Welcome to episode two in our series Unveiling Trauma's Impact: Navigating the Hidden Costs. In this episode, we uncover the hidden costs of unaddressed trauma in the healthcare system.
Sheila Phicil, a social innovator and equity architect, joins us to discuss how our backgrounds and traumas influence the care we receive, the personal and collective journey of healing, and how trauma shows up in our healthcare system. We also talk about the transformative potential of placing patient experiences at the forefront, the intersection of trauma, identity, and the response from the medical community, and looking to a future where policies and practices align more closely with patient needs and well-being.
We also discuss innovative policy approaches that consider social determinants of health and the 'crossing guard effect'—a metaphor for community-led initiatives that protect societal health. Join us as we explore these critical issues and envision a healthcare system that embodies equity and compassion.
Sheila Phicil is a visionary leader and transformational change agent with over 15 years of experience in healthcare, where she has spearheaded initiatives in policy, strategy, operations, and the elimination of health disparities. Additionally, as the CEO and founder of Phicil-itate Change, she champions social innovation through systems thinking, intelligent operations, and human-centered design, demonstrating her commitment to creating impactful and sustainable change.
Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.
Invite Manya to inspire and empower your teams + position your organization as a forward-thinking leader in fostering resilience and trauma sensitivity.
Welcome to episode two in our series Unveiling Trauma's Impact: Navigating the Hidden Costs. In this episode, we uncover the hidden costs of unaddressed trauma in the healthcare system.
Sheila Phicil, a social innovator and equity architect, joins us to discuss how our backgrounds and traumas influence the care we receive, the personal and collective journey of healing, and how trauma shows up in our healthcare system. We also talk about the transformative potential of placing patient experiences at the forefront, the intersection of trauma, identity, and the response from the medical community, and looking to a future where policies and practices align more closely with patient needs and well-being.
We also discuss innovative policy approaches that consider social determinants of health and the 'crossing guard effect'—a metaphor for community-led initiatives that protect societal health. Join us as we explore these critical issues and envision a healthcare system that embodies equity and compassion.
Sheila Phicil is a visionary leader and transformational change agent with over 15 years of experience in healthcare, where she has spearheaded initiatives in policy, strategy, operations, and the elimination of health disparities. Additionally, as the CEO and founder of Phicil-itate Change, she champions social innovation through systems thinking, intelligent operations, and human-centered design, demonstrating her commitment to creating impactful and sustainable change.
Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.
Invite Manya to inspire and empower your teams + position your organization as a forward-thinking leader in fostering resilience and trauma sensitivity.
So I think what's unique about the healthcare industry is that we see, in our work and what we do, the direct results of the barriers. Right Meaning people might show up in our emergency room with a cancer diagnosis that was missed or ignored and they might not leave the hospital right. Like that is we see it.
Manya Chylinski:
Hello, welcome to Notes on Resilience. I'm your host, Manya Chylinski. Today is an episode in the series Unveiling Trauma's Impact Navigating the Hidden Costs, and we're talking today about Trauma's toll on healthcare costs. My guest is Sheila Phicil, the Director of Innovation at Boston Medical Center's Health Equity Accelerator, and the CEO and Founder of Facility Change LLC. We had an amazing conversation about how trauma shows up in the healthcare system, both for patients and healthcare providers, and we talked about social determinants of health and how can we address the impact of trauma on the healthcare system. It was a wonderful conversation and I know you're going to learn a lot. Hi, Sheila, thank you so much for being here today. I'm really excited for our conversation.
Sheila Phicil:
I am too Manja. Thank you for having me Before we dive into the topic.
Manya Chylinski:
I would love to know if you could have dinner with any historical figure. Who would it be and why?
Sheila Phicil:
Yeah, I appreciate the question and there are actually quite a number of historical figures I would pick, and I think, because of the time of year that it is, the person that came to mine was Martin Luther King, obviously because of what he stood for. But, if you don't mind, me like cheating a little bit on the question, because the person I would really love to have dinner with is my grandmother, who passed away almost two and a half years ago now, and the reason why, especially in reflecting on some of the topics that we'll discuss today. She was the embodiment of resilience and it's only after her passing that I was really able to fully grasp and understand how much she changed in trauma and all kinds of life situations that she survived and thrived through and remained empathetic, joyful, like beacon of hope for our family. And she did not know how to read or write, so she was able to tap into something deep inside of her that I think was really powerful, and I would love to explore that with her more.
Manya Chylinski:
Yes, she sounds like a very special lady.
Sheila Phicil:
She was, she was.
