Healing the Healers: Addressing Moral Injury in Today’s Clinician Market

Introducing Dr. Jennie Byrne

John Farkas:

Welcome everybody to Healthcare Market Matrix. I’m your host, John Farkas, and today we’re talking about some really important things that are right at the dashboard of our healthcare system, and that is the critical nature of the wellbeing of the clinicians who are at the front line of the care that we as patients so desperately need. If there’s one thing the pandemic did, and there’s a lot of things the pandemic did, but if there’s one thing that it did, it shone the light on the critical nature of mental wellness at large.

I mean, it’s a really critical component of our culture, and we were face-to-face with a lot of the shortcomings in the support structures necessary for that in our world. And there was a lot of response to that that came out of the pandemic. One of the deep underscores was in the critical nature of caring well for those who care for us. And that’s what we’re going to be talking about today and how the technology platforms that we’re bringing forward that are ideally working to help clinicians. Just some of the things we need to have at the forefront of our minds as we’re bringing those kinds of solutions forward and how we’re talking about effectively supporting the well-being of clinicians and the factors that are surrounding that.

So today we’re excited to welcome Dr. Jennie Byrne to the show. Jennie is an advisor for healthcare innovators. She leverages an impressive blend of clinical expertise and entrepreneurial spirit focused around the behavioral health ecosystems, working with companies like LunaJoy Health and PsychNow and others. And she’s at the forefront of revolutionizing mental healthcare delivery through the strategic integration of technology, data and collaboration. And she’s the co-founder of Belong Health, which is the purpose-driven healthcare company dedicated to serving vulnerable populations through innovative health plan partnerships.

Jennie has both an MD and a PhD in neuroscience and as a board-certified psychiatrist, she offers a unique perspective on the biological and psychological aspects of human behavior and health. She’s also an author and she’s brought forward two important books, the first called Work Smart, which is a guide on leveraging brain and behavioral science to enhance productivity. And her latest book, Moral Injury: Healing the Healers is really the cornerstone of what we’re going to be talking about today. It’s shedding light on the pressing clinician crisis that’s surrounding the American healthcare system and what we can really be doing to actively address some of those needs. So Jennie, welcome to the Healthcare Market Matrix, and thank you so much for joining us today.

Jennie Byrne:

Yeah, thank you for having me here. I’m very excited to chat.

About Dr. Byrne’s Background and Her Writing Journey

John Farkas:

So tell us a little bit about your journey. Tell us about yourself and ultimately what inspired you to write Moral Injury, because I know that there’s a strong heartbeat behind that.

Jennie Byrne:

So I mean, my journey was different than a lot of folks in healthcare. I wasn’t a kid who knew they were going to be a doctor when they grew up at all. And I actually started out as a music performance major and then quickly shifted gears because I wanted to live overseas, so I was a French major. It really wasn’t until the end of college that I took a class in brain and behavior at the University of Pennsylvania where I was as an undergrad, and I just totally fell in love with it.

John Farkas:

Wow.

Jennie Byrne:

Yeah, I would say all the things I’ve done really have circled around human brain and behavior in some form or fashion. And along the way, I’m very curious. I love to learn. I’m always asking questions. And so I’ve gained this unique perspective on the way healthcare ecosystems work, including the tech parts, but also business, operations, finance, as well as being a practicing clinician, which gives me that deep visceral understanding of what it’s like to be a clinician today.

And so I’ve really been feeling passionate about this topic of taking care of clinicians and understanding what’s going on because it’s honestly kind of a crisis. I mean, when you ask clinicians behind closed doors, many of them are considering leaving for good. Even folks in medical school and residency are talking about leaving. And I’m sure you’ve experienced, I’ve experienced as a patient, many of my providers who are leaving the profession or sometimes even their wonderful people just aren’t really fully present with me when I’m in there for an appointment.

So I felt like this topic was really important. So that’s what inspired me to write my second book and get it out there quickly. And it’s on the topic of moral injury, which is a little different than burnout, and most people talk about burnout, but I think it’s a little bit more than that.

John Farkas:

Let’s go there for just a minute and help us into an understanding of the, because Moral Injury is not a light title.

Jennie Byrne:

No.

John Farkas:

There’s a lot going on there, and that’s intentional, I have to think. So unpack that a little bit for us and what that means.

Jennie Byrne:

So as I started researching and talking to my colleagues and then I started interviewing other folks, I kept hearing these negative emotions and these experiences that people were suffering from, but they had trouble putting words on it and they would say, “Well, I guess I’m burned out.” But the burnout term wasn’t really resonating with them. So I continued to dig deeper and I talked with a colleague of mine here in North Carolina whose name is Dr. Warren Kinghorn, and he is a super interesting background as a psychiatrist, but also somebody that works with veterans at the VA and also someone who has a degree in theology.

So he’s at the intersection of the military, psychiatry and religion or faith, I would call it faith. And he was the one that introduced me to this concept of moral injury. And really it comes from the military experience where they were seeing soldiers come back with these real profound problems, but they didn’t really fit into PTSD and they didn’t really fit into depression. And sometimes it wasn’t even somebody who was on the front line and they were trying to figure out what was going on.

So they came up with this concept of moral injury, which has three main components. The first is that you do something, witness something, or are part of something that goes against your values, that it is either ordered or condoned by somebody superior to you and that the stakes are high. So you can imagine many scenarios for a soldier who maybe has to take a life or do something they don’t want to do, and that wounds them because it’s going against their values.

Well, similarly, clinicians do things every day that go against their values, their personal values, their values as a professional healer, and those wounds feel like a wound on your soul and the stakes are high. So that’s where the concept of moral injury comes from. There’s a couple of variations on that definition, but that’s the one that I’ve been using for the book. And that’s different than burnout. They can coexist, but that’s very different than this concept of burnout, which everybody is talking about these days.

Weighing the Fear Factors Associated with New Technology

John Farkas:

Yeah, I think that that’s an important highlight because what I know in my experience with talking and working with and around clinicians is that most of them have a heart component around what they’re doing. There’s a driver that is past a salary, past some of the perks that the position brings, which are probably fewer and fewer as the years go by, but really are into some form of calling.

And the understanding of that and what I’m aware of and the frame that I sit in is usually looking at how technology companies are married to the clinical environment and looking at clinicians as some form of stakeholder in decisions for adopting new technology. And what I’m aware of is the charged environment that we’re walking into anytime we’re touching the clinical workflow, for instance, because there’s a lot going on there. It’s not just making somebody’s life easier. There’s a whole lot of factors that you need to be considering and weighing in this. I mean, this is the thing that’s occurred to me over the last three years. You’re often dealing with people that are at some level on the brink, and holding that awareness when you’re dealing with that stakeholder ends up being pretty important. So how do you see that part of the world?

Jennie Byrne:

So a couple of things I would love the folks who work in tech, some of your listeners to understand is that that third thing I said about moral injury, that the stakes are high. When you’re a clinician or a healer, the stakes feel high all the time. Everything you do, it’s not just a job where your boss is going to be mad at you if you do the wrong thing or maybe you don’t get a bonus because you did the wrong thing. Or worst-case scenario, you get fired from your job for doing the wrong thing.

When you’re a clinician, when you do the wrong thing, you literally could kill someone. And you’re making decisions, endless number of decisions, any one of which could be really harmful to another human being that’s in your care. And not only that, you’re held to this level of perfection where you’re expected to be right a hundred percent of the time, and if you’re not, you are subject to penalty and you can lose your medical license.

So when a new tech solution comes to your office, for example, and the clinician is wary of it, even though it’s going to help them and they’re wary, it really helps to understand that it’s not just whether this thing is going to work or not, it’s whether it could hurt someone by accident or whether it could actually result in the clinician losing their license. Because if they lose their license, they don’t work anywhere. It’s not just you lose a job, you lose your career, you lose 20 years of training. So it’s very scary.

So there’s a lot of fear for tech, I think, that clinicians have, and there’s a reason for that. And understanding that that’s emotional and it may not be logical. I think that would help tech folks understand the clinician point of view. It’s not just a job, it’s a calling. It’s decades of work. It’s your license, it’s your family. The stakes are always very high.

