Choosing a healthcare system that protects the brain
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Center for Health Innovation and Implementation Science
Healthcare Thinkathon
http://www.hii.iu.edu/healthcare-thinkathon/
Better Care of Your Brain with Malaz Boustani, Chief Innovation and Implementation Officer at Center for Health Innovation and Implementation Science was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and , inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Today I have the privilege of hosting Dr. Malaz Boustani. He’s a director and research scientist for the Center for Health Innovation and Implementation Sciences at Regan Street Institute. He’s a research scientist at Indiana University’s Center for Aging Research and Richard M. Fairbanks, professor and aging research at Indiana University School of Medicine. Dr. Boustani is a senior implementation scientist with extensive experience conducting implementation research focused on developing tools, processes and strategies to rapidly implement evidence-based, cost effective health care solutions in the real world. This is core to the Outcomes Rocket and I love the work that he’s done currently as the founding director of the Regan Street Center for Health Innovation and Implementation Science. About a year ago I had the privilege of working with Dr. Boustani to run the Healthcare Thinkathon. It was an incredible conference that I think many of you learned about. And if you didn’t have a chance to attend, it’s happening again on July 23rd in Indianapolis. We’re going to dive into a little bit more about that during our podcast together. But over the past decade, Dr. Boustani has built a clinical laboratory within two health care systems in Indiana. Indiana University Health, as well Eskenazi Health Indiana its 18 hospitals, Eskenazi is a safety net health system serving the needs of underprivileged and Marin County residents of Indianapolis. He uses his clinical laboratory to train implementation scientists and has developed a graduate certificate in innovation and implementation science to provide the country with transformational agents who are skilled in building learning health systems to help folks. In the fall of 2015, Dr. Boustani became the principal investigator of the CNS funded Great Lakes Practice Transformation Network. This network is working on supporting the transformation of 15000 clinicians in the Midwest into highly reliable practices, capable of providing the triple aim of better health and better care at lower cost. It is with a true pleasure that I host him here on the Outcomes Rocket today, and I’ll give you a warm welcome Malaz. Thanks for joining us.
Malaz Boustani:
Well thank you so much for the invitation. It’s a really a privilege to talk with an innovator like you, Saul.
Saul Marquez:
Thank you so much, Dr. Boustani. Now, you’ve done an incredible amount of work. You enjoy studying aging, you’re very focused in the innovation scene in Indianapolis. But what is it that got you into the health care sector?
Malaz Boustani:
It’s really personal for me, so I’ll share with you my obsession with life. So I like, I love, I want to live as long as possible. And if you want to live as long as possible, then you are going to be at risk for losing your brain for a devastating disease as an Alzheimer’s disease. So that was the driving force for me to choosing healthcare system to protect my brain. And during my journey of protecting my brain, I discovered a lot of intervention, a lot of solution that might actually protect the brain of my family, my wife, my son, my daughter, my community and overall my patients and their families. So that was my why for coming over to the healthcare system and trying to really protect the brain for everybody in this world.
Saul Marquez:
Well, that’s a that’s a very clear purpose. I mean, it doesn’t get any clearer than that.
Malaz Boustani:
So, you know, it’s for me having a purpose and having a life saver for my journey. You know, you get lost on your journey. Sometimes you get distracted by a lot of not important or maybe not highly valuable activities. And and with somebody like me who who has a very low attention span, without that purpose, I will get lost very, very quickly.
Saul Marquez:
And I love it. And so you’ve worked on a lot of different projects, very highly respected organizations, and you’ve done some incredible research and many publications. But out of everything that you’re focused on, Malaz, what do you think is a hot topic that needs to be on House leaders agenda today and how are you and your teams approaching it?
