Ep. 106 - Why Healthcare Keeps Saying No to Better Solutions (ft. Holley Miller)

What happens when an industry built on science and data refuses to act on its own evidence? Host Meredith Hirsh sits down with Holley Miller, a veteran health tech strategist whose 40-plus years navigating medical device adoption, robotic surgery and emerging technology has given her a clear-eyed view of why healthcare is structurally designed to protect the status quo even when it underperforms. Holley reframes clinical resistance not as stubbornness but as rational risk management and makes the case that what looks like innovation failure is really a change management crisis hiding in plain sight. From laparoscopic surgery to AI adoption, she breaks down what it actually takes to move stakeholders, why incremental change rarely sticks and what leaders get wrong when they lead with solutions instead of problems. If you have ever walked out of a conference fired up and watched the momentum die in your next team meeting, this one is for you.

Pull up a chair and tune in. This conversation will change how you think about change.

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Transcript

SPEAKER_00 0:00

If you're getting value from working healthcare, I have a quick ask. Follow the podcast and leave a five-star review on Apple Podcasts, Spotify, or wherever you listen to the podcast. That simple action helps more physicians and leaders find these conversations and better understand how our healthcare system actually works. And that matters because we can't fix what we don't understand. I am Meredith Hirsch, and this is working healthcare. Did you know that about 40% of commercially insured patients leave their health plan within a year? So why does any change have to be made? So I just interviewed Holly Miller, and she has spent her career watching better solutions fail to gain traction in healthcare, not due to lack of innovation, not because of how decisions are made. Her perspective reframes the industry's stagnation as a change management failure driven by risk aversion, misaligned incentives, and systemic complexity. We all want to create change, but do we really? And Holly and I actually figured out a way to talk about our love of bourbon. You do not want to miss this. Holly Miller, welcome to Working Healthcare. Thank you. I'm so excited to be here and have this conversation with you. I am too, because everybody I interview on this podcast, we talk about the problems and healthcare, the problems, and they'll even bring up solutions. But our American healthcare system doesn't seem to want to incorporate these solutions. And I know that is what you're passionate about. Why, when we have insurance challenges and all of these other challenges within our system, are we so resistant to change?

SPEAKER_01 2:05

It's interesting because to your point, it seems so logical, but what we see in practice is the antithesis of that, right? And so healthcare is structurally designed to protect the status quo, even when the status quo underperforms.

SPEAKER_00 2:21

So now I want to go back to who you are and why you got into healthcare, because your journey was not into the efficiency side and trying to fix what was broken. How did you get into healthcare, Holly Miller? I was trying to avoid law school, truly.

SPEAKER_01 2:43

I decided to take a year off before I went to law school. I didn't really have the passion. I ended up in marketing. I was in advertising in New York City. I was selling cigarettes basically. Then I went to California and I was answering an ad that I thought was for PR. And I realized very quickly when I went to the interview that it was the world's first surgical robotic company. And I was just blown away by the intersection of technology and innovation and advancing the standard of care. But I realized very quickly that I was working with a bunch of engineers and clinicians, and they didn't know how to talk to people. They couldn't communicate, they couldn't translate their vision. And I said, you guys should hire a person who knows nothing about this space. And they did. And that was, you know, 30 plus years ago. Yeah, exactly.

SPEAKER_00 3:34

That was you. How does a girl from New York get to California?

SPEAKER_01 3:40

Um, maybe it's a story as old as time I followed a boy.

SPEAKER_00 3:44

Oh, everybody follows somebody.

SPEAKER_01 3:46

And so uh I ended up staying, but I didn't realize that while you might think of New York as like the hub of advertising, California is really the hub of innovation when it comes to the medical device and kind of biotech space. And so it was a happy, you know, a happy mistake or a happy uh happenstance thing, but it really did ground me in this high-tech innovative world that you mentioned where there's constant, you know, improvement, constant acceleration of solutions, but it is at this um duality of this really slow adoption in healthcare, which almost seems at odds with what one might imagine the healthcare space to be.

SPEAKER_00 4:27

You started in the laparoscopic world in the 90s, and now we're like, of course we would do every surgery laparoscopically if we could. Who wants to be cut open? But you shared with me that in the 90s, when you went into these clinics and hospitals, everyone was like, no way. What resistance were you getting?

