Podcasts about nejm catalyst

Cannabis is complicated. It can mean many things, including a specific type of plant, the chemicals in the plant, synthetic analogs, or products that have these components. The doses of the most widely discussed pharmacologically active ingredients, THC and CBD, vary by product, and the onset and bioavailability vary by how it is delivered. If you believe the evidence for efficacy to manage symptoms like neuropathic pain, how do you even start to think about recommending these products to patients? On today's podcast, we answer that question with our guests, David Casarett and Eloise Theisen. David is a physician who wrote the book “Stoned: A Doctor's Case for Medical Marijuana” and gave a TED talk on “A Doctor's Case for Medical Marijuana” that was watched over 3 million times. Eloise is a palliative care NP at Stanford and co-founder of The Radicle Health Clinician Network. So, take a listen and check out the following resources to learn more about medical cannabis: Radicle Health's curriculum and modules for healthcare professionals on cannabis NEJM Catalyst article on integrating medical cannabis into clinical care David's TED talk on “A Doctor's Case for Medical Marijuana” A JPSM systematic review of current evidence for cannabis in palliative care Our past GeriPal episode with Bree Johnston and Ben Han on cannabis in older adults

"There's good news, we're actually seeing signs of a virtuous cycle, we're seeing [workforce] pride in organizations and that leads to people working together better, making the care better, which means the patients are more grateful, which makes people feel even more pride". — Dr. Thomas H. Lee, Professor of Medicine at Harvard Medical School and Chief Medical Officer at Press Ganey.In this episode, Dr. Thomas H. Lee discusses his professional growth, career development, and the core competencies of healthcare leaders. He distinguishes between leadership and management while highlighting their vital roles within complex health organizations. Dr Lee explores clinicians' important contributions to value creation, and the need to hone in on the "value chain". He further develops the idea that people should have choices when it comes to healthcare and we (healthcare providers) should be working hard to be chosen. Dr. Lee underscored the importance of trust-building with patients and staff alike.Follow Dr Thomas H. Lee: Twitter/X, LinkedIn.About the guest: Dr. Thomas Lee is the Chief Medical Officer for Press Ganey and an internist/cardiologist who practices at Brigham and Women's Hospital in Boston, Massachusetts.  He is on the faculty at Harvard Medical School and Harvard School of Public Health and is Editor-in-Chief of NEJM Catalyst and a member of the Editorial Board of The New England Journal of Medicine. He is a member of the Board of Directors of Geisinger Health System and chairs the Board of Geisinger Health Plan. Before joining Press Ganey in 2013, he was Network President for Partners Healthcare System.Additional resources mentioned in the podcast:Book - Healthcare's Path Forward: How Ongoing Crises Are Creating New Standards for ExcellenceBook - HBR's 10 Must Reads On Leadership for HealthcareTurning Doctors into Leaders - Harvard Business ReviewMusic attribution: AudioCoffee from Pixabay.Contact information: If you'd like to get in touch, reach out at jono@clinicalchangemakers.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com

Alexandra Drane, serial entrepreneur and co-founder of ARCHANGELS, discusses her unconventional experience working as a cashier at Walmart and its importance in informing her approach to business and life: solving complex problems by starting with the community and addressing real-life issues. Alexandra delves into “the unmentionables” of healthcare: the idea that when life goes wrong, health goes wrong. She emphasizes the importance of small acts of care and attention as the foundation for meaningful change in healthcare and society. Key Highlights: How working as a cashier at Walmart gave Alexandra a new lens for seeing the strength of the people who make up a community. How to help change a healthcare system that isn't set up to treat patients or healthcare providers as whole humans. The power of focusing on the details of life to create meaning.  About our guest: Alexandra is co-founder and CEO of ARCHANGELS. She co-founded Eliza Corporation (acquired by HMS Holdings Corp: HMSY), Engage with Grace, and three other companies (all boot-strapped). A serial entrepreneur, she is also a cashier-on-leave for Walmart. She believes communities are the frontline of health, that caregivers are our country's greatest asset, and that we need to expand the definition of health to include life. Alexandra is an inventor on numerous patents and has co-authored multiple peer-reviewed journal articles, including publications with the CDC, the Journal of Affective Disorders, and NEJM Catalyst. She joined Prudential Financial as a Wellness Expert for a film series called “The State of US” that was turned into a national ad campaign and generated close to two billion impressions. She has one hobby outside of her passion for revolutionizing health care, and her love of family and adventure…car racing. Key Moments: 11 minutes: On tapping into the expertise of patients. “Patients, humans who are in these situations where the traditional healthcare system is not offering a solution, they become genius inventors. And you can look condition by condition, whether it be childhood diabetes to life-threatening allergies to every type of cancer. There will be someone who has, in their basement, in their church, in their YMCA, rigged something together that is solving a previously misunderstood problem. And they figured it out. There is genius everywhere.” 25 minutes: On the challenge of the current structure of the healthcare system. “You had said something earlier about how sometimes we're dismissed. And I was thinking, as you were talking, about just how difficult it is to be a patient, to be a human in the system, when the system's not equipped to really think about you as a human.” 40 minutes: On the power of intention. “I think the healthcare system, which let's be clear, the healthcare system is nothing other than the fabric of society. The healthcare system is our lives. How we care for each other and get cared for ourselves is not a system, it is humanity. And I think we need to go back to what matters, who are we, how do we show up for each other? How do we lead with love? And guess what? When you do that, you can be sustainable and scalable.” Visit the Manta Cares website  Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

