Elevating joy and meaning in medicine


AMA STEPS Forward® podcast

Elevating Joy and Meaning in Medicine

Sep 21, 2023

In this episode of the AMA STEPS Forward® podcast, Amanjot Sethi, MD, urologist and director of wellness operations with The Permanente Medical Group, discusses how they’re working to elevate joy and meaning in medicine as part of a total performance strategy. This important work also includes the interconnected components of operational excellence and exceptional care experience.

For more tips for putting the joy back in medicine, visit: stepsforward.org   


  • Amanjot Sethi, MD, urologist and director of wellness operations, The Permanente Medical Group


  • Jennifer Mathews, practice transformation and sustainability, AMA

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Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.

Mathews: Hi, everyone. Thank you so much for joining us today. My name is Jen Mathews and I am the communications manager for professional satisfaction and practice sustainability here at the AMA. And today, I am very excited to announce that we are joined by Dr. Aman Sethi, a urologist and director of wellness operations with the Permanente Medical Group. Dr. Sethi, hello, thank you so much for being here with us today.

Dr. Sethi: Hello, Jen. Thanks for having me. I'm excited to be here. Thank you.

Mathews: You know what, why don't we just start out with you telling the listeners a little bit about yourself and about your background?

Dr. Sethi: Sure. I'm not sure how far back you want me to go but I was—

Mathews: Let's start with birth and then we'll just work our way—No, you can start wherever you feel comfortable.

Dr. Sethi: Yeah. Well, I mean, birth is a good place to start.

Mathews: Sure, right?

Dr. Sethi: I'm a native New Yorker. I was born in Flushing, New York, and raised on Long Island. Well, I spent most of my early years on Long Island. I trained in Boston for 14 years. So actually, Jen, what that results in is some really confusing sports allegiances that end up making anyone I speak to angry whether they're from Boston or New York.

Mathews: Yes, major rivalry.

Dr. Sethi: Right. For baseball, I'm a Mets fan, but for football, I'm a Patriots fan and so that really ticks most people off no matter who you speak to. But yeah, so, as I mentioned, native New Yorker, trained in Boston. Actually did a robotics and minimally invasive surgery fellowship in Indianapolis after completing my residency training in Boston. And then soon after that moved to the Bay Area after interviewing with the Permanente Medical Group, who I am with now.

And I have to say it was a big jump for me that West Coast move. My wife and I were both raised on the East Coast. Both of our families are there on the East Coast or were there on the East Coast. And I interviewed all along the Eastern Seaboard after fellowship and really thought I was going to end up on the East Coast. I actually took the trip out to California thinking, “Oh, well, let's just end the interview trail with a quick trip out to California, an interview with the Permanente Medical Group. It'll be a fun trip.” Not thinking that I would ever end up here.

But I was so blown away by the model of integrated care that we have here. The thought of being part of a physician-led group. And honestly, the thing that was most important in my decision is the community and camaraderie that I saw in our medical group and especially in my department when I interviewed. Just to see those connections, it was very different. And not to put shade on the East Coast but it was very different than what I saw in the practices on the East Coast.

And that's what inspired me to move here and actually even move my entire family here. My parents are here now, my siblings have followed. They're not here for the job so, of course, the weather and other things about the Bay Area have helped. That's how I started my journey out here. So I'm a urologist and robotics surgeon as I mentioned. But in terms of my well, physician health and wellness work that's been a passion for years in the making as well.

I was participating in some local—by local I mean in my service area because the Permanente Medical Group, as you may know and I think we've talked about before, is the largest medical group in the nation. We're 10,000 physicians across Northern California. We're the sole providers of medical care for Kaiser Permanente here in Northern California.

So in my local service area, which is called the Diablo Service Area, I started out by leading some work there. And I was inspired by a mentor in the work that I was doing previously, health promotion work, to start leading work a number of years back for physician health and wellness for our local area of about 900 physicians at the time.

