Symposium 3: Navigating the fog

Hello and I guess this is good afternoon or maybe good morning. My

name is Garvia Bailey and I will be your moderator for today’s symposium. Welcome,

on behalf of the McKinnon Trauma and Recovery Lab’s PHAC project Healthcare

Salute. This symposium is called “Navigating the fog: The role of

healthcare leaders in supporting provider mental health during the COVID-19

pandemic.” I am a journalist by trade, a storyteller by nature, and every now and

again, I have the great fortune to be asked to

moderate an event like this one. I consider this legacy work. These deep

conversations, the research in institutions like McMaster, set the

agenda for the actions we should be taking and the conversations we should

all be having before, during, and deep into the long tail of an international

crisis like we are facing with COVID. So, I want to thank you for being here. I

would like to acknowledge the land that we’re on right now. My family came here

from Jamaica in the 1970s, and we continue to be ever so

fortunate and grateful to have come to this

country and be on this land and this territory as immigrants and settlers. I

live and work on land that we recognize as the traditional territories of the

Haudenosaunee and Anishinaabe Nations and recognize and act on the responsibility

that comes with that. I’d also like to acknowledge the land on which McMaster

University is located, which is the traditional territory of the Haudenosaunee and

Anishinaabe Nations and within the lands protected by the Dish with One Spoon

Wampum Belt. The wampum uses the symbolism of a dish to represent the

territory and one spoon to represent that the people are to share the

resources of the land and only take what they need. Further to that, the Truth

and Reconciliation Commission’s 94 Calls to Action reaffirm that the

treaties with Indigenous peoples must be lawfully honoured. We are all treaty

peoples and are responsible for honouring and upholding those

agreements. Again welcome to this symposium. Now over the past close to

four years, we have heard much about the strain on the healthcare system and on

healthcare providers due to the pandemic. But those providers are not

rudderless; they are steered by leaders and it’s impossible to paint a complete

picture or look to solutions without looking closely at

leadership and how leaders can better support their teams. Today we will hear

from researchers from across the country doing the work to quantify and pinpoint

the pressure points for those working in healthcare and offer up valuable

solutions and best practices. We will hear personal stories, dig into the

challenges and concerns from the perspective of leaders, and healthcare

workers. Today we have two leaders who were in the front lines during the

height of the pandemic. John Yip, who is the CEO of SE Health, and Dr. Heather

Morrison, PEI’s Chief Medical Officer of Health. So, today is about sharing

knowledge and experiences and marrying that with deep research, which

hopefully leads to a cultural shift. Learning and adapting through crisis is

a true mark of leadership. If you’re a healthcare worker and/or occupy a

leadership position and you’re watching right now, we truly can’t thank you

enough for your service. So, some of what you might hear

today might be difficult to process. There will be links to wellness supports,

they’re linked here in this video but they will be in the chat as well,

so take a look at that if you feel like you just need a break. Thank you

to the Public Health Agency of Canada and all of our partners for their

commitment and support. This symposium is being recorded as part of the broader

research project, so you will have the opportunity to look back at this

symposium if you miss anything. There is an open chat function for this virtual

event. Please be respectful in your interactions and try and keep the chat

on topic, but it is open there for everyone to use. You know, maybe right now

just drop in the chat where you’re coming from where you’re at right now at

geographically, not spiritually, we don’t have to get into

all of that right now, but if you just let us know where you are, by dropping

that in the chat, that will be great! That’s where we’ll be interacting. We’ll

also interact in the Q&A. So, if you scroll on to your Zoom you’ll see

something called Q&A along the bottom. It’s to the right of the record button.

You can drop questions into the Q&A because there will be question and

answer periods after each session. And the chat is going to be

updated throughout the symposium by Sangita. Thank you so much Sangita for

doing that. Ancaster, hello! The Regina campus, good morning! Hello from Sudbury!

Lots of folks tuning in, I love it! And we have two sessions I should tell

you about today. One in the morning. We’re going to take a short break at about 12.

We have two sessions in the morning and then one in the afternoon so,

we’re going to take a break at 12 and then we’re going to come back after that,

so if you want to take a break then, that’s great. Hello Calgary, and hello

Winnipeg! Okay now, with leadership at the very top of mind, I’d like to now welcome

Dr. Margaret McKinnon, the team lead on this project. Hello, and good

morning Margaret. Wonderful to see you! It’s wonderful to see you, my friend! I

would say and you know I would be I think really remiss if I didn’t start by

thanking Media Girlfriends for their many, many contributions to this project

Garvia, Hannah Sung, and their teams have traveled across Canada, conducting

interviews with healthcare leaders, front line healthcare workers, along with

public safety personnel, to really tell the stories of those individuals who

faced the challenges of the pandemic head-on — who served at the front line as

leaders, on our hospital floors, in ambulances, and fire trucks, and police

cruisers throughout the pandemic. And Garvia and Hannah have really worked so hard to

tell the stories and I just want to thank you Garvia for everything that

you’ve done and Hannah. I also want to thank our production team, Make Things Well,

who has really been an incredible partner in this project, who created our

website, and has supported us throughout. I just wanted to acknowledge that in

this symposium series because we haven’t done that before, and I really did want

to do that. I want to also thank John Yip and Dr. Heather Morrison for being here

today. We so appreciate you being here. I want to also say that you know, I had

the honour and the privilege of serving on the front lines during the pandemic,

to provide mental health supports, and I spent time in the COVID-19 units, on

medical floors, supporting staff. But I also spent time with the senior

leadership teams, in the boardroom — I’m on a hospital board and also seeing the

challenges that leaders faced and I think at

times, it was difficult for people to know and appreciate what leaders also

experienced. I have been in rooms full of tears, because so many hard

decisions needed to be made. Often times, leaders were seen as the face of

something that they really had no control over. Decisions were often

changing in the moment. I am an academic leader and I know we would make

decisions and within seconds they would change, so I just want to also really

thank Dr. Morrison, John Yip for being here. But also to say thank you to all

of Canada’s healthcare leaders. You also made many services and many sacrifices

as did your families, and we just want to thank you for that. I also want to

quote something that John said during a video interview that was conducted

with him earlier that’s posted on our Healthcare Salute website. And John

said, you know I would never ask anyone to do something I wouldn’t do myself. And

I think that is really the marker of service among leaders. They also

went in, they served. Their families made many, many sacrifices. Often they weren’t

able to go home at night, they stayed there. I can recall being on a

COVID-19 unit for 36 hours, the majority of this in the storage

closet because it was the only time when people had a chance to take a break and

receive mental health support. And leaders were in the same position, so I

just want to acknowledge that it’s really, really important to acknowledge

your service and your sacrifice, as well. So, I’m going to now introduce Aneesh

Joseph. Dr. Aneesh Joseph. Aneesh Joseph is a member of our Trauma and Recovery

Lab here at McMaster. He received his PhD in Social Policy from Southampton

University, and he joined us recently in our group to conduct research and

also to provide real leadership around knowledge translation.

So bringing that research to Canadians trying to shape and influence

policy and healthcare practice through that work. Aneesh has spent much time also

working as an addictions counsellor as well. So in addition to his research

training, he’s also been on the front line. I really just want to thank

Aneesh most warmly for the work that he’s been doing. And all of the Healthcare

Salute team who have really been supporting this project. I think it’s an

important time to acknowledge everyone’s contributions and I really want to do

that. So, we’ll turn it over now to Dr. Joseph.

Thank you Garvia and Margaret. Hi, all. Thank you for joining us

today. I am happy to present the findings of our research on the role of

healthcare leaders in supporting provider mental health during the COVID-19

pandemic. At the outset, I would like to thank the team at the Trauma and Recovery

Research Unit at McMaster University under Margaret McKinnon, and all the

healthcare workers who participated in this

project. Since February 2021, a dedicated team at the lab have been working with

healthcare workers across Canada to research, analyze, and document the impact

of the pandemic on the mental health and well-being of the healthcare workers and

generate helpful tools and interventions to support

them. The findings can be accessed on our Healthcare Salute

website. These extensive research prompted us to look at the

organizational culture within the healthcare sector and look for areas and

elements that need to change for creating a better work environment that

supports the healthcare workers’ mental health and

well-being. The concept organizational culture

represents loosely how things are done here and how that affects the way

members think, feel, and behave. So cultural change will mean

moving from current state to a preferred state of how things are done

here. This presentation discusses some of the key elements of the current state of

organization culture and also will present recommendations that came from

the data to support how we envision a culture change within healthcare

organizations. With this intention, we surveyed and conducted semi-structured

interviews with healthcare workers from front line, middle management, and

leadership. The data have been thematically analyzed and will be

presented today. These are the demographic

information — age, provinces, and professions of the 24

healthcare workers who we interviewed for the

survey for the study. We used Organizational Culture

Assessment Instrument to understand and gauge how the members are thinking about

changes within the organization. OCAI scale is based on

comparing values framework and looks at four modes of culture within the

organization and seeks to understand the kind and direction of change they wanted

to happen within their

organization. Clan, adhocracy, and hierarchy and

market are four different segments within this

framework. Preliminary analysis show that there is a strong desire to move towards

clan. That represents collaboration, connection, trust, communication, and a

reasonable aspiration to incorporate. Adhocracy, which represents

innovation, cutting edge services, and growth. It is important to note that the

data shows an equally strong desire to move away from the current market

orientation and hierarchy in the organizational

culture. The qualitative data expounds the intensity and depth of this need and

aspiration for organizational culture change. We will be discussing the major

themes and sub-themes that emerged from the data, and we’ll be presenting them

as themes and

recommendations. While COVID-19 challenged everyone in the organization

in different ways, the healthcare workers acknowledge and appreciate the work that

the leadership and management did to steer through the difficulties of

pandemic. They also unpacked some of their concerns regarding the way current

organizational culture is constructed. Three major themes emerged

from the data that can be considered as challenging aspects of current culture:

widening disconnect, mismatch between words and actions, and misalignment of

priorities. Theme one: widening disconnect between leadership and front line.

