Erik Mikaitis, MD (Host): Hello, and welcome to our latest edition of Pulse Check, the internal podcast for Cook County Health employees to know what's happening within the health system. Today, we're having a discussion about caring for yourself and your colleagues. And we're joined by Janine Sergay, Director of Organizational and Workforce Development; and Andy Wheeler, Manager of Trauma Recovery Intervention and Prevention. I'm grateful to you both for the work on making Cook County Health a better place to be.

Healthcare is a challenging profession, and our team faces risk of burnout, compassion fatigue, stress, anxiety and loneliness. So before we start our conversation about our health system's efforts to support the mental wellness of our amazing staff, I want to call out two resources available to our employees. Talk to someone 24 hours a day, seven days a week by calling ComPsych, our employee assistance program. It's free, it's fully confidential, and we have trained staff answering calls and providing support for emotional needs, work-life balance support, and financial resources. Call ComPsych at any time, day or night, at 1-800-890-1213. That's 1-800-890-1213. Access online resources as well at guidanceresources.com and register and enter your web id. It's B-C-B-S-I-L-E-A-P. That's B-C-B-S-I-L-E-A-P. When you spend your day taking care of others, it's essential that you also listen to your own needs and take care of yourself. So, let's jump in.

We're going to start off by asking each of you, Janine and Andy, to briefly describe your roles at Cook County Health. Janine, let's start with you.

Janine Sergay: Well, basically, my role is to help CCH across all our affiliates, our leaders, our teams create an environment that help people learn, perform, get results, belong, drive, thrive and grow and want to stay and feel connected. Just basically ensuring we're a learning organization that attracts and retains talent and stays healthy.

Host: I love it. Andy, how about you?

Andrew Wheeler, LCSW: Yeah. In my role, like you said, I'm the manager of our Trauma Recovery Intervention and Prevention Team, which is in the Department of Trauma at Stroger Hospital. And in this role, I provide mental health care to our patients and families in the trauma and burn department. And I also manage a team of social workers and manage our Hospital Violence Intervention Program called Healing Hurt People Chicago. So in my world, I am around a lot of traumatic events a lot, and a big part of my job is to help care for our staff. We often view our staff as sort of extensions of our patient and family care, so we understand that the things that we see in our department are obviously traumatic. And so, we try to incorporate our trauma-informed care principles within our department.

And another initiative that Janine and I are also a part of is the Trauma-Informed Care Collaborative, which is spread throughout the health system where we both provide leadership in that initiative as well.

Host: Wonderful. So Janine, what does wellness in the workplace mean?

Janine Sergay: Workplace wellness isn't just about having a gym membership, though Cook County has negotiated discounts for us, by the way, or offering free snacks, though we know those can help. At its core, it really is about creating an environment where people feel safe and supported and empowered to thrive physically, mentally, emotionally. You know, I've once worked with an organization where the staff were feeling kind of buried in meetings, so they introduced No Meeting Fridays. Don't roll your eyes. But it worked for them to help with focus and reduce burnout. And at first, it felt strange to the staff. But over time, people reported feeling more productive, less stressed. And just that small change that was obviously relevant to their environment made a really big difference to them. And this really isn't just anecdotal.

You know, if we look at research that was published in 2022, you know, in the Journal of Occupational Health Psychology, they found that organizations with strong wellness cultures, including things like the mental health support that we get from our EAP program and flexible work arrangements, team collaboration, one-on-one connections with your manager and opportunities for growth have burnout dropping by up to 25%-- in my book, a good number-- and job satisfaction going up significantly, and that's a win for everyone.

But we also have to remember that wellness is also deeply personal. For one person, it may mean having the flexibility to care for a loved one. For another, it could be access to the mental health resources or somebody feeling psychologically safe to speak up. That's why empathy is key. And leaders need to listen as do team members. They need to understand diverse needs and co-create solutions with their teams. If we look, you know, from Maslow to Bowlby to Fredrickson, where she even indicated, you know, kind word or a shared laugh can make all the difference. Or to Lieberman, you know, who is a neuroscientist at UCLA and who with the use of fMRI scan showed our brain's default mode is social thinking. We are basically biologically wired for connection. So as Brené Brown says, people are hardwired for connection. So, wellness means making space for that connection. And wellness in the workplace is a shared responsibility, and when we get it right, we all benefit.

Host: I love that. It's so much more than gym memberships and snacks. And I think it ties into a lot of the conversations we've had around high reliability as well as you touched on, you know, psychological safety. So, a few of those points were made already, but Andy, maybe unpack a little bit more. Why is it important to build a system of support for employees and give them the ability to better cope with negative experiences when they happen?

