Podcasts about healthcare improvement

Healthcare improvement is never just about systems, measures, policies, or processes; it is fundamentally about people. In this special transition episode, Dr. Philip McAdoo introduces himself as the new host of Turn on the Lights, a podcast by the Institute for Healthcare Improvement (IHI). He honors the foundational work of previous hosts Don and Kate while laying out an expansive vision for the podcast's next chapter. To bridge where the show has been with where it is going, Philip announces a summer series re-broadcasting the five most popular episodes from the past year. These episodes cover critical subjects like patient-centered quality, the systemic roots of patient safety, Medicaid access, inclusivity in healthcare measurement, and the financial complexities behind rising premiums. Looking ahead, Philip shares his commitment to widening the podcast's frame by treating stories as evidence, balancing data with human dignity, and bringing frontline workers, patients, and marginalized communities directly to the table. About Philip McAdoo Dr. Philip Dorian McAdoo is an organizational strategist, educator, author, advocate, and storyteller. He serves as Director of Internal Equity & Workplace Well-Being at the Institute for Healthcare Improvement, where he helps strengthen the cultures, practices, and conditions that allow people and systems to improve. As host of Turn on the Lights, Philip brings a human-centered lens to conversations about trust, dignity, leadership, and building better healthcare systems. Resources: Connect with and follow host Philip McAdoo on LinkedIn Learn more about the Institute for Healthcare Improvement (IHI) by visiting their LinkedIn and website. Learn more about your ad choices. Visit megaphone.fm/adchoices

What if your healthcare team already knew what happened during your hospital stay — before you even explained it? What if someone on your care team noticed you were struggling on a Saturday and simply showed up? In this episode, Jamie sits down with Christopher Laffey, Nurse Practitioner at Your Health, to break down what a truly connected, proactive model of care actually looks like when it's working. Christopher practices in North Charleston, SC, where his team — nurses, therapists, social workers, community health workers, and more — functions less like a traditional office practice and more like a living, breathing safety net woven around each patient's real life. What you'll hear in this episode: Why most patients are failing not because nobody cares, but because the system itself is fragmented — and what doing it differently actually looks like on a Tuesday morning The real difference between "patient-centered" as a marketing phrase and patient-centered as a daily practice (hint: it involves seeing the medication bottles on the kitchen table) A powerful real-life story of a bedbound patient whose caregiver suddenly disappeared — and how the team mobilized over a weekend, on their own time, to prevent a hospitalization The single mindset shift every clinician needs to make the transition from visit-based thinking to longitudinal care Why "value-based care" doesn't mean discounted care — it means the organization is accountable for your outcomes, not just your appointments If you've ever left a doctor's appointment feeling more confused than when you walked in, this episode will show you what healthcare can feel like when it's actually designed around you. www.YourHealth.Org

What happens after 150 conversations about the future of health care? In this episode, co-hosts Dr. Don Berwick, Former Administrator and CMS President Emeritus at IHI, and Dr. Kedar Mate, Founder & CMO of Qualified Health-genAI for Healthcare and Former CEO of IHI, look back on more than 150 conversations exploring health care reform, patient advocacy, medical debt, AI, and global health systems. They discuss how the podcast evolved into a platform for making complex health care topics more understandable through candid conversations and personal storytelling. The hosts also announce a transition as the podcast continues under the Institute for Healthcare Improvement, with new leadership, while they prepare their next collaborative project. Looking ahead, they share their excitement about diving deeper into subjects like artificial intelligence, international health care comparisons, and investigative-style series shaped by listener feedback. Tune in to hear Don Berwick and Kedar Mate reflect on what they learned, what surprised them most, and where the conversation about health care innovation, AI, and reform goes next! Resources: Connect with and follow Dr. Don Berwick on LinkedIn or reach out via email! Connect with and follow Dr. Kedar Mate on LinkedIn or reach out via email! Follow IHI on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices

Does healthcare have a moral emergency? In this episode of the Medicine and Science podcast, Kamran Abbasi sits down with healthcare leaders Maureen Bisognano, president emerita of the Institute for Healthcare Improvement and Bob Klaber, director of strategy at Imperial College Healthcare NHS Trust, to discuss why they're calling the lack of humanity in medicine an emergency. We ask why this dangerous imbalance between the rational (efficiency, data, and metrics) and the relational (human connection, empathy, and listening) has developed in modern medicine. We also learn how simple changes, like asking "What matters to you?" instead of just "What's the matter?, can help us put the humanity back into healthcare.   Reading list Read the BMJ Article: Healthcare's moral emergency: reconnecting healthcare with its mission and purpose Michael West on workforce kindness Amy Edmondson on psychological safety Len Berry on cancer care & kindness  

Lavon Medlock has spent over two decades enhancing leaders' skills in problem-solving and coaching. Skilled in a variety of continuous improvement methods, she has trained leaders in creating effective daily management systems, deployed an integrated facility design approach to new construction projects like a 90,000-square-foot patient tower, and enhanced operations across different sectors.With a primary focus on the healthcare industry, Lavon has worked with clinical leaders to combine the Institute of Healthcare Improvement's teachings on quality with A3 thinking and key project management principles. She's a practitioner, teacher, and coach in the field of A3 thinking and holds certifications in both Project Management (PMI-PMP) and Six Sigma Green Belt.In addition to instructing and coaching for the Lean Enterprise Institute, she teaches graduate coursework at The Ohio State University. Her educational background includes a Bachelor of Science in Public Health from the University of North Carolina at Chapel Hill and a Master of Science in Healthcare Administration from Oregon Health & Science University.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

In episode 299 of the IDEAS+LEADERS Podcast, I'm joined by Jeff Wetherhold, Harvard-trained behavioral scientist, change leadership expert, and faculty member with the Institute for Healthcare Improvement. Jeff has spent more than 20 years helping leaders engage people in meaningful change through the principles of Motivational Interviewing, bringing evidence-based communication strategies from healthcare into leadership, education, government, and nonprofit organizations.We talk about why so many change initiatives fail, why difficult conversations often create resistance instead of reflection, and how leaders can recognize the early signs of disengagement before they become conflict. Jeff shares practical insights on leading change with curiosity, dignity, and less exhaustion while building genuine commitment instead of compliance.In this episode, we discuss:• Why 88% of change efforts fail to create lasting impact• Why clarity and honesty alone don't guarantee productive conversations• How leaders unintentionally create defensiveness instead of engagement• The early language signals that reveal ambivalence before resistance appears• How Motivational Interviewing helps leaders create trust, ownership, and lasting changeThis is a practical and thought-provoking conversation for leaders, managers, coaches, and anyone who wants to communicate more effectively while leading people through uncertainty and change.You can connect with Jeff here: https://www.changewithdignity.com/https://www.linkedin.com/in/wetherhold/Thank you for joining me on this episode of IDEAS+LEADERS. If you enjoyed this episode, please share, subscribe and review so that more people can enjoy the podcast on Apple https://apple.co/3fKv9IH or Spotify https://sptfy.com/Nrtq.

What if the most powerful thing you could do for your patients, your teammates, and your own career is simply to say: I made a mistake? In this episode of Your Health University, host Jamie Preston is joined by the Your Health Patient Experience Team — Jennifer Kistler, Kim Metz, Whitney Myers, Carlos Heyward, and Rebecca Dillard — for one of the most honest conversations in this Values Series yet: a deep dive into integrity. Not the word on the wall, but the daily practice of accountability, consistency, and courage that defines who we really are. What you'll hear in this episode: Why fear is the single biggest barrier to integrity in healthcare — and what leadership must do about it The real-time story of Rebecca owning a patient complaint oversight at 5:45 AM, and why it made all the difference Whitney's powerful reframe: integrity isn't just doing the right thing when no one's watching — it's consistency, whether it's easy or hard Jennifer's insight on how strong patient-provider relationships reduce malpractice suits — and why that starts with honesty The unforgettable story of a million-dollar mistake, a resignation letter, and a CEO who said: "Why would I let you go? I just spent a million dollars training you." Integrity matters here. At Your Health, it's not a policy — it's a promise. Press play and find out what it looks and feels like when an entire team commits to living it every single day. www.YourHealth.Org

What if the resistance you're seeing in your organization isn't defiance, it's information? What if the way you're talking about change is the very thing blocking it? Episode Summary In this episode of A World of Difference, host Lori Adams-Brown sits down with Jeff Wetherhold, founder of the Sustainable Change System and MI for Health, to unpack why 88% of organizational changes produce no lasting results, and what evidence-based leaders can do differently. Drawing on more than 20 years of experience and the robust science of motivational interviewing (MI), Jeff offers a radically practical reframe: your team isn't resistant. They're ambivalent. And that ambivalence is something you can actually work with. What You'll Learn Why traditional change management frameworks often fail — and what survey data reveals people actually need How to hear the difference between 'change talk' and 'sustain talk,' and why reflecting the wrong one can derail an entire initiative The evidence behind motivational interviewing: 2,000+ randomized control trials, 200+ meta-analyses, and applications across fields from healthcare to organizational transformation Why resistance is a 'blanket term' that blinds leaders to actionable insight — and what to ask instead The critical difference between intrinsic and extrinsic motivation, and why leaders who rely on extrinsic shortcuts exhaust themselves What makes change stick: the role of practice, systems, and sustained organizational support — not just training Guest Bio Jeff Wetherhold is the founder of the Sustainable Change System and MI for Health, where he equips leaders and organizations with evidence-based communication skills for navigating change. He is a faculty member with the Institute for Healthcare Improvement, a member of the Motivational Interviewing Network of Trainers (MINT), and a Prosci-Certified Change Practitioner, with clients including the State of Illinois, MIT, and the University of Nebraska Medical Center. Timestamps 00:00 Introduction — what if resistance is information? 02:30 Jeff's background: behavioral science, adult learning & change management 04:00 What the data says: 88% of organizational changes produce no lasting results 07:00 The 'why' problem — why leaders think they've communicated, but haven't 09:30 Cross-cultural dimensions of change communication (Erin Meyer, The Culture Map) 11:30 Intrinsic vs. extrinsic motivation — why shortcuts backfire 14:30 What Jeff does differently: skills + practice vs. frameworks alone 18:00 What is motivational interviewing? Origins, evidence, and applications 21:50 Reframing resistance: change talk, sustain talk, and the 19x rule 28:40 Champions for change — why volunteering someone into a title isn't enough 34:40 Real stories: one manager's shift, and a holiday table breakthrough 38:55 How to work with Jeff + Patreon preview Check out the Patreon exclusive with Jeff on how he would advise a leader on talent strategy here. Connect with Jeff Website: jeffwetherhold.com LinkedIn: Jeff Wetherhold Sustainable Change System + MI for Health: jeffwetherhold.com Connect with the Show Subscribe, leave a review at https://www.aworldofdifferencepodcast.com/reviews/new/, and share this episode with five people who lead people through change. Visit https://www.aworldofdifferencepodcast.com for more resources. Join our Patreon community of Difference Makers: patreon.com/aworldadifference Learn more about your ad choices. Visit megaphone.fm/adchoices

What if the resistance you're seeing in your organization isn't defiance, it's information? What if the way you're talking about change is the very thing blocking it? Episode Summary In this episode of A World of Difference, host Lori Adams-Brown sits down with Jeff Wetherhold, founder of the Sustainable Change System and MI for Health, to unpack why 88% of organizational changes produce no lasting results, and what evidence-based leaders can do differently. Drawing on more than 20 years of experience and the robust science of motivational interviewing (MI), Jeff offers a radically practical reframe: your team isn't resistant. They're ambivalent. And that ambivalence is something you can actually work with. What You'll Learn Why traditional change management frameworks often fail — and what survey data reveals people actually need How to hear the difference between 'change talk' and 'sustain talk,' and why reflecting the wrong one can derail an entire initiative The evidence behind motivational interviewing: 2,000+ randomized control trials, 200+ meta-analyses, and applications across fields from healthcare to organizational transformation Why resistance is a 'blanket term' that blinds leaders to actionable insight — and what to ask instead The critical difference between intrinsic and extrinsic motivation, and why leaders who rely on extrinsic shortcuts exhaust themselves What makes change stick: the role of practice, systems, and sustained organizational support — not just training Guest Bio Jeff Wetherhold is the founder of the Sustainable Change System and MI for Health, where he equips leaders and organizations with evidence-based communication skills for navigating change. He is a faculty member with the Institute for Healthcare Improvement, a member of the Motivational Interviewing Network of Trainers (MINT), and a Prosci-Certified Change Practitioner, with clients including the State of Illinois, MIT, and the University of Nebraska Medical Center. Timestamps 00:00 Introduction — what if resistance is information? 02:30 Jeff's background: behavioral science, adult learning & change management 04:00 What the data says: 88% of organizational changes produce no lasting results 07:00 The 'why' problem — why leaders think they've communicated, but haven't 09:30 Cross-cultural dimensions of change communication (Erin Meyer, The Culture Map) 11:30 Intrinsic vs. extrinsic motivation — why shortcuts backfire 14:30 What Jeff does differently: skills + practice vs. frameworks alone 18:00 What is motivational interviewing? Origins, evidence, and applications 21:50 Reframing resistance: change talk, sustain talk, and the 19x rule 28:40 Champions for change — why volunteering someone into a title isn't enough 34:40 Real stories: one manager's shift, and a holiday table breakthrough 38:55 How to work with Jeff + Patreon preview Check out the Patreon exclusive with Jeff on how he would advise a leader on talent strategy here. Connect with Jeff Website: jeffwetherhold.com LinkedIn: Jeff Wetherhold Sustainable Change System + MI for Health: jeffwetherhold.com Connect with the Show Subscribe, leave a review at https://www.aworldofdifferencepodcast.com/reviews/new/, and share this episode with five people who lead people through change. Visit https://www.aworldofdifferencepodcast.com for more resources. Join our Patreon community of Difference Makers: patreon.com/aworldadifference Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a MessageIn this episode of Culture Change RX, Sue Tetzlaff explores the nine essential 'ITs' of customer service excellence in healthcare. She emphasizes that building a multi-faceted systematic approach, rather than just providing training, is key to achieving sustainable service quality and patient satisfaction.Quotes from the episode: “Exceptional service is not created by training alone — it is created by systems.”“Organizations that excel in service don't just focus on patients — they invest equally in their people.”“Service excellence is not the end goal — it is part of something bigger: organizational vitality.”“Leadership behavior sets the ceiling for the organization.”“We have to move from training for service… to building systems for service excellence.”“A strong employee experience enables a strong patient experience.”“Data should drive improvement — not overwhelm, punish, or confuse.”“Service excellence is not a service initiative — it is a people-plus-systems outcome.”We're stepping forward in a bigger way—growing our team of rural healthcare experts, growing our capabilities by adding a strategic planning division … all of this so we can expand our ability to help even more rural hospitals and other small healthcare organizations in 2026. … We'd love to explore how we can support your organization in being the provider- and employer-of-choice so you can keep care local and margins strong! Learn more at CaptoneLeadership.net Learn more and register for the 2026 Healthcare Executive Forum - We look forward to seeing you on June 17-18 in Madison, Wisconsin!Hi! I'm Sue Tetzlaff. I'm a culture and execution strategist for small and rural healthcare organizations - helping them to be the provider and employer-of-choice so they can keep care local and margins strong.For decades, I've worked with healthcare organizations to navigate the people-side of healthcare, the part that can make or break your results. What I've learned is this: culture is not a soft thing. It's the hardest thing, and it determines everything.When you're ready to take your culture to the next level, here are three ways I can help you:1. Listen to the Culture Change RX PodcastEvery week, I share conversations with leaders who are transforming healthcare workplaces and strategies for keeping teams engaged, patients loyal, and margins healthy. 2. Subscribe to our Email NewsletterGet practical tips, frameworks, and leadership tools delivered right to your inbox—plus exclusive content you won't find on the podcast.