Disconnect is delineated in words and phrases such as “distrust,” “invisible,” and

“unavailable,” “lack of presence,” “lack of transparency,” and “lack of understanding,”

“unilateral decision-making,” “hierarchy,” “feeling done to,” or “treated as a

pawn.” This disconnect was pronounced in the way decisions were made within the

organization.

There are considerable aspirations for engaging leadership that is present,

visible, and

accessible. Theme two: Mismatch between words and

actions. Words without actions were perceived as superficial, disingenuous, and

lip service. Especially when it comes to

supporting the mental health of the staff, these mismatch between words and

actions were considered to be eroding the trust within the

leadership. Fear of retaliation has been identified as a strong deterrent that

prevents staff from being open and from voicing their perspectives, concerns, and

genuine

feedback. That contributes to how they experience the

organization as a place where their mental health is not

supported. Theme three: Misalignment of priorities. There’s a perception that the

staff and leadership have divided priorities. While the staff — while the

organization wanted to be run like a business, the staff wants to prioritize

patient care and self-care. This division, this divided

priorities, keep them focusing on different aspects within the

organization and that focuses their energy in caring for different areas of

the organization and its

culture. “Being in a rudderless ship” suggests the experience of lack of direction,

initiative, and collaborative leadership. This has been an experience

of — especially when people came out of the

pandemic — they wanted strong direction to move everything forward from what has

been going through, and staff experienced a lack of leadership

initiatives in many aspects of organizational

culture. Some of the recommendations for moving towards a desired organizational

culture are as follows. The first recommendation is

rebuilding trust and fostering connections. The organizations need to

initiate processes and procedures that can rebuild trust and enhance connection

within the

organization. Rebuilding trust and fostering connection can help the

front line staff to feel heard, listened to, supported, and provide them with a

sense of belonging to the organization and its

work. Second recommendation is matching words with

actions. The organization needs to devise ways and

take — ways to take accountability for matching their words and actions and

also create ways to communicate those with the staff. The organization needs to

create mechanisms for ensuring that the values, policies, promises that it claims

to stand for are adhered to in the everyday dynamics of the work

environment. The third recommendation is prioritizing wellness,

safety, and mental health of the

staff. Following through critical incident debriefing, promoting self-care

for the staff, facilitating mental health support

(preferably onsite), and providing systemic support, such as manageable workload,

proper staffing, and higher allocation of funds for mental health in the benefit

and compensation package, can all help to embed these changes within

organization. When we really take these changes seriously and work towards

making it happen and making it embed within the organizational culture, that

will definitely lead to a trauma-informed organizational culture and work

environment, and towards trauma-informed

leadership. Thank you so much! With this, I conclude my presentation. I will now turn

it back to the

moderator. Thank you so very much, Dr. Aneesh Joseph. That was

wonderful, and really, some words that are sticking out: present, visible,

accessible. I feel like that presentation does an excellent job of

providing context and conversational fodder for the discussions that we’re

going to have today, and the discussion that we’re about to have right now with

two healthcare leaders. Now I should preface all of this by saying that this

is not putting these leaders on the hot seat. They’re not… this is not a session

that is meant to put their their feet to the fire. Because I’ve

spoken to both of these leaders at length and I know that they provide

the kind of leadership that the models that Dr. Joseph

put out just now — they very much adhere to this and I think it’s just

talking about their experiences being on the front lines during the pandemic.

John Yip is currently the CEO of SE Health. During the height of the pandemic,

John was the CEO of Kensington Health, a community not for-profit healthcare

provider in downtown Toronto. They provide community-based long-term

care, hospice, and ambulatory programs. Thank you for being here, John. And Dr.

Heather Morrison is the Chief Medical Officer of Health for Prince Edward

Island. Dr. Morrison also worked as an emergency room physician right up to the

beginning of COVID, so her experience spans not just being on the floor, but

being one of those leaders that a whole province was looking towards for help.

And I should add that the province itself loves Dr. Morrison, they really do!

They named a chicken after her, so — I don’t know who else can say that, but Dr.

Morrison can! Thank you both for being here. I want to start with a

question for both of you about Dr. Joseph’s presentation. Was there anything

in that that stood out or surprised you to learn any of this? I’ll start with

you, Dr.

Morrison. Good morning, good afternoon. It’s quite — it’s a

pleasure to be here. I’m in Charlottetown, Prince Edward Island, and so it’s nice to

see from the chat people from different parts of this wonderful

country. I think, you know, when I hear Dr. Joseph speaking,

I think the COVID pandemic highlighted and brought to the fore many issues that were

already there before and they highlighted them. So you know, we

probably did not have the best supportive environment for mental

health of our healthcare workers before COVID. And after COVID, we need it

more than ever. And so, it really wasn’t that it surprised me but I

think, it emphasized the fact that along with many other parts or things that

happened during COVID, it really got highlighted. Absolutely! For you,

John, was there something that that jumped out about Dr. Joseph’s

presentation? Well I wish I had a chicken named

after me! I think there’s a pig somewhere running around Ontario named

after me. I am based in Toronto. Thanks for inviting me to this session. I think

it’s critically important that we talk about these things. And I quite

enjoyed listening to the snippet, the video there of Dr. Joseph. And I agree with

Dr. Morrison’s comment — you can almost hear and read that paper

pretending that COVID never happened and that those findings would be exactly the

same findings pre-COVID and it would be just buried and no one would really pay

attention to it. If there’s any good that came out of COVID — there

are a couple good things, despite the tragedies

involved — is that the plight of our front line staff, the mental health and

well-being of our front line has been put to the forefront. And even now, dare I say

post-pandemic, it is still a major, major issue. And the pandemic did shine a

light on these issues that pre-existed and continue to exist right across

the country for our front line healthcare workers. Yeah. You know I had, as

we’ve mentioned, I had the pleasure of speaking to both of you in person

over the course of this summer and spent, you know, probably too many hours

sitting in front of you asking you some very pointed questions. And one of the

questions that — you know, you both talked about moments in which you

realized that there was a shift in what was happening. That this

pandemic was something that was unique, and that perhaps the way that you

were approaching leadership might have to shift slightly. Can you tell me about

what was happening? Can you paint the picture of when you realized that

this was something that would require something maybe that you hadn’t had

to, kind of, like, dig into post- COVID? I’ll start with you Dr.

Morrison. Well, I mean, in our experience here in PEI, I will preface it by

saying, it was different maybe in our province, compared to some of the other

provinces. And I think there were a few things.

One: how we managed when we realized how long this could last. I

think that was a big key thing — this was not going to be over in eight weeks,

like a SARS kind of journey. It was going to be much longer. So how we

we were going to get through this, and looking further ahead.

We — I said this at different times, so it may not have been at a

certain point, but we knew early on that we would not

always make the right decision. But we — and looking back, we knew that we would

make mistakes. But we knew we had to make the best decisions with the information

we had at that time. And make them for the right reasons! And if we were doing

that, that would help us going

forward. For us, in PEI, when Omicron came, almost two years

after the pandemic started, that was a huge shift for us. Because up until —

for almost two years, we did not have a death. We had hardly any hospitalizations.

We did not have a long-term care outbreak. But with Omicron, how we managed

had to shift, and we also had to lead differently to the public because

they weren’t used to seeing COVID. We had to

adjust with government, with our partners, and with the team here in

the office. So, that was probably one of the biggest times of

changing — knowing we had to change to learn how to live with, you know, we

heard often “have to live with COVID,” and for us that was really when Omicron came.

But it was like, the worst of the pandemic for us here, came at least when

we had vaccines and some of our processes and

PPE in place. I mean, those were some key points.

Yeah, for sure. John, for you, I know that there was a time in which you

spoke to your staff at Kensington Health at the time, and

said that “We have to do things differently.” Can you just

paint that picture — what was happening during that time, when

you realized that this was something unique, and would require some different

skills from you? Yeah, sure. Just to give people

context, Kensington Health has a 350-bed long-term care home on its site. It’s one

of the largest homes in downtown Toronto, and well sought after — the

waiting list is five years long. So, a lot of demand for the home, and I think

mainly because of the fantastic quality of care the teams provide there. So, when

I went up on the floor, this is the day after the WHO declared the pandemic,

and even leading up to it, I think around end of January, we were…

Someone had the foresight to dust off the pandemic plan, and we kind of had a

look at it in Jan. That was the sort of turning point number one is, we had not

updated our plan. We looked at our stock of masks. We had three days of N95 masks.

