"AI has the potential to re-ontologize healthcare—to completely redesign what we consider to be a disease, what we consider to be a disability, and how we organise care. But we need to decide what good healthcare actually means before we AI-ify everything."

— Dr Jessica Morley

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

In this episode of Clinical Changemakers, Dr Jessica Morley, an AI ethics expert and researcher from Yale Digital Ethics Centre, challenges our understanding of what large language models actually are and what they mean for healthcare. Drawing from her work on data ethics and her involvement with OpenSafely during the pandemic, Dr Morley explains why viewing AI as "stochastic parrots" is crucial for healthcare implementation, explores the concept of re-ontologizing medicine, and argues why we need ethical frameworks before technological deployment rather than after.

Key Takeaways

Stochastic Parrots in Medicine: Large language models don't understand medical concepts—they predict the most likely next word based on probability from their training data. This means they can give you different answers to the same medical question and lack the contextual understanding crucial for patient care. Understanding this fundamental limitation is essential for safe healthcare implementation.

The Re-ontologizing Power of AI: AI doesn't just replace existing tools like upgrading from a physical to digital stethoscope. It has the power to completely redesign healthcare by redefining what constitutes disease, changing how we organize care, and separating diagnosis from physical patient interaction. This transformation can be powerful and positive, but only if we're intentional about our goals.

The Inverse Data Quality Law: Just as the inverse care law states that those who need healthcare most get it least, the inverse data quality law means those who need AI healthcare tools most will have the poorest quality data about themselves. This creates a two-tier system where marginalized populations get inferior AI-driven care.

Social License Trumps Legal Permission: Technical feasibility and legal compliance aren't enough for successful AI implementation in healthcare. Projects like the UK's Care.data failed despite being legal because they lacked social acceptance. OpenSafely succeeded by building in privacy protections, transparency, and meaningful public engagement from the start.

Where to Find Our Guest

Dr Jessica Morley (LinkedIn, Google Scholar)

In This Episode

01:27 - Stochastic parrots: Understanding what LLMs actually do

04:27 - Emergent properties: Why LLMs remain sophisticated probability machines

11:57 - Moral worth and parasocial relationships: When humans attach meaning to AI

14:33 - Re-ontologizing healthcare: How AI redesigns medicine itself

19:28 - The ethical traps: What happens when we AI-ify without thinking about outcomes

25:33 - Two-tier systems: How AI could worsen healthcare inequalities

28:44 - Ethics vs. law: Why we need both rules and values

32:31 - Learning from NHS failures: The importance of not making assumptions

47:43 - Global policy tensions: EU regulation vs. US "let it rip" approaches

54:33 - False dichotomies: Moving beyond "some care vs. no care" thinking

59:02 - Current global sentiment: From tech optimism to healthcare caution

Referenced

• Dr Morley’s Paper - The ethics of AI in health care: A mapping review (link)

• Defining a Stochastic Parrot (link)

• OpenSafely platform and approach to health data research (link)

• Lessons from Care.data project and its failure in the UK (link)

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

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As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it.

Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com

"We want a two-way flow of communication so that we have a better understanding through the levels of an organisation up through those levels of what's actually happening and we can make decisions closer to the ground."

— Dr. Sharen Paine

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

In this episode of Clinical Changemakers, Dr Sharen Paine, a systems thinking expert with a doctorate in business administration focusing on cybernetics, explores why healthcare organisations repeatedly struggle with the same problems despite constant restructures. Drawing from her hands-on work with ophthalmology services, Dr Paine introduces the Viable System Model (VSM) as a framework for creating truly functional healthcare organisations that can adapt and thrive rather than merely survive.

Key Takeaways

Cybernetics vs. Command-and-Control: Healthcare systems fail because they rely on one-way, top-down commands rather than cybernetic feedback loops. True organisational health requires continuous information flow between all levels, like an aircraft's autopilot system that constantly adjusts based on environmental feedback, not rigid directives from a distant control tower.

The Black Hole of Management Chaos: Service managers and clinical directors get consumed by day-to-day firefighting because healthcare systems lack proper coordination functions. Without clear coordination mechanisms, everything collapses into the management layer, creating a "tumble dryer" of urgent tasks that prevents strategic thinking and long-term planning.

The Five Functions of Viable Systems: Every healthcare organisation needs five continuously operating subsystems: (1) Operations that deliver patient care, (2) Coordination that orchestrates daily activities, (3) Management that sets conditions for success, (4) Intelligence/Planning that looks ahead strategically, and (5) Governance that defines purpose and values. Most healthcare systems conflate these functions, leading to dysfunction.

Recursive Autonomy Creates Efficiency: The VSM applies at every level—from national health systems down to individual departments. Each level requires all five functions to operate with appropriate autonomy. A $150 equipment purchase shouldn't require Wellington approval, just as an ophthalmology clinic shouldn't decide national hospital placement. Right-sized autonomy eliminates bureaucratic bottlenecks.

Coordination is the Missing Function: Healthcare systems fail to recognise coordination as a distinct, critical function requiring dedicated resources and IT systems. Coordination includes prioritised wait lists, rosters, schedules, skills matrices, and training—currently done manually or through spreadsheets, creating errors and inefficiency. Proper coordination would prevent most day-to-day chaos.

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Where to Find Our Guest

Dr. Sharen Paine (LinkedIn)

In This Episode

00:00 - Introduction: Dr. Sharen Paine's background in cybernetics and systems thinking

07:37 - Sharen's journey: From mental health services to ophthalmology system challenges

15:05 - Production planning struggles: Why system changes fail without organizational support

18:16 - The governance-management-operations disconnect in healthcare hierarchies

25:04 - Introduction to the Viable System Model: Five essential organizational functions

26:59 - Defining viability: How organizations persist and adapt over time

28:05 - The five subsystems explained: From governance to operations

36:05 - Applying VSM to ophthalmology: What it looks like in practice

46:33 - Functions vs. roles: VSM describes what needs to happen, not organization charts

55:29 - Building collaborative understanding: Clinicians learning constraints, managers understanding frontlines

59:48 - Bottom-up implementation: Practical steps toward VSM adoption

1:05:12 - The VSM perspective: Seeing cybernetic patterns everywhere

Referenced

• Utilising insights from cybernetics and the Viable System Model to address health system disconnects (Doctoral Thesis)

• Principles for embedding learning and adaptation into the New Zealand health system functioning: the example of the Viable System Model (paper)

• Utilising VSM insights to address health system disconnects: introducing three novel organisational pathologies (paper)

• Mapping clinical governance to practitioner roles and responsibilities (paper)

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay.

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As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it.

Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com

"I think judgment, I've been honing in on that word more frequently recently because I feel like the judgment piece is the piece that feels particularly like human in this decision."

