Latest / The Advancing Healthcare Innovation Show / E186: Why Americans Are Sicker Than Ever Despite Having the Best Hospitals in the World

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E186: Why Americans Are Sicker Than Ever Despite Having the Best Hospitals in the World · The Advancing Healthcare Innovation Show

0:11
Hello and welcome back to the Advancing
0:13
Healthcare Innovation Show. I am your
0:15
host, Michael Stamatinos,
0:18
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So, like many of you, I do a lot of
1:26
reading and um stumbled upon an article
1:29
a couple weeks ago and it just so
1:31
happened to be written by Dr. Scott
1:34
Neely. was titled better health think
1:37
different. The idea was pretty simple
1:40
but it but it really rocked me. Um and
1:43
the kind of question that came into my
1:45
mind was well what if what if American
1:48
health care system is doing exactly what
1:51
it's been designed to do because
1:56
instead of blaming the symptoms
1:59
it kind of asks us that question asks us
2:01
to look at the design and I think that's
2:03
the question that I've been kind of
2:04
sitting on. So Dr. Neely
2:08
brings a very rare perspective to this
2:10
conversation. Ridiculously he trained at
2:13
Harvard, Stanford, did his residency and
2:15
fellowship University of Chicago. He's
2:17
he's taught at some of the most
2:18
wellrespected institutions in the
2:20
country. And I think here's what makes
2:22
him different. He's a physician and he's
2:26
an executive. He's doing both. So he's
2:28
like a Swiss Army knife. And when you're
2:29
in the wild, there's no better
2:31
instrument tool to have than being a
2:33
Swiss Army knife. He is the president
2:35
and CEO of Sierra Nevada Memorial
2:38
Hospital, a rural community hospital
2:41
where the realities of access,
2:44
prevention, and financial sustainability
2:46
are are very deeply personal to the
2:49
people that are being served and the
2:51
stakes are very very real. Um there's
2:54
more than 600 rural hospitals in the
2:56
country that are at risk of closing and
2:58
over half the patients uh his hospitals
3:00
serve are on Medicare and the hospital
3:03
loses money on nearly every one of them.
3:06
So this is sort of the context and
3:08
leadership ground that we're standing
3:09
on. So he's led his hospital to the top
3:13
1% in the country for a critical patient
3:16
safety benchmark. So one that in uh I
3:19
think in his 40 years of medicine he
3:21
said he's never really seen any hospital
3:23
achieve. So um moreover when he needed
3:27
surgery major surgery on himself he did
3:30
it right there because he trusts his
3:33
team that much. So, we've built an
3:36
incredible system for treating disease,
3:40
but HealthSpan, which is a word that I'm
3:43
I'm saying he's coining, the portion of
3:45
our lives that's spent actually healthy
3:48
and free from chronic illness, is
3:51
shrinking. And right now in the United
3:53
States, the highest rate of adults with
3:57
multiple chronic conditions and diseases
3:59
of any advanced economy in the world.
4:01
So, like we're doing really well at that
4:03
as a country. Not great. So this is
4:05
where the conversation begins. Today
4:07
we're talking about health span, old
4:09
person wellness, uh the role of
4:11
hospitals in the future. We're going to
4:14
talk even about meditation uh and and a
4:18
lot of the tension that's that's
4:19
happening between keeping communities
4:21
healthy and at the same time sustaining
4:24
the economics of the institutions that
4:27
built them. So this is like a real
4:29
leadership conversation. It's about
4:30
incentives, responsibility, and what
4:33
healthcare is really meant to do. So,
4:35
Dr. Ney, great to see you. Welcome to
4:39
the show.
4:40
>> Ah, thanks, Michael. That was uh that
4:42
was quite an introduction. I don't think
4:44
I been described as a Swiss Army knife
4:48
before. I've I've been described as a
4:50
lot of things, but that actually uh
4:52
isn't one of them. So, I I got a laugh
4:54
out of that, you know. And I just want
4:56
to say upfront, number one, uh it's been
4:59
great meeting you and getting to know
5:00
you. I love your engagement and the way
5:04
that you think in the moment. Um uh
5:07
that's just such a hallmark of a great
5:09
conversationalist. Um so thank you for
5:12
having me here today. And the second
5:14
thing I want to say is I didn't coin the
5:16
phrase or the term health span. I am
5:19
appropriating it. uh you'll find uh a
5:23
lot of references to that term out
5:25
there. But the reason that I I I I
5:28
grasped uh on to Healthspan
5:32
now going back, you know, two two and a
5:34
half years is that I think that
5:38
>> uh it more than any other word captures
5:41
what I believe we should be going for
5:44
both as human beings uh in our own
5:47
personal lives uh and uh what I hope
5:52
that we as uh people who are promoting
5:56
health in communities are aspiring uh to
5:59
uh for those that we serve because
6:02
HealthSpan
6:04
captures, you know, your functional uh
6:07
uh vibrant living life. you know, the
6:10
the part of your life where you can take
6:12
care of yourself,
6:14
>> where you can enjoy the company of your
6:17
loved ones, where you can uh take a walk
6:20
uh and uh see the sun rising over a a a
6:26
beautiful Sierra foothill
6:28
scene, you know, that that's that is our
6:30
health span. And you know when I started
6:33
to learn more about this, I think one of
6:35
the things that you know really, you
6:38
know, brought sadness to me is the
6:40
thought that with all of our technology
6:42
and our wonderful ability to heal injury
6:46
and and and acute illness,
6:50
health span in the United States has
6:52
actually decreased uh as more and more
6:55
people suffer from one or more, you
6:58
know, even multiple chronic illnesses.
7:00
is uh people are spending a greater
7:04
proportion of their life chronically ill
7:07
or even debilitated. Uh and that is
7:11
something that is worth focusing on.
