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Difficult Conversations in the NICU with Dr. Vita Boyar

Dr. Vita Boyar (2s):
I think as a novice people are often afraid to admit that something went wrong. We gave the wrong medicine, or you gave the wrong breastmilk the IV extravasation happened and the baby has a wound. Now I think they have to be able to acknowledge this has happened. And you can say, I’m sorry that this has happened to the child. People are afraid to say, I’m sorry, I’m sorry that you as a parent are going through the angst of being worried about this process. Saying sorry is not accepting the blame, saying sorry is not saying that something is wrong. To me saying sorry and acknowledging that they are worried about it is being on the same level with them, making them feel as a part of a team and have knowledge of what they’re going to do is valid.

Announcer (47s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 32s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol, drugs, and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment, and they are customized to meet the unique needs and challenges of physicians, dentists, pharmacists and nurses struggling with substance abuse. Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. Beginning of March 9th, Veritus will be launching a free CME substance abuse webinar series for the medical community.

Dr. Anthony Orsini (2m 16s):
This CME webinar series will bring together experts for a panel discussions. What the future has in store in a post COVID world helping physicians who are struggling with substance abuse. This is an event that you do not want to miss. You can register for this free CME webinars at www.Veritussolutions.com. Today, I want to introduce to you or another amazing guest today. I had the honor to introduce you to Dr. Vita Boyar. Dr. Vita Boyar and Assistant Professor of Pediatrics at Zucker School of Medicine at Hofstra University She is a board certified Neonatologist Associate Medical Director of the Neonatal Intensive Care Unit and is a certified wound specialist physician practicing both neonatology and wound care at Cohen’s children’s medical center of New York Northwell health hospital system.

Dr. Anthony Orsini (3m 9s):
Dr. Boyer is the only Wound Certified Neonatologist in the country and develop Northwell Neonatal Wound service. The only one of its kind in the area. Her work with neonatal and wound products has been featured on Good Morning America published in various journals and has received awards and honors. Her teaching style and dedication to compassionate care led her to her nomination and completion of the humanistic mentoring fellowship program at the Zucker school of medicine at Hofstra and in 2018, she was honored with Queens Ambassador award for exceptional contribution to the community and the professional field. Born in Eastern Europe she came to us during our high school careers, and that attended college in North Carolina.

Dr. Anthony Orsini (3m 50s):
She’s stayed in North Carolina, graduated medical school at the prestigious University of North Carolina Chapel Hill and then she made her way to New York where she completed her a pediatric residency and fellowship. Dr. Vita Boyar is a reviewer for various medical journals. She is a member of the society for pediatric research and has published extensively in various medical journals herself. Well welcome, Dr. Boyar and we’re so honored to have you here. I think you and I met, I think, a lot about a month or two ago through LinkedIn, I believe correct?

Dr. Vita Boyar (4m 20s):
Yes Tony. Well, first of all, thank you for the kind introduction we have met and it was Linkedin actually, and I came across your podcast by actually looking into the one of my previous colleagues from the pediatric residency that you have interviewed as well. And I was just really at the discussion that you had and they reached out to you and I just wanted to say, Hey, I said this is so great and this is so useful for other people to hear and different aspects of what a difficult conversation might have been a medical and personal life.

Dr. Anthony Orsini (4m 50s):
You know, we had that conversation, we had a quick call and you and I had such a flow of conversation, which happens, you know, every now and then when we have a lot of common, both be in Neonatologist. But then we started talking about my favorite topic Difficult Conversations and I knew right away that you would be a great guest on our podcast. So I kind of grabbed you right there and said, please come on in. And you were gracious enough with your time. So I wanna thank you again. And we’re going to discuss all of that. You know what I make two promises to my audience in every week in that is one to be inspired and two, to learn something about how to have difficult conversations. And we’re going to talk about both of those things and I’m sure I’ll keep my promise today. But first I usually like to start out with just getting the audience to know about you.

Dr. Anthony Orsini (5m 36s):
So who is Vita Boyar. Do you have an incredible story coming from Eastern Europe and how you ended up in New York, long Island? Correct. And so I just want them to find out who the Vita Boyar is it, tell us a little about your professional and what excites you. And I also noticed too, that you have some very cool hobbies and call yourself at adventure junkie, but tell me all about Vita.

Dr. Vita Boyar (5m 56s):
Sure I see from the professional stand point, as you said it, I practice neonatology in long Island, outside of New York at the level four neonatal intensive care unit. And I think that was my first professional passion. You know, as I went through my pediatrics residency, I always knew I wanted to work with children. And my first year that I realized the taking care of the premature and vulnerable babies, having an approach to the patient as a whole and not just ne organ, is important and also a thrill and the excitement of seeing them do better having an inability, to do procedures, collaborate different sub-specialties is what made me wanna be a neonatologist.

Dr. Vita Boyar (6m 38s):
So I think first and foremost, I identify as that. I enjoy teaching, I enjoy a collaboration and this is why I’ve stayed for all of these years in our institutions. It’s an academic institution. They have fellows, we have residents. So in a big part of my day is not just clinical care is actually teaching the residents how to interact with patients, teaching them how we can talk to parents, collaborating this consulting physicians. You want me to think, I identify myself from the professional and point as a Wound Physician as well. This passion came early in my career as a Neonatologist. My early interest were in respiratory care and respiratory kids, and then realized that a lot of our, neonatal babies have very fragile skin and many had skin injures and all of them had surgeries and nothing could have been done, but others were caused by us by the hospital, the equipment by taking care of the really fragile premature or a tiny babies, actually statistic’s is very important to know about 30- 40% of small kids in the NICU have injuries and about 8% of them left as a scar.

Dr. Vita Boyar (7m 46s):
And so when I started this, I realized that I would look around and ask my colleagues, how do I treat this? So how do I enhance this more out there? How do I help these to heal faster? Let’s say, or a baby who is 500 grams in twenty-four weeks. They’ve had a really good answers at that time. And so I think I’m a curious person. And I think I like the challenge. As soon as the beginning of a challenge, I want you to just figure it out for myself. I thought there would be a better way to approach this. And even if there wasn’t a better way to have to know what’s out there, what needs to be developed, what needs to be taught. Then I decided to certify in the adult specialty and I reached out around the country and asked multiple nurses and other physicians help me tell me, is there a guidelines?

Dr. Vita Boyar (8m 30s):
Is there something you could share? And unfortunately there was no who was interested in sharing this. And so I proceeded was doing my clinical and academic and going through the specialty and became the first. And so it was the only one that I think I was the first wound certified Neonatologist in the country and went on to build our own neonatal wound service, as well as seeing too many pediatric patients throughout our hospital. So I think professionally, this is my second and ongoing passion. I combine both neonatology and wound care and that’s really, it has been a great ride. Personally. I am a mom, I would say. And what I liked to do, one of my hobbies, I guess, one of my greatest joys in life is to travel myself, but it was my kid’s.

Dr. Vita Boyar (9m 16s):
And I actually often combine my professional and personal interest in, in this unique field. And I have been lucky enough to be invited to travel to different countries, to present at different conferences and help in difference NICUS, how to build a skin teams and then at the same time in taking opportunity to take my kids with me. As a neonatologist you are very busy, it’s a lot of call, it’s a lot of work and it’s often very difficult to find a balance as a mom and as a professional. And so that’s sort of, what does the two combined.

Dr. Anthony Orsini (9m 48s):
So you describe yourself at one point I heard you say you were an adventure junkie. What does that mean? Where do you like to do? I know you’re a football mom and you played tennis. My family all played football. So we had that in common, but when you say adventure junkie, what do you like to do?

Dr. Vita Boyar (10m 6s):
Well, we traveled, if you find interesting activities, is that some of them, but I would say in my own personal adventure, it doesn’t necessarily go well, you know, and I sort of dragged my kids. And as sometimes we swim is the shark’s and, you know, I’d tell my family later if we had done that. And when we traveled to Australia, find their highest Sydney bridge, just walking on the edge of it. And I have flying the the highest Alaska mountain on the glacier. And it seems like that, you know, it wasn’t too extreme, but at the same time, interesting thing to do.

Dr. Anthony Orsini (10m 39s):
That’s great. And we have to have that work life balance, which is so hard. Most people might not know this with listening, but neonatologists are different. We’d like to small challenges. That’s why you think we picked the little babies and we tend to be into an adventure. Also, your story struck me as you were talking about it, when you are trying to find some information about wound care and didn’t find any, it really paralleled what happened to me when I was in a Neonatal fellow and I was seeking help for people to tell me how to have difficult conversations. And I was asking people, please tell me how to tell a mother that their baby suffered severe brain injury.

Dr. Anthony Orsini (11m 19s):
And the answers that I got mostly where, well, this is how I do it, but I don’t know if that’s right. I was told things like, just say it faster and get it over with really bad advice. And then I did a very similar to what you did. I looked through the literature have found nothing. That was just like you, I had to seek it out. And in my instance, it was just interviewing parents and family members who have heard bad news. So I certainly identify with that. And you’re a trailblazer. And then you’re right. I do find that there are a lot of skin problems in the NICU and having as somebody who is a Neonatologist that can do that is awesome. This episode is about Difficult Conversations. I want to move over to that. And you and I had discussions about you’re also the director of the NICU and in our neonatal intensive care unit, for those people in the audience who are not in Medicine, there are babies that are born very prematurely around one lb, and they sometimes spend over a hundred days in the NICU and even more so not many, but some of those babies go home on ventilators and tracheostomies.

Dr. Anthony Orsini (12m 22s):
And those can be the most difficult conversations I think, to have with a family other than your baby’s dying or passing away, but they are very hard to navigate. You and I talked a little bit about this, but how do you navigate through that conversation that you need to speak to the mother with was we call it a family meeting and try to navigate through that. This is what’s the realistic aspect of what’s going on, and baby might need to go home on a ventilator, et cetera. Tell us how you do that and give us some advice. If you don’t mind.

Dr. Vita Boyar (12m 55s):
I think this is one of the most difficult part of the NICU. You can sort of have this conversation that doesn’t happen abruptly, but then you can have this prolonged States. In a bunch of babies you can have somebody who is about eight months old, who is now in our unit, going to digress for it, like 30 seconds. I don’t remember one time watching the lecture, a psychology teacher who raised a glass or above her head, sort of held him for a while in that students how heavy it is. And the students throw in, you know, five ozs or three ozs is sort of now and then she said, yes, that’s true, but it’s not about that. About the perception. If you hold it for a minute, this is not heavy. If you hold it for an hour or you can sort of hurts, if you hold that for a day, you’ll want to drop it because you are in pain.

Dr. Vita Boyar (13m 35s):
If you hold it up in a longer, it becomes a constant in your life that you will never be able to move on and do anything else until you resolve how to do this? This is babies who are in a NICU for a long time. This baby is chronic lung. It’s like that. It’s a good parallel lives. If you’re in a NICU for a week and its tough, you can manage it. If you are in the NICU for a month and you still see that life in the end of the tunnel? And if you are there for so many months and you have so many ups and downs, this is when it gets emotional. And so hard and so draining. And so the way that we should speak to you, the families, it should be based on that. If you have to understand that they are there for a long haul, it’s not a sprint, it’s an marathon.

Dr. Vita Boyar (14m 20s):
And so I think initially when you start your conversation, you build the rapport as a Physician, as a scientist, you’re tell them what the baby has. This is what it will be going on. But at the time passed us. I think you have to step out of being in this physician. You have to put yourself in a situation of relating on a personal level. You have to relate and then you have to somehow connect. And that is a perception of you as the human being by the parents is what’s going to help you. You too have a successful conversations. I guess they call it. I think there was a bunch of tactical empathy. Empathy is not feeling sorry for somebody it is being able to understand the person who are sitting across from you.

Dr. Vita Boyar (15m 2s):
You find yourself in that person’s shoes and not seeing what they think is right or wrong, but trying to understand what is it that is important to them? How are they feel about some of them and what is it that you can do to help? So when I have this conversation, because these families and it happens more than once, that’s what I do I try to sort of update them. This is where we are. And then explain that this is what’s happening to the child, this is what they are faced with and this is what might be a potential outcome. Then you have to move on and you have to see where do you stand as a parent? Do you understand what they are telling you? What might come from this?

Dr. Vita Boyar (15m 42s):
And what would you like to see? What are you hoping for? You have to hear their side as well. But as far as the basic advice, I think a lot of the newly practiced, Physician have a fear of having a difficult conversation there afraid that the parent’s might be angry and often they are. They are afraid that showing any emotion is not the right thing to do, which is often not taught in medical schools. So there’s a lot of mnemonics actually I think are out there. What they can help you. And I guess if you, important points to talk about is setting. You want to make sure that you speak to as a family and say, I would like to have a meeting with you. What is a good time for you to come? Is there a family member is that they can come and support you in this time.

Dr. Vita Boyar (16m 22s):
And so we usually try and set a time aside in the common areas is the family member or maybe the social work, at least in my practice. Usually they have support that it’s calm it’s quieter. My phone is off. We sit down and we can have a face-to-face conversation where nobody feels that they are being hurried. And you would just sort of on this side of the conversation, it’s a conversation have to be determined. They have to be in as a purpose. And then I think you have to put it in perspective while you are here. You have to send the stage. And that usually like to give it a little bit of an overview, which has happened today or what has happened in the last week. And this is where the challenges are. And if the patient is not doing well and we train, you have our babies who have chronic lung disease, or maybe the neurologic problems, you tell them what are you doing and what the outcomes are.

Dr. Vita Boyar (17m 11s):
And if things are not great, you can say, Oh, I wish there was a feeling better. I wish we could go off on a ventilator settings, but you are still trying to do a everything we can, then you ask the parents to have their turn to summarize. What does they understand? What are they hoping for? What are they wishin for, is there something that we can do for them? Because over many months they are part of the story as much as a child,

Dr. Anthony Orsini (17m 37s):
Right? I think that’s really important. And there are different acronyms out there in my book, it’s on the Delivery I’ve developed an acronym called Program the take home points of what you just said. It is so important. It is about active listening. I’ve trained thousands of thousands of doctors on how to break bad news. We do videotape improvisational role playing. And when I review their tape with them, I’ll ask them, what was your main goal in this conversation? And the most common answer is give information. And I kind of just have heartedly and kind of jokingly say there, why didn’t you just handle it or a piece of paper? And the young doctors will just realize that it’s not about information. It’s about what you had said.

Dr. Anthony Orsini (18m 17s):
It is about forming that bond with them and listening to what you were describing. So well, it was really what people call active listening. Right? And, and I think sometimes we don’t do that. The other thing that I thought that was great, that you mentioned was about this being a marathon and in the NICU it gets to you, right? I love that, that example of holding the glass up. So there’s parents that come in that are the sweetest loving parents and they are just being frustrated. I mean, they maybe had a little bit of setback and we have to do as a group, even though we’re tired. And we were working really fast trying to put ourselves in their shoes and saying, okay, so they yell at, and they act it a little irrationally, but you don’t blame them.

Dr. Anthony Orsini (19m 1s):
That glass is getting awfully heavy. Right. So I think that’s really, really great advice for them. And then there’s also a medical error advice, but I just thought of it because some of the problem’s in the NICU, which you talked about for wound care, as you mentioned, very clearly, some of those are <inaudible> as we say, or they come from the treatment. So I, the infiltrations people in their art in medicine, or NICU the IV catheters we put in these babies are often bigger than their veins. And so sometimes they get infiltrates in wound care and that could be the source of a lot of anger. And it sounds like you’re the one often that has to discuss with the parents, that there may be, may have a scar and you’re doing it.

Dr. Anthony Orsini (19m 42s):
And so any different or a different advice you can give when you’re discussing something that went wrong, because things do go wrong in Medicine.

Dr. Vita Boyar (19m 51s):
I think as a novice people are often afraid to admit that something went wrong, gave a wrong Medicine you gave the wrong breast milk. Did it happen? And the baby has a wound. Now think we have to be able to acknowledge that this has happened. And you can say, I’m sorry that this has happened tothe child. People who are afraid to say, I’m sorry, I’m sorry that you are as a parent going through the angst of being worried about this process saying sorry, it is not accepting the blame. Saying sorry is not saying that I did anything wrong, to me saying sorry is acknowledging that they are worried about it. It Is being on the same level with them, making them feel as a part of a team and acknowledge that what they’re going through is valid.

Dr. Vita Boyar (20m 32s):
And then you have to say what happened in a simple way. Most of our families who are not medical people and explain what does it been willing to do about this? This is what happens when they transition occurs. And this is a treatment and I going to start on a new baby and I’m going to do to make sure that the skin heals well. So that’s one example is simple. The one, but I think are really angry, often brushing injuries from devices or a surgical wounds that this test is often a list. If you have to stop away from the anger and you have to allow them to, then as I say, I hear that you are saying, I understand that is how you feel. And I wish that it didn’t happen but it did.

Dr. Vita Boyar (21m 16s):
And we are going to do everything we can to make them feel better. So I think acknowledgement and connecting to the patient on this case as a parent on a personal level as well. I think it’s not specifically the actual, so this is more of a as the chronic lung kid or a piece for it in the NICU for different reasons. I’ll give you an example. Just recently I had the families was there. They admitted to the NICU. The baby was in the chronic facility on oxygen therapy and has failed us and needed to have a tracheostomy done. The tracheostomy had a really tough recovery for the week after. And mom and grandma came just really, really angry at the hospital and we will do this and this, and this is just very, very angry at this has happened to the child and we sat in a quiet room.

Dr. Vita Boyar (22m 3s):
And they told them what happened. And then on top of this the baby had an externalization. And Mom said, and now because of this the baby has an infection in her foot, and I said no the baby doesn’t have an infection they have a very fragile veins. From the grandmother who’s actually the dominant figure in this family said, Oh yeah, I have really fragile veins. Anytime I have to go for a blood draw they have to poke at me so many times I have bruises and they say, Oh, you know what me too. And it happens to me all the time and it’s, you know, about, so this happened to my son. He fainted once and the rest, and we’ve talked about something else with a personal level. But at the moment I did this, her angry attitude, subsided and her warrior face softened, and we sort of connected to human interaction levels to blame anymore for somebody who understood what she was going through.

Dr. Vita Boyar (22m 54s):
So if you can do that as well as acknowledge and understand what happened and that you are going to try and make it better. So it was as the two key points in the interaction.

Dr. Anthony Orsini (23m 3s):
That’s fantastic advice in, in my book, it’s all in the delivery. I will go through the acronym Program for breaking bad news and also for a patient experience. And when we discuss conflict resolution, which is what you’re speaking about, the G in Program is genuine. And so many times I’m put in a situation or maybe because that’s what I do, or I enjoy it where it’s Dr. Orsini, I’m glad you’re here we have an angry parent and being a genuine person and saying, and you relate it to that grandmother. You said, my son has it too. I have it too. All of a sudden, you weren’t this Dr. Vita Boyar. You were Dr. Vita Boyar, who also is a real person and right away and people in general, I can’t tell you how many times I speak to the risk managers about medical errors.

Dr. Anthony Orsini (23m 48s):
And I’ve done some training at other hospitals about how to talk about medical errors and right now medicine is still far behind business in communication. And, and so there was a medical error and all of a sudden the risk manager wants to come in to the room with you two attorney’s the charge nurse and you are walking in there with five people. And all of a sudden, the mother of the patient is looking at you and they are going something’s really wrong. They are trying to hide something. Why are all these people here? When the best thing that you’ve said is have the doctor go in and say that they’re sorry that this happened. And the patients want to know that your doing whatever you can do to help that and to prevent it from happening again. And the American bar association made a statement 10 years ago, that if you feel a relationship with your doctor, you’re unlikely to Sue even if prompted to do so.

Dr. Anthony Orsini (24m 36s):
So even if a lawyer says, Hey, Tony, I think you should go sue the doctor, I would say, no, I really liked Dr. Boyar. I’m not doing that to her. It was an accident. And then it happened. And so it’s the right thing to do. And this is why I love communication so much. I mean, you could really change the outcome of that. Look how much you made that grandmother feel better instantly. Oh almost like a premature baby is like me we both have fragile veins and I get it. And so that was, I really think that’s awesome. So let’s keep moving on to God, there’s so many difficult conversations that we have. So now you’re such a great communicator. You are teaching the students, the medical students, the residents, it’s still not taught in medical school.

Dr. Anthony Orsini (25m 22s):
Very little is taught about communication. So how do you help? Do you bring them in a medical students? And I’ve said in other episodes before, sometimes I’ll ask the resident, did you call the mother? And then I’ll throw them off by saying, what did you say? And then they go, well, what, what, what do you do? And I said, I want you to know what you’ve said and So, or I’ll say, Oh, go ahead and talk with the mother. And I’ll stand at the back end. I’ll go, well, you didn’t sit down and you didn’t, you know, there was a lot, he didn’t do how much time do you spend going over communication with your residents and for other physicians who want to help them learn better? Communication, what’s your advice.

Dr. Vita Boyar (25m 56s):
So you think you have to balance the fact that you’ve been worked on people and you’re in the room and you give them some of the bad news. Sometimes I have done that. And specifically, when I came on the team, when we have residents, fellows and parents are often there and they try to update them, do an hour of clinical rounds. And so what I have found is sometimes they would tell the residents and sort of on this side and I pull up a chair and they sit next to their parents and they are there in the room. So it was like, you can observe, but they were really not visiting the active conversation, but then having the parents and they have this active conversation with his mom or Dad or both, and I asked them, I said, I would like to give you a update, how baby X is doing.

Dr. Vita Boyar (26m 38s):
We would now be a good time and you can use it now. And I think sometimes the best way to teach somebody how to do something well is to show it to them. With the residents and fellows, how to be empathetic, shows them how to deliver bad news, how to react to potentially a volatile or crying reaction. And hopefully as they can learn and get them to step out of the rooms, I will talk to them soon, too often, before we go into the room, I say, well, if a parent asked them, what would you say? And you have to understand your medical facts first and foremost, because we are in there as a physician, then you’d have to be prepared that you have to do our due diligence and all this.

Dr. Vita Boyar (27m 18s):
I always talk about it. Don’t go into the room saying, Oh, let me get this. You know, Donny is a, not so much. Sure. You have to know. So always be prepared, but finding an appropriate settings, make sure that you understand his parents’ perception. That’s really, really important. The other thing that we pay a lot of attention to is attention to, is it’s important what you say, but it’s important how you say it. And it’s in the body language. As well. Remember, years ago, I heard a lecture by actually an FBI person who usually does a negotiation and he said, it Seven three 65 rules. People pay attention, 70% of what you said, 35% to how you deliver and 55% from your body language.

Dr. Vita Boyar (27m 58s):
So it’s important what you to say it, but how are you saying that could mean you have totally different meanings. If you are a sarcastic, if you are not genuine, if you go to them, if you hide, tell them exactly the same sentence in some totally different somebody’s. If you look an interested in, if you have your phone next to you, when you’re looking to the side, while you were given this bad news, does the family, they want to know you’re not genuine and you really don’t care when you just stay to give you the news and stuff like that. That’s one of the big points that I want my fellows to understand, you really have to be present. And as you said, active listening, but also active engagement in the conversation.

Dr. Anthony Orsini (28m 33s):
In my book, that’s why I called my book “It’s all on the Delivery” because exactly what you say it’s not what you say it’s how you say it. If you’re listening to this podcast, go back to my podcasts listen to the interview with Dr. Helen Riess. Helen Riess, is really the world expert on empathy. And we had a great conversation. Previously. She wrote a book called the “Empathy Effect” and how it affects us in every aspect of our lives, both their professional and our personal lives. And so this is Difficult Conversations. And so one of the things that I do when I try to train healthcare professionals, and now I’m going into businesses now, because it’s the same communication techniques that help managers become real effective leaders and it doesn’t have to be in medicine.

Dr. Anthony Orsini (29m 19s):
These are all Communication that way you talk about active listening, building relationships, building loyalties. These things are really very important in your private, any new professional life. And it also helps in things in marriage and it helps us build a rapport. And sometimes what I’ve learned through medicine I’ve really helped me with my marriage because it’s all the same, right? It’s about building relationships and listening to each other.

Dr. Vita Boyar (29m 42s):
You think it’s all in a communication and while I think marriage is and taking care of the patients, that’s for sure or have any children. That’s another one. But yeah, I think active listening is not easy. I think when they listen, they are almost always sort of thinking ahead, hey, what am I going to answer? Or what would I say to that to respond and you almost thinking about their own experience. So I think it’s really tough to step away from that mindset and just say, I’m just going to listen, hear what the other person says, you don’t have to agree to this point of view. Why didn’t you clean after yourself? Well, because I was busy doing that.

Dr. Vita Boyar (30m 23s):
So it’s not the fact that maybe 12 or to, and she was wrong and why, and what happened to write to really hear somebody else’s perspective. And they think that is the same in business and the management. What is the other person’s point? What is his point of view? Again, you don’t have to agree, but maybe it will make you understand what he/she coming from. And then you can bring your point of view from a different way.

Dr. Anthony Orsini (30m 48s):
And in business and every other week we tried to do business. In business using these communications techniques. If you want to ask your boss for a raise or a promotion, how do you go about doing that? If you have a problem with an employer, a teammate, instead of just being upfront with them and tell them here’s the issue. If I’m giving you a bad progress report to a worker or a team member, or want that person to leave that room feeling that I disappointed Dr Orsini and I want to do better. You don’t want that person to leave being angry. And these communication techniques work, especially during conflict resolution, even in my teenagers where I try to get to come home to visit their mother on Valentine’s day or visit their Mother on their birthday.

Dr. Anthony Orsini (31m 30s):
It’s tough to tell as a kid to do that. But if you do it right, as I say, you lead them to water and my son or daughter who will say that maybe I’ll come visit mom too, is that I’m like, Oh, OK. So you just got to let them up to that. But that communication is wonderful. And with all of these episodes, this is why I’m so excited about this podcast because they just stack up on top of each other and each week we learned stuff from you that I relate to an interview that we had with Helen Riess are we, when we laid back to an interview that I had with Claude Silver, who is the chief heart officer of VaynerMedia and how we use empathy, compassion, relationships to get through our lives.

Dr. Anthony Orsini (32m 10s):
And for me, we just had Dr. Dike Drummond who is a, an expert in physician burnout. And we talked about when you’re engaged with your job, when you’re engaged with your patients, you talk so great about imagining and putting yourself in their place. You go home feeling better about your job. And I think you decrease your incidence of physician burnout. Would you agree to just go home feeling better?

Dr. Vita Boyar (32m 32s):
Oh, I agree. I did listen to the podcast. It was great actually and I can relate to it. It’s not just a physician, but I think in the last six, seven months, this COVID and then a lot of the physicians are under so much stress and strain and in a NICU I mean they are always under stress or a stressful job via a and his life passed quite a bit or a visitor babies who have been in their chronic pain. So I think burnout it’s really, really important is how do you prevent it? I think communication is actually a very, very important to me. Each of you have superiors and you know, itself is a really important, I think if you feel that what you do is valued. If you have spoken to you respectfully, if you are happy with your job, if you enjoy what you do that will lessen that burnout, even if you work many hours and even if you work for a really tough, and if you have a better communication with the nurse, the fellow physicians is the parents.

Dr. Vita Boyar (33m 30s):
I think mental burnout is even harder than physical. I think physicians, they are perfectionists or at least many of us and we are our biggest critics. And if you didn’t do something well, if you didn’t say something well, or if the conversation went really badly with your boss you are going to go home and you’re going to perseverate about it and say, Oh, I could have done this and it could have done that. So I think stopping for a second, thinking about what does it, do you go on to say, how will you going to say is really important? And then in your personal life, sometimes they think they are angry or tired, or if you’re stressed out, maybe stepping out for a minute where maybe sleeping on it for tonight and have that discussion to the next day.

Dr. Vita Boyar (34m 14s):
Same at work as a boss. If you have to give somebody a criticism or a suggestion think about how you are delivering it, not rolling your eyes, facial expressions can say so much, not being sarcastic, tone of voice. All of this, I think are a little tricks that can make somebody feel better and make or break in a relationship.

Dr. Anthony Orsini (34m 32s):
Yeah. And body language is so important and the message, that’s why I call the book. It’s all in the Delivery. When I do consultations and hospitals and we do a patient satisfaction programs that help them improve their patients’ satisfaction scores. As we walk around in the hospital and we read the signs and after a few signs that we bring up or even the administrators start to chuckle and start to laugh. ’cause you see that person put that sign up there and it could have been worded so much better. It sounds like these are the rules and this is what you’re supposed to do. And I showed a sign of three people standing up in my workshop, three people standing up at attention in a row holding briefcases and it says stand online.

Dr. Anthony Orsini (35m 14s):
And so we’ll go over these signs and say, do you think there’s a better way of saying it? You know? So, you know, we will be with you in a second, please wait here. And so after a while, people graduate from my workshops and I can’t stop doing this either. I’ll go to Walmart. And I looked at a sign and go, Oh my God, that sign is terrible. So it’s the message. Communication is a lifelong learning process. I’m learning every week from people like you and from the other guests that I’ve had, even though I’ve taught thousands of thousands of people you constantly learn and you just add on top of it and stack on top of it and it affects every part of your life. And that’s why I love doing this podcast so much.

Dr. Anthony Orsini (35m 56s):
And certainly my audience was inspired by you and you gave such great advice, but we still make mistakes. It’s a lifelong learning. And back to what you talked about with the resident, sometimes I’ll leave the room at the residents watching and I’ll say I made a mistake. I said something that I should have said, what was it? And it’s like a little game. They play in the car. You know what? Dr. Orsini you talked a little too fast or I always sit down. So I never make that mistake, but Helen, Riess talks about what you just mentioned. This empathy Effect slides up and down a part of our day are sometimes our day is bad or we’re not doing well and maybe we need to wait until we’ve had a second alone before we go and have that difficult conversation. I think that’s great advice.

Dr. Vita Boyar (36m 36s):
Yeah, absolutely. I think in a NICU, you know, at night it may have a patient pass away and yet you are expected to complete that task and go on and take care of the 50 other’s. And so being in tune with yourself and if you need to step away for five minutes and being able to take the time to recollect yourself is very important.

Dr. Anthony Orsini (36m 58s):
Yes it is. I can’t tell you how awesome of an episode this was. How informative this whole thing was if anyone wants to get in touch with you, they can do it through LinkedIn or email. How would they, if they wanna speak to you, how it was the best way to get in touch with?

Dr. Vita Boyar (37m 13s):
Yeah, absolutely. I am on LinkedIn and my email is VBoyer@northwell.edu or both will be totally fine.

Dr. Anthony Orsini (37m 18s):
And we’ll put that all in the show notes. So everybody we’ll have the links to that. Thank you again, if you like this episode, please hit subscribe by it. And we’re available in Apple, Spotify, Amazon, and many others Google podcast. And you can go ahead and subscribe to get an automatic download. Don’t forget to go back and listen to all of the other episodes. It’s been great. If you want to know more about the Orsini Way you can contact me, doctor Dr.

Dr. Anthony Orsini (38m 13s):
Orsini @theOrsiniWay.Com, where you can just go to theOrsiniWay.com and get the contact lists. Thank you, Dr. Boyer. It was an absolute pleasure and I hope we will speak frequently. This has been great.

