Episode 1: The Enterprise Triad

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The inaugural episode of Well-Being at Michigan Medicine has Dr. Elizabeth Harry welcoming the organization’s triad leadership – Dr. Paul Lee of the U-M Medical Group, Julie Ishak, M.S.N., the chief nurse executive, and Dr. Charlie Reuland, the chief operations integration officer overseeing operations at the clinical enterprise.

Some of the topics that the quartet discuss include fostering a culture of people feeling cared at work and how it can make a difference in patients’ lives, recognizing stress and structural issues and how to stave off burnout, and reducing cognitive load.

Learn more about the host of Well-Being at Michigan Medicine, Dr. Elizabeth Harry.

Episode guests:

• Julie Ishak, M.S.N., R.N.
• Paul Lee, M.D., J.D.
• Charlie Reuland, Sc.D., M.H.S.

Transcript

Elizabeth Harry:

Hello and welcome to the Well-Being at Michigan Medicine Podcast. I am your host, Elizabeth Harry. As the Chief Well-Being Officer at Michigan Medicine, it is my dedicated mission to empower the expertise of our team members by improving well-being and reducing burnout to advance seamless healthcare. This show's purpose is to bring vital topics of conversation in the well-being space and to expand on them. This isn't an email, it isn't a team's message and it isn't a text message. It's a conversation, an exploration. My goal is to improve the culture of shared purpose, trust, accountability, aligned values and psychological safety where we all can work and grow. We are putting the we in well-being, but we're not alone.

This summer and fall, we will chat with leaders and experts across Michigan Medicine in the well-being space. In these interviews, you'll get to know these experts, learn from them, and hopefully connect with them better. Leadership development and transparency is key to a healthy working relationship. We'll dive into topics across the healthcare industry, from the medical school to inpatient services to administration, to the clinics, offices and break rooms we occupy. So follow, like and subscribe to wherever you get your podcasts as we'll be regularly adding new episodes. 

Today I'm very excited to have an interview with all three of the enterprise triad, which is our leadership triad that oversee all activities within U of M Health.

Today we have Dr. Paul Lee, who's an MD and a JD. He's the Senior Associate Dean of Clinical Affairs at the University of Michigan Medical School and the Executive Director of the University of Michigan Medical Group. He holds degrees in medicine and law from the University of Michigan and Columbia University. His training includes a residency in Ophthalmology at Johns Hopkins and a fellowship at Harvard's Mass Eye and Ear Infirmary. Dr. Lee has held academic positions at the University of Washington, USC, Duke University and the University of Michigan. He's a leading researcher in eye care and health policy with numerous honors including introduction into the National Academy of Medicine. Dr. Lee has been extensively involved in administrative roles within U-M health and various professional organizations. 

We also have Julie Ishak. Julie Ishak is the Chief Nursing Executive of U of M Health since March 1st, 2024. She's responsible for the professional nursing practice across all of U of M Health entities. Previously, she was the chief nursing officer for Ambulatory Care at U-M Health. She has had multiple leadership roles at Ascension Michigan, including vice president of the neuroscience service line. Julie's pursuing a doctor of nursing practice degree from Wayne State University where she also earned her MSN. She's actively involved in several professional nursing organizations and has presented at various conferences.

In addition, we have Charlie Reuland. Charlie is the Chief Operations Integration Officer at U-M Health overseeing operations across the clinical enterprise. He previously served as executive vice president and COO at Johns Hopkins Hospital and COO at Johns Hopkins Bayview Medical Center. Dr. Reuland holds degrees from the University of Michigan and Johns Hopkins University. He has extensive administrative experience and has served on leadership committees for various health organizations such as the United Way of Central Maryland. Dr. Reuland is also an executive sponsor of the Michigan Medicine Administrative Fellowship Program.

Well, with that, I am so excited today to have our enterprise triad with us all together for a period of time to talk about my favorite subject, well-being. So Julie, Charlie and Dr. Lee, so happy to have you and I was going to ask you if I can call you Paul for the duration of the visit.

Dr. Paul Lee:

Absolutely.

