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Agency Is Neurological Before It's Philosophical, with Kris Nessa and Erica Olenski · The Clinical Realist

• 0:00
  SPEAKER_01: All right.
• 0:01
  SPEAKER_01: So everyone get it together and I will do our cold open and then I'll start.
• 0:05
  SPEAKER_01: Everyone cool?
• 0:06
  SPEAKER_01: Yeah, but it's I'm also off to the side because I know in podcasts, if I sit towards the middle, I look like that.
• 0:17
  SPEAKER_02: Well, I have this is my good side, so I'm like, hey Chris, how's it going?
• 0:22
  SPEAKER_00: Sarah, I used to have the same haircut as you before I lost all my hair.
• 0:25
  SPEAKER_00: I had this really cool Viking man buzz ahawk thing for three years.
• 0:31
  SPEAKER_00: It was amazing.
• 0:32
  SPEAKER_02: I love that.
• 0:34
  SPEAKER_02: It makes him so good.
• 0:35
  SPEAKER_02: I really enjoy it too.
• 0:37
  SPEAKER_02: All right.
• 0:38
  SPEAKER_02: All business now, people.
• 0:39
  SPEAKER_02: All business.
• 0:44
  SPEAKER_02: At three in the morning in a house somewhere, there's a parent suctioning a trach tube.
• 0:49
  SPEAKER_02: They're not a nurse.
• 0:51
  SPEAKER_02: They were handed a discharge feet, a phone number that goes to voicemail after five, and a good luck.
• 0:57
  SPEAKER_02: Every technology decision made in American healthcare this year was made in a conference room by people who may have never been in that house at three in the morning.
• 1:06
  SPEAKER_02: And that's the gap.
• 1:07
  SPEAKER_02: My two guests today have spent almost 20 years each on the opposite sides of it.
• 1:12
  SPEAKER_02: And I'd rather they tell you who they are than have me do it.
• 1:16
  SPEAKER_02: So Chris and Erica, thank you both so much for joining me today.
• 1:21
  SPEAKER_02: I want to start with you, Chris.
• 1:22
  SPEAKER_02: Chris, you've sat at Cleveland Clinic, Sterner, Dell, and now you're CTO for healthcare at SHI.
• 1:28
  SPEAKER_02: Introduce yourself through the rooms.
• 1:30
  SPEAKER_02: Which side of the table have you spent the most time on?
• 1:33
  SPEAKER_02: And what did that teach you that the other side doesn't know?
• 1:37
  SPEAKER_01: Oh goodness.
• 1:38
  SPEAKER_01: And I will have to update.
• 1:39
  SPEAKER_01: I am no longer with SHI, but the longest time that I've spent, it has been on the innovation side.
• 1:47
  SPEAKER_01: However, I'm going to caveat that I think I was raised right.
• 1:59
  SPEAKER_01: And I call it back in the heyday.
• 2:00
  SPEAKER_01: Neil Patterson, one of the co-founders, was still alive.
• 2:04
  SPEAKER_01: And one of the intrinsic things that uh all of us at Cerner were taught is that we ourselves are patients.
• 2:10
  SPEAKER_01: So all of us sitting there making decisions, doing implementations, doing product designs.
• 2:15
  SPEAKER_01: Any of us might be a patient in the hospitals that we were serving.
• 2:19
  SPEAKER_01: And that started to like seep into my lived experiences a little bit, especially when I was single.
• 2:27
  SPEAKER_01: I did end up in a few of our facilities.
• 2:30
  SPEAKER_01: And there's always the, oh, who do you work for?
• 2:32
  SPEAKER_01: And you turn over your insurance card.
• 2:34
  SPEAKER_01: And at Cerner, it had Cerner's logo on it because we were self-insured and stuff.
• 2:39
  SPEAKER_01: Like, oh, you work at Cerner.
• 2:41
  SPEAKER_01: Yeah, we have it.
• 2:42
  SPEAKER_01: And then sometimes the nurses would talk to you, sometimes it wouldn't.
• 2:45
  SPEAKER_01: And whatever.
• 2:47
  SPEAKER_01: Um, but fast forward all these years, and now that I'm a parent and I have children, I've ran product and innovation teams on innovations that were supposed to help me with my child.
• 2:59
  SPEAKER_01: As my child was in the hospital, um, it's a totally different ballgame, and it all goes back to those first like Cerner years in the impact.
• 3:08
  SPEAKER_01: And there's not a time that I don't sit in a labor and delivery room or even when my kids' clinic visits that I'm not like scanning the room.
• 3:16
  SPEAKER_01: It's like, man, this could be better, that could be better.
• 3:19
  SPEAKER_01: I've seen something better than this.
• 3:21
  SPEAKER_01: But um I still know a lot of it comes down to the people in process because honestly, there's enough technology to solve a lot of our problems.
• 3:30
  SPEAKER_01: It's the rest of it that has to change.
• 3:32
  SPEAKER_02: So I'd agree with that too.
• 3:34
  SPEAKER_02: Well, wonderful, Chris.
• 3:35
  SPEAKER_02: Thank you so much.
• 3:35
  SPEAKER_02: Yeah.
• 3:36
  SPEAKER_02: Now, Erica, your turn.
• 3:37
  SPEAKER_02: So we have Monarch Futures, board certified patient advocate.
• 3:41
  SPEAKER_02: You chair the patient and family group at ACHDM.
• 3:44
  SPEAKER_02: You found an August artist, but introduce yourself the way you'd introduce yourself at three in the morning in a hospital robe and not at a conference badge.
• 3:52
  SPEAKER_00: So I was that mom you described, the 3 a.m.
• 3:55
  SPEAKER_00: suctioning a trach in my son's bedroom.
• 3:58
  SPEAKER_00: Probably, you know, third, fourth night in a row, private duty nursing called out, even though we were approved for 167 hours.
• 4:06
  SPEAKER_00: And uh I vividly remember that scenario.
• 4:09
  SPEAKER_00: I was laying on the floor on a mattress topper I bought at Costco that was a roll away mattress.
• 4:14
  SPEAKER_00: I was eight months pregnant, and that was the best I had because my son required, you know, a specific kind of bed in his room, and we had his machines and all of his equipment set up there.
• 4:25
  SPEAKER_00: And uh and my back hurt, as you can imagine.
• 4:28
  SPEAKER_00: Um, and my sleep was fragmented, you know, it wasn't restorative, it was um a constant state of hypervigilance.
• 4:35
  SPEAKER_00: So I I I know that world deeply, um, and I appreciate you opening with with that um vignette, if you will.
• 4:41
  SPEAKER_00: Um three o'clock in the morning.
• 4:44
  SPEAKER_00: If I uh if I start talking to a physician team that comes into our room, likely not the physicians, more often than not at 3 a.m., but let's say they're rounding at 6:30, 7 a.m., uh, they're meeting a mom on a mission more often than not.
