Episode Transcript
[00:00:03] Speaker A: Welcome to the Ortho Joe Podcast, a joint production of the Journal of Bone and Joint Surgery and Ortho Evidence.
Join hosts Mohit Bhandari and Mark Swankowski as they discuss current topics and publications in the world of orthopedics and beyond.
[00:00:19] Speaker B: Well, good morning, Mark. How are you?
[00:00:21] Speaker C: I'm good. What do you got for Joe?
[00:00:24] Speaker B: I have good old fashioned McMaster University brewed coffee. I'm not sure where it's coming from, but it's. It's good. It's good. You're right. I don't have the usual Tim Hortons, but this is pretty good. It's pretty good.
[00:00:34] Speaker C: Yeah. Well, as you and I have discussed, I've got a block away a Duncan, and I'm longing for the day when Tim Horton shows up in Minnetonka, Minnesota. So I'm gonna, you know, my hopes are high.
[00:00:48] Speaker D: Coming. It's coming.
[00:00:50] Speaker C: So we have a special guest, and before I let you introduce, Dr. Taylor, I just want to inform our special guests that you will be receiving a Ortho Joe travel mug.
And there are conditions surrounding this travel mug. You cannot resell it. We watch ebay because these things, these things are priceless and highly desired. And it's just a token of our appreciation for you spending time with us. But please, please, treat it as your gift only, okay? Absolutely.
[00:01:25] Speaker D: Absolutely.
[00:01:26] Speaker B: All right, get ready, folks, to be impressed. Dr. Erica Taylor is a nationally recognized healthcare strategist and orthopedic hand and upper extremity surgeon. She's fellowship trained in hands and upper extremity surgery at the Cleveland Clinic. She also holds an MBA from the Duke School of Business. And in 2020, of great interest to us and I think some of our discussion today, she started or founded the Orthopedic Diversity Leadership Consortium, a national network dedicated to equipping clinicians and healthcare professionals with the structure, strategy, and community needed to drive lasting, meaningful change in medicine.
Currently, she serves as the Vice Chair of Culture, Engagement and Impact in the Department of Orthopedics Duke. Welcome, Dr. Taylor. How are you?
[00:02:12] Speaker D: I am great. And I know you didn't ask this, but I have a cup of
[00:02:21] Speaker A: two
[00:02:21] Speaker D: days in on decreasing my coffee intake, so. This is Earl Grey tea.
[00:02:25] Speaker B: Oh, look at you.
[00:02:27] Speaker D: Pray for me. I'm struggling, but, yeah, it's such a pleasure to be here. Thank you to both of you.
[00:02:33] Speaker B: Well, you know what, Mark? I was going to have you lead off, but do you mind if I just jump in?
[00:02:38] Speaker C: No, go out. All right.
[00:02:40] Speaker B: So, Erica, you and I have had, you know, had interaction with Ben Ullman. And as I was telling you before, Dr. Ben Allman, who is your current chair, is the individual. When I was a medical student at St. Michael's Hospital and I was doing elective at the Hospital for Sick Children, he was the fellow with Dr. James Wright. And I remember him and I doing our very first study together. And so I'll never forget that he was a big part of what really got me excited about academics. I have a feeling he's probably done the same with you.
[00:03:15] Speaker D: Absolutely. You know, this is such a small world. So Dr. Allman, affectionately, we call him Ben. And I actually started at Duke the very same day. Our first day of work as New Kids on the block was September 1, 2013. And it's really interesting because I'm a double Duke graduate. At the time, I'd only been a graduate of the medical school.
And we came into an environment that was really interesting. I mean, I know today there are a lot of different complexities of health care, but even back then, there were challenges and headwinds and dynamics that were unique, particularly in orthopedics. We started in an environment, a culture, if you will, where there was always this level of uncertainty.
The two of us bonded as being newbies, but also bringing some different perspectives and backgrounds to a relatively traditional program rooted in North Carolina. And so over the years, you know, Ben has become one of my biggest cheerleaders, champions, allies, and all the things. But he's also an interesting debater. And so I don't know if you've ever been at a post meeting or, you know, an ORS meeting or anything. He loves data. He loves diving deep and going beyond the surface with even residency interviews, you know, a little heads up for med students. But it's. It's something where people ask me, why do you stay at Duke? Or why do you love your institution? It is because my limitation is simply me. I go as far as my creativity and my insight takes me because of leaders who push you like that. And so we've grown together, I like to say, but it's such a small world, and I have been stories for days.