Dr. Vita Boyar (38m 26s):
Thank you for the invitation Tony it has been fantastic.

Dr. Anthony Orsini (38m 30s):
Thank you and have a good night call tonight. Thank you. Bye-bye this episode has been sponsored by Veritus. Veritus offers virtual alcohol and drugs and trauma treatment programs exclusively for licensed medical professionals. Their virtual confidential provides safety and security medical professionals need to get help while continuing to work confidential, convenient and compassionate, or does it brings world-class treatment to your home or office. Again, don’t forget about their free webinar series. Beginning of March 9th, as CME webinars series will bring together experts for panel discussions or what the future has in store or in a post COVID world who are helping physicians who are struggling with substance abuse.

Dr. Anthony Orsini (39m 13s):
This is an event that you do not want to miss. You can register for this free CME webinar series at www dot Veritus solutions.com.

Announcer (39m 22s):
If you enjoyed this podcast, please hit the subscribe and leave a comment or review to contact Dr. Orsini and his team or to suggest guests for a future podcast visit us at the Orsini Way.Com.

Conversations about Child Advocacy with Anthony DeVincenzo

Tony DeVincenzo (1s):
The one thing I think that I always tell people is understand that you’re going into this conversation about to break news of probably like I said, the most horrific thing that has happened, you know, to this family, you are dropping a bomb right on this family. In this field and I don’t know, you know, this may be true of the medical profession too. It’s very easy for us because we’re dealing with tragedy all the time. It’s very easy to get callous. And then we just get focused on doing our job. I’m going to go in, I’m going to do my job. I’m going to tell them what the child said. I’m going to get the information that I need and I’m going to get out because I got it. Then I have to continue on with the next steps of our job.

Tony DeVincenzo (44s):
I think it’s just important to understand that you’re going in and talking to some people whose lives have literally been turned upside down in the last, you know, however many hours we’ve been involved in this investigation.

Announcer (59s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 45s):
Welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. You know, I’ve been blessed to have so many great guests on this podcast, far beyond what I had ever imagined when I first started out. And from each one, I can honestly say that I’ve learned something. And after speaking with them, during our typical introduction phone call and then interviewing them for the podcast, I really feel like I’ve gotten to know each and every one of them on a personal basis and call many of them my friend. Well today is especially exciting because not only do we have a perfect topic for the podcast and the perfect guest, but I get to interview a very long time friend, Tony or Divo, as I knew him growing up, have known each other since we were 12 years old.

Dr. Anthony Orsini (2m 35s):
We played on the same baseball team, now we both played on the same high school football championship team, and we’ve also kept close contact for years. So this is going to be a lot of fun, but also informative about a real important topic. And that is child abuse and child advocacy. Today my guest is Tony DeVincenzo. Tony is here to talk about difficult conversations and child advocacy, child abuse. He is currently a training specialist with the Northeast regional children’s advocacy center and that role, he provides training and technical assistance to child advocacy centers and child abuse, multidisciplinary teams throughout the Northeast region of the United States.

Dr. Anthony Orsini (3m 18s):
Tony has also presented workshops on a variety of topics related to child advocacy at regional and national conferences. Before working in the child advocacy field. Tony had a 25 year career in law enforcement, in New Jersey. He began his career as a patrol officer with the Roselle police department, and then served as a detective with the Morris County prosecutor’s office. As a detective, Tony worked at a variety of units, including the child abuse unit and the major crimes unit, but spent the majority of his career investigating crimes against children. Tony retired from law enforcement in 2013 as a Lieutenant supervising the sex crimes, child endangerment unit, internet crimes against children and Megan’s law unit.

Dr. Anthony Orsini (4m 4s):
In addition to his law enforcement career and his role in child advocacy Tony is an adjunct faculty member at local colleges, teaching courses related to criminal justice and child advocacy. Welcome Tony. It’s great seeing you again. Thanks for coming on.

Tony DeVincenzo (4m 21s):
It’s good to see you, Tony. Thanks for having me here.

Dr. Anthony Orsini (4m 23s):
Last month. I guess you do your own podcast. And last month I was a guest on a yours, and that was a lot of fun and I’m glad you were able to reciprocate your so busy. So this is a topic that is really important and something that my audience I think is really going to learn a lot from. And I always promise them to inspire and that they’ll learn something valuable about communication. So this is perfect. I’m looking forward to asking a whole bunch of questions and this is going to be a really great podcast. So thanks again.

Tony DeVincenzo (4m 50s):
I appreciate you having me.

Dr. Anthony Orsini (4m 53s):
From my experience. So you’ve been in this field for what, 30 years now, I guess it is. I hate to say it’s been that long,

Tony DeVincenzo (5m 2s):
But yeah me too, about that….

Dr. Anthony Orsini (5m 2s):
As I said in the introduction, we know each other, since we were 12 or a little league baseball high school football, first as local benchwarmers where we sat together on the bench and then we both got a chance to play. So it’s been a long time. And then we have mutual friends and we lived near each other. So it’s been great. I come from a family of police officers, almost everyone in my family’s a police officer, except for me. And even someone in my family, my brother did a little time in juvenile. I don’t think it was his best assignment. He, I think he liked it, but it wasn’t great, but you did it for a long time and that’s gotta be really hard. Isn’t it? I mean, the stuff that you saw, how were you able to identify that’s what you wanted to do and stick it out for that long?

Tony DeVincenzo (5m 48s):
Yeah. It was hard. Specifically being in the child abuse unit where I spent probably 13 of my 25 years in law enforcement, I spent in the child abuse unit for a County agency. We were investigating all types of child abuse cases, really in all cases involving crimes of a sexual nature, both with kids and adults. And to be honest with you, I got in it by happenstance. I wasn’t looking to go there in the beginning. A couple of friends of mine who were in the unit thought I’d be a good fit for it because you have the opportunity to do a lot of the things that you like to do in law enforcement, doing investigations, search warrants, interviewing suspects, things like that.

Tony DeVincenzo (6m 28s):
But what I found was when I got into the unit, it really just became a passion project. For me. It was a place where I found personally, probably I did the most gratifying work that I did in my entire law enforcement career.

Dr. Anthony Orsini (6m 42s):
There’s nothing more special than helping a child and giving them a second chance. But you must have seen some pretty horrific things. Is there anything particular that stands out or any type of crime that just made you go home and say, wow, that was a rough day.

Tony DeVincenzo (6m 57s):
Yeah, there was a lot, anytime you’re dealing with children and kids that have been hurt in whatever fashion that is, whether it would be child sexual abuse or physical abuse, those cases just tend to get to,you have been thinking about this question because you told me you were going to ask it. And it’s hard to pinpoint a specific case that really affected me more than others. There certainly are a bunch that are out there, but I would say, I think anytime that there was a death of a child, those are the ones that really hit home for me, as part of my job, we had to do death notifications. I had to go to autopsies and watch autopsies and collect evidence during autopsies.

Tony DeVincenzo (7m 37s):
And anytime you’re seeing a child that’s been killed or has died in whatever matter those cases. And I’m sure you, as well as anybody, those cases just tend to, to stick with you and they go home when you take those home. And however you decide to deal with them, there’s a personal issue. Yeah. Do I go home and have a glass of wine or a beer or whatever that may be, but yeah, there’s a lot of cases like that. And then I think anytime that you have to work with kids, a lot of those cases tended to get to me too. I was a forensic interviewer for a long time. So part of my job was interviewing kids about the abuse that happened to them. Just talking to those kids and asking them the questions and hearing the stories that they’re telling about what people had done to them.

Tony DeVincenzo (8m 24s):
A lot of those cases you can’t get away from bringing those cases home with you.

Dr. Anthony Orsini (8m 28s):
Yeah. I would say two things about that. One is having a family of a bunch of police officers, most people in this world, thankfully have no idea what’s going on out there, right? The horrific things that you’ve seen. And some of the stories that my father and my uncles and my brother tell me, and even stuff that I see in the hospital, most people don’t even know that this is going on. And it’s just so incredibly sad that it’s hard. And as you say, just like in my job, when I have a death or whatever, I tend to go home and Lauren, my wife will have maybe dinner on the table and I might just say, I need a minute, pour myself a glass of wine and then just turn on ESPN and sit in the dark for a few minutes just to catch.

Dr. Anthony Orsini (9m 14s):
But people have asked me that question too. And my answer is that, and you said it before, it’s so gratifying in the end because you feel like you’re doing something important and either you run towards it or you run away from it and there’s nothing wrong with running away from it. There’s physicians who choose to deal with the life and death. And there’s physicians that want to do more of the primary care. My family member that was in juvenile, he said, this is not for me. And he did something else and he had a great career, but it is hard. But before we talk about the child advocacy center, let’s talk about, maybe we can talk about that. So tell the audience how this happens, right? So you get a phone call and there’s a report of child abuse.

Dr. Anthony Orsini (9m 54s):
There’s multiple conversations that have to happen versus the police officer. And then it goes, take us through how that works. If you don’t mind,

Tony DeVincenzo (10m 1s):
We’ve really come a long way just as a society in the way that we respond to child abuse cases, probably over the last 40 years or so. Where today we really are engaging in more what we call multidisciplinary team investigation. So all of the different partner agencies at different disciplines that are typically involved in investigating an allegation of child abuse, law enforcement, child protection services, medical people, mental health, family, advocates, all come together at the beginning of an investigation. As soon as there’s an outcry from a child, they come together and really start to work more in cooperation with each other, right from the beginning.

Tony DeVincenzo (10m 42s):
And that’s a big difference in what used to happen. What used to happen is if you can imagine the child makes an outcry. And before we had multidisciplinary teams, before we had child advocacy centers, that child would have to engage with all of these different professionals, a lot of times at different times and in different places. So the child may be brought to the police station and have to talk to a police officer. And then a CPS worker would want to talk to them and show up at the home. And maybe if the circumstances warranted, they’d have to go to the emergency room for a medical exam when the child is being bounced around and at each stop being asked all of the same questions over and over again. And what we were finding was that this system that was really designed to protect kids was retraumatizing kids.

Tony DeVincenzo (11m 26s):
And not through any fault of the players, the people are all doing their work with good intentions. We just didn’t really know how to cooperate and how to collaborate. And that’s where this child advocacy center model came into being. And this idea of doing more multidisciplinary team investigations. So what happens now is that same child will make an outcry. And sometimes someone will respond to the house or to the school or wherever the child may be. And there may be that initial discussion with a police officer and a CPS worker, if the case warrants that kind of a response. And that’s an initial conversation that needs to be had with family members a little bit with the child, anybody else who may have some information about what this allegation is about.

Tony DeVincenzo (12m 12s):
But ideally what we want to do is to have that child brought to a child advocacy center as quickly as possible. And it’s there where that team will come together and start to engage in all of the conversations that need to be had with non offending caregivers or guardians. They will set up a time to do a forensic interview of that child, where someone’s actually going to sit in a room and talk to the child and ask questions about the allegation and then discuss with the family, some followup steps, and what’s going to happen next.

Dr. Anthony Orsini (12m 41s):
So the forensic interview with the child, you did that. And so it’s gotta be very different interviewing a five-year-old and interviewing a 15 year old, how much training do you get for that? And how difficult is it, which one’s harder to interview?

Tony DeVincenzo (12m 55s):
tough to answer, because the one thing I always say, when you’re talking about, you know, you’re not interviewing children, you’re interviewing a child and every child is different, right? So sometimes a four year old can be the easiest interview in the world because they don’t really have a, a concept of what has happened to them is something bad. So they will very easily and almost sometimes even laughing and just tell you about what happened, because they have no context for that. Like teenagers sometimes can be really difficult. If anybody out there has teenagers, you know, how difficult those conversations can be?

Dr. Anthony Orsini (13m 34s):
Oh God, I talk about

Tony DeVincenzo (13m 38s):
In general. But now imagine going into that conversation and trying to ask them about what I would imagine is probably the most traumatic thing that has ever happened in their life. So I think they’re all difficult conversations. We’re trained. Typically forensic interviewers are trained in a specific type of protocol about how to ask the questions. And that protocol is really designed to elicit information in a neutral fact-finding way. Let’s get to stand up in court, that’s going to be legally acceptable. And so there’s training in that and included in that training is a lot of information about child development and how to ask proper questions and things like that.

Tony DeVincenzo (14m 19s):
I think we could do a better job though, in, in training forensic interviewers, and really everybody that’s involved in responding to child abuse in their communities, just around how to have those more everyday conversations and how to just talk to children and talk to adults about child abuse and what’s happened to them.

Dr. Anthony Orsini (14m 39s):
Yeah. So you have the conversations with the child, typically who initiated the complaint. Is it a neighbor? Is it the child? Is it, we always joke. It’s always the boyfriend. Is it the mother, the father what’s the most common?

Tony DeVincenzo (14m 52s):
I don’t know that there’s a common way. Usually allegations have come out in a couple of different ways. You either, it comes out accidentally, the child will be demonstrating some type of behavior. That’s not normal. That would give someone an indication that maybe they’re being abused. And then there’s other purposeful allegations where a child will just come out and say, uncle so-and-so is doing something to me. Or sometimes we’ll see allegations come out in the school setting where something will come up in school, there’ll be some kind of a prevention program or an awareness program, or there’ll be talking about the topic. And then a child will disclose to a teacher or a counselor. Those are a lot of different ways that, that the allegations could come out.

Dr. Anthony Orsini (15m 32s):
So I’ll tell you a funny story just to lighten this up just a little bit. So my oldest one, Joey was I guess, five, and he wasn’t a great eater. He didn’t never want to eat anything. He wanted eat pasta. And that was it. And so when he was really into WWE wrestling, that was his thing. He watched it every night and he loved WWE wrestling. And so the thing that at that time was daddy would come home from work. And then after dinner, we would pretend the wrestle on the ground and he would pretend he was WWE and, you know, think kind of thing a dad does what his son, when he wouldn’t eat dinner, I try a little reverse psychology. And I’d say, Joey, please don’t eat. Because if you eat that chicken, it’s going to make you really strong. And daddy won’t be able to be joined wrestling.

Dr. Anthony Orsini (16m 13s):
And of course he’d shovel the food down one day, Lauren gets a phone call from the kindergarten teacher and she says, Mrs. Orsini I feel really weird about asking you about this. But Joey says that if he doesn’t eat his dinner, daddy beats him. And so Lauren gets, Oh my God, we’re in trouble. So Lauren explains it to the teacher and she gets a good laugh, but I always thought that was a funny story. Like he says, my daddy beats me If I don’t eat chicken.

Tony DeVincenzo (16m 44s):
I’ll say it was a funny story, but I applaud the teacher for following through because one of the challenges that we have in this field is that people don’t know what to do. They don’t know how to respond to a situation like that. And sometimes the easiest thing to do is to say, Oh, they probably didn’t mean anything by that. Dr. Orsini is a doctor and a pillar in the community. There’s no way he would ever beat his child and just leave it at that, which can be dangerous. One thing I will say about being in this field for such a long time, it is the one thing that kind of spans every demographic. You know, I worked in Morris County is where I did a lot of my work, which I think still today is probably one of the 10 richest counties in the United States.

Tony DeVincenzo (17m 27s):
And we’ve had cases that involve some of the richest people in the County and in the country to some of the people that were really disadvantaged. Lawyers to homeless, you name it, men, women, every demographic you could think of there have been incidents of abuse within those communities. You know, one thing I always tell people when I’m out in the community, doing more awareness work is don’t ever think that this can’t happen because, and so is, and you fill in the blank, a doctor or the coach of the team or a teacher or whatever the case may be.

Dr. Anthony Orsini (17m 60s):
I think it’s a common misconception that this is something that happens in the inner city, low socioeconomic, but it’s really not true. And we see that in our emergency room. And we see that just about everywhere. You and I last time spoke about a conversation that occurs after you’ve found out or determined that the child is as being abused. And maybe let’s say it’s uncle Rick or uncle John or whatever, or the boyfriend. We talked about a particular conversation that you have to have when you’re actually sitting with mom and maybe that’s the boyfriend or the uncle. And you have to tell mom, listen, we’ve determined that is being sexually abused by the uncle or whatever.

Dr. Anthony Orsini (18m 42s):
Take us through that conversation because that’s gotta be hard the first convince them maybe, or do they generally know it, but won’t admit it or how’s that go.

Tony DeVincenzo (18m 50s):
It kind of runs the gamut. And it’s interesting. And there’s really, I think two conversations where I have found to be really difficult. One is that initial conversation when a family first shows up at a child advocacy center and let’s just use the example that the family’s coming down to a child advocacy center is when you really have to engage with that family. And it’s that introductory period where family they’re aware that there’s been some kind of an allegation, but they really don’t know what’s going on. And all of a sudden they’re being brought to this new place and a child to keep that in mind too, a child is also being brought to this new place to talk to these new people. And that is a difficult conversation to have with a family, to introduce them to the process, to introduce them to what has been said at that point.

Tony DeVincenzo (19m 37s):
We really don’t know what is true and what’s not true, but we need to tell them what is being said. And then I think what’s equally important is then to get them on board with the process. These are the steps that we are going to need to take to follow through with these allegations. And like you said, you’re dealing with people that can be anywhere from just in complete disbelief, right? There’s no way that this happened. I’ll go through this, but there’s no way that this happened to complete crisis mode. And then they could be anywhere in between. And as I’m sure they can move up and down that continuum, as you’re speaking to them in the middle of that conversation, we can go from disbelief to full blown crisis and then all the way back.

Tony DeVincenzo (20m 21s):
And that is a difficult conversation that I think anybody can be having that conversation. Law enforcement, CPS in our child advocacy centers. Now we have an incredible group of people that are family advocates, and they are just such a great resource to the child advocacy centers. And they really do a lot of work with family members and non offending caregivers, and really help us to have better conversations in that context. And getting back to what you were talking about, the conversation that we had once you do get them on board, and then you go through that forensic interview that we spoke about. There’s another conversation that needs to happen with non offending caregivers, where you’re telling them what happened in that forensic interview.

Tony DeVincenzo (21m 2s):
And it’s that conversation that I kind of parallel to what you talk about a lot about breaking bad news when you’re breaking bad news about a diagnosis. I think it’s that conversation where this really becomes real. If the child has disclosed that they’ve been abused, we need to go into that room and have a conversation about this is what the child said. This is now what we know has happened. And that is not an easy conversation to have. And I’ll be honest with you. We don’t get a lot of training in how to have those conversations.

Dr. Anthony Orsini (21m 33s):
And you approached me a few months ago about maybe the Orsini way, providing some training for your advocates, but just to give some advice because you did it for so long, what’s your best advice on how to begin that conversation and tell that what’d you call it a Non-offending what’s our terminology is usually not offending caregiver. Okay, there you go. A lot of times we step, we go right to mom,

Tony DeVincenzo (21m 56s):
But that’s not always true. And a lot of times it’s not apparent at all. It could be a guardian, it could be an aunt and uncle, some other kids, someone else that’s caregiving that is the caregiver for the child. So we tend to use that phrase, non- offending caregiver, but like I said, we don’t always get a lot of training in that conversation. We do get training, especially in law enforcement, we get a lot of training and crisis intervention. People are in crisis. They need to be deescalated. We get a lot of training around that, how to deescalate people that are in crisis. But I think it’s that everyday conversation that you need to have that I think is so impactful to the family members that oftentimes we don’t spend a lot of time working on. And I use a lot of the tips.

Tony DeVincenzo (22m 37s):
I have Tony, honestly come straight from you. And the work that you do, the one thing I think that I always tell people is understand that you’re going into this conversation about to break news of probably like I said, the most horrific thing that has happened to this family. You are dropping a bomb on this family and this field. And I don’t know, this may be true of the medical profession too. It’s very easy for us because we’re dealing with tragedy all the time. It’s very easy to get callous. And then we just get focused on doing our job. I’m going to go in, I’m going to do my job. I’m going to tell them what the child said. I’m going to get the information that I need and I’m going to get out because then I have to continue on with the next steps of our job.

Tony DeVincenzo (23m 24s):
I think it’s just important to understand that you’re going in and talking to some people whose lives have literally been turned upside down in the last, however many hours we’ve been involved in this investigation. I’m hoping we can get some of your training into the child advocacy center world, but just little things like where you sit, sitting next to people. I think one of the big things about this is to be patient. This is not a two minute conversation. This is a case that needs to take as long as it needs to take. Yeah. It’s hard to say how long it should be, but yeah. And I’ve had people ask me that I’ve had new detectives and new child protection workers.

Tony DeVincenzo (24m 4s):
Well, how long should I be in there? And the answer is this, as long as you need to be, as long as it takes. And I think we have to give a lot of family members, the opportunity to process what we’re saying, that you can’t just leave this on them, wipe your hands and walk out of the room, give them a little time to process what you’re saying, listen to what they have to say. I always think observing how people are reacting to this is also a big part of that conversation. And then just wait and answer whatever questions that they may have for you. The one thing I always tell people is people are probably, and you may know more about this than I do because you’ve done a lot of the research on this.

Tony DeVincenzo (24m 48s):
People are probably processing what, maybe a third of what you’re actually telling them. If that, of the information that you’re giving them,

Dr. Anthony Orsini (24m 55s):
What we teach is that after you break the bad news, you know, your child was abused. They only process 10% after that. And so my biggest advice when I discuss breaking a bad news, and as you and I have spoken before the parallels between what you do and what I do to tell mother or father their child has cancer or their child’s going to pass away. There’s so many parallels to that. But what I always suggest my main suggestion is give the evidence first and let the person who’s receiving the bad news, almost come to that conclusion on their own. So I think there’s a lot of times we make mistakes and say your child has cancer. And then spend the next 20 minutes Trying to what I always say is the person who’s receiving the bad news, their job is to prove you wrong.

Dr. Anthony Orsini (25m 41s):
If you’re saying I’m here to tell you that uncle Todd is abusing your child, their first response is going to be denial. So the same thing is if I’m telling you that you have cancer, you’re going to be in denial. So if I could present the evidence first, and then when I tell you have cancer, you almost already know that it’s coming. I think that’s really important, but yeah, it’s 10% afterwards. And so I love what you said, be patient, because then you have to sit there silently. And if you rush through it, they’re going to think that you rushed through your decision that you’ve made this determination. You’re not even sure. So I think that’s really great advice.

Tony DeVincenzo (26m 18s):
It’s very specific to our field is, and we train on this all the time and I can’t say it enough is, but you should always be number one, always have that conversation. And number two, always give the non-offending caregivers some information. There’s a variety of reasons in a child abuse investigation, where you may not be able to share everything that you know, at that point, but you should never leave them with no information. And I think honesty and just being transparent is listen. There’s a bunch of things that I just can’t talk to you about right now. And that’s not because I don’t want to there’s, but there’s a different re and if you can’t explain why you can’t tell them, explain why you can’t tell them, but just make sure that you’re explaining to them why you can’t do that and never leave them with no information at all, because you could just imagine if you’re being broken that kind of news and someone just walks in and says, yep, your child disclosed that they’re being abused.

Tony DeVincenzo (27m 15s):
We’re going to go on with our investigation and we’ll be in touch. It’s just

Dr. Anthony Orsini (27m 20s):
Not going to go well.

Tony DeVincenzo (27m 22s):
Because honestly, and I’m sure you know, this in the medical field too, a big part of that conversation is you want this family to be on board with the rest of this process. Selfishly, we want people on board because it’s just going to help the investigative process. But we also know from a lot of research that, and I’m sure this is true in the medical field as well, support from non offending caregivers and family members. It goes a long way in helping the child heal from any kind of trauma. And if we can’t get the family on board with that, we’re just putting this child at a disadvantage to process the trauma that has happened to them. And then to move forward through their healing process, forget about the investigative part.

Tony DeVincenzo (28m 5s):
It’s just their healing process that we also need to be concerned about as well.

Dr. Anthony Orsini (28m 10s):
Great advice. Tony, tell us about the Northeast children’s advocacy center, who they are, what they do and your role current role in that position.

Tony DeVincenzo (28m 19s):
So we are, what’s called a regional child advocacy center. We’re a project of the department of justice, who is our grant funder in the North, either for regional child advocacy centers around the country. One of ours in the Northeast that is based out of the Philadelphia children’s Alliance, which is the child advocacy center in Philadelphia. There’s a Midwest region in Minnesota, Western region, out in San Diego and a Southern region down in Alabama at the national children’s advocacy center. And we’re basically, we’re tasked with providing training and technical assistance to the 900 plus child advocacy centers and multidisciplinary teams that are spread out across the United States.

Tony DeVincenzo (29m 1s):
And so that’s what we do here in the Northeast. We do the nine States. I like to say, I draw a line at the bottom of New Jersey and Pennsylvania, and then I just go up the coast to Maine. Those are the nine States that we cover. So we work with teams on training, on a variety of different issues, team development, leadership, team building, all of that kind of stuff.

Dr. Anthony Orsini (29m 21s):
Do you work with every city, every town, or is it their choice whether to participate or not? Or is this, should I assume that every city is involved?

Tony DeVincenzo (29m 31s):
Yeah, like I said, there’s about, I don’t know the exact number. That’s about 900 plus child advocacy centers across the United States. Right now we do regional work where we’ll provide training and technical assistance, more global, more general topics. If a child advocacy center wants us, then we will come in and do a more deeper dive with individual centers, individual teams. But yeah, if you look at any County city, even small towns around the country, and I know you have an audience that spread out around the country, there’s a child advocacy center somewhere close by.

Dr. Anthony Orsini (30m 4s):
You’re a training specialist. What does that mean? That they specifically do?

Tony DeVincenzo (30m 13s):
That’s like I said, we go out, there’s three of us in our region. And like I said, we’ll go out and provide workshops on a variety of different topics from victim advocacy to vicarious trauma for professionals in this field. And then, and like I said, then we’ll do, and we also do more individual work. So we’ll go in and work with a team on strategic planning, on setting goals for their team on team building activities, and really trying to get that multidisciplinary team to work as collaboratively and cooperatively as they possibly can when they’re responding to child abuse.

Dr. Anthony Orsini (30m 49s):
Sounds like an absolutely wonderful thing. And I’m really so glad. Is it a 501C3 or is it funded? Can people help out if they want to help out?

Tony DeVincenzo (30m 58s):
Yeah, like I said, we’re grant funded from the department of justice, but my suggestion would be, if you were interested in getting involved, find your local child advocacy center, there’s probably a child advocacy center somewhere in your community or close by. There’s a national organization to the National Children’s Alliance that works with all the child advocacy centers around the country. You can look and they have a website. You could look into helping them if you wanted to do something on a bigger scale. But I love to direct people to their local child advocacy centers because it’s down there that on the ground level where people are doing that direct service work, that’s where a lot of the magic is happening. And that’s where just, you will find a group of passionate, dedicated people whose sole purpose is to help these kids that have been traumatized.

Dr. Anthony Orsini (31m 46s):
There’s nothing more satisfying than helping a child because you’re literally changing their trajectory of their life. They’re going down the wrong way and you help them out. And, and these amazing people that work with you are doing it for very little money. No, one’s getting rich doing this.

Tony DeVincenzo (32m 4s):
Absolutely not. And that’s everywhere from the law enforcement people that are working in this unit to the CPS workers, to the mental health and the medical staff and all of the people that are working in the child advocacy centers. I don’t know too many that are becoming wealthy doing this. I can tell you that that doesn’t affect the passion that they have for this work. It’s probably been the biggest joy of being involved in this for so long. And you asked me one of the questions you asked me earlier is how I’ve stayed in this for so long. And I think that’s probably one of the biggest reasons that I just have the opportunity to meet and engage with some of the most passionate people that I’ve ever met in my life.

Tony DeVincenzo (32m 44s):
And I’m amazed every day about the work they’re doing and just how dedicated they are to help these kids. And that hasn’t manifested itself more than it has over this past year because child abuse hasn’t gone away just because we’ve been quarantined. Has it gotten worse because of the COVID you think it’s hard to say right now? I think reporting has certainly Jew everywhere of reporting has gone way down because children just aren’t being exposed to a lot of the people in the places where it would make these reports, schools, physicians, things like that. And I don’t know what the numbers are saying yet, but I would guess that the numbers are going to be just as high, if not higher than they ever were.

Tony DeVincenzo (33m 26s):
I know there’s been some early research around people are seeing a lot more severe physical abuse cases than we’ve seen in the past. People are bottled up and emotions are running high. And sadly in a lot of cases that gets taken out on the kids that are in the home.

Dr. Anthony Orsini (33m 39s):
Yeah, I know alcoholism’s up drug abuse abuses is up depression, suicide. The kids are home from school. Their suicide is up for the kids. Maybe as you said, tempers are running short because the kids are home all day. So I would urge everybody to take Tony’s advice and support your local child advocacy center. Tony also has his own podcast. The name of the podcast on

Tony DeVincenzo (34m 3s):
Our podcast is called the NRCA C team talk podcast. And we focus on really things that are happening in child advocacy centers around the country.

Dr. Anthony Orsini (34m 12s):
Fantastic. And thank you so much for being on today. If they want to get in touch with you or someone where you are, what’s the best way to do that.

Tony DeVincenzo (34m 19s):
You can check out our website, it’s www N R C A C.org. I can put my contact information into your show notes as well. If anybody wants to reach out to me directly, the national children’s Alliance is another great resource for information about child abuse. They have a website which I will give you their website, too, that you could put in their show notes. I’ll put it in the show notes. And then, like I said, if you want more local information, please, I would direct you to your local child advocacy center. They’ll have a wealth of information about child abuse in general, how to report all of that kind of information. And they are always looking for support from the community.

Dr. Anthony Orsini (34m 59s):
That’s awesome. Thanks so much. Who would have thought that when we were 12 years old, these two goofy kids, what ended up interviewing each other on their podcast? So it’s an issue we’re just trying to get through life. Tony, thanks so much for coming on. This was fantastic. Put all the stuff for contact information on the show notes. If you want to learn more about the Orsini way, please contact me@ Dr.Orsini@theorsiniway.com. Our website is TheOrsiniway.com. Tony. Thank you. It was a pleasure and hope to talk to you soon.

Tony DeVincenzo (35m 30s):
Yeah, I really appreciate it, Tony. Thanks for the opportunity to let people know about this issue. And I will just leave you with, if you do suspect something just report it. There’s ways that you can report it in your community, in your individual States. So don’t hesitate to make those reports If you suspect something.

Dr. Anthony Orsini (35m 47s):
Thank you for doing what you’re doing, it’s really important work. And it’s like you said, it’s not something you get rich on, but you get rich inside and you get rich I believe in heaven because this is great work. So thanks again. And I will speak your real soon. Thank you.

Announcer (36m 1s):
If you enjoyed this episode please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us @theorsiniway.com.

Positive Culture Change in the Workplace with Siobhan McHale

Siobhan McHale (0s):
Culture is co-created and each part within the organization plays a role in the co-creation of the culture. However, culture changes leader led. So if you want to change the culture, you’ve got to get leaders at all levels, actually, to step into the role, to change the culture in their parts. But what often happens is that the leaders step into their business as usual role, and they delegate culture change to HR. So they say, Oh, well, that’s the soft stuff. That’s the HR department. I’m too busy running the hospital or running my medical practice. I’ll just give that to somebody else. And that invariably is disastrous for the change effort.

