Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 191 | November 14, 2023
Fighting for our Heroes
Chief Executive Officer, Dr. Lorna Breen Heroes’ Foundation
Welcome to Difficult Conversations. You may have heard the story of Dr. Lorna Breen, who was an accomplished physician that tragically took her own life during the spring of 2020. Today, Dr. Orsini and Liz Poret-Christ are honored to introduce guest, Corey Feist, who is the co-founder, and President of the Dr. Lorna Breen Heroes’ Foundation. Corey dives into his personal journey, driven by the tragic suicide of his sister-in-law, Dr. Lorna Breen, and his mission to transform the healthcare system to support the well-being of healthcare professionals. The Dr. Lorna Breen Heroes’ Foundation’s work includes awareness efforts to break the stigma surrounding mental health issues, advocating for changes in licensing laws and credentialing questions to protect healthcare workers’ rights, and advancing solutions that aim to improve the overall well-being of the healthcare workforce.
Corey shares insights into the challenges within healthcare, such as electronic medical records and burnout, which prompted him to take action. He discusses the “All in Wellbeing First for Healthcare” initiative, that includes grants to fund well-being solutions, a starter kit for healthcare systems to kickstart well-being initiatives, and a focus on removing barriers to mental health access. We’ll also hear the significant progress the foundation has made, including the passing of the Dr. Lorna Breen Healthcare Provider Protection Act and the creation of the All In Champions Challenge Badge program,. Corey emphasizes the importance of healthcare professionals reaching out for help and clarifies that the most reliable source for information on the status of physician licensing and mental health concerns is their website because the foundation regularly updates this information. He also discusses the need to remove questions about past mental health issues from peer reference forms, stressing the importance of creating a supportive environment and ensuring confidentiality for healthcare workers seeking help. If you enjoyed this podcast, please hit the subscribe button on your favorite podcast platform and download this episode to hear more!
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Corey Feist (2s):
The response by the healthcare workforce to Lorna’s death was the catalyst for the creation of the foundation. It was not that Jennifer and I were looking to memorialize her sister in some way. Rather, it was that we heard a refrain that we could not ignore, which was enough is enough. Our mental health matters, our well-being matters. Somebody needs to do something about it. And in that moment, we felt like we were in a unique position to try to turn tragedy into something that would help make an immediate and long-term impact on the healthcare workforce. For futures to come.
Welcome to Difficult Conversations lessons I learned as an ICU physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether, you are a doctor faced with giving a patient bad news. a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 27s):
Hello, Welcome to Difficult Conversations Lessons I learned as an ICU physician. This is Dr Anthony Orsini and I’ll be your host along with Liz Poret-Christ this week. Now You may have heard the story of Dr Lorna Breen. Dr. Breen was an accomplished physician who during the spring of 2020 tragically took her own life. Today we are honored to introduce to you Dr. Breen’s story, the foundation that was established by our guest today in her name and a story of triumph for healthcare workers around the world that has directly resulted from this tragedy and the work of this foundation. Today we are joined by Corey Feist, who is the co-founder and President of the Dr. Lorna Breen Heroes Foundation, and Brother-in-Law to Dr.
Dr. Anthony Orsini (2m 11s):
Breen. He is a healthcare executive with over 20 years of experience and he has served as Chief Executive Officer of the University of Virginia Physicians Group, which includes over 1200 physicians and advanced practitioners in the UVA system. Corey holds an adjunct faculty appointment at the UVA Darden School of Business where he recently taught a course entitled Managing in a Pandemic, the Challenge of COVID19. Corey, thank you for joining us. You know, we’ve had several guests on this podcast discussing the epidemic of physician burnout and physician suicide that we are experiencing right now. Guests like Dr.
Dr. Anthony Orsini (2m 51s):
Dyke Drummond, who is an expert on physician burnout, Susan Wilson who spoke to us about second victim syndrome and of course Dr. Michael Myers and Robyn Symon, who are frequent speakers on the topic of physician suicide. But Dr. Breen’s story has had a lot of interest and the work you do with this foundation is so impactful. I’m delighted that you are graciously accepted our offer to come on today. I think as always, it would be a good start if you told us first a little bit about yourself, the story of Dr. Lorna Breen and how the foundation was started in her name.
Corey Feist (3m 27s):
I began as an attorney in Florida and moved to the University of Virginia where I spent the predominant part of my career as an in-house lawyer and government relations representative, first on the hospital side of the business. And then they have a very large medical group that all physicians and advanced practice professionals at UVA Health are employed into And. I began as their general counsel and then was in the fortunate position to put myself back to school, got an MBA and ultimately became the CEO of that same organization. So that’s a little bit about my academic bio and my job history. I also have an amazing wife, Jennifer, who we met in law school at Penn State Dickinson Law School back in the late nineties.
Corey Feist (4m 11s):
She was my first co-counsel and we have been attached to the hip ever since. Jennifer was Lorna’s youngest sibling and connected by about 20 months at birth. She likes to say that she was born to be Lorna’s Playmate because they had two older siblings who were close in age and then a pretty significant separation there before they had Lorna. I think her dad was a surgeon and mom as a nurse felt like Lorna needed a playmate. So there came Jennifer. We have two wonderful children, a 20 year old and a 16 year old boy and a girl, 20 year olds in college. And our 16 year old is a sophomore in high school and we live in Charlottesville, Virginia where we have spent the last 22 years and really enjoying life here.