Google Chief Clinical Officer Dr. Michael Howell joins this week for a conversation on building clinical careers in tech and the role of big tech companies like Alphabet in healthcare. In this interview, Howell discusses his recent piece in NEJM Catalyst on building successful clinical teams in large tech companies and the role of clinical teams in the tech industry. Join for a conversation on fostering cultural shifts from clinicians as collaborators to healthcare innovators. Read Howell's recent NEJM Catalyst article here: https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0440 --- Send in a voice message: https://podcasters.spotify.com/pod/show/tdio/message

Happy New Year! We have an exciting lineup for 2023, but first, we'd like to reflect on a few things we learned this past year. Some favorites include our legal series and our series on women in EM - listen to the full episode to hear which juicy knowledge bites we can't let go of! What stuck with you this year? Do you enjoy our podcast series, or do you prefer stand alone episodes? We'd love to hear your thoughts. Tag us on social media, @empulsepodcast, reach out via email empulsepodcast@gmail.com, or connect through our website, ucdavisem.com. Encourage your friends and colleagues to listen and share their perspective, too! ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Resources: Episodes referenced: Do I really need to LP a febrile infant with a UTI? Legal Part I: A subpoena is not a party invitation Victims of our own success: ED crowding part 1 It isn't just our problem: ED crowding part 2 Pay attention  Mind the gap The leaky pipeline My role is doctor  Please don't hurt me! Articles referenced: Mahajan P, VanBuren JM, Tzimenatos L, et al. Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics. 2022 Oct 1;150(4):e2021055633. doi: 10.1542/peds.2021-055633. Emergency Department Crowding: The Canary in the Health Care System.   Commentary in NEJM Catalyst by Gabor D. Kelen, MD, Richard Wolfe, MD, Gail D'Onofrio, MD, MS, Angela M. Mills, MD, Deborah Diercks, MD, et al. Sept 28, 2021. Book referenced: Brave, Not Perfect by Reshma Saujani Video referenced: PACES Just-in-time: Positions of Comfort Guideline referenced: EIIC/TREKK: Bottom Line Recommendations: Pain Treatment *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Understanding social determinants of health (SDOH) is fundamental to the work we do in public health to ensure that people can live their healthiest lives. But it can sometimes be hard to explain social determinants fully and succinctly to people outside our field. Whether you are searching for the words to help teach others or you are new to public health yourself and still trying to get a handle on why -- despite educational campaigns and even strong individual motivation and intention -- systemic barriers often prevent people from engaging in healthy behaviors, today's episode is for you!In addition to helping you explain the basics, we'll cover two critically important rules for discussing social determinants of health with people outside public health -- whether partners from other sectors, community-based organizations, decision-makers, even friends and family. And we will also set the stage with this discussion of “Social Determinants 101” for several other related episodes. So enjoy today's show and stay tuned for a whole lot more on social determinants soon!Resources:Social Determinants of Health, Healthy People 2030, published by the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.Social Determinants of Health (SDOH), from NEJM Catalyst, Social Determinants of Health (SDOH). Published by New England Journal of Medicine, Dec. 1, 2017.Please click the button to subscribe so you don't miss any episodes and leave a review if your favorite podcast app has that ability. Thank you!For more information, visit the Health Comm Central website at: http://www.HealthCommCentral.com© 2022 Karen Hilyard, Ph.D.

