[00:00:00] Dan: Hello and welcome back to We Not Me, the podcast where we explore how humans connect to get stuff done together. I'm Dan Hammond

[00:00:13] Pia: And I am Pia Lee

[00:00:14] Dan: And I think Pia Lee might be in Melbourne again. Are you on your

[00:00:19] Pia: I am, I'm actually next to an open range zoo actually, where I'm staying, which is quite fun. So in the middle of the sort of Victorian countryside is an open range zoo. There's, there's rhinos and giraffes on the outskirts of where I'm staying, which is quite

[00:00:35] Dan: Have you been working so hard? You're hallucinating, or is this actually reality?

[00:00:39] Pia: been been sprinkling some strange dust over the salad.

[00:00:43] Dan: I, I just harvested some mushrooms. Yeah, exactly.

[00:00:48] Pia: No, this is, no, this is quite, I, I've actually, we've actually worked with clients in the past here, done, done morning walks with the lion across past the, the lion lions den. They are locked up, but it, it is, it's quite an amazing place, quite a unique place. Some of these open range zoos.

[00:01:05] Dan: Yeah. If the, you sort of think if it is completely open range. You think they, they, they're in a safari park too, aren't they? So, oh, look, that's interesting. Humans.

[00:01:17] Pia: oh. Still reminds me of the ones that we used to do as a child where the baboons went on your car and tried to take the windscreen wipers

[00:01:23] Dan: Oh, classic stuff. The, the saf, the Safari Park. Absolute gold. Gold.

[00:01:30] Pia: My dad used to try and time it so that he got the, the jet of water to sort of just give them a surprise and then they'd try and actually pull the whole thing off. You'd draw with laughter as a family? No. Yeah, no devices. It was all, you know, it was,

[00:01:46] Dan: that's it. That was it. That was, that was just, just, yeah. It's squirting the boons. That was, that was all you had in those days. Yeah. Yeah. Well, I've had a, I've had a

[00:01:54] Pia: Yeah. You are working with your brother.

[00:01:56] Dan: I am. I have been doing a little bit when he, when I, I met him, uh, in London for lunch and he said that we're trying to sort of do some work with the team and the practice and um, and I've actually done a, a Squadify with them before, but he said he really wanted to, they had a young team and he really wanted him and, um, he and his wife who, who works in the practice as well and really leads on this stuff. Um, wanted to be more patient-centric, so how could they make the team, how do an exercise in a, to sort of help the team to be patient-centric.

[00:02:27] So yeah, we're doing a bit of work with them, which is fabulous and it'll be very interesting to see much needed, I think, across the, uh, across the primary care network.

[00:02:35] Pia: And the primary care network. , certainly in the UK and as we're gonna talk about in the US, under extreme pressure, it was almost pres unprecedented times, because the needs have increased. But the, the ability to supply is under huge pressure. And that puts, that, puts a lot of tension on the people that are in it. And that, that, that's a big reason why we really wanted to speak to Dr. Tim Arnold. Who, who, who? We won't call Dr. Tim

[00:03:04] Dan: No, exactly. For reasons that will become clear. And Liz Dean, who's a great friend of ours and a team whisperer of the first order, both from Minnesota, um, which is buried under snow at the moment. So they, uh, they joined us from their warmed homes to talk to us about life in primary care and t exactly. The furnace was, was igniting just before we spoke to Tim and Liz. So let's hear, uh, that conversation now.

[00:03:29] 

[00:03:32] Dan: Tim and Liz, thank you so much for being with us on the show. It's great to have you here.

[00:03:37] Tim: Thank.

[00:03:38] Liz: Thank you Dan and Pia for having us.

[00:03:40] Dan: We're really looking forward to hearing well more about, well, a lot about healthcare in the US and the role of teams there that you've, you've both got into some depth on, so we, we can't wait, but you can't do that. Before we do the conversation starter cards, and I'm going to select a little card

[00:03:58] Pia: initiation

[00:03:59] Dan: Yeah, that's right. It's, it's, it's an easy ride after this. and your question is, oh, here we go. Is a nice one.

[00:04:07] Pia: beware when he chuckles. 

[00:04:09] Dan: I'm amazingly good at, I'm amazingly good at, what are you amazingly good at? That's a nice one. I like that one.

[00:04:17] Tim: Oh my gosh. . Liz, you have to go first on this.

[00:04:20] Liz: Wow.

[00:04:22] Dan: this is no time for modesty, Liz. Come.

[00:04:24] Liz: I'm amazingly good at empowering leaders and teams to be their best self.

[00:04:33] Tim: So I'm, I'm gonna go off, uh, off the business side. I'm gonna say I'm amazingly good at baking bread.

[00:04:38] Dan: Are you really? 

