Episode: 210

Assessing the Impacts of Social Determinants on Population Health with Rob Fields, SVP, Chief

End of Life is a Human Endeavor, Not a Medical Issue with Dr. Shoshana Ungerleider, Founder at End Well
EP. 213
15 min 7 sec

Dr. Shoshana Ungerleider, Founder at End Well

End of Life is a Human Endeavor, Not a Medical Issu

End of Life is a Human Endeavor, Not a Medical Issue with Dr. Shoshana Ungerleider, Founder at End Well

Episode 213

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End of Life is a Human Endeavor, Not a Medical Issue with Dr. Shoshana Ungerleider, Founder at End Well

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health leaders. Today I have a very special guest for you. Her name is Dr. Shoshana Ungerleider. She’s the founder at End Well. She’s a physician, philanthropist and speaker. She received her medical degree from Oregon Health and Science University in Portland and completed residency at California Pacific Medical Center. She’s got a lot going on right now. She’s passionate about improving how people are cared for throughout the continuum of life. She started the Ungerleider Palliative Care Education Fund to support innovative programs that further palliative care. And she’s also a starter of the company. As I told you End Well, very focused in this piece but on top of that, she’s also a producer. She executive produced a film by the name of Endgame, a short documentary on hospice and palliative care. It received Academy Award was with Academy Award directors Rob Epstein and Jeffrey Friedman. But she also funded extremists. It’s a short documentary about end of life decision making in the intensive care unit and this film was premiered at Tribeca Film Festival and was nominated for Academy Award nominated for two Emmy Awards. So as you can see here, this physician frontline also producer entrepreneur is very passionate about this space and it’s with big pleasure that I welcome Shoshanna to the podcast. Welcome.

Thank you so much for having me.

It is a pleasure. Now Shoshanna did I leave anything in your intro that you want to share with the listeners.

Gosh you covered a lot. I guess the only thing that I would add is that my favorite hobby is singing karaoke.

Nice, I love it. Any favorite songs?

Oh man there’s so many. I love Whitney Houston, she’s a crowd favorite.

Love it. I love it. Yeah it’s a great one. I love the karaoke. Obviously, very focused in this niche of end of life. What would you say, just going back to the root of it all. Got you into the medical sector?

It was funny, I studied as wife at 10 different majors in college. I was kind of all over the place everything from Spanish, to fine arts, to women’s studies. I finished college with a degree focused on marine biology and actually thought I was going to pursue a Ph.D. there and I realized that very, very end of college that after spending a few months at the marine lab on the Oregon coast that I was not going to be happy studying little tiny microorganisms floating around in oceans. I really wanted to work with people and so I decided to put the premed route. So I ended up back in school and then many years later in medical school.

Nice. So you made a really great choice right, because obviously you’ve contributed a lot. And you’re enjoying what you’re doing. Shoshanna what do you think is a hot topic that needs to be on every medical leaders agenda today. And how are you and your organization tackling it?

Well a topic that I care the most deeply about is improving the end of life to make it a more human centered experience. So we have 10,000 baby boomers turning 65 every single day in this country.

Wow. Everday?

Every day. And actually the latest estimates are even higher. So even if we were to have massive breakthroughs in longevity science never in our history with such a large number of people die in such a short time span from natural causes. Right. And to further complicate this causes of death are now largely chronic conditions can require care for years and years. And I think with the work that I’m doing with the End Well which is a project which is a nonprofit is we’re coming at this from a few different angles. You know we started in thinking about medical education reform to train clinicians in how to have conversations with patients about prognosis, about goals of care, about palliative medicine fundamentals. I mean we continue to support that but we also realize that a broader societal shift internees that take place. And I firmly believe that dying is not a medical issue it’s a human issue. So we’ve created a media platform and we support an annual international symposium which convenes people from the world of tech, of healthcare, of policy, education, patient advocacy, the media arts and faith communities to really create an interdisciplinary network and try to develop human-centered solutions for the end of life experience. So we’re kind of I like to say we’re bringing in the creative experts, the technical experts and the life experts into one room.

Love that. And you bring a really good distinction. You know it’s it’s end of life. It’s not a medical condition it’s a life thing. It happens. So what message would you give to the folks listening about end of life and how they address this?

Gosh it somewhat depends on you know where you’re coming from in terms of the conversation. But to me I think it first starts with personally reflecting on what matters most to you as a human being, as sort of how you live your life and then have a conversation about that with the people that you love. We know that critical conversations are not taking place to make sure that the care people get is care that they really want. And I’m talking health care and care otherwise. And so I think the more that people can be thinking about this and talking about it, gets them closer to making sure that those things are aligned for them.

It’s a great great message there Shoshanna. Can you give the listeners an example of how End Well is creating results and doing things differently to improve outcomes?

