Episode 28: Don’t Let Staff Get Lost in the Shuffle

Engaging healthcare staff takes a different style of leadership and communication in the Age of Consumerism, according to Britt Berrett, program director and faculty at University of Texas at Dallas, and New York Times bestselling author of Patients Come Second. The lessons he learned as CEO of two major hospitals apply just as much, if not more, to smaller practices. Learn how smaller practices are, in fact, better equipped to pivot quickly and make necessary changes, which helps them address the evolving needs of patients without causing staff to get lost in the shuffle.

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Full Transcript

Announcer: It’s time to think differently about health care, 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 health care 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 health care 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 here today with co-hosts Jared Johnson and Scott Zeitzer. On today’s episode, we’re talking to Britt Berrett, program director and faculty at University of Texas at Dallas and “New York Times” bestselling author of “Patients Come Second.” Hi, Britt, and thank you so much for coming on the show today.

Britt: No, I’m delighted. Thank you for the invitation to be with you today.

Jared: Great. You mentioned that lovely Texas weather. How’s that working out for you this week?

Britt: Everything is bigger and better in Texas, that’s all I’m gonna say. That’s all I’m going to say.

Jared: Yes. We’ll just move on from that because I’m agreeing, I’m nodding. You can’t see me, but I’m nodding in agreement. Indeed, Britt, I know you and I have known each other for a few years, quite a few years if I really think about it and we appreciate you coming on the program. From the perspective that you’ve got, you’ve got such a unique way of understanding, not only what’s here now but what’s coming. And I think that’s the one thing I’ve always admired about our interactions and about any conversation I’ve ever had with you is that you see what is coming and you’re able to put all that perspective off what’s going on right now.

One of those things that I’m sure it’s ever since the book came out and all the way leading up to it, this whole thought of “Patients Come Second, ” right? So, it’s been out there in the world for a handful of years now, but it still seems like the lessons about staff engagement are just as valid now as when you first wrote it. I’m wondering if we could start there with the basic premise of the book and the effects of approaching staff engagement in the right way.

Britt: Well, you know, it’s an interesting experience. I’m originally from Canada, so I’ve lived through socialized medicine. I spent a couple of years of my life in South American, Peru and I saw health care in different environments. Decided that I would get into the health care space so I spent 25 years of my life as a hospital CEO and executive. While I was navigating through health care, there was this emerging consumerism that was knocking at the door. And what we found is in the past, we had created these baffles, these shields, these fences between the patient and the clinician. So, the doc would use jargon that they don’t understand. They would wear white coats. The nurses would carry stethoscopes, and we wouldn’t allow them to access their medical records. And the fathers would wait in the lobby rooms as the mothers delivered. I mean, the list goes on and on. Those days are over.

Today’s consumer is much more capable, has higher expectations, demands accountability and transparency. So, as I was navigating through health care, I always insist that we build teams that were responsive and so culture became a very important element of my leadership and the teams that I worked with were just fantastic. As I studied that a little bit further, I pursued my PhD. And my dissertation was on the convergence of strategy and leadership, I gotta lead. Well, unfortunately, no one read the dissertation.

I thought a buddy and I, Paul Spiegelman, we would write a book on this topic. Initially, the title was “Leading Change by Changing How You Lead.” So, to lead the change in health care, there’s emerging consumerism, there’s engagement of patients. I remember a day when I would talk to doctors and I would introduce the idea of something new called the internet and the idea that patients could email you questions and the doctors were a gas.

They were like, “Listen, they can come to my office if they’ve got a question.” Fast forward, you know, a couple of decades, patients explore the internet and get diagnosis and possible treatment protocols and they bring them to their practitioner. So, as I was navigating through this experience, leading change was very important. At the last minute, we changed the title to “Patients Come Second” and it has been a fantastic experience of connecting with individuals in the health care field that feel the same, that we have got to lead change in new and unique ways.

Jared: You know, when I think about this too, it sounds like we are still in the midst of this evolution, right? We’re still seeing these principles that apply that are kind of timeless. How’d your experience as a president, as a leader, as a CEO of major hospitals, lead you to write the book and like what else kind of factored into that? Were there any particular experiences that kind of led up to it other than, you know, the fact that this was something that you focused on with the dissertation, and have those reactions changed over time? Like, are those same types of experiences happen?