7:13
It's worth trying to reverse uh and it's
7:18
something where there is a pathway to to
7:21
reversing this uh and helping people to
7:23
move in the other direction. So that's
7:25
why I I grasp onto that term. I talk a
7:29
lot about it. uh as we try to do this
7:32
work in our community uh up in Nevada
7:34
County
7:36
uh California. Um and uh so that's kind
7:40
of a little bit of the history of my use
7:42
of that term. I'm
7:43
>> curious when when you were kind of
7:45
coming up through the ranks um when you
7:47
were becoming a physician,
7:49
were you thinking about health span?
7:51
Like what did you think healthc care
7:52
was? Like what was the picture that was
7:54
in your mind as you were kind of coming
7:56
through?
7:58
Well, when I was coming through, I I was
8:02
attracted to the adrenaline. So, no, you
8:05
know, short answer, no. I wasn't
8:08
thinking about this. Um,
8:10
>> okay.
8:10
>> I I I loved working in the intensive
8:13
care unit. Uh, I loved uh grabbing a
8:17
patient out of the emergency department
8:19
who was uh crashing and burning. Uh I
8:22
loved doing the things that I was
8:24
trained to do uh to turn that patient
8:27
around uh and sometimes actually save a
8:30
life. Uh and uh you know that's what I
8:34
came up in medicine really loving. And
8:38
you know there was a day uh and it was
8:42
quite a few years ago now but there was
8:44
a day when I looked at what we were
8:47
doing and I saw something that uh you
8:51
know it really impacted me. It impacted
8:53
me because to the point that I remember
8:55
that moment.
8:56
>> What was it?
8:58
>> I was uh I was in an intensive care unit
9:01
on Central and Addison in Chicago. Um,
9:05
and I was taking care of a man who was
9:08
uh probably not terribly old, but he was
9:11
biologically pretty old. He was a rail
9:14
railroad worker. Um and um
9:18
he had um you know he had lived hard um
9:25
and he had multiple chronic illnesses,
9:29
heart disease, lung disease
9:32
um uh and uh he he had really reached
9:37
the end of his natural life. Uh and what
9:41
we were doing uh uh in that moment uh
9:45
was using all of the technological tools
9:50
at our disposal
9:52
uh to prolong this gentleman's life. And
9:57
I was I was I was standing at the foot
9:59
of his bed and I was looking at him and
10:01
it was just occurring to me that what I
10:05
was seeing was essentially years of of
10:09
damage uh years of
10:12
>> uh living in such a way that
10:16
you know the the body's aging processes
10:19
had been accelerated. Uh there was, you
10:22
know, actual injury to the body from uh
10:25
probably multiple toxic substances,
10:28
probably a lack of uh healthy sleep
10:30
patterns, probably a lack of healthy
10:33
exercise or healthy activity, probably a
10:37
lack of human connection and uh uh uh
10:41
and love uh which are very important
10:44
things uh
10:45
>> in creating health. and and and it just
10:48
occurred to me that here we were um you
10:52
know exerting all of these efforts uh
10:56
when the horse was out of the barn. Uh
10:59
and and what was more it was very
11:01
evident to me that this man was truly
11:03
suffering uh both uh from the failure of
11:08
his body and from the invasiveness of
11:11
the efforts we were making to prolong
11:13
his life. Uh, and it it just struck me
11:17
as incredibly sad.
11:21
And, you know, I I think I think
11:24
compassion uh arose in me. It wasn't,
11:27
you know, compassion wasn't something
11:29
that particularly motivated me when I
11:32
was younger. I I
11:34
>> right
11:34
>> um, you know, I don't say that with any
11:37
pride. I'm just saying, you know, I I
11:40
didn't come out of medical school uh
11:42
with the with the heart that I carry in
11:44
me now. Um and uh you know, that man,
11:49
you know, he kind of changed my life. Um
11:52
>> and um
11:55
you know, I began to think of things
11:57
differently and it's been a long journey
11:59
since then, but
12:01
>> yeah.
12:01
>> Uh that's that's uh that's a moment in
12:04
time that I'll always remember. uh and
12:07
that you know had an impact on what
12:09
happened with my uh with my professional
12:12
life after that.
12:14
>> Was that was that sort of the the
12:17
tipping point for you to kind of bold
12:19
towards the business and administrative
12:22
of care delivery?
12:24
>> Were there other factors that were
12:25
pulling you into that? uh the the things
12:28
that led me towards the administrative
12:31
side of things were not the same things
12:33
I think that leaded many leaders into
12:36
health care. I I was uh increasingly
12:40
passionate about safety and quality uh
12:45
and um really providing value to people
12:49
>> with the care that we delivered. Um and
12:53
you know that led me uh to really
12:58
you know become a
13:00
uh become a a a mover uh when it came to
13:05
improving the quality of care, improving
13:07
the safety of care that we were
13:08
delivering. Um and and gradually I moved
13:12
away from uh you know strictly being on
13:16
the front lines delivering care to
13:18
taking a little bit of a step back uh
13:21
and doing process improvement work and
13:23
quality work and uh and patient safety
13:26
work in the clinical environments where
13:28
I was um you know delivering care and
13:32
you know that led me uh to the hospital
13:35
near where you live uh to St. Alexis in
13:39
Hoffman Estates where I was
13:41
>> that's where my first kiddo was born.
13:43
>> Yeah. I was brought on there to develop
13:45
their intensivist program to develop a
13:48
247
13:50
uh in-house critical care program for
13:53
that hospital and um you know we did
13:57
some wonderful things there. Um we uh uh
14:02
did some fantastic work in terms of uh
14:04
the quality and safety of care that we
14:06
were delivering in the ICU. We did some
14:08
fantastic work uh in terms of the safety
14:12
and appropriateness of blood
14:13
transfusions that we were giving and uh
14:16
uh you know one thing led to another and
14:20
I became the chief medical officer of
14:22
that hospital. Um, and then a couple
14:25
other things led to another and I became
14:28
uh the chief medical officer of a big
14:31
hospital in in rural central California
14:35
uh where I uh where I worked for eight
14:38
and a half years. Uh and then I had the
14:41
opportunity to to move up and be the CEO
14:44
at Sierra Nevada which is in the Sierra
14:46
Foothills um northwest of S northeast of
14:50
uh Sacramento. So uh it was my uh it
14:56
really was my my passion for improving
14:59
the quality and safety of care and the
15:01
value of care that we were delivering.