Corey Feist (4m 56s):
Jennifer was born in Charlottesville, her dad was in residency at UVA and her mom was a nurse here and they moved away. Her dad was got his first job at Geisinger in Pennsylvania. And so Jennifer returned here later in life. And so it was great that my job was able to bring us here and reunite with some of her family, but this was always home. And that’s kind of part of the story about Lorna for me as I think about the last couple of years that we’ve been at this work, the work really began probably almost a decade ago, and that was when I was inside the health system that was adopting this electronic medical record that everybody was talking was gonna change the world and was really impacting the balance sheet of the health system and the financial ways.
Corey Feist (5m 45s):
But you know, everyone was talking about how this was gonna be the greatest thing ever. And then all of a sudden we started to hear a steady and increasingly loud drumbeat from the clinical teams about how challenging that electronic medical record was making their day-to-day environment. In fact, I recall going into the very first patient rooms that I saw after we installed this electronic medical record and looking at an exam table in one corner and then in the opposite corner up against a wall, a big computer on an arm that didn’t allow the clinician to be really anywhere near the patient and certainly had his back to the patient. And just kind of looking at it going, who, who thought this through?
Corey Feist (6m 28s):
Everything from just the logistics of the placement of the computer to the rest of it. And so as that 10 years went on, about five years into it, the drumbeat was so high and the data was starting to mount about the connection between the engagement or the satisfaction of our clinical teams and this increasing administrative burden that I called the time out at UVA Health And I said, we need to do something about it and what are the evolving best practices? And so what we began was a very concrete and focused effort through distinct pilot initiatives at first, and then they scaled later to draw that connection between reducing administrative burden through optimizing, that’s the term, optimizing the electronic medical record for the user.
Corey Feist (7m 20s):
And really we’re having some pretty great success in that. While it was too slow, the results were just palpable. And we started to do things like incorporate into compensation of leaders within our organization, leaders who don’t necessarily even touch patients reduction in pajama time. That’s the time before and after work that healthcare workers are in the electronic medical record, really trying to be very progressive to say we work for them, we are here to serve them, they are serving patients. Everything we do needs to be aligned with making the lives of our clinical team better so they can just do their job.
Corey Feist (8m 1s):
And I’ll pause there by saying, when my sister-in-law had her only mental health event of her career, which was catalyzed by a very difficult bout of Covid in March of 2020, followed by a return to work too early while she was still sick and in the compounding nature of what she was observing and what she was responsible for, because she was not just a clinician, she was a leader in healthcare who was responsible for others and responsible for multiple teams. And that episode, which culminated as you said into her tragic death, opened our eyes and my eyes in particular as a healthcare leader, to something that had been hidden in plain sight and continues to be hidden in plain sight for many, which is the mental health challenges which have to be hidden, which have to be shoved down, which have to be ignored, which are often penalized that plague our healthcare workforce.
Corey Feist (9m 6s):
You know, that’s a little bit of my career arc focused on this work and how it’s now come into the Lorna Breen Foundation. And maybe I’d, I’d end this answer by saying that the response by the healthcare workforce to Lorna’s death was the catalyst for the creation of the foundation. It was not that Jennifer and I were looking to memorialize her sister in some way. Rather it was that we heard a refrain that we could not ignore, which was enough is enough. Our mental health matters, our wellbeing matters, somebody needs to do something about it. And in that moment, we felt like we were in a unique position to try to turn tragedy into something that would help make an immediate and long-term impact on the healthcare workforce for futures to come.
Dr. Anthony Orsini (9m 53s):
You know, it’s really interesting you bring up the electronic medical records, the physician wellbeing, you know, I’m actually preparing a keynote speech about physician wellness. My other hat is chief of wellness for my group. And if you really look at, when you start looking at physician wellness and what makes us tick, we talk about getting back down to the why Simon Sinek, Remember Your Why And so much I think is the key to physician wellness is getting back to remembering our why. When you have architects who start putting computers with their backs facing the patients when you have electronic medical records and have administrators who’ve never been physicians before, we start to confuse what our why is.
Dr. Anthony Orsini (10m 35s):
And our why really is the relationships that we have with our patients enjoying each other, getting to know them and fulfilling our own lives by doing something that we’ve been born to do, to be honest with you, and all of this, as you mentioned, the electronic medical records, all of this has forced a lot of physicians to forget their why. And we’ve had Liz, And, I have had multiple people on who’ve discussed physician suicide, physician wellness like Mike Drummond, Michael Myers that you probably are aware of, wrote a wonderful book, then we had Robyn Symon who did this beautiful film about physician suicide. So you started the Lorna Breen Foundation. Tell me what you’re doing now, I mean I know you’re doing incredible things.
Dr. Anthony Orsini (11m 16s):
But tell everybody what this foundation has done. And I’m gonna be honest with you, Corey, are we making any headway here? ’cause this is something that scares me. And I see stats like 52% of physicians said that they would not be in medicine if they could financially afford it. How are we making this impact?
Corey Feist (11m 35s):
Well, I’m glad that we have five and a half hours for the rest of this show this afternoon so that we really can dive into the impact that we’re making. One thing I just wanna point out, I’ve come to know Simon pretty well since actually Lorna’s passing, Simon Sinek, you mentioned him, And I, think he’s spot on with the why And I think, you know, maybe to refine your point a little bit, if I may do so, I think it’s really the things that get between the clinical team and their ability to fulfill what they feel like is their why really tend to mount up as the barrier, the barriers to the why. And maybe we’ll ask Simon if he’ll write an updated article about that and the barriers to the why those, those seem to be really challenges.
