Anya hosts an enlightening discussion about health care, policy, leadership, and organizational change with CPH alumnus, author, and leadership consultant Joe Tye (76MHA). They discuss Tye’s recent article, “Caring for COVID’s emotional long haulers,” about the effect of the pandemic on health care workers’ mental health.

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Anya Morozov:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Anya Morozov, and if this is your first time with us, welcome. We are a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and outside the field of public health. Today, we are chatting with Joe Tye, who is the CEO and head coach of Values Coach, which provides consulting, training, and coaching on values based leadership and cultural transformation. He earned a master’s degree in hospital administration here at the University of Iowa, and then went on to get an MBA from the Stanford Graduate School of Business.

Anya Morozov:

He is also the author or co-author of 15 books, including his newest release, Building a Culture of Ownership in Healthcare, co-authored with Bob Dent. He also recently co-authored an article in Nursing Management titled, “Caring for COVID’s emotional long haulers.” Today, he is here to talk with us about that article, along with his career and background. Welcome to the show, Joe.

Joe Tye:

Thank you for having me. Looking forward to it.

Anya Morozov:

So, to start, can you walk us through your background and what led you to your current role?

Joe Tye:

I stumbled into hospital administration. I got a job at a county hospital in San Antonio, Texas, right out of college. Liked it, so I came to UI, to Iowa for an MHA. Worked at university hospitals for about eight years, primarily with emergency medical services. I was there when we started air care, for example. Went to business school for an MBA in California. Ended my career in hospitals as chief operating officer of a large community teaching hospital, actually two of them. And about 25 years ago, left that field and started Values Coach.

Anya Morozov:

Yeah. So, I’ve only really heard good things about you from multiple MHA students who have seen you in classes, but myself and many of our listeners are likely not that familiar with your work. So, what is Values Coach Incorporated?

Joe Tye:

Values Coach is me and a few support staff. So, we’re not a big company. We do two things, we work with hospitals on culture. So, we’ve worked on a concept we call invisible architecture. When you walk into any hospital, UIHC, anywhere else, your first impression is the bricks and mortar. But if you’re a patient in a bed for four or five days, when you leave you’re not going to talk about the beautiful artwork and the carpeting. You’re going to talk about the care that you were given. And we call that the invisible architecture. And we use a construction metaphor where the foundation is core values. What you stand for, what you won’t stand for, defines who you are. On that foundation of core values, the super structure in our construction metaphor is culture. That’s the personality, it’s the character of your organization, and the interior finishes workplace attitude.

Joe Tye:

Now, just like with a building, if you have a great architect and a great builder, those things are seamless. You don’t see a gap between the foundation and the walls. You don’t see wallpaper peeling off and bubbling up on the walls, it’s seamless. And it’s the same thing in an organization. If one of the values is integrity, that’s the foundation. You don’t hear people talking about coworkers behind their back, because that’s a gap between what you say your values are, who you say you are, and what is actually happening in the culture. And so, we challenge the hospitals we work with, and mostly our clients are hospitals, to actually create a cultural blueprint. Put as much effort into the invisible architecture as you do the bricks and mortar, and you’ll have less of a gap. So, that’s the first part of what we do.

Joe Tye:

The second part is guided by one of our key insights, which is, culture does not change unless and until people change, because the culture of any organization is shaped by the collective attitudes and behaviors of the people who work there. And if nobody’s willing to change, if everybody’s saying, nobody ever holds anybody else accountable, but I’m not the problem. You can bring in motivational speakers, give everybody a book, give everybody happy face pins. Three months later, the books are in the trash, nobody remembers the speaker, the happy face pins are upside down. The second element of what we do is help people get more clear about their own personal values, help them make the changes in attitude and behaviors that collectively will help you change your culture.

Joe Tye:

There’s a wonderful meme I found on the internet. It’s a tabby cat looking in the mirror and seeing a lion look back. And that is such a great metaphor, because it raises the question of, who could you be and what could you achieve if you really lived up to your potential, if you didn’t let fear stop you from doing what you have to do, if you lived your values? So, those are the two key pillars of our work, culture and personal.

Anya Morozov:

That’s really interesting to hear. I like your focus on trying to make organizational change, but also recognizing that you have to have buy in from the individuals to be able to make that change. So, the bulk of our episode is going to be focused on how the pandemic has affected clinical care workers. But first, I’d love to know, how has your work at Values Coach changed since the start of the COVID-19 pandemic?

Joe Tye:

I think that change is going to be underway for a long time to come. The first thing that’s happened is, for two years, in-person meetings stopped and most of our work is in person, either me speaking or consulting with organizations. So, we’ve had to do more virtually. Have not put as much effort into that as many others have, and that’s just not my strength. But what we’re going to be doing in the future is figuring out ways to do more things virtually and to do things that leverage our content in ways that don’t require a lot of people to be in a classroom for two or three days.

Anya Morozov:

Yeah. I think even on the podcast, we’ve had to transition to a lot of virtual meetings since the pandemic started as well. So, your article, COVID’s Emotional Long Haulers, discusses three different ways that the pandemic has affected nurses’ mental health: burnout, moral distress, and post-traumatic stress disorder or PTSD. Could you describe the difference between these three important mental health issues?

Joe Tye:

I have been in healthcare for more than 40 years, and every year there are headlines about the healthcare crisis. And this is the first time I’ve really felt like it’s warranted. And one of the reasons that it’s warranted is because of the stress that it has caused, the impact on the mental health and emotional wellbeing of caregivers. And I define caregiver very broadly to involve anybody who works in the caregiving setting, you know, a housekeeper that has to clean up the room after a COVID patient has been discharged or deceased. We tend to use three terms interchangeably. We talk about burnout, PTSD, moral injury, those are very different syndromes. And if we lump them together, we run the risk of a wrong diagnosis, leading to wrong treatment.

Joe Tye:

Burnout is a state of exhaustion, cynicism, frustration that usually builds up over a long period of time, and it was a problem before COVID. It has been made worse by COVID. PTSD is something we really haven’t seen in healthcare so much, until the last two years. It’s really more a combat related syndrome. It is the reaction that one has to having been involved in or having witnessed one or more traumatic incidents, and it is something that can creep up on you. It can explode years after the event. It’s been widely predicted that we’re going to see an epidemic of PTSD in healthcare. I had one chief nursing executive tell me, she had a nurse come in tears with a resignation saying, “I’ve had to zip up more body bags this week than in my entire previous career. I cannot do it anymore.” That is somebody who’s probably going to struggle with PTSD.

Joe Tye:

Moral injury is different. Moral injury is having to make a decision or take an action where you can honor one value or another, but not both. Anytime a caregiver who’s used to having maybe two patients in the ICU and now has to care for four or five and is not able to give the quality that he or she wants to give to each one, has to make a choice. I can either give the optimal quality to two or three and ignore the others, which is really not possible, or I can take care of everybody, but not at the level I want to. That is a person who has had to make a moral decision that is distressful, painful.

Joe Tye:

Anytime a manager, a nurse manager has to look at a caregiver, a staff nurse and say, “I know you’re exhausted. I know you haven’t spent enough time with your family. I know you should go home, but I can’t let you go home, I need you to stay another 12 hour shift tomorrow.” That manager is put in a position of moral injury. Doing what has to be done for the patients, means you’re not doing what should be done for the caregiver. And those are three very different syndromes and we needed to diagnose them for what they are and treat them appropriately. And the real challenge is, one person can have all three of them and they build upon each other.

Anya Morozov:

Yeah, that’s very true. I think I personally have probably used those terms interchangeably myself, so it’s really helpful to have that distinction going forward. So, to address burnout, moral distress, and PTSD, the article also described an analogy with four levels of action, tourniquets, bandages, sutures, and surgery. And I actually really found it useful for thinking about how to move forward when it comes to mental health of the clinical care workforce or the public health workforce. So, can you discuss this analogy and each of the levels in a bit more detail?

Joe Tye:

Sure. One of the reasons that my co-authors were working on this, is that some people are saying, “Oh, well, that’s just a band-aid,” and only focusing on the long term fix. So, we really need to be thinking about things at these four levels. So, tourniquet. A tourniquet would be suicide prevention, a crisis hot line. Band-aids, that’s more like a meditation room, bringing in yoga instructors, giving people a little more time off. That’s not going to fix the ultimate problem, but it is going to help people get through the immediate challenge. Think of the purpose of a band-aid, stop the bleeding and prevent infection. It doesn’t fix the problem, but it prevents it from getting worse. And right now, in a lot of healthcare, that’s where we’re at, we’re putting band-aids on.

Joe Tye:

Sutures would be something longer term, so for example, getting rid of 12 hour shifts. I mean the evidence is clear that somebody who’s working 12 hour shifts, especially if they’re having to do four or five in a week, can’t provide the quality of care that they want to provide and are paying a real personal cost. So, restructuring the scheduling system, that’s more like putting a suture on. And surgery would be long term system change. One of the arguments being made is that making nurses a cost center, rather than a revenue center, the way physicians are, diminishes the value of the nurse and it also creates inappropriate incentives. That’s going to take a very long time to change. So, that would be surgery. So, those are the four levels that we were thinking of.

Anya Morozov:

Okay. Can you actually clarify the difference between a cost center and a revenue center, because I’m not familiar with either of those?

Joe Tye:

Any accountant would probably cringe at what I’m going to say, but a revenue center is where you’re charging for a service. So, a patient comes to the emergency department, is cared for by a physician, there’s a doctor’s charge. So, there’s a direct connection between the work the doctor does and the bill that goes out to the patient. The nursing care is just built into the overall hospital. So, if you’re trying to increase revenue, you focus on the doctors. If you’re trying to reduce cost, you focus on the nurses, and that can create some inappropriate incentives. Does that help?

Anya Morozov:

Yes. Yes, it does. Yeah. And I think just in general, the analogy overall is really useful, because like you said, bandages, you don’t want them to fix everything, but in the short term, they can be a useful fix for some things. We should be looking at the longer term fixes as well, but you need all of them to really move forward. So, what are your thoughts on what leaders in healthcare can do and what the community can do going forward?

Joe Tye:

I think that there’s a real risk that we’re starting to say, “Well, COVID’s behind us, let’s move on.” And the emotional impact, what we call COVID’s emotional long haulers is going to be with us for a long time, just like the physical impact of COVID’s clinical long haulers will be with us for a long time. And I think, as healthcare leaders, we need to be very careful about not putting on rose colored glasses, not thinking, “Well, we’re doing everything we can for our staff,” which is probably not enough in many cases. And I think for the community, when you make decisions about not wearing a mask, about not being vaccinated, recognizes not just a political statement you’re making, you might be actually having a detrimental impact on the hospital, on the primary care clinics in your community, which have been overwhelmed.

Joe Tye:

I mean, it was a tragic thing to see the CEOs of the nine largest healthcare systems in Minnesota run a full page ad in Minnesota newspaper saying, “We are heartbroken. We are overwhelmed. We can’t go on like this, please get vaccinated.” We have to get in front of that public dialogue as healthcare professionals, but our communities need to listen to that too. It’s not just about your personal choice, it’s about how your personal choice can impact for better or worse, your family, your community, the hospitals, and clinics in your community.

Anya Morozov:

And I know your article talked about some strategies for leaders who are currently within the healthcare setting, such as nurse managers. Do you have any advice for how they can address mental health and the pandemic as its effects continue?

Joe Tye:

Yeah. If I had an easy answer to that one, I would be on my way to Stockholm to get Nobel Prize and a million dollar check. But there are two things that I would say are really important. One, to reiterate, take off the rose colored glasses. Be realistic about where your people are, about how they’re feeling, about the pressures they’re under, about some of the challenges that, in particular, your middle managers are facing, because this is a very difficult time for them. And the second is simply to show up. My favorite book on leadership is The Lord of the Rings, which it’s a fictional story, but J. R. R. Tolkien has done a better job of any writer ever in describing different kinds of leadership. And in the book, he has Gandalf the wizard show up where he was most needed and least expected.

Joe Tye:

And for leaders, I think if you’re a hospital CEO, that means you get out to the emergency room on a Friday night. You show up at food service at seven o’clock in the morning when they’re trying to get food trays ready. If you’re a nurse manager, you really listen to your staff. Even though you’re already overwhelmed, show up and be there, be present for them. Those are two things. Those are band-aid sorts of things that we can do now and we can do well.

Anya Morozov:

What is one thing you thought you knew, but were later wrong about?

Joe Tye:

Well, that is a fabulous question. I have always known that people can have very strong opinions. And I’ve seen the research, that we make up our minds and then look for facts to justify our opinions and not the other way. We don’t look at the facts and then make up our minds. But I once thought that if somebody was shown facts that clearly showed they were wrong and that changing their opinion would be in their own personal interest or in the interest of their families, I once thought that people would be flexible enough to change their minds. I don’t believe that anymore. Looking at COVID, it is very clear that getting vaccinated will protect you and your family and your community, and still how many people have refused to do it because they’ve listened to the charlatans on social media and the talking heads who don’t know what they’re talking about.

Joe Tye:

Looking at gun violence, as we speak, we’ve had four major massacres and still there are people saying, “Well, the problem’s not too many guns.” The research is very clear, giving more people more guns does not work, it makes things worse. And yet people are even more entrenched in their opinions about this public health crisis. Michael Dowling, the CEO of Northwell, a large healthcare system in New York, recently said, “This is an abomination.” And he challenged healthcare leaders at every level to come out and do something to reduce gun violence. And at one time, I would’ve thought if people knew, number one, more guns don’t make us safer, and number two, some sort of regulations on a well-regulated militia, the first words of the Second Amendment, could do more to protect your community and your family. I would’ve thought there’d be more willingness to at least think about a compromise on that, instead of people getting even more cemented into their positions.

Anya Morozov:

Yeah. I think we have definitely learned that just providing the information isn’t enough always, and we have to really think about how we communicate information.

Joe Tye:

I love what Brené Brown said about stories. She said, “Stories are data with a soul.” And I think we’ve gone overboard on presenting the data, but we haven’t done enough to share the stories. That’s what’s going to get people to change their minds, change their opinions, is doing a better job of storyfying. I made that word up. But doing a better job of presenting the data in a way that touches people’s heartstrings.

Anya Morozov:

Yeah. Yeah, stories can be a very effective way of presenting things. Well, thank you so much for coming on the podcast today. It’s been great to have you. I’ve learned a lot from this discussion. And I also learned a lot from the article, Caring for COVID’s emotional long haulers. There will be a link to that article available in the podcast description. And if you have any other final words that you’d like to share, please do.

Joe Tye:

First, you are a great interviewer, great questions. I’ve enjoyed our conversation. And second, I’d say anybody who’s in healthcare today at any level, public health, acute care, long-term care, your work has never been more important than it is today. It’s maybe never been harder, but it has never been more important. So, remember what you’re calling is, remember why you got into the healthcare, the healing professions. And it is probably not to get rich and famous, it’s to take care of people who are in need. So, Anya, thank you very much for including me today. It’s been a great interview.

Anya Morozov:

Thank you. That’s it for our episode this week. Big thanks to Joe Tye for coming on with us today. This episode was hosted, written, edited, and produced by Anya Morozov. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have an idea for the show? You can reach us at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.