July 3, 2025 • 35 mins
In this Take Two episode of Relentless Health Value, host Stacey Richter reflects on her conversation with Dr. John Lee to explore the challenging intersection between mission and margin in healthcare.
They discuss the nuances of cognitive dissonance faced by healthcare professionals, particularly when organizational priorities conflict with patient care. Dr. Lee shares insights on finding a sense of mission within the constraints of the current healthcare system, emphasizing the importance of incremental improvements, team-based care, and peer support.
The conversation also highlights real-world examples of systemic issues and practical advice on how individuals can contribute to meaningful change without feeling demoralized. This episode is part of an ongoing series addressing critical topics in healthcare, and listeners are encouraged to tune in next week for further discussions.
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08:05 What is cognitive dissonance relative to the healthcare industry?
09:23 What are the systems that start to bear down on individuals within the healthcare system?
10:15 EP391 with Scott Conard, MD.
10:53 EP415 with Rob Andrews.
11:50 EP326 with Rishi Wadhera, MD, MPP.
12:27 “The system has almost gamed them.”
15:44 How can alignment still be achieved in the face of cognitive dissonance?
17:12 EP431 with Kenny Cole, MD.
20:43 Why does it take more than one person to solve the dysfunction in the healthcare system?
23:01 What are some little changes that can help change the cognitive dissonance in healthcare?
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
"Take Two, because I'm on a tearcalled, is it mission and or margin?
Let's talk about how this goes downwhen you're in the belly of the beast."
Today I am speaking with Dr. John Lee.
(00:21):
American Healthcare Entrepreneurs andExecutives You Want to Know, Talking.
Relentlessly, Seeking Value.
I am so focused right now on theintersection or lack thereof of mission
and margin, so I'm taking a second.
Listen to this episode right now withJohn Lee, MD because it is so ridiculously
(00:45):
relevant given that I am as stated ona bit of a tear, this mission slash
margin bender kicked off actuallyif I had to diagnose the root cause.
It's because of all of the conversationsthat happens after what I'm calling
the trust through line episode.
Episode 477.
(01:06):
Because if you think about it, andI have, if we are talking about
trust, what does that even mean?
Like trust to what end.
And when you start distilling it down,you wind up with trust that someone is
gonna do right by patients and purchasersand the actual clinicians providing the
care that even if there's a stack ofBenjamins to be had by doing the wrong
(01:30):
thing, we can trust that mission willbe put over margin or at least balanced
with it in some kind of palatable way.
Right?
That's a big piece of what it meansto be trustworthy in healthcare.
You are what you won't do for money.
That was a headline to or RyanHoliday article I read recently
and wrote down, because, right?
Now it's one thing for each ofus listening here to contemplate
(01:54):
mission and margin and that matters.
But it's quite another thing for thiscontemplation to happen at scale,
at status quo, consolidated healthsystems, carriers, many status quo, not
transparent, brokerages, PBMs, TPAs,status quo, stakeholders across the board.
But because of this actions beingtaken at the organizational level, may
(02:18):
not mirror the mission slash marginratio that you or I might aspire to.
So why this episode with Dr. John Lee?
You may be wondering.
How did this conversation get teedup for a Take Two in the midst
of this mission slash margin tearthat I apparently am on right now?
Dr. John Lee talks about and givessome advice for individuals in a status
(02:40):
quo, not transparent organization, howto find a mission to feel good about.
I would also highly recommendlistening to the show with Larry Bauer.
It's a Summer Short, and it'scalled "Knights Knaves and Pawns".
So here's my conversation with Dr.John Lee, and next week come back
because I'm gonna continue the missionmargin conversation with Dr. Ben
(03:01):
Schwartz and it's a really good one.
So come back next Thursday too.
Hi, I'm Chris Deaconwith VerSan Consulting.
If you're listening to RelentlessHealth Value, we already have
something important in common.
You care about fixingwhat's broken in healthcare.
This isn't just a podcast I tune into.
It's one that I revisit.
Reflect on and highly recommend.
(03:22):
Stacey's conversationsdon't stop at the mic.
They spark ideas, challengeassumptions, and fuel the work so many
of us are doing to fix healthcare.
If you're here for real change,you're in the right place.
Subscribe to the podcast.
Sign up for the newsletter, andlet's keep the momentum going.
Thanks for listening.
Let's say a person believes theywant to do well by patients.
(03:43):
But their performance review dependson, as just one example, making
care less affordable for patients.
But somehow this individual is able toconclude that what they're doing is a
net neutral or a net positive, despitein this hypothetical, let's just say
obvious indications that it is not.
In this hypothetical, there aresay clear facts that show that
(04:05):
what this person is up to isindisputably a problem for patients.
But yet at every opportunity this persontalks about their commitment to patients,
this rationalization or earmuffs don'tlook, don't see is cognitive dissonance.
Cognitive dissonance is when what someonewinds up doing, their actions are in
conflict with what they believe in.
(04:25):
Now it's harder to engage in cognitivedissonance the closer you are to patients
because you see the impact up close.
Unless these at the bedside cliniciansenjoy a robust lack of self-awareness,
those who are seeing patients don't a lotof times have the luxury of pretending
that what is going on is good for patientswhen they can see with their own two
(04:47):
eyes that it is not good for patients.
The further from the exam room orthe community, however, the easier it
is to not acknowledge the downstreamimpact, if you can even figure out
what that downstream impact is.
Sometimes it's legitimately difficult toconnect the dots all the way down the line
to the customer's, members or patients.
(05:07):
Today I am talking with Dr. John Lee aboutwhat to do in the face of all this when
working in the, as I call it, the belly ofthe beast, working for a large healthcare
organization such as a hospital.
Because hospitals, sometimes andwe certainly do not want to put
all hospitals in the same category.
They are a wildly diverse bunch,but sometimes some people at some
(05:29):
hospitals do some things whichare, not things I think they should
be doing anyway, they're fairlyegregious breaches of trust actually.
But yet within that same organization,you have doctors and other clinicians
or others who are working really hardto serve patients as best they can.
This is the real world that we'retalking about, and the question
of the day is, so now what?
(05:52):
When you are a person not suffering fromcognitive dissonance, at least to the
level of those around you, what do youdo to not get, I don't know, demoralized.
And look, while it would be amazingif someday we build a whole new health
system that didn't include some peopledoing things that I don't think they
should be doing, that day is not today.
And it's not tomorrow.
(06:13):
I'm gonna hope that there's otherpeople in our village who are full
on doing the disruption thing, but ifwe are not able to do that personally
for whatever reason, but we still wantto inch forward within the existing
environment and do the things that makeus feel like we're achieving our mission,
what's the best way to think about this?
That is what I asked Dr.John Lee, and that's what our
(06:36):
conversation is about today.
Summing up his advice,which is really good advice.
Dr. Lee talks about how it's so importantto celebrate the small wins and feel
good about care that is a little bitbetter than it was six months ago.
He talks about incremental improvementthat helps both patients, but also
colleagues, and that's not insignificantto really consciously consider how to work
(06:59):
together and help to support each other.
Dr. Lee's last piece of advice.
It's really important to seek outlike-minded individuals as sounding
boards and as a support network tocommit to supporting each other.
And I hope all of you that youfeel like you found your tribe
here at Relentless Health Value.
You guys are an amazing bunch, soknow that and don't hesitate to reach
(07:22):
out to each other when you need help.
Dr. John Lee is an ER doc emergencyroom doc by training who is
also an informaticist and ChiefMedical Information Officer.
I can tell you from personalexperience that Dr. Lee is one of the
most creative and pragmatic problemsolvers that I have encountered.
