Latest / Becker’s Healthcare Podcast / Courage, Value Based Care, and Leading Through Uncertainty with Dr. Ramin Davidoff

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Courage, Value Based Care, and Leading Through Uncertainty with Dr. Ramin Davidoff · Becker’s Healthcare Podcast

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Welcome to this episode of Leadership Unscripted at
0:40
Becker's Health Care podcast. I'm Chris Sosa, your
0:42
host. I'm very happy to be joined by
0:44
today by doctor Ramin Davidoff. He, of course,
0:46
is co chief executive officer of the Permanente
0:49
Federation.
0:50
Ramin, thank you for joining us today. My
0:52
pleasure, Chris. Thank you for having me. Wonderful.
0:55
Yeah. We always love when you're able to
0:56
give us your time.
0:58
Our conversation today is gonna dive pretty deep
1:00
into who you are as a health care
1:02
leader and what has led you to make
1:05
decisions you've you've made and, you know, just
1:07
your your overall journey.
1:09
And before I do that, though, I wanna
1:10
give you a chance to let our audience
1:12
know a little bit more about yourself as
1:14
well as your organization.
1:16
Thank you so much. I appreciate that opportunity.
1:18
My name is Ramin Davidoff.
1:20
I'm the executive medical director for the Southern
1:23
California Permanente Medical Group, which is a very
1:26
large autonomous independent
1:29
and physician led medical group in Southern California.
1:32
I'm also honored to be the co CEO
1:35
of the Permanente
1:36
Federation,
1:37
which is a
1:38
entity that conglomerates all of the Permanente medical
1:42
groups under one umbrella.
1:44
And, I'm a urologist.
1:46
I practiced
1:47
urology for twenty three years before I took
1:50
on the role as the executive medical director
1:53
here in Southern California as well as the
1:55
co CEO of the Permanente Federation.
1:58
Thank you so much, Ramin. Obviously, you wear
2:00
a lot of hats and, obviously, keeps you
2:02
very busy.
2:04
But, you know, you've had quite a a
2:05
career so far, and I wanna delve into
2:07
that.
2:08
Specifically, our first question for you is simply,
2:10
what's something you've learned outside of health care
2:13
that you've applied to your career?
2:16
That's a that's a great question. Lots of
2:18
life lessons,
2:20
but I will say that from the very
2:22
beginning, I I learned as a kid
2:25
from my parents and family that there is
2:27
no substitute
2:29
for
2:29
working hard
2:31
and treating people with
2:33
kindness and respect.
2:35
I've definitely brought that into the work environment.
2:38
I also
2:39
learned that it was really important to make
2:41
people around you
2:43
feel that they are safe. And that way,
2:45
they can be the best version of themselves
2:48
in their personal and professional lives. These these
2:51
values have led me to truly believe
2:54
in and champion
2:56
the team based care approach that we have
2:58
here in Kaiser Permanente,
3:00
which essentially,
3:01
in a team based model,
3:03
we flatten the traditional hierarchies
3:06
so that every team member can work to
3:09
their fullest potential.
3:11
I have no doubt that that's paying off
3:12
in in your organization.
3:14
It's something that, you know, it's gotta filter
3:16
down from the top. Right?
3:19
That's terrific. Alright. So next question I have
3:21
for you, Irene, is
3:23
and this could be more than one thing,
3:24
but I wanna ask you what accomplishment are
3:26
you most proud of? It could be inside,
3:28
you know, at at the Permanente Federation or
3:31
and another entity,
3:32
and why?
3:34
Great question. And there are multiple things that
3:37
I'm incredibly proud of.
3:40
I will say, though, that they're all team
3:42
accomplishments.
3:43
They're not mine.
3:45
The one of the biggest ones is that
3:47
the way we came together as a medical
3:49
group as and as an organization
3:51
to manage through the pandemic,
3:54
keeping our patients and our physicians and staff
3:57
as safe as possible.
3:59
The reason I'm very proud of that is
4:01
because our organization was able to
4:05
figure out a way to manage through the
4:07
chaos,
4:09
with all the uncertainty that was going on,
4:12
figure out a way to continue to put
4:14
the patients at the center of what we
4:15
do, and at the same time,
4:17
being able to protect our physicians and staff
4:20
as well because there was a lot of
4:21
fear
4:22
and uncertainty about their own personal,
4:26
safety and health. And so the way the
4:29
organization came together,
4:31
we all were learning
4:33
as this thing was unfolding.
