Episode 16: Highlights and Insights, Part 4

Take a deeper dive into what it takes to be a change agent by revisiting recent interviews with DJ Mitsch, Colin Hung, and Dr. Jim Ballard. Join Scott, Michael, and Jared as they review how to create a vision and gain buy-in to create incremental changes that have a ripple effect in other organizations. It isn’t quick or simple to become a change agent, but we need more to enact the bigger changes that will lead to transformation in healthcare.

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Show Resources

1. https://www.p3inbound.com/blog/episode-12-coaching-through-the-chaos-of-change/ – Episode 12 – DJ Mitsch, Coaching Through the Chaos of Change
2. https://www.p3inbound.com/blog/episode-14-open-minds-online-communities/ – Episode 14 – Colin Hung, Open Minds and Online Communities
3. https://www.p3inbound.com/blog/episode-15-bundled-payments-bring-benefits/ – Episode 15 – Dr. Jim Ballard, Bundled Payments Bring Benefits

Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans, and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together, and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare,” and thank you for listening. I’m Michael Roberts with my co-hosts, Jared Johnson and Scott Zeitzer. On today’s episode, we’re taking a deeper dive into some of the themes that have come up in recent episodes. Today, guys, I’d like to talk about how paradigm shifts are happening because of change agents. The leaders, you know, that really have a vision of what they want to change, and then they go out there, and they just make it happen.

Jared: Yeah. Michael, I think one of those things we are going to talk about those qualities of a change agent are, right? Like, what are the qualities that make somebody an agent of change, and how are they leading things, and what’s their vision, like you said. So the three most recent episodes that we were talking about that we want to recap today and kind of relate to that theme of change agents started with DJ Mitsch, who was a healthcare coach, which is a pretty new field. And, you know, pretty much every guest we’ve had is in a role or a field that didn’t exist that long ago.

And so, this whole thought of healthcare coaching as a field, as a necessity for helping healthcare grow, is a phenomenon. And she talks about how leadership really, the idea of it has changed as well. The paradigm shift has happened about leadership in healthcare. It means not just what we used to think about, it really means moving beyond the exact confines of being right with a medical answer and those who are used to a precise answer with data supporting every part of it, you know, that it’s an evidence-based field while leadership is a bit of a softer field.

There are people involved. It’s mostly dealing with people. And so there are different things there, and we have to understand where healthcare fits into that. And so, DJ really talked a lot about moving to those uncertainties of how to help other people, of how to, as leaders, help ourselves understand change and help them understand and be able to motivate other people. And I think we’ll talk about how that has to do with change agents. The other episode that we talked about was Colin Hung from the HCLDR tweet chat and the online community associated with that.

Colin has been around leading this tweet chat for many years, and he talked about how just the respectful exchange of ideas with that tweet chat and with that online community, how it’s grown, and how that’s created positive change. Part of that change has to do with awareness of different ideas and being respectful and understanding the different aspects of health care. And Colin, absolutely, had to be a change agent to see that that was something that was needed, that conversation needed to happen, and that without it, we were only going to be able to grow in certain ways. And so, he started that.

He was one of the founders of it and helped it grow from nothing. So, again, that’s, to me, something that has to do with being a change agent. And then the third one we’re going to talk about today and kind of recap was Dr. Jim Ballard, orthopedic surgeon, who is a friend of ours, friend of the program. And he talked about… it was funny how that conversation, out of all of them, kind of evolved from talking about bundled payments, but then really enlarging that conversation to talk about how doctors even look at the world and bundled payments can be seen as one of those things that, “Oh, this is just another thing we have to deal with, and we have to figure out.

And it’s just something that we can bemoan, and it’s another difficulty of the healthcare system,” or they can take a look at it and find the opportunities there and the challenge. And so I think those are some of the things we wanted to talk about how those relate to the change agents that we talked with and what the implications are for the rest of healthcare. I don’t know, Scott, what do you think about it? You want to start with Dr. Ballard and kind of where we went with his conversation?

Scott: Yeah. Ballard is a change agent. You mentioned it about… I’ve spoken to so many doctors, surgeons, etc., healthcare field people, and some people simply just bemoan their fate. “I don’t know what to do about X. Glad I’m going to retire soon,” stuff like that. Ballard took a look at what was going on with joint replacement. There are a lot of cost pressures both at the hospital, in the surgeon’s office, a lot of conversations with insurance people.