15:04
uh I also you know became a paliotative
15:07
care uh physician during that period of
15:10
time uh and started paliotative care
15:13
programs uh both in Chicago and uh in
15:17
Stockton where I uh was the um
15:21
CMO for a while. So it was just I guess
15:27
I would simply say uh
15:30
feeling very strongly about doing better
15:34
uh with what we were providing people
15:38
>> uh and my efforts in that area just led
15:43
me to leadership because that's where I
15:45
could most
15:48
effectively lead change and you know
15:51
opportunities uh opened up for me as a
15:55
result of that. I guess I I can't I
15:58
can't think of any other way to say it.
16:01
>> Well, in our first conversation kind of
16:03
off camerara, you mentioned to me around
16:05
sort of the shift in culture and you
16:08
talked you mentioned this word about
16:10
compassion.
16:12
How do you how do you feel like you
16:14
infuse this level of compassion? Because
16:16
you mentioned around this the shift in
16:18
culture. I'm just sort of curious
16:19
because you know when you step into a
16:20
new role from CMO to CEO there's
16:23
probably like you have like a 90-day
16:25
period where you're assessing things
16:27
like how long did it go before you
16:29
started really realizing that there was
16:31
something different going on in the
16:32
culture where you're at
16:35
and what was the catalyst of that?
16:40
Um
16:42
I
16:45
I think that there are a lot of things
16:48
uh that build culture, but I think
16:52
you know what one person can do
16:57
uh is that
16:59
uh number one they can walk the talk.
17:03
>> Yeah.
17:05
>> And demonstrate what's important to you
17:07
by the way you behave. And I'll just
17:10
give you one small example of that.
17:12
>> Yeah, please. Uh
17:16
every day my management team uh about 40
17:21
people or so 40 something people uh
17:24
gather on a Zoom call
17:27
and we have uh a patient safety huddle
17:33
and I lead that huddle every day that
17:36
you know I'm actually around and
17:39
working. I will lead that huddle. You
17:41
know, if I'm off campus, but I can get
17:43
into the Zoom, I will lead that huddle.
17:46
I think it's important that the CEO lead
17:48
that huddle. Uh, you know, obviously my
17:51
my chief medical officer, my chief
17:53
operating officer, both just outstanding
17:57
clinical leaders, they lead the huddle
17:58
as well. But, um, uh, I think it's
18:02
important that whenever possible,
18:06
the CEO leads the safety huddle. I'll
18:09
give you another small example. Uh
18:13
when we have a board meeting or when we
18:15
have a management team meeting, we start
18:18
we start every meeting with a safety
18:21
story
18:25
>> and
18:27
uh we then move to a patient letter or
18:31
uh the voice of the patient.
18:34
>> Love that.
18:36
So those are just little things that you
18:38
can do. But when
18:41
when you're you know when you're
18:43
conducting a board meeting and you spend
18:46
the first 45 or 60 minutes of the
18:49
meeting talking about patient safety,
18:52
talking about harm events that have
18:54
occurred in the hospital and how your
18:56
team is dealing with them. Talking about
18:59
your quality and safety outcomes uh and
19:02
the systemic uh process work uh that you
19:06
are doing uh to improve those outcomes.
19:08
talking about patient experience and
19:10
listening to the voice of the patient uh
19:13
and uh really uh uh hearing how they are
19:18
experiencing your product. The only
19:20
product
19:20
>> is the care you're providing those
19:22
people. Right.
19:22
>> That's right. That's right.
19:23
>> So you spend your first 45 60 minutes of
19:26
a board meeting doing that and then you
19:28
go to finance.
19:31
>> You know what's interesting is just how
19:33
you've laid down groundwork and
19:35
consistency. consistency over a long
19:37
stretch of time. Uh I remember one of
19:40
the senior leaders I worked for, Rick,
19:42
would always say, you know, what you
19:44
inspect, they respect. In essence, what
19:47
you're telling your team is these two
19:49
things, safety and quality, you know,
19:51
patient experience. These are things
19:53
that I value greatly as a leader, and
19:56
I'm going to inspect these things
19:58
regularly, i.e. I'm going to be on this
20:01
team huddle call every day talking about
20:03
patient safety. So that level of
20:06
consistency, in essence, you're seeing a
20:08
compound effect happen across your team.
20:11
Hey y'all, these are important. Safety
20:14
is important. Patient experience is
20:15
important. It seems to me that that sort
20:18
of permeates, but you got to be in the
20:19
seat long enough for that to happen. You
20:21
got to be consistent long enough. Yeah.
20:23
It doesn't happen overnight. Doesn't
20:24
happen overnight.
20:26
one of my one of my leaders u recounted
20:31
uh a conversation he had with one of my
20:34
team members, you know, um it's kind of
20:38
sad, but when you're the CEO, not
20:40
everybody brings their, you know,
20:42
deepest thoughts to you. Um
20:45
>> no, no, that doesn't happen.
20:49
But uh um uh my my COO was having uh a
20:57
conversation uh with one of our other
21:00
leaders uh and and that individual said
21:03
to him,
21:05
"Is is he going to do this every day?"
