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No state has fallen further than Kansas in America’s Health Rankings. We used to be 8th in 1991.
Why did we slip so far down in the rankings? The answer might surprise you; it’s based on a leadership challenge.
At the Kansas Health Foundation, our bold vision is to make Kansas the healthiest state in the nation and to do so, this movement must be powered by Kansans in positions of authority and influence to shift Health outcomes.
Starting with the launch of the 2025 publication, Leading Health, written by President and CEO of the Kansas Health Foundation, Ed O’Malley, this podcast aims to break down key concepts of this leadership challenge and actionable ways that we can work together to make a real impact on Health in Kansas.
In each episode, Ed O’Malley, and Senior Advisor at Kansas Health Foundation, Susan Kang, will highlight a chapter in the book and discuss with Kansans who are actively engaged in expanding our definition of Health.
Leading Health is an invitation to move the needle on Health in Kansas, and we invite you to join us in leading the way.
Ep04
===
[00:00:00]
Ed O'Malley: welcome back to another episode of Leading Health, the podcast that dives into the book Leading Health, how You and 30,000 Kansans Help Communities Thrive. So [00:01:00] Susan, here's where we've been. The last few episodes we started with talking about capital H Health versus lower H Health, and the difference between the two in that this book is about capital H.
Health. We then described the 30,000 who they are, what role we need them to play if we're gonna help Kansas thrive. And we juxtapose those 30,000 to Alice, that population of the working poor, whose health outcomes have suffered, whose population size has grown over the last 20 years in Kansas. And we also described.
The health ranking as an incredibly valuable North star. It's a rallying point, and the book makes that clear. Now, today we're gonna dive into what's life like when Kansas is ranked in, in, in the bottom half. What's life like when Kansas is ranked number 29 in the ranking like it was when this book was published?
And of course, we're doing all [00:02:00] this so we can fan the flames of a conversation about health in Kansas, a conversation. Frankly that we need the 30,000. Those are Kansans with roles of authority throughout civic life, elected officials, pastors, rabbis, university presidents, school superintendents, community-minded business people.
We need a conversation among them about the critical nature of improving health, and that's what we're trying to do with this podcast. It's great to be back with you.
Susan Kang: It's so good to be here. Okay.
Chapter Four Focus
---
Susan Kang: I am so excited about diving into chapter four. Right. That's what we're talking about today. We've talked about and Ed already
referred to this. So we have the goal to lead the nation in health, right? Which is absolutely awesome. But first we need to take an honest look at where we are in Kansas today. So when the book was written, we are 29th today. As we sit on the rankings, we're 27th in the nation. All right? So yay for the incremental progress that we are making.
We
Ed O'Malley: made a little bit of progress.
Susan Kang: We did a little bit, but we wanna make more, right?
Ed O'Malley: A lot
Susan Kang: more. Okay. So this chapter [00:03:00] as we dive into it, it's about how the. This chapter challenges us to start thinking collectively and take some responsibility for moving forward from good enough to true excellence.
So, super excited about this. Ed, would you just go over some of the key concepts that you think would be really helpful for us to know?
Ed O'Malley: Yeah.
Leadership Starts Dissatisfied
---
Ed O'Malley: This is the chapter where I feel like I run the risk of everybody thinking that I'm a glass half empty person way, and I'm not, no, no way.
It's not true. No way. I'm a very positive, optimistic person. Yes. But I've also learned throughout my career, throughout my life that leadership always, every single time starts with dissatisfaction. Mm-hmm. You know, it starts with, somebody on a football team craving more victories next year than this year.
Somebody in a theater troupe craving better, reviews, better attendance right next season than this past theater season. Leadership is always about dissatisfaction, and that's what this chapter is [00:04:00] trying to do. It's titled, you know, Kansas at 29th, and it starts off. With a lot of depressing data.
Yeah. And we won't go through that here, but folks can go to the book and check out chapter four. See that data that we're pulling from America's Health Rankings and some other sources too, to paint a picture for. What life is like in Kansas when we're in the bottom half of the states from a health standpoint, and the reason why this chapter is so important, and especially so important for the 30,000 mm-hmm.
Is because as we explored in a previous episode in the health of the 30,000, the health of people with a lot of opportunity, with a lot of authority, frankly, their health is as good or better than it's ever been. Right, right. So what we're really talking about is as we fall, as we have fallen the last 35 years in the health rankings, it's the health of people across the state, the Alice [00:05:00] population and beyond that is suffering.
This chapter tries to hit that home, but it, it's really a chapter about how leadership requires us to face the music, to face hard, tough things and not just sweep those under the
rug.
