Innovating Leadership:
Co-Creating Our Future

Resources:

The website for Carsten’s organization, the International Society for Quality in Health Care, is https://isqua.org.

Our host, Maureen Metcalf, posts a newsletter every week on LinkedIn. You can subscribe here.

Maureen’s latest book is Innovative Leadership & Followership in the Age of AI. You’ll find details about it at https://bit.ly/LeaderInAI. Her other 10 books are available on Amazon here.

Books we’re reading for fun or personal development right now include:

• Becoming Superman: My Journey from Poverty to Hollywood by J. Michael Straczynski
• Own the AI Revolution by Neil Sahota
• Time and Chance by Kim Campbell
• Three Rocks: The Story of Ernie Bushmiller, the Man Who Created Nancy by Bill Griffith

Guest(s):

Guest(s) Bio:

Carsten Engel is a physician by background (graduated 1984). In 2006, he joined IKAS, The Danish Institute for Quality and Accreditation in Healthcare, where he was appointed Deputy Chief Executive 2010. In IKAS, he was a member of the team that developed, implemented and managed the national Danish healthcare accreditation programme. In 2021, he joined ISQua as CEO.

He was appointed an ISQua Expert in 2013 and a member of the ISQua Academy of Quality and Safety in Health Care in 2019.

He has published and presented on accreditation-related topics and on topics related to quality, patient safety and person-centred care.

Transcript
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Speaker 1 0:00
Change can be difficult, and as Karsten Engle, today’s guest, explains, change is very much needed in healthcare systems, but for healthcare leaders, managing that change can literally be a matter of life or death. One key to success, Karsten says, is building a culture of learning. He explains more in this episode through coaching or classes. Learning cultures and managing change are just two of the skills we teach at the Innovative Leadership Institute. Learn more after the podcast@innovativeleadership.com

Maureen 0:41
I’m Maureen Metcalf, your host of Innovating Leadership, Co-Creating Our Future. I’m also the founder and CEO of the Innovative Leadership Institute. Today, we welcome Karsten Ingle, CEO of ESQA, the International Society of Quality in Healthcare. We’ll discuss leadership beliefs and mindsets today’s healthcare leaders need to embrace Karsten. We’re glad you’re with us, and we thank the International Leadership Association for sponsoring this podcast as part of their 25th annual global conference. Karsten, let’s start with summarizing the situation of healthcare in this moment, and what do you see as the most important challenges?

Speaker 2 1:20
Thank you, Maureen. At the moment, we know very well what we want to achieve, and one way to summarize it at a high level is by quoting the quintile aim. The quintuple aim says that patients should experience good care. This care should result in better outcomes for the population as a whole at a sustainable cost. This was the original triple aim, and we have later come to realize that clinician well-being is essential if good quality is desired. You can’t expect healthcare providers who are suffering themselves to be able to deliver good care. And finally, the fifth component under quintuple aim: good quality includes equity and good health for all, but we also know that the situation is difficult. One of them is the gap between resources and demand, and not only talk about the financial gap, but we have increasingly become to realize that manpower is really the bottleneck, and that manpower not always can be bought, even if we had more financial resources than we have, there’s also a gap between what we’re actually doing and what it would be deriveable to do. There’s a recent paper that demonstrates that, if anything, the incidence of avoidable harm has increased over the last 25 years. That’s a paper from Boston, from David Bates and coworkers, and we also know that 60% of the care we deliver is aligned with evidence-based knowledge and consensus among experts. 30% is wasteful, and 10% causes harm. So, a large proportion of what we actually are doing is wasted. We have new expectations arising. The climate crisis is around us, and hospitals where great carbon sources are expected to lead the way towards a carbon-neutral future. The patients expect to be treated not as things we are doing things to, but as partners, as persons, what we call curd-centered care, and equity is a huge issue. And finally, we have been through the pandemic aware of vulnerability when we are facing large scale disruptions, and the climate change will provide even more of that over the next year.

Maureen 3:29
Part of the stat that you mentioned that really strikes me is 60% of care is evidence based, 30% is wasteful, 10% is harmful, and I assume nobody intends to be wasteful or harmful, so there are things in the system that need attention, and there are exogenous things like climate change that we have no control over, but we still need to attend to in as deliberate a manner as possible. What our healthcare organizations doing, or what can they do to meet these significant challenges?

