August 28, 2025 • 45 mins
Dr. Lawrence Yang's powerful story begins with a stark confession: "My body had to say no for me because I didn't know how to do it myself." This candid admission sets the tone for a conversation that weaves together personal vulnerability, system transformation, and the science of hope.
As a family physician who once installed a bedroom and shower in his clinic to work longer hours, Dr. Yang's burnout journey will resonate with healthcare professionals everywhere. His turning point came through an unexpected avenue—quality improvement science—which provided both methodology and community when he needed it most. "I think quality improvement science is a science of hope," he explains, revealing how structured approaches to system problems can alleviate the moral distress that accompanies witnessing poor care experiences repeatedly.
The conversation explores British Columbia's innovative Physician Quality Improvement program, which has trained nearly 800 physicians through a unique collaboration between government and clinicians. This "silent army" represents tremendous potential for healthcare transformation, demonstrating what's possible when improvement capacity is intentionally built at scale. Dr. Yang artfully distinguishes between moral injury, moral distress, and burnout, while explaining how joy in work requires leaders to facilitate safety, purpose, autonomy, community, fairness, and recognition.
Looking toward 2030, Dr. Yang envisions primary care transformation through honest quality assessment, team-based models enabling everyone to work at top-of-scope, and transparent metrics aligned with the "sextuple aim." His advice to new clinicians cuts through professional martyrdom culture with refreshing clarity: "The system will not benefit from your martyrdom. What's in your job description is to model sustainability and wellness for your patients, colleagues, and family members."
This conversation isn't just about surviving in healthcare—it's about finding the courage to bring our full selves to the work we care about, and in doing so, creating the conditions for healthcare transformation. What might be possible if we approached system change with both vulnerability and courage? Dr. Yang's journey suggests the answer could be revolutionary.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Lawrence (00:00):
My body actually had to say no for me because I
didn't know how to do it myself.
Every person who goes to workis actually on a gradient
towards unwellness.
I think quality improvementscience is a science of hope.
Jason (00:14):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C-suite.
I'm your host, Jason Meadows.
Today's guest is someone whoseenergy and authenticity I deeply
(00:39):
admire.
Dr Lawrence Yang is a familyphysician in Surrey, British
Columbia, and while he's heldleadership roles and done
incredible work in data andquality and systems change, what
really stands out aboutLawrence is how openly and
courageously he's talked aboutburnout.
He's taken something that somany physicians quietly struggle
with and turned it into amission, not just to survive the
(01:02):
system but to help change it.
He's been leading wellness andleadership workshops across
Canada and recently brought thatwork to the Institute for
Healthcare Improvement AnnualForum, which tells you something
about how widely this messageis resonating.
This conversation is about joyand work, but more importantly,
it's about what happens whenwe're brave enough to bring our
(01:23):
full selves, even the painfulparts, to the work we care about
.
I'm grateful to have Lawrencehere to share his story.
Dr Lawrence Yang, welcome tothe podcast.
Lawrence (01:34):
Thanks so much, jason.
It's a pleasure to be here.
I'm excited for your podcastand I'm excited to be here.
Jason (01:42):
Well, thanks so much.
I'll jump right into yourorigin and your background
because I'm really excited here.
Well, thanks so much.
You know I'll jump right intoyour origin and your background
because I'm really excited.
Even though we've known eachother full disclosure for a few
years, with social mediaconnection, with meeting every
year at the IHI I think there'sa lot we can delve into about
you, and so I'd like to do thatright now if I could.
One thing that might be a goodplace to start is you've had
(02:04):
this experience that is anincreasingly common experience
in Canada these days, which ishaving studied and worked in
medicine in both the US andCanada, and I wonder how this
shapes your view of primary caresystems and the work that you
do.
Lawrence (02:21):
Yeah, thank you.
So yeah, I did my residency atWill Cornell Medical College in
Brooklyn, new York, and afterthat I practiced in Long Island,
new York, in the urgent caresetting.
So during my residency I hadexperience of an inner city
family medicine clinic.
I followed and learned frompreceptors and mentors who
worked both in the clinic aswell as in the hospital seeing
(02:43):
their own patients who areadmitted into the city hospital.
I remember working with thechallenges of billing different
insurers and the challenges ofgetting funding as a clinician
for the clinical work that wedid.
That's very different in Canada, where we have pretty much a
single payer, and so, aside fromthat, those are really the main
(03:07):
differences that I've noticed.
I think both US and Canadasuffer from a shortage of human
resources right now shortage ofphysicians, some challenges with
funding and forming adequateteams for primary care I think
these are common challenges.
Burnout in healthcare workersthose are common challenges.
So the funding is different inthe systems, but a lot of the
(03:32):
big challenges we face are verysimilar.
Jason (03:35):
Yeah, it's such a valuable perspective and it
really is humbling, isn't it, tosee that both sides struggle
perhaps a little differently,but with similar challenges, and
I appreciate that perspective.
Struggle perhaps a littledifferently, but with similar
challenges, and I appreciatethat perspective.
Fast forwarding a bit, I'mcurious what drew you to quality
improvement rather thanfocusing entirely on clinical
(03:56):
practice?
Lawrence (03:58):
Well, I kind of happened upon quality
improvement science accidentally.
I was someone who was reallydevoted to running my own
practice, being theowner-operator of a clinic in
inner city, metro, urban,greater Vancouver, in a city
called Surrey that you mentioned, surrey, british Columbia and I
(04:19):
burnt out.
I burnt out really quicklybecause I was managing and
juggling all the businessaspects, my human resources.
I was my human resourcesdepartment because I was
managing and juggling all thebusiness aspects.
I was my human resourcesdepartment.
I was my leaseholder for myclinic.
I was the person who was makingsure there was nothing
dangerous in my parking lot,while also trying to manage a
full panel of over 2,000patients with many complex
(04:42):
challenges, including mentalhealth challenges, addictions,
chronic disease and manycomorbid diseases.
And the only thing I knew howto do was work harder and do
more, spend more time in theclinic.
I got to the place where Iactually put a bedroom into my
clinic.
I hired a handyman to install ashower in my clinic so that I
(05:05):
could spend more time in myclinic, because all I knew how
to do was do more and, of course, I burnt out.
I burnt out probably within thefirst three years of my career,
from 2010 to 2013.
And when I say I came acrossquality improvement by accident,
what I meant is that I startedto try to grow my circle.
Having done training in theStates and then practicing in
(05:29):
Canada, I didn't really have allof the relationships that
really make referral networkawareness easier, so sometimes I
really felt that I was workingin a silo as a family
practitioner.
So as I tried to heal myselffrom burnout, I realized that
growing my circle was a reallyimportant change idea and so I
started to grow my circle, andin that circle was the CEO of my
(05:53):
health authority.
In British Columbia we haveabout six different health
authorities and at the timeFraser Health was led by a CEO
named Michael Marshbank and Iwent up to him at one point
because I was working in thehospital the hospital that I
admitted my patients from myclinic to and I said my patients
are having a lot of challengingexperiences at the hospital.
You know they're notexperiencing trauma-informed
(06:15):
care.
I do my best in my clinic toprovide that trauma-informed
care, but when they get to thehospital it doesn't seem to
exist.
It's like there's no capacityfor caring.
And then michael said you know,this sounds like a problem.
And it sounds like you reallycare about patient experiences,
and I said, yes, I do.
And then he said, well, in 2016they started this program
(06:37):
called physician qi, pqi, andphysician qi was a project that
was started by an anesthetistand a cardiologist.
The cardiologist has sincepassed away from health issues,
but the anesthetist is Dr KurtSmetcher, who I think you might
have met before at IHI Forum,and what he did is he took he
(06:57):
became aware of the Institute ofHealthcare Improvements advisor
program QI advisor program andhe took a lot of that advisor
program QI advisor program andhe took a lot of that, the
curriculum, and he modified itfor a Canadian context and then
he he brought that in anddeveloped some mentorship and
facilitation training for some,for folks like myself.
(07:18):
So I was taught by Kurt's metyou're in around 2016, 2017, and
then I became a faculty of thatprogram and and it was just
because I struck up thatconversation with my CEO at the
time of my health authority andhe pointed me in that direction,
saying that these intrepidphysicians were already, who
also cared about quality qualityof care, had started a program,
(07:40):
and so I started learning inthat program and I spent over
maybe 200 hours in learningaction projects in classroom
settings, just learning thescience of improvement and
practicing on my own projects.
And then I became a facultymember of that program and I
still teach there today.
(08:01):
So that started in 2017.
And here we are in 2025.
I'm eight years into thisquality improvement, teaching
and spreading and workshopfacilitation, and it's very
meaningful work.
I'm really, really stoked thatI'm part of it.
Jason (08:20):
I mean thank you so much for sharing that.
I feel like there's a lot ofpower in that narrative that you
just shared.
