S3E8: Residency and the Making of a Leader (feat. Alexa Lisevick MD, Samuel Oduwole MD, & Salvatore Falisi MD)

Brooke:

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul:

Welcome to this episode of Learning to Lead. I'm your host, Rahul, and with me our co-host, Amber and Pete.

Pete:

Hello.

Amber:

Hello. Happy to be here.

Rahul:

Today's show is a special one. We're reconnecting with three Quinnipiac alumni who sat in the same leadership class as medical students just a few years ago now, seven years later, they're in their third year of residency out in the field, living and leading at the front lines of healthcare. We are here to reflect on their journeys, what's shaped them, what's challenged them, and how they've become the leaders and team members they are today. Alexa, Sam and Sal. Welcome to the show. Let's talk about the transition to residency. So how did you end up deciding what you're going to pursue for your specialty career and what role did leadership training do in that?

Sal:

This is Sal. So I ultimately decided on pursuing anesthesiology as my specialty and I'll kind of tell the story of how I got there and then leadership is kind of integrated into that. So I came into medical school assuming I was going to be some kind of surgeon, and then doing third year rotations. I found myself on my surgery rotation, more interested in what was going on. On the other side, I was really interested in the hemodynamic management and the procedural, doing airways, doing lines, pressors kind of ACL S. All of that stuff was more interesting to me than the actual surgery stuff, more of the physiology than the anatomy. Basically, leadership didn't factor so much into that decision for me in terms of specialty, but coming into medical school I accepted an Army HPSP scholarship, so I knew I was going to do a military residency and then owe a few years as an attending as a medical officer.

So I was more interested in applying leadership in that aspect of my career. The military loves to stress that all officers, all soldiers are leaders, all officers are kind of leaders amongst leaders and certainly all physicians are leaders on their healthcare teams. So I had no prior military experience in medical school, so I was viewing it more as a preparation for that aspect of my future career. That said, I use a lot of it clinically often, so obviously most of my time is spent in the OR is a very high intensity, very high performing team environment. A lot of the things we learn about apply. And the interesting thing about the OR is that who's wearing the leader hat can change at the drop of a hat. When we're doing our pre-safe checks, the circulator is kind of running that show at our hospital when it's induction time and we're doing the airway, we're kind of running the room when surgery's underway. It's a surgeon patient codes. When we start ACL S, it's kind of back to us and it's a very fluid situation. Sometimes there's multiple surgical teams and we're shuffling even amongst that end. So being able to kind of turn on and off the leader button and switch between different styles and is more or less a daily occurrence in anesthesia. And that's not even getting into the labor and delivery floor, which we could probably do a whole episode on the dynamics of that, but I'll leave it there.

Alexa:

Ironically, Sal, I think we were on the same surgery rotation and I, prior to that rotation really did not have aspirations of becoming a surgeon. And then I after that rotation very strongly felt like, oh, I think I'm going to be a surgeon. And it's funny how that happens, but I think a lot of the things that you've spoken about I also love and as it relates back to leadership training, earlier I had mentioned that part of the way I was leading teams was related to the way I thought that the world sort of wanted me to behave, particularly as a woman, as a young woman, I think there is something to be said for that. And on our surgery rotation, it was one of the first times where I saw women surgeons bounce very dynamically between leadership styles, whether that was leading rounds, whether that was leading teaching sessions in the operating room, in the trauma bay. And I think I just fell in love with it. I mean I thought it was the greatest thing and it's interesting how that all came full circle and I can tell you now as a surgery resident, it takes so much time and energy in learning to try to get to that level of functionality. I mean every day is kind of extremely humbling.

Sam:

Wow, this is Sam here. Those are great responses. My colleagues, I don't know if I can match up, but my choice of specialty was decided before I got into medical school. I knew that I wanted to be a surgeon in the musculo cell system, so I chose orthopedic surgery. They knew me as the ortho person in medical school. It's kind of funny that I've changed my career paths now to physical medicine and rehab. I think that was a fixed decision for me going in. I knew that that's what I wanted to do at that time and medical school, me, pre-medical school, me wanted to do that. But as I learned more about myself and my leadership styles and as I went into residency and prioritized what was important for me, I recognized that a different field, one that still prioritized the musculoskeletal system because I really liked that system and want to help people gain the mobility, be able to live life to the best that they can.

Switching to physical medicine really allowed me to accomplish those goals and also kind of balance my life. What's important to me as far life being able to see my 2-year-old who was an infant when I started a residency, see my wife, engage in my hobbies and better have the bandwidth to be a leader better be able to have the impact that I had mentioned earlier. I was doing a few of that for me, a lot more time and more longitude of care of patients where I can, an individual will have that impact and have the bandwidth impact teams and systems. And so been quite a bit of a change, but I'm so much better for it. I can be a better leader as I have the bandwidth to meet those needs at this time.

Rahul:

Wow. What great stories as you made your transition from medical school to residency, what surprised you or challenged you?

Alexa:

This is Alexa speaking. I would echo what Sam has alluded to. I think the challenge from being a medical student to being a intern and then later a resident can be really challenging. And I think similar to Sam in medical school, I spent a lot of time becoming a well-rounded person, whether that was goals, hobbies, taking care of myself, focusing on my own health and wellness and all of those things require time. And then you transition to residency in very abruptly. You go to working approximately 80 hours a week in a hospital where you are expected to be the best version of yourself as much as possible. And the time that you have outside of the hospital then becomes smaller and you are tired and sometimes you're hungry and then trying to reconcile that you can't do all of the things that you once did that you previously took a lot of pride in or invested a lot of yourself into. For me, it changed a lot of the way that I saw myself and I think it really impacted my resiliency, especially at the beginning. And so I think you have to learn to take care of yourself in a different way to give yourself grace and flexibility and rebuild some of those expectations. I think it's challenging

Rahul:

And what makes it even more challenging is how little control you have over your schedule and over the expectations that are set for you plus changing into a new organization, a new town a lot of the time.

Alexa:

Yeah, absolutely. No, also that's a great point. It can be isolating and there can be moments where you are away from family friends and that support system that was physically there previously.

Sal:

Yeah, completely agree. I remember vividly as a med student, how could a resident possibly forget they have a student or something? How could, no freaking way what? And then you're like, oh yeah, now I see. Okay. But the flip side that I will say surprised me how kind of early on in intern year was having real responsibility and an actual role. I feel like as a med student you're generally pretty superfluous. Maybe on a subi you're pretty useful, but especially early M three, you're there to learn. You're not there to accomplish tasks. So that is basically an overnight change. Like day one of intern year, you have things that need to get done to take care of patients. And yes, the hours were exponentially worse and everything, but I got infinitely more satisfaction out of actually having a well-defined role than checking tasks off. So much worse for all the reasons Alexa kind of already mentioned, but also far, far more rewarding than being a med student

Rahul:

And that matches up with who you are. So much s you love doing things.

Sal:

Yeah.

Amber:

I love hearing all of your stories. It's so meaningful to hear your lived experience and what's going on in health systems and your roles on teams because as a medical student, yes, I'm exposed, but it's still kind of an abstract way of thinking of how I'm going to be a leader in these systems soon. So thank you for picking out the stories and how they relate to leadership because yeah, I'm so passionate about leadership development, but when I hear these stories it just confirms why it's so relevant, so important to pick up these skills on my way there. So thank you guys.

Rahul:

Let's talk a little bit more about teamwork then. Can you think of a first experience when you felt you were the leader of a team? And if it's an interprofessional team, then tell us who all are on this team when you have this moment.

Sal:

So the way my particular program is structured, we do a little bit of ICU kind of every year. So you do some as an intern at PGY2, and then when you're a PGY3, you were the senior for your month and you make the schedule for all the interns and residents and you're kind of overseeing the team. There's a fellow and an attending above you, but the ground level leadership is your role. So that was kind of early on this past year for me. And that's particularly interesting because we get interns coming through from every different surgical service, anesthesia, the transition year interns, people going into fields that are never going to be anywhere near an ICU presumably for the rest of their career after intern year. So just navigating all of that and the different dynamics and some programs, even when they're on the ICU, they're still, they have other responsibilities for the call pool on the weekend or what have you.

So that was really, really challenging and trying to make it a fruitful experience for everyone trying to assign patients in a way that it was at least somewhat relevant to their field or make sure that my surgical interns weren't getting completely slammed because they were also on call for 72 hours straight on the weekend because that's a thing that people still do in certain fields. So it was kind of taking a peek behind the curtain at all these different places people were coming from was challenging, rewarding. And that was probably the first time I was getting a significant amount of feedback, kind of bottom up feedback. People that I was responsible for were telling me I'm pissed about the schedule or great lecture today or can I swap this? So I like to think I did a good job that month, but that was probably the most interdisciplinary crazy team that I've had to lead during residency so far.

Alexa:

I think being an intern is very interesting in that as you said, it is the first time when you become an intern, at least at my institution, you are responsible for the medical students. A large part of their experience is driven by, as you said, their assignments to cases and you help them get onboarded and oriented. They need to be in the right places and what to do in the operating room, how to prepare for the cases, how to behave in the operating room. There's a lot of things that you have to do. And it is coupled at the same time with a time period where you start receiving a lot of feedback, constant feedback from everyone, from people that are senior to you, from people that are junior to you. And I think it can be really somewhat overwhelming to the senses because certainly there can be good feedback, but a lot of times when you do something right, it's kind of like a checkbox like okay, you did it. Whereas when you do something wrong or you don't do something right, it's like, okay, you did not do that right. We can't have this again. And so also the balance of what is considered to be positive versus negative also shifts as well when you become a trainee. So it's an interesting time.

Sam:

Yeah, this is same here. I agreed with what my colleagues have said, thinking of times when I've been a leader on a team, when I was the PGY two and the trauma service, there's the leader PGY three, the four or five, they were above you, but they're usually in the operating room and you're the two and you're taking care of the intern. So we are responsible for everything that's going on the floor. So making sure the intern's doing their job, doing it well, while also getting consults from the trauma bay, the ED all over the hospital. And for me, providing guidance for the intern was critical for me to make sure that they felt comfortable in their role and that they could come to me and I was always open to them to just stopping and saying, Hey, how can I help? And making them know that no question was a dumb question and creating that environment of psychological safety was critical for me.

So I really liked being a senior to the junior residents because seeing them grow and seeing them feel comfortable coming to me because I know sometimes in residency it's hard. You don't want to feel silly about asking a question, that's a dumb question. But I learned that with my style of making my juniors feel welcome to ask a question and feeling safe, they asked more and they felt more comfortable and more confident and did better. Same with the medical students. When I had medical students on the service, I really try to nurture 'em and say, Hey, I'm near the talk. I can answer any question you like. I'll walk you through a scrub machine. And so I noticed that because as a medical student you do have this fear that you're doing something wrong, so you're always being evaluated. And so I was really big on making the interns and the medical students feel comfortable and they really very appreciative. And I was actually inducted into the Penn Gold Human Society by the medical students. So the rising fourth years induc me or nominated me that was inducted into the gold humanist society or how I interacted with the medical students. So I feel very proud about that and it makes me know that I'm doing the right thing with the students and that in large part is being a good leader and how I learned that from this class and trying to lead of kindness.

Rahul:

Woo-hoo. Cheering for you, Sam. That's fantastic. Congratulations.

Sam:

Thank you.

Pete:

I thank all of you for providing that construct around feedback. How did you handle critical feedback and then how did it improve you providing critical feedback?

Alexa:

I think so I will say we get a fair bit of particularly grand round speakers who come and speak about feedback in the context of surgical education. And one of the more helpful things that I have found is asking the person how did they think that something went first? And allowing them, whoever you're going to be delivering the feedback to, allowing them the opportunity to speak because it can help to set the tone and the context for where they are mentally and emotionally and then help you to deliver more impactful feedback or sometimes to even recognize, okay, now is not the best possible time to do so. And sometimes a lot of learners are really self-aware and so they can tell you what they thought went well, what they thought didn't go well, or what they feel like they want to improve on next time before you even say it. And so I think giving some credit to the learner and trying to give some credit to yourself when you are the learner can help to reduce the stress of giving and receiving critical feedback.

Pete:

Thank you. Sam, how about you?

Sam:

Yeah, I think specific feedback is very helpful. So when I had a medical student going rounds and we do dressing changes, and so I wanted the medical students to found a feel empowered and help the chief resident, so lot of 'em to go and the chief resident one, the medicals, see how the medical sit would do on rounds. And one of my students wasn't prepared, didn't have some of the dressing stuff and so I pulled 'em aside, Hey, give 'em good feedback on what they've done already. And I know there's some theory about how to go about doing it, but then I said, for this next patient you'll need this, this and this. I will get this for you and show you where they are. And then the chief would really like it shows that you take initiative on the next patient if you have all these ready by your side.

She had her pockets, her saline syringes, her AB pads, galls, I made sure she all that ready for the next time and the chief resident commented on and said, Hey student, that was great. I liked that you were prepared and had that. And so just giving that specific feedback for things that could improve the experience and then go to the next step, helping them accomplish that, showing them where to get those things and how much sooner to go to get those things and to create a platform and system for them to make that change happen. That's when the change happen.

Pete:

Great. Sal, you got any examples?

Sal:

Yeah, what Alexa said about kind of assessing the receiver of feedback's perception is always the first thing I do. I think that's so key because it's very, very rare where someone kind of doesn't know that they're not meeting expectations or whatever you're kind of doing generally people know it's pretty rare where you're like, oh, I need to really tell them something and they're like, Nope, crushed it. It's usually you're kind of on the same page. But if it is different, that's a wildly different conversation. So I always like to start there and agree with what Sam said. I've definitely, as an intern, I had a few med students who we would go through before rounds on a medicine rotation and this is what we're going to talk about, this is your plan. We're going to give these values here, really go over it. And then they would go to present and you could see just the anxiety of presenting itself.

So we would just do practice presentations beforehand, just like the reps of doing it once through would be more to help overcome that. But again, I think assessing perception, getting on the same page in that regard and then just setting someone up for success. People will be more receptive to your feedback if they feel you're invested in the first place. If you have a med student and you're like, yeah, you got it, you wing it on rounds and then they bomb it and then you go try to give them feedback, it comes off as kind of hollow to me like, well, it would've been nice to have a conversation before and maybe so setting people up for success in the first place and showing them you're invested will make them trust your feedback more.

Rahul:

Great. I love those pearls. And I'd say just to build on that, giving and receiving feedback is certainly a muscle that can be strengthened. And a couple of things that I'm picking up from what you're saying is ask the person first how it went from your perspective and then you can share what you think might be helping them grow. And a couple of things I've realized is giving positive specific feedback is a great way to build this skill. So I'll often ask someone I'm working with, how did that go for you? And once they say what they say, which as you said, Sal is rarely I crushed it, I might actually tell them this is where you crushed it, you did so good there. And where leaders are in the business of not just seeing people for who they are but who they can become.

And so that positive feedback can really help someone build confidence and identity. And typically leaders need to try to have a four or five is to one ratio of positive to negative feedback. So people should not be hearing from you just when you have something critical to say, they should be hearing from you all the time. And that's one way of building the muscle. And it can happen in expected roles, but it can also happen in unexpected situations or across professions too, where I think it can really break boundaries. I want to come back to interprofessional teams. So tell us a little bit about the interprofessional teams that you're a part of and how you're navigating that. What's working well for you, and then what are areas where you wish you could be doing better?

Sam:

Hey, it's Sam, I can pitch into this. I think I mentioned earlier, intern year when you have AL rounds and social work rounds, PT rounds at the rehab, there's a lot of overlap and conversation between the occupational physical therapist and speech and language therapist because often people who have strokes may need one or all three of those specialists to help get them back to their baseline or somewhere near it. And so there's a lot of conversation between doctors and the therapist at rehab. I'll start first of what I want to learn and get better at. What I've been trying to do is understand the language of the therapist. So for example, P-T-U-S-A men assist, guard assist or full assist, all this language, you don't really learn in medical school what that means. And so trying to partner with the therapist and help the patients and help families understand where they are means I need to go and learn more from the therapist.

What I did was an elective just where I shadowed the therapist and saw what they did on a day-to-day basis. Understand, okay, what do you mean when you say this? Tell me the language. 25 oh men assist miny like 25% or less moderate cyst, 50 full cyst where you're basically doing work and what types of aphasia you're seeing and how you're helping patients improve. Just really understanding the language that's used really allows me to then come back to the patients and families and tell 'em how their family is doing in rehab and where their sheer goals are for discharge. And so I'm still an intern now in physical in rehab, but as I go into my PG two year where I'll be rotating at the rehab, I want to go in knowing that I can understand the basic language of the therapist. And so when we talk about we do rounds and say, all right, this patient's being discharged on this date, they'll need this DME, why they need a rolling walker because they need this much assistance. I think understanding the basic language of the therapist will allow me to then come to terms and say, okay, this is an appropriate discharge date we can get, I'll sign the DME and we will get this patient to the next stage, to the next level. So that's something in a professional team, especially for rehab physicians understanding the basic language.

Alexa:

Yes, I think that is a really excellent point. I think that especially when you first start off, something that you have highlighted is that there's a huge external cognitive load. You are trying to learn the languages of different providers. You're trying to learn how to do your job effectively. And so I think as it comes to working in an interprofessional team, I think it has gotten easier as time has gone on because as that sort of external cognitive load has gone down a little bit, and I've learned more about how each of the team members functions as you highlighted, the pharmacist, the physical therapist, the nurses, the medical students, the other residents, the occupational therapists, the nutritionists, and then also all of your senior people as well. You start to have a more bird's eye view of things and you can orient in a timeline in a patient's hospital visit, what things need to be managed more quickly or prioritized. They are acute and which things will naturally take some time and that is okay. But I think when you first start out, that can be completely overwhelming to the system. And I think at the very beginning a lot of it is trying to identify expectations of people around you and recognize where you fit into that mold.

Sam:

I would say Pete being our senior person, you're in the nursing field. I have, it's funny, in medical school you're taught your nurses are the backbone. They see the patient, they the patient very well, always have respect for them and listen. And I've really taken that the heart, as I've gone to residency, I find that residency kind of can bog people now a little bit and sort of that's lost not by the nature of anyone being selfish or whatnot, but there's sometimes be an adversarial nature between the providers and the nursing about types of questions. And I have found that I, ICU nurses are special because everyone, and they're amazing and they're essentially the residents listen to ICU nurses. But I think where you have some conflict elsewhere, I tend to always listen with empathy when the nurses present something to me and if a nurse says something's wrong, I would take the extra time to go and see the patient.

And this year there's been time where the nurses were concerned about something and other people were like, I don't know. And I went to see the patient and something was clinically wrong and something changed and needed an intervention. And so that as a lesson to Amber and other students that the nurses are the eyes and ears and so when they say something, listen some of empathy and go check it out. That's something that has been important. And I know Sal and Alexa comment on that because there's a push and pull with the providers in nursing and how to best optimize that relationship.

Rahul:

Yeah, that makes me think of the charge nurse who trained me when I was a first year resident in India, in Delhi, India. And I will not forget her and could not be more grateful to her until my dying day. Because here I am joining the first year of medicine residency in the largest tertiary care hospital in Delhi. And she had all the knowledge about workflow, about how patients would come in and out. She had been there for more than a decade and I learned so much from her, whether that's interacting with the patient or family, getting procedures set up and done discharging patients, simple things like making time to eat, getting a breather in the middle of a night shift. I mean, I think that when across professions we can have each other's back, we can lift each other so much. It's incredible. Now, Alexa, you mentioned bird's eye view.

So I want to have us look at a bird's eye view at the systems level. In medical school you were building foundations of leadership and learning a lot about yourself and others. And then as you came to residency, you really hit the playing field on how to interact across professions within professions, inpatient care. Talk about systems a little bit. So what are the kind of systems exposure you are getting? What are the roles and experiences, whether that's in your organization or outside your organization, in your specialty or with the healthcare delivery system? Where are you learning about systems and how are you growing that muscle?

Alexa:

Yeah, I will say that it is not uncommon that opportunities arise to get involved in systems level discussions. I think when you are a resident, I think you're limited by time. But for instance, one particular, I was a member of a work group focused on interdisciplinary communication on the acute care floors, so the surgical patients and then medical acute care as well. And it was a very interesting experience because it was one of the very first times where I had a significant amount of time listening to particularly the nurses and the mid-level providers and apps about where do we as residents and as fellows and as attendings fall short. And the whole focus was how do we communicate care better to the patient? So it wasn't even focused so much as to how do we communicate better between providers. That was part of it. But a lot of it was, as you said, Sam, the people who are directly in front of the patient who interact most closely with the patient's family, where are the places that communication from the acute care medical or acute care surgical team, where is that communication falling short? And I mean, it was really interesting and it was really challenging to try to find a time that we could promise to be at the bedside when the family was also at the bedside to have a conversation. It was surprising how difficult that was to try to find maybe five to 10 minutes in a day. And so, yeah, no, the medical healthcare system is very interesting.

Sal:

Yeah, one little one-liner, Dr. Anand that I remember from you from when we were medical students was every system is designed to get the outcome it gets,

Which I think about all the time. So my residency is kind of unique. Well, most military residencies bounce to many civilian hospitals just because the nature of our patient population to get the numbers required. We don't take care of many kids certainly don't have enough babies for L and d numbers, things like that. So we bounce around to a lot of civilian hospitals. So one of the benefits of that is we see how similar things are done in multiple different institutions with different incentives, big academic centers, military hospitals, more of the private practice kind of environment. So from a passive exposure setting, we definitely can see the different practices and different practice environments, which I think is really, really beneficial. And then in a more formal setting, so we're recording this in April, so I recently found out I'll be a chief resident for this coming academic year. So seeing behind the curtain of coordinating with all these different hospitals and the two states and DC and coordinating the training licenses and the training agreements and is a herculean task that our program directors and admin staff do a tremendous amount of work for. So just getting a little bit of the behind the scenes of just the amount of coordination stuff like that requires is eyeopening.

Rahul:

Congratulations, Sal. Yeah, being a chief resident is a great stepping stone to systems level experiences.

Sal:

Yeah, I'm looking forward to it a lot. Thank you for the congratulations.

Rahul:

Well, thank you for sharing your journey as a medical student first and now as a resident with us. What's the one greatest thing you've learned about leadership and teamwork as a resident?

Alexa:

Ask help and advice from people who have done it before you. If you are in a new situation, you don't know what to do, ask your senior resident, call your administrative chief. They have an abundance of very applicable knowledge and are tremendously helpful.

Sam:

Yes, and I'll second that as well. And I'll say being a good leader to others first comes by being a strong leader yourself, meaning being a good leader of your own self. There's a reason we have the domain self teams and systems. Find out how you can optimize the way you interact with your teammates and your systems and that will then help you better lead others within the team in systems.

Sal:

Yeah, I would say along those lines, the one piece of advice I would give anyone who's anywhere in this process, I think is kind of lead by example. So I think everyone can think of an example of the leader who is the first one to leave early or give themselves the favorable call schedule or not. There's plenty of examples, but you can start from day one of intern year, be the person that helps out your co-interns, be the person that embraces challenge, has those interprofessional conversations we talked about. And people will look to you as a leader even when you're not in a formal position of leadership.

Rahul:

Such a wonderful message. Yeah, it does compound over time. Well, Alexa, Sam Sal, thank you so much for being here. It's been a privilege and a joy. And listeners, if you're thinking about your own leadership journey, we'd love to hear from you too. Thanks for tuning in. Until next time, take care and keep leading and learning.

Brooke:

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E7: Building the Foundations of Leadership in Medical School (feat. Alexa Lisevick MD, Samuel Oduwole MD, & Salvatore Falisi MD)

Brooke

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul

Welcome to this episode of Learning to Lead. I'm your host, Rahul, and with me, our co-host, Amber and Pete.

Pete

Hello.

Amber

Hello. Happy to be here.

Rahul

Today's show is a special one. We're reconnecting with three Quinnipiac alumni who sat in the same leadership class as medical students just a few years ago now, seven years later, they're in their third year of residency out in the field, living and leading at the front lines of healthcare. We are here to reflect on their journeys, what's shaped them, what's challenged them, and how they've become the leaders and team members they are today. Alexa, Sam and Sal, welcome to the show.

Alexa

This is Alexa. Thank you so much for having me. I am initially from Avon, Connecticut, and now I am in my third year of general surgery residency at the Medical College of Wisconsin.

Sam

Hey everyone, I'm Sam Oduwole. I am from Philadelphia, originally from Liberia in West Africa. I'm currently at the University of Pennsylvania as a resident. I've made a short career path change. I'm now in physical medicine and rehabilitation residency, third year residency, but first year of this residency. So thanks for having me all. It's great to be here.

Sal

Hi everybody. I'm Sal Falisi. Graduated with these two guys from Netter in 2022. I'm originally from Long Island and I am currently an active duty army officer and anesthesia resident at Walter Reed Military Medical Center in Bethesda outside DC.

Rahul

Alexa, Sam and Sal, we're delighted to have you on. So let's go back to the beginning of your journey. What brought you into healthcare? Alexa, you want to get us started?

Alexa

Sure. So I think what initially brought me into healthcare was a desire that a lot of healthcare professionals share, which is a want to help others and care for other people. But I think very closely adjacent to that, I really wanted to be a problem solver. And so healthcare providers every single day are problem solving and being able to relieve the burden of disease from someone is something that is outstanding and tremendously satisfying.

Rahul

Sam, what about you?

Sam

Yeah, I went to college and I was a biology major and I knew I liked science and interpersonal, I love people and I love being with people and taking care of people. But I decided to go to medical school while working in clinical research with patients and suddenly realizing that my love for science and my love for exploring, understanding complex things match well with medicine where I can really apply my love for science and biology to the human body and make people better. And so during that time, I decided to apply to medical school and knowing my media family had to go into medical school. My mother actually was in medical school in our country before the Civil War, but that ended her time in medical school. And so I knew that I liked medicine, but no one that I knew closely was in medicine at that time. And so it was a dream. I figured I could give it a try and to get that email that I was accepted was a pretty surreal experience for me.

Sal

Wow, this is Sal. So yeah, similar themes for my colleagues here. So what brought me to medicine initially was just a love of, I mean broadly science, but just the human body is just incredible and just wanting to know more and more about how it works from an anatomical level to a physiologic level all the way down the individual little proteins that we learned about in biochemistry classes in M1. That stuff is just always amazing. And I still have days at work where I'm amazed by some function of the human body, some medicine I give or something. So yeah, medicine was a career. I'm a fundamentally lazy and easily bored person, so I didn't want to do something that would feel like work. And don't get me wrong, it's still work and it's still a job, but it's rewarding enough that I think I will do it for a long time.

Rahul

Wonderful. So tell us what motivated you to take up leadership training in medical school. I'm sure you had many choices, so there was something motivating you.

Sal

This is Sal. I'll take a stab at this question first. So honestly, if I remember looking through the course catalog for the electives, we all had to take certain number of the electives. I was mostly drawn by the instructors. So I remember seeing your name, Dr. Anand and Dr. Drying who co-taught that first cohort. And I had separate experiences with both of you. I knew you were both coming from very different places from a leadership perspective, you more of the business entrepreneurial medical education side, and then from her prior naval military experience, which was relevant to me as a military scholarship student. So I was really just intrigued by kind of the blending of those two different perspectives. And also just the idea of being a Guinea pig for a new course was not a bad thing. I was kind of excited. Netter itself a very new school at the time, I think we were the third or fourth graduating class, so taking that plunge wasn't such a leap from going to netter in the first place. So getting in on the ground floor was kind of an exciting prospect in that way.

Alexa

This is Alexa. I would echo what Sal said, and I would also add that I think that it is well recognized that all doctors are leaders. And I think a lot of medical students, myself included, come into medical school with some sort of leadership experience and the recognition that leadership can be very rewarding, but there can also be a lot of bumps along the way and there can be uncomfortable moments as well. And no one necessarily teaches you how to be a leader. And so having formal education of any sort and dedicated time to work on that is I think a super unique opportunity.

Sam

Yeah, this is Sam. I'd also like to echo what my colleagues spoke about. I agree with the themes mentioned already. For me, setting up for this course in medical school, I'm a bit of an adventurous person. So I saw a course and I thought, this is a really cool course and it's applicable as Alexis said, to being a physician. You are a leader in your team. The big reason for me choosing leadership was that I want to make an impact on the people around me, the teams that I'm with and the systems that I encounter or interact with. I believe that I do things based on values. And so whatever I'm doing, I try to do the right thing and I believe that things should be done the right way. Kindness, love, love effort. And so I think this class for me was an opportunity to learn the foundations of leadership.

I know that being a doctor is being a leader, which you forget in medical school because you are the bottom of the totem pole. But I recognize that I would be a leader in the future and I want to have an impact, influence on those around me for the better. And so having a structured course where I can learn the foundations and really foster the tools to be a effective leader was something that stood out to me. And so I decided to take the course to get those means, and I found within the course a great core of people and it was really fun and such an amazing experience.

Rahul

So what I'm hearing is that you see being a leader as part of being a physician, it was part of the identity of a physician, which was one of the motivations. And you also see these skills and tools helping you be more effective as a physician, which was another motivation. And a third one was wanting to do it in a space with peers and faculty that you trust. So that was part of the package that helped you take that leap?

Alexa

Yes, absolutely.

Rahul

Sam, you talked about it being a great experience. So what stands out to you now as you think back to that experience? Were there any key moments or stories or lessons that stayed with you?

Sam

I think a big part of the group that made it so successful was the safety in the group. We all felt that we could be vulnerable and share and give real life experience and our vulnerabilities, our successes in order to become better leaders. Thinking to the Everest simulation, I thought that was a really incredible experience that we all did together. And now as a resident physician and looking back, seeing the significance of that Everest experience, seeing in healthcare is a pretty complex multifaceted system with multiple stakeholders and people with various interests and navigating those interests for the good of the patient, the good of the health system is something that you really truly face when you are a resident. I think that seeing the patients who liked this evidence-based medicine says this, the hospital needs to have these many discharges to have open beds and families want to do this, but patients themselves want something else. So navigating all those different stakeholders interests and desires and ultimately doing the best thing for the patients and society is something that I thought was very well illustrated by the Everest simulation.

Rahul

So just for context for listeners, the Everest simulation is a team simulation played in groups of five or six where everyone has different roles and they're climbing up the Everest Mountain over six days and the simulation creates scenarios and conflicts that pull out rich lessons in leadership. And it's from Harvard Business School publishing. Sam, you talked about safety. Let's explore that thread a little bit with the group. So what is it that created safety in this group for you?

Sam

I felt safe because as Sal mentioned, Dr. Anand and Dr. Drying both fostered an environment of safety. They're both vulnerable and shared anything that they would ask us to share. So I felt very genuine connection with the instructors and they created a culture of that where we could all share if we wanted to or not. And the more we each shared, the more others around us would follow suit. And we also put each other through all that sharing and vulnerabilities. And we were motivated to be better in whatever we were trying to accomplish. So I think it starts in the top down and the professors and the instructors did a really good job of creating that environment which allowed the rest of us to open up. I'm an extrovert, so I share regardless, but I think watching other members of the cohort who are not as extroverted, open up and feel safe was pretty incredible.

Rahul

Alexa, Sal, your thoughts to build on that?

Sal

Yeah, I will agree with what Sam said. I think just the concept of safety in general is so important to an educational environment. People should be able to share their thoughts and challenge others' thoughts without fear of reprisal or judgment. And I think from day one, it was very apparent that we could be vulnerable, we could ask questions of each other. There was that environment, there was no judgment, there was no reprisal or negative repercussions. And it's the kind of thing that I had not intellectually learned about as a concept, like psychological safety. And now that I've went through the course, you see it and you see it's absence real quickly thinking of some clinical scenarios I've been in. But it's so fundamentally important to create effectively leading a team and creating a cohesive environment and educational environment. So yeah, just agree wholeheartedly that it was there from day one for our course.

Alexa

Yeah, I would agree with that. I think in particular, the fact that there was gratitude expressed to people for sharing and being open, I think provided positive reinforcement to continue to create that environment. And I think that is one thing that I have tried to take forward with me because as a resident or just in general, you're not always the leader or the boss, but you can always try to build in psychological safety with small techniques such as being respectful and being grateful for people who do speak up. For instance.

Rahul

Sal, Alexa, your thoughts on experiences or moments or lessons that stayed with you?

Alexa

I think one of the things that really stood out to me in this course was actually early on when we discussed situational leadership and the application of different leadership styles in different environments. And this was the first time that I really learned that to be an effective leader, you need to be able to bounce between each leadership style to be efficient and effective. And I think internally I began to recognize that the leadership style that I was using most often was probably what came most comfortably to me, but also maybe was a bit socially constructed, meaning I thought that that is what the world wanted from me and unlearning that and recognizing that you need to be able to use different leadership styles and then being able to externally see that in people around me in various different situations. That was wildly mind opening for me.

Sal

Something that has definitely stuck with me, and I don't know if it was a, I don't remember the specific lesson, but I definitely remember that it being a big kind of core of the Everest simulation that we've talked about already is alignment of goals for effectively leading a team. If you have five people on a team, one of them's goal is just to get home as soon as possible. One of them is to do as many cases as possible. One of them is to do a lot of teaching, finding a way to meet those different purposes and aligning all those different things so that everyone is getting their desired outcome is half the battle in healthcare. I feel like very, very often, and I think Alexa mentioned as a resident, you're not always the leader. You typically have at least an attending over you or a fellow or something. But as you go through the years and you're a junior resident and then a senior resident, you have a little bit of influence. And so just getting people on the same page is sometimes the best thing that you can do to move a team forward,

Sam

The different desires of people on a team, because healthcare I believe is a big team and sometimes it can be us versus them mentality, and that's just kind of human nature sometimes. But an example of this as an intern, I was sort of the leader and sometimes in social work rounds. And so we get rounds together where I represent the clinical team and then you have the switch workers talk about this physician. The therapist will be there talking about PTOT, case management, talking about their needs, medical devices, and sometimes the nurses about who's being discharged, like other things. And so a big part of, I think for me leading is just listening. I'm a big talker, so I do try to listen. I think listening is something that I work on to just sit there and just be with the silence and listen. And you can glean a lot of these motivations just by listening.

In the Everest simulation, some of the motivations are hidden, but in healthcare, at least within the clinical team, onsite team, you can really, if you listen, you can hear from the motivation. So for example, I would be motivated to discharge a clinically stable patient. This patient is done, they no longer need to be in the hospital, we can get a bed for someone else. I wouldn't discharge this patient. So we say, oh, the family would like to be home for discharge. Can we delay the discharge till tomorrow? And so now I have opposing things like my desire and the social worker desire, but I realized that it's all for the good of the patient and their wellbeing, their family. And so for me, while this patient's clinically stable, tomorrow could be a bit of discharge for them because they have the support system with their family there to receive them and family's happy, patient's happy, and it creates a better situation. So that's just one example of how listening and seeing and meeting each other where we are and seeing that in the end we all have the same shared goal and compromise can be done, but that's an example. I'm sure you all have examples of being in these multidisciplinary rounds and seeing the misaligned or being in the operating room and the different goals people may share.

Rahul

I love how what you're saying builds up on each other. How did this experience of leadership training change you and what impact did that have on the rest of your medical school journey?

Alexa

This is Alexa speaking. One of the quotes that I think I like is the eyes cannot see what the mind doesn't know. And I think that the way in which this leadership training changed me as a student and as a learner was that I began to have a critical eye for watching the behaviors of people around me who were leading and trying to orient myself and decide is that helpful in this situation? Is that efficient in this situation? What worked really well, what could have been better? And then sort of putting that into my own toolbox so that when I am in that situation, these are things that I can consider or I should do something like that, or I should attempt to be mimic or model similar behavior that seemed to work really well. And so I think having more things in your toolbox, it just helps to make your learning overall more efficient, more effective.

Sam

Yeah. Thanks Alexa, this is Sam here from the class. I noticed that Alexa brought up earlier the different types of leadership styles and being effective means utilizing all of them. And I very quickly learned that I have a preference. For one, it was a more passive style and for me, recognizing that I did need to incorporate the others was very helpful. This class really allowed me to contemplate on myself and what I bring to the table and how I can be more effective by utilizing goals that are realistic. And so I think that was the biggest thing for me in this class, just being able to be self-reflective and then set out tasks that allow me to change and grow.

Rahul

Yeah. Sam, what you're talking about, so for listeners, Sam's talking about the four leader behaviors in path goal theory, which are directive, supportive, participative and achievement oriented.

Sal

I think something that I took from the course pretty early on was kind of growth mindset. So I think something that I've seen as you kind of progress through the years of medicine from a student to a junior resident, senior resident, as you kind of move up, you get more and more comfortable saying like, oh, I'm not sure about that. Let me look it up. Or at least the people that I strive to emulate are very much like that. And I think seeing things you don't know as an opportunity to learn or you're asked a question on rounds as a med student or an intern and you almost don't want to say, I don't know because you feel like you're being evaluated and that's going to negatively reflect, then I should know that. But you can't know everything. You can't see everything. And just seeing moments like that, not as a sign of failure or shortcoming, but more optimistically as an opportunity to learn something that day has I think continually served me pretty well.

Rahul

Yeah, that's such a huge lesson. I remember from one of our times at a community health center I was working at, we had a large audit coming up of our HIV program, and so everybody had this very natural tendency to be defensive and hope that nothing is found. And I remember our program manager, she was having a real growth mindset because she said, Hey, look, this is a great opportunity. We have some experts in the field coming and looking at our small program and whatever they're going to find is going to help us grow and become so much stronger. I thought it was a beautiful example of how that growth mindset, if nurtured, can take you really far even at the toughest moments in the future.

Alexa

Yeah, that's amazing. I can imagine that must have reduced so much stress of the moment when she said that.

Rahul

It completely changed my mindset. Now I was looking forward to what they're going to find.

Sam

That's awesome. I'm going to piggyback off the groove mindset here a little bit. In some of this clinical application. As I mentioned earlier, I've made a career path change in my residency. And so for me, doing two years of one residency and going to another year and starting over, essentially being an intern is a job, a task that you learn how to do. And so for me, having the growth mindset was really acutely applicable year in that learning how to doing the intern role in a different specialty. There's some things that are the same. So how to write notes, I write notes, use templates, smart phrases, putting in orders, those things are unchanged, but how you do med reconciliation was slightly different. How you phrase something in your notes slightly different, how you rounded was different. So for me, even though I had done the interim role before, being humble and understanding there was a lot to learn in a different way people do things was actually very helpful for me because I learned even during intern year for the second time, a lot more at this time. So it was really helpful to be humble and being open to learn and do things a different way. And I found a lot more efficiencies in the way that I review the chart and things that are applicable with the patient care. So it is cool. Having a growth mindset really does help you learn and give better care to patients.

Rahul

What a beautiful example, Sam. Well, Alexa, Sam Sal, thank you so much for being here. It's been a privilege and a joy. And listeners, if you're thinking about your own leadership journey, we'd love to hear from you too. Thanks for tuning in. Until next time, take care and keep leading and learning.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E6: Followership: The Foundation of Great Leadership (feat. Lauren Weber, MD)

Brooke

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke

Welcome everyone back to Learning to Lead. Today with us is Lauren Weber, MD. Lauren is a clinical cardiologist and currently practicing with the Wenatchee Valley Medical Group in Central Washington. She's also the co-founder and lead of strategy at All Levels Leadership, a healthcare consulting, education and coaching company dedicated to helping everyone in healthcare at any level effectively lead and influence the decisions that impact their practice patients and lives outside of work. She enjoys spending time outdoors with her husband and three beautiful active boys. Lauren, welcome to our show. It's a delight to have you here today.

Lauren

Thank you. I'm so excited and honored to be here.

Brooke

So I guess we'll start off with just getting to know you a bit. So what initially brought you into healthcare?

Lauren

Yeah, I wish I had one of these stories where I was holding a stethoscope at five years old and always knew that I wanted to be a doctor, but I don't. It happened a little bit less organically Through high school I really thought I was going to be a violinist and probably around my senior year of high school I started to get some real challenging questions that I think were really good in terms of what are your other life goals, what do you want your work-life balance to be? What do you want in terms of being able to support your family? And then I think one of the others that was really provocative was my instructor at the time said, you definitely have what it takes to become a professional musician, but you also have to be ready for the day where somebody who's six years old comes in auditions and blows you out of the water, is like the best on their worst day that you'll ever be on your best day.

I didn't love that in addition to the answers to all those other questions. And so I went into college really kind of not knowing what to do. I declared as pre-med and I would say over the time I got very comfortable with this idea of being very minded in liking that, but also really liking being in a field where I was going to help and interact with people. And so by the time I was ready to apply, very solid in the fact that I wanted to be a physician, but that's how I got into healthcare.

Brooke

Wow, that's great. That is such a unique story. And so how did you evolve from medical school to where you are today?

Lauren

I'm going to try to keep this a brief story because my journey is not a linear line. I went into medical school thinking I was going to be a surgeon of some kind after training, had a change of heart, did my internship in internal medicine, and then I took a break in training actually. So in the Navy, after your first year of residency, you can go do one of three things. You can be a flight surgeon, which is aviation medicine, a dive medical officer or a general medical officer on a ship. Earlier in medical school, I had had an experience in between the summer where I got to go train with a T 45 jet trainer squadron, so affectionately what they call just self-loading cargo. And so I was able to fly around for several weeks and after that experience I absolutely knew I was going to pursue aviation medicine after internship.

So I did that with the Marines for two and a half years, really invaluable experience. Came back, finished my residency, which I will say is a very humbling experience after having stepped away for two years to come back to training, did my chief year and then stayed on at Walter Reed to continue my cardiology fellowship. And after that was really very lucky to have a lot of opportunities. So I became the associate program director for the cardiology fellowship program. Ultimately went on to become the deputy chief for the Department of Medicine. So really having a lot of leadership and teaching experience, both of the things I loved. In 2020 2021, it was time to step away from military service. And so there are actually quite a few veterans here in Wenatchee, Washington. Sort of unbeknownst I reached out to a couple of people that I had trained with in the past, which is how I ended up here practicing in beautiful central Washington.

Rahul

Thanks for sharing that, Lauren. I loved listening to that and it reminded me of how we got connected to you with two of our colleagues here at Quinnipiac, Jennifer Riling and Andre Nero. So shout out to both of them and I remember them telling me, have you heard about Lauren Weber? She's a great cardiologist and she's been talking about followership and I'm just so delighted that we got to know you through them.

Brooke

So Lauren, what is the origin of All Levels Leadership?

Lauren

This is a good story. I think it's a good story, but I'm biased of course. So I was in the military, as you know, and all of the people at all levels leadership are all veterans. And so two of my other partners were having brunch in Bethesda, Maryland, both about to retire from the military service and thinking about what is it that we want to do afterwards. We are all deeply connected to teaching and mentoring, and we all are very deeply connected to really bringing leadership skills and making them as applicable, as approachable to people. And they were talking about we should really start a leadership coaching consulting education company. And so my partner Jess said, hang on a second, we've got to get Lauren on the phone. So they call me and put me on speaker, I can hear the people in the background and they said, Lauren, we know what we want to do when we grow up. We want to start a leadership company. And I said, I'm in because we had been part of this conversation for a very long time. So we met actually later that summer and spent a whole weekend kind of in a apartment in Leavenworth. And when we left we had a mission statement, a vision statement, a structure. We were able to launch about a year later and have picked up some clients and are just really in love with what we do. And I have probably the best team anybody could ask for.

Brooke

Wow, that's awesome. And yeah, the work you guys are doing is super important and admirable.

Lauren

Thank you.

Brooke

That's a good segue into talking about followership. So Lauren, you do a lot of work on followership and healthcare and that is some of the most impactful work that we've come across as yours. So for our listeners, can you start by telling them what is followership?

Lauren

Well, first of all, thank you for that. I appreciate the compliment very much. I think the question of what is followership is an interesting one because I will say the definition has been a little bit dynamic. If you were to Google even just a couple of years ago, what is followership? You would get the willingness to follow the leader. And so I think this conversation builds on when you ask the question, what is followership? Because followership has been around for a very long time. I'm talking 15 hundreds. We've been exploring the dynamic between followers and leaders. But you see it sort of start to show up in leadership doctrine, I would say in the 1950s. And those early depictions of followers are pretty negative. So think sycophant, lemming, no original thought in your head. You're just robotically doing what it is that you're told. And I think that tracks, because I like to challenge people and ask them, what is your initial feeling when somebody says you are a follower?

