How we moved from stress to trauma…and what leaders can do about it with Diana Hendel

In this interview Quint Studer talks to hospital CEO turned trauma expert Diana Hendel. After experiencing a deadly workplace shooting, Diana began studying how trauma impacts individuals and organizations. In assessing COVID-19 she quickly realized it has all the hallmarks of a traumatic crisis. This surprises people because they think trauma is a single horrific event. But the pandemic is traumatizing employees, leaders, and entire organizations—and all of us, collectively, as a nation.

Diana says it’s vital to make the distinction between stress and trauma. With short term stress, employees can usually power through. But once we cross over into trauma—and the duration, intensity, and frequency of change we face now makes this far more likely—we must treat the problem differently. Coping and building resilience is very important but insufficient alone in dealing with trauma that affects an entire organization. (Not that they don’t work.)

In this interview Diana reveals some of the ways trauma manifests in individuals and companies. And she discusses some tools and tactics that can help leaders of all types of organizations navigate through traumatic crises and periods of intense change. The good news? Not only can your organization survive trauma it can thrive on the other side—growing into a stronger, better, more unified version of itself.

Diana will be a keynote at EntreCon 2020. Click here to learn more.

Diana Hendel, PharmD, is the author of three upcoming books. One, Responsible, is a memoir about leading a major medical organization through a deadly workplace shooting. The other two, published by Harper Collins, are coauthored by Mark Goulston, MD: Why Cope When You Can Heal? helps healthcare workers deal with the trauma caused by COVID-19, and Trauma To Triumph guides leaders in navigating their organization through change and traumatic crisis.


Quint Studer  0:01
Well, it’s so exciting for me to have Diana Hendel here. If you’re in healthcare, you know who Diana Hendel is, if you’re not in healthcare, you’re going to learn all about her and wish you had known her before. But certainly be grateful, you know, or now she’s got great academic background, see all the hospital, but I think what I’ve done is learned so much from her and her books. Um, she has three books, and we’re gonna sort of talk a little bit about maybe, but Diana, why don’t you tell for the people that might not have? No, you will just a little background information. Of course, you know, I know he was the CEO of a hospital and so on. But your your topic way beyond being in healthcare, your topic of trauma is probably all sitting here thinking this morning, man, you’re the right person at the right time that this country needs with this topic. And so we’re fortunate to have you So tell us a little bit of your story and sort of how you became what many people consider the guru of not organizational trauma? How about teaching people how to handle organization or trauma? Great, good?