Susan Kang: Right? So, so you, you, you know, talk about an easy interpretation versus a. Tougher, tough. You know? So I wanna, I wanna emphasize this.
It's not a tough interpretation. It is a tougher interpretation, right? As between the two so say a little bit about that.
Easy vs Tougher Takes
---
Ed O'Malley: Well, I think the, I mean, I've noticed over the last 25 years as we have slid in those rankings, and I've, I've been around, I've been involved in civic life for 25 years in Kansas in lots of different ways.
And what I've noticed is. When their rankings were come out, first of all, they often wouldn't get talked about 'cause who wants to talk about bad news? Right. Well, I think people who are trying to. Create change, often need to talk about bad news, but, but it often wouldn't get talked about very much when it would get talked about.
My sense is it would be explained [00:06:00] away.
Mm-hmm.
It would be Well, yeah, but you know, I mean, the ranking, you know, they, they, you can't trust rankings. I mean, you know who, who knows who's actually behind that thing anyway. And I think the easy interpretation was to assume. That No, we're actually doing fine.
There's something wrong with the ranking.
A tougher interpretation is what if the ranking's accurate? What if it's actually a really good proxy?
Susan Kang: Right. A little scarier.
Ed O'Malley: Yeah. Now it's a little scarier. You know? What if, you know, tougher interpretation is Wow. I mean, really during the time the Kansas Health Foundation has been in existence.
We've been falling in the rankings Until the last few years and we've, you know, for the first time, we're very proud of this. As you know, Susan, for the first time in 35 years, Kansas, for three consecutive years. Has improved in the ranking. We went from 31st to 29th, 29th to 28th, 28th to 27th. Now we're not satisfied and we have a long way to [00:07:00] go, but the easy interpretation is to assume this ranking isn't relevant.
It, it, it doesn't really concern us. We're doing great, but we have to explore tougher interpretations. What this chapter's all about.
Susan Kang: tell us a few more, like give us a few more examples to help us see between the difference between the easy and tougher interpretations.
Ed O'Malley: Yeah. You know, Susan, again, this is such a key concept, right? Those who exercise leadership. They know that they can't just always assume the easy answer or the comfortable answer is the answer, right?
Or the easy, the comfortable way of, of, of explaining the situation to themselves is the correct one.
Agency and Shared Responsibility
---
Ed O'Malley: So, for example, I hear a lot of times, well, our health is going, down the drain. Our health ranking is falling low. It's gotta be these lazy people who aren't taking care of themselves. Mm-hmm.
Who aren't exercising, who aren't eating well, who well. Okay. That's a very comfortable interpretation. Mm-hmm. It's saying, it's not my fault, it's somebody else's fault. Mm-hmm. Now, I don't wanna say that there might not be personal [00:08:00] responsibility in this equation, but what we've said often throughout this book is.
If we can make sure there's a level playing field for everybody, then yeah, somebody's poor health is on their back. If the playing field's not level. Mm-hmm. Then let's assume there's some collective responsibility too, or like another easy interpretation is. Well, this is all just a big national thing.
Like Kansas is in the flow of a national river when it comes to health. Mm-hmm. Capital H health, what? What can we really do in little old Kansas? We're pretty tiny compared to the bigger system. Mm-hmm. Or the bigger nation. And I just refuse to believe we lack agency. I refuse to believe that we are just along for the ride, but so.
This idea, like if we don't get people to question the easy story, it's really hard to mobilize the difficult, frankly, provocative work that's needed. And we'll talk about that provocative work later on in this [00:09:00] podcast series. Okay. Yeah. But we've gotta land this idea first.
Susan Kang: I love the notion of us, Kansas.
Having agency, right?
Ed O'Malley: Yeah. Well we have,
Susan Kang: especially over our health capital, H Health.
Adaptive and Collective Challenges
---
Susan Kang: So I think all I'm gonna, I'm gonna hold that may I ask you to talk a little bit, is there, there's another concept that I want our listeners to know about, which is this notion of our biggest challenges, requiring both adaptive.
And collective work together. Right. Leadership. So say more about that.
Ed O'Malley: Yeah. This idea came from a lot of deep listening. We did in 2022, lighter had half of 20, 22. In 2023 when we were trying to reground ourselves in the voices of Kansans. We're doing a lot of listening and when I started the Kansas Leadership Center, I did a similar process.
Susan Kang: Yeah. Yeah.
Ed O'Malley: With the team that started the Kansas Leadership Center where we asked big open-ended questions to Kansans to try to get our arms around what's happening mm-hmm. In the state and wanting to use that. Listening to [00:10:00] inform our thinking and eventually our strategies. And on one hand, you know, I heard a lot of things I've heard before.