SPEAKER_01 4:49

I think the first key learning was that despite the fact that healthcare is incredibly science-driven, data-driven, at the at the center of it are human beings. And the human being's brain works the same way as a you know, a neurosurgeon, as if the same way a teenager's mind works, essentially. And so you have to really find a reason to make someone change. It's not going to happen by asking them, telling them, trying to present data. It really has to happen with giving them a reason to change. And with laparoscopy, if you think about it, you were telling a surgeon, you can cut open someone's abdomen, have amazing visualization, amazing access to organs, what have you. Or you can essentially be given chopsticks. And now you're gonna have to do a surgery with chopsticks in a completely different format. And people were like, no, thank you. You're making my job way harder. Yes, rationally, it's better for the patient. It's less invasive, probably lower, you know, um trauma, but it just was hard. And it really wasn't an overnight, you know, shift. It was years of really getting people to recognize, hey, this is better, it's worth changing, and we're gonna help you do it. But the truth of the matter is, most of the established surgeons that became um that were introduced with laparoscopy, they didn't want it. It was really the younger people, the newer people who were like, oh, I don't already have my behavior so entrenched, I'm willing to try this. And then once patients realized, oh, I have a choice, patient demand really helped hospitals kind of make this a standard of care.

SPEAKER_00 6:30

Having this conversation reminds me of what we do in our clinic with ultrasound. So it was early 2000s when rheumatologists, sports medicine physicians, anybody were giving blind joint injections. They were either using fluoroscopy or they were doing it blindly. But my husband learned how to give blind joint injections. Nobody had ever thought of using ultrasound. Fast forward to 2005, when Medicare created changes within their system and said, you can't do these specific procedures unless you're using imaging. So either the doctors stopped doing those procedures and found another revenue source, or they were adding fluoroscopy into their clinics. And I met a group, a husband-wife duo in Texas, who shared that they were using ultrasound and how ultrasound could be used. We're in 2026, so this conversation with them was 2008. So we're almost 20 years later, and there are still so few rheumatologists who utilize ultrasound. I would say the younger generation, meaning probably 50 and under, are utilizing ultrasound. But if you've been doing it that way and you think you have the best results, and a lot of the studies haven't even been done because there's not money in it right now, but yeah, they're not changing. And I don't see this big flood like I had with laparoscopic surgery, as I have, I haven't seen that in ultrasound. But you're right, I think patients tend to be the drivers. What needs to be proven to doctors, to the healthcare system to create change, even in procedures?

SPEAKER_01 8:24

Yeah, it's a great question because again, it seems so obvious, right? If it even if we have a better product, a better test, a better protocol, that should win. But in healthcare, familiarity wins, to your point. How you are trained, what you what you have access to, what you think works, um, that that is the the default. And so I think the biggest problem is that change is often put into two buckets. Either it's a nice to have, or it's a must-have. And if it's not a must-have, frankly, it does not, it's not going to get traction. And so that's why I think even when you see things like patients falling out of care or HTP burnout, staff shortages, um, you know, uh major problems happening, it's not because people don't care. It's because the system hasn't made the new way feel safer, clearer, or inevitable. And so I think what often gets labeled as resistance is really risk management, right? Clinicians aren't anti-change. They're accountable for outcomes. And if the new way isn't clearly safer or clearly smarter, they just default to what's known. And then even if you present evidence to them, that does not reduce perceived risk. And so I think that's really where the healthcare system is a little bit flawed, is that it's designed to reduce variation, right? We want predictability in healthcare. And introducing new things really creates that destabilization, right? You have protocols, you have training, you have compliance. That's all about consistency. And anytime you introduce change, that is a variable that can translate to risk. And I think that's why change doesn't happen as fast in healthcare, despite innovation. And that's why I also think we're getting more incrementalism, incremental improvements that are just like barely taking tiny steps forward, but it's not translating to improve patient outcomes, reduce costs, all the things we're trying to achieve. It's almost like we're talking two different languages.

SPEAKER_00 10:36

Well, we always say change doesn't happen until what you're doing is so painful that you have to create the change. And I love what you shared at one point in one of our conversations is you can't be a cowboy in healthcare. And you really can't. And so it requires somebody to be the innovator and that early adopter. And being the cowboy, why can't you be the cowboy in healthcare?