John Farkas:

Yeah, it’s interesting. One of the things we talk about in the context of our work with our client partners is you can’t ever underestimate the inertia and the factors that surround change. And when you’re dealing with somebody whose margin is cut razor-thin, because of all the factors that you just mentioned and you’re introducing some other variable in their world where they already are emotionally redlining and you’re going to put something else and you’re going to introduce change, you can’t take that lightly. You can’t just say, “You need to do it. Why would you not do that?”

Jennie Byrne:

I get that a lot, yeah.

John Farkas:

Well, because it’s asking something of me, dang it. And I don’t have much of me to be asked of right now.

Jennie Byrne:

I think that’s definitely a big part of it worth talking about. But again, the other part just to again highlight and kind of put a point on is that if you do something and something bad happens to a patient and the medical board comes to you and they say, “Why did you use this tech thing?” And you say, “Well, I thought it was the best thing to do”, they can say, “That is not the standard of care in your region.”

You are judged against the standard of care. Standard of care may not be good, and it’s definitely lower tech, but if you’re judged against the standard of care and you’re using a new technology, you can be penalized because you use the new technology. So any new technology has this inherent risk to it for a clinician, in addition to what you said, that their bandwidth to change or their interest in change may be very low.

And I would say clinicians, we’re pretty stubborn. Even for me, when I’m the boss of my own business, it’s pretty hard to change my own behavior. I did a little experiment once and I tried to use some rating scales for my own practice, and lo and behold, I did the same thing everyone else did. I got wary. It was hard for me to change my own behavior even when I was the boss and I wanted to do it, right?

John Farkas:

Right. It is not a small thing. It was interesting. One of our advisory board members is Kelly Aldridge and she’s a nurse informaticist and among many other credentials that Kelly carries around in her huge capability. And she was talking about just how dogmatic she is when she’s looking at new tech solutions, right?

Jennie Byrne:

Yeah.

John Farkas:

She’s like, “Well, what’s the accuracy here? Or how reliable is this?” And if they come back with some 90 something percent number, it’s like, “Well, guess what’s not enough? Come back when we’re looking at darn close, if not a hundred percent, because it has to be up there because I can’t put my clinicians in with a system that works pretty much all the time.”

Jennie Byrne:

Because if it’s 90% of the time. Okay, so you see a hundred patients, that’s 10 patients.

John Farkas:

Yeah, guess what? Not acceptable.

Jennie Byrne:

That’s more than enough to lose your license over. That’s more than enough to make you feel terrible inside that you have the guilt and shame that you’ve done something that harms someone that you didn’t have to do. You could have just used the old way of doing things, even if the old way wasn’t the good way.

Systemic Factors That Contribute to Moral Injury

John Farkas:

So talk about some of the… We’re kind of pushing around this. What are some of the systemic factors that contribute to moral injury in healthcare systems? What are some of those elements that are in place that end up being repeat offenders and hurting people in that way?

Jennie Byrne:

So there’s a couple of main ones. So the main one is that in every single interview I did, I did 30, 40 interviews, they all said the same thing, “I feel injured when I am not able to take good care of my patients.” And there’s many reasons that that can be, but it’s the feeling that I am unable. I know what to do, I can do it, but something is getting in the way of me taking care of my patients the way they deserve to be taken care of, number one. Number one cause of moral injury.

Number two is lack of trust. Trust has been really eroded throughout healthcare. Trust between patients and their doctors, trust from one doctor to another, from the nurse to the doctor, between the nurse and the nurse, the administrator, the nurse, really throughout with the tech, right? The trust with the tech. Trust has really been eroded and COVID accelerated that quite a bit, but it had already been started.

So those are the two main things that drive moral injuries when you can’t take care of patients the way you know are able and when you’re no longer trusting the system around you. So how does that happen? There’s a million different ways that can happen. It can happen because the clinicians are misaligned with the administration, which is kind of the classic story that people tell, right? There’s a greedy CEO and they want to make profit and the clinician’s trying to do the right thing. And I think that’s a little bit of a oversimplified narrative, frankly. I don’t really love that narrative. I think I know a lot of healthcare executives and they’re not greedy at all, and they’re trying to do the right thing too. So I don’t love that narrative.

It could be technology, it could be that their technology is so old and outdated, it’s driving them up a wall. We’re getting faxes, people are still using faxes. We can’t text our patients because of regulations. We can’t do this, we can’t do that. That definitely can be part of it. The staffing of places and hospitals, hospitals are really struggling in particular. So staffing has become such an issue that they’re closing down hospitals, they’re closing down units because they can’t get nurses and physicians and others to work in those places. So when you’re short-staffed and something goes wrong, wow, that feels terrible.

I have a story in the book about an ER physician who works in short-staffed ERs and literally a little girl died because they were short-staffed. And just the injury, I don’t know how, again, to express as a nurse or doctor the wound. That’s a wound that sits with you for life. That little girl that died, I mean, that’s a wound on his heart that he will never heal entirely. So there’s many ways that those things can happen, but that’s kind of the core of it. They’re not able to take care of the patients the way they know they can and trust has been lost and they feel like they can’t trust anymore.

John Farkas:

And so that’s again, just a very important thing for our listeners to consider, the trust quotient. What are you doing to actively cultivate that? How are you? And I see it a lot of times with especially earlier stage tech companies, whose clinical expertise is an inch deep and they’re making all kinds of assumptions and they’re super proud of their technology and they’re not taking the steps and doing the things to understand what empathy looks like in this environment. I see this pretty often. And some of the reality is physicians can be a temperamental, demanding bunch.

Jennie Byrne:

Perfectionists.

John Farkas:

Yeah. And so often in the conversations, they’re sort of vilified prima donnas, I’m just going to call it the way it is, without mentioning. I know that because I’ve been in these conversations where that’s the perception, and that is one side of the continuum. And there is some reality to that that can be dark and hard and difficult, and you can choose to look at it that way or you can look at it like, “These are some people that are under incredible pressure, incredible scrutiny, and their standard is perfection. That’s what they’re up against.”

And so if you’ve got somebody under incredible scrutiny whose standard is perfection and anything less is at best a malpractice suit, and at worst the death of somebody, an avoidable death, who are we to be critical of them in that scenario? And so understanding those stakes and what is being asked of them, anytime they’re asked to jump out of a norm and into something that is different, we would do well to understand what is at stake there and speak directly to it and make sure our solutions are coming with something that’s not going to contribute to the problem in any way, shape, or form, or do our best to mitigate it.

Jennie Byrne:

And there’s some things that I have rarely seen a tech company do that I think I’m always surprised why they don’t do it. It would really build the trust much more quickly than the way they’re trying to do it. So the first thing I always suggest is a very pragmatic thing is don’t survey us. Stop. I’m a physician. I don’t like being surveyed. Get on an airplane or get in the car. Find a physician who will let you observe them for the day or a hospital, whatever, and just shadow them. Don’t even talk. Just be there. Just be a good listener, be curious, be observant. Watch what their day is like, watch the kind of things that come in, watch how they react, look for their emotional state. Look at their body language. I think you would gain more from one day of observation than you would from surveying 10,000 physicians.

John Farkas:

Wow. That is a powerful underscore. And something I honestly haven’t heard somebody say in that many words.

Jennie Byrne:

I’ve never seen anyone do it and honestly, I’m not sure why. As a physician or a nurse, that’s how we learn is we have this system where we watch and we learn and we’re mentored and we learn by watching. There’s a saying, what is it? Watch one, help one, do one. That’s how we learn. And so being physically present and watching what it’s like, I think you’ll get a much better understanding of the folks that you’re trying to work with as a tech company.

And the second thing, like you were saying, yeah, we are perfectionists. Of course. How do you think we got through med school? How do you think we got through three board exams? How do you think we got through residency? How do you think we wake up in the middle of the night when we’re on call and have people asking us life or death questions in the middle of the night? Yeah, we are perfectionists. Probably a lot of us are a little OCD. A lot of us are anxious. We are type As. We are competitive sometimes.

So you can call it a prima donna and you would be right in some ways, but yeah, heck yeah. We’re perfectionists. Don’t you want your doctor to be a perfectionist? Do you want to go to your doctor and have them be, “I’m like a 60 percenter”? No, you don’t want to be them. You want them to be a hundred percent right every single time. Anytime you have a question for them, anytime you see them, you expect them to be a hundred percent. Which is an impossible for anybody, right? It’s totally impossible. But that’s the expectation.