And we decided we better start doing N95 fit testing. So, that was like, a big

moment. Organizations do N95, particularly in long-term care homes, on

an annual basis, so this was not anything new, but fortunately, our Director

of Care had the foresight to do that. The second sort of shift was going up

on the floor and seeing the staff — and this was day one after the WHO

declared the pandemic. And we had masks, we were wearing masks, and you could

tell the fear in people’s eyes. You just look. I went up on the

floor and there was silence. Then there were tears, no one was talking, there were

tears. You could see the fear, you could feel the fear on the floor. The

staff were begging for universal masking. This is again, way

before any province in the country had instituted universal

masking. And I couldn’t tell them that we only have a two-week supply of

masks. Like, I couldn’t tell them that. Because if we instituted universal

masking, we’d run out and then we wouldn’t have any masks. So, having that

internal debate, and being able to look our staff in the eyes and say look, “We’re

going to have to just make do with what we’ve

got. And we’re gonna have to put our residents at the forefront, despite how

you feel.” The next day, I go back on the floor,

70 percent of the staff had left. Walked out, called in sick, went on

vacation. And, we’ve got two 25-unit sections with four staff total

managing. That’s not even enough staff to manage one 25-bed unit. And that’s when the

real panic started to kick in, and we went into overdrive.

Dr. McKinnon mentioned a quote from you that you

wouldn’t ask of your staff anything that you wouldn’t do yourself, and I know that

a part of the story you shared with me is that you went on the floor, and did

the work that was necessary, just because of that

shortage. I wonder about those sorts of decisions. I know that pressure

comes to both of you from above, as you’re trying to manage all of your

staff, so I wonder about a decision like that — how crucial it was and how you

think that that decision was seen by those that you were leading, John?

Yeah, so the overdrive was, we got to staff up. These residents aren’t

getting fed, they’re not getting changed. They’re not living their best lives. In

fact, they’re living their worst lives. And we know from the news what

happened to unfortunately, many long-term care homes, and that was top of mind. This

is before — I was like, this is a tragedy in the

making. And I’m not a clinician. I’m not even trained to be a personal

support worker. In fact, I realized the only skill I have is one of a

residential aide, which is to feed our residents, which I did in any way

possible to help. And then it was a call to action. It was a call across our

organization — we have an ambulatory surgical site, we have community supports,

we have a research arm. And I called a town hall and said, “Look, I’ve been on the

floor for 36 hours straight, feeding, doing labour, cleaning” — doing a lot of cleaning,

I think the floors were cleaner than my own floors in my own house at the

time. And I said “I’m on the floor, I — we need your

help. Who’s going to volunteer?” Twenty hands went up. We had a

research assistant, a clerk, someone from the finance team, three nurses from our

surgical division, which were amazing. Lined them all up, split up,

and got to work. I think that action alone spread to the families, who at the

time — I think people will remember no visits, no visitation to long-term care. You know,

the iPads, the faces against the window, remember that? The families heard about

this, and one family member proposed, “Why don’t we go in and work too?” And I said,

“That’s the craziest idea ever! You know, the union will

be against that, our lawyers will fight against that.” You know, a very

administrative response — can’t do that! I called the lawyer, called the union

steward. Within 24 hours, we had 20 family members on the floor working as staff, as

temporary part-time, earning $17 an hour as a residential aide. They already knew

the people on the floor, so they were more than happy to help out. You

know what’s amazing too, is all those family members donated those wages back

to the organization. They didn’t keep it. It wasn’t about the money, it was about

serving, and it was about taking care of their loved ones and the loved ones of

others. And that to me is what community is all

about. But it’s also, you know, an example of leadership, in knowing that

you had to get rid of these barriers. Like, that is on you.

To remove the barriers so that people can actually help. So, that is one of

those those visionary things that was happening during that time. Dr.

Morrison, we talked this summer about your team, and Dr. Aneesh’s

research talked about trust — about building trust. And I remember clearly,

you saying that there was a certain moment in which you felt that you had

pushed yourself too hard, and perhaps you had pushed your team too hard during

that. And that is in retrospect, in looking back. When you look back at

that, what do you think might have helped you in being aware that maybe the push

was just too hard? Is there anything that could have prevented that looking

back, that pushing way, way, way too hard for yourself and your

staff? Well, I mean I heard one of the staff say to me, you know, “I’m only

working this hard — like I’m staying here, missing my

family, here all weekends, late at night, because I see you doing the same

thing.” And that’s what I think — it means that I can be here too, because if I

didn’t see you working this hard, I wouldn’t be able to be here.

And at the time, I thought okay, well that, you know, this is how we trust

each other. We all work together, we support each other, but maybe, that was

a sign that I wasn’t doing what was best for

them, either. Again, in hindsight. But you

know, we talk about things that were not there before COVID. We did not

have the surge capacity that we needed to manage any kind of

crisis. And we certainly don’t have that now. And just at a time, I think –

and maybe this will come up later, I mean, but just at a time when we really should

be putting more resources and human resources to help make the system better,

it’s just when I have fewer staff than I ever did in the height of COVID. But we

really need to recognize that surge capacity. But that trust is really

important. And how we create trust with our teams, with the politicians

that we serve, with the public, and trying to make sure that we had regular,

open, transparent, honest communication

was really, I think, what I tried to do with the team, and with the

public. And that meant that we showed emotions

sometimes. And I wouldn’t recommend crying on TV because it’s sort of, not a

great look, but it happens. And it happened in front of senior

officials, it happened with my team, and it also happened in the public.

Because it is emotional, it is about fear. But I think in doing so, it

allowed for some really honest communication and trust. And at a

time when we all needed that. You know, I would highly

recommend if folks are listening, to go to the videos that

we shot with John Yip and Dr. Morrison (you knew I was going

to do that!), and have a look at their stories, because it’s

a very deep… stories of their own fears during that time, and I wish

that we had another hour to get into all of that, but the videos I think,

do a great job. Dr. Joseph’s research outlined three themes that

emerged in the research: a widening disconnect between healthcare

workers and leaders, a mismatch between words and

actions, and a misalignment of priorities was the third. And you know, I think

the pandemic set the table for these issues to emerge, but as you both

have said, these are issues that have been ongoing. It just so happened that,

you know, this is an opportunity to look at all of it, all at once. What methods

did you use to help maintain trust with those you were leading during such a

stressful time?

John? Yeah, I think the old phrase of “actions speak louder than words” really

played a key role. Same example as Dr. Morrison, if staff see you doing what

you’re asking staff to do, it models that type of behaviour. And it’s okay to be

able to be vulnerable, it’s okay to share your fears, which I did on a daily basis.

Because while I work in healthcare, I am not trained to do any of this.

Particularly when there were deaths, where funeral home providers weren’t

allowed into the homes, and two very tiny PSWs and I

would bag the body the individual. Not in a dark body bag that is typically done,

but in a transparent plastic

bag, and writing their name and time of death on their face,

while you see the face, and wheeling them out in the hallway — empty hallway, and

into the front, where there’s a little bit more staff, into the hearse

that’s waiting. The staff looked at me and

said, “I’ve never seen a CEO do this.” And I said, “well I’m not the CEO right now, I’m

here to help. I’m just trying to help.” Trying to keep everything together and

doing the manual, hard labour that our teams do every day. They see this every

day within — outside the pandemic. It has given me a huge appreciation for the

bedside care and the care that happens before people come in and when people

leave. And I think that perspective has made me a way better

leader in terms of really narrowing that gap that Dr. Joseph talks about.

Really saying things that I mean and will do. If I won’t do it, and if we aren’t

going to do it as an organization, I’m not going to say it. I’m not going to

commit anything. I’m not going to be that bobblehead leader, which I think I was

pre-pandemic. You know, and as a young

staffer, I would look at leaders and just roll my eyes at a lot of things leaders

would say. And I didn’t want my teams to look at me that way. So, I think really

getting into the trenches like Dr. Morrison did is one way of endearing

that trust. You know, you’ve done the hard work together. You’ve shared these

very intimate details about yourself, and you carry that through post-

pandemic. And I still maintain very close friendships with many of the staff,

some of them who are still at Kensington, others that have left, and ironically, some of

them have joined SE Health. I still maintain very, very close relationships

with them. We don’t talk about the pandemic. We talk about our families, talk

about life, the good things in life, even though we’ve experienced a lot of

not-so-good things during the pandemic.

Yeah. Dr. Morrison, what about you? You know, now you are still

leading the province, you still have your staff with you. What have you done to

help to maintain that trust and build that trust after such a

stressful time? Well, I mean during the pandemic,

it sort of became the phrase I’d finish every press conference with,

and it — people started wearing t-shirts and putting it on

billboards like, “Be patient, be kind.” And I’ve had to almost — I’ve put it up

so I can look at it every day to remind myself, because I really want to lead us

as a group, post-pandemic, with some of that

same thing. “Be patient, be kind” as we — and we had to be patient and kind

with ourselves because it was really hard. And I think even for me

personally, I underestimated how long it would take

me to sort of come out, and how much it impacted my own mental health.

And of course, the team that I work with, and have the privilege of

working with all the time. And so, I think as John

said, you have a different bond with people you spent that much time with, and

you worked with. And it was — even as a collective, as a population,

especially in, you know, through that first part — to have that

collective sense of what we were doing. We were all working together in PEI,

and as a team, to try to protect our community and our health care system.

And I’m not sure I’ll see that sort of collective action, and that thinking

about others, in quite the same way. It was — it was really amazing to see that.

And that cooperation between so many different partners, whether it

was restaurants, businesses, long-term care

facilities, and our team all working together and forging those partnerships.