And that's where my passion started and I was able to build that passion through some of the work that we did here, and then ultimately wound up having the role that I have now, director of wellness operations for TPMG. And that's been quite a journey as well, and I'm sure we'll talk about some of that today. But that's, I guess, in a nutshell, my story to date.

Mathews: So, I wanted to get into the work that you're doing at the medical group to elevate joy and meaning in medicine as part of your total performance strategy, which also includes the interconnected components of operational excellence and exceptional care experience. So can you talk a little bit about the strategy and also how those three components work in tandem?

Dr. Sethi: Yeah, Jen. So, the evolution of our total performance strategy for the Permanente Medical Group actually predates the pandemic, of course. And I'll have to think back a few years now, but when our new CEO at the time—this is around 2017, Dr. Richard Isaacs took the helm of the Permanente Medical Group, he very carefully considered how we can continue to succeed in advancing our mission to provide high-quality affordable care. To continue to improve the health of our members, the communities we serve. But to do so in a health care environment that was evolving already very rapidly.

Of course, a lot has changed since the pandemic, but even at that time, health care continued to evolve rapidly. And so that's what led to the deployment of total performance which is our organizational strategy designed with these needs in mind. Now, you would probably expect a strategy of this proportion to address the foundational components of our systems, how we provide through operational excellence and taking excellent care of patients. Those strategic components are always elevated in any health care organization and are always very visible and, of course, they're very essential pieces.

But what Dr. Isaacs, his executive staff, our board of directors and many leaders actually, also recognize that in order to continue to deliver on that high-level quality of care, that personalized and convenient care, we really needed to make sure that the part of our strategy that supported the incredible people who were actually delivering that care was approached with the same vigor and the same visibility as our other top priorities. It's not that we didn't have a people strategy or strategy to support physician health and wellness, actually we did, but to really make that as visible as possible.

And what that meant at the time is having it at the same level as other organizational priorities. Making sure we were measuring that space on the same level. And so that's how we started. And first, it was really important to understand and address, at the time, what we knew was a huge problem nationwide, and that's physician burnout and its drivers. Obviously, this was an issue affecting the health care industry nationwide.

Yes, we also … we were very concerned that if we made mitigating burnout our only narrow focus, we would fall short. And we really wanted to build further on all of our efforts to support people across that full spectrum of professional fulfillment and well-being. And so that's how the concept of Joy and Meaning in Medicine—and JAMM is the acronym—was evolved as a top organization party. That's how it was born.

I worked very closely with our physician executive over physician health and wellness. People, our entire people team. Physician education and development, her name is Dr. Ellie Farahabadi. And she brought together an engaged group of leaders in a task force, a wellness taskforce. This is leaders from across our organization who did a really deep dive into the literature, into the work of other organizations like the AMA, the Institute for Healthcare Improvement, as well as some of the most prolific researchers in this space. And they work together, these passionate contributors. And there's really too many that deserve acknowledgment to recognize in this short podcast. But they worked together in developing the strategy, and we all did that together.

And ultimately, we developed a strategic framework that reflects what is really the comprehensive nature of what's needed to support Joy and Meaning in Medicine. To mitigate burnout. And to ensure that all of us, especially the leaders at all levels of our organization, because we're so big, but ensuring that we can all speak the same language when it comes to defining the components of JAMM.

And I'll just tell you real briefly that the strategy, although it has many really significant components, is organized around three areas of focus. That's practice support. The goal to design a practice environment where you're always working to design systems and tools that are better optimized to allow people to spend more of their time on meaningful and the purpose-driven work that drew us to medicine. The second is culture. So, addressing the ingredients of a culture that supports Joy and Meaning in Medicine. And then finally, personal wellness, where we're supporting physicians and prioritizing their own health.

And we did so for many years. We had a robust array of innovating programs that nurture personal health and wellness, well-being, resilience, mindfulness. I think the point that we were making here is that as important as personal wellness is, and as much as we weren't going to back off on those priorities at all, we really needed to include practice support and culture to make sure that we were meeting our goals. And this is not surprising. I know that you've seen other models like Stanford and others that, of course, influenced and informed us as well that have very similar kind of broader models.