Announcer (42s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Announcer (1m 26s):

Dr. Anthony Orsini (1m 28s):
Welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini and I’ll be your host again this week. You know, in keeping with our format of combining the best leaders in healthcare and the best in business. I feel exceptionally fortunate today to have Siobhan McHale as my guest this week. Siobhan is one of the world’s leading experts in culture change in the workplace. She is the author of the well-known book, the insider’s guide to culture change. And over the past 30 years has helped thousands of leaders create more agile and productive workplaces. Siobhan began her career as a management consultant at Price Waterhouse Coopers in London, and later with the international Chicago-based consulting firm, Accenture.

Dr. Anthony Orsini (2m 12s):
After a decade as a consultant, Siobhan became the executive in charge of change at a series of large complex organizations. Siobhan is most well-known for steering a radical seven-year culture change project that Australia and New Zealand bank group Limited ANZ and transformed the organization from the lowest performing bank in Australia into one of the highest performing and most globally admired banks in the world. Her work with ANZ was so incredible that it was used as a case study by professor John Kotter at Harvard business school to teach MBA students how to manage change. The insider roles that Siobhan has had gave her a different perspective on culture change compared to the views of academics, consultants, and journalists who are mainly writing on the topic of transformation, the insights she has gained has allowed her to develop a groundbreaking approach to bringing about real and lasting change described in her book.

Dr. Anthony Orsini (3m 9s):
Her book insider’s guide to culture change has been described by culture pioneer, Carolyn Teller, as “the most groundbreaking thinking on how to change workplace culture that I’ve seen in many years” and so well welcome Siobhan thank you so much for coming on today.

Siobhan McHale (3m 26s):
Thank you, Tony. And thanks for that glowing introduction.

Dr. Anthony Orsini (3m 30s):
Well Siobhan is coming to us from Australia down under, so it’s early in the morning there and late in the evening here. So I thank you for taking some time out. I’m really excited to talk to you today. We combined, every week we try to alternate healthcare and business and the same topics keep coming up every single week. And those are words such as communication, trust, culture, leadership and I’ve been really looking forward to speaking to you. And as I’ve been doing this podcast now for about six months, multiple people have kept bringing your name up. And so when we finally spoke on the phone a couple of weeks ago, I knew this was going to be a really great episode.

Dr. Anthony Orsini (4m 13s):
So thanks again. Now I’ve got so many questions to ask you, but I always want to start out the same way. One of the things that I teach when I teach communication is being a genuine person. To be a leader you have to be a real person. You have to have people get to know you, whether that’s your patient and I’m a physician or it’s an employee and a leader. So before we even start, just tell us a little bit about Siobhan. And so we can get to know you.

Siobhan McHale (4m 36s):
I was born in Ireland and as you can probably tell by my accent. And, but I moved to Australia in 1994, actually. And I’ve spent most of my life living here in Australia. I studied psychology by background, but rather than taking the route that all my other classmates were taking, which was more into clinical psychology, I decided to take the less worn path, which was trying to figure out how people can work, optimally, how can they be at their best and highest in the workplace and what actually makes productive and constructive workplace culture. And that was really my passion and where I’ve spent my whole career is this whole exploration of workplace cultures and creating better places for people to work in.

Dr. Anthony Orsini (5m 24s):
One of the reasons why I’m so excited to speak to you is that, you know, I’ve been in healthcare my whole life. I think healthcare right now, no matter what country you’re in is in a crisis. And I can’t speak for other countries. I think the problem with healthcare, if you ask me, is the non-starter of healthcare leadership and healthcare leadership really seems to be lacking. It’s almost like we’re decades behind business, and there’s really no leadership. And there’s a culture of healthcare that is going really in the wrong direction where starting to get away from the human aspect of medicine. Healthcare is not run by physicians, at least in the United States.

Dr. Anthony Orsini (6m 6s):
Now anymore, it’s run by a bunch of administrators and CPAs and people who are telling you what you need to do that has led to in medicine, physician burnout, nursing burnout physicians with the highest suicide rate in the country of any profession is physicians. So this is why I’m so excited to talk to you because I think if anybody needs you, it’s the healthcare sector, but before we talk about it in your book, which I loved you define culture as how things work around here. So just elaborate. Cause we, we have to define it before we can fix it.

Siobhan McHale (6m 42s):
Absolutely. And I think how things work around here is my working definition of culture. And often the big myth about culture is that it’s just about employee relationships and about engagement. When actually culture is much broader than that. Culture is how you design, you fulfill your customer needs, you manufacture your goods, you serve your patients. It’s from Whoa to go. It’s not just about whether employees feel engaged. So I think we’ve got to redefine culture in its whole sense. It’s about the whole functioning of the hospital or of the business entity.

Siobhan McHale (7m 22s):
And often underpinning are at the heart of culture are the passions or the hidden agreements that are actually running the hospital are running the business. And those patterns are often deeply embedded and they’re difficult to detect you become caught by them and they just, the way that things are done. So the first step in culture change is to diagnose those deeply embedded patterns.

Dr. Anthony Orsini (7m 47s):
So let’s talk about this depth. Let’s go over. If you don’t mind telling this story of ANZ when you got there and what kind of the systematic approach that you took when the bank was having trouble so that people out there can learn about what are the first steps that we have to do. So let’s use ANZ as an example of how to turn around a company.

Siobhan McHale (8m 8s):
Yeah. So the first thing we did when the CEO John McFarland got there in the early 2000s, there was a lot of noise. There were a lot of, there was bank bashing and the media, there was a lot of noise about how the banks had behaved badly. And he had turned the company around from a financial perspective, but he knew there was more work to do and that he had to fundamentally change the culture and restore the faith and the trust of customers and the community in the bank. So we started out step number one, we had to diagnose what was really going on and uncover and have those difficult conversations about what was the reality. And one of the things we noticed was a big pattern that was running the organization, where the people in head office had stepped into role of order givers, and they were giving the directions, they were in charge.

Siobhan McHale (8m 60s):
They thought of themselves as in control and the 700 branches where there were 40,000 staff, they were in role of order takers and they saw the job is just taking the orders, almost a victim mentality and just going through the motions. And when I walked into these branches, what I saw was paint peeling from the walls, customers standing, shuffling and long queues and not getting the answers that they needed when they eventually got to the top of the queue. So the passion or the hidden agreement between head office and the branches was that you’re to blame for the poor customer service. So each part was pointing the finger at the other and saying, no, you’re too blame for the poor customer service, no your to blame for the poor customer service.

Siobhan McHale (9m 46s):
And meanwhile, the bank had the lowest levels of customer satisfaction of any bank in the country. So yeah, it was absolutely abysmal. So the first step we took was to see the roles that they were taking up and to use the power of role reframing. So this is one of the things I talk about in the book, the remarkable power of role reframing, which you can do at an individual level, but you can also do at a collective level. So we reframed the role of head office from order givers to support providers. They would be the enablers providing all sorts of IT services or HR services or risk services or strategy services to the branches.

Siobhan McHale (10m 32s):
And the branch’s role was reframed from order taker to service provider to the customer is essentially, and this role reframe was supported by a whole lot of processes and system changes. But this new operating model that we put in place really was the trigger for a massive transformation. And within seven years, we had gone from the worst performing bank in the country in terms of customer satisfaction, to the number one bank in the country in terms of customer satisfaction and also the number one bank in the world on the Dow Jones sustainability index.

Dr. Anthony Orsini (11m 12s):
Wow, that’s incredible. You know, one of my favorite quotes is “the biggest concern for any organization is when your most passionate employees go silent”. And it sounds like that I truly believe that I see it in all these toxic places that I’ve worked or people that I speak about. Once you start silencing the people on the ground, I guess it’s game over

Siobhan McHale (11m 34s):
It is game over. But also what happens is that culture is incredibly powerful. So you can have a person that has one set of values and beliefs outside the hospital system. And when they walk into that hospital, they are captured by the culture they are captured and they step into these roles inadvertently with all the best intentions, they can just step into roles instead of caregivers, we’re administrators, that’s our role is to financially balance the books and they haven’t got the interest of the multiple stakeholders at heart. So the first step is to see that pattern that is running the organization and naming that pattern and seeing the roles that different parts are taking up because often what happens is people say, Oh, well, it’s the administrators they’re to blame their fault, but they don’t see how the pattern is co-created by multiple groups or multiple parts in order to be sustained.

Siobhan McHale (12m 33s):
So diagnose the patterns is the first key step in culture change.

Dr. Anthony Orsini (12m 38s):
I’ve found that when I do a lot of patient experience, what you do, I do on a different level. It’s walking into a unit of a hospital that has having difficulty with their patient experience scores, which is the same as customer experience. And when we start speaking to people, what we used to do is we used to train the doctors in one room and train the nurses in another room. And what I invariably got was the doctors saying, we’re really good. We’re really nice. We’re really sweet. But the nurses, they just ruin everything. And then the nurse would say, Dr. Orsini, I’m doing everything I can, but that doctor comes in and he, or she’s just a jerk. And so they just, like you said, they’re pointing fingers.

Dr. Anthony Orsini (13m 19s):
And so now what I do is I make sure that they’re all in the same room and we train them together and we give each one of them, a license to give positive and negative reinforcement. But it is kind of like that, right? Everybody says, it’s not me, it’s you?

Siobhan McHale (13m 35s):
Yeah. You can get all sorts of dysfunctional patterns depending on what the culture is. And again, it’s not one size fits all. So every organization, the culture is unique as a thumb print. And it’s also assessing what type of culture do you need for this particular business? So this particular practice, and that’s not always a one size fits all. As I said, sometimes it depends. It depends on the context. It depends on the challenges depends on the client base that you have.

Dr. Anthony Orsini (14m 5s):
My grandfather used to tell me about an old Italian saying that I love that says the fish rots from the head down. And it’s usually often the leader that causes it. Is that true that you find that really it starts with the leader on whatever attitude or culture there is.

Siobhan McHale (14m 21s):
Culture is co-created and each part within the organization plays a role in the co-creation of the culture. However, culture changes leader led. So if you want to change the culture, you’ve got to get leaders at all levels, actually to step into the role, to change the culture in their parts. But what often happens is that the leaders step into their business as usual role, and they delegate culture change to HR. So they sell that’s the soft stuff. That’s the HR department, I’m too busy running the hospital or running my medical practice. I’ll just give that to somebody else. And that invariably is disastrous for the change effort because the change ends up being seen as HR has responsibility, the line managers, the general managers at every level, just see it as something that’s off to the side.

Siobhan McHale (15m 10s):
That’s nothing to do with them. And you don’t get what I call leader led change without leader led change. It’s usually the benefits will not be realized.

Dr. Anthony Orsini (15m 19s):
Yeah. Do you find that, you know, I get a lot of hospitals that call me and say, my CEO told me to fix this patient experience to fit the culture here, but I don’t have a budget. I don’t have a staff. It’s all me. And he, or she said to me, fix it. I don’t know how to do it, but just go ahead and do that. So I guess if the CEO or the head of the company is really not totally vested in it, it’s going to be difficult.

Siobhan McHale (15m 44s):
Yeah. It is going to be difficult. And often the fix is seen as a technical fix. So many managers try to fix it with processes or policies worked in one organization where they had a safety problem and they implemented about 5,000 different safety policies and nothing changed. In fact, the safety incidents got even worse. So you can help to change the culture with policies, procedures, and systems, but you must also change these patterns or these agreements, these hidden agreements between the parts, because otherwise people find work arounds. They work around the new process, the new tools, the new system, and nothing really changes on the culture goes back to it’s old ways.

Dr. Anthony Orsini (16m 30s):
And it all comes down to how important is the leader to be able to communicate well, because that’s what this conversation is all about, is about conversations that leaders have. How important is communication at every level in order to fix this culture that’s gone toxic.

Siobhan McHale (16m 46s):
I think it’s critical, but I often say communication on its own it’s communication from what role. So I worked with one CEO who was in an infrastructure company and he wanted to create a better, more commercial, higher performing culture. And he had a teleconference with his top 200 leaders. And afterwards he was really frustrated and he said, Siobhan, I’m really frustrated. Nobody on the call said anything, and everybody was just waiting for the call to finish so that they could get back to their jobs, their day jobs. And I said, what role do you, so they’re not really changing anything. We’re not becoming higher performing we’re not becoming more commercial..

Siobhan McHale (17m 29s):
We’re still losing money on our key contracts. And I’m really quite upset about it. And I said, what role do you think that your top 200 leaders are in? And he thought about it for a while and he said, Oh, they’re just in business as usual role. So they’re just involved delivering business as usual. And I said, and what role do you think you’re in? And he said, Oh, I’m in the change leader role. You’re the one change leader and they’re in delivery business as usual role. And as soon as he saw that, he called a conference and brought them all together for a two day event and he reframed their role. And he said, I’m the change leader, but now I’m also inviting you into the change leader role.

Siobhan McHale (18m 13s):
What are you going to do to create a more performance driven and commercial culture within your part of the business? What is your plan? So he reframed the role and the agreement between them, the agreement was they had an agreement was that the CEO would do the change and we can just focus on what we’ve always done.

Dr. Anthony Orsini (18m 32s):
Yeah. That’s a great point. So there’s people out there listening right now, going, okay. I want to improve my culture in your book. They’re hoping right now I can feel it. They’re hoping that I’m going to get some, really some concrete advice from Siobhan. And so in your book, you talk about the culture disruptor and the four steps to positive culture change. So if you don’t mind take us through that. So this whoever’s on the other end, listening to this with their piece of paper and pencil, trying to get some notes, of course, by the book, that’s the best way to do it, but can you take us through those four steps and what you mean as the culture disruptor and that some practical advice?

Siobhan McHale (19m 8s):
Yeah. The first critical step is to diagnose. So it’s a little bit like a doctor. You’ve got to diagnose what’s going on in the culture and you can do that by getting multiple perspectives. So you can’t just talk to one part, you’ve got to talk to multiple parts and figure out what is going on. So mid-block a, and Zed, R and Z is there. You might call them. I walked in there and I was told the people in the branches are the problem, they don’t know how to serve customers. Imagine if I had gone in and put, you know, thousands of people in the branches on a training course, we need to improve your customer service skills. What do you think would have happened would have created even more noise and more discontent.

Siobhan McHale (19m 50s):
But what we did was see the passion of the branches or enroll of order taker. The head office is enrolled of order giver. There’s an agreement between them that they blame each other. We’ve got to reframe that we’ve got to change the operating model. So rather than focusing on the individual is how do you change the operating model and reframe the roles of the parts within the organization, and then enroll your leaders. The third one said, there’s reframing and there’s breaking the pattern. So every day the leaders have to be seeing that pattern of blame and breaking it. Often we collude with the pattern we say, Oh yeah, I really do agree that they are the problems.

Siobhan McHale (20m 31s):
So people pick up on that stop the bland game or whatever the pattern is. Don’t step into that yourself. And then the fourth one is you’ve got to keep your foot on the accelerator and you’ve got to consolidate your gains over the longer term. So many management teams that I see, they go away for a couple of, they have the off-site, they have lots of ideas and brainstorming two weeks later, they’ve run out of steam. So do less three priorities at a time, get those completed and keep your foot on the accelerator for the longer term.

Dr. Anthony Orsini (21m 4s):
I think that’s so important when we do patient experience programs, we do something really silly after everyone is trained. There’s a phase four of our program called see something, say something. And we allow everyone to take the program, allows themselves to be open to criticism in a nice way. And they also allow themselves for positive feedback. So we have these little stickers. Siobhan that just say it’s all in the delivery of the programs, call it to all the delivery and you can give the chief medical officer of the entire hospital and nurse would hear a doctor have a beautiful relationship and a nice conversation. The nurse will give the doctor this sticker that you used to get excited about when you were three years old, going to the pediatrician and this 65 year old man will get so excited about getting the sticker, but it keeps it going.

Dr. Anthony Orsini (21m 57s):
And if someone does something that maybe is not with the culture that we want, the housekeeper can say to the doctor, Dr. Orsini, it’s all in the delivery, it means I call you and that keeps it going. So keeping your foot on the accelerator, I think is a great way of saying that because you fall back into your old patterns don’t you.

Siobhan McHale (22m 14s):
Yeah. And I love that example of one of the ways to fuel that journey because it is a bit like, and marathon it’s a long journey is to get feedback, get that positive energy. And what I love about that story as well is that every body is co-creating the culture. So it doesn’t matter where in the organization where I’m in the hospital, they are, they see themselves as part of the culture journey. One of the things we did today and say, for example, was we implemented a value called lead and inspire each other to, rather than the leaders will be the leaders and inspire people know it’s lead and inspire each other.

Siobhan McHale (22m 54s):
So leadership exists at all levels within your hospital, within your organization.

Dr. Anthony Orsini (22m 58s):
So you’ve done a lot of consulting when you come in and you’re in that first phase where you’re just watching or observing, you’re gathering data when you’re trying to fix culture. And there’s someone, maybe not the top leader, the CEO, but maybe somewhere down the line who is really resistant. I’m sure you’ve come across that many times where they’re not interested in culture change. They’ve been doing it this way. They don’t want to change. And I guess they could even sabotage the whole thing can’t they?

Siobhan McHale (23m 25s):
Yeah. Once you’ve got to realize is that one individual actually represents a part of the culture that is very valid. The culture that exists today came about for a very valid reason. It doesn’t exist in isolation. It came about because if help the organization in some way to adjust to its context, and you start to appreciate that there is a valid reason within its context, why that culture has served the organization in some way, for some of the stakeholders, then you start to appreciate that one individual actually represents probably they’re the tip of the iceberg. There will be more people who think like that, but actually that way of thinking.

Siobhan McHale (24m 10s):
So for example, I worked in a construction company where they were very relationship focused because they had grown up in a soft contract environment where all they had to do was to deliver the project, build the bridge, and they got a hefty margin on top. So what became important in that culture was the relationship with the client. But after a while, the environment shifted to a hard contract environment and actually the culture needed to become more commercial. You couldn’t be giving away favors for free to the client because you’d end up with a budget that was in the red, the project that was in the red, but yet they were still acting like that. They were doing lots of free favors for the clients without charging for the work as if they were still in a soft contract environment.

Siobhan McHale (24m 56s):
Now getting them to change. Why would they change? The client thinks I’m a nice guy. I liked being the nice guy. The clients always asked me for favors for free, build the wall over there and move that pipe three inches. Or could you fix up that leaking valve? And I’ll always do those extra favors for free. So we had to take those people on a journey and reframe their role from relationship managers, to basically commercial leaders who are managing the budget and the relationship with the client and showing them if we continued like this, the company would go out of business, but you can see why they acted in that way. And there was culture, there was a rational reason and the culture always has an internal logic within its context.

Dr. Anthony Orsini (25m 42s):
That’s a great point. I quoted you and your book. You said, culture change is the hardest work you will ever do. And it sounds that way, but can you expand on that? Why is it so hard?

Siobhan McHale (25m 57s):
It’s hard because it’s not a technical task. I think if you want to, people want to build a bridge. There’s a blueprint. If you want to create a budget in an Excel spreadsheet, that’s been done before some technical tasks, you can sit in a room with a few individuals and you can solve for those problems. Whereas culture change is complex. It’s adaptive. There’s no one blueprint that can guide you because every single situation is unique. And it requires a whole range of adaptive skills that leaders haven’t been taught. And this is one of the reasons that I’m so passionate about culture change is that I see in the workplace that leaders are trying to figure this out through trial and error.

Siobhan McHale (26m 39s):
They haven’t been given the toolkit for culture change. And yet we talk about it as one of our greatest assets. But when you ask people, well, how do you change a culture? How do you manage your culture? I haven’t been given a toolkit. So it’s a bit like doing an operation without having the right gear, the right tools.

Dr. Anthony Orsini (26m 56s):
How important is that emotional intelligence? Because that’s the hot topic right now, emotional intelligence for the leaders. Is that something really important? Do you believe that you can teach any leader to be an effective leader and to move culture change in a positive way?

Siobhan McHale (27m 11s):
Of course, emotional intelligence is important, but also I think what we need to appreciate is the power of role and the role that you’re stepping into and giving you a simple example. If you wake up in the morning and role of husband and you speak to your wife and say, good morning, then you might walk down the card or you meet your children. You step into the role of parents, your behavior changes. Then you go into work. You’re the director of a department in a hospital and you step into another role. Then you meet a colleague. You step into role of colleague. Then you are in a meeting where you’re negotiating that piece of equipment, medical equipment for your department. You step into role of negotiator that evening. You go out for drinks with some old school friends, you step into a different role again.

Siobhan McHale (27m 55s):
So in each one of those interactions, you’re still your same authentic Tony. You haven’t changed. You’re still Tony, but you have changed your role and your behavior has changed as a result. Even people who are not great listeners are you, haven’t the greatest IQ I’ve worked with them to say, in this situation, you have to step into role of listener. Now they might say, what are you think? And what do you think? And what do you think that might still be very directive and controlling, but they have stepped into a different role and the role has influenced their behaviors. So I think if we can think about role in the workplace, rather than trying to change who we are and our personality, which is very hardwired, I think we can get a lot more, a lot more change with less noise by reframing role.

Dr. Anthony Orsini (28m 42s):
I believe it can be taught teaching communication. There’s so many people that I come across to just I’m told this person’s a lousy communicator, but it can be taught. And I think, as you said, that particular role may be something that he or she struggles with, but with time you can teach it, right?

Siobhan McHale (29m 0s):
Yeah. Oh, I think you can. And I’m the first step in that is exploring with that person. What role do they see themselves in? And often if they draw a map of that role, it turns out that they see their role purely in technical terms often. So they see themselves as I see myself as a doctor and a deep expert in this specialist area, and I’m helping patients and I’m doing operations or whatever it might be rather than seeing their role in terms of the culture leader in the hospital or in the business. And if they frame their role in that way, then it’s, Oh, if I’m a cultural leader, then I have to do a whole lot of other things that I haven’t been doing. I’ve got to engage with people.

Siobhan McHale (29m 40s):
I’ve got to communicate. I’ve got to keep people updated on where we’re at. So reframing their role can be a first key step, as well as giving them the skills. But often that is a huge impetus on the change journey,

Dr. Anthony Orsini (29m 54s):
Putting them in a position to succeed rather than a position that they’re gonna fail or bound to fail. Now, next question I have is you’ve been an insider or you are an insider, but you’ve also done some consulting work. What are the advantages to accompany that, of having someone inside the versa consulting and what do you find to be easier or harder? What’s the positive and negatives of each one when you’re coming in.

Siobhan McHale (30m 18s):
I think as an outsider, as an external consultant, which I’ve spent half my career, as you have a great advantage, because you can see things objectively, you can see the passions often that people within the organization have become blind to. So you can go in and say, Oh, this is the way it works. And that’s the way it’s happening. And they can go, wow, that’s such a revelation for us, even though it’s so resonant for us. So that’s the big advantage of being an outsider. And often you can name things that it’s more difficult to do as an insider, but as an insider of which I now am. So I’ve been the executive in charge of culture change in a series of multinational firms. One of the great advantages of being an insider is that you’re on the journey over the longer term.

Siobhan McHale (31m 3s):
So one of the things that I found a bit frustrating about being a consultant was flying in and out and you not really on the journey, you’re just coming in and out and flying in and out and not really doing the change just coming in and advising. So being an insider, you roll up your sleeves, you’re in the middle of the change storm and you’re making it happen with the other executives. And that’s very satisfying.

Dr. Anthony Orsini (31m 27s):
So positives to both. Yeah. I find sometimes as an outsider coming in and doing some consulting work, that it’s easier for me because when you’re inside and it’s your home, what’s the old saying the shoemaker’s wife has the worst shoes. And so sometimes when you’re an insider and you have relationships, sometimes you’re not taking this seriously, but as a consultant, also, you leave and you don’t know what happens afterwards, or you worry about what happens afterwards.

Siobhan McHale (31m 54s):
Yes that’s a very good point.

Dr. Anthony Orsini (31m 56s):
I have one last question. This has been great. And so very practical advice. And we’re going to put your book on, on all the show notes. And again, I highly recommend it. I think I warned you about this question because I asked everybody this question at the end, the name of the podcast is difficult conversations. I ask every guest at the end, what is the most difficult type of conversations that you’ve had in your life professional personal, and give us some advice on how you navigate through those.

Siobhan McHale (32m 26s):
So often some of the most difficult conversations are the ones with CEOs where they are, co-creating a culture that’s not working or certain stakeholders. So one example was then that ahead of an infrastructure company. And he was trying to create this culture of accountability and he was failing. And I had a meeting with him and I could see that he was really struggling with this culture of accountability. And when I walked into the room, I could see he was really annoyed. So I said, Oh, what’s up Ben? And he said, Oh, I’m really annoyed. Because, so what’s been happening is that all of us, Tim, the head of marketing three months ago to put a billboard on the top of the building, on the rooftop to advertise our services in the area and this billboard still hasn’t appeared and it’s three months.

Siobhan McHale (33m 18s):
And it’s just another example, Siobhan of a lack of accountability in the culture, rather than thinking on, in a difficult conversation here. And I have to give him this feedback. What I did instead was say, well, who have you spoken to then about this billboard? You know, this miss deadline for the billboard. And he said, I’ve spoken to the head of finance. That’s spoken to the head of HR. I’ve shared it with the head of X, Y, and Z ed person. Instead of talked to a whole lot of people about I’m really annoyed. I said, yeah, but have you spoken to the head of marketing about it, Tim, the head of marketing. And there was a silence, anyone he went, no, and his jaw dropped and he looked at me and he said, Oh my goodness, I’m part of the problem, the passion.

Siobhan McHale (34m 6s):
And I just looked, I didn’t have to have the difficult conversation. I had to ask the right question. And often with my work, I’m looking for what’s going on right now. And how is that happening? And what is your role in that and how, what conversations have you had? And the penny drops. So rather than me thinking the stress of I’m going to have a difficult conversation, now I’ll just go in and I explore what’s going on. What’s whose role is that? What role are they in? What role are you in? And it emerges.

Dr. Anthony Orsini (34m 41s):
Yeah, I’ve loved what you just said, because the old saying is, let them think it’s their idea. And I do this in my book. I talk about the four pillars of conflict resolution. And at the end, that’s number four is let them think it’s their ideas. There’s an old joke that I’ll share with us. As we part there wasn’t a comedian and he was doing a show and he had a big audience and he was talking about marriage. And he said, how many people here have been married 20 years? And a bunch of people raised their hands. Then he says, 30 years, 40 years, he gets the 50 years in this very old couple raised their hand. And the comedian says stand up. And so they stand up and he said, 50 years. That’s amazing. Can you tell us what your secret is? The man puts his chest out the husband and he says, she makes all the little decisions and I make all the big ones.

Dr. Anthony Orsini (35m 29s):
So the comedians, that’s interesting. Give me an example of a big decision. And he said, I don’t know, we haven’t had one yet. So there’s a great example. Is she let him that he was in charge the whole time. I’ll part with that. Siobhan this has been really a pleasure. Like I said, your name always kept coming up and I was so pleased when you said yes, your book is amazing. We’ve got to put it on the show notes. I think culture is so important right now, as I said, six months of doing this podcast, culture, trust leadership, communication comes up every single episode. It’s so important in your professional life, but it’s also important in your private life, the culture of your house and how things run there.

Dr. Anthony Orsini (36m 12s):
And so I’m really glad that you were able to give some really practical advice to the audience. And what’s the best way for them to get in touch with you. Probably LinkedIn, you can follow me, connect with me on LinkedIn. That’s fantastic. And we’ll put all those links in the show notes in case you’re driving. I don’t want you to stop or pull over. So we’ll put that all in Siobhan. Thank you again. Really appreciate you coming on.

Siobhan McHale (36m 36s):
Thank you, Tony, for having me as a guest and for all the great work you’re doing in the space.

Dr. Anthony Orsini (36m 40s):
If you like this podcast, please go ahead and hit subscribe. If you want to hear more about The Orsini Way and the programs that we do here, you can reach me at Dr. Orsini@theorsiniway.com. Siobhan thank you. Have a great day. Appreciate everything. If you enjoyed this podcast, please hit the subscribe button and leave a comment and review you. To contact Dr. Orsini and his team, or to suggest guests for future podcast. Visit us at TheOrsiniWay.com.

Conversations about Second Victim Syndrome

Dr. Susuan Wilson (2s):
So the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician. So the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone, so any member of the healthcare team, whether it’s the physician, mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms.

Announcer (46s):
Welcome to Difficult Conversations: lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you..

Dr. Anthony Orsini (1m 29s):
I am honored today that the Orsini way has partnered with the Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU physician, the Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. That was created by their founder, Noelle Moore who’s sweet daughter, Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby. And the time when you get home, that led her to start the Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement.

Dr. Anthony Orsini (2m 24s):
The Finley Project has helped hundreds of women across the country and I can tell you that I have seen personally how the Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I will be your host again this week. Well since our first episode on August 4th of 2020, we’ve had a variety of guests from both healthcare and the business sector.

Dr. Anthony Orsini (3m 8s):
And if you’ve been listening on a regular basis, you’ll probably recognize that there’s many parallels and overlap between the two. Now a frequent topic during the healthcare episodes has been physician burnout and the high suicide rate among physicians and healthcare workers. In fact, one of our earliest episodes, I interviewed Dr. Dike Drummond, who literally wrote the book on burnout. And if you haven’t heard that yet, I highly suggest that you go back and listen after this interview because it’s really very inspiring and you can learn a lot. Well today I have another physician and coach who’s here to talk about physician and nurse wellbeing and a topic that I must admit I knew very little about before I spoke to her.

Dr. Anthony Orsini (3m 51s):
And that’s the topic of second victim syndrome. My guest today is Dr. Susan Wilson. Dr. Wilson has been practicing emergency medicine since 1994. After attending Loyola school of medicine in Chicago and completing her residency at the medical college of Wisconsin in Milwaukee she retired from clinical practice in June of 2019. Wanting to maintain involvement in medicine, Dr. Wilson completed coursework in coaching, forming SJW professional coaching services, LLC, with the goal of providing guidance and support the healthcare professionals, her 25 years as a hospital-based board certified physician has afforded great insight into the challenges of medicine into this arena.

Dr. Anthony Orsini (4m 37s):
Having seen the evolution of medical practice and witnessing firsthand how these changes have impacted her colleagues, Dr. Wilson sees professional coaching as an important tool to addressing issues of burnout among health care providers. She is currently affiliated with vital worklife, EAP and surgeon masters as a physician peer coach. She is a member of physician coaching Alliance and also serves as a volunteer physician coach for California medical association. Susan is particularly passionate about second victim syndrome, which I find fascinating. So please keep listening. You’ll learn a lot. It’s an extremely important topic.

Dr. Anthony Orsini (5m 17s):
And one that every healthcare provider should know about and every patient should care about. Susan has been a Midwesterner her whole life, and I’m happy to get an opportunity to learn from her today and to truly be inspired, Susan, welcome. And thank you for taking the time out to be a guest today.