Britt: Great question. Great question. Health care is becoming much more complex. It is $4 trillion industry. It’s 20% of the gross domestic product. It has moved from a mom and pops, religiously sponsored palliative care, meaning, we’re just going to give you comfort, but we certainly are going to solve your illness. Now, we’re spending billions and trillions of dollars in the health care space and it is big business. And individuals are experiencing significant economic hardship and decisions when they choose health care. I went in the other day for some dental work, and I don’t know if you know this, but to put a crown on, it’s $1,000. I mean, we’re talking in terms of economics, a huge responsibility.

So, in the past where you might have an insurance company or employer cover all your expenses and you don’t have to worry about a thing, today, consumers have to make purposeful and informed decisions and they’re demanding it. So, health care leaders have got to just respond to that. They can no longer hide behind this cloak of secrecy. So, to do that, you’ve got to lead practitioners in a different direction. That’s much more responsive and much more dynamic, evolving as we speak.

Scott: Yeah. You know, just to jump in here for a second, I was thinking about this whole culture idea that when you started talking to the doctors and surgeons way back when about essentially being aghast at having to interact with them at any point other than in the clinic. Now, obviously, things have changed and you were, as you mentioned, talking about changing the culture. Now, it might be more like tweaking the culture, and how does that affect, say, you know, smaller mom and pops because it certainly is an issue there as well, correct?

Britt: As a matter of fact, mom and pops can pivot faster than big, monolithic hospitals. So, we’re seeing a lot of smaller organizations trying new and innovative ideas. They’re the first ones that came out with electronic medical records. We had a bunch of physicians that said, “Boy, it sure would be easier if I could put this on a spreadsheet,” which spun off to like, “I wish it could connect with my pharmacy orders and my lab results.” But the mom and pops, they’re the ones that led the change because they were able to pivot so quickly. And so, I think if you go into physician’s offices and watch what they’re doing, you will learn a lot about where we need to go into the future. There are some peak performers out there that are probably listening to this podcast because they’re so curious and have these innovative ideas, and they’re starting to change that bigger organizations must, must embrace into the future.

Scott: And I couldn’t agree more. I have a friend of mine who has an issue with dry eye and was on the phone with a potential provider, an ophthalmologist, and its some new procedure. And she was interested in learning a little bit more, and it got to the point where I believe the person who answered the phone, who obviously wasn’t well-trained, was suggesting about connecting this friend of mine with the actual patient. All right. These HIPAA alarms are going off and, you know, so anybody listening who’s just trying to figure out like, you know, “Should I take the time to train my staff?” It’s like, yeah, there’s some, you know, minimums in terms of training staff and then, goodness gracious, how much better you can do when the whole team is in sync.

Britt: The complexity of the health care delivery system is beyond, “Let me write you a bill on a little piece of paper and send it.” The complexity, the ICD-9s, ICD-10s, the codifications, and now some will resist that. Some will say, “Oh, this is horrible.” Okay. You’re probably going to have to retire and get out of the business because it’s not slowing down. It’s not going away. It’s the early adopters who say, “I get it. I’m going to embrace it, and I’m actually going to do it better.” I’ll give you another good example.

You’re going to hear a lot more about pricing transparency. And I was the Executive Vice President for Texas Health Resources, and it’s a large integrated delivery system here in the DFW.

It’s like the Sutter or Sharp HealthCare or an Intermountain Healthcare, big system. And as the Executive Vice President, we sat around the table and I said, “Patients want to know what their pricing is.” They are no longer willing to just say, “Well, just bill my insurance and I’ll pay the copay deductible.” And it was a fight. It was a real knockdown drag out fight to just say, we have got to be transparent. Well, that’s the way the consumer’s moving. And now, the Feds are moving in saying, “Consumers want to know the pricing is, now you have to post your pricing.” And once again, getting back to the original comment, the grumps will say, “Oh that’s horrible. We’ll just comply as much as we have to.”