Elizabeth Harry:

So that's wonderful. So, I'm so excited to have you all here and really excited to chat with you about all the amazing work that you're doing to help us all advance well-being across Michigan Medicine. Before we get started, could you all just tell us a little bit about yourselves, the roles that you have, particularly how they're advancing well-being, and maybe a little bit about your why and what got us here. So Charlie, maybe we could start with you.

Charlie Reuland:

Sure. Thanks for doing this, Liz. This is really helpful to us and me in particular because I've only been on board for a year and a half now, so I'm a relative newcomer, as are you.

Julie Ishak:

Yes.

Charlie Reuland:

And so it's a nice opportunity and what I usually say is I'm a returnee to the University of Michigan. I was here for undergraduate many years ago. My first job was as a dishwasher in the Mary Markley dorm. That's a true story, but it'd been back for a year and a half now. And my sort of why is I guess that medicine has been in my family forever. Dad's a retired physician. My brother was in medical school ahead of me. I was one of these who was geared in that direction and realized in college that I wanted to be in the field, but I was good at organic chemistry because I'm competitive, but I didn't really want to do that. And so I went to the School of Public Health at Johns Hopkins.

Did not plan to be there for 32 years, but fell in love with the academic mission and tripartite mission and just kept having opportunities to grow. And very few places would draw me away and back. But Ann Arbor and University of Michigan is one of those. And so when this opportunity came up, we jumped at it and I just view it as a privilege to be in a position to serve an institution like this. A great day for me is when physician, nurse, PA, environmental service worker says, "Thank you. You helped make it possible for us to do what we do well today." And that's what gets me up every day.

Elizabeth Harry:

Wow, that's a great story. Thank you. Julie, how about you? You're also relatively new to your role.

Julie Ishak:

Yes. Hi. I am Julie Ishak, and I have been in this role now six months already. So it has been wonderful. I'm not new to Michigan, although I think relatively new in comparison to most of my colleagues and that I've been with U of M for five years now. And so a little bit about me. I've been a nurse for about 24 years now, which is hard to believe, and a nurse practitioner for 15 years. And so for me, I would say my why, much like Charlie grew up in a family of physicians, nurses, and my mom who I think is probably one of my favorite humans in this world, is also a nurse and retired at the age of 72. And so I grew up very much really understanding full force what a nurse does and what impact a nurse has on the lives of patients and the lives of their families, on the lives of everyone they touch.

Because I had such a wonderful role model in my mom. For me, nursing was one of those things that I thought to myself, "I'll get into it, I'll see if it's what I stay in." I kind of always say, "I always thought maybe I'd go to law school or maybe med school or maybe something different." But lo and behold I stayed in nursing because it kind of draws you in and feel really, really fortunate to be in this role, which is kind of like your dream role as a nursing leader to be in a position like this at an organization like this. So I feel really fortunate to be here and to also have Paul and Charlie as my colleagues for sure.

Elizabeth Harry:

That's wonderful. How about you, Paul?

Dr. Paul Lee:

So thank you for having us here. Dr. Harry or Liz. I think just this conversation and the fact we're working together really celebrates why we're here is because we all love Michigan through different reasons. Like Charlie, I'm a bounce back. I did my undergrad and medical school here, loved it. My wife, when she came here for the first time when I came back to be the director of the Kellogg Eye Center, the privilege of doing that. She said, "Do they put something in the water? Because everybody wants to come back to Michigan."

Elizabeth Harry:

That's true.

Dr. Paul Lee:

And I think it's true and it speaks, I think because this is a truly values-driven place. We're imperfect human beings, so we don't always live up to our values, but we try very hard to and we try to get better the next time around. And so knowing that we're a values-driven place means a lot to me and to a lot of folks. It is not transactional. We're here for a higher purpose. The higher purpose for us, we have the privilege of supporting our teammates and to work with you to do a really better job every day on doing that so that we can accomplish the really important things. We were talking earlier today at a meeting about how we have such a wonderful opportunity.