• 4:58
  SPEAKER_00: I'm giving them the full record download verbally with medical history, uh, letting them know where our priorities are for that day, what we're currently focused on, what was remains unresolved, um, what we need clarity on for the day ahead, um, whether that's, you know, maybe we're getting discharged, or what does discharge timing look like in terms of conversations?
• 5:17
  SPEAKER_00: Are there any procedures that we're anticipating for that day that we need to be building our schedule around?
• 5:22
  SPEAKER_00: And shortly after that, I'm walking down the hall.
• 5:25
  SPEAKER_00: Uh, maybe I have to sneak out because my son was very attached and wanted to make sure I wasn't leaving the room.
• 5:32
  SPEAKER_00: Likely sneaking down to get a cup of coffee so that I can join a conference call for the work that I do in the day.
• 5:38
  SPEAKER_00: And um, somehow timing that to physician rounds.
• 5:42
  SPEAKER_00: And hopefully my call schedule allows me to be engaged with the that team when they finally make it to our room sometime between 6:30 in the morning and 11 a.m.
• 5:54
  SPEAKER_00: Uh, I, as a professional, have been in the healthcare innovation space for almost 20 years now.
• 6:00
  SPEAKER_00: Uh, started my career, funny enough, working in radiology.
• 6:03
  SPEAKER_00: Um, I was recruited during college by a radiology manager who taught me everything I could imagine, just as a newbie without any context or children or really any meaningful inpatient experiences to reference.
• 6:17
  SPEAKER_00: And I fell in love with healthcare through radiology.
• 6:20
  SPEAKER_00: I I recognized at that point that um radiology in particular sits at a very unique moment in the patient journey, and I arguably one of the most vulnerable.
• 6:32
  SPEAKER_00: And I realized how sacred that moment was.
• 6:35
  SPEAKER_00: The patients I was interacting with, that I was getting set up on an MRI machine, for example, and screening them and getting them positioned properly for the text to do their work.
• 6:44
  SPEAKER_00: I realized that that experience was likely one of the scariest that these patient families encounter.
• 6:51
  SPEAKER_00: Because in many cases they might have cancer and they're trying to figure out what is it, or is this in fact cancerous, you know, short of a pathology report, right?
• 7:02
  SPEAKER_00: But what am I dealing with?
• 7:03
  SPEAKER_00: I've had these symptoms and I'm afraid and I'm frightened and I don't know what's ahead.
• 7:07
  SPEAKER_00: And and being both sides, you know, patient-facing and being behind the curtain or behind the window and seeing what was happening visually.
• 7:17
  SPEAKER_00: Um, you knew also in many cases what that patient was about to encounter.
• 7:22
  SPEAKER_00: And there was something just so sacred about that moment that I recognized I wanted to be a part of, even if I wasn't gonna be the clinician, I wanted to have a part in how that patient experienced that journey.
• 7:34
  SPEAKER_00: And so even early on, I decided I wanted to pursue healthcare from a communication standpoint.
• 7:40
  SPEAKER_00: So my degree is in PR, funny enough.
• 7:43
  SPEAKER_00: But uh I've always shared an intrinsic passion with the clinicians in my life that I've encountered.
• 7:49
  SPEAKER_00: Um, because I've thought of the work that I do as just serving in a different capacity, but the same vision and mission to make you know that experience of healthcare better for everybody.
• 8:00
  SPEAKER_02: That's great.
• 8:01
  SPEAKER_02: So the thesis that Erica and Chris brought to me, and it's the reason I put everyone together in this room, is that agency is neurological before it's philosophical.
• 8:10
  SPEAKER_02: So you can't design for it from a conference room.
• 8:13
  SPEAKER_02: So let's find out where that gap actually is.
• 8:16
  SPEAKER_02: So, first, Erica, you know, when you were taking care of your son, dealing with the trach or the G2 or whatnot, at some point you became the person running that, not a nurse, not a case manager, you.
• 8:29
  SPEAKER_02: So when did you realize you were also the one holding his agency?
• 8:35
  SPEAKER_00: So my son was diagnosed with aggressive brain cancer at only five months old.
• 8:39
  SPEAKER_00: Um, that's a really unique experience to be in because a lot of pediatric oncology generally is oriented to uh, let's say, five to ten-year-old child who, you know, can express some of their needs.
• 8:52
  SPEAKER_00: Likely that patient was neurotypical prior to diagnosis, um, and can express, you know, needs and desires is just a byproduct of that development process already being in place.
• 9:04
  SPEAKER_00: In my son's case, he was only five months old.
• 9:06
  SPEAKER_00: So we were actively neurologically developing at that time.
• 9:09
  SPEAKER_00: And so what I recognized in that moment, having worked in the space and having a little bit of context on the the kind of power dynamic of healthcare, if you will, and how data and money move through the system, I recognized that my son's care was really an extending into me as well.
• 9:28
  SPEAKER_00: I was as much a patient as he was.
• 9:30
  SPEAKER_00: And a large part of that, honestly, was breastfeeding because he was up until his point of diagnosis exclusively breastfed.
• 9:37
  SPEAKER_00: That was something really important for me as a mom to be able to make possible for my children.
• 9:41
  SPEAKER_00: And it was a required its own level of advocacy to be able to do just on a day-to-day basis with a uncomplicated typical child.
• 9:51
  SPEAKER_00: That moment for me was at the first hospitalization we had.
• 9:57
  SPEAKER_00: We had been admitted, my son had emergency surgery, he survived a 14-hour brain surgery, made a near full recovery.
• 10:04
  SPEAKER_00: But in after extubation, we still continued to have some airway challenges.
• 10:09
  SPEAKER_00: And so he was diagnosed with a compromised airway or was at risk for aspiration.
• 10:14
  SPEAKER_00: When you're breastfeeding exclusively, that's a problem, right?
• 10:18
  SPEAKER_00: So my son received an NG tube to help make sure he was nutritionally supported, um, in a large part supplemented by breast milk I was pumping real time.
• 10:30
  SPEAKER_00: But we all know breastfeeding has a lot more benefits than just nutrition, right?
• 10:35
  SPEAKER_00: And an infant who is oriented to living their day-to-day life with the psychological safety that comes from that experience of nursing is a critical one when you're thinking about neurological recovery post-op.
• 10:49
  SPEAKER_00: And so it was in that moment after his surgery as he was recovering that I realized I needed to override this determination to some extent with the clinical team, or at least challenge the clinical team to think about how my son's recovery could be augmented by being able to nurse while still maintaining nutritional value.
• 11:11
  SPEAKER_00: You know, so agreeing that the NG tube can stay in place and that perhaps we just nurse around that and not for nutritional benefit, but for the psychological benefit.
• 11:21
  SPEAKER_00: And that required a specific kind of aid of advocacy to be able to do because an aspiration risk carries clinical consequences, it create it creates financial consequences for the health system.