Dr. Susuan Wilson (5m 34s):
Thanks so much. It’s great to be here. Great. To be able to talk about something that’s very near and dear to my heart.

Dr. Anthony Orsini (5m 41s):
I just said, told everyone you’re at Midwestern your whole life, but you just told me right before you’re in California, at least for a few months now, is that correct?

Dr. Susuan Wilson (5m 47s):
It is. Yes. I’ve been in actually did my entire career in the Milwaukee area. And I’m originally from Northern Illinois and yeah, now just spending a few months of the winter in California, but otherwise in Northern Wisconsin during the summer.

Dr. Anthony Orsini (6m 4s):
Fantastic. So last time we spoke, you told me about your journey and it’s fascinating and how you got here. And I really want to talk about second victim syndrome about coaching. And of course this is always about difficult conversations, but I also love to start out with having my audience, get to know you. So if you just tell us about who is Susan Wilson, how did she become a physician and how did she kind of evolve into now doing what you’re doing now?

Dr. Susuan Wilson (6m 29s):
So I actually am from a medical family. My mother was a practicing internist. And so that subsequently spurned me on to go into medicine. And so I have done all my training, as I said in the Midwest. I started practicing emergency medicine back in 1994 and actually had to retire last year in June, 2019 because I have developed this progressive retinopathy. And so my vision has become an issue really to the point where I couldn’t practice effectively anymore. So I had to retire. And then I was thinking a lot about what I wanted to do, what the next chapter would be.

Dr. Susuan Wilson (7m 10s):
And I really still wanted to be involved in medicine and I really wanted to still be interacting with my colleagues. So I thought, well, coaching would be a great way to do that. Especially, you know, given the fact that people seem to be having a lot of struggles now with job satisfaction and burnout. And so I really wanted to try to help my colleagues with that piece. And then also I’ve along the way, become super interested in the concept of second victim syndrome. And so also really wanted a way that I could continue educating my colleagues about the syndrome and the fact that there is actually help out there and their support.

Dr. Anthony Orsini (7m 53s):
Fantastic. And before we get into the second victim syndrome, if anyone has not heard the interview with Dike Drummond, but if you’re in healthcare, you really know that physician burnout is a problem and suicide rates of physicians higher than any other profession, which most people that I meet do not know. I just like your point of view now that you’re coaching, and this is an issue that you deal with all the time, how bad of a problem is it, and what do we really need to do to kind of bring these suicide rates down? Just tell us your feelings about how we can stop this terrible thing from happening.

Dr. Susuan Wilson (8m 26s):
Well, you know, it is the more and more I learn and I hear about burnout, particularly in medicine. It’s just become very clear that, I mean, it’s a multifactorial issue. And really, I think traditionally, you know, you think about somebody getting burnt out, you think there’s something actually wrong with them and that they can’t handle the job. And there’s an inadequacy there, but more and more, I think we’re seeing that it’s not the physician. It’s really the environment that they’re in, that’s causing them to become burnt out. And you know, it’s interesting, there’s actually an article. You may be familiar with this that came out just this year.

Dr. Susuan Wilson (9m 9s):
I think in July in JAMA talking about the kind of correlation between resiliency, particularly in physicians and burnout and what the article pointed out was number one, that physicians have higher resiliency rates than it, than the general population, but then also there’s still a significant amount of burnout even in the most resilient physicians. So I think what they quoted in this article was like, even the physicians that scored highest and resiliency still had up to a 30% rate of burnout. And I think what that speaks to is, you know, the idea that really, it’s not the physician they’re already super resilient and they’re already coping with challenges, but what are speaks to, I think is the fact that we really need to change the environment that we’re practicing in.

Dr. Susuan Wilson (10m 2s):
And so then you’re starting to talk about trying to reach out to the healthcare organizations, the administrators, and really get the culture to change. And I think that’s the big challenge right now. I think getting that message out there to the big organizations is the strategy that really needs to happen.

Dr. Anthony Orsini (10m 23s):
It seems to me and from my own personal views, and I’m getting ready to interview Quint Studer, who you may be familiar with. The founder of the Studer group and Quint is a very successful entrepreneur, but also very successful person in healthcare does a lot of really successful stuff with patient experience, but also is a really world-known speaker on leadership. I just finished reading his last book. They talked about the importance of employee engagement and the success of a company. My personal view about physician burnout is very similar to employee engagement. I think in the 26, 27 years that I’ve been practicing I personally feel that the patients appreciate us just as much.

Dr. Anthony Orsini (11m 9s):
I don’t believe that administration and, and the leaders in healthcare appreciate us. Do you think that’s a major role? Am I dead on with that? That it’s really not feeling like you’re not appreciated at the end of the day.

Dr. Susuan Wilson (11m 21s):
Yeah, I really think there’s a lot to that. You know, it’s kind of interesting when I think about, I mean, I’ve been observing the changes in medicine really for 40 years. I mean, when I think about what I remember my mother’s practice was as an internist and that I think about my own career, I think about how I have observed the shift from, you know, physicians practicing independently or being members of independent groups to now the vast majority I think are employed and the whole transition, you know, from handwritten clinical notes to an EMR, but the pressure that’s put on the physician, you know, to see more patients more quickly.

Dr. Susuan Wilson (12m 5s):
And I don’t think, I mean, just from what I’ve observed, I don’t think necessarily that those challenges have been really appreciated by administration, but how difficult they are. So I definitely think that there has become a progressive disconnect between the physician and the practice and what they’ve been asked to do and the administrators.

Dr. Anthony Orsini (12m 29s):
And if you’re a physician out there, I think you’re going to relate to this. If you’re not a physician, you’re probably going to learn something, but on a journey of a physician, you’re a medical student and then you say, if only I can get past this, I’ll do better because I’ll be a resident I’ll have more control than you realize you’re the low resident on the totem pole. If only it could be the chief resident that I’ll have more control. If only I could be the attending physician, I’ll have more control and you work your whole life towards this autonomy. And then you find out that you never get it. And I think that’s what, in my opinion is, what’s leading to this and that’s why we need coaches like you. And we’re going to talk about your coaching style and your theories about that in a second. I think I want to tie that in what second victim syndrome be honest with you.

Dr. Anthony Orsini (13m 12s):
I had never heard a second victim syndrome until we spoke and I know my audience out there is going, I need to know what this is. So tell us about second victim syndrome and why it’s such a problem.

Dr. Susuan Wilson (13m 23s):
So I have to say, interestingly, I had never heard this term myself either until 2017 when I went to a lecture. And so, you know, I’ve been practicing well, I had practiced up to 25 years until, until I retired. And I realized after hearing about it, I have been living this my entire career. So yeah, it’s something that just, I observed that the majority of physicians really don’t know. I mean, I think they know what it is because they’ve experienced it, but they don’t know that there’s a name for it. And so the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician.

Dr. Susuan Wilson (14m 6s):
And so the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone. So any member of the healthcare team, whether it’s the physician, a mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms. And for example, the physical symptoms are things like elevated heart rate, high blood pressure, GI symptoms are pretty common like nausea, even vomiting and diarrhea, sleep disturbances.

Dr. Susuan Wilson (14m 52s):
And then there are a whole host of psychological symptoms that come along with this, including things like feeling, shame, grief, feeling irritable, feeling inability to concentrate, certainly lack of self-confidence is a big one. People oftentimes will describe stress and anxiety. That’s increased depression and even suicidal ideations really fall into this category.

Dr. Anthony Orsini (15m 20s):
So it’s, so something happens at the hospital, which is inevitable because we’re human beings. There could be a medical error. There could be no medical error, right? Just the death of a patient that you’ve bonded with. And I’m a big proponent of not blocking our emotions because I think that makes things worse. And, you know, with my patient experience teaching and my teaching with breaking bad news, I tell doctors all the time it is okay to show emotion. In fact, it helps, but basically second victim syndrome is something happens that doesn’t go perfectly well. And we often think that maybe as lay people or physicians, you know, the patient dies. There’s a medical error. We feel bad, but we carry that with us a long time.

Dr. Anthony Orsini (16m 2s):

Dr. Susuan Wilson (16m 3s):
Oh, absolutely. Absolutely. And as you alluded to, I mean, I think medical error is probably the number one cause of this syndrome, but there are so many other scenarios that fit this and, you know, complication of a procedure. If you miss a diagnosis or you’ve had delay in diagnosis, obviously a patient death, all of these things really can then contribute to this feeling. And I actually even would put the whole concept of medical malpractice lawsuits in here because I really think that, you know, a physician or any healthcare professional that’s named in a lawsuit, really, it brings up a lot of these, both physical and psychological symptoms.

Dr. Anthony Orsini (16m 47s):
Most people don’t really understand that this is how this really affects us. I had a colleague that I really looked up to. He had practiced neonatology for many years in New Jersey. He was phenomenal with patients and with families. And he had gone his whole life really with no malpractice lawsuits. And then something happened with a baby who needed to have their eyes checked after they went home for retinopathy of prematurity, which is a common blood vessel disease of premature babies. He had documented multiple times that the mother had to follow up and it was in writing and the mother for some reason did not.

Dr. Anthony Orsini (17m 29s):
And the child sadly went blind because of no followup. And really, I don’t know what else he could have done just on a personal note to explain, but whatever. So he got sued and although the documentation was there and they settled and you know, he watched the lawsuit, but I got to tell you, Susan, he was probably 30 years into his practice. Every day he came into the office. He was thankful for being a physician. And on that day that he lost the lawsuit. I can tell you, it was never quite the same. So you don’t have to do something wrong or cause a medical error, just the act of being sued.

Dr. Anthony Orsini (18m 10s):
He just felt he took it personally, which she probably shouldn’t have, but we’re human beings. Right? You counter that a lot too, just with the malpractice that these people just can’t get over it.

Dr. Susuan Wilson (18m 19s):
And you know, I even think to my own career and to my own personal second victim experiences and yeah, I mean, even if you know, you did everything possible and you did everything correctly. Yeah. You just, you know, there is just, there’s an emotional scar there. And I think the challenge in these situations is how to get through that, how to deal with it. And interestingly, one of the things that we learn about second victim syndrome is there’s a very well-defined recovery trajectory and there’s all these different stages that people go through. It’s kind of like the Kubler-Ross stages of grief.

Dr. Susuan Wilson (18m 60s):
And after you’ve gone through all these different stages, the very final stage is moving on. And so people will either thrive, survive, or they’ll drop out. And so I think what happens to a lot of us and I think it’s, I think it depends on the scenario. I think you can certainly thrive through one scenario and maybe you’re just surviving through another. But basically what happens is if you’re thriving, you’ve learned something from the event, it makes you a better clinician. You kind of get in the long run, it’s sort of a positive experience that kind of spurs you on in your career. Then the whole idea of surviving is that you have gotten through it, you are figuring out how to cope, but you still have, you’re having a really difficult time forgiving yourself.

Dr. Susuan Wilson (19m 51s):
And so you sort of have this permanent emotional scar. And so while you’re still practicing, you’re still going through the motions. Yeah. It’s just there and it changes you. And then as I said, there’s even some people that just after an episode like this, they completely drop out. So whether they quit where they’re working and find another group to join and to have a fresh start, whether they leave the specialty of medicine that they’re in and go into something else or whether they leave medicine altogether is certainly a possibility.

Dr. Anthony Orsini (20m 22s):
That’s where you come in. We need physicians to stay on the job. We need nurses to continue. Especially during this crisis, I come from a family. I’ve mentioned this before in previous episodes, you came from a medical family. I come from a family of police officers. They’re all police officers, except for me, I went into medicine obviously, but my father who was a police officer for 30 years, said to me, when I entered medical school, he said, there’s only two people in this that have to be perfect every time. And that’s police officers and doctors. And that kind of stuck with me, especially pertinent right now, right with what’s going on in the news. But what people forget is that police officers and doctors are human beings also. And human beings by definition are not perfect.

Dr. Anthony Orsini (21m 5s):
And I think we need to recognize that for ourselves and for other people that we make mistakes. It doesn’t mean that we’re a bad person and it doesn’t mean that we’re mean, but we often make mistakes. So how does this work now? So let’s assume there’s a physician there. If he or she is feeling very depressed or feeling a little burnout, there was possibly an event that occurred and now they need some help. How does it generally happen? Did they reach out to you? How do you get that referral? Is it mostly from someone else or that he says, find you and say, Susan, I need some help.

Dr. Susuan Wilson (21m 43s):
Well, I think, you know, there’s multiple ways to get the help. And I think the one thing that I would like to kind of point out is that the second victim scenario, I really kind of feel like that is an acute event. Whereas somebody seeking coaching for issues of job satisfaction or burnout, that’s kind of more of a chronic ongoing process. And so it’s almost like, I think an analogy to make would be, you know, you go to your primary care doctor once a year for your, like your annual checkup and you have your ongoing medical care, you’re checking your cholesterol, blah, blah, blah. And these second victim events are really more like unscheduled care.

Dr. Susuan Wilson (22m 25s):
So it’s like, you know, you cut your finger and you have to go to the urgent care to get it sewn up, or you’re having a heart attack and you need to go to the emergency department. So the coaching strategies for both those with burnout and job satisfaction, and then those with second victim scenarios, the principles are kind of the same, but it’s just getting the help in a timely fashion specific with second victim. So in terms of how to get it. So in terms of the second victim scenarios, there are actually several large hospital organizations that have established what’s called peer support processes.

Dr. Susuan Wilson (23m 6s):
And that is peer support is what we describe as the treatment, if you will, for second victim syndrome. And so like for example, John Hopkins has this, their program is called RISE resilience in stressful events. And then university of Missouri has the four U team. And that actually is basically a team within the hospital that responds like within, I don’t know, 30 minutes to someone that has experienced an adverse event. So those are ways to get help quickly through hospitals if they have these programs in place. But challenges that I think the vast majority of institutions across the country don’t have these kinds of things.

Dr. Susuan Wilson (23m 51s):
So oftentimes what happens is that if someone, if a clinician is identified as being a struggling after an event, they’re oftentimes referred to maybe HR or maybe their EAP and then the EAP would in turn, refer them. I work at, I’m actually a consultant with an employee assistance program, which is EAP who specialize in providing services for healthcare organizations. And I’ve actually set up a protocol or process with them that if a client is referred to them specifically for a critical event, like a second victim scenario that they connect with me immediately, and then we get the ball rolling to provide the support because it is really important for these people to get the support in a timely fashion.

Dr. Anthony Orsini (24m 43s):
What percentage of people that come to you after a second victim event come reluctantly? And what portion do you think are really seeking help?

Dr. Susuan Wilson (24m 51s):
Well, it’s interesting. So the people that I’ve been helping so far with the peer support piece have come to me through the EAP and one of the gals, she didn’t even know that this was even a benefit that she could access. So she didn’t know anything about, you know, the service that the EAP offered. It was only when she was in crisis that she had a supervisor say, Hey, you know, let’s get you some assistance. So I think it’s kind of, it’s kind of all over the board. I think some people are aware of it, but the vast majority, and again, I’ve worked with mainly physicians, but the vast majority of the physicians that I’ve worked with don’t necessarily know that this is even available for them.

Dr. Susuan Wilson (25m 36s):
And so that’s the piece. I think it’s really important to get the word out that yes, coaching is out there. It’s both for you for ongoing support to help you realize your ultimate goals in terms of your work, but that also it’s there for you for these acute events as well.

Dr. Anthony Orsini (25m 56s):
We think we’re Superman and Superwoman and I can handle it. And until you can’t and I think it would be really nice if we can convince physicians that you don’t have to be as Superman or Superwoman and that it’s okay to go to a coach or a psychologist. And so I think my guess is, and tell me if this is true, that there’s a whole bunch of people out there that need your help and need coaching. That just don’t even know they need it or know they need it and won’t come.

Dr. Susuan Wilson (26m 29s):
Absolutely well. So interestingly, I think some of the data about second victim syndrome mirrors some of the data regarding burnout. So I’ve heard like burnout up to maybe 50% of physicians feel burnt out. So the data with second victim syndrome is that it’s estimated that 50% of all healthcare professionals will experience this at some point in their careers. And I really do think that number is probably closer to a hundred percent because I feel like if you are in a profession where you have any significant interaction with a patient, this is going to happen at some point.

Dr. Susuan Wilson (27m 10s):
I mean, you know, you may not have somebody die, but you know, some, something will happen that you will, that will trigger this feeling. And then of the people that even admit that they have suffered this right now only 30% of those are even seeking help. So the vast majority obviously are just suffering in silence. And again, I think part of that is because of, as you talked about, you know, the stigma notoriously, you know, physicians feel like they just can handle anything themselves and they don’t want to seek out help. But then also just not knowing that this kind of support is available.

Dr. Susuan Wilson (27m 50s):
So, yeah,

Dr. Anthony Orsini (27m 52s):
So I interviewed Helen Riess, Dr. Helen Riess psychologist, and one of my earlier interviews and Dr. Riess wrote a great book. And Alan Alda was the writer of the foreword for her book. And I often joke that I became a physician because I was a big mash fan. And I know mash probably every episode, every word is just my thing. But when you really think of Hawkeye Pierce, as you were speaking about second victim syndrome, you were speaking about physician burnout. And I know there’s a lot of people that are listening right now that are so young, they’re going, what’s mash. But if you’re old enough to know what my peers had, classic physician burnout, he was someone who, and in the end, I think it’s the last episode.

Dr. Anthony Orsini (28m 37s):
He actually has a breakdown, a mental breakdown. And I think this happened a lot during the war, from what I read, you know, just seeing people die over and over again. So I just went off on a tangent, but just classically Hawkeye Pierce just came into my mind. So now they come to you and how do you help? You know, I come to you, Susan something’s happened, I’ve been referred EAP. How do you take me on that journey of feeling better?

Dr. Susuan Wilson (29m 4s):
First of all, I will say that as I’ve mentioned earlier, the quote unquote treatment for second victim syndrome is this whole concept of peer support. And so I will say that physician coaches, I think are uniquely qualified to provide this kind of support because not only are they a peer, but they also have these specific training of coaching skills. So these kinds of conversations really require strategies that we’ve all been taught as coaches. So for example, so when I have someone that I’m talking to specifically about a critical event, it needs to be obviously a very confidential conversation.

Dr. Susuan Wilson (29m 48s):
They need to be reassured that it’s just the two of us. It’s non-judgemental I think the important thing for any healthcare professional experiencing this is to know that they have a safe space when they’re talking to you. And so by ensuring that they have the safe space, then they feel comfortable. They can vent, they can say whatever they want and it’s okay because, you know, this is where they are certainly the types of questions that we have been trained to ask as coaches they’re called open-ended questions. And they are very important because that’s kind of then allows the clinician to really elaborate on how they’re feeling and maybe getting some new perspective and new insight into the event for themselves.

Dr. Susuan Wilson (30m 39s):
And so the initial conversation really is kind of establishing a relationship with the individual. And then the other piece of it, it’s really important to have several conversations, you know, to have follow-ups. So for example, when I’ve had peer support interactions with people, I’ve had at least four different conversations with them, so that, you know, we’re kind of, you know, making sure that they’re kind of heading in the right direction in terms of their thoughts and their emotions. The other piece of it is that if you’re having these peer support conversations with someone, certainly as a physician coach, we know what it looks like for somebody to have a significant mental health problems.

Dr. Susuan Wilson (31m 22s):
So if you identify that somebody now looks like they are clinically depressed, they’re having debilitating anxiety recognizing that, and then being able to refer them for a higher level of mental health care, whether that’s a therapist or a psychiatrist is important.

Dr. Anthony Orsini (31m 39s):
Yeah. And so this is not a short journey back. This is something that takes a long time with you. And then even afterwards, I would think that, especially in a medical error, I weep for the ones out there, God willing, it won’t happen to me. But as you said, it’s something happens to all of us that is feeling that they need help and don’t seek that out. And I think that’s what happens with the physician suicides. We had, I know somebody from a colleague that did do that sadly, and we don’t really understand what that is. And I think part of that is our ego. We really got to get over that ego and ask for help and people like you and other people now, I think physician coaching is getting exponentially more popular.

Dr. Anthony Orsini (32m 25s):
Isn’t it?

Dr. Susuan Wilson (32m 26s):
Yeah. You know, interestingly, I just was a part of a physician coaching summit this past weekend and yeah. You just realize there’s so many people out there that are practicing coaching. Interesting a lot of the physician coaches that I’ve encountered so far have come to coaching because of their own burnout story. And the thing I kind of feel is a little unique about me is that I left medicine, not because I was burnt out, but because I had to physically. And so I kind of feel like, you know, what, I still, I mean, I love medicine.

Dr. Susuan Wilson (33m 6s):
I always have, it’s always been a part of my life. And I loved like, you know, you hear a lot of people talking about how they just absolutely, you know, they couldn’t stand medical school or residency or anything. And I actually have really fond memories of both medical school and residency. And I kind of feel like I, through my career was able to find the formula to make it really satisfying for me. And so now as a coach, I want to help others find their own formula because I do feel that as we’ve talked about earlier, with all the new challenges that have kind of developed in the last 25 years, that people do need a little bit more guidance and a little bit more support in terms of finding where do they fit in and how can they feel really good and really satisfied and fulfilled with their career in medicine.

Dr. Anthony Orsini (33m 57s):
And I do a fair amount of coaching as well, but on a totally different end, my coaching as you know, is to help that physician and that nurse communicate with their patients, build better practices, enjoy their job more. So it’s a different end, but an event it’s also physician coaching. And I don’t think we’ve all had coaches in our lives. There’s no reason why we shouldn’t keep having coaches and mentors, especially when there’s areas that we need help for. And there’s not a lot of people that turn to, so that’s why people like you are just so important to our profession, especially at this time during COVID, it’s been much harder on healthcare professionals.

Dr. Anthony Orsini (34m 37s):
As I mentioned in one of my previous podcasts where the general public is looking out and seeing things like healthcare heroes, and we’re seeing pictures on TV of these doctors and nurses who are working 24 seven during the COVID crisis. But those of us working in the hospital and also seeing the other end with the burnout, the nurses who are getting furloughed doctors who are losing their practices. And so we only see the one end, it looks like to the public that every doctors and every nurse is working 24 seven, but because of all the elective procedures and everything going down, actually many nurses have lost their job. And so that makes it even harder. Susan, before we break, I always ask everyone the same question last and most people say it’s the hardest one.

Dr. Anthony Orsini (35m 23s):
So get ready. You have a lot of difficult conversations. And is there one conversation that particularly stands out or it could be a type of conversation that you can point out that is the most difficult and then teach the audience something about how you approach that?

Dr. Susuan Wilson (35m 40s):
So I, in terms of coaching, I would definitely say that the peer support conversations are the most difficult. And the reason I say that is because I am entering into this relationship with these clinicians when they are truly in crisis. And so, you know, that is the challenge. I will say, even though it’s the most difficult conversation, I have definitely found it the most rewarding because I really feel like in a relatively short period of time, I mean, when I have my follow-up conversations, I mean, these are occurring over like two weeks. So I may have four conversations with somebody over the course of 14 days, because I want to make sure that they are getting through that they are coping, that they are finding ways to, you know, wrap their head around what’s happened.

Dr. Susuan Wilson (36m 31s):
And so it is really rewarding to me when I go from the first conversation where somebody may be actually crying and in tears for 20 minutes to maybe the fourth conversation where I can just tell, I can just hear it in their voice, they’re much stronger and they’re kind of regaining their old self back. So that is the most challenging for me, the way I approach those is as kind of, we talked about earlier, really reassuring the clinician that, you know, this is confidential. I’m not writing anything down. This is just me being here for you. I’m just providing you emotional support. And so this time is for you to vent and say what you want to say.

Dr. Susuan Wilson (37m 11s):
And then I do probe a little bit in terms of asking them, how are they doing, who is supporting them? I think one of the other things that’s super important, both in peer support and in regular coaching is ensuring that the client has some kind of self care that they’re following. Because I think we all tend to sacrifice our own personal self care for that of our patients or our career.

Dr. Anthony Orsini (37m 41s):
So for the person who, Oh, I’m going to ask two follow up questions. One is the person who’s in the hospital, doctor, nurse, who recognizes someone that they care for care about and kind of starts to see this physician burnout or an event has happened. Can you give me or someone else some advice on how to approach that person? I mean, that’s gotta be a really difficult conversation.

Dr. Susuan Wilson (38m 9s):
So if it was me and I identified, one of my physician colleagues in the emergency department seemed to be struggling or just wasn’t doing well. I think the first thing I would do is I would just ask them, you know, how are you doing? And you just kind of allowing them and, you know, and probably they’re going to say, Oh, I’m fine. Everything’s cool. And then trying to gently probe, I mean, obviously you don’t want to push somebody and you can’t force something on someone that, you know, they don’t want, but I think then my follow up would be, well, you know, I just want to make sure everything’s okay. It just seems like maybe some of the situations that we’ve been in recently seem like they’ve been really difficult and I want to make sure that you’re feeling okay with that.

Dr. Susuan Wilson (38m 57s):
And I just want you to know that I’m here and I’m happy to talk through some issues with you. And I think, you know, just being gentle and just kind of letting people know that you care. And certainly we as physicians that we empathize with our colleagues, I think that’s super important, you know, not being condescending and not trying to be in a superior role. I think letting them know that you want to collaborate with them to help them find a better solution or you want, you know, you’re a colleague and you’re an equal, I think that’s really important.

Dr. Anthony Orsini (39m 30s):
And having someone that you can recommend I think would help. So before you have that conversation and say, listen, I know this great person, and she’s done some great things and you know, why don’t you just call her it’s can’t hurt, you know, let’s refer her to, so that’s where you come in and other physician coaches. So having said that as we finish up, what is the best way for people to get in touch with you, whether they want you to speak more about second victim syndrome, or they need some help or they want to refer somebody what’s the best way to get in touch with you.

Dr. Susuan Wilson (40m 4s):
So I actually have a website it’s S J W professional coaching.com. And that kind of gives a little bit more detail about my coaching services talks about the methodology that I’ve used. And then my email is Susan WilsonMD@gmail.com. And certainly anyone is welcome to connect with me either on that email or going to my website. I do want to emphasize that there is so much overlap between the whole concept of burnout and second victim syndrome.

Dr. Susuan Wilson (40m 44s):
And I really think it’s important also for clinicians to understand that if you do seek out coaching, that doesn’t mean that there’s anything wrong with you. It’s kind of like having a personal, yeah, it’s kind of like having a personal trainer. Like when you go to the gym, you have your personal trainer, that’s helping you optimize your fitness. So I kind of feel like the coaches just really helping you optimize. There’s so many different aspects in people’s lives that they can get coaching for. It’s not all about just your job, there’s personal issues, but whatever it is that you really want to improve, or you want to optimize coaching can really help that.

Dr. Susuan Wilson (41m 25s):
And that does not mean there’s anything wrong with you. It just means that you are trying to be the best you can be.

Dr. Anthony Orsini (41m 31s):
Oh, that was a great analogy. How ironic is that? You know, if you tell somebody, Hey, I’m going to LA fitness and I have a personal trainer, everybody goes, wow, that’s really cool. But for some reason you don’t say, Hey, I’m going through this coach to work on my mind. So that’s just a society thing that we have to get over with. But, and for those people listening, Susan, there’ll be, all of your links will be on the show notes. So we just go to the show notes, the links will be there to contact Susan. So you don’t have to worry about writing it down. It’ll be all there. Susan. This has been really very inspiring and enlightening. And I think my audience really got a lot out of this and most of the healthcare people out there now know what second victim syndrome is.

Dr. Anthony Orsini (42m 10s):
And we just have to keep pushing to tell physicians and nurses that it is okay to say, I just need to speak to somebody and we’re a long way there, but I think we’re getting there. So thank you so much. This was great.

Dr. Susuan Wilson (42m 25s):
Well, thank you, Tony. I really appreciate the opportunity to talk about this because as I said, I’m really passionate about the subject and you’re right. I think just continuing to try to get the message out there and educate our fellow healthcare professionals is so important.

Dr. Anthony Orsini (42m 41s):
Well, we’re going to push this episode on social media. I’m going to take a screenshot of you as soon as we’re done with this interview. So we can post that. If you liked this episode, please go ahead and hit subscribe. This is available on Amazon, Apple, Google play, Android and Spotify. So please go ahead and hit subscribe this way you’ll get automatic downloads every week. This episode drops every Tuesday. If you want to hear more about the Orsini way and what we do for coaching and also for patient experience in breaking bad news, please go to the Orsini way.com and you can contact me through that, Susan. Thanks so much. And thank you again for being on this and I can’t wait for this to drop so everybody can hear it.

Dr. Susuan Wilson (43m 19s):
Thanks again, Tony. I really appreciate it.

Dr. Anthony Orsini (43m 22s):
Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician. And I want to thank the Finley Project for being such an amazing organization, please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (43m 52s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for a future podcast. Visit us at TheOrsiniWay.Com.

Connect and Be Heard with Dr. Kevin Pho

Dr. Kevin Pho (0s):
Social media while blogs at that time had really the power for us to extend our influence, extend our voice outside of the exam room, where doctors can, instead of traditionally talking one-to-one to patients in the exam room, we now could talk one to many. And I think that idea has only snowballed over the past few years because we have these really influential platforms for better or for worse. And we’re going to be talking about some of the downsides of that, but I think that that influence is something that I’ve been talking about for the last 15, 16 years and how it’s really important for physicians to really get online and use these platforms to influence patients outside the exam room.

Announcer (42s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 28s):
Well, I am honored today that The Orsini Way has partnered with the Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU physician, the Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home that led her to start the Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 11s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician.

Dr. Anthony Orsini (2m 51s):
This is Dr. Anthony Orsini. You guessed it, I’ll be your host again this week today, we have a very special guest and the audience is really in for a special treat today because my guest today is Dr. Kevin Pho. Dr. Pho is a Practicing board, certified internal medicine physician, a nationwide media commentator, and coauthor Of the book establishing, managing, and protecting your online reputation, a social media guide for physicians and medical practices. He has been a leader in healthcare, social media since 2004. And if you are a healthcare professional, you likely know about the Kevin MD website, Dr. Pho built the Kevin MD platform from scratch in 2004, and now receives over 3 million monthly paid views and exceed 250,000 followers on Facebook and Twitter.

Dr. Anthony Orsini (3m 42s):
Kevin has been named the Web’s top social media influencer in healthcare and medicine. The New York times called Kevin MD, a highly coveted publishing place for doctors

Dr. Kevin Pho (3m 53s):
And patients, Forbes magazine

Dr. Anthony Orsini (3m 54s):
Called Kevin MD, a must read health blog and CNN named @Kevin MD. One of its five recommended Twitter health feeds as a highly sought after keynote speaker. Kevin shares his story nationwide with both clinicians and non-clinicians. His signature keynote connect and be heard, make a difference in healthcare with social media takes the audience through Kevin’s social media journey since 2004, with video audio and an emphasis on storytelling. He inspires audience to use social media and be healthcare influencers. These perspectives define his unique social media journey, and the story has brought audiences to their feet.