— Dr Graham Walker

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

In this episode of Clinical Changemakers, Dr Graham Walker, an ER doctor and AI healthcare leader, discusses his role at Kaiser Permanente and the challenges and successes of integrating AI into healthcare. He emphasizes the importance of communication, leadership, and the need for alignment in large healthcare systems. Dr. Walker shares insights on predictive AI tools, the operationalisation of AI in patient care, and the ethical considerations surrounding AI's explainability. He also highlights the rapid adoption of AI scribes across 4.6 million members and the balance between AI benefits and risks in clinical practice.

Key Takeaways

Leadership through servant mentality: Successful healthcare innovation requires leaders who ask "How can I help you?" rather than directing from above. Clear communication, removing blockers, and building relationships are essential for large-scale change.

The 85% capacity rule: Healthcare systems running at 100% capacity fail due to variance in patient complexity and unpredictable demand. Queuing theory suggests keeping 10-15% flexibility to handle the inherent unpredictability of medical care.

Predictive AI has staying power: Kaiser's Advanced Alert Monitoring system, running live since 2018, successfully predicts ICU transfers and rapid responses across all inpatients. The operational challenge isn't building the model—it's fine-tuning sensitivity/specificity and creating sustainable workflows.

AI scribes: Healthcare's fastest adoption: The rapid rollout of AI scribes represents perhaps the fastest technology adoption in healthcare history, driven by ease of use (just install an app and hit record) and immediate physician benefit in reducing "pyjama time" documentation.

Judgment remains human: While AI excels at pattern recognition and data synthesis, clinical judgment—weighing risks, understanding context, and making treatment decisions—remains distinctly human. The scraped knee doesn't need septic workup; that's judgment, not diagnosis.

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Where to Find Our Guest

• Dr. Graham Walker (LinkedIn)

In This Episode

00:00 - Introduction: Graham Walker's role at Kaiser Permanente Northern California

04:36 - Innovation framework: Value-based care vs. fee-for-service and finding ideas with potential

07:08 - Commercialisation strategy: Building internal tools for external deployment

11:00 - Leadership lessons: Coalition building and relationship management in large institutions

16:34 - Queuing theory in healthcare: Why running at 100% capacity breaks systems

19:48 - Predictive AI success story: Advanced Alert Monitoring system in production

26:00 - The human element: Why unexplainable AI might force better clinical thinking

32:33 - AI scribes rollout: Fastest healthcare technology adoption in history

39:30 - Information fidelity challenges: Note bloat, omissions, and human nature

45:02 - The judgment frontier: What remains uniquely human in clinical decision-making

50:20 - Advice for healthcare leaders: Use AI tools daily to understand capabilities and limits

53:57 - Off-call introduction: Building transparency in physician work and workload data

Referenced

• Dr Walker’s company website Offcall

• Dr Walker’s Medical Calculation Website MedCalc

• Paper: Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration (Link)

• Paper: Ambient Artificial Intelligence Scribes to Alleviate the Burden of Clinical Documentation (Link)

• Queueing Theory (Wikipedia)

• Servant Leadership (Link)

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay.

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“You know, what if they were to actually put it’s [AI] mind to a science of practical compassion for everybody?… if the right machines were to come along and help us do it, that's going to be a fabulous thing.”

— Dr. Richard Lehman

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr Richard Lehman is a retired GP from Oxfordshire who had a "ringside seat" to the birth of evidence-based medicine, previously he held academic positions at Oxford and Yale, later becoming Professor of Shared Understanding of Medicine at the University of Birmingham. Dr Raj Mehta is a physician and evidence-based medicine educator who views EBM as essential heuristics for discerning truth in clinical practice. Together, they bring decades of experience wrestling with how we know what works in medicine, from the historical foundations laid by James Lind's scurvy trials to the AI revolution that promises to transform how we synthesise and apply medical evidence.

Key Takeaways

Truth-seeking requires method, not just conviction: Before EBM, medicine operated largely on "conviction-based" approaches collected in massive textbooks. The shift to systematic evidence evaluation transformed how we separate opinion from fact in clinical practice.

Numbers Needed to Treat illuminate magnitude: Tools like NNT help clinicians and patients understand effect sizes. Context and timeframe matter enormously.

AI could democratise and personalise evidence: Rather than replacing doctors, AI might enable real-time synthesis of evidence matched to individual patients, creating feedback loops between treatments and outcomes at an unprecedented scale.

The evidence map has gaps and mountains: Current evidence is like an 18th-century road atlas - some areas well-mapped, others blank. AI could be the "sat nav system" for medicine that acknowledges uncertainty while guiding decisions.

Social determinants still trump beta blockers: While we refine molecular treatments, the biggest health impacts remain at the policy level - safe neighbourhoods, warm homes, and social conditions. Medicine must embrace "practical compassion" beyond prescriptions.

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Where to Find Our Guests

• Dr. Richard Lehman (X/Twitter)

• Dr. Raj Mehta (X/Twitter)

In This Episode

00:00 - Introduction: Why evidence-based medicine matters now more than ever

02:54 - The scientific method in medicine: Discerning truth from fiction in clinical practice

06:06 - James Lind and scurvy: The 200-year gap between discovery and adoption

12:01 - Bradford Hill and the RCT revolution: Moving from mechanism to measurement

14:29 - Richard's ringside view: When "evidence-based medicine" arrived in Oxford

19:10 - The limits of population evidence: Why Numbers Needed to Treat aren't enough

22:39 - Shared decision-making complexity: The overwhelming challenge of multimorbidity

26:00 - The AI revolution: From medical scribes to comprehensive evidence synthesis

29:39 - Patient empowerment in the age of monetised medicine

36:43 - The pre-Copernican challenge: Are we just getting better at measuring the wrong thing?

39:01 - China as a sandbox: Where innovation might overtake Silicon Valley

44:54 - Beyond beta blockers: Why social determinants still matter most

54:10 - COVID-19's mixed report card: EBM's triumphs and failures in crisis

59:04 - Communicating uncertainty: The topographical map of medical evidence

1:01:39 - Looking forward: Why this is a "fabulous time in medicine"

Referenced

• Richard Lehman’s weekly review of medical journals (Link)

• James Lind Library (Link)

• Richard Lehman on Evidence-Based Medicine (Podcast)

• The RECOVERY Trial (COVID-19 treatment comparison) (Link)

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay.

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"When the frontline feels we're actually offering, 'what do you need? What are the resources we can help?' We'll co-create. Of course, they don't have the control of the resources or some decisions, but that's what executives can do."

— Dr. Raj Srivastava

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr. Raj Srivastava is a pediatrician, health system leader, and implementation science researcher, serving as Chief Clinical Programs Officer at Intermountain Health. With an MPH from Harvard and over two decades of experience transforming healthcare delivery, Dr. Srivastava has pioneered approaches to scaling evidence-based practices across one of America's largest health systems, which spans 630,000 square miles (roughly the size of France, Germany, Spain, and the UK combined) and employs 64,000 people. From his early work mapping 150 million lab results across six children's hospitals to his current role orchestrating clinical transformation across 33 emergency departments, he brings unique insights into why healthcare struggles to implement best practices and how to overcome these challenges through learning health systems.

