As burnout, compassion fatigue, and moral distress continue to affect the health center workforce, the third season of the STAR² Center Talks Workforce Success podcast presents insights, lessons learned, and first-hand experience in navigating and overcoming the challenges of these issues from those working in the field. In this episode, ACU’s Helen Rhea Vernier interviews Dr. Jay Moreland, Primary Care Physician, Community Health Centers, Inc. in Midvale, UT about the psychology of positive thinking and meditation. With over 25 years of experience at this health center, Dr. Moreland speaks to team dynamics and organizational culture as tools for employee self-care and retention.

Transcript by Rev.com

Helen Rhea Vernier: Welcome to the third episode of the third season of the STAR² Center Talks Workforce Success Podcast series. I’m your host, Helen Rhea Vernier, training specialist at Association of Clinicians for the Underserved, or ACU. This season, we’re focusing on employee self-care and exploring how those in the field are engaging in successful, sustainable, organizationally-supported self-care and the impact that has on retention and recruitment.

Helen Rhea Vernier: Today, I’m talking to Dr. Jay Moreland, a primary care physician at Community Health Centers, Inc. in Midvale, Utah. Thank you so much for being here.

Dr. Jay Moreland: Thanks for having me, Helen.

Helen Rhea Vernier: Could you introduce yourself and tell us a little bit about your organization?

Dr. Jay Moreland: My name is Dr. Jay Moreland. I’m a family physician, and I’ve been practicing in the same community health center for over 26 years. I do full-spectrum family practice and we do full-spectrum family practice. I deliver babies, take care of babies all the way through grandmas and grandpas. I’ve had multiple generations of patients that I’ve delivered and followed those baby through. I also do a little bit of hospice as a side gig. My organization, Community Health Centers, Incorporated, has been in Utah for something on the order of 30 or 35 years, so we’ve been around quite a long time. We’re quite a large organization. In Utah, we have something like 10 clinics now, I think, and many providers, dozens of providers. We are mostly family physicians, but we have a few pediatricians, we have internists, we have of course dentists and OBGYN, but we’re primarily focused on the primary care mission.

Dr. Jay Moreland: More than 50% of our patients are uninsured, so we do a lot of care of a lot of different groups, including immigrants from Afghanistan and Vietnam, all the way through the many immigrants that we have from many Latin American countries. The vast majority of us speak Spanish and we spend quite a bit of time in Spanish.

Helen Rhea Vernier: Great, thank you so much for that introduction. What does self-care mean to you, and what do you think the differences between self-care and self-maintenance are?

Dr. Jay Moreland: Let me address self-maintenance first. The way I look at self-maintenance is basically taking care of the basics, the basics to live or survive. That’s the feeding yourself, sleeping, just maintenance. Self-care, I think, takes it to the next level. When I think about self-care, I think about being compassionate to myself and being loving to myself. What I mean by that, when I say self-compassion, to me, compassion means decreasing my own suffering, which to me means decreasing my own negative thinking. That’s compassion, working with myself to decrease my negative thinking. Then self-love is more about being happy, and so what that really is increasing my positive thinking or having more positive ways of thinking about life. That’s love and compassion for yourself is, for me, the core of self-care.

Helen Rhea Vernier: How can we talk about self-care without just putting another thing on the never ending to-do list and overburdening already busy employees and frontline workers?

Dr. Jay Moreland: I thought about this question. Really, to me, that self-care starts with putting an end to that never-ending list, because that list can be a negative thinking in and of itself. That is one of our negative thinkings that we can have, is our mind going on and on, “I have to do this, this, this,” and it can really get us wound up and really can be a source of suffering in and of itself. I think setting limits is important and this means creating space and time in your life so that you don’t have to suffer so much from that negative thinking and you have space to allow your own natural happiness to arise. That’s how I think about self-care and putting an end to that to-do list.

Dr. Jay Moreland: Yes, we do have to take care of the basics, but setting limits starts with our own thinking and consciously limiting where are we going to put our mental efforts and really focusing that on the things that are most important.

Helen Rhea Vernier: Can you tell us about the impact meditation has on self-care?

