Why Implemention is The Best Way of Innovating in Health with Sanjay Shah, Director of Strategic Innovation at Dignity Health
: [00:00:01] Welcome to the Outcomes Rocket 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, Saul Marquez.
Saul Marquez: [00:00:19] Outcomes Rocket listeners. Welcome back once again to the outcomes Rockit where we chat with today's most inspiring and successful health care leaders. Thanks so much for tuning in. Visit us at outcomesrocket.com/reviews. And that's where you'll get an opportunity to give us a review on Apple podcasts. We love hearing from our listeners as well as our guests. And so take the time give us your perspective and we'll make this show even better each time you turn it on. Without further ado I want to introduce my outstanding guest. His name is Sanjay Shah. He's a director of Strategic Innovation at Dignity Health. He helped support dignity's health innovation efforts which seek to create test and invest a novel services programs partnerships and technologies from within or outside of healthcare that have the potential to reduce costs of care, improve quality or increase access to healthcare services across the organizations 39 hospitals in Arizona Nevada and California. He's got a wealth of experience in healthcare. But what I want to do here is open up the microphone to this wonderful man. Sanjay welcome to the podcast.
Sanjay Shah: [00:01:37] Thanks. So how are you doing.
Saul Marquez: [00:01:39] Doing fantastic man. It's a pleasure to have you on. It was great to connect with you at Health 2.0.
Sanjay Shah: [00:01:45] You know there was a great energy in that environment. It was all interesting I think for all of us to see now that HIMMS has acquired Health 2.0 to see what would happen what would change what would be different. Matthew Holt come out in a tie and get inside come out with shorts as well. But you know it was none of it changed. It was a fantastic event. As usual a lot of great early startup energy passion and focus on the patient voice and how that should be heard and can impact the way health care is created practiced and provided.
Saul Marquez: [00:02:20] Yeah I agree. It was awesome and really enjoyed the energy. Yeah that's a good call. The energy and I loved talking to all the people that stopped by the outcomes rocket and you know I wanted to ask you. We didn't get to connect on this but what got you into medicine in the first place.
Sanjay Shah: [00:02:36] You know if you're if you're South Asian or Indian descent your family and in my case my father especially kind of prescriptive wants you to be a doctor that they planted that seed early on. But I'd say that pretty quickly became my vision of what I thought I really wanted to do and it really was being a practitioner and to be a physician had no thought and specialty in terms of what would be an interest or a focus. And so as as I was going through junior high school and even my first year of the college someone would say What do you want to be. And it was I want to be a doc and then I opened up the cat. My first day of studying for the Incat and I shut it immediately afterwards. I don't want to be a doctor. This is one of those things where I was fortunate to be able to experience a couple of different fields while I was still in college and I took my first business class after a semester of prelaw half a semester of education and political science. And then I took my first business class and it just clicked. I said there's something around the aspects of business and then that aspect of business and health care that really connected to me as what I was excited to do going forward.
Saul Marquez: [00:03:58] Wow. And then you just kind of found your space business intersection of healthcare and here you are.
Sanjay Shah: [00:04:05] Yeah. You know I've been fortunate to experience all different sides of healthcare. And so in the beginning there was a local durable medical equipment company called the low rental on Warren Michigan. It happened to be one of my best buds today. The name Shaji Jacob and it was his family owned family business and his father gave me a chance to understand how to run a small health care business from the ground up anything from patient care to billing to position management claims supplies and management and delivery. And so it was it was a great apprentice. And from there I got a chance to really just go right I understand how to how to navigate something including when reform and regulation happened which completely changed the business that you could bill a traditional fee for service on a monthly basis to a capped service. So you pretty much lost your patience after three years and if you weren't a large enough player you had to change it. Think about your model differently so it was fascinating to see all of that and then matriculate down you know from an MBA to a little bit you know if you're from the Midwest you have to spend some time usually on a motor company. So after I did I did my stint at Ford Motor Company for a little bit and at that time actually found the end of Excel it exists. I created a sheet that actually got all the way to the end. How can I go any further. Yeah. It's like triple Z or something like that. But.
Saul Marquez: [00:05:31] It's funny.
Sanjay Shah: [00:05:31] You know it was it was good to experience that but then was fortunate to do what was called an innovation function about the medical innovation center at the University of Michigan. Some consulting in the innovation space all related to health care healthcare in academia healthcare in practice and even in industry. And then came out to California with the California Health Care Foundation which was to practice not only the grant side and development of grant initiatives but to also invest in introduce or entice startup companies to focus on their patient markets and had a great four years there and learn a lot about really the distribution of funds and managing funds into the venture side. Even though it was from a nonprofit a non-profit sector but they were real venture Metro levers and I wanted the chance to get really hands on in operations. And that's what the opportunity a Digne health became two years ago and it's been fantastic ever since.