SPEAKER_01 11:06

I think, you know, we talked about um a couple things. Well, in the US, especially, it's a very litigious society. I mean, a lot of doctors can't even afford malpractice insurance, right? It's it's almost untenable. So I think just this idea of taking risk is is is not where it's not the common lane for people, right? Of course, if someone doesn't take that initiative to be the early adopter, to be the innovator, to question why do we have to do it this way? Why do you have to monitor a patient only if they're in the hospital? Why do you have to prick your finger uh to take your, you know, to touch her blood sugar? Why does the surgeon have to be standing scrubbed in next to the patient and the OR? If someone doesn't start to like reject the premise, we would just be, you know, uh, progress would never be made. But I think, as you point out, you have to really find, I think, um, a problem that's worth solving, that would have a big enough outcome that people think, yeah, this is, I see the future. I see this is the way things are going, and I want to be a part of that. But you also start small. You're not gonna boil the ocean, as I say, right? You're gonna find a killer application that really makes sense. So going back to laparoscopy and robotic surgery, which I had my uh initial kind of focus on. Intuitive surgical, DaVinci robot, it's it's everywhere. It's a multi-billion dollar company. But for 10 years, really, that company was looking for a procedure that made sense. And that surgery has ended up being the radical prostatectomy. But it wasn't, it was not the first application. The first application was beating heart, endoscopic cabbage, which is like the hardest thing in the world you could possibly do. It's like putting, you know, someone on the moon. And instead of saying, like, hey, let's just try to get someone into space first, we tried the hardest thing. It wasn't until, to your point, the lap coli became the default uh standard for surgery. It wasn't until that happened that people said, why can't we do more procedures minimally invasively? And radical parasitectomy became the starting point because it allowed the surgeons to get deep access into the patient anatomy, which they couldn't before, but it also preserved their open technique. And so to your point, you were changing something they wanted, which is kind of access, uh, dexterity, um, precision, but you weren't changing their technique. And so I think that's very important when you're thinking about really innovation. It's like you can't create new problems. You have to find a problem that's worth solving and then essentially make it make sense and start with kind of your beach head and then figure out how to expand. But it's not just like you make a mandate and it happens.

SPEAKER_00 14:02

I just interviewed Dr. Alan Voskanian, and he talked about physician burnout and pebbles versus boulders. And there are so many pebbles. And I asked, how do you squash the pebbles? And I'm just thinking about change management in healthcare because this is what I have to focus on as well as the CEO of the Hirsch Center. And I have all of these boulders, not even pebbles that are standing in my way. I have payers and providers and regulators, and it's so exhausting. Like, how do I even start? And what's the purpose of starting?

SPEAKER_01 14:46

Yeah, I love that question because I think it's easy to point to the problems, and it's much, it's much more difficult to figure out well, how do we actually solve this, right? And to your point, it's not just like one thing. There's many, many things that you could focus your energy on. So I always, you know, think like, what would lead, what should leaders do? And I'll give you a framework in a minute, but I think it's it's sometimes good to have a real world, real world context to think about this. So, you know, new innovations, I think, or even new protocols, have to be first evaluated, I think, through the lens of is this incremental and transformative? If it's incremental, it's just one of many boulder, I mean, sorry, one of many pebbles. And like maybe it's uncomfortable to walk with a little tiny rock in your shoe, but like you can still get around, right? So I think it's this idea of if it's not transformative, like don't even, don't even fight that battle. I think the second one is you have to crystallize why this needs to exist for all the key stakeholders. And it, you know, that could vary by clinical, you know, setting. So you've got you know, EMS in a hospital. That's the same, that's an important stakeholder as the hospital, you know, chief medical officer. So really understanding that there has to be a clear reason this needs to be acted on and acted on now. I think there are a lot of problems that are real, but you can still wait to address them. And so let me give you one example of hospital-acquired infections. I think the status something like um bacteria alone causes 90% of AHIs, and almost 100,000 patients die each year in the United States from hospital acquired infections. Hospitals, I think, spent something like $45 billion each year on this. Um, and when you look at the cleaning practices, decontamination basically is 50% of the problem. You're just not cleaning, we're just not cleaning surfaces well. So we we we know we have better and we have new disinfection tools. But what hospitals are saying is let's just all wash our hands more. Like that's kind of the lowest, you know, barrier we're already supposed to be doing. If we just wash our hands more, that's gonna somehow fix the problem. But we know that's just not true. People just they don't do it. And so I think to your point, even if you prove I just read all those stats, even if I give every single person in the hospital those statistics, that is not going to move them. They have to be emotionally connected to, I want to be part of this. It's almost like you have to create a calling to create a cause for people to get around. And then I think the idea is like find some place to begin. So, like with A um HAIs, the ICU is like the worst place for this. It's the most problematic place, starting starting in the ICUs. And so you can't just say, do a better job. You know, you have to say, let me give you a framework that's gonna make this make sense to people. And I think that's where people don't know where to begin. They just make people watch a training video. They maybe put a poster up in the break room, you know, they and they do grand rounds, like all these things, but it has to really make sense to people. Otherwise, it becomes optional and it doesn't feel inevitable.

SPEAKER_00 18:04

I think it's important to bring in the empathy to bring in the relatability, right? You have to explain the why. I always say, okay, that may be our policy, but that's not something that is going to help you understand or retain the why behind it and to create the change that needs to be implemented. And I'm struggling with in the world of AI right now. I went to the MGMA meeting, Medical Group Management Association meeting last year, and I think 90% of the vendors were involved in AI in some capacity. I come back into my clinic super excited about all of these ideas. I shout them out at my leadership team meeting, and they all look at me like, oh my God, don't go to another meeting, and they're overwhelmed by the number of changes I want to create because I love change. I thrive in change, but most people don't. So, how can we actually get from all of these ideas and a way to fix it to actually implementing it and getting even your leadership team on board?