Manya Chylinski:
I wish I had that magic wand and could grant you that wish. I know they would each be valuable in their own way, definitely. Thank you for sharing that, sheila. I appreciate that and, as you know, we are here today to talk about the hidden costs of trauma in the healthcare system and how trauma impacts healthcare costs and in the context of this discussion, we're talking about a wide range of costs. It could be financial implications, but it could also be maybe less tangible but equally significant costs like opportunity costs or burdens on society or long-term consequences that we're just not paying attention to. So, given that context, from your perspective within the healthcare industry, what are the most significant hidden costs that you can associate to unaddressed trauma and how are they impacting us?
Sheila Phicil:
That's a great question, great place to start.
Sheila Phicil:
I have a little over 15 years of experience in healthcare and I've worked in a variety of different settings, whether it's like community-based organizations, as part of like the Veteran Affairs Hospital, in like major academic centers. I've been patient-facing as well as behind the scenes, so it's been interesting to be able to see how these like unaddressed trauma, as you've talked about, has shown up, and we see it also in our data and in outcomes of our patients. I think probably where we see it the most is when we look at major indicators like how long we're living as Americans in this country, having one of the most sophisticated and complex and expensive healthcare systems, yet we're not keeping up with our peers in terms of longevity. So I think a lot of that has to do with some of the unaddressed like traumas and the ways that we respond to those. So, and I think like the work of showing up for our patients and then falling short in terms of keeping them alive or healthy, in itself, when it happens in the moment, can be pretty significant.
Sheila Phicil:
You know, when you think about the most vulnerable time in our life, for most of us it will probably be when we're laying down on our back on a hospital bed, right, and in those moments if we fail to be cared for or given the appropriate treatment or being treated with respect or dignity. It comes at a huge cost. So it's not just in terms of the health outcomes, but in terms of hope and optimism, both on the part of caregivers who are having to show up day after day for patients, as well as those who are receiving the care, and without things like hope and optimism and kind of like being bought in that the system of care is like designed to help me. Then, of course, the system has become stagnant.
Sheila Phicil:
And, to your point about opportunity costs, I do think that trauma alone is it's not the biggest issue, but it's also how we instinctively react to the trauma that fundamentally shapes how we see ourselves, how we interact with others and how we experience life right, like a child who's been bitten by a dog will cry and run away every time they see a dog, instinctively, even if we know that dogs can be such a great source of joy and love. So in speaking of someone who's also been on like a personal healing journey, you know how we then shape our experience. How trauma shape our experiences speaks a lot to the underlying costs, but there's also an opportunity to unpack that because traumas, when we deal with them and heal from them, can offer very different perspectives, give us deeper empathy, have us explore new ways of showing up in the world. So there's also an opportunity cost in not really healing from and facing those traumas.
Manya Chylinski:
Yes, well, thank you for that, and I really appreciate that you started this off by saying, yes, there's a cost to the patients, but there's also a cost to the healthcare providers. I think that's a really important piece of the puzzle that I wasn't even thinking of when I was asking the question, so I appreciate that you brought that up. So you talked about lifespan, and I think that's a cost that we can kind of viscerally understand through the people in our lives and our own experience. I'm curious does that translate into lost economic opportunity?
Sheila Phicil:
I think it absolutely does. When people die before their time, they're not able to contribute to overall economic productivity, whether it's by working or being part of families and communities that they help sustain. So when you think about that, maybe in the form of someone who loses a mother at an early age to breast cancer, in themselves, have children and no longer has that person as a support system, and now it's like it's an additional cost to them to pay for additional childcare or have those other supports Because they don't have that social support in their life. So I think all of that is compounding.
Sheila Phicil:
But to your point it is something that we feel very viscerally and I don't know that economic tools like productivity or GDP or inflation or employment are enough or alone can really signify what the impact of it is, because, ultimately, what you're talking about is time, and time is our most priceless and precious resource.
Manya Chylinski:
Yes, absolutely, when you get right down to it. So you mentioned specifically the economic impacts, to your knowledge. Is there a way to tie that back to trauma, to traumatized individuals making their way through life and through the healthcare system?
Sheila Phicil:
How I would respond to this is I don't know that there is a direct step between measuring economic productivity and trauma. However, when we see breakdown in social institutions and the ways that people support each other, that in itself is a cost. So when trauma results in mistrust, mistrust is going to result in.
Sheila Phicil:
I am not going to engage with this institution anymore to receive whatever resource or help I might need, and then that in itself can create societal costs, because then people are not accessing the resources and tools that they need to keep themselves healthy and are maybe showing up in an emergency room rather than having a yearly doctor's visit, for example.