What if the greatest threat to healthcare isn't a broken system — it's a dehumanized one? In this episode of Experiencing Healthcare, Jamie Preston and Your Health CEO Matt Staub wrestle with a deceptively simple idea from Harvard Business School Professor Ryan Buell: service is the business of people helping people. Sparked by Matt's experience at an Athena Health executive leadership forum, this is a conversation about what it truly means to serve — in a world where technology promises to do it faster, cheaper, and at scale. Key topics covered: Why you can never fully take people out of a service industry — and what happens to care quality when you try How ambient listening technology like Mobius is using AI to restore human connection in the exam room, not replace it The ICU nurses who used tough love to get a post-heart-surgery patient walking — and what that story reveals about what genuine service really looks like The "can vs. should" question every healthcare leader must ask before deploying new technology How to show up and serve others with excellence, even on your hardest personal days Healthcare will always evolve — but Matt and Jamie make a compelling case that the human at the center of care is the one thing worth protecting above all else. This one's worth the listen.

Protecting nurses and healthcare workers physically and mentally is not just one component of the Safer Together National Action Plan; it may be the one that holds all the others together.   In this third episode of our Safer Together series, Patricia McGaffigan, RN, MS, Vice President of Safety at IHI, President of the Certification Board for Professionals in Patient Safety, and co-chair of the National Steering Committee for Patient Safety talks with Christine Pabico, Senior Director of the American Nurses Credentialing Center's Pathway to Excellence and Well-Being Excellence Programs.  Patricia and Christine trace the development of ANCC's Well-Being Excellence Credential, the first of its kind to encompass the entire workforce across every type of care setting. We also hear from two of its pilot organizations, Children's National Hospital in Washington, D.C., and BayCare Health System in Tampa Bay, to hear how they became certified through the ANCC Wellbeing Certification and what that means for their organizations.   Patricia McGaffigan, MS, RN, CPPS  ·  Senior Advisor for Safety, Institute for Healthcare Improvement (IHI); President, Certification Board for Professionals in Patient Safety; Co-chair, National Steering Committee for Patient Safety  Christine Pabico, PhD, RN, NE-BC, FAAN  ·  Senior Director, Pathway to Excellence and Well-Being Excellence, American Nurses Credentialing Center (ANCC)  Nikki Daily  ·  Chief Team Resources Officer, BayCare Health System   Rocky Hauch, DNP, RN, PCCN  ·  Advanced Professional Development Practitioner and Nurse Well-Being Lead, BayCare Health System  Trish Shucoski, DNP, MSN, RN, NEA-BC  ·  Chief Nurse Executive, BayCare Health System  Simmy King, DNP, MS, MBA, NI-BC, NE-BC, CHSE, FAAN  ·  Chief Nursing Informatics and Education Officer; Associate Professor of Pediatrics, The George Washington University School of Medicine    Safer Together Series In the first episode of our Safer Together Series, Donald Berwick, MD, co-founder and President Emeritus of the Institute for Healthcare Improvement, and Patricia McGaffigan, RN, MS, Vice President of Safety at IHI, President of the Certification Board for Professionals in Patient Safety, and co-chair of the National Steering Committee for Patient Safety, issued a call to action: safety is not a matter of individual effort; it is a total system responsibility, built on four interlocking pillars, one of which is workforce safety and well-being.   In the second episode, Kelly Randall, PhD, Vice President for Patient Safety and Regulatory Services at Ascension, where she leads the health system's comprehensive patient safety program, high reliability strategy, and system-wide deployment of the Safer Together National Action Plan, showed us what it looks like to answer that call, shifting culture across nearly 100 hospitals, one huddle, one conversation, one near-miss at a time.    Resources   1. The Foundational Workforce-Safety Lucian Leape Institute. (2013). Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston: National Patient Safety Foundation. https://www.ihi.org/library/publications/through-eyes-workforce-creating-joy-meaning-and-safer-health-care  Gandhi, T. K., Kaplan, G. S., Leape, L., et al. (2018). Transforming concepts in patient safety: A progress report. BMJ Quality & Safety, 27(12), 1019–1026. https://doi.org/10.1136/bmjqs-2018-008768 https://pmc.ncbi.nlm.nih.gov/articles/PMC6288701/    2. The Safer Together National Action Plan  National Steering Committee for Patient Safety. (2020). Safer Together: A National Action Plan to Advance Patient Safety. Boston, MA: Institute for Healthcare Improvement. https://www.ihi.org/partner/initiatives/national-steering-committee-patient-safety/national-action-plan-advance-patient-safety  Integrating the Safer Together National Action Plan to Improve Nurse-Led Models Focused on Patient Safety. PubMed. https://pubmed.ncbi.nlm.nih.gov/40876046/    3. Nurse Burnout and Patient Safety  Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., & Shanafelt, T. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Network Open, 7(11), e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059  Getie, A., Ayenew, T., Amlak, B. T., Gedfew, M., Edmealem, A., & Kebede, W. M. (2025). Global prevalence and contributing factors of nurse burnout: An umbrella review of systematic reviews and meta-analyses. BMC Nursing, 24(1), 596. https://doi.org/10.1186/s12912-025-03266-8  Smiley, R. A., Kaminski-Ozturk, N., Reid, M., et al. (2025). The 2024 National Nursing Workforce Survey. Journal of Nursing Regulation, 16(1), S1–S88. https://doi.org/10.1016/S2155-8256(25)00047-X    4. Workplace Violence Against Nurses  Pascale, A., George, N., Potter, C., & Warshawsky, N. E. (2025). Alarming rise in nurse assaults: Urgent call for legislation. Nurse Leader, 23(3), 321–327. https://doi.org/10.1016/j.mnl.2024.12.012  Wolf, L. A., Delao, A. M., & Perhats, C. (2014). Nothing changes, nobody cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care. Journal of Emergency Nursing, 40(4), 305–310. https://doi.org/10.1016/j.jen.2013.11.006    5. ANCC Well-Being Excellence Credential  Carson, W., & Bates, M. (2024). Elevating professional well-being in healthcare: A crosswalk of the NIOSH Impact Wellbeing campaign and the ANCC Pathway to Excellence Framework. Nursing Administration Quarterly. https://pmc.ncbi.nlm.nih.gov/articles/PMC11373476/  American Nurses Credentialing Center. (2025). ANCC Well-Being Excellence Credential. NursingWorld.org. https://www.nursingworld.org/organizational-programs/well-being-excellence    6. Nurse Well-Being: Building Peer and Leadership Support Program  American Nurses Foundation. (n.d.). Nurse well-being: Building peer and leadership support program. NursingWorld.org. https://www.nursingworld.org/foundation/programs/nurse-wellbeing/    7. Healthy Nurse, Healthy Nation  American Nurses Association. (n.d.). Healthy Nurse, Healthy Nation. https://www.healthynursehealthynation.org/     

Today, we're going to back at the recent BJGP Research Conference, which was held just last week on the 20st of March 2025 in Bristol. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.960 - 00:00:39.550Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today.In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest.And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson.Speaker B00:00:40.270 - 00:01:16.520My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work.But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved.It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day.Speaker A00:01:17.320 - 00:03:26.850So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas.We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia.The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust.And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well.And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers?And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level.And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself.And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day.Here's just a short snippet of Martin speaking at the conference.Speaker C00:03:27.570 - 00:04:45.260I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy.It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept.So sometimes just a window opens that allows you to do something.And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs.And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change.The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can.Speaker A00:04:46.460 - 00:11:57.780So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work.And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers.There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future.At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research.Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research.And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion.And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work.And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice.And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate.And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics.And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program.He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work.So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience.And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away.And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne.And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint.Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice...

Healthcare organizations keep adding new tools, yet frontline frustration continues to grow. More dashboards. More data. Slower decisions. This conversation digs into why focusing on integrating existing technologies together can make a bigger difference for clinicians and patients.In this interview, Josh Clark, Vice President of Quality & Safety Operating Systems at the Institute for Healthcare Improvement (IHI), shares what he's seeing across health systems globally. He explains why integration, not acquisition, has become the real bottleneck in healthcare IT, how delayed data undermines frontline decision-making, and where process-level insights can improve care in real time.Josh also discusses why IHI often advises organizations to pause new technology adoption, how CIOs can gain space to focus on integration, and where AI has the most practical potential to improve quality and safety without adding more burden.

What if the most expensive healthcare decisions aren't made in the boardroom — but in the exam room, when the wrong infection gets treated with the wrong antibiotic? In this episode of the Your Health University, Podcast, Jamie sits down with Madison Browning, a registered nurse in urology at Your Health, to talk about what proper urological care actually looks like, why it matters far beyond the individual patient, and how a strong, collaborative provider team is the difference between a patient thriving and a patient stuck in a revolving door of emergency room visits. What you'll hear in this episode: Why getting a UTI diagnosis right the first time has massive implications for patient health and system costs The role nurse practitioners play in specialized urology care — and why their expertise is often underestimated How the team-based model at Your Health empowers every provider to collaborate and deliver better outcomes The direct connection between outpatient urology care and reduced hospital stays, ER visits, and downstream Medicare and tax costs Madison's genuine gratitude for the team around her — and what it looks like when a healthcare culture actually works If you've ever wondered whether the healthcare system could do better — this episode is proof that it already is, one patient at a time. www.YourHealth.Org

Surgical quality is a term that is often thrown around in surgical practice. We have multiple quality improvement projects, metrics and benchmarks that motivate us to do better, and of course the ever expanding patient reviews to possibly “reflect” the type of surgical care provided. But what does quality actually mean? What metrics can we use to understand the type of care being provided by ourselves, our colleagues, and the health system at large. Today, we delve into these questions to understand how quality is currently understood within surgery and how we hope it to evolve in the future. Joining BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam are two fantastic guests - Dr. Mark Cheetham, joining us from the UK, has deep experience in national audits and system-level quality improvement. Dr. Cheetham is a colorectal surgeon and the National Clinical Lead for General Surgery at the Getting it Right First Time Programme in NHS England, or GIRFT. Dr. Alexander Perez is representing the US; he is a board-certified general surgeon and minimally invasive surgeon at Baylor St. Luke's Medical Center. He has worked extensively with institutional quality programs and is the current assistant Dean for patient safety, simulation, and process improvement at the Baylor College of Medicine. Resources: Institute for Healthcare Improvement: https://www.ihi.org/library/tools/quality-improvement-essentials-toolkit NSQIP: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/ Getting it right first time (UK): https://gettingitrightfirsttime.co.uk/ ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Send us a MessageIn this episode of Culture Change RX, Sue Tetzlaff, cofounder of Capstone Leadership Solutions, discusses the unique advantages of small and rural healthcare organizations. She emphasizes the strengths of relationships, agility, and community loyalty, arguing that these factors contribute to a strategic advantage in the healthcare sector. Sue shares insights on how small organizations can leverage their size to foster deeper connections, adapt quickly to changes, and ultimately provide better care for their communities - making the preferred choice, the better choice. The episode concludes with a call to action for small healthcare organizations to embrace their strengths and challenge the notion that bigger is better.We're stepping forward in a bigger way—growing our team of rural healthcare experts, growing our capabilities by adding a strategic planning division … all of this so we can expand our ability to help even more rural hospitals and other small healthcare organizations in 2026. … We'd love to explore how we can support your organization in being the provider- and employer-of-choice so you can keep care local and margins strong! Learn more at CaptoneLeadership.netHi! I'm Sue Tetzlaff. I'm a culture and execution strategist for small and rural healthcare organizations - helping them to be the provider and employer-of-choice so they can keep care local and margins strong.For decades, I've worked with healthcare organizations to navigate the people-side of healthcare, the part that can make or break your results. What I've learned is this: culture is not a soft thing. It's the hardest thing, and it determines everything.When you're ready to take your culture to the next level, here are three ways I can help you:1. Listen to the Culture Change RX PodcastEvery week, I share conversations with leaders who are transforming healthcare workplaces and strategies for keeping teams engaged, patients loyal, and margins healthy. 2. Subscribe to our Email NewsletterGet practical tips, frameworks, and leadership tools delivered right to your inbox—plus exclusive content you won't find on the podcast.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, speaks with Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, about her Norma J. Shoemaker Honorary Lecture at the 2025 Critical Care Congress and the transformative impact of the 4Ms framework—What Matters, Medication, Mentation, and Mobility—on age-friendly critical care. Dr. Fulmer shares her journey from bedside critical care nurse to national leader in geriatric health, emphasizing the need to adapt healthcare systems to meet the needs of an aging population. She discusses the development of the Age-Friendly Health Systems initiative, a collaboration among the John A. Hartford Foundation, Institute for Healthcare Improvement, American Hospital Association, and Catholic Health Association. Now implemented in nearly 5000 facilities, the initiative is supported by evidence from models such as the Acute Care of the Elderly (ACE) units, Hospital Outcomes Program for Elders (HOPE) initiative, and Nurses Improving Care for Healthsystem Elders (NICHE) program. The episode highlights the January 2025 adoption of a Centers for Medicare and Medicaid Services measure that incorporates the 4Ms into inpatient care standards. Dr. Fulmer explains how hospitals of all sizes can implement age-friendly practices using existing resources and how multiprofessional collaboration is key to success. She also discusses findings from a national survey from Age Wave and the John A. Hartford Foundation, which revealed that only 19% of older adults feel their clinicians consistently address all 4Ms. Listeners will gain insight into how the 4Ms framework improves outcomes and promotes functional recovery in older adults. Whether you're a clinician, educator, or healthcare leader, this episode offers practical strategies and a compelling call to action to join the age-friendly health systems movement.

