PetsApp Podcast - A few words on Burnout, with Dr Ivan Zak

Thom Jenkins: 0:09 Welcome back to the PetsApp podcast. Today, I'm joined by a very good friend of mine, Dr. Ivan Zak. I steadily stalked Ivan's progress with Smart Flow for quite some time before we actually got to meet at VetForum in Portugal in 2018. Ivan is a vet with an incredible backstory and career, including establishing a reference laboratory in Moscow, followed by a stint as an emergency vet before founding Smart Flow, which was acquired by IDEXX where Ivan served as Director of Veterinary Software and Services. He is now CEO of Veterinary Integration Solutions, providing an operating system for that new consolidators. He's also co-host of 'Consolidate That' and of course the ever popular 'Veterinary Innovation Podcast' on which I actually made my podcast debut. So welcome Ivan. And thanks for that.

Ivan Zak: 0:57 Hi Tom. Thanks for inviting me.

Thom Jenkins: 1:00 So today we're going to talk about a subject that I know you've... Not only as close to your heart, but you've actually done real academic study on - burnout. So for our listeners, could we start by just defining what burnout is precisely?

Ivan Zak: 1:19 So , you know, there's, there's , a couple of definitions. I think that the , what I like is the distinction between the two , cause a lot of people will use interchangeably - compassion fatigue and burnout. And I give all the credit for these definitions to Marie, who is , as a special interest in this topic and she's a consultant helping veterinarians out there. But a lot of people use those two interchangeably. So the burnout is more of a n emotional exhaustion and depersonalizing from clients and pets, developing cynicism, having a low, sense of personal accomplishment and it's, i t kind of doesn't go away and it translates into personal life. It's like this deep depression and dissatisfaction with what you do. And the difference between that and the compassion fatigue is that compassion fatigue comes from the repeated episodes of moral stress, that builds up and, and the moral energy to care for patients and clients. But it does go away if you're taking time off. And if you're, y ou k now, outside of the... outside of the work environment and it's quite similar to PTSD in, as post traumatic stress disorder. So those are the two terms that I like to define.

Thom Jenkins: 2:38 Ah, okay. That's interesting. So compassion fatigue and burnout are two distinct phenomena. Both of which seem to be prevalent within and across the veterinary professions. In terms of sort of monitoring and looking for the signs, are there signs that you yourself, or a colleague might be at risk of burnout?

Ivan Zak: 3:01 So it's a tough one because that externally could look like any other sort of depression, sadness, and tiredness. And what I like to do now is to look where the people are in their environment, especially at work. That's a huge emphasis that we put on the... Actually on the consolidation management these days through various integration solutions, as well as internally in the company. There's six well-known triggers of burnout. And if you ever know Christina Maslow, who was sort of the mother burnout , if you will, and she determined those, and those are very well-documented in the literature, but if you see any of those in the organization and you're wondering if people are burned out or not, you can seek for these six triggers and among them is lack of control in your environment. So if you don't provide autonomy or if you're, micro- managing value conflict , that's another one. If your values don't align with the organization that you work for, the continuous misalignment, there can lead to burnout. Insufficient reward; o if people are continuously underpaid or just taken for granted for what they do , and I've experienced that actually now that I look back at my personal experience with the burnout, that's been always a thing where yo u're t aking extra shifts, you're doing all you want, but you don't feel like you're appreciated for that - happens a lot to t he night emergency guys. Then work overload. And that's really the one that everybody thinks th e b urnout is: "I'm doing too much work". But there's six of those things. So two more: unfairness, if there is a clear favoritism within the organization, as well as break down al l t he community, there's no feedback loop. And if there's no framework for conflict resolution, so those are the six triggers that can predispose to burnout. And what I'm doing right now with the consolidation clients, as well as internally, we 're t rying to continuously apply all our management strategies and methodologies against those triggers.

Thom Jenkins: 5:05 Yeah, because it seems as a lot of those triggers are external rather than coming from the person as he facing burnout. A lot of it's the environment that they're in. So do you think there is a duty of care issue here from veterinary employers, and what are the key things you'd recommend them looking at or doing to avoid putting their team members at risk of burnout?

Ivan Zak: 5:30 Well, that that's sort of what now became the purpose and the passion in my going forward career. I actually think that the personal care and the the self care and mindfulness and all those strategies of resilience that we are now learning and teaching veterinarians to have is only one part of it. And I truly believe that as management as industry in general, we can create an environment where if you consider these factors and provide the environment that avoids those triggers, it really is on us rather than on the veterinarians themselves to avoid burnout and ultimately suicide in some instances.

