Burnout, Boundaries & Better Clinics

0:00 You're listening to the PT Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. All right, thanks to VoiceOverGuy. Big thanks to Empower EMR. If your clinic is stuck in an EMR that slows you down, that sucks. But that's also your fault, because you can get out of that. It's like you're married to your EMR. You can actually even get out of that. Empower EMR gives you speed, Clean workflows and features PTs actually asked for. Just making the template a different color is nice, but I want to make it easier. Better notes, faster documentation, smoother operations, all wrapped up in customer support that doesn't ghost you.

0:40 Because when something breaks, and it will, you want to make sure that someone's going to help you get out of it and unbreak it. EmpowerEMR.com. That is EmpowerEMR.com. All right. Let's talk about today's guest. Started as a PT. treating complex pelvic and jaw cases. She still does that. But today, she's redesigning entire clinic cultures. That's a different kind of treatment from frontline resilience to executive leadership development, whether she's leading DEI programs, improving communication systems, or making lunch breaks a reality again in clinical care. She's proving that healthcare doesn't have to be this broken. Yes, one person is doing all this.

1:22 uh she's helping teams connect with their purpose and each other uh let's bring in today's guest holly cunningham holly welcome to the show poof and there you are hello all that's you i yeah i mean obviously we have people in how about we can delegate i just meant but what i mean is like that's wide you're doing a lot of things and i love it i love the multitude of my every day it's fantastic So we'll get into some of the specifics, but what I like people who went in a door that lots of other people go into. And then when they're there, they sort of make a left turn like me. Like I do some, I'm still a PT.

2:02 I swear I had the license. I got the degree somewhere, but I'm doing something different. At what point were you like, at what point and why were you like, Hey, I'd be a good fit for doing this other stuff. And how'd that, how'd that go? Great question. So I actually took a I call it my sabbatical. I took like a year and a half in Michigan. I am in Colorado, but I was living in Michigan for a year and a half and I was in a slightly different setting. I was kind of like bouncing around and I noticed how many people that I worked with were so Burntown's not the right word. They were just so much less passionate. And they had been in the field for so long. And Michigan wasn't even that crazy of a place to treat in.

2:45 They weren't asking people to double book. They weren't doing all these things because the reimbursement's a little better than Colorado. But I just noticed the lack of passion and it wasn't that they weren't taking continuing education, anything like that. And I was trying to figure out what was going on. And I started talking to all of the various higher ups that I worked with in the various settings. So this was between outpatient hospital staff. IPR, all those things, and trying to figure out what the disconnect was. And a lot of them hadn't treated patients in... decades and they couldn't figure out how to connect with their employees in order to make them feel like their every day was worthwhile.

3:32 Like the abusive patient or the abusive family of the patient or the non-compliant patient and outpatient or whatever it may be, they couldn't connect with their staff PTs in order to make the staff PTs feel like their day was okay. And so we started coming up with strategies and I really liked it, but there was no space really in those settings for me to connect all of them and continue what I was doing. And then I spoke with the company that I had worked for in Colorado and I missed them. I was thinking about coming back to Colorado and I was like kind of ready and especially ready for better weather and talk to them about what my goals were.

4:14 And I was like, I think this is really valuable because you're going to improve your retention rate, your quality of care is going to go up, all that. And they came back to me and they were like, let's do it. So I came back in twenty, twenty three and basically have had a hybrid role as the, as focusing on the employee experience, leadership development, all of that. And then on top of that, treating patients and managing clinics. So it was nice because I know it sounds like a lot, but it's nice because it all kind of fits together. Like I get to work on my own resiliency while also helping other people. I get to help run clinics in a more efficient way that drops how much clinicians have to do in order to meet a productivity that keeps the doors open.

5:03 It keeps the higher ups happy, all of those things. So it fits hand in hand. Plus you don't lose, you don't fall into the trap you just described which is you're still doing it even in a reduced amount of hours or interactions you're still doing the thing i'm curious did the higher-ups who were losing connection and not able to relate did they try pizza parties because a lot of times in our profession we love people maybe two pizza parties so many pizza parties literally like a monthly pizza party they're like we're feeding them i don't understand what's happening i'm like well food is great like we need the calories to have the energy to help these people but like you're not really you know making them feel valued you're not reminding them that like what they're doing is um incredible like absolutely life-changing for people so yeah So let me start with this.