Andrew Wheeler, LCSW: I think that was all very well said, Janine. And I think it's important because, I mean, just in essence, it's just the right thing to do and it's the right thing to do, because we're in the business of health and that includes the health of our staff. Like Janine said, you know, our employees need to feel not only physically safe at work, but also emotionally and psychologically safe, which is consistent with building a culture of safety and high reliability in the organization.

And this is about organizational culture and shifting that culture into this mindset of what it means to be psychologically and emotionally safe at work. And a lot of this is also consistent with our ideals of becoming a trauma-informed organization where we realize the prevalence of trauma trauma and stress that our employees deal with on a day-to-day basis, which is for every employee, not even just the employees within places you would definitely expect to be experiencing super high levels of stress, like the emergency department or the trauma department. But this is for employees who work in environmental services, who are cleaning up blood in different places. This includes our clerks who are dealing with stressed out family members who are coming in, who are worried about a sick loved one admitted to the hospital; even like our administrative staff, who are working with employees who are trying to take off work because of sick leave, either for themselves or somebody else. And all these things over time have a cumulative effect on our staff.

We sort of need to know that there's this prevalence of stress within our staff. And leaders need to recognize the signs and symptoms and respond to them appropriately. And doing all this isn't just, because like I said, it's the right thing to do, it's because we care about our colleagues, we care about their wellbeing, but it also helps us better serve our patients. That's why all of us are here. I think Cook County Health has a really incredible mission that we are all committed to. It's a difficult mission sometimes. But that's why we're here is we have this passion of serving our patients and our communities, and it's really hard to provide quality care when you're overwhelmed with stress or trauma. You're not able to engage your prefrontal cortex and have like complex thinking. You're not able to engage with difficult situations. So, providing our staff with opportunities to care for themselves and focus on their wellness ultimately improves patient care, which is the whole reason why we're all here.

Host: Definitely. And I think a key takeaway in what you just said, Andy, it's more than just the people in the emergency room or in the trauma unit, right? This touches everybody across the entire organization, clinical, nonclinical, everybody. So that said, what advice would you have for leaders who would want to implement some type of an initiative that would help improve the wellbeing of their teams? Janine, maybe you have some thoughts.

Janine Sergay: So first off, building off of what Andy just shared, it extends, and as you mentioned, you know, to those who are working out in the field, in the communities and what they encounter. Those folk in county care who are hearing the stories of trauma day after day or in the Department of Public Health. It's in every area of CCH. And just to know that, with our EAP services, we can obviously reach out as individuals to get help for five free sessions for an issue per annum for ourselves and our family members. And if you have more than one issue, you know you can reach out even more.

But as leaders, if a critical incident happens in your area, and we know it happens frequently, for our staff and our teams know that you can reach out to our Chief Human Resource officer, Win Buren; our Associate Chief Human Resource Officer, Pramuk-Volk, or myself at any time when something like that happens and we organize for group counseling to come into your team so that actually, we know with trauma, we want that to happen within a 48-hour period of time best to process it. Know that your team shouldn't be alone with this either.

But broader than that even, if you're a leader thinking about launching a wellness initiative for your team, first know that it's not about checking a box, right? It's about building a culture where people feel seen, supported, and able to thrive. So, my advice is really simple. Start by listening. The most effective wellness programs aren't built-in meetings with other leaders, sorry to say. They really are built through conversations. Ask your team what wellness means to them, what helps them feel supported, what gets in the way. Basically, that's your foundation and research backs this up. A Caleb study found that when employees feel heard and involved in shaping wellness efforts, engagement increases by up to about four times, I think. And that's huge. And it's not just about surveys. It's about creating space for honest dialogue.

Second, think small and sustainable. You don't need a massive budget to make a meaningful impact. Sometimes it's the little things. Like mental health check-ins, even a quiet space to recharge, like the wellness lounge starting in the central campus and hopefully going to other areas in our organization. And just really going back to one of our values, being kind to each other in a team or more fundamental things like setting objectives and action plans with your team members. So, expectations are clarified. Because we know from stress research that brings stress down and having one-to-one development planning conversations, having one-to-one check-ins, so everyone's on the same page and are succeeding together. These are the actions that make the biggest difference.