Absolutely. So End Well is a nonprofit. And one thing I’ve learned is this, we’re really, really siloed in our approach to problem solving around the end of life experience. I think doctors talk to other doctors and then you have the hospice people talking to other hospice people. Of course insurers speak to insurers and the policy makers speak to policy makers and nobody seems to be talking to patients. And while we are all in agreement that our health care system is broken, the majority of what we propose as solutions is to rearrange or just to fine tune what we already have. I think we’ve really internalized the idea that specifically death is a medical issue. So we keep looking for medical solutions. And I think what’s unique about End Well is that we’re really focused on bringing diverse voices a real interest professional group of people together to listen and to learn from each other and our symposium which this year is December 6th in San Francisco is to really create a cultural shift that supports new collaborations, new systems, protocols and even products that foster new and existing networks of support. And this really hasn’t been done before in this particular arena and we’ve been successful in terms of the metrics that we’re looking at. So End Well 2017 was our inaugural event. We sold out 3 months beforehand and had several hundred people on our waiting list to attend. We just that blew our minds at this topic that people really wanted to dive into. Our hash tag on Twitter #endwell17 reached over ten million Twitter impressions and 20 seats in 15 countries in a matter of hours. We had CNBC NPR’s On Being San Francisco magazine all cover our event. So that shows us just in terms of reach that the people are really wanting to engage in this content related to end of life. And so we’re going to keep going.

That’s awesome. Now thank you for that Shoshana. And folks if end of life is on your mind you definitely need to check out the conference that’s coming up in December. It’s the endwellproject.org. If you look up endwellproject.org you’ll find information there. It’s coming up it’s in San Francisco. Definitely one that you’ll want to miss. You won’t want to miss especially if you’re wanting to surround yourself with the thought leaders in this space and and to Shoshana’s point right. Knock down those Shiloh’s or connect the silos at least to be able to make some strides in this space because it’s definitely needed.

Give us an example Shoshanna of a time when you had a setback. I feel like we learn more from these setbacks. What did you learn from that setback?

Absolutely. Well you know I think what I want to share is maybe not necessarily a setback but something that early on we realized. I first started off my career around philanthropy thinking about medical education reform. What I knew was residency training and that there were major gaps or maybe we’ll just call them opportunities for training providers in communication skills in palliative care fundamentals. And so I thought well, if we can train all healthcare providers in how to have these really important conversations with patients in a more effective manner and if they have an understanding of palliative care that will improve outcomes. And I think that that’s very true but I really quickly realized that scale and sustainability were going to be huge issues. Thinking about the many many programs around the country each have their own ways of funding up thinking about curriculum of thinking about these issues frankly. And if I’m somebody that you know has bigger goals for change and I want to have this happen in my lifetime, right. So I really shifted my focus my time my energy my resources to tackle some of these issues from the consumer side and I realized that that was what I’m betting on it was going to be more impactful. So I’ve gotten much more involved in documentary film as a vehicle for sharing this information and sparking conversation and creating the End Well platform really is focused on culture shift.

Yeah you know and Shoshanna I love a love that you saw that right. You mean you’re like OK I’m gonna aim at these institutions, these educational institutions and quickly just saw that. Wait a minute, I want to scale this and I don’t see it happening. So you made a quick shift and went to the consumer and I love that you did that and did it in such a creative way. I mean you went to the documentary space I mean what sparked that idea?

Well the idea was already happening. So you know it turns out that a good friend of mine a friend and colleague Dr Jessica Zimmer And I were having coffee and she mentioned she is an ICU doc and also practice palliative medicine. And you know we’re having coffee and she said listen, did I ever tell you they’re filming a documentary in the ICU about end of life and I said no. Like what do you mean. Like that sound incredible. So she connect me with the director. And it spent several months actually already filming at the Highland Hospital in Oakland and he sent me a five-minute rough cut. I was totally blown away by what it should, you know film is not something that I had studied in school or even knew much about but I just when I saw those that really brief footage I just thought gosh like this is a story that needs to be told and he’s captured it in such an amazing way and I have always felt that we need to let people into what it’s really like to be seriously ill in a setting like the ICU so that they understand you know maybe what they’re signing up for or maybe they don’t want that or at least to empower people with some information so that they can make that decision for themselves about what they might want. Should that issue arise and so I funded that film and never in a million years that I think that it would take off like it did. I think we just got really lucky and filmmaker Dan Kraus just did an amazing job.

That’s awesome Shoshanna. And listeners think of yourself as a coffee table right now. You’re sitting here with Shoshana. with me. You’re hearing this. This topic of end of life. We’re connecting silos right now as we speak. So don’t wait. This is an opportunity, don’t wait and do something about it right, if you’re looking to make make something better happen within the space of end of life. Do it now. So Shoshana you pivoted. You had some great, great success. What would you say one of your proudest medical leadership experiences or moments that you’ve had to date?

Gosh, I don’t know if this is a medical leadership experience but getting to go to the Oscars was pretty unbelievable.

It’s pretty cool.

Extreme is which is on Netflix. It was nominated last year. So that really blew my mind. I was also named Woman of the Year by the women’s healthcare executive.

Congratulations.

Two months ago. So that was really a wonderful more healthcare focused experience. But it’s been a wild ride the last few years. That’s for sure.

That’s awesome. And you know the message here listeners is like Shoshanna, right. She was mission focused, she was outcome-centered. And there’s so many ways that you could get the word out and share your passion and your solution. It could be a medical device. It could be a process. It could be a documentary in this case who knows you may be sitting next to Shoshanna at those awards next time, right. But just do it. And so Shoshana, what would you say right now in the midst of all the things that you’ve got going on, great things that you’ve got going on is an exciting project or focus that you want to talk to us about?