Last week's show was with Wayne Jenkins, MD, from Centivo; and we talked about how insurance design, when not done well, can lead, in a nutshell, to mental and physical health problems for employees. This is a great lead-in to the conversation in this healthcare podcast with Dan O'Neill. And before I get into why it's a great lead-in, let me just start here—and don't roll your eyes. What is value-based care? Consider this delineation: There's value-based payments, and then there's the type of care that these payments incentivize. You would hope that a value-based payment would result in care that was of value (ie, great patient outcomes and patient satisfaction at a fair total cost of care). But those are two distinct things—the payment and the care. If we change the payment model but the provider behavior doesn't change in a way that actually improves patient outcomes and care, then what are we doing here? Or the converse: If we do not change the payment model, then how does anyone expect the care paid for is going to change? Employers or carriers who just meander along with the broad PPO network happily paying as much for low-value care as for high-value care and happily paying centers of excellence as much as non–centers of excellence … how is a provider who wants to spend time and money building out a practice to deliver better patient outcomes, how can they do that without overcoming some pretty fundamental business model challenges? This whole concept is one that my guest today, Dan O'Neill, has talked about and will talk about in this episode. Dan says the first step is for insurers, IPAs, managed care organizations to take an absolute chainsaw to their network management bureaucracy. There must be a clear door to a value-based payment model. It must be that if you're a provider or you're a physician practice (primary care practice, in particular), and you want to go down a value-based care path, there has to be a clear door and a pathway for you. I think I have a non-perfect litmus test for anybody with a value-based payment program who wants a heuristic to check if their value-based payment program is actually meaningfully impacting models of care in the marketplace: If most of the provider organizations who are part of that value-based program still incentivize and pay their doctors using FFS incentives like RVUs (relative value units), I'd step back and think about that for a piece. Contemplate that doctors, who are responsible for care decisions, still have every incentive to do everything that they would have done had the provider organization just been paid FFS. What's the point of value-based payments that extract exactly zero behavior change? And that is not a rhetorical question. So, back to the conversation from last week with Dr. Wayne Jenkins citing all of the things that can go horribly wrong when an employer's benefit designs are misaligned with the financial realities of their workforce. You get what you pay for, and I don't just mean that in terms of the dollars outlaid, since we all know in healthcare prices and quality have nothing to do with each other—I mean, in terms of what you choose to pay for and how you choose to pay for it. That's the macro of this whole thing, but indulge me as I get into the micro for just one sec. Let me just remind everybody about Goodhart's Law: “When a measure becomes a target, it ceases to be a good measure.” More on the why of this in the interview with Rishi Wadhera, MD, MPP, on the hospital readmission reduction program (EP326) and also what happens when we don't adhere to Goodhart's Law as we evaluate PCPs, which Rebecca Etz, PhD, talks about in EP295.   In this episode with Dan O'Neill, we go through where we're at on the continuum of value-based payments and how those payments are impacting the care, value-based or otherwise, that is incentivized by those payments. We tick through four gradations of value-based payments: A pure volume contract (otherwise known as FFS [fee for service]) A clinician bonus for achieving quality measures A piece of the savings (ie, MSSP [Medicare Shared Savings Program]) Global risk My guest, Dan O'Neill, is chief commercial officer over at Pine Park Health. Besides over a decade in healthcare tech and services, he was a policy fellow at the National Academy of Medicine and worked in the Senate on the Senate Health Committee. You can learn more at dponeill.com or connect with Dan on LinkedIn. Daniel O'Neill, MA, MS, currently serves as chief commercial officer for Pine Park Health, a value-based primary care group that delivers on-site care in senior living communities. Prior to that, Dan was a health policy fellow at the National Academy of Medicine, working primarily in the US Senate on legislation focused on surprise billing, anti-competitive contracting practices in the commercial market, and price transparency. Dan has also worked as a senior vice president with Change Healthcare and as an advisor to venture-stage healthcare services and technology firms. At Pine Park, Dan is responsible for risk-based contracting with IPAs and insurers and for the group's participation in CMS value-based care models, including direct contracting. Dan's research is available in NEJM Catalyst and on the Health Affairs blog, and he holds graduate degrees from Johns Hopkins University and Stanford University.   05:06 What is the spectrum of value-based contracts? 07:24 Why don't value-based contracts at the organizational level always trickle down to the provider level? 11:25 What are the two things that need to happen to drive outcomes in value-based healthcare? 15:24 How do insurers play into improving value-based contracts? 19:46 “There's a strong case to actually clamp down on prices.” 23:47 “Right now, we're still in a place where if you want to do something other than fee for service … you have to fight like hell.” 24:03 What's the first step to making value-based contracts more accessible? 24:27 What's the second step to making value-based contracts accessible? 25:23 Why are the incentives to change American healthcare pretty weak? 27:10 “Organizational change is just exceedingly difficult.” 28:45 What should you do if you want to start pushing organizations toward value-based contracts? 32:42 EP351 with Eric Bricker, MD.  You can learn more at dponeill.com or connect with Dan on LinkedIn. @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What is the spectrum of value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth Why don't value-based contracts at the organizational level always trickle down to the provider level? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What are the two things that need to happen to drive outcomes in value-based healthcare? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth How do insurers play into improving value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “There's a strong case to actually clamp down on prices.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “Right now, we're still in a place where if you want to do something other than fee for service … you have to fight like hell.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What's the first step to making value-based contracts more accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What's the second step to making value-based contracts accessible? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth Why are the incentives to change American healthcare pretty weak? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth “Organizational change is just exceedingly difficult.” @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth What should you do if you want to start pushing organizations toward value-based contracts? @dp_oneill discusses #vbc on our #healthcarepodcast. #healthcare #podcast #valuebasedpayments #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber  