The smart ones are saying, “Okay, what’s the next step? How do we introduce pricing transparency and then let consumers choose the low-cost provider or the measurement of quality.” And so, they aggregate information in such way that the consumer goes, “Yeah, that’s who I’m going to select and this is why.” And your HIPAA violation example is spot on because you can’t do this alone. You can’t do this on your willy-nilly. You’ve gotta be very purposeful, very intentional, and very wise as you introduce change.

Scott: You know, I have a comment I always make about, because I tend to make very quick choices and a lot of the…I call myself the king of unintended consequences sometimes. And so, thinking a little bit before you move forward for all those people out there trying to figure out what next steps to do if you are in a mom and pop practice, there’s a lot of different resources out there and taking a step back and trying to get a good feel about, you know, what are your overall goals? Some of it would be taking great care of your patient, which is always upfront and part of taking great care of patients to your point is, hey, set expectations regarding price as well as care. Any small business in America, set expectations. It’s all about the expectations.

Britt: One interesting experience I’m having is when I was ready to step away, I’d received my PhD, and I was committed five years with THR. I got a call from the business school here at the University of Texas at Dallas. The dean calls me and says, “We see health care as a significant industry with significant potential but lacking real business acumen.” And he was spot on. He was absolutely correct. When I got my master’s in health administration from Washington University School of Medicine in St Louis, I was one of two business majors in that field.

But, you know, now it’s $4 trillion and the dean said, “We need to prepare these students. They need to have an understanding of all the dynamics of health care and the complexities of integrating business processes.” And so, it’s just been a delight. I’ll tell you, these kids are smart. They get it. They understand that consumerism is here to stay and that they want to be part of that change. But those who don’t, I think they’re going to be…it’s going to be a rude awakening as this industry continues to pivot towards consumerism, integration of technology, responsiveness, and leadership. I mean, we are really pivoting quite rapidly.

Scott: Yeah. I think the people who are going to be successful about it are the people who kind of get excited about it and embrace it.

Britt: There’s a great organization up in Oklahoma, I have an exercise with my students and I say, “Do you know how much a hip replacement costs?” And, well, yeah, there’s probably some price list or something. I said, “Okay, here’s the exercise. Call three hospitals and ask for their pricing for a hip replacement.” You can’t get it. And then when you do get it, does it include the anesthesiologist, the radiologist? The cost varies from $17,000 to $170,000 in the United States. That’s not even talking about…one entrepreneurial student called the Philippines and he got it for, you know, a tenth of that price.

So, we could talk ad nauseam about that but the point I’m making is something as simple as pricing transparency is not prevalent in the industry, but there’s a hospital up in Oklahoma City that decided they would be completely transparent. So, they have their listing, I think it’s Oklahoma Surgical Center, and they have a picture of a body. You click on the knee or the hip, these are the prices. They’re guaranteed prices and includes everything that you would need as anesthesiologists, pre-op, post-op. Those are the kind of organizations that get it. And I think you’re seeing more and more of that in United States. Like I said, I bet many of the listeners here are on the cusp of doing something like that or have actively engaged in it.

Michael: Britt, you’ve talked a little bit about the undergraduate program that’s there at the university that you’re at. I’d love to know a little bit more about, you know, how you’re observing some of these administrators and what you’re doing to prepare them. We’ve had a few different people come on the show and talk to us about leadership, both from like the physician side of things as well as the administrators and just how impactful that can be with the entire practice, the entire hospital. But I’d love to hear more about what the university’s doing there.

Britt: Well, there’s a couple of tracks I can walk down, but one of the things I think is important is we entered to this industry. We need to understand it’s purposeful. We’re not making widgets. This isn’t a financial institution. This is taking people in their most desperate times. And so we are looking for men and women that are purpose-driven, that they want to change the world, and they can start by one small effort, one small activity. So, that’s the foundation. The building blocks on it, what’s the history? It’s fascinating. I’ll ask the kids, they’ll say, ‘Why do you have all these hospitals that are named after religious institutions?” You know, Baptist Hospital, Methodist Hospital. Why is that? Catholic Hospital?

