Well-being and burnout aren’t new topics, but they’ve been in the spotlight since the COVID-19 pandemic. Dr. Natalia Dorf Biderman, a hospitalist at Park Nicollet Methodist Hospital in St. Louis Park, Minnesota, and co-chair of the clinician well-being taskforce at HealthPartners, shares how burnout expresses itself and relates to well-being. She also discusses belonging, from comfort to connection and contribution.
Well-being and burnout aren’t new topics, but they’ve been in the spotlight since the COVID-19 pandemic. Dr. Natalia Dorf Biderman, a hospitalist at Park Nicollet Methodist Hospital in St. Louis Park, Minnesota, and co-chair of the clinician well-being taskforce at HealthPartners, shares how burnout expresses itself and relates to well-being. She also discusses belonging, from comfort to connection and contribution.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Natalia Dorf Biderman, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Hello, everybody, and welcome to our show. We are very thankful to have Dr. Natalia Dorf Biderman to our show today. She is a HealthPartners and Park Nicollet physician. More specifically, she is a hospitalist at Methodist Hospital, and she also serves as the chair of the HealthPartners clinician well-being task force. And she's also the clinical documentation integrity medical director. So welcome, Dr. Dorf Biderman.
Natalia Dorf Biderman:
Thank you for having me today. Super-excited for the conversation.
Steven Jackson:
You carry a lot of hats, and we're going to get into some of that. But just want to know a little bit about your story. Who are you and where do you come from?
Natalia Dorf Biderman:
Well, I typically say, "Long story short," but it's never short. So I was born in Uruguay and I lived there for 27 years, so with my family who is still there. I went to medical school in Uruguay and then moved to Chile to do residency. And while I was doing residency, I met my husband, who was living in Duluth at the time, but is originally from Canada, so exactly-
Kari Haley:
Big north-south difference there.
Natalia Dorf Biderman:
Except that he claims that we are midway. So we are not. We were part of a medical delegation. He was the medical director for the American delegation at a sports meet for Jewish sportsmen from around the world. And I was the medical director for the Chilean delegation. And then we got married and moved to the U.S. I did my recertification of all of my medical degree in Boston. Then we moved to Minnesota, where I did my residency at the University of Minnesota, second residency at the University of Minnesota. And then I started working at Methodist Hospital as a hospitalist, more than a decade ago. So.
Kari Haley:
What you're saying is on the second time around, you were the best intern ever?
Natalia Dorf Biderman:
Yes.
Kari Haley:
Yes, yes.
Natalia Dorf Biderman:
Why not? There were so many good residents there.
Steven Jackson:
It wasn't even close, though. I just feel it. That's awesome. For those that are listening, we're going to dive into maybe one particular hat, one particular area of focus and leadership. And that's basically you being the chair of the HealthPartners clinician well-being task force. Well-being obviously is very important. We've lived through a pandemic, living through it. We've had a lot of, some call it civil unrest, some call it the uprising. But we've had basically a lot of stuff going on, not only locally but worldwide, as it comes to the concept of racial injustice and equality and equity. And though the battle was worth it, the battle was tiring, and maybe in a different way these days. And so we're going to spend some time just really hearing from you, and wanting to know where should our minds be, and how can we preserve what we bring to the table as physicians and as people in general?
Natalia Dorf Biderman:
Yeah. Well, thank you for the conversation. It's a really, really important conversation. And when we think about well-being, it's important that we think about well-being in relationship to burnout. There's a lot of conversation around burnout. And while burnout is a guiding post, is something that is being very well studied, we really like to focus on well-being, on an aspirational goal. Much like the World Health Organization thinks of health, not as just the absence of disease, we think of what we want from work, not as just the absence of burnout. Many organizations call it different things. Call it well-being, call it professional satisfaction, call it professional fulfillment. The Institute for Healthcare Improvement went even beyond and said, "The goal is joy in work." And why is that? Because when we do that, we are not only trying to squash or remove the friction, but we really try to elevate all the positive things that our health care professions bring to the table, all the meaning and purpose and joy and relationships.
We want to elevate that experience, too. So when we talk about, there's a lot of emphasis right now and well-being and burnout, but it's not new. It's been going on for a very long time. The pandemic and the social unrest and the reckoning of the racial issues that our country and the world is experiencing really highlighted some of these problems, and really enhanced some of those that were in the past. But if we think of it in medical terms, it's more like an acute on chronic problem. It didn't start three years ago.
Steven Jackson:
That's right.
Kari Haley:
We are having an acute exacerbation-
Natalia Dorf Biderman:
Exactly.