In the conversation that follows,Dr. Lee offers a really nice array
(07:43):
of examples of incremental in thebelly of the beast, stuff that
might be possible in the real world.
So without further ado, my name isStacey Richter, and this podcast is
sponsored by Aventria Health Group.
Dr. John Lee, welcome toRelentless Health Value.
Thank you so much for having me.
This is the highlight of my day.
Well, it is the highlight of myday to speak with you, my friend.
(08:03):
Why don't we just start out withif you're thinking about cognitive
dissonance, how do you think about it?
What is it?
There's a lot of rhetoric sayingwe have to change how we do things.
Once people who buy into that getinto the system and try to change the
system, particularly from the inside,they're often overwhelmed by the tide
(08:24):
of the momentum continuing to pushthe system in, essentially in the
same way that it's has been continuingto go for the past several decades.
The cognitive dissonance thatyou're describing is the feeling
that I wish we could do more,but the system just won't let us.
And there's many people who'vetalked a lot about this, but just
(08:45):
from a personal perspective it'ssometimes can be very frustrating.
And one of the reasons why Igravitated toward your podcast,
'cause it was a different tribe thatI could feel like I could belong to.
That at least maybe I can't make thatsort of grand scale impact that I want
to make, but at least I can be surroundedby other people who are of a like mind.
(09:06):
Well, I appreciate that and that isactually a goal of the podcast to
provide a sort of community that canwrap around and give some bolstering
and comfort to those who may feelvery alone for maybe the reasons
that we can talk about right now.
You have a system that after all thistime, very fee for service oriented.
(09:28):
There was this one presentation givenby an internal medicine physician,
and he and his team stood up a really,really good heart failure program,
and they were really successful.
They were really successful inreducing the number of hospitalizations
that these heart failure patientswere having by almost like a third
or a half or something like that.
And it was a fantastic presentation.
(09:50):
I went up to him afterward.
Congratulate him shook his hand and hiscomment afterward was, yeah, I didn't
wanna say it during the conversation, helooked a little bit downcast and he said,
yeah, we have to actually sunset thisprogram because it is too successful.
The commentary that he made was thatmy CEO told me that we have to stop
the program because it's reducingheart failure admissions too much.
(10:13):
It's costing the hospital money.
And actually, I just recently listenedto your podcast with Scott Conard who
talked about how, in a similar way,in a larger sense, his clinics were
so, so successful that the healthcaresystem bought his clinics and then
shut it down because they were reducingthe number of hospitalizations.
(10:33):
That's the sort of cognitive dissonancethat is so frustrating to people who want
to try to actually improve our system.
So here you are, and here thedoctor who set up that heart failure
program was, here's Dr. Scott Conard.
There are so many examplesof great clinicians and very
mission-driven individuals.
Rob Andrews also talked about thison the show, wherein the way that the
(10:57):
money flows right now, you don't getpaid a lot for preventing anything.
One percent of heart failurepatients are on optimal medical
therapy in this country.
I can cite stats like that off the topof my head because I was so shocked.
Yeah, and I would say that the sortsof conversations that I had with that
internal medicine physician is probablymore an exception rather than the rule.
(11:20):
Most healthcare systems arejust obliviously ambivalent and
satisfied with doing things thecurrent way that they're doing it.
Well, it's interesting because I alsowas at a physician summit a couple of
years ago, and I listened to a doc whoalso stood up a heart failure program to
prevent readmissions, and it was also verysuccessful and it also got shut down, and
(11:45):
there was more money in those readmissionsthan in the poultry CMS finds.
Actually, you know, the show withDr. Rishi Wadhera gets into this in
depth, so for sure you definitelyhave system level factors that
start pressing down on individuals.
But, so I know of many of my colleagueswho are very focused on RVUs and the
(12:08):
volume of services that they produced,but I also know that they're really
good docs who really, really care abouttheir patients, but they're existing
within an environment that just inducesthat sort of behavior so that it's less
of an issue where they're trying to,they're not trying to gain the system,
but the system has almost gained them.
(12:29):
And, you can't really blame mostof the people for doing the things
the way that they're doing them.
And what we have to do is tryto actually change the system.
But a third of healthcare wasteis somebody else's profit.
That profit buys a lot of influence.
Let's talk about how thesesystemic pressures really
press down on individuals.
So if I'm just making a list of thingsthat create this cognitive dissonance,
(12:54):
it's the, the way that comp models work.
You mentioned RVUs.
Yeah.
You know, let me kind of paint a pictureof something that has been a theme,
particularly amongst some of my ambulatoryand primary care based colleagues.
They're constantly being pushedharder and harder to see more and
more patients to increase that volumebased revenue, it all just becomes
(13:17):
like you're a CPT, RVU machine.
And, I think from a technologyperspective, there is the ability
to actually change that paradigm.
To introduce more team-based care.
To actually create very proactivemechanisms so that the primary physician
who's responsible for a particularpatient, he has an entire team surround
him to support how that physicianinteracts with that patient, so that
(13:40):
if they do have that interaction withthe patient, they actually feel like
they're actually moving the ball forwardand improving that patient's life
.Or I guess, uh, to use the Peter Atia term that improve that patient's health span.
There's obviously consequences onboth sides of the room there, in which
you have a physician who is beingtreated or feels like an RVU machine,
(14:04):
a CPT code machine, as you just said.
But on the other side, you'vegot a patient who's like,
I guess I'm a widget too.
So we have a system at this juncture thatis pressing people into these modes that
reduce the human aspect of healthcare.
If I'm reinterpreting what you just said.
Layer onto that, the idea whichcould be especially demoralizing to
(14:28):
someone such as yourself who can seea way forward, who can see, wow, we
could use technology in this way,we could do this, we could do that.
There's so many ways that Icould see to improve this.
And then you have a system that'slike, nah, I think not right?
Like I could also see how that wouldbe frustrating to the good people,
you know, like the people that wantedto try to figure out how to fix it.
(14:51):
And no one is interested.
One of the things that I've sort ofmigrated to in my thinking is that I'm not
gonna make that wholesale massive change.
What I can do is nibble around the edges,help things in little ways, and even if I
get just a little win, hopefully I will bethat one little win compounded with other
(15:12):
little wins that other people make aswe try to improve our healthcare system.
What you're talking about is working fromwithin the belly of the beast surrounded
on all sides by giant institutions.
So for you, the best path forward might besmall things that make a difference right
now for patients and your colleagues.
What works in some situations as wethink about bigger and more disruptive
(15:36):
is just not gonna work for somebody else.
It's just not even possible.
So what I wanna hear from youis, okay, you know, now what?
How do you make lemonade out of lemons?
How do you contemplate still feelinglike you're working in alignment
with your values and what you wannaaccomplish despite so many pressures?
You and I have had some conversationsearlier where if you come up with
(16:00):
something that you'd like to do, and thenthere's all sorts of obstacles in the way.
You said it's really easyto become disillusioned.
And you were talking about howyour advice and your mindset then
has to be, okay in the face ofwhat's going on, what can I do?
What can I accomplish?
So how do you think about theincremental improvements that you can
(16:20):
realistically make, or what are someexamples of things that you have done?
One of the things that I'm really,really proud about is I helped create
a system that my fellow emergencyphysicians, they were actually okay with
it, unlike many other colleagues aroundthe country, they viewed the system as
pretty well designed, and so that forme was that one little thing moving the
(16:43):
ball forward so that we could actuallystart digitizing some of the data that our
system creates in taking care of patients.
And in me helping my colleaguesbe more comfortable with a digital
system, now we've created data.
That data can then informother tools downstream that
can help transform the system.
That's the very first step.
(17:04):
We can't do anythingelse without doing that.
And then another is justcoming up with different ideas.
Some of them may not stick.
