See, Hear, Feel

EP42: Brian Ferguson on the importance of your emotional landscape in your performance

December 28, 2022 Professor Christine J Ko, MD / Brian Ferguson Season 1 Episode 42
See, Hear, Feel
EP42: Brian Ferguson on the importance of your emotional landscape in your performance
Show Notes Transcript

"The most important parts of life come from being able to access an emotional landscape." This quote from Brian Ferguson is in this episode, part 2 of my conversation with Brian, and if that doesn't tempt you to listen, we talk about skills that will help you be more physiologically, physically, and emotionally present. Brian Ferguson has built his career in high-performance organizations, including the military. He has continuously learned from leaders and decision-makers in US national security and technology, founding Arena Labs, a company pioneering healthcare’s first “Performance as a Solution” platform. Arena Labs brings the tools, training and technology of the world’s top performers into frontline surgical teams, ICUs and trauma environments. Brian served in the military as a Navy SEAL Officer where he deployed to Afghanistan and various parts of the Middle East. He received an MSc from The London School of Economics.

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today I have the great pleasure of continuing my conversation with Brian Ferguson. Please listen in to the last episode, if you haven't heard it yet, because it's more of a little bit of a background for some of the stuff that we're going to talk about today. Brian served in the military as a Navy SEAL officer where he deployed to Afghanistan and various parts of the Middle East. Could you talk a little bit about your vision for Arena Labs and Arena Strive

[00:00:27] Brian Ferguson: Absolutely. So Arena Labs came first and is the umbrella company of what we do and what we call high performance medicine. At a very basic level, the question we explore is, Why don't we offer frontline medical teams the same tools, training and technology that we give to other high risk, high consequence professions? What I mean by that is that when you look at the military, the creative arts, elite sports: all of those professions have an underlying degree of pressure in order to perform.

[00:01:02] And part of performance is not just a technical skill but is the ability to perform a technical skill under pressure. And so there's a massive amount of training that goes into what's called human factors or human performance that is really about equipping the human being to manage stress, to be self-aware, and to learn to rest and regenerate in the face of that pressure, day in and day out, over the long arc of a career.

[00:01:25] So at Arena Labs, we talk about serving those who serve us, and our mission has been to bring all of that wisdom that has been garnered, over decades now of modern technology and training in other high risk professions, to frontline medicine. We started the company in 2017, and we were initially a boutique services business.

[00:01:44] There's a longer backstory, but the short version is I had grown up in healthcare. I always thought I'd go into healthcare. I ended up going into the military, and my last job in the military involved collaboration with the heart surgeon at the Cleveland Clinic Heart and Vascular Institute.

[00:01:59] And it was the first time I was in a cardiac surgery OR that I saw the disconnect between how people doing really high risk, high stakes work were not given ample tools to manage that risk and pressure. And at the time, I was in a special operations community, where as an analog, I was given an inordinate amount of tools to understand my own levels of stress, how to sleep and rest, and regenerate more smartly, how to be self-aware. And so that led to this ongoing conversation with that surgeon that became the basis of Arena Labs. And a good three years, we would embed in hospitals and work alongside OR teams, we'd work in departments, whether that was orthopedics or neurosurgery or entire perioperative services. And we would build performance programs that focused on those three pillars, helping people be more self-aware, equipping them with tools to manage stress, and to rest and regenerate more smartly at both the individual and in the aggregate team level. 

[00:02:51] But that's a long sort of prelude, Christine, to Arena Strive. When Covid happened, as you can imagine, we could no longer go into hospitals. And 2017 to 2020, this focus on burnout was a big issue that we were looking at from a very different lens, which was to say, What if we were to put data around this upstream of the actual end state burnout? And when Covid happened, since we could no longer go into hospitals, we started offering remote content and we were doing some basic data sensor monitoring. And when we combined those two things, that became the vision for Arena Strive, which we call "Healthcare's First Performance Coach". And deconstructing that: if you think about, again, people who are in high risk fields, they often have a coach who is helping them understand themselves. It's not just about the technical performance, it's about the whole human and performing, being able to rest and regenerate to show up in the best sense of one's self, cognitively, physically, emotionally.

[00:03:48] Christine Ko: I love it. I've had the opportunity to explore Arena Strive a little bit, and it is a really wonderfully comprehensive tool and performance coach. One thing I really like about it is it's short. I mean, each module is short because people don't have enough time. An average video length is under four minutes for sure. And you can get tools from short things. 

