Latest / Hearts of Excellence / How Empathy Changes Healthcare
Transcript
- Dr. Adrienne Boissy (00:00): A really humbling reminder of no matter how much knowledge you have, you are treating the human condition, not just the medical one. Chelsey Gheyara (00:12): You're listening to Hearts of Excellence brought to you by Majestic Care, where real stories from long-term care come to life. I'm honored to welcome Dr. Adrienne Boissy, Chief Medical Officer at Qualtrics, neurologist, former Chief Experience Officer at the Cleveland Clinic, TED Speaker and co-chair of the Cleveland Clinic Empathy and Innovation Summit. Dr. Boissy has spent her career redefining what it truly means to put people at the center of healthcare, from the bedside to the boardroom. In this episode, we'll explore how empathy, clinical insight, and technology come together to shape meaningful, human-centered experiences and why empathy isn't just of value. It's a driver of outcomes. So Dr. Boissy, thank you so much for being here and welcome to the Hearts of Excellence podcast. Dr. Adrienne Boissy (01:04): Thanks for having me thrilled to be here. Chelsey Gheyara (01:06): Dr. Boissy, tell us about one moment early in your medical career that shaped how you think about patients, not just as cases, but as people. Dr. Adrienne Boissy (01:18): So I was an intern. I was doing a medicine rotation, but I think I was on neurology and I was part of a larger team with lots of residents and senior residents and a staff. And a young woman had come in kind of early 20s. She was a jet ski instructor and she'd come in because over the course of a day, she could no longer feel nor move her legs. She couldn't tell when she needed to go to the bathroom. She was having accidents and it was a devastating change for her, as you might imagine. And over the course of a couple days, I got to know her and her family. She had this incredibly loving family. They showed up for all the rounds. They were present at the bedside all the time asking good questions. And she had a sort of doting, devoted boyfriend. (02:07): They seemed to have a lot of affection for each other, constantly at the bedside and just present, showing up in ways maybe we all hope our family and loved ones show up. Anyway, this one night I was on call and the nurse paged me and said, "This young lady would like to speak to you. " And I, in a sort of my snotty, at the time, sleepless resident tone. I said, "Well, but what for? I don't know anything. I'm the low man on the totem pole. I don't know that much about what she has. Are you sure? It's me. What does she want to talk about? " And the nurse appropriately so said, "I don't know. Could you just come to the bedside?" And I actually was in a panic that she was going to ask me something I didn't have the answer for. And so I ran to my call room and I opened up the book and studied what she had at the time, which was transverse myelitis inflammation within the spinal cord. (03:09): And I studied all up on it. What's the pathology, physiology, etiology, likelihood it's going to improve prognosis, drugs, drug development, side effects. Everything I could cram in about a 50 minute time period, I crammed in. And I go to the bedside and she says, "Hi, Dr. Boissy. I feel like I've gotten to know you a little bit since I've been in here and I have something to ask you. " And I said, "Okay, I'm ready." Got my full knowledge in my pocket. And she says, "I'm wondering whether you think I should marry my boyfriend so that when I'm in a wheelchair, when I'm older, I'll have somebody to take care of me. " The words still get me choked up. It's difficult to talk about because that's just the crux of it, right? That sometimes we come at it with our perspective. I'm a trainee. (04:03): I don't know anything. They're going to ask me medical things. I don't know. I got to have all the answers medically. And this is just a scared human being wondering about what the rest of her future looks like. And it was jarring for me at the time as a reminder, as a really humbling reminder of no matter how much knowledge you have, you are treating the human condition, not just the medical one. I remember sitting down on the bed next to her and I said, "It just sounds like you're really scared. Tell me more about what's going on in your head." And we proceeded to have a meaningful conversation about it. I think that was one of the maybe early moments that I just had my breath caught by what a patient taught me. Chelsey Gheyara (05:01): I can't imagine just what you felt in that moment and also what level of trust that that patient gave you and truly she looked to you because you obviously cared for her and that's heartbreaking. So thank you for sharing Paul Pruitt (05:19): That. What's interesting, Dr. Boissy, I watched some of your TED Talks and the one about empathy. And again, I'm a PTA clinically by background, so I practiced for quite a few years. And it is those most humbling moments because it's not about the diagnosis. It's not about the ... I also watched the other one about labeling. It's not about it. People are scared