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Interviewer: In this episode, we get the opportunity to listen to a conversation between Dr. Michael Good, the CEO of �㽶��Ƶ of Utah Health and the Senior Vice President of Health Sciences, and Dr. Nita Ahuja, Chair of Council of Faculty and Academic Society at the AAMC.

So when it comes to rediscovering the joy of academic medicine, why is it important that we focus on making sure everybody gets that joy? Well, actually, before we do that, is this a problem?

Dr. Ahuja: Heck yes. Oh my God. I mean, I think this is . . . there have been a lot of discussions over this topic in the last 10 years. COVID, the pandemic, just made this problem perhaps more exponential.

What's interesting is we used to say it's a doctor problem, a physician problem. And what we have learned is that our nurses are burnt out, our students are burnt out, our staff is burnt out. So this idea of burnout or lack of well-being is there in all parts of our health system. And if the people who deliver health to the nation are not healthy, then you've got a problem.

Interviewer: Has this been your experience, Dr. Good, as well at �㽶��Ƶ of Utah Health?

Dr. Good: First, I want to thank Dr. Ahuja in her role as Chair of the Council for Faculty and Academic Societies, one of the principal groups here at AAMC, for making this a focus of her time as chair. The CFAS, the council, had their annual meeting in Salt Lake City, and we were able to have a panel, a well-attended panel there. And again, here at the AAMC meeting in Seattle, a well-attended session today.

Health care continues to evolve in both good and challenging ways. And as I told the group this morning, health care is human beings taking care of human beings. And certainly our patients, the second group of human beings there, come to us sometimes when they're well, but certainly more often when they're not well and they're seeking to regain health.

The first group of human beings is health care professionals, and particularly our physicians. If they're not well, they're not going to be able to provide that human-to-human care that is really, I think, the reason so many of us go in to health care.

Yes, this is an important topic. I'm, as I shared with the group earlier today, very pleased. �㽶��Ƶ of Utah was among the first to have a Chief Wellness Officer. Dr. Vivian Lee, during her time in the Senior Vice President role, appointed our inaugural Chief Wellness Officer. And several years ago when that individual retired, I was able to appoint Dr. Amy Locke, our current Chief Wellness Officer, and she's built a team, particularly including our resiliency center.

So on the one hand, to your question, yes, well-being is an important area for us to focus on in healthcare. We're not where we would like to be, but on the other hand, I'm also pleased with some of the talented individuals and experts we have at the �㽶��Ƶ of Utah who are helping to guide us to get better and to be all that we can be for our individuals and our teams.

Dr. Ahuja: I'm so glad you mentioned the fact that we need to think about the well-being of the organization. This is something that we at CFAS, which is the Council of Faculty and Academic Society that represents the physicians from each of the medical schools and our academic society, has spent a lot of time thinking about and has published reports on that.

And a lot of our thinking over the past few years has been that it takes all of the people in health systems to start to address this problem.

Certainly, there are a lot of efforts early on spent on thinking about what we as physicians could do. You may remember all the things we talked about, yogas and meditation rooms. But increasingly, it's been really gratifying to start to hear CEOs and deans start to come to this realization that we all need to address this collectively.

I guess my question to you is, as we think about perhaps the different ways we address it, how do we know what's successful? Is there a metric we can start to use that all of us can adapt and say, "Yeah, this one's working because we're moving the needle in this"?

Dr. Good: I think that's why I'm so pleased to see you, to see CFAS, to see the AAMC addressing this issue, because as a community, we're stronger and we'll gain that knowledge more quickly.

There are a number of things going on at our member institutions, and in a session like we had this afternoon here at the annual Learn Serve Lead meeting, we heard some of those examples.

At �㽶��Ƶ of Utah with a new survey, we're trying to consolidate. We're all so tired of every time we do something, we're surveyed, right? And "I need a 5, please. Please give me a 5."

Delta Airlines is a big part of our city and our community. And I get so tired of, "Please give me a 5." But we're trying to be more sophisticated in the way we seek input from our team members. And we are also working with professionals in that space, in the experience space, so that we can identify actionable items that would make the workplace and coming to work more exciting for our team members. So a work in progress, as they say.

But I do think the measurement techniques . . . Again, this is all emerging. It's happening so fast. But often, the richness that comes in a survey comes in the write-in comments. Not the 1, 2, 3, 4, 5, but the write-in comments.

And our teams now are using artificial intelligence natural language processing. We finished up our most recent survey on Friday, and by Tuesday, the team had given me the key drivers at the organizational level. I mean, there were just thousands and thousands of free text entries, but the AI was able to consolidate that so much more quickly than the human interpretation.