Key Takeaways

Co-creation beats imposition: Successful implementation requires working with frontline staff to understand their needs rather than imposing solutions. When clinicians feel heard and involved in designing solutions, resistance melts away.

Learning health systems require discipline: It's not just about having data or technology - it's about creating systematic approaches to identify what works, scale it appropriately, and sustain improvements over time using scientific methods.

Start with the problem, not the solution: Too often, healthcare gets excited about new technologies (EMRs, AI, big data) without first understanding the specific problems frontline staff face in delivering evidence-based care.

Systematic vs. one-off barriers: Distinguishing between system-wide challenges (like data infrastructure) and location-specific issues is crucial for effective problem-solving and resource allocation.

Trust enables speed: Building strong interpersonal relationships and psychological safety among leadership teams dramatically accelerates implementation. The "meeting before the meeting" matters.

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Where to Find Dr. Raj Srivastava

• LinkedIn

In This Episode

00:00 - Introduction and why evidence-based medicine is so hard to implement in daily practice

04:47 - The gap between medical training aspirations and healthcare system reality

07:31 - Moving from descriptive research to application-based implementation science

09:05 - Transforming patient handoffs to reduce harm across multiple sites

19:32 - Systematic barriers and facilitators: Moving beyond "AI will solve everything"

23:53 - Addressing health equity through targeted subpopulation analysis

33:38 - "Build it and they won't come": The importance of co-creation and marketing

35:24 - Creating repeatable, scalable pathways for clinical improvement at enterprise scale

39:07 - Governance structures for managing clinical transformation across 630,000 square miles

41:23 - The power of pre-meeting communication and building executive trust

Referenced

• Increasing Adherence to Evidence-Based Clinical Practice (Paper)

• Intermountain Health, Health Delivery Institute (Link)

• Intermountain Health, Leadership Institute (Link)

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay.

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"At the end of the day, we don't really invest as much into products as we do into people. It's the people behind the products that are going to make the product successful"

— Dr. Amandeep Hansra

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr. Amandeep Hansra is a general practitioner turned health tech entrepreneur, advisor, and investor, founder of the Creative Careers in Medicine community (with over 25,000 members), co-founder of Australian Medical Angels and is the Chief Clinical Adviser for the Australian Digital Health Agency. From accidentally falling into telehealth to building virtual care services across Australia and Asia, Dr. Hansra has spent her career at the intersection of clinical practice and technology innovation. Her work with Medical Angels provides crucial funding and expertise to health tech startups, while her community platform showcases the diverse career paths available to medical professionals beyond traditional clinical roles.

Key Takeaways

Say yes to unexpected opportunities: Career pivots often happen by accident - being open to opportunities outside your planned path can lead to transformative experiences and skills you never knew you needed.

Networking is essential but different for doctors: Medical professionals aren't taught to network, but being visible in health tech communities and conferences is crucial for discovering non-traditional opportunities.

Regulation vs. innovation balance: Health tech faces unique challenges in evidence generation and regulation that differ from those of pharmaceuticals, requiring new approaches to safety while not stifling innovation.

People over products in investing: When investing in health tech startups, the founding team matters more than the initial product. Mission-driven founders with clinical awareness are more likely to succeed.

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Where to Find Dr. Amandeep Hansra

• LinkedIn

In This Episode

• 00:35 - Accidental entry into digital health: from GP to telehealth pioneer

• 04:13 - The power of saying yes: building a portfolio career through opportunities

• 06:45 - Creating community: building Creative Careers in Medicine from scratch

• 10:25 - Global burnout crisis: why 70-80% of doctors wouldn't recommend medicine to their children

• 15:26 - Investment challenges: why health tech struggles to attract traditional VCs

• 19:40 - Evidence standards: adapting pharmaceutical rigour to rapidly evolving technology

• 25:23 - Regulatory sweet spot: balancing safety with innovation accessibility

• 29:32 - What investors look for: mission-driven teams over hockey-stick projections

• 32:42 - Corporate vs startup innovation: lessons from building inside Telstra

• 39:31 - Global expansion: how the same product succeeds differently across health systems

• 47:07 - Exit strategies: why health tech doesn't follow traditional pathways

Referenced

• Creative Careers in Medicine

• Australian Medical Angels

Contact

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

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"The enterprise of medicine has both scientific and moral dimensions, and they're inextricably balanced"

— Dr. Vikas Saini

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr Vikas Saini is a Cardiologist and President of the Lown Institute, where he leads a non-partisan think tank advocating bold ideas for a just and caring system for health. With a unique background combining philosophy and medicine, Dr. Saini has spent decades examining the intersection of ethics, evidence, and economics in healthcare. His work on the Social Responsibility Index challenges traditional hospital rankings by measuring what truly matters: equity, value, and patient outcomes rather than reputation and revenue.

Key Takeaways

Philosophy enables systemic healthcare thinking: A philosophical background provides tools to step back and examine healthcare's "water" - the invisible assumptions and frameworks that shape medical practice and policy decisions.

Healthcare is fundamentally a moral enterprise: While science guides medical decisions, the uncertainty inherent in complex human systems requires ethical frameworks. The profession exists to serve others, making moral dimensions inseparable from scientific ones.

20-30% of healthcare may be unnecessary: From procedures lacking evidence to system inefficiencies driving unnecessary hospitalisations, overuse represents a massive opportunity for improvement - but requires paradigm shifts, not just cutting services.

Hospital consolidation hasn't improved care: Despite promises of efficiency, consolidation has primarily raised prices while hospitals increasingly operate like businesses, with some running billion-dollar hedge funds rather than focusing on community health.

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Where to Find Dr. Vikas Saini

• LinkedIn

In This Episode

00:08 - Philosophy's influence: learning to think about thinking in healthcare

02:45 - Healthcare as a moral and scientific enterprise: beyond the science

11:13 - The penicillin paradigm trap: why silver bullets fail for chronic disease

15:13 - Individual patients vs population means: the clinician's dilemma

19:15 - The culture of "doing something": when waiting is the hardest medicine

23:24 - Longitudinal care and efficiency: why more time means better outcomes

25:33 - Measuring overuse: from clear waste to uncertain benefits

30:36 - Why Choosing Wisely hasn't moved the needle significantly

34:28 - Policy opportunities: professional self-regulation over bureaucratic control

38:49 - Origins of the Social Responsibility Index: beyond reputation rankings

43:29 - Nonprofit hospitals acting like businesses: when mission meets margins

46:00 - Hospital consolidation: King Kong vs Godzilla, with patients trampled

50:58 - Advice for clinicians: taking up the cause of patients in systemic change

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Referenced

• Abraham Flexner and the 1910 Flexner Report (Original Report)

• Dr. Bernard Lown (Profile)

• Continuity in general practice as a predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway (Paper)

• Choosing Wisely (Website)

• Lown Institute's Social Responsibility Index (Website)

Contact

Contact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

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"The way to prevent cascades is to keep your eye on the goal, to understand what you're trying to accomplish and not to go down rabbit holes chasing abnormalities, but rather to be focused on the outcome that you're looking for."