Malaz Boustani:
I went through it through a transition of my interests early on in my career and the early 2000s or so, I was obsessed about creating a system that would protect the brain of my patients and obviously my family. And I thought the solution is to really discover new model of care delivery for brain care and develop a new intervention to prevent Alzheimer disease or manage Alzheimer’s disease. So I’ll give you an example. So in 2007 or so, our research laboratory discovered that actually exposure to certain medications that are available over the counter, such as Benadryl and may actually increase your risk for developing Alzheimer’s disease, especially if you are genetically not vulnerable for developing Alzheimer’s disease. And we published our paper in a very prestigious journal, the neurology paper, and I thought, that’s it. My work is done. And I thought just by publishing a paper and a prestigious journal, things will work out very well. And to my surprise, almost 10 years later, now, more than two decades in the rate of exposure to these medications have not changed at all. And the only people who benefit from our discoveries is the folks who come over and see me in my Center for Brain Care Innovation and at this Canarsie. So when I discovered that, I shifted my entire focus on cracking this inefficient translation psycho from medical discovery to care delivery. So, for example, it usually takes 17 years for a medical discovery that has evidence that has approved to make it all the way to become part of the routine. In that 17 years translation cycle happen for only 40 percent of these medical discovery and only less than only only 1 percent or 2 percent of patients may end up getting benefit for that medical discovery after 17 years. I mean, that is the disaster. You imagine. So that’s why I end up shifting into trying to figure out, can I come up with a solution to optimize this discovery to delivery? And I found a potential solution into this new science that emerged for the past decade or so called implementation science. And I became obsessed with it. And I and I became really thirsty to gain insight from. From that implementation science for my team to develop processes and tools and strategy to actually optimize that discovery to delivery translation cycle.
Saul Marquez:
Well, it’s it’s. And thank you so much for sharing that story and the evolution of of your your career and your thought process. Dr. Boustani. It’s fascinating to hear you speak about implementation science with the same passion that you speak about brain care. So it’d be interesting to hear from you in the… And so so how long have you been on this implementation science journey?
Malaz Boustani:
It’s been technically 2010, 2011. So it’s almost a decade, massive decade. And we’re getting closer to come up with a blueprint for that optimisation cycle.
Saul Marquez:
So almost a decade and now you’ve got the work that you’re doing through this certificate. And I’ve had a chance to meet one of your cohorts and I mean, incredibly bright people from across the country looking to get better at this implementation science. Tell us about how the program has created results by helping folks do things differently.
Malaz Boustani:
Well, you know, let me tell you, why did I, you know why did I even decided to do this graduate certificate? I’m a terrible educator. Seriously, I don’t have the attention to it. I don’t have the patience. Man, you can ask my daughter, the one she asked me question when she was young. Wow. I wish literally I would lose it with her. So I didn’t want to do education, but I knew that I want to change the healthcare system.
Saul Marquez:
Yes.
Malaz Boustani:
I knew that the current discovery to delivery cycle is really terrible and specifically for protecting the brain. I wanted the healthcare system to change. So as a researcher and pragmatic researcher and applied scientist, I looked around and say, all right, there’s no way say I can actually change the healthcare system on my own. I’m just a simple one person. So I thought, alright, I’m going to have to actually change the healthcare system within. And I looked at the kind of healthcare system we have approximately 6000 hospital or so healthcare system in the United States. In each hospital usually has a department of quality and medical quality and safety. And I thought if I can actually embed one change agents who I can train and coach, how to become an influencer and how to become a columnist for this translation cycle on optimization healthcare system, then I will have you know, I will have a shot of actually make the health care system from my daughter or my son or my wife better. And I know also for myself. So, look, look, you know, I did. Back of the envelope calculation. And I needed to do six thousand. I need to have a six thousand warrior, passionate and resilient folks. So I said, all right, I guess I’m going to have to think about how I can actually share my insights with other people. And because I don’t like to listen to long lecture. I don’t like to. I don’t like to come over to a lecture where the speakers speak for, like, you know, 90% and then the audience have only 10% question and answer and the message is not personalized, we speak to the average. So I end up looking at the school of business and learned from them. IU and others. And we develop this graduate certificate to literally coach and train and recruit this Army of Change agent and embed them within the healthcare system. Hopefully we’ll change the health care system before Amazon and Apple changed the healthcare system.
Saul Marquez:
That’s incredible. And I really like the approach, just establishing that. That’s six thousand person army taking notes from business where, you know, you find ways to apply and get results as fast as possible. It is an interesting approach as well. I’m sure it hasn’t all been rainbows and sunshine. I’m sure you’ve had some some setbacks along the way. Share with us one of those setbacks and what you learn from it that’s made you and the work that you do better.