There's no better group of people in the entire country to work together with across the university, all three campuses and our alumni on creating a health and healthcare system for our country for the future that we desperately need. That we can keep people healthier, that we can keep people from getting diseases and delaying the complications of diseases. So that way we can all enjoy our lives to the fullest extent possible. And I think when we've run across our teammates, everybody is here for a lot of reasons, but that seems to be a common unifying theme for a lot of our folks. And I think that speaks to the why for all of us.

Elizabeth Harry:

It's a really good point, Paul. It's such a pivotal time in healthcare and there's a lot of complexities and the opportunity to get to be part of that solution. And as with all complex problems, we'll only get there through the merging of multiple minds and multiple different disciplines, which I love. I have to say, when I interviewed here over and over, I heard the story, "Well, I came here for four years, 35 years ago," or something like that. And so I had the same question of like, "Well, what's happening that everybody comes for this short period of time and never leaves?"

So Julie, maybe we can delve a little more deeply with you and ask you, when you think about the nursing community that you've talked about being part of and now have the opportunity to help lead at Michigan Medicine, how would you describe the well-being and the culture in the community? And what is your vision of how to really create that culture of well-being?

Julie Ishak:

Yes. I mean, I think nursing is often very much a generational type of role. If you talk to many nurses, their moms were nurses, their aunts were nurses, their sisters. And so it is one of those roles, one of those careers that I think nobody goes in not understanding just how difficult it is. There are definitely different ways to make a living, easier ways to make a living. So I think people who go into nursing understand that it's going to take a lot out of you both physically, emotionally, and so I think the well-being of our nurses is top of mind for me. It's such a difficult position to be in. It's become more difficult since the pandemic. And I think if I were to describe the well-being of our nurses now and the culture that we have, I think it's one of recovery and hope.

I think there is a lot of recovery that's happening within our nursing community now. I mean, we have so many wonderful things. I mean when you talk about what brings me here, I think there has never been a health system I've worked in that invests in nurses the way U of M does. And that makes me very, very proud. And I think that we have a really loud voice at the table, which also makes me feel really fortunate to lead here. But I do think that the well-being aspect of our profession is one that has been kind of slowly on decline for quite some time. The pandemic did not do it any favors. And I think that we're in a period now of recovery and really trying to find our footing in terms of what it means to be a nurse in this day and age, what it means to be a nurse in our post-pandemic world.

And I think that there a lot of work being done there to move towards a place of hope. And I do think that that's where we're headed. I think we have a really strong culture within U of M, and it's a really positive one. I think one where people value the work and the care that's being delivered at U of M. There's a great sense of pride I think, to be a nurse here for all the reasons that Paul just described. That they're taking care of patients that many other places are unable to take care of. And there's a real sense of pride that our nurses are delivering that care in many instances. And so I think I would describe it as a community who makes patients the center of what we do and continues to want to expand our nursing practice to meet the needs of our patients at large.

One of the things is I think about what my goal is and vision is, we have all these pockets of really wonderful care that's being delivered in all of our segments. And we operate in this segment-based care delivery model where we talk about inpatient nursing or outpatient nursing. And for me, when you are a patient, you really don't care and you don't see it in that segment approach. And so a goal for me in terms of our nursing community is to continue to build those relationships. We have really strong relationships at the unit level, along with a sense of well-being comes a strong sense of belonging. If we can continue to build our relationships with each other, with our leaders across our continuum, with our physicians, with our administrative colleagues, with our ancillary support.

Relationships are really at the center of what provides really good patient care and safe patient care.

Elizabeth Harry:

I love that. That's such a great point about the patients don't think of it in a segmented experience in the same way we do. And I would agree with you just having gone on executive rounds listening to some of our nurse units, I have never seen the level of esprit de corps that our units have. It's really amazing how they feel so connected to one another so clearly, which is a very special thing. You can see why that would become generational for sure.

Dr. Paul Lee:

So thank you Julie. It's wonderful to hear the vision and to see when we round how well so many of our units work together. And I think one of our commitments is we want to have that kind of experience everywhere across our entire enterprise. And so part of this is, and we're particularly grateful in this setting, focusing on the well-being of our teammates because our teammates who take care of our patients are the foundation of everything that we're able to do. And so I think Charlie, you and Julie expressed really nicely that our purpose as the enterprise triad is really to support our leaders and therefore all the folks, our teammates who take such great care of our patients.

