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Michael Carrese: Welcome to the ASHRM podcast made possible by the American Society for Healthcare Risk Management, to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ASHRMorg/membership to learn more and become a national member. I'm Michael Carrese. And, you know, we're living in perhaps the most stressful period in memory. Everybody's work lives and personal lives have been upended by the Coronavirus pandemic. And especially for those working in healthcare, the challenges have been daunting, and unfortunately it looks like there's no end in sight, at least in the short term. So today we're going to talk about resilience in the face of stress and give you a moment to think about how you're doing with it, and perhaps what else you could be doing to manage it effectively and protect your own health. Our guide will be Dr. Michelle Kinneer. She's a Senior Risk and Patient Safety Consultant for Constellation Mutual. Dr. Kinneer is bringing an awful lot to the table here today. She's earned a PhD in leadership, a law degree. She's has a Master of Science and nursing, and is Certified in Healthcare Risk Management, Healthcare Compliance, and Healthcare Privacy Compliance. And thank you very much for being with us.

Dr. Kinneer: Thank you.

Host: So, I thought we could start by having you tell us more about your background in risk and patient safety, and also about Constellation Mutual.

Dr. Kinneer: I am the risk and patient safety education manager now for Constellation. And one of the roles that I have here is to do things like education, resources, tools for our customers, and our customers range from clinics, hospitals, and long-term care. We are a collection of companies under the umbrella of Constellation Mutual. We have MMIC, we have Arkansas Mutual, and we have UMIA. So we really cover the Midwest and Western States. And it is a pretty good wide footprint that we have, and we're able to help our clients, our hospitals, our physicians, and healthcare providers, those at the front lines with doing support for their patient safety activities and their risk management efforts.

Host: Talk a little bit more about your career in risk management. What have you been up to all these years?

Dr. Kinneer: I've been up to this for a very, very long time. So when I first got into risk management, I really didn't know what to expect. I had a law degree at the time, and I think that's how I got the position, but I'd never really done anything in quality or performance improvement, patient safety, risk management. And the time that I entered was when we were starting to move from the blame and shame or circle the wagons and cover up everything to one of more of a transparent role to one where we're actually giving information to the patients. And as a nurse, I have been a firm believer in like holistic nursing, where we focus on the entire patient where we think about things like the impact. Like if a patient says to a certain, like a CT study, well, they might be saying no, because it's 2:20 and the kids get home from the school bus at 3:15. And so maybe that's why they're saying no.

So, finding out those things. So I really enjoy the openness, the transparency that RISK has gone through. So I started out in one hospital as a risk manager and ended up going to another facility where I added the role of patient safety, as well as compliance. So I kind of was all three of those and really saw how compliance, risk, patient safety, really work together and do best as working together as a team, thinking about things from both the business side. So kind of the enterprise risk management to thinking about the clinical side and the direct care to patients. I did decide at one point that I kind of wanted to get and have a broader reach outside of my one facility. And so that's when I joined Constellation and I've been able to do things like risk assessments, podcasts, such as this, webinars, education. It has been a lot of fun being able to connect with others.

A lot of times, I go into an organization to deliver a program, the risk manager, the quality professional, the education manager might be sitting in the back. I'm saying the same things about documentation, dotting your I's crossing your T's that they've said, but because I'm from afar, people are like, Oh, we never heard this before. So I understand that when it comes to that with our risk managers. And so I like being able to help support them and their efforts in what they're doing. So I really see risk. It's kind of twofold. It takes care of the patients, but in my mind, it also helps take care of those individuals, those frontline workers, those nurses, techs, physicians, PAs, nurse practitioners, even the janitorial service that's helping with the care of those patients. So that's why I enjoy this profession so much.

Host: So, let's dig into this a little bit about resiliency, but first start with emotional intelligence because these are often paired together. So what is emotional intelligence in your mind and why is that an important quality for leaders to have?

Dr. Kinneer: So emotional intelligence gets into some of those softer skills of leadership that we hear about, being able to work with individuals, being able to assess situations. I do kind of prefer the way that Daniel Goldman has kind of conceptualized emotional intelligence, where it really works with kind of that self awareness, knowing those triggers for yourself, being able to manage how you respond, how you react to things, also your relationships, managing the relationships with others, understanding when something is probably not going to impact as well or something you need to take offline understanding when those are. It's kind of like when a leader has multiple people working for you and you have a staff meeting that's coming up. Well, you might know that some in your department are a little bit more quiet, but maybe they're the ones who want to see the agenda written out before they get there, because they need to think about it. They need to consider it before they offer ideas.

