[Music]
how many of you heard that healthcare in
the United States is ineffective
inefficient and very expensive raise
your hands okay so it’s no secret that
we need to make changes in our
healthcare system today I’m going to
tell you the story of how I became an
accidental expert and just helping to
change healthcare and it was a total
Alice in Wonderland experience I don’t
necessarily know nor now know what I’m
doing
but I’ve learned a lot that I hope today
I can leave you with some lessons that
you can use to think about cultivating
collaboration both in healthcare and in
your own life so a few years ago I was
put in a room with a group of strangers
who are now my close colleagues and we
were told to design in a professional
collaborative care model at a new clinic
that was opening interprofessional
collaborative care as well health care
providers intentionally work together to
be on the same page with patients and
families to deliver care for those of
you outside of healthcare it might sound
strange that we don’t work together but
it’s not really our norm to be that
collaborative and I’ll talk a little bit
about why in a couple of minutes when we
started this journey there’s no roadmap
for what we were doing we literally had
to create and innovate to figure out the
best ways to deliver care and figure out
how we would do it in a system where
that presents a lot of challenges so
today what I’m going to do is talk a
little bit about some of those
challenges and then give you six lessons
that I think you can take in your life
to help lis move change forward in a
positive way so the Institute for
Healthcare Improvement has identified
three ways in which we need to change
our healthcare system improve to improve
delivery of care one is to address
population health our healthcare system
is really good at doing acute care when
people have an accident or injury or a
flare-up in a disease but the reality is
lots of our patients have chronic
disease and we need to get better at
managing that and keeping people healthy
in addition to that we need to improve
the experience of care and whether
you’re a healthcare provider or not our
one unified experiences at some time in
our life will all be a patient and it’s
important for us to work together to
provide you that best experience and
then the other aim that’s been
identified is cost how do we provide
more cost effective care that’s also
efficient and keeps you healthy working
at healthcare additional
is hard and we haven’t done a good job
of taking care of our clinicians so a
fourth aim has been added and now this
is called the quadruple aim because
unfortunately we have high rates of
clinician burnout depression anxiety and
even suicide and our first year of
delivering collaborative care the reason
I bring up the quadruple aim is because
we hit all of these we saw dramatic
reductions in emergency department
visits hospitalizations hemoglobin a1c
which is a type 2 diabetes indicator and
we saved millions of dollars in addition
our clinic where we do this work has
consistently scored 2nd out of over 150
clinics and employee engagement so if
this is important and we should do it
why is it so hard well there’s lots of
reasons why it’s challenging and I’m
going to briefly talk about two that
really make the work hard and the first
is the business of health care so say
you go to McDonald’s and you order a Big
Mac the Big Mac you get at the
McDonald’s you’re at or a location a few
miles away or one across the country is
pretty much the same Big Mac but when
you enter a clinic or a hospital the
composition of services of that facility
are different you have different health
care providers for example you might
have a pharmacy on-site and you might
not there’s not uniformity and how
health care services are comprised and
so it’s difficult to take one model and
just plug it into somewhere else in
addition you can’t get your Big Mac
unless you can pay for it and you know
what the prices in healthcare we don’t
have good price transparency about what
we’re paying and sometimes we don’t know
what the cost is going to be based on
the illness or situation in addition
health care systems have to deliver care
to people that can and those that can’t
provide care all these complexities make
it difficult to change the system the
other challenge we have is how we
educate health profession students and
the best way in order to describe this
is using the lego movie so if you’ve
seen the lego movie you know there’s
this character named Emmett and he’s
like this regular guy kind of like me a
regular person that fell into this
circumstance and there’s a part of the
movie where they’re pretty despondent
he’s with all these master builders and
they’re really great at what they do
and he says to
them you guys are all so talented and
you know what you’re doing you’re
master-builders but your problem is you
don’t know how to work together that’s
exactly the problem we have in Health
Professions education in today’s world
we graduate great pharmacists nurses
physicians but we haven’t taught them