And if you're anything like me, it's a little bit negative. When somebody first asked me, it was actually Josh Hart Sue who asked me to talk about followership. I was a little offended. I was military officer, I was a chief resident. I'm like, not a follower, I'm a leader. And that's where that comes from is those early depictions of followers where it's just this very simple definition, willing to follow the leader, but what ends up happening in the eighties, we'll say, and as industry changes from more agricultural individual roles into industries that require team-based initiatives and success, as we start to see followers get a little bit more agency into the role, because now more than ever, we recognize that how people function in a team and how they support their leaders is really the lynchpin to success or failure. And so I'll give you an example.

So in an orchestra, we know the conductor intuitively is the leader and he is directing the orchestra. What happens if a trombone player gets up and walks off stage? That's like a bad day. And to delineate followers from teams a little bit where team, we talk about the collective follower, we talk about the individual. What if the trombone player has been whipping up the other trombone players in the back and now the entire trombone section gets up and walks off stage? That's a really bad day. And so we start to see really the influence that an individual can have on their team and on their support of the leader. So Josh Hartzel, Jess b and I worked really hard to really rethink and redefine what followership is. And we published that a couple of years ago. I'm actually going to read it for you. It's a longer definition, but I think it's an important definition.

Do we redefine followership as the leadership practice by individuals who are in positions of responsibility but not authority whereby they exert their influence to execute the vision of their leaders or accomplish organizational goals? And for healthcare, I think for me this definition really resonates because when you think about being in a position of responsibility, which I would say everybody in healthcare has, the physicians have it, the nurses have it, all our allied forces have it, but we are often in positions of great responsibility and have very little authority. And so how do we lead? We lead through influence.

Brooke

Wow, thank you for that. I had never even thought about that first part that you said about when someone calls you a follower, because right when you said that, I thought all those negative thoughts came into my head too, but for some reason that does sound different than followership versus a follower, but it really is one and the same. So I think that that definition that you guys have come up with is way better than the one that originally was attached to it. Thank you.

Rahul

Yeah, this is Rahul. Thank you for that. I had the same negative reaction when I heard the word first, and I think a lot of our listeners might have too, because a follower follows orders. But I'm reminded of a friend of mine, he was a fellow med student, and when we were in our surgery rotation, so this would be the equivalent of doing a sub internship. So finally year of medical school, the surgery chief resident would say about him. He not only does what we tell him to do, but he'll go the extra step and follow through on it and anticipate what else could come up and try to come up with a solution for that. So I think listening to you and reading your work has made me change my frame from somebody who just follows orders to somebody who's now a key part of the team and understands that and over time can go the extra distance in many different ways as they grow to help the team.

Lauren

Yeah, absolutely.

Pete

I like to chime in here. This is Peter. Your story has, I dunno, it started, all my neurons started firing and leadership. I've been looked upon it from high school football throughout my whole career and my philosophy, I guess my leadership philosophy is to intrinsically get people to follow what I'm trying to do, but not really as a, I'm better than anyone, but the direction to help everyone be better rather than extrinsic and forcing them to do it. Knowing when I was nurse manager, I knew I had the authority to do certain things, but that's not the way I like to operate. I like to get them to see what I'm trying to do and value it and buy in because then when I'm not around, it's going to continue and I don't have to be babysitting whatever it is my project or all that good stuff. So that's where it brought me. So thank you.

Lauren

It's funny, I think both your stories hit on something that's really important about followership. So Rahul, your story is how do leaders get selected? They often get identified by being really good at followership principles, right? It is the going the extra mile, it's the taking the ownership, it's the initiative, it's the bringing the people along with you. You sort of naturally end up in this situation where people want to give you some authority and put you in charge. And then Peter, on your side, you've gotten really comfortable with those skills where you can give those back to the people you're leading and you don't have to be authoritative because they feel inspired to follow you. So two ends on the up and quite, but I think you're both hitting really important aspects of followership

Brooke

That kind of goes into why does being an effective follower matter for anyone who's learning to lead?

Lauren

Yeah, again, I think it goes back to how do leaders get selected. So first of all, I will say I do not think that everybody needs to or wants to become a leader, in which case you're going to spend most of your career in a followership role. Even if you're aspiring to become a leader, you're going to spend most of your career in a followership role. And I have yet to meet a leader who wasn't responsible to someone accountable to someone. Maybe that's an immediate boss, maybe it's a board of directors, but every role that you have has some component of service resuming responsibility to something else. So there's a followship component thread that goes along to it. If you are aspiring to be a leader, again, how do we identify our leaders? We identify our leaders before we've ever given them authority, before we've even ever thought about it.

So what are those traits and values? Those are bringing people along collaboratively, working, taking ownership, challenging when something doesn't seem right or is going wrong. That's probably one of the most important aspects of followership is having that willingness to say, I think something is going wrong. It's all of that consistency that we see that helps people rise on the leadership journey and sort of ladder. So if that's important to you, I would say followership is a foundation to build on. The last thing I'll say is that followership gets a little trickier. The higher up on the leadership rung you are. And when you've established your own brand, your own reputation as a leader, but you have a boss, it's so important to bring your followership skills to that relationship. So I'll talk about this from the perspective of the leader. You've surrounded yourself by probably a core group of people that you really rely on and you're counting on them to give you ideas to hold you accountable, to challenge you. But then also once you all leave the boardroom or the conference room, go out there and support the initiatives. And so if you're not comfortable in that role, it can get really sticky and you end up sort of stepping on your leader's toes maybe in a way that you didn't intend to.

Brooke

Thank you for sharing all of that. And I think it's very true that we spend so much time as a follower. I feel like to this point, maybe just because of where I am right now, I've been a follower pretty much the entire time. I haven't really had any big leader roles. So what are some tips or practices that you recommend to being a better follower?

Lauren

Great question. So there's a lot of them, which is good because you don't have to practice all of them, you just have to practice some of them. I would say maybe before we get into tips or tricks, I would like to talk about the different kinds of followers and the behaviors I think that we see in followers. There are lots of different versions out there. And again, going back to the earlier part of our conversation, a lot of the depictions and archetypes of followers has a slightly negative overtone to it, with the exception I would say of Iris Shale who describes followership in his book, the Courageous Follower, and I still use it, I use it in my coaching, I use it in my mentoring because it really resonated with me and I think it's probably the depiction that I think translates best to healthcare.

So he talks about four different types of archetypes of followers, and he describes them based on two things. So that's their willingness to support their leader and I'll say change as well. And then their willingness to challenge them. And so if you were successful at both, then you are a partner. So these are people who are coming up with ideas, they're going to support change, but they're also going to challenge their leader. They're going to go into their office and say, I feel like we're off track here. So those are partners. Then there's implementers. So these are folks that like a project, they like change, they're willing to support it, but they're not necessarily going to challenge the leader if they feel like things are going awry. There's a resource. So these are the low support for change in their leader, low willingness to challenge their leader.

That can sound a little negative, but I also really like to think about these as my subject matter experts. These are the people who come and they do a good job, they go home, they don't have the bandwidth for the other stuff, which may be okay depending on where they are in life, but not going to stand in the way of change, not going to tell people if they think things are going wrong. And then there's the individualist, which is low support for their leader or change, but highly vocal and challenging. I would say most of us have usually worked with somebody like this, and that's because they tend to take up a lot of airtime in meetings. They always have the reason as to why something's not going to work, and they're going to let you know they're going to tell you all the reasons why we shouldn't do it.

One of the things that I think is really pivotal about sharif's work though is that none of the four is innately negative. You can be effective as a follower depending on what your base model is in each of those. And I really like to think about them as dynamic. So maybe I can be a partner, I strive to be a partner, but maybe I can't always be a partner. So those are the kind of archetypes I like to think about in terms of the different kinds of followers. And then for the behaviors, kind of switching to that, going back to Shayla, if he describes these as six different courage’s so to speak. And in a way I think that really pays honor to the fact that the type of things that we're asking people to do to be effective followers, much in the same that we ask them to be effective leaders, this can be hard stuff.

So he has the courage to serve. I would say in healthcare we are no stranger to serve. We serve a lot of people. And here the challenge is to really think about what you do in service to your leader and to your organization. There's the courage to assume responsibility, the courage to challenge. I would say that's probably I find the one that people have the most anxiety about is the courage to challenge their leaders, the courage to participate in transformation. We're very good at that in healthcare, right? Pi qi projects, we've got it. We like transformation, the courage to take moral action and then the courage to speak to the hierarchy. And what he means about that is feeling comfortable that if you're the person to give a brief or presentation to your boss's boss to talk to the C-suite, that you feel courageous enough to step into those shoes.

So those are the behaviors of effective followers. There's one other thing here that I want to add that I think are important. Let's call them personality traits of anybody who's looking to effectively influence. And we've hit on some of these a little bit through your stories. One is consistency. So I'd like to think about this as your brand. You should feel really confident when you're not in the room, what people are saying about you. That reliability of bringing people along, not shaming people when they're wrong goes a long way to trust. The second is the ability to find common ground. And this is really important when we talk about the behavior of challenging. So being able to find common ground is a really good place to start from if you're going to challenge somebody. And then the last one is optimism. And I'm not talking about blind optimism. So nobody wants a rainbows and puppy dogs conversation when the house is burning down. We do want acknowledgement of barriers and challenges, but we also want to follow and partner with people who believe in the fortitude of the team to still be successful to get things done. So overarchingly, that's the way I sort of think about maybe what the different archetypes flavors of followers are and some of the behaviors that support effective followers.

Brooke

Yeah, that's great. Thank you so much.

Rahul

So I want to build on something that Brooke began with, and then Lauren, thank you for walking us through. And I think it's putting it in a slightly different spin, which is this journey of the follower from becoming like, I don't know who I am or do I even belong here to becoming the superhero, so to say? And I can, if Brooke is okay, I'm going to give her example. And a lot of us deal with leaders who are not perfect though working with a flawed leader like me, for example, on this podcast. And the journey began when she decided, okay, let me just do this and take a chance. These people have never done a podcast. They have never done production. I have never done it either. And now I'm going to show up to be a producer of this podcast because I believe in the mission or the work maybe.

And so that's where the journey is beginning. Just picking the right project or the people that you're working with then is the journey of doing the job. You're designed the part that no one likes, but there's a difference in how you do it. The way Brooke did it is to make sure that she's learning with an expert we had on podcasting and working through the ropes and using chat GPT or whatever resource we have. And if she's not able to do it, then saying, Hey, I need help or how can I do this? Struggling through it, versus it could have been that I'm emailing her, have you done this? Have you done this? So if she can't do it and something's not happening, she would come to us or will come to us that I'm not. So there's that reliability I think that you talked about.

And I think the journey doesn't stop there. Like you said, it evolves to now not only am I reliable and I'm going to follow through, but I can begin to anticipate what are the things this team is going to need. And so she's done that for a long time now, where, okay, what's our schedule of releases or who are we going to bring in next that is going to be helpful to us and be a part of that conversation? So we go then from that anticipate to, like you said, having the difficult conversations, challenging maybe. So I or some of us will pull her in four different directions and let's change the schedule or let's get six more guests and there'll be someone doing a reality check. We don't really have the time to record them or to release them, and is it really going to be helpful to our listeners?

And then I think finally is the stage where you become the co-creator. So at this point you are here because Brooke reached out to you and talked to you, and a lot of our guests will want to know her questions and her perspective. So I think this project could easily go ahead without me, but it's very difficult to move it forward without her. So she's at this stage where she's become the co-creator and a leader of sorts, and I think it just illustrates the journey of a follower. So I'd love any comments you have on that as well.

Lauren

I love that. I think it's a really important story and it starts with this, I will say assumption of responsibility. I've given a task, I don't necessarily know how to do it exactly, but I'm going to dive in. I'm going to bring well-researched solutions, I'm going to find help. And in that you bring the other people on the team along and you build trust and you're able to challenge each other. And this is where individual behaviors affect team dynamics, affect culture. And you're right, sometimes you won't always be paired with an easy leader to work with, but that's just one person that we're interacting with and that we're influencing and our day-to-day, there's a whole host of other people, particularly in healthcare that we're influencing and how you show up and how you tackle your problems and how you collaborate with other people impacts them. We sort of say you're kind of in a ninja way displaying some of these traits that we really want everybody to try to get good at so that we all come up though. That's a good story.

Brooke

Thank you so much Dr. Anand, for your kind words and everybody, and you are a good leader, not a bad leader at all. So

Rahul

Maybe just goes to show that the follower, a good follower can also coach and improve the leader with the right kind of work together and feedback over time.

Lauren

Yeah, I think that's right. We're inextricably linked leaders and followers and we should be supporting each other.

Rahul

I think I'll just add that if the follower is reliable and is progressing, then the leader's role does change from, because in the beginning they need a lot of direction and even support. But then as the journey progresses, then the leader's role changes to what is this person today and what do I see they can become. And sometimes the follower may not know this, and it's our job as educators especially to see people for who they can become, not who they are today. I think that's one part. And so one has to be constantly thinking like, okay, how can I help grow this person and gradually increase that temperature or must build that muscle over time as the follower is progressing well versus a leader who may not let you grow. And then the follower might get frustrated that I'm doing so much and there's no growth here and maybe I'm going to grow somewhere else. So I think that's how the diet is also very intricately related.

Lauren

I think it's an important point. And I will say we are very comfortable with that progression, so to speak in medical training. That's exactly how we do it. You come in, you're a clean slate and we dump knowledge into you and then we put you in experience and we just, we're constantly slowly turning up the temperature. You're getting feedback all of the time with this very distinct goal in mind that you're an independent practitioner and we're very comfortable with that. And for some reason, as soon as we step out of our clinical role, we forget that we learned how to do it and the skills really translate. So if you've been on a multidisciplinary team, I'm sure all of you have been on a multidisciplinary team, if you've had to have a difficult conversation, you've practiced a lot of these skills and they do translate. They're just as impactful at the bedside as they are in a conference room.

Brooke

You mentioned feedback and I know that you also speak a lot about feedback. So I guess in this context, how do you get better at receiving feedback as a follower if it's negative or positive?

Lauren

That's the holy grail. I think this is such an important conversation. It could be its own conversation just separately, but receiving feedback is essential to followership, it's essential to leadership. All along the spectrum. If you're going to get better at something, you have to be able to receive feedback. And I like to think about that maybe in three big buckets. So mindset, what I'll call analysis, and then what we're going to call filtering. And so to start with mindset, in order to be able to receive feedback, I would say you've got to get yourself in this mindset that is on this parallel track. One I would say we're really familiar with in healthcare, which is growth mindset, which is being willing to hear new information and exposed to new ideas. Pretty good at growth mindset. The next one I'm going to say is we'll call it recalibration mindset or reexamining and challenging what we think we already know and believe.

Adam Grant wrote the book Think Again, one of my favorite books, I think a lot of leaders really resonate with this book and he talks about thinking like a scientist when it comes to rethinking, and it makes me chuckle a little bit just because scientists get feedback in this very objective way, like the experiment worked or did not work. And wouldn't it be lovely as leaders and followers if we could get this very objective type of feedback, but we don't. We get it from people. And so it has a lot of nuance to it. Who gave it to you? How did they say it? What did they say? So we have to be willing to recalibrate. And I would say if we don't come to the mindset of growth and recalibration, we can't ever get to analysis because we won't make it past. Ouch. I have very few people say to me that they're struggling to process the positive feedback that they got.

I have a lot of people come to me and say they're struggling to process the critical feedback that they got, and it's the critical feedback that's required for growth. So we want to be able to recalibrate and then we want to analyze. And I think it's important to have a framework in which to analyze what was said, maybe what wasn't said. And there's a lot that goes into that. So I won't go through all the details, but that's who said it, what did they say, how did they say it, how was it delivered? And when we're done in analyzing the feedback, then we're going to filter it and decide is this something that we need to put in action? Now I needed to hear this. Or maybe it's on the whole other opposite. This was something that I didn't need to hear. It wasn't very helpful, in which case I'm going to disregard this and maybe even recover from it if I need to. So I think it's really important to be able to go through that process and receiving feedback. We talk a lot about giving feedback in healthcare and I will say I think giving feedback, giving effective feedback is definitely a skillset. I would say receiving feedback effectively is much more of a journey.

Brooke

Yeah, I completely agree with that. I think also the kind of feedback that you're getting, like you mentioned, plays a big part into how you process through it, depending on how hard it hits or those vulnerable spots if it's hitting there and how to process that.

Lauren

Yeah, a hundred percent. We don't start anything in a LL, any coaching or workshops or anything without the self-reflection piece of knowing where you are and how you receive things. Because a really important integral part to being able to get to a place where you can recalibrate or rethink.

Rahul

One thing I want to build on that is that the constructive or critical feedback especially, is a form of conflict. And I think this is not recognized in MedEd as much with the astel ask or the positive, negative, positive frameworks because it's either something you do not know about yourself or you know about yourself, but you're hiding it from yourself or others. And now it has come up. So if you're going to grow that persona of yours beyond what you already know and can do, then a recognizing that it is a form of conflict for both people. And then secondly, as you said, take time to process it and see who gave it. What's the context? Do they really know me? What's going to be most helpful to me and now I'm going to digest it and be able to grow myself? I think that's a nuance that wasn't clear to me until recently that it is basically a conflict and you have to think of it in the lens of a conflict as this is happening, whether you're giving it or receiving it.

Lauren

I really like that. And I like it specifically because I think we very rarely handle conflict on our own. And so in my group, we really like to get our clients and our M mentees to find a feedback partner to sort of unpack this because like you said, some of this, it's unclear to us, it's hidden from us. It's sort of our innate behaviors. We aren't aware. And so having somebody who's sort of willing to hold up the mirror a little bit and call you all on stuff is really helpful. The other aspect is the stuff that does hurt maybe isn't true. I think is also really helpful to have a feedback partner to kind of unpack that and say, well, was there something here I could use? What is that? And then how am I going to put that forward in the future? So I agree with you.

Brooke

Well, Lauren, thank you so much for this great conversation and for telling us about All Levels Leadership. So before we close, is there one message that you want all of our listeners to take away?

Lauren

The one thing I want you to take away is to know that I always get nervous when I talk to people about followership, and that's because of the innate negativity that comes when you hear the word follower or followership and the sort of conflict that can create. But I would really like to challenge everybody to sort of move past that and look towards what followership really entails and what it can hold for you in terms of being able to be successful as a peer, as a colleague, as a future leader. And if you want to get better at this, lean into this concept of followership because I really think it's a great bedrock which you can build on to make yourself effective really in any position you hold.

Brooke

That's great. Thank you.

Lauren

Certainly if anybody wants to explore followership or feedback or anything else that you have having a leadership challenge with, I would love to be able to support you. My team would be able to love to support you. So, check us out on our website, which is AllLevelsLeadership.com or same tag, any of the social media. We're on LinkedIn, Instagram, and Facebook, and we would love to connect with people.

Brooke

Alright, and thank you everyone for tuning in. So until next time, take care and keep learning and leading.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E5: Leading Through Difficult Conversations (feat. Lauren Weber, MD)

Brooke

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke

Hi everyone and welcome back to Learning to Lead. With us today is Dr. Lauren Weber. She is a clinical cardiologist with the Wenatchee Valley Medical Group in Central Washington, and she's also the co-founder of All Levels Leadership. So Lauren, what is one of your favorite tools or hacks to become a better leader?

Lauren

So if I had one tip to share with you, I will say it is good for leaders and it is good for followers, and I will hopefully be speaking with you guys a lot more about followers and followership here in the future. But I would say one of the things that people struggle with, and probably the question I get the most is how do I have a difficult conversation? I know I need to have it. The person I have to have it with is either in charge or they're a little scary or I really respect this person. So how do I even get started? And so one thing I want you to think about is developing and having in your back pocket and opening alignment statement. And so what I mean by that is we're really going to try to set the stage that we're here to help.

We came with good intention. And so that might mean or look like I really love working with you, but I have something I want to talk about or I really respect you and I'm sure you would want me to bring this to you. Or I'm a little concerned that maybe something's going on that you're not seeing it. It's okay if we talk about it and practice that. Try it on a couple of people, try it on yourself in the mirror. But having that statement ready to go, knowing that that's going to be your opener, I think can really decrease the amount of anxiety just to starting the conversation. So try figuring out and sort of scripting out for yourself and opening alignment statement.

Brooke

Yeah, I love that. That's a great hack. I definitely think I need to get one of those. I struggle with having difficult conversations and I think that that would make me feel less anxious. And also it makes me think that it's preparing the other person for whatever I'm going to say too. So that also makes me feel better. I always feel bad, especially when you're going to say something that maybe the other person doesn't want to hear. That's the part that kind of makes me really anxious. So giving them that warning shot that I have something, but prefacing it with letting them know how much you do value them.

Pete

And Lauren, do you ask permission to see if they're ready for that feedback? Like, Hey, Rahul, whatever my alignment statement is, can I give you some feedback? Are you ready for some feedback? What are your thoughts about that?

Lauren

I think it depends a little bit on who the person is and how well you know them. I like to ask, I like to say, is it okay if I share this with you? Is now a good time to have a conversation? Because Brooke, you're absolutely right. We want to create a situation where hopefully this person isn't feeling immediately defensive and they're going to feel a little bit right. If somebody's going to lean in to give you critical feedback and you kind of get the angst of that, your anxiety is going to go up. So giving some permission to have the conversation I think is really helpful. If it's something you need to say or needs to say, let's say it's related to safety, and you also know maybe the person's going to say, no, I don't want to have that conversation. You may try to restructure it. But in general, I think asking for permission is a really good technique.

Rahul

This is Rahul. I really enjoyed what you said as well. Reminds me of a couple of things. One of them is the four step getting to yes negotiation framework. And the first step is separate the person from the problem. So from a very cognitive point of view, you can think about that. The other thing that came to mind is once in our leadership training, we had to do this communication style survey. Brooke's done this as well, and I remember ending up as an amiable type, which is where I really care about relationships, and I do not want to break the piece or break the relationship. So what you said really is helpful because it's putting this conversation in a positive relational context. Like I'm saying, you matter so much to me, which is why we're having this conversation and has to be genuine. The other person has to matter. You cannot fake it. But that's actually making me more courageous to have this conversation because I do care about you. If I didn't, I would not give you this feedback and I would walk away. Or maybe it's pinching me and I need to say this to you because I care about still being a part of this team. So building that relational framework and before the disagreements are surfaced,

Lauren

Thank you for using the word relational because it's very important. And I would say it's some of the thing that we feel really passionately about at a LL is making sure that the strategies that we're using enhance preserve, grow the relationships between the people, you and the people you're working with. Strong teams. This is what makes success. And so some of that is certainly about your individual growth and development, but what is the impact that has on all the relationships that are working with you?

Brooke

Thank you, Lauren, for that hack. Make sure everyone to tune in to our next episode where Lauren is going to dive into followership. So until then, keep learning and keep leading.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E4: When Physicians Face Litigation: Lessons in Leadership

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Amber

Welcome everyone to another episode from Learning to Lead. My name is Amber Vargas and I'll be co-hosting this episode along with our several co-hosts here. So who I'll let introduce themselves.

Rahul

Hi, it's Rahul Anand.

Liza

Hi, it’s Liza Landry.

Maya

Hi, it's Maya Doyle.

Pete

Hello, it's Peter Longley.

Amber

So Dr. Gita Pensa is an Emergency Medicine physician practicing in Rhode Island since 2001. She graduated from the University of Pennsylvania School of Medicine, now Perelman School of Medicine in 1997. She continued on to residency at the combined George Washington Georgetown Emergency Medicine residency in Washington DC graduating as Chief Resident in 2021. She worked in community emergency medicine for 13 years before joining the faculty at the Warren Albert School of Medicine at Brown University in 2014. She's currently an adjunct associate professor in the Department of Emergency Medicine. Dr. Pena is now also a physician defendant, wellbeing coach and consultant. She was the host and editor of a EM Early Access a research podcast for the Academic Emergency Medicine Journal through 2024. She's also a regular contributor to the emergency medicine reviews and perspectives and wrap and the co-host of its uc Max program at the Medical School of Brown University. She served as a Mary B. Arnold longitudinal mentor to over 40 medical students yearly until 2022. She lives in Providence, Rhode Island with her husband, three daughters and dog Maggie. So welcome Dr. Pensa and thank you for being here with us today.

Gita

Thank you so much for the invitation. I'm excited.

Amber

We are so excited to have you. So to get us started, can you tell us a little bit about yourself and your journey? Why emergency medicine? When did you begin to see yourself as a leader in healthcare?

Gita

Sure. Well, I wound up becoming an Emergency Physician largely because of my older brother's influence who was also an Emergency Physician. So he's three years ahead of me and when I was in medical school, I really kind of liked everything. I really couldn't decide. I really very much enjoyed, I kind of thought I was gravitating towards critical care and my brother was the person who said, I'm going to emergency medicine. I think you should think about it. It's pretty awesome. And Penn at the time did not have an emergency medicine residency program. It was early enough that a number of schools that you may think of as sort of leaders in medical education actually did not have emergency medicine residencies because emergency medicine was sort of this late bloomer in terms of being a specialty. And so I hadn't really thought about it and I wound up rotating through the emergency department finding that I actually loved it and there was this great appeal in just being able to see different stuff for the rest of my career.

So that's really kind of what clinched it for me. Then I did my residency. I was the educational chief resident at GW Georgetown when I graduated and I had this full expectation to take an academic position and my husband got a fellowship at Brown. He became a GI doctor. And when I came up here for reasons I won't get into, I sort of interviewed at the academic ship and I was supposed to be the second full-time female faculty member that they had. And I was expecting a child and I got some funny vibes about the whole thing and I decided I'm going to take this community job over here, which was a real detour that I did not expect. And then it turns out that I loved that place. And so I was a nocturnists there. I worked as I did nights for a number of years and then I transitioned into regular emergency medicine shift work.

And I don't think I really saw myself as much of a leader. I just was trying to practice good medicine and be a good doctor in the community. And about five years after I graduated from residency, I saw a patient that was going to completely change the trajectory of my entire life and my career. And it was a young woman who had had a really strange set of medical complaints and I spent a lot of time with her and I knew at the time it was kind of strange and I imaged her and I made a plan with a consultant and then I wound up discharging this person hoping that the consultant was going to see her at nine. And then she didn't make it there. She actually went home and she had a pretty massive stroke at the age of 31.

So yeah, so I became the defendant in a lawsuit where there was an extraordinary demand initially for $28 million. This is back in 2006, 2007. And I didn't know the first thing about litigation. I'd never been taught anything about it other than some basic risk management principles. And I that began this sort of descendant to madness I guess. And the case wound up lasting 12 years. And I went to trial in 2011 and again in 2018. And even though I won at both trials, I would say that there was this real transformational process between trial A and trial B that truly changed me and made me realize that we don't teach about this the way that we ought to be. We don't think about this the way that perhaps would be more helpful. And the shame around the topic of litigation and medicine is holding us all back and creating so much distress for people. And the majority of doctors will wind up in a lawsuit at some point. And so it makes sense that we prepare for it and we teach about it and we talk about it openly, but we're not there yet. So that is, I think that's where if I can be considered a leader in this particular arena, I think that's the origin story.

Liza

Wow, so much of what you said is so interesting and with litigation and feeling that increase in responsibility that you talk about in medical school and then in residency, and I'm sure that there's another huge jump when you become an attending. Is there anything that you wish you could tell medical students or people who are going into medicine and what that change in responsibility feels like and how you navigated that and kind of coped with that?

Gita

Oh, that's really interesting. So I think that as you come into residency as an intern, you know that you don't know enough. And that's frightening because you're going to be assigned some responsibilities and you don't feel quite ready for them except that you're always sort of reaching to show that you're able to handle the responsibility. And so this can be very challenging, but at least you're not expected to know everything. And I think for me in my career, my probably peak cockiness was I did a four year residency. And so somewhere about the middle of fourth year of residency, I kind of thought I was the bomb. I was like, I'm really good at this. I can run the emergency department. I'm so ready. And then my first weekend alone, there's a meme, I don't know if you've ever seen it, and it has a little cute little cat and maybe this is just being fed to me, but I thought it was hysterical and it was this cat looking so for Lauren, and it said, the moment when you look around for the attending and you realize it's me and I want to find the attendee attending to help.

But that's a huge transition and for me, wow, was it a trial by fire? Because I took this job where I was, it was in the community. I was a nocturnists and I was the only doctor in the hospital at night, so I would have to run the emergency department. I did not have a PA or NP or any other. I had nurses and me and T and me. And then I would also have to go from the emergency department upstairs when there was any sort of critical situation while we were waiting for that doctor to come in from home. We did not have hospitals in those days. So I would go upstairs to run a code or if someone did an airway, I would go do that. Or if someone was on labor and delivery, I would have to leave the department and catch a baby waiting for the OB to come in.

And this was terrifying because all of a sudden I was supposed to be the person that actually did know everything and I knew that I didn't. And that's just sort of this dunning Kruger love. The more you know, the more you realize you don't know. And so coming to peace with that of there was some struggle, there was some real struggle. I can remember, I didn't know enough the first night, but going back the second night, I told my husband, I don't think I could do this. I don't want to go. I really feel like I should quit right now. And he had to give me the pep talk of like, well, I'm a fellow and make no money. We just bought a house and we have a baby, so someone's got to go to work. I really think it should be you. But then also you're as well-trained if you don't go, they won't have anybody

And you do know how to do this as well as anybody else does. So just show up and do your best. That's what I kept doing day after day after day shift after shift after shift. But the trouble was the litigation thing really kind of took that cut the wind out of my sails a lot, and that really set me back to square one where I was really much less confident in my own decision, making much less sure of myself, a lot of second guessing, a lot of analysis paralysis, and I did not feel like quite the hot shot that I had.

Liza

Yeah, I can imagine that would take a toll. After going through that, how did you navigate building your confidence back up after going through the litigation that you went through?

Gita

I did not do it very well, and it took a really, really long time. And part of it is, and this is largely why I do the work I do now, is that I didn't have any support, any understanding you're instructed when you're sued to not talk to anybody. And we're pretty good rule followers, so we don't, and I didn't just showed up. If I could have quit, I think I would've, but we had loans and a baby and a mortgage and I felt this responsibility, I have to show up, but I didn't want to show up. And so I would pull up to the ER and cry in my car and then get out and just white knuckle my way through a shift, just completely terrified of everything. And that is not a feeling that left me for many, many, many years. It really probably wasn't until after the first trial when I decided that I was going to figure out a different way to be with this because I had been really dealing with this entity that now I know is called litigation stress. But I'd been dealing with that for the better part of a decade and I'd really missed a lot of my own life and certainly the enjoyment of my career. But it's pretty amazing how somebody with a lot of grit and determination, as most of us can keep showing up to a job that you are unhappy at day in and day out because you feel like you have the responsibility to do so. But you could do that for a really, really long time. And unfortunately some people will spend a career like that.

Amber

Are there things that would've made you feel more supported or that would've helped you in that situation?

Gita

I can identify a number of things that I think would've helped over time. First of all, some institutions now have peer support around adverse events and litigation. That's sort of like an up and coming area, but we recognize now that these really terrible adverse events and litigation are kind of occupational hazards. And so if you look at the responsibility of the workplace to ensure the safety of their workers, not just from violence, which is obviously a problem too, especially in emergency medicine, but from these really traumatic experiences that are part and parcel of our work, then the institutions I think have a responsibility to create systems of support around them. And so that's something that we're just waking up to now. So if there had been something like that available to me, that would've been marvelous. I think if one of my instructors had ever talked openly about getting sued or about it in real time if it were happening to them.

Most of our learning in medicine is really, it's kind of generational. You learn stuff in medical school, but then wait, when you get to residency, what you're going to do is pick the attendings that you want to be like and then you're going to model yourself after them. That's how we learn. We pick who our mentors are going to be and then we try to be like them. And I think if I'd ever had someone that I thought of as a role model who also got sued or was open about litigation and how they were coping with it and that it was difficult, but there were strategies to move forward with it or during it, I think that would've been pretty amazing. But I had nothing. I had no one. And the feeling then is that if it doesn't happen, you might know the numbers, but if you've never seen anybody do it, there's still a feeling of this does not happen to our people.

So you still feel like a pariah. You're still really just the shame is really overpowering. So I think if there were just anyone who in my people not, maybe someone might've done an abstract lecture, even me when I go to institutions and I talk about this, it's really different then if someone that you know and admire is telling you about their experience. And notably I think in real time, which is something that a lot of people have a lot of trouble with right now, but I think that would be marvelous because you can't talk about maybe the details of your case, but you can talk about the experience, you can talk about how it's making you feel, and we avoid all of that. So that would've been truly instrumental. And three, if I knew one thing about litigation before I wound up in it in terms of the system, how to perform as a defendant, what it means, what it doesn't mean, what it means about me as a doctor, what it doesn't mean about me as a doctor, if I knew any of that, I think it would've gone a long way. And so that is the lens that I work through now. I help systems with their peer support development. I work with people in terms of dealing with the shame of litigation and how to move forward in performance. And I teach the skills required to be a good defendant. And I think everybody should be a good defendant. There's no shame in that. I think we should all know how to operate in this arena.

Liza

Kind going off of that, can you just talk about a little bit, we've talked about litigation a lot and kind of thrown the word around. Can you kind of help us define what's the purpose of litigation healthcare and how do you feel like it gets misused and why?

Gita

That's a big question. So civil litigation in the United States, right? So medical malpractice litigation is under the umbrella of civil litigation, something called tort law. And tort law is really a means of dispute resolution in the courts. That's all it's right. And so civil litigation is supposed to be mostly about money. Just party A over here feels like they were wronged somehow by party B, and you have to use this system if they can't figure it out on their own. You use the courts to say, is party B liable? We use the word liable for the damages to party A, and if so, how much money? Because you can't, whatever the damages, if it was someone who was harmed medically, you can't necessarily fix that, but what would be a reasonable transactional amount of money? So truly the civil litigation system is kind of supposed to be transactional.

It's not supposed to be punitive. And it was never meant this is a huge mistake. It was never meant to adjudicate whether or not the medical care in a case was good because the jury doesn't understand medicine, the judge doesn't understand medicine. You are not being adjudicated by anyone that understands medicine. And so it becomes largely about optics and the battle of dueling experts and the jury of laypeople who will have to look at all of these disparate facts being presented to them and sort of come up with a decision. And we have unfortunately equated the outcomes of civil litigation with whether or not care was good, and it was never meant to do that. So when someone settles a case, there is this sort of general feeling amongst the public that they must have done something wrong. And that is in fact often not the case.

This is just a means to say, okay, we have this dispute and neither one of us wants to keep going through this process. So how about we give you this amount of money? And we both call it a day. That happens a lot in court. Most of the time in civil litigation, you're going to court because you feel like you want to defend your care, which is very different from other arenas of the law, but you go to trial in an effort to defend what you believe to be good care. And the doctor does win the majority of the time that is true, but sometimes they don't. In cases where you really thought that you were going to, and that can obviously be devastating, but then that goes in the paper and everybody assumes that the doctor did something horrible because there was a $3 million verdict against them or something like that.

And we in medicine haven't really talked about it openly enough to realize that that's not what this was for. But we got here because we totally abdicated our responsibility for creating a system that actually adjudicates care. And we probably need to address that. And there are some efforts out there if you read about the Michigan model of Rick Boothman, but there are attempts in institutions now to restore the ability to communicate between the injured patient and the caregiver. But the traditional litigation route completely gets rid of the dispute resolution part that's supposed to come before you go to court.

Amber

So after you realized that this was important to you, that there needs to be more education around litigation, we need to be talking about this. How did you start this new journey? Where did you begin?

Gita

Well, that was sort of an accidental story, and I'm not sure I made the decision before I started walking in a certain direction, but part of it started because I realized that I was in real trouble when I actually got the news that I won at trial the first time. Then there was an appeal, the plaintiff side appealed, and then I went through all the layers of court in my state, and then when I got the news in 2015 that they were overturning my verdicts and I had to go back to trial, I literally lost my mind. I actually just completely freaked out.

And that was the beginning of this decision that I could not be like this anymore because I felt like I was actually in danger. And I had spent so many years, and this is something that we know that litigation actually is. We have data now to support that. Litigation is a driver of suicide in physicians. Physicians have sort of a suicide problem, and it's a driver of suicide. It is a driver of substance use and abuse. It's a driver of relationship harm, divorce, and certainly a driver of career abandonment, but no one, no one's talking about it. But me as this person, this isolated person in the system, I realized that I was actually, not only had I just been unhappy for a long time, but I was actually in a really dangerous place and I did make the decision that I had to change something.

I had to look for something outside of myself that was going to, I'd been doing this as doctors often do, is just figuring out in my own head, I'm going to figure this out. And I was not. So for the first time I realized I think I might have to get out of my own horrible echo chamber of a mind and learn some things. And so it started with a very sort of, I read a book about litigation that had been published called When Good Doctors Get Sued. And someone had given it to me ages before and I had not read that thing. In fact, that was the first thing I did was like, I'm going to go read this book and I'm going to see if there's anything in there for me. And lo and behold, there was, and so that sort of started this like, oh, okay, well, and I call this sort of the breaking of the self-help seal, where I started to realize perhaps other people could give me some information that would be useful to me in this scenario.

And maybe it's not coming from medicine, it could be coming from somewhere else. So I kind of made a study about how one digs out of misery and burnout and all of that stuff. And then as part of that, more and more, the better I felt, then I decided I got to figure out what to do with medicine. I have to figure out am I going to love it or leave it. And as part of that, I wound up joining Brown's academic faculty, and I dunno, mix it up. I had always sort of felt that I'd been destined to be a teacher and that was the avenue I was going. And here it was 13 years later and I hadn't done it. So I was like, well, maybe if I reengage with that, I'll like that. When I showed up and I was talking to the residency director and saying, I'd really like to do this, but I don't have an academic niche.

I'm a generalist. I'm a good generalist, but I don't have any special research skills. I don't know any of this stuff anymore. She suggested that I become the social media educational technology person. So this is around 2015 ish. I knew nothing about it, but this is sort of my new like, all right, I'll try, I guess. And so I took classes at Brown's Instructional Technology Group and I started learning a lot about using social media for education and educational technology stuff. And then the residents wanted to make a blog. So we did that and then they wanted to make a podcast. So I learned how to podcast, and that was actually the thing that started me on this path to really being, having the career that I do today, is because as I approached trial the second time, I had this idea of I wonder, I'm feeling more comfortable.

I want to teach about this. I gave the residents a couple of lectures, and then I felt like, well, wow, what if I made a podcast about this thing and I had learned how to edit, I did all the audio editing and stuff like that. You couldn't do it out of a box then. So I had to learn how to audio edit and that kind of stuff. So it really was like this creative flex. And then after I went to trial a second time, I released this podcast and I didn't do it through Brown. I did this as a side just passion project, and it got passed around a lot and it still is. And so now we get about 10,000 downloads a month. So I know they use it as a teaching tool and insurance companies use it, resonate programs use it, people just find it and they passed around to people they think need it. So that was a long answer to your story, but that's kind of how it all went down. And by the time I went to trial the second time, I was a totally different person. I had studied tort law, legal performance. I knew exactly how to show up. I invited my residents to come to trial to watch me testify. And it's funny, the junior residents were like, could you do that again next year so that we could also come?

Please? No, thank you. So it was a really incremental, I did not set off for any of this to happen. And really it was just once you decide I need to move from this place, just picking a direction and just walking in it and just making decision after decision after decision with a very different lens of I need to go somewhere from here and this is where I wound up.

Amber

Thank you for being so vulnerable. The first time I heard you speak at Brown, I was like, oh my goodness, you made such an impact on my life. And I'm like, I've never heard someone talk about these things and say it's okay to be feeling these things, but here's how I did it and here's how you can do it too. So thank you. Thank you for that. And I'm sure that so many people are going to benefit from listening to your podcast, from listening to you here and from meeting you. Oh my goodness. I hope we continue to cross paths.

Gita

Oh, Amber, I hope so. I hope so.

Rahul

It just strikes me how at the beginning of this story, when it happened the first time, you are not talking to anybody, you're by yourself. It's a big black cloud over you and how you turned that, as you said, digging out of misery to this time when you are learning about it, teaching about it, you actually have your residents in the room with you as you're testifying. Oh my goodness, what a concept that is. Hats off to you.

Gita

Thank you. I think the whole thing, at some point I felt empowered to try to make the thing I wish I had. And recognizing when you come out of that place of misery and complete just, I call it with the people I coach, I call it the snow globe, where everything, you shake the thing up and everything is just swirling around and you couldn't pick one feeling, thought anything out of that whole storm. And when you come to a place of clarity about what was going on in there and what the reality is, then you can start, I think, to make meaning out of it. People talk about finding meaning. I believe that we make meaning. And when you make meaning out of it, then I think you're in, you're prepared then to you make this narrative that then propels you in a direction. And a lot of what I do, I think is just showing people, there's another narrative.

I think that we have this very default narrative in medicine. I can't tell you how many people I've met who say my plan was to practice until I got sued and then I was going to quit. It's super common, and I might've had that in there somewhere except I got sued right out of residency. I mean five years, but still it felt like I was still young and new. And I really think that the ability to talk about it comes from being able to come out of that really shaken up place and recognize this is something that is almost a universal experience eventually in medicine. And if you don't experience it, you fear it, but we aren't talking about it. And so then I guess I felt empowered to start talking, and then the more you talk about it, the easier it gets to talk about.

And so what I hope to do eventually is to make that a norm, because I actually think that that will really impact the way that younger people in medicine show up to deal with it when it happens to them if they show up knowing that they're truly not alone and that they don't need to be isolated and that they deserve to be supported through the process, whether or not they were responsible for whatever the harm was. There's always going to be difficult stuff to contend with, but the shame and the isolation is what makes it just so much more dangerous than it I think inherently needs to be. And then also our sort of ignorance and naivete about the whole thing and how it works.

Rahul

Yeah, thank you for sharing that. And I'm completing the quote. It's in pieces that you're sharing, but digging out of misery by finding meaning and then making the thing you wish you had first for yourself and then for others.

Gita

Yeah, thanks for that condensed quote.

Rahul

And sometimes that is leadership that you have just two or three bad options. There is no good option, and you have to then cook that conflict and take people along with you choosing the best you can. But any of the choices you would make collectively is going to make some people unhappy at you. And like you showed here, the two options, one was to keep practicing until you face litigation and then quit. And the other option is not even getting your hat in the ring or doing anything for the fear of litigation, and none of them is good for the healthcare professional or good for the community that they serve.

Gita

No, it doesn't feel good. It doesn't feel good to always be operating from this place of fear. And so what we don't do is actually unpack that fear. We have this undifferentiated fear and no available resource really to just sort of help us break down the thing that we're afraid of. And that's where I think that we could do a lot of work in terms of education and preparation.

Liza

And I think that kind of goes into the concept of resilience. When we were reading up on your work and your podcast and the different talks you give, it seems like you come back to resilience a lot, and it's something that's brought up I think a lot throughout medical training as kind of this ambiguous concept of we need to be resilient, we need to build resilience. But how do you feel is the best way, or do you have any advice on how to build that resilience and what that means to you?

Gita

So I think that if you are here, if you are studying this, if you are becoming a doctor or a nurse or another healthcare professional, you are already quite resilient. And it's tough to ask people to continue to just take all the hits and just be as resilient as you can. I'm not sure that's really quite the answer, but I do think that when there is something like this that you weren't expecting, that's probably when you feel like it ought not to have happened or you should be better prepared for this, and you're judging yourself for being in the situation. It is harder to be resilient. It's much harder when you're judging yourself about the event, judging yourself, about feeling the way you do, about being sued, judging yourself when you're judging yourself. That is not really a place where you can rise to, I'll just be resilient through this.