It sounds like you were one ofthe early cohorts, perhaps, of
this PQI program and that it'sreally changed the trajectory of
your career and also perhapswas part of this awakening out
of the burnout that youdescribed.
Lawrence (08:41):
Absolutely yeah.
So, coming out of burnout,there really aren't too many
supports in British Columbia andprobably other jurisdictions as
well.
So, quality improvement,learning in a cohort, setting
along with other clinicians ofdifferent backgrounds, that in
itself, that building of thatcircle of support, that sense of
(09:03):
community, was actually really,really healing.
And at the same time you're allaligned in shared values around
excellent human experiences inhealthcare as well as a hope and
an optimism for improvedprocesses and especially for
(09:24):
resource stewardship.
One of the greatest impetusesfor I don't know if that's a
word, but one of the things thatsparked off the Physician QI
program was a sense that there'swaste going on in our system,
that there's a lot of peopledoing a lot of different things
but they're not following acommon methodology and they're
(09:45):
trying a lot of things butthey're not following a common
methodology and they're trying alot of things but it's not
really sticking.
So dr Kurt Smetcher and dr Jancorner, the late physician, dr
Jan quarter, they knew thatthere are, there was a science
to improvement and they broughtthat to our province through the
Institute of HealthcareImprovement.
And, yeah, it gives you, givesone, a lot of hope.
(10:05):
A lot of times when people areburnt out, it's because of the
distress of seeing poor humanexperiences happen over and over
again.
And when I got into healthcareand like when you got into
healthcare, we got into itbecause we wanted people to have
great experiences.
We want to be proud of theexperiences that were a part of
delivering for our patients inour service.
(10:26):
But when that doesn't happenover and over again, we
accumulate a moral distress andin some cases it's almost akin
to vicarious trauma watchingother people fall through the
cracks of the system.
It's a traumatic experience forsome of us and that accumulated
distress sometimes manifests asburnout and when sometimes the
(10:48):
most healing thing is to takeaction in the other way to
redesign systems, to be morehumanistic, to redesign systems
for better health outcomes andto reduce waste in the system.
Just knowing that you can dosomething is a very powerful
healing experience, andespecially when you're doing it
with new friends, people whoshare your vision, but they have
(11:11):
other talents, they have otherclinical foci, they have other
resources that they're bringingto the fore and the chance to
align some of these resourcesjust in that kind of pure
mission of improving things forhumans.
It's a very gratifying and ahealing experience.
Jason (11:32):
It sounds like the unexpected experience within the
educational experience of QIfor you was a therapeutic one.
It was one where you discoveredthat people who wanted to learn
improvement science also foughtwith difficult problems,
problems which they maybe foundwere intractable and that were
(11:52):
bigger than them.
Lawrence (11:54):
Absolutely.
I think a common realization, acommon finding looking
retrospectively back over thepast eight years, is that I
would say at least 90% of thosewho have found themselves and
devoted their their time intolearning quality improvement in
our program the physicianquality improvement program they
(12:15):
expressed that they haveexperienced symptoms of burnout
in the past and so much of itwas related to a sense of
hopelessness in the face of verycomplex challenges and complex
problems where they didn'treally have a clear roadmap on
how to make those next steps andfor them, the science of
(12:35):
improvement, the methodologiesof improvement, the model for
improvement, all helped to be aremedy for some of that
ambiguity and hopelessness.
Yeah, I think qualityimprovement science is a science
of hope.
Jason (12:50):
Wow, that might be the quote for the day.
That's really powerful, andthanks for sharing that.
I like to shift a little bit tothe current work that you're
doing and where that's takingyou.
You've mentioned PQI, so thePhysician Quality Improvement
Program based out of BritishColumbia, to my understanding
(13:12):
and I could be mistaken aboutthis, but my understanding is
that this may in fact be uniqueas a province-wide quality
improvement training programwithin Canada.
I'm not aware of any suchprogram in the States or in
Canada.
What makes this model soeffective?
Lawrence (13:33):
and why don't we see it in other provinces?
Do you think?
I think the secret sauce tophysician QI in British Columbia
was really what we call thejoint collaborative committees.
Joint collaborative committeesare committees of physicians and
health ministry representatives, so government and physicians
sitting together at a table andagreeing that we needed a way
(13:56):
forward, and over 10 years agothey committed millions of
dollars to paying physicians tocover their overhead from their
clinical practices, while theytook time out of their practices
to learn the science ofimprovement.
That is the secret sauce.
(14:16):
Other practices to learn thescience of improvement that is
the secret sauce.
The advocacy that went into this, to allocating this public
funding to this huge endeavor ofcreating capacity in the system
for health system leadership inthe form of skilled physicians
who are skilled in qualityimprovement.
That is at the crux of whatmade this possible.
(14:40):
Now you mentioned it beingsuccessful.
It's successful in that we havemany alumni.
We have probably almost 800alumni within British Columbia,
which is a fantastic number.
But in terms of actual impactsin the system, we haven't
effectively really measuredthose quintuple aim or even the
(15:02):
sextuple aim impacts yet.
But that's ongoing work rightnow.
We've been really focused in thepast 10 years on building
capacity, building people withthe skills of a QI advisor and a
clinician background, so wekind of have a latent army
that's really ready to tacklesome of the health system's
(15:22):
greatest challenges.
And yeah, that advocacy forthis possibility of this
physician activation was a keypart of that.
Historically, physicians havebeen seen as being full of
counter will.
It's kind of like the healthministry, the politicians, are
(15:44):
trying to do something andphysicians would often come in
opposition of those becausethere was not a shared
understanding of shared values.
And this is a very rareoccasion where physicians and
health ministry have both agreedwe need to use science when we
approach health system redesign.
So that's what really makesthis unique.
Jason (16:02):
Wow, I mean it sounds like a great problem to have
that we're even having theconversation about.
We haven't yet measuredquintuple aim impacts of this,
because it means that you'vecome far enough to be able to
have educated this huge as yousaid, I think a silent army of
clinicians who, you know, cameinto it from different
(16:26):
backgrounds and differentspecialties, um, but are united
in having done this.
I mean, I think that's it'struly remarkable and I think a
lot of people listening would be, uh, would be envious of having
the problem of having thesilent army that you're just
trying to figure out a littlemore what to do with or how to
measure the broader impacts ofthat.
(16:47):
So I think that's reallyspecial.
I wanted to shift towardssomething which I think has
become, you know, one of thebiggest focuses for you, which
is your work on joy and work andyour the experiences you've had
with burnout that you've sharedso candidly and so bravely and
I really appreciate.
There was a quote that wentsomething like this that I
(17:09):
encountered when I was takingthe school for change agents out
of the NHS in England, and thisis an online course.
It's it's freely available.
I'm not involved with them, butI was really impressed with
what they did, so free plug forthem.
The quote went something likethis there was a comic of a man
looking a bit uncertain standingon a desert island and it said
(17:31):
people aren't willing to setsail on an adventure if they
don't feel secure on land.
And this was intended to be ametaphor of the kind of the
burnout, the joy and work, thepsychological safety spectrum
with QI which really can beventuring into new territory and
(17:53):
maybe feeling a little insecureabout that.
I'm curious how you think aboutthe joy and work and QI
intersection.
Lawrence (18:02):
Yeah, thank you.
It's a little bit of a chickenor the egg thing.
I think that unless apractitioner has some extra
cognitive capacity that they'vereserved in their lives extra
cognitive capacity, extraempathic capacity unless you
reserve some, it's actually verychallenging to jump into
(18:23):
quality improvement learning,because it's a new skill set,
it's a new muscle, it's a newneurological muscle that you're
using.
I know that's not scientific,but I think you know what I mean
.
It's figuratively, but yeah,you kind of have to be well at a
certain threshold in order tolearn quality improvement
effectively and to be aneffective change agent.
(18:43):
You also need to have a certainreserve of wellness.
But that being said, those whodo have that reserve of wellness
, we have that opportunity tolead from wherever we are and to
shift how we're being, suchthat we shift culture to be a
healthier culture.
The School for Change Agentsreally taught me things about
(19:06):
what a change agent does.
A change agent thinks ininterdependent ways rather than
individualistic ways.
They're unreasonably optimisticthat's what a change agent is
but they are grounded inscientific and honest data
(19:28):
analyses.
So these are some of thosethings that really resonate with
me when you talk about jointwork.
When I did the joint worktraining out of the IHI, and the
IHI has a free white paper foranybody who's listening.
You can download the whitepaper for joint work.
Some of the really key thingsthat leaders need to facilitate
in their clinic teams, in theirhospital teams, is a sense of
(19:51):
safety physical andpsychological safety.
A connection to purpose, sofeedback loops about how their
efforts are actually resultingin improvement.
A sense of autonomy, so reallysupporting your teams to engage
in improvement of theirworkplaces, so QI on their
workplaces.