Susan Kang: Mm-hmm.
Ed O'Malley: You know, the team that did that listening, we heard a lot of things we'd heard before. Which is okay, that's fine. So it's confirming some things had stayed the same things like we need more and more people who understand how to immobilize others now understand how to exercise leadership.
Mm-hmm. Like just being passionate isn't enough.
Susan Kang: Right. Right.
Ed O'Malley: So some of those things we heard, again, one of the things we heard that was new is this idea that the challenges. Aren't just adaptive. Mm-hmm. So that refers to, you know, adaptive challenges, wicked problems vaccine challenges, lots of different ways versus technical stuff.
Yeah. Versus technical stuff, right? Mm-hmm. Mm-hmm. So the language that I've always used is, you know, adaptive challenges versus technical problems. Well, for years we've been hearing that the toughest challenges are adaptive, [00:11:00] meaning they're messy, there's no easy solution. So on and so forth. Yeah. Now what we heard that was new.
That you're bringing up and that we write about in this chapter is that in the 2020s, the challenges are adaptive. And collective.
Mm-hmm.
So the key difference there is they're still adaptive. They're still vexing, they still resist easy answers. There's still no way to make progress without evolving, adapting, which means like taking on some loss, like letting go of some things.
Mm-hmm. Mm-hmm. But also they're collective. Meaning like nobody can do this by themselves. No one Kansan, no one community. No one organization. It takes us working together, frankly, is what Kansans were telling us in ways we haven't. Learned how to do yet. Mm-hmm. To make progress. So, improving health capital h Health is adaptive and it's collective.
[00:12:00] So what we're trying to say in this chapter is, Hey look, we've been falling and Kansas' at 29th, and now again, now we're 27th, but when we wrote the book, we were 29th. Kansas' at 29th is no good. And here's what it looks like. And improving that will require us to face the music and to do it together in a collective way.
Mm-hmm.
Susan Kang: Yeah.
Why Collaboration Matters
---
Susan Kang: And I love the fact that not only our leadership challenges are adaptive, which we already knew about, but also now collective. And the word collective for me also brings forth the need for collaboration. And I know we're gonna cover some of the stuff I think, in some of the other chapters, but the importance of collaboration when working with more than one
Ed O'Malley: group.
Yeah. It, it's such a, I mean, we can hit these points several times because they're hard to absorb, but we will not make progress if we don't begin to get people working together. In ways they aren't used to working together. Mm-hmm. That means like the 30,000. Mm-hmm. Right. So like elected [00:13:00] officials working with the private sector on health capital H health related things that looks like different levels of government working together in ways they're not accustomed to.
Frankly, it looks like different factions with different political ideologies, finding common ground Right. In ways that are necessary and what we're trying to do with this chapter, say, look, we've been dealt a hard hand. We're in the bottom half of states now, but we're not playing the hand well.
And we've gotta play it better. And the people who get to control how we're playing the hand is the 30,000.
Susan Kang: Right. And these are some tools,
Ed O'Malley: these are some tools
Susan Kang: 30,000 can use.
Ed O'Malley: So we're gonna get into this.
Meet Kari Bruffett
---
Ed O'Malley: and, and one thing we're excited about is we've got Kari Bruffett from the Kansas Health Institute with us today.
And Kari's just one of those people. That if you wanna talk about health in Kansas, you better have Kari close by because,
Susan Kang: so true,
Ed O'Malley: so true. She leads an amazing organization. The Kansas Health Institute. We're obviously very fond of it. The Kansas Health Foundation has a long history of [00:14:00] supporting the Kansas Health Institute.
It's one of the foremost entities in the state that can not only dive into. And help us understand us, meaning the 30,000 and beyond, an entity that can dive into and help people understand what's currently happening related to health in Kansas. But it's also an entity that looks forward and can help us understand what's to come.
Mm-hmm. If we don't evolve the way we think about. Working together. If we don't evolve the way we think about the relationship between policy, and that can mean lots of different things. Corporate policy, organizational policy, governmental policy, the relationship between policy and capital H Health Kari is phenomenal.
Let's get Kari up here with us and get this conversation going. Kari, awesome. Having you with us. You have been so involved in Kansas Civic Life. You've done so many different things. You worked for the University of Kansas Health System. You were a cabinet secretary. You were the Secretary of the Department of Aging and Disability Services.
You are now [00:15:00] the president and CEO of the Kansas. Health Institute. It is awesome having you with us. I love our partnership. Thanks for being a partner with KHF and thanks for being here today.
Kari Bruffett: Hey, well thanks for inviting me. I'm looking forward to it.