So I think we're learning how to better measure. And again, that's why I'm so proud to see this on the agenda for CFAS and for AAMC, because just as happened this afternoon, our member institutions are going to come up with solutions. And some of those solutions are going to be very institution-specific, but many of them will translate. You see this in so many aspects of academic medicine.

Dr. Ahuja: I love that, hearing that AI is now starting to help us. We're hearing things that . . . A lot of us as clinicians worry about in-basket or electronic health records, and now starting to hear how AI may help our lives get better.

I was fascinated to hear that you had invested as CEO. So many people committed to this task in your health system, and you've taken the message from the top and then put it down to each unit. I guess when you sort of think about making decisions and balancing, there are only so many resources. How did you make the decision that you're going to invest so much of your resources in this domain?

I can imagine that you only have a limited bin of resources, and to invest that struck me as remarkable. And I'm hoping that our other deans and CEOs will sort of make this . . . You'll make this contagious. So I wondered how you came to that balancing mission.

Dr. Good: I don't know how to provide world-class health care without world-class health professionals. The physicians, the nurses, the pharmacists, the whole interprofessional team. And because of that, it's just a natural . . . We have to invest in our people.

I distinctly remember periods in my career where I woke up early. I couldn't wait to get to work. There were just so many exciting things that happened. Sometimes I stayed late. And I also remember those periods where I dreaded . . . you hit the snooze alarm three or four times. At that moment, the environment wasn't right. It wasn't resonating. I wasn't finding meaning, like we talked about.

So, again, I think perhaps at different points in our career, we all have these different chapters, but we need to make a lot more of the former chapters.

I want our team members waking up, can't wait to get shoes on and get to work because the environment is meaningful. It's delivering purpose. It's delivering joy, and really trying to eliminate or mitigate or minimize some of the barriers that make it the other way.

I'm also a realist. I mean, there are things that have to get done. We have a rapidly growing population in Utah, and we have to take care of a lot of patients. And so that means some days there are very busy clinics and very busy OR schedules and so on. But I also think we have the ability to say . . . I view it as sprint and rest, sprint and rest. You're a surgeon. You know all about long days and sometimes nights in the OR.

Dr. Ahuja: Yes.

Dr. Good: But can we sit down and figure out ways so that, much like a relay race, there's a certain member of the team who's running hard on Monday and Tuesday, and then somebody else picks up and runs on Wednesday and Thursday?

And I do think other health care organizations . . . I think either leadership of the present or leadership of the future will have to be mindful of this concept of wellness, or our academic medical centers won't be able to excel in their missions.

Dr. Ahuja: So I'm curious. I think all of us say that culture is critical to all of this, and a lot of the sense of feeling joy, feeling a sense of belonging is building a great culture and also modeling good practices. 

I wonder if you can talk about how you ensure that culture is set up in your organization so people see that and say, "Oh, yeah, this is important to my leader."

I think that can be so powerful, much more than dashboards. And this is coming from a surgeon who loves dashboards. But I do think that there's a lot of how we model our behavior that our folks around us see and mimic, and I wonder how you do that in your daily life.

Dr. Good: I've spent a lot of time thinking about culture, and my kind of framework for culture is our organizational culture is shared values and beliefs demonstrated in daily behaviors and actions.

For example, kindness, respect. We talked earlier about civility and dignity. I may disagree with your position on a particular situation, but I need to be able to respect your opinion and sit down and figure out how to either, if we can, resolve our difference or agree to disagree.

When we talk about organizational culture, for some it will just resonate with the values and the mission statement and so on, and they'll really believe that. But if they're having trouble finding that alignment, I just ask them to focus on their daily behaviors.

I find great joy in my own job. I tell people, "Come to work today and make somebody else successful. Help somebody else achieve something that they're trying to achieve."

We get so focused on ourselves. "I need to get this done today and I need to get this done today." Come to work and ask a colleague, "What are you trying to get done today?" and lean in and help them. When you see them succeed at something in any of our spaces, I find that very rewarding.

And the second thing about culture is you have to not be afraid to talk about it, and you also have to not be afraid to take action, particularly when there are transgressions that are out of bounds.

I appreciate you bringing that up. I think culture is both a very challenging topic, but also just so critically important.

Dr. Ahuja: And we had talked a little bit . . . We titled this . . . We had, as you mentioned, a session about rediscovering joy in academic medicine. And part of it was, of course, that there are a lot of challenges with our jobs. These are tough jobs. We work long hours. But can we start to educate ourselves on little moments?

And I'm glad you touched upon that. How do we ensure that our clinics, our pods, our departments, divisions, our classrooms celebrate the little wins and take pleasure in those little moments?

I'm glad you said it. I often take joy when I see a patient in the clinic a few weeks after surgery and they're feeling good. It gives me a lot of joy. And I really model that and talk to my residents about that.

