This pre recorded show furnished by Matthew Matern. This is Matt Matern. And this is the Unite and Heal America program. My guest today is Dr. Diana Hendel and she is here with us. Has written a couple of books, I would love to share those with the audience and talk to talk to you, Diana about your experiences and running a hospital and, and your background, how you got into the medical field.

And sure, well, my professional career started in the late 1980s. And I was started as a clinical pharmacy student and then a clinical pharmacy resident at Long Beach Memorial Medical Center, and Miller Children's Hospital, which are in Long Beach, California. And at the time, I had envisioned be becoming a clinical pharmacy pharmacist and staying on as a clinical pharmacist.

But I ended up doing a second year residency in hospital administration and found that as much as I liked clinical practice, I loved the operations of hospital, I loved how no one patient could be cared for by any one person alone. It really took a team effort, the logistics, the technology, the verbal handoffs, the written handoffs were really well, so amazing to me. And it was also a thrill to be able to care for people on their very best days, and on their very worst days.

So like at our medical center, any one moment, someone might be experiencing the very best day of their life, they're having a baby or a newborn is being brought into their family. But at that same moment, perhaps someone else or their family has experienced the worst day of their life, that passing. And it was just, it always struck me as the responsibility and the honor of being for people at all stages of their life. And to do that, as a team was really extraordinarily fulfilling.

And so I stayed on actually, as a supervisor in the pharmacy department. And then my over the course of the next 20 years, I had the opportunity to serve at all levels of leadership and throughout our health care system, and then ultimately becoming CEO of Long Beach Memorial and Miller Children's Hospital in early 2009. So that's my background of career and why I chose hospital, hospital administration as a career.

Sure, well, that's a it's a great story. And as far as you know, being the CEO of Long Beach Memorial Hospital is quite a big job, I would imagine there are hundreds, if not 1000s of employees that support the facility. And it is it is a pretty complex organization. Maybe you could tell us a little bit more about that and what that entails?

Well, sure, you know, in addition to being providers of care, and everyone would recognize that a hospital provides care. We were also an educator of the public, and of course, a training site for future medical professionals. But we were also one of the largest employers in the region. So we were a major economic engine for the reeds for the region, and very much a cornerstone, very much a part of the fabric.

In fact, Columbia Memorial had been in existence since 1907. So well over 100 years of caring and educating and providing jobs, employment for people in the in the region. There are more than 6000 employees associated with Long Beach Memorial and Miller children's, more than 1500 independent practicing physicians. And then several 1000 More contractors that worked as part of our are called Long Beach Memorial and Miller children's home as an employment opportunity.

So that's the background of the size of the organization. And it's important to the community. And I say a lot of that with such kind of reverence. Because, as I had mentioned, being part of something that was very mission driven there for people at all stages, their career, but also that responsibility of providing care, educating and providing jobs was something that was not lost on any of us and the leadership team.

Well, it's it's kind of like a small town and maybe you're talking about 6000 employees and 1000s of contractors and 1500 doctors, that's a that that's not a it's more than a few streetlights that you have to go through to go through that small town. So it's a it's a big operation. So I would imagine is very challenging is the CEO of an organization like that? What were the things that you found most challenging and rewarding while doing that job?

Yeah, well, it certainly was a city within a city. And like all cities, we never closed, it was a 24/7 365 day a year operation we never closed. We certainly had, you know, lots of challenges. Healthcare and hospitals in particular are very razor thin margins. And more than half of expenses are, is labor. And so managing the 1,000s of people who work in that environment and ensuring that we are as efficient as possible, but that we're also able to provide as much care to people in our community, we were not for profit.

And so we're there to serve, regardless of someone's ability to pay. And certainly throughout my career, in that kind of intense operation, I'd encountered lots of adversity and had lots of experience managing the unexpected, you know, the operational mishaps that might happen, or financial hardship, you know, the very lean years to external or internal disasters, power outages, water outages, earthquakes, external disasters were traumas were brought to us, you know, an occasional PR nightmares. And our teams had really been very well trained, and seasoned in crisis management.

