April 30, 2025 • 26 mins
In this episode of the MGMA Insights Podcast, host Daniel Williams sits down with Steve Brewer, Chief Operating Officer of GI Associates, to explore a critical issue facing healthcare professionals: the psychological impact of burnout. Through an in-depth conversation, Brewer shares insights from his personal experience and research, challenging how we traditionally approach and discuss workplace stress and mental well-being.
Key Takeaways:
0:01:36 - Personal Journey: Steve Brewer discusses his firsthand experience with burnout in healthcare leadership
0:09:48 - Neurological Impact: Chronic stress physically changes brain chemistry, strengthening negative neural pathways
0:14:19 - Broaden and Build Theory: Positive emotions can expand awareness and build emotional and social resources
0:17:48 - Positivity Cycle: Small acts of kindness can create a chain reaction of positive interactions
0:22:22 - Leadership Self-Care: Fewer than 50% of healthcare leaders take steps to support their own resiliency
Actionable Takeaways for Medical Practice Leaders
- Acknowledge reality, then act
- Recognize and address depressive rumination early
- Counter chronic stress with positive practices
- Shift meeting dynamics toward problem-solving
- Design wellness programs focused on well-being, not burnout
- Practice and model the “Broaden and Build” approach
- Reframe leadership roles around building resilience
- Prioritize self-care as a leader
Resources:
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are back with another MGMAinsights podcast, and we have a
return guest, Steve Brewer. NowSteve is a seasoned health care
leader, and he has pennedanother article for MGMA. It's
(00:25):
titled, Can Focusing on BurnoutCause More Burnout?
And by the time you're listeningto this, we believe that that
article will be on MGMA.com, andso we'll provide a direct link
as soon as we can to thatarticle. So, Steve, we've had
you on the show before. You andI have talked. We've met at
(00:47):
leaders conferences and enjoyedeach other's company there. But
just for the sake of ourlisteners who may not know who
you are, just bring us up tospeed where you are currently,
tell us anything you want toshare about your practice,
anything else like that.
Steve Brewer (01:04):
Daniel, thank you for inviting me back on. I
really appreciate it, and I hopethat the article really
resonates with a lot of folks.Thanks for that. By way of
background and reminder, I amSteve Brewer. I'm the chief
operating officer with GIAssociates, independent
(01:25):
gastroenterology practice groupin Wausau, Wisconsin.
So if anybody's looking at myvideo background, that's not the
view from my office right now.
Daniel Williams (01:36):
Well, Steve yeah. You and I were talking
about that offline because Iknew you were in Wisconsin the
last time I talked to you, and Iwent, wow. Did Steve move to the
Bay Area?
Steve Brewer (01:47):
Nope. Nope. I'll have to get some pictures of
lakes or maybe Granite Peak skiarea. That'll be a little bit
more representative of ourwonderful community here in
Wausau, Wisconsin.
Daniel Williams (01:57):
Alright. Well, it's always great to catch up
with you, and looking forward toseeing you at a live face to
face event with MGMA, not wherewe're talking via technology,
but we can just sit down andhave a good chat. So let's start
with this topic. So can thinkingof burnout cause more burnout?
(02:19):
Where did you get the originalidea to research this topic?
Steve Brewer (02:25):
So it probably occurred to me a number of years
ago. And part of it was, asDaniel, you and I have talked,
I've been on my own kind ofjourney you know, I've been in
burnout and have felt burnoutpersonally. I've watched it with
our clinicians and our leaders,etcetera. So it's been kind of a
(02:46):
personal journey for me. And theidea kinda struck me one time.
I was in some meetings and wespent most of the time, you
know, kind of complaining about,dynamics that we were frustrated
with. We were talking about howit was really compounding
frustration and burnout, and wedidn't really do any kind of,
(03:10):
proactive problem solving oranything like that. And then as
I kind of got more in tune withthat, I started to notice that
as being kind of the norminstead of the exception is that
folks really just kind of wereruminating and complaining about
frustrations. And then as Italked to early careerists and ,
you know, leaders, managers,physicians, nurses, even some
(03:32):
family members that they'rereally not that far into their
career and they're alreadyfeeling burned out. And I feel,
you know, I think one levelthat's kind of sad and tragic
because, you know, they've goneto school, they have this this
passion for helping people andalready they're a bit
disillusioned.
But I also noticed a trend thatthat's the common theme. The
common conversation is how arewe frustrated? How burned out
(03:54):
are we? And as I've gone throughmy learnings and my studies, I
came across the concept of thisrepetitive negative thinking and
where our minds focus and howour minds can kind of adapt to
what we experience and thinkabout, that we almost set
ourselves up for failure, thatthat's what we focus on maybe
(04:15):
consciously as well assubconsciously. And that kind of
brought forth, I'm like, how doI title this?
But it just simply, you know,can focusing on this actually be
making it worse? And so that'ssome of the background and the
experience that that brought meto this article.
Daniel Williams (04:28):
Yeah. I I wanted to ask you a question
then. I've brought this up onthe, MGMA podcast before.
Previously, I I covered thefinancial services industry. So
we've been if we've got 401ks,if we've got investments, we
might be a little bit nervousright now.
But one of the things there's aneconomic study. It really looks
(04:50):
at the way our brains work, andwe look at the power of losses,
that we are affected more deeplyby loss than we are by gain. And
it really speaks to bells areringing in my ears right now
hearing what you're talkingabout when we get into that
(05:11):
repetitive negative thinking canreally drag us down there. I
don't want to put you on thespot because it's not a question
I had planned to ask you, butwhen you said that, I wanted to
ask you what has your researchtold you about that repetitive
negative thinking and how thatcan really impact us as human
beings?