Corey Feist (12m 16s):
I’ll tell you, I was recently in Chicago speaking at a national meeting of physicians and we’re about a thousand of ’em. And the theme of the meeting was Hope. And, and I’ll tell you, despite our family’s tragedy, the progress that we’ve been able to make in the three year period on this as a singular foundation with help from many, many really continues to give me hope even in our darkest days, And I’ll share with you just a little bit about our work and why I think there should be hope and there needs to be more hope. So our foundation was begun in the summer of 2020. At that time, we were really reacting to just a tremendous volume. I mean, the volume of requests and contacts that we were receiving really for the first two years of our work was unmanageable to get.
Corey Feist (12m 58s):
And and if you’re listening, And I never responded to your email, I’m sorry, my email box is full of messages from people that even today that I didn’t know yesterday. So that’s what we spend a lot of the first part of our our work doing. But what we’ve really been able to focus is in three main areas. But those areas all are a tactical approach to achieving two very focused goals. The first goal is to scale solutions to support professional well-being and mental health of health workers heavily focused on the operational or systems change needed to do that. The second area that we focus on is eliminating the barriers to mental health access that uniquely stand between healthcare workers and their ability to take care of themselves and obtain mental health treatment without repercussions and penalties.
Corey Feist (13m 48s):
So those are our two goals that we have. And so the way that we implement our goals is really in three different domains. I learned in business school businesses can only do three things and it’s best if they start with the same letter. So we do this through awareness, advocacy and advancing solutions. From an awareness perspective, what we’re doing is we are raising awareness to healthcare leaders across the country as well as healthcare workers as to what these things really are and and trying to lift the boats from an educational perspective. And I say that because you just even mentioned that in your title, you’ve got the title Wellness. Well, as Jennifer likes to say, I think you all have misbranded this, it sounds to me like she says, I’m not in healthcare, but it sounds like what you’re talking about is efficient healthcare operations. That’s what you want.
Corey Feist (14m 28s):
You’re calling it wellness. And she says to quote a staff member of a, a member of Congress who we were talking to, she’s like, are these kitty cat posters and meditation apps that you’re talking about? And we’re going, no, we’re talking about efficient healthcare operations. And so when we’re doing the education, we always point out that what we’re talking about is for the professional well-being and job satisfaction. And what we mean under that, or the way that we attack that I should should say, is we attack that in two very significant domains with a big overlap. So this is my virtual Venn diagram that I’m, I’m gonna describe for you is, the way we think about this. So you’ve got burnout on one side of this Venn diagram, and burnout is an occupational syndrome. It drives people either to increase or decrease their burnout based on the job factors.
Corey Feist (15m 13s):
And so if you make the work environment a better place, the burnout will go down. If you make it more stressful and there’s more inhibitors, the burnout is gonna go up. And within burnout, the way that we are advocating through our awareness work and through our solutions work, by the way, and I’ll guess our advocacy too, that what we need to do is we need to both hold pressure on the bleeding wound through individual support for healthcare workers, but also look to the root cause of a wound, which is looking to why there’s a bleed in the first place. And those are the systems changes that need to come online. Those can be electronic medical record inefficiencies, they can things that be things like pre-authorization. It’s really anything that gets between a clinician and the clinician’s patient.
Corey Feist (15m 54s):
That’s kind of the burnout domain. And so we’ve really done a lot of education to say this is the tactical approach. The tactical approach needs to be around system support. And what we’ve heard, and our research supports this over and over again is that by and large, the response by leadership and health systems to health workers has been in the form of what Jennifer was describing as the no-no, which is, this is not about kitty cat posters and meditation apps. Those help you hold pressure on that bleeding wound, but they never solve the underlying root cause. So that’s burnout. On the mental health side of our Venn diagram, we look at why is it that healthcare workers and physicians and nurses, as an example, are dying by suicide at twice the rate of the general population.
Corey Feist (16m 37s):
Why is it that female nurses are dying eight and a half times more by suicide than females in the general population? Why is it that physicians in the United States die by suicide at greater rates than any physicians than anywhere else in the world? And one of the reasons why we understand that there are three primary drivers of suicide of healthcare workers, and the very first one is the stigma associated with the loss of license and their credentials. And so what we have done is we’ve developed a very tactical toolkit and a Badge recognition program for the country. So that hospital systems, through their credentialing arm and boards of medicine, boards of nursing, insurance companies, and others can use this to eliminate those barriers.
Corey Feist (17m 20s):
By doing that, we know that that will be a life-saving exercise. So that’s number one in our tactical plan when it comes to mental health support. The next level is in scaling suicide prevention. We know for a fact that doctors and nurses are experts at diagnosing and treating. We know that. We also know and have learned that physicians and nurses don’t always know the signs and symptoms of suicide or what to do about it. And so what we’ve seen is when health systems train their workforce in suicide prevention, proactively, those healthcare workers will not only use those techniques or their training to look at the signs and symptoms in their patients, but also in their clinical team members.
Corey Feist (18m 0s):
And we’ve heard story after story after story about where they’re intervening with each other and literally save each other’s lives. And then finally, the way we think about this is we think about this in making sure that there is confidential access to care. Because we know about this stigma. We know that the stigma is the primary driver of Suicide, and then right in the middle of the Venn diagram that we paint all the time are the two ultimate accelerators or inhibitors of change and those being leadership and culture. So we know that as we build this Venn diagram and this approach in our awareness, in our advocacy, in our advancing solutions, we need to make sure that we recognize that we are only as good as our leadership and our culture allow us to be in this change. So that’s been our work in awareness.
