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Tips on Leading Complex Change in Health Systems with Dr. Baligh Yehia, Senior Medical Director at Johns Hopkins Medicine

Episode 127

Outcomes Rocket - Baligh Yehia

Tips on Leading Complex Change in Health Systems with Dr. Baligh Yehia, Senior Medical Director at Johns Hopkins Medicine

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders really want to thank you for tuning in again and I invite you to go to outcomesrocket.health/reviews where you could leave the rating and review and what you thought about today’s podcast. Because we have an outstanding guest for you today. His name is Baligh Yehia. That is Dr. Baligh Yehia. He is currently at the Hopkins Medical Center and he’s a senior medical director there where he leads transformation initiatives to ensure the seamless coordination of patient care to improve outcomes experiences and reduce costs. He is a systems level thinker. High level regional national level really focused on making sure that systems can work together as a network so that they could collaborate more instead of coordinating. And he also has experience as deputy undersecretary of Health U.S. Department of Veteran Affairs. He’s got a really interesting diverse experience in healthcare. And so what I wanted to do is open up the microphone to Bali so he could round out that introduction. Bali welcome to the podcast my friend.

Baligh Yehia: [00:01:32] Thanks Saul, a pleasure to be here today. Thanks for having me.

Saul Marquez: [00:01:35] Absolutely it’s a pleasure to have you here too and so I wanted to ask you what is it that got you into this business to begin with.

Baligh Yehia: [00:01:42] Well I’d probably like many other clinicians who really entered medicine. It’s more of a calling as a profession than a job and so that’s really where her mind started is how can I make an impact on the lives of people in that kind of slowly evolved into not just individual people but to communities and populations and the work that I do now is really focused at that level of how can we improve the health experiences wellbeing of our communities across the country.

Saul Marquez: [00:02:09] That’s really interesting. You know you’ve taken that leap sort of you’ve got the frontline experience but now you’re wanting to do it in a more impactful way and for the listeners that are also wearing this hat like Baligh you’re looking to make an impact at the community at the regional and national level. Today’s discussion is going to be just that. So hold onto your seats don’t answer any phone calls. This is about to get good so badly. One of the things that am curious about thinking at the level that you are what do you think should be on leaders minds today as it relates to organisational issues.

Baligh Yehia: [00:02:42] Well I think many leaders know that healthcare is rapidly rapidly changing and the way that we deliver healthcare is also changing. Our population is getting older. There’s multiple locations and sites of care where patients can interact with different healthcare providers. Some within your system sent outside of your system. There’s growing types of new care models whether they’re accountable care organizations or clinical integrated networks. So there’s all this change that’s occurring and really we still continue to be to continue to be tasked to figure out how do we create value for our patients. How do we make sure they’re healthy are happy and that we are providing healthcare at an affordable price to the nation and to systems. And so in order to do that really what’s been occurring over the last number of years is we have to start to work more closely together and healthcare as we know it’s just as important about your genetic code as it is your zip code. Yes how do you start to work with different organisations in your communities. How do you start to work with actually other healthcare systems other providers to really manage populations and really be accountable for the total cost of care and really drive wellbeing forward. So that’s really a different way of thinking. Most. Hospitals and different practices have for many years have been relatively siloed. Patients come into their system they might do a good job coordinating within their system that more and more and more their bottom line is impacted by just how healthy their population is and how well they can improve their outcomes and to do that everyone really knows that you cannot do it by yourself. You have to work with others and so really strengthening those muscles of how to work well with others is where I think Successful organisations will really tap into the future.

Saul Marquez: [00:04:34] I think that’s really insightful. Dr Yalea and you know one of the things that we’ve had several guests discusses is this topic of population health and what is it that we’re doing to properly address the communities that we serve. If you had a high level of just philosophy on that how would you describe that in the way that you guys tackle that over at Hopkins.

Baligh Yehia: [00:04:54] Well I think we need to think about understand that communities are different in every community is different and just as there is a movement across medicine in personalised medicine precision medicine really leveraging advanced technologies and targeting those therapies to the person in front of you. That same concept applies to communities and populations. How do you start to tailor interventions here models the right members of the Kerry team to those communities. It’s not a one size fits all. And so really that needs to be kind of the next phase in evolution of how do we take care of our communities and our populations in our outpatient impatient and at home and in their in their neighborhoods is really becoming a little bit more precise a little bit more nuanced about how we deliver their services or think about what we can offer them.

Saul Marquez: [00:05:44] I think that’s a fresh approach sort of taken from the precision health mindset applying it to the community because once you get the feel for the communities that you’re serving you’ll see themes and you’ll see ways that you could serve them in a very precise way.