Diana Hendel  1:08
Well, it’s great to be with you. And what you may not realize, Clint is you have had just a tremendous influence on my upbringing as the leader. I have followed you for years. And so it’s really a tremendous honor to be able to be on this podcast with you and I really grateful for the invitation. Thank you. As you mentioned, my backgrounds in healthcare. I started as a Clinical Pharmacy student, I live in Southern California, out of Long Beach, California, and I grew up in a health care organization like many health care providers and leaders. I started as a Clinical Pharmacy student, and over the 20 years that followed, progressively grew in leadership roles, initially as a supervisor, and then every level of leadership throughout the organization throughout every level of operations, including strategic outreach and mergers and acquisitions, etc. And in 2009, became the CEO of the hospitals that I had grown up with in one was an adult hospital and when was a large Children’s Hospital, but they occupied one central campus in Long Beach, California. And we’re considered amongst the very largest Medical Center complexes on on the west coast. I loved being in healthcare, and I loved being the CEO. I loved being part of a community that was there to serve others whose purpose was to be there, sometimes on the very best day of someone’s life, sometimes, of course, on the very most difficult day, and we were there for them. And it was really quite a privileged privilege. I liked being part of something that was much bigger than myself, it was my calling. I was exactly where I was supposed to be. But in 2009, and it was a day that really changed everything. changed everything in my life as a person and as a leader. On April 16 2009, a man came to the outpatient pharmacy, which was located in the lobby of the hospital. And he shot and killed the supervisor of the pharmacy at point blank range. He then traveled through the halls of the hospital exited the building, where he then shot and killed another man who was the executive director of the pharmacy department. Before the man, the shooter turned the gun on himself and committed suicide. I had been in the vicinity. And as the CEO ended up responding to all three scenes within minutes. The event of course, was horrific. And in and of itself, it shocked us to the core shock the entire organization to the core. But the fact that the shooter was an employee in the organization, and an employee who had been Beloved, he had recently been our employee of the quarter. He was one of our own. It just shattered our sense of who we were as an organization. It disrupted everything about what we had believed in. And then the ensuing rumors about his motive, one being layoff on potential for a layoff, really, really turn the screw on the amount of emotional damage that it did not just to individuals but to the organization as a whole. And so I think we’ve all can well relate to trauma that affects individuals. But the idea that trauma could, could damage or disrupt or affect an organization itself, the culture of the organization itself, that the organization itself could be traumatized was really new, you know, lots been written about individual trauma, but very little had been published about organizational trauma over the ensuing or the next several years, six years. years actually, I became a student of organizational trauma, observing it firsthand myself, but also trying to study it in other organizations that had experienced trauma, and found that there were a lot of patterns and similarities within organizations that had experienced trauma. And so I set out to really study it and learn from it. I retired early in 2015. And I retired because I had begun to experience PTSD. And I knew that the organization deserved a healthy CEO and I deserve to recover. So I stepped down, recovered, healed, and then reinvented myself around the need to contribute and to help other organizations who had gone through trauma, help other leaders navigate severe trauma that happens in their organizations. So that’s, that’s in a nutshell, how you did a great story.

Quint Studer  6:01
You and I had a pre call. And, you know, it’s interesting how I have learned so much since our pre call. And I’ve learned that there are certain things that I called stress that are stress. certain times, I think people of course, need resiliency. But sometimes it goes into trauma. And I wouldn’t have called a trauma till I read your book, Trump to trauma or roadmap and leading through disruption driving on this side, you were nice enough to ask me to write the foreword. And I’m very, very grateful for that. When I read your book, I’ve talked to you it’s becoming so aware now that this is what we’re going through with COVID. And it doesn’t have to be COVID. It could be major, other disruption. But for this conversation right now, what we’re going through right now is COVID. And I’m just sitting here thinking of the trauma. So for example, I talked to JJ Cooper, a baseball America the other day, and was saying, you know, all these minor league teams seem to have a season this year. What’s that doing to people got laid off? So, so talk about how do you? How do you know you’re moving from stress to trauma? I mean, what, what are the various symptoms or to sort of identify where, where am I? And then we’re going to talk, of course, about what what do you do, and I love your organizational account, I get till your book. And as I’d never thought about organizational trauma, but true when an organization lays off a bunch of people that have trauma, when their product changes drastically. It’s trauma in many, many ways. It’s deeper than stress, particularly when it’s going to be there for a while. So once you talk about sort of the stress of trauma, have you seen it?

Diana Hendel  7:42
Yeah, we raised such a good point. I think we often think of trauma as single horrific events, death, of course, destruction, things that challenge our livelihood. And we think that they come and go. And that, you know, perhaps, you know, we’re lucky that we can avoid them. But I think what we’re experiencing now with COVID, is collective trauma. And it mirrors so much of what I saw in the organization, so when, when the shooting occurred, although we all were affected, we had varying perspectives, we had a wide range of points of view, not everybody experienced the trauma in the same way. And yet we collectively experienced it. With COVID, we’re now experiencing it as a nation. And it does transcend the usual whitewater the usual stresses that we think of in businesses that we’ve really over the last number of decades kind of gotten used to a lot of change, but where it crosses into trauma is when it disrupts when it’s an existential threat, if you will, not just to life but also to livelihood. So you raise a great point with COVID. Some people are directly affected and have or may die or know someone who will die. Many others, though, aren’t aren’t going to be directly affected by COVID from an infection perspective, but it’s created so much turmoil from a business perspective to the point of furloughs, layoffs, that financial insecurity, and that collective our collective experience of we don’t know what’s coming next, both in terms of potential infections, but also financial ruin. So that crosses over from mere stress to something that’s threatening to our livelihood in our lives, and that’s trauma. And so, while resilience is so important, and of course, we’re not going to jettison that. It goes further and the skills and the needs as leaders goes further in how to address trauma and how to help people not just survive in the short run, but actually thrive, reinvent themselves create stronger organization. where they can thrive and actually do better than they might have? Had they not gone to the experience?

