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Mitch: We're here at the AAMC Learn Serve Lead Conference having conversations about how different organizations within academic medicine are rising up to meet the challenges of the modern world, and what's happening to improve equity, diversity, and inclusion within our organizations.

Today, we are joined by Nafisa Masud. She is a content specialist with University of Utah �ǿմ�ý. We're also joined by Natasha Ovuoba. She's from Huntsman Cancer Institute and she is the Associate Director of Equity, Diversity, and Inclusion. As well as Abdulkhaliq Barbaar, who is the Director of Equity, Diversity, and Inclusion at the University of Utah �ǿմ�ý.

So one of the things that we wanted to talk about here today is what is life like in our space dealing with burnout after COVID? The novel coronavirus came. It changed everything. We had the Black Lives Matter protests. We had marches and movements. We had press releases. Nafisa, you and I working on those press releases, trying to educate the public about things. It's now been years after that and we're . . . I don't know. For me, at least, it still feels like I'm dealing with burnout. My team is dealing with burnout.

What are you guys seeing in your own organizations? And what are you guys trying to do to acknowledge that experience, move forward? Yeah, let's just have a conversation about that.

Natasha: Yeah, you are not the only person dealing with burnout. An analogy that I like to think of is if you've ever been someone who is trying to zero-scape your yard, so to make it more eco-friendly, use less water, oftentimes you sort of change that grass, some of those flowers to rocks, or to concrete. And oftentimes, it might seem easy to just scrape up the grass and to just lay down some rocks and say, "Okay, I'm done." But then in a few months, especially as the weather warms up, you start seeing that grass, those weeds grow right back up through those rocks.

That, I think, is the moment where we are right now with our burnout. Because we've said, "Okay, we're through COVID. Vaccines are out. Boosters are out. We've got masks available. We're out of the crisis." But we've never laid down the tarp that is supposed to act as that block barrier for weeds to stop growing altogether.

So really, what we're experiencing right now with the trauma of COVID, with the trauma of the racial reckoning, we are experiencing this place of, "We're done. We did it. We hired the EDI teams and directors, and we don't have to worry about COVID." And our clinical staff, our operation staff is all going, "I never laid down that tarp. I never put in the barrier of protection to stop the pain and the hurt from creeping back up through my rocks."

Mitch: Sure. So we're still experiencing burnout. We're still having trauma responses. We're still dealing with those very real raw emotions. How about you, Nafisa? How are you feeling, I guess, after COVID?

Nafisa: Yeah, that's a big question. I think I find myself swinging on a pendulum where it feels like no time at all since COVID first hit, and at the same time, it feels like we've been doing this for years longer than we have.

And I think something that in a strange, twisted way has made me grateful is that COVID has forced me to reevaluate a lot of the practices that I had in place in my workplace. And also, just personally, I think realizing that in some ways the way that we were working, the way that we were communicating, the topics that we were focused on are just not sustainable, or it's not correct, or it's not accurate, or it's not inclusive.

And so that was an interesting awakening for me to realize that I have limitations. I have boundaries. And historically, that's been an issue for me to verbalize and to really put in place.

And then I think as far as the EDI sphere, it really has been an awakening in a lot of ways, not only to the issues that I think as a person of color you're aware of, but that you also now feel a responsibility to make others aware of and to devote more of your time and your communications to covering those topics.

So there definitely felt a greater sense of urgency and meaning to covering those topics. And I think in some ways it's great that we've had that momentum, but it was also a long time coming, and that's the difficult part.

Mitch: You and I both are working on the EDI group within our marketing and communication field, so I've seen some of the stuff that we've been trying to do and some of the great steps we've taken in one way or another.

One of the things I wonder just for you specifically as a content creator and promoter and so forth is what is the biggest shift pre- and post-COVID for you? I mean, we went in assuming one thing about what's going to happen in a pandemic, what's going to happen after a pandemic, and now we're spit out the other side. How has your strategy and your team's strategy changed?

Nafisa: Yeah, that's a good question. I think the biggest takeaway for me really is that our communications are not one-size-fits-all, and our decisions as a healthcare system are also not one-size-fits-all.

I think in the past, when we were rolling out a policy change or a program, it felt very one-dimensional. And in some ways now, I feel like we're more aware of the fact that health issues like COVID are affecting communities in vastly different ways. And it's also highlighting ways that they struggle to access care or be treated equitably when accessing care.

And so I think it's caused me to realize that when I'm creating any form of content, I cannot have just one goal and I cannot have one audience in mind, because it is so complex and so multi-dimensional. And I owe it to those audiences to really tailor our content and center them in a way that they haven't always been.

Mitch: Absolutely. I mean, one of the things that I find interesting is that we're part of a university, right? We're part of the public education arm, and now we're starting to really think and really, really devote time and energy and resources to making sure that everyone can understand us? I think that's a silver lining of everything that happened.

And how about you, Abdulkhaliq? What are some of the things that you've seen pre/post/after COVID? What's going on right now burnout-wise, and what is your group doing to recover?

