Contributor: Akshat Shekhar
Work and Life is radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).
On Work and Life, Stew Friedman spoke with Dr. Stephen Klasko, President and CEO of Thomas Jefferson University. Dr. Klasko has advocated for a more holistic approach to health care delivery, along with the smaller iterative changes that make such an approach possible.
The following are excerpts of their conversation.
Stew Friedman: Tell us about “interactive action” and why that’s so important.
Stephen Klasko: Part of what we’ve done in healthcare is focus on the past. Think about everything you can do as a consumer online. The Friday after Thanksgiving you can be in your pajamas watching Game of Thrones and do all your holiday shopping. But if you have a stomachache can you put “stomachache” on your iPhone and get an appointment with a doctor?
SF: WebMD—doesn’t it do that?
SK: No because with WebMD you cannot get an appointment with a doctor or really do “telehealth” like you would do anything else. My goal is to look at what’s going to be obvious 10 years from now in healthcare and just start doing that today. A lot of that is changing the DNA of the system one physician at a time. The number one thing about the Affordable Care Act that hasn’t really been talked about is that we haven’t changed the physicians. Our physicians are living in the 80s and 90s, and yet we’re trying to build a 21st century healthcare system.
SF: Let’s stay on this concept of “interactive action,” and then talk in more detail about what you’re doing to change both the mindset and skillset of the medical community. How does “interactive action” come into play?
SK: We’ve gone to our docs and said, “I want you to visualize yourself as a patient, figure out what you would want if you were in their shoes, and then just start doing it.” I’ll give you a couple of examples. We started a model where our doctors, nurses, and population health professions are all working together in a simulation. We have things happen that would normally happen in a hospital, and we look specifically for their first communication. After, we talk to them about what they can do to change the way they interact with other folks in order to be more effective. There’s almost none of that in medical school. I never learned how to interact with a team member until I learned by doing when something went wrong.
SF: This simulated environment is for the seasoned professionals already on the job, right?
SK: Actually it’s for both. We created the Center for Transformation Innovation not only for the seasoned professionals, but also for our medical students. Everything about medical education is ‘look to the left of you, look to the right of you—only one of you will get in.’ It’s constant competition in medical education, but then we’re amazed when physicians don’t work together as high-powered teams. A lot of my research has been based on what makes physicians different from average people. Interactive action is about taking steps to go from having physicians being autonomous, competitive, and hierarchical creatures to having them become more interdependent and members of a team.
SF: Wow, that sounds radical, Steve. So what does it mean for a physician to become a member of a team?
SK: It means you have to teach doctors more “followership” as opposed to leadership. We thought it was a big revolution to teach doctors leadership, but some of us are pretty good leaders already. We like to give orders. Now it’s about how we become followers. Maybe the nurse knows more about something than you do, and you have to listen. It’s about listening skills, interaction skills, and ultimately making those practices an important part of what they do every day. We’ve shown that this model provides better care because medical teams are communicating better. In an accountable care organization in Florida we showed improvements in the triple aims of patient satisfaction, cost, and quality, just by communicating and interacting in a different way. Rather than doctors giving orders, we encourage getting teams together and making decisions together.
SF: What resistance have you met in trying to push a different mindset and role for physicians in the medical community? What was the most important hurdle you overcame?
SK: I actually did a study with Richard Shell from Wharton about why doctors don’t understand collaboration and found that doctors blindly followed rules. When the MBAs didn’t get it, they said, “We failed.” When the doctors didn’t get it, they said, “I’m really sorry, but at least the other person didn’t win either.” The way we select and educate physicians now creates a cult around a competitive, autonomous, hierarchical, and non-creative bias.
SK: The issue is not that we’re not creative, but when we asked MBAs and entrepreneurs if creativity was something that helped them in their profession, they said yes. Doctors, not so much. When I went to Wharton, they said, “You are so lucky to be in a $2 trillion industry in transition. Things are going to be good and going to be changing.” Then I’d be back in our old lounge, looking at the same set of data, and doctors would say, “I wish things were still the way they were 20 years ago.”
SF: They were threatened by change.
SK: The MBAs felt change would help them come up with an answer, whereas we doctors felt we would be autonomous creatures losing control. We found that to deprogram this cult that we doctors are entering into, we have to change the DNA of the system by selecting and educating physicians in a totally different way than we do in medical schools today.
SF: That’s a big agenda, Steve. Where do you start with the education and socialization of medical students?
SK: We still accept students based on science GPAs, MCATs, and organic chemistry grades.
SF: Well, I want my doctors to be smart.
SK: One thing is that we’ve been surprised that doctors aren’t more empathetic communicators. Is a doctor with a 3.9 in memorizing biology much better than a doctor with a 3.6 or 3.5? Or would you rather have a doctor with a 3.5, who memorizes 92% of the Krebs cycle instead of 100%, but also can communicate with you? We started a medical school admission model where we actually choose the students based on emotional intelligence. We’ve chosen 56 students a year based on empathy and social awareness. Once they reached certain academic minimums, we knew they were smart enough on science.
