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.