The Edge of Healthcare: Antifragility: Learning From Difficulties In Healthcare

Martin Cody: Welcome to the Edge of Healthcare, where the pulse of innovation meets the heartbeat of leadership. I’m Martin Cody, your guide through riveting conversations with the trailblazers of healthcare. Tune in to gain exclusive access to strategies, experiences, and ground-breaking solutions from influential payer and health system leaders. This isn’t just a podcast, it’s your VIP ticket to the minds shaping the future of healthcare right now. Buckle up, subscribe, and get ready to ride to the Edge of Healthcare, where lessons from leaders are ready for you to use today.

Martin Cody: Welcome back, everyone, to another episode of The Edge of Healthcare: Lessons from Leaders to Use Today. And today, we have an expert in just about all facets of healthcare. But he didn’t start in health care. And I am thrilled to have on the program, Dr. Scott Ellner, because I think you’re going to want to learn a little bit about what Scott does today, but more importantly, how he got into health care. Scott, welcome.

Scott Ellner: Great to be here, Martin. Thanks for having me.

Martin Cody: Our pleasure. And I’m continually fascinated when I get the opportunity and really a privilege to speak with leaders that are in this space. It’s a very complex space. It’s a very demanding space. And I think nowhere is that more true than on the clinician. And I, and for clinicians, I’ll use physicians and nursing. But specifically, you, obviously, can speak to the physician part of it. So you didn’t really start out in medicine. And I’m curious what on earth, how did you get into healthcare, this crazy business that we’re in?

Scott Ellner: Okay, just to set a background. I grew up in Calabasas, California, near about. So I grew up surfing quite a bit, and one of my surf spots was Zuma Beach. And I was toward the end of my education at UCLA, and I was passionate about the environment, and I really thought I was going to go to law school to pursue a degree focused on environmental law and initiatives to help support the oceans. And there was a day where I was, had a great surf session, and I was walking back from the waves to my truck parked on Pacific Coast Highway. And as I turned to put my board into the back of my truck, I heard this awful screeching sound. And then I felt this presence roll up onto the back of my legs, pushing me against my truck, and as I looked down, it was a helmetless man who had just been struck head-on by a speeding car. He was on a Harley Davidson motorcycle. Motorcycle was probably 150ft away, and he was in bad shape. Clearly had a traumatic brain injury. There was blood coming from his ears. And at the time I was 21 years old. Didn’t know anything really about health care. And it just, it, I was paralyzed with fear. Except I just knelt down, held his hand. Literally within 30s, this car pulled over and this woman, very composed, she jumps out of her car and she runs over. And the lifeguard had just got there and he had a kit. She grabs the laryngoscope, as you all know, to intubate and intubates this guy right there on scene. And she saved his life. And it’s a story. I call it Angel on a Harley. He was a Hells Angel. He had a tattoo across his chest that said Hells Angels. And you could see it, the color fading in the sunlight because he was bleeding internally from hemorrhagic shock. But it was a moment in my life where I pivoted and I decided I want to be a surgeon. And this trauma surgeon who saved this man’s life really pivoted the direction of me going into health care.

Martin Cody: Wow. There’s a bunch of things in that story that are, that resonate at a cellular level and emotional level. And one of them, I think, is really profound. And that’s the kindness of strangers. This woman rolled up and, like you said, saved this man’s life. You knelt down and prayed with the individual. Three complete strangers and things took a different trajectory and path, all as a result of one incident and the kindness of strangers. Just absolutely incredible. So from there, you decided, forget the environment, it’s fine, nothing’s going wrong with the environment. Let’s go into health care. What was the next step from that incident to, okay, I need to learn about medicine?

Scott Ellner: Yeah. It’s not so easy to switch from a psychology degree to a neuroscience degree. So I did pivot. I had to take the MCAT, the medical admissions test, three times. I did end up getting a master’s in public health at San Diego State, but I eventually was able to get a spot in medical school and did well. I was very passionate, loved anatomy. Even though it was challenging. It wasn’t without failure and mistake, but I did well enough to go to UC San Diego and get a general surgery residency spot and then go on to work as a surgeon.