• 11:33
  SPEAKER_00: But I had a fantastic inpatient speech therapist who went to that with me as his advocate.
• 11:38
  SPEAKER_00: It was my first experience really in advocacy at all.
• 11:42
  SPEAKER_00: When I said, it's important for my son to be able to experience this thing that he's received and experienced his entire life as a part of his recovery from this surgery.
• 11:52
  SPEAKER_00: And withholding that from him is going to cause additional suffering that's avoidable.
• 11:57
  SPEAKER_00: And with the help of the speech therapist, we were able to actually convince the clinical team to allow us to nurse outside of the NG tube.
• 12:05
  SPEAKER_00: And I think, you know, in in fast forward, it was a absolutely critical differentiator for what outcomes he ultimately had access to clinically as a result of that, because he was able to psychologically recover from that surgery, was able to continue nursing through four rounds of really intense chemotherapy that caused GI tract ulcers and other complications like that, which breast milk, ironically, also has antibacterial properties.
• 12:33
  SPEAKER_00: So being able to nurse on top of that was something that clinically was not observable, not something controlled that people had a clinical decision or perspective around, but had absolutely clinical consequences that I think actually contributed to the good outcomes that he experienced.
• 12:48
  SPEAKER_02: That's interesting.
• 12:49
  SPEAKER_02: You know, Chris, when you hear the caregiver holds the agency, does that land as something the system designed for or something it missed entirely?
• 12:56
  SPEAKER_02: Because it sounds like from Erica, it missed it entirely.
• 13:01
  SPEAKER_01: Oh, yeah.
• 13:02
  SPEAKER_01: We could probably have three podcasts about this.
• 13:05
  SPEAKER_01: So if we're gonna hyper focus on the United States healthcare continuum here and its business framework.
• 13:29
  SPEAKER_01: We have operationalized so much.
• 13:31
  SPEAKER_01: Good old meaningful use, stage two, and everything where we're at trying to do it today.
• 13:38
  SPEAKER_01: And where I'm going at is we've still designed a lot technologically to feed the machine, to feed how it was built, right?
• 13:51
  SPEAKER_01: And operated.
• 13:53
  SPEAKER_01: And I would argue that the desire for value-based care and changes in who we are in the United States like are still kind of altruistic.
• 14:06
  SPEAKER_01: I mean, the industry itself is a unique paradigm that would be a different podcast, right?
• 14:11
  SPEAKER_01: Like it is a consumer-driven experience that really none of us want to be a consumer of.
• 14:19
  SPEAKER_01: But then when we're in it as a consumer, we want like Amazon-like care.
• 14:25
  SPEAKER_01: We want the ultimate consumer experience because you you demand that, you need that, and I think that's what brings you true agency.
• 14:33
  SPEAKER_01: Um, but we design still for reimbursements, meeting all of the uh clinical informatics uh things that we need to attest to for CMS and everything else that we need to report out to to get the and I'm not trying to diminish it, but like leapfrog certifications and all the stuff that we want as a health system.
• 15:03
  SPEAKER_01: And it's hard.
• 15:04
  SPEAKER_01: It's hard.
• 15:05
  SPEAKER_01: And lost is that intrinsic thought of we're all still patients here.
• 15:14
  SPEAKER_01: Like the scenario, Erica, that you even opened with about trying to ensure that you could hit uh rounds for your child while you're taking a work phone call.
• 15:24
  SPEAKER_01: I can tell you a story of how we designed that same innovation at Children's National with the help of Dr.
• 15:31
  SPEAKER_01: Jessica Hirsteck, because we recognize that in our patients.
• 15:35
  SPEAKER_01: And I had my child admitted there, and I couldn't use my innovation in time because we weren't live.
• 15:42
  SPEAKER_01: That is, yeah.
• 15:45
  SPEAKER_01: But um we we lose track because it's still the balance that uh at the hospital you see still need money to run and pay the paycheck, pay the clinicians.
• 15:59
  SPEAKER_01: But we're missing the mark sometimes, and the EHR is still so rigid in design for reimbursement.
• 16:08
  SPEAKER_01: Uh I'm just waiting for the day that it's a microphone and a video camera in the room because that's really all we need technologically, I feel.
• 16:15
  SPEAKER_02: But I think that's the direction we're probably going.
• 16:17
  SPEAKER_02: You know, back in my next gen days, I actually was in charge of the patient portal during some of the MU 123s.
• 16:24
  SPEAKER_02: And I'm sorry for anyone listening to this because it's my fault, I'm sure.
• 16:28
  SPEAKER_02: But the I try to explain that the speed required to bring all the features necessary for attestation for meaningful use was so fast from a development perspective at that time that it was next to impossible to get those requirements in, let alone actually make it usable.
• 16:47
  SPEAKER_02: So when anyone buys a portal or a care coordination platform or a discharge planning tool, someone in that room says, oh, this is going to reduce caregiver burden.
• 16:57
  SPEAKER_02: Yeah.
• 16:58
  SPEAKER_02: But I don't think I've ever seen anything that actually reduces caregiver burden.
• 17:02
  SPEAKER_02: Erica, as an advocate, what's actually helping patients?
• 17:08
  SPEAKER_00: So one of the big ahas I had as I've been integrating my experience as a caregiver and an innovator in this space and being involved in several projects, both on the interoperability front to, you know, uh 5G telecom infrastructure and conversations around that.
• 17:26
  SPEAKER_00: One of the big ahas I had was that we've made a really gross assumption in healthcare that everyone, whether it's the patient, the caregiver, the clinician, the therapists, the administrators, the policymakers, everybody is engaging with healthcare with a nervous system that's feeling safe and secure.
• 17:45
  SPEAKER_02: All right, let's just drop the mic.
• 17:46
  SPEAKER_02: I think we're done here.
• 17:47
  SPEAKER_02: Thank you, Chris and Erica.
• 17:48
  SPEAKER_02: I think we're done with the whole thing here.
• 17:50
  SPEAKER_02: We're just gonna put that in big print on the whole thing.
• 17:53
  SPEAKER_00: So that assumption, right, has become a design framework for the work that we've done.
• 17:59
  SPEAKER_00: It's inspired and guided policy.
• 18:01
  SPEAKER_00: It is in it's informed executives of these health systems, of the tech companies, of everybody that's participating in the ecosystem of healthcare across the continuum of care.
• 18:12
  SPEAKER_00: This assumption has physiological consequences because we do know with high level of confidence that our brains, when we are feeling hypervigilant, function differently than they do when they're feeling safe and secure.
• 18:25
  SPEAKER_00: And ironically, and I say ironically, because the expectations we've placed on caregivers and patients, in particular when it comes to patient experience initiatives, has embraced that assumption and demanded that engagement happen through executive functioning, which is the one-ish category of function that is meaningfully impaired when you're feeling hypervigilant.