Today, we're in the city of Scarborough in the northwestern state of Maine, USA, to chat with Jeff Wetherhold, a trainer and coach with 15+ years of experience supporting hundreds of teams in making and sustaining change with improved outcomes. Jeff is a member of the Motivational Interviewing Network of Trainers who has trained and practiced in quality improvement, motivational interviewing, facilitation, mediation, negotiation, and evaluation. He is also a faculty member of the Institute for Healthcare Improvement, where he has supported healthcare organizations in adopting evidence-based safety practices. Throughout his career, Jeff has observed that the most common obstacle to change is poor-quality conversations. Motivational interviewing is the most effective discipline that he has found for improving those conversations, both with patients and within teams.  Visit the C4C website to gain full access to the transcript, show notes, and guest links.  Coaching 4 Companies  

In this episode, Sylvia Trent-Adams, President and CEO of the Institute for Healthcare Improvement, shares how IHI is helping health systems strengthen operations, integrate technology, and build resilient, patient-centered organizations. She also outlines her vision for advancing quality, safety, and workforce well-being in the decade ahead.This episode is sponsored by Institute for Healthcare Improvement.

Dr. Mike Heenan is the President and CEO of St. Joseph's Health System and President of St. Joseph's Healthcare Hamilton. On the episode, Mike tells us about a time when he received one very striking complaint and how it pivoted his work and that of the organization. We also speak to Mike about his career path and how no matter who you are, you can have an impact on someone's life. Throughout his career, Mike has dedicated a lot of time to learning. He shares with us his views on how it's an important balance for all of us to keep in view. While covering some heavy but important topics, Mike also touches on how his family grounds him. And of course, how he's a big Blue Jays fan! Quotables: “I think when you go through life and you say what's my value proposition, it allows you to focus on what gets you up every day and it doesn't look like a transactional job, but a career calling.” – M. Heenan “It's these real-life experiences that can stop you as a leader… but it's these humanistic ethical issues that really make a leader pivot and say enough is enough, we really need to deal with this.” – M. Heenan “This happens in coffee shops, and it happens in hospitals. And so, I'm not going to change society overnight in one healthcare organization, but I can contribute to us fixing it one incident at a time, or one hospital at a time.” – M. Heenan “Even though we have signs in our hallways across all our hospitals in this country that say there's zero tolerance, the fact of the matter is, we do tolerate some of it.”  – M. Heenan “Someone like the IHI or HIROC who sees all these different organizations can bring this very diverse perspective to a table and apply it depending on the environment.” – M. Heenan “I appreciate all of HIROC's support. Most people see HIROC perhaps from an insurance reciprocal perspective but the value-added services and the partnership it provides to the whole continuum of providing quality care…” – M. Heenan Mentioned in this Episode: -              St. Joseph's Healthcare Hamilton -              St. Joseph's Health System -              Catherine Gaulton -              HIROC -              Dr. Kevin Smith -              University Health Network -              National Museum of African American History -              Institute for Healthcare Improvement -              Longwoods -              London Health Sciences Centre -              McMaster University -              Ontario Hospital Association -              Toronto Blue Jays Access More Interviews with Healthcare Leaders at HIROC.com/podcast Follow us on LinkedIn and Instagram, and listen on Apple Podcasts, Spotify, or wherever you get your favourite podcasts. Email us at Communications@HIROC.com.

On episode 141 of PSQH: The Podcast, Dr. Sylvia Trent-Adams discusses her new role as President and CEO of the Institute for Healthcare Improvement.

This episode, recorded live at the 10th Annual Health IT + Digital Health + RCM Annual Meeting, features Josh Clark, Vice President, Quality & Safety Operating Systems, Institute for Healthcare Improvement. He discusses how IHI's CareOS approach helps healthcare organizations bridge the gap between technology and care delivery by optimizing systems, reducing clinician burden, and ensuring technology truly enables safer, more reliable care.This episode is sponsored by Institute for Healthcare Improvement (IHI)

Jeff Wetherhold is a change expert with over 15 years of experience helping mission-driven teams evolve with clarity, connection, and measurable impact. As Founder and Principal of MI for Health, Jeff equips organizations to navigate transformation using behavioral science and practical frameworks that sustain real results.From healthcare systems to community initiatives, Jeff's approach bridges the gap between theory and practice—training leaders to engage even the most resistant audiences through evidence-based methods like Motivational Interviewing, Reflective Listening, and Deep Canvassing.A Certified Change Practitioner and Harvard-trained educator, Jeff has partnered with institutions such as MIT, the Institute for Healthcare Improvement, and multiple state-level initiatives. His work blends empathy, science, and strategy to help organizations not just manage change—but embody it. https://www.jeffwetherhold.com/  Become a supporter of this podcast: https://www.spreaker.com/podcast/i-am-refocused-radio--2671113/support.Thank you for tuning in to I Am Refocused Radio. For more inspiring conversations, visit IAmRefocusedRadio.com and stay connected with our community.Don't miss new episodes—subscribe now at YouTube.com/@RefocusedRadio

I've worked with older adults for a long time, and if there's one thing I've learned, it's this: the hardest conversations are often the most necessary. We plan for weddings, retirements, even vacations—but not for how we want to be cared for when we can't speak for ourselves. That's why I invited Kate DeBartolo, Senior Director at the Institute for Healthcare Improvement, to join me for a powerful, practical conversation about how to talk with your loved ones about your wishes for care through the end of life. Spoiler alert: it's not really about dying—it's about how you want to live. 

Welcome to the Sustainable Clinical Medicine Podcast! In this episode, Dr. Sarah Smith sits down with Dr. Marcia Kashani, a nurse and experienced healthcare improvement advisor, to explore practical strategies for making your clinical day more efficient, effective, and—most importantly—sustainable. Drawing on years of experience facilitating primary care transformation and team-based initiatives, Dr. Kashani shares stories of real-world success: from leveraging the strengths of every team member, to optimizing clinic workflows, and even reimagining how tasks get delegated to maximize value for both clinicians and patients. If you've ever felt overwhelmed by a never-ending list of tasks, long wait times for appointments, or the challenge of figuring out what you can hand off—and to whom—this is an episode you won't want to miss. Dr. Smith and Dr. Kashani offer actionable insights into improving access, reducing unnecessary physician workload, and embracing change as a path to better care and a better work-life balance. Whether you're part of a large clinic or running a small practice, you'll find inspiration and hope for positive change right here. Tune in and take one step closer to reclaiming time for your patients—and yourself! Here are 3 key takeaways from this episode: Empower Your Team: Distinguish between physician, nurse, and administrative tasks. When tasks are thoughtfully delegated—like patient screening calls or form-filling—clinicians can reclaim time for patient care and improve office efficiency. Reduce Unnecessary Visits: Examine return visit rates and consider whether clinical follow-ups always require physician attention. Thoughtful use of nurses, pharmacists, and even patients' support networks can safely reduce visit volumes and waiting times. Leverage Process Improvement: Document and map out workflows to highlight inefficiencies, duplications, and points of delay (like EMR optimization or referral processing). Even simple changes—like consistently titling scanned documents—deliver significant time savings for clinicians. Meet Dr. Marcia Kashani: Marcia has over 40 years of front-line nursing and progressive leadership experience in primary care, community care and acute care. Notable accomplishments include involvement in the business planning and governance of multiple Primary Care Networks in the Edmonton Zone. In 2005 her focus turned to Quality Improvement and System Redesign where she became the first non-physician AIM faculty, participating in several AIM collaboratives. She completed the Improvement Advisor Program through the Institute of Healthcare Improvement and continued as a facilitator for the program. Most recently, Marcia has been a project manager with the Edmonton Zone Primary Care Networks team and North Zone Primary Care Business Unit, including work with Transitions of Care, Specialty Access and Referral teams, and assisting Practice Facilitators with improvement initiatives. You can find Dr. Marcia Kashani on: LinkedIn: https://www.linkedin.com/in/marcia-kashani-44898638/ -------------- Would you like to view a transcript of this episode? Click Here **** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine. Learn more at https://www.chartingcoach.ca **** Enjoying this podcast? Please share it with someone who would benefit. Also, don't forget to hit “follow” so you get all the new episodes as soon as they are released. **** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life. **** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.

John A. Dues serves as the Chief Learning Officer and Chief Operating Officer at United Schools in Columbus, Ohio. He is an accomplished systems leader and improvement science scholar-practitioner and has recently published his first book entitled Win-Win: W. Edwards Deming, the System of Profound Knowledge, and the Science of Improving Schools. Throughout his career he has served on the founding teams of seven school and nonprofit organizations. John has a BA from Miami University, an M.Ed. from the University of Cincinnati, and recently completed the Improvement Advisor program through the Institute for Healthcare Improvement.Connect with Johnhttps://www.linkedin.com/in/johnadueshttps://stan.store/johnadues Connect with HunterEmail:  ⁠edessentials.network@gmail.com⁠X: ⁠@edessentials_⁠Instagram: ⁠@edessentials_⁠LinkedIn: ⁠https://www.linkedin.com/in/hunter-flesch-669a36122/⁠Facebook: ⁠@edessentialscollection⁠Website: ⁠https://www.edessentials.net/⁠

Send us a MessageIn this episode, Sue Tetzlaff discusses the challenges and strategies for leadership in healthcare organizations, emphasizing the importance of moving beyond the status quo to foster growth and community impact. She introduces two contrasting formulas for organizational success: the fading formula, which leads to deterioration, and the rocket fuel formula, which focuses on investing in people, service, and quality to drive growth. Tetzlaff shares her experiences and insights on strategic planning and execution, urging leaders to prioritize foundational pillars for sustainable improvement.The strategic formula you follow matters: the “Fading Formula” leads to burnout and stagnation, while the “Rocket Fuel Formula” powers lasting improvement and faster growth.The 2-minute video clip referenced in this episode:  https://vimeo.com/1096998506?share=copyA flawed strategy formula can quietly erode even the best organizations—deteriorating culture, overstretching people, and stressing systems.The fading formula stresses people and deteriorates quality, leading to organizational decline versus the intended positive growth.The rocket fuel formula emphasizes a priority investment in core pillars which represents the core mission of the organization - high quality services. Successful healthcare organizations prioritize people, service, and quality.Strategic plans must be built on effective formulas for success.Expert guidance can enhance strategic planning and execution.Strengthening healthcare organizations positively impacts communities.Need help improving the culture, performance, and results of your healthcare organization? If so, let's talk:  https://www.capstoneleadership.net/contact-usAre we connected yet on LinkedIn? https://www.linkedin.com/in/suetetzlaff/Reach us at CapstoneLeadership.net or info@capstoneleadership.net

Josh Clark, the Institute for Healthcare Improvement's VP of quality and safety operating systems, targets the problem care operating systems aim to solve and explains how they also help improve workforce engagement and satisfaction.

Leslie J. Pelton, MPA is a senior program officer at The John A. Hartford Foundation, where she oversees grants that are transforming care for older adults and family caregivers through the Age-Friendly Health Systems movement. Prior to this, Leslie was vice president at the Institute for Healthcare Improvement, where she collaborated with funders, national partners […] The post Age-Friendly Health Systems (HLOL #261) appeared first on Health Literacy Out Loud Podcast.

Despite decades of effort and innovation since the groundbreaking To Err is Human report over 25 years ago, preventable harm in healthcare persists, and violence against healthcare workers continues to rise. With record understaffing, burnout, mandatory overtime, and mounting documentation demands, the pressure to provide safe care has never been higher nor the stakes more urgent. In this first episode of our new series focusing on safety in healthcare, we explore a bold shift toward "total systems safety" with two leaders at the forefront of this movement who know these challenges all too well. Patricia McGaffigan, RN, MS, CPPS, Senior Advisor for Patient and Workforce Safety at the Institute for Healthcare Improvement, and President of the Certification Board for Professionals in Patient Safety, and Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. Together, they continue to shape national safety efforts including IHI's Safer Together: National Action Plan to Advance Patient Safety the first public-private collaboration of its kind. Spearheaded by McGaffigan and bringing together 27 major organizations that had never collaborated before. The plan aims to restructure the very foundation of healthcare, building safety into every level of the system around four interlocking pillars. Leadership & Governance: Strong, visible leadership and policies that make safety a strategic priority. Workforce Safety & Well-Being: Protecting nurses and healthcare workers – physically and mentally – so they can care safely for others. Patient & Family Engagement: Partnering with patients and family caregivers as co-designers of safe care. Learning Systems: Creating feedback loops and continuous improvement so lessons from one hospital spread everywhere.   At the heart of this movement is a truth long understood by nurses: safety is not a checklist or a policy, it's a culture, a commitment, and a collective responsibility. As Patricia McGaffigan reminds us, “You can't have patient safety if you don't have a safe workforce.” And as Don Berwick warns, “The illusion that safety is a matter of individual effort is one of the most toxic notions in the whole safety enterprise. It is we, not me.” Nurses have always led by example, holding space for healing while navigating broken systems. Now, their leadership is essential in building the future of healthcare safety: one that protects not only patients, but the people who care for them. Where healthcare is not only safer, but also is a culture that ensures we're all Safer Together.

St. Paul had a female traveling companion but we never hear about her; women suffering at all times of their lives from menstrual cramps to menopause are told by untrained doctors that it's in their heads, and even when mice are the subjects of medical experiments, they are almost always male. Long accustomed to taking a back seat and suffering in silence, women are increasingly speaking up for better treatment at the hands of medicine. Two of them from different generations, Abby Lorch, a UAlbany student, and Liz Seegert, a long-time health journalist talk about what should be done — and their despair that Health Secretary RFK will do it.Abby Lorch is a 21-year-old UAlbany student graduating with a journalism degree and a law and philosophy minor. She plans to attend Albany Law School starting in fall 2025. She has always been interested in women's issues, and reporting on the university community and the Capital Region has given her insight into how these issues affect her neighbors.Liz Seegert  is an award-winning, freelance journalist with more than 30 years experience writing for magazines, newspapers, radio and TV news, digital, PR, corporate, government, non-profit, and educational institutions. Her work has appeared in national, regional and local consume and trade outlets. She has done numerous fellowships with organizations such as  the Institute for Healthcare Improvement, the center for Health Policy and Media Engagement, and the Gerontological Society of America. She is active in the Journalism & Women Symposium and is an instructor at the Empire State College.

Long accustomed to taking a back seat and suffering in silence, women are increasingly speaking up for better treatment at the hands of medicine. Two of them from different generations, Abby Lorch, a UAlbany student, and Liz Seegert, a long-time health journalist talk to Rosemary Armao about what should be done — and their despair that Health Secretary RFK will do it. Abby Lorch is a 21-year-old UAlbany student graduating with a journalism degree and a law and philosophy minor. She plans to attend Albany Law School starting in fall 2025. Liz Seegert is an award-winning, freelance journalist with more than 30 years experience. She has done numerous fellowships with organizations such as the Institute for Healthcare Improvement, the center for Health Policy and Media Engagement, and the Gerontological Society of America. She is active in the Journalism & Women Symposium and is an instructor at the Empire State College.