Steve Brewer (05:29):
Well, so even on the dynamic of, you know, we
have our our portfolios and allof a sudden, you know, it's less
today than it was yesterday. Asas we get into the kind of the
natural human condition whereour brains are prewired to be
kind of on the lookout forsomething's gonna go wrong.
We're predisposed or a negativebias a negativity bias. And when
(05:53):
we experience those things, it'sbeen proven that our reactions
are quicker to be you know, toreact or be negative. They last
longer, and it really kind ofinvades our our mindset some.
So when you look at those inthat economic example, that's
hand in glove with sciencearound psychology and
neuroplasticity and that sort ofthing. So that is, you know, a
(06:17):
non health care related example,but it's true across, different
fields. And it's just really, Ikind of call it that human
condition. So repetitivenegative thinking is really kind
of the same thing where it'salmost kind of the odds are
stacked against us a little bitbecause our minds are kind of
prewired to always look out forthe next, you know, stock is
(06:41):
gonna fall, for example. Andthen it happens like, see, I
told you so.
And then when it doesn't happen,it's like, yeah, but it's not
gonna last. So we have this kindof almost natural tendency to
have these repetitive negativethinkings of something went
wrong in the past or I'm gonnabe anticipated in the future and
we just kinda get stuck.
Daniel Williams (07:00):
And you always have to consciously really pull
yourself out of that spiral. Solet's discuss that in more
detail then. So there isbringing awareness to a
situation like we'reunderstaffed. And so myself, my
team, we're overworking. We'reoverburdened.
We're spending all this pajamatime going over administrative
(07:21):
tasks. You know, we're burningourselves out. So there's
awareness to what's happening.And then there's repetitive
negative thinking. So bring usup to speed where how do we sort
of bring those together in a waywhere it can be a net positive
for us so we know these thingsare going on and we can do
(07:41):
something about it versusthere's a dark cloud over our
heads and the sky's falling.
Steve Brewer (07:48):
Yeah. That's a really nice way, Daniel, to
queue that up. And I'll weave ina little bit of personal
experiences as it relates toalso some of learnings that I
picked up on. So as we look at,you know, things aren't going
well. You know, we got pajamatime, we have all these other
kinds of things that arehappening.
(08:08):
Nothing should be interpreted aswe just don't think about that.
It'll go away. I think thecontrast is true by actually
acknowledging it in a proactiveway. And I'll take some
learnings out of leadershipmodels. So there's
transformational leadership oradaptive leadership.
One of the core tenants of thosetwo models is you're not afraid
(08:34):
to face reality. So if we havetoo much pajama time, we have
things that aren't working well.One of the things is just to
pause and acknowledge it.Sometimes we get caught up in,
we're just so frustrated. Wedon't wanna talk about it
anymore.
We start to feel kind ofspiraled or hopeless about it,
and we just kind of give up.Well, this is actually a way of
acknowledging that and thenpausing, rebreathing, re
(08:58):
centering, and then kinda like,okay, here's where we're at.
What are we gonna proactively doabout it in a way that
personally fits with what ourgoals and values are, but also
giving each other permission tokinda talk about that in a
proactive way and kind of stopthat negative negative cycle and
then start to build morepositive. And that becomes the
(09:20):
focus of the conversationbecause we always are gonna have
some challenges or things orobstacles that we have to
overcome. It's how we adapt tothose and proactively manage
them with a more positivemindset that really makes a
difference.
Daniel Williams (09:33):
Let's look at the brain then. What is going on
in the brain when we are subjectto sustained stress levels? When
they're at a high level and itjust doesn't subside, what are
we talking about in the humanbrain?
Steve Brewer (09:49):
Yeah. So I think most folks are familiar with the
concept of the mind bodyconnection. And then when we
experience chronic stress, it'snot good for us physically:
heart disease, diabetes,obesity, other kind of things
that come from dealing with ortrying to manage chronic stress.
But in addition to, as Imentioned, kind of the odds
(10:11):
stacked against us just a littlebit, our brains become, it's
called the term isneuroplasticity is that the
neuron connections, thereceptors and the different
synapses, they actually getstronger and more of them
develop depending on what ourbrains are processing at the
time. So we are in chronicstress mode, crisis mode,
(10:32):
distress mode.
Those parts of the brain thatare known for having those
feelings become stronger. Theneurotransmitters that, you
know, like norepinephrine arequicker to release that
amplifies that. And, again, wethink of it like we've had more
stronger hardwiring as well asthe the grease that that makes
(10:53):
that run actually gets morepronounced in our brains and it
just continues to make itquicker to react, quicker to go
right to that negative part. Andit actually can shrink what's
called the prefrontal cortexwhere that part doesn't get
activated as much, and itactually starts , like muscles,
starts to shrink or atrophy alittle bit. And the good news is
(11:16):
that you can reverse some ofthat.
Daniel Williams (11:18):
Okay. Let's talk about how we do that. So
one of the things that wasreally interesting in the
article, I have a early copy ofthat, you write about something,
I want to get this right, calleddepressive rumination, and how
focusing on being burned out candeepen those feelings for some
people. Let's talk about thewarning signs that someone might
(11:41):
be caught in this sort of amental loop of depressive
rumination.
Steve Brewer (11:46):
Yeah. So I came across that term in the
psychology literature as itspeaks traditional psychology
works on trying to help peoplewho are in that kind of
distressed or crisis mode andhow do we cope with that. And
one of the concepts is thisdepressive rumination where I
almost think of it as you wakeup in the morning and then
(12:09):
you're like, oh yeah, well, I'mawake. Here's the morning. Oh,
that's right. I'm depressed.Today's gonna go bad. It's not
gonna work out well. Ourthinking kind of gets more
narrow. And then sure enough,the way we behave, something's
gonna happen.
