Meditate Like a CEO: Real ROI from Mindful Leadership

Hey everyone.

Welcome to another episode of the Value Based Care Advisory podcast.This one is a very special one where I actually explore one of my deepest fascinations, which is mindfulness meditation and mindfulness practices as they relate to the cross section of neurology, biology and emotional well being.It's interesting because we'll take it a step further and talk about mindfulness meditation practices and outcomes as to healthcare leadership quality, healthcare leadership effectiveness, and just enjoying.

Doing what you're doing.

I had really good reviews on this webinar I conducted, so I decided I would share the video with you.

So essentially the goal of this gathering here today is to really bring in the ivory tower research and kind of all of the wonkiness that goes on in psychological and neurological research around the concept of mindfulness to commercial application and particularly to leaders in healthcare with a tool to really hack their performance both personally and organizationally. So this is, this looks like a long agenda. It really isn't.So essentially, first we're going to define what mindfulness is and how it's not like a religion or it's not per se meditation.We're going to look at some scientific evidence that backs the assertion that we're making today, which means, which is essentially mindfulness improves several levels of performance, but particularly the neurological aspects of the mindfulness as a training.And then we'll look at some relevance as to how it's related to healthcare leadership and we'll do a little guided, a little guided mindfulness training so you could get a sense for, for what it really is. For those of you that do not know me, which doesn't seem like to be many today, I have a long healthcare administrative background.I have to admit and preface this that I've had even a longer fascination with mindfulness. And this dates back to my undergraduate studies where I was a psych major and working in research labs in positive psychology and neurocognition.So what's interesting for me is to kind of try to link some of these together. So to link mindfulness training to performance in healthcare leadership and value based care settings.And how do we kind of leverage mindfulness is a competitive advantage when we're doing business. And it's interesting because, you know, survey shows that about 60% of healthcare leaders report being stressed.And now honestly, that sounds like a little low because, you know, they all lie, these healthcare executives. It sounds a little low to me, 60%, but that's more than half right. And we know that the number one killer of leaders is, is not Luigi Mangioni.But it's stress. And so the aspect of kind of modulating that stress really makes a difference from the leader leadership level down to the organizational level.And of course that's not even mentioning that half of physicians are burnt out and all of the supply side that we know about. I want to focus on the leaders in this discussion. So let's first define mindfulness.So mindfulness is the scientific definition of mindfulness is a particular state of present oriented consciousness, okay. That's basically characterized by your moment to moment experience, your moment to moment awareness of your subjective experience.And the goal of mindfulness training is to provide you with the tools that you need to basically integrate your internal external experiential components. Now what does that mean?When we talk about internal and external experiential components, we're talking about essentially internal environments being your affective and cognitive states. You know, that's kind of what you're experiencing as, as the self, right?Kind of your, your affect is what you're feeling and it's different from emotion. Emotion is emotion, affect is affect. And essentially the external environment is everything that's outside of yourself.So all phenomena that's perceived as occurring outside of yourself, like your grant applications or your reimbursement rates or the health insurance company that's giving you a migraine, all of those are external components.And the point of mindfulness training is to give the practitioner or the, you know, the person who's training a, was practicing mindfulness a particular ability to integrate your internal and external experiences together. So when you think about that word integrate, we hear that a lot in healthcare integration, integration.So how about we start with integrating our own internal and external experiences right where we are, as we are. And kind of won't that trickle down to the whole hashtag integration we talk about in healthcare?And it's really to essentially work towards cultivating a non judgmental awareness of your moment to moment experiences. So when you're aware of your moment to moment experiences, you might then label them as positive or negative.So really this helps you to cultivate a non judgmental awareness. So you're not labeling your experience as positive or negative, you're just experiencing it.So this has actually been done in healthcare settings, healthcare corporate settings, in bmc, Boston Medical center as well as Aetna.And since we're, you know, kind of like health insurance wonks over here, trying to be mindful, I'm going to talk about the Aetna application just really briefly.So the former CEO of Aetna, super cool guy, Mark Bertiglioni championed, like mindfulness and yoga and these types of things at Aetna, believe it or not. And this was a long time ago. So now if you're having issues with Aetna is no longer there. So everyone's