Well, it’s because we couldn’t do anything. Patients were cared for as they died because we couldn’t treat them. It’s not till this century that we were able to introduce pharmaceuticals, antibiotics, imaging, I mean, x-rays, I mean, ultrasounds. Now, we’re talking about proton beams and gamma knives. And, you know, it sounds like a “Star Wars” convention. So, the understanding of the evolution of the technology and the foundation and then the growth, it really helps students grasp the trajectory. Now, we also have classes required in accounting and macroeconomics, comparatives with internationals. You know, as I mentioned, I grew up in Canada. And when we were in Canada, we loved to tease the Americans and say, “Oh, we get free health care.”

But if you’re a Canadian, you go, “This healthcare, I’m probably going to die before they see me.” So, we do comparatives of the international. And the regulatory, we have one class, the entire class is on the regulatory environment. We have an attorney, she’s phenomenal. She was part of the Dallas-Fort Worth Household Council and an executive with them for years, and she teaches the regulatory environment, pharmaceuticals, nutrition, you know, the list goes on and on. So, those are the foundationals.

Then we split off the specific sidewalks, like, we need better communication in health care. I mean, how many advertisements do you see on the TV about pharmaceuticals? And at the end it says, “Oh, and by the way, there is a possibility that this medicine will kill you, harm you, maim you, mutilate you,” and you’re there like, “Well…” So, one of the swim lanes that we’re focusing on is communications.

How do we communicate through social media, through interactive portals? You know, how do you capture? Then the other portal that we really see is the integration of technology. How do we help practitioners gather really relevant information to make wise decisions about the diagnosis? Not the treatment, but the determination of what the illness is. How many times do we have a misdiagnosis, right? We have a disease that we don’t quite know what it is, so we give it a general generic term, but we’re still not quite sure why it manifests itself in the way it does.

So, we teach our kids, you know, these are two big areas that opportunities will grow. That doesn’t even get into the space of the revenue cycle, or supply chain, or… I could go on, 3D printing. I mean, how about a hip replacement? And instead of having a hip that you have to order, in the OR, you have a 3D printer that builds an orthotic for you right there in the OR. I mean, OR just sound like has some exciting things.

Michael: Absolutely. You know, one of the many things that you’ve covered there, the whole aspect of communications and how hospitals and health care systems communicate with their patients in general. You know, we’ve had some different folks on the show, you know, Dr. Smith was one of the ones that I think about first kind of talking about how he interacts with patient. But I love this concept of moving that responsibility and moving that ability, in general, that capability beyond just the doctor. It’s not just the doctor that needs to be giving those public service announcements for lack of a better term because, you know, we do a lot of work within marketing and so a lot of the conversations that we have with practices are around, “Here’s how to communicate for the sake of attracting patient.” But that’s only a fraction of the communication that practices and hospitals need to be doing. There’s so much more that they need to be getting across.

Britt: So true. And the unintentional communication. You know, I was running a big 900-bed hospital in Dallas, Texas. And, you know, you’d walk down the hall and you just assume everyone knew how to get where they wanted to go. And you just assume that when a woman is diagnosed with a lump in her breast, that she’ll immediately know to contact an oncologist and that she’ll enter… Obviously, it’s so untrue. Communication is imperative. And to help people navigate through that experience, practitioners need to be much more attuned to that.

And it’s not just by word, it’s by virtually every touch point in their experience. So, they call it the patient experience. And, you know, the book talks about “get great people.” The book talks about “if you want to be attentive to this, you can have the best strategies in the world.” But if you have individuals that are disengaged, you just hired them from the DMV, they used to work as a fast food and you’ve tried to infusing them the sense of purpose and meaning, that’s a hard, hard challenge. So, build a great team, introduce innovative change, and lead the organization through that change.

Scott: Yeah, I couldn’t agree with you more. The idea that only the doctor, only the caregiver can provide information, I mean, it’s just not appropriate anymore. You talked about a patient who could have potentially breast cancer and just trying to figure out what to do next. Obviously, they need to communicate well with their doctor, their primary care provider, their oncologist, and there’s so many people along the way that can make that journey so much easier for everyone, of course, for the patient where it’s done…

Britt: Well, not only that, but we’re going to be forced into it if we don’t embrace it. The smart ones are engaging in bringing in talent to help them understand that. The dumb ones are waiting for it to be imposed upon them. A perfect example is HCAHPS Scores in hospitals. We’ll do a patient satisfaction survey, we’ll see how happy people are, but the ORs are busy, the hospital beds are full, blah, blah, blah. Now, if you don’t have a happy patient, you get penalized and reimbursement through the Medicare program as HCAHPS.