Martin Cody: Is there anything, you mentioned there were some mistakes. And I’m a big proponent of we learn far more from our mistakes than we do our successes. And I was, I’m curious if in looking back on some of the mistakes you made, were there any lessons that you pulled out of them that said, Okay, I’m not going to do this again or I need to prepare more, I need? What were some of the things that resonated with you and left an imprint?

Scott Ellner: Yeah, every experience that I think most of us have, there is a lesson to be learned and particularly understanding, to take time to reflect. There were moments within my general surgery residency, actually, where you feel like, okay, this isn’t going to be a long process. People in your, who are your friends, are in their 20s, they’re starting their careers, they’re starting their families. And I thought, I’m missing out. I’m missing out on these great things that my friends are doing. They’re making money. And there were times when I thought maybe I should quit. Maybe I should just go into something else. That would have been a mistake. And fortunately, I had people that I could go to, mentors, coaches, which I still use today, great coaches to say, Be patient, good things will come. And sometimes I act it out. Sometimes I did stupid things; you’re tired, you’re overworked. And from each of those mistakes, you learn to be a better person. Not just a better clinician, but a better person.

Martin Cody: It’s interesting you talk about coaches, and I think they’re, in my opinion, there’s a double standard there, or maybe even a hypocrisy that society has. Because when you think about any athlete, the coaching sessions of Michael Phelps swimming all those years are legendary, and many books have been written on him. You’d think any Olympic elite athlete, any musician, any sports, any golfer, they all have coaches. But when an individual says, I think I’m going to get a life coach or I’m going to get a performance coach on things in life, it is almost … like, oh, there’s something maybe psychologically wrong or what’s wrong, you can’t do it on your own. So I think we do ourselves a giant favor if we all just maybe even pursued having a personal coach from a development standpoint. Because when I talk to successful leaders and you just did it unsolicited, you spoke with coaches, you had coaches, you had mentors, and they’re the ones that have been there before and can lift you up out of these tough situations. And like you said, have some patience with yourself.

Scott Ellner: It’s so true. I’ll just share a little bit. My first CEO role was tough. I was green, I didn’t understand the dynamics of necessarily how to work with a board, but you shift from being a physician to now a healthcare executive. And I’ve heard this time and again with some of my colleagues who are also CEOs of health systems; it’s lonely. But to have a coach who is on the outside, most outside of the organization and who can give you a different perspective and can give you guidance as long as you’re willing to accept that; very powerful. And so I’ve been using executive coaches as a healthcare leader for about nine years now, and many of them are my friends. I do have a coach now for public speaking, and she gets on my case about you sound a little down. You got to raise up your voice or so. There’s no shame in having somebody giving you guidance. It only makes you better. So that’s why.

Martin Cody: And I agree, it only makes you better and more capable of serving the people you are intentionally serving in the career that you’ve chosen. I don’t understand why there is that double standard, but I appreciate your perspective on that. And I completely agree. And I talk a lot about persistence and resilience. And it’s funny because you mentioned, it took you three times to pass the MCAT. And was there ever a point in time where after the first one, you’re like, I didn’t get in, and the second one you think, okay, maybe I’m not cut out to be in healthcare?

Scott Ellner: Oh yeah. There were several times where you look back and you say the self-doubt starts to build and you say to yourself, maybe it’s just not going to happen, but there’s a part of all of us who we have this ability to shift our mindset. And I call it grit. And the other aspect of that that I like to use is also gratitude. But I’ll focus on grit for a second. A good friend of mine, Dove Barron, said recently that it’s not just about resilience, it’s about antifragility, which is, I believe, a term by Nassim Taleb. And when you fall, don’t just get right back up and do the same thing again. When you fall, reflect. Okay, what was it that I probably should have done differently? And the antifragility is really about not going back and doing the same thing over again. It’s about going back and learning from every single mistake and working on polishing those skills so that you get it right the next time, because we fail all the time.

