Narrator
This episode contains references to some topics that may be challenging for listeners, including self-harm, suicide, and mental illness. Please listen at your own discretion. If you or someone you know is struggling, free, confidential help is available 24/7 by calling or texting 988.

Narrator
Welcome to Brilliant in 20, a podcast from Emerald One, where we celebrate the unique brilliance of today’s leaders and share their experiences with you in just 20 minutes.

Kai Miller
Welcome to Brilliant in 20, a podcast from Emerald One, where we celebrate the unique brilliance of today’s leaders and share their greatest lessons with you in just about 20 minutes. I’m Kai Miller. Today we’re sharing another special edition of our podcast to recognize National Suicide Prevention Month. Suicide and mental health are deeply personal topics for many of us, and they have far-reaching emotional, physical, and economic impacts.

Kai Miller
With me today is Janae Sharp, founder of the Sharp Index, a nonprofit dedicated to reducing physician suicide and burnout. Janae and her team create human-centered, data-backed tools and interventions to address the complex issues at the source, improving the quality of life for health care providers through their observations and advocacy. The Sharp Index also promotes mental health research, provides tools to help transform health care systems, supports community-building initiatives, and amplifies physicians’ voices to raise awareness.

Kai Miller
Janae, thank you so much for joining Brilliant in 20 today.

Janae Sharp
Thank you so much for having me. I’m thrilled to talk about our work and to talk to you too.

Kai Miller
I am very excited to hear about it. And we genuinely appreciate it. So give us a little bit of an overview. What is the Sharp Index?

Janae Sharp
The Sharp Index is a nonprofit, and we are dedicated to improving physician and clinician mental health and preventing suicide. Health care workers have more workplace violence and are more likely to die by suicide than other groups. And my former husband died by suicide before finishing his residency. And at the time, it was really overwhelming for our kids, and I didn’t feel like the people that I knew and even the school responded in a great way, like it’s like they didn’t know what to say.

Janae Sharp
So I decided to start a nonprofit a few years later, and here we are. That was in 2018.

Kai Miller
So, what does the Sharp Index provide for health care professionals?

Janae Sharp
That’s a great question, and I’m glad you asked it. So a lot is the answer. Like, it’s a pretty big nonprofit. We have some tools that are, you know, checking in on your state, checking in on mental health versus burnout. We also have direct support and scholarships that we’ve done for people and advocacy work, as well as working with health care systems to create a healthier structure.

Janae Sharp
Because we decided to start with what we were good at, which is a lot of the founders – they’re CMIOs, which for people who don’t know, that’s people who are great at informatics, and me, I have had a background with health care IT. So we got all the geeks together and started there. So some of the things we can provide are, you know, a visualization of people’s behavior or something like a survey for people who are doing great and people who aren’t.

Janae Sharp
And I think there needs to be a combination of direct input from clinicians that you’re working with. And, you know, you looking at and collecting data on your end.

Kai Miller
Yeah. Yeah. So we have kind of a blend of those, those two things that the Sharp Index where you’re able to give the organizations a view of maybe how their employee base is doing overall, as well as provide some ways of adjusting if they’re not doing as well overall. Am I – is that – am I hearing that correctly?

Janae Sharp
That’s right. Yeah. It’s interesting to talk to people about it too, because they’ll tell us something that you wouldn’t necessarily tell your employer like there. I don’t know if you’ve ever worked for a place that has like a survey or they ask you and you’re like, “Things are great. My boss is reading this.” So in health care, the stigma for having an issue might even be higher.

Janae Sharp
So it’s important that some of those reporting systems and some of those methods of collecting data are something that you know are anonymous. So we’re glad to partner with people on kind of like a, a third party way.

Kai Miller
Yeah. Being that kind of safer third-party space to go to.

Janae Sharp
Right.

Kai Miller
I love that you describe that. You got the you got the geeks together and then you just solved some problems as geeks do. So. Yeah. That’s amazing. You said you started this Sharp index in 2018, so that the obvious question that leads to is we then hit 2020, which is one of the most significant times of crisis for our health care system.

Kai Miller
What are some of the things that you at the Sharpe Index observed during that time, or some of the, the, the advancements that you had within the organization too?

Janae Sharp
That’s a great question. During the pandemic and during that era when people were in more crisis, I observed a few things that I think we should talk about today. One, people were more likely to accept help. Before when we would talk to people, they might have high levels of burnout or even high levels of depression, but they did not have a high willingness to participate in any solution.