And I think all of us have personal stories about the amazing care that we get here, and that's part of the reason why we have all this demand. Once people actually come in and get the care that we could deliver, people don't want to leave and they tell their friends and families that everybody wants to come here and get that care. So it's a shout-out to everyone listening from the clinical care community at Michigan. And if we look upon extending what you're saying, Julie, to what we're trying to do with our faculty, I'd love that spirit of partnership and collaboration with our nurses. For us on the physician faculty side, it's a partnership with our departments, our divisions, our faculty leaders, formal and informal with the dean's office.

So grateful, Liz, for your partnership and joint integration collaboration with everything that we're trying to do. Visits in service of how to recreate that teamwork. Everybody who's a Michigan person knows Bo Schembechler's, "The team, the team, the team." And that is one of our core values. And so that's the underlying way we want to do this. We all play our roles. So one of us in our enterprise triad role is to really help address some of the structural factors that are upstream of people's experience and well-being. So we could try to do some blocking and tackling and to make adjustments for all the pressures that we know our teammates are facing.

And so I want to really thank you, Liz, for your work in pointing out the importance of cognitive load for all of us and how that's creating both a sense of burnout if the cognitive load is too high, as well as really in a positive way, all the things we can do to reduce cognitive load. And so that's one of the core commitments that we have is to reduce cognitive load and that includes reducing administrative burden for things that don't work very well or as you've pointed out, our medical group board meetings, the repetitive messaging of the same message over and over. And so there are lots of great activities we could get into later that deals with how can we work together to do that.

But it has to be having that partnership that you described, Julie, with every one of our departments and our divisions and our dean's office in service of each and every faculty member and every member of our team.

Elizabeth Harry:

Well, I love that Paul, and a nod to why we're even doing podcasts is to try to reduce some of the cognitive load of maybe email overload and trying to find another mechanism or venue to connect with people. I loved your focus on team and team effectiveness. Can you share a little bit about any initiatives that might be going on to really support the growth and the development of our faculty in this space of enhancing well-being and the team effectiveness?

Dr. Paul Lee:

Sure. One of the wonderful things of having a great group of folks who have different perspectives is, I want to give a shout-out to you Liz for the council on well-being because I really want to acknowledge our ambulatory leadership and our interprofessional education group for working together to work on a initiative to see what we could do and also to thank Raj Mangrulkar and his team at the Center for Interprofessional Education for also leading in on some inpatient opportunities as well because this is something that we could work across.

And I think one of the structural issues that we all recognize is that during the pandemic, the opportunities for our newest members of our professional care teams to interact were different. And so there may be opportunities to sort of create more collaboration in how we interact with each other to make up for the changes and/or in other ways to take advantage of the changes that have occurred because of the pandemic relative to our usual training pathways or experiences.

Elizabeth Harry:

It's been really inspiring to watch that partnership develop. And that's one of the cool things about Michigan is just all the resources that we have available like the Center for Interprofessional Education to really help us. So Charlie, as we're talking about and thinking about leadership and different leaders and how they're coming in and helping us think through what is really a very complex problem, how do you see our leader's role in recognizing signs of operational stress and acting on those signs to help our entire teams deliver this care that we're discussing?

Charlie Reuland:

Thank you. I mean, I think this is an industry that's for people, by people and we'll always be that as far as I can tell. And so it's as foundational as it gets as leaders for us to be concerned with fielding the great teams of people that we need to field day after day to do the work we do. And so it sort of doesn't get more basic than the team and the well-being of the team. How do you do that? We talked a little bit about rounding. You're out listening and stories are powerful. When a person actually doing the work tells you a story about what works and what doesn't work, that's incredibly powerful. You then back that up with data and then data take a story and say, "You know what wasn't just a story. It's really happening a lot."

And so you listen actively. You use data to drive what you do and you try to improve the operations in ways that I think help our team members be great at what they do. There's a book that you might've seen that's called Patients Come Second, and if you haven't read it, you sort of get the gist of it just by its title. The idea is of course, that we'll often say patients are first and at some level of course they do, but it's making the point that investing in your teams and thinking about how they operate is the best way to put patients first. And I think that's a really powerful sort of lesson that I took from that. And I think we try to live in all those ways every day as leaders.