[00:04:40] Tim: Well, it, it's actually just one kinda bread. Uh, it's a challah bread. It's a Jewish egg bread, and it's, uh, absolutely fantastic. Love it. Uh, Kenny, too much of it. It adds on the weight kind of fast if you do, but it's, uh, it's fantastic. 

[00:04:54] Dan: It's a be, it's a beautiful looking bread as well. So you, you making that is probably not that easy I suspect.

[00:05:01] Tim: Correct. It's a, it's a braided loaf, uh, kind of that fancy looking braided loaf that you'll see sometimes in a bakery.

[00:05:07] Dan: light. Beautiful. Yes,

[00:05:08] Pia: Well, as it's breakfast time here in, in my part of the world that that's, that's, that's really got the juices going, so that, that's fantastic. 

[00:05:17] So, um, so we are in three different corners of the world recording this, so, I'm Dan here in Australia. Dan's up in the UK. You guys are in Minnesota. Tell us what, so give us a little bit, what's it like outside the window?

[00:05:34] Liz: It's a very typical Minnesota day. Um, beautiful white, fluffy stuff right outside our window, gray skies, so we'd like to see some sunshine, but it really is a beautiful day, fresh snowfall.

[00:05:48] Pia: Well, that sets the scene beautifully. So take us into that world.

[00:05:53] Tim: Yeah, so, uh, again, my name is Tim Arnold. I'm a family medicine physician here in, uh, Northern Minnesota. I completed my undergraduate training at, uh, a small liberal. Arts University, uh, called St. John's University and then completed my, my, uh, doctorate at the University of Minnesota. And then, uh, completed three years of residency, uh, in, uh, Duluth, Minnesota, which is a northern, uh, town in northern Minnesota. And then I have been at, uh, the facility that I work at now for 22 years. Uh, most of that time practiced really full spectrum, which meant, uh, delivering babies and taking care of patients in the I C U and working in the emergency room and clinic and hospital and, and it's really, uh, broad spectrum. 

[00:06:34] Here in Northern Minnesota we as primary care, we really do cover the waterfront. We, we, uh, um, really do almost everything, uh, simply because we don't have the specialists necessarily available to us. But it's also kind of the culture here in terms of primary care and northern, uh, the northern Midwest of the United States. That's how we basically practice medicine here. So, so that's, yeah, so that's, that's been my world.

[00:06:59] Um, In terms of talking about teams and healthcare, um, if I can bring you maybe a little bit to, um, my thoughts about healthcare, at least, uh, you know, here in the US and I realize that you have listeners all over the world, but if I could just paint a little picture so that, uh, Uh, listeners that may not necessarily be, uh, familiar with how healthcare is delivered here in the us, um, I kind of wanted to talk a little bit about, uh, sort of the macro stage of kind of how the finance and how healthcare is delivered here. And, and then with that, I think we'll, we'll get ourselves into teams really quickly in terms of some opportunities as well as some headwinds, uh, against, uh, really working as teams.

[00:07:41] And the first thing that I really thought about a lot was, How healthcare is really structured from a financial, uh, uh, picture here in the us. Um, of course we have free market economy. We have different healthcare systems that are competing against each other. . Um, and if you think about working, uh, as a large group from a macro perspective to try to deliver better care, there is some, obviously there's, um, uh, you know, that's counter to, to working together because it's a free market economy and we're, we're going to compete against each other. I think the other really important thing for your listeners to think about is sort of the financial structure of how things are, are paid for here in the US and, and it's really opaque. 

[00:08:24] Um, if you think about it, the, the consumer doesn't know what the cost is going to be and the producer doesn't really know what the cost is going to be. So as a consumer, when we enter the healthcare system, we don't know what it's gonna cost us to have a certain procedure done or a visit necessarily. It's not clear. And as a producer, uh, myself delivering that healthcare, I don't necessarily know what it's gonna cost my patient to, to see me nor to have a procedure done or a lab test or radiology. And it's not that. We don't want to know what that cost is going to be. We literally can't know what that cost is going to be. Because there's a, uh, this payer in the middle that has separate contracts with the same healthcare system for different costs.

[00:09:12] So you have this really opaque system that no one really knows what's happening. And if you think about what that sets up in terms of the ability for us to function as a high quality team to deliver that care, no one really knows what the cost is going to be. No one knows what the consequences of that's going to be. And then you layer on top of that a system where we still are primarily paid on production. 

[00:09:35] Dan: Okay. So by procedure rather than the outcome of that procedure, is that what you, is that what you mean,

[00:09:41] Tim: Yeah. So if a, if a if a patient enters the healthcare system, the healthcare system gets paid based on the widgets it produces. Okay? So the more tests we do, the more intervention we partake in, the more we essentially are paid. And if you think about that, that doesn't really lend itself, the overall structure doesn't really lend itself to then, you know, produce good high quality outcome because the outcome doesn't matter in this picture. It's really the number of times we interact with that, with that patient.