5:54 You've seen the system from both sides, patient care and people ops, and you still do that. What's the one thing we still get wrong when it comes to putting those things together? What's still the disconnect or the big misconception? I always say most communication breakdowns are because of misaligned expectations. I expect A, but I got... cue and that's not good so i'm angry so what what do we still get wrong um remembering people's values so it is that disconnect so like if i go and talk to one of my staff physical therapists and i come at them from purely a if you don't see this many patients you're not going to make enough money for the company so our doors are not going to stay open I'm threatening their livelihood, right?

6:49 But I'm not connecting to what they value the most. That person, that individual might value their PTO, their time off to go see their family in a different state. They might value money. Most people do. They might value quality of care and seeing more patients. That's why they got into PT. So if I come at them with a conversation of, hey your patients are starting to fall off for where you know our empty our schedule is pretty empty what's like asking them questions what's going on but then connecting it back to hey like if you hit x numbers you're gonna get x amount of more pto you're gonna be able to travel more or you're gonna make x amount of bonus you're gonna make more money those kinds of things so so connecting it to the individual is what i've noticed is that's where people lose that.

7:43 Like they think they just need to speak to the general public, but in reality, you have to speak to the individual. Otherwise you're just going to go right over their head. If we say in communications, when you try to talk to everybody, you talk to no one, right? Right. Which is not a product for everybody. I don't know. Ice cream and pizza already have the world sort of, that's everybody except the lactose intolerant. Those people are out. But if you can, right. So I'll bring this up. When I worked at a pretty large multi-state clinic, we focused on, you said, remembering their values. So we brought in this big old fancy company, paid them, I don't know how much, that's about my pay grade, paid them a lot of money. And they interviewed a lot of people across different roles, different geographic places, different parts in their career.

8:28 They got a good sampling, cross sample. And they came back and they said, hey, listen, People come here and stay here for one of three reasons. It's probably a little bit of all three, but you need to talk to each of these archetypes or you're going to miss. And the good part was, of course, because we love in marketing when they all have alliteration. So these all began with the letter C. And the three C's were craft, cause, and community. And at first people were like, no, no, no. And when you drill down, craft meant like, I'm here to be the best PT, PTA, OT, speech therapist, athletic. I'm here because I am super PT.

9:10 I go to conferences. I read, I eat, I sleep, I breathe. I'm a PT. cause would be what's the whole organization doing we're here to protect athletes we're here to protect old people we're here to you know make babies better that's what the mission of the group the boat which what boat am i on am i the best craftsman would be like am i the best rower the person who cares about uh cause would be like where's the boat going and then community is like what's the vibe of the people on the boat is this a good party or a bad party now we all want generally a little bit of all three, but there was, they were like, you need to make sure there's a little bit of, if you're making a meal, if you're making a new program, um, doing a webinar, something, there needs to be a little something, a little seasoning from each one of those jars in it.

9:59 Or the person who values that the most is like, I don't get it. Why is this for me? Notice I didn't say at any point, people are there for a pizza party. That's not why they're there. They could buy their own pizza. I will buy my own pizza. I don't need you to do that. I need you to do the other things that I can't do. at home. So it sounds like we're speaking the same language there too, which is making sure you understand the who and their values. Now, you've said you've had patients, lots of patients, tell you that you were the first person to validate their experience as a clinician. I want you to use that situation to talk about the system.

10:40 What's that say about our system if you were the first person to validate their experience and they've probably had lots of interactions with their clinicians before that? This is sad. This is a canary in a coal mine, right? It is, you're right, it is incredibly sad. It makes me incredibly frustrated with our system because I'm nowhere near the best clinician out there at all. But what I think that people forget is that patients are people and all you have to do is listen to them. And all you have to do is recognize that there is truth in what they're telling you. It may not be everything because they don't know everything.

11:21 We don't know everything. But what they're saying is valid. And this is true for employees, too. So I use this technique for everybody. I think with our health care system, one of the things that is broken, and this is true across every type of MD specialist, every type of surgeon, PT, whatever, any type of health care provider, is that when you go to school, there are so few programs that tell you to listen first. They are told to, you know, know what these symptoms added up should equal.

12:01 They are told that this if this test comes back negative, then it's not this disease, you know, blah, blah, blah. But we are not told to sit there, look at the patient, see them in front of us and listen to what they're saying. And I think that would change if those programs started doing that. Our health care system would change drastically. Scary, isn't it? terrifying because it doesn't cost doesn't like it costs a whole lot it costs nothing they can record it like it can it can cost zero money it can cost zero a lifetime like face to face like you can still be productive and efficient it takes no no effort to sit there and listen Wild.