how to work together and then we put
them in the clinical environment
expected to just happen well I can tell
you it doesn’t
and then Amit wisely says is in the
movie when I had a plan I could really
do great things and that’s what we need
to teach our health profession students
to do to work together and come with
plans with patients to help optimize our
healthcare system so I want to leave you
today with six lessons that I’ve learned
in this experience that I hope can you
can take with you to make the world a
better place in healthcare or whatever
industry you work and I’d like to tell
you that changing a system begins with
changing yourself and if you can change
yourself and what you know and how you
act you can begin to change the world
and make it better so here are my six
lessons that I’ve learned as Alice in
Wonderland
the first is grit if you don’t have grit
and are willing to take on challenges
and face things that are gonna be
difficult this work is not for you it’s
tough it’s not easy the second one is
don’t listen to no and this is something
I love about Alice in Wonderland how
many times has she told not to go down
the rabbit hole or listen to these
characters that she did there’s going to
be everyone that tells you you can’t do
what you’re doing it won’t work
it’s impossible you’ll never make a
change don’t listen to no it’s very
important the next lesson is to get over
yourself because guess what you’re not
guys gift to the world and that means
you either ego down admit I’m not God’s
gift or you ego up and in my case on a
healthcare team I have to ego up because
I’m trained as an occupational therapist
an occupational therapists help people
with disabilities and disorders engage
in activities that are meaningful things
they choose to occupy their time in the
medical model my delivery of care is
prescribed by a physician and when I was
trained I was trained to be subservient
to physicians but I wasn’t really
supposed to bring my voice to the table
so when I come to the health care team I
have to ego up and say what I’m doing
with
patient matters and the whole team needs
to know it the next lesson is from wrote
what’s called psychological safety dr.
Amy Edmondson is study this extensively
and psychological safety happens in
high-performing teams because people are
allowed to speak up and engage without
threat you can say something and have a
different opinion without consequence
without penalty it’s easy to talk about
and hard to do and so that gets to the
next lesson
define your culture and in our clinic we
define our culture of psychological
safety with two mottos the first is
everyone teaches everyone learns when we
believe that from the front desk to our
patients to our families to our
physicians that we can all teach each
other something and learn from one
another we democratize our team and we
recognize that we all bring value and
that’s very important to help cultivate
collaboration the second lesson or the
second motto is assume positive intent
instead of viewing people with different
opinions or different ideas as against
you or not with the idea you have when
you reframe it and think that everyone’s
here for the betterment of the patient
and we assume everyone’s got that same
goal we can work together much more
effectively these two models have really
shaped that culture of collaboration and
I encourage you to take those especially
assume positive intent it applies
everywhere I’m not just in healthcare
the last and probably most difficult
lesson the most painful one is that you
have to know yourself and know yourself
really well and that means knowing your
strengths on a team but also your
weaknesses and often you get to know
yourself through self-assessment so our
team did a self-assessment on conflict
engagement and I scored a hundred
percent accommodating so later you can
come to my office and I’ll give you
whatever you want it explains a lot
about hi function on my team and my
marriage but it’s also important for me
to know and it’s it’s also embarrassing
frankly to admit that you might have one
way that might negatively affect the
rest of your team but if you don’t own
that and aren’t willing to become humble
and recognize the impact of that you’ll
never make progress on a team and so
even though it’s painful it’s very
important so as I come to a close I want
to challenge you will you be like Alice
go down the rabbit hole I can tell you
four years ago I knew basically nothing
about what I’m doing today I have
learned so much and it takes take taking
that leap and going down the rabbit hole
and I’m gonna tell you don’t have to
know anything and everything about the
topic but you have to be willing to put
yourself out there and try to do the
things that will make the change but I
will leave you with this advice you can
be Alice but don’t go at it alone
because I’ve learned that we’re better
when we have different perspectives and
different people at the table and please
remember that to change healthcare we
have to do it together and we are better
together thank you [Applause]
how many of you heard that healthcare in