Corey Feist (18m 42s):
We also have done quite a bit of work around National Physician Suicide Awareness Day, September 17th, which is the, you know, was created by emergency medicine residency program directors who said there are 400 doctors a year that died by suicide. So on our website, npsa day.org, we have a myriad of resources. We have ways that you can talk about these issues and really very practical solutions to solve these issues because suicide is preventable. The last thing I would say about our awareness work for just a second before I go onto the other two, is that while there are a significant number of issues that we’re dealing with here and they’re complicated and they lack, they’re going back many years, what we’ve learned from our awareness work is that simply speaking about these issues, naming them, creating space to talk about them, has an incredible positive impact on changing the culture right in the middle of that Venn diagram.
Corey Feist (19m 38s):
And that’s critical. We’ve recently passed another anniversary of 9/11 And I. Remember the summer of 2020 working with a post 9/11 mental health professional who said to me, she said, Corey, you know when the unspeakable happens to you, And, you speak of it, it gives others permission to speak out too. And I’ll tell you that that alone, we’ve seen it play out. I’ll give you a recent example. I’m standing there in Kansas City speaking to the American Association for Family Medicine Physicians, And I may have botched their full name, and I’m sorry if you’re part of the association, I can’t remember the society, if it’s a society or dissociation or a, anyway, I finished speaking, the crowd sat down except for one guy And.
Corey Feist (20m 18s):
He went to the microphone, pointed at me and said, that guy, that foundation gave me the courage to speak out about my own mental health challenges. And I’m doing something about it. I’ve written articles about it, I’ve shared my story, and we have saved lives together. And buddy on the stage, you don’t even know me, And, you, And don don’t know you. But we’ve already done this work together and that physician is named Dr. Christopher Thomas Veal and he’s finishing his residency in Urbana, Illinois right now. He’s gonna be practicing the Chicago area, he’s now one of our speakers. But it’s doctors like Christopher Veal who have made a conscious decision to follow this model of speaking out, which I think And I know is having an incredible impact.
Corey Feist (21m 3s):
So when we talk about impact, when we talk about hope, those are huge. Let me segue now, we’re gonna step over a little bit. We’re gonna talk about advocacy because that’s another area that we’ve just absolutely gone all in on. All in. We’ll come in and that’s actually our Advancing Solutions campaign. But from an advocacy perspective, we passed the first federal law ever that is looking out for the mental health and well-being of healthcare workers. Hard stop, The Dr, Lorna, Breen Healthcare Provider Protection Act was signed into law on March 18th, 2022 by President Biden. We were in the oval office with him, it immediately infused $140 million worth of new programs to support the current workforce and the future workforce in healthcare.
Corey Feist (21m 43s):
44 organizations obtained the grants through HRSA that were administered to provide those resources. And they are making themselves great progress as we monitor it. Great progress towards Improving, the Wellbeing in their 44 institutions. Our job, I feel like is to be a megaphone on that progress and make sure that hospitals and health systems across the country are benefiting from their learnings. Because while there’s a lot of data and actually a lot of science that we know about Improving, well-being and real tactical solutions, it’s not scaled yet. And so we, we feel like we can use The, Dr. Lorna, Breen healthcare Provider Protection Act, grant recipient learnings in real time to get that information out. We’re not waiting for some reports from Congress five, 10 years down the line.
Corey Feist (22m 26s):
We’re just working right now with them. I will share with you that that law is up for reauthorization already. And so any of the listeners who wanna help us support reauthorizing the law and extending its reach and its impact for many more years to come, and we need to make sure it’s funded as well in that process. That’s a twofer. That’s not a one for, you can’t just get the thing reauthorized without getting the money because it’s a program creation. We need to make sure that that happens. In addition to the advocacy domain, we have spent a tremendous amount of time changing licensing laws at a state level and changing credentialing questions at a hospital level. So very briefly, the issue is this, physicians and nurses have to answer questions when they apply for licenses.
Corey Feist (23m 7s):
They have to answer questions when they apply to work in hospitals. Many times those questions are overly invasive about prior mental health treatment or diagnosis. When they ask questions on those applications that expand in any way beyond asking about current impairment, whether that be mental or physical, if physicians and nurses and other licensed healthcare workers are being asked any questions about in the past, other than current, that is a more likely than not a violation of the Americans with Disabilities Act. So we have published a three step toolkit. Remember I told you what I learned in, in business school, you can only do three things things. So we’re doing a three step toolkit.
Corey Feist (23m 48s):
It is free on our website at Dr. Lorna Breen.org. Anyone can use it, anyone can download it. And it is scaling the country. And when organizations use it, they don’t just benefit their workforce in a lifesaving way. We also give them communications toolkits and a visible Badge that they can hold out to their workforce. So their workforce knows that where they work is safe. So that Badge, we call it the All-in Champions Challenge Badge. And here’s some hope for you. When we started this work on this part of our work, which was just over a year ago, there were 17 states in the country that really met our standards to obtain our Badge in less than a year we have over 25 states currently in this country.
Corey Feist (24m 35s):
There are over 600,000 physicians who are benefiting from our Badge program. 600,000. There are in states where it is safe to get mental health treatment on the local level. On the institutional level. We started with cohorts of hospitals. We began in Virginia because we were asked, not just ’cause we live here, but because we were asked, we got the Virginia Hospital Association, the Medical Society and the Nursing Association together. And we said we had to do this work together. So get your membership and let’s do this. We did the same Badge challenge with them. We just had a steering committee meeting recently. We started with a baseline of zero hospitals that were compliant with our recommendations. We are now at 64%. And what’s exciting about both the medical licensing work and the hospital credentialing work is that those numbers don’t tell the full story.