I think what we did—and I'm not saying it's different but something that was very important to us and a critical tactic in our strategy, was to very purposefully engage our operational leaders, right? So, it wasn't just about our wellness leaders but engage our operational leaders at every level of our organization, right down to department chiefs, to make sure that this wasn't going to be a program or a strategy that's living in a silo. And that physician well-being wasn't the sole responsibility of one individual or a group of wellness leaders or assigned to any one role in the organization.

And as we hear often now, I think this is very commonly talked about, it's not about the individual physician being more resilient. It's all of us together as an organization rolling up our sleeves and putting in the work to ensure that we as an organization are as resilient as possible in face of significant challenges. So, the burden of those challenges doesn't fall only on our physicians, our providers and our teams. This is something really, we should all want ownership of.

And we recognized this even prior to the pandemic and I'm glad we did that because I think it's helped us as we've navigated the pandemic. The only other thing I'd say is I'll speak a lot today to the physician part of the strategy. We, of course, all very acutely understand that no team—and the same is true in our medical group, is made up of just physicians. We attend to the needs of the entire health care workforce.

Because my role is specifically designed to work with operational leaders who lead physicians, I'll speak to the physician parts of this but we, of course, have leadership that is aligned to address the entire—the staff, other employees of the Permanente Medical Group and their health and wellness needs as well. I probably won't focus as much on that today, but I wanted to openly call out that, of course, this is about the entire health care team.

Mathews: Absolutely, yeah. Working in tandem, it's definitely important that the entire care team feels supported. I'm curious, so you brought up something that consistently comes up in discussions that we've had with other physicians and physician leaders. And it's the idea of personal resiliency versus organizational resiliency. You specifically mentioned the importance of resiliency throughout the organization. And that you have reached out and made a focused effort on engaging operational leadership as well as just individual physicians. So, could you talk a little bit more about how you've intentionally gone about doing that?

Dr. Sethi: Yeah. Very early on even in my role, it was really important to call out the fact that—again, we all should want ownership of this and well, we needed to have certain leaders in place who lead efforts around Joy and Meaning in Medicine. And really, it's more about aligning all the efforts. This was to make sure that given when we look at our strategic framework and all the components under culture, practice support and personal wellness, we knew that a lot of the work that needed to happen was already happening.

But one important piece was to make sure our operational leaders understood the nature of the priorities, understood what the accountabilities in this space were, and understand how to inspire conversations in each of their departments to ensure that we were getting the necessary feedback from our physicians, and understanding what Joy and Meaning in Medicine really meant and what the strategy was.

But the next piece was actually connecting with each of those operational leaders. So since I work across Northern California, my early goal was to really make some of these important connections with each of our specialty chairs. So, these are the leaders, if you could imagine—let's say primary care, for instance, or a group like adult and family medicine. Connecting closely with the chair who leads all the chiefs from across Northern California, all the adult and family medicine chiefs, and brings those chiefs together in a peer group.

Or let's say a surgical specialty like my own, urology, really making sure we're staying connected with the leaders of those chiefs groups to make sure that Joy and Meaning in Medicine is part of the agenda that is being talked about and those chiefs are being empowered to really understand what are the factors that are most relevant to their specialty group that impact the day to day practice for the physicians in that group. And what are the things that they can prioritize as a specialty, number one, things that bubble up and can be really addressed across especially but also encourage those chiefs to have conversations at the department level to see what makes the most sense to address in each of the individual departments as well. So that operational leader engagement is critically important to ensure that this strategy doesn't live in a silo.

Mathews: That's really fascinating. So, in addition to reaching out directly to the chiefs of each individual practice or specialty, I would imagine it's also important to get direct physician feedback from all the physicians and other members of the care team. So how do you go about doing that? Do you rely on the chiefs to communicate the feedback from each individual practice or do you go directly to the care team members? And how? And then how are you incorporating that feedback into your overall process?