In this episode of The Patient From Hell, host Samira Daswani speaks with oncology nurse Joshua Carter about his path into cancer care, shaped by personal experiences with family illness. They explore the differences between palliative and hospice care, the complexities of pain management, and the vital role nurses play as advocates. Josh also discusses misconceptions around pain medication, the promise and challenges of e-health tools, and the often-invisible workflows nurses navigate daily. He shares practical advice for patients, caregivers, and fellow clinicians, emphasizing the importance of early palliative care and being a bold advocate within the healthcare system.About Our GuestJosh Carter is an Oncology Nurse at Stanford Women's Cancer Center. His entire 17-year nursing career has been in oncology, with inpatient, industry, and outpatient experiences in Cleveland, Chicago, San Diego, and San Francisco. Josh holds undergraduate degrees from Kent State University and Ohio University and is currently on track to complete his Master's at the University of Michigan School of Nursing this Fall. He is a certified Oncology and Breast Care Nurse. His interests include Nursing Innovation, Digital Health, Patient Advocacy, Patient Education, Patient-Centered Design, Healthcare Improvement, Quality, and Implementation Science. With his interests in Healthcare Quality, Josh is currently a Site Assessor for the Michigan Oncology Quality Consortium. Josh has spoken at the National Oncology Nursing Society Congress and Authored Chapters of Oncology Nursing Society Text Books. Josh has been involved with research for caregivers of Cancer patients and has helped in the launch of newly approved cancer treatments. Josh has experience working on a cancer care delivery team at ASCO and has been awarded the DAISY Award for Extraordinary Nurses. Resources & Links:This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features the PCORI study “A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice”Sections00:00 - Journey into Oncology Nursing03:22 - Understanding Palliative vs. Hospice Care07:04 - Pain Management in Cancer Care10:23 - Pain Management Strategies and Misconceptions20:32 - E-Health Interventions in Pain Management23:19 - The Complex Workflow of Oncology Nursing27:48 - Quick Tips for Patients and CaregiversConnect with Us:Enjoyed this episode? Make sure to subscribe, rate, and review! Follow us on instagram, facebook, or linkedin @mantacares and visit our website at mantacares.com for more episodes and updates.Listen Across Platform:Website: https://mantacares.com/pages/podcast?srsltid=AfmBOopEP5GJ-Wd2nL-HYAInrwerIVhyJw67salKT-r9Qb_gadBvbHie YouTube: https://www.youtube.com/@mantacares Spotify:  https://open.spotify.com/show/6gM1GxDBUgXrHwlO0Zvnzs?si=9edb8680461d4eaa Apple: https://podcasts.apple.com/us/podcast/patient-from-hell/id1622669098 Disclaimer:All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.This episode was supported by an award from the Patient-Centered Outcomes Research Institute.

In this episode of the WLEI Podcast, we speak with Steve Spear, a senior lecturer at MIT's Sloan School of Management, senior fellow at the Institute of Healthcare Improvement, and associated faculty member at Adriane Labs of the Harvard School of Public Health. Spear is also author of The High-Velocity Edge and Wiring the Winning Organization and principal of SeeToSolve. The conversation explores:  Stellar examples of product development innovation (and the learning cultures that made these achievements possible) What Lean, Six Sigma, Agile, DevOps, and more schools of systems thinking and management all have in common What business and product leaders across hardware and software can learn from each other Key ideas and core principles you should take away from his latest book  What kind of leadership Steve believes is needed now and what good leadership looks like in practice, given all of the organizational challenges companies face today

Howie and Harlan are joined by Alexi Nazem, a Yale-trained internist who co-founded the healthcare staffing company Nomad Health and now leads healthcare investments at AlleyCorp. Harlan reports on new research from the American College of Cardiology meeting; Howie examines the consequences of vast staffing cuts in the federal healthcare infrastructure.  Links: Research from the American College of Cardiology Meeting “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial” “Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial” “Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism” Alexi Nazem The Human Genome Project Institute for Healthcare Improvement “100,000 Lives Campaign: Ten Years Later” “Continuous Improvement as an Ideal in Health Care” “The Science of Improvement” Health & Veritas Episode 145: Max Laurans: An Entrepreneurial Life in Medicine Nomad Health Yale School of Management case study: “Nomad Health: The disruption of physician staffing services" “Staffing Marketplace Nomad Health Raises $105 Million As It Expands Beyond Travel Nurses” “America Is Running Out of Nurses” “Staffing Marketplace Nomad Health Lays Off 17% Of Workforce” “Why AI deals in healthcare have grown faster than other areas of tech — and what VCs are paying close attention to” Turmoil at Federal Health Agencies “Mass Layoffs Hit Health Agencies That Track Disease and Regulate Food” “The top FDA vaccine official is forced out, cites RFK Jr.'s 'misinformation and lies'“ “NIH cuts halt 24-year program to prevent HIV/AIDS in adolescents and young adults” “Princeton's US grants frozen, follows Trump actions against other schools” “Trump Administration Abruptly Cuts Billions From State Health Services” “Texas measles outbreak grows to 90 cases, worst level in 30 years” “As Trump pursues his policies, Democratic states block his path” “Proposed foreign aid cuts could lead to millions of HIV deaths, study estimates” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Send us a MessageIn this episode of Culture Change RX, I discuss the concept of high reliability in healthcare, emphasizing the importance of setting ambitious goals. The conversation delves into the challenges of goal setting, the significance of a growth mindset, and the systems necessary for fostering high reliability organizations. I highlight the upcoming Healthcare Executive Forum, where healthcare leaders will explore strategies for achieving high reliability and continuous improvement.Setting ambitious goals can drive organizational improvement.Leaders and employees can often feel that big goals are impossible goals and a set up for failure.Setting ambitious goals can lead to significant performance gains.Celebrating the positive gains is important, even when goals are missed.Goal systems are crucial for continuous improvement.High reliability benefits patients, employees, and communities.Need help improving the culture, performance, and results of your healthcare organization? If so, let's talk:  https://www.capstoneleadership.net/contact-usAre we connected yet on LinkedIn? https://www.linkedin.com/in/suetetzlaff/13th Annual Healthcare Executive Forum - June 18 (afternoon) and June 19 (morning)High Reliability, Just Culture & Psychological Safety Made Simple focuses on breaking down these critical concepts into practical, actionable strategies tailored for senior leaders in small and rural healthcare settings.

Rusty is the founder and CEO of Resonate Leadership Lab, a healthcare leadership development consultancy with a mission of “Building Leadership Capabilities.” His passion for developing leaders and shaping organizational culture are hallmarks of his 30 years as a physician executive. Rusty has degrees in both Religious Studies and Psychology, and considers himself a lifelong student of how leaders and teams accomplish great things.Rusty's leadership has been central to three health system mergers, integrations and ownership changes involving academic, non-profit, venture capital, private equity and publicly traded entities. Most recently, he was chief medical officer for Lifepoint Health, a national health system comprised of 89 hospitals in 30 states, where he led the organization to win the John M. Eisenberg Award for Innovation in Patient Safety and Quality. Previously, Rusty was chief operating officer and chief clinical officer of Cogent Healthcare, a provider of hospital medicine and critical care solutions in over 120 locations in 28 states. He began his career as faculty at the University of Minnesota and senior medical director of hospital services for HealthPartners. Rusty completed his undergraduate and medical school training at Washington University in St. Louis, and his Internal Medicine residency and chief residency at the University of Minnesota.Rusty has served as Past-President of the Society of Hospital Medicine, founder of the SHM Leadership Academies, is a Nashville Healthcare Council Fellow, voted a Top 50 Physician Executive for Modern Healthcare, and is an author and co-editor of the textbook, Comprehensive Hospital Medicine. His frequent speaking engagements have included the Institute for Healthcare Improvement, American Hospital Association, Society of Hospital Medicine and the American College of Healthcare Executives, among others. Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

This episode's Community Champion Sponsor is Ossur. To learn more about their ‘Responsible for Tomorrow' Sustainability Campaign, and how you can get involved: CLICK HEREEpisode Overview: In healthcare's technological revolution, the balance between innovation and patient-centered care has never been more critical. Our next guest, Dr. Craig Norquist, brings an extraordinary perspective as CMIO of HonorHealth, drawing from his unique journey from Navy nuclear operator to emergency physician. While together, Craig shares his vision for technology that enhances rather than compromises the sacred provider-patient relationship and how this approach is transforming care delivery. With dual board certifications in Emergency Medicine and Clinical Informatics, Craig champions high reliability principles learned in both nuclear power plants and hospital settings. As a 19-time Ironman triathlete and cancer survivor, his patient experience profoundly shapes his approach to healthcare technology. Join us to explore how Dr. Norquist is leveraging informatics to reduce provider burden, improve safety, and create a learning health system that truly puts patients first. Let's go!Episode Highlights:Navy Nuclear Experience: Craig brought high reliability principles from his Navy career to healthcare safety.Personal Cancer Journey: His lymphoma battle transformed his view on patient access and care delivery.Protecting Provider Focus: Craig shields clinicians from technology overload to preserve patient interactions.AI Enhanced Documentation: Language models can reduce chart review time and boost patient engagement.Health System Collaboration: Phoenix hospitals worked together during the pandemic to manage patient loads.About our Guest: Dr. Craig Norquist currently serves as the CMIO of HonorHealth after practicing as an Emergency Physician for almost 20 years. He is board certified in both Emergency Medicine and Clinical Informatics. He serves as the Program Director for the Clinical Informatics Fellowship at HonorHealth and as Clinical Assistant Professor in the Informatics Fellowship at University of Arizona College of Medicine – Phoenix Fellowship in Informatics.Prior to becoming the CMIO, he was the Network Patient Safety Officer for HonorHealth, and has previously served as Department Chair of Emergency Medicine as well as Chief of Staff for the Thompson Peak Hospital. In 2017-2019, he completed professional development programs through academic and professional organizations that prepared him for his leadership roles, including Intermountain Health's Advanced Training Program and the Institute for Healthcare Improvement's Patient Safety Executive training. His additional credentials include EPIC physician builder certification, executive training at Harvard Business School in healthcare delivery, and training in artificial intelligence from MIT.His areas of interest are process, quality, and outcome improvement as well as improving the patient and provider experience with information technology in healthcare. His expertise has resulted in invited membership on panels and reports with the ECRI Institute and the National Quality Forum. He continues to work on the state level on opioid prescribing, use disorder recognition and treatment, as well as risk reduction methodologies including naloxone distribution from the Emergency Department. He has organized and chaired the Arizona College of Emergency Physicians opioid prescribing summit for the past 9 years.Dr. Craig is passionate about the use of technology to facilitate the improvement of care and development of a learning health

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Don Berwick of the Institute for Healthcare Improvement about his paper as part of the Vital Directions for Health and Health Care: Priorities for 2025 package that proposes strategies for how health care in the US could be transformed.Order the February 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