Saul Marquez: [00:06:28] That's so cool and you really have had the full gamut of every single stakeholder in healthcare. This theme of innovation Sanjay it's something that is on the agenda of a lot of healthcare leaders. But what would you say makes innovation strategic rather than just innovation for innovation sake.
Sanjay Shah: [00:06:45] I'd be remiss if I you know quote my my boss the chief cities innovation officer a Dignity health betroth and today. It sounds cute but it's real innovation in healthcare today. Implementation. We're catching up as an industry on all of the different technologies and mediums that exist in so many other industries. We're just incorporating them now into healthcare and whether that's good or bad is not really the debate but it's happening which is what what's good right we're catching up folks that have purchased things and experience solutions and experience purchases and different service layers in finance and consumer product goods and shopping and even food. Those are becoming core now to health care. But in healthcare while we're catching up on all those things the key is is to implement. And it's not just the pilot but to implement at scale is really the secret sauce of innovation. If I go back to my innovation consulting days when we when we played the semantic game around what's an innovation it wasn't invention right. Invention is the idea that you build something right. Innovation happens when people adopt it when you scale it. So it's not so much concerning around whether this is incremental versus disruptive but it's about the fact that are people using it and arm people making it a part of their everyday practice. And I think that's the key. That is the key differentiator of innovation in healthcare today. Some things are still early on in stage and invention level and others we have been able to go ahead and full fully really revamp and change and transform the way health care is practiced and those are the real innovations that we're standing on today.
Saul Marquez: [00:08:26] Sanjay that's such a thoughtful response there and innovation is implementation listeners. And so think about that across the continuum of services and industries. We have so much going on by way of you know new products new services new technologies. How can we implement these into our facilities into our patient care methodologies in a way that helps improve outcomes. I think this is so awesome Sanjay and a great perspective to put on innovation its implementation.
Sanjay Shah: [00:08:58] You know I had a thought yeah backing off implementation and this notion of outcomes and you know you titled this podcast outcomes rocket there's something to innovation in outcomes as well. That's a little different to healthcare. Healthcare traditionally and the way it's reimbursed and the way it's measured in the way health is defined is for all all the right reasons. On a longitudinal scale and so traditional metrics take a long time to get to there are scientific and their approach. Their evidence base their research their research. You know in its purest core. But then you try to overlay that in the innovation world which has to move at a different pace whether it's for catch up or to get ahead. And I think one thing that just came to mind is this notion around taking those traditional metrics that are still valuable still impactful still the way that a majority of the business and operations run. But unpacking them in a way whether you call them K.P. eyes or micro metric things that will show you trends things that you can measure in three to six months that you can feel confident on and will help you scale that innovation help you implemented further versus waiting for the full you know 18 to 24 month cycle to determine did we avoid a readmission or did we significantly improve patient insurance based off of you know the full end of outcomes on the back end. And so I think there's something to also this these two sides that are against each other when it comes around innovation and outcomes and starting to strip away the traditional measures in more digestible pieces which will then help your innovation scale further and farther and give you the time you need to build momentum and a business case and value to prove those hierarchy outcomes that you started with in the first place.
Saul Marquez: [00:10:50] Now that's a really interesting idea Sanjay so basically you're coming from the premise of the cycle the time cycle in health care can be a little too long. Why don't we chop it up into more digestible units. To then be able to scale more effectively.
Sanjay Shah: [00:11:06] Absolutely. I mean if you look at any startup partner and the venture partners and with us being in the Bay Area obviously we're swimming in a great market of all kinds of very interesting activity from venture corporate the tech companies and the startup companies. But if you tell them that they're on an 18 to 24 month evaluation that can be literally in and of itself can be what really is a startup initiative. It can be what ruining something that was entrepreneurial. So by unpacking the traditional metrics into bite sized chunks it allows the company to keep hitting strides or the innovation initiative to keep hitting strides and build momentum but still allow you to kind of buy into it and spend into it so that you're not prematurely ending things because you're afraid of the long tail or long process. Wish those two things are at odds with each other right from the beginning. You can't move fast and evaluate innovation if you're tying into a metric that takes two years to get together.
Saul Marquez: [00:12:04] That is so true. And so how do you make it work then. So if you have such a you know a long traditional cycle how do you make it into bite size pieces.
