Medical School Hotline: "Leading Change" Speech Delivered at the JABSOM Convocation, May 15, 2016 Kennedy Theater, University of Hawai'i, Honolulu, HI.

Dean Hedges, other distinguished guests, faculty, graduating medical students, family, and friends of the graduates, Aloha! Congratulations class of 2016. You've done it! Thank you for allowing me to be a part of this very special day. Unlike many of the commencement speeches I've heard, I am not here to tell you how to live your lives as doctors. I'm not here to tell you to live your lives to the fullest, to be kind to others, to look after your own health, although of course I do hope that you will do all of those things. I don't think I need to share these words of advice for you because you already know them. After all, you were smart enough to attend medical school here in Hawai‘i, in paradise. Instead, I am here today to encourage you and to cheer you on—to do what I think you are already destined to do, which is to help us lead the transformation of health care in this country. In 2009 Simon Sinek delivered one of the most popular TED Talks ever. It already has almost 27 million total views. For those of you Googling right now it's called, “How Great Leaders Inspire Action,” and his concept is very simple. He makes the observation that great organizations and leaders are able to inspire because they communicate their Vision using a common framework—Leaders start from the central question of why, and then move to the issue of how, and then finally discuss what. I thought I would challenge his theory in reverse by applying his framework to this talk, and then see whether it would inspire you and your friends to watch the video of this talk 27 million times. Just kidding. My theme today is transforming health care. I would like to make the case that all of you in this room will play critical leadership roles in this transformation. And not only will you play these roles, but that you are uniquely able to…to a far greater degree than most of us who have taught you. The reasons for this are because you know not only why, but you know how and what to do. Let's start with why. Actually unlike most of us in the room a generation or two ahead of you, why is not even a relevant question for most of you. You were born in the late 1980s and early nineties. Before you knew you ever wanted to be doctors, you already had heard the words “health care reform.” Hillary Clinton and her team had already started working on the prequel to the ACA before you even graduated from elementary school. You have come into the medical world knowing that we need to reform. And here in Hawai‘i, you have seen the benefits of a well-run health care system that serves one of the healthiest populations in the country. Furthermore, your system achieves that healthiness at reasonable costs. We in Utah share some of these attributes, however we have not managed to create the same access to health care that Hawai‘i has been so successful in doing. In short, you have learned from the best. You may see the pressing need for health care reform through the lens of social justice or through economics and global competitiveness. Or you may see it simply as an essential human right to alleviate suffering and enable the pursuit of life, liberty, and happiness. Perhaps you see it as all of the above. In any case the why of health care reform is essentially a given for you. That makes the rest much easier. Easier, but not easy. This is where the how and the what come into play. The how is how we think about health care reform. And again, here I believe that the core principles will resonate with your generation far better then with most of us who are struggling with this change. There are many ways to think about this question. I offer two. The first is data. The second is diversity. We live in an age of data. There are very few questions that my children can ask me that I can justifiably say, I don't know. Because in about 2 minutes I can find the answer to just about any question, by consulting the internet. Anything. Even my favorite recipe for bai tang gao or steamed Chinese rice cake can be found in print or you tube in English, Chinese, Vietnamese, Dutch, Spanish, you name it. We live in a data-driven society. Decisions, including how to improve health care, can be made better now, because we have virtually unlimited access to data. We can share data. Which means we can share wisdom. That means we can change faster and more effectively. You know this all better than anyone. After all most of you have had the internet in your back pocket since high school. What about diversity? In his book, The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies, Scott Page shows that when challenged with very difficult problems to solve, groups of individuals who are very different, especially in their cognitive approach to problems, produce better solutions than more homogeneous groups, no matter how high their intellectual or skill level. Probably no state in the country reflects cultural diversity like Hawai‘i. You have a distinct advantage of feeling comfortable with diversity. What about interprofessional teams? Interprofessionalism is an example of a new kind of diversity in our working teams to deliver better outcomes. We also need diversity in leadership. We need diversity in making decisions that are best for patients. We need people at the table who reflect the values and differences of the people we care for. And of course, there's tremendous value in listening to our patients' voices themselves. You all inherently understand that. Finally, let's talk about what should be the easiest part of health care transformation and that is what do we actually do? A big part of transformation is changing people's behaviors, whether it's patients or providers or health insurers. How successful we are depends a lot on the tools that we have and our comfort level using them. On this front, you are already ahead of the curve. I'm going to speculate that what my generation thinks of as “innovative,” your generation thinks are simply “common sense” or should be. For example, let me use some words that are expected for you and challenging for many of us: Customer centered or patient-centered Transparency Technology Social media Empowerment Accountability And specifically in health care, how about: Health and Wellness Palliative care Integrative care Interprofessional care Paying for value How we approach health care transformation very much depends on our ability to embrace change and to leverage what really turns out to be common sense. Let me give you an example. Earlier this week, I had the chance to speak at a plenary session of Health Datapalooza with Yelp CEO Jeremy Stoppelman. We discussed the controversial topic of on-line reviews of doctors. In December 2012, just after the last presidential election, University of Utah Health Care became the first health care system in the country to post its patient satisfaction scores and patient reviews on-line. Using a system of five yellow stars made popular by Amazon.com, we now share with the world the actual scores of how patients rate our physicians on 10 key questions about communication, respect, shared decision making, even wait times. And we post all the patient comments online. What's been the result? For 3 years in a row now, about half of our docs score in the top 10 percentile in patient satisfaction, and an amazing 1/4 of our doctors are in the top 1%. We've achieved these results without any financial incentives to providers. We're pleased that in the past year others have launched a similar effort, like Duke, Stanford, Cleveland Clinic, and Wake Forest. This initiative was part of our effort to deliver what my predecessor Lorris Betz in 2008 called, an “Exceptional Patient Experience.” He said, we can't be a great medical center if our patients don't think we are. We chronicled our journey in an article in the March 2016 issue of Academic Medicine. With this initiative, we have transformed ourselves into the most patient-centered organization I know. We've found ourselves on a virtuous cycle. Web traffic is up. Referrals are higher than ever. Quality—top in class for last 6 years. Costs among the lowest in the country. Medical malpractice is down. And best of all, we all feel really proud of how much patients love us. This last year we started doing the same with our residents and fellows, who are much more accepting and matter-of-fact than some of our seasoned clinicians. Like you, they grew up with Yelp, TripAdvisor, and even think being reviewed as a customer by an Uber driver seems reasonable. What we've done is simply the Yelp-ification of health care. And it's helped to bring us and health care into the 21st century. Up next, we are working on advancing quality and patient reported outcomes, tackling the costs of care, and innovating around access to care. For us, patients are the Why; data, transparency, engagement, and diversity are the How; and continual improvement is the What of Health Care Transformation. What are yours? This ceremony bookends your journey in medical school. At the white coat ceremony at the University of Utah, I talk about how over the next four years, our faculty will be transforming our students, from recent pre-meds to internship-ready physicians. In fact, what I know is that today, when you walk out these doors, with your new medical degrees in hand, you will be the ones who will transform us. Lead on…Mahalo!