A sense of community,facilitating connections that
(20:14):
could just be at the beginningof your meeting having people
share things.
They're grateful for somethingthat really brings out that
human side and speaks to thevalues of the people on your
team.
A sense of fairness, andsometimes fairness looks like
people being recognized for thecontributions they've put in.
Sometimes fairness means, ifsomebody's violating the
(20:34):
precepts of a compassionateculture, that it's addressed
quickly and in a way that'srespectful to everybody,
something that restores justicein the team.
So that is really in a cap in aminute or two, what joy and work
is.
It's something that leadershave to facilitate and leaders
(20:57):
need to first prioritize theirown wellness in order to
facilitate this type of joyfulwork culture.
A lot of people hear the wordjoy and work and then they're
triggered into cynicism becausejoy feels so far away.
But I believe it was Dr DonBerwick who once said that we
(21:19):
were all created for joy, thejoy is actually our default and
that there's stuff, there's abunch of crap that's covering it
up and not allowing the joy tocome out.
And so when I look at oursystem and look at the humans in
our system, I look at it froman asset-based lens and I see
that there's joy that's reallytrying to bubble up, that's
(21:41):
trying to come out, and we haveto just use some team-based
quality improvementmethodologies to uncover that
joy.
And that's how I approach joyand work.
Jason (21:51):
So it sounds like you view joy and work and QI as
interdependent, as synergistic,not necessarily that one depends
purely on the other, that youneed to have joy and work before
you do QI, or vice versa.
Did I get that right?
Lawrence (22:11):
Yeah, has many moving parts.
It's a complex, adaptivereality where each of us will
have energy that that ebbs andflows, and in those days when
the energy is higher, we canbring more joy and work.
We can bring more joy to ourcolleagues, we can facilitate
more connections, more fairness,more sense of purpose and and
(22:34):
some days we can't.
And so each of us has a role togrow in our own self-awareness.
How we're showing up in work,because how we show up, which is
how we lead, how we're being,is actually what, through the
principle of emotional contagion, it's what sets the climate for
all of the QI work that we'retrying to do, all the health
(22:55):
care service work that we'retrying to do, all the healthcare
service work that we're tryingto do.
So joint work is a strategythat appreciates the assets in
the system and that those assetscan eventually coalesce and
rise up to create virtuouscycles of compassion.
(23:16):
Less and rise up to create avirtuous cycles of compassion
and instead of the viciouscycles of burnout, that we are
so commonly seeing.
Jason (23:22):
Now I wonder if it's worthwhile to disentangle and
kind of create some spacebetween a few terms that you've
either mentioned or that arekind of implied in the
discussion earlier you mentionedwitnessing poor care
experiences over and over, andI'm reminded of a video I
actually saw of you.
You posted last month.
It was a talk on this exacttopic, and you're kind of
(23:46):
alluding to the idea of moralinjury here.
I wonder what you can tell meabout the terms moral injury
versus burnout, versus joy andwork, where the latter term
might be a lot newer or maybeeven brand new to some of our
listeners.
Lawrence (24:18):
I believe it would be sociologists were studying the
psychological burdens and traumathat existed in in citizens who
had fought in wars, and I thinkmoral injury is distinctively
described as when one has takenaction in a knowing way,
voluntarily, which caused harmto another human, and the injury
(24:43):
that results in oneself fromhaving caused harm to another
human.
I think that's what reallydistinguishes moral injury from
moral distress.
In distress there's a distressbecause we have an idealized
vision of what a humanexperience ought to be, but
(25:05):
there are system factors whichprevent that ideal future from
actualizing and we watch otherhumans go through suffering due
to these system factors.
So I distinguish moral injuryfrom moral distress in that way.
I personally do.
(25:25):
I don't know if that's a sharedunderstanding by by any, by
anyone.
The other term, burnout burnoutis a is a syndrome where
exhaustion uh is is part of it,depersonalization is part of it,
where we kind of have lessempathy.
Depersonalization for me is is,that is where we've run out of
(25:49):
empathy in our own empathicreserves.
We haven't preserved anyempathy so we don't have much
else to give and and so wedepersonalize our interactions.
Things become moretransactional.
If someone complains to us,we're like not my problem bye
those types of things,depersonalization, and there's
also a sense of inefficacy,burnout you have a persistent
(26:12):
sense that you're not doing agood job.
Sense that you're not doing agood job.
Some burnout cases also have asense of dread when
contemplating going back to work.
So those are some of thedistinct elements of burnout.
Joy in Work is an idealizedsummary of what has been seen as
(26:35):
a bright spot inhigh-performing health systems,
where leaders have intentionallytaken a scientific approach to
making workplaces more well,more conducive to wellness
rather than conducive todistress.
We have so many health systemsright now that, just because of
(26:57):
how culture is designed and howworkflow processes are poorly
designed, it's every person whogoes to work is actually on a
gradient towards unwellness.
That's a reality for a lot ofhealthcare, because of being
short-staffed, because of thelack of a learning system, where
(27:17):
the same problem impacts theworker every day and becomes an
agonizing frustration that justwears on them day by day.
A system that does not learn isa system that's conducive to
distress.
A system that has a vacuum ofleadership is a system that's
conducive to distress.
(27:38):
A system that has nointentionality towards wellness
for the workers is a systemthat's conducive to distress and
joy in work is describing asystem where safety, purpose,
autonomy, community fairness,recognition those are
intentionally focused on.
(27:58):
That's what joy and work is and, like you said, that's not
commonly discussed but it's inthe literature, it's in the
white paper, there are courseson it, so I encourage everybody
to take them.
Jason (28:09):
Yeah, and I mean thank you so much for kind of clearing
that up, because those are suchimportant terms and how we
distinguish them, how we talkabout them.
You know I had a mentor in mypalliative care journey who
would always say language drivesthought, and so how we use
these terms really does help usto drive how we think and how we
(28:30):
go about making change.
So thanks for that.
You know this kind of youmentioned courses and workshops.
I mean, at the outset Imentioned that you're running
these amazing workshops topromote all of these important
ideas, and you've been now askedto do this all around Canada.
Sounds like you're in reallyhigh demand.
One of the big focuses I want tohave for this podcast this
(28:54):
being our first episode ishighlighting concrete steps that
people have taken in theirleadership journey.
I think that's an area where,within this quality improvement
world whether it's you know, youread a journal article and you
can't quite tell what they did,or it's someone who's achieved
success in running workshopslike you have you want to get,
(29:17):
you want to dive a little deeperand you want to kind of
understand what did this persondo?
What's the special sauce forthem?
And so I'm curious how you gotstarted with running these
workshops and how have you madeit grow.
Lawrence (29:30):
Thanks, jason.
Interesting question.
No one's ever asked me thisbefore, but as you were talking,
I came up with some ideas.
I want to shout out to HelenBevan and her team at NHS
Horizons for the School forChange Agents, which you already
mentioned, jason.
What a transformativeexperience, and the fact that it
was free is ridiculous.
(29:52):
So School for Change changeagents was definitely a
transformative experience for me.
Another thing that would beaccessible for anybody in Canada
would be accessible, meaningyou can pay for it is the QI
coaching certificate out of theInstitute of Healthcare
Improvement.
It's mostly distance learningnow.
It's not cheap, but I foundthat really effective.
(30:16):
William Edwards Deming, who isone of the great originators of
quality improvement science inthe manufacturing and in the
health sphere, he said that aleader is a coach, not a judge,
and so the QI coachingcertificate teaches you coaching
principles as well.
It ensures that you havequality improvement methodology
(30:37):
in your tool belt.
So the QI coaching certificateteaches you coaching principles
as well.
It ensures that you havequality improvement methodology
in your tool belt as well.
So things like how to do a goodaim statement, how to do a
driver diagram, how to do afamily of metrics, how to do
project charter, how to doethics evaluation, how to do
ethics evaluation, how do you doa force field analysis, a cause
(31:00):
and effect diagram, a treediagram.
So they combine qualityimprovement tools with quality
improvement coaching approaches.
And if you want to lead qualityimprovement, if you want to
lead systems redesign, I thinkthat QI coaching certificate is
(31:20):
very very valid.
Yeah, yeah there's, I think, forleadership itself, just how one
leads themselves.
There are so many differentoptions out there.
Which one was most impactfulfor me?
You know what Studying joy andwork is a leadership?
It's a leadership program.
(31:41):
The Institute of HealthcareImprovement has its Leading for
Well-Being course, which kind ofincorporates some of leadership
principles as well as the joyand work stuff in it.
As well as the joy and workstuff in it.
The King's Fund out of Londonalso has a compassionate
leadership training and I foundthat really enlightening.
(32:06):
You know.
It validated a lot of thoseapproaches that I would take,
naturally, and so I think Imight leave it at that.
There's the School for ChangeAgents, there's QI Coaching
Certificate, leading forWellbeing and the King's Fund's
Compassionate Leadership, whichtalk about compassionate
(32:26):
leadership.