and they don't understand. The systems are so complex, insurance and who's paying and out of network pockets and all that. So I just need to provide for my family. I have a husband, I have kids, I have a wife. Just all those factors, and then they're overlaid with all of this medical complexity, just scared. And how do we show up differently? Dr. Adrienne Boissy (06:02): We don't talk about enough that the complexity and the friction and the opaqueness and the confusion are only amplifiers of the emotional distress that patients are already carrying. They are already suffering. We are just piling it on by making it harder for them and their families to do what they need to do. And I just don't have tolerance for it. I really don't because it's too much to ask patients to navigate our complexity. That's not fair. And it continues to this day, and I think we need to be much more bullish about changing it. The other story I was going to share was a factory worker who had started to drag his leg at work and ultimately had an accident and got sent to me. And he had robust inflammation in his spinal cord, but he had hopped doctor to doctor to doctor to doctor to doctor for months before landing with me. (07:11): He and his wife had this sort of fabulous, sarcastic dialogue between them. They had been married a long time. They were high school sweethearts and I just immediately fell in love with them as people. And I put him on a drug that I thought would be helpful, but it was an aggressive treatment that had a lot of side effects. And of course, he went on to develop one of the worst, most life-threatening side effects that he could have. And ultimately, he died from complications related to that. And his wife had to advocate for the entirety of his disease, for their wheelchair to be paid for, for services to come into the home, to get the care locally she needed. She drove three hours to see me. It was just heart wrenching to sort of be a part of a system that made it so hard. (08:14): And it wasn't one place. It was multiple parts of the system, long-term care, short-term care, rehab. It was multiple parts that they touched. And unfortunately, I got a call maybe a couple years ago that she committed suicide. I'm not saying that everything that she went through was the sole reason. I just think, A, she couldn't live without her life partner and B, everything was just too Paul Pruitt (08:45): Hard Dr. Adrienne Boissy (08:46): For her to manage on her own. We talk about the cost of what we do sometimes in dollar value or in operational costs or efficiencies, but I also think there's a real human emotional cost. I will never forget them. And every time I go to advocate for my patients, I think of my patient and his wife and their family that's surviving and how we could better wrap our arms around every family to make them feel more loved as they move through the system. Paul Pruitt (09:23): One of the things we talk about here, Dr. Boissy, and I've been in long-term care, posted kids been pretty much where I'll call born and raised through my career, from a nurse aide to a PTA, administration, and so on. And it's small stints in the hospital and got to see how those systems are built and developed. But what's interesting is long-term care has changed so dramatically for the type of residents we care for. And then I always say nobody chose at six years old, this is the way they wanted to live. Nobody chose at six years old. I hope I destroy my whole family dynamics and my support system and I have nobody all those or I live in a hundred square foot room with my meals dictated to me. Nobody wants this, but that's where it's like, how do we change this environment? And you're right, how do we get more bullish and say, "This isn't okay. (10:24): This isn't good enough and nobody should have to live this way." Yes, there's parameters you have that situational things that we can't change. I can't change a hundred square foot room, but I can offer more resources, more opportunities to live a life within those four walls, whether it be, and Chelsea and I've talked about this, and what would it look like if a resident's room in a nursing home became their true bedroom, but the community became our community such as I'm going to get up and I'm going to go to group therapy, I'm going to get up and I'm going to go down. Hey, they're going to be doing art therapy down there and I want to be part of that or where they're literally living a life. And it doesn't matter your social economics. It doesn't matter if your diagnosis, none of that matters. (11:18): You're still a person that has a life that we should be honoring. And it's the piece that I just want to see healthcare change because it is overwhelming for our patients to deal with. Dr. Adrienne Boissy (11:28): I think you're asking an important question though, which I don't hear often enough, which is how might we? (11:35): How might I create a community of caring, even if they don't have choice over everything, even if they didn't want to be here? And I think it starts with that sort of, I call it empathic