Sanjay Shah: [00:12:13] I think it comes in our case and in our environment to health what's really helpful is we bring a lot of different stakeholders in any innovation initiative together and deliver that might be the operating team key executive leadership I.T. legal H.R. administrative services. And we look at an innovation initiative we understand are our processes that we're going to have to do to get something from our initial review to actually getting into the operations and implementation. But then we're looking at well what would be really needed for an impactful along the way we understand what the eventual target is or the goal and what could we uncover along the way that would meet our near term objectives. So if you think about something like avoided readmissions could you be looking at items or metrics like time to first follow up appointment or refill of initial discharge medication. You know Linkous they there really time time to go home or some form of checks that were processed on understanding of patient instructions and medication medication list. So you start to take what would feed into and you know you've got it get a little complex right. This process of ebbs and flows where the budget is wider and narrower wider and narrow to get to the end goal. But if the end goal and avoid readmission if possible for 30 60 90 day time frames what are the things in those first 14 days the 30 days that you could uncover working with your team including that your sare soordination team. Have outreach with them within the first week or so and are you able to do some form of assessment before they get to their house or after they get home. Those are the types of things that you can actually do in the near term. And if you look at them and you put them in aggregate you will feel confident if they're positive on even in those micro metrics or KPI that you're on your path to a successful larger more impactful outcome.
Saul Marquez: [00:14:12] Love that, that's such a great example. Thanks for walking us through that. Sanjay I know I was sort of wondering how do you break it down and I'm sure the listeners were wondering the same thing and I'm so glad you were clearly able to walk us through that because oftentimes you have that end goal but you have so many outputs there are going to help you improve outcomes along the way. So keep your mind and your eyes and your ears open to those things as they come.
Sanjay Shah: [00:14:39] Absolutely.
Saul Marquez: [00:14:40] That's so great. Can you give the listeners an example of a successful innovation or implementation that lead to better outcomes recently.
Sanjay Shah: [00:14:48] So you've got to we've got a couple that are hitting the press in different ways right now but if you look at our partnership with a company called magnetics which does tell ascribing and other supportive services the Google Glass as a platform and you know that is significantly impacting patient experience provider experience. I think it easily allowing providers to see more than 2 patients per day while spending less The EHR around almost two hours a day less on a daily basis. So we're creating more access. And at the same time taking a task of patient charting off of physicians plate allowing them to establish a much more connected and deeper relationship with their patients because they're focused on the patients and not on the computer screen. So that's an example of something that's scaling across the health system as we speak. You know it's ironic because that's one where we were the first health system partnering with them and working on validating the use case in technology in a clinical environment in the first place so it's great to see that is where it is today. On the other side of the House would be you know our recent focus we're collectively dignity help and a few departments that took the lead helped set up our Office of Digital that's led under Dr. Shez Partovi and we really wanted to not only uplift what we call our digital front door but on the clinical side of the House or as we transform more into the clinical side of the house beyond kind of surgeons schedule and some the basic functionality that people just need and expect to experience when they're looking for something and they want a booking schedule. But we were looking at patient journeys and on the maternity patient journey where we started first or if you want to call an old be patient journey. We looked at two partnerships that we've established with companies one Docent health and the second is a partnership with wildflower health on a Digney health maternity called my baby. And so with this layering of docent Health which has both a technology and a service layer to help consumers navigate their journey from what services they should consider what questions they may have. You know they do everything nonclinical and when something breaches clinical they help that consumer weave back to the clinical team and including you know on the day of delivery helping that individual says you get to their room or get a real of or Sipes service so helpings really nice patients with kids who might have to want months of coloring or Harsley certified that they can help install CARSI and helping complete the end to end the physical side. And then you pair that with my baby as a mobile app to support the mobile side and the digital journey that someone may be experiencing outside of our four walls. And you really created something that's seamless and helps improve and impact a patient journey which is you know from end to end. Not just one point in time when they're coming into a hospital facility for their birth but how they may be thinking about options for you know let's say breastfeeding versus formula feeding and the benefits and when you may have to consider one or the other for nutrition purposes and really helping folks understand the value of breastfeeding in the golden hour that we talk about and things like that that people can learn about each consume and digest in the mobile format similar to how they're digesting in other categories or other sectors of their shopping. But we're starting to put healthcare in that realm.