Quint Studer  10:06
Well, when I think, Diana, what you’re talking about too, and you know, I know a lot of organizations and they, I speak at them, and you speak at them, and you sort of see the agenda. Just yesterday, I’ve got a talk coming up at caravan health. And, again, they’re a great organization. And I looked at their presentation, and they’re almost everyone’s doing something on stress right now, almost every organizations kind of speaker talking about stress, and resiliency. But I wonder, and I mean, that’s all good. But I’ve not seen one topic that says trauma. And is it because we don’t want to mention the word it’s because we don’t understand the word. Because I know more and more, and looking at saying, I used to call things stress, but it’s more than stress. It’s way beyond that. So tell us, why don’t you see? Is it just because people don’t understand trauma? So how is that a point? Or how do we understand it better? It’s a question.

Diana Hendel  11:07
Well, I think it can be a couple of things, I think we’ve become accustomed to the languaging of stress and labeling of stress. And we are sort of a stiff upper lip kind of society, you know, we just move on and get going. So it’s a badge of honor to be able to navigate stress, I think we do ourselves a disservice when we aren’t able to name trauma because trauma, by the definition of it being so disruptive, or destructive, or threatening to life or livelihood, that crosses in to something that is much it invokes for individuals, it invokes a fight, flight or freeze a natural biological response. So on the individual level, we are our nervous systems are charged up many times, we can just reset that, you know, if there’s a near miss, and we startle, but we can our nervous systems reset. But for organizations, of course, the impact can be insidious. And I think to your point on why we haven’t recognized it or label trauma, besides the stiff, stiff upper lip mentality, it’s also that this has been a bit of a slow roll out. And not everybody affected in the same way at exactly the same time. And so it’s like that frog in the boiling pot analogy that, you know, we’re in a, we’re a frog in a pot, and suddenly, you know, the heats turned up. But if we were to leap into that pot, of course, we’d recognize it and you know, jump out and pull away. So I think there’s a couple factors at play. But I think by labeling it trauma, it doesn’t exaggerate it, it actually helps us to address the impact on individuals, and on organizations, much more whole art wholeheartedly and not just resort to getting over it, or resilience, which, of course, is very important. It’s a factor. And it’s an important component. But it’s not enough.

Quint Studer  13:14
I, again, you’ve turned a light bulb on for me, since reading your book, and I’m talking to you, you know, I’m trying to figure out, I mean, even in companies I have changed so dramatically, you know, people that used to do events, can’t do events or the events that they could do have to be so little for they’re dealing with brides and all these things. Having my old my second oldest grandson, as a senior in high school, he plays sports and they’re canceled. And, you know, I think it’s more than stress. I think you look at layoffs, you know, most every company I’ve talked to lately is either calling it furloughs or layoffs, but they’re cutting back. We noticed with our own companies, we’ve been pushing a lot more willingness to seek out mental health therapy. Yesterday, early morning, I got a phone call from somebody and they’re just terrified about their adult son. And you know, he’s in a real bad spot. And, of course, he’s in a business that I know in his business, I guarantee his revenues taken a huge hit. And then you know, this future I thought I had I don’t know. But But I think again, we all know that there’s a sudden death or when there’s an accident. But this is something you know, I just kept thinking about, you know, when it first started, I talked a lot about Erik Larson’s book, where on Winston Churchill when they were getting bombed and, you know, you know, we’ll get through this, but then you get to a point, I guess, where you sort of start questioning, will we get through this and will I get through this? Is that part of trauma?