[00:04:13] Brian Ferguson: Yeah, I appreciate your saying that. I would like to take credit to say out of the gate we knew that, but we've been humbled over time. If you think about the demanding realities of most people in the front lines of medicine, in today's world, time is our most valuable asset and most limited resource. And that is especially true in healthcare. When we first designed Arena Strive, we initially thought it might be a six month experience. Very quickly were humbled by the reality that asking someone to commit to anything longer than about six weeks felt daunting because there's so many demands. On top of that, the daily accumulation of knowledge and learning had to start with just asking for five minutes a day. And so the experience is built around a six week commitment to five minutes a day, over 42 days.

[00:04:56] Now there are a lot of people in medicine who are elite athletes, elite musicians who served in the military, and so they have a baseline understanding. In fairness, though, the average person in healthcare has never been deliberately exposed to understanding their own stress through the autonomic nervous system, or reminded of the science of sleep and understanding stages of sleep as a relevant mechanism to improve decision making and cognitive acuity. So to teach all of that in a way that feels accessible and not overwhelming, it's taken us a lot of time to break it down over a six week journey that is just five minutes a day.

[00:05:29] So, we take a lot of pride in our entire experience. It's built for the realities of frontline. Not for elite athletes, not for military personnel, who have more time to train. 

[00:05:38] Christine Ko: Yeah. That's awesome. I still have to explore Arena Strive a little bit more, but there are certain things that I've learned. I think that if more healthcare workers had access to this, I think it would benefit us all because there are certain things we already do know about physiology and anatomy and certain things. You have some things about light and how that interacts with our nervous systems, and things like that, and just breathing. And a physiologic sigh.... there are certain things that really can become useful. Little small things [Mm-hmm.] that actually have a much bigger impact than you might think. Another thing that I really appreciated learning is about the sleep cycle, because you break it down simply, and maybe it's really simplified, but I think it does work: think about in one and a half hour chunks, and think back to what time you need to wake up, and then dial back one and a half hours times whatever from that. And that is useful to me, that has been really useful. 

[00:06:31] I wanted to ask you is what you think the role of emotional intelligence is in life or work and how Arena Strive addresses that? 

[00:06:39] Brian Ferguson: I am not an expert in emotional intelligence. I will tell you that I am convinced the fulfilling parts of life come out of an ability to access an emotional landscape. And that becomes a prelude then to how is that question relevant in medicine? And my observation of medicine, like many of these other disciplines, is that it incentivizes compartmentalization of emotion. In medicine, the classic archetype is totally compartmented and has no emotion. That archetype looks and says, I don't need emotion. That archetype is built so strongly they're almost afraid of accessing that. 

[00:07:14] Christine Ko: Yes. 

[00:07:15] Brian Ferguson: In some ways that is necessary, in the middle of a trauma or an emergency. Of course, one has to have the faculties to focus, and being overly emotional is a disservice to one's self and to that patient. But I think what we're learning in modern psychology and neuroscience is that if we keep those emotions compartmented or shut off, they inevitably come back to haunt us. I don't mean that in an overly dark way, but we know that emotions manifest in some ways in our body as energy, as pain, et cetera.... At a basic level, that doesn't mean someone needs to go out and be overly emotive, but it does mean that we have to have an understanding of that landscape to be sophisticated and healthy.

[00:07:56] Because of my time in the military, the time that I served was a real enlightenment around this, that when you look at the definitions of post-traumatic stress, those are generally anchored in the disconnect between emotional experiences and how the mind and body are storing them. There's been a lot of work in people who are actualizing or healing beyond those experiences. It's ultimately addressing the emotional landscape. 

[00:08:18] Now at Arena Strive, we are careful. We ultimately are a performance platform. We recognize that performance can be a slippery definition. To be clear, this is not just about physical performance. People come onto our platform for different reasons. You may, to your point, you may be on there because you're just at a point in life where some basic breathing just helps you deactivate your nervous system throughout the day and feel a little more rested at home. Some people, they're in residency, and they want to understand, How can I be sharper mentally? Other people are trying to figure out how to deal with the transition and moving from the hospital to their home life. All of those are an ability to access performance in the interplay between the mind, body, and emotional landscape.