Thom Jenkins: 6:12 Of course. I mean, that's the shocking statistic we're all confronted with, isn't it, it's just how high up vets ranking those in those suicide figures, but it's not just the vets, is it? I know from some of, some of our previous discussions that, vererinary technicians, veterinary nurses also suffer with burnout.

Ivan Zak: 6:31 Yeah. That was one of the findings of the of the survey that we deployed, because I wanted to find out how the industry... Well, whether it is burned out or not. And then, and then because we interviewed anonymously all the members of the visionary team... what came out, which was very interesting is that nurses are actually more burned down than veterinarians. And you don't hear as much about it. There's all these initiatives to protect the veterinarians to help the veterinarians. But I don't hear many of those that focus on the nurses and if the statistics are right... I mean, we should be focusing on those professionals as much or more.

Thom Jenkins: 7:12 Yeah. I mean, all too often overlooked and within vets. I mean, I suppose I can see that there is within... The service of animal welfare, there is something of a culture of martyrdom of, you know, nothing is too much to ask when it comes to helping our patients and helping animals. So I can see why veterinary professionals would be prone to burnout, but are there any particular categories of vets, you know, I'm thinking: age, gender, that sort of thing. Have you noticed any correlations there?

Ivan Zak: 7:46 So that was another finding that we had in our survey and it, to me, again, it was quite that one was actually even more surprising that it turns out that the veterinarians that are under 30 or in their early thirties, they're more burned out than the sort of baby boomers generations. And that that's something that we've proven statistically.

Thom Jenkins: 8:09 Do you have any sense as to why that is? I mean, you mentioned sort of compensation, insufficient reward. Do you think that's something to do with why the younger vets are facing greatest challenges? Or did you tease anything else out in your survey?

Ivan Zak: 8:25 I actually know because the finding was sort of incidental. I have my own hypothesis that are not necessarily supported by evidence, but I don't actually think that insufficient reward is one of the highlights of that. When we were looking at the veterinarians that are, that are younger right now, I think it's more rooted into how we consume information, what our expectations of the balance between work and life. And I think that just younger generations are more prone to focus on work-life balance. And then as you know, going through the vet school, you're going, you know, 150%, full on , through the studies. And then when you get out the, I think that the expectation is out there, that that's what you're going to be doing at work as well. And then those people that value their time off at all a lot, then I don't think that they can really , really exploit that post university. And the other thing is that I think that with the amount of information that you have to consume through the, you know, pre-vet and vet school, then you get to a certain point of velocity off of goal achievement that is so high. And then when you get out in the field and start just day-to-day , you know, business as usual, apply the existing knowledge without more challenge. I think that that also leads to a depression in a way that "I'm not challenged that much anymore". And that's, that's sort of the dilemma of millennials, you know, how a lot of people talk about them that you know , people are laughing about the fact that millennials don't feel appreciated, or I don't think it's that. I think it's, you know, if you look at the blowout studies by Maslow , I think that's that esteemed portion that we're not challenging enough younger professionals with the goals and not setting the right goals is just show up, do your work go home. I think that after such a stimulation by the vet school, they kind of get to this complete halt of the goal achievement in their life.

Thom Jenkins: 10:29 Yeah. I think that's a really great point. And also you spend all that time at university where you have this incredible community... Sort of ready-made community around you, and then transitioning from that community to practice where you're trying to get up to speed with your, with your new role. And maybe you're... you've started somewhere new. You mentioned breakdown of community as a risk factor. It sounds like that could be at play too.

Ivan Zak: 10:56 And that is too, and again, I like to refer back to Maslow, but I think that the community in the way of the and creating a community , by what they mean in the burnout triggers, it's more about how you build the community. Not that you're disconnected from community, but do you have a proper structure of social interaction within your new environments ? Can people give you direct feedback? Can they, when there's conflict, 'cause conflicts happen all the time, and then when you were studying how to treat a disease, but then you get upfront and someone is screaming at you for waiting for an extra 10 minutes. You just don't know how to deal with that stuff. So conflict resolution techniques, and how to teach that. I think that's important aspect of... Of the practice that we just don't learn, or how do you react to a family of the, you know, just euthanized pet that is, you know, crying in front of you, how to deal with grief. So there's, there's a lot, I think , that is, that is packed in there. And I'm unfortunately not a specialist in all of those areas of psychology, but I think all of that has taken a toll on the professionals.

Thom Jenkins: 12:08 No, I fully agree. And especially in this time, and , you know, in the context of a global pandemic, it makes sort of setting those structures that facilitate a sense of community, all the more difficult and all the more challenging. Sort of coming on to proposed solutions. You've always for as long as I've known you anyway , you've been a complete geek when it comes to 'lean methodology', what makes you think it can help here?

