Innovating Children's Healthcare: Strategies and Successes with Dr. Marc Gorelick

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*Please note this transcript is not edited

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Ken Segel - Value Capture (he/him/his): Brain.

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Ken Segel - Value Capture (he/him/his): Hi, everyone! I'm ken Siegel. I'm the CEO of value capture and very excited on this edition this edition of habitual excellence to welcome mark garlic.

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Ken Segel - Value Capture (he/him/his): Mark is a physician and a CEO at Minnesota. Children's 1 of the nation's largest freestanding

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Ken Segel - Value Capture (he/him/his): children's health systems. In the twin cities where he has led absolute transformational work behind his values, of trying to create the best care possible.

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Ken Segel - Value Capture (he/him/his): In a sustainable way. At this moment in American medicine. It's been exciting to watch and

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Ken Segel - Value Capture (he/him/his): Mark has done a lot of thinking about what is critical to successful significant change in an organization and the implications for him as a leader, and I think other leaders will respond to that authentically.

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Ken Segel - Value Capture (he/him/his): But enough of my big introduction. Mark, welcome, welcome to virtual excellence.

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Marc Gorelick (he/him), Children's Minnesota: Thank you. Thanks for having me.

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Ken Segel - Value Capture (he/him/his): And will you start by sharing a bit more about your background and maybe your path to becoming

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Ken Segel - Value Capture (he/him/his): a health system leader at this time. How did you get here.

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Marc Gorelick (he/him), Children's Minnesota: Yeah, you know. My path. My path is in many ways like our path towards continuous improvement, which is not a straight line. And not necessarily fully planned out in advance.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: My entire career has been in in children's healthcare and in children's health systems. I'm a pediatric emergency medicine physician

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Marc Gorelick (he/him), Children's Minnesota: and had 25 years of academic pediatric emergency medicine practice in a couple of different places.

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Marc Gorelick (he/him), Children's Minnesota: and you know one of my motivations, as I sort of made decisions about steps in my career was always trying to have up a bigger impact, and I loved taking care of patients. I loved the clinical setting. I love my colleagues.

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Marc Gorelick (he/him), Children's Minnesota: and I wanted to think of how I could impact the health and wellbeing of even more kids. So my decision, for example, to

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Marc Gorelick (he/him), Children's Minnesota: do clinical effectiveness research as as

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Marc Gorelick (he/him), Children's Minnesota: as my career. You know. If I take care of a kid with asthma, I help one kid with asthma. If I can come up with a better method of taking care of asthma. I can help not only my patients, but other people's patients as well.

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Marc Gorelick (he/him), Children's Minnesota: And so in that spirit I I had no particular aspirations to leadership, certainly not to the role I'm in now. I probably would have laughed

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Marc Gorelick (he/him), Children's Minnesota: myself silly if you had suggested this to me 25 years ago.

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Marc Gorelick (he/him), Children's Minnesota: but I did have sort of increasing levels of leadership within the academic medicine world. And then

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Marc Gorelick (he/him), Children's Minnesota: got involved in some leadership on the hospital side of things, and I saw a path there to having an even bigger impact.

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Marc Gorelick (he/him), Children's Minnesota: I still remember the last day I actually practiced pediatric emergency medicine. One of my colleagues said, Well, how many patients do you think you've seen in your career doing this for 25 years? And I said, Hmm!

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Marc Gorelick (he/him), Children's Minnesota: Well, a little count took out a napkin, did some math. I said, probably somewhere around 35,000.

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Marc Gorelick (he/him), Children's Minnesota: That's a big number.

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Marc Gorelick (he/him), Children's Minnesota: Took me 25 years to impact 35,000 kids. We see over 160,000 kids each and every year in our system. So if I can get the system of care right or help get the system of care right?

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Marc Gorelick (he/him), Children's Minnesota: I can expand that by more. So that's always been my motivation. And so, since 2,017. I've been here at Children's, Minnesota.

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Marc Gorelick (he/him), Children's Minnesota: initially as chief operating officer, and since December of 17, so about 6 and a half years now as CEO,

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Marc Gorelick (he/him), Children's Minnesota: and just a little bit about Children's Minnesota. We are a an independent

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Marc Gorelick (he/him), Children's Minnesota: children's health system. We have 2 hospitals here in the Twin Cities, one in Minneapolis, one in Saint Paul, about a dozen clinics. We're the largest pediatric provider in the upper Midwest. We're one of the 10 largest pediatric health systems by beds in the Us. And and we're the. We're the market leader here. In our region. And you know. Our vision, we say, is to be every family's essential partner in raising healthier kids and

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Marc Gorelick (he/him), Children's Minnesota: as I think about our journey to transformation, it's been, how do we? How do we keep doing that and doing it better.

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Ken Segel - Value Capture (he/him/his): And that is an inspiring vision, and

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Ken Segel - Value Capture (he/him/his): I want to.

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Ken Segel - Value Capture (he/him/his): I'll next get you into talking a little bit about what you've done in Children's Hospital, but at at Children's Minnesota, in that direction. But I want to

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Ken Segel - Value Capture (he/him/his): on leadership. As you came up

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Ken Segel - Value Capture (he/him/his): you said you saw an opportunity to do more, and the philosophy of impacting more kids is there?

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Ken Segel - Value Capture (he/him/his): What was it in you that others saw in terms of you know, seeing you as it made sense to move you into those next levels of leadership or in yourself. What? What connected for you? Not just about the opportunity to impact more people, but that you might be good at it, and good at helping others get there.

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Marc Gorelick (he/him), Children's Minnesota: Sometimes I wonder that?

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Marc Gorelick (he/him), Children's Minnesota: I I think.

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Marc Gorelick (he/him), Children's Minnesota: as a pediatric emergency medicine physician.

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Marc Gorelick (he/him), Children's Minnesota: What? What? What distinguishes us as a specialty is not the diseases we take care of. There's nothing we take care of that others don't do.

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Marc Gorelick (he/him), Children's Minnesota: It's

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Marc Gorelick (he/him), Children's Minnesota: our place in the system of care. And really having that system view.

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Marc Gorelick (he/him), Children's Minnesota: And and I think it was that system view that that

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Marc Gorelick (he/him), Children's Minnesota: willingness to look very broadly to think about where we fit into the larger

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Marc Gorelick (he/him), Children's Minnesota: whole of whether it was the medical school or the hospital.

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Marc Gorelick (he/him), Children's Minnesota: that doesn't always come naturally to physicians. Many physicians. They get very specialized. They get really good at what they do, and they tend that that can create a narrow focus. And and in our specialty we have to have a very broad focus.

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Ken Segel - Value Capture (he/him/his): Wow! I am so glad I asked that question because I think that systems view and that system change view and how things connect is so fundamental

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Ken Segel - Value Capture (he/him/his): to having the chance to succeed at really lifting the performance to support help raising healthier kids. And so

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Ken Segel - Value Capture (he/him/his): so that's great. So you saw the opportunity. You kind of have a framework that it was based on for you as a leader.

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Ken Segel - Value Capture (he/him/his): You come into children's, and you're

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Ken Segel - Value Capture (he/him/his): because you're a leader that does the work, not just talks the work. And so through Covid and everything, you've been setting a path.

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Ken Segel - Value Capture (he/him/his): Can you sort of walk us through some of what that path has been for the organization and for you as a leader. Some of the

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Ken Segel - Value Capture (he/him/his): goals, some of the steps along the way, some of the key learnings and challenges.