Corey Feist (25m 23s):
Because when it comes to medical licensing, we got another 10 states that are almost through the process with us. And on the hospital side, we will be up to close to a hundred percent of the hospitals in Virginia who have our Badge by the end of the calendar year. So when we talk about hope, when we talk about progress, this is what I see every day as practical action that is going tactically at improving the well-being of the workforce. Now, none of this, none of this matters if we don’t tell the workforce what we’re doing, whether that be an operational initiative or a policy change. And so as we’ve recently all experienced a very public murder suicide in New York, as an example of a physician who died, I think it was this early summer or late spring like Lorna, she was in New York State, a state that is compliant with the Americans with Disabilities out a state where from a licensing perspective, physicians are not penalized at all.
Corey Feist (26m 23s):
Did that physician know it? Lorna certainly didn’t because she told us repeatedly she was gonna lose her license to practice medicine. So we have a huge communication gap here between the understanding of what the rules are and what they actually are. And so just like any operational initiative or any change, we need to make sure that healthcare leaders in particular are concrete with their workforce about what actually is happening and what the rules are. Because just simply knowing that there are no ramifications on your license for obtaining mental health treatment and the states we’ve given the Badge out is lifesaving.
Corey Feist (27m 5s):
And so we know that it’s worth taking that time to communicate the rules. I could go on And, I would like to tell a little bit about the Advancing Solutions campaign that we’ve got going on, but I wanna pause for a breath and let you jump in here. ’cause I’ve been mono, I’ve been monologuing for a little bit here. You asked, I answered,
Dr. Anthony Orsini (27m 23s):
You’re passionate and that’s why you’re on and that’s why you’re so effective in what you’re doing. There’s really a lot to unpack there. Starting out with really the title of this podcast called Difficult Conversations. And we had talked in our previous episodes about physician suicide, about how often the most difficult conversations is the one that you have to have with yourself. And I’m interested in asking you about generational culture change because I see it already and it’s for a positive. You know, millennials right now sometimes get a bad rap, right? But millennials, gen Z, they’re, oh, they’re this, they’re that. But one thing that I think, tell me if I’m wrong, it’s my observation is that when I went through the system, And I was working 36 hour shifts.
Dr. Anthony Orsini (28m 8s):
And when one of the residents got fired, they said to me, by the way, now you’re working 48 hour shifts. The culture of medicine was, Hey, you’re only working 36 hour shifts. I’m working 72 hour shifts. You only saw a hundred patients. I saw 200 patients. And if you said, I need to put my head down, you were considered weak and, you would never have that conversation with yourself. Tell me if I’m wrong, but I think the millennials are a little bit more aware of that and are, do you think that they’re more willing to ask for help than say, my generation, the generation before or more willing to have the conversation? Because you first have to have that conversation with yourself, right?
Dr. Anthony Orsini (28m 50s):
You have to say before you even go into the laws and will I, there’ll be ramifications of this. You first have to admit you have a problem. Right?
Corey Feist (28m 58s):
I agree with you. I’m gonna back it up just a second. I was sitting at the National Institute of Health’s Action Collaborative on burnout. And when they were rolling out their national plan, Darrell Kirsch, the former president of the double AMC, said, you know, we used to, in my generation, we wore burnout as a Badge of honor. Oh yeah. That’s what you’re describing and you’re totally right. Here’s the thing, the current generation, if that’s millennials who are entering medicine, they talk more openly about mental health. They talk regularly around much more boundaries, much more healthy boundaries and work life. And they have a different expectation on how they’re gonna be treated when they hit the workforce.
Dr. Anthony Orsini (29m 42s):
Corey Feist (29m 42s):
The thing that you know, and I’ve heard, but I haven’t experienced is there’s this thing called the silent curriculum. There’s what you’re taught in medicine and what you’re taught is gonna happen in residency and then that there’s your experience and a lot of what you talked about culturally is the experience. What I would say is this, I think healthcare is behind many, many generations when it comes to how it takes care of its workforce. I think that healthcare has, maybe not intentionally, but as a matter of fact, largely ignored the impact of the work on the workforce and has been so focused on the patient care, they’ve forgotten or assumed that the workforce would just do whatever they can to take care of patients.
Corey Feist (30m 23s):
They would stay, oh obviously if I don’t have another colleague, I’m gonna stay and I’m gonna work 48 hours. I contrast that a little bit with what we know about, you know, the airline industry. So I’ve been now on the planes a lot and I’m often inconvenienced by a timeout that the crew has to take because we know that if you fly a plane and you’re working too long, there are errors that occur. And that is for the safety of the passengers. There is a tremendous amount of data that shows that extended hours for healthcare providers negatively impacts patients. I don’t know how the general public has been kept from this information as long as it has, but I have an opinion, which is that if the general public knew about the error rates because of extended work hours and the work conditions, they would be as much of a humane cry about workforce hours and just environment coming from the public as there have been in pockets coming from within healthcare.
Corey Feist (31m 23s):
But when you’re within healthcare, as you know, it’s really hard to raise your hand within a big organization and say, we need to change without being viewed as somebody who’s trying to stir the pot. And then you’ve got all the cultural professional stigma and all the competition that you’re surrounded by. So I think very much so that the older generations, the current generations practicing medicine need to first and foremost start to model the behavior that is expected and they wanna see. Recognizing that when I say that leaders are right in the middle of that Venn diagram from before, everybody who puts on a white coat in some way is a leader like it or not.