— Dr James Mold

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr James W. Mold is a family medicine physician, geriatrician, researcher and academic with a Master of Public Health degree and is Professor Emeritus at the University of Oklahoma Health Sciences Centre. His pioneering research focuses on transforming healthcare from a problem-oriented to a goal-oriented paradigm, addressing the limitations of traditional problem-focused approaches. For over 20 years, in collaboration with the Oklahoma Physicians Resource/Research Network (OKPRN), Dr Mold has completed more than 75 major projects, resulting in more than 100 publications.

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Key Takeaways

Clinical cascades are preventable through goal focus: Unnecessary medical interventions often cascade from initial anxiety-driven decisions. Maintaining focus on patient outcomes rather than chasing every abnormality prevents harmful escalation.

The problem-oriented paradigm has reached its limits: While effective for acute, single problems, traditional disease-focused medicine struggles with the reality that all patients have multiple risk factors and complex needs.

Four universal healthcare goals exist naturally: Every patient wants to survive as long as possible, maintain quality of life, have a good death, and continue personal growth—goals that require individual understanding rather than standardised approaches.

Practice-based research networks bridge the research-practice gap: Successful implementation requires trusting practitioners, addressing their real-world questions, and providing ongoing facilitation support rather than just education.

Goal-oriented care is more satisfying and effective: This approach makes medicine more enjoyable for providers while resonating strongly with patients, though system constraints make adoption challenging.

Where to Find Dr James Mold

• LinkedIn

In This Episode

01:07 - Early experiences in family medicine and the humanising revolution

05:40 - Transition from family practice to academic geriatrics

10:31 - The cascade effect: when one decision spirals into unnecessary care

15:32 - Building practice-based research networks and learning from practitioners

22:00 - Implementation research and the "aeroplane repair in mid-flight" challenge

26:45 - The problem-oriented paradigm: how we got here and why it's failing

33:57 - Goal-oriented healthcare: the four universal goals every patient has

40:47 - Implementation challenges and global adoption of goal-oriented care

Referenced

• Goal-Oriented Healthcare (Link)

• The Cascade Effect in the Clinical Care of Patients (Paper)

• Goal-Oriented Prevention: How to Fit a Square Peg into a Round Hole (Paper)

• The Law of Diminishing Returns in Clinical Medicine: How Much Risk Reduction is Enough? (Paper)

• Thomas Kuhn's "The Structure of Scientific Revolutions" (Book)

• Failure of the Problem-Oriented Medical Paradigm and a Person-Centred Alternative (Paper)

• Oklahoma Physicians Resource Research Network (Link)

• Practice-based research network methodology (Link)

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Contact

Contact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

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"We need to pay more attention to the networks that operate between people and the networks that operate between organisations.”

— Professor Ingrid Nembhard

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Professor Ingrid Nembhard is an Organisational Behaviour expert in healthcare systems, based at the Wharton School of the University of Pennsylvania. Her research focuses on how characteristics of health care organisations, their leaders, and staff contribute to their ability to implement new practices, engage in continuous organisational learning, and ultimately improve quality of care.

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Key Takeaways

Relationships and networks drive outcomes: The connections between people and organisations significantly impact healthcare delivery. Traditional structural changes often fail because they ignore these relational dimensions.

Psychological safety is essential: Creating environments where people can take interpersonal risks—raising concerns, offering suggestions, sharing half-formed ideas—enables both innovation and problem-solving. This requires relationships built on trust and respect.

Standardisation and creativity complement each other: Rather than being opposed, standardisation helps identify where creativity is needed, and creative solutions can become new standards. Healthcare requires both standardised processes and customised approaches.

COVID revealed organisational potential: The pandemic demonstrated healthcare's capacity for creative problem-solving and adaptability. Organisations should maintain the communication channels and cross-functional collaboration that emerged during this crisis.

Where to Find Professor Ingrid Nembhard

• LinkedIn

In This Episode

00:01 - Introduction

00:34 - Is healthcare truly different from other industries?

03:16 - The growing recognition of organisational factors in healthcare

05:31 - How organisational skills should be incorporated into clinical education

10:20 - Learning the broader healthcare context vs. operational skills

14:25 - Understanding networks in healthcare organisations

18:47 - How to map and leverage relationships within organisations

22:48 - Building networks prospectively rather than retrospectively

26:26 - Creating psychological safety in healthcare teams

31:24 - Practical steps for leaders to implement psychological safety

36:40 - How standardisation and creativity can complement each other

42:51 - Lessons from COVID-19 for healthcare management

Referenced

• Integrating network theory into the study of integrated healthcare (Paper)

• NEJM: Responding to Covid-19: Lessons from Management Research (Paper)

• COVID-19 Inspired Creativity In Health Care: Lessons For Management And Policy (Article)

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Contact

Contact Information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

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"Epic charges researchers to access the data that the same Institute has spent thousands of hours storing. They're not a good custodian of data... they're literally locking your data away and holding it for ransom." — Dr. Sidharth Ramesh

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr Sidharth Ramesh is a medical doctor, clinical informatics expert, YouTube educator, and co-founder of MedBlocks, a company dedicated to creating patient-centric digital health platforms and providing tools, products, educational materials, and services. His work spans healthcare data models, API standardization, and breaking down data silos to enable innovation across healthcare systems globally.

Key Takeaways

Legacy Healthcare IT stifles innovation: Current systems either lock you into vendor ecosystems or create unstable bespoke solutions that can't evolve with changing requirements.

Health data platforms offer a solution: By standardising data models and APIs, these platforms allow for consistent data storage while enabling innovation through applications built on top.

Global standards matter: Projects like OpenEHR with over 1,000 standardised clinical data models prevent reinventing the wheel for common healthcare concepts.

Headless EHRs are emerging: The concept of slimmed-down EHRs focused on data storage with standard APIs rather than locked-in workflows is gaining traction.

Policy can drive change: Regulations like information blocking rules in the US have started to crack open data monopolies, though progress is still needed.

Where to Find Dr. Sidharth Ramesh

• LinkedIn

• YouTube

In This Episode

00:01 - Introduction

04:13 - How the healthcare industry stifles innovation

07:47 - Problems with bespoke IT solutions in healthcare

11:59 - Integration challenges of best-of-breed approaches

14:30 - Examples of inconsistent data representation

17:05 - The healthcare data platform concept

19:22 - OpenEHR and global data models

22:09 - Consistent APIs and standards

23:15 - The benefits of platform approaches

27:46 - AI's impact on healthcare data access and patient empowerment

33:49 - Challenges with AI in healthcare

36:38 - Why big tech companies struggle in healthcare

39:52 - The role of policy in unlocking healthcare data

44:52 - The mission of MedBlocks

51:28 - The future of MedBlocks

Referenced:

• Medblocks Company (link)

• The Innovator's Prescription by Clayton Christensen (Book)

• Clinical Knowledge Manager (CKM) for OpenEHR (link)

• FHIR standard for healthcare interoperability (link)

Contact Information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

🙏 Hi, Jono here - if you're finding value in Clinical Changemakers, please share this episode with a colleague who's interested in healthcare innovation. Thank you for your support!

