EP 58: Transforming Healthcare Culture Through Relational Rounding

CB_58. Dr. Cindy Lefton: Audio automatically transcribed by Sonix

CB_58. Dr. Cindy Lefton: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Dr. Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Dr. Renee Thompson.

Dr. Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. I hope wherever you are, you're in a good place. And actually, as we're recording this right now. It's not quite a week past Hurricane Helene. So, especially wherever you are, I hope you're safe. I hope you're in a place where you have support and you're being well taken care of. Okay, all right. I spend the majority of my time talking about bad behavior, dealing with bad behavior. People reach out to me every single day, bad. Sometimes, even all that badness gets to me, and it feels like such a heavy burden. So anytime I get to engage in a conversation with someone about the goodness in healthcare, what's happening that is positive. It's a very special day for me. And today I'm excited to have a conversation with Dr. Cindy Lefton. She is an organizational psychologist, and she's the pro bono Director of Research and Patient Experience for the DAISY Foundation, which you all know is about shining a light on the goodness. So Cindy, oh my gosh, thank you so much for being here.

Dr. Cindy Lefton:
Thank you, Renee. I appreciate you inviting me, and I certainly echo the sentiments for all the people whose lives were impacted by the hurricane. I appreciate the opportunity to be here today.

Dr. Renee Thompson:
Yes, we've been having obviously a lot of conversations about that. And I keep going back to the, what Mr. Rogers said when he was a little boy, and he was scared something scary would happen, and his mother told him, look for the helpers. When you're scared, and there, bad things happen, like, we know what happened with this hurricane, look for the helpers. And you know what? Many times it's the healthcare people who are the helpers and firefighters and police officers and all of that. And I've seen over and over again on social media the helpers. And that's what gives me a little bit of peace, knowing that there are so many people out there helping. All right, let's dig into this. I really want to talk to you today about meaningful recognition. And our mutual dear friend Bonnie Barnes from the DAISY Foundation recommended you and Cindy. You and I had a conversation, and I thought, oh my gosh, I need to have a chit-chat with her on our podcast because some of the work that you're doing is pretty amazing. And here's also what I love about you. I already mentioned you're an organizational psychologist, which, you know, they're my people. I wish I would have been one. Okay, I'd like to be one, maybe in another life. And the work that you do with DAISY is awesome. You also have written a lot of publications on communication, collaboration, meaningful recognition, however, something that's really unique about you, and think about the roles that you have right now, is that you're still practicing as a bedside nurse. And I think … cool, so tell us about that.

Dr. Cindy Lefton:
So, I work in an emergency department. I've been in emergency department for, I'll say, 39 and a half for my 41-year career. And I also, three years ago, decided to see if it was true, if you could teach an old dog new tricks. And age 62, I thought if I hung dopamine, I can hang chemotherapy. That's not necessarily a correct assumption because there's a lot involved with hanging chemotherapy. But I learned how to be an infusion nurse, and I also give chemotherapy to women who are experiencing gynecological cancer. So I do both. I work in the emergency department, and I'm also an infusion nurse, and it's really been interesting. It's been an incredible career.

Dr. Renee Thompson:
This is, first of all, I so respect you for maintaining your practice, okay? And I actually went back into practice probably about 8 or 9 years ago. I've had this company for 13 years, went back into practice because I wanted to keep my toe dipped in the water. I wanted to see what was happening out there. And that was going to help me be better at the work that I do. And oh, I got some great examples. I got some amazing stories, amazing experience. But then I moved to Tampa, Florida, and wasn't able to continue that. But what we recognize, too, is when you're especially looking at things like culture change and cultivating a healthy work culture, you have to be relevant, and you're so relevant. So when you look at the work that you're doing, even at DAISY, firsthand, the value of meaningful recognition, especially with people in healthcare who are the helpers who are out there sacrificing themselves for the sake of strangers. Basically, can you tell us a little bit about what does meaningful recognition mean to you? Because we all know it's not giving people pizza, and I've said that a thousand times. Meaningful recognition is not pizza. What does it mean to you?