Dr. Sethi: Yeah, the feedback is incredibly important. I mean, it's one of the foundational pieces of our strategy to make sure that we're getting feedback directly from physicians. So we have a number of organizational surveys over the course of the year through which we collect this direct physician feedback. I think what's most relevant to our conversation today is this one very important survey instrument, in particular, it's called the “JAMM measure.” This is a concise measure of the most relevant drivers of professional fulfillment and burnout. That data is collected once a year and measures themes such as workload, wellness, the impact of clerical and administrative burden, professional development, psychological safety, these are just to name a few.

So this data is captured specifically for our operational leaders of departments and specialties. And the idea is for these leaders to use the data to track the strengths of their departments but also really importantly, the areas of opportunity. And also, it's a way for them to measure the impact of any interventions they design. So, while it's important to be purposeful about also hearing directly from physicians, you're not going to make much progress, Jen, unless you also have a strategy. And I'm thinking this is the root of your question, to use this feedback in actionable ways, including how you drive your broader organizational priorities.

So for us, this means asking those operational leaders over each of the specialties and departments to work with their physicians, to use the feedback to identify ongoing tests of change that improve that department's practice environment. So, we encourage them to ask in that moment and ask the question, what are the things that we have control over, and can change over the next few months that can improve our professional experience? And use that data that we collect, and we give our operational leaders as a springboard for that conversation.

Now, it can be daunting, as you can imagine, especially in these times for a department chief to have to embark on those conversations. But what we remind chiefs is it's not their job to have all the solutions. That doesn't fall on their shoulders. But what is their job is to provide the form and psychological safety to have these discussions, and to encourage people to land on things that are under the control of the department, but also to identify the boulders, right? Those are the pebbles but identify the boulders that we need to move at, let's say, the medical center level. Right in that particular medical center or across the organization even.

As part of this JAMM, we need to equip, and we have equipped our department leaders with the resources that are designed to help them lead these conversations that hopefully will result in actionable change. So that's one thing. One, the conversations at the department level are really critical. Another reason to tackle these issues in this way at the department level, in a way that's relevant for each group, is exactly that. The relevance for each group. When we measure a theme like clerical burden, we measure it across the organization, right? So that's how we try to make this as concise, as simple as possible. And to reduce survey fatigue, we send the survey across the entire organization.

And so, with the clerical burden, for instance, that's one of the lowest-scoring items. It's not just for us. I know that nationally we're seeing that. So, of course, for any leader in an organization, you want to be able to impact this. But unfortunately, there's no broad-brush stroke intervention that's going to fix clerical burden for everyone, right? So a clerical or administrative burden in a primary care department is going to look different than you might find for a group of ER physicians or a group of dermatologists or surgical specialists.

So that's exactly why in addition to having the survey, the conversations—those conversations with the department level are so important to get to the why behind the data. And it comes to just addressing the tasks regularly done by physicians that perhaps don't require physician-level training. And I'm not talking about groundbreaking interventions here. We're finding time and time again; it is more of some of the modest changes and interventions at the department level that have the most meaningful impact on physicians' professional experience. I mean, we have hundreds of examples of this. I don't know if it'd be helpful for me to share a few of them but I'm happy to.

Mathews: Yeah, I mean, at least a couple, I think that would be great to hear.

Dr. Sethi: None of these things have to be groundbreaking. I'll share a few examples with you. There was an orthopedics department that just developed—after having this discussion, looking at the data, I think they also focused on clerical burden and that was their decision to focus on that particular area of focus. They developed new ordering templates so that the medical assistants could easily put in orders for physical therapy based on the type of patient that that surgeon was seeing. So this was a really small and simple intervention but when you look at feedback from that department, this has had a tangible impact.

Another example is there was a set of primary care departments that decided to set aside a small amount of time regularly to have the physicians in their department who are their department technology leads, actually have dedicated time to coach physicians. The physicians who struggled most with charting and time spent in the EHR. And so, this included helping them set up their voice dictation systems with all the functionality that they weren't even tapping into yet, setting up EHR templates. While these are things that we can all do, just providing that dedicated time and coaching helped these physicians considerably reduce charting time.