Dr. Jay Moreland: The way I understand it, when we’re talking about trauma, we’re really talking about overwhelming emotional experiences. That’s how I think about it. What those overwhelming emotional experiences really we are as they’re creating a suffering or a negative thinking or a negative emotional response that’s really about, I’m going to use a technical term here, it’s our amygdala or our lizard brain, that deep down primarily simple brain that is starting to run wild. It’s really part of the brain that creates that fight-or-flight response. When you get that running, you get a dominance of those panic or emergency or negative nervous systems, what we call the sympathetic nervous system, the adrenaline, the cortisol and stress-based system that happens when we’re stressed.

Dr. Jay Moreland: When we do self-care, it’s really about counterbalancing that part of the nervous system and heading towards more what they call the parasympathetic. That parasympathetic part of our nervous system is more the peaceful, calm, centered, loving, and non-stressed, quiet kind of a nervous system. It’s more of the rest and digest part of the nervous system.

Dr. Jay Moreland: From a biological perspective that can be done with a lot of different techniques. For me, meditation has really been one of the most powerful techniques in terms of what improves that balance of those two nervous systems. Both of those nervous systems are necessary, but the stress or the burnout tends to be an overriding dominance of the sympathetic nervous system. Meditation is been shown to really counterbalance that and recenter the brain on a more parasympathetic course.

Dr. Jay Moreland: The part of the brain that you work with when you’re working with meditation is called the prefrontal cortex. That’s more the front part of that brain that really is directed at attention and purposefulness. Directing your attention and your purposefulness in more healthy directions is what meditation really does.

Dr. Jay Moreland: Actually, I should probably define a little bit, when I say meditation, what is meditation? In the Western world, we have a little bit of a false conception of what meditation is a lot of times. My definition that I was taught, meditation is nothing more than thinking a thought more than once. If you think something twice or more times, you’re meditating on it. Things that are stressful that we meditate on are bad for us, and things that are loving and kind and good are better for us.

Dr. Jay Moreland: The formal practice of meditation is really about training your mind to pay attention to what you’re thinking about. It’s really about training your mind to have what they call meta awareness or an awareness of what your thoughts are doing. It’s about training your mind to focus on things that are more healthy or more positive in the moment, because we get easily trapped in that fight or flight. It’s a very animal part of our brain, it’s very easy to get trapped in that pattern. That trauma-inducing or overwhelming emotional experience, it’s very easy to go there. Meditation has been shown to really help us train our prefrontal cortex to focus our meditation on things that are healthier.

Dr. Jay Moreland: Those overwhelming emotional experiences drain our emotional batteries. I don’t know if you want to think about it like a battery, but you only have so much energy, emotional energy, and when you have so much of that negative thinking going on, it really drains us. In order to have resilience, you really need to have a counterbalance to those emotional loads. The way to do that, you have to focus on the part of the brain that does the balancing. The prefrontal cortex is the one that does that balancing, that says, “Okay, now I’m going to put my attention here.” That’s why meditation works is, because it helps you refocus your attention and counterbalance that thinking.

Helen Rhea Vernier: If you don’t mind sharing, what are some of your other self-care activities?

Dr. Jay Moreland: When you’re talking about those neurologic systems and the thing that the meditation works on, it’s not that meditation is the only thing that improves that neurologic balance. A lot of those activities that they tell us to do that are good for our self-care all actually work on the same systems, maybe from a slightly different perspective and maybe not as directly. For example, if I try to get good emotional support and have good friendships and bonding with people and regular exercise and prayer and I play music, all of those things also work on that rebalancing as well. They all can play a role, and I think play an important role.

Dr. Jay Moreland: Everybody’s different in terms of what combination of those things works best for them, but creating that space in our lives so that we can have those counterbalances is really critical, but you have to make almost an appointment or you have to make a commitment and set aside that part of your life as being important. Nobody else can do that for you, but you have to do that. If you want to have a balanced life, no one else can do that but you. You have to make a priority of doing those activities to create that balance.

Dr. Jay Moreland: In terms of how that works out in the brain and our brain chemistry and all that, they all work on that parasympathetic, they all work on that decreasing your stress hormone, the cortisol, and decreasing the adrenaline and improving that dopamine, that bonding, the oxytocin, if you’ve heard about that hormone, the hormone of bonding. All of those are part of that peaceful, kind, patient part of our brains that we all know that we need, but it takes a commitment to do those activities that promote those kinds of mental outlooks.

Helen Rhea Vernier: Thank you. I love this idea of grounding our understanding and our personal work on this, in that intentionality that you’re talking about and in the balance. Can you tell us about your podcast and maybe include some inform how folks can access it?

