Leadership Lessons from a Surgeon General - Vice Admiral Forrest Faison

spk_0:   0:00
I want you to take a second and think back on all of the clinical rotations you've ever had. Who was your attending physician on those rotations? Can you remember them? The people you're picturing are probably either some of the best leaders you've ever had or some of the worst leaders you've ever had. Those are the ones we tend to remember. So I have a question for you. Which one do you want to be? Do you want to be the leader who inspires your staff and your students to achieve great things? If so, you are going to love today's conversation. I'm talking with a physician who has led men and women through wars pandemics and has always maintained a grip on what's important helping his patients first. You are going to love this conversation. Let's kick it, Theo. Welcome to the scope of practice podcast, where we help busy healthcare professionals learn to manage their businesses successfully in master their personal finances. Now here's your host, Dr Brent Lea Si. Hey, everyone, thanks so much for joining us for Episode two of the scope of practice podcast where you can gain the knowledge and resource is you need to manage your business more successfully and master your personal finances. If you haven't already subscribe to the podcast, please make sure you go ahead and hit that subscribe button right now so you don't miss out on any of the amazing upcoming episodes. Also, make sure you stay tuned to the end of the show and you'll hear about the free resource is that I'm giving away to our listeners this week to help you become a stronger physician leader. You'll also get to hear my conversation with this week's featured online community. Military H PSP students and physicians. My guest today is the recently retired U. S Navy Surgeon General Vice Admiral Forrest. Phase on. He spent his 30 year career in the Navy, first as a pediatric neural developmental specialist before moving into executive medicine and eventually leading all of the Navy Medical corps. As its 38th surgeon general. He has had an amazing career. He's been leading the men and women of the Navy and Marine Corps through some incredible hardships, such as wartime combat hospital operations as, well, a six pandemics. This is a phenomenal conversation you're about to hear if you ever wanted a free masterclass in physician leadership. This is it. So it is now my honor to present to you my conversation with retired Vice Admiral Forrest face on. Um, I'm very excited to welcome Teoh. The scope of practice podcast. Very distinguished guest. This is retired U. S. Navy Surgeon General Vice Admiral Forrest. Phase on animal phase on. Thanks so much for joining us.

spk_1:   2:46
Thank you. Thanks, Brennan. Zahra proves you to be here.

spk_0:   2:48
So, Admiral, you spent several decades in the military, first as a pediatric neuro developmental specialist, then as commanding officer and several roles, and eventually a surgeon general of the Navy. And that's a pretty amazing career. By any standard. Are there any times or eras in your career that stand out to you is the most enjoyable or having the greatest impact?

spk_1:   3:10
Yeah, that's that's a great question, Brian. I think, um, there's several. I think I've been most proud to be in American when I was commanding officer of a combat hospital in theater. Uh, because we were taking care of fair number of casualties. These were all men and women who had volunteered to serve their country. On day, I looked at my medical team. Aziz. Men and women weren't in it for the money. They weren't it for the fame before they were in it to help people on helping them in a very austere, challenging time. I think may be very proud to be an American, to see the great things they were doing. I was, You know, you're going to mess it to help people. I was exceptionally proud of my opportunity. Teoh, leave the medical response to both the Haiti earthquake in the Fukushima disaster in Japan, where we took the hospital ship for Haiti that had a big hole in the side. Because we're replacing the C T scanner in a period of 48 hours. Only that's that whole staffed and provisioned that shifts of that ship could get down to port a prince five days ahead of schedule to start saving lives on. And I just watched the men and women that we're doing that just I stood back in awe when Fukushima happened. We didn't really have good good radiation monitoring capability, and you can imagine being a young young sailor, their spouse with young Children on, and they're worried and so we arranged for anybody that want Teoh, uh, to leave country. So we evacuated 7000 people over about 48 hours back to the United States. Pretty proud of that. But most challenging was a surgeon general because we came home to a country that was very grateful for the things that military medicine was able to dio Way had the highest combat survival in history. Many women who would have died in any previous conflict came home to their families, and we came home to a country that was very focused on the cost of health care. And so there were dramatic changes on a scale that we've not seen in 50 years to basically modernize and reform health care. But really no good articulation of what success? Waas. And so my whole challenge during my time as a surgeon general was to make sure we didn't break something that we're gonna need for high combat survival in a future conflict. That was, I think, my most challenging experience. It's been a great career.

spk_0:   5:37
Well, so for our listeners who maybe aren't so familiar with military medicine, I'm gonna give a little bit of background here. So after you've advanced to the rank of captain in the Navy, which would be the equivalent of a colonel in the other branches. You have an option of either going into an executive medicine track and onto, ah, the Admiralty or remaining on the clinical side. And I think probably most of the docks that I've met me and Grant said, I'm not an executive medicine myself. So most of the ducks that I know have elected to stay on the clinical side. So I'm curious what made you decide to go into executive medicine.