See, I told you it's not gonnawork out, and they just kinda
have this self fulfillingprophecy. Same thing with
burnout. I can see folks, youknow you know, metaphorically
(12:31):
kinda waking up and going, yep.This is a good night's sleep
perhaps. But, oh, that's right.
I'm burned out. I'm gonna have abad day. And that is then they
kind of build this cycle thatdevelops. And I think of it a
little bit like if you've everbeen in the market for a new car
and you go, "hey, I'm gonna gobuy a new car," and all a sudden
you start seeing that same modelthat you're looking at
(12:53):
everywhere you go.
Daniel Williams (12:54):
Right.
Steve Brewer (12:54):
You've just become more attuned to that. And that's
kind of maybe a goofy example ofthat, but I think that's kinda
how is we attend to what wethink about.
Daniel Williams (13:03):
Yeah. No. The car one is a great example
because I bought a car a fewyears ago, and I'm not sure. I
maybe saw this model of car onceevery couple of months. Then
just like what you said, thenI'd see one four times a day.
And it's like, good gracious.What did everybody get the idea?
(13:24):
Did we all read the samearticle? But it's something
going on in the brain then? Whatelse can you tell us about that?
Steve Brewer (13:31):
Yes. I think that's because we become more
attuned to that one. So oursynapses are more like, "oh,
there's the model. There's acolor," whatever I'm looking at.
And then same thing on more ofthese these concepts.
So if you are kind of eitherpersonality trait wise or you've
had this chronic negativitydevelop in your brain is quicker
(13:52):
to activate those parts of yourbrain and the connections and
synapses go along with that,something else happens negative,
and then boom, you're right backthere. And that just happens to,
you're more aware, and that sortof thing. You're actually the
contrary. Sadly, you're lessaware of the positivities. And
(14:13):
so it's the same kind ofconcept, but with how we
internalize and processexperiences.
Daniel Williams (14:18):
You highlight something you call the broaden
and build theory of positiveemotions. I don't know if it's
in the same universe. I wasthinking of something like,
well, just fake it till you makeit. Just build some strength
here in looking for thepositive, but talk about broaden
and build. What is this?
What's going on here? And how dowe develop this? How do we put
(14:42):
this into practice in our ownlives?
Steve Brewer (14:44):
Yeah. This this model again comes out of the
positive psychology literatureand the studies. And so Barbara
Fredrickson is a well knownpsychologist in the field and
developed this broaden and buildtheory or model in the late
nineties. And almost opposite ofthe effects of repetitive
negative thinking, it takessimilar mechanisms, but it's
(15:08):
actually then in the reverse. Sothe basic tenet of broaden and
build is one with positiveemotions , I'm gonna kinda go
back to pausing, reflecting,being self aware and just
acknowledging, like, well, I'mreally kind of stuck in this rut
of negativity or this cloud, butit's really giving yourself
(15:30):
permission to take a step backand reframe.
There's a lot of refraining inthese models. What's real?
What's more realistic in mysituation, my environment,
etcetera? And then actually, aswe pause and we don't get so
stressed out and we have morepositive experiences, some of
the researchers show thatliterally our vision broadens,
(15:53):
our awareness of oursurroundings broaden, our open
mindedness to new ideas andconcepts builds or broadens. And
it starts this kind of catalystof, oh, actually things maybe
aren't quite so bad.
And then, you know what? Maybeif I approach this from this way
and I start to get positiveoutcomes from that. And then I
(16:15):
start to actually frankly bemore open to relationships and
things like that. And peoplelike, Hey, you know, Daniel's a
nice guy and I'm gonna reach outand maybe give him some help or
some thoughts. And you start tobroaden and build both emotional
resources, but also socialnetworks.
And then also physicalresources. We need a certain
(16:37):
amount of income and otherthings to kind of build on that.
This just kind of starts thisit's almost like, think of it as
we do positive networking. Oneperson networks with another,
you build this kind of networkof colleagues or connections.
It's the same kind of thing, buton a much bigger scale.
But the basic tenet of this isactually if you find yourself
(17:01):
kind of in that either naturaltendency or that experience of
having chronic, you know,negative thoughts, I'm burned
out, I'm frustrated, nothing'sever gonna get better, is to
actually pause and allowyourself to experience some joy
and go, you know what? Thatactually was pretty nice. And
these aren't a one and done kindof exercises. It's almost like
(17:23):
any other exercise or fitnessroutine. It has to become things
that you build out in practice.
But you could be amazed at howfar taking that new approach to
things and kinda I don't wannasay shunning, but getting away
from always going towards anegative. And you'll be
surprised at how much that canchange perspective. And then
(17:44):
that actually starts to createphysical changes in both
yourself but also yourenvironment.
Daniel Williams (17:49):
Yeah. And hearing you talk about this, it
reminded me of something thathappened over the weekend. I was
in line like we are when we gothrough the drive through at
Starbucks, and we got up there.We'd placed our order, and we
were handing over well,actually, we have the the app,
so we were gonna scan it. Andthen they said the person in
front of you paid for it.
(18:10):
And we went, oh my gosh. Thatwas so incredible. We wanna pay
for the people behind us. Andthen the the attendant there
said, you don't wanna do that. Ithink maybe it was a soccer team
or something.
I don't don't know what it was,but they said, but thank you.
It's a nice gesture. But thereason I bring that up is it's
that idea of someone doessomething really nice to us, and
(18:32):
we wanna pay that forward orpass it along. What's going on?
Is this talking in some of yourresearch, have you come across
this where when we find somebodyreally doing a nice thing for
us, then we wanna respond inkind and share that sort of
kindness to other people aswell?