curiosity, right? Teach us who you are. Tell me what's important to you. What do you value? Where do you find joy today, even though things look different than they did last year? Give them choice around what types of activity to participate in. I always call it leaning on walls over time. You have to lean on enough walls to know which ones will move and which ones they're going to take years to move, but you do need to keep leaning because I think you can alter a lot of things about the design and the environment to make people feel humane in human spaces. And it does start with sort of curiosity about who are you, teach me who you are and what's important to you so that I can begin to bake that in to not only environment, but processes and operations within the system. (12:45): I think that's a fabulous first few steps. Chelsey Gheyara (12:49): Something you said at X4 was in your session, Dr. Boissy, was oftentimes social isolation on an imaging looks the same as a physical harm done to the body. And that's something Paul and I see in our industry is, and that's to his point, creating that environment so our residents can thrive and are not stuck in that a hundred square foot room. That was such a powerful piece of knowledge that you shared with everyone because I think so often we forget, take healthcare out of it. And I just think it's such a great reminder for every listener on here. We have so many listeners that are leaders and we want to make sure we are caring for our residents and not leaving them behind. Social isolation is real and that stuck with me when you said that. Dr. Adrienne Boissy (13:44): Yeah. We were talking about the notion of belonging a bit and the social isolation. And I was describing this quote I heard around these concepts that, what is it? Sort of being invited to the dance is being included, being asked to dance is being engaged and dancing like nobody is watching is belonging, not trying to fit into any environment, but finding your own stride, your own dance, your own rhythm. And I think that's actually, and what I was sort of then drawing a parallel to or just pulling from sort of what we understand about neuroscience was highlighting, as you said, that the same parts of your brain that light up in functional MRI when you're in physical pain happen when we're excluded in social situations. This is the notion of sort of that the brain can feel both socially and physical pain very similarly. That's important for all of us to be thinking about, but particularly in these environments, especially even with the dawn of AI, right? (14:52): There's some interesting studies that also highlight that yes, people are engaging in AI for therapy and yes, it might be more effective and more consistent and more readily available, but what's happening is they're doing it in isolation, right? You're sitting in a dark room at nighttime by yourself engaging with a sort of AI therapeutic mechanism, which in itself we need to have some caution around because that may certainly have a place, but then we need to be intentional about also designing those community spaces so real humans are also connecting with other real humans. It's a design challenge. I have found in my own leadership and over the course of my career, as I've navigated different leadership positions, that actually one of the most important choices I have had to make is what kind of person do I want to be in this world? And because being a leader is very difficult. (15:52): You can't show all your cards all the time. You can't be vulnerable all the time. You can't be running around telling sob stories and crying in meetings. There's lots of things you can't do. You can't share all the information you have. You can't maybe behave the way you would want to as a human being or a friend or a colleague. You need to make decisions as a leader as to what's best for the organization. That is very different. That can be in and of itself a very isolating experience. And so one of my own, I think, sort of learnings about my leadership is that when I've been in environments that don't allow me to be the person I want to be, surrounded by people I trust in an environment where I can grow and thrive, where I feel like my personal values are aligned to the organizational values, then you need to make a decision about your career because it can have consequences for you as a human being if you stay in some of those less fitting environments. (16:59): And so I just call that out to say what comes first is you deciding what kind of legacy you want to have on the world. How are you going to move through the world in alignment to what values and according to whom? And I think that has to look inward. We always say that, but I haven't always seen people do the work to understand who am I? What values will I move through the world with? What values are important to me? How will people know? What behaviors will I associate? What choices? What skills do I need to continue to live? And there's a great ... Danny Meyer, if you haven't read his book, Setting the Table, gives a great example. He's the founder of the