You'll have others in your department that may be raising their hand and jumping up in their seat, wanting to share before you even finish what you're asking for. So understanding the different needs of people is so very important in risk leadership management, regardless of the industry, but then healthcare, we interact with the patients. We interact with their families that have a whole different dynamic. We have other caregivers, things are different. I had a board member once who was from manufacturing and he was like, explained to me why we can't do this. I'm like, because we're not widgets. We don't put out this one little widget with the same four sides because this one widget might have diabetes, which brings on these complications. And this widget over here lost someone to a condition just like this, and that's impacting what they're doing for their healthcare. So understanding how those play and then really that emotional intelligence piece, understanding yourself, knowing what things trigger you.

And that's really where that connection is between emotional intelligence and resilience is that self-awareness. And I'll give you a for instance on self-awareness, for me as a risk manager, I know there are certain lawsuits that I'm like, really? Why are you filing this? But my understanding of that, my understanding of myself, when I see that means that when I see that lawsuit, I can read through it, put it aside and then let myself digest it and then come back to it with a more open mind. If I didn't have that level of emotional intelligence to understand the impact, understand why somethings are my triggers and why things aren't, I wouldn't be able to manage that as well. And that's kind of where that resilience comes in. We need to know ourselves and we need to be able to think about how this is impacting me. And if this is impacting me, what I need to do to make sure I minimize the harm that it does.

Host: So, you understand what the triggers are for you. But then the resilience piece is being able to absorb that blow and not overreact or, talk about how you see resilience?

Dr. Kinneer: So, what are the best kind of descriptions that I've seen a resilience is if you think about a rechargeable battery, so you're a rechargeable battery, maybe you're at full charge. You are able to put that in the vacuum and vacuum the house. Everything's good. But once you get to a certain spot, the vacuum starts not really working as well because the rechargeable battery is almost out of juice. It's very similar for us. And especially those that are in the caretaking professions, whether it be in healthcare, even the police EMT, fire professionals, we're a caring industry. We are socially interacting. We are giving and giving and giving, and there comes a time where you have nothing else left to give. And so you have to make sure that you put yourself on that charging dock, so that way you are able to give to the next person.

Because what happens in healthcare, especially in those caring industries, when we give and give and give, and we don't take time to replenish our own personal stores, we're now at risk for compassion fatigue, for burnout, for emotional exhaustion. We're at risk of leaving our chosen profession because we don't have anything else left to give to individuals. So that's really what I see as resilience. I've seen definitions where they talk about bouncing back or going back to a normal state. To me, it's not really about going back to a normal state, but it's about finding a balance and finding what that new normal is. For instance, that's how I like to see it is that recharging of your batteries, because seriously, we've all experienced it, right? Where you have that one person who just irritates you or bugs you and you just give and give and give. And then at some point you're like, I don't want to deal with that person anymore. But then when you go away and do something to kind of restore and recharge, you're able to tackle that.

Host: So, you're plugging into that recharging dock. What is it delivering? What is being replenished? And is it different for different people?

Dr. Kinneer: I think it is different for different people. It's just a way to kind of collect yourself back in and figure out what you need to make sure that you're at your best. If you met me in a group of people, I would be the quietest one there. I am the poster child for being an introvert, but there are things I do in my profession and my professional life that I know here's what I need to do. Here's what I need to focus on. And I go out and I'm able to do it. Actually, one of my colleagues has called me a situational extrovert, which I thought was a perfect name for it. But after our conversation today, I actually have about 30 minutes of time plugged in on my calendar to just recharge, to unwind from this because I need something. And I think introverts, especially, I think we're pretty good at knowing when we kind of hit that wall. And we're like, okay, we need to sit back.

We need some quiet, we need space. We need to think. And so it is different and finding what it is that helps you the best is so important. Another thing that I do just for myself is I schedule, of all things, workouts. If I don't schedule them, I'm not going to do them. If I don't schedule a 30 minute walk with a dog, if the dog goes out and does their business, is ready to go back in, I'm ready to go back into. So making sure that you make time, time for yourself and whatever your passion is, it can be jogging around the block. It can be walking the dog, playing with the kids, reading a book, whatever it is that helps you to find your own kind of balance and what you're looking at. And that's where that kind of emotional intelligence and resilience overlaps, because that self awareness, knowing those things that help you get through some sort of trial, some sort of chaos that's going around us, it's really helpful.

And there was one thing that you mentioned in the kind of beginning opening piece about, we don't know about COVID. We don't know when this is going to end. We don't know when the last thing is. For most of us when it comes to stress and attacks on our resiliency, it's very similar. It's that fight or flight and how are we going to fight COVID really? I mean, we can't just like roll up our sleeves and challenge it to an arm wrestling event. We can't run away screaming. We also don't know when it's going to end or when we're going to have the cure when we're going to have a vaccination for it, or when we're going to have herd immunity or when it's going to stop being such an impact to our lives. Since we don't know when that is, it is really tackling all of us and attacking all of us when it comes to our own resiliency, which is why this conversation is so very important.

