The Future of Health with Zayna Khayat, Future Strategist at SE Health: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Zayna Khayat. She is a Future Strategist with SE Health, formerly Saint Elizabeth Health Care, a health and social impact enterprise with a major focus on creating a better future for aging adults in their homes and communities. Zayna is faculty of Singularity University’s Exponential Medicine Stream and is an adjunct faculty in the Health Sector Strategy Stream at the Rotman School of Management at the University of Toronto. Dr. Kiante was previously the lead of health system innovation at Mars Discovery District Health Innovation Hub in Toronto, Canada. In 2017, she was seconded to the Reshape Innovation Center at Harvard University Medical Center in the Netherlands. Zainah completed her Ph.D. in diabetes research from the University of Toronto, followed by a career in strategy consulting, including as a principal in the health care practice of the Boston Consulting Group. She currently resides in Toronto with her husband and three children and is proficient in French and Arabic. How she does it all, and I’m not sure, but she’s great at it. Zayna, it’s such a privilege to have you here on the podcast.
Zayna Khayat:
Thanks for having me.
Saul Marquez:
Absolutely. So, you know, I definitely appreciate you carving up time for today’s discussion before we dive into the work that you guys are doing, in particular around the future of aging and the core focus that you guys have, talked to me about what inspires your work in health care?
Zayna Khayat:
Know, it took me a while to figure out the answer to that question, but once I did, then everything was a lot easier in terms of how I make choices every day, every month, every year. We imagine like a four-part Venn diagram, I’m right in the middle or in my sweet spot of really matching my purpose. My inspiration to my work is four things that are in place. So one bubble of the Venn diagram is, am I working on an intractable problem of society and moving health care to the home out of institutions for older adults? Yes, check. The second is, is it a problem that’s important to society? Like, can the impact be significant? And obviously, health systems produce health that’s pretty important. And also poorly run health systems are bankrupting most economies. So it’s a pretty messy problem and important. The third is I got to be doing that with a team that I love. I’m not a solo worker. I can’t be a consultant. I can’t, that’s not where I get my energy. And so I got to be working with a team and therefore an organization that I love. So that’s kind of I found my place there and just all of us being part of something. And then the last is I got to get paid for all that. I believe no matter whether you’re a non-profit and I work with a non-profit, you know, you need highly skilled people and they deserve to be honored for that skill. And so that’s going to work for me, for my sustainability. So that’s the long answer.
Saul Marquez:
Hey, Zayna, that is probably one of the most thoughtful responses to that question I’ve had. And we’ve published over 600 of these. Good for you. I love how clear you are about your mission and the work that you do. And it certainly is inspiring to even step up the reason why I’m doing what I’m doing. You certainly have challenged me in that respect. So as you think about what you and see health care is doing to add value to the health care ecosystem, what would you point to as that core offering or the area of focus?
Zayna Khayat:
The core organization, one hundred and twelve years old, has been delivering largely, let’s call it home-based health care for a long time. And we now have like nine thousand people on the street doing that every day. I think 21,000 care exchanges. That’s the core. When I got recruited, I was working in Europe at the time, so I moved back to North America and I said, you know, I’m not going to just be a Chief Innovation Officer or something like that trying to innovate on the core. I really believe that the job to be done in health care is to actually blow up what we currently are doing and put it back together for the future, because the needs and expectations of really all the stakeholders of health care, especially our patients, are really almost nothing like what they were when we built the institutions we have today that we’re largely stuck with. So point is, we created a team called The Future’s Team. So that’s what I lead. I’m the future strategist of our org and we’re like that and applied our future team that is a separate incubation cell to the side that can design test. And then if it works at scale, next practices, next business model, not best practices, next practices. So I call this an R&D center for business models in health care. And I think that’s pretty special because a lot of health org need to do this. But it’s very, very hard to set aside that kind of capacity and to live with the consequences of what it produces, which often means yourself disrupting your own business model and organization. That’s not a natural act know for most organizations. And then I think specifically we decided to focus on older adults and keeping them at home as long as possible. So it provides a big enough space, but at least it’s quite targeted, which allows you to be quite focused in your work.
Saul Marquez:
Well, I think that’s awesome. And, you know, these models of how you do it the next what did you call them again next?
Zayna Khayat:
Next practices is not best practices.
Saul Marquez:
I love that. I love that. That’s something that I’m going to have to use the next practices. You know, it’s good to know where the puck is going and think operationally through it with a model. It sounds like you’re really good at these.
Zayna Khayat:
Yeah, I don’t know if we’re good, but at least the words and what I find is why we never meet the future and we just keep recreating the past in health care if we start with what we have today and try to evolve from it. And this is different. What we do is start with a normative view of the future based on looking at all the signals and then create that from scratch. And that’s not normal practice. So I think that’s what I think is different. I can’t say we’re successful, to be honest yet, because we’re pretty new, we’re two years in. But I feel like the model at least is working in terms of achieving what we thought we would from a methodology standpoint.