In our last episode, we discussed several factors that lead to emergency department crowding, as well as the consequences for patients and providers, as presented in a recent commentary in NEJM Catalyst. We continue the conversation with one of the authors of the article, Dr. Deb Diercks, focusing on potential solutions.  Is your ED overcrowded? How is your hospital handling it? Connect with us on social media, @empulsepodcast, on email empulsepodcast@gmail.com, or through our website, ucdavisem.com. We're working on an episode on what it's like to be a woman in emergency medicine. We'd be honored if you'd share your story? Contact us as above, or leave your story on a brief voicemail at 951-251-4804  (don't worry, we'll edit it to make it sound smooth!).  ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Deborah Diercks, Chair of Emergency Medicine at UT Southwestern, President of the SAEM Academy for Academic Chairs in Emergency Medicine  Resources: Emergency Department Crowding: The Canary in the Health Care System.  Commentary in NEJM Catalyst by Gabor D. Kelen, MD, Richard Wolfe, MD, Gail D'Onofrio, MD, MS, Angela M. Mills, MD, Deborah Diercks, MD, et al. Sept 28, 2021. ERs are now swamped with seriously I'll patients - but many don't even have COVID.  By Kate Wells. NPR CapRadio News, Oct 26, 2021. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

If you've been in the emergency department recently, either as an employee or as a patient, you've undoubtedly seen the effects of ED crowing - busy waiting rooms, long wait times, and delays in care, just to name a few. In part one of this two part series, we discuss some of the factors that lead to ED crowding and boarding of admitted patients, as well as some of the consequences. Stay tuned for part 2, when we'll talk about potential solutions!  Is your ED overcrowded? How is your hospital handling it? Connect with us on social media, @empulsepodcast, on email empulsepodcast@gmail.com, or through our website, ucdavisem.com. We're working on an episode on what it's like to be a woman in emergency medicine. We'd be honored if you'd share your story? Contact us as above, or leave your story on a brief voicemail at 951-251-4804  (don't worry, we'll edit it to make it sound smooth!).  ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Deborah Diercks, Chair of Emergency Medicine at UT Southwestern, President of the SAEM Academy for Academic Chairs in Emergency Medicine  Resources: Emergency Department Crowding: The Canary in the Health Care System.  Commentary in NEJM Catalyst by Gabor D. Kelen, MD, Richard Wolfe, MD, Gail D'Onofrio, MD, MS, Angela M. Mills, MD, Deborah Diercks, MD, et al. Sept 28, 2021. ERs are now swamped with seriously I'll patients - but many don't even have COVID.  By Kate Wells. NPR CapRadio News, Oct 26, 2021. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

“The secret sauce of the Transitions, Referral and Coordination (TRAC) team was including a  lawyer.”  This is brilliant and will ring true to those of us who care for complex older adults who end up in the hospital for long, long, long admissions. On today's podcast we talk with Kenny Lam, Jessica Eng, Sarah Hooper, and Anne Fabiny about their successful interdisciplinary intervention to reduce prolonged admissions, published in NEJM Catalyst.  Many of the problems that older adults face are not medical.  How to find housing.  How to stay in their homes.  How to get a paid caregiver to help them stay at home.  How to get someone to pay bills.  How to assign a surrogate health care decision maker.  The legal obstacles to accomplishing these tasks for complex older adults, particularly those who may have marginal decision making capacity, can seem insurmountable.  Having a lawyer on the team is brilliant - in much the same way that having a handyperson on the team for project CAPABLE to keep people at home was brilliant.  For more, listen also to our prior podcast with Sarah Hooper on medical-legal partnerships.

Stacey Chang is a designer and engineer.  Until 2014, Stacey was the Managing Director of the Healthcare practice at IDEO, the global design and innovation firm. He left to found the Design Institute for Health at the University of Texas at Austin, a first-of-its-kind institution, dedicated to applying design approaches to solving systemic health care challenges as an integrated part of an operating health system and a medical education and training program. As Executive Director of the Design Institute, Stacey and team cover topics such as the design of health services and tools, the built environment, new care models, and the structure and functionality of the health ecosystem itself. Stacey has served as a TEDMED Editorial Advisory Board member, and a Thought Leader for NEJM Catalyst. He holds degrees in engineering from MIT and Stanford. Follow Stacey on twitter. Rachel Smith- identifies as I'm a multidisciplinary Latina Design Leader who believes in Designing for social impact. She is the founder of Design to Combat COVID-19, a virtual community of creatives—now over 2,200 strong—who volunteer their skills and time using design thinking to support medical professionals, service workers, and under represented communities affected by the pandemic. By day, Rachel Smith is a Senior Product Designer at Zillow, and previously has worked with companies such as Nordstrom and The Home Depot. The rest of the time, the LA native works on a range of creative projects, both within her local community and globally. Follow Rachel on twitter. 