spk_1:   6:13
So So, you know, I think I think I was probably as surprised as anyone. So I was a general pediatrician at the Airbase in Fillmore, California, and then went on to the University of Washington to do a fellowship. And I did my fellowship in neuro developmental pediatrics and what folks may not realize. Because the department defense stations service members all over the world, their families are all over the world. And so D. O. D. Runs a school system for their families overseas, and about 2 to 3% of Children it everywhere will have some degree of either learning disability or some sort of developmental disability. And so, after completing my fellowship, I went Teoh be station in Japan, where I was responsible for, ah, developmental services for Children throughout me in Japan. And I love that I had a great time. Do what I love taking care of those Children and their families. And I had no intention of going into executive medicine except the medical director of the hospital left. And I knew the CEO wanted me to be the medical director, and I was a lieutenant commander of the time. I don't want to do that because that was pushing papers. Now, don't do that. So I avoided this guy for, like, five days where he waas. I wasn't. Except one day I was walking down the hallway and I ran into him. And since then, come with me. There's Admiral level at that time, Captain D s. And he says only the medical director will use your boss. What do you say? Yes, sir. I'm happy to do it. And you looked at me. Go. This is gonna change your life forever. And I believe at the time said, Yeah, but he was right. And so you know I think I think that was the biggest surprise. I did not intend to do this.

spk_0:   7:54
Was it hard giving up her clinical practice?

spk_1:   7:57
What? You know, as I got it, I see clinical as long as I could. Um, so actually, up until the time I was a deputy commander at Portsmouth, I was so clinically active, but but But there came a point where, especially in my specialty of Nirvana pediatrics that these air high need families and high need Children. And I just wasn't available to them because of my other responsibilities. But up until that, and so I made the decision toe to know Stay clinical after that. But up until that point, I had been clinical throughout my career. But as I got more senior, I realized that executive medicine, unless you take care of people, but in a different way. You know, I don't wear a lab coat or have a stethoscope in a matter of bedside one on one. But I'm taking care of a lot of people on. As a surgeon general, I was responsible for the 67,000 men and women of needed medicine who in turn took care of the 2.6 million people that we care for around the world, so I'm still being a doctor just in a very different way. So So it was a difficult transition. But as I got more senior, I realized I was making a difference in in a way I could never have done otherwise.

spk_0:   9:04
That's great. And like you said, we get into medicine, toe help people and sometimes that looks differently, as we as we kind of advanced, move along, maybe we find that like he said, moving into executive medicine or looking into, ah, you know, policy making or advocacy. There's lots of different ways that we can start to make a difference and and really continue to serve our patients. But just in a different leadership role. When you went into executive medicine, did you find that your prior experience as a clinician gave you credibility? Or did you noticed a shift in people they started to say, Well, now you're just a suit or, you know, your you know, Now you're kind of on the other side of things.

spk_1:   9:44
Yeah, that's a that's a great question. I think being a clinician gave me a lot of credibility because I've been there. I understood what the issues were. You know, medicine is complex on and you have to understand the different complexities and where things are challenging and where things do go wrong. And I think being a clinician before I went into executive medicine, Gaby, that credibility. But, you know, I think what was gave me even more credibility is a commitment that no matter what you do or where you serve or, you know, if your medicine, you're in it for the patients on. And I made it very clear that that every decision I made the patient was gonna be at the center of my thinking, A Z, You get more senior things get much more complex, and it's really easy to get distracted by different agendas, different, different things that are pushing things around really true. North is keeping the patient at the center because if you don't, you don't take care of the patient and make sure that we got what we need to take care of. The patient then really got asked, What are you doing? Eso I found that people understood that and so credibility wasn't wasn't an issue for me.

spk_0:   10:52
So one of the things that I coach, my residents and my students on is that competence is critical to establishing your credibility. And your authority is a leader because, at least in the military, I know this is true. But I think to a certain degree on the civilian side as well that in order to advance, you have to not only be a good doctor, you really have toe. Um, I want to say, pad your resume, but you really have to go after some of those collaterals and look for leadership roles. And it's, I think, generally true that the best clinicians aren't necessarily the ones that promote but rather the best people have the best resumes, I guess, for lack of a better term. But But I find that if you're not a good clinician, people won't follow your leadership in other areas. And you know the kind of thing that you'll hear people say or they'll think is you know, well, he's not a good doctor, So he's probably not good at leading doctors. You agree with that?

spk_1:   11:42
I absolutely agree with that. Yeah, If you're not a good clinicians, you have no business leading clinicians. So So what? I tell people that the folks that I mentor go on home your craft, complete your residency, go out and do a utilization tour. You know, if you train is a pediatrician will be a pediatrician. Get your board certification, be good at your craft, and then look at other opportunities. Look at how you can make a difference in other ways on get involved in those things because I'm a big believer. Medicine is so complex with such an uncertain future. We need good clinicians. But they gotta be clinicians who have perfected and home their craft. They're good at what they do. They understand our clinical medicine is provided. And then they went into leadership positions.