I think all leaders should have that as sort of job one.

Elizabeth Harry:

And I love that emphasis on sometimes I think there's a temptation to think about improving well-being or delivering excellent care as mutually exclusive when really the literature really supports that they support one another and that when we have teams who are doing well, they deliver better care. And when we think about the care we would want for our loved ones, we don't want someone who's burnt out or emotionally disengaged.

You want someone that has the cognitive bandwidth to be thoughtful and careful and present and the emotional bandwidth as well. And so Julia, I'm curious in the nursing space, when you're thinking about this culture of well-being, how does fostering that culture impact the day-to-day operations and this efficiency of care? What does that relationship look like?

Julie Ishak:

I think to Charlie's point, we are like whole beings that come to work. And I think whenever we don't treat people like they're whole beings, and that really means making sure that we are treating them from a place of understanding that when they come to work it is really hard to forget about life. I think many times we've tried to separate those two things and we say work-life balance as if that's a real thing. But I saw this depiction that I thought was really interesting to me where it had kind of life at the top, work at the bottom, everything in between, relationships and money and health and family and leisure and travel and all these things that we prioritize as part of being whole beings.

And I think one of the things that creating a culture of well-being does is that it allows people to integrate those two things, to integrate their life, to integrate their work and to feel cared about. And when you feel cared about and you feel a sense of belonging, it's a lot easier to come to work and do your best work. I think when you're feeling burnt out, when you're feeling a sense of not belonging to an organization, when you're feeling that people don't value you as a whole person, it is really hard to come here and forget about everything else that we're dealing with day in and day out.

And so I think fostering a culture where people feel cared about, where people feel, in many ways it sounds a little hokey, but in one of the other organizations that we talk to about well-being, about belonging, they said the foundation of it is love. And that sounds like a strange thing to say in a workplace, but it's really true. I mean, if you feel loved by those around you, you're going to be able to come and be your best self at work despite what's going on. And recognizing that we all have families and we all have things that are weighing on us heavily outside of work. And if we can feel a sense of belonging and well-being at work, we can then come and do what we're here to do. With the support and recognition of that from our colleagues and peers that we work with.

Elizabeth Harry:

And not only are we whole people bringing our whole selves to work, but what we do is hard. We are meeting other humans at some of the most challenging times in their lives and having the bandwidth to be able to hold that and hold one another effectively is what I hear you saying in that period of time. And creating that capacity within the organization to hold space for the challenges that we're helping people through, in some ways will make us more effective, more efficient, better able to deliver that care.

Julie Ishak:

That's right. And I mean in many ways, I think sometimes the opposite where you come in and if there's not a culture where you can say, "I need your help. I'm feeling really tired today. Maybe I'm not on my best game today. I need you to swoop in and help me out." I think that's the culture we want to create and our patients are going to benefit from it. Oftentimes even Paul, Charlie and I will say, "I'm actually not completely firing on all cylinders today. Are you seeing it the same way I'm seeing it?" And in the patient care world that looks like, "I need your help with this because I'm not at my best self today."

And that being a culture that we support to say that we need help and many of those principles tie into being a highly reliable organization to be able to say, "I need help. I need support." And our patients will benefit from that level of transparency and love that we show one another ultimately.

Elizabeth Harry:

I love that. It's almost counterintuitive in that it's a little bit go slow to go fast, because a lot of this does take investment upfront to build those relationships, to build those cultures. And so Paul, I'm curious, given that it's a little bit counterintuitive, given that some of it is a bit go slow to go fast or invest to be more lean, do you find that you run into skepticism or resistance around prioritizing well-being ever? And if you do, how do you approach that?

Dr. Paul Lee:

So one of the wonderful feelings about being here at Michigan is that there's really a broad commitment that's deep towards well-being for our teammates. And so that involves sometimes operational adjustments where we trade off some "efficiency" in the short term. But as you and Julie and Charlie have pointed out, if we have really engaged team members who feel supported, I love the word loved, that's a wonderful concept because we don't talk enough about that in our society today. It's the most powerful force there is. Then better things happen. I think there's actually, as you noted, empirical studies that showed that the goal is not to be more productive.