In this interview, we talk to Dr. Stephen J. Swenson. He is dedicated to the support of thoughtful leaders who aspire to nurture fulfillment of their staff. He is a recognized expert, researcher and speaker in the disciplines of leadership and burnout. Dr. Swensen serves as Senior Fellow of the Institute for Healthcare Improvement, where his focus is Joy in Work. He works as the Leadership Theme Leader for NEJM Catalyst. For three decades he served patients at the Mayo Clinic. As Director for Leadership and Organization Development, he co-led the Professional Burnout Initiative and oversaw the development of 4,100 physicians and 232 key leaders. As Chief Quality Officer, he established the Quality Academy wherein 37,000 colleagues were certified as Fellows during his tenure. As Chair of the Department of Radiology, he and his team used their Value Creation System to improve the welfare of both patients and professionals. As professor in the Department of Radiology, he was Principal Investigator of two National Institutes of Health grants and has authored three books and 207 articles. He was honored with the Diamond Lifetime Achievement Award, served as the president of two international societies and founded the Big Sky Group. Dr. Swensen has been married for 43 years, has two children and has completed 39 marathonsIn this episode we discuss his book "Mayo Clinic Strategies To Reduce Burnout: 12 Actions to Create the Ideal Workplace" which YOU CAN ENTER TO WIN by joining our email list. This contest will run until January 11th! We also discuss the MAYO clinic model of care, creating a culture of espirit-de-corps, and the importance of curiosity in medicine. Questions we asked include: Tell us about how you came to write this book? What is espirit-de-corps and how did you arrive at it?Why did you use the paradigm shift of "work life integration" instead of "work-life balance" in your book? Can you introduce us to that and tell our audience what are some of the things that are different at MAYO?Why don’t you think this model has spread everywhere else?What traits do you think physician leaders should work on cultivating? What advice would you give to physician leaders? Our favorite quotes: “Leadership is a potent combination of strategy and character. But if you must be without one, be without strategy.” -General Norman Schwarzkopf“You have to act as if it were possible to radically transform the world. And you have to do it all the time.” -Angela Davis“[In healthcare], we have a shared responsibility to do our work, to improve our work, and to care for each other.” -Dr. Swenson “The needs of the patient come first” -MAYO Clinic Mission“You change culture one behavior at a time” -Dr. Swenson “In order to teach something you have to understand it at a different level and be able to communicate it in a way that’s understandable.” -Dr. SwensonIf you enjoy what we're doing at Leading the Rounds, subscribe and give us a positive rating. You can also connect with us at leadingtherounds.com and on social media.

Dr. Sanjay Saint is the George Dock Professor of Internal Medicine at the University of Michigan and Chief of Medicine at the VA Ann Arbor Healthcare System. Dr Saint completed his Medical school at UCLA and Residency and Chief Residency in Internal Medicine at UCSF. He was a Robert Wood Johnson Clinical Scholar at the University of Washington where he also received his Masters in Public Health. His research focuses on patient safety, implementation science, and medical decision-making; he has authored over 350 peer-reviewed papers. He serves on the editorial board of multiple peer-reviewed journals including the BMJ Quality & Safety and NEJM Catalyst. He has been awarded the Distinguished Mentor Award from the University of Michigan, and has received the National VA Physician of the Year Award. Our success in a career in medicine is heavily influenced by the mentors who we choose to surround ourselves with. But the challenge is finding and building relationships with said mentors. Today, Dr. Sanjay Saint teaches us the science and the art of finding a great mentor. The science being: The past is a great predictor of the future. Most great mentors will have a track record of positively impacting other mentees. The art is: Following our gut instincts, How do I feel when I'm in the presence of a potential mentor? Do I feel positive, supported, and seen? If the answer is yes, we should listen to our instincts—and trust our hearts. As Dr. Saint puts it, we've gotten this far as humans by trusting our instincts with individuals, whether it's with friendship, love, or business. Those instincts are finely honed—and we should respect and trust them. Pearls of Wisdom: 1. Practice mindfulness during our hand wash. During that time, reflect on the way you have the ability to change the atmosphere in the room you are about to enter. And when you get into the patient's room, be fully present: Don't think about the previous or the next patient. Give that patient your time. 2. Everyone is an expert in something, and we can learn something from everyone. Pay attention to each interaction with another person—there is always something new to learn. 3. The key to finding a great mentor is a balance of science and art. Science in the way that the past is a great predictor of the future: Great mentors will likely have a great track record. And art is where our gut feelings will help us: How do we feel in a mentor's presence? If it's a positive feeling, trust that and move forward.