Michael West is one of theirheads of thought leadership at
the King's Fund and his40-minute keynote that he did
for us in British Columbiareally shaped a lot of my
approach for leadership, and Imention these because they're
(32:48):
available online.
There are some experiences thatI had that might be British
Columbia-centric which I'm goingto leave off right now.
Jason (32:58):
Yeah, fair enough, and thanks for sharing that.
I mean, that's that is a richlist of resources.
I'm curious when you're nowbeing asked to to go across the
country and run workshops andyou're being asked to the IHI to
to run workshops, what kind offeedback are you getting from
people?
There must be people havingsome really transformative
(33:20):
moments and I'm curious whatstories you're hearing.
Lawrence (33:24):
Yeah, and I want to be clear here, I put an abstract
in along with some colleaguesChristina Krauss, who's the CEO
of Health Quality BC, which isour health ministry's quality
arm, and also Dr Hussain Kanji,who's a leader in the intensive
care and ECMO space.
The three of us partnered andput in an abstract.
(33:47):
We weren't necessarilyrecruited to present at these
workshops but, yeah, we did athree hour workshop and, you're
right, we did get I believe itwas a transformative experiences
.
Within those three hours.
We were able to give peopletime to really reflect on self.
How are people managing theirown empathy?
(34:10):
Were they preserving theirempathy so that they had enough
to apply in the places thatmattered to them?
And that's often self,self-empathy, self-compassion,
family, family compassion,friends compassion, workplace,
team compassion, and then youcan go to community and systems
(34:30):
leadership.
We really gave time for peopleto, in those three hours, to
grow an awareness of some oftheir inner narratives that
might be driving them tooverextending themselves, which
is conducive to burnout anddistress, and to reflect on some
of the narratives that theymight choose instead so that
(34:52):
they can have a more sustainablework life.
And so we really went from selfto team leadership to systems
leadership in those three hours.
And yeah, the feedback isfantastic.
I've posted it onto my LinkedInand you can find me at Lawrence
Yang on LinkedIn and I'veposted some of the feedback
survey reports on there.
(35:13):
I like to do that because it'skind of like a closed loop.
You come to my sessions andthen you wonder what other
people thought survey reports onthere.
I like to do that because it'skind of like a closed loop.
You come to my sessions andthen you wonder what other
people thought about the sessionand they just look at my
LinkedIn and it's free.
You can see the feedback loopof how it went.
Jason (35:26):
And that's feedback for me.
Lawrence (35:28):
But it's also feedback for anybody else who's
interested.
Jason (35:31):
You're running PDSA cycles all the time, even with
your own workshops.
Lawrence (35:36):
That's right, and you had mentioned, you had asked me
earlier what are those keyleadership things that I learned
.
I think social media is reallyhow I've gotten my voice out
there.
I think it's a part of how youand I, jason, have connected.
But it's also how I'veconnected a little bit with
Helen Bevan, a little bit withAmar Shah you know these quality
(36:00):
improvement leaders around theworld and Doug Eby out of NUCCA,
a system of care.
So social media has been, I'veused it.
Social media can be a lot ofthings.
It can be a lot of bad andnegative things, but when in the
hands of people who really justcare about community, it can be
very powerful, as you know, andso, as a leader right now in
(36:22):
healthcare spaces, whereadvocacy and the necessity of
leaning into politics reallymatters, the use of social media
effectively, I think, is a keyskill for change agents.
Jason (36:36):
Yeah, well, if anyone uses it well, well, and people
should check out your socials,which we'll we'll kind of
include at the end.
But if, if, if you use it well,and you certainly do, that's
you know, I've seen the powerthat you, that you've kind of
extracted from that and I'mcurious, you know, as we think
forward, we've talked a littlebit about about your work in
(36:57):
work in physician qualityimprovement, pqi, in British
Columbia, and we've talked aboutthe workshops that you run.
What does five years from now,if we think 2030, in Canadian
primary care?
You can limit that to BritishColumbia or to the whole country
, if you like.
What's different?
Because we finally, quoteunquote, got QI right.
Lawrence (37:21):
We've all drank the Kool-Aid the QI Kool-Aid yeah.
My hope is that family doctorsreally lean into both
vulnerability and courageousness, and what that means is that we
become honest with the level ofquality that we're delivering
(37:42):
our patients and the level ofquality that we're allowing
ourselves to experience in thecourse of giving care.
Why I say that is that if we'rehonest about how we're
delivering quality and we'rehonest about how we're
experiencing life at work,change will become a necessity.
(38:02):
We will have to move out of ourcomfort zones of potentially
lower quality and high volumepractices to team-based care.
I think team-based care is theonly way that we can get to the
quality that we need tosustainably.
We can no longer work in silosjust a physician, maybe two
(38:23):
physicians and two MOAs.
We need to have co-locatedskilled team members that we can
delegate to who are doing ourcounseling, who are doing our
social work, who are doing sothat we can all work at the top
of our scopes.
Because there's just not enoughphysicians in Canada to deliver
the care that needs to be done,because Canadian physicians are
(38:45):
doing things they don't need tobe doing, that are not at the
top of their scope.
That slows them down.
We need to figure out a waywhere physician owners can
actually, in a reasonablefinancial arrangement, have
co-located skilled workers,skilled team members, to deliver
(39:05):
care.
And we have to become morecourageous about sharing some of
the metrics that reflect thesextuple aim in our work.
When I say sextuple aim, I meanhealth outcomes, patient
experiences, health providerexperiences.
I mean resource stewardship howare we stewarding the resources
(39:29):
?
I mean advancing equity and Imean planetary health health.
So developing metrics anddashboards around around these,
these important aims in qualityimprovement and making sure that
, even though I my main job thatI was trained for is just
(39:51):
delivering care, that I'm doingit in a way that produces
lasting, positive impacts on thecommunity rather than just
throughput, and a lot of thatlies in the hands of system
leaders system leaders, who haveto be courageous enough to make
big changes based on and in adata-informed way, rather than
(40:15):
based on.
I think this is what we shoulddo.
I think this is like there is,there's a methodology to how
change can happen in a datainformed way.
So that's my hope for 2030 thatwe move closer to data
transparency in how public fundsare spent in the course of
(40:35):
delivering health care and thatwe really value the human
experiences and, like I said,the sex double aim in there.
Jason (40:44):
Yeah, yeah, I mean, well said, I've got nothing really to
add there.
That's perfect.
I wanted to close by asking youhow you personally talking
about joy and work, how youpersonally protect your own joy
and work these days, and ifthere was something that you
could embed as a mindset shiftin every new clinician, what
(41:09):
would that be?
Lawrence (41:11):
I think the concept of sustainability has been a huge
thing right, and sustainabilitymeans something different from
each person.
What really resonates with me,like my experience, my lived
experience, was that I had avery low awareness of how much
time I needed to devote torecovery after working really
(41:33):
hard clinically, after workingreally hard clinically, and so I
had that almost invincibility,or I thought that I had the
ability to endlessly give andgive and give, and I was not
aware, I didn't know how to sayno and set my own boundaries,
until actually my body actuallysaid no to me.
I developed autoimmune flares,psoriatic arthritis and some
(41:58):
pain symptoms from thatinflammation, emphysitis and
dactylitis.
So my body actually had to sayno for me because I didn't know
how to do it myself.
And I think that's that mightbe a common experience for a
minority of physicians, wherethey they just never were
trained or given an intentionalplan to preserve themselves
going forward.
(42:19):
So if, when you talk aboutabout new clinicians, definitely
reserve time for at least onehobby in your life, at least
have one hobby.
Definitely prioritize yourfamily.
If your family is your priority, definitely reserve time time
for your own maintenance of yourown body.
(42:39):
The system will not benefit fromyour martyrdom.
I think that's a big message.
Being a martyr for the systemis not in your job description.
So what is in your jobdescription is to model
sustainability and wellness foryour patients and for your
colleagues and for your familymembers.
(43:01):
Modeling sustainability andmodeling wellness is a great aim
for your life.
We're still in that positionwhere the money is enough in
health care.
You're not going to be as richas some tech entrepreneurs who
got really lucky.
No, that won't happen.
You might not be a real estatemogul, but the money is enough
(43:26):
in healthcare if you live in amoderate way, and I think that,
as you definitely do thefinancial planning that you're
going to do.
But, yeah, I think the focus onreally getting clear on what
your values are, ensuring thatyou're allocating time and
energy to those things that youreally value and often that's
(43:48):
yourself and your family firstand really protecting and
prioritizing that, and thenleaning into your clinical
services and your leadership.
Jason (43:58):
It sounds like the wellness version of pay yourself
first.
Lawrence (44:03):
I like that.
Yeah, pay yourself first, yeah,I like that.
Jason (44:06):
That's really powerful and I appreciate you sharing
that.