21:10
And um you know, Rob, my my COO, said,
21:15
"Yeah, you know, I think I think he is
21:19
I think I think this is how it's going
21:20
to be. Um and uh you know it's it's
21:24
funny because that individual who who
21:27
had the conversation, Rob, um bit of a
21:31
skeptic, a fa a fabulous clinical
21:34
leader. Um but you know, definitely
21:37
somebody who is skeptical, certainly
21:40
capable of tremendous critical thinking.
21:43
>> Um she took a while to win over. um she
21:47
has become, you know, truly one of my
21:51
just foundational pillars uh in the
21:54
organization that we have now. She's
21:56
such an incredible leader. Uh and I
21:59
>> What did it take to win her over?
22:02
>> Is there was there a moment?
22:04
>> What do they What do they say when
22:05
you're doing strength work? Time under
22:07
tension. I think um I think it took time
22:10
under tension. I think it I think in her
22:12
case it probably was a matter of
22:17
you know developing confidence
22:20
uh that I was actually you know going to
22:24
continue to walk this talk. Uh and uh
22:28
you know I suppose
22:31
uh when I saw the growth in her as a
22:34
leader and just you know saw what a uh
22:38
what a an incredible
22:42
part of my team she was becoming uh as
22:45
she became more and more confident
22:48
uh in her leadership. you know, that was
22:50
a signal. Yeah, we're we're getting
22:52
there as a team. But, you know, the I
22:55
you know, maybe there are people who
22:57
lead really dramatic turnarounds in
22:59
organizations.
23:01
I've seen this typically take a few
23:03
years,
23:04
>> right? uh and I've this is my third
23:08
>> uh I don't know if it's fair to call it
23:10
a turnaround but this is the third
23:11
organization where I have seen uh a
23:15
culture change
23:17
uh and where I have seen uh the
23:20
frontline leaders uh you know gradually
23:25
>> adopt the toolbox
23:27
>> uh and gradually come to believe that
23:30
yes this is who we are
23:33
>> this this actually is who we are and
23:37
I've seen them become proud of that.
23:40
>> That's great. That's great.
23:42
>> So I I I I think it's just in many cases
23:46
probably steadiness um and giving, you
23:51
know, people the opportunity uh to
23:53
understand that you mean it.
23:57
you mentioned around then going into the
24:00
financials and the board meeting because
24:01
like here's here's kind of what I want
24:02
to understand the seat that you're
24:05
sitting in the um like how do you
24:09
personally sit with that tension of
24:13
running an institution that generates
24:15
revenue from illness
24:18
while
24:20
sort of simultaneously
24:22
believing that the goal is to keep
24:27
people well and out of the building.
24:33
>> Um
24:36
I would say it's entirely consistent
24:39
with what I believe our mission is.
24:44
you know, um there's no uh inconsistency
24:50
uh uh in those, you know, sort of dual
24:55
uh dual goals with regards to our
25:00
mission. My mission is to serve this
25:01
community.
25:03
>> Yeah.
25:03
>> Period.
25:06
And if we can serve them in a such a way
25:09
that we allow them to live healthier
25:11
lives,
25:13
>> that's great. We've done our job. Uh if
25:18
when they do need care, we can provide
25:20
the absolute best care available,
25:24
then that's also great and we've done
25:26
our job.
25:28
>> But you know,
25:32
there there has to be a certain belief.
25:34
Now there is evidence that this is true
25:37
but you have to also you know kind of
25:39
make the leap. Organizations that do
25:43
better quality work
25:46
uh and do a better job of engaging with
25:49
their patients and communicating with
25:51
their patients such that you know people
25:53
feel truly cared for. Those
25:56
organizations do better financially.
25:59
Remember
26:00
>> who?
26:00
>> We've hit our financial goals for four
26:02
years in a row.
26:07
this particular hospital had not done
26:09
that. I don't think it had actually done
26:11
that four years in a row.
26:14
Um
26:16
we um
26:20
you know we hit our financial goals by
26:22
providing better care but we also hit
26:25
our financial goals by growing our
26:28
reputation in the community and making
26:30
people feel confident
26:32
that they don't need to drive down to
26:35
Sacramento to get good good care when
26:38
they're sick.
26:40
So you know it is kind of tough. I think
26:42
you you touched on something important.
26:45
Uh it is kind of tough when a lot of
26:48
your revenue comes from people you know
26:51
being ill or injured.
26:53
>> Uh and
26:56
you know that's a structural feature of
26:59
the health care system that you know
27:01
many folks would would like to see
27:03
changed, right? But it is what it is.
27:06
And um you know so I I want to keep you
27:10
healthy. I I want to do everything that
27:12
I can uh to support you in living the
27:15
healthiest life that you can live. And
27:18
if you are ill and need care, I want you
27:20
to choose us to care for you because,
27:25
you know, it's our it's our mission to
27:27
do so. That's what we're here for.
27:31
>> So, what what are what are some programs
27:33
and some little wins that you can share
27:35
in terms of what you've done to keep the
27:37
community healthy? like share with us
27:40
some examples that that you're proud of.
27:44
>> Well, uh you know, you
27:49
you've read some of the stuff we've
27:50
written. I I think that the the thing
27:53
that is going to be kind of the
27:55
centerpiece of our our community
27:57
approach to healthcare is is Healthspan
27:59
Nevada County. Now, that's a that's a
28:02
program that's very early in its
28:04
development, but it is based on the
28:09
evidence-based
28:11
understanding
28:12
that 80% of our health outcomes
28:16
arise from factors that are outside of
28:19
the traditional medical model.
28:23
Uh, and that is a that's a that's a
28:27
wellsupported
28:29
thesis or theory.
28:31
>> Um, there's a lot of evidence that backs
28:33
that up.
28:34
>> Uh, there's a lot of evidence that uh
28:39
supports the idea that the way you live
28:40
your life uh has a very powerful effect
28:44
on your health outcome. Uh and that's
28:47
through
28:49
uh to begin with you know sort of the
28:52
physical factors healthy activity
28:56
healthy eating healthy sleep
29:00
uh you know we can do a lot to both
29:03
prolong our lives but prolong the
29:05
quality of our lives as well.
