Why We Must Focus Narrowly to Successfuly Innovate in Healthcare with Dr. Stefano Bini, Orthopaedic Lead at UCSF CDHI

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 wonderful guest for you. His name is Dr. Stefano Bini. He’s a professor of clinical orthopedics at UCSF Hospital. He’s a professor of orthopedic surgery specializing in hip and knee replacement which their department is ranked top six departments in the U.S.. He’s a founder and chair of the digital orthopedics conference known as Doc SF and a regenerative orthopedic conference, R O C S F both held in San Francisco Doc S.F. aims to bridge digital health and clinic orthopedics and thereby catalyze the adoption of digital health tools in a must good ole skeletal vertical R O C S F aims to bridge biotech research and the patient. Dr. Stefano Beeny is deep into this. He’s so niche down and he has a passion for helping patients improve their outcomes but also a passion for bringing together the orthopedic community to take their practice to the next level so it’s a pleasure that I have Dr. Bini here on the podcast. Welcome.

: Thank you.

: It’s a pleasure to have you here Dr. Bini. Now what is it that got you into the health care sector to begin with?

: Well you know being a surgeon and being involved with digital technologies basis since the late 90s it was becoming more and more obvious that as the technologies were maturing their potential impact and the delivery of health care was going to really help us get to the old triple aim and talk about for so long been sort of challenge for the U.S. health care system which is access improving access across the country to folks who may not be near major medical centers like University California San Francisco. Decreasing the costs by optimizing resource utilization and we’re starting to see I really make an impact in that. And then we also have the issue of cost. So it’s really that’s a little bit harder to prove that with decreasing costs get such a fudging cost. How can health care is really difficult to measure. We’re seeing some and we’ve done our own research on this area where some of these technologies are really decreasing the cost of providing care. So I think the vision is sort of working itself out that visual health will be one of the solutions to get to a point.

: Now that’s for sure and Stefano and as we think about these technologies, we’ve had several guests in the past approached this and one of the ways where costs do get reduced is access. Just having digital aspects of ways to access care. What are your thoughts on that?

: Well actually I have a good example for you. So a couple of years ago when I was still at Kaiser Permanente, I did a study perspective randomised control study with a partner or capture proof and they had an asynchronous video platform and we theorized that if we’re able to manage patients after surgery using videos that were created by our physical therapist that would send to the patient to use at home without coming into the hospital and then have them visited cells and have this video conversation with a therapist that it could be manage at home and it had a proven outcome. So we did a prospective randomised controlled trial of the surgeons like to do. And the outcomes were identical. We had no decrease, no change in the clinical outcomes but the patient satisfaction was through the roof. And when they graced stories around that was that one of my patients came back for a second knee replacement and a bonus to me. He was in the office and it was just going ballistic was really getting really angry with my nursing staff and I didn’t know who it was I got up and get up and go. What’s going on. That’s a fictitious name. What’s going on he said. Well I want I want my health loop Well what happened was that he had he had signed up for the research project but had randomise out choose standard physical therapy and it was a bit because he had experience the video experience and be able to do this at home. He didn’t have the support system to drive him to the hospital for the physical therapy as it’s there’s a long way for him and he was live at the news of ex football player six for four he was intimidating all my staff. But he had the random I think him out of the research project and just give him the app so that he could be happy again.

: That’s a great story to follow. And then a great example of how these technologies are helping.

: A 70 percent decrease in resource utilization.

: Wow, and when we think about the strains on the health care system. We’re talking about a 70 percent decrease. That’s enormous. Can you give an example to the listeners of how you and your organization maybe we could shift focus to Doc S.F. How are you guys improving outcomes and the way health care is performing with that?

: Well Doc S.F. The Detroit previous Conference is a event that’s designed for leaders in health care space to come together in a networking event and share and actually hear from startups that have been successful in decreasing in establishing a foothold in the health care system. So we have a big competition. The then like four startups to 1 to 2 spaces that come and show not a Don’t pitch not to pitch what they do allowed to do is to present a case study where they went into the hospital, impacted outcomes and shared the ROI with the leadership in the room. So then everybody who wants to get into that space sees how it works. So for example last year we had refocussing artificial intelligence and Leem tests which the computer presented came in with some of the work they’d done going into hospital systems and then basically we asked the U.C. Colorado one of the best examples they went into the operating rooms looked at a year’s worth of eight or eight months worth of data that downloaded from the electronic health record and then they applied their AI algorithms and little machine learning to figure out what opportunities the operator had and they had with a relatively small investment something like a 16 million dollar return the first year just by optimizing. It wasn’t even the complicated politically dangerous area of Block reallocation we take time away from one surgeon to give it to the other. It will was more about looking at some of the levers are easier to pull like lock release times. So that is when a block is a block a block of time in the operating room for the specific room. If a certain hadn’t filled it within say that there’s not a schedule for two weeks from now they’ll give it to somebody else. That’s a little bit easier to do. And like I said they’re able to increase their margins by 50 million dollars and our programs only about 2 to 3 percent but still it’s a big chunk of change.