Saul Marquez: [00:18:24] I think that's really cool
Sanjay Shah: [00:18:24] the only great outcome. Yeah. It's fantastic. You think about as consumers look this is how I somehow want it to be. And so the outcomes that we're seeing there are folks are absolutely more satisfied or extremely satisfied with their patient experience and they feel better connected with their physician. They feel that they have been better heard or listened to and were able to also support of why a wider aspect of their care from including surfacing sometimes in a postpartum depression concerns because they have a relationship with more than just the condition they have a relationship with dignity health and their experience and their partners whether it be through the Docent that Docent health whether it be through my baby mobile application like there's more ways that they feel connected in a part of their their journey their process. And so that's been great to also see more recently matriculate across our health system.
Saul Marquez: [00:19:17] Now you know and my wife and I just had a baby eight months ago. And you're talking.
Sanjay Shah: [00:19:21] Congratulations. Thank you. It means it means you're not sleeping.
Saul Marquez: [00:19:27] Yeah pretty much. And you know as you're talking through the experience and I just kind of kept thinking about all the things that we did through the process and you know a lot of times we found these on our own or we research them on and to have a health system that would have supported us the whole way and just thinking wow how cool would that have been.
Sanjay Shah: [00:19:48] You know I think it's it's our job. You know this is this is where we are in health care and we're not the only healthsystem doing this. There are plenty of peers that are also thinking about this format or the view of a patient journey. And if our right to improve that health care experience like you I've got I've got a 3 year old and a 9 month old and a 3 year old with a gun that we kind of test pilot ourselves. We have five apps amongst ourselves and different resource and we were really active and involved including the right tracker's for the ins and the outs and we had to do a Niki's day because of Donnis. And you know we made it easy for the healthcare team. And it wasn't a burden on us because we wanted to be a part of that. Indeed yes these tools helped this track those rate and in some cases where we were more concerned and we were really concerned about ins and outs and feeding times and sleeping time. These trackers the though it has a digital asset helped us get through that journey helps us track it because you're not sleeping so to try to keep that mental memory is not going to work very well. And so that's that's the goal right is to accompany the journey that is a health care or health experience and make it better and improve upon it. And that's the potential for digital and digital tools today.
Saul Marquez: [00:21:07] Love it. Sanjay this is such great stuff. Time flies when you're having fun and I want to ask you what is a focus that you're working on right now. That's exciting.
Sanjay Shah: [00:21:17] Yeah the notion of patient journeys and it's applicability to others. So we're we're figuring out right now I think is really exciting. I think rightfully so. All of us in healthcare are really actively looking at social determinants of health. Yes and finding a way to talk to a little bit about Digne health but you know as a mission based organization focused on making sure that all who need care have access to care it's vital for us and really consumers in the numbers and the communities that we serve to think more about the episodic issue which is sometimes the health care issue and think about the longitudinal issues or the community issues and how we can play a role in improving and impacting those. So whether it's access to food transportation educational resources housing not only providing access and transparency to them and facilitating those but also bringing those back in loop on how we practice healthcare. And so I'm excited with my peers across multiple streams from you know I.T. to legal to population health community health and the different clinical champions across the health system. This is something we're starting to really band together on and many health systems are an understanding that our impact our mission goes beyond our four walls goes beyond the traditional definition. And I don't know if it's the traditional vision but it's the evolved definition of health care and we're going beyond that. You could probably go back how it used to be which is a person is a whole person and everything that impact them it would impact their wellness their well-being. And you know more so that that's really what's behind the human kindness. So this notion of journey the notion of social determinants of health are two really exciting opportunities for us to direct our focus on which also helps us bring our mission and really correlate that with innovation all at once.
Saul Marquez: [00:23:15] Yeah I think that's so exciting and it's interesting because yeah. Lot of hospitals a lot of companies and you know a lot of payers are all focused on this area of social determinants of health. I think with this focus the next few years we're going to get some pretty cool solutions that come and I'll be looking to dignity health to see what you guys are up to for sure.
Sanjay Shah: [00:23:37] It's an exciting opportunity area because it's a chance to do so much more than just provide you know foundational healthcare which is hugely valuable. But again that's an episodic view versus being a partner with an individual as they're going through their journey. And you know that ties into this third area that I think a few others including Dignity health are really excited about is this notion around Medicaid Innovation and considering that and trying to help transform that into being a strong and viable market in and of itself or the place where innovation can start and translate upstream a lot of things to start for commercial patient areas or commercial volumes or commercial settings in terms of a payer perspective. And that's where innovation starts because the belief is is that the business model that can support it. And I think today now more than ever with the socially minded and socially responsible entrepreneurs with the focus and attention to funding with health systems like Dignity health and others that have focused on this base and the fact that we're part of these communities. We might be able now to include the venture community that are also supporting the areas to think about the market the Medicaid market being an innovation first opportunity and in of itself that business models can be validated here and derive value where you're designing for a broader patient base that might still translate up to all different types of nano and.
