Month: January 2018

Full Podcast Transcript

Addressing Global Health Inequalities by Empowering People with a Vision with Vanessa Kerry, M.D., CEO, Seed Global 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 Rocket where we chat with today's most inspiring and successful healthcare leaders really want to thank you for tuning in today. And if you love what you hear today or in general visit and that'll take you straight to our Apple podcast where you can leave us a rating and review. We love hearing from our listeners so drop us a line. They're always excited to hear from you. Without further ado I want to introduce to you my outstanding guest. Her name is Dr. Vanessa Kerry. She's the CEO of Seed Global Health. Seed Global Health is a nonprofit organization whose mission is to work closely with developing country partners to promote and support new generations of health professionals to serve as global health educators and work within countries facing critical human health care resource shortages. She is also a doctor in critical care at Mass Genn and has an outstanding history of just being a contributor and health care. Without further ado, I just want to open up the microphone to our special guest and let her in any of the gaps in that intro. Vanessa, welcome to the show.

Vanessa Kerry: [00:01:34] Thank you so much. It's a pleasure to join you. And it's a really I think tremendous thing that our is doing just in terms of trying to highlight stories in health especially I think that one of the things we just talked about it seemed is that health is really the underpinning of almost everything we do or want to do in life. So telling these stories is incredibly important and we're really honored to be able to join you.

Saul Marquez: [00:01:59] Thank you so much. Dr. Kerry and so why don't you share that beginning story that first domino that led to it all. What is it that got you into health care.

Vanessa Kerry: [00:02:08] You know what got me into healthcare in the first place. I'm not actually so sure. Now I think that was just a very intrinsic thing in me. I was always interested in science in general. And then I had an outstanding biology teacher prop up Polly in seventh grade and Mrs. Polly. Just something about the way she taught her own excitement about the work ignited biology especially for me. And I actually decided in seventh grade that I was going to be a surgeon. I had no idea what that would. You know I'm not a surgeon. But it's not really my idea of being a physician. And there's always determined to go to medical school.

Vanessa Kerry: [00:02:47] I think that what became interesting is how that got shaped and molded by various experiences in my life. One being the daughter of two public servants. I had a father that was very engaged in international relations and I had a mother who was very proactive about fighting the stigma of depression and talking about depression a time when nobody else was. Both my parents grew up abroad.

Vanessa Kerry: [00:03:10] And so I had a real understanding of how you can be 100 percent American. Love this country still understand how we weave into the world outside of our borders. And then I think through my own experiences that I had I really realized that I wanted to be engaged in global health. When a story they always tell is that I had this unbelievable privilege of going to Vietnam when I was 14 and really saw an extraordinary poverty unlike anything I'd ever seen before and couldn't really make any sense of it as a 14 year old I just hung on that experience. And that ended up catapulting me to spending a lot more time abroad working in Uganda and working in Rwanda and so as I was finishing up my residency I really knew solidly that I was going to have a career that worked on the health disparities in the world both what we see in variable resource limited countries abroad as well as I think becoming invested in what some of the Raspberry's are in this country.

Saul Marquez: [00:04:08] Wow what a story and really appreciate you sharing that. You know a combination of your parents and teachers and then also your exposure to the world has sort of taken you around the globe and around this the system of health care to now. Frontline practitioner to now leading this amazing team in this effort that you have at Seed Health. Really excited to jump into some of these things. Vanessa what would you say a hot topic that should be an every medical leaders agenda today. And how are you guys addressing that.

Vanessa Kerry: [00:04:41] It's a great question.

Vanessa Kerry: [00:04:42] I actually very strongly believe that one of the most important topics we can be addressing in any health related or leaders agenda needs to be people and how do you train really good people. How do you have the right resource mix of people and how do you have them working in the right place. Urban versus rural clinical versus hospital how do you incentivize people to create that spread. And I think very importantly how are you keeping them in the health care industry. And I think that's an issue in any country whether you're United States or elsewhere and certainly in the places we work. So Seed Global Health really just in this space we are training future doctors nurses midwives in countries that have very severe shortages of these health professionals. These health professionals are critical because are the leaders of their health care system. They are able to not only provide outstanding care to patients immediately but they're able to support the health care all the health workers and the health folks in the health care workforce across the whole system and very importantly they're able to train their successors so that you can ensure there's a pipeline of qualified providers that are going to be available to these countries that are in your face these incredible shortages. Just to give an example a country like Tanzania has one woman die every hour from a complication of pregnancy or childbirth one every hour. Yet this is a country that has only one physician and 24 nurses for every 100000 people. Wow. To put that into perspective. You know the United States has about 240 physicians and 980 nurses for the same population. So we're talking about really severe shortages of healthcare providers. And I think this is going to be one of the really critical crises that we're going to be seeing globally.

Vanessa Kerry: [00:06:31] If we don't do something about it and it's even measurable predicted the World Health Organization knows that if we don't step in and do something about the human resources for health crisis in the world there were no shortage. Just going to grow from seven point two million doctors nurses midwives to 18 million by 2030. If we don't change how we're addressing.

Saul Marquez: [00:06:52] It is a definite issue. And even here in the States too you like shortages are happening. How do you retain people from getting out of this business of healthcare. We have the issue here in the States too. It's even bigger abroad. And so you seemed to be a leader, Vanessa that loves to tackle difficult challenges. Right. You go to critical care where it's definitely not the easiest problems to address in health care. And now you're you're going to these countries Malawi, Tanzania Uganda, right. It's just these countries that really need help and you're doing the grassroots efforts. Can you give us an example of what you guys have done to create change and better outcomes there.

Vanessa Kerry: [00:07:35] Absolutely. So I can give you two examples. One example would be in Malawi in nursing where we had one of our nurse volunteer in nursing clinical educators many Weschler was working in hostile northern Malawi. And during her work she saw trauma and surgical patients who were getting their dressings and other things done without any pain medication. And she realized that there really was a lack of understanding of how much pain medication could help and that it could be used appropriately and that there was a year of addiction of these pain medications and so using a small grant that we supported she gathers and her colleagues and they work together do a practice improvement project where they ended up really redesigning not only the algorithms and protocols by which the medication could be given for these patients but how the medications are distributed in the hospital how their sort of access them. So what happened was that they ended up doing this whole education program and it not only got successfully rolled out in the wards that patients were getting their dressings changed and other procedures done with appropriate pain medication but in up getting rolled out across the hospital and I think it's been a real example for other locations about how this can be done appropriately. And it means that patients dressings were being changed wounds were being kept clean they're getting appropriate treatment to care infections go down and has a real in addition to just leaving people horrible pain.

Vanessa Kerry: [00:09:03] It has a real impact also just on outcomes and how people do and I think that's really you know I think for us powerful story of how one person can institute a pretty large systemic change. Another example is Dr. Ali Asghar Caskey who is a medical student in Tanzania who taught by one of our clinician educators. After spending a couple of weeks with our educator Dr. Esther Johnson he went on to one of his other rotations and the they're doing morning rounds there's a baby that wasn't breathing. And Ali Asghar instituted the protocols he learned as a clinician educator realized the baby still had a pulse he could resuscitate this baby saved the baby's life. And Ali Asghar was so affected by the realization that he could have such an impact on a patient life with just knowledge that even more equipment necessarily ended up organizing a training for 200 other providers at his hospital became a master trainer neonate or a citation. Now he's traveling Tanzania teaching others. And if you ask him what he wants to do when he finishes training he'll tell you he wants to be a Tanzanian Doctor Who stays in Tanzania and who teaches others and his successors.

Vanessa Kerry: [00:10:12] I think that's the kind of real example that we're trying to show because Seed Global Health does is trust things on a very personal individual level your relationship and sort of you know shared problem solving. But we then really try to institute that systemically and to have that have a lasting effect across generations so that our hope is that in five 10 years we will work ourselves out of a job we will have trained their replacements. That's a big reason that in Swaziland one of the five countries where we work now we were asked to expand to afford nursing training schools there they're all for training schools in the country which allows us to have a really systemic countrywide impact on the quality of education and nursing leadership. It's why the president of Liberia asked us personally to come to Liberia and help our country rebuild after Ebola and to both support medicine and nursing education and training. And I think that what we've been struck by is that in the last year alone we had over 20 requests for partnership or expansion which I really think speaks to our model and the reputation that we're starting to build.

Saul Marquez: [00:11:18] I would say so as well. And what amazing stories that you've shared and you know just kind of puts it into perspective. There is an opportunity out there to improve outcomes and in a place where it's appreciated not that it's not here but there is an opportunity to truly improve outcomes for people that really need it and appreciate it. So I had a guest on my show not too long ago. He's the chief medical officer over at Sutter Medical Group one of the things that his program provides for physicians is being able to let them go abroad and providing a stipend of like 2500 bucks to help them do that. Are you guys looking for more physicians to help with your trainings. What kind of partnership could have been here now.

Vanessa Kerry: [00:12:05] I love that. And we're only going to solve really big problems if we do it through partnership and through collaboration.

Vanessa Kerry: [00:12:12] And I think strategically about how we can complement one another to tackle these big issues us as one of the unique things about our model that I'm very proud of is that we require people to go for a minimum of beer. Oh wow that allowed it. To and I know that seems that's a commitment. But what it does is it allows people to build the relationships and the trust needed on the ground to be really effective at what they do.

Vanessa Kerry: [00:12:37] And one of the stories I love is that we had one of our volunteers was the guy from San Francisco who was under the bed fixing foley catheter when a Ugandan tour came through and one of the visitors asked Ugandan host whose name is Ogu which is the term for foreigner under the bed and the Ugandan host's response was that's not. That's Ari and he's one of us. And that was so striking to me about the rock the trust that we feel. And I think it's one of the things that's really profound for our model. We know that the big problems sometimes take big solutions. I know we're always looking for silver bullets and fast ways to achieve big outcomes. And I think there are ways that we can contribute to healthier lives better prevention really knocking down some of the big health challenges that we see in the world through some of those answers. But we are going to have to put the time and the effort in to training people who become health leaders and can really be profound agents of change in their country see the country strategy that need to be done.

Vanessa Kerry: [00:13:44] Know how to implement the technology appropriately and in the right places know how to use silver bullets fly them widely and disseminate them. And that's the work that he is very committed seed global health is very committed to doing.

Saul Marquez: [00:13:57] Love your vision. It's so awesome so compelling makes me want to go out there for a year and for the listeners. If you do have that type of commitment if you are looking for that stretch you know I think this is an organization you should follow. Seed Global Health. Check them out there on LinkedIn. They're on social media. Definitely an organization to follow. Can you give us an example of a time when it was difficult. And you know Dr. Kerry you had a setback and what you learned from that setback.

Vanessa Kerry: [00:14:30] And I feel like we're starting an organization we're only five years old. We're laced with setbacks along the way just by the nature of being a young organization. We've had really rapid growth and that part has been incredibly I think validating and exciting to see that demand for the work we do. I think the setbacks are there's all different types of setbacks. I mean a I would say that one of them you know just on a personal note a setback for example.

Vanessa Kerry: [00:14:59] I think that I had a just for example when I first got into this work and I remember my first trip to Uganda and I was charged with figure out ways that we could build partnerships with one of the institutions we were working with there. And I just went in gung ho ready to go in patient, time to get things done. This is TELL ME EVERYTHING you tell me and when can you meet me and how can you do it. And I got two pretty speedy feedback through you know a colleague also working there that I had managed to insult her off foot about half the partners on the ground.

Vanessa Kerry: [00:15:36] And I was really devastated by that because I went in with the best of intentions right. But what I sort of had failed to realize was one there really was a cultural norm and to to be patient. And I think that that was a very important reminder to me that I feed into our work its Seed Global Health. That's the long hard real work is about partnership. It's about listening. It's about studying. It's about understanding your context and it's about really working together. There's an African proverb that I will get slightly wrong but they say if you want to go fast go alone. If you want to go farther go together. And I think that's a very important lesson that I try to carry with me every day because the work we do is hard and sometimes we do need to stop and pause and defer and really ask ourselves are we doing this right or what values are we put into it.

Vanessa Kerry: [00:16:35] And I think one of the reasons that we've built the reputation we've built and we've been able to expand to five countries and we've had the impact of training over 13000 doctors nurses and midwives in our first four years has been because we've tried to really adhere to that kind of philosophy.

Saul Marquez: [00:16:51] If you want to go farther go together and listeners think about this as you build your initiatives whether it be here in the states whether you be a provider or a payer industry if you want to go farther go together think about that and think about your front line what are you doing to replace yourself. What are you doing to train your bench. What are you doing to give these people decision making power. This is the focus that Dr Kerry and her organisation do so well. What are you guys and gals doing about this for your organisations because this is what's going to determine the future is what's going to help improve outcomes. Dr Kerry let's focus on a good thing. Tell us one of your proudest leadership moments to date.

Vanessa Kerry: [00:17:34] Oh my gosh. I don't know if there's any one I have to tell you. I'm I think when I can just step back and see that Seed Global Health is working at 34 sites in five countries that we've helped train over 13000 doctors nurses and midwives in four short years that we've built a reputation you know that people want to work with us that has been a tremendous source of pride for me. Every day we have an outstanding team. I and my colleagues are incredible our partners are incredible and so every day for me frankly is one of huge pride. I think there have been moments where I've been pretty stunned though or that it crystallizes a little bit more strongly and I would say that one moment was in 2013 when our first group of 30 came to their orientation and lined up to go and were standing there before me and something that had started as a grassroots movement because that's how we started. We were just an idea trying to get people to support it. To see the value of sending US physicians and nurses and midwives abroad to not just deliver care but to educate and to train and to build that from a movement into something that became reality in a way was extraordinary.

Vanessa Kerry: [00:18:52] And then when we expanded in 2014 it was announced that we'd be expanding to two new countries. That was a moment of just extraordinary pride because we were still going. But you know I got to be really honest with you every day that we're still standing and still having an impact especially I think at a time when the world is changing so much. It makes me really proud. I think seed global health is doing really great work and it is wonderful work that not only impacts the places that we work in Africa I think it brings benefits here home to the US as well where we know that over three quarters of the people who participated in our program are working in education or with at risk populations here in the United States. And so seeing seed global health impact I think just in terms of redefining how we engage with people how we engage in health how we engage with one another some ways is really important. We try to stay humble and we try to be really iterative and try to always make seed global health be more effective at what we do.

Saul Marquez: [00:19:58] Yeah that's really cool. And you know didn't even think about that aspect of it but the cultural dynamics and the processes that are formed abroad can really help serve in the efforts of population health at risk populations here in the States. And I think you know like these people that have dedicated themselves and then they come back. Wow. Like I'm sure they can just put things into perspective and say to their peers hey you know what level this out. I've seen worse. And we can make this happen. This is pretty cool.

Vanessa Kerry: [00:20:34] Yeah I mean I think it's we are we are very blessed with a lot of resources in this country which can make that delivery of medicine easier. I will say though part of the reason I say practicing clinically even a little bit so I stepped away from my main practice is because it's really important to stay grounded in the vulnerability of being a patient and being reminded of that that my practice is critically important because they are patient United States are patient abroad. When you're facing some sort of medical issue you're suffering and hopefully here in the United States there is a possibility you know for treatment and care being able to get better. That is probably more robust and in many places it is more robust than many as we work. But. The vulnerability of being a patient is very real in all aspects and I think that's the special thing about being a health care provider whether it's a nurse midwife doctor or others that you really have this incredible trust to do the best you can to care for folks for sure.

Saul Marquez: [00:21:33] Yeah it sounds like you definitely are staying connected keeping that part of practice real that you know patients are people and when they're in their biggest need that's when they depend on you. And so I think it's so cool. Dr. Kerry, let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It is the 101 course or the ABC of Vanessa Kerry M.D.. And so we're going to run out the syllabus with this lightning round. There's four questions and then we're going to finish it with a recommendation for a book.

Vanessa Kerry: [00:22:10] Oh great. Sure.

Saul Marquez: [00:22:12] So here's the syllabus. Listeners, get ready. What is the best way to improve healthcare outcomes.

Vanessa Kerry: [00:22:17] For me the best way to improve healthcare outcomes is to really put more emphasis on prevention and on trying to get to the upstream causes of disease because it's far more cost effective and there's far less suffering if we can cut things off earlier rather than having to worry about treating people when things are full blown. And that for me is definitely around not a treatable disease which is an increasing issue. I think globally in addition to some of the preventable infectious diseases that we could be treating earlier. But it's something that I think we as an entire global culture need to be better at.

Saul Marquez: [00:22:52] What is the biggest mistake or pitfall to avoid.

Vanessa Kerry: [00:22:55] I would say the biggest pitfall to avoid is to assume that there is a silver bullet or a fast way around really big problems. It doesn't mean that you can't get a really powerful leveraging answer or impact it could have a huge effect or it needs to be often really rooted and better set in a much more long term and probably complex solution if you're going to really tackle a complex problem.

Saul Marquez: [00:23:20] How do you stay relevant as an organization despite constant change.

Vanessa Kerry: [00:23:24] I think for seed global health we stay relevant because we're addressing a very fundamental problem that has needed to be addressed for years the shortages of doctors nurses and midwives around the globe are very significant and only growing and it's not a new problem. It's one that's been made. I can go into the history lesson but it's a lightning round that has been made for years for a whole variety of reasons. And so for us I think we are going to remain relevant because we are tackling a fundamental problem that if we don't tackle we're going to find ourselves in the exact same place in 20 30 years that we are in today. And so by the nature of training health leadership and future providers any training we are insuring an investment that can you know last generations.

Saul Marquez: [00:24:07] Awesome. And finally what is one area of focus that should drive all else in your organization.

Vanessa Kerry: [00:24:14] I think the one area of focus that drives all else the Seed Global Health is that we really believe that we need to close the two standards of care that exists in the world and make sure that we increase an understanding that health is integral and essential to everything we as a global community want to do. It has to be critical to the economy. It is critical to climate is critical to political stability is critical to national and global security just to personal well-being. It can be the difference to a household being above or below the poverty line. But we live in a time it's 2017 where there remain two very profound standard of care and that can be both across countries but even within countries and we are very committed to trying to close those two standards and just showing the world that it doesn't need to be in 2017.

Saul Marquez: [00:25:03] Love that. What book would you recommend, Vanessa.

Saul Marquez: [00:25:06] So there are two books I think for later reading Corelli's Mandolin is just one of my favorites. I don't know what it is about it. My mother grew up in Italy and there was an Italian. He writes out the book I just adored. And it's just a wonderful wonderful allegory. And then I think long walk to freedom by Nelson Mandela. Nelson Mandela was a really extraordinary leader and you know not without tremendous sacrifice and complexity but I think his vision his beliefs his calm his patience but just his optimism that we can help people do the right thing is a really powerful message and only more so today.

Saul Marquez: [00:25:50] Love it. What a wonderful recommendation. Haven't read that one so I'll definitely be picking that up and listeners don't worry about jotting this down. All of these show notes all of these books all of the links to see global can be found at that's S E E D. And you'll be able to access everything that we've discussed in a nice neat format and linkable to all the things that you want. So Dr. Kerry I just want to say thank you so much. But before we conclude I just want to offer one opportunity to give a closing thought to the listeners and then the best place where they could reach you and your team.

Vanessa Kerry: [00:26:28] Thank you so much for letting me in the story of seed global health join you today. I think my closing thought is that we really should be optimistic about these big problems are solvable. We just need to join together to I think tackle them and all bring our different strengths to the table. But I think most importantly we as a global community just need to think strategically about what are the ways that we can make us healthier, happier or safer and for us at people health our contribution is really about building that health care leadership the doctors nurses and midwives needed in these places of dire burdens of disease. But without the needed personnel to help them tackle it. And if we can create a global population that is healthy. And from that comes opportunity and hopefully I believe more peace security in all of these things. So I think it is about dreaming big but making sure that we make a contribution to that vision. If you want to find out more about the global health you can go to And again that's S E E D like planting seeds for global health for years to come. Thank you so much for letting us join you.

Saul Marquez: [00:27:44] It's been a pleasure Vanessa and looking forward to keeping up with your organization and what your team accomplishes here in upcoming years.

Vanessa Kerry: [00:27:51] Thanks.

: [00:27:55] For listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources inspiration and so much more.

Recommended Book/s:

Corelli's Mandolin: A Novel

Long Walk to Freedom: The Autobiography of Nelson Mandela

Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast - Stewart Gandolf

Full Podcast Transcript

Six Ways to Market Your Practice with Steward Gandolf, CEO of Healthcare Success

: [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: [00:00:18] Outcomes rocket listeners, welcome back once again to the outcomes rocket where we chat with today's most inspiring and successful health care leaders if you like what you're listening on the show. Please go to and you'll be able to rate and review us on Apple podcasts. This is super huge for us because it's the feedback we need to make the show even more amazing. So without further ado I want to introduce my outstanding guest. His name is Stewart Gandolf. He's the CEO of health care success, a medical advertising and Internet marketing agency. His focus is helping you, my listeners get your marketing and advertising in line so that you could achieve your goals. Want to open it up to you Mr. Gandolf to fill in any of the gaps in the introduction. Welcome to the show.

Stewart Gandolf: [00:01:14] That was great Saul thank you. I love doing that stuff and I love doing our own podcast so it's great to be a guest on it's fun it's a lot less pressure from me. I can just talk which is awesome.

Stewart Gandolf: [00:01:26] Believe me I can talk you actually to a pretty good job. I would say that our firm exists to help our providers promote primarily defined as doctors and hospitals attract the patients they want and so there's lots of marketing companies I've worked for great big ones I've worked for smaller ones I've done other things in my life but at the end of the day a lot of people do marketing because they want to do a great image. They want to have a great brand. They want to be very creative and we do all those things and we like those things too. That's not what makes us special. Our whole philosophy everything we do is driven towards attracting patients in fact on our conference room wall we have our logo along with our tagline and our tagline is scientific marketing that delivers patients and periodically in meetings with my team I'll point to the wall. It's like guys work here. They all say okay we're going. So it really is all of it. So again it's with to help doctors and hospitals profitably attract new patients.

Saul Marquez: [00:02:22] That's really great. Thanks for filling in the gaps there. And Stewart one of the things that I'm curious about why did you decide to stay out of all areas in the world land on health care.

Stewart Gandolf: [00:02:32] It's funny that's why I say I don't know if anybody ever asked me that question at home actually kind of went down when I work when I first came out to California worked client side for a while and there was actually in San Diego I think it was sharp or scripts I forget which one but it had a baby and a stork statue out in front of it.

Stewart Gandolf: [00:02:52] I was working in financial services I worked with a lot of big banks on Citi and chase and all those kinds of people back when they were completely gold plated names back in the day. But at anyway, I used to always think well that's interesting hospital marketing and I didn't think about it ever again. Flash forward a decade and a half I was working at Joe tops which is a huge ad agency. It's one of the biggest in the world and our spoke. I was working on an account called Bally's Total Fitness which used to have a bunch of health clubs chains like Cher and cineaste Heather Locklear were our spokespeople. I remember the Bentley. Yeah. Okay great. So anyway I was a former rider of mine. At that point you know I did that there and I was kind of through with advertising it's playing that game at least to me was pretty political and it just I'm kind of a stay independent in my thinking and I thought it would be. So I took a break from advertising and a former writer I knew. I reached out to him and said hey that's firm I'm working with one does marketing for doctors and I'm like, man does anybody do that really. And this seems sort of you know I was my buddy at Walter as a piece of an 80 million dollar budget. This is back and you know a couple of decades ago back when 80 million dollars was a lot of money right. And worked for private practice doctors seemed crazy to me. And so I ended up accepting the job and worked there for about a decade took a break from health care and then years later we started this firm so we've been around for about 11 years for him and I love what I do today happens to be a terrific day. We've had good news like all around the board. So it's it's good that that.

Saul Marquez: [00:04:27] What was the good news.

Stewart Gandolf: [00:04:28] We actually signed three new clients today. So they've got quite a week for us already.

Stewart Gandolf: [00:04:34] Thank you. We've just signed about a month and a half ago. Yale medicine which is very good has a prestigious client. But this today and we love that we're excited about working with them. They're terrific people but today we signed a 17 location addiction treatment center and no budget practice. And then another actually in ophthalmology facial plastic who's a friend and a friend of mine and a fan of our company. So it's been quite a good day.

Saul Marquez: [00:05:01] Awesome, outstanding. I'm glad to be here with you celebrating Stewart and thanks for sharing that too. You know it sounds like he kind of ebbed and flowed into health care and eventually just kind of stuck. And so. So here we are you know just kind of chatted about how doctors and providers can better market services because at the end of the day if you don't have people walking into that front door and they're not repeatedly coming through you're not going to be benefiting them with all the things that you're thinking about and helping improve outcome. So can you give us an example Stuart of how you guys do things differently.

Stewart Gandolf: [00:05:36] Well it's funny. First of all you brought up doctors and the fact that you can't it doesn't matter if you don't have patients right way back in the day.

Stewart Gandolf: [00:05:44] I like music and one of my professors told me that you know it doesn't. You know if you're doing something really creative and really wonderful nobody nobody's watching you what have you. CRUZ And in medicine we use that analogy as well that there is a sort of push and pull dilemma when it comes to doctors in particular over marketing. So they want patients, they want to be successful but they don't want to be what I call cheesy needy greedy and sleazy. So they want to market it in a way that is tasteful and that's ethical. And so having you mentioned I stumbled into this but my sensibility really worked well for this field because I thought it was going to be an engineer. It was really good at science and math and I was in engineering school. I happened to take a marketing class on a lark and just fell in love with it. It turns out I'm a creative person and analytical at the same time which is pretty rare. It's kind of explains why I'm so not like a good town but what interesting is our philosophy the way we do business matches with the doctor personalities. So meaning that what they don't really care. Most doctors we work with don't really care about branding they don't really care about Web sites they don't care about newspaper ads they don't care about it they just want patients. They really are focused on patients. So how you get there is kind of subjective.

Stewart Gandolf: [00:07:01] My joke is when I'm speaking our seminars is not everybody. In fact I had a exception yesterday I was speaking with somebody. Most are looking to put 100 dollars into a box and the patient pops out. That's exciting. So at the end of the day the doctors that we work with are very very focused on results and so that's why you ask. It's kind of maybe circuitous the way I'm answering your question but what makes us unique what that focus about patients and ROI and it turns out that fits perfectly with doctor personalities. Most doctors are very skeptical about marketing. They haven't met anybody that's very good. So when they meet us you know we're taught focusing on our why we're focusing on educating or talking to them in terms of that they can understand science and at best practices and evidence and testing hypotheses and tracking them. They seem to love that. Which again makes sense in which many as I mentioned engineering background a lot of people that do what I do. I mean they're all good people but a lot really are frustrated doctors. I'd rather be a doctor. That's not me at all. I love what I do. I love doing the marketing side of it. But I think doctors really appeal that we try to develop way you know marketing systems that bring patients profitably. And I can describe that if you like I mean if you going to go down what that looks like.

Saul Marquez: [00:08:15] Yeah and definitely want to hear about that. And so kind of made me wonder. Healthcare success is is the name of your firm and I love that because it just summarizes it pretty succinctly right. You're helping health care providers have success by giving them the patients and then they could focus on an outcomes improvement.

Saul Marquez: [00:08:34] And so I'm curious of a time now that hasn't always been smooth. Stewart I'm wondering of a time where you had some setbacks and what you learned from those right if you like a lot of times we learn more from those and maybe there's people out there working on their own to get their marketing done.

Saul Marquez: [00:08:52] Share something with them that you learn.

Stewart Gandolf: [00:08:55] In terms of set backs for me personally or on set backs for clients with which way do you mean.

Saul Marquez: [00:08:59] Let's talk about the clients as it relates to efforts to reach out to pay it.

Stewart Gandolf: [00:09:05] Got it. Okay. So the thing is that the principles work that we talk about there not just from us.