And I — so those are the things. So, talking about how do we maintain that trust, it’s

about maintaining those relationships that were really important and that

helped us achieve some really amazing things

during COVID. So, how do we make sure that some of that can continue for the

months and years ahead as we struggle with a precarious health

system and increasing demands from our population? Yeah, for sure. I want to

open up the floor to questions but I do want to talk to — so the Q&A section is

right there, if anyone wants to drop in questions for John Yip and Dr. Heather

Morrison, we’re open to that right now. But I do need to talk about mental

health. Not for just — I know the two of you struggled yourselves

personally. I wonder if you are thinking about the mental health of your

staff and yourselves differently now that we’re in this long tail of the

pandemic. How are you thinking or rethinking mental health now? Dr.

Morrison, can I start with you? Well, I think healthcare workers,

including Public Health officials, were subject — besides all the hard

parts of the pandemic, and what the whole community was going through — we

were subject to some harassment, bullying, threats, and vitriol that

really we hadn’t always experienced before.

And I know that impacts us in a

terrible way. You had people at your door — like, protesting you at your door! I

mean, that is pressure! Yeah, we had loud protesters,

in groups with loudspeakers and drums, outside our windows here at the office

for days and weeks. We had people come to my home. We had RCMP, we had police

calling me saying, “There have been threats, where are your children?”

They told me I couldn’t go anywhere by myself. I didn’t go out to

eat with my family for almost three years, I didn’t go to a grocery store. I

mean, some of those are for me. But I think, you know, as

healthcare workers, there was so much kindness we saw, but we saw some

real hard things too. And we were subject to people or to some having

some threats and vitriol. Which I think, this is the time — so I think

about how can we protect healthcare workers and public health officials,

in terms of legislation, in terms of policy, before the next crisis. And, even

without a crisis, how can we do a better job? Because it is really hard,

what healthcare workers do, every single day. And we certainly don’t need that

added element to impact us. And it has long

repercussions, long-standing repercussions, when there is threats to

yourself or to your family. And we are doing our jobs, so we should be protected

and be able to do our jobs, in a very safe environment, and not be subject

to that. Yeah, thank you so much for sharing all of that. John, what about

you? Have you been thinking about mental health? You have a new

position now with SE Health. You’re in a leadership position once again. How

are you approaching mental health and how are you approaching your own

personal mental health after such a — after this

crisis? I would admit this… mental health and well-being for

staff, pre-COVID… maybe, was not the top three things that I focused on. I can

admit that publicly. You know, I think leaders have an idea that

it’s important, but you know you got budget pressures, you’ve got

government policy changes, you know, all the other things that take

up your time. And so, I will admit it was not in the top

three. In my new-ish role, it is number one. It is number one. It’s largely

with the sector that I work in now — home care and long-term care. Eighty percent of the

staff are racialized women. Many of our staff struggle to put food on the

table with the wages. They have families, they have cars to fix because it’s

home care, and they carry a burden. A burden of not just caring for

their clients, but the burden of taking care of their

family. And we, I would say broadly, as a healthcare system, don’t

really invest or pay attention to it the way that we should. And, it’s no surprise.

We see, you know, thousands of front line workers leaving the system. It’s why we have

packed ERs and hallway medicine. The crisis that’s faced in

healthcare is not just about underinvestment in new infrastructure,

new programs and services — there’s that. But there’s just been a massive exodus

of people that we ignored. In Ontario, there was a controversial piece of

legislation called Bill 124 which kept wages for public sector employees, and

was only just repealed by the highest court in the province last week. Well,

if your wages are capped and you’re working 36 hours, you know, serving the

public, and your wages are capped — and are purposely capped, why are you

working that hard? So you know, for me, and it’s very interesting. Yesterday was

a big day of three back-to-back meetings, six hours of

inclusion work. And we are, as an organization, going to invest in wellness.

And we have — when we look at our benefits now, it’s not trying to find the cheapest

plan. We’re going to invest in giving our staff the necessary supports they

need. Whether they need them or not, they should have access to

it. And so, we’re being very intentional about addressing

this. And then for me, personally, it’s interesting. Like, I kind of joked before

in the practice call that, you know, I blocked out — these three years I’ve

blocked out. And I was running the other day in the

forest, and I just stopped and started crying for no reason. Like, I couldn’t

understand it. I just really couldn’t understand it. It’s happened once before

when my father died. It was many years later that it happened, and I

realized I actually hadn’t talked about it. I didn’t want to acknowledge it, and

it just came out. And I went to talk to my family, and my partner’s in healthcare

too, and I told her this, and she just said, “I think you’ve got a bit of

post-traumatic stress symptoms.” Years later. And I didn’t even realize

it. And so, part of participating in this session, and with you in the

video series, and I’ve talked about it with you, Garvia, is that I didn’t really talk

about it. Didn’t feel the need to talk. I didn’t want to talk about it — I didn’t

want to do this! But I think I’m so glad that

I’ve participated. I’m glad there is being research being done on this.

It’s critically important to be able to share these thoughts,

experiences that kept bottled in. And I didn’t

realize what an impact it had on me until that run in the

forest. Yeah, thank you so much for sharing that. I want to just ask each

of you — we have a couple minutes left, each of you have about a minute for

this huge question that Dr. McKinnon has posed: What would you tell

future leaders who face these same challenges in the future? What would your

advice be? Dr.

Morrison? I was wondering if I had to go first. [laughs] You could just throw it to John,

if you really want. You’re allowed! I just — I just wanted to pick up –

before I answer the question, pick up on John. I mean, I think you’re so right.

Sometimes, I focused on thinking that other

people, wanting to make sure we had lots of sort of mental health debriefing,

for post-COVID, for teams and others, but I didn’t think I needed to participate in

them. So, I recognize that because I — and only later did I realize that

every time I talked about some of the issues, I would start to be super

emotional. Anyway, so I certainly appreciate that, John. I think one of

the things I would say to future leaders is

that our decisions always need to be balanced. So, the impact of our

public health decisions… I’m not sure we always

got the balance right, because it’s really hard. You’re trying to save lives,

but we also had huge impacts on mental health. And to be more cognizant from

the very, very beginning of those — that kind

of balance that we need to have going forward. I

think recognizing the need to have

the capacity built into our health care systems and public health

system, to manage these crises – which will continue to occur. And

because if we don’t have that surge capacity, with not enough people,

they work so much that it does impact their mental health, and then we can’t

continue. So, we will protect everyone better if we have

enough to manage in those surge situations. And then I think I mentioned,

the maybe — the final comment is around what we can that — it’s important to do

this research, to talk about it, to have these sessions. Even though I would like

to sort of not talk about it, sometimes, because I want to move on. But it’s

exactly what we need to do, so that we can learn, and that we can create

environments that make us more resilient, and

healthier, in this inter-pandemic period. And that includes

making sure that we are protected and don’t tolerate any kind of

bullying type of behaviour in any sense for us as healthcare

workers. Yes, thank you. John, you have a message to future leaders? It’s hard to

top that! No wonder why Dr. Morrison got a chicken named after her! [laughs] Thanks for going

first! She earned that! She did! Definitely, definitely! I would say two

things, and one is, use TikTok. And it sounds funny, but the point is this –

use the communication tool that the people you’re communicating to, will use

and absorb. We had done your typical PPE types of workshops, and people would

still not don and doff properly. And we came up with a 15-second TikTok video

of dance moves and so on, and guess what? Adoption rate of donning and doffing

went — like, shot up to a 100 percent. So I think as a leader, and I think Dr. Morrison does

it well, and her public health colleagues right across the country are amazing

communicators — they take very complex issues and articulate it in very simple

ways, so that the public can understand. So, number one is communicate well. Use

whatever mode is appropriate. In my case, since we had a younger workforce,

everyone was using TikTok. So communicate. Communicate often, simply, and

again, and again, and again. Number two, would

be — you know Jay-Z said this, when he accepted his Grammy,

and I completely, I subscribe to what he said. He said in accepting his award

is, “to show up.” And it’s as simple as that. As a leader, show up. Show up when

it’s hard. You don’t need to show up when it’s great. I think there, you allow

others to shine. But your job as a leader is to show up during those very

difficult, very, very uncomfortable situations, where bad news is horrible.

And when good news is great, let others take that on, and you can stand in the

shadows. But I think there are many people, still — leaders (that) don’t show up… don’t

show up for their staff, don’t show up for their clients or their patients.

And that’s not being a leader. So it sounds very simple. Jay-Z

has a way of being simplistic, but he’s a very, very intellectual guy. And

when you unpack that, there’s multiple dimensions about showing up. Showing up

as a friend, a family member, a leader, partner, father, whatever. Mentally,

physically, like it is very multi-dimensional. and I’ll let

everyone kind of gnaw at that, and what that

means. I love that. Maybe, Jay-Z was following some of the words of even

Winston Churchill from a long, long time ago. It just made me think of it. You

know, Churchill describes really anyone can — well, not anyone, but you can lead more easily

in good times. But it’s when things are harder, that it really takes true good

leadership. And I think that really is about showing

up. And it is when things are harder, that you have the leadership

that you really need. So, maybe Jay-Z and Winston Churchill were connected

some way. Let me tell you, two things I did not think were gonna show up in this

chat — Jay-Z and maybe Winston Churchill! I’m not sure, but I love that they both

came together, and I so appreciate both of you. John Yip, Dr. Morrison, thank you

for taking taking the time to be here, and be so generous in talking

about leadership in this way. I know it’s not easy to reflect back and

think about the things that you wish you would have done, but your generosity in

sharing your stories is just so appreciated in this forum. I even went

overtime! I’m only going to give people three minutes to rest and come

back, but thank you so much for this. And with that, I will leave everyone

to leave. Maybe we’ll give you an extra six minutes and

then we can come on back, and start our session again. So, see everyone

back here at about 1:05. Thank you, John, and thank you, Dr. Morrison. Thank you.