Speaker 2 4:08
When you’re talking about the 6030 10 challenge, one of the things we can do is to be very focused on nurturing learning healthcare organizations, and in fact, I think that is perhaps one of the most crucial things that a healthcare leader should be concerned about doing, and when I talk about a learning healthcare organization, I do not just mean an organization where the individuals improve their professional knowledge, but also an organization that learns to develop the way in which it delivers care, the written and unwritten rules, the understanding of how the system works, and that will allow us to have very good access to knowledge, and will also allow us to collect information and learn from what we are doing in new ways.

Maureen 4:53
I love the idea of a learning organization, both humans and the organization learning. We’re going through some of this right now. As we realize some of our processes, probably like every organization, they change and grow over time, and then you need to step back and say, okay, does this make sense now, without stepping back and reevaluating our processes and learning, then just systemically we fall into a routine that over time becomes suboptimal, and then adding the AI to it can either streamline or make it more complex.

Speaker 2 5:27
That’s right. And now you touched upon one of my other favorite topics: complexity. Healthcare is perhaps the most complex system that humans have ever created. And what is it that makes it complex? Well, it is that things are not just progressing in a linear, straightforward way. There are feedback loops, positive and negative. What we do impacts what other people are doing. There are cross links between processes, and all of this results in a system where we can’t create a manual that will tell us exactly how things will evolve and what we must do. Instead, we must create the ability to understand the local situation where we are, and people are actually good at reading and understanding the system locally, but they may not always realize that what you do here have consequences somewhere else. To manage the unpredictable things that are coming up, we need to nurture our ability to anticipate what might happen here, where I am now, to monitor what is actually happening, to respond, to have a good toolbox, a way in which we can respond to what is going on, and then to learn from how things evolved. Did what we did actually work in the way we wanted it to work? Anticipate, monitor, adapt, respond, three core components of a resilient complex adapted system,

Maureen 6:46
and as you say, that one of the things that strikes me in working with healthcare researchers is things we thought were true. The science is advancing, so how we treat someone is also changing as our systems are becoming more complex, so the adapting is happening not just with how I bill or how patients show up, or if we have COVID, it’s also now that we have proton accelerators to deliver radiation treatment and lasers that we use on people’s faces to help mitigate the impact of radiation, and so the treatment protocols are more complex, and the humans in healthcare facilities do that, presumably at different rates.

Speaker 2 7:29
Yes, and I mean, even the most resourceful and most focused person would have difficulty in being on top of everything that’s happening, even in a narrow field. That’s maybe one of the reasons why some researchers found that it on the average takes up to 17 years from research evidence to be translated into practice in an actual clinic. A lot of new things we need to learn, but we must also be aware that we have to unlearn things that are no longer true. One of the ways to leverage AI is, of course, that it is very good at remembering and connecting things that we are not able to have in our brains all the time,

Maureen 8:03
it’s way more complex and getting exponentially so.

Speaker 2 8:07
Yeah,

Maureen 8:07
and AI will accelerate that research for any physician to stay on top of things. We don’t want to wait 17 years to go from we have a cure to I can actually get cured, so our systems must also adapt more quickly, and they’re not built to adapt that quickly.

Speaker 2 8:25
No, what will the role of this addiction then be? Well, that’s why I think person-centered care comes into the picture. But what is person-centered care? Person-centered care is about seeing the patient not as an object but as a partner. We bring different things to the table. The professionals bring their professional knowledge. The patient brings the experience of their own health stories, their own values, their own preferences, their own beliefs. What we must do together is then identify what’s the problem from your point of view, what matters to you, what is it you want to achieve? What have we to offer that we can reasonably provide to you? And we then come together to make a plan for what we then eventually will do, and we monitor if that this plan leads to you achieving what matters to you in a way that’s consistent with your values, but is of course also consistent with professional ethics and professional good practice.

Maureen 9:23
I have a very personal story on this. I was the healthcare power of attorney for my mother, who just passed. The process of being clear about her end of life wishes, working with the physicians to ensure that she got what they consider appropriate and what her wishes were, and then to also sit with her as the nurses came in and tried to continue to provide care, like why are you poking and testing when we’re not going to change anything we’re doing, so just that advocacy and getting from the doctor and I agree. On the course of care through the system to each person who touches her and ensuring that that is delivered in the way that is honoring of the patient’s wishes was a complex process. Every person that touched her had to have that conversation.