: [00:09:11] So again with that whole best practices concept in advertising is really two schools of thought. There's what's called a name or initial branding where you're getting your name out here's my name here's my name here's my name. And then there's also a direct response and direct response is all about finding some that works and testing it and doing it. So for example in traditional direct response you have offers. So for example if you're America's main doctor a big offer they do as varicose veins screenings you know on a certain day you get to get your screen not a full exam but a screening for free. So the principles work where practices can get caught up in. There's lots of obstacles. So for example some of the things we teach is how to ask patients for referrals to get them to refer to it more often it turns out most doctors hate the idea of asking patients for free will they feel needy and they just don't like doing it. It really works so it's very easy for in terms of a failure for doctors to rely on that but they never actually ask or they ask once and it's awkward and they never do it again. It's possible too. Now I'm trying to think of anybody who's sort of a poster child for that for example not thing I remember Prats we grew like crazy and every year they invited us out to teach their daughters how to ask patients for fros and every year I'd say it's a start.

Stewart Gandolf: [00:10:25] Meaning by Ok who did it last year. Never would sort of look at me she said of all the marketings working so hard we don't have that space. So my girl yes you do. So that happens a lot. I would say been thinking of other you know specific client stories. I think it really comes down to the people that haven't been successful either. They don't do what's proven expenses or they bring too much emotional baggage and a lot of times it's today it's groups where you have partners who are excited about moving forward. But there's other partners that don't. And so they end up doing nothing. So the classic is and I don't know if any of my list or any of your listeners rather are groups of 10. But if there's a group of ten doctors prototypical you're going to find and they always think I'm psychic because I've actually had this happen to be two doctors that are thrilled with marketing excited pushing it forward 60 after the two that are dead set against it and it's just kind of the common dynamic and so that's where failure usually arises worry. Lose sight of the bigger picture. And we agreed to agree some day and it just gets lost the momentum gets lost. Was that helpful to the nine Nerium things I see.

Saul Marquez: [00:11:29] Very common very much helpful some some good nuggets there and and contract listeners take this into consideration. You know sometimes it's the simplest things like asking for referrals that will lead to a growing practice and you can't overcomplicate some things sometimes. But you also have to think outside the box and maybe do things that are a little uncomfortable for you. And so. Stewart, what do you do if you're uncomfortable with these things. What do you suggest?

Stewart Gandolf: [00:11:57] Know I tweeted something about this a couple of days ago I'm going to try to find a target because I heard a quote that I thought was perfect and I don't remember what it was but rather than have you guys wait while I'm looking on the Internet here.

Stewart Gandolf: [00:12:09] The thing about it is is that what I think might be really helpful for your listeners is one of our most successful articles ever was all about there are six ways to market any practice. There's just six ways and so people love that idea. And when you break it down it's like Oh that kind of makes sense. So the first way which we just referred to is internal marketing or also sort of a corollary that is patient experience. So internal marketing means includes asking patients for referrals. It includes for example cross-selling additional services. For example if you're in a plastic surgery practice that somebody come in for Botox and upselling them surgery that includes answering the phones right which is absolutely crucial and difficult and hard. And there's nothing happens if that people don't make it off the front desk. And so for a lot of your listeners I'll give you another uncomfortable issue if you are the wrong person on the front desk. You're killing yourself. You are causing you know it's common for 50 percent 75 percent of new patient inquiries to be lost to the front desk. So if you're not willing and able to intervene and either train that person which is the right thing to do is just the wrong person make that change you're going to carry that baggage on forever.

Stewart Gandolf: [00:13:23] And it's brutally expensive. Another uncomfortable story that you'll probably like this one of the things I share my seminars a lot is about the. And it turns out this was an EMT practice in North Carolina I think it was where he finally went to the seminar we taught a fired his grumpy used to Laurus was grumpy curmudgeonly office manager and they all got used to saying it's still ours. That's for us anyway they fire the Mersey. Actually that's not true. They didn't fire. I remember now it's even worse than that she retired myrth the police retired after 30 years. And what happened was the practice shot up by 30 percent immediately upon her retirement. So think about that. Nothing else had changed. 30 percent influence over 20 years or Doris's of the practice. How successful or how expensive was the. The fact was uncomfortable being willing to fire her a reprimand or by the way I found the quote and I was from a conference last week and this is awesome. This hopefully or our listeners will write this down if they're not driving.

Stewart Gandolf: [00:14:26] Glad you're comfortable. Yeah your comfortable place is not your place of growth. So it's kind of funny I read that about a week ago when this happened to remember it took me away to finish.

: [00:14:37] Yeah it's an awesome when I did. That was just something that somebody said offhand and like that is awesome I love that. Anyway going back to the six way so that's one way internal marketing and that's a big area right there. Second one is internet marketing it's one of our favorite areas of digital or expertise. How we grow our company Websites as the pay per click, Facebook, social media, reputation all those things. That's a huge huge area doctor referrals is another key one that most people don't think of as marketing and that's absolutely crucial and that's a big big area for us and we need work on. By the way in all six of these areas creating ongoing systems that positively influence doctors is a huge area of opportunity for nationalist fourth category is branding, fifth category as public relations which mostly includes publicity getting free press and community events. And the sixth category is its advertising. So there's a lot there. It's a huge palette of strategies that you can choose from. But the whole comfort thing is think about all the areas we can be uncomfortable with what I just described. You can be uncomfortable. You know I'm gonna write an article about this. Thanks for reminding me because as I write my own blog article this is how we got them for their content but the place of comfort is you can be uncomfortable asking patients for referrals, you could be uncomfortable managing your staff you can be uncomfortable. We talk about doctor referrals it can feel like a dirty salesperson trying to build doctor referrals. You can feel comfortable with branding and publicity publicity being in front of TV. I'm too comfortable with advertising as you're worried about losing money you can worry about what you look like online. There it is. Perhaps we solved the whole problem.

Stewart Gandolf: [00:16:13] It's all about being uncomfortable. Well there you have the biggest obstacle. Now we're done now. We can hang out.

Saul Marquez: [00:16:19] Yeah. The problem solved. Let's move on to the next big challenge shall we say the listeners. Yeah. One thing the take away here is like Stewart said is the place of growth is the place where you're uncomfortable and maybe that means outsourcing this to a company like Stewart's. Maybe it means replacing somebody that's not working. So ask yourself that question, what is it that it's going to take for you to take your marketing to the next level so that you could do what you do best which is take care of patients. Such great advice here. This is amazing right. We went through so much and the time just flies. We're getting close to the end here but what I want to do is a quick lightning round with you. Sure. It's a course on marketing and what it takes to be successful. Let's call it the ABC of Stewart Gandolf. And so we're going to go through this four questions and then we're going to end with a book that you recommend to the listeners ready.

Stewart Gandolf: [00:17:17] Sure.

Stewart Gandolf: [00:17:18] All right, so what's the best way to improve your health care outreach.

Stewart Gandolf: [00:17:24] I would say the key is to figure out a way to get marketing systems in place.

Stewart Gandolf: [00:17:29] The problem is it's very easy to be sporadic and OK you ask somebody for referrals are you going to get around to it again and then you know you look up in six months went by. That's one of the reasons why we like digital marketing so much. And of course it sounds self-serving but one of the things is that by digital marketing is used are the most cost effective ways to get patients passively. You can spend money on marketing. You can spend time on marketing. There's nothing that's free on both time and money. So the usually I would say that if you're looking for patients digital is the way to go because it can be work in spite of you not doing your part about patients for referrals or going out to lunch with other doctors and then the cool thing about it is is that when it works. Paying for it next month is out of profits in this month. So it can be a virtuous cycle.

Saul Marquez: [00:18:11] I love it. What's the biggest mistake or pitfall to avoid.

Stewart Gandolf: [00:18:14] I would say looking at it from marketing as an expense I would be probably number one.

Stewart Gandolf: [00:18:19] So it's not about at all but marketing cost. It matters what did you invest versus what did you make. So for example I think to a lot of credibility with clients and audiences when we speak at conferences or wherever. When I say you know what I'm asking to spend money on marketing but I spend 30000 a month. So it does not many marketing companies we haven't earned Amely and our company 25 people 40 50 60 clients. There's not a lot of companies that are size in this world like unfortunate doctors. I'm not aware of anybody like that. Those are small people. There's no like not many companies of scale. And then why am I willing to do that because I know it's profitable. And so the fact that if you're willing to look at and figure it out in terms of how can I invest money and test track and adjust and do it in a way that's profitable. What's great is like a lot of things to come back and say I'm going to spend more if I'm spending 10000 a month to get 100000 a month. Well what if I spent twenty thousand. Could I get two hundred thousand a month.

Saul Marquez: [00:19:13] Now this is great. It's not inexpensive. If it's bringing you money it's an investment.

Stewart Gandolf: [00:19:18] And so that's a really easy to focus solely on the cost side of it for sure.

Saul Marquez: [00:19:25] What do you say is important to do to stay relevant despite the constant change.

Stewart Gandolf: [00:19:31] It's a great question.

Stewart Gandolf: [00:19:32] Healthcare changes so fast and you know it's funny because I talked to people about it all that time in terms of our own business like while how do you guys continue to grow it's because we are willing to and really have to reinvent ourselves. I know people say that it's kind of a buzz word but it's the truth. You know like I was just yesterday I talked to a client or former seminar attendees not a client as a former seminar attendee that went to one of our seminars six years ago and our company is unrecognisable to what it was back years ago. So I think it's brilliant. You didn't really it was really difficult actually of a call because in his mind we were something we were six years ago as a completely different company. And so I would say that in healthcare you have telemedicine for example. You have urgent care you have if you're on the primary care side you're competing with Walgreens. Now the realization of health care the fact that patient experience is I could go on and on and have you know you don't have time but about patient experiences consumer demands and expectations are completely different than they've ever been before. So all these things are happening really really fast. My primary care guy I talk to him about I send him an email were friends about what's going on now. Telemedicine I was talking and in my comment my last comment was hey healthcare is changing fast and email back said way too fast for me and so I would say that's like figure oh high deductible insurance plans. All these things are crazy crazy fast and it's really really difficult to keep up but you have to if you want to stay in business and then on board.

Saul Marquez: [00:21:08] Yeah absolutely. Finally the last question here is what's one area of focus if you had to pick one. Stewart that should drive everything else in your marketing efforts.

Stewart Gandolf: [00:21:19] Okay that's a great question. I would say the product. Okay. So this is funny having a marketing person say the product because what I often talk about is is that you know amateur marketers will rush and start talking about promotion right away. It's

Stewart Gandolf: [00:21:32] A simple thing to do. It's like well if you sell radios that you can talk about first right radio if you're a newspaper salesperson you know a newspaper of your market consult you're going to somehow talk about consulting. But really at the end of the day like when we work with our clients we have a couple different levels of clients but we work with clients. We typically start with what we called Exam diagnosis and treatment plan. And before and when we talk about we so we do a real deep dive on their business. And rather than do or call marketing malpractice and give them a bunch of ideas on what to do. We start off by looking at their business and what's great what's not doing a swat analysis and really thinking through like what should the product be. Because you know I'll give you a quick story on that. My mom when she was she just passed away about a year and a half ago too but I wanted her last doctor's appointments with thank you. It was great actually because she made it to 94 her last day she saw she saw a play and had spaghetti dinner. You know she had complete control over faculty's so some breasts are tragic. Hers was asking a lie. Thank you. But the. At any rate her cardiologists we went there one time at 730 for her appointment and we're sitting around at age 15. Mike what gives. Nobody here what's happening. Oh well the doctor doesn't come until 9:00. And it turned out I was speaking on patient experience the Cleveland Clinic and a couple weeks.

Stewart Gandolf: [00:22:52] They picked the wrong time or if they had the wrong guy to pick on.

Stewart Gandolf: [00:22:56] But my point is is that you know I was livid. I'm like You must be kidding you're insulting me. My mother is sitting here for 45 minutes. She's not a morning. Not all morning people by the way are early risers now so we're both sitting there and I ask why on earth would you ever have to sit here. And they said well because more convenient for the doctor than is all thinking that is passed. And those people are going to be employees up there not already. Really so many consumers just won't stand it. Old people they grew up with the doctor knows everything. Those people are dying off. So yeah I would say that that's the biggest thing.

Saul Marquez: [00:23:33] I like it. And finally what book would you recommend to the listeners.

Stewart Gandolf: [00:23:36] Stu I know it's so funny ever since you said that thought oh my gosh I've read so money or so many rather and most of what I'm reading now is very tactical.

Stewart Gandolf: [00:23:45] Like you know Internet marketing really specific things that I think are sort of outside of common reading and so I'll try to think of some additional ones and if you care we can link are also just some after this podcast. Shared the one that strikes me is one that you probably wouldn't expect from a marketing person. I had and I'll share with you the anecdote it was a black dermatologist's African. He was still chief of his tribe. He was one of my seminars and he was larger than life and his name was Namadi, I'm not sure of his last name. But he was larger than life and always did finish my seminar with the sort of inspirational part and I talked about positive thinking and you know what does it take to grow really big business and what are the traits of the really successful practitioners. And I went through this whole thing and it's typical of my audience somebody was skeptical and said hey that's all truth and that's all great but not Namadi. He's just like that because he was really larger than life. I mean he had 11 practices the only been out of school for or been practicing for a few years. He already had 11 locations he was African and lily white Rhode Island he used to wear where he was a fly back to Africa to be with his people as a chief of the tribe on a quarterly basis.

Saul Marquez: [00:24:51] So you're literally right where a tribe I thought you were using it as chief of a tribe.

Saul Marquez: [00:24:56] You know the culture as it is.

Stewart Gandolf: [00:24:58] No he was really touchy and he was just larger than life. I mean he had everybody of those guys ever. He just wants to follow.

Stewart Gandolf: [00:25:05] And there were smitten men. He was just and then they said Namadi that's everything. It just said is true. But not really it's just you. They said no no no. Think and Grow Rich. Changed my life he said as a young boy I was poor. I read that can grow rich and it changed my life. I always think that story is amazing and people ask me I just had one of my employees actually asked me how did you get to where you are. It's kind of cool because at this point they ask that they want to be me which I think is awesome like I'm sure. Like wow I don't know how I got here but you know it's like I've read probably hundreds and hundreds of books and think and grow rich is one of them. But it's not so much about that specific book but it's about continual growth and learning and being open and saying Who am I to argue with the Mahdi. And I did better than you know what I mean.

: [00:25:50] You know Stewart, a great story and funny story is that I I love that book and recommend to any of the listeners I just finished reading it again for the fourth time. It's amazing. It is one of my all time favorites and listeners. If you have not picked up thinking grow rich don't take it from me don't take it from Stewart. Take it from Namadi just a wonderful book that you'll get seriously. Every time I pick it up there's new tidbits that help me build my business. And it's not about you know growing rich financially only it's about growing rich emotionally with your relationships it's just outstanding this is wonderful Stewart thank you for presenting it with the wonderful story right.

Stewart Gandolf: [00:26:30] I really enjoyed this. Thanks anytime and good luck to your listeners and I appreciate it.

Saul Marquez: [00:26:35] Yeah I know. It's been a blast and now what would you say the best place for the listeners to get a hold of you would be.

Stewart Gandolf: [00:26:42] If you go to better than that though.

Stewart Gandolf: [00:26:45] Give all kinds of free stuff from my website. So we have a blog with several thousand articles on it. You can go to my website

Stewart Gandolf: [00:26:53] Go to the free resources as a blog there. There's a ton of white papers too there. So for example we talked earlier about skeptical doctors and groups. I have white papers on things like the seven deadly sins of marketing or how to advertise and so forth. The one is how to convince skeptical doctors on the need for marketings. There's all kinds of you know having done this now for 20 years with doctors and hospitals. I really I can almost finish their sentences when they tell me about their stories about what it's like at their practice trying to get stuff done. So I think there's tons of free stuff there that they can get ZERO obligation. I do it for the good. If you're interested, more than now that we have seminars we have across stations we do that in a day we're full service agency. Most of our club pays our bills is not the free stuff obviously but people come to us and say hey we just want a patient. I mean I told you today we signed this big addiction center today. He called us off a calling for a seminar but our seminar says what if he'd just rather we do it all for you.

Stewart Gandolf: [00:27:49] We said that's it. I want you after all.

Saul Marquez: [00:27:51] I want that option.

Stewart Gandolf: [00:27:53] Yeah exactly.

Stewart Gandolf: [00:27:54] I don't learn about this crap I just want you to do it for me and that's so I thought that's how we pay the bills.

Stewart Gandolf: [00:27:59] But the other stuff is free for everybody so I'll bet.

Saul Marquez: [00:28:02] That's awesome stored so listeners please go to Thats G A N D O L F. It's Mr. Stewart Gandolf and you'll find all the links to the resources that Stewart has mentioned as well as all the show notes. So you don't have to worry about pulling over and writing it down. So thank you so much Stewrt. It's been a blast. Looking forward to staying in touch.

Stewart Gandolf: [00:28:25] Goo day, thank you. Take care. Bye bye.

: [00:28:31] Thanks for listening to the outcomes Rocket podcast.

: [00:28:34] Be sure to visit us on the web at for the show notes, resources inspiration and so much more.

Recommended Book/s:

Think and Grow Rich

Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast - Stewart Gandolf

Outcomes Rocket Podcast

Full Podcast Transcript

Radically Improve Your Medical Education Now with Aaron Bright, CEO & Founder of Hippo Education, LLC

: [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: [00:00:18] Outcomes Rockett listeners welcome back once again to this show where we chat with today's most inspiring and successful health care leaders that I have an outstanding guest for you. His name is Aaron Bright. He's an emergency physician and he's also the CEO and founder of hippo education. That's like Hippocrates. And so what I wanted to do is just cannae extend a warm welcome to Aaron and have him fill in the gaps in the introduction here because he's got a lot of really cool experience to air and welcome to the podcast.

Aaron Bright: [00:00:51] Thank you for having me. Thank you very much. Yeah I know you've got to pretty much right that might have when you said successful and or the other thing you said successful.

Saul Marquez: [00:01:00] Inspiring.

Aaron Bright: [00:01:00] Yes I'm just I'm both of those things. But you know you've got to I'm an E.R. doctor by training I graduated from UCI medical school and went over to USC in Los Angeles to do some emergency training. And then after a long time of it in the community and various medical directorships and leadership stuff I got back into academics and then from there I ended up starting the company hippo where we are mostly focused on disrupting might be a cliche term but we're trying to turn the education of practicing doctors and clinicians on its head and hopefully to have that translate over to the health care administration side as well.

Saul Marquez: [00:01:38] I think that's really neat. So what principles guide the turning on the head type of things that you guys are doing.

Aaron Bright: [00:01:44] Yeah a lot of people who they might be familiar with this but what we found and the way I was talk about it is that you as a clinician and as a provider you're hopefully you when you're in training you've got you're kind of surrounded by mentors you're surrounded by kind of your heroes. Everything is on the up and up. The complete goal is patient care and your Hi5 and everybody all the time you do something cool and there's nine people behind you. And so you're kind of used to this mentors and geniuses surrounding you all the time. And then as you get past training and they dump you out in the real world that basically completely cuts off what you're left with is more of a seamy industry if you will it's not really that people are worried about education anymore that continuing education for doctors and clinicians becomes a hoop jump and more of a regulation you're required to do it. And so there's a lot of companies out there that were doing education that is maybe subpar in a lot of ways maybe is made by people who are not quite expert and then signed off on by chairs of departments and things so everybody who is trained classically in medicine actually knows that. And so what happens is you get this giant apathy you after you graduate you go where's all the education. Well you know what I'm going to keep my eye on him and read this giant stack of papers and I keep up and then you get bombarded by the system and then after a while everybody's self education system tends to fall apart.

Aaron Bright: [00:03:03] You end up pulling all those journals off your desk into the trash. And then you have this weird spiral where you go. I'd like to catch up. I know I'm supposed to be caught up. I'm getting behind. Then you have this weird shame and nobody talks about it and we think that contributes to burnout in all kinds of patient outcome problems and all kinds of financial problems it's just not as it's not as direct as you would see and maybe some of the other people you would talk to. But the foundation of patient outcomes and successful financial health care systems is the education of these people are on the frontlines and that's where so turning on its head by literally making better education. Caring about it having clinician people spearheading the education and designing the education and giving us what we want and even being more engaging in a little bit goofy and a little bit more human admitting when we don't know things taken apart that whole bow tie and lectern education model where you're just dry and you're going through the epidemiology and then you go into this and going through that. Where everybody falls asleep and it has to be an hour even if it's a five minute topic and all those things were ripe to be reworked. And so I think that's why people picked up on what we were doing and we we got pretty popular pretty fast.

Saul Marquez: [00:04:09] I think that's really interesting Erin and one of the things that you said that sticks out to me is this idea that elephants don't buy it mosquitoes and you're gone through the day to day and it's those little things that happen that all of a sudden just catch up to you. Right. And so what you guys have done there at hippo is just really take it to the next level and make it more fun by. OK. Providers are actually creating your content right. We know what's applicable because we're in the frontline.

Aaron Bright: [00:04:36] That's exactly right. It's it's weird or maybe surprising. It surprised me that that wasn't the norm. The norm is is not that at all and I'm not blaming anybody for trying to make great education with the resources they've got. It's pretty hard to find super talented clinician educator technology forward driven people who our time in their schedule all that stuff is really a challenge and so we just sort of were able to piece it together at the beginning and make something that people liked our first couple of chunks of education. And then from there we were able to expand but it's really unusual to have education that's not focused more on the CMA credit hour for the doctor or the clinician and more focused on the education with the credit our the afterthought you can't rely on on the system to guarantee that that great educations coming out there and so everybody had the same problem. We started in emergency medicine. We went to primary care in pediatrics and every place that we went we found the same kind of thing lacking.

Saul Marquez: [00:05:33] So your programs are resonating Aaron. And obviously education is key right to the focus that you guys are driving at hippo. But right you say if you wanted to dive deeper and get more granular what's a hot topic that you feel should be on every medical leaders agenda.

Aaron Bright: [00:05:48] You know that's really interesting. I'll give you the deep one it's deeper but a little still a theory. And that it's on everybody's tongue right now. But it's wellness and burnout sick. It's really tempting for leadership in health care scenarios that are you know nonmedical and are sort of maybe not practicing you know they are medical. To think that that burnout and that wellness is distant from them and make it feels a little bit touchy feely. We're just used to it. But we're finding on the ground level is that all of these various pieces of the system contribute to that burnout. And one of the biggest pieces is the sort of physician ground level clinician education and the gap in that education. So for instance I was talking to a CMO friend the other day and we're starting to do as I was saying earlier we're starting to do more education that aligns kind of what you call the hospital and system leadership with the ground troops. Traditionally we want to admit it or not admit it. There can be some animosity between these goals at the hospital has whether it be the mission or the or the bottom line are out and out. Yeah. And the goals of even the governmental organizations so you've got that surgeon general making some sort of initiative. Those are very hard. It's almost easier to translate if you're in leadership than to understand if you're on the ground. Frontline. Park because you're going to be working 70 hours a week and it's really hard for you understand why that initiative is there.

Aaron Bright: [00:07:15] All you see is a new form or a new stat or a new way to follow up. And so we've been focusing on on that. And one of the core pieces that ground troops tend to say is the command you give me this new form to fill out and I get it. Yeah we shouldn't have any Sedef around here and I would like to do as much as I possibly can to reduce our stats on having these infections but I'm exhausted and I'm burned out. And you give me another form and all I can see is the form. So the form nobody wants to have a form given to them. And I understand that we should all be working to minimize those forms and increase those efficiencies. But just finding a way to help those clinicians not be burned out gives you a massive a much larger level of buffer to tolerate those forms. And if you ignore the burn out and the wellness stuff it's to your own peril and then every time you change a tiniest little bit of the system as you know you've got cranky clinicians freaking out. So as granular as you're talking about that's a deep point and we're starting to see education start to focus on that and start to see the hospital leadership and the health care leadership start to pay attention to that in more than just lip service.

Saul Marquez: [00:08:23] Yeah Aaron. And it's really irrelevant all these requirements that EMR reporting the forms I mean what is the why behind all of these things and communicating it to the frontline and there's really a need for more leadership capabilities for that. You know let's just say that the medical directors are the clinical directors pushing it down.

Aaron Bright: [00:08:44] Yeah and that had given them a tool kit to do that. It's much I think that people don't understand the psychology the psychology of the difference between a hospital leader even if that leader was a clinician or a clinician so and somebody who's on the frontlines who may be a fantastic very productive clinical person. They're kind of different personalities.

Saul Marquez: [00:09:02] Totally.

Aaron Bright: [00:09:03] And when it makes sense to you as a leader may not be as obvious to you as it is maybe more obvious to you as it pertains to the purpose behind things than it is for these Gramp people and the toolkit that we're trying to make and that's why it all comes back to education for me even though it is my passion. But I really think it's important. There are ways to bridge that gap and it's not always obvious. And so giving people the tools and the education in a way to describe something to your ground troops can change completely and really turn around the numbers and really turn around the attitude that's around there and as you know that you saw one of those problems right. And the next problems easier you solved one of those problems wrong and you get an angry medical executive committee meeting. Then the next one is much harder.

Saul Marquez: [00:09:45] Yep. Now that's really good. And so Aaron give the listeners an example of a time that you guys have created results by changing some of this education.

Aaron Bright: [00:09:54] Yeah that's a good question too. We've done so as we say all of our education is made with the end user in mind you know a practicing clinician the frontline person and then we back it up from there. And having been on that on both sides me as a leadership in hospitals and me as as an educator and me as a as ground troops I think we kind of back it up from and so one of the things that we like to do and Bob doing for a long time is kind of targeted education based around performance measures in the hospital so it's we've done a lot of steamy stuff for MyoKardia infarction in order needle times and all these different things for ERs where we start with here's what we're supposed to do. Imagine if you will a clinician that that's your goal. Now how are you going to get that to be as efficient as possible knowing that you cannot set up your E.R. to do things like automatically activate the cath lab and automatically do is not regular. So you take the first step being let's describe the clinical needs and then the next step being how can your environment support that. And then the next step is how can your system support that and then the next step is how is your system supporting that and how is your system hardwiring it. And so we've done that and then have some pre and post data to show that that makes outsized differences.

Aaron Bright: [00:11:13] Things you wouldn't expect you'd think Geez all I did was really explain it differently.

Saul Marquez: [00:11:16] And it sounds like you guys are taking more of a systems approach where you're equipping the learner with instead of check the box exercise that helps you get your CMEs you're actually giving them a systems approach to a way to to address it and it makes it interactive and more useful.

Aaron Bright: [00:11:34] Yeah it does though though overarching theme there is that if you as an educator are dedicated to getting that information across in a true way and nothing to do CME hours or anything that just it comes I mean if you're doing good education you get plenty of CME the hours. If you're really looking at how to best make that information usable to these ground troops it's really easy to back up and see it from a system perspective and you know and make it more more real. One of the pieces that I think is most effective is sort of being a little more human about it and being not so much. Everybody understand this but you which is a typical kind of medical model. You know we say oh here's describe all this stuff but more to say look everybody has a hard time with this. Let's try to work together and figure it out. And what we're doing at Hippo's we're trying to build a community of it's even hard to explain but almost like conscious conscious learners where you know that they're not alone that there's a lot of people that don't understand this stuff or that need to keep up with this stuff.

Aaron Bright: [00:12:34] You take that as the baseline and then they're much more open to learning the reasons why they're going to do this or that. And we've found even people that go just don't have understood that before. And those people end up when they find themselves in leadership positions in a much stronger area. So the bottom line is education is one of those fundamentals that's really hard to focus on because it's you know maybe who are. However you do it in your hospital it's either kind of you've already got a system you're not really sure if it's working you're trusting that because you're getting CMA units maybe it is working but you're not sure. It's hard to focus on it because it feels like you can't see the change in outcomes so perfectly there's two or three steps but I would encourage people to. However you do it focus on really good education. Find it somehow and give it a little time to work and then just check things hard to follow those variables but check yourself six months after that education started you'd be surprised at how much turns room.