Janae Sharp
So the willingness to be open about how hard it was drastically changed. And for us, that was a great thing. The levels of personal distress also skyrocketed. And what we found was that initially, that meant levels of burnout decreased because when there’s a crisis, we have a physiological response. We step up to it, especially people who are trained for that. And people in health care, they really stepped up and did more.

Janae Sharp
But the sustained problem created a massive need. Yeah. People, you can only sustain that level of crisis for so long before you just quit.

Kai Miller
Yeah.

Janae Sharp
So we noticed that. I also noticed that the way that people outside of health care talk about health care, mental health, and providers was so much more human. And that was a huge change that I thought was super important. Just the depictions of health care providers and and physicians that we’ve lost was so much more positive.

Kai Miller
When you say sorry, go ahead, go ahead.

Janae Sharp
Oh, sorry. No, I was going to change it. So if you have a question, I was gonna move on to the next thing I noticed.

Kai Miller
Yeah, I was just going to ask. That’s an interesting observation that you had. So prior to that time, you shared that they started to refer to health care professionals more as human. Yeah. So prior to that, was it in sort of this heroic or pedestal kind of way or how was it before? What was the shift that you saw?

Janae Sharp
I feel like we still referred to them as heroes, like literally.

Kai Miller
Yeah.

Janae Sharp
But before that, I think we were dealing with this human thing where we compete for resources and when we’re talking about, like, supporting people, usually we want to support the people who need the most. And that’s not always going to be physicians or nurses. They’re not the saddest.

Kai Miller
Yeah.

Janae Sharp
So people would have that that pushback where they’d be like, well, I probably should be supporting someone else. And these guys are just whining. They make enough money that they can just get over it.

Kai Miller
Yeah. Yeah.

Janae Sharp
Without fully understanding the importance that has for us or for patients or even what that means. And they they blamed physicians and nurses more than during the pandemic. You know, there is a danger in, in calling people heroes because you have a high expectation for heroes. Like if Hercules lets you down, that’s a big let down.

Kai Miller
A little bit of a problem. Yeah.

Janae Sharp
You did expect perfection. So I thought it was a positive move that we’re moving more towards seeing health care providers, physicians and nurses as humans that we’re working together with. So that was hugely popular. No, that was hugely positive. Yeah. Also, I will say we noticed a huge need specifically for childcare and for support for physicians or nurses that had families during that time.

Janae Sharp
We expanded the nonprofit to work with all health care professionals at that time, and we provided a lot of direct aid for people who might not have childcare. They work irregular hours, and the people who were most negatively impacted were people who are early in their career or in their training, or had a lot of need. And during the pandemic, I think it was about a year ago, I started noticing that every single parent that we talked to, because we talked to people in crisis, their children were also in crisis.

Janae Sharp
And it was staggering to realize how poorly people were doing. So while our perceptions and our willingness to get help has seen huge improvements, like the need has also skyrocketed, and somewhat, you know, now we’re facing kind of like post-pandemic. People are a little bit over it. Yeah. You know. Yeah. People are over it, they’re a little bit tired.

Janae Sharp
So some of those challenges remain.

Kai Miller
So let’s talk a little bit about… I find it so interesting that you were able to be having direct conversation with some of the health care providers, as well as gathering data and the quantitative side. So you have this really great blend of the qualitative stories that you’re hearing directly from people and some quantitative data to back that up that may help you have a little bit of a better image of what distress looks like and what burnout might look like.

Kai Miller
So distress is something that can look very different on every person. Have you identified some key indicators that someone is in distress that leaders may be able to use as they’re working with their employees or their teams?

Janae Sharp
Yes. And this is something anyone could do with their existing data and with their IT team. There are a few things that you can look at. I don’t know if you mean, like, generally program-level or in your electronic health records because there are different ways to approach it.

Kai Miller
Yeah.

Janae Sharp
Yeah. A really simple way to look at this, to identify distress is to look for changes in behavior. If you have someone who’s been really consistent and they have a drastic change in their behavior, that’s something you need to look at. Okay. Another thing that people need to address is volume of work. And how you address that can be… you can approach it from many angles.

Janae Sharp
You could look at how much people are working in hours. You can look at your scheduling. You can look at how often someone has to… is getting sick and you’re having that. So understanding people’s workloads is critical because if you if you looked at it, especially over the past few years, we’ve had a lot of turnover in some aspects of health care and that longevity matters and that understanding the organization makes you more effective at your job. But just looking at something like, how many hours did this person work doing actual work, not just your scheduled work? Yeah. How many hours are they working during the day? And you can track that. You know, sometimes in that electronic health record you can see. Are they working after hours?

