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Recent episodes
The Ethics of AI in Healthcare: Beyond the Stochastic Parrot | Dr. Jessica Morley (Yale Digital Ethics Centre)
Sep 24, 2025
1h 03m 14s
How Systems Thinking Can Fix Healthcare's Organizational Chaos | Dr Sharen Paine
Sep 8, 2025
1h 11m 55s
AI's Jagged Frontier and Why Human Judgement Still Matters | Dr Graham Walker (Kaiser Permanente)
Aug 12, 2025
54m 47s
The Rise, Fall, and AI-Powered Rebirth of Evidence-Based Medicine | Dr. Richard Lehman & Dr. Raj Mehta
Jun 24, 2025
1h 02m 47s
Scaling Evidence-Based Medicine Across 630,000 sq Miles | Dr Raj Srivastava (Chief Clinical Programs Officer, Intermountain Health)
Jun 17, 2025
43m 48s
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| Date | Episode | Description | Length | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 9/24/25 |  The Ethics of AI in Healthcare: Beyond the Stochastic Parrot | Dr. Jessica Morley (Yale Digital Ethics Centre) | "AI has the potential to re-ontologize healthcare—to completely redesign what we consider to be a disease, what we consider to be a disability, and how we organise care. But we need to decide what good healthcare actually means before we AI-ify everything."— Dr Jessica MorleyIn this episode of Clinical Changemakers, Dr Jessica Morley, an AI ethics expert and researcher from Yale Digital Ethics Centre, challenges our understanding of what large language models actually are and what they mean for healthcare. Drawing from her work on data ethics and her involvement with OpenSafely during the pandemic, Dr Morley explains why viewing AI as "stochastic parrots" is crucial for healthcare implementation, explores the concept of re-ontologizing medicine, and argues why we need ethical frameworks before technological deployment rather than after.Key TakeawaysStochastic Parrots in Medicine: Large language models don't understand medical concepts—they predict the most likely next word based on probability from their training data. This means they can give you different answers to the same medical question and lack the contextual understanding crucial for patient care. Understanding this fundamental limitation is essential for safe healthcare implementation.The Re-ontologizing Power of AI: AI doesn't just replace existing tools like upgrading from a physical to digital stethoscope. It has the power to completely redesign healthcare by redefining what constitutes disease, changing how we organize care, and separating diagnosis from physical patient interaction. This transformation can be powerful and positive, but only if we're intentional about our goals.The Inverse Data Quality Law: Just as the inverse care law states that those who need healthcare most get it least, the inverse data quality law means those who need AI healthcare tools most will have the poorest quality data about themselves. This creates a two-tier system where marginalized populations get inferior AI-driven care.Social License Trumps Legal Permission: Technical feasibility and legal compliance aren't enough for successful AI implementation in healthcare. Projects like the UK's Care.data failed despite being legal because they lacked social acceptance. OpenSafely succeeded by building in privacy protections, transparency, and meaningful public engagement from the start.Where to Find Our GuestDr Jessica Morley (LinkedIn, Google Scholar)In This Episode01:27 - Stochastic parrots: Understanding what LLMs actually do04:27 - Emergent properties: Why LLMs remain sophisticated probability machines11:57 - Moral worth and parasocial relationships: When humans attach meaning to AI14:33 - Re-ontologizing healthcare: How AI redesigns medicine itself19:28 - The ethical traps: What happens when we AI-ify without thinking about outcomes25:33 - Two-tier systems: How AI could worsen healthcare inequalities28:44 - Ethics vs. law: Why we need both rules and values32:31 - Learning from NHS failures: The importance of not making assumptions47:43 - Global policy tensions: EU regulation vs. US "let it rip" approaches54:33 - False dichotomies: Moving beyond "some care vs. no care" thinking59:02 - Current global sentiment: From tech optimism to healthcare cautionReferenced* Dr Morley’s Paper - The ethics of AI in health care: A mapping review (link)* Defining a Stochastic Parrot (link)* OpenSafely platform and approach to health data research (link)* Lessons from Care.data project and its failure in the UK (link)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comHey there 🙌As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it.Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 1h 03m 14s | ||||||
| 9/8/25 |  How Systems Thinking Can Fix Healthcare's Organizational Chaos | Dr Sharen Paine | "We want a two-way flow of communication so that we have a better understanding through the levels of an organisation up through those levels of what's actually happening and we can make decisions closer to the ground."— Dr. Sharen PaineIn this episode of Clinical Changemakers, Dr. Sharen Paine, a systems thinking expert with a doctorate in business administration focusing on cybernetics, explores why healthcare organisations repeatedly struggle with the same problems despite constant restructures. Drawing from her hands-on work with ophthalmology services, Dr. Paine introduces the Viable System Model (VSM) as a framework for creating truly functional healthcare organisations that can adapt and thrive rather than merely survive.Key TakeawaysCybernetics vs. Command-and-Control: Healthcare systems fail because they rely on one-way, top-down commands rather than cybernetic feedback loops. True organisational health requires continuous information flow between all levels, like an aircraft's autopilot system that constantly adjusts based on environmental feedback, not rigid directives from a distant control tower.The Black Hole of Management Chaos: Service managers and clinical directors get consumed by day-to-day firefighting because healthcare systems lack proper coordination functions. Without clear coordination mechanisms, everything collapses into the management layer, creating a "tumble dryer" of urgent tasks that prevents strategic thinking and long-term planning.The Five Functions of Viable Systems: Every healthcare organisation needs five continuously operating subsystems: (1) Operations that deliver patient care, (2) Coordination that orchestrates daily activities, (3) Management that sets conditions for success, (4) Intelligence/Planning that looks ahead strategically, and (5) Governance that defines purpose and values. Most healthcare systems conflate these functions, leading to dysfunction.Recursive Autonomy Creates Efficiency: The VSM applies at every level—from national health systems down to individual departments. Each level requires all five functions to operate with appropriate autonomy. A $150 equipment purchase shouldn't require Wellington approval, just as an ophthalmology clinic shouldn't decide national hospital placement. Right-sized autonomy eliminates bureaucratic bottlenecks.Coordination is the Missing Function: Healthcare systems fail to recognise coordination as a distinct, critical function requiring dedicated resources and IT systems. Coordination includes prioritised wait lists, rosters, schedules, skills matrices, and training—currently done manually or through spreadsheets, creating errors and inefficiency. Proper coordination would prevent most day-to-day chaos.Where to Find Our GuestDr. Sharen Paine (LinkedIn)In This Episode00:00 - Introduction: Dr. Sharen Paine's background in cybernetics and systems thinking07:37 - Sharen's journey: From mental health services to ophthalmology system challenges15:05 - Production planning struggles: Why system changes fail without organizational support18:16 - The governance-management-operations disconnect in healthcare hierarchies25:04 - Introduction to the Viable System Model: Five essential organizational functions26:59 - Defining viability: How organizations persist and adapt over time28:05 - The five subsystems explained: From governance to operations36:05 - Applying VSM to ophthalmology: What it looks like in practice46:33 - Functions vs. roles: VSM describes what needs to happen, not organization charts55:29 - Building collaborative understanding: Clinicians learning constraints, managers understanding frontlines59:48 - Bottom-up implementation: Practical steps toward VSM adoption1:05:12 - The VSM perspective: Seeing cybernetic patterns everywhereReferenced* Utilising insights from cybernetics and the Viable System Model to address health system disconnects (Doctoral Thesis)* Principles for embedding learning and adaptation into the New Zealand health system functioning: the example of the Viable System Model (paper)* Utilising VSM insights to address health system disconnects: introducing three novel organisational pathologies (paper)* Mapping clinical governance to practitioner roles and responsibilities (paper)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay.Before you go! 🙌As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it.Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 1h 11m 55s | ||||||