Steven Jackson:
I like it.
Kari Haley:
... of it.
Natalia Dorf Biderman:
Exactly.
Steven Jackson:
Sounds medical.
Kari Haley:
It does.
Natalia Dorf Biderman:
Exactly. And it's really important that we're really paying attention to it, because it really does have a significant impact on our individuals, on our communities, on our patients, on our organizations. And so while we say that it's been going on for a while, and we're paying attention now, it's really important that we are when we'll take it.
Kari Haley:
Then I know in some of the things that you've talked about in the past and even are really, it seems like, a very advocate for, is in that space of well-being, the sense of the concept of belonging. And I think that that's something that is incredibly hard to also put a finger on and define, but if you can take a stab at it, to you, what to is belonging and how do we belong within an organization? How do we belong within our communities and within society? And how is that different or how is that the same?
Natalia Dorf Biderman:
Yeah. So well-being, professional satisfaction, there really is a multi-pronged goal. Burnout is a multipronged and very complex problem. And so this conversation really is going to double-click until the issue of belonging. But I don't want anyone to think that we are equating well-being with belonging. The important is that burnout in and of itself is something that is an issue that expresses itself in individuals, but is an environmental, occupational syndrome. And so there are a lot of many things that impact well-being and burnout. And one of them being belonging. When we think about belonging is that sense of that you're part of a community, that you're accepted, respected, and valued by your peers, by the people that you surround yourself, whether it is in your community, in your family, in your place of work. And so the sense that you are comfortable and that people see you, the community around you, see you for who you are and value for who you are.
And so historically, the interesting piece about this is that historically, we've thought about belonging, specifically belonging at work, in terms of comfort. So being comfort, the first piece, being valued and respected for who you are, feeling psychologically safe to bring your whole self to work. And now we're thinking about belonging even beyond that, being from comfort to connection to contribution. Really having those three pillars where you're valued, respected for who you are, where you connect meaningfully with the people around you and with the mission and vision and values of the organization, the kind of work that you do, and contribution, where you are accepted for your talents, where your gifts and special ways of doing things at work are valued and celebrated. So that is what we think of when we think of belonging.
Steven Jackson:
And it's interesting, because if you think about those three C's, you can't really have a third one out the second one, and you can't have the second one without the first one. So it's almost like there has to be some sort of emphasis primarily, or at least at first, on the comfort. And when I say comfort, people that are listening, I'm not talking about complacency, but I'm talking about a sense of "I feel OK being myself here. I don't have to code-switch. I don't have to change my accent or change my clothes or change my hair to fit."
"I can be me. It's OK to be me. And now that I feel OK being me, now I feel OK connecting. And if I feel connected now, what's on the inside of me can come out. My talents, my gifts, they can really be expressed," which stands to reason. If you have people that are not comfortable being who they are or who they need to be, then it's a detriment to the organization as a whole. Because now you have talented people who refuse to use their talents, because they don't feel connected. Because they don't feel comfortable.
Natalia Dorf Biderman:
Absolutely. So from-
Steven Jackson:
That was good. That was good.
Natalia Dorf Biderman:
But it's absolutely true, because we know that there's obviously an impact on the individual level, on the people who feel or don't feel belonging. And so some leaders or some people within an organization might think, "Why are we talking about belonging in the workplace?" Because we know that it significantly impacts the organization, too. We know from data-
Steven Jackson:
Absolutely.
Kari Haley:
Yes.
Natalia Dorf Biderman:
... that you see when people feel like they belong, you see 56% increase in job performance. We see 50% reduction in turnover, and we see 75% decrease in sick days. And that there's a direct line to the outcomes of the organization. We see that organizations in which people feel like they belong, they have high rates of belonging. They're two times more likely to meet or exceed their financial goals. Three times more likely to be high-performing organizations, six times more likely to be innovative. And there's no question that feeling of belonging and that you can share your talents-
Kari Haley:
Absolutely.
Natalia Dorf Biderman:
... wherever background you have, that six times more likely to be innovative and agile, and eight times more likely to achieve their business outcomes. And so while it definitely has impacts to the individual, it significantly has impacts for the organization. So for those leaders listening to this conversation out there and thinking, "Why are we talking about belonging at work? It's a soft conversation." There's financial direct outcomes related to a conversation around belonging.
Steven Jackson:
Yes.
Kari Haley:
I mean, if you bring data to the table, you bring facts, you bring data to the table. This is a downer question, but why do you think we still have such a problem with it then? If we know things are better at individual level and the organizational level-
Steven Jackson:
That's a good question.