29:06
>> Yeah. Yeah.
29:09
But there's other very important factors
29:11
and and I think that this is something
29:13
that we want to, you know,
29:18
continually support in the work that we
29:20
do in the community because it's not
29:23
just how you treat your body physically.
29:26
It's it's your attitude. It's how you
29:28
think. It's it's how you socialize. You
29:31
know, the Harvard grant study
29:34
>> uh revealed a very very powerful
29:37
insight. If you looked at men
29:41
uh uh at the age of 50 years old, sadly
29:46
the Harvard grad study focused only on
29:48
men, but if you looked at men uh at the
29:52
age of 50 years old, the most empower
29:55
the most powerful predictor uh of their
29:59
health status at the age of 80,
30:02
>> yeah,
30:03
>> was whether they had a relationship that
30:04
was that was beneficial.
30:08
I isn't Isn't that the longest ongoing
30:10
like study in the world or something
30:13
like that?
30:13
>> It's one of the it's one of if not the
30:15
longest longit longitudinal health
30:17
study.
30:18
>> Yeah,
30:18
>> it's actually I I think they merged that
30:21
data with the Framingham uh study to
30:24
some extent, but uh
30:27
>> it all rel took college age men they
30:30
took college age men in the 1930s and
30:32
they followed them for their entire
30:33
lives.
30:35
uh and uh it wasn't your it wasn't your
30:37
smoking status, it wasn't your blood
30:40
pressure, it wasn't your cholesterol.
30:41
The most powerful predictor as to
30:44
whether you would live a long and
30:47
healthy life was your relationship
30:50
status, you know, whether you
30:53
>> whether you had a a a fruitful,
30:55
supportive relationship.
30:58
So, you know, and and the longevity data
31:03
powerfully supports that. People who
31:05
live with purpose have less
31:09
neurodeenerative disease.
31:12
people who um uh people who manage to,
31:18
you know, effectively control their
31:20
emotional life, who don't suffer from
31:22
chronic anger, uh um
31:27
have less cardiovascular disease. Um
31:30
>> yeah, that was another recent article
31:31
you had written around anger. That was
31:32
fascinating.
31:34
>> Yeah, it's it's incredible stuff. People
31:36
who people who have significant
31:39
histories of trauma have higher
31:41
incidences of autoimmune disease, higher
31:45
incidence of cancer, higher incidence of
31:47
cardiovascular disease. The big killers
31:50
are actually powerfully
31:53
uh uh influenced
31:56
by
31:57
significant childhood trauma, chronic
32:00
stress. Uh so there's there's so much
32:04
that goes into you know a healthy life
32:08
that is beyond even the the things that
32:11
the sort of wellness community is
32:13
focusing on a lot. Um and
32:16
>> but here's really
32:18
>> if if if we know these things I know
32:21
there isn't a magic bullet
32:24
but like what is within someone's locus
32:27
of control that they can take action on?
32:29
Is there something small, effective,
32:32
efficient that they can do on a
32:33
day-to-day basis? I think this is kind
32:35
of where where where
32:38
you know the mindset kind of comes into
32:40
place like what like what is that? Is is
32:43
is meditation that is it is it you know
32:45
is there something else to it? I'm just
32:48
I'm trying to lead the witness but
32:53
>> um I'm I'm a work in progress, Michael.
32:56
I, you know, I'm I'm not there yet, but
32:59
>> I'm not there either.
33:01
>> Yeah,
33:01
>> but you're further along than me, so I
33:02
might as well learn from you.
33:04
>> Um,
33:07
you know, um
33:10
there's a lot of little things. I
33:13
sometimes talk about the hundred
33:15
decisions that we make every day, you
33:17
know. Um, do you, you know, and I think
33:20
about it in my own life. I I make time
33:22
for meditation because I believe you
33:25
know I've seen the benefit of that in my
33:27
life. Okay. I actually also know the
33:30
science that says that contemplative
33:33
practices improve your brain health uh
33:37
and u uh lower your chances of
33:41
developing neurodeenerative disease. You
33:44
know, living with purpose, living I
33:46
believe that living with purpose and
33:48
love
33:50
>> improves your longevity and improves
33:53
your health span.
33:54
>> Uh so, you know, things that I'm not
33:57
very good at, I I try to be better at,
34:00
you know, and and that includes being,
34:02
you know, a caring husband uh and a a
34:06
connected uh father. I mean because
34:10
frankly those weren't the things that I
34:12
was great at but uh I keep working at it
34:16
because I do understand
34:19
um that you know it's a big circle you
34:23
know benefiting others and having
34:26
beneficial relationships with other
34:28
people that it just it adds to their
34:30
lives it adds to your life and it
34:32
actually improves your health. So you
34:35
you spend time on those things. You have
34:37
coffee with a friend. You call up
34:39
Michael and you know have have a Zoom
34:42
call. You know
34:43
>> you go for a walk. You spend
34:45
>> Yeah.
34:45
>> Even if you spend five minutes uh you
34:49
want you want to do a breathing
34:50
exercise. I was actually thinking about
34:52
this. I I forgot.
34:54
>> This is this Yeah, we're going to do it
34:56
right now. This
34:57
>> right now
34:57
>> I I I think it's called a 4x4. I call it
35:00
a 4x4, but you could do it anytime
35:01
during the day.
35:02
>> All right.
35:03
>> Okay. We're going to take a slow deep
35:06
breath and we're going to, you know, do
35:10
that with a four count. And then when
35:13
our lungs are full, we're going to hold
35:15
our breath gently
35:17
for a four count. And then we're going
35:19
to slowly breathe out for a four count.
35:22
And then we're going to allow our bodies
35:24
to just sit there with our lungs empty
35:26
for a four count. So that'll be about 15
35:30
or 16 seconds maybe. And then you can do
35:32
that again.