• 18:50
  SPEAKER_00: So we've placed an expectation on everybody that's engaging with healthcare, every human being that's engaging with the system that they are physiologically incapable of actually doing.
• 19:03
  SPEAKER_00: And it's ironic, right?
• 19:05
  SPEAKER_00: Because we've done incredible work.
• 19:07
  SPEAKER_00: There's a lot of thought and energy that's been put into the systems we have in place today.
• 19:12
  SPEAKER_00: We know it's broken, but we know it was also designed this way, right?
• 19:16
  SPEAKER_00: That said, that design has had the wrong design inputs.
• 19:20
  SPEAKER_00: If we just build for this shift and assume instead that everybody engaging with healthcare is doing so from a state of hypervigilance, it shifts what expectations we place on those key stakeholders.
• 19:32
  SPEAKER_00: It changes how we can expect people to engage and problem solve and exercise their agency as a part of that.
• 19:39
  SPEAKER_00: And if we can design for that, I actually am of the belief that all the work that we've done can actually have a much bigger impact than it has or that it would otherwise.
• 19:52
  SPEAKER_00: And all it does, and and funny enough, the the way we shift that is actually we can we can look at things in in trauma recovery as a guide map and a framework for us to think about how we move forward with that difference.
• 20:05
  SPEAKER_00: So rather than just assuming people don't have access to executive functioning, for example, what we can do instead is proactively anticipate that frame of mind and build for psychological safety before we ask for engagement.
• 20:20
  SPEAKER_00: And in trauma recovery, if we begin with building for that psychological safety through validation, confirming that you know what you're experiencing is in fact challenging, what you're going through is hard, and recognizing that we're not going to ask anything of anybody.
• 20:34
  SPEAKER_00: We're not gonna expect them to click a button, we're not gonna expect them to remember a password.
• 20:40
  SPEAKER_00: Before we ask any of that, we have to build for psychological safety.
• 20:43
  SPEAKER_00: And that does mean that we have to be thinking more integratively in the work that we're doing.
• 20:48
  SPEAKER_00: Technology cannot be isolated from the physical space of care.
• 20:52
  SPEAKER_00: They have to be integral to one another.
• 20:54
  SPEAKER_00: Your physical environment is something that can create psychological safety.
• 20:58
  SPEAKER_00: There's ways we can build spaces that elicit that type of environment and that experience.
• 21:03
  SPEAKER_00: And I believe the future of patient experience can be anchored in a way that supports agency by acknowledging the human experience and the real nervous system realities that every single person carries with them.
• 21:15
  SPEAKER_02: So it's interesting as I think back to all my surgery days and the trauma response I probably was having at that time.
• 21:21
  SPEAKER_02: Um, you know, when we think about the trauma of being a caregiver, the trauma of being nurses, doctors, and people working in a hospital as well.
• 21:29
  SPEAKER_02: I wonder how we might design with that in mind for the workers in healthcare.
• 21:34
  SPEAKER_02: What do you think about that one, Chris?
• 21:37
  SPEAKER_02: Oh, it's a great one.
• 21:39
  SPEAKER_02: Um it's not easy work.
• 21:42
  SPEAKER_02: I mean, the folks who get through COVID, it's amazing that they're still going, you know?
• 21:47
  SPEAKER_01: But some of them are coming back around as patients and uh integrating back in with us because of the trauma of those events, right?
• 21:58
  SPEAKER_01: It and I go back to I call it like My soapbox, it's the unique dichotomy of the industry, right?
• 22:05
  SPEAKER_01: Like we're working our workers to death, they become patients, they're trying to fix everything that's in their public domain and in their city and all that.
• 22:18
  SPEAKER_01: Like, and at the same time, when you're in there as a patient, you're not divulging everything, too.
• 22:26
  SPEAKER_01: Like, to your own point, Erica, like somebody's what's in their bank account and what's in their fridge are sitting in their brain and has an impact on how they're answering questions or even not answering questions.
• 22:38
  SPEAKER_01: So let's go to like my product design skills.
• 22:41
  SPEAKER_01: We're designing everything for the 80% workflow.
• 22:45
  SPEAKER_01: What happened to the rest of the 20%?
• 22:46
  SPEAKER_01: What happened to that edge 1% use case that's not supposed to happen?
• 22:50
  SPEAKER_01: But how is the system supposed to react?
• 22:54
  SPEAKER_02: Now I would argue that we're actually designing not for the right 80% either.
• 22:58
  SPEAKER_02: We're usually designing for an early 30s white male, college educated, has a cell phone, has a researcher basically.
• 23:08
  SPEAKER_02: Exactly.
• 23:08
  SPEAKER_02: And that's not the right patient.
• 23:10
  SPEAKER_02: That maybe is the third at absolute most.
• 23:12
  SPEAKER_02: And so our 80% is actually speed pretty well.
• 23:15
  SPEAKER_01: Correct.
• 23:15
  SPEAKER_01: And now we're at the point of having machine learning and AI at our fingertips that's looking at all the past, even clinical research.
• 23:22
  SPEAKER_01: And it's at least exposing, like, look at all the women really now talking about like menopause and everything that they would kind of like different than all the years prior.
• 23:33
  SPEAKER_01: And that's because a lot of research was always done on a white 20-year-old male.
• 23:40
  SPEAKER_01: That's true.
• 23:41
  SPEAKER_01: So oh my goodness.
• 23:43
  SPEAKER_01: Yeah.
• 23:44
  SPEAKER_01: How do you design for the physicians and everything?
• 23:49
  SPEAKER_01: A camera and a voice recorder.
• 23:51
  SPEAKER_01: That's it.
• 23:51
  SPEAKER_01: Because I mean, like ultimately, we have, like I said, it is still the people and the processes, ultimately.
• 23:58
  SPEAKER_01: It's where it lies, and that's where the agency is.
• 24:01
  SPEAKER_01: Technology exists to go do things for us.
• 24:04
  SPEAKER_01: And if you would stick a video camera in that room and a recorder and just let people be people, you're gonna get everything that was said, and you're gonna get visually everything that wasn't said, and little nuances and psychological cues to maybe help coach people to even dive deeper.
• 24:19
  SPEAKER_01: It's like, oh man, I didn't ask that question during that one interview.
• 24:23
  SPEAKER_01: Maybe I should have.
• 24:24
  SPEAKER_01: Maybe I didn't ask if that person actually had a bed to sleep in.
• 24:29
  SPEAKER_01: Maybe I didn't ask, like, what are the other kids in your family like?
• 24:35
  SPEAKER_01: Because, yes, you you're taking home an infant that needs extra special care.
• 24:40
  SPEAKER_01: But are there other kids at home?
• 24:42
  SPEAKER_01: What are their lives like?
• 24:43
  SPEAKER_01: Do you need extra help?
• 24:44
  SPEAKER_01: Can you afford extra help?
