How Health Leaders Can Innovate Without The Traditional Drawbacks with Nadia Adams, COO at Indiana University School of Medicine
: [00:00:01] Welcome to the outcomes Rockett podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host Zoll Markels
Saul Marquez: [00:00:18] Outcomes Rockett listeners welcome back once again to the outcomes Rockett podcast where we chat with today's most inspiring and successful healthcare leaders if you like what you heard today and like what you hear in general. Please go subscribe and rate and review the podcast. We always want to hear what your thoughts are what you like don't like. This is how we improve. And so really appreciate you doing that. Without further ado, I want to introduce my outstanding guest. Her name is Nadia Adams. Nadia Adams is the chief operating officer of the Centre for Health Innovation and implementation science at Indiana University School of Medicine and she also serves as a network director of the Great Lakes practice Transformation Network. Nadia uses the tools of innovation and agile implementation to transform healthcare for over 10 million patients. Her work focuses on accelerating the adoption of evidence-based practices into everyday environments to provide better care better health and lower costs for targeted patient populations. When successful models have been localized and implemented Naalya concentrates on scaling up these models to increase systematic impact across multiple health systems and care venues. Nadia has accomplished this by partnering innovative researchers with healthcare systems and matchmaking. Evidence-based knowledge with health care delivery needs best the tip of the iceberg listeners. But what I want to do is open up the microphone to Nadia to finish up that intro. Nadia welcome to the show.
Nadia Adams: [00:01:48] Thank you for having me. I really appreciate the opportunity.
Saul Marquez: [00:01:52] Absolutely Nadia. And so I wanted to always just like to know why health care what got you into this.
Nadia Adams: [00:01:58] All right. So my goal in medicine and health healthcare is to make sure that we eliminate preventable medical errors and deaths. My brother is actually one of those statistics as of today. Actually, there are 75000 annual preventable deaths in the United States. We use 30 percent of patients experience preventable harm. And so having my younger brother who has them have been impacted by the healthcare system in this way I have been fortunate lucky to be able to really find my passion. So health care for me is not just a job. It really is my passion to make sure that I can do whatever I can to make the health system better. When my brother was born the umbilical cord was wrapped around his neck so suffocated and had severe brain damage. My mom came into the hospital in the middle of the night and when they found out this situation they rushed her into emergency c-section. The process that happened. Nowadays there are deaths and procedures to make sure that the situation that my brother does not happen to anybody else that that time it was preventable.
Nadia Adams: [00:03:08] The doctor had to deliver my brother was 45 minutes late. And then there wasn't really anybody else at the time that could really deliver him to the hospital we were at. And so it's not any one person's fall because I believe that we have very bright people in this health care system people that are really good at their work their passion about what they do and they really want to help people. Well, we have just a very very broken system. We've spent seven hundred fifty billion dollars in wasted annual healthcare spending and the work that I do really focus on how we can implement it into everyday care. And today less than 50 percent of patients actually receive residency care. And so this is really kind of my driving passion is to make sure that we eliminate preventable medical errors and death because I have fortunately and unfortunately experienced this, fortunately, I've really been able to see how it's impacted my family and my brother and really take that perspective and really try to make make sure that we can impact the health care system.
Saul Marquez: [00:04:15] Now Nadia really appreciate you sharing that story. And you know I could definitely tell this is definitely your driver and your motivation for why you're in here.
Saul Marquez: [00:04:24] And some of the stats that you shared are just staggering right I mean 700 billion in waste is in my mind unacceptable and I'm glad that folks like you are really putting in the hours the thought and the effort to make it better. And so in the light of this topic of preventing the preventable what would you say a hot topic that should be on every medical leader's agenda should be and how are you guys at Ayyu approaching it.