Dr. Cindy Lefton:
I think that the best definition of meaningful recognition comes from the American Association of Critical Care Nurses. And if anybody is interested in the elements of a healthy work environment, AACN.org can provide you with a wealth of free information about the healthy work environment. I don't work for AACN, but I am a member, and they were really the first to put out the whole notion of a healthy work environment in 2005. Meaningful recognition is one of the standards, the key elements to a healthy work environment. So what is it? I'll use again, their definition, which is giving somebody feedback on what they did, their actions, their behaviors impacted you and made a difference. And it's delivered in a way that's meaningful to them. And that's really the crux, and that it's not over the top or like a thumbs up for something that was just really tremendous.

Dr. Renee Thompson:
That statement, it sounds so, I don't know, simple is the right word. But yeah, of course, giving somebody feedback on something that they did that made a difference in the life of someone else. And yet, we have such a hard time doing that. And do you think, Cindy, I wonder if it's because, all right, let's just say I'm a manager of a busy emergency department, and I want to provide that specific feedback to that individual in my department, something that they did that made a difference? But I have a gazillion other things on my plate today. And I think about it, and I think about it. And then I wake up in the middle of the night realizing that I never had that conversation. So can we talk about how to take that and actually make it practical for especially leaders? There's the organization. So, I think as an organization, you need to build in meaningful recognition as some type of strategic plan. But if you're someone's boss, how can they do that in a way that's practical?

Dr. Cindy Lefton:
Well, that's a good question because the span of control in healthcare is way different than the span of control in corporate America. And I speak from my experience as an organizational psychologist. And when I was doing executive coaching and I was working with leaders in non-healthcare organizations, and then working with leaders in healthcare organizations is a lot different. We now have 200 employees. You have 50 employees, or you have 20 employees, it is complicated. I'm not going to deny that. But that's where I think that our grounding is important for staff. Nurse leader rounding is really critical because it gives you the opportunity to have that face to face for a couple of minutes and to recognize somebody in a way that's meaningful. Because all of you leaders out there, stuff about your staff, how many children they have who can't work Fridays but can work with, why that's important is because you have some insight into what's important to them. It's already there, and also to people broadcast their needs by their behavior, by their actions. So, what do I mean by that? You who likes recognition in front of a group of people who want you to put a billboard up outside the hospital commending them. Who wants recognition in private? Not in front of a bunch of people. That who likes their recognition tied to how what they did helped the team. As a leader, because you give these people feedback in their performance reviews every year. Well, this already, so you don't have to do any extra work. You just have to think about it a little bit differently and then go to the people. And that's where the leader rounding comes is really important. I've heard that leaders will say, and I understand you want to go out and round. All I hear is problems and problems. Yes, you do. Yes, you do. But then how it's important to hear problems. But I understand that's also very draining, too. Then how do you, in that moment, change that conversation to recognizing people? And then all of a sudden, you start doing it over and over again, and then you change the culture. So it's those little steps that really do make a difference and then become big steps.

Dr. Renee Thompson:
We're big on leader rounding, too, and not leader rounding from an employee rounding, so your team, and we actually encourage relational rounding. So it's three things. It's number one: build a relationship, as you said, Cindy. These leaders especially if they've been there for a while, they know their people. They know how many kids they have that they like to work Fridays or don't work Friday like they know it. But if you're a new leader, you don't. And if you're a leader who maybe has some people on your team who are, let's just say, the resisters, we tend to avoid them. So you might not know a lot about them because you don't want to go near them. It's getting to know them. Build a relationship, okay? The other, the second thing is pitch in and help, even the unit clerk, the person sitting at the desk. Pitch in and help. Find one person that you can help, do one thing, and then catch them doing something right so you can give that meaningful recognition, that feedback related to a specific thing that they did. And what it sounds like, you're also saying, though, it has to be intentional. You have to be looking for opportunities throughout your day to catch people doing something that then you can provide feedback to. Because I know I can imagine if somebody says, okay, I'm going to start giving meaningful recognition, and I'm going to give feedback. And then they sit down, they're like, okay, what am I going to tell them? And they think they don't know what to just let it happen organically. But at the same time, there has to be some, you have to be somewhat intentional. So I'm going to go out round, and I'm going to look for anything that somebody is doing that they're doing really well so that I can give them that feedback. Does that make sense?