4:35
And it was very difficult to keep everything
4:38
together, and so many people came,
4:41
together to be able to manage and stay
4:43
united,
4:45
work through our fears, work through the uncertainty,
4:48
and get the organization and the communities that
4:51
we serve through the pandemic. That is one
4:54
of the highlights
4:55
of my professional career that makes me so
4:58
proud of the health care industry in general.
5:02
Another one is our laser focus
5:06
on quality.
5:07
We continue to have a very,
5:10
very high,
5:12
view of quality care as one of our
5:14
foundational guiding principles.
5:16
We always have that as a very top
5:18
priority for the organization.
5:20
Just to give you an example of some
5:22
of the things that have been accomplished as
5:25
a result of this laser focus and investment
5:28
and making sure we have the right systems
5:30
and protocols in place,
5:32
in 2025,
5:34
we led the country
5:36
as a top performer in 71
5:39
HEDIS measures.
5:41
This is most of any health plan, and
5:43
we ranked among the top rated Medicare plans
5:46
in every state we served
5:48
for seven consecutive years.
5:51
Another thing that I'm very proud of is
5:53
how we've been able to leverage technology
5:55
and
5:56
artificial
5:57
or what we call augmented intelligence,
6:00
such as, use of the integrated electronic health
6:03
record,
6:04
data analytics, and also AI enabled tools
6:08
to help enhance the value based care model
6:11
that we have in our organization
6:13
and at the same time
6:14
improve the care for our patients,
6:17
but also reduce the clinician administrative burdens that
6:20
they've been experiencing. And it's increasing more and
6:23
more year after year after year of practice.
6:26
So
6:27
those things are, things that I think in
6:30
my career
6:31
have come about, and the organization
6:34
has really found a thoughtful way to work
6:36
through them.
6:37
And
6:38
I'm really proud of the way we've managed
6:40
through all these, what I would say, inflection
6:43
points in the history of the health care
6:45
industry and certainly of our organization.
6:49
Romino, I wanna follow-up. So it's one, it's
6:52
just hard to believe, I think, for a
6:53
lot of us that the pandemic
6:55
was about a half a decade ago.
6:58
You mentioned just sort of the fears and
7:00
uncertainty
7:00
that, you know, can develop
7:02
really an entire country, an entire planet. So
7:05
but as a health care leader,
7:07
when
7:08
it comes time to say, you know what?
7:11
This is how we're gonna do that.
7:14
How do
7:15
you instill a sense of calm with those
7:17
you're working with?
7:19
Really great question, Chris. And
7:21
I was very new to my role. In
7:23
fact, the pandemic happened in my first year
7:25
on the job,
7:27
and there was so much fear and uncertainty.
7:29
And we were seeing the pandemic unfold,
7:32
in the other side of the world. And
7:34
we always felt that eventually it will get
7:37
here, but we didn't know for sure, and
7:39
certainly it came to The United States. And
7:42
the the way we were able to manage
7:45
through that as leaders,
7:47
uncertainty,
7:48
fear,
7:49
lots of things that we didn't know. We
7:51
didn't know how to test,
7:53
for for the virus. We didn't know how
7:55
to prevent the virus. We didn't know how
7:57
to vaccinate for the virus. We didn't know
7:59
how to care for all the patients that
8:01
would need
8:02
to come into our medical centers and the
8:04
medical office buildings.
8:06
And it's a brand new disease, essentially.
8:09
So the disease process was also unknown. So
8:12
the things that
8:13
evolved and we learned and we implemented were
8:17
very important to be real with our people.
8:20
Don't sugarcoat things.
8:22
Be realistic.
8:24
State the issues and the realities and the
8:26
facts that we have and the knowledge that
8:28
we have about the information that we have.
8:31
Have a regular communication mechanism
8:34
with as wide an audience in the organization
8:37
as possible because
8:39
the communication
8:40
really does alleviate to some extent the fears
8:43
and the anxieties
8:45
and allows for people to want to be
8:47
a part of the solution,
8:49
delegating appropriately
8:51
so that
8:52
not not to feel that all of the
8:54
burden is on one person or three people,
8:58
but finding the leaders in the organization that
9:01
you can delegate to and trust to be
9:03
able to execute on what we've decided upon,
9:06
and then just make decisions.