Baligh Yehia: [00:05:58] That’s right. Exactly.

Saul Marquez: [00:06:00] I love that. And so as the years have gone by and you guys have implemented a lot of programs there where you’re at at Hopkins. Can you think of one that sticks out as as a wow you know this worked out so well.

Baligh Yehia: [00:06:12] Well I think again it’s it’s really getting to know the different communities that you serve in and that that terminology has many different meaning different things to different people we might be talking about a community of elderly individuals that have certain sort of frailty indicators who may be talking about a community of patients that are younger but they have some sort of disability or they are have end stage renal disease and are on dialysis. So it doesn’t necessarily have to be a specific geographic neighborhood a good Gonchar unity of like minded patients or are patients that have similar medical social and behavioral needs. And once you start to really what’s called segment that population understand what are the needs of those different groups. You can then start to tailor very nuanced and precise interventions to take care of them and that’s where I think is really where you are start to seeing the biggest impact where you have very focused programs interventions approaches you really need communities where they are.

Saul Marquez: [00:07:14] Yeah for sure it’s more than just the geographic but also the segmented disease states said that the combination of social determinants that are all kind of part of the mix.

Baligh Yehia: [00:07:25] That’s right. And a lot of folks sometimes focus on just a condition so they might think about diabetes or they might think about developing something for people with heart failure or kidney disease but that only really scratches the surface. So what we’re talking about here is a layer above that which is really populations of individuals that have similar medical social and behavioral needs and they might not have exactly the same clinical conditions but they might have maybe five different clinical conditions rather than just one. And groups like once you start to create groups like that you determine that there are certain themes that are common across that group and you can tailor those specific interventions.

Saul Marquez: [00:08:08] Yes super interesting and by how do you see machine learning and artificial intelligence playing a role as part of this or not.

Baligh Yehia: [00:08:15] Well I think you have to leverage all kinds of technologies as we move forward. The era where a face to face visit is the only way to deliver care is really has gone has passed us. We need to think more about. How our patients can engage with us and how we can engage with them. And I think thinking it through ways that you can actually provide those both through individuals different layers of practitioners from nurses to doctors but then also maybe in more automated or machine AI type programs as well. So I think those are more on the forefront that are an interesting way to think about how to make sure that you can and if you’re able to provide access to your patients when they need it.

Saul Marquez: [00:08:59] Now for sure and you know it just that the theme here is flexibility in your approach an open mind to collaborating and you’ve done a lot and you’ve launched a lot of programs Baligh. Can you think of a setback that you guys had at some point and the pearls that you got out of it because a lot of leaders at the forefront doing things that you’re doing. You run into things that work and don’t work and one of the huge values of the podcast is sharing those things that didn’t work and what you learn out of them.

Baligh Yehia: [00:09:26] Sure there’s a couple things that I think are lessons learned. I think when you really need to start where they shared vision and the work that we’re talking about involves multiple people and those people are stakeholders are not always within your institution. And so it becomes a little increasingly harder to make sure that you understand what are all the views and what are all the expectations of the different stakeholders or partners that you have. So I think that’s a very important lesson especially since academic institutions are large hospitals tend to be a staple in many of the communities they have a lot of employees. That doesn’t necessarily mean that they should have the strongest voice when it comes to improving the health of populations. So that’s really one of the big lessons learned is to come to the table make sure that you have the right people on the table and make sure that you well the right shared vision as he moves forward and I think as part of that you start to think about how do you develop the right governance structure. How do you develop the right then use to bring up ideas and to start to move things forward. Like I said the motion is really towards not just working together network or in a coordinated way but to really start to collaborate or cooperate together integrate different services. And that really starts to take it up to the next level how you can deliver effective therapies and specific routes. Probably the last one I’ll say is is about aligning you know aligning incentives and making sure that you have both financial and financial. So those tend to be really good catalysts are tools to help groups kind of meet their goals. And so if the incentives are not aligned even though the the vision might be the same you might end up having issues across your stakeholders.

Saul Marquez: [00:11:12] And that’s really insightful and oftentimes I think it’s the blocking and tackling that gets lost with the shiny new initiative right.

Baligh Yehia: [00:11:19] That’s right.

Saul Marquez: [00:11:19] Yeah. So as you the listeners you know you look to implement your programs. Be sure you don’t forget these crucial basics that Bali just shared with you. Make sure that all the stakeholders are sitting at the same table make sure that all of the incentives are in line because the end of the day you don’t want to lose all the hard work that you’ve done to get this program implemented. I think it’s such a great message. Can you share with us Baligh a time where you experience just like ultimate success just something that you’re proud of in your medical leadership career.