Thank you. Very nice to be back again with you.

Welcome back for those who are joining us or just joining today’s symposium.

It’s entitled “Navigating the fog: The role of healthcare leaders in

supporting provider mental health during the COVID-19 pandemic.” Now in our first

session, we were presented with findings from Dr. Aneesh Joseph. We

also spoke to two leaders in healthcare, John Yip and Dr. Heather Morrison,

who gave us firsthand accounts of what it was like to lead at the height of the

pandemic. It is so clear that in order to face the ongoing challenges — some would

call it a crisis in healthcare in the wake of COVID-19,

we not only need to hear stories but there also needs — we also need the

research. We need the empirical evidence. We need all of those things. To talk

about their research, we have some incredible leaders in research. Dr. Kim

Ritchie is here with us. Dr. Ritchie is an Assistant Professor in the School of

Nursing at Trent University. she completed a PhD in Rehabilitation

Science from Queens University, focused on understanding and identifying the

clinical presentations of PTSD and dementia in older veterans. Since

joining the Trauma and Recovery Unit at McMaster in

2020, she has also co-led the program of research that underpinned development of

our PHAC-funded Healthcare Salute initiative. To this day — I’ve

been working with you guys for so long and I still don’t know if I should say PHAC

or P-HAC. I need to get with the program. Dr. Jenny Liu is also here. Dr. Jenny Liu

is a post-doctoral associate with the McDonald’s Franklin OSI Research Centre

and an adjunct research professor in the department of Psychiatry at the Schulich

School of Medicine and Dentistry at Western University. Dr. Liu’s

background is in the science of stress and resilience — so important. She works

with stakeholders to identify the determinants of resilience in different

communities and supports efforts to promote or build resilience using a

number of evidence informed strategies and approaches. And Dr. Dayna Lee-Baggley is

also with us. Dr. Lee-Baggley is a registered clinical psychologist in

British Columbia, Alberta, Ontario, and Nova Scotia. She has an active research

program on behaviour change, obesity, chronic disease, professional

resilience, and acceptance and commitment. Again, if you have questions for our

research panel please put it in oh — P-HAC or PHAC, we don’t mind. Okay, thank you

Shannon! I will say it either way. If you have questions, please put it in the

Q&A portion. I’m sure you will have questions for these researchers. Welcome

to all three of you, thank you for being here. I think the best thing to do

right now, is just to ask each of you to give us just a little bit of a

Cole’s notes on — a little short synopsis of your research projects — and maybe just

a little bit about the findings and then we can go from there. Dr. Ritchie, can I

start with you, Kim? Is that okay? Yeah, absolutely. It’s so nice to be

here and thank you Garvia, for the warm welcome. It’s a real privilege to

be part of this panel and to be talking about such an important topic.

You know, Aneesh’s presentation and the the discussion that just happened with

John and Heather was so important and so moving. I just want to thank

them. So for our research, as part of the Trauma and Recovery Lab, we have been

doing research for just over three years now, talking to healthcare providers.

And we have now completed interviews with 126 healthcare providers from right

across Canada and we’ve collected surveys from over a thousand. And so

we’ve really, you know, come to learn a lot about what their experiences have

been through the pandemic. And I think one of the things that we’ve really

learned about that I think is relevant for the discussion today, is about

how impactful organizational support is on the mental health of healthcare

providers. And when I heard John specifically talk about how, you know,

prior to the pandemic I think we knew it was important, but maybe not in the

top three or in the top 10 sort of priorities. And so I think we’ve really

learned now about how important this topic really is and how much the work

itself really takes a toll on the mental health of healthcare providers. We all

spend a lot of time at work, but I think, you know, for healthcare providers they

they see a lot of really difficult, sometimes emotionally stressful things

as part of the work. And we don’t talk about it enough and I think that’s

been something that, now, we’re starting to talk about it a little more, which is

a really positive thing. Great. We are going to circle back and talk about your

findings shortly, but Dr. Liu, what about the — what

you’re up to with Revel. Sure! Thanks Garvia.

It’s a pleasure to be here today and you know, every time we talk about Revel I

kind of have to dial back a little bit and talk about kind of the background of

how we arrived here. So we’re also a P-HAC or PHAC-funded — thanks

Shannon! — we’re also PHAC-funded project and originally our research

centre specializes in military research. And so, what we set out to do was adapt

the resilience training for the military, the R2MR Program or the Road to Mental

Readiness Program, and adapt it for healthcare contexts using an

implementation science framework. So focusing on adoption, focusing on

implementation. And part of that process was identifying who’s, you know, our

target reach or target audience and then doing in-depth work with them to figure

out what are their needs, so that we can customize that adoption. And during this

process, it dawned on us very quickly, so Road to Mental Readiness is

essentially a program, you know, there’s modules, there’s kind of self-learning,

self-directed training, and all of those things. And our learnings were, you

know, in the midst of the pandemic and all of the sort of the subsequent

effects, healthcare workers don’t want any more modules. They’re already

inundated and overburdened as is and the last thing that anyone wants to do is to

take more time from their daily lives, probably not reimbursed, to log on to do more

modules and do self-directed learning. So that was kind of one of

the big learnings. And then also most of the stressors that were identified

during that process of deep discussions, were organizational in

nature. So it wasn’t a lack of awareness of mental health strategies, it wasn’t a

lack of yoga that was, you know, contributing to their organizational

burnout. It was very much the organizational policies, the rapid

changes, the feeling like your organization doesn’t have your back. All

of the things that we’ve just heard in the last hour — those were the themes

that emerged and that was why we couldn’t just say “Okay, let’s just stick

with our original plan, let’s adapt the R2MR.” So we want to actually shift our

approach and essentially want people to revel in the work that they do want them,

to re-engage with the organization. And how we do that is by working with

organizations to re-conceptualize and transform the way

that they think about well-being support. Right? Is it just that we throw a bunch

of, you know, individual-level things at these healthcare workers and some hit

and some don’t, and you know, and look at where they stick? Or is it that we

just transform the way we think about well-being and the role of the

organization and the role of leaders? And that’s very much the work that we’ve

been doing in the past two years. I love that. I love that because Dr.

Joseph’s presentation talked about a cultural shift and that’s what you’re

talking about. It’s not just the modules and teaching people, it is shifting

culture, which is — can feel like an iceberg, I’m sure. But we’ll talk about

that. Thank you. Dr. Dayna, can you tell us just a little bit about the work

that you’ve been doing? Yeah, thank you. Thanks for having me. So I’ll just

focus on the work kind of relevant for this topic. During — so I was a

front line worker during the pandemic. I was working on the medical, surgical,

and cancer care teams at the hospital. In Wave 1, I got redeployed to give therapy

for front line workers and medical first responders of the shooting in Nova

Scotia. And then in Wave 2, I was working in the cancer centre. And so we

got some funding to do burnout in front line workers with my colleagues at

St. Mary’s University, in industrial organizational psychology. And similar to

Dr. Liu, I was like, “We are not going to tell these people that they just need to

do more yoga or if they just did more mindfulness everything would be okay”

And so we chose to do leadership training, because leadership is a way

that you can address some system level problems and your fastest way of doing

that. And so we developed, you know, a training program. We’ve now tested it,

you know, in three randomly, you know, weightless designs, both in home

care workers as well as physicians. We did it during the pandemic, so in our

weekly data you can see “Here’s where Wave 3 hit of the pandemic” and

showed that we could reduce their own burnout, involuntary indicators of

stress like their resting heart rate, so that we could address some of those

system-level problems. The second thing that we did was we did an

intervention on moral injury for nurses. And so we are working with people

who work in the military, to work on moral injury. There was a lot about

that you know, potentially being a problem for healthcare workers and so we

did an intervention with them as well. And a lot of similar issues about –

that have been mentioned already, about the institution not being there to

protect them, the institution failing them. Those were often the sources

of the moral distress and the moral pain that people were experiencing. And

so, what we’ve really been working on now – as a psychologist, I spent most of my

time helping individuals, right? But then, somehow like, sending them back to toxic

workplaces, and I was like, “I really just want to fix some toxic workplaces for a

while,” and so we’ve really been working with workplaces on having comprehensive

mental health strategies. Which, for the record, is not an EAP, right? Those are

lovely, you should have them, for sure. But that is when the crisis has already

happened. So we focus on, “How do you put fluoride in the water? How do you embed

this in your everyday actions?” And so we think about, you know, trauma-informed

leaders, we think about psychological safety in the workplace — these are

the organizational factors that we need to address. You don’t want to rely on

help-seeking behaviour of employees, like — so we always want to empower employees,

but we really need to be targeting those systemic organizational factors and

that’s really what we’ve been focused on. And then lastly we just — I get so

frustrated, because they’re — when I started working in corporate land, they

just make stuff up — I’m not kidding you, like, there’s not a lot of research there.