Factors that Influence Trust

John Farkas:

Yeah, it’s a critical thing to keep in mind. And just to your point about observing, I’ll say, and my team has heard me tell this story a lot of times, because I don’t have an opportunity very often to go in the field and observe one of our client solutions. And I had the opportunity to do that and had an incidental opportunity off the record to interact with one of the clinicians that was making use of a technology that truly was changing her world and the looking at somebody, this is sort of the other side of it where you have somebody who is so passionate about what a technology has enabled that they’re literally in tears telling me how this has changed how they practice and how it’s so important. And feeling that, when you realize the power of what technology does have the opportunity to do.

Now, what was so interesting about that story is the front end of it, what she told me she was anticipating when she first heard that this was going to be implemented. She was not at all looking forward to it and dragging heels all over the place and really afraid of what it was going to bring. And then when it actually did deliver as promised, when it did do what it was going to do, part of the good aspect of this particular solution is that it has clinical leaders crawling all over the growth and implementation of it. And so they come from a very highly empathetic understanding of what needs to happen in the environment. But that’s so important. And the results are, you have really strong advocates because this actually helped improve care at the bedside, which is what ends up being so important.

So Jennie, let’s dive in a little deeper into the idea of trust, because that’s a lot of what we’re circling here and talking about when we’re talking about the systemic nature of things and how we’re introducing something new into a clinical environment. What are some of the factors that influence trust, and what are some ways that an organization looking to be seen favorably by clinicians, what can they do and communicate around that idea that would help?

Jennie Byrne:

And I said this before, I think trust is one of the most important things to rebuild in healthcare. So for a tech company especially, again, remember that you’re up against a history of being wary. Understand-

John Farkas:

You’re coming in at a disadvantage and understanding that to start with. You’re suspected.

Jennie Byrne:

So first of all, I would say just be super upfront about that. That’s the elephant in the room and say, “I get it. A new technology is, even if it could help you, it’s kind of scary. I mean, you worry about an error, you worry about the board and just lay it out there. I get it. I know that’s the elephant in the room.”

So what I see a lot of companies do, and I understand why they do this, but I think it’s a little bit of a mistake. I’ll see them get advisory boards and put these really big names on there. And then the advisors don’t actually do anything. They’re kind of just… I don’t want to say. I’m over exaggerating, but they’re mainly there for trust, right?

You’re putting these famous names on there, their pictures up on your pitch decks and your things, right? Because that’s trust. And you hope that by putting those big names up there, you’re going to be getting a halo of trust from their reputation. So I see that as what people do to gain trust and there’s nothing wrong with that. But when those clinicians are detached from the actual company and they’re actually not doing much to advise the company day to day with the practicalities of it, sometimes that can backfire a little bit. There’s better ways, I think, to get trust. So I think the role of the advisor can be valuable in gaining trust, but I think there’s other things as well.

So for example, having a common language, showing empathy through common language is huge. So one mistake I see tech companies and others make is they use the wrong lingo. They use their lingo to go speak to clinicians. And we all have our own tribal lingoes, but I see people use corporate lingo or tech lingo to go talk to clinicians. And by doing that, you’re automatically demonstrating that you haven’t done your homework and you don’t have empathy for them. Because if you really had empathy and you really wanted their trust, you would learn their language.

John Farkas:

That’s awesome.

Jennie Byrne:

So don’t say action items. Don’t say cascading information, don’t say UX. Scrub your content and what you say, scrub it and look what might be lingo. Switch it out to either common language that everybody uses or where possible use medical lingo. But the flip side is make sure you’re using it correctly. So if you don’t know what something means, you need to say, “Oh, pause. I don’t know what that term means. Could you please explain it to me?” If a doc says, I don’t know, “Neurophysiology of the temporal cortex”, and you have no idea what that is, don’t pretend like you know what it is.

Just say, “Oh gosh, I don’t really know what that is. Where is that in my brain? Can you show me?” Don’t be afraid to ask questions and be curious. Most clinicians love to teach, and so by asking them to be a teacher, sometimes that really can help build trust as well.

I see a mistake of you think you have to know everything and be the smartest person in the room, but clinicians like to teach. They’re learners. So if you can lean into learning and curiosity, it’s a great way to connect with clinicians. “Here’s what I’ve learned about what you do. I’m assuming this. Am I right? I don’t know. Tell me what it’s like for you. Put it in words that I’ll understand.”

So I think language, because language is culture. So by really looking at your language and culture, and I mentioned learning and education. So one of the things that is pretty universal to clinicians is they love to learn. We spend, I don’t know, 20 years in school. We obviously are learners. So putting things in terms of learning. So if you have a new tech product and you want to build trust, instead of putting some fancy advisor on your deck, get some experts who are other clinicians.

So if you’re pitching to a nurse, get another nurse who’s an expert. Get some experts together and then deliver educational material, whether that’s a webinar, an ongoing lunch and learn series, but it should be from their peers, not from you. So that’s the other key thing is you’ll gain trust much quicker if a peer delivers the information than if you deliver the information.

Like you said, that one clinician who became your biggest champion. If you have someone who was a skeptic that used your product and is your champion, that is your best salesperson that you will ever have. Use that person to go educate others. And I’ve been advising health tech companies recently, I would actually consider doing educational series as part of what you do with your product. Make it an educational product, give someone a certification that they’ve learned how to use AI, how to use AI in your daily workflows. Maybe you do a little class that they can get CME for, which is continuing medical education. We all need it. I need 40 hours a year just to keep my license. So free continuing education that they can use in their real practice is like gold.

So think about your role as an educator in this new world of tech or this new world of AI and all this other stuff. Most of us are curious. I’d say people who are, I don’t know what, 50 years old and younger are really curious, but it has to be practical for them. So if you can find a way to weave education and ongoing learning and professional development from other experts that are clinicians, I think you build trust, you help them really learn how to use their product, and they’re going to feel a lot more confident about using it. And skeptics convert over to champions, and then you’ve got a sales team that’s out there doing all the work for you.

Building Bridges of Understanding between Clinicians and Tech

John Farkas:

Some really great points there. And I just want to back up and reiterate some of them. So one of the things I heard you say a little while ago, take the time to shadow people in the real clinician environment. Don’t spend time surveying. Although there’s probably a place for surveying for some things, we’ll say. I’ll just put the caveat out there.

But if you’re wanting to learn, do the best to get as close as you can to walking a mile in another man’s shoes because that’s going to be where you see it. And I can vouch for that because that’s what I had the opportunity of doing that really changed my perspective on something and underscored something at such a level that I felt it in my heart. And that’s where you want to carry it because that’s what this is. If we’re looking for empathy, we’re looking for heart level connections where you understand something.

Make sure you have a common language, make sure you’re using the common language that somebody in the clinical environment would actually use to communicate and talk about something. And if you don’t know it, learn it because that’s where you’re going to meet them. And that echoes the shadowing opportunity. I mean it has some of that in there. So avoiding tech lingo, that’s not it. If you’re not saying it in terms that they would use, it’s not going to connect. Make sure that you understand what the language is that they would use to talk about the thing that you’re doing.

Lean into learning. So we’re dealing with people that are inherent learners. How can we bring… And we talk about this all the time in the context of our work with Ratio. You have to work with people to help them know how to think about new technology. It’s not just telling them what they should think. It’s building the bridge of understanding to help them learn how. It’s teaching and helping them learn how to think about something in light of what’s now possible will equip them and they’re by nature into that. Just if I’m hearing you right, that’s part of it. And learning is part of the clinician culture. It’s just a continuous process. So what can you do?

And so this, I really liked that you said. Get close to the peers. It’s not about the figureheads and the celebrities. It’s about the people that really are in the experience and get them to talk about what’s going on in their embrace of this technology, not the celebrities that might be sort of talking about it from a little thin slice of experience they have because they’re on a board or maybe they’re an investor and the company.