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Ken Segel - Value Capture (he/him/his): Yeah. And and then I'm gonna ask you to talk about what you think of some of the key ingredients to making this kind of change successful.

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Marc Gorelick (he/him), Children's Minnesota: Yeah.

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Marc Gorelick (he/him), Children's Minnesota: you know again, like my career path, I think

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Marc Gorelick (he/him), Children's Minnesota: this has not been a straight line. Although I maybe to paraphrase Dr. Martin Luther King, Jr. You know the the arc of health care is long, but it bends toward improvement. So

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Marc Gorelick (he/him), Children's Minnesota: But I think that you know, coming out of

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Marc Gorelick (he/him), Children's Minnesota: the the height of the pandemic.

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Marc Gorelick (he/him), Children's Minnesota: We, you know, sort of end of 2020.

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Marc Gorelick (he/him), Children's Minnesota: We were engaged in a strategic planning process.

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Marc Gorelick (he/him), Children's Minnesota: It's a really hard time to think. 5 or 10 years down the road. I mean, it was we all remember. It was a hard time to think. 5 or 10 weeks down the road.

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Marc Gorelick (he/him), Children's Minnesota: And so we decided we wanted to focus our efforts for the next

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Marc Gorelick (he/him), Children's Minnesota: 3 year period, the strategic plan we're now finishing up 3 years

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Marc Gorelick (he/him), Children's Minnesota: on building core capabilities, that

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Marc Gorelick (he/him), Children's Minnesota: we we might not be able to look at what Children's Minnesota is going to be 10 years down the road, but we know some core competencies that we're going to need if we're going to be successful.

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Marc Gorelick (he/him), Children's Minnesota: And the 2 things that we decided we really needed to focus on one is recognizing that we serve an increasingly diverse population, and we have an increasingly diverse population in our workforce.

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Marc Gorelick (he/him), Children's Minnesota: We need to really get good at principles of diversity, equity, and inclusion. So that's 1 set of core competencies.

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Marc Gorelick (he/him), Children's Minnesota: the other was around continuous improvement.

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Marc Gorelick (he/him), Children's Minnesota: not that healthcare has ever been static.

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Marc Gorelick (he/him), Children's Minnesota: The the pace of change and the the lack of of ability to make predictions was daunting even to an emergency physician who's used to that.

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Ken Segel - Value Capture (he/him/his): That's saying something.

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Marc Gorelick (he/him), Children's Minnesota: And so we we really needed as an organization to say, how can we develop a a mindset and a set of tools and systems that will allow us to be more flexible, to be norm, more nimble, to create

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Marc Gorelick (he/him), Children's Minnesota: improvements as needed in response to what? What felt like more rapidly changing, more volatile circumstances. So those were the 2 things that we really focused on in that in that 3 year period and a a lot of our journey has been around that you know that continuous improvement creating what we call the Children's Minnesota continuous improvement system.

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Ken Segel - Value Capture (he/him/his): That's great. And so you said, it's not been a straight line. So you know. And and any leader who's tried to do either of those 2 10 pulls of work which is in the in the commitment has been so authentic.

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Ken Segel - Value Capture (he/him/his): Can you talk a little bit about some of the stages, some of the effort, some of the stories. So people get a sense of what that for your art has been for you as you've tried as you've created those competencies.

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Marc Gorelick (he/him), Children's Minnesota: Sheriff.

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Marc Gorelick (he/him), Children's Minnesota: So I I'd say some of the zaginess was right from the beginning. So we were we. We knew we wanted to create this continuous improvement, but identified value capture as a partner that I can help help us do that. And so we talked about the way the the goals and the ways right? What are we trying to get better at, and how are we going to commit to getting better at? It

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Marc Gorelick (he/him), Children's Minnesota: was very easy was very tempting for us to focus on the way.

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Marc Gorelick (he/him), Children's Minnesota: Well, the goal is obvious.

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Marc Gorelick (he/him), Children's Minnesota: We're it's a that we don't have to talk about.

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Marc Gorelick (he/him), Children's Minnesota: But in fact, it's not necessarily obvious and and I think

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Marc Gorelick (he/him), Children's Minnesota: the advice that we got was to be very explicit about those goals.

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Marc Gorelick (he/him), Children's Minnesota: Now I should say that

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Marc Gorelick (he/him), Children's Minnesota: in a relatively recent past. Just before I came to the organization we had made an effort at trying to do something similar. We had created a lean office.

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Marc Gorelick (he/him), Children's Minnesota: It was going to lead lean improvement efforts.

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Marc Gorelick (he/him), Children's Minnesota: It lasted about 2 years, but it was finally being shut down for good just about as I arrived.

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Marc Gorelick (he/him), Children's Minnesota: and so I asked people who'd been there like, what did we learn from that cause? I don't want to do that again.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: One thing we learned is,

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Marc Gorelick (he/him), Children's Minnesota: that we created this tool.

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Marc Gorelick (he/him), Children's Minnesota: And people were like, well, what's that? What's that tool there for? Right, we didn't have that alignment on. We're going to use this specifically to create improvement in this.

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Marc Gorelick (he/him), Children's Minnesota: So we, we we kind of put the way in without thinking about the goal. The second thing is, people don't get inspired by tools.

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Marc Gorelick (he/him), Children's Minnesota: People get inspired by goals

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Marc Gorelick (he/him), Children's Minnesota: right? So you know

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Marc Gorelick (he/him), Children's Minnesota: the the Apollo, John F. Kenny didn't say. By the end of the decade. We're going to build a rocket, he said. By the end of the decade we're going to put a man on the moon.

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Marc Gorelick (he/him), Children's Minnesota: And so we said, Okay, well, let's let's start. Let's start with the goals.

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Marc Gorelick (he/him), Children's Minnesota: And here's where some of the zigging happened, because value capture. And they're very experienced. At this. They came in with a

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Marc Gorelick (he/him), Children's Minnesota: a very strong recommendation

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Marc Gorelick (he/him), Children's Minnesota: that we have a very specific focus on safety as the goal. We are going to be maximize safety. That's the thing we're going to devote our effort to.

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Marc Gorelick (he/him), Children's Minnesota: And I really pushed back on that that did not resonate with me for for a couple of reasons.

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Marc Gorelick (he/him), Children's Minnesota: we that was the one thing where we already had focused improvement efforts in our organization, and with a fairly high degree of success. We've been involved in the

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Marc Gorelick (he/him), Children's Minnesota: National Children's Hospital Solutions for patient safety. For many years we had done a lot of work around building, the culture of safety and the the systems to support that

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Marc Gorelick (he/him), Children's Minnesota: we had made what felt like fairly aggressive year over year, 10% reduction in preventable harm, and although not every year met that goal over the course of 5 years, we had done that.

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Marc Gorelick (he/him), Children's Minnesota: I I didn't think that felt sexy enough like if I go out and tell people, okay, we're going to do this big new thing. So we focus on safety. And they say, Well, what have we been doing.

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Ken Segel - Value Capture (he/him/his): Great.

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Marc Gorelick (he/him), Children's Minnesota: The other is I I had spent the last 2 years really trying to get the organization to think holistically about quality.

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Marc Gorelick (he/him), Children's Minnesota: We talk about quality and safety. And when we do that.

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Marc Gorelick (he/him), Children's Minnesota: almost always when I ask people, what do you mean by that? What quality is outcomes?