[00:10:12] Dan: It's It's fascinating, Tim, cuz in our world we, we find ourselves in conversations about incentives and goals and, uh, around teams. And of course the question we always ask is what behavior will that drive? You know, it's all about the behaviors ultimately, that the, that the sounds like there's some, you've talked a lot of, even in there's few sentences you just said, there's a lot of, uh, countervailing forces there and competing forces, it sounds like.

[00:10:39] Tim: Now that now to be said, the, there is a drive towards pay for outcome or pay for quality, however you want to do that in CMS, our, our federal system to pay for healthcare is starting to drive this outcome-based payment model. But for the large part, it still is really production-based. And if we're going to try to, to work together as a team to drive high quality, after all, that's what we really want for our patients, is to have a good outcome, there's a countervailing force there that pushes us to just, you know, episodic one and done. Don't think about the long term big picture, the more.

[00:11:15] From a healthcare provider's or a healthcare systems perspective, there isn't right now, although there's more, but there isn't a, uh, uh, forces in place to, to try to keep our patients outta the emergency room or keep them out of the hospital. Although, again, that is starting to change. But by and large,

[00:11:30] Dan: It's still there. 

[00:11:31] Um, so, so before we, let's, before we dive a bit further into how you've worked with in teams to, to sort of try to navigate in this situation, let's bring Liz in. So Liz, uh, tell us a little bit about you and then how you came to work with, with the good Dr. Arnold here.

[00:11:50] Liz: Yeah, absolutely. So I spent 20 years in the same organization where Dr. Arnold works, and had the great opportunity of really working in the space of business development and innovation. And over the past year, I left my position in the organization to venture off, uh, because I'm absolutely obsessed by helping leaders and teams be more successful, more productive, and ultimately healthier and happier. And so now I do independent work with healthcare schools and businesses, really helping leaders optimize their leadership skills. their teams and their organizations to be more successful. 

[00:12:34] As it relates to healthcare. It is absolutely an industry that is ready and in great need of support for their leaders, uh, their practitioners and their teams. It's an industry like others that is being significantly disrupted at very high speeds, and we have to figure out how to do things differently. And as Dr. Arnold alluded to, it's a system that's really. One way, um, not necessarily conducive to change and or, um, standard teamwork, but it's necessary. And so, um, I'm really honored to be able to work with leaders and teams across the country and internationally to really help them create the conditions of success to be better, to be more productive, to be innovative.

[00:13:31] Pia: Let's dive in a bit more, Tim, into where you see teamwork playing out. Where's it, where's it looking positive and where's it not looking so positive in the world that you, you exist in?

[00:13:44] Tim: As I had mentioned, There are some new sort of payment models and structures coming in that are pushing us to start to really think about this outcome-based measure. and, and I see a lot of really positive, uh, movements and changes there. And if we think about this, um, from a large macro perspective, again, there is, uh, lots of, uh, structures being set up to, to help healthcare systems actually collaborate together to make sure that we deliver high quality care to that patient, but then also on a micro level, uh, down at the individual patient encounter, there is a number of, uh, changes in terms of how things are, are structured for us to have, for example, uh, we have our end care coordinators inside of our system, and most systems do now, and those RN care coordinators, their sole job is to work as a team with the provider to make sure that we manage really complex patients, uh, on more of a day-to-day basis, uh, in a way that the providers don't have, or physicians don't have time to do. And that has been a big change.

[00:14:50] I've been in this business now for 23 years and we didn't have, uh, something like an RN care coordinator in that space. And again, they're, they're will real job is to, to work as a team with the nursing staff and with the providers to get their hands around all the needs that that patient may have. And regular communication is important. Uh, you know, all of the, the basic fundamental principles of good teamwork, uh, is in play to really keep that patient outta the emergency room out of the hospital, keep them, uh, away from some sort of exacerbation of their, of their illness that they may have.

[00:15:27] Dan: Sorry, Tim saying, what's the name of that role that you mentioned there that's bringing that to, to the patient if you like, and guiding their care? 

[00:15:34] Tim: Yeah. So in our system, we, we call them RN care coordinators. I suspect other systems may call them something different, but the basic fundamental role is to have a seasoned, um, uh, nurse, uh, typically a bachelor degree nurse who has lots of experience in healthcare, who, uh, knows how to navigate the system. And they're kind of a middle man to some, some degree between a complex patient and the healthcare system. Their job is to make sure that they, uh, are, are taking their medicines correctly. So they oftentimes will be calling them on a regular basis to check in with them and, and what's happening with their diabetes. And, uh, are you going to make it to your lab appointment next week and you've got an appointment with a cardiologist two weeks from now, or do you have all your transportation arranged? Do you have any issues there? Really trying to work as a team.