Like, no, that's not how you feel. You're telling yourself, your inner critic is telling yourself all the ways in which you are messing this thing up, and that is not a place where you can actually really foster a lot of resilience from. I don't know that it's possible in all circumstances to just be resilient. I think that's too big an ask. But I do think that it's a great frame to say that I believe that I am a resilient person. I know that there is probably something that I can learn or do that might help me. Let me look for those solutions. Like maybe I don't giving yourself the grace, which I did not for many years, but giving yourself the grace to realize I am not doing this in a way that's super helpful to me, but I know about myself that I am a resilient person.

I am a worthy person. I am a good doctor. I know these things to be true, and litigation honestly should not be, or actually even truly error, which is going to happen in every single career, should not be the thing that shakes those foundational beliefs. They have to get baked into that foundational belief. I know these events are coming at some point, and they will be very difficult to contend with, but they don't change who I am and they don't change all the good that I am doing in the world and that I aspire to continue doing in this work. And knowing who you are and your worth and not letting this outside business, which we can get into what it means and what it doesn't mean, but not letting that shake your foundational belief in who you are and the good that you do, that is where your resilience is going to come from. So I don't often use the, I don't advise people, I want you to be more resilient. That's not going to work. But I think that the more we can convince people that it's okay to continue to believe in themselves during, despite these processes, they will find their resilience.

Liza

That's beautiful. I love your emphasis on just trusting yourself and having such a strong sense of self that it allows you something to fall back onto.

Gita

Well, it's interesting you asked me about in training, becoming more confident in training. Nothing will shake your confidence in your own abilities like litigation will, because we never know enough. You always feel like, could somebody else have done it better or is there another doctor out there that would've done something differently? Would somebody have felt health have been able to catch this thing, or would they not have made this mistake? That kind of chatter we indulge in a lot as perfectionists in this arena. So learning to recognize that and to still sort of, I am learning and I also have value. I'm learning, just like my husband said on day two, like, you do this as well as anybody else. I used to go back to work, but recognizing there's no perfection, even though we're always striving for it, that's great, but there is no perfection. There is no arrival. But you go to work every single day armed with information, always striving to be better, keeping the patient at the center of your decision making and leading yourself with your values. That's who you are at whatever stage you are in this whole thing and recognizing that that is worth it is not easily, you are the person that will let that fritter away. You are the person that has control over that. Then don't let it go easy.

Amber

What are some of the key non-negotiable principles or practices that you live by?

Gita

Okay, well, I just say I aspire to live by, I don't get it right every time, but I think it's interesting in my fifties now, and I've finally realized that, oh, we keep growing and evolving. And I think one of the focuses today has really been of conflict. And one of the things that I aspire to do now when I am in conflict, I used to be kind of a hothead tell you the truth. I've learned, and we can learn these skills as we go along. I've learned to approach conflict a little differently and to think about when I'm going to have a tough conversation, what is it that I need in this conversation? And I try to think, what does the other person in this situation also need? And this actually will change my language. It changes my lens, it changes my perspective. It's really broadened my perspective with a lot of people and my patients, the people that I work with, the people that I live with is trying to put myself, not just putting myself in my shoes, but thinking, what do they need?

I have needs here in this conversation. What does that person need? And so that's something that's a work in progress. I'm aspiring to, as I continue to evolve, learning how to navigate conflict like that has definitely made me, I am better at it than I used to be. I think a little more strategic, but also I think that that's more in keeping with who I want to be. And when I say your values, I value integrity. I value honesty. I value inclusion. I value that every single person has a story and a perspective. And if I allow myself to really lead with those as my intention, when I approach these hard conversations, I do better.

Rahul

I love that principle of yours, and it reminds me of the concept of dignity, which is so important when people are in conflict that how can we hold this conversation in a way that upholds my dignity and the dignity of the others involved?

Amber

Perfect. Yeah. Something we speak about in our leadership curriculum a lot is staying on your side of the net. So this is what's going on on this side. That's what's going on that side. And lets understand that.

Gita

Yeah, I like that. Really clean and keeping your side of the net clean. Yeah.

Amber

Well, thank you so much. Thank you for your time and for your expertise today. It was a pleasure getting to know you and your journey. Dr. Pensa, if someone wanted to listen to your podcast, how can they do so?

Gita

They can search for it by name. It's called Doctors and Litigation: The L Word, and if they Google it, they'll find it. It's on Apple Podcast, Spotify, and my website is doctors and litigation.com.

Amber

Thank you so much, Dr. Pensa. It's a pleasure. Pleasure meeting you. Everyone on this call, thank you for engaging in the discussion.

Gita

I appreciate that. Good luck to everybody.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E3: Leadership Hack: The Power of Feedback (feat. Elizabeth Koltz, EdM)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke

Hi everyone. Welcome back to Learning to Lead. With us today is Elizabeth Koltz. Beth is the Senior Director of Instructional and Curriculum Design and assistant professor at the Hackensack Meridian School of Medicine. Beth, what is your favorite tool or hack to become a better leader?

Beth

For me, my favorite hack is feedback. Leaders really need to appreciate feedback both to receive and to learn to give it. And in fact, giving feedback to employees, healthcare workers, students is really critical to improving things and ultimately for success. When you ask for feedback from people in an organization, you are really saying that you care about them, that you want to hear their input and that you really want to try to do something to improve yourself. But if you can teach your people, if students, faculty, healthcare workers can learn to give feedback in a way that's constructive, that allows people to improve, it's a gift. It's truly a gift. And so is it easy to receive feedback all the time? No, it's not. Sometimes it's hard to receive feedback, but when you get a constructive feedback that you can use to improve, it is a gift and you can receive feedback by asking for it.

In this way, you've opened up your own mind for receiving the feedback. It's easier to receive feedback if you've asked for it, and if you haven't asked for it and someone wants to give you feedback, one of the things that you can do to receive feedback is self-assess. Really thinking about what you can do, how do you think you're coming across and taking what that person is giving to you for feedback and then trying to apply it. So my hack is always feedback. It's something that people can use all the time, and if you have a trusted person to get feedback from, ask them and they would be able to give you that honest feedback and keep going forward with it.

Pete

Ooh, me. Hey, Beth, that's excellent. Because I have actually incorporated it into all my courses at the graduate and undergraduate level. Either they make a video because it's more personal and it's more difficult. People are more careful with their words if they're doing a video or in person. I've been selling it, if you will, as this is a way to help you as a person and to help the profession or even the industry at large if you can say, Hey, Maya, if you're ready for some feedback, I got some great things for you. And asking permission first usually is more helpful than just being like, oh my God, Maya. Right? You can't, yeah, don't drop it like a bomb, but share it. So I love that feedback is a great leadership hack. It's a great human hack.

Brooke

Yeah, I agree. Feedback can be such a tricky one too. I know there's one saying that unwarranted or asked for feedback is often perceived as criticism. So I feel like it's your point of asking or before you deliver it, kind of prefacing it for that person. Or it's even better, like you were saying, if you ask for it because then you're already prepared for it.

Rahul

Beth, I want to add to your hack with a specific perspective of getting feedback as a follower, especially while things have not gone our way. So when I think of the challenges with feedback and think about the Johari window, which tells us that we all have arenas that are known to ourselves, and then there's parts of our persona that are not known to ourselves. And if feedback is positive or affirming, a lot of times it's about the things we already know we're doing well, sometimes it isn't, but a lot of the times versus when the feedback is about something that hasn't gone so well, it might be about opening up a blind spot, which is why feedback is a gift. And it is also a conflict in that conversation because now we're getting to learn about something that we did not know about ourselves before or maybe we knew it and it's just being reinforced and is sinking in now.

And I think that the reason it can be a great hack as a follower is because some of the people I've worked with that I really remember are when I had to deliver news to them, maybe it didn't work out for them, a regret letter, and then they respond to me and say, thank you. And they may even go the extra distance and say, for the future, if you could give me feedback, what could I have done that would've made this stronger? And I'm thinking of it in my own life as well, that there's a recent scenario where something didn't go my way and the person who was in the decision-making capacity was kind enough to sit down with me and explore areas which I could strengthen so that the next time something like this came around, I would be so much stronger. And whether that happens in the same position or not, doesn't matter because now I can use that feedback and become so much better in so many ways. So I think it is a great hack and one has to recognize that blind spots are going to open up and this is going to be hard and be prepared for that.

Maya

It's Maya, if I can just add, I think this hack connects so nicely, and I hope our listeners will leap to our longer episode about growth mindset and that more maybe rigid or fixed mindset, because that's part of what accepting, being able to accept that feedback is about am I flexible enough to take it in and allow it to sit, or am I going to instantly be, no, I don't want this, or I'm going to take it, but I'm not going to do anything with it because I don't want to hear it right now. So it really connects nicely, I think, to what we've been spending some time together talking about around just how flexible or inflexible we may be.

Beth

And when you do receive feedback, that might be difficult. It's a good idea to have some coaching and that the person giving the feedback can provide more coaching to what steps can be taken and give a little bit more input on what can be done. Because to leave it as just feedback, some people can come up with the ideas themselves, others need help with coming up with ideas, and that's where coaching really can come in and help with that and make sure that there's improvement so that it can feel like a gift.

Brooke

Thank you so much, Beth, for sharing that hack. And thank you everyone for listening.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E2: From Fixed to Growth: Reimagining Mindset in Leadership (feat. Erin Barry, PhD and Elizabeth Koltz, EdM)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul:

Welcome listeners. I'm your host, Rahul Anand, and with me today are Maya.

Maya:

Hello.

Rahul:

Pete.

Pete:

Hello everyone.

Rahul:

And Brooke.

Brooke:

Hello.

Rahul:

Today's the day we've been really excited and looking forward to sharing with you this entire season. Imagine a world in which the best leadership experts come together to share their insights and reflections from a life-changing book or article so that you can use it right away to become a better leader. Well, today we're excited to share our platform with Erin Barry and Elizabeth Koltz, who are taking this concept to the next level. Erin and Beth, welcome. Allow me the honor of introducing you to our listeners. Dr. Erin Barry is an associate professor in the Department of Health Professions Education at the Uniform Services University. She's a health professions education researcher who designs curriculum, develops assessments and studies, leadership, followership and teamwork in healthcare. Erin is an ICF certified leadership coach and co-founder of the International Leadership Association's Healthcare Leadership Community. She has co-authored more than 80 papers in book chapters as well as three books including Leading Self and Others with Emotional Intelligence. Erin earned her PhD in Health Professions Education from Marick University, focusing on leadership and followership within healthcare teams, and she's been with USC since 2010. Erin is passionate about helping healthcare teams lead and learn more effectively. Erin, welcome to Learning to Lead.

Erin:

Thank you, appreciate it. Looking forward to talking more with everyone.

Rahul:

Elizabeth Koltz is the Senior Director of Instructional and curriculum design and an assistant professor at the Hackensack Meridian School of Medicine. Beth works with course and clerkship directors, faculty, and even students so that they can use engaging, effective strategies including technology and active learning strategies to help learners achieve desired outcomes. Beth also leads the development of the School of Medicine internal electives and teaches both curriculum development and introductory medical education research electives. She also teaches and conducts research on feedback, metacognition team dynamics and leadership skills, and teaches faculty development in these areas. She has presented in numerous regional, national and international conferences. Beth received both her BA in English literature and EdM in adult learning and educational technology at Boston University. I've personally known Beth for seven years now, and believe me, she has the power to turn any team into a highly functioning team with her exceptional leadership skills. Beth, welcome.

Beth:

Thank you very much. It's an honor to be here.

Rahul:

So listeners, we hope this is the first in a recurring theme where Erin and Beth can help us translate the evidence from articles and books that everyone should know about into meaningful bite-sized pieces that can help everyone become a better leader. Erin and Beth, we'll hand over the platform to you so that you can guide our listeners through this episode. Let's start with your story. So how did you get into the field of leadership?

Erin:

So I think leadership itself, how we got into it, long journey for me. I started as a biomedical engineer, got my undergrad and master's in there and had been working managing a lab. And in working with my PI, he was very into leadership, and we shifted departments and started building out a leadership program for our medical students here at the university. And so from there it just kind of started spiraling, lots of different ideas, lots of things to talk about, and it just kept going. And for me, the followership part really was a big part of what got me into the leadership world.

Beth:

And for me, I had started out working in the corporate world and had done a lot of instructional and curricular design with corporations for managers, leaders, and using my education skills, but I picked up on everything that was being taught to the managers and leaders and started applying it to my own life and did this for many years. And then when I moved into medical education and healthcare, I just decided to continue with it because I could see that there was a need and a benefit for year two.

Rahul:

Well, we're grateful that your paths crossed this way into the path of leadership and teaching leadership as well. So tell us what do you have for our listeners today?

Erin:

Yeah, so as we've kind of been talking about different ideas, we've thrown out so many ideas because I think leadership, there's so many directions you can go in so many ways to apply it, but when we kept talking more and more, the growth mindset really came out as such a theme. And so we figured we'd start there because I think it is a thread that's gone through a lot of the episodes that you guys have done already and it just really felt like a great way to start and really dig into that topic. So we wanted to start with a bit of a story, and so I'll share that when I was in college, again, I majored in biomedical engineering, which is not known to be a very easy major, turned out to be more electrical engineering as I found out the hard way. And so during my sophomore year when you're really getting into those engineering classes, I hit what felt like a wall and I failed four out of the five midterms and I mean I failed those midterms.

And so it was one of those moments that really shakes your confidence. It's the first time that failure really hits in a place that it hurts. And so I remember sitting in my dorm room thinking, I'm not cut out for this. Maybe I should change majors, all the spirals going through your head. So I really got stuck in this loop of shame and self-doubt replaying all my mistakes, convinced that I was an imposter, I shouldn't be here, I'm not smart enough. And so what I didn't realize at the time is that I was really operating in a very fixed mindset. I thought that that failure meant it was a very permanent thing about me rather than it's just feedback on my approach. What I had been doing had not been working. And so eventually once I clawed my way back out of that spiral, I decided to try again.

So I started asking for more help, doing more study groups, changing my study habits, and little by little things changed and I graduated with my engineering degree. But looking back, I wish I had gotten out of that spiral sooner. I think that that was what really stuck with me is that if I'd asked for help sooner, I wouldn't have been in such a deep hole that I had dug myself into. So going back, if I could go back and tell my younger self, you're not alone. Everyone's going to struggle through all of these things and it's okay to reach out for help. And I think with failure, what matters most is what you do next. And so I think that was what really when we were talking through different things, that was what really inspired our thought of starting with the growth mindset there.

Beth:

We started looking at different literature that would support this growth mindset. The first thing we found was a Harvard Business online blog, and it was called Growth Mindset vs Fixed Mindset: What’s the Difference? The article is based on Carol Dweck's book, which is Mindset: The New Psychology of Success. Dr. Dweck studied many individuals for a growth mindset or a fixed mindset. She used electronics and was able to monitor brain activity. And through that brain activity she saw with those folks that had a growth mindset, their brain was signaled When they were presented with an opportunity, they actually were able to see it as something they could do that they were able to do. And there were a lot of lights going off, but with the fixed mindset folks, if they were presented with the same opportunity and maybe these folks did not have any type of training or were not aware, those folks were like, I can't do that.

That's not something I'm able to do. And so what she studied was those that were able to have a growth mindset, they were more resilient. They were able to go forward with believing even if they didn't have the training, believing that they could achieve things that they hadn't really thought about before. And the static mindset or the fixed mindset, those folks were not able to do it. And she did a lot with parents and helping teach children and helping them instill a growth mindset in their children. So this is an important skill to learn for individuals and for leaders, particularly because in the online Harvard Business School article, the entrepreneurship focus that the article had, it's relevant to leadership, to entrepreneurship and in helping people succeed. Definitely helpful for students and in the current state of healthcare for all of us to think about a different way to think and re-imagining how we can think.

So one of the things that I want to talk about was just a little bit about my own experience with this fixed mindset or growth mindset. And it was my past experience working in learning and organizational development. I've had to work with a lot of groups and in medical education as well. And I was working with a group and I always came across, I know I'm an expert in this, in education and everything, and I want to help everyone learn how to do education principles and learn to teach differently. And so I've come across a certain way and in my mind I'm giving information that's very helpful for people and for faculty. But sometimes faculty would use this information and they would do well and they try a new method and their method would work really well in the classroom and we would celebrate other times, particularly when I was working with larger groups and helping them learn to develop curriculum a little bit in a different way, I might not be able to achieve that.

There were obstacles. So I hope was thinking about the growth mindset and sat back and really started to reimagine how my mindset might work differently. And in thinking about this, I opened myself up a little bit more and opened myself up to the people that I was trying to work with and trying to put myself in their shoes, trying to really work on the dynamic. And a lot of it is listening, as Erin pointed out, listening is very important. So I continued to work with them over time, and it did take several sessions much longer than we thought it would to get to the real root of why people would not move forward with this. And once we were able to identify that obstacle, we could then move forward. But I was convinced that if I didn't step back and think about my mindset of telling people how to do this as opposed to really just opening it up and listening to them and working with them, that we would not have gone forward and being able to achieve what we're achieving. So I think that's important.

Erin:

I really like the points that you brought up, especially around the kids. I feel like that's where I see a lot of this really happening in my own life, even more than my own. But with their lives, you start really seeing that mindset and how they can deal with different things. Things are hard and in their mind, even those things that we don't see as hard, they're hard for them. And so getting someone to see when a mistake is made, changing the wording, the way you're talking to yourself of I'm a failure and sticking in that fixed mindset, I'm a failure versus changing it and saying, I made a mistake now and I think it's now what am I going to do here to change, to get better and to grow? What am I going to learn from this situation? And I think kids, it's always difficult. It's difficult to get them to see that it's okay to fail because again, as speaking for myself in those moments where I had failures in college, where I've had failures in life, it's not an easy place to sit in. But I think if we can take a moment and stop and reflect and recognize, we learn so much more when we fail than through those successions. Success feels really great and we want those, but we're going to learn so much in that moment of failure and how we deal with those problems.

Beth:

And so the awareness that if you have a fixed mindset or any type, the awareness of your mindset, if you come across a failure or you come across an issue, is really the key to this, that we all have fixed mindsets or things that we use every day, and that's okay. And Carol Dweck mentions that the fixed mindset versus the growth mindset isn't about doing this all the time in your life. That there are times when you need a growth mindset. There are times when you need a fixed mindset. And so that's okay that if we apply this when we really need it to step back and say, maybe I need a little mindset adjustment, maybe I can reimagine how things can be that that's helpful. So I do think that it's not something we need to use all the time, but it's definitely something to think about when you come across obstacles.

Rahul:

Beth, I appreciate you said that about all of us having a fixed mindset and a growth mindset at various times. It's one of the things that really resonated with me when I was reading her book, because she talks about certain triggers that will bring the fixed mindset into play, like a big failure or a loss or a rejection or a task that's really big or maybe a task that's really hard, or even comparing yourself to someone who might be way ahead of you in terms of their accomplishments and thinking, I'm never going to do that. So I love that part of her book because she talks about giving your fixed mindset persona a name I named mine, the judge. Love it. That's great. Giving your growth mindset persona a name as well. So I named it the coach, nurturing coach. It just underscores the point that the fixed mindsets are there because they are defense against doing harm to ourselves, but then they do get in our way and we need ourselves and even maybe others around us to coach us from one to the other.

Maya:

Beth, I was really struck as you were telling your story about you were teaching other folks, you're helping instruct other folks about leadership because you are the expert in leadership, but also recognizing sometimes our expertise almost becomes a crutch, right? We're talking at rather than listening because what we're comfortable with, I know it can deliver this package, but it's about recognizing the folks that we're trying to lift up and inform. The other thing that I always, I don't know who gave me this piece of advice, but if we're working harder than our participants, so if we're working harder than our classes or we're working harder than the folks that we're trying to coach, then we're not giving them a chance to shine and let them grow. But that means we have to grow and to be willing to learn from the people that, oh, maybe they don't know the stuff I know, but they know a lot of other things that they have to bring us. So that openness I think is so important.

Erin:

I love those points. I think that it really brings out too, especially in those moments where others are struggling, you're trying to provide that help. I'm a fixer. I like to try to fix things. I'm an engineer. That's how my brain works. My husband is the same way, but there are times when I may not want someone else to fix my own problem or my kids don't want me to fix their problem, or a student comes and sometimes it takes that moment of the listening part of hearing them say something and then trying to, instead of offering the advice or the solution, trying to let them work through that problem for themselves, not respond for myself, okay, well what's going on here? We try to dig in more and see what else is happening for them so that they can find their own way forward because my path may not be the path that's going to work for other people. And so I think it's always fun to play that role of where should we be stepping in some of these places and how do we lead other people? Because I think the mentoring, the coaching part of it is it's very much what's going to work for you. It's your life that you're living. It's not going to harm me in any way the direction you pick, but it's going to impact you. So how do you want to move forward?

Beth:

Such a great point. One of the other things that came out and really resonated with me was I recently attended a leadership class, and I never really thought about this, but in the class, the emphasis was don't think that your mindset is just in your mind. Don't think that it doesn't affect others, that your mindset, your thoughts are in your mind obviously, but when you have a particular mindset, a strong mindset that maybe is not allowing you to solve an issue, that that mindset comes across with your behaviors. So don't always believe that that mindset, even though it's your mind and your thoughts, that doesn't influence your behaviors. And so that was one of the things that I needed to do was not just change, realize that I had a mindset change, but also that I had to create new behaviors. I had to create new actions that stemmed from that, that I needed to happen. So that was an eyeopener. Oh, yes. Not just in my head that I'm actually doing things that people know book. Yeah, it's there. So it's good to think about and the way you interact with people. That was my lesson from this too.

Erin:

I was going to say, I think, and it's also interesting to recognize in those moments that you're not alone and we're going to need the feedback from other people in those moments when maybe we didn't realize our mindset was not the most productive for the team or for other members around us. And so how do we get people to help us in those moments, catch us and push us, Hey, we need to shift gears a little bit here. This isn't working. So how do you find those people in the groups that you work within that can be your person to call you out on some of those items?

Maya:

You're making me remember also just working with team leaders who had that more rigid mindset and how it would feel for us as a team walking into rounds or that team meeting and then it gets everyone else. It's a physical, and even remembering, I'm having a physical reaction to what that environment was like as opposed to, okay, we're all coming in together to kind of put our ideas together and see what we're going to come up with today or see how things are going with our patients as opposed to like, okay, we all better be prepared to toe the line. And there are

Erin:

Times when you have to toe the line, but creating that learning environment, it can make a huge difference. If you come in with a very fixed, this is the only way to do it, failure is not acceptable. That changes how you can approach people. It's fascinating to watch.

Pete:

One of the things I think I use to help when educating the students is I never think of myself as the expert, and it helps me stay open and I can listen and hear them instead of thinking I know it all and bring it to them. But yeah, it's a balance sometimes in school.

Erin:

That's a great point. It comes up in coaching a lot. Whose problem is it? That's one of my favorite questions, especially when people are spiraling with a lot of the things that they have going on and this and that, and it's like, who's problem? Is this your problem to take care of? Or is this someone else's?

Pete:

Right? Always my students like, you're smarter than I'm, I just have 30 years of experience, so just take a deep breath and I try to get them to relax and move forward. Sometimes they get paralyzed in their fixed mindset.

Erin:

I think that paralyzation is really, it's interesting. Again, it's that moment of how do you help someone when they have frozen, get past that? How do you dig yourself out of your hole? You internally yourself, but as a leader, how can we help other people in those places where they're stuck? I think that that can be a challenge. And finding ways, again, to ask the question, get them to reframe again, going away from that, I'm a failure to, it's a mistake. We all make mistakes. Let's normalize that mistakes happen, and we're going to learn from this now. What can we do to help you now? So I think the questions that we really want to hear are your guys' thoughts on is how do you apply this? How do we change when we're stuck in that fixed mindset? How do we jump to the growth mindset? I'd love to get your guys' thoughts and what's worked for you.

Pete:

I can go first. I don't know. No, the safe space, having safe space where you can just be vulnerable and make those mistakes and have a good laugh or everyone learns from it very quickly, but I'm stuck. I used to have a very growth mindset when I was younger, and I find myself leaning towards the fixed mindset as I get older, and I don't know if that's just life experience or you've been hurt in the past or stuff like that. So it's a journey I think, to figure it all out. And then I'm trying to stay positive and optimistic for the students right now because I was, oh, you're Pollyanna and you're all this when I was younger, but I mean, I have taken on many obstacles and it was a growth mindset that did help me, was in the army. I wanted to get educated.

So I went to night school and I had the right leader be like, all right, go do something. Take the truck, go to college, come back into the field and you take the first watch. So stuff like that and setting that all up. And then I was like, I want to be a pilot. So I started getting my private pilot license and it was nothing got in the way. I just, you figured it out, right? You're like, all right, I need whatever, $50 to go fly for an hour on an E four budget. I was challenged, but it didn't stop me. Now I'm like, do I want to do that? That sounds painful. I see all the obstacles and I don't know if it's just life experience or not.

Erin:

That's a really interesting point and how that might change over life with all of our experiences. And I almost wonder if having the awareness in those moments of changing our mindset or being aware of why we might be doing things a certain way is a helpful situation. Sometimes it is protective in different ways.

Maya:

Yeah, I think it depends what the stakes are because at different points, say either as students or in our career from early to mid to senior, there's places where you can take risks and be open. And there are places like, well, no, I just have to deliver. This is the way I have to do it. I can't have flexibility. And I think it's also maybe there are areas where I can have flexibility. I can have flexibility now within my classroom. I've been doing that for a decent bit of time now, and I feel like I'm comfortable enough that if I fail, I'm not going to completely fall in my face there. But there are other areas where I'm like, no, I still feel, I was thinking about our podcast actually yesterday and realizing there are places where I feel really confident and experience in other places. I still feel like a newbie, and I'm not a newbie. I'm not a newbie in social work. I'm not a newbie in teaching at this point, but yet I still carry a little bit of that, which has both the ability to have growth, but also the ability to be like, no, I still need to be really careful that other people may still be judging. So it's really a tricky, I think it depends on what sector of our lives we're talking about.

Erin:

I think the context is huge in the situation of what is happening in these different spaces for us in those moments. And when that imposter syndrome kicks in different places, even when we might have been doing it forever, it still kicks in. It still surfaces every now and then.

Maya:

Brooke, as a student, I'm curious about this from your point of view.

Brooke:

I know I was thinking, I was like, I don't know if this is just going to be my perspective versus every student. Probably not everybody, but for me, I'm just sitting here listening, thinking that I did not realize that I think I have a very fixed mindset, which is not great. But I think that this is something that I was thinking about with school. Obviously you're in a learning environment, so it's a space where you're meant to fail. But something that I struggle with is I can fail a few times in a day. For example, I can fail this thing, fail this thing, and I'll be like, okay, I can come back from that. But then it's like after so many failures, they start to, I feel like trap a little bit where it's like, well, maybe this isn't just a failure. Maybe this is really because of me. So I'm wondering how do you get out of that or keep yourself from getting trapped in that?

Erin:

I think that's such a good question. I don't know if there's a great answer to that. I think a lot of times it's the reflection part. And I think to me sometimes it's catching yourself in those moments of recognizing why is this such a big deal? What is this? Why was this the stone that broke everything? And so it's in those moments of, okay, pause for a minute. What else is going on? Because clearly this wasn't as big a thing as maybe half these other things that have just happened, but this one, it just took me there. And so I think being able to pause in those moments, and it's easier said than done to not spiral, but try to catching yourself in those moments. You can reflect on everything that's happened. Be sad when failure happens. There's nothing wrong with it. Naming those emotions that you have when that happens. But I think it's trying to stop that negative self-talk that we have with ourselves and try to really reframe. And we can keep growing in those moments. But again, easier said than done. I think we all find ourselves in those places that say, I definitely still do as well. So you're not alone in that.

Brooke:

Yeah, that's reassuring right now, listening to everybody. I'm like, oh, I guess it isn't just me. Even people that are aware of it and know about it, struggle to

Beth:

And be kind to yourself. Don't just stop, pause as Erin says, just pause, reflect, and give yourself a little kindness. You've got to break it. You've got to break that cycle, whatever you're going through. So with kindness really I think works sometimes.

Erin:

And I think just recognizing we're not all alone in these situations. I think sometimes when we fail, there's so much shame around that failure, that recognizing that there's probably a lot of other people in the same seat as us or have been through the same seat. There's so many things that have happened to everyone. And so having those people that you feel close enough with that you can go to and just let it all out. Sometimes just saying it and it can get that better. But I said we were in a session this morning and someone brought up the question of, if you're going to say such negative things to yourself, what's your best friend saying to you? How do you get the best friend in your head to give yourself that pep talk that you're not failing, that you can make yourself out of this. It's going to be okay.

Maya:

I love that phrase, best friend in your head.

Rahul:

Yeah. Brooke, I really appreciate your recognizing and vulnerability in saying that because I'm thinking of the same thing that I have a fixed mindset in many areas where I would like to move it to a growth mindset. And I'm remembering what Beth Frady had taught us at some point of time about mindset. And her example was of firing the gremlin and hiring the princess from which I'm thinking of how to quieten down or fire the judge and hire the nurturing coach. So I think that's one piece of the puzzle, just our internal piece still, I think how do we take this from an academic concept, which is nice to know, to actually something that is useful in our own life. And I think there is more beyond just the mindset. The mindset is like a seed, but it does need the right soil and conditions for it to actually germinate and flower.

So I'm thinking of something that's coming to mind as I was reading this book in the last three weeks. Another event was happening on the side. So I have a fixed mindset in not being able to dance. So my entire life have been really awkward, self-conscious, cannot do it to save my life. So last month we run into this situation where my son wants to perform at an event, and as luck will have it, he doesn't have his peers to form the team with him. So he comes up with an idea that let's do this as a family. It would be a unique concept and we can do it as a family, not as a group of peers. So he comes up with a song, convinces the entire family, I have to be roped in. And so I'm coaching myself, firing the judge and trying to hire the coach and say, okay, this is not about how I'm going to perform.

It's about how I can support my son and I can do that. So I embark on the journey. So I think the first step here for me was really connecting with my why and picking up the motivation that yes, now this is about my son. And so I have the courage to take a risk where I might have been burned many times before or failed or been judging myself. So what happens next is we pick the song and we start to practice. And I'm terrible. My 8-year-old teaches me step by step, shows me the recordings, helps me make notes so I can remember the sequence, gives me feedback and gives me some autonomy as well to practice in my own quiet time. And then we rehearse together and we get a little bit better. So I think here the next piece from picking an area was going into a supportive environment, including people in systems.

And my kids, believe me, had read the playbook for how to apply path goal theory of leadership on me. So giving direction, encouragement, support, practice feedback, everything you need inspiration to keep going. I think the other piece is chunking a very big task that may appear big to us, maybe not to others, into a small next step. What's the next step? Maybe I cannot do the full thing, but can I do one step? Can I take the next step and the next step and keep going? And thankfully it worked out really well at the main event. So now we have some memories that we can watch and bond together. And I think what I learned from the ending of it is that it does take some reflection in self-coaching, and then you celebrate the small wins and you don't stop at one because then it's your fixed mindset coming back. But you think, how can I now take the next step and build on this, whether it's in the same arena, or can I take this to the next arena of my life and use these lessons that I've learned? So I would say in response to what you're saying, I think we all struggle with this. This is the human condition, and if we can shift our mindsets even in one task a day, that's really important to our purposes, that's a win.

Beth:

So Rahul, are you now going to be taking dance lessons?

Rahul:

I am already. So what we're doing next is that they'll pick a song every few days and they'll say, let's do one step from, so I've convinced them, let's do one step from the song, not the entire song. And of course, they're great at it and they enjoy it themselves. And my journey is to just be there and not be conscious and just enjoy the time with them.

Erin:

I love the point too that kind of keeps coming up in some of your stories is recognizing that sometimes when we see ourself as failing at something or that fixed mindset of I'm not good at something, we're so focused on ourselves that even when we're doing it, no one else is really focused on us. It's more in our head. And so how do we get out of our own head? I mean, I am definitely fall into that category all the time. And so I think that it's trying to recognize it's not all about me. We're making memories, we're doing different things, but even still, the spotlight's probably still not on me. I'm making more of a deal out of certain things than other people are.

Rahul:

And I ended up listening to the book and leaving with the impression that our own lives can be so much better. We're just terrified of letting ourselves lose our lives. Could be so much better if we just do not worry as much about ourselves.

Erin:

Exactly. I love it.

Maya:

I think I got that lesson because I lived and worked a good chunk of my life in New York City and I ride the New York City subway and I would worry about like, oh, am I wearing the right thing or whatever. And then I look around me and I'm like, why do I need to care? Everybody here is different. Everyone has a different vibe. Some people are fashionable in this way, some people are kooky in that way. Nobody really cares about what any one of us is doing. We're all just part of this great mix. And so then I just try to remember I'm just a person on the subway.

Erin:

I love that. I think it's recognizing where we fit in and try not to get hung up on all the different things that are in our heads. How do we calm that voice in our head that's talking badly to us? Yeah.

Maya:

I guess what I was thinking about from Raul's story about moving out from you to your family and moving out from ourselves and even our teams to our organizations, and I know I talk with my students about the idea of whether or not they're in a learning organization or not, and I think as we talk about improving healthcare or re-imagining healthcare, how do we help make the environments that we're working in or that we're sending our students out into more like that as opposed to going out into very rigid settings where you stay in your lane and you don't agitate?

Erin:

Right. Similar conversation from today that came up of talking about culture change.

We can't change big cultures very quickly. That takes time if it's going to happen at all. I think one of the things that always sticks out to me, and I try to remind myself, especially when things are difficult, is pausing to have those moments where recognizing I have influence within my small sphere of people that I can work with that I interact with on different days. And so how can I use my own influence in those situations to really do something good, to be happy, to have a fun time to collaborate with people that I want to be working with and try to remove some of that negativity. We all know it's there, but maybe we can't change it. So how do we keep the positivity in those situations?

Pete:

Yeah, I think you are spot on by having the right focus on what can I do around me? Because what I got stuck in when I was younger is this healthcare system is broken, I'm going to fix it. And I burned out and did a lot of different things. But I think trying to, how can I make this room that we're in right now, the six of us a little bit better is a great way to focus on it. My scope might be too big, but I just want to make everything better for everybody, but I probably need to start with the microcosm of the smaller environment. That's great.

Rahul:

Pete, I agree with you. The unit of change is the relationships and the small groups that we work in. That's where change is going to begin.

Maya:

Have either of you been part of organizations where you've sort of been part of trying to bring about culture change though, in terms of this idea of growth and being open? I know I've been part of different, working in different healthcare settings and been part of leadership or even just sort of team building activities, and I'm wondering maybe what you all have seen or been part of.

Beth:

I have, and it can be pretty dynamic when it's done in certain ways. I think that the big thing is starting and having a plan. And I think about expressing and communicating about the culture and vision that you want to have and bringing people into it from various places so that you're not just doing it with a few people in the same location, but you're kind of bringing people from different aspects that might agree with you or go along with the same thing and are willing to try to bring it forward in different departments or different locations. So I think that it's got to be the spark is lit here and then you're bringing it to different places and it depends on what you're doing, but it has to be a culture of acceptance, of positivity, of this idea of growth. I think the biggest thing is acceptance and just keep growing and improving and having that desire to continue to improve and being open that failure is okay. That's the hard part I think in this field. Is it okay to fail? Where is it okay to fail? But I think that yes, it can work. I'm thinking we've done a lot with feedback and with learning, using feedback to learn to improve and really having everyone kind of be on the same page is important. You can brand things. You can create your own little emoji or logo to keep it visually going. There's lots of things you can do.

Erin:

Yeah, I think yes, I feel like change is always happening, is really what it comes down to. And a great place to throw my disclaimer, these are my opinions, not those in my institution, department of war. So I think that it's really difficult at times to create that change, especially when you're a small group. How do you get that influence to grow bigger? And I think it really comes to getting that institutional support in a lot of ways of trying to find places where the higher up leadership supports you in these different things to recognize what failure looks like. Because I think sometimes if you don't have that or if your higher up leadership sees certain things as failures, it becomes really difficult and becomes a very hard environment to work on and to try to enact a lot of different changes and different things. I think we've struggled over the long course of developing a leadership curriculum. What does that look like? How do we adapt and change? And what does failure look like? And if we have 180 medical students that we're teaching and three don't like something, are we going to completely change it for those three versus the other 177? And so it's really interesting to look at what is failure and how does your leadership react to that. I think that that's where sometimes you can have some of those friction points in the organization itself.

Rahul:

Erin and Beth, thank you so much for a great conversation on re-imagining our mindsets. It's been a joy and a privilege. I'd love to ask you if you have a message that you'd like our listeners to walk away with.

Erin:

It's a great question. I think there's been so many good things talked about today. I'm trying to think of what is the one thing that's sticking out to me. And I think again, that you're not alone is really what it comes down to with the mindset that trying to really get away from that idea that failure is only happening to you, finding others to help you in these moments so that we can keep moving forward and you're not stuck in your little hole that you've created.

Rahul:

Beth, what about you?

Beth:

Yeah, and I would say if you're really having an obstacle, a challenge with a task or relationships, that stepping back, pausing and just being aware, is it a mindset that you have that you might want to think differently about, start to think differently? And so we want to kind of address the audience of how do you think you can reimagine things for yourself?

Rahul:

Fantastic. Brooke, Maya, Pete, what are you taking away?

Pete:

I think I'm taking away, we all have this mindset, all these challenges, and because a lot of my backstory, I was in the army and then so I have this hierarchy in my head like, oh, the leader, whoever that is, the doctor, the general, they know it all, and I'm just here being a cast member in their play kind of thing. And just understanding it's human nature. And I think it's just understanding and accepting that, but being vulnerable and being like, ah. And that's tough for me at times.

Maya:

I think my takeaway here connects back to the self-talk conversation we were having. And that's, I'm the social worker in the rooms, of course, that's where my head goes. But one of you had asked earlier about how do we make that leap from the fixed mindset to the growth mindset? And I think the self-talk is where that happens first, right? Recognizing, wait, I'm really getting stuck, Brooke, what you were talking about. I'm getting stuck and I'm kind of beating myself up and it's a really hard thing to do, but how do I catch that phrase and change it and say it differently and give myself a different mantra to carry forward that's more encouraging, more positive, or that I didn't do this so well, but next time I'm going to do it differently. And that's enough. It sometimes has to be the self-talk, not like you're the best, but just, no, I'm going to get there eventually, and it has to be the message. So I feel like that's the bridge between those two mindsets.

Brooke:

Yeah, I agree. I think going off that, my takeaway is that your mindset, you have control over it and you can change it, which is a really good thing, but it is really hard. So that's something I'm going to try to work on.

Rahul:

I echo that, and Beth and Erin, thank you again for helping take our podcast to the next level. We appreciate it and look forward to many more episodes of collaboration. Listeners, we'd love to hear from all of you as well. How are you using this mindset shift in your life? Thanks for tuning in. Until next time, take care and keep learning and leading.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S3E1: Leadership Hack: Listen to Learn, Not to Respond (feat. Erin Barry, PhD)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke

Hi everyone. Welcome back to Learning to Lead, with us today is Dr. Erin Barry, PhD. Erin is an associate professor in the Department of Health Professions Education at the Uniformed Services University. She's a scholar, author, and ICF Certified Leadership Coach. So Erin, what is your favorite tool or hack to become a better leader?

Erin

Thank you. So I think the one that's sticking out to me the most is listening to learn and not respond. And it's something that I first put into practice through my coach training, and I'm honestly still working on it, especially at home with pre-teen daughter and a teenage son. I think it's something that I'm constantly trying to do better. So I realized that really truly listening requires silence, and that silence is my own thoughts and my desire to fix everything and even my assumptions about where that conversation is going. And so there's really three takeaways in that broader sense of everything that's really been helpful in that space for me. And so first is that we've all had those moments where we ask someone, Hey, how are you? And we've already continued halfway down the hall or thinking about how we're going to respond after we've introduced ourself in different ways.

And so I think when we do that, we're really missing what's being said, whether that's verbally. And so I think really listening to learn is asking us to slow down, to get curious and give other people space to reveal what's on their mind in different situations. And then secondly, from that and coaching, I've also learned that sometimes the first thing that someone brings up in a conversation isn't really what's bothering them. If you cut them off in that moment, you don't get to the actual problem that they really want to focus on. So usually it's down the path letting them continue talking, that last thing that they say is really the issue at heart. And so letting them have that space to talk and to just get something out there so that it doesn't become my path that we're walking down, it becomes their path.

And then finally, with that, I think listening also means paying attention to a lot of those nonverbal communications. So someone's tone or their energy shift. If someone says, I'm fine, but they're looking really uneasy, that's a lot of data that we're collecting on people. And so even too, when people are exploring new ideas, whether it's research or different things that they want to go and do with their time, you can see in their expression the way they're talking, that excitement of what really is jazzing them up or something that they're really not interested in doing. And so I think being able to pay attention in those moments and watch and listen to what they're saying, I think that's really been fun to see. And that's the space where you can be like, tell me more about that. I noticed a shift here. Tell me more about what's going on right there. And so for me, I think this hack has really transformed how I can connect with other people, people, whether that's my coaching clients, whether that's students, even my kids. I'd say they're going to be examples in everything I use. And so I think it really reminds me that leadership isn't always about having the right answer for myself because sometimes it's about creating spaces for other people to find their own space.

Brooke

Yeah, I love that. That was all so well said. Also, I think that on the outside it seems simple just listening, but it's something that we all struggle with and it's really, as you said, there's so many layers to it and you can learn so much from just listening and really trying to take in what they're saying.

Erin

Absolutely. Because that monologue going in your head, it's really hard to stop sometimes. But trying to get it to stop and truly listen to what someone else is saying is always fun.

Rahul

This is Rahul. I have a couple of things to add. One, as you were saying that I was literally trying to tell myself to listen, to learn and not respond. So thank you. And second, I've been given some communications homework to to work up my skills, and I think I learned more from you in a few minutes than I might have learned in the entire year. So thank you.

Erin

Happy to help. Different situation again. It's still something I am working on myself. This is not a simple tool.

Maya

Well, and we got to give ourselves grace, right? We're never going to do it perfectly all the time, every day. No way, no way. But to make that effort to hear others is so important.

Erin

Right? Well, and even in those moments too, if you recognize that someone's having a hard time and you don't have the time taking that pause of like, Hey, I am noticing something's really off. I have to run and do this, but can we reconnect in a few minutes? I just want to make sure everything's okay. So I think it's recognizing those moments and showing that you're there and you're truly listening, I think is really what people see.

Pete

And one of the things I struggle with, this is Pete is knowing or assuming I know where they're going with the conversation. My wife always would be like, just let me finish. And I'm like, ah. But I do it sometimes with, I'm more patient with students because they are learning and I just kind of back off and listen, but I don't know where they're going. So it's really family and friends, stuff like that where story or you think you know where the story's going. I tend to give non-family and non-friends more of my listening skills. So sometimes it hurts to get to truth.

Erin

It's fair. It's hard too when you've been listening for so long at work to come home and have to listen more sometimes. It's hard. It's a long day of listening.

Pete

Very true.

Brooke

Thank you so much, Erin. That is such a great hack, and I think all of our listeners will benefit from hearing that.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E14: Leading as a Team: Building a People-Centered Model at The Towers (feat. Jesse Wescott, Tim Smith, and Karisma Quintas)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Maya

Hello everyone and welcome to the Towers Edition of Learning to Lead. I'm Maya Doyle, your host for this episode from the Department of Social Work at QU. Joined by my colleagues Rahul Anand from the School of Medicine.

Rahul

Hello

Maya:

And Pete Longley from the School of Nursing.

Pete

Hello everyone

Maya

And our fantastic med student producer, Brooke Weber.

Brooke

Hello.

Maya

Today we are connecting back to our interprofessional roots and we are talking about leadership, teamwork, leadership as a team and a leadership team As a model for all the people working in an agency or institution. The Towers is an innovative senior living community in New Haven. We are thrilled to welcome Jesse Tim and Karisma the leadership team from the Towers. I'm gonna let them each introduce themselves and then we're gonna talk about the elements of teamwork and leadership that allow the towers to serve and support their residents so well. So I'm gonna toss this, Jesse ,to you first. Tell us a little bit about The Towers and who you are and then tell us about the team that works at The Towers and we'll introduce Tim and Karisma as well.