Dr. Anthony Orsini (32m 0s):
Corey Feist (32m 1s):
And people are watching and people need to know it. And so as these young students come out into the residency and as those residents become attending physicians, everybody needs to know that everyone is watching here when it comes to the way that the behavior is being modeled. And are people walking the talk or are they not? There continues to be a big backlash. And I’ll just give you one last example, I’ll turn it back over to you. To give you a sense of how important this issue is to me, students, we had a group of medical students who reached out to our foundation and they said, we want to create an arm of your foundation devoted to medical school. And we said, great, we have no capacity to do it ourselves, but if you do, wonderful, well, in a very short period of time, all of a sudden, every single medical school in the Commonwealth of Virginia had students who are raising their hand.
Corey Feist (32m 47s):
And later this evening we have our very first nationwide, Dr. Lorna Breen Heroes Foundation Medical Student Coalition meeting, and we have over a thousand medical students who are interested in creating chapters at their medical schools about this. So if that is any indication for you about how the current workforce in training feels about these issues look no further than the fact that I had to up my Zoom subscription to accommodate all of the people that have signed up to be on Zoom with us because they wanna create chapters. So anyway,
Dr. Anthony Orsini (33m 25s):
I guess my point is that your work with changing the states and changing the hospitals and making it more easily and without any problems, when a person says, hey, I have a problem. All that work that you’re doing right now is so timely because it’s lining up perfectly with this generation. Because as I said, if you’re not gonna have that difficult conversation with yourself first, all the laws in the world aren’t going to help you. So this generation is more willing to have that conversation with themselves and they’re more willing to help. So I think the work you’re doing not only is amazing, but it’s timely. It’s fantastic. You know, you mentioned a while back about wellness and how it’s probably misnamed, Liz, And, I were doing, we do consulting for patient experience, et cetera.
Dr. Anthony Orsini (34m 9s):
We were walking around the hospital and we saw four nurses standing in front of this bulletin board in the hallway giggling. And there was a poster up there that was obviously put up by somebody who didn’t really understand how deep this problem is. And it was a professional burnout poster with a bingo card. And the bingo card had, you know, just like a bingo card five across and five down, and it had all things that you can do to reduce your chance of getting burnout, go to a movie, take time to have a date with your spouse, meditate, all things that are great. I’m not saying anything bad about them, but what struck me is that they were laughing in the comment by one of the nurses to the other three was, if I had the time to do all that stuff, I wouldn’t be burned out in the first place.
Corey Feist (34m 56s):
Wouldn’t be burned out in the first place. There you go.
Dr. Anthony Orsini (34m 59s):
So that was kind of funny.
Corey Feist (35m 1s):
Our first article that Jennifer And I co-authored was in US News and World Report, we analogize this to the canary in the coal mine. And what we said was, we don’t need stronger canaries, we need to redesign coal mine, And I think that that’s where we all need to go in this conversation and starting to think about this. And I’ll just also say to your poster, one of the areas within The Dr. Lorna, Breen Healthcare Provider Protection Act that was created was a multi-year education and awareness campaign. And it was originally intended on two audiences, health workers and health leaders. And when we did hundreds of in-depth interviews across the country, and it didn’t take long to come to this conclusion, we wanted to take the health worker campaign and put it in the pocket in the drawer and say, we don’t need a health worker campaign.
Corey Feist (35m 52s):
What we need is we need to help healthcare leaders understand what the operational tools are, tools that they need to employ in their organizations to make the workplace a better place. And the big conclusion that we came to also are, the observation we saw was that healthcare leaders and healthcare workers were talking right past each other, in terms of what they want and actually what they want is exactly the same thing, which is an efficient healthcare delivery system. Everybody wants that. Who doesn’t want that? And so I support the statement and I’m not surprised that you saw nurses standing in front of that poster because they know why they can’t go outside of work and do all those things.
Corey Feist (36m 32s):
’cause they don’t have time to go to the bathroom. You don’t have time to eat when you’re working so
Dr. Anthony Orsini (36m 37s):
Well, we only have about 10 or 15 minutes left, so I know you wanted to get to your new initiative and the other part of the Lorna Breen. So I’m anxious to hear about it. I’m sure everybody else is.
Corey Feist (36m 45s):
Yeah, for sure. So under the Advancing Solutions campaign, one of the things that I immediately recognized when I came to start this work was that first of all, there’s not enough resources across healthcare to begin another initiative, whether you call it efficient hospital operations or just well-being. And so what we need to do now more than ever, is to lock arms regardless of where you are within healthcare, knock down silos and work together to address this issue. And so in order to do that, what we did was we launched a national campaign called All in Wellbeing First for Healthcare, recognizing that the very first thing before patient care becomes the well-being of the workforce. And we did that with a cross section of about 15 national organizations.
Corey Feist (37m 27s):
And they range from everything from the American Medical Association, the American Hospital Association, the American Nursing Association to Thrive Global in the Creative Artist Agency in Johnson and Johnson, and the Schwartz Center for Compassionate Healthcare and the Black Nurses Association and the Philippine Nurses Association. And end to end, to end to end many, many people coming from different sectors to lock arms. And what we said was what we wanna do with a national campaign called All in well-being, First for Healthcare is to get solutions out there. And the way that we’ve predominantly done that on well-being solutions is to fund grants. So we took private money that was coming towards us and we put it into a grant program, And, you know, we had this federal grant program going, why can’t we create a complimentary grant program to the federal program where we can use the same or similar analysis of how to fund solutions and let’s get more money out there.
Corey Feist (38m 17s):
And so we’ve done that. We call it the All-in Fund. And the all-in fund has now given grants to over 11 organizations across the country, big and small, rural and urban, working on both systems change and individual support. So that’s been fantastic. The other thing that we did was we recognized that while there were some programs out there that were just really superb on advancing this work such as the AMA’s Join Medicine program, what those organizations are doing in the joint medicine program is a pretty mature work when it comes to supporting well-being initiatives. There are a couple hundred organizations every year that obtain joint in medicine status.