Don’t you think that’s going to occur even more, and that we’re going to be able to measure quality? So, if your systems and processes don’t work in your office or your clinic, you’re cruising for a bruising because there’s an economic penalty for that. And the consumers…I remember these HCAHPS Scores. I used to say, “Oh, I can’t believe. These are patients that are sick and, of course, they’re not going to be happy.” And then that was indefensible. That was completely indefensible because…

Scott: That’s a definite culture shift. You know, thinking a little bit about the small practice and how some of these principles, do they apply in the same way when you’re talking to, say, a practice with, say, four practitioners?

Britt: Absolutely. Probably, even more so and more intimate. I would suggest that big health care delivery systems that are monolithic move very slowly and implement change very slowly. So, their competitors move with that same cadence. So, if Baylor introduces a new program and it starts to erode market share, that will occur over a prolonged period of time. But in the clinic, it can be almost instantaneous.

Patients will shift the legions that quick if they do not have an expectation met and an experience, they’ll immediately move. And the older generation, we’re loyal to a physician. There used to be a time when, you know, it’s Dr. Smith, and I’ve gone to Dr. Smith for generations. This new generation, if you don’t provide to me and fulfill my expectations, I will find someone else and I’ll get on the internet. And soon, you’ve got Yelp for restaurants, there’ll be Melp for medical. They’ve already…

Scott: It’s there. We do quite a bit of reputation marketing development and advising in that whole area. It’s there. It’s actually a good thing.

Britt: Absolutely.

Scott: I’ve never spoken to a medical care provider who didn’t care about their patients and the opinions of their patients. Now, they might get indignant because they didn’t like what they said, that’s a whole different conversation, but they care and…

Britt: Let me push back just a little bit on that. They care, but do they care enough to change? Do they care…is this discomfort so central to who they are that they’re willing to give you guys a call and say, “Hey, come help us?” Or is it just….

Michael: Thankfully doc, I will tell you this. Most of the practices with which we work…now, again, we work with much more on the mom and pop, you know… Like the quotes of anywhere from 1 to say 20, they really do care and the vast majority try to figure out, you know, “What do I need to do?” To the point where we’ve had actually some practices reach out to us about, like, “Do you have any people like coaches or advisors that we can talk to?” And one of our podcasts was actually with a team that helps coach and one of their things was like, you know, the day’s long and hard, you know, so everybody in that clinic, when they go see 60 people, it’s not just the doc that’s working really hard and the doc is.

There’s a whole team of people shuttling people in and out trying to get them billed, try to get them taken care of. And one of the comments that that person said was like, you know, at the end of that day, instead of just going home, thank them. You’ll get a lot of buy-in. You know, just like you were saying about that team approach.

Britt: One of them real fun things that I’m doing. So, I consider myself an academic now. I’ve got a Tweed jacket, I’ve got, you know, elbow patches. I’m all in and I love it. But because of the popularity of the book, I’ll get calls from health care systems to say, “We have a poor-performing hospital or area, you know, our IT is dysfunctional, can you come and do a cultural assessment?” And I gotta tell you that it’s a blast because I’ll go in for two days and I’ll just interview people on those dimensions that are contained in our book. And that cultural assessment is a precursor or a predeterminer if an organization is willing to change. And I love that because like they say, “Culture eats strategy every day.” You could have a beautiful facility in an ideal location, but if your culture is toxic, failure’s on the horizon. So, that’s a great place to be. And I’m inspired by the people that are in that space right now that are willing to do more and lead change in health care.

Michael: This is exciting stuff, Britt. Thank you so much for coming on the show. Obviously, we could keep going in a lot of different topics. I love that we get to come in contact with so many people that are so passionate about this space. So, thank you so much for being on the show and for doing what you’re doing, sir.

Britt: My pleasure. My pleasure. Reach out here at the University of Texas at Dallas anytime, as we say, “Health care is our business.” So great to be with you today. Thanks for the invitation.

Scott: Thanks so much, Britt.

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.