We’ve talked to many people about that triad, you know, so to speak. And Ballard was interesting in that he started thinking about bundled payments. So, for everybody who is not familiar with that, it’s basically a one-price-fits-everything if there is any need for the patient to come back, any kind of issues, etc., hey, man, it’s all one cost. So if I need an extra x-ray, if I need an extra anything, one cost. I know a lot of surgeons and/or doctors would be a little wary of taking on all that responsibility. How do I control all that? That type of thing.

And Ballard kind of walked through the process about, “Hey, man, you’ve got a lot more control than you think you do over this.” And one of the things that he decided with his group was moving that surgery, when appropriate, to an ambulatory surgical center where, again, a control issue where they have more control over the process. This is something, like, people don’t realize. When you, as a patient, walk into a hospital, you can be walking in there from everything from, “Hey, I need to deliver a baby,” to, “I stubbed my toe,” to, “I’m having a heart attack,” to, “I need a joint replacement.” And I think is extraordinary what lots of hospitals are able to do under those set of boundary conditions.

What Ballard did was he goes, “Hey man, I’m going to move this. I’m going to move this to an ambulatory surgical where we’re only going to do this,” whatever “this” is. Every ambulatory surgical center is different in what they will do, but they’re under control about what they’re going to do. And then they employ very specific things. I remember one of the things I enjoyed about him was he was talking about, Dr. Ballard, was talking about, when you get on a plane, there is one set of steps that you, as a pilot, are going to do. You’re going to get on that plane, right, and this is what we do. And, we’re at, I don’t know, I’ll pick United Airlines.

This is what we do at United on a 737-900. This is what we do. In a hospital, it really is the other way around. “Oh, what surgeon do we have,” right? And then I guess we’re going to have these trays out, and we’re going to hand it off in this manner. And I would have loved to have been in the meeting with all the different surgeons. Michael and I have talked to surgeons over a long period of time. Surgeons require a large ego. I don’t mean that in a bad way. I’ve always said that. If you’re going to have a scalpel in your hand, and you’re going to open somebody up, and you’re going to take care of them, they better have a good-sized ego.

But they put those egos away all for the sake of saying, “How do we make this setup work?” And they looked at this is an opportunity, all those surgeons, not just Ballard. Ballard led the way with it, came up with a methodology that worked, then came up with a bundled payment. Michael, what I found interesting about that was that when they went to the insurance companies, they were like, “Wow, this is great. We have no idea how to do that.”

Michael: It’s one of the things that I find interesting because this isn’t like a brand new idea. The whole concept of bundled payments, this isn’t the first time anybody’s ever talked about it. So, it’s already out there. And I think what’s interesting about podcasts like these, we get the chance to interview somebody, and we get to hear their story with where they’re at.

You know, Jared had an episode where he talked to Dr. Smith, you know, years ago, and we kind of got like a progress report on how far along he’s come. So we get to talk to Dr. Ballard about bundled payments, and it’s like, “Here’s where we’re at right now, and we still got so long, such a journey to go before this is really like set, before this is really adopted.” And so this whole concept of change agent, it’s not something you do once and then you kind of check off like, “Oh, I did it. It’s fine”

Scott: Right, I’m done. You know, and I think interesting to me, Michael, was that when we talk about Smith, we talk about Kirschenbaum, we talk about Ballard, Greene, they all saw a problem, and they decided to take the bull by the horns and make it their responsibility and say, “What am I going to do about it?” When you talk about Smith, like everybody told him initially, like, “Oh, so you’re just going to spend more time educating patients when you should just be seeing them?”

And he was like, “Yeah, I’m going to take that onus on. I’m going to take the risk. I believe that this is going to help in the long run.” And that was Dr. Smith. Dr. Kirschenbaum who sees more patients in his clinic than the entire City of Cleveland, and go listen to that particular talk as well, and he took it upon himself to figure out a system. Ballard, same thing. It’s like, “Hey man, look at all these cost pressures.We got to figure out a way to get on top of this. I’ll take the risk. I’ll take the onus.”

Greene, “I got to come up with a way. If I’m seeing 50 people on an afternoon, how I’m going to make sure that I take good care of them? I’ll take it upon myself to come up with the system.” I find it fascinating, and it’s like, “All right, man. I’m the captain of the ship. I’m going to go figure it out. I’m not just going to roll my eyes and walkthrough, right?

Michael: Right. The whole concept of change leads us well into the episode that I did. I got to interview DJ, and she was talking about the healthcare coach that works with a lot of executives. And so hospitals are, obviously, going through a lot of changes. They’re obviously trying to shift how they’re, you know, doing things. They do have more competition from, you know, ambulatory surgical centers, all sorts of other organizations, and that process of change is so difficult. And you think about, here at P3, we’re a relatively small company. Introducing change for us, it’s still like we have to get enough people in the room.