Corey Feist (38m 59s):
As an example, But, we know that there is almost 6,000 hospitals in this country. And so where there needs to be a starter kit to do this work. And so we created the starter kit. This is like when you get the new piece of electronics and there’s a big thick manual, but right on top there’s just like a one sheeter quick start. So we’re the one sheeter, we’re the starter kid, we’re the quick start guide and we call that all in Caring, For Caregivers. And that can be deployed across health systems or among groups of health systems. I mentioned our Virginia work before because in Virginia we launched all in Caring for Virginia’s Caregivers because all those organizations came together in Virginia and said, we wanna create the best place in the country to practice medicine and deliver healthcare.
Corey Feist (39m 39s):
And so wait for it. It’s a three step program. I know you’re gonna love this. All the same letter. I wish I’m good, but I’m not that good. Couldn’t get that. Okay. I couldn’t be but I, we’ll work on it. The very first thing that we do is we focus on removing barriers at a local level to mental health access by giving out the Badge. The next thing we do is we put organizations through a digital well-being 1 0 1 course and that course is delivered in bite-sized chunks to delivered for healthcare leaders to understand what the real issues are and importantly what the practical solutions are to it. And then that leads into a 12 month work plan, identifying an operational initiative in their organization that they can take on to improve professional well-being, whether that be through an electronic medical record optimization effort or by taking your existing quality infrastructure and adding quadruple aim as opposed to the triple aim, right?
Corey Feist (40m 35s):
Quadruple aim, being looking at how the work is impacting the workforce in every quality initiative across your organization. And there are a myriad of options that organizations would have to go through. But that’s our all-in Caring For Caregivers program. And we’re deploying that across Virginia. We’re about to deploy it across another state because these states are coming together and they’re going, we wanna do this work together. We’re also doing it across a very large multi-state medical group that’s got physicians in over 40 states in the country. So there’s a lot of different ways that we’re deploying the All-in Caring, For, Caregivers. And we’re just really thrilled and excited that it’s taking hold. And as an example, it was the all-in Caring For, Caregivers working together that got 64% of the hospitals already through phase one and got the Badge.
Corey Feist (41m 21s):
And we’re moving on to phase two and we’re getting everybody through that Wellbeing programming. So it’s really exciting for us to see progress. So you know, you started this off by saying, you know, geez Corey, I don’t know that there is progress. And what I’m saying is I’m doing this every day and I’m seeing it and I’m hearing from it now, is it fast enough? Is it gonna quickly scale the country? Heck no. But let me just leave you with this one thought. We’re a small organization, we’ve got great partners, we’ve got about five or six people that work for us now. But everything that we just talked about in the last few minutes, 43 minutes according to the recording thing across, we’ve been able to do that with about five people and partners. Imagine what we could do as a healthcare industry if we all just took a beat and we locked arms and we said, we’re gonna work on this together, we’re gonna be focused, we’re gonna take one thing at a time and we’re gonna make a huge impact together.
Corey Feist (42m 12s):
That’s why I have hope is because our organization has been small and we’ve been incredibly impactful. And I see organizations jumping in and saying, tell us how to do this work. How can we do it? How can we do it? How can we do it? They’re following our playbook, they’re doing this work, they’re having an impact.
Dr. Anthony Orsini (42m 29s):
I think your timing is perfect. As I said, this is absolute timing. Liz, is there any thing you want to add to this? I’ve been dominating the conversation here.
Corey Feist (42m 38s):
I’ve been dominating
Liz Poret-Christ (42m 38s):
Corey. I just wanna say I’m in the New York area. And Lorna’s story really resonated with me and Dr. Orsini And I see a lot of residents in a year. And in the 10 years that we’ve been working together with the Orsini Way, we have a particular program called Breaking Bad News where we train residents one-on-one in this art of compassionate communication, And I notice a huge difference in the residents post covid versus pre covid. And Dr. Breen’s story has really resonated with me in a way that when I sit down with them, the first thing I say is, I know how incredibly hard this is. And I know we’re asking you to do something that is not only very difficult, but that you’ve never been taught to do and you’re having Difficult Conversations 20 times a day.
Liz Poret-Christ (43m 28s):
And that’s not easy, just in the way as an instructor, I go about talking to them and acknowledging those struggles as they might be trying to hide has really changed the trajectory of all the residents that will train in the future. And there’s been thousands of them that we’ve already trained. So even that, you might say you’re small but mighty, but I think there’s even more impact than you know by sharing this story and creating such an incredible awareness. And I’m really in awe of what the foundation’s been able to accomplish in such a short time.
Dr. Anthony Orsini (43m 60s):
Corey Feist (44m 0s):
Thank you so much for saying that. I wanna just add an anecdote to what you said because I think that we’ll never know the impact, but I was in Chicago recently for a meeting of the American Bar Association health law section. ’cause I wanted the lawyers who do health law in the country to understand this And I speak lawyer. Unfortunately, I’m still reforming, I’m working through it. But this was the part of the conversation that I love. I finished my talk and a guy who’s a chief medical officer in a hospital Wisconsin, tapped me on the shoulder. He said, Hey, you got a minute And I said, sure. He said, I want you to know the impact of the work you’re you’re doing. And I said, okay great, thank you so much. It’s nice to meet you. Tell me what’s going on. He said, and this is part of the sensitivity that you’re bringing and and is being brought I think in large part because of this work.