[00:16:21] And of course the patients will call them back with, uh, issues or problems and they may troubleshoot that or they may, uh, come to a provider to, uh, seek advice to translate back to the patient. And so it's, it's really much more of a team approach around taking care of complex patients. Uh, they may work with a pharmacist, they may, may work with rehab. They are sort of helping to lead that, that larger team to take care of those complex patients.

[00:16:49] And, uh, it's really, uh, and, and by the way, the data is there on that. We know that those patients cost less. We know, uh, that, uh, they have higher quality of care. And, and that's part of, uh, what, uh, CMS, our payment, federal payment system is doing, uh, something called shared savings where if we can ultimately, take care of that patient successfully with these RN care coordinators cost less, at the end of the day, we share in the savings, uh, back to the healthcare system from Medicare, Medicaid.

[00:17:17] Dan: And Liz, what do you see from the outside of these medical teams or when you've, when you know from where you are sitting, what's your observation of the, the challenge of it? Also, the solutions that are being found?

[00:17:29] Liz: Well, first I would say there's huge opportunity. We have, um, so many bright and talented willing people that want what's best. For their patients and for their organizations. And so, um, the opportunity really lies in bringing these great minds together to work better together, to really execute, um, solutions more rapidly. This meaning whether it's in patient care or out. Side of patient care, really bringing experts together across all dimensions within the organization. And I think that's where I've seen the, the most significant opportunity is when we take the patient care folks, the non-patient care folks, through all layers of the organization, really put our heads together to create, um, systems, processes, and, and execute opportunities.

[00:18:19] And, and it's when done correctly. , this happens rapidly. This happens without a lot of frustration and it's extremely rewarding and, and both Dr. Arnold and I have had that opportunity to work in a team on multiple teams that are cross-functional through the organization. And really, when you have the right elements and the right conditions and the right people, it's amazing what you can make happen in shorts amount of time, and, uh, much at much greater extent than you really ever thought possible.

[00:18:56] Dan: Um, what I'm sure what a lot of teams will be asking as they hear you talk, Liz, is what are those accelerators? What are the conditions that will help a team to really start to deliver, deliver those savings that Dr. Arnold's talking about? What, what's, um, what do you see that that makes the conditions right?

[00:19:14] Liz: Well, first and foremost, clarity. And I think the biggest opportunity I see with a lot of teams, it's, it's always surprising when you go in and work with a team. Um, there is a lack of clarity and so really having clear understanding around why we exist and, and what we're trying to accomplish, that's where I've seen, um, real acceleration take place when first and foremost we're clear. Obviously you need the right people, um, and sometimes you have the wrong people in the wrong positions, and you need to make adjustments in order to move that, that team forward. And, um, yeah, I mean, you need to have the right climate as well, right? I mean, you, you really do need to have, um, the right skills, the right people, the right environment to really move this work forward.

[00:20:03] Dan: Could I ask you both to drill into that clarity piece a little bit? Because what we hear very often from teams is, well, we don't really talk about this. It's really obvious what we're doing. Everyone knows what we're trying to achieve. And you could say that, and I'm sure in primary care, well, it's the patient and we're trying to keep cost, whatever. Where did you see in this specific example, what were the clarity gaps or areas where you really felt you had to, you know, sharpen the pencil of clarity, if you like, so that people were really on the same page.

[00:20:32] Liz: Oftentimes, it's narrowing the scope. Everybody has a little bit different idea of where they're headed, and so really first articulating among your member, among your team, what does clarity mean to you? That is really quite important because what clarity means to me might be drastically different than what clarity, um, means to Dr. Arnold on this particular team. And so really having conversations around, um, what we are trying to accomplish as a team in really sharing that information. among your team members is really critical. 

[00:21:10] And again, as I alluded to earlier, narrowing the scope because, um, you know, everybody of course has said, well, we all exist for better patient care or to move, uh, this innovative service line forward. Well, that's quite broad. And so narrowing the scope and honestly aligning timeframes is pretty important too because clear, a clear goal for the next 12 months is very different than a clear goal for what are we trying to accomplish in the next 30 to 60 days.

[00:21:41] Pia: I think that makes it easier, doesn't it? So everybody has a stake, um, in the, in the outcome, so it becomes, becomes clearer. 

[00:21:49] So, um, what are you seeing as the types of behaviors when it breaks down, when you don't have clarity?