Martin Cody: And it’s interesting. I’m a huge fan of the Antifragility concept, and carrying that a step further with regards to getting outside your comfort zone, because from an antifragility mental perspective, we need to get conditioned to embrace difficulties. Seek out the challenges. Ryan Halliday has a great book called The Obstacle Is the Way, and it’s go out and get the obstacles. Let them bring the obstacles to me. Bring it on because I know I’m going to be better on the other side of this obstacle, which is outside my comfort zone. And guess what? It’s going to be uncomfortable by definition because you’re outside your comfort zone. So I completely agree with the Antifragility concept. And I’m glad, and thankfully, I’m sure thousands of patients are too, that you took it a third time and went back into medicine. I want to pull on the string with regards to the public speaking of what you’re doing today. So how long were you in healthcare as a trauma surgeon, which is just unbelievably impressive. And what was the catalyst to say, Okay, I want to get into more leadership?

Scott Ellner: Yeah. I was practicing full-time for at least 12 years, sometimes 36 hours within the hospitals. The surgeons who are listening to this, they know. You don’t see your family during that time and you’re dealing with gunshot wounds, horrifying injuries. Some of them we can go into, which are amazing saves. And then even the deaths that occurred where you can actually help to donate life was fascinating. My passion for patient safety and leadership, which are really tied together, surgical quality, is what led me to pursue further leadership opportunities. I became very involved with the American College of Surgeons National Surgical Quality Improvement Program, and I realized that just telling people that you need to improve your processes was … You really need to learn the leadership skills to develop influence, to develop referent power, to explain the why; kotter’s change management principles. So it was patient safety and quality that led me to get more and more into leadership and ultimately to become a CEO of physician groups and a CEO of a health system.

Martin Cody: I love the CEO of physician groups and CEO of Health Systems dynamic, because they’re two distinctly unique aspects, if you will. So walk us through what was the biggest challenge in being a CEO of physician groups.

Scott Ellner: Wow. First off, I think for non-physicians who are working with physicians, I feel for them because many times the physicians will say, you don’t understand what I’m going through. You don’t understand my pain. Until you’ve clicked within Epic and the EHR 50 times for one patient, you don’t really understand the amount of administrative burden. So I think for the challenge working or having oversight of a physician group is to really ensure that the physicians feel valued for the work that they’re doing, both for direct care and indirect care. And the best thing you can do is to allow them to be, not allow them, but actually encourage them to be engaged in the organization’s strategic goals, to give them that strong voice, because they’re the ones closest to the patients, to actually improve on operations, improve on processes they know. Now, can you give them everything? Absolutely not. There is a delicate balance, but working with physicians is really inspiring them to feel like they are an important part of the operations and the strategy of the organization, not just the clinical folks.

Martin Cody: Yeah. And I think in that capacity you mentioned encourage them to get involved, inspire them to get involved. I also think the health system leadership has to enable them to get involved, because oftentimes, as I’m sure you’ve experienced, there’s things said from the ivory tower, but that doesn’t materialize in action. And the physicians, I believe over time believe and feel as if they’re just getting paid lip service and what their wants and needs and desires are isn’t getting the appropriate attention. So with that theme there, and then flipping your hat on to being CEO of a health system, how did you balance what you just described as what physicians need to feel valued as an executive of a health system?

Scott Ellner: Sure. And I’m going to share. I’ll be very, I’ll share a humility. I’ve been guilty of that. You say we need to do something, why isn’t it happening, without really taking the time to explain the why. And so, again, learning from those types of mistakes to be a better leader. One of the biggest shifts from being a CEO or an executive over a physician group to a health system, is that it moves from really focusing on the physicians to really caring for all the people in the organization. So now you really have to focus on 6000 employees plus who, and it doesn’t matter what department they’re in. These are people who are your priority. These are people you want to make sure that they continue to have a job. These are people that you want to make sure that they’re feeling like they’re making an impact in the organization, even if they’re not touching. So my shift really was about caring for every single person in that health system to make sure that they knew that their contributions were valued.

Martin Cody: And how do you do that? I love the approach. I certainly, I endorse it, but I’m curious what sorts of tangible. If someone is listening to you today who is in first, second, third year of a CEO of a health system and might feel the same way you felt early on as a little bit green, maybe a little cautious and tentative because of that greenness, what are some of the actionable things they can do today to galvanize the employees? And I’ll even take it a step further. You also have a responsibility to the community that you’re serving beyond the, say, 6000 or so employees.