Saul Marquez: [00:13:27] Yeah for sure. And how about nursing. You guys do anything on the nursing side or is it. Is it mainly physician.

Aaron Bright: [00:13:32] We do some work for nursing and almost as a secret level. We don't have any products for nursing yet. We really love the field.

Saul Marquez: [00:13:41] I'm just thinking like alarm fatigue. Right. Yeah. Oh it happens a lot. So like things like that.

Aaron Bright: [00:13:47] Yeah alarm fatigue sort of teamwork. The new we're doing stuff now we're we're we're talking to people bigger systems where they're trying to align a much more forward thinking future thinking sophisticated way of dealing with the team right. So you've got a alarm fatigue that's nurses registered nurses only you have to listen to this alarm. That whole paradigm to your part of the team you're rounding with the clinician you're you know nobody's the hierarchy's so meaningless nowadays the information is so huge and there's so many mistakes that can happen with information passing from level to level that we're looking to you know things like alarm particular a really good example of a team being disjointed. So you've got documented lawsuits and things where you've got to know several different people who technically didn't need to hear that code Bell not to walk in right past the room because that's not their alarm. It's because the other nurse was you know someplace as a trigger. That's just ridiculous and needs a lot of subtle education about how that's more effective and can make everybody happy including the people that are supposed to be the boss having a much more sophisticated team is going to make the clinician's job way way easier. Yeah.

Saul Marquez: [00:14:55] So Aaron you've been on the frontline. You've been a medical leader and now you're the CEO of this really cool education company that helps improve outcomes by improving education. Give the listeners an example of a setback you've had and what you learned from it and kind of the pearls that you got out of it.

Aaron Bright: [00:15:14] That's a good one. You want a setback of business set. Are kind of a failure in our model. I can give you some setbacks. I got some of. What's most interesting.

Saul Marquez: [00:15:23] Anything related to maybe this theme of education since we're already on it.

Aaron Bright: [00:15:27] Yeah. I think that we've we've run into a few. I'm not sure if there are setbacks as much as their learning experiences where you're trying to figure out the best way to get education across to people. And what we started with early on is kind of doing everything that everybody else was doing. But with a little bit more human touch and a little bit more humor and a little bit more entertainment. And what we got was a lot of people very interested and I think what we initially decided was our first goal is like just don't let people fall asleep. That was all we were after were like just how many times have we missed a lecture and we dozed off and we know. And so we sort of put together that is are you were really proud of that and what we found was that while we were gaining customers we weren't really sure when we looked at the data and you sort of do pre-test and post-test and stuff like that. Were we getting this education across to people as much as we had hoped. And the answer was yes because they were awake which is a giant step forward. But the answer is you could probably do more. And I think that what we learned. For instance we were doing these sort of half hour to hour long lectures and we were doing a traditional outline where you introduced the problem you'd get some epidemiology you do this and your treatment and you're sort of comprehensive all the time. And we learned that not only did people not necessarily retaining that information but it wasn't something that wanted to retain on the tips of their fingers.

Aaron Bright: [00:16:47] That was stuff they could look up but you need to know how many type 2 diabetics failed that form and you can look that up. You don't have that. When Mrs. Smith comes into your office that's right. So what we ended up doing is we would take topics that are traditionally an hour long and distill it down to six seven minutes of even type stuff and none of the fluff. And then maybe do a deeper dive later for people that were just fascinated by that. And then we started to do that looking at how people were doing in and staying awake and not just staying awake but retaining that got a lot better so we keep doing these things where we'll try something and we'll go out and work and we'll we'll tweak it to the point where we're there we're more outside the norm at this point. We've got a we have a conference that we run called essentials of emergency medicine which is the biggest E.R. conference in the world really a single room there's a couple thousand people in this one room and we've found is that we have to we literally for three days and you know six to eight to nine hours a day are doing five to eight minute presentations. And we've got a stage set up and we will throw somebody up there in bang and I do an eight minute something to pull them back off there's two seconds of music in your bank. Put somebody else up there. And you would think that that would exhaust people. But it does the opposite it keeps them awake and it keeps them engaged.

Saul Marquez: [00:17:58] That's pretty cool. By the way I like that idea you know because anybody could make things seem complicated and long. It's talent and it takes skill to really hone it into what resonates most. So I'm intrigued that you actually do this for three days straight at your meeting.

Aaron Bright: [00:18:14] It's pretty impressive. Pretty cool. It took some time and it's one of those. It's one of those things that it sounds easy until you try to shuffle on forty five people a day.

Saul Marquez: [00:18:25] And so do you get pushed back from some of the speakers like Hey man I really need a half hour for this.

Aaron Bright: [00:18:30] We used to. And we don't as much anymore because the thing has been so popular is it basically has changed the entire paradigm of how you would do emergency medicine education and now the rest of the world is doing almost the exact same thing and we've sort of trained the E.R. docs at large that I don't have to listen at this hour so they don't do that. So now they don't complain. And what happened is this interesting side product which I think translates into outcomes in all levels of you know using education as the lighter fluid if you will to after all this change when you challenge the status quo in a way that makes sense not just to make everybody freak out but just to you know nobody wants to hear two hours on on diabetes from soup to nuts it's just impossible to absorb that. What we end up happening is now our speakers will come in our educators and they'll be very excited because they got to focus in on one little section of that that's most important to them clinically and make a tremendous it's hard to do good education in eight minutes and you have to have gone over it 200 times. You take away all of the crutches that we tend to use where you make a couple opening things you put a picture of Dilbert you like you know there's a whole different ways that people do it. We've taken that away and what we've found is that without even us having any talent about it we're being offered education that's so much better. So we're hope we're trying to get that into the rest of the world too. Same thing with humans you're talking about compliance issues. If you gave people a lie detector test nobody wants to hear that issue for an hour. Nobody.

Saul Marquez: [00:19:56] No, Aaron. I love this and I think comes raket listeners a thing that we could all pull from this is as leaders in this field. We have to be able to communicate simply. And if you have a mission, a vision, something that you want a common theme through the year distill it to that six or eight minutes that Aaron's talking about here and watch what happens. You know what happens to your people. They become owners of that word and it becomes an identity almost cultural shift that Aaron has created over there. Him and his team what this meeting sounds like a really cool one. I'd love to pop by sometime.

Aaron Bright: [00:20:34] You should come in a lot. It's very interesting to watch how excited people are. I think it's monkey brain stuff you can't stay excited for an hour about anything.

Saul Marquez: [00:20:42] Yeah. No it's true. And I've been like I've been to these meetings and some of them are good. But you can't help but just start pinching yourself. You know at the end of day one even sometimes.

Aaron Bright: [00:20:52] Yeah I think that's not even a reflection of these educators. I think a lot of times if you take a great educators used to doing an hour and you tell them you've got 15 minutes goal to comes out of that. It's all there and people remember it and they have good questions and you just never lose that focus. But yeah I think that's a good what you said is a really good way a simple way to say it which is to simplify and that simplification is the hardest part to write a 15 page diatribe about something is a lot easier than trying to get your point across in a couple of paragraphs. It's really hard but it forces you to go over it again and again and again and cut the fluff and cut the fluff and it's a good way to do almost everything. There are some things maybe airline pilot training maybe the timing of that almost two things.

Saul Marquez: [00:21:36] You don't want to put through this on, Aaron. And really good stuff man. And so can you share with the listeners maybe the other side of this. Give us a time or it's been one of the proudest moments that you've had in medicine.

Aaron Bright: [00:21:49] Yeah let's think about that. We've done a lot of stuff that we're proud of over here. I think one of the things that we're most proud of and it's a little bit more team oriented than anything educational or clinical but what we've done is that by adopting all this new way of educating as we've sparked interest by bigger organizations we have partnerships now with for instance rehabber. We do the AP board review test prep things that we do in partnership with AOPA which is a great organization for coalition assistance. We're working with some other people that I probably shouldn't expose before it happens but people are noticing and realizing that when they have a piece of their organization that is education focused but it's not their organizations focus that doing it on their own is a lot harder and a lot less productive than it seems. Krischer because we're not you know we're not looking to gouge anybody we've got it. We're very mission focused. We've been very excited to sort of see people pay attention and start to reach out and make partnerships with us and other people are really proud that people are noticing that. And I think watching honestly the most private thing that we have has happened since day one.

Aaron Bright: [00:23:00] But we have got to save every single comment that we get out of the tens of thousands of people that were learning things that are teaching things too. And the stuff that they say and makes you realize how important that education is to the individual person and how quickly the stuff that your listeners are doing and that we're doing translates to a bedside whether you had anything to do with medicine or not everybody that's in the health care system that's doing anything of any that has any focus on on outcomes translates down to my grandmother and your mom and us eventually to the bedside and it's sounds like fluff and cliche. It is not. And we have hundreds and hundreds and hundreds of stories that people say I listen to this thing on your podcast. You know we have these primary care rap podcasts that we do as audio monthly education. I listen to this thing on primary care rap and then the next day I saw this and I went to the hospital and this person and we change the entire management that's so rewarding that most of us would do it even if we were not as successful as we are and so that's really what we're doing it for.

Saul Marquez: [00:24:08] Yeah I think that's great. And so are these monthly things that you do on your podcasts are they actually like rapping sessions or.

Aaron Bright: [00:24:15] That's a good question there. That's a rap. We started it stands for reviews and perspectives.

Saul Marquez: [00:24:21] Ok well that was what I was thinking like the Zdogg M.D.

Aaron Bright: [00:24:23] Exactly. This is free rap and rap music and we used to get that all the time. I bought your thing there's no music in there at all.

Saul Marquez: [00:24:32] I was expecting hip hop. There's nothing out here.

Aaron Bright: [00:24:34] Yeah but it's that's been a really rewarding thing is having that.

Saul Marquez: [00:24:38] That's pretty cool.

Aaron Bright: [00:24:39] That monthly education that engages people and then they never leave. So you've got a real community it's not just test prep it's like I use this to stay up to date and to keep from getting burned out. I've listened to it on my run and on my way to school and all this stuff and that has been a wildly successful thing for us to do all this audio as you know what you're doing right now is the really it's the next generation of having people be able to access or share youthful stuff without changing their day or sitting in front of a computer and staring at it that can.

Saul Marquez: [00:25:07] So if we got the listeners interested in this work and they check you out I mean you know you could tell them right now and then I'll include it in the show notes. But you know let us know how can we get access to these resources.

Aaron Bright: [00:25:17] I appreciate that the company has hippo education and we have the front page of the website as work, too. But then you can sort of Browse through and see what we've got. We hope that you'll see all the different specialties that we're involved in and all these products. We basically do live courses like do for essentials of emergency medicine redo exam prep for what we're most proud of is these podcasts like you're doing when we do a monthly two to three hours of education more steamy than you need each year. And just a really entertaining short bite size pieces of education that will basically take over the entire job of keeping a clinician up to date and then behind that education we also do custom stuff for bigger systems and compliance in these bigger bigger questions for for healthcare. And so if they want to talk to us about that you can always email us we can contact us through the website.

Saul Marquez: [00:26:07] That's awesome man. Thanks so much for sharing that Aaron. So this is kind of apropos to what you do and my attempt to try this.

Saul Marquez: [00:26:15] This succinct approach that you take so you and I are building a medical leadership course. What it takes to be successful in medicine. It's the one alone or the ABCs of Aaron Bright.

Aaron Bright: [00:26:25] Yeah.

Aaron Bright: [00:26:25] And so you and I are going to write the syllabus for questions lightning round. You'll give me some quick responses and then we'll finish it up with a book that you recommend to the listeners. Radich lots of good writing as I. What's the best way to improve health care outcomes.

Aaron Bright: [00:26:39] Education is the best way to improve outcomes.

Saul Marquez: [00:26:46] What is the biggest mistake or pitfalls to avoid.

Aaron Bright: [00:26:49] I think the biggest mistake or pitfall to avoid for outcomes is and this may tyna in my book is ego. I think you check your ego we're all on the same team. We've artificially boxed ourselves into these certain things but it's ridiculous and if you look deep into it we're on the same team so check yourself when you see yourself Tommy some animosity toward the group on the left.

Saul Marquez: [00:27:09] Awesome. How do you stay relevant as an organization despite constant change.

Aaron Bright: [00:27:13] That is our bread and butter we love change and we're a sort of technology forward company but we stay relevant by brute force by deep diving and swimming in this stuff all day every day. I think if we didn't do that we'd be pretty easy to fall behind and I feel bad for people who can't do that but find yourself a trusted resource whether you've got a Twitter list or whatever and go over it regularly and you'll find yourself just accidentally because of interest kind of keeping up with all these different changes in the healthcare world.

Saul Marquez: [00:27:42] And finally what's one area of focus that should drive all else in your organization.

Aaron Bright: [00:27:46] We're almost to a fault mission driven on the idea of respecting our and clinician and so we are looking for ways in always every way. Like how you log into the website how you do a test how you are given feedback all the way through the education and thinking Is this the most respectful way to use that person's time and whether we're talking to the hospital CEO or we're talking to Joe family medicine doctor. We are always focused on that. In fact we've hardwired it into our system where when we're going to get to a certain point we say what part of this is kind of disrespectful and that's art. So it's a respect issue for us.

Aaron Bright: [00:28:27] And what book would you recommend Erin. You know my books are not I don't read a lot of health care books. I love to go on day and so anything that written by that guy he has one most recent one is oh I lost it. Is it more being on being mortal or something like that. OK. That's a tool Gwanda his most recent book. And it kind of talks about how clinicians die and that's a fascinating read. But I would say that what I've been recommending most is a weird when I'll give it to you and your people who are resonating with this idea of you know mission driven and being on the team and then growing as a person as you go and serve all these different populations. There's a book called Ego is the enemy. And I don't pass it out like candy. That's right. A guy named Ryan Holliday. And it's just a really beautiful example of how focusing outside yourself in all ways not just for your thinking about the patient but the people around you and your team ends up rewarding you tenfold when you're not even trying and it's a really easy your way to live anyway. A fantastic read to read ego is the enemy and that's a good thing.

Saul Marquez: [00:29:28] That's awesome. Thanks for recommending that and listeners. Be sure to go to - Aaron Bright. That's B R I G H T and you'll be able to get all of the show notes, links to the books that he's mentioned as well as links to his educational resources so you can dive in. So don't worry about hitting rewind or stopping your car or even writing while you're driving that would be really crazy. You don't want to do that just go to and you'll be able to find this Aaron. Before we conclude I just want to ask you to share one closing thought and then the best place where the listeners could get a hold of you.

Aaron Bright: [00:30:06] Yeah no I guess the closing thought is that I believe very strongly to my depths that all of us that are involved in all of this healthcare stuff is a real beautiful thing for world and to be proud of yourselves and realize that the stuff you do is very very meaningful and translates all the way down so don't give up it's very frustrating place and seek out some community and some education that you like in some ways to figure out whether people are doing that you don't feel so lonely. I hate the burnout. And then if you want to check out what we're doing where we're on the web at and you can contact us for anything there. My email is and we would love to hear from you and I'm always open to chatting with people that are looking for advice or ways to change things. And I love what you're doing over there. Also I appreciate being on on board.

Saul Marquez: [00:30:57] Hey appreciate you Aaron and it is a ton of fun to have you on. Definitely a lot of insights for the listeners and now looking forward to staying in touch with you.

Aaron Bright: [00:31:05] Thanks Saul, appreciate it.

: [00:31:10] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Ego Is the Enemy

Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast

Full Podcast Transcript

Save Time, Money, and Lives with Curt Bashford, President & CEO at GD

: [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: [00:00:18] Welcome rocket listeners welcome back once again to the outcomes Rocket where we chat with today's most inspiring and successful health care leaders if you like what you heard today or like what you hear in general please leave us a rating and review. Always love to hear from you. Just go to and I'll take you straight to our podcast page. Subscribe rate and review. Love to hear from you. Without further ado I want to introduce the outstanding guests that's with us today. His name is Curt Bashford. He referred himself as the protagonist of response innovation. He's the CEO of G.D. which is general devices and general devices is a company focused on software technology specializing in innovative telemedicine and communications solutions. G.D.'s pure core. It's why is to improve the health and well-being of the public at large by providing responsive innovation for public safety responders and health care providers. This is just the tip of the iceberg for Curt about what I want to do is flip over the microphone to him so he could fill in the gaps. Curt, welcome to the show.

Curt Bashford: [00:01:28] Morning Sal and thanks for inviting me. Glad to be here. You did a great intro there. There's not a lot that new users little bit about me my background is an engineer. So my formal schooling undergrads electrical engineering master's in biomedical engineering.

Curt Bashford: [00:01:44] A member of that I've got into the business side so I'm a number of entrepreneurs organization in my role here at GD has change. I'm in my 31st first year with the company now which is kind of usual these days.

Saul Marquez: [00:01:57] Wow congratulations that's a marathon.

Curt Bashford: [00:01:59] It is certainly it's been an interesting journey.

Curt Bashford: [00:02:03] So as he would say and my role evolved quite a bit over time from coming in at the intern level as you would. And you know now run the business.

Saul Marquez: [00:02:12] Wow that's pretty awesome. Like a Jack Wall story right. Start at the bottom and end up at the top and then take the business to new levels. And I know that you've been doing a lot of really great things, Curt been keeping up with what the company's been up to and what you've been up to so excited to dive into that today.

Curt Bashford: [00:02:28] Sure looking forward.

Saul Marquez: [00:02:28] So let me ask you you kind of gave us a little bit of background but let's dive into the why why did you decide to get into healthcare.

Curt Bashford: [00:02:35] Yes so it's an interesting story. I've thought about that a few times myself. There's kind of two life events I think that I can point to that help me get into that. One was back when I was 12 years old when dad was thirty six at the time he got the Gameboy race and terminal left paralyzed. So you could say that went out from the time I was 12. The whole family really became engage in healthcare if you think about it that way right now. So yes you know he went through a lot of hospitalization therapy and then then being home. So we were all part of that health care and we just you know it wasn't something you really thought about it was something you just did and you know you grow through it and evolve with it. So that was was a learning experience and exposure to it there. And then when I probably my I think probably freshman year of undergrad I had a physics professor that was talking about engineering and technology and all that. And at the time. So this is indeed in the 80s a lot of engineering was towards defense contract type work. Yes Neil suffered a military net really didn't float my boat so much but the professor was talking about how magnetic fields helped bones heal faster and it kind of flipped the switch in my head. I think a little bit about you know technology and medicine and how the two can come together enough that when I got to my senior year right specialized in medical instrumentation and then went on to my masters for biomedical engineer. And fortunately for me the alignment with the company was there too because the founder company had similar backgrounds and degrees and came from a hospital arm. So the two kind of mesh pretty well and then also in that early time I became an emergency medical technician and was run an ambulance and it failed. And that actually intersect that well with where we were going what we were doing as well and began bit of a foundation for some of our core products.

Saul Marquez: [00:04:25] Interesting wow what a cool story.

Saul Marquez: [00:04:29] Curt and I appreciate you sharing that. You were in the classroom and then just the guy starts talking about healing bone with engineering and it just the light bulb went off and you're like wow.

Curt Bashford: [00:04:39] It did.

Saul Marquez: [00:04:40] Yeah and Ankit as you were sharing a story I could hear it in your voice like you know that passion that of was ignited when you heard that what happened with your dad and now you have this skill set and this guy's telling you you could do something with it to help people. And it's just that it's amazing how it all came together.

Curt Bashford: [00:04:58] It's it really is how sometimes the pieces fold place it put yourself out there and you make opportunities happen and they did for me. So it's appreciated by all those that help on that path.

Saul Marquez: [00:05:10] Super interesting man. So you're in it now and so you got in at the ground level and you had this role in an emergency medicine and now you've kind of integrated core product.

Saul Marquez: [00:05:20] What do you think,Curt, is a hot topic that should be on every medical leaders agenda and how is G.D. handling this?

Curt Bashford: [00:05:30] So this is a topic you know for us it's dealing with change. And our tagline responsive innovation is part of that and that's kind of always who we've been as a company and we knew we tagged that as a core value you know responding to customers needs and needs change that certainly in medicine you know we talk about Healthcare 2.0 in EMS emergency medical services there's sort of a mess 3.0 and how do these intersect.

Curt Bashford: [00:05:58] And you know technology's out there. It tends to lag getting to medicine and it also has another lag layer getting down to the best side of the house. Change is hard and.

Saul Marquez: [00:06:07] It sure is.

Curt Bashford: [00:06:08] And it is in this industry they're frazzled they're being asked to do more with less.

Saul Marquez: [00:06:14] So if you have something that's disruptive and you know some of the solutions we have are disrupted right. They change the way you practice something or do something. And if you're busy and don't have time to embrace that change because it represents may be perceived as some extra words and training I'm too busy I don't have time for that. You go to hospital when they switch over to an electronic medical record that ties them up for a year on technology that they've heard they can't do anything else and people and users get complacent is the way we've always done it and don't always come up for air to see haters. Better way we can help you save time and money a lot.

Saul Marquez: [00:06:54] Yeah. You know what. This whole topic of change is definitely key, Curt. And you know to the listeners you know this this excuse that we sometimes make of Hey I don't have time. I'm busy. It's oftentimes what ends up getting us in the end. And that's why you have to make time.

Saul Marquez: [00:07:10] So in this wave of constant change what are you doing to block out time in order to ensure that you're questioning your innermost assumptions about your business about your practice about what you're doing. Like Curt just just suggested you suggest something to think about as you as you listen to Curt's words of wisdom here and we dive deeper into the episode. So, Curt, can you give the listeners an example of how you and your organization have created results by doing and thinking differently.

Curt Bashford: [00:07:39] Sure.

Curt Bashford: [00:07:39] So some of the technologies that we provide are solutions like mobile telemedicine. So if you think of you know the power to we carry in our pockets on on our mobile devices what can we do to make the job of the health care provider easier provide better health care appropriate time appropriate location. Some examples are somebody having a heart attack a steamy type episode and you know it would be a mess and medics in a field can transmit 12 lead EKG to the emergency department at some point it needs to get to the cardiologist at 3:00 in the morning or may be at home responding and if it's not a full time facility and we have ways of taking that information and tying it with the medics voice report and painting a fuller picture so that when this cardiologist is reviewing this ways of taking that data and information to paint that picture to help them make better decisions appropriate decisions because the goal is outcomes and outcomes and saving money. And if you can do both you know it is a win win certainly. So if you can do things to help progress the care faster shorting door to treatment times getting appropriate patients to take care of getting patients to the appropriate facility or not transporting when we can touch on out there's the whole facet of the mess needs to go and not everything is a transport emergency to them. So things you can do there where it's appropriate. You know technology can't just be a shiny object.

Curt Bashford: [00:09:14] You know those days are over. It needs to provide value and that value can come in the form of saving time money or lots. You know they all provide they all relate and that all ties in with outcomes.

Saul Marquez: [00:09:27] Now I think that's great. And this example of being able to package information differently to deliver that information quicker to the people at the hospital. There's a huge gap there and some of these things could happen whether it be a heart attack or a stroke or whatever it might be. It takes time and seconds can mean the difference between a save and a really catastrophic event.

Curt Bashford: [00:09:50] Yes it does. And so think about imagery. So a lot of this is voice or hand or any information is passed on. But the neurologist says the stroke patient yeah some period of time after EMA got there and transport E.D.. So how did his patient really present initially to them. You know because it's usually different by the time you get to the E.D. you know they're already treating it they're seeing some improvements. But you know now you have the ability to do videoconference with a neurologist or at least document that episode and help in that continuum of care.

Saul Marquez: [00:10:25] Yeah that's really interesting and I just think of OK if my parents end up and the emergency room and they have a stroke or they have a heart attack I want their physician to know exactly what's going on how they presented rather than losing that because so much that happens at the beginning. It is so important how they get treated.

Curt Bashford: [00:10:44] It is in nuances and how you give a report can be very different from the perception of how you. It's like e-mail right now what's the tone of an e-mail. Exactly. So you know that that sets the stage for the progression of care. And if you can do things and paint a fuller picture rather be through a video or imagery you know you don't need video for everything. If it's a burn or wound or trauma a still picture may give all the information that's needed. So it's that variety. What can we do better for the patient and the technology's there. But that's it that represents a change in how they might do it and it can't be a distraction from the patient care. Has that aid to the patient care innate value and there's a balance there. But it is a tool and it is a piece that's going to continue to grow and evolve.

Saul Marquez: [00:11:34] Thanks for sharing that. That's such a great example Kurt. And that's a really great way you guys have made an impact on the system. Maybe you could share with the outcomes rocket listeners a time when you had a setback and what you learned from that setback.

Curt Bashford: [00:11:49] So thinking about that probably one of those things has set back has to do with timing. So you know the expression you can tell the Pioneers by the arrows in their back and there's the adoption curves and we've been on both sides of that. We started Judy in general voices. You know we evolved from a company that did primarily design contract work and then around 1990 we got into our own products and then we evolved and been growing the company more of late and we got into telecom care back in 1995 it was working over plain old telephone lines at the time but we did to a video voice and data measurements and all things that you do today. Tom DeLay and you can do now from its from this work device but way ahead of the curve. And so we focused on the technology. We anticipated the need. But the industry wasn't ready so we didn't read. So is your what what didn't go well. You know you might deem as a failure we didn't read the market in the industry perhaps and we've got ahead of it. And then you get to watch because you know we shell some of that and reintroduced to a few different times later. But again adoption of slow change is slow and hitting that timing rate is tricky and you know if you wait too long then you get passed by also.

Saul Marquez: [00:13:09] That's so true. And the cool thing that you mentioned Kurt is that you guys. All right you brought out some telemedicine solutions. They didn't quite hit it off right away but you shelved them. And that's such a key thing right. If something doesn't work and the timing isn't right it doesn't necessarily mean that you have to toss it out the window right it.

Curt Bashford: [00:13:28] We did and we did that a few times so we did the home care piece and we learned a lot from that but again there was no reimbursement and worker wasn't ready. Communications weren't quite there back then. Then we rolled that out mid 2000s and we did a project in Tucson Arizona. We did a city wide project that was telemedicine the back of every ambulance there for an hour. And this is 2007 time frame. Back to University Medical Center was really cool stuff they put in a wireless mesh network because this predated LTE wow. So they get some federal funding at a dlt of interest and did this and it worked great were they had coverage. Guess what were they didn't have coverage. You can't do some of these things and then they're were supposed to build that out. And then the market crash in 2008 in that area got hit pretty hard. Neera laying off police and firefighters and didn't have money to build out the network. So we kind of learned and shelve that but at that time the equipment was bigger was built into back to ambulance. Fast forward today. Now we have the power in mobile devices.

Curt Bashford: [00:14:31] We don't need to do builtin systems.

Saul Marquez: [00:14:33] That's right.

Curt Bashford: [00:14:33] We have LTE broadband that's pretty ubiquitous. We have the big pipes now now we have the small powerful less expensive devices. Now we can really do this in an appropriate way where people are more accepting and it's more affordable. And then on top of that there's the piece that you know you may not be aware of but there is something called First net first net first net. So first net is a think of it as it's a will be a public safety broadband network nationwide. And states are opting in now.

Saul Marquez: [00:15:06] Is this real now.

Curt Bashford: [00:15:07] I mean is this is real so he was awarded the bid to stay here and that will provide high speed dedicated bandwidth route wireless broadband for public safety use dedicated Quogue safety. So they're not relying on our network and the rest of us you know adding congestion when they're trying to do important stuff whether it be for police fire and it certainly is a big piece of that and where we stay in quite involved with some projects that are in the country.