| 8/12/25 |  AI's Jagged Frontier and Why Human Judgement Still Matters | Dr Graham Walker (Kaiser Permanente) | "I think judgment, I've been honing in on that word more frequently recently because I feel like the judgment piece is the piece that feels particularly like human in this decision."— Dr Graham WalkerIn this episode of Clinical Changemakers, Dr Graham Walker, an ER doctor and AI healthcare leader, discusses his role at Kaiser Permanente and the challenges and successes of integrating AI into healthcare. He emphasizes the importance of communication, leadership, and the need for alignment in large healthcare systems. Dr. Walker shares insights on predictive AI tools, the operationalisation of AI in patient care, and the ethical considerations surrounding AI's explainability. He also highlights the rapid adoption of AI scribes across 4.6 million members and the balance between AI benefits and risks in clinical practice.Key TakeawaysLeadership through servant mentality: Successful healthcare innovation requires leaders who ask "How can I help you?" rather than directing from above. Clear communication, removing blockers, and building relationships are essential for large-scale change.The 85% capacity rule: Healthcare systems running at 100% capacity fail due to variance in patient complexity and unpredictable demand. Queuing theory suggests keeping 10-15% flexibility to handle the inherent unpredictability of medical care.Predictive AI has staying power: Kaiser's Advanced Alert Monitoring system, running live since 2018, successfully predicts ICU transfers and rapid responses across all inpatients. The operational challenge isn't building the model—it's fine-tuning sensitivity/specificity and creating sustainable workflows.AI scribes: Healthcare's fastest adoption: The rapid rollout of AI scribes represents perhaps the fastest technology adoption in healthcare history, driven by ease of use (just install an app and hit record) and immediate physician benefit in reducing "pyjama time" documentation.Judgment remains human: While AI excels at pattern recognition and data synthesis, clinical judgment—weighing risks, understanding context, and making treatment decisions—remains distinctly human. The scraped knee doesn't need septic workup; that's judgment, not diagnosis.Where to Find Our Guest* Dr. Graham Walker (LinkedIn)In This Episode00:00 - Introduction: Graham Walker's role at Kaiser Permanente Northern California04:36 - Innovation framework: Value-based care vs. fee-for-service and finding ideas with potential07:08 - Commercialisation strategy: Building internal tools for external deployment11:00 - Leadership lessons: Coalition building and relationship management in large institutions16:34 - Queuing theory in healthcare: Why running at 100% capacity breaks systems19:48 - Predictive AI success story: Advanced Alert Monitoring system in production26:00 - The human element: Why unexplainable AI might force better clinical thinking32:33 - AI scribes rollout: Fastest healthcare technology adoption in history39:30 - Information fidelity challenges: Note bloat, omissions, and human nature45:02 - The judgment frontier: What remains uniquely human in clinical decision-making50:20 - Advice for healthcare leaders: Use AI tools daily to understand capabilities and limits53:57 - Off-call introduction: Building transparency in physician work and workload dataReferenced* Dr Walker’s company website Offcall* Dr Walker’s Medical Calculation Website MedCalc* Paper: Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration (Link)* Paper: Ambient Artificial Intelligence Scribes to Alleviate the Burden of Clinical Documentation (Link)* Queueing Theory (Wikipedia)* Servant Leadership (Link)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay.Before you go! 🙏If you enjoyed the podcast, please share the love by rating us and sharing it with a friend or colleague. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 54m 47s | ||||||
| 6/24/25 |  The Rise, Fall, and AI-Powered Rebirth of Evidence-Based Medicine | Dr. Richard Lehman & Dr. Raj Mehta | “You know, what if they were to actually put it’s [AI] mind to a science of practical compassion for everybody?… if the right machines were to come along and help us do it, that's going to be a fabulous thing.”Dr Richard Lehman is a retired GP from Oxfordshire who had a "ringside seat" to the birth of evidence-based medicine, previously held academic positions at Oxford and Yale, later becoming Professor of Shared Understanding of Medicine at the University of Birmingham. Dr Raj Mehta is a physician and evidence-based medicine educator who views EBM as essential heuristics for discerning truth in clinical practice. Together, they bring decades of experience wrestling with how we know what works in medicine, from the historical foundations laid by James Lind's scurvy trials to the AI revolution that promises to transform how we synthesise and apply medical evidence.Key TakeawaysTruth-seeking requires method, not just conviction: Before EBM, medicine operated largely on "conviction-based" approaches collected in massive textbooks. The shift to systematic evidence evaluation transformed how we separate opinion from fact in clinical practice.Numbers Needed to Treat illuminate magnitude: Tools like NNT help clinicians and patients understand effect sizes. Context and timeframe matter enormously.AI could democratise and personalise evidence: Rather than replacing doctors, AI might enable real-time synthesis of evidence matched to individual patients, creating feedback loops between treatments and outcomes at an unprecedented scale.The evidence map has gaps and mountains: Current evidence is like an 18th-century road atlas - some areas well-mapped, others blank. AI could be the "sat nav system" for medicine that acknowledges uncertainty while guiding decisions.Social determinants still trump beta blockers: While we refine molecular treatments, the biggest health impacts remain at the policy level - safe neighbourhoods, warm homes, and social conditions. Medicine must embrace "practical compassion" beyond prescriptions.Where to Find Our Guests* Dr. Richard Lehman (X/Twitter)* Dr. Raj Mehta (X/Twitter)In This Episode00:00 - Introduction: Why evidence-based medicine matters now more than ever02:54 - The scientific method in medicine: Discerning truth from fiction in clinical practice06:06 - James Lind and scurvy: The 200-year gap between discovery and adoption12:01 - Bradford Hill and the RCT revolution: Moving from mechanism to measurement14:29 - Richard's ringside view: When "evidence-based medicine" arrived in Oxford19:10 - The limits of population evidence: Why Numbers Needed to Treat aren't enough22:39 - Shared decision-making complexity: The overwhelming challenge of multimorbidity26:00 - The AI revolution: From medical scribes to comprehensive evidence synthesis29:39 - Patient empowerment in the age of monetised medicine36:43 - The pre-Copernican challenge: Are we just getting better at measuring the wrong thing?39:01 - China as a sandbox: Where innovation might overtake Silicon Valley44:54 - Beyond beta blockers: Why social determinants still matter most54:10 - COVID-19's mixed report card: EBM's triumphs and failures in crisis59:04 - Communicating uncertainty: The topographical map of medical evidence1:01:39 - Looking forward: Why this is a "fabulous time in medicine"Referenced* Richard Lehman’s weekly review of medical journals (Link)* James Lind Library (Link)* Richard Lehman on Evidence-Based Medicine (Podcast)* The RECOVERY Trial (COVID-19 treatment comparison) (Link)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay.😯 Hey there!Found this discussion on evidence-based medicine thought-provoking? Share it with your colleagues and discuss your take on the current state of evidence based medicine. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 1h 02m 47s | ||||||
| 6/17/25 |  Scaling Evidence-Based Medicine Across 630,000 sq Miles | Dr Raj Srivastava (Chief Clinical Programs Officer, Intermountain Health) | "When the frontline feels we're actually offering, 'what do you need? What are the resources we can help?' We'll co-create. Of course, they don't have the control of the resources or some decisions, but that's what executives can do."Dr. Raj Srivastava is a pediatrician, health system leader, and implementation science researcher, serving as Chief Clinical Programs Officer at Intermountain Health. With an MPH from Harvard and over two decades of experience transforming healthcare delivery, Dr. Srivastava has pioneered approaches to scaling evidence-based practices across one of America's largest health systems, which spans 630,000 square miles (roughly the size of France, Germany, Spain, and the UK combined) and employs 64,000 people. From his early work mapping 150 million lab results across six children's hospitals to his current role orchestrating clinical transformation across 33 emergency departments, he brings unique insights into why healthcare struggles to implement best practices and how to overcome these challenges through learning health systems.Key TakeawaysCo-creation beats imposition: Successful implementation requires working with frontline staff to understand their needs rather than imposing solutions. When clinicians feel heard and involved in designing solutions, resistance melts away.Learning health systems require discipline: It's not just about having data or technology - it's about creating systematic approaches to identify what works, scale it appropriately, and sustain improvements over time using scientific methods.Start with the problem, not the solution: Too often, healthcare gets excited about new technologies (EMRs, AI, big data) without first understanding the specific problems frontline staff face in delivering evidence-based care.Systematic vs. one-off barriers: Distinguishing between system-wide challenges (like data infrastructure) and location-specific issues is crucial for effective problem-solving and resource allocation.Trust enables speed: Building strong interpersonal relationships and psychological safety among leadership teams dramatically accelerates implementation. The "meeting before the meeting" matters.Where to Find Dr. Raj Srivastava* LinkedInIn This Episode00:00 - Introduction and why evidence-based medicine is so hard to implement in daily practice04:47 - The gap between medical training aspirations and healthcare system reality07:31 - Moving from descriptive research to application-based implementation science09:05 - Transforming patient handoffs to reduce harm across multiple sites19:32 - Systematic barriers and facilitators: Moving beyond "AI will solve everything"23:53 - Addressing health equity through targeted subpopulation analysis33:38 - "Build it and they won't come": The importance of co-creation and marketing35:24 - Creating repeatable, scalable pathways for clinical improvement at enterprise scale39:07 - Governance structures for managing clinical transformation across 630,000 square miles41:23 - The power of pre-meeting communication and building executive trustReferenced* Increasing Adherence to Evidence-Based Clinical Practice (Paper)* Intermountain Health, Health Delivery Institute (Link)* Intermountain Health, Leadership Institute (Link)ContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay.🙋♂️Hey there!Want to help me out? Share this in your team group chat if you know someone who'd benefit! Thank you for your support. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 43m 48s | ||||||
| 6/10/25 |  How One Doctor's Career Pivot Inspired 25,000 Others to Rethink Medicine | Dr. Amandeep Hansra (Founder, Investor & Chief Clinical Adviser) | "At the end of the day, we don't really invest as much into products as we do into people. It's the people behind the products that are going to make the product successful"Dr. Amandeep Hansra is a general practitioner turned health tech entrepreneur, advisor, and investor, founder of the Creative Careers in Medicine community (with over 25,000 members), co-founder of Australian Medical Angels and is the Chief Clinical Adviser for the Australian Digital Health Agency. From accidentally falling into telehealth to building virtual care services across Australia and Asia, Dr. Hansra has spent her career at the intersection of clinical practice and technology innovation. Her work with Medical Angels provides crucial funding and expertise to health tech startups, while her community platform showcases the diverse career paths available to medical professionals beyond traditional clinical roles.Key TakeawaysSay yes to unexpected opportunities: Career pivots often happen by accident - being open to opportunities outside your planned path can lead to transformative experiences and skills you never knew you needed.Networking is essential but different for doctors: Medical professionals aren't taught to network, but being visible in health tech communities and conferences is crucial for discovering non-traditional opportunities.Regulation vs. innovation balance: Health tech faces unique challenges in evidence generation and regulation that differ from those of pharmaceuticals, requiring new approaches to safety while not stifling innovation.People over products in investing: When investing in health tech startups, the founding team matters more than the initial product. Mission-driven founders with clinical awareness are more likely to succeed.In This Episode* 00:35 - Accidental entry into digital health: from GP to telehealth pioneer* 04:13 - The power of saying yes: building a portfolio career through opportunities* 06:45 - Creating community: building Creative Careers in Medicine from scratch* 10:25 - Global burnout crisis: why 70-80% of doctors wouldn't recommend medicine to their children* 15:26 - Investment challenges: why health tech struggles to attract traditional VCs* 19:40 - Evidence standards: adapting pharmaceutical rigour to rapidly evolving technology* 25:23 - Regulatory sweet spot: balancing safety with innovation accessibility* 29:32 - What investors look for: mission-driven teams over hockey-stick projections* 32:42 - Corporate vs startup innovation: lessons from building inside Telstra* 39:31 - Global expansion: how the same product succeeds differently across health systems* 47:07 - Exit strategies: why health tech doesn't follow traditional pathwaysReferenced* Creative Careers in Medicine* Australian Medical AngelsContactIf you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay😄 Enjoying Clinical Changemakers?Help other healthcare professionals discover these inspiring stories! Share this episode with a colleague who's ready to think differently about their career. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 48m 57s | ||||||
| 6/3/25 |  A Philosopher-Physician's Fight To Reclaim Medicine's Soul | Dr. Vikas Saini (President of Lown Institute) | "The enterprise of medicine has both scientific and moral dimensions, and they're inextricably balanced"Dr Vikas Saini is a Cardiologist and President of the Lown Institute, where he leads a non-partisan think tank advocating bold ideas for a just and caring system for health. With a unique background combining philosophy and medicine, Dr. Saini has spent decades examining the intersection of ethics, evidence, and economics in healthcare. His work on the Social Responsibility Index challenges traditional hospital rankings by measuring what truly matters: equity, value, and patient outcomes rather than reputation and revenue.Key TakeawaysPhilosophy enables systemic healthcare thinking: A philosophical background provides tools to step back and examine healthcare's "water" - the invisible assumptions and frameworks that shape medical practice and policy decisions.Healthcare is fundamentally a moral enterprise: While science guides medical decisions, the uncertainty inherent in complex human systems requires ethical frameworks. The profession exists to serve others, making moral dimensions inseparable from scientific ones.20-30% of healthcare may be unnecessary: From procedures lacking evidence to system inefficiencies driving unnecessary hospitalisations, overuse represents a massive opportunity for improvement - but requires paradigm shifts, not just cutting services.Hospital consolidation hasn't improved care: Despite promises of efficiency, consolidation has primarily raised prices while hospitals increasingly operate like businesses, with some running billion-dollar hedge funds rather than focusing on community health.Where to Find Dr. Vikas Saini* LinkedInIn This Episode00:08 - Philosophy's influence: learning to think about thinking in healthcare02:45 - Healthcare as a moral and scientific enterprise: beyond the science11:13 - The penicillin paradigm trap: why silver bullets fail for chronic disease15:13 - Individual patients vs population means: the clinician's dilemma19:15 - The culture of "doing something": when waiting is the hardest medicine23:24 - Longitudinal care and efficiency: why more time means better outcomes25:33 - Measuring overuse: from clear waste to uncertain benefits30:36 - Why Choosing Wisely hasn't moved the needle significantly34:28 - Policy opportunities: professional self-regulation over bureaucratic control38:49 - Origins of the Social Responsibility Index: beyond reputation rankings43:29 - Nonprofit hospitals acting like businesses: when mission meets margins46:00 - Hospital consolidation: King Kong vs Godzilla, with patients trampled50:58 - Advice for clinicians: taking up the cause of patients in systemic changeReferenced* Abraham Flexner and the 1910 Flexner Report (Original Report)* Dr. Bernard Lown (Profile)* Continuity in general practice as a predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway (Paper)* Choosing Wisely (Website)* Lown Institute's Social Responsibility Index (Website)ContactContact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay👍 Enjoying Clinical Changemakers?This is a one-man band, and I need your help for this to be sustainable. If this episode sparked something for you, please share it with a friend or colleague. Thank you! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 49m 26s | ||||||