Manya Chylinski:
And we know that is the most expensive way. If we're just talking money, that's the most expensive way to get healthcare. It is Okay. Thank you for clarifying that. I started off wanting to do this series, wanting to be able to put a number on it. Every traumatized person is costing X amount of dollars for this, this, this and this, and I know it isn't as clear cut as that, yeah, and that maybe isn't even really what the goal should be. But digging into these other costs, the societal burden and the larger cost is really high. Opening, because I don't think as a group, as a society, we don't tend to think about this massive impact, that being that one individual being traumatized has a ripple effect. So what systemic or structural barriers have you encountered within the healthcare system that make it harder to address some of these hidden costs we've been talking about?
Sheila Phicil:
Probably the biggest barrier that I see over and over is when well intentioned, well meaning people, teams, organizations are attempting to solve these problems and build solutions, but they're doing it without the people who are directly impacted by the problem or who have faced the trauma.
Sheila Phicil:
So the people who have the lived experience are being thought of, but they're not in the conversation, they're not driving the conversation, and because a lot of these are fundamentally social issues that are being tackled, I think we fall into this trap that we can intellectualize or come up with some novel technology that will solve the issue, and although those things can certainly help and they do we risk building the right solutions but with the wrong delivery mechanisms or with the wrong messages, and that's no different than committing to do a surgery on a patient without ever laid eyes on them, or deciding to build a house and all you have is a hammer and a ladder Right. Yes, we're not giving ourselves the best chance of coming up with the best solution because of who's in the room and having the conversation and shaping the decisions, and I think helping teams and organizations meaningfully engage with the people who are at the sharp end of the problem is where innovation really starts and what I feel is like my life's mission.
Manya Chylinski:
Yes, well, nothing about us without us, yes, yes. So what I think is really important is that we know and encapsulates what we really need to be doing, which is expanding the voices at the table, listening to the people with the lived experience. I can tell you not specifically in the healthcare space, but I did, as a survivor, reach out to somebody in order to help with something and being intentionally vague here and I said I am a survivor and this is why I want to share this information with you and they said we don't want to hear from people like you, we are doing it on our own. That's incredible. It was incredible because, on one hand, you can think, oh, maybe they didn't think to reach out to people like me. They thought, intellectually, we can deal with this. But when myself and others reached out and said we're here, we can help you, and they said, no, that was particularly galling, but, I think, not unusual from what you're describing as one of the major structural barriers to this change. Yeah, definitely.
Manya Chylinski:
Do you think there's anything unique about the healthcare industry when we think about the structural or systemic barriers?
Sheila Phicil:
So I think what's unique about the healthcare industry is that we see in our work and in what we do the direct results of the barriers.
Sheila Phicil:
Right Meaning people might show up in our emergency room with a cancer diagnosis that was missed or ignored and they might not leave the hospital Right like that is. We see it, we watch it happen when black mothers are coming in to deliver babies and either they themselves or the babies are not going home For whatever reason. So we have to live with the results of how we show up and how we deal with the Barriers and issues that exist within our own institutions. So I think it's harder to ignore not impossible to ignore, because it can be ignored. It's harder to ignore when you see it every day. But I also think what makes healthcare Incredibly unique is that it is also an industry that is slow to change. Even when you think about Electronic medical records, that's something that's, you know, only come online in the last ten years. Covid is when we really learned that we could do visits via, you know, telephone calls and videos. Like it's not the world coming to a global pandemic for healthcare to figure it out like we're slow.
Sheila Phicil:
We really are, yeah. So I think that creates a double-edged challenge, because we see the problems but, for whatever reason the way our systems are designed we can sometimes be very slow to act and respond.
Manya Chylinski:
Why do you think that is the slow time to respond? Is it just the big complex nature of the healthcare system? Are there other barriers that maybe you can identify that we should be looking at?
Sheila Phicil:
You know that's a great question and I mean, having been in healthcare for a long time, especially on the administrative end. It's not for lack of trying or effort or intention. Even, I think, the way that Medicine as a field in science has evolved. It's been very centered on the science of medicine and, in some ways, the experience of doctors or providers. So I think where we see huge advances in Medicine and science is, you know, some of the you know robotic Surgeries that that were able to do and you know surgeries that people would have to be in the hospital for weeks. Now they can kind of like leave in a day and We've created these, like you know, complex brick-and-mortar institutions where patients come in. They can get blood work in labs, radiology and this and that, and We've become really good at how we treat the disease or illness. And A lot of that centers around the experience of the provider and being able to treat right, dispense meds and, you know, take you up after surgery, those other things.