Kari Haley:
... why do we still have such a problem with people feeling like they don't belong?
Natalia Dorf Biderman:
I think the world has changed, to be honest with you. While this conversation is particularly important for people from marginalized backgrounds, that is also very important for in general, or everybody in the world right now, specifically people in health care. The issue is that everything has changed. And so for those leaders who are thinking, "How do I make my team process or individuals really come to the table in a more holistic way?" I think that the way we do things, the way that things are now are radically different than what they were before. And so a lot of people are feeling like, "Wait, I don't know that I belong here. Do I belong here?"
Kari Haley:
Sure. Yep.
Steven Jackson:
Yep, yep.
Natalia Dorf Biderman:
Is it because I have a mental health issue now? Am I the only one that has a mental health issue now? Is it because I'm a single parent and it's hard for me to deal with things? I think we are all reckoning with this idea that belonging is important. And the world is seeing work in a different way right now. Individuals are engaging with work in a different way. The workscape, like we call it, has changed. And what is it? What kinds of organizations do we belong now? And so we internally, certainly at HealthPartners, are doing a significant amount of work around that. And I'll tell you, I don't know about you guys, but I think the conversation has changed. And I think the structures that we put in and just like this podcast, really opens up the conversation within, like we said, teams or people listening within the organization, and certainly outside the organization to really open the conversation, and weave it through and hardwire it through the organization.
Steven Jackson:
My gosh, there are so many different directions to go with this conversation.
Natalia Dorf Biderman:
I know.
Steven Jackson:
I'm giddy over here. So I think about, as a leader, I get a sense that my team desires connection. Now, it may not look the same for every person, but I believe that people are tired of business as usual, work as usual. The conversation has changed, the context has changed, the landscape has changed. And I think it takes a savvy person, whether a leader or colleague, to recognize that clinician well-being is no longer optional. But this is something that's mandated, and I don't mean mandated from the top down, but it's imperative, lest you burn out and leave the organization, leave health care, go home and sit in the dark. You know what I'm saying? And so I think at the end of the day, having this conversation, it's a need.
It's not a want. It's not, "Yeah, we kind of should do this now." But it's a need, because people are leaving organizations. People are leaving the health care field or education or law, they're leaving because they don't feel connected. Because we didn't do step one, the comfort. Helping people to be themselves and feel themselves. I'll give you an example. And whether you go on social media or even you read it in books or magazines, the concept of what is professional? I want to ruffle some feathers here, but why don't you dress professionally? Why don't you present yourself professionally?
Well, what does that mean, though? And who sets that standard? Is it a suit and tie? Well, that's traditionally what it has been. Being clean cut or having a nice fade. What about locks? Why can't I wear my locks? Anyway, I won't go into the specifics of it, but the whole point is those very things can be the things that deter a person from joining an organization or remaining at an organization. And again, it takes a person who's willing to challenge that which is normal. We talk about that a lot on the podcast, but what is normal? We need to challenge what's normal and break certain barriers, so that we have people who are gifted and talented and willing to use those gifts and talents for the betterment of everybody, so.
Natalia Dorf Biderman:
A hundred percent. So I mean, I couldn't agree more. The issue that you bring up is the issue of authenticity and identity. And from personal experience, I have to say that I've grappled, much like probably both of you have grappled with those questions for a while now, right?
Steven Jackson:
Yeah.
Natalia Dorf Biderman:
And especially when we are as clinicians, and one thing that we didn't mention that while we are speaking about clinician well-being right this minute is because we are clinicians, but really this expands to all of our health care workforce, and really anyone at work, well-being at work. But nurses and dieticians and physical therapists and pharmacists and beyond grapple with the same issues, too. And when some of us who come from diverse backgrounds like a Latina coming into a leadership position, and with my own cultural background, I had to do a lot of work around "How do I show up authentically, knowing that I am not of the normative or the dominant culture?"
I had some feedback around different things, and even for quite some time, I worked with one of our previous HR business partners who also comes from a diverse background, and really trying to understand how does it mean to lead authentically in an organization? And the interesting piece about this, one of the things that I learned is that authenticity doesn't have to look one way. And so it doesn't mean-
Steven Jackson:
That's awesome.
Natalia Dorf Biderman:
What we're talking about doesn't mean that I'm going to be the same here at work that I'm going to be at the bar with my friends shooting pool, or at home engaging with my children or my husband. And I can find the way to be authentically myself with my background and with my differences, and with my gifts that I bring, not in spite of them, but I can find a way to be authentic with that, because of that at work.