At the end of the day, health care should be about helping patients find their way to health while doctors, nurses, and other clinicians don’t burn out in the process. It’s becoming increasingly indisputable that the way to get to this North Star efficiently is through human-centered health care. Human-centered health care is a term coined by Dr. Sylvia Romm, and it’s a play on the term customer-centered design. How do we innovate? How do we use technology to intensify the human experience for both provider and patient? How do we rid ourselves of friction points and create a continuum of care that is sticky and makes getting healthy as enjoyable as Instagram? In this health care podcast, I speak with Sylvia Romm. She’s an MD and an MPH with a background as a researcher and a telemedicine entrepreneur prior to coming to Atlantic Health System as their chief innovation officer. We talk in this podcast about human-centered health care—what this means, what the success factors are, and how to make it happen. We also take into account the assorted challenges to overcome on the way there. This interview was recorded moments before COVID-19, and I say that as a good thing. Dr. Romm brings up telehealth as, let’s just say, a first step toward actuating human-centered design in health care. Clearly in the past, that was quite a hurdle. No longer. So, those health systems or you other stakeholders in the mix who have gotten the telehealth thing nailed, listen on for ways that you can leverage your success. And for those of you who haven’t, well, here’s a little extra motivation. You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm.  Sylvia Romm, MD, MPH, is driven by a passion for transforming health care delivery to patients and communities. She brings her background and expertise as a clinician and an entrepreneur to her role as chief innovation officer for Atlantic Health System. Firmly believing that a patient-centered focus is vital to health care innovation, Dr. Romm works with Atlantic Health System’s team members and physicians to find new ways to improve access to high-quality, affordable care. She also forges relationships with local and national innovation partners and works to expand the organization’s research profile. Dr. Romm is an avid author and speaker in the areas of health care, technology, and health information technology (IT) policy. She has written articles for various publications—including NEJM Catalyst, Forbes, KevinMD, and the Huffington Post—and was named one of Fierce Healthcare’s 8 Influential Women Reshaping Health IT and Becker’s Women in Health IT to Watch in 2020. A board-certified pediatrician, Dr. Romm has served in a variety of clinical leadership roles throughout her residency and as a hospitalist. Before joining Atlantic Health System, she was vice president of clinical transformation for American Well, the largest video-based telemedicine company in the United States. In addition, she was the founder of MilkOnTap, the nation’s first telehealth company focused on the needs of nursing mothers and lactation support. Dr. Romm earned her Master of Public Health in global health from Harvard TH Chan School of Public Health. She holds a medical degree from the University of Arizona College of Medicine and completed her residency in pediatrics at Massachusetts General Hospital. 02:18 How Dr. Romm’s background in research, public policy, and being a pediatric hospitalist intertwine to create great innovation strategies. 03:22 “How do we look at populations?” 03:31 “It’s really about affecting the system in its entirety.” 04:33 What human-centered health care means. 06:36 “You’re only as effective as the rapport that you build with [this] person.” 08:05 “What do people really need … but also, what do they find valuable?” 09:42 How data are folded into human-centered health care. 11:55 “The endgame is to figure out … how to have a better experience.” 12:39 How this fits into the quadruple aim. 17:19 “We are going to have to earn and learn agility.” 19:38 What has the most promise in deepening the connection between patients and providers. 20:32 “Is this about you, and how do we know … how people outside feel about creating a relationship?” 23:29 Is there a best practice for furthering the patient/doctor relationship from afar? 24:24 The need for a variety of approaches to patient/doctor connections. 27:30 What innovation initiatives need to be successful. 28:07 “People have to understand the ‘why.’” 29:38 The classic tenets of change management. 30:02 A challenge Dr. Romm is proud of having solved. 31:56 Secret weapon: collaboration. You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm. Check out our newest #healthcarepodcast with @sylvia_romm of @SonderHealth and @AtlanticHealth as she discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation “How do we look at populations?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “It’s really about affecting the system in its entirety.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What does human-centered #healthcare mean? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “You’re only as effective as the rapport that you build with [this] person.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “What do people really need … but also, what do they find valuable?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast How are data folded into human-centered #healthcare? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “The endgame is to figure out … how to have a better experience.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “We are going to have to earn and learn agility.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “Is this about you, and how do we know … how people outside feel about creating a relationship?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What do innovation initiatives need to be successful? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “People have to understand the ‘why.’” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What are the classic tenets of change management? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast Why collaboration is the secret weapon to innovation in health care. @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast

As Ashwin Kotwal and Lynn Flint note in the introduction to their Annals of Internal Medicine essay (https://www.acpjournals.org/doi/full/10.7326/M20-1982?journalCode=aim), one year ago people were outraged at the thought of a physician using video to deliver bad news to a seriously ill man in the ICU. And look at where we are today. Video and telephone consults at home, in the ICU, and in the ED are common, accepted, and normal. What a difference a year makes. This week, in addition to Ashwin and Lynn, we talk with Claire Ankuda and Chris Woodrell from Mt Sinai in NYC about their experience with telephone and video palliative care. Claire and Chris recently published a terrific NEJM Catalyst piece about their remarkable ramp up of a telephone based palliative care consult service. Take a look at the figure depicting time trends of health system confirmed/suspected COVID19 cases in their health system and the dramatic rise in tele-palliative care consults (https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0204). Their service peaked at 50 consults per day, and as they note, that is likely an undercount. About half of the consults were in the ED. Ashwin and Lynn talk about the nuts and bolts of of how to prepare and conduct video and telephone based serious illness discussions with patients, as described in their Annals essay. Eric and I talk briefly about our experience conducting palliative care consults remotely with patients at New York Presbyterian Columbia, described in our recent JAGS paper. And (bonus!) you get to sing along to "Call Me Maybe." -@AlexSmithMD

Suzanne calls Michael Chernew, PhD, director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy at Harvard Medical School. They discuss his December 2019 publication in NEJM Catalyst, “How Different Payment Models Support (or Undermine) a Sustainable Health Care System: Rating the Underlying Incentives and Building a Better Model,” co-authored with Jermaine Heath, AB. The article examines the theory and evidence of fee-for-service, episode-based payments, and population-based payments, and makes recommendations around which payment models can create better incentives. Listen in to get into the weeds on how payment reform works while also staying grounded in a fundamental truth: we can’t expect any Alternative Payment Model (APM) to be successful if the model isn’t sustainable to those who deliver the care.