Sheila Phicil:
But I don't, I think where healthcare has been slow and I'm starting to see that changes, what is the experience of the patient Like when you think about when you go into a healthcare system and you're logging into your healthcare portal to access your medical records. None of those portals were built for patients, right Like it's. I'm in healthcare, okay, and it's hard for me to navigate a word I need to click to see and how do I send a message. And why isn't this working? And what does this lab mean? Like these tools were not Built for us, like they were built for providers, are built for payers and insurance and regulations and all this other stuff. So I think that's probably why the innovation has lagged in terms of the, the structural barriers, in terms of how people experience Healthcare. So I hope that changes in the sense that, like you know, it's becoming much more mainstream to collect patient experience information and have patient advisory boards and Giving patients more of a voice.
Manya Chylinski:
I appreciate the giving patients more of a voice. And and something else you said also leads me into the next question you mentioned the maternal mortality rate for black women and we know this is a problem and that Makes me think, you know, when you think about the interconnected nature of identity so it's race and gender, sexual orientation, socio-economic status and how that can compound trauma for individuals, I guess how does that intersection challenge or create some hidden costs of trauma and what can we do to get past that and deal with that intersectionality?
Sheila Phicil:
I'll start by kind of framing my understanding of trauma and identity and how they intersect. So to me, and based on kind of my own experience, trauma, our experiences, the shape how we relate to and go about satisfying our fundamental human needs. Like when you think of Maslow's hierarchy of needs, like there's physiological needs like breathing, food, water, shelters, safety and security, loving, belonging all the way up to the top is self-actualization and depending on experiences that you've had a lot of them in childhood and onward, you frame different beliefs in terms of how you go about meeting those needs, right? So if you were a child that grew up often hungry and not having enough food, you might now believe that food is something that should always be rationed and there's never enough of, and that might reflect how you relate to food, right? Our identities, I think, determine how others relate to our needs and, depending on the level of power that that might, identity gives me in a situation that can be hugely beneficial or detrimental, right? So, in just using an example like, imagine a loved one who experiences some severe adverse medical event either like there was a
Sheila Phicil:
misdiagnosis where they were experiencing prolonged pain and not having given appropriate medications. Once someone has lived that experience, you might come to believe that you're not safe in the hands of a medical team. You might not trust that your pain and what you feel in your body is going to be believed or handled with care and giving appropriate medications. Now let's say that that person is a 40 year old black woman. Now, on top of what they've experienced in terms of like, my needs don't matter. Their identity also means that, if they might, if they go to raise concerns or advocate for themselves, they're more likely to be viewed as aggressive or drug seeking. So then you create the situation where the intersectionality of this adverse experience plus how others treat me in these situations because I have the least power and my identity shows up in a way that I'm not given power. So this person is probably likely to opt out of the healthcare system altogether right and just say like it's not worth it. And people make those kinds of decisions all the time, Wow.
Manya Chylinski:
And thank you for giving that very clear explanation of how those relate and how just gives the picture of how difficult it is to tease apart the different pieces and how an actual response to this is going to require so many different elements from so many different areas. So are there any promising practices or innovative approaches within healthcare that you feel like are showing positive results in helping address these costs of trauma?
Sheila Phicil:
Yeah, so I think one thing that I'm really excited about seeing is, more and more there are healthcare policies and regulations that are focused on addressing social determinants of health.
Sheila Phicil:
I mean, the literature and the imperative around social determinants of health has existed for a long time. We've known that roughly 80% of our health is based on factors outside of, like healthcare. It's like where you live, where you work, where you play, where you worship, how you sleep, what kind of food you eat. All of those things factor into your overall well-being. And now we're seeing state and federal regulations that are requiring that hospitals, healthcare systems providers take these matters seriously by asking patients about them and starting to think about how we connect patients to resources.
Sheila Phicil:
What I find most promising about this is just that it puts the overall patients well-being in a more central and focal point in healthcare and makes it part of the conversation that doctors need to have or need to consider with their patients. Right. Where I'm cautiously optimistic about is, yes, we're going to collect all this information about things that we are we could probably relatively assume are happening, like housing instability or lack of access to healthy food in various neighborhoods or communities, and a lot of those things are tied right back to the legacy of racism and policies that have been instituted and including redlining and other things. But then what do we do about it when I say we, we healthcare as an institution, when often not equipped to address these challenges, and we're going to be collecting all the stated information about how do we mobilize communities, governments, other businesses to care right About what's happening?