[00:04:57] Speaker C: Well, thanks again for joining us. And we were fortunate enough to receive a fresh hot off the press interview you did with Becker Spine Review.
And thanks very much for pointing that out to us. And it really gives a lot of insight as to how you have climbed into a lower oxygen area and Duke, where you have some real influence on the. On the healthcare system. And there was lots of insights that were provided in your interview there.
But I just, I read it with interest because in my dealings with healthcare administrators, it's all about how are we going to pay for this?
And what I didn't see was how do you deal with people that constantly push back when you have professional ideals that are based really in the Hippocratic oath and their pushback is always, well, great, but that's not practical. How are we going to pay for this?
How do you deal with people who give you that pushback?
[00:06:05] Speaker D: You know, that's such a great question. I'm not welcoming dissension, but I do enjoy it to an extent. Because if we are, if I am receiving curiosity questions back, I know you're engaged.
I know that I have your attention because somewhere in the labels and the headlines and some of the assumptions, there is a source of commonality that we share. And so over the years have given hundreds of presentations, really in all types of states, to be frank. And when I lead with who's interested in achieving the optimal levels of health for your patients? Who wants the best outcomes? Who's part of quality improvement here? Who cares about clinical workflows and operations?
Who wants your people to stay and not leave?
I don't have a single person who's walked out of the talk of the strategy session.
In fact, from perhaps the most diverse set of backgrounds, people want to dive deeper and know more. But to your point, who's going to pay for it? That is a very critical question because it's not only about the value or the price or the cost of goods when it comes to filling some of the social drivers of health gaps.
It also is about who's going to fund the protected time for us to do the research, who's going to fund the data informatics team to adding that dashboard feature. And there's some really granular costs that need to be discussed to be succinct. My piece of advice for those who struggle with determining the roi, if you will, of this type of work, I invite you to listen closely to your quality improvement leaders or your chief quality officer, or if you're in a PRAC practice, a private practice, solo practice, the person who manages your bundles or your value based care payment models. Because there are savings to be had if you find the way to decrease readmissions of your patients. In fact, we calculate estimate that every readmission costs us about $25,000. And so if you can use the already proven evidence, published research to correlate addressing health related social needs to decreasing readmissions or decreasing cancellations that come at the Last minute or no shows, then you are literally building a more top line way to add profitability, sustainability, affordability while decreasing cost. I think that's the way we have to talk about this.
A lot of our value management or preparations from joints and spine and now some of the even shoulder surgery, you know, bundles come from how do we coordinate care better? How many times does a patient really need to see us? And it forces the conversation to go around transportation, growth areas where our services located. Should we be co located with the neurologist or the rheumatologist? Would that be more systemic, systematic care? And those are the conversations that move us from labels and assumptions to the real work.
And the last thing I'll say about that is across the board, whether you're talking about health equity, quality improvement, hiring new surgeons, sustainability, your practice, the core is access. Access is in every one of those conversations. And that's where I would hit home for first.
[00:09:33] Speaker C: Mo if you don't mind, I've got, I've got a follow up question. Over 20 years ago we, when I was the department head we built a center that is self contained, primarily outpatient, but with a hotel recovery program, et cetera such and in that center we have people from all different departments that only practice in musculoskeletal.
I want to hear if you would agree with this statement. I have long felt that the only reason to have departments now is for professional certification and quality management, that we should really have musculoskeletal centers, we should really have gastrointestinal centers, we should really have cardiovascular centers and forget these archaic departmental lines and really collaborate across disciplines to improve care and share insights.
Do you agree?
[00:10:29] Speaker D: I'm going to be very intentional with my answer. I think it's a both and because you know, I'll brag a little bit about Duke Health. We years ago started instituting the concept of service lines and the difficulty was when you hire a new team member, whether it's someone in the app world, a therapist, a surgeon, a researcher, we all are focusing on the, the goal of improving outcomes for all patients, healthier communities, but we bring different skills into. There is something to be said about having a segment of your system where the researchers, where the therapists can coalesce, combine, collaborate and amplify their value and then having an area where those who are clinically oriented, who are involved in the or dynamics can combine, collaborate, coalesce and really try to drive movement in that way.