Nadia Adams: [00:04:50] Yes. So a hot topic that I believe should be on the agenda of every healthcare leader is how to innovate in an environment like today. And then also how to implement and sustain evidence-based practices. And so if you look around the healthcare industry is one of the only industries that really doesn't have far indeed with the health care system. So if you look at other industry there's always research and development department now for funding that's allocated to it and in the healthcare system, there isn't. Never thought about it that way. Yeah and I think with the changes that are arising with the changes within our payment system health systems will have to know how to innovate to be successful. And I always say innovation thrives in a limited resource environment and that's exactly the environment that we have today. Now it's making sure that leaders are equipped with the skills of innovation so that they can lead their team to innovate in that environment. And then the other one is implementation science as I call it basically implementation science. How do we take evidence-based practices or bright spot? Some people like to say and really take those areas that are doing well or work that really kind of a bright spot within the healthcare industry and localize it to each healthcare leaders environment. So that what people are experiencing at Johns Hopkins or group how they can experience their local environment and local communities as well. And implementation science basically is how do we take evidence-based practices and actually identify the core elements of that evidence and localize it to the local environment so that people in the local community can benefit from the same outcome. And so what we believe is right now on average it takes 17 years for any new discovery to be actually being implemented into routine care setting. As you can. 17 years.
Nadia Adams: [00:06:53] So as you can see.
Nadia Adams: [00:06:54] Yes exactly 17 years the world when it's actually implemented the world has greatly changed. And so what actually happens is the people that are producing all of this new discovery are evident. Their work and how they're evaluated and promoted is basically by the type of grants that they get and the number of publications that they have in the impact of their publication. And so after they publish the findings of their study they really view their work as. Hey, I've shared my resolve with the entire world. Now going to move on to the next discovery. So what happens is the people that are working in the everyday healthcare system they are really busy people. Yeah, we can't just assume that they're going to take these publications in JAMA or New England Journal of Medicine and actually read it in employment. And so the implementation science really bridged the gap from discovery to delivery. What we like to say is we like to move evidence from the bookshelf to the bedside. But in order to do that healthcare leaders need to figure out how to facilitate the local adoption of that evidence into their own environment. Because we cannot just read the publication and do exactly what Mayo Clinic or group health does. Right. Right. What we have to do is localize or there may be differences in patient population and resources and staffing. There are all these local differences that need to be accounted for. And so what we really do is provide leaders with the skill to be able to do that. And I think we are to be successful. And the environment today in order to really need. Michael, I said eliminating preventable medical errors from our healthcare system improving the value that we actually deliver to the communities that we serve and patients that we serve. I think that healthcare leaders need to master the skills of innovation implementation.
Saul Marquez: [00:08:53] This is wonderful. Nadia and thank you so much for laying out the groundwork here and in the discussion and to the listeners you know what are you doing to put the book knowledge to practice. Nadia said it more eloquently. What was the tagline that you said they're not?
Nadia Adams: [00:09:08] I loved it from the show that from the bookshelf to bedside.
Saul Marquez: [00:09:13] I love it. So what can you do to do what Nadya just said bookshelf to bedside in a much faster time frame them than 17 years? And these implementation ideas that Nadia is discussing are really fascinating. And so something to think about as a provider and even as a device company or a pharma company trying to help providers deliver care. So maybe you could share with the listeners an example of how you guys have done what you've just discussed in a particular example.
Nadia Adams: [00:09:44] Yeah. Go back to kind of the 17 years bigger and really finish it right now. Not only does it take 17 years to implement new discoveries into everyday care settings but on average only up to 1 percent of all new discoveries are actually being implemented. And all of the funding that we're putting in traditional research that's costing us you and I a billion dollars in taxpayer money. So if you think about the value right now. Right. We're spending a billion dollars to discover new things yet it takes 17 years for these new discoveries to actually even be implemented into the everyday setting. And only 1 percent of those new discoveries are actually ever implemented into routine care settings. And so what we've done is we've really been using a kind of the past five years to figure out what is the core skills that to be able to do this to implement evidence to scale it up. And when you are faced with a challenge and there's no evidence that exists how do you build that innovation to facilitate your team to think outside of the box in a measure the result of that innovation. And so what we've done. I'll give you an example. We have discovered so my boss actually Dr. Malach Bustani he's really known and bald Hymer's cognitive impairment and behavioral health world. And so he's actually created a model of care that has proven to deliver better care better health or cost and improve patient experiences as well as caregivers experience. So when he first started his trial only served 200 patients. And so after the trial was successful the CEO of the local system that hey you have something that worked.