So in healthcare, everything has to be evidence-based, like you have to, you know,

you don’t just get to make stuff up. But in workplace — like, mental health? There

are tons of people who have just come up with their own strategies, their own

ideas, it’s not tested, there’s no theory. And I was really shocked by that! And

so, it’s also become our mission of, like, how do we increase access to

science-based information? There’s a lot of good research and it is not getting

to the people who need it. There is like, this major delay between research and

implementation. And so we also work on that: How do we get more access to

people so that they can stop suffering? Like, we know a lot of ways to help

people and it’s really not getting translated fast enough into everyday

lives. That was like a mic-drop moment right

there, Dr. Dayna. Thank you very much for that. It is, you know, we keep circling

back to systems and I’m really interested in Revel and what

you are doing there, especially within the military, Dr. Liu. I had the

great fortune of talking to Major Beaucage, Marilou Beaucage, who led some

of the first teams that went to Wuhan and brought back Canadians. She’s just

this incredible leader in the military. But she talked about the

systems, she talked about the pressure that she gets from above and the need

for the whole kind of system to lock into place. So I’m

wondering about the — what is the most urgent need –

systemically, if you could just wave your wand Dr. Liu, and say, “This is what the

system needs.” I know this is a big question, but what needs to be addressed

urgently, right in this moment, before the next crisis comes? Oh, tough question.

So, I think I want to unpack that a little bit, right? So first, we’re

talking about, you know, the — all the work done in the military and

that’s a huge system, you know? Lots of different kind of channels, lots

of different moving parts, and an old institution, right? And take that

and apply it to healthcare and you’ve got the same challenges, right? You’ve got

bureaucratic channels, you’ve got like – you know, it’s institutions that’s been

around, and you’ve got a lot of moving parts with not a whole lot of cohesive,

sort of, glue to tie them together. And that’s really one of the fundamental

challenges, is that the system was inherently broken well before a pandemic

even hit, right? And any kind of lack of acknowledgement of that is not

true, right? We’re not — it’s not like pandemic created these problems, it just

magnified and amplified all of the challenges that we face now. So things

like shortages and resources, not having, you know, a wellness vision or wellness

strategy — all of those were in existence, and so that’s really the fundamental

challenge. It’s about how do we transform wellness and inject it

into this institution and all of its moving pieces? So Dr. Lee-Baggley, you

talked about, you know, a wellness strategy. That’s so key. That’s one of the

challenges we’re toying with anytime we’re partnering with an organization

and thinking about wellness at an organizational level. It’s — for some it

might mean that, you know, well-being or staff well-being wasn’t

even in a mission or vision statement. Now, if that’s the case — let’s just kind

of play that out, right? What does that look like? It looks like, you

know, at the highest, highest level, where a lot of these decisions regarding

resource allocations are being made, someone doesn’t have that within their

mandate to do so. And so then where do you squeeze out the time, the effort, the

resources, the focused attention, to attend to wellness, right? Someone,

somewhere down this cascade chain, needs to be responsible. And where do you see

that? And if that’s not a vision or mandate, how do we then highlight it and

and make others aware so that it becomes a strategic

priority? And in the presence of a priority, you know, what does that look

like? What does that strategy look like? I think you answer a

question right there that I’m going to pose to Dr. Ritchie about focusing

on leadership, because when you’re looking at the stream that’s coming down,

where can you — you know, where can you be the beaver to put in

the stop, let’s look at this first. And the beavers, in this case, are leadership.

It’s the leaders — this is why this is happening. So Kim, I’m wondering if

you can tell us what the research is telling us about the mental health of

the leaders themselves? Because there is — if we want to help these leaders to

implement these things, I think that there is a crisis — within the leaders

that I spoke to, for sure, in their own mental health. They’re having their own

mental health challenges. What were you — what were you hearing in your

research across the country? Yeah, I — that’s exactly it and

I think, you know, we interviewed front line, middle management, and senior

management, and I think they’re all struggling with mental health and I

think that, you know, the point about how things were already very broken

before the pandemic and things are just amplified now, along with this

amplification also of the mental health struggles across everybody. And one of

the things that we’ve been working on to try to address this within the

leadership is taking the idea of trauma-informed care. And I think, you

know, most healthcare providers are familiar with trauma-informed care,

because it’s something that we’re very trained to do for our patients and

clients. But it’s sort of taking that and turning that to the employees and staff

and people themselves and embedding that. And how do we embed that into an

organization and train leadership and train front line staff to embellish and

integrate these ideas of trauma-informed care? In the prior

presentation, we talked a lot about trust and I think that’s one of the really

primary things that we’re all talking about within the system, you know? How can

we develop greater trust and safety within our organizations and with our

leadership — between our leadership and front line and between each other within

teams? And I think that’s the real foundation of trying to rebuild these

connections and trying to rebuild the organization in a better way, hopefully,

than even before the pandemic. I think sometimes it, you know, it takes a crisis

to create these changes. And we’re really at this point now, where we’re — we

have to make these changes. So addressing this from sort of a systems

level of how do we look at the organization in embedding something like

trauma-informed care, but how does that trickle down to each level? And what are

the responsibilities then for the leadership within that? What are the

responsibilities at the front line? Because I think we all — in any organization, there’s

a responsibility for everybody to, you know, to integrate those types of

standards for each other. Well, that brings me to

that question of uptake, especially within leadership. Dr. Liu talked

about the fact that there is, you know, people don’t want modules.

They don’t want to spend the time, they don’t want to spend the resources, they

don’t want to — you know? But in order to implement some of this,

there has to be — it has to start somewhere and there has to be some kind

of uptake. Even Dr. Morrison, who we spoke to earlier, she said, you know, “My first

instinct is I want to move on, I don’t want to talk about this stuff anymore. We

need to move on.” And I think that that is a very natural, humanistic way of

thinking of a crisis, but that is not possible. So Dr. Dayna, I want to ask

you about the uptake in some of these programs that we’re seeing

coming out of this massive influx from PHAC to try and to create

these systems. What about uptake? Like, what is needed to jump that shark of,

“Here’s the stuff, how do we get people to just start using

it?” Yeah, the opportunity is that when people are in crisis, they’re more

willing to change, right? So a lot of the work we do is really on the behaviour —

like, the science of behaviour change — and so, for example, when we’re teaching

something about psych safety for leaders, we’re breaking that down into

behaviourally what does that look like? Like we have all these concepts of be a

trustful leader, be authentic, what does that look like? Behaviourally, what do

you need to do? And one of the things that we do in all of our work is why

is this important? We try to find value-driven reasons for change. And in

our theoretical models, values are about what you want to give to the world, not

what you want to get from the world. So they’re about how you want to show up,

right? The kind of leader you want to be, the kind of employee you want to be, the

kind of partner or parent you want to be. And so we’re always trying to find that

motivational reason for change so that it doesn’t become a check the box

kind of activity. When you can find value-driven reasons for change, then

you know, it’s a sustained change. So there is a ton of data on the ROI when

you invest in mental health. Like, there’s just a huge amount of data saying if you

invest in mental health, your numbers look better, your productivity is better,

your retention is better, right? But sometimes that data isn’t enough. I think

we also need to talk to leaders about what kind of legacy do you want to leave?

How do you want to be seen as a leader? How do you want to be known or

recognized? Because when you start caring about people’s wellness and their mental

health, then people start being loyal, people start wanting to do, you know,

extra. They want to be there and they’re well enough to stay, right? I left after

Wave 2 for my own burnout reasons, right? And you know, that maybe was, like,

a canary and the coal mine, but also we never said the canaries had to be more

resilient, right? Canaries in the coal mine is that, like, the environment is

toxic, right? You need to fix the environment. And so, I think we need to

start thinking about — again, there’s a ton of science of behaviour change. How do you

get people motivated? How do you get people ready for change? How do you

support them in the behaviour change aspects? Both for employees and

for leaders — and for organizations — about who they want to be. There’s a huge HR,

you know, crisis in healthcare, where there’s not enough people to do

the work and we’re just burning out the people who remain even faster. And so we

need a radical shift in terms of what kind of organization do you want to be,

how do you want to be seen by your employees, and making wellness — you

know, as the previous speakers said, like, the top priority. Like, employees are

always going to be your most valuable resource and we actually — you know, prior

to the pandemic, we would apply for research on resiliency in healthcare

workers and we wouldn’t get funded and the feedback was this isn’t patient

focused enough. So taking care of your employees, your staff, your healthcare

workers, isn’t patient focused enough, right? We need to see these not as separate

things, but what you need to do, to do good patient care, right? So we talk about

when you’re well, when you’re charged, when you have energy, who benefits from

that? It’s not just you, it’s also your patients, your colleagues, probably anyone

you interact with. Because, you know, we’re less grumpy and so we need to connect

these motivational reasons for change. And again, there’s a lot of science we

could be using to help make those changes.