: It’s a huge chunk of change that could be reallocated in a big way. Now listeners I had a chance to connect with Dr. Bini and he’s definitely driving this innovation in the orthopedic space and one of the things that really sort of resonated with me is his focused approach right. He’s very very honed into orthopedics. So Stefano I wanted to ask you is how did you land on that and was it something that you learned early on that maybe you had a setback that helped you say you know what I’ve got to focus clearly. How did you land and just being focused on ortho?

: So much that I had a setback is that I’ve watched everybody else have a setback or you know as no one said I parked yet and you wonder why is it. And I thought as I look at that I have a chance of change management sort of my thing is to change that in large organizations is that a good bite off too much you are inevitably going to fail. And I care how big and how many resources you have. It’s just the human condition can’t handle too much change at once. Healthcares well if the U.S. economy. How do you tackle healthcare. Everybody wants to be the platform while you know things are different in Georgia Louisiana or New York. Everything from culture to the actual problem is to be solved varies. You just can’t be that nimble it can be flexible within healthcare, the variation in practice from a surgeon to a primary care physician, there tremendously within surgery. We’re talking early a cardiothoracic surgeons challenges and not the same as an orthopedic sort of challenges. So my thought was that, OK, well we don’t even know what part of other digital economy within was going to apply to healthcare effectively. We’ve obviously the last to adopt all these technologies. So we don’t really know what works yet. So if you have do that weren’t you focus on one vertical. Why don’t you focus on a what’s already integrated where the patients themselves are relatively healthy so don’t have the variable of patient illness where the cycle times just short enough that the U.S. can actually invest into a venture and have a short or quick return on investment because the cycle comes not 20, 30 years like this in diabetes. So for example in orthopedics most injuries are resolved within six months of the most a year. And you can actually get to the outcome whereas with something like diabetes which plays out about 20 or 30 years you can measure process outcomes like sugar control. But in terms of actually looking at mortality or some of the diabetic complications you have waited a long time to see which it did make a difference. So orthopedics also it’s centralized, it’s not in every single clinic. It’s become even more centralized. The government is focusing on got the full power of the FDA and CMS helping you sort of drive change in that space. That’s a really fantastic vertical to focus on and it’s like I said it happens to be the one I worked in so that was an easy choice.

: That’s outstanding and folks if you haven’t had a chance to check out Doc S.F., just go to docsf.ucsf.edu. You’ll be able to find the tremendous work that’s being done there at the moment. And fascinating right. Taking notes from all others that have failed. It is so important to niche down. We had a previous guest Gavin Théo. He’s over at the Capitol group and one of the things he mentioned was poignant. It was health care is not a vertical it’s an economy and much like Dr. Bini is now on us he chose a vertical within healthcare. And I think as as we look to innovate and move the needle forward in health care we’ve got to do like Stefano and choose a vertical with health care and focus, focus, focus. What would you say what are your proudest medical leadership experiences is to date Stefano?

: The early launch of Doc SF has seen the resonance is how it was such a novel idea. When I started talking about four years ago this idea of asking people that run into a health healthcare system to focus their time and resources on one’s vertical was a little bit out of the box and its success has been quite a source of pride I suppose. But I have to say that with then the beauty of being health care is the ability to actually impact patient lives and that’s ours too. Some of the things that we’ve done. Actually you can go into a patient clinic visit with a lot of work UCSF recently deploying a patient gaged in platform called Healthloop and patients love it. And I’m sure that level the other platforms as well. But it’s just so it’s gratifying because you’ve done that work and you go and and people say buy a lottery like that health that thing. It’s been great. The connectivity is super advanced within a couple hours a couple days. And that’s gratifying. So there’s no taking your skills that are planning to leading this sort of change in the world of healthcare. We are solving problems that people have. Were really truly making their lives easier. And I think that in of itself is very gratifying if you get a chance to see it like you know the front lines talking to patients about it. It’s really wonderful. If you’re the person creating the product you may not get as much feedback to direct but it’s really part of the part of what makes us so we’re trying to work.