Join host Andrew Stotz for a lively conversation with Cliff Norman and Dave Williams, two of the authors of "Quality as an Organizational Strategy." They share stories of Dr. Deming, insights from working with businesses over the years, and the five activities the book is based on. TRANSCRIPT 0:00:02.2 Andrew Stotz: My name is Andrew Stotz, and I'll be your host as we dive deeper into the teachings of Dr. W. Edwards Deming. Today, we have a fantastic opportunity to learn more about a recent book that's been published called "Quality as an Organizational Strategy". And I'd like to welcome Cliff Norman and Dave Williams on the show, two of the three authors. Welcome, guys.   0:00:27.1 Cliff Norman: Thank you. Glad to be here.   0:00:29.4 Dave Williams: Yeah, thanks for having us.   0:00:31.9 Andrew Stotz: Yeah, I've been looking forward to this for a while. I was on LinkedIn originally, and somebody posted it. I don't remember who, the book came out. And I immediately ordered it because I thought to myself, wait, wait, wait a minute. This plugs a gap. And I just wanna start off by going back to Dr. Deming's first Point, which was create constancy of purpose towards improvement of product and service with the aim to become competitive and stay in business and to provide jobs. And all along, as anybody that learned the 14 Points, they knew that this was the concept of the strategy is to continue to improve the product and service in the eyes of the client and in your business. But there was a lot missing. And I felt like your book has started really to fill that gap. So maybe I'll ask Cliff, if you could just explain kind of where does this book come from and why are you bringing it out now?   0:01:34.5 Cliff Norman: That's a really good question, Andrew. The book was originally for the use of both our clients only. So it came into being, the ideas came out of the Deming four day seminar where Dr. Tom Nolan, Ron Moen and Lloyd Provost, Jerry Langley would be working with Dr. Deming. And then at the end of four days, the people who some of who are our clients would come up to us and said, he gave us the theory, but we don't have any methods. And so they took it very seriously and took Dr. Deming's idea of production viewed as a system. And from that, they developed the methods that we're going to discuss called the five activities. And all of our work with this was completely behind the wall of our clients. We didn't advertise. So the only people who became clients were people who would seek us out. So this has been behind the stage since about 1990. And the reason to bring it out now is to make it available beyond our client base. And Dave, I want you to go ahead and add to that because you're the ones that insisted that this get done. So add to that if you would.   [laughter]   0:02:53.0 Dave Williams: Well, thanks, Cliff. Actually, I often joke at Cliff. So one thing to know, Cliff and Lloyd and I all had a home base of Austin, Texas. And I met them about 15 years ago when I was in my own journey of, I had been a chief quality officer of an ambulance system and was interested in much of the work that API, Associates of Process Improvement, had been doing with folks in the healthcare sector. And I reached out to Cliff and Lloyd because they were in Austin and they were kind enough, as they have been over many years, to welcome me to have coffee and talk about what I was trying to learn and where my interests were and to learn from their work. And over the last 15 years, I've had a great benefit of learning from the experience and methods that API has been using with organizations around the world, built on the shoulders of the theories from Dr. Deming. And one of those that was in the Improvement Guide, one of the foundational texts that we use a lot in improvement project work that API wrote was, if you go into the back, there is a chapter, and Cliff, correct me if I'm wrong, I think it's chapter 13 in this current edition on creating value.   0:04:34.3 Dave Williams: In there, there was some description of kind of a structure or a system of activities that would be used to pursue qualities and organizational strategy. I later learned that this was built on a guide that was used that had been sort of semi self-published to be able to use with clients. And the more that I dove into it, the more that I really valued the way in which it had been framed, but also how, as you mentioned at the start, it provided methods in a place where I felt like there was a gap in what I saw in organizations that I was working with or that I had been involved in. And so back in 2020, when things were shut down initially during the beginning of the pandemic, I approached Lloyd and Cliff and I said, I'd love to help in any way that I can to try to bring this work forward and modernize it. And I say modernize it, not necessarily in terms of changing it, but updating the material from its last update into today's context and examples and make it available for folks through traditional bookstores and other venues.   0:05:58.9 Andrew Stotz: And I have that The Improvement Guide, which is also a very impressive book that helps us to think about how are we improving. And as you said, the, that chapter that you were talking about, 13, I believe it was, yeah, making the improvement of value a business strategy and talking about that. So, Cliff, could you just go back in time for those people that don't know you in the Deming world, I'm sure most people do, but for those people that don't know, maybe you could just talk about your first interactions with Dr. Deming and the teachings of that and what sparked your interest and also what made you think, okay, I wanna keep expanding on this.   0:06:40.0 Cliff Norman: Yeah. So I was raised in Southern California and of course, like many others, I'm rather horrified by what's going on out there right now with fires. That's an area I was raised in. And so I moved to Texas in '79, went to work for Halliburton. And they had an NBC White Paper called, "If Japan Can, Why Can't We?", and our CEO, Mr. Purvis Thrash, he saw that. And I was working in the quality area at that time. And he asked me to go to one of Deming's seminars that was held in Crystal City, actually February of 1982. And I got down there early and got a place up front. And they sent along with me an RD manager to keep an eye on me, 'cause I was newly from California into Texas. And so anyway, we're both sitting there. And so I forgot something. So I ran up stairs in the Sheraton Crystal City Hotel there. And I was coming down and lo and behold, next floor down, Dr. Deming gets on and two ladies are holding him up. And they get in the elevator there and he sees this George Washington University badge and he kind of comes over, even while the elevator was going down and picks it up and looks it up real close to his face. And then he just backs up and leans, holds onto the railing and he says, Mr. Norman, what I'm getting ready to tell you today will haunt you for the rest of your life.   0:08:11.8 Cliff Norman: And that came true. And of course, I was 29 at the time and was a certified quality engineer and knew all things about the science of quality. And I couldn't imagine what he would tell me that would haunt me for the rest of my life, but it did. And then the next thing he told me, he said, as young as you are, if you're not learning from somebody that you're working for, you ought to think about getting a new boss. And that's some of the best advice I've ever gotten. I mean, the hanging around smart people is a great thing to do. And I've been gifted with that with API. And so that's how I met him. And then, of course, when I joined API, I ended up going to several seminars to support Lloyd Provost and Tom Nolan and Ron Moen and Jerry as the various seminars were given. And Ron Moen, who unfortunately passed away about three years ago, he did 88 of those four day seminars, and he was just like a walking encyclopedia for me. So anytime I had questions on Deming, I could just, he's a phone call away, and I truly miss that right now.   0:09:20.5 Cliff Norman: So when Dave has questions or where this reference come from or whatever, and I got to go do a lot of work, where Ron, he could just recall that for me. So I miss that desperately, but we were busy at that time, by the time I joined API was in '88. And right away, I was introduced to what they had drafted out in terms of the five activities, which is the foundation of the book, along with understanding the science of improvement and the chain reaction that Dr. Deming introduced us to. So the science of improvement is what Dr. Deming called the System of Profound Knowledge. So I was already introduced to all that and was applying that within Halliburton. But QBS, as we called it then, Qualities of Business Strategy was brand new. I mean, it was hot off the press. And right away, I took it and started working with my clients with it. And we were literally walking on the bridge as we were building it. And the lady I'm married to right now, Jane Norman, she was working at Conagra, which is like a $15 billion poultry company that's part of Conagra overall, which is most of the food in your grocery store, about 75% of it. And she did one of the first system linkages that we ever did.   0:10:44.5 Cliff Norman: And since then, she's worked at like four other companies as a VP or COO, and has always applied these ideas. And so a lot of this in the book examples and so forth, comes from her actual application work. And when we'd worked together, she had often introduced me, this is my husband, Cliff, he and his partners, they write books, but some of us actually have to go to work. And then eventually she wrote a book with me with Dr. Maccabee, who is also very closely associated with Dr. Deming. So now she's a co-author. So I was hoping that would stop that, but again, we depend on her for a lot of the examples and contributions and the rest of it that show up in the book. So I hope that answers your question.   0:11:28.2 Andrew Stotz: Yeah, and for people like myself and some of our listeners who have heard Dr. Deming speak and really gotten into his teachings, it makes sense, this is going to haunt you because I always say that, what I read originally... I was 24 when I went to my first Deming seminar. And I went to two two-day seminars and it... My brain was open, I was ready, I didn't have anything really in it about, any fixed methods or anything. So, for me, it just blew my mind, some of the things that he was talking about, like thinking about things in a system I didn't think about that I thought that the way we got to do is narrow things down and get this really tight focus and many other things that I heard. And also as a young, young guy, I was in this room with, I don't know, 500 older gentlemen and ladies, and I sat in the front row and so I would see him kind of call them on the carpet and I would be looking back like, oh, wow, I never saw anybody talk to senior management like that and I was kind of surprised. But for those people that really haven't had any of that experience they're new to Deming, what is it that haunts you? What is... Can you describe what he meant when he was saying that?   0:12:42.9 Cliff Norman: I gotta just add to what you just said because it's such a profound experience. And when you're 29, if most of us, we think we're pretty good shape by that time, the brain's fully developed by age 25, judgment being the last function that develops. And so you're pretty well on your way and then to walk in and have somebody who's 81 years old, start introducing you to things you've never even thought about. The idea of the Chain Reaction that what I was taught as a certified quality engineer through ASQ is I need to do enough inspection, but I didn't need to do too much 'cause I didn't want to raise costs too much. And Dr. Deming brought me up on stage and he said, well, show me that card again. So I had a 105D card, it's up to G now or something. And he said, "well, how does this work?" And I said, "well, it tells me how many samples I got to get." And he says, "you know who invented that." And I said, "no, sir, I thought God did." He said, "no, I know the people that did it. They did it to put people like you out of business. Sit down, young man, you've got a lot to learn." And I thought, wow, and here you are in front of 500 people and this is a public flogging by any stretch.   0:13:56.1 Cliff Norman: And it just went on from there. And so a few years later, I'm up in Valley Forge and I'm working at a class with Lloyd and Tom Nolan and a guy named, I never met before named Jim Imboden. And he's just knock-down brilliant, but they're all working at General Motors at that time. And a lot of the book "Planned Experimentation" came out of their work at Ford and GM and Pontiac and the rest of it. And I mean, it's just an amazing contribution, but I go to dinner with Jim that night. And Jim looks at me across the table and he says, Cliff, how did you feel the day you found out you didn't know anything about business economics or anything else? I said, "you mean the first day of the Deming seminar?" He said, "that's what I'm talking about." And that just... That's how profound that experience is. Because all of a sudden you find out you can improve quality and lower costs at the same time. I'm sorry, most people weren't taught that. They certainly weren't taught that in business school. And so it was a whole transformation in thinking and just the idea of a system. Most of what's going on in the system is related to the system and the way it's constructed. And unfortunately, for most organizations, it's hidden.   0:15:04.2 Cliff Norman: They don't even see it. So when things happen, the first thing that happens is the blame flame. I had a VP I worked for and he'd pulled out his org chart when something went bad and he'd circle. He said, this is old Earl's bailiwick right here. So Cliff, go over and see Earl and I want you to straighten him out. Well, that's how most of it runs. And so the blame flame just takes off. And if you pull the systems map out there and if he had to circle where it showed up, he'd see there were a lot of friends around that that were contributing. And we start to understand the complexity of the issue. But without that view, and Deming insisted on, then you're back to the blame flame.   0:15:45.1 Andrew Stotz: Yeah. And Dave, I see a lot of books on the back on your shelf there about quality and productivity and team and many different things. But maybe you could give us a little background on kind of how how you, besides how you got onto this project and all that. But just where did you come from originally and how did you stumble into the Deming world?   0:16:08.9 Dave Williams: Sure. Well, sadly, I didn't have the pleasure of getting to sit in on a four-day workshop. Deming died in 1993. And at that time, I was working on an ambulance as a street paramedic and going to college to study ambulance system design and how to manage ambulance systems, which was a part of public safety that had sort of grown, especially in the United States in the '60s. And by the time I was joining, it was about 30 years into becoming more of a formalized profession. And I found my way to Austin, Texas, trying to find one of the more professionalized systems to work in and was, worked here as a paramedic for a few years. And then decided I wanted to learn more and started a graduate program. And one of the courses that was taught in the graduate program, this is a graduate program on ambulance management, was on quality. And it was taught by a gentleman who had written a, a guide for ambulance leaders in the United States that was based on the principles and methods of quality that was happening at this time. And it pieced together a number of different common tools and methods like Pareto charts and cause-and-effect diagrams and things like that.   0:17:33.1 Dave Williams: And it mentioned the different leaders like Deming and Juran and Crosby and others. And so that was my first exposure to many of these ideas. And because I was studying a particular type of healthcare delivery system and I was a person who was practicing within it and I was learning about these ideas that the way that you improve a system or make improvement is by changing the system. I was really intrigued and it just worked out at the time. One of the first roles, leadership roles that emerged in my organization was to be the Chief Quality Officer for the organization. And at the time, there were 20 applicants within my organization, but I was the only one that knew anything about any of the foundations of quality improvements. Everybody else applied and showed their understanding of quality from a lived experience perspective or what their own personal definitions of quality were, which was mostly around inspection and quality assurance. I had, and this won't surprise Cliff, but I had a nerdy response that was loaded with references and came from all these different things that I had been exposed to. And they took a chance on me because I was the only one that seemed to have some sense of the background. And I started working and doing...   0:19:10.1 Dave Williams: Improvement within this ambulance system as the kind of the dedicated leader who was supposed to make these changes. And I think one of the things that I learned really quickly is that frequently how improvement efforts were brought to my attention was because there was a problem that I, had been identified, a failure or an error usually attributed to an individual as Cliff pointed out, somebody did something and they were the unfortunate person who happened to kind of raise this issue to others. And if I investigated it all, I often found that there were 20 other people that made the same error, but he was, he or she was the only one that got caught. And so therefore they were called to my office to confess. And when I started to study and look at these different issues, every time I looked at something even though I might be able to attribute the, first instance to a person, I found 20 or more instances where the system would've allowed or did allow somebody else to make a similar error.   0:20:12.6 Dave Williams: We just didn't find it. And it got... And it became somewhat fascinating to me because my colleagues were very much from a, if you work hard and just do your job and just follow the policy then good quality will occur. And nobody seemed to spend any time trying to figure out how to create systems that produce good results or figure out how to look at a system and change it and get better results. And so most of my experience was coming from these, when something bubbled up, I would then get it, and then I'd use some systems thinking and some methods and all of a sudden unpack that there was a lot of variation going on and a lot of errors that could happen, and that the system was built to get results worse than we even knew.   0:21:00.7 Dave Williams: And it was through that journey that I ended up actually becoming involved with the Institute for Healthcare Improvement and learning about what was being done in the healthcare sector, which API at the time were the key advisors to Dr. Don Berwick and the leadership at IHI. And so much of the methodology was there. And actually, that's how I found my way to Cliff. I happened to be at a conference for the Institute for Healthcare Improvement, and there was an advertisement for a program called the Improvement Advisor Professional Development Program, which was an improvement like practitioner project level program that had been developed by API that had been adapted to IHI, and I noticed that Cliff and Lloyd were the faculty, and that they were in my hometown. And that's how I reached out to them and said, hey can we have coffee? And Cliff said, yes. And so...   0:21:53.1 Andrew Stotz: And what was that, what year was that roughly?   0:22:00.3 Dave Williams: That would've been back in 2002 or 2003, somewhere in that vicinity.   0:22:02.0 Andrew Stotz: Hmm. Okay.   0:22:06.8 Dave Williams: Maybe a little bit later.   0:22:06.9 Andrew Stotz: I just for those people that are new to the topic and listening in I always give an example. When I worked at Pepsi... I graduated in 1989 from university with a degree in finance. And I went to work at Pepsi in manufacturing and warehouse in Los Angeles at the Torrance Factory originally, and then in Buena Park. But I remember that my boss told me, he saw that I could work computers at that time, and so I was making charts and graphs just for fun to look at stuff. And he said, yeah, you should go to a one of these Deming seminars. And so he sent me to the one in... At George Washington University back in 1990, I think it was. And but what was happening is we had about a hundred trucks we wanted to get out through a particular gate that we had every single morning. And the longer it took to get those trucks out the longer they're gonna be on LA traffic and on LA roads, so if we can get 'em out at 5:00 AM, fantastic. If we get 'em out at 7:00, we're in trouble. And so they asked me to look at this and I did a lot of studying of it and I was coming for like 4:00 in the morning I'd go up to the roof of the building and I'd look down and watch what was happening. And then finally I'd interview everybody. And then finally the truck drivers just said, look, the loaders mess it up so I gotta open my truck every morning and count everything on it. And I thought, oh, okay.   0:23:23.7 Andrew Stotz: So I'll go to the loaders. And I go, why are you guys messing this up? And then the loaders was like, I didn't mess it up. We didn't have the production run because the production people changed the schedule, and so we didn't have what the guy needed. And so, and oh, yeah, there was a mistake because the production people put the product in the wrong spot, and therefore, I got confused and I put the wrong stuff on by accident. And then I went to the production people and they said, well, no, it's not us. It's the salespeople. They keep putting all this pressure on us to put this through right now, and it's messing up our whole system. And that was the first time in my life where I realized, okay, it's a system. There's interconnected parts here that are interacting, and I had to go back into the system to fix, but the end result was I was able to get a hundred trucks through this gate in about 45 minutes instead of two hours, what we had done before.   0:24:18.8 Andrew Stotz: But it required a huge amount of work of going back and looking at the whole system. So the idea of looking at the science of improvement, as you mentioned, and the System of Profound Knowledge, it's... There's a whole process. Now, I wanna ask the question for the person who gets this book and they dig into it, it's not a small book. I've written some books, but all of 'em are small because I'm just, maybe I just can't get to this point. But this book is a big book, and it's got about 300... More than 300 pages. What's the promise? What are they gonna get from digging into this book? What are they gonna take away? What are they gonna be able to bring to their life and their business that they couldn't have done without really going deeper into this material?   0:24:57.7 Cliff Norman: Dave, go ahead.   0:25:01.4 Dave Williams: Well, I was gonna joke by saying they're gonna get hard work and only half because this is just the theory in the book and many of the... And sort of examples of the method. But we're in the process of preparing a field guide which is a much deeper companion guide loaded with exercises and examples of and more of the methods. So the original guide that that API had developed was actually about an eight... Well, I don't know how many pages it was, but it was a thick three inch binder. This, what you have there is us refining the content part that explains the theory and kind of gets you going. And then we moved all of the exercises and things to the field guide for people that really wanna get serious about it.   0:26:00.3 Dave Williams: And the reason I say hard work is that the one thing that you won't get, and you should probably pass it if this book if you're on Amazon, is you're not gonna get an easy answer. This is, as a matter of fact, one of the things that emerged in our early conversations about was this project worth it? Is to say that this is hard work. It's work that a very few number of leaders who or leadership teams that really want to learn and work hard and get results are gonna embark on. But for those, and many of our clients, I think are representative of that, of those people that say, gosh, I've been working really hard, and I feel like we could do better. I feel like I could make a bigger impact, or I could serve more customers or clients.   0:26:44.0 Dave Williams: And but I am... And I'm in intrigued or inspired or gotten to a certain point with improvement science on my own, but I want to figure out how to be more systematic and more global and holistic at that approach. Then that's what QOS is about. It builds on the shoulders of the other books that you mentioned, like The Improvement Guide which we talked about as being a great book about improvement, and improvement specifically in the context of a project. And other books like The Healthcare Data Guide and the Planned Experimentation, which are also about methods, healthcare Data Guide being about Shewhart charts, and Planned Experimentation being about factorial design. This book is about taking what Cliff described earlier as that... I always say it's that that diagram that people put on a slide and never talk about from Deming of production views as a system and saying, well, how would we do this if this is the model for adopting quality as strategy, what are the methods that help us to do this?   0:28:01.3 Dave Williams: And this book breaks that down into five activities that are built on the shoulders of profound knowledge, built on the shoulders of the science of improvement and provide a structure to be able to initially develop a system, a systems view of your organization, and then build on that by using that system to continually operate and improve that organization over time. So the book describes the activities. The book describes some of the things that go into getting started, including being becoming good at doing results-driven improvement, building a learning system, focusing in on the things that matter to your organization. And then working towards building the structure that you can improve upon. The book creates that foundation. It provides examples from clients and from people that we've worked with so that you can see what the theory looks like in practice get, kind of get a flavor for that. And we hope it builds on the shoulders of other work that I mentioned in the other books that compliment it and provides a starting point for teams that are interested in taking that journey.   0:29:26.5 Andrew Stotz: And Cliff, from your perspective, if somebody had no, I mean, I think, I think the Deming community's gonna really dive in and they're gonna know a lot of this stuff, but is gonna help them take it to the next level. But for someone who never had any real experience with Deming or anything like that, and they stumble upon this interview, this discussion, they hear about this book, can they get started right away with what's in this book? Or do they have to go back to foundations?   0:29:49.6 Cliff Norman: No, I think that can definitely get started. There's a lot of learning as you know, Andrew, from going through the four-day to understand things. And I think we've done a pretty good job of integrating what Dr. Deming taught us, as well as going with the methods. And one of the things people would tell him in his four-day seminars is, Dr. Deming, you've given us the theory, but we have no method here. And he said, well, if I have to give you the method, then you'll have to send me your check too. So he expected us to be smart enough to develop the methods. And the API folks did a really good job of translating that into what we call the five activities. So those five activities are to understand the purpose of the organization.   0:30:35.6 Cliff Norman: And a lot of people when they write a purpose, they'll put something up there but it's usually we love all our people. We love our customers even more. If only they didn't spend so much, and we'll come out with something like that and there'll be some pablum that they'll throw up on the wall. Well, this actually has some structure to it to get to Deming's ideas. And the first thing is let's try to understand what business we're in and what need we're serving in society that drives customers to us. So that word is used not need coming from customers, but what is it that drives them to us so we can understand that? And then the second part of that purpose needs to define the mainstay, the core processes, the delivery systems that relate directly to customers. And just those two ideas alone, just in the first activity of purpose, most people haven't thought about those ideas.   0:31:27.8 Cliff Norman: And can somebody pick up this book and do that? Yes. And that will answer a big challenge from Dr. Deming. Most people don't even know what business they're in, haven't even thought about it. And so that we... That question gets answered here, I think, very thoroughly. In this second activity, which is viewing the organization as a system contains two components that's viewing the organization as a system. And that's difficult to do, and a lot of people really don't see the need for it. Jane Norman reminded Dave and I on a call we did last week, that when you talk about a systems map with people, just ask 'em how do they know what's going on inside other organizations, other departments within their organization? How do they know that? And most of us are so siloed.   0:32:11.2 Cliff Norman: Somebody over here is doing the best job they can in department X, and meanwhile, department Y doesn't know anything about it. And then three months later the improvement shows up and all of a sudden there's problems now in department Y. Well, somebody who's focused on the organization as a system and sees how those processes are related when somebody comes to a management meeting said, well, we've just made a change here, and this is gonna show up over here in about three months, and you need to be prepared for that. Andrew, that conversation never takes place. So the idea of having the systems map and this book can help you get started on that. The second book that Dave was just talking about, there are more replete examples in there. I mean, we've got six case studies from clients in there than the practitioners and people who actually are gonna be doing this work.   0:33:01.7 Cliff Norman: That's gonna be absolutely... They're gonna need that field guide. And I think that's where Dave was coming from. The third activity is the information activity, how are we learning from outside the organization and how do we get feedback and research into the development of new products and services and the rest of it? And so we provided a system there. In fact, Dave took a lead on that chapter, and we've got several inputs there that have to be defined. And people just thinking through that and understanding that is huge. When Dr. Deming went to Japan in 1950, he was there to do the census to see how many Japanese were left after World War II. And then he got an invitation to come and talk to the top 50 industrialists. And he started asking questions and people from the Bank of Tokyo over there and all the rest of it.   0:33:52.4 Cliff Norman: And Dr. Deming says, well, do you have any problems? And they said, what do you mean? He says, well, do customers call up and complain? And he said, yes. And he says, well, do you have any data? And he said, no. He says, but if they complain, we give them a Geisha calendar. And then Dr. Deming says, well, how many Geisha calendars have you given out? So it's like, in 1991, I'm sitting here talking to a food company and I asked him, I said, well, you get customer complaints? Oh yeah. Do you have any data on it? No, but we give 'em a cookbook. I said, well, how many cookbooks are you giving out? So I was right back to where Deming was in 1950, so having the information activity, that third activity critical so that we're being proactive with it and not just reactive.   