SPEAKER_01 19:18

Yeah, I love the question because you're right. Most of us don't thrive in change. And I think, you know, going back to an earlier point, you can't change everything. I mean, even if it's, you know, cleaning your house, it's like don't take on everything, take on one task, right? Just, you know, tidy up the dishes, whatever it is. And so I think sometimes we try to take on too much. That's one problem. The second thing I think is um, I I kind of recommend like a three-part, um, sorry, four-part um framework for leaders and you know, leaders at any level, again, whether you're in an office setting, whether you're, you know, a mom at home, I think you have to first start by clarifying the problem that must change. Because if the current way still feels acceptable, the new way will always be optional. And so I think that status quo has to feel, you know, visible, costly, you know, increasingly untenable. If people just think, oh God, you know, Meredith just came back from another show and she's talking about AI again, right? Like they don't care. They don't know what problem really needs to be solved. So I don't think you should start with a solution of AI. I think you should start with why the current way is no longer good enough. And I think I'm not gonna lie, there can be different scenarios and different stakeholders where that cost, like that problem, is more acute. And I often give the example of um if you're flying to a conference or you're flying to a meeting, if you're if you get a free upgrade, that sounds amazing. But if I cancel your flight and you can't get to your very important meeting, that's really a disguster, right? But if I'm a college student and um you they need an extra seat for a CEO to get on a plane and they offer me a thousand dollar, you know, flight credit, I might think that's amazing because I'm a poor college student, and so I really want that. So I just think we have to be realistic. Not all stakeholders are gonna have the same level of acuity with that problem. And you just have to be aware of that.

SPEAKER_00 21:21

I also think it's an issue with longevity. I think that people job hop often. And so if you are going to create a change that hopefully isn't just this little incremental change, and you want to create a larger systemic change, how do you do so if you're constantly having a revolving door within your clinic?

SPEAKER_01 21:45

That's a really good question. I just read an article by Becker's, I think earlier this week, about the cost of nurse turnover. Um, and it was shocking. And I was like, this is, you know, this is a really big issue. And so I think one of the things you it's just

SPEAKER_00 22:00

Share that issue with Holly. I also read a statistic, and nurses are the largest turnover issue for hospitals. Over 100% turnover within a year for nurses. I literally go to hospitals to recruit for my infusion nurses because I know that they don't want to stay there. And then you have hospitals gobbling up other hospitals and so forth. So going to your point again, yes, the turnover. And what are we doing?

SPEAKER_01 22:32

And I think, you know, it goes back to um. I think it goes back to, yes, every hospital and clinic and and environment has these workflow protocols. And so I think the idea is a lot of times, I mean, this even happens, you know, talking about, you know, surgeries. You might love a surgical tech or a surgical scrub nurse. And if they're not there that day, like it makes your day, you know, go crazy. And so I do think there is this variability that we don't like in healthcare. And so I think, you know, going back to your question, I think one, what are we going to change? Um has to be important. Two, what does better actually mean? If people don't know what it looks like in the day-day decisions, they'll default what's familiar. And so I think in your point, we have to teach people, one, whatever change is, it needs to have a very positive impact. So if you if you say like, okay, when you're at the bedside, do X, you know, in this next visit, do Y. I think people have to really understand how these abstract improvements really um filter down into their dimensions or moments or actions. And I generally feel if it makes sense, people really don't mind the change. If it doesn't make sense, I think that's where things get really crazy. And I think to your point, in general, like what's causing nurse turnover, that could be multiple factors. But I think the idea is the more we can help improve things, I do think we'll see some more stability overall. That's a big, you know, a big, big picture item. But then I think there has to be this reduced perceived risk in the moment of decision. What I mean by that is people don't adopt change when they're convinced. They're going to adopt change when they feel safe on acting on it. And what I mean by that is peer validation, you know, clear guardrails. So those are all things that make people feel good, nurses, EMS people, you know, doctors, um, department heads, like there is this idea of celebrating the wins, but it all again stems from like, why does this matter? And we have to emotionally be invested. You know, who's already doing this? How can I trust, you know, that this is going to be okay?

SPEAKER_00 24:43

So one of the ways that I create change within our practice, and I'm thinking specifically to MIPS protocols, so our merit incentive payment system. And they every year we have to follow different quality measures, or we may have to add one more, or one was discontinued. I mean, God, CMS is always creating new opportunities for us to practice change management. So this year I am reviewing opportunity costs with Shelly on my team. Shout out to Shelly. She listens to working healthcare. And she does an amazing job of reviewing all of the opportunity costs or the missed opportunities in documenting the quality measures. And when we have monthly incentives that the team can earn $50 or $100 if they reach a hundred percent or a 95% plus documenting the quality measures, they do fabulously. And then you take away that incentive and they forget. And that frustrates me because I've spoken to managers about that on our team, and they're like, well, part of their job is to document these quality measures. Why are we having to give a bonus because they reach a certain threshold to document? So I struggle with that as well. Yes, they like affirmation, good job, but they also like money, right? Money talks. And so how do you balance this? Where does it end? Because I'm just seeing at this lower level of documentation how to make sure that we are constantly dotting our I's and crossing our T's.