Saul Marquez: [00:15:37] Hey that's pretty cool. So first net is something that I imagine they would probably even include hospitals on.

Curt Bashford: [00:15:44] So the hospitals as far as you know communicating with the best in the field. Yes and that's the space that we play that ether between prehospital care and the hospital saw that that vacuum in between.

Saul Marquez: [00:15:57] So yeah trusting but not the actual acute facility it just the communication with the public safety.

Curt Bashford: [00:16:04] Right. So it's everything that happens out in the field.

Saul Marquez: [00:16:06] Hey that's cool man I wasn't aware of that. It's good to know that that they're building highways so to speak for the web to enable these public health really.

Curt Bashford: [00:16:15] Right. Right. It's all public safety so it's police fiery mess it's it's you know everything. Data right now it's it's image data it's information you need to get that you need these pipes to be able to do it properly.

Saul Marquez: [00:16:27] Hey man and that's pretty cool and that's pretty neat that you guys are a part of that infrastructure. An exciting to see where that where that heads for sure. You guys do any blogging there on your site that we could keep up with.

Curt Bashford: [00:16:39] Not yet but it's an area that we're going to be beginning shortly. We need to start doing that outreach and share and we just started putting together some case studies again to demonstrate how this or at this disruptive technology. How are others doing. We're in a row for 500 hospitals around the country. And there's I think are equipment's handling probably over 10000 calls a day. So we need to do better at sharing that information those experiences for others.

Saul Marquez: [00:17:08] Yeah I mean I think just with the with the experience that you guys have in the footprint that you have I think I mean I would definitely follow it. I'd definitely be reading on it.

Saul Marquez: [00:17:16] I think a lot of the listeners would too. So it be interesting to see see that when it comes out I'll be looking at it or.

Curt Bashford: [00:17:22] I appreciate that appreciate the push.

Saul Marquez: [00:17:24] Yeah. And Curt whenever you do I'll be happy to share with the listeners because I know that there could be some good learnings there.

Curt Bashford: [00:17:30] That'd be great.

Saul Marquez: [00:17:31] So tell us a little bit about maybe what are your proudest medical leadership experiences to date, Curt.

Curt Bashford: [00:17:37] Sure. So in thinking about that there's kind of two areas so one in the last year or so we've gotten a lot of business acolytes are we meeting 5000 list recognized right smart CEO in New Jersey biz and some other innovation wards and that's all great on the business side. But more personally it's more satisfying when it when it comes from what we do and what we do how it helps people out there. So I mentioned you know we're in a lot of hospitals and in the messes around the country there's often times and you know you're at home you watch the evening news you tend to hear about the bad stuff that's happening whether bad accidents or shootings or other kinds of catastrophes. And it's not uncommon to see a situation described and somewhere else in the country and say I know the hospital not area they have our stuff in some small way. We were involved in that and helped in some small way.

Curt Bashford: [00:18:30] There has been some higher profile ones the shootings in San Bernardino a few years ago in and in Arizona and rouge and we know those people there are notes users know that the care providers are the real heroes in such folk we know our equipment was used so that satisfying that in some small way what we did touch some of those lives and then we had similar aspects more recently here right here at home. One of our employees while he was at home had a stroke and was you know they were able to call them one one and a the paramedic service in a hospital there use our equipment and that was part of his care process as he was en route to the local hospital. He's in the manufacturing department and worked on that equipment. So there's a direct correlation of how what he does helped save his own life. And yeah and we had a similar one at one of our sales guys had a heart attack and the same kind of thing. So those are the proud moments that kind of hit home that you know what we do makes a difference in matters that at some level.

Saul Marquez: [00:19:34] Now that that's for sure. Talk about the most appropriate way right. The thing that you're working on actually saved you. Yeah that's just unbelievable. Tell us a little bit about an exciting project that you're working on today.

Curt Bashford: [00:19:45] Right. So I would say that kind of relates more back to the mobile telemedicine with aspects like first net that we got this bandwidth that we can extend that out. There is a facet of emergency medical services called the Mobile integrated health care or slash community care medicine there's kind of two interchangeable terms depending on who you ask and that has M.S. 3.0 world that's the thrust of you know does everything need to go back to the emergency department. The obvious answer is No. But the problem is reimbursement and the is upside down. It's all for transport of a patient kind of looks like a transport that Eidi but we know there's a lot there really doesn't need to go there is a lot of care to be taken to a more appropriate location or a treat and release. And right now reimbursement doesn't handle that. But there are some innovative interesting projects around the country and some bigger groups that are doing it that are partnering with the health care systems to manage these patients at home. So some of them at a basic level. It's the high utilizers that you know system users and such were you know can identify those and manage them better at home. Sometimes it's a referral to a medical facility or clinic or physician and routing and navigating that better. Then there's the whole aspect of partnering with like home care agencies and such and managing patients house discharge to avoid unnecessary re-admits and what can we do for certain groups that offer a system savings and M.S. as a resource for that right. You know who else is a 24 hour service. We had a response team about to serve as a role for them in their health care evolves and it goes towards really treating the population properly and not just taking everything to the Department.

Saul Marquez: [00:21:31] Man that's a really interesting idea, Curt and just hey the emergency folks are there.

Saul Marquez: [00:21:35] They're there 24/7. So if they could go to the site of where the patient is and if it's something that could be treated on the spot that they have the skills for why not.

Saul Marquez: [00:21:44] Right.

Saul Marquez: [00:21:45] I mean instead of taking them to the E.R. that's pretty cool and sort of a way to think about it as like you don't really need to add fancy gadgets just rethink the process and layer and service.

Curt Bashford: [00:21:57] Right. So some of that's real basic some of it's different treatment modalities. They're going to see different type patients that are more complex and they're not just treating you know over a broken bone or something from an accident it's a different scenario. But they have some skill sets and they can evolve into that. And that's where we'll look at some of the tools that we provide. So if there's someone certainly know you can do a telemedicine cuts right from the living room to their physician and get a determination. Do we know this OK.

Curt Bashford: [00:22:24] Do we need to monitor or do we need to transport this action.

Saul Marquez: [00:22:28] Now that's really interesting and also exciting just to think that whole EMS realm it could evolve into something completely different.

Curt Bashford: [00:22:36] It is and there's a lot of programs around the country you just don't know about a lot of them. Some hospitals are keeping it close to the vest some are very public about it and sharing information is there you know start group out of Texas that's doing some great stuff and sharing their experiences and they're getting reimbursed by partnering with the bigger systems and getting a piece of the savings are different and you know international in Europe it makes more sense where you got a single payer system. You do an improvement here the system saves and it's easier to implement. But here you know what our system it's so different and it's in challenges.

Saul Marquez: [00:23:08] Yeah no that's for sure.

Saul Marquez: [00:23:09] So Curt let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine it's the one on won or the ABC is of Curt Bashford. And so I'd like to just write out the syllabus with you I'm going to ask you four questions. We'll get some brief answers as the lightning round and then we'll finish up the syllabus with the book that you recommend to the listeners. You ready for.

Curt Bashford: [00:23:32] Sure go for it.

Saul Marquez: [00:23:33] Awesome. What is the best way to improve health care outcomes.

Curt Bashford: [00:23:36] So I think it's understanding the needs and the pain points that a provider and engaging them and the stakeholders in that solution need to come up with appropriate solutions that saves time money reliance.

Saul Marquez: [00:23:47] What is the biggest mistake or pitfall to avoid.

Curt Bashford: [00:23:50] I'd say being complacent having that we've always done it this way attitude whether it be in a business and a company or with know users and health care providers

Saul Marquez: [00:24:01] Love that one.

Saul Marquez: [00:24:02] How do you stay relevant as an organization despite constant change.

Curt Bashford: [00:24:05] For us it's keeping your finger on the pulse of who your customers and users are understanding and kind of relating back to the other question what their needs are. Where is healthcare going and where is technology going where they intersect.

Saul Marquez: [00:24:19] What is one area of focus that should drive all else in your organization.

Curt Bashford: [00:24:24] Serasa that's our core value responsive innovation responding to changing needs and doing in an appropriate way.

Saul Marquez: [00:24:31] I like that whole you know I like responsive innovation curve because innovation is just like okay there's a lot of reasons why you would innovate a responsive innovation is you're doing it in response to a need right. So it's it's more like relevant.

Curt Bashford: [00:24:44] Yeah. And that's kind of.

Saul Marquez: [00:24:45] Love that.

Curt Bashford: [00:24:45] That's one of our hallmarks for a long time and innovation is kind of an overused word to a little bit these days but it is a fit here for us it's in our DNA it's who we are what we do.

Saul Marquez: [00:24:57] I love that the DNA your daily natural actions. So Kurt what would you recommend for the listeners to read or listen. Audiobooks right?.

Curt Bashford: [00:25:06] Yeah yeah.

Curt Bashford: [00:25:07] So for me audiobooks on my computer and over the last three years I think I've done about 40 45 and it's hard to keep track if it's for the business side I love the Lencioni books five dysfunctions of a team and things how to look at it that way and you can apply it to a business or to a health care organization.

Curt Bashford: [00:25:26] But if it's on the health care one there's one that sticks out a little bit for me and that is the patient will see you now.

Curt Bashford: [00:25:33] And if you know that one by Eric Topol it really touches on big data and technology and it starts with the history of medicine. And how you know the dominance of physicians and there are the keepers of the data and it really the power needs to shift to the patients. And you mentioned that MIT quote you know the patient is the single most unused person in healthcare. And you know we have these devices and we can take a bigger role and date is going to play a bigger role. And so it's so it's kind of some interesting thoughts that are out there are probably accurate on where some things are going to go.

Saul Marquez: [00:26:08] That's pretty cool. Kurt I've heard of that book so many times and haven't picked that up so it is officially on my list. I appreciate you sharing that.

Saul Marquez: [00:26:16] And to the listeners check out those business books and as well as the Eric Topol book that Kurt just mentioned don't worry about writing it down. Just go to that's C U R T and you'll see all the show notes on the things that we discussed today the links to Kurd's company and the services he provides as well as the books that we just discussed. So Curt really appreciate these recommendations and now before we conclude I do want to ask you for your closing thought and then the best place where the listeners can get ahold of you.

Curt Bashford: [00:26:48] Yes of for close you know first most thank you for the many opportunity to share from some of our experiences and what we do we enjoy that and we like to continue that people can get a hold of me at my email. First the initial list names so it's or at the Web site and get information on there. And I'd be happy to share you know things that we've learned along the way. That's how this works Saul, sharing the learning experiences.

Saul Marquez: [00:27:20] Absolutely. Well Kurt just want to say thank you so much for carving out some time to share some pearls of wisdom here with us and looking forward to seeing how you guys make a difference in this area. So really appreciate that.

Curt Bashford: [00:27:32] Thank you. Saul, thanks again.

: [00:27:37] Thanks for listening to the Outcomes Rocket podcast.

: [00:27:40] Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

The Five Dysfunctions of a Team: A Leadership Fable

The Patient Will See You Now: The Future of Medicine Is in Your Hands

The Best Way To Contact Curt:

Mentioned Link/s:

Healthcare Podcast

Full Podcast Transcript

Reduce The Burden of Type 1 Diabetes with #OpenAPS with Dana Lewis, Co-founder at OpenAPS

: [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 Rocket where we chat with today's most inspiring and successful healthcare leaders. If you liked the show, please do leave us a review on Apple podcasts. Go to and let us know what you think. Love to hear from you all. Without further ado, I want to introduce my outstanding guest Dana Lewis. She is the co-founder of open APS. And she is been in healthcare for quite some time looking to apply the best of analytics data and programming to health care so that we can leverage these technologies to make healthcare better. Dana, I want to welcome you to the show.

Dana Lewis: [00:01:05] Thanks for having me.

Saul Marquez: [00:01:05] Absolutely so maybe you could round that out a little bit better and give the audience a better understanding of what Open APS is and what you are focused on in health care.

Dana Lewis: [00:01:16] Sure. So open APS is the open source artificial pancreas movement which is led by patients like me who have said we're not waiting for commercial technology to come to the market in a couple of years. So we've created DIY technology whether it's remote monitoring or artificial pancreas says and are using open source principles to make the code better to share with other people and to bring other people into the community. And that's one big focus of my work.

Dana Lewis: [00:01:39] But the other thing I'm working on is how do we scale what we've done in the diabetes community to other patient communities. And I'm actually now the principal investigator I cret funded by the Robert Wood Johnson Foundation in order to study this work but also figure out how to leverage it and scale it to other communities.

Saul Marquez: [00:01:55] I think what you're doing is so awesome. It's sort of like at the center of the patient as CEO. I had Robin Farmanfarmian on the show and you are literally doing just that.

Saul Marquez: [00:02:06] Dana you are the patient CEO representing for all those with diabetes which is so cool and opening up the floor to anybody that wants to collaborate and innovate.

Dana Lewis: [00:02:17] Yeah I think it's really important that we have a lot of flexibility and providing opportunities to patients. There are some patients who want to do more and they're just not able to. But not everybody needs to create a non-profit or create a company or truly be CEO all the time. So one of the things I'm very interested in doing is exploring what are the many many different ways patients can be involved when they have a spare hour during the week where they want something longer term and really being flexible and adapting to people at all levels and all parts of the world. However they can't so people can take time off of work to do stuff some people can't. So we really need to think about what are different ways we can engage patients at different levels of activity.

Saul Marquez: [00:02:53] Now it's such a good call out. And Dana what would you say the turning point was that got you into the medical sector.

Dana Lewis: [00:03:00] So I was diagnosed with Type 1 15 years ago this weekend actually at my age of 14 and high school. And so that really was my first training point of deciding I was going to do something in health care. And I really wanted to figure out how do I help as many people as possible. I thought about going to medical school becoming an endocrinologist decided that wasn't the way I could make the most difference. But I've really focused on using communications throughout my professional traditional career as well as what I've done with Open APS to educate and inform people about what's possible and to bring people together to collaborate because I think that's one of the strengths that social media provides us in the modern era of healthcare is really how can we come together in new and different ways when traditional infrastructure of companies businesses and healthcare hasn't allowed that. So for me the turning point was really that realization of social media as a powerful connector of people and then figuring out what are the different ways we can apply that to make health care about her.

Saul Marquez: [00:03:53] That's huge and just being able to knock down the barriers and help bring solutions by using social media is so awesome.

Saul Marquez: [00:04:01] And I just you know I think of the DIY movement my brain goes directly to like the 3D printers and all the other things that are going on I 3D printers is just comes up to mind and the stuff that was able to happen because of the DIY movement in 3D printing is just phenomenal. And I'm really intrigued what will happen now that you and your team have started this movement it's kind of exciting.

Dana Lewis: [00:04:24] I think it's incredibly exciting and I'm so excited to see what comes next. I mean I think diabetes is actually a data driven disease. So it was quote unquote easy for us because we had the data we knew already how to deal with the data to really kind of push the envelope and figure out what came next.

Dana Lewis: [00:04:37] But I'm really interested to see other communities as they leverage technology and collaborate with others how they to decide to apply this DIY technology whether it's 3D printing or open source algorithms and software or open source hardware but really see what's possible because I think people who live with these diseases they deeply understand we deeply understand the problems and what we think is the number one thing that we should be solving and what we think should be solved is not always what companies and the bottom financial line decide are important.

Dana Lewis: [00:05:07] There's often a gap there. So I'm excited to see more people working together and sharing the ideas. It's not that all of them can't eventually become commercial solutions. Many of them can but they and we'll start from a really deep place of understanding and solving somebody's problem and then turning around sighting. I want to share with other people because it really helped me. And they're allowing it to grow and improve as people take it on and make it their own and make it even better.

Saul Marquez: [00:05:31] The movement has started no doubt. Dana you bring such a great point. What is driving innovation isn't always exactly meeting the needs of patients.

Saul Marquez: [00:05:40] And so it will be really interesting to see what bubbles up from your efforts and the people that are getting involved. What do you think a hot topic you feel should be on every medical agenda today. And how are you and your organization approaching.

Dana Lewis: [00:05:53] So I think interoperability is absolutely key. And I mean that because the devices that are designed today and health care are often designed for the company that makes them they're not designed for the patient or the doctor or whoever the end user is. It's incredibly frustrating. And then also if you take device a device b they do not play together. And that's going to stymie further innovation. It's going to stymie outcomes and quality of life. And we're just at a point where we can't accept that anymore. And so I think companies really need to be thinking about having flexible architecture and infrastructure that yes maybe a patient or a doctor out there might build something really great but they shouldn't see that as a threat. They should see that as an opportunity to have these small innovation labs out in the community out in the world figuring out how to better work with their product. It's a win win for the company getting additional perspective has just been shut down. Don't be interoperable that's a bad thing. But I think what we're seeing is true interoperability is really going to be the game changer for the bottom line for these businesses.

Saul Marquez: [00:06:49] It's a great column Dana and I think about Bluetooth. For instance the things that we could do because everybody decided Bluetooth is the standard right. We need Bluetooth for devices.

Dana Lewis: [00:06:58] Yes. And that exact ability of we went to that built into the device that we can communicate the way we want. Maybe the average person isn't going to control their pump themselves but there's a small community of people out there who deeply want to understand and control their device to make it better for them and they're going to stay on your product and get better outcomes versus moving away to a competitor in search of a product that's going to work better for them so that interoperability and that flexibility for customization is really going to help everybody. And again it shows the company the market of here's what people are wanting to do if they're that willing to DIY. There is a market need out there and you don't really see that market grow.

Saul Marquez: [00:07:35] Yeah absolutely. And then you start getting innovation that stems from the actual user and things that maybe would not have ever come up in your innovation lab during your R and D.

Dana Lewis: [00:07:46] Yeah I think it's fascinating from my seat in the diabetes world for things that I've heard people say that's totally impossible and people don't want that and people aren't willing to do that. Well as I said today there's over 400 people worldwide who have self built hardware and software to have an artificial pancreas and there are definitely pros and cons to that and a lot of risk. But people have decided that the net risk reduction is worth it and they're willing to go through a lot of effort to get those outcomes and so no it's not impossible and people aren't willing to do it. And it's really I think important for companies and people of companies to take a step back and listen to users and listen to customers and listen to patients to really see how is a quality of life such that they are willing to make such a significant investment and time and energy to have a better quality of life.

Saul Marquez: [00:08:29] Dana, you're an example a healthcare leader that refuses to accept no for an answer.

Saul Marquez: [00:08:36] You refuse to accept convention as the way and it's this courageous view that you have that really will be the catalyst for change. I really commend you for your courage and your strength and not accept what is and can you give the listeners an example of how you have done things differently to improve outcomes.

Dana Lewis: [00:08:56] I think it really comes down to a lot of the open source principles that are part of the open apx community for those who are not familiar open source Houghton's maybe fluid and scary but this open source mindset is really about allowing other people to see the source of what you're working on to be able to have an open and transparent discussion about what could be better show your work in progress. Allow other people to review it and that's what we do and open APS is the code that runs the open hardware and the open software is freely available for anybody to review whether that's individuals or companies and so they can chip in ideas or suggestions on how to improve it. They can also take it for themselves apply it and make it better which is awesome but also our documentation is open sourced to like people would be doing this if we didn't have documentation that helped kind of show them. This is the safest way to do it. Here's the things to be thinking about and people are constantly coming back and feeding and new ideas. And that sounds pretty straightforward and it seems like maybe everybody should be doing that. But when you think about the traditional way of designing medical devices everybody has closed Sorens devices. They have closed source user guides and so people like me patients will turn to social media and create wikis, blogs and forums and all this other content that's not maybe always 100 percent open source but it's working towards that open source of. We need to be able to freely share ideas about what doesn't does not work and how to hack at work around. And if companies aren't willing to adopt that and different and allow people to interact like that. People are going to find a way. But I think it would be better for more companies to think about this open source principle of being transparent about what their product does and does not do and allow people to help make it better.

Saul Marquez: [00:10:29] Totally. Give me an example Dana of a time when you had a setback. And what did you learn from that setback.

Dana Lewis: [00:10:38] So when we first close the loop and that means adding a small computer to send commands to my insulin pump to automatically adjustments when dosing. We did this on a Thursday night and I went to bed and I woke up the next morning my blood sugars were great and we designed the system is just an overnight system. But I loved it so much that I was like I'm never letting this out of my sight.

Dana Lewis: [00:10:57] I unplugged it put a battery and it took it to work brought it home and did that. However the computer we were using at the time a Raspberry Pi has a known issue where if you unplug it suddenly sometimes I'll crash the SD a crash the SD card. It was Friday afternoon and by the time we figured it out. This was before Amazon to our shipping and so I can get a SD card until Monday and I had to go the whole weekend without looping which after two days of looping was heartbreaking and so upsetting and so we very quickly learned to always carry backups and have a backup for that so that we didn't have that. But that was a very important lesson for us to have early on was to assume that the hardware is going to fail in ways that we didn't expect and making sure we know what to do. But that became a very important principle Open APS community which is designed for failure we had planned a design for failure around. What happens if you lose communication for any other reason but it really reemphasized to us that we have to assume that every command at the system sends is the absolute last command it would send. So be conservative and do the safest thing based on the available data and that's really stayed true. So I've had many other quote unquote failures for years with this project. But the big major setbacks are really big disappointment because we just had this mindset of assuming you will fail and always try to learn from it and try to make it better. It's very easy to look at it as a learning opportunity. You always have this growth mindset of. OK. We learned something else that didn't work. Or we found another edge case. We're going to design some more safety constraints around that so it's better for the next person and you do that and you move on. And it's really great to have that mindset and not to feel threatened or worried by oh gosh something went wrong. It's like that's a matter of fact moving on.

Saul Marquez: [00:12:33] Now that's exciting and I can't imagine being in your shoes and all of a sudden it crashes and oh my gosh. Now I know I'm not getting my insulin delivered and you're just freaking out.

Dana Lewis: [00:12:43] It's not that I wasn't getting insulin delivered. It's just I have to go back to the old way of doing things where I had to do God like I see. OK. Out of that analogy. Yeah the automation goes away like it was the best two days of my life.

Saul Marquez: [00:12:56] And that was too funny.

Saul Marquez: [00:12:59] And you know the thing that sticks out is what you said earlier in the podcast is this idea of net risk reduction.

Saul Marquez: [00:13:06] You know sure there are some risks to doing this but you're doing it on your own accord and the overall net risk reduction is there and that's why you're going for it.

Dana Lewis: [00:13:15] And I think that's so incredibly important when people talk about it and question open apx and questioning is good that's where the transparency comes in we say yes there is additional risk but the overall benefit makes it a net risk reduction and that's why so many people have decided to do this is yes they understand the risk. They understand how it could crash and go wrong but in hundreds of people over many years and like millions of hours of experience with this technology we've never had any terrible significant adverse event outcome like you might expect or predict happen and that's because of the safeguards. And it's also because people go into this with their eyes open they know it's DIY. They know they're taking the risk on themselves and they get to decide what level do they put their safety threshold how much insulin can the device give it. And so they are really in control of their experience. And like all projects you see different personalities coming in that people do everything without reading the instructions and they get up and running and then they crank their safety settings all the way to the max like on day one which is for me because I'm not that personality that terrifies me. And then you have other people who will start in Phase 1 with like all the safety settings turn to the lowest possible and they stay there for weeks until they're comfortable moving on. And that's fine. But I think again that customization that flexibility and having that knowledge being transparent to the person so that they get to decide their level of concern about risk and safety. And it's up to them about do they keep using this device day in and day out and they think that people who continue to use this year after year is testament to having the right amount of knowledge for people to feel informed and to decide that it is true that risk reduction and that they are safer with the system about.

Saul Marquez: [00:14:49] What would you say.

Saul Marquez: [00:14:50] One of the proudest moments that you've experienced to date is.

Dana Lewis: [00:14:54] Oh there are some good ones that when I think about just give me chills.

Dana Lewis: [00:14:57] I mean for me I was proud day one because the reason I did this is because I was afraid to go to sleep at night that my blood sugar would drop dangerously low. And so the first time I traveled after I had the system and I was in a hotel room by myself you know I was getting ready to go to bed. I used to kind of like lay there for a couple of minutes and kind of mentally prepare myself for how bad it was going to go I was going to wake up and have to drink juice where I wasn't going wake up and I'm going to feel terrible in the morning and what if I didn't wake up and being afraid to go to sleep that night is not something that people experience forget. And so after we had the system in the first night I used on the road I went to sleep without worrying and I woke up the next morning going I was able to go to sleep without fear. And that was just a light huge weight lifted off of me and a light bulb went off.

Dana Lewis: [00:15:39] And for me that was that moment. But then I hear parents who talked about being able to be at work and a kid being able to be at school. The kid does their job which is to be at school. The parent does their job at work and nobody worried about diabetes for the day because a systematic cupboard or a parent being able to go with their teenage daughter for not talking about diabetes for 36 hours for the first time and two years since they were diagnosed just a little moments like that where different people have these different relationships different burdens of diabetes and this type of technology freeing them up for that or giving them new experiences to me just makes it all rewarding. I have never thought that we would have so many people using this kind of technology. But I always said if one other person found it as valuable as I did it would be worth open sourcing it. So the fact that we continue to hear these stories week after week and for people around the world to different life situations it's just absolutely amazing.

Saul Marquez: [00:16:29] It's a testament to the applicability of what you're doing. So Dana give us a little bit on an exciting project that you're working on today.

Dana Lewis: [00:16:38] So open APS to me is the exciting project but one cool thing is that the system that we designed to almost three years ago is the same system we're using today we've continued to innovate on algorithms and features. Yes. Where the version in development that I'm testing right now is one such that instead of having to manually just make insulin at the start of a meal instead of having to count carbs and dose insulin and let the system pick up from there I'm now able to simply put in a carb estimate entry like this is a medium sized 60 Karmiel and I do not have to manually dose my insulin and it's able to pick up and go from there and give you to similar outcomes when before I was manually dosing. So the most people that may not sound like a big deal but having to remove the burden and the decision making from somebody around meal time was one of those like last big barriers for having a more automated system. And that's totally what's exciting to me as we've crossed another one of those barriers of making this even more frictionless for people with diabetes.

Saul Marquez: [00:17:35] I love it that's so exciting. And you just kind of continue to find those barriers and keep breaking through. Hey maybe you'll be the next Medtronic.

Dana Lewis: [00:17:42] No no no we're not going commercial. But it's exciting to see is the speed at which we can innovate. We always think OK Shirley we're done. We can't do anything else to top ourselves. You know as a community about the future. And then somebody comes up with an idea and we coded and test it and roll it out to the community people like oh my gosh it's even better than the last. Nice spread that we thought was amazing. And I think it is a testament to the whole entire community that works on this. But also again that open source of being able to have fresh ideas fresh energy people contributing around the world at all hours. And we all have that shared goal of making life with diabetes better. So it's just it's cool to be a part of something like that.

Saul Marquez: [00:18:22] Very cool.

Saul Marquez: [00:18:22] I think it's super cool and I always think that if you're getting the traction that you're getting now I mean just imagine the number of lives that you're going to be able to improve just by what you're doing.

Dana Lewis: [00:18:35] Yeah I mean they see it in the people who have chosen to use this technology but what I'm also really excited about is there are companies looking at our code and looking at how do they make their product better as a result of what we've learned. And I think that's where you start to really see the ripple effect as it's not about commercializing it's scaling our particular thing. We don't want to commercialize that we want to keep it open source but that doesn't mean that the traditional companies who have the ability to scale to hundreds of thousands of people shouldn't be leveraging what we've learned over the last couple of years and taking advantage of that iteration and that's what I'm excited to see more of is companies partnering with the patient communities with these open source communities that deeply understand and have solved a lot of the problems that maybe they couldn't figure out how to solve with their infrastructure and their resources. And it doesn't always have to be complex. We found some very very simple approaches for solving some really really complicated problems. And what we found is that if you can't simply explain your solution it's probably still too complicated. And so I'm excited to see more of those conversations and relationships happen and again beyond diabetes too because there's a lot of expertise out there and other patient communities whether we're talking about cystic fibrosis or cancer or you name the health condition. There's expertise out there by nontraditional experts and it's crazy for us with all the health care problems we have to look that expertise wherever it is.