Dr. Jay Moreland: Sure. Well, they can just Google Dr. Jay’s Peaceful Meditation and they can find it on the web, but the actual URL that they can put in and find with their smartphones or with their web browsers is www.buzzsprout.com. That’s B-U-Z-Z-S-P-R-O-U-T.com, then /969985. That should find my podcast.

Helen Rhea Vernier: Great. Then can you tell us a little bit about what the podcast is and what people can expect to find there?

Dr. Jay Moreland: It’s designed for the exact kind of people who are listening to this podcast. Believe it or not, I did it exactly for folks working in community health centers. It’s not a technical podcast, so anybody of any kind of background can listen to it. Basically, it’s divided into very brief podcasts. It’s both in English and in Spanish, by the way, I’m bilingual so I do both English and Spanish. It’s about a five or 10-minute teaching followed by about a five or 10-minute guided meditation. The topics of each teach are in the title of the talk so you can, most of the time, just know what that discussion is going to be about. Then the meditation, I try to relate it as closely as possible to the topic so that it supports that particular topic.

Dr. Jay Moreland: I’ve been doing this since the COVID started, since we had the epidemic really start to shut things down, back in, what was it, March of 2020. Actually how I ended up doing is I was teaching a prevention and burnout seminar and teaching meditation to my community health centers in conjunction with the University of Utah. I’m a faculty that has helped them with prevention and burnout seminars that they do. As an outflow of that, we had originally been planning on doing face-to-face meditation with the different clinics in my system, but because of COVID, we shut down and we couldn’t do that and I said, “Well, how am I going to do that?” Well, I decided I would do it with a podcast, and so that’s how the podcast got started.

Dr. Jay Moreland: At any rate, please take a look at my podcast. There’s emails at the end of the podcast that says my email. If people have any suggestions of things they’d like to hear about or different ways that we can make the podcast better, I would appreciate it. Thanks for allowing me to put a little plug in there.

Helen Rhea Vernier: Absolutely. I personally have listened to some episodes and I’ve really appreciated it and liked them. I really love how accessible you make them, that they are these shorter snippets of peacefulness that we can access in these really stressful times, and that you do them in English and Spanish I think is really wonderful. I’m happy that you’re able to be here discussing it with me and that we can hopefully get it out more health center folks. Thank you so much.

Helen Rhea Vernier: Now pivoting more to your organization. How does Community Health Centers, Inc., as an organization, support employee self-care?

Dr. Jay Moreland: Well, as I said, they sponsored a retreat that directly was training providers and then later the support staff. Those are the kinds of things that they’ve done. They also have a very sensitive approach to allowing the employees to work within the company to create changes to do their own self-care. I think they’ve been really good at encouraging people to find those times for themselves, even to the point of allowing people to try to do a little bit creativity with their schedules a little bit. Particularly when there are family related things that people have to do, they really work hard to encourage people to do that. We also are encouraged to support each other from that standpoint. It’s a very, very supportive environment to work at, I have to say.

Dr. Jay Moreland: I like to think we have a very professional approach to how we do healthcare and we really expect that kind of professionalism out of each other. I like to think that that’s also how we treat each other. There’s a difference with how you treat each other in a workplace like that, there’s a difference with how you treat the patients in a workplace like that. There’s a professionalism that flows from your attitude that has to run throughout the company. I think when you do that, everybody steps it up a notch.

Dr. Jay Moreland: We all know, working in a community health center, it is just a fact that we have to do more with less and we just have to figure out how to make that happen, but when you have a culture in an organization that really expects people to do that with honor and integrity and to work to the best of their ability, to the maximum of their training, to do the right thing, it means being professional with each other and with the patients. If we’re just getting by and fudging it and making due, over time, to me, that wears me down. If we make that part of the culture, I think it just wears everybody down.

Dr. Jay Moreland: I think one of the keys to our organization, Community Health Centers, Incorporated in Utah, is we have great people and we’ve kept people for many, many years. I’ve been working there 26 years and there’s been people who’ve been working there 30, 35 years, that are my partners, that I’m proud to call my partners. One of our keys to success is really just that different expectation of professionalism throughout the organization. I feel it, I think that’s really the key of why we don’t burn people out and why people stay for a long time, because I want to work with people who have that view of “I’m going to be professional every day, day in, day out”. I’m proud to call those people my partners and my workmates and my colleagues. I think that’s the key to preventing burnout.