Jesse

My pleasure. And let me start off by saying that we are humble to be a part of the recording and we hope that we can stand up to some of the amazing recordings that have already happened. The Towers is a, a unicorn of a facility located in Urban New Haven. We've been around since the late 1960s and we have 328 apartments in our two towers. We've got a couple of different subsidy streams through hud. We have some Section eight housing, we have some middle market housing and we also have some pre 1974 prac 2 0 2 housing. And at any given time we've got about 320 seniors, 62 to 104 who live with us. And between our residents, our staff and our direct provider partners, there is over 500 people who call the towers home every day. And that's very, very humbling for us. I found the towers about seven years ago when I came with our current president and CEO Gus Ke Longo from a state pilot demo assisted living in Hartford.

And this was my first journey from a finance and care background into operations. And it's been just an amazing journey. We have built systems and we just cut the ribbon on our 32,000 square foot ground floor project, which gives our residents such an amazing envelope to live their lives. Outside of that, I'm really excited to be here with Tim and Karisma who are really and truly the, the wind beneath my wings. They're the reason why the towers shines. Aside from other parts of our leadership who aren't able to join us are finance department, our foundation. So they're, our team is a little bigger than than the folks you're meeting today and I wanna make sure that they're acknowledged for their amazing work. And with that, I'm gonna pass it over to Tim.

Tim

Thank you Jesse and thank you Quinnipiac for having us. I echo Jesse's remarks there at the beginning. So my name's Tim Smith, I'm the director of Quality Operations here at the Towers. I oversee everything that is related to brick and mortar and I know we'll get into that a little bit more later. But specifically our security and front desk team, renovations, housekeeping, maintenance, so on and so forth, really falls under my purview. I've been here at the Towers for just about a year and a half now, although I have been associated with the tower since 2018. When I met Gus, Jesse and team, I was working for a contract food service and facilities provider operating facilities from Roanoke, Virginia all the way up to Burlington, Vermont. The towers at the time happened to be one of my clients and at one point back a couple years ago, I had a conversation with Gus and Things Unfolded where I had the opportunity to join the team at the Towers here. And after having been with them and associated with them and for a couple of years, seeing how they operate, what their vision was about and how they do things, I was very impressed to the point where I jumped ship from a company that I had spent the last 22 years with and decided to join Jesse and Gus because of their vision for the future of senior living and what the towers does.

Karisma

So I'm Karisma and thank you for having us by the way Maya, this is very exciting stuff. I started at the Towers about three years ago as the resident care manager overseeing the RSC team, the social workers, right. I am at a new role right now, which is the assistant director of resident support. Since July, before I started at the Towers, I worked in an access agency agency on aging coordinating care and support to the elderly. And I jumped at the chance to work at the Towers because of the unique approach they had to support the elderly. One of our guiding principles and our mission is to lead with quiet competence serving one another with care, strength and humility. It is a great to be part of this team, which is genuinely looking to better a marginalized community. So I love this team. This is like where I was meant to be when I finished my master's in social work. It just fits right in to my core values also.

Maya

That's amazing. Karisma. It's so great to hear that. And actually that it transitions really nicely sort of into my next question for you all. You know, we think a lot about interprofessional teams at QU and interprofessional competencies that make healthcare better, that make healthcare work. And I know you are in senior living, which maybe is part healthcare and part other things, but we'll keep that healthcare lens a little bit for today. But one of the competencies that we talk about there is this idea of shared values. And it's so clear from what you've already said, what the shared some of what the shared values are at the towers. But can you kind of operationalize that for us a little bit more about what those values mean at the towers?

Jesse

Absolutely. So I love the segue that Karisma gave us here. And I will say as a whole, we're a small but mighty team. So our core staff is around 50. And then when you add in all the direct providers, we get up to about 200 folks with 50 our Core Tower staff. And when you look at the heart of our values, it's to create an inclusive community to put the person before the task and genuinely connect with them and to find innovative ways to help. And then as Karisma said, to lead with that quiet competence. And really what that means for the towers is that the resident is the center of everything. So all of the services, all of the housing piece that Tim will talk to, all of the model that we have for our support and engagement that Karisma will speak to all keeps the resident at the center.

And part of why it's so successful, or we feel it's so successful, is a couple of things that really lend themselves to what Tim and Karisma really live with their teams, which is tools and permission. So if you have both of those things, there's no reason why as a leader, like Rahul mentioned, you can't just get out of the way. We love quotes. And so like, you know, Spider-Man's uncle said, with great power comes great responsibility. And when you think about what we do at the towers from the housing perspective, we are taking on somebody's loved one. We have an exercise that we do as a group where we bring everybody together and we ask them to put their cell phones on the table and then we ask them to walk away and we ask our, our new teammates how do they feel? And when you think about how that relates to caring for somebody, you know, these are folks who have had a career, who have lived their life, who have raised children, and then suddenly they're supposed to put their entire life in the hands of a group of folks they've never met.

So when we talk about living our values, we really are talking about how do we care for somebody who potentially cared for somebody else, right? How do we pay this forward and how do we live those values? And one thing that I've noticed over time is that when new folks join our team, they either flourish immediately. And that's something that I can say about Tim and Karisma. They jumped right in and they were a perfect fit. We've also noticed the latter that there are folks who join our team and it's pretty apparent after the first couple weeks of newness wear off that this, this just isn't a good fit. And that doesn't say anything about their professional skills, it's just that our Kool-Aid is a little different at the towers. And folks who live our values are assimilated quickly. And the folks who maybe are not do really well in other facilities and we wish them well, but it's very apparent from the start that this isn't a good fit.

And the last piece of of that is that we all have this philosophy that comes down from our president, CEO, that our ideas are organic and the cream always rises to the top. So the tower's philosophy is starting with yes. And so we always start with a yes. And sometimes that yes can turn into an idea that's not feasible, but nonetheless it's always a yes. It's never a no. And Tim and Karisma have been really phenomenal at walking the yes through. 'cause sometimes the yes is a little out of left field. So as a whole to circle back, I think that the real core competency of how we really mesh as a team is, is that everybody there is speaks with the passion that Karisma speaks with, right? When she said she loves being there, it's evident she walks in and the amount of caring that she has for the folks that come into the office when they're in crisis is just incredible to watch. And so I, I don't want to steal thunder from Tim and Karisma as their pieces will be segued in, but you'll hear it from them and you'll feel it from them. And I'm, I'm just so proud of both of them.

Maya

That's so great to hear. Jesse, I know you talked to me a little bit about, you know, how Tim and Karisma's role gets differentiated in terms of pulse and no pulse, <laugh> <laugh>, which I really loved. And I want you to talk a little bit about that and then really thinking about sort of how you use that method to really wrap around the services and support that you provide and, and all of us can kind of think about how we wrap services around the people that we're taking care of.

Jesse

Absolutely. This is Jesse, and I am going to tiptoe my way through this because I want to make sure that Tim has the ability to talk about maintaining the envelope and Karisma has the opportunity to talk about our proactive partner model and how that handles there. So I can say from a, from a top down perspective, when you think about housing and you think about elder care, a lot of times your mind goes to the traditional model of a nursing home or the traditional model of an assisted living and the towers being the unicorn that it is. We are really just the envelope and you can fill your envelope with different providers, you can fill your envelope with different amenities. And so I'm really excited to hear them both talk about that. But from a a leadership piece, the only way that this works is that there are zero silos.

So there are no departmental barriers, there are no, you know, I don't do this, this isn't my job. Or there's absolutely no, hey, a resident told me this, I'm passing it off to you. There's really this underlying culture of ownership. And I want to speak a little bit about kind of how everybody's title has a slash in it. And I know Maya, that was something that you and I had talked about and I watched your face just get very excited. So I wanna make sure we really honor this. So everybody's badge has a title on it because you have to, you know, you have to have a title, you have to have a job description. But everybody's title at the tower is very clearly, and we speak about this a lot, has a slash with a caregiver. So at the end of the day, you're a caregiver, I'm a caregiver, Tim's a caregiver.

Karisma is a caregiver. And so what that means in practice is I can be walking through our community on the way to meet with Tim to talk about capital expenditures and, and large purchases for operations. And I might see somebody sitting down crying. And the expectation for all of our team is that in that moment you stop, you take a knee so that you're on eye level with that person and you say, how you doing? Letting somebody know that I see you. And when we think about a word that we use at the towers is Hamish, which is a Yiddish word that we try to embody as homey and cozy and pleasant. That's really the environment that keeps me invigorated. You know, I go into our building every day and I watch our front desk officers hug people. I watch our food service providers call people by nicknames.

I watch our housekeepers come up and hug folks. I watch our maintenance people walk by and fist bump or talk about the game with residents. And so as you, as you walk through the towers, you can't help but notice that albeit dysfunctional occasionally we are one big family. And I can tell you, looking at origin stories, I couldn't work somewhere where that wasn't the case. And so as, as we're describing this amorphous amazing model to people who have only known what they read on the internet, you know, they need to know who Tim is and they need to know who Karisma is. So the easiest way to segue that is to say that, does my concern have a pulse or no pulse? If it's a pulse that's a person related concern, we want Karisma and her team to spearhead that. They may pull Tim in and if the problem is no pulse, that is my light bulb needs changing or there's something wrong with my TV or, or something like that, that's a no pulse problem, we're gonna push that over to Tim's teams and he's gonna triage that with them. So we found that as, as we try to describe what we do, because I think it confuses people because there's absolutely titles, but then all of us are walking around helping each other with things. It, it's nice to be able to say, you know, Tim and Karisma Pulson No pulse.

Maya

I love that. Pete, I always think about our conversations about sort of making healthcare better and just that idea of breaking down silos, like that's such a different, it's such a different way to think than probably a lot of the institutions that maybe we've worked in over the years. And that idea of really kind of co-branding everyone as a slash caregiver is, is so beautiful. Yeah. Rahul, go ahead.

Rahul

Yeah, so as I'm listening to you, it's beautiful. Uh, and a couple of concepts are coming through. One is what I've read in team of teams by Stanley McChrystal who was spearheading the US charge in Afghanistan at one point. And what he described was having a shared consciousness as you described, like we have shared values and purpose. And then secondly, you've given the tools and permission to the team on the ground so that they can execute without having to be held back or coming back up to you for permission. The other thing which resonates even more is your idea of breaking the silos. And I remember hearing from Paul Leblanc who was the president of Southern New Hampshire University and wrote the book Broken about when organizations become bigger, they try to build these processes to scale things. But what gets lost in that scaling is really the people, because they are now running into these rules and policies and procedures and systems that we've built to scale organizations, but it frustrates the hell out of them when nobody's listening to them and caring for them. And so you describe a beautiful way to break through that, that there are no silos and that it's a simple process, whether it's a person issue and Karisma's team takes care of it or it's a non-person issue and Tim's team takes care of it. So it's very people centered rather than being process or organization centered, which is beautiful.

Jesse

The reason why it works is one of our leadership methodologies is that Simon Sinek esque circle of safety and that comes from the top down. And so to be able to truly say to Tim and Karisma and our other leaders please take risks. And I think that that, that, especially for Karisma has been something that has probably tasted like castor oil because I'm the first one to say, if somebody's making a bad decision, let it play out. You know, let's support them. But we don't necessarily have to give them the cushion, allow it to feel a little raw. And I know that Karisma and her team sometimes come to me and say, how can we make this decision? And I love the fact that they can come into my office and say that and feel it. And my answer back is, you know, we're, we're adults taking care of adults. And so sometimes you have to let our residents make bad decisions. We can give them some guardrails. But as you know, the lessons learned, sometimes you have to let them be who they are. And speaking to your point, Raul, none of this works if as a leader you haven't created that circle of safety.

Pete

I love that. And I just wanted to bring the point that the towers team is actualizing our ideals, right? They're not just the vision and mission put on the wall and they can speak well to it, but it doesn't feel like they're doing it when you're in the space. So that's great and it speaks well to, to the culture because if the leaders are just talking about it and it's not really being role modeled or actualized in real life, I love that you let people fail 'cause they're gonna learn so much more by doing that. Yeah, gotta have guardrails, but you let 'em, 'cause that's gonna stick a lot more to me telling them saying, Hey, you probably shouldn't do that. Or this is probably a better way.

Maya

And it's not infantilizing either to these folks who have lived full lives and have now come to be your residents, right? That they have all this knowledge and skill and, and life experience that they're bringing to you especially. So it's especially honoring, I think to your residents. Brooke, did you have any questions you wanted to ask or observations?

Brooke

I agree with what everyone's saying. I really think that it's amazing that you guys are putting the person that you guys are caring for. Like at the center, I feel like that's something that I hope to do and that's where, that's a place where I would wanna work. And that's also a place where I would want my loved ones to be. So I feel like that is just really amazing.

Tim

Yeah. And this is Tim. Peter, I just wanted to touch on one thing that you also touched on in what, in your previous comments just now about missions and visions and values. You know, being on the wall of so many different companies and you know how the towers walks the walk and talks the talk, if you will. And we truly do. As I stated previously, you know, in my introduction, being with my former company for 22 years and being in the role that I was in, I, I had the opportunity to work with many, many senior living communities over the years who all had different missions, visions and values. And it's unfortunate and somewhat hurts to say this, that of a lot of those organizations, there was a good portion of them that did not practice what they preach. They didn't follow the the words on the walls. And it's so refreshing to know that we do that and why it was so compelling for me to join this organization because we truly do. We really do live and breathe those words that are on our wall.

Pete

That's great. And it sounds like you make it a family environment for the people also of your residents and having a good time and making it livable. Right? You're fist bumping people, it's their life. Right? And you're just characters, isn't it? It's, it's awesome to see.

Maya

I was kind of gonna go back to our, our tools and responsibility conversation from earlier and maybe ask Karisma and Tim if they sort of had maybe examples of that that they could give us things that maybe you've instituted and how it played out.

Tim

So this is Tim. I don't know if necessarily there's been a lot of things that have been instituted. I think it's more just a fostering as you go along because the guardrails are in place, systems are in place, you know, there's always tweaking. But it's just, as I said, fostering what we're already doing and and reinforcing the good that that people do. You know, we talked, started talking about the pulse and the no pulse and the responsibilities, and I know we'll get into this more, but living in the gray as Jesse says, right? We absolutely live in the gray when it comes to the pulse and the no pulse because when you look at that and if it's a people issue versus a physical plant issue, at the end of the day the teams that report up to me, interact, see, visit, and are in the apartments of all of the residents more than anyone else in the building. Whether that's because we're up there doing a room cleaning loads of laundry, a wellness check or turning an apartment and we're interacting with somebody in the hallway. Those are our opportunities as the no post pulse people to interact with the residents and really gives us the opportunity to be able to see, observe, and hear if there's something going on with that resident. And then we've got our conduit with Karisma to be able to work with her team if we're seeing issues.

Maya

That's beautiful Tim. And I know from visiting and having students there at the Towers and and talking with Karisma, right, that individual residents may have all kinds of challenges, right? And what's happening in their home space is often so revealing around, right? The other sort of coping mechanisms and wellness and mental health pieces and Karisma. Maybe you, you wanna talk about a little bit more sort of again that tools and responsibility piece, like where does that fit in terms of meeting those mental health needs? It sounds like that's something that you're really working on.

Karisma

So yes, this is Karisma. Piggybacking on what Tim said about they see the residents, their team is larger than ours, right? They have, he has more staff that go into the residents space more than we do. We have a very high caseload, each social worker has a very high caseload. So for Tim's team it's easier to see what's happening. So what happens in this great place is that everyone takes ownership of what they see. So when they go into that apartment, if it's the lady that's going to pick up the laundry and she sees something that concerns her, that person will reach out to her supervisor and that supervisor will immediately email me, text me, see me in the hallway, where are you? We saw this, this and that. We also have apartment inspections every Tuesday that our staff goes with the maintenance people. But sometimes we don't get to every apartment because there's so many needs. We stay in one apartment or two and that communication remains open. Where if they see something, they say something and it helps us all to be able to see what's happening even before the resident voices their their need. So it's like a proactive approach if you wanna call it <laugh>.

Yeah, and we're always thinking outside of the box, this place is, we always coloring outside of the box <laugh>, there's nobody in a box <laugh> trying, I'm limited with this. No, everybody is in the trenches together trying to make this work. So

Tim

Yeah, well said, Karisma. This is Tim. Just to add on and to finish that off maybe, I think our biggest, most useful tool is, and again not to be redundant, but going back to the slash caregiver, everybody understanding that slash caregiver is all of our responsibilities, all part of every single one of our job descriptions. That's the most useful tool that we have as a team that continues to drive us in the direction that we're going with everybody. Understanding that it makes it so fluid to share concerns, ideas, and information across departments regardless of what it is positive or negative. And when we're all embracing that, it's so great to see because it does make things so seamless. Like Karisma said, we, we will do apartment inspections and what those are is every week we've identified one floor of one of the buildings where we need to go in and we need to do a safety inspection per HUD guidelines.

The residents are aware of it ahead of time. We go through and we make sure that there's no unsafe items or situations in resident apartments. The RSC team comes with us when they're able to, but sometimes get called away and when and if that happens, if my team goes in and observes a hoarding issue or no food in the refrigerator or a pet may look neglected or or something like that, it's easy for somebody who doesn't really believe in that slash caregiver piece to sit there and say, well that has a pulse and that's not part of my job. And just to ignore it. But we, we don't have that here. We have people who are caregivers, so as people that work for the no pulse, that's why it goes back to living in the gray. As soon as they're done with those apartment inspections, they're emailing, they're calling or they're walking up to Karisma's office to say, Hey, here's what I saw in so-and-so's apartment and I think we need to follow up on it. And then to take it even further, that person or those people that do that after a week, if they don't hear anything, they'll come into my office and say, Hey, hey, what happened with this? Because they truly do care. So I think at the end of the day, in our toolbox, in my opinion, that's the most useful tool that we have here is that slash caregiver mentality.

Maya

Yeah, it's so powerful and I, I'm thinking about for those of us that have been in sort of classic healthcare settings too about, I think sometimes we forget about the physical plant around us, right? The facility, the space around us and around our patients and how that we can have responsibility and voice even though the roles may be more siloed and more distinct, but just how important that is because that it becomes often those settings are home for us. Like I worked in one hospital for seven, eight years. I would see it every day. I would see where things were working well or not working well for even my patients who maybe were there short term, but it might not have necessarily been the thought that, hey, we have responsibility to speak up for that. Like no that's somebody else's problem. But that idea of really, you know, seeing it all as something that we can be aware of, the physical space and constraints around our patients, I think is so powerful. How do you keep all of your staff sort of empowered to keep thinking this way, to keep this energy up because it's fabulous but it's also a level of attentiveness that is hard to maintain.

Jesse

If I can start, this is Jesse, echoing, Karisma and Tim. It's a top down methodology and that that even extends to our board. So one of the things that we worked really hard on that I'm really proud of for our team is, and I can't speak to pre 2018, but there never was a, a space for our team to, to have a mindfulness minute or to really truly relax. So as we looked at our ground floor renovation, one of the things that was on my wishlist was to actually create a break oasis for our team who deserves it. So our board heard about this and our foundation heard about this and said we're gonna get, we're gonna jump into, so there is a staff break room that I am just uber jealous of 'cause it's on the other side of campus. And for our team to be able to go in there and because of our partners and our board and grants, we've got VR goggles that are loaded with mindfulness minutes and the ability to jump out of a plane or race an F1 car.

We have a on demand gelato maker that makes gelato in the form of a Keurig cup and it is phenomenal and Tim's always finding some great new flavors and twice a month we load up the counter with all kinds of snacks and things and all those funds are, are brought to us from a donor or secretly we pull some out of Tim's operations budget. But this way if staff are coming into work, leaving work or simply just need a moment, right? Because when you, you deal with caregiving sometimes you just need that moment. I love that they can go into this break space and there it's not just chairs, there's sofas, there's uh, like a high back recliner, there's a TV in there that's loaded with our in-house cable network and you know, you can go in there and take a breath, maybe put your VR goggles on and jump out of a plane or you can have a little bit of gelato or a cup of coffee or a little snack and you can kind of take a break.

And I think that realizing that all of us as slash caregivers are humans caring for humans, having that break oasis is huge. And then I also think about how none of our leaders, I can speak for myself, take themselves too seriously. Like I can say one of my greatest joys in the last three weeks was Tim and I were in the back looking at a physical plant thing. I think we were inspecting the need to reduce some of the refrigeration in the back part of our kitchen. And Tim looked away and by the time he looked back I was over mopping the floor with one of our associates and having a conversation. Because one of the things that I've learned is with our line staff, you never want to come in and tell them, I would rather do something and model the fact that I'm not gonna ask you to do something I personally won't do.

And Tim and Karisma and our other director level leaders exude like just ooze that. And I think that getting back, Maya, to your question about how do we keep people bought in is I think that you have to, you have to take a a second and realize that again, we're human right, everybody's gonna have a bad day. And especially when you have this this gray area where people are kind of working on things together, you're gonna have that friction and you're gonna do the dance and you're gonna step on somebody's toes. And so being courageous and and being able to have those conversations or kind of referencing Brene Brown's marble jar, you know, how can we make sure that we are making deposits enough so that when we have to inevitably take some marbles out of that jar, we can come back and say, you know what, I did you dirty or I didn't recognize you when I talked about this, or I may have bulldozed you a little bit here and I'm sorry. And, and I really look at our team and when that happens, I believe every single one of 'em. And, and it's because they have that heart of the caregiver

Maya

That's really powerful. And I thank you for the reminder about the marble jar. 'cause I think that's such a nice, you know, way to think about what we, you know, what we put in ahead of time so that we can support each other when things get sticky and and difficult. So, you know, you all have been building and supporting this fantastic structure and I know physically right renovating and going through all of all of that in my last couple of visits. And congratulations on that, that project being almost done almost right. Tim, what are the sort of, what are the next, like do you have sort of the next big things? I feel like innovation is something that you're, you try to stay so open to. So what are the next pieces for your team and for the towers?

Jesse

So I'm, I'm gonna be a horrible boss and I'm gonna put Karisma on the spot for a moment because I, I really want her to talk about her insight on how we're approaching a model that we're gonna roll out in January where we're going to do something a little avant-garde and we're gonna separate engagement and support. So Karisma's team is going to do some innovative kind of proactive approach using some tools that we got from our partnership with School of Health Sciences at Quinnipiac, right? Shout out to Nicole Fiza and her group for helping us to develop a part of this. So I wanted, I want to pass this to Karisma and ask her to talk a little bit about what we call the proactive partner model, touching on the three legs of the stool and how that helps our residents know themselves sometimes better than they think they know themselves.

Karisma

Karisma again, so I have a team of five RSCs now with the new one starting next week. And core of what we do is like we utilize a proactive holistic model of wellness, right? And we prioritize early identification of needs and coordinate support across the continuum of care. So what that means is that, like Jesse mentioned, we use validated assessment tools, some that were created by the QU students and the faculty, like with Nicole Feda, through that partnership we use HealthPRO that they use additional evaluations such as the mini cog, the get up and go, uh, failed assessments and the false tracker. And throughout the year we maintain regular touch points with our residents and provide coaching support, collaborating with the teams, with the family to be able to wrap around services for the resident because we want them to age in place, like we mentioned before, we put the person before the task, the team works cohesively to address both planned and emergent needs, prioritizing dignity and autonomy and individualized care over checklists or routine. So we put everything down, whatever is in front of us, that person comes first and whatever tasks we have to do, we just figure it out later on. The ESS we're working on, like I said something with Jesse where next year we gonna formalize more the deliverables that are designed to support the aging in place, such as the assessments that we do, the A DL assessments, the perceived self wellness assessment and the check-in call, which measures isolation and loneliness, all of that. Plus the documenting is essential <laugh>, you know, that Maya,

It, it never happened. So we have thanks to Jesse, I call him the father of the SOAP notes now because he developed a way for our frontline staff from the front desk officers to write an incident report to Dish to us, you know, the information that we need to continue the care for the residents. So it's called Dish soaps

Maya

<laugh>, I love it.

Karisma

So everybody gets a training every year and a certificate showing that we, we are competently doing the documenting and the follow up notes in a cohesive way so that everybody's on the same page. So that's a little bit of what we're working on.

Maya

The evidence-based assessment is fantastic and you know, the way that everyone is involved in documenting and communicating and I mean, I'll just say, you know, for myself with my own experience with other loved ones in senior housing or in an assisted living, even that sense of really checking in on everybody and everyone having that level of communication is not necessarily certainly what I've witnessed in other places. So, you know, this adds to your unicorn status for sure.

Karisma

<laugh>, right? We have our dashboard that we're working on also where all of that is gonna be in one place and we are gonna be able to tap into that data so that we can see what other things are out there that can help support us.

Jesse

This is Jesse. So we, dating back to 2018, started a process to get to know our residents and, and try, you know, we did some surveys, we did some focus groups and what we saw was that about a third of the respondents of the survey reported feeling isolated or lonely and other teams may have shied away from that, but the leaders at the towers really leaned in. And so over the course of about three years, we've developed what we are gonna call the resident engagement platform. And that takes the assessment tool that Karisma talked about that is administered by an OT that was developed using validated tools from ak and that assesses your level of frailty. And then Karisma spoke about a call and the science behind that really marvels me. That is a, a phone call that uses a, an AI driven transcription to look at the psycholinguistic markers in your conversation and it gives you what we call a social quotient.

Basically how lonely are you projecting to be? And then Karisma spoke about the third piece, which was stemming off the off of Dr. Bill Hitler's six dimensions of wellness. And we've been able to take that and morph that into a survey, which I believe was developed by the University of Texas and Austin and showing the no silos piece. We took that research and our accounting manager figured out how to build the weights of each answer using that methodology in Excel and then partnered with our software developer to put this in. So you can take the survey now on an iPad and once you get the answers to that, you're able to have the coaching proactively from Karismas team to say, okay, here are the pathways based on your answers that I think will give you the best bang for your buck and bring you the most purpose.

We're gonna coach and cheerlead and champion you to attend those. And so what we want to do in 2026 is take that platform that's giving us some of these details along with some really great false tracking and then tie that all together with program attendance, those three validated tools and some impressions from Karisma team and be able to get a holistic look and profile of that resident. And then take it a step further to stem off of what Maya said, my, what do they call it? The big audacious dream is to be able to have this system self-generate reporting with some tips and communication tools to the loved ones of the folks that we take care of to say in this past semester, your mom or dad or loved one attended x amount of programs was was lesser of a risk at fall, had a isolation loneliness quotient that went up or down.

And then based on that, have a couple of, here's what you might do and then I'd love to tie that back to please reach out to your resident service coordinator with questions so we can get a dialogue going. Or if you'd like to learn more, here are some links to Tower's website where you can take a look at our programming calendar to give your loved one, you know, maybe a, a print nudge as they say to go to these programs. And through our website you can even build that into your professional Outlook calendar. So you could be at work, get an Outlook reminder, and then call mom and say, Hey, that's that program that we talked about that I think you really love. I think you should go. And then if you want to volunteer, because volunteerism is huge at the towers, here's a link to our volunteerism page with some opportunities.

So we really want to take what Karisma and her team have been doing for many years and bring in some volun, extra volunteerism, bring in those stakeholders and be able to really wrap everything while keeping that resident at the center so that Karisma and her team are able to have more engaged families and have some sort of rapport so that when they need to call and say, Hey listen, we're following up because your loved one came down and we need to quickly get this paperwork in for a Medicare redetermination. Or Hey, there's been a change of status and we're gonna need to bring in assisted living services agencies or, uh, blocks of home care. It's not a cold call. So really wanting to take that feel that we talked about, that Hamish feel of the towers and extend it out further than our community and with Karisma at the helm. I have zero doubt that this is gonna be wildly successful.

Maya

And it is just wonderful that you've really tied in all of this, right? You're tying together that sort of mission and goals and shared values from the beginning to like now. And this is how as a team, as a whole agency and residents, right, you're using technology to do the next thing. Putting your patients at the center like and, and living the value, you know, where we started at the beginning of this conversation. So that's really, that is so exciting. And I think a lot of our listeners are gonna wanna come and work at the Towers, have their loved one live at the Towers <laugh> might be part of, you know, be part of this community that, that you've continued to build.

Rahul

So this is Rahul, what I'm taking away from this incredible conversation, first of all is how great of a place you've built congratulations. And secondly, the major innovation that I'm hearing, which I'm gonna put this on my ID badge right now, is that you've changed the identity of everybody who's in that building to a caregiver. And so by doing that one thing, you've really, across the organization, made it people centered. And I'm gonna put it on my ID right now. I hope I live it up as much as you do. So you've really inspired me for that.

Pete

And Rahul, to go off of you a little bit is that makes it a place you wanna work and it's just not, I work at the Towers, right? It's, I'm at the towers and I care for all the residents, et cetera. It, it's not just an organization, it's a place you want to be. I think two things that I'm taking away is I'm not as anxious, um, getting old 'cause I have a place to go to now you'll feel like home.

So in the Hebrew Hamish, you know, so, um, I love that you have created this and you wanna just keep spreading that. So when I do get older, 'cause I don't think you're all gonna be around still when I, when I need you, but your concepts could be there. So I love it. It's, um, great work.

Jesse

Can I just thank Pete for teeing me up for like one of my favorite quotes. So one of the things that we, we always love to finish with at The Towers is, “We are planting the seeds for trees, which we will never get to enjoy the shade from.” And that is a total plagiarism from a famous quote. But when we think about the fact that Tim, Karisma, and myself stand on the shoulders of giants over the past 50 plus years that have gotten the towers to where it is now and looking to the future where we may build a third tower in the future speaking, I hope for Tim and Karisma and myself, we find ourselves incredibly and humbly fortunate to have landed in this fertile ground where, like Pete said, our ideals and our systems and the the things that we are doing today will hopefully resonate for that next generation and pave the path that one day we will walk.

Pete

Well said.

Maya

I love that. I think that resonates for us so well on the educator side too, right? We're planting seeds that we hope and we have strong sets of values and mission that we hope we're sending our students out into the world in. But we may not see it, but we have to have some sense of trust that this is what we're doing and that, you know, that's what's gonna grow in the future.

Well thank you all for spending time with us here on learning to Lead. This has been wonderful and I don't know, I feel really good after this whole conversation, <laugh> <laugh>. So you brought your magic to the rest of us today. So thank you so much and we look forward to talking to you all again soon. And thank you to our audience.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E13: Leadership Hacks from The Towers Team (feat. Jesse Wescott, Tim Smith, and Karisma Quintas)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Maya 

Hello, everyone, and welcome to the Towers edition of Learning to Lead. The Towers is an innovative senior living community in New Haven. We are thrilled to welcome Jesse, Tim, and Karisma, the leadership team from The Towers. 

Brooke 

So, Tim, what is a tool or hack that you use to become a better leader? 

Tim 

So, I'm not sure if it's necessarily a hack, but teaching. Always taking the opportunity to teach those that you're leading, whatever that may be. Because leadership's not about being the best. It's about making everyone else better. I'm only going to be as good as the team that I'm leading. And if I have weak links or holes in the dam, then that's on me. If somebody doesn't know how to do something, it's because I haven't followed up with them. So always taking the time to teach people to make sure that they understand their roles and understand what the expectations are and then me as the leader to go back and inspect what I expect. 

Maya

Fantastic.

Brooke 

Yes, I think that is such a great hack. That's something that Dr. Anand has taught lots of my fellow classmates in our leadership class in medical school is that the leader is like setting the tone. So if you are trying to support your team, then they'll do better for you. So I think teaching them those tools is really great. 

Jesse 

So this is Jesse, and I will say that one of the hacks that I have tried to live by is to continually invest in yourself and be mindful of yourself. It's very easy in the field that we're in when you're a human caring for other humans to get burnt out. And I think you hear this over and over again about caregiver burnout or about doctor burnout. And so one of the things that I think is so important is understanding that the same way that we reference the towers as the envelope, your body is also the envelope. So when you think about your profession and you think about your career growth, you're only going to go as far as your machine is going to take you. So be mindful about what you're putting in your machine. And that comes in the form of nourishment, that comes in the form of learning, that comes in the form of your circle of peers. that comes in the form of finding a professional mentor and being courageous and loyal and asking those questions. And then once you've filled that cup, overfill it and find people who you can also mentor. And if you surround yourself with the right circle of folks in your personal and professional life, and you can give yourself the grace to know that you're not always going to get it right, but if you continually show up every day and just show up, be ready, you're going to find that you're going to be successful in your career, and you're going to find that you create this gravity where it's the universe or it's some other worldly power that bring people into your sphere that are going to make you better. 

Karisma 

This is Karisma. I'm not sure if it's a hack, but the way that I lead is I was reading up on the concepts, and I came across operationalized empathy. And it says it takes something emotionally heavy and turn it into structure, stable system that reduces chaos to build trust, both with the residents and the staff. And that went back, when I thought about that, I said, yeah, that sounds about right. And it kind of aligns with the quiet competence, right? Where you would lead steadily, stay grounded, bring calm. My belief is that you can't pour from an empty cup, so you have to fill yourself up with things that are good and zen-like, I guess, if you want to say that, so that you can pour that out and people will fall into place or emulate you. I don't know, that's the way that I run through my day. I come in and I put everything into its place. so that when things are thrown at me, I'm like, yeah, I can, let me break that down. In my head, I break it down quickly. And then done. Okay, yeah, it's not that serious. We're going to do this, and that. So I don't know if it's a hack, but that's how I work. 

Maya 

But leading with empathy, right? That's that value. That's the first line of what you think about. And then next you decide, okay, then what step do we take. But that empathy and calm is at the beginning. Well, thank you all for spending time with us here on Learning to Lead. We look forward to talking to you all again soon. 

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E12: Leading with Energy: A Conversation with Dr. Tracy Van Oss DHSc, MPH, OTR/L

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Pete

Hello everyone. Welcome back to Learning to Lead. I am Peter Longley and I am here today with Tracy Van Oss and also Rahul Anand.

Rahul

Hello.

Pete

So, Dr. Tracy Van Oss is a Professor and a Doctoral Capstone Coordinator in the Occupational Therapy Department. Tracy has earned a Doctor of Health Science degree, a Master’s in Public Health degree, a Bachelor of Science degree in Corporate Communication, and a degree in Occupational Therapy from Quinnipiac University. So we know who is one of our funders also. So please welcome Dr. Tracy Van Oss.

Tracy

Thank you so much, Peter, for that introduction. I'm glad to be here.

Pete

So Tracy, I'd like to start off where our friendship actually began many moons ago. So we were running around the hallways in Yale New Haven Hospital.

Tracy

Yes, we were.

Pete

Me as a nurse and you as an occupational therapist, and the one thing that continues to stand out throughout decades of knowing each other is you are always positive. I just want to know how do you stay positive all the time.

Tracy

Well, thanks Pete. It was a pleasure working alongside you at Yale in the SICU, our trauma patients, phenomenal recoveries that we have seen right in the acute care phase. We unfortunately didn't get to see the end phase of the rehab, but we know that during that critical time, the work that we did, and I praise you for that because you're one of the best ones out there. So

That was a great time down at Yale and I was thrilled to see you as a colleague at Quinnipiac and I'm thrilled to be here with you today. My energy, I believe I inherited much of it from my dad. My dad was full of energy, he was always positive. My brother and I, he just continued to do things with us and keep us active and I just felt like our days were just filled with going and doing things. However, my mom, who is now currently, she'll be 87 next week, has just as much energy and positivity. She is out every day and I think does almost a laundry list of more things than I do in a day. Going to the pool in the community center and hanging out with her boyfriend at dinners and dances and she just really is a great role model for me to share that. My excitement for life then and now will continue when I'm in my late eighties.

Pete

Wow, that's awesome. That's some great genetics and role models that you have there. Knowing that you get your energy from role modeling really in your genetics. How would you describe your leadership style or philosophy?

Tracy

Well, as you can see, I like to do things. So the bio that you read, I do love to learn, but I also love to coach others. So I guess it's a coaching style where I'm hoping to motivate others to want to do something that might bring them joy or something that might be challenging for them or anything that they can get out into the world and explore and do I collaborating with others who have a similar drive to me, I like to get things done. So you can imagine the circle of people that I work alongside. I have that all day, right? I've I got those great colleagues who I have something I'm working on with one and something I'm working on with another. And again, pulling in their strengths. I think the biggest thing is for students is I want to teach them to lean in.

I want them to lean into their strengths and there's lots of group projects in college and as well as when you're working in the ICU, we're working as a team. So I tell them to lean into their strengths and continue to improve those areas that need improvement. So we're not always all going to be great at everything. And of course nobody knows everything. Although with AI now, I think we all can, but realistically even this team right here, as we get a little bit further into the discussion of lifestyle medicine, I know this piece of it and the two of these other pieces of it, but together we can make a powerful impact.

Pete

Wow, that's great. How do you approach conflict differences of opinion professionally or even personally if you can't find a professional conflict since you're always out there smiling?

Tracy

Well, and I think professionally when I'm at my job, I bring the mentality of this is a job. This is a portion of my life that matters. It matters a whole lot, but it is in the end, it is my daily work. It's not my life. In my life and in my job. I do respect and appreciate that people have various perspectives. Nobody has this linear, this is the way we think, which is a beautiful thing. Sometimes I listen and just keep quiet, although that is one of my vices. I do need to practice listening more. So I do go to the listening labs and I'm learning how to listen. I might not always agree with what everybody is saying with different individuals. People have different backgrounds and different upbringings that kind of fuel what they know and believe. But I also know that there's different personalities.

So not everyone can be upbeat all of the time. Some people approach situations differently and I think it's important that I respect, again, people's personalities are different than mine. So I'm always thinking about conflict in a way that if someone's angry or looking at a situation and really getting fueled about it, it's like I take a step back and they might just had a bad day. I see lots of people in home care who are just really having a bad day and they might be sharing something that's personal or bothering them, but it has nothing to do with me or my situation. It's just what's happening. So it's a good time just to be a soundboard. So my tactic really is to listen, share my perspective, but if I do have something to say that I'm really adamant about, I want to back it up with evidence as much as I can to make a point and not just say something off the cuff and hope people believe me.

Pete

Was that a dig at me? I do that all the time.

Tracy

No, not at all. No, but I think it's important. People love to talk and people like to talk about themselves and I want to allow people to do that. But then if they start going down a rabbit hole of something that they personally believe in that I may not, I might say, oh, that's interesting. My perspective on that might be this. And it's not to cause conflict, it's just to share that it's my perspective and that's all it is. It's not right or wrong.

Pete

When was your last conflict?

Tracy

I don't know. A conflict; I know there's certainly things at work, if people are trying, we're making decisions, I don't consider those conflicts. I consider it's a problem and we problem solve it. So I view a conflict as we all have problems. Every single one of us has a problem, if not more. And how are you going to attack it? How are you going to go and solve the problem? That's really all.

Rahul

This is Rahul. Let me just follow that thread for a little bit because I appreciated what you said about the different aspects of conflict. One is the very cognitive aspect and we need to get all perspectives in. And the second is the emotional aspect of conflict where you seem to be having a lot of empathy for somebody having a hard day. So I would differentiate problem from conflict as a problem or difference may not have that level of emotions attached to it, but then a conflict not only has differences, but also some heavy emotions attached with the differences. So maybe just going back to Peter's question of looking at a story which is far back enough that you feel comfortable sharing where there was conflict in seeing how you did respond to that with your energy and attitude?

Tracy

I honestly get in trouble for seeming I don't care when there's a conflict because I really am like, whatever, it's not going to bring my day down. It's not going to hamper my mood. It's not going to, and again, Pete in the ICU, we've seen people on the worst day of their life.

They're in the ICU and all of our patients, even in home care, I'm seeing people on having really in really bad situations. And I just know that I am so thankful for the life that I have and the health that I have. And I mean, all good things are around me all of the time. I just don't see what the negative energy I'd have to pull up from somewhere to share disgrace that something so wrong that I'd start a conflict. So if somebody starts a conflict, I'm more or less kind of like, okay, get over it. I'll talk to you again tomorrow or let, let's take a break, let it simmer. Because there's really nothing that I'm, I'm not adding fuel to the fire. I really have no reason to throw more fuel down because I, again, go back to it's a problem. How do we solve it? There's always options. What are the options? Should we go option A, option B, option C, and let's just solve the problem and move on to the next thing.

Pete

Right. That's great. And that's great for our listeners to understand. Don't get wrapped up in someone else's emotions to spoil your day. Because once everyone's emotions get energized, things get very heated and out of control very quickly.

Tracy

And from what I've learned over the years is people's emotions get brought to the table not because of that specific problem. It's usually something else is going on in their life. Something happened that morning, something's going on with their health, something else is going on to cause them to bring all that fuel to the fire. And it's usually not, the schedule is off, right?

Pete

Yep. Yeah, the timing is all upside down. You went from corporate communications and then stepped into healthcare. So what was the driver? What drives you? What was like, Hmm, this isn't working. I'm going to go be an occupational therapist.

Tracy

So that's a great story. My first degree was corporate communications, and I finished school early. I finished a semester early, so I actually went and worked at Disney World. That might be your answer. That might be, I have this, I'm pixie dusted, if you will. So when I worked at Disney World, I came home to work in the world of corporate communications, went down to Manhattan, was offered a job in advertising on Madison Avenue for such a low amount of money. I couldn't possibly live there or commute there. I said, something else has to be in the mix. Quinnipiac was down the street from me. My mother always listened to, your mother told me from high school, please go to Quinnipiac for physical therapy. I was like, no way. I'm not interested in that. Well, a friend of mine who also lived in North Haven was working at a hospital, the other hospital down the street, and I volunteered to watch her for the day doing occupational therapy. And I fell in love instantly. I was like, wow, you're working with a team of people to help somebody reach their goal. I want to do that. So I shadowed a couple other places to ensure that was the profession I wanted. Got on their wait list that summer and was accepted into the program at Quinnipiac and I never looked back.

And I love, I just love that I get to go to work every day. I'm in a profession that is just something that really gives me so much I'm able to give all day. But as I tell my students every day, you have to take care of yourself. It's so important to do self-care because you're giving, you're giving and you're seeing a lot of bad things. So you've got to be able to take care of yourself.

Pete

Yeah. Wow, great. I do great.

Tracy

What other things that drive me are my family hanging out with my family. I have a 14-year-old Labradoodle, which you might hear in a little bit, but I also love to learn, as you can see in the bio that you read. I love to continue to learn love traveling, just doing things that make me happy. I ensure those things are included in my day every day.

Pete

That might be the secret sauce right there. What are your hopes and dreams about the future of healthcare?

Tracy

Tough question, right? Tough question. So here we go. We all know there's lots of challenges with healthcare today. Having a public health degree and being an occupational therapist, one of our areas of occupation in our role is working on health management. So I love that I'm talking to the both of you because lifestyle is critical to getting people to take care of themselves, but it's very difficult for many reasons. One being long work hours. I just don't have the time to eat better or be physically active and do the things I should. I took this for the past five years and been working on a program of incorporating lifestyle redesign into first year college students, and it's around the themes of sleep, physical activity, nutrition and stress management. Right now, I started in their living learning community. I moved it to an FYS, which is a first year seminar course. Now it's finally found a home in my occupational therapy 101 course. It's the first year we've rolled it out and it is working. We're having the students write goals, reflect on them, incorporate them into their routines, and hopefully develop some habits for first year students now that they're living in a dorm and they're eating out of a cafeteria, they've got a beautiful sleeping giant across the street. So what are some things that you can do to include in each and every one of your days to be well?

Pete

Wow. And that's great because you're giving them the tools to be successful.

Tracy

And I think it's so important because they, they're giving tools to patients to future patients. So they're telling someone who is pre-diabetic, oh, you need to exercise, eat this, don't eat that, do this, don't do that. But they're learning for themselves how hard those changes really are. We say drink eight glasses of water, be active is 30 minutes a day, but to actually do it is so much harder than it is to just give them a prescription and say, here, this is going to be really important. We all know what to do. How do you actually incorporate it into your daily routines is what I'm teaching them.

Pete

Yeah, the consistency is key. Even if you have, you don't do great with your diet today, you have tomorrow, you can reset. Yep. That is excellent. Yes. Lifestyle medicine is something I prioritized once I hit 50 and all my labs started going sideways.