So, your podcast with Kenny Cole,within it, he mentioned something
about Metformin and how peoplestop taking Metformin because
of gastrointestinal side effects.
But I know that how that's documentedwithin the system, it's very
(17:26):
different based on who documents itand what system they document it in.
If we could somehow encapsulate thatas a piece of data that's consistent
and reliable across systems or acrossoffices or across practitioners, then
you can start aggregating that and thenbeing able to say, okay, these are the
things that actually predispose somebodywho is on Metformin to stop taking it
(17:49):
because of gastrointestinal side effects.
And then if you can start encapsulatingthat as a digital picture, then you
can actually start putting into place,even something simple as, well we
see based on the data that's in yoursystem that you're predisposed to
having gastrointestinal side effects.
We are going to have somebody call youa week after you start Metformin and
(18:10):
see how you're doing and, and see ifwe can put in some mitigating processes
so that you can stay on Metformin.
But the first step of that isactually encapsulating that as data.
And what I did was I took that podcast,I forwarded on to some people I knew
who are very astute data scientists, andthey have a way to actually encapsulate
(18:30):
that and encode that into something thatis very easily digestible by multiple
systems across multiple organizations.
And that's something thatwould be really valuable.
Now, I'm realistic enough to know thatputting that out there and kicking that
off, that may or may not go anywhere, butI keep trying because that's my makeup.
I wanna try to help move the ballforward and use technology to actually
(18:54):
improve our healthcare system.
And that's the sort of thingthat I keep trying to do.
I'm very inspired by you andthe initiative that you have
when you do stuff like this.
It's another thing, but it also mightbe exactly what is necessary to feel
like a difference is being made.
When you consider how you may helpyour colleagues, like how do I, within
my current role, potentially supportcolleagues who are trying to figure out
(19:17):
how to do right by patients, which manyare, and you give two examples there.
One is in your role at the time, andeverybody's gonna have their own example
of this, but you were tasked withbuilding an ER, IT infrastructure, the
system that you built, aligned withwhat your colleagues' needs are, not
just what somebody dictated from above.
(19:39):
So you took the time to ensure thatthe system that you built was gonna
work for colleagues as well as thehospital system writ large, which I can
definitely see would give a measure ofappreciation and pride, rightfully so.
And then the second part of thisis what do patients really need?
You gave the example of the episode withDr. Kenny Cole from a couple of weeks ago.
(20:01):
He talks about just how many patientsfail on Metformin because they're
actually not taking it properly.
I'm gonna come off as a StaceyRichter fanboy on this, but I'm gonna
quote another episode that you had,I forgot what the exact quote was.
You used the Marcus Aurelius quote.
Something about being happy withthe smallest progress, and I
think that's what we have to do.
(20:22):
Some of us are big names, have biginfluence, have big personalities and
can do big things, Mark Cubanish typethings, but others of us, we have to
be able to be satisfied with doingthe right things that we feel like
we can do and be satisfied with that.
Figure out how to support your colleagues.
You can figure out how to supportpatients in whatever ways.
(20:43):
What's your advice for someone whomight not have the same job as you?
One of the teams that I used to workwith, I would use this metaphor a lot, our
healthcare system, the dysfunction in ourhealthcare system is like this enormous
boulder stuck on the side of a mountain.
Just one person isn't going topush that boulder down the hill,
which is what we need to do.
But what we can do is take the littlepieces of pebbles around that boulder.
(21:06):
If enough of us are taking out enoughof those pebbles, at some point
that boulder is gonna start rocking.
And then once that boulder startsrocking, at some point, somebody
is going to be able to push it.
And then once that boulder startsrolling, it can't be stopped.
Because the things that weneed to do with our healthcare
system all make a ton of sense.
Once that logic takes hold and the thingsthat our patients need align with how we
(21:32):
actually deliver healthcare, then it'sgonna be a force that can't be stopped.
I may be being a little bittoo optimistic, but that's
what I truly firmly believe.
That's a wonderful way to put this.
Exactly like you just said.
If there's a boulder and we each justtake a pebble, then we can really create
change in an organic way, even if it'snot necessarily some kind of formal
(21:55):
collaborational alignment that if eachof us just thinks, what can we do?
What are the simple opportunities?
I think you've called it wherein wecould make even a small difference.
If there's enough people who are thinkingthat way, inevitably change will wind
up happening just because it's almostcreating a zeitgeist of a certain kind.
(22:16):
Yeah, absolutely.
That's a great way to put it.
The other thing, here's anotherword for zeitgeist, a tipping point.
One of the things in that MalcolmGladwell book, if only 12% of
individuals are pushing in a certaindirection, tipping points happen.
It's just, it's amazing how wordtravels ideas spread, especially if
(22:36):
there's enough people who believesomething in their heart of hearts
and want to see something happen.
And I do feel like there's so manyacross the healthcare industry that
realize something's gotta give.
We just need to be able topush back against that system.
And, you know, to use another metaphor,if the current system is a, is a big river
pushing us downstream, as difficult asit sounds, we need to reroute that river
(23:00):
so it points in a different direction.
So one of the things that you saidwas, as we just talked about, Dr.
Kenny Cole, talked about just how manypatients stop taking Metformin because
of avoidable gastrointestinal symptoms.
And that is something thatcould be codified if we A, know
it because we have the data.
But B, we can build somethingto disseminate that information.
(23:23):
But what else?
Give us some bright spots here.
Things that people may contemplate.
So let's say you're a medical assistantin an office and you see the doctor doing
all this labor that you think that youcould do, then maybe suggest, Hey, maybe
we can do this and take the load offyour shoulders, doctor or to the nurse,
and feel like you're contributing more.
(23:44):
It could probably positively impact howyou feel about your being part of the team
and contributing to the patient's care.
Also making the team moreeffective and efficient.
The other thing is to startidentifying places where there are
waste and they're all over the place.
That sort of identification and thereporting and trying to execute on that
(24:06):
sort of observation that's an entireproject altogether, but at least start
maybe taking that and injecting kind ofthat culture of, you know, we shouldn't
be really doing this, or there is adifferent way of approaching this.
Why is that printer way over there20 feet away from the computer when
everybody goes to that printer forevery single patient, as we print stuff
(24:28):
out, little things can add up to a lot.
Those are some great examples thathave just so much packed into them.
One of them is just make asuggestion and it's in a way
a commentary on the healthcaresystem today that even comes up.
We've gotten ourselves into a placewhere we talk about team-based care,
(24:50):
but we have to bring up, if someonesees something that could be improved,
maybe we should talk amongst ourselves.
Yeah.
The unfortunate reality is that there'sa lot of healthcare systems, maybe even
most of them that are very hierarchical.
The doctor or the C-suite administratorsays, We have to do it this way and
people have to kind of march in line.
(25:11):
I think it would benefit ourhealthcare system writ large if
we weren't like that as much.
That if we could actuallyincorporate the sorts of suggestions
or input of the entire team.
And this is almost an organizationalextension of the concept of
team-based care around a particularpatient, but team-based care from
an organizational perspective.
(25:33):
I just wish that a lot of ourhealthcare systems would absolve
themselves of the top down hierarchicalapproach to managing out systems.
Well, here comes Gen Z, and the one thingI've heard about Gen Z is they really
don't like hierarchy very much, but in away, a command and control environment is
somewhat antithetical to team-based care,having teams wherein the team feels afraid
(25:57):
to speak up and make suggestions becausethe hierarchical, you know, like those
that sit above them are gonna lash out.
Like there's a lot of consequences.
Yeah.
It's there.
It's in their best interestto promote that sort of stuff.
So maybe contemplatewhat's the environment?