0:34:43.7 Cliff Norman: And so I think people can read through that and say, well, what are we doing right now? Well, I guess we're not doing this and move on. Then the fourth activity is absolutely critical. This is where you know that you've arrived, because now you're going to integrate not only the plan to operate, but a plan to improve. That becomes the business plan. For most people in business plan they do a strategy, and then they have a bunch of sub strategies, and they vote on what's important, and they do some other things, and then a year later they come back and revisit it. Well, what happens here is there's some strategic objectives that are laid out, and then immediately it comes down to, okay, what's gonna be designed and redesigned in this system? Which processes, products and services are gonna be designed? 'Cause we can all see it now, Andrew.   0:35:31.6 Andrew Stotz: Mm.   0:35:31.6 Cliff Norman: We can, it's right in front of us. So it's really easy to see at this point, and now we can start to prioritize and make that happen on purpose. As an example when Jane was a vice president at Conagra, they came up with five strategic objectives. Then they made a bunch of promises to corporate about what they were gonna do and when they were going to achieve it. When she laid out the systems map for them, they were horrified that over 30% of the processes that they needed to be having precooked meat didn't even exist. They were gonna have to be designed. And so Jane and I sat there and looking at 'em and said, well, if you'd had this map before you made the promises, would you have made those promises? No, no, we're in trouble right now. I gotta go back to the CEO of the holding company and tell 'em we're not gonna make it.   0:36:22.4 Cliff Norman: But there's a whole bunch of people that sit around in goal settings. We're gonna do this by when and have no idea about what they're talking about. So that's a little bit dangerous here. And then the fifth activity, it's probably the most important. And where I want people to start, I actually want 'em to start on the fifth activity, which is managing individual improvement activities, team activities. And what I mean by that is, nothing can hold you up from starting today on making an improvement and use the model for improvement. The three basic questions, you can write that on an envelope and apply it to a project and start right away. Because learning the habit of improvement, and when you identify, and this is typical in the planning process, again, a chapter that Dave took a lead on in the planning chapter.   0:37:03.8 Cliff Norman: When you lay that out, you're gonna come up with three to five strategic objectives, but that's gonna produce anywhere between 15 and 20 improvement efforts. And when people start three improvement efforts, and they see how difficult that is to traffic through an organization, particularly if you have a systems map, makes it a lot easier. If you don't have that, then there's all sorts of things that happen to you.   0:37:21.3 Andrew Stotz: Hmm.   0:37:22.8 Cliff Norman: But the, the idea of that all coming together is critical. And where you... Where that really shows up for the reader here is in chapter one. So Lloyd Provost took a lead on chapter one. If you read chapter one, you got a pretty good idea of what's gonna happen in the rest of the book. But more importantly, in that book, in chapter one, there's a survey at the end. And every time we give this out to people, they feel real bad.   0:37:48.1 Cliff Norman: And well, Cliff, any, on a scale of one to 10, we only came up with a four. Well, what I would tell 'em is, if you can come up with a four, you're pretty good. And those fundamentals have to be in place. In other words, the management needs to trust each other. There are certain things that have to be in place before you can even think about skating backwards here. And quality as an organizational strategy is all about skating backwards. The people who don't have the fundamentals can't even start to think about that.   0:38:15.0 Cliff Norman: So that survey and the gap between where they are at a four and where they're going to be at a 10, we've integrated throughout the whole book. So as you're reading through the whole book, you're seeing that gap, and then you have a good plan forward as to what do I need to do to get to be a six, an eight, and what do I need to do to finally arrive at a 10? Dave, why don't you add to what I just said there, and I gotta turn on a light here, I think.   0:38:39.2 Dave Williams: Well, I think one of the things that, and Cliff has probably been the one that has helped me appreciate this to the biggest degree is the role in which improvement plays in quality as an organizational strategy. So, I mean, I think in general, in our world, improvement is seen as kind of like a given, but in our case, what we've found is that many times people are not working on the things right in front of them or the problems in which they have, that they are on the hook... I like to say, are on the hook to get accomplished right now. And like Cliff mentioned, many of my clients when I engage with them, I say, well, what have you promised this year? And they'll give me a list and I'll say, well, okay, what are you working on to improve? And they'll be working on projects that are not related to that list of things that they've got to affect. And so usually that's a first pivot is to say, well, let's think about what are the things that you're working on or should be working on that are either designing or redesigning your system to achieve these strategic objectives.   0:39:48.8 Dave Williams: And the reason to put the attention on that fifth activity and get people working on improvement, there's a good chance that the improvement capability within the organization currently isn't to the level that you need it, where you can get results-driven projects happening at a clip that will enable you to chip away at 20 projects versus four in a year. And that it's not well integrated into the leadership, into the support structures that you have. In addition, if you're trying to use improvement on things that you're on the hook for, and Cliff noted, especially if you've got a system map while you're on that journey, you're gonna start to pick up on where the disconnects are. Similar to your example, Andrew, where you were describing your experience working backwards in the process, you're going to start to recognize, oh, I'm working on this, but it's linked to these other things. Or in order for me to do this, I need that. Or... And so that amplifies the project to be kind of just a vehicle to appreciate other things that are interconnected, that are important in improving our work together.   0:41:05.1 Dave Williams: And so I think that that's a critical piece. I mean, I sometimes describe it as the disappointment that people have when they open QOS because they want to have a new method or a new thing to work on. I said, well, there's a lot new in here. And at the same time, we want to build on the shoulders of the fundamentals. We want to build it because it's the fundamentals that are going to be able for you to activate the things that are necessary in order for you to skate backwards, like Cliff was describing earlier.   0:41:36.2 Cliff Norman: I got to add to what Dave was saying because this actually happened to me with a... I'm not going to mention the name of the company, but it's a high-tech companies worldwide. And we got up, a good friend of mine, Bruce Bowles, and we were introducing the idea of quality as an organizational strategy. And one of the guys in the front row, he says, Cliff, this just sounds like common sense, why aren't we all doing this? I said, that's a real good question. Let me put that in the parking lot here. So I put it up on a flip chart. And so we went through the idea of... We were working on Shewhart control charts. And so we showed him one of those. And at the end of all that, he raised his hand and I said, yeah, he says, Cliff, this is hard. I said, well, let me put that up here. This is hard. Then we went through the systems map and he says, look, this is hard. By the end of the two days, it was, this is hard, this is hard, this is hard, this is hard. This goes back to what Dave was saying earlier about once you open this page, there's some work that takes off, but more importantly, there's something new to learn here.   0:42:40.3 Cliff Norman: And that's frustrating to people, especially when they've got to quit doing what they've done in the past. It's what Deming says, you got to give up on the guilt and you got to move forward and transform your own thinking. So there's something here for the management to do. And if they're not willing to do that work, then this is probably not a good thing for them. Just go back to the blame flame and circling org charts and that kind of stuff and then wonder why we're losing money.   0:43:11.8 Andrew Stotz: Yeah, and I think that that's one of the things that we see in the Deming community is that, why are people doing it the way they are, dividing things up and doing KPIs and saying, you take care of that. And we're gonna optimize by focusing on each... We see how that all kind of falls apart.   0:43:27.9 Cliff Norman: It all falls through reductionism.   0:43:29.8 Andrew Stotz: [laughter] Yeah.   0:43:32.5 Cliff Norman: It doesn't understand the system, yeah.   0:43:32.5 Andrew Stotz: Yeah, so what I want to do now is I was just thinking about a book on my shelf called "Competitive Strategy" by Michael Porter. And there's a whole field of study in the area of strategy for businesses. Now you guys use, and you explain a little bit about the way you come up with... Why you come up with organization rather than let's say company as an example. But let's just talk about strategy for a moment. Generally we're taught in business school that there's two main strategies. One is a differentiation strategy. I like to teach my students like Starbucks. It's very differentiated from the old model. And you can have a low cost strategy, which is like McDonald's, where it's all about operational efficiency.   0:44:18.4 Andrew Stotz: And those are two different strategies that can get to the same goal, which is to build a strong and sustainable business that's making a good profit for the employees to get paid well and for shareholders. And so for somebody that understands some of the foundations of typical strategy, it's hard for them to think, wait, wait, wait, what? You're just talking about just better quality is the strategy? How should they frame this concept of quality as a strategy in relation to what we've been taught about low cost and differentiation and other types of strategy? How do we think about this book in relation to that?   0:45:03.2 Cliff Norman: When Deming wrote his book, his very first one of the four "Out of the Crisis", which was the whole idea about quality and competitive position. But he was kind of answering that. And at that time, what we had is we had three companies in the United States that were going at each other, Ford, GM, and Chrysler. And they'd call each other up, well, what are you doing this year? Oh, we're making cars that don't work. Sometimes they break down. That's why we have Mr. Goodwrench to repair them. That's an extra revenue source for us. As one of the executives that are challenged, a colleague of mine, he said, you don't realize how much money we're gonna lose here taking the repair business out because we make a lot of money out of repair. So making cars that don't work has been a good revenue stream for us. Well, all that works out great, until somebody shows up like Toyota that has a car that works and doesn't need to be repaired by Mr. Goodwrench all the time.   0:45:58.8 Cliff Norman: So the mind shift there, and what Dr. Deming was saying is that he was focused on the competition's already licked. And I don't think Porter's thought about that very much, not to be overly critical, because I'm an admirer of his, but the idea of focusing on the need and why is that customer coming to us so that we make a journey, and the Japanese call that being in the Gemba, being in the presence with the customers as they use the product or service and doing the research and the rest of it. And then coming back and then redesign that product or service so that it not only grabs the current customer, but we start thinking about customers that are not even our customers and innovate and actually come up with a design that actually brings new customers to us through products and services that we haven't thought about yet. So if I show you three products just to make a picture of it, we often show like an abacus, which was a hand calculating machine about BC. Then there's a slide rule that came out about the same year that Columbus discovered America. And that was good till about 1968.   0:47:06.0 Cliff Norman: And then the calculator, the handheld calculator came out. Well the need for all three of those products is to do handheld calculations. So we've had that need since BC. Now in 1967, K&E Calculator was making that slide rule, which I used in junior high school. If you'd have come up to me and said, Cliff, what do you need in the way of a better slide rule? I said, well can you get me a holster for it? 'Cause I don't like having to stick me in the face. I put it in my pocket and it sticks me in the face. And if you can give me a holster for that, that would be my view of that. I wasn't about to come up with the TI calculator. That wasn't gonna happen. Not from Cliff. It's gonna come from an engineer at TI. Now, K&E Calculator, if they'd been doing research in the marketplace and saying, is there something that can totally disrupt us going on here? Rather than just looking at figuring out a way to make the K&E slide rule better, they might've discovered that.   0:48:07.0 Cliff Norman: Most people don't do that. They just go back. They just lose their business. And it was interesting in '67, their annual report put out, what's the world gonna look like 100 years from now? So they had dome cities, they had cars flying, they had all sorts of things going on that were great innovations, but they didn't have the TI calculator in there, along with the HP calculator. And that wiped out their business. And so if people understand the need, and that's what Dr. Deming is getting at, he says, they really haven't thought about what business they're in. So why are the customers coming to us? He says, no customer ever asked for pneumatic tire. No customer ever asked for a microwave oven. That came from people with knowledge that were looking at how the customers are using the current products and services and say, now, is there technology innovation going on that we can actually do a better job of providing a better match in the future?   0:48:56.9 Andrew Stotz: And can you explain why you use the word need as opposed to want?   0:49:06.5 Cliff Norman: That's a good question. The idea is that there's a need that's constant in society. So that need of having to do handheld calculations or needing healthcare or to pay bills, that need is constant throughout civilization. And so if I want something that's interesting, that might be the match. That might be something to do with some features what I'm offering and so forth. I'd like to have this, I'd like to have that. But the need and the way we're using that is it doesn't come from customers. It's what drives customers to us. And it's always been there. It's always been there. Need for transportation, for example. Whether you're walking or driving a bicycle or a car or a plane.   0:49:53.6 Andrew Stotz: And Dave, how would you answer the same question when you think about a person running a business and they've had many strategy meetings in their business, they've set their corporate strategy of what we're doing, where we're going and that type of thing. And maybe they've picked, we're gonna be a low cost producer. Thailand's an interesting one because Thailand had a ability to be low cost producers in the past. And then China came along and became the ultimate low cost producer. And all of a sudden, Thai companies had a harder time getting the economies of scale and the like. And now the Chinese manufacturers are just really coming into Thailand, into the Thai market. And now it's like, for a Thai company to become a low cost leader is almost impossible given the scale that China and the skills that they have in that. And so therefore, they're looking at things like I've got to figure out how to get a better brand. I've got to figure out how to differentiate and that type of thing. How does this... How could this help a place like that and a management team that is struggling and stuck and is looking for answers?   0:51:07.0 Dave Williams: Well, I go back to what Cliff said about that many organizations don't pause to ask, why do they exist? What is the need of which they are trying to fulfill? Much of my background involved working in the service industry, initially with public safety and ambulance systems and fire systems, and then later in healthcare and in education. And in many of those environments, especially in places where in public systems where they've been built and they may have existed for a long time, when you ask them about what are they trying to accomplish as an organization or what is it that they... The need that they're trying to fulfill? Typically, they're gonna come back to you with requests or desires or wants or sort of characteristics or outcomes that people say they expect, but they don't pause to ask, like, well, what is the actual thing of which I'm trying to tackle? And Cliff mentioned like, and we actually, I should mention in the book, we have a list of different strategies, different types of strategies, all the different ones that you mentioned, like price and raw material or distribution style or platform or technology.   0:52:30.9 Dave Williams: There's different types of strategies, and the one that we are focusing in on is quality. But I think it's important for people to ask the question. Cliff mentioned transportation. There's a number of different great examples, actually, I think in transportation, where you could look at that as being an ongoing need as Cliff mentioned from the days when there was no technology and we were all on foot to our current day. Transportation has been a need that existed and many different things over time have been created from bicycles, probably one of the most efficient technologies to transport somebody, wheels and carts. And now, and you were referencing, we've made reference to the car industry. It's a fascinating experience going on of the car world and gas versus electric, high technology versus not, autonomous vehicles. There's, and all of them are trying to ask the question of, are there different ways in which I might be able to leverage technology to achieve this need of getting from point A to point B and be more useful and potentially disrupt in the marketplace? And so I think the critical thing initially is to go back and ask and learn and appreciate what is that need?   0:53:58.6 Dave Williams: And then think about your own products and services in relation to that. And I think we include four questions in the book to be able to kind of think about the need. And one of those questions is also, what are other ways in which you could fulfill that need? What are other ways that somebody could get transportation or do learning or to help sort of break you away from just thinking about your own product as well? And that's useful because it's super tied to the system question, right? Of, well, this is the need that we're trying to fulfill and these are the products and services that are matching that need. Then the system that we have is about, we need to build that and design that in order to produce, not only produce the products and services that match that need, but also continually improve that system to either improve those products and services or add or subtract products and services to keep matching the need and keep being competitive or keep being relevant. And maybe if it's not in a competitive environment where you're gonna go out of business, at least be relevant in terms of the city service or community service, government service that continues to be there to match the need of the constituents. So I think it's a really important piece.   0:55:17.0 Dave Williams: It's that North star of saying, providing a direction for everything else. And going back to your original comment or question about strategy, and many times people jump to a strategy or strategies or, and those might be more around particular objectives or outcomes that they're trying to get to. It may not actually be about the method or the approach like cost or technology that they may not even think that way. They may be more thinking about a plan. And I really encourage people to be clear about what they're trying to accomplish and then start to ask, well, how's the system built for that? And later we can bring a process that'll help us learn about our system and learn about closing that gap.   0:56:05.1 Cliff Norman: Yeah. Just what I'd add to that, Andrew, because you mentioned China, a few other countries, but I think the days are coming to an end fairly quickly where somebody can say, oh, we can go to this country. They have low wages, we'll put our plant there and all that. There's a lot of pushback on that, particularly in the United States. And if that's your strategy, that hadn't required a lot of thinking to say the least. But in 1966, over 50% of the countries in the world were, let me rephrase that, over 50% of the population of the world lived in extreme poverty. So there were a lot of targets to pick out where you want to put your manufacturing. And in 2017, and you and Dave were probably like myself, I didn't see this hit the news, but that figure had been reduced from over 50% down to 9%. And all you have to do is just, and I worked in China a lot, they're becoming very affluent. And as they become very affluent, that means wages are going up and all the things that we want to see throughout the world. And I think that's happening on a grand scale right now, but you're also getting a lot of pushback from people when they see the middle class in their own country, like here in the United States, destroyed, and say, I think we've had enough of this. And I think you're gonna see that after January. You're gonna see that take off on steroids.   0:57:31.7 Cliff Norman: And that's gonna happen, and I think throughout the world, people are demanding more, there's gonna have to be more energy, every time a baby is born, the footprints gets bigger for more energy and all the rest of it. So it's gonna be interesting, and I think we are going into an age for the planet where people as Dr. Deming promised that they'd be able to live materially better, and the whole essence of this book is to focus on the quality of the organization and the design and redesign of a system to a better job of matching the need and cause that chain reaction to go off. When Jane and I went over to work in Sweden, Sven Oloff who ran three hospitals and 62 dental clinics there and also managed the cultural activities and young shipping. He said, Cliff, I report to 81 politicians. I don't wanna have to go to them to put a bond on an election to get more money for my healthcare system, I wanna use Dr. Deming's chain reaction here to improve care to the patients in my county and also reduce our costs. A whole bunch of people that don't even believe that's possible in healthcare.   0:58:39.9 Cliff Norman: But that's what Sven Oloff said that's what you're here for. And that's what we proceeded to do, they launched about 350 projects to do just that, and one of their doctors, Dr. Motz [?], he's amazing. We taught him a systems map, I came back two months later, and he had them in his hospital on display. And I said, Motz, how did you do this? He said well Cliff, I'm an endocrinologist by education as a doctor, of course, that's a person who understands internal systems in the body. So he said the systems approach was a natural for me. But I'd like to say it was that easy for everybody else, that systems map idea and as you know, being in the Deming seminar, that's quite a challenge to move from viewing the organization as an org chart, which has been around since Moses father-in-law told him, you need to break up the work here a little bit, and the tens of tens reporting to each other, and then of course, the Romans took that to a grander scale, and so a centurion soldier had 100 other soldiers reporting to him. So we've had org charts long and our federal government took that to a whole new level.   0:59:46.1 Cliff Norman: But the idea is switching off the org chart from biblical times to actually getting it up to Burt [?] about 1935 and understanding a system that's kind of a nose bleed in terms of how much we're traveling there to get us into the 21st century here.   1:00:04.0 Andrew Stotz: And I left Ohio, I grew up outside of Cleveland, and I left Ohio in about 1985, roughly. And it was still a working class, Cleveland had a huge number of jobs and there was factories and all that, and then I went to California, and then I moved to Thailand in 1992. So when I go back to Ohio now, many years later, decades later, it's like a hollowed out place, and I think about what you're saying is... And what's going on in the world right now is that I think there's a desire in America to bring back manufacturing to bring back production and all of that, and that's a very, very hard challenge, particularly if it's gone for a while and the skill sets aren't there, maybe the education system isn't there, I talk a lot with John Dues here on the show about the what's happening in education and it's terrifying.   1:01:05.9 Andrew Stotz: So how could this be... Book be a guide for helping people that are saying, we've got to revitalize American production and manufacturing and some of these foundational businesses and not just services, which are great. How can this book be a guide?   1:01:25.8 Dave Williams: One thing I would say that I think is interesting about our times, many times when I reflect on some of the examples that you just provided, I think about how changes were made in systems without thinking about the whole system together. And there may have been changes at various times that we're pursuing particular strategies or particular approaches, so it may have been the low-cost strategy, it may have been to disrupt a marketplace. And oftentimes, they don't think about... When somebody's pursuing one particular view, they may miss other views that are important to have an holistic perspective. One of the things that I appreciate about QoS in the methods and overall as a holistic view of looking at organizations that it's asking us to really think initially about that North Star, what we're trying to do, our purpose, and what are the tenants. What are the things that are important us, the values...   1:02:38.7 Dave Williams: That are important to us in pursuing that particular purpose? And in doing that, really thinking about how does the system work as it is today, and if we make changes, how does it move in alignment with the values that we have and in the direction that we wanna go? And appreciating, I would say, part of the value of the scientific thinking that is in the Science of Improvement is that it encourages you to try to see what happens and appreciate not only what happens in relation to the direction you're trying to go, but also the... Have a balanced view of looking at the collateral effects of things that you do, and I think that systems do is really important there. So I think from that perspective, the quality as an organizational strategy brings a holistic picture into these organizations, or at least...   1:03:45.1 Dave Williams: To be paying attention to the system that you have, maybe the direction you wanna go, and what happens as you... What are your predictions and what do you see when you study the results of making changes in the direction of the vision that you have. And I think that's at a high level that is one of the ways that I think about it. Cliff, how would you add on there?   1:04:09.1 Cliff Norman: Your question made me think of something that happened about two years ago, Jane and I got a call from a lady that worked for her in one of the chicken plants, and she said, Jane, I had to call you because I need to order some of those Shewhart charts. But what happened today, you should have been here and Jane said, what... She said, Remember that 10 year thing we buried in the ground that we're gonna open up in 10 years, and she said, yeah, said, well, we opened it up today, and the new plant manager was here, and those Shewhart charts came out, and he looked at the costs on them. He said, you were operating at this level? She said, yeah, routinely. And he said what happened? He said, well, they had new management come in and they got rid of the charts, that's the first thing they did, and then gradually they try to manage things like they normally did, and then they forgot everything that we had learned. And that's kind of where we are right now.   1:05:11.0 Cliff Norman: So just think of that a decade goes by, and it just as Dr. Deming said, there's nothing worse than the mobility of management, it's like getting AIDS in the system. And they basically destroyed their ability to run a low-cost operation in an industry that runs on 1 or 2%. And when you watch that happen and understand that we still have food companies in this country, and we have to start there and start looking at the system anew and start thinking about how it can actually cause that chain reaction to take off, and that comes from focusing on quality of the system. And then as Dr. Deming says, anybody that's ever worked for a living knows why costs go down with two words less rework, but instead of people will put in extra departments to handle the rework. Next thing they start building departments to handle...   1:06:01.8 Cliff Norman: The stuff that's not working because the system they don't understand. So that was a... What do they call those things, Dave, where they put them in the ground and pull him out?   1:06:11.0 Dave Williams: Time capsule.   1:06:13.4 Andrew Stotz: Time capsule yeah.   1:06:13.5 Cliff Norman: Yeah. Time capsule. The a 10-year time capsule.   1:06:19.2 Andrew Stotz: It's a great, great story. And a great idea. We had a company in Thailand a very large company that the CEO of it came upon the idea of the teachings of Dr. Deming and over time, as he implemented it in his company, the Japanese Union of Scientists have their prize and his company won that prize and then he had about 10 subsidiary companies that also were doing it and they also won over time. And so Thailand is actually is the second largest recipient of the Japanese Deming Award outside of India. But he left and he retired and another guy took over, a very bright guy and all that, but he threw most of that out and focused on newer methods like KPIs and things like that. And just at the end of last year, maybe six months ago, they reported a pretty significant loss, and I was kind of made me think how we can spend all this time getting the Deming teachings into our business, and then one little change in management and it's done.   1:07:26.9 Andrew Stotz: And that made me think, oh, well, that's the value of the book, in the sense that it's about building the concept of quality as a core part of strategy as opposed to just a tool or a way of thinking that could go out of the company as soon as someone else comes in. Go ahead, Dave.   1:07:41.9 Dave Williams: I was gonna say, Andrew, you raise a point, I think it's really, really important and Cliff mentioned this in terms of the problem of mobility of management. One thing that I don't know that we outline probably in dark enough ink in the book is the critically important piece of leadership, building the structures and the capability. I know we talk a little bit about it, but doing it in a way that both builds up the people that you have... So Cliff emphasiz