Steve Brewer (18:50):
Yeah. It actually that has a kind of a dual
effect. So that's actually oneof the things they talk about
these positive psychologyinterventions. So one of them is
we feel good about ourselves andfeel positivity when we have a
sense of altruism we're givingto others. So one of those is
like, hey.
I wanna pay for the car behindme. And so I've now done a good
(19:10):
deed, that maybe brightens myday. But I've also now
brightened the person behind metoday, and that prompted you to
go, well, maybe I can kindabuild this chain of positivity,
if you will. And so there's thatthat dynamic that is out there.
And so I think that's actuallyboth for the individual as well
as those that are on thereceiving end.
And then that's just the way tokinda, you know, kind of a
(19:32):
foundational way to kind ofbuild on these kind of things.
So exactly. It's a greatexample.
Daniel Williams (19:37):
Yeah. One of the other things you bring up in
your article is talking aboutwellness programs at work. And
so how does the team, theleadership strike a balance
where they can develop someguardrails or some positive
programs within the organizationbut not do what we were talking
(19:58):
about at first, like remindingeverybody, gosh, everybody's so
burned out. How do we strikethat balance? What's the tone to
get people on board but not kindof reminding everybody how
stressed out we are?
Steve Brewer (20:13):
Right. Well, couple of thoughts on that. One
is, you know, from a leadershipperspective, one of the things I
would strongly advocate for iswhen we make a work environment
or whether that be a singlemeeting, a team meeting, or, you
know, or just how we approachthings. When we can approach
(20:34):
things from a more relaxedperspective, more supportive, we
get others around us to relaxand actually enjoy some of their
day. They become more creativeproblem solvers, etcetera,
versus that kind of hard drivingkind of component to that.
So when we look at kind ofgetting away from burnout, you
(20:55):
notice in that example, I nevermentioned the word burnout. And
we're actually starting to justcreate a more positive work
environment without going, well,I know everybody's stressed or
burned out, so we're gonna do agratitude exercise. So everybody
has to name one good thing thatwent well today. And then now
we'll feel better after that.That's similar, but not exact
(21:17):
quotes in some meetings.
So I'm like, that's not gonnareally turn the corner if we're
like, you know, hurry up, getpast your burnout, and think of
something positive. Now let'sget on to the regular business.
So there's, I'll call structuralthings that we need to think
about and give people the tools,the environment to be
successful. But also as we dowellness things, and I know this
is kind of a balancingconversation I need to have
(21:39):
because I wholeheartedly believein a lot of those programs, self
fulfillness, wellness,well-being, etcetera, obviously.
None of it's always coached.
We gotta combat burnout, sowe're gonna put up a yoga class.
We gotta combat burnout, sowe're gonna do a healthy eatings
class. It's like, well, you knowwhat? We want people to be
(21:59):
healthier. We want people tohave better wellness.
So we have these classes. Andthat burnout thing will kinda
start to take care of itselfwithout always calling attention
to it. And really is that theonly reason we're doing it is
just because people are afraid?Aren't we doing it anyway
because it's the right thing todo? There's my dissertation on
(22:20):
that.
Daniel Williams (22:22):
Final thought then. You cite an MGMA stat poll
where fewer than half of healthcare leaders have taken steps to
support their own resiliency. Ifwe take a step back and think of
that in the bigger picture,sometimes people who are
caregivers and others will spendso much time helping others, but
(22:45):
they're not helping themselves.What can we do? Any of our
listeners right now who arehealthcare leaders, what can
they do to take steps to makesure, even though they're
helping their teams, they'rehelping family members, they're
helping others, but sometimesthey neglect themselves.
So what can they do to make surethey're taking care of
themselves as well?
Steve Brewer (23:07):
Yeah. I think it's it's a dynamic that's I can't
say for sure if it's stronger ormore prevalent in health care,
but we go into health care totake care of others. And health
care workers are somewhatnotorious for not taking good
care of themselves. They arealmost too selfless in that
respect. And I think leaders arethat way to an extent too.
So part of that is like, youknow, I have to be that stoic
(23:30):
leader. I have to be there formy teams. I have these kind of
things. And I think the tideshifting saw that you do some
Google searches or research onit. I'm starting to see more
about the importance of healthcare leaders or readers in
general need to take care ofthemselves so they can actually
be there for their families andtheir teams and partners.
So it's kind of reframing. Youmentioned reframing early on.
(23:52):
It's reframing what's theimportance for me to take care
of myself if I can't do it formyself. You know, sometimes
doing it for others is enoughwhat would change or reframe.
They're like, you know what?
I do need to get better sleep atnight. I need you to make better
lifestyle choices. It's okay toeven talk about. That's also
another thing as leaders,similar to like physicians and
(24:12):
some other healthcare workers,well, we're uncomfortable even
talking about it andacknowledging it. But as I have
conversations like this, I hearmore and more people saying,
well, know what?
Nobody's coming to ask me howI'm doing as a manager or
director or vice president orwhatever that leadership role
might be. And I kind of, youknow, flippantly say, you know,
leaders are people too, and weneed that sort of thing as well.
(24:35):
So I think that and then it'sreally giving ourselves
permission to take a step backand not necessarily to listen to
some of the literature because,you know, early on, it's like,
well, as a leader, your job,your number one job is to help
mitigate the burnout for yourpeople, for your physicians,
your nurses, your worker. Butthen all that did is really
(24:57):
kinda add weight to, like, myshoulders as a leader. I'm like,
well, here, I'm not a goodleader if I'm not mitigating
their burnout.