[00:08:56] Christine Ko: Yeah. Going back to what you started off with when you said something like, I can't quote you directly, but, "The most fulfilling parts of life come out of being able to access an emotional landscape." I think that having access to someone's emotions, your own, or someone else's, and being able to share that really does make life much more rich. 

[00:09:16] Brian Ferguson: Hundred percent. [Yeah.] And that's ultimately, I think, my belief, at least in the thousands of clinicians we've worked with and I've met, that's why people go into medicine. It's ultimately the emotion of taking care of others or serving others. There's a closed loop there that's making someone feel like they're doing work that matters to human life. 

[00:09:34] Christine Ko: Yeah. 

[00:09:34] Brian Ferguson: Even the pursuit of higher human knowledge through science to advance society, all of that stuff has an emotional foundation that's really important to keep in mind. 

[00:09:44] Christine Ko: Yeah. Yes. I... everything you say. I just love it. Okay. So Arena Strive, Arena Labs is founded on this concept of deliberate practice, of practicing, of doing. We can't really incorporate things into our lives without practicing, without trying to make certain things habit.

[00:09:59] Brian Ferguson: One of the things that was surprising to me when we first started with this concept of high performance medicine, I thought we were gonna be doing very sophisticated work at the edges of performance. Meaning when you look at how elite athletes, Olympians, professional athletes, the military have evolved, people are thinking about cognitive load. Someone's a surgeon. That we know there are limits to how much the brain can process, and with that there's an energy expenditure that's high consequence. So I thought, we were working with the top surgical teams in the world, we'd be looking at measuring cognitive load and these things that would be on the forefront of neuroscience and technology.

[00:10:37] And again, this respectfully, what happened is we had to come back to this idea of: how do we give people a foundational understanding of performance so that they can get, so that they can be curious to want to grow. 

[00:10:47] Give us six weeks and try this and see if it works for you. And hopefully that moves into a growth mindset where these tools start to feel like they're providing a sense of agency. What I think is more important is that it's less about the psychology of mindset and more about institutional architecture that I think is really challenging in modern healthcare.

[00:11:07] And what I mean by that is when you look at the literature around what causes people to feel burnout, it is most of the time administrative. Here's what's important though. I think we falsely conflate administrative bureaucracy and say, This is not a human problem. No, it very much is, because it's about a mindset.

[00:11:27] And so just like in the military there, don't get me wrong. In special operations, any part of the military, there's plenty of bureaucracy. And so the question is, and part of that is an institutional structure part, but how are we endowing people with a sense of agency in the face of those challenges to have the right mindset.

[00:11:44] And where this intersects, I think, is to say we hope that we can change the paradigm, which in most of healthcare is to say the burnout problem is fixed through macroeconomics or macroefficiencies. Meaning, most of the time when you look at how hospitals are thinking about 21st century medicine, they're investing more in macroefficiencies, which is increasing patient throughput, turnover time; these things that are long standing metrics. And they are important because they keep the hospital doors open. That then moves into the macroeconomics of how do we get marginal revenue improvement on a case, or think about travel nursing, and how we're balancing our expenses. Those things at the macro level are important, but they fundamentally miss the most vital component of a hospital, which is the individual clinician.

[00:12:32] Christine Ko: Yes. I think that the Great Resignation is, has been and is, hitting healthcare at all levels. And so there are staffing issues just across all jobs, all levels. I think the doctors, my colleagues that I know who are physicians, the reason that they want to retire or get out is because of this lack of agency. Because with burnout, technically, definitionally being a system problem, what doctors and staff and nurses are up against in healthcare right now, you don't feel a sense of belonging or agency because you're like, this system's too big. 

[00:13:09] Brian Ferguson: The reality is we couldn't bring an individual coach to every person in healthcare. And so we started to think about how we might create a really dynamic platform that offered that experience asynchronously on demand. And so Arena Strive was born in early '21. And so we now are getting close to about a year and a half, almost two years in to the platform. And our vision is that it becomes a scalable means of educating frontline nurses, physicians, the whole spectrum of medical personnel, on the tools that we think should have been offered as part of medical school residency or nursing school. And we can get into sort of more of the philosophy behind it, but that's the basis of our work now and a mission that we love. 

[00:13:48] Christine Ko: Thank you so much for spending the time. I've enjoyed it so much. 

[00:13:53] Brian Ferguson: Yeah. Christine, thank you so much. Really grateful. A conversation that's invigorating I can't pass up.

[00:13:58] Christine Ko: Yeah.