Speaker 2 10:17
It’s a very good example, and looping back to one of the things we mentioned in the beginning, the waste. I am sure that having a good dialog about what matters and what the options are, and how we together select the best options, will help us eliminating some of the waste we’re currently seeing.

Maureen 10:34
They kept taking blood tests, even though we agreed that there wasn’t going to be a follow-up action, and so I would have considered that waste. Why were they doing that step? Other than that’s part of the prescribed protocol.

Speaker 2 10:48
I agree, and I also think that we perhaps sometimes tend to see protocols too much as prescription what you must do. Protocols, clinical guidelines, I would rather like to see them as a way of summarizing evidence-based knowledge, you can do this, and then you can expect that to happen. You can do that, and then you can expect this to happen. And often the natural thing to do will be to follow the guidelines, but in particular, if you have persons with many coexisting morbidities, that may not be possible. You end up with having 20 or 30 tablets a day to take, or you may even end up with guidelines that are contradicting each other. And how do you solve that dilemma by together with the patient finding out what matters, what is possible? How can we do this in a way that suits all of us? One trouble we often hear about is non-compliant. The patient is not taking the medicine as prescribed, but instead of trying to find out how do we convince or find ways to make the patient do what we think they should do, then instead have a talk to them, why are we not doing this, and then maybe during that conversation we’ll find out how to solve the problem and find the way that’s the right way for you to take,

Maureen 12:00
we as humans intend well. When I leave the doctor’s office, I probably intend to take my medication.

Speaker 2 12:06
Yeah,

Maureen 12:06
I have habit that overrides any good intention some days.

Speaker 2 12:10
And then maybe we should try the way to change the description, so you choose your habits better.

Maureen 12:15
Yeah, I think for most of us we find a way to do the things we want to do.

Speaker 2 12:19
Yeah,

Maureen 12:19
maybe if I added chocolate to my medication in the morning.

Speaker 2 12:22
No, a very good suggestion. I like that.

Maureen 12:27
I can’t imagine any protocols are going to be rewritten to add chocolate.

Speaker 2 12:30
No.

Maureen 12:31
What are you recommending as options? You talked about anticipating, monitoring, acting, and learning. I assume in this I have to identify what are my biggest problems. What do I study? What do I allow to sit for a while, so that I can efficiently operate at the same time as I’m continuing to learn and improve.

Speaker 2 12:53
Yes, and I mean all of this leads to adaptations, and when we say that the system adapt, it is nothing mystical and metaphysically, that’s happening. What’s happening is that the way people think, the rules that people follow when they choose how to act, be it written rules or unwritten rules, they change. That’s going to adapt, and that makes the system perform differently. And as a leader, you must allow this to happen. Your task is to be very precise about what are the aims and what are the goals for our organization and make sure that we have the means that are needed to achieve those goals, so the standards we provide to people when we describe the accreditation business as well, so we are engaged in exploitation standards again, in some cases they are prescriptions. If we check your identity before we set up a blood transfusion, this should be done in a very specific way every time, but in other cases these standards should more be like what are the means I have to solve a given problem, what’s my aim, what means to be able to achieve these aims? I need to understand the pros and cons, and the nature, both of the situation and the aim, and a way to assess whether I’m progressing towards my goals and aims

Maureen 14:08
that seems consistent in healthcare or any organization.

Speaker 2 14:12
Yeah,

Maureen 14:12
that as a leader I need to be clear about my organizational aims, and then the aims for improvement, and I like the focus on it’s not just changing behaviors, it’s the written, unwritten rules about how do we work around here, that’s often ignored when we make formal policy, that if the formal policy is opposed to how we typically do things, the probability of successful implementation goes down.

Speaker 2 14:39
You have the thing, the culture eat policy for guns. It

Maureen 14:43
does seem to, doesn’t it?

Speaker 2 14:44
Yeah,

Maureen 14:45
because I do see people occasionally over rely on that, and then they just don’t create policy or strategy. So we need to both attend to the culture and also clear protocols.