the United States is ineffective
inefficient and very expensive raise
your hands okay so it’s no secret that
we need to make changes in our
healthcare system today I’m going to
tell you the story of how I became an
accidental expert and just helping to
change healthcare and it was a total
Alice in Wonderland experience I don’t
necessarily know nor now know what I’m
doing
but I’ve learned a lot that I hope today
I can leave you with some lessons that
you can use to think about cultivating
collaboration both in healthcare and in
your own life so a few years ago I was
put in a room with a group of strangers
who are now my close colleagues and we
were told to design in a professional
collaborative care model at a new clinic
that was opening interprofessional
collaborative care as well health care
providers intentionally work together to
be on the same page with patients and
families to deliver care for those of
you outside of healthcare it might sound
strange that we don’t work together but
it’s not really our norm to be that
collaborative and I’ll talk a little bit
about why in a couple of minutes when we
started this journey there’s no roadmap
for what we were doing we literally had
to create and innovate to figure out the
best ways to deliver care and figure out
how we would do it in a system where
that presents a lot of challenges so
today what I’m going to do is talk a
little bit about some of those
challenges and then give you six lessons
that I think you can take in your life
to help lis move change forward in a
positive way so the Institute for
Healthcare Improvement has identified
three ways in which we need to change
our healthcare system improve to improve
delivery of care one is to address
population health our healthcare system
is really good at doing acute care when
people have an accident or injury or a
flare-up in a disease but the reality is
lots of our patients have chronic
disease and we need to get better at
managing that and keeping people healthy
in addition to that we need to improve
the experience of care and whether
you’re a healthcare provider or not our
one unified experiences at some time in
our life will all be a patient and it’s
important for us to work together to
provide you that best experience and
then the other aim that’s been
identified is cost how do we provide
more cost effective care that’s also
efficient and keeps you healthy working
at healthcare additional
is hard and we haven’t done a good job
of taking care of our clinicians so a
fourth aim has been added and now this
is called the quadruple aim because
unfortunately we have high rates of
clinician burnout depression anxiety and
even suicide and our first year of
delivering collaborative care the reason
I bring up the quadruple aim is because
we hit all of these we saw dramatic
reductions in emergency department
visits hospitalizations hemoglobin a1c
which is a type 2 diabetes indicator and
we saved millions of dollars in addition
our clinic where we do this work has
consistently scored 2nd out of over 150
clinics and employee engagement so if
this is important and we should do it
why is it so hard well there’s lots of
reasons why it’s challenging and I’m
going to briefly talk about two that
really make the work hard and the first
is the business of health care so say
you go to McDonald’s and you order a Big
Mac the Big Mac you get at the
McDonald’s you’re at or a location a few
miles away or one across the country is
pretty much the same Big Mac but when
you enter a clinic or a hospital the
composition of services of that facility
are different you have different health
care providers for example you might
have a pharmacy on-site and you might
not there’s not uniformity and how
health care services are comprised and
so it’s difficult to take one model and
just plug it into somewhere else in
addition you can’t get your Big Mac
unless you can pay for it and you know
what the prices in healthcare we don’t
have good price transparency about what
we’re paying and sometimes we don’t know
what the cost is going to be based on
the illness or situation in addition
health care systems have to deliver care
to people that can and those that can’t
provide care all these complexities make
it difficult to change the system the
other challenge we have is how we
educate health profession students and
the best way in order to describe this
is using the lego movie so if you’ve
seen the lego movie you know there’s
this character named Emmett and he’s
like this regular guy kind of like me a
regular person that fell into this
circumstance and there’s a part of the
movie where they’re pretty despondent
he’s with all these master builders and
they’re really great at what they do
and he says to
them you guys are all so talented and
you know what you’re doing you’re
master-builders but your problem is you
don’t know how to work together that’s
exactly the problem we have in Health
Professions education in today’s world
we graduate great pharmacists nurses
physicians but we haven’t taught them
how to work together and then we put