Saul Marquez: [00:19:54] I love it. That's great. Dana. This is the part of the show where you and I do a lightning round. It is basically we're going to put together a course on what it takes to be successful using technology and healthcare the 101 of Dana in tech and health. And so I have got five questions for you. And we're going to go through these pretty quickly. So I just want to know you're ready.

Dana Lewis: [00:20:19] I'm ready. Awesome.

Saul Marquez: [00:20:20] OK. So what is the best way to leverage data to improve outcomes.

Dana Lewis: [00:20:25] Design for data first and not last.

Dana Lewis: [00:20:27] Oftentimes data is thrown on at the end of the hour we need to display something versus made central to the design experience. And it also means that people are usually designing for the company's use and not truly the end user or the patient the doctor whoever's actually going to be using the technology.

Saul Marquez: [00:20:44] What common pitfalls or mistakes should be avoided.

Dana Lewis: [00:20:47] Forgetting about your end user and that means again designing for the patient first the doctor second the hospital third and your company. Fourth and it's really about easing the way of the person who's going to be using it versus making it easy to get it approved through your company or proved through regulatory.

Saul Marquez: [00:21:02] What is the one thing companies or providers must focus on to create meaningful improvements.

Dana Lewis: [00:21:07] I would say to stop thinking about the next tiny incremental change and to really step back and think about designing for what is best for your end user and really what is going to make the biggest difference. I think we often let these companies limit themselves way too much in terms of what they should do next versus thinking about what is really possible and applying their expertise to solving that problem.

Saul Marquez: [00:21:28] Now that's a great one. And what can organizations do to stay relevant with rapidly changing technologies.

Dana Lewis: [00:21:36] Say what we patients say which is we're not waiting we are going to find a way to leverage everything possible the fastest technology and change the company in order to catch up. But don't be beholden to decades old manufacturing or design processes.

Saul Marquez: [00:21:50] I love that. And finally they know what book would you recommend to the listeners.

Dana Lewis: [00:21:53] So I really appreciated reading Thomas Friedman. Thank you for being late. I think he does a fantastic job talking about technology and some of the pivot points of where the technology really sped up and how the technology companies themselves adopted but also just it's an interesting mindset for us individuals as we work in health care about how do we both speed up to take advantage of the technology but also slow down and really think about the problem and the end users that we're trying to solve for.

Saul Marquez: [00:22:20] Low that I'll have to pick that one up. I haven't heard of it before.

Dana Lewis: [00:22:23] It's a really good read.

Saul Marquez: [00:22:24] Thank you for being late. So there you have it listeners take a look at the show notes for all the things that Dana has discussed with us today. You can go to that's a and a. And you're going to be able to find all of the show notes a summary of what we've talked about including links to the fun stuff that Dana's working on and a community that she's built. So I just want to ask you Dana to ask really just to conclude with a closing thought and then share the best place that the listeners could get ahold of you.

Dana Lewis: [00:22:56] I would say the closing thought is we are not waiting because we can't afford to wait. And I would love to see more people working in healthcare adopt that urgency mentality and to find me. I'd say check me out on Twitter. I'm Dana M. Lewis. And then also open AP and org and at up yes on Twitter to learn more about the DIY artificial pancreas.

Saul Marquez: [00:23:13] We love it Dana. Keep up all the amazing things that you're up to. I'm just going to folks. She's a girl you want to follow. Definitely somebody that's going to be making some moves here to improve patient outcomes.

Saul Marquez: [00:23:25] Dana thank you so much for being with us.

Dana Lewis: [00:23:27] Thanks for having me.

: [00:23:31] Thanks for listening to the Outcomes Rocket podcast.

: [00:23:35] Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Thank You for Being Late: An Optimist's Guide to Thriving in the Age of Accelerations

The Best Way To Contact Dana:

Twitter - @danamlewis

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Full Podcast Transcript

Make Your EMR Work For You with G.T. LaBorde, Chief Executive Officer at IllumiCare

: [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: [00:00:18] Outcomes rocket listeners welcome back once again to the outcomes racket where we chat with today's most inspiring and successful health care leaders. Today I have an outstanding guest. His name is G.T. Laborde. He's the chief executive officer at Illumicare. At Illumicare, They focus on influencing physician orders by illuminating and really what they focus on is electronic medical record workflow. The financial and patient safety implications of access utilization. This helps physicians be better stewards of their patient safety as well as the hospital's resources. Deity's had a really long history in healthcare and what I'd like to do is just open up the mike to him to introduce himself on anything that I may have missed. G.T. welcome to the show. Thank you so much.

G.T. LaBorde: [00:01:06] A pleasure to be here. Yeah I'm actually a retired attorney so there were health care there and some have told me those retired attorneys are the second best kind of attorneys who can figure out everybody's favorite kind. But anyway.

Saul Marquez: [00:01:22] Nice. I love that. We'll catch you into the medical sector, G.T.?

G.T. LaBorde: [00:01:26] Not a friend of mine from high school actually. Who brilliant guy. And he invented a data mining techniques in the late 90s to track infections in hospitals. I was always an economics major and I always had kind of a business and entrepreneurial and sort of finance mind and knew one day that he might invent something and we would we would make a company out of it and that's what happened so we built a company called Mad mind that tract infections in hospitals and did quite well with that and that's where we really kind of built the team and cut our teeth on understanding healthcare and finances and the nitty gritty of healthcare data and all that good stuff.

Saul Marquez: [00:02:05] Wow that is fascinating.

Saul Marquez: [00:02:06] And you know one of the things that I find so interesting is that as a chat with the healthcare leaders in our industry the power of thinking and you sort of planted the seed back when you knew you were going to create something with your friend. And fast forward here you guys are creating different businesses together and the message there for the listeners is your thoughts are the field which you sow your future. And as we work to create better outcomes and reduce inefficiencies in health care what is it that you're thinking and how is it that it's playing out in your life. So appreciate you sharing that G.T.

G.T. LaBorde: [00:02:44] That you've had today.

G.T. LaBorde: [00:02:45] Illumicare is based on the idea of another friend of mine actually he was also a practicing physician.

G.T. LaBorde: [00:02:51] So now I find I'm the business guy that comes along and takes these great ideas but these docs who have their their hands in the middle of it and see opportunities to improve the process and try and make them reality.

Saul Marquez: [00:03:04] Really that's a talent you know to be able to turn ideas into businesses is not easy what is it that you believe helps you do that.

G.T. LaBorde: [00:03:14] No you just need a well firstly I put all the really. They're the ones who have come up with that with the genius idea and how we really need to change things.

G.T. LaBorde: [00:03:23] You know there are just so many little blocking and tackling kinds of skills that you need to kind of turn that into reality you have to understand how to protect that intellectual property to understand really what's going to be possible and how you could make it easy on health systems or providers to adopt the solution that you have in mind. Just think of things from their perspective. And you know obviously the easier you can make it on them to adopt what you're thinking about the more likely it is you're going to be successful in selling them. You know that thing I'm in interest interest a lot of a lot of other skills accounting and recruiting and being able to find the other technologist and salespeople and all those other you know the army of other people that you need to make it successful and then the ability to raise money to fund all of that effort or just a lot of little things that you've got to do just right. And even if you do them all just right you might still fail. That's the course of entrepreneurship.

Saul Marquez: [00:04:17] That's right. That's right. And say you've been around the block several times obviously successfully and so success becomes a habit in your time in this field.

Saul Marquez: [00:04:28] What would you say you know now were here and now you're with a Illumicare what's a big area of focus that should be on the agenda of healthcare leaders today.

G.T. LaBorde: [00:04:38] I really believe in the Illumicare is really all about making the cost of things transparent to providers. It really was amazing and we as we got into really investigating prior studies and so forth.

G.T. LaBorde: [00:04:51] The one piece of data that providers who are being asked by the way to provide quote value based care but that no one ever tells them at the time they're making these decisions what things cost.

G.T. LaBorde: [00:05:03] If someone told us to go into a restaurant and get good value for our money and we opened up the menu and there are no prices on the menu and there are no prices on the wine list oh how exactly what are you supposed to do that.

Saul Marquez: [00:05:14] You could get out of control quickly.

G.T. LaBorde: [00:05:16] Yeah. So I mean who knows tonight by this Keano from Oregon or this you know this otherwise you know there's not a price on any bottle item.

G.T. LaBorde: [00:05:25] I'm not sure how you're supposed to make a value based decision. There were efforts in health care to kind of make prices transparent to consumers. But we really you know I mean and those have had mixed results and the problem is that consumers don't really choose they don't know enough to know really what an appropriate alternative is or what really is in their best judgment. So the experts who have that knowledge are the physicians or the providers. And so really it's about informing them and making cost transparent to them so that they can really exercise their clinical judgment understand really what's appropriate and what is the most efficient way of doing what needs to be done.

Saul Marquez: [00:06:04] Yeah. That's a really great point. And to your knowledge G.T. what percentage of physicians out there are given this transparency in pricing.

G.T. LaBorde: [00:06:14] It's a very difficult thing I think. I think that percentage is tiny. The problem with doing this. Many physicians get told sort of after the fact they have these quarterly or or periodic meetings with administrators who may tell them look you're you tend to be a high cost provider relative to your peers on this specific argi or something like that. But that's not very actionable. I mean you know sitting in those meetings it's very hard for a provider to know what decision do you want me to make differently because really that's what happens at the end of a quarter is really accumulation of a thousand little decisions right. And so the key is is to giving this cost data to people in real time as and when they're making the decision or when making the next decision of what to do. And the challenge with that is that the clinical data that you get in real time is often dirty. It's often unstructured. Absolutely doesn't have unique identifiers that in any way match supply chain data. So for example you may see a clinical order for an I.V.

G.T. LaBorde: [00:07:16] medication and it's in nearly equivalent will even the identifier of that medication in the clinical data very frequently doesn't match the identifier of that drug in supply chain data. So you go to pharmacy and you ask how much this cost. There isn't like one number one unique identifier that ties the two together. And by the way they don't buy anything and a milk equivalent. It's a unit of measure that's an expression of a combination of a certain amount of drug and when a certain amount of failing given over a certain drip rate over a certain timeframe so you have a problem with units of measure a different you can't even tie the two identifiers together it's a lot of work to do this in real time. And that's why really so few people do it or very few if any do it. It's because it's just it has all these inherent difficulties in doing it. So those are all the difficulties technically that you have to overcome if you want to actually achieve this kind of transparency.

Saul Marquez: [00:08:11] And how is it that Lumad care helps get around that.

G.T. LaBorde: [00:08:14] It just because even in our prior business we've just had about 15 or 20 years of working with real time HO7 feeds from hospitals and building systems that can both auto map things as well as systems that are very sophisticated and efficient in handling outliers and even having humans deal with the really extreme cases. All in real time so it's a huge infrastructure that enables you to kind of keep up with this constant flow 24/7 flow of healthcare data messy. You know health care data and turn it into something that is structured and really amenable to financial and risk analysis so that you can give providers something in real time that helps them make better decisions.

Saul Marquez: [00:09:01] That's really fascinating. It sounds like you guys embed yourselves in the infrastructure and make it possible that way. Can you give the listeners an example of how Illumicare has created results through the system.

G.T. LaBorde: [00:09:13] Absolutely. So it's been studied in both academic settings as well as community hospitals in several of these places what we've done is essentially run kind of a controlled trial where you take hospitalist an internal medicine physicians and you may take two thirds of them and provide and give them this tool that by the way just appears either embedded within or hovers on top momentarily of the electronic medical record. And then if they don't interact with it it automatically minimizes and gets out of their way.

G.T. LaBorde: [00:09:43] So a lot of the design of this party is like it's going to be kind of workflow friendly let's say.

Saul Marquez: [00:09:48] I was looking at some of the screen shots on your website and it looks pretty slick.

G.T. LaBorde: [00:09:52] Yeah we worked with about 145 physicians in building it. And one of them you know one of the recurring themes was we have alert fatigue. You don't slow down the workflow. I want you to be there if I want to learn something or I want to access something I want it to be available but I don't want to have to click something degree or something don't slow me down. Yeah. You know don't obstruct my workflow and so we really built that a physician's view because of course my business partner is a practicing doc and he hates being slowed down. So that's part of it. But yeah in both academic and community centers we run these tests where because of the nature of how it's engineered you don't have to give it to every physician in the hospital initially you can really pick and choose which physicians have access to it and so will give it to all two thirds of the hospitalist and two thirds of the internal medicine docs and then not give it use as controls. The other third in the same hospital and then we'll track their spending habits so we know every order for a medication lab or radiology tests of every provider we know who the ordering provider is and we know the cost of those tests so we can kind of track historically the spending of each provider on a DRDO adjusted basis on a risk adjusted basis.

G.T. LaBorde: [00:11:02] And then there's that spending change after they get access to this tool and then does that change in spending differ from the controls you didn't ever have access to it.

G.T. LaBorde: [00:11:12] So it's both the historical comparison as well as a comparison to a control group of the same type of Doc in the same hospital and in every case we've done that we're finding that the providers who have access to it lower the cost of care by something like 200 to 300 dollars per admission. So when they see cost data it really causes them to be.

G.T. LaBorde: [00:11:32] Those two things that causes them to be more diligent more thoughtful and in ordering so that really kind of translates to fewer orders per patient or per patient day. And then when they see in their mind two drugs that are clinically equivalent in the situation and one is five times more expensive than the other.

G.T. LaBorde: [00:11:49] They tend to choose between the one they're not wasteful. I mean it providers do the right thing if they have the right information.

G.T. LaBorde: [00:11:55] So the combination of those two things ultimately means that it both lowers the cost of care lowers the amount of resources being consumed on an inpatient stay which is really good for hospitals because for most of their patients they get paid some fixed fee whether it's some 60 arrangement like an ACA or whether it's ideology payment or whatever. I mean the vast majority they get a penny saved is a penny earned for them.

G.T. LaBorde: [00:12:20] Right it's also good for patients because really everything that we do for every drug you know when we we give a patient 12 and 14 medications and you know we stick them 60 70 times to run a bunch of labs that may or may not be absolutely necessary. It's not good for patients that everything that we do to them involve some risk. And so it isn't just about making the cost transparent. But we also make those clinical risk transparent so we show providers hey here's how much radiation exposure this patient has received and what the cancer risk of just that medical radiation exposure means to them in their lifetime. Here's how much blood you've taken from the patient and phlebotomy and the risk of anemia from all those years. They're on three antibiotics. Here's the increased risk of them getting Sieda because of what you're doing because of the current prescriptions they're on now we never say therefore you should change or whatever we never tell a doctor what to do.

G.T. LaBorde: [00:13:17] But we bring to light these kind of human and economic costs and give them and allow them to make decisions without Amaan.

Saul Marquez: [00:13:24] And I think that's super interesting. Sounds like you found a home and these three levers of medication costs lab costs and radiation.

G.T. LaBorde: [00:13:33] We settled on those because those are three items of marginal spin. So when you know many people say well we like to save hospitals money because we can reduce length of stay or something like that.

G.T. LaBorde: [00:13:44] And what you find when you're of CFO of a hospital is it's really hard to then look to a department budget and say OK you know we've reduced length essay by point two days. I can see that savings here sort of a large amorphous thing.

G.T. LaBorde: [00:13:57] And so whereas when providers are switching from the five times as expensive drug to the ones you know do the cheaper drug right. You could look at the pharmacy line item and say wow we're spending a lot less on the very expensive drug or wow we're you know we're running a lot of these tests and therefore whether ordering fewer reagents or whether it's spending less on send out to reference labs whatever it is is that cost becomes I mean you can actually point to a line item and say wow yes I can see the results of that. And these are three things that our provider controlled. You know we thought about does it make any sense to tell a provider what a you know what a gauze cost or something like. Now they can't do anything about that but they are exercising judgments about what medications a patient gets or what labs will be ordered. I mean is the providers that control about and therefore if you're going to put something in their workflow put something that they have control over you can help them make a better decision.

Saul Marquez: [00:14:51] I think that's really great. And you know G.T., I've been in conversations with a lot of health care leaders and you're right.

Saul Marquez: [00:14:57] I mean it's to speak to a CFO about savings through cost avoidance like reducing length of stay or something like that. It's not as hard cold as a line item as these. And I think it's pretty cool. Have you've aligned these three physician controlled costs. And it's an easy way to not necessarily easy but easier way to truly understand the savings that you're giving a system. I'm floored by how affordable this looks. I mean I'm looking at the site here and per patient. It's like 12 dollars and 50 cents.

G.T. LaBorde: [00:15:30] Right. So why is it so easy.

G.T. LaBorde: [00:15:34] Well what's really interesting about this platform is this it can display other information. So really the displaying of cost and risk is like the first thing that we can do for health systems and what becomes fun for our customers as they adopt this and they see the huge savings and they're paying not that much for the platform and so it's something that they like and they were positive about. But then they start to think about well if you have this platform that can put information in front of physicians in a non-intrusive way by the way we can actually show different things to different users and different things in different environment.

G.T. LaBorde: [00:16:10] So the way that we've engineered this little ribbon is that it can show one thing to a case manager something different to her oncologist something different to a hospitalist something different a patient is the ECB or ambulatory versus on a particular inpatient unit.

G.T. LaBorde: [00:16:26] So hospitals have the flexibility after they've sort of adopted this platform to begin to leverage it in other ways. And so hospitals can then spend more to do more with it. It becomes fun for them to see you know a way of sort of using it to do lots of different things and so we've seen them bring in pharmaco genomic data you know at the point where we've seen them use it to bring in population health type things on an outpatient basis to bring in predictive analytics at the point of care. There are all these you know there's lots of data that can help providers that isn't in the EMR.

G.T. LaBorde: [00:16:56] So it really becomes kind of this malleable tool to do other things with as well.

Saul Marquez: [00:17:00] That's fascinating. And I think it's cool that he just kind of hey here's here's some capabilities that we've seen or proven now that you've seen how it work. It's up to you how you want to morph this tool and Illumicare will help you get there.

G.T. LaBorde: [00:17:13] Let me just pause and give give physicians a lot of credit here.

G.T. LaBorde: [00:17:17] The biggest issue the two things that when we really started the company that seemed to be administrators biggest worry a physicians would would find it you know would they even want to know what things cost it specially because they don't really directly make any more money if they're making these decisions appropriately. Would they even care. And I have to say that there's you know in every for every provider we talked to said man give me the information and I will I will do the right thing. It's like trust me to do the right thing. And now more and more people I mean I had to you know I met with two large health systems over the last just four or five days. And both of them without prompting said this is something that our our physicians are asking for they want to know what things cost. They're conscious about it and they would like us to provide that to them. I just want to give a shout out to you know the physicians to say they really will do the right thing if we if we give them the information that empowers them.

Saul Marquez: [00:18:11] Oh absolutely. I think that's a great shout out G.T. and this thing is really really awesome. It wasn't always so. Maybe maybe you can share it with the listeners setback or a mistake that you made in the process of building it and sort of what you took from that moment.

G.T. LaBorde: [00:18:28] The hardest thing about building something like this is taking the responsibility to make it work in every different environment. So here's what I mean by that. The easiest way to build a solution is to get all this data from a hospital where the Rachel 7 or some other way and then build a Web site that people log into because you can control that environment you can control how it's displayed what it looks like.

G.T. LaBorde: [00:18:51] You don't have to worry about integrating with anything else. And we really kind of set out to say how can we build this in a way that is so flexible that you don't have to integrate it with the EMR. It will work on its own and display as you change patients in the EMR.

G.T. LaBorde: [00:19:06] It will also kind of change patients it will sort of match you it will maintain contact. That's called that to do that involves so much complexity. And there was a lot of you know it was really going to be possible can we really do this. And that took a good probably a year year and a half to figure out you know lots of ups and downs and failures of Hoddy without controlling the inputs in the environment necessarily because you want to be able to do it on top of that that can help us learn are on top of McKesson on top of all these different that it's like all these different EMRs without having to directly integrate with them.

Saul Marquez: [00:19:36] Can you build something that flexible and boy there were a lot of there were a lot of bumps along that engineering road. You know where you're just hoping that it flashes on the screen right. Does it until like you got to go back and fix something.

G.T. LaBorde: [00:19:46] And so that's the hardest part is if you're willing to take the heavy lifting so the hospital doesn't have to do it to implement your solution then it means you have to engineer all kinds of flexibility into your solution to be able to adapt to all these crazy environments you find when you know doing business with many hospitals.

Saul Marquez: [00:20:02] So are you guys able to interface with all the different EMR systems at this point.

G.T. LaBorde: [00:20:07] When we started building this you know like the word interface is a four letter word for most hospitals because there are just so many projects that you know that kind of deep integration or you know back and forth with the EMR causes all kinds of headaches and then upgrade problems and all kinds of other stuff. And so we set out to try and build something that was EMR agnostic and required no integration. It's like boy how do you do that and why would you do that. And the why is because we can implement faster you know like once somebody decides they want which you have. I want to validate that decision as fast as I can. So the way that you know by implementing it and beginning to show value in the people who trusted us along the way to give us the honor to work for the health system I want to be able to demonstrate results them as fast as possible. And so to do that means that you've got to engineer it in a way that you can really implement it without a lot of heavy lifting on the part of the hospital and that means you can use whatever age of 17 they have they don't have to build one to your back.

G.T. LaBorde: [00:21:05] It means I don't require integration with the EMR. I've already figured out how to display this on and on the screen without having to integrate anything with it. It's all of these little things that you engineer into your solution to make it was really an eye to implementation because easier you make it on them the faster it will go for everybody and a more though they'll appreciate you as a vendor.

Saul Marquez: [00:21:27] Yeah that's pretty cool. It sounds like you guys sat back and you asked the question early on you know what are the main obstacles to adoption. And certainly you know one of the things that happens is the integration piece with all these EMR is the fees that are associated with it. And you guys tackle that head on. And it wasn't the easy thing to do but it sounds like it's really worked out as an access point for you all. So nice work on that. That's really interesting how you guys did that.

G.T. LaBorde: [00:21:51] Appreciate we just have a soft heart. I mean I certainly do for hospital CEOs. They have a super hard job. I mean a hospital is a difficult place to run. You know there are a lot of different moving parts. A lot of complexity lost to different I.T. solutions that may or may not talk to one another that you've got to make play nice with everything and it's a tough job. So you know our view is going to make us as painless as possible to the hospital IDs so that they can worry about a well for sure.

Saul Marquez: [00:22:19] So what would you say what are your most proudest medical leadership experiences that you've experienced to date.

G.T. LaBorde: [00:22:24] It's just really love sitting down with the administrators customers who have trusted you the CEOs and the CIOs and the CMOs and the CMI those people who get involved in acquiring Illumicare and being able to come back to them within a month or two months or three months and go live and show them the results that their providers are having with this tool. It's just so heartening that you validate the decision that they've made. You really can help them. I mean one CEO recently told the group that they're having their best year financially and they attribute some of that just a bit of that to the solution and even said you know physicians aren't generally positive about most IT things that we do for them. But this is one of kind of randomly overheard providers speaking positively about so.

Saul Marquez: [00:23:12] Very cool.

Saul Marquez: [00:23:13] You know it's just the validation that you get that you know when you're doing the right thing and you really are both providers and administrators value what you do and your solution it's it's awesome.

Saul Marquez: [00:23:21] Yeah that's really great. Appreciate you sharing that. And yeah definitely sounds like the differentiated piece on this is the ease of use.

Saul Marquez: [00:23:28] So let's go to the part of the podcast here where we build a medical leadership course together on what it takes to be successful it's the 101 or the ABC's of G.T. and so we are going to write out the syllabus together and it's a lightning round there's four questions. And after we finished that with your brief answers you'll recommend the book to the listeners you ready.

G.T. LaBorde: [00:23:50] OK.

Saul Marquez: [00:23:50] All right. So what is the best way to improve healthcare outcomes.

G.T. LaBorde: [00:23:54] I mean obviously given my life's work I believe that cost transparency.

Saul Marquez: [00:23:57] What is the biggest mistake or pitfall to avoid in running a business or running healthcare or healthcare.

Saul Marquez: [00:24:04] You know I would say whatever comes to your mind right now.

G.T. LaBorde: [00:24:07] May not organizing your personal life in a way that allows you to be successful at work. You know it family first obviously and it sort of God and family and get here getting that done right with you more on that one really kind of really kind of invest yourself in your life's work because you've got that stuff right.

Saul Marquez: [00:24:26] I love that man. How do you stay relevant as an organization. Despite constant change.

G.T. LaBorde: [00:24:30] You have to constantly change too.

G.T. LaBorde: [00:24:36] I mean I wake up every day trying to do today better than I did yesterday and try to improve what we do over what we did yesterday.

Saul Marquez: [00:24:42] Love it. What is one area of focus that should drive all else in your organization.

G.T. LaBorde: [00:24:48] Just the customer experience. If you are bringing value to the provider making decisions and empowering them to make better decisions for patients and for resource allocation everything else will take care of itself.

Saul Marquez: [00:25:01] Awesome. And what would you say that book that you recommend for our listeners.

G.T. LaBorde: [00:25:05] It's an oldie but still a goodie. I think it's crossing the chasm recently re read it and I think you have to understand that and maybe the Gartner hype cycle you sort of have to understand the technology adaption life cycle.

G.T. LaBorde: [00:25:18] And if you're building a solution or have some new innovation understand where you are in the adoption of that and that will in many cases drive the way you communicate about it how you have to influence its adoption price and I mean there's just so many implications about introducing new innovation that it's important to understand the technology adoption life cycle.

Saul Marquez: [00:25:42] That's pretty cool. I've never read that and that's Jeffrey Moore right. I think that's right. Yeah. I just pulled it up. Looks pretty cool. Outcomes rocket listeners make marketing and selling high tech products to mainstream consumers. This is one that I'll definitely add to my list. Appreciate you sharing.

Saul Marquez: [00:25:57] And to the listeners all of the things that we've discussed here with G.T. you'll be able to find it on our Web site. If you go to You'll be able to find the show notes and also links to any of the things that we've discussed including this book and also Illumicare and all the services that they provide. And so before we conclude, G.T., another time just flies I really just enjoyed our time together. I'd like to just open up the mic to you one more time seek and share a closing thought.

Saul Marquez: [00:26:29] And then the best place where the listeners can get a hold of you.

G.T. LaBorde: [00:26:32] Closing thought I guess would be that you know health care is complicated it's dynamic it's super tough to run a health care organization. I get that I mean you know your reimbursement changes every year it's in and then it's you know every 10 years it's radically different in the make up of insurance and government reimbursement and so forth. It's incredibly difficult. And then there's all kinds of innovation that happens in actual care and medicines and procedures and things like that.

G.T. LaBorde: [00:27:00] So it's it's an amazingly dynamic field but I don't think that should discourage us from from trying to you know make it more efficient from trying to put our own stamp and our own influence on it and so I'm just excited to play just a little part in that effort and enjoy really working with some of the best healthcare systems in the country to figure out how we can help them become more efficient.

Saul Marquez: [00:27:22] And what would you say the best place for the listeners to reach you.

G.T. LaBorde: [00:27:24] Yeah our website has contact us information and that's the best way to get through to me.

Saul Marquez: [00:27:29] Hey we'll really appreciate you spending the time here. I know you're pouring your heart and soul into this work that you're up to.

Saul Marquez: [00:27:36] And for the listeners if something that that G.T. said struck a chord with you. Take a look at the website. Check out what they're up to. It really looks like a fantastic platform to help reduce inefficiencies and really do a better job for our patients and also our providers. And so just want to thank you again G.T., for spending some of those up to connect with you soon.

