How to Have Meaningful End of Life Conversations with Jethro Heiko, Co-Founder and CEO of Common Practice

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 have a magnificent person for you. His name is Jethro Heiko. He’s the co-founder and CEO of Common Practice. He leads the company’s mission to make great conversations in health care common practice much like here at the outcomes rocket through the podcast. They do it a little bit more uniquely Jethro has over 20 years of experience applying his skills in community organizing strategic nonviolence and bereavement to authentically and deeply engaged individuals, organizations and communities. Following the death of his father 20 years ago, Jethro founded a bereavement support organization which helped college students cope with the serious illness of death of a loved one. This is a really serious topic today as much of our family ages as well as ourselves. We have a lot more deaths per year and so the question is how do we deal with this stage of life? How do we deal with even early stages of life when people are faced with a chronic illness or a potentially deathly illness? This is the topic that we’re going to be focused on today because Jethro and his team are very focused on this. So it’s with an absolute pleasure that I welcome Jethro to the podcast welcome my friend.

: Really excited to be here. Thank you , Saul.

: Absolutely now did I leave anything in that intro that I may have missed that you want to share with the listeners?

: I don’t think so. I mean I think one thing I mention is that the listeners may think oh this is going to be a morbid topic. What kind of work is starting as a young person. I didn’t realize I need to update my bio. My father died 25 years ago this summer and I have a 20 year old at the time. We were very close. He was very good at talking about his experience with cancer and he has also a terminal diagnosis. He knew he was going to die and that I did work with young people for a number of years we’re coping with this years almost of a loved one and loss issues and what I found is this is not a joke, when you’re more and more comfortable with these topics it opens up an entire new window into your experience. Professionally, personally you know it’s not just about death and end of life it’s about living your life in a way that’s mindful of the fact that it won’t be forever. So I think that just one thing I mentioned I want people to stay on people to stay and listen. So..

: No for sure. I think that’s a good call. Jethro and and folks you know we’ve had this end of life discussion with other guests that we’ve had on the podcast it’s a very interesting topic to Jethro’s point it brings to mind, you know Atul Gawande’s book on being mortal talking through some of those things and the changes that have led to how we look at death today. So excited to dive into the things that you’re doing Jethro. Now why did you decide to get in the medical sector to begin with?

: From that experienceiIn my 20s I did work in community work. It was not specifically health care related. And about about 6-7 years ago my co-founder and I and our team found ourselves in the midst of a very interesting consulting project with a State Government around healthcare issues. And when that project ended in 2010 and 2012 we felt like we should really solve some meaningful issues in the medical sector in healthcare and felt that based on my experience and work around bereavement and our kind of work as human centered designers which is the way we kind think of ourselves that there was a real opportunity to explore ways that we could help health systems and the communities that they serve this better engage in conversations and interactions around these kind of tough topics that are often avoided. So that’s what brought us into healthcare was a consulting project. And then when it ended and feeling like I’ll really make an impact in this area.

: Very cool so there’s more to be done there and you guys decided to keep running with the torch. Now as you guys have been in this space for the last six seven years. What do you feel Jethro is a hot topic that needs to be on every medical leaders agenda today and how are you guys addressing it?

: That’s a great question. I think that one of the main things that we work on is closing this gap, the gap between a clinician and a patient family whether that’s in the office or at some kind of appointment or meeting or on the phone. There’s often this divide between the experience of the person who’s dealing with illness and their loved ones and the health care provider whether that’s a physician or a nurse right and the other kind of provider. And I think the bad gap which relates to how to initiate conversations can be filled not just through training and skills through really well design tools. So in our case it’s a game called Hello and we think there’s other opportunities out there design other interventions that improve medication and true relationship building build trust in a strong way without needing to take a lot of time. Time is of the essence and we don’t have much of it in these interactions. And I think that those relationships and the way we communicate in healthcare then has all these other ripple benefits when it comes to both critical outcomes as well as really important top of mind issues for healthcare leaders like you know issues of turnover and burnout among the workforce which is a huge issue. And other kinds of costly things reputation, bad press stories, you know when you look at the actual reasons why bad things happen in healthcare. At the core of it it’s often not necessarily a clinical intervention. Often the root is often more of a communication challenge. So I think that that’s the thing I would bring to the special clinical leaders is really focusing on things that sometimes do seem a little bit more as a soft skill that are really critical and can be improved upon through very well design tools.