spk_0:   12:30
Well, and sometimes sometimes showing confidence is a simple as just showing up on time and being ready toe work. I remember you were telling me a story of one time about ah, particular intern that showed up and ah, didn't really have that locked down and had some uniform issues. Had to get dressed down by his chief. Can you share that story with us?

spk_1:   12:50
Absolutely. This is a picture. You're only as good as your presence. You know, in the military, you know this as well as ideo. Your credibility is tied to your military barren. You could be the most the most accomplished best doctor in the world. But if your shoes look like crap or your hair isn't kind, you have no credibility with the crew and they're not gonna trust you. Ah, and that's true. Whether you're civilian or in the military, you have to look the part. You have to act with presence and basically be able to command respect. So So when I was a resident, San Diego, the pediatric clinic overlooked the front gate of the hospital, and I will never forget there was this intern that came through the front gate that didn't go to the course that we all go to the water, not put on your uniform and all that stuff. He just wants to the uniform shop. And so he bought an admiral's hat and everyone shoulder boards and Chief Shankar's and a bunch of ribbons and white shirt, black shoes and white pants and the whole bit. And he thought he looked really good and he looked ridiculous. And the chief standing guard at the gate kind of watched this guy and pulled him aside and said, Son, let me tell you how you dress And that was probably the most important lesson that Inter never got is he would have had no credibility. And if you don't have credibility, you can't leave

spk_0:   14:10
so kind of Teoh. Stay with that for a second. What role do you feel like a team plays as a leader? Do you feel like it's really critical to have a good team behind you? Or are there times when you just kind of got to do it all yourself?

spk_1:   14:24
Yeah, that's a great question. I will tell you to two things I've learned. Wonder what medicine is incredibly complex. You can't know it all, Uh, and so you've got to be able to function as a team that's reporting my specialty. No developmental pediatrics. We take care of some incredibly complex folder that have got multi disciplinary issues. I can't know it all, So I worked very closely with the PTSD. Ot is the psychologists and others team they self care is really the best health care that we can provide. Number one number two is the more senior you get. But Mawr, things are what I call gray. You know, everything that was black and white, pretty straightforward. Somebody else saw by the time they get to your level is a senior leader. It's gray, and there's different ways you can approach it in different possible courses of action. Different solutions. You've got to surround yourself with what I call people who are smarter than you are, and they give them what they need to get out of their way. S. O. T. Based Health care is essential for the future.

spk_0:   15:25
Now, when you're leading a team, especially in a setting like the military or in a residency program where there's a lot of turnover, you've constantly got new people coming in. You're constantly having to train new folks. You're kind of in a training mode all the time and having to reassess your team dynamics as new people come in and old people leave, and that can be challenging. But do you see that as ah benefit in terms of, you know, constantly having to reassess and improve your processes? Or is it just an unnecessary hassle that you're just never quite getting to where you want to be

spk_1:   15:57
now I see it is an absolute bath for several reasons. Number one is you get new blood, new perspectives. That's always good. You know, if it's same people at the time after time for a long time complacency, crude said. And complacency is dangerous in medicine. So So I see fresh blood, new perspectives coming in all the time. As as good number one Number two is occasion, opportunity trained people. They're going to take the place. You know, medicine is only partially learning blocks. It is is an art that is passed on from generation to generation. And having new people come in allows you to groom those people that will one day take your place. I think Navy medicine is a perfect example of this. You know, I look across the street in Cleveland clinic. They have about a 2% staff staff turnover rate. Navy Medicine had a 28% staffed for noble rates in about 40% of our team have been on a high school less than five years. And despite that fact, numerous study shows that we gave here that was on a par some of the best health care institutions in the country. I'm not talking about the run in the middle hospitals down Street. I'm talking about Cleveland Clinic Sloan Kettering Memorial Hermann, all of the top institutions in the country. Navy medicine had outcomes that was crumpled, that despite a high turnover rate despite a young age routine.

spk_0:   17:21
So how do you motivate people as a physician leader?

spk_1:   17:26
Yeah. So nobody Nobody goes into medicine except to help people wanted medicine to help people on dso You motivate them by appealing to that in helping them realize that they were bigger, that they're part of something that's bigger than themselves. So So when I was a surgeon general, every talk I gave every speech I gave, I always talked about what I expect of you and to help people understand They were part of something that was bigger than themselves. It wasn't the day to day grind and the end of the patient that was important with the effort of once they were apart, the team that they were part of whose bigger than themselves. So I had to re expectations actually with that. And then I do this for every speech I gave the surgeon general, and the first was to be worthy of the trust that's been placed in our hands. These were privileged to care for the less than 1% of our nation that will volunteer to sacrifice and serve but to defend our freedom. And every one of them and their families back home on and their families with them are hoping, praying and depending on us to provide them the best care our nation can offer and one day return them home safely. So I talked about what that meant. I talked about the worthy of the uniform. You aware of that uniform represents not only honor, courage and commitment, which are Navy core values. It represents hope and carry in compassion and life for countless thousands whose lives have been saved or change or approved by those who went before us. We carry on that legacy, but wearing that uniform and then I talked about to be worthy of the privilege of leadership. I tell people leaders don't sit on the mountaintop and think great thoughts and some Hubble work. It's done down below meters, air down there walking the deck plate. They know what's going on with their people they're cutting through red tape, getting them the things that they need to do today. Get the job done today and preparing them for the responsibilities of tomorrow. That I told people that think you wore on your collar is never a look how great I am. It's a tool that you use to help the people, that your problems to leave and by talking about those expectations. I hope people realize you're part of something bigger than yourself here, and it's a lot more than just the day to day health care that you give. That's important, but what's more important is what you mean and what you represent and what the future means. And your part in that