Speaker 2 14:59
Yeah, it is. A balance, and if we standardize in the right way, we can reduce complexity. We can standardize in particular when we work across organizations’ boundaries, be it across department boundaries within a hospital or between organizations. When we treat patients in their homes, then it’s very important for us that we are clear. We have a common understanding of what our aims are, that we have a clear understanding of what we can expect from the others. What are their roles? What is my role? How to work together? How do we communicate that we don’t have to find out that every time we need to do something. There are ways to reduce complexity and allows us to focus on the creative part, finding out and now exactly what of the options that we have is it that we should use now.

Maureen 15:48
That sounds so rudimentary. It is really complex to stay on top of

Speaker 2 15:54
it. Is you need to trust that people in your organization know what they’re doing. There’s no way that any one person can understand everything that’s going on in the hospital, but one person can perhaps understand what is that important for us. What are our general aims, our values, our mission? Add a break that story within the organization,

Maureen 16:15
and hopefully everyone in the organization is clear about the overall mission of client health and well-being, patient-centered positive experience, and the guiding principles

Speaker 2 16:27
into my mind comes now a study, a number of years old, I think something like 10 years old, from England, from the NHS by Mel Dixon Wood and colleagues, that examined well and not too well performed in hospitals and identified traits. One of the things that was found to be important is there are conflicting goals. Then you’re in trouble, and it’s very important to find ways to reconcile convicting goals. We need to make trade-offs from time to time between different considerations, but this is not something that should be felt as a responsibility of a single professional, because in my opinion, one of the leading causes of burnout is you feel that you are not able to do what you should do. One of the other things is the ability to listen to what’s going on. No one can understand everything in the sense that they can manage it, but they must understand what’s going on, and she, the group, distinguish between two approaches to information, the problem sensing versus the comfort seeking. The problem sensing person wants to understand what’s going on, wants to identify the problems and not take them over, but help solving them, whereas the comfort seeking tried to treat data in a way that seemed to convince us, well, if it’s not going to look so bad, we are not worse than the average, or whatever you might think of,

Maureen 17:45
and I assume most of us have a dominant type, but I see myself as a problem seeker, but boy, there are times I want to avoid some conversation, so I become a comfort seeker at other points.

Speaker 2 17:58
Yeah, we all experience that, but then again, my own experience is often when we, for instance, talk about bringing up difficult problems in difficult situations, the thought of doing it is sometimes the worst worse than actually doing it.

Maureen 18:13
I think that’s true for many people much of the time, right? We go through the mental gyrations of what if this, what if that, what if the other.

Speaker 2 18:22
Yeah, yeah.

Maureen 18:23
And it’s the internal conversation that wears us out before we even start to have the conversation with the humans.

Speaker 2 18:29
Yeah, for Abby, very well. Yeah.

Maureen 18:31
What are the mindsets and behaviors for leaders to close these gaps? And I know we’re talking about healthcare, but I will make the assumption that many of these can be generalized from healthcare to other organizations as well.

Speaker 2 18:45
You are right, I think the same holds true for any complex system. I think you should try to understand and embrace complexity and a systems way of thinking. Coming back to healthcare, you should be aware that one thing, providing healthcare is not just a question of knowing the things you should do with patients, the care you should actually provide. It’s also about setting up a system that’s able to deliver this care where it’s needed. Implementation, making a system change in ways, is not just a question of saying, look at this. This is a very good practice. We should do that. No, it is about creating a sense of change management. We need to change this. Is how we’ll do it. Identify the barriers that prevent us from doing it by talking to the people we expect to change the habits, also identifying the facilitators, finding champions that we can ally with when we promote the change, finding ways of measuring and celebrating successes when we actually do improve.

Maureen 19:50
That sounds like almost the textbook blueprint for change management overlaying a systems approach, because often we go change a portion. Of a system without regard for the overall system, which then makes us lopsided.

Speaker 2 20:06
Yeah, exactly. And that’s one of the points. I think something here it may improve my situation locally, but what are the effects elsewhere in the system?