: For sure. Yeah it’s definitely a big need right I mean especially like you mentioned once you leave the hospital or a hospice for that matter it’s hard to make that transition. Long term care facility. So what would you say Jethro is an example of how your organization has created results by doing things differently? You mentioned this game that you guys have maybe you talk about that a little better or maybe another example.

: Great the game Hello is really one of our primary intervention. It’s an analog game so it’s played in person or by video but you know live with people using groups of anywhere from like three to five people. And I think one of the other innovations is that we now have health systems and their community partners holding events as large as you know 200 300 people within initiatives that help people engage in these conversations about things like advanced care planning, caregiving, coping with chronic and serious illness in a way that’s actually enjoyable. So it’s it is a game that’s made up of questions that are very thought provoking things like what activities make you lose track of time or who haven’t you spoken with and you’d like to speak with remedies with last six months that you’d like to speak with before you died the question to get at the heart of who you are. Someone know a bit more clinical. Some of them not as much clinical. So anyway I think that’s our real prime example and bringing games into health care not the not the easiest thing to do. Been about over almost five years now since you released the game and increasingly there’s a lot of openness to creative solutions in healthcare which is very good for us and I think good for healthcare. So I’m sure I can sort of talk about more about the game but if you think about meaningful conversations that you have with groups or friends your family sitting around a table after the game does but it doesn’t require you to think so much or to come up with questions because the game itself facilitated by the players. And one of the research studies actually a number of research studies now show is that players play the game at a very high rate 80 percent of players take a meaningful advance care planning step within eight weeks without any other intervention.

: I think that’s that’s pretty meaningful Jethro and so how did you guys come up with this intervention? It could have been a lot of things. How did you come up with this solution?

: So it went right where we thought there might be a need and talk to people who dealt with that need all the time. So we met with and interviewed various kinds of healthcare professionals laypeople patients people that are coping with serious illness and advancing series on so people that are coping with death and dying on a regular basis. And what we heard from those folks in particular are remember a bunch of hospice nurses telling us that they could tell whether or not families had conversations about end of life care and those families that have had those conversations they could provide better care more quickly too. And we sort of took that as a challenge to design something to solve that problem.

: So you didn’t start with a video game and you are just kind of open minded?

: Yeah actually yeah it’s an analog game so it’s not digital. We’ve started with really a question where do families have conversations. So we thought okay well families have competitions often around a table and we thought well, if it’s just a regular conversation that’s not quite enough. But where else do we kind of start conversations. We’ve got all our families have game nights that sit around and play a game after a Thanksgiving dinner. So we thought OK let’s stick a little bit deeper into what games can offer when it comes to health care and communication healthcare.

: Very cool Jehtro, that’s a great idea. You know we recently had a guest on the podcast, Lucienne from there now and he’s been involved in sort of singularity movement on health care and now one of the messages that he said is go where they are, meet them why they are – we are talking about how so many failures are made when ideas come up and you just come up with an idea without actually surveying or vetting out what you’re going to do and being where they are was his message and sort of you took it to the essence of that right. Like where are our families having these conversations. And I love that that you came up with this idea that yeah you know dinner tables one thing but afterwards a lot of families do have this game time. So it’s pretty neat that you landed on this show after you got it. I mean what were your findings? Did you did you pressure tested? Did you run with it?

: First there was a response to a design challenge by the California HealthCare Foundation where named one of the winners. So we knew we had something, that family is a prototype of the game and that we felt like I needed even more testing so we get a Kickstarter campaign. This was in the summer of 2013 so five years ago this summer and reach our goal, we exceed our goal and we used all those Kickstarter backers as our test subjects. So we sent prototypes out to folks we would set up essentially focus groups the people playing the game in front of us so we could see how it worked. We tested over 400 by 450 questions to get down to though what’s now 32 questions that are in the games like primary tool which is a questions booklet that each player has and writes in. So he is testing testing and that’s one of the things about our approach a common practice is this real strong belief in iteration and really almost an embracing a failure failure as a real generative approach or opportunity. So that’s the way we approach it as we did. So we go in knowing what we wanted to do we kind of went in and again love what Lucien said on a previous podcasts. You’ll meet them where they’re at which is a very you know it’s very similar to the things that people say and the kind of work I did community work was you know you want to really keep an eye on where the people the community is at and an eye towards where they’re going and the goal of design the kind of design that we do is kind of building our bridge between those two things.