Union Hospitality Group in New York, a bunch of restaurants. But he says, when you become a leader, all of your employees get a microscope and you get a megaphone. (17:56): All of a sudden, everything you do and say will be amplified and everything you do, every single thing you do from walking, talking, decisions you make will be scrutinized and that can be a lonely place. So I'm just calling out that I think that work is the most important work to do as a leader, at least what I have found in my own career. And sometimes it means getting out of the environment you're in. Paul Pruitt (18:22): I remember early on in my leadership, I always thought it always was portrayed that you have to show up different, leave it at the door. Nothing comes in from your personal life. You have to come in as a robot, basically. That's how I always felt and realizing that's not reality. Today I argued with my wife, me and my daughter got into it, the dog just peed on the floor. All this stuff happens and to shut it off to walk through a doorframe just doesn't happen. And I think that's what I want to be involved in an organization where we can be real. Now, Dr. Boissy, I don't agree with you on this one. Dr. Adrienne Boissy (18:58): You're bringing up a couple different points, one of which is that I think sometimes people equate being real with just sort of vomiting out what's going on in Paul's life. And I don't think that's what you're advocating for. I hear you advocating for the idea that you could give some lens into the real mess of life so that people feel more connected to you as a leader and they can see themselves in you and in the organization. And it's validating to know, right? Oh, I'm not the only one who could hardly get my kids out to school today or can keep it together. Paul Pruitt (19:39): Or if they have a bad day. The bad day wasn't because of just a bad day. It was just life. Dr. Adrienne Boissy (19:44): That's right. I think the skillset there in part is figuring out what are you sharing and for what purpose for whom? If it's a therapeutic for you, that's not a helpful share. If it's sort of a dose of a story or a piece of the story so that there's connectivity created and people can see themselves in it, I think that's a very different intent. And I think that's an important skill for a leader is to turn that dial at the right time authentically. Authenticity there really matters. And the other skillset that you're calling out as a leader, which we, again, I would love to see practiced more is the idea of how to speak up very often. How do I disagree with you agreeably in a way where we can sort of have a productive dialogue about a disagreement on a point or a topic without shutting one down or it feeling personal. (20:42): And so it comes around to a lot of the work that I've done over the years in communication skills. Sometimes people equate empathy or kindness with just sort of going along in group think and doing what other people want. And I think we have to be really careful to say we can always be relational in our communications with each other. And it's a skillset to say, Paul, that's a really interesting idea. I've never thought about it that way. I'd like to share my perspective, which maybe touches a different point or sees it differently. I think sometimes we still place value on people who seem to know all the answers and their perspective. It's said with confidence and therefore it must be true. And I think again, effective leaders are very intentional about making sure they hear more voices, dissenting opinions, maybe get better about asking, "Great, we've got three people who think this is a great idea. (21:44): I'd love to hear concerns around it. Why might this not work? How might we make it an even better idea?" Because as a leader, people get afraid to tell you what they really think. You are by nature of your role removed from the reality, and so you have to work much harder to understand that reality more so than everybody else. Chelsey Gheyara (22:04): Great thoughts here. I've got another question for you. How did you make the leap from, let's say, your full-time practice with patients to leading experience-driven initiatives in your prior chief experience officer role, and then now working as the CMO at Qualtrics? I've been at Dr. Adrienne Boissy (22:24): The Cleveland Clinic for almost 25 years, I think, practicing as a neurologist. And I was the chief experience officer there for the global system for about seven years. And that's when I ran that Empathy and Innovation Summit or co-chaired it with the fabulous Dr. Kelly Hancock, the chief caregiver officer at the Cleveland Clinic. And so I was always juggling a little bit that desire to want to impact processes and operations and policy at scale, but also continue to have my feet grounded in the realities our patients face. And so I maintained a little bit of that, I call it the joy of imbalance, right? There are days I'm a great doctor, days I'm a great leader, there are days I'm a great mom, but they often don't happen all on the same day, I can assure you. And so the