Susan Kang: Welcome, Kari. Super, super excited to have you here.
So I'm really glad for this conversation.
Data Dismissed Then Faced
---
Susan Kang: So one of the concepts that, you know, we talk about in this book and, and Ed highlighted is this notion of multiple interpretations and especially, you know, around tough versus, or easy versus tougher interpretations.
So I'm curious to know if you can share a situation in your many years of data experience mm-hmm. Especially right where you've seen data initially dismissed. Explained away, but then you took a closer look. Right. And that led you to a tougher interpretation.
Kari Bruffett: Yeah. So you guys were talking about America's health rankings and our quest to, for Kansas to lead the nation in health.
The Kansas Health Institute has worked for many years with the. County health rankings. So [00:16:00] I'm gonna give an example, and I don't wanna confuse the two, they're very different, but it really is very on point to your question about tough interpretation. Mm-hmm.
Wyandotte County Wakeup Call
---
Kari Bruffett: So I was working at the KU health system.
It was called something different then the KU hospital in 2009. So, well before I was at the Kansas Health Institute, when KHI produced the first Kansas County Health rankings before it became a national thing. And why in county? Kansas City, Kansas is where KU Hospital is located. Came out ranked a hundred fifth out of 105.
And I remember being at a meeting that the mayor at the time, mayor Joe Rearden, had called to sort of understand or really dig into those rankings and there were some in the room. Including probably some folks like me from the KU hospitals. Like how could this be? There must be some sort of other explanation or we can explain it away.
We knew there were challenges. Mm-hmm. Economic challenges and infrastructure challenges. Wenda County. But seeing the 105 out of. 105 was a really stark reminder and a need for [00:17:00] urgency. So there was a, concerted call for organizations to really work together. But I will tell you, I spent some of the time after that first meeting, looking at those rankings and sort of trying to.
Go in and say, well that can't be, or, well, how could a hospital or a health system really control these? Why are these included in the rankings? Mm-hmm. Mm-hmm. And really sort of trying to say that. So not to fully discredit them, but say there is something else we can use to explain it. But that wouldn't have gotten us anywhere just to explain away something.
It's like a check engine light on in your car. Mm-hmm. If it goes on and you say, oh, I don't really want to pay attention to that check engine light. You can tape over it or ignore it, and probably your car runs for a while and then ev eventually you break down if you don't address the issue and get to the bottom of the issue.
Policy Barriers Behind Rankings
---
Kari Bruffett: So, you know, you talked about America's Health rankings and for KHI, one of my colleagues at KHI Kevin Koach. Inspired by the leading health initiative really did a study of a lot over the last 18 months or so, working with [00:18:00] leaders across Kansas to say why. Not just, we know that Kansas dropped from, had the experienced the greatest drop in America's health rankings.
But why is that? Why? And instead of, again, trying to explain it away, I've heard that sometimes explained away as, oh, well, Kansas is an aging state, so that explains it. Mm-hmm. It doesn't, all those rankings are age adjusted. Mm-hmm. So what are the explanations? So what we got to are the result of that.
Project, which was asking more than a hundred people that had experience across domains, both in health, public health, business government and policy. A lot of folks from public health were the ones who really engaged with it and responded to it, identified. Policy barriers as being the primary thing.
And those are hard, and those aren't just governmental policy, barriers, as you talked about, Ed, they can be a lot more. And it's not gonna be a technical challenge or a technical fix that corrects or turns around America's health rankings for Kansas. And we have to. When we examine what is [00:19:00] actually driving it, we know it's not gonna be quick either.
It's gonna be long and hard and important work. So I think those really getting into some, maybe some uncomfortable interpretations of policies who is responsible for implementing those policies and how does that impact our ranking overall? That can create some pretty challenging conversations.
So. we dive into that and we wanna bring other people into the conversation so they can see themselves not just in the problem, but hopefully in the solution.
Check Engine Light Lesson
---
Ed O'Malley: Kerry, I wanna play with just a couple things you talked about for a minute, and one of them is, I love that you referenced the story back to 2009.
Kari Bruffett: Yeah.
Ed O'Malley: And I remember some of those conversations. I wasn't living in Wyandot County, but I was with the Kansas Leadership Center and I ended up intersecting with some of those conversations in Wyandotte County. And I just really appreciate you bringing that up as a story and as a situation where it would be easy.
To assume or to tell ourselves a story. Tell people in Wind County to tell themself a story. Yeah. That this can just be explained away. And my recollection is Joe [00:20:00] Rearden, who was mayor at the time, really didn't allow that. Really said Absolutely we're not, we're not going to just put this behind us.