We have to talk about it. We have to figure out what are the consequences of dismantling something. Like, it’s a process. It’s not something you just do and, you know, hope for the best, right? So you think about taking that to a much larger organization, to a hospital, to a healthcare system, you know, everything from primary care all the way through, like, these changes get, obviously, much bigger and much harder to implement.

One of the things that DJ brought up, and we kind of got to talk about it a little bit in the episode, but some conversation that she and I had around the episode really talked about, you know, the mentality of leaders. Like, what do you need to do to be able to make change possible? And we had brought this up last week, the whole idea of Maslow’s Hierarchy, right? So that base level of the hierarchy is just, “Do I have enough food and shelter?” And you kind of move up that pyramid towards self-actualization, right? It’s psychology 101.

You know, can we move up the steps here? Well, a lot of what she works with when it comes to working with leaders, with helping train them, helping them create an environment that’s ready for change is kind of walking through a similar process. You know, she calls it like that base level of just humanity, you know, that includes just basic things, but it’s not stuff that’s not always present in every organization, right? So trust, the ethics, the agreements between everybody there.

Like, having that level of just, “I’m safe here. I can have real conversation. I know that people are doing things in a manner that I’m good with, that we as an organization can stand firm behind these things and then moving up that.” Like, once you have that humanity established, being able to start exploring, getting in real conversations, active listening, really direct communication, not having to dance around everything you want to say. If there’s a problem, you simply say what the real thing is.

Scott: Right. When you have trust, you can have better communication. What I find interesting about the whole concept as DJ goes to consult with a lot of his hospital execs, a lot of which are doctors, current, taking care of patients, etc., where “they’re in charge.” Whatever they say goes and it’s operating room. It’s like, “Look, man, there’s one captain of the ship.” That’s the way it needs to be. And that surgeon is certainly in charge, and everything is on that surgeon. So normally, it’s a one-way path of communication for obvious reasons. But here, that surgeon walks out, and DJ is coaching them on how to build that trust, how to actively listen. It definitely is a different set of capabilities that needs to be coached and enhanced.

Jared: And take that even further into the stage of actual innovation. You’ve set an organization where you can be transparent enough with one another or you can have trust, and then you’re starting to communicate more directly, and then you’re actually creating. You’re actually shifting. So a lot of these ideas we’ve been able to discuss on past episodes. You know, things like getting into social determinants of health, getting into like predictive data around what’s possible for patients. Like, these are big, bold, new ideas. They don’t fit the old models.

You can’t just keep doing things as usual. And so, there’s a lot of, to use another buzzword around all this stuff, but there’s a lot of vulnerability that goes into that. I’m not just going to do the surgery I’ve done 100 times before, and we’re going to do it again. It’s, “Here’s something new. Here’s something uncharted.” And, again, as we talked about before, like somebody is taking that on. Somebody taking that risk and is willing to jump out there.

Scott: You know, and Jared, you talk about a little bit about Colin Hung from the tweet chat HCLDR. And if anybody isn’t listening to it, it’s a great way to kind of hear a lot of voices. And I think one of the things that I really found to be like the principal of us was that, “Hey, everybody has a voice, and it’s equal.”

Jared: Right, right. And those are hallmarks still of the tweet chat that has been going on, I think it’s now seven years, I think it’s what he said?

Scott: I think so, yeah.

Jared: Yeah. It’s amazing just to think about that. Even just to take a step back from that, you know, to think about where it started with Colin and others and to look at it now compared to the influence that it had at the beginning. You know, think about what it means to be a change agent, right? Somebody has to have a vision of where something needs to go to make that change happen, and it was very clear that everyone who has been or is now a host of that tweet chat has helped turn it into this online community, a global community where people can have this exchange of ideas.

And so the part about it of being able to have that vision to be recognized is there are going to be those who are saying, “Oh, there’s just not any value in this. I’m not going to participate,” to kind of cast those naysayers aside and to still keep up with your vision. And not only to carry it out yourself, but then you have to convey that vision to everyone else. You have to tell everyone, “Hey, here’s why it’s worth taking an hour out of your night on a Tuesday night,” you know, after most of us have kind of wrapped it up for the day.

“Here’s why it’s worth spending another hour engaging with people,” in his case, “engaging in this tweet chat and understanding, and learning, and engaging with other people.” So he’s had to explain what that vision is. So that’s another part of being an agent of change, is conveying that vision to other people and having them buy into it. You do have to build some trust. Scott, like you were saying earlier, that’s a big part of it.