The reason I say it's a both and is that that siloing to your point, Mark, is very dangerous. If left unattended, you will eventually develop four strategic plans around musculoskeletal care. You'll develop four systems of leaders. You'll develop four compensation models mean it, they were separated.
If there is a service line that connects it all with a dual or a triad leadership model between nursing, administration and, you know, clinical leaders, you do empower all of those segments that make phenomenal care to have a voice, but you have to do it with intention. You know, I find that systems who have the same person leading all the different segments, it causes a little confusion, but you do have to have a central part where there's a source of truth.
One example of where this works really well is if you go back to medical school in the days, you know, of the past, where we learn things in terms of systems. I mean, I graduated from medical school 20 years ago, so 24 years ago, first year of med school at Duke was literally, this is the organ system we're going to focus on and we're going to divide it into genetics, anatomy, pathophysiology, et cetera. Now we're going to move over to pulmonary, now we're going to move over, etc. That's how we were trained, is how we learned. So then when we get into our careers and we have to separate our parts, you know, the research part of me belongs here, the data part of me belongs here. The clinical part of me belongs here. It causes a bit of dissonance and we wonder, are we helping anyone? Because we're moving slower separately. So I appreciate cultural norms, differences in terms of backgrounds, PhDs versus MDs versus MD, MBAs, etc. But I do think I agree with you. There's got to be a common thread where we all have skin in the game, where we all contribute financially and then are rewarded as alike. And I believe that's the movement that's happening. But there are going to be some people who are slow adopters of that because of how they were onboarded, because. Because of what their compensation model incentivizes. So we have to really rethink the entire system.
[00:13:45] Speaker C: Thank you.
[00:13:47] Speaker B: So I wonder if I can. So if you look behind, well, behind me that way you see that word create. And that actually is. Yeah, that's our department's six pillar strategy. And C is for a culture that includes. So, you know, there's research, education, advancement, technology on blah, blah, blah, obviously, excellence in patient care.
But I'm really curious about your role in culture because I'm sure you believe this, and I truly believe this is that without a culture and shifting culture to what makes to an inspiring culture, it's very hard to be successful in all the other areas. And I wonder about your role in culture and whether it's the challenges or the opportunities that you faced as you've been thinking about shifting culture. And maybe you haven't had to shift culture, but I suspect there's been some shifting involved.
[00:14:36] Speaker C: Oh.
[00:14:37] Speaker D: Oh, absolutely. How much time do we have?
[00:14:39] Speaker B: Yeah, right, right.
[00:14:40] Speaker D: Think about, you know, I mentioned this just a minute ago. You know, I. Well, let me back up. I first walked onto the duke campus in 2001. I was an engineering student at UVA. I was always pre med. You know, I was 15 years old when I decided to be an orthopedic surgeon. So that was always the plan, but I still majored in engineering. And, you know, the first surgeon that I ever met and shadowed was Dr. Frank McHugh.
And I spent my summers with him in the athletic training rooms. And it never once dawned on me if you know anything about Dr. McHugh, I mean, quintessential physician and human.
It never dawned on me that orthopedics had a culture opportunity because my first introduction to him was extremely engaging.
He was invested in me achieving my goal. I saw how he cared for athletes and took them home after. I mean, it was just. That was my view of orthopedics. And as an engineering student, I was very much used to working in teams. I thought team collaboration was the way of the world.
And so in 2001, I spent a summer at Duke, loved it, and decided to apply and ultimately attended med school there. And it wasn't until that first year, being in an environment in a very traditional program with hierarchy truly embedded in medicine nationally, that I recognized that there was this thing called culture.
It was more and more apparent that we were fishing water, not realizing we were in water. You know how that adage goes. And so for a period of time, when you're a learner, you don't have a lot of agency, particularly when you're pursuing one of the most competitive fields. I mean, you are, in a way, in survival mode. But the beauty of that is you start finding networks, you start finding innovative, creative paths that are ultimately shifting culture. You just don't know it. And we just hadn't called it that at the time. And so when you look over the course of one's career, going from residency into fellowship and then coming back, things felt a little different. But I don't Know, to your question, if it was because the culture shifted or I shifted, and then maybe it was a little bit of both, maybe I discovered that, hey, you do, Erica, have a little expertise in this area because somehow you made it through when odds were against you.