• 24:47
  SPEAKER_01: It's just multi-layered, multifaceted.
• 24:50
  SPEAKER_01: Uh it's hard to design for, but I go back to that.
• 24:59
  SPEAKER_01: Yes, agency needs to be there.
• 25:02
  SPEAKER_01: And I think what you okay, okay.
• 25:08
  SPEAKER_01: We can go on this tangent here.
• 25:10
  SPEAKER_01: All right.
• 25:11
  SPEAKER_01: I'm kind of also of the uh belief, especially with AI now, that we're gonna enter this realm of where software in SaaS is really going to change.
• 25:22
  SPEAKER_01: Because that is important.
• 25:23
  SPEAKER_01: Absolutely, already has.
• 25:25
  SPEAKER_01: But I believe that the user experience layer is actually gonna become dynamic, meaning you're never gonna double-click on Excel again.
• 25:33
  SPEAKER_01: You're gonna talk to a computer, integrate with it somehow, and it's gonna serve up a UX experience on the fly.
• 25:42
  SPEAKER_01: So if you take a concept like that and what we're entering into from a technological standpoint, I would think it should afford us to have greater agency to make the technology do whatever it is we need or to prompt us in a fashion based off of prior research and prior data and prior video training to nudge somebody to maybe do something that they did they forgot or a question that they forgot to ask.
• 26:10
  SPEAKER_02: I'll shut up for that.
• 26:12
  SPEAKER_02: Tech is absolutely the easy part.
• 26:14
  SPEAKER_02: Yeah, I'm gonna bring this back to Erica.
• 26:16
  SPEAKER_02: Erica, let's think about a less technical intervention.
• 26:21
  SPEAKER_02: So, August Artist gives hospitalized kids window crayons.
• 26:25
  SPEAKER_02: Crayons.
• 26:26
  SPEAKER_02: Not digital, crayons.
• 26:29
  SPEAKER_02: Tell me about that.
• 26:30
  SPEAKER_02: And what did you see that told you this was the intervention needed?
• 26:35
  SPEAKER_02: Not some technical who knows what, but crayons.
• 26:40
  SPEAKER_00: There was one kiddo on my son's oncology floor that I always come back to, this story.
• 26:45
  SPEAKER_00: Um I just think it illustrates this concept so beautifully.
• 26:49
  SPEAKER_00: This child was on the oncology floor, uh, was preparing for two weeks of NPO, meaning they can't take anything by mouth.
• 26:57
  SPEAKER_00: So they're getting nutrition another way, either TPN via IV or they're doing some sort of NG tube, G tube nutrition.
• 27:05
  SPEAKER_00: Can't do anything by mouth.
• 27:07
  SPEAKER_00: Um they, I think, were battling a digestive GI tumor cancer type.
• 27:13
  SPEAKER_00: Um, I don't remember exactly which one.
• 27:15
  SPEAKER_00: But this kiddo, as they were preparing for this two weeks of NPO, was determined to eat a ton of cookies as soon as he could get food back in his mouth.
• 27:26
  SPEAKER_02: I love this guy.
• 27:27
  SPEAKER_00: He's like, I just want a giant pile of chocolate chip cookies and I'm gonna stuff my face like cookie monster.
• 27:33
  SPEAKER_00: This kiddo was, I think, even just like one room away from my son at the time.
• 27:38
  SPEAKER_00: And you'll see this in children's hospitals across the country.
• 27:41
  SPEAKER_00: You'll see pictures on the windows because it's a a way to personalize the space.
• 27:46
  SPEAKER_00: Um, and a lot of the clinical teams actually embrace a lot of the activity as well.
• 27:50
  SPEAKER_00: It's not necessarily family driven.
• 27:52
  SPEAKER_00: Um, but even the clinical teams will draw pictures for their patients, especially if ratios are a little more flexible at night or um there's more text available, they'll go and color pictures on the windows and maybe for a patient that they're caring for.
• 28:05
  SPEAKER_00: Well, this kiddo wanted a picture of Cookie Monster on his window.
• 28:09
  SPEAKER_00: And so overnight, two or three o'clock in the morning, I drew a picture of Cookie Monster so he could wake up the next morning and have this cool cookie monster there on his window, reminding him that as soon as he got through that two weeks of NPO, he could stuff his face full of cookies.
• 28:23
  SPEAKER_00: Now, nobody's measuring the clinical value of that experience, right?
• 28:29
  SPEAKER_00: No one's saying, oh, you know, how many of you have to do that?
• 28:31
  SPEAKER_02: I would love to do an N equals 5,000 of Cookie Monster pictures because I'm here for this.
• 28:36
  SPEAKER_02: Let's just do it, right?
• 28:37
  SPEAKER_00: Like, like what's possible with you know inspirational visuals that can help people meet the clinical expectations that they have to have, right?
• 28:46
  SPEAKER_00: It was important clinically that this kiddo was NPO for two weeks.
• 28:49
  SPEAKER_00: We know that he was given that directive.
• 28:51
  SPEAKER_00: His adherence to that was also meaningful.
• 28:53
  SPEAKER_00: We know that that is a measure that we were trying to ensure from a clinician's perspective and even a reimbursement perspective.
• 29:01
  SPEAKER_00: If you want to get into the policy and administrative side of it, so it was important that he adhere to that.
• 29:06
  SPEAKER_00: How do you not just tell a kid that that's what he has to do and he has to get over it?
• 29:12
  SPEAKER_00: You have to meet them in that experience, right?
• 29:14
  SPEAKER_00: You have to see what's gonna motivate them.
• 29:17
  SPEAKER_00: Well, he's clearly goal-oriented, he had a vision in mind, he had a reward in insight.
• 29:24
  SPEAKER_00: So the picture, all it did was reinforce that thing that was allowing him to engage with that clinical expectation.
• 29:32
  SPEAKER_00: We know that there's value of that.
• 29:34
  SPEAKER_00: Now we're not measuring that today, but just because we're not measuring it doesn't mean it wasn't valuable.
• 29:40
  SPEAKER_00: And so what Argus Artist does is it recognizes that there is value in that.
• 29:45
  SPEAKER_00: And that the families, you know, especially in oncology where you have a lot of isolation protocols, you have a lot of kiddos that that don't have, frankly, the energy to even leave their room.
• 29:55
  SPEAKER_00: Um, if they do, they might step into the hallway.
• 29:58
  SPEAKER_00: And that's the vision change that they get for weeks on end in some cases.
• 30:03
  SPEAKER_00: That's the perspective change that they get.
• 30:06
  SPEAKER_00: Being able to step outside the room and see artwork that inspires them or elicits some sort of emotional response that meets them in that experience is incredibly powerful.
• 30:17
  SPEAKER_00: And if that kiddo can even walk down the hallway, it gives them something to look at than a bunch of blank outdoors.