sooner we lean into the idea that there's never a perfect percentage that I'm giving any one thing at any one time, but I had been doing that for some time when I was at the clinic in that executive role. (23:27): And then it started to dawn on me a couple different things, the first of which was I wanted to continue learning from other industries. I felt that there was a little bit of an echo chamber and some of the experience sort of conversations I was in that we were trying the same practices, we were trying to get consistency, we were doing continuous improvement and things would get better for a while and then sort of not. I felt the need to have fresh ideas as to how we might do things. The second factor for me was I was thinking about what's the growth, right? I was a chief experience officer at a top hospital system, and so I wanted to make sure that I was continuing to grow professionally in a way that was new so that I could feel challenged. And then the last was I wanted to maintain the footprint in patient care, but I could also see that technology was going to be a huge tool for how we scaled and amplified great work empathy in caring systems, and I wanted to be closer to that. (24:41): Those were some of my drivers, but I would say I spent about a year pontificating, thinking, debating, pro and conning it for a long time. The moment that something I did that was very helpful to me in that journey, if any of your listeners are thinking about making a move was, and it hearkens back to my earlier comment, was I was thinking about all these titles. Who should I be? I should be a chief empathy officer. I should be a chief people person. I should be like, "What title do I need?" And I found myself very frustrated by that because maybe ultimately as I came to eventually, it's not about the title, it's about the impact that I could have on the world. And so I sat down and I scribbled on a piece of paper, a circle, and I just divided it into pie sections of what I wanted my impact to be for the next 10 years. (25:40): And I'd never done that. Of all the time we come up with business plans for the work we're doing or strategic ROI, I'd never done it for myself. How do I want the next 10 years of my life to be spent? How would I allocate my time, energy, effort? I want to be more present for my kids. I was always on my phone, I was texting, I was getting home at seven o'clock at night and leaving at six in the morning, and I was not present when I was there. I was doing work. I was bringing my laptop to the soccer games. I was just completely absorbed and I didn't want to work like that anymore. And another was be a better friend. We talked about loneliness before. You can't be friends with everybody you work with. And I had become a sloppy friend. I was missing their birthdays. (26:28): I was not showing up with gifts. That's not who I want to be. And another slice was doing work to reduce suffering and create more joy. And that was really important to me. And so anyway, long story short, I called this ultimately my joy pie. And as I was interviewing for jobs, I interviewed at Qualtrics and I was talking to the chief operating officer at the time and he said, "You know what? I'm not sure about you. You do compassion and you write articles about love and empathy and worst software." And I said, "Well, the great news is I've mapped my joy pie and you are not on it. " I mean, he was sort of jarred. And I said, "Respectfully, this is as much an interview for you as it is for me because I'm not going to work in a place where I can't reduce suffering and create joy. (27:26): And if that aligns with what you're trying to do, we'll be great. And if it doesn't, that's okay." And I said, "But here's what's important to me and how I want to show up in the world and you can be a part of that or not. " And absolute credit. He said, "You know what? You're right. Go map your JoyPie is one of my pieces of advice, not that you asked for it. " Chelsey Gheyara (27:47): I love it. I actually have done that and it's not called My JoyPie, but it looks very similar. This is not on our questions, but I want to ask it because here at Majestic Care, innovation is something we are very serious about and also very excited about. How can we, as Paul likes to put it a lot of times, is how can we put our nurses and our clinicians at the bedside and doing what they signed up to do, right? We have a lot of regulations for good reason, and how can we leverage technology and innovation and AI to make sure we have, I guess, dare I say the best of both worlds. So you mentioned love and technology and all of that. AI is really exciting and our teams use it, my team use it every day. We use it at Majestic Care for good purposes, but what would you say to make sure we do keep people still at that focus while leveraging and continuing to soar and innovation? (28:45): How do you think we should remain grounded in love and in people in the midst of technology? Dr. Adrienne Boissy (28:52): I'm sure you have a lot of data about what's going on in your system today from your people, from your