| 5/27/25 |  Goal-Oriented Healthcare: Breaking Free from the Problem-Focused Paradigm | Dr. James Mold (University of Oklahoma) | "The way to prevent cascades is to keep your eye on the goal, to understand what you're trying to accomplish and not to go down rabbit holes chasing abnormalities, but rather to be focused on the outcome that you're looking for."Dr James W. Mold is a family medicine physician, geriatrician, researcher and academic with a Master of Public Health degree and is Professor Emeritus at the University of Oklahoma Health Sciences Centre. His pioneering research focuses on transforming healthcare from a problem-oriented to a goal-oriented paradigm, addressing the limitations of traditional problem-focused approaches. For over 20 years, in collaboration with the Oklahoma Physicians Resource/Research Network (OKPRN), Dr Mold has completed more than 75 major projects, resulting in more than 100 publications.Key TakeawaysClinical cascades are preventable through goal focus: Unnecessary medical interventions often cascade from initial anxiety-driven decisions. Maintaining focus on patient outcomes rather than chasing every abnormality prevents harmful escalation.The problem-oriented paradigm has reached its limits: While effective for acute, single problems, traditional disease-focused medicine struggles with the reality that all patients have multiple risk factors and complex needs.Four universal healthcare goals exist naturally: Every patient wants to survive as long as possible, maintain quality of life, have a good death, and continue personal growth—goals that require individual understanding rather than standardised approaches.Practice-based research networks bridge the research-practice gap: Successful implementation requires trusting practitioners, addressing their real-world questions, and providing ongoing facilitation support rather than just education.Goal-oriented care is more satisfying and effective: This approach makes medicine more enjoyable for providers while resonating strongly with patients, though system constraints make adoption challenging.Where to Find Dr James Mold* LinkedInIn This Episode01:07 - Early experiences in family medicine and the humanising revolution05:40 - Transition from family practice to academic geriatrics10:31 - The cascade effect: when one decision spirals into unnecessary care15:32 - Building practice-based research networks and learning from practitioners22:00 - Implementation research and the "aeroplane repair in mid-flight" challenge26:45 - The problem-oriented paradigm: how we got here and why it's failing33:57 - Goal-oriented healthcare: the four universal goals every patient has40:47 - Implementation challenges and global adoption of goal-oriented careReferenced* The Cascade Effect in the Clinical Care of Patients (Paper)* Goal-Oriented Prevention: How to Fit a Square Peg into a Round Hole (Paper)* The Law of Diminishing Returns in Clinical Medicine: How Much Risk Reduction is Enough? (Paper)* Thomas Kuhn's "The Structure of Scientific Revolutions" (Book)* Failure of the Problem-Oriented Medical Paradigm and a Person-Centred Alternative (Paper)* Oklahoma Physicians Resource Research Network (Link)* Practice-based research network methodology (Link)ContactContact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com👍 Hey there - if you're enjoying this episode, make sure you share it with a friend! Thank you for your support. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 44m 25s | ||||||
| 5/21/25 |  Networks, Culture & Safety: How to Build Effective Healthcare Organizations | Prof. Ingrid Nembhard (Wharton School) | "We need to pay more attention to the networks that operate between people and the networks that operate between organisations.”Professor Ingrid Nembhard is an Organisational Behaviour expert in healthcare systems, based at the Wharton School of the University of Pennsylvania. Her research focuses on how characteristics of health care organisations, their leaders, and staff contribute to their ability to implement new practices, engage in continuous organisational learning, and ultimately improve quality of care.Key TakeawaysRelationships and networks drive outcomes: The connections between people and organisations significantly impact healthcare delivery. Traditional structural changes often fail because they ignore these relational dimensions.Psychological safety is essential: Creating environments where people can take interpersonal risks—raising concerns, offering suggestions, sharing half-formed ideas—enables both innovation and problem-solving. This requires relationships built on trust and respect.Standardisation and creativity complement each other: Rather than being opposed, standardisation helps identify where creativity is needed, and creative solutions can become new standards. Healthcare requires both standardised processes and customised approaches.COVID revealed organisational potential: The pandemic demonstrated healthcare's capacity for creative problem-solving and adaptability. Organisations should maintain the communication channels and cross-functional collaboration that emerged during this crisis.Where to Find Professor Ingrid Nembhard* LinkedInIn This Episode00:01 - Introduction00:34 - Is healthcare truly different from other industries?03:16 - The growing recognition of organisational factors in healthcare05:31 - How organisational skills should be incorporated into clinical education10:20 - Learning the broader healthcare context vs. operational skills14:25 - Understanding networks in healthcare organisations18:47 - How to map and leverage relationships within organisations22:48 - Building networks prospectively rather than retrospectively26:26 - Creating psychological safety in healthcare teams31:24 - Practical steps for leaders to implement psychological safety36:40 - How standardisation and creativity can complement each other42:51 - Lessons from COVID-19 for healthcare managementReferenced* Integrating network theory into the study of integrated healthcare (Paper)* NEJM: Responding to Covid-19: Lessons from Management Research (Paper)* COVID-19 Inspired Creativity In Health Care: Lessons For Management And Policy (Article)ContactContact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com👋 Hey there - Jono here. If you enjoy this episode, please share it with a friend. Thanks for the support! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 45m 48s | ||||||
| 5/5/25 |  Liberate Health Data and Escape the EHR Trap | Dr Sidharth Ramesh (Medblocks Founder) | "Epic charges researchers to access the data that the same Institute has spent thousands of hours storing. They're not a good custodian of data... they're literally locking your data away and holding it for ransom." — Dr. Sidharth RameshListen now on Apple, Spotify, YouTube or wherever you get your podcasts.Dr Sidharth Ramesh is a medical doctor, clinical informatics expert, YouTube educator, and co-founder of MedBlocks, a company dedicated to creating patient-centric digital health platforms and providing tools, products, educational materials, and services. His work spans healthcare data models, API standardization, and breaking down data silos to enable innovation across healthcare systems globally.Key TakeawaysLegacy Healthcare IT stifles innovation: Current systems either lock you into vendor ecosystems or create unstable bespoke solutions that can't evolve with changing requirements.Health data platforms offer a solution: By standardising data models and APIs, these platforms allow for consistent data storage while enabling innovation through applications built on top.Global standards matter: Projects like OpenEHR with over 1,000 standardised clinical data models prevent reinventing the wheel for common healthcare concepts.Headless EHRs are emerging: The concept of slimmed-down EHRs focused on data storage with standard APIs rather than locked-in workflows is gaining traction.Policy can drive change: Regulations like information blocking rules in the US have started to crack open data monopolies, though progress is still needed.Where to Find Dr. Sidharth Ramesh* LinkedIn* YouTubeIn This Episode00:01 - Introduction04:13 - How the healthcare industry stifles innovation07:47 - Problems with bespoke IT solutions in healthcare11:59 - Integration challenges of best-of-breed approaches14:30 - Examples of inconsistent data representation17:05 - The healthcare data platform concept19:22 - OpenEHR and global data models22:09 - Consistent APIs and standards23:15 - The benefits of platform approaches27:46 - AI's impact on healthcare data access and patient empowerment33:49 - Challenges with AI in healthcare36:38 - Why big tech companies struggle in healthcare39:52 - The role of policy in unlocking healthcare data44:52 - The mission of MedBlocks51:28 - The future of MedBlocksReferenced:* Medblocks Company (link)* The Innovator's Prescription by Clayton Christensen (Book)* Clinical Knowledge Manager (CKM) for OpenEHR (link)* FHIR standard for healthcare interoperability (link)Contact Information:If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay🙏 Hi, Jono here - if you're finding value in Clinical Changemakers, please share this episode with a colleague who's interested in healthcare innovation. Thank you for your support! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 45m 20s | ||||||
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| 4/22/25 |  From Evidence to Exit: Building Credible Health Tech | Dr Saira Ghafur (Co-Founder of Provea Health & Lead for Digital Health at Imperial College) | “The market was flooded with all these new tools and technologies that people were using, but no real evidence base behind them. Now we’re in this space where we need evidence. — Dr Saira GhafurListen now on Apple, Spotify, YouTube or wherever you get your podcasts.Dr Saira Ghafur is a medical doctor specialising in respiratory medicine, an academic and expert in digital health at Imperial College London, and co-founder of two startups, including Prova Health, where she serves as Chief Medical Officer. Her work spans cybersecurity in healthcare, evidence generation for digital health technologies, and translating research into practical applications that improve healthcare systems.What you'll learn:* Why healthcare cybersecurity attacks have grown fivefold and become increasingly sophisticated and state-sponsored* The unique challenges of healthcare cybersecurity compared to other critical sectors like finance or energy* How to build resilient health systems that can continue providing care during cyberattacks* Why digital health technologies remain a "wild west" when it comes to evidence generation* The importance of gathering different types of evidence throughout a product's lifecycle—from qualitative user research to clinical outcomes and economic evidence* How simulation and synthetic patient data can help evaluate