And now the focus is there withmore pressure, ironically,
instead of like, well, I need torole model that and do my do
that myself, and then that'llstart to build that positive,
you know, broaden and build cutsat the top of it.
Daniel Williams (25:16):
Alright. Well, Steve Brewer, as always, thanks
for joining us on the MGMApodcast.
Steve Brewer (25:22):
You're very welcome, and thank you so much,
Danny.
Daniel Williams (25:24):
Yeah. We've been talking with Steve Brewer.
He's got an article coming out.Can focusing on burnout cause
more burnout? That's going to beavailable on MGMA.com.
We will include that in theepisode show notes when it's
available. Until then, hope allof y'all are taking care of
yourselves out there, and thankyou so much for being MGMA
(25:45):
podcast listeners.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are back with another MGMAinsights podcast, and we have a
return guest, Steve Brewer. NowSteve is a seasoned health care
leader, and he has pennedanother article for MGMA. It's
(00:25):
titled, Can Focusing on BurnoutCause More Burnout?
And by the time you're listeningto this, we believe that that
article will be on MGMA.com, andso we'll provide a direct link
as soon as we can to thatarticle. So, Steve, we've had
you on the show before. You andI have talked. We've met at
(00:47):
leaders conferences and enjoyedeach other's company there. But
just for the sake of ourlisteners who may not know who
you are, just bring us up tospeed where you are currently,
tell us anything you want toshare about your practice,
anything else like that.
Steve Brewer (01:04):
Daniel, thank you for inviting me back on. I
really appreciate it, and I hopethat the article really
resonates with a lot of folks.Thanks for that. By way of
background and reminder, I amSteve Brewer. I'm the chief
operating officer with GIAssociates, independent
(01:25):
gastroenterology practice groupin Wausau, Wisconsin.
So if anybody's looking at myvideo background, that's not the
view from my office right now.
Daniel Williams (01:36):
Well, Steve yeah. You and I were talking
about that offline because Iknew you were in Wisconsin the
last time I talked to you, and Iwent, wow. Did Steve move to the
Bay Area?
Steve Brewer (01:47):
Nope. Nope. I'll have to get some pictures of
lakes or maybe Granite Peak skiarea. That'll be a little bit
more representative of ourwonderful community here in
Wausau, Wisconsin.
Daniel Williams (01:57):
Alright. Well, it's always great to catch up
with you, and looking forward toseeing you at a live face to
face event with MGMA, not wherewe're talking via technology,
but we can just sit down andhave a good chat. So let's start
with this topic. So can thinkingof burnout cause more burnout?
(02:19):
Where did you get the originalidea to research this topic?
Steve Brewer (02:25):
So it probably occurred to me a number of years
ago. And part of it was, asDaniel, you and I have talked,
I've been on my own kind ofjourney you know, I've been in
burnout and have felt burnoutpersonally. I've watched it with
our clinicians and our leaders,etcetera. So it's been kind of a
(02:46):
personal journey for me. And theidea kinda struck me one time.
I was in some meetings and wespent most of the time, you
know, kind of complaining about,dynamics that we were frustrated
with. We were talking about howit was really compounding
frustration and burnout, and wedidn't really do any kind of,
(03:10):
proactive problem solving oranything like that. And then as
I kind of got more in tune withthat, I started to notice that
as being kind of the norminstead of the exception is that
folks really just kind of wereruminating and complaining about
frustrations. And then as Italked to early careerists and ,
you know, leaders, managers,physicians, nurses, even some
(03:32):
family members that they'rereally not that far into their
career and they're alreadyfeeling burned out. And I feel,
you know, I think one levelthat's kind of sad and tragic
because, you know, they've goneto school, they have this this
passion for helping people andalready they're a bit
disillusioned.
But I also noticed a trend thatthat's the common theme. The
common conversation is how arewe frustrated? How burned out
(03:54):
are we? And as I've gone throughmy learnings and my studies, I
came across the concept of thisrepetitive negative thinking and
where our minds focus and howour minds can kind of adapt to
what we experience and thinkabout, that we almost set
ourselves up for failure, thatthat's what we focus on maybe
(04:15):
consciously as well assubconsciously. And that kind of
brought forth, I'm like, how doI title this?
But it just simply, you know,can focusing on this actually be
making it worse? And so that'ssome of the background and the
experience that that brought meto this article.
Daniel Williams (04:28):
Yeah. I I wanted to ask you a question
then. I've brought this up onthe, MGMA podcast before.
Previously, I I covered thefinancial services industry. So
we've been if we've got 401ks,if we've got investments, we
might be a little bit nervousright now.
But one of the things there's aneconomic study. It really looks
(04:50):
at the way our brains work, andwe look at the power of losses,
that we are affected more deeplyby loss than we are by gain. And
it really speaks to bells areringing in my ears right now
hearing what you're talkingabout when we get into that
(05:11):
repetitive negative thinking canreally drag us down there. I
don't want to put you on thespot because it's not a question
I had planned to ask you, butwhen you said that, I wanted to
ask you what has your researchtold you about that repetitive
negative thinking and how thatcan really impact us as human
beings?
Steve Brewer (05:29):
Well, so even on the dynamic of, you know, we
have our our portfolios and allof a sudden, you know, it's less
today than it was yesterday. Asas we get into the kind of the
natural human condition whereour brains are prewired to be
kind of on the lookout forsomething's gonna go wrong.
We're predisposed or a negativebias a negativity bias. And when
(05:53):
we experience those things, it'sbeen proven that our reactions
are quicker to be you know, toreact or be negative. They last
longer, and it really kind ofinvades our our mindset some.