There's been a number of departments that have gone ahead and worked with their medical assistants and nurses about which labs and, let's say, inbox messages that should just be fully handled by the assistant rather than the physician. So they work together in collaboration. This was not about dumping on the staff, but really understanding, like, how are people going to work to the highest level of training, establish a workflow, have a set of expectations for both physicians and staff, and then to move forward and see what the impact of that type of intervention was. So there's been a number of departments that have done things like that. I'll give you one more here because I thought this was interesting.

Many of our departments in our medical centers use API process and use daily huddles. That's become the norm in many of our operational workflows. And there was one occupational medicine department who after looking at their JAMM measure data, saw that psychological safety and recognition were themes that they needed to address, and they agreed on that. And so, the chief decided as part of their daily huddles at each of their facilities, that the specific focus each day was going to be engaging each and every team member. Making sure that all team members had an opportunity to lead the huddles and have input on the huddles. And they decided to really publicly celebrate wins and recognize people regularly and consistently in public during those huddles. And their scores the next year for both recognition and psychological safety increased dramatically actually. So that's very gratifying to see the impact of that type of work.

Mathews: You sort of led me perfectly into my next question because you already touched upon this. You mentioned scores and the next year's scores. How exactly are you tracking your progress and outcomes with this process, and how are you measuring or even defining what success looks like?

Dr. Sethi: We see tracking progress and tracking outcomes in three parts. We looked at this critically actually a few years back, and we understand—for us at least, the first piece here is to understand and communicate progress that you're making at the broader organizational level, right? Part of our feedback strategy is to use the feedback to move some of the larger boulders that do affect all physicians. So leveraging technology to reduce workload, continue to innovate and integrate tech solutions to build a more sustainable practice. I'm not saying that this is easy or we have it all figured out, but these are the things that we have to move at the broader organizational level.

So we have to know, what are the resources, systems, processes, that have either been put in place or changed based on direct physician feedback. We have to look at these things regularly to make sure we're on track. And then the really important piece here is we have to effectively communicate back to physicians about these. And that's where I think we continue to grow and we continue to evolve. We need to find the effective ways to communicate across such a large organization.

Because, Jen, when you think about progress over time, one essential step is to regularly take that step back, take stock of what you've accomplished over a period of time, and really to take a look at what you previously heard from people. What you've understood as opportunities for improvement. And what you did about those opportunities, right? But also, to make sure your people are aware. Because often you do things and you tend to feedback but are you circling back and letting people know what's happened with that feedback? So that's the first part.

The second for us is tracking the progress and outcomes at each of our many medical centers. So we're, again, across Northern California. We have many medical centers. We even have many medical office buildings within each of our 15 service areas. So, we needed to establish a set of accountabilities and performance measures in this space, right? That's getting back to total performance. Making sure that JAMM is measured and tracked at the level of the other organizational priorities. So that's what we did. We established accountabilities and performance measures, again, driven by physician feedback. And from each of the medical centers and service areas, we get yearly reports out of this progress on these measures. And then we report these back to our internal medical group and share some of the best practices and bright spots.

And now the third piece is the one that maybe we more typically think about when we think about tracking progress and that's the direct measures of the surveys we've been talking about. The surveys that assess the drivers of professional fulfillment and to track how we're doing on those. When I think back to the first deployment of the JAMM measure a few years back, that indicated to us that the most commonly identified areas of opportunity were clerical burden, which I've already mentioned. Things like workload, professional development.

And so, each of these themes then in turn became a common focus of intervention in individual departments. We tracked that too, what are departments focusing on once they have their data? In October of 2020 even after two surges from the pandemic, our JAMM measure showed improvement in 11 of the 15 survey items which was great. I mean, including the five low-scoring items in 2019. And I think there's various reasons why that was probably the case even in the midst of the pandemic. One of it was just before the pandemic in the years before, really establishing this strategy and the foundation and infrastructure to do this work and how the data would be used. But the other piece was, of course, just coming together in a pandemic to make sure that people were being supported and attending to people's needs.