Scott Ellner: Yeah, it’s a great question. And there was a book by Chris Van Gorder, I think he’s down in San Diego, that I read a couple of years ago, and he really talked about visibility and approachability. How do you do that? You take the time to get out there, and it can be uncomfortable. When you’re the leader, people look at you and they sometimes they expect you to be perfect. Many times they do. So my approach was to go out there and just show, hey, I’m just a good person. I want to get to know you. I want to understand what are your challenges. What do you love about your job? And it could be working with environmental services and understanding what is it that’s impacting them. Do they feel connected to the organization? So it’s really about the visibility and walking around. And sometimes it is incredibly uncomfortable because people will challenge you, especially today when there’s probably more and more incivility, people will feel more comfortable. They’ll feel more comfortable if they’re behind a computer screen and they’re anonymous. But some will actually be brazen enough to approach you and really share, give you a piece of their mind. And my approach is to not just, not respond right away, but to pause and really show them that I’m listening.

Martin Cody: It’s fascinating because you and I probably have read what seems about 50 of the same books, because the pausing, the reflection, the listening; all tried and true principles and strategies. And you also said it’s going to be difficult and it’s going to be uncomfortable. And that harkens back to what we talked about earlier. If you’re in a leadership role, especially over a health system, get comfortable being uncomfortable. And if you can flip that switch mentally in your head and not shy away from the discomfort, but actually approach the discomfort, because on the other side of this, that’s where the growth occurs, then I think you’re that much more effective as a leader and you can serve the doctors better, you can serve the employees better, you can serve the community better. But it’s not an overnight sensation or an overnight fix.

Scott Ellner: No. Absolutely not. It comes with some stumbling, some challenges where you’re going to have to check your ego. You have to remember your title means nothing to people. It’s not about your position, it’s about who you are. One of my coaches said it’s your brand or who you are is not about what you say, it’s what others say about you. It’s important to connect with people and to really avoid that ivory tower approach, as you had alluded to early on. And that seems to work. That seems to create a connection where people will say, Okay, this guy is, he’s decent. Yeah, I think he cares. Doesn’t happen immediately.

Martin Cody: And there’s all sorts of slang acronyms for what does MBA stand for. And the folks that I think get it like the acronym management by being accessible. And so you said that go out and be visible, be accessible. And we’re talking about leadership specifically, but I want to broaden the lens from a macro perspective on the healthcare system. And there has been so many changes from a regulatory perspective in the last five years, with even beyond the Affordable Care Act and now moving into the No Surprises Act, price transparency, good faith estimates, provider data. If you could wave a regulatory wand and sit down with CMS from a policy creation to enforcement, what would you want to do from high on from the top of the ivory tower, so to speak, to help improve health care?

Scott Ellner: Wow. Change the payment system. And first and foremost, one of my law school professors. Oh, by the way, I did go back to law school okay, later on.

Martin Cody: So impressive.

Scott Ellner: But one of my professors said reimbursement is not the same as payment. Reimbursement means that if you take out your team for lunch, your work, your employer will reimburse you for the cost of that lunch. In healthcare, we are not reimbursed the full payment. We are given a portion of that payment based on a physician fee schedule or an inpatient payment system. Yeah, there is a lot of work here that needs to be done to improve the payment system now. What I would do is, first off, I would fix the way that we get paid for services.

Martin Cody: Any ideas on how to do that?

Scott Ellner: Create a level of accountability for the patient on the adherence to their health. I know this is crazy. You asked me the ivory tower. When I was younger, I actually worked at a health club and I saw a bunch of people in the health club, and they were all on Stairmasters and they were all on their bikes and they were generating energy. And I thought, what if we took all that energy that those calories that were being burned and we put it into a system which collected that energy and it created, it commoditized it like carbon units and how we use that today for sustainability. And so I really think that if we can look at changing the payment system that’s beneficial for both the physicians, so they get paid reasonably and equitably, that’s beneficial to the health system, now, the insurers are always going to figure out a way to get paid well. They’ve navigated it. And that goes back to, there’s a whole history behind how the employer-sponsored insurance programs developed back in the early 1900s. But, and then the patients. Do we give patients credit or actually pay them some way to incentivize them to adhere to a regimen? That may or may not work. But I would really look at the payment schedule today, make it less complicated, the EOB or the explanation of benefits, and how that works. Let’s simplify this as much as we can to help patients navigate the health system. I know the transparency is getting better. We’ve got the 300 shoppable services. Let’s really make it as if you’re going to the mall or the grocery store or the mechanic, and you know what you’re going to.