Yes. The Our second film a different team of filmmakers I executive produced called end game which you mentioned earlier about hospice and palliative care and that was done by Academy award winning directors Jeffrey Friedman and Rob Epstein. Just came out on Netflix and we’re we’re actually launching a national impact campaign focused on education related to the film both for medical professionals and for the general public. So we’re hosting screenings across the country with a curriculum to help spark these important conversations related to advanced care planning to discussions of mortality and really what it means for all of us to live well until the very end. So I’m really excited about that or be rescreening it around the country over the next six to nine months and people can actually host their own screenings so you don’t need us. You can actually just log in and get some folks together to watch it and talk about it.

Now this is super exciting. So for the andwell film. Is this something that listeners that want to know more, where can they go for this?

Absolutely. There’s a couple places, but probably the most straightforward is the endgame documentary website. So the film itself streams on Neflix so you just type in Endgame on your Netflix accounts. But if you want to read or check out the resources for the documentary that’s on our documentaries website which is endgame-documentary.com.

Awesome. So simple check it out on your Netflix or end game dot com slash documentary?

No it’s actually endgame-documentary.com.

Oh got it, endgame-documentary.com. There you have it folks. And what we’ll do to is will we’ll provide you links to this film on the show notes to the podcast. So make sure you check that out. So we’re getting close to the end here Shoshana, 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 of Dr. Shoshana Ungerleider and so I’ve got four questions lightning round style for you, followed by your favorite book that you recommend to the listeners. You ready?

Yep.

All right. What’s the best way to improve healthcare outcomes?

Well I think aligning incentives to achieve the quadruple aim which is improving patient experience, creating better population health, lowering the cost of care all while increasing the joy and well-being of providers.

Love that, what’s the biggest mistake or pitfall to avoid?

Well I think the best way to avoid mistakes or pitfalls is to constantly ask yourself is what I’m doing today serving my overall goal or my mission? I think it’s easy to get distracted and off track constantly reevaluating that is really important.

It’s a great, great tip there. How do you stay relevant as an organization despite constant change?

Gosh I think there’s so many ways to think about this. For me in terms of focusing on culture change I think figuring out how to best leverage social media and staying current which we don’t always do the best job of in health care you know on LinkedIn there’s 250 million monthly active users Twitters 330 million and that as of early this year Facebook at 2.19 billion monthly active users. So I think leveraging if we’re thinking about culture change leveraging the world of social media.

Love that. What’s one area of focus that should drive everything in an organization?

Well I think I can tell you what what we’re focused on we want all care, healthcare or otherwise to be aligned with people’s goals and values of how they live their lives and our end goal as a nonprofit is actually to go out of business or to shut our doors because we’re no longer needed. That’s the end goal.

Love that. So what would you say your favorite book is Shoshana?

I have several but the one I would recommend is Being Mortal if you haven’t already read it by Dr. Atul Gawande.

Love that. Folks, check out all the resources provided by Shoshana here the syllabus that we just put together go to outcomesrocket.health/endwell and you can find all that there as well as a transcript of our discussion today. Shoshana, before we conclude I love if you could just share a closing thought with the listeners and the best place for they could follow or get in touch with you.

Sure. You know I’d like to challenge listeners out there to think about reframing our conversations in healthcare. So what if the entire health care system was geared toward asking patients one question and that question is what are your goals and values of how you want to live your life and then tailoring all care based on the answers to that question and whether it’s about treating high blood pressure diabetes or talking about serious illness and end of life. I think this is a way to shift our thinking and move forward. And you can thank you. You can reach me at shoshanaungerleider.com or if you can’t spell that which I know it’s hard on Twitter @shoshiumd. I’m on LinkedIn, I’m on Facebook, I’m on Instagram haven’t yet figured out Snapchat but I’m available.

I love the listeners they have it. Shana has provided several ways, several channels to get in touch with her and her work. Take action, do your part to make this end of life process better for your patients, for your loved ones. And I think in this interview, we’ve provided multiple ways for you to take action. So whether it be Shoshana’s documentaries, the upcoming documentary or just checking out her conference. Do something about it. It’s definitely a great opportunity for all of us to tackle, so Shoshana just want to say a big thank you to you for sharing your mind your heart with us and we’re really excited to keep up with your work.

Thank you so much. It was great to chat with you.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast. Once again as a leader in health care you have big ideas great products a story to tell and are looking for ways to improve your reach and scale your business. However there is one tiny problem. Health care is tough to navigate and the typical sale cycle is slow. That’s why you should consider starting your own podcast as part of your sales and marketing strategy at the outcomes rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

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Recommended Book:

Being Mortal Illness, Medicine and What Matters in the End

Best Way to Contact Shoshana:

LinkedIn: Shoshana Ungerleider

Twitter:  @ShoshUMD

Instagram:  shoshstagram

Email:  shoshanaungerleider.com

Mentioned Link:

End Well

endgame-documentary.com

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