SPEAKER_01 26:30

Yeah. It's a great question. And I I would say the short answer is those people haven't been converted. You know, they don't actually believe that this documentation is the better way forward, or inevitably this is important. But honestly, it isn't.

SPEAKER_00 26:44

Holly, it isn't. It is a waste of our time and it is a game. And I can't even tell them. But this is what I say. If we don't do it, and I and maybe you can help me with this, because they don't care if the practice makes more money. But I do say if we get a bonus for submitting these quality measures, that bonus seeps into your salary increase, your hourly pay increase. That still doesn't seem to convince.

SPEAKER_01 27:14

Yeah. And I think it's because it's they're kind of like the college student. Like they don't really care if the flight takes off or not because they're gonna get a two, you know, a thousand dollar, you know, cred credit on their next ticket. So like that problem, even if it's like it's a requirement, it just doesn't really motivate them. And I hate to say it. So I think the truth is when you have multiple stakeholders, right? I think you have to find a way to win with each of them. And it may be different. You can't be schizophrenic, you know, like, hey, we do it because of this. But I think the truth is you do have to find um a way to, you know, connect with them and make it feel like it is worth her effort. Yeah, with enough time, maybe it does become like default, but I do think sometimes those motivations just don't feel like enough if they go away. It feels optional. I think that's the difference really with true evolution, true advancement, especially of healthcare, is that it means that the old way is no longer adequate. You can't defend the old way. And I also think to your point, it's not gonna be like you flip a switch. You know, unfortunately, I think healthcare it does take time, but I think the reality is you're gonna have to find a way to make it matter to each of your stakeholders, and it could, it could vary.

SPEAKER_00 28:26

Change management is exhausting.

SPEAKER_01 28:29

It's exhausting. I'll I'll give you one example. I mean, again, I'm not saying this applies to everyone, but for my team, um, I wanted to keep people engaged, I want them to be happy, they're super talented, I don't want to work without them to your point. Going and finding another person is exhausting, it's expensive, it it's it's something I don't want to have to deal with. I just asked them, like, hey guys, like maybe I can't give you a promotion, maybe I can't give you a raise. But what if I gave each person one extra day off a month in addition to your PTO? And like people were so Oh, that's amazing though. But like to me, like it didn't cost me anything. Yes, it did. So you have to get covered in anyway. But the truth is, like, that was a huge thing for them. And to me, I thought it didn't, it didn't cost me anything. I didn't, I don't have to pay them more. I don't have to change salaries. It's just really something that they valued, which was having more time to do whatever they want and they could plan weekends, blah, blah, blah. So I think again, sometimes you'd be surprised on like what people, what they want. And, you know, I talked to someone else, she wanted a promotion. I said, well, just tell them you want a promotion and title, but you don't need a salary change. If the title change is most important to you, but they'll give it to you out a salary change, take it. You know, like that's a win for you and a win for them, you know.

SPEAKER_00 29:46

So when our employees hit their 90-day review, we give them a book entitled The Five Languages of Appreciation in the Workplace. And I we hand it out to the employee and we're like, this is a gift. Congratulations, you've hit 90 days, and you have the option to read the book, read it if you want, don't read it. But there's a seven-minute little quiz. It's not a quiz, I don't even think we use that word quiz, but there's a seven-minute form. Here's the QR code, go ahead and fill it out. It helps me understand better as your manager how you feel appreciated. And our team members really enjoy it. I know I like acts of services, number one, and words of affirmation, number two, and giving me gifts is my least favorite appreciation language. But it, to your point, helps employees feel recognized and appreciated for what they're doing because some people may want that PTO day. Some people may want money, some people might just want the pat on the back, but it's trying to figure out what every employee wants. I interviewed Ashuk Gupta. He's a physical therapist who created this amazing company that is virtual physical therapy. And the turning point and what made it so difficult was COVID, right? COVID was massive for change. And because of COVID, we now have a lot more telehealth. Do we have to wait for another COVID to see great improvement in our American healthcare system?