The goal is to be fully present as much as we can at that stage in our lives today and to move forward on that. And so everyone here, Charlie, Julie, you are really exemplars for us on how we can do that. So I would say understating that is important. I think we've had the privilege of Coach John Beilein, the basketball coach come work with us this year. And he emphasized over and over and over to all of us that the foundation of what we do is relationships or are relationships. What you and Julie just spoke so well and Charlie has mentioned as well, is that was the basis. And we also had some great speakers, Dr. Chris Szynski for the AMA, who also talked about a relationship basis to what we're doing.

And so one of the things that the pandemic really impacted was the ability to form and strengthen relationships. And people know, I made the observation that because we were very mindful here at Michigan for many years to try to recruit in people who believe in our values and who therefore are relationship minded, we were potentially impacted even more by the distance from the pandemic because people who hungered for relationships couldn't get it. And so that's something that Julie mentioned we're trying to get to a better place in that.

Then on a very practical matter, I think by now thanks to the wonderful leadership we have across the organization with Dr. Miller, pushing the awareness, push is not the right word, of supporting and emphasizing the importance of the belonging, access, safety, and experience as the organizing framework for our goals. Belonging experience are half of those measures. And so that in itself for what our system goals are of how we as leaders hold ourselves accountable for the work that we do, belonging experience are right there.

Elizabeth Harry:

It's half of the focus and half of the goal. And I think really underscores the importance and the dedication as you're mentioning. And then as we step out to the university level, there's also a huge emphasis on well-being and wellness across the university as a key priority area. So I would agree there's a lot of investment. Charlie, you and I and the team often talk about how this isn't a Michigan Medicine problem, this is an in the water problem. It's the water of healthcare right now. And that for better or worse, there really aren't organizations that are exempt from this at this time.

And one of the things that I know we've really partnered on trying to focus on here is strategies and processes, how we can use the data to really find areas that we can make improvements, but recognizing that it's a team sport. That we all have to sort of be in it together and that no one individual or group of individuals are sort of responsible for breaking healthcare despite the narrative at times across the country that happens. I'm curious if as we're thinking about our colleagues around the country and everybody who's really wrestling with this together, can you think of a lesson or an insight that you've gained from your experience thus far in improving our organizational efficiencies and organizational well-being that others might find valuable or be able to learn from?

Charlie Reuland:

Right. There's an amount of humility we all have to have when we look at these things because it is a sort of a societal and industry-wide set of challenges we deal with. And I guess what I would say is one of the lessons is that little things can really matter too. That some of these feel so big that they're intimidating and you think, "Gosh, there's no easy answer to this." And at some level that's right. But on the other hand, demonstrating to the team members that you can make little changes in things that directionally are taking us the right way, go so much farther than even that little thing you fixed. It's that somebody cared what they were doing.

So the phlebotomy team on rounds a little ways back, indicated that the very carts they use every day to do the work, were not the right ones. Well, we were able to go through and get those replaced. And is that a big sexy thing that's going to make the national news? Of course not. But that team felt like they were heard, listened, and the one thing they needed to do their jobs better, they got. And so even though that doesn't change the whole world of phlebotomy or even the hospital, it sent the message that we hear you and we're going to try to fix things where we can. And this is true when you think of the ambient technology for our faculty. As you know, that's a huge...

That one is incredibly exciting to me, that one could really make a difference for a lot of different people. And so little things make a difference. And I would also say that I'm struck by how much presence makes a difference, even without fixing it, just the listening and presence part. A nurse in the ED that is way overcrowded with 60 boarders and a full waiting room. By us showing up, we're not necessarily helping her. And in fact, if we want to talk to her too much, we're probably slowing her down. But sending the message that we see it, we know it and we appreciate it and we'll do what we can to help with it is a lot.