• 30:24
  SPEAKER_00: It allows them to walk to the coffee machine that their mom or dad goes to every day, every morning before their conference call and allows them to walk to that coffee machine and see five or six pictures of their favorite characters or inspirational images that they can be excited by.
• 30:41
  SPEAKER_00: And that excitement also we know has value.
• 30:44
  SPEAKER_00: Being able to be calm and secure and engaged holds value.
• 30:50
  SPEAKER_00: It allows them to have agency in what's happening to them.
• 30:54
  SPEAKER_00: Even if they can't exercise that completely.
• 30:57
  SPEAKER_00: Right.
• 30:57
  SPEAKER_00: And so what August Artist does beyond just donates the window crayons and makes that experience available is we also commemorate the artwork that the kiddos have.
• 31:04
  SPEAKER_00: So when they get discharged, one of the things that can be really disorienting is, oh my gosh, I just spent three weeks in the hospital and I have no idea what just happened.
• 31:13
  SPEAKER_00: But you can't bring a lot of things home with you from that space.
• 31:16
  SPEAKER_00: And there's not a lot of ways you can personalize that space enough to actually like reintegrate at home very easily.
• 31:22
  SPEAKER_00: It's a hard process to go through because you're not just dealing with the trauma of a diagnosis, you're dealing with the trauma of an experience in a foreign space in a space that likely caused pain and harm and memories of pain and discomfort.
• 31:34
  SPEAKER_00: And maybe even just like psychological distress, watching your parents be really disturbed about what was going on and witnessing that and feeling that energy.
• 31:42
  SPEAKER_00: So they go home and being able to bring with them something that was a fixture in their visual memory of that space that maybe brought them comfort and joy can be incredibly powerful for trauma recovery.
• 31:55
  SPEAKER_00: It validates that what they experienced in that space was in fact real and that they can reintegrate more easily when they're home, recognizing that, hey, that thing did happen and now I'm creating my new normal from that.
• 32:09
  SPEAKER_02: That's interesting.
• 32:10
  SPEAKER_02: You know, Chris, on the product and design side, I'm thinking through decades of work here on product, and I'm thinking to myself, well, perhaps the instinct to digitize is actually a disease.
• 32:24
  SPEAKER_02: So when we think about our sassy lives here, Chris, it's like, oh, we have a problem.
• 32:30
  SPEAKER_02: Well, how can we make that sassy, right?
• 32:32
  SPEAKER_02: Um, how can we make a platform for this?
• 32:35
  SPEAKER_02: What do you think about some things should not be digitized?
• 32:40
  SPEAKER_02: And what's the instinct to do that from a product perspective?
• 32:43
  SPEAKER_02: Because it's tough because we're selling technology.
• 32:46
  SPEAKER_02: So leaving something outside of that can be difficult for the business.
• 32:50
  SPEAKER_02: But how can we decide what not to digitize?
• 32:56
  SPEAKER_01: I think we need to go back in business, and it should be the three of us.
• 33:00
  SPEAKER_01: We will sell pieces of paper, pens, and crayons.
• 33:06
  SPEAKER_01: Let's common sense.
• 33:08
  SPEAKER_02: Can we please sell some common sense?
• 33:10
  SPEAKER_02: Because I think there's a huge market for it right now.
• 33:13
  SPEAKER_01: Let's go resell all the downtime forms to the hospitals because asterisk, there's some of them that are not prepared for downtime right now.
• 33:21
  SPEAKER_02: I would agree with that.
• 33:22
  SPEAKER_01: Um so where you got me going?
• 33:25
  SPEAKER_01: You know, my brain can go on all these rabbit trails.
• 33:30
  SPEAKER_00: They're called side quests, Chris.
• 33:32
  SPEAKER_01: There's a million side quests.
• 33:34
  SPEAKER_00: There is.
• 33:35
  SPEAKER_01: So let's talk about the resurgence of vinyl records.
• 33:41
  SPEAKER_01: Okay.
• 33:42
  SPEAKER_01: I think this feeds into what you're talking about.
• 33:44
  SPEAKER_01: Now, I do have a record player over here on the side.
• 33:47
  SPEAKER_01: I'm old enough to be an original kid with them.
• 33:51
  SPEAKER_01: And um part of it's digitized.
• 33:54
  SPEAKER_01: I've got this little Bluetooth thing, so it pipes into speakers without the chords.
• 33:58
  SPEAKER_01: However, the latest thing I saw, my oldest daughter's into these little tiny things, tiny mates, or I don't know, it's like making the world more miniature.
• 34:12
  SPEAKER_01: And the latest thing I saw in a Target store was an actual little mini record player that had a Bruno Mars song on it.
• 34:23
  SPEAKER_01: So it was like a teaser to my eight-year-old daughter about a record player, and she could buy more oh, mini brands.
• 34:31
  SPEAKER_01: She could buy more mini brands, albums, and they're albums of today's artist, but they're miniature, and she puts them on this little like vinyl record player, and it plays music.
• 34:42
  SPEAKER_01: And there's plenty of talk and about like AI and ML isn't bad, and it is speeding things up, and this is a wild time right now.
• 34:58
  SPEAKER_01: But if anything, what is going to inevitably and intrinsically show is the importance of agency and human-to-human contact.
• 35:10
  SPEAKER_01: Because what's gonna become a commodity is our experience.
• 35:15
  SPEAKER_01: People are paying high dollars to go have coffee with people, to have a human.
• 35:20
  SPEAKER_02: I'm available, just show anyone who's listening.
• 35:22
  SPEAKER_02: I'm very available about compensating coffee.
• 35:25
  SPEAKER_02: If you want coffee with all three of us, or for the right price, all three of us will be there for coffee, and we're here for it.
• 35:31
  SPEAKER_01: And we'll equip you with downtime forms and pens.
• 35:33
  SPEAKER_01: Um coffee.
• 35:35
  SPEAKER_02: I got you guys, we're good.
• 35:37
  SPEAKER_01: But uh yeah, like the dog walking experiences, people walking, like it is becoming more, I think the offline is going to be the commodity.
• 35:49
  SPEAKER_01: And so, like, go back to my thought of a video camera and a listening device.
• 35:56
  SPEAKER_01: Make it as minuscule as possible and repush the human experience because there is enough technology to take care of the stuff it needs to take care of to get reimbursed, to meet all of your CMS policy measures and everything you have to test to.
• 36:15
  SPEAKER_01: I don't know.
• 36:18
  SPEAKER_02: So we're gonna wrap up here shortly, but I want to make sure I ask several questions for both of you.
• 36:24
  SPEAKER_02: So I'm gonna start with Erica.
• 36:27
  SPEAKER_02: Erica, what do you think is the single accountability gap in healthcare technology right now that nobody in the vendor room is willing to own?
• 36:36
  SPEAKER_00: Ooh, accountability gap, what do you mean by that?
• 36:38
  SPEAKER_02: So where's the gap in the system that we all still pretend doesn't exist?