So when you look at those inthat economic example, that's
hand in glove with sciencearound psychology and
neuroplasticity and that sort ofthing. So that is, you know, a
(06:17):
non health care related example,but it's true across, different
fields. And it's just really, Ikind of call it that human
condition. So repetitivenegative thinking is really kind
of the same thing where it'salmost kind of the odds are
stacked against us a little bitbecause our minds are kind of
prewired to always look out forthe next, you know, stock is
(06:41):
gonna fall, for example. Andthen it happens like, see, I
told you so.
And then when it doesn't happen,it's like, yeah, but it's not
gonna last. So we have this kindof almost natural tendency to
have these repetitive negativethinkings of something went
wrong in the past or I'm gonnabe anticipated in the future and
we just kinda get stuck.
Daniel Williams (07:00):
And you always have to consciously really pull
yourself out of that spiral. Solet's discuss that in more
detail then. So there isbringing awareness to a
situation like we'reunderstaffed. And so myself, my
team, we're overworking. We'reoverburdened.
We're spending all this pajamatime going over administrative
(07:21):
tasks. You know, we're burningourselves out. So there's
awareness to what's happening.And then there's repetitive
negative thinking. So bring usup to speed where how do we sort
of bring those together in a waywhere it can be a net positive
for us so we know these thingsare going on and we can do
(07:41):
something about it versusthere's a dark cloud over our
heads and the sky's falling.
Steve Brewer (07:48):
Yeah. That's a really nice way, Daniel, to
queue that up. And I'll weave ina little bit of personal
experiences as it relates toalso some of learnings that I
picked up on. So as we look at,you know, things aren't going
well. You know, we got pajamatime, we have all these other
kinds of things that arehappening.
(08:08):
Nothing should be interpreted aswe just don't think about that.
It'll go away. I think thecontrast is true by actually
acknowledging it in a proactiveway. And I'll take some
learnings out of leadershipmodels. So there's
transformational leadership oradaptive leadership.
One of the core tenants of thosetwo models is you're not afraid
(08:34):
to face reality. So if we havetoo much pajama time, we have
things that aren't working well.One of the things is just to
pause and acknowledge it.Sometimes we get caught up in,
we're just so frustrated. Wedon't wanna talk about it
anymore.
We start to feel kind ofspiraled or hopeless about it,
and we just kind of give up.Well, this is actually a way of
acknowledging that and thenpausing, rebreathing, re
(08:58):
centering, and then kinda like,okay, here's where we're at.
What are we gonna proactively doabout it in a way that
personally fits with what ourgoals and values are, but also
giving each other permission tokinda talk about that in a
proactive way and kind of stopthat negative negative cycle and
then start to build morepositive. And that becomes the
(09:20):
focus of the conversationbecause we always are gonna have
some challenges or things orobstacles that we have to
overcome. It's how we adapt tothose and proactively manage
them with a more positivemindset that really makes a
difference.
Daniel Williams (09:33):
Let's look at the brain then. What is going on
in the brain when we are subjectto sustained stress levels? When
they're at a high level and itjust doesn't subside, what are
we talking about in the humanbrain?
Steve Brewer (09:49):
Yeah. So I think most folks are familiar with the
concept of the mind bodyconnection. And then when we
experience chronic stress, it'snot good for us physically:
heart disease, diabetes,obesity, other kind of things
that come from dealing with ortrying to manage chronic stress.
But in addition to, as Imentioned, kind of the odds
(10:11):
stacked against us just a littlebit, our brains become, it's
called the term isneuroplasticity is that the
neuron connections, thereceptors and the different
synapses, they actually getstronger and more of them
develop depending on what ourbrains are processing at the
time. So we are in chronicstress mode, crisis mode,
(10:32):
distress mode.
Those parts of the brain thatare known for having those
feelings become stronger. Theneurotransmitters that, you
know, like norepinephrine arequicker to release that
amplifies that. And, again, wethink of it like we've had more
stronger hardwiring as well asthe the grease that that makes
(10:53):
that run actually gets morepronounced in our brains and it
just continues to make itquicker to react, quicker to go
right to that negative part. Andit actually can shrink what's
called the prefrontal cortexwhere that part doesn't get
activated as much, and itactually starts , like muscles,
starts to shrink or atrophy alittle bit. And the good news is
(11:16):
that you can reverse some ofthat.
Daniel Williams (11:18):
Okay. Let's talk about how we do that. So
one of the things that wasreally interesting in the
article, I have a early copy ofthat, you write about something,
I want to get this right, calleddepressive rumination, and how
focusing on being burned out candeepen those feelings for some
people. Let's talk about thewarning signs that someone might
(11:41):
be caught in this sort of amental loop of depressive
rumination.
Steve Brewer (11:46):
Yeah. So I came across that term in the
psychology literature as itspeaks traditional psychology
works on trying to help peoplewho are in that kind of
distressed or crisis mode andhow do we cope with that. And
one of the concepts is thisdepressive rumination where I
almost think of it as you wakeup in the morning and then
(12:09):
you're like, oh yeah, well, I'mawake. Here's the morning. Oh,
that's right. I'm depressed.Today's gonna go bad. It's not
gonna work out well. Ourthinking kind of gets more
narrow. And then sure enough,the way we behave, something's
gonna happen.
See, I told you it's not gonnawork out, and they just kinda
have this self fulfillingprophecy. Same thing with
burnout. I can see folks, youknow you know, metaphorically
(12:31):
kinda waking up and going, yep.This is a good night's sleep
perhaps. But, oh, that's right.
I'm burned out. I'm gonna have abad day. And that is then they
kind of build this cycle thatdevelops. And I think of it a
little bit like if you've everbeen in the market for a new car
and you go, "hey, I'm gonna gobuy a new car," and all a sudden
you start seeing that same modelthat you're looking at
(12:53):
everywhere you go.