spk_0:   19:46
No, that's that's so huge. I think that's really important that we keep in perspective what trust has been granted to us in the form of ah, this leadership expectation and that, you know, we really see it as a calling, I think not as ah position. I'm fond of the saying that Ah boss has the title. A leader has the

spk_1:   20:08
people exact. That's exactly right, you know. That's why I think it's so where you and I talked about earlier to have that have that experience. You know, when I was in theater in that convent hospital, I would look in the eyes of these casualties that would come in these I E. D victims and see in their eyes this trust a document Get me through. So I go home and see my family aren't yet. You know, that's a trust that's put in our hands every day, whether in the military or anywhere. If we're in the profession of medicine, every day a trust is placed in our hands and it's up to us to be worthy of that trust.

spk_0:   20:41
Well, and I think that's true, even even when you're not in the military. Um, you know, if we've got someone who's coming in and we're just tired, we're having a bad day, you know, that something I was told in med school is that you know, however, about a day you're having, however tired you are, however, fed up you are. Just remember, the person that you're taking care of is having a worse day than you.

spk_1:   21:00
Yeah,

spk_0:   21:01
um, and I think having that attitude is really important. So in thinking about that when you have a team members that maybe they've got attitude problems or they're just they're not quite getting the job done or they just aren't bringing it every day. Um, what's your strategy for getting those people back in line? I mean, do you Do you work to rehab those folks? Or is it you just, you know, fire him and find the right people toe, get the job done? I mean, what does that look like for you?

spk_1:   21:31
Yeah. So, you know, I'm a big believer. Nobody goes into medicine intentionally to do a bad job for people. So people are having a bad day or of lost focus or having difficulty to understand why, you know, I'll give you a perfect example of this. When I was a surgeon general, I used to get called frequently by the dean at the Uniformed Services University about different students, that we're having difficulty. And he called me this one day about this one student that that actually was was on academic probation, had failed twice, and they were getting ready to kick kick this young man out. And I said, Well, tell me a little bit about him. Well, you know schools in the chest up, he says. Well, he's living up in, uh, Hagerstown, which is like an hour and 1/2 away, and said, Well, there's your first red flag So what's his finances? I don't know. I said, Well, nobody lives in Hagerstown and he goes to school but fessed up unless they can't afford to live about that stuff. So what's going on? What's going on with this family? Who's got 444 kids? Are they in good health? I don't know. Turned out one of his kids was having refractory seizures. So here's a young man that was worried about his son, her star, who can afford to live closer to medical school. I said, I'm amazed that that he's lasted this long. Let's get him into financial counseling. Let's get him some family support services. Let's make sure his daughter is getting well taken care of. And I was proved before I retired to shake that young man's hand

spk_0:   23:01
Well, and those are the stories that you remember, right? I mean, the stories of the great redemptions and the ones that you know, you kind of pulled him out of the fire. You snatched defeat from a snatch victory from the jaws of defeat. That's that's awesome.

spk_1:   23:13
So you understand there's There's usually a reason why somebody is not performing well. So find out what that IHS. Now, if you do that and you address that, they're still not performing well, that then you have what I call the come to Jesus talk. Why in medicine, how can we help you? Here's what I expect of you. Here are some discreet, definitive, objective things that I expect you to do. Um, And if you don't do it, then I'm gonna need to look at other options because I'm a big believer before you pull the trigger and somebody ought to tell when your expectations are given a chance to meet those and as they can, the most important job of leaders never be afraid to make a change, because that's what people expect.

spk_0:   23:54
Well, I know we're experiencing a time of great change at the moments. I mean, the cove in 19 pandemic has just up ended the economy. I mean, it's the largest economic crisis that we face that least on the last half century. Perhaps, you know, since the Great Depression I mean, it's just it's just practically unprecedented. Now is a war veteran. You've had a leading crisis before, so how do you do it?