Helen Rhea Vernier: Great. I think that’s a really interesting perspective. Like I said, especially in this time when we are seeing a lot of turnover and a lot of retention and recruitment woes, it’s so exciting to hear from someone who’s been at their health center for so long and whose health center as a whole organization has these folks with longstanding appointments who are clearly, like you’re saying, proud of where they work and proud of working together. That’s really great.

Helen Rhea Vernier: My last question is, while conversations around burnout, compassion fatigue, and moral distress have become more commonplace out the pandemic, we know that this has been a growing issue in the healthcare workforce for a long time. What can leaders and staff do to keep staff wellness at the forefront of their organization’s mission and values?

Dr. Jay Moreland: I think the leaders need to walk the walk, not just talk the talk. Sometimes there’s maybe a bit of a tendency to take the easy way out and think that this app that encourages people to exercise is going to be the answer or your watch that reminds you to meditate is going to be the answer. We look for the easy way out. We look for something that’s going to make things easier, because, of course, why wouldn’t we? But that’s not always the best approach.

Dr. Jay Moreland: I think the best leaders are the ones who really walk the walk, the ones who are setting the example that this is a better way to be. It can mean checking in with people to make sure that on an individual basis you’re aware of where are the pressure points for any individual, because I think one of the things about human beings is we all have different pressure points, we all have different things that tend to create stress. I don’t think there’s a one size fits all on that. My wife is an introvert and she doesn’t like big crowds and a lot of people and I’m extrovert and I like crowds. For her, being away from big crowds of people is good, and for me, just I’ll dive right into the crowd. That’s just one example. I mean, I think it’s the same thing with our schedules or where we need space in our life to take care of our family responsibilities and what are the things that tend to drive each of us nuts. Everybody has a little different thing.

Dr. Jay Moreland: Good leadership in the organization, I think is one that listens to people. You can’t do the same thing for everybody. You have to set up a system and obviously there has to be a certain structure and you can’t just do it the way individuals want a hundred percent, but I think you can listen to where people struggle most and listen to what it is that makes an individual tick. Sometimes it can be something as simple who are they working with or how the structure of their early part of their day is, how the first couple of patients are versus the end of the day, versus how do they like to take care of more complicated patients.

Dr. Jay Moreland: It takes really fitting people together. I used to have two medical assistants, and then they had to split up my team because when you have two experienced medical assistants, always one has to go with a new person and then you start over again with training a new one. But my more experienced one who stayed with me was in the position where she had to figure out who she was going to partner with. She spoke up and she said, “Look, I really like this person. We get along well and we work well together.” I just trusted her. I said, “Okay.” I didn’t know the other person as well, but I think just trusting her and saying, “Okay, she knows that she works well with this person.” Lo and behold, my day is easier because they work well together.

Dr. Jay Moreland: To me, that’s a really good example of where one size doesn’t fit all. People matter, and how people get along and how they support each other in a professional level matters. I think when you have management who recognize that and try to really empower people to own their environment, to own their workday, to make it a better place, at least you have buy-in. It doesn’t make all of the stress go away, but at least you know that you’ve been given enough wherewithal, enough environmental rights, that you can manage your stresses in a way that you have some control over. That prevents burnout too.

Dr. Jay Moreland: Having people have a little bit of control of when and how they’re stressed is really important. I found that to be super valuable for my team, that my manager at my clinic allows my team to figure out how to work as a team without being too much of a micromanager. I would just encourage managers, you need that balance. You do have to have structure, but you also want to allow people to really find their own power and their own strengths and how to work with other people’s strengths to make a better team.

Helen Rhea Vernier: Thank you so much. Do you have any final thoughts you’d like to add?

Dr. Jay Moreland: Well, just remember that it’s pretty simple, all of our happiness and all of our stress is based in our mind and what we do with our mind matters. Working with our mind to catch us when we’re doing negative thinking, catch those negative thoughts and let them go and then refocus on a more positive line of thinking is what happiness is all about. If you do that well, day in day out, your stresses will be more easily let go and your strengths will pull you through the day.

Helen Rhea Vernier: Thank you so much, I love that thought.

Helen Rhea Vernier: Thank you very much for joining us today. We hope today’s conversation provided our listeners with ideas, suggestions, and insights into ways they can approach, encourage and organizationally support employee self-care, wellness, and resilience at their organization. Be sure to check out all of our free workforce tools and resources found at chcworkforce.org.