Send us a MessageIn this episode, Greg Opseth, a former Chief Nursing Officer and now Chief Operating Officer in rural Iowa, shares his insights on the importance of authentic leadership in healthcare, particularly in rural hospitals. Greg shares his experiences and emphasizes the need for a safe and enjoyable work environment. They explore strategic planning, employee involvement, and the unique culture of night shift workers. Greg also highlights the significance of community engagement through volunteering and the mission of Highland Medical Staffing in supporting rural healthcare facilities.Authentic leadership fosters a positive work environment.Creating fun in serious settings enhances team morale..Night shift workers have unique perspectives and needs.Memorable patient interactions can significantly impact care.Volunteering enriches personal fulfillment and community ties.Rural hospitals benefit from tailored staffing solutions.Cultural engagement in schools mirrors healthcare environments.

In this piece, recorded at Anesthesiology 2024 in Philadelphia, TopMedTalk explores the evolving landscape of patient safety and quality standards in anesthesia. What have been the significant shifts in patient safety culture? What is the importance of a proactive approach to risk management in anesthesia? We mention this excellent article: https://www.apsf.org/article/why-should-i-obtain-the-certified-professional-in-patient-safety-cpps-credential/ Desiree Chappell, Mike Grocott and Monty Mythen speak with their guest, Jonathan Cohen, anesthesiologist, Vice Chair of Quality & Safety in the Department of Anesthesiology at Moffitt Cancer Center in Tampa, Florida, Associate Professor at the University of South Florida, Clinical Assistant Professor in the Department of Medical Education at University of Illinois Chicago, Faculty for the Institute of Healthcare Improvement's (IHI) Certified Professional in Patient Safety Course.