Dr. Anthony Orsini (4m 35s):
So welcome, Kevin, I’m excited to have you as a guest this week, and I’m sure my audience is in for a real treat.

Dr. Kevin Pho (4m 40s):
Thank you so much for having me on the show.

Dr. Anthony Orsini (4m 44s):
So one of the things I stress about teaching communication to healthcare professionals and business leaders is that to be a true leader and build a trusting relationship, you must be a genuine person. So what I mean by that is that in order for patients to trust us, they must first think of us as real people and they have to get to know us. And I go through some exercises on how to share personal information with patients so that you you’re a real person. It’s also important for leaders when they’re trying to be good leaders for their employees.. So if you don’t mind, let’s just take a moment to tell my audience who Kevin Pho is. Tell us a little bit about yourself, your journey, and how you got to where you are with the Kevin MD website.

Dr. Kevin Pho (5m 28s):
Sure. I’m an internal medicine physician. I practice in Nashua, New Hampshire. I’ve been here for almost 20 years now. I trained at Boston university, so not too far from here. And I still practice. I see patients two and a half days a week. And as you mentioned, I’m also the founder of Kevin MD, which I founded back in 2004. And what that is, is a platform on Kevin md.com, but also on Facebook, Twitter and LinkedIn, where people across the healthcare spectrum can share their stories. And I often say, it’s, we hear the stories of those that we don’t normally hear from in the healthcare world.

Dr. Kevin Pho (6m 7s):
Because a lot of times when patients think about their doctors, they think about doctors making a lot of money. They don’t think a lot about some of the issues and obstacles that doctors have when we’re treating patients. So I want to have a platform where doctors can really share those stories behind the curtain that they talk about things like physician burnout. We talk about things like student loans. We talk about healthcare reform, and of course over the last year, we talk about the trials and tribulations of the coronavirus and COVID-19, and the effects of the pandemic has on the medical profession. And now we talk about the vaccine and although my audience and my writers are primary clinicians, I also have a lot of non-clinicians as well.

Dr. Kevin Pho (6m 51s):
I have nurses, I have respiratory therapist, physical therapist, and of course I have patients as well, because just as it is important for patients to hear what doctors are going through, I think it’s important for physicians to hear what patients are going through as well. Because a lot of times we’re insulated from a lot of the hardships that patients are going through. So my goal over the last, how many years has it been? It’s been almost 15 years of doing this is really to bridge that gap between doctors and patients and having a platform like Kevin md.com. And of course the various social media platforms that extend out of that, it’s an ideal medium for those conversations to happen.

Dr. Anthony Orsini (7m 31s):
So take me back. The reason why I went into communication training is I really had a profound moment during my training when I witnessed physicians struggle to give bad news. And that kind of sparked way back when I was a neonatal fellow, this interest on how do we teach doctors, how to communicate. So I can point to a moment in time where I said, this is where I’m going to go with my career. Was there something leading up to starting Kevin MD? Or how did the idea of Kevin MD really come into play?

Dr. Kevin Pho (7m 58s):
Well, I could lie and say that I had a plan for the very beginning to be what it is today. But back when I started in 2004, I think very few physicians had blogs. I think blogs were just entering the vernacular and it was something that I started because one of my family members said, Kevin, do you have a lot to say about health care? You know, you should start a blog. So I started one a blog, or I wrote a few articles and I wasn’t really sure where this was going to go. I didn’t really appreciate the applications that might have, but I think there was one time back in the early two thousands, there was that anti-inflammatory Vioxx and it got pulled from the market because of some cardiovascular risk. And at that time we had a lot of patients on Vioxx.

Dr. Kevin Pho (8m 40s):
And I remember writing an article about that, about what patients could ask their doctors about what are some substitutes and what patients should do if they’re on that medication. And I didn’t really think much of it. It was just my commentary and opinion. What happened a few days after I wrote that article, I remember walking into the exam room and I walked in and that’s the first thing that patients said to me. I read your blog post this morning, and I was really comfortable what you had to say. And now I realize I have other options other than vioxx. And I realized that time, that social media, while blogs at that time had really the power for us to extend our influence, extend our voice outside of the exam room, where doctors can, instead of traditionally talking one-to-one to patients in the exam room, we now could talk one to many.

Dr. Kevin Pho (9m 28s):
And I think that idea has only snowballed over the past few years because we have these really influential platforms for better or for worse. And we’re going to be talking about some of the downsides of that, but I think that influence is something that I’ve been talking about for the last 15, 16 years and how it’s really important for physicians to really get online and use these platforms to influence patients outside the exam room. Because as we both know that patients are getting this information anyway, and there’s a whole misinformation pandemic that’s going on. And I think it’s really up to us in healthcare to really get online, use these platforms and connect with these patients and direct them to reputable sources of health information.

Dr. Anthony Orsini (10m 7s):
I’ve been a fan of Kevin MDs for awhile while I had known about it for a long time. I visited frequently. Recently I submitted a contributing article. I was excited when you accepted it. And then I was really honored when you interviewed me for your podcast. So, but I was really excited when you agreed to come on to this podcast because Kevin MD is all about conversations, as you mentioned. And I think that in medicine right now, there are not a lot of ways that physicians can speak to each other and get information, but I’m also really concerned with a lot of websites out there and a lot of the ways that patients get information.

Dr. Anthony Orsini (10m 46s):
And it’s a great way for patients to really go on and see how doctors are thinking, what they’re saying. What percentage do you think of the Kevin MD visits our patients? And non-clinicians,

Dr. Kevin Pho (10m 58s):
I would estimate about a quarter, perhaps are non-clinicians and that’s to expand on the point that you mentioned. I think I read an article just a few weeks ago is that I think one third of people get most of their news from Facebook. And we’re not just talking about health news, but just their news in general, if you look at some of the data from the Q research and they estimated that people going online to look for health care is a third most popular use on a web. So there’s a tremendous thirst for health knowledge. And I think a lot of that is part of our own doing as well. It’s, it’s very difficult sometimes to talk to a physician. And I think the medical profession, we need to do a better job at being more accessible, because if we aren’t assessable, patients are going to go elsewhere for the health information and that’s happened to their own detriment.

Dr. Kevin Pho (11m 46s):
If you look at the whole problem with the false connection between vaccines and autism, for instance, I think a lot of that has been propelled by social media because you have all these anti-vaccine activists, they know how to do search engine optimization. They know how to gain the YouTube and Facebook algorithms. And they’re light years ahead of us in a medical profession. And that lead time has caused a tremendous amount of damage because they can now propagate false information online. And patients are just exposed as information without any interpretation and take it at face value. And I think that we have a lot of catch up to do regarding that.

Dr. Anthony Orsini (12m 25s):
And a lot of physicians I falsely or incorrectly I think will encourage their patients not to go on the internet. I think there’s a problem with that. Twofold. One is it’s not going to happen anyway, no matter how much you tell them not to go on the internet and get their information, but two, this is all about trust. So the main theme I would say that has come through me doing this podcast since August now, and we’ve fed over 10,000 downloads and every week, whether we’re discussing business or healthcare, the word trust comes in over and over again. And during my workshops, that’s exactly the word that I use is that you have to, as a physician and we, as physicians are not taught how to communicate as you know, in medical school.

Dr. Anthony Orsini (13m 8s):
And if we’re taught how to communicate, it’s more about information. This is how you do it, history and physical. This is how you do a review of symptoms, but they don’t say this is how you bond. And so this is all about trust. And so I encourage physicians to say, listen, I know you’re going to go home and you’re going to look this up on Google. Google’s become a verb, right? You’re going to Google this. Here’s some really good websites or whatever website you go to you and I trust each other. We have a great relationship. Let’s actually talk about it afterwards. And one of the techniques we use for communication is I always tell physicians, when you give a diagnosis, many physicians will say you have cardiomyopathy, and this is what it is.

Dr. Anthony Orsini (13m 53s):
And one interesting thing, what happens when you say the word cardiomyopathy, you instantly see the patient on the other side, their eyes go up and what are they’re doing? They’re trying to figure out how to spell it. And they’re trying to remember it because they can’t wait to go home. So one of the techniques we teach doctors is to say, you have a disease of your heart called cardiomyopathy, and I will write that down for you when you’re done. Because by doing that, you’re basically bringing their attention back to you. And so having websites, I guess my point, I mean, websites with such as Kevin MD, that you can say, listen, here’s a list of websites, which I think are really great because you’re exactly right. You look up immunizations or vaccinations. There’s all kinds of false stuff out there.

Dr. Anthony Orsini (14m 35s):
Isn’t there.

Dr. Kevin Pho (14m 36s):
That’s absolutely true. And if you Google that you get a lot of false information. Although we’ll talk about this later on about how platforms I think are now taking responsibility. They’re starting to realize the power of their platforms, and they’re starting to prioritize reputable health information. They’re starting to de platform false actors or actresses that spread false information, but it’s taken a pandemic really for them to act. This has been going on for 15 years now. And this is something that I’ve been trying to advocate for years, and it doesn’t have to take a pandemic. It doesn’t have to take something as serious as that for them to really take action and take responsibility and take accountability for what’s going on in their platforms.

Dr. Kevin Pho (15m 17s):
And just to expound on what you said about patients researching online. And I think you’re absolutely right. I think rather than trying to be adversarial and telling patients not to go online and don’t trust Dr. Google, you just have to realize that they’re going to do it anyway. And we need to partner with patients and we need to guide them to reputable sources of health information. And if they come to us and say, I read this on this particular website, or is this supplement, okay? We just need to tell them that this may not be reputable information. You tell them that, Hey, you know these supplements, it’s not vetted by the FDA. You don’t know what’s inside them and just partner with them and guide them to something that is reputable. You could tell them that, Hey, this website may not be reputable, but you may want to go to the CDC website.

Dr. Kevin Pho (16m 3s):
You may want to go to these hospital websites. You may want to go to these.gov websites instead. And some of them may not listen to you and that’s fine, but at least there is going to be a proportion of patients who will listen and say, Hey, next time I Google this stuff online, I’m going to remember what my doctor said about whether this is reputable or not. So rather than trying to encourage them not to go online partner with them. And that’s really my philosophy when it comes to doctor patient relationship, I think we do need to be partners and we need to be more guides. And I think that’s certainly a shift from medicine back to yesteryear when there was a more of a paternal relationship right now is I think we’re more guides for our patients.

Dr. Anthony Orsini (16m 42s):
And you discussed being a leader in social media. Let’s talk about, cause we brought it up a couple of times already today. Let’s talk about what’s going on without getting too political with social media. Now, censoring different websites, as you said, it’s a good thing. Sometimes it’s a slippery slope other times. Are you concerned about the future of social media, where you have someone who may not even be a medical clinician, who’s censoring what you’re saying or what someone else is saying?

Dr. Kevin Pho (17m 9s):
So I think the thing with social media is things are evolving so, so quickly. In terms of its ramifications, I can’t predict what’s really going to happen in the next year, let alone six months. I think that the fact that social media platforms and we talked about things like Twitter de platforming, Donald Trump, and you think about Facebook and YouTube, they’re also involved in de platforming. Should they be also D platform purveyors of false information? So I think that’s a question that we need to discuss. I know that whenever there’s false medical information regarding COVID, if you go on Facebook, they specifically say this is false information and go to this website instead.

Dr. Kevin Pho (17m 49s):
I think the issue is that a lot of these platforms they’re trying to do it algorithmically. They’re trying to curate information and they’re trying to find what’s false information, just algorithmically and the robots and machine technology. And sometimes I think with healthcare, I think it’s a little bit more nuanced than that. I do think that there needs to be a human curation component to it. And I know that’s going to take a lot of people power for that to happen. But I think that’s something that we need to do, especially with Facebook. Facebook is certainly so influential. You have billions of people on Facebook. And as I mentioned in that study before a third of people get their information from Facebook. So I do think that needs to be some human curation component rather than outsourcing.

Dr. Kevin Pho (18m 29s):
I know that Facebook, they try to outsource all their curation to these third parties and they try to shift responsibility away from Facebook itself. But I think that more resources need to be done in terms of curation and something that’s obviously harmful, for instance, anything that’s anti vaccine or anything that perpetuates the false connection with anti-vaccine and whether they need to be de-platformed I think that needs to be seriously considered because from a medical standpoint, from a physician point, it really makes our work a lot harder. When you have patients come in and they express doubts about vaccines that are proven to be safe, proven to be effective like MMR vaccines and the vaccines that should be without any scientific question.

Dr. Kevin Pho (19m 12s):
And I think that we need to have a discussion about whether people who spread false information against such a public health good need to be the de-platformed or not.

Dr. Anthony Orsini (19m 21s):
But it really comes back to the word again, trusting relationship. If you have a trusting relationship with your doctor, I get this all the time. I mentioned this in a previous podcast, someone will say to me, I went to my doctor. He was a cardiologist. This is what he told me. But then I read on Google about this, and they’re asking me, I’m in neonatologist, It’s about a cardiology problem, which I’m not qualified to speak about. And my answer is almost always the same. You either trust your doctor or you don’t, and you need to find someone that you trust. And of course, you’re always going to have control of your own healthcare, but if you have a trusting relationship with your doctor, you’re going to trust them. And I do the same thing as a physician. If I’m going to an orthopedic surgeon for a hip replacement, either I’m going to trust them, or I’m not going to second guess them.

Dr. Anthony Orsini (20m 5s):
And you know, as a physician, I get second-guessed all the time. I’d rather do this. I’d rather do that. But it’s also about the relationship with your trusted websites. And so that’s why I think Kevin MD is such a great platform for non-clinicians to visit because everything there is legitimate and you can trust and have a trusting relationship with the website. Let’s move on to your keynote speaking because you do a lot of that. I do that also. I love it. There’s nothing to me, more fun than standing in front of an audience and giving a keynote. But some of the topics that you discuss, we listed one topic I want to discuss today that we’ve discussed in other episodes before is physician burnout.

Dr. Anthony Orsini (20m 52s):
I don’t know if the average patient understands the healthcare crisis that we’re in right now between physician and nursing burnout. And I know you speak about that at your keynote. So tell us what your views about that are and give us some advice about that.

Dr. Kevin Pho (21m 6s):
So I think physician burnout was, has been a phenomenon even before the pandemic. If you look at the studies before COVID-19 hit, almost half of doctors experienced symptoms of burnout. And a lot of it is because that we’re losing control of the profession. You talk to a lot of doctors. I think one of the biggest reasons they feel burned out is that they don’t feel that they have any control in terms of what they do. They’re told by higher powers, corporate powers that they have to see more patients. They have to see more patients in less time. They have these electronic medical records foisted on them. And it just adds time. I think there was a study where for every hour we saw patients, we spent another two hours on a computer doing charts. And I think that we’re just losing a lot of control in our profession.

Dr. Kevin Pho (21m 47s):
And I think to me, that is the biggest driver of burnout. You go into medicine, you want to see patients, you want to develop that trust. As you said, you want to spend time with patients, especially in primary care, you want to sit with them. And I think that’s the only way really to garner trust is really spend time with patients, but really all the forces that medicine over the last five, 10, 15 years really is against that, where we’re based on these metrics, where based on how many patients we see, in fact, a lot of our compensation is based on productivity, right? The more patients to see the more RV use relative value units you earn and that your compensation is based on that.

Dr. Kevin Pho (22m 27s):
So all the incentives is really towards quantity and productivity. And I think that certainly leads to burnout. And now you have COVID-19 in addition to that, and you could only imagine the added stress that’s placed on frontline clinicians. I think early on, back in last March, April, you had doctors speaking out about the lack of personal protective equipment. And for those, you heard news stories about these doctors who spoke out or wrote on social media, they got fired for speaking out. So I think that there’s that added stress. So not only are you on the front lines dealing back then, which was an unknown pandemic, you’re not given the proper protective equipment you get fired for speaking out, and you have all those stresses added to the burnout that was already present before the pandemic.

Dr. Kevin Pho (23m 13s):
So I think that it’s something that I certainly highlight on my site. I don’t think a lot of patients know about physician burnout. They think about doctors. And first of all, let me just say, patients are also going through tremendous hardships as well. It’s very difficult to be a patient in the United States healthcare system. And a lot of patients themselves of course, are going through tremendous hardships during this pandemic as well. But one of the things that I do want to emphasize is that it shouldn’t be an us versus them thing. And that’s one of the things I talk about my keynote is that doctors and patients really should be on the same page because if doctors are burnt out, if they quit medicine, if they go part-time, if they leave medicine, because they’re burnt out, really who’s going to see patients.

Dr. Kevin Pho (23m 53s):
So I try to frame burnout, not only as a physician issue, but a patient issue as well, patients should care about physician burnout, because if there is a doctor to see them, then it’s not going to help patients at all. So that’s one of the ways I try to frame burnout and try to get patients to care about some of the things that we go through. So whenever I have stories on my side about some of the ordeals that physicians are going through, some of the pressures that they’re facing and some of the reasons why they’re burnt out, I don’t hesitate and put that on my site. And, and these stories are very visceral. They’re tremendously powerful. And I get emails from patients all the time saying, I didn’t realize what you guys are going through. And just having that empathy from patients about what physicians are going through.

Dr. Kevin Pho (24m 36s):
I think if we could change a few minds and hopefully get us on the same page together, that’s going to affect some change.

Dr. Anthony Orsini (24m 42s):
And when I give lectures on burnout as well, a lot of it has to do with, you could be in business. It doesn’t have to be physician burnout. When you enjoy what you’re doing and you leave home satisfied. It doesn’t matter how hard you work. I mean, we know entrepreneurs like you and other business leaders, they work 12, 15. My wife’s a realtor. She works 18 hours a day on the computer. But when you enjoy what you’re doing, you’re going to decrease burnout and you hit the nail right on the head as physicians, I had Dike Drummnd on who’s one of the leading experts in physician burnout early on. And he talked about how physicians spend their whole life looking for control. But you’re a lowly college student who can’t go out to party because you have to get straight A’s and then you’re in medical school and you can’t do anything cause you have to get straight A’s and you say, but one day I’m going to have my own practice.

Dr. Anthony Orsini (25m 29s):
I’m going to be in control. And then you go through residency and you’re the low man on the totem pole. And then all of a sudden you get to be a physician and you find out that you’re being told what to do by hospital administrators and by insurance companies. What I try to do is try to remind people why they went into medicine in the first place. And I think that’s where that genuine and that conversation comes into play. And if we can use certain communication techniques to, for you and I as a patient in a, with our patients, if we can come up with certain techniques where we can have a laugh and we can bond real quickly and still be out of there and not too much time, then it’s a win-win situation.

Dr. Anthony Orsini (26m 10s):
But physician burnout is a crisis. And I’m glad that you’re bringing light of that to that, because it’s also a dangerous thing, right? So physicians who are burnt out, don’t perform at the level that they’re supposed to. So we have to bring medicine back to that human to human interaction that is so important and that all starts out with communication. So I think that’s a real topic that we need to really delve into more and more, and I’m glad your website is bringing it into that. So thank you for doing that. What advice do you have? So you’re really an entrepreneur. I just mentioned that. So I’m seeing more and more physicians maybe it’s because of burnout, I’m seeing more and more physicians looking I don’t want to call it a side gig because people like to call that. I don’t think that’s a good thing.

Dr. Anthony Orsini (26m 49s):
I’m doing that with this podcast. And with my workshops, I’m seeing more and more physicians saying, I need an exit strategy. Now, yours wasn’t because of an exit strategy because you’re still young. But what advice do you have for doctors who want to say, I’m passionate about this and I want to get into something else.

Dr. Kevin Pho (27m 4s):
So I wouldn’t call it an exit strategy. I think that it’s so important for physicians to have a passion outside of medicine. Now let me say, if you’re passionate is clinical medicine, then by all means be 100% involved in your profession. But for the majority of doctors, they don’t be defined by medicine because you don’t want to be defined by what you do. You want to be defined by who you are. You want to be remembered as a good husband, father, wife, mother. You want to be defined as the person you are because physicians, no matter how hard you work, you can always be replaced. So he’d been working for 30 years at a hospital and you could put your blood, sweat, and tears into that job.

Dr. Kevin Pho (27m 45s):
And to the hospital, you could just be easily replaced by the new graduates. So I see a lot of doctors who may not be 100% invested or 100% passionate about what they do. And they work 80, 90, a hundred hours per week. They will do this for 30 years and the hospital lays them off because not enough revenues are coming in because of the pandemic. So to the hospital, that’s an easy decision. So I think it’s important to have a passion outside of medicine. So you talk to a lot of physicians who want something outside of medicine. And for me, it, of course happens to be social media has to be speaking during a pandemic. I actually got furloughed because a lot of primary care doctors got furloughed because of decreased revenue. And I wasn’t able to speak, obviously because of the, we weren’t able to travel because of the pandemic.

Dr. Kevin Pho (28m 28s):
So what I do, I started a daily podcast. It was something that I had a time to do. And it’s something that I’ve been wanting to do. I did some research and it does take a lot of time to do a podcast, but it’s tremendously rewarding, but it’s something that I was passionate about. So I do encourage physicians to have that passion outside of medicine. And if you could make some money from it, I think all the more reason why that’s good, because you don’t necessarily want to 100% rely on what we call your W2 job, your job within medicine, because that can go away in an instant. So if you could have another leg on the stool that can support you where you can cut down and it doesn’t have to be social media.

Dr. Kevin Pho (29m 9s):
We have a lot of doctors who are interested in investing in real estate. They write books, they do online courses. There are dozens of ways where physicians can leverage their MD degree to make an income outside of clinical medicine. And if that income allows you to cut down a little bit on your clinical responsibilities and reduce them on a burnout, ironically, that’s going to make you stay in medicine a little longer than you ordinarily would have, because there are so many doctors who don’t have these proverbial side gigs, and there are 100% invested in what they do. And they get burnt out to leave medicine earlier. And you contrast that with a physician who may be only working 75% clinically, they’re happier.

Dr. Kevin Pho (29m 49s):
They have something else outside of medicine that they’re passionate about and they end up staying in medicine longer. So from a patient standpoint, you want the physician who stays in medicine longer. You’ll want the physician who is less burnt out, because as you said, when a physician’s worn out they actually make more medical errors. So I definitely don’t want to shy away from having passions outside of clinical medicine. I think that the days where the physician does medicine and only medicine for 100 hours per week are over, I think for physicians to survive these days, we do need to have an interest, a passion. You could call it entrepreneurial spirit.

Dr. Kevin Pho (30m 30s):
You need to have some way of alleviating some of the burnout that is associated with being in medicine all the time. And if you could make money from that and be less reliant on your W2 job, I think that is definitely helpful going forward.

Dr. Anthony Orsini (30m 42s):
Yeah. I love what you said. I tell my kids that all the time when they were growing up, what you do is not who you are and that’s really important. And physicians get caught up in that many times. It’s you know who you are, I’m a physician. No, you may practice medicine, but you have other skills. The other thing I would say that I totally agree with is for someone who does a lot of workshops, a lot of lecturing and has the podcast and does patient experience stuff. I find that that makes me so happy that when I go to work to see babies and take care of the neonates, I think it makes me a better physician because I’m happier. I have variety in my life, which I’m sure you could agree with.

Dr. Anthony Orsini (31m 25s):
And that when I come back to see those patients and I’m still full-time actually, but I come back and see those patients. I really am in the moment. And I think it just makes me better. And especially when it’s something you’re passionate about, I said on other podcasts, sometimes you feel like you have this thing to teach and you want to stand up on a top of a roof and say, I found the secret. Let me just tell you about it. And so this podcast has been a way of doing that and I couldn’t agree with you more. So, Kevin, as we’re getting to the end, I think I warned you about this. I ask everybody the same question and all my guests tell me that it’s the most difficult question that I’ve asked them, but the title of this podcast is difficult conversations.

Dr. Anthony Orsini (32m 7s):
And so I’m going to ask you what I ask every other one in medicine, in your personal life, what do you think are the most difficult types of conversations that you need to have? And what advice can you give my audience about how to navigate through those really difficult conversations?

Dr. Kevin Pho (32m 24s):
I think of two examples. And I think to me, when people have difficult conversations, what does that really is? People have a fundamental disagreement with what you say and what you believe in. So there are two instances where I think that happened. I think one was after I was giving a keynote and there was a keynote to primarily a patient advocate audience. And I was giving what I said before about how we need to get doctors and patients on the same side. And in order for us to make any changes in healthcare, whether it’s to alleviate burnout, whether it’s to give more time to primary care doctors, physicians, themselves, can’t do it. We need patients on my side. And I think that after that keynote, I remember a group of the audience member came up to me and kind of vehemently disagree with what I said.

Dr. Kevin Pho (33m 8s):
And I think they believe that doctors were in it for the money. And a lot of primary care doctors just churn through more patients and we want to do it to bump up our incomes. And in that instance, no matter what I said, I really couldn’t. All I could say is that that’s not true. I think we were on your side and we would like nothing more to spend more patient, but there are forces above what we can do. It’s not like we can magically conjure up more hours in a day to do do what we do. The second incident was my thing related to, I think what I said before in terms of having a passion outside of medicine. And I think I did talk to a physician who did believe that, you know, medicine should be 100% all in and physicians who are part-time, they’re just wasting their degrees and physicians who go into social media.

Dr. Kevin Pho (33m 56s):
Again, it’s a waste of the degree. They had no use for that. And again, I was sharing my story and really talking about what we talked about today in terms of it’s better to have someone who is part-time clinical medicine, but lasts longer than someone who is a burnt off physician full-time. But again, he would have none of that and basically said, I was like wasting my degree. So I think in both of these disagreements, I think that I always believe that when you have a general audience, I always divide it up into thirds. So I think that there is a third of people who will always agree with you, no matter what you say, I’m really passionate supporters of you.

Dr. Kevin Pho (34m 37s):
And I think there’s a third of people who actually won’t agree with what you’re saying. We see that of course, online, very polarized environment that we live in. It’s very difficult to change some people’s minds, no matter what you say. And of course there’s that middle third, right? Who can kind of be persuaded either way. And I always tell fellow physicians whenever, especially when they’re online, there’s a lot of disagreements, very polarized online is that you don’t necessarily want to speak to your supporters because they already agree with what you say. You don’t necessarily want to speak with people who cannot be convinced because no matter what you say, they’re always going to be entrenched in their beliefs, but it’s that middle persuadable third that I think that you want to speak to.

Dr. Kevin Pho (35m 18s):
So in these two instances, when I was talking to people who disagree with what I said, or I struck a nerve with what I said, I didn’t expect to really convince all of them. My job really isn’t just sway everyone to think the way I do. But if there were like three people there and if I could maybe have one of them, think twice and maybe change their minds, even to me, that’s a success. So I think that’s really the lesson that I want to give is that whenever you’re online or whenever you’re trying to influence someone, when you’re trying to persuade someone, your goal isn’t to persuade 100% of the audience that you’re talking to. I think your goal is to maybe make a third of the people that you’re talking to just think twice about what they believe in going in.

Dr. Kevin Pho (36m 2s):
And if you could make that proportion of people, think twice, I figured my job is a success.

Dr. Anthony Orsini (36m 7s):
Boy, with the political climate that’s going on right now that’s great advice. I mean, I wish our politicians would take that advice and stopped just speaking to the people that like them and against the people that disliked them and started speaking to the middle. Maybe you should be running for Congress someday. So, but that is a great way to end because that’s just fantastic advice. Kevin, I want to thank you for your time. This has been really great. I think the audience is going to be fascinated. We’ll put all your contact information on the show notes, but everyone should just contact you through Kevin MD?

Dr. Kevin Pho (36m 40s):
Yes, that’s correct.

Dr. Anthony Orsini (36m 40s):
Okay, great. So thank you so much. If you enjoyed this podcast episode, please go ahead and hit subscribe. If you want to find out more about The Orsini Way, please go ahead and go to our website@theorsiniway.com. It has been an absolute pleasure to have you Kevin, thank you so much. And hopefully, and I will continue to visit Kevin MD as I always have. And hopefully my audience will too. So thanks. Thank you so much.

Dr. Kevin Pho (37m 3s):
Thanks for having me on.

Dr. Anthony Orsini (37m 4s):
Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician, and I want to thank the Finley project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (37m 37s):
AIf you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast. Visit us@theorsiniway.com.

Leading Your Ship to Success with Capt. Mike Abrashoff

Mike Abrashoff (2s):
And I interviewed every sailor on the ship individually, all 310 of them. I’ve never been done before in the Navy and it wasn’t about business. It was getting to know them. Tell me about your family. I learned the names of every sailor, their spouse’s name and their children’s names and their home town, their favorite football team. It enabled me to connect with them and get them to feel like I care about them. And you know, if the people who are dealing with, think you care about them, they will follow you in the battle. And so only at the end of the interview, did business come up, you know, tell me what would you like to improve about the ship? What do you hate most ?

Announcer (39s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker and author Dr Orsini has been training health care professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor are faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 25s):
Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr Anthony Orsini, and you guessed that I’m your host again, this week, today, I’m really fortunate to have amazing guest. Today is someone who I really had on my radar for the last six or seven months. And I’m so glad that he’s on today. And that’s Captain Mike Abrashoff. Captain Abrashoff is a graduate of the U S Naval Academy in Annapolis, Maryland. An was a Military Assistant to the former secretary of defense, the honorable William J Perry. He left the Navy in 2001 and co founded GLS worldwide, a consulting agency that provides practical solutions on how leaders can achieve breakthrough results. At age 36, Mike Abrashoff was the most junior officer in the Pacific fleet when he took command of the near worst performing ship,.

Dr. Anthony Orsini (2m 13s):
12 months later, the USS Benfold was the best ship of the entire Navy using the same crew. The story of that stunning transformation has become legendary inside and outside of the Navy, Mike establish a set of management principles that he calls the Leadership Roadmap at the core of his leadership approach is as a process of replacing command, the control with commitment and cohesion. Mike is the author of three books. His first book is It’s your Ship: Management Techniques from the Best Damn Ship in the Navy and has sold over 1 million copies. And was a New York times and Wall Street Journal bestseller and we’re going to spend a lot of time talking about that book. His next book, It’s our Ship and the best title ever Get your ship together showed how Mike leadership principles have been put into action by leaders in their own organizations everywhere.

Dr. Anthony Orsini (3m 2s):
In addition Mike is a highly sought after keynote speaker for audiences to looking to ramp up organizational performances. I heard him speak a few years ago at my company’s conference, and I was just blown away. Mike and you were a literally one of the best keynote speakers I’ve ever heard. I also spoke at that conference by the way. And after hearing you speak to my first thought in my head was, thank God. I didn’t have to follow him. So thank you so much for coming on today. I really appreciate it.

Mike Abrashoff (3m 29s):
It’s an honor. Thank you.

Dr. Anthony Orsini (3m 30s):
Thank you. So there’s so much I want to talk to you about, so I actually, the last few hours I’d been spending here, try to get this down from three hours to one hour, because I’m such a fan of your book and I was such a fan of your speech, but before we jump into communication leadership and your book, I always like to start off letting my audience find out a little bit about who Mike is. And I’m such as a student that we are where we come from. And so if you don’t mind just telling us to hear a little bit of your background. I understand that you’d come from the military background, how you all the events that led up to your command of the USS Benfold.