12:46 It is crazy. As somebody who's now leading, I mean, is this employee experience? Well, first of all, what do you call it? Is it employee experience? Is that like, yeah, okay. I mean, just people ops. Just fancy. People ops. That's like the tech, the business side of it. But I'll call it employee clinician experience. As someone now who's leading that, What are the hidden signals that a clinical team or a member of the team is burning out before they even realize it? My dad was a fireman. He's like, this is how you put a fire out. He's like, the best thing to do, make sure the fire don't start. Like that is prevention, right? So what are some of the things that people could look at in their own teams and go, okay, before this fire starts, at least I know that there's something wrong here.

13:34 What are the things that you suggest people look for? Cool. You know, I've always tried to figure out because I do leadership development. So I try to help other clinic directors with this as well as our higher ups so they can sort of see the trickle down effect that they create. But I think, honestly, one of the biggest things is when the clinician stops working. listening. So patients recognize this really quickly. So they'll leave an MPS score or a review pretty fast and say it doesn't feel like they heard me. It feels like I was just another person.

14:16 I didn't feel like it was treatment tailored to me. Those cues, especially someone who has hadn't had that issue before um that started to pop up i'm like oh that's not good because all of a sudden that clinician no longer has the energy to pay attention to the person in front of them their brain is shutting off and creating an extra boundary so that they don't have to put in that extra brain power and they're just going through the motions we know this though Yeah. And it's tricky because PTs are more complicated because most PT programs and OT and speech, obviously, I haven't gone through those programs, but PT programs are like PTs are taught to listen.

15:02 Right. But. it's a it's not natural for everybody um so if you come in and you've learned it but then that starts to trickle down that might be the first thing to go if it's not natural for you and then on top of that if it is natural for you that's a big red flag if you are no longer listening if you are just kind of Well, it's, you know, I mean, it's what a four-year-old would do. So it's what we default to, which is like, uh-huh, uh-huh, uh-huh. I should say teenagers. I have experience with teenagers with friends of mine. I feel like it's a teenager thing. Uh-huh, uh-huh, yeah. Exactly. Teenagers can have phenomenal boundaries. Their frontal lobe not being developed yet, like, good for them.

15:44 But as a clinician, we need to find that, like, in between. Like, emotional boundaries where you're not taking it home, right? And bring yourself out that way, but not to the point where you're losing that quality of care and listening to people. Episode today brought to you by U.S. Physical Therapy, national leader of clinics focused on developing clinicians, not burning them out. That's good. Leadership tracks, mentorship, career growth. Oh, my. And the stability to build your future in PT. If you want a place that supports how you want to practice, that could be U.S. Physical Therapy, USPH.com. That's USPH.com. dot com. So what advice would you give right now to someone who is not in the profession, a PT student?

16:26 who wants to maybe come in and change healthcare, but might also feel like, man, I'm not even on the totem pole yet, right? But feels totally powerless right now. How do they pick a place that they don't get caught up in this? If they do get to a place, how do they use their words and not their non-listening skills? So let's go with the first one. How would you tease out for a PT student If an environment they, because of course, I mean, PT students are in demand now, baby. PT students, you have the power. They need you. They want you. They need you. But make sure you don't go and chase.

17:09 Listen, I'm all about you getting that bag. But if you chase it, but you get there and the situation is bad, the situation is something that Holly's describing. How would you teach them to ask a question or two that could tease that out? That's a really good question. I think a company like if you're talking to the clinic manager or the owner, whoever it may be, depending on how big the company is and talking to them about what the company values in terms of day to day, like the company is going to have their values written on their website and it's. their you know global mission statement but which is yeah great everybody has a good one regardless of how good the company is uh that's the whole point but what are they valuing day to day if they're only valuing if they tell you like we want you to see like keep your schedule full um Your patients can be seen one-on-one.

18:07 You don't have to double up. That's already a good start because what that means is that they're not prioritizing you seeing absolutely as many patients as possible. They're giving you that time to have that face-to-face with patients. That's a pretty good thing. On top of that, what is their value of Con Ed? We all want Con Ed to be paid for. That's a big deal. However, Con Ed has been shown to reduce burnout. If someone has a lot of knowledge, they are not going to be taxed as much every day trying to problem solve and figure out what's going on with patients. So if that company can prioritize Con Ed and not just saying like, oh, we have our own in-house Con Ed that you can take for free, but we won't pay for anything outside of that.

18:53 Not good. You should be allowed to take what you want because there's so many good programs. Shout out Institute of Clinical Excellence and all those other ones. But It's how they are able to support your growth and supporting you in terms of making your life easier. They all say get some mentorship, but what does that actually look like? Actual mentorship programs are so rare. Residency programs, different, obviously. mentorship programs are super rare so they actually have a structured program with someone who is going to sit with you regularly with a structured schedule of like how that meeting should go each time that's a big deal because they're prioritizing your learning and making sure you feel confident and comfortable in what you're doing i would also say making sure you never work alone because Then you get that extra support and that community feel.