Malaz Boustani:
Well, you know, the first big surprise is really in my decision to how should I distribute and allocate my time. So as a scientist, I thought if you have a problem and that problem affects millions and millions of people, that technically I would spend ninety five percent of my time, my resources into finding a solution or discovering the solution. And then the rest of it, 5 percent, I will end up really spending it on and maybe convert that discovery into a peer reviewed paper. That’s what I thought. So for for almost the first five years or so of my journey of this discovery to to delivery translation cycle optimization journey, I thought I’m just don’t have the discovery. And I need to spend more and more and more of my time on that discovery. Then came to my curiosity from learning from other disciplines that actually my resource allocation was completely was off. So apparently if you want to change the world on a scale, you should allocate your resources in a different way. So apparently the optimal distribution of your resources for scale is maybe 5 to 10 percent of discovering a solution. Another maybe 10 to 15 percent in packaging that solution. Another maybe 30 percent or so, 30 to 35 percent. And finding distribution channel for these kind of packaged solution than the rest of your resource, which is 40 to 50 percent. It would be actually to create market demand for your solution. And this has happened is I will be knocking on the door of my colleague is in the C suite and my health care system even in my within school and knocking on door door and waiting for them to open the door so I can show them distribution and the discovery that I have to figure out. And then no one usually will open the door. You keep knock, knock, knock. No one open the door. No one will come over and say, you know, I need a solution for you. Because they don’t have a problem that they think your solution will work on it. Yeah. Oh, just discovering this concept, you always start with the problem and create a demand for solution to fix that problem and go from there. It was a big, big discovery and very disappointing because, you know, I never went to business school. I’m a scientist and you know, I’m I’m good in discovering solution. I’m not good at packaging and distributed the market. So I had to learn all these new things and thank God for Siri and Google and YouTube, because you can go there very quickly and you’ll learn a lot.
Saul Marquez:
Yeah, that’s awesome. Yeah. It’s an incredible way to phrase it. And sort of like the percentages that you laid out, the discovery and solution, the packaging of it, the distribution, and then finally creating that market demand and really focusing on that. And I think a lot of entrepreneurs in healthcare also go through the same challenge. I asked this question a lot. Dr. Boustani, I ask: Tell me about a major setback. And I look back on over 400 interviews that I’ve done and 60 percent of the people that respond to this go back to I’ve built it and they didn’t come.
Malaz Boustani:
That was my case.
Saul Marquez:
And it’s super interesting. A lot of very talented people. And now, you know, you’ve taken this lesson and applied it in a major way. And the work that you’re doing has certainly got a lot of traction. And so I’m excited to definitely share a little bit more here soon. How about on the other side of the coin, Malaz? What what would you say one of the proudest medical leadership experiences you’ve had to date is?
Malaz Boustani:
You know, the biggest one is when I got the confidence from my colleagues in five states to actually work together and lead Great Lake practice transformation for the past four years and accomplishing a great, great perspective. Here I am, a person who immigrated from Syria, came over to this country because I was watching Hollywood movie and I would come over to the United States and you would find, you know, gold on the streets. But the other piece is coming over to the United States and have this amazing opportunity to actually work very hard, to get a little bit lucky and change it. So he is an immigrant with an accent who’s leading, you know, 30 organization men working on providing support and transformation of fifteen thousand clinician within five states serving 10 million lives. There is supported by the Center for Medicare and Medicaid. In October of 2015, when we received that award from Center for Medicare and Medicaid Services and my colleagues gave me their trust and that I can help together co-lead our network. And now, almost four years later, we have accomplished an amazing, amazing, really success and milestone. An example, we actually provided support for thousands of clinician. We were able to help thousands and thousands of patients. We reduced more than ten thousand thirty thousand inappropriate hospitalization. We led to saving in the 700 plus million dollar from quality. And now we are on a journey of moving behind the Great Lakes so we can be expanding our network from five states to nine states and from a 50,000 clinician to 120,000 clinicians. So walk in on a scale I never thought I will have that opportunity come into from a small town in Syria, in the Middle East. But this is speak of America as the land of opportunity is just simply amazing.
Saul Marquez:
That is amazing. And certainly a lot to be proud of, Dr. Boustani with the number of people that you’re impacting, your army of six thousand. And you know, this number of clinicians that you’re you’re able to influence, the number of lives you’re able to improve and the dollars. Right. I mean, it all comes back to outcomes, both clinical and economic. And you’re leading in a tremendous way. And so, you know, just having them part of the work that we did together with the Healthcare Thinkathon I saw how you led and inspired your teams and definitely took a lot of notes about how we work together. So, Major, kudos to you. And so what would you say today is an exciting project that you’re very excited about?