Abdulkhaliq: Thank you so much, Mitch. And thank you, Nafisa and Natasha, for great points. I think working in the EDI space, burnout is a topic that we should always and constantly discuss with our teams. Because working in the EDI space trying to change policies, procedures, and practices, we are always swimming against the current.

Therefore, checking in with our team, how are they doing, how is the week going, before we even get into work, right? Just checking in, self-care. How are you taking care of yourself? How are you doing? It's critical to surviving in this type of space.

And what we have seen in the community . . . Because we are the bridge, right? I call myself a convener. We are the bridge between the community and the University of Utah �ǿմ�ý. And we always constantly hear about how the leadership or the dominant group is advancing academically in health, all of that, compared to the minoritized groups. We hear that and we take that personally, right? So that checking with each other and asking each other how are we doing is critical.

Mitch: Sure. So when you say checking in, making sure they're not getting burned out, are you talking about just with day-to-day life, or with dealing with equity, diversity, and inclusion issues every day for your job?

Abdulkhaliq: Day-to-day life, right? What we do in the community and at home will affect how we perform at work. So we constantly have to check in about, "How is your weekend going?" Then after that, talk about work, right? Sometimes we forget about our other life, right? So that's what I'm talking about.

Mitch: Got you. So one of the things I want to ask the three of you is from your backgrounds, your personal experience, what are some of the good things that you think have happened since after we've come out of this situation and as we are trying to build from the ground up? Rebuild, right? That's kind of the take-home message that we're trying to do with some of these conversations. But what can we look forward to? What efforts are being made now? What are the good things that happened?

Abdulkhaliq: I was at a session today and they talked about how Congress has an act, �ǿմ�ý, Equity, and Accountability Act of 2022. That happened because of COVID, I think. Now we recognize the . . . Actually, the silver lining of about COVID is we recognize the disparities in health, disparities in economics, disparities in communities, right? And now, we are hiring more health equity leaders within our universities and community to address those.

We have a long way to go, but now we see the disparities clearly and we are working to address it. We're not there yet, but we are working to address it.

Natasha: I was actually going to speak to a point that Abdulkhaliq said a little bit earlier, which is about finding these moments of significance with those who you're surrounded by.

And something that I have noticed outside of COVID . . . especially because we are still in this hybrid world. But before, we were only on Zoom, we were only on phone calls, and not able to make a lot of those face-to-face connections. Now, whenever I have the chance to be in an in-person meeting and there is that time to just grab a cup of coffee and sort of chat with people and say hi and ask how they're doing, it's given me the opportunity to really break up the mundane, maybe, of our everyday work and sort of just the coming in, clocking in, clocking out, and to be able to see my fellow co-workers as people.

And I think especially for equity, diversity, and inclusion work, especially that inclusion part, that belonging part, there's no way that you feel that sense of belonging if people don't see all aspects of you.

And so being able to connect with people in person now to ask them how they are, how their families are, what color they just painted their nails, whatever it might be, it's just that chance to maybe even move beyond the nurse title, or the researcher title, or the assistant title, and to just be able to connect and find common ground with my people, with my community.

Mitch: I like that a lot. I think that's something that I've experienced myself. It seems like beforehand, I was a content specialist, editor of podcasts, whatever. But we were all kind of forced into extraordinary circumstances, right? And all of a sudden, I care about what your hobbies are, co-worker of mine, because we're both human beings. I think that's really an interesting new foundation that we're building from, and it's very heartening to hear that other people are experiencing that too.

How about you, Nafisa?

Nafisa: I think related to what Natasha and Abdulkhaliq said, we are more . . . I think in our workplaces, we're being seen as more than the work that we do. And obviously, the source of that was not a positive way to learn that, but I think there was this overall focus on resilience and wellness.

The idea that your value does not just lie in the work that you do, and the content you create, and what you produce, but who you are and how you're feeling and how you can contribute to social space and not just a productive one. And so I thought that pivot has been really beautiful to see.

The idea that we see each other as not just colleagues and co-workers, but as friends and as neighbors, as cheesy as that sounds. We're not just productive, but it matters that you're well and that resources and programs are being put in place to ensure that employees and groups are well.

And then I think the other benefit is flexibility and adaptability, the transition to remote work, and allowing for more flexibility for different situations. And I can speak personally. I relocated less than six months ago and moved cross-country. The fact that I was able to do that, it's not something I ever considered . . .

I still have very strong connections with my co-workers, and we've found ways virtually . . . Even though it is so nice to be able to meet in person like this, we found ways to stay connected, to continue to strengthen those bonds and those partnerships without necessarily losing anything over the distance.

Natasha: If I can add in there, I am so glad that you said that because I don't want to sound like that person who sort of says, "Oh, yes, everybody should come back to work, because that's the most engaging way." You know what I mean? We need to do things that are healthy for each of us, because I think that's the way that we are able to show up the best each day in our work.

I think what is really, really important to understand is that even when we talk about right now, in this moment, this is health. I think sometimes we can think, "Oh, healthcare is just at the hospital, seeing the doctor, having the surgery." No. �ǿմ�ý is our social health. �ǿմ�ý is our educational health. �ǿմ�ý is our financial health.