spk_1:   24:16
So this is my sixth pandemic that I've been privileged to be part of the leadership response for their complex, their complex. They're scary on DSO. Here's what I tell people. And this is the advice that I gave gay folks off that I spoke with recently. First and most important, focus on the patient. What does the patient need? Uh, make sure that you are dealing with the things that are necessary to take care of the patient, cause that's what this is all about. The second is the job of the linear is you've got to think on the horizon. You know, it's really easy to focus on today's prices, and that's important. But you've got to be thinking down the road. What on the horizon? What does this look like? A head and you've got to be thinking about second and third order impacts and consequences. Perfect example of this Daniel. Laters. National short of the ventilators. So I was worried about the ventilators, which is important, but then you think about Okay, who's gonna run those ventilators? Were the restaurant technicians? Do we have enough respiratory technicians to go to run those ventilators and were given thought to that? Were we doing about that on in? This virus, in in particular, has been very predictable. So So if you look at, how did it spread? It came into the A ports of entry, and it spread via the airline routes in the airline hubs. There's a reason West Virginia, with the last state to have the had the virus because people, by and large don't fly there. But they fly over Russell. We've seen this happen, and and then the virus has not mutated that much, so it's been very predictable on the populations at risk in and the severity of disease. What does that mean? That means you ought to be able to do predictive supply chain management. You want to be able to predict where is this thing going to go next? And preposition supplies and personnel so that when the virus does show up, you're ready to respond instead of playing catch up. If you get into a catch up mood, you'll never catch up. And so the job of the leaders to think on the horizon. Where is this going to go next? And what are the second and third order impacts that we need to be thinking about? Ventilators? Restaurant technicians? What's the nation's oxygen supply? Things like that you could be thinking about 13 you need to go to do is calm fear. You've got to be able to calm fear because people are worried about this. And that means getting out there being seen and talking to people. E mail is not a tool of leadership. You've got to get out and talk to people and understand what they're going through that you have to be seen where that and and then the fourth thing that you do, which may be the most important thing, his creative vision for the future. People have got to be able to see that there is life beyond this. The example that I use that I could quote frequently is thicker. Uncle Aziz, you probably know Victor Franca was a Jewish psychiatrist that was practicing in Vienna at the Africa World War two must put into Auschwitz, and focal made a distinction between those, um um in intricate Constitution camp inmates, Um, in Auschwitz there was a group that that were able to survive and get on with their life. And there's a group that just gave up. And he noticed the difference between us to with those that survived had a vision for life after Auschwitz. And he noticed that in all creation on Lee Man could look to the future. That's true. And the job of leadership is to create that vision. So people have hope. So those are the four main jobs of a leader in a pandemic response that I say

spk_0:   27:53
so as a leader. How do you cast that vision? I mean, is it something that you just collect all the data and come up with something and then go and tell your team I figured out what we're doing? Or are you seeking input the whole time and trying to, you know, figure out what the consensus already is? I mean, are you? I guess I would ask, Are you seeking consensus or you molding consensus?

spk_1:   28:15
Yeah, that's it. That's a great question. In terms of a response like this, it's important to create that vision. So So I say is the leader of the Cleveland State University Pandemic Response Team. The students can we care for our two served largely underserved urban students that air sacrificing a great deal? Teoh get their education so they can get a better life for themselves and for their families. They need to have hope that the university is gonna be there for them. Now, when all this is done, we're gonna go back to classes and we're gonna help them get their victory and get on with their future. I tell students that your future starts today. Yeah, we got a little hiccup. You're doing classes a little differently, but just future is still your future. This is not going to impact your future and help them see beyond this prices when it comes to change in medicine, medicines undergoing incredible change. Right now, everybody thinks while you just you're the leader, you just stick, take what you want, it don't happen, and that's that. That never happens. I would say in the 10 years that I was that an admiral, I never gave an order because I realized that if you don't have consensus, your vision only last until you leave and that's not how sustainable change occurs, so you've got it. Build consensus, give people credit for things When things don't go well, fly top cover. Take the blame. But if things go well, give him credit. That's the job of the leader. Create the vision, Create consensus. Building elaborate means you really need to get out of their way.

spk_0:   29:44
One of the things that I've seen in the crisis is that, um in one sense, I think it's easier than perhaps leading in non crisis times in that there's a very clear mission. There's a very clear objective. The goal is, get through the crisis, fixed the underlying problems. And then in non crisis times, you know, I feel like there's a lot of different competing objectives. You know, it's there's there's just a hodgepodge of things that everybody is concerned about, and you're trying to address all the things at once. Do you think it's It's harder to lead during peace time as it were, or non crisis times are harder to lead during crisis times? Or is it just hard in a different way?

spk_1:   30:25
Yeah, it's just they're different. They both bring their own challenges that there's no doubt that, then, in a crisis like this, everybody is oriented to what, what's important, which is saving people's lives and the crises you're dealing with our supply chain management, getting supplies you need calming fear, all the stuff I just talked about. The other thing you deal with. This is what I call the psychology of 10 dammit, because people will reach out desperately and trying to hold on to some degree of normalcy is the world around them is changing and they feel out of control. They will try and grasp on to some sense of normalcy, which is good unless it's inhibiting what you need to get done. So some, for example, in a large organization, some people will grab onto a sense of normalcy, which involves processing things as usual when you need agility and rapidity to response and things like that. And you just have to understand these people are being obstruction. A secret war aren't being bad. They're just trying to hang on to something that is brings them comfort. And so you're dealing with that in times of peace that those are not as big an issue. What becomes a bigger issue is politics in all the other agendas that people deal with, Um, those fall to the wayside in a crisis. But those air supplanted by other challenges

spk_0:   31:47
in your career. I mean, you've had opportunities Teoh work with, ah congressional leaders with, you know, folks on Ah, and you know, the upper echelons of governments and the military. And so I imagine you've had the chance of study at the feet of a lot of masters, and I I'd be curious to know what do you feel like is the best leadership advice that you ever received from someone?