Malaz Boustani:
It’s all right now. No, our big one. It’s like, you know, the stretch goal. So I believe that there is enough insight from our scientists, from different disciplines that we can actually do create the second generation of social organization. I call it a smart organization or agile organization that can actually adapt to its social and physical environment and become as resilient as a city and obviously not to fail as a publicly traded company. So I’ve been obsessed with the question that was raised by some amazing scientists in Santa Fe Institute of Complexity Science, where that person who was a physicist, he noticed that if you bring a bunch of a human together and cluster them in a social organization under the vision of a publicly traded company, then the lifespan of that social organization, that publicly traded company is 10.5 years. But if you organize the same number of a human into a city, then you get that social organization. It’s so amazingly resilient. You can you can throw thousands of civil war in that city and you can you can throw even a nuclear weapon on that city and the city will still survive. So that fascination over a resilient social organization organized the city and the frailty of publicly traded company. It excited me and told me like, maybe I can find that sweet spot between growth and create a smart organization that has a fascinating infrastructure of how to distribute resources across the agents or the individual of the social organization. At the same time, how you actually distribute and exchange social interaction among the social organization. So I’ve been obsessed. Or maybe somehow I will create a blueprint. My team and our team will create a blueprint for this next generation smart organization. And so far, what we have been doing, we’ve been gaining insight from two Nobel laureates based one. Yeah, I bet you familiar with the public name for it. Behavioral economics and.
Saul Marquez:
Oh sure
Malaz Boustani:
of the economy. Just simply said for the past now 40 years, there is technically no human. That is a rational trader. Most of us, even our economists. They make emotion based trade. So you think about it from that perspective. You gain insight. Then this complexity science that I share with you is what happened when you bring people together and organize them in what’s kind of emergent behavior that happen as the resiliency of a city or frailty of publicly traded company. So we’d bring these two theory together and we call it like an agile science piece. And from that inside, from these two theories, these framework, these mindset, we are now building three processes or three pillars that we believe they are the main pillar for this social, second generation agile organization. In the first pillar is agile innovation that we are creating. The second one is agile implementation and the third one our agile analytics. So my goal, hopefully over the next five years, ten years that we will have enough insight in enough to the processes to create this agile organization. That agile organization hopefully will be able to provide affordable, accessible, great healthcare solution and that kind of reduced price and a progressively reduced price. The great health outcomes great quality of care, an amazing experience not just for the patients and the family, but also for the provider. So that’s kind of my dream. Hopefully with the next 5 10 years, if I continue to learn from amazing sociologist and artificial intelligence scientists and other amazing leaders, I can learn from them and kind of match it all together and create this blueprint for this agile organization.
Saul Marquez:
Well, super fascinating. And for the listeners tuning in, you’re probably like me thinking, wow, this is awesome. I want to know what I want to learn more about this. And so the beauty of somebody like Malaz is you definitely can continue to learn from his thoughts and the way that he does things. An example is go to the Healthcare Thinkathon, and that’s going to be taking place here. Indianapolis, July 23rd, we’ll leave a link to the meeting in the show, notes go to outcomesrocket.health in the search bar type in Malaz. That’s a lazy. And you’ll see a link to the work that Dr. Boustani has done, but also linked to the Healthcare Thinkathon, which is a one day event where they’ll be sharing ideas such as the one that he just share around. This smart organization is agile organization. And so it’s time for the lightning round malaise. Are you ready?
Malaz Boustani:
Sure. No problem.
Saul Marquez:
All right. What’s the best way to improve health care outcomes?
Malaz Boustani:
Make sure you listen to the patient and family and work with them to co design their solution.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Malaz Boustani:
Not to listen to patient, not to listen to other people and not to leverage diversity.
Saul Marquez:
How do you stay relevant as an organization despite constant change?
Malaz Boustani:
Obsessive with learning
Saul Marquez:
What’s an area of focus that drives everything in your work?
Malaz Boustani:
It’s all about serving others and trying to survive and get better.
Saul Marquez:
Love that. And these next two bills are more on a personal note for the listeners to get to know you. What’s your number one health habit?