SPEAKER_01 31:28

I love the question because I think to your point, uh, you know, telehealth is a great example. That was around forever, right? Many, many, many moons. But guess what? People weren't getting paid for it. So the payers were the ones really who were making that, um, preventing that really from becoming a reality, even though providers or clinicians and patients wanted it, right? But payers didn't. COVID forced their hand. They had to do it, right? And it became very clear there are some things you can't undo, right? Masks have kind of been undone, telehealth has not been undone. And so the thing I think which is gives me hope and optimism about healthcare is that um I've spent most of my career helping uh companies create what we call new categories, which is new ways of doing things. Um, instead of again, just making things incrementally better, it's like we're gonna do something radically different and radically change patient health care and patient outcomes. And as you as you were kind of alluding to earlier, like that's very hard to do because people don't like change. They kind of want to default to the way, you know, the way it goes. But the the formula that I have come to um recognize, and this is what gives me hope, is that change in context creates new opportunities for new innovations to come to fruition. And what I've learned by that is that if you do something too crazy and too radical, it's too much for people. So it's this idea of being adjacent possible, what's taking where we are today and adding one more meaningful step that's still grounded contextually in things that are familiar to us and things that we like, and just kind of pushing them. And it's not pushing it a little bit, it's enough change that it actually is different and new. And so I think this idea of um COVID and how things change, but that's not, it's not just a pandemic. It can, I mean, AI is another example, right? The healthcare industry has been laggards with AI. Some of it is payer-driven, some of it is FDA driven, you know, some of it is um just the complexity of disconnected, you know, data centers and patient information. We've been behind that. But the truth of the matter is going back to patient demand. Like the rest of the world is pushing forward, and the healthcare industry has realized we've got to get on this boat, right? Like it's it's leaving the dock with or without us. Let's be on it. And now health systems, payers, they're all trying to create their own AI systems, right? To help them because they realize this is not going away. And so I do think to your point that change is good. You know, it it does force new innovations and force new ways of doing things. But I think in healthcare, it's never gonna feel like an overnight change. It's always gonna feel, I think, um, kind of resistant. And then you do hit that breaking point of crossing the chasm. And then I feel like it feels obvious. And I think there's many, many, many examples of that. But I think every innovation going back to penicillin, the big thing for penicillin was the war. War uh soldiers came home from the war and they were missing their missus and they were having syphilis. And so they're like, let's actually give them, you know, drugs. It also drove healthcare change. So I do think these changes of context are what drive changes, but you want them to not feel like a pandemic. You want them to feel much more positive.

SPEAKER_00 35:05

I love that you brought up the chasm. One of my favorite books is Crossing the Chasm. And we in healthcare, and that's because you and I both were in advertising, so we read the book. Uh in healthcare, we are innovators and then early adopters, and you move up the chasm, right? And then you finally get to cross it. None of us want to be the innovators. We don't want to be those who are testing the first iPhone. We don't. That's not who healthcare workers are. That's not what doctors want to do. And then you have administrators, they like to call us the MBAs, or you know, the ones who get to tell them what to do, and get angry at us when we want to create that change. And I think about the government who can't even properly fund all of the aspects of our government right now. And I sort of wait. So when a new protocol comes out and we're given one year, two years, three years lead time, I sit back and wait because I feel like when we have a new administration come in, it's gonna revert because every four years and sometimes every two years, our government, our federal government, I mean, 80% of my medical practice is Medicare. So I'm waiting for the federal government to create these changes. But I'm constantly playing whack-a-mole against what's coming up. So trying to put something into place for a positive feels too ambitious. Do you see this day in and day out with healthcare facilities? Am I alone? Or is this what you see in your line of work?

SPEAKER_01 36:50

100%. And I was just having a conversation with um someone yesterday. I need to introduce you because I think you guys would be like, um, you he would, he'd be a great guest for you. But I think the reality is, as you were saying, is that we have the triple aim, right? We know that. We we ascribe to it. No one's gonna be like, no, I don't think we should have better patient care, lower costs. Like everyone's agreeing with this, right? I think to your point, though, it's what's mandated and how how do you do it? And a lot of things they do give you run, right? Because they recognize the the realities of healthcare. You can't just again flip a switch, you can't just, you know, re-engineer um, you know, everything from the ground up. And I also think we're a little bit fatigued, maybe for lack of a better term, we're fatigued with all these like kind of back and forth, right? It's this and that, and it's this and this. And so I think there is appropriately so this kind of like, let's just see what sticks. Let's just wait a little bit. And so I think that is just expected, right? I think which um I think what I think is is has been a missing piece of the puzzle to some degree is having the data that could potentially be harnessed to make those things feel like the right thing to do in general, versus just it's a mandate. And what I mean by that is um you mentioned, you know, your patient composition. Um, this company has the ability to take your data, patient data, postoperatively, let's look at hernias, for instance, and they can say, okay, here's here's how much this hospital makes or loses for every hernia case. And it's looking at all these different factors. And if overall it's like, okay, this is bad news, it's you know, a thousand dollars, we lose every hernia. What are you supposed to do with that? Even if they're like the mandate is to take all your hernia to an ASC, you know, it's like, it's like, why, right? But if you could say, here's your hernia data, and for your Medicare patients, if you use this approach, this is the better outcome you would have. And it not just lowers the cost, but it actually creates better outcomes consistently. If you do um, you know, a robotic approach, what happens and the ability to like toggle between factors to give real clinical intelligence to hospitals and administrators and the clinicians, to me, like that's really empowering because you can see this is what we should do, this is what our goal is. And I feel like there's been a little bit of a missing link between what people say we need, what the mandates are, but how do you actually do this? And so I'm hopeful that there is um becoming available new pieces of the puzzle that make it much easier for hospitals, for clinics, um, you know, um providers, even private providers, to really recognize these are the things I can change to get better outcomes that make sense and I can actually do.