I wonder if there's more we should start to do, because that was some of our premise, that yes, there should be Chief Wellness Officers, there should be CEOs who think about it, but perhaps what should we as physicians start to do in our own lives that are things that bring us joy? Are we holding onto that?

You talked a little bit about that in your own life. I would love for us to talk a little bit more on what do you do to make sure you hold onto that joy in your own life?

Dr. Good: Well, the first part I'm so glad you brought up. I use the phrase "connect to purpose," right? We went into medicine to help other people heal, to conquer health challenges, and so on.

And many of our days are filled with those moments where you've performed a surgical procedure. Somebody had a problem, and sometimes it may have been life-threatening, you perform a surgical procedure, and they get back on with their life. I think the busyness of our days challenges us to take a moment and celebrate those accomplishments.

For a whole variety of reasons, life is busy. It comes at us fast, and now comes at us in our phone, in our email, in our texts. Many people keep to-do lists. I keep a done list. I just write the stuff I got done today. Sometimes I look at that and I say, "Okay, I got a few things done today . . ."

So I don't know. Maybe some of it is perspective, maybe some of it is taking the pause, but I worry that . . . And I do it too. We get so caught up in the busyness of life that we miss those special moments and don't take a second to celebrate them. So I think that's part of it.

I've always said I think the first thing a leader has to lead is their own life. I think many leaders are often in a family unit and often are leaders in their family unit or co-leaders in their family unit.

Again, a lot of times in medicine, we say, "I want to become a physician." I call it the launch sequence, right? You take the classes they tell you in college to get into medical school. In medical school, you go through the curriculum. Your big decision in medical school is trying to discern what practice area you want to go to, specialty. And I don't know about you, but it was like 14, 15 years later, I said, "I have to start making some decisions in my life." You just follow the playbook . . .

And for me, I was enjoying the . . . I trained at the �㽶��Ƶ of Florida and I enjoyed that environment. I just went in and asked the chair, "I'd like a job." I didn't even negotiate. I said, "Could I come on the faculty next year?" It wasn't until a year later that I realized I hadn't got a very good contract.

But my point is we're often into our mid 30s as physicians before we have to explore this concept of intentionality with our own lives. Maybe we start a little late. I don't know.

Going back to the question you raised, I think not being afraid to have panels like we had today and the other activities of CFAS. I've always enjoyed learning from colleagues, everything from, if you will, the science and the art of medicine, but also some of these more humanistic and personal aspects of our profession.

Dr. Ahuja: Well, I think these are some incredible points, especially those last points of, yes, we can put in all the champions, but creating a culture, modeling that joy is important.

I love the joy pause because, as you and I both know, you're an anesthesiologist and I'm a surgeon, we take a surgical pause before we operate on a patient, saying, "It's important we think." And I wonder if we could take a joy pause in our life weekly to sort of say, "These are the things that bring me joy."

So I'm so glad to hear this and I wonder if we can start teaching this to our students a lot earlier in life.

Dr. Good: I think you just invented something, the joy pause.

Dr. Ahuja: I know.

Dr. Good: I love it. 

Dr. Ahuja: I know. We're going to patent that, the joy pause.

Dr. Good: All right. There we go.

Dr. Ahuja: There we go.

Interviewer: Dr. Good and Dr. Ahuja, it was fantastic to listen to some of these ideas about how we can rediscover joy in academic medicine. Some of the ideas I heard are find help when you need it and seek out those resources. Culture is important, which an employee might not be able to control, but you could look for a culture that's going to be supportive, obviously, or take a leadership position and attempt to change the culture. Some great ideas of how to do that.

Modeling self-care, showing everybody else it's okay to do these things as a leader. Try to help one other person succeed, which I love. That's going to make you feel good every single time. And then reeducating ourselves to allow ourselves to take care of ourselves and also to look for moments of joy, like you talked about. Some great ideas.

Before we wrap up, were there some other ideas or some other things you're hearing other academic medical centers doing that we didn't discuss today? Just a brief mention of those ideas.

Dr. Ahuja: I think there are a few things that we mentioned earlier in our panel, which is to try to get the minimum amount of bureaucracy in our health systems that we need to get the work done. We do need to do work. I heard that you have eliminated many surveys and gone to a single survey.

In-basket comes up often as our electronic health record has improved lives, but has also created a lot of work. So are we measuring that?

And I love this. It's to get rid of the stupid stuff. Are we getting rid of all of those things?

I think those are some immediate things that come to mind. Mike, I'm sure you have a few other thoughts on this.

Dr. Good: We heard from colleagues at other institutions. I think the collective is wiser than any one individual place. And just don't forget on your list the joy pause. I think there's something there.