And really where it all centers around, to me, where what Colin touched on, in different ways, was how you have to be so dialed into what other people care about and what they need. That’s your currency. That’s what it means at the very base to be an agent of change. It’s not just, “Hey, you know, I’m going to do this. I’m going to build this thing. I don’t care what anyone else says. I’m just going to do it.”

No, it’s always leading other people, which means you have to get people to buy into who you are, what you’re all about, what that vision is, and where it’s going to take you, and what the value of it is. There’s so much to it. It’s no wonder there aren’t that many more change agents out there these days, you know, especially with how little people want to change in the first place. That’s one reason healthcare is where it is, and that’s why these paradigm shifts have been happening incrementally over the years. It’s because, still, people just feel safe where they are and they don’t want to change.

Scott: Yeah. And, you know, there’s a lot of outside forces that are forcing these changes. In Ballard’s case, costs. Well, costs are probably in a lot of the cases now that I think about it. My perspective on all this is I see a problem, and I have some thoughts about how that problem can be solved, and I want to talk about it. I want to build some trust about it, and I want to see how we as a team can figure it out. You know, when you think about all three of the people we’re talking about, DJ, Colin, Jim Ballard, they all saw an issue.

But instead of being islands, they recognized it was going to take a team that was going to fix it. And the previous talks we’ve had, you know, Kirschenbaum isn’t an island in the South Bronx, over at Bronx Lebanon. He sold that concept to all the orthopedic surgeons, to the entire staff. I mean, there’s no other way that you’re going to process that many people very well, by the way. Green has an entire team that sits within Baton Rouge Orthopedics. Not only do they do it, they believe in it, and that’s why it really works. Ballard, the same way.

Hey, he had to convince other surgeons, by the way, some of them his competitors who were also at that ambulatory surgical center. “Hey, we got to come up with a common way to do this, and this is why.” Everybody kind of… he not only saw the problem, he not only came up with what he thought might help, but then he had to go sell that and get other people. And the only way to do that is to build trust, to listen, etc. All these guys and girls, pardon me, seem to be able to not only spot the problem but work with others to solve it. And that to me is so critical.

Michael: So here’s a question for the two of you guys, going completely off-script and just jumping in there. So one of the things that I’ve seen in various chats that I’ve been a part of, especially around healthcare, the whole field of healthcare, is incremental change the only thing that’s possible for individuals to lead? Can individuals bring in any kind of just drastic reworkings of a healthcare system or drastic rework is done? Maybe at a practice level, they could do something. But, you know, as far as this hospital, this entire group, is it possible for one person to be able to lead that kind of change or is that only in the realm of government? You know, a policy is introduced and we all just have to change.

Scott: My quick thought would be, it’s probably on either end of the spectrum. So what I mean by that is, hey, it’s a smaller practice or it’s very large. So, on the large side, we think about…and I think we’re going to have a conversation with somebody over at Walmart Healthcare. That’s large, to put it mildly. You think about Amazon combining with, if I’m not mistaken, it’s Amazon, JP Morgan Chase, and I can’t remember the third.

Jared: Yeah, Berkshire Hathaway.

Michael: Thank you. Berkshire Hathaway. The three of them, thanks, Jared, all getting together to go, “Hey, man. We’re going to go move a mountain here,” right? And then on the other end of the spectrum, it could be just like, “Hey, man. Here’s this small practice.” I do believe you have to have some ability to steer this ship. So whether that’s, “Hey, I got this small boat on the lake here.” I think we spoke to someone over in Arizona, the ACO, right? Was that…

Jared: It’s actually a fairly larger organization.

Michael: But still when I compare it to Walmart Health, small, right? So all these places where you can steer the ship. So there’s this like, yes, it’s a large organization but not compared to Walmart Health, but they have the ability to steer the ship, right? Smaller practice. Ballard going in to do what they’re going to go do. Kirshenbaum being empowered in Bronx-Lebanon to go like, “Hey, man, go do it.” So there’s going to be some empowerment. Jared, what are your thoughts?

Jared: That’s a really good way to steer this. I just think if I had to kind of summarize it, I would say the incremental changes that change agents have created in the last 5 to 10 to 15 years have allowed us to start thinking bigger. And there are those who are creating bigger changes, like you said, like Walmart Health, you know, a retail health clinic brought to you by the biggest retail chain in the country or the world or whatnot. That could not have happened any earlier than it did. And it had to happen because you had to have enough of these change agents taking a chunk of it here and making that part better and shifting minds in that one area.