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Marc Gorelick (he/him), Children's Minnesota: Well, the Institute of medicine. Or now the National Academies of Medicine defines 6 domains of quality.

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Marc Gorelick (he/him), Children's Minnesota: and we had focused a lot on outcomes. And we focused a lot on safety with good results.

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Ken Segel - Value Capture (he/him/his): Moody.

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Marc Gorelick (he/him), Children's Minnesota: And that made us realize that we have pretty significant gaps in some of the others things like patient centeredness and timeliness and efficiency and equity.

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Marc Gorelick (he/him), Children's Minnesota: So I've now spent 2 years telling people we need to think beyond safety. We need. We need to think about quality. Holistically.

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Marc Gorelick (he/him), Children's Minnesota: i i i felt like a step backwards to focus on.

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Marc Gorelick (he/him), Children's Minnesota: So I really wanted the goal to be. We're going to maximize all 6 domains of quality.

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Marc Gorelick (he/him), Children's Minnesota: perfect outcomes, no harm, no delays, no waste.

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Marc Gorelick (he/him), Children's Minnesota: perfect experience, no disparities that's going to be our goal.

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Marc Gorelick (he/him), Children's Minnesota: We had some back and forth about that.

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Marc Gorelick (he/him), Children's Minnesota: and and ultimately that's where we landed.

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Marc Gorelick (he/him), Children's Minnesota: I think in retrospect I would say that

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Marc Gorelick (he/him), Children's Minnesota: we probably would have made progress faster if we'd had a more narrow focus.

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Marc Gorelick (he/him), Children's Minnesota: but it wouldn't have felt as true to who we were as an organization, and I think in the long run

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Marc Gorelick (he/him), Children's Minnesota: we're probably still getting to where we needed to. Maybe the curve has been a little bit

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Marc Gorelick (he/him), Children's Minnesota: slower to start, and steeper to rise.

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Marc Gorelick (he/him), Children's Minnesota: but that deciding. So setting a framework that's with my 1st key of success is setting a framework

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Marc Gorelick (he/him), Children's Minnesota: that is going to inspire people and is true to who we are as an organization.

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Marc Gorelick (he/him), Children's Minnesota: And I really appreciated the partnership with value capture to say we.

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Marc Gorelick (he/him), Children's Minnesota: We we think it's really important to set out the goals. And the way you need to figure out what that means for you, we can't tell you. We can tell you what we've seen in other organizations. We can't tell you what's going to be authentically children's Minnesota. So that was the 1st thing I'd say we did.

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Ken Segel - Value Capture (he/him/his): Yup!

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Marc Gorelick (he/him), Children's Minnesota: The second key was they their their strong recommendation, which we did follow this time was

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Marc Gorelick (he/him), Children's Minnesota: really making sure that we are starting at the top with buying at the top levels, including very significantly from myself.

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Marc Gorelick (he/him), Children's Minnesota: That made sense. Because, again asking what? What didn't go. Well, when we tried this lean experiment 8, 9 years ago.

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Marc Gorelick (he/him), Children's Minnesota: That was one of the things. It was one executive's project.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: The CEO was not necessarily bought into it. The other executives weren't bought into it, and

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Marc Gorelick (he/him), Children's Minnesota: one executive can't drive or wide change.

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Marc Gorelick (he/him), Children's Minnesota: so so that made sense.

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Marc Gorelick (he/him), Children's Minnesota: It also made sense.

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Marc Gorelick (he/him), Children's Minnesota: And this was this was kind of a sandwich approach. We need absolutely the topmost leaders buying in. We also need to focus on the very bottom.

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Marc Gorelick (he/him), Children's Minnesota: And the Aha I had was

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Marc Gorelick (he/him), Children's Minnesota: those are the 2 groups that are the most motivated to do this.

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Marc Gorelick (he/him), Children's Minnesota: I'm motivated to do it, because I can see across the big picture where we have all those gaps and why we need to

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Marc Gorelick (he/him), Children's Minnesota: make this in workwide effort.

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Marc Gorelick (he/him), Children's Minnesota: The frontline staff are the ones dealing with these problems every single day. So if the goal is to empower people

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Marc Gorelick (he/him), Children's Minnesota: to when they have

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Marc Gorelick (he/him), Children's Minnesota: problems that get in the way of doing their work, to see those problems and speak out about them.

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Marc Gorelick (he/him), Children's Minnesota: within their team and across teams, to solve that problem to its root cause not just fix it for today, but fix it for good, and then share that so others could benefit from it.

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Marc Gorelick (he/him), Children's Minnesota: they're motivated to do that because they're the ones who every single day are dealing with, not getting the medicines they need or not getting, the phone answered, or whatever that problem is

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Marc Gorelick (he/him), Children's Minnesota: that middle layer of management is not going to be as motivated. They're not as affected by the day-to-day problems. They hear about them. They see them. But

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Marc Gorelick (he/him), Children's Minnesota: it's not.

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Marc Gorelick (he/him), Children's Minnesota: The rock isn't in their shoe.

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Marc Gorelick (he/him), Children's Minnesota: and they've got their area they're focused on. They don't see what's happening across the organization. So even if the middle management is not

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Marc Gorelick (he/him), Children's Minnesota: overly obstructive.

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Marc Gorelick (he/him), Children's Minnesota: they're just not as incentivized to change in the same way that the executive team is and the frontline staff are. So we really focused on those 2

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Marc Gorelick (he/him), Children's Minnesota: so that we could drive the culture change that we wanted.

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Marc Gorelick (he/him), Children's Minnesota: And then the 3rd thing I would say it gets at that culture

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Marc Gorelick (he/him), Children's Minnesota: we talked about wanting to build a culture. Culture is a big, hairy beast, I mean culture. You don't change a culture overnight, and I'm an er Doc. I get kind of impatient, right? I want to see results quickly.

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Marc Gorelick (he/him), Children's Minnesota: And I think one of the things that I learned is, you know, I we step back after some number of months of doing this.

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Marc Gorelick (he/him), Children's Minnesota: and I felt like we made rapid progress on providing tools. You know, we had this real time problem solving. We had tiered daily huddles we had a system to share. We have all these tools in place. We were rapidly expanding this through the organization.

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Marc Gorelick (he/him), Children's Minnesota: And we had a lot of people

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Marc Gorelick (he/him), Children's Minnesota: using the language

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Marc Gorelick (he/him), Children's Minnesota: they talked about real root cause problem solving. They talked about, you know, help chains. They talked about rules and use.

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Marc Gorelick (he/him), Children's Minnesota: and

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Marc Gorelick (he/him), Children's Minnesota: I felt like

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Marc Gorelick (he/him), Children's Minnesota: the character in the Princess Bride who said, you keep using those words? I don't think they mean what you think they mean

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Marc Gorelick (he/him), Children's Minnesota: it it there was a mismatch like, Okay, you're speaking the language, but that

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Marc Gorelick (he/him), Children's Minnesota: you're not doing the real work. It didn't feel like real

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Marc Gorelick (he/him), Children's Minnesota: problem solving. And so I got frustrated and impatient. But what I realized in retrospect was

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Marc Gorelick (he/him), Children's Minnesota: culture is just the sum total of tools and the systems and the language and the behaviors. If we've got 3 of those elements in place and we keep pushing it.

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Marc Gorelick (he/him), Children's Minnesota: the behaviors will click and the culture will move, and it has eventually happened.