No, these are folks that are in the trenches making it happen, seeing the results. Let’s talk to them because that’s going to sing really loud if somebody understands that this is a real person doing a real thing and it’s working for them. And so what does it mean to enter their professional development universe and what can you provide for them as resources that could enhance their professional development? I think all those are golden. Wow. I think that’s all some really good input. Anything else you would add to that list?

Jennie Byrne:

One more thing in terms of how you communicate. I’ve seen some tech companies are really good at this, and some of them are really bad at this. Humans learn in facts and figures and rational things. And then they also learn in, like you said, the heart, the stories, the human connection. And the best pitches or the best communications are when you have both. And so clinicians, the way we tell those stories of the heart is we’ll often tell a true patient story or a true clinician story.

And that’s what I try to do in my new book is really weave stories with data because that’s how people learn. And there’s some neuroscience I could go into on that, but tell the story of the patient, tell the heartfelt story as well as the facts and figures. Tell the clinician story like this was a skeptic and this is why. This is what they did and this is what their life is like now. So weaving those two together is powerful. I see some companies still leaning really heavy on one or the other.

And they have to be real stories, by the way. Don’t make them up. They have to be real and they have to be de-identified, but don’t make up a fake patient because I can spot that a mile away. Tech company comes to me with fake patient stories, I can tell. It’s got to be a real story that’s going to really connect with me. And if you can do both of those well, that’s where you really start to make the progress.

Yes, we like facts and figures. We’re students, we really like that, but we have to connect at that heart level to make change. Like you said at the beginning, making change requires an emotional state. There’s a famous, if you get into behavioral science, which is one way of understanding human behavior, there’s this concept that education alone does not change human behavior. So it’s not just telling someone or showing them the facts and figures. It has to have some emotional resonance. And so finding that balance of emotion, head and heart, finding that combination. I’ve seen some tech companies do that really well. Not a lot, but I have seen some of them do that really well.

Embracing Technology in Healthcare’s Innovative World

John Farkas:

Very interesting. What a great set of wisdom that you’ve… So I’m curious, we’re coming up on our little window here, but if you were to look at the healthcare organizations and wanting to help them into a culture that is looking at some of this. Creating a safe environment and how technology can help, what does it mean to move into something where it’s going to be generative, where it’s going to be creative, where they’re going to be able to adopt the kind of innovation that is going to create an environment of trust? And what would you have to say that realm? That would be good too.

Jennie Byrne:

And that was actually kind of the topic of my first book, which was on ways to work together in this new world. And again, the premise is that to get to creativity and connectedness, which is what we crave, we really crave that. Time management and communication are the keys. So in terms of tech, this is where tech I think can shine. There’s a lot of things that tech and AI can do better than people. So I try to make it a little bit lighthearted. I say, “Let the robots do the robot work and let the humans do the human work.” And the more space and time that you can extract, and it’s not just time and space in the physical sense, it’s also kind of emotional time and space to be able to be creative and to think ahead.

If you’re fearful, tired, exhausted, everything, negative, negative, negative, you tend to go into this very fearful, constricted way of thinking. To open up creative thinking, you actually have to be kind of relaxed and positive. So anything that you can do to create time and space for people is tremendous. And the one thing for leaders, so if you have leaders that you work with in these organizations, one of the hardest things as a leader is modeling what you want to see in others and managing your time and showing up a hundred percent of yourself every day is really hard.

It requires a tremendous amount of self-awareness. I mean, I feel like I was so fortunate that I did all my psychotherapy training because that’s where I learned how to do all this. If I didn’t do all that psychotherapy training, I probably wouldn’t know how to do all this stuff. So being very self-aware and being very thoughtful about how you show up every day matters quite a bit to set the tone.

So in other words, if you’re sitting on email all day, three second email response to everybody, you show up rushed, you’re late to meetings, you look unhappy, you can’t really expect your team to show up in a good way and creative and take their vacation if you’re not doing it yourself. So it takes a tremendous amount of intention as a leader to create that kind of environment. But it can be done. I’ve seen it be done. I’ve done it myself. I know you can do it, but everybody wants to do the work. And sometimes the work is about helping people to be able to work. And leaders struggle with that. They feel like, “Well, we’re not doing the thing”, but having intention and putting time and effort, sometimes that is the work.

John Farkas:

And that follows through everything we’re talking about. I mean, it ends up being so important to come at this with the creative and collaborative spirit that empathetically understands and is working to facilitate those kinds of conversations where real creativity can take place. Because so often I see, and this is an example, there’s several things here where I think coming at the conversations with a really good familiarity and understanding of what some of the inherent problems are, but being there and open and listening to understand some of the nuance that exists in a certain clinical environment that might need to be addressed in a certain way.

And you open up a conversation that instead of saying, “Here’s the way I think you should do it” it’s, “Let’s talk together about what could be possible.” That’s a different conversation and has an opportunity to go a very different direction than, “Here’s our little naive prescription on how you ought to solve the problem that we see that you have that we don’t fully understand yet.”

Jennie Byrne:

Yeah, I would say just two final thoughts maybe I have is first of all, if you want to know how to do this stuff, you don’t have to be a psychotherapist. Go online, look up active listening skills. Go to YouTube, watch some therapists do active listening. Anybody can learn how to be an active listener. You don’t have to be a therapist. Just go look it up.

And then the final thing I guess I would say is what can you do to create that space? I think people underestimate kindness, just being nice. Just be kind. Just open the door. In the virtual world, what’s the equivalent of opening the door for somebody? I think showing up on time is a tremendous sign of respect. Ending meetings on time online is a tremendous sign of respect. Not being distracted, not doing email while I’m talking to you. That would be disrespectful. You’re not doing your email, I hope, while we’re talking, right? Like that.

So I think they’re like these acts of kindness and respect that we can show to one another. And that goes a long way. So if you ever are at a loss for words with a clinician and you want to say something kind, you cannot go wrong with this. Tell them, “Thank you for all you do.” You can’t go wrong. And it’s not just thank you for taking care of me. Not just thank you for your time. No, but for all that you do, I guarantee you that will go right to their heart. Every time somebody tells me that, it goes right to my heart and it feels good. So if you can sincerely tell a clinician, “Thank you for all you do”, it takes less than two seconds and it will go a long way.

Closing Thoughts

John Farkas:

Well, that is obviously some very well-founded perspective Jennie, and thank you for all you do.

Jennie Byrne:

Thank you.

John Farkas:

And really appreciate you taking the time here. Some tremendously practical insights that I think are going to go a long way and just a critical component to understanding. What I know is that many of the solutions that are getting traction right now in the healthcare technology universe are ones that are in the clinical workflow because there’s such need in that space. And so having a clear understanding of what those needs are, having the ability to get that common language to really understand. Spending some time in their shoes, walking with them, understanding what it looks like, getting the common language, leaning into the learning piece of it, and looking to involve the voice of peers. All that is just such great insight. And I want to appreciate you underlining all of those for us today. Tell us a little bit of how we can get our hands on your books, because that’s some good opportunities for people to dive deeper into some of this insight.

Jennie Byrne:

So it’s very simple. Go on Amazon. That’s where books are sold these days, literally. That’s what I’ve learned. So go on there. You can search my name, Jennie and spell J-E-N-N-I-E Byrne B-Y-R-N-E, Moral Injury. Put that in the search bar. It’ll pop it right up. My first book, Work Smart is also there. You can look at that if you’re interested in more of the ways of working.

And then I would say the best way to reach me is connect with me on LinkedIn, connect with me, and then send me a message there. So if you want to have more information, if you love the book and you want a book club or you want me to come talk or anything like that, honestly, LinkedIn is probably the best way to get ahold of me.

John Farkas:

Awesome. Dr. Jennie Byrne, thank you so much for joining us today on the Healthcare Market Matrix.

Jennie Byrne:

Thank you.

Outro:

Healthcare Market Matrix is a Ratio original podcast. If you enjoyed today’s episode, then jump over to healthcaremarketmatrix.com and subscribe. And we’d really appreciate your support in the form of a five-star rating on your favorite podcast platform. It does make a difference. 

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Ratio is an award-winning marketing agency headquartered in the Nashville Tennessee. We operate at the intersection of brand and growth marketing to equip companies with strategies to create meaningful connections with the healthcare market and ultimately drive growth. Want to know more? Go to Goratio.com. That’s G-O-R-A-T-I-O.com. And we’ll see you at noon Central next week for an all new episode from our team at Ratio Studios. Stay healthy.