Conversely, perhaps it was that we had became more inclusive in our medical experience experience, our training experiences, the acgma, perhaps there were different rules in place so that we cultivated a culture of not just optimal training, but kindness and compassion for one another in addition to patients. And so when I think of culture, you know, there's a saying, culture is the worst behavior you're willing to accept.
When you think of what we started amplifying attention around what we had very courageous voices calling attention to as opportunities for improvement, that bar of that worst behavior, that started to lower and lower and lower in our tolerance for the lack of professionalism, the lack of inclusivity, the lack of optimal success opportunities for all that, that culture shifted. So I think it's a combination of how you view your agency and I tell my mentees, even as med students, you all, first of all, this generation is not afraid to hold society and systems accountable for responsibility to their communities. But this generation has a lot of power.
If you with a careful critical lens, find an opportunity to improve culture, say something, do something, find a sponsor, a mentor and do it together.
And so I'm excited that for nine years I've had this role in my department. I'm a poor succession planner is the take home from that. But you know, my chair and my other leaders across the system have been very supportive in not only identifying opportunities, but co creating solutions.
And so it could be anything from, you know, we have these meetings with the same people in every meeting. Maybe we should invite some different voices to the table or hey, we really thought about visibility in our communications. When we send out newsletters, who's featured, who's not, hey, can we give the communities, our patients voices at tables where decisions are made?
Then all of a sudden, the humanity, the humanism in medicine returns. And it wasn't because of one initiative, it was because we moved it together. So my role is simply having that courageous curiosity and that voice to bring the perspectives of others that may be completely different than mine into rooms where decisions are made. And those rooms are generally around hiring practices, clinical operations, retention strategies, reviewing our culture data, speaking truth to power, and reimagining how we define excellence.
And over time, this is a long cycle type of job, right? You don't get your improvements every quarter, but over time you recognize that there is joy still left in medicine and there are valuable people who don't often get the visibility they deserve. And we can work on that for sure.
[00:20:08] Speaker B: That's great. One quick follow up and maybe I'll let Mark ask a final question then. Erica, how do you measure the roi? I mean you're obviously business trained, you're thoughtful about this, but culture and measuring shifts in culture is tricky. And everyone says, you know, culture, a company's culture is good for business, but how do you measure that?
[00:20:26] Speaker D: Oh, I love this question. So one of my most rewarding professional roles is serving as vice president of health equity for the Duke Health clinician practice. And that transcends orthopedics, that covers all of our specialties. I work in close partnership with Duke primary care and our hospital based efforts, etc. But with that role I have a really neat view into data.
And I mentioned this because a lot of the return our investment, or as our previous CEO used to say, voi, the value of an investment has to do with the things that are important to us, which essentially is what we measure. We typically in health systems only measure the things that matter to us.
And so when you look at our staff retention, for example, you can glean some insights not just by looking at the gross number, like number in, number out. And hey, we're positive, we're net positive, so we're doing well. But if you really take the time to look at exit interview data, if you look at the reason for departure, that tells you a lot about what investment value there is to not only retaining your team members, but advancing them. So I'll give you a couple examples. One group that I have had the pleasure of having a lot of interaction with, engaging, leading teaching, is our clinic staff.
So once a month, every second Tuesday 9am, I do a virtual teaching session for one person from every clinic site in our ambulatory platform. It equates to about 80 different humans and I teach them something about healthier communities, inclusivity and care. And then I leave time for them to meet a leader, hear from a leader, and then there's back and forth conversation.
The importance of that is one would say, hey, this is one of Dr. Taylor's health equity efforts.
Is it? Because at the end of the day, the number of clinical ladder advancement forms I have signed because these liaisons are essentially leaders in their clinics. The number of comments I get about how gratifying it is for them to be able to help patients with financial assistance or health related social needs, empowering Front desk staff, radiology techs, ITechs, etc.
That's an investment in retention.
And so if you look at the cost of losing team members, the cost of recruiting and hiring surgeons, I mean we're a very expensive search process, to be quite honest.
If you can retain and advance your talent force, your cost savings when you do those analyses is tremendous.
In fact, there's a Deloitte article I love, we love Deloitte, their healthcare sector published about the over one trillion dollar savings that can be realized. And they have all the economic analyses that they use and the assumptions they used in that paper that could be realized if you decrease gaps in care not only for patients, but for your employees. And so that's one example of how using the data in a different way don't need to create a new survey, you don't need to create a new data warehouse. But using what you have to tell a story of what is the experience of a team member, surgeon, app therapist, clinic staff member in your organization, then you can see where you can do a little bit more to retain them, to really tease out the value. They appreciate that as well. Often at the end of those monthly sessions, the comments in the chat are, this is why I work at Duke. This is why I love working here. Because I gave them power, I gave them agency, I gave them a voice. And if we do that for the entire team, we're going to be better off for it.