Diana Hendel  14:58
Yeah, and that’s that link During uncertainty, and then the continual undercurrent of fear, that sense that what we considered ground, you know what we consider normal, you know, the before and after, when people use the terminology of the before times, and now the after that itself is a really strong indicator of trauma that parallels very much with people who’ve individually gone through trauma, that’s a very consistent way that they describe their lives. On this day, everything changed. There was the before. And now there’s the after. And of course, collectively, we’re talking about is that a new normal? You know, I think we’ve, while we hope we can go back, I think we all know that we’re moving to a different future. And that creates a lot of uncertainty and fear. And that ambiguity, the prolonged nature of this adds to it. So it is without a doubt, traumatic to our systems, and traumatic to our organizations as well.

Quint Studer  16:05
Living I love about you, Danny, you know, many people come up with the problem and get everybody, you know, they get great credit, right, identifying the problem I remember. And, you know, we just get caught up in, you know, the, here’s what’s happened and bum bum bum. And then and then, but what’s the solution, and I think it’s easier to identify the problem than the solution. And what I love about you is you talk about that tell about your roadmap for managing change in a situation where you feel there. So trauma in the organization, you’re sort of you’ve taken change way to another level that I’ve taken it, for sure, you’re much more accomplished than I am. And I thought I was pretty good and change until I met, you know, I’ve got my level of incompetence. Some talk about your roadmap for managing organizational change.

Diana Hendel  16:56
Well, since the trauma happened for me, I spent the next 11 and a half years studying it, studying and observing, experiencing it, learning from others. And so I became a student, I don’t know that there’s much I haven’t read or consumed, if you will, about trauma and how it affects an organization. So along the way, of course, there were really amazing things that happened on that day, you know, we talked about the worst day of our lives also bring out the best and a lot of people. So in studying both the impacts that were negative, the problems, I also observed, what we did really well, and then created a roadmap for the organization on how we could capture and double down, if you will, on what we did really well. And then be really honest about the things we didn’t do well, without finger pointing without blame, without with with a student’s curiosity, like, what how is this different? And what can we then do to respond to what’s happened in a way that not just allows us to survive a future trauma. You know, for a little while, we kind of thought, Well, we’d had a terrible trauma. And we had this bit of illusion that Well, nothing bad can ever happen again. But then we realized, you know, life presents traumatic situations, but not just survive a future trauma, not just be prepared to survive, but also what might we do that allows our organization to thrive to be better than it ever was before. So by being honest about the problems that surfaced, and by also celebrating the good parts, we were able to implement a roadmap. Now, for a lot of folks outside of hospitals probably don’t have rapid response teams. Those of you in hospital settings, know about rapid response teams and the value of being prepared. I work with organizations now to help them develop a simplified, rapid response team. And that’s really one of the first things that needs to happen in an organization, can you pull a team together, that can cohesively and in collaboration, address the trauma that’s emerged? The second phase of the roadmap, of course, is the leaders visibility. Often, more often, well, people say that crisis can make a leader. I don’t know if that’s really true as much as what I do know is certain crisis reveals a leader. And so helping leaders be able to be visible to stand in to be front and center and take charge doesn’t mean there’s not consensus. But having a person who is point having a person who is visible, who’s trusted, who’s credible, who can be the spokesperson, I found to be one of the single most important factors for an organization not just surviving but thriving, and that leader, and the third part of the roadmap is very intentionally messaging unity from the get go, because what happens in organizations right after the what happened, what after right after the knowledge of what has happened occurs, the question of why becomes predominant, and it happens, you can see it in a split second, why did it happen, who let it happen? Who should have known and, and prevented it, and that questioning of why which is natural, creates a lot of blame, and finger pointing. And often in an organization, there’s guilt. And then depending upon the type of trauma, there may be shame. So knowing that division that polarization, deep polarization can occur and deep and deepen, especially if it’s an emotionally charged event or series of events. The leader, it’s incredibly important that right from the get go, the leader serves as a unifier, and does not feed the division. Absent the visibility of a leader and absent unity, it makes it very difficult for organizations to not just survive, but have any hope of actually thriving. So those the first parts of the roadmap, and those were based on my experience, but also based on 11 years of study.