Nadia Adams: [00:11:33] Why are you only serving 200 patients. We need to be able to care for everybody that has cognitive impairment. Yaghnobi he into the issue. And so he was able to then expand that to now serve over 2000 patients. And we really utilized the skills of implementation science to do that. But 2000 patients still not enough because there are over 5 million patients with cognitive impairment Alzheimer's and behavioral health issues. And so what we've really done is try to one take the work that he's done. Figure out the core element of how to deliver a model of care and then work with other health system leaders to actually implement this across the nation. And so really trying to look at OK this is kind of the evidence. What's the core elements then how do we actually work with other leaders within their communities to localize this evidence and then create an evaluation plan or feedback loops? I like to say a GPA some because we strongly believe I strongly believe that whatever you implement the first time is not going to give you the gold star. You need to be able to know what element do not work so that you can modify update course correct. Like you would when you're on a road trip for example. And then really update modify and then continue to refine the implementation process. And then when you actually have success working on scalability. So really we've been using the core tenets of the implementation science to be able to spread and scale this work.
Saul Marquez: [00:13:08] This is a great example of that Natya. And so you also mention that every first implementation is going to be that Goldstar. Can you share with the listeners a time when that did happen? You had a setback and what you learned from it.
Nadia Adams: [00:13:23] Yeah I think when we first kind of ventured into that work or when I first ventured into those work didn't realize I knew of the importance of making data-driven decisions and having as real-time as possible feedback loop but didn't realize how important that is.
Nadia Adams: [00:13:43] The one before you even implement anything. We're talking about a healthcare system right. And so everything that we're implementing we're asking people to do something differently. So the healthcare system it's people providing care for other people. And so humans by nature do not like to change. Majority of us we don't like change and so not only did I underestimate the feedback loop. I also underestimated kind of a human side of things. And so the other thing that we really focus on to be able to do that work well as we call behavioral economics or nudges which is really understanding human understanding the system understanding the implementation that has to happen and how do we actually take people that are used to doing things one way and create a processing system that allows for that human component of flexibility and adaptability and then build in the data-driven component to be able to say okay we're taking people we're asking them to change. We want to sustain this result. How do we create a data feedback loop system to make sure that we're evaluating the whole entire system and then measure results because a lot of times what we see happen in healthcare and that's the kind of what happened initially and some of my first experiences are we like to call it the placebo effect. No, we say we have a problem right we need to let's say our problem is handwashing. Right we need to excuse our handwashing rates. And so we have all these and taskforce and these interventions and we end up improving hand hygiene. Right. And then we go to another problem. We need to decrease fall. OK so now we're all out of time decreasing falls are decreasing the number of faults that we have.
Nadia Adams: [00:15:32] Well the hand hygiene or handwashing doesn't get sustained and then the other problem first of people are not implementing evidence. So a lot of times in the healthcare system we're very reactive instead of proactive. And this was a major thing that I had to kind of retrain my brain to think differently about my experiences that initially working in the health system and now kind of being in an academic environment. That being the bridge between academia and health care delivery system is far more places of the problem. Let's figure out if there's evidence and then there's evidence. How do we actually make sure that we're not just improving the results because it's a new focus? And then there's the unintended consequence of happening or our system in other areas because we're not really monitoring the effects of the entire system. And so I think this has a lot of time as the failure that I see in failures that I experienced when I first started doing this work as we have all these competing priorities. We put time and resources into it and then when we start working on it we don't first check to make sure we're not reinventing the wheel and then when we're putting our resources on it we're not measuring the impact of an entire system to see. OK. Am I improving because there are more people working in this area and then something else is suffering because of this or am I am proving and it's a really sustained improvement that is going to have a long-lasting impact or than higher health care?