digital health tools in low-risk environments* The challenges of creating evidence for AI in healthcare and why data quality is fundamental* Lessons learned from founding two healthcare startups as a clinicianKey TakeawaysCybersecurity is healthcare's blind spot: Despite healthcare's increasing digitisation, research into cybersecurity resilience lags far behind other critical sectors, creating significant vulnerabilities.Resilience requires planning for multiple catastrophes: Healthcare organisations must prepare not just for cyber attacks but for compounding disasters, like a cyber attack followed by a mass casualty event.Evidence generation must match the product lifecycle: Early-stage technologies need qualitative user research, while mature products require real-world evidence gathering—one size doesn't fit all.Data accessibility is crucial but challenging: Access to high-quality healthcare data remains difficult, especially for smaller innovators who can't afford to clean and curate it properly.Secure data environments offer a path forward: Creating spaces where innovators can access data without it leaving the secure environment addresses both security concerns and patient fears.Economic evidence is increasingly essential: With constrained healthcare budgets, proving value for money has become non-negotiable for digital health technologies.Where to Find Dr Saira GhafurLinkedInIn This Episode00:00 - Introduction to cybersecurity in healthcare01:04 - How cyber threats have evolved in healthcare04:45 - Building resilient healthcare systems08:47 - The research landscape in healthcare cybersecurity11:17 - Digital health technologies and evidence generation15:48 - Regulatory challenges in digital health21:45 - Using simulation for evidence generation26:02 - Evidence generation for AI in healthcare31:44 - The importance of high-quality data34:32 - Economic evidence in digital health36:35 - Lessons learned as a clinician founderReferenced:* Challenges for the evaluation of digital health solutions - A call for innovative evidence generation approaches (Paper)* Safeguarding our healthcare systems: A global framework for cybersecurity (Paper)* FDA - Software as a medical device (Website)* NICE - Evidence standards framework (ESF) for digital health technologies (Website)* PECAN - Fast Track Digital Tools in France (Website)* DiGA - Fast Track Digital Tools in Germany (Website)* Prova Health (Website)* Generating economic evidence for digital health solutions (White paper)* Trust through evidence: Evidence generation for AI solutions in healthcare (White paper)* Be Smarter than your lawyer and your VC (Book)Contact Information:If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay👍Hi, Jono here - if you're enjoying my work, please share it with a friend or colleague. Thank you for your support This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 40m 56s | ||||||
| 4/9/25 |  Customer Obsession in Healthcare: Primary Care Redefined | Dr Raj Behal (Amazon One Medical) | "I think of quality as what is the patient's ‘job to be done’. What are they trying to get out of this encounter or from their help? What are they trying to achieve? Making quality about that."— Dr Raj Behal.Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.Dr. Raj Behal is a medical doctor and Chief Quality Officer at Amazon One Medical. With a background in internal medicine, medical informatics, and public health, Dr. Behal has spent his career translating evidence into better care. Before joining One Medical, he worked with academic medical centers to improve quality metrics and patient outcomes. Today, he's focused on redefining quality in primary care through a blend of in-person visits, 24/7 virtual care, and digital health solutions.Key Takeaways* Quality is multidimensional: The Institute of Medicine defines healthcare quality through six domains—safe, timely, effective, efficient, equitable, and patient-centered—but these shouldn't be viewed as separate boxes to check.* Standard metrics aren't enough: HEDIS measures like cancer screening rates and diabetes control are important but capture only "a sliver of what people actually want from their health and healthcare providers."* Respect drives efficiency: One Medical starts appointments exactly on time not because of efficiency targets but out of genuine respect for patients' time—a cultural shift that transforms the care experience.* The coaching approach works: When hospitals received mortality data without guidance, nothing changed. When Dr. Behal worked directly with clinical teams to interpret the data and develop solutions, mortality rates dropped 20-25% in less than a year.* Technology should augment, not replace: The future isn't about AI diagnosing patients but about automating routine tasks—"about 80% of routine testing screenings can be ordered by a machine," freeing clinicians for higher-value work.Where to Find Dr. Raj BehalLinkedInIn This Episode00:00 - Introduction to quality in healthcare 02:57 - Defining comprehensive healthcare quality 07:19 - Approaches to meaningful healthcare measurement 14:00 - Using AI to extract quality signals from clinical data 19:51 - Importance of coaching in quality improvement 28:45 - The One Medical model and Amazon acquisition 33:31 - The "three-body problem" in healthcare delivery 40:47 - Ambitious goals for transforming heart disease preventionReferenced:* Six Domains of Healthcare Quality (Website)* The Healthcare Effectiveness Data and Information Set (HEDIS) (Website)* Failure mode and effects analysis (FMEA) (Website)* Amazon’s PR/FAQ process (Website)Contact information:If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay👋Hi, Jono here - if you’re enjoying my work, please share it with a friend! Thanks for your support! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 47m 40s | ||||||
| 3/26/25 |  The Economic Imperative: Why Health Equity Matters for Everyone | Prof. Bola Owolabi (NHS England Director) | "The greatest legacy we can leave as this generation of leaders is to make meaningful progress in narrowing those health inequalities between communities."— Prof Bola Owolabi.Episode OverviewIn this episode, Professor Bola Owolabi, GP and National Director for Healthcare Inequalities at NHS England, shares her insights on health inequalities in England, how the COVID-19 pandemic exposed pre-existing disparities, her views on leadership and the innovative Core20Plus5 framework she's implementing to drive meaningful change across communities.What you'll learn:* How the COVID-19 pandemic exposed pre-existing health inequalities and acted as a catalyst for systemic change.* Why addressing health inequalities has both moral and economic imperatives, potentially saving healthcare systems billions annually.* The framework behind Core20Plus5 and how it provides focus, traction, and impact by targeting specific populations and clinical areas.* Why community engagement and listening are fundamental to designing effective healthcare interventions.* How a comprehensive ecosystem approach with multiple levers—including legislation, research, innovation, and funding—drives sustainable change.* The distinction between courage as an individual trait versus a function of supportive community and shared values.Some Key Takeaways* Health inequalities cost the NHS approximately £5 billion annually, with additional costs of £30 billion in productivity losses and another £30 billion in reduced tax revenue and higher welfare payments.* The COVID-19 pandemic didn't create health inequalities but exposed existing disparities: Black men experienced 2.2 times higher mortality in the second wave, while men from Bangladeshi backgrounds had 5 times higher mortality in the first wave.* Pre-pandemic data showed stark life expectancy gaps: 10-15 years for people with learning disabilities, 15-20 years for those with serious mental illness, and a 19.6-year difference in healthy life expectancy between the most and least affluent areas.* Core20Plus5 provides a clear framework for action by focusing on the 20% most socioeconomically deprived populations (Core20), plus specific underserved communities, across five clinical areas with significant mortality disparities.* Effective healthcare delivery requires meeting communities where they are—like mobile clinics for fishing communities whose livelihoods depend on unpredictable sea conditions.* Innovation for Health Inequalities Program (InHIP) leverages trusted community voices to increase uptake of approved treatments, resulting in a 70% rise in cholesterol-lowering medication use among Black African communities in Greater Manchester (UK).* Courageous leadership requires surrounding yourself with people who share your values but are willing to challenge you—creating psychological safety through "community and company rather than lonesome leadership."Where to find Professor Bola Owolabi* LinkedInIn This Episode* 00:01 - Introduction to Professor Bola Owolabi* 00:22 - Defining health inequalities and their impact* 01:36 - Distinction between inequality and inequity* 03:18 - How COVID-19 exposed pre-existing health inequalities* 08:44 - Community engagement experiences and listening to affected populations* 14:56 - Economic costs and business case for addressing health inequalities* 20:51 - How leadership enabled strategic focus on health inequalities* 25:18 - The importance of courage and support in leadership* 30:27 - Core20Plus5 framework explanation and implementation* 36:38 - Innovation for Health Inequalities Program examples* 44:16 - Scaling and sustaining change through a comprehensive ecosystem approachReferenced:* 8 Urgent actions to address inequalities in NHS provision and outcomes (Report)* Red Cross report on high use of emergency care utilization (Report)* Core20PLUS5 (Webpage)* Deloitte - US health care can’t afford health inequities (Report)* NIHR launches £50m ‘Challenge’ funding to tackle inequalities in maternity care (Webpage)* Health and Care Act of 2022 (Webpage)* Innovation for Healthcare Inequalities Programme (InHIP) (Webpage)Contact information:If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay👋Hi, Jono here - if you’re enjoying my work, please share it with a friend, it would mean a lot to me!Thank you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 48m 34s | ||||||