Quint Studer  21:28
I think, you know, I’m the plumber with leaky pipes. I tell people, one of my favorite stories was a CEO called me one day and he said Quint, here’s the situation, I called you to see how you would handle it. And I said, you know, my recommendation would be to keep calling people. And when you find out what to do call me back because I’m in the same situation. And I see it because you know what, with us this year, people that don’t know what I do out. Besides health care, I have some local things. And I noticed what when baseball was canceled, our minor league team just exactly did what you did. People got caught up and who’s working harder Are you working, who’s pulling their weight, who’s not pulling their weight. So this divide sort of just happen, because without something to put your arms around anymore, all sudden, you’re paying a lot of attention to two things. So as I’m listening, as you’re doing the tape, I’m thinking I got to make sure we all listen to this because it’s just amazing that people can listen to you. And entre Khan. We’re so excited. We’re so excited for you to be an entrepreneur. I’m sitting here thinking, how many other places that you need to be? You know, I am, I’m on the board of Cammy, which oversees all the Masters in healthcare administration, very close with a u PHA, which does all the undergrad degrees in healthcare. And, man, it would really be sad if every student that’s learning how to lead wouldn’t learn, put and learn from you and beyond healthcare, almost because we’re going through a trauma as a country, and all sorts of ways and you don’t read about it. It’s all about stress and resiliency, I get it. But I now realized what I thought was stress and resiliency has all the elements of trauma. So you’ll be keynoting at entre con. What What can people What do you think, people you want people to walk away from with your talk?

Diana Hendel  23:30
Well, I’m privileged to be able to speak at intercon. And I thank you for the invitation, I had an opportunity to sort of visit the Voltron the virtual community and I couldn’t help but just be laughing and giggling It was such an extraordinary experience. So I’m, I’m delighted for everybody watching

Quint Studer  23:46
Oh my little, my little character, I’ve lost about 30 pounds just by using a new character for myself.

Diana Hendel  23:54
I loved creating the avatar, it was wonderful. So I’m excited about it. It really probably

Quint Studer  24:00
breakers as you know, many of the names you write recognize, I mean, we’ve really sort of got a who’s who including you. So tell us and you know, I also don’t want people to think well, gee, this was healthcare, or GG from big organizations, and I’ve got this 20 employed company, or I’ve got this food truck, or I’ve got this, because, you know, one of the things we believe people ask me periodically is, gene is leadership in healthcare different than leadership, other places, and I said, I think it’s very, very similar. The way we get paid is a little unique, but other than that, it’s pretty dang similar. So you’re gonna have people that are just onesies and twosies up to people that have hundreds of employees. So tell us what a person is Dr. Khan could walk away or you hope they walk away with from your presentation.

Diana Hendel  24:53
Yeah. Well, we’ll definitely talk about how this is really how we’re living in a time of great upheaval and it’s on a new level. So We’ll talk a lot about stress and trauma and how it affects individuals and businesses. And we’ll talk about the roadmap, we’ll talk about what can people do individually and for their businesses to help survive, but also thrive. So this is a message of, of empathy, and compassion, and a lot of hope. And so while the subject matter, trauma is a heavy one, it’s something that this is that we’re all experiencing together, and our ability to come together and talk frankly, about it, but also validate the feelings that people are having, and offer solutions. So I’ll be sharing, you know, a story, of course of my own trauma and what I’ve observed and how I’ve helped other organizations. But I’ll also be sharing really practical tips and tactics that can be used by individuals and businesses. So it’s a message of hope. It’s a message of we are all in this together, there is a lot of camaraderie, and by us observing the things we’ve done really well in response, and capitalizing on that we can really optimize our future and create something, frankly, that’s even better than what we had before in the before times. So it’s an honor to be able to be on intercon. And we’re really looking forward to it.