9:08
And you have no idea if the decisions
9:11
are gonna work or not, but you have
9:13
to make timely decisions
9:15
after evaluating all the available information.
9:18
And
9:19
if the decisions were the wrong ones, pivot
9:22
quickly,
9:23
accept the error, own the error, and move
9:26
on to the next thing that you have
9:27
to do. Lots and lots of learnings
9:30
about the pandemic and how we manage through
9:32
it. None of that comes innately for any
9:35
leader. A lot of it is learned,
9:38
and I had to learn quite a bit
9:39
of that in my first year on the
9:41
job.
9:42
That's very well said for me. It's certainly
9:44
there's a lot to be said in situation,
9:47
especially similar to those
9:49
that are that communication and transparency
9:52
are are very important. I like what you
9:53
said about how
9:55
it just if you make a mistake, own
9:56
it because that's going to happen in in
9:59
any
10:00
leadership space. Right? I mean, you'd love to
10:02
be right all the time, but, unfortunately, that's
10:04
just not realistic. So, yeah, I think,
10:07
as you said, just being transparent and and
10:09
communicative can be
10:11
very, very good strategies.
10:13
I wanna pivot now, speaking of pivoting for
10:15
me. I wanna go to
10:18
what issue or aspect of health care do
10:20
you think deserves a brighter spotlight, and who
10:22
should be shining that spotlight?
10:25
Really great question. I will tell you that
10:27
I genuinely believe
10:29
in value based care, and I think that
10:33
aspect of health care
10:35
absolutely deserves much brighter spotlight
10:38
as probably the answer to the issues that
10:41
we have around health care in our country.
10:44
Much of the care in this country is
10:46
not based and focused on value.
10:49
Value based care, the way we define it,
10:52
it rewards
10:53
positive health outcomes rather than volume
10:57
of services that are provided.
10:59
It focuses on prevention
11:01
and early detection of disease,
11:04
in keeping people healthy proactively,
11:07
in managing chronic diseases,
11:10
very well to prevent complications
11:13
and hospitalizations,
11:14
and also focusing
11:16
on truly on
11:18
greater health outcomes for our patients and communities
11:22
and not solely on revenue generation.
11:25
That's our definition of value based care. It
11:29
absolutely
11:30
needs a greater focus in our country.
11:33
I believe that there is a way to
11:35
align all of the incentives
11:37
that are needed for the different
11:40
aspects of health care system
11:42
to come together to deliver on value to
11:44
our patients,
11:46
including the providers,
11:48
including the payers, including the hospital systems.
11:52
The aligned incentives
11:53
on providing outstanding patient outcomes
11:57
have to be front and center for our
11:59
country to be successful
12:00
because the current model is frankly
12:03
absolutely unsustainable, and we do need to do
12:05
something different.
12:07
Another area that I believe needs a much
12:10
higher focus
12:12
is workplace safety,
12:14
and violence in the health care setting
12:17
is
12:18
a problem. It's a major problem. There's violence
12:20
against physicians and care teams,
12:23
and we are seeing an increase a significant
12:25
increase in the past five years.
12:28
The American College of Emergency Physicians reported in,
12:32
about three years ago that up to eighty
12:34
five percent of emergency room physicians
12:37
believe that violence in their workplace has risen,
12:39
and ninety five percent
12:41
have been victims of,
12:43
violence at some point. So I've experienced that,
12:47
in my department when I was practicing urology.
12:51
In my medical center, there was a clear
12:54
act of violence
12:55
in the department, and it was very traumatic,
12:58
and it took a long time for the
13:00
department to recover.
13:02
I do believe that deserves a much larger
13:04
focus
13:05
in our country through legislation,
13:08
through the different,
13:10
organizations that are involved with assuring that violence
13:14
does not impact the workplace.
13:16
Workplace violence in a health care setting, first
13:19
and foremost,
13:20
impacts
13:21
safety and the quality of the care that
13:23
is provided
13:24
for the patients, and it certainly, of course,
13:28
impacts the, safety of our physicians and staff
13:31
and nurses. So,
13:33
value based care, front and center, by far,
13:36
top of my list. And the next one
13:38
I would say is workplace safety.
13:41
Thank you for sharing that,
13:43
Rameen. It's it's certainly
13:46
when you're in a situation
13:47
that can be scary
13:49
in a hospital setting where there's violence involved,
13:53
yeah, it it's hard to say how that's
13:55
going to affect your your staff.