Saul Marquez: [00:17:05] This is truly insightful Nadia and I really appreciate you diving into that comes Rockett listeners you know you get to make sure not only to pay words to this idea that you need that feedback you know Nadia definitely stressed the importance of having a system that will drive that feedback and not only to make your goals attainable but you also have to make them sustainable and so through the things that Nadya discussed I think we could definitely take away some pearls to put some of these things into action to help drive that sustainable change to improve outcomes. That was just wonderful. Thank you for sharing that. My pleasure. So we kind of went to some of the learnings that came from setbacks Nadia maybe you could share what one of your proudest leadership moments in healthcare has been to date.
Nadia Adams: [00:17:52] Ok I would say that probably one of my proudest moments as one of the health systems I work with I trained all of their primary care practices in population health management. And so I think today well a lot of times when you hear about population health management we hear about OK well we need to take the data and actually make it meaningful data right. We have a lot of data but we don't know the signal from the noise level. My work of population health management is yes we need to use that data but we don't really work on how to kind of work with that local team to help them work at the top of their license, for example, to even be able to do population health management. The data is really not really helpful or meaningful. So what I've done with my our population health training is really train people on how to work at the top of their license how to be the quarterbacks of their team and really working differently moving from a case management approach to population health national approach.
Nadia Adams: [00:18:53] So I had the opportunity to train one of the health systems I work with to train all of their primary care practices. So all of the lead physicians all of the practice managers all the social workers and all the population health nurses and patient liaisons in these locations and then after we trained and implemented this new way of work. A few months later I came back to one of the practices and there was actually a federally qualified health center and population health nurse and the social worker actually told me because of working with you and going through the population health management what teachings and trainings and the implementation of science we have seen to homeless patients that told us that they have now been able to access the system for 10 years and we were able to connect them with the resources and provide them with what they needed and actually care for them. And I think that that is kind of one of my major accomplishments I would say that I have really thought like wow what we're doing is making a difference.
Saul Marquez: [00:20:00] Yeah I No that's a really great story Nadia and there are so many people out there that we don't think about you know on the fringes that are just struggling and wanting care but just can't seem to find a way to get it. And sounds like what you did through the project of educating those folks over there on population health. You really started just a ripple effect of increasing access and overall you know it's the health of our communities that are going to determine the health of our overall system.
Saul Marquez: [00:20:29] And I think you're doing some pretty great things out there. Nadia thank you. Tell us a little bit more about an exciting project or focus that you're working on.
Nadia Adams: [00:20:36] Yeah. So I would say that the most exciting project that I'm working on right now is called the Great Lakes practice Transformation Network. This network is a network of seven states. We have over 15000 providers enrolled in our network. So primary care physician specialists advance practice providers clinical pharmacists and we have within those 15000 physicians or providers they make over 21 Hunter practices. So the providers I'm working with and the practices that I'm working with they are within Indiana Illinois Michigan Ohio Kentucky and then we have some in Virginia and West Virginia. And what's exciting about it is really being able to apply everything that I've talked about and to lots of different settings and see how it works. Does it work? Does it not work. What do we need to do differently to make sure that these tools do work? And so what we're working with them on is providing support and technical assistance so that they can be successful and a new payment environment and other alternative payment environments that we're using implementation science innovation population health management Olean and taking all those concepts and be real change the real economy. Putting all those concepts together to see if we can support these practices in moving from a fee for service environment to being successful in alternative payment environment. And we have clinicians and roles from we work I work with a single doctor practice all the way to large academic health centers. And so it's been a really great project because I'm able to actually see OK. What does that wall provider need versus what does that urban large academic health center or system need to be able to improve the value that we deliver to Americans?
Saul Marquez: [00:22:30] That's super exciting Nadia and it sounds like you guys are doing some major wayfinding there. There's definitely no Mac and you guys are doing the right things instead. The Great Lakes. What did you call the program?
Nadia Adams: [00:22:43] The Great Lakes practice Transformation Network.
Saul Marquez: [00:22:46] I love it and the name just has a ring that hey you know what. There is a bright future ahead and we're working toward it. Not yet. I know that. I wish we had more time.