[00:21:55] Tim: What I, I feel like I see is misunderstanding and, uh, frustration and, uh, I'm not valued. You didn't hear me. Um, those kinds of things. And if we think about what happens on the team, it, it's, you know, sort of really about the human psychology of, uh, making sure that we feel heard and listened to and important and, and our opinion matters. And, and when we don't have clarity in terms of what direction we're going, oftentimes that's misinterpreted as, well, you didn't value what I had to say cuz we're heading in a different direction, or, um, I'm not important in this process because we're not, uh, we're not doing what I, what I think we should be doing.

[00:22:35] And so I, I really think it just boils down to if you don't have good clarity, you, you just end up with that, uh, that, uh, space where people don't feel like they're valued. And what does everybody want in a. . I mean, what do you really want? When you're a part of a team, you want to be valued. If you're not valued, you're, you're not a part of the team. What do patients want when they come in? They want to be heard. They want to be known that they're important. And what do team members want? They wanna make sure that they're an important part of that team. If they're not, they're not a part of the team. It's, it's not a team.

[00:23:07] Dan: I think this is fascinating actually. You see it timing again, where actually it boils down to something quite simple and consistent that you, you, you make sure everyone's heard in your team and you make sure everyone's heard, the patient's heard outside your team. It's a, it's the same , it's the same behavior across, isn't it?

[00:23:23] I mean, um, medicine is not re is quite renowned for having a lot of, um, it's, it's for not making people safe in a team, I guess sort of hierarchies and, um, let's face it, egos and, and, you know, all of those problematic factors. Uh, Tim, without being too modest, what ha what stance have you adopted in the team to make pe, help people to feel heard and to feel valued?

[00:23:49] Tim: I think I did this poorly in the first half of my career, and I think I'm much more aware of it and cognizant of it now, uh, than I was in the past. You know, some really simple things, and I know this sounds crazy, but I, I, I ask my staff to call me. And some won't. 

[00:24:04] Pia: Do they call you Bob instead,

[00:24:06] Dan: Some, some other random name

[00:24:08] Tim: know that well some of them wanna call me Dr. Arnold again, but, uh, I.

[00:24:13] Pia: You just say Stop. Stop that.

[00:24:15] Tim: Well, and, and some of them will still kind of refuse to call me Tim, but I, I, I mean, I think that's really important. When I call staff, uh, the other parts of the hospital, like when I ring them up, I, hi, this is Tim. It's Tim Arnold. You know, this is what I'm looking for.

[00:24:27] Pia: Why is that? Because I noticed that.

[00:24:29] Tim: Don't know. I, I, I mean, I, I was raised and trained in this hierarchical system and I know that it makes people around me feel uncomfortable, and I know that it, it puts me in a different place in that relationship. And if you think about teams, we, we, we can't have unbalanced relationships, right?

[00:24:50] Those relationships have to be balanced. And if we start off the team with people calling me Dr. Arnold, which I don't always correct. And I, and I, and it isn't something that I do often, but I really try hard to do as much as I can to just, you know, call me Tim or you know, hi, this is Tim, or whatever. And I, and I'm just trying to balance that relationship a little bit, uh, to try to help people feel more comfortable so that we can work as a team that we, we everyone knows that they feel just as valued as, as everyone else. And. 

[00:25:18] Dan: is reminding me of that, um, how Korean airlines reduce their accident rate by changing the language in the cockpit to English because it has less deferential language contained in it. It's the same, it's the same thing. It created safety, uh, reduced the power gap and created more safety. So I think you are very much doing the same thing, um, to. Lives in the lives in this case.

[00:25:45] Tim: The last four or five days, uh, spent, uh, on the hospital service. So inpatient, uh, and we do something called, uh, group rounds in the morning. So our entire team goes in and sees the patient together. The goal there is to make sure that the entire team is on the same page with the patient and the family. So if you can sort of envision. Uh, marching into the, to the, uh, to the room in the hospital with the patient and the family there. And then we have myself, and we typically have a pharmacist. We have the therapy staff. We have, uh, the charge nurse, the nurse for that patient. We even, oftentimes we'll have, um, the financial staff, so our financial coordinators, and then also social services, all with us in the room, sort of standing around the patient bed. Patient feels like, a bit like they're in a fishbowl, but nevertheless, we, we all try to stand together. And, um, one of the things that I do, knowing that I'm in the position of sort of leading that team, uh, one of my goals is to always sort of at the end of that say, you know, is there anybody on the team that needs to say something? Do we have anything that we're missing? Is there anything else on the team here? And I typically go through the team members pharmacy. Do you have anything to add? How's the med med list Look, are we, are we missing anything? Um, nursing, what are we missing? You know, do you have anything to add? That kind of thing. 

[00:27:00] And so I feel like in my position that I'm in, how do I sort of break that down a little bit? Well, one of the things I can do is to actually call in everybody to voice their opinion, to make sure that everyone has their ability to, uh, speak up. And then we're all on the same page. We all know what's going on with that patient for the day. We all know what the plan is. The family knows what the plan is. The patient knows what the plan is. Everyone's on the same page. We're all heading in the same direction. 