Corey Feist (44m 45s):
And here’s what he said. He said, we had a physician who was exhibiting behavior issues and the leadership of the hospital brought everybody together in a room and said, this physician is a bad doctor. This physician needs to be fired. And somebody in the room said, have you heard of the work of The Dr Lorna Breen Heroes Foundation? Because I wonder if this physician has an untreated mental health condition. And what did they do? They made a referral. That physician to a mental health professional, instead of firing that individual, which is what they convened that day to do. That physician is under treatment. That physician is taking care of patients. No patients were impacted negatively, no colleagues were impacted negatively.
Corey Feist (45m 26s):
That physician is being taken care of and treated as a human. And, I think Liz, what you were talking about is we’re just trying to bring the human components the way that we take care of each other in healthcare right now. And for me, that story by a complete stranger in a state that I have only been to once to visit my brother for Thanksgiving was like the best fuel for us. Because that is what we’re talking about here. We’re thinking about this humans before Heroes, we named our foundation the Heroes Foundation at the beginning of the pandemic when everybody was referring to physicians as Heroes and healthcare workers as Heroes, And, I don’t know if we’ll change that someday, but no matter what, these are humans before Heroes, And, I think that whole human approach needs to be taken when we, without taking care of the workforce.
Dr. Anthony Orsini (46m 12s):
That’s a great story, Corey because Liz, and I also do some lectures on leadership. ’cause we do a lot of communication and we tell the story all the time, and this is well known. A poor leader in business says, Hey Corey, you’re not meeting your sales numbers, you’re not performing here. If you don’t step it up, you know we’re gonna have to let you go. The good leader says, Corey is there’s something going on that I should know about that you’re having trouble at home. I’m very concerned that you’re not meeting your numbers. And I hired you ’cause I expect you to do this. I just worried about you. Are you okay? That’s been happening in business to a certain extent for a long time. And as you said early on in this conversation, healthcare is way behind, way behind in everything.
Dr. Anthony Orsini (46m 56s):
But the work that you’re doing is I think catching up and it’s an amazing foundation. Last question, Cory, there’s somewhat out there right now, a physician who’s listening to this. ’cause most, 75% of our podcast listeners are healthcare and they’re going, I feel like contacting somebody. I have all these issues that I’m worried about. Am I one of these states that Corey Feist talked about where it’s safe to do this? How do they get that information and where do they go? They go to your website or is there something other places?
Corey Feist (47m 26s):
Right on our website, we are the source of truth right now when it comes to this and on September 20th, we are publishing the most current map of the country will be up for physician licensing.
Dr. Anthony Orsini (47m 36s):
Corey Feist (47m 36s):
And. I would say, this is the kind of thing that we will continue to update and healthcare workers need to be asking of their institutions at orientation and other places when they don’t need that mental health treatment necessarily. When it’s really safe to say, Hey, what are the rules here? And I will tell you, it is surprising how few people know the rules on this and yet how predominant the thought is and how dominant the thought is that they’re gonna be negative consequences and and it’s reinforced by the facts in many states. But that is changing so fast and that’s what’s exciting.
Dr. Anthony Orsini (48m 12s):
That’s great. Well, as a section chief, I get evaluations from Dr. So-and-so, or nurse practitioner, so-and-so is applying for credentialing at this place you worked with her last year. Please answer the following questions. And one of the questions usually is, are you aware of any past mental health issues? So that needs to be removed too.
Corey Feist (48m 34s):
It’s all part of that analysis. It’s the applications and the re and the peer reference forms. You’re exactly right. The peer reference forms absolutely should follow the same exact rules. And there are many layers of why it’s wrong to have a peer opine about it. Not only is it an expansion beyond what’s allowable under the Americans with Disabilities Act, but also because we know that confidential peer support is something that is really coming online at scale across hospital systems. What a horrible position for you to be in. If you’re a confidential peer supporter, And you and all of a sudden three months later you get this form and it’s about somebody that you’ve been talking to. I mean, this is unbelievable. So we need to take these completely off the peer reference forms and that’s part of our work as well.
Corey Feist (49m 18s):
It’s included in the Badge for hospitals. We look at all of this and for licensing boards,
Dr. Anthony Orsini (49m 23s):
Fantastic. Well, Corey, we could have done this, as you said, for five and a half hours, but I know you don’t have five and a half hours because you’re doing so many great things. And I’m really happy that we’re able to do this. And I can’t wait for the audience to listen to this and I’m sure there’s gonna be somebody out there, if not multiple people are gonna benefit from your message. The Dr Lorna Breen Heroes Foundation. I can’t thank you enough for taking time out. And I, hope that you, And, I and Liz. We can stay in touch and and keep this relationship going. Whatever you need from us, we’re there.
Corey Feist (49m 50s):
Thank you so much for having us. Remember, we’re online at DrLorna Breen.org. Our social media is also in every one of the different social media domains. Our children, our adolescents. Still don’t think that anyone will take us seriously until we get to 2 billion social media followers. So please follow us on social media to get my kids off my back a little bit. Friends, tell your friends, but also in terms of tell your friends, also tell your friends about 9, 8, 8, maybe let’s leave on that because 9 8 8 is the 9 1 1 for mental healthcare and that is a life-saving phone number. So thanks for having me. Really a pleasure. Would love to continue this conversation in another time. But thanks for having me today.
Liz Poret-Christ (50m 28s):
Thank you Corey.
Dr. Anthony Orsini (50m 29s):
All right, Corey, thank you. It’s been a pleasure.
Announcer (50m 34s):
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Dr. Anthony Orsini
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