Yes! I would just love for either one of you, Dr. Liu or Dr. Ritchie, to

jump in on this, because I think there’s a lot to build on here, in

talking about how we jump it into actual action —

implementation of these things. Dr. Ritchie, can we just start with you? I’ll

throw it at you. The implementation of the systems that

need to be in place. How do you see that rolling out, having done the research and

now seeing what leaders are thinking and feeling? Are they ready for it? How does

it happen? Yeah, I think that’s such a great

question and it’s so — it’s such a hard answer at the same time. I think — you

know, I think we’re in a space now where there’s this — I think you said it too,

where this — a sense of “Let’s just get on with it,” and, you know, “The pandemic’s

behind us, we’re just going to get on with it. We’ll do things the way that we

have done them before and we’ll just get going along that same train.” And I think

it’s really hard to stop and to say, you know, we’re not going to do it that way,

that we’re going to intentionally make a new change. And I think that that takes a

lot of courage, that takes a lot of — that’s kind of a really, sort

of, hard place for people to be in. So I think we have to sort of start

showing that there is something to be gained by doing these types of things,

that there are positive outcomes that we can build on, and that employee mental

health is a not just an individual responsibility but an organizational

responsibility. I think, you know, we’ve all talked about the research — we’ve all

talked about our own research and the wider research that really shows

that mental health of employees — if you have better mental health, you don’t

have the turnover. You have higher retention, you have better patient

outcomes, you know, we have seen that in our own research. Where we have many

healthcare providers — about one in two — saying that they are intending

or have an intention to leave their organization and/or profession. And so

these numbers are staggering and they’re really scary! You know, one of the

turning points, I think for me, during the pandemic when I was learning about what

was unfolding, was in conversations that I had during interviews and

healthcare providers said, you know, “The pandemic’s taking a real toll on my

mental health and my family, my friends, are all saying, you know, it’s time for me

to leave. I need to walk away from my job, but I don’t want to leave. I want to be

here and I’m really good at my job, but I need my organization to help me to do my

job better and to keep me here and to take care of my mental health.” And so I

think, you know, if there’s any sort of first thing, it’s that idea of leadership

in an organization prioritizing the mental health of their

employees. And I think Dr. Dayna mentioned that as well, is that has to

become the first step that we have to do. And I think by showing, you know, through

resources, through changes in the way that we connect and deal with

each other, by offering more than just EAP — offering more resources. There’s a

lot of healthcare providers who have no mental health resources or extremely

limited. And I think those are the places where we can really start to

build trust, to build connections, and to show this type of caring that we need to

do to build our biggest resource in healthcare,

through our employees. And in turn, as others have said, then we’re going to

really help our patients too. And we’re going to be better humans in our

personal lives and our professional lives, for sure. But are leaders buying in? Like,

are you getting to the people that need to be reached in order for this

change to happen? I think that that’s where I’m getting stuck, personally, in

listening to everyone. Is it getting to the right people? I think Dr.

Morrison and John Yip are — they might be exceptions, I’m not sure. But I’d

like to know if the work that you’re doing is

getting to the right people. Dr. Liu? Absolutely. That’s an

important question, and you know, working with our partner sites in the

project that we do, and whether we’re speaking with middle management or

whether we’re speaking with, you know, C-suites, executives, the CEOs… the

messaging is the same from them. It’s that they care, they want change to

happen, they recognize that there’s challenges. Where the disconnect often

comes from is from, you know, the — kind of the different levels, right? As it

trickles down, things are not necessarily communicated. So even from the earlier

session this morning, we hear about difficult decisions being made and rapid

changes, and those kinds of decision making and the kind of struggles are not

communicated in a transparent way. And so that’s where the cultural shift is,

that’s where the front line feels like no one has their back. While their

leaders, might be trying very hard working with the limited knowledge, the

limited resources that they have. And so solutions of yesterday, right, where we

focused on, you know, individual levels, where we focus on, you know, doing

patchwork here and there and trying to fix the solutions, they’re not

going to actually help share that information and bridge the gaps. And so one

of the the things I’m hearing from both Dayna and from Dr.

Ritchie is that the struggles of yesterday, like getting funding for

a project that focuses on implementation, that focuses on the employee experience —

you know, those things are not — they weren’t funded before, but

now they’re being recognized. And so one thing I want to highlight is that, you

know, what got us here to this point is not going to get us to the next stage.

And so, transformative change is required. Change is required, meaning that,

you know, whether it’s funding opportunities, they need to recognize

it’s not about a simple pre-/post- intervention design anymore. It’s about

implementation, system transformations. And we’re starting to see from

researchers’ perspectives more opportunities that are geared towards

that type of setup, right? At the beginning, even when we were doing

a lot of our projects, the funding opportunities didn’t look like what it

did now. And it’s going to take elect change on the leadership side. They’re

also now recognizing that it’s not just a top-down decision model that’s going

to, you know, have the maximum impact on employee well-being. It’s going to take,

you know, a horizontal approach where people feel represented. Where front line,

the staff, the people that are on contracts – everyone, as part of an

ecosystem — feels like they’re seen, feels like they’re heard, feels like they’re

valued. And that’s the type of solutions that need to be designed and pushed

forward for things to to change.

Thank you for that. And again, just to reiterate back to your question, leaders

want those type of solutions. Leaders are open to hearing about the evidence. And,

you know, there’s tons of that available. It’s just about how do we translate that.

And here, we kind of go back to communication, right? It’s about that

communication. How do we communicate decisions? How do we communicate that

leaders care and that things are being done? Are being planned to help?

And that we want to transform — we want to change. You know, that beautifully brings

me to a question about the next steps in your research. Where the

research needs to go next, and how the next steps in

your research will build on what you’ve already — on the momentum that you

have with each of the individual projects that you’re working

on. So what happens next? What

would you ideally — it sounds like there is a buy in,

this is a great time. You know, as we’re — as Dr. Morrison, said we are inter-pandemic —

we’re in the inter-pandemic period, right now — thank you for that. And we’re

preparing for better responses for whatever comes

next. What is the next phase in the research that needs to be

implemented? And I’ll start with you, Dr.

Dayna. Yeah, for sure. So you know, we actually partnered with a tech company —

we created a tech company to create a scalable, science-based solution. And so

we came up with an app — because that’s a nice, scalable, science-based solution

that’s full of science called Impact Me — and the resources is in the chat.

But we did that because we feel like we have enough — the science

in our app is based on a thousand randomly controlled trials of how this

therapy, you know, impacts a wide range of things. And it’s, you know, out of my

comfort zone to be like a co-founder in a tech company. It’s not something I ever

envisioned, but I would — like, my mission in life is to help reduce human

suffering and it’s not going to happen through one-on-one therapy, right? That’s

why — that’s partly why I left the hospital. I was doing one-on-one therapy

with cancer patients, clearly a deeply meaningful thing to do, but the mental

health needs of the planet had gone up in Wave 2 and I was like, one-on-one

therapy is not going to cut it. And so, there’s a lot of science. We need to be

implementing it, we need to be partnering with people who know how to get these

systems into corporations, into organizations, into hospitals, into other

places, so that we can actually start having an impact with all this knowledge

that we already have. And so that’s what we’ve come up with as a solution to,

again, increase access to science-based information. And I think that it is

this, like, implementation — partnering with people who know how to do it. Researchers

actually are not great at it, because we’re great at the research, but that’s —

it’s not our skill set to necessarily, like, you know, bring it to the people who

need it. And so we need to be partnering with the people who do know how to do

that to, like, get it into the hands of the people who need it

most… Of course, I have to do that every Zoom, at least. Every Zoom I have to do at

least once. Are you seeing some of that happening? Is it getting into some hands?

Is it in action and what does that action look like?

Yeah. So, you know, we have, you know, an early version of the app available.

And so we start the conversations. And really, this is from a motivational

perspective, you know, from clinical psychology. You start with the people who

are most ready. We talk about it like a traffic light: you can be green light

you’re ready, yellow light ambivalent, red light not ready. Start with the green

light companies! There are companies — and I would not actually describe

healthcare as being one of the ready companies. They’re a little more

yellow light and red light. But there are other organizations who have

absolutely bought into mental health being important for their employees and are

willing to invest into their employees. And so we start with them — we start with

the people are most ready. They — you know, healthcare is always in a crisis

and so they can never be forward thinking. They can’t — they often are not

proactive, because they’re always dealing with the crisis. And I hope that that

crisis helps motivate them to do something different. Healthcare,

you know, and like in lots of places — certainly in my province — kind of looks

like a dumpster fire. But I’m hoping that maybe if it just burns down, we can build

something better. Because the culture needs to change, the attitudes need to

change. And I’m hopeful about that because I think we can be hopeful in

possibilities, right? That there is such a crisis now that maybe people will

start investing in their employees and trying to retain them, and not just, you

know, think that you can just find as many workers as you need. And so we get

lots of good feedback, you know, because the app is dealing with burnout —

burnout for leaders and burnout for employees. So again, we’re targeting

those system-level problems through leadership training. We get lots of good

feedback on it and, you know, we’ve created it in a way that is viable to be

scalable to help a lot of people. And so, yeah, ask me a year from now how

it’s going? Hopefully it’ll be really great and everyone has access to it.