: I love it Jethro. I think that’s so great that you guys are able to kind of go through that process. And here you are. Can you give the listeners an example of what kind of outcomes you guys have created improved outcomes through this?

: Sure. There’s all the research done mostly at Penn State Hershey Medical Center that is looking at things like the use of the game by patients and laypeople which is showing this activation rate at a very high rate of 80 percent or 75 percent across all studies. There’s been research also about a lot of use of the game in training settings. So there was a study last year with chaplains and training and it turns out that just playing the game two or more times increases confidence and comfort with difficult conversations and an increase in the frequency in which these providers actually engage in difficult conversations that excite us because we think that we’ll never scale will ever get to the scale we need around engagement around these issues just through skills training that we need very simple to use tools. Like I mentioned earlier when we have a lot of health systems that are in some ways the proof is in the pudding like organizations that are engaging in the thousands of people through initiatives where their staff are using the game to engage various community groups various patient populations and caregivers and families to really align care to initiate goals of care conversations and to encourage advance care planning.

: I think that’s pretty neat. Jethro and.

: Thank you.

: You know what. It just proves that people are open to these types of resources and becoming part of the normal training routine and making it part of an order set so to speak if death is to be near. I think it provides great resources for physicians. So if you’re a physician leader or chief medical officer listening to this thinking to yourself, what are some gaps that we need to bridge? Jethro really has a great solution here for your practice for your organization and at the end of the podcast to provide you way to get a hold of him and check out the organization and what they provide. So don’t go anywhere and still going to be having some more discussions about Jethro’s experience here. So can you share with the listeners a time when you actually had a setback maybe something that almost made you want to stop what you’re doing right now what you learned from that failure that the listeners can also learn from?

: That’s a great question I think, I mean in some ways the impetus of creating organization was like hey I’m not a pretty big failure. Many years ago which was six years ago I’d say which was that we basically had a crisis of imposter syndrome crisis. So you know we’re you know felt like we were pretty good doing consulting work first time coming into health care and consulting and felt like we needed our team alone didn’t have the skills or experience to do it effectively. So we actually hired a number of contract workers to work with us and our team. And they were seasoned and they are very experienced. And before we knew it we kind of lost control and let’s just say it wasn’t the prettiest of outcomes. So yeah in some ways I was kind of brought us I think eventually to kind of a more authentic approach to our work that was really as a people that really embrace change work and background. Like you mentioned that through the organizing and non-violence strategy our interests really are about helping people in leadership make the changes that they seek that are in support of the communities that they serve. And I think we thought what we have to look differently, we act differently, to talk differently with the sort of “be smarter than we were”. And I think about my career about 25 years of it I’ve noticed that about myself that it’s I can kind of undervalue things that I bring to the experience. And I think that’s unusual for professional but.

: It’s very normal and you know I’m glad you’re bringing this subject Jehtro because I think this is all too common actually and I think all of us have at one point or another had gone through this. Some learn the lesson, others don’t. But I think folks with Jethro’s talking about here as he called an imposter syndrome and also the feeling that what you have to offer isn’t enough or it’s not as valuable as you think it is. And in the end what ends up happening is your own belief that it isn’t makes it so. Jethro, it sounds like with this sort of brought in some some people from outside of the organization spun out of control but then you went back to your roots what you knew and now you guys are rocking and rolling again.

: And one resource that was really helpful and many of your listeners may have already may know her work that was really helpful to us and in some ways is very much. I think the principles behind her work are embedded into the design of our game because when we were the game her work was definitely top of mind. We were reading her books is the work of Brene Brown. That’s the book that I think we were reading at the time was daring greatly. But she’s had a couple of books since then. You know she’s a scholar in Texas who looks at issues of kind of vulnerability and shame and really like very practical tools. I wouldn’t say so much self-help. I mean really in some ways even more nitty gritty tangible things that you can use and that that may help us understand all this is what happened here is how we get back to who we are. Here’s how we get back to adding value how we want to be in the world. So anyway that’s a resource that I definitely recommend to listeners.

