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 Alex Rohlwing speaks with Brooke Sims, Director of Integrated Health, Carrie Farquhar, Director of Workforce Development, and Dr. Dana Vallangeon, Chief Medical Officer, at the Ohio Association of Community Health Centers. In this conversation, the OACHC team shares their assessment of the current state of the health center workforce and their approach to wellness as a collective, collaborative, integrated process both for Ohio’s health centers and internally at the PCA.

Transcript by Amberscript

Alex Rohlwing: Welcome to season four of the STAR² Center Talks Workforce Success Podcast. I’m today’s host Alex Rohlwing, Training Specialist at the Association of Clinicians for the Underserved. In this fourth season, we’ve been focusing on ways or organizations support their employees and empower them to address and prevent the challenges of compassion, fatigue and burnout. Creating workspaces that foster resiliency in wellbeing is critical to building and retaining a strong, compassionate workforce, and we’re hearing about a variety of approaches to doing that.

Alex Rohlwing: Today I’m joined by three wonderful guests from the Ohio Association of Community Health Centers. I’d like to welcome Brooke Sims, Director of Integrated Health, Carrie Farquhar, Director of Workforce Development and Dr. Dana Vallangeon, Chief Medical Officer. Thank you all for being here today. I’d love for folks to hear a little more about your backgrounds and work at OACHC. Brooke, do you mind starting?

Brooke Sims: Hi, I am the director of Integrated Health here OACHC. I am also a licensed professional clinical counselor and a registered art therapist.

Carrie Farquhar: Hi Alex, thanks for having us. I’m Carrie Farquhar, director of Workforce Development. I’ve been with OACHC for about four years and prior to that I worked in public health for about 30 years. In Ohio we administer a statewide health professions education and training program. It’s in its eighth year. That’s our signature program, and in addition, we provide support and technical assistance to health centers in the area of workforce, including training, data collection and reporting.

Dana Vallangeon: Hi. Thanks for having us on the show. I’m Dana Vallangeon and I have been at the Ohio Association for about three and a half years in the role of Chief Medical Officer and that role really works to support all of the providers and clinicians in health centers across the state. As far as my background, I’m a family physician and an addiction medicine specialist. I founded a health center in Columbus and was the CEO and provider there for about 18 years and then worked at a substance use disorder treatment facility here in Columbus for about a year and a half as their medical director prior to coming to the Association.

Alex Rohlwing: Thank you. Really exciting to have three people with such tremendous backgrounds here with us today. To start off, I wanted to ask you, at your organization and at your health centers, what workforce challenges are you specifically seeing with respect to burn out, compassion, fatigue and just generally maintaining wellness among staff?

Carrie Farquhar: Alex, this is Carrie. Thanks. That’s a great question. The workforce challenge is that we’re seeing they’re real and they’ve been very difficult for health centers in Ohio. They’re really not different from what other health centers and really health care systems in general have experienced. Health centers are struggling with recruiting and retaining providers. They were even before COVID, but during COVID it became even more difficult.

Carrie Farquhar: Health Centers are reporting that they have higher rates of turnover, that there is incredible competition with other healthcare systems for the limited staff. Others are providing sign on bonuses and increased pay, and it’s made very competitive. Providers have retired, they’ve left clinical practice and clinical support staff, such as medical and dental assistants, have also been leaving for other jobs such as Amazon and fast food and other employers that offer similar pay but can offer more flexible work hours. Some staff have left to stay home just because of the childcare challenges that they’ve experienced.

Carrie Farquhar: We’re finding that filling the increased vacancies has been really challenging in the face of a smaller workforce available to fill those shortages and that those who continue to work in the health centers are finding themselves stretched very thin. They’re trying to cover for vacant positions as well as their regular workload, so they’re working longer hours and they’re just not seeing relief in the near future.