Dr. Nicolas Nguyen is our guest this week. Dr. Nguyen is a practicing Family Physician and the Director of Physician Experience and Provider Development at Beth Israel Deaconess HealthCare. He has created a model for clinician community building, which was highlighted and published in NEJM Catalyst, and he joins us to talk about his initiative. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @audreymdmph, or drop me a line at contactATrospod.org.

In today's episode, we chat with Sylvia Romm, M.D.  about her journey from being a pediatric hospitalist to an innovator in the technological side of medicine. Listen as as she shares how she started her own telemedicine business to help women with breastfeeding and how she now works as an innovator in the telemedicine industry. In this episode, you will learn: How she got involved in the technological side of medicine. Why she decided to start her business helping breastfeeding moms. How telemedicine has grown and changed over the past 5 years. How Parity Laws have changed the landscape of telemedicine and helped it grow. Why she feels that telemedicine can be a helpful tool to most physicians. How telemedicine is affected by insurance providers and reimbursement laws. How telemedicine can help with the prevention of physician burnout. Why she feels that deviating from traditional medicine has improved her life. Sylvia Romm M.D., MPH, is the Vice President of Clinical Transformation at American Well and works with health systems, employers, health plans, and other health care innovators to design and implement their digital health strategies. Dr. Romm worked first as a pediatric hospitalist before founding, Milk on Tap, a company focused on telemedicine for new mothers, and then joining American Well full time. Through these experiences working both as a clinician and as an entrepreneur, Sylvia believes that the integration of digital health care delivery into the traditional health care ecosystem is a key component to the quadruple aim of enhancing patient experience, improving population health, reducing cost, and improving the work life of health care providers. She is an avid author and speaker in the areas of healthcare, technology, and health IT policy, with articles published in NEJM Catalyst, Forbes, KevinMD, and Huffington Post and named as one of FierceHealthCare's “8 Influential Women Reshaping Health IT.” Dr. Romm holds a medical degree from the University of Arizona College of Medicine and a Master of Public Health degree from the Harvard School of Public Health. She completed her Pediatrics residency at Massachusetts General Hospital. Links we discussed in the show: Check out Sylvia's business to help mothers with breastfeeding: Milkontap.com. Special thank you to this week's show sponsor: Northwestern University's Master of Science in Global Health Program. Find out more about it at www.sps.northwestern.edu/global. Thank you for listening to the Hippocratic Hustle! I know that time is your most valuable resource so I really appreciate you spending some of it with me. If you enjoyed today's show, please share it! If you'd like to help me improve and grow the podcast, send your suggestions to: Carrie@HippocraticHustle.com Lastly, don't forget to subscribe to the podcast, so you won't miss an episode!

https://accadandkoka.com/wp-content/uploads/2019/02/Chandra-pic-e1549144948426.jpeg ()Amitabh Chandra, PhD Some drugs cost more than diamonds though their health benefit seems marginal.  Others cost less than a package of M&Ms though they are demonstrably life-saving.  Some drug prices have spiked to 3-fold, 4-fold, or even 10-fold from what they were just a few years ago.  Drug pricing seems to be an irrational and incomprehensible aspect of our economy. To help us gain clarity on the matter, we have as our guest Amitabh Chandra, the Malcolm Wiener Professor of Public Policy at the Harvard Kennedy School of Government and the Henry and Allison McCance Professor of Business Administration and the Harvard Business School.  He is among the best decorated healthcare economists alive, having received the highest awards in the field.  He is an elected member of the National Academy of Medicine, a member of the Congressional Budget Office panel of health advisors, and a research associate at the National Bureau of Economic Research. Professor Chandra has published seminal papers in the most highly ranked journals of economics and medicine.  His research has been featured in The New York Times, The Washington Post, CNN, Newsweek, and on National Public Radio and has testified to the US Senate on matters of healthcare policy. GUEST: Amitabh Chandra, PhD. https://twitter.com/amitabhchandra2 (Twitter) and professional pages at https://www.hbs.edu/faculty/Pages/profile.aspx?facId=868461 (HBS) and https://www.hks.harvard.edu/faculty/amitabh-chandra (HKS). LINKS: Bagley N, Chandra A, Garthwaite C, and Stern A.  https://catalyst.nejm.org/time-reform-orphan-drug-act/ (It’s Time to Reform the Orphan Drug Act.) (NEJM Catalyst, Dec 19, 2018) Chandra A and Gartwaith C.  https://www.nejm.org/doi/full/10.1056/NEJMp1705035 (The Economics of Indication-Based Pricing). (NEJM Perspective, 2017) WATCH ON YOUTUBE: This episode is not available on YouTube Support this podcast