Saul Marquez:
Yeah. Now that’s fair. That’s fair. And so as you think about what you guys are doing to make things better or just different than what’s available today, that’s at the core of what you do. Can you give us an example of that?
Zayna Khayat:
Yeah. So I mean, if you think of today’s paradigm and we’re the dominant discourse is all the energy, all of metronics work honestly and outcomes are value-based care, et cetera, it’s still being applied to two paradigms, a facility-based paradigm, i.e. the hospital and the clinic and everything that goes on in those walls and the disease-based paradigm. We apply value-based processes or innovations or remote monitoring, all these new tools to diabetes or cardiovascular or kidney pathway. Well, the fair share of people who need help from health care systems don’t have one disease and they spend twenty five percent of their time in a facility. So all the action goes down outside the facility and nobody is really defined by their disease. And so that’s what differentiates that. We focus on the home setting as the primary location for all health care activities and we focus on complex older adults who not only have three, four, five, maybe six comorbid illnesses so you can never lead with a disease. But more importantly, those are just one leg of a stool of two other challenges around psychosocial challenges of isolation or literacy, and then functional challenges like movement and mobility. Those are not physical health care problems. They’re just aging problems. So it’s really I hate to use the word holistic because everybody does, but we really start with who is the person where they need to live their best life at home. And if health care interventions or innovations is a cost to get their will back into it, but we never leave with it. And I think that’s kind of, I think, a special approach that is much needed for the people whose needs are the least well served in our current disease-focused paradigm.
Saul Marquez:
That’s a really great way to say it, Xana. And so I’m very curious about the work that you guys did. There is a book, The Future of Aging, co-authored by SE Health and an Idea Koocher. Tell us about that and what it’s about and why should we care?
Zayna Khayat:
So if you imagine, I always like to use the analogy of Christianity had a Bible to help spread the ideas and anchor everybody around a common framework. We found that if we’re going to go down a path of creating the future of aging at home, we better really understand where aging is going, because, again, it’s not about health care. It’s not about housing. It’s about life as you age. And so we did a year and a half of discovery with our partners. That idea to look globally, all the signals and the trends and what’s happening with aging. And then we backed into five themes or clusters of signals. Health care was one, housing was one. The economy and labor force participation was one. The technology was one. And that’s what we package into the book. And so that’s two purposes. One is it becomes our Bible, our roadmap, if you will, that we can reference because we know a pretty good framework of the future, like a normative scenario that we can design for. And the second is, of course, there’s no way we’re going to change the world by just the work we do. So there’s a bit of a influencing, shaping and making that understanding available to everybody else. So that’s our whole speaking circuit and writing and workshops and just kind of capacity building, if you will, in the ecosystem. And that’s what the value of publishing the book and then all the other assets around it has been.
Saul Marquez:
I love it. You know, the analogy of that, the religious book, the Bible, the Koran or whatever, the Torah, whatever it is, right?, every every good thought and philosophy is backed by its writings. And I love it. I think it’s important. And it puts you know, it puts it into a different context. It’s not aging and it’s living and we need to think about it differently. So in and of itself, I love the idea because it is kind of next type of practice to do something like this. I really love the idea. Like, how did you guys even land on this approach?
Zayna Khayat:
I think, again, when you’re in love in the futures work with strategic foresight or any of these methods, the methodology leads you there, because if you start by saying that we’re one hundred and twelve year old home health care provider, let’s solve this using home health care. Well, by default, you’ve just missed the whole mark. By letting the data tell us and older adults tell us and watching signals, of course, around the world, because there are other jurisdictions or cultures that already have figured this out, you know, really well, then we let the data tell us and it got packaged in, some very clear themes emerged. And I also think if you think of any organization that has to continuously pivot, I firmly believe no industry will stay in its industry anymore. I actually think the company goes away as a construct. It’s a very industrial era construct. So you know, your mission, as it were, your purpose statement. So how are you going to reconstitute your assets to find the best channel to deliver on that mission? And our next optimal channel will go well beyond delivering care in people’s homes 20 thousand times a day, much like hospitals are pivoting and getting into housing and food security and transportation and income security. It’s just a kind of a natural evolution of the pivot that every industry has to go through.
Saul Marquez:
Fascinating. Hey, this is really neat. And it’s fresh and I appreciate that. And so as you take this fresh approach to solve a tough problem of how do we take care of ourselves when we age, how do we take care of our loved ones as they’re aging? Talk to us about what you guys are doing to improve outcomes and and make business better.