| 3/18/25 |  Money, Power, Health: How Corporations Shape Our Health | Dr. Nason Maani (Commercial Determinants Researcher) | "The health impact of corporate power isn't just about products—it's about how commercial interests shape the entire landscape of health policy and research." — Dr Nason MaaniListen now on Apple, Spotify, YouTube or wherever you get your podcasts.Dr Nason Maani, lecturer in Inequalities and Global Health Policy at the University of Edinburgh, author of "The Commercial Determinants of Health," and host of the podcast “Money, Power, Health” discusses the complex interplay between commercial interests, power dynamics, and health outcomes.What You'll Learn:* How multinational corporations employ similar sophisticated strategies to influence health policy, including lobbying, revolving door employment, and strategic philanthropy* The specific ways commercial actors shape evidence through research funding priorities and selective publication of results* Why structural market failures in healthcare create environments where commercial interests can dominate public health concerns* How to identify and counteract corporate messaging that shifts responsibility for health from systems to individuals* The measurable impacts of commercial determinants on health inequities across different socioeconomic groups and geographic regionsSome Takeaways:* Understanding the commercial determinants of health is essential for addressing root causes of health issues* Corporate actors view their customer base very differently than we do, putting a high reliance on ‘super-users’* Public health approaches must consider the influence of commercial interests if they are to be successful* Transparency about financial interests in healthcare research and policy is crucial for building trustWhere to find Dr Nason Maani* LinkedInIn this episode, we cover:(00:00) Introduction to Dr. Nesimani(01:00) Overview of commercial determinants of health(05:30) The "Money, Power, Health" podcast journey(10:45) Key themes from "The Commercial Determinants of Health" book(15:20) Case studies of commercial influence on health policy(22:15) Strategies for clinicians to navigate commercial pressures(28:40) Global variations in commercial determinants(34:10) Future directions for research and advocacy(40:25) Practical tools for identifying commercial bias(49:19) Closing thoughts and resourcesReferenced:* Money, Power, Health (Podcast)* The Commercial Determinants of Health (Book)* The WHO - Commercial Determinants of health (Article)Contact information:If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 50m 01s | ||||||
| 3/3/25 |  Science Communication: Why the Basics Matter in an Age of Sound Bites | Dr Aaron Carroll (CEO of Academy Health) | "I'd rather have people understand why they should believe something, not just that they should." — Dr Aaron CarrollListen now on Apple, Spotify, YouTube and or wherever you get your podcasts.Dr Aaron Carroll, pediatrician, professor, president and CEO of Academy Health, and renowned science communicator, discusses the art and science of effective communication in healthcare. Learn how he developed his skills through years of dedicated practice at the Incidental Economist, to global reach at the New York Times. He reflects on the challenges of translating complex research into accessible content, and why building trust is essential for changing minds.What You'll Learn:* Why repetition and consistency are fundamental to effective science communication* How to build trust through transparency, evidence-based reasoning, and admitting when you're wrong* Why the academic publishing model limits practical applications of research* The challenges of communicating during the COVID-19 pandemic and navigating controversial topics* How to balance personal storytelling with scientific rigor in public-facing contentSome Takeaways:* Science communication requires consistent practice and coaching, just like any other skill* Academic research often takes years or decades to translate into practice, often due to communication barriers* Many healthcare practices lack strong evidence, yet professionals often present all recommendations with equal confidence* Building trust requires explaining not just what to do, but why it matters and the evidence behind it* Personal stories can significantly increase audience engagement and build trust when balanced with scientific evidenceWhere to find Dr Aaron Carroll:* Twitter/X* LinkedInIn this episode, we cover:(00:00) Introduction to Dr. Aaron Carroll (01:00) Why science communication became his passion (02:30) The gap between academic and public communication(06:30) The limitations of peer-reviewed literature (08:33) How to develop science communication skills (13:16) Building trust through consistency and transparency (16:43) Institutional approaches to science communication (19:36) Addressing myths and biases in healthcare (23:40) Challenges with clinical decision support systems (28:33) Writing for the New York Times during COVID-19 (32:22) Navigating controversial healthcare topics (37:00) The power of personal storytelling in science writing (41:50) Balancing scientific rigor with accessibilityReferenced:* The Incidental Economist: https://theincidentaleconomist.com/wordpress/* Healthcare Triage: https://www.healthcaretriage.info/* Academy Health: https://academyhealth.org/* New York Times - Dr Carroll's articles: https://www.nytimes.com/by/aaron-e-carroll* About Aaron Carroll - https://academyhealth.org/about/people/aaron-e-carroll-md-ms* Dr Carroll’s BooksContact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic Attribution: Music by AudioCoffee from Pixabay This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 45m 15s | ||||||
| 4/10/24 |  Leading New York State & Bridging the Private Sector | Dr Nirav R. Shah (Senior Scholar at Stanford) | "There is a lot of mistrust between the two, the private sector thinks about government bureaucrats who've done the same way for 20 years...the public sector talks about the private sector... who just want to make money at any cost... and they're both wrong." - Dr Nirav Shah, Senior Scholar at Stanford.In this episode, Dr Nirav Shah reflects on his early journey into healthcare, in particular how a patient error influenced his direct to focus on quality and safety, and how his mentors were a huge part in 'skip level opportunities'. Next, Dr Shah outlines how he navigated politics and responsibility as the Health Commissioner for New York State. Opportunities in digitizing processes, transparency and public engagement were way to effect change. Finally, we explore Dr Shah's experience working in the private sector and the need for bridges to be built across the public/private interface to ensure trusted relationships and a common goal. This episode is a treasure trove of enriching insights and inspiring stories from one of the key voices in healthcare. Don't miss this riveting conversation with Dr. Nirav Shah.Follow Dr Shah:* Twitter/X* LinkedInAbout our guest:About our guest:Nirav R. Shah, MD, MPH, is Senior Scholar at Stanford University’s School of Medicine. He is a distinguished healthcare leader with experience as an operator, scientist, innovator, and regulator. His expertise spans public health, public and private health insurance, and clinical operations across the continuum of care. At Stanford, Dr. Shah conducts research on improving healthcare quality and safety while lowering cost, driving adoption of digital technologies, and quantitatively evaluating the resulting value for US and international health care systems.Additional resources mentioned in the podcast* Article - Doctors Petition for Limits on Painkillers* Article - A Boy’s Life is Lost to Sepsis. Thousands are saved in his Wake.Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comIntro and Out Music Attribution: Music by AudioCoffee from Pixabay This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 47m 19s | ||||||
