I already mentioned it, but establish a strict morning routine. Ideally, this routine will include some time for exercise, reflection/meditation/mindfulness, and daily planning/prioritizing. I already described my routine earlier, so I won’t go into that again. I’d just make a point to include it. If you need to end up waking up earlier to fit it in, then do it. It’s totally worth it. After a while, it becomes habit. I’m not saying it’s always easy to get out of bed when my alarm goes off at 04:30 or 05:00, but at this point it’s so ingrained in me that I find myself rolling out of bed and getting going even if I’m saying “No! Sleep!” inside.
I had the pleasure to interview Rafael E. Salazar II, MHS, OTR/L; Rehab U Practice Solutions. A licensed Occupational Therapist practicing in the State of Georgia, Rafael is a graduate of the Augusta University (formerly MCG) Department of Occupational Therapy class of 2012. Rafael has become recognized as a leader in field of outpatient orthopedic rehabilitation and in the field of Occupational Therapy, being asked to serve on multiple committees for the National Board for Certification of Occupational Therapists (NBCOT), as a subject matter expert for examination test content development. In August of 2018, he was elected to the Board of Directors for NBCOT. He was also appointed to the Georgia State Board of Occupational Therapy, as a licensed board member. He has taught courses on Evidence-Based Rehabilitation and Applied Kinesiology for the OT department that he was graduated from at Augusta University. After several years as lead clinician in an outpatient specialty clinic, Rafael left the VA to begin consulting with the State of Georgia, assisting in transitioning individuals from State-run institutions to community residences; a position that allowed him to leverage his clinical knowledge & expertise as well as his ability to effectively communicate, educate, and train people in order to ensure that the individuals transitioning from these institutions received the highest quality care and support possible. His role in developing provider training materials and templates became a crucial part of transition planning for the State of Georgia. He also worked to develop a framework for community engagement as part of the transition process. In 2017, he started Rehab U Practice Solutions to leverage his knowledge & clinical expertise with a gift of education & speaking, and a unique understanding of the rehab world & healthcare environment, to empower therapists to radically change the way they do business & break out of the paradigm that causes burnout and poor clinical/professional outcomes.
Thank you so much for joining us, Rafael! Can you tell us the “backstory” about what brought you to this specific career path?
Well I like to say that Occupational Therapy found me. The summer before my senior year in high school, I fell onto a glass bottle and cut a flexor tendon in my left thumb. That landed me in an outpatient OT rehab clinic 2x a week for the balance of my summer. That experience inspired me to go into the field and help those who experienced the same types of injuries that I did. That led me to the VA, where I worked in an outpatient specialty rehab clinic, treating and serving veterans with all types of shoulder, elbow, and hand injuries and post-operatively. After that, I left the VA to begin consulting as a private contractor on a large project for the State of Georgia, assisting with transitioning individuals out of state hospitals into community residence. I ended up making the decision to leave the VA because the consulting opportunity allowed me to tap into other skills and areas of professional development that would otherwise have not been a possibility at the VA. Around that same time, I started Rehab U Practice Solutions, a consulting and training company helping therapy clinic owners improve patient engagement and retention and developing models of service delivery that not only improve the patient experience, but also clinical outcomes, and decreased clinician burnout. And that leads us to where we are today.
According to a 2006 Pew Research Report report, 26% of women and 21% of men feel that they are “always rushed”. Has it always been this way? Can you give a few reasons regarding what you think causes this prevalent feeling of being rushed?
I think, there’s always been a segment of the population that “always feels rushed”. This may be related to personality traits or career choices. My grandfather was a vascular surgeon at a large medical center in Ohio and also owned his own private practice. He always had his pager on his hip and seemed like he was always on call. He never seemed rushed to me. I also have friends who are in fields of work that, at least to me, seem less involved than that and always feel they’re running from one fire to the next. Some of this may be personality, and another part may be time management skills and the way we handle pressure. Technology hasn’t made it any easier. Our phones buzz or ding us on the regular. Heck, when I first wake up in the morning I have several emails, calendar notifications, or calls/texts waiting for me. If that’s the first thing you’re looking at every day, it can feel like you’re starting your day a step behind your life. That itself will make you feel rushed.
Based on your experience or research can you explain why being rushed can harm our productivity, health, and happiness?
I think a big reason that being rushed hurts our productivity, health and happiness is directly related to behavioral psychology and our own biology. Humans are unique, in that we have the ability to reason, forecast the future, and have executive planning abilities. This gave our ancestors an advantage in prehistoric times and allowed us to thrive, when other species weren’t able to. It’s part of what has made us so successful as a species. However, that can play a negative role when we are placed in an environment where most of our everyday decisions and situations aren’t life-or-death. Our brains are wired to do what is in our best interests for survival. However, answering 10 late emails, returning five phone calls, or even remembering to put the bills in the mail don’t necessarily have that type of impact in our lives. Yet, our brains make us feel that they do. The stress and anxiety related to not completing these tasks, or feeling like they’re hanging over our heads, triggers our fight-or-flight response system. Our bodies release cortisol — the stress hormone — into our blood. This decreases our ability to complete higher level cognitive tasks, think long-term, or calm down before deciding. That will lead us to make poor- or low-quality decisions, which can impact our productivity and happiness. Cortisol can also lead to fat storage in the belly area, which is no good for our health. It can also increase blood pressure and elevate our risk for cardiovascular disease. The saying “stress can kill” is no joke. If you live in a constant state of stress, you’re going to experience negative outcomes in your health, productivity, and overall happiness.