[00:27:23] Dan: And needed, I think not really necessary because I can imagine the opposite, where you say, has anyone, you know, I've just said something, has everyone got anything to else to say? Actually stepping into that space is, is fraught with difficulty. So actually I, I think that's a good tip for any leader is to proactively actually bring people in, not just create space and let them step in. Because the stepping in is an act of courage, isn't it? 

[00:27:46] Tim: And then particularly when someone speaks up, make sure you acknowledge that.

[00:27:49] Liz: And so what, um, Tim talks about here isn't as common in healthcare either, that, um, the physician really is the lead. And, um, there, you know, a lot of people are hesitant to speak up because the physician is the lead and is in charge. And I think what Tim is doing here, is quite valuable, valuable, and in fact it's something I'd love to, um, see healthcare do a little bit more work in to really analyze those teams that work better together. Might that in fact be pro improving the end result for the, the patients versus the teams that don't work as well together? Whether that be in a clinic setting an or, or a hospital round. Because you're really tapping the minds of so, multiple experts and, and as Tim alluded to really opening up that space for people to speak up, um, really can create some incredible answers that one had not considered.

[00:28:52] Pia: And one of our previous guests, It gave us the scenario when speaking up might have saved the life of the person that was on the operating table. So this is critical, and I think as Dan said, it's you, you do have to invite, you've gotta create the right climate for people to feel safe, to be able to do that. And when you've got a hierarchical system, that, that puts tremendous pressure for people to be able to, to speak up like that.

[00:29:20] Dan: Can I come back to the top of the conversation? These sort of competing forces, this tension that the team is in, I guess, to try to balance all these things. How do you, um, engage? How, how, how do you deal with that? You've got a patient here that needs care. The, the environment around the team is complex and pulling in different directions. How, how do you help 'em to navigate that?

[00:29:45] Tim: I'm gonna add another variable here. Uh, one that is Dr. Dramatically affecting the US healthcare system right now. A and that is the lack of staff. And the tremendous pressure. Of course, all, uh, uh, sectors of the economy are, are having some of the same issues. Um, uh, front page of a major newspaper this, uh, this morning here in the us uh, was talking about nursing staffing shortage here. And I, I know in the UK there's been some strikes and things with, uh, some of the healthcare workers. The, you know, the post covid, uh, you know, everyone held on during covid and now everyone's saying, uh, they're exhaling and dropping out of the healthcare space. And so the additional variable with all of this is, you know, a team of, you know, seven is now a team of three. And there's tremendous pressure right now, and I don't think the average. , um, American here understands how on the edge the healthcare system is, and it sounds like potentially the same as in the UK at the moment. Uh, how, how right on the edge we are of surviving.

[00:30:45] An example this weekend couldn't transfer a patient to a higher level of care who needed it, uh, dramatically due to a cardiac issue, not because that higher level of care didn't have beds. They, they had physically had beds, but they didn't have staff to, to staff those beds. 

[00:31:00] Pia: Where have, where have the staff gone? I know that sounds a really crazy question, but it's a little bit like water. It's drained from one place to another.. I, I mean, I, I actually had an incident where I was in the plane and they actually said, sorry, we're waiting to taxi. There isn't enough staff to enable the plane to be brought into the, into the airport. And I'm just like, what? What? Where's everyone gone?

[00:31:28] Dan: We're asking some big questions, tim.

[00:31:30] Tim: You know, I, my, my impression on all of this, I, I call it the covid shuffle. Honestly, what I mean by that is I think people didn't necessarily leave the workforce altogether. They just moved to something different. , and particularly in healthcare on the, the clinical side of things, the pressure was so high and the, particularly our direct care, our nursing staff, our respiratory therapy staff, all those folks that had direct patient care, they really just got hammered and they just, you know, are walking away and going to law school. They're, doing something different in business. You know, they're just sometimes getting completely out of healthcare.

[00:32:09] Dan: And how so? Um, teams under pressure, under-resourced, to some extent. That's, you know, as, as Liz will know, this is the number one issue we see in teams across the world is resources. But you've got patients there who need treatment, they need human engagement to do that. H h what, what is, how, how have you handled both the sort of practical and the, the emotional, psychological side of, of having a teen that should be seven, that is now three?

[00:32:36] Tim: Not very well 

[00:32:37] Dan: With difficulty. Yeah.

[00:32:39] Tim: Right? I don't know that I have a great answer other than to say, I think we're all aware of it, and I think everyone is trying from top to bottom to, to make sure that, uh, we're taking care of our people as best that we can. But it's, uh, I, I'm not, I'm not sure that we necessarily are doing it very well. And maybe Liz, you can speak to that more. You might know more of the data on that,

[00:32:59] I just. And, and I don't honestly know what the options are when, when you just don't have the people there. How do you have an effective team and when the patient is still sitting in front of you, for example, I had this weekend needed to be transferred, couldn't get transferred, there's nothing you can do other than just continue to, to move forward and do the best you can.