And so to hear moments, like you touching on that remote work and the benefit of remote and hybrid work, that is something that has been helpful. We've heard this across so many voices, across social media, you name it. So many people who have said, "It has been so much healthier for me to be able to work from home. It helps my anxiety. It helps me spend more time with my children because I don't have to spend an hour in the beginning of the day getting ready to leave to sit on the freeway for another hour. It helps me with my disability because, honestly, the building I was in was not quite that accessible anyway. And so now I can just start my day at home, and now I have all of the tools I need to do my job successfully."

I think it really is important to understand that all of our health is so individualized. And so when we talk here about our health and creating healthy outcomes and having health equity in our communities, we need to remember that it's not just who we see as patients crossing the threshold of our buildings. It's what we offer as employers, as professors, as members of our community, supporting other members of our community for their health goals.

Abdulkhaliq: And your children sometimes now will jump into the screen, right? And now we don't feel guilty. We don't feel guilty. Everyone will say hi to the children, right? So that's amazing. And that is another self-care. Feeling guilty eats up on you, but now we don't have to feel guilty about that. It's just liberating.

Mitch: Say someone is out there listening right now who's maybe at the AAMC or just any . . . If you're listening right now, one of the questions that I was wondering is if they're in an organization that is still struggling, if they're in an organization that is still having trouble with burnout and the aftermath of everything that's happened over the last few years, what would be one piece of advice that you would give them that has worked within your own teams, within your own lives, etc., to make sure they can meet that challenge of burnout?

Abdulkhaliq: Michael Good, our leader, last week said, "Organizations don't make change. People do." It's not the building, it's not the organization, it's not the system. People make changes. And we need to value our people. They are more than just workers, right? We need to value of who they are, what they do, the context they live in. We have to look at their supporting structures.

And also, there are two systems that people live in: their nurturing system, and sustaining system. The nurturing system is our family. If we don't have that, we struggle. And the sustaining system is the hospitals, our work, our schools, right? If those two do not support each other, we will struggle. Therefore, we have to look at people from that perspective and support them for who they are.

Natasha: Yes to all of that. I'll add this. And this comes from actually a session that I attended today at the AAMC conference, which was really around being a leader who can help solve problems. And I think to do that, you have to look beyond the obvious and practice a growth mindset. What does that look like looking beyond the obvious?

Sometimes we talk about in the EDI space, we don't have enough people of color, people of the LGBTQ+ community, people with disabilities. They aren't applying for school with us, they aren't applying for our jobs, whatever it might be, right? We talk about not having an adequate number of representation. Look beyond that, right?

If you have a candidate who applies for a job, you have a chance to talk to them, to see them, and you say, "They aren't quite there yet." Instead of just, "Well, we're going to hire the person with the most experience," can you go back to this candidate say, "Okay, you didn't get it this time. Let me help you"?

Or as a leader, if you have a team member who applies for another job, can you say, "Okay, you applied for this job that's a little bit different than what I thought"?

If Nafisa is applying for a job, which I'm not saying she is, but if Nafisa is applying for a job, it's not, "Oh my goodness, she wants to quit." It's, "Okay, I'm seeing a goal that she's showing me that she wants to accomplish." And then that growth mindset. How can I help her get there? Instead of, "Oh my gosh, we're losing a member of our team," it's, "How can I help her grow and get there?"

Or with the jobs when someone is trying to grow, how can I help someone develop the skills they need to get to be a vice president, a COO, a dean? What do I need to do to help them get there? Instead of the, "We can't do it," change that mindset to, "How can we do this? How can we work together for this?"

Nafisa: That's a great point. I think the advice that I would give to an organization that may be struggling with burnout is to focus less on resiliency and more on restoration.

And what I mean by that is many of the resources we got at the beginning of the pandemic, and those resources have changed over the years, focused on "What do you do when you're already past the point of burnout? How do you create wellness for yourself? How do you relieve stress? How do you process?"

That worked in the moment that we were in, but long-term I think we need to focus on the root of the problem and say, "Which of our policies are restoring our employees? How do we prevent the fact that they feel drained and burned down in the first place?"

So rather than fostering resiliency at the end of that process where they're already burnt out, what policies and programs do we have in place that are nourishing and nurturing our employees so that they never reach that point moving forward?

And obviously, speaking now, we have a lot of burnout and a lot of stress and trauma that we're still processing. But long-term looking to the future, how can we avoid that self-care revolution that I think was really necessary and make sure that if we were to enter into a situation like this, or as post-COVID continues, how are we nurturing our employees so that they're not reaching the state of burnout or the levels of burnout that they're currently at?  

Mitch: That is some great advice for I think any organization at any time really. When we're looking at building back after this particular event, we're looking at the end of COVID and what's next.

Abdulkhaliq, Natasha, and Nafisa, thank you so much for joining us. And if you're listening, there are plenty of other discussions here at the AAMC floor from University of Utah �ǿմ�ý and The Scope at uofuhealth.org/aamc22. And if you're interested in any other health-related podcasts, talk shows, basic information, you can also hear more of me at thescoperadio.com.