David M. Williams, PhD is an internationally respected scholar-practitioner of the Science of Improvement. With 25 years of experience in improvement, he has worked with leaders and teams worldwide to develop people's abilities to make rigorous, results-driven improvements and adopt quality as an organizational strategy. Dr. Williams coauthored Quality as an Organizational Strategy: Building a System of Improvement. His writing on improvement is also found in many books and published papers. Dr. Williams is a former chief quality officer, consultant, and senior leader at the Institute for Healthcare Improvement. He is a lead faculty in IHI's Improvement Advisor Professional Development Program and developed and led IHI's Chief Quality Officer program. He created the Mr. Potato Head and Coin Spin PDSA exercises, which are used worldwide to teach PDSA testing and measurement for improvement.Dr. Williams is a former city paramedic and a subject matter expert on ambulance service system design.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

Dr Jeff Jarvis joins Rob Lawrence to discuss the recently released National EMS Quality Alliance (NEMSQA) Measures Report – “Enhancing airway management one measure at a time.” The report begins with the following robust Foreword: “NEMSQA is not satisfied with the state of airway management safety in EMS. As you will see, the data clearly shows that we can do much better across our industry! Partnering with experts and EMS agencies around the country, NEMSQA is leading the second national EMS Quality Improvement Partnership (EQuIP), the Airway Management Collaborative to put the new NEMSQA airway measures to work.” “Enhancing airway management one measure at a time” is the sequel to the Lights and Siren Collaborative and will utilize the Institute for Healthcare Improvement's Breakthrough Series collaborative model. The goal of the project is to support national improvement in the safety and effectiveness of invasive airway management by focusing on two goals: Reducing the adverse events, such as peri-intubation hypoxia and hypotension Improving the use of waveform capnography to confirm and monitor all invasive airways Rob and Dr. Jarvis discuss the report and actions individuals and their agencies should take to improve their personal and organizational airway management and patient outcome results. Find more EMS One-Stop episodes here!

The Path to Healthcare Improvement: Collaborative Innovation Healthcare's future depends on embracing disruption and rethinking traditional approaches to patient care. On this episode, David Sylvan, Chief Strategy, Innovation & Marketing Officer at University Hospitals, shares his approach to addressing healthcare's inefficiencies by focusing on problem identification and leveraging technology, process reengineering, and partnerships. He believes healthcare must embrace disruption and innovation, with openness to partnerships across industries to drive positive change. Hosts: Stuart Hanson Rachel Schreiber Guest: David Sylvan, Chief Strategy, Innovation, and Marketing Officer, University Hospitals Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Is your CME content scratching the surface or truly addressing the core issues in healthcare practice? As a CME professional, you're constantly striving to create educational interventions that make a real difference. But sometimes, despite your best efforts, the impact falls short of expectations. Root cause analysis (RCA) could be the missing piece in your needs assessment toolkit, helping you uncover the true sources of performance gaps and design more effective CME programs. By listening to this episode, you'll discover: How to apply RCA techniques to enhance your needs assessments and identify the root causes of practice gaps Step-by-step guidance and practical tools for conducting RCA Real-world examples of how RCA can lead to measurable improvements in healthcare outcomes Tune in now to unlock the power of root cause analysis and revolutionize your approach to CME program development. Resources Agency for Healthcare Research and Quality (AHRQ). Root Cause Analysis. Institute for Healthcare Improvement. Improving Root Cause Analyses and Actions to Prevent Harm. Singh G et al. Root Cause Analysis and Medical Error Prevention. StatPearls. Driesen B et al. Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review. J Patient Saf. 2022;18(4):342-350

Today we're looking back to one of our favorite conversations from season 1 with Dr. Don Berwick, President Emeritus and Senior Fellow of the Institute for Healthcare Improvement. Dr. Berwick is a long-time advocate for improving healthcare for both patients and providers. During this conversation, we talk about the moral imperative of change in healthcare; how we can approach the challenges more effectively; and why working together will be critical. We want to hear from you. Send a voice memo or note to podcast@moralinjury.healthcare. CME: https://earnc.me/0aUaBU Support the podcast: https://www.fixmoralinjury.org/get-started Twitter - @fixmoralinjury Instagram - @moralinjury Facebook - @MoralInjuryofHC LinkedIn - Moral Injury of Healthcare

Join Corey Dion Lewis in this insightful episode of The Healthy Project Podcast as he talks with Dr. Sandra E. Ford, the former special assistant to the President for public health and science in the White House Domestic Policy Council. She is also the principal author of the White House Action Plan identifying whole-of-government policy actions to address SDoH. This episode dives into the US playbook to address SDoH, offering valuable insights into policies and practices aimed at promoting health equity. Don't miss this essential conversation on transforming health equity and improving public health outcomes. 

For a full transcript of this episode, click here. Cognitive dissonance is kind of rampant in the healthcare industry. Cognitive dissonance is when what someone winds up doing, their actions, are in conflict with what they believe in. Cognitive dissonance also can mean when someone holds two contradictory beliefs at the same time. Let's say a person believes they want to do well by patients but their performance review depends on, as just one example, making care less affordable for patients. But somehow, this individual is able to conclude that what they're doing is a net neutral or a net positive despite (in this hypothetical, let's just say) obvious indications that it is not. In this hypothetical, there are, say, clear facts that show that what this person is up to is indisputably a problem for patients. But yet at every opportunity, this person talks about their commitment to patients. This rationalization, or earmuffs don't look, don't see, is cognitive dissonance. Now, it's harder to engage in cognitive dissonance the closer you are to patients because you see the impact up close. This is probably why moral injury and burnout is most associated with clinicians who are seeing patients. Unless these at-the-bedside clinicians enjoy a robust lack of self-awareness, those who are seeing patients don't, a lot of times, have the luxury of pretending that what is going on is good for patients when they can see with their own two eyes that it is not good for patients. The further from the exam room or the community, however, the easier it is to not acknowledge the downstream impact—if you can even figure out what that downstream impact is, which is also worthy of being mentioned. When the machine is really big, sometimes it's legitimately difficult to connect the dots all the way down the line to the customers, members, or patients. Kate Wolin, ScD, talked about this in an episode (EP432) a couple of weeks ago. But this whole dissonance exploration was a big reason why actually I created my manifesto, which is episode 400, because almost everything that we do in healthcare wherein we are making money or helping someone else make money is dissonant to some degree. And it literally keeps me up at night contemplating how much dissonance is too much dissonance or how much self-interest is too much self-interest. This is tough, subjective stuff. So, again … episode 400 for more on at least how I think about this. But in this healthcare podcast, I am talking with John Lee, MD, about what to do in the face of all this when working in the, as I call it, belly of the beast—working for a large healthcare organization such as a hospital. Because hospitals sometimes (and we certainly do not want to put all hospitals in the same category—they are a wildly diverse bunch), but sometimes some people at some hospitals do some things which are not things I think they should be doing anyway. They're fairly egregious breaches of trust, actually. But yet within that same organization, you have doctors and other clinicians or others who are working really hard to serve patients as best they can. This is the real world that we're talking about. And the question of the day is … so, now what? While it would be amazing if someday we build a whole new health system that didn't include some people doing things that I don't think they should be doing, that day is not today. And it's not tomorrow. I'm gonna hope that there's other people in our village who are full-on doing the disruption thing. But if we're not able to do that personally, for whatever reason, but we still want to inch forward within the existing environment and do the things that make us feel like we're achieving our mission, what's the best way to think about this? That is what I asked Dr. John Lee, and that's what our conversation is about today. Summing up his advice, which is really good advice, Dr. Lee talks at length about how it's so important to celebrate the small wins and feel good about care that is a little bit better than it was six months ago. He talks about acknowledging that you can't do everything. He talks about incremental improvement that helps both patients but also colleagues, and that's not insignificant to really consciously consider how to work together and help to support each other. Look, I just finished reading a post on LinkedIn about toxic medical culture and just how brutal and cruel some physicians and physician leaders and others can be to their colleagues. Ann Richardson writes about topics like this a lot. Follow her on LinkedIn if you're interested. So does J. Michael Connors, MD. But just saying, it's pretty cognitively dissonant to talk about the potential of team-based care and then condone or engage in toxic behavior with those same team members. There's like 90 studies on this whole topic linked to this book. But bottom line, fixing cognitively dissonant paradigms in any sort of durable or scalable way is, for sure, going to require a culture that inspires constructive criticism, innovation, and collaboration. It also requires—and this is Dr. Lee's last piece of advice—it's really important to seek out like-minded individuals as sounding boards and as a support network to commit to supporting each other. And I hope, all of you, that you feel like you've found your tribe here at Relentless Health Value. You guys are an amazing bunch, so know that and don't hesitate to reach out to each other when you need help. And I know, I know, I need to create a directory so you can all hook up more easily, so do subscribe to the weekly email because I am inching closer to finally managing to get this done and you won't know about it unless you're subscribed. Go to the Web site relentlesshealthvalue.com. You will be hit with a pop-up window fast enough, but back to easing cognitive dissonance and the why here. I thought Michelle Bernabe put how much of a difference the right culture can make for patients and those who work together really eloquently recently. This is a great why, since we spend so much of our life at work. She wrote, “Each day, we come together [ready to] roll up our sleeves, committed to our own growth, our boundaries, … and our teamwork. This collective dedication resonates throughout our organization and is, I trust, felt by our clients and [our] partners!” In the conversation that follows, Dr. John Lee offers a really nice array of examples of incremental, in the belly of the beast, stuff that might be possible in the real world (at least in the bellies of some beasts), plus some other points of contemplation. Dr. Lee is an ER (emergency room) doc by training, who is also an informaticist and chief medical information officer. I can tell you from personal experience that Dr. Lee is one of the most creative and pragmatic problem solvers that I have encountered. He says he's dedicated to trying to help move the ball forward and changing our healthcare system using information technology and using our ability to be far more transparent with the things that we try to do in a positive way in healthcare. Below are some additional episodes concerning heart failure readmissions: EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP INBW34: The Absence of Collaboration Between Healthcare Stakeholders: What It Means EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH Also mentioned in this episode are Kate Wolin, ScD; Ann M. Richardson, MBA; J. Michael Connors, MD; Michelle Bernabe, RN, KAT; Scott Conard, MD; Jodilyn Owen; Rob Andrews; Rishi Wadhera, MD, MPP; Peter Attia, MD; Barbara Wachsman; Kenny Cole, MD; and Mark Cuban.   You can learn more by following Dr. Lee on LinkedIn.   John Lee, MD, is both a practicing emergency physician and a highly regarded clinical informaticist. He has served as chief medical information officer at multiple organizations and has an industry reputation for maximizing the utility and usability of the electronic medical record (EMR) as a digital tool. He was the recipient of the HIMSS/AMDIS Physician Executive of the Year Award in 2019. He has deep expertise in EMRs, informatics, and particularly in Epic. He has multiple analyst certifications, which gives him a unique advantage in delivering solutions to Epic organizations. His vision is a healthcare system that is driven completely by transparent data, information, and knowledge, delivered efficiently.   07:37 What is cognitive dissonance relative to the healthcare industry? 08:57 What are the systems that start to bear down on individuals within the healthcare system? 10:14 EP391 with Scott Conard, MD. 10:48 EP421 with Jodilyn Owen. 10:59 EP415 with Rob Andrews. 12:30 EP326 with Rishi Wadhera, MD, MPP. 13:10 “The system has almost gamed them.” 17:49 EP430 with Barbara Wachsman. 19:07 How can alignment still be achieved in the face of cognitive dissonance? 20:34 EP431 with Kenny Cole, MD. 24:06 Why does it take more than one person to solve the dysfunction in the healthcare system? 26:26 What are some little changes that can help change the cognitive dissonance in healthcare? 28:22 Why is a hierarchal healthcare structure not necessarily beneficial? 30:38 The RaDonda Vaught story. 37:58 “Be happy in the small things.”   You can learn more by following Dr. Lee on LinkedIn.   John Lee, MD, discusses overcoming #cognitivedissonance on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson, Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole