Jason (00:48)
Hi Brian, how you doing?

Brian (00:49)
Good, Jason. How are you?

Jason (00:51)
I'm doing great. Thank you so much for joining us on the wise in five. I can't wait to ⁓ to dig in with you.

Brian (00:57)
I appreciate the invitation. It's this is gonna be fun.

Jason (01:00)
my pleasure. So before we dive into our wise in five questions, I thought it'd be great if you could just give all the viewers and listeners a a background of your amazing career and how you got to the point you are today at Vanderbilt.

Brian (01:14)
Well, thank you. ⁓ so grew up in in the Pennsylvania area, ⁓ did the very traditional college ⁓ right to grad school and so I went to grad school for hospital administration. and then ⁓ in that path were required to do ⁓ a postgraduate fellowship. So I did that in Chicago at the University of Illinois, Chicago, then started my career in practice management at Northwestern medical faculty foundation ⁓ at the time.

and then did a stint in Western New York as a private practice administrator, a group practice administrator, and then was recruited to Vanderbilt University Medical Center in 2007 to help run the i Institute and did that for about six years or so. ⁓ and then was asked to take this system level role over patient experience and have been doing that for the last what 10 or 12 years. So

Grew up in operations, but now, you know, obviously working in the system level strategy ⁓ arena influencing patient experience.

Jason (02:08)
Yeah, that's wonderful. So you're coming up almost twenty years at Vanderbilt. That's incredible. Well, and for those who are not familiar with the healthcare space, Brian is one of the foremost leaders in patient experience in the space. So we're we're thrilled to have you on and to share your wisdom.

Brian (02:12)
Almost. Yeah, pretty close.

Appreciate that.

Jason (02:25)
So first question that I wanted to to dive into and I ask everyone who comes on the the wise in five is just where do you find inspiration just in in daily life?

Brian (02:35)
Yeah. well, you know, I I feel very fortunate because there's no shortage of inspiration in the healthcare space. I'm in awe every single day of not only the caregivers, but the patients that come through. ⁓ it is the true essence of humans caring for humans and you see it live in color every single day. The good, the bad, you know, miracles, unfortunate circumstances.

And I mean that's just so humbling to see because there's just amazing miracles that that take place in in watching it watching it happen. so that's that's primary where I get a lot of my inspiration and motivation. But you know, I think the second area which I'll share with with your listeners is I'm I'm a believer in in the in the ancients. So I'm a I was a philosophy miner. I think a lot of what's already been ⁓ a lot of what has we have today has already been said and we just try to say it in a different way. So

Yeah, the classics, Plato, Marcus Aurelius, Socrates, you know, Confucius, all of those are some of my favorites. And I I I tend to lean on those for ⁓ for inspiration as well.

Jason (03:34)
that's fantastic. Well, that gives me much more insight in into you because having spent time with you, like I completely get that. I see the line. So thank you for sharing all of that. well, why don't we dive in? So, Vanderbilt, for those who don't know, top 20 academic medical center, really amazing in the in the region. what patient experiences

Brian (03:39)
Ha ha ha.

Yeah.

Jason (03:55)
have you seen translate to smaller mid market healthcare organizations that may not have the same resources that Vanderbilt has?

Brian (04:03)
Yeah. I mean first I think it's important to ground on just my thinking around experience. So I I think of experiences, it's not one thing. It's the sum of all interactions that go on. And what is important to me is not necessarily important to you. Our experiences are different. But those experiences have life, long alterations in memories of what we do, how we conduct ourselves, to what we remember, what we don't remember, what we lean into, what we don't lean into.

So I think, whether you're a big academic like Vanderbilt or a small community hospital, people are walking in every day and experiencing the care that you that they're receiving. I think where ⁓ where there's opportunity is is people assume scale. How do I scale this? But the actual the the the linchpin is really in consistency and coherence. So what leaders say, managers permit, and what managers permit workers do.