I’ve got two books sitting right here literally on my desk right now. One is by Dr. Zeev Neuwirth called “Reframing Healthcare,” who’s got his own podcast. It’s unbelievable. And he’s a physician himself. He is not a small thinker. He is a big thinker. He’s like, “Here’s what’s got to happen to completely change the delivery of care.” And it’s meant for providers, administrators, and for everybody. And then the other book that’s sitting here is called “Making the Healthcare Shift.” It’s by Scott Davis and Jeff Gourdji, who talked to like dozens of different health care leaders. And they’re not talking about small changes either.

Well, they kind of are at first, but they’re like, “No, these are the big things that need to happen.” I don’t think these types of books and ideas could have even gotten out there without those who have made the types of incremental changes over the last few years to kind of prepare people and get them thinking, “Oh, yeah. Holy cow. We can make a difference and we can change things in this one little area and maybe we really can be more,” because I think before these types of things, before the Colin’s, and the Dr. Ballard’s, and Dr. Kirschenbaum, and the DJs of the world who are really out there making a difference in their little corner of it, nobody knew what to expect and so no one was trying.

Scott: While you were talking to me about this, Jared, and talking to everybody, what came into my mind was Dr. Smith at UT. And he started out by being an incremental agent, right? “Hey, I’m going to just take care of my own little island here, the patients that I take care of,” and he quietly kind of explained himself over and over, I’m sure. And then all of a sudden, I think he’s in charge of social media for UT if I’m not mistaken. Is that right, Jared?

Jared: Yes. It really is. It had to do with just the minds he had to change at the beginning. There really weren’t those who were on board at first. And so he knew that he wasn’t going to be able to get buy-in for where he ultimately saw this. And I think that was a credit to his leadership and his ability to prove, “Let me do this trial. Let me do this test case. Let me do this part of it for a couple of years, and then everyone’s going to see, and everyone’s going to be wondering why we didn’t do this all along.”

Scott: Yeah. You know, Michael, I think of DJ Mitsch. And I’m sure when she started out, it was like a coach, “What do I need a coach for?” And now I’m pretty sure she’s quite busy just trying to stay on top of all of her work.

Michael: Yeah, absolutely. One of the ideas that keeps coming to mind, and we’ve briefly touched on it, but this concept of trust, and this is something that we’ve delved into a lot more with the episode with Colin, but trust is so much based on your track record. You know, I got out there, I tried it, this worked. I got this far. And even if it didn’t work this time, I kept trying. You know, I kept going at it, and I started gaining that ground a little bit at a time. And getting that momentum, getting that started, that’s such a difficult process. And there’s so many people…I don’t think not everybody is out there looking for people to fail, right, but there is like that easy, dismissive nature that we can all fall into.

Scott: Absolutely.

Jared: “Oh, that’s not going to work. I don’t want to make that change. I’m not going to take that risk, you know, so I’ll just kind of brush it to the side.” But seeing people stick with it, seeing how long Dr. Smith stuck with it, seeing how long some of these folks have…you know, seven years of a tweet chat. You know, like that perseverance that engenders trust in a way that just saying, “I’m trustworthy,” it’s not nearly the same.

Scott: I agree. You know, and it’s funny that you mentioned that. I have this vision of all these people on one side of the hill. It’s a snowy hill, and they’re just making that snowball, and they’re working so hard to push that snowball. And most of us tend to go like, “Yeah, that’s cool. Whatever, man.” Like you said, they’re being more dismissive than they are being mean. They’re just like, “Whatever, man. When you get to the top, let me know because then it’s going to be cool.”

And I’m sure, guys, if we were all that smart, then when Jeff Bezos started thinking about selling books online and we all rolled our eyes and said, “What?” Or Netflix came out, and they were like, “Come on, man. I’m going to buy more stock in this blockbuster. That’s gonna make me money.” You do. There’s changes that are occurring, and my best advice to everybody is, keep reading, keep listening. I’ve got a couple of books on my desk as well, and it is about everybody have an open mind because it’s changing.

There are external forces, especially on the healthcare side, and most of it is dollar related. The economies are changing. There’s lots of conversations occurring on the ground level, on the front lines, so to speak, and there are lots of very large conversations occurring on the political and corporate level about how to attack this. I think it’s just fascinating to me. But that’s why we’re having this talk all the time.

Michael: Absolutely. Absolutely. All right, guys, thank you both so much. I’m fascinated by this process. I hope that all of the potential change agents that are out there that’s listening that you’d take encouragement in this, that you’d be encouraged to go out there and start small, start making that change that you can start that process, start building that track record that’s going to engender trust down the road. Thanks so much for listening.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.