Lawrence, I didn't askpermission at the outset to call
you Lawrence, but we've knowneach other for a while and I
really do appreciate you comingon and talking with me today and
sharing this story.
If people want to know moreabout you, your socials and the
work that you're doing, whereshould they go?
Lawrence (44:28):
You can find me on LinkedIn under Lawrence Yang.
You can also find me on X underGateway Medic.
My clinic was called GatewayMedical Center because it was
next to the Gateway SkytrainStation in British Columbia.
So Gateway Medic on X and Ithink that's probably it.
That's the best ways to find me.
Jason (44:50):
That's great.
Well, we'll link to those inthe show notes.
Again, appreciate your time somuch, lawrence, and it was great
to see you.
Thank you.
Lawrence (44:59):
Thank you so much for having me, jason, honored to be
a guest on your first episode.
Jason (45:05):
Thank you very much.
Bye now, thank you.
My body actually had to say no for me because I
didn't know how to do it myself.
Every person who goes to workis actually on a gradient
towards unwellness.
I think quality improvementscience is a science of hope.
Jason (00:14):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C-suite.
I'm your host, Jason Meadows.
Today's guest is someone whoseenergy and authenticity I deeply
(00:39):
admire.
Dr Lawrence Yang is a familyphysician in Surrey, British
Columbia, and while he's heldleadership roles and done
incredible work in data andquality and systems change, what
really stands out aboutLawrence is how openly and
courageously he's talked aboutburnout.
He's taken something that somany physicians quietly struggle
with and turned it into amission, not just to survive the
(01:02):
system but to help change it.
He's been leading wellness andleadership workshops across
Canada and recently brought thatwork to the Institute for
Healthcare Improvement AnnualForum, which tells you something
about how widely this messageis resonating.
This conversation is about joyand work, but more importantly,
it's about what happens whenwe're brave enough to bring our
(01:23):
full selves, even the painfulparts, to the work we care about
.
I'm grateful to have Lawrencehere to share his story.
Dr Lawrence Yang, welcome tothe podcast.
Lawrence (01:34):
Thanks so much, jason.
It's a pleasure to be here.
I'm excited for your podcastand I'm excited to be here.
Jason (01:42):
Well, thanks so much.
I'll jump right into yourorigin and your background
because I'm really excited here.
Well, thanks so much.
You know I'll jump right intoyour origin and your background
because I'm really excited.
Even though we've known eachother full disclosure for a few
years, with social mediaconnection, with meeting every
year at the IHI I think there'sa lot we can delve into about
you, and so I'd like to do thatright now if I could.
One thing that might be a goodplace to start is you've had
(02:04):
this experience that is anincreasingly common experience
in Canada these days, which ishaving studied and worked in
medicine in both the US andCanada, and I wonder how this
shapes your view of primary caresystems and the work that you
do.
Lawrence (02:21):
Yeah, thank you.
So yeah, I did my residency atWill Cornell Medical College in
Brooklyn, new York, and afterthat I practiced in Long Island,
new York, in the urgent caresetting.
So during my residency I hadexperience of an inner city
family medicine clinic.
I followed and learned frompreceptors and mentors who
worked both in the clinic aswell as in the hospital seeing
(02:43):
their own patients who areadmitted into the city hospital.
I remember working with thechallenges of billing different
insurers and the challenges ofgetting funding as a clinician
for the clinical work that wedid.
That's very different in Canada, where we have pretty much a
single payer, and so, aside fromthat, those are really the main
(03:07):
differences that I've noticed.
I think both US and Canadasuffer from a shortage of human
resources right now shortage ofphysicians, some challenges with
funding and forming adequateteams for primary care I think
these are common challenges.
Burnout in healthcare workersthose are common challenges.
So the funding is different inthe systems, but a lot of the
(03:32):
big challenges we face are verysimilar.
Jason (03:35):
Yeah, it's such a valuable perspective and it
really is humbling, isn't it, tosee that both sides struggle
perhaps a little differently,but with similar challenges, and
I appreciate that perspective.
Struggle perhaps a littledifferently, but with similar
challenges, and I appreciatethat perspective.
Fast forwarding a bit, I'mcurious what drew you to quality
improvement rather thanfocusing entirely on clinical
(03:56):
practice?
Lawrence (03:58):
Well, I kind of happened upon quality
improvement science accidentally.
I was someone who was reallydevoted to running my own
practice, being theowner-operator of a clinic in
inner city, metro, urban,greater Vancouver, in a city
called Surrey that you mentioned, surrey, british Columbia and I
(04:19):
burnt out.
I burnt out really quicklybecause I was managing and
juggling all the businessaspects, my human resources.
I was my human resourcesdepartment because I was
managing and juggling all thebusiness aspects.
I was my human resourcesdepartment.
I was my leaseholder for myclinic.
I was the person who was makingsure there was nothing
dangerous in my parking lot,while also trying to manage a
full panel of over 2,000patients with many complex
(04:42):
challenges, including mentalhealth challenges, addictions,
chronic disease and manycomorbid diseases.
And the only thing I knew howto do was work harder and do
more, spend more time in theclinic.
I got to the place where Iactually put a bedroom into my
clinic.
I hired a handyman to install ashower in my clinic so that I
(05:05):
could spend more time in myclinic, because all I knew how
to do was do more and, of course, I burnt out.
I burnt out probably within thefirst three years of my career,
from 2010 to 2013.
And when I say I came acrossquality improvement by accident,
what I meant is that I startedto try to grow my circle.
Having done training in theStates and then practicing in
(05:29):
Canada, I didn't really have allof the relationships that
really make referral networkawareness easier, so sometimes I
really felt that I was workingin a silo as a family
practitioner.
So as I tried to heal myselffrom burnout, I realized that
growing my circle was a reallyimportant change idea and so I
started to grow my circle, andin that circle was the CEO of my
(05:53):
health authority.
In British Columbia we haveabout six different health
authorities and at the timeFraser Health was led by a CEO
named Michael Marshbank and Iwent up to him at one point
because I was working in thehospital the hospital that I
admitted my patients from myclinic to and I said my patients
are having a lot of challengingexperiences at the hospital.
You know they're notexperiencing trauma-informed
(06:15):
care.
I do my best in my clinic toprovide that trauma-informed
care, but when they get to thehospital it doesn't seem to
exist.
It's like there's no capacityfor caring.
And then michael said you know,this sounds like a problem.
And it sounds like you reallycare about patient experiences,
and I said, yes, I do.
And then he said, well, in 2016they started this program
(06:37):
called physician qi, pqi, andphysician qi was a project that
was started by an anesthetistand a cardiologist.
The cardiologist has sincepassed away from health issues,
but the anesthetist is Dr KurtSmetcher, who I think you might
have met before at IHI Forum,and what he did is he took he
(06:57):
became aware of the Institute ofHealthcare Improvements advisor
program QI advisor program andhe took a lot of that advisor
program QI advisor program andhe took a lot of that, the
curriculum, and he modified itfor a Canadian context and then
he he brought that in anddeveloped some mentorship and
facilitation training for some,for folks like myself.
(07:18):
So I was taught by Kurt's metyou're in around 2016, 2017, and
then I became a faculty of thatprogram and and it was just
because I struck up thatconversation with my CEO at the
time of my health authority andhe pointed me in that direction,
saying that these intrepidphysicians were already, who
also cared about quality qualityof care, had started a program,
(07:40):
and so I started learning inthat program and I spent over
maybe 200 hours in learningaction projects in classroom
settings, just learning thescience of improvement and
practicing on my own projects.
And then I became a facultymember of that program and I
still teach there today.
(08:01):
So that started in 2017.
And here we are in 2025.
I'm eight years into thisquality improvement, teaching
and spreading and workshopfacilitation, and it's very
meaningful work.
I'm really, really stoked thatI'm part of it.
Jason (08:20):
I mean thank you so much for sharing that.
I feel like there's a lot ofpower in that narrative that you
just shared.
It sounds like you were one ofthe early cohorts, perhaps, of
this PQI program and that it'sreally changed the trajectory of
your career and also perhapswas part of this awakening out
of the burnout that youdescribed.
Lawrence (08:41):
Absolutely yeah.
So, coming out of burnout,there really aren't too many
supports in British Columbia andprobably other jurisdictions as
well.
So, quality improvement,learning in a cohort, setting
along with other clinicians ofdifferent backgrounds, that in
itself, that building of thatcircle of support, that sense of
(09:03):
community, was actually really,really healing.
And at the same time you're allaligned in shared values around
excellent human experiences inhealthcare as well as a hope and
an optimism for improvedprocesses and especially for
(09:24):
resource stewardship.
One of the greatest impetusesfor I don't know if that's a
word, but one of the things thatsparked off the Physician QI
program was a sense that there'swaste going on in our system,
that there's a lot of peopledoing a lot of different things
but they're not following acommon methodology and they're
(09:45):
trying a lot of things butthey're not following a common
methodology and they're trying alot of things but it's not
really sticking.