Is there any influence that you mighthave on the environment that could
(26:19):
enable people who are trying to dothings in a better way or who may
have insight into how to improve?
Can they feel like they can speak up?
That's number one.
Or number two, if you, you seesomething, maybe say something.
And I'm not sure if you have any advicefor, if someone is working in the
hierarchical environment and they do seesomething and they wanna say something, is
(26:40):
there, I was chatting with Anne Richardsonthe other day who had just one example
after another of times when someonebrought up something that was a potential
patient problem or was a patient problem.
And the response of the system wasactually to blame that individual for
the problem, and wow, my heart juststarted to bleed for some of these really
(27:02):
mission-driven people, getting their facessmashed against the wall for daring to
do the right thing on behalf of patients.
Well, that's an entirediscussion altogether.
I mean, whenever I think aboutthis in the recent history, I
consider the Redondo Vaught story.
She's a nurse.
Sedating a patient, I think for anMRI, and there were two medications.
(27:23):
One was Vecuronium, which is aparalytic, and the other one was Versed.
And because both of themstarted with ve, they were close
together in the medication cart.
She was supposed to giveversed to sedate the patient.
She gave vecuronium, whichparalyzed the patient.
The patient died.
She self-reported this mistakeand then she was criminally
prosecuted for doing this.
(27:43):
This was recent, we'll, we'll linkto that in the, um, the show notes.
But this is the sort ofthing that needs to stop.
Yes, tragic, yes, she made a mistake, butI can almost guarantee you that at least
one, probably more nurses almost made thatsame mistake, but they didn't report it.
Phew, that was a near miss.
I'm gonna get on with my day.
(28:05):
Imagine if they had reported that and thenthere were like three or four reports of
that somebody noticed and said, Ooh, thatwould be a really bad mistake to have.
So let's systematically try to create,you know, rearrange the medication cart
or do something so that that sort ofmistake can't happen in the future.
Then that patient wouldn't have died.
That nurse would not befacing a prison term.
(28:27):
Wow.
That is so horrific.
You really have to think throughthe outcome you're trying to create.
Is it to prevent additionaldeaths or punish a nurse who
reported her own mistake?
Because in a way, maybe we have topick one because we can't have both.
So this kind of goes to this largerdiscussion that we're having.
(28:48):
This big system is pushingeverybody in a certain direction.
I can understand how somebody who,say a medical assistant, who sees
something, doesn't wanna speak up.
Or they don't feel empowered to contributeto the team, and I hope that people
start doing that a little bit more.
So if we're thinking about constructingour pieces of advice here, the
(29:10):
first piece that we talked aboutwas really contemplative of what do
patients need, what's gonna help.
Second one is, how doyou support colleagues.
Thinking about both of these two thingssimultaneously, you had mentioned waste.
Where is there waste within the systemthat could negatively impact patient care?
Example of this, there's lots of peoplenot in exam rooms because they're
(29:34):
walking around trying to get printouts.
Time is a zero sum situation.
So it's certainly a win-win.
In order to achieve either oneof those two aims, it does take
trying to figure out how to buildan environment that people bring up
suggestions to continuously improve.
The other piece of this though is thatyou also have to acknowledge that you
(29:57):
can't do everything and that thereare certain capacity constraints.
Even if you say, suggest that you movethat printer, you may not necessarily
realize that IT has to come by and theyhave to rewire all the cables and then
they have to remap the printer to, it'ssomething that seems simple, often isn't
simple, and so I think as somebody who'strying to do stuff like this, you also
(30:20):
have to accept the fact that there arecertain limitations on what you can do.
There are capacity constraints.
And then not necessarilyget frustrated about it.
It may be a lot of steps for someindividuals, but it's closer for others.
So there's this compromise situation.
One of the things we talked about,team-based care, being a part of this
(30:42):
and doing things to really support andemphasize the team in the team based care.
So not getting frustrated by that,the, what's that African proverb?
If you wanna go fast, go alone.
If, if you wanna go far, go together.
So the going far togetheris always gonna take longer.
But the other one that you had mentionedwas the whole idea of moving this
(31:04):
whole transformation thing forward.
It's bigger than a boulder, right?
It's probably planet sized.
So we each have to just be happywith what we actually can accomplish.
Like we can't let perfect be the enemyof the good and mental health and
just our motivation to keep doing whatwe're doing on behalf of patients.
(31:26):
Let's really feel good about the pebblesthat we have pulled out and fixed.
Yes, absolutely.
Otherwise, you'll just get frustrated.
I do feel like in, in a lot ofenvironments, it's the really
good motivated people who arethe ones that wind up leaving.
I feel like this is a really importantconversation to have because it's exactly
those individuals, you know, the onesthat are listening to this show that we
(31:48):
really need to continue to inspire andbe inspired in the face of all these
contrary forces and just B.S. Becauseit's this crew that's gonna transform
healthcare if anybody's gonna do it.
Well, and I think also one of the thingsthat, uh, that just came to mind is it
is really helpful to have like-mindedindividuals to be able to be sounding
boards for other like-minded individuals.
(32:10):
One of the things that I would love foryou to do is create some sort of mechanism
for people to connect and communicate witheach other who are of like mind, so that
I don't feel like I am the only RelentlessHealth Value person in my organization.
There may be some others.
I've certainly encountered others who havein some of the work that I do around the
(32:30):
country, I mentioned your podcast and theysaid, oh yeah, I love talking to Stacey.
And then that creates almost kindof an instant bond that, yeah, we
know what we want to try to do andwe know that we're both frustrated.
And we also know that if we get toofrustrated, we can count on each
other to talk us off the cliff.
That's such a lovely way to put it.
And it really just emphasizesthe importance of community.
(32:53):
Just to have that kind of releasevalve, which could be a conversation
with a colleague either nearor far, who is trying to push
that same boulder down the hill.
Feeling alone is so hard.
It takes a village and we all haveto work together and figure out
how we are supporting each other.
And maybe that's something that thoseof you who are listening to the show can
(33:14):
really keep in mind and think about howon somebody's worst day if we are there
and able to say, good on you, keep it up.
You're amazing.
That really matters.
So maybe as our last piece of advicehere, there's, it's a commitment to
support each other and to keep our eyesopen for those who are trying to do
(33:38):
better, do right, fix something to justoffer them a measure of our heartfelt
support and thanks and appreciation.
Because that actually maybe makeall the difference in the world.
Yeah, absolutely.
And be able to have some sort of privatemechanism to do that, because a lot
of times you're hesitant to do thisin like a public forum, but if you
(34:00):
have some degree of familiarity andtrust with somebody who thinks along
the same lines as you and being ableto pick up the phone or text them, I
think that that will go a long way.
I couldn't agree more.
I mean, there's plenty of timeswhere I'm about ready to throw in the
towel any day of the week and someonejust comes outta the blue and says,
thank you, or much appreciation, or,this was really meaningful to me.
(34:20):
I can tell you just personallyhow much that really matters.
Dr. John Lee, is there anything that youwanted to mention that you didn't have
a chance to in the conversation today?
Be happy in the small things.
Have conviction in the thingsthat you think you wanna do
is right, that it is right.
Keep plugging away.
It may not turn around all at once.
(34:41):
You may not be that person whopushes that boulder down the hill.
But be happy that you may have contributedto taking one of those pebbles out.
Here, here.
If someone's interested inlearning more about your work,
where would you direct them?
LinkedIn.
It's probably the easiestplace to connect with me.
Dr. John Lee, thank you so much forbeing on Relentless Health Value today.
Thank you.
This is Dr. Scott Conard from ConvergingHealth, encouraging everyone to
(35:04):
listen to Relentless Health Value.
Stacey, I listen to your show every week.
I can't wait for it to come out.