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Marc Gorelick (he/him), Children's Minnesota: So I think a a lesson that I took from that is

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Marc Gorelick (he/him), Children's Minnesota: Don't be impatient.

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Marc Gorelick (he/him), Children's Minnesota: you know. Really. Think about where you have made progress.

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Marc Gorelick (he/him), Children's Minnesota: and how that's contributing to your overall progress.

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Marc Gorelick (he/him), Children's Minnesota: and and then work with that to get the result you want.

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Ken Segel - Value Capture (he/him/his): I love it. So any healthcare, CEO that's quoting Princess Bride, or eluding obviously is rising to a level a high level with the listeners, and lots of other things you've said, and I'm sure I can hear people talking about middle management, and what is their piece, and what might they say?

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Ken Segel - Value Capture (he/him/his): And thinking about that?

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Ken Segel - Value Capture (he/him/his): mark what you said. The behaviors are now clicking in, because you know, and and you counted yourself not to be impatient but

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Ken Segel - Value Capture (he/him/his): patiently impatient, and a leader can be good. But what? What had been some of those moments where you said, Okay, it's clicking in. We're starting to see the behaviors. We're starting to see. The results are there.

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Ken Segel - Value Capture (he/him/his): you know. Sometimes a leader will observe a moment of story and then see it as a pattern as well. So where there can you give it anybody some a feel for someone when you said, Okay, finally, it's clicking together for me.

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Marc Gorelick (he/him), Children's Minnesota: Yeah, I think you know. I was doing a go and see in in our cardiovascular unit, and I was watching a nurse do, addressing change a patient with a particular system. So it's a

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Marc Gorelick (he/him), Children's Minnesota: somewhat involved process. There's a lot of standard work around it.

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Marc Gorelick (he/him), Children's Minnesota: This person had literally written the book on this, I mean, wrote the Procedure Manual, for this very experienced nurse clearly knew what was going on.

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Marc Gorelick (he/him), Children's Minnesota: and I just watched quietly and

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Marc Gorelick (he/him), Children's Minnesota: every couple of steps

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Marc Gorelick (he/him), Children's Minnesota: she'd have to leave and go get something to go do right

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Marc Gorelick (he/him), Children's Minnesota: and

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Marc Gorelick (he/him), Children's Minnesota: And I was told it was going to take about 15Â min, and it took

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Marc Gorelick (he/him), Children's Minnesota: closer to 25Â min.

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Marc Gorelick (he/him), Children's Minnesota: and I get and she'd say things like, Oh, this is missing, or

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Marc Gorelick (he/him), Children's Minnesota: you know, and and so we? We debriefed afterwards. And I said

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Marc Gorelick (he/him), Children's Minnesota: that, you know. Thank you for letting me watch this. This is really intricate. It's amazing. You do this every day.

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Marc Gorelick (he/him), Children's Minnesota: Clearly you do this a lot. How did it feel to you? Said, well, no, it was good, I said, Oh, you know, I tell me you know you said it would take about 15Â min, and it took about 25. 0, yeah, well, you know it. It's always this way. There's stuff that's missing.

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Marc Gorelick (he/him), Children's Minnesota: So we talked about, and I said, Well, what? What might help you

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Marc Gorelick (he/him), Children's Minnesota: like? How could you get it to be 15Â min? You said we'll be really great

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Marc Gorelick (he/him), Children's Minnesota: if someone would just put this kit together for me, so I don't have to pull it together in real time.

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Marc Gorelick (he/him), Children's Minnesota: So that's brilliant. What? Let's go talk.

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Marc Gorelick (he/him), Children's Minnesota: Let's go talk. We're we're we're supposed to go debrief with your superfite. Let's go talk to her about it

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Marc Gorelick (he/him), Children's Minnesota: and share that idea. But but then this got like, okay, you know, if if

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Marc Gorelick (he/him), Children's Minnesota: my problem is, I'm trying to find stuff. If I had a standard, I've got standard work, but I don't have. But my supplier doesn't have standard work.

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Marc Gorelick (he/him), Children's Minnesota: If my supplier could have standard work about giving you what I need, I could get this done

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Marc Gorelick (he/him), Children's Minnesota: that. That's when I thought, okay, we're getting somewhere.

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Ken Segel - Value Capture (he/him/his): Mark, that! That's such a great story, and it shows so much including, you know.

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Ken Segel - Value Capture (he/him/his): CEO, on the front line. Not just saying, Hi! Not just surrounding. What are your challenges, but actually watching the work and honoring the work, and then making kind of helping make some of the system connections you're talking about.

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Ken Segel - Value Capture (he/him/his): And you know our current.

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Marc Gorelick (he/him), Children's Minnesota: Tell you one of the things I learned there, Ken.

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Marc Gorelick (he/him), Children's Minnesota: I was so tempted halfway through to say to her.

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Marc Gorelick (he/him), Children's Minnesota: Why don't you have somebody give you a kit.

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Ken Segel - Value Capture (he/him/his): Right.

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Marc Gorelick (he/him), Children's Minnesota: But I did my tongue.

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Marc Gorelick (he/him), Children's Minnesota: and I waited to to get her to that realization

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Marc Gorelick (he/him), Children's Minnesota: cause coming for me, it'd be like.

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Marc Gorelick (he/him), Children's Minnesota: Well, yeah, it's easy for you to say, well, that's not gonna happen. But she came up with the idea.

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Ken Segel - Value Capture (he/him/his): Yeah, exactly. And you unlock that potential and the energy behind that aspirational idea, people being excited by the goal being involved

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Ken Segel - Value Capture (he/him/his): etc, in ways that make a difference for themselves and their patients. And you know, I think, listeners who are the listeners to this podcast are very sympathetic with this way of thinking. I think

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Ken Segel - Value Capture (he/him/his): we all feel if more leaders, and it was the standard to lead, as you are doing, and setting those patterns

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Ken Segel - Value Capture (he/him/his): across American healthcare. You know this. This could be happening at even greater scale, even faster. But it's also exciting. You mentioned solutions for patient safety. And I think we all wanna tip our hat to your efforts and to the children's

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Ken Segel - Value Capture (he/him/his): hospitals. Efforts collectively around the country were armed to kids has been driven down by more than half through collective efforts. So far, so

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Ken Segel - Value Capture (he/him/his): it is. It is a great tradition to build on, and you know, and then help everybody make the connections that you're making in that way.

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Marc Gorelick (he/him), Children's Minnesota: Right.

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Ken Segel - Value Capture (he/him/his): Mark earlier, as you talked about coming to something

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Ken Segel - Value Capture (he/him/his): that was authentic to the organization. You know you use the word authentic and use. And you've talked about authenticity for you and for the organization as being a key to

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Ken Segel - Value Capture (he/him/his): success.

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Ken Segel - Value Capture (he/him/his): Could you talk a little bit more about

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Ken Segel - Value Capture (he/him/his): how you came to think about that, realize that.

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Ken Segel - Value Capture (he/him/his): and and and why it's so important to

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Ken Segel - Value Capture (he/him/his): something changing in a very complex.

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Ken Segel - Value Capture (he/him/his): you know. Culturally sad organization.

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Marc Gorelick (he/him), Children's Minnesota: Yeah, you know.

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Marc Gorelick (he/him), Children's Minnesota: again, I think some of it, as I alluded to is is

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Marc Gorelick (he/him), Children's Minnesota: doing something that's gonna inspire people. And

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Marc Gorelick (he/him), Children's Minnesota: you know we have people who've been here for not very long. We've been people who've been here for a very long time.