: That’s awesome yeah. And folks you’ve heard a couple references to health loop. It is fascinating patient engagement tool. Take a look. That’s healthloop.com. If you’re curious, I know the story of Dr. Bini’s patient wanting it really made me sort of want to figure out what it was. If you’re trying to figure out what it is they have it.

: It’s definitely clear that the patient who is making a fuss was the capture proof which is a video platform.

: Although it was different?

: Healthloop is actually an engaging platform.

: Got it, got it.

: It’s what additional e-mails every day. What you should do is you would expect was capture prove as a asynchronous video platform allows. Well done video but also photo to compare images over time and to create. I think you could call it a visual visual history that it pays for. Anyway it’s a different technology but there are also all these technologies are getting to the the first mention about access and how you create, how do you optimize access in the world that now is all visual I mean and the idea that patients who want to take 15 years drive for an hour sit 20 minutes in my office before I give chances. Actually I visited with them then to drive home and have lots of their work in this in today’s world where people are going to want us to hologram into their homes and track their sensors and visit them with these asynchronous technology. There’s no question. So it’s coming.

: No doubt about it and it’s cool that you guys are so honed into the Orthos space on it. So I know that you’re a practicing physician and you also have this innovation forum with DOCSF. There’s a lot of exciting stuff going on but if you had to pick one exciting project that you’ve got going on right now, Stefano, what would you say that is?

: My favorite project now that revolves around my research. We are doing work with several wearable sensor technology companies. So we’re asking a question we’re aware that we can use these commercial sensors that people are wearing for their own personal reasons or their sensors are actually built into their watch or their iPhone or their phone in General opted not to take on and that information. Run it through a algorithms using machine learning to see if we can predict outcomes. But more the pretty dark as managing outcomes. So let’s say you have surgery and you have a single repair or total knee replacement or shoulder surgery. And we know that you’re going to have a certain recovery period today. My actual dataset is what happens after you leave the operating room. Your first visit after surgery usually a week or a month out but there’s a timeframe then another timeframe.So the two and maybe the e-mails and phone calls we have. I mean that’s it. Yeah but you take it you drive home and you have a card that has about 50 sensors five microprocessors a dashboard that’s feeding information. But the second you can drive home safely. Why do not have a dashboard that from a lot of patients in 2018. The technology is there. So we have to see is what data points are useful. I mean the points you have to collect and over what time-frame. So we’ve been collecting hundreds of thousands of data points on patients and we’re starting to see some real patterns emerge to the point that we’re now predict the outcomes that will happen in six weeks and two weeks or two weeks on exactly or have a very good sense of where this particular patient will be in six weeks. So that if that’s the case say look you’re looking like you need to get any more help in the future. Can I intervene at two weeks and put you back on path right. For someone but not generically but how we get it down to precision medicine type stuff. In other words how can they get it down to the path that you’re following. Is there a path for someone your gender, your age, that lives in your neck of the woods. Because in Japan and the United States going to be very different. That’s the holy grail.

: That’s pretty awesome. Now the research that you’re doing is sort of defining a structure for patient reported data that will help within the space?

: That’s the thing about where we are today. When you fight to the future there’s a little bit more scientifically we don’t have a clue even the basic like how many data points that we need is that every second every minute every hour, during every day. Is it OK to get an average how many of those data points as useful. Do you need step count, stair counting, how many how far you climb the heart rate is that we don’t know any of that. It’s really been slow to get to the point you just mentioned was sort of a far down the road. Confidence base I think we’re at work on getting our infrastructure in place first just basics and that’s what we’re working on now to understand what the basics are and then there’s other people working too. So I expect this will go relatively quickly.

: That’s awesome. And if people were curious about this work, where could they check it out?

: Oh unfortunately we’re not still on the same top community that we’re presenting it to the abstracts to the American Academy of Plastic Surgeon, American Association at Plastic Surgeon wants to research published or present that then we are going to be making available on, I to put published info stuff on LinkedIn but uses some digital stuff so..

: Got it.

: Sort of Mention it.

: No sweat and folks again talking to Dr. Stefano Bini digital health innovator Doc S.F. Conference Chair Professor of orthopedic surgery at UCSF. We’re having a great discussion here getting close to the end though. We’ve got a little section of the podcast Stefano where we build a leadership course with the lightning round and then after this will conclude. So you and I are going to build the leadership course on what it takes to be successful and digital orthopedic medicine today. It’s the 101 of Dr. Stefano Bini for questions here for you followed by a book that you recommend to the listeners. You ready.