Introducing Dr. Jennie Byrne

John Farkas:

Welcome everybody to Healthcare Market Matrix. I’m your host, John Farkas, and today we’re talking about some really important things that are right at the dashboard of our healthcare system, and that is the critical nature of the wellbeing of the clinicians who are at the front line of the care that we as patients so desperately need. If there’s one thing the pandemic did, and there’s a lot of things the pandemic did, but if there’s one thing that it did, it shone the light on the critical nature of mental wellness at large.

I mean, it’s a really critical component of our culture, and we were face-to-face with a lot of the shortcomings in the support structures necessary for that in our world. And there was a lot of response to that that came out of the pandemic. One of the deep underscores was in the critical nature of caring well for those who care for us. And that’s what we’re going to be talking about today and how the technology platforms that we’re bringing forward that are ideally working to help clinicians. Just some of the things we need to have at the forefront of our minds as we’re bringing those kinds of solutions forward and how we’re talking about effectively supporting the well-being of clinicians and the factors that are surrounding that.

So today we’re excited to welcome Dr. Jennie Byrne to the show. Jennie is an advisor for healthcare innovators. She leverages an impressive blend of clinical expertise and entrepreneurial spirit focused around the behavioral health ecosystems, working with companies like LunaJoy Health and PsychNow and others. And she’s at the forefront of revolutionizing mental healthcare delivery through the strategic integration of technology, data and collaboration. And she’s the co-founder of Belong Health, which is the purpose-driven healthcare company dedicated to serving vulnerable populations through innovative health plan partnerships.

Jennie has both an MD and a PhD in neuroscience and as a board-certified psychiatrist, she offers a unique perspective on the biological and psychological aspects of human behavior and health. She’s also an author and she’s brought forward two important books, the first called Work Smart, which is a guide on leveraging brain and behavioral science to enhance productivity. And her latest book, Moral Injury: Healing the Healers is really the cornerstone of what we’re going to be talking about today. It’s shedding light on the pressing clinician crisis that’s surrounding the American healthcare system and what we can really be doing to actively address some of those needs. So Jennie, welcome to the Healthcare Market Matrix, and thank you so much for joining us today.

Jennie Byrne:

Yeah, thank you for having me here. I’m very excited to chat.

About Dr. Byrne’s Background and Her Writing Journey

John Farkas:

So tell us a little bit about your journey. Tell us about yourself and ultimately what inspired you to write Moral Injury, because I know that there’s a strong heartbeat behind that.

Jennie Byrne:

So I mean, my journey was different than a lot of folks in healthcare. I wasn’t a kid who knew they were going to be a doctor when they grew up at all. And I actually started out as a music performance major and then quickly shifted gears because I wanted to live overseas, so I was a French major. It really wasn’t until the end of college that I took a class in brain and behavior at the University of Pennsylvania where I was as an undergrad, and I just totally fell in love with it.

John Farkas:

Wow.

Jennie Byrne:

Yeah, I would say all the things I’ve done really have circled around human brain and behavior in some form or fashion. And along the way, I’m very curious. I love to learn. I’m always asking questions. And so I’ve gained this unique perspective on the way healthcare ecosystems work, including the tech parts, but also business, operations, finance, as well as being a practicing clinician, which gives me that deep visceral understanding of what it’s like to be a clinician today.

And so I’ve really been feeling passionate about this topic of taking care of clinicians and understanding what’s going on because it’s honestly kind of a crisis. I mean, when you ask clinicians behind closed doors, many of them are considering leaving for good. Even folks in medical school and residency are talking about leaving. And I’m sure you’ve experienced, I’ve experienced as a patient, many of my providers who are leaving the profession or sometimes even their wonderful people just aren’t really fully present with me when I’m in there for an appointment.

So I felt like this topic was really important. So that’s what inspired me to write my second book and get it out there quickly. And it’s on the topic of moral injury, which is a little different than burnout, and most people talk about burnout, but I think it’s a little bit more than that.

John Farkas:

Let’s go there for just a minute and help us into an understanding of the, because Moral Injury is not a light title.

Jennie Byrne:

No.

John Farkas:

There’s a lot going on there, and that’s intentional, I have to think. So unpack that a little bit for us and what that means.

Jennie Byrne:

So as I started researching and talking to my colleagues and then I started interviewing other folks, I kept hearing these negative emotions and these experiences that people were suffering from, but they had trouble putting words on it and they would say, “Well, I guess I’m burned out.” But the burnout term wasn’t really resonating with them. So I continued to dig deeper and I talked with a colleague of mine here in North Carolina whose name is Dr. Warren Kinghorn, and he is a super interesting background as a psychiatrist, but also somebody that works with veterans at the VA and also someone who has a degree in theology.

So he’s at the intersection of the military, psychiatry and religion or faith, I would call it faith. And he was the one that introduced me to this concept of moral injury. And really it comes from the military experience where they were seeing soldiers come back with these real profound problems, but they didn’t really fit into PTSD and they didn’t really fit into depression. And sometimes it wasn’t even somebody who was on the front line and they were trying to figure out what was going on.

So they came up with this concept of moral injury, which has three main components. The first is that you do something, witness something, or are part of something that goes against your values, that it is either ordered or condoned by somebody superior to you and that the stakes are high. So you can imagine many scenarios for a soldier who maybe has to take a life or do something they don’t want to do, and that wounds them because it’s going against their values.

Well, similarly, clinicians do things every day that go against their values, their personal values, their values as a professional healer, and those wounds feel like a wound on your soul and the stakes are high. So that’s where the concept of moral injury comes from. There’s a couple of variations on that definition, but that’s the one that I’ve been using for the book. And that’s different than burnout. They can coexist, but that’s very different than this concept of burnout, which everybody is talking about these days.

Weighing the Fear Factors Associated with New Technology

John Farkas:

Yeah, I think that that’s an important highlight because what I know in my experience with talking and working with and around clinicians is that most of them have a heart component around what they’re doing. There’s a driver that is past a salary, past some of the perks that the position brings, which are probably fewer and fewer as the years go by, but really are into some form of calling.

And the understanding of that and what I’m aware of and the frame that I sit in is usually looking at how technology companies are married to the clinical environment and looking at clinicians as some form of stakeholder in decisions for adopting new technology. And what I’m aware of is the charged environment that we’re walking into anytime we’re touching the clinical workflow, for instance, because there’s a lot going on there. It’s not just making somebody’s life easier. There’s a whole lot of factors that you need to be considering and weighing in this. I mean, this is the thing that’s occurred to me over the last three years. You’re often dealing with people that are at some level on the brink, and holding that awareness when you’re dealing with that stakeholder ends up being pretty important. So how do you see that part of the world?

Jennie Byrne:

So a couple of things I would love the folks who work in tech, some of your listeners to understand is that that third thing I said about moral injury, that the stakes are high. When you’re a clinician or a healer, the stakes feel high all the time. Everything you do, it’s not just a job where your boss is going to be mad at you if you do the wrong thing or maybe you don’t get a bonus because you did the wrong thing. Or worst-case scenario, you get fired from your job for doing the wrong thing.

When you’re a clinician, when you do the wrong thing, you literally could kill someone. And you’re making decisions, endless number of decisions, any one of which could be really harmful to another human being that’s in your care. And not only that, you’re held to this level of perfection where you’re expected to be right a hundred percent of the time, and if you’re not, you are subject to penalty and you can lose your medical license.

So when a new tech solution comes to your office, for example, and the clinician is wary of it, even though it’s going to help them and they’re wary, it really helps to understand that it’s not just whether this thing is going to work or not, it’s whether it could hurt someone by accident or whether it could actually result in the clinician losing their license. Because if they lose their license, they don’t work anywhere. It’s not just you lose a job, you lose your career, you lose 20 years of training. So it’s very scary.

So there’s a lot of fear for tech, I think, that clinicians have, and there’s a reason for that. And understanding that that’s emotional and it may not be logical. I think that would help tech folks understand the clinician point of view. It’s not just a job, it’s a calling. It’s decades of work. It’s your license, it’s your family. The stakes are always very high.