And that all really rolls up into culture. And that's where I spend most of my space and passion is how we do our work every single day in the healthcare space. So I think of culture as culture is what you tolerate, not what you declare. and so often in the health in smaller community hospitals, they have the opportunity at scale because they have much more control. They don't have the bureaucracy that a big academic does to really influence that culture on a day-to-day basis.

Jason (05:17)
Mm-hmm.

Brian (05:22)
and drive change at a much faster pace. But again, it's about consistency and coherence, not about, you know, scale and and just a new initiative and things of that nature.

Jason (05:33)
So you hit three C's, which is the consistency plus coherence equals culture. I think you need to trademark that. I I really like that. And it makes a ton of sense. it's simple to say, right? And and to but really hard to do, especially I would think at an organization like Vanderbilt, but to your point, more, smaller mid market healthcare organizations may have an easier time wrangling everyone together.

Brian (05:34)
I did. I did.

I think the other part to that, Jason, is is also recognizing that the experiences our patients are having are directly tied to the experiences our workforce are having. So leaning into that culture and what's a workforce experience, I firmly believe if you give the caregivers the tools to do their job in this space, they're gonna deliver not only outstanding quality care, but an experience that people will remember as well. And what people want to remember is that that feeling of of I was cared for, you know, someone cared for me.

Jason (06:24)
That's right.

Well, and and it becomes, an overused term, but it's authentic that way. It's if if people who are working at Vanderbilt feel like Vanderbilt's taking care of them, then it's just a natural extension to say, well, I'm going to take care of the people who come to Vanderbilt.

Brian (06:30)
Yeah.

percent. And that's not unique to healthcare. Any every organization, because we're we're human beings. We're we have to we want to experience, we want to feel cared for no matter what industry we work in. So it's the same in banking as it is in healthcare. So

Jason (06:44)
Mm-hmm.

Yeah.

That's right. Very smart. So to to what we're talking about, how do you measure that patient experience in a meaningful way beyond I know surveys are are really important, especially in the healthcare space, but how do you go beyond the survey scores and and what metrics do you feel that, you know, smaller organizations should track?

Brian (07:06)
Yeah.

Yeah. Well, first, I'm a firm believer what what gets measured gets managed. but what gets felt gets remembered. So the hard part is is trying to focus in on those metrics around that feeling. Those, you know, what are those experiences people are walking away with, both on the workforce side and on the patient side. So on the workforce side, I think it's things like workforce retention. do you have

people coming and staying or are they leaving and what's the reasons they're leaving for? engagement plays into that as well. You know, there's metric scores around that. Most institutions most institutions measure those things. And then on the on the patient side, ⁓ there's things like complaints and grievances. You know, what's the narrative, the what's the stories people are telling when their things aren't going well? But on the flip side, what's the stories when their things are going well? Because

you know, human nature being as it is, we're more often likely to tell what's not working well than the stories around that than what's working well. But I also know we do far more right in healthcare than we do wrong. And we don't spend enough time focusing on all of those positive stories that are going on every every minute of the day. They kind of get drowned out over what's what, you know, the problem or the the the issue is of the day. So complaints and grievances another metric. Brand, you know, measuring, you know, your brand strength.

⁓ patient retention. Are patients coming back to you? and also trying to figure out is how can we measure trust? And I think that's a newer newer space that I don't have the answer to. It's it's an it's a it's an evolving space in the healthcare. How do we get a firm grasp? But trust is complex because it's not one thing, it's a multiple thing. So there's not one metric that you can look at and say, yep, we have high trust or we don't have low trust. So

Jason (08:32)
Mm.

Brian (08:50)
I'm looking forward to kind of digging into that over the coming years and figuring out how do we measure trust as a as a patient engaging in the healthcare space.

Jason (08:58)
That's a that's a really intriguing metric and one that I can see, even if you can measure it, I would think you could do you know ninety-nine things right, ninety-nine out of a hundred, and that one experience that someone has, if it goes the wrong way, hurts the ninety-nine before it, right?