Again, to us — to me, it’s about helping to reduce human suffering and increasing

access to science-based information. And so, taking a big leap out of my comfort

zone as a researcher, to then try to offer something that’s viable to the

public. That’s great. I want to open up the floor to questions, as well, for

our researchers. So the Q&A tab is there for you. If you have

questions, please put them in the tab. Dr. Ritchie, I’m going to continue the

conversation with where you see the research going for the Trauma and

Recovery Lab. What needs to happen next? This is a big chunk that you’ve bitten

off, a lot of interviews being done. What happens

next? Yeah, so that’s such a good question. And so, I think, you know, we sort of

are taking sort of a multi-prong approach. I think for our next step, we

have learned a lot during the pandemic. We’ve talked to a lot of

leaders, a lot of front line healthcare providers, and I think now it is

about implementation and evaluation. So, you know, taking what we’ve learned,

especially around things like the culture change and the culture shift

that I think we’ve all talked about today, the trauma-informed care lens that

we have learned a lot about — what are the barriers and facilitators to

implementing those types of principles into an organization? And how do we go

about implementing that and scaling it up? And then I think really

importantly, evaluating to see how are these things actually working for the

organization and are they making the types of changes that we’re hoping to

make across the board? So I think that for us, in the Trauma and Recovery Lab,

that’s one thing that we’re really focused on and thinking a lot about is

how do we implement some of these things. We’ve also — the other thing

we’re working on is trying to put together a lot of resources for the

front line healthcare provider who’s struggling and just wants things —

and for the leaders! And so we’re trying to tailor different resources for them,

through our videos and through other things so that we are coming at it from

a couple different ways. Looking at it from a structural — a structural

way, but also for the people that are, you know, working day to day and just need

some of those resources and help and want to see themselves. You know, the

the most — the worst thing is to feel like you’re the only one who’s struggling. So,

I think by, you know, starting these conversations, like this symposium today,

and through all the work that everybody’s doing, I think it’s starting

to make that feeling of “They’re not so alone.” Thank you for that. Dr. Liu, what

about the next steps for the Revel project and for research in

general? You know, we are not out of it. There is going to be other waves,

other crises. What needs to happen next?

Where do you want your research to go moving forward? Absolutely. And it’s — no, my

answer is not going to be dissimilar to what Dr. Ritchie, Dr. Lee-Baggley said.

You know, change is uncomfortable. Change is uncomfortable, especially when

we’re working with system transformations. And one of the things

that we’re really trying to work hard at is, how do we make make these efforts

evergreen? How do we sustain and maintain this momentum of change, right? When

crisis hits, everyone’s motivated. Everyone recognizes that, you know, things

need to happen, things need to change. But when things get better, that’s when we

often default to what was comfortable — what was known. And so the the challenge

has always been, right, when we’re working with an organization, how do we embed

ourselves to help them, but have them remain autonomous in the way that they

maintain and sustain these transformations? So working with them to,

you know, asset map their available programming, to transform their vision

for well-being, to help them understand what are the roles- what are the

transformations, setting up short-term/long-term plans — those are the things

that we want to support organizations in doing, but not directly do for them. And

then at the same time, take — taking the learning along the way and

embedding it back into what we call a Revel framework, which is really a set of

methodologies for working with organizations. And so that’s what we’re

continuing the work for, and we hope that, you know, this kind of work

will continue to be prioritized. Whether it’s by funding, whether it’s through

communications, through, you know, channels like this where we have a panel talk to

get this information out to others. We hope this is a topic that continues to

be prioritized. Mhm. You know, there’s a

question here that I think is really important. We have a couple of

minutes left and I want to think about this question, because there

are — right now, we’re probably, you know, everyone in this room — “this room” — we’re

preaching to the choir. Everyone is kind of on the same page. We’re here because

we want to talk about a very specific thing. But if you’re a front line worker

and you’re hearing about the research that you’re doing and the app and all

these things that that can be implemented by their

organization, how does a front line worker encourage or push forward the idea

that change is needed? They have to talk to their leadership about it — it’s

just a whole other level of pressure for a front line worker to have to say, “These

things are out there in the world, can we think about them?” So what kind of advice

might you give someone like that, who wants to see Revel somewhere, wants to

see the app, you know, wants to get that research into their

organization? What kind of advice would you give them? Who wants to

start? This is the only time I’m going to make you guys decide — the only time — for

the last question. Yeah, I can take a crack at it, since you mentioned Revel

first. You know, one of the things — going back again, change is

uncomfortable, but you know, solutions need to make everyone feel seen, feel

valued, feel heard. And so, as a front line worker, sometimes the first signs of

burnout comes from, you know, feeling not as attached, feeling

disengaged from your work. And actually, the opposite of burnout is not

necessarily resilience, right? It’s about meaningfully engaging with the work. And

so, sometimes it just takes conversations — whether it’s with your

manager, whether it’s with your colleague about things that are happening at work.

And so we can, you know, initiate some of the sparks that will lead to some

transformations or some discussions, right? Baby steps here. But it’s about

not disengaging, about taking a step

in leading with, you know, what you value, right?

And starting that conversation. That’s great, thank

you. Dr. Dayna, go ahead please. I’ll add that which is, you know,

one, connect with other people. You know, an individual can only make system level

change with other individuals, so connect with other people who believe the same

things as you do, that are thinking the same way, so you have that support.

Because groups do make change and they make change all the time, so don’t be

hopeless about it. It happens all the time. Think of all the things that we

have changed in the world, right, through groups deciding that they want

to change. The other thing you can do is to model the behaviour yourself, right? We

had some great role modelling by leaders today, about being vulnerable, about

sharing their challenges, about being authentic. So, you know, we can role model

wellness ourselves, which sometimes, in healthcare, is about placing boundaries.

It’s about, you know, recognizing that my well-being is in the service of my

patients well-being. That I can’t, you know, I can’t be unwell and really serve

patients well. And then finally, this is what leadership is. Leadership is

making the hard choices. You know, character is who you are when it’s hard,

not when it’s easy. And so leaders need to step up and say these changes need to

happen. And you need bottom up and top down to make these kinds of changes.

Leaders need to step up and say, “We’re just going to do it. We’re going to do it

and we’re going to support people through this change.” And it’s necessary

because that’s exactly what we need to have happen and that’s what real

leadership would be. Yes. Dr. Ritchie, you have one

minute. Yeah, I think, you know, very similar — same lines. I think, you know,

working together with your peers, trying out what works for you within your peer

group, and then scaling that to others in your unit or in other units, or taking

that to your organization. I think those types of stories, of saying, you know, “This

has worked well for me, you know, why don’t you try it?” And then it just starts

to build and it becomes a momentum of its own. And then if you have a group of

people who are able to say, you know, “I’ve tried this app,” or, “I’ve tried this

particular type of website and this is where I go to get my resources.” Those

stories are very powerful and I think that’s a way to engage others in the

conversation and ultimately engage your leadership and your

organization. I think everybody’s looking for answers and I think these are types

of ways that we can, you know, give our own testimonies of, “These are the things

that are working for us,” and that’s very powerful, I think, for an

organization to hear. Amazing. Thank all three of you so

much for your generosity, your knowledge translation, which I think

is such a key component for organizations — having all of this

research and then being able to translate it into a way that makes

sense for folks to implement is is huge. So I want to thank you all for

taking part right now. And for those in the audience at this symposium, who

took part — a very lively chat happening. I love this one from Daniel that says

“Dr. Liu said it correctly, staff do not need more modules. Enough is enough.” Yes!

You know, thank you for everyone taking part and being really open to

these conversations. I appreciate it. I’d like to now welcome Dr. Margaret

McKinnon back for some closing words on this symposium. Thank you all,

again. Thanks so much everyone. I want to just offer our most heartfelt

thanks to everyone who participated today. To hear the stories

of leaders and to hear the personal costs that came with their sacrifices,

and also what we can learn from what happened in the past to make a better

emergency and pandemic response for the future. Thank you Dr. Morrison, thank you

John for sharing your stories. We could not be

more grateful to you. I want to also thank our expert panelists and just to

say that, again, I think as Dr. Morrison talked about, we’re in that inter-

pandemic period or inter-crisis period right now. And I think there were a lot

of lessons that were learned as we started to mount a response to the onset

of the pandemic, where we didn’t have enough PPE, we weren’t prepared with

psychosocial or psychological responses for healthcare workers, public safety

personnel, our military members, our Veterans, and even for the public. And

you know, as we have this maybe grace period that we’re in right now, how

do we move forward to ensure that the next time we’re ready? Because we had the

SARS pandemic, and I think we learned a lot, but we didn’t always take the

opportunity to leverage those lessons. If we can do so now, we’re going to be so

much farther ahead than next time this happens. But all that said, you know, I

think we can reflect on the systems level, but we also need to reflect on the

individual level. So, thinking about the individual sacrifices of healthcare

leaders, the sacrifices of their families, the sacrifices of the front line. I

think when we think about how do we recognize that, we recognize the

individual and their contributions, and then we recognize at the systems level,

as well, what we need to do change that system. I think it’s just a remarkable

conversation and I just want to thank everyone so much. And I want to end by

also thanking Cristina Stef, Sangita Singh, Andrea Brown, and many others in

the Trauma and Recovery Lab who contributed to putting this

information together into the whole of the project. Along with Garvia,

Make Things Well, and others. I just want to say thank you from the bottom of my

heart. At the end of this, I just do want to say, we salute you, Canada’s

healthcare workers and leaders. And we thank you for your

service and for your sacrifice, just as we would to military members and

Veterans who have stood in similar war footing over many, many generations in

Canada. This was another generation that faced that challenge and we’re so

grateful to you, so thank

you. Thank you, Dr. McKinnon, and thank everyone else. Thank you everyone for

taking the time to be here today. We hope that you are leaving with helpful

takeaways. Thank you for taking part in the chat. If you want to leave one word

in the chat right now about how you are feeling about this session, please do.

Half of you have already gone, but if you want to just drop something in here, just

to — a word of appreciation for our panelists today, taking the time and

putting in the effort to chat with us. Thank you again for joining, have a great

day, and Dr. McKinnon — last word is yours. One last thing: We must thank the

Public Health Agency of Canada, as well, for their support of Healthcare Salute,

of the symposium series, and for really the efforts that were mounted, as well, to

support all Canadians. So thank you to the Public Health Agency of Canada, as well.

And to our healthcare workers, our front line leaders, and our front line staff, thank you.