[00:33:15] Dan: Yeah. And you have the covid shuffle. You also have still have covid ripples, don't we? In the healthcare untreated cases, worse things that have been, um, sort of conditions that have worsened. So you're probably dealing with higher demand as well. 

[00:33:28] It's, um, but it's, it sounds like, um, one of your approaches is to, as a align to everything else you've been doing, which is to be open about that and not to, I guess not to try and hide it, but to actually see it as an actual issue. Put it out on the table, not to hide it and pretend everything's fine, but to actually put it out on the table and make sure we all see it and we deal with it the best way possible.

[00:33:50] Liz: I think this is where there's another really significant opportunity in healthcare, and that is the teams outside of our organizations, and because we're all faced with the same pressures, the same disruption, the same staff shortage, we really do need to look outside our walls as an industry and and outside of our industry to really come together as. to identify ways forward.

[00:34:17] We, we, I, I mean, you must, there, you, we can't, um, settle for the status quo. We'll do the best we can with the resources we have, but I think at the same time we proactively really need to have conversations with, you know, neighboring organizations, states, and across the country and inter I mean, and globally, how can we do better?

[00:34:40] And at the same time, we, we really have to recognize the people who are in it and helping them. You know, the, the leaders, the everybody in healthcare, it's hard work. And there, there have been, everybody's undergone so much change. We really need to make sure people have the resources to continue to be their best self. 

[00:35:01] Pia: And that probably sort of leads to the, the kind of a final question really, because, you know, we've, there's obviously some obvious pressures and strains. Um, what's, what would be your advice for team leaders who are under that type of systemic pressure?

[00:35:22] Tim: I think of all, um, challenges as an opportunity. Right, so, so we have all this, this massive pressure on us and all these dramatic changes and challenges, but at the same time, there's always a flip side to that, and it does provide us with an opportunity to maybe make the system better, to change the way that we do things, and maybe those teams that are under tremendous pressure maybe ought to just start small. um, and, and see this as an opportunity. And the more positive we, uh, approach it, uh, the more that we, uh, start to think out of the box. I think when we think about it negatively or it's this, um, this looming pressure on us. So we oftentimes shut down our creative side. So if we can think positive about it, start small, uh, it may really present, present an opportunity to be innovative and to actually change the system that doesn't work well in the first place. So let's, let's take this opportunity and let's, let's flip it on its head.

[00:36:16] Liz: Amen. Yes, I totally agree. And I would say in addition to start small, start within. There's, you know, one great place everybody can start to be better as a team leader and as a human being. And that is to really start within what's working, what's not, uh, and what can I do to make things better? Um, because yeah, it really, we, we do need to be, well, to be creative, we need to be grounded in order to lead teams, and in order to do that, we really need to take care of ourselves first. 

[00:36:51] Dan: So true. Well, as Tim said, um, you know, right across the world, health healthcare is under pressure. And to be honest, whenever we talk about healthcare on this show, it's things start to sort of get a bit dark and we talk about problems, but you've left us with a really optimistic note there to really start small, start with the team and then, and then think of self first. So, um, there's some real opportunities there. But thank you for all the amazing work that you do for patients in your world. And, uh, I hope, I hope today's episode will help spread that to love a little bit further into other parts as well. So thank you so much for being on the show.

[00:37:27] Pia: Thank you.

[00:37:27] Tim: Thank you.

[00:37:28] Liz: Thank you, Dan and Pia.

[00:37:29] 

[00:37:29] Pia: I think it's really interesting, this whole notion of titles. I think that that was a really interesting part of the conversation. and I struggle with this slightly, so the doctors are revered for their knowledge and I have no problem with that. It's when it's attached to an almost a deferential rank that actually the problems in dynamics can occur. And I thought Tim's approach to this cuz you working in such complexity, just call me Tim. Because otherwise there's a, there's a, a barrier which becomes critical when you're dealing with people's lives and you're dealing with sickness.

[00:38:10] Dan: And you can imagine the ego that could be at play where you're phoning, as he said, another department in the hospital, and you, you want, you don't want to just say, hi, it's Dan here. You wanna say it's Dr. Dan, you know, he sort of right that, that's pegged me as a certain person that you need to obey. And my life's then going to be easier potentially. But it ta it, it sort of shortcuts the actual human relationship, which is can you lead without rank, by doing things that make sense and by giving people space and, and inviting people in? Yeah. But that simplicity, the simplicity of taking away that rank.