Tracy

And it's important. And if we can teach younger people now that this is a way of life, it's not a remedy. It's not something where you're like, okay, when I get diabetes, I'm going to try doing A, B and C. But how do you, each vegetable you have now is going to count later. Each cupcake you have now will count later, which you can certainly have one, but what's going to be your consistent,

Rahul

Yeah. I think that that's an area that's of great importance for students, for leaders, for patients. Definitely. When I talk to people in the healthcare industry, whether it's students or practicing professionals, two things are always true. One is, we came into this profession both to make our own lives better and those of people around us and our patients better. And while it's a cliche, but it is so true, and when we do one at the expense of the other, it just isn't working out. And the second, which I appreciated your point about teaching goal setting and habit design, is that there is a huge gap between what we want to do and what we actually do. So closing that gap using the tools of behavior therapy and habit design, I think is a skill both healthcare professionals and leaders need to develop. Because same with leadership, there's a huge gap between what we want to do and what we actually do. And there's just so much opportunity there. I'm curious to know how you're teaching that.

Tracy

Sure. So it's in person. So of course with AI at our doorstep, teaching in the classroom now has to be more engaging. So the modules are each two weeks. We had them do a time diary at the beginning of the semester to really 24 hours a day, three days in a row, what are you doing? You're a brand new student and I love times of transition. So that high school took, college is a huge transition, so it's a great time for them to really change their behavior, really incorporate new wellness routines. So we talk about each of the programs, but one of them, so for the first one, physical activity, we talked about it, the benefits of it, linked it back to our OT practice framework, which is our language. How is this even OT that we're talking about physical activity. But then the second time we brought them out to Sleeping Giant and they had to do what one of the assignments is called an occupational profile.

Basically it's a patient history, but it's taking inventory on who are you, what are some of your likes and dislikes, and communicating that to their peer while they're walking around the circle at Sleeping Giant and choices, giving these kids choices. The whole class is all about giving them choices and making sure that it's not prescriptive of you must do this physical activity for one person might be getting on a treadmill for 30 minutes, but for someone else it might just be walking one more time at night down the path. So we want to make sure that we're not saying you have to do physical activity or exercise, but we do introduce them to Rockwell. All of the activities that are going on over there. Wellness on Wednesdays, they have all of the different machines and classes, and I'm happy to report that many of them now are actively involved with the yoga, the Pilates, the wall climbing. They're doing that as part of their, they're enjoying their campus and they're meeting new people and it's getting them active in a different way.

Rahul

I love that it kind of aligns with what OT is all about in a way from the outside. For our listeners, do you want to just tell them what the differences between OT and PT for the listeners who do not know?

Tracy

Sure. Occupational therapy, we do, some of my best friends are physical therapists, so we do align ourselves with working to holistically rehab somebody after they've had an illness, an injury, but also we're wound to tomb. So it's actually right from the very beginning, someone who may have a developmental disability or were burned prematurely. Physical therapy is going to be working a lot more on the motor, the gait, the walking, the mechanics of mobility, occupational therapy. What we do is we work on ability, the quality of performing daily tasks, we call them ADLs or activities of daily living, ensuring that somebody after they've had a serious illness or injury such as a stroke, can now get themselves dressed and get themselves into the shower and get themselves toileted and get themselves feeding themselves. So doing all of those daily activities that are important to them, which you can see why when I'm working at this low level of the basic needs, Maslow's basic needs of just taking care of yourself, why I have such gratitude for my own life because my life is good.

I want to share another example in the class for OT101 for nutrition. So we're going through and as you're on a new college campus and you're trying to find out what am I going to eat? We hear freshmen 15 is a real thing, but understanding how you're fueling your body matters of how you're going to perform academically. So bringing in the research articles that they can, there's proof. It's not just Tracy saying this, this is what you should be doing, but I also send them in pairs down and do a field trip around the different stations and areas on campus to go find all the different places that food is so that they're not just running to one station every single time, getting the chicken and fries thinking that's all there is to offer. So it was a nice time for them to get to know more people in the class and to explore our campus and to find some of the different areas there are to eat.

Pete

Wow. I think I want to be a student In your class now, what lessons do you prioritize for your students looking into the future? Where are you pushing them or guiding them?

Tracy

One of the things I just mentioned, bringing them outside of the classroom. So we all know learning happens inside the classroom, but I believe most of the learning happens outside of the classroom. So asking students to explore and apply for opportunities so that they can grow as individuals. We've got so many opportunities at Criti Piac to do the QUA and the QU in Washington DC and faculty study abroad come with us to Bahamas, to Barbados, learning to be with groups of people. So again, healthcare, you're working in teams, you're always going to have to know what's in the books for academia and pass your boards, but we need you to be able to work with others and enjoy others' company and do things outside of the classroom, whether it's a club or it's an experience or it's going down and getting pizza in New Haven. It's doing things together and learning how to socialize and each other and respect differences and understand different people's perspectives that really will help these students grow and flourish.

Pete

No, I totally agree because the context, right? You can be very academic and book smart, but putting it all together out in the real world, that's where the nuance you trip up on and all of a sudden things kind of fall apart and then the stress level comes up and you default actually to your lowest behaviors. Really, you regress very quickly where you feel safe. So no, that's awesome.

Tracy

And think about nurses and doctors. Most therapists we're with our patients for long periods of time. We're usually in treatment sessions 30, 45 minutes at a clip. So we really get to have those conversations and build those rapports. Sometimes a doctor might have, I don't know how many minutes you're down to, but a short amount of time to engage with your clients. It matters that you have great personalities when you're coming through the door and are able to build that rapport in three seconds so that your patients want to come back to see you and trust you. And so I think if they're able to do that with their peers, they're going to be more likable in that short amount of time that they get to see patients.

Pete

Yeah, you're making it very relevant. Excellent. How do you stay fresh? How do you stay on your game and consistently improve the way Tracy teaches or engages your students?

Tracy

This is my favorite. I do practice gratitude every day, and my dad, when he passed, we actually sprinkled his ashes in Aspen down the Colorado River where my parents met, and I brought home this rock. It's a very symbolic rock. It's just a little rock. It would mean nothing to anybody but me. And every morning when I put my rings on, I have this rock, and I just wish everyone a great day. I have got different pictures in my house and everyone's including myself. I want to make sure everyone's just going to have a really great day. And that's just part of my morning ritual, and it just kind of grounds me for the day to say it's going to be a good day and it works. It really works for me. Now, if it's pouring rain, it was this week when it was coming sideways, that first blast of rain in my face doesn't always don't make my day go.

But again, I'm thinking, guess what? The birds are happy today. The birds are a little extra happy. And I also, as I mentioned before, seeing my healthcare families every day I can tell a story of this patient, this family, this caregiver lacking in the systems. The systems aren't working, they're not talking the communication. They need a ride. They don't have food, they don't have the right food. It's like there's so many issues that need solving, and I'm only there for a short snippet, but I call my team when I'm working in home health. So I call my team and we problem solve and really get these patients to a better place before we leave them. But I'm just grateful of how fortunate I am, and that really keeps me happy.

Pete

Yeah, no, you bring up a great point about systems. People usually react and end up blaming the person, but the systems are not set up for everyone to be successful, and that's where the rub is, right? And I've been trying to work on systems for the past 30 years, but hey, I'll continue.

Tracy

I think a lot of it, the automation, my mom doesn't have a cell phone where she can press the buttons or answer her MyChart to say, yes, press one if you're going to be showing up. So I took on the responsibility of ensuring that she gets to her appointments, but she's still keeping track of all of 'em. I'll just call to confirm, mom, you have something tomorrow morning at three 40? Yes. Good. I'll hit the one. But I think about those patients who don't have a Tracy, who don't have a daughter, who don't have a family member down the street who don't have the ability to work with the remote and robotics of the pharmacy, so they're standing in line a little longer, but their legs are heavy and tired. They can't stand that long in line. There's just so many, there's ways to be more efficient and effective in healthcare that there seems like there will be lots of open jobs in that area. We should be

Rahul

Very true. Yeah, I completely agree with what you're saying. What you're saying reminds me of a book I read called Broken by Paul LeBlanc, the ex-president of the Southern New Hampshire University. And he makes a great point that we've built these quote systems to scale organizations for the benefit of organizations, but then as they scale with all the processes and rules, it makes people who are the end users who may not be as savvy, fall through the cracks. And the job of the designer of the system or the humans in the system is really to help ensure that that doesn't happen or when it's happened, it's addressed. And I agree with you as we look back at the era of electronic medical records and how that promise did not deliver, at least in terms of better processes for both the healthcare workers and at the patient side, AI is an opportunity where we can look at where it will need designers, design thinking experts so that the system can be better for the people who work in it and the end users, not just for the organizations or the insurance company, for example.

Tracy

I think the billing gets done, it gets taken care of, which is important. Of course, healthcare is a business, but right for the user, it gets clunky and for the actual patient, it's just sometimes an uphill battle to figure out how to get an appointment and then how to get there.

Pete

It is those little things that people assume, oh, everyone's got a car, everyone can get there, no big deal.

Tracy

And family, I mean we've got FMLA on the board that people can use, so they're trying to build systems to allow patients to be taken care of, but as our population is aging, I'm just seeing more and more and more snags and problems arising for families that are stuck like, okay, now what do we do with mom? I am just going to keep her home because I don't even know how to navigate getting her out of her house to another system. I don't even know how to navigate people getting into the house to help out. It seems second nature to us because what we do, which is great that they have us there to kind of guide, but there's so many people that just don't even have a clue.

Rahul

And if you look at it from a systems perspective, even from the business standpoint, it's clear then listening to you, there's an opportunity because there are people who are not accessing care because they find it so hard to access or complicated. And even on the prevention side, there's people wanting prevention and we see them channel that desire into various things that may not work necessarily based on the evidence, but they're really desiring to be healthier, to prevent disease, to live happier, to live longer. And the system is not designed for it, it's just designed for taking care of end stage diseases in a way.

Tracy

Correct. And you brought up business. One of the things I'm planning as the doctoral capstone coordinator, so our OT students go out and do field work, traditional field work, they work in the ICU, they work birth to three, they work in school systems and rehab centers. But for the 14 week capstone experience for our students, they get to work in outside agencies, if you will, that don't have an OT yet. And where would an OT infused in there for 14 weeks be able to make a difference, build a program? Where are some needs that are lacking that you just can't get to? And I'm going to be talking to the business school next week about how we can kind of synergize some of their capstones with our capstones because again, it's a business and sometimes the business end of it doesn't understand. The patient needs the human aspect of how do we improve the quality of life while you're building the systems. And then I want the OTs to understand that healthcare is a business. So you can't leave out the fact that you might have this wonderful program, but you've got to follow the money. Where's the payment?

Pete

Very true. No margin, no mission. So as we start coming towards the end, is there any message that you want the listeners to take away here?

Tracy

For anyone who's new in healthcare or a student, I want you to keep learning. It never ends. So I mean, you might have your diploma in hand or you might have your transcript completed, but you want to always keep growing. I'm in an AI course right now for the next six months, right? Just absorbing as much as I can, learning about the pros and cons and usage of ai. I also want you to think about exploring opportunities. So figuring out, especially in your college years when you actually have the gift of time, believe it or not, this is the most time you'll ever have in your life that you want to explore as many opportunities as possible. So put yourself out there, join a club. If you're new in a hospital, join a new committee. Figure out what it is that you're good at, what you like, what you are not so good at, and what you could improve.

Or maybe you're never going to be good at that. We're not always all good at everything, so don't beat yourself up. If you get to something you're like, wow, I'm really not a business analytics person. I don't do Excel sheets, that's okay. Somebody else will. When you're doing research, it's the same thing, right? You may be there excellent at doing the lit review and you'll be asked to be part of the team to do that portion of it. You might be the person who wants to run the focus groups. So always be thinking about your teammates, be thinking about who they are, get to know them. People are fascinating. We all have a story. We all came from somewhere. We all have unique perspectives. Get to know people. I think one of the greatest gifts is learning who different people are and their strengths and their attributes, so that way you can call on them and hang out with them. So I'm fortunate that Pete called me because we hung out in former years, but he wouldn't have known that had we not connected then. So connect with people. That's what this life is about.

Pete

Great message. How would people be able to get in touch with you if they wanted?

Tracy

I love LinkedIn, so if you are on LinkedIn, Tracy Van Oss, LinkedIn.

Pete

Alright, we want to thank everyone again, especially Tracy Van Oss. She has provided us with a lot of good content and information to help us continue to learn to lead. And as a moderator for this episode, I want to thank everybody all, especially all of our listeners, for continuing to follow us on Learning to Lead. Thank you very much.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E11: Leadership Hack – The Power of Daily Gratitude (feat. Tracy Van Oss DHSc, MPH, OTR/L)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Pete

Hello everyone and welcome to Learning to Lead. This is Peter Longley with the School of Nursing at Quinnipiac University. And today with me I have Dr. Tracy Van Oss, DHSc, MPH, OTR/L.

Tracy

Hello everyone. Thank you for having me.

Pete

Tracy, what one leadership hack would you provide all of our listeners with?

Tracy

Thank you, Pete. I work in the healthcare field and I see patients and families every day that have challenges due to many complicated medical issues. I know for myself, I'm very fortunate that I'm healthy and that keeps me happy every day. But one of the hacks that I'd like to share with you is practicing gratitude. Each morning I get up and I have a very special rock that is meaningful to me and I have time for myself where I'm just grateful and I share my gratitude with each member of my family to myself. But that just kind of grounds me for the day and gets me ready for going out into the world and being able to go out to work with my students as well as to help patients and their families. So if there's something that is symbolic for you or if there's something that you can just think about each morning or include as part of your everyday routine, I think it's really important for you to decide that there's something to be grateful for because each and every one of us has something that's going well for us.

Pete

All right, well, thank you very much because I'm grateful for you and Rahul in this Learning to Lead podcast, so thank you very much.

Tracy

Of course.

Rahul

I echo that. Tracy, this is Rahul. First of all, I love both your hack as well as the example you gave of having an anchor and a time of the day, which always brings you back and remind you to do it. My follow-up question is, when did you begin this habit and the story behind that?

Tracy

Great question. So actually the Rock is from a very special place in Aspen, Colorado. My parents were married there back so many years ago, and when my dad passed away, we actually brought his ashes out to Aspen and sprinkled him in the Colorado River. So the rock is actually from that very special place. So it's a very meaningful rock, if you will, that kind of grounds me every day knowing that my dad is kind of getting me ready for the day as well as me being grateful for all the things that I have.

Rahul

Wow, what a story. God bless his soul. So you started this habit as grownup adult. It wasn't there early on. Was there something that prompted you to start it?

Tracy

In passing, I think it was knowing that he had moved on at 88 years old. He had a beautiful life. We were all okay with him passing at the time that he did. It happened in his sleep, which is a blessing in itself. He wasn't sick, he just passed one night. And from that moment forward, I realized that he was always with me, and so I knew I wanted to talk with him every day. And I know he's with me all of the time now. He and his angel friends are always here with me, and I do believe that and I know that if I can share a little bit of him with my family, my husband, my son, and my daughter, I've got pictures of them in my room and I just really look to that each and every morning and just wish them all a good day.

Rahul

I can totally relate to that somehow the birth of a child and the passing of the parent, those are events that completely change us. They bring a big transition to who we are. So what's the impact of this gratitude habit then on your life, on good days or bad days? How does it change anything?

Tracy

I think it allows me to, again, just be grounded each and every morning of recognizing all of the good things that are happening in my life. We all have problems and I believe that all problems are solvable, but I think if I wake up each morning and say, today's going to be a good day, I put on that spirit already that no matter what problems arise or conflicts that come up, life is good and I'm going to have a good day no matter what.

Rahul

I appreciate that there's both an intention that you're setting to begin with and then your attitude to how events unfold, and it's clear how that's adding a sense of agency to the vast majority of events that are out of our control. But you're deciding to have some agency for your attitude and how you respond to what happens to you.

Tracy

Well, and as a healthcare provider, I need to bring that positivity into a person's home. I can't come in saying, oh, I'm having a bad day. It's raining out and explain that to my students all the time. You need to leave your problems or your happenings at the door. You're there full force for your patients and their families. So in order to go in there and bring my best self, I need to be in a good place. So again, that self-care is so important, making sure that I'm taking care of myself and doing the things that I enjoy throughout the day and sprinkle them in. I bring my 14-year-old Labradoodle out for a walk every day because that brings him joy. It brings me joy with his face out the window, and it brings me my physical activity, a little bit of movement just to get him and I to walk. So I feel like just again, sprinkling some self-care for that health management that we talked about is so important versus later needing that healthcare that we so desperately need to help.

Rahul

I'm reminded of a quote that Beth Freddy said to me once, she's a Lifestyle Medicine expert at Harvard, thinking we are grateful to someone and not expressing it is like wrapping a gift and not giving it to the person who you got it for. So my follow-up question would be what are some of your practices to express gratitude to others?

Tracy

I think the gift of time. There's not enough of it. So not everyone in my family lives in my house. So when they do come home, they know that the hair loved sometimes too much. My son's like, okay, mom, I get it right. But making those connections, whether it's via text, my daughter likes to hang out with me. I'm on the same college campus as her, and she's like, where are you? I want to hang out. I will drop everything and go find her and to go hang out with her because whatever I was doing or the work that needs to get done, I can do it later. My husband is home and he likes to cook, thank goodness, and I like to clean up. So we have those connections of time with each other that I think you make the short amount of time that you have available meaningful.

There's one thing I did forget to add is my husband loves boating and I was always like, why do we sit on this boat? There's nothing to do. We just sit here. But that has taught me how to just sit and I don't have to be on my computer and I don't have to be on my phone. I can just sit and be, and that is such a gift because I never knew how to do that before. So I thank him for that. So when he's like, do you want to go on the boat? I'm like, ah. It's that time to just chill. And that's good for the soul too.

Rahul

Yeah. So the gift of time, the gift of your presence, the gift of love, I'm hearing all of that and I'm reminded of a couple of guests who've been on our show. One, Josh Hartzell, MD from Uniform Services University. He shared the story of a medical student who would go around on the floor or office unit he was rotating on and before the day ended, he would make sure to express gratitude to someone on the floor who had helped him in some way.

Tracy

I love that.

Rahul

And then Lisa Coplit, MD, who's also been in our show, our Dean at the Medical School at Netter shared this with me once. She said one of the things one of our mentors taught her was before the day ends to express gratitude to someone who has been kind to you or helped you during the day in some way. So I think it's not only a practice that makes one happier, it's also a practice that helps give instant feedback that's positive and behavior-based and build connection with others as well.

Tracy

And speaking of connections, I do have all of my colleagues from Quinnipiac on speed dial, and I do call at least one a day to tell them that they did a good job or I'm thankful for something that they did. So we're either texting or I'm calling them because some days are harder than others where there's just more issues going on and things and more problems to solve. And I always do take that time on my drive home to call someone or text someone, not while I'm driving to say thank you.

Rahul

I've seen healthcare professionals appreciate this a lot as well. If you go into anyone's office, you cannot miss their thank you card that a learner or a patient has given them. And so it's very obvious that the vast majority of healthcare professionals hold gratitude very close to their heart.

Tracy

True, true. I have a box that I plan to open when I am a little bit older and have time to read through them all. But when I do get those thank you cards, I have a very large box in my office.

Rahul

Yeah, good old-fashioned cards I think are brilliant because they are not going to be thrown away. They're going to be kept.

Pete

Wow. That's great. Well, thank you Tracy. These were some great hacks and Rahul for expanding on them to get the nuance out there. Thank you very much.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E10: Medicine Meets Business — Lessons from Matthew Swanson MD, MBA

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul

Our guest today is Matthew Swanson, a graduating medical student from Netter School of Medicine at Quinnipiac University. Matt began his career in Pharma at Pfizer, then switched to medical school at Quinnipiac starting in 2019. Mid-training in 2022, he took a detour to NYU Stern’s School of Business for two years to complete an MBA focusing on healthcare and finance. In 2024, he returned back to Quinnipiac to complete his final year of medical school and is now set to begin his residency in anesthesiology at Harvard's Beth Israel Deaconess Medical Center in Boston. Matt has had many interesting roles during this journey, including being a Choosing Wisely STARS leader for which he'd received a national Student Excellence award in 2022, hosting episodes of AMA's “Making the Rounds”. podcast, going on to run for AMA's Board of Trustees and medical student section leadership, re-imagining NYU's Healthcare Conference by anchoring it in public health, and many more roles in pharma, consulting, and finance. Matt, welcome to the show, we're delighted to have you here.

Matt

It's great to be here. It's a privilege. So thanks for having me.

Rahul

And with me today are Pete, Maya and Amber.

Pete

Hello.

Maya

Good morning.

Amber

Hello.

Rahul

So Matt, let's dive into this conversation by exploring your journey upfront. Tell us what brought you into healthcare and how did you find yourself in medical school?

Matt

It all started just back in high school when I was good at chemistry and I thought maybe this is something that I can do. Moved off into college and chemistry continued to be something that I excelled at. I hadn't intersected specifically with considering becoming a doctor. I was envisioning myself actually becoming a pilot or an engineer or something along those lines. I didn't think I was smart enough to become a doctor, but I was surprised myself in being pretty good at biochemistry. So I continued on in that path and probably in my third year of college I decided that, yeah, you know what? I think this is something that I want to think a little bit harder about. I was able to get a clinical research position at Boston Children's where my older sister was working in the same lab, and I did that for over a year, was able to go to the ARVO conference, be involved with posters, had my first publication, and I really found just a connection to the work that they were doing.

It was important and I love the smell of the hospital. I knew this is where I wanted to be. Yeah, I guess the biggest kind of driving force that brought me into medicine really was the loss of my mother, though it came gradually and then suddenly, so I like to describe it. She had suffered from breast cancer for the majority of my childhood growing up, and one day I was sitting in chemistry class, organic chemistry, and I got a text from my father and it was a picture of my mom. He said, I need you to come home as soon as you can. And I was at the Air Force Academy at the time and I did something no student ever does. I stood up in the middle of class and I left and went back to my squadron and I tried to find my way back home because I knew something was up, something was different. Fortunately, I was able to get home and she was being treated at Brigman Women's Hospital in the ICU and was able to see her just a day before she passed, but came kind of all the sudden. I remember being in a room in the ICU and we kind of knew how things were going to go. The situation was grave. There weren't very many options. She's already tried everything. She's been fighting this for a long time. She was tired. It was time, but I had a lot of hope. I had a lot of kind of just hope in that the doctor when they walked into the room was going to give us something to kind of let us lead the rest of our lives in the best way possible that this situation wasn't going to devastate us and ruin everything that was to come. I wanted to know, did this doctor love my mom as much as I did? Did they know that I loved my mom? Did they sleep well last night? Did they do everything and think through every option possible to make sure that we're giving my mom her best possible outcome, the best possible chance that she could have? And the doctor did that and I was really happy about that. But in the days following my mother's passing, I thought, you know what?

That's something that I can do well. I want to be able to instill that hope in my patients and not only dive deep into the books and think through all of the clinical outcomes, but love patients. I want to be able to bleed with them like their families do. And I think that's really the driving force that brought me there. So I graduated from college and I went off and worked at Pfizer. Was fortunate for that opportunity and it took a lot of people giving me a break. It seems like everything is about people giving you a break, taking you under their wings, mentorship, whatever it may be. But I found my way into Pfizer and that was more than I could have ever hoped for at that kind of situation in my life. It's a big pharmaceutical company and a great job. And I went off there and I was working on biologics, medical devices, and a little bit of market research.

It opened my eyes to the scale of impact possible in medicine and also to how broken the system was. I learned about how those biologics are priced and some of just the simple kind of back of the envelope calculations that are done to put these huge price tags on these drugs. And I didn't agree with it because medicine isn't like any other commodity. It's something that people are willing to give everything for when they need it, and it makes it a entirely different type of business. So I stayed there for two years, but I really wasn't satisfied and optimizing strategy or doing benchtop studies. I wanted to be closer to the patient and I was fortunate to be able to take the leap and go into medical school knowing that I needed to combine both of the lenses then to really make a difference. But that's how I found myself into this seat and fortunate for the opportunity now to go off and become a physician.

Rahul

Yeah, I've known you for four years now. I hadn't heard the full story up till now. Thanks for sharing that.

Matt

You're welcome.

Rahul

And what resonates with me is it starts with loss, a profound loss, and then from there you find your way to love doing this out of love, and I'm sure a little part of your mother lives in and touches everyone through you and the love that you carry.

Matt

Yeah, I think that's kind of my takeaways from it as well. I didn't grow up from when I was just a young kid, always aspiring to become a doctor. It wasn't that way. I come from a military family. I wanted to be a pilot just like my dad and go off and serve my country, but loss is the one that connected me to I think my true calling, my true self. It's the blessing in disguise because loss can fundamentally, it fundamentally changes us and makes us bleed a little bit. You have to build resilience in order to learn to cope with that, because more loss is to come throughout our lives, but you build that resilience and you can build yourself then into some better version of yourself, and it's this continual state of evolution. I think now looking back, it's hard to say that you're ever fortunate to have lost your mom or to have gone through this trauma. Whatever I say about it, it was a blessing in disguise for me that got me to where I am now and my mother still is with me. I find her on my shoulder every time I walk into the hospital. Every time that I go into a patient's room and I talk with them and hear their story, it's like I'm listening to my mom. It's like she's right there with me. I think that she's proud of me.

Rahul

She sure is. Yeah, I can relate to that when my dad passed away since then, I can feel the same. It's happened gradually, but I can now see a little bit of him in everyone. Same thing with my kids. I can see a little bit of them in everyone, and it helps to just connect with everyone on a human level. So it's 2019, you come and join the Netter School of Medicine and then COVID hits in 2020 and your dream experience suddenly becomes very different. You still persist through it and go into second year of medical school. Tell us how you decided then to mid medical school leave and go do an MBA.

Matt

Yeah, I had already been familiar with the issue of cost of medicine. I was still in my parents' insurance, so I hadn't experienced it personally up to that point in my first year when I was first then kicked off of that insurance, seeing the bills for myself and witnessing patients not coming up to their appointments because they couldn't afford that bill. So I thought from that beginning year that the cost of medicine is really the most urgent clinical problem we're not trained to solve, and I needed to get some more tools in my toolbox to help create solutions for it. I had been involved with the American Medical Association specifically to think about this problem. I needed to leverage the resources that were afforded to you in that institution to try to create some momentum for change. However, I was always up against a wall.

I had the medical background to think about those types of problems. But when you're coming down to the financial incentives and financial problems, you need to have a different member of your team that's an expert and has credibility in that space. So they wanted me to bring different people onto the team. While I had continued to think it's really difficult to explain the clinical repercussions to a finance person and for the finance person to explain to me when I don't know the language, the financial repercussions to create some kind of synergy for positive change and positive policy that ultimately wouldn't just get voted down by the house. I thought really the best way for me to do this is just to go out there, get the skills myself, and then take the time required in order to do this. Right. So I'd been thinking about it for at least those first two years, and I went off into my clinical year over third year and trying to now observe problems that I was seeing on the wards that I was seeing with patients throughout all of the different mandatory clerkships. I think I studied for the GE at that time as well, and it was pretty demanding to try to

Figure out how I was going to apply. But ultimately I did a lot of this kind of in the shadows in the dark because this is a new path. This isn't something that people do in medical school. You just are trying to get through it and get to the next side. But by the time that I had gotten my acceptance to NYU Stern, that's when I called in Dr. Boatwright and I kind of talked through this a little bit more with her so that she could understand my priorities, but I could also understand the priorities of the medical school, and it was only ever supportive. And if I have only one regret, it's that I would've started these conversations earlier and kind of tried to get as much feedback as I could from the people that really are the most invested in us, our teachers right here at Quinnipiac. So I went off and tried to learn what I needed to learn in order to think a little bit more about cost of medicine and why it's so expensive here in the United States.

Rahul

And then you've come back and finished your medical training now and you're having a happy ending to that story and after residency and anesthesiology. So, congratulations.

Matt

Thank you. Thank you.

Rahul

What we want to bring out from this episode for our listeners is what you learned from your experience doing an MBA that every healthcare professional should know. Not every healthcare professional has a chance to do an MBA, but they have a chance to learn the lessons from you. So tell us what are the things that you've picked up in this journey that everyone should know?

Matt

Yeah, it kind of really rewired the way that I think about problems, about solutions, about people, about institutions. I stopped asking what's the right answer? I started asking, what's the best kind of move given the trade-offs? Trade-offs to everything, there's consequences to every decision that we make good consequences and bad count consequences. So keeping in mind the trade-offs, I learned to see healthcare as a web of incentives, capital, and stakeholders, not just as a system of care. And I learned to build teams to pitch ideas and to move fast, which medicine doesn't always teach. I also kind of got to rebuild NYU's healthcare conference that you touched on, and I centered it around public health by inviting the New York City Health Commissioners for two straight years. And I think it taught me just how much people want to engage with big ideas when given the chance.

So it's not only you that's kind of serving your patient, it's an entire team of people and I think a lot of people are interested in trying to shake things up here and there to dream big and to do whatever they need to do in order to fix whatever's broken with how we're doing things right now, regardless if you're in the middle of a city at one of the best academic institutions in the world or serving in a more rural setting with your own different set of problems than might be experienced here in the northeast. But it taught me to give people the benefit of the doubt, take big risks, and I think that people will come and support your mission.

Rahul

So one of the things that I'm hearing from the path you took and what you said is do not be afraid to take risks, to have the courage to make your own path. And you certainly did that by leaving med school, middle of it and going to do an MBA and then coming back. What's the biggest fear when someone chooses to create their own path? What was your biggest fear?

Matt

There's a lot of uncertainty around it. You have a pretty safe road ahead of you. If you just do what others have done, you continue to walk that trodden path that's laid out in front of you. Everyone will always tell you just do what they've done, what kind of, I think a part of mentorship is trying to teach people the struggles that you face, they don't have to face themselves, and they've kind of found the answers that you might've found along the way as well. So in some ways it might be really challenging to break that idea that we have for ourselves. I think the biggest challenge for me is that there's also a lot of financial consequences to taking the road less traveled by. For me, it was two additional years as a student before residency, which ultimately accounts to two less years of physicians earning income, and I'll never get that back. And there's some things that you may never get back in taking risk, but the downside potential to taking big risks is also mirrored by the upside risk

And they're proportional. So if you're taking risks that you've justified to yourself in the moment and you have no regret, you're doing the best that you can, you're putting in the work, you'll capitalize on that upside risk and you'll make it work for yourself. I think that just being scared that I didn't have people that I could talk to about these types of risks because they hadn't personally taken them for themselves or they hadn't taken this path before. But you have to keep your head down, have confidence in yourself, and go for it. We're a risk averse type of institution in medicine and trying to have some tolerance for risk is what I think makes you into a great leader and also opens up an entire world of opportunity for you.

Rahul

Very true. So lesson number one, don't be afraid to take risks and create your own path.

Pete

What I've seen in my life and my experience is physicians usually go after they’re done, when they're an attending and they're like, Ooh, I need to learn more about business. Really what's driving a lot of decisions. And you're out way ahead of it, and you're like, I'm going to pause, go get, and you're taking a whole nother lens forward, which I commend you. It's a breath of fresh air and the way you're thinking is systematic. And I think that way too. I'm like, the system's broken. It's not people as you see, you can bump into a lot of people who are still thinking, let's fix this. And it's really just having that drive and the consensus where you get enough people and you hit that critical mass and change starts to happen, of course.

Rahul

Alright, so let me bring you back. What are some other things that you learned that you feel everyone should know now that you're back on the healthcare frontline?

Matt

Yeah, so the first is don't be afraid to create your own path. Next is you should really learn to negotiate. It's whether you are advocating for a patient, hiring a team, or renewing your contract. Negotiation is a clinical skill. I learned frameworks for how to anchor, reframe and find alignment. And I've used those skills more often than I've used the Kreb cycle. And I don't think that very many of us have used the Krebs cycle very often, but I think that we have a bias towards salespeople from our own personal experiences with them. When you walk around a shopping mall or you go to buy a car, but sales is all around negotiating, finding some kind of common area with who you're talking about and trying to make the outcome not only good for yourself but good for them as well. So learn to negotiate. It'll help you deliver better care for your patients, but also help you find better outcomes for yourself as well throughout your own personal career.

Rahul

Let's unpack that a little bit because as an infectious disease specialist, I felt every single patient I saw is a negotiation really, whether you're the primary and others are feeding back their recommendations to you or you are the consultant and now you have to influence the team to do what you think is the best thing in the patient's care. It's a key skill. So tell us what makes you think this is a key lesson? You've been back in healthcare for a year, what does this look like in practice to you? Does anything memorable come to mind from the last year where you used these skills in negotiation?

Matt

Yeah, I think that, I mean, I'm on neurology right now and patients are, they're upset whether they are in pain, they're having headaches, whether they have a demyelinating disease and now they have symptoms or they've had symptoms for a long time. They've tried all of the different medications that are out there and now they're just tired. So now I'm just another person, another medical student that they have to talk with to share their story over again. It seems like every time that they come in, all they do is just share their story over and over and over again. So the first lesson is just listening and encouraging them to be open. And we learn in medical school, one of the best ways that you can continue a conversation with a person is by staying silent. I think probably on my psychiatry rotation, that was one of the focal points to continue conversations with people, stay quiet when quiet doesn't work, use a little bit of body language with a head nod or something.

Let them open up because then you'll start to get an understanding to what their goals really are. What are their chief concerns, what is the primary complaints that they have that we can help with? So the first thing you have to understand is what really is the problem and what do they want as a solution for it? Can we help with that? Can we help close that gap and figure it out? But you also have to understand that there's going to have to be some level of compromise on both sides of the table. So whether it's me compromising and trying to get through a really long detailed history in just 15 minutes of time, or them not wanting to share their story over and over again, but willing to do so, I think then it goes off into treatment. And this is definitely another hard space, hard nut to crack.

These patients have gone through other treatments before and they haven't worked. They may have their own idea of what they need from chat GPT, from WebMD, from online resources, from other doctors, from family and friends. So I think a lot of it is listening to what they already know, what they think is going on and responding to that directly, but in a manner that doesn't make them defensive, responding to it, providing some level of evidence for why we're going to do something different or why we're going to go with what they already know is the right way to go. Listening is the biggest takeaway from negotiating. Well, yeah.

Rahul

This reminds me of the interest based bargain gaining that they teach in law school, Fisher and Yuri, getting to Yes. So number one, separate the person from the problem, which is saying that you're really listening with empathy and you're not categorizing the person just because they have a difficult problem that you can't solve. The second one is focus on interests, not positions. And then the next step is create options or invent options for mutual gain. So what are all the things on the table that we have not even discussed yet beyond this one position that is different on each side? And we don't really train healthcare professionals on negotiation. We train them on frameworks for communication, but it implies that what you have to say is the right path or that the patient will agree with. We never really train them formally in healthcare focused negotiation.

Maya

Then we respond with language like adherence and non-adherence. The work that I've always been asked to do as a social worker is patient isn't doing the thing we've told them to do, and now it's our job to negotiate or really to convince. And so instead thinking about, wait, let's really slow down. Listen, let's actually hear what's going on. I've done a lot of rare disease work and done some work with pharma as well. And when I really talk to patients, what I heard is we're not trying to be non-adherent, finding the treatment tolerable. And we keep telling our teams that it's hard to tolerate that. It makes us feel sick, it makes us feel tired, it has side effects, but if no one is listening or there's no change, what do we do? It's easier to not comply and so much of our role in healthcare is trying to convince folks that, well, here are the things, the steps you need to follow to maintain or regain a standard of health that you want. But it's often it is a negotiation. It's interesting to frame it that way.

Rahul

And it also reminds me of the part two of negotiation, which is the follow-up after the first deal has been made, which is I think so critical in healthcare where if we've chosen one path, maybe it's path A or path B from whatever we've discussed, how does that follow up in the next few days or weeks or months? So that if path A does not work out, we've negotiated that now we're going to go to path B and we're both invested now in making sure that whatever path we chose together is going to be the best and work out.

Matt

Yeah, I think that makes a lot of sense.

Rahul

The other thing, I think any patient or if we're talking about education industry, any student, the biggest thing that matters to them is are we all on the same team? Are you on my side? Because really it's the healthcare professional at the bedside who has the patient's back, and I think that's the first and starting point for even a conversation to begin. One more thing that came up when we were chatting before this episode was how you keep in touch and connect with the people in your life, and that's a lesson that got amplified in your business school training. So talk about that.

Matt

Yeah, so recognizing the power of networking, it's something that's been important to me even from the beginning of medical school. But at Stern I saw how relationships move ideas forward faster than resumes ever could than anything that we have in our background in medicine. I think we need to stop thinking of networking as transactional and start seeing it as coalition building. I've been able to collaborate with leaders across tech, policy, care, delivery, but really the only reason I was able to do that was because I wasn't afraid to ask for a conversation. So it's about those coffee chats, those informal settings where you can just kind of both build trust with each other around talking about your values or things that are important to you, your background. Because ultimately everyone offers something that we might not, everyone's an expert in something and you run up against a lot of problems and issues and questions in healthcare.

It's nice to have a phone book of people that you can call up for a curbside at any time of the day, regardless if it's a financial question that's a patient might be up against legal opinion about something quick or probably more frequently a medical question. I think speaking back to this neurology clinic I'm in right now, I see the provider there whenever he's up against a question, he has a phone book of people that he can call and it comes through taking advantage of all of the diverse settings that he's trained in. He has connections all over the country that are all now experts in all of these different very niche areas of neurology that he can call people up and ask the question. It makes things faster for the patient and ultimately then delivers a higher quality of care for them and better satisfaction because they don't want to be bumping around and having delays and delays going to consults or follow-up appointments.

They want to know what they need to do right now. And leveraging the power of a strong network can allow us to do that. But then also just personally, so there's a lot of different opportunities that I think are difficult to envision for ourselves when we're in medicine. Unless you're considering alternative paths just immediately, unless you're doing different degree programs, unless you're talking to as many people as you can and you might feel as though eventually in your career you get burnt out, that there might not be an exit for you because you're too far along that this is the only thing that you could ever do and that's not the case. And a strong network reminds you of that. There is always a need for a medical doctor, a clinician, any person, and a whole range of different industries. So reminding yourself of that so that if ever you feel burnt out or you can't go on that there is always something else that you can be doing and you can find satisfaction in that as well. There's always hope there. Burnout being one of the biggest forces in this country right now. And also globally, people have to remind themselves of that, that there are other options for you. Another reason why it's good to build a strong network.

Rahul

Yeah, I think of a network now as traditionally, it used to be that you are employed and supervisor, maybe it's your program director or your department chair or chief are the ones guiding you through your career. But now I think of your personal board of directors. These are the 3, 4, 5, 6 people who are really close to you over the long term and know you well and can guide you through difficult times. And then there's the circle outside it, which is all the people you care about and care about you. Maybe it's from past interactions or from your present position. And this becomes your network of caring

Maya

In listening to what you're talking about and the networking and the mentorship pieces. And I was rereading from our prior guest from Josh, what he writes about sponsorship instead of mentorship. And that idea that for each of us, what's done for us also, hopefully we are doing for others in our networks, but always providing those connections and those links to kind of the next thing, or this might be the person to talk to. And even we were doing it here today when we were informally chatting and what students know, other people and other faculty and oh, this person might help you. All of those little connections are ways that we do that. And then I guess as we rise and unquote rank, we have more power to do that mentorship piece. There's a gap, a power differential there. Whereas sponsorship, anyone can do it. I can say, Matt, you know what? You've been talking about this. I know so-and-so at Deaconess, I can give you some connections to go and talk to. I actually do know people in neurology.

Matt

I love that networking right

Maya

Now. I was born there too, and there's a whole other story there about me in Boston and Deaconess, but thinking about how we bridge those gaps and also this speaks back to relationship and the value of human relationship that is not going to be replaced, could be helped maybe by technology, but isn't going to be replaced by that.

Matt

Of course, it's an important reminder as well. We can all be sponsors, so we can always look for avenues to help others. Sometimes you always have this, some people especially in medicine, have imposter syndrome. It can't be me. I'm not ready yet. I'm not the right fit, I'm not the right background to help them. Please speak up. We're always afforded the opportunity to be a sponsor for someone. Just remembering that going forward, putting it out there, helping them, I'm sure that they'll appreciate it and pay it forward themselves.

Rahul

Yeah, with great power comes great responsibility. So any listener, if you're in a position of power, it's your responsibility to open doors for others, sponsor others.

Amber

Matt, thank you for sharing. Thank you for being here. Everything that you've said has resonated with me in so many ways. A little bit about me that I'm going into emergency medicine, that I also sit on the board of directors for a national organization, the Latino Medical Student Association. So a lot of the things you said about risk taking with decisions when you're representing a company or an organization that really hit home, a lot of things that we do are involved with policy and advocacy and being a change maker in terms of vulnerable patient populations. So I guess the question for you, I mean, I'm also interested in getting an MBA in the future, and I wish I had done it in between medical school because now you have this unique perspective moving forward, right? You already have the background and you're learning every step of the way now moving forward with this lens. So I think that's amazing that you were able to accomplish that in medical school. For students who have not gotten their MBA or have not had some professional training in terms of policy or change making or financial literacy, any of these things, how do you recommend we educate ourselves?

Matt

Yeah, no, I think it's a great question and I want to say it loud and clear. I don't think that an MBA is for everyone. And you can build that toolbox for yourself without going through a formal education, without taking those two years off to do it. I think there's a multitude of resources out there to learn more about personal finance, and there's people that want to help you as well, whether it be the white coat investor or whether it be watching lectures on YouTube. So for example, Dr. Anand, we talked about a famous evaluation professor at NYU Stern before I began. His name's Professor ETH Odin and they call him the Dean of evaluation. He makes all of his lectures publicly available on YouTube and real time, not only the lectures, but then also the exams and projects that the students are working on. And he also has a group chat that everyone throughout that semester can join. And it's a large commitment, but if you're trying to get to the level of an MBA student in understanding finance,

For example, one of the top finance schools in the world, you watch those YouTube lectures, and I love that it's publicly available in that way as well. So learning finance, it can be a difficult learning curve, but once you get over it and you learn the jargon that everyone else uses, then you can talk confidently about it and people will believe you and unfortunately they'll believe you whether you're right or wrong about what you're saying. And that's, I guess the one caveat. So a reminder to everyone, when people are talking to you about finance, more than likely they're acting as if they know a lot more than they really do about things.

Rahul

I've heard there's more fairytales written in Excel than inward.

Matt

That's right. But honestly, you should begin getting involved with leadership as soon as you possibly can. So when I started medical school, I didn't have any of this background yet, but I thought that I wanted to get experiences for myself that range both locally, nationally, and globally. So I always use that type of framework when thinking about leadership. So what can I be doing at my medical school or at my hospital now as a resident? What can I be doing nationally in these organizations? And then are there any global opportunities for me to get involved? Because there's different pain points that you'll witness and you'll experience in looking through all these different lenses, but then it also changes the story and your flexibility in approaching those problems moving forward. And an MBA really is supposed to teach you about case studies about problems that leaders have faced in a whole range of different industries and how they work through those problems.

In a long case study published by Harvard Business School. So you can buy those case studies for yourself as well, or you can go out there and you can personally experience it and make the case studies yourself. I think you can think about these voluntary leadership organizations. You can also think about starting your own business and being empowered to do that. When you find a problem and you validate that problem amongst the people that it's most influenced by the people that will be your customers, you might have enough of what you need in order to build something successful. So in my first year of medical school with a few of my medical student peers, I tried to create my own business and it was called Comet Health Ventures. And because at the MetCom at Mountain Range here, and it was around trying to create a digital health passport just because we are in the heat of COVID. Unfortunately, a few months into building that nature, published an article, the Top 10 reasons why basically this specific idea wouldn't work, how it will drive inequity across both our population here in the United States and globally. So we stopped everything, but we learned a lot of lessons from that. And moving forward, I went to pitch competitions with more Quin PX students and tried different ideas. I went to Singapore and I tried to create a business that was similar to Doximity because the pain point that I found there was that doctors felt siloed.