G.T. LaBorde: [00:27:57] Thank you.

: [00:28:01] Thanks for listening to the Outcomes Rocket podcast.

: [00:28:05] Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

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Full Podcast Transcript

Prevent Life-Threatening Adverse Drug Events with Kristine Ashcraft, CEO at YouScript

: [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: [00:00:18] Outcomes rocket listeners will come back once again to the outcomes rocket where we interview today's most inspiring and successful health care leaders. So thankful that you decided to join us again today and please leave a review and rating. When we get a chance it truly makes a difference for us. Just go to and you'll be able to see the apple podcasts pop up there and you'll be able to do that. So thank you so much. It makes a big difference for the way the show ranks and gives us feedback that we need to make it amazing. So without further ado I want to introduce my guests. Her name is Kristine Ashcraft. She is the CEO at youscript that where they're catalyzing the adoption of precision medicine. She's had various roles in healthcare and has provided guidance as the chief executive officer at Gen-X as well and really has a love for healthcare. And I'm so excited to have her on the show today. So Christine thank you so much for being on the podcast

Kristine Ashcraft: [00:01:19] Thank you so much for inviting me. I appreciate it.

Saul Marquez: [00:01:21] Anything that I missed in your intro that maybe you want to add on?

Kristine Ashcraft: [00:01:25] I think the only thing I would add is I have been specifically in the precision medicine space for 17 years long before it became sexy because Obama called it out of the national priority a few years ago when I'm really excited to be in that field at this time because I feel that we're really at a tipping point where we're going to see dramatic care improvements and cost reductions based on that technology.

Saul Marquez: [00:01:49] Oh thank you so much for that. You know 17 years even before it was sexy. I mean now it's it's got its its debut. So excited for you too, K Kristine. And so why did you decide to get into the medical sector to begin with.

Kristine Ashcraft: [00:02:03] Sure. So I actually studied genetics in college and that was because my grandmother died of cancer when I was in high school and like a lot of people I had big dreams to go and find a cure for cancer when I went to college.

Kristine Ashcraft: [00:02:17] I did not end up doing laboratory work on the bench. I realized I was better suited to actually speaking and working directly with people a lot more but I did really want to continue to do something that I thought could truly impact health care.

Saul Marquez: [00:02:32] It's a powerful driver for sure. You know the lost of a loved one is definitely never easy and if you have the power to come up with solutions to help others avoid that pain then I think it's super admirable.

Saul Marquez: [00:02:46] What do you think Kristine is a hot topic that should be on every medical leaders agenda today. And how have you guys and your organization approached it.

Kristine Ashcraft: [00:02:54] Sure. So I think as I alluded to earlier precision medicine really needs to be on the agenda of medical leaders.

Kristine Ashcraft: [00:03:02] I did see a survey across my inbox today and it said that over 70 percent of leaders think precision medicine is a focus but only 30 percent of them have actually allocated money to a procession medicine program. So I think it needs to move up obviously and priority. You can't make something a priority if you don't invest some resources into it. But a lot of the focus has been around oncology and doing genetic tests that help determine the best cancer therapy. I think that my advice would be to widen the thought process around precision medicine. We're really focusing the precision medicine space although we take them into account is not cancer medication so much as the majority of medications that a patient is taking. Right now we really prescribe medications in a one size fits all manner. And about 93 percent of patients have a variation in a gene that impacts their response to at least 10 percent or more of commonly prescribed medications. So kind of broadening that thought hey genetics doesn't just impact cancer medications. It impacts pain medications, mental health medications cardiology medications, virtually all of these medications. When you think about it, think about it in a larger context. Can this help me improve drug Endo's selection for patients that are taking a lot of medications for the rest of their life not just as this helping cancer.

Saul Marquez: [00:04:27] Yeah and the thing that comes to mind here Christine is not only improving outcomes but also taking a lot of cost out of the system.

Kristine Ashcraft: [00:04:34] Correct. Correct. Actually I've gone through a series of studies to validate that we can both improve care and reduce costs.

Kristine Ashcraft: [00:04:43] One of the big questions that we got from physicians and pharmacists over the years are I've I've heard is well how do we know who to test and then how do we know how to act on it. So we've gone through a series of studies that validate our ability to do that in real time in a clinical workflow. So step one how do we know who to test. We provided an unrestricted grant to the University of Utah's pharmaco economics department and they actually got a very large claims and clinical data point database from Unova line of several hundred thousand patients that were over 65 taking several medication and they ran those against genetic risk score. So we have a patent pending score where I can essentially say hey saw based on the medications you're taking there's a 70 percent chance that if I do this genetic testing I'm going to recommend an evidence based drug or dose change to one of your doctors when the results come back. So to validate that they ran all these patients against a genetic risk or and what we saw as as the genetic risk percentage increased so did the likelihood that that patient ended up in the hospital or the emergency room. What was really cool about that increase is that they somehow made these patients otherwise equal by age, gender, race, disease, state, and the known drug drug interactions we currently flagged for. So a very clear signal that hey this appears to be causing more emergency room visits and hospitalizations.

Kristine Ashcraft: [00:06:10] So we followed that up with a study in which we provided information on how to optimize drug and dose response based on the use script clinical decision support and analytics framework and about several outpatient clinics around the United States. And what we saw compared to past historic control was a 39 percent reduction in hospitalizations and 71 percent reduction in emergency department visits in just four months with an estimated savings of about 11 32 per patient prior to the cost of intervention. Big pushback on that was not the gold standard the gold standard as a prospective randomized control trial. So followed that up with just a few months ago published a study in home health. So in this particular program there were pharmacists that were actively managing medications for patients that were at very high risk of being readmitted to the hospital. And we flagged them for genetic risk and they were either put in the control or the intervention and in the intervention arm the pharmacists had access to youscript and appropriate genetic testing. And what we saw in just 60 days was a 52 percent reduction in readmissions 42 percent reduction in emergency room visits saved over 43 hundred dollars a patient in just 60 days. I mean it wasn't one of the endpoints of the study but we did also see a statistically significant 85 percent reduction in mortality which certainly merits looking into further.

Saul Marquez: [00:07:35] That is fascinating, Kristine. And so you guys have done the studies you've done the prospective you've done the retrospective in this number of preventable deaths is really fascinating to me. I heard 440000 preventable deaths per year and you're able to reduce such a large number I think that's super interesting and merits a look at what. Like you said you know broaden the perspective or the scope that you can apply precision medicine to.

Kristine Ashcraft: [00:08:04] I certainly think so I think one of the things that you script really does is it enables providers to treat polypharmacy taking multiple medications as if it were a disease state in and of itself.

Kristine Ashcraft: [00:08:16] So what we have going on and everybody knows this is we tend to treat patients in different silos. Here's the cardiology silo and here is the mental health silo and here is the pain silo and the issue is all of those drugs interact with each other and the genetics impacts that. And you really need a tool. And I would say a pharmacist care manager ideally that's proactively managing that.

Saul Marquez: [00:08:39] Now that's fascinating, Kristine. Can you give us an example of a time where you also had a setback and what you learned from that.

Kristine Ashcraft: [00:08:48] Sure.

Kristine Ashcraft: [00:08:48] So when I first started talking to health systems and hospitals about youscript and targeted pharmaco genetic testing I didn't do enough homework in advance and I was talking to a hospital system.

Kristine Ashcraft: [00:09:04] And at the end of the meeting one of the CMO looked over at me and he was like I want to say something. I said OK. He's like I just want you to know this is great technology. And we certainly apologize.

Kristine Ashcraft: [00:09:18] There's a siren going by I can't control at all. Anyway the CMO is sitting across the table for me like, Kristine I want you to know this is amazing technology I really think that it can help.

Kristine Ashcraft: [00:09:29] And it's not that we don't want to do something like this it's just you have to understand there is a really big technology agenda that we need to act upon. We need to achieve all these things for meaningful use. And he said you're you're essentially coming in here and saying hey we have these amazing solar panels we can install them and you'll never have an electricity bill at your hospital into the end of time if there's ever any kind of natural disaster you're still going to have electricity which sounds amazing but are super effective. And so you know I realized I had to be more targeted in the health system that I was reaching out to. And so I started just focusing on the ones that are Stage 6 or 7 for health care I.T. adoption that are really ready to start integrating additional innovations into their workflow. But I definitely spun my wheels for a while now. Not tightening that net.

Saul Marquez: [00:10:20] You know Christine that's a great call out you know every everybody every system in health care has different stage of advancement and we have to ask ourselves if we have a technology or piece of equipment that we could use to help them out. It's not going to help to give them solar panels if there's sewage has backed up.

Kristine Ashcraft: [00:10:40] You know I think the analogy I had it was a good one it started with me I was like oh that makes a lot of sense.

Saul Marquez: [00:10:46] It makes a lot of sense and so it's our responsibility as innovators and also just people looking to make outcomes better to ask ourselves what stage in the process are they.

Saul Marquez: [00:10:58] And that's my solution fet so I think this is a wonderful learning that you've shared with us. Christine thank you so much for that.

Kristine Ashcraft: [00:11:04] Thank you.

Saul Marquez: [00:11:05] So what would you say what are your proudest medical leadership experiences you've had to date is.

Kristine Ashcraft: [00:11:11] I think that you know it's really about the patients stories all I'll share one.

Kristine Ashcraft: [00:11:16] There is a woman that I'm still in contact with. Elise Castleford who raced out because one of her pharmacists had changed her medications based on genetics and she said you know I thought I was in the early stages of Alzheimer's. I had given up my weekly bridge game and when her medication was changed based on her genetics her memory issues resolved in just a few days.

Saul Marquez: [00:11:37] Wow. Yeah it's incredible.

Kristine Ashcraft: [00:11:39] But stories like that are not real people where you know you impacted their quality of life in a real way.

Kristine Ashcraft: [00:11:47] That's what keeps me going.

Saul Marquez: [00:11:48] And that's such a great great story Christine and you think about it now. I mean to get a genome test done is? What is it a thousand bucks now?.

Kristine Ashcraft: [00:11:57] For genome sequencing which doesn't include the entire team.

Kristine Ashcraft: [00:12:01] It's a bit of a misnomer.

Kristine Ashcraft: [00:12:03] It's coming down it depends where you go and the tests that we operate on are very specifically looking at genes that dictate response to medication. So we don't focus on disease prediction or anything like that that those tests are just a few hundred dollars so they're fairly inexpensive and they help patients understand how they're going to respond to the vast majority of medications they'll be exposed to in a lifetime.

Saul Marquez: [00:12:27] Really fascinating and I think an area that's worth devoting some more time listeners. There's a lot of things that maybe we're assuming right. Like I just assumed all these tests are a thousand bucks. Kristine what resource would you give to us to further our knowledge and understanding of this precision medicine field.

Kristine Ashcraft: [00:12:46] Sure. I think that it depends who you are but if you're on the healthcare side and you're a health care provider I think one thing that people aren't aware of is there's actually a clinical pharmacogenetics implementation consortium that's under the auspices of HHS.

Kristine Ashcraft: [00:13:01] And it is a great group of academics and private companies that have worked together to coalesce guidelines on when you should be taking genetics into account when you're prescribing different medications and they've done a really good job. I think sometimes people don't realize that there's a separate group working on this. Again back to the silos people are going to make wait for the cardiologist to tell us which cardiology drugs this applies to. And you know oncologists for the oncology drugs and know there's actually a group or pharmacogenetics made up of a ton of very smart people in this space and I say if you don't go anywhere else to go to the CPA website and take a look at those guidelines.

Saul Marquez: [00:13:41] And what's the website Kristine?.

Kristine Ashcraft: [00:13:42] It says

Saul Marquez: [00:13:46], listeners.

Saul Marquez: [00:13:49] So if you don't go anywhere else that is the place that you go for information. And what we'll do is we'll provide it in the show notes. So if you go to that's a s h c r a f t Ashcraft. You'll be able to find the show notes as well as any links to the resources that we addressed today. That's a great one. Christine I'll definitely be sure to study that.

Saul Marquez: [00:14:15] What would you say an exciting project. Obviously what you're doing overall is exciting but something in particular with what you're doing that's exciting today.

Kristine Ashcraft: [00:14:24] Sure I think one of the projects I'm most excited about. We did get Highmark health final innovation grant and they have. Yeah pretty exciting.

Kristine Ashcraft: [00:14:35] So they were so impressed by the results of our studies that they wanted to test it out in some patients. So we did a risk stratification to determine which patients in their Medicare Advantage program had genetic risk and then we integrated youscript right into the clinical workflow and in all scripts ehr for a primary care clinic under Allegheny Health Network and they are getting plaids for the patients coming in for appointments that would benefit from testing and in this particular program they actually have a pharmacist care manager that is talking to the primary care physicians and other physicians both to recommend testing and also to recommend drug or dose changes when the results come back. And that's live for a few months now and we're seeing really incredible results. They're very happy with the integration and the care improvements that they've seen so far so very excited about that. We're not going to see final results for awhile now but I think it's great when an organization does what Highmark did and actually puts their money where their mouth is in terms of innovation. Think there's a lot of talk about innovation. But again people haven't put the resources behind it to make sure that they're providing a platform for innovation to move forward. So I think they've done a really good job.

Saul Marquez: [00:15:51] Now congratulations on that Christine. Sounds like you guys have gotten really exciting and outcomes improving project off the ground over there with high marks so kudos to that partnership that you guys struck and I think it's a great point.

Saul Marquez: [00:16:05] You know listeners put your money where your mouth is you know that you're looking to make some meaningful change that improves outcomes invest the money in it try out some pilots that will help you explore these technologies like Kristine is discussing to improve outcomes in your system. Christine 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 course or the ABC of Kristine Ashcraft and so we're going to write out a syllabus. I've got four questions for you that will do in a lightning round fashion and then you will conclude the syllabus with a book you recommend to the listeners. You ready.

Kristine Ashcraft: [00:16:44] I am

Saul Marquez: [00:16:46] Alright. So what is the best way to improve healthcare outcomes.

Kristine Ashcraft: [00:16:49] Well I know the correct answer should probably be precision medicine.

Kristine Ashcraft: [00:16:55] I think that that would be the correct answer though I think one of the things just to take take a step back more globally is that we really need to do a better job understanding the social determinants of health. I heard before that you know where your zip code is more of a determined to termination of how young you're going to die than pretty much anything else. And I think as a society we need to start creating ways to address that in a more meaningful way. I do also think that personalizing care based on genetics and other factors is key but social determinants of health are really really big thing that we need to look into more.

Saul Marquez: [00:17:34] What does the biggest mistake or pitfall to avoid.

Kristine Ashcraft: [00:17:37] I think that's a no. We go back and forth about whether Einstein really said this or not but they say the definition of insanity is to do the same things over and over again and expect different results.

Kristine Ashcraft: [00:17:48] And I think one of the biggest mistakes or pitfalls we need to avoid is just tweaking ever so slightly the way that we've done things and expect real results. So we're doing with youscript historically when somebody gets a prescription to run against back and that's like this binary chassis. It's kind of like they crucified a paper map Shearmur when we used to look young.

Kristine Ashcraft: [00:18:12] Maybe you don't remember we used to plan road trips using paper map.

Kristine Ashcraft: [00:18:17] We know we fell out our phone and in real time it takes into account a ton of different factors. And that's essentially the leap that we're taking to medication management. But it doesn't work on a binary chassis. So how do we really make big jumps forward in medicine if we continue to take this binary or a very siloed approach. So I think biggest mistake or pitfall again just trying to make a slight improvement to the things that haven't worked.

Saul Marquez: [00:18:49] Great message.

Saul Marquez: [00:18:50] How do you stay relevant as an organization.

Saul Marquez: [00:18:53] Despite constant change.

Kristine Ashcraft: [00:18:54] I think that one of the things that we've done a good job of here youscript is written all over we have one of those you know visual boards where you have some huge pictures of things you're supposed to focus on.

Kristine Ashcraft: [00:19:06] But the number one thing we have on all of our minutes and agendas and everything that kind of circulates internally and some things externally is never losing sight of your mission. At the end of the day as long as that's first and foremost in your mind. I think that you're going to change and evolve around it because if that mission is critical you have to adapt in order to achieve that and at you script our mission is to end avoidable adverse event.

Saul Marquez: [00:19:36] What is one area of focus that should drive all else in your company.

Kristine Ashcraft: [00:19:39] So I think the chance of being a bit repetitive it's it's once again never losing sight of the mission.

Kristine Ashcraft: [00:19:46] At the end of the day we need to take care of customers and listen to them. But it's all based around what is it that we're trying to achieve here. Everything needs to be flowing down from there.

Saul Marquez: [00:19:59] What would you say Christine. The book that you'd add to the syllabus for the listeners.

Kristine Ashcraft: [00:20:04] Okay so this has nothing to do with health care but my favorite book and there are there are some health care there are some health care things in there.

Kristine Ashcraft: [00:20:15] Holographic Universe by Mike Talbott it's a lot about physics but there's actual very specific examples in there of mind over matter I think one of the most common ones in healthcare is the placebo effect. So there have been people that have become a lot better when they were given up Sebo that really there was no logical reason for that. They were given a sugar pill. But it's it's a very interesting book with a lot of studies that I think put forward some interesting theories on mind over matter and I think anybody would find it an interesting reading.

Saul Marquez: [00:20:49] I love that Kristine and listeners take a note from that. You know it's you don't have to get your inspiration from health care based resources. You could get your inspiration from anywhere so long as what you take out is just what gives you that fire that spark that idea to create that change is going to improve outcomes and health care. I love it Kristine. Thanks for going with a not health care book.

Kristine Ashcraft: [00:21:10] You're welcome.

Kristine Ashcraft: [00:21:11] I'll say I did pull it up on Amazon to look at some of the people that have commented on it and a lot of them were in health care. I'm not alone in line.

Saul Marquez: [00:21:20] There you go again now.

Saul Marquez: [00:21:23] So listeners go to and you'll find the link to that book as well as these tidbits of amazing wisdom that Christine has imparted on us. Kristine before we conclude I'd like to ask you to just share one closing thought and then the best place where the listeners could get a hold of you.

Kristine Ashcraft: [00:21:42] Ok. So my my one closing thought I keep talking about the youscript mission of ending avoidable adverse drug events.

Kristine Ashcraft: [00:21:51] So I just want to make sure I stop talking here that people understand how large of a problem this is. One person dies every five minute from adverse reactions to properly prescribed medications. Just to put that in perspective that's equivalent of a full 747 every 34 hours. We have ended much yeah. We spend as much on average drug offense as we do on the drugs themselves. Half of medications don't work as intended and are therefore wasted therapies. And this problem is getting worse as we put people on more and more drugs because the genetics is more likely to have an impact. But it's a huge huge problem and I think people don't often realize what a big problem it is. So I think the big takeaway is you need to be doing something about this and if you have a loved one or someone you care about or even yourself and you're taking a lot of medications you should really look into it. There are some resources on our website and our phone number and email is on there as well.

Saul Marquez: [00:22:52] Wonderful Kristine and listeners do yourself some work and take advantage of the things that we just learned here with Kristine and take a dive into this really impactful problem that that exists and I encourage you to check out the website.

Saul Marquez: [00:23:08] Make sure you access the resources that Kristine shared with us and do your part to improve outcomes by preventing adverse medication events. Christine just want to say thank you so much for being on the show.

Kristine Ashcraft: [00:23:21] Thank you so much for having me on. And best of luck with this it's a really cool program you put together.

: [00:23:29] Thanks for listening to the outcomes Rockett podcast. Be sure to visit us on the web at for the show notes, resources, inspiration, and so much more.

Recommended Book/s:

The Holographic Universe: The Revolutionary Theory of Reality

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Saul Marquez

Full Podcast Transcript

Thank You! A New Year's Message for Health Leaders with Saul Marquez, Outcomes Rocket Podcast Host

: [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.

: [00:00:14] And now your host Saul Marquez.

Saul Marquez: [00:00:21] Welcome back to the Outcomes Rocket podcast where we chat with today's most successful and inspiring healthcare leaders. Hey I really want to thank you for tuning in again and I welcome you to go to where you could rate and review today's podcast or any previous podcast.

Saul Marquez: [00:00:42] You know one of the things that we did as as we entered into the new year was rebranded our site. You probably noticed it. We used to be But we switched to and we just felt it was so appropriate. I was so excited to actually find out that they had a health domain. I was at the Health 2.0 meeting the one that that just got acquired by HIMMS and Matthew Holt and Indu and that team over there just doing such an amazing job. Got to connect with so many amazing health care entrepreneurs and just people doing amazing things for the health system. But among them I was able to connect with Jennifer Lanane and Cydonia Suaram from the the .health group and they were just a pleasure to hang out with and I got so much just energy just hanging out with those two gals they're doing such an amazing job with the with the with the work that health is spreading. But I was just so amazed and and so what I wanted to do is rebrand the site. So as we entered the new year we took the time to to move everything over to the health domain.

Saul Marquez: [00:02:03] And I'm so happy that we did because it is just such. It looks so cool and apart from that it's so appropriate for what we're doing here and the outcomes rocket which is removing silos to improve healthcare. And so it's just one of those those really cool opportunities where if somebody doesn't know what you're doing and they want to get an immediate understanding of what you do the .health domain helps it become so crystal clear that you're in this for the health of it. So it's something that we did and in the process you know .health it just became some really good friends and also a partner of the podcast and so I am truly grateful for them and all the things that they do to support the efforts that we have going on at the outcomes rocket which is ultimately centered around you the listener the guests that we have on the show and everybody on this podcast listening and participating is focused on improving outcomes and removing silos to make healthcare better. So a big thanks goes out to the .health team for helping us do this better.

Saul Marquez: [00:03:10] My friends today. Got a special treat for you. I'm actually not going to have any guests. I'm going to just share a little bit about an experience that I had in December going into the new year and I wanted to kick this podcast off by wishing you my friends a very Happy New Year. I know we're already halfway through January. It's amazing how fast the time flies. But nevertheless I wanted to to take pause and and really just reflect on the previous year and also take pause to thank you my amazing listeners and also the amazing guests that we've had on the podcast it's just been such a privilege to finish the 2017 year with with the high quality guests and the amazing listeners of this podcast. And I just want to I just want to start this year with a token of gratitude and appreciation for all of you. So a big thanks goes out to all of you for your support and for collaborating because again the reason why were we're on this podcast is because we have something to say and we're doing something about improving healthcare outcomes and so I just want to say how happy I am about the collaborations that are happening behind the scenes the connections that are being made and also the amazing friendships that are being formed in the process so can't say how happy I am and how thankful for having gotten this thing started. And also for being surrounded by amazing people like you. Because at the end of the day you are the average of your five closest peers. And so I've been I've been hanging out with some pretty amazing people on the podcast as you've listened to.

Saul Marquez: [00:05:01] And as a listener so have you. Whenever I record these podcasts with the guests that we have on I always imagine it's three people in a room. It's it's our amazing guests for that episode. It's me and most importantly as I would say just as importantly as the guest it's you the listener. And so it's cool whenever whenever I'm with the guest it's us three in the room. And so I hope that the feeling that you get after listening or while you're listening to the podcast is that it's me it's it's our guest and it's you in a room. And so what ends up happening is you two are hanging out with amazing people five days a week. The show is now five days a week and it becomes your circle and it's a privilege that I have to to be able to to share that. And and a big thank you for the guests that come on to the podcast as well. And so just just keep that in mind as you as you turn in the new year what you can do to bring your A game up higher. Keep listening because you are the average of your five closest and.

Saul Marquez: [00:06:12] And so it's a privilege and I know that you all are making for an amazing 2018.

Saul Marquez: [00:06:19] And so I wanted to I wanted to share this experience that I had in December. So little backstory my wife and I had a baby 11 months ago now.

Saul Marquez: [00:06:31] It's amazing how time flies and I'll tell you what we were working to figure out how to rekindle our relationship with each other. I found that I just got so consumed by work and the podcast and the routine at home with the baby that I really just stopped living in the moment I was living in my head and I'm going to get more into this living in my head concept below but you know what ended up happening is is I signed us up for the date with destiny event hosted by Tony Robbins.

Saul Marquez: [00:07:08] He does it once a year in Palm Beach Florida and if it sounds familiar to you it's because they actually did a Netflix documentary on it called I'm Not Your guru if you haven't seen it. It's totally worth a watch. Some really great concepts that are shared and they're about self development and leadership. And if you're a healthcare leader which I know you are looking to do better for your teams for your patients for your communities. This is something that I definitely would check out. It's called I'm Not Your guru on Netflix. Regardless the event that we went to is a six day event where you dive deep into your values your beliefs your goals your relationships and you decide what you want your destiny to be like rather than just passively accepting what's been programmed inside of your software right in your brain. And so out of all the insights that I made I really just wanted to share one that I was most grateful for and one that that also resonated with what we do as as leaders in healthcare. So during one of the exercises and at the event we were solely focused on relationships. It was a deep dive and because there was a focus area for my wife and I it was one that we were looking forward to so they asked us to write down our relationship vision and you know writing down a vision for the business for the podcast just come super easy to me.

Saul Marquez: [00:08:40] But I got to tell you I was just stumped. And and as much as I tried I really struggled to create a vision. And truthfully I felt sad and I felt really frustrated that I couldn't look beyond to something compelling and and so I just focused on what I had going on in my mind and I did my mind just kept going around in circles and I jotted down my notes and then when the exercise was done we had to share with some some partners to people that they assign you in. So I was sharing my story with my buddies in my in my group at the at the event and the one thing about this event that you have to do.

Saul Marquez: [00:09:25] You have to agree for people to call B.S. on you. OK. If what you're saying is is not true or not B.S. you've got to be willing to accept that. And so you know as part of playing Fallout I said yeah let's go with this. And and so I started sharing my notes with my group.

Saul Marquez: [00:09:43] And they gave me the proverbial smack in the face and they just said Saul, get out of your head. And I said well listen guys I mean I just I just can't come up with it like this is what I don't want my relationship to be this is what I don't want this to be. This is what I and I just couldn't get past that I couldn't get a relationship vision. It was frustrating. I just I felt like a failure. And in my relationship I felt that way.

Saul Marquez: [00:10:14] And and so I was frustrated. You know achiever mindset always wanting to succeed but man it's tough. And so I got shaken up by the comments that get out of your head get out of your head at the same time I knew that they were coming from a place of love right. You don't come to this event if you don't want to take your life to the next level. And so I want to take my relationship to the next level. And so I started scratching things out in my notepad and then and then I began to read deliver my findings to them. And I started regrouping my thoughts and that kept going. At which point they said get out of your head again. I'm just like oh my gosh I was just when they delivered that last get out of your head message to me. It was like the spell had been broken. It's really crazy. It's really crazy. So I was just like wow I actually got out of my head. And it's amazing how easily we could get consumed by things in our daily life, the daily routine, the daily things that you have to do. Is there something that you could relate to. It's the things that that be begin to drive us as people rather than us driving them. And it's so important as leaders that we actually take time to pause. Like I'm doing today with you to say thank you to pause and not to stay in your head to be present from your heart.

Saul Marquez: [00:11:47] And so the insight that I made you know I had been playing this tape over and over and over and my head of our routine at home and I hadn't been able to get out of my head in such a way that would allow me to be present with my wife and feel her with my heart. The saying at the event is that if you get in your head you're dead. And while it was early on in our relationship journey I can be brutally honest with you and tell you that we were on our way to death if we continued to cohabitate rather than share our lives deeply. We both wanted to so because we cared and love each other so deeply we decided to do something about it to get us out of the routine and then invest some time invest some money into ourselves. And I'm so thankful that we did because you know it's tough. I mean you know nobody gives you a book on how to raise a kid or or how to how to take care of your family or your relationship after a baby. Nobody gives you a handbook and how to be a leader in health care. And so I wanted to share this. You know what we do is is wayfinding. Like a friend shared on the podcast. You know we are way finders and that's what we do.

