Creating work spaces that foster resiliency and wellbeing is critical to building and retaining a strong, compassionate workforce. The fourth season of the STAR² Center Talks Workforce Success podcast focuses on the ways organizations support their employees and empower them to address and prevent the challenges of compassion fatigue and burnout. In this episode, ACU’s Michelle Fernández Gabilondo interviews Mimi Mateo, Director of Employee Wellness and Diversity, Equity & Inclusion at TrueCare in California about her role and TrueCare’s whole-person and mission-driven approach to supporting employee wellbeing.

Transcript by Amberscript

Michelle Fernández Gabilondo: Welcome, everyone. Thank you so much for listening. My name is Michelle Fernández Gabilondo. I’m the Associate Director of Workforce Development at the Association of Clinicians for the Underserved, part of the STAR² Center program. We’re here today with the STAR² Center Talks Workforce Success. This is our fourth season focused on burnout and compassion, fatigue, and wellness.

Michelle Fernández Gabilondo: We’re really excited. Today, we’re talking with Marie “Mimi” Mateo, director of Employ Wellness and of Diversity, Equity and Inclusion at TrueCare in California. She also serves as a certified midwife. Welcome, Mimi. We’re so excited to have you here and just to get started with some questions. Could you introduce yourself? Just tell us a little bit more of who you are, your role and your organization?

Mimi Mateo: Sure. Thank you so much, Michelle. I’m so happy to be here and have the opportunity to talk about this really important work. I’m thrilled that you’re focusing on it.

Michelle Fernández Gabilondo: Absolutely. Yes, it’s a critical area.

Mimi Mateo: Yeah. I’ve been a certified nurse midwife for more than 30 years. I have spent my whole career in FQHCs, Federally Qualified Community Health Centers. I have been on the US Mexico border my whole career, first in Texas and then here in California. I’ve been working at TrueCare for a little more than 20 years. TrueCare is an FQHC that’s been around for more than 50 years.

Mimi Mateo: We have 13 sites. We deliver care across the spectrum. In addition to women’s health and an obstetric program, we have an adult medicine, a pediatric program. We offer behavioral health, dental care, chiropractic, pharmacy and we’re deeply imbedded in the community doing all kinds of outreach and support. Our primary mission originally is to care especially for the underserved or marginalized communities and because we deliver such great care, we take care of the whole community.

Mimi Mateo: We have both insured and under insured or uninsured patients who come through our door. Now a year ago, I transitioned out of a clinical leadership role in our OB Program and my full scope midwifery practice. Now I just see patients in the office one day a week. I tell people I hung up my baby catching mitt and I did that so that I could take on this inaugural role of Employee Wellness and DEI director. This is new to our organization, to have a dedicated leadership role in this area.

Michelle Fernández Gabilondo: Thank you for that explanation and introduction. There is so much right now on the workforce, especially as they’re carrying, and there’s so much need. We know that things like burnout, compassion fatigue and just general struggle with wellness has been a challenge. I think this has been even from before the pandemic, but it really just heightened that. What are some of those challenges that you are seeing at your organization with your workforce? I also wanted to say I can’t imagine anybody better than a certified nurse midwife to be doing a wellness program and really directing that.

Mimi Mateo: Well, I appreciate your endorsement and it’s funny. When I stepped away from the OB program, the OB team said, well, that’s okay, because now you’ll be the midwife for the whole organization. You are on the same wavelength, Michelle. I think what you point out is truly accurate. Certainly, things got a lot tougher with the pandemic, but burnout in healthcare settings has been on the rise steadily for many years and there’s lots of contributing factors.

Mimi Mateo: One of the first big waves, I think, was really the introduction of the electronic chart, and while it has really helped us deliver care across settings in a more comprehensive way, it does bring with it certain challenges. I explained to people. I would never, in the old days, have left the office with a stack of 20 charts, but now, as a provider, I have remote access and am expected to respond to lab values and care management even when I’m away from the office.

Mimi Mateo: That’s one thing that started to build. We have gotten a lot better about managing that. Certainly, in our setting at TrueCare, we have been really proactive and are tracking how people work in the electronic chart. Offering support and efficiency tools. That was the buildup to this burnout that was coming. Now the pandemic hit, and we had to make so many changes so quickly and we had a lot of loss in our settings.

Mimi Mateo: We had patients that we lost, we had workforce suffering loss, showing up really stressed out. We had employees who were trying to manage children not able to go to school. All of that stuff. The other thing I want to call up, part of what led TrueCare to really push for this role that I have, it had been on the back-burner for a while, but remember when COVID hit, we also had a summer of social justice and racial justice issues percolating and coming up to the surface. There was a lot going on that people were having to negotiate, not just for themselves, but for the patients coming in the front door. I think the challenges are almost too many to list.

Michelle Fernández Gabilondo: I couldn’t agree with you more, and part of what really happened was also, we just started seeing that people were people in the workplace. What everybody is going through is incredibly complex and, as you said, goes way beyond the COVID pandemic and there are a lot of challenges right now that across the board all the health centers are facing. Thank you for bringing up those different areas.

Michelle Fernández Gabilondo: One of the things that I think also goes along with that is, we talk a lot about self-care and if we look at these issues, I think self-care has been the default in many ways. We don’t always talk about the organizational strategies when we’re dealing with these challenges, when we’re dealing with the area of wellbeing. How do you think that organizations can support that, employ self-care without the staff feeling like, this is another thing added to my to do list, which of course is exactly what you don’t want when you’re talking about self-care?

Mimi Mateo: Yes, I couldn’t agree more. We cannot add one more thing to the list right, that we’re asking employees to manage. From an organizational perspective, I think what’s really critical is that every individual in the workforce is seen and valued for what they do and they are given the tools to do what they show up to do every day. TrueCare has an incredibly committed, dedicated workforce. We have really high employee retention. Everyone at our place is mission driven, so they get up in the morning wanting to make a difference in their community.

Mimi Mateo: Now we just went through the whole list of the challenges that they’re facing. Staffing challenges, really sick patients, things they’re negotiating at home, trying to see more patients in less time. What TrueCare did was really consider, what tools do we need to help connect people with why they get out of bed and do this. Part of why I was tapped to come into this role, about four years ago, I got involved with the Academy of Communication in Healthcare and I became a certified facilitator in relationship centered communication.

Mimi Mateo: This is an evidence-based approach to how communication should happen in the exam room between providers and patients. It’s founded, of course, in an empathic approach to communication. Here’s the important piece, what made me a true believer, we teach skillsets, concrete tools to increase efficiency, to help providers and frontline staff connect with their patients in an efficient and effective way. The research tells us that if we use the tools, patient health outcomes are better, patient satisfaction is higher and the health care workforce the burnout goes down.

Mimi Mateo: The miracle is using these tools on average decreases a patient encounter by about two minutes. Now, if I’m expected to see 20 patients in a day, I can save two minutes per encounter. That gives me 40 minutes to wrestle with the electronic chart, manage other follow-up I have to do. Even more important than that, when I close the exam room door and walk away, I have the feeling that I have connected in a meaningful way with my patient, and that’s why I spent all those years in school. That’s why everybody spent all that time in school.

Mimi Mateo: They didn’t spend it so they could show up and be overwhelmed by overbooked schedules. New changes in health care insurance, dictating practice, struggling with computer, all of that stuff. That’s not why we went to school. We all went to school because we want to take care of people and this gives us tools. When the organization made the decision that every provider at TrueCare would get an opportunity to learn these skills through workshops, at this point I have facilitated 12 workshops and we have had almost 130 providers experience it.

Michelle Fernández Gabilondo: That is excellent and being so intentional about these changes and training people, preparing them, I think, is such an important part of this work. I wanted to pivot a little bit on one of the questions, because you brought up that piece of the empathetic communication and really learning how to better have that human-centered communication. Is that also something at your organization that leadership is really taking a role in this? Because I think when we’re dealing with all of these challenges, people look up to leadership. They’re like, what are you doing? I’m wondering if a lot of those skills are also being exemplified with the leadership?

Mimi Mateo: It’s an excellent question and I’m proud to give you a big yes on that. In addition to the upfront investment of taking providers out of clinic for this all day workshop, we have as part of our strategic plan that is about to be launched. This is a little bit of a spoiler alert, but we will be doing relationship-centered, communication-based leadership development organization wide.

Mimi Mateo: We will be providing workshops on leading high-performing teams with relationship-centered communication, reframing conflict and engaging in a productive way with this communication approach, committing to feedback, fostering equity and inclusion. Within each of these subsets again, leaders will be given real-time tools that they can use and the workshops are interactive, so people bring their scenarios in and we work them out.

Michelle Fernández Gabilondo: That is so great and just such a wonderful idea, and we hear more and more in the training that we do here at the STAR² Center, there’s such a need for training leaders to then support this within their organization. It’s clear that your health center is way ahead of the curve and doing amazing work not only for your community, but also for the individuals who work at your health center.

Michelle Fernández Gabilondo: I think you really answered this question already, but is there anything else that you would share about organizational change that can take place to improve the staff well-being, combat burnout, compassion fatigue? Like I said, I think you really talked a lot about that. I just wanted to give you space, if there was anything else that you wanted to share regarding that?

Mimi Mateo: I appreciate you giving the space, Michelle, because there is another critical element from my perspective, even though I’ve only been in my role for a year. One of the first things I did preparing to come into this role was complete a certificate in Employee Wellness through Stanford. Not surprisingly, foundational in workplace wellness is the issue of psychological safety, and I believe that has come up in some of your other sessions.

Mimi Mateo: What I really want to emphasize, because I have had other community health centers reach out to me and ask me what our approach is, what we are doing, and it is really critical that built into the system is an authentic invitation and ability to hear from the workforce. Anything we do in this arena needs to come from the ground up. If these efforts are led from on-high and handed down, it’s unrealistic to imagine that the workforce is going to engage and feel like they own it. It’s going to become one more thing they have to do, and I feel we’ve got really strong proof of this.

Mimi Mateo: Several months ago, I did a listening project with our support staff, with the medical assistants. We surveyed them and then I did eight focus groups. I had almost 90 medical assistants show up and what we heard again and again, that the best part of their work at TrueCare was the people that they work with, their coworkers and their teammates. If I am now going to move Wellness and DEI program forward, I’m going to take what we are doing well and build on that.

Mimi Mateo: Central to well-being is a sense of belonging. I matter here. I’m part of the team. I have your back; you have mine and look at the difference we make in our community. This, starting with listening, I think, is one of the most important things. From there, we have all kinds of things going on. We’re creating a wellness platform that I anticipate a certain percentage of the workforce will engage with, and a certain percentage won’t.

Mimi Mateo: We’ve changed the way we start meetings. Any meeting or any clinical huddle every morning, we take a minute out and start. The first thing you say to somebody is you share one good thing. What’s one good thing since you got up this morning, and how that creates relationship, meaningful human connection with another person and sets the tone for what’s to come. We have lots of little pearls like that, but at the end of the day it’s about authentic belonging, I think.

Michelle Fernández Gabilondo: I love that phrase authentic belonging, and with everything that you’ve said, it makes so much sense why TrueCare has such good retention numbers, because it is completely clear how much you care for the well-being of your workforce as much as you do that well-being of your community. I’m also really glad that you mentioned the psychological safety, because the truth is pretty much most of the recordings and interviews that we’ve done, everybody will bring up either psychological safety, trauma-informed care, conflict management or just really understanding the importance of that in the workplace. Thank you so much. That was excellent.

Michelle Fernández Gabilondo: Just to wrap up today’s interview. Again, I think you’ve provided a lot of this, but I always want to allow more space for it, because I think just the work that you all are doing is so wonderful. Do you have any advice, strategies or tips for other health centers or PCAs and it could also be other healthcare organizations that are beginning work in this area, because I think as you’re talking at TrueCare, you all are very advanced in what you’re doing and you understand the importance of that ground-up work rather than the top-down, but for others they may be in the starting phases of this. Do you have anything that you could– Bits of knowledge that you can give them?

Mimi Mateo: Yes, thank you for that invitation. I think the ground-up instead of top-down is probably the most critical. I guess, the other thing, I think the lens that I really took was, we are here looking outward to our community. We want to make sure that we are addressing social determinants of health we also practice, of course, trauma-informed care. We want to extend welcome outwards and so what’s really important is to be honest and turn that around and look inward.

Mimi Mateo: Are we offering the same wellness, the same attention to our employees’, social determinants of health? Everything we’re doing for patients; we want to think about in terms of our workforce. Again, this is where my dual role of Wellness and DEI come together. I want to make sure that every member of the workforce feels welcome and included and celebrated for the strength that they bring, and so I think it’s really time for us to use the skills that we have developed facing outward and turn them inward.

Michelle Fernández Gabilondo: I love that phrase. Everything that you’ve said. Many of the training we do we always say, your mission is so valuable, but how you’re reflecting that externally needs to also reflect how you’re treating your workforce internally. Completely on the same page with all of this. I want to say such a genuine thank you for having you here. I could talk about this for so much longer. I think it’s such an important topic, but the work that you’re doing, the work that TrueCare is doing, really, I cannot emphasize enough. I think it’s so amazing and you are taking wellness to that next step of where it really needs to be to support the workforce. I want to say a very heartfelt thank you for having you here today. As we begin to wrap up are there any last things that you would like to share?

Mimi Mateo: No, I think there are a lot of resources out there and I would encourage people to check out the Academy of Communication in Healthcare and certainly look up TrueCare find my contact information. It’s thrilling and I am so grateful, having had a 30 plus year career caring for women, something I feel so passionately about. To have this opportunity at this stage to be able to live my passion in a different area. I’m here to midwife anybody who needs a little help as they go.

Michelle Fernández Gabilondo: Thank you so much and for those who are listening in the description for this podcast, you will find Mimi’s name and information on TrueCare. You can get more information on there. Again, Mimi, thank you so much. You’re doing amazing work. Again, this is Michelle Fernández Gabilondo from ACU and our podcast is STAR² Center Talks Workforce Success. We just had an amazing conversation with Mimi Mateo from TrueCare in California, director of Employ Wellness and of Diversity, Equity and Inclusion, as well as a Certified Nurse Midwife. Thank you so much.

Mimi Mateo: Thank you.