Malaz Boustani:
I would love to play soccer, but I can’t do it anymore. So right now is just spending my time on the left tackle. I need to learn. And if I have time, I would love to go back and really run again. I would love to go back and run this 100 hundred meter dash again. But I know I’m going to have to pay for it.
Saul Marquez:
And how about your number one success habit?
Malaz Boustani:
Is listening to others and continuously reading book. I just got a book binge last week. I went on Amazon and I bought six books, two of them one network Science and how to use algebra and stuff. I’m a weird. Can you imagine? I actually love reading physics and my vacation. I mean that. But I’m self-aware.
Saul Marquez:
It’s amazing. I love it. I love it. And, you know, like when you go to school and never had an appreciation for this until a couple of years ago, and all those things that you learn that you think to yourself, these aren’t applicable. In fact, they are. You know that the way that you wrap your mind around different subjects really makes you a critical thinker. I think it’s awesome.
Malaz Boustani:
It’s really this is one of the benefits of being in academia. You are constantly learning and you get paid for it. Can you imagine? I said to learn, which is amazing.
Saul Marquez:
So on the topic of books, I realize and I know you have one coming up here in January, which. Hook in for the listeners within the next couple months, we’ll be giving you some more insights into that book. But besides that, the one you’re writing right now. What book would you recommend to the listeners?
Malaz Boustani:
Well, I loved the book Sapiens: Brief History of a Human. It was a fake but the author is a great writer as a great storyteller. I was able to finish it very quickly. So Sapiens has been really a good book for me to reflect on it. And in the other book that I strongly recommend is Life 3.0, between the sapiens story like 3.0 – you have you have a fun summer.
Saul Marquez:
So Sapiens, read it. Harari – Amazing. What’s Life 3.0?
Malaz Boustani:
Life 3.0 always just talk about how we can actually evolve from Life 1.0, where you think about us as a human. From a computer perspective. A software and hardware. All right. So life one point all we have no control at all with our software or hardware. We are going broke. We couldn’t treat it. They are brain is not working in cognition. We don’t do it like 2.0. We start becoming, you know, somewhat in control of our hardware. So, you know, right now, for example, we can do it, you know, heart transplant, kidney transplant, face transplant. But we still have no control of our software with our brain. Life 3.0 is we’ll be able to actually control and produce a free flow from bullets, from hardware and software. And that’s in a nutshell, Life 3.0.
Saul Marquez:
Fascinating. Fascinating. Some great recommendations. And and folks, what we’ll do is we’ll provide links to these books recommended by Dr. BOustani. Again, just go to outcomesrocket.health and in the search bar type in Malaz. You’ll find all of our recommendations there, a full transcript of our of our discussion today. So we’re here at the end of the study. This has been an incredible time. I love if you could just share a closing thought with the listeners and then the best place where they could continue the conversation.
Malaz Boustani:
Well, I think for me, the best thing is to keep listening to you, number one, because it’s been fascinating. We don’t have that opportunity of not too long or not too short conversation to get to know, you know, people deeply. So that’s number one priority. And for me, the number two priority is embrace diversity. Just get out of your routine and go out. People who think different than you, not just a gender and race, which is a must, but even personality, perspective, different discipline. I learned the most from my journey so far from other industry. I love the hospitality industry, the retail industry, the banking industry, and obviously the biotech industry. I learn from them so much. And most of the time, the last thing I tell you, innovation is simply matching. It’s not coming up with something new is just matching and you can’t match if you have not, get out of your room and embrace diversity.
Saul Marquez:
What an interesting thought to leave us with. Miller’s innovation is matching. So as you listen to this. Think about how you can match solutions to problems that exist and leave inspired as I am from this conversation with Dr. Boustani. And again, the invitation for you to continue the conversation, go to outcomesrocket.health type in Malaz and you’ll find ways to get in touch with him as well as check out the Healthcare Thinkathon here in July. And with that, Malaz, just want to give you a big thanks for spending time with us.
Malaz Boustani:
Been fun. I can’t believe it’s been 45 minutes already, man.
Saul Marquez:
Good conversations always fly by some. I’m privileged that you’re able to carve the time out for us. Thanks again.
Malaz Boustani:
No problem. Thanks for the invitation. Have a great day.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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