Both because I lovethe people you have on.
They're brave, courageous peoplewho are willing to speak out,
and that is really challengingin today's political environment.
And, two, what I learned, andI always learned something.
And what comes to me as I listen tothis is who can I share this with?
(35:26):
And so I will send the RelentlessHealth Value link, text it to
people and email it to people.
And it's amazing to me how people listen.
They get turned onto you andthey change the way they're
designing their health benefits.
They're reviewing their contracts,they're getting their PBMs contracts,
and it is so exciting to be ableto have you in the world doing that
(35:49):
because I don't know of anybody elsethat has the wisdom and the vision
that you're putting forth and bringingbig people that you are on your show.
"Take Two, because I'm on a tearcalled, is it mission and or margin?
Let's talk about how this goes downwhen you're in the belly of the beast."
Today I am speaking with Dr. John Lee.
(00:21):
American Healthcare Entrepreneurs andExecutives You Want to Know, Talking.
Relentlessly, Seeking Value.
I am so focused right now on theintersection or lack thereof of mission
and margin, so I'm taking a second.
Listen to this episode right now withJohn Lee, MD because it is so ridiculously
(00:45):
relevant given that I am as stated ona bit of a tear, this mission slash
margin bender kicked off actuallyif I had to diagnose the root cause.
It's because of all of the conversationsthat happens after what I'm calling
the trust through line episode.
Episode 477.
(01:06):
Because if you think about it, andI have, if we are talking about
trust, what does that even mean?
Like trust to what end.
And when you start distilling it down,you wind up with trust that someone is
gonna do right by patients and purchasersand the actual clinicians providing the
care that even if there's a stack ofBenjamins to be had by doing the wrong
(01:30):
thing, we can trust that mission willbe put over margin or at least balanced
with it in some kind of palatable way.
Right?
That's a big piece of what it meansto be trustworthy in healthcare.
You are what you won't do for money.
That was a headline to or RyanHoliday article I read recently
and wrote down, because, right?
Now it's one thing for each ofus listening here to contemplate
(01:54):
mission and margin and that matters.
But it's quite another thing for thiscontemplation to happen at scale,
at status quo, consolidated healthsystems, carriers, many status quo, not
transparent, brokerages, PBMs, TPAs,status quo, stakeholders across the board.
But because of this actions beingtaken at the organizational level, may
(02:18):
not mirror the mission slash marginratio that you or I might aspire to.
So why this episode with Dr. John Lee?
You may be wondering.
How did this conversation get teedup for a Take Two in the midst
of this mission slash margin tearthat I apparently am on right now?
Dr. John Lee talks about and givessome advice for individuals in a status
(02:40):
quo, not transparent organization, howto find a mission to feel good about.
I would also highly recommendlistening to the show with Larry Bauer.
It's a Summer Short, and it'scalled "Knights Knaves and Pawns".
So here's my conversation with Dr.John Lee, and next week come back
because I'm gonna continue the missionmargin conversation with Dr. Ben
(03:01):
Schwartz and it's a really good one.
So come back next Thursday too.
Hi, I'm Chris Deaconwith VerSan Consulting.
If you're listening to RelentlessHealth Value, we already have
something important in common.
You care about fixingwhat's broken in healthcare.
This isn't just a podcast I tune into.
It's one that I revisit.
Reflect on and highly recommend.
(03:22):
Stacey's conversationsdon't stop at the mic.
They spark ideas, challengeassumptions, and fuel the work so many
of us are doing to fix healthcare.
If you're here for real change,you're in the right place.
Subscribe to the podcast.
Sign up for the newsletter, andlet's keep the momentum going.
Thanks for listening.
Let's say a person believes theywant to do well by patients.
(03:43):
But their performance review dependson, as just one example, making
care less affordable for patients.
But somehow this individual is able toconclude that what they're doing is a
net neutral or a net positive, despitein this hypothetical, let's just say
obvious indications that it is not.
In this hypothetical, there aresay clear facts that show that
(04:05):
what this person is up to isindisputably a problem for patients.
But yet at every opportunity this persontalks about their commitment to patients,
this rationalization or earmuffs don'tlook, don't see is cognitive dissonance.
Cognitive dissonance is when what someonewinds up doing, their actions are in
conflict with what they believe in.
(04:25):
Now it's harder to engage in cognitivedissonance the closer you are to patients
because you see the impact up close.
Unless these at the bedside cliniciansenjoy a robust lack of self-awareness,
those who are seeing patients don't a lotof times have the luxury of pretending
that what is going on is good for patientswhen they can see with their own two
(04:47):
eyes that it is not good for patients.
The further from the exam room orthe community, however, the easier it
is to not acknowledge the downstreamimpact, if you can even figure out
what that downstream impact is.
Sometimes it's legitimately difficult toconnect the dots all the way down the line
to the customer's, members or patients.
(05:07):
Today I am talking with Dr. John Lee aboutwhat to do in the face of all this when
working in the, as I call it, the belly ofthe beast, working for a large healthcare
organization such as a hospital.
Because hospitals, sometimes andwe certainly do not want to put
all hospitals in the same category.
They are a wildly diverse bunch,but sometimes some people at some
(05:29):
hospitals do some things whichare, not things I think they should
be doing anyway, they're fairlyegregious breaches of trust actually.
But yet within that same organization,you have doctors and other clinicians
or others who are working really hardto serve patients as best they can.
This is the real world that we'retalking about, and the question
of the day is, so now what?
(05:52):
When you are a person not suffering fromcognitive dissonance, at least to the
level of those around you, what do youdo to not get, I don't know, demoralized.
And look, while it would be amazingif someday we build a whole new health
system that didn't include some peopledoing things that I don't think they
should be doing, that day is not today.
And it's not tomorrow.
(06:13):
I'm gonna hope that there's otherpeople in our village who are full
on doing the disruption thing, but ifwe are not able to do that personally
for whatever reason, but we still wantto inch forward within the existing
environment and do the things that makeus feel like we're achieving our mission,
what's the best way to think about this?
That is what I asked Dr.John Lee, and that's what our
(06:36):
conversation is about today.
Summing up his advice,which is really good advice.
Dr. Lee talks about how it's so importantto celebrate the small wins and feel
good about care that is a little bitbetter than it was six months ago.
He talks about incremental improvementthat helps both patients, but also
colleagues, and that's not insignificantto really consciously consider how to work
(06:59):
together and help to support each other.
Dr. Lee's last piece of advice.
It's really important to seek outlike-minded individuals as sounding
boards and as a support network tocommit to supporting each other.
And I hope all of you that youfeel like you found your tribe
here at Relentless Health Value.
You guys are an amazing bunch, soknow that and don't hesitate to reach
(07:22):
out to each other when you need help.
Dr. John Lee is an ER doc emergencyroom doc by training who is
also an informaticist and ChiefMedical Information Officer.
I can tell you from personalexperience that Dr. Lee is one of the
most creative and pragmatic problemsolvers that I have encountered.
In the conversation that follows,Dr. Lee offers a really nice array
(07:43):
of examples of incremental in thebelly of the beast, stuff that
might be possible in the real world.
So without further ado, my name isStacey Richter, and this podcast is
sponsored by Aventria Health Group.
Dr. John Lee, welcome toRelentless Health Value.
Thank you so much for having me.
This is the highlight of my day.
Well, it is the highlight of myday to speak with you, my friend.
(08:03):
Why don't we just start out withif you're thinking about cognitive
dissonance, how do you think about it?
What is it?
There's a lot of rhetoric sayingwe have to change how we do things.
Once people who buy into that getinto the system and try to change the
system, particularly from the inside,they're often overwhelmed by the tide
(08:24):
of the momentum continuing to pushthe system in, essentially in the
same way that it's has been continuingto go for the past several decades.