Maureen 20:15
We worked with enterprise software systems, and we were paid to go in and do a system implementation. We were not necessarily paid to change their culture because of that. Just like patient noncompliance, we had employee noncompliance. Either they didn’t understand what they needed to change behaviorally, or they chose not to. But I think in some cases we didn’t do a good job of saying start doing this, stop doing this other thing, and then create the path for them to feel safe and comfortable that they were going to be rewarded for this new thing where they used to be rewarded for the old thing.

Speaker 2 20:56
People’s mind are not always just changed by deliberate decisions, the system also has an influence on our mind. An example, it is now not seen as appropriate to smoke in most public settings. Is this because people have changed their minds about smoking, and then the rules change? No, I actually think that much of the influence was the other way around. We had rules and people were influenced by the rules because they became engrained and internalized as the way we do things here. Influence runs both ways and that’s something that we need to manage. Cleverly,

Maureen 21:33
a lot of the change management piece, exactly as you’re saying, as we’re learning how brains operate, how we help people change their behavior, I believe, needs to be reconsidered or reimagined based on what we know about neuroscience and how people actually change versus how much like 90% of what we do is habit. So, as you say, not smoking near the hospital entrance, which used to happen. What need is getting met by the smoking, in addition to nicotine? Is it the need for community? Is it the need for employees who want to have the collaboration that happens around the smoke break? So, if we take away the smoking, how do we substitute the need of bonding getting met, so that we can successfully change the behavior, versus they just go across the street and smoke.

Speaker 2 22:29
One of the ways is, if you can create a sense of this is the right way to do things, and if you can align with professionals, then the professional ether of wanting to do the right thing is a strong driver,

Maureen 22:43
and then you said reinforcing with positive rewards, promotions, and replacing the rewards that the brain gives, so the dopamine hits and such, finding a different way to do that as well.

Speaker 2 22:59
Yeah,

Maureen 23:00
so I get the professional acknowledgement of I’m doing the right thing, and my colleagues may acknowledge me for doing a good job.

Speaker 2 23:10
And then a very basic thing, I mean, changes that make life easier are much more likely to succeed than changes that make life more difficult.

Maureen 23:18
Yeah, unlearning and eliminating some of the complexities seem like they would be beneficial,

Speaker 2 23:24
which of course also means that when you see resistance to changes, you should ask why.

Maureen 23:29
We had a conversation recently about everyone’s rational when you consider their perspective, so most people don’t behave irrationally from their lens. From my lens, there were certainly behaviors that seem irrational, but they have a different mental algorithm than I do. Yeah, in their head they’re behaving rationally, so I have to understand them, not impose my algorithm on their thinking,

Speaker 2 23:56
and that’s exactly the way we also must think when we’re talking a person-centered care, and discuss care options with and care goals with patients.

Maureen 24:05
I imagine being a physician, and so committed to someone’s health and healing. How frustrating it would be if a patient isn’t compliant and doesn’t have the same goals for themselves that I, as the healthcare provider, think they should have,

Speaker 2 24:21
when it comes to health equity, we know that one important component is to assure that everyone has the same access to healthcare without financial restraint, but that’s not enough. There are both social determinants before you come to health care that are important to health, and healthcare should, to the extent it can, support everything that can promote health rather than repair health damage, but there are also sources of equity in the way we deliver health, and this has very much to do with what expectations, what concepts of disease and health does the person come to the hospital come with what led. Devin is he or she’s looking through, and if we don’t understand that, we will not be able to provide equitable care.

Maureen 25:07
I wonder if it’s even possible to provide equitable care when we think about the lens people walk in with. There were people who come in with a massive distrust of the healthcare system.

Speaker 2 25:21
Yeah,

Maureen 25:21
I wonder how possible it is for someone who inherently thinks healthcare providers are untrustworthy to get the same kind of care as someone who comes in thinking healthcare providers have the answer and they’re good people to be trusted,

Speaker 2 25:40
and that’s not something you can change easily. One of the ways of doing it is working with the community, because people come from a community, their belief and their expectations are very much shaped by the community they come from. If you can reach out to the community, you will eventually be able to build up that trust, but I’m sure it’s not something that happens overnight, and there are long historical reasons for these trusts that are not easy to agree, but that’s what will work to do. I