After all, trauma was a big part of our business, it just that it was almost always other people's traumas that we faced. And rarely were we in the position of responding to our own internal trauma. But that all changed on April 16 2009. And we had an extraordinary workplace trauma that affected the organization and me personally for years to come.

And it was a day that we really described as the before and the after a trauma that shook the organization to the to its core, will tell us a little bit more about how did it shape you and the organization going forward?

Yeah, well, on April 16 2009, a man entered the outpatient pharmacy of the hospital, and it was adjacent to the main lobby, and he shot the supervisor of that Outpatient Pharmacy several times, quite blank range. He then ran a considerable distance through the hallways of the medical center. And he waved the gun and yelled at people to get out of the way, because he didn't, you know, he didn't want to hurt them. He exited the building near the emergency department.

And he then encountered the executive director of the outpatient pharmacy services. And he proceeded to shoot him several times at point blank range before he ended up turning, turning the gun on himself. The two victims and the shooter died on site. And obviously, this event was terrifying for those who witnessed the shootings and responded to the scenes.

And as the CEO, I was in the vicinity of the first shooting, and ended up responding to all three scenes. I'd known both victims, and one in particular was a very good friend. Regard regardless of any one person's proximity or involvement, it was traumatic for everyone in the organization, because the shooter was an employee.

He was not only a member of the pharmacy staff, he was beloved by many throughout the hospital. And he'd even been recently honored as the employee that month, quite traumatic. And I can't even imagine what that would have done to you personally or the effect on the organization. The fear that must have pervaded your organization after something like that happens. Maybe you can describe that for sure.

Well, as I mentioned, as an acute care hospital, we couldn't close after the shooting or stopped to regroup. We still had more than 600 patients that were in house and needed our care, as we had to go on. And so I often thought of it is the like the off sided Business Idiom of continuing to fly the plane and repairing at the same time. We made a lot of mistakes and our response, but we did an extraordinary job. What I found in responding to trauma that happens internally like that, the level of camaraderie, connectedness, it really revealed this extraordinary esprit de corps in survival mode.

There were many, many positives, driven, I think primarily around our human tendency, at least initially, to come together in a crisis. And I've seen this pattern certainly as I work with other individuals and organizations that have been traumatized. But Even as the immediate danger passed, and the event was deemed over, the full extent of its impact didn't really end on the day of the shooting. Many individuals, myself included, and the organization itself had been severely traumatized.

And, as I'd said, shaken to the core. And I think often when I hear of other shootings or other traumas that are so shattering, particularly around safety and security, I often I often think about the people who we all think the event is over. And I think it's just beginning for all the survivors, for the families, for the people involved. It's just beginning and the ripple effect of what trauma does, both certainly for individuals, but also for the organization itself. And I learned that the organization itself can be traumatized. And I started to see the patterns in other organizations that had been traumatized.

Well, that's a you know, incredibly powerful story and experience. And we're going to ask more about that after the break. You're listening to Unite and Heal America, our guest, Dr. Diana Hendel, former CEO of Long Beach Memorial Hospital, and we'll be back in just one minute.

Welcome back to Unite and Heal America. My guest again, Dr. Diana Hendel, CEO, former CEO of Long Beach, Long Beach Memorial Hospital, you're listening to KABC 790. And I wanted to talk to Diana about how this affected you personally, after the shooting, and what was what was your response in going forward?

What was an interesting, kind of two pronged, as the incident commander, as the senior most person, I was leading our response. And because we all had been so well trained, and really seasoned, we had an experience something as tragic as this, we could go into auto mode, we had a really well designed structure for responding to disasters, and we practiced it and used it many times. But having that structure really served us well, it helped to study our emotions, it helped to keep us really focused. So on the one hand, I could move just readily into professional mode.

But on the other hand, this was my home department. These were people I knew well. And I had been witness to the scenes. And so for me on an individual basis, I was severely traumatized. And I don't know that until months and months later, and thinking about thinking back on it, that I realized that I'd really been in shock for a number of months, I threw myself into hyperdrive. I found that I coped in what I thought were really socially acceptable in very positive ways.