The cognitive dissonance thatyou're describing is the feeling
that I wish we could do more,but the system just won't let us.
And there's many people who'vetalked a lot about this, but just
(08:45):
from a personal perspective it'ssometimes can be very frustrating.
And one of the reasons why Igravitated toward your podcast,
'cause it was a different tribe thatI could feel like I could belong to.
That at least maybe I can't make thatsort of grand scale impact that I want
to make, but at least I can be surroundedby other people who are of a like mind.
(09:06):
Well, I appreciate that and that isactually a goal of the podcast to
provide a sort of community that canwrap around and give some bolstering
and comfort to those who may feelvery alone for maybe the reasons
that we can talk about right now.
You have a system that after all thistime, very fee for service oriented.
(09:28):
There was this one presentation givenby an internal medicine physician,
and he and his team stood up a really,really good heart failure program,
and they were really successful.
They were really successful inreducing the number of hospitalizations
that these heart failure patientswere having by almost like a third
or a half or something like that.
And it was a fantastic presentation.
(09:50):
I went up to him afterward.
Congratulate him shook his hand and hiscomment afterward was, yeah, I didn't
wanna say it during the conversation, helooked a little bit downcast and he said,
yeah, we have to actually sunset thisprogram because it is too successful.
The commentary that he made was thatmy CEO told me that we have to stop
the program because it's reducingheart failure admissions too much.
(10:13):
It's costing the hospital money.
And actually, I just recently listenedto your podcast with Scott Conard who
talked about how, in a similar way,in a larger sense, his clinics were
so, so successful that the healthcaresystem bought his clinics and then
shut it down because they were reducingthe number of hospitalizations.
(10:33):
That's the sort of cognitive dissonancethat is so frustrating to people who want
to try to actually improve our system.
So here you are, and here thedoctor who set up that heart failure
program was, here's Dr. Scott Conard.
There are so many examplesof great clinicians and very
mission-driven individuals.
Rob Andrews also talked about thison the show, wherein the way that the
(10:57):
money flows right now, you don't getpaid a lot for preventing anything.
One percent of heart failurepatients are on optimal medical
therapy in this country.
I can cite stats like that off the topof my head because I was so shocked.
Yeah, and I would say that the sortsof conversations that I had with that
internal medicine physician is probablymore an exception rather than the rule.
(11:20):
Most healthcare systems arejust obliviously ambivalent and
satisfied with doing things thecurrent way that they're doing it.
Well, it's interesting because I alsowas at a physician summit a couple of
years ago, and I listened to a doc whoalso stood up a heart failure program to
prevent readmissions, and it was also verysuccessful and it also got shut down, and
(11:45):
there was more money in those readmissionsthan in the poultry CMS finds.
Actually, you know, the show withDr. Rishi Wadhera gets into this in
depth, so for sure you definitelyhave system level factors that
start pressing down on individuals.
But, so I know of many of my colleagueswho are very focused on RVUs and the
(12:08):
volume of services that they produced,but I also know that they're really
good docs who really, really care abouttheir patients, but they're existing
within an environment that just inducesthat sort of behavior so that it's less
of an issue where they're trying to,they're not trying to gain the system,
but the system has almost gained them.
(12:29):
And, you can't really blame mostof the people for doing the things
the way that they're doing them.
And what we have to do is tryto actually change the system.
But a third of healthcare wasteis somebody else's profit.
That profit buys a lot of influence.
Let's talk about how thesesystemic pressures really
press down on individuals.
So if I'm just making a list of thingsthat create this cognitive dissonance,
(12:54):
it's the, the way that comp models work.
You mentioned RVUs.
Yeah.
You know, let me kind of paint a pictureof something that has been a theme,
particularly amongst some of my ambulatoryand primary care based colleagues.
They're constantly being pushedharder and harder to see more and
more patients to increase that volumebased revenue, it all just becomes
(13:17):
like you're a CPT, RVU machine.
And, I think from a technologyperspective, there is the ability
to actually change that paradigm.
To introduce more team-based care.
To actually create very proactivemechanisms so that the primary physician
who's responsible for a particularpatient, he has an entire team surround
him to support how that physicianinteracts with that patient, so that
(13:40):
if they do have that interaction withthe patient, they actually feel like
they're actually moving the ball forwardand improving that patient's life
.Or I guess, uh, to use the Peter Atia term that improve that patient's health span.
There's obviously consequences onboth sides of the room there, in which
you have a physician who is beingtreated or feels like an RVU machine,
(14:04):
a CPT code machine, as you just said.
But on the other side, you'vegot a patient who's like,
I guess I'm a widget too.
So we have a system at this juncture thatis pressing people into these modes that
reduce the human aspect of healthcare.
If I'm reinterpreting what you just said.
Layer onto that, the idea whichcould be especially demoralizing to
(14:28):
someone such as yourself who can seea way forward, who can see, wow, we
could use technology in this way,we could do this, we could do that.
There's so many ways that Icould see to improve this.
And then you have a system that'slike, nah, I think not right?
Like I could also see how that wouldbe frustrating to the good people,
you know, like the people that wantedto try to figure out how to fix it.
(14:51):
And no one is interested.
One of the things that I've sort ofmigrated to in my thinking is that I'm not
gonna make that wholesale massive change.
What I can do is nibble around the edges,help things in little ways, and even if I
get just a little win, hopefully I will bethat one little win compounded with other
(15:12):
little wins that other people make aswe try to improve our healthcare system.
What you're talking about is working fromwithin the belly of the beast surrounded
on all sides by giant institutions.
So for you, the best path forward might besmall things that make a difference right
now for patients and your colleagues.
What works in some situations as wethink about bigger and more disruptive
(15:36):
is just not gonna work for somebody else.
It's just not even possible.
So what I wanna hear from youis, okay, you know, now what?
How do you make lemonade out of lemons?
How do you contemplate still feelinglike you're working in alignment
with your values and what you wannaaccomplish despite so many pressures?
You and I have had some conversationsearlier where if you come up with
(16:00):
something that you'd like to do, and thenthere's all sorts of obstacles in the way.
You said it's really easyto become disillusioned.
And you were talking about howyour advice and your mindset then
has to be, okay in the face ofwhat's going on, what can I do?
What can I accomplish?
So how do you think about theincremental improvements that you can
(16:20):
realistically make, or what are someexamples of things that you have done?
One of the things that I'm really,really proud about is I helped create
a system that my fellow emergencyphysicians, they were actually okay with
it, unlike many other colleagues aroundthe country, they viewed the system as
pretty well designed, and so that forme was that one little thing moving the
(16:43):
ball forward so that we could actuallystart digitizing some of the data that our
system creates in taking care of patients.
And in me helping my colleaguesbe more comfortable with a digital
system, now we've created data.
That data can then informother tools downstream that
can help transform the system.
That's the very first step.
(17:04):
We can't do anythingelse without doing that.
And then another is justcoming up with different ideas.
Some of them may not stick.
So, your podcast with Kenny Cole,within it, he mentioned something
about Metformin and how peoplestop taking Metformin because
of gastrointestinal side effects.
But I know that how that's documentedwithin the system, it's very
(17:26):
different based on who documents itand what system they document it in.
If we could somehow encapsulate thatas a piece of data that's consistent
and reliable across systems or acrossoffices or across practitioners, then
you can start aggregating that and thenbeing able to say, okay, these are the
things that actually predispose somebodywho is on Metformin to stop taking it
(17:49):
because of gastrointestinal side effects.
And then if you can start encapsulatingthat as a digital picture, then you
can actually start putting into place,even something simple as, well we
see based on the data that's in yoursystem that you're predisposed to
having gastrointestinal side effects.