Zayna Khayat:
So, again, like I said, we’re about two years into this program, so a bit early for the kind of impact at scale that I’d like to see. But in the interim, we do have a balance sheet, our own metrics for our team that are quite aspirational around impact. And so we had a target for this year at a minimum, that through our work, which is still in the design stage, that we would reach about a thousand patients or family caregivers in the year in the testing stage of our various projects. And I think we hit 12000 last year. So that was good. Now, ultimately, when we’re at scale, it’s a very different number, but nothing we’ve done yet has been adopted at scale. It takes a while. And then we have another KPI that’s similar to how I said about the book, like the book is both our Bible to do our work, but also a platform to teach and influence others. Our other KPI for impact is like a reach metric. So how many people do we touch your influence through speaking, writing, media interviews, all that stuff. And then we’ve got both a number of target and then a mix. So if it’s all in our backyard in Toronto, that’s echo chamber. So we targeted something like ten thousand impressions if you will, and that 50 percent must be international. And we blew through that last year as well. I think it was like twenty-five thousand people reached and influenced by our work. And I think 50 or 60 percent, not international, say 50 percent or more that was national or international.
Saul Marquez:
I love it. That’s awesome. And the clarity in those metrics is loud and clear. Hey, on this podcast we get seventy thousand plus downloads a month. So.
Zayna Khayat:
Noise.
Saul Marquez:
You could hit some numbers with this one.
Zayna Khayat:
You just blew my KPI. I bet you have to see how many people actually listen to this one, but yeah.
Saul Marquez:
Yeah, I’ll give you the number of the data. But yeah it’s absolutely and mean the listener base for the podcast is highly engaged. It’s B2B health care. So certainly the right people talking with about this topic. And so walk us through one of the biggest setbacks you guys have experienced and a key learning IVC. I can imagine many of them with any new idea, but I’d love to hear what you would point to as the one.
Zayna Khayat:
First to set the stage, another one of our KPIs in the accounting sheet of our work is our failure rate. So we actually have a target of 70 percent or higher of any projects we take on should not work, because if it’s lower than that, then we’re not pushing hard enough and we’re at about ninety two percent. So I just did an inventory. I just counted out of a total of twenty nine, let’s call them projects we’ve worked on. Only five are active. Six were complete failures. Like they stopped and were shut down and we’ll never take them off, take them on again. And another 18 are on hold. We call them. We have a graveyard that we track is called our Elmo Elmo. Enough. Let’s move on. I don’t know where I stole that from, but that’s our Elmo. Elmo has twenty-four are the other shows.
Saul Marquez:
I like to call the graveyard the shelf.
Zayna Khayat:
Yea the shelf. So so if I reflect on those of the six that were total failures that we’ll never pick back up again. Four, involve testing emerging technology and figuring out how can we integrate them into a care model that could then allow and unlock a very new business model for health care and two of them that it failed because the tech failed. It actually had a fundamental problem. It wasn’t ours. It’s a third party. So that’s look, a lot of lessons for us there alone. Have we wasted so much time designing a new care model and all that, but the tech itself wasn’t where it needed to be, so we won’t let that happen again after two times and then the other two, the tech was great as a standalone. The new model they unlocked was exactly what everybody wants, but we failed in both of them to even be able to accrue or recruit enough people to test the model in the testing period. So you can’t even recruit people to try the tech when it’s free. And you’ve got a ton of resources around the process because it’s kind of like a clinical trial if you will. That’s a pretty good signal about how hard it’s going to be to enter the market. So both of them, we ran out of money on testing because we couldn’t even get enough people to test in the first place. So lots of lessons and that’s a lot of resources basically flushed down the toilet for those four projects. I gather the most biggest setback, obviously. I’m sure all your guests and listeners is just what COVID did to our whole portfolio. So we had probably our biggest project in for years to design a completely disruptive business model for home care. I mean, it’s like fifty-five innovations all into one program, supposed to be four years. We’re at year and a half and the whole thing got pulled in in the summer. So that’s, I still haven’t recovered.
Saul Marquez:
That’s a tough one.
Zayna Khayat:
It’s tough. Yeah. But the good news is, again, we salvaged a lot of learnings in the first year and a half and we’re now actually decided it’s good enough with what we learned is enough. It’s not great. We’re now moving to embedding it into business as usual in the company, which ibasically means we’re adopting sooner than we would have is COVID didn’t happen. So I guess that’s a silver lining.
Saul Marquez:
Yeah, and there always is. And frankly, you guys are running these projects. There are so many lessons that come out of these failures. There’s so many best practices and maybe even standard operating procedures that you guys could that you now have as a result of them. So the learnings will we’ll get you the ROI. That just happens to be what I believe.
Zayna Khayat:
But one hundred percent I mean, that’s built into our model. We have like we have a schematic of our innovation process. And then we have like when things fail, we have a little recycle box underneath that catches like the learning. And we have an intentionality around codifying those learnings and integrating them into the next time.
