video that a friend of mine had introduced me to with the caption, now for something completely different. It was a TED talk by a photographer with the National Geographic by the name of Dewitt Jones. It's called celebrate what's right with the world, and I found this TED talk to be really transformative.

Dewitt talks about his charge from the National Geographic as being to go out and celebrate with his camera what's right with the world every day. The take away message is that there are bad things happening in the world, but you can always find wonderful things happening, and it's important to celebrate those things. I think that's a message that we need to bring to medicine too, because yes there is a lot wrong with medicine.

I think that's contributing to clinician burnout, caregiver burnout, but if we celebrate the small victories, the little wins, the heartwarming things that happen, we can make medicine better.

Dr. Anne Pendo: Yeah, I absolutely agree. Dike Drummond came and spoke to us a few years ago about physician burnout, and one of my favorite takeaways from his talk was acknowledging the, thank you. We get busy, we get distracted, we just think oh, this is just part of our work. When a patient or family member says, "Thank you," we should really pause and stop and celebrate that moment.

I think that, that fits really nicely with the, celebrate what's right with medicine. I think it's easy, I'll be anxious to hear your thoughts. It's easy to focus on the negative.

Taki May: Absolutely, misery loves company, right? Actually company doesn't love misery, we'd rather be ... We're more drawn to positive people, or positive things, but it's true that attitudes can be contagious.

Dr. Anne Pendo: Yes, and just prior to coming in today to meet with you, Terry Flint and I were teaching a clinician communication course. One of the things that we do, or one of the exercises is a gratitude exercise as a way of combating feeling burnt out, or the feeling of being burned out. The exercise was for you to turn to the partner next to you and share three good things that happened to you in the last 24 hours.

It was so quiet right away, because people really had to think what were those good things that happened? I was struck by that, how easy it is to go down that negative road, and then once people started chatting with each other and sharing those, the energy just really rose in the room. It was that what you just said, that shift in attitude.

Taki May: I think you can train yourself to scan for the positive. I think that's a term that Shawn Achor, who's a positive psychology expert has in one of his books about learning to scan for what's good, because we do tend to latch onto the negative really easily. It's a little bit harder to scan for the good, but once you start doing it, it does become a habit.

Dr. Anne Pendo: Would you be able to share with us today some of the things that you're doing differently, or that you've been noticing in medicine in the last little bit?

Taki May: Well I have actually been keeping a gratitude journal for years, and it's one of the ways that I keep myself focused on the positive. After a 13 hour day, you can go home feeling pretty exhausted, but I always take three to five minutes at the end of my day to jot down three wonderful things that happened. Sometimes they're about medicine, sometimes it's about what I saw on the journey home.

I don't pay too much attention to the commute, I try to pay more attention to what's beautiful. For example, I took care of a patient who ultimately succumbed to her illness. She'd been in the hospital for about 10 days by the time she died, and I had actually been her admitting physician, was off service for a little bit, and then came back on. Was on service with her and her family when she passed away.

I had met her for the first time when I admitted her, but when I saw her obituary, the family had actually mentioned me by name in the obituary. You could look at that as a negative, I failed to save her, but at the same time you could also embrace the positive that my connection with them allowed that to be the best possible experience it could be if that was what was going to happen.

Dr. Anne Pendo: I really appreciate you sharing that. I think that we often look at those end-of-life moments as a failure. Again, in reframing.

Taki May: Change your lens, change your life.

Dr. Anne Pendo: Exactly, that you can look at it as, I'm going to show up each day to take care of our patients, and make a difference, make it better for them. The fact that they acknowledged you in the obituary is really very powerful. We call it the entrances and the exits that are the moments where those interactions are so powerful, so memorable.

I think the way you cared for this woman and her family was really powerful. The entrance, which is your admitting, and then the exit, which was the caring for her at the end of her life.

Taki May: Caring for the family too.

Dr. Anne Pendo: The family too, and I would venture to say that the way that, that was done on was really a useful part of their grieving, and gave them comfort in a way that is probably more valuable than we will ever know.

Taki May: Right.

Dr. Anne Pendo: Yeah, yeah, do you see, or have you noticed that in your team of hospitalists that your celebrating, or noticing the things that you're grateful for, has that changed the way you interact as a group of hospitalists?

Taki May: I think that's an area where I would like to expand my positivity, because I think we don't get as much feedback as we could use when things go right. We hear a lot when things don't go right, but that's one aspect where I would like to say, "Hey, you did a really good job taking care of this patient," or, "This patient mentioned that they just loved having you as a doctor," and give them that type of feedback.

Dr. Anne Pendo: Yeah.

Taki May: I try to express gratitude to my partners if somebody covers the shift for another member who's ill. I always like to give feedback to that person say, "Hey, thanks for taking one for the team."

Dr. Anne Pendo: That matters.

Taki May: It does.

Dr. Anne Pendo: It does matter, it does matter. Before we went live today, we were talking about safety moments and caregiver moments, and can you share with us a little bit about how you think those can be woven into the, celebrate what's right with medicine mindset?