: It’s a great call out, will make sure to add that in the shownotes. So you guys made a great turn around. I mean it’s been seven years you found your core strength again you built from it. And now you’re adding huge value I mean thousands of people using your platform is no joke so you’re obviously adding value to the conversations that affect all of us. All of us as listeners all of us as providers, all of us as entrepreneurs patients you name it. So what would you say Jethro is your proudest medical business leadership experience that you’ve had to date?

: Tough one. You’re like summer about to come up like I’ll be speaking at upcoming conference in Charlotte. I’m very excited about. I’ve actually recently I was in Scranton Pennsylvania and was a visiting professor at the right center for graduate medical education. And in some ways I was the proudest moment because I don’t think of myself really as an educator or my father and my mom to both educators. My father was a professor. So even just that one day of being called a visiting professor and having classes, you know sessions every session we played our game hello and then had discussions about kind of again how do you manage this gap what’s in between people and really like in a clinical encounter. And it was great to have a set of five sessions during the day two of them were with third year residents and those sessions were very insightful, very dynamic. It’s a really good robust discussion and so that was a very proud moment to be you know in front of groups of residents as a visiting professor and sharing what I’ve learned the wisdom and how to take things that much of the work I’ve done outside of health care and learning how to integrate got into the healthcare community benefit from some things that are oftentimes left outside of healthcare system work that really healthcare community benefit from.

: So that’s pretty great Jethro congrats on that. How did you feel? I mean you’re you’re the professor and you’re kind of like in the footsteps of your parents. That must have felt pretty good.

: It felt great. I can’t say it was quite as dynamic as my father like you know being a professor of production management expert and a Japanese production manager just in time management principles so he included things like. Oh yeah exactly. Once he rode a Harley I think into the Harley uses that approach management he’d always serve sushi to his classes.

: Dang. He sounds like a fun professor. I wanna be in his class.

: Exactly. I didn’t match him yet but I still have time to do it.

: It’s awesome man. He sounds like a fine guy and yeah and hey my wife’s Japanese so little love there. That’s very cool man. I love that. Well congrats on that and more to come because you’re just at the beginning of it man. I mean you’re doing so many great things, you’re impacting the lives of many. And one thing that comes to mind here folks is the things that are most important. And and for me I kind of got this after reading that On Being Mortal by Atul talking thinking through what’s important to you. I mean I found myself talking to my wife about “hey, how do you want to you want to be buried? You want to be cremated? How do you want to die. Do you want to die at home at the hospital? As you fall even though you’re maybe far from death it’s important to consider these questions as you put together your wealth or your trust. Because as you write out what you want to happen it’s very healthy to have these conversations. What are your thoughts on that Jethro?

: I think it’s very healthy I mean it’s funny because while I was designing the game my daughter was 5 my son was 3 or 8 now and I engage privily my daughter quite a bit in discussions about the game. We’ve been like tested questions on all the questions on her to answer all of them. So I think there’s often a kind of perspective that this stuff is really scary. I think our approach on the kind of the questions that we have including the game it and the structure of the game like it’s not just questions it’s also there’s chips in the game called Thank You chips which players give to each other to express gratitude for either of the other rules that make it safe. So for example you don’t have to answer the question you can always pass you’re always able to control the way that you’re disclosing things. So there’s I think that there’s a lot to make from a lot of learned as a young person in coping with you know mortality with the fact that illness happens that happens to us it happens for people we care about. And those are going to be facts of life that you can’t really control. But there is things you can control. You know how do you respond to those moments of adversity how you either do run from caregiving or you run towards it. You express the things that you feel are important to the people that you care about or you don’t. I mean those are all things that we can choose when life sends us things that you can’t choose. So that’s the way I sort of see the work that we do. Yes it’s about end of life and yes it can be frightening and yet there’s a bunch of tools a bunch of skills about a bunch of insights that you know we didn’t create on and it human beings have been creating ways for us to cope with this reality and challenge of life forever. Right. So what we’ve done in our work is harness harness some of those insights into an experience that is propelled by a game so that people find know non-threatening to engage in things that they might avoid. So I would say you know what we’re not encouraging is just to blindly go into the world and talk about issues without some structure instead are really encouraging is whether it’s our game or other structures use those structures, use those systems, use the fact that you may be part of a strong family or strong team or learn how to build those strong teams of strong families so that you can engage in the discussions but also cope with the reality of very challenging situations that unfortunately we’re going to face. You know it has a number of times in our life and we can do better at it.