Baligh Yehia: [00:11:53] It always goes back to for me when you’re sitting down around the table with patients and they tell you this impacted my life. I mean those are the stories that I think drive a lot of a lot of my colleagues a lot of people that are probably listening those nuggets of thank you’s for what you’ve done or you see how lives have been transformed because of the different work that we’ve done. So are most meaningful by my clinical background as an HIV and I I’ve had more than I can count a number of really great experiences from my patients where really their lives have been changed because of some of the ways that we organize ourselves to meet them where they are to deliver care. And so I think that’s probably the most gratifying and goal I think of any institution or organization that that’s in the healthcare space is to really maximize those. How can you deliver those sort of experiences that are transformative on the regular and thinking about. You know this is the whole concept we have here is how do we get more personalized in our approaches so that we really are being as nuanced and tailored and meet people where they are.

Saul Marquez: [00:12:58] That’s really great. Thanks for sharing Matt is pretty cool that that HIV is your focus. I did not know that. So that’s a really interesting fact about you. Thanks for sharing. And we’re all sitting here and it’s very highly likely that you’re healthy and you’re listening to this podcast and you’re not thinking of this from the lens of a patient. Maybe you are taking care of somebody in your life and elderly parents or grandparents. And I think what Baligh just mentioned is super important. The physician goes through a lot. The decision has a very difficult job. At the end of the day your physicians human and they like to hear thank you. So take a minute to thank your physician today or the physician that is helping your loved one because boy that is the spark that lit them to do what they did to begin with. And that is the spark that helps them keep going. When do you agree Baligh.

Baligh Yehia: [00:13:48] Oh for sure. Yeah.

Saul Marquez: [00:13:49] So like take it from Dr.. Here he’s the soul. And the reason why he’s doing this is because he is moved by it. And so thank your physician today. But quadruple aim today. Let’s make sure to include you guys and gals into the gratitude circle now. Thanks so much for sharing that. So maybe share with us a little bit of an exciting project you’re working on today.

Baligh Yehia: [00:14:11] Well you know we’re at Hopkins. Most of the health care system is in the state of Maryland and it’s a unique state. It’s called the all payer state. It’s pretty much the whole state as a demonstration under CNS and all the different payers from Medicaid to the privates actually paid the same and the hospitals are more and more responsible for what’s called the total cost of care for populations. And so this experiment has been going on now for the last couple of years and we’re continuing to evolve. Of all the work in that state. So it’s actually very exciting because some of the principles that we’ve talked about and value based care population health are really playing out in that state some for good some for bad that there are definitely lessons to be learned that could be applied across the country. And so that’s really exciting for me to be part of the team that’s really thinking about really how can we take care of the entire population not just those that walk through our doors. How can we continue to care for the communities that surround our hospitals and really also the next number Monsen years as part of this different demonstration project is how do you start to bring in different parts of the healthcare system who practices long term care facilities. And so a lot of that is really exciting is to see how do we how do we start to line up all the different pieces of the continuum all the way from outpatient impatient long term care and we have care together to be managing populations and also be jointly accountable for that total cost of care. So a lot of that work is really now in planning in the state. And so I’m kind of excited to see how we start to execute against those goals.

Saul Marquez: [00:15:51] That’s fascinating. And you guys are definitely ahead of the curve there because if the nation takes a turn for this system everybody’s going to be calling you. So what are you going to do when your phone is just blowing up because.

Baligh Yehia: [00:16:05] Well you know we’re number one I’m happy to take calls. I have seen though a lot of this stuff is I think a lot of viewers across the country they know this stuff is just getting the system kind of organized in a way that allows you to achieve those aims. So I think if you talk to anyone from New York to California to Alaska and Florida they’re all about improving outcomes for their patients and they’re all about making sure that they’re delivering excellent care experiences. And I think many people understand the value proposition. So that is not a hard sell. I think it’s more how you organize the system to help meet those goals. And right now all the way that the system is organized and how incentives are structured and how we’re going about the work doesn’t always align with those goals. So we have to continue to innovate and to change and to come up with different ways to organize ourselves and to better care for patients so that we can achieve those. And I think there was experiments in innovation across the country where there was different bits and pieces of this and hopefully we’ll take the best practices and lessons learned and be able to come up with a couple key models that will help us sustain us in the future because we definitely did do something about kind of how we are delivering health care and how we’re financing healthcare today.