Taki May: I think again, it's a matter of framing, because usually if there is a safety event, something either didn't go right, or could have gone very badly. Instead of focusing on that, if you can take it to the point of, hey somebody stepped up and said something that prevented harm, that's something that we should celebrate, and so I like safety moments for that reason.

Dr. Anne Pendo: One of the things that we in our internal medicine practice had noted that when we started sharing safety stories, they often felt that they were viewed in a negative light. Using the technique of reframing this was a good catch as we started our huddle. Then ending our huddle with a caregiver story, and you're assigned weekly, somebodies assigned to do the safety story, and then somebody is assigned to do the caregiver moment.

The caregiver moment could be one of our MAs acknowledging another MA who went above and beyond for a patient. It could be our PSR front desk caregiver sharing a story about how a patient needed help, and they went and were able to find the physician, and together they worked as a team to solve it together. It could be caregiver to caregivers, so our MAs who were having a lot of prescriptions to be called in, and they all pitched in together at the end of the day to complete that task.

It was a really nice way to end our huddle on a very positive go team moment. It was really nice to see that it could be patient related, but also caregiver to caregiver related. When we were talking about our hospitalists passing each other in the night, or the day, and not working often ... The people you work with will vary day to day.

Figuring out a way to be able to do some of those recognitions.

Taki May: Right, yeah I was thinking about an episode not too long ago where we came in, in the morning. I got in earlier than my partner and assigned a patient to his team, and he came in a little bit later. In the meantime I found out that, that patient wasn't very stable. I'd been back to the ICU talking with the ICU nurses. She needed a central line placed, she really needed to be transferred to a higher level of care, and so when Dr. Williams came in he got to work on the central line.

I was working on getting the patient transferred doing the dock to dock with another provider. It was a really nice example of working together as partners to get the right care for the patient.

Dr. Anne Pendo: Yeah, which I think brings us to ways to recognize each other. How do we do that? Everyone has a different way of acknowledging the appreciation, and I think that thinking about caregiver shout outs, or patient shout outs, or experience shout outs is a way of doing a, thank you for the great teamwork today in taking care of critically ill patient.

Thank you for helping me get my notes done, so I could go home and be home in time for dinner and celebrate my child's birthday.

Taki May: Celebrating the little things is really important, and I think it applies not only to caregiver to caregiver, but caregiver patient. You might know your patient needs to lose 50 pounds, and they've lost one, well we should celebrate the loss of that one pound, and the fact that they didn't gain more weight.

Dr. Anne Pendo: Yes, exactly.

Taki May:I think it's important to patients too, because often my mother says that she doesn't like to go to the doctor, because all we do is find more things wrong with her. What if we could celebrate every time one little thing that's gone really well.

Dr. Anne Pendo: Yeah, we just talked about that day, is celebrating those little, small steps. The five pound weight loss, the taking your medicine every day. The going to physical therapy twice a week as you planned, so you can get back to your exercise routine. It is those small things to celebrate, and then thinking about the small things that are really routine to us, but can be so much more to our patients.

Taki May: Yes.

Dr. Anne Pendo: I'm thinking of warm blanket when you are done with your colonoscopy. Getting your patient some ice chips, because that is really meaningful to them. To you it might just be part of your day-to-day work. Any of those small moments come to your mind?

Taki May: Actually my mother was in the emergency room back in December, and she had a bacterial bloodstream infection, although we didn't know it at the time. The nurse got her a meal, and my mother for whatever reason wanted a cheeseburger. Normally that's not something that's accessible in the emergency department, but they got that for her, and she was just thrilled with that.

Dr. Anne Pendo: I love that, so really it's a routine task to get a meal, right? She got the cheeseburger that she wanted, and that's the little thing that meant so much. As you think about what you might be doing differently going forward with the mindset of celebrating what's right with medicine, talk a little bit about what you're going to do differently to scan for the positives.

Taki May: Well I've been trying for quite a while to incorporate more comments about teamwork like when I'm introducing myself with a patient, and finishing up the visit I will say, "Your nurse today is a great nurse, and you're in really good hands." That both the patient knows that we're a team, and we are working together to take care of them, but also so that the nurse knows that I think she's impressive, or he's impressive, and that I know that they're going to take good care of my patients.

Dr. Anne Pendo: Yeah, I just imagine if I were patient and I knew that I had a team around me, how comforting and may be anxiety reducing that would be for me. It would give me the confidence that I'm getting the treatment that I need in the right way at the right time, all of those things.

Taki May: I think it's important to catch people doing a good thing in the moment, and getting feedback to their supervisors.

Dr. Anne Pendo: I agree, so I'm hoping that you and I can team up again to have a conversation maybe in a few months to see what you're doing differently, how things have changed on the unit here up at Logan regional, and how your hospitalists and nurses and ward clerks are all celebrating what's right with medicine.

Taki May: Well, I hope I'll have some good stories to share.

Dr. Anne Pendo: I think you will, thank you so much for taking time to visit with us today, and we'll look forward to talking with you soon.

Taki May: Thanks.