35:34
So let's just do it.
35:56
Feel lighter. Not going to lie. Go. Go.
35:59
>> It changed the way your body felt,
36:00
right? Yeah. Just feel like you just
36:02
activated. You just activated your vag
36:04
nerve.
36:06
>> You activated your vagus nerve, which is
36:08
the big nerve that runs out of your
36:10
brain and and regulates your heartbeat
36:12
and your blood pressure and your
36:14
>> your GI tract and you know, all sorts of
36:17
stuff. So you could what if you did
36:20
that, you know, four times, one minute
36:25
when you know,
36:27
>> do you do that in board meetings when
36:28
you get everyone to just come?
36:29
>> Oh, absolutely. I I I'll I'll go like,
36:31
"Oh
36:34
my my heart is ra, you know, my my chest
36:38
is clenched. My heart is racing.
36:41
I can feel it, you know. My body senses
36:44
I am tense, you know, so I'll just I'll
36:47
just sit there and do that. Nobody has
36:48
to know I'm doing that, but you know."
36:50
>> Oh, I'm thinking like guided with people
36:52
like, "Hey, let's let's do a little
36:53
exercise."
36:54
>> Well, if you do it together, I mean,
36:56
yeah. I mean
36:58
>> nothingice or anything.
36:59
>> My practice involves a lot of group
37:01
meditation too which is another
37:04
>> you know wonderful and beneficial
37:07
experience. But um there's so many
37:11
different ways that you can just assist
37:14
yourself sort of support yourself with
37:16
you know coming to a sense of presence
37:19
uh and attention or awareness.
37:22
Um, and uh, you know, there's there's
37:27
there's actually good science that
37:29
that's that's that's that's beneficial
37:32
for your your blood pressure, your
37:33
diabetic control, your brain health. Um,
37:37
so, you know, yeah, there's a few things
37:40
you can do every day, you know.
37:41
>> Yeah.
37:42
>> You can sit down and rest and have a cup
37:45
of coffee with your wife or friend, and
37:46
you can, you know, you can spend a few
37:49
minutes in in mindful awareness.
37:52
you can go for a walk and you can eat
37:53
healthy food, you know. Um there's a
37:57
there's a uh
38:00
there's a great study that the VA did uh
38:03
and I think they called it the million
38:05
veteran uh uh study but you know they've
38:10
because of the power of the VA health
38:11
system to to you know engage with and
38:15
connect with you know thousands and
38:18
millions of people uh over a long period
38:20
of time. They they they studied these
38:23
things and you know every one of these
38:25
things that somebody did avoiding excess
38:28
alcohol, having having supportive
38:31
relationships,
38:33
>> um getting regular physical activity,
38:36
sleeping seven hours, you know, every
38:39
one of those things that people did
38:41
added years to their lives.
38:45
So, so you know it's what we do in
38:49
American healthc care delivery is you
38:53
know it's fabulous what we do.
38:55
>> Yeah.
38:56
>> You know and and I've been a recipient
38:58
of that. I mean,
39:00
>> and I want to go into that
39:01
>> because you chose to have, you know,
39:03
major surgery done at your own hospital.
39:06
And I'm just sort of curious like what
39:08
what did it feel like to
39:11
be on the other side of the bed, kind of
39:14
be a recipient of that?
39:17
>> Um,
39:20
uh, it made me feel, you know, very
39:22
humble. Um
39:25
uh it made me feel really really
39:28
grateful. Um
39:31
you know um
39:37
I I have a you know kind of a purpose
39:39
statement that my team would be able to
39:41
recite to you. You know, because what
39:45
what I think we do is that we deliver
39:47
exceptional care
39:50
with love to everybody who comes to us
39:52
in need. And um you know, when I was
39:55
being cared for, I felt like I was
39:58
getting exceptional care and I was
40:00
experiencing love. Uh and um I was
40:05
incredibly grateful for that.
40:12
Well, another thing that I've just been
40:13
kind of pondering on, um, it's like, you
40:16
know, you've been in the game for a
40:17
while. You've experienced a lot of
40:19
things.
40:20
>> Yeah.
40:20
>> And you have to make a lot of decisions,
40:23
some easier than others.
40:26
Has there been a decision that's kind of
40:28
kept you up the longest? Like you don't
40:31
have to like name names, but like what
40:33
kind of what kind of decision was it?
40:39
Um,
40:42
for me, the hardest decisions that I've
40:44
made have been uh deciding
40:50
that uh um somebody needed to separate
40:54
from our team to end somebody's
40:57
employment.
41:01
>> I'm talking about professional
41:03
decisions, not personal decisions.
41:04
>> Yeah. Yeah. Yeah. Yeah. Yeah,
41:06
>> but it becomes personal when you're
41:08
talking about things like that. So,
41:11
you know, when when somebody's not a
41:13
good fit
41:15
>> for the team
41:17
um and and they don't recognize that
41:19
themselves,
41:21
that's that is for me the hardest
41:23
leadership decision.
41:27
>> Yeah.
41:28
Yeah. Those are never easy.
41:30
>> No.
41:31
>> I haven't met one leader that love
41:32
firing people. No, it's it's it's
41:35
horrible.
41:36
>> Um, so
41:40
I I would say that's the hard one. You
41:42
know, there's quite a few tough ones.
41:44
Um,
41:46
you know, there are some tough ones when
41:48
you're dealing with, say you're dealing
41:50
with a physician who is, you know,
41:53
technically a very good physician,
41:55
provides a good medical care to people,
41:58
is a valuable member of the
42:01
organization.
42:02
uh but engages in behavior that
42:05
undermines the culture,
42:09
>> undermines the culture of safety is the
42:11
is the code word, you know.