Steven Jackson:
That's good. I feel like saying amen.
Kari Haley:
Yeah, I know. Yes.
Steven Jackson:
That's good.
Kari Haley:
Yes. Preach. I think that we could go so long with this conversation.
Steven Jackson:
Oh, my gosh.
Kari Haley:
There's so many things. But since I asked a very negative question, I feel like, last time, so let's maybe go for the positive. Where do you see things going in the realm of wellness and burnout? And I feel like we've at least moved on behind the mandatory resiliency training. It's like we're made a step beyond that, at least. But what is the next step? What is the next thing coming or what should we looking for? What should we be doing within ourselves and within our peer groups to help further things and better the organization, better our own workplace?
Natalia Dorf Biderman:
One of the things that I always like to remind every single individual that I meet when this conversation or teams or leaders, but specifically frontline clinicians and frontline health care workforce professionals, is that remember that you have agency in your life, in your experience. While obviously, this is an organizational priority right now, it's felt that it's not a nice to have, but a need to have, right? Things don't have to only come from leadership. We can look at our experience at work, find what's working, find what's not, tweak it and take responsibility for some of those things. For example, comfort, connection, and contribution. Right?
Kari Haley:
Yes.
Steven Jackson:
Help us listen.
Natalia Dorf Biderman:
We can find in ourselves a way to feel more seen, more respected. Do we feel like we have a voice? Can I share my opinions? "I want to test, I'm going to share my opinions." "We are listening." Can we connect with one another? We know that connection, community, camaraderie is a foundation to sustain the very stressful jobs that we have, that we will have forever. We work in health care, and so can I individually reach out for meaningful connection, either with my peers, with my leaders, with my team, and then contribution? Do I feel like I am contributing with my gifts and with my talents that I really think that I can contribute with to my organization?
So individually, we can do that. And so when we start paying attention, we can do that. As an organization, we understand that we need to change the environment in which our health care workforce, our clinicians are working in. And so you'll see more and more coming through. But that's what we're doing. And I think the world is hearing, the world is listening, the world is changing, and there's a future that we can all contribute to. And that's the very important thing, engaging with this work, understanding that we have a voice and that we can do things in reclaiming that agency, and innovating what needs to come next. I think that's where we're at now.
Steven Jackson:
I think restoring joy in work again, not only is just a desire, it's a need. If I calculated it, I probably spend most of my awake hours at work. Because at home, you go home, you might hang for a little bit, but then I'm in the bed. I'm asleep because I have to come back to work. So if that's the case, we might as well optimize our work environment in such a way where work doesn't just feel like work. Maybe it feels like an opportunity to utilize my gifts to take full advantage of the gifts and talents that are around me. One question I wanted to know, really, is as we think about next steps, is there a balance between taking care of ourselves as clinicians, but also not forgetting about the people that we serve? I always think about the airplane. Don't give oxygen to someone else without first giving it to yourself kind of thing. And can you speak on that briefly? What is that balance, and how do we make sure that it's balanced appropriately so we're accomplishing what we're trying to accomplish?
Natalia Dorf Biderman:
Absolutely. In medicine, in health care, there's so much meaning and purpose in what we do that really elevating that experience and bringing that back is really at the bedside. And so going from this transactional way in which we engage, that the health care system has made it so that we are changing into a transactional environment, really honing in into that relational way in which we went into medicine. How do we elevate that experience where we can give to ourselves by giving, this is what we are in. This is what the kind of industry that we went into. Nurses, pharmacists, clinicians, even nursing assistants or transport people are engaging with patients when they are moving them from point A-
Steven Jackson:
That's right.
Natalia Dorf Biderman:
... to point B. We see that transport people talking and telling stories to the patients. This is what we are here for. And so while it's true that there's a lot that health care takes from us, because it takes a lot of energy, when we lean into that relationship, it is a way in which we can do our work, our jobs of taking care of someone else while also taking care of ourselves.
Steven Jackson:
Thank you. We got to have you back. We're so appreciative of your time. I feel like I've learned a lot. And this topic today, it's for today and it's for our future as well. This is a need, not only a want. And so thank you for educating us and spending time with us today.
Natalia Dorf Biderman:
And like I said before we even started, I have to thank you, because I do think that what we're doing here today really makes a difference. It weaves a conversation throughout our organization and beyond that needs to be had. And by doing that, we really empower people to be thinking for themselves about these things, to be thinking for the teams that they are leading. And we change lives. It does change lives. So thank you.
Steven Jackson:
You're welcome.
Kari Haley:
Thank you.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.