spk_1:   32:09
The best advice I ever received was you never stop learning as a leader read incessantly. You know, I travel a fair amount. I've got an iPad with the Kindle app when I've got any time About 70 books on there. Most great new ideas for medicine come from outside of medicine. You know, you'll remember. We did this inside, maybe medicine where we had, you know, medicines and are. And sometimes things don't always go well. So how do we How do we deal with that? We do root cause analysis. We generate a report, it gets put on the shelf and nobody reads it. So said, Meanwhile, we look at the at the aluminum industry. Alcoa has 1/10. The safety accidents is anybody else in that industry cause they do the swarm and basically bringing together. They talk about it within an hour, then six hours of goes to the plant manager within six hours. After that, it goes to the regional director and within 24 hours is that it's at the desk of the CEO and then pushed out across across the Enterprise. We brought that swarm. So how we did patient missing patient of events and patient adverse outcomes on we cut adverse outcomes in meeting medicine by 93%. So read incessantly is invested by, say, I think I ever got The best lesson I ever got from a mentor was when I was 1/4 year medical student at uses, and it uses she have to do this course called Bushmaster, where they basically they've taken up in a plane down to San Antonio at the time, take you out into the field and your run basically a MASH unit for two weeks under different scenarios. Now I'm a big fan of camping. There's a reason God made room service. So I I like I avoided this as long as I could, but I had to go and we flew down there and, uh, the plane opened up and it was pouring down rain. And my mentor at the time was Lieutenant Commander might count who later on went under Trump by several nights, my cow And I said, We're going to be OK, you aren't read up the officer's quarters and he laughed and he took us after these tents. They were Lisicky. It was rainy and his buddy. And then for the next two weeks, for very little sleep, we ran these mashes. They taught us that the mass casualty disaster response. But by the end of this thing, you're just tired. Your wet, your hunger, you're cold. You want to be anywhere but there. And we had the mask, the big mega code, if you're well, um, and during the hot wash of this, he's talking says, Hey, you're cold, you're wet, your tired, your hungry. Why do you do it? That's a That's a great question because because that guy in the structure and you stand back, Homer, depending on you to do it. And I forgot that lesson. Brent, I was cold. I want to get out of there. So where's the pizza? I was promised. I promptly forgot that lesson. Ask forward. 21 years I was I was engaged surgeon with the Marine Corps. We were on an exercise in Australia in the phone rang one day, and it was one of my medical officers up in the northern part of the camp. Yeah, who told me about this Marine that had developed acute shortness of breath And you know as well as I do when you've been a doc long enough, when something doesn't sound like it's probably not right and this just didn't sound right. I said, Hey, bring this marine down. Let me take a look at it. Best decision I ever made my life. Three hours later, we were intimating that Marie, where the most rapidly progressive pneumonia I have ever seen in my life there was nothing. All we had was a was a field hospital with a pretty rudimentary ventilator. But about an hour outside the training area was this little tiny sheep town that had a lot to bed. I see you with a better ventilator than I had. So we made this Hail Mary run to put this. Get this Marine there, Put him on this ventilator and this doc from South Africa and I took turns four hours on four hours off to take care of this kid. And despite our best efforts, we put him on every any fungal antibiotic any viral that we could find. Despite our best efforts, this young race continued to get worse. And also, we started going toe multi system organ failure. And I made the most difficult call in my life When I called his parents back in Texas and I said I told why Waas and said your son's gonna die. Uh, it just it was I will try and keep him alive until you can get here to say goodbye, but no promises. And I hung up the phone and just sank in the chair and just wept. You know, all the training, all the all the all the study and I couldn't even state in 19 year olds life. It was a real low point for May, and I remember, for reasons I can't explain to this day For whatever reason, Cowan's works came into my brain at that time and said You do it because that guy in the structures depending on you to do it and it Stanley back home and I got renewed energy and went back out, and we started taking care of this guy took the family three days to get Australia. But in that time, that Marine start to get better, so that by the time he got Mom and Dad got the bedside, we were actually excavating yet and he reached up and he looked and he said two words. I never thought I'd hear him say my mom and we packaged him up, got him stabilized. The Air Force came to pick him up. I went with them to get make sure got on the plane. He got out of there. Ondas were walking up the ramp to the plane. Um, that young Marine grabbed my hand and looked into my eyes and he said, Thanks, Doc and I couldn't say anything, so I was so choked up I really couldn't see because of the tears in my eyes. I still get emotional about it, Um, but that made it all worthwhile for me. That simple lesson in that field in Texas, back when I was 1/4 year medical student about why we do what we do made all the difference. And I've never forgotten that throughout my career.