13:57
So as
13:58
someone who's in the position you're in, what
14:01
are some of the steps that you've taken
14:03
to
14:04
assure first your staff well, not first, but
14:07
assure your staff and your patients that, hey.
14:09
This is something that's on our mind. This
14:10
is something we're working on.
14:12
Absolutely. So clear communication to our physicians and
14:16
staff
14:16
that this is a priority for our organization
14:19
and not just say it,
14:20
but enact in actions to demonstrate it. And
14:24
some of the things that we've done to
14:26
demonstrate this is,
14:28
for example, workplace
14:30
violence,
14:31
seminars and training sessions
14:34
for our physicians and staff to be able
14:37
to recognize the early signs and signals
14:41
of potential violence happening in the work setting.
14:44
Lastly,
14:45
improving the safety mechanisms in the medical center,
14:50
the hospital, as well as the medical office
14:52
buildings, including
14:53
visibility
14:54
of
14:56
protective services,
14:58
of,
14:59
say you know, guards that are are looking
15:01
at,
15:02
making sure that our there is safety in
15:05
our organization.
15:06
And also, frankly, there are times where you
15:08
need actually
15:10
metal detection
15:11
mechanisms
15:12
at our emergency room entrances.
15:15
So those are all things that we've
15:18
taken action on and put into place, and
15:20
it has required significant investment.
15:23
It has required
15:24
a a revamping of our workplace violence
15:28
and safety and security
15:30
protocols
15:31
and strategy,
15:32
both in the short term and in the
15:34
long term for the organization.
15:36
But we've communicated it, and we've done our
15:40
best to deliver
15:41
on what's needed to help people feel safe
15:44
in the workplace environment.
15:46
Got it. Thank you so much again for
15:48
sharing, Ramin.
15:49
Next question I have for you relates to
15:52
just
15:53
how managing people is part of your job.
15:55
Right? And not only that, just what traits
15:58
you like to see
15:59
in in any leader, and that can be
16:02
someone who's a CEO, co CEO, all the
16:04
way on down. Right? I mean, you mentioned
16:06
how important it is to be a hard
16:07
worker. That's one thing. That's a wonderful thing
16:10
to have no matter what kind of leadership
16:12
position you're in. But I also wanna ask
16:14
you, what is it do you consider it
16:15
to be an underrated
16:17
leadership trait, And who's have you seen embodied
16:20
it? It can be one person, one role,
16:23
and any way you see fit to answer
16:24
that question.
16:26
Good question. I really appreciate that. I often
16:28
think about
16:29
leadership qualities that are so critically important. And,
16:34
the underrated ones, in my opinion, are I
16:37
have four, but I will focus on one
16:39
of them in particular.
16:41
Well, you can mention four. Let's start with
16:42
one now. Okay. I I think about courage.
16:46
K. Very important and underrated leadership trait.
16:50
Humility is another one. Empathy
16:53
is critical that I believe is underrated in
16:56
leadership.
16:57
And last one is clarity, being very clear
17:01
in the communications,
17:03
in the thoughts,
17:04
being transparent
17:06
and very focused
17:08
so that people can understand
17:10
complex issues
17:11
and make it simple for them to be
17:13
able to understand it.
17:15
Well, I will focus a little bit on
17:17
courage
17:18
because
17:19
in my five years on the job, I
17:21
have found that courage is really a critical
17:24
aspect, and it's at the top of the
17:26
list for me. All those four are really
17:28
important,
17:29
But the courage to stand for the right
17:31
principles
17:33
and doing the difficult things that leaders sometimes
17:36
shy away from, but are very important to
17:38
do because
17:39
of the message that it sends to everyone
17:42
in the organization,
17:43
making those hard decisions that are in the
17:46
best interest
17:47
of the people
17:48
in the organization, but also of the communities
17:51
that we serve.
17:53
I will tell you that throughout history, there
17:55
are many courageous leaders that I admire
17:58
in in the
18:00
historical sense that Winston Churchill,
18:04
Abraham Lincoln,
18:05
Martin Luther King, these are courageous leaders that
18:08
come to my mind. But in the health
18:11
care setting,
18:12
I don't have to look too much farther
18:14
than,
18:16
and our ICU leaders during the pandemic, our
18:18
emergency department leaders,
18:20
our hospitalists,
18:22
who were admitting critically ill patients without knowing
18:25
how to treat it, whether they were gonna
18:27
get sick themselves or not. And so I've
18:31
seen it over and over again in health
18:33
care
18:34
and also historically.