: Yeah.

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

: Measurable metrics that people can control and focus on outcome in the process.

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

: Focusing on technology acknowledging forgetting that culture change is a pre-requisite to successful the point of technology.

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

: So will whole session of that at DOCSF last year for our leadership segment. It is really hard because you have to have in one hand a culture of innovation which is completely at odds with the group that’s actually driving your day to day products that you’ve been famous for that made you popular. So keeping a foot on both is critical. It’s the acknowledgement that you need to have a section of your company that’s allowed to freewheel and free think there’s a sort of given a different vibe and the resource allocation is set to get the work done. And then once they come up with a tenable project you have to have the leadership skills necessary to deploy internal. The last piece of that and I talked that thing that I say all the time to come is that there’s a lot of companies out there that think that digital health and technology is something that they add-on that they sell to their customers whereas internally there’s still paper-based. If the company expects to sell technology they internally have to look and say Where can we adapt internally what can we do better internally that utilizes technology because otherwise it’s impossible it’s like somebody selling you something to them you know anything about they have no experience with it. So I think that that’s an important thing to take home. Okay that’s great. I’m signed to acknowledge this for the established companies want to get into whether its block chain or virtual reality or whatever. But internally they’re still doing email. They;re going to have a, don’t even use their Slack. Say Okay where do you think you’re going to be credible in five years.

: That’s awesome. That’s a great message. So you got to eat your own cooking.

: Yeah absolutely. You can’t sell something you don’t need. You just can’t. At some point somebody who does walk the talk is going to get the business better than someone just talks the talk.

: What a great take away there folks again. The beauty of the podcast is that you could always hit rewind listen to it again during your next run. Great, great discussion here with Dr. Stefano Bini. And the last question here what’s the one area of focus that should drive everything in a health organization?

: The patient.

: Love it.

: The short and sweet answer.

: I love it. What book would you recommend to the listeners?

: Besides mine?

: Well tell us about yours. We’ll put a link to the podcast and then one beside yours.

: Oh, excellent. It’s called The Team Engagement Strategy, and it came out of the learnings I had at when I was running large teams of Kaiser Permanente and then I resigned from a bunch of those roles and still have to be changed by the stripes on my shoulder and what it focuses on is it creates a relatively novel build on other techniques about how to engage different lines to solve their problems of oneself alone time to support the success. In that environment, he leader there as a supporter supports this as opposed to a driver of change distributed leadership model is frontal center. It’s a short little time looking for except perhaps that assistance law partners for the action I should.

: Get your glasses out people but it’s a good one.

: And the other one that’s good sapiens sapiens, if you have all known Harare you know him. That was an amazing book about the human condition, I think that’s pretty impressive.

: Outstanding. Folks you could take a look at these books, Team Engagement Strategy and Sapiens along with a transcript of our podcast show notes everything could be found at outcomesrocket.health/stefano and check us out there, you’ll be able to play it on the player. Some great transcripts or you could click on it right where you want it to start. Stefano, this has been a blast. I’ve really enjoyed having this discussion on digital health in Orthopedics with you if you can just leave the listeners with a closing thought and then the best place where they could get in touch with you.

: Closing thought, the worst ever perpetrated by Silicon Valley is to fail often fail fast. That’s fine for them. But when they fail they never call it a failure. They call it judicious use so resourced across multiple risky allocations. Truth is that we don’t necessarily fail. There are options. We do the best we can as leaders in this space. But if such a negative concept the thing we have times it doesn’t succeed. But that’s very different from failure. So yeah. Fail don’t often just do your best and succeed as much as possible. It’s just that I love it.

: I love it. That’s a great message. And what would you say the best place the listeners could get in touch with you or follow you?

: LinkedIn probably the best place to post the most to detract a fair amount and on Twitter as well that Linton is where posts are mostly interesting thoughts.

: Outstanding, no, it’s good. Listeners, if you were intrigued by today’s podcast I’m sure you are. Just go to outcomesrocket.health/stefano and you’ll find links to his twitter, LinkedIn, his DOCSF conference as well as the books that he recommended. Stefano and it’s been a pleasure and looking forward to staying in touch.

: Looking forward to. Absolutely. Thank you. It’s been a pleasure.

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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