Ivan Zak: 12:36 Well, there's several things. So lean was just the area that, you know, because of Smart Flow and because of how that perfectly sort of was laid over the... The lean methodology and the whole theory of constraints and managing the bottlenecks. I was drawn to research that area. So in the literature search portion of my dissertation, that's what I did. I took lean and I researched the human health... field where they applied it successfully. And many practices from there really were attractive. And specifically, I focused on looking at the lean principles rather than the tactics that were developed by John Tucson, who was , who is the... he was the CEO of Fede Care {sp] which is the Wisconsin healthcare association. And so he implemented it there. And then he developed a group , a lot of articles about the success, but since then... we didn't chat since then. I think , then I, I started looking further in the, into the management of consolidation and veterinary practices and what is more applicable to our domain. So we started adding more components and we added more so lean. We added Kanban, we added agile framework from the software management, but we applying those old directly against these triggers. But if we want to kind of zoom back at at the lean principles and why they were so attractive to me, there's sort of six main lean principles that they use in the healthcare.

Thom Jenkins: 14:10 Before you dive in to the principals, Ivan, sorry to interrupt, but what, just for those that are listening, not everyone's going to be super familiar with lean as an idea. Could you just summarize sort of give a brief overview of what lean is, what it means to operate in that way?

Ivan Zak: 14:26 Yep . So lean came, came from Toyota. A lot of people heard probably about their lean management and in a way , some of the principles are eliminating waste and that's why they call it lean so everywhere in the production cycle, eliminating waste of waiting, waste of over production, waste of... Time. And then also with the respect to people that are performing the work and it was all to optimize the workflow. And that's why it sort of was so interconnected with Smart Flow. But it was applied in the manufactured as successfully and then many other verticals since then. And that's how we'd arrived sort of to medicine and was converted into these principles that are more applicable to that space.

Thom Jenkins: 15:12 That's super helpful. So I can see in the context of, of burnout that, you know, you could use lean methodology to address work overload, for example, to improve capacity through improving workflows. Where else do you see the impacts coming through?

Ivan Zak: 15:30 Well, the most important that I see is the principle of respect for people that do the work, because for the most part you know, large businesses are looking at the employees as the cog in the big mechanism, but what lean principles bring out is the communication and feedback loops with the people that are doing actual work. We were visiting San Francisco general hospital, I think, and we were doing the lead for executives over there. And their CEO is doing the regular weekly walk around the hospital and checking in it's called 'Gamba' in lean methodology. And and checking with the people that are doing the actual work. And then everybody is empowered to do changes that will optimize work. So the other term that is probably known to the audience, the Kaizen, which is... Which means continuous improvement is giving the power to people that do actual work, to come up with the optimization to the work that they do. So it's really a continuous improvement culture as well.

Thom Jenkins: 16:40 Gotcha. And yeah, you can see how that would address sort of the feeling of a lack of control if you feel like you're being listened to, and able to implement that change, and maybe that improves alignment with your values. I can certainly see how this all feeds into each other and can help us tackle burnout. For those that are listening, and they want to learn more about lean methodology and how it could be applied to the context of a veterinary business. Do you have any recommended resources?

Ivan Zak: 17:09 Yeah. So if you're looking at the at the level of the hospital, there was one book that was published by Dr. Chip Ponsford. It's available on Amazon, I believe for six bucks and it's called Lean Vets. I think you did a really good job of describing and creating the analogy of the organism with all the systems in it, to the veterinary clinic and how it functions within the lean methodology, interesting approach. And I think that that does, you know, he did a good job describing that. So that's at the level of the hospital... veterinary hospital. And if you want to look into more sort of lead and other methodologies apply to a consolidation, as that's something we work on, selfishly recommend visiting our website, which is: vetintegrations.com. And we have interesting framework described there, and a lot of free resources to research.

Thom Jenkins: 18:06 It's an incredible resource looking at some of the frameworks you've come up with. What I like here, Ivan, is clearly, you know, that burnout, compassion fatigue , mental health, all these things are very much front of mind for us in the vet... Across the veterinary professions. But it's nice to have sort of practical frameworks and approaches that we can take to actually address some of these issues rather than just talk around the issues. And so I'm very grateful for the work that you've done on this and grateful to you for joining us on the podcast today.

Ivan Zak: 18:39 Well, thank you for having me.

You can find Dr. Ivan Zakharenkov's full investigation on burnout in the veterinary profession here.