However, when we measured again in 2021, we saw many of these items drop towards their pre-pandemic levels. And, of course, this can feel discouraging to many leaders, including chiefs of departments and operational leaders who have worked so hard to have these conversations, design interventions, that process continued. This is actually something I had a chance to talk to Dr. Tait Shanafelt about, who I've had the pleasure of having conversations about this with.

Most recently at last year's American Conference on Physician Health, we had this conversation about this very topic about what does this data look like as the pandemic endures. And he shared with me that many organizations were seeing similar trends. And he gave us some really good advice at the time. He made sure that we remember to remind leaders that the trends of these measures were certainly not an indictment on all their efforts.

So that's how we contextualize it for our physicians and our leaders that to call out the fact that the struggle was real. So, as you track progress, and as we tracked progress last year, the scores certainly suggested that the ongoing pandemic has had a significant impact on the professional experience for our physicians, that the results needed to be contextualized with the historic challenges we were facing, right? The 2021 survey actually was deployed during one of our highest surges—during the Omicron surge.

And while many of the roots of these areas of opportunity existed prior to the pandemic—I'm not saying it's all pandemic-related but collecting and acting on this feedback is as important as ever. Look, the results aren't going to always be pretty, but that's OK. What we understand is we need to be getting this feedback. We need to know where our physicians are at and we're not going to shirk on that responsibility. And we can find a lot of opportunity through these results as well to make sure that every department and every specialty, we're understanding what their strengths and their opportunities are for continuous improvement.

Mathews: So, the concept of “joy in medicine” can be triggering for some physicians, especially after the impact that COVID's had on health care. So, what has your experience been with that and how are you addressing it?

Dr. Sethi: That's an excellent question and one we've grappled with quite a bit. When you reflect on the experience of living through a pandemic, especially as a health care provider, that doesn't naturally evoke the feelings of joy for many. I think that physicians are still very connected to meaning and purpose; that’s what drew us to medicine. And it's not that physicians don't naturally connect to joy, but even before the pandemic, the day-to-day practice of medicine can be quite difficult. Can be quite grueling. Can impact this connection.

And you add a worldwide health crisis to this and it makes things a lot harder. So, talking about something like JAMM or Joy and Meaning in Medicine without the context of what we really mean by that is not going to be well received. And you can call the strategy whatever you want. What's important is how your strategy is helping you address the factors that impede professional satisfaction and really what are the systemic factors that do that.

So that's why for us it's been really important to continue to define and contextualize Joy and Meaning in Medicine, help our physicians understand that the strategy goes well beyond the semantics of its name. And that beyond the semantics of the name is the strategic framework that was developed before the pandemic. It's based on your feedback, all of our physicians’ feedback, and is addressing those drivers of burnout.

And even early in the pandemic as we consider a strategy, it was important to critically assess what areas of the strategy we needed to prioritize, how we needed to pivot. It's an important part of us—Important part of this was understanding the unique nature of the stressors brought on by the pandemic. I mean, you remember early on, the uncertainty of going to work each day, the fear of exposure, how we'd protect our families. Physicians were very vulnerable to significant moral distress. So much was unknown about COVID-19, its natural history, its management.

I still shudder to think about the day-to-day, minute-to-minute trauma experienced by our inpatient teams early on in the pandemic on the front lines of COVID care—our emergency room docs, our critical care doctor hospitalists, the dramatic death tolls that they had to deal with. And, of course, this happened across the country, but just to think about that has an impact, of course. And it's not to say that our outpatient docs weren't challenged, especially our primary care colleagues who were flooded with outreach from patients' backlogs in care. And now we're seeing as the pandemic's evolved, some patients are projecting their anxieties and often anger on people on health care teams, including physicians.