mindless.And some of the outcomes, some of the outcomes are like this. So 28% reduction in stress, an extra 62 minutes of productivity per employee per week.So you would think these people are taking time to be mindful and like standing yogic poses, that they're kind of, you know, losing time. You have to respond to the email and you have to get the ECM patient in and enrolled, but they're getting more time. That's.That was incredible to me to find 3,000 unadjusted for inflation. So this is many years ago. So now it's probably like 5 or 6,000 if you want an added value per employee per year.And that had a lot to do with, like, lower turnover, more productivity, and these. The healthcare costs for these employees, which is picked up by the employer, dropped by 7%.These are just incredible ROI from, from where I'm sitting. So kind of, what are the underpinnings of this? What are the neurological applications? Before I get there, let's look at the clinical application.Right? You see a lot of things on the screen right now. And part of this is to stress you out so that I could give you mindfulness.But when I was studying this in school, I was intrigued by this, this kind of center study that you're seeing. So there was a study, a landmark study back in 2002.And essentially that study looked at the application of mindfulness in the form of what's called acceptance and Commitment Therapy ACT with schizophrenic patients. So now imagine trying to implement this with schizophrenic patients. Essentially what happened was that there were two groups.Group number one was essentially treatment as usual. So essentially those patients that, you know would be doing whatever it is that they're doing at the hospital. So this was a psych hospital.And the other group was the mindfulness group, mindfulness intervention group. Now, what they found is that those patients.And this was an experimental study, so it wasn't like a correlation, like, you know, it might be associated with mindfulness. It was like a rigorous research method that kind of was able to isolate the intervention of mindfulness and its effects.Because you're comparing apples to apples, right? So one apple, one, you know, basket of apples is kind of doing the ACT training, and the other is just Doing what they usually do.What happened was that these schizophrenic patients started to report greater symptomology. Now that might.You might think, oh, wow, okay, so now they're getting more symptoms, but instead what's happening is that they're realizing that these experiences that they're having are delusion or hallucinations, and they're not reality. Because, like, the main component of a cognitive disorder, like schizophrenia, is the inability to distinguish reality from non reality.And so that's why you think the TV is talking to you directly, because you're having delusions of persecution, or you think, you know, you're Louis the 29th or whatever, you're having delusions of grandiosity. These patients were able to report more symptoms and report less believability in those symptoms, which I found fascinating.And I'm like, if it could work with this population, imagine with, you know, semi clinical healthcare leaders. So essentially then it made me think, okay, well, healthcare leaders, we're kind of busy. How long does this take?Do I need to hide in a mountain for a long amount of time? The real estate's very high in the mountains here in California. They catch on fire. So I might be even more stressed.So how long does it take for me to get this benefit that Alex keeps talking about?So I searched and searched and did research and research for you, and I found that there are almost immediate effects, immediate neurological effects of mindfulness training. And what you're seeing is changes in white matter in the brain. So greater density of white matter in as little as 11 hours.So 11 cumulative hours, not all at once. Training over four weeks. And I'll show you images of the brain scans. There were significant changes, you guys, in white matter microstructure.So what that is is if you look at white matter and gray matter.So essentially gray matter, the more gray matter you have in a particular region of your brain, the better you are at that one function that that part of the brain performs and the kind of pain perception. So what you're seeing is on your left side, you're seeing white matter changes on your right side. I found studies that in.In as little four days of mindfulness training, FMRI studies showed that those folks were reporting less pain perception. Okay? And so again, it was an experimental design. So meaning apples are being compared to apples.And one basket of apples essentially was, you know, going through this mindfulness training, and another basket was not. And essentially these were pain patients.And so what you're seeing is in as little as four days of this training, these folks were reporting less pain perception and that was the only intervention that happened. So now here there's a number of different aspects, right. So I'm not. This is essentially when I circulate this slide.And if you're very interested, you can look at the study.But the point I'm making here is that this is backed by hardcore research, okay, that looks at brain imaging and looks at the before and after intervention. And here is kind of like the highlights of some of the things that were found. So essentially increased cognitive flexibility.You kind of need that when you're in a health care leadership role because you have a strategic outlook, but you also have to have a technical tactical whereabouts. Like, you know, we sit here and plan what's