42:13
>> Yeah. Those are those are really
42:14
difficult conversations because
42:17
you're talking to an individual who's
42:20
highly trained, highly skilled, cares a
42:22
lot about what they do, actually does
42:24
many of the things that they do really
42:25
well,
42:26
>> but they're behaving in a way that's
42:28
undermining your culture of safety and
42:31
making, you know, maybe making people
42:33
uncomfortable uh uh to, you know,
42:36
communicate with that individual uh or
42:39
to bring uh important concerns to that
42:42
individual. because they're afraid
42:44
they're going to get their head taken
42:45
off. Those are really difficult
42:47
conversations. I've had a few of those.
42:50
>> You know, I could sit here and think of
42:52
some more things, but those are the kind
42:54
of things that uh those are the kind of
42:56
things that a healthcare leader, you
42:57
know, runs into that I think are really
42:59
challenging.
43:00
>> Yeah. And since, you know, we kind of
43:02
brought up kind of bouncing around, but
43:04
I just want to make sure I get this in
43:06
because we talked about the the
43:08
coalition that you're building in Nevada
43:10
County to
43:11
>> support community health span. Like what
43:14
who's at the table for that? Like what
43:15
does that look like in practice?
43:19
>> Well, um it started with a with a talk
43:23
that I gave to the board of directors of
43:27
our philanthropic foundation about two
43:29
years ago.
43:31
And um you know I I talked about many of
43:35
the things that you and I have been
43:36
talking about and the opportunity to
43:39
collaborate with other kind of
43:42
like-minded people and organizations to
43:45
to focus on that as a community because
43:48
I really think the community is the
43:49
locus of action for work like this.
43:53
>> And and it just so happened that one of
43:55
the county supervisors was a member of
43:58
that board. And at the end of that
43:59
conversation, she she raised her hand
44:01
and she said, "How much money do you
44:02
need?"
44:04
>> And so
44:07
that county supervisor has been at the
44:09
table along with the CEO of the county.
44:12
Uh
44:13
>> how much did you ask for?
44:16
>> She said, "How much do you need?"
44:18
>> Well, what we've done, I I'm I rather
44:21
than give you a number. What we've done
44:23
is we've entered into a partnership with
44:25
the county where Dignity Health and the
44:27
county uh have provided equal amounts of
44:30
money uh and we've committed to three
44:32
years of startup funding for Healthspan
44:35
Nevada County that has allowed us to
44:37
hire an executive director, this you
44:39
know incredible uh young person that I
44:42
told you about. Uh and um you know uh
44:47
what we the people that we sit at the
44:49
table with are people like uh an
44:52
organization called Sierra Harvest uh
44:54
which has just done incredible things in
44:56
our community uh to connect with
45:00
local food producers farmers uh and to
45:04
you know for example I told you about
45:05
the program where we've established a
45:09
central kitchen that is provided scratch
45:11
meals. talk more about that. That's so
45:14
cool.
45:15
>> Yeah. No, this organization has been uh
45:20
critical in developing this central
45:22
kitchen. I mean, if the central kitchen
45:24
is now run by the unified school
45:25
district,
45:27
>> but they are providing scratch meals,
45:30
breakfast and lunch to kids uh rather
45:33
than plastic wrapped to, you know,
45:36
frozen pizzas, you know. Exactly. Um,
45:39
and uh, it's it's just a it's just such
45:43
a great program, you know. It just like
45:46
it it fills me with joy, you know, uh,
45:49
to to know that we're giving kids
45:51
healthy food every day, you know, and
45:53
we're teaching them what healthy food
45:55
looks like by doing that, you know. I
45:57
told you about the little girl who, you
45:59
know, the first first time her school
46:03
>> had lunch delivered by the central
46:05
kitchen, she said, "Oh, we're having
46:06
special lunch today." Uh, and uh, you
46:09
know, one of the one of the teachers or
46:11
administrators said, "No, we're we're
46:13
actually switching lunch over
46:16
uh to to this new kitchen, these new
46:19
cooks who are going to make lunch." And
46:21
she said, "We get special lunch every
46:23
day." you know, it's so cool, right? So,
46:27
they're at the table. Sierra Harvest is
46:30
at the table. Uh we have an organization
46:32
in in Nevada County that is just it's a
46:36
it's a an incredible organization
46:38
supporting youth. It's called Bright
46:40
Futures for Youth. They provide, you
46:42
know, shelter to unhoused kids. They
46:45
provide a really cool, safe, fun
46:48
learning place for kids to hang out at
46:51
safely uh after school.
46:54
They they have groups that, you know, do
46:56
a lot of organized activity. Uh they
46:59
have they have a an arm of their
47:01
organization that brings in a cohort of
47:04
young girls.
47:06
>> Yeah.
47:07
>> Sixth graders. And actually that's that
47:09
cohort stays together through graduation
47:12
of high school. That's that's bright
47:15
Futures for Youth. They're part they're
47:17
they're going to be a you know
47:18
foundational partner in this. Uh we've
47:21
got a guy up there uh who's been
47:24
teaching Tai Chi in the park. Uh and
47:27
Keegan, I'm I'm probably butchering
47:29
those terms, but you know, he's he's
47:32
like, you know, thank you guys for doing
47:34
this. I want to be a part of it, you
47:36
know. So, we're partnering with
47:38
organizations like that. Uh and and we
47:41
believe that as a collaborative, one of
47:43
the things we'll be able to do is
47:44
actually get more funding uh to support
47:48
pushing these things out.
47:50
because you know in Nevada County it's
47:53
it's it's not a wealthy county. There
47:55
are certainly wealthy people in Nevada
47:56
County, but there's a lot of people who
47:58
are at risk. And one of the things that
48:00
we know about Healthspan and and the
48:02
practices that we've talked about is
48:04
that this is an equity issue,
48:07
>> right?