We're not gonna, I loved your metaphor of the check engine light. Yeah. We're not gonna put tape over the check engine light. We're gonna focus on it.
Mayor Confronts The Data
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Ed O'Malley: Can you talk a little more about, 'cause in some ways that's a really good example of a member of the 30,000
Kari Bruffett: Yeah.
Ed O'Malley: Trying to rally people to focus on capital H health.
Yeah. So what was that like? How did you experience him doing that?
Kari Bruffett: Yeah. So, and again, I was working at the KU hospital at the time but was. Have talked subsequently to some of my colleagues who were at KHI at the time too, and they remember a meeting I wasn't in, but that they were in with the mayor where he asked some tough questions and really sort of interrogated the rankings and how they should think about the rankings.
And then said, okay, what are you gonna do to help us fix it? And so one of the things they did was they actually asked KHI and other partners. I think Leadership Center and others to come to Wyandot County and help engage the full [00:21:00] community and leaders in the community. You know, others of the 30,000 who could really dig into.
What they needed to, to do to create change in Wyandot County.
Upstream Barriers And Action
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Kari Bruffett: And one of the things they really did extra research and diving into are what are those factors, those upstream factors that maybe weren't even yet in the rankings that they didn't even show up in the rankings, but were behind something that was in the rankings.
Mm-hmm. Mm-hmm. And so, for example, one of the things they identified were transportation barriers. Mm-hmm. That were real. Impacts on people's, not just access to care, but their ability to get to jobs and, you know, impacting their ability to access other services in the community. So they took community action and created organizations ~that ~that still exist today that make a big difference in y do county changing some of the conditions that impact health in Wyandot County.
So yeah, it was absolutely inspiring and then the mayor said, Hey, KU Hospital folks and other folks, you need to be at the table too. You're a great hospital. How can we also improve the entire health, and not just our healthcare, but the health [00:22:00] capital h health of Wyandot County?
Authority And The 30000
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Ed O'Malley: It is a great example, and my recollection is Mayor Rearden did not run on a platform of what we would call capital H Health.
Right. He ran on a platform of all kinds of things, economic development and growing, OT County, all this stuff. But he responded to the data. Yep. And he did so in a way that I think is a really beautiful example of what we need from people with authority. He used his authority to convene and to direct attention.
On something that needed attention. Like, so that's, you know, for the members of the 30,000 who are listening, that's what we're talking about. Yep. Like that's the role and the mayor can do that in that situation. Yeah. Differently than, a prominent physician at the hospital system. Right. Could do it.
Different people are gonna show up at the table, and that's the point. This is not a problem, a [00:23:00] challenge, a situation that can be solved with health care at the tip of the spear. Mm-hmm. Healthcare is a part of it, but the tip of the spear has gotta be the 30,000 engaging people differently. I just love that you told that story.
Thanks for bringing that up.
Kari Bruffett: Yeah, you bet.
Susan Kang: That's a great example of member of the 30,000 truly exercising leadership, right? Yes. And, and trying on tougher interpretations. I think that's really great.
Why Kansas Settles For Average
---
Susan Kang: And there's another chapter highlight Ed that I wanted to talk a little bit about but I might need you to talk a little bit about that before I ask the question of Kari.
And that is this notion of even when we try, even we as Kansans, try our best, we end up sort of arriving at average. So. That doesn't sound great to me. So first of all, why is that in the book? Well, and what what should we know about it?
Ed O'Malley: I mean, this is the chapter where I am, I'm embracing the part of me that is a glass half empty.
Yeah. Although I am more of a glass half full type of person. But yeah, we put that in the book because [00:24:00] I think what we found, and this also came from the listening. I, I mentioned the listening that we did earlier. One of the things, one of the other things we heard during that listening. Was that a lack of bolder aspirations was actually getting in the way.
That, there's a little bit of uh, aw shucks. In Kansas, we're humble and, you know, we're kind of attitude, which on one hand is, is beautiful and, and full of humility and fantastic and kind of that great plains ethic of we're just gonna kind of be out here by ourself and handle some things and we don't need any attention on us.
But what Kansans were saying, in essence, in in so many words, were, yeah, yeah, yeah, yeah, yeah. It's fine. However, when trying to solve a vexing adaptive challenge, like the massive decline in the health rankings, a lack of bolder thinking is a problem. And so that led us down this [00:25:00] path of thinking that, when we do rally.
When we do really work on something as Kansans, it's hard to find many examples where we're trying to like rally to get to excellence rather than just like rally to catch up. And I give a couple examples in the book and one of 'em is. Here in the city of Wichita, a meeting I was a part of a couple years ago where I'm on the board of the Greater Wichita Partnership, which is an amazing organization, and we were having an update from the city about the need to evolve our economic development policies in the city.