Janae Sharp
Are they doing extra shifts? And you could ask them if they’re working other places. Understanding how much people are working is one of the easiest – but people don’t always think of it – the easiest ways to track distress. Yeah, because we found with asking people, there’s kind of an inflection point. And once you’ve reached that inflection point, those people won’t engage with you.

Janae Sharp
They’re probably going to quit. They’re high-stress, high-burnout and high-work. Now, when those changes happen, they aren’t willing to engage. But the people that you really can help, the changes in their behavior start before that on the curve. They’ll start missing more, or they’ll have erratic behavior or a change in behavior. Or maybe they just need more support.

Janae Sharp
With with the way your health care system delivers care. So that’s what I would say is the most important thing. Look for any change in behavior.

Kai Miller
Yeah. So that’s kind of your first-line indicator. And it gives you the cue to be having the the conversations, the interactions with people. What do you say to leaders in an organization when they say, “That’s so much time for me to notice changes in behaviors… I have this huge staff in my health care system.” What are some of the ways that leaders can be looking to embrace that level of regular familiarity with their employees routines, their behaviors, the things that are normal, so that they can then see the changes.

Janae Sharp
That’s a great question. I tell people the same thing I tell my kids. Start with what you can do. Start with what you know.

Kai Miller
Great advice. Yeah.

Janae Sharp
Before you do anything. And start with the tools you have. Because people might not realize this, but their electronic health record, chances are, has a way to track this. Or their team leaders probably know who needs help. So start with what’s easy. Start with what you know. Most systems have a method of tracking either behavior or attrition. They just… and it’s really a simple report.

Janae Sharp
You know? You call the guys. They do. It takes an hour.

Kai Miller
Yeah.

Janae Sharp
You just might not know it exists and that’s why. But yeah, that’s why you think it’s a lot of work. Because it’s actually not.

Kai Miller
Yeah. Or it’s a simple… It sounds like it’s a simple conversation with the team leaders and adding that extra question every week. “How’s everyone doing?” “Does anyone need help on the team?” And it might cue those middle managers, the team leaders, into paying attention to those things as well so that it goes on. Right. So health care is an incredibly complex environment.

Kai Miller
We’ve talked about burnout being high there. Pressure seems to… While people are over Covid and the pandemic, talk of the pandemic, we also have had a lot of attrition in health care, so people are doing more with less in the health care system. So what are some critical changes that you and your team are noticing are necessary to create, create or build healthier work environments?

Kai Miller
How do you maintain the level of good mental health when you may not have tons of resources to do that?

Janae Sharp
That’s a great question, because I’ve seen people do it in different ways, and some of it hasn’t gone so well. Obviously, people are leaving health care and I don’t think we would have heard from the Surgeon General that health care workers are in crisis if they were doing well. Yeah. In terms of building a healthy system, I think it’s important to build it together with the people who are involved.

Janae Sharp
And that’s not just your health care team. That’s not just your nurses and your health care workers, it’s also with your community. Some of the most successful hospital systems in terms of attrition, they have strong ties in the community, whether that be through service that they have done or through education. So one of the most helpful things that health care systems and leaders can do is to get more involved with their local community and local leaders.

Janae Sharp
Also, ask the people who work for you. And I said that really slow because that is something that really people really struggle with.

Kai Miller
Yes.

Janae Sharp
They really do.

Kai Miller
Where do you notice the struggle happening with that?

Janae Sharp
I think a few things are there. I just think some people do not care, and we need to, like, really be… really acknowledge that. People aren’t going to break down a system that where they won. You’re not going to criticize the game you win every time. So sometimes the people in the most power, the leaders, they’re like, “Well, it was okay for me,”

Janae Sharp
so it’s really hard for them to accept how things are now.

Kai Miller
Yeah.

Janae Sharp
So we talked a little bit about scheduling. Yeah. We had we’ve provided some aid and connected people with, like, actually attorneys. And that system, I had someone come to me and say, you know, “My health system isn’t being very kind to me. Like, do you have a support group for moms who have lost babies?” And I’m like, “That’s very specific.”

Janae Sharp
So this physician had an order from their doctor for a certain work schedule and was getting a lot of criticism from other, from their supervisor, and they felt like it was retaliatory. And whenever you come to that, you have a few choices. You either find a new job, you try to work through it, or you advocate for yourself.