John Farkas:

Yeah, it’s interesting. One of the things we talk about in the context of our work with our client partners is you can’t ever underestimate the inertia and the factors that surround change. And when you’re dealing with somebody whose margin is cut razor-thin, because of all the factors that you just mentioned and you’re introducing some other variable in their world where they already are emotionally redlining and you’re going to put something else and you’re going to introduce change, you can’t take that lightly. You can’t just say, “You need to do it. Why would you not do that?”

Jennie Byrne:

I get that a lot, yeah.

John Farkas:

Well, because it’s asking something of me, dang it. And I don’t have much of me to be asked of right now.

Jennie Byrne:

I think that’s definitely a big part of it worth talking about. But again, the other part just to again highlight and kind of put a point on is that if you do something and something bad happens to a patient and the medical board comes to you and they say, “Why did you use this tech thing?” And you say, “Well, I thought it was the best thing to do”, they can say, “That is not the standard of care in your region.”

You are judged against the standard of care. Standard of care may not be good, and it’s definitely lower tech, but if you’re judged against the standard of care and you’re using a new technology, you can be penalized because you use the new technology. So any new technology has this inherent risk to it for a clinician, in addition to what you said, that their bandwidth to change or their interest in change may be very low.

And I would say clinicians, we’re pretty stubborn. Even for me, when I’m the boss of my own business, it’s pretty hard to change my own behavior. I did a little experiment once and I tried to use some rating scales for my own practice, and lo and behold, I did the same thing everyone else did. I got wary. It was hard for me to change my own behavior even when I was the boss and I wanted to do it, right?

John Farkas:

Right. It is not a small thing. It was interesting. One of our advisory board members is Kelly Aldridge and she’s a nurse informaticist and among many other credentials that Kelly carries around in her huge capability. And she was talking about just how dogmatic she is when she’s looking at new tech solutions, right?

Jennie Byrne:

Yeah.

John Farkas:

She’s like, “Well, what’s the accuracy here? Or how reliable is this?” And if they come back with some 90 something percent number, it’s like, “Well, guess what’s not enough? Come back when we’re looking at darn close, if not a hundred percent, because it has to be up there because I can’t put my clinicians in with a system that works pretty much all the time.”

Jennie Byrne:

Because if it’s 90% of the time. Okay, so you see a hundred patients, that’s 10 patients.

John Farkas:

Yeah, guess what? Not acceptable.

Jennie Byrne:

That’s more than enough to lose your license over. That’s more than enough to make you feel terrible inside that you have the guilt and shame that you’ve done something that harms someone that you didn’t have to do. You could have just used the old way of doing things, even if the old way wasn’t the good way.

Systemic Factors That Contribute to Moral Injury

John Farkas:

So talk about some of the… We’re kind of pushing around this. What are some of the systemic factors that contribute to moral injury in healthcare systems? What are some of those elements that are in place that end up being repeat offenders and hurting people in that way?

Jennie Byrne:

So there’s a couple of main ones. So the main one is that in every single interview I did, I did 30, 40 interviews, they all said the same thing, “I feel injured when I am not able to take good care of my patients.” And there’s many reasons that that can be, but it’s the feeling that I am unable. I know what to do, I can do it, but something is getting in the way of me taking care of my patients the way they deserve to be taken care of, number one. Number one cause of moral injury.

Number two is lack of trust. Trust has been really eroded throughout healthcare. Trust between patients and their doctors, trust from one doctor to another, from the nurse to the doctor, between the nurse and the nurse, the administrator, the nurse, really throughout with the tech, right? The trust with the tech. Trust has really been eroded and COVID accelerated that quite a bit, but it had already been started.

So those are the two main things that drive moral injuries when you can’t take care of patients the way you know are able and when you’re no longer trusting the system around you. So how does that happen? There’s a million different ways that can happen. It can happen because the clinicians are misaligned with the administration, which is kind of the classic story that people tell, right? There’s a greedy CEO and they want to make profit and the clinician’s trying to do the right thing. And I think that’s a little bit of a oversimplified narrative, frankly. I don’t really love that narrative. I think I know a lot of healthcare executives and they’re not greedy at all, and they’re trying to do the right thing too. So I don’t love that narrative.

It could be technology, it could be that their technology is so old and outdated, it’s driving them up a wall. We’re getting faxes, people are still using faxes. We can’t text our patients because of regulations. We can’t do this, we can’t do that. That definitely can be part of it. The staffing of places and hospitals, hospitals are really struggling in particular. So staffing has become such an issue that they’re closing down hospitals, they’re closing down units because they can’t get nurses and physicians and others to work in those places. So when you’re short-staffed and something goes wrong, wow, that feels terrible.

I have a story in the book about an ER physician who works in short-staffed ERs and literally a little girl died because they were short-staffed. And just the injury, I don’t know how, again, to express as a nurse or doctor the wound. That’s a wound that sits with you for life. That little girl that died, I mean, that’s a wound on his heart that he will never heal entirely. So there’s many ways that those things can happen, but that’s kind of the core of it. They’re not able to take care of the patients the way they know they can and trust has been lost and they feel like they can’t trust anymore.

John Farkas:

And so that’s again, just a very important thing for our listeners to consider, the trust quotient. What are you doing to actively cultivate that? How are you? And I see it a lot of times with especially earlier stage tech companies, whose clinical expertise is an inch deep and they’re making all kinds of assumptions and they’re super proud of their technology and they’re not taking the steps and doing the things to understand what empathy looks like in this environment. I see this pretty often. And some of the reality is physicians can be a temperamental, demanding bunch.

Jennie Byrne:

Perfectionists.

John Farkas:

Yeah. And so often in the conversations, they’re sort of vilified prima donnas, I’m just going to call it the way it is, without mentioning. I know that because I’ve been in these conversations where that’s the perception, and that is one side of the continuum. And there is some reality to that that can be dark and hard and difficult, and you can choose to look at it that way or you can look at it like, “These are some people that are under incredible pressure, incredible scrutiny, and their standard is perfection. That’s what they’re up against.”

And so if you’ve got somebody under incredible scrutiny whose standard is perfection and anything less is at best a malpractice suit, and at worst the death of somebody, an avoidable death, who are we to be critical of them in that scenario? And so understanding those stakes and what is being asked of them, anytime they’re asked to jump out of a norm and into something that is different, we would do well to understand what is at stake there and speak directly to it and make sure our solutions are coming with something that’s not going to contribute to the problem in any way, shape, or form, or do our best to mitigate it.

Jennie Byrne:

And there’s some things that I have rarely seen a tech company do that I think I’m always surprised why they don’t do it. It would really build the trust much more quickly than the way they’re trying to do it. So the first thing I always suggest is a very pragmatic thing is don’t survey us. Stop. I’m a physician. I don’t like being surveyed. Get on an airplane or get in the car. Find a physician who will let you observe them for the day or a hospital, whatever, and just shadow them. Don’t even talk. Just be there. Just be a good listener, be curious, be observant. Watch what their day is like, watch the kind of things that come in, watch how they react, look for their emotional state. Look at their body language. I think you would gain more from one day of observation than you would from surveying 10,000 physicians.

John Farkas:

Wow. That is a powerful underscore. And something I honestly haven’t heard somebody say in that many words.

Jennie Byrne:

I’ve never seen anyone do it and honestly, I’m not sure why. As a physician or a nurse, that’s how we learn is we have this system where we watch and we learn and we’re mentored and we learn by watching. There’s a saying, what is it? Watch one, help one, do one. That’s how we learn. And so being physically present and watching what it’s like, I think you’ll get a much better understanding of the folks that you’re trying to work with as a tech company.

And the second thing, like you were saying, yeah, we are perfectionists. Of course. How do you think we got through med school? How do you think we got through three board exams? How do you think we got through residency? How do you think we wake up in the middle of the night when we’re on call and have people asking us life or death questions in the middle of the night? Yeah, we are perfectionists. Probably a lot of us are a little OCD. A lot of us are anxious. We are type As. We are competitive sometimes.