I've learned that there's a humility because when I think, "Gosh, the most helpful thing I can do is not come down here and do nothing, it's go and try to find a solution." But at some level, sending the message that you care enough to be there is as almost as important as finding the solution itself, I think. And so that's one of the things that I think about again and again. And the other thing you said that I'll add to is learning from others. People will get tired of me saying this, but I will say, what do five other places do with this problem? Because we are not the only ones dealing with this.

And as you said, and there are a lot of smart people, committed people around the country trying to solve these things, and boy, what a shame it would be to not keep your ears open and listen for those things. So I think those are just a couple of thoughts I have.

Elizabeth Harry:

Well, and to pull out a theme of a lot of those things is communication and how are we hearing from other people and how are we sharing what we're doing and learning from other organizations and being present to hear. And Julie, I'm curious in your work, what strategies you've found effective in really maintaining open lines of communication across different departments and levels within a really big and matrixed organization?

Julie Ishak:

I think part of it is that your first line of defense in any situation is to build those relationships. So I think it is really hard not to assume best intent with someone that you have built a relationship with. And to Paul's point, many of our colleagues that have started since the pandemic, we've had a hard time creating trusting relationships because we haven't had that ability to connect with one another and to assume best intent. So I think for me, one of the strategies that I try to use is to assume best intent in most situations. The way you keep open lines of communication is from my perspective, to make people feel really heard.

And I think in some instances, our first reaction sometimes can be defensive or to defend oneself if someone's bringing up something to you that may feel uncomfortable. And part of my leadership growth and journey is to sit with that and realize that that's mostly my ego talking when you get into those situations. And so I try to approach any conversation I have with someone. I'm not always successful, but I try to sort of put my ego aside and really hear what they're trying to say. And I think that that is something that our organization, it's very matrixed. People are very passionate about their point of view. And I think that's very common, right? We're in healthcare because we are passionate people for the most part.

And some of the success I think we have as an organization as it pertains to communication is really making sure the other person feels heard. And then it's kind of like the approach I take with my teenager, not to have much of a reaction because it's when you have a reaction that the lines of communication gets shut down pretty quickly. So I think ensuring that you're hearing the other person no matter who that other person is, and then once you've built that relationship and you sort of have that social capital, it's good to then have more of that dialogue.

But that's just been one way that I've tried to do it, is to just really listen, not get defensive, not try to explain why things are the way they are or try to make the case, but rather just hear people. Not really always offer up a solution, but just listen. And then when the time is right, you can have productive dialogue about what next steps are. So that's been a way that I've tried to approach communication within the organization.

Elizabeth Harry:

Well, I just think that's such a beautiful and humble and authentic response. And I'm also going to take notes for when my kids are teenagers because I think that is a very helpful tip. So Paul, you've really talked about some of the strength of Michigan being our teams, our ability to come together and really innovate because of all of the different interdisciplinary strengths that we have across the organization.

When you think of innovation, what practices or policies can you share that have been implemented that you think either really have or are going to impact well-being, and that may similarly to what I was asking, Charlie, serve as a model for other institutions trying to solve this with us?

Dr. Paul Lee:

Thank you. When we talk about innovation, there's innovation at the local level that really makes things better, that is often generalizable, that there's the large-scale institutional issue, but they fall on the spectrum of innovation as one of our core values through teams that work together. To your point, Julie, is the feeling included means we hear each other, and that's also part of our caring. And so that's really a key thing for us. And I see that one of the innovations on a larger scale to supplement what some of the things are compliments, some things that Charlie said at the more local level is the way that our office of well-being is organized.

It is for everyone, not just the faculty. And I know there are discussions about having this done on a university level. That's really a testament to the institutional commitment across all of Michigan for this. That's a really important structural innovation. Congratulations on helping move that forward. I think another key innovation that is really important for us to consider is how we are framing the work. I know other people have done it before, but really systematically framing this as a cognitive load issue and how we could then go about, and every time we do something that we actually measure the impact in the PDCA-HRO work. And so we have great colleagues that can help us do that.

Whether it's improve or choosing wisely or IHPI or IPE, there's just all these wonderful colloids that can help us measure, so we could really create a innovative structural model of continuous innovation on this. And I've heard that there may be some exciting advances in the future where there may be a institute of well-being for the University of Michigan.