I just threw myself into work. And in some ways later, realizing that that overwork, there was some relationship to atonement, I had been the leader responsible, and the responsible leader for an event that had affected our organization. And the motive surrounding the event was very complicated. And because it was an insider, created a tremendous amount of complication for us as an organization. For me personally, one of the motives that emerged instantaneously was the shooter had been angry about an upcoming layoff.

And I had struggled with that particular layoff and the decision around it. And so it just was like an arrow to the heart, a dagger that years later. Now, of course, I can see that, of course, I didn't cause the shooter to do what he had done. But in the throes of trauma and as an individual. What was deep seated for me was a belief that I had been responsible that I had somehow benefactor. And while I could talk, try to talk myself out of that, and think of being irrational, that really only the shooter was responsible.

What I noticed that when traumas like this happen, once we know the what, and who wants the details, and once we're stable, if you will, but the event is over our natural question, as a society as groups as individuals is to ask the question why? Why did this happen?

Well, that question inadvertently, can cast a wide net of secondary blame and self blame. And so I think there were lots of us that evaluated our relationship with the shooter, and had created narratives around whether somehow we played a part. And we see this a lot in people who've been traumatized. It's not uncommon for soldiers or commanders to feel responsible for death or injury to their troops, and so very much as the commander in chief, if you will, I felt that now I got help. And we secured psychological counseling for our teams, in addition to, to all the other logistical kind of help that we needed.

But remaining in the same environment, year after year, seeing the same scenes, I couldn't completely recover and heal. And so I found after six years, in the organization that we had rebounded, the organization, in some ways had gotten stronger than ever, in some ways I had gotten stronger than ever. But I found that I did need to accept the fact that I did have PTSD, that I needed to step aside. And, you know, the organization deserved a completely healthy CEO. And I deserve to completely recover and heal. And so I stayed for six years and enjoyed every minute of it, but also was privately tortured by it. Many people have asked, Why didn't I leave sooner if I had been so traumatized? Or why wasn't able to recover in the same location.

And I think back on it, and I think that I didn't stay one day too long. And I didn't leave one day too soon, we had healed in the best way we could, and I personally had had healed as much as I could. And so then it was time to step aside. And that's what I did. And so that's how it affected me as an individual.

Well, it's certainly very admirable of you to to see that you had reached a point where it was valuable to you and to the organization to move on. Because I think that there's probably a lot of leaders out there that would grip on to the bitter, bitter end, and not give the organization a chance to kind of reach to the next level. And it might not even be in that traumatic of situation, but they have a hard time relinquishing the grip on on the organization.

So kudos to you for doing that. And I guess I would ask, just kind of segwaying that experience to how that informed the writing of books that you've written, why cope when you can heal what you wrote with Dr. Mark Goulston. And you co authored. Tell us a little bit about that and, and how your experiences at the hospital informed that book?

Well, it did take me about a year to completely recover and heal. It was a loss of identity. It was a nearly 30 year career, I had started our conversation with talking about that sense of commitment and mission. And I started that way on purpose because it was a large part of my life. And it was a large part of my reason for being it was my calling to serve at the hospital and ultimately as the CEO. So departing was another trauma in some ways, and having to navigate and reemerge as an individual and as a leader and as a professional.

But I knew in my heart the day that I did the part, that it was the right thing to do. I never doubted that whatsoever. I knew it was absolutely necessary to pass the baton to an extraordinarily strong team that had been developed. And an organization that as I mentioned, had been that was legacy. It had been serving that community for more than 100 years. So it was I had done my part and it was time to pass the baton.

But what motivated or what brought me to Dr. Mark gholston was actually that I had written a memoir called responsible and it was a memoir of my experience of leading through that shooting and the effect on me as an individual but also on the culture of the organization. It served as a tribute to my fallen colleagues and also as a tribute to the co workers who had served have lived and who I had worked alongside for the next six years.