Dr. Cindy Lefton:
Yeah, and I think you made a bunch of really great key points. First of all, thank you for the clarification about the leader rounding. … Rounding on patients is great. I spent some time in patient experience. Love it. It's important. But you also have to, as you refer to it, I love that relational rounding. You have to round on your staff, and we, the data is very clear that before COVID, we had issues, and COVID just blew those up and exacerbated those even more. They didn't go away. It's not business as usual or business as normal. There's a lot of people out there that were hurting before COVID because it's hard. I love being a nurse, but it is really hard work, and it was hard before COVID. It's challenging, challenging now, and I know it's challenging for leaders, all the decisions that you're making, and the supply chain. And you talked about current events right now, it looks like the port workers are going on strike. So that could impact our supply chain. Again, for a leader, I don't envy you, but I think relational rounding is really important. And I also think to your point, it's about catching all the right going on. There is so much good happening in your organizations, and I know this for a fact, because if your organizations were really messed up, then the Joint Commission or your state would close them down, okay?

Dr. Renee Thompson:
That's true.

Dr. Cindy Lefton:
Yeah, there's way more, right, going on, but you have to be available to see all of that going on. So you have to be out there rounding so that you can observe all the right going on. I promise you, wherever you work, your staff is, you know, helping somebody relieve their pain, or maybe hugging a family member who's scared to death, or maybe they're touching a patient who hasn't had anybody touch them in six months. There's all sorts of amazing, extraordinary things happening in your organizations 24/7. You don't have to create that. It's already happening. What you have to do is be there so that you can see it, capture it, and give somebody feedback about how what they did made a difference in the life of another and impacted you.

Dr. Renee Thompson:
So that's so powerful, and you're right. We sometimes forget because we are so overworked, and leaders are dealing with an expanded the span of control that they have and their scope of work, and how many people are reporting to them, and supply chain issues, everything that you said and more, that it's easy to view your work and your day, even through that lens of negativity and feeling overwhelmed. And honestly, I can get like that, too. If I look at my calendar and I want to do all these great things, but I have back-to-back meetings all day long, right away. I think it's normal for human beings to go into that overwhelm. I'm stressed. How am I going to get all this done? And we start then, I think, looking for reasons to justify why we feel so overwhelmed. See this happen. Now I know that it's going to take me an extra 20 minutes to do that, but to be intentional about changing the lens and looking through the lens of what's going well. And you had mentioned something earlier about, yeah, when the leader rounds, all they hear are problems. And with a lot of the leaders we work with, it's a common situation where the leader comes into work first thing in the morning, and they're hit by the night shift with all the badness that happened. And sometimes, they're legitimate. Other times, it's just resister complaining. It's recreational complaining. That's how they are. And I've advised the leaders to save this. So I really want your input on this to say look I will listen to you complain for a couple of minutes, okay? But you have to tell me one good thing that happened first. Okay, just tell me one good thing. And if they say I don't have anything good. Okay, when you have something good, then you come and talk to me, okay? Don't let them off the hook. But something good did happen. Maybe it's their patients are still alive. Okay. It could be something as basic as that, but there's always something good. However, you have to look for it. Because if you just go by your default human nature, we have this negativity bias. And as an organizational psychologist, I know this. We have to almost force ourselves to look for the good because it is there.

Dr. Cindy Lefton:
Absolutely. I think you, absolutely. I think, I don't know if it's, I don't know the literature well enough to know if it's just human nature that we focus on the negative. But I've been in plenty of meetings over the years and in my various roles, and it's very rare that the meetings are all about all the good going on. It's usually in a meeting that's generated by a problem. And again, I understand that I have great respect for quality improvement, process improvement, morbidity, and mortality meetings. All of that is really important because we have to understand when we made a mistake, we do have to get to the root cause analysis and understand it so that we can fix those things and put the correct system pieces in place. But I also understand, and I will throw this out to all of your listeners, Because this with all my heart. Why can't we have a root cause analysis with the rigor of a root cause analysis that focuses on all of the right going on? I don't know if any of your listeners want to do something like that. I will help you on my own dime. I've been saying this for years, and I can't get anybody to take me up on it. Why can't we have rounds of right and remarkable? So again, we'll still have … rounds. Those are important. But why can't we dissect all of the right that went on some of these cases that we do on a daily basis a gazillion times, and look at all but what we did right under the microscope and say, how can we bring more right into our organizations? How can we bring more right into our cultures? How can we recognize those right behaviors? HR has all these policies about tardiness. And if you call in sick and all those things, what about if you show up every day and you give it up? And so, at the end of the year, you get a lawn chair, or a backpack, or a cooler.

Dr. Renee Thompson:
Yeah! Oh my gosh. As you're talking about this, I always know I'm really connecting with a message when I get those goosebumps. And talking about root cause analysis, not on something that went wrong, but something that went right, so that we know what made it right so we can repeat it. You're right. I don't think anybody's doing that. And it reminded me of, I'm working with an organization right now. Leaders in this organization. I talked with the executive, and then I actually had a conversation with the physicians, okay, as part of our work that we do. And we're early in this work, so it's okay, what would you like to see as a result of our work together to a whole year long program? The physicians basically said, and these are physicians, and you think, oh, they're so left-brained. They don't need any of the fluffy stuff and meaningful recognition. Oh, they don't need any of that. But Cindy, one of the things that they shared and they were in a group is that people are so quick to criticize them when they haven't done something right or when something wasn't perfect, but rarely do they ever get that sort of pat on the back for doing good work. And the executives said the same thing to me. In a separate conversation, she said basically, she was at a meeting with all the other executives, and there were ten, I'm making this up, I can't remember, but let's just say ten metrics from the quarter before that they had to work on, and out of the ten, they improved nine of them. What did the other executives focus on? The one that they didn't. I get it. It's maybe human nature to look at that, but we need to stop that. And we need to start recognizing the things that are going right and do that root cause analysis so that again, we know what was done so we can repeat it. I don't know, how can we do that? If anybody's listening and they want to partner with Cindy. Okay. And just in the show notes, we'll have her email address, and I'll also have the link to the AACN for their healthy work environment, and we actually have a relational rounding guide. I'll drop that into the show notes, too, but I'd love to explore this, Cindy. I really, healthcare needs this. We need to equally focus on the things that we're doing. How do we do that?

Dr. Cindy Lefton:
I think that's a really good question because it's it's a culture change and you're an example of that meeting is perfect because that's what happens. We are in healthcare. We are not football. We are not baseball. It's not about okay; we won today. That's our goal, is to win. Because sometimes and I teach I used to teach ACLs. When I would teach ACLs, I would tell the newer staff members, obviously, we all want to save a life. We do. But sometimes you can do everything perfectly and everything right, and that's not going to happen. So you got to ask yourself, did I do my very best? And we can't say, oh, we're just culture. We're this, and we're that. But you can't just say it in words and have it on paper. You have to have the actions that really follow that. So, it's a huge culture shift. And I don't mean to be disrespectful to any leaders because you have a hard job, and the higher you get in an organization, the lonelier it gets, and you're making decisions. I know that sometimes in your heart you don't believe in, but that they're very tough decisions that you have to make, and I don't envy people in those positions. It's hard, but I think it's really important that we reconnect with why we came into this field to help others. That is always our true north. And that, I think, will invigorate what I've been told over the years. And we did actually worked with Dr. Leslie Kelly, a brilliant researcher at the University of Arizona, and Shelley Fitzgerald, another brilliant researcher. We actually did one of the first studies on compassion fatigue in nurse leaders, and we published it, I believe, in Jonah, and I got to interview 16 nurse leaders from different organizations. And it was really I learned a lot from them. The smaller hospitals, you're so flat, you don't have a lot of people that you can fight these big urban academic medical centers. But it is it's lonely at the top. It's hard, but you're experiencing compassion fatigue. You're experiencing burnout, too. We know that. And what people told me is how they nurtured their own souls and re-energized themselves was reconnecting with why they went into nursing and healthcare. And you can do that with relational grounding and see all of the extraordinary because I promise you, if your staff is doing a great job, you get credit for that because every time something bad happens, it falls on your responsibility. Whenever anything good happens, you're responsible as a leader for that, too. All that is great. Yeah, it's because you're creating an environment where people can do that.