[00:38:44] You know, we were talking earlier, weren't we, that in the medical world, in the uk, if you're a consultant, you become Mr. Again or ma'am, I think. And of course that's just saying, I'm not, I'm too good to whatever, whichever, whichever. Um, but that's sort of saying I'm, I'm too good to be a doctor now. I mean, even so it all, you doctors need to be differential to. Do you know what I mean? So it's fascinating and I love that. I think it's one to one to watch out from is that subtle use of language, like in the Korean Airlines cockpit.

[00:39:16] Pia: And I think that's across the board because I think we have certainly in the last 20 years become quite obsessed about titles. You know, whatever sphere and when they're a VP or an EVP or an SVP or a, you know, whatever the, or president, you know, it's all that. And I think that, I think that's actually slightly less so as, as organizations are flattening and changing their structure in their ways of working.

[00:39:39] But I think it's one to watch out, because we seek it and then we almost can weaponize it once we, once, once we have that title. Whereas in actual fact, yes, it's a recognition to work that you've done, but it doesn't actually say much about you, that that's your leadership probably is a, is much more about how you relate with people and can bring them along, which is clearly what Tim was trying to do in a world of complete

[00:40:02] Dan: Definitely, and I think it's worth a scan for any leader to say what around me gives su, gives me subtle clue, subtle hints of my own superiority and rank. You know, I, I remember when I worked in the, in the States, you'd go up to the executive floor and you'd be walking along these really, through the beige corridors, through these sort of, uh, across this sort of industrial carpet. You get to the executive floor and you are waiting through blue shagpile. You're sort of pushing yourself through. It's like walking long grass up to one of the secretaries who were, you know, they weren't even personal assistance then. But they were, they're all signs of rank and, you know, when you go in there, you were clearly under. And, uh, it wasn't, it wasn't helpful. It wasn't helpful for that organization.

[00:40:47] Pia: doing that in a, in, in, um, in Sydney in a well known global media organization. And all the floors were gray except the floor where the boss worked, and that was all plush and red. It just sounds such a strange mess. I mean, it's just, it's a bit like me too. It's like, it's like, it's one of those things, once we become aware of it, it's just not cool. It's just not cool anymore.

[00:41:13] Dan: Yeah. And actually, to be fair, I had an office in that building. There were cubes, the engineers were in cubes, marketing, people were in offices. What the heck? What is that about? You know? Whereas the engineers actually made the implants. So the marketing people were making brochures. I mean, which would you put it in an office when we think about it? So, uh, yeah, it's an inter, yeah, all little subtle signs around.

[00:41:31] But I think the other, the other thing we saw, I think it came through very strongly, was this complexity. You, you started the show with this, the healthcare systems are under huge pressure financially. I think it's systemically set up pretty badly. Now with staff shortages, you know these, but that complexity described when. The doctor doesn't know what this procedure's gonna cost. The patient doesn't know that. It is just total uncertainty, and it was fascinating to see how his answer to that was. A team was to bring people around to do their very best. Not to try to solve the problem, but to get the best possible outcome in a, in a, in these adverse conditions.

[00:42:15] Pia: And I would imagine that was what, what he's attempting to do is quite rare. In a, in a pressurized system. But nevertheless, a great example of, of a different way of a approaching it, because at the end of the day, what can you control? And there are many factors in that complexity that you can't. And the one thing that you can control is the way that you're relating with people, the way that you're collectively trying to think through the problems that you've got. That's the choice that you have. And so it's sort of stepping out of it and, and rather letting the system envelop you and, and potentially sort of almost d debase your, your behavior. You rise above it to think about what you could do. And I think that was a really powerful message.

[00:42:56] Dan: it's so tempting, isn't it? That's a good word. To debase you only become a, a victim of it. It really reminded me of David Snowden's, um, model Cynefin, you know, where the sort of we're used to working in the, what he calls complicated, the complicated sort of quadrant where actually this is, this is where I'm most comfortable where If we're smart, we can figure it out with the spreadsheet. But this is not that, you know, it's, this is complexity and chaos where we actually don't know. We don't know enough to know even what the result of our actions are. So we, we have to just go out there, try something, but crucially bring people around to get multiple perspectives on this same thing and, and do the best we can and forget a perfect answer. It's not out there. Really, um, really powerful. Excellent. Great, great episode. Lovely to talk to, um, to Tim and Liz.

[00:43:44] Um, but that is it for this episode. You can find show notes and resources at squadify.net, just click on the We Not Me podcast link. If you've enjoyed the show, please do share the love and recommend it to your friends. If you'd like to contribute to the show, just email us at wemepod@gmail.com. We Not Me is produced by Mark Steadman of Origin. Thank you so much for listening. It's goodbye from me.

[00:44:09] Pia: And is goodbye from me.