SPEAKER_00 39:50

Well, I think hospitals have an easier time doing it because they're larger, they have more money. I'll use my medical practice as an example for an independent practice, wanting to be up to 2026 and using the AI that I know that we need to implement. I have a leadership team of eight people. There are eight of us on our leadership team. There are about 60 people on my entire staff. And we have a conversation about workflows and about creating and utilizing AI tools so that we can provide better outcomes for patients in the sense of I'm talking the business side. So patient retention and recall and reactivation, and then on the other side, medical record requests and trying to figure out a way to save us manpower and automate the system. But I get a lot of resistance from I get a lot of enthusiasm at first from my leadership team. And then I get resistance because nobody has time. So I decided I'm gonna hire my son for 90 days. So my son is a mechanical engineer by trade, and he is in the bourbon industry, and he created a data analytics company that automates warehouses when bourbon is age. So any type of age spirit. He could do tequila, he could do whiskey, bourbon, any of these things. So he scotch for those in Scotland, but this is what he has created. And I'll tell you, working in the bourbon industry is like working in a 200-year-old startup. They don't like change either. And so Ethan is working through this, and I said, Oh my God, you have to figure out how we can use AI in our healthcare practice. You grew up at the Hirsch Center. Like, come in. I want you to use the brain that you've used looking at different companies, Buffalo Trace. He was there and created workflow efficiencies. And so I shared this with my team and they were resistant. And so I feel like I'm hitting walls all of the time. Krista, my team, has gotten them very excited about Ethan coming in, and I'm really hopeful, but I'm looking at how can independent medical practices implement change if this is what I'm experiencing.

unknown 42:19

Yeah.

SPEAKER_01 42:21

I think it goes back to this idea of like um the inertia that you you mentioned, it's it's because humans are involved, you know. And that's just kind of the way our brains work. And so instead of I think people being frustrated, I think we just have to kind of one recognize that um I think on AI specifically, this has been my experience with AI specifically. I think that people, um, the people you're talking to are not AI experts, right? Um, even in the case of, you know, your son, like I love bourbon. So like I think it's fascinating that he's using this, but like I don't have to become the expert. I'm just gonna drink my age bourbon, I'm gonna love it and I'm gonna be happy, right? I want the, you know, when when my when the AI says this this batch is ready for release, I'm gonna put my name on the waiting list, I'm gonna be super happy, but I don't have to basically know AI, be an AI. It doesn't make any difference. I think with your team potentially, what they feel is like this is not my area of expertise, and I don't know what the implications for this mean to me. Am I gonna be replaced? You know, is something else gonna happen? And I think um we've been doing this with my own company, and what I realized, and maybe this is similar to what you guys are doing, is like kind of being like, hey, we're gonna use AI, there's lots of ways we can do it. Everyone go do it. It was met with very mixed results. What we've done now is say, okay, we're gonna first ask people, what are the tasks we do repeatedly? You know, like what are the things we do every day or often do? And that was the first step. The second one was how much time does it take to do those things? The third one was what would be the most meaningful change in metrics? So, you know, whatever your guys' KPIs are, there are You know, they're whatever they get, you know, graded on, what have you. If that could be improved, you know, pick one, which one do we think is the most important, if that could be improved, would would it be worth it? And I think it was once we kind of had those conversations, it was very clear of like no one's being replaced. We're talking about how do we leverage technology like AI to act as a force multiplier for us. Because what my team, I feel like is getting paid for, what we get paid for, is our intellectual capital. I'm sure your team, I you want them to feel the same way. Like you need them, right? You're not trying to outsource their expertise or roles. And so I think once we reframed that as this is helping us work smarter and faster, but we're the ones thinking it did help change. But I think we had to go through a very step-wise process and do it kind of slowly. So I think I'm hoping you'll be excited after your son comes in and kind of does his analysis. I think it might create more structure and framework that might actually allow them to get more excited and more open to that. But just coming in and being like, we're doing this, I have found like doesn't translate well.