And third, model the behavior. Leaders who prioritize their own wellbeing send a powerful message, it's okay to take care of yourself here. And that kind of permission can shift culture. Okay. I hope my team are not seeing this or hearing this, because I'm still learning that one myself. I am not good. So, there's a message in this for both leaders and team members, actually. Listen deeply to each other, act thoughtfully and lead by example. Wellness isn't a one-time initiative. It's a way of working together on a daily basis that helps everyone thrive, because when we take care of each other, we all do better together.

Host: It's wonderful. And I'll add I think when we see those periodic instances, we've tried to be more intentional from the leadership perspective to try to flag those opportunities to pull in EAP. It can be hard, you know, as Andy mentioned earlier, you have those incidents and that you don't engage the prefrontal cortex even as leaders with a more local team, try to deal an incident that happened. It may be hard to kind of think of that. So, we have tried to make that concerted effort. And what I'm hearing, Janine, from the suggestions around how a leader can engage, a lot of it's more about kind of prevention and creating an environment where you try to avoid and get in front of some of those signs and symptoms of burnout. But Andy, what are some of those signs, if we haven't quite gotten to that prevention stage yet, and we do end up seeing some of the impact of those stressors? What are some of the signs that we, as leaders, even as coworkers with our colleagues, that we could be looking for in terms of secondary traumatic stress?

Andrew Wheeler, LCSW: Yeah, that's a great question. And I think, there are many, many signs. Some of them are things that might be really obvious. So, seeing someone who appears chronically exhausted, being extremely irritable, saying that they want to avoid coming to work and calling out frequently. And, you know, as a leader, you might not be prone to this, but you would assume some folks who might be starting to talk about using more substances or, you know, maybe drinking more to make themselves feel numb to their experiences here. We actually know that substance use is actually quite common among physicians and healthcare workers.

So, those are all things that you might think of as pretty common things or other common reactions to trauma, like difficulty sleeping and hypervigilance and things like that. But there's lots of other less obvious things. Sort of like a lack of creativity, for example, a lack of ability to see different options. Having a colleague that is morphing into having this very black and white thinking is a very common reaction to trauma, because you sort of want to put things into very predictable categories. Seeing folks who are minimizing very serious issues, either like patient issues and suddenly being like, "Ah, this isn't a big deal," something like that. Something I've even found in myself and some of my colleagues is, even though the times where we feel the most stress at work, we actually find ourselves working more and wanting to be here and being more involved in things than we would have before.

There's also a common feeling of helplessness that happens to folks or a sense of persecution, or just times where people are having these sort of dissociative moments. So, people who are having a difficult time focusing, you're talking to them and they're sort of looking off other places and things like that. These are things that you would see in a change. And it might be obvious sometimes where you had a big event at work that you know was really stressful, and that might be easy dots to connect. But sometimes, you might these types of symptoms in somebody, and you're like, "Everything's been going okay at work. I'm not sure what's going on." But obviously, we lead lives outside of here. And I think that's why it's really important.

One of the tips Janine mentioned is to listen and to provide space for your staff to open up to you and realize that listening is an action. Being a good listener does not mean that you're just providing space. You're actually taking in the information somebody's giving to you and realize that it takes a lot of effort to listen and to reflect with somebody. And it's okay to be quiet and give somebody the opportunity to really open up to you.

Host: Great advice. Janine, do you have any additional advice? I know you touched on a few things. What's, kind of the one big takeaway that you would give to someone interested in wellness or self-care?

Janine Sergay: Coupling onto what Andy said, there was one area in the organization that asked me to come in because they'd identified symptoms. There was huge amount of conflict. So, they said, "Come in and help the team manage conflict." And when I went in with the team and we did our first session, which is around listening to what's happening, I found out that eight out of the 14 people had suffered a personal trauma in the previous seven months. And that's huge. And so, the behaviors that they were exhibiting at work were really a direct relation to what they were experiencing holistically in their life. And so, we just changed tack and instead dealt with grieving and mourning and how we can help and support each other through it. And suddenly, we didn't even have to deal with conflict management. That wasn't the issue. And I think we sometimes need to recognize that.

But I know you asked specifically about what about our wellness or self-care. So if you are interested in wellness and self-care, the best advice I can offer is start small, stay consistent, and I think be kind to yourself. Wellness isn't about doing everything perfectly. It's about finding what helps you feel grounded, energized, and kind of supported in your daily life. That may mean taking a short walk during lunch, setting boundaries around your time, finding a community at home or at work or embarking on, I don't know, development opportunities. Simply checking in with yourself at the start or the end of the day, even five minutes-- and I know I got this one from Andy-- of intentional breathing or even journaling can make a difference. And please don't forget laughter. There is huge research on that.