So you can call it a prima donna and you would be right in some ways, but yeah, heck yeah. We’re perfectionists. Don’t you want your doctor to be a perfectionist? Do you want to go to your doctor and have them be, “I’m like a 60 percenter”? No, you don’t want to be them. You want them to be a hundred percent right every single time. Anytime you have a question for them, anytime you see them, you expect them to be a hundred percent. Which is an impossible for anybody, right? It’s totally impossible. But that’s the expectation.

Factors that Influence Trust

John Farkas:

Yeah, it’s a critical thing to keep in mind. And just to your point about observing, I’ll say, and my team has heard me tell this story a lot of times, because I don’t have an opportunity very often to go in the field and observe one of our client solutions. And I had the opportunity to do that and had an incidental opportunity off the record to interact with one of the clinicians that was making use of a technology that truly was changing her world and the looking at somebody, this is sort of the other side of it where you have somebody who is so passionate about what a technology has enabled that they’re literally in tears telling me how this has changed how they practice and how it’s so important. And feeling that, when you realize the power of what technology does have the opportunity to do.

Now, what was so interesting about that story is the front end of it, what she told me she was anticipating when she first heard that this was going to be implemented. She was not at all looking forward to it and dragging heels all over the place and really afraid of what it was going to bring. And then when it actually did deliver as promised, when it did do what it was going to do, part of the good aspect of this particular solution is that it has clinical leaders crawling all over the growth and implementation of it. And so they come from a very highly empathetic understanding of what needs to happen in the environment. But that’s so important. And the results are, you have really strong advocates because this actually helped improve care at the bedside, which is what ends up being so important.

So Jennie, let’s dive in a little deeper into the idea of trust, because that’s a lot of what we’re circling here and talking about when we’re talking about the systemic nature of things and how we’re introducing something new into a clinical environment. What are some of the factors that influence trust, and what are some ways that an organization looking to be seen favorably by clinicians, what can they do and communicate around that idea that would help?

Jennie Byrne:

And I said this before, I think trust is one of the most important things to rebuild in healthcare. So for a tech company especially, again, remember that you’re up against a history of being wary. Understand-

John Farkas:

You’re coming in at a disadvantage and understanding that to start with. You’re suspected.

Jennie Byrne:

So first of all, I would say just be super upfront about that. That’s the elephant in the room and say, “I get it. A new technology is, even if it could help you, it’s kind of scary. I mean, you worry about an error, you worry about the board and just lay it out there. I get it. I know that’s the elephant in the room.”

So what I see a lot of companies do, and I understand why they do this, but I think it’s a little bit of a mistake. I’ll see them get advisory boards and put these really big names on there. And then the advisors don’t actually do anything. They’re kind of just… I don’t want to say. I’m over exaggerating, but they’re mainly there for trust, right?

You’re putting these famous names on there, their pictures up on your pitch decks and your things, right? Because that’s trust. And you hope that by putting those big names up there, you’re going to be getting a halo of trust from their reputation. So I see that as what people do to gain trust and there’s nothing wrong with that. But when those clinicians are detached from the actual company and they’re actually not doing much to advise the company day to day with the practicalities of it, sometimes that can backfire a little bit. There’s better ways, I think, to get trust. So I think the role of the advisor can be valuable in gaining trust, but I think there’s other things as well.

So for example, having a common language, showing empathy through common language is huge. So one mistake I see tech companies and others make is they use the wrong lingo. They use their lingo to go speak to clinicians. And we all have our own tribal lingoes, but I see people use corporate lingo or tech lingo to go talk to clinicians. And by doing that, you’re automatically demonstrating that you haven’t done your homework and you don’t have empathy for them. Because if you really had empathy and you really wanted their trust, you would learn their language.

John Farkas:

That’s awesome.

Jennie Byrne:

So don’t say action items. Don’t say cascading information, don’t say UX. Scrub your content and what you say, scrub it and look what might be lingo. Switch it out to either common language that everybody uses or where possible use medical lingo. But the flip side is make sure you’re using it correctly. So if you don’t know what something means, you need to say, “Oh, pause. I don’t know what that term means. Could you please explain it to me?” If a doc says, I don’t know, “Neurophysiology of the temporal cortex”, and you have no idea what that is, don’t pretend like you know what it is.

Just say, “Oh gosh, I don’t really know what that is. Where is that in my brain? Can you show me?” Don’t be afraid to ask questions and be curious. Most clinicians love to teach, and so by asking them to be a teacher, sometimes that really can help build trust as well.

I see a mistake of you think you have to know everything and be the smartest person in the room, but clinicians like to teach. They’re learners. So if you can lean into learning and curiosity, it’s a great way to connect with clinicians. “Here’s what I’ve learned about what you do. I’m assuming this. Am I right? I don’t know. Tell me what it’s like for you. Put it in words that I’ll understand.”

So I think language, because language is culture. So by really looking at your language and culture, and I mentioned learning and education. So one of the things that is pretty universal to clinicians is they love to learn. We spend, I don’t know, 20 years in school. We obviously are learners. So putting things in terms of learning. So if you have a new tech product and you want to build trust, instead of putting some fancy advisor on your deck, get some experts who are other clinicians.

So if you’re pitching to a nurse, get another nurse who’s an expert. Get some experts together and then deliver educational material, whether that’s a webinar, an ongoing lunch and learn series, but it should be from their peers, not from you. So that’s the other key thing is you’ll gain trust much quicker if a peer delivers the information than if you deliver the information.

Like you said, that one clinician who became your biggest champion. If you have someone who was a skeptic that used your product and is your champion, that is your best salesperson that you will ever have. Use that person to go educate others. And I’ve been advising health tech companies recently, I would actually consider doing educational series as part of what you do with your product. Make it an educational product, give someone a certification that they’ve learned how to use AI, how to use AI in your daily workflows. Maybe you do a little class that they can get CME for, which is continuing medical education. We all need it. I need 40 hours a year just to keep my license. So free continuing education that they can use in their real practice is like gold.

So think about your role as an educator in this new world of tech or this new world of AI and all this other stuff. Most of us are curious. I’d say people who are, I don’t know what, 50 years old and younger are really curious, but it has to be practical for them. So if you can find a way to weave education and ongoing learning and professional development from other experts that are clinicians, I think you build trust, you help them really learn how to use their product, and they’re going to feel a lot more confident about using it. And skeptics convert over to champions, and then you’ve got a sales team that’s out there doing all the work for you.

Building Bridges of Understanding between Clinicians and Tech

John Farkas:

Some really great points there. And I just want to back up and reiterate some of them. So one of the things I heard you say a little while ago, take the time to shadow people in the real clinician environment. Don’t spend time surveying. Although there’s probably a place for surveying for some things, we’ll say. I’ll just put the caveat out there.

But if you’re wanting to learn, do the best to get as close as you can to walking a mile in another man’s shoes because that’s going to be where you see it. And I can vouch for that because that’s what I had the opportunity of doing that really changed my perspective on something and underscored something at such a level that I felt it in my heart. And that’s where you want to carry it because that’s what this is. If we’re looking for empathy, we’re looking for heart level connections where you understand something.

Make sure you have a common language, make sure you’re using the common language that somebody in the clinical environment would actually use to communicate and talk about something. And if you don’t know it, learn it because that’s where you’re going to meet them. And that echoes the shadowing opportunity. I mean it has some of that in there. So avoiding tech lingo, that’s not it. If you’re not saying it in terms that they would use, it’s not going to connect. Make sure that you understand what the language is that they would use to talk about the thing that you’re doing.

Lean into learning. So we’re dealing with people that are inherent learners. How can we bring… And we talk about this all the time in the context of our work with Ratio. You have to work with people to help them know how to think about new technology. It’s not just telling them what they should think. It’s building the bridge of understanding to help them learn how. It’s teaching and helping them learn how to think about something in light of what’s now possible will equip them and they’re by nature into that. Just if I’m hearing you right, that’s part of it. And learning is part of the clinician culture. It’s just a continuous process. So what can you do?

And so this, I really liked that you said. Get close to the peers. It’s not about the figureheads and the celebrities. It’s about the people that really are in the experience and get them to talk about what’s going on in their embrace of this technology, not the celebrities that might be sort of talking about it from a little thin slice of experience they have because they’re on a board or maybe they’re an investor and the company.