“The market was flooded with all these new tools and technologies that people were using, but no real evidence base behind them. Now we’re in this space where we need evidence. — Dr Saira Ghafur

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr Saira Ghafur is a medical doctor specialising in respiratory medicine, an academic and leader for digital health at Imperial College London, and co-founder of two startups, including Prova Health, where she serves as Chief Medical Officer. Her work spans cybersecurity in healthcare, evidence generation for digital health technologies, and translating research into practical applications that improve healthcare systems.

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Key Takeaways

Cybersecurity is healthcare's blind spot: Despite healthcare's increasing digitisation, research into cybersecurity resilience lags far behind other critical sectors, creating significant vulnerabilities.

Evidence generation must match the product lifecycle: Early-stage technologies need qualitative user research, while mature products require real-world evidence gathering—one size doesn't fit all.

Data accessibility is crucial but challenging: Access to high-quality healthcare data remains difficult, especially for smaller innovators who can't afford to clean and curate it properly.

Economic evidence is increasingly essential: With constrained healthcare budgets, proving value for money has become non-negotiable for digital health technologies.

Where to Find Dr Saira Ghafur

LinkedIn

In This Episode

00:00 - Introduction to cybersecurity in healthcare
01:04 - How cyber threats have evolved in healthcare
04:45 - Building resilient healthcare systems
08:47 - The research landscape in healthcare cybersecurity
11:17 - Digital health technologies and evidence generation
15:48 - Regulatory challenges in digital health
21:45 - Using simulation for evidence generation
26:02 - Evidence generation for AI in healthcare
31:44 - The importance of high-quality data
34:32 - Economic evidence in digital health
36:35 - Lessons learned as a clinician founder

Referenced:

• Challenges for the evaluation of digital health solutions - A call for innovative evidence generation approaches (Paper)

• Safeguarding our healthcare systems: A global framework for cybersecurity (Paper)

• FDA - Software as a medical device (Website)

• NICE - Evidence standards framework (ESF) for digital health technologies (Website)

• PECAN - Fast Track Digital Tools in France (Website)

• DiGA - Fast Track Digital Tools in Germany (Website)

• Prova Health (Website)

• Generating economic evidence for digital health solutions (White paper)

• Trust through evidence: Evidence generation for AI solutions in healthcare (White paper)

• Be Smarter than your lawyer and your VC (Book)

  Subscribe now

Contact Information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

👍Hi, Jono here - if you're enjoying my work, please share it with a friend or colleague. Thank you for your support

"I think of quality as what is the patient's ‘job to be done’. What are they trying to get out of this encounter or from their help? What are they trying to achieve? Making quality about that."

— Dr Raj Behal.

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr. Raj Behal is a medical doctor and Chief Quality Officer at Amazon One Medical. With a background in internal medicine, medical informatics, and public health, Dr. Behal has spent his career translating evidence into better care. Before joining One Medical, he worked with academic medical centers to improve quality metrics and patient outcomes. Today, he's focused on redefining quality in primary care through a blend of in-person visits, 24/7 virtual care, and digital health solutions.

Key Takeaways

• Quality is multidimensional: The Institute of Medicine defines healthcare quality through six domains—safe, timely, effective, efficient, equitable, and patient-centered—but these shouldn't be viewed as separate boxes to check.

• Standard metrics aren't enough: HEDIS measures like cancer screening rates and diabetes control are important but capture only "a sliver of what people actually want from their health and healthcare providers."

• Respect drives efficiency: One Medical starts appointments exactly on time not because of efficiency targets but out of genuine respect for patients' time—a cultural shift that transforms the care experience.

• The coaching approach works: When hospitals received mortality data without guidance, nothing changed. When Dr. Behal worked directly with clinical teams to interpret the data and develop solutions, mortality rates dropped 20-25% in less than a year.

• Technology should augment, not replace: The future isn't about AI diagnosing patients but about automating routine tasks—"about 80% of routine testing screenings can be ordered by a machine," freeing clinicians for higher-value work.

Where to Find Dr. Raj Behal

LinkedIn

In This Episode

00:00 - Introduction to quality in healthcare

02:57 - Defining comprehensive healthcare quality

07:19 - Approaches to meaningful healthcare measurement

14:00 - Using AI to extract quality signals from clinical data

19:51 - Importance of coaching in quality improvement

28:45 - The One Medical model and Amazon acquisition

33:31 - The "three-body problem" in healthcare delivery

40:47 - Ambitious goals for transforming heart disease prevention

Referenced:

• Six Domains of Healthcare Quality (Website)

• The Healthcare Effectiveness Data and Information Set (HEDIS) (Website)

• Failure mode and effects analysis (FMEA) (Website)

• Amazon’s PR/FAQ process (Website)

Contact information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

👋Hi, Jono here - if you’re enjoying my work, please share it with a friend! Thanks for your support!

"The greatest legacy we can leave as this generation of leaders is to make meaningful progress in narrowing those health inequalities between communities."

— Prof Bola Owolabi.

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Episode Overview

In this episode, Professor Bola Owolabi, GP and National Director for Healthcare Inequalities at NHS England, shares her insights on health inequalities in England, how the COVID-19 pandemic exposed pre-existing disparities, her views on leadership and the innovative Core20Plus5 framework she's implementing to drive meaningful change across communities.

What you'll learn:

• How the COVID-19 pandemic exposed pre-existing health inequalities and acted as a catalyst for systemic change.

• Why addressing health inequalities has both moral and economic imperatives, potentially saving healthcare systems billions annually.

• The framework behind Core20Plus5 and how it provides focus, traction, and impact by targeting specific populations and clinical areas.

• Why community engagement and listening are fundamental to designing effective healthcare interventions.

• How a comprehensive ecosystem approach with multiple levers—including legislation, research, innovation, and funding—drives sustainable change.

• The distinction between courage as an individual trait versus a function of supportive community and shared values.

Some Key Takeaways

• Health inequalities cost the NHS approximately £5 billion annually, with additional costs of £30 billion in productivity losses and another £30 billion in reduced tax revenue and higher welfare payments.

• The COVID-19 pandemic didn't create health inequalities but exposed existing disparities: Black men experienced 2.2 times higher mortality in the second wave, while men from Bangladeshi backgrounds had 5 times higher mortality in the first wave.

• Pre-pandemic data showed stark life expectancy gaps: 10-15 years for people with learning disabilities, 15-20 years for those with serious mental illness, and a 19.6-year difference in healthy life expectancy between the most and least affluent areas.

• Core20Plus5 provides a clear framework for action by focusing on the 20% most socioeconomically deprived populations (Core20), plus specific underserved communities, across five clinical areas with significant mortality disparities.