Saul Marquez: [00:13:07] They don't give us a book for this. In order for for us to do a great job we have to be present and be present with our heart. It's heart consciousness and to get out of our heads in order to get out of our own way to be successful in what we do. So by the end of that night we both wrote love letters to each other. It was I mean my heart was pounding. I felt like my entire body was in ecstasy. I felt reconnected. And when I was writing her this love letter I just I was just so thankful. And what happened was we walked back to the Caribbean b that we were renting and we sat outside of the pool and outside of the house and read the letters to each other before we walked back into the house. And you know what a it was it was just so beautiful. I felt like we we we were pouring so much into into our daily life into our son that we stopped pouring into each other and I felt after we read each other this letter and just recommitted to each other we were full. You know we filled each other up. And so you've got to take time to fill up the people around you. And the beautiful thing that happens is that when you fill them up they fill you up and it was just such a beautiful moment.

Saul Marquez: [00:14:37] And it was filled with love. It was filled with connection. It was filled with joy, aliveness. And it was just amazing. And it was so amazing to be back. It was just like the first year we started dating eight years ago. It was amazing. And so now fast forward a month already is just so crazy how time flies. We're now more heart conscious we're more heart conscious of each other and we aware of how to be there for each other and no matter how much time we spend with someone or doing a particular thing our innermost assumptions always have to be questioned. If we're going to continue progressing a little message that that and either promote as shared in one of the first episodes that we had. And I totally agree with it. We've got to question those innermost assumptions and what we have to do is get in touch with our heart intelligence to do this in the best way. And so when we're in health care it's so easy to get stuck in our heads. Health leaders it's easy to get stuck in our heads. It happens every single day. And so I recently did an interview with with Dean Golay from the School of Public Health at Boston University.

Saul Marquez: [00:15:50] And you guys will hear this in the next next month or so. But what he said resonated with me so deeply. And when that comes up I'll be sure to share it with you all. And what he said is we have to change the script in order to improve health outcomes. And when he talks about the script it's not about the head script only it's about the heart script. And so we have to start with the different end in mind and play a different tape of possibilities not only in our head but in our heart and what's going to happen is the impact that we make in our own lives in the environment that we live in and the influence that we're able to have in our community to improve outcomes is going to be that much better. And as healthcare leaders let me just rephrase. As health leaders we all work to deepen the impact we have in our communities we serve. And so I encourage you to examine that script and question it and make sure that you live it from your heart and not just your mind. I mean what would happen just to stop and think for a second. What would happen if you allowed your heart intelligence to chime into your life and your strategy in 2018.

Saul Marquez: [00:17:09] Spending time and listening to the health care leaders on the outcomes rocket podcast five days a week by the way is another awesome way to stay inspired and rewrite the script and it's so much fun. So I encourage you to continue listening and take action on the things that inspire you. Take a listen to the latest interviews and keep working toward leaving your footprint on this health system which needs you so dearly and so with that I just I just want to wish everybody on this on this podcast. A very Happy New Year. I'm looking forward to making 2018 a heartfelt year of being present and delivering huge value to you my listeners. And and just looking forward to seeing you at a meeting across the year. And just super excited that that we get to do this together. It is an opportunity to give and I'm looking forward to doing it together with you so have an amazing 2018 and I'm looking forward to connecting with you and and maybe even having a cup of coffee with you soon.

Saul Marquez: [00:18:23] Take care.

: [00:18:26] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes. resources, inspiration and so much more.

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Healthcare Podcast

Full Podcast Transcript

Why Direct Primary Care Is Better For Your Health with Dr. Rob Lamberts, Owner, Dr. Rob Lamberts, LLC

: [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: [00:00:18] Outcomes Rocket listeners, welcome back once again to the outcomes rocket where we chat what today's most inspiring and successful healthcare leaders if you like what you listen to on the show. Please make sure that you go to so let us know and give us ratings and reviews on iTunes, apple podcasts because that's what truly informs me of what's going on with the show and how it's resonating with you. So without further ado, I want to introduce our out standing guest. His name is Dr. Rob Lamberts also known as Dr. Rob and show Dr. Rob spin in the field for quite some time now owns Dr. Rob Lamberts practice and is also the author and writer at He is super funny but also touches on all of the things that are important in medicine. And I want to welcome you to the show Dr. Rob.

Rob Lamberts: [00:01:19] Nice to be here. I appreciate you inviting me to talk and putting all that pressure on me to be funny.

Saul Marquez: [00:01:27] Well don't worry about it. I think you just got to be yourself. And it just naturally comes out.

Saul Marquez: [00:01:32] So no pressure. But what I wanted to do. Dr. Rob is ask you why did you decide to get into medicine to begin with.Oh

Rob Lamberts: [00:01:39] Oh, I actually when I started college it started as a voice major vocal performance major way back when and it was the main reason I chose that is because my dad wanted me to go into science and I just was like I'm not going to do what you told me to do. He's a physicist. And so but then I realized that I kind of had this vision of becoming this middle school music teacher. And you know if there's a punishment from an afterlife you either become a slug or you become a middle school music teacher at least and I shouldn't say that.

Rob Lamberts: [00:02:13] Maybe some of those among your listeners and they are wonderful people but to me that was not very nice to my middle school music teachers.

Rob Lamberts: [00:02:20] So anyway.

Saul Marquez: [00:02:21] Yeah it's a pretty rough time right.

Rob Lamberts: [00:02:22] Yeah yeah.

Rob Lamberts: [00:02:24] I have to switch to science chemistry and honestly didn't even think about medicine for a while because I hated the premeds that I had to deal with in my call but they were all just kind of jerky and brain hungry and whatever and they just didn't seem like my kind of people and so I did chemistry and I did some philosophy.

Rob Lamberts: [00:02:44] And I did a lot of this and that but kind of ended up coming to the point where I thought you know I like to be around people I like science. What combines those things and medicine became that thing that just kind of stuck in my brain as being OK well let's say the AMT. Let's see how I do and I did well and that was just like OK well but even even in medical school when I was going from my second to third year the first two years she was doing academics in the third year is all going on though the clinical stuff. And I just remember being terrified that I would either hate it or I would kill a bunch of people or whatever. And you know much to my relief it's kind of exactly what I want to be doing with my life.

Saul Marquez: [00:03:28] That's really awesome and congratulations on sort of following that path based off of the things that you were looking for what you were passionate about and the one thing that I find particularly interesting about your story Dr. Rob is what led you to what you're doing today. It's a nontraditional approach and for the listeners that don't know about Dr. Rob he is solo practice. But there's a story behind that. And so I was hoping then you could share that with the listeners.

Rob Lamberts: [00:03:53] Got it. Well about five years ago I like to say that my sobriety date was September. My five year sobriety date was September 20th of this year. It was the last time I took money from an insurance company or at least billed that to the insurance company. And in that time I have been in a practice I was a senior partner actually in a practice for 18 years. I do board certified internal medicine and pediatrics so I just do primary care medicine and I love primary care medicine. But I felt like I was drowning. I felt like every day I was leaving a little less of myself in the whole equation. And I was leaving a bunch of care on the table and that that feel like I was giving good care to anybody and that kind of drove me to really rethink what I was doing it or try to push to allow my practice to still give high quality care despite a system that was doing the opposite that was wanting me to see as many people as I possibly could that was wanting me to focus a lot more on documentation than on actual care. That's stuff that any primary care doctor and a doctor pretty much knows what it's like. It's this hamster wheel that keeps going faster and it's exhausting. I was with a couple of other docs and they had a whole different way they wanted to move.

Rob Lamberts: [00:05:13] It seemed to me that they wanted to move more in the business side and run that business. Efficiently and I just like taking care of people and I don't want to make it sound like that. I was the Crusader and the good person then there the the sinister evil folks who are always fighting against. I was an idiot in my own ways but ended up basically getting a divorce with my partners in that circumstance which is very much like that and then I had to kind of say OK what am I going to do. I don't want to go into insurance based practice again. It's going to be even worse if I do it solo. And I'm I'm too much of a headstrong alpha I guess to work for another practice and be a junior faute person. I had been senior for a long time and working at the V.A. worked in that for a hospital again seemed like I was going to the dark side. So I ended up talking to David Chase. Dave had read some of the stuff I wrote and Dave's is.

Saul Marquez: [00:06:05] A great guy. Yeah I'd call him had him on a show recently actually.

Rob Lamberts: [00:06:08] Yeah I called Dave my Yoda because he doesn't talk that way he doesn't draw

Rob Lamberts: [00:06:15] Very we'll do that.

Rob Lamberts: [00:06:18] He has though he is very very wise and he actually we were talking I forget exactly what started this talk and I think some of my stuff I'd done on the healthcare blog some of his stuff is gone. Health Care Blog. He just wanted to connect up because he resonated with some of the stuff that I was writing. And we talked and he told me about direct primary care which is have a different take on the whole concierge type of an idea it's still a monthly membership fee but the concierge practices. I like the idea because it was so high price that it would basically price all my patients out.

Rob Lamberts: [00:06:52] So what could I do. And this was a much lower price model that focused on efficiency that focus on using communication tools. Once they started talking about it it just clicked with me it was like This is what I need to be doing. And you know there weren't many practices out there that were doing it.

Rob Lamberts: [00:07:09] There were very few actually. I think it was under 100 when I first started five years ago. Now there's almost a thousand and the term direct primary care yet term direct primary care is what you use and the big features of this type of practice are that first off that you you don't accept any money from insurance at all. You just dump insurance. In fact most of the docs have opted out of Medicare as well which was scary as all get out because there's a two year opt out period that you can't go back. And so if I had wanted to do something I couldn't.

Saul Marquez: [00:07:43] What about just out of curiosity these more consumer plans like you got bright health now an Oscar.

Saul Marquez: [00:07:50] Is it still the same philosophy. Not taking money from them either.

Rob Lamberts: [00:07:53] One of the keys for me is that I work for my customer my patient is my customer. And whoever pays you is the one you work for. One of my favorite ways of looking at this is if you look at the business of normal health care is the normal business of health care is who do I work for as a doctor who is the customer and who is the consumer. Well the reality is in that circumstance who's paying the doctors wants insurance companies OK where are they paying them for health care. No actually you get paid entirely based on your coding. So it's really the ICD CPD codes you submit those. Ian Nemko right. Right. And now there's some data you could throw into that. And OK so the product codes the customer is the insurance company. And so the good customer service is to treat the insurance companies well get their data exactly like they want to documentation simply supports the billing makes. So you don't get in trouble. And so what are patients. And the answer is Well patients are kind of raw material for codes and so they are like cows that you can milk the codes out of. You know they come in and milk from you know and then another cow comes in your milk some more codes and can I get it. And it's a crass idea but it resonates so well because that's what patients feel like when they go to a doctor's office they feel like not at all sure rushing stuff and you're doing stuff. So this idea of taking money from a third party payer the minute you get money from even some of these more quote unquote moral third party payers. To me the minute I do that I let them into the exam room with me. I let them into the exam room to say so let me look at your chart to make sure you're doing everything that you should be doing. And I just want to give them flipping the bird and say Get away from me and my patient.

Rob Lamberts: [00:09:46] I love my relationship with them and the other thing is that it makes it so I'm unequivocally on their side. I am unequivocally that they don't question that I'm somehow their notes are going to go to the insurance company which they can't because there isn't an insurance company involved that you know all of that stuff they know that I am working for them and I'm going to do the right thing for them.

Saul Marquez: [00:10:11] So now that's really great. And appreciate you sharing that because I know that there's you know listeners you're out there and you're feeling what you're feeling today.

Saul Marquez: [00:10:22] You're a physician and the pressure and the charting and everything that you have to do and Dr. Lamberts here was going through what you went through and has decided an alternative method and he feels obviously that this is benefiting his patients and so it's a way of doing things that is more personal and detached from being a puppet of the system. I think it's really cool and very admirable. You're weaning yourself or I forget what you said but you stopped your sobriety. Yeah your sobriety. So congrats on five years of sobriety from the system. So what do you think a hot topic that should be in every medical news agenda today. And how are you and your organization dealing with it.

Rob Lamberts: [00:11:02] Ok. For me one of the problems that we've got a health care reform stuff that's out there totally misses the point at least if you look at the Affordable Care Act or if you look at stuff before that the Hi-Tech act or some of the reasons that the Congress is trying to get through all of this stuff is not addressing the main problem which is the cost of care. How do we decrease the cost of care because if you're not I mean the reason that health care became inaccessible is because we kept spending money and the insurance companies keep jacking up costs jacking up costs and that is if you're rigid Dave Chase's book it just makes you want to take a shower after reading chapters about how insurance companies bent you know they'll let fraud go through so that they can chase it down and earn money for getting fraud. It just eliminating fraud. It's just oh it's just so horrible. And you see all of these ways in which nobody is incentivized to actually save money. And I really believe that the only way you can do that is to flip the equation and have somebody who benefits from actually having people who are well people who are not utilizing the system and people who were avoiding doing extra procedures. And you know the problem is that in the typical practice doctors are paid most by having sick people sick the better doing lots of procedures on spending as little time with them as we possibly can. That's how I earned the best money. And that's one of the core conflicts in my. The reason I broke up with my partners is because they ended up saying kind of gave up and wanted to embrace it and I said Hell no I don't.

Rob Lamberts: [00:12:46] I don't want to embrace that because it goes against their side of what I'm doing. And so I think that this idea of saying OK so how are we going to have somebody who's playing the defense whether it is a universal healthcare plan for everybody. OK so how do you control costs aside from passive aggressively saying OK let's look you up and if you're spending too much we're going to make you not get as much money or whatever. That's part of big problem right now. All of the myths and Macra stuff. I mean it's all basically doctors all feel like that is big brother looking over your shoulder looking for a way to take more money away from you when it's not our fault when the system is taking all the money it's the health care administrators itself that's the plans it's all. It's the drug companies it's the pharmacies all of these people are stealing money and yet we're the ones who were responsible for controlling costs. Are you kidding me. And yet I can control costs when I'm working for my patients in a very different way because if I keep my patients well in the office then I can grow my panel I'm up to about 700 patients now and continuing to grow that reasonable pace as much as I really I want to I can dial it up if I want to and lets me pay attention to them and if if I take good care of them and keep them happy they keep paying monthly payments and I get more patients.

Saul Marquez: [00:14:10] That's really great.

Saul Marquez: [00:14:11] And you bring up a phenomenal point that oftentimes gets ignored.

Saul Marquez: [00:14:16] And with the reform that happened with ACA and even when Romney launched it over in Massachusetts right this cult thing about runaway costs still is not being addressed. And you're calling it robbery on behalf of all these other people the system administrators and plans. And ultimately how do we incentivize right because ultimately things get followed when there's incentives in place. And how do we incentivize making people healthy.

Rob Lamberts: [00:14:45] Well mean the answer is put the patient at the center because as a patient we're all patient everybody here is a patient and they answer the question What do you want. Do you want to spend more on your health care or less. I want to spend less. Do you want to be more sick or less sick. I want to be less sick. Do you want to go to the hospital and get unnecessary procedures. I mean all of the things you want to pay more for your drugs or less for your drugs. Meet the one person in the whole equation who has the most incentive for saving money for running the system efficiently is the person who the system is created for in the first place. And yet it's the person who's become that cow that you milk you know milk codes out of in the regular system. And the one that feels the most disempowered you know it's this whole idea of patient centered healthcare. It's almost like Are you kidding. Patient centered health care. That's like saying number centered mathematics it redone what is should be redundant but it isn't. It's become it's entirely the way that medical records are they patient centered. No they're billing records. They are pure and simple billing records that have medical stuff in there. But there's so much what I call computer vomit of all this junk that's put in the notes to justify your billing. Everything about health care has gone away from patient centered on this and I think somehow and that's that's why I see the success of what I do as being I am very much outcomes based because the person who cares the most about the outcome is the patient.

Rob Lamberts: [00:16:14] They don't want the outcome to be bad. They want me to know that I'm on their side that I'm willing to educate them that I'm willing to do the right thing that I'm willing to answer their questions without forcing them to come to the office to do things in a way that makes sense.

Saul Marquez: [00:16:30] Now that's really interesting Dr. Rob and can you give the listeners any example of what you're doing with your practice has improved outcomes.

Rob Lamberts: [00:16:39] Do I have statistics. The answer is no statistics but boy do I have a ton of vignettes. I have a ton of situations where a person I had a guy in my practice my regular practice for years. And then he switched over. And this is fairly early on and I had seen somebody else recently with the head neck cancer just had a kind of a hard lymph node and we ended up sending him in and he got treated for a head neck cancer and this other guy comes in and says You know I got this lump on my neck and you know that ring the bells in my hand and said Just come on in. And you know I could do that right away. He came straight in and I looked at him and first it was like it's a little early but let's do this but my you know I was in that paranoid mode for sure. It was funny in that circumstance and say you're paying a little bit more attention to it. Turns out that he did have a head neck cancer as well. And he came to me later. And then he sends me a text message which they're allowed to do in my practice and he sends me a text message and says Yeah my wife is thinking I should do alternative medicine stuff for this. And I said Whoa whoa whoa whoa wait a minute. That's why Steve Jobs is dead. He had a curable cancer that he chose to use alternative medicine on in this circumstance and for this type of a problem. I'm not I'm not totally close minded alternative medicine but you know when it comes to a head and neck cancer which are bad enough in traditional medicine to wait six months a year before you start treating it is is asking for a huge trouble. And so we talk about that. And he ended up getting that taken care of and he's doing fine. But he came back to me afterwards and said I wouldn't come in if it was your own practice. I would have waited a lot longer. But you're available. I've had tons of pizza.

Saul Marquez: [00:18:21] Trust be the word additional trust is created additional trust.

Rob Lamberts: [00:18:25] But the truth is what do you know I was thinking about what is my minimum viable product because I talked I've read the whole Lean Startup stuff and the idea of it because I'm basically a startup. I was a startup at that point in time and there really wasn't a model in which I was modeling myself after I was really trying to build it from scratch and figure it out.

Rob Lamberts: [00:18:46] I talked to a few folks but I made it up and the big product that I am selling the thing that people would pay were really willing to pay for is access they want access to me they want access to my nurses they want access and that doesn't mean I have to answer my pages immediately or whatever that just means that they don't feel like people come to the office to the regular doctor's office. They don't feel like they have the doctors attention when they call the office. They go through this tree of people who are trying to play defense to keep patients the doctor away from these patients that are hungrily trying to get free care out of the doctor. That's the attitude of the office staff that most doctors offices. Not all guys sure. Here's the text message thing that you can get a hold of them right away. I had another guy who sent me a text message on a Sunday night and saying I've right lower quadrant pain. It's like oh hey appendicitis there you go. He was there and I said OK so couple of questions first is are you eating.

Rob Lamberts: [00:19:45] Yeah I'm eating fine I'm I'm doing no problem. Are you having problems. Yeah I have. BOB MOON sexually doing fine. I said OK. It's really unlikely to be appendicitis if you're eating well if you are about moments you know people have an illy. Isn't that circumstance and it's much worse it's still possible but in on a Sunday night a guy this guy who had no insurance could I felt comfortable holding him off because I knew him too. I mean that's the other thing is. Not only do they have access to me but they know that I know them and I'm willing to question he came in. He didn't have appendicitis. He had some other stuff going on or whatever but I prevented ER visit and I see that all the time whether it's even just doing a text message within the ER and say show the doctor this and I give them you know whether it's their labs or whether it's they're just saying this is what I did on you before.

Rob Lamberts: [00:20:38] And it just gives that extra level of communication and continuity in my patients feel like I can cut the cost of care improve the quality of care I can do all of those types of things.

Rob Lamberts: [00:20:48] And yeah the improved outcome is the fact that people walk out of my office feeling like they're getting kicked err they don't feel like they're getting the run around which most people feel like.

Saul Marquez: [00:21:00] Obviously you're passionate about it. And for me you know I'm just thinking of myself as a patient too. I definitely would like that access and being able to feel that additional trust. So I think it's really great that you're doing this. And what would you share with other physicians out there that are maybe the fans and maybe fearful of leaving the system. What would you share with them as far as advice and encouragement.

Rob Lamberts: [00:21:26] Well first off my story I started when I started I didn't have a lot of help. In fact there weren't. I didn't even have a good medical record system. You know the medical records systems out there are totally garbage. They're based on billing and they've gotten farther and farther away from good patient care. Question is OK so what would a medical records system look like if the only reason for it was to give patients care which is again it's just like think patient centered medicine it's like patient centered medical record it's almost seems like it should be obvious but it is completely the opposite. And I couldn't find any that I ended up building my own for a while on a database. I am kind of a geek in that regard and ended up finally finding one. But it took several years while I was practicing before those products started catching up with the fact that direct primary care was becoming a thing and there was a company doing billing software that I hooked up with that I kind of helped them get started actually. And there's a bunch of things that have now come along. Communication software other tools that make it much easier. So first off I would say my story is a lot harder for me because I was just kind of trekking across.

Saul Marquez: [00:22:35] You're pioneering it right.

: [00:22:36] A hundred now there's a thousand.

Rob Lamberts: [00:22:38] Now there's a thousand folks and everybody loves what they do and wants to help out. So there's a lot of resources out there a lot of you know whether it's there's a Facebook group on it. There's a company called hint as community about bore or family practice group has a community message board where people communicate and just give ideas. I had a you know just last night got a message from somebody from Chattanooga said while we're in town do you think we could stop by and just see what your practice is like us said sure come on in and you know seeing it in real life is the best thing. But that's the thing it's not smoke and mirrors. I mean I've really done it five years and despite being a doctor I haven't driven it into the ground. I like to say this is so easy even couples do it because we're not. Actually it was the fact that I admitted that I suck at business that I'm not I I'm allergic to decimal points that all of that little accounting stuff just you know makes me have high and I made it so I dumbed down as simple as I possibly can. I don't want copays because that's stupid because that's just one more thing I have to collect on. I don't want other things to complicate. I want people paying six months at a time or a year at a time because what happens if they leave or if I get in a car accident then I've got to figure that out.

Rob Lamberts: [00:23:52] But just do monthly payments. That's as simple as I possibly can. And the cool thing is getting back to the whole copay thing. The cool thing is that if my business model is simply there is one thing that I want in that is more patients paying on a monthly basis then all my motivation is turn to making sure people have such value that they can't afford to leave. So I just started dispensing medications where I'm able to give yeah your blood pressure pill costs a dollar for six months or whatever you know you can give medicine really cheap because the wholesale prices are really cheap or labs are really cheap and I've had people say well why don't you know a few of the cost of those you could earn a little extra like I could earn an extra fifty dollars a month by increasing my fees or a hundred dollars a month or maybe even 200 dollars a month. But that is now because I charge between like you know on average 40 to 50 dollars a month for my monthly fee. That's like four extra patients. That's it. And if I can keep people from leave for extra people from leaving because I have such frickin low prices for medicine because I'm so available because I do things that are patient centered then they can't afford to leave. And people are constantly saying boy you've spoiled me boy you've spoiled this business model. A rate.

Saul Marquez: [00:25:11] I was wondering to Dr. Rob like what does the cost per month and between 50 60 bucks.

Rob Lamberts: [00:25:16] Yeah I actually or it depends on it depends on age.

Rob Lamberts: [00:25:20] And one of the things that I've kind of been an evangelist for within the community because I think there's a lot of folks who do now 50 as your baseline. And 75 maybe if you're older and you know even a little higher but it's under 100. In general for that the problem is that if you're dealing with the population who's 50 and up yeah they see the value in it in general. I say that as a 50 person myself that you know we think about her health a little bit more and we're willing to invest a little bit more in it. But if somebody is in their 20s.

Rob Lamberts: [00:25:53] I mean 50 bucks a month that's a lot. And they're not going to utilize you. And so if you charge those folks 50 bucks a month. The only folks in their 20s who are going to pay it are going to be exactly the wrong patients exactly the wrong customers. Once you want to utilize you as much as possible to quote unquote get their myse worth. And I have kept that price down to 30 dollars in a 30 dollar month range which seems to be palatable in that range and I've even you know I was having trouble attracting pediatrics because there's a whole immunization fiasco with when you don't have insurance you're dealing with. But I've decided that I'm probably going to lower that cost to ten dollars a month than maybe 20 for the other just so that I can get more kids. And honestly kids visits are so easy and they don't have these long big chronic problems that you have to deal with. And again part of it's just I like to mess around with a little kid and that's I have about 10 percent pediatrics malpractice I had about you know 50 50.

Saul Marquez: [00:26:54] And that's one of your strengths right.

Rob Lamberts: [00:26:56] Yeah. Yeah it is so.

Saul Marquez: [00:26:57] And so you're lowering the cost because you feel like the higher cost gets you the quote unquote wrong patient. Right.

Rob Lamberts: [00:27:05] Right. The difference. Yeah. You don't want the folks who are going to call you all the time and need all this help all the time. What you want are the folks who are willing to you know if you have 100 people who are writing you checks every month and don't really care. They don't really think of it. Well. You've got to be careful not to select out the very patients that you want.

Saul Marquez: [00:27:26] That's cool. And we're getting close to the end here. I wish we had extra time but what we'll do. Because this is so interesting and I think the audience will find it interesting too.

Saul Marquez: [00:27:34] Dr. Lamberts I think we definitely need to do a part two and direct primary care maybe within the next couple of months. If you're up for it. Absolutely. But I was curious you know so you're doing all these things that are you know more modernized. And I heard you say check like the people still pay you in checks or do you take pay pal and credit cards like how does that part of your practice work.

Rob Lamberts: [00:27:55] Yeah that's an anachronism. Well people some people do pay checks on people paying cash. You have done some bartering. I haven't gotten I have had people bring me eggs and other produce but that's not been a payment thing.

Rob Lamberts: [00:28:09] But in general I'll do any way that is easy for people I prefer doing the monthly draft and I prefer it from the bank because I get charged less.

Rob Lamberts: [00:28:18] But you know if people want to do it on their credit card if people want to write a check that's fine. I don't really care.

Saul Marquez: [00:28:25] I was just curious you know I was wondering what your thought process was.

Rob Lamberts: [00:28:29] That's just mean I'm 55 years old and when I say write a check it's an anachronism from the days get paid right.

Saul Marquez: [00:28:38] Ok. No. Very cool. Very cool so let's pretend you and I and this is a little lightning round.

Saul Marquez: [00:28:42] Dr. Rob we're building a course on what it takes to be successful medicine today. And it's the ABC of Dr. Rob. And so we're going to write out a syllabus for questions lightning round style and then we'll finish the syllabus with the book that you recommend to the listeners are you ready for it. OK.

Saul Marquez: [00:29:01] So what's the best way to improve health care outcomes?

Rob Lamberts: [00:29:04] Make patients the center because they're the ones who it matters to the most incentivized doctors to care about what the patients care about.

Saul Marquez: [00:29:12] What is the biggest mistake or pitfall to avoid?.

Rob Lamberts: [00:29:15] Making yourself the center of the universe as a doctor and that sounds redundant but were, it's health care. That's about the patient damage. It's about them. And the more we start listening to people so many people who say they're the first doctors ever listen to me and just like that just makes me angry to hear that people go through health care and don't get listened to. So the biggest mistake is not to listen to the people and to see the patient as an adversary rather than the people who were here for.

Saul Marquez: [00:29:45] How do you stay relevant as a physician.

Saul Marquez: [00:29:47] Despite constant change.

Rob Lamberts: [00:29:49] Embrace technology for one I think text messaging is fine. The other is to also be flexible because some people can't do it. But for me it's embrace technology keeping up with you know whether it's making sure I'm reading enough stuff to keep up with the business side of things. What's going on there with the medical side of things but also presently booking stuff with some artificial intelligence to augment my practice using a machine learning type of tools to make it so that that I'm more efficient so that I'm running better and that allows me. It's not that the technology is the center it's that that technology makes stuff so much more efficient that it allows me to sit and chat with people about their kids or sit and do house calls or whatever. And that's the cool thing. So I think embracing technology for what it's good for and that is making things more efficient.