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Marc Gorelick (he/him), Children's Minnesota: Something that feels foreign is not going to be as inspiring.

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Marc Gorelick (he/him), Children's Minnesota: so I think, building on what we already have, we have. We want to be every family's essential partner raising healthy kids. We pride ourselves in providing high quality care

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Marc Gorelick (he/him), Children's Minnesota: and really leaning in so that

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Marc Gorelick (he/him), Children's Minnesota: again, we've been thinking about quality holistically. Let's

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Marc Gorelick (he/him), Children's Minnesota: run with that and say, let's

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Marc Gorelick (he/him), Children's Minnesota: work on advancing that particularly, because, again, safety is something where we'd actually made progress. We started recognizing especially, you know, remember, this was not only in the wake of the 1st months of the pandemic, but also in the wake of the murder of George Floyd.

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Marc Gorelick (he/him), Children's Minnesota: which happened just 12 blocks from our Minneapolis hospital.

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Marc Gorelick (he/him), Children's Minnesota: It affected our community in a in a significant way.

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Marc Gorelick (he/him), Children's Minnesota: and the the the

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Marc Gorelick (he/him), Children's Minnesota: wide open view we had to the disparities that we had in our community, and within our system

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Marc Gorelick (he/him), Children's Minnesota: there was a real urgency that we felt about addressing equity.

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Marc Gorelick (he/him), Children's Minnesota: I I couldn't expect to get the same level of buy in on continuous improvement if I excluded that. So so it allowed us, as an organization to be authentic.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: I think it also. You know, part of it was, this is something that I I'm

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Marc Gorelick (he/him), Children's Minnesota: passionate about, right. And partly it's my earlier career again, and

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Marc Gorelick (he/him), Children's Minnesota: you know, clinical effectiveness, research, and so on. But

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Marc Gorelick (he/him), Children's Minnesota: one of the it really resonated with me because I

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Marc Gorelick (he/him), Children's Minnesota: did not use the language of continuous improvement, but an experience I had early on in my time about feeling empowered to make a change.

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Marc Gorelick (he/him), Children's Minnesota: One of the most common procedures that I had to do as a as a Ph emergency position was suturing wounds

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Marc Gorelick (he/him), Children's Minnesota: and as we all know. You know, the eyes go after a while, and we're often using very little sutures in little kids. I was ha struggling to see the sutures, and I see the consultants come in with their fancy loop classes, and I said we should get those.

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Marc Gorelick (he/him), Children's Minnesota: So I asked her that you know

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Marc Gorelick (he/him), Children's Minnesota: patient care, manager, so can we get

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Marc Gorelick (he/him), Children's Minnesota: these loops?

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Marc Gorelick (he/him), Children's Minnesota: Well, you know we've tried that, but they're very expensive, and they always walk like.

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Marc Gorelick (he/him), Children's Minnesota: you know, we can't secure them.

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Marc Gorelick (he/him), Children's Minnesota: I said, well, I have an idea

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Marc Gorelick (he/him), Children's Minnesota: we have a medicine cabinet, the pixis system that only the nurses have access to.

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Marc Gorelick (he/him), Children's Minnesota: Could we use one of those drawers to store the loops, so if I need them.

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Marc Gorelick (he/him), Children's Minnesota: I have to go ask the nurse, and there's a record of me having it, and you know, and it's got to go back in, and we're both responsible for that.

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Marc Gorelick (he/him), Children's Minnesota: Sure, we can try that. Let's see what happens. So we tried that those loops were still there 14 years later, when I was no longer working in emergency department.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: But that was

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Marc Gorelick (he/him), Children's Minnesota: I did not hit the bureaucratic snow. Wall. I

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Marc Gorelick (he/him), Children's Minnesota: I had an idea, might have been a crazy idea. Who heard of putting a piece of equipment in a medicine cabinet.

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Marc Gorelick (he/him), Children's Minnesota: People said, Sure, we can give that a try.

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Marc Gorelick (he/him), Children's Minnesota: and and that empow. I felt that empowerment.

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Marc Gorelick (he/him), Children's Minnesota: So I know what that feels like, and I want others to feel that too.

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Ken Segel - Value Capture (he/him/his): Oh, that's great!

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Ken Segel - Value Capture (he/him/his): Anchoring in that human emotion from having done the work and put, you know, and which is all about, and the people who do the work. I just. I just love that story.

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Ken Segel - Value Capture (he/him/his): Mark. You, make so many connections, and you don't just make them intellectually. You make them in the doing so. I want to sort of go to some of these connections so.

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Ken Segel - Value Capture (he/him/his): and and thank you for

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Ken Segel - Value Capture (he/him/his): bringing up

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Ken Segel - Value Capture (he/him/his): the murder of George Floyd in that moment, the the moment in time that we're still living in after, and and the intensity of the proximity and the meeting in the twin cities.

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Ken Segel - Value Capture (he/him/his): And so you centered there as part of your Cqi journey.

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Ken Segel - Value Capture (he/him/his): and you you talked about creating these twin competencies of inclusion. And you're much more eloquent about it than I and Cqi.

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Ken Segel - Value Capture (he/him/his): What are? What's the relationship between the 2? How has one helped the other? Vice versa, or in a challenge? You know, I can think of different ways.

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Ken Segel - Value Capture (he/him/his): How? How are those 2 things knit together? Give us some texture that way.

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Marc Gorelick (he/him), Children's Minnesota: Yeah, no, I I do think they're. They're mutually supportive and reinforcing in many ways. So again, if I think about.

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Marc Gorelick (he/him), Children's Minnesota: we're trying to apply continuous improvement to the way we improve all 6 domains of quality

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Marc Gorelick (he/him), Children's Minnesota: and including the domain of equity. So it was, we think, about

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Marc Gorelick (he/him), Children's Minnesota: disparities. It can get really discouraging. Right? There's

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Marc Gorelick (he/him), Children's Minnesota: I I mean, it's so multifactorial. It's partly what happens within our walls. It's a lot about what happens outside of our walls. It's really easy to feel daunted by it. If I put a continuous improvement mindset on it, of

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Marc Gorelick (he/him), Children's Minnesota: talking to people who are doing the work.

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Marc Gorelick (he/him), Children's Minnesota: getting their ideas for improvement, trying little things to see what works

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Marc Gorelick (he/him), Children's Minnesota: can help break down what feels like an overwhelming problem into one that

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Marc Gorelick (he/him), Children's Minnesota: I'm not gonna fix the whole thing. But I can make progress, and I'm not gonna make progress always. Some of those experiments will tell will tell me that that's not actually an effective intervention.

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Ken Segel - Value Capture (he/him/his): Right.

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Marc Gorelick (he/him), Children's Minnesota: Collectively. It's a way of making progress.

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Marc Gorelick (he/him), Children's Minnesota: Similarly, as we take on continuous improvement in

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Marc Gorelick (he/him), Children's Minnesota: whatever domains of our organization.

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Marc Gorelick (he/him), Children's Minnesota: making sure we're looking at it with an equity lens.

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Marc Gorelick (he/him), Children's Minnesota: Am I designing my tests of change in a way that will benefit everybody? Or are there going to potentially be unintended consequences that I need to think about.

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Marc Gorelick (he/him), Children's Minnesota: So they do become mutually supportive, and in a way that I think has been very important.

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Ken Segel - Value Capture (he/him/his): Oh, that's great.