Manya Chylinski:
That is a great question and it's it's something I think about a lot. You know, how do we mobilize communities and individuals to care about these issues that are, on one way, seem really simple and straightforward but, in other ways, are incredibly complex and interconnected and, like we said, don't have just this one button you can push to fix it.
Sheila Phicil:
Exactly, yeah, and it's not a problem that any one institution is positioned to fix right Now, the one thing I will say with that, going back to the earlier point about you know nothing about us without us is that I'm I do think the answer exists in communities already, humanity, if you look over the course of time, like we're resilient, we've come back from plagues and wars and devastation and all the other things, like you know how to build back, we know how to heal, we know how to regroup, and that happens at a macro level and at a micro level in terms of, like, individual families, and I think there's a lot of knowledge and innovative practices that happen at the very small, like community, family, organization level that are very innovative and impactful and should not be overlooked, because sometimes it's not these, like it's not a broad reaching policy alone, but it's enabling the change makers at the local and community level to do the things that you know they've been doing for generations.
Sheila Phicil:
I think about it as like the crossing guard effect, like when you think about communities and schools and like somehow or another we have crossing guards. Like have you ever seen a crossing guard job posted somewhere?
Manya Chylinski:
I've never seen one, so how do these?
Sheila Phicil:
people get these jobs and how do they know about what's? Somehow, but somehow these people show up for their community and say I'm going to make sure these children can cross the street. Now, could the children cross the street without a crossing guard? They figure it out. There'd probably be a lot of fatalities. But they do not. They figure it out. But as a community, somehow or another, those people show up and they do that work and I think valuing that and making room for that and celebrating that is really going to be the source of where a lot of these problems get solved, so that ultimately, like our humanity has to save us.
Manya Chylinski:
Right. Well, I appreciate the point that the answer already exists in our communities and it's a question of finding them, it's a question of lifting them up, it's a question of building those connections so that we're not existing in these little islands where this one little group is doing it right. Let's find ways to make those connections.
Sheila Phicil:
Yes.
Manya Chylinski:
Well, sheila, we are at the end of our time and I'm sad because I could talk to you for many more hours about this topic, because it's fascinating to me. But before we completely wrap up, do you have any final thoughts about the topic that you want to share with our listeners?
Sheila Phicil:
We touched on it a little bit, which is that when we talk about what's it going to take to really promote healing and resilience, I think having lived through COVID was an interesting experience for a lot of us because we were all experiencing the same thing at the same time Right, and what that did was it created a common language and understanding of the world for people honestly all over the globe. Like I've traveled since COVID, so I've gone to different countries and I'm like what did you do during lockdown? And everybody knows what I mean when I say lockdown. So it was a shared experience that gave us shared language and it's a tragedy that you know, obviously like global pandemic, and a lot of people lost their lives. But what I thought was interesting from that experience is that we were able to communicate with each other on a level and have a level of understanding that I don't know that we've been able to harness, because that just the fact that we were experiencing the same thing at the same time brought us together.
Sheila Phicil:
So I would love for us as people as leaders seek to create more tools and forums that equip people and families and institutions and leaders to be able to create more of those types of moments where we can truly embrace, understand and learn from the lived experiences of others, even if we may not be able to directly to relate in it, because that's really what's going to move us forward towards greater empathy and even innovation, because then we're like we're speaking the same language, you know that we care about the same things and we can really work together to solve these problems.
Manya Chylinski:
Wonderful. Thank you. All right, everybody, let's get to it. We're going to make this happen. Sheila, before we sign off, how can our listeners reach you if they want to learn more about what you do and maybe further the conversation on this topic with you?
Sheila Phicil:
Yeah, please reach out to me on LinkedIn, Sheila Phicil. I also have a website, sheilaphicil. com, if you'd like to send me a message or a note on there, or you can email me hello@sheilaphicil. com Excellent.
Manya Chylinski:
And we will put links in the show notes for our listeners so they can find you more easily. Sheila, thank you so much. This has been a wonderful conversation and I have learned so much. Thank you, I enjoyed it. Bye everyone. Thank you for listening. I hope you got as much out of this conversation as I did. So if you'd like to learn more about me, Manja Chylinski, I work with organizations to help understand how to create environments where people can thrive after difficult life experiences, and I do this through talks and consulting. I'm a survivor of mass violence and I use my experience to help leaders learn about resiliency, compassion and trauma-sensitive leadership to build strategies to enable teams to thrive and be engaged amidst difficulty and turmoil. If this is something you want to learn more about, visit my website, www. manyachylinskicom, or email me at manya@ manyachylinski. com, or stop by my social media on LinkedIn and Twitter. Thanks so much.