Saul Marquez: [00:22:55] So we're kind of getting here toward the end and maybe we'll do a part two because this has been fun let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It's the 101 or the ABC of Natya Adams. And so what I'm going to do is I'm going to ask you for questions. It's a lightning round. You'll give me some prompt responses and then we'll finish up the syllabus with a book you recommend to the listeners. Ready.
Nadia Adams: [00:23:21] Yes. Ready. Awesome. OK. So what is the best way to improve healthcare outcomes really localize evidence-based practices?
Saul Marquez: [00:23:28] What is the biggest mistake or pitfall to avoid is going blind having no sensors no sensors no feedback loops to what you're doing today. So when it comes to let 's say we're in another drought where financially we have to make cuts within our healthcare system much like kind of what many systems face back in 2008. Being able to actually not be blind and know what programs are working and that you should invest money in and what programs are not working and really say that's what this failure we failed at this and we're going to cut this program instead of keep on doing it just because of the way things are strong.
Saul Marquez: [00:24:06] How do you stay relevant as an organization. Despite constant change.
Nadia Adams: [00:24:10] I think you really really need innovation and not being the Kodak of the health care system which is Kodak had a great market for photography and cameras and then because they were not able to innovate. Apple really kind of took them out of business was able to kind of put our camera in our pocket.
Saul Marquez: [00:24:34] That's a great example there. That idea of a fee for service is those pictures the old school pictures and what's coming is going to be completely different. I really love that. What is the one area of focus that should drive all else in the organization?
Nadia Adams: [00:24:46] The one area of focus that should drive all else in the organization. I think that you have to start with data that is used and useful and actionable. And so a lot of times we have data but then we asked people Do you really use it or understand it. And most of the time what I hear is No not really. And so how do we move from just saying that we have data to make data-driven decisions. And I think if we had the data then we can actually translate it better to patient outcomes and improvement. And so I think right now Steve Jobs has had a famous saying that you know the consumer doesn't know what they want. I believe that the patient in the United States may not know what could be of the health care system. I think that because of the way the healthcare system has been the patient or the consumer thinks Well this is just how it is right. This is the health care system. I can't get my care here because my insurance is that there's no coverage for it. I think we work in the health care system know what the health care system should be and knows what the health care system could be. And so I think it's our responsibility to say how do we take data to make it meaningful actionable or so that we can make the future of what health care should be. Because that's the right thing to do for all the people that we serve.
Saul Marquez: [00:26:19] That's powerful. And finally Nadya what book would you recommend to the listeners.
Nadia Adams: [00:26:23] I have a lot of favorite books. You know we've talked a lot about innovation today.
Nadia Adams: [00:26:29] And so I would say if anybody's even interested in just what skill set should you acquire gene and start thinking about how to innovate within your own organization I would recommend the innovators DNA byplay, Christensen. Chris Clay innovators DNA.
Saul Marquez: [00:26:49] I love it. Innovators DNA definitely have to add that to your list Ockham's rocket listeners and don't worry about writing it down.
Saul Marquez: [00:26:56] Visit us at outcomesrocket.health/nadia. And now as Nancy a DIY you'll be able to find all of the show notes and links to the projects that Nahmias working on as well as the book that she just mentioned here so no need to worry about writing that notes. Just go ahead and visit. Outcomesrocket.com/nadia. Nadia this has been so much fun. Really appreciate the time that you spent here. But before we conclude I just want to just open up the mike to you one more time to share a closing thought and the best place where the listeners can get in touch with you.
Nadia Adams: [00:27:30] Ok. A closing thought is I think we're on this how all work and health care to really make a difference. And so if we can even just build upon each other's knowledge connect and collaborate and figure out all of our strengths and weaknesses and really also think outside of the box what's working well in other industries that we can actually take into the healthcare system and create better value for the patients that are being served in the healthcare system. And then the best way to contact me would be via LinkedIn or my email.
Saul Marquez: [00:28:05] Awesome Nadia listen I just want to thank you so much for spending time with us today it was so informative and really hope to get you on next time.
Nadia Adams: [00:28:14] Thank you so much for the opportunity and really appreciate it.
: [00:28:20] Thanks for listening to the Outcomes Rocket Podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes resources inspiration and so much more.