Wednesday, June 6th 2018 our special guest is Griffin R. Myers, MD, the Chief Medical Officer of Oakstreet Health Network.  Dr. Myers is a board-certified physician responsible for the excellence of health care delivery at Oak Street Health. Oak Street Health is a growing organization of value-based primary care centers serving adults on Medicare that is headquartered in Chicago.  At Oak Street Health, Dr. Myers has successfully guided the company’s growth into additional markets and explores additional partnerships to broaden the company’s reach. He has built the medical group and helped to develop the innovative care model at Oak Street. He is a frequent speaker and publisher on behalf of the company and a rising voice in the health care industry. Prior to Oak Street Health, Dr. Myers was a Clinical Fellow at Harvard Medical School, where he did his residency in emergency medicine at the Brigham and Women’s and Massachusetts General Hospitals. He previously worked as a Project Leader at The Boston Consulting Group. Dr. Myers is BS graduate of Davidson College, has an MBA from the University of Chicago Booth School of Business, and has an MD from the University of Chicago Pritzker School of Medicine. He is a diplomate of the American Board of Emergency Medicine and an Adjunct Instructor of Emergency Medicine at Northwestern University’s Feinberg School of Medicine. Dr. Myers is also a Fellow at Doximity, a Thought Leader for NEJM Catalyst, and a Presidential Leadership Scholar.

Date: June 14, 2017 Featuring:  Christina Pagel, PhD, MSc, IHI Fellow and 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund) Jennifer Reed Beloff, RN, MSN, APN, Executive Director of Quality, Brigham and Women's Hospital Dorien Zwart, MD, PhD, 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund) ​Learning from failure is an important part of quality improvement in health care. But what can we learn from improvement efforts that languish or stall due to the inglorious nature of the work itself?  This issue has caught the attention of a researcher and a physician who argue in arecent article in NEJM Catalyst that not all QI initiatives are created equal; some are inherently more interesting and enjoy a higher profile in an organization (e.g., reducing sepsis), while other projects, no matter how necessary (e.g., decreasing patient no-shows), occur out of the spotlight, are tedious and, sometimes, just plain boring. Is that a fair characterization of what goes on in your organization? Would you put it another way?  Of course, what's boring is often in the eye of the beholder. Developing the technological and administrative processes needed to get information from primary to acute care — and the other way around — in a timely, accurate fashion may cause the eyes of some members of your clinic staff to glaze over, while others are completely energized. We discussed navigating that dynamic with our guests on the June 14 episode of WIHI.

Paul Rosen, MD, MPH, MMM http://www.paulrosenmd.com/, was named ‘One of the First 100 Innovators' by the U.S Federal Government Agency for Healthcare Research and Quality for his work on patient-physician communication.  He blogs for NEJM Catalyst,  http://catalyst.nejm.org/posts?q=rosen Healthcare Success, the Healthcare Guys and Health Tap.  He co-hosts Pediatric Chat, http://pediatricchat.org/, a podcast that offers pediatric information to families across the globe.  He is a TEDx speaker https://www.youtube.com/watch?v=8BKN7RFhdq4, and has appeared on Sirius XM on the Business of Healthcare show to discuss the patient experience movement. Dr. Rosen is a pediatric rheumatologist.  He serves as the Clinical Director of Service and Operational Excellence for Nemours Children's Health System.  Dr. Rosen was named the head of the Philadelphia/Delaware chapter of the Society of Physician Entrepreneurs  (SoPE).   He mentors medical students in innovation, leadership, and quality improvement. He serves as a mentor for the entrepreneur program at Wharton Business School.  Dr. Rosen also serves as a mentor in the Health for America fellows program. He is interested in using health delivery science to deliver value and achieve the quadruple aim. 00:00 Paul's take on Patient Engagement. 01:00 Partnering with Patients, Controlling their pain. 02:45 Why Patient Engagement is controversial. 03:45 How do patients judge quality? 04:30 “Who is judging quality better than patients?” 05:00 Quality or Service - why patients expect both. 06:15 Do online public review tools actually affect clinical business? 07:00 What good looks like for a Health System in Paul's eyes. 09:20 Helping people make the right decisions and building trust. 12:20 Things that get overlooked in the patient experience. 13:45 “Swarming,” what this is, and what it takes to make it work systemically. 15:15 The process of “Continuous Improvement” and what this looks like in action. 17:10 Learning what to focus on, and what to disregard with patient reviews. 23:00 Healthcare Professional Burnout. 25:15 What Paul sees as the major causes of Healthcare Professional Burnout. 25:45 What Paul is doing to fight burnout. 29:00 Designing tools to fit into physician workflow. 30:00 Learning to understand how ED doctors think. 32:00 You can learn more at http://www.nemours.org// or by visiting http://www.paulrosenmd.com/.