Finding Joy at Work
Episode 417

Lakshmana Swamy, Fellow in Pulmonary and Critical Care Medicine at Boston Medical Center

Finding Joy at Work

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Finding Joy at Work

Episode 417

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The Fearless Organization

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Finding Joy at Work with Lakshmana Swamy, Fellow in Pulmonary and Critical Care Medicine at Boston Medical Center transcript powered by Sonix—the best audio to text transcription service

Finding Joy at Work with Lakshmana Swamy, Fellow in Pulmonary and Critical Care Medicine at Boston Medical Center was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Lakshmana Swamy. He’s a Fellow in Pulmonary and Critical Care Medicine at Boston Medical Center. His interests focus on teaching and evaluating the safety and delivery of care, especially in the field of Pulmonary and critical care medicine. He’s passionate about equitable and cost effective health care. C is keynote about joy and burnout. It is a good one. We’ll leave a link for that in the show notes. It was in 2016 that he gave it at the British Columbia Equality Forum. Lakshmana recently served as co-chair for the 2015 Annual Forum for Quality Improvement in Healthcare, and he’s been a keynote speaker and debate participant at Major QI Conferences. He recently served as a resident member on the ACGMECLER Evaluation Committee and is focusing his research on the importance of clinician well-being, specifically the impact of burnout in ICU clinicians on patient outcomes. These topics are critical for everybody listening, and it’s a privilege that I open up the microphone to Dr. Swamy to join us. Welcome.

Lakshmana Swamy:
Oh, thank you so much. It’s really an honor and Lakshmana is fine. You know, I think this is it. It just got me smiling to hear about it. Here is the thing about I haven’t thought about some of that stuff in a while, but really, I’m a clinician at heart, you know, in the ICU and pulmonary clinic. But through my sort of training, my MBA, my my medical training, my experience with quality safety, medical education, I think the thing that really stands out is that the way that we deliver care is so fragmented and broken and it has a really negative impact on the people receiving that care patients as well as the people delivering it, the doctors, nurses, therapists, everyone else. So I think it’s just exciting to be in this realm and talk about this right now with you.

Saul Marquez:
Thank you for that. Yeah. And I couldn’t agree more, Lakshmana and the quadruple aim is something that I think folks that strive for it are really going down the right path now. I’d love to hear from you. What made you decide to get into the health care sector?

Lakshmana Swamy:
Oh, yeah. You know, actually, as a college student, I wanted to be a classics major and then.

Saul Marquez:
A classics major.

Lakshmana Swamy:
Oh, really?

Saul Marquez:
Yeah.

Lakshmana Swamy:
You know, I just had such a love for sort of like the mythology and how it tied into the history and what was happening and how it informs so much of the way we think today. But I kind of got a little more interested in initially psychology and neuroscience, and I started to feel more and more like I wanted to help people. You know, we all have those stories of people in our lives who, yes, were sick or something. And I found that in in medicine. But the more I got into it, I found that sometimes the way that we care for people and the culture that we’ve built around caring for people can actually be pretty toxic to both patients and the people who are delivering that care. So so I’ve become like really interested now in addressing that sort of toxic atmosphere.

Saul Marquez:
Yeah. Now I think it’s wonderful. And hey, you’re obviously smarter. You went forward with a different career path.

Lakshmana Swamy:
No, not at all. It teaches us so much. You know, like being and being in touch with that is so important, I think.

Saul Marquez:
No, I agree. But nevertheless, hey, man, here we are, right? We’re both in health care. You’re doing some fantastic work in the field of burnout for clinicians, physicians. It’s such a critical time. Do that with suicide rates being at an all time high. You know, mental health now taking a center stage. We’re caring about it. What do you think needs to be on health leaders agendas today and how are you approaching it?

Lakshmana Swamy:
Yeah, you know, I think that’s that’s such an important question. You know, for leadership. I think, first of all, it’s it’s disheartening, but such a common sentiment. You see it on social media, on Twitter everywhere. And you hear it all the time in the hospital, in the clinic that clinicians really feel like leaders don’t get it, right. They feel like they’re totally disconnected. They have no idea what’s going on. And I think that’s a little unfair. I think leadership has a lot of its own challenges to face. There’s a lot going on at that level that takes up a lot of time and effort. But I think the biggest thing that leaders can kind of focus on to try to address these issues is it’s just to ask the question, what is actually happening on the frontlines of care? What’s it like to really be a patient in my organization? And what’s it like to be the nurse, the doctor, the therapist trying to care for that patient? What are we doing as leaders to make that better, to make the job of caring, to make that easier? Right. To make the job easier. What are we doing to make the suffering of being a patient less? I think all of these things really it’s sort of the same day, the same solutions apply a lot of this together, if you’re creating that kind of environment where a patient can sleep at night, then that’s also helping the environment for the nurses, for the doctors who are working. And it all kind of goes together. I think it’s sort of that idea of going to gamba and lean language. I think leadership needs to get out there. And for me, I remember, you know, when I was a chief medical resident, I felt like all my work was on this computer. Right. and I’d be sitting there doing like schedules and doing all these projects, quality products myself. And I it felt so counterintuitive to just get up and go walk around and talk to people. But when I did that, every single time I did that, I felt like I was the most valuable thing I did that day.

Saul Marquez:
That’s awesome.

Lakshmana Swamy:
And yet when I was back at my desk, it was like, I can’t make time for that today. It is so it’s so, you know, I get it. It’s hard. It’s it’s an intangible. It’s not measured Right., but it really makes a huge difference.

Saul Marquez:
Yeah, that’s a great call out. And Lakshmana, tell me about your work at Joy at work.

Lakshmana Swamy:
Oh, yeah, absolutely. So I think there’s sort of two facets to all of this. You know, you mentioned the suicide rates. I mean, it’s terrifying rate and it’s happening. We are more and more knowing someone who that’s happened to. So there’s that extreme and then there’s all the depression that sort of leads up to it. And then I think I see sort of a little bit of a related but distinct issue is the burnout that’s so vastly many people are feeling, you know, 30 to 50 percent of doctors, nurses or, you know, people really feeling that. And that’s a little different in that it’s not like all of those people are having thoughts of hurting themselves, but they certainly have lost that energy at work. They’ve certainly lost that empathy. Right.. And it’s having, I think, a real impact not only on the care they’re delivering the patients, but on their own experience. So there’s sort of two ways of looking at this. I think the one way is addressing the burnout and the drivers of the burnout. And I think paired with that has to be looking at the choice side because it’s sort of not enough to make us the most efficient to remove all the barriers to delivering excellent care. There’s got to be something else that has brought all of us to this profession in whatever way we are engaging with caring for people. Right.. And I think that’s where the joy at work really comes into play. It’s to look at how are people, how are organizations bringing that out and bringing the light out again and saying, look, people are enjoying the work. People did come here for a reason. This isn’t actually a war, right.. It’s not like we use that language a lot. I use that language like being on the frontlines of care. And it feels it has that feeling. A lot of times that’s actually what it is. We’re here to care for people and we’re here to be humans with each other. So I think there’s so much room and reason to find joy at work. That’s why we came to this work and we can really bring that out. So especially through the Institute for Healthcare Improvement, I look at things through that lens of saying, where is the joy, how do we find it? How do we bring it out?

Saul Marquez:
Well, I think it’s wonderful to approach it that way. Change the question you ask and and take a look at it from a different perspective. And it’s amazing what you’ll find. One of my favorite things that I learn is a simple shift in words when something happens rather than saying, hey, this happened to me. I look at it and say, this happened for me. And that simple shift of two to four, you know, like, OK, you know, where’s the bigger purpose here? Yeah. And then go back to your point of joy, right. and now. So tell me a little bit more about just something you’ve done or one of the roles you’ve served in how you guys have been able to make things better for physician burnout.

Lakshmana Swamy:
Sure. So, you know, I think I really believe that burnout is predominantly a systems driven, right.. So you know, the rates of burnout are so high that I think it’s so flawed and unfair and untrue to say it’s because people sort of aren’t resilient enough. I think people are catching on to that more and more that you can’t just say like life.

Saul Marquez:
I agree with you.

Lakshmana Swamy:
You know, yoga classes and all that’s important. But the truth is, I think it’s the work that is the problem. Right. burnout is a problem that arises from the work. And I think the way that we address it is to tackle the work and to make the work better. And that comes in a few different flavors. So I’ll say, like, for example, one part of that is it’s quality improvement. One part of that is saying, you know, the people who are actually delivering the care and the people receiving it, they’re the local content experts, right., and they’re the ones who know how things are done. They know the work around. They know the problems. So, you know, again, I’m thinking about that. We actually published this, but there was a project we did when I was a chief resident at the V.A. in Boston where we kind of flipped the education paradigm upside down. And we said instead of trying to teach quality improvement and teach all this stuff, let’s put all these people in a room together. And so we got, you know, mostly the residents. Really hard to get people’s time right now. That’s one of the system’s barriers, like how do you get floor nurses into a room? It’s hard. Well, we got chargers in the room. We got some pharmacists, we got some administrators. And we would bring up patient safety incidents that the residents filed. So there’s something happened. Someone either almost got hurt or got hurt. And this is something that day that mattered to them. Right. matters to them. That was the work that they were engaging in. And what was amazing was we just gave them the problem. We helped them with a little bit of QI tools and sort of working through it. But we let them run the show, right. We let the doctors that you know, that the interns and residents. We let the nurses. We let the pharmacy. We let them figure it out. It is amazing because health care is so siloed. And every time we say that, we kind of don’t even realize how profound it is. So, you know, normally these improvement efforts would be happening in one realm or another. And you’d come up with these ideas that seem great and then they would crash and burn after on a lot of efforts putting into building them. But instead, in one hour, these people are coming together and an intern is saying, well, why can’t the nurses just do this? And the nurses are saying, well, here’s all the reasons. And it’s amazing because it was such a warm, collegial conversation, but it pushed the envelope. You know, people were challenging each other. Definitely. It was it was like robots. It was vocal. It was it was a great meeting in that way. Right. And it got through so much of that stuff that would have just failed early on. And just having that conference about every month resulted in so many quality improvement projects that started off, you know, way ahead, way ahead, because people that already had buy it in order to get by. And the idea itself came from the people doing the process, not just from the doctors, not just from the nurses, Right.. And all of that initial stuff got hammered out early on and said all none of that work. None of that will work. OK. And it led to all kinds of improvements, improvements in how quickly we could get antibiotics to someone who had newly detected sepsis on the floor. We changed everything around like we had figured out which antibiotics put in the pixies and how to get them there and all that, because pharmacy. Was that right? How do you know? Recognize vital signs, abnormalities, when to call, who to call? A huge part of it was just communication. How do you read? How does the nurse reach the intern that they need to reach? It was so just complicated and we really were able to straighten it out by having people in the room together. So much improvement continues to churn out of that conference. So the intervention from our part was just putting people in a room together, giving them a little bit of structure and letting them innovate. Right. letting them innovate and bring their expertise. So I would say the bottom line was that we just broke down silos.

Saul Marquez:
Love that man. That is so great. And big kudos to you guys for being able to create this forum and totally resonates with what we’re doing here on the podcast. This is why we’re bringing you on to share your story, right?

Lakshmana Swamy:
Yeah. Yeah.

Saul Marquez:
And so how about the other side of the coin? Give me an example of something that didn’t work and what you learned from it.

Lakshmana Swamy:
Yeah, definitely. You know, I think this is some I have to say, when you asked me kind of what didn’t work. Right. And thinking about failures, it’s it’s a little different. I can tell you about all kinds of QI projects that didn’t work. And we learned from them and this and that. But I think what really sticks out is when I was attending on service Right., I was sort of the top of the medical hierarchy running around teaching and all of that. And an elderly patient said something that was mildly inappropriate to one of the women physicians on the team. He commented on like how attractive she was or something was inappropriate, but kind of subtle. And it went by really quickly. Rounds went on. I realized I totally missed that moment to say something. Right. And it really got to me. You know, I was the role model on the team. I was the one representing professionalism. And by letting that slide, I kind of said that that’s normal and that’s OK. And the funny thing is, I’ve so worked up about missing that moment that I didn’t realize that I missed the second moment, which is just going and talking to her and saying, I recognize this and I’m sorry I did. I should’ve said something. I don’t even do that. Right. And I think it may seem like kind of a small thing to say, like this is the failure I’m thinking of. But I’m such a big believer in building a strong culture. And my silence really worked against that. I feel like if you have an opportunity to build psychological safety, right, you need to take it, because if you’re not building safety, you’re losing it.

Saul Marquez:
Right.

Lakshmana Swamy:
And so I felt like become more and more cognizant of that. And I realize that sometimes you don’t even know what’s happening to your people. Right. and this is definitely true for leadership, which is further and further disconnected. Right. who knows what’s happening to that intern, who’s talking to that patient or to that CMA who’s giving like a bad expunge that’s in to an elderly patient and nursing home, something Right.. Who knows what those conversations are like and what those people are experiencing. So if you can create that culture where people can expect to say things that are challenging and hard to hear and know, they’ll be heard. I think you’ll start to hear those stories. And for me, it’s still not easy to to recognize those moments. But I think the key thing is it gets easier. And by making sure you have a constant dialogue about gender inequity, racism, all the stuff that really is happening. Harassment is happening around us. And we kind of want to pretend like it’s not. I think that each time I catch that and speak up about it, each time I ask about it, it gets a little easier. And I hope that that starts to build the kind of culture that we want to actually have.

Saul Marquez:
That’s a great message, Lakshmana, I appreciate you sharing the story and definitely sounds like you’ve made an impact on you. And while like these steps that you’ve taken since then to even bring it up on this podcast for others to take action, I really appreciate that.

Lakshmana Swamy:
It’s honestly, it’s not easy. I think it’s really foreign. A lot of how it feels really awkward to me because you were so trained to say, like the patient is the sort of like the one we defer to for so much. And I I believe that. But it’s also like we have to set some boundaries and say, well, you’re kind of acceptable and protect our people. Right.

Saul Marquez:
Totally agreed. Totally agreed. So tell us about an exciting project you’re working on today.

Lakshmana Swamy:
Oh, yeah, definitely. So, you know, right now I think there’s a couple of things that I’m really focused on burnout and joy and work. And I think that the reason is that those are the best lenses for me to see how to fix our broken system, because it’s like it’s how we kind of care for each other and all that. So I think for me, what is a project I’m working that are most exciting? There’s a few. So I think one thing is building is kind of. So one thing isn’t on the speaking side of things. I incorporate all of this into I recently spoke at the at MDA, which is the nursing home directors organization. It’s basically the society for a prosecutor and long term care. So I spoke at the Society of Positive Long Term Care recently about burnout and all of the work that I did there. All of the conversation I had was about building culture. It was about saying, how do we build psychological safety? How can we work against against harassment and racism and all of that in our units? And then paired with that, how can we promote quality improvement? How can we empower the front line to make the processes better? So I think what I’m working on the speaking side is kind of like getting that message out that burnout is rooted in systems issues. And we can we can tackle the system’s issues and it’s more than we can. We really have to. And we’re the only ones that can. I think, you know, on the research side, I’m diving deep into what is really driving burnout. Like what? What are the parts of the culture? What are the parts of the of the way that we are delivering care that are that are making it so bad? You know, I think it’s different for different people. I think it’s different for a nurse in the ICU than it is for a primary care doctor than it is for a physical therapist. But the flavors are kind of different, but the themes are really the same. So I think it is important to understand that better because the solutions are never going to really be one size fits all right. I think the themes of the solutions will be in the sense that people need to get out there and improve the work. I think being involved in improving the work that itself can protect us. Think a little bit against burnout. Right. being involved in making the work better. It gives you a sense of sort of personal accomplishment. But I think that understanding burnout, it feels at a young field, even a burnout literature has been around since the 70s. But really understanding what’s happening today with the electronic medical record, with the way we pay for care and the struggles that patients have in getting care connected, all of that, all of that stuff is kind of new. And I think it’s created a very different experience of care.

Saul Marquez:
Some great stuff that you have gone on there and Lakshmana. So keep up the awesome work. Really excited to see the findings that you bring from from your research as well as the workflow improvements that you come up with. So Lakshmana, at this point we’re gonna do the lightning round. So I’ve got a couple questions for you. Followed by a book that you’d recommend to the listeners. You ready?

Lakshmana Swamy:
OK.

Saul Marquez:
What’s the best way to improve health care outcomes?

Lakshmana Swamy:
The best way, I would say, is to listen to doctors, nurses and patients.

Saul Marquez:
What’s the biggest mistake or pitfall to avoid?

Lakshmana Swamy:
It’s sort of paired with that, but it’s thinking that you are the expert in leadership. We so often see where we’re managing so much, making so many decisions, but we’re not the experts, the experts or the people involved in the local processes. And that’s the people delivering the care and receiving the care. And I think all of us as improved as administrators, innovators. We’re all here to use those skills to help make their jobs easier. Right. to make the job of being a clinician or a patient easier. And you can’t do that without their insight.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Lakshmana Swamy:
This might sound a little counterintuitive, but I think the key to staying relevant today in health care is to focus on joy. Amy Edmondson points out that one of the key steps in building psychological safety is to reframe failures right.. And I think reframing them assistance is not individual failures and to reinforce motivation. I think staying relevant, focusing on joy. Motivation is so critical. We take so much of that motivation for granted every day, too. We want to stay relevant. We should make sure that our people are reminded every day by us in person how important that work is, how important they are to the mission. Because when you’re in it and when you’re turning through all that stuff, you’re going to forget a little more everyday when you’re going through the paperwork and the meetings and all of that stuff. So you’ve got to find that spark that they come in with and you’ve got to feed it. And it’s not going to happen on its own.

Saul Marquez:
Love that. And what one area of focus that drives everything in your work, Lakshmana.

Lakshmana Swamy:
Let’s say for me, I think it’s it’s really the relentless drive to improve joy and improve outcomes by fixing broken systems and building better culture.

Saul Marquez:
That could not have been more succinct, my friend. I love that. Value, value, value. Folks, focus on today. Don’t make it complicated. Focus on joy. Think about how you could do that. Make the ripple effect that Lakshmana is creating here. Touch you. So I have two more questions in the lightning round. More on a personal note. The first one is what is your number one health habit?

Lakshmana Swamy:
My number one health habit for myself is probably the combination of sort of distance running, which I know a lot of people kind of say, I love it. It gets me free from both my you like from all obligations. I feel truly liberated. And I can really think, well, I’m out there, you know. And baking, which is kind of.. And bakes.

Saul Marquez:
That’s awesome. What’s your favorite thing to bake?

Lakshmana Swamy:
I’ve been really into sour dough lately. .

Saul Marquez:
So you make your own bread stuff.

Lakshmana Swamy:
Yeah. Yeah. It’s not that hard. Once I know. I kind of like apprenticed with one of my friends. I went to a, I watched everything.

Saul Marquez:
That’s awesome. Yeah, I love that. So what is your number one success habit?

Lakshmana Swamy:
I think my number one success habit is probably reflection. But when I say reflection, it’s pretty active reflection. It gives conversation really so I think the thing I do is that I put myself out there and I say things that I think are a little bit pushing the envelope to people that I really respect. And I get really, you know, what I’m fortunate to have is that I get incredible feedback. So, for example, when like when I was at ACGMU working with Clear, I was a resident representative at that time, I represented the trainees and in a pretty huge motor like organization. And it was, you know, sitting in that room with people all around me who are incredible, really and insightful way, way like veterans in their careers. And I’m here I am. I felt like, you know, I just kept saying things. It was amazing how much I learned and how much I had been wrong about. But I think the I guess I’m kind of like getting a little convoluted here. But the success habit for me is in putting things out there and getting feedback constantly all the time from everyone.

Saul Marquez:
Love that man. It’s a great habit. Thank you for sharing those. And what book would you recommend to the listeners?

Lakshmana Swamy:
I kind of have mentioned this a few times, but I would say right now the book that is really motivating me and giving me direction is the Fearless Organization by Amy C. Edmondson. It’s just an awesome read about it. It makes it very concise words, the importance, the data behind the importance of psychological safety, what it really means in every industry and how to build it, how how anyone can and has to be contributing to it, and how how much of an impact that can have on on every.

Saul Marquez:
Great recommendation, Lakshmana. Listeners for the full transcript of today’s interview, as well as links to the books recommended and other resources mentioned, go to outcomesrocket.health and in the search bar type in Lakshamana that’s LAKSHMANA. You’ll find all of it there. Lakshmana, this has been fun. I’ve really enjoyed our talk.

Lakshmana Swamy:
Oh yeah, me too. This is awesome. Thank you.

Saul Marquez:
Hey, before we leave though, I love if you could just leave the listeners with a closing thought and then the best place where they could get in touch with or continue the conversation with you.

Lakshmana Swamy:
Sure. So I think I think my closing thought is that the entirety of the way we deliver care and receive care pushes us to think otherwise. It pushes us to think not this, but it’s so important to remember that all of us who are in this game, who are here to care for people, we bring our whole selves to it. We are caring, extremely skilled, educated, talented people. And we make mistakes because the systems that we work in are incredibly complex and fragmented and let us down. And it’s so easy to blame other people and to feel that to see blame really everywhere around you. But we’ve got to avoid that. We’ve got to really got to support each other. And we’ve got to understand that people are here with good intention and good backgrounds and good skills. And we need to help everyone succeed.

Saul Marquez:
What a great, great parting message and you were going to share your best place to.

Lakshmana Swamy:
Oh, yeah. Yeah. Those are honestly the easiest way is probably Twitter, LinkedIn. It’s @laxswamy.

Saul Marquez:
Outstanding. There you have it. Lakshmana Swamy just chatting about physician and clinician burnout. Focusing on joy, psychological safety and making sure that we’re doing the best that we can do so that we live in a joyful way. So much more. I just want to say thank you so much and definitely looking forward to staying in touch.

Lakshmana Swamy:
Yeah, definitely. Thanks so much Saul, it’s awesome.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.

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