Saul Marquez: [00:25:04] That's for sure. It's super interesting. I think that it's it's amazing time to be in healthcare. So Sanjay let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today it is the course or the ABC of SANJAY SHAH. And so we're going to write on a syllabus someone ask you four questions lightning round style and then we'll finish up the syllabus with a book that you recommend to the listeners. Ready.
Sanjay Shah: [00:25:33] Got it.
Saul Marquez: [00:25:33] Awesome. What is the best way to improve health care outcomes.
Sanjay Shah: [00:25:38] Remembering that health care is a service industry.
Saul Marquez: [00:25:42] What is the biggest mistake or pitfall to avoid.
Sanjay Shah: [00:25:45] What I said earlier. Tying yourself to traditional longtail clinical outcomes.
Saul Marquez: [00:25:49] How do you stay relevant as an organization. Despite constant change.
Sanjay Shah: [00:25:53] Focusing in refocusing and laser focusing on patient and provider experiences or mentoring that both are extremely connected.
Saul Marquez: [00:26:03] What is one area of focus that should drive all else in the organization.
Sanjay Shah: [00:26:07] Go back to the roots of what healthcare is and the mission and you know we call it Hello human kindness here Dignity Health but it's the compassion and the values that you bring in supporting someone in that time. And if you think about that and you whether you look at it from a provider perspective I no longer than an the response but you think about it if you think about it from a provider perspective a business perspective a payer perspective. If we all commit at that length and the consumer as well we should be able to come out of that and feel like we won like we all succeeded and no one should feel at a loss of a tug of war scenario.
Saul Marquez: [00:26:42] I love that. What's one book Sanjay that you recommend to the listeners.
Sanjay Shah: [00:26:48] This is tough. Ok you know one book that folks don't usually. And this is back from the innovation space I remember the black swan theory by Taleb. That's a great read but I'm going to caveat with like one B and one C is pretty much anything by Malcolm Gladwell and another book. I really do like in terms of understanding how big businesses are formed. It's just a great read from a historical perspective and the way that's what was put together but it's a book called anything by Robert Greene. But the book that I'm really thinking of is 48 Laws Of Power.
Saul Marquez: [00:27:22] Love it. So outcomes rocket listeners they have it Sanjay. He just put together an awesome course for you. Go to outcomes rocket.com/Shah And you're going to find all of the show notes as well as the tidbits in the syllabus and book that he just put together for you. So don't worry about writing it down. Just come go to outcomes rocket.com/Shah. Sanjay this has been a lot of fun. Before we conclude can you just share one closing thought and then the best place where the listeners can get a hold of you.
Sanjay Shah: [00:27:57] In light of everything that's going on right now with respect to change and potential change in focus on what does that mean. Whether it be for fee for value I think all of that put aside we still are responsible for improving the health care experience for everyone and improving that from both a business model a practice model an inexperienced model. And therefore innovation within healthcare really has no opportunity to stop now has no opportunity to change and is required and will always be required if we're going to improve upon the practices and the model that were established a long time ago and transform over time. So I think as you put it saw an exciting time to be in healthcare and continues to be so. And I'm really looking forward to what we establish now in the near term the next three to five years. And what we may really be able to leverage from a technology perspective when we're talking about voice and VR and mixed reality in 3D printing and you know the value potential decreases the block chain and whatnot. So that's what's really inspiring exciting about this time today in healthcare innovation. And lastly you know you'll find that they give you help myself my colleagues at your expected national you know health events whether it be J.P. Morgan or HIMMS or Health 2.0 any entrepreneur or event that you can expect happy to and feel free to send us a note on Twitter you know see us on that you know whether through the dignity health account or personal stuff that you can find there and we're happy to engage with you there as well.
Saul Marquez: [00:29:27] That's so awesome Sanjay. Hey really appreciate that. And listeners reach out and collaborate. This is what the outcomes rock it's all about. Sanjay this has been so much fun every time I chat with you. I just get jazzed up I get excited about what's next and so really looking forward to having you on the show again in the near future. And just thank you again for making time for us.
Sanjay Shah: [00:29:50] Fantastic. Thank you so much. Appreciated this. And I for one love the fact you're doing a podcast. I know our team is the huge fan of them. They make all our plane trips and bike rides than any other work. We go and go by so much better so I don't know whom to listen to myself because that's always interesting experience do look forward to listening to the other outcomes rocket Podcast.
Saul Marquez: [00:30:10] Thanks brother.
: [00:30:15] Thanks for listening to the outcomes Rockit podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.
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