• 36:42
  SPEAKER_02: And again, that can be from your perspective, from the vendors, the providers, the system in general, payers, whatever it is.
• 36:48
  SPEAKER_02: Where is this gap?
• 36:50
  SPEAKER_00: So we've we've circled the wagons on this concept, this conversation, but I have a name for something I want to introduce to you guys.
• 36:56
  SPEAKER_00: And this is the concept of determinants of agency.
• 37:00
  SPEAKER_00: They are the variables and factors that influence our ability to exercise agency and engage in our care and exercise decision making that comes with that.
• 37:08
  SPEAKER_00: We know there's clinical value for people exercising agency and correlating to better health outcomes.
• 37:14
  SPEAKER_00: If the industry is going to be accountable and move towards a value-based care model whenever that happens, if it's truly gonna be pervasive, we have to embrace agency as a design principle for that work.
• 37:26
  SPEAKER_00: The nervous system state I mentioned earlier is one example of that.
• 37:29
  SPEAKER_00: It might be, like you mentioned, Chris, it might be the amount of money someone has in their bank account and that influence that has on when they decide to have a surgery, for example, that they know they need.
• 37:40
  SPEAKER_00: It's gonna impact their quality of life.
• 37:43
  SPEAKER_00: But they might be putting it off because they know it's gonna cost too much money and they need to make sure their kids have food on the table in the meantime.
• 37:51
  SPEAKER_00: Those determinants of agency, I think, are a big blind spot for vendors today.
• 37:55
  SPEAKER_00: If we can identify what those are, which funny enough, if we listen to lived experience with intention and we don't abstract that lived experience down to a persona or archetype, and we actually retain the humanity of that lived experience as much as possible, it reveals what those determinants of agency are.
• 38:15
  SPEAKER_00: And if we design for those proactively, I'm of the opinion that it can drive value in ways that are unimaginable with the infrastructure and work we've already built.
• 38:24
  SPEAKER_02: I like it.
• 38:25
  SPEAKER_02: So, Chris, same question.
• 38:27
  SPEAKER_02: What's the single accountability gap in healthcare technology, if you want to mention that one or otherwise in the system?
• 38:33
  SPEAKER_02: The one that the vendor room is not willing to own.
• 38:36
  SPEAKER_02: No one wants to take it.
• 38:41
  SPEAKER_01: My brain here lately has been on how much we have platformized and SASIfied healthcare.
• 38:51
  SPEAKER_01: And if you think about it, uh most of the systems they've outsourced almost everything to platforms and SaaS and cloud.
• 39:00
  SPEAKER_01: And there isn't much space for them to do AI and ML on their own.
• 39:06
  SPEAKER_01: So it's being happened, it's happening to them.
• 39:10
  SPEAKER_01: And I'm kind of tired of the word governance.
• 39:14
  SPEAKER_01: I think it's a new four-letter word.
• 39:17
  SPEAKER_01: I think it's kind of a sham.
• 39:19
  SPEAKER_01: How can you govern something sitting in another vendor's system that they're doing to you?
• 39:27
  SPEAKER_01: It's their agents and it's getting integrated into your system.
• 39:30
  SPEAKER_01: It's gonna go talk to some other platforms agents, gonna do something.
• 39:34
  SPEAKER_01: They're off running around doing stuff you don't even know about.
• 39:37
  SPEAKER_01: How do you govern that?
• 39:39
  SPEAKER_01: That was the contract that you signed.
• 39:42
  SPEAKER_01: But sometimes in those T's and C's right now, it's finger pointing because they're wanting everything to come back on the health system and the physicians and the nurses and everybody sitting around the table.
• 39:56
  SPEAKER_01: But like, you don't know the LLM that that was built on.
• 40:03
  SPEAKER_01: Who wrote that code, who set all of that up, and even their own agency and how they felt in writing it?
• 40:10
  SPEAKER_01: Let's go back and talk about the people at the keyboards, starting from scratch, doing that, and any of their predetermined like thoughts and opinions on people in this world and how they might have coded something that therefore is now running amuck and doing all this automation and uh predeterministic thinking, making decisions for you.
• 40:32
  SPEAKER_02: It's an interesting thought process.
• 40:34
  SPEAKER_00: So, Chris, rather than scrapping governance, I'd love to redefine it instead.
• 40:39
  SPEAKER_00: What if governance is actually the mechanism in which we return value back to the patients and caregivers that inspire the work that we build?
• 40:49
  SPEAKER_00: And it's a commitment we have to make, right?
• 40:51
  SPEAKER_00: Vendors have to say, I am going to bring value back to whoever gave me the direction to go build this product or service.
• 40:59
  SPEAKER_02: So value recovery.
• 41:00
  SPEAKER_00: Absolutely.
• 41:01
  SPEAKER_00: They have to bring it back.
• 41:02
  SPEAKER_00: And we have to acknowledge, otherwise, if we don't do this, right, and we say lived experience is important, let's go interview a bunch of patients and caregivers about what we need to build and um see what they say, right?
• 41:12
  SPEAKER_00: And then we go and run and build it with their direction.
• 41:15
  SPEAKER_00: If we never return value back to them, we're effectively valuing their insights at zero.
• 41:22
  SPEAKER_00: And is that really what we want to have happen?
• 41:25
  SPEAKER_00: No, of course not.
• 41:26
  SPEAKER_00: Right?
• 41:27
  SPEAKER_00: The byproduct of the experience of our product or service is not substantial value to the patient or caregiver who's going to experience it.
• 41:35
  SPEAKER_00: They still have contributed something of economic value that deserves to be returned to them.
• 41:40
  SPEAKER_00: And so I'd love to see vendors think differently about that governance function, that it can actually be a mechanism for how they are committing that return of value back to the patients and caregivers that are inspiring the products and services that they're building.
• 41:54
  SPEAKER_02: So I love that.
• 41:55
  SPEAKER_02: I think for me, when I think about the accountability gap there, one thing, and again, I've seen some health systems do this, but not many, is I really think that the gap is they pretend that that community around their system doesn't exist.
• 42:09
  SPEAKER_02: You know, like you said, how are we bringing value back to our community?
• 42:13
  SPEAKER_02: Is it because everyone's starving and we're on Medicaid and and and are we helping that community in ways for food security, childcare, all these pieces?
• 42:25
  SPEAKER_02: And I think a lot of systems, first of all, are like, well, that's not our job or that's not our mission.
• 42:31
  SPEAKER_02: And again, well, where does your mission end and begin?
• 42:34
  SPEAKER_02: Where does your vision uh begin and end?
• 42:37
  SPEAKER_02: And from a technology vendor perspective, again, difficult because incentives are such that they are incentivized to sell their stuff, right?
• 42:48
  SPEAKER_02: But I love what you're saying about that, Erica.