SPEAKER_00 45:05

It's funny because he said, You can pay me by allowing me to be on the podcast. I'm your only child who hasn't been on working healthcare. I said, Ethan, you're not in healthcare. He goes, I will be now. I should be, right?

SPEAKER_01 45:18

I will be. But I think he's gonna have, I mean, you should, because I think he's gonna have a very interesting perspective. And similarly, we first got into healthcare, I think I was valuable because I came from outside. I brought a different perspective and I helped them translate kind of their vision a way that made sense to their stakeholders, just like Ethan might have a way to say, I'm not constrained by the healthcare, you know, constraints. I'm gonna come in and kind of solve the problem the way I think makes the most sense. And I actually think that can be really enlightening and very, very productive.

SPEAKER_00 45:49

With all of these opportunities for change, Holly, if you could create one change within our American healthcare system, what would it be?

SPEAKER_01 46:01

Surverbon to everyone in the hospital. I'm just kidding, that would be terrible. That's a great one. I mean, this is such a hard question, but I think one potential change that I think could be transformative is to have all patient data interconnected. So there's, you know, visibility by all the different parties, everyone can access it because it's so siloed right now. And I have older parents, and trying to manage them, first of all, from 3,000 miles away is difficult, but they're all in different systems. My dad's part of the VA. My mom's in different places, they have different doctors, different things. They're in different cities sometimes, these doctors. And so no one has the information they need. No one can really see everything. And therefore, you can't make informed decisions. And I think that's kind of where healthcare gets off the rails is if we don't have all the right information, how can we possibly create a care pathway for patients that helps us achieve the triple aim? So I think without that, I don't know how we really make meaningful inroads. I can name a million other ones, but I think if I could be, you know, queen for a day and wave my magic wand, I think that would be a good place to start.

SPEAKER_00 47:13

You know how I'm going to help solve your problem? You're gonna listen to two podcast episodes. One, okay, with Steve Lewis, amazing. He created a platform for patients to be able to store all of their medical records. And he used AI. He's actually in Australia, and uh hopefully my he'll be my son's BFF when uh he studies there in the fall. But Steve Lewis is great. His company is Naboo, N-A-B-U, and I did a podcast episode with him. And then and then a shook goop da, he just sat in a meeting with heads of insurance companies and tech companies, and they are creating a way to integrate the health record for patients. So the government, and they're starting with Medicare, and I said, Really, you're gonna have a 65-year-old plus patient have the be the platform for uh using AI and using a Q. Yeah, using a QR code. I'm like, can we start in pediatrics? But this is at least in the forefront and bubbling, and I am very excited about it. So, to your point, Holly, change is possible.

SPEAKER_01 48:28

It is. And I love that. And I'm glad people are tackling those problems because those are the ones really worth changing. And I do believe that, you know, finding finding the ways to break down those types of barriers really will produce change. And I think it can start on the patient side. You know, there's been such a great shift, I think of pause once to patients being more empowered about their healthcare and their decision making. And so I think that's a great place to start. And I, like I said, I'm actually very hopeful that a lot of um new innovation and new opportunities and those those innovators who are who are willing to do the work will have change. I just think we have to recognize that, you know, pick your pick your starting point where it really makes um you know the difference, make it matter to the people, and then figure out how to expand it. You're not gonna be able to do it at scale. You just can't. And so to your point, pick a place to start, pediatrics, ICU, you know, a certain condition. Um, and I think a lot of the things that people thought were impossible or wouldn't work, they do, you know, they do. And I think you gave a great example of telehealth. We kind of knew where the writing was gonna be on the wall from this, which was like, yes, people would prefer an injection over, you know, bariatric surgery, but also there aren't enough doctors to prescribe it, you know. Then they created telehealth centers just specially um designed for this. They have um, you know, created now an oral version. They are using it in other ways to help patients. And so it's just one of those things where like when something innovative happens, there is a way to affect change with it, but it does take time. And I think that once that shift happens and it becomes, you know, inevitable in people's minds, you don't go backwards, you know. No one's using a, you know, uh an analog thermometer, digital thermometer. Like, you know, no one's telling patients that you have to only go to the hospital to have your vitals monitored. This doesn't make sense, you know, you don't go backwards typically.

SPEAKER_00 50:38

Holly Miller, thank you for joining me on working healthcare. If this conversation hit home or made you think a little differently, don't keep it to yourself. Share the episode, tag a friend, or post about it on social media. Connect with me on LinkedIn to keep the conversation going in between episodes. If you've got a question, an episode idea, or someone you think I should feature, send me a note at MeredithHirsch.com. Thank you all for the five-star reviews. They help more listeners find the show. New episodes drop every Tuesday. Subscribe so you don't miss what's next. Tune in weekly as we explore the inner workings of healthcare because you can't fix what you don't understand.