Daniel Williams (12:54):
Right.
Steve Brewer (12:54):
You've just become more attuned to that. And that's
kind of maybe a goofy example ofthat, but I think that's kinda
how is we attend to what wethink about.
Daniel Williams (13:03):
Yeah. No. The car one is a great example
because I bought a car a fewyears ago, and I'm not sure. I
maybe saw this model of car onceevery couple of months. Then
just like what you said, thenI'd see one four times a day.
And it's like, good gracious.What did everybody get the idea?
(13:24):
Did we all read the samearticle? But it's something
going on in the brain then? Whatelse can you tell us about that?
Steve Brewer (13:31):
Yes. I think that's because we become more
attuned to that one. So oursynapses are more like, "oh,
there's the model. There's acolor," whatever I'm looking at.
And then same thing on more ofthese these concepts.
So if you are kind of eitherpersonality trait wise or you've
had this chronic negativitydevelop in your brain is quicker
(13:52):
to activate those parts of yourbrain and the connections and
synapses go along with that,something else happens negative,
and then boom, you're right backthere. And that just happens to,
you're more aware, and that sortof thing. You're actually the
contrary. Sadly, you're lessaware of the positivities. And
(14:13):
so it's the same kind ofconcept, but with how we
internalize and processexperiences.
Daniel Williams (14:18):
You highlight something you call the broaden
and build theory of positiveemotions. I don't know if it's
in the same universe. I wasthinking of something like,
well, just fake it till you makeit. Just build some strength
here in looking for thepositive, but talk about broaden
and build. What is this?
What's going on here? And how dowe develop this? How do we put
(14:42):
this into practice in our ownlives?
Steve Brewer (14:44):
Yeah. This this model again comes out of the
positive psychology literatureand the studies. And so Barbara
Fredrickson is a well knownpsychologist in the field and
developed this broaden and buildtheory or model in the late
nineties. And almost opposite ofthe effects of repetitive
negative thinking, it takessimilar mechanisms, but it's
(15:08):
actually then in the reverse. Sothe basic tenet of broaden and
build is one with positiveemotions , I'm gonna kinda go
back to pausing, reflecting,being self aware and just
acknowledging, like, well, I'mreally kind of stuck in this rut
of negativity or this cloud, butit's really giving yourself
(15:30):
permission to take a step backand reframe.
There's a lot of refraining inthese models. What's real?
What's more realistic in mysituation, my environment,
etcetera? And then actually, aswe pause and we don't get so
stressed out and we have morepositive experiences, some of
the researchers show thatliterally our vision broadens,
(15:53):
our awareness of oursurroundings broaden, our open
mindedness to new ideas andconcepts builds or broadens. And
it starts this kind of catalystof, oh, actually things maybe
aren't quite so bad.
And then, you know what? Maybeif I approach this from this way
and I start to get positiveoutcomes from that. And then I
(16:15):
start to actually frankly bemore open to relationships and
things like that. And peoplelike, Hey, you know, Daniel's a
nice guy and I'm gonna reach outand maybe give him some help or
some thoughts. And you start tobroaden and build both emotional
resources, but also socialnetworks.
And then also physicalresources. We need a certain
(16:37):
amount of income and otherthings to kind of build on that.
This just kind of starts thisit's almost like, think of it as
we do positive networking. Oneperson networks with another,
you build this kind of networkof colleagues or connections.
It's the same kind of thing, buton a much bigger scale.
But the basic tenet of this isactually if you find yourself
(17:01):
kind of in that either naturaltendency or that experience of
having chronic, you know,negative thoughts, I'm burned
out, I'm frustrated, nothing'sever gonna get better, is to
actually pause and allowyourself to experience some joy
and go, you know what? Thatactually was pretty nice. And
these aren't a one and done kindof exercises. It's almost like
(17:23):
any other exercise or fitnessroutine. It has to become things
that you build out in practice.
But you could be amazed at howfar taking that new approach to
things and kinda I don't wannasay shunning, but getting away
from always going towards anegative. And you'll be
surprised at how much that canchange perspective. And then
(17:44):
that actually starts to createphysical changes in both
yourself but also yourenvironment.
Daniel Williams (17:49):
Yeah. And hearing you talk about this, it
reminded me of something thathappened over the weekend. I was
in line like we are when we gothrough the drive through at
Starbucks, and we got up there.We'd placed our order, and we
were handing over well,actually, we have the the app,
so we were gonna scan it. Andthen they said the person in
front of you paid for it.
(18:10):
And we went, oh my gosh. Thatwas so incredible. We wanna pay
for the people behind us. Andthen the the attendant there
said, you don't wanna do that. Ithink maybe it was a soccer team
or something.
I don't don't know what it was,but they said, but thank you.
It's a nice gesture. But thereason I bring that up is it's
that idea of someone doessomething really nice to us, and
(18:32):
we wanna pay that forward orpass it along. What's going on?
Is this talking in some of yourresearch, have you come across
this where when we find somebodyreally doing a nice thing for
us, then we wanna respond inkind and share that sort of
kindness to other people aswell?
Steve Brewer (18:50):
Yeah. It actually that has a kind of a dual
effect. So that's actually oneof the things they talk about
these positive psychologyinterventions. So one of them is
we feel good about ourselves andfeel positivity when we have a
sense of altruism we're givingto others. So one of those is
like, hey.
I wanna pay for the car behindme. And so I've now done a good
(19:10):
deed, that maybe brightens myday. But I've also now
brightened the person behind metoday, and that prompted you to
go, well, maybe I can kindabuild this chain of positivity,
if you will. And so there's thatthat dynamic that is out there.
And so I think that's actuallyboth for the individual as well
as those that are on thereceiving end.