them in the clinical environment
expected to just happen well I can tell
you it doesn’t
and then Amit wisely says is in the
movie when I had a plan I could really
do great things and that’s what we need
to teach our health profession students
to do to work together and come with
plans with patients to help optimize our
healthcare system so I want to leave you
today with six lessons that I’ve learned
in this experience that I hope can you
can take with you to make the world a
better place in healthcare or whatever
industry you work and I’d like to tell
you that changing a system begins with
changing yourself and if you can change
yourself and what you know and how you
act you can begin to change the world
and make it better so here are my six
lessons that I’ve learned as Alice in
Wonderland
the first is grit if you don’t have grit
and are willing to take on challenges
and face things that are gonna be
difficult this work is not for you it’s
tough it’s not easy the second one is
don’t listen to no and this is something
I love about Alice in Wonderland how
many times has she told not to go down
the rabbit hole or listen to these
characters that she did there’s going to
be everyone that tells you you can’t do
what you’re doing it won’t work
it’s impossible you’ll never make a
change don’t listen to no it’s very
important the next lesson is to get over
yourself because guess what you’re not
guys gift to the world and that means
you either ego down admit I’m not God’s
gift or you ego up and in my case on a
healthcare team I have to ego up because
I’m trained as an occupational therapist
an occupational therapists help people
with disabilities and disorders engage
in activities that are meaningful things
they choose to occupy their time in the
medical model my delivery of care is
prescribed by a physician and when I was
trained I was trained to be subservient
to physicians but I wasn’t really
supposed to bring my voice to the table
so when I come to the health care team I
have to ego up and say what I’m doing
with
patient matters and the whole team needs
to know it the next lesson is from wrote
what’s called psychological safety dr.
Amy Edmondson is study this extensively
and psychological safety happens in
high-performing teams because people are
allowed to speak up and engage without
threat you can say something and have a
different opinion without consequence
without penalty it’s easy to talk about
and hard to do and so that gets to the
next lesson
define your culture and in our clinic we
define our culture of psychological
safety with two mottos the first is
everyone teaches everyone learns when we
believe that from the front desk to our
patients to our families to our
physicians that we can all teach each
other something and learn from one
another we democratize our team and we
recognize that we all bring value and
that’s very important to help cultivate
collaboration the second lesson or the
second motto is assume positive intent
instead of viewing people with different
opinions or different ideas as against
you or not with the idea you have when
you reframe it and think that everyone’s
here for the betterment of the patient
and we assume everyone’s got that same
goal we can work together much more
effectively these two models have really
shaped that culture of collaboration and
I encourage you to take those especially
assume positive intent it applies
everywhere I’m not just in healthcare
the last and probably most difficult
lesson the most painful one is that you
have to know yourself and know yourself
really well and that means knowing your
strengths on a team but also your
weaknesses and often you get to know
yourself through self-assessment so our
team did a self-assessment on conflict
engagement and I scored a hundred
percent accommodating so later you can
come to my office and I’ll give you
whatever you want it explains a lot
about hi function on my team and my
marriage but it’s also important for me
to know and it’s it’s also embarrassing
frankly to admit that you might have one
way that might negatively affect the
rest of your team but if you don’t own
that and aren’t willing to become humble
and recognize the impact of that you’ll
never make progress on a team and so
even though it’s painful it’s very
important so as I come to a close I want
to challenge you will you be like Alice
go down the rabbit hole I can tell you
four years ago I knew basically nothing
about what I’m doing today I have
learned so much and it takes take taking
that leap and going down the rabbit hole
and I’m gonna tell you don’t have to
know anything and everything about the
topic but you have to be willing to put
yourself out there and try to do the
things that will make the change but I
will leave you with this advice you can
be Alice but don’t go at it alone
because I’ve learned that we’re better
when we have different perspectives and
different people at the table and please
remember that to change healthcare we
have to do it together and we are better
together thank you [Applause]
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