Carrie Farquhar: This long term, increased demand on our healthcare providers and staff has contributed to an increase in burnout and compassion fatigue. We know that people can rise to that challenge for short periods of time, but when it becomes the norm, it takes a toll and the toll is in terms of their personal health and wellness and, as we know, it’s hard to take care of others if we’re not taking care of ourselves first.

Carrie Farquhar: Healthcare staff may start to show signs of hopelessness or anxiety and depression. We need to be addressing these challenges and help individuals how they can take care of themselves and that it’s important for them to take the time to do that, and we have to be supportive of that. At the same time, leadership needs to be developing or identifying ways that they can help alleviate those sources of stress, and they need things that the health care system creates, such as the time that providers need to spend recording treatment in the patient record.

Carrie Farquhar: Basically, the factors that contribute to burnout are multifactorial. It’s individual, it’s the system, and the approach to addressing these challenges has to be multifaceted too to be effective. There is really no single approach to solving the problem of burnout and compassion fatigue.

Dana Vallangeon: This is Dana and I would just way in to echo what Carrie is saying. We have clinician calls and CMO leadership calls. Everybody is definitely expressing a sense of fatigue at this point, like an actual physical fatigue, as well as that work and compassion and mission fatigue. I think that would be the most ubiquitous thing for staff that are in health centers right now. They’re tired and maybe a little bit less engaged.

Alex Rohlwing: Absolutely, and you mention leadership calls, what do you see as the specific role leadership can play as far as trying to help staff recover resiliency and build well being, especially after the past couple of years?

Dana Vallangeon: Yeah, I think the leadership role is huge. It really all starts there and as far as leadership have to see it as a priority, they have to call it out and be willing to recognize the state of where everything is and where their workforce is. Not be afraid to measure it, so that we can really see if interventions and strategies are making improvements or not, and be willing, even with the priority status, to fund a wellness position, maybe for the first time in a health center. I think that the leadership role is huge.

Dana Vallangeon: We recognized that with Brooke’s arrival at our organization and I’m going to let her talk a little bit about because we recognize how important it was some of the stigma free work that we’ve been doing to really, first of all, help health center leaders recognize the importance of creating a stigma free workplace that normalizes the fact that many of us are struggling with mental health and/or substance use issues.

Brooke Sims: Thanks, Dr. Dana. To add to that, I think it’s really a common misconception that burnout is a 100 percent the individual’s responsibility to change or to do something about. Like Dr. Dana said, I think we believe that organizations must make addressing this a priority and really have a top down approach with their leadership teams.

Brooke Sims: What Dr. Dana was speaking to with our stigma free initiatives, we actually partnered with NAMI, the National Alliance on Mental Illness and adopted their stigma free company initiative. First within OACHC internally, we really took that, we have to practice what we preach, approach first. NAMI the definition of a stigma free company is a company with a culture of openness, acceptance and understanding about employees’, overall health and wellness.

Brooke Sims: Internally OACHC we really increased a lot of our wellness activities that we offer our internal staff. We increased our education during our monthly meetings. We actually have a stigma free little section at all of our monthly all staff meetings where we go over a specific topic each month together. Then me coming on to this team, I really advocated for an addition of an employee assistance program that we didn’t have in place before, and now I’m really excited to say that we do have.

Brooke Sims: We really started with our approach internally and embodied NAMI’s definition of what a stigma free company is first, and then we were able to take that information and all of the resources that NAMI has provided us to create a stigma free toolkit for our members. We’ve also held training for our members. Like I said early, we really focused on a top down approach first. This toolkit and these trainings were all centered around the importance of eliminating stigma, first in the workplace to promote employ wellness.

Brooke Sims: That’s been our big project here that we were super excited to launch. Then now we’re currently working on a second edition of that toolkit and trainings to take it to the next level or the next step, which is focusing on stigma free patient care. We really think that internally you have to start so then you can make wider, more active approaches to the communities that we serve.

Alex Rohlwing: Wow, very cool. Can I ask you to describe a little more the stigma free session and some of those wellness activities that you mentioned?

Brooke Sims: Yes, so internally, some of the wellness activities like I shared earlier. I’m also a licensed professional clinical counselor and registered art therapist. Our OACHC team have started biweekly Breath with Brooke Session, we call them. It’s not therapy or anything like that, it’s an opportunity for our staff to connect together. We started this when we were still primarily virtual and not being in the office together, and there was a lot of disconnect.

Brooke Sims: I wanted to bring this to our organization, to just connect again, talk about things, be humans together, and so that’s something we did internally and then a little bit more about the efforts externally with our members of our health centers. We did trainings on really what even is stigma? How does that affect our employees? I think we hear a lot of anti stigma campaigns and how we should be treating patients, but we saw a real miss.

Brooke Sims: We have to start internally with our own work environments and our own workplaces to make sure that the employees that are serving these patients also feel safe and not stigmatized and feel they’re supported in their work. We brought a lot of information to them, statistics. We met with the CEOs of our health centers to really hopefully drive the importance of this so that our health centers can also make this a priority.

Dana Vallangeon: Alex, this is Dr. Dana. I think one of the things that I’ve learned across the years is that it’s important for not only leadership to own this, but leadership to model it and to be authentic and vulnerable. Even yourself as a leader, it’s okay to not be okay and to show some vulnerability about struggles or things that are going on, for you to help normalize that across the organization that we know everybody’s dealing with stresses on things outside of work as well as in work. We want it to be a safe space in a place that people can come to work and be authentic.

Dana Vallangeon: I think the other thing that I was going to state is that it’s also important to help everybody continue to understand the connection of mission to what they’re doing daily. That’s another thing that our organization are attempting to focus internally here on. Helping us start meetings with a mission moment or thinking about how the things we do is the PCA connect to health center mission and patient care. It’s also really important at the health center level.

Dana Vallangeon: On our leadership CMO call have a mission moment where either myself or other clinical leaders CMOs share about a patient’s story that’s impacted them and why the work that they’re doing at the health center matters. Not that that’s an antidote for fatigue and stress, but it does provide an element helping to reconnect to that mission and enhancing the importance of what we’re doing.

Alex Rohlwing: Absolutely. I really like what you mentioned there, what I call, Calling Out the Wins. I feel like it can be really easy, especially in health care, to overlook the victories and focus too much on the challenges or the things we can’t do. Yeah, making sure to focus on what we’ve succeeded in doing. I think it’s really important and I also really love, it’s okay to not be okay.

Alex Rohlwing: That’s very true and worthy of reiteration. Really good points. Since we’ve talked about some of the broader approaches to wellness, as you mentioned earlier, wellness looks different for different people. How do you attempt to address that variety of needs that different staff have for maintaining their wellbeing?

Dana Vallangeon: I can take a crack at that question. I think you know it is, first of all, having the focus on priority, as we’ve talked about, and shifting maybe some of the culture paradigm. Then it does come down to how do we build into each of our team members resiliencies? Everybody’s at a different spot and that spot changes continually and it’s not that resiliency again, is a one-sided antidote for burnout and compassion fatigue, or that it’s the person’s issue at all.

Dana Vallangeon: It is definitely important and studies have shown how important building into resiliency can be as part of a solution to improving wellness and workplace environment and just burn out. We have been journeying down that path for the last couple of years here at the Association. Resiliency and increasing that internal person capacity was one area that we tested and we tested several system and external factors. Because it’s important to be thinking about what can we do in the system to help with everybody’s wellbeing, as well as enhancing the resiliency of each team member over where they are currently.

Dana Vallangeon: The resiliency work actually led us to Ohio State College of Nursing, has done a lot of work in research in this area and has developed a Mind Body Strong curriculum that is specific for nurses and healthcare professionals. We adapted that with them to actually be specific for providers and health centers and health center teams and tested it. It was actually amazing to see the improvements in depression, anxiety, work satisfaction, work stress, perceived stress scores for the participants in that little tiny cohort of eight to nine providers of that one health center.

Dana Vallangeon: Because of those positive results and because we feel like a mind-body strong process is pretty cost-effective as well as pretty scalable and doable, for health centers. Were now in a process of allowing health centers, all of the health centers in Ohio, to check that out, and make a decision about whether they want to get approval, basically to have facilitators trained and then teach the class on an ongoing basis.

Dana Vallangeon: The curriculum is very intuitively. It’s not revolutionary curriculum. It’s about self-care. It’s about the importance of sleep, the importance of nutrition, the importance of physical activity while at the same time coupling self cognitive behavioral therapy to recognize negative patterns of thinking and help the participant gain self-awareness and increased positive self talk and reframing of thinking. We’re super excited to see how health centers adopt this and fold it into their life cycle in their organization.

Alex Rohlwing: That sounds really truly and sounds like a good training program. I think there is a lot to be gained from teaching people to teach and with imbuing those skills. I think probably also helps people to practice them for themselves as well.

Carrie Farquhar: Yeah, I’ll refer back to something Brooke said related to the Breath with Brooke that she has done internally within our PCA. I think there’s some of that same thing going on with this resiliency training at the health center level. It’s an opportunity for a smaller group to come together on a regular basis and share, kind of develop that intimacy, know more about each other and the struggles they’re facing, maybe be more forgiving in the middle of a clinical day when things don’t go well.

Carrie Farquhar: I think they also know that they’re part of a group and they hold each other accountable. There are a lot intangible maybe benefits to meeting periodically. I know that a health center that did this on their own said that they have the first cohort, continues to meet. It’s a seven-week training sessions that we did, but they continue to meet periodically just to hold each other accountable and to share their successes and challenges.

Carrie Farquhar: There’s a lot. The training itself is important and I hear my four-year old, and eight-year old, grandchildren practicing some of the same techniques. Deep breathing when the four-year old gets frustrated, the eight-year old is practicing positive self talk already. I think it’s clear that we all need to learn and practice self-care at all levels and at all ages. It’s not something someone singled out for, it’s something we all benefit from.

Alex Rohlwing: Wellness works for people of all ages. That’s great. Taking this out to apply to our listeners. Do you have any tips or thoughts for other PCAs or health centers who are on this path or want to start down this path of building a robust, all-encompassing wellness program for their staff?

Dana Vallangeon: I think it is to think about the fact that it’s coupling enhancing resiliency with something. Whatever that something intervention looks like, along with identifying an extrinsic factor that’s fueling lack of wellness or burnout, thinking about that internal external factor and how can you go after it combined would be effective. For our external factor here that we’ve identified in Ohio there’s some momentum around scribing to reduce that documentation burden. I think that’s tip one.

Dana Vallangeon: Tip two is look for low-hanging fruits, and maybe something that is pretty amenable to something that you can impact quickly and that doesn’t take a lot of organizational change or a lot money or dollars behind it. My other big thing is, you got to measure it. We have to not be afraid to measure staff engagement and or burnout. Measuring it allows us then to have benchmarking and a way to look at the impact of interventions. Measuring it that’s part of making it a priority.

Alex Rohlwing: Can you talk a little bit more about measurement and how you have used measurement or how you would recommend people start to measure the impact of those programs?

Dana Vallangeon: Sure. With our health center controlled network here in Ohio and with that emphasis through HRSA on provider burden. We actually did some research on work on a provider burden tool, and the short answer is basically the Mini-Z is the tool that rose to the top as most practical and most do-able. It’s a relatively short inventory and it can be done regularly by providers and that coupled potentially with a little bit of an EHR burden assessment, can go a long way to helping you figure out if you’re moving people in the right direction, especially at a clinical level.

Alex Rohlwing: Very interesting. Do you mind saying the name of the burnout tool one more time?

Dana Vallangeon: Sure. It’s the Mini-Z, as in “zebra”.

Alex Rohlwing: Thank you. Because yeah, the first thing is you got to access where you are before you start planning things.

Brooke Sims: Yes, and I can speak a little bit more to some tips and advice for other people in the space. I think we know that mental health concerns like burnout and compassion fatigue when they aren’t addressed, the symptoms experienced as a result can cause many challenges in the workplace. As we’ve been saying multiple times here in this discussion, the leaders in the organization have an ability, but also an obligation to create a supportive and healthy environment, just as we would for our patients and communities.

Brooke Sims: We know that well supported employees do better work. Organizational changes should really include education and support for our employees, also transparency in conversation to create a culture of trust and then providing access to care through EAPs, through benefits packages and then also implementing guidelines, creating policies that protect a work-life balance and providing flexible work practices.

Brooke Sims: When you’re doing those assessments of where you’re at, we should also be looking into our current workflows that we have, our current policies as a company that we have and see where our strengths are, but also see where we can have additions to make us even stronger, because all of that really fosters hope and optimism. It then creates effective workflows, higher employee satisfaction, career joy, which then really illuminates back to our communities that we serve.

Brooke Sims: Then to my other caveat that I have to speak on is that we talk about and promote integrated health because we know it works, and so that’s no different in this space or with this topic. We really have to focus on integration and remind ourselves that we are all whole people. We all have to remember our goals and our passions and values we have, because we’re in the business of helping people, but we are also people who need help too. We got to eliminate the silos in our teams and work together to collaborate across all of our teams, because without that full integration there will always be a missing piece that impacts wellness rather than an opportunity to foster and promote wellness.

Alex Rohlwing: Wellness is a collective, collaborative and integrated process. Very interesting and really good advice, I think. Those have all been a great mix of the broad view of approaching wellness with some very achievable activities and starting points. I wanted to ask, is there anything else you would like to add that you feel is unique to OACHC or the Ohio health centers, or something that you feel has worked, especially well for you or even something that going forward you’re looking into implementing as a next step?

Carrie Farquhar: I think that some of the work we have done is unique and I think listening to it could be intimidating. Dr. Vallangeon and Brooke have done some great work in Ohio. One thing I would say is, don’t be overwhelmed. Start small, start simple. When Dr. Vallangeon and I participated in the IHI Joy in Work, one of the things we learned was to start with the question “what matters to you”. That sounds so simple, but it’s so important.

Carrie Farquhar: Because otherwise we could be making a decision for the staff in terms of what we think they need and implementing it and finding totally off target. What they need or want could be a major organizational change and it could be ordering different writing pens. I’m a left-handed person, I can appreciate that. Just a pen that works for my hand would be phenomenal. It can just be what they call pebble in your shoe kinds of things.

Carrie Farquhar: Then respond and try to meet that need. If it’s not something that can be met, given the constraints, be transparent and share why it can’t be met and then, discuss other changes, other things that might help alleviate the issues. I think my point would be, don’t be overwhelmed, but start with the simple question, what matters to you and see what you can do to address those issues.

Alex Rohlwing: I love that point. Start with what matters to you and your organization, and also that it can be something very small, something very do-able, like your example with the pens. I think that is just a tremendous amount of information in one podcast. You all three have been just absolutely incredible. Thank you so much for being here today and sharing your wisdom with us. I think you’re doing amazing work for your health centers in Ohio and all of their staff, and you’ve shared so much that we can all take and use going forward. I really appreciate it.

Dana Vallangeon: Thank you. It’s been a privilege to be with you. I enjoyed the conversation.

Brooke Sims: I echo that. Thank you for creating a space to have conversations like this.

Carrie Farquhar: Thanks Alex. You did a great job.

Alex Rohlwing: Thank you and thank you to everyone out there for listening in today. One more time I want to thank the fantastic team at the Ohio Association of Community Health Centers for sharing their thoughts and wisdom with us. Be sure to check out all of our free workforce tools and resources found at chcworkforce.org and if you haven’t already, you can find more fantastic insights on wellness and workforce in the other episodes of our STAR² Center Talks Workforce Success Podcast. Have a wonderful day.