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Ken Segel - Value Capture (he/him/his): Yeah. And then.

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Marc Gorelick (he/him), Children's Minnesota: And and we've and a great example. We've been able to apply continuous improvement in all of those domains. So

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Marc Gorelick (he/him), Children's Minnesota: we we set out what we were told

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Marc Gorelick (he/him), Children's Minnesota: by our board was a very aggressive goal

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Marc Gorelick (he/him), Children's Minnesota: of increasing the proportion of our workforce that identified as people of color. We were at 19, in 20,

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Marc Gorelick (he/him), Children's Minnesota: 19

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Marc Gorelick (he/him), Children's Minnesota: and 2020, we were looking by the end of our strategic plan to get to 32%.

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Marc Gorelick (he/him), Children's Minnesota: And one of our board members is head of HR. At a

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Marc Gorelick (he/him), Children's Minnesota: fortune, 500 company here in town and said, That's really aggressive. We said, Yeah, but we'd rather aim high and, miss, we're 33 now. We still have 8 months to go.

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Ken Segel - Value Capture (he/him/his): Terrific.

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Marc Gorelick (he/him), Children's Minnesota: We used continuous improvement principles to do that.

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Ken Segel - Value Capture (he/him/his): Right. We.

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Marc Gorelick (he/him), Children's Minnesota: Trying things, seeing what we learn.

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Marc Gorelick (he/him), Children's Minnesota: Whether it's how do we get

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Marc Gorelick (he/him), Children's Minnesota: trying little tests of change to get a wider applicant pool, trying tests of change to promote retention. So it's not just

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Marc Gorelick (he/him), Children's Minnesota: cost savings. It's not just

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Marc Gorelick (he/him), Children's Minnesota: safety. It really is across the board that we're thinking of that way of doing things.

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Ken Segel - Value Capture (he/him/his): What a what a beautiful and hopeful application! And you know one senses it gets you moving faster. It gets you learning and improving faster. It's so. It's both reducing the risk and then sort of increasing the likelihood of success.

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Marc Gorelick (he/him), Children's Minnesota: Right.

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Ken Segel - Value Capture (he/him/his): You don't have this, you know. We we see it across so many health systems of

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Ken Segel - Value Capture (he/him/his): agonizing for years to come up with a perfect plan and a Powerpoint that you know, people have been scared to implement.

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Marc Gorelick (he/him), Children's Minnesota: And we still do a lot of that right. This is a journey.

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Ken Segel - Value Capture (he/him/his): But it is a secret.

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Marc Gorelick (he/him), Children's Minnesota: Can thinking. Look! We don't have to.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: Let's just try this thing.

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Marc Gorelick (he/him), Children's Minnesota: and if we do

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Marc Gorelick (he/him), Children's Minnesota: so, our hypothesis was, if we go to this people of color career fair, we will identify applicants

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Marc Gorelick (he/him), Children's Minnesota: for positions that we've had trouble getting under represented minority applicants in and

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Marc Gorelick (he/him), Children's Minnesota: get some higher. So we went to the 1st one, and we had like

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Marc Gorelick (he/him), Children's Minnesota: 20 inquiries. And we hired 3 people. I said, that's awesome.

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Marc Gorelick (he/him), Children's Minnesota: What did we learn? Well, we learned that if we have a way for them to actually send us their resume right on site. Some people will follow more. So we did that. And then next year we hit 40 applicants and 10 hires. And so it's just but it's that iterative process of of, you know, trial and error.

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Ken Segel - Value Capture (he/him/his): No, that's people

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Ken Segel - Value Capture (he/him/his): that's great in the method. And again, I'll I'll draw it out. Dr. Burke is using the terms we and mark leads from the front on all these things that are most important. So when he says, we went to the fair, my guess is, you were at the fair, and.

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Marc Gorelick (he/him), Children's Minnesota: Wait!

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Ken Segel - Value Capture (he/him/his): You were at the front line, and.

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Marc Gorelick (he/him), Children's Minnesota: Absolutely.

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Ken Segel - Value Capture (he/him/his): Calls, that.

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Marc Gorelick (he/him), Children's Minnesota: I think that's really important. Yeah.

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Ken Segel - Value Capture (he/him/his): Where your your feet, where you're where the message is up

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Ken Segel - Value Capture (he/him/his): on the focuses

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Ken Segel - Value Capture (he/him/his): another connection. You talked earlier about

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Ken Segel - Value Capture (he/him/his): when it was hard to see around the corner coming out of Covid, you decided you're gonna create these twin linked, energizing each other for competencies of continuous improvement everyone every day, and inclusion and equity. And now you you know you said it may, you know, took a little longer, maybe, than you hope to get to the point where you wanted. But you're going now.

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Ken Segel - Value Capture (he/him/his): and let's go back to the link to strategy. Wh? Where do you find yourself now? How do you think about now having those engines at your disposal as you think about? You know the leaders job to look around the corners and and see where the organization might go next in terms of what work to do, where to do it. That kind of thing.

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Marc Gorelick (he/him), Children's Minnesota: Yeah. So you know, our

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Marc Gorelick (he/him), Children's Minnesota: current strategic plan. The one we're just finishing up is built on 3 pillars, and that that middle pillars, what we call thrive, which is really about building the core competencies. And the 2 that we were really focused on there was building continuous improvement building diversity, equity and inclusion.

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Marc Gorelick (he/him), Children's Minnesota: We're now

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Marc Gorelick (he/him), Children's Minnesota: finalizing our strategic plan for 2025, through 27,

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Marc Gorelick (he/him), Children's Minnesota: we do have a longer 10 year vision. We now say we want to be the premier provider of pediatric specialized care. And we want to be differentiated on experience. We've defined experiences multi-dimensional.

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Marc Gorelick (he/him), Children's Minnesota: So the core competency that we're now building. We've kept the same pillars, and in that thrive, although we've turned them on their side. So now it's actually a rocket ship going this way towards the star of experience.

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Ken Segel - Value Capture (he/him/his): Nice.

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Marc Gorelick (he/him), Children's Minnesota: The competency we're building is around experience.

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Marc Gorelick (he/him), Children's Minnesota: What we have literally drawn as the engine on the side of the rocket

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Marc Gorelick (he/him), Children's Minnesota: are intertwined, continuous improvement in diversity, equity, and inclusion.

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Marc Gorelick (he/him), Children's Minnesota: And it's interesting because when we 1st laid out our current strategic plan and we propose a project around building continuous improvement, one of our board members said, well, continuous improvements, not a project. It's just the way you do stuff.

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Ken Segel - Value Capture (he/him/his): Hmm.

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Marc Gorelick (he/him), Children's Minnesota: Ultimately we hope it will be. The project is building the systems and the culture to make it the way we do stuff.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: Just like any Yup

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Marc Gorelick (he/him), Children's Minnesota: engines require maintenance. So we still need to maintain our efforts to to keep up the pace.

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Marc Gorelick (he/him), Children's Minnesota: But we're now at a point where it's no longer a project to build it. We're maintaining that engine. And that engine is what's going to propel us. You know, towards that goal of differentiated experience.

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Ken Segel - Value Capture (he/him/his): That's great. So these are engines that will propel you that you can just aim in the direction the organization decides, to go and and get their faster, shorter.