Mike Abrashoff (4m 5s):
Well, I’m from a small town in Pennsylvania, a place called Altoona, and there were 10 of us living in our home growing up and we had one bathroom. And so when I get out of the Navy, he was able to buy my first home, but it has four bathrooms in it and I use every one every day, just because I can, that’s basically all you need to know about me. I’m number 6 of 7 kids and the best path to get an education for me was to go to the Naval Academy. And so I graduated in 82 from the Naval Academy and then worked my way up, going from one progressively tougher job to the next culminating in getting command of USS Benfold, which incidentally was named after somebody from the medical field, it was named after Edward C.

Mike Abrashoff (4m 53s):
Benfold, who was a medic in the Korean war. And one afternoon he was tending to two wounded Marines in a foxhole when several enemy soldiers stormed in the foxhole, throwing grenades into it. And at the age of 21, Edward Benfold decide that he was going to become a leader. He picked up those grenades, he stormed the oncoming enemy, soldiers blowing them up, blowing himself up, saving the lives of those two wounded Marines. So I use to take them to see on his ship every six months or so, in addition to the neighboring a ship after him, he was also awarded the medal of honor. And I used to tell his crew, make sure Edward Benfold as smiling down upon us tonight. And I would also tell them, you never go wrong when you do the right thing.

Mike Abrashoff (5m 34s):
If your doing the right thing nobody’s ever going to criticize you just, if what you’re doing appeared on the front page and the Washington post tomorrow, would you be proud or embarrassed, and if you would be embarrassed, don’t do it. And then if you’re proud, I will support you 100% of the time. And so from there, we got featured in the Harvard business review, and that was my big break. Literary agent started calling him and said, you have to write a book. And I didn’t think I can do it at first. And it was actually an easy process. I talked into a tape recorder every night and it had the recordings transcribed and in low, and behold the book came out in 2002. It’s a sold over 1.1 million copies.

Mike Abrashoff (6m 13s):
And in a year ago this month, a business owner in Canada bought 11,000 copies for each one of his employees.

Dr. Anthony Orsini (6m 21s):
Smart move. I read the book, that’s a smart move, but I do believe we are where we came from. And I do know Altoona, Pennsylvania only because they have a Penn state campus. There is one thing they do, when you are applying to Penn State, I went to Rutgers university and no offense. They said you would have to spend a couple of years in Altoona first before you go to the main campus and I said, no, I don’t think so. I’m a big city boy from New Jersey. So that was the end of that.

Mike Abrashoff (6m 47s):
My parents, children left home at age 17 and never returned to Altoona. We think my mother, should write a book on parenting on how to get your kids to leave home.

Dr. Anthony Orsini (6m 59s):
That’s a good one. My kids keep coming back. And now with COVID, my adult children are living with me down here in Florida. And I have two of the three of them work in New York city so there are certainly back. Our experience really shape who we are and before you became, I read in your book, before you popped into the Benfold that you had a couple of setbacks, right? I mean, you weren’t always at the top of your class, everything that you did, wasn’t always successful, but what really came out about your book is that every time things didn’t work out perfectly for you, you learn from your mistakes. So tell us about that.

Mike Abrashoff (7m 29s):
Well, it’s true. I graduated at the top 80% of my class at the Naval Academy.

Dr. Anthony Orsini (7m 34s):
That’s the name of my book. It’s All in the Delivery and I loved the way you said that top 80%. That’s right.

Mike Abrashoff (7m 39s):
I never got all the best assignments starting out, but you play the hand that you’re dealt and you make the most of it. And instead of complaining, I worked hard and learned my trade. And as I got more senior and senior, I would always watch the commanding officers that I worked for for the traits that I admired and one of the emulate, but also for the traits that I have abhorred and didn’t wanna fall into that same trap. So you can learn from both great leaders and poor leaders. If you have the self-awareness to understand how you’re showing up. So I’ve learned from both types of leaders and I’ve picked and chosen the traits that matter the most to me.

Mike Abrashoff (8m 28s):
In prior to getting commanded of the ship, I was selected to be the number two assistant to the secretary of defense. His name was William Perry. And it’s interesting. He is the best leader I’ve ever worked for, or seen an action. And it wasn’t because he was charismatic, because he lead with a sense of humility and it really appealed to me. I would eventually come to call his leadership style excellence without arrogance. And it didn’t matter who you were, you could be a janitor or in the halls of the Pentagon, or you can be the chairman of the joint chiefs of staff, every interaction with him, he made it seem like you are the most important person on the planet. And I would watch people and how they would respond to that.

Mike Abrashoff (9m 10s):
And they became more loyal and dedicated and committed to him. So this concept of excellence without arrogance, it’s something that I’ve tried to take with me and, and emulate myself. And I believe my crew responded to it. And also I believe the audiences that I’ve spoken to over the last 20 years, appreciate that humility, as opposed to I’m a Leadership expert. I know him at all. I’m here to tell you what to do. No it’s a journey and you live and learn and you get better because none of us is a perfect leader and none of this is a born leader. So it’s all about having self awareness to understand, but yet they were pretty good, but we are not perfect.

Mike Abrashoff (9m 52s):
And life has a journey and we needed to continue to improve each and every day.

Dr. Anthony Orsini (9m 57s):
I’ve always said, when I give my lectures, when we talk about we as a society, often look at the people who fail and we give them a hard time in who are not doing well. And what we should be doing, this is exactly what you’ve talked about just now, is we should be saying, there is a person who has succeeded. I want to figure out why William Perry succeeded to where he was, what made him the best leader. And if we spend more time watching the people who are good at what they do, we can learn so much more from that. So that’s a great point. The other point, I’ll draw parallel to what I do in medicine, in and teaching physicians, how to build trust with their patients.

Dr. Anthony Orsini (10m 36s):
And I talk about frequently and my book being a genuine person. And by being a genuine person, you are building trust. And in many ways, the reason why I do this podcast is that physician to patient is kind of like a leadership role in that I know we’ll talk about it later, but trust is the most important thing when your being a leader. And we know that when patients don’t trust their physician, they are less likely to take their medications they are less likely to follow up with their care, they’re more likely to sue or never come back. And so I think it’s really important that you are a genuine person. And that seems to be what you’re saying right now about Dr. Perry, right?

Mike Abrashoff (11m 14s):
So sometimes we perform the way we think that the organization wants us to perform. And there was always this, when you’re a captain of a ship, this is what you need to do for you. You need to tell people what to do. You need to be decisive, bark orders. And what you get is people who are performing the way they think others expect him to be instead of being in their genuine self. And I give people the credit to know a fraud when they see one. And if you’re trying to be somebody that you’re not the people will see right through that, but you’re genuine and authentic self, as you say, and that’s people want to surround themselves with.

Dr. Anthony Orsini (11m 56s):
It looks fake, right? So, and I tell physicians that all the time, if you walk into a room and there is a patient waiting for you and you say, you know, I teach them, let’s talk about just for one minute something that’s not medical. Let’s not walk in and immediately get down in the business, but to talk about the Yankees or what happened to me today, or how are you doing? And I noticed in your book that you did that with your sailors a lot. Sometimes you, you bent the rules, you did the movies and you did stuff from morale that made you really, they respected you. And sometimes I think that leaders think that if you’re not rigid, you’re not going to get respected. I think is the opposite way. Isn’t it?

Mike Abrashoff (12m 31s):
I firmly believe it’s the opposite way. And I interviewed every sailor on the ship individually, all 310 of them and never been done before in the Navy. And it wasn’t about business. It was getting to know them. Tell me about your family. I learned in the names of every sailor, their spouse’s name and their children’s name, their hometown, their favorite football team. It enabled me to connect with them and get them to feel like I care about them. And you know, the people who are dealing with the things that you care about them, they will follow you in the battle. And so only at the end of the interview is the business come up, tell me what would you like to improve about the Ship? What do you hate most? And so the first part was about establishing that connection and engagement and make them feel like you care about them.

Mike Abrashoff (13m 18s):
And only then would I talk about the business side of it, and by the time you have the, you know, and then they’ll open up and they’ll give you ideas, it will start taking greater ownership, greater accountability. But I can’t order that from the beginning of an interview, you’ve got to lay the groundwork and we’ve now been in COVID crisis since last March. Everybody is doing online calls. Whenever I do any calls with any of my people. First, we talk about family what’s going on. And everybody in this country has been impacted. And to be honest, there are days when I’m depressed, like why you even get out of bed this morning. And so if we’re depressed because of this, it’s only natural that the people we’re dealing with maybe down as well, they may have lost a loved one.

Mike Abrashoff (14m 5s):
They may have somebody who’s hurting physically as a result of COVID. And so if you go right to a business, you won’t understand the personal drama that everybody in this country is going through right now. And by talking about it in an advance, it gives you some context so that you can better design how you’re going to communicate with them and connect with them. So it’s all about the personal touch in caring. Now be your genuine, authentic self. If you don’t care, they don’t ask some people don’t care. And you know, if you try to act like you love them and you don’t, they are going to be suspicious of you. But if you genuinely care take the time to talk to them about it.

Dr. Anthony Orsini (14m 47s):
But it’s also going to help you when you’re trying to run that ship or that company, I’m a Rutgers university graduate. And the Rutgers university and the early eighties was very difficult at it. From the athletic point of view, they were horrible in football and they’re horrible in basketball. They were good at women’s basketball. It was not much better now, but it is a little better. But my point is in the eighties, I decided I needed to adopt another team just to root for. So I got very interested in Duke basketball and become a big coach K fan. Coach Krzyzewski fright, every one of his leadership books. And in his book, one of his books, he says he takes the incoming freshmen and they spend, I don’t remember a day or a weekend with him and his wife at the house one by one.

Dr. Anthony Orsini (15m 30s):
And they get to know them. And through that, he learns, you know what? This kid can do, what he will respond to. Some kids respond to being yelled at. Some kids will need more encouragement in your book. You talk about, put a round peg in a round hole. How much of that interview helps you with that?

Mike Abrashoff (15m 50s):
Well, I would say a a hundred percent by interviewing every sailor oftentimes I found out they knew what they didn’t want to do, but they couldn’t quite figure out what they did want to do. And I have a feeling that’s what coach K does in that weekend with each kid. Do you have a choice between going down the wrong path or choosing the correct path? And many of them have never had role models in their lives to coach them and to mentor them. And the only way you can do that is to learn about them. And so the more I can learn about them, the more precise I could be in helping to coach them and mentor them in helping them choose the right path that fits them so that they could make something of themselves.

Mike Abrashoff (16m 35s):
And so that’s where the enormous satisfaction came from was helping young men and women decide how the chart their own course for their lives and become successful.

Dr. Anthony Orsini (16m 48s):
And so after you became genuine, you build that bond, you’ve got to know the names of them. Then you ask them what the Ship can do to get better. And there was a story about a sailor and the rusty bolts that I have repeated 20 times since I heard you speak, because I think is just amazing. Can you share that with us?

Mike Abrashoff (17m 6s):
So when I found out how smart my sailors were in, and we offered the sat exam, onboard the ship, and I had never had never been done on a small ship before 50% of my crew took the sat because there the interviews I found out that they may want to go to college. So let’s help them get in one of my entry level seamen scored a 1490 out of 1600, which was almost double what I took when I say preparing for the Naval Academy. And it hit me how smart these young men and woman are. And there were even smarter today. ’cause they have access to information that we never had access to. I couldn’t get into the Naval Academy today because the kids out there are so smart.

Mike Abrashoff (17m 47s):
And so when you realized how smart the people are that are working for you, why not unleash that potential, because who better than the people on the front line going to work, they actually have ideas on how to improve the way that you do the work. So when I found out how smart they were, I added three questions in the interview. What do you like most about Benfold? What do you like least? What would you change if you were the captain of the ship? Once they learned, came in and says, do you know how many times we’ve painted their ship in the last 12 months? I said, no. And he said six times, but every time we paint the ship, it takes us a month to paint it. So every other month we’re painting the ship. And then he said, have you ever painted you’re home? And I said, yes.

Mike Abrashoff (18m 27s):
And you said, it’s sucks, doesn’t it? And what’s your point? We have been painting ships for 244 years. He said, did you ever stop to notice why we have to paint the ship every other month? He said, whenever a new piece of equipment is added top side to the hull of the ship it’s being held in place with nuts and bolts, screws, washers, and fasteners that are made out of ferrous metal, that rust in saltwater. But when it rusts, rust stains down on the side of the ship, he said, have you ever heard of stainless steel? Well, now that doesn’t rest in saltwater, now I’d been in the Navy 16 year by this point, I walked past that every day, because that’s the way we’ve always done it.

Mike Abrashoff (19m 11s):
And when the sailor pointed it out to me, it hit me. I’ve got sailors hanging from a safety harness on the mast of the ship. And I’ve got sailor is hanging over to the side of the ship with a life preserver on, and it’s an inherently dangerous task that provides $5 an hour or a value to us. And so why not get out of the lines of work that we’ve been doing for forever so that we would have the time of the day to do higher value work. So we scoured the globe, looking for the right materials to change this stuff out. With spent about $25,000 changed out everything we could painted the ship. We did not have to paint a ship again for the next 10 months.

Mike Abrashoff (19m 54s):
And some people from Washington came out to inspect the ship, and they were amazed that it looked like a brand new ship and the newer than most new ships coming out of the ship yard. And so they start doing investigations at a Navy wide level. And the people who procure this equipment in Washington never took into account the man hours that the sailors have to spend maintaining this equipment. Total cost of ownership. Wasn’t part of their criteria at the lowest bid was, well, if you go for the lowest bid and then I have to spend all these man hours doing $5 an hour of work, we’re not working together.

Mike Abrashoff (20m 36s):
So now whenever a new piece of equipment is bought, the total cost of ownership has to be addressed so that we are not putting undue burdens on the sailor’s out on the ships to have better things to be doing, like figuring out how to defend ourselves better. So that all of that came from a 21 year old, who was free to challenge. Why are we painting the ship every other month?

Dr. Anthony Orsini (21m 0s):
That’s an incredible story. After I heard you tell that story, but no exaggerating. I must’ve told 10 or 20 people. I heard this guy speak, and here’s the story of this first class seaman or whatever he was, but basically change the Navy with something that has basically common sense, but it’s just, it’s a great story. It really is. Let’s move on. So you come on to the Benfold and tell the story of how the former captain left and he didn’t leave under the best circumstances. In fact, it was some disrespect paid to him as he left that must’ve of scared you as like, what am I getting myself into? But you also mentioned that one of the issues was that he was an extremely smart guy who micromanaged.

Dr. Anthony Orsini (21m 43s):
Can you tell me more about that?

Mike Abrashoff (21m 45s):
My predecessor was absolutely brilliant. Nuclear trained engineer may be the best nuclear trained engineers in the Navy. And when he left, as his departure was announced on the public address system, my crew stood and cheered at the fact that he was leaving and to my knowledge, and it never happened before in the history of the Navy. And I take a step back. And the first thing I thought was, what do I have to do to keep that from happening to me.

Dr. Anthony Orsini (22m 10s):
What am I getting myself into?

Mike Abrashoff (22m 13s):
The second thought that went through my mind was I may never be liked. It’s not part of my job description, keeping them safe is so I examine what went wrong and he was so brilliant. He tried to do everything himself and not only that directed how everything was to be done. And so what he created was 310 order-takers. People are just waiting around to be told what to do in order to takers, don’t accept accountability for their results. Things go wrong. He said, well, I’m just knowing what I was told to do. And so I realized I needed to go from that top-down command and control to the one where I added a four word question, when a sailor who would come and asked me how to do something.

Mike Abrashoff (22m 58s):
And my response to them was what do you think? I think those are the most powerful words in the English language, instead of telling him the answer. What do you think, and get them to come up with the answer? And one sailor said, nobody on the ship is ever asked me to think before, and the way I’m asking you to think, how would you do it? So he says, well, this is what I do is to do it. He turned it in flawless performance and he lifted burdens off my shoulders. So if, if I know that he’s out in doing a good job on something, I don’t need to go to micromanage him. So that gives me time in the day to go do something more important, like figure out how to defend ourselves better. And so to your micromanager listeners out there, I say, it’s time to change.

Mike Abrashoff (23m 45s):
And the way that start is those four words. What do you think?

Dr. Anthony Orsini (23m 49s):
I think it was Steve jobs that said it, it doesn’t make sense to hire smart people and tell them what to do. And I’ve had a few leadership roles in the, my past and present, and I’ve had some fantastic bosses. Bosses that I would walk from fire for and other bosses who were nice people are really smart, but it just would never allow anyone else to develop themselves. One of the theories is that is a self confidence thing that it takes a lot more confidence to do to let your people run. I know that I have found when I was training as a physician, there were some of my senior physicians who used to say to me, this is how you have to do it.

Dr. Anthony Orsini (24m 29s):
You have to use his exact dose. You had to use this exact medicine, but the real smart ones, the ones that I looked over said, Tony, there’s three or four different right ways of doing it And one wrong way, don’t pick the wrong way. So you think that’s a self confidence issue right now?

Mike Abrashoff (24m 43s):
Absolutely. And, and I was full of insecurity as well. Like, am I doing the right thing, but I never went wrong when I trusted my sailors. And so I had to get over my own self confidence. And once they started delivering results, I became more confident that as a leader, knowing that this was the right way to do things. And the other temptation I would advise your listeners to avoid sailors would come to me with a solution that may not have been the way that I would have done it, but if it could get the results, I would always say, do it your way.

Mike Abrashoff (25m 23s):
Just like you said, you just don’t pick the wrong solution. There are three or four ways to do it. It doesn’t have to be the way that I would have done it, but I do it. And let’s see what happens. And what I found out was sometimes the way that I would have told them to do it was better or more times than I care to admit the way that they chose to do it was better than the way I would’ve told them how to do it. And so that’s the only way people learn is through experience and giving them the opportunity to make a decision and then go back and look at it and say, was it the right decision? Or is there a better decision than the constantly learning and improvement?

Dr. Anthony Orsini (25m 58s):
And when you micromanage a really lowering the bar, aren’t you, as opposed to raising the bar and say, this is what I’m expecting you to do, and I trust you to do it. I think that makes people really rise to the occasion. Or do you think so?

Mike Abrashoff (26m 11s):
Well, when I worked for the secretary of defense, I was a number two assistant. And honestly, I was a glorified gopher. My job was to push paper and the senior Military assistant is a three star, Colin Powell had a job. John Kelley had the job and it’s our most important three-star job. And once the general started to trust me, he started delegating more and more of his responsibility to me. He put me in charge of the sec, they have security detail, the trip planning team, the communications team. I had 45 people report to me and a job that historically have been an individual contributor job. And I never got any feedback from the general as to how I was doing.

Mike Abrashoff (26m 52s):
But then one day his wife came into the office, comes back to my desk and says, I wanna thank you for everything you were doing for Paul. Because the first time since he has had this job, he comes home at night happy. So he could have continued to hoard all the power and all that responsibility, but he wasn’t going home happy at night. And he found that the more of his responsibility he could delegate to me, it freed him up to do the important three-star work. He’s getting more pride in getting better results. And it frees him from the mundane stuff so that he can go home happy at night.

Mike Abrashoff (27m 34s):
So that’s my challenge to your listeners is what can you do to lift burdens off your shoulders so that you can go home happy at night? Because Lord knows we are working hard enough as it is. There’s no need to make our jobs even tougher. So how do we lighten our load? And to me, it comes from bringing our people all along and training them and delegating to them. And we can do the a thousand dollars an hour work as well

Dr. Anthony Orsini (27m 59s):
For the leader out there, whether it’s in health care or not, who is coming in. And we had Stephen M.R. Covey on a few months ago, the author of speed of trust. And Stephen spoke a lot about trust. We’ve had Claude silver on chief heart officer of VaynerMedia. The overwhelming theme of that was the trust. The word that we’re using right now is servant leadership. Things have really changed over the last 10 years. I would say, now this is the way, but yet we still have a lack of leaders. I think we have more managers that we do leaders. What advice do you give to that person? Who said who’s a, in a leadership position? He or she is scared to death. I had just been promoted and I have the 310 people underneath me.

Dr. Anthony Orsini (28m 41s):
The first thing, how do I establish that trust? What’s the first thing that you would say to them?

Mike Abrashoff (28m 47s):
Two months after I took command and the crew didn’t trust me, they thought everything I was doing was flavor of the month and it wasn’t going to work out. I would revert to the old way of doing things. And then the big day left and we left San Diego en route to the middle East for a first appointment. And the first seven days of the transit was spent doing a major exercise design to increase our ability to defend ourselves for doing this with, to other ships, Harry W. Hill U S a scary admirals embarked on Harry W. Hill. And the exercise was to be over the following Friday afternoon at 5:00 PM. At which point we were to enter Pearl Harbor spend the night in Waikiki. Well, instead of being over at 5:00 PM, that Friday afternoon, it was unexpectedly over at 9:00 AM.

Mike Abrashoff (29m 33s):
We had achieved. All of the objectives were sitting off the coast of Waikiki. Stephen in circles, wasting fuel, wasting taxpayers’ money, waiting five o’clock because that’s what the plan called for in the way that we enter, port in the Navy is by the day to rank have the senior officer or in each ship. The admin was on Harry w HIL. They were to go in first. I was the junior captain in the entire Pacific fleet by date of rank. We were to go in last so I can see why I can see Waikiki through my binoculars, but I’m not going to say to you, and this is stupid and what are we doing out here when we should be there? So I call the Captain of the Harry w HIL on an encrypted satellite voice radio that any sailor or any of the three shift can punch on the button and listened to the conversations.

Mike Abrashoff (30m 17s):
And I said, why don’t you ask the Admiral if we can go in early, he said, I can’t, I’ve got an engineering problem. I can only have fix it at C. I have to stay out. I call the Captain of the next Ship. He explodes at on the radio for the sailors on all three shifts to hear. You’re the junior captain you’re going in last don’t challenge to the plan. So I call the Admiral. I I’m in my cabin on this ship, I can tell by the gruffness of his voice, he had been listening to these two conversations. My hand literally starts to shake while I’m talking to them on the phone and he said, why should I grant Benfold something I’m not granting the other two ships. I said, most of the exercise is over early were sailing in circles wasting fuel I said, I got a piece of broken equipment I can only fix in port.

Mike Abrashoff (31m 6s):
When I said reason, number three, I’m going to put my crew on the beach early in Waikiki today. Now, when he said that I was two decks above the operation center were 30 sailors were on watch. When he said permission granted, I could hear cheering through two decks of steel. Now we have four engines on a Arleigh Burke-class, a destroyer, and our normal configuration has only the steam on one engine because that’s our most fuel efficient. You can do up to 18 knots on one engine. And unless it’s an emergency, everywhere we go, we’re allocated one engine, but you can do 24 knots on two engines and use twice the amount of fuel. You can do 27 knots on three engines, and you can do 31 knots on four engines.

Mike Abrashoff (31m 52s):
When the Admiral said permission granted, I put all four engines online, came up to the full power. When an Arleigh Burke-class destroyer is at full power it’s a thing of magnificent beauty. It kicks up a rooster tail of water. That’s two stories high. Wow. Ship vibrates from the power and we screaming in Pearl Harbor at full speed, tied up at 10 15 off the Ship at 10 45 on our way to Waikiki, never did save taxpayers one drop of fuel that day. Next day, we get underway to continue our transit to the middle East. And the first sailor comes up for his interview.

Mike Abrashoff (32m 33s):
And he says, you know, Captain, it seems to us the crew that you don’t care if you ever get promoted again. And I said, where on earth did you get that from? He said, what you did for us yesterday, you had nothing to gain. You did it for us. We want you to know we got your back. And to me is trust is when you have your people’s back and they have your back for us. There was this magical moment, but trust is like a bank account. And you’ve got to make deposits each and every day. And after awhile of making a deposit in every day, you have a nice sum in your account. And that’s what trust is by demonstrating that you’re going to do the right thing, that your people can count on you to do the right thing.

Mike Abrashoff (33m 21s):
And if they have that sense, they will have your back. And it’s the same with your patients and its the same with your customer’s. But you can’t order it you have to earn it and you need to know your people who are watching you every day. And if there’s a disconnect between what you say and what you do, then that will erode the trust that you’re trying to build up.

Dr. Anthony Orsini (33m 48s):
And it, it really is a difference between good leadership and bad leadership, but also it affects the bottom line. So you talk in your book about employee turnover or in your case, Navy turnover and how many people re up. I think if you look at it, it surveys, it’ll tell you that most employees leave because they don’t like their manager. It’s not about money. And yet I think when you took over, there was a big turnover on the ship. And then you had, I want to say a hundred percent retention?

Mike Abrashoff (34m 14s):
So the quarter before I took command on our retention rate was 8% meaning we were retaining 8% of the sailors eligible to re-enlist. And in my last year, our retention rate was almost 100%. We had the highest retention of any ship in the Navy. And when I first got there, the retention was that our burning issues and the Navy couldn’t generate replacements as fast as we were losing them. And so I had a sailor getting out of the Navy the next day I call them up to my cabin. And by this time his mind’s already made up and I said, why are you getting out? He said, Captain nobody ever asked me to stay.

Mike Abrashoff (34m 55s):
And I started thinking, sometimes we overthink this. Maybe if I just asked them to stay, they’ll stay. And so I implemented a program nine months prior to any sailors contract end date, that sailor would come up to my cabin for another interview. And I would ask them, are they thinking about staying in or are they going to get out? And if they’re thinking about getting out, what is it that I can do to help you change your mind? And here’s what I heard. T if you get me this training or this education, I’ll stay, if you put me in this different job, I’ll stay, my family’s on the East coast If you transfer me back to the East coast I’ll re-enlist. And so if you give me nine months to solve a problem, I can generally do it.

Mike Abrashoff (35m 36s):
If you give me a day to solve a personnel problem where they’ve already decided to get out, I can’t do that. So it was about putting in a discipline process to find out what’s on sailors mind and what would get them to stay in, keep them interested. And then delivering. I didn’t have a 100% goal that was one sailor at a time. And then over a period of a year, it’s like, wow, we haven’t lost anybody. So it’s just having a disciplined process to get people to know that you want them to stay and then see what you can do to keep them because what does it take to train a Dr and how much money or a nurse nurse’s most hospitals have tremendous nursing turnover.

Mike Abrashoff (36m 23s):
I think about how much money is spent on their training and how many opportunities they have. And I had known nurses who we’ll stay at a certain hospital and make less money, but stay because they get treated with respect and they know they are appreciated. You know what? Those physicians have a direct impact on that. And it doesn’t cost a dime. It just costs them self awareness and giving the nurse a pat on the back and are not demeaning him or her. And it’s not rocket science, but you get so many people don’t do it because they don’t have the confidence in themselves to make a difference.

Dr. Anthony Orsini (37m 4s):
And it really underlines the importance of communication is your first sailors said to you, and no one ever asked me to stay and people want to know that their valued. And if they are valued, their going to be loyal, we are ever having a health care crisis right now. And that is because of the bureaucracy of health care right now there’s more doctors and nurses working for hospitals instead of doctors being in private practice and a thriving hospitals value their doctors and nurses. But there are many hospitals right now we’re saying, listen, I know you have 20 years’ experience as a nurse, but if you leave, don’t let the door hit you in the way out. I got six graduate nurses. And by the way, there are $10,000 a year of cheaper because there are just starting out.

Dr. Anthony Orsini (37m 48s):
And what do we doing in the end? We were wasting money. And in the end, who suffers the patient ’cause now the patient gets a nurse has got three months experience instead of 10 years. And so they think that’s a really important thing is let’s communicate how important everybody is to you in, and that really helps.

Mike Abrashoff (38m 5s):
Then that sends a signal to the next nurses who have been there 10 years if this is how are you get treated after 20? Why should I hang around? So everybody watches what happens to everybody else.

Dr. Anthony Orsini (38m 17s):
Communication is a return on investment. So I know we’re running out of time. I just want to get some more great advice from you about communication. I am sure that being in the Navy all those years, you have had many difficult conversations. I want to talk about two types. Can you give us some advice to people who have to have a difficult conversation with their boss, or maybe you don’t agree with the boss? Maybe you need to, must be even harder in the Navy, but do you want to say to your boss, Hey, I disagree with what’s going on. I’d like to do it this way. Can you give us some really good advice on how to start that conversation?

Mike Abrashoff (38m 51s):
For you have to choose wisely the time when you make that appeal. If your boss is under a lot of pressure and frazzled and is under pressure, that’s not the time to do it. I would always do it late in the day. Especially with the General in the Secretary of Defense, his office, I never challenged him in the heat of the battle. I never did it publicly. So if you’re doing it publicly with other people listening, that’s not a good idea. I would always do it. One-on-one when it’s a calm moment. So I’m a football player. I loved football. And in the NFL, when the head coach disagrees with the call by the official he throws what’s called the red flag, which means I would like an NFL instant replay on this.

Mike Abrashoff (39m 40s):
And so if you do something that has disarming that doesn’t put them on the spot and on the defensive, I would say, hey boss, I would like to throw the red flag on this decision. And it’s a completely changes their demeanor and their mindset so that they are more open to listen to your ideas. And so I would never CC anybody on an email. If I had to do it by an e-mail, it just one-on-one communication. And I would say, you know, boss, Admiral, here’s the deal. I know this is what you want to accomplish and this is how you told us to do it, but we’ve looked at this and if we do it this way, we might be able to deliver better results and accomplish what you’re looking for.

Mike Abrashoff (40m 21s):
So when I’m challenging a decision, you don’t put the person on the defensive and you don’t challenge them in public. And you also give a solution instead of dropping another problem on your boss’s doorstep, provide the solution. And then you have a greater chance of being able to do it your way. And so I bet, you know, I won 90% of my NFL instant replays, and if I lost, I saluted and I said, you have my a hundred percent support. But the key is the timing and not to put your boss on the defensive and embarrass them in front of others.

Dr. Anthony Orsini (41m 1s):
As I say, as the name of my book. But as I say, 10 times a day, it’s all in the delivery. And so if you went to your boss and said, hey, I disagree with you. That kind of gets their back-up right? And now there ready for a fight. But I love that can throw a red flag. It’s almost kind of funny and it makes light of everything. And then you can have a nice conversation.

Mike Abrashoff (41m 17s):
Their response would be to laugh and shake their head. That’s better than to get their claws out. They want to dig into you, laugh, shake your head. Okay Abrashoff what do you want?

Dr. Anthony Orsini (41m 27s):
I love that. I think I’m going to steal that from you. And I think a lot of people out there I’m going to steal that also. And then finally you’ve had have Difficult Conversations in your life that you’ve run with either with your sailors or et cetera. So I always finish the podcast with the same question. What is the most difficult Conversation you have ever had to have? Or what type of conversations do you think is the most difficult that you’ve had to learn to navigate?