And remember, self-care is not selfish. It's essential. You know when you take care of ourselves, we shot better for our teams, our families, and our communities. As the same goes, you can't pour from an empty cup, we got to fill our cups. So whether you know you're just starting out or looking to deepen your wellness practice, I think give yourself permission to explore what works for you. There's no one-size-fits-all. Again, it's not about perfection, just progress. You know, that one step at a time.

Host: I love it all kind of packed into be kind to yourself. And Andy, you gave a lot of advice already. Any main takeaway for those interested in wellness?

Andrew Wheeler, LCSW: Yeah. I think the only thing I would add to what Janine said is stress and trauma live in our bodies. And so, doing physical actions ways to kind of release that stress or focus on your body and get to know yourself. You know, see where do I hold stress? How can I relax myself? How can I have some type of physical exercise? And doing some type of physical activity is really important. And a lot of these things are things that you're kind of doing anyway. A lot of people are stressed about time and things like that. You can do, like what Janine said, taking some intentional deep breaths.

You can also do things mindfully. So, the science of mindfulness has really emerged over the past 10 years about its benefits with wellness. And that doesn't always mean you have to go meditate for half an hour. You can do things you're already doing mindfully. So like physicians and-- well, everybody here-- we all wash our hands a lot. You can wash your hands mindfully and really pay attention to, you know, your senses while you're doing things that you're already doing.

And I also think that it's important to recognize, you know, self-care obviously has self in the word, it is something you can do, but self-care is not your sole responsibility. There are actions you can take and everything that we just listed, but it also is a responsibility of organizations and leaders to create the conditions for you to have the space to care for yourself. So, I think that's also something important to note. And we've done a lot of that, everything we just talked about with our access to the EAP, we have good benefits. I think also I would really like to reduce the stigma of accessing just therapy in general and going to talk to somebody outside of work and outside of your family. I go see a therapist. It's very common in the social work field for us to do that. And I think for all of us here, I think it's really important to reduce the stigma of seeking some type of mental health counseling.

Host: Wonderful. Thank you for that. So maybe, we'll end with any last words from each of you for those who are already suffering from compassion fatigue or burnout or have tunnel vision and feel like they're alone. Janine, we'll start with you.

Janine Sergay: If you're feeling burned out or overwhelmed and it feels like, you know, you're the only one struggling, please hear this. You are not alone. Compassion fatigue is real, especially in healthcare where you're giving so much of yourself. It can leave you feeling emotionally drained, but your pain is valid and it's shared by many who care deeply, just like you. So, there's no shame in feeling exhausted. In fact, it's probably a sign that you've been showing up for others often at the expense of yourself.

And the first step is just to acknowledge that and then to reach out, because healing doesn't happen in isolation. It often happens in community. So, you know, whether it's a trusted friend, a peer support group, or as Andy mentioned, you know, a mental health professional, using EAP, which is totally confidential. And you need to get the amount of people who've used it, not who uses it. Connection again is key, and you deserve that care just as much as the people you care for.

Host: Wonderful. Andy, any final thoughts?

Andrew Wheeler, LCSW: I think those were all great points and I think, if you feel alone, I can only just say you're not alone. I mean, I'd say I've held many debriefs with staff over the years I've worked here, and probably the biggest takeaway from it is for people to say it's not really what they're saying, it's the realization that somebody else is feeling the same thing as them can be very scary and isolating to experience trauma and stress and feel like you're out of control and like no one could understand. And like Janine said, healing happens within communities. We know that it affects other people, because we have these words for it. The term compassion fatigue was defined by a nurse. I mean, it comes from healthcare.

There's a writer, Gabor Maté, who says there's not really such thing as compassion fatigue. It's self-compassion fatigue, meaning that we haven't taken the time to really focus on ourselves and give ourselves compassion that we are designed to care for other people. Like Janine said, we're meant to be with other people. And when we feel this burnout, it's really a sign that we haven't taken the time to really give ourselves some compassion and be kind to ourselves.

Host: That's great advice. Thank you both and thank you both for your time today and, more importantly, for your leadership in advancing our mission. At a time when our teams are experiencing a lot of micro and macro stressors, I want to encourage everyone to be cognizant of your own needs. Take the time to explore the benefits that are available at no cost. Thanks to our entire team, for your incredible work and everything you do to support each other, especially during these difficult times. Thanks as well for watching. And tune in next month for more updates and to Pulse Check.

Andrew Wheeler, LCSW: Thank you.

Janine Sergay: Thanks.