Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

Carolyn Carpenter, M.H.A., F.A.C.H.E.
President of the National Capital Region
Johns Hopkins Health System 

1. The job of a leader is to listen to what their team members want to get out of life, and create an environment in which they can align this with the organization’s purpose.
2. In a culture of “generous listening,” leaders seek to understand each team member’s strengths, aspirations and unique contributions. This enables leaders to make connections and allows diversity to flourish.
3. The following are two relational leadership activities to try: a) Incorporate intentional team building activities into meetings, such as sharing personal moments or answering thought-provoking questions. b) Start individual conversations by acknowledging the person first before discussing work-related tasks.
4. Are you unsure about relational leadership? Start with a mindset of listening and curiosity. Come to the table with a genuine desire to understand team members. This can shift the dynamic and create an environment that supports well-being and professional fulfillment.

Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

Cheryl Connors, D.N.P.
Program Director of Organizational Resilience
Johns Hopkins Armstrong Institute for Patient Safety and Quality

Matt Norvell, D.Min., M.S.
RISE Team Manager
Spiritual Care and Chaplaincy Department Clinical Manager
The Johns Hopkins Hospital

1. A culture of connection and support is essential to improving the well-being of individuals and health care teams. Offering a peer support program, which provide a safe space to talk, is a key strategy.
2. Talking to someone who can relate and bear witness regarding the distress we face in health care can help us feel less alone and enable us to return to work and to our families without carrying the weight in silence.
3. Leaders, managers and supervisors can’t be all things to all people and need to focus on areas like safety and staffing. A peer support program, such as RISE, can impact the institution by off-loading some of the emotional support responsibility from managers.
4. Key drivers of success include:
   1. a training curriculum and onboarding program for peer responders
   2. endorsement from leaders so staff feel they have permission to take time to receive support and so volunteer peer responders can help their colleagues in a rewarding way, and
   3. care for the peer responders themselves. RISE offers a debriefing so volunteers can process difficult responses.

• RISE Internal Link for the Johns Hopkins Medicine Community
• Caring for the Caregiver Program
• Helping Without Harm: Providing Emotional Support to Health Care Workers in 2023
• Confronting the Inevitable: When a Urologist Feels like a Second Victim

Lee Daugherty Biddison, M.D., M.P.H.
Chief Wellness Officer
Johns Hopkins Medicine

Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

Rich Safeer, M.D. 
Chief Medical Director for Employee Health and Well-Being 
Johns Hopkins Medicine

1. Culture is defined as the shared behaviors, beliefs and attitudes of a group of people. Culture influences well-being at many levels — in the organization, in the discipline/field, in the department and on the team.
2. There is no one size fits all approach for well-being in the workplace. We need to adapt our approach to account for the lived experiences and needs of different groups.
3. Norms are defined as the expected and accepted behaviors of a group. To support well-being, teams can start by talking about norms and how they can support one another to create healthy behaviors and emotions.
4. There are many low-cost well-being interventions, including: listening, making time for meaningful conversation, putting the healthy choice first, peer support and leadership engagement.
5. Fostering employee well-being reaps benefits for the organization. When employees feel supported and cared for, they are more engaged with the mission and with one another, and more likely to stay with the organization.

Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

Karen Swartz, M.D.
Professor of Clinical Psychiatry Johns Hopkins School of Medicine 
Director of Clinical Services at Johns Hopkins Mood Disorders Center 
Director of Johns Hopkins Adolescent Depression Awareness Program

1. An estimated 1/3 of clinicians are not getting preventive screenings or primary care.
2. We need to make it easy for clinicians to access care. Two strategies for organizations are:
   1. offering confidential, high-quality mental health care on campus and at convenient hours, and
   2. training supervisors to recognize when someone is suffering.
3. We all need time to rest, so we have the energy to do our best work and to enjoy life. Leaders and clinical supervisors should consider how they are protecting clinicians who often have long hours and take work home.
4. When we notice that someone is suffering, we have an obligation to support their ability to access care. Treatment for depression and other mood disorders works. 