On the flip side, can you give examples of how we can do more, and how our lives would improve if we could slow down?
By slowing down, taking back control (or even perceived control) over our time and lives, we’re able to deal with situations that arise from a position of strength and relative calm. Instead of feeling like we’re running from one fire to another with a water bucket, we’re able to handle situations as they arise in a methodical and controlled way. Time management and daily planning play a huge role in this. For example, I never check my emails/texts/calendar for the first 60–90 minutes that I’m awake. That is my sacred time. I exercise, shower, pray, and prioritize my day before I ever look at that stuff. This does two things: 1) It lets me start my day from a position of control. By the time I look at those notifications, I’ve already taken the time I need for myself, my mental health, my own planning. 2) It makes me the commander of my day. I don’t start the day with other people or events commanding my time, requiring a response. This is hugely empowering. I basically start my day, plan my day, and then see how those notifications and needs fit into my already prioritized to-do list. Sometimes this isn’t an option depending on your line of work. But you can always move as close as you can towards that. Even just setting the first bit of your day apart to establish a routine involving some exercise, planning, and reflection time has been shown to decrease anxiety, stress, and depression.
We all live in a world with many deadlines and incessant demands for our time and attention. That inevitably makes us feel rushed. Can you share with our readers 6 strategies that you use to “slow down to do more”? Can you please give a story or example for each?
Sure, here are six that your reader may find helpful:
1. I already mentioned it, but establish a strict morning routine. Ideally, this routine will include some time for exercise, reflection/meditation/mindfulness, and daily planning/prioritizing. I already described my routine earlier, so I won’t go into that again. I’d just make a point to include it. If you need to end up waking up earlier to fit it in, then do it. It’s totally worth it. After a while, it becomes habit. I’m not saying it’s always easy to get out of bed when my alarm goes off at 04:30 or 05:00, but at this point it’s so ingrained in me that I find myself rolling out of bed and getting going even if I’m saying “No! Sleep!” inside.
2. I alluded to this earlier, but don’t look at your technology, notifications, or messages for at least 30–60 minutes after waking up. We are programed to respond to the ding, buzz, or beep from our devices. And -truth be told- those devices can help us achieve great productivity. However, we need to be in control of them, or they will quickly rule our time. By not looking at or responding to notifications at the beginning of your day, you are taking back control of your time. Instead of starting the day in a reactionary mode, you start with a plan and in control.
3. Another tip I’d give is to plan your day (as much as you can) to work in 30–90 minute “chunks” of time, with breaks in between. Research has shown us that we are more effective at work when we work on a project for a shorter period of focused time, rather than trying to slug it out all day. This involves picking a project, say writing a sales letter or working on one particular deliverable. Then you spend 30–90 minutes intensely working on that project. After that time is up, you take a break and step away from it. Go for a walk; grab a drink of water/coffee; do some jumping jacks- just take a break for at least 15 minutes. If you haven’t finished that particular task, you may get hit with inspiration during your break. The solution may just come to you. At the end of that break, sit back down at your desk or workspace and work for another chunk of time. Fill your day with work chunks like this and you will find yourself more productive, less mentally exhausted, and maybe even peaceful.
4. In line with the previous tip is this: create a daily, weekly, monthly game plan or to-do list. This list should be prioritized and updated regularly (the daily list should be updated every day). As the late, great Jim Rohn said: “Either you run the day, or the day runs you.” One of the best things we can do to make sure we don’t feel rushed or reacting to everything that arises is to take time, ideally during your morning routine, to create your plan for the day. That way, anything new that comes up when you’re checking your emails or getting notifications can be prioritized and worked into your list. If things need to be shifted or rearranged, you can do that in a controlled manner; instead of getting an SOS call and feeling that the rest of your day gets tossed out the window. Yes, there may be some emergencies that arise that end up taking out a whole day, but the fact that you created a priority list means that, after that emergency, you don’t need to spend any time trying to “recover” or think about all the things that got set aside. You already have them on your list, and they can be rearranged, added to the next day, or scheduled out as needed.
5. Again, similar to not answering notifications when I first wake up, I also recommend setting specific times during the day when you don’t answer phone calls or emails. For me, a big time is when my family and I sit down for dinner. During that time, my phone is in another room, on silent, and I don’t look at it. This does two things: 1) again, it’s another way that I take control of my own time, instead of allowing technology or other people’s priorities to dictate how I spend my time and 2) it allows me to live in the current moment, with the people in I am with then. I’m not checking my phone, wondering what I’m missing -or who needs what. I am just there, building relationships. I try and do the same thing during business meetings. My phone stays in my pocket and on silent. This makes me feel less rushed, because I’m not constantly looking at my phone and seeing the messages and notifications stack up. It lets me make cool, calm, collected decisions and to direct all of my focus to the task at hand.