Janae Sharp
And that’s uncomfortable if you’re in a position where someone’s critical of you. And we realized after talking to them, one, the the leader did end up needing training and understanding for how to provide the care. I think a lot of times we assume, like, managers or leaders in health care understand what they’re doing, but they might not. And two, it ended up being, like, a legal issue about their rights.

Janae Sharp
We’re not always understanding that you should have a right to a healthy workplace.

Kai Miller
Yeah.

Janae Sharp
Even in health care. And if you lost a child, you should have a right to, to grieve that time and to have support. And they actually had a scheduling tool – the health system had it – but they hadn’t turned it on. So they could have written in all the rules from that doctor, whether that be for grief or for a medical release.

Janae Sharp
You can write the rules into, into their scheduling, but they hadn’t because they didn’t know how to use the tool. And that was super frustrating. Like, they could have provided a great experience, but they didn’t understand patients’ rights or employee rights either. And they could have made it easy and invisible, but they didn’t know how to turn it on.

Kai Miller
And they didn’t have an understanding of the tool that they already had available that would have alleviated everyone’s experience across the board.

Janae Sharp
It would have made it so much more positive, and you wouldn’t have had that, that animosity between the manager and the employee who needs a modified schedule. I have talked to a lot of leaders who say it’s difficult to follow those things. Like, that’s a lot of work, and you have to make your technology, your tools accountable to make it less work.

Kai Miller
Yeah, that’s a, that is an excellent story about using technology to enable you to provide that supportive environment that your employees need without it being additional operational challenge. Right. So just knowing what’s already available to you. Like you said, start with what you can do. Look at what’s already around you and use those things to make it better for everyone across the board before you go looking for something new or try to implement some complex process.

Janae Sharp
Yeah.

Kai Miller
Yeah. Thank you. I’m glad that’s… That was an excellent story. I was going with.

Janae Sharp
A sad story. It was a sad story for them. I mean, like…

Kai Miller
It is, but it’s a good story for others to learn from. I think, I love your mantra of “start with what you can do.” I think that’s an excellent, it’s an excellent point for all of us to start from. And that’s… I wanted to go back to you sharing that. It’s a struggle for some leaders to understand what they can do.

Kai Miller
What are some of the questions that they could be asking to, to better get in tune with these things? What are some of the what are some of the questions that a leader could be paying attention to?

Janae Sharp
Well, there are a lot of studies about which questions are best and which ones are going to work. I advise people to start with what people love. So write down the things that you as a leader think are the most important and great things that you were willing to try. And then ask either your team leaders or employees to get that data for you.

Janae Sharp
What are people excited about trying? What are people excited about making better? And you can even position that as a positive thing. You know, what have you seen that you would love to try? What do you think we need to do? And, and build it based on what people say. Because the success of your program isn’t always based on the program.

Janae Sharp
People are much more likely to have success when they do something that they picked. And that’s the single greatest indicator of if your program will succeed, if it’s what people wanted to do. It could be anything. It doesn’t matter. Of they picked it, it’s going to have better support and a better outcome than if they didn’t pick it.

Kai Miller
Yeah. Great advice and I think it’s it’s very useful for those of us who might be leaders and are trying to think our way around the, “Well, I set up a committee for this in the committee is in getting things done.” That committee is probably the same group of people who volunteer for nearly everything in your company. Right?

Kai Miller
It’s not necessarily… Yeah, it’s not necessarily the committee. It’s the opinion of the broad employee base. So I think that’s a that’s a great approach to getting some feedback on making change. So. It’s hard, though.

Janae Sharp
It’s hard for leaders to let that go. I think, yeah. Especially when they’re in medicine, because they’ve been trained to be perfectionists and, like, know everything. So the idea that, like, there’s no one best way that’s a very huge challenge to a physician leader.

Kai Miller
Oh, I can imagine. I think probably for many leaders – because they typically are CEOs, are executives, are highly trained, highly educated – they’ve solved a lot of problems in their careers. And hearing those different voices, or knowing how to hear those different voices and opinions and factor them into the solution. Right. Sometimes can feel just like a lot of a lot of noise coming at you to be able to portion that out.

Kai Miller
So it seems like that’s one of the the great values of organizations like the Sharp Index. You can kind of help see through that noise a little bit.

Janae Sharp
Yes. It’s also nice because we have, you know, we’re less threatening sometimes than your employer.