spk_0:   37:51
That's amazing. That's definitely one of those life changing stories that you just it changes you and just never forget it.

spk_1:   37:58
Yeah, yeah, that's exactly right.

spk_0:   38:01
So for the physician out there who's, uh, not sure what they want to do And they're they're thinking there's ways that they should be changing the system or they wish the system was different. You know, what advice would you give to that person? As faras um, how do they go about trying to make themselves ready for those leadership roles? And what kind of quality should they be cultivating? What kind of experiences should they be seeking?

spk_1:   38:26
Yeah, that's a That's a great question that, you know, I have the problem of mentoring a lot of a lot of young positions who are just starting their careers on, and they all wanna aspire to be a commanding officer in a hospital or a lot of clubs out to be a certain general in day, and we have the talk that call the talk with him and I said, Why don't we do that? What? You know why? Why do you want to be a leader in medicine when we talk about that? Because some people do it for the right reasons, which is again make making a difference for people helping people in ways that you could never really do otherwise on a much broader step. But some people, when they kind of reflect on it, maybe aren't going into it for the right reason they needed because they want the title they needed for her self esteem. They need for their ego. They needed for any other reason except the patient. And we talk about that because it's a tough road. You know, everybody gets enamored with the parking spot and the job and the title in the office and the whole thing. It's a tough road, long hours, tough, thorny problems, things like that. You really want to make sure you're going into it for the right reason. So the most important thing I could tell young young physicians is be clear in your own mind why you're going into leadership in medicine, especially now. There's so many challenges in medicine because all the different what I call tectonic plates that are moving now at the same time that are creating an environment and basically a, uh, a time and medicine of really unprecedented change. If you're going to get involved in that in a leadership role, do it for the right reasons because there's implications for you and there's indications for your family. That's the first thing I'd say. The second thing I'd say is state clinical as long as you can. But start dipping your toe into the executive medicine. You know, get involved in Credentials Committee, get involved in quality assurance and some of these other committees, and see if it's right for you. The third thing I tell him is get involved in a professional organization outside your specialty. You know? I got it. I got involved in the American College of Position executives very early on. And then you got to see a get to talk to people who are senior to you on and pick their brains about, you know? What do you see? Why are you doing in water? What is sin? Some if you will, some pearls that you can share, but there's others out there a c h e a M C. There's a ton of organizations getting involved in those and see if it's right for you. So those air kind of awesome some pearls that I would share with young positions that are just starting down this trail.

spk_0:   41:05
One of the things that I like toe tell some of my my students and my residence is, um, to make sure that they're demonstrating excellence in the rule that they are already given, because my attitude is if you can't demonstrate to me that you're going to be outstanding in performing the job that's already set for you, why would I trust you to with more responsibility if you could be faithful with a little thing, that I am more likely to trust you with more?

spk_1:   41:33
Yeah, that's exactly right. We call that blossom where you're planted. I can't tell you the number of times when I was served in general, people would come to because they want to be the CEO of bigger places, and that's more places, and I tell them I said, in medicine, all problems are major orders of magnitude and scale eso the problems that are smaller places. You won't see a bigger places, but there nonetheless just is important. Can you handle those? It's not about the size of the organization that you you lied. It's not about the responsibilities of the job. It's How old did you do it? And are you doing it for the right reasons?

spk_0:   42:08
Well, as we start to wrap up here, I want to ask one more question. If you can give one final piece of advice to the the 30 year old version of you. So you've got a medical student or a resident or someone who's newly graduated out there and they're listening and thinking, and I don't know if I could do all that are you know, what's he going to take her? You know, am I? Am I cut out for this? What's what's one piece of advice or one piece of encouragement you would give to that person?

spk_1:   42:36
So what I tell him is all of this going to medicine to help people. There are so many ways to do that that don't involve a bedside lab coat or stethoscope. I tell people life is a one time good deal. While you're helping others, you also live in your life. There are so many ways to help people don't get to the end of your life. You realize that you spend it in a hospital, get out and help people in any way you can. And if the hospitals where you're happy and where your home stay there be excellent. Be a leader there, make a difference. I said the most important thing that you will ever get out of life is when a patient will grab your hand or hug you and look at you and say thank you. Uh, and it may. It may be one on one and maybe in a leadership position, But get out there and find those ways to make a difference. And don't constrain yourself to thinking that you got to be in an exam room at a bedside or with the stethoscope. There are so many different ways to help people that don't involve of but are nonetheless important for a physician to be involved in and make a difference. That's what I chair.

spk_0:   43:38
Wow. Well, Admiral, thank you so much for joining us. I I know that the people that are listening to this are getting just a masterclass in ah, in physician leadership. So thank you so much for joining us on the podcast today.

spk_1:   43:52
We'll Brennan, thank you as well. Thank you for the opportunity coming, speak and in the real privilege and thank you again for all the your Julian for this and for taking care of me. But it's my doc. I thank you. You are. You are making a difference of thank you very much.