• Effective healthcare delivery requires meeting communities where they are—like mobile clinics for fishing communities whose livelihoods depend on unpredictable sea conditions.

• Innovation for Health Inequalities Program (InHIP) leverages trusted community voices to increase uptake of approved treatments, resulting in a 70% rise in cholesterol-lowering medication use among Black African communities in Greater Manchester (UK).

• Courageous leadership requires surrounding yourself with people who share your values but are willing to challenge you—creating psychological safety through "community and company rather than lonesome leadership."

Where to find Professor Bola Owolabi

• LinkedIn

In This Episode

• 00:01 - Introduction to Professor Bola Owolabi

• 00:22 - Defining health inequalities and their impact

• 01:36 - Distinction between inequality and inequity

• 03:18 - How COVID-19 exposed pre-existing health inequalities

• 08:44 - Community engagement experiences and listening to affected populations

• 14:56 - Economic costs and business case for addressing health inequalities

• 20:51 - How leadership enabled strategic focus on health inequalities

• 25:18 - The importance of courage and support in leadership

• 30:27 - Core20Plus5 framework explanation and implementation

• 36:38 - Innovation for Health Inequalities Program examples

• 44:16 - Scaling and sustaining change through a comprehensive ecosystem approach

Referenced:

• 8 Urgent actions to address inequalities in NHS provision and outcomes (Report)

• Red Cross report on high use of emergency care utilization (Report)

• Core20PLUS5 (Webpage)

• Deloitte - US health care can’t afford health inequities (Report)

• NIHR launches £50m ‘Challenge’ funding to tackle inequalities in maternity care (Webpage)

• Health and Care Act of 2022 (Webpage)

• Innovation for Healthcare Inequalities Programme (InHIP) (Webpage)

Contact information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

👋Hi, Jono here - if you’re enjoying my work, please share it with a friend, it would mean a lot to me!

Thank you.

"The health impact of corporate power isn't just about products—it's about how commercial interests shape the entire landscape of health policy and research."

— Dr Nason Maani

Listen now on Apple, Spotify, YouTube or wherever you get your podcasts.

Dr Nason Maani, lecturer in Inequalities and Global Health Policy at the University of Edinburgh, author of "The Commercial Determinants of Health," and host of the podcast “Money, Power, Health” discusses the complex interplay between commercial interests, power dynamics, and health outcomes.

What You'll Learn:

• How multinational corporations employ similar sophisticated strategies to influence health policy, including lobbying, revolving door employment, and strategic philanthropy

• The specific ways commercial actors shape evidence through research funding priorities and selective publication of results

• Why structural market failures in healthcare create environments where commercial interests can dominate public health concerns

• How to identify and counteract corporate messaging that shifts responsibility for health from systems to individuals

• The measurable impacts of commercial determinants on health inequities across different socioeconomic groups and geographic regions

Some Takeaways:

• Understanding the commercial determinants of health is essential for addressing root causes of health issues

• Corporate actors view their customer base very differently than we do, putting a high reliance on ‘super-users’

• Public health approaches must consider the influence of commercial interests if they are to be successful

• Transparency about financial interests in healthcare research and policy is crucial for building trust

Where to find Dr Nason Maani

• LinkedIn

In this episode, we cover:

(00:00) Introduction to Dr. Nason Maani

(01:00) Overview of commercial determinants of health

(05:30) The "Money, Power, Health" podcast journey

(10:45) Key themes from "The Commercial Determinants of Health" book

(15:20) Case studies of commercial influence on health policy

(22:15) Strategies for clinicians to navigate commercial pressures

(28:40) Global variations in commercial determinants

(34:10) Future directions for research and advocacy

(40:25) Practical tools for identifying commercial bias

(49:19) Closing thoughts and resources

Referenced:

• Money, Power, Health (Podcast)

• The Commercial Determinants of Health (Book)

• The WHO - Commercial Determinants of health (Article)

Contact information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

"I'd rather have people understand why they should believe something, not just that they should."

— Dr Aaron Carroll

Listen now on Apple, Spotify, YouTube and or wherever you get your podcasts.

Dr Aaron Carroll, pediatrician, professor, president and CEO of Academy Health, and renowned science communicator, discusses the art and science of effective communication in healthcare. Learn how he developed his skills through years of dedicated practice at the Incidental Economist, to global reach at the New York Times. He reflects on the challenges of translating complex research into accessible content, and why building trust is essential for changing minds.

What You'll Learn:

• Why repetition and consistency are fundamental to effective science communication

• How to build trust through transparency, evidence-based reasoning, and admitting when you're wrong

• Why the academic publishing model limits practical applications of research

• The challenges of communicating during the COVID-19 pandemic and navigating controversial topics

• How to balance personal storytelling with scientific rigor in public-facing content

Some Takeaways:

• Science communication requires consistent practice and coaching, just like any other skill

• Academic research often takes years or decades to translate into practice, often due to communication barriers

• Many healthcare practices lack strong evidence, yet professionals often present all recommendations with equal confidence

• Building trust requires explaining not just what to do, but why it matters and the evidence behind it

• Personal stories can significantly increase audience engagement and build trust when balanced with scientific evidence

Where to find Dr Aaron Carroll:

• Twitter/X

• LinkedIn

In this episode, we cover:

(00:00) Introduction to Dr. Aaron Carroll

(01:00) Why science communication became his passion

(02:30) The gap between academic and public communication

(06:30) The limitations of peer-reviewed literature

(08:33) How to develop science communication skills

(13:16) Building trust through consistency and transparency

(16:43) Institutional approaches to science communication

(19:36) Addressing myths and biases in healthcare

(23:40) Challenges with clinical decision support systems

(28:33) Writing for the New York Times during COVID-19

(32:22) Navigating controversial healthcare topics

(37:00) The power of personal storytelling in science writing

(41:50) Balancing scientific rigor with accessibility

Referenced:

• The Incidental Economist: https://theincidentaleconomist.com/wordpress/

• Healthcare Triage: https://www.healthcaretriage.info/

• Academy Health: https://academyhealth.org/

• New York Times - Dr Carroll's articles: https://www.nytimes.com/by/aaron-e-carroll

• About Aaron Carroll - https://academyhealth.org/about/people/aaron-e-carroll-md-ms

• Dr Carroll’s Books

Contact information:

If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

Today marks an exciting milestone for the podcast — Clinical Changemakers is now on YouTube!

To everyone who has tuned in, shared, reviewed, and supported our journey - a heartfelt thank you. You are enabling us to expand to new platforms and reach more people.

And a special thank you to the Commonwealth Fund who’ve provided support to make this expansion possible.

Why YouTube Matters

For those wondering about this move: YouTube now dominates TV viewership (yes, even beating Netflix) and has become a preferred platform for discovering and consuming podcast content.

The video format offers an additional dimension that brings you closer to our guests and conversations - allowing you to see facial expressions, hand gestures, and the genuine moments of connection that audio alone can't capture.