I knew that they had also felt siloed here in the United States. So Nate Ross from Doximity built Doximity back in 2010 to solve it, and I think it works pretty well. And now they're public and doing great. The issue remains in Southeast Asia and then in business school thinking through PBMs, how can we make costs? How can we reduce the cost of medicine in the United States? Is there a way for us to cut out PBMs? So I started a company called Med Block, and it was specifically around trying to cut out PBMs, and it's a long, long range in order to try to build that out, but it's going to take an expansive network in order to build the relationships to find solutions for these misaligned incentives. But we're working towards it, and blockchain allows us to do that by cutting out middlemen specifically, and then finally fund my cure. And that's my kind of latest project that I'm working on now. So how can we provide alternative sources of capital for people building and researching curative therapeutics specifically for rare diseases? We need to create solutions. So think outside of the box, build, build, build, build. You can. You know what the problems are, so just go do it. You don't need to have an MBA to do it.

Rahul

Thank you. That's wonderful. Well, one of the things I am taking away from this conversation is to find what you're passionate about and then have the courage to take risks.

Pete

I'm taking away never to give up hope. I've let the system beat me down a little bit, got a little jaded, and I mean, both of you are a breath of fresh air. And I don't know when you sleep, Matt, you got so many things going on in middle of med school, you decided to go to get an MBA, I'm in awe. I'm just like, wow. But it also inspires me.

Maya

I really appreciated, you said something early on about how getting the MBA changed your lens, and I think just that reminder that we always need to be open to that possibility. I mean, I feel like all the leadership work that this team has done in the last three years has changed my lens in both academia and in healthcare. And I think whatever professional silo we are in or discipline silo, we're in the ability to say, wait a minute, what else can I learn if I look at this from a different direction? And the incentive piece you mentioned about healthcare, that's going to keep spinning in my head for a while. So thank you for planting that particular seed because now I can again think about how that functions both with patients, but also in our larger systems.

Matt

Yeah, I think that you bring up an important point. So something that was really on my mind throughout my entire life is that I'm living with blinders on how am I going to attack those blinders, break down barriers and boundaries between people or my ideas about things. And I think that we all need to continue that fight, whether it be, whether it mean continuing education, doing other types of things, new experiences or traveling, talking to as many people as you can, putting yourself out there, taking risks and putting yourself into uncomfortable situations because growth comes from that. The blinders open up and you can see the world more clearly. I just want to see the world more clearly.

Maya

Well, it's also why diversity and inclusion matter, right?

Matt

Exactly.

Maya

Because getting in perspectives from everyone around you.

Matt

Of course, of course.

Amber

I think one of the take home points for me is I've been working on how do I separate personal from work moving forward? I am like, okay, my family is here, my patients are here, and I have them in two separate boxes. But I think it's been really inspiring to hear how you have been vulnerable in overlapping those two things and really seeing your family through your patients and embracing that. And so that's something that I'm really going to take with me moving forward from this conversation.

Matt

I appreciate that. I think one takeaway from the MBA is that I know healthcare is not like any other type of business or any other type of industry, and it can make you, it's not easy, but it can make you a better provider, a better listener, a better person for your patients. If you're able to blur those lines a bit, if you can really demonstrate that you love them, you love your family, and patients need that sometimes, and what do I know? But, eventually, hopefully, learn that a little bit more as we go.

Maya

We all need that, sometimes.

Rahul

Thank you for that, Matt. What a great conversation this has been. I've learned a lot from it, and I know our listeners will learn a lot too. Thank you so much for being here with us.

Matt

Thank you so much for having me.

Rahul

For anyone who wants to stay connected with Matt, you can find him on LinkedIn and Twitter at Matthew J. Swanson, our listeners, we'd love to hear from all of you as well, what resonated most with you. Share with us, let us know. Thanks for tuning in. Until next time, take care and keep leading and learning.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E9: How to Pitch with Dr. Andi Cooley, DO

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul

Welcome listeners. Our guest today is Dr. Andrea “Andi” Cooley. Andi is a cardiothoracic surgeon and founding faculty at UT Tyler School of Medicine, where she leads clinical clerkships and simulation and works on tech-enabled change and innovation. Andi presented a high stakes pitch at the UT System AI in Health Care Symposium in 2024 that changed her life and probably that of many more people underscoring her commitment to re-imagining healthcare using design thinking and technology. Andi is a Harvard Macy's Scholar and Faculty and teaches faculty from across the world on how to pitch so that your ideas get adopted. Andi, welcome to the show. It's a delight to have you join.

Andi

I'm very, very excited to be here.

Rahul

We are too. So, Andi, let's just start with your personal journeys. Tell us what brought you into healthcare. How did the journey begin?

Andi

I think the theme in my healthcare journey is to never say never. Pretty much everything I've ended up doing are things that I said, well, that'll never happen. So to start, way back was really interested in sports medicine, athletic training. So I went into that in college as my major, but I'd never go to med school until one day I had one of my athletes get injured and something I could not fix. His ankle was pointed, the complete wrong direction. So our orthopedic surgeon happened to be there, and as I was holding his ankle in place, I said, oh, I want to be able to do that. So I decided to apply to med school. Going through then I liked surgery, wanted to be ortho, and then said, you know what? I actually like something really fast paced and high stakes fit my personality well.

So leaned into trauma. I ended up going to a general surgery residency for that, and then partway through there I said, you know what? I don't know if that's really what I'm looking for right now. Try a bunch of different things. And then I did a rotation in cardiac surgery and said, oh, that's the longest training. I never will do that. But then it kept speaking to me and I couldn't get away from it, and I was like, well, that's what I'm doing. So I ended up doing a cardiothoracic surgery fellowship in Dallas, and that was a three-year fellowship. I also did heart and lung transplants and had the opportunity to rotate through pediatric cardiac surgery. I said, oh, I don't need to spend any more time. I'm already a PGY eight, so I'm going to go ahead and actually get a job. But then I really liked that.

So I did another year of fellowship. So finally after nine years of post-grad training, I decided to get a job, ended up out in Tucson originally and then came back to Texas here to Tyler to practice where I was in practice for about eight years. Had really a frontline look at health disparities in the rural population and just dramatic difference in what we had available here or what we have available here compared to 90 miles west in Dallas where I trained. So that opened my eyes heavily. It also came to light really of this big discrepancy in the access to care here at the attention of the state, and that's when the UT Tyler School of Medicine was getting developed. So I got a little bit involved in that, said, I'm going to operate until I'm 75, but I'll help. And then got a little bit more involved in that and said I would never switch to academics.

And then lo and behold, three years later, I have now switched over to academics completely. I'm the, like you said, assistant dean, but I'm over the clinical rotation, so basically the third and fourth year, but really leaning into how innovation and tech and AI can change our region and rural health in general. We talk about being able to build up the workforce, but that takes decades and we need it to be faster. We need to catalyze the change. And really we're at a really fortunate time in history where technology and AI has come through where we can actually do something about that and combine with technology to really have this force multiplier both through our region. So that is where I have ended up with a whole bunch and I'll never do that, and that's where I landed.

Rahul

I love listening to that. So what I'm hearing is Andi Cooley never say never. Something comes up, a unit of exploration, opens a road, opens up that channels into my big why, and then I am open and flexible into adapting to it and finding a new path. So what is the why behind all your work then?

Andi

I think really seeing where I can make the biggest amount of change. There's a lot of things and I see this especially, I mean as a surgeon, very plan everything. It's a very type. So my normal personality would be just to keep going toward this is the plan, this is what it always has been, and I'm checking things off my list and going. But starting to see, and this is advice I give a lot of students and residents that you can be good at a lot of things. You can like a lot of things, but there's something that's very unique to what only you can do. And this is actually the advice that I got from one of my academic heroes, Martin Pu, when I went through Harvard Macy the first time, and he said, don't focus on the things a lot of people can do because doing them focus on the special things that drive you and that you can do. So I think that's really my why of I loved operating and I loved helping those people, but then moving toward education, I can help and amplify that even more. And then moving on that care side to be able to amplify as well, even more. So I think that's really pulling my passions and then that drive together to make change.

Rahul

What a great story. So it's connecting your why with what you can uniquely contribute to the world to make it better. Fantastic. Pete, Maya, any reflections?

Maya

I'm just really loving the story of your journey, Andi, and especially that movement from clinical care to academia and that ability to, I've been caring for these patients and I also come from a pediatric nephrology background and rare disease background, working with these sort of far-flung populations and then how do you move into helping others amplify that, amplify that work, and to reach a broader group? So I just love that realization and I think you can't have that realization at the beginning of your career. Our early students may not be able to see that yet, but staying open and being able to say, wait, where is this drawing me? And yet there's something still key about what's important to you.

Andi

The big pulse too, and will, I mean honestly goes into how I give pitches and I think why they're gaining some traction on some of these bigger moonshot type projects. One of the reasons I said I'd never do academics is that was not my background. So I am not a researcher. When I went up for promotions, they said, well, you can put your papers on here. I was like, oh, there it is. My one, it's right there. So that's not the style of productivity that I have. And so I thought that would always lock me out of these opportunities, but that's such a blind spot I think in a lot of the fields is what are the boots on the ground experience, not just what's the scientific discovery, how do we get that discovery out to people and to the teams and to the patients?

So I think seeing that that is very valuable and that can be a really great area that counts. This is academic productivity and it needs to be published and it needs to be presented. It was very eyeopening because I just always kind of thought, well, that's not my cup of tea, but it hasn't been the cup of tea, and that's why there's a big gap in disparities out there. So I think that's again, the right time for these things to start coming up. So I'm pretty fortunate that it's aligning with where my career is right now.

Rahul

You make great points that applying things so that they're reaching our patients and learners, integrating them across disciplines and engaging with and benefiting the community. Those are such rich areas of scholarship that are not traditionally given as much attention and are given now are being given now. So Andi, I attended your session at Harvard Macy on how to pitch, and it was so impactful that by the end of the session one of the faculty commented that it felt like you were a tree with roots growing into the ground. That's how much people love that session. So let's dive into how to pitch. Can we just start with saying what is a pitch?

Andi

We definitely can because I think through the years, what if my understanding of what it is has really changed? Initially you think a pitch is something where you're sharing an idea and this really cool thing that you've come up with and it's going to be great. It's more of a show and a tell. So you're trying to get someone to see this idea that you have and be just as excited as you are. So if it was just a presentation, that would be fantastic. But the difference on a pitch is you need them to engage and you're trying to sell something, right? So sometimes it's because you are literally selling something, you need resources. Sometimes you need their permission to move forward. Sometimes you're teaching and you're trying to sell to your students. Now you really need to learn this. This is going to matter later in your career to understand in this depth, and I'm selling that you need to spend your time on this instead of the 20 other things you need to spend your time on. Sometimes you're selling the idea that to the frontline teams, you are very busy. I need you to add another protocol and more clicks on your workflow. Why does that matter? So the idea though is that you need, you're engaging them so they not only see your cool idea, but that they are invested in it personally. Sometimes that figurative and sometimes literally

Rahul

You make an interesting point that in business pitches are a lot about selling something, but in healthcare a lot of times it is about ideas and having the other person listen and understand why this matters to them and we understand why it really matters to them and then move them into either engaging with the idea or doing something that would collectively move us forward.

Maya

I'm just thinking what I'm really hoping to learn as we proceed in this conversation is that engagement piece or are we pulling folks into those ideas and letting them feel like it's a worthwhile investment of their time? Energy?

Andi

I found a lot of the tools really with educators crossover. So active learning strategies, self-determination theory, those type of things that we're used to on the academic side and the medical and healthcare education side really play into the underlying it's human behavior and across the board, whether it's business or tech or education that applies everywhere, but I feel like those who are students and are used to receiving those techniques and then the faculty who are used to delivering those techniques almost have a foot up of just learning to apply it in a different setting. That makes sense.

Rahul

Yeah. So Andi, when I began listening to you in your session, my frame of mind was very eye centered. This is my idea. I am pitching and I want you to do X for me, which will mean that my pitch is successful, but you really flip that on its head. So tell us, what is your big idea when healthcare professionals are pitching? What is the biggest thing they have to keep in mind?

Andi

I think the thing that keeps it from being, here's this really cool idea and you start explaining it and then you start seeing their eyes glaze over and they're missing the details and you're like, oh no, but this is really cool. The thing to flip it is not necessarily what your big idea is, but how you can use that to solve their problems. So you're engaging them, but there's different layers of how you do that, but you're not just asking for them to give you whatever those resources are because they also have, again, 50 other people asking for those resources. So it's just another almost burden for them. Even if it's the coolest thing on the planet, it's still a risk. It's still resources that have to go out. It's still their time. So it's a zero sum game. Usually if they're giving that to you, they're not giving it to someone else. There's politics involved with that as well. So how can you flip it so you're actually using it to also solve their problems that may not appear to link on the surface because then they have a lot easier path to say yes, and it's taking things off their plate.

Rahul

That sounds great, but I'm going to need your help to learn how to do that. So how do you begin to unpack that so you are able to understand what their problems are?

Andi

So I think it's really kind of looking through different layers of things. So typically when we start, think of when you're writing a PowerPoint for whatever it may be, we all have a standard order we go in. So say it's about a patient, you start with here's our background and demographics, here's our epidemiology, here's the pathophysiology, here's the history. So we go through this pattern automatically it's kind of shutting off. Same thing on a pitch. You start with here's the idea and it's flashy and you might have things popping up on your slides and cool transitions and animations, but really the hook to get someone invested not just intellectually, but where they feel like they are a part of this is you want to frame it in a way that can inspire them but then empower them at the same time. So the inspiration comes around really with starting with what the problem is that you're solving.

What is the big reason I'm doing this? And a lot of times it has to do with patient care or the students aren't doing well in this area, or we want to help them here, whatever those things are. So really what is the big reason and the goal of your actual innovation and then start pulling in how they can be a part of making that happen. So you're not just asking 'em to saying you can do this and help here. When we're looking at that, how we would empower 'em kind of a couple of different ways, but how you interact with the audience that you're talking to, you really want to start drawing in their ideas. If they make a comment, I was encouraged like please speak up. Especially if something, either you want clarification, but especially if you think it's not going to work or there's a problem here, I want to know because whatever reason it may be.

But when you start saying they make a comment and you lean into it and you're excited, you're like, yes, that's amazing. I don't care if you've already thought about that and planned it and it's been a that's not going to work. You're still engaging and processing it through with them and saying, yes, we want those ideas and your input is valuable and your expertise and your perspective. So this is where some of that design thinking starts. It's more of in the pitch, you're actually gathering their perspective and that empathy with that. So that's starting to get them involved. So I know there's some psychology related to that. The more they feel like they've given a little bit here and they have some stake in the game, they're already more likely to start wanting to see it through and then to help make it happen together.

So is co-development a collaboration, not a I'm telling you or I'm asking you, but this is like how can we do this together? On the other side of that, I think really using that if you have not been able to do it before. So preparation is a key to figure out what are the thorns in their side, what are their frustrations, what are the barriers? But even using that in the moment to try to start getting that information and that kind of gets you ready for the next steps after you've gotten through that why that we're doing this, here's the why, here's kind of just a bit of my idea so they know what we're talking about, but then you're really going into the next pieces that have to do all of them.

Rahul

I love that. So to reflect what I'm hearing, the first part is to begin with inspiring. Share the big why, who we are doing this for, what is the big idea or goal here? And then empower by drawing in and co-creating. So one of the things that I heard in empowering others to share their ideas is if they do share an idea, then lean into it and have them co-create with you what the solution might look like. And secondly, to draw them in if they haven't put their ideas out, ask questions that may have them share their perspectives. So how do you do that? How do you think about questions that would be appropriate to draw them in?

Andi

So this is where it kind of feels like a cheat code, but this is really I think where chat GPT and other similar, not endorsing just one, but other similar AI tools are very helpful to really figure out their perspective. So one of the things I like to do, especially when I get nervous before some of these and depending on who I'm talking to or how big the audience is, this is definitely not my background. This is something I've had to grow into and learn is to figure out who is my audience of one, who is the one person in the room that I'm speaking to because it makes all of the other pieces fade away. So I prep for that one person. So it may be my dean, it might be a third year student, it might be a CEO of a tech company, it might be a philanthropic donor.

So as you're trying to figure that out, one, think of the things that matter to them. All of those are very different. If it's business, they're worried about the return on investment and the risk of the situation. Dean might be more concerned about, well, is there an educational impact? Or you just out there doing some weird things along the lines, students we talked about why does this matter for me when I'm a resident versus I have to study for this test right now. So really figuring out what that one person is and prep work with chat GBT of saying, Hey, this is my pitch. What do they care about? And it's really good of having that conversation there and practicing there of things that may come up and how to talk. The other thing too, I said lean into what they say. I mean that in too the interest of it, but also physically.

So your presence of how your mannerisms and your nonverbals are of literally walking, if you're standing, especially not to stand like a statue, you're kind of moving around a little, kind of gets the energy up in the room, but you literally, when someone's talking, you hands together so it's not scary and lean forward and listen to them. And then this is very difficult for me because my thoughts move a million miles a minute, let them finish. So I tend to interrupt people as I think I already have about five times today, but then also purposefully pause because otherwise it sounds like you were just waiting for your chance to talk. So I had to train myself to do this. This is not natural for me at all to literally count in my head like 1, 2, 3, make sure my face looks like I'm considering it even though I know I'm counting in my head and then move forward. Now some people are very introspective and they're great at that side, a skill I was born on, so I've had to learn that piece of it.

Maya

We talk with our social work students all the time about learning to sit in silence, to wait and not offer. And that is a really challenging thing to do, especially when all that energy is there. I've got this great idea, I want to share it. What you're talking about is so fantastic though, when thinking about how do I structure this so that my audience and that audience of one can really feel invested that

Rahul

Yeah, I love a couple of things. You said one of them, and listeners may not see this because it's audio podcast, but Andi literally leaned in and we could feel the energy in the virtual meeting go up as well. So you can do this virtually as well, but physically lean in and then the power of the pause so that you're letting people reflect on things, let it hit home, give them the chance to say what's on their mind first instead of being very eye centered. I also appreciate how you're bringing in concepts of relational leadership where now this is a co-creation and a dialogue between the two of us, not just I talking about my pitch and systems thinking, working with Chad GPT to bring in interpersonal and systems perspectives so that we can open up our blind spots and create better solutions.

Andi

I think that's one of the really just great benefits I've seen through Harvard, Macy of being able to do the program that looks at systems and the program that looks at design thinking, because I think they absolutely go together. Whereas on the surface it may seem almost opposite. One's a complete drill down to personal experience, and one is the entire infrastructure you're building, but just the concept of an ecosystem and having to really get out to the edges for anything disruptive is just that key of your targets you will have for a pitch are related to the ecosystem. What are all of the different sectors, even if it's within one setting, a hospital still has multiple sectors. There's departments, there's different health professions, there's different administrative pieces, finance and regulatory and safety and all of these things. And sometimes it's very literal multi-sector of the tech industry, the pharma industry, business, the government, those type of things.

So being able to adjust what your pitch looks like depending on which sector you're talking to is key. And identifying that beforehand. That's really the next piece of how to do this is one of my favorite quotes is the world needs dreamers, the world needs doers, but above all what the world needs is dreamers that do. So the dream is the idea. That's the thing you're saying, this is what we can do. And I would say that the majority of the time, I don't have stats to back this up, but it seems like that's where it ends in a pitch. Look at all these things we can do. And everyone's like, yes, that would be wonderful, but that's the devil's in the details. It's the how do you actually do that? Is this feasible? Is this feasible right now? Those type of things. So having those answers is really the key.

So having that mapped out of how would we implement that? Where are the barriers? And then figuring out the answer to that because they're going to ask these questions during the pitch. It would be great if you're already proactively addressing 'em before they even have to ask. So that's showing that you're not just up there saying, this is a cool idea. You have a strategy, which means it is less risky for them. I think another piece of it as well is showing that it doesn't have to be the massive plan that they have to agree to upfront. This is where we're going. We have a roadmap where we're going to break it down into here's the right now, here's the midterm by six months, here's a year, and eventually we'll get there. So that's showing a plan and that system involved and who's involved. But then there's also the way to really loop in some of the other innovation startup methodology like lean and agile of it's rapid iteration.

We're making sure we're building the right thing and we're also making sure we're building it. So those two concepts of, okay, you know what, we're taking the risk of you saying last way down. If I'm just going to start with this little pilot in this one department or with this one cohort on this one class, and we're just going to check it out, see how it goes, and I'll report back to you and if we're good, this would be the next step. So you have that mapped out. So it's not this huge leap of faith. It's not a huge, if you're asking for finance and resources, it's not a huge jump that they have to do. And then find out a few years down the road if it worked, that's all part of that co-development mentality to really say, you know what, one, I have a strategy and then here's how it's actually feasible. And then the key is sustainable too.

Rahul

So what I'm hearing is that after the first step of inspiring and empowering, this is the second step or piece of the puzzle to be the dreamer and the doer. And so many times we are so passionate about our pitches that we just cannot believe that other people don't agree with our ideas or won't immediately say yes to. Your words are very wise, be the dreamer and the doer. And you said the first piece of it is once you listen to their perspectives, you may have to iterate or modify the plan or understand why they're not saying yes immediately because they have another perspective which you may not be aware of. And the second piece you said is, can you put your innovation and design thinking cap on and think not of the big project and outcomes, but where is a small place we can begin that may show results within a more finite timeframe for which maybe we have resources and then demonstrate those results to build confidence.

Andi

And that's right where you can put those questions. So if they bring up a problem or a no or something like that, that just like, oh, it feel derailed and just deflated actually using that right to your advantage. Again, that pause, the reflection. And then one of the best phrases is what if we, and then roll whatever they said into whatever your kind of rollout processes. What if we pull that into this step in the process to see if we can build an automation so the MAs don't have extra forms to fill out, it already goes into their workflow. I wonder if they would work with us on that and then let them give that response. So you can always fall back to the things that are going to be a no for everybody have to do with time and it has to do with money.

So if nothing else, some like, oh, we could plug this in here. We can reduce the burden. What if we did it this way? What do you think? Those type of things. Another tip that again, picking up things and I'm convinced everything's connected and you just have to have it living in your head. And then at some point you can plug things in certain places. So there's this book called Never Split the Difference by Chris Boss, and it's great. He was a hostage negotiator and now he's in business. So he talks about all these different things he did as a hostage negotiator that actually worked great when it comes to pitches and other negotiations. So some of the things that he says there, when you get that, no, when something pushing back, well, you need to collect your thoughts and strategize the words. Tell me more, right?

You don't have to have an answer right there. Sometimes that'll seem too slick as well that you're discounting what they're saying. So tell me more. So you want to learn about that. And then the other one, if you are really thrown off, he calls it mirroring. There's two different types of mirroring I would say, but this one is verbal where you just repeat their last three words back to them, oh, this will never work. This is a terrible idea, a terrible idea. And then they keep talking or we don't have the money for that, or no one's going to want to do it, they're not going to want to do it. And then kind of just use that to gather more information in more detail. And he's got some great examples where he just keeps going and he just keeps doing it. And then he really says almost nothing.

But then they kind of talk themselves into it. It's pretty impressive. I am not a master hostage negotiator, so I'm not at Chris false level. And then the other mirroring is actually more of that physical communication where you take on the same stance that someone has or the same hand gestures, expression, unless they're outwardly hostile, don't do that back. But if they have their arms kind of crossed and casual, do that. Or a lot of times they have their hand up on their chin like they're thinking can kind of do that things and it naturally bonds your conversations for what it's worth.

Rahul

Love those tips. So mirror their last three words. What a great tip,

Andi

Great for conflict as well.

Rahul

And it also prevents us from going into defensive or judgment mode. I love your tip about mirroring the last three words in a way that opens up the conversation even more. Andi, those seem like some excellent tips. So the big idea I caught was how can you make your pitch in a way that solves their problems with your ideas? And the first big piece was inspire and empower. The second big piece was be the dreamer and the doer. So I want to walk through what you said in the beginning, never say never. So I'm thinking Andi Cooley said, I'm never going to be a pitcher. What made you work so hard on pitching?

Andi

I think it's the idea of when you have something that strikes and whatever it is that is your passion and your interest and it matters enough that you need to pitch someone, not just like, oh, I'm going to do this thing over here as part of my project, but this is something that this needs a pitch. I need other people engaged. I'm building this. That idea that once you see it, you can't unsee it, so it can become something that drives you and this is why it's your passion. So having to learn how to do that and having to learn how to be brave enough to do that is really big part of it. So I think that is where it really came about is that I'm not trying to pitch things so I get a job somewhere. These are ideas and these are things that will make a difference.

And so in order for that to happen, you have to collaborate, you have to have people on board with you. So it's a must to learn how to do this if we want all of these amazing ideas we have in these dreams and everyone in this field is brilliant and caring. So how do we take all of that passion and experience and life expertise and seeing the things we see impacted up to keep making the differences we care about? None of us are here to just go through the motions and keep things status quo. We're always trying to improve whether it's clinical care or learn more or make differences in the community. So we have to learn these skills to be able to do that. I used to be really, really scared of public speaking. And so to know now that this has become such a big part of my life of what I do is just, again, I never say never.

I never thought I would be on stage or talking to the people that I'm talking to. But when your eyes on the goal of what you're trying to do and what your big why is, then this is something that is to get you to that goal. So it's not as much focusing about, yep, I have to get in front of these people. It's focusing on that end. So one of the things that I realized is I am terrible at standing up for myself, standing up for, gosh, I can loan someone money and I'm just, I feel too uncomfortable to even ask to get it back, that type of thing. I won't do that for myself, but you better believe I will defend someone else and I will stand up for my patients if someone's being bullied. So it's a lot easier to, in my mind, to defend and to stand up for people without a voice than it is to do it for myself. So that's the way I see this and how I find my bravery is to say, I'm not speaking for me. I'm speaking about this issue and that's where everyone's attention's going to be. So that's kind of how I got toward pitching and why I think we all need to learn things like this.

Rahul

I've heard you say it before and it's definitely changed my life and made me be less afraid of pitching. You've said it makes it a lot easier to be brave when you're rooting for someone else, and that's a life-changing idea.

Andi

Yeah, it works. Worked for my experience so far. So we'll take it

Rahul

Us back to a moment where you had to be brave for someone else and had to make a pitch. So let's just begin by framing where this pitch happens and what's at stake in this pitch.

Andi

So this, it was a life changer for me. So there's some innovations and some ideas that I have related to AI and rural health and really underserved healthcare nationally and globally. So I have this crazy moonshot dream idea that involves changing the entire healthcare system top to bottom, in and out for complete transformation. I mean, it might be crazy idea like that level. So we had our first University of Texas AI symposium scheduled in May of 2024, and we are the newest medical school. We had been open a whole year at that point. I'm not an academic, like I said, not a computer scientist. I'm not all of these things that I'm not. And so every institution of the eight UTS is coming together for this talk. And there's really no one from Tyler. I was the lone person on the planning committee and the lone person going to this back in Dallas.

So it's really with these big institutions, MD Anderson, UT Southwestern, Dell Medical, all of them. And so I was on this planning like, oh, we're going to do an equity, an AI and health equity. And I said, oh, okay. And I thought I was supposed to find a speaker and they're like, oh no, we'll just have you speak. And I was like, oh, okay. So there's state senators there, there's keynotes. And I was on the plenary stage and I had 15 minutes and I was like, oh my gosh, what am I going to talk about here? And I'm like, well, I'm going to take my 15 minutes and I'm going to let it rip. So it was really on rural health disparities, the digital divide and then my whole, here it is, this is the dream plan. I was sick to my stomach nervous about this for months, and I happened to go through one of the HMI programs that talked about how to set up design of your slides more like a business model.

So looking up things on YouTube, like McKinsey style slides, they're very clean, they're very different on their color schemes and their graphics. The take home message I had from that was there's not an animation and PowerPoint that's ever changed my mind. So to try not to add all the flashy things, we always put in that ED pictures up, here's an interesting picture of a child or whatever it may be to keep that retention. And this is much more to the point other things too of it's not the title of the slide, it's just like introduction, epidemiology. It actually is your story. So it's almost like sentences along the top so someone can flip through and just read the actual story of your pitch based on the slide titles only, and then the content of the slide is giving the evidence for that title. So that mentality is, okay, I'm going to do this and here we go.

So I was at the end of the day and I got up there and I told my story of East Texas and the disparities and I knew I had them when I started out right with the story and the why instead of just, here's why I'm telling you a story. So people relate to that much more. But the fact that in East Texas we have 450,000 kids in our region or the size of West Virginia geographically, and our pediatric mortality rate is 245% higher than the national average because we have entire counties, 27 of our counties has zero pediatric providers. So we just do not have care for these kids. And so I knew I had the audience when I had audible gasping, I was like, yes, I got 'em. So that was the hook. They're all involved now. So I said, I'm in a room of innovators here.

Can anyone, if you had an idea of something that could fix this, raise your hand. All hands go up. So then engaging them in co-development and then say, okay, now if your idea requires ai, please lower your hand. So about half the hands went down. It was an AI conference leading the audience little, but then I said, what if it involves the internet? More hands went down. What if it involves a computer? More hands went down. So then that was the flip. The key was that 45% of our region doesn't have access to the internet, so all of these other solutions aren't possible. So that's what really started pulling in the draw to the challenge I gave, which is think bigger. We have to think systems. And then the idea that I was able to put that out there. So lo and behold, it went great.

I thought it was like I told you so nervous. I thought we were going to have potentially a big potential donor there that our schools said they might be able to show up. I had no idea who it was going to be, but I'm like, this is the one person in the audience. I don't have to talk to all the computer scientists and all the PhDs at this research level. I'm talking to the one person from a foundation that I can focus on. Well, it turns out they were not there. So that ended up not mattering. It helped, but at the very end I had people come up and chat afterwards and I actually got to go to dinner with some of the fancier people and things like that, which is nice. But then someone came up and shook my hand. He said, hi, my name's David.

I was really interested in your talk and I think there's some things we can do to work together. I really wanted liked the idea and I have some ideas of myself. And so we talked all dinner, it was great and exchanged numbers and all that. And then it turns out he's the global chief medical officer of Microsoft, and he did not mention that. He just said, oh, I worked with Microsoft. So from that point on, within 48 hours, this has just taken off. So absolute life changer as far as the whole dream of what I put out there is now the intro part of my presentation because of how fast it has just gone at the speed of industry instead of the speed of university of just accelerating. And it's amazing to see how many people from how many sectors actually do care about these issues as long as we can also frame it in a way where we can all work together.

So I think that has been very eyeopening for me as well, just from a leadership standpoint. But then again, it all comes down to the systems and that design thinking and really looking at process to see from our perspective of the people in education and the people in healthcare where we are on the front line, we see where every piece of the pie lines up. So when we have that, we're looking at things from end to end, which is really what only we can do because we're with patients and students. That whole journey and that whole spectrum, if we have those pieces mapped out, it makes it a lot easier to see where each part fits. And so that's where you focus on that and then you're ultimately building a whole system by focusing on each need together. So that's kind of my story and we'll see where it goes. It's been a year and a half since that point and it's gone like wildfire, so I can't imagine what another year and a half will look like.

Rahul

What a story. And I've heard you share a part of this before at Harvard Macy as well. When I was listening today, it reminded me of the movie Inception where you've created, you've outlined the problem and now almost drawn everybody who's sitting there in so that we can dream the dream together. And I remember from your presentation that as you had opened up the forum to get to understand what their perspective is, you had asked questions for people to map out in this system, who are all the parties that are involved and affected? And that had been really effective in opening my eyes to who's involved and can be a part of the solution.

Andi

I think a lot of times the people who are really essential to the success of it, I said a lot of times I would say actually every time are the people that are actually the ones doing the work you're putting forward. So you have to get approval and you have to get funding, and you have to have your reports or whatever you're going to need to do on the people. We typically think we're pitching the people who you really need the engagement and the understanding of their life. It's the people you're asking to actually do the work. So if it's we're asking nurses to do another workflow, if we're asking the front office to say, okay, when you're checking people in, we have to have you have them fill out some more things or make some more phone calls, or we're asking students to do different projects and things like that, really getting their perspective.

That is the key on the clinical side. Think of when we're charting and you have the medical record and there's all these bells and whistles in there, and this alert pops up and this is tracking here, but it doesn't work unless the people are clicking the clicks and there's only so much time and you just, okay, click, click, click, click, click because I got to get this thing off my screen so I can work on what I need to work on really investing the time and the energy on these projects. There's the one that we're doing is called Healthcare from the eye. It's the AI retina scanning for different systemic disease. It's like Star Trek level, amazing things. I'm so excited about it. But we literally walk the clinic from where the patient sits, how they check in, we walk with the MA of where things are laid out, literally what the clicks are, what the screen looks like for every single piece of the whole patient journey we have mapped out because one, just seeing where can we make that more efficient?

You only have so many hours in the day. And then if we're adding something to the process and we're adding any more steps or clicks or tasks, that's not a solution we're trying to consolidate. The focus for them is consolidate their time and their effort instead of just adding more to their pile because no matter how much they believe in what we're doing, reality sets in and other pressures set in and other responsibilities set in. So really making sure that we're focusing on the people who are doing it and the people who are going through it.

Rahul

And your example illustrates why we are the ones on the frontline who need to be brave because we understand every piece of this process so intimately being involved in it day to day, which somebody with an MBA degree or an innovation background might not completely until we can partner with them. I also want to go back to your pitch because I remember you had shared, not only did you map out who are all the people involved, for example, who are the providers involved, the professionals involved, the associations, researchers and politicians and legislators, bodies, corporations, everyone. You also had prepared that what matters most to each one of them, what motivates them? And you were ready when you asked those questions, even though you were drawing people in, you had done your background work about who all are involved and what matters to them as those answers started to come.

Andi

So there's some really great frameworks that are out there. So it says instead of, let me just brainstorm. There's some good ways to, if you look up ecosystem, so there's ecosystems of social determinants of health that's from all the way from the patient all the way through their home environment, their town, their health system, all the way to national, all the way to digital. So global level things. So starting to think of what is in each layer of this onion that needs to be addressed for healthcare. Anytime you are thinking patients, you can substitute the word student, right? Because especially in health professions, education, similar data, similar challenges, similar logistics and operational structures and theories and all these things. So that same idea applies, but then there's also the ecosystem of who are all the sectors and who are all the stakeholders who have a say.

And that's exactly what you look at. So you look at, it's the one I use looks like a wheel, and you're okay, who are all the people that have something to say about whether this is going to work? And then not only work but continue working. So how are we going to sustain this? And I think that's when we get towards the leadership side and the funding side. Really the big system level questions is the sustainability. That's the biggest thing that holds them back. If we're just going to depend on someone continuing to give us grants or donations or this is a never ending draw on our financial resources and we need to hire more people, that's not going to be a sustainable plan. So having, yep, I need some things right up front for this, but this is how we're going to make it self-sustaining in those later stages.

And I think that's part of that key. But until I started looking at that systems approach from their perspectives, then I never ever had any of those things in there. And then the success of things, getting one approved and then adopted, there's a lot that gets approved and do all the work and then it just sits on a shelf. It never actually happens. Or it happens until a resident who started it goes off service and then it fizzles. And so those things, and then that with the scaling to another floor or another class or another school, those things are all that sustainability that I think they look for of, okay, yep, this has been fought out and it's going to make that impact. There's a path to get there.

Maya

All of this is spinning in my head because I literally am building a little pitch for something in the next two weeks that I have to present to people who will make some decisions about what we invest money in and and all of details that don't matter. But thinking about that story again, how do we pull folks in and build that investment? And then the other side about sustainability is so important. We're not doing this just because, oh, it's a great idea. We're going to make it happen, but we can make it happen in a way that it continue to happen over time. And I think we don't tend to be long-term thinkers across so many sectors. And so I think that's a piece that, and yet that can also get you stuck, right? You can't just go, okay, we have a solution that's going to work for the next decade. Well no, maybe we need something that works right now. Like your AI pieces, the speed of change around AI is happening so quickly that what we can do now, what we can do five years from now may be so different. So you can't wait.

Andi

I think that's a whole new layer of complexity that's come out of the speed. And in medicine and in education, we are not set up for speed in a clinical moment. Emergency absolutely second to none. But when it comes down to systems change and things like that, I mean, it's a machine, right? There's so many parts and complexity and checking things and caution from all angles. But right now with ai, how fast things are moving, if you don't jump on it, it's gone.

Rahul

So let's bring this a little closer to our listeners. What are places where they can practice these pitches so that they can put what you've taught into action?

Andi

I think you can practice this anywhere because when we say innovation, it does not have to be tech. You can innovate how you're teaching, you can innovate a process, you can innovate teamwork. There's so many ways to innovate and people sometimes think it has to be a product that they're making or some sort of technology. So really anytime you're interacting and trying to build or change management, that's a pitch. Doesn't mean you have to have PowerPoint slides up every time. So any of those interactions that starts working. So I think even practicing, I mean if you want to get to the most fundamental level, we're trying to convince a patient to quit smoking or to change their diet, you're pitching it to them. You're trying to sell them on this idea to do something different than what is routine for them, what is comforting to them, whatever that may be.

So really it goes into a lot of things like our patient-centered care and our student-centered education, all of those things. But we're already doing. So start applying the things that we do in our day job to these projects. We're primed for it already. We do it, we just don't realize we're doing it. So we make those connections with students and patients. We make those connections with the other people on the team. That's exact same thing. So I would say that is where to start. The next thing is really looking, starting to think in process instead of just the end result of what are the steps? And then just what's a tweak that could make that easier? What's the tweak that could make it where they only have to make one phone call instead of five? Starting to see that really with that systems process, but from their perspective.

So that's where that design thinking plus systems come together, but go after the pain points. What's frustrating, what's burning someone out, it's typically not, man, that was a hard case and I just have too many patients. It's typically just the stuff, right? The busy work and it just doesn't end those types of things. So start thinking in those processes and practice tweaking things from different perspectives. And then that's eventually when you have your pitch, it's all about how it's the process and where those things can fit in for whatever job needs to be done for the CFO or the nursing team. And then I think the third thing is start getting more creative in your mind of, I think Liz Armstrong, who was one, the founder of the Harvard Macy Institute. Well, one of my favorite things is if you're going to do the work once, make it count twice.

And that's our whole idea of scaling a project. So if you have done the work once for this course, will that framework that you built work in the next course? Will it work for a different school? Will it work for a new project that just needs some tweaks? Because each time there, you're starting to streamline and amplify, but you've already proven it out some. So now all of a sudden, especially if you're trying to convince your administration for some projects, say, okay, we can build this, but you can actually use this idea here, here, here, and here. So really I'm solving five problems for you if we just build this underlying enabler. So I think one of the disruption principles is that you have to have an enabler. And that's not the one project, that's the underlying framework or infrastructure that can help with a whole bunch of things. So really using that to ground your project of what does this enable and start seeing how it works. But then you're also amplifying change, which is amazing. And once you have these things built out, you have yourself a little pipeline and a blueprint and a toolkit and you can share it. And this is, I think where we start making big change as we share with the institutions across sectors and really can spread out quickly.

Rahul

Fantastic. So I heard at least three themes in there. One is when we talk with patients, that's a very rich opportunity to apply all of this. And it's also empathy and patient centered. How can we co-create framing the problems and the solutions? The second thing is, within a team, often it's the process of working where there is a need for making it less frustrating or more efficient. And that's a great place to start. And the third, as you quoted, Liz Armstrong, is do the work once. Make it count twice or twice or as many times as you can. So think about being that scholar of integration and how can you build and scale on your work and hopefully co-create with other smarter people across disciplines. Pete and Maya, what are you thinking? What are places for people to practice this or apply this?

Pete

Andi stole all of mine. I was thinking more right there at the bedside, getting the patients to care for themselves. Better would be somewhere for new physicians to focus on. But then Andi kept going the bureaucracy of being in a hospital, trying to just tweak the little things and not trying to blow it all up and start over again, which is what I would always trying to do. I was very idealistic and it would push back very hard. We're not doing that. So the little things trying to make it work just a little bit better tomorrow and maybe a little bit better the next day.

Rahul

And I think nurses are so wonderful at this. When I worked at Middlesex, I remember one project where we were dealing with catheter associated urinary tract infections. And unfortunately the numbers that year were such that we were languishing in the state. And from a top down perspective, you might just be, how can we bring down the number of catheter associated infections in our intensive care unit? But it was the nurses and the patient care techs who said, why are we reimagining it so little? How about we reimagine it so that we do not need the catheters in the first place? And can we build a fully free ICU as much as possible? And in one year with ground up innovation, we went from being amongst the worst in the state, amongst the best in the state. So I think nurses have very rich opportunity because they're in it so deep that what they're seeing, nobody else is probably seeing.

Maya

I got to say, I really like that. I think the same things happen for social work. We're seeing things on the patient level that we don't always get to raise up to the next, although we're trained in ecosystems, that's what our training is. It's the core of the discipline and yet bringing that voice up and out. And I actually evaluation research class. I literally have students working on change proposals, little ones, little quality improvement proposals right now. But what you're making me think about is I haven't taught them how to pitch. I haven't taught them. And that ties back to also all our talk about working with the interprofessional team. What's your audience? You're not just convincing another social worker. You're not just convincing someone who shares your values and ideas. You're having to convince that whole audience and the decision makers. And so logistics is one thing. They could tell me the steps of, this is the methodology I would use if I built the needs assessment. But how do you actually convince the group that you're with that, Hey, I have the solution to your problems. We have the solution to our problems together is a piece I think we miss in when we're teaching. And I don't know what's happening across other disciplines as well as I should. I know I own,

Andi

From what I understand, I mean, I think things in healthcare, other fields as well, but are so siloed. So I think that experience is very consistent with what I've seen, where I've worked, where I've talked to other people between departments and different healthcare professions institutions. I think that is definitely key. And both of you in your examples mentioned, okay, well here's we want to take on the world, but maybe we should start with these small projects. So that's not mutually exclusive. Just wanted to point that out. So if you look at disruptive innovation, it does start with the little things that people are kind of ignoring and then it gets better and bigger and bigger until it does disrupt and change. So you take these things and you start putting them together. So when you have a student saying, okay, I'm going to do this project right here for this care plan, and a lot of times that's a student's project and it lives on their unit and it does a good job, but for some reason it doesn't go to a floor below or a floor below.

So using that as that is phase one has been, okay, now we have this pilot. Here's our numbers, here's the process the student made, and now we're going to scale it to all floors. Or phase two is multi-site, and then eventually it's adopting there. But then how many students do you have? How many projects are going each year? So that is how we're getting change and getting that momentum going. So I think that idea of a small project, yeah, it makes a small difference here, but that's exactly how you disrupt things, is you start with that small way and then build.

Rahul

Andi, thank you so much for such a great conversation. It wasn't about pitching, it was about listening to others and becoming a better leader. And I've certainly learned a lot from our time together. Before we end, Andi, if there is one message you hope listeners take away, what would it be?

Andi

In general? I think really looking at the relationships between, whether it's just your day-to-day work or if you are trying to do a project, but really listening and learning what other people see. And then the other piece of that is actually showing them you value that perspective. So I think as a leader, one of the most important things is not just assuming like, oh, you did your job. That's exactly what you're supposed to do. I tell a lot of my students, you are not going to run out of compliments. So if someone does something and they deserve it, they need to know that you saw it. Right? So I think we take that for granted. Just assume, yeah, people did their job, but to give them sincerely and often because people do not hear it enough and it can really make a difference.

Rahul

Thank you so much for that, Andi. And listeners, we'd love to hear from all of you as well. What are you learning from this episode? What are you taking away? Let's keep the conversation going. Thanks for tuning in. Until next time, take care and keep leading and learning.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E7: Leadership Hack - Owning Your Failures (feat. Dave Tomczyk, Ph.D.)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul

Welcome to Learning to Lead. Today's Leadership Hack is with Dave Tomczyk, Ph.D., a powerhouse of insight when it comes to pitching, entrepreneurship, and leadership. Dave, what is one of your favorite hacks or tools to become a better leader?