Quint Studer  26:22
Well, to wrap up with your three books. I know you have the memoir that people can read. But you know, we have hopefully a lot of healthcare people listening and then we’re gonna have a lot of non healthcare people listening. I’m talking about why cope when you can heal how healthcare heroes of COVID-19 can recover from PTSD, because that’s something that’s just coming out.

Diana Hendel  26:43
Yeah, yeah, it’s coming out December 1. It follows the memoir. And my memoir, of course, was very personal, and my experience as a leader, leading through trauma, but it’s written, really, for a wide readership, lots of people can relate to. And I think as people read it, they see that while they’ve had experiences in their life, and the feelings and thoughts that emerged, they too can relate to the why cope when you can heal was unnatural. And I had the honor of CO authoring it with Mark Goldston, a leading psychiatrist and person who’s experienced in suicide and, and trauma. And so we recognized early that healthcare workers, people on the front line, we’re at great risk, not just for becoming infected with COVID, but also the impact financially. And so they were at great risk for traumatic stress and the potential for developing PTSD. And so we wrote the book, in hopes of helping them. So we’re excited about it. And we think it certainly many people will read it outside of healthcare, and it applies. So well, but

Quint Studer  27:53
it’s perfect timing, because it’s just, it’s just knowing healthcare. So many people in healthcare thought, this will be over by now. Yeah. And, and it’s not and you, you know, you sort of the waves, and then you got the outpatient hitting, you get to LA, it was sort of went telehealth and it went back to visits now could go back to telehealth. So it’s amazing. How about your new book in the spring of 2021? drunk? Yeah,

Diana Hendel  28:21
I am really excited about that, that takes

the the audience the readership is really all leaders. And it is the navigation of trauma and converting it to try out a large largely around the roadmap, of which I’ll talk at intercon about, but really a message of both tactical practical help, but also hope in how we can navigate trauma and become even stronger in the aftermath. So I’m really excited about that, in fact, the manuscripts do just before intercon, so I got really this looming deadline, but it’s coming together really nicely.

Quint Studer  29:04
And it’ll be in the spring with I can cope. So that’s my fault, too. So, but um, I just think I’m just sitting here all day thinking about, um, you know, how I’ve got to get your books and you and you are ready, but even more in front of more people. Because there’s not a there’s not an organization out there that’s not going through this and you’re bringing a message you saw around the corner. And I think what you’re looking at, you have the skill set to see what’s next. And most of us are just dealing with what is so I think the gift that we hope to bring to the listeners to this podcast and through you speaking at our conference and through me recommending you all over the place because I’m just sitting here thinking I’m on the border, a couple of places and they do training and I I just think for me, maybe it’s just you you have really turned on a light bulb that just wasn’t On, it just wasn’t on with me, you know, I’m one of these, like you said, This too shall pass, we will get through this, you know, bear down, bear down, um, you know, let’s, let’s grind it out, we’re gonna grit and grind through this thing. And, and just not realizing that what I thought was stress could really be way more dramatic than that. And it’s just just sort of happens. You know, we had an employee who, yesterday found out his father, a lung disease. And I talked to him today. And it’s so interesting how it’s like this, it’s I don’t think dealing with that this is a trick not understanding. He’s in a traumatic situation. We’re just gonna get through this. We’re gonna do a little prayer and praying, but it’s all good stuff. But yeah, it might just there might be better solutions out there. And that’s what you bring to the table. So we’re just, I’m so privileged to know you privileged to be part of grateful that you’re in my life. And I don’t think things happen for a reason. I’m a big believer in synchronicity, and I think we got were together for a really unique reason. And one of the things is, I just think that you do it on your own. But one of the things I always like to do is bring solutions to organizations. And it doesn’t mean me many times, it means people I know that are much more skilled than me and bringing these solutions. So Dan handled, thank you for what you’ve done for all these years to make people’s lives better.

Diana Hendel  31:30
Thank you. Thank you quit. It’s really, really honor to spend time with you. I appreciate it very much. Thank you.