Martin Cody: It’s interesting you say that because I’ve been in health care for 35-plus years, and a lot of it on the electronic medical record side, and trying to remove the friction and the inefficiency in it. And yesterday, I had a dermatology appointment and I was greeted, I’ve been going to this dermatology appointment or this practice for three years. Apparently every three years they want to update all the demographic information. Yesterday, I was greeted with a clipboard and 14 pages of forms to fill out. That, to me, is a clear sign that they aren’t putting the patient first, and they’re going to scan those forms in and never look at them again. That putting the patient first, I think, is first and foremost the single most important thing we have to do and decide as leaders. That’s funny. And I didn’t come up with this. Dr. Eric Bricker, who I interviewed for the podcast a couple of weeks ago, talked about it as well. And if there’s executives, if there’s clinicians, if there’s environmental folks at the hospital, the decision has to or the question has to be asked, how is this helping the patient? And if it’s not helping the patient, then maybe we need to think of a different route, because I don’t think we’re doing that enough. And so you just talked about it getting aligned with the patient, which I think would be a great first step. I don’t know how to put that into action. I would like to learn how. Maybe it’s more dialogue like this and then get it in front of some legislative bodies and groups to say, This is what has to happen to improve health care. Following up that and knowing how extremely difficult your position was and is, what does Scott do to recharge?

Scott Ellner: Oh man. So I do spend every single day journaling, reflecting on the successes of the day. It could be small things, like my son scoring a touchdown, first time scoring a touchdown, and reflecting on things that I could have done better. I do meditate a few minutes every morning, and I consistently look for ways to stay in better shape. Today at 54, I’m in better shape than I was in my 40s. And as I was writing about this, I took my daughter surfing a couple of years ago. And I used to compete in surfing, and I was good. I couldn’t even stand up on the board. And that was from several years of standing in the operating room, which, by the way, is ergonomically … And then sitting in a chair, and my hips were terrible that I couldn’t move. So I made it a point that I was going to go back and work on my mobility exercises, work on my balance posture, and so now I can get back up and surf again. And my daughter doesn’t think I’m a kook.

Martin Cody: Dad says he has to be good at this. He’s terrible at this.

Scott Ellner: Terrible. Yeah. So it’s really about focusing on working on your mind and stretching out and just staying active. Mobility.

Martin Cody: All great points and it’s amazing. As we get older those things become increasingly more important, for sure. I would be curious now that we’re at these seasoned ages in our 50s, what would you tell a younger Scott Ellner that today, that you didn’t know that?

Scott Ellner: The things that seemed really important to you back then, you will realize that in the grand scheme of things, it’s just a small bump in the road; if it’s a challenge, the breakup of a girlfriend, the crashing your car, I mean, hopefully, being not injured, making mistakes. Everybody learns from this adversity and it makes you hardy. It makes you stronger. My recommendation, though, is, and I actually did this with my son last night. My son, he’s 11 years old. He got upset. He was playing a video game and he broke his iPad. And he was so angry. He was so upset with himself. And I said, What can you learn from this opportunity? So what seems like a real serious problem for him, I said, you’re going to learn from this and you’re going to know next time. Take the lessons learned from the adversity that you’re experiencing today, because it will carry over and make you a better person, not just a better leader, a better person in the future.

Martin Cody: Yeah, I love it. And that’s that antifragility aspect coming back to as well. And those I think we all refer to those as first-world problems when you break the iPad playing a video game because it is a catastrophe, though to an 11-year-old, because that is their world. That’s great. All right. Let’s transition to this segment of the show called Word Association. So I’m going to say a word or a phrase and you tell me the first thing that pops into your head. Surfing song of all time.

Scott Ellner: Social Distortion ball and chain.

Martin Cody: Okay, I’ll be googling that after this episode. So is that a song you grew up with out of the beaches out in Southern California? 

Scott Ellner: Yes.

Martin Cody: I’m liking it. All right. Quadruple aim.