patients, from your residents. I would encourage you to do a SWOT or an inventory of where you are, right? Do you have thrilled residents and exhausted people? Because again, so I don't know your landscape well enough, but I do think sort of taking an honest stock of where are we or do we not have enough data points to know? Because if you don't have enough data points to know or you're doing an employee engagement survey every two years, you're not listening enough. And so just at the baseline sort of hard look at what are you doing, who are you listening, how are you listening and what is it telling you today? Some things I think about along that journey are, I think caregivers are beautiful, amazing people, both caregivers in terms of a family caregiver, but also in terms of clinicians. (29:50): But let's talk about clinicians and healthcare employees for a second. I think one of the greatest uses of technology must be to show show, appreciation, love, feedback, gratitude on our caregivers as much as humanly possible. And the brain gets bored. If you have the same employee recognition program that you've had for five years, your employees are tired of it. So think about more creative ways to keep the brain on edge about the ways you are recognizing them. Some of that could be technology, but some of it should be a pop-up CEO shows up on rounds and says, "Hey, I'm going to read you what a patient said about you yesterday. Thank you for being a part of Majestic." And then the next day it's a video message and the next day it's a phone call. We have to keep it fresh. If it's true that the brain has an attention span of three milliseconds and we make a first impression within seven, then you got to be thinking more creatively, more in the moment and I think much more generous with how we show our love for our people. (31:13): I feel like we're still leaning on some of the same old tools and it's not landing. So that would be one thing to be thinking about. I also think I would think about sort of points of connectivity. So we have whiteboards in resident rooms or hospital rooms. Or one of the most beautiful projects I remember working on was simply writing on the whiteboard something about the patient that was important to them. And then the caregiver could come in and be like, "Oh, I didn't realize you served in the Navy. Thank you for your service. So did I. " And then all of a sudden you create an authentic moment of unexpected connection. And I think technology can serve some of that up, although we need to be thoughtful about what we're serving up to whom. Most people really have that deep relationship with their clinician or care team. (32:08): And then maybe there's something lighter that we could serve up to somebody else. "What's your favorite song? "And then you surprise them with having music therapy come sing their favorite song. I think technology has the ability to surface not preferences, but maybe a little bit of the, " If I had one wish today, think about the dream team at X4 running around fulfilling participants' wishes. Why don't we do that in healthcare? If you had one wish today, what would it be? Or if you had a dream that you want to accomplish in the next year, what would it be? "And then save just like 10% of your fabulous people's time, energy, and effort to work on it and play with it and see what they could craft to try to help that dream come true. I just want to see more fun and creativity being applied to the human condition. (32:57): And then maybe the last one on the patient side is we in healthcare, and I say that broadly, do not follow up with people about what they say. We ask them for their feedback, they give it to us and then we do nothing with it or we read it and think it's great. That's not how it works. What would be meaningful is for Chelsea to walk in the next day and say," Hey, I realized you submitted an idea or wrote a Daisy nomination for our nurse, and I just wanted to personally stop by and let you know that meant everything to her. "But can you imagine the patient's like, " What? You actually read what I wrote? It mattered. "So again, I don't know that there's a recipe for it, but I do feel like there's lots of things we probably do that we could dial up the humanity on and think about the processes that run today and how might we make them just a little more magical, just a little more special, just a little more memorable. (33:59): That feels like it would drive us closer to some of the relationship-centered care that we all are going to want. Chelsey Gheyara (34:08): This conversation has been a delight. Don't be a stranger and we are so excited to be launching with Qualtrics and I'm sure we will hear from you sometime, hopefully soon again, but thank you for joining us on the Hearts of Excellence podcast. Dr. Adrienne Boissy (34:24): Thanks, Dr.- Absolutely. It was a joy. I am at your service and could be happier to partner with all of you. Thank you. Paul Pruitt (34:31): Thank you. Chelsey Gheyara (34:34): Thanks for listening to Hearts of Excellence. 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