So dr Kurt Smetcher and dr Jancorner, the late physician, dr
Jan quarter, they knew thatthere are, there was a science
to improvement and they broughtthat to our province through the
Institute of HealthcareImprovement.
And, yeah, it gives you, givesone, a lot of hope.
(10:05):
A lot of times when people areburnt out, it's because of the
distress of seeing poor humanexperiences happen over and over
again.
And when I got into healthcareand like when you got into
healthcare, we got into itbecause we wanted people to have
great experiences.
We want to be proud of theexperiences that were a part of
delivering for our patients inour service.
(10:26):
But when that doesn't happenover and over again, we
accumulate a moral distress andin some cases it's almost akin
to vicarious trauma watchingother people fall through the
cracks of the system.
It's a traumatic experience forsome of us and that accumulated
distress sometimes manifests asburnout and when sometimes the
(10:48):
most healing thing is to takeaction in the other way to
redesign systems, to be morehumanistic, to redesign systems
for better health outcomes andto reduce waste in the system.
Just knowing that you can dosomething is a very powerful
healing experience, andespecially when you're doing it
with new friends, people whoshare your vision, but they have
(11:11):
other talents, they have otherclinical foci, they have other
resources that they're bringingto the fore and the chance to
align some of these resourcesjust in that kind of pure
mission of improving things forhumans.
It's a very gratifying and ahealing experience.
Jason (11:32):
It sounds like the unexpected experience within the
educational experience of QIfor you was a therapeutic one.
It was one where you discoveredthat people who wanted to learn
improvement science also foughtwith difficult problems,
problems which they maybe foundwere intractable and that were
(11:52):
bigger than them.
Lawrence (11:54):
Absolutely.
I think a common realization, acommon finding looking
retrospectively back over thepast eight years, is that I
would say at least 90% of thosewho have found themselves and
devoted their their time intolearning quality improvement in
our program the physicianquality improvement program they
(12:15):
expressed that they haveexperienced symptoms of burnout
in the past and so much of itwas related to a sense of
hopelessness in the face of verycomplex challenges and complex
problems where they didn'treally have a clear roadmap on
how to make those next steps andfor them, the science of
(12:35):
improvement, the methodologiesof improvement, the model for
improvement, all helped to be aremedy for some of that
ambiguity and hopelessness.
Yeah, I think qualityimprovement science is a science
of hope.
Jason (12:50):
Wow, that might be the quote for the day.
That's really powerful, andthanks for sharing that.
I like to shift a little bit tothe current work that you're
doing and where that's takingyou.
You've mentioned PQI, so thePhysician Quality Improvement
Program based out of BritishColumbia, to my understanding
(13:12):
and I could be mistaken aboutthis, but my understanding is
that this may in fact be uniqueas a province-wide quality
improvement training programwithin Canada.
I'm not aware of any suchprogram in the States or in
Canada.
What makes this model soeffective?
Lawrence (13:33):
and why don't we see it in other provinces?
Do you think?
I think the secret sauce tophysician QI in British Columbia
was really what we call thejoint collaborative committees.
Joint collaborative committeesare committees of physicians and
health ministry representatives, so government and physicians
sitting together at a table andagreeing that we needed a way
(13:56):
forward, and over 10 years agothey committed millions of
dollars to paying physicians tocover their overhead from their
clinical practices, while theytook time out of their practices
to learn the science ofimprovement.
That is the secret sauce.
(14:16):
Other practices to learn thescience of improvement that is
the secret sauce.
The advocacy that went into this, to allocating this public
funding to this huge endeavor ofcreating capacity in the system
for health system leadership inthe form of skilled physicians
who are skilled in qualityimprovement.
That is at the crux of whatmade this possible.
(14:40):
Now you mentioned it beingsuccessful.
It's successful in that we havemany alumni.
We have probably almost 800alumni within British Columbia,
which is a fantastic number.
But in terms of actual impactsin the system, we haven't
effectively really measuredthose quintuple aim or even the
(15:02):
sextuple aim impacts yet.
But that's ongoing work rightnow.
We've been really focused in thepast 10 years on building
capacity, building people withthe skills of a QI advisor and a
clinician background, so wekind of have a latent army
that's really ready to tacklesome of the health system's
(15:22):
greatest challenges.
And yeah, that advocacy forthis possibility of this
physician activation was a keypart of that.
Historically, physicians havebeen seen as being full of
counter will.
It's kind of like the healthministry, the politicians, are
(15:44):
trying to do something andphysicians would often come in
opposition of those becausethere was not a shared
understanding of shared values.
And this is a very rareoccasion where physicians and
health ministry have both agreedwe need to use science when we
approach health system redesign.
So that's what really makesthis unique.
Jason (16:02):
Wow, I mean it sounds like a great problem to have
that we're even having theconversation about.
We haven't yet measuredquintuple aim impacts of this,
because it means that you'vecome far enough to be able to
have educated this huge as yousaid, I think a silent army of
clinicians who, you know, cameinto it from different
(16:26):
backgrounds and differentspecialties, um, but are united
in having done this.
I mean, I think that's it'struly remarkable and I think a
lot of people listening would be, uh, would be envious of having
the problem of having thesilent army that you're just
trying to figure out a littlemore what to do with or how to
measure the broader impacts ofthat.
(16:47):
So I think that's reallyspecial.
I wanted to shift towardssomething which I think has
become, you know, one of thebiggest focuses for you, which
is your work on joy and work andyour the experiences you've had
with burnout that you've sharedso candidly and so bravely and
I really appreciate.
There was a quote that wentsomething like this that I
(17:09):
encountered when I was takingthe school for change agents out
of the NHS in England, and thisis an online course.
It's it's freely available.
I'm not involved with them, butI was really impressed with
what they did, so free plug forthem.
The quote went something likethis there was a comic of a man
looking a bit uncertain standingon a desert island and it said
(17:31):
people aren't willing to setsail on an adventure if they
don't feel secure on land.
And this was intended to be ametaphor of the kind of the
burnout, the joy and work, thepsychological safety spectrum
with QI which really can beventuring into new territory and
(17:53):
maybe feeling a little insecureabout that.
I'm curious how you think aboutthe joy and work and QI
intersection.
Lawrence (18:02):
Yeah, thank you.
It's a little bit of a chickenor the egg thing.
I think that unless apractitioner has some extra
cognitive capacity that they'vereserved in their lives extra
cognitive capacity, extraempathic capacity unless you
reserve some, it's actually verychallenging to jump into
(18:23):
quality improvement learning,because it's a new skill set,
it's a new muscle, it's a newneurological muscle that you're
using.
I know that's not scientific,but I think you know what I mean
.
It's figuratively, but yeah,you kind of have to be well at a
certain threshold in order tolearn quality improvement
effectively and to be aneffective change agent.
(18:43):
You also need to have a certainreserve of wellness.
But that being said, those whodo have that reserve of wellness
, we have that opportunity tolead from wherever we are and to
shift how we're being, suchthat we shift culture to be a
healthier culture.
The School for Change Agentsreally taught me things about
(19:06):
what a change agent does.
A change agent thinks ininterdependent ways rather than
individualistic ways.
They're unreasonably optimisticthat's what a change agent is
but they are grounded inscientific and honest data
(19:28):
analyses.
So these are some of thosethings that really resonate with
me when you talk about jointwork.
When I did the joint worktraining out of the IHI, and the
IHI has a free white paper foranybody who's listening.
You can download the whitepaper for joint work.
Some of the really key thingsthat leaders need to facilitate
in their clinic teams, in theirhospital teams, is a sense of
(19:51):
safety physical andpsychological safety.
A connection to purpose, sofeedback loops about how their
efforts are actually resultingin improvement.
A sense of autonomy, so reallysupporting your teams to engage
in improvement of theirworkplaces, so QI on their
workplaces.
A sense of community,facilitating connections that
(20:14):
could just be at the beginningof your meeting having people
share things.
They're grateful for somethingthat really brings out that
human side and speaks to thevalues of the people on your
team.
A sense of fairness, andsometimes fairness looks like
people being recognized for thecontributions they've put in.
Sometimes fairness means, ifsomebody's violating the
(20:34):
precepts of a compassionateculture, that it's addressed
quickly and in a way that'srespectful to everybody,
something that restores justicein the team.
So that is really in a cap in aminute or two, what joy and work
is.
It's something that leadershave to facilitate and leaders
(20:57):
need to first prioritize theirown wellness in order to
facilitate this type of joyfulwork culture.
A lot of people hear the wordjoy and work and then they're
triggered into cynicism becausejoy feels so far away.
But I believe it was Dr DonBerwick who once said that we
(21:19):
were all created for joy, thejoy is actually our default and
that there's stuff, there's abunch of crap that's covering it
up and not allowing the joy tocome out.