No, these are folks that are in the trenches making it happen, seeing the results. Let’s talk to them because that’s going to sing really loud if somebody understands that this is a real person doing a real thing and it’s working for them. And so what does it mean to enter their professional development universe and what can you provide for them as resources that could enhance their professional development? I think all those are golden. Wow. I think that’s all some really good input. Anything else you would add to that list?

Jennie Byrne:

One more thing in terms of how you communicate. I’ve seen some tech companies are really good at this, and some of them are really bad at this. Humans learn in facts and figures and rational things. And then they also learn in, like you said, the heart, the stories, the human connection. And the best pitches or the best communications are when you have both. And so clinicians, the way we tell those stories of the heart is we’ll often tell a true patient story or a true clinician story.

And that’s what I try to do in my new book is really weave stories with data because that’s how people learn. And there’s some neuroscience I could go into on that, but tell the story of the patient, tell the heartfelt story as well as the facts and figures. Tell the clinician story like this was a skeptic and this is why. This is what they did and this is what their life is like now. So weaving those two together is powerful. I see some companies still leaning really heavy on one or the other.

And they have to be real stories, by the way. Don’t make them up. They have to be real and they have to be de-identified, but don’t make up a fake patient because I can spot that a mile away. Tech company comes to me with fake patient stories, I can tell. It’s got to be a real story that’s going to really connect with me. And if you can do both of those well, that’s where you really start to make the progress.

Yes, we like facts and figures. We’re students, we really like that, but we have to connect at that heart level to make change. Like you said at the beginning, making change requires an emotional state. There’s a famous, if you get into behavioral science, which is one way of understanding human behavior, there’s this concept that education alone does not change human behavior. So it’s not just telling someone or showing them the facts and figures. It has to have some emotional resonance. And so finding that balance of emotion, head and heart, finding that combination. I’ve seen some tech companies do that really well. Not a lot, but I have seen some of them do that really well.

Embracing Technology in Healthcare’s Innovative World

John Farkas:

Very interesting. What a great set of wisdom that you’ve… So I’m curious, we’re coming up on our little window here, but if you were to look at the healthcare organizations and wanting to help them into a culture that is looking at some of this. Creating a safe environment and how technology can help, what does it mean to move into something where it’s going to be generative, where it’s going to be creative, where they’re going to be able to adopt the kind of innovation that is going to create an environment of trust? And what would you have to say that realm? That would be good too.

Jennie Byrne:

And that was actually kind of the topic of my first book, which was on ways to work together in this new world. And again, the premise is that to get to creativity and connectedness, which is what we crave, we really crave that. Time management and communication are the keys. So in terms of tech, this is where tech I think can shine. There’s a lot of things that tech and AI can do better than people. So I try to make it a little bit lighthearted. I say, “Let the robots do the robot work and let the humans do the human work.” And the more space and time that you can extract, and it’s not just time and space in the physical sense, it’s also kind of emotional time and space to be able to be creative and to think ahead.

If you’re fearful, tired, exhausted, everything, negative, negative, negative, you tend to go into this very fearful, constricted way of thinking. To open up creative thinking, you actually have to be kind of relaxed and positive. So anything that you can do to create time and space for people is tremendous. And the one thing for leaders, so if you have leaders that you work with in these organizations, one of the hardest things as a leader is modeling what you want to see in others and managing your time and showing up a hundred percent of yourself every day is really hard.

It requires a tremendous amount of self-awareness. I mean, I feel like I was so fortunate that I did all my psychotherapy training because that’s where I learned how to do all this. If I didn’t do all that psychotherapy training, I probably wouldn’t know how to do all this stuff. So being very self-aware and being very thoughtful about how you show up every day matters quite a bit to set the tone.

So in other words, if you’re sitting on email all day, three second email response to everybody, you show up rushed, you’re late to meetings, you look unhappy, you can’t really expect your team to show up in a good way and creative and take their vacation if you’re not doing it yourself. So it takes a tremendous amount of intention as a leader to create that kind of environment. But it can be done. I’ve seen it be done. I’ve done it myself. I know you can do it, but everybody wants to do the work. And sometimes the work is about helping people to be able to work. And leaders struggle with that. They feel like, “Well, we’re not doing the thing”, but having intention and putting time and effort, sometimes that is the work.

John Farkas:

And that follows through everything we’re talking about. I mean, it ends up being so important to come at this with the creative and collaborative spirit that empathetically understands and is working to facilitate those kinds of conversations where real creativity can take place. Because so often I see, and this is an example, there’s several things here where I think coming at the conversations with a really good familiarity and understanding of what some of the inherent problems are, but being there and open and listening to understand some of the nuance that exists in a certain clinical environment that might need to be addressed in a certain way.

And you open up a conversation that instead of saying, “Here’s the way I think you should do it” it’s, “Let’s talk together about what could be possible.” That’s a different conversation and has an opportunity to go a very different direction than, “Here’s our little naive prescription on how you ought to solve the problem that we see that you have that we don’t fully understand yet.”

Jennie Byrne:

Yeah, I would say just two final thoughts maybe I have is first of all, if you want to know how to do this stuff, you don’t have to be a psychotherapist. Go online, look up active listening skills. Go to YouTube, watch some therapists do active listening. Anybody can learn how to be an active listener. You don’t have to be a therapist. Just go look it up.

And then the final thing I guess I would say is what can you do to create that space? I think people underestimate kindness, just being nice. Just be kind. Just open the door. In the virtual world, what’s the equivalent of opening the door for somebody? I think showing up on time is a tremendous sign of respect. Ending meetings on time online is a tremendous sign of respect. Not being distracted, not doing email while I’m talking to you. That would be disrespectful. You’re not doing your email, I hope, while we’re talking, right? Like that.

So I think they’re like these acts of kindness and respect that we can show to one another. And that goes a long way. So if you ever are at a loss for words with a clinician and you want to say something kind, you cannot go wrong with this. Tell them, “Thank you for all you do.” You can’t go wrong. And it’s not just thank you for taking care of me. Not just thank you for your time. No, but for all that you do, I guarantee you that will go right to their heart. Every time somebody tells me that, it goes right to my heart and it feels good. So if you can sincerely tell a clinician, “Thank you for all you do”, it takes less than two seconds and it will go a long way.

Closing Thoughts

John Farkas:

Well, that is obviously some very well-founded perspective Jennie, and thank you for all you do.

Jennie Byrne:

Thank you.

John Farkas:

And really appreciate you taking the time here. Some tremendously practical insights that I think are going to go a long way and just a critical component to understanding. What I know is that many of the solutions that are getting traction right now in the healthcare technology universe are ones that are in the clinical workflow because there’s such need in that space. And so having a clear understanding of what those needs are, having the ability to get that common language to really understand. Spending some time in their shoes, walking with them, understanding what it looks like, getting the common language, leaning into the learning piece of it, and looking to involve the voice of peers. All that is just such great insight. And I want to appreciate you underlining all of those for us today. Tell us a little bit of how we can get our hands on your books, because that’s some good opportunities for people to dive deeper into some of this insight.

Jennie Byrne:

So it’s very simple. Go on Amazon. That’s where books are sold these days, literally. That’s what I’ve learned. So go on there. You can search my name, Jennie and spell J-E-N-N-I-E Byrne B-Y-R-N-E, Moral Injury. Put that in the search bar. It’ll pop it right up. My first book, Work Smart is also there. You can look at that if you’re interested in more of the ways of working.

And then I would say the best way to reach me is connect with me on LinkedIn, connect with me, and then send me a message there. So if you want to have more information, if you love the book and you want a book club or you want me to come talk or anything like that, honestly, LinkedIn is probably the best way to get ahold of me.

John Farkas:

Awesome. Dr. Jennie Byrne, thank you so much for joining us today on the Healthcare Market Matrix.

Jennie Byrne:

Thank you.

Outro:

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Ratio is an award-winning marketing agency headquartered in the Nashville Tennessee. We operate at the intersection of brand and growth marketing to equip companies with strategies to create meaningful connections with the healthcare market and ultimately drive growth. Want to know more? Go to Goratio.com. That’s G-O-R-A-T-I-O.com. And we’ll see you at noon Central next week for an all new episode from our team at Ratio Studios. Stay healthy.