Saul Marquez: [00:17:25] Dr. Yehia that’s so on point and listeners take some notes here and listen to these thoughts in a way that you can implement them as well. But at the end of the day it’s the things that you do with what you hear that make a difference. And so Dr. Yahiya you guys are definitely paving the way there at Hopkins. You too, with the things that you’re doing your thought leadership. So appreciate you sharing these nuggets of wisdom.

Baligh Yehia: [00:17:48] My pleasure.

Saul Marquez: [00:17:49] Let’s pretend you and I are building a leadership course on what it takes to be successful in medicine. The one on the ABC is of Dr. byly you’re. So we’re going to write out a syllabus here with our lightning round for questions followed by a book that you recommend to the listeners. Ready.

Baligh Yehia: [00:18:05] Sure.

Saul Marquez: [00:18:06] Awesome. What’s the best way to improve healthcare outcomes.

Baligh Yehia: [00:18:09] I think the best way is to stay focused on what your patient and your communities need. We really need to understand what does health look like for them. And many of the things that we think are important are not important in our patients or communities lives. So I think that’s really the most important is to think about make sure that you’re measuring and you’re working towards the right target. That’s sometimes where clinicians think is not always what patients are our neighborhoods and communities need.

Saul Marquez: [00:18:39] Awesome. What’s the biggest mistake or pitfall to avoid.

Baligh Yehia: [00:18:42] I think the biggest mistake is really the concept that you can it only takes one person or a small group of people I think health care is everywhere from transportation to availability of grocery stores and healthy foods to being able to walk safely in your neighborhood to exercise. So really we need to kind of continue to expand and keep our focus that Health in All Policies is very important and it is not just the actual delivery of medical care that’s important. It’s really all this combination together that creates a healthy society.

Saul Marquez: [00:19:18] How do you stay relevant as an organization. Despite constant change.

Baligh Yehia: [00:19:22] I think change is what allows people to be fresh being you be on the cutting edge and I am embrace that. And so I think continuing to experiment explore creating space for your organization to do that in a flexible manner where individuals are able to bring up ideas you’re able to kind of try out different things we’re in a very supportive environment and culture thing that’s really important. Innovation really create happens when there is room for innovation and so organizations need to create those spaces that culture to allow that to.

Saul Marquez: [00:19:58] Great message. Last question here What is the one area of focus that should drive everything else in your organization.

Baligh Yehia: [00:20:05] I think it goes back to what I had said before in the business of healthcare which is taking care of people and communities and populations and so that needs to continue to be true north throughout.

Saul Marquez: [00:20:16] Strong what book would you recommend to the listeners.

Baligh Yehia: [00:20:18] You know there’s I don’t know there is one book but I think I’ve always been impressed with. Good to Great by Tim Collins. Yes and also kind of along the same lines of talking about change of leading change. And I think those are really there’s a lot of key lessons there that could help many organizations as they go through this very different environment that we’re in today and healthcare.

Saul Marquez: [00:20:42] Great recommendation and listeners don’t worry about writing any of that down this syllabus as well as the show notes are available to you all under one page. Just go to outcomesrocket.health/Yehia. That’s why Y E H I A. You’ll be able to find everything there. And so this has been so much fun. Time flies when you’re having fun. We’re here to the end Dr. Yehia and you just share one closing thought with the listeners. And then the best place where they could follow you or reach you.

Baligh Yehia: [00:21:11] Sure. I think it takes a village to continue to drive forward positive change and healthcare. And I just want to encourage folks to continue to think to innovate to talk to patients to get out there in their communities and that’s really where a lot of the ideas come from the positive. Many of my colleagues including myself didn’t get here by ourselves. It’s through support from mentors and people that open doors. And so think about who are those individuals in your life and thank them. And how can you pass it on to others. And so I think that’s very important to kind of continue to train the next generation of leaders and healthcare and folks can follow me on Twitter @byehia.

Saul Marquez: [00:21:53] Outstanding. Really great message Baligh. This has been so much fun just kind of going through the awesome things you guys have going on there. I’m excited for the listeners to take action off of what they’ve listened today and so just want to send you a big thank you.

Baligh Yehia: [00:22:06] Well thanks again for having me Saul it’s been a pleasure.

: [00:22:12] 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.

Recommended Book/s:

Good to Great: Why Some Companies Make the Leap…And Others Don’t

The Best Way To Contact Baligh:

@byehia

Mentioned Link/s:

https://www.hopkinsmedicine.org/

Episode Sponsors:

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Outcomes Rocket - Baligh Yehia