Brian (09:02)
Mm-hmm.

Mm-hmm. Mm-hmm. Mm-hmm. Yep.

But the big part of that is how did we lean in when it didn't go well? Did we lean into it? Did we acknowledge it? Did we try to address it? Because some of our biggest advocates in the healthcare space are actually people who had a less than ideal experience, but it's because we leaned into it that they felt like, okay, you heard me and you had my back and you're trying to help me.

Jason (09:23)
Mm-hmm.

Very smart. I had an early career in financial services and we'd be with call centers and you know, people would be calling in to ⁓ share grievances most of the time. And what we would say is if you handle it the right way, you actually develop a more loyal customer because you've solved their problem, set them on a path forward, they felt heard, and they can then say, Okay, this is someone to your point that I do trust and I want to keep doing business with.

Brian (09:49)
Mm-hmm.

Yes.

Mm-hmm. Yeah.

Jason (10:05)
So I I

think that's really, really smart. So, to to where we are, I'm going to talk innovation for a second, around patient experience. So what is one's patient experience innovation or initiative from Vanderbilt? Or if you want to go beyond, Vanderbilt, but what do you think is underutilized in terms of innovation and patient experience? And do you feel that there's something that

Brian (10:12)
Yeah.

Jason (10:28)
off that innovation mid market organizations could implement tomorrow.

Brian (10:32)
Yeah. Recognition. To buy to what I just said a few minutes ago, we do far more right than we do wrong. And we don't recognize that nearly enough. We don't fill the cups of the caregivers and all that is going well. We go in with why is the score low? Why was this going wrong? Why didn't this case go right? Whatever it may be, versus the the countless other ones. So, one of the things I'm really proud of of something we developed at

Jason (10:35)
Mm-hmm.

This point.

Brian (10:55)
at Vanderbilt, ⁓ Vanderbilt Health a few years ago was, so we get tons of comments from patients. The vast majority of those comments are positive in nature. But they sit in a database that requires someone to go through, read it, and be like, ⁓ Jason was a great nurse. Jason, I know who Jason is. You know, paste, copy, send over to Jason. Jason, I got this great comment about you. And the hardest job in

Healthcare is middle management. Middle manager leaders are pulled in 10,000 different ways on a daily basis, and there's just not the time to go read these comments and share that recognition, whether it be in a Huddle or via email, however, people like to get recognized. So a few years ago, we wrote a matching algorithm program that pulls the pom positive comments from the surveys. We go in and we look at the the security logs of who accessed the patient's record, and then we do a match on that.

Jason (11:22)
Mm-hmm.

Brian (11:47)
So we can see the patient was on seven north. There's this nurse on seven north that's named Jason. We have a match here. We review those and then we send them out automatically from the s at a system level. So we've now sent out over a hundred and five thousand positive comments to caregivers over the last, I guess, four years now. and the beauty of it, yes, physicians get by far the most, nurses are second.

Jason (12:02)
Yeah.

Brian (12:10)
But we get other caregivers in there. we've gotten billing people recognized. You know, patients will write, Jason, I had a great you know, Jason really helped me in trying to resolve my bill. Would have never known. And just that small little pickup gives the experiences to the workforce members that lets them know they're valued and they're doing a great job. And if you give them that experience, they're gonna give that experience to patients then.

Jason (12:23)
Mm-hmm.

Yep.

Yep. And how do you how do you do the recognition? Is it one on one with that individual or do you make it more public?

Brian (12:39)
Mm-hmm.

No, ⁓ so we so two ways. We send it to them via email, so it's more one on one. we do let their manager know so they can they can acknowledge them if they want to in a in some sort of public forum. Separate from that, so we don't these are separate initiative now, we do have an institution wide recognition program that we launched called Cause for Applause in the last two years, where any any any caregiver can recognize any caregiver.

Jason (12:54)
Mm-hmm.

Brian (13:06)
We can re all recognize each other. Now we don't share those positive comments in the out right now, but that's an innovation we're thinking about doing in there as well.