• 42:50
  SPEAKER_02: How can we, from a technology business perspective, gain incentives from actually helping the community and the patients for real?
• 42:59
  SPEAKER_02: Um, and I think that's the trick.
• 43:01
  SPEAKER_02: How could we assist delivery systems in providing for their communities and clearly providing value back to patients in ways that hit the bottom line a positive way, hit all the heartstrings in a positive way, and actually hit patients properly, not just aspirationally?
• 43:19
  SPEAKER_00: Yeah, I think a big part of this problem is that we haven't been measuring that today.
• 43:24
  SPEAKER_00: But we're at this really interesting inflection point with technology, right?
• 43:28
  SPEAKER_00: AI is going to create the opportunity for us to be able to measure things that have been immeasurable to this point.
• 43:35
  SPEAKER_00: And so as we look forward, you know, not only is what scaling going to be contributed to AI, but also what we measure is now available with this technology in an unprecedented way.
• 43:46
  SPEAKER_00: So we need to be thinking differently about the impact of our products and services and the way that they might impact food scarcity, to your point, or caregiver burden, for example.
• 43:56
  SPEAKER_00: I see, you know, palliative care and hospice is a great example of this.
• 44:00
  SPEAKER_00: Or complex care, especially with pediatrics, right?
• 44:03
  SPEAKER_00: If your patient has survivorship, but the caregiver winds up with a massively costly chronic illness and mental health issues as a result of that caregiver burden, but it's not measured, obviously attributable to the diagnosis of that child.
• 44:19
  SPEAKER_00: Were we really that successful if that kid survives and the caregiver falls apart?
• 44:23
  SPEAKER_02: I guess it depends.
• 44:24
  SPEAKER_02: If it's a pediatric hospital, the hospital did great from a pediatric's perspective, but maybe not from an adult perspective, right?
• 44:31
  SPEAKER_00: Correct.
• 44:31
  SPEAKER_00: But that cost becomes a social cost either way.
• 44:34
  SPEAKER_00: It just depends on who's measuring it.
• 44:37
  SPEAKER_00: And so I'm I'm I'm optimistic.
• 44:39
  SPEAKER_00: I think we're we're at a really interesting inflection point, and we've got people passionate and thinking the right way around these things.
• 44:46
  SPEAKER_00: We just need to be bold and brave enough to go do it.
• 44:49
  SPEAKER_02: All right.
• 44:49
  SPEAKER_02: Last lightning quick question for both of you.
• 44:52
  SPEAKER_02: Chris, you're going first this time.
• 44:54
  SPEAKER_02: If you could change one thing about how health systems talk to caregivers, not the policy, not the product, not not any of that.
• 45:02
  SPEAKER_02: The actual conversation for you, Chris, what do you think it would be?
• 45:06
  SPEAKER_01: Oh goodness.
• 45:07
  SPEAKER_01: Recognize them as a true human being and what is happening in their life, in their agency, and what could be surrounding them because it's going to impact how they show up every day to their job and how they reflect upon you in the community.
• 45:23
  SPEAKER_02: And what about you, Erica?
• 45:25
  SPEAKER_02: What's one thing you would change about how health systems talk to caregivers?
• 45:29
  SPEAKER_00: The caregiver experience is the patient experience.
• 45:33
  SPEAKER_02: I love that.
• 45:34
  SPEAKER_02: I'm thinking through right now the patients I've seen recently.
• 45:37
  SPEAKER_02: And again, I don't do kids, thank goodness for that.
• 45:39
  SPEAKER_02: But there's so many adults with caregivers that come to my office, and it's so intertwined.
• 45:45
  SPEAKER_02: And it's different than parent-child.
• 45:48
  SPEAKER_02: It's brother-sister, mom and dad, you know, spouse, etc.
• 45:52
  SPEAKER_02: And there's lots of different configurations of this that are very interesting.
• 45:58
  SPEAKER_02: Well, Erica, I'm gonna let you have the last word.
• 46:02
  SPEAKER_02: And I know that you're a caregiver.
• 46:04
  SPEAKER_02: I know you've been in the middle of it.
• 46:06
  SPEAKER_02: For the caregivers out there who are feeling like they're holding everything alone, what do you want them to hear?
• 46:16
  SPEAKER_00: You have people in your corner in healthcare today that are trying to make this better for you.
• 46:22
  SPEAKER_00: And your perspective and your experience is as important as the patient that you're caring for.
• 46:28
  SPEAKER_00: And we're listening, and we want to build from that experience something that's really meaningful and serves you.
• 46:35
  SPEAKER_02: Chris, Erica, thank you so much.
• 46:37
  SPEAKER_02: That was the conversation I was hoping for.
• 46:39
  SPEAKER_02: Um, and here's what I'm taking out of the room.
• 46:42
  SPEAKER_02: You know, Chris spent her career in the rooms where healthcare decides what to buy.
• 46:45
  SPEAKER_02: Erica spent hers in the room at three in the morning where those decisions actually land.
• 46:50
  SPEAKER_02: And the distance between those two rooms, it's not just a communication problem.
• 46:54
  SPEAKER_02: It's a design problem.
• 46:55
  SPEAKER_02: And that means it's fixable.
• 46:57
  SPEAKER_02: And unfortunately, almost no one's really working on it right now.
• 47:00
  SPEAKER_02: So before we leave, Erica, how can people get in touch with you?
• 47:04
  SPEAKER_00: LinkedIn's the best way.
• 47:05
  SPEAKER_00: That's a great one.
• 47:06
  SPEAKER_00: Uh, LinkedIn, you can find me on LinkedIn, Erica Olenski.
• 47:09
  SPEAKER_00: Fun story.
• 47:10
  SPEAKER_00: There's only one of me in the world.
• 47:12
  SPEAKER_00: So it should be easy enough to find.
• 47:14
  SPEAKER_00: Um, if you're interested in the work that I do, though as well, you can find my firm Monarch Futures um online at monarchfutures.com.
• 47:22
  SPEAKER_01: And what about you, Chris?
• 47:23
  SPEAKER_01: How can people get in contact with you?
• 47:25
  SPEAKER_01: LinkedIn as well is the best way.
• 47:27
  SPEAKER_01: I think I might be the only Chris Nessa, but who knows?
• 47:30
  SPEAKER_02: I like it.
• 47:32
  SPEAKER_02: So I'm Dr.
• 47:32
  SPEAKER_02: Sarah Matt.
• 47:33
  SPEAKER_02: This is a clinical realist, where we take healthcare's most confident promises and ask what actually happens at the bedside.
• 47:39
  SPEAKER_02: So follow the show wherever you listen.
• 47:41
  SPEAKER_02: And if this one landed, don't just like it.
• 47:43
  SPEAKER_02: Send it to the person you were thinking about while it played.
• 47:45
  SPEAKER_02: They're probably the one holding everything.
• 47:46
  SPEAKER_02: So we'll see you next week.