Scott Ellner: Oh, a reckoning. Oh, okay. I didn’t know you were going to have us go into. I think that it sounds good. It means well, but we really have to put in the hard work and not just talk the talk, but walk the walk. And I think we’re at a point in healthcare where the triple, quadruple, even quintuple aim, we need to do it much better. And health care is going through a reckoning right now, which I think means that we need to change drastically to serve patients better.

Martin Cody: Completely agree. And we talked about that walking the walk and talking the talk earlier. So it just continues to repeat as a theme. We have to make certain that we practice what we’re preaching. And that’s a great example of what you just provided. Prior authorizations.

Scott Ellner: Sad.

Martin Cody: Enough said. You don’t need to expand on that one. All right, let’s get to the funny question everyone likes. If you could sit down with anybody in healthcare, living or deceased, and have an adult beverage with them to pick their brain for an hour or two and a great conversation, who is this individual and what are you drinking?

Scott Ellner: Okay, first, what am I drinking? There was a good friend of mine, Cliff Coe. He’s a surgeon at UCLA, at the VA, also with the American College of Surgeons. He actually went on to become a Somm, sommelier. And one night we went out to dinner and he ordered wine. I would say that night it really impressed me. He ordered a Spanish wine. So I like a red, earthy type of wine. It does have a little hint of tobacco. So we’d be drinking a Spanish red.

Martin Cody: Okay, awesome.

Scott Ellner: And for me, in a weird way, one of my heroes who’s, he’s not living anymore, he’s an American surgeon named Ernst Codman.

Martin Cody: Like Codman, the instrument company.

Scott Ellner: Codman is named after a lot of things. Ernst Codman was a surgeon, and in 1911 he worked at the Mass General Hospital. And he was really a pioneer in patient safety and quality way back then. Right? This is before the Spanish flu pandemic. Codman, he was following all of his patients and he was recording their outcomes. Why? Because he wanted to learn. He wanted to get better. He had these reams and reams of data that he kept in boxes or Rolodex, we talked about Rolodex earlier. No computers. And he went to his department at Mass General, and he said, We should all do this. We should all share our data so that we can learn from one another. He was fired. He was dismissed from the medical staff because of fear of the public knowing the complications that surgeons face. And so he left and he started his own hospital called the End Results Hospital, and continued to pursue data acquisition and really focusing on improving patient outcomes. What that led to was the formation of the American College of Surgeons. It also led to what is now today the Joint Commission. So he’s really the father of quality and patient safety in health care. And at the end, results hospital is really how we look at ensuring quality within hospitals and health systems. So I would love to hear his story, what he went through and the history behind his focus on better outcomes.

Martin Cody: Wow, what an inspiring and amazing individual, and thank you for bringing that experience and that example to light, because I was unfamiliar with him as a surgeon. Was familiar with the Codman Instrument Company from back in surgical days. But that would be a fascinating interview. I’d like to be in an adjacent table and listen to that conversation, because there’s a lot of wisdom to glean from that conversation. Scott, thank you so much for sharing some very poignant ideas, philosophies, and strategies for how we in healthcare can all get better and improve. Today we’re grateful, and I can’t thank you enough for the opportunity to learn more.

Scott Ellner: Martin, it was a pleasure. Thank you for having me. And for those out there who are thinking about going into healthcare, either as a clinician or as a healthcare care executive, I think it is a noble calling. Please persevere. It’s hard, but in the long run, you’re serving the most vulnerable people in our community and it’s very meaningful, purpose-driven.

Martin Cody: Outstanding and completely agree. If someone wanted to get Ahold of you, Scott, how would they get Ahold of you to maybe have you speak or ask a question or just?

Scott Ellner: My email or on LinkedIn. My LinkedIn: just look me up. My email is SCE127@mail.Harvard.edu.

Martin Cody: Perfect. Thank you again for the time. I know you’ve got many things to be doing. We’re grateful for the opportunity to learn more, and I’m sure you and I will catch up soon.

Scott Ellner: Sounds good Martin, thank you again for having me.

Martin Cody: Thanks for diving into the Edge of Healthcare with us today. I hope these insights will fuel your journey in healthcare leadership. For more details, show notes, and ways to stay plugged into the conversation, head over to MadaketHealth.com. Until next time, stay ahead of the curve with the Edge of Healthcare, where lessons from leaders are always within reach. Take care of yourselves, and keep pushing the boundaries of healthcare innovation.