Season 2 Starts Next Week 📆

Our second season launches next week featuring conversations you won't want to miss:

• How to Apply Network Theory to Healthcare Organizations - Transforming how we think about structure and people in our systems.

• Setting a Higher Standard for Hospitals - Elevating quality across the board

• Health Equity Success at the NHS - Practical lessons from the UK's healthcare system

• Entrepreneurial Success Inside and Outside Large Organizations - Innovation strategies that work

Plus many more thought-provoking topics with healthcare leaders worldwide.

Subscribe so you don’t miss a thing:

📙Substack

🍎Apple

🟢Spotify

Some Extras 📚

Books Currently Inspiring My Thinking:

• How Big Things Get Done by Bent Flyvbjerg and Dan Gardner — from megaprojects to renovating a kitchen, this book illustrates the key factors that determine whether projects succeed or fail.

• God, Human, Animal, Machine: Technology, Metaphor and the Search for Meaning by Meghan O'Gieblyn — a profound look at consciousness, nature, technology, and what makes us human in the AI age.

• High Conflict: Why We Get Trapped and How We Get Out by Amanda Ripley — an insightful exploration of how we can move beyond destructive conflict often based on an ‘othering’ of our fellow humans.

• AI Needs You: How We Can Change AI’s Future and Save Our Own by Verity Harding — a fascinating reflection on three recent technology revolutions and how these shaped society and lessons for our AI world.

Podcast Episodes Worth Checking Out:

• The Studies Show: Episode 63 - Philosophy of Science — a fascinating discussion about how we know what we know.

• Turn On The Lights: Combating Misinformation and Restoring Faith in Evidence-Based Medicine with Rich Baron— critical insights for navigating our information landscape.

• Money Power Health: Episode 4 - Commercial Influence on Science — exploring the many ways that commercial actors influence science, and what to look out for.

Help Us Grow 🌱

If you're enjoying what we're doing, here are a few quick ways you can help:

• Subscribe to our YouTube channel

• Share your favourite episode with a professional WhatsApp or Facebook group

• Rate or review us on your podcasting app:

  • 🟢 Spotify

  • 🍎 Apple Podcasts

That's it from me - for now! I’m very excited to introduce season 2 next week.

Thanks again for all of your support.

Cheers,
Jono

Listen to the podcast on Apple, Spotify, or wherever you get your podcasts.

As we wrap up 2024, I am excited to share some updates on my professional journey and the future of Clinical Changemakers.

Life’s Been Busy 🚀

2024 has been a year of growth and change. After returning to New Zealand from the US last year, we welcomed a new addition to our family - now balancing life with two under three!

Professionally, I transitioned to part-time General Practice, took on a new role as Product Manager of Aotearoa's Immunisation Register, and joined the Health Informatics New Zealand board. These experiences have been both demanding and rewarding, reinforcing my passion for improving healthcare systems.

Big News for Clinical Changemakers! 🔊

Thanks to the support from the Commonwealth Fund, Clinical Changemakers Season 2 is nearly live. It features inspiring conversations with globally renowned healthcare leaders on topics like:

• Science Communication with a New York Times writer.

• The Commerical Determinants of Health.

• How to scale clinical best practices across an organisation that spans 630,000 sq miles (the geographic size of France, Germany, Spain and the UK).

• Amazon’s One Medical Approach to Quality Care.

• The Failure of Problem-oriented Medicine.

• The “Headless” EHR revolution.

• Plus many more exciting topics.

We’re also expanding to video on YouTube, where you’ll find both our back catalogue and the upcoming season.

5 Lessons From Starting This Podcast 💡

Creating Clinical Changemakers has been an incredible learning experience. Here are five key takeaways:

1. People are generous. Guests have been remarkably generous with their time and stories, reinforcing my faith in our global collective potential to drive positive change in healthcare.

2. Content creation is hard. Behind each episode lies countless hours of planning, research, editing and thoughtful packaging to value the listeners' time. My perfectionism often clashes with deadlines, an area of growth for me.

3. Feedback is lumpy. Initially it felt like talking into a void, but when feedback did arrive, it came from unexpected people and places, offering kind and thoughtful messages. If someone makes something you like - tell them! It’ll make their week!

4. Authenticity is gold. The best moments often come from unscripted honesty and unexpected tangents.

5. Impact takes many forms. Podcasts can amplify ideas and spark conversations far beyond the reach of traditional research papers.

Podcast Growth 💪

With close to 300 subscribers, 3,300+ downloads, and listeners spanning 14 countries, we continue to see healthy growth. You have been instrumental in how we grow, so thank you to everyone who has helped spread the word!

Looking Ahead to 2025

I’m very excited for Season 2 to launch early next year. As I continue this journey, I’d love your support - please share your favourite episode with a friend or colleague. It’s the best gift you could give this holiday season!

Thank you for joining me.

Here’s to a great 2025!

"There is a lot of mistrust between the two, the private sector thinks about government bureaucrats who've done the same way for 20 years...the public sector talks about the private sector... who just want to make money at any cost... and they're both wrong."

— Dr Nirav Shah, Senior Scholar at Stanford.

Listen on Apple, Spotify, or wherever you get your podcasts.

In this episode, Dr Nirav Shah reflects on his early journey into healthcare, in particular how a patient error influenced his direct to focus on quality and safety, and how his mentors were a huge part in 'skip level opportunities'. Next, Dr Shah outlines how he navigated politics and responsibility as the Health Commissioner for New York State. Opportunities in digitizing processes, transparency and public engagement were way to effect change. Finally, we explore Dr Shah's experience working in the private sector and the need for bridges to be built across the public/private interface to ensure trusted relationships and a common goal. This episode is a treasure trove of enriching insights and inspiring stories from one of the key voices in healthcare. Don't miss this riveting conversation with Dr. Nirav Shah.

Follow Dr Shah: Twitter/X, LinkedIn.

About our guest: Nirav R. Shah, MD, MPH, is Senior Scholar at Stanford University’s School of Medicine. He is a distinguished healthcare leader with experience as an operator, scientist, innovator, and regulator. His expertise spans public health, public and private health insurance, and clinical operations across the continuum of care. At Stanford, Dr. Shah conducts research on improving healthcare quality and safety while lowering cost, driving adoption of digital technologies, and quantitatively evaluating the resulting value for US and international health care systems.

Additional resources mentioned in the podcast:

• Article - Doctors Petition for Limits on Painkillers

• Article - A Boy’s Life is Lost to Sepsis. Thousands are saved in his Wake.

Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music Attribution: Music by AudioCoffee from Pixabay

“You can be successful as an innovator, even as a physician or any other background you have, as long as you follow the process and really focus on the needs. That's the key.”

— Dr Josh Makower, Director and Co-Founder of the Stanford Byers Center for Biodesign.

Listen on Apple, Spotify, or wherever you get your podcasts.