And so when I look at oursystem and look at the humans in
our system, I look at it froman asset-based lens and I see
that there's joy that's reallytrying to bubble up, that's
(21:41):
trying to come out, and we haveto just use some team-based
quality improvementmethodologies to uncover that
joy.
And that's how I approach joyand work.
Jason (21:51):
So it sounds like you view joy and work and QI as
interdependent, as synergistic,not necessarily that one depends
purely on the other, that youneed to have joy and work before
you do QI, or vice versa.
Did I get that right?
Lawrence (22:11):
Yeah, has many moving parts.
It's a complex, adaptivereality where each of us will
have energy that that ebbs andflows, and in those days when
the energy is higher, we canbring more joy and work.
We can bring more joy to ourcolleagues, we can facilitate
more connections, more fairness,more sense of purpose and and
(22:34):
some days we can't.
And so each of us has a role togrow in our own self-awareness.
How we're showing up in work,because how we show up, which is
how we lead, how we're being,is actually what, through the
principle of emotional contagion, it's what sets the climate for
all of the QI work that we'retrying to do, all the health
(22:55):
care service work that we'retrying to do, all the healthcare
service work that we're tryingto do.
So joint work is a strategythat appreciates the assets in
the system and that those assetscan eventually coalesce and
rise up to create virtuouscycles of compassion.
(23:16):
Less and rise up to create avirtuous cycles of compassion
and instead of the viciouscycles of burnout, that we are
so commonly seeing.
Jason (23:22):
Now I wonder if it's worthwhile to disentangle and
kind of create some spacebetween a few terms that you've
either mentioned or that arekind of implied in the
discussion earlier you mentionedwitnessing poor care
experiences over and over, andI'm reminded of a video I
actually saw of you.
You posted last month.
It was a talk on this exacttopic, and you're kind of
(23:46):
alluding to the idea of moralinjury here.
I wonder what you can tell meabout the terms moral injury
versus burnout, versus joy andwork, where the latter term
might be a lot newer or maybeeven brand new to some of our
listeners.
Lawrence (24:18):
I believe it would be sociologists were studying the
psychological burdens and traumathat existed in in citizens who
had fought in wars, and I thinkmoral injury is distinctively
described as when one has takenaction in a knowing way,
voluntarily, which caused harmto another human, and the injury
(24:43):
that results in oneself fromhaving caused harm to another
human.
I think that's what reallydistinguishes moral injury from
moral distress.
In distress there's a distressbecause we have an idealized
vision of what a humanexperience ought to be, but
(25:05):
there are system factors whichprevent that ideal future from
actualizing and we watch otherhumans go through suffering due
to these system factors.
So I distinguish moral injuryfrom moral distress in that way.
I personally do.
(25:25):
I don't know if that's a sharedunderstanding by by any, by
anyone.
The other term, burnout burnoutis a is a syndrome where
exhaustion uh is is part of it,depersonalization is part of it,
where we kind of have lessempathy.
Depersonalization for me is is,that is where we've run out of
(25:49):
empathy in our own empathicreserves.
We haven't preserved anyempathy so we don't have much
else to give and and so wedepersonalize our interactions.
Things become moretransactional.
If someone complains to us,we're like not my problem bye
those types of things,depersonalization, and there's
also a sense of inefficacy,burnout you have a persistent
(26:12):
sense that you're not doing agood job.
Sense that you're not doing agood job.
Some burnout cases also have asense of dread when
contemplating going back to work.
So those are some of thedistinct elements of burnout.
Joy in Work is an idealizedsummary of what has been seen as
(26:35):
a bright spot inhigh-performing health systems,
where leaders have intentionallytaken a scientific approach to
making workplaces more well,more conducive to wellness
rather than conducive todistress.
We have so many health systemsright now that, just because of
(26:57):
how culture is designed and howworkflow processes are poorly
designed, it's every person whogoes to work is actually on a
gradient towards unwellness.
That's a reality for a lot ofhealthcare, because of being
short-staffed, because of thelack of a learning system, where
(27:17):
the same problem impacts theworker every day and becomes an
agonizing frustration that justwears on them day by day.
A system that does not learn isa system that's conducive to
distress.
A system that has a vacuum ofleadership is a system that's
conducive to distress.
(27:38):
A system that has nointentionality towards wellness
for the workers is a systemthat's conducive to distress and
joy in work is describing asystem where safety, purpose,
autonomy, community fairness,recognition those are
intentionally focused on.
(27:58):
That's what joy and work is and, like you said, that's not
commonly discussed but it's inthe literature, it's in the
white paper, there are courseson it, so I encourage everybody
to take them.
Jason (28:09):
Yeah, and I mean thank you so much for kind of clearing
that up, because those are suchimportant terms and how we
distinguish them, how we talkabout them.
You know I had a mentor in mypalliative care journey who
would always say language drivesthought, and so how we use
these terms really does help usto drive how we think and how we
(28:30):
go about making change.
So thanks for that.
You know this kind of youmentioned courses and workshops.
I mean, at the outset Imentioned that you're running
these amazing workshops topromote all of these important
ideas, and you've been now askedto do this all around Canada.
Sounds like you're in reallyhigh demand.
One of the big focuses I want tohave for this podcast this
(28:54):
being our first episode ishighlighting concrete steps that
people have taken in theirleadership journey.
I think that's an area where,within this quality improvement
world whether it's you know, youread a journal article and you
can't quite tell what they did,or it's someone who's achieved
success in running workshopslike you have you want to get,
(29:17):
you want to dive a little deeperand you want to kind of
understand what did this persondo?
What's the special sauce forthem?
And so I'm curious how you gotstarted with running these
workshops and how have you madeit grow.
Lawrence (29:30):
Thanks, jason.
Interesting question.
No one's ever asked me thisbefore, but as you were talking,
I came up with some ideas.
I want to shout out to HelenBevan and her team at NHS
Horizons for the School forChange Agents, which you already
mentioned, jason.
What a transformativeexperience, and the fact that it
was free is ridiculous.
(29:52):
So School for Change changeagents was definitely a
transformative experience for me.
Another thing that would beaccessible for anybody in Canada
would be accessible, meaningyou can pay for it is the QI
coaching certificate out of theInstitute of Healthcare
Improvement.
It's mostly distance learningnow.
It's not cheap, but I foundthat really effective.
(30:16):
William Edwards Deming, who isone of the great originators of
quality improvement science inthe manufacturing and in the
health sphere, he said that aleader is a coach, not a judge,
and so the QI coachingcertificate teaches you coaching
principles as well.
It ensures that you havequality improvement methodology
(30:37):
in your tool belt.
So the QI coaching certificateteaches you coaching principles
as well.
It ensures that you havequality improvement methodology
in your tool belt as well.
So things like how to do a goodaim statement, how to do a
driver diagram, how to do afamily of metrics, how to do
project charter, how to doethics evaluation, how to do
ethics evaluation, how do you doa force field analysis, a cause
(31:00):
and effect diagram, a treediagram.
So they combine qualityimprovement tools with quality
improvement coaching approaches.
And if you want to lead qualityimprovement, if you want to
lead systems redesign, I thinkthat QI coaching certificate is
(31:20):
very very valid.
Yeah, yeah there's, I think, forleadership itself, just how one
leads themselves.
There are so many differentoptions out there.
Which one was most impactfulfor me?
You know what Studying joy andwork is a leadership?
It's a leadership program.
(31:41):
The Institute of HealthcareImprovement has its Leading for
Well-Being course, which kind ofincorporates some of leadership
principles as well as the joyand work stuff in it.
As well as the joy and workstuff in it.
The King's Fund out of Londonalso has a compassionate
leadership training and I foundthat really enlightening.
(32:06):
You know.
It validated a lot of thoseapproaches that I would take,
naturally, and so I think Imight leave it at that.
There's the School for ChangeAgents, there's QI Coaching
Certificate, leading forWellbeing and the King's Fund's
Compassionate Leadership, whichtalk about compassionate
(32:26):
leadership.
Michael West is one of theirheads of thought leadership at
the King's Fund and his40-minute keynote that he did
for us in British Columbiareally shaped a lot of my
approach for leadership, and Imention these because they're
(32:48):
available online.
There are some experiences thatI had that might be British
Columbia-centric which I'm goingto leave off right now.
Jason (32:58):
Yeah, fair enough, and thanks for sharing that.
I mean, that's that is a richlist of resources.
I'm curious when you're nowbeing asked to to go across the
country and run workshops andyou're being asked to the IHI to
to run workshops, what kind offeedback are you getting from
people?
There must be people havingsome really transformative
(33:20):
moments and I'm curious whatstories you're hearing.
Lawrence (33:24):
Yeah, and I want to be clear here, I put an abstract
in along with some colleaguesChristina Krauss, who's the CEO
of Health Quality BC, which isour health ministry's quality
arm, and also Dr Hussain Kanji,who's a leader in the intensive
care and ECMO space.