Jason (13:14)
Great. That's great. And and I think easy to implement, right? Anyone can implement that. I mean, this is not a heavy lift ⁓ and not not high technology, but I think that's really, really great. And ⁓ so thanks for sharing that. So

Brian (13:19)
Hundred percent. Mm-hmm.

Yeah.

Yeah. So we just

just parenthetically we we Epic, who is our electronic health record and the largest in the healthcare space, so vast majority of of healthcare institutions are using Epic. They took that idea and implemented it in their latest update. so it's it's a little different in how it works, but it's it's there now. So ⁓ you can now use if you're on Epic, you can use the latest update and you can actually turn this on and provide recognition.

Jason (13:33)
Mm-hmm.

Brian (13:54)
⁓ through the c positive comments.

Jason (13:55)
Well, are you getting recognition for that?

Brian (13:57)
Of course, absolutely. Yeah.

Jason (13:58)
There's a Brian Carlson button with an Epic, you just click that

and off you go.

Brian (14:02)
No, I wish, but no.

Jason (14:05)
Well, I'm curious,

like with with this amazing journey that you've been on, who are some of the advisors or mentors that you've gone to or continue to go to as you start to take on ⁓ new and and different things?

Brian (14:18)
Yeah. there are countless ⁓ over the years and and to too many to to be named. But I think the the mantra I give is just trying to stay curious and through that curiosity being open to asking questions of others. And nine point nine times out of ten, if you just ask the question of someone else, they're gonna give you a you're gonna give you some advice or opinion that you may or may not be looking for. It can go both ways, of course. So ⁓ you know.

Jason (14:43)
Mm-hmm.

Brian (14:45)
past colleagues, past coworkers, people I've met through The Wisory people I've met through ⁓ the Athena project. I'm I'm talking, you know, to a couple of them. We've stayed connected. so they people are are more than willing to be open to giving advice and and if you need it and and support as well. and I think it's just being curious and asking the questions.

Jason (15:05)
I think that's great. And thanks for the the recognition for The Wisory I I should have a bell that that we ring for that. So Brian, we flew through the questions and no no surprise to me, you passed with flying colors. So thank you for that. But I do have a a bonus question for you. So as our members want to engage with you on The Wisory, what are some of the the topics or questions that you feel you're best positioned to help them answer?

Brian (15:08)
Mm-hmm.

Ha ha

Yeah.

Ha ha

Yeah.

Yeah. I mean, of course, anything within the experience space. And that that could be customer or patient, because it really comes down to how humans are interacting with humans at a system level. And there's no one size fits all. Every problem is a little unique. So if you're having challenges getting adoption, if you're having challenges trying to get recognition, if you're trying if your challenges getting uptake on on some initiative, or you're just thinking about I'm thinking about doing this.

Do you think this will have impact or what should I what should I be thinking about that I'm not that could have a negative you know impact on this direction I'm trying to take with within the organization, within my business unit, whatever it may be. So all of those are are the intersection of where I where I think and where I do my work at. So any and all questions in the culture space, in the experience space, you know, workforce space are are wide open, and and up operations as well, because what people have, how they do their work.

You know, how they do the work on in on a daily basis influences their experience. So how can we fill their cup more than taking away from them?

Jason (16:31)
Mm-hmm.

Yep. That's fantastic. Well, I can't thank you enough for making the time and sharing your wisdom. How fortunate for Vanderbilt to have you and how fortunate for for me and our viewers and listeners to have you sharing your wisdom with us. So thank you. I truly appreciate it. And have a wonderful rest of your day.

Brian (16:53)
Thank you, Jason, and and keep up the great work. What you're doing with The Wisory is absolutely awesome. And I hope ⁓ more and more people find it and and embrace the wisdom that they can gain from from engaging in The Wisory. So congratulations to you. Yep. Thank you. You too.

Jason (17:06)
Well, that's very kind of you, my friend. Thank you. All right, all the best.