[00:24:18] Speaker B: Great, thanks.
[00:24:20] Speaker C: Well, thank you very much again, Dr. Keller, for spending time with us. And I don't know that we've mentioned this in this discussion. You are a card carrying, certified hand surgeon.
I am going to ask the last question. How do you use that basic fundamental identity to help you as you expend so much energy trying to improve the system at Duke and the situation in musculoskeletal care nationwide? You expend a lot of energy and time and how, how do you use that, that basic identity to help charge your batteries?
[00:25:01] Speaker D: Oh, thank you for ending with something near and dear to my heart. I mentioned earlier, I decided to be an orthopedic surgeon when I was 15 years old. I have to always give honor to my late great father, Charlie Taylor, who was one of the pioneering players in the team now known as the Washington Commanders. He's with them for 30 years as a player and a coach.
And I grew up in this environment where, you know, there was him as this record breaking hall of famer player and then there was my mom who spent 31 years as an educator For Fairfax county public school system, go Northern Virginia Nova. And so this idea, as the baby of the family. So I grew up, you know, with this concept that there's power in education.
Education is the key to opportunity. That's what my mom instilled in me. And then my dad and story for a different day of how he broke barriers in the NFL as well, showed me that there are going to be times where you may not feel like you belong on the team, but if you run hard, if you keep your head down, if you, you know, reach back and pull out others to come with you, then you're going to be a star. And so that's how I grew up wanting to be a sports medicine surgeon, orthopedics, and then spent time with Dr. Bobby Chabra as a resident and fell in love with hand surgery. And the reason I fell in love with hand surgery and the reason why it carries me and actually makes me a better leader today is because I realized I love details. I love being a precision surgeon, as sometimes we're referred to, where every millimeter, every angle, every trajectory matters. And you can literally restore function to activities that we all do. Not a specific sport, not a specific function or job, but literally everyday activities like opening a jar, buttoning your shirt, combing your hair.
Those things matter to my patients, and they matter to me. So we automatically connect. I don't have to do what they do to understand what they need and how they need it. And for that reason, when I look at the leadership domains that I am privileged to be a part of, I see the other side of the table, and I'm training myself to be able to look from the lens, the perspective of other people.
And it's really rewarding. Now from hand surgery, you know, sometimes I tell my husband, I feel like this month I operated on every finger in Raleigh, North Carolina. You know, there's no shortage of cold trauma, acute trauma, you know, in the hand and wrist. But, you know, there's something that happens when patients come in my. In my office or my. Or when they see me. There's like a sense of calmness.
And I truly believe it's because they see themselves in me for some reason, whether we're connecting over football. You know, I even take care of Dallas fans. It hurts me to do so. I provide them with the same level of optimal care, but we even connect on that. Some patients even show up wearing Dallas gear, you know, just. Just to get in my skin. And I love that. So that human connection translates. The detail, precision translates from what I do as a surgeon all the way to what I do as a leader. And my prayer, my hope is that somewhere, somehow, someone's watching this so that they emulate the best of me. Not all of me, but the best of me, you know, as they segue from pure clinical care into leadership and entrepreneurship and all the great things that life has to offer.
[00:28:47] Speaker C: Well, what a great way to end this conversation. We're greatly appreciated. Appreciative of your spending time with the OR so Joe. Community, surprisingly, is still numbering in the thousands after five or six years. Mo and I have been doing this,
[00:29:04] Speaker B: so I love it.
[00:29:05] Speaker C: I love it. We're. We're grateful for you spending time with us, and you're an inspiration, and I think you.
You speak to the better side of us in orthopedic surgery and beyond, and we would like to express our gratitude. And I know I speak for Mo, and anything we can do to help you in your mission, just let us know.
[00:29:26] Speaker D: It's a deal. Thank you again. It has been an honor to spend time with you all.
[00:29:31] Speaker B: Great. Thanks so much, Erica. Okay, bye.
[00:29:34] Speaker C: Bye.
[00:29:35] Speaker D: Bye.