But I also wrote it because I wanted to, in essence come out as a leader who had PTSD, I experienced a tremendous amount of stigma. And much of that stigma was my own, coming to grips with the fact that I had a diagnosis of PTSD. You know, we toss that word around pretty casually. But when someone really has it, you really have the feeling of the stigma. And as I said, it was many of my own beliefs tangled in the idea that PTSD was somehow a personal weakness, that I hadn't been able to rise above it.

And it wasn't until going through the full recovery, to understand the injury, and understand that actually, I had become even stronger in the result as a result of the trauma. So weakness was not the factor. It was an injury that I had to recover from. So that memoir was really important to me. And it's what drew me to Dr. Mark gholston. He and I then collaborated this past summer, on a book specifically for health care workers.

And you said the title, why cope when you can heal. And it was specifically to both record the history of the COVID pandemic, and the impact on health care workers, validate the traumatic stress that they're experiencing, and hopefully augment the services and programs that many hospitals have put in place to ensure optimal well being.

Because we know that health care workers are at risk or for burnout, they're at risk for traumatic stress now, and potentially at risk for PTSD. And so we wanted to be of service to to help others on the healthcare front lines, as they navigate what now is, well over a year of pretty stressful conditions within healthcare organizations.

Well, I think one of the things I just want to clarify, when you're talking about PTSD, we're talking about post traumatic syndrome, stress disorder. And post traumatic stress disorder, a lot of times is associated with combat and troops in the military and a man a lot of our troops have suffered from that.

And certainly the type of trauma that you had been through is similar to the types of trauma that somebody would see on a battlefield shooting. But sometimes it doesn't have to be quite as dramatic as trauma of shooting to to register at that level. And maybe you can describe, you described it a bit in your book, but I think it'd be helpful to the listeners to, to hear a little bit more about that.

When I think of the trauma definition as something that, in essence, is an existential crisis, something that threatens our existence, our lives or our livelihoods. Something that involves death, or threat of death, or such major disruption or destruction where people describe a sense of groundlessness that what they thought they could count on, they no longer can and something that really supersedes adversity or routine, business stress.

And without a doubt, health care workers, let's be really clear, they're amongst the most resilient, the strongest, the most emotionally tough people in our society. We'll continue this after the break. You're listening to Unite and Heal America with Matt Matern and my guest, Dr. Diana Hendel. And we'll come back in a minute talking about our heroic health care workers. So stay tuned.

You're listening to KABC 790. Unite and Heal America with Matt Matern. Our guest today is Dr. Diana Hendel. And we were just talking about PTSD as it relates to health care workers during the pandemic. And your book, Why cope when you can heal, which you've co authored with Dr. Mark Wilson.

Tell us a little bit more about what organizations have what health care organizations and health care workers have had to go through that would have caused a fair amount of PTSD in those facilities?

Yeah, as I mentioned, health care workers are extraordinarily resilient, and they are accustomed to handling death. It's not uncommon, but nothing on the scale and scope and the duration of the code. Did pandemic. And so, initially when there wasn't much information known about the virus, there was a lot of risk for healthcare workers themselves. And so it was very similar in some ways to the Insider. That many times people are brought to hospitals for care.

But people being brought to the hospitals for care also posed a risk to the health care workers themselves. But the other part of the traumatic stress that healthcare workers have experienced is that, certainly in the initial days, and even throughout the entire pandemic, most patients will no patient was was able to be in the company of their own family members. And so witnessing, bearing witness to patients passing away by connection to iPad with their family members, is extraordinarily stressful.

And again, while a health care worker might be accustomed to a death, on occasion, nothing to the scale that we saw with the pandemic. The other part that would create a tremendous amount of traumatic stress is that many health care workers were separated from their families, they themselves didn't want to infect their family members. And so many were working long hours, and separated from their family members.

So those elements of of trauma, if you will, because they do involve death, because they do involve so much groundlessness and uncertainty, we have seen a rise in traumatic stress. Now, whether we'll see it actually become PTSD remains to be seen. And it was one of the reasons that Dr. Mark Wilson and I wrote, why coping, you can heal because we wanted to be able to be, again in service to intervene and help organizations intervene sooner.