We are going to have somebody call youa week after you start Metformin and
(18:10):
see how you're doing and, and see ifwe can put in some mitigating processes
so that you can stay on Metformin.
But the first step of that isactually encapsulating that as data.
And what I did was I took that podcast,I forwarded on to some people I knew
who are very astute data scientists, andthey have a way to actually encapsulate
(18:30):
that and encode that into something thatis very easily digestible by multiple
systems across multiple organizations.
And that's something thatwould be really valuable.
Now, I'm realistic enough to know thatputting that out there and kicking that
off, that may or may not go anywhere, butI keep trying because that's my makeup.
I wanna try to help move the ballforward and use technology to actually
(18:54):
improve our healthcare system.
And that's the sort of thingthat I keep trying to do.
I'm very inspired by you andthe initiative that you have
when you do stuff like this.
It's another thing, but it also mightbe exactly what is necessary to feel
like a difference is being made.
When you consider how you may helpyour colleagues, like how do I, within
my current role, potentially supportcolleagues who are trying to figure out
(19:17):
how to do right by patients, which manyare, and you give two examples there.
One is in your role at the time, andeverybody's gonna have their own example
of this, but you were tasked withbuilding an ER, IT infrastructure, the
system that you built, aligned withwhat your colleagues' needs are, not
just what somebody dictated from above.
(19:39):
So you took the time to ensure thatthe system that you built was gonna
work for colleagues as well as thehospital system writ large, which I can
definitely see would give a measure ofappreciation and pride, rightfully so.
And then the second part of thisis what do patients really need?
You gave the example of the episode withDr. Kenny Cole from a couple of weeks ago.
(20:01):
He talks about just how many patientsfail on Metformin because they're
actually not taking it properly.
I'm gonna come off as a StaceyRichter fanboy on this, but I'm gonna
quote another episode that you had,I forgot what the exact quote was.
You used the Marcus Aurelius quote.
Something about being happy withthe smallest progress, and I
think that's what we have to do.
(20:22):
Some of us are big names, have biginfluence, have big personalities and
can do big things, Mark Cubanish typethings, but others of us, we have to
be able to be satisfied with doingthe right things that we feel like
we can do and be satisfied with that.
Figure out how to support your colleagues.
You can figure out how to supportpatients in whatever ways.
(20:43):
What's your advice for someone whomight not have the same job as you?
One of the teams that I used to workwith, I would use this metaphor a lot, our
healthcare system, the dysfunction in ourhealthcare system is like this enormous
boulder stuck on the side of a mountain.
Just one person isn't going topush that boulder down the hill,
which is what we need to do.
But what we can do is take the littlepieces of pebbles around that boulder.
(21:06):
If enough of us are taking out enoughof those pebbles, at some point
that boulder is gonna start rocking.
And then once that boulder startsrocking, at some point, somebody
is going to be able to push it.
And then once that boulder startsrolling, it can't be stopped.
Because the things that weneed to do with our healthcare
system all make a ton of sense.
Once that logic takes hold and the thingsthat our patients need align with how we
(21:32):
actually deliver healthcare, then it'sgonna be a force that can't be stopped.
I may be being a little bittoo optimistic, but that's
what I truly firmly believe.
That's a wonderful way to put this.
Exactly like you just said.
If there's a boulder and we each justtake a pebble, then we can really create
change in an organic way, even if it'snot necessarily some kind of formal
(21:55):
collaborational alignment that if eachof us just thinks, what can we do?
What are the simple opportunities?
I think you've called it wherein wecould make even a small difference.
If there's enough people who are thinkingthat way, inevitably change will wind
up happening just because it's almostcreating a zeitgeist of a certain kind.
(22:16):
Yeah, absolutely.
That's a great way to put it.
The other thing, here's anotherword for zeitgeist, a tipping point.
One of the things in that MalcolmGladwell book, if only 12% of
individuals are pushing in a certaindirection, tipping points happen.
It's just, it's amazing how wordtravels ideas spread, especially if
(22:36):
there's enough people who believesomething in their heart of hearts
and want to see something happen.
And I do feel like there's so manyacross the healthcare industry that
realize something's gotta give.
We just need to be able topush back against that system.
And, you know, to use another metaphor,if the current system is a, is a big river
pushing us downstream, as difficult asit sounds, we need to reroute that river
(23:00):
so it points in a different direction.
So one of the things that you saidwas, as we just talked about, Dr.
Kenny Cole, talked about just how manypatients stop taking Metformin because
of avoidable gastrointestinal symptoms.
And that is something thatcould be codified if we A, know
it because we have the data.
But B, we can build somethingto disseminate that information.
(23:23):
But what else?
Give us some bright spots here.
Things that people may contemplate.
So let's say you're a medical assistantin an office and you see the doctor doing
all this labor that you think that youcould do, then maybe suggest, Hey, maybe
we can do this and take the load offyour shoulders, doctor or to the nurse,
and feel like you're contributing more.
(23:44):
It could probably positively impact howyou feel about your being part of the team
and contributing to the patient's care.
Also making the team moreeffective and efficient.
The other thing is to startidentifying places where there are
waste and they're all over the place.
That sort of identification and thereporting and trying to execute on that
(24:06):
sort of observation that's an entireproject altogether, but at least start
maybe taking that and injecting kind ofthat culture of, you know, we shouldn't
be really doing this, or there is adifferent way of approaching this.
Why is that printer way over there20 feet away from the computer when
everybody goes to that printer forevery single patient, as we print stuff
(24:28):
out, little things can add up to a lot.
Those are some great examples thathave just so much packed into them.
One of them is just make asuggestion and it's in a way
a commentary on the healthcaresystem today that even comes up.
We've gotten ourselves into a placewhere we talk about team-based care,
(24:50):
but we have to bring up, if someonesees something that could be improved,
maybe we should talk amongst ourselves.
Yeah.
The unfortunate reality is that there'sa lot of healthcare systems, maybe even
most of them that are very hierarchical.
The doctor or the C-suite administratorsays, We have to do it this way and
people have to kind of march in line.
(25:11):
I think it would benefit ourhealthcare system writ large if
we weren't like that as much.
That if we could actuallyincorporate the sorts of suggestions
or input of the entire team.
And this is almost an organizationalextension of the concept of
team-based care around a particularpatient, but team-based care from
an organizational perspective.
(25:33):
I just wish that a lot of ourhealthcare systems would absolve
themselves of the top down hierarchicalapproach to managing out systems.
Well, here comes Gen Z, and the one thingI've heard about Gen Z is they really
don't like hierarchy very much, but in away, a command and control environment is
somewhat antithetical to team-based care,having teams wherein the team feels afraid
(25:57):
to speak up and make suggestions becausethe hierarchical, you know, like those
that sit above them are gonna lash out.
Like there's a lot of consequences.
Yeah.
It's there.
It's in their best interestto promote that sort of stuff.
So maybe contemplatewhat's the environment?
Is there any influence that you mighthave on the environment that could
(26:19):
enable people who are trying to dothings in a better way or who may
have insight into how to improve?
Can they feel like they can speak up?
That's number one.
Or number two, if you, you seesomething, maybe say something.
And I'm not sure if you have any advicefor, if someone is working in the
hierarchical environment and they do seesomething and they wanna say something, is
(26:40):
there, I was chatting with Anne Richardsonthe other day who had just one example
after another of times when someonebrought up something that was a potential
patient problem or was a patient problem.
And the response of the system wasactually to blame that individual for
the problem, and wow, my heart juststarted to bleed for some of these really
(27:02):
mission-driven people, getting their facessmashed against the wall for daring to
do the right thing on behalf of patients.