And then that's just the way tokinda, you know, kind of a
(19:32):
foundational way to kind ofbuild on these kind of things.
So exactly. It's a greatexample.
Daniel Williams (19:37):
Yeah. One of the other things you bring up in
your article is talking aboutwellness programs at work. And
so how does the team, theleadership strike a balance
where they can develop someguardrails or some positive
programs within the organizationbut not do what we were talking
(19:58):
about at first, like remindingeverybody, gosh, everybody's so
burned out. How do we strikethat balance? What's the tone to
get people on board but not kindof reminding everybody how
stressed out we are?
Steve Brewer (20:13):
Right. Well, couple of thoughts on that. One
is, you know, from a leadershipperspective, one of the things I
would strongly advocate for iswhen we make a work environment
or whether that be a singlemeeting, a team meeting, or, you
know, or just how we approachthings. When we can approach
(20:34):
things from a more relaxedperspective, more supportive, we
get others around us to relaxand actually enjoy some of their
day. They become more creativeproblem solvers, etcetera,
versus that kind of hard drivingkind of component to that.
So when we look at kind ofgetting away from burnout, you
(20:55):
notice in that example, I nevermentioned the word burnout. And
we're actually starting to justcreate a more positive work
environment without going, well,I know everybody's stressed or
burned out, so we're gonna do agratitude exercise. So everybody
has to name one good thing thatwent well today. And then now
we'll feel better after that.That's similar, but not exact
(21:17):
quotes in some meetings.
So I'm like, that's not gonnareally turn the corner if we're
like, you know, hurry up, getpast your burnout, and think of
something positive. Now let'sget on to the regular business.
So there's, I'll call structuralthings that we need to think
about and give people the tools,the environment to be
successful. But also as we dowellness things, and I know this
is kind of a balancingconversation I need to have
(21:39):
because I wholeheartedly believein a lot of those programs, self
fulfillness, wellness,well-being, etcetera, obviously.
None of it's always coached.
We gotta combat burnout, sowe're gonna put up a yoga class.
We gotta combat burnout, sowe're gonna do a healthy eatings
class. It's like, well, you knowwhat? We want people to be
(21:59):
healthier. We want people tohave better wellness.
So we have these classes. Andthat burnout thing will kinda
start to take care of itselfwithout always calling attention
to it. And really is that theonly reason we're doing it is
just because people are afraid?Aren't we doing it anyway
because it's the right thing todo? There's my dissertation on
(22:20):
that.
Daniel Williams (22:22):
Final thought then. You cite an MGMA stat poll
where fewer than half of healthcare leaders have taken steps to
support their own resiliency. Ifwe take a step back and think of
that in the bigger picture,sometimes people who are
caregivers and others will spendso much time helping others, but
(22:45):
they're not helping themselves.What can we do? Any of our
listeners right now who arehealthcare leaders, what can
they do to take steps to makesure, even though they're
helping their teams, they'rehelping family members, they're
helping others, but sometimesthey neglect themselves.
So what can they do to make surethey're taking care of
themselves as well?
Steve Brewer (23:07):
Yeah. I think it's it's a dynamic that's I can't
say for sure if it's stronger ormore prevalent in health care,
but we go into health care totake care of others. And health
care workers are somewhatnotorious for not taking good
care of themselves. They arealmost too selfless in that
respect. And I think leaders arethat way to an extent too.
So part of that is like, youknow, I have to be that stoic
(23:30):
leader. I have to be there formy teams. I have these kind of
things. And I think the tideshifting saw that you do some
Google searches or research onit. I'm starting to see more
about the importance of healthcare leaders or readers in
general need to take care ofthemselves so they can actually
be there for their families andtheir teams and partners.
So it's kind of reframing. Youmentioned reframing early on.
(23:52):
It's reframing what's theimportance for me to take care
of myself if I can't do it formyself. You know, sometimes
doing it for others is enoughwhat would change or reframe.
They're like, you know what?
I do need to get better sleep atnight. I need you to make better
lifestyle choices. It's okay toeven talk about. That's also
another thing as leaders,similar to like physicians and
(24:12):
some other healthcare workers,well, we're uncomfortable even
talking about it andacknowledging it. But as I have
conversations like this, I hearmore and more people saying,
well, know what?
Nobody's coming to ask me howI'm doing as a manager or
director or vice president orwhatever that leadership role
might be. And I kind of, youknow, flippantly say, you know,
leaders are people too, and weneed that sort of thing as well.
(24:35):
So I think that and then it'sreally giving ourselves
permission to take a step backand not necessarily to listen to
some of the literature because,you know, early on, it's like,
well, as a leader, your job,your number one job is to help
mitigate the burnout for yourpeople, for your physicians,
your nurses, your worker. Butthen all that did is really
(24:57):
kinda add weight to, like, myshoulders as a leader. I'm like,
well, here, I'm not a goodleader if I'm not mitigating
their burnout.
And now the focus is there withmore pressure, ironically,
instead of like, well, I need torole model that and do my do
that myself, and then that'llstart to build that positive,
you know, broaden and build cutsat the top of it.
Daniel Williams (25:16):
Alright. Well, Steve Brewer, as always, thanks
for joining us on the MGMApodcast.
Steve Brewer (25:22):
You're very welcome, and thank you so much,
Danny.
Daniel Williams (25:24):
Yeah. We've been talking with Steve Brewer.
He's got an article coming out.Can focusing on burnout cause
more burnout? That's going to beavailable on MGMA.com.
We will include that in theepisode show notes when it's
available. Until then, hope allof y'all are taking care of
yourselves out there, and thankyou so much for being MGMA
(25:45):
podcast listeners.
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