Saul Marquez:
Beautiful. Love that it’s built-in there. And just a really well thought out thing. I, I’m saying and again, I keep saying this and so appreciate you sharing those so freely. We learn most from those. And so now that you guys have, you know, your two years in and you’ve got some years ahead still to put a program together here. But what are you most excited about today?
Zayna Khayat:
I mean, I guess macro’s, you imagine I’m coming back to Canada. I’m trying to figure out where I want to do my work. And I chose to be in the home health space to really, you know, I often say, like, we’re going to move 70 percent of care out of facilities and into homes. That’s a big value push. And with seniors, well, who would have thought this pandemic would hit? That primarily affects older adults and that home is the place everybody needs to be right now, including for health care. So I guess I’m kind of excited that really the opportunity to do our work has kind of exploded. I think more broadly, though, for those of us who are trying to create the future, we often use a metaphor. Rock the boat, so be an agitator, but don’t fall out like all of us who do this work, we’re always at that fine edge between the core every day because you have to have credibility and access and trust and speak their language. But you’ve got to be in the future. And that’s very difficult the edgewalk. Well, now the whole thing is rocky, so all the boats are rocking. So, you know, there’s no rules. I think that’s really exciting. So I’ve used the metaphor about sacred cows are now finally becoming bosomy and it’s just happening. And I just think it’s a window now better than ever before to try things that were so difficult to even get off the ground before that. If you mention them, you would get kicked out of the room. But now they’re going to hug you for it. You know, like who would have thought so excited? Yeah, just the this is the time for the innovators. And it’s it’s long overdue.
Saul Marquez:
Yeah. Well said. And, you know, I forget who said it, but they said a crisis is a terrible thing to waste. And that’s being said a lot, you know, and saying that we’re saying that in the in a good way, you know, not like, hey, let’s take advantage of a pandemic. It’s let’s learn from it. Right. like your recycle bin. Let’s be let’s have a method that we can use to learn from this and tell a story to our children and tell a story to our community about what we learned and how we got better.
Zayna Khayat:
Yeah. Yeah. That’s another metaphor or framework I’ve heard a lot is build back better. And I use sometimes the example. I don’t know if people know about it, but when 9/11 happened, you know, the terrorism and the whole economy of the five boroughs of New York was just decimated. I mean, the whole world had it a bit. But this area, it was really bad. Right, kind of like how it is again today. And with a lot of, you know, future-minded civic leaders, they’re like, OK, let’s not rebuild back to what we were. They were a lot of problems with the way the boroughs like Brooklyn and others. So they built back better. They actually leapfrogged coming out of this terrible, terrible tragedy and crisis. And I sense that’s what a lot of us have in our mindset, which I think is going to be a nice silver lining of all this.
Saul Marquez:
I totally agree with you. Totally agree with you. You and I need to hang out more. I like how you think.
Zayna Khayat:
All right!
Saul Marquez:
Zayna, you know, the future’s bright and obviously we’re thinking about ways to do it. There is a trend toward more care in the home. And awesome that you thought about focusing there. And I mean, who would have predicted the pandemic and what it would have done to that trend acceleration? So you guys are there and I’m excited about the thinking you guys are doing, folks. So Zayna wanted me to share with you all their book, The Future of Aging is available. You could go to TheFutureofAging.sehc.com or go to OutcomesRocket. Health and type in future of aging. And you’ll see our entire interview with Zayna and a link to the book. Its FutureofAging.sehc.com. Check it out there. Zayna, this has been so much fun. I really enjoyed your ideas and the approach that you guys are taking. Take us home with a closing thought and then the best place for the listeners could reach out to you to or anybody on your team to keep the conversation going.
Zayna Khayat:
So I’d say that business model innovation, which is either changing what you offer, what do I do, what other people do and how do we get paid is the unfinished business of health care. And I just do not waste your time on any new work that isn’t tackling that. And if you get faced with a chance to do something that makes things incrementally better, don’t do it. Life’s too short and the problems to be solved are too big. So that’s that’s my call to action is – go for real true business model innovation. I’m my stream of consciousness is available to the world through my Twitter feed. So let’s just go for that. So it’s @ZaynaKhayat. You can see my spelling and that’s where I kind of put ideas and re-tweet a lot of awesome people in this space. So that’s probably the best thing you can just reach out to me there by dm as well.
Saul Marquez:
I love it. Well, I really appreciate it. And all the listeners also appreciate the fresh ideas you share with us today. Zayna, we thank you so much and certainly look forward to staying in touch with you as far as the ideas you guys are implementing unfold at your organization. So thank you again for spending time with us.
Zayna Khayat:
My pleasure. A great discussion.
Saul Marquez:
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