Dave

I love this question because my favorite answer to it is failure. And that sounds like a weird thing, but I do not think that we fail enough. Now, I don't know about you guys, but during almost every single graduation I've been through, and I've been through quite a few, they talk about go out and don't fear failure, and yeah, cool. Don't fear it, but if I do fail, I'm gonna get punished for it. And that's embarrassing and that's huge problems for like my career and life. So how do we do failure? So for effective leaders, there's two things that you should know about leadership. The first is when you are in a leadership position or when you are first on in a career, when you make a mistake, acknowledge the mistake, apologize for it, say what you're going to do to correct it and then follow through.

It is that simple. Honest to goodness, one of my favorite stories comes from a colleague of mine and he will be quite happy that I am sharing that he nearly cost a Fortune 500 company, $100 million because he put the amount of money to be drawn out of a bank account one day early. He had it coming out of the account on December 31st, when it should have come out on January 1st, and the end result was that the account got over drafted and that was not good. As soon as he got the notification that this was a problem, he immediately called up not only his boss, but all the other relevant people said, here's what I'm going to do to fix it. He spent the next 48 hours working frantically to get it all straightened away, got the bank involved, got everything set aside, and at the end he said, here's what I'm going to do to make sure that that never happens again.

And the end result was, sure, there were quite a few people who were like, for shame, don't do this. But they were also really impressed with the fact that he took the responsibility to correct it, and they started to look at him as a reliable person. There's a really good book called What Got You Here Won't Get You There, which is written by an executive coach who talks about one of the big failings that many people going up in leadership do is that they try to hide away their failures. They brush them off. They are like, no, no, that's not a problem. And they try to redefine it, gaslighting other people, or they try to shift the blame to other people. I'm personally blameless. It's totally Brooke's fault or what. No, own it. Everyone knows who actually caused it. I can try to blame Brooke as much as I want to, but everyone on their brother knows that it's actually me that did it.

So take ownership of that failure and walk through it. Now, I said that there's a part for you as the person who causes failure, but inevitably you're going to have employees and they are going to also mess up. You probably have heard things like punish in private reward in public, and those are really, really good sayings because it's all about how would we want to be treated? We don't want to be chewed out in front of others, so pull the person off to the side. But the biggest thing of all is how do you create an organization that allows for the inevitability of failure? Things are going to go wrong. So do you just fire that person? Do you scream at them? Do you pull them aside every single time they make a mistake? There's another really good book called The Right Kind of Wrong, and the author talks about how do you build an organization that's resilient to failure?

And it's not by punishing failure, and it's not by saying, we only reward success. It's by creating an environment where people can fail and the organization as a whole learns from that failure. If I do something wrong, I take ownership of it, the organization helps support me in that. And we say, look, that's an investment in you. And then we say, is there stuff that the rest of us can learn from it? Is there a new practice that we should follow? Are there new policies we should put in place? And if the answer is yes, we do so. And if the answer is no, then we don't. Before Netflix became the weird beast of a company, it is now, when it first was starting out, they had a culture deck, which was a series of PowerPoint slides that explained their philosophy towards, well, pretty much everything.

And one of their core things was, we don't add policies. And that seems weird because it was a large company even years ago, but their whole thing is if Dave, the employee, misuses the company credit card, and it's very clear that it was a one-off thing. Oops, he, he accidentally used it to buy food and he shouldn't have done that. Whatnot. Instead of saying, well, now we're gonna create a new policy about how to use credit cards for every single person to follow. They said, Dave, that was stupid. Don't do that again, and then just let everyone go because it was one person who made the mistake. Not everyone. Now, don't get me wrong, there are certain things where you definitely need to have policies in place or a reaction that affects everyone. If something resulting in a life-threatening event, if there is something that is destroying the company culture and you want certainly block that off, sure.

But most of the time people inherently don't want to fail. And so if you give them the chance to grow from it and you say, it is okay, you get the one pass, we'll go forward from there. They will self-correct, they will come up with better ways of doing things. And that's incredible. I'm going to end this by talking about one thing I learned during my time at NASA. So I was a young, fairly dumb guy, about 25 years old. I was working for one of the jobs I had in the office of the Chief Information Officer, and I was looking at IT security specifically. I was tasked with trying to make the IT security training better for NASA. We had a program, it was overseen by a contractor, and the response rate to the whole thing was pretty mediocre. We were hovering somewhere between 50 and 70% of people even did the training, much less passed it or remembered it a couple of months out.

So young go-getter, Dave goes, gets his task, goes online, goes to a forum and says, Hey, I work at NASA and we're looking at changing our training, and what do you guys have? I found out that the IT security community is relatively small. And so some of the people saw the forum post, they contacted the contractor, she called my boss and she's like, am I getting fired? What's going on? This is a disaster. So I got called into my boss's office and he said, Dave, you need to think things through. You need to be more careful. And I was like, got it. That was a simple mistake. It was an honest one. And so honest mistakes are totally fine. It's a one-off. So I go back to my desk, sat down, go 10 pages deep into Google, start looking for the most remote of remote forums and whatnot.

And I find one and I go on there and I post and I say, Hey, I'm at NASA, we doing this IT security training, da, da, da. An hour later I was back in my boss's office, and all he does is he picks up the phone, hits speaker, hits voicemail, and I hear the voice of our contractor, I thought you said that this was being fixed. Am I being fired? Da, da da. She was the forum moderator. So that was really bad. So I went from making a stupid mistake to now making a lazy mistake. And that is the worst kind of mistake of all see honest mistakes, everyone makes them. Not a problem, a stupid mistake. Not everyone makes them, but hopefully you learn from that. But when you get to the lazy mistake, that's when people say, this is who you are. It took me a long time to rebuild the trust that I burned through that, both with the contractor and with my boss, because incidentally, we didn't fire her. That wasn't the goal. Uh, and I learned a very important thing. Honest mistakes are okay. Anything beyond that isn't.

Rahul

Wow. I so appreciate you being vulnerable and sharing that, first of all. Yeah. And second, from personal experience, I can relate that it takes time and work to get over and mistakes like that. And it's a sign that you've truly forgiven yourself when you found meaning in those mistakes and now can share them with others to benefit from. So thank you.

Dave

You're very welcome.

Rahul

I have two reflections and then a follow up question. The first lesson you taught us there is do not be afraid to make mistakes or fail. And I remember when I joined Netter, Dean Bruce Koeppen at that time, who had hired me. Gave me an empty mug as a joining gift, and he said, just like this mug will sometimes spill, you will make mistakes. So do not be afraid. Go mistakes, as long as you learn from them and you are ready to refill your mug and keep going. So it reminded me of how leaders are the ones who set the culture and yes, free up their followers to fail early and fail often. The second lesson you taught us is about being accountable to learn from our mistakes. And it reminded me of Jocko Willink and his TED Talk, “Extreme Ownership” that we share with our students and use in our leadership course as well, where you talk about being accountable for learning from our mistakes. Otherwise what are they worth if we're not gonna learn from them? And your story of going from a honest mistake to a lazy mistake really drove home that point. I wanna ask you a follow up question because in healthcare, even honest or small mistakes can be costly. And so, we certainly have a stigma of failing. One thing from the entrepreneurship and design thinking world that may help our listeners is the concept of starting small and prototyping. Can you talk about that and how that can be used to make it okay to fail?

Dave

Yeah. So the earliest reference that I remember seeing that really, really became popular, Eric Ries did a book about The Lean Startup, and he talked about MVP: Minimum Viable Product. And the idea is that instead of trying to make this the perfect, most amazing everything, well just create something, get out there and get the feedback. Because whatever you create inevitably is not going to be right. And that's a really good idea to take. Whether it is a physical thing that you're making, a prototype, a digital spreadsheet, whatever you're creating isn't going to be right the first time. Probably not gonna be right the fifth time or the hundredth time. It's going to be constantly changing In entrepreneurship, there's something known as the entrepreneurial death trap of the perfect mouse trap, which is you sit there and you engineer it and you reverse engineer it, and you sideways engineer it and you upside down engineer it, and you make it the most amazing mousetrap ever.

But it took you 50 years to get there, and by the time that you have it, it's probably obsolete. And 10 other companies have come out and done something better. Perfection is the enemy of progress. And we hear that saying all the time, but it's important for a reason. Now, don't get me wrong, there's certain things that you do want to be perfect on. If you're doing surgery, try not to make too many mistakes. But even there, when you focus on perfection, what happens is you are dedicating a ton of resources to not failing. Well, that's great, but not failing doesn't mean that you're succeeding well. So you can either dedicate resources to not failing, or you can focus on how do I maximize success? How do I make it the most likely to happen, and how do I make it the biggest impact when it does happen?

So going back to the original question, when you're saying they're working with a prototype that's focusing on success max maximization, let's get it out there. Let's get the feedback when it costs very little, when the risk of failure is relatively low, and get that feedback and improve it. Now, does that mean that you should just like do a quick and dirty sketch on a napkin and show that to the world? No. Take some time, refine it, make it to the point where people can look at it and say, ah, I understand what you're doing. Let me give you good critical feedback on what it's like, how it works. If you're testing out a new flavor of sandwich, make some samples of it. But don't worry about having the high quality panini press in order to get the exact right crisp on the bread, get it out there, get people to try it, get the feedback.

Rahul

Love it. So the hack I'm taking away is do not be afraid to fail. Start small, be accountable. Learn from your mistakes. Keep building and maximize your chances of success in projects and in life.

Dave

A hundred percent, yes.

Rahul

Alright, thanks again for joining us on Learning to Lead. Next week, we are going to come back with a full episode with Dave Tomczyk on how to pitch. Until then, keep leading and learning.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E5: Storytelling in Healthcare and Leadership with Dr. Sarah Smithson, MD, MPH

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul

Welcome back to Learning to Lead. Our guest today is Dr. Sarah Smithson, an internal medicine physician and co-founder of Relational Leadership Partners (RLP), an organization devoted to human-centered culture change in healthcare teams and systems. Sarah is an expert in leadership development and team-based care within and across professions and health systems innovation. Prior to founding RLP, Sarah served as the Co-CEO and Vice President of Partnerships for Intent Health Strategies, was the Assistant Dean for Clinical Education and Director for Interprofessional Education and Practice at the UNC School of Medicine while delivering primary care for over a decade. Sarah earned a dual MD MPH degree from Emory University and completed internal medicine residency at Brigham and Women's Hospital in Boston. Sarah, it's an honor to have you with us. Welcome.

Sarah

Thank you, Rahul. So happy to be with you all.

Rahul

Also with us today is Dr. Rebecca Zucconi. Rebecca is an OB GYN trained physician and faculty at the Netter School of Medicine. We fondly call her as our chief storytelling officer, and Rebecca will return in a follow-up episode bringing these concepts home and showing us storytelling in action live in our community. Rebecca, welcome.

Rebecca

Thank you, and thanks for inviting me to be part of this today

Rahul

And with us today. As always are Pete.

Pete

Hello everyone.

Rahul

Maya.

Maya

Hi everybody.

Rahul

And Brooke.

Brooke

Hello.

Rahul

So Sarah, we're excited to dive into this conversation on storytelling with you. Let's just begin with talking about what a story is.

Sarah

I thought it might be helpful to frame the beginning with a story. I know you mentioned that many listeners are students and trainees, and so as I was thinking about coming here to be with you all, it took me back to actually being a fourth year medical student myself. So will that work, if I start with the story and then we'll break it down a little bit. I was thinking about when I was a fourth year medical student and how I had this laser focus, which I think is not unique among medical students, but this laser focus for me was of course about achieving the best match that I could in categorical internal medicine. So I remember putting on my suit and grabbing my leather portfolio and traveling from program to program to interview. And I was doing this all in the context of the personal statement that I had written and the personal statement that I wrote reflected on a specific moment during the year that I got my Master's in Public Health between my third and fourth years of medical school.

And I was working on a group project with a partner. We were doing work on life expectancy, and I remember the two of us sitting there pouring over data on our computers and suddenly he said, oh, I know why there are more elderly women than elderly men. It's because the elderly men felt so much stress providing for the women while the women spent 60 years on the couch. And I'm still looking down. And I thought, oh, well, he must be kidding. And I looked up and saw his face and realized he was not kidding, he was being genuine. And in that moment I realized we were going to have really different perspectives and it was going to be really important for the success of our work together for us to find our complimentary skillsets rather than dwell in that conflict. And so in my personal statement, I wrote about how that was my approach to not only clinical practice, but I was really hoping to take that approach beyond the clinical into administrative roles.

So I'm traveling around to my interviews and I go to one particular interview in the southeast and I walk in, there's this big imposing wooden desk. The walls are aligned with diplomas and books, and the attending who's a leader in the health system is asking me questions I've answered along the way over and over, pretty comfortable. And then midway through, he leans forward on his elbows and looks me squarely in the face and says, very seriously. Now what I really want to know is what makes you think you can be a department chair when you're not even a resident yet? And I felt so taken aback. I thought I had done something wrong and what I had written in my personal statement and in that moment I thought, okay, laser focus best match I can. I moved that program down on my wish list and just kept going a few weeks later at what I know is a reach program for me.

So a program, it's not a given, I'm going to match there. I'm thrilled to have an interview. And I walk into my interview with the program director. We're sitting side by side and he's holding my application in his hands and he looks at me and he says, I think you are a great primary care applicant. And I genuinely looked at him and said, what's primary care? And he was so generous to explain not only primary care to me, but to tell me that they have a primary care track that's attached to their traditional categorical program that trains future leaders in population health. And he said, you should come back and interview on a primary care day. And so I walked out and I thought, gosh, well, I don't know. Do I want to make a whole nother trip? This is a big commitment. I've already been traveling.

It's so expensive. This isn't categorical, and who even knows what primary care is anyway? And I didn't know anybody else pursuing this path, but the more I thought about it, I thought, okay, I'll give it a shot. So I scheduled into their very last interview day, and I literally remember I'm wheeling my suitcase down, the salt crested sidewalk that January and I had traveled so much, the wheels of my suitcase started falling apart, like little bits of plastic are shooting out down the sidewalk behind my suitcase, which felt very analogous to how I felt in the whole interview process. And then I walked in with the residents in this program. Oh man, it was just like when you go into a room and you just feel the energy in that space and it fills you up. That's how it felt. My interview with an alum from that track, the time flew.

I called my husband between interviews. I was just so excited. It felt like I was home. And so match day came and I thought, what if it was just me? What if they didn't feel that same connection? And I remember the clock strikes noon and I'm holding my envelope. I still have that envelope. So Brooke, keep it when you get it, file it away, but I still have it. And I slid the seal open and pulled out the paper and saw the name of that program on my match sheet, and I mean, just almost cried with relief and happiness. And that match really set me on a trajectory for my career. And I realized that no, it was not where my leisure focus was. It was not my original plan, and ultimately it turned out to be even better than I could have thought.

Rahul

So let's talk about the story itself. As we're listening to these wonderful stories, what are the elements or the components of a story as you're looking to put together a good story?

Sarah

Yeah, great question, and I think you all, and probably many of the listeners will know, there's no single framework for stories. So I think to find a framework that resonates with you and then build on it over time is a good recipe for bringing stories more consistently into your life. The one that has resonated with me, which credit to the person who trained me on storytelling, who's Matt Lewis, who now is working at Oregon Health and Sciences University in Portland, co-leading their Relate Lab there, we would often lovingly joke with him, he has his PhD in storytelling. And he learned from Marshall Ganz at the Kennedy School who uses a framework of challenge, choice, and outcome. And thinking about stories in this context as a tool for sharing our values. I mean, I think when you're thinking about telling a story, one of the questions you want to ask yourself is what is your goal?

And whatever your goal is, that's kind of where you want to end. And so that can help you then think about, well, who am I telling this story to? And therefore, what is the right story? What is the story that gets me where I want to end? And what is the story that might most resonate with the people that I'm talking to? And then you can reflect back, ideally on a moment in your life or a time period where you can identify a challenge, a choice, and the outcome within that arc. What you hope your listener will hear are your values and hear more about you than you could ever just say, like Rahul, if I had said I'm adaptable, when change and opportunity presents itself, you probably would've been like, oh great, Sarah, that's awesome. Which is different than you hearing it in the context of a lived moment in my life.

Rahul

Yeah, definitely. So you are choosing which story to tell me and what value it portrays.

Sarah

Yeah. This gets to actually an important point about stories, which is about the relative power of stories. So when we hold the microphone or when we're observing whomever's holding the microphone to tell a story, I think it's important for us to recognize that that storyteller holds a certain power in the space. They are getting the opportunity to share their perspective, their experiences with whomever is listening. There is a powerful author, Chimamanda Adichie, who has a great Ted Talk, Maya, I see you nodding, yeah, about the danger of a single story. And so we do want to be careful either as we are telling stories or we're listening to stories about others, that we don't take that one singular story to be the definitive definition of who they are as a whole, right? And especially when we're working with other people who come from different places, different professions have different perspectives. Stories are really an opportunity for us to exhibit our curiosity to share about ourselves, but to invite a multitude of stories from them as well so that we start ideally to break out of, especially in healthcare, some of the stereotypes that can come naturally with a hierarchy that is so pervasive around us. So Rahul, I love that you brought up those values that are highlighted and it gives us the opportunity to think about story as a dialogue to really engage with others and learn more about them than just a singular definition.

Rahul

So you work a lot with healthcare professionals in storytelling, probably one of the foremost people teaching storytelling to healthcare professionals. Tell us what are all the places that storytelling show up in education and healthcare? And I'll point out, you started with the personal statement.

Sarah

Anytime you're trying to convey who you are or what's important to you, storytelling has value. We are humans who by design we thrive on stories. We also need data, right? But data without story is not likely to motivate change and engagement. So basically any situation where you want to connect with others and or motivate and sustain change, storytelling is a really essential element in your toolbox. So it can be in formal settings like the ones we've talked about, personal statements, interviews. It can be if you are going to be teaching at the front of a room, you're going to be giving a keynote. These are all moments where you have an opportunity to plan, to think again about your goal and your audience. Those are valuable, but more formal aspects of storytelling. And some people would argue, I'm glad some people would argue with what I'm about to say because if we all agreed all the time, life would be really boring.

But I think there are really, you can take down to little anecdotes of what you did over the weekend or asking people who you work with, what they did over their weekends. What comes out is a little story, and that little story is an opportunity for connection. Now, it may not be a life-changing moment, but that's not always what we're talking about in these kind of micro story, micro connection moments that can happen throughout the day. So I think a classic example in healthcare is if you are on a unit or you're in a clinic, chances are whatever your role is, you're very busy because we know healthcare is chaotic and there are a lot of pressures on our time taking that extra moment, my perspective as a physician, as I'm walking into the unit and maybe I see the nurse who's caring for our shared patient, I could go up with my check boxes and say, we need to do this and this and this.

How would it feel differently if I walked up? And first I said, how's it going today? Genuinely? I mean, that's a key piece of storytelling. It has to be authentic. It has to feel genuine to you, which means this is a tool that you have to adapt to what feels right to you. Because if you try to tell a story or ask someone else how they're doing and you're not authentically trying to connect with them, that is going to come through loud and clear and you can actually do more harm than good with that kind of interaction. So I think stories as a vehicle in that moment of, let me pause and take a breath. I know I have my checklist, but more importantly what I have before me is a colleague who I care about. I have no idea what's going on for them in this moment.

Let me just pause and see how they're doing, how they're coming into this space. What tends to come out of that pause is a little story. And then I would say gauge here. A story is a gift, a little offering to you, and you can decide how to receive it. Sometimes the best way to receive it is just to kind of take it in, listen, absorb, maybe ask some follow-up questions and thank them. Sometimes you may feel like, oh my gosh, yeah, me too. And you really want to share with them in the moment. This is a bit nuanced, and so just kind of keep your antenna up for, is this a moment when I should also share back, or is this a moment for inviting story from someone else and taking it in as a gift?

Rahul

I love how you've spent so much time talking about how to receive and honor the stories from others. Let's just start there and then we'll circle back to the use of storytelling as leaders in our spheres of influence.

Maya

Sarah, I just want to respond to that, that I think it's a good reminder if we're going to ask folks, how are you, what's going on? What's happening? We have to be prepared to listen to it. We tend to use that as sort of a quick cliche, hello, rather than if we're asking, we have to ask in a way that we're really going to then catch a breath and listen.

Sarah

Absolutely. And you can think about these moments of connection like little pebbles over time. So if you've asked this person before and for instance that maybe they have a child going off to college, you can say, how's it going? Is everything packed up again with genuine interest and in service of connection? And I think the real power of this is that then inevitably when one of us missteps, when us doesn't answer the message, doesn't answer the electronic message or the page or the text, or is having a bad day and kind of brushes that other person off, typically what we get is grace from them. We have a background of knowing like, oh, we're invested in each other, we care about each other. I know that that's not how Sarah usually is. So something must be going on in the context of healthcare delivery where errors and patient care is on the line. That moment of grace can be the difference between a good outcome or a suboptimal outcome for a patient, which in turn is the same for us. None of us want to show up and make a mistake. So if we're able to offer each other grace and be more connected with each other, in my mind, that's ultimately in service of our true north of delivering great care for patients.

Rahul

I love that. So the first leadership tip coming here is if you want to be a better storyteller, learn to look for listen for and honor other stories. Alright, and then to come back to what you were mentioning about uses of storytelling in leadership, so I'm picking up at least three themes in what you're telling us. There's probably more. The first one as we talked about the personal statement and your stories is using stories to share one's own values or how you dealt with key challenges yourself, and we would call that the story of self, let's say. So you're choosing these moments to convey key information about challenges that you faced and where do we use those kinds of stories the most?

Sarah

Those kinds of stories you can use in a lot of spaces. We've talked about the formal spaces. I think again, when you're connecting with others, with colleagues, with patients, I will say the question that I usually ask myself, especially if this is in the context of sharing with a patient, is what is my motivation for sharing this story? If my motivation is because I want the other person to say, oh my gosh, Sarah, I'm so sorry to hear that. If I'm seeking support from them, that is not the right motivation to share a story in service of connection. If my true motivation is to draw a link and ultimately connect with that other person, including with a patient, then I think I'm more on the right track. And sometimes, especially with a patient, you may want to pause and ask permission and say, this makes me think of an experience that I've had too. Is it okay? Do you mind if I share with you? Right. And then if you do share to say, I would love to hear, how does that feel to you? Does it feel similar or am I off? That's almost like reflecting back to the patient what they said to you and then asking for clarification. So even if you're off the fact that you're saying, what do you think you're offering them that opportunity to say kind of, but not really. You're getting really important information as a clinical caregiver in that context.

Rahul

I've also seen some folks use these stories of self, not of the moments that have gone brilliantly, but maybe of a situation where things did not go well and then trying to share that to create trust or show their vulnerability or maybe show the other person that I suffered. But my intention and value here is that you don't suffer and we can talk about what you can do so that you don't have to go through the same outcome.

Sarah

Absolutely. I think especially when we are working in teams, if you are in a leadership position in that team, and it doesn't have to be a formal leadership position, right? When you show up on a team, you're influencing the way that team feels. You are part of the group that is setting the culture for that team. I mentioned that telling a story is offering a gift, telling a story about where something went wrong is maybe one of the most vulnerable gifts that you can offer. And I do want to say being able to share a story about a time when something went wrong implies that you have a certain level of safety, maybe a certain level of relative power within that team. Not everyone is going to show up in the same space and have the same relative safety to be able to share with vulnerability.

The other thing, again, credit to Matt Lewis, I love when he says, tell your stories from your scars, not from your wounds. Meaning if you're going to share a vulnerable story, make sure that it's something that you yourself have had time to process so that you can share it with confidence and you can be reassuring the person or people you're sharing the story with. I'm okay, I'm sharing this to help us as a team or to share so that as you said, rule holes so that hopefully things will be better for you when you're sharing from your wounds. Sometimes it's just too fresh and that ends up being, again, like you're seeking support from those around you, which can be appropriate, but not when we're thinking about story as a leadership tool.

Rahul

That's well put. Yeah, and you also bring up a good point that being authentic isn't easy and it needs a lot of trust and safety and sometimes even a certain element of power in that group or relationship because there's always the tension of fake it till you make it when you're the newbie versus being authentic when you're secure in that space.

Sarah

And I do want to say, don't feel like you have to wait to start trying this until you've got it perfected, right? That's not what I want to communicate. If you want to start trying to use stories more, find people around you who you feel relatively comfortable with and say, Hey, I'm trying a new thing. So would love your feedback about how this goes and know you're going to make mistakes. Things are not going to go that well. Guess what? That is also you sharing a bit of your vulnerability and it's simply going to invite those around you to do the same thing. And then collectively, you're going to grow and learn together. So again, depends on your perspective, but even when things don't go well, you can always be learning and growing.

Rahul

Thank you.

Rebecca

I have a question for you, Sarah. This is Rebecca At this time of the year, it's mid-August and I work with a lot of fourth year students and I'm reading over a lot of personal statement drafts these days, and students are often in their first draft very eager to show what they've done and what I try to help them understand is exactly what you pointed out in your opening, which is we're really trying to communicate who you are and what's motivating you and what your ambition is, and some of these characteristics, and a lot of medical students are not naturally inclined towards writing, but I'm wondering if you could speak to the value of story writing for the writer in terms of being able to maybe self-reflect and identify some of those more deeper characteristics or motivations. Is there any value to that exercise? Because I think a good personal statement really can be a very powerful tool for exactly what you said, which is finding a position or an institution that has shared mutual values with yourself. So I'm just wondering if you have any thoughts about that.

Sarah

Oh, I think this is a great, great question and it's really hard. I mean, I think it's, yes, our fourth year medical students struggle with this. I think often many of us struggle with this because ultimately the questions we have to ask ourselves to get to the underlying reasons is why and what can feel so intimidating about this? You cannot ask chat GPT for the answer. It's not out there. The answer is inside you and you are the only one who has that answer. Sometimes, especially I think in the throes of medical school, we're so overwhelmed with data overload and we're trying to get the best grades and get the best feedback on our rotations, and maybe we're trying to do research and we're trying to volunteer and it just feels like we're doing and doing and achieving and achieving, and really what's going to stand out to those programs, as you said, Rebecca is the why behind the passion for why you're doing what you're doing.

And so I think there are a few things that fairly painful exercise of just why. Okay, so you did this research or you volunteered in this program, why and when There's an answer to that, why? And you could just free form, write it. No one else has to read it. Just start writing and let it come out. Go take a walk, go for a run, go for a swim. And I know this is sometimes hard to hear as a student when you're just so, so busy. Sometimes it's getting out of that analytical part of your brain and into that creative core, which is not always super accessible when we're focused on these analytical achievements that helps you answer the why and the why and the why, right? The other piece is sometimes it's drawing. Rahul was kind to share with me another great storyteller, Matthew Dicks, who has some amazing tips and tricks about storytelling.

And I was kind of fascinated when he said he doesn't ever write down, this won't work for a personal statement. You have to write that one down. But if he doesn't write down what he's going to say, he just kind of has these moments in time or these images in his brain, Matt Lewis would call these the lily pads that you're going to move from. Draw them, draw the pathway, draw your why. Use whatever creative outlet is most appealing to you to try to access the part of your brain that is a little less analytical and a little more at your creative core to help you really answer those hard questions.

Rebecca

That's a great answer. Thank you.

Rahul

Yeah, I wished you were allowed to send drawings in because you could draw your iki guy and send that in as your personal statement. And I also will see people in their offices or rooms or homes of course, sharing these artifacts, whether they're photographs or something someone has made for them. And those are little stories sitting right in front of our eyes.

Sarah

Oh, Rahul, I'm so glad you said that because another place where story comes out and where you can use story as a leader is if you are responsible for leading meetings, starting your meeting with a check-in can be so valuable. We literally did one in a meeting once where it was look around, you pick up an object that has meaning to you. We were on Zoom and share it with the group, and one of the first people shared a nut bowl, this carved wooden nut bowl that had belonged to her grandparents. And I saw another team member's face just light up, and he said, just a minute. And he went in the next room and brought his nut bowl, and it's just, you would never think to ask someone, tell me about your nut bowl, but the two of them, and then all of us somehow felt this thread of connection through these familial nut bulls. So yes, take those moments of check-in and be creative with them. I love that idea of the artifact that has meaning. There's stories within those two,

Rahul

And I think your work and that of Marshall Ganz and the Leading Change Network has definitely influenced me to think about this second theme of using storytelling to build community. And I heard that in your response as well. So maybe we touch on that use of storytelling for leaders to build community or the story of us as they say, how can we use stories to build community within a classroom session or within a healthcare team that we're leading?

Sarah

Stories are essential for that building of community in whatever context you're in. Typically when you're coming together as a group, there is some common reason why you're coming together. There are some shared values that exist across that team, so finding ways to seek them out and highlight them becomes really valuable. A couple examples of this. One is a colleague and I will often go into an undergraduate seminar class at UNC, and we're talking a little bit about relational leadership and just we touched lightly on storytelling and we asked the students to go around and talk about something from the last week that they're proud of or something that added some stress for them. The autonomy to choose is really important for them to feel like they can safely bring whatever they want into this space. And by the end of going around, we usually ask them, did you learn something about someone else in this group that you didn't know?

Of course the answer's always yes. And then it's if you were going to go forth and start a new initiative or try a new project, did you hear people in this room express shared values with you where now you could go to them and say, Hey, do you want to come together and try this thing with me? And essentially they've built relational power by identifying shared values through that process. Another example is in the clinical setting, we would have these big all hands meetings once a quarter where everyone from the clinic would come together in basically a big staff meeting, and at the end we would do a shout out hour. It was usually 10 minutes, not a full hour, but we would get the opportunity to offer gratitude and honor what we had seen our colleagues do that essentially highlighted our shared values. I mean, you could say like, wow, I saw Holly notice that this patient in the waiting room was really struggling with their mobility.

So without anyone asking, she went and got a wheelchair, went to that patient and brought them back to the back right away. And it's not a story about me, it's a story about what I witnessed Holly do. But by calling it into this space where we're all together, it starts to exemplify the shared values that we think are most important as a group. And that starts to create cohesion in the room, which becomes really important through difficult uncertain times where you've got navigate uncertainty or launching new projects, sustaining change. And I feel like all those things are pretty synonymous with healthcare. So there's real value in doing something like that.

Rahul

I think anyone who's the director chief in any position of leading a team needs to be the chief storytelling officer for that team and create and hold these spaces where people can tell stories about how values were upheld, the mission was forwarded, or just what people are doing to contribute. I think so many people in healthcare and education just feel so unseen that they're working hard all day half of it or more on a device where nobody's seeing them and nobody's acknowledging them. So what you said is so powerful, even that one thing.

Brooke

Yeah, I just had a thought from way earlier on in your opening story, because when you were telling it, I wasn't even thinking or consciously aware that I was picking up on what your values are. I was just listening to the story and then subconsciously I was like, oh, okay, that means she's this, she's this, she's this. Then I didn't even realize I realized all those things until we were talking about it afterwards. And so I just thought that was really cool. I think that also goes back to Dr. Zucconi when you're writing a personal statement or sharing a story, it isn't genuine If you're saying, oh, that means I am authentic versus showing it. So I thought that was really, really cool.

Rebecca

Yeah, you nailed it. I think also bringing attention to your point, Sarah, about knowing who your audience is, really knowing who your audience is, and with these personal statements, this is a big part of the work I do too with students, is reminding them you are writing to a very specific audience with a very specific goal in this case. So knowing that you're appealing to program directors, you might not necessarily want to spend two paragraphs talking about why internal medicine is the best medical specialty there is. Those people already agree with you.

Sarah

That's right. They get it. And this is true for your interviews too. So when you get into a space, I didn't mention this in detail, but when I had that interview with the program alum, we talked about home remodeling. We didn't talk anything about the work. I mean, I think it started in some context of systems, but we just went, we connected as people, a shared passion. And my hope is that that connection, that energy, that's just this intangible feeling that then gets carried with these folks into that inevitable meeting, the debrief that happens after, you want them to carry into that shared space and excitement about you. And that will happen when you feel a connection with that person more than it will happen when they read your grades and your test scores and your research. Research publications.

Rahul

Yeah. So I want to bring you back to the third theme that I picked up in your use of storytelling. You said it can be used to influence people and lead change. So how could we best use stories to make it clear with our listeners if one path is better than the other path?

Sarah

Great question. I think in part, so there are kind of two aspects of this that I think of. It goes back to what you said about sharing stories about times when things did not go well. I think certainly we can think of leaders in our past who shared a facade of perfection and maybe we honor them and we hold them in high regard. I think the people who we truly want to follow and feel like, oh my gosh, I could really put up with a lot of things in my job that I don't like because I want to work with this other person. They're usually the more flawed leader, the person who's showing us some of the cracks, who shows us that they're still learning, who then wants us to grow and develop with them. And so I think there is this element of being an inspiring leader through the stories that you share about yourself and supporting and helping other people grow along with you.

And then there's a more structural approach to this, which goes back to Marshall S's work, right? The story of self, the story of us, and then there's the story of now, which is why now? What is the urgency? Why do we need to make change on this? Why do we need to move forward? Usually that's after you've built that sense of us in the space. What is the thing or the things that the US cares about collectively? How do I best share that? How do I really inspire and motivate people to move in that direction? I mean, I think about the really challenging work of being a medical director. Medical directors sit in this space of both delivering the clinical care typically, and they're working alongside folks delivering clinical care. They're also answering to and communicating the needs of the leadership level above them. Sometimes those wants and needs feel like they're in conflict with the values of the people delivering the care.

So this is an essential skill for those folks, especially. How do you authentically, we're not trying to, this is not all about being positive all the time. How do we authentically get to the core of why we actually do need to make these changes? How are these changes in service of our ultimate shared goal? Whether that's the best clinical care, optimal access for our patients, keeping the clinic sustainable, keeping the doors open, helping everybody in the practice keep their jobs right? There's usually a core reason. How do we come together in that context and effectively communicate the why behind the change that needs to happen? And it's not easy. It sounds, I'm making it a little bit formulaic. It is not that easy when you bring together a collective group of people with a lot of different perspectives and motivations.

Maya

I was just thinking in a slightly different direction in terms of story as advocacy. So whether we're doing that to influence something within our team, or even we're trying to influence something on behalf of our patients or help our patients and our clients do that. So really leveraging story in that way to change minds, to change policy. Doing it with data alone often isn't enough. Both are equally important. But personalizing and helping someone connect to the why that you were talking about earlier. Why do we need to do this, right? Why do we need to advocate for a policy change or a change in the way we do things, say in our medical center to better serve patients? I think that piece is key. And we have to remember that's part of our power as healthcare providers. If we can harness that and use that. Yes, absolutely.

Rahul

Yes, stories sticks, stories are memorable. Stories are going to make us more powerful. So Sarah, you've convinced us to tell more stories. We are feeling a bit braver. So tell us how do we make a story come to life in engaging for our listeners?

Sarah

I think you all have mentioned this over and over, it's authenticity. So coming from a space that feels like it's truly yours, it's sharing those values. Ideally, you want to take your listener into that moment with you. And some people will say, oh, we need the richest imagery. I actually love what Matthew Dix says about this, which is if you're going to describe a space that a lot of people are familiar with, they're going to come up with an image on their own, in their own mind. You don't have to describe the grocery store with its beeps and bings and aisles and produce. I mean, most people have been in a grocery store. They're going to conjure that on their own. Now, if you're trying to describe a space that you think is going to be unfamiliar to your audience, you may want to bring them more into that moment with you.

You certainly want them to feel the feelings you were feeling. You also need some tension in there. You need a little bit of contrast. He says, think about where you want to end in your story, and then where you begin is when you felt the opposite of that. And so to create that tension of, and in the story that I shared, I ended being matching in a primary care residency. Well, I started saying, one focus categorical internal medicine. That's the only life for me. And so how do you create that tension, the uncertainty? How do you help people be curious and wonder what's going to happen next? What is she going to decide? What will she choose that helps bring them along through the story? And bear in mind, this is I think, more practical for those formal sharing of stories or your written stories more so than don't feel like in the moment if you have an anecdote, you want to share that you can't share it because you've got to sit there and formulate, where do I want to end? Okay, now where do I want to begin? Now, where's the imagery? How can I bring them along? Just share the anecdote and connect with that person. So this is all on a scale, and you decide where on the scale or the spectrum is right for the moment.

Rahul

So what I'm picking up from you is one is be authentic, meaning you are in the story, or if it's someone else's story, you're telling it through the lens, you observed it.

And then thinking about that challenge, choice, outcome, and trying to keep your story as focused and clear about that challenge and the choice being made and having the rest of the elements of the story serve it. And then the third thing I heard is be clear about how you want the story to end. Often that's where you're starting to construct your story. And then you can think about the beginning, which is hopefully, or in most cases, the opposite of it. And now your arc of story faces that challenge and how you choose and overcome that and have a good outcome or bad outcome. However you want the story to go is how you're forming the arc of your story.

Sarah

Yes. Another thing that Matt Lewis will often say is when we teach this and we put a timer on the learners and we say, three minutes, you've got three minutes. And they've just crafted this story, and usually the timer will go off and they'll say, oh, I was just getting to the good part. And Matt, every time says, well, then start with the good part, right? So it makes it sound like it's really easy and you just plug and play. It takes a lot of practice. I'm still learning and growing every time I do it, for sure.

Rahul

Sarah, thank you. That's been a masterclass in storytelling. Before we end, if there is one message you hope our listeners take away, what would it be?

Sarah

Try stories. Look for them all around you in your own life. They're everywhere. Invite them from other people. Don't be afraid about making it perfect. It will never be perfect. Just try it and start to really observe how it changes your connection and relationship with the people around you.

Rahul

That's wonderful. Sarah, thank you so much for a great conversation on telling more stories, telling stories to connect, telling stories to share about us. It's been such a joy and privilege. One of the things that I'm taking away from this conversation is not just the power of telling stories, but also the power of just listening to stories and honoring stories from others. And when we are telling our own stories, just start simple, start small. You got to practice it, and it will help you connect better with people and be a better leader.

Maya

I'll add something in that is echoing from your original story, Sarah, which the idea that our stories also are never done. So you might've had an assumption of this is the story, this is the map, this is the road that I'm on, and yet there's always some new curve, some new plot twist, shall we that may surprise us and make us more fully ourselves and our authentic selves. So I think sometimes we get very stuck and I think we can get stuck as a young person that, oh, I think this is the plan, but even as we're further in our professional lives, this is who we are. And that really never has to be static. That can always change. So that was a nice reminder.

Rebecca

I also appreciate the reminder to not only be authentic with our storytelling, but really to listen authentically to people who are sharing stories with us and to remember to see perhaps some of the vulnerability behind that sharing.

Brooke

Yeah, I would definitely echo that. The word that I was taking away was also authenticity and the importance of that in telling stories. And I think that you really explained the importance of that and showed why it's so important.

Rahul

Sarah, before we end, how can our listeners reach you and stay connected with you about the work you're doing?

Sarah

I would love for folks, I hope that's been very clear. I love being connected with folks, so I would love for anyone to reach out. They can find me on LinkedIn or by email. And my email is sarah@rlpconnect.com.

Rahul

Thank you so much. It's been such a joy. And our listeners, we'd love to hear from you as well. Let's keep the conversation going. Thanks for tuning in, and until next time, take care. Keep learning and keep leading.

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

S2E2: Leadership Hack – Giving Others a Second Chance (feat. Miklos Fogarasi, MD)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke 

Welcome back to Learning to Lead. Our guest today is Doctor Miklos Fogaras, physician and educator at the Netter School of Medicine at Quinnipiac University. Welcome. 

Miklos 

Thank you. It's great to be here. 

Brooke 

All right. So, we'll just jump right in. What is one of your favorite tools or hacks to become a better leader? 

Miklos 

Yeah. So that's such a wonderful question. And I thought about something that's straightforward. I call it a second impression, beating a first impression. And technically, I had so many times in my life when after some important encounters, I wish that I did better. And I wish I could replay it or do it again. So, in my practice, both with patients, and with students, and coworkers, I decided to give a second chance. So, when I meet someone, a new co-worker, a student, a learner of any level, someone who was just introduced to me, I pay close attention to positive first impressions, positive first visits. And if that goes well, I cherish them. But I don't let a negative first impression bother me too much. I basically chalk it up to a person having a bad day, or someone have a hurried schedule, or an unexpected obstacle, or just as simple as getting into a traffic jam. And sometimes I simply tell myself, you know, maybe the issue I proposed was not the most important for that person that day. And so I let a first impression go, and if it's negative, this prompts me to schedule a second quick meeting within 3 to 10 days to give that person a second chance to come back better prepared to come back, less hurried, and to show their true colors to me. And what's really interesting, I don't say that that's the purpose, but most people realize, you know, I have a second chance and they come back well prepared. They come back smiling, they come back enthusiastic, open to discussion. So I do get impressed, I would say about 50/50 that after the second visit I have an unfavorable opinion that now changed to a favorable one. So that's a pretty good deal. Giving a second chance to get 50% more people in the good camp. 

Rahul 

Wow. This is Rahul. I love that hat for a couple of reasons. One, in healthcare or education, we don't know who's having a hard day. And often people are having a hard day. If we think about healthcare professionals as leaders in their patient interactions, our patients are pretty much having a hard day, which is why they are there to see us. So that is a great hack to give people a second chance. I'm also thinking about my own interactions in the past, where people have almost put me down in the first meeting. And to protect my own identity, I guess I told myself a story and didn't want to continue the interaction with them as enthusiastically as could have benefited me or the purpose. So I also love your hack for that reason that if our purposes are aligned, we always have a reason to come back and give people a second chance to work together. 

Miklos 

I fully agree with you. I think I got so many excellent, great collaborations born out of this process, basically not rejecting someone for a suboptimal first encounter allowed me to also come more openly to the table. It's interesting, the listener, who was not so impressed, it's also somehow more open. There is this, both of us being more interested in a good second encounter. And recalling over the years, how many second encounters went well, I use this now all the time with my students, with my colleagues, someone, a fellow co-worker who is just being introduced to me, and it's so simple. Give it a try. 

Brooke 

Yeah, I also agree that that's a really good hack that I really think anyone can use because we're always interacting with new people. And I think it's really optimistic of you, which is really nice that you don't just immediately jump to the conclusion that it's like a bad person and you're considering more than that. Thank you for listening to this hack, and thank you Dr. Fogarasi for joining us. Make sure to tune in next week to listen to the full episode where Dr. Fogarasi talks about Ikigai. 

Miklos 

Thank you for having me. 

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

Episode 8: Caring Inspired Leadership with Joshua Hartzell, MD

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Rahul 

Welcome everyone. Our guest today, Dr. Joshua Hartzell, (MD, MS-HPEd, FACP, FIDSA) is a retired Army Colonel with a distinguished 25-year career in military medicine. He earned his medical degree from the Uniformed Services University of the Health Sciences (USUHS) and completed both his Internal Medicine residency and Infectious Disease fellowship at Walter Reed Army Medical Center. Josh has held many leadership positions, including Program Director for the National Capital Consortium Internal Medicine Residency at Walter Reed, as well as roles in Graduate Medical Education and Faculty Development at USUHS. He also deployed as a Battalion Surgeon with the 82nd Airborne Division in Afghanistan. His latest book, “A Prescription for Caring in Healthcare Leadership: Building a Culture of Compassion and Excellence,” highlights his passion for developing leaders who really truly care in healthcare and beyond. Josh, welcome to the show. It's an honor to have you here.  

Josh 

Wow. Rahul, thank you so much for having me and thank you for that very kind introduction. I'm definitely looking forward to this discussion. 

Rahul 

Wonderful. And with me as always are Pete Longley, Maya Doyle, and Amber Vargas. So let's get into the conversation and get our listeners to know you a little bit better. Josh, take us to the beginning, how did you get into healthcare, how did the journey begin. 

Josh 

Sure. So healthcare for me really began back in, I would say like high schoolish time period. And I had a sort of personal experience, my mom had breast cancer at a fairly young age for her and that was probably my first profound introduction into healthcare. And I had sort of been interested in science before that, but I think going through that with her really sort of led me to this like, hey this might be a a career. And then over time as I went to college and experienced other things related to health care and got to do some shadowing, I realized that this is where I wanted to sort of be with my career. 