So that we call attention to it being traumatic stress, and didn't just label it every day, or routine stress, so that measures could be taken to ensure that people got the help they need. And healthcare is one of those environments that we characterized as a stiff upper lip that just get over it kind of culture. As I said, health care, people are really tough.

And so just interrupt you for a second, I just wanted to underline what the difference is between stress and trauma if you could make that sure.

Well, trauma always involves death and destruction. So or the threat of and stress is sub acute is less than that. We think of setbacks are adversity, disappointments, that those are stressful, and they can create a tremendous amount of stress for us in society, but traumatic stresses where it involves the threat, or the actual death or threat of death, to individually individuals who are are involved.

And so the pandemic has been extraordinarily stressful for people in healthcare. And I think many of us outside the hospital are not as aware of how stressful it has been within. Now the organization's many have done a tremendous job in ensuring that there are assistance programs, lots of psychological support or chaplains or others who can be or peer support groups, be in support.

And so the hospitals have really stepped up to call it traumatic stress so that it doesn't just, we don't just close the door on that chapter and not not process the feelings and the emotions that healthcare workers have experienced over now this well, more than a year now.

So how do you see what can be done by healthcare professionals and leaders in health care of healthcare organizations to address this trauma and stress that have deeply affected healthcare workers?

What I'm seeing many organizations do, certainly in the early phases, they established employee assistance programs, so they had an array of services available, but also people were extraordinarily busy. And so it made it hard to access those services. I'm seeing most organizations be very forthcoming about naming the stress, if you will, that their workers have been under honoring them, if you will, and that that has this has been an extraordinary year and not just pushing on and not just moving forward without also processing what they've been going through.

What a lot of the work that we do and others do and and as healthcare professionals in the hospitals have been doing is helping healthcare workers take care of themselves focus on, in essence, putting their own oxygen mask on first and making sure that they have habits for self care or access to additional care for themselves.

So that's first and foremost, we're also working with organizations on helping individual workers identify moments that need processing moments that were perhaps triggering for them, perhaps a weak, or a particular set of days where there was inordinate amount of death, that they had to just keep going forward, and now do need to process through.

So that's been a lot of the focus, certainly, of hospitals, and a lot of the work that we do, and helping to support that, I would imagine that there's going to be some moment when as this pandemic hopefully begins to wind down that the healthcare workers kind of collapse kind of and feel like, now I've gone through this incredibly stressful time and the defenses kind of finally come down a bit. Yet, given the 24/7 demands of our healthcare system, will they ever get that kind of break in order to have you have that moment?

You know, it's such a good question. And the observation that by nature, these organizations, are these hospitals, they just keep moving forward, they are 24/7. And so will there be those moments and there is fear that large segments of the workforce will burn out or suffer from traumatic stress or, you know, potentially PTSD? And so organizations are talking readily about that?

How can they redesign their processes and their structures? How can they evolve their workforce so that workers can have more time off, who can also access more self care. And so it's a large part of the conversation, that this in a way has has kind of pop that bubble of men essence, the extreme limits of resiliency, this isn't about healthcare workers becoming stronger or tougher. It is also about them being able to process and about the workplace structures changing to continue to support them.

Right. And this, the question I have is in terms of the number of people that experienced the trauma, both in the healthcare and outside of the healthcare field that you had said in your book, approximately 70% of the general population experiences trauma, some come some kind of traumatic event during their life. So what percentage of that group will go on to experience PTSD, Post Traumatic Stress Disorder?

You know, it's interesting that the research is still evolving. And currently, most of the research has been done in military settings. And it ranges the prevalence of PTSD in soldiers who have been traumatized or experienced trauma. The prevalence really ranges from Gosh, 3% to 20% in some studies, but much more needs to be done, because we often think about the factors that lead to someone officially having a diagnosis of PTSD.