19:53 It is so rare that a PT does well working by themselves, even twenty years later, because that twenty year veteran no longer has that up to date research that the new grad has. So you are just seeing a different way. Like not I mean, nothing against research. Right. But just like we get in ruts, right? That too. Exactly. And you see like a new exercise or yeah, I forgot about that thing or yeah, that's a good idea. Or, Oh, I forgot about that diagnosis or, you know, whatever made me exactly. Yeah. You got it. Yep. I think, I think I'm getting it. Um, do you want to play a quick game?

20:34 We're going to call it, we're going to call this game culture check. You ready to play culture check? Sounds awesome. Okay. gonna throw a statement at you you tell me if it's a green flag or a red flag in a clinical culture you ready for that yeah i'm a little sweaty but okay let's go all right no one there no one at the clinic ever takes all of their pto green flag or red flag red flag yeah why it's there for a reason take a break yeah but that show in my opinion it shows the culture is we value you working hard which i'm okay with we value not taking the thing that you just you deserve everybody deserves it when i ran radio stations i said you have two weeks or three weeks vacation and five personal days if any of you hit january or december thirty first with all of those i don't do it don't do it that's amazing don't do it that's how it should be red flag green flag we talk about dei but no one really knows who owns it if there's no one who owns it red flag yeah why Because someone should be making sure initiatives are happening, making sure that things are where they need to be.

21:42 It doesn't have to be everybody has a piece of it, but one person for sure has to be making sure that they're tracking and making it okay. Here's free consulting advice or one of my things. When I get brought into an organization, it doesn't matter, in healthcare most of the time for me, I say, hey, if this doesn't go well, who gets in trouble? And it's a weird question to ask in a room full of adults. And when they can't answer it, I go, oh, that's why I'm here is because no one owns it. So if no one owns it, everybody's just like, they just look at it like it's, you know, it's a turd on the floor. Like, well, someone else will clean it up. And then everybody just walks around it. Yeah, you just sort of like, you look at the court, you know, it's there. You own it, it gets done.

22:24 Nobody owns it, doesn't get done. All red flag, green flag, all staff meetings start and end on time. Green flag. Yeah. Respects boundaries. Yeah. Values other people's time. Absolutely. Came prepared. Somebody had a crazy statistic that if you are going to lead an hour meeting, you should spend like, I don't know if I agree with this person. They're like, you should spend twice the amount of time preparing for the meeting. And I was like, that seems insane. to prepare for two hours, but you do you. I do like when you can tell there's a structure, there's a purpose. What are we doing here? Okay. Today's goals are these three things. And if we can hit them in twenty eight minutes, we're out of here.

23:04 If not, we got sixty. Last one. We have exit interviews, but never change anything. I mean, this is obvious, but red flag, green flag. And why? That's a terrifying red flag. I don't think that at all is great. That's fantastic. Right. But flat out, we never change anything. Like, even without extra interviews, you should be constantly as an organization trying to get better. Always. I was in a Facebook group the other day and someone was like, asking for the, you know, what should and shouldn't I say in the exit interview? And I was very clear. I'm like, if you're leaving, you understand that that exit interview is for them.

23:46 And I'll get an expert in here, but I'm pretty sure this is a legal thing for them. They are right. HR does exit interviews. HR works for the company. HR doesn't work for you. Let's be very clear. So do you owe them an exit interview? I don't know if they, I mean, I have never, I did a bunch in the early career because I was like, I'm going to show them. And then I'm like, oh, wait a minute. If they cared, they would have changed it six months ago before I left or whatever it was. So I have never done them ever again. But if you do them and no one, because there are those people who are there to change things because they want to leave their coworkers better. And maybe I can, you know, tell them and I wag a finger and they do it.

24:28 But if nothing ever changes, man, oh, that's so frustrating, right? I can't even imagine. I mean, honestly, like that, that shouldn't be the only time you're given to give feedback. But if that's the only time you feel brave enough to feel that, give feedback, then I could understand it more. That should have been on my list. Red flag, green flag. No productive or clear routes to give feedback. And is something done? I've been in organizations where we've done structured quarterly feedback. And after the first two times, when I thought, you know, the first time, all right, let's do it thoughtfully. What do I want to improve? Because, hey, this is where I spend eight hours of my day or whatever it was.