In this episode, Dr Joshua Makower discusses his newest medical device approval Moximed and how his multi-disciplinary education of engineering, medicine and business has supported his successful career as an inventor. He goes on to highlight how clinicians and healthcare systems need to embrace innovation to solve some of our biggest challenges. Dr Makower puts forward how lessons working on innovation at Pfizer influenced the Biodesign approach to innovation. Finally, he covers the policy and investment landscape for progressing healthcare innovation.'

Follow Dr Makower: Twitter/X, LinkedIn.

About the guest: Josh Makower, MD is the Boston Scientific Applied Bioengineering Professor of Medicine and of Bioengineering at the Stanford University Schools of Medicine and Engineering, and is the Director and Co-Founder of the Stanford Byers Center for Biodesign, and Founder of Stanford’s Biodesign Policy Program.  Josh also serves as a Special Partner on New Enterprise Associate's healthcare team supporting their medtech/healthtech practice.  Lastly, Josh is the Founder and Executive Chairman of ExploraMed, a medical device incubator that has created 10 companies over the past 20 years. 

Josh currently serves on the board of directors for DOTS Devices, ExploraMed, Allay Therapeutics, Lungpacer, Moximed, Willow Innovations, SetPoint Medical, X9 and Coravin. Josh holds over 300 patents and patent applications for various medical devices in the fields of cardiology, ENT, general surgery, drug delivery, plastic surgery, dermatology, aesthetics, obesity, orthopedics, women’s health and urology.

Additional resources mentioned in the podcast:

• Moximed

• Biodesign at Stanford

• Book - Biodesign: The Process of Innovating Medical Technologies

Contact information: If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com

Music attribution: AudioCoffee from Pixabay.

If you haven’t listened to it yet, check it out on Apple, Spotify or wherever you get your podcasts.

The Mental Health Cost of a Medical Career.

When considering a medical career, it’s easy to imagine a fulfilling job dedicated to helping others.

However, few realise the true cost of such a role, where statistics paint a grim picture with greater risks of burnout, depression, drug addiction, and suicide compared to the general population123.

Nearly two decades ago, during one of my first lectures in medical school, the topic of our atrocious mental health was briefly raised, before we swiftly moved on to caring for others. It wasn’t until the COVID-19 pandemic when the public eye was focused on healthcare, that we were reminded of clinicians’ well-being.

While not new, burnout became the catch-all term to describe the feeling of an overworked and undervalued workforce. This went beyond mere stress at work; but a deeper, pernicious, feeling of overwhelm, cynicism, emotional exhaustion and depersonalization. Despite not being a clinical diagnosis, its interconnectedness with depression and anxiety highlights the significance of the experience.4

Some contributing factors to burnout are readily apparent, including burgeoning administrative tasks, chronic understaffing and constant time pressure. However, there is one often overlooked driver that threatens the very soul of the caring profession.

The Disconnection Between Values and Reality.

The story goes that people choose to pursue medicine because people wish to care for others. While this common trope is admirable - and no doubt true for many, it unintentionally implies that those who choose different paths lack the same compassion. Caring for others is a fundamental human trait, but not everyone has the opportunity (or luck) to express it through a healthcare career.

Most medical students enter their study, with limited firsthand experience of what it truly means to care for a sick person as a clinician. This means they are ready to be primed with the idealism of developing powerful clinical skills to make a meaningful difference in people's lives consistently.

Unfortunately, this is often unchallenged until the stark realities of work life expose a disconnect to be uncovered later.

As clinicians go through their careers, they start to collect experiences that force them to compromise their values and work. From discharging patients who have nowhere to go, to prescribing medications that a patient can’t afford, to keeping a patient in hospital because their home is unsafe, to patching up a wound that will get the proper follow-up care and so on. Each story chips away at that original idealism that once drew them into the field.

Moral injury arises from such painful stories. Ones where clinicians are continuously forced to operate within a system that prevents them from providing what patients truly need.

Over time, they internalise this unique form of psychological harm.

How Clinicians Respond to Overwhelming Odds.

Left unaddressed, moral injury often manifests as defensive medical practices, emotional detachment, and maladaptive coping mechanisms like substance abuse. Clinicians may restrict their sense of contribution, subtly avoiding particular environments, or patient cases as a form of self-protection. This can be illustrated by clinicians refusing to ‘take’ (medical speak for ownership) a patient who may be on the borderline of their area of care.

By controlling your contribution and care you minimise the risk of further moral wounds.

This professional cynicism can be a norm in some hospitals and medical cultures, turning altruistic intentions on their head. Behaviours that are antithetical to the mission of healing but are rational in the face of overwhelming odds.

Three Places to Address Burnout.

Addressing moral injury as a driver of burnout requires a multi-faceted approach that extends beyond individual mental health support resilience.

It necessitates a shift in the burden from front-line clinical workers to the decision-makers who can advocate for and implement systemic changes at the organisational and societal levels.

At the organisational level, healthcare systems must commit to creating and utilizing evidence-based strategies to reduce burnout. The National Institute for Occupational Safety and Health in the US offers a framework to help organisations address burnout, which includes six steps;5

1. Complete a Hospital Wellbeing Review.

2. Build a Professional Wellbeing Team.

3. Break down Barriers to Seeking Support.

4. Prioritize Two-way Communication.

5. Integrate Professional Well-being measures into ongoing Quality Improvement measures.

6. Developing a Long-term Professional Well-being Plan.

It is crucial to recognise that the healthcare sector alone cannot solve all of the moral injuries it faces.

And while a well-funded healthcare system is necessary, it is not sufficient due to the significant impact of the social determinants of health, which are the seeds of moral injury.

This requires healthcare leadership that is in relationship with other sectors to solve our common concerns - such as in housing and welfare.

Despite the aversion of many clinicians, political engagement and mobilisation offer a key opportunity to address the drivers of moral injury. While clinicians could be a powerful force, they are typically less likely than non-clinicians to participate in the public debate on how to fix these issues6. This creates a paradox, where if we truly dedicate our lives to improving the lives of others, then there is an obligation to contribute in some way to the public policy changes needed to better their lives.

In Eric Topol’s article ‘Why Doctors Should Organise’, he outlines a rallying cry around the common cause of patients and organisations who’ve taken the lead - while shaking off some historically self-interested activities.7 Action may start in the form of gradations of participation - such as simply joining advocacy groups or turning up to listen at a local community meeting.

The Key Takeaway.

Moral injury is a pervasive, yet often overlooked driver of burnout in medicine. It acts as a wedge between the idealistic values we should strive for in healthcare and the harsh realities of clinical practice.

When left unaddressed, moral injury inflicts profound harm on healthcare workers with devastating consequences for the caring professions.

To effectively tackle this crisis, systemic changes at the organizational and societal levels are needed. This requires courageous and compassionate leadership that spans outside the clinic. It is willing to be humble and embrace meaningful relationships with other contributing sectors. This also includes clinicians actively engaging in political advocacy, to share their unique personal insights and begin to address the root causes of moral injury.