But the whole frame was we have to get our policies caught up with the other cities that are competitive peer cities. It's like we gotta catch up. The aspiration is to make sure we don't get left behind. It's not to lead the way. And you know, we know what happens when people decide to lead the way.
Chasing Excellence At KU Health
---
Ed O'Malley: And Kari, I mean, you were at the, the University of Kansas Hospital system. Yeah. That's a hospital. And I write about this in the book. [00:26:00] That's a system that was one of the worst in the nation. And when I was working for Governor Graves, the discussion was to shut it down.
Right. And the story goes that they were given one last chance to kind of, let's see if we can make this thing work.
And because of incredible leadership from so many people that is now one of the best hospital systems in America. But they strove not just to survive. They decided we're gonna go for excellence. Yes. It's an incredible, incredible story. So yeah, part of what we're saying here is we gotta rally not to catch up, rally not to get to average.
But if we rally to be excellent, it changes the mindset of things. Does that feel right to you? To, to both of you?
Susan Kang: Yeah. And so what I wanna know from Kari is, can you share an experience where the goal shifted mm-hmm. From just catching up to true excellence? And if so, if you have one of those examples, what I'm also curious to know is what had to change maybe culturally.
Maybe structurally
Kari Bruffett: right
Susan Kang: in the organization or in the community that helped you [00:27:00] make that shift?
Kari Bruffett: Yeah. You know, Ed talked about the key health system already, and I and the best example from my early part of my career really was that it was not a matter of, Hey, let's just survive as a hospital. It was leadership among the folks, including many folks who are still in leadership at the, in the health system who said, no, we're gonna become the best.
We're not just going to get to survive and and not be closed down, to your point, Ed, but to actually exceed, to get national Cancer Center national Cancer Institute. Yes. Designation, for example. That's, that was an important step and that was. That's not something that was easy to accomplish.
And it was something that was important that isn't just to excel, for Excel sick, that is for the good of the people of Kansas but in order to get that designation, you have to excel. So I think you already took my best example. I will say in my time in state government, both when I was in state agencies or I'd be testifying before the [00:28:00] legislature. And even at KHI, when we provide comparative data about Kansas and other states, I see that symptom that you talk about Ed pretty regularly, which is policy makers and others just want to say, well, where are we below average or maybe trailing our neighbor states?
Mm-hmm. How do we get up there, you know, if we're kind of in that. Territory we're probably okay, is sort of the take. And so the focus is on maybe where Kansas is trailing the most, which that's important to fix that, but it isn't often on, well, how can we. Beat 'em all. Yeah.
So that's a bold aspiration, right? Yeah. And not for the sake of being competitive and ever all, all that, although there's probably some element of that that might be appealing to some. But for the best outcomes for Kansans. So I do see that very starkly and very real.
And I think that can be a reason why sometimes with America's health rankings. The change for Kansas wasn't overnight. There were a couple years where maybe the dip was a little bit faster, but for the most part, it's sort of gradual. Yeah. So that check engine light [00:29:00] was on pretty early and all of a sudden it wasn't till we were.
Well below, not in the middle anymore, but actually below the middle that it really caught the attention. But we're not trying to get us like, oh, let's get to 25th and then we'll be happy 'cause we're in the middle.
Susan Kang: Right. Right.
Kari Bruffett: So I appreciate that. I think one of the things that.
I don't know. I can't speak for culturally within KH KHF, but within KHI, one of the things that I see is sometimes a limiter to thinking about going to EXCEED or Excel is the idea of being limited by our current systems and the status quo. And feeling like the only things that we can do are sort of adjustments around the edges, modifications, even if they're adaptive changes, that they're still kind of just adjustments.
Or they're small technical changes that may be really important for certain programs or maybe even some subset of populations, but really aren't gonna drive real change. So.
Reimagining Beyond Constraints
---
Kari Bruffett: One of the things we're experimenting with at KHI is this [00:30:00] idea of reimagining the healthcare system. It is. We've had a couple of these, we're gonna have them across the state too, where we ask people to come with all sorts of backgrounds from the 30,000 and in their communities, really across the state to say, if you could design a healthcare system.
That was the ideal of what we wanted for our healthcare system. And you're not limited by anything. You're just starting from the ground up. What would it look like? And then we'll take from there, create things that can be changes that can be made that maybe will be some of the incremental things, but we're not bound by.
The federal limitation here that maybe we could ask for a waiver around or, oh, we've always done it this way. So it'd be really hard to get, this industry to change their perspective on something, think big in order to exceed, to excel. And I do think that's a limiter, and I don't think that's unique to Kansas by any means, but I do think I've seen that as a symptom over time, too.