Mike Abrashoff (41m 52s):
So the problem in organizations is not everybody is going to get with the program. I call them cave dwellers, citizens against virtually everything. I looked at it and no matter what your for their against And, I bet you have one or 2% of the crew on Benfold, where they were disgusted. They just couldn’t wait to get out. They couldn’t wait for their contract to be up in, nothing I was ever going to do or try to connect with them was going to make any difference. But they’ve got a different interview with me. It was a cave dweller interview, and you never let this interview become emotional or confrontational. William Perry called it iron logic. They go into the conversation with 20 facts that the person can’t refute of how their performance didn’t compare favorably to the rest of the sailors.

Mike Abrashoff (42m 41s):
And you get them to admit that they are not performing. And you can do that with generalizations. You have to have cold, hard facts. So I would get the person to admit that they are not performing at the same level as their shipmates. And then the follow up question is why. And honestly, here’s where my education came in. Some sailors chose to share with me personal issues like they’re in debt or marital issues, or kid’s on drugs. We got family members with COVID and your home schooling your children. I mean, these are problems that we’ve never had to face before, but our people are now facing. So there are, they become impediments that we have to deal with.

Mike Abrashoff (43m 24s):
And so if you understand that, then you can help him in a, for sailor shows to share with me on a personal issue. Do you know what I’m a compassionate and humane person I’ll help you. If I can, I’ll give you some time to address it. And hopefully you’ll be back in a couple months, ready to go. If a person didn’t have the training, I’ll get you the training. But if a cave, dweller was a cave dweller, because they just didn’t want to be there. I put them on a six month program, they got to come see me once a month for six months. And if they made no effort to improve, I separated them from the Navy and I had to get rid of five sailors this way. I hated every time. And I got no sleep the night before getting rid of the first sailor and I come to work and I said, you know what?

Mike Abrashoff (44m 9s):
I lay line in the sand. I got to separate the sailor. So I did. And then the most amazing thing happen. The 98% of the sailors who did care started stopping me in the passage way and said, what took you so long? We owe it to the good performers, not to tolerate disruption from one or 2%. And that’s what a critical conversation is about. Leadership is not a paycheck. It’s about having those critical conversations and getting to understand why people aren’t performing as expected. Help them if they are having a personal problem, but also tell them what will happen if they choose not to get with the program, because we owe it to our patients.

Mike Abrashoff (44m 54s):
We owe it to our customers. We owe it to the rest of our staff, not to tolerate disruption from a few malcontents.

Dr. Anthony Orsini (45m 3s):
Successful people know how to communicate. And I think that’s the bottom line. And that’s why I worked so hard to do, to help people learn to do that. That’s what I have this Podcast, that’s why I had you on. ’cause you’re a master communicator, a leader. And I want to thank you so much, but before we leave, how has COVID effecting you or the GLS worldwide? I have been here. I used to do a lot of speaking and that came to a halt. And so it must be, what are you doing nowadays to keep busy?

Mike Abrashoff (45m 28s):
I am doing virtual keynotes. I’m doing probably five or six a month. And my business partner, Stacy Cunningham three years ago had developed a virtual leadership development program. And so in times of COVID, people are looking for ways to break up the endless zoom calls. So we’ve got this 26 Lessons virtual program. Each lesson takes about 15 minutes. And so we’re getting pretty fantastic results with that. But I haven’t flown in an airplane since March 14th and I normally fly probably 200,000 miles a year. And the first six weeks I’d love that. I’m going to be thinking, boy, this pandemic is great.

Mike Abrashoff (46m 8s):
I’m on vacation, but I was bored for the next two months until I started doing the virtual keynotes. And so you adapt and I realized somebody always has it worse than you. So I’m very fortunate, but you make the most of it. And I set up a studio in my basement where I do my virtual keynotes from and continue pushing the consulting side and also taking some time for myself and, and just thinking about what the future holds and how I’m going to position myself and how I can be of value to clients because of the challenges they’re facing with COVID as well. Y

Dr. Anthony Orsini (46m 47s):
eah, I’ve done some virtual keynotes too. I love to speak in front of a crowd because you get that feedback, right? you can be on that stage in your speaking and you get a lot of verbal language that confirms what the head nods hard to do that on virtual, because you have no idea if anyone’s sleeping or not.

Mike Abrashoff (47m 2s):
And, and not that people would care, but in a virtual setting, you have to stand still in one place in front of the camera. And my first keynote, I, for some reason, I dressed up and put my hard soled shoes on, even though you can only see from the waist up and I’m standing on the same hard floor and the exact same spot for an hour and a half. And what I was done, my legs and feet were shocked. Like they’ve never been before. And I had to sit down for like four hours until her recovered. But now I wear sneakers whenever I’m doing a virtual keynote, but the audience is probably to ever think of that, but it’s tough standing up in the same place for an hour and a half.

Dr. Anthony Orsini (47m 40s):
It sure is. And you know, just last week I gave one it and you have no idea whether anybody is still out there right now, you’re, you’re talking away and you’re giving us and it’s not until maybe you get an email or afterwards where the moderator comes up and says that it was a great lecture, whatever, but I can’t wait to get back to in-person stuff. I got my first COVID vaccine worked for taking it one week before Christmas, I got my first vaccine two days ago. And as a health care worker, and it looks like God-willing, we are going to be getting this out to everybody in the next five or six months in. Maybe we can get back to normal. Lets the hope so, thanks to Mike. I can’t thank you enough. I think this is going to be an awesome episode for the audience.

Dr. Anthony Orsini (48m 20s):
My audience is really lucky that you’re out there and that you did this. What is the best way for them to get in touch with? You will put it in the show notes. So if you’re driving, go write this down, but what’s the best way to get in touch. MAbrashoff at APG Leadership. com.

Mike Abrashoff (48m 33s):
Great. And we’ll put that in the show notes. Thank you so much for being on today. Thank you everybody for listening. If you like this podcast, please subscribe on Apple or, or your favorite podcast platform. If you want to learn more about what we do at the Orsini Way you can reach me at The Orsini Way.com. Thanks again, Mike. Appreciate it.

Dr. Anthony Orsini (48m 50s):
And have a wonderful holiday.

Mike Abrashoff (48m 55s):
You got it Doc, Take care of.

Announcer (48m 55s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast. Visit us at The Orsini Way.com

My Journey into Medicine with Michelle Atwell

Michelle Atwood (1s):
But I try to help them understand that accepting this is necessary. It’s going to happen to all of us. We’re all on this journey. None of us are getting out of here and some of us are closer than others, but the most important thing is, is that we all have to live every single day, the best we can so that we can move forward and have a life that we can say was worth living. And that we are with the people that we love and we care about. And we have a little bit of control at the end, over what we do.

Announcer (34s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of The Orsini Way. As a frequent keynote speaker and author Dr Orsini has been training health care professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 19s):
Well, I am honored today that the Orsini Way has partnered with the Finley project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician The Finley project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable. The loss of an infant. It was created by their founder Noelle Moore who sweet daughter Finley died in 2013. It was, at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home. That led her to start the Finley project. The Finley project is the nation’s only seven part holistic program that helps mothers after infant loss by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 3s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement. The Finley project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley project has literally saved the lives of others who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley project.org. The Finley project believes that no family should walk out of the hospital without support. Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician.

Dr. Anthony Orsini (2m 43s):
This is Dr. Anthony Orsini and I will be your host again this week. Well as many of you already know, it was early in my career as a training physician that I was very aware of how frequently physicians struggled navigating difficult conversations with patients specifically when delivering sad or tragic news. In fact, in my very first podcast ever, which was the only one that I didn’t interview, a guest, I talk about the life changing moment that led me to a 10 year quest to eventually develop the breaking bad news program that started in 2010. And as of now trained thousands of physicians and healthcare professionals across the country. As I mentioned, many times, few people would realize that as a whole physicians and healthcare professionals get very little training on communication skills, especially when it comes to delivering tragic news.

Dr. Anthony Orsini (3m 34s):
One of the reasons that the breaking bad news program is so impactful, I believe is that in addition to receiving feedback from other doctors, the participants also get feedback from nonmedical instructors that have experienced real tragedy and can give real advice from firsthand experience. What I have found over the years is that that communication is all about building trusting relationships with patients. Physicians and healthcare providers who are able to be genuine and learn to relate to their own life experiences are able to provide the best care, especially during difficult times. Well, today I am honored and privileged to have a guest Michelle Atwell.

Dr. Anthony Orsini (4m 16s):
Is it safe to say that few health care professionals possess the depth and breadth of experience in the patient care giver dynamic that Michelle does. First as a mother managing the diagnoses of the life threatening illnesses to her daughter and son. And now today in her role as a physician assistant at a major health care system in Orlando, Florida. After the tragic loss to her first child and only daughter, Michelle who had a successful career in the banking industry was driven to invest her grief in the care and care of other patients battling similar afflictions. She began volunteering with Shepherd’s Hope Clinic first as a member of the general volunteer staff.

Dr. Anthony Orsini (4m 57s):
And today as a licensed healthcare provider. Michelle is a proud alumni of the university of central Florida with a degree in life and biomedical science and social and behavioral science. And she now has a physician’s assistant degree at Nova Southeastern university. Michelle didn’t stop there. She’s volunteering with beautiful feed international mission teams. She’s in the middle of a publishing, a contributing article to an upcoming medical genetic textbook. She is a member of the American association of physician’s assistants. And winner of the 2017 Nova Southeastern University PA Program Gold Standard Award. Well Welcome Michelle thank you so much for being on today.

Michelle Atwood (5m 40s):
I’m so glad to be here with you and speaking with everyone. Thank you for having me.

Dr. Anthony Orsini (5m 45s):
I was like, you know, I want to say we both work at the same health care system, and by the way, as always, I must disclose that neither Michelle nor I, are representing that health care system and our views are solely our own. I always have to disclose that to make the lawyers happy. Michelle although we work at the same health care system, since you work with adults and I work with pediatrics, our paths really never crossed until I think it was about a month ago. Wouldn’t you say?

Michelle Atwood (6m 10s):
You did a training a few years ago, and I was a guest at the training and I heard you speaking, and I was a brand new employee wasn’t even credentialed to work yet. And it was so interesting to hear your perspective and how you were teaching people to approach patients. And I thought, wow, that’s great. I’m working for this great organization where they are really teaching these doctors how to talk to people. And it’s so important even before I start there, making sure I get this training. And it was really excited about that. And so then I looked you up again, and I saw that you were doing all of this podcast and that you actually had an entire training program. And I was really impressed. And so just wanted to get back in touch with you.

Dr. Anthony Orsini (6m 51s):
That was about a month ago. And we spoke for about an hour and I want to say it was really moved by our conversation and your journey and so will get it. This is right off the bat. I know I’m a big fan of you and what you’ve gone through and, and where you’ve come right now. I would say, I want to say right away that your story was deeply moving to me and is very important to my audience. I liked to have Michelle take you through her journey because, you know, I always promised the audience the same thing that they’ll be inspired and learn communication skills. And today your story is so inspiring. And I think this we’re going to learn so much in the next hour from you, but if you would, let’s just take the audience along your journey.

Dr. Anthony Orsini (7m 33s):
And where are you started with your daughter, Victoria? You were in the banking industry, as I said in the intro, and then your daughter gets sick. So can you just tell us about that a little bit? And specifically as you go through her story, some of the conversations that you had to have with the medical professionals.

Michelle Atwood (7m 50s):
So my daughter was in fourth, it was the summer between fourth and fifth grade, and she was starting to have some issues where she would get sick and throw up a little bit here and there. And I didn’t really know what was going on. And so I took her to her pediatrician and I said, there’s, you know, something going on here. She is starting to feel sick more often. And I had been divorced. I had just gotten divorced and maybe in the last six months before that, and the pediatrician really said to me, you know, it could be that she’s upset about your divorce, or she could be having onset of menses. So it could be just emotional and let’s start with changing her diet.

Michelle Atwood (8m 30s):
So I changed her diet and we went to therapy. I did all the things that you should do it. And it wasn’t Improving. So after about two or three months of that, there was more, now I’m having headaches. Then I’m also throwing up more. And I thought this doesn’t seem right. So I took her back in. I said, we changed the diet. We did everything you said still it’s happening. And she goes, I think your daughter just wants some attention from you so I was doing. everything to give her a lot of attention. And she goes to bed at any rate, lets get you some propanolol which his, a beta blocker. I know nothing about any of this. I was working at a bank and I was very young and I thought, great.

Michelle Atwood (9m 10s):
They gave him her beta blocker. We’re going to take this beta blocker. And that started sometime after Thanksgiving, between Thanksgiving at Christmas, we were having this beta blocker and it helps with anxiety. But and there wasn’t quite so much throwing up. But in the meantime we were noticing that her hands were starting to shake too. And so part of me was the mom saying, well, you’re kind of being dramatically stopped that. But then there was a, the other part of me saying, you need to drink your soup with a straw and instead of having a spoon and so we went home for Christmas and my mom said, this is very unusual. She hadn’t seen us since summertime.

Michelle Atwood (9m 50s):
And so for her to change was so drastic. She is like completely different. Like she’s does it feel well all of the time then I said, what could be the medicine she was taking this medicine? And my mom said, no, you have to go back to that pediatrician. There’s gotta be more than this. So, and so we came home from Christmas break and I went to the pediatrician and I said, my mom insists that something be done. This is not the right answer. And in the meantime, while we’re waiting for that appointment for a neurologist, I had a customer come into the bank and her husband had Parkinson’s disease. I had no idea what was going on with the husband. I just knew that he was this old guy and he had some unusual mannerisms and it reminded me of what I was starting to see at home with my daughter.

Michelle Atwood (10m 32s):
And so I asked her, what, what is it that your husband has? And she goes, well, he has a neurological condition called Parkinson’s disease. And I said, do kids ever get that? So innocently? And she said, no, kids don’t get that. And some of the things he does, the way he’s holding his hands and things are very similar to my daughter. And she said, you have to get that checked right away. And I told her that we had this upcoming appointment. And so we came the day that we went to the neurologist’s office, the neurologist was great. He did his exam, a great neuro exam. And he immediately said, we’re going to send you across the hall or down the hall to get an MRI done.

Michelle Atwood (11m 11s):
And so we went and straight away to do that. And I thought, well, this is unusual. I fought so hard to get here. Now they’re just doing everything right away. But I lived in Vero beach, this was Melbourne. And I thought, wow, I’m in the big city. They are getting everything done quickly. So he sends me down there. And so while they’re doing it, that gentleman that was doing the scan, I was in the room and I thought, well, I don’t know anything about this, but it looks weird. There’s like a butterfly in her brain. And I thought, well, that’s really cool. It looks like there’s a butterfly. Of course my daughter’s in fifth grade butterfly’s are cool. I just think it’s really pretty. And so the guy says, well, we’re going to need to get you some lunch. The doctor wants you to wait here. And then he’s going to have you go back to the office.

Michelle Atwood (11m 52s):
And I say, well, is this normal way that things are done? And he says not usually. Usually, we are able to have people come back and get their results later. And at that point it was kind of dawning on me that this was an unusual progression of a day at a doctor’s office. When my daughter had always been healthy. So I’d never seen any kind of thing like this, where it was, see the doctor, do the test, go back right away, get the results. But he brought me into the room and he said, well, what you suspected was right. There is something that’s unusual. We did find that there is this tumor. And so he starts throwing a lot of big words. That mean bilateral fam thalamic And things that I had no idea what any of this meant. And I said, so you’re saying, and how big is it?

Michelle Atwood (12m 35s):
And he goes, well, it’s the size of a Tangerine. So maybe five to eight centimeters. And of course, I don’t know if five to eight centimeters are. So I’m thinking it that’s a pretty big and is that the butterfly? And so he actually pulled up the, the film and put it on the wall, old school, let me look at it. And he said, yes. And we’re going to need you to go right away to have a neurosurgeon, look at this and as well, is there any way it can be anything else because this doesn’t seem likely she has always been healthy. We don’t have any, we are not, she’s not been sick. And he said, well, how long has this vomiting been going on? And I told them it was maybe six or eight months. And he said, well, that was the first time that really she was having any impact.

Michelle Atwood (13m 17s):
And prior to that, it had been there, but it had been growing unchecked because it was in an area called the ventricles, which are like a Lake or a river. And so there was plenty of room for the growth without really affecting to much of the function. So from there I remember calling my boss, my daughter was super excited though, because she said, yeah, it’s a tumor. I was so excited. It’s not that I’m just really bad at handwriting anymore. And she was making jokes about talking like, Arnold wants to know if it’s a tumor in. So she was very funny. And I remember being in the car and I had to call my boss and say, yeah, so it’s just the tumor I fully expect to be at work tomorrow will be no problem.

Michelle Atwood (13m 58s):
But on Friday they want me to go to Arnold Palmer and I’m going to go have to see this neurosurgeon And but everything will be fine. I’ll be back at work. No problem. And my boss was so wise and she said, how about you? Give me a call back later when everything is kind of settled down and let me know what you think.

Dr. Anthony Orsini (14m 15s):
So in retrospect, if you don’t mind me interrupting, so the neurologist says tumor, at that point, you, you can really understand the severity of it or so you just thought this was a good day.

Michelle Atwood (14m 26s):
So I thought it was a mistake. I really thought it was a mistake. There was no way that my daughter had a tumor number one, number two, just impossible. That It was what he was saying. There’s no way it’s where it is. There is no way it’s that big. The, the pictures were wrong, something was wrong. And I was completely and totally in shock. I don’t remember much of the other things he says.

Dr. Anthony Orsini (14m 52s):
Tell us about the conversation when you first understood the seriousness of the diagnosis with Dr. Was it the neurosurgeon, then

Michelle Atwood (15m 0s):
It was the neurosurgeon. So the next morning I went to school and I took her to check her in and I told the front office, you have to check them in. And I said, she’s got a brain tumor and she’s got to go to this appointment. And I’m kind of in shock. I don’t know what I need to do. And the secretary said, you know, there’s another kid here who has a brain tumor, and I’m going to get her mom to talk to you. And I thought, Oh, this is great. There’s another mom. And so this other mom contacted me and she said that she’d been seen in Boston. And she said, do not go to the local people. This is a Florida, there is no good health care here. You have to go to the Northeast. That’s where all the good health care is in America. He must go northeast and so she sent me up to this neurosurgeon and she did all of the phone calls.

Michelle Atwood (15m 43s):
This mom was terrific. She called the office at Brigham and women’s. She was able to say, this mom needs an appointment. Another friend of hers, the mom bought had her friend donate money and bought me a ticket. Literally we were in Vero beach on Wednesday getting a diagnosis. Then on Friday, we were in Boston at one, o’clock sitting in an office 48 hours later at this neurologist office, this very well-known neurologist.

Dr. Anthony Orsini (16m 12s):
Tell us about that conversation. When he came in and tell you the news,

Michelle Atwood (16m 16s):
It was a very difficult day because he said that he had reviewed the films and that it was a really large tumor. And based on the location that doing a surgery would be impossible. He said that because it was bilateral, meaning on both sides of the brain, that there could be too much damage to the optic nerve, to her cerebellum and that she could have a physical deficits, things that she wasn’t already experiencing, and that they wouldn’t be able to do that. There would be no way for them to debulk the tumor at all. And I said, Well well, how do you know what kind of tumor it is? Or how do we know how bad it is then if it was there for a long time, it’s got to be slow growing.

Michelle Atwood (16m 59s):
So is probably going to be fine, right? What are we going to do? And he said, well, let’s do the biopsy and I’ll be able to give you some more information. And so at this point still, I don’t have a good idea of what’s going on, but we checked into the Ronald McDonald house that afternoon. And that’s when it became very obvious to me that I was now a member of a club that no one wants to be in. And that’s the mom of a very sick, possibly terminally ill child. And that it was going to be very difficult from here on. And so there were pictures of the kids on the wall, kids that have been treated at the same facility and who had seen the same surgeon.

Michelle Atwood (17m 42s):
And there was even a ward of this Ronald McDonald house where the bone marrow transplant kids lived. And so you couldn’t go down there and we would sit at the table and we were eating with children that their hair was falling out in their soup. And they were so sick. And the scared look at the hall of faces of all the other moms and was so hard for me to believe that this was actually really happening to me. And it was just the two of us. I was a single mama at that point. So it was just me and my daughter. And she was my whole world. And I felt that wasn’t going to be the case. And I was super scared. So when he actually did the surgery, the following week, he came from the biopsy and dad had arrived at the time of the biopsy.

Michelle Atwood (18m 25s):
He was there for results and we were in the waiting room and he came out and he says, we were able to get a piece of the tumor. And I said, there really was a tumor? I kept thinking maybe it was just water or a, some kind of cyst. Maybe it’s not really a solid tumor because we were able to get a piece of the tumor and I’ll get that down to the lab. And so this was maybe only five days, six days later, I literally threw up in the floor of the family waiting room because it was so unbelievable to me that it was actually real at that point. And he goes, so I’m going to have to let you know, based on the biopsy findings, how bad this tumor is, and then what the treatment plan will be after that, that will get it over to the tumor board and they will make a good plan.

Michelle Atwood (19m 11s):
And so that, that was that conversation. It was just extremely difficult. He was all in his scrubs and he stayed distant from me. So he was very, to the point it was, we are going to find out, we’ve got some of it. We are going to find out more.

Dr. Anthony Orsini (19m 26s):
And so, as we say, we were teaching the classes, I’m sure you would agree that at that moment, the doctor delivered that news, your life changed forever. And you think it’s safe to say that you remember everything about that conversation? It sounds like.

Michelle Atwood (19m 39s):
Yep. I remember the, the look of the title on the floor. I am going to tell you right now that floor versus any other hospital floor, everything about it.

Dr. Anthony Orsini (19m 49s):
And that started a long journey with Victoria with multiple procedures and chemotherapy. And sadly Victoria passed in November.

Michelle Atwood (19m 60s):
It was 2003. So she fought for 30 months. We went through all of the treatment protocols, chemotherapy radiation. So she was so sad when she got home from Boston. And she realized that we went to the radiation appointment to get fitted for the skull helmet that they wear during radiation for stereotactic radiation. And she was doing all this fitting and she goes, why do I have to do this? I already had brain surgery. And the doctor said, well, they didn’t get the tumor out. And she just started crying. Yeah. I had told her that they took a biopsy, but I guess I didn’t realize as her mom, but I hadn’t said the tumor was not there anymore.

Michelle Atwood (20m 46s):
I did never clarify to her that tumor was still there. So that day she went home and she actually contacted a friend of mine whose husband had been in the military. And she said, can you shave my head? I want the military cut. I do not want to have chemotherapy. She’s 11. And she called my friends and said, I want to cut my hair. And so she got her head shaved because she wanted to go back to school different. And at that time there was this Jim Carrey movie, the mask. And literally when she got the haircut, she goes, somebody stopped me. And she had such a sense of humor. And she goes, Oh, all I need is some really big teeth so that I can really make this work.

Michelle Atwood (21m 27s):
And so she just had such a great sense of humor and realized we were going to need that. And so I really tried to lean into her way of looking at things, but she shaved her head. It was done by the time I got home from work had no choice. So then she started doing things on her own. There was a big field trip for all the fifth graders. And she goes, I planned on going to get Tallahassee and I’m going to right mom? The school was kind of afraid. I said, you know what, nothing bad’s going to happen on this trip or worse than what’s already happening. She went on the trip. We did radiation. The tumor grew, we did chemotherapy. The tumor stayed stable. There were lots of trips back and forth. So in Orlando, I was being seen by a team of a bunch of different doctors.

Michelle Atwood (22m 12s):
And so it was being seen by Neumors so than I was being seen at it. It was called the Walt Disney, children’s it? But it was at what it is now. Advent health is a great doctor there that he was an adult neuro oncologist. There wasn’t a pediatric neuro-oncologist in Orlando. So I was kind of piecing together. This guy does oncology for kid’s. This guy does neuro oncology. So it can put these two guys together. And we have a pediatrician back in Vero who can coordinate some things. So there was a lot of coordinating on my part,

Dr. Anthony Orsini (22m 40s):
A lot of conversations along the way, just to bring it back to there. And when you contacted me about your experience on the patient family side, and now as a physician’s assistant, as I said in the intro, a few people really have that perspective and Medicine on both sides of that. We had a couple of guests, my niece was an early guest and she had, I am so proud of her and she had a cancer and survive leukemia lymphoma, sorry. And this is now a pediatric cancer nurse, but along the way, can you give us some memories of maybe one particular Physician you don’t have to say the name who in somehow made it a little bit better by the way, he or she can communicated it and maybe tell us about a conversation or maybe it was that first conversation with the neurosurgeon.

Dr. Anthony Orsini (23m 29s):
That seems to be because of the lack of communication skills may be made things a little worse.

Michelle Atwood (23m 35s):
So the neurosurgeon was an excellent neurosurgeon. He had a great team, but basically they just handed me back and said, we are not going to be able to do anything more because we’re neurosurgeons and you have a surgery and you’re going to need to contact, some people down there. And that’s when I was looking for who’s going to take care of this. And the one doctor that was just the oncologist, who just didn’t feel real comfortable talking about how we were going to approach this brain tumor. And it was really an inoperable. And I did have a very unfortunate incident happen with them. And that’s what made me look for different practice and why it ended up going to Duke. But he actually said, this is so unusual. May I have students come and speak to your daughter?

Michelle Atwood (24m 16s):
And I thought one or two, maybe, or maybe one at a time. And he sent a pack of students and it must have been eight or 10 residents that came in. And I felt like we were in a zoo. Like my daughter was a specimen that everyone was looking at and it really freaked her out. She goes, is it really is so weird. I mean, is it so bad mom? And I thought, I don’t know. I have no idea.

Dr. Anthony Orsini (24m 43s):
So the doctors really are, I believe are all compassionate as you probably know right now. But sometimes we really have to remind ourselves that Medicine at its best is a human to human interaction. Right. And when I teach patient experience as a Michelle, sometimes, you know, and we don’t mean anything by it, but you’ll see, you’ll hear our nurses and physicians talk about are the kidney patients in three or two and a heart patient in four. And that’s what made you feel that I think your daughter uses the word specimen, is that what she used at 11 years old? That’s remarkable. And then looking back, you go to Duke and was there a particular, I think I know the answer to this. Was there a particular Dr. That just seems to make things a little bit better?

Michelle Atwood (25m 26s):
Yes. So then they have a team, they have this Duke brain tumor group. And so I had heard of these doctors on a, basically like a Facebook group of back then. We didn’t have Facebook. It was some group that we would text each other late at night on the computer. And they were talking about the Friedman’s and these guys would fight for their patients. And so, and I said, wow, I want to be part of this. I want to be fighting this thing as much as possible. And so they had all of the team. And so the doctor would come in and he would explain what was going on. But then he had the child life specialist and the other teams. And he had people who were looking at the lungs and the eyes and the physical PT and OT and neuro-psych, and they were just able to let us know that this affects the entire child.

Michelle Atwood (26m 15s):
In in fact, it’s your entire family. And we’re here to support you in all of these ways. And they really were putting everything together. They even worked with the doctors here and they said, this is who you need to see. And they streamlined the process for us. And they said, this is where you’re going to go. This is who you are going to see. We are going to communicate about these things on our end. You don’t have to, as the mom walk around carrying MRI’s wherever you go. And also the last doctors notes, because I have to have everything with me all the time. This is because doctors weren’t talking to each other. So I felt like I was just the keeper of the information. And I wasn’t being the mom. You know, that I was noticing all the other things that were going on. So when they started coordinating their care and talking to each other, and these doctors were working together and they were coordinated is the biggest thing I think.

Michelle Atwood (27m 4s):
And they were taking care of her and me, and they were making sure that we were taking care of physically, mentally, emotionally, and even financially, they worked with the social workers to help. We’ve got in touch with Ronald McDonald. Your, this is where the address for that is we didn’t have GPS back then. I would drive with my little map. I would write down, I’m going to take the second left and I’m gonna go to this Ronald McDonald house. Then I would walk in and I would say the person’s name. And they would say, yes, we have a room for you. You’re going to be here for three days.

Dr. Anthony Orsini (27m 34s):
What a great experience. You had there with him. I am in my book and then the break and bad news program. And now that you are an instructor, you’ve heard me say this before we talk about the three goals of discussing tragic news. One is to show your compassion, which are clearly, it sounds like that neurosurgeon didn’t have much. Or, and even though the neurologist has brought it up on all the students, but to do is show them that you’re the expert in the room. And as I say, in my classes and in the book that patients should feel as if they can figure to put their arms around your shoulder and you will lead them to the next step in, as you’re speaking, I was feeling really good about myself, because I see just a tiny smile on your face. When you talk about Duke and clearly they had an impact, but clearly It was that you really felt that you are in good hands, right?

Michelle Atwood (28m 21s):
Absolutely. No one had told us before what the prognosis was. It was Duke. And I was already maybe four months into it. At the point I got in touch with them, like, what’s the prognosis? What does this road look like? What do I have to do? What can I expect to happen? And no one had really sat down and giving me a comprehensive look at that. Everyone had told me there are parts. The surgeon was excellent, but it was all about, this is what you can expect after the surgery. This is what we can do. The radiation oncologist. This is what radiation I was like, and this is what we do after that. But Duke was able to give us the entire perspective of what all of it look like, the good and the bad. And I think that was the biggest thing was he didn’t shy away from the fact that we are getting ready to go into a very difficult thing.

Michelle Atwood (29m 7s):
And it was going to be really hard, but that we weren’t doing it all alone. And it wasn’t just giving us a tiny bit in saying, this is fine. We’ve got this one part, but we are not going to tell you all the rest of it. We really knew what it was. And we were able to look at the thing and say, OK, so we’re going to do all of this. And we could still have a really bad outcome, but along the way, there’s going to be these supports. And we are going to be in this guy’s trusted hands. And that guy was with me the whole time. And he’s now in Florida. I’m so happy that in Florida, when I found out he came to Florida, call them and I thanked him for coming here.

Dr. Anthony Orsini (29m 46s):
You can say his name.

Michelle Atwood (29m 50s):
Oh, good, Dr. <inaudible> If you’re out there,thank you. He is at university of Florida and now, and he’s running they’re neuro oncology center there. Fabulous at Shannon. So, so happy that he’s here and we’re having this care available in Florida because I was literally driving my old Honda, you know, 850 miles each way. But when she got really sick at the end and we were changing so quickly, I would just have to get to Duke. Well, I have to have the doctor at, Duke see her to tell me what’s happening. It was a seizure that signaled the end, that there was a big change. Something happened. She wasn’t speaking correctly anymore. I now know that it’s called word salad and that the brain tumor had grown a lot And.

Michelle Atwood (30m 35s):
So I even remember calling him and he answered his phone on a Saturday morning, and he was at his kid’s soccer game. And I said, is hospice the right thing to do now, is this what you would do? And he said, you have done with everything else that you could do medically. And as a mom, this is what you can do. And it’s okay to do that. And I felt like I needed his permission to give up because he had fought with me so hard for so long. It was almost three years. I saw him every 10 weeks for three years when he was part of my life and part of my family. And I just felt like he was just taking care of us.

Dr. Anthony Orsini (31m 7s):
And you said that you needed his permission. And I think that’s many of the, that happens a lot when we’re dealing with end of life. We’re going to have Dr. Knops on in a few weeks and Dr. Knops Is one of the most amazing palliative care people I’ve ever met. And I learned a lot from her, but in the NICU and even in the life, when we teach about end of life discussions, many people are in fact looking for permission, not that they need our permission, but they need somebody to say, who’s the expert in a room once he established with you that he was the expert in the room, but to say, that’s okay, it’s a loving thing to do as a parent. And so it, it’s amazing that you said that.