Dr. Renee Thompson:
So I think, and I've been doing this a lot lately, if I see somebody who posts something on LinkedIn that they got an award, that they achieved some degree certification. Yes, I will congratulate them. But what I also add is, how will you celebrate this? Okay, because we don't do a good job celebrating our accomplishments. We have the goal. I want to get this degree or this certification or this award or whatever it is. And as soon as we reach that, scratch it off the list. And now we have something else we have to do. But I've been even mindful of that myself, where if I have a goal that I want to accomplish, how am I going to celebrate that so that it means something? It's not just something that I've written that I want to achieve, and I cross it off my list. And I think leaders who can celebrate with their teams and celebrate their accomplishments are the ones that they don't feel as overwhelmed and drained, that they actually can leave work feeling good about being a leader in that department or a leader in that organization. It's so funny. So, on my team, when we accomplish something really big, like when we got our provider status through ANCC, okay, and that's rigorous. You have to go through, not easy. And Cheryl Fletcher, she's the one that really helped with all the documents. I would have never been able to do it. I am not detail-oriented like her. Like, thank God for her. Bobby helped. And so the three of us went through the process and when we achieved that award, I'll call it an award. It felt like an award. Yeah. Our way of celebrating is Cheryl and I both love red wine, and we love anything from Caymus the Wagner family. Now, Caymus is anywhere from $90 to $110, depending on where you live. So it's a special occasion. Wine to celebrate, I planned it. You have to be intentional, I planned it. We're going to have a little happy hour, virtual happy hour. And I sent a bottle to Cheryl. I sent a bottle to Bobby. I had my bottle, and we celebrated. Because if you don't, it's almost. If you don't, did it really happen? But it makes it more meaningful when we can actually get together and then celebrate a win. Celebrate the goodness. Celebrate something, especially if we work really hard to celebrate getting through a really tough period of time. But I think I don't know, Cindy, I see that also as part of meaningful recognition that you're recognizing your accomplishments, not just scratching it off your list and saying, okay, what's next? Because I think we tend to, I know I tend to do that.

Dr. Cindy Lefton:
You know, putting it, you get it, you get a certificate, you take it to the shop to frame it. That's another errand.

Dr. Renee Thompson:
Yeah, or remains in your, on your desk.

Dr. Cindy Lefton:
I think I love your example of how you celebrated. And because so many times it's okay, let's move on to the next task. If you're a nurse leader, your inbox is full of emails waiting for you. You probably have voicemails. If you are lucky to have an admin, they probably have a task list of things for you to do, so it's always go on to the next, go on to the next. And so you've got to make, as you said, be intentional and take those moments to recognize what you did accomplish and how what you did made a difference. Because I would believe, as I believe with staff nurses, with nurse leaders, that somewhere in your day, you did something that was helpful and meaningful to another human being on this planet, probably in your organization. And when you go home, you get in your car. That drive is going through the list of things you didn't do or have to do, and you're not reflecting on what did I do today. Because, and we know, there's a whole lot of work on neuroplasticity, and I'm not an expert in that field, but it's really some neat stuff, but just how all of this thinking with positivity reality that can reset your neural circuits, and it really does make a difference. Think about it. When you take a break, or you think about something, or even if you look at puppy dogs on Instagram, you're resetting your. And I think that we need to build more of that in our day, especially for nurse leaders that are going from meeting to meeting to meeting.

Dr. Renee Thompson:
I know, death by meeting. Maybe it's creating some reminders for yourself. So if you're listening to this and you're in a leadership role and reminders to be intentional, reminders to catch people doing something right, reminders like I learned, okay, now if you're listening to this, you won't see this, but if you're watching this, you'll see this. I learned this from my friend Quint … He says. You know how sometimes you get up and you have to go to work and you're like, oh my God, I have to do this. I have this meeting, I have that meeting, I got it. And I catch myself doing the same thing. And he says, no. Change the language to, and I have a little index card on my desk that says, I get to fly to California to give this presentation, even though it's going to take me a day to get there and a day to get, I get to do this podcast with an amazing human being, Cindy Lefton. Okay. I get to. And just that, even sometimes it's so funny, my husband, he'll catch me sometimes being a little cranky of all the stuff I have to do. And I'll say, you mean the stuff you get to do? Thank you for the reminder, honey. Okay. But yeah, like, we can all fall into that. But it's setting up those reminders on something that maybe you want to be intentional about that you haven't been. I get to round on my team today. I get to catch them. Do I get to just, I don't know, just something practical? I know it's helpful for me to have them. These little reminders set up, especially when I'm having one of those days. Cindy, as we start wrapping up, if somebody is listening right now and they really want to be more intentional about recognizing their team in a meaningful way, I don't know, what would you recommend as a first step?