: Inevitably and for sure it’s a great out that structure keeping it there is key. Tell us about an exciting project or focus that you guys are working on there?

: Super exciting project. Well I’m starting to get a lot of interest in the in the south which for me is exciting in part because I’m not from the south emerging from Boston even though my name is Jethro. I know. Strange but anyway so.

: What does your name mean by the way?

: Well Jethro is a biblical name. He was the father in law of Moses.

: Oh wow. Cool.

: And my parents like the story because Jethro gave Moses this advice that when Moses was overwhelmed with demands on his leadership that he should find 10 people to trust and in turn those 10 people will find people they trust is basically like how do you build a structure to deal with challenging issues. So.

: Yeah

: They like that. So kind of.

: Kind of measures of what you did now.

: Yeah, exactly.

: That’s pretty cool.

: So I think it’s really exciting to engage the people that I didn’t engage with as a young person. I did encounter a lot of folks in the south. I haven’t traveled that much in the south although I have been more recently and I do think I think it’s fairly likely that if there is a statewide initiative that uses the Hello game to engage you know hundreds of thousands or millions of participants which I think will as will happen I think it will likely be a state in the south.

: How do you feel that?

: One because they’re further along. So they are our largest partners are health systems and other organizational partners and I’d say right now North Carolina, Georgia.

: Gotcha.

: We’re investing a lot of energy and time in that region in part not because we sort of said like let’s focus our energy on the south so much as the South has sort of shown up as giving energy to us and really making investments that make sense and help us get to the scale we need to. Yeah of course if your listeners are not from the south and they say, “no, no we want to be the first state”. I’m happy to talk to anyone like the other funny thing is we have a lot going on in British Columbia

: Cool.

: So I got this sort of like diagonal coming across the U.S. and Canada. So yes that’s why I think the exciting thing is that we’re starting to talk with partners about a scale that I feel like is really necessary to change the culture in a way that’s meaningful around these issues which you know at a much larger regional statewide level.

: That’s pretty cool. So listeners if you’re in the south or not if you’re anywhere – Health care system leader looking to engage this topic of end of life in a refreshing way that is impactful to your physicians, to your patients, and caregivers definitely reach out to Jethro. If you go to outcomesrocket.health/Jethro you’re gonna find the show now as well as a transcript and contact information there that Jethro will share here closer to the end. So just good outcomesrocket.health/Jethro for that. So Jethro, let’s pretend you and I are building a leadership course and what it takes to be successful in the business of medicine today it is the 101 of Jethro Heiko. We’re going to build the syllabus for questions lightning round style followed by a book that you recommend to the listeners. You ready?

: I’m ready.

: All right. What’s the best way to improve health care outcomes?

: Creating psychologically safe teams.

: What’s the biggest mistake or pitfall to avoid?

: Over investing in technology.

: How do you stay relevant as an organization despite constant change?

: Talk to your customers.

: What is one area of focus that should drive everything in a health care organization?

: Communication.

: What’s your all time favorite book jobs that you’d recommend to the listeners?

I think for the syllabus I’d go with The Culture Code by Daniel Coyle a more recent book but it’s fascinating and I think kind of fabulous.

: Love it. The Culture Code. Again listeners go to outcomesrocket.health/Jethro for links to the book, Jethro’s company, as well as any of the other resources and transcript. This has been a blast brother I love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.

: I’m grateful for your time Saul and your energy and for the patience of the listeners for listening in and so excited to see what comes next. I’m happy to talk to anyone I really enjoy, I don’t think I would be true to myself if I started a company like this and didn’t enjoy talking to people so happy to talk with any of your listeners and explore opportunities to partner and I think the best way to get a hold of us and certainly the website commonpractice.com way to learn about our work. A lot of videos there as well and some of you can also email me jethro@commonpractice.com and happy to find a time to talk directly as well.

: Outstanding there you have it, listeners you get the website, you got the email address, make it happen. Don’t sit there after this and just think about it for later if something about today struck a chord with you, take action. Jethro, just want to say thanks again really appreciate dedicating your time to the listeners as well as the community and looking forward to staying in touch with you.

: That would be great. I really appreciate it, thank you Saul.

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.

Automatically convert audio to text with Sonix