Host: Yeah, it's sort of this background level of stress and worry, and it does wear you down. I want to jump in here and remind folks that are listening to the ASHRM podcast, which is made possible by the American Society for Healthcare Risk Management, to support efforts, to advance safe and trusted healthcare through enterprise risk management. You can always visit ashram.org/membership to learn more and become an ASHRM member. So there are these particular things you reflect on, you figure out for yourself what helps me recharge and build resiliency, but there's also the overall being in good health that we're always reminded about with diet and exercise and good sleep habits. Talk about that connection to this sort of being a healthy person and caring for yourself in general.

Dr. Kinneer: Absolutely. A lot of times we've all heard that right. Eat right sleep well, but it can be that simple. When we are eating healthier, when we are getting enough sleep where our bodies are able to make the repairs that they need and where we're able to go onto the next day, those are the things that help build us. They help our immunity. They help our stress levels because we're able to take on more. Those are some of the ways that we end up recharging ourselves without even knowing it. Because if you think about it, for instance, final exam weeks, most of us have all had those at one point in our educational careers. A lot of times people are cramming two, three o'clock in the morning. Can you maintain that? Absolutely not. You can maybe get through exam week, but after that, you're going to be sleeping until 10, 12 o'clock on Saturday. So that really does kind of set us up. The healthier our bodies are with our diet, our exercising, sleeping well, getting enough sleep at night that really helps us ward off health conditions and helps to kind of help us maintain that chronic health conditions that we have better and manage them better. And when we have our health being managed, that's one less stressor that's impacting our resilience.

Host: What would you say to listeners who might think resilience is, you know, maybe a little touchy, feely or abstract?

Dr. Kinneer: I hear that a lot. And so what I share with people, because it seems like people like the business side and think more of the business effects. So I tell them, go learn about emotional intelligence, focus in on that, because some of those skills, the self awareness piece, the understanding others piece, those are going to improve. And when you're improving those skillsets and when you're able to understand yourself more and gaining those insights, now all of a sudden you're increasing some of your resilience along the way, and you didn't even know it. And yes, I know, believe me. The hardest thing for me ever is to sit still. I had a person tell me to meditate once. And I'm like, yeah, this isn't working because I'm like, I'm going 24/7. And so I find that difficult. But when you look at it from kind of more of that business lens and think about, okay, I'm going to work on my emotional intelligence, it sounds better. I can envision these button up, suited individuals saying, okay, I can work on my emotional intelligence. I don't want to go to the golf course and tell my buddies that I'm working on resilience. You know, they might look at me a little funny, but if I tell them I'm working on my emotional intelligence, Oh, well, that's in the Harvard business review. That's here, that's here. It's what people work on.

Host: So, it sounds like in your view, this doesn't just sort of build over time necessarily that you really do need to be intentional about thinking about resilience, thinking about emotional intelligence and doing things to sustain what you've got and grow it over time. It's you just can't be passive about it.

Dr. Kinneer: I think that does help. There are times where we can grow our emotional intelligence skills along with resilience, just by the experiences that we have and what we see happen. For instance, if there's a tornado that happens, we know what to expect. We know what that experience is going to bring us. It teaches us lessons at the end that we can use if we're faced with that, but really thinking about emotional intelligence and resilience, especially right now during this pandemic, because we don't know when that end is going to be. So right now is when that intentional list really does come into play. Because think about our hospital leadership, they may not be the ones on the frontline working with the patients that have either had or symptomatic and are in critical condition and that sort of thing. But they're thinking about how are we getting enough money coming in the door, so we're able to pay our staff?

How are we working with the supply channel? How are we doing this? How are we doing that? There is a lot of stress that's going on right now, in all levels. We have it in our personal lives. We have it in our professional lives. So really taking a few minutes, whatever it may be, scheduling it on your calendar, 15 minutes, 20 minutes, 30 minutes, reading, walking, whatever it is that you're doing to just make sure that you're providing care for yourself. So that way you can continue caring for others. And right now it's a great time to think about being intentional with whatever it is for emotional intelligence or resilience or whatever. However you want to frame it in your own mind to work on, because we don't know when that end is going to be.

Host: Right. Yeah. The unknown. Well, listen, that's great advice and giving everybody a lot to think about, and I want to thank you for being with us today.

Dr. Kinneer: Absolutely. Thank you for having me.

Host: You're listening to Dr. Michelle Kinneer, she's senior risk and patient safety consultant for Constellation Mutual. This podcast is made possible by the American Society for Healthcare Risk Management, the support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ASHRM.org/membership to learn more and become an ASHRM member. I'm Michael Carrese. Thanks for listening.