SF: So technical excellence is needed, but you also need to be able to communicate effectively and listen well. Once you make a certain cut, then you test on other factors?
SK: We look for self-awareness and empathy, much like Google and the airline industry do. They want to conduct behavioral and clinical interviews. We take these applicants to art museums, for example, and we ask, “What do you see?” Half the kids can only see what they see linearly.
SF: Concrete thinking.
SK: I’ve delivered over 2,200 babies, and I know it’s easy to deliver a healthy baby. But if you deliver a Downs Syndrome baby and the mother asks, “Doctor, what does that mean?” you can’t reply “It means that the chromosome…” Consider that doctor compared to another who says “Your vision of what a perfect baby means might have to be adjusted.”
SF: Now you’re helping me understand.
SK: It’s about seeing versus observing. To see is to see linearly, to see the DNA, but to observe is to recognize what signals the patient is giving you. We believe the folks we accept based on empathy and self-awareness will be better partners, better fathers or mothers, and better in their work-life integration.
SF: Why is that important to you, as the CEO of Thomas Jefferson University and Health System?
SK: It’s important to me because I believe that in order for healthcare to fundamentally transform, it needs to be about the people that provide the care. If we have a more stable and caring workforce of physicians and nurses, patients will get better care, and we’ll be able to provide better access to them.
One of the things we do at Jefferson which I love is that we have a practice which includes standardized patients. We have the physician go through what they would actually go through in an examination, but then we have the patient critique them while videotaping the doctor throughout. Normally medical schools just check off whether or not you asked all the right questions, but we look at the communication skills, and we ask the patient how he or she did in that regard. If a doctor or faculty member says, for example, “That’s ridiculous, I wasn’t looking at my watch,” we can check at the video like when a golf instructor tells you you’re lifting your head in your swing.
SF: Does it break through to them once they see the data?
SK: Well, if they’ve been doing this for 20 years, they’ll say they think the video was doctored! For the medical students, they really get it: think about not doing that, and think about the fact that we unleash doctors on folks without any of that cultural bias training. Part of the training we’ve done is that we’ve coached these medical professionals and residents so that their overall professionalism skills will be up to where they need to be.
SF: The fact that physicians need to have lives that are enriched not just in the clinic, but also in what they’re doing in the home and community—why is that important to you and the future of medicine?
SK: That’s sort of my job, as a president of a university. I gave a talk on “Humans of Tomorrow” in the Hospitals of Tomorrow for US News and World Report, and I started out by telling my introducer, “You know what? I may never get invited back here after saying this, but I think you’re a big part of the problem in healthcare because what you judge us on is not based on what you personally would want in a doctor. You judge us on technical attributes, but not how our folks are doing after spending $200,000 at our university.” He looks at me and says, “You’re right—you’re right that you’ll never be invited back!” But since I charge these students $55,000 a year, I view an important part of my job as ensuring that five years from now, that doctor that came from Jefferson not only provides great care, but he or she also provides great caring. I also would like to know that they’re great mothers or fathers and partners, and I view that as my job too, not just teaching biology and cardiology and OB/GYN.
SF: How did you come to that understanding that an important part of your job is that people have lives beyond work that are enriching and meaningful?
SK: Frankly, a lot of it came from when I went to Wharton and law school and seeing that there are different ways of teaching. The way we select and educate physicians is not only maybe creating a cult, but it also might not be the right way to the future. I looked and saw that so many of my physician friends had gone through divorce and had not been happy in their profession. The Wall Street Journal says 70% of physicians feel unhappy 2 or 3 years out, and they’re also not happy about their futures. I think they’re unhappy because they’re autonomous, competitive, hierarchical, and they don’t think creativity.
Our goal is to create physicians that are excited, for example, about change, so that when something like the Affordable Care Act comes, they ask “How can I help?” as opposed to “How can I go back to where we were 20 years ago?”
If you go to a tennis coach for a year, you expect to be a better tennis player. At Jefferson, we’ve launched a pilot initiative to make our patients feel better a year from now. We’re bringing in more than just the typical physicians to help them do that. Medicine needs to go from these episodic sicknesses to continual and sustained wellness.
SF: That’s so exciting, Stephen. For people listening out there, can you share what you have learned about creating meaningful change in organizations that you’d like to pass on?
SK: If you look in my office, there are two quotes. One’s from Buckminster Fuller: “If you really want to change something, don’t try to change the existing reality. Create a new model that makes the old one obsolete.” A little further in my office is another philosopher, Mike Tyson, who says, “Everyone has a plan until they get punched in the mouth.” I believe if I’m running a mom-and-pop shop or academic medical center and something needs to be changed, I need to start by creating an optimistic view for people around the future. We have a great morale here because we’re trying to envision and create the future today.
Dr. Stephen Klasko, a Wharton grad, is the President of Thomas Jefferson University and CEO of Jefferson Health System. To learn more about his work follow him on Twitter @SKlasko.
About the Author
Akshat Shekhar is an undergraduate junior at Wharton and in the Engineering School.