25:08 And after I did it twice and saw nothing changed, Holly, what do you think I did the third time it was time to do structured feedback? I wasn't even, I was sitting in the back of the room. I filled it out. Like I was like, yeah, everything's great. You're great. I love you. You're great. What am I doing? Smart people don't do dumb things most of the time. They do sometimes, but they're not going to put effort into it unless they think it's going to actually lead to something. Right, exactly. And I think companies need to recognize, even if you can't necessarily fix something, people are going to have all kinds of feedback. But if they can't fix something, you need to address it regardless. If someone hears that you heard them, Oprah said people want to be seen, heard, and understood.

25:50 The amount of complaints and frustration, and I believe, if I'm getting the story right, the amount of vandalism, like damage in a city's subway system or metro system, went down when they installed digital readouts telling you when the next train was going to come. Because when's it coming? I don't know. People would get, and people study this. People are smarter than me. They'd be like, people would get frustrated after six minutes of waiting. But if you put a thing up that said it'll come in twelve minutes, they didn't get frustrated because they're like, it's coming in twelve minutes. I have some, okay, you see me being frustrated, but you're like, it's coming in twelve minutes.

26:32 I cannot fix this, but I see you, and when I have an opportunity, that is number, it's in my top ten. Just knowing that does not remove the frustration, but it reduces it. And sometimes that's all we can do. I mean, listen, man, I've been in leadership and I've been in whatever, followership. I've been a personal follower and I've been frustrated. But when I've understood, my boss is like, I got you. Listen, hey, man, I wish I had all the money in the world to just throw at this problem, but I don't. I'm like, all right, man. Well, hey, I appreciate you. That works. It does. And I tell all my staff this, like whether you're a clinic director or a PT trying to help a patient, like managing people's expectations.

27:13 Woo! changes the game. It completely changed. It makes you less frustrated. It makes them less frustrated. Everybody's on the same page. You don't have to over-communicate, but just managing their expectations. This is what you should expect is literally like magic. I think it's a thousand dollars if I'm getting it right. I think the Ritz, Ritz Carlton, says anybody in the organization is allowed to spend up to a thousand dollars to solve a problem without asking. So let's say this, you're in housekeeping and something goes wrong in the room, something broke and Holly was gonna go to a wedding, but now her dress is ruined and it was our fault, like something in the room, the hairdryer exploded and now her dress is, you can just be like, what size dress are you?

28:08 And you call the front desk and you're like, I need four dresses up here for Holly to pick one. And you're just like, is it a thousand dollars? No, it's less. Didn't solve it. We'll figure it out later. Because solving it now for less than a thousand dollars is worth ten thousand. An ounce of prevention, pound of cure. Thousand dollars of prevention, pound of cure. And... It doesn't even need to be a thousand dollars is what I feel like I'm hearing from you. And I agree, which is it could just be like, hey, man, you're right about that. I'm going to I'm going to get on it. I honestly don't know when I'm going to be able to fix it, but I'm on it like that solves. I'm going to go on the limb here and say more than fifty one percent of stress could at least help reduce. Hundred percent.

28:48 That weird. It's so nothing complex here, Holly, but all of this is terribly important. It is. And it's so underrated. It's so underrated. It's understated and underrated. Understated. That'll be the title of the episode. Understated and underrated. Holly, we have a tradition on the show. It is called The Parting Shot. This is The Parting Shot. One last mic drop moment. No pressure. Just your legacy on the line. pressure whatsoever it's just this is what everyone's gonna remember everything this is how dumb humans are we remember the last mostly the last thing we heard so this is it uh what do you want to leave with the audience as we wrap up you can reiterate something you've already talked about or go rogue on me but what do you got for your parting shot I would say that the biggest thing to remember, whether you're a clinician, a patient, a human, is just to communicate to any other human like you would want to be communicated with.

29:46 And remember that everybody just wants to be, like Oprah said, listened to, seen, and heard. You don't even need to be like a giant communication expert. Listen to what Holly just said. Think about how you would want to be treated in this situation and do that. Quite literally, again, I'm not a mathematician or a researcher, but that would solve eighty seven percent of the issues. I completely fabricated that statistic, but I stand by my fabrication. Holly, if someone wanted to reach out and they were like this, I like her. How do they get in touch with you? What's the best ways? I'm on LinkedIn. I'm on Instagram. So either one of those, super easy.

30:26 Happy to always chat about all of it. All the things. Holly, appreciate your time. Thank you for playing the games. Great parting shot. Thank you. Thanks for having me. That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode. Want to go deeper? Hit us at pgpinecast.com. Or find us on YouTube and socials at pgpinecast. And legally, none of this was advice. It's for entertainment purposes only. See, Keith? We read the script. Happy now?