And we often think about the individual elements, their past histories, their past traumas, perhaps, but a lot of it has to do with the specifics of the trauma. And even though two people may experience a trauma, they very likely don't experience it in the same way. Their proximity to it. The relationship or history with the people involved their role in, let's say in leadership or commanding, if it's a military setting, the nature of the trauma, the severity of it, the shocking or surprise nature, if the perpetrator or the person who has caused the trauma is known if it's random act of violence versus an internal violence.

So all those factors come into play. And so there's not enough not yet known about our ability to predict who might have PTSD But it's why it's so important for D stigmatization of PTSD so that we can be right from the outset, casting a wider net so that people who might develop PTSD do get the care they need.

Well, I want to ask you a question about common the frequency of somebody experiencing trauma say, whether it's a healthcare worker or a military veteran, and whether that also plays into it. And we'll get back we'll have you answer that question. After the break. You're listening to Unite and Heal America with Matt Matern. My guest, again, Diana, and Dell, former CEO of Long Beach Memorial Hospital, and author of a number of books. You'll come back in one minute.

You're back listening to Unite and Heal America with Matt Matern. Our guest again, Diana Hendo. Please, if you would doctor, talk to us about whether the frequency of traumatic events affects whether or not somebody is more likely to get PTSD. And then also like to just kind of segue into your second book with Dr. Mark Goulston, that you wrote trauma to try them a roadmap for leading through disruption and thriving on the other side?

Yeah, so I'll start first with people who've experienced repeated traumas, most of the research does suggest that they're more likely to develop PTSD, that doesn't mean they will develop PTSD. Again, lots of factors involved. And I think that while the study of who who develops PTSD following a traumatic event is really important. I think where the research has continued to go is looking at the factors such as repeated traumas, the types of trauma, the proximity to it, the relationship to the perpetrators, or to the victims.

So those, there are many, many factors that contribute, but none of them suggests that someone will or absolutely will develop PTSD. Patients who were there's intervention and full processing can occur, often don't develop PTSD, or may have short term acute stress injury, but don't develop full blown PTSD, it really varies. I think, much more the research has also, besides the processing piece, has really moved into where does trauma, in essence reside in our bodies.

So much of our response to traumatic event is in that biological automatic response of fight, flight or freeze. And so there's a lot of study about how many times we're able to, once we've been shocked, and we, you know, might flee, or we may fight, or we may freeze in order to survive. Once the event is over many times, we can shake it off, in essence, and I'm using that term, Shake It Off loosely, but we can reset, and we can reset to baseline.

But again, depending upon the trauma, and depending upon how, how thoroughly it's processed, that that trauma can in essence reside in our bodies. There's been lots of research done about where traumatic stress resides in our bodies. And so many patients besides emotionally processing an event or a series of events, will also really do a lot of body work on how to release that tension release that traumatic stress from their bodies.

That's fascinating. It's It's amazing that I think post traumatic stress disorder has been around or that diagnosis has been around for probably going on 50 years or more. And yet, we're still just kind of in the infancy as to discovering its origins and how it how it operates within our system. That's fascinating. And just turning to your to your second book, the roadmap, the trauma to try them. Tell us a little bit about that. And what brought you to writing that book.

Yeah, it's another collaboration with Dr. Mark Alston. And this book, different from the white coat when you can heal that was focused on healthcare workers and individuals dealing with Traumatic Stress. This one is at the organizational level. So when I shared my story about the trauma that happened at the hospital and shared the impact on me as an individual, there also are signs and symptoms if you will All of trauma that shows up in an organization that's been traumatized.

And many times, well, we don't always recognize them. At the time, they're much more recognizable in retrospect. And at the time that our organization was traumatized, of course, we did get lots of help for individuals. But there weren't experts in the world for how trauma affects the organization or the culture of the organization. And in fact, today, there are very few books that are published that talk about it at an organizational level. And so the work that I've done over the last 12 years and in working with clients, and my own study, is that there are the signs and symptoms that most organizations display when they've been traumatized.

And we think of trauma as the single events like a shooting, or a natural disaster or death of a co worker, or something that in an instant, shakes the organization to the core. But we've also discovered that there are more chronic traumas that can occur. I mean, certainly, our country is dealing with systemic racism, and has been for hundreds of years. But we're now much more openly talking about that sexual harassment, a layoff, or the ongoing threat of layoffs can be very traumatic for an organization.

And so in working with organizations that have been traumatized, we see these patterns and the signs and symptoms. And so we wrote the book, one to provide these observations. And many organizations that have been traumatized, see themselves in the mirror and say, Aha, we did discover that we did see those patterns. But then the rest of the book is very tactical, very actionable.

We didn't want to just describe a problem, we wanted to have actionable tactics for how organizations and their leaders could address trauma so that they didn't just position themselves to survive through an existing trauma or prepare themselves to survive the next trauma, because it's not really a matter of if it's really a matter of when, but also what we learned in my own organization is how we rebounded.

Our focus on team building our focus on decision making, our focus on our communication practices, they actually made us stronger, for everyday circumstances. So we became a better organization, in the aftermath, because of how the trauma had affected us, will tell us about the signs and symptoms of a traumatized organization, as opposed to a traumatized individual, even though we all experienced the same trauma. In our example, the shooting or in the COVID example, we're all experiencing the same pandemic trauma, but we're not all experiencing the same way.

The proximity, the relationships, as I've mentioned, all those were factors in how it affected the individuals. So at the organizational level, then, because there are these wide points of view, because very few people have access to all the information. There are all these narratives that emerge. And so with that, and that question of why, what very often happens after that initial coming together and camaraderie and esprit de corps and connectedness, net feeling like we can get through this. What happens when the question of why then the blame happens?

Fingerpointing happens, and sometimes it's really outright and sometimes it's more insidious under the radar. But that's a characteristic of most organizations and the impact on their culture that there's an underlying blame or finger pointing about the cause. Questions like, why didn't the organization prevent it? Why didn't Why did leadership do the layoff? And in this case, that caused it mean that that belief? Were there signs and symptoms that were missed? Why didn't we have bulletproof glass? Why weren't our security guards armed? Questions like that in any kind of trauma? There's a series of blame oriented questions that emerge.

But the second is that there's a wide range of guilt and at the individual level and at the organizational level, and then ultimately, a fair amount of shame. Sometimes the organization is ashamed of what has happened and can their customers can their patients in our case, can their communities trust them? How how they navigated or how they conduct for themselves, did their culture cause that trauma to occur. So that kind of trifecta of blame and guilt and shame is really quite common in organizations. And that last one, the shame often makes the conversation pretty taboo.

Because there's a wide range of points of view, it makes it really difficult to process, what's happened as an organization. And so it becomes taboo and often very unspeakable. And even though the event or the circumstances aren't talked about, they remain underground. And that causes a lot of cultural harm in the organization.

Let me ask you, in terms of just kind of wrapping this part of it up, we got about a minute to go. How would you counsel organizations to to move forward to get to the triumph that you talk about in your book?

Yeah, well, quickly in a nutshell. And again, we really elaborated in our our roadmap book, we talked about being prepared and having a rapid response team. And having an organization that is able to assemble its members really quickly and not haphazardly. We talk about the ability to once a bit of the dust settled, to be able to look back and do a really honest assessment of what's gone well, and what hasn't.

We talk about communication being absolutely important, critically important, and that it's named as trauma, that the event is not just brushed aside or brushed under the rug that a lot of effort to describe how it can affect an organization to normalize it in a way that we could expect Plame to occur, we could expect guilt and shame to occur. And talking about that versus having it go under the rug is really important.

We talk about team building and the importance of a recommitment to that team building decision making is a large part. Certainly organizations need to be able to respond quickly, but also ensure that they have gotten a lot of involvement from people in the organization. So that's one example of the importance of decision making and an element of it. And again, I mentioned communication being a cornerstone, and very clear about how the organization communicates about what has happened.

Well, it's a fascinating conversation and been wonderful to have you on the show. You've been listening to Unite and Heal America with Matt Matern and my guest today Dr. Diana Hendel, author of a couple of very interesting books by cope when you can deal and trauma to triumph.