It's not just like, let's, [00:31:00] hey, let's make sure we're in the middle, but also. There's only so much we can really do is sometimes the limiter.
Susan Kang: Yeah.
Ed O'Malley: And one of the, one of the roles of authority is to help people not be bound. By what people perceive to be kind of the system constraints.
Kari Bruffett: Right.
Ed O'Malley: You know, so like, like your practice of asking people to come together to reimagine, that's such a beautiful word, to reimagine the health system. Mm-hmm. You know, and you could imagine other members of the 30,000. So I carry you in your role as one of the 30,000 CEO of the Kansas Health Institute.
You're using your authority. To ask people to imagine something that doesn't have the current constraints. Mm-hmm. And that doesn't mean we can just wipe away all those current constraints. Right. But if we can, if we can begin to imagine something beyond that, we might be able to be inspired enough to then figure out how to knock some of those constraints down.
But you could, we all could picture other members of the [00:32:00] 30,000 asking similar questions. How do we reimagine our. Workplace in this manufacturing plant. Mm-hmm. To optimize capital H health. Yeah. What would that look like? Don't be constrained by what is right now. Imagine we were re-imagining this manufacturing plant from scratch.
Mm-hmm. How would we do it? So there could be lots of versions of the process you just described. Absolutely. I love that word, reimagine
Susan Kang: Well, and that creates a safe. Space. Mm-hmm. I would say for your, employees and other people who work with you, partners to be aspirational, really creative and really bold.
You know, and I think without that, we never get to the awesome solutions.
Kari Bruffett: Yeah, absolutely.
Susan Kang: Yeah. I think I love that. Thank you. That is an excellent example of a cultural or structural shift. Yeah. So I have another question for you. Okay. This is so great.
From Scarcity To Collective Leadership
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Susan Kang: You know, Ed already covered this whole notion of, our biggest challenges being.
Adaptive and collective in nature. But you know, it's increasingly more difficult, [00:33:00] right? Like we know that it takes more than two organ, you know, more than one organization. Mm-hmm. More than two organizations to really try to tackle the challenges that Kansas faces. But, you know, polar polarization around across political spectrum, societal and systemic issues.
You know, I mean, those continue to widen which makes it hard, I think. So in your experience, like what helps. Groups move from sort of the scarcity mindset in my minds. Mm-hmm. Sort of, that's one of the problems. So, you know, having a scarcity mindset, that is to say fighting for a piece of a limited pie.
Right. To embracing collective leadership and, you know, around adaptive challenges.
Kari Bruffett: Yeah.
Cowley County Data Walk
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Kari Bruffett: So I have an example that Ed's gonna be familiar with because he. Was involved in this as an mc, so Cowley County this was in, I think in 2022. So leaders from legacy, which is a regional community foundation collaborated with Rise Cali and the school district early literacy program.
Mm-hmm. To host something called a data walk. And we can go [00:34:00] into detail about what data walks are. They're, we love them. It was the first one we got to participate in. But the idea of a data walk is to bring people together from a lot of different background experiences, some. Some of the 30,000, maybe some of the 300,000 mm-hmm.
That are influencing or affected by challenges in their communities. So in this case, the limited resources weren't necessarily dollars. They might have been, but it could have been attention from policy makers or credit for working on an issue. But they brought together, large subsection of Cali County to look at community health data. A lot of focus on early childhood and educational data, but it had broader capital h health data as well. So there's these big posters that show data that are, that sometimes can be challenging, that require multiple interpretations.
Mm-hmm. And instead of those posters telling people, here's what you should take from this. It's asking people, what can you tell us or what can you tell each other? Mm-hmm. About what you see in [00:35:00] this data. You know, why are there challenges for literacy in our schools? Why are there different graduation rates?
Why are there disparities? And so the idea of the data walk is you're hearing from. Your neighbors. Mm-hmm. Some of the 30,000 or even, yeah. A larger subset of folks who can dive into and understand data. But it also requires collaboration. So it's not just like at the end of the day everybody says, oh, here's some interesting data that we learned about together, but there's action that follows afterwards
it really did change the idea of who owned both the issue and the problem. And it wasn't one entity, it was the collective. Those groups that, not just the organizations that convened the data walk together, but those who participated. So if I recall correctly, they had folks from law enforcement saying, can we use those posters and we're gonna do a data walk?
And from the school system saying, we wanna do that with our teachers. And so they used. The data walk. Maybe it's a catalyst for those conversations, but it also brought people together to work [00:36:00] collectively on issues afterwards through the Pathways to a Healthy Kansas project, a project we work on that's funded by Blue Cross Blue Shield of Kansas.