Elizabeth Harry:

Well, and what I love about what you're saying is really bringing this academic and intellectual lens to, again, what we've mentioned a lot of times is a very complex, or as they sometimes say, wicked problem that has a lot of layers that when you pull on one node, sometimes have unintended downstream consequences. And this is why I love this idea of bringing in all these different types of experts that have different lenses to help us think through how to solve it. Because if it were easy to solve, someone would've done it already. And so Charlie, I'd like to wrap up with asking you, looking ahead, what are your aspirations for the future of well-being and culture at Michigan Medicine?

Charlie Reuland:

What a fun question. I guess what I'd say is that most people going into healthcare, and maybe everybody who goes into healthcare will say they're in this to help people at some way, and they have a why. And if we as leaders are doing really well, people are closer to their why every day when they do their job and they're not feeling as distanced from it by all of the difficult things that they've got to do and the administrative red tape that can happen. And we all know that that's there, and it'll never be zero, but boy, we could work to make it less so that people will really feel closer to why they went into this every day and not feel like they've been held back from it at some level.

Because I think that's a lot of what our work has to be. I am remembering one of the highlights during the peak of the pandemic, and I think most of us remember that as a sort of highs and lows of all of our careers at some level. And one of the high points was, I remember hearing a story of a CRNA, and she said that she was relating the story that she was going to intubate somebody. And the patient asked her, "Are you going to be the last person I ever see alive?" And she apparently said something like, "No, we're going to treat you. We're going to get you through this, and when you wake up, we're going to get you whatever food you want. What is that?"

The person said, "Chocolate ice cream." Apparently the patient, two weeks later, does come out. She goes to visit the patient and says, "How are you doing and having chocolate ice cream?" And the patient says, "This chocolate ice cream is terrible." And it just was this story that got shared with 200 people on a Zoom call doing hard work of managing through a pandemic. But it's those kinds of stories that were like, that's why she went in to be a CRNA. And if we can have more people feel that close to their work every day, boy, wouldn't that be a really powerful place to be.

Elizabeth Harry:

Wow. That gave me goosebumps. I just have to say this entire conversation has been so inspiring and motivating for me. I feel so lucky to get to work with the three of you and have such a committed group of people that are really trying to advance this work. I guess my last question to all of you would be, if people are interested in learning more, if they have questions, if they want to reach out, where should we direct them?

Dr. Paul Lee:

I think in surface to what we've discussed, we're always open to having people reach out to us directly. We also try to encourage the principles of Harvard Library organization to work more locally, because our goal is not to centralize everything. On the contrary, we want to try to help everyone be able to solve problems locally. So I would say, yes, we have an open door policy, but please try to work more locally and then escalate issues because our goal is to try to help all of us be able to resolve as many problems as possible and as appropriate at the local level.

And that's our goal. That's how we're going to get to the great places. I mean, Charlie and Julie, you shared some wonderful stories that exemplify how people locally can identify the best solutions and that's what we're committed to.

Julie Ishak:

No, I agree with Paul. I mean, I think, yes, we are an open door. Reach out to us at any time. But also with that, I think the three of us feel really, really fortunate with the leaders that work in this organization and learn from them every day. And so I can say unequivocally that we have leaders here that care very deeply about the teams that they lead, and certainly they will work really hard in service of those teams. And we're here to support them and to support our teams at large. But yes, feel free to say hello to us, to email us, to reach out with any suggestions, concerns, comments, or good ideas.

Charlie Reuland:

Absolutely. Liz, I'll just add that you said it sort of at the beginning. If we're out on rounds, might people be comfortable talking to us. Sometimes when I'm out, people will say, "I don't want to burden you with this." And I'll say to the contrary whatever you're about to say is why I'm out here. And so talk to us. We're whole people, as Julie said, and we're trying to do things as well as we can, and there's sort of no substitute for direct communication sometimes. So we welcome it.

Elizabeth Harry:

I love that. Well, thank you all for taking the time to be with us today. I really appreciate it.

Julie Ishak:

Thank you.

Dr. Paul Lee:

Thank you.

Charlie Reuland:

Thank you.

Elizabeth Harry:

It's great.