Kai Miller
So if you were to, when you sit down with health care executives, with health system executives, if one of them were to ask you, “Janae, what is the one thing I need to do to create a better environment in this organization?” What is the one thing you tell those leaders?

Janae Sharp
Sometimes I just ask them what they’re passionate about. You do the thing that you care about the most. The other thing I would advise them to do is rounding.

Kai Miller
Rounding?

Janae Sharp
Yeah.

Kai Miller
Explain a little bit.

Janae Sharp
In health care, leaders should be walking around to see and watch patient care. They should be rounding on patients. They should be rounding on teams. They should be there where care is happening. They should call and make an appointment for themselves at their own health system. Good luck, you’re going to hate that! Good luck! You know, they, they should be on the frontline of care.

Janae Sharp
Watching what it is when people have to click through 10 billion windows, watching to see if their policies for scheduling actually work. And sometimes the horrible experiences they have, just scheduling something they’re enough. If you listen, I don’t know if you’ve heard the story, Chris Ross talks about having cancer, and he talks about how hard it was to schedule his own care as the CIO of Mayo Clinic and

Janae Sharp
you can’t always simulate that. Like, you can’t give someone the understanding that being that lived experience has. But you can learn a lot from just going through the process. Like, what’s it like to get mental health care at your health system? Go through it. Try it. So that’s the thing I think is critical. If you’re going to succeed and build a healthy organization, you have to sometimes not just ask your committee members, not just ask your leaders, but actually be rounding.

Kai Miller
Immerse yourself. Yeah.

Janae Sharp
Yeah.

Kai Miller
Okay. Let’s switch focus to the employee. If there’s someone experiencing distress, if they’re getting close to that burnout point, but they’re not yet at the disconnect point, and they struggle with with asking for help, what do you advise them?

Janae Sharp
There are a lot of programs that can help that have lower, like, barriers to entry, and we’ve provided help directly to people. But one of the most successful programs that we’ve had, this was even before, before, you know, 2020, when people really started to feel like they could ask for help more. They had an easier time participating as a mentor for someone who is younger.

Janae Sharp
So people who are struggling, sometimes the most effective programs are, like, supporting a medical student. So you teach the skills of, like, mental health coping, but your role is different, so you don’t have the same stigma. So I tell people to look for something where they’re a mentor. Like, if they really don’t feel like they can just come right out and say it – because in some places they cannot –

Janae Sharp
I feel like that’s something that I cannot emphasize enough. It is not always safe to get help, but you can find places where it’s safe to be a supporter, to be peer support, where you can get those same tools and the same education without that stigma that you might personally have or you might have at your organization.

Janae Sharp
So I tell people to look for that.

Kai Miller
Excellent advice, and I know many people will probably get a lot out of that. That’s not something – the mentorship approach is not something I’ve heard in the past. So thank you, I appreciate it.

Janae Sharp
And we did that when we had, like, so many people who are unwilling to do it for themselves, but they’re willing to do the same program as, like, a helper. And I’m like, “Well, your outcomes are improving, but you didn’t have to say, ‘Look, I’m really depressed,'” which is the hard thing to say. Well, I know you’re

Kai Miller
in a career that is so focused on helping others.

Janae Sharp
Right? Sometimes it’s like in AA where they say the first step is acceptance. I am telling you, you can succeed even without accepting. Yeah, you can get you can get better. You can get support without accepting that maybe you need help.

Kai Miller
You need it. You need. Yeah. You can’t avoid it a little bit. Right?

Janae Sharp
Yeah. It’s just not as direct. Like, we don’t need your acceptance. We can help you anyway.

Kai Miller
Yeah. Well thank you, Janae. This has been incredibly educational on so many levels. I love that we’ve gone from health care systems to health IT to culture change to helping individuals. I really appreciate it. And I am hopeful that our audience looks up the Sharp Index and learns about some of the incredible things that you’re doing.

Janae Sharp
Yes. Thank you so much. I hope we can get involved and that people realize we we do a lot with data. And I was obsessed with it at first, trying to show people why it’s important. And I really think in the end of the day, it’s our connections and our humanity that drives improvement. We’re not going to make these changes because we see a great spreadsheet.

Janae Sharp
We’re going to make these changes because we care about each other.

Kai Miller
Yeah, absolutely. What a wonderful note to end on. Thank thank you so much. I appreciate you joining us.

Janae Sharp
Thank you.