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Marc Gorelick (he/him), Children's Minnesota: Whether whether we call them foundational. If we had them still as pillars, they'd be the foundation or the

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Marc Gorelick (he/him), Children's Minnesota: but that concept of. But they still require maintenance. You have to maintain your foundation. You have to maintain your engine. So it's not like we're

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Marc Gorelick (he/him), Children's Minnesota: no longer putting effort into getting better, because we that are, we're we're

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Marc Gorelick (he/him), Children's Minnesota: still a waste going that arc. Just let's be clear

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Marc Gorelick (he/him), Children's Minnesota: still, quite a ways to go on that arc.

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Ken Segel - Value Capture (he/him/his): Yeah.

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Marc Gorelick (he/him), Children's Minnesota: But but we're now in a position where I think we could take for granted that we're making that progress.

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Marc Gorelick (he/him), Children's Minnesota: Not take it for granted that we still have to pay attention to how we make that progress.

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Ken Segel - Value Capture (he/him/his): Right right. That's the moment it falls apart. But so the humility and the openness and transparency is a key part of it, and and so welcome to here. And hear you model.

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Ken Segel - Value Capture (he/him/his): Another connection you made earlier that I just want to touch on is

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Ken Segel - Value Capture (he/him/his): you alluded to? An earlier.

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Ken Segel - Value Capture (he/him/his): you know. Well intentioned, and

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Ken Segel - Value Capture (he/him/his): I'm sure extremely confident. Well, meaning effort. To get going years before you came that didn't take.

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Ken Segel - Value Capture (he/him/his): And you alluded to the role of the process excellence team or performance improvement team. And you've been very clear, actually, and very eloquent on sort of who has to own the change.

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Ken Segel - Value Capture (he/him/his): For success to happen. Could you share some of that with the audience in terms of how you think about that, and how you make sure the organization is thinking about it right?

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Marc Gorelick (he/him), Children's Minnesota: Yeah.

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Marc Gorelick (he/him), Children's Minnesota: Early on, when I 1st started in Children's Hospital, Wisconsin, as medical director, the emergency department.

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Marc Gorelick (he/him), Children's Minnesota: one of the things I was responsible for was submitting a

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Marc Gorelick (he/him), Children's Minnesota: our annual quality report to the

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Marc Gorelick (he/him), Children's Minnesota: to the Quality Committee, so I hadn't done that before, so I asked one of my colleagues who's been there for a while.

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Marc Gorelick (he/him), Children's Minnesota: How? How do you go about that? What advice do you have? I? Said I. I let the Quality department do that.

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Marc Gorelick (he/him), Children's Minnesota: So that's interesting. So yeah, the the quality. But they're in charge of quality.

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Marc Gorelick (he/him), Children's Minnesota: I just looked at him.

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Marc Gorelick (he/him), Children's Minnesota: I said, no, they're not, I said.

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Marc Gorelick (he/him), Children's Minnesota: like quality is just the result of the work you do. You're the one doing the work they're they're not doing the work you're responsible for quality. Your your docs are responsible for quality.

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Marc Gorelick (he/him), Children's Minnesota: You can't give up ownership of that, I mean, I was kind of intense conversation, like Whoa back off. But but it really struck me like the Quality Department is not in charge of quality. They don't take care of patients, they don't deliver services.

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Marc Gorelick (he/him), Children's Minnesota: Their job is to help me.

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Marc Gorelick (he/him), Children's Minnesota: and I really liked the way

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Marc Gorelick (he/him), Children's Minnesota: chief medical officer, I used to work with Mike. Good site, said this. He said. We have 2 jobs

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Marc Gorelick (he/him), Children's Minnesota: taking care of patients and getting better at taking care of patients.

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Marc Gorelick (he/him), Children's Minnesota: That's our job.

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Marc Gorelick (he/him), Children's Minnesota: I do feel like the way we set up our prior effort. We put this

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Marc Gorelick (he/him), Children's Minnesota: Improvement Office in place, and it was like, Oh, improvement! That's that's the improvement team's job.

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Marc Gorelick (he/him), Children's Minnesota: No, our job is to get better at what we do.

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Marc Gorelick (he/him), Children's Minnesota: All the domains of quality.

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Marc Gorelick (he/him), Children's Minnesota: Their job is to help us do it. They have expertise in those methods.

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Marc Gorelick (he/him), Children's Minnesota: I have expertise in doing the work.

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Marc Gorelick (he/him), Children's Minnesota: and I I feel very strongly that that the end.

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Marc Gorelick (he/him), Children's Minnesota: the front line, whether it's clinical or nonclinical, the person doing the work is, owns the quality of that work, and and that's empowering, too.

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Ken Segel - Value Capture (he/him/his): Yes.

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Marc Gorelick (he/him), Children's Minnesota: Like if I do a good job. If I deliver great care, I've done a great job that's on me.

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Marc Gorelick (he/him), Children's Minnesota: Nobody else gets the credit for that. That's me.

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Ken Segel - Value Capture (he/him/his): 3.

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Marc Gorelick (he/him), Children's Minnesota: So I think it's important to make sure that we do locate that responsibility and authority

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Marc Gorelick (he/him), Children's Minnesota: for delivering quality

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Marc Gorelick (he/him), Children's Minnesota: in the people who do the work.

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Ken Segel - Value Capture (he/him/his): You know, it's such a foundational part of the leader and organizational mindset that has to be in place to succeed and succeed at scale and with sustainability. And that's 1 so often because of our overwhelmness and how things people think delegation get missed. And so

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Ken Segel - Value Capture (he/him/his): you've shared many nuggets today. But I hope leaders will

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Ken Segel - Value Capture (he/him/his): attach to that one, and think through its many implications, which can actually be quite simplifying and empowering, as as you said, which are.

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Ken Segel - Value Capture (he/him/his): which is terrific.

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Ken Segel - Value Capture (he/him/his): Mark another last, you know. Again, the connections you've made. You talked about your clinical effectiveness research, and that's not a topic that's come up much on habitual excellence. But it's a fascinating one, and it's it's it's great to also think about the connections between that in continuous improvement and operational leadership, and you're sort of in position to put them all together.

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Ken Segel - Value Capture (he/him/his): So

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Ken Segel - Value Capture (he/him/his): you know, looking back on the different all of the parts of that elephant you've been a part of leading and and and in different ways.

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Ken Segel - Value Capture (he/him/his): What advice do you have for the clinical effectiveness community on the one hand, and and advice for fellow leaders, medical and operational.

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Ken Segel - Value Capture (he/him/his): who may not be aware of the riches of insight that can be offered by by the research on operational effect. This.

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Marc Gorelick (he/him), Children's Minnesota: I think it's great, because there is an a growing body across many specialties of clinical effectiveness research. And you know that's a fairly broad term, but it includes, you know, not only

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Marc Gorelick (he/him), Children's Minnesota: traditional sort of clinical trials, but you know, care algorithms, scoring systems, and so on. And you know, to me. And again, I did not use this term. I think a lot of what I did fell in the category of developing standard work for clinicians.

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Marc Gorelick (he/him), Children's Minnesota: So on the one hand.

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Marc Gorelick (he/him), Children's Minnesota: clinicians sometimes push back on this concept of standard work

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Marc Gorelick (he/him), Children's Minnesota: and helping them realize you've actually

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Marc Gorelick (he/him), Children's Minnesota: your culture is one that actually drives that right. You you, I mean

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Marc Gorelick (he/him), Children's Minnesota: any special. It comes to me I can pull a body of literature from their practice. That shows that sort of

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Marc Gorelick (he/him), Children's Minnesota: Nope.