Maureen 26:07
love the idea of back to your systems thinking, considering the community as part of the system, because I think there’s research that says one of the bigger determinants of health is the zip code in which you reside, part of that is economics that I grew up with access to health care, but there was something in my healthcare experience that was also scary. My dad was in the military, and we went to Walter Reed Army Medical Center. It was also during the Vietnam era, and so many of the patients were people who were service members, so as a kid sitting in the waiting room, I would see people with missing limbs and suffering from PTSD, and it was a different hospital experience than a place that had a beautiful pediatric center where I was playing with toys. I was in fact sitting in a room with people who had experienced extreme trauma, and so my experience of going to the hospital, not better or worse, but the hospital was a place where people got care, absolutely, and it was good care, but it was a little scary for a kid to see people who had severe injuries and were in great pain. At least, what I grew up isn’t what hospitals are now, with harps in the lobbies. There were no harps in the lobbies of that facility. I kind of wish there were, but helping folks see the medical treatment as a positive. How do we help the community see this as a desirable and a must do, along with preventive care? How do we help build equity? In your experience, are we going to communities?

Speaker 2 27:58
That’s one of the ways of doing it. One also put it in this way. What do patients expect? And his answer was, they expect acknowledgement, respect, care, and cure in this order of priority. Acknowledgement is to be acknowledged as what you are, what your experiences in your beliefs and your values, acknowledge them to understand that, and to get the sense of acknowledgement, I think that’s one of the main things we can learn from being connected to the community, and there’s respect, and there’s care, and there’s cure. Of course, cure is important, but we also know that hospitals can’t always cure people. Often it can be difficult for a professional to accept that we can’t cure this person, but we should still care for the person, respect and acknowledge it

Maureen 28:45
intuitively makes sense. As a healthcare provider, I would also struggle with I can’t cure as a consultant. I want to fix everything. I recognize that sometimes I can’t, although that’s a word I don’t use often.

Speaker 2 28:58
No, but you mean I worked as an anesthesiologist in the past, and one of my duties was working in intensive care. Sometimes we did miracles, and at other times we had to realize, no, I’m sorry, there’s nothing we can do. And then we must find a way of bringing the care to conclusion in a respectful and caring way.

Maureen 29:17
Let’s go back to person-centered care, as you say, a respectful and caring way. You use the word co-production. What is that in healthcare?

Speaker 2 29:28
Co-production is realizing that the care experience is created as a cooperative effort, is determined by what I do, but also by what the other person does, and patients have a role to play in their care. They’re co-producing it, which sometimes can be very literal. Back to modern technology, if I had diabetes, for instance, I would nowadays be able to care very much for myself. I would have access to monitors that would monitor my blood. Tribal leader, I would eventually learn to understand that I have seen not patients, but colleagues who are diabetic, who probably understand their own body and how it reacts better than any professional will do, because they know this one body and how it reacts, so they were able to adjust the insulin dosages to whatever food they ate to whatever activities they were doing, that’s the way co-production, but from time to time you would then have an issue where you would need to refer to the professional knowledge, and modern technology would allow us to design patient pathways that were not like you come here every three months, and then we see how things go, and as young physicians, I sometimes said, and was struggling with finding something to say that would justify to myself and to the person why he or she had taken several hours out of his daily routine to come to the clinic, but instead we can have a system where you monitor yourself, you are able to use technology to help you to help understand what is going on and what you should do, but you have access to expertise when you need it, and this will then liberate resources and allow us to spend more on those who are perhaps not inclined or able to do the same thing

Maureen 31:15
as you describe that I think of some of the technologies that just basic things like my fitness watch can help me do all kinds of things now,

Speaker 2 31:26
exactly. And that will only grow and be more and more.

Maureen 31:29
At some point, I’ll have my genome mapped, I assume, and I’ll know what I am likely to experience based on my own genetic makeup. Then I can do things preemptively for my structure, rather than I exercise, I eat well, but I don’t necessarily do an anti-inflammatory diet, but maybe my DNA will say I need something that’s anti-inflammatory, I can co-produce my wellness, so I spend less time with my esteemed medical colleagues in the hospital. I may spend time with them at dinner.

Speaker 2 32:06
Yeah, in the diabetic example, what the diabetic does is exactly anticipating that when I do this and this, my insulin requirements may change, so I will monitor my blood sugar a little bit closer than I would otherwise have done, and I know how to act on these fluctuations. I see, then see how they respond to what I do. I learn to become better and better at keeping it on the right level.