Lee Daugherty Biddison, M.D., M.P.H.
Chief Wellness Officer
Johns Hopkins Medicine

Manisha J. Loss, M.D.
Associate Professor of Dermatology
Associate Chief Medical Information Officer
Johns Hopkins Medicine
Medical Director, Patient Access Services
Office of Johns Hopkins Physicians

1. Until recently, we have expected clinicians to simply adapt their practices to new technologies: to take classes on EHR optimization or develop work-a-rounds, which add to the burden of clinical practice. We now understand that, instead of adding to the work, we must find ways for the technology, like AI, to make work easier rather than adding to the burden. 
2. In its best iteration, AI has the possibility of supporting one of the most rewarding aspects of medicine- our relationship with our patients. The renewed connection with patients and their families can enhance our sense of meaning in work and promote retention. 
3. Because these technologies are so new, it’s important to study outcomes in different clinical settings and with different members of the clinical team. Roll outs need to be carefully planned so not to unintentionally add to the burden on our teams. 

Lee Daugherty Biddison, M.D., M.P.H.
Chief Wellness Officer
Johns Hopkins Medicine

Kimberly Peairs, M.D.
Vice Chair for Clinical Affairs, Department of Medicine, Johns Hopkins Medicine
Medical Director for Primary Care Value and Innovation in the Office of Johns Hopkins Physicians

1. We work in teams. If one person or group is exhausted and frustrated, it can affect the whole team’s ability to deliver care. As we design interventions to improve care delivery, we need to consider the whole team.
2. We need to look for opportunities to share knowledge within the team. When prescribers know which medication prescriptions are most frequently denied by payers, they can choose an acceptable alternative. Working smarter can reduce the workload and frustration for all involved.
3. Centralizing a service like prior authorizations can lead to economies of scale, but it also comes with risk of disconnection and depersonalization. It’s important to look for ways to retain relationships in order to foster a sense of belonging and connection within the team.

• AMA resources for prior authorization

Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

Elizabeth Harry, M.D., S.F.H.M.
Chief Well-Being Officer
Michigan Medicine

1. Overload is associated with burnout, and our risk of overload increases as the amount of data coming at us increases.
2. Organizations seeking to address burnout can look at interventions that affect extrinsic load, such as instituting standardization, reducing redundancy and ensuring that clinicians are not forced to split their attention.
3. It’s important to be patient with our early career doctors, nurses and other clinicians, who are experiencing especially heavy cognitive load because they are building new mental models while gaining experience.
4. Cognitive overload shows up in our work and in our home lives. Practical tips for reducing cognitive load: Standardize and set routines, protect our attention by limiting interruptions and prioritize focused attention on the things and people that matter most.

• ResearchED Video: "John Sweller - ACE Conference/researchED Melbourne"
• Armstrong Institute for Patient Safety and Quality

Lee Daugherty Biddison, M.D., M.P.H.
Chief Wellness Officer
Johns Hopkins Medicine

Elizabeth Harry, M.D., S.F.H.M.
Chief Well-Being Officer
Michigan Medicine

1. Solving for burnout at the organizational level can feel overwhelming. Let’s not go it alone. We can learn from each other within health care and also from disciplines outside of health care. We need not only an individual growth mindset, but a collective growth mindset across health care.
2. We now live in an attention economy — our attention is a scarce and valuable resource. We need to be intentional about where we choose to place our focused energy.
3. As we lean into the power of AI, it’s important to consider how the technology is contributing to our well-being. Is AI reducing the number of clicks, steps or human interactions needed to complete a given task? In doing so, is it freeing up cognitive bandwidth for complex medical decision-making?

• Nature Medicine article: "Evaluating and reducing cognitive load should be a priority for machine learning in healthcare"
• TED Talks presentation: "The power of believing that you can improve"
• Opal app for "time sucks"

Lee Daugherty Biddison, M.D., M.P.H.
Chief Wellness Officer
Johns Hopkins Medicine

Carolyn Cumpsty Fowler, Ph.D., M.P.H., N.B.C.-H.W.C., P.C.C.
Executive Director for Nursing Well-Being
Johns Hopkins Health System

1. Self-care is important for well-being, but focusing on individual behaviors will never be enough to improve our well-being at work.
2. Because well-being is foundational to our ability to achieve what we care about (safety, quality, professional fulfillment, etc.), we must prioritize it.
3. As with anything we care about, there are few quick fixes, but we do have guidelines and an emerging evidence base to help us move forward. We need to lean into a growth mindset, pace ourselves and realize that good things take time.