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Marc Gorelick (he/him), Children's Minnesota: So we use the term best practices instead of standard work. But it's the same concept.

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Marc Gorelick (he/him), Children's Minnesota: And then so that's on the one hand, and then, on the other hand, help helping people realize you don't have to reinvent the wheel right? If you want to understand standard work, for you know, asthma

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Marc Gorelick (he/him), Children's Minnesota: for a lot of

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Marc Gorelick (he/him), Children's Minnesota: studies out there that will tell you what the standard work should be. You just have to take it and put it into a form that works for your in your system.

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Marc Gorelick (he/him), Children's Minnesota: So you don't have to redo all of that. There's a lot out there that we can borrow from each other.

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Ken Segel - Value Capture (he/him/his): Well that those are. Those are great connections to make and I and I appreciate you doing it because it. You know, it's in many ways. We're working in different parts to try to be systemic together and try to learn together and take advantage of really the embarrassment of riches of these fields, building up knowledge, etc, effectively. So thank you for representing the bridge across. And what the possibilities are.

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Ken Segel - Value Capture (he/him/his): Mark, when you think about what's next for you as a leader and children's hospital. You talked about strategy emerging and things like that. But in in staying on the improvement engine I'm not assuming that you have it. Are there other things you see ahead for yourself, and other lessons or things that we haven't touched on yet, that you think you know, peers sitting with similar values based ambitions, as you, and also similar challenges.

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Ken Segel - Value Capture (he/him/his): you know, that might be helpful in moving, helping them and helping the community, move forward, overall.

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Marc Gorelick (he/him), Children's Minnesota: Yeah, I think

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Marc Gorelick (he/him), Children's Minnesota: for me.

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Marc Gorelick (he/him), Children's Minnesota: one priority is, is is getting to this the point where it's hardwired.

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Marc Gorelick (he/him), Children's Minnesota: I think it's it's it's still relatively easy

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Marc Gorelick (he/him), Children's Minnesota: to say, Yeah, Mark, we're in here. Maybe we might wouldn't be doing this. It's getting harder to say that.

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Marc Gorelick (he/him), Children's Minnesota: But I don't know that it's actually hardwired yet, and I think hard wiring. It is important because

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Marc Gorelick (he/him), Children's Minnesota: again.

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Marc Gorelick (he/him), Children's Minnesota: the the pace of change is is

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Marc Gorelick (he/him), Children's Minnesota: not gonna slack enough. The the challenges that we're gonna face

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Marc Gorelick (he/him), Children's Minnesota: to, to deliver better outcomes, to deliver more safety, to be more efficient, to be more timely, to be more patient centered, and especially to be more equitable. They're not going away.

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Marc Gorelick (he/him), Children's Minnesota: So so I wanna make sure that this is this really is. You know, the way children's Minnesota does things

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Marc Gorelick (he/him), Children's Minnesota: for me. I you know the the I'll I'll be honest. The hardest part of this transition for me

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Marc Gorelick (he/him), Children's Minnesota: has been a a broader leadership change that we're trying to do here, which is to to really move from a model of leader, as expert to leader, as coach.

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Marc Gorelick (he/him), Children's Minnesota: and and in healthcare in particular

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Marc Gorelick (he/him), Children's Minnesota: expertise is so valued, so many people, especially clinical people.

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Marc Gorelick (he/him), Children's Minnesota: 1st become leaders because they're really good.

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Marc Gorelick (he/him), Children's Minnesota: What they do. When you asked earlier, like, what did someone see? And you?

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Marc Gorelick (he/him), Children's Minnesota: They saw it was a really good er Doc, with a good publication record, I mean, I had no record of leading.

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Marc Gorelick (he/him), Children's Minnesota: I got my 1st opportunity to lead because of the expertise I.

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Ken Segel - Value Capture (he/him/his): Interesting.

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Marc Gorelick (he/him), Children's Minnesota: We often

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Marc Gorelick (he/him), Children's Minnesota: stay in that mindset of leaders expert, and it works up to a certain level.

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Marc Gorelick (he/him), Children's Minnesota: There's no way a CEO can be expert in

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Marc Gorelick (he/him), Children's Minnesota: close to everything that we do.

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Marc Gorelick (he/him), Children's Minnesota: I know next to nothing about supply chains, about managing accounts receivable about managing a radiology department. That's just not my expertise.

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Marc Gorelick (he/him), Children's Minnesota: but but so often the leader reinforcement is.

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Marc Gorelick (he/him), Children's Minnesota: you're really good at it. You're the best at it. So you become the leader, and the temptation is to then solve the problem. It gets back to my experience with observing in the in the cardiovascular unit it was so tempting to say.

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Marc Gorelick (he/him), Children's Minnesota: put together a kit for crying out loud.

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Marc Gorelick (he/him), Children's Minnesota: but to step back, and instead of being the expert who's looking at and saying, Well, I see what your problem is coaching that person. See the problem.

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Marc Gorelick (he/him), Children's Minnesota: And that's you know. Again, I grew up in academic medicine. That's not the culture of leadership and academic medicine. It's more of a culture of leader as expert.

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Marc Gorelick (he/him), Children's Minnesota: And so that's been so, I'm continuing on my personal journey, of continuing to try to be more of a coach

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Marc Gorelick (he/him), Children's Minnesota: and less of an expert.

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Ken Segel - Value Capture (he/him/his): I love it. I love it. And another absolutely foundational point and sort of truly, deeply challenging, but also energizing

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Ken Segel - Value Capture (he/him/his): base to sort of drive organizations forward optimistically and in an empowering way. And on that note, and you talked about, you know, clinical expertise being surprised and clinical leadership rising that way. So

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Ken Segel - Value Capture (he/him/his): listeners to the podcast may hear echoes of Mark's chair of surgery, Tim Lander, who did a podcast with us, talking about his transformation journey, of the same experiences that Mark led which he was eager to have mark on. Because of how you've created the opportunities for that. But it's it's it's a rich bookend to exactly what you're talking about or what that looks like from that clinical leader. And

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Ken Segel - Value Capture (he/him/his): within the organization. So check that out listeners and

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Ken Segel - Value Capture (he/him/his): Dr. Willard Mark. We can't thank you enough for joining us today. It's it's been full of rich learning. And I know listeners will agree listeners. If you're not already a subscriber. To habitual excellence, please check it out on your favorite podcast distributor of choice. Give us a like, etc. You'll find lots of leaders who

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Ken Segel - Value Capture (he/him/his): think and act and do like Dr. Gorlak, to help us collectively move healthcare forward. And if you want more information about what children's Minnesota is doing, which is truly terrific stuff.

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Ken Segel - Value Capture (he/him/his): Their website is not run in the mill. It is inspiring and full of many resources you can tap into there.

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Ken Segel - Value Capture (he/him/his): Dr. Gore like is sought after, thought leader, and it's not hard to find interviews and discussions with Mark and other places on the web. So

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Ken Segel - Value Capture (he/him/his): together with, together with his peers, and of course our website. Value capture. Llc. Com.

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Ken Segel - Value Capture (he/him/his): Has resources connected to many of the ideas and systems

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Ken Segel - Value Capture (he/him/his): moving forward topics that have been discussed here. So check that out as well, Mark. Thanks for being with us.

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Marc Gorelick (he/him), Children's Minnesota: Thank you so much for the opportunity to reflect and share.