18:36
So
18:37
courage, I would put at the very top
18:39
of that list, but certainly
18:41
humility,
18:42
clarity, and empathy are also very underrated.
18:46
I'm seeing a lot of important through lines
18:48
in our conversation, I mean, and they all
18:50
come back to,
18:51
well, courage is part of it, but I
18:54
think it it also melds into what you
18:55
mentioned before just about how it's important to
18:58
own your mistakes
18:59
and, you know, be forthright about any decision
19:02
that you're making and and being able to
19:03
move on and always be doing it in
19:06
the best interest of, not only your
19:09
your staff, but your patients as well. And
19:12
that's a really good segue actually into my
19:14
last question for you, Ramin, and that is,
19:16
speaking of courage, what is one risk you've
19:18
taken that has paid off?
19:22
Great question. That one risk I have to
19:24
tell you, I practiced
19:26
full time clinically for twenty three years.
19:29
So it was a big leap of faith
19:32
to go from clinical practice
19:34
into
19:35
leadership and administrative roles. So that transition was
19:38
a big risk for me.
19:40
And the reason I say that, Chris, is
19:42
because
19:43
I really had a purpose in clinical practice.
19:47
I was purpose driven. I'm still purpose driven,
19:49
But I had a purpose, and that was
19:51
to help impact the life of the patient
19:55
in front of me and their family members
19:57
that were in the exam room with us
19:59
as we were having conversations
20:01
and to heal
20:03
and to educate to the best of my
20:05
ability.
20:06
I have purpose, and I didn't know if
20:08
I would find that same purpose in administrative
20:10
work. And I can tell you I have
20:13
found that purpose. I really have because
20:16
in in this role, I am now able
20:18
to
20:19
with the help of an incredible team
20:22
and a phenomenal medical group and, of course,
20:25
of the Permanente Federation,
20:28
to be able to have a broader impact
20:31
on our organization,
20:33
on the care delivery model, on what I
20:35
truly believe in is
20:37
value based care and implementing that consistently and
20:41
in a standardized fashion across our organization,
20:45
and also creating the systems and processes
20:48
that will allow for every member of the
20:51
team
20:51
to be able to be the best version
20:54
of themselves, including
20:55
team based approach,
20:57
flattening systems and hierarchies that I believe are
21:00
an impediment to value based care,
21:02
and eventually and ultimately
21:05
absolutely
21:05
help improve patient care more broadly. So
21:09
I will tell you that that was a
21:11
big risk. I didn't know I would enjoy
21:14
doing this work the way I do.
21:17
I really miss clinical practice
21:20
in a big way. In fact, I, once
21:22
in a while, go back into the Operating
21:24
Room and in the exam Room because I'm
21:27
just that's part of my DNA.
21:29
But I have found a purpose in administrative
21:31
work,
21:32
and I'm very grateful for the opportunity to
21:35
be have able to have such an impact
21:38
on a broader organization
21:40
and ideally
21:41
also in the health care industry in the
21:44
future
21:45
because I do believe in spreading the tenants
21:48
of value based care.
21:50
Rameen, not that I
21:52
think that you should be pushed back into
21:54
clinical care, but I am curious. Do you
21:55
ever see yourself doing more of that since,
21:58
clearly, it's something that's very important to you?
22:01
I do. I actually do. I think once,
22:04
my tenure as a executive medical director
22:08
is over, I actually very much look forward
22:11
to going back into clinical practice.
22:13
I really do miss those conversations with my
22:16
patients,
22:17
with the staff in the department, in the
22:19
operating room, with my colleagues, anesthesiologists,
22:22
and the other staff. So, yes, after the
22:25
tenure has ended as in this role, which
22:28
I love,
22:29
I very much look forward to getting back
22:32
into clinical practice.
22:34
Got it. Well, it seems like a great
22:35
gift to have found such purpose in both
22:37
roles. It has led you to hear. And
22:39
thank you again so much, Ramin, for being
22:41
on this podcast.
22:42
I mean, we're gonna love sharing all these
22:44
insights with our audience, and we cannot wait
22:46
until the next time our paths cross.
22:49
I look forward to it, Chris. Thank you
22:51
so much.