6. The last tip I have is to take a “tech-break” at least every quarter (every three months). For me, this involves taking a 3 or 4 day-weekend, leaving my computer at home or put away and my phone off or on silent and not on my person. Again, this is a time to slow down, refocus, refresh, and live in the current moment. Instead of thinking about work, business, next month, or next week; I am able to do something simple like working in the vegetable garden with my kids. I’m not checking email during this time and I love it! It’s great to take some time every few months, especially those of us who’s work can be all-encompassing, and just breathe.
How do you define “mindfulness”? Can you give an example or story?
I see mindfulness as being aware of what’s currently going on around you in the present moment. It means not living your days in the future, directing time and energy into what’s coming up. While this may sound a little odd (I mean, we have to plan ahead, right?), being present to the moment doesn’t necessarily mean not looking ahead to the future. It just means that you don’t overspend energy and focus on what’s coming down the road. It’s like the old saying “taking one step at a time”. We often spend a lot of energy and anxiety worried about the decisions we’ll have to make next month, that we often neglect situation that require attention now. I had a great experience of this back when I decided to leave my full-time job to begin consulting. When I was getting ready to do that, I became worried about things like “What happens when this contract runs out? What will my work look like in 2 years? What will I have to do for taxes with my LLC and my personal return?” The list went on and on. I could have spent untold amount of mental energy focused on those things. Instead, I made my prioritized list and took everything a day at a time. I focused on doing the tasks and taking care of the things that were right in front of me, that I could actually do something about that day. This gave me peace, reduced my stress, and allowed me to continue to work in a productive and efficient manner.
Can you give examples of how people can integrate mindfulness into their everyday lives?
The best way I know of how to integrate mindfulness into your everyday life is to make some time to practice it every day. If you’re already starting to establish a daily morning routine, this is a great place to stick that. I take time in my daily routine to pray, think, and focus on what’s currently going on in that present moment and pausing to “take a breath” before I start my day. Some people find it easier to do this during lunch or at the end of the day.
Do you have any mindfulness tools that you find most helpful at work?
Whenever I start to get stressed at work, or the “things” begin to pile up; I take a deep breath to calm down. I then go back to my prioritized list for the day. If things need to be adjusted, I adjust them. If not, I add those “things” near the bottom of the list, to be added onto tomorrow’s list if necessary. I always try to make sure that my mental energy and focus doesn’t get pulled away from whatever I am working on then and there. I don’t want to finish work at the end of a day and realize that I spend most of my time thinking about/worrying about things coming up next week, next month, etc.
What are your favorite books, podcasts, or resources that inspire you to use mindfulness tools or practices
I once listened to a podcast (I think it was the Brainfluence Podcast) where an interviewer discussed mindfulness practices. That got me started thinking about it and looking into it. Since then, being a licensed OT and needed CEU credits, I took a few continuing education courses on mindfulness-based therapeutic interventions that helped me understand and grasp it a little more.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I think the quote that has pushed me, or influenced me, to become better is something my dad would always say. Whenever I was doing something growing up, chores or projects, he would look at me and say “If it’s worth doing, it’s worth doing right.” Even today, as I go about my daily tasks and projects, I think to myself that I’m going to do it “right”. If I’m not willing to go that extra mile to ensure that it’s handled 100%, then it’s not worth my time. It’s something that either needs to be contracted out or dropped off of my to-do list. Thinking about that saying always helps me prioritize what I’ve got going on, both in my personal and professional lives.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Something I’ve been thinking about a lot recently, has been the state of healthcare -primarily in the physical rehabilitation world. There are so many clinics and clinicians out there offering cookie-cutter therapy treatment. Patients roll into and out of the clinic like they’re on a giant conveyor belt. You show up do your exercises, get your ice, and come back in a couple days. This model of treatment leads to clinician burnout and substandard outcomes for patients. It’s not a good environment or model for the long term. A lot of this has to do with the way our reimbursement model works, and the drive for constantly improving productivity. If I could inspire one movement to bring the most amount of good to the most amount of people, it would be a movement aimed at stepping out of that model of healthcare. Instead of third-party payer dictating to clinicians and patients what they will or won’t pay for, and in what quantities, the patients would begin to take control of their health. Clinicians would either opt out of the insurance-based payer model, or offer out of network/cash-based services; services based on quality of outcomes rather than minutes of therapy billed for. This would provide higher value to patients, with better outcomes, less clinician burnout, and allow clinicians to make real human connections with their patients. Because, after all, that’s what healthcare is all about: people. It’s about helping another person recover from or overcome some dysfunction, injury or disability. That’s what healthcare needs to get back to; the idea that it’s about people helping people.
Thank you so much for these insights! This was so inspiring!