The three of us partnered andput in an abstract.
(33:47):
We weren't necessarilyrecruited to present at these
workshops but, yeah, we did athree hour workshop and, you're
right, we did get I believe itwas a transformative experiences
.
Within those three hours.
We were able to give peopletime to really reflect on self.
How are people managing theirown empathy?
(34:10):
Were they preserving theirempathy so that they had enough
to apply in the places thatmattered to them?
And that's often self,self-empathy, self-compassion,
family, family compassion,friends compassion, workplace,
team compassion, and then youcan go to community and systems
(34:30):
leadership.
We really gave time for peopleto, in those three hours, to
grow an awareness of some oftheir inner narratives that
might be driving them tooverextending themselves, which
is conducive to burnout anddistress, and to reflect on some
of the narratives that theymight choose instead so that
(34:52):
they can have a more sustainablework life.
And so we really went from selfto team leadership to systems
leadership in those three hours.
And yeah, the feedback isfantastic.
I've posted it onto my LinkedInand you can find me at Lawrence
Yang on LinkedIn and I'veposted some of the feedback
survey reports on there.
(35:13):
I like to do that because it'skind of like a closed loop.
You come to my sessions andthen you wonder what other
people thought survey reports onthere.
I like to do that because it'skind of like a closed loop.
You come to my sessions andthen you wonder what other
people thought about the sessionand they just look at my
LinkedIn and it's free.
You can see the feedback loopof how it went.
Jason (35:26):
And that's feedback for me.
Lawrence (35:28):
But it's also feedback for anybody else who's
interested.
Jason (35:31):
You're running PDSA cycles all the time, even with
your own workshops.
Lawrence (35:36):
That's right, and you had mentioned, you had asked me
earlier what are those keyleadership things that I learned
.
I think social media is reallyhow I've gotten my voice out
there.
I think it's a part of how youand I, jason, have connected.
But it's also how I'veconnected a little bit with
Helen Bevan, a little bit withAmar Shah you know these quality
(36:00):
improvement leaders around theworld and Doug Eby out of NUCCA,
a system of care.
So social media has been, I'veused it.
Social media can be a lot ofthings.
It can be a lot of bad andnegative things, but when in the
hands of people who really justcare about community, it can be
very powerful, as you know, andso, as a leader right now in
(36:22):
healthcare spaces, whereadvocacy and the necessity of
leaning into politics reallymatters, the use of social media
effectively, I think, is a keyskill for change agents.
Jason (36:36):
Yeah, well, if anyone uses it well, well, and people
should check out your socials,which we'll we'll kind of
include at the end.
But if, if, if you use it well,and you certainly do, that's
you know, I've seen the powerthat you, that you've kind of
extracted from that and I'mcurious, you know, as we think
forward, we've talked a littlebit about about your work in
(36:57):
work in physician qualityimprovement, pqi, in British
Columbia, and we've talked aboutthe workshops that you run.
What does five years from now,if we think 2030, in Canadian
primary care?
You can limit that to BritishColumbia or to the whole country
, if you like.
What's different?
Because we finally, quoteunquote, got QI right.
Lawrence (37:21):
We've all drank the Kool-Aid the QI Kool-Aid yeah.
My hope is that family doctorsreally lean into both
vulnerability and courageousness, and what that means is that we
become honest with the level ofquality that we're delivering
(37:42):
our patients and the level ofquality that we're allowing
ourselves to experience in thecourse of giving care.
Why I say that is that if we'rehonest about how we're
delivering quality and we'rehonest about how we're
experiencing life at work,change will become a necessity.
(38:02):
We will have to move out of ourcomfort zones of potentially
lower quality and high volumepractices to team-based care.
I think team-based care is theonly way that we can get to the
quality that we need tosustainably.
We can no longer work in silosjust a physician, maybe two
(38:23):
physicians and two MOAs.
We need to have co-locatedskilled team members that we can
delegate to who are doing ourcounseling, who are doing our
social work, who are doing sothat we can all work at the top
of our scopes.
Because there's just not enoughphysicians in Canada to deliver
the care that needs to be done,because Canadian physicians are
(38:45):
doing things they don't need tobe doing, that are not at the
top of their scope.
That slows them down.
We need to figure out a waywhere physician owners can
actually, in a reasonablefinancial arrangement, have
co-located skilled workers,skilled team members, to deliver
(39:05):
care.
And we have to become morecourageous about sharing some of
the metrics that reflect thesextuple aim in our work.
When I say sextuple aim, I meanhealth outcomes, patient
experiences, health providerexperiences.
I mean resource stewardship howare we stewarding the resources
(39:29):
?
I mean advancing equity and Imean planetary health health.
So developing metrics anddashboards around around these,
these important aims in qualityimprovement and making sure that
, even though I my main job thatI was trained for is just
(39:51):
delivering care, that I'm doingit in a way that produces
lasting, positive impacts on thecommunity rather than just
throughput, and a lot of thatlies in the hands of system
leaders system leaders, who haveto be courageous enough to make
big changes based on and in adata-informed way, rather than
(40:15):
based on.
I think this is what we shoulddo.
I think this is like there is,there's a methodology to how
change can happen in a datainformed way.
So that's my hope for 2030 thatwe move closer to data
transparency in how public fundsare spent in the course of
(40:35):
delivering health care and thatwe really value the human
experiences and, like I said,the sex double aim in there.
Jason (40:44):
Yeah, yeah, I mean, well said, I've got nothing really to
add there.
That's perfect.
I wanted to close by asking youhow you personally talking
about joy and work, how youpersonally protect your own joy
and work these days, and ifthere was something that you
could embed as a mindset shiftin every new clinician, what
(41:09):
would that be?
Lawrence (41:11):
I think the concept of sustainability has been a huge
thing right, and sustainabilitymeans something different from
each person.
What really resonates with me,like my experience, my lived
experience, was that I had avery low awareness of how much
time I needed to devote torecovery after working really
(41:33):
hard clinically, after workingreally hard clinically, and so I
had that almost invincibility,or I thought that I had the
ability to endlessly give andgive and give, and I was not
aware, I didn't know how to sayno and set my own boundaries,
until actually my body actuallysaid no to me.
I developed autoimmune flares,psoriatic arthritis and some
(41:58):
pain symptoms from thatinflammation, emphysitis and
dactylitis.
So my body actually had to sayno for me because I didn't know
how to do it myself.
And I think that's that mightbe a common experience for a
minority of physicians, wherethey they just never were
trained or given an intentionalplan to preserve themselves
going forward.
(42:19):
So if, when you talk aboutabout new clinicians, definitely
reserve time for at least onehobby in your life, at least
have one hobby.
Definitely prioritize yourfamily.
If your family is your priority, definitely reserve time time
for your own maintenance of yourown body.
(42:39):
The system will not benefit fromyour martyrdom.
I think that's a big message.
Being a martyr for the systemis not in your job description.
So what is in your jobdescription is to model
sustainability and wellness foryour patients and for your
colleagues and for your familymembers.
(43:01):
Modeling sustainability andmodeling wellness is a great aim
for your life.
We're still in that positionwhere the money is enough in
health care.
You're not going to be as richas some tech entrepreneurs who
got really lucky.
No, that won't happen.
You might not be a real estatemogul, but the money is enough
(43:26):
in healthcare if you live in amoderate way, and I think that,
as you definitely do thefinancial planning that you're
going to do.
But, yeah, I think the focus onreally getting clear on what
your values are, ensuring thatyou're allocating time and
energy to those things that youreally value and often that's
(43:48):
yourself and your family firstand really protecting and
prioritizing that, and thenleaning into your clinical
services and your leadership.
Jason (43:58):
It sounds like the wellness version of pay yourself
first.
Lawrence (44:03):
I like that.
Yeah, pay yourself first, yeah,I like that.
Jason (44:06):
That's really powerful and I appreciate you sharing
that.
Lawrence, I didn't askpermission at the outset to call
you Lawrence, but we've knowneach other for a while and I
really do appreciate you comingon and talking with me today and
sharing this story.
If people want to know moreabout you, your socials and the
work that you're doing, whereshould they go?
Lawrence (44:28):
You can find me on LinkedIn under Lawrence Yang.
You can also find me on X underGateway Medic.
My clinic was called GatewayMedical Center because it was
next to the Gateway SkytrainStation in British Columbia.
So Gateway Medic on X and Ithink that's probably it.
That's the best ways to find me.
Jason (44:50):
That's great.
Well, we'll link to those inthe show notes.
Again, appreciate your time somuch, lawrence, and it was great
to see you.
Thank you.
Lawrence (44:59):
Thank you so much for having me, jason, honored to be
a guest on your first episode.
Jason (45:05):
Thank you very much.
Bye now, thank you.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.