Well, that's an entirediscussion altogether.
I mean, whenever I think aboutthis in the recent history, I
consider the Redondo Vaught story.
She's a nurse.
Sedating a patient, I think for anMRI, and there were two medications.
(27:23):
One was Vecuronium, which is aparalytic, and the other one was Versed.
And because both of themstarted with ve, they were close
together in the medication cart.
She was supposed to giveversed to sedate the patient.
She gave vecuronium, whichparalyzed the patient.
The patient died.
She self-reported this mistakeand then she was criminally
prosecuted for doing this.
(27:43):
This was recent, we'll, we'll linkto that in the, um, the show notes.
But this is the sort ofthing that needs to stop.
Yes, tragic, yes, she made a mistake, butI can almost guarantee you that at least
one, probably more nurses almost made thatsame mistake, but they didn't report it.
Phew, that was a near miss.
I'm gonna get on with my day.
(28:05):
Imagine if they had reported that and thenthere were like three or four reports of
that somebody noticed and said, Ooh, thatwould be a really bad mistake to have.
So let's systematically try to create,you know, rearrange the medication cart
or do something so that that sort ofmistake can't happen in the future.
Then that patient wouldn't have died.
That nurse would not befacing a prison term.
(28:27):
Wow.
That is so horrific.
You really have to think throughthe outcome you're trying to create.
Is it to prevent additionaldeaths or punish a nurse who
reported her own mistake?
Because in a way, maybe we have topick one because we can't have both.
So this kind of goes to this largerdiscussion that we're having.
(28:48):
This big system is pushingeverybody in a certain direction.
I can understand how somebody who,say a medical assistant, who sees
something, doesn't wanna speak up.
Or they don't feel empowered to contributeto the team, and I hope that people
start doing that a little bit more.
So if we're thinking about constructingour pieces of advice here, the
(29:10):
first piece that we talked aboutwas really contemplative of what do
patients need, what's gonna help.
Second one is, how doyou support colleagues.
Thinking about both of these two thingssimultaneously, you had mentioned waste.
Where is there waste within the systemthat could negatively impact patient care?
Example of this, there's lots of peoplenot in exam rooms because they're
(29:34):
walking around trying to get printouts.
Time is a zero sum situation.
So it's certainly a win-win.
In order to achieve either oneof those two aims, it does take
trying to figure out how to buildan environment that people bring up
suggestions to continuously improve.
The other piece of this though is thatyou also have to acknowledge that you
(29:57):
can't do everything and that thereare certain capacity constraints.
Even if you say, suggest that you movethat printer, you may not necessarily
realize that IT has to come by and theyhave to rewire all the cables and then
they have to remap the printer to, it'ssomething that seems simple, often isn't
simple, and so I think as somebody who'strying to do stuff like this, you also
(30:20):
have to accept the fact that there arecertain limitations on what you can do.
There are capacity constraints.
And then not necessarilyget frustrated about it.
It may be a lot of steps for someindividuals, but it's closer for others.
So there's this compromise situation.
One of the things we talked about,team-based care, being a part of this
(30:42):
and doing things to really support andemphasize the team in the team based care.
So not getting frustrated by that,the, what's that African proverb?
If you wanna go fast, go alone.
If, if you wanna go far, go together.
So the going far togetheris always gonna take longer.
But the other one that you had mentionedwas the whole idea of moving this
(31:04):
whole transformation thing forward.
It's bigger than a boulder, right?
It's probably planet sized.
So we each have to just be happywith what we actually can accomplish.
Like we can't let perfect be the enemyof the good and mental health and
just our motivation to keep doing whatwe're doing on behalf of patients.
(31:26):
Let's really feel good about the pebblesthat we have pulled out and fixed.
Yes, absolutely.
Otherwise, you'll just get frustrated.
I do feel like in, in a lot ofenvironments, it's the really
good motivated people who arethe ones that wind up leaving.
I feel like this is a really importantconversation to have because it's exactly
those individuals, you know, the onesthat are listening to this show that we
(31:48):
really need to continue to inspire andbe inspired in the face of all these
contrary forces and just B.S. Becauseit's this crew that's gonna transform
healthcare if anybody's gonna do it.
Well, and I think also one of the thingsthat, uh, that just came to mind is it
is really helpful to have like-mindedindividuals to be able to be sounding
boards for other like-minded individuals.
(32:10):
One of the things that I would love foryou to do is create some sort of mechanism
for people to connect and communicate witheach other who are of like mind, so that
I don't feel like I am the only RelentlessHealth Value person in my organization.
There may be some others.
I've certainly encountered others who havein some of the work that I do around the
(32:30):
country, I mentioned your podcast and theysaid, oh yeah, I love talking to Stacey.
And then that creates almost kindof an instant bond that, yeah, we
know what we want to try to do andwe know that we're both frustrated.
And we also know that if we get toofrustrated, we can count on each
other to talk us off the cliff.
That's such a lovely way to put it.
And it really just emphasizesthe importance of community.
(32:53):
Just to have that kind of releasevalve, which could be a conversation
with a colleague either nearor far, who is trying to push
that same boulder down the hill.
Feeling alone is so hard.
It takes a village and we all haveto work together and figure out
how we are supporting each other.
And maybe that's something that thoseof you who are listening to the show can
(33:14):
really keep in mind and think about howon somebody's worst day if we are there
and able to say, good on you, keep it up.
You're amazing.
That really matters.
So maybe as our last piece of advicehere, there's, it's a commitment to
support each other and to keep our eyesopen for those who are trying to do
(33:38):
better, do right, fix something to justoffer them a measure of our heartfelt
support and thanks and appreciation.
Because that actually maybe makeall the difference in the world.
Yeah, absolutely.
And be able to have some sort of privatemechanism to do that, because a lot
of times you're hesitant to do thisin like a public forum, but if you
(34:00):
have some degree of familiarity andtrust with somebody who thinks along
the same lines as you and being ableto pick up the phone or text them, I
think that that will go a long way.
I couldn't agree more.
I mean, there's plenty of timeswhere I'm about ready to throw in the
towel any day of the week and someonejust comes outta the blue and says,
thank you, or much appreciation, or,this was really meaningful to me.
(34:20):
I can tell you just personallyhow much that really matters.
Dr. John Lee, is there anything that youwanted to mention that you didn't have
a chance to in the conversation today?
Be happy in the small things.
Have conviction in the thingsthat you think you wanna do
is right, that it is right.
Keep plugging away.
It may not turn around all at once.
(34:41):
You may not be that person whopushes that boulder down the hill.
But be happy that you may have contributedto taking one of those pebbles out.
Here, here.
If someone's interested inlearning more about your work,
where would you direct them?
LinkedIn.
It's probably the easiestplace to connect with me.
Dr. John Lee, thank you so much forbeing on Relentless Health Value today.
Thank you.
This is Dr. Scott Conard from ConvergingHealth, encouraging everyone to
(35:04):
listen to Relentless Health Value.
Stacey, I listen to your show every week.
I can't wait for it to come out.
Both because I lovethe people you have on.
They're brave, courageous peoplewho are willing to speak out,
and that is really challengingin today's political environment.
And, two, what I learned, andI always learned something.
And what comes to me as I listen tothis is who can I share this with?
(35:26):
And so I will send the RelentlessHealth Value link, text it to
people and email it to people.
And it's amazing to me how people listen.
They get turned onto you andthey change the way they're
designing their health benefits.
They're reviewing their contracts,they're getting their PBMs contracts,
and it is so exciting to be ableto have you in the world doing that
(35:49):
because I don't know of anybody elsethat has the wisdom and the vision
that you're putting forth and bringingbig people that you are on your show.
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