going to happen in the year. But then that during that same planning, something blows up.The day after the patient is doing this and the day after that the staff is doing that. Right. So you have to be have cognitive flexibility, strengthened executive control, which is your prefrontal cortex.We saw images of greater density of gray matter, improved emotional regulation. So being non reactive and being composed in the face of those external circumstances I talked about earlier, all of those have been demonstrated.That's why I have kind of at least two studies under each of these categories to again further support this assertion I'm making. So here's an image of fmris. So essentially I. Although you see two heads here in front of you, this is a compilation of many, many, many brains, okay.Into one image and essentially to your left. So what happened here is that these participants were shown emotional images, okay. And their response to these images was measured in the FMRI scan.So to your left. And here's your amygdala. Everybody could like try to reach their amygdala.If you actually insert your finger in your brain and go past your cerebellum, it's kind of in here. Everyone can massage your amygdala. Massage it. Okay. So what you're seeing here is the response to emotional stimuli was greater.You could see that the left FMRI scan here shows more yellow. It's kind of even a little bit larger in the activation area. Right. You're seeing a strong response from the participants.Now after, and this was, I believe, an eight week training.After eight week training, the very same participants were shown a different set of emotional images because, you know, the theory could be that they already got used to that one emotional im. So then they're reacting less.So they showed other emotional images and look at that response, a more muted response A less kind of dramatic response because the yellow means more, so red means that there's some activation there. Now as it gets yellow, this activation is, that's the strength of the activation. You could see very composed activation pattern.Again, this isn't one person's brain. These are people who've never done mindfulness training before. After eight weeks, look at that.This is not, you know, this is, in theory, you can't mess with the FMRI images. This is what we're seeing. It's literally a picture of the brain, many, many brains into one. So some even might have had less activation. Right.So this I found to be incredibly interesting, particularly in kind of when you want to stay composed under pressure, right?When you're getting rapid fire questions, when you have to do an application for a grant from the state, when you have to do a number of different things as a leader, you need to be able to. We all want to be composed under pressure, but by definition pressure is stressful. So we're not always going to be composed.So how could we make changes in our brain structure and activation patterns to help us be a little bit more composed?For example, and this is just the amygdala, like the slide before this, I showed you all the various parts of the brain that have been studies that have been studied and have been shown to make significant changes. So from this slide I want you to take away what I've underlined. So essentially, why is mindfulness, why does it matter in healthcare leadership?Because again, from my very own experience doing this for many, many, many years in leadership capacity is that especially when you're doing value based care models and kind of implementing new things, you need to have a sharp focus mind, you need to be able to have empathy, you need to be resilient. Healthcare leaders must absorb a vast amount of information very quickly.So essentially, especially if you're operating in multi state organization, you need to know all the laws and regulations and the market dynamics. There's a lot of information to want to process. It really is.And the decisions are high stakes and they demand you to be calm and demand that you are able to connect with the teams and your patients on a human level. So now all of our busy leaders on the call are going to be doing a little training and this training essentially I'm going to break down into.So there's a number of different types of trainings, breath work, body scan and visualization. These could be standalone, right?As of their own, or what you're going to experience today is a kind of compilation of these together so you get a taste for each type. So what you're seeing in the gray box is what you're going to experience now.And holy Jesus, your brain's going to like have more gray matter after this call. And then I have some like, you know, implementation suggestions. So.But before we get started, what I want to do is kind of talk about some pointers as to how this can affect the organization. Now if you're, you know, each of these could be tailored to your specific environment.If you lead a large health system, for instance, leading from the top, you can have the CEO, like the Aetna CEO we talked about, or a VP kind of championing the cause.If you run a small clinic, it might mean that, you know, the office manager practices mindfulness a little bit and then invites others to join a few minutes each day. The important part is to start where you are and be consistent and know that even a few champions can spark change.Remember that mindfulness can be integrated at any organizational level, again, regardless of its size.And even small scale mindfulness efforts could lead to broader organizational improvements in well being and performance, which is what we're going to do today.