Dr. Cindy Lefton:
I think there's three things. The first is listen for a little bit different conversation as you're talking to somebody. Listen to, listen in a way to catch that right and remarkable. And we nurses, we're not really good about touting ourselves some more, but I think for the most part, and they do. Bonnie Barnes will tell you, with the DAISY Foundation, so many times, people who get recognized with the DAISY Award will say, I was just doing my job. Yeah, you may just be doing your job, but your job is pretty remarkable if they can't say it. Observe. Go out. Go in the third piece. Go to the people and observe. Just watch. Because if you stand out in that area where they're delivering care, you're going to see and you observe and you listen, you're going to see extraordinary things. I promise you, it surrounds you.

Dr. Renee Thompson:
Wow. I recently interviewed the chief nurse executive, Stacy Alves, and she said this, and I quote, You can't care about your people from your desk. And I thought, wow, that is so powerful. So get out there. Listen to your people, observe your people. They will tell you what they need from you.

Dr. Cindy Lefton:
Yes, and they may not tell you directly, but you can observe by their behavior too, because again, we broadcast our needs to our behavior.

Dr. Renee Thompson:
You're absolutely right. And guess what? Listening and observing. It's free. It doesn't cost you anything. Look at that … Especially now, I remember. So I went to college right out of high school, University of Pittsburgh, and we had these pizza wars. Okay, so the local pizza shops, they would have these specials: $5.99 Extra large cheese pizza, and it was like $4.99, while Capri Pizza, $3.99 for an extra large cheese pizza. That was the lowest. And let me tell you, that's where I gained my freshman 15. Okay. What is that? That pizza. But today, I don't think you can get a large pizza for under 20 bucks. It's ridiculous. But listening and observing is free.

Dr. Cindy Lefton:
And going into your port, going to the people you know, you really can change the culture that way. So you're always going to hear feedback about things that are not going right. But if you start capturing all the things that are going right, your people, you have to be consistent, just like anything else, but your people will follow, and then you're going to get an extra added boost back because you're going to hear about all the good and you had something to do with all that good.

Dr. Renee Thompson:
Yeah, absolutely. I think this is probably more important now than ever before for leaders who we know are really struggling. So, hopefully, you're listening right now, and you were taking notes. Although if you're listening in your car, hopefully, you'll stop somewhere and break down those notes because I know I listened to a lot of podcasts in my car. I listen to them when I'm getting ready. Cindy, if people want to connect with you, we already mentioned that it's okay for us to share your email address in the show notes, correct?

Dr. Cindy Lefton:
Absolutely, absolutely.

Dr. Renee Thompson:
Yeah. We'll make sure that we have your email address there. And I told you that I'll share the AACN Meaningful Healthy Work Environment link. And I'll also share the relational rounding, and I have to look to see when Stacy's episode is coming out, but I'll make sure if it's out before this airs, that we'll go ahead and put the link to her episode in the show notes. Cindy, thank you so much for being a part of this show and having this really amazing conversation with me. I just know you're going to help a lot of our nurse leaders who are listening right now.

Dr. Cindy Lefton:
Thank you, Renee, for inviting me. I really appreciate you giving me the opportunity to talk about all the extraordinary happening in our profession. And to all of the people listening, I know that you have done something amazing today to help another person. You're going to do other things amazing today and tomorrow and next week and next month and next year. And you really, your work is extraordinary, and you're an extraordinary human being on the planet, and the planet needs you.

Dr. Renee Thompson:
I could not agree more. So thank you, Cindy, for just your great work and for continuing to practice and being a voice for goodness out there, especially your work with the DAISY Foundation, and extra special thank you to our friend Bonnie Barnes for recommending you. I just so value her friendship and the amazing work that she, and Mark, and the whole team at the DAISY Foundation are doing. And I really want to thank you who are listening, who are watching for doing your part to really cultivate a healthier work culture, we need it now more than ever before. So, if you like this podcast, if you could please review it, rate it, and maybe share it with someone who may need to hear this today. And just so you know, this episode will air at the beginning of November. We're doing a campaign right now to try to get 50 reviews by the end of the year. So please post a review. You can go on Apple Podcasts and it's easy. Just write and then go ahead and put in a review for us. I'd be super grateful for that. So thank you all for being here, and we'll see you next time. Take care everyone.

Dr. Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found this podcast helpful, we invite you to click the Subscribe button and tune in every week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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