| 3/27/24 |  The Intersection of Invention, Innovation & Business | Dr Josh Makower (Serial Entrepreneur, Investor, Leader of Bio-design) | “You can be successful as an innovator, even as a physician or any other background you have, as long as you follow the process and really focus on the needs. That's the key.” — Dr Josh Makower, Director and Co-Founder of the Stanford Byers Center for Biodesign.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Dr Joshua Makower discusses his newest medical device approval Moximed and how his multi-disciplinary education of engineering, medicine and business has supported his successful career as an inventor. He goes on to highlight how clinicians and healthcare systems need to embrace innovation to solve some of our biggest challenges. Dr Makower puts forward how lessons working on innovation at Pfizer influenced the Biodesign approach to innovation. Finally, he covers the policy and investment landscape for progressing healthcare innovation.'Follow Dr Makower: Twitter/X, LinkedIn.About the guest: Josh Makower, MD is the Boston Scientific Applied Bioengineering Professor of Medicine and of Bioengineering at the Stanford University Schools of Medicine and Engineering, and is the Director and Co-Founder of the Stanford Byers Center for Biodesign, and Founder of Stanford’s Biodesign Policy Program. Josh also serves as a Special Partner on New Enterprise Associate's healthcare team supporting their medtech/healthtech practice. Lastly, Josh is the Founder and Executive Chairman of ExploraMed, a medical device incubator that has created 10 companies over the past 20 years. Josh currently serves on the board of directors for DOTS Devices, ExploraMed, Allay Therapeutics, Lungpacer, Moximed, Willow Innovations, SetPoint Medical, X9 and Coravin. Josh holds over 300 patents and patent applications for various medical devices in the fields of cardiology, ENT, general surgery, drug delivery, plastic surgery, dermatology, aesthetics, obesity, orthopedics, women’s health and urology.Additional resources mentioned in the podcast:MoximedBiodesign at StanfordBook - Biodesign: The Process of Innovating Medical Technologies Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 37m 13s | ||||||
| 3/13/24 |  Moral Injury & the Musical Chairs of Housing | Dr Margot Kushel (Director of the UCSF Benioff Homelessness and Housing Initiative) | "There is a very evidence-based way to house people for people who are experiencing homelessness, it has been around a long time, it's been testing empirically, it's called housing first" — Dr Margot Kushel, Director of the UCSF Benioff Homelessness and Housing Initiative.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Dr Margot Kushel explores the moral injury of being a frontline clinician and having to discharge people back onto the streets. How her College told her that no medical school would ever accept her and her success has been to honor the commitment to others who face unfair treatment by our system. Dr Kushel elaborates on her landmark research into homelessness in California, highlighting the moral, medical, social and economic impact that this issue has on those individuals, their families and society as a whole. She goes on to emphasise that homelessness is a housing problem and that this is one of the key areas that needs to be addressed. Dr Kushel outlines the less forgiving the structural and safety net factors are, the fewer individual factors it takes for people to end up homeless. Finally, she explains the types of activities that clinicians can get involved in to help solve this issue.Follow Dr Margot Kushel: Twitter/X, LinkedInAbout the guest: Margot Kushel, MD is a Professor of Medicine at University of California San Francisco, and Division Chief and Director of the UCSF Center for Vulnerable Populations, and Director of the UCSF Benioff Homelessness and Housing Initiative. She is a practising general internist at Zuckerberg San Francisco General Hospital. Margot's research focuses on the causes and consequences of homelessness and housing instability, with the goal of preventing and ending homelessness and ameliorating the effects of homelessness and housing instability on health. She speaks at a local, state, and national level about issues of homelessness, and frequently provides testimony to legislative bodies.Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 43m 51s | ||||||
| 2/27/24 |  Exploring AI, ChatGPT and Clinical Informatics | Professor Nigam Shah (Founder, Chief Data Scientist for Stanford Health Care) | "Even though you trained them for something silly, like to predict the new word, new capabilities emerged, as in, now they can answer, which is something they weren't trained for" — Professor Nigam Shah, Chief Data Scientist for Stanford Health Care.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Professor Nigam Shah shares his early experiences with AI, called 'application of reasoning', how this has evolved, and how AI and web applications like ChatGPT have changed the landscape of how AI is being used. He notes we should be guarded about their general application in healthcare without appropriate research and trials. Professor Shah explores his informatics consultation service at Stanford, which uses real-time research to support clinicians in challenging circumstances. Finally, Professor Shah outlines his teams’ framework for better understanding and evaluating AI tools.Follow Professor Nigah Shah: Twitter/X, LinkedIn.About the guest: Dr Nigam Shah is Professor of Medicine at Stanford University, and Chief Data Scientist for Stanford Health Care. His research group analyzes multiple types of health data (EHR, Claims, Wearables, Weblogs, and Patient blogs), to answer clinical questions, generate insights, and build predictive models for the learning health system. At Stanford Healthcare, he leads artificial intelligence and data science efforts for advancing the scientific understanding of disease, improving the practice of clinical medicine and orchestrating the delivery of health care. Dr. Shah is an inventor on eight patents and patent applications, has authored over 200 scientific publications and has co-founded three companies.Additional resources mentioned in the podcast:Shah Lab StanfordThe Green Button - Research PaperAtropos Health (The Green Button Company)Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 40m 38s | ||||||
| 2/15/24 |  Leading a Nation through a Global Pandemic | Sir Ashley Bloomfield (Former Director General Of Health) | "One of the conclusions I've drawn from COVID...in a sense, was that our communications approach was our most important public health intervention" — Sir Ashley Bloomfield, Former Director General Of Health, New Zealand.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Sir Ashley Bloomfield reflects on his humble upbringing and how he approached being a generalist and took on new opportunities. He goes on to explore early experiences as a doctor, and how he picked up on leadership behaviors from others. Sir Ashley Bloomfield goes on to describe what it's like to be at the nexus of public health, public service and politics. He elaborates on the importance of the public service in being a trusted institution and how this was vital to New Zealand's COVID-19 response. Sir Ashley's enlightening insights provide a roadmap for governments around the world to navigate public health crises.In the final segment of our discussion, we zoom in on Sir Ashley's perspective on leadership and communication during a pandemic. He underscores the power of learning from global contexts and how transparency and effective communication build public trust. His emphasis on continuous learning and growth is a testament to his journey and the lessons he has gleaned from it. This enriching and enlightening conversation with Sir Ashley Bloomfield isn't just a podcast episode—it's a masterclass in leadership in the face of unprecedented challenges.Follow Sir Ashley Bloomfield: Twitter/X, LinkedIn.About our guest: Sir Ashley Bloomfield trained in medicine at the University of Auckland and specialised in public health medicine. He has 25 years of experience in public policy and health leadership, including at the World Health Organization in Geneva. He was Director-General of Health from June 2018 to July 2022 and led the country’s health response to the COVID-19 pandemic. He was appointed a Knights Companion of the New Zealand Order of Merit (KNZM) in the 2023 New Year Honours for services to public health and is now a Professor at the University of Auckland's School of Population Health.Additional resources mentioned in the podcastDeveloping Future Public Service Leaders for Aotearoa New ZealandNew Zealand’s COVID-19 response saved 20,000 lives - researchContact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 43m 47s | ||||||
| 1/29/24 |  Power, Managers & the Science of Teams | Professor Sara Singer (Director of the HELIO Labs at Stanford Medicine) | "You have to be somewhat more strategic, you have to identify your sources of power and use those sources of power to influence the people you want to enact whatever it is you are asking of them" — Professor Sara Singer, Director of the HELIO Labs at Stanford Medicine.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Professor Sara Singer reflects on her early experiences of healthcare with her father being a surgeon and starting in strategy and policy. Professor Singer highlights that the best leaders and managers do a lot of really good listening and delegation and that there is an important distinction between the two concepts, even if they are being expressed by a single person. She goes on to explore the challenges that managers have in working with experts and the potential for parallel hierarchies within organizations. Professor Singer outlines how clinicians should reflect on their sources of power to better influence colleagues to enact the change they are seeking. Next, she discusses the "Army Crew" case, as an example of when a team loses its identity and needs an intervention to improve the team culture and performance. Finally, Professor Singer packages up the well-studied literature on the science of teamwork as a framework for use in the healthcare setting.Follow Professor Sara Singer: Twitter/X, LinkedInAbout our guest: Sara J. Singer, M.B.A., Ph.D., is a Professor of Medicine at the Stanford University School of Medicine and Professor of Organizational Behavior, by courtesy, at the Stanford Graduate School of Business. She is Associate Director of the Clinical Excellence Research Center in the Department of Medicine and Faculty Director of the Health Leadership, Innovation, and Organizations (HELIO) Labs in the Division of Primary Care and Population Health. She is affiliated faculty with the Stanford Department of Health Policy, Freeman Spogli Institute for International Studies, Clinical Excellence Research Center, Center for Innovation in Global Health, and Woods Institute for the Environment.Additional resources mentioned in the podcastHealth Leadership, Innovation, and Organizations (HELIO) LabsThe Army Crew Team, Harvard Business School CaseLeading Frontline Covid-19 Teams: Research-Informed StrategiesContact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 38m 40s | ||||||