And so, all of these added stressors are precisely why we've been so intentional over the last two and a half years of using every avenue at our disposal to expand wellness resources. We expanded COVID-related benefits during the height of the pandemic, including childcare resources, financial support where it was necessary. We really worked hard to streamline easier access to mental care and emotional health support across our medical centers, including performing proactive outreach for those who are highly impacted, some of these highly impacted specialties we've talked about. And now we're ensuring that we're mobilizing teams at each medical center. They already exist but even making this work more robust to making sure that each medical center knows who their teams and who are going to address the threatening behavior if it happens from patients.

And I have to say, Jen, that even at the height of this emotional strain of the pandemic, what we've learned is that some of the most pressing factors impacting joy and meaning are still those systemic pebbles and boulders that impact the practice day to day. So, pandemic or not, we've continued to be really committed to addressing those systemic issues and that drive burnout, detract from that professional experience. And this is why getting that feedback through measurement is so important.

Mathews: Do you have any suggestions for, like, key steps or strategies that leaders that are listening right now and are interested in improving morale, supporting physician well-being at their organization? Do you have any suggestions of some key early steps that they could take to do that?

Dr. Sethi: Things that come to mind are one, really focusing on community and camaraderie. I think across health care there's been some erosion of that understanding that we all have our unique challenges in any particular specialty department. But there's still this shared human experience. So, this year we're very focused on bringing people together across specialties to restore some of these connections and even collaborate on how to make the work together more sustainable. So that's one thing.

I would strongly recommend leaders to be vulnerable. To really attend to physician well-being in a way that creates space for dialogue and psychological safety for dialogue for physicians to process what they've been through over the last few years. And that's one area of focus that we have to create some of those safe spaces. Because as you know, physicians don't often want to focus on their own emotional and mental health. But as a leader, if you inspire a culture where it's OK to reach out for help and support and be vulnerable by yourself and share some of your own vulnerabilities, I think that goes a long way.

Another is, capture that actionable feedback directly from physicians. Make sure that you're using that feedback to drive tests of change. Do this at all levels. Our CEO recently actually—even though we had recent JAMM measure data, he wanted to know more. So, he went from medical center to medical center over a period of a couple of months to hear directly from all physicians, in these site visits. And now he's actively collating that feedback to guide ongoing strategies to support what he's hoping to be a more sustainable practice environment, of course.

The last thing I would ask leaders to focus on is empowering your team with hope. I think hope is something that gets talked about but also, I think people shy away from it because they don't want to provide false hope. Jen, early in pandemic—I came across this article in Forbes by a guy named Ron Carucci. I think he's an organizational and development expert. And this article really stuck with me because Carucci wrote about inspiring people with hope even in the face of the darkest times—and this is even early in the pandemic.

And he spoke to what leaders can do about this and called out the fact that it's not just as easy as saying, everything's going to be okay. Leaders can’t send a click here for hope icon over email, right? I think he speaks to that. We've all heard, we've talked about this in our organization that hope isn't a strategy. And it's not. But what Carucci speaks to this article—he also speaks to what hope is also not. And hope's not delusional. It's not about ignoring the real challenges. It's about making that choice as a leader to yourself see beyond the current circumstances but also help your people do that and creating spaces of hope for your people. Or actually creating spaces for your people to discover hope themselves, the hope for something better.

So, I think for a leader, creating this space comes down to a couple of things. One is providing an honest and clear accounting of the challenges that you and your teams face. And, of course, delineating the ways that you're going to help address those challenges. But also, it's essential for leaders—we have to remind our people that collectively we have the tools to get through this. Some of the more important tools. And that's solidarity, a shared purpose, remind people that we have this shared human experience to build off of. And that connection to hope is really important, and I think especially when things are at their most difficult.

Mathews: As always, it's so great to talk with you. Thank you so much for being on here today and sharing your time with us.

Dr. Sethi: Of course, Jen. It was great to be here, great to have this conversation. I just want to express, also, my gratitude to all the leaders across the health care landscape who are leading this type of work and supporting our health care teams through some of the most challenging times we've seen in our lifetime.

Mathews: Absolutely. Thank you.

Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.

Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.