Maureen 32:32
My dad’s diabetic, and I think what he learned is how to manage his deviant behavior better. I remember watching him eat Cadbury eggs, and just be horrified because he’s diabetic, but he learned he could monitor, adjust his insulin, and occasionally eat Cadbury eggs.

Speaker 2 32:51
Yeah,

Maureen 32:52
but even that is at least a preemptive behavior, so he doesn’t end up in the emergency room, and he gets the same treats as other people do on Easter.

Speaker 2 33:01
Yeah,

Maureen 33:02
we talked a little bit about equity. Actually, we talked a fair amount about it. How can you use these ways of thinking to support the movement toward EDI equity, diversity, and inclusion? Sorry,

Speaker 2 33:14
if we consider the patient as an actor, someone who has agency and uses this on the background of his or her culture experience expectations, beliefs, and if we are interested in getting to know and understand those events, as we call them before, which we again to repeat, partly do by being curious and interacting with the community, but of course there are also some of the more hardcore things we shouldn’t forget about, like making sure that everyone actually has access and access that is realistic, both in terms of physical access and financial access. It is

Maureen 33:57
such an interesting challenge, both physical and financial, and I’m coming from a US-centric lens, but in my travels it seems consistent globally that if I live in a large city, at least I probably have physical access. If I’m in a rural area, and especially if my economics don’t support access, then getting the same caliber of care is based on the system going to be challenging.

Speaker 2 34:26
Yes, and this is where we have to change the system to make it easier. Telemedicine makes it a little bit easier nowadays than it used to be, but it’s still something that requires a deliberate will to design an appropriate system.

Maureen 34:40
I have a client. There were two facilities in the country using this treatment. So, to get to this treatment, you had to go to one or two places, and there weren’t a lot of people trained in this technique, so most people didn’t get it. They were testing 3D printing. Devices and sending chips based on patients’ needs, so that if you’re in a rural area, you can pick up the laser thing and the chip is set up so that you can’t overdose yourself, so we don’t allow for some of that misuse of a device, and with the technology there are places where care will be more accessible,

Speaker 2 35:24
absolutely, and this we should leverage clearly,

Maureen 35:27
because there were others, like proton accelerators, that we’re probably not going to be able to, um, print and send out,

Speaker 2 35:33
no, not in the near future, I guess. It’s also my understanding that people accept that they sometimes have to travel far to get something very special. What they don’t accept is if it’s difficult to get, let’s say, usual commonplace things that should be easily accessible to everyone.

Maureen 35:54
I don’t know that we can completely remove inequity, but we can certainly work to remove it as much as humanly possible.

Speaker 2 36:01
Yeah,

Maureen 36:02
Kirsten, any closing words for our listeners?

Speaker 2 36:05
Well, one of the things that I feel encouraging is that they are in a way intertwined, and one of the examples is the first stages of becoming more carbon neutral is very well aligned with using waste. Some of the steps that lead us to more person-centered care are very well aligned with leveraging the digital transformation, so things are interconnected.

Maureen 36:30
I love that we can intermingle rather than putting at odds carbon-neutral, person-centered care and leveraging the digital assets.

Speaker 2 36:40
That doesn’t mean that it’s piece of cake, very easy to accomplish everything. I don’t think anyone believes that, but there are alignments and there are synergies.

Maureen 36:48
Thank you so much for sharing your wisdom with our guests. How might someone find out more about your work?

Speaker 2 36:56
Well, the website is isco.org and there you can see more about what the organization is doing, and we are a small organization. Our staff is around 14 or so, but we have very large reach because our members, the experts we work with, that’s what makes it possible for me today, and bring these ideas to you. They all come from our network, and our vision is to spread knowledge.

Maureen 37:20
Thank you so much, and I trust that through this podcast others will hear of your work and will take on the ideas that you’re putting forward.

Speaker 2 37:31
I hope so. And thank you,

Maureen 37:32
thank you, and thank you to the International Leadership Association for sponsoring this conference, and to our guests. Please like us, follow us, and most importantly, share what you’re learning.

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Unknown Speaker 38:37
now.