spk_0:   44:16
You will not find a better example of selfless, humble servant leadership than that. Talk about impressive. You really should go back and listen to that again. Trust me. I think you could listen to that interview five more times and still take away something newly valuable each time. This conversation encourages me that as physicians, we have roles to play that transcend clinical medicine. American needs physicians to step up into leadership roles like that. Statistically, hospitals that are run by doctors have way better safety ratings and are more productive. I love hearing stories from the physicians that are out there leading their hospitals, taking on roles as public policy advocates and becoming thought leaders, especially during the health crisis that we're currently facing. There are so many physicians that are out there that are making a difference, and I just want to say thank you. You are the ones that are patients. Count on you are the ones that will help us achieve the health care system that this country needs. So thank you. Hey, if you're thinking that you have untapped potential to be a physician leader, then I've got a great free resource for you. This guy is called creating a personal mission statement. You can download it for free at the scope of practice dot com slash mission statement guide. This free pdf will take you step by step through the process of crafting a mission statement for yourself. Now, this isn't a wish list. This is a statement of your values, your aspirations and your life's purpose. If you've never done an exercise like this, I highly encourage you to do this. As Simon cynic says. Start with Why? What's your why you can go check out this free resource and get started on it today. Just go to the scope of practice dot com slash mission statement guide or click the link in the show notes, and you can download it for free. If you're a leader of a team, I encourage you to have your whole team go through this exercise together. You'll be amazed at how much it can increase your team's productivity and improve their attitude. Now let me introduce this week's featured online community. Each week we feature one social media community for physicians. This is a great opportunity to branch out and explore some new groups that you can connect to in build community. This week's group is military H PSP students and physicians. Here we go. I'm joined today by Dr Sam Billingsley. He's here to tell us all about his Facebook group that he's an admin for military each PSP, students and physicians. Thanks for joining us orally, Doctor Billingsley. Glad to hear awesome. So tell us about the group. So the group is its general was originally started. Teoh kind of connect students and physicians and anybody with interest in H PSB, um, and the health care within the military. It can be very confusing process. And so it was a good place for everybody to kind of get together, they can ask questions. Informally. We do have a lot of resource is their formal resource is within the website. So a lot of people from U Med are on there and they could answer questions directly. Um, and then it provides a lot of career insight for people that just aren't sure where they want to go or to connect them with somebody who's done something like an operational tour. GMO fast questions. It sounds like a great resource for people who are currently in the health profession scholarship program. But for folks who are maybe just kind of thinking about joining the military, they're not sure if they want to join the military. Is it still a good place for them to check it out? Yeah. Yeah, Anybody is welcome. That has any kind of affiliation, um, or wants to make affiliation. So are when you when you try and apply to get onto the page, it's pretty easy. Um, you know, we we are open toe h psb uses strap. Um, any applicants, graduates, spouses or anybody who just wants to know more about the program? Well, I think it's really cool. I really wish I had had something like this when I joined. I mean, that was good. Golly, 15 years ago now and, you know, uh, didn't even have ah, web page at ah uses for this. I had to create something for for the people in my school. So I love that you guys have this awesome resource. So what is your favorite thing about the group? My favorite thing is that so you can ask somebody a pretty simple question that if you asked one person, you get one response for, um but you will guaranteed get 456 different opinions about the same exact approach to about the same exact question. Um, so that that's probably my favorite part. It doesn't mean I necessarily agree with everything that everybody says because we all just share anecdotal experiences for the most part. But you get to at least see six or seven different anecdotal experiences. That's fantastic. Well, I love having groups that are really engaged because, ah, you know that if someone's looking for help are looking for some support, then you got a lot of people that are willing to reach out and help, and that's really fantastic. So if people want to connect to the group, how did they do that? So they just log into Facebook and then they click. Apply. There's, I think, five or six questions. Um, and they have two weeks to fill out those questions. If at the end of the two weeks, the questions they're still blank or they weren't filled out properly, will either ask for more information or they won't be accepted in the group. But they're pretty basic in terms of you know what, your military affiliation, what medical help profession are you interested in or affiliated with, um, and then which branch? And if you're if you're an applicant and you're not affiliated with the military, Dole or you just have questions, their spots in there that it says you don't just put the German applicant or put which branch would be your favorite branch if you were going or your most ideal branch to join. If you're going to awesome, let's fantastic. We'll make sure the linked all that in the show notes as well. So, um, if you want to check it out. The group is military H, PSP students and physicians. And so if you're in the military or thinking about the military or former military. Go check it out. Thanks a lot for joining us today, Dr Billingsley. Yes. My pleasure. That's all for this episode. Thank you so much for joining us on the scope of practice podcast today. Remember to get your free copy of the guide creating a personal mission statement at the scope of practice dot com slash mission statement guide. Also, make sure you hit that subscribe button so you never miss an episode. Thanks so much for joining us. We'll see you next time. Thanks for listening to the scope of practice podcast at www dot the scope of practice dot com.