48:07
>> Okay. folks who folks who are
48:10
privileged, who are well off,
48:13
they they know this stuff already, you
48:15
know, may maybe they don't know it all,
48:18
but you know, they have the means uh to
48:22
to observe these practices, to bring
48:24
these practices into their own lives.
48:27
You know, not everybody does. And so
48:31
it's a focus on
48:34
both helping people to understand what
48:36
leads to a healthy life, but also
48:39
creating the conditions that allows them
48:40
to actually do that, right?
48:42
>> Yeah.
48:43
>> You know, the single my I've mentioned
48:46
this in things that I've written. a
48:47
single mom uh who's who's got two jobs,
48:51
you know, uh and lives in a in a food
48:54
desert isn't like, you know, it it's not
48:58
easy for that person to, you know,
49:00
provide healthy food for his or her
49:03
kids.
49:04
>> Yeah.
49:05
>> You know, they may not have a safe way
49:08
to, you know, exercise or to get healthy
49:12
activity.
49:14
I mean, you know, a healthy sleep
49:16
pattern, forget about it. I mean, you
49:18
know, all of these things, you know,
49:20
powerfully impact your health, right?
49:23
Uh, but they're not they're not
49:25
accessible on an equal basis to
49:27
everybody. So, you know, that's another
49:29
that's another key key point of this is,
49:33
you know, creating the process and
49:34
structure
49:36
to to make it available and make it
49:39
something that more people can do. um
49:42
you know and and that's something that
49:46
other countries actually do. One of the
49:48
things that's been observed about the
49:50
American health care system
49:52
>> is that we don't invest upstream
49:57
>> in the resources the the structures that
50:02
allow people, families, young people uh
50:06
to you know observe all the components
50:09
of a healthy life. and and
50:12
country societies that do more of that
50:14
upstream investment, they don't spend as
50:17
much on the downstream care when all of
50:20
these health conditions show up. We
50:23
throw a ton of money at the downstream.
50:26
>> That's right.
50:28
>> At the downstream point of care. Yeah.
50:30
>> And we're really good at it.
50:32
>> We're great at it.
50:34
>> You know, I I don't I don't have
50:35
problems with the healthcare delivery
50:37
system. It's
50:39
it's too expensive and unsustainable,
50:41
but it works really well. Uh,
50:45
but there is a better way.
50:48
>> I mean, you've just articulated
50:51
what it looks like. You've architected
50:53
what it looks like to care for a
50:55
community. And that was the whole basis
50:57
of this conversation is like you how how
50:59
do you do that? And you illustrated
51:00
that.
51:02
>> Well, hopefully hopefully that's how
51:03
it's going to turn out, you know.
51:05
>> Yeah. We're going to continue to follow
51:07
us. We're g, you know, obviously I'm
51:08
looking forward to coming out there and
51:10
checking this out.
51:11
>> Yeah, you gotta come.
51:12
>> 100% coming.
51:14
>> Direct flight from Midway to Sacramento.
51:16
It's not a problem.
51:17
>> Yeah, it's easy. What What is What is
51:20
the best way for people to continue to
51:23
follow the work that you and your team
51:25
are doing? Kind of give a little shout
51:27
out, little commercial, and then we'll
51:28
wrap.
51:30
Um,
51:32
well, right now I'm I'm trying to, you
51:35
know, pull the threads together in the
51:37
content that I'm putting on LinkedIn.
51:40
And, you know, I'm thinking about
51:41
whether I need to whether I need to open
51:45
up any other channels. I mean the most
51:48
important thing is the work that we're
51:50
doing internally in the community. Mhm.
51:53
>> But I would also like to, you know, sort
51:56
of elevate awareness
51:59
uh of this
52:01
because I I I think it's out there, but
52:05
I also think that it often times is
52:08
muddled
52:09
within the threads of marketing messages
52:12
uh in the, you know, the so-called
52:14
wellness movement because not all of
52:18
what's being promoted by, you know,
52:20
wellness influencers is is scientific or
52:23
evidence-based
52:25
or even, you know, beneficial for
52:27
people. And, you know, the fundamentals
52:30
actually aren't complicated. You don't
52:32
need uh peptide infusions
52:35
uh or um you know,
52:39
week-long spa retreats and things of
52:42
that nature to, you know, have a healthy
52:44
life. You can just kind of do the basics
52:46
every day. It doesn't cost a lot of
52:48
money, but it's not necessarily easy for
52:50
people uh to to all do this. So, you
52:53
know,
52:54
>> it does take discipline though. It does
52:56
take discipline, intentionality, and
52:57
effort and consistency.
52:59
>> It does. It does. But you can actually
53:03
also start to enjoy it, you know.
53:05
>> Yeah. Dr. And this this is exactly the
53:09
kind of conversation
53:11
um that and like the reason as to why I
53:14
started the show to have conversations
53:16
like this. People coming in being
53:19
rigorously honest going deep. Um and
53:23
then just sort of sharing stuff that a
53:26
lot of leaders in the space are kind of
53:28
afraid to you know speak publicly like
53:31
having a point of view on this. So, I'm
53:32
grateful
53:34
that you were able to do that, like went
53:37
above and beyond. And if you're
53:40
listening to this right now and you
53:42
found it equally entertaining and
53:45
enjoyable, my one request would be is
53:48
like, man, would you mind sharing it and
53:50
broadcasting it to the people that you
53:52
care about? Maybe do it to three people
53:56
and maybe ask those three people to send
53:57
it out to other three people because
54:00
this stuff is important.
54:02
And if there is a topic that you want us
54:04
to explore or leader that you want us to
54:06
hear from you, just drop me a note. We
54:08
do read them. This this totally is a
54:10
platform that is about a community that
54:12
is interconnected. It's not just
54:14
content. So, thank you for listening.
54:16
Keep leading with purpose and and keep
54:19
building. We'll see you next time on the
54:20
Advancing Healthcare Innovation Show.