| 1/17/24 |  Venture Capital in Silicon Valley - From Clinician to Investor | Dr Oliver Keown (Director at Intuitive Ventures) | "In times of hesitancy in the market, leaders lean in, they assert themselves, they flex and they find an opportunity” — Dr Oliver Keown, managing director of Intuitive Ventures.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Dr. Oliver Keown discusses his career journey from a doctor in the UK's National Health Service, to a venture capitalist as Managing Director at Institutive Venture Fund. Dr Keown highlights how clinicians have important roles to contribute to this space through our training and experiences. He explores the industry of private equity in healthcare and explains the types of attributes that make a successful partner. Dr Keown put forward suggestions for how policymakers can shape the innovation and venture market that could improve its focus on equity.Follow Dr Oliver Keown: Twitter/X, LinkedInAbout the guest: In 2021, Oliver was recognized as a Top 50 Emerging Leader in corporate venture capital, and in 2022, selected as #39 on the Global Corporate Venturing Power List of the 100 most influential investors in the industry. Before coming to Intuitive Ventures, Oliver was a healthcare investor with GE Ventures, driving international startup deal flow and supporting numerous portfolio companies operationally and at the board level. Before that, he advised an array of UK, US, and global healthcare innovation projects across technology, government, commercial, and academic fields.Additional resources mentioned in the podcast:Intuitive VenturesContact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 43m 39s | ||||||
| 12/20/23 |  Trust, Strategy and Resilience & Moving Healthcare Forward | Dr Thomas H. Lee (Harvard Professor, Chief Medical Officer at Press Ganey) | "There's good news, we're actually seeing signs of a virtuous cycle, we're seeing [workforce] pride in organizations and that leads to people working together better, making the care better, which means the patients are more grateful, which makes people feel even more pride". — Dr. Thomas H. Lee, Professor of Medicine at Harvard Medical School and Chief Medical Officer at Press Ganey.Listen on Apple, Spotify, or wherever you get your podcasts.In this episode, Dr. Thomas H. Lee discusses his professional growth, career development, and the core competencies of healthcare leaders. He distinguishes between leadership and management while highlighting their vital roles within complex health organizations. Dr Lee explores clinicians’ important contributions to value creation, and the need to hone in on the value chain. He further develops the idea that people should have choices when it comes to healthcare and we (healthcare providers) should be working hard to be chosen. Dr. Lee underscored the importance of trust-building with patients and staff alike.Follow Dr Thomas H. Lee: Twitter/X, LinkedIn.About the guest: Dr. Thomas Lee is the Chief Medical Officer for Press Ganey and an internist/cardiologist who practices at Brigham and Women’s Hospital in Boston, Massachusetts. He is on the faculty at Harvard Medical School and Harvard School of Public Health and is Editor-in-Chief of NEJM Catalyst and a member of the Editorial Board of The New England Journal of Medicine. He is a member of the Board of Directors of Geisinger Health System and chairs the Board of Geisinger Health Plan. Before joining Press Ganey in 2013, he was Network President for Partners Healthcare System.Additional resources mentioned in the podcast:Book - Healthcare's Path Forward: How Ongoing Crises Are Creating New Standards for ExcellenceBook - HBR's 10 Must Reads On Leadership for HealthcareTurning Doctors into Leaders - Harvard Business ReviewContact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.comMusic attribution: AudioCoffee from Pixabay. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 41m 43s | ||||||
| 12/6/23 |  Upstream Doctors & Social Interventions Research | Dr Laura Gottlieb (Director of Social Interventions Research & Evaluation Network) | "We think as healthcare institutions as just healthcare institutions...actually healthcare institutions are just big businesses that happen to do healthcare, this idea is that there is a whole array of other activities besides healthcare, that have an enormous impact on our local communities" — Dr. Laura Gottlieb, Family Physician and Director of SIREN.In this episode, Dr Laura Gottlieb explores her early frustrations with providing healthcare in a complex system and how she sought out better tools to arm clinical teams to be successful. Dr Gottlieb then elaborates on the need for more translators of the 'Social Determinants of Health' research, to enable frontline providers and policymakers to know what to do next. Spending time in the field has highlighted the ongoing challenges in the complexity of research and how her thinking has evolved over time. Dr Gottlieb outlines the 5 A's framework which illustrates the approaches that providers and communities can take to address underlying social conditions and needs. She then explores the concept of the anchor institutions, and how healthcare institutions provide more than just healthcare.Follow Dr Laura Gottlieb: Twitter/X, LinkedInAbout our guest: Dr Gottlieb is a Professor of Family and Community Medicine at the University of California, San Francisco. Her research explores healthcare sector programs and policies related to identifying and addressing social risk factors in the context of care delivery. She is the founding co-director of the Social Interventions Research and Evaluation Network, a national research network that advances research on healthcare strategies to improve social conditions. Dr. Gottlieb is also Associate Director of the Robert Wood Johnson Foundation Evidence for Action National Program Office.Resources mentioned in the podcast:The Social Interventions Research & Evaluation NetworkHealth Care Sector Activities to Improve Social Care and Strengthen Social Resources (The 5 A's)Music attribution: AudioCoffee from Pixabay.Contact information: If you’d like to get in touch, reach out at jono@clinicalchangemakers.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 39m 51s | ||||||
| 11/22/23 |  Digital Health and Career Reflections at Microsoft | Dr. Simon Kos (Former Chief Medical Officer) | "If we had a multitiered, multilayered approach to clinical leadership where we don't just provide about patient care, but we think about improving the processes and tools...and leave a legacy over time then I think we'd have greater success in driving digital change in health" — Dr Simon Kos, Healthcare Executive at Microsoft.In this episode, Dr Simon Kos explores his journey into digital health, his career reflections and the evolution in the thinking of digital healthcare. He reflects chance life events and educational experiences that allowed him to progress from the Emergency Room into a globally recognised digital health leader. Dr Kos highlights many of the challenges in digital health in terms of just digitizing processes versus transforming processes. He describes how with particular digital tools, benefits can accrue at different levels, and as such, it is vital that frontline staff are included in those benefits. Finally, he covers key questions that all earlier and mid-career professionals should be considering when looking to the future.Follow Dr Simon Kos: LinkedInAbout the guest: Dr Simon Kos is an internationally recognized leader in digital health, working in senior executive roles for over twenty years. He is a registered medical practitioner who has practised critical care medicine in Australia. He holds an MBBS from UNSW, an MBA from AGSM and is a Fellow of the Australian Institute of Digital Health (FAIDH). Significant past roles include global Chief Medical Officer of Microsoft based in Seattle, CEO of Next Practice, Physician Executive with Cerner, and the co-chair of the Global Commission to end the Diagnostic Odyssey for children with a Rare Disease. He is currently the Chief Medical Officer at Microsoft ANZ, a mentor in both NHS and Australia’s Clinical Entrepreneur Programs, a casual lecturer at UNSW School of Medicine, a board member of Innowell, and an advisor/investor in digital health start-ups.Resources mentioned in the podcast:How Simon Kos found his way back to MicrosoftAI MythbustingMusic attribution: AudioCoffee from Pixabay.Contact information: If you’d like to get in touch, reach out at jono@clinicalchangemakers.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com | 50m 29s | ||||||
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