Mm-hmm. The leaders in Cali County were trained in health and all policies, which is definitely a capital H health approach to thinking about policy. And so you think about that scarcity is there's not enough or. My group or my issue needs all of the attention or the resources and leadership or, collective leadership is we can do this together and we're only gonna change, make change if we do work together.
It's a wonderful example, just great leadership in the community, but it also elevated people who I don't think had been identified as leaders before.
Susan Kang: Yeah. It sounds like they were empowered.
Kari Bruffett: Yeah.
Susan Kang: You know, to learn, learn, learn about what their portion of their
Kari Bruffett: Yeah.
Ed O'Malley: So I just wanna, wanna lift something up about that real quick and then I know Susan, you always have our closing question that you wanna leave us with here in just a moment, but that data walk, which is a little bit of a wonky term Yeah.
Data walk, but. [00:37:00] It was really cool and it's another example. You're giving us a lot of good examples today, Kari, of things that the 30,000 can do, so. Mm-hmm. You told the story of Mayor Reardon and the unified government, right. And how he brought people together to focus attention. That data walk in Cali County was similar.
It was people at the community foundation. Who said, you know what, we should create a different conversation and then, the police department want to do the same thing and so many different groups in the 30,000. And what it makes me think about is when the problem is what we call technical, the job of the 30,000 is to just solve it,
Like, just like allocate the resources, solve it, make the decision, solve it when the problem is adaptive. And the health slide is an adaptive challenge, and climbing the health rankings is an adaptive challenge. Being at 29th is an adaptive challenge. When the challenge is adaptive, the role [00:38:00] of the 30,000.
Is to frame the conversation, Force the conversation. Focus the conversation, and trust people to emerge with the right answers. Yeah. Alright. Great. Having you with us, Kari, Susan? Yeah. Thank you. Yeah.
Susan Kang: How do you
Ed O'Malley: wanna take us outta
Susan Kang: here? Well, I just wanna say one more thing about the data walk. What really came up for me as you're describing it, is.
It created a safe space for people to build trust Yeah. Around the problem. Mm-hmm. And learn what everybody's role around that problem was. Yeah. And, you know, that's a great way to start, right? Yeah. Around this adaptive challenge. So thank you for sharing that.
Adaptive Leadership Takeaways
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Susan Kang: All right, so this is time when we talk about our takeaways.
So I'm gonna go first and then I'm gonna ask you Kari next, and then Ed will close us off now. So one takeaway for me during this conversation is regarding the collective nature of our challenge. That shouldn't be a surprise. I mean, you know, this is, and also this is what you learned based on the listening tour that you did of cantons, right?
That's super important. So. To the listeners out there, I invite [00:39:00] you to think of a situation around health that's capital H Health, and figure out what could be achieved if you collaborated across differences. So that could be different stakeholders, different beliefs, different geography even, right?
Just to name a few. So think a little bit creatively about that, what that might look like. Kari, would you like to share?
Kari Bruffett: Yeah, you bet. Ed, Ed, you reacted to the term reimagining, and that sort of struck me in our entire conversation and the conversation you and Susan were having earlier too.
I guess I would challenge folks who are listening or who are reading the book to think about what they could reimagine too, if they're not limited by. What is, and they could envision what we want. That's motivating and that's the driving force behind leading health and for Kansas to lead the nation in health it will require re-imagining.
But Ed, I loved your point. It doesn't have to be. Only reimagining big picture. It could be reimagining in your workplace, it could be imagine [00:40:00] reimagining in your sphere of influence, whatever that is. So challenge folks to think differently and remove those barriers and then work together collaboratively to make it happen.
Susan Kang: I love that.
Ed O'Malley: I think for me, my call to action, it's the same Kari, it's around re-imagining and I love it. And so my call to action would be to ask listeners, What could you ask people to reimagine? Yeah. You know, the Kansas Health Institute could ask people to reimagine the whole health system because of your stature, your credibility on that question of the whole health system.
But for the listeners, what could you ask people to reimagine related to capital H Health? It might be how your team supports each other's wellbeing, your team at work. It might be how your family. It emphasizes health. It might be how your community focuses on uncomfortable data, but what could you help people reimagine?
Thank you for joining us, Kari. For the listeners, the [00:41:00] viewers, thank you for joining us. Next time we're gonna be diving into chapter five, which is describing Kansas when it's gonna be number one. So if this chapter was looking at the glass half empty, next time we're diving into the glass half full, it'll be great to continue the conversation.
Kari, thanks again, Susan. We'll see you next time. Thanks everybody.
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