Saul Marquez: [00:30:40] Excellent. And finally what's one area of focus that should drive all else in your practice.

Rob Lamberts: [00:30:47] That is a great question. I'm going to flip it because I'm going to take it from my perspective as a clinician and rather than say a patient centered message that sounds like I'm just being gratuitously nice guy ish.

Rob Lamberts: [00:31:00] I want to have a good life. I want to have a good life as a doctor. To me that doesn't mean I'm going to get a yacht down not a yacht person. I'm not even a new car person. I'm a used car person I'm just as happy as a used car. But for me being happy is that when I leave my office I spend most of my days liking what I'm doing. I spend most of my days. I feel like I've hit the perfect thing where I have a job that I like that pays me well that I'm good at and that does good for people and I walk away every day feeling like I am the lucky I am just really lucky for what I'm doing and the minute I stop feeling that way and that's what happened in my old practice. I think my guiding star is that feeling of contentment with what I'm doing. Again it's not having a huge 401k that's for which it isn't because I went through several years of not making any money early on. But for me my guiding star is if I'm doing the right thing if I'm happy because my patients are happy yes but also because I'm happy. That's really cool.

Saul Marquez: [00:32:07] Yeah I think that's great. And just keeping it simple and keeping your guiding star. I love that and what would what book would you say you recommend to the listeners here on the syllabus.

Rob Lamberts: [00:32:18] Well undoubtedly David Chase says book the CEO what it is called. Just look at Dave Chase's new book that is so educational as to the pernicious nature of a lot of the health care system. The other thing I would recommend to anybody who is starting out in a practice like this would be the lean startup. I actually benefited greatly from reading that book because it got me. I felt like I needed to build the perfect practice. Actually David Chase also taught me to read that book but it's this idea that I wanted the perfect practice and it now all I have to do is do what's good enough and build it from there and then let me know because I still think that doctors do in this type of practice are startups and the more you understand that mindset the better.

Saul Marquez: [00:33:05] Now that's a really great message. So go ahead and check that resource out.

Saul Marquez: [00:33:09] Outcomes rocket listeners and just go to d-o-c-t-o-r-r-o-b and you're going to find all of the notes from this episode along with all the links to Dr. Robbs blog as well as his practice so you could check it out if you're curious. So Dr. Rob I really appreciate you spending time today and before we conclude just wanna open up the mike to you one more time so you could share a closing thought. And then the best place that the listeners can get ahold of you.

Rob Lamberts: [00:33:42] Well the latter is just you can follow me on Twitter under doc_rob or on my on my blog. I mean there are ways to contact me on all those places if you need to. My practice Facebook page is another place people like to follow what my final words of wisdom you know the health care system is this monolith and how could little practices like mine change things really. The answer is in my book. I grew up in Rochester New York. My dad worked at Eastman Kodak Eastman Kodak used to be this monolith this humongous business that you couldn't imagine the world without Kodak because everything was Kodak. But in a very short time using the right technology and the right tools combination of digital photography and social media Kodak has become an afterthought. And it was done so by small companies but better technology better ways of doing things and it seems like how are we going to change things in the healthcare system. The answer is by building an Instagram by building those types of things that can totally revolutionize the system and make it so that these seemingly impossible tasks are now simple because we're utilizing a system that's better designed and a system that utilizes the technology to make it work well. So my hope is that when I look at it and say how could we defeat this monster. The answer is we can. It's been done lots of times before.

Saul Marquez: [00:35:12] Now very encouraging words.

Saul Marquez: [00:35:14] Dr. Rob and what's the best let the listeners get in touch with you.

Rob Lamberts: [00:35:17] On my blog.

: [00:35:18] And you can either do it there. I mean you could send me a direct message on Twitter if you wanted to as well. That's about it.

Saul Marquez: [00:35:25] Excellent. So listeners will go ahead and put posts those things on the website so you can definitely tune in with that. Dr. Rob is doing some pretty cool stuff. All aimed at improving outcomes. Dr Rob thank you so much again for being on the show.

Rob Lamberts: [00:35:41] My pleasure, Saul.

: [00:35:46] Thanks for listening to the Outcomes Rocket podcast.

: [00:35:49] Be sure to visit us on the web at for the show notes, resources, inspiration, and so much more.

Recommended Book/s:

CEO's Guide to Restoring the American Dream

The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses

The Best Way To Contact Dr. Rob:

Twitter - @doc_rob

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Full Podcast Transcript

How Health Leaders can Empower Physicians and Increase Work Satisfaction without Experiencing Burnout with Stephanie Hartselle, Founder and Owner of Hartselle and Associates

: [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] Rocket listeners welcome back once again to the outcomes Rocket really appreciate you tuning in.

Saul Marquez: [00:00:24] This is where we chat with today's most inspiring and successful healthcare leaders. And you're tuning into yet another awesome show. If you like what you're hearing in the previous episodes or what you're about to hear now with my awesome guest go to outcomes where you could go and then I'll send you straight to our Apple podcasts reviews where you could subscribe. Leave a rating leave a review. This is how we grow the show. This is how we get feedback to make it better so that it serves you the listener. So without further ado. I want to welcome our guests. Her name is Dr. Stephanie Hartselle.

Saul Marquez: [00:00:59] She is the owner and founder of Hartselle and associates as well as a clinical assistant professor of psychiatry at Brown University. Dr. Hartselle welcome to the show.

Stephanie Hartselle: [00:01:11] Thank you for having me.

Saul Marquez: [00:01:13] Absolutely. And so one of the things that I really wanted to do Dr. Hartzel is dive into this topic of health as well as sort of mental health as being part of it because a lot of times it gets left out of the equation or separated. Exactly yeah. And it's just like this different thing but yet it's part of the whole and so you I want to dive into that in today's show but I wanted to ask you first and foremost what got you into medicine.

Stephanie Hartselle: [00:01:40] That's a great question. I wanted to be a doctor ever since I was little and throughout school I actually just kind of messed around wasn't very serious and was always sort of those that are writing and speaking. And I was at math science and I never knew a doctors and so I figured being a doctor was completely out and so wonder my way through high school, wonder my way through college really graduated poorly and was working as an orderly and emergency departments and I love that even though it was you know just really scrappy work but I still love that and all of a sudden realize oh no I want to I want to be a doctor and then have to go back and so I was working nights and then it actually and for a while taking medical classes that took me about four years and that actually got to do it in university.

Stephanie Hartselle: [00:02:29] So I was thrilled. I actually thought I wanted to be an emergency doctor. That's why I knew then I figured out that what I loved about emergency was both psych and the trauma and I didn't want to be a trauma surgeon. And everyone said I'll talk to psychiatry and so I went ahead and become a psychiatrist.

Saul Marquez: [00:02:46] That's amazing. And it's so cool that you had this thought that you wanted to do it kind of hold the away and then all of a sudden here you are in the E.R. and it's just calling you and calling you and you just had to answer.

Stephanie Hartselle: [00:02:57] It did. It was it was funny because I gotten home from night shift and called my parents at 7:00 in the morning and said I'm going to go to medical school.

Stephanie Hartselle: [00:03:04] And you know my parents agreed that they had them right there. I said OK sure. Four years later you know that change is funny.

Saul Marquez: [00:03:15] And Dr. Odzala it's one of those things where it's like sometimes we don't choose medicine it chooses us right.

Stephanie Hartselle: [00:03:22] I think it's also a great way for me to connect with some of my patients. I'm anxious.

Stephanie Hartselle: [00:03:27] It is and our goal is to make this as any kind of piano or anything else. I've made our way through and I.

Stephanie Hartselle: [00:03:35] Well actually yeah you know I had a really difficult to do anything backtrack and work hard for it you get there.

Saul Marquez: [00:03:47] That's pretty awesome. Yeah. What would you say Doctor Hartselle is a hot topic that should be every medical leaders agenda today. And what are you guys at your practice focused on in approaching.

Stephanie Hartselle: [00:03:59] So I definitely think it's positioned right now. That is something that's all over. I think the general news is all over the medical news. We have an incredibly high suicide rate and physicians mostly because we don't miss almost everything she knows. Yes. Yes quotes But I think the most effective way to die.

Stephanie Hartselle: [00:04:19] And I think they're a combination of factors that are going on but I think that the fact that these issues are dying and they're doing it by their own hand is something that needs attention. And I think it has so much to do with psychiatric health, mental health and physical wellness.

Saul Marquez: [00:04:34] So what do you think is a good way to deal with it. Yeah.

Stephanie Hartselle: [00:04:39] Good question. So there's a combination of factors going on medical screening.

Stephanie Hartselle: [00:04:45] So you know it's four years of college if you do it once or twice then you do it once it's four years of college four years of medical school at least three years of residency although most of us I did five most people do between five and after I have people from 11 years.

Stephanie Hartselle: [00:05:02] And they get out and suddenly they're in these situations where they aren't in charge of patient care. And I think that can be really devastating. And so the person in charge of patient care is a system that will charge of patient care has changed into this kind of big box medicine. Now hospitals are having a private practice those are becoming big conglomerations becoming corporations. And if I want a giant box of cereal that will last me three months. I want to go to a big box store if I want my child to be treated really well for something that's happened to him. I want to go to physicians not burn them out and who's not being ruled and dictated by. I think that this is and it's medicine and I think that

Stephanie Hartselle: [00:05:39] As I think that's the real bait and switch for a lot of medical graduates and people who are mid career those the people who are killing and some of the highest rates.

Saul Marquez: [00:05:47] Now that's really interesting. And so you get through medical school you get through residency which could be very long and then you start practice and you realize oh my gosh I am not in control right.

Stephanie Hartselle: [00:06:00] I'm not in control and I'm not able to actually do what I want to do which was treat patients well and actual care for them in a way that I think is useful to us.

Stephanie Hartselle: [00:06:09] Instead you're often in clinic you're mandated to see 46 patients or more an hour. So you're running from the room.

Stephanie Hartselle: [00:06:16] I don't know. This is more and more complex I wonder you are able to make any kind of sessions like during the 2000 - 4000 patients there or more. And there's just no way to treat human beings and their medical complexities. Well that way I think doctors become just hired and burned out. And it was worth it.

Saul Marquez: [00:06:36] Yeah it's definitely an issue. You know I mean you see it in their physician bloggers out there there's people just expressing their frustrations. And I do feel like there is this undertone of just I've had enough.

Stephanie Hartselle: [00:06:49] Yes very much very exasperated a lot of people retiring early. And so to answer your question about how to how do we fix it.

Stephanie Hartselle: [00:06:56] I think one really important ways to make room for potential leadership so is hospitals and the corporations to not just have a board of MBA.

Stephanie Hartselle: [00:07:06] We're running a hospital series. The solution at any time is up to the leader. Yes gonna be carved out. One of the reasons I have now practice your own practice is you know how to treat patients.

Stephanie Hartselle: [00:07:21] We're learning how to run the business end of things. You know that's a learning experience every single day. But I'd rather learn that than I have people who understand how to run business help me how to treat patients. And so I think that's one of the ways that we improve.

Stephanie Hartselle: [00:07:34] I think they always start early and that's for training physicians to have them care cells how to stand up for themselves and how to make sure they're not psycho and feel like they have an ounce lot are trapped.

Saul Marquez: [00:07:46] Now that's a really good point and I do agree and just having spoken to many physicians physician leaders to you know just like this is a hot topic. Yes.

Saul Marquez: [00:07:55] This is a really hot topic and.

Stephanie Hartselle: [00:07:57] Then it doesn't just affect doctors it affects it you know if you think about it's a tragedy to lose a human being suicide but one physician dying and he's lost.

Stephanie Hartselle: [00:08:06] Now that doctor for thousands of physicians and even a family of her or him that's the connection that's so important and they've lost it. So this impacts not just the physicians and that impacts all of our patients.

Saul Marquez: [00:08:23] It sure does. Yeah the domino effect is without a doubt very serious. Can you give an example to the listeners. Dr. Hartselle of of how you and your practice or any other things that you may be involved with have created some results by doing things differently.

Stephanie Hartselle: [00:08:40] Sure.

Stephanie Hartselle: [00:08:41] And I can even tell you about how I was stuck in a box and after graduation I took a job as a medical director of one of the pediatric sites are here. It's one of the highest volumes surprisingly there are children in psychiatric crisis. And it was just it was a set up and it's like a hall and many many psych yards where the system has suddenly began yearly a patient or has increased and so

Stephanie Hartselle: [00:09:07] Hospitals do try their best. They try to cobble together teams to handle this but it's therapists and couples together. And I think you know I was stuck in a position where I wanted to be a physician leader I wanted to change decision but they're outside the resources at the time.

Stephanie Hartselle: [00:09:23] And in some cases because it's mental health not the interest because mental health hurt certain areas of medicine so scary. And so I had to leave that area and open my own practice.

Stephanie Hartselle: [00:09:33] And there were two things that had stuck with me and are in residency you know one was or thought that I would be able to care for patients in the way that I thought it could. And I learned later that that was not only possible in the system which it was working. The second was physicians come in and told us about how it was really important that after all these years of training as a psychic and just because there are so few of us in the country that we had a real charge to not only treat our individual nations but to also figure out a way to reach people across the country that after seven years of training and this much investment that we had to figure out a way to provide care to more people. So I think what you're doing with the show is really critical. So you are doing so well. Is it mandated that we do which is reach people everywhere and it's another thing that I've also tried to work on and so in addition to the private practice where I can or kind of rich people one to one I'm hoping to be able to bring videos about how to do some software for physicians and patients and be able to reach more people that way because there just aren't enough of us and be able to figure out a way to reach more people.

Saul Marquez: [00:10:35] That's outstanding and kudos to you Dr. Hartselle for saying you know what I want to make a bigger impact and I'm going to find a way to multiply myself and give these people that are looking for solutions for answers those answers and solutions.

Stephanie Hartselle: [00:10:51] I'm hoping so.

Stephanie Hartselle: [00:10:52] I really am because it's hard anyway to get in with a doctor regardless of where you are in the country to get in with a psychiatrist or child psychiatrist. It's almost impossible.

Stephanie Hartselle: [00:11:02] And I want to make that mark.

Saul Marquez: [00:11:05] That's amazing. And so I really admire you for making that effort outside of all the things that you already have going on to say you know what I want to do something because this is my calling. Without a doubt it is your calling and I'm excited to see what you put out there.

Stephanie Hartselle: [00:11:20] Thank you.

Stephanie Hartselle: [00:11:20] I'm hoping it will be great. Really I'm working on both. First of all how to get physicians can and maybe step away from the larger big box medicine and produce their own practice that's driven by themselves and think those practices like Pamela Weible as someone who is a real leader in this area I don't know her personally. I have exchanged e-mails with her but she talks about general medicine and how to scape a general physician and open up your own practice for very little money and be able to treat patients the way you want to. I think she's another wonderful physician into but I think that it's really important and then secondly some of the videos and I'd like to share on sleep insomnia I think that affects so many people and so for patients to be able to work on their own sleep and work on our own anxieties.

Stephanie Hartselle: [00:12:02] And that's where I'm aiming.

Saul Marquez: [00:12:04] We'll see how plastic. This is a truly exciting and it's so interesting because we went from an environment where physicians did you know they got out of medicine they hung their shingle and they practiced medicine and made to care of their patients.

Stephanie Hartselle: [00:12:18] Stayed at home visits which I get to do. But yeah we're traditional old old world authors.

Saul Marquez: [00:12:24] And there's no reason why if that's what you want to do you can't.

Stephanie Hartselle: [00:12:27] It's true. I think we're very indoctrinated funny word.

Stephanie Hartselle: [00:12:31] But yeah we have these huge hospital systems and I think you know in certain industries first orthopedic cases that you have to have an OR you have large systems.

Stephanie Hartselle: [00:12:43] But I think the general medicine is I think the NBN is fordable for patients and that helps you live a life worthwhile and helps your patients live better that that's absolutely rewarding thing that have seen the last few years was watching people get better and actually be able to not have to do therapy.

Stephanie Hartselle: [00:13:08] Right.

Saul Marquez: [00:13:09] Now that's really interesting and I agree. And if you're a physician listening to this interview and you're just thinking to yourself wow she's so right. Why don't you think a little bit more about what you want to do and collaborate. Definitely the people that come on the show like Dr. Hartselle are looking to collaborate with other like minded individuals. You were dealing with big issues here and the more common minded people that we can get together to deal with them the better wouldn't you agree. Dr Hartselle

Stephanie Hartselle: [00:13:37] I absolutely agree and I'm happy to talk to anybody who has great ideas about this because I think it's so important.

Saul Marquez: [00:13:43] Absolutely so. You shared with us some some really cool things. Now let's take a look at the other side of the coin here. Can you share a time with the listeners when you've had a setback and something that you learned from that setback.

Stephanie Hartselle: [00:13:55] Sure. So when I came straight out and was I just graduated from residency and was hired as the medical director I think I came into that system kind of guns blazing and had been trained for adult reasons yet all the hospital for those who are not in New York and I grew up in California didn't know what the hospital was and a lot of people who are older do. But it's one of the biggest psychiatric hospitals in the country is the oldest psychiatric hospital in the country and has hundreds of psychiatric beds and basically treats I think the most ill patients in the country if not the world. So it's why I chose to train. It's self-selecting.

Stephanie Hartselle: [00:14:28] I love that place still and it is a place where you kind of have to fight to get what you need. And I came I think into the bound system. So with that attitude. And I think that coming into a medical director position it is still middle management and I think I came into meetings and systems and blazing.

Stephanie Hartselle: [00:14:48] Why can't we change this. What's going on. I think now I would have tried to work with us live a little more even though it would have really been frustrating for me. So slowly but I think I could have made better change had them or patients in the system. And so if I continued in that position or if I may some day consults in that position again I think I'll be watching carefully and see how I approach the system and being more empathetic and listening more.

Stephanie Hartselle: [00:15:13] I think talking less I think I really came out knowing what I wanted to do and not were to anybody else I think that's a that's a real problem.

Saul Marquez: [00:15:21] They learn that that is really interesting you know because across the country I mean it's not one size fits all right. Every system is going to be different. So what advice would you give to somebody leaving one system and going to another on how to make big impact and get what they need.

Stephanie Hartselle: [00:15:40] I think for the first year that you leave the system then you go into another system.

Stephanie Hartselle: [00:15:44] I think the first year and head down and listen.

Stephanie Hartselle: [00:15:48] And also picture put your oxygen mask on yourself first. That's always a message to everyone is can't help anybody else.

Stephanie Hartselle: [00:15:55] You are burned out tired to let yourself down listen and just go with the flow for the first year and then start.

Stephanie Hartselle: [00:16:03] And certainly make a connection you see are moving in middle and then start to have the conversations and listen more than your like you. Now this is the. First. Time yourself when you figure out how to survive. This is something unsearchable.

Saul Marquez: [00:16:20] I love it that listeners put your oxygen mask on first because if your tank is empty there's no way you're going to be able to give. There's just no way you can't.

Stephanie Hartselle: [00:16:29] It's the last thing that goes with most people is work. And for physicians especially if less so everything else their lives will fall apart.

Stephanie Hartselle: [00:16:35] Families, their health the work will go last. So notice that because they will stop caring about what's going on a little more Brosnan's more every day.

Saul Marquez: [00:16:44] Yeah that's such a great message. Really great message. And so what would you say. Dr. Herd sell is one of your proudest medical leadership experiences to date.

Stephanie Hartselle: [00:16:54] So in June I was awarded the Dean's excellency award for teaching and that of us.

Saul Marquez: [00:17:00] And congratulations.

Stephanie Hartselle: [00:17:02] That was amazing just because it's an amazing award to get.

Stephanie Hartselle: [00:17:04] But also my mother was a teacher and I remember watching her in the classroom and thinking Oh my goodness she works hard.

Stephanie Hartselle: [00:17:12] I'm not doing our job. It's hard. I'm becoming a Doctor. I'm not kidding about that I really.

Stephanie Hartselle: [00:17:17] To this day I watched teachers and I have two patients and I work so hard and in residency I had a wonderful resident mentor her name is Grace Henessy from an MBA degree in Tennessee she made me lead a group from the SBA with a group of men.

Stephanie Hartselle: [00:17:36] It was incredibly squirrelly group and it was difficult. I remember trying to do it and coming to Dr. Henessy.

Stephanie Hartselle: [00:17:42] I felt like that went horribly ignorant. So the fact is the Brownstein had a word.

Stephanie Hartselle: [00:17:49] They were the ones who voted for has been in award with. Actually the proudest moment I've had in medical career

Stephanie Hartselle: [00:17:55] Besides getting getting into medical school, that was amazing. I was just I was just so proud of and so so happy about.

Saul Marquez: [00:18:02] Yeah you know and congratulations on that.

Saul Marquez: [00:18:04] And you know many of us in leadership positions in medicine oftentimes forget that hey we didn't get here alone we had teachers and we're standing on the shoulders of those that got us here. And so I think you bring up such a great point and thank a teacher today if you haven't thank your professor from 10 years ago or 20 years ago. If you're listening to this episode just send an e-mail to one of your previous teachers that made a difference today.

Stephanie Hartselle: [00:18:31] I so agree I think about the fact that I took some of my classes at the community college and then orders for my finance classes and two of the best teachers I had and professor and I are getting there and they were amazing and I had so many mentor for me. I read it.

Saul Marquez: [00:18:49] Yeah. And what happens is it takes you back and it puts your roots back down and it makes you understand what your DNA is. It does. yYu're here because of that. So thank them and Dr. Hartselle, thank you for that because I'm going to do it as well as soon as our interviews over.

Stephanie Hartselle: [00:19:05] I am, too. I am going to go right.

Stephanie Hartselle: [00:19:08] Dr. Ruth Emerson and tell him thank you again.

Saul Marquez: [00:19:14] I love it. I think that's great. So listeners. Be sure to do that as well. You know great things and really great outcomes can often start with gratitude. And so it's an awesome thing. Let's all do it. So Dr. Hartselle, tell us a little bit more about an exciting project or focus that you're working on today.

Stephanie Hartselle: [00:19:32] Sure.

Stephanie Hartselle: [00:19:33] I have a great friend now and Yuri Tomikawa who know me a few years ago and had said that she was putting together some Web sites out there. And of course I was there as well as some recommended.

Stephanie Hartselle: [00:19:47] And I said Hey I have a conversation. I realized what she was doing was. So needed because it was decided that it was all recommendations that it's. For

Stephanie Hartselle: [00:20:02] Psychiatrist. And she created the Zencare. So lucky to be a part of it. Now about her visor on it do it because I believe on it..

Stephanie Hartselle: [00:20:14] You see she interviews therapists she has this great job a head shots and videos of therapists

Stephanie Hartselle: [00:20:23] We interview couples the therapists and physicians and we make sure that we're creating a space for people to reliably find someone and make it so hard to reach out for help. And so I think it's a video of someone who has been vetted by several people and at least makes a certain level of excellence. And if anybody thinks that's most helpful thing therapy and then she has some amazing things. Every time I forget people I talk about it in different cities and good at it.

Stephanie Hartselle: [00:21:03] And everyone says well when is this coming to D.C. when they are Vermont or when's it coming in Chicago. Yeah.

Saul Marquez: [00:21:10] Doctor it's so I had the chance to meet with Yuri here on the show as well and it was just a wonderful person to speak with and has a strong vision that we said you know what you have the not that Uber put the lift of mental health does you really really does I think anything.

Stephanie Hartselle: [00:21:27] She has a concept like really the Stenzel areas in medicine and generally but you really this is such an important thing and her own personal during her honesty and that is why she likes this project they really think and are so proud of her. I'm so proud to be a part of that.

Saul Marquez: [00:21:45] That's pretty awesome. Yeah it's super exciting and for the listeners who haven't taken a listen to that podcast go to that's y-u-r-i. I know you'll be able to hear our conversation with her and the cool things that Dr. heart cell and Yuri are working on through zencare. So, Dr. Hartselle, let's pretend that you and I are building a medical leadership course on what it takes to be successful in medicine today. It's the 101 course or the ABC of Dr. Stephanie Hartselle. We're going to build a syllabus here for questions lightning round. We're going to finish with a book that you recommend to the listeners you ready. I'm ready. All right. So what would you say the best way to improve healthcare outcomes is.

Stephanie Hartselle: [00:22:26] I think take care of your providers first for making sure that they know how to figure out what is the biggest mistake or pitfall to avoid.

Stephanie Hartselle: [00:22:35] I think branding medicine as glamorous medicine is not a cause in any kind of machine. We're not a treadmill. Make sure that you are not since you need any other kind of operation that has priority number one all the time for employees and also they also have

Saul Marquez: [00:22:58] A strong message. How do you stay relevant as an organization.

Saul Marquez: [00:23:01] Despite constant change.

Stephanie Hartselle: [00:23:03] I think you really do need to keep up with what's going on.

Stephanie Hartselle: [00:23:05] I think there's a certain amount of social media and news that well over in terms of putting your own oxygen mask on.

Stephanie Hartselle: [00:23:12] I think there's with that small steps you need to make sure you have your finger on the pulse.

Stephanie Hartselle: [00:23:16] But for things to take way that I think you in half an hour understand what the trends are right now.

Saul Marquez: [00:23:25] What is one area of focus that should drive all else in your organization.

Stephanie Hartselle: [00:23:30] Always always always patients first always.

Stephanie Hartselle: [00:23:33] That is of course the caveat that you are in yourself are healthy and it is making sure that whatever you are doing, have the patient in mind and that's the bottom line and things will fall into place.

Saul Marquez: [00:23:44] Love it. What book would you recommend to our listeners.

Saul Marquez: [00:23:47] Dr. Hartselle.

Stephanie Hartselle: [00:23:48] This year I read getting things done by David Allen and I really enjoyed it and really talked about prioritizing and I think it's a stand for everything else static.

Saul Marquez: [00:23:56] That's wonderful.

Saul Marquez: [00:23:56] And so to the listeners everything that we've talked about here all of the pearls of wisdom that Dr. Hartselle has shared the book her website the things that she's up to the show notes you could find those at

Saul Marquez: [00:24:12] That's H A R T S E L L E.

Saul Marquez: [00:24:16] So don't worry about writing them down. You could just go ahead and check it out on line. So before we conclude Dr. Hartselle I like to just ask you to share one closing thought and then the best place for the listeners to get ahold of you.

Stephanie Hartselle: [00:24:28] Sure.

Stephanie Hartselle: [00:24:28] So I think my closing thought would be for medical providers so that anybody in medicine physicians or nurses anybody providing healthcare to others.

Stephanie Hartselle: [00:24:38] If you are burned out if you are struggling and feel like you have no work is.

Stephanie Hartselle: [00:24:44] More than anything else.

Stephanie Hartselle: [00:24:46] What we do as all the rules and there are places where if you are not going right and you have nowhere to go. My cell phone is on my Web site. I'm not kidding.

Stephanie Hartselle: [00:24:58] It's all on there all the time and it's with me all the time and we will try to figure something out. We've got nowhere else.

Saul Marquez: [00:25:08] Such a wonderful message Dr. Hartselle and the listeners just know you know you're definitely not alone and if you do find yourself in that place and you can't reach your oxygen mask. You just can't do it on your own. Go to and you'll find the best way to get ahold of Dr. Hartselle there if you need her answer. Doctor thank you so much for spending time today. It's been so much fun. And really looking forward to seeing the awesome things that you do with the videos.

Stephanie Hartselle: [00:25:39] I was really excited to be here.

Stephanie Hartselle: [00:25:40] I really appreciate you for having me.

Outro: [00:25:46] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at dot for the show notes, resources, inspiration, and so much more.

Recommended Book/s:

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