Rahul 

Wow, yeah thanks for sharing that with us. I'm listening to you and reminded of Ikigai, that Japanese phrase, a reason for being. And how you found something that you really truly cared about and then as your journey was progressing, you were like, “Yeah I'm good at it, and I love doing it, and the world needs it,” and here we are. 

Josh 

Yeah, no I think that's true, and I think the other thing is that you know medicine was the sort of beginning of my career and that's also evolve to other things that I really am passionate about which is, you know, teaching and leading. So that that Ikigai has kind of evolved over the last 20 plus years. 

Rahul 

Yeah. We would love to go on that journey with you, your Ikigai, going through a time machine. So how does it go from there? So you're interested in medicine and then how do you get into military medicine? 

Josh 

Yeah. So when I was in high school, and really even before that, I was a huge reader. I mean I loved to read and most of what I read was biographies and history and a lot of military history. I just happened to be interested in those topics or genres, if you will, and I think that got me thinking about the military. I actually only had like one uncle who had served the full career. My dad had spent a couple of years in the military, but no one other than an uncle had spent 20 plus years. But I was interested in the military, and I also came from a very small town. I graduated with like 62 or 63 kids in my class. And so when I was getting ready to go to college, I was thinking the military is gonna offer me a lot of opportunities in terms of, you know, it's like almost like a commercial, and getting to see the world and getting to do different unique and interesting things. And again, most of my, I don't know, childhood, teen, sort of idols were people who were in the military or historical figures. So it was a nice blend. And then, you know, quite honestly the other thing was my family was, you know, we weren't poor but we certainly weren't rich, and I did the Reserve Officer Training Corps. Which afforded me the opportunity to go to a really good school and not have to pay for it, you know. And and I went to Duquesne undergrad in Pittsburgh, and then at that point my experience in the Reserve Officer Training Corps was exceptional. I had great cadre or faculty as we would call them and they really invested in our careers and helped us develop as you know not only military officers, but also students. And when it got ready to go to medical school, the Uniformed Services University, which is our nation’s military medical school, just seemed like the dream to me. Like I get to combine this, you know, being a military Medical Corps Officer with becoming a physician. And fortunately, everything worked out that I got accepted there and then was able to go to school at that school. 

Rahul 

Wonderful. Yeah, those early experiences and the role models you meet early on are so formative. Like they really define how you think of the field and what that quote unquote dream place looks like to you. 

Josh 

The other thing I would say, and I do this with one of the classes I teach for leadership, is that you know a lot of those early experiences, whether it's our parents, our neighbors, sports coaches, we learn a lot of leadership from them. We may not call it leadership, but when we actually reflect back on why we do certain things we do as leaders, it's because of those early experiences and how they shaped us. And sometimes that's shaped us in a good way, and other times it's shaped us in a way that maybe we need to adapt or adjust. But I was really fortunate that I had some very remarkable leaders early in my life that I think shaped a lot of how I think about and approach leadership. 

Rahul 

Yeah, that's a great point. So then how does the journey go on from there? You get into Uniform Services University, and then how do you get in from there to your first quote unquote leader position? Like take us through the journey where you first see yourself as a leader in healthcare. 

Josh 

I think when I was a student, I mean we talked about leadership, but I didn't, at that time at least reflecting back, didn't necessarily think of myself sort of fully as a leader. I think during residency is where this transition started. And I was very fortunate to have a Residency Program Director, Greg Argyros, who I interviewed for the book, who really empowered residents. So and we also had another faculty member I remember distinctly, his name was Keith Posley, who I believe still works at one of the Veterans Affairs hospitals in California. But they really empowered us to make changes in our Residency Program. And I think that was sort of this shift of, I'm not just here as kind of a participant, which I was, but hey, we can lead and make change in our program. So those were some early routes. And then, you know, I was blessed with the opportunity to be Chief of Medical Residents for our Internal Medicine Residency and that was a clear, distinct leadership role. And at the time, there was only one Chief Resident. We had 40 plus residents within our program, so I had the opportunity for a year to really be immersed early in my career, as someone who was leading other residents, interns, rotating medical students. But also leading up to our faculty and hospital leadership, in terms of getting what we needed to support our residents. So I think those experiences in residency allowed me to see myself as a leader and then that just sort of evolved over over time. 

Rahul 

So, what I'm hearing is that it was when you were a resident that the seeds of quote unquote agency were sown. That yes, we can make changes to make our lives and of those around us better. And then those propelled you to the next role, more formal, which was a Chief Medical Resident. 

Josh 

Yeah, absolutely. And I think that idea of going both with formal leadership title positions, but also informal roles. And we lead from both of those positions. And it's part of the reason why I love that Amber is on this call, right, is is she's already doing this in Med School. And I think as I've become more senior, I've tried to look sort of back and say, “Hey, how can I help medical students lead from where they're at? How can I help our Interns and Residents lead from where they're at?” And just sort of bring that to the surface so that they see themselves as leaders. And as you mentioned the word “agency,” I think that's critical, right? That they're here, and their input is valuable and that they can take the reins and lead things. They can make things better for themselves, for their classmates, for our healthcare organizations. When I was Program Director at Walter Reed, when I met with our new Interns, I would always tell them, “Look you're all coming from across the country. You're coming from different hospitals, different healthcare systems. I can assure you, without a doubt, you are doing things, you've done things, better than how we do them here. Like you just have to, there's so many of you, so many different experiences. You can make us better by teaching us those lessons, teaching us new processes.” And really sort of planting that seed for them from, you know, these are Interns, but day one, hey we expect you to lead, to have agency, a say in what you do and help us get better.

Amber 

Thank you for sharing your story. As you were speaking a lot of things that you said resonated with me, in terms of like, you know, your first experiences with leading teams as a Resident. I'm curious to know, is there anything that you were exposed to in medical school or that happened during medical school that prepared you for those leadership positions as a Resident? And on the other side of the token, is there anything you wish you had done, or you wish you were exposed to in medical school to be better prepared for that? 

Josh 

Wow, that's a great question Amber. I think part of it for me, like I had already done 4 years of ROTC, so that was definitely part of it. And our school, like we're blessed at the Uniformed Services University, that leadership is part of the culture. This idea that you're going to lead, and that we're going to teach you how to lead, that's part of the culture at the school. So I think that empowers our students to think of themselves early as leaders. And then then the question becomes, OK what does that look like? What are the skills I need? So I think partly having a culture that is supportive, you know, much like I mentioned the culture of our residency like, our goal is to empower our residents, to give them that agency, to help them figure out how to push ideas and lead from where they're at. So I think for me, it was just being immersed in that, and having prior experience that I had learned from my time in Army ROTC. Things that I wish I would have maybe done differently; I don't know that there would be. I, you know, I felt very blessed in my medical school time. I had great classmates, we had amazing faculty who listened to us, and they would take input and advice. And I think for most of us, like that's really what we need when we're in follower positions. I do think one of the things I would if I could go back now, I didn't really learn about the term “followership” and what it was to be a follower. And some of the specifics around that honestly till probably, I don't know 5, 6, 7 years ago. Lauren Weber, who was a Chief Resident of ours and now is out of the Navy, but she's really sort of an expert in followership and she taught me about it. I think if I had known those follower skills that probably would have made me have more agency. And think about like just more intentionally how I approached leading from that follower position. I think the good news is people are becoming more familiar with followership and what it means and how followership is really the cornerstone of becoming an effective leader. And also, that no matter where you're at in your career, you're almost always going to be a follower to somebody. So I think that would be the only thing that I could really think of is just knowing more and learning more about followership. 

Rahul 

That's a fantastic concept. So before we go ahead, just for our non military listeners, what's ROTC? And then I'm going to ask you about followership. 

Josh 

Sure. So ROTC is the Reserve Officers’ Training Corps so the Army, Navy, Air Force all have a program that basically pays for your college if you agree to serve, I think it's still 4 years, but 4 years after you've completed college. They have 3- or 4- year scholarships. But it's a it's a great way to go to school, get military experience, serve your country and then, you know, if you want to stay in great, and if you want to get out after your commitment is up you can also you know move on after that. 

Rahul 

Thanks. So let's come back to followership because a core value for a medical student or health professional student or trainee even attending in their first 5, 10 years is survival. And so the instinct is, you know, I'm doing my work, I'm doing excellent work, but I'm gonna do my work and go home. I'm not gonna get involved in all of these politics and tangles of leadership. So tell us what followership means to you and what are the concepts or elements of followership that our trainees and early career professionals can use to build these early experiences of leadership. 

Josh 

So to me, followership is how do I, as someone who's not in a position of leadership, support my leaders. In a simplest sense, that's really what a follower is. So Rahul, you're in charge, I am one of your followers, how do I support you and our mission so that we're successful? So I think you know there's a lot of ways you can do that. You can do that by doing your job really well. So if Amber is on a 4th year rotation and she does a great job supporting her, I'm just going to say Internal Medicine, because I think she should do Internal Medicine, but if she's on that rotation that, you know, like how does she support the interns and residents on her team so that they can get the work of the day done, so that they can better take care of patients. Maybe she volunteers to go meet with a family because they have a bunch of questions and she knows the patient really well. Maybe she agrees to write a discharge summary so that the intern and resident can go take care of something else. I think there's all these ways that we can support our leaders to make their jobs easier. And the fact is Healthcare is a team sport. So we need everybody to sort of play at the top of their game. And I think as followers we can do that I think so not just supporting your your leaders with the work you do, but if I'm Amber and I see that, you know, Josh is my attending and the way we're rounding is really taking too long, could she mention to me, “Hey Dr. Hartzel, can we, you know, think about running a different way?” Or can she give input on something else that she thinks might impact patient safety. So it's partly advocating as well. I think that's really essential for effective followers is to be able to bring up good ideas, bring up, give feedback, right, like we don't know if we're messing up if no one is willing to tell us. It also means that as leaders, we have to create a culture and environment where our followers feel comfortable telling us those types of things. So it's really a, you know, it's a 2 way relationship. But when we do it well, we can maximize our ability to care for patients, but also to care for each other in the healthcare team. I just wanted to add one story which I think is such a great example of followership. And I can't remember the students name, I feel bad about this, but several years ago we had a student who was rotating at Walter Reed. And he said one of the things he did as a medical student was at the end of each day, he gave positive feedback to the resident about something the resident had done. And the reason why he did it is because he knew that, one the resident worked hard and didn't necessarily always get a lot of positive feedback, so he wanted to basically give that resident positive feedback to put the resident in a better mood, to help that resident feel good about the work that he or she did. And of course that's not just the impact on the resident, right, because when that resident gets that feedback, how is their interaction going to be with the next nurse they interact with? Or the next patient they interact with? Or if they go home after that, is their interaction going to be a little bit better with their spouse or partner or kids? And again, this is a medical student rotating on a service and making a positive impact as a follower by thanking and recognizing the work that one of the health care team members did. 

Rahul 

What a great story. And in that there's something that every one of us can do no matter where you are in your training or work. That's a granular hack that everyone can use: take a moment and give positive feedback to the person who helped you that day because that's gonna make their day so much more better. Thanks for that. So let's come to the concept of caring inspired leadership. That's something that I'm learning interacting with you and reading your book. So let's begin by just starting with leadership before we go to caring inspired leadership. What does leadership mean to you? 

Josh 

It's evolved overtime for me. And the definition sort of that I've landed on is going to go back to your other question of what caring inspired leadership is. And to me, leadership is simply taking care of your people, so that they can take care of the mission. I think everything else we do as leaders, falls sort of under and within that. I mean it's ultimately about influence and how we get people to do things. But if I take care of you as a follower, as someone who I need to do certain things, you're going to be motivated to do them because you feel cared for. So to me, it's just ultimately, how do we take care of our people so that they can optimally take care of the mission. 

Rahul 

Wonderful. And so of all the ways that leadership can be done, there's many many theories, styles, you name it, why caring inspired leadership? What's so special about this brand? 

Josh 

So I think what I have sort of seen, and learned, and realized over time is thinking about all the leaders that like, if you ask me today, like would I do something for them? Like I, I like to refer to these as like run-through-the-wall criteria. These are leaders that we would run through a wall for if they asked us. And sort of the one thing that keeps coming back to me, that I could easily answer about those leaders, was that they cared deeply for me, personally and professionally. They wanted the best for me professionally, but they also cared for me as a person. And in some cases they cared for me and my family. And, you know, so I think when we think about, how do we get people to want to follow us? Well we can inspire them through our caring. If we take care of them, they're gonna wanna do great things. You know, we talked about the idea of how do you motivate people? Well, people are motivated by knowing that you want the best for them, and that you're going to create opportunities for them, and you're going to support them. That's what motivates people. 

Rahul 

Maya, you have a question, go ahead. 

Maya 

I had a thought reflecting on what Josh just said, and thinking about that, you know, what motivates people. And I, I've always thought about, right, that idea of sort of intrinsic and extrinsic reward of why we do things, right. And yes, it's nice to have the extrinsic reward of getting paid, and getting titles, and having those things. But that sense of doing things because you're valued. And because you're treated as if you're valued is such a crucial piece. And I think, you know, well I the 30 years I've been working in healthcare now, we've been in bigger and bigger institutions and more complex institutions, which maybe from someone on the military side, isn't so surprising. But like for me, I went from working in one hospital being within a huge network, right, and how you keep that sense of kind of intrinsic value going when you're a smaller and smaller cog and a bigger and bigger healthcare wheel, is is challenging. So just reflecting on maybe, what other things you've sort of done to be able to provide that sense of intrinsic value and reward. 

Josh 

Yeah that's a really good, I think, insight. And you mentioned cog in the wheel. We hear people say like, “I'm just a number on a spreadsheet. I'm a widget.” And, you know, those are sort of devaluing terms. Unfortunately, I think for a lot of us in healthcare because of the systems we've worked in, and in some cases because of the leadership we've had, it makes us feel like we are those things. We're replaceable, you know, we're only about the number of RVUs we generate. And I think when people feel valued and respected, they are going to show up motivated and they're going to do a good job. When they're not valued and respected, they'll show up and they'll do the work they have to do for the whatever period of time you're going to pay them. But I don't think that's what we want in healthcare. And I don't think that's fair to people. People want, you know, to have careers that they feel good about. And, you know, how do we do that, as leaders? I think a lot of it is reminding people of the value that they bring at every single level. One of the things I wrote about, this was actually several years ago, was that we often take for granted the amazing things we do in healthcare. I had a resident, who had kept a patient alive overnight, that had coded several times. And my initial reaction to this, because there were a couple emails of like, “Wow, what a great job, you know, this resident had done.” And my initial reaction was aren't they supposed to do that? Like that's why they're in the hospital. And then it just dawned on me, this resident kept another human being alive. And the response was simply like, “Well, that's their job.” Well, you know, that's not many people's job in this world. And you know everyone in healthcare, while this becomes routine for us, it is not routine for the people that we deal with. And that's not just coding a patient overnight. But it's having an end-of-life discussion with a patient and their family. While that might be the 3rd end-of-life discussion we have during the day, it's the only end-of-life discussion potentially that family is going to have with that family member ever. And, you know, there's so many examples of that. So I think one of our jobs as healthcare leaders is to not let the routine become routine. How do we remind people that the work that they're doing is life changing and life altering for the people that that do it. The way our, you know, cafeteria workers interact with patients and family members when they're there, has a huge impact, right. Family members there, they may have just been told they have a cancer diagnosis, they may be going to get something to eat because they have another appointment and they've got stuff stacked. And if that person treats them well, maybe smiles at them, maybe says something about like, “Oh I love your sweater,” or just something that gives them an ounce of positivity, that can make a huge difference in a patient 's life. And I think we we have to get to a point where as leaders, followers, everyone within our system, that we recognize that and we help people see the value that they bring every single day and not take it for granted. 

Maya 

Yeah. And every single person in our environment, right, needs that. 

Rahul 

Yeah. Let's say I'm somebody skeptical though. I'm not entirely convinced by hearing what you're saying. What is the evidence that this works? What are the benefits of being a leader that's driven by caring?

Josh 

Yeah, and I actually recently been thinking about like sort of the term “evidence based leadership". We talked about evidence based medicine, but what is the evidence based leadership? And what I've tried to do in the book is really give not only like anecdotes or examples of things that I've seen work, but also provide data where we have data. And I think I can't quote it all off the top of my head, but there's very clear data that by doing some of these things, it improves outcomes. The other thing I would say is we know very clearly that the burnout data shows that physicians, nurses, others in healthcare, when they're burnt out, they have worse patient outcomes, they have worse patient satisfaction; we have worse retention issues, we have depression and suicide sort of at at the end of that as well. All of those things have huge costs to our healthcare system. Just to replace a physician, the estimated cost is somewhere between $500,000 to $1,000,000.00. When you think about lost revenue, severance packages, hiring somebody new, onboarding them, right. So when we think of those costs, what if we just treated people a little better? What if we invested some of that money upfront to change, you mentioned culture, I mean that's part of the reason why culture is in the title of the book. Is what if we created cultures where people actually wanted to come to work? Where they weren't burned out? Those are going to lead to better patient outcomes, the data supports that. It's going to lead to more cost effective care, the data supports that. I think the issue is is getting people to be proactive and not reactive, because a lot of times what we do is after somebody leaves, right, well we just have to hire somebody else. We need to be implementing these things much more frequently. And we need to have intentional ways of addressing, you know, some of these issues in the healthcare system and changing our system. Otherwise we're just going to see more of what we've seen, which is staggering rates of burnout. And we again, we know the data behind that leads to worse outcomes. 

Rahul 

So I cannot imagine that somebody who's a leader comes and begins their day and has the intention, “I do not want to care.” I would just think they care about other things and not the people. So let's just take that perspective as to what's holding people back from being a caring inspired leader driven by caring? Where is the attention going? Is it going towards getting the task done, no matter what the impact on the people?

Josh 

Yeah, it's a great question. I don't know that I know definitively. And I'm only speaking from one person's perspective, although I can add some other things I've heard people say. The one thing, and I would agree with you completely, like every leader shows up every day wanting to do the best for their people and their organization. Like I truly believe that. You know, look, leadership is hard. Leadership in Healthcare is really hard. So, you know, everyone has good intentions. I think it's hard, you get distracted with numbers. People put budget numbers in front of you and, you know, if you're hospital leadership, I know this is as residency program director, every day people are bringing you problems to solve. And your day becomes just enamored with putting out fires and solving these problems. So I think that means as leaders, we have to step back from the fray, and think about, OK I'm dealing with those issues, but how do we step back and actually, again going back to that word “proactively,” proactively address taking care of our people? And this is where I think there is a little bit of a lack of understanding of what it means to take care of your people, and what are the intentional steps that I can actually do. It's interesting to me, I mean I'll meet with people sometimes and and they'll say, you know, I've never really had an effective mentor in my career. I've never really had somebody who invested in my professional development and helped me think about like, what my next career step were, and how I wanted to approach, you know, this position. I've never really had anyone give me feedback that changes my performance. So I think part of it is actually really thinking about OK if we want to take care of the healthcare team, what are those intentional steps? Because if you as a leader, have never seen them or never experienced them, it's hard for you to do that. Because we we are ultimately a product of what we've observed and learned. And one of my hopes of the book would be that we create this cadre of leaders who lead from a place of caring. So that when Amber is going through her residency, she sees them lead in that way, and she feels like taken care of, she feels inspired. And not only that, but they're teaching her how to lead in this manner. So that when she's done with residency, it's just natural for her to do these things in leadership. I think part of it is we just haven't taught people how to do this. So we need to catch up, we need to show people what these skills look like, we need to help people feel what it feels like when you have a leader who is fully invested in your career, who is fully invested in your family. I think when you feel that, when you've experienced that, you wanna give that to somebody else. You want someone else to feel that way because you know how it made you feel. 

Rahul 

Absolutely. What you're saying makes me think of people who I've met on my journey who have transformed me, not just helped me, you know, do something specific but changed who I am. 

Josh 

I would also liken it to clinical skills. If you need to learn a new clinical skill, as medicine evolves, which it does, right, you have to figure out a way to learn that. And I think it's it's also incumbent upon us, as leaders, whether we're in a titled position or whether we're leading informally, to dedicate some time to fostering our leadership development. Because when we do that, not only is it an investment in ourselves, but it's an investment in those we lead, and it's an investment in patient care. And I think part of this is getting healthcare organizations to recognize that investing in leadership development is an investment in patient care. If you want to improve access to care, patient satisfaction, you want to improve provider well-being, invest in leadership. That's going to move the needle. There's a great quote by Angela Acosta, she's one of the nurses who I interviewed in the book, and she said, “Do you know what makes happy patients? Happy nurses.” If we take care of nurses, and we treat them well and value and respect them, they will do amazing things with patients. 

Maya 

I would just add, Josh, what you've observed, you’re talking about nursing sort of interprofessionally, because I'm not sure across other professions in healthcare, and I'm not sure if outside of academic medical settings, that that idea of mentorship is as present for other professions. Like I managed to find myself some mentorship honestly through the physician and the nurse manager that I worked with, not necessarily within my own profession because it's not expected in the same way. And so I wonder like I think we've gotten really good at promoting mentorship as an idea, but I'm wondering how we really broaden it out. And maybe starting with our students, who go out maybe with a higher expectation. Like Amber, I think you're gonna go out in the world, and know, “I wanna find mentors,” right, that's going to be helpful to me. And I I wonder if we, how we sort of set that up more broadly, maybe across our healthcare institutions. I don't know what you've seen in your institutions, Josh, that sort of allow that for everybody, not just the physicians because I often feel that that's where the focus starts. 

Josh 

Thank you Maya for that comment. I think part of the reason why I interviewed nurses, and other healthcare providers, physical therapists, for the book was because these lessons are not just for physicians. I do agree with you that I think mentoring is not a common thing among a lot of healthcare professionals. I think this is actually why we see such a robust growth in coaching, paid coaching within healthcare. It's because they're not getting that type of professional development and that type of support where they work, right. So I do some coaching and, you know, it's great for coaching business, but what it means is is that we need to we need to train people within our organizations. And not only within our organizations, but look if I own a private practice, and I have people who work for me, how do I invest in their careers so that they don't want to leave, right? Or how do I invest in their careers, and they do leave, but there are 5 people knocking on the door to come work for me because they know, “boy if I go work for Josh, look what the people who have worked for him have gone on to do,” right. Like they're going to want to work for me because they see opportunity in it. They know they're going to be treated with value and respect and I'm gonna help them further their career. Yeah, I think we we have a lot of work to do, but I am excited. I think these are intentional skills that we can teach people how to do, it’s just going to take some work. 

Rahul 

OK so I'm going to double click on this culture of caring from a trainee and an early career healthcare professional perspective. So let's talk about trainees, what is the culture of caring look like for a trainee in the health professions when they're looking at a program? You've been a Program Director and certainly explored others as well, what does a great culture of caring look like? 

Josh 

Yeah. So I think, and I'll just kind of say how we set up our culture I guess as a as an example. I think one, you have to talk to the residents who are there and just ask them, “Do you feel like your program leadership cares about you?” If the answer is yes, then you could ask them, “Why?” So what does that look like for me? I think number one, when I have trainees the way I look at it is as a program we're responsible for your professional development and your personal well-being. Now you might say, “Josh, why are you responsible for your residents personal well-being? Like how can you control their personal well-being?” Well, I can't control it all, but what I can control of it, I know very well having, you know, trained hundreds of residents, that if you're struggling personally, you're not going to show up and do the best work. It's impossible. And it's the same for faculty, right. So we have to have some way of thinking about how are we taking care of people personally? Now that might mean, hey, what do our call schedules look like? Are we like working people into the ground, and not allowing them time to rest? Are we giving them weekends where they can recover? Are we giving them time off during the week sometimes so that they can actually do the things they need to do like change the oil in their vehicle or go to their own physician, right? Are we setting up schedules that allow them to take care of themselves? If one of their family members is sick or ill or dies, how do we treat them in those moments? I can assure you that no matter what else you do, if you treat them well in those moments, and you take care of them and you're like, “Hey, listen, we got you. You go do what you need to do for your mom, dad, spouse, partner, brother, sister.” They will never forget that. They will never forget how you treat them when they're in those moments. And, you know, I had a boss, Bill Schimmel, who used to say life is messy, right. And the fact is if you're a resident in a 3-year program or 4 or 5, something is going to happen in your life. So we have to support people during those times of need. That's sort of the personal side. The professional side is, look, if you're coming to my program, I'm going to have very high standards for you because I want you to leave this program having reached your full potential. If we're not helping you reach your full potential, I am failing you as a Program Director. So that means I'm going to set very high standards for you. We used to say when people would come to Walter Reed, you're not here to be mediocre. Like we're not looking for residents who are just here just to get by, right, like we have a high standard for you. But if I'm going to set that high standard for you, then I have to do things like give you the support you need to be successful. I have to give you the coaching, and the feedback, so that you can learn and grow and evolve. I might have to create opportunities for you to stretch your limits, to create opportunities that will align with your career interests and your career goals. So, you know, what does that look like? Well I've had residents for example who are interested in healthcare policy. I know nothing about healthcare policy, I won't say nothing, but like it's not my expertise, right. So how can I link this resident up with maybe a colleague or someone from a different institution to help them learn about healthcare policy. Maybe Pete. But the goal is set high standards, and then coach, give feedback, create opportunities. So that they know, when they leave, they're going to feel like number one, they're incredibly clinically prepared, that's the foundation, like you have to have the clinical skills. The second part of that is what are the other things you're really interested in? Is that teaching, is it research, is it leadership? How do we help you explore and grow and build in some of those other areas? Again, so that you feel like, man, Walter Reed was really invested in my professional development. And I think you can ask a lot of residents, “Do you feel like that's the case or not?” That will tell you the answer. But I think those are just some of the ways we would set up that culture of caring for a residency program. The feedback piece is is really challenging cause a lot of times people think, “Caring, oh that’s, it's really soft and like mushy.” Like for me to hold you accountable and tell you that you're messing up might actually be the most caring thing I do for you the entire time you're in my residency program, right. Because if I don't fix the fact that you can't interact well with others, that maybe you have some emotional intelligence that needs, you know, coaching and improvement. If I don't fix that, then I've let you down. Not only have I let you down, but I have let every single patient, every other healthcare provider that you're going to interact with over the course of your career. Like that's thousands of people, I've let them down. So if I really care about you, and I care about our healthcare system, then I have to give you that feedback. Now, I need to deliver it in a kind way, but if I care, I have to give it to you. 

Rahul 

That was  part of your book that really resonated with me. That yes, it begins with having strong personal relationships and knowing your people. And then it builds on that by setting high expectations, and giving them the support, and the feedback, and the coaching to really meet those expectations. That's truly a part of caring because you're caring for your people and in making them excel, the mission is also getting fulfilled. 

Pete 

How do you, I'm just curious, because I have high expectations of myself. I'm easier on other people. But how do you hold the bar up really high without crushing their spirit, right? Without really smothering and then making them feel bad and having them cry into the corner, right?

Josh 

Yeah, that's a great question as well. I mean there are limits and I think that's where like getting to know people, and understanding them, and like assessing the situation. Trying to figure out like how far you can push people. We obviously, we have this pandemic of burnout. So the the flip side of this actually, to that question I think Pete, one of the things I did a lot of as a resident, and actually do probably 5 times as much when I'm coaching or working with faculty at all stages, is getting them actually to do less. And it's by doing less, that they're actually able to concentrate their energy on some of the areas that they're really they really want to focus on. So I think it is setting high standards, and pushing and pushing knowing when maybe to back off. But also knowing how to prioritize and help people be focused on the things that are really going to be helpful for them. You know, sort of, I'm a big sports fan, and you know, how do you coach people to the edge without sort of pushing them over? Part of that is just feel. I wish I had a a great way to to tell you to do that, but I think it can also be a discussion between you and the person you're leading. Just checking in like, “How are you doing?” And, you know, and if you notice that they're sending you emails every day at 9:00 or 10:00 o'clock at night, well you're pushing too hard, right. Like that's not what we want. So then you maybe got to back off a little bit, and hold them accountable for their wellness. “Hey, look this is not sustainable. I see you're sending me emails at 10:00 o'clock at night. How do we fix this so that you can show up optimally at work?” 

Pete 

Wow, thank you. 

Rahul 

One more perspective is a lot of our listeners, trainees, early career professionals, they're leading from where they stand. And, you know, most of the time they're dealing with people who have not read your book. So what are some things they can do that are in their locus of control to contribute to a culture of caring and be a caring inspired leader themselves? 

Josh 

So they could just buy the book, and like recommend that someone read it. Maybe like, “Hey, this might help you Sir.” No, I wouldn't do that, it's probably not gonna go over well. I think it's a couple things, one is when you can give people feedback, and I would actually say this is an area that I wish we were all better at. Most faculty, not all but most right, like really want to be effective teachers. And they may actually be doing something that they're unaware of. They don't know how much of an impact it's having but no one has given them the feedback. So one of the things students can do is give honest feedback to their faculty about things that they think they could do better or more effective. That's one way to do it. There obviously has to be a sense of safety in that and a feeling that there won't be retribution. But most faculty, if they knew there was something they could do that would help them more effectively teach or lead their students, they would want to know that. So I think one of it is to give feedback. The other is, I think to not internalize those things personally for yourself if you're a student, right. Understand that that person means well, they're just not necessarily leading as effectively as they could, and then it has no reflection on who you are as a student. The other thing I think students can do because, we've all experienced this, is keep track sort of internally for yourself, what is it about really effective teachers that I like and that I want to do when I have that opportunity? And what is it that I've experienced that I don't want another student to ever have to experience this again? To not perpetuate and carry those traits on because I think too often what has happened in medicine is that we've had those experiences, but that's what we've observed and seeing and then we end up doing the same thing when we're in those positions. So I think having this awareness of those things and recognizing that there is a different way. Hopefully that's going to allow us to break some of this cycle of, “Well that's just how I was treated as a student or a resident or junior faculty.” We can lead in different ways when we're in those positions. 

Rahul 

Thanks, that last bit is such a great piece of advice. I remember when I was in my surgery rotation in India as a medical student, that's the first thing my surgery chief resident had told me. That in the year ahead, you're going to meet many people, and some are gonna be role models and teach you how you should be. And some are going to be the exact opposite and teach you what you will never do to anybody else in the future. And I think that's an important piece to say it because we don't want to be the person who says, “I had to do that, so you have to now as well.” We certainly want to learn those lessons and then do the best to others where it's in our locus of control. 

Josh 

Totally agree. And when I was the intern director at Walter Reed, when I met with the interns, I would exactly say that to them. “Watch everybody because in a year you're going to be a resident. What are you learning by watching that you can do or not do, that will help you be a more effective clinician, teacher, leader just simply by watching.” It's like one of the cheapest forms of leadership education we have is observing, reflecting, and being intentional about what we put in our tool belt and what we don't in terms of leadership or teaching for that matter. 

Rahul 

One other thing I would add is the interprofessional aspect, just from my own experiences. When I was in the US early on as a trainee and had very little social support, sometimes when it's not expected, acts of caring are just the most memorable and will live with you forever. So I will never forget like the nurses at the nursing station who knew that I had not had lunch or dinner that day and would like give me a little bit of whatever they had. And, you know, these are little acts of caring and when they are across professions or across hierarchies I think they stand out even more. 

Josh 

Yeah, I love that example actually. I remember very distinctly being a resident, you know, and doing like night shifts and when the nurses would invite you to eat with them like that was the best. It really made you feel like you were part of that team, that you were together and that they were, you know, there to help you. And I think we we miss opportunities sometimes just to go up to somebody and say, “Hey, listen, I know you were taking care of Mr. Smith, and Mr. Smith is like a really challenging patient. I know how mad he gets. I saw how he was treating you. I just want to say how impressed I was with how you kept your calm and like you treated him so well and you got him, you know, sort of settled. Like I don't think I would have been able to keep my cool like that. Thank you so much for doing that.”

Rahul 

Yeah, and this is after the event feedback. Sometimes I think even making that warm introduction to the patient or to the trainee for another health professional goes a long way because, you know, they may not know the other person, and do not have a relationship, but you do. And if you speak about them in a positive way, that's authentic, then it really goes a long way to build that relationship on a positive note. And what goes around comes around too. 

Josh 

Yeah. And I think to speaking positively, it reminds me of one time we were getting ready to go have a family meeting with a patient. And it was really related to a swallowing issue and, you know, what foods they can eat or not eat and aspiration. And we were getting ready to go in and fortunately we had the speech language pathologist there who would, who knew the patient. And I really, I sort of looked at team, and I'm like, “We're going to let you know this person lead this discussion because she is the expert. She knows this stuff way better than any of us do. So we want you to lead this discussion, right.” And I think in healthcare this happens all the time. Like I don't know physical therapy as well as our physical therapist does, I don't know whether you're safe to go home or not. I can make a judgement, right, but this is what they do for a living. And I think you're right, like by recognizing that, and showing, and pointing out to the team, pointing out to others, like, “Hey, this is the real expert.” Or “We're going to listen to you.” Again, it just goes back to this simple concept of do you feel valued and respected for the work you do. 

Pete 

Oh that's great. Hey Josh, I'm curious, I was been reading a little bit, and trying to distill or reflect on like your personal experiences, who you are, your purpose, your values and, you know, differentiating that from the organization's values, societal values, stuff that's all floating around in your head. How do you know what's true? That's really yours compared to everything else. That's like, well, do I really have integrity? Is that a value, is that mine? Or is that really cause Rahul said it and that's what's stuck in my head. 

Josh 

That to me, goes to us really spending some time thinking about that question. And, you know, I have a chapter on this in the book. But this is one of the exercises I like to do when I'm teaching about leadership is a values exercise, and helping people really spend time and think about, “What are my values?” And not just do it like that day, that one time, and then go about your life. But, you know, write them down, and then ask yourself at the end of each week, “Have I lived out these values?” Right, like, “What is most important to me?” And I my hope would be that if you do that, and you're intentional about it, that you go back to those. Then you are sure what your values are. Why is this important? Well because Pete, when I have to make a decision, if I don't really know what my values are, what do I use to guide me, right? I mean I can use logic, I can use, I mean we make lots of decisions in medicine, right. But some of these decisions come down to internal values that drive us. So I think spending time on those, and really being clear for you, can help you make decisions. 

So I usually think of values as like my compass. They're going to keep me on the path I need to be on in terms of where I need to go. The other thing I guess I would say about that is we can also do that with our organization. So as a residency program, we spent time talking about what our values were and what is important to us. Shockingly, like right, “caring” was one of those values. So how do we as a residency live out that value of caring so that people know about it. And do we talk about it? Because, you know, we talk a lot about culture, and how do you build a culture, but this really has to be an intentional process. If well-being is important to you and your culture, anytime you see somebody doing an act that is supporting well-being, you should try to highlight that. And remind people, “Wow hey, Rahul, listen, yesterday I saw you walk by and you saw Pete at his desk at like 6:00 o'clock.” Number one, neither one of you should have been there, but you saw Pete, you're like, “Hey, why are you still here? I know that you need to be home for something. You need to get out of here, go home.” And if I know that, then I go to you and like, “Hey, Rahul thanks for sending Pete home. Like that's a great example of upholding our value of well-being.” We need to talk about these things and make them intentional and not just like some Internet slogan, or something you see when you walk in the elevator and you're like, “Oh, those are our values? Well you wouldn't know it by the way people treat each other.” But you need to live them out and make them real. But I think as an individual leader, to get to your initial question, we need to spend some time thinking about this and, you know, writing them out and then holding ourselves accountable for living those values. 

Pete 

Great, thank you. 

Rahul 

Yeah, and the hardest part is when some of our core values clash with each other. You know, when like number one is family, and number three is service, and when they clash with each other, that's really really hard. And as Pete brought up, when your personal values might clash, or you know, get repeatedly violated in an organization, that can really weigh on you. So it is something worth reflecting on and in the long run, on the converse, if you can match your personal values, or a lot of them with the environment you work in, or the teams you create, then that can be an area of flourishing. Especially a team where people know each other's core values and are honoring, them can really make a team flourish. 

Josh 

The one point maybe to both what you said Rahul, and what Pete said, is you know, we are often in very large organizations. And sometimes our values, I mean in an ideal world yes, they align with the organizational values. Sometimes they don't line as much as we would like. One of the things I like to get people to think about though is, how can you at your level, right, which is way removed, potentially, from the senior level leadership, how can you on your particular floor in a hospital, or you in your clinic, or you know, your small space, whatever that is. How can you live out your values there and create a culture that you want and that the people around you want. It may not align completely with the organizational values, but how can you at least get those within your sphere of influence as close to living out the values that you all agree on or that you individually want to see within your workplace. 

Rahul 

Big lesson, bring it back to what's in your locus of control. What can you control? Excellent. So one of the biggest things I'm taking away from this conversation is that being a leader who's driven by caring can really make you more effective, as well as more connected. And that caring is not just about personal relationships but it's really about setting high expectations, and then supporting the heck out of your people to help them meet those high expectations and excel. Josh before we close if there's one message you hope listeners take away about leading with care what would that be. 

Josh 

It would just be what you just said. Which is that when we lead with caring, and people feel cared for, they will show up and do amazing work. So if we can intentionally lead, in the book you know that's the whole purpose of the book, is to give prescriptions or ideas about what does this actually look like? What can I do? If you show up that way, it can ignite our cultures to be more effective. There's really no greater return on investment than investing in your people and investing in them with a way that shows you care for them. These are proven strategies that are going to help people be more effective. Not only professionally, but the the better we feel at work, that leads over to how people feel at home. So you know I think these are strategies that are going to help people personally and professionally. 

Rahul 

Love that Josh. Josh, what a great conversation. It's been fantastic having you on our show and I've learned a lot from this conversation about leading with care and I hope that our listeners have as well. I'm sure they will. For anyone who wants to keep learning from Josh, his book A Prescription for Caring in Healthcare Leadership is available on Amazon, Barnes and Noble, and wherever books are sold. If people want to keep up with you and what you're putting out Josh, what are the best ways they can keep in touch? 

Josh 

LinkedIn is definitely my primary venue at this point. 

Rahul 

Thanks for that. Well, thank you again, it's been a joy. And to all our listeners, thanks for tuning in until next time take care and keep leading with care. 

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.

Episode 7: Leadership Hack - Investing in Others (feat. Joshua Hartzell, MD)

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Brooke 

In today's episode, our guest Dr. Joshua Hartzell, shares a powerful leadership hack, intentionally investing in the careers of those around you. Josh is a retired Army Colonel as well as a boarded certified Internist and Infections Disease Physician.

Rahul 

So Josh, one of our sections is Leadership Hacks. So what's one Leadership Hack to become a more caring leader as a healthcare professional?

Josh 

Yeah so probably the one that I use the most is I am on constant lookout for ways that I can invest in people's careers. Every interaction I have with somebody, unless it's maybe a clinical, but even then I'm probably like thinking about this is, OK Rahul works for me, what could I do to help Rahul's career? What could I do to help him be more successful, right? Now some days that may just simply be like, “Hey Rahul how can I help you today? I know the service is really busy. We've got lots of consults.” But more intentionally, “Hey Rahul, I know you're interested in HIV medicine. Listen, I heard there's this HIV conference coming up. What do you think? Is that something you'd be interested in going to?” Or, “Hey Rahul, I know you're really interested in academic medicine. I have a colleague who you might want to meet, who I think would be a good connection for you.” Or, “Hey I'm writing this paper, I was thinking about it but I feel like you would be a great co-author.” So I'm always looking at whoever that person is in front of me and thinking is there something I can do to help their career. And boy, what if you worked in an organization where every time your leader was thinking about how can I help the careers of the people in front of me. And you know, that might be me giving you a piece of feedback about something that you need to learn on. It might be me putting you on a committee because you being on that committee is going to be helpful for your career or you're going to learn something that will be valuable for you. So I think yeah, my probably most prominent Leadership Hack is how can I invest in the careers of the people I'm leading. 

Rahul 

You live that. I can attest to it. And that blows my mind, what would a place like that look like? It would be a just an incredible place to work. 

Pete 

Very true. 

Brooke 

Thank you for listening to this mini-episode. Stay tuned for the full episode next Tuesday, where Josh draws from his military and medical experience to share what it truly means to lead with care in healthcare. 

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.​​

Episode 6: Advice to Our M1 Selves

Rahul 

Welcome to Learning to Lead, a podcast about leadership, teamwork, and reimagining healthcare. This podcast is for learners, educators, and healthcare professionals interested in building leadership skills in a supportive community.

We are your hosts Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas, and Brooklynn Weber.

Together we bring you conversations with emerging and established leaders, deep dives and hacks to help you become the best leader you can be.

Amber 

Hi everyone. My name is Amber Vargas. I am a fourth year medical student at Frank H. Netter School of Medicine at Quinnipiac University here in Connecticut. So if everyone could just say their name.

Adebowale 

So my name is Adebowale, but people call me Wale.

Emmanuel 

Hello, my name is Emmanuel Jomo.

Liza 

Hi, my name is Liza Landry.

Amber 

So if there's just one thing that you can tell your M1 self, what would it be? 

Adebowale 

It's never as bad as it seems. Never. I always felt like my world was like crashing around me, but it was never that bad, it really wasn't, when I looked back. And I could have used a lot of that pent up energy and frustration to, you know, do more positive things or study more or whatever. But yeah, I just felt I spent a lot of time stressing, so I would have done a lot less of that. I would tell him to just relax and fall into your hobbies, things that make you happy. And then you know, get back to work after you feel happy again. 

Emmanuel 

For me, I would say Med school is hard, so take time to enjoy the little pleasures of life when you have them. When you have the moment when you have the chance, do something fun for yourself. Do those hobbies, those little things that you know really rejuvenate you and make you happy do those because Med school is hard. 

Liza 

I'd say resilience and grit are not the same thing. Grit implies a certain level of kind of brute force, and eventually it's pretty exhausting. Resilience is a lot more bendy and flexible, and in order to have that resilience, resilience is built from small celebration of all the little moments along the way. So don't be afraid to celebrate yourself and celebrate all the small wins, because that's what you're going to fall back on when you are feeling down, when inevitably something doesn't go right or there's disappointments. You can always fall back on the things that are the little glimmers in your life and the little celebrations and that will keep you going.

Adebowale 

Absolutely. 

Amber 

For me, I would tell my M1 self to do more self-care things, like eating right, going to the gym, prioritizing those things. I think I felt like I just had to go above and beyond in terms of academics and extracurriculars and so I would tell my M1 self that it's OK to take an hour, go to the gym. You know it's OK to take an hour, cook something. So, that's what I would tell my M1 self. 

Liza 

I definitely feel like there was a lot of comparison, not not comparison like outright. But I think internally coming in that sense of impostor syndrome of feeling like everyone else has it together. I remember looking around our class and hearing people talk about this really cool research project they were doing, and that was always something that I felt really self-conscious about that I didn't feel strong in. There were other people who were doing, who had just the coolest back stories and such interesting paths to where they were. I was like, how am I ever going to measure up to these kinds of people when I have to when I have to apply to residency. And like I, I had confused the growth mindset for if you just push yourself harder and harder and harder and harder then you'll be successful. And I think it's really hard to navigate like that comparison of being like, OK, none of us are going to have all the same strengths. And that's what makes us such a great class. And I think that's what makes us such diverse providers in all the different fields that we're all going into.

Amber 

I think we all have feelings like that, you know, like, I felt like that towards everyone in this room. You know, Liza like you would speak up and in our group sessions, and you had all your cheat sheets. And I was like, oh, my goodness, what am I doing wrong? I don't know all this stuff. You know, like everyone, you know, had their own strengths in their own ways. And I think it also helped the rest of us feel motivated and inspired, like OK well, I can do that too. That person is doing that. Let me ask them what they're doing like, let. Let's connect, right? Let's do it together. 

Emmanuel 

Yeah. 

Brooke

Thank you for listening to our show. Learning to Lead is a production of the Quinnipiac University podcast studio, in partnership with the Schools of Medicine, Nursing and Health Sciences. 

Creators of this show are Rahul Anand, Maya Doyle, Peter Longley, Amber Vargas and Brooklynn Weber.

The student producer is Brooklynn Weber, and the executive producer is David DesRoches.

Connect with us on social media @LearningToLeadPod or email us at LearningToLeadPod@quinnipiac.edu.