Dr. Anthony Orsini (31m 47s):
So sadly, Victoria passes on November 14, 2003, I can’t imagine how difficult that must have been for you. And then you try to get through this. You are still a banker at this point,

Michelle Atwood (32m 0s):
Still in banking. So luckily when all of this has happened to you, right? Remember September 11th, I also happened and I had been working at the bank a really long time. So I had had a lot of stock and I cashed out my stock right before September 11th happened because I needed to pay and be out of work. So had cashed out my stock. When I think bank of America was 60 something dollars a share. So really high. And I had a nice little nest egg of money. I had gone back to work while she was sick in having chemo. But for the first, maybe for six months, I was out. So I had this money and I was able to take some time off. But after she passed November, I thought I needed to be home.

Michelle Atwood (32m 43s):
And I was home about a month and I couldn’t be home anymore. And I got in touch with a friend of mine and she said, we need you back. We need you to come back to work. And I said, I don’t think I can do it. And she goes, we are here where your team were. You can come back in. So I went to work for a smaller community bank with people who were my friends. I was very happy to be there. And so I worked full time all day, Monday through Friday eight until 5:00 AM and until six on Fridays. And then I also went to school full time. And that was just taking some classes I did not ever want to have one minute of my day, that was not occupied. So I went to school full time and I work full time.

Michelle Atwood (33m 25s):
And I just, I went from bed to work, to school, to bed at four to six months, try to keep busy, staying busy and just trying to put one foot in front of the other and maintain some semblance of normalcy in my life. And so that was a very difficult or recovery. And

Dr. Anthony Orsini (33m 43s):
Then in September of 2005, what happens is that summer of 2005.

Michelle Atwood (33m 49s):
So I met and got married to the most wonderful husband ever 16 years now we’ve been married and I was pregnant. And in September I went into labor a couple of weeks early. And so our little boy was on the way. And we were so excited. We went to our local hospital, we had done our hospital plan to have him. There was absolutely no indication that there was going to be anything but a normal delivery. I had a normal delivery of my daughter. I thought it was going to be a, just a perfect delivery. We went to the local hospital and when he was born, usually there’s that moment, you know, they kind of cut the cord and they hand you the baby. And I was so looking forward to that minute, I had been without my daughter, as herself, since 2001.

Michelle Atwood (34m 35s):
So this is 2005. It’s been five long years. Here’s this baby. And I am going to hold this baby. And they didn’t hand him to me. And I’m like, what is happening? They should have handled the baby in my husband is the first time dad. So he doesn’t know what’s happening. It was like, I don’t know if there’s a bunch of people over there. And I said, what kind of people are they? What are they doing? And he goes, they were putting a mask on him and they say, well, he shouldn’t need a mask. He’s a newborn. And I couldn’t remember, did he cry? Did he cry? And they said, yeah, he cried. And so I asked the nurse what happened? You know, when his apgar was great, he was at 10, but then he drops really suddenly. And I had no idea what they are talking about it. I just knew that something was wrong. He’s not getting enough oxygen.

Michelle Atwood (35m 17s):
I thought, well, there’s not been a problem. I’m advanced maternal age. I’ve had these scans the whole time and there shouldn’t be a problem. This is a perfect baby. They promise me all along. I did all the testing to make sure everything was fine. If that was not the case. So they put him with oxygen that we weren’t allowed to really hold him. He was in a box. They moved him into some special unit. I’m just struggling to understand what’s happening. My OB doctor comes in and I said, what happened? It was a perfect pregnancy. I didn’t have any problems. I mean, I had to do a blood thinner. I G I gave myself a shot every day for nine months. So I could have this baby and everything’s should be fine.

Michelle Atwood (35m 57s):
And when they said that there was something wrong and he was blue, he was a blue baby. And I says, well, why what’s wrong? Has it his lungs, there are always fine at, and they said, no, it’s his heart. And I thought that this is impossible. I did everything. I did everything I was supposed to do. And so they said that they were going to change him to a different hospital. They were taking him downtown to the hospital, where they had some pediatric doctor who could help him because the doctors in the hospital where we were really didn’t know what to do. And I thought, well, this is impossible. I can not go through this again. I just went through this. I cannot have this happen to me again, too

Dr. Anthony Orsini (36m 37s):
Much, too much.

Michelle Atwood (36m 38s):
And I thought, well, I can’t not be in this room. I can’t be here. I can not have my son in another hospital if I’m not there. And so at this point, I did learn a few things on my previous. And I said, I want to know exactly. I started asking the people in the unit, who’s the best person to go to for this kind of problem. If this was your kid, where would you send them? Who has the best outcomes? What are the typical survival in a situation like this? I want to leave AMA right now. I want to go in. And of course there is a whole lot of pushback. No, it hasn’t been wasn’t even in three hours. I don’t think And so meanwhile, my son has put into an ambulance and he’s taken downtown and I’m still there.

Michelle Atwood (37m 23s):
And I am convincing everyone that I am leaving. Whether they gave me permission or not, I call it the OB doctor. And I say, I have got to go. I can’t, I can’t not be where my sonis. If he is going to leave this world I’m going to be in the room. I’m going to be there with him. I have to go. And so he signed papers. Then I was able to go in. So we went downtown and we met Dr. Garcia. He’s a pediatric cardiologist. And he’s amazing. He came into the room and he was so it’s been a long day for you. I said, yes, definitely. He is. I can’t believe you were able to get here. And I say, well, thank you. And it was so as your son got here this afternoon, we were able to do the testing. And here’s what we found.

Michelle Atwood (38m 4s):
Big words. Again, lots of them. We have a transposition of the great vessels. There is one thing is going over. The other thing that your son’s blood isn’t going out into his body. It keeps re-circulating the oxygenated blood into the lungs to the heart, but it never goes through the body. So this incompatible with life is incompatible with life. And he goes, and I said, well, where, what, what do we do now? And then he said, well, we have surgeons. You can go to Tampa or you can go to Miami. And Tampa is closer and families closer. And as well, I want to know about the outcomes, all these questions that I asked earlier of the team and our ultimate, they ask the exact same questions and they recommend a We that Tampa had a very good outcome.

Michelle Atwood (38m 48s):
So that in Miami, just to make a choice, whatever is most convenient for your family. But he’s took the time to sit and draw the picture of the heart. For me, show me where the vessels we’re going to tell me exactly what the surgery would look like. How many surgeries this surgeon had done. How are these outcomes are all of the patients that he has to come back from this and how he treats them until they’re adults and even into adulthood and all of the good outcomes that he had. And I thought, okay, I believe you I’ll sign the papers. So my son can go to another hospital for all of this next part.

Dr. Anthony Orsini (39m 30s):
And so To Tampa, he has this surgery or more difficult conversations. I can’t imagine what your thinking right now, if that would help you in the Victoria.

Michelle Atwood (39m 39s):
Yep. So this was Lucas of Lucas is the boy and he’s born. And he is Victoria’s first brother And. So Lucas was so amazing. He was just so beautiful. And that the doctors start explaining what about surgeries? Surgeons are so different than all the other doctors may know exactly what they are going to do. And it’s so clear to them what’s going to happen. And they have these conversations all the time, but it just seems to me like they are so familiar with it. They don’t realize how hard it is for us to imagine that they’re going to take some tool and they’re going to cut right into your kid.

Michelle Atwood (40m 21s):
And that somehow we’re supposed to believe that it’s all going to be OK. And then at the end of it, you have to sign a paper saying, but if it isn’t and I already know that if I already know that this may end in death at the end of all of them it’s and death. And it’s a really awful as a parent to have to, to say, I know that this could lead to death, but I’m counting on you that it’s not going to be. And it’s not, I don’t believe it’s really in the doctor’s hands. I mean, I know we do everything we can, but at some point, but it’s much higher than us and things will go the way they are going to go. But Dr. Do the best that they can.

Michelle Atwood (41m 1s):
But he, they came in and he was, he told me about the patients that he saw and the great outcomes that he’s had. And I just felt really comfortable. And he warned me. Thankfully about what after surgery was going to look like, because that’s what you can not be prepared for all the tubes and the swelling and your kid doesn’t look like a baby anymore. And it’s an awful thing. It will look like some kind of a freakish Halloween.

Dr. Anthony Orsini (41m 34s):
So tubes or coming Out everywhere, there’s lines there. So Lucas comes home, but on his due date are basically so wow. What a great story that is. I mean, think, thank God it, it worked out, but I, I can’t imagine what you went through a second time, but you have been through the ringer to say the least and unimaginable pain, bad obstacles to go through with health care of your children. And many people would say, I never want to see another doctor again, and I never want to enter hospital again, but you did something quite differently.

Dr. Anthony Orsini (42m 18s):
What you decide that you want to go out and help people. And so how do you go from those two really horrible experiences? And Thankfully look, he is doing well.

Michelle Atwood (42m 28s):
Yes, he’s doing great. 15 years old and Jacob and I do what Jacob is almost 13. So two very healthy boys that enjoy life and are very active in, which is a good thing.

Dr. Anthony Orsini (42m 38s):
So Now you have a conversation with yourself. You say, Michelle do I want to do that?

Michelle Atwood (42m 43s):
And with a therapist as well. So After Jake between Lucas and Jacob. I was okay. It seemed like everything was fine and there’s about two years difference. But when Jacob came along, I started really going through the stages of grief that had a perfect life. I lived in a perfect home. I had a great husband, two beautiful children, and yet there was this sadness and I thought, what is going on? Why can’t I just be happy? I should be happy. I have everything I could want and everything I never thought was possible. And why can’t I be happy? So those are seeing a therapist and part of the, a therapy was really looking for, and she would say, well, we have to look at this.

Michelle Atwood (43m 24s):
And so I would look at things and I would say, it doesn’t make any sense. None of this makes any sense. I don’t understand. And she says, well, have you found you again then? Because I had been seen as a single mom working and everything and used to be doing my own thing. And I was a stay at home mom at that point. And she goes, well, what do you do? That’s just for you. And the answer was absolutely nothing at all. It’s really hard to be a stay at home mom. So shout out to all of the, stay at home moms that are out there finding their way, especially after maybe you’ve had a very successful career. It’s very challenging. So my therapist said, well, you’ve got to do something that’s just for you. And I thought, well, I want to learn about this brain tumor thing. How did this happen? And it was such a shock to me. And how did I not know it was the mom guilt?

Michelle Atwood (44m 6s):
Or why didn’t you realized something was wrong, six or seven months sooner, you could have done something better. So I go over to UCF and it was great. I said, I would like to be a non-degree seeking student. And I just want to take this class on neurobiology. And it’s a junior level course. And the reason I had to be non-degree seeking as I didn’t have a medical or a pre-med or any of the prerequisites needed, and they wouldn’t let me take the course. And I said, well, I’m not degree-seeking. I just, just wanna sit in and find out what this is all about. And I said, well, okay. And I did great. And I really enjoyed the course. And so I thought, well, this is neat. I’ll take another course or too. And so I started taking these courses and found a lot of Information.

Michelle Atwood (44m 47s):
So you guys learn a lot in medical school. So I am like, well, this explains everything. I can see exactly all the things they should have done. And I kept taking the classes, I got to be in a lab. I got to see brains and pathology. And it was really exciting. And at some point along the way, one of my professor said, well, your here with all of these pre-med students, what school are you planning on going too? And I says, Oh no, I’m just not going into medicine. So I’m not going to be doing that. And he said, well, you really need to do that. And luckily, everybody knows Dr. Sam Because. He teaches over at UCF and everyone has to get through his anatomy course in order to become a doctor. And everyone knows that.

Michelle Atwood (45m 27s):
So he really encouraged me. He said, you should do it. And I said, I have two little kids at home. And with my tragic loss, I didn’t want to waste time. I did. There was not enough time to spend with them anyway. So I was only taking a couple of a class two days a week when they were in school. So I didn’t want to waste their time. But as they were getting older, they were going to day school, a couple, two or three days a week, and I would go to school. And so I’m part-time and no one’s part time. Pre-med everybody knows when you are. Pre-med. If I wouldn’t say that to me, how are you doing this part time? And I say, well, if it works out and if it does, and I’ve learned a lot, so I just kept going. And at some point, the banker in me says, is this financially worth the time and effort you’re putting in.

Michelle Atwood (46m 10s):
And you’re about to spend a lot of money. And I said, okay. And so I had to sit down and make the spreadsheet. And I decided the best thing for me to do was take the courses that can get me a job in health care that I can find out. So I started volunteering. That was a Pat and those doctors were like, you should do it. You are missing nothing, but it was an outpatient clinic. And there wasn’t anything terribly tragic going on most of the day. And so I said, I’ll go be a scribe at an ER. And if I can take that blood on, probably could do. Okay. And it was bloody. And there were people coming in there with all kinds of situations. And I was so happy and I realized that the reason I was so miserable and the bank it’s, I had gotten used to the level of urgency that was possible in that environment.

Michelle Atwood (47m 0s):
And also knowing what to do, seeing this situation, handling this situation that I got used to it. I really got used to the flow of a hospital, the beeping, the everything. And I missed it when I was not in a hospital, but I didn’t want to be sick anymore. I didn’t want to have a sick child. I just wanted it to be there. And I was going to do it no matter what. So when I interviewed for the PA program and one of the doctors that I was interviewing me so well, you already are a very successful person. You have this career, or you have these children in obviously doing well in your personal life. Why would you come and do this? Why would you put yourself through what you’re going to go through to get this degree? And I say, well, here’s the thing I’m gonna do it.

Michelle Atwood (47m 41s):
Whether or not I have a degree or not, and I will volunteer forever, but I am going to be helping people one way or another, and I’m going to do it, whether I’m getting paid or not, because I’m okay with that. I can do it for free, but this is what I’m going to do. And that was a sufficient enough answer. And my interview, well, there were a whole bunch of other questions, but that was, I think the one that really made me decide right then and there, that whether I got into that school or not, I was going to continue helping people. And I had already been doing all of the things I had done fundraisers in for the national children, cancer society for a March of dimes, for a brain tumor center, for all kinds of fundraisers. But this was where I want it to be. I was going to be helping one way or another.

Dr. Anthony Orsini (48m 22s):
That’s fantastic. So you can get your PA degree. We are running at a time. So I want to get some real good advice that you get your PA degree. And now your PA in treating congestive heart failure, cardiac adults. And as I said, in my intro, a few people have the experience that you have of that can really help your patients for the physician. The nurse is the PAs and NPS nurse practitioners, all the people out there that treat patients. And many of us don’t have the experience that you have, and not as much more fortunate than you are. We, most people haven’t had the experience of losing a child. How do you use that? In what advice can you give to people after you’ve had all these conversations good and bad is a great experience at Duke other experiences, not so much.

Dr. Anthony Orsini (49m 11s):
How do you use that? Michelle if at all, while you take care of your patients, how do you think it’s impacted you?

Michelle Atwood (49m 16s):
I look at every single patient and family as if it were me and my daughter or me and my son. And I think about where they are in the process. So some of them are newly diagnosed, so it’s a brand new, fresh there, scared to death, and they just need someone to let them know what the road looks like. Some of them have been at it a while and they’re tired of fighting, or they’re really used to how things are going, but they’re kind of scared about what the future looks like. And I want them to understand what those outcomes can look like. And then I’m there, I’m a fighter with them. And then I’m also there end stage. And I help a lot of patients and their families understand that we’ve come to the point where I am doing everything I can in.

Michelle Atwood (49m 57s):
You’ve done everything you can. look at the outcome that’s happening now is we need to prepare for the next stage. And that is where I try to really let them know that it’s okay to stop fighting because children will try to make their parents stay in fight longer. And it’s really hard for the parents because they don’t want to let their kids down. And husbands don’t want to let their wives down. And they feel like its a losing battle that I try to help them understand that accepting this is necessary. It’s going to happen to all of us. We’re all on this journey. None of us are getting out of here and some of us are closer than others. But the most important thing is, is that we all have to live every single day.

Michelle Atwood (50m 42s):
The best we can so that we can move forward and have a life that we can say was worth living. And that we are with the people that we love and we care about. And we have a little bit of control at the end over what we do.

Dr. Anthony Orsini (50m 59s):
That’s just so beautifully put and I wish this were a video podcast. We can see your face because there’s so much authenticity to your facial expressions in whether you choose to share your journey with your patient or not. When you speak about the decisions that need to be made in the journey. And just when you speak about allowing people to have permission, your face really says it all Michelle, you can see there is some genuine credibility to what you’re saying and your tone of your voice and through this really difficult journey of yours and that’s a true gift that ends up for your patients. And that’s why we said in the intro, how it was really a fan and I’m really in awe of where you’ve come from to where you are now and your patience through your going to school for PA at withtwo children after all of that, your patients are really the ones that are really getting the benefit of that.

Dr. Anthony Orsini (52m 1s):
And so that’s really just incredible. This has been an inspiring story. Michelle is now going to be working with me. It just so everybody knows and the breaking bad news program. And she will be teaching physicians in healthcare providers alongside of me, teaching them from both the patient family point of view, but also from the doctor PA point of view. And that is a gift that she was going to be giving to all these doctors that we train. I’m really privileged and honored that you have chosen to work with me and honor that you have agreed to tell your story today that you have shared with me before that this is a difficult time of year for you as many people with a loss.

Dr. Anthony Orsini (52m 44s):
And I want it to be sensitive to that. And I appreciate that you are willing to tell your story for the benefit of my audience and for any other patients, family members that are out there going through the losses. So this has been an amazing hour and I just want to thank you so much for being on this episode and really do. Is there anything you want to say before we close out,

Michelle Atwood (53m 9s):
Be safe over the holidays and enjoy the time with your family? Even the things that are awkward end up being the fondest memories that you miss.

Dr. Anthony Orsini (53m 17s):
Thank you, Michelle so much. We really appreciate having you on. If you like this podcast, please go ahead and hit subscribe to tell your family and friends about the podcast. Go ahead and download all the previous episodes if you want to get in touch with me. You can reach me at the Orsini Way.com and we are going to be here at each and every Tuesday. So hit subscribe. Now, Michelle, thank you so much. I hope to see you real soon and I’ll be praying for you during the holidays and enjoy.

Michelle Atwood (53m 40s):
Yeah. Well thank you Tony and you as well. Thank you.

Dr. Anthony Orsini (53m 44s):
Well, before we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician and I want to thank the Finley project for being such an amazing organization, please, everyone who’s listening to this episode, go ahead and visit the Finley project.org. See The amazing things they are doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So the find out more go to the Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (54m 15s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr Orsini and his team, or to suggest guest’s for a future podcast, visit us at The Orsini Way.com.

Healthcare Leadership During COVID with Anthony Viceroy

Anthony Viceroy (1s):
What we found to be the most effective form of getting through those dark days was over communication. And I can’t stress that. It, it seems so simple. And so if someone says now, how did you get through a pandemic? And they want this magic formula there wasn’t one. But my every day we would talk to the whole organization, whatever we heard, good or bad we share. And I think that was important to build up credibility and to build up again that trust. And you know, whether it was a difficult conversation or if they was a little bit better, we had to share it, right? Every one was in this together and everyone needed it to appreciate what was going on, what would be expected of them and how the plans will change.

Announcer (51s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of the Orsini Way, As a frequent keynote speaker and author Dr Orsini has been training health care professionals and business leaders, how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor are faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Orsini (1m 36s):
I am honored today that the Orsini Way has partnered with the Finley project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician. The Finley project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder Noelle Moore who sweet daughter Finley died in 2013, it was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home, that led to start the Finley project. The Finley project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Orsini (2m 20s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement. The Finley project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to the Finley project.org. The Finley project believes that no family should walk out of the hospital without support. Well welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician this is Dr.

Dr. Orsini (3m 1s):
Anthony Orsini and I will be your host again this week. You know, with the COVID crisis, it’s really affected everyone, but especially those of us in the health care organization, those of us had to provide quality care, really under incredible circumstances. The best organizations have learned how to adapt, adjust, and survive the things that are just they’re just different now. And as a physician, I’ve never experienced this before. Hospital and healthcare executives have had to make some very tough decisions that are along with those decisions, come some very tough conversations. So today I have is a guest, someone with a proven record, whose going to talk about how health care organizations adapted to this crisis.

Dr. Orsini (3m 43s):
So in 2015, Anthony Viceroy has been the chief executive officer of Westmed medical group and award-winning multi-specialty outpatient organization comprised of 500 physicians and advanced care providers, and more than 1500 employees throughout Westchester County, New York and Fairfield County in Connecticut. As one of 548 accountable care organizations in the United States Westmed has earned a national reputation for its focus on improving the quality of care for patients while reducing unnecessary costs in the health care system. And we’re going to talk a little bit about that today? According to the CMS, Westmed has ranked within the top 6% nationally for total savings generated compared to the benchmark and has achieved savings consistently in each year.

Dr. Orsini (4m 31s):
In addition to his focus on maintaining excellence and quality initiatives, Mr. Viceroy has also championed enhancements to the Westmed patient experience and has led the group to achieve an impressive 95 percentile ranking for overall patient satisfaction. Westmed is on repeat the industry recognition as one of the best work places in the country by fortune magazine, under Mr. Viceroy’s Leadership, And we’re going to talk a little more about that. I can’t wait to actually talk about that. Mr. Viceroy received his MBA in global management and corporate finance from Fordham university and his BBA in public accounting, my Iona college. He holds an executive certificate from Cornell university in Healthcare Leadership. He is a CPA and a chartered global management accounts.

Dr. Orsini (5m 14s):
In addition to his work at Westmed Anthony Viceroy is a member of the board of advisors for a New York medical college, and started as a member of the board of directors of the West Chester County associates. He’s also a member of the board of trustees at Manhattanville college in Harrison in New York. And that was quite a long introduction, but Anthony thank you so much for joining us today.

Anthony Viceroy (5m 34s):
Thank You Tony I’m happy to be here.

Dr. Orsini (5m 36s):
you know, we met through a mutual friend, my cousin and we spoke on the phone a month ago and two guy’s name Anthony I guess we just hit it off. So it was really exciting to get to know you. And the more I learned about your work and about Westmed the more excited I get, because I know we’re going to learn a lot from you today, but before we get into that, I always like to start the same way. Who’s Anthony Viceroy how did you get here today? Tell us a little bit about yourselves and learn about you.

Anthony Viceroy (6m 7s):
That I’m still trying to discover who Anthony Viceroy is. I think I’m a self-proclaimed workaholic. I love what I do, and I’m very fortunate to be doing what I do, especially as we’ve seen throughout this global pandemic. It’s just how important, you know, health care truly is. My background is extremely out of the ordinary. I would say I spent probably about two weeks in the morning coming out of college and realized that, that it was something that I didn’t have a great passion for. I had moved over to the corporate tax and spent a number of years doing both domestic and international tax, four, three of the Large, s accounting firms and did a brief stint do in some management consulting.

Anthony Viceroy (6m 52s):
And then I ended up at Novo. Nordisk’s a Danish by a pharmaceutical company where it was there for five years, working my way through to become a treasurer of North America. And after Novo Nordisk had a great opportunity to join Omnicom Group, which was a fortune 200 global marketing and communications company. It was there for 10 years. That’s where I got to meet our mutual friend, James and probably the first six years I was in corporate roles, had a portfolio of agencies kind of, you know, under me or working closely with the CEO’s and CFO’s at those organizations. The last two was really doing much more on the client side.

Anthony Viceroy (7m 37s):
If you think back to 2007, 2008, there was a lot of focus around reducing costs in marketing spend, especially for these large brands for large organizations. So my role was really to kind of be as, you know, work effectively as part of the team to drive greater value or demonstrate that value to the Proctor and Gamble’s, at HBS of the world. And then in 2009, I ended up joining one of the agencies, ordering a belly as initially I came in as a global CFO, and then we moved into a global president of the organization. And then in 2012, I had an opportunity to join Westmed medical group. And even though I had a biopharmaceutical experience, so I have no real healthcare background and I thought it, it was definitely a great industry at that time.

Anthony Viceroy (8m 27s):
It was probably 17% of GDP. You knew that health care was just on the verge of doing something special. It needed to kind of progress. Most of what was in health care was the old model as it was a good to be more focused around delivering care in a more efficient manner and, and core structure. I thought this was a great opportunity to kinda get in and, you know, learn a new industry, but also be part of change, which I thought would have been exciting. So I’ve been fortunate that, you know, for the last eight years I’ve been part of such a wonderful organization and just a lot of great physicians, nurses, front desk managers.

Anthony Viceroy (9m 7s):
I mean, really everyone is just outstanding and really have shown who they are, especially during this global pandemic in this crisis when we mentioned the front line, your roles. And, you know, although we are not a hospital, we are in an outpatient facility still when you’re going through COVID patients that are coming in and wanting to be tested, not sure if they have it, but showing a lot of symptoms, it takes a tremendous amount of resolve to not to come in here every single day in deliver the highest possible care that you can, the, the, the most extreme, or at least on my lifetime of circumstances that anyone has ever seen. So, you know, it’s definitely been a great learning experience.

Anthony Viceroy (9m 47s):
And like I said, I was just very fortunate to be in this position.

Dr. Orsini (9m 51s):
So I’m going to jump right into it. We’re going to talk about COVID in a second, but when I’m reading about Westmed and I was reading about you and I’m looking at what you’ve accomplished there. So you’re an accountable care organization, which means that you really focus on cost reduction for people out there that don’t know what that is. Maybe you can, Mentioned talk more about that. So you’re in the top 6% nationally for total savings generated during the 95 percentile in patient experience. And you, one of the best at the fortune magazine named is one of the best work places in the country in health care. There are many people Anthony that would say that you can not have all three of those.

Dr. Orsini (10m 32s):
That to save money to have that kind of higher patient satisfaction and that kind of employee engagement would be a pipe dream. And yet you were able to do that. How did you pull that off? I personally believe they’re all tied together. You don’t see that trifecta.

Anthony Viceroy (10m 47s):
You know what I’ll say is this, I mean, every day you work at it, right? I mean, nothing, you know, are, is as simple as you know, and it isn’t one person or even a small team. It really is an organization that has to be committed to delivering this type of care at this type of satisfaction every single day. And you know, in our market in New York and Connecticut, you know, to the very hyper competitive market, large health systems, you know, technology companies looking to be disruptive. So I think it’s important that we always have to balance kind of the needs of all the key stakeholders always look for ways to improve each and every day.

Anthony Viceroy (11m 30s):
And I think when you bring that level of a mindset and you surround yourself with a very talented people, you’ll be surprised when you’re able to accomplish. You know, there are days where I feel like we move may be a little bit better on, in one direction than the other, but I think that’s how you need to, to balance your organization and balanced the business. It’s hard to be great at everything. And there’s a lot of organizations that celebrate not being great in some in areas because they are very great in other areas and that’s their brand, but when you’re delivering care or as you can appreciate why you can’t make that distinction have what’s important and what isn’t. And I think today we had, when I entered back in 2012, it really wasn’t about patient experience.

Anthony Viceroy (12m 14s):
So it was really just starting to get formulated. It was still a much more of a physician driven practice. And my personal belief is that, you know, we probably have shifted a little bit too much now. So the other extreme where I think physicians are often forgotten about in this equation and they have such a very important part of making sure that care it gets delivered effectively. So what we try to do was make our physicians feel valued and an important a part of the solutions, but we also have to appreciate that in the eight years, since I joined the world has changed and moved into a very digital platform, access and convenience and experience is the future of health care.

Anthony Viceroy (12m 58s):
And you have to be able to anticipate what your patient who is also a consumer now purchasing Healthcare what their needs are and what they want. And then how do you build that into a culture that has to be continuously look to perform at a very high standard? So, you know, its about recruiting. I think the right people initially I’m very much a big believer in talent, but also in shared beliefs. I’ve seen a lot of talent that people who come in to the system, but if they don’t believe what you believe culturally, it just doesn’t fit. So I think it’s important that you have shared beliefs and everyone kind of buys into what we’re trying to accomplish here.

Anthony Viceroy (13m 40s):
Then you have to just everyday work at it. And I think, you know, part of why I love what you’re doing in particular is now a Difficult Conversations are important conversations. And the more of that you have these compensations, they become less Difficult, but more importantly, when you start to build trust, build relationships. And that’s how I think they were able to accomplish a lot more when there is mistrust and a lack of relationships, you’re not going to be able to move as quickly as you need to move. And especially today when we talk about agility, but it is so important to be able to move rapidly because you know, otherwise you’re just left behind.

Dr. Orsini (14m 21s):
You know, you said trust and relationship, but I can tell you, this is probably about the 25th, 28th episode that I’m recording right now. And I don’t think it’s an exaggeration at a 20 or 22 of those episodes. Those two words came up and we know whether we’re talking business, whether we’re talking doctor, patient relationship and employee leader relationship, it is all about trust. So we dropped Stephen Covey’s, Episode just recently the speed of trust. And that was just a great episode, but they are really inerlaced. I’m not sure a lot of people understand that. So patient experience, which I’m so passionate about as you know, it clearly effects clinical outcomes.

Dr. Orsini (15m 3s):
So you are providing good care. If you are providing patient experience and you can’t provide good care If you have unhappy nurses, unhappy doctors and unhappy receptionists. You know, I often wonder sometimes when I go to a doctor’s office, does the doctor ever call his own office? Does he realize how has the phone as being, you know, the name of my book, it’s all in the Delivery. It’s like what I tell a story in my book about, I called a cardiologist or maybe it’s in my workshop. I called a cardiologist for an appointment and the cardiologist’s that the receptionist so that they don’t have anybody for any appointments for four weeks. And I said, I don’t really like to do this, but does it help them have a doctor? You know, maybe, you know, I’m a doctor at this hospital and she said, I will never forget this.

Dr. Orsini (15m 46s):
She said nope. And I said, OK. So I hung up the phone, I called another group and she didn’t have an appointment for four weeks either. But she said, you know what, doctor, let me see what I can do. She got on the phone for 30 seconds later. And she said, I really tried. I just can’t. And I appreciate that. And I felt so much nicer about her. And there’s a difference between just having it, a happy employee and another employee. Who’s not so happy. So the top 80, I think he was 69% of all hospital executives and leaders have named patient experience and their top three priorities for the year or 2018.

Dr. Orsini (16m 26s):
I believe it was Yet very few or If while some of them have, but most of them have not really put the resources into improving patient experience, but it sounds like Westmed has, I think he used some outside organizations to help you and just place that emphasis on everybody. How important do you think that whole thing is to the success of Westmed?

Anthony Viceroy (16m 46s):
I think its vital. I think it’s a, unfortunately were not in an evil war atmosphere anymore. Right? So you have to do a very good job of engaging physicians. And I keep going back to, you have to have physicians be part of the solutions as Healthcare has so many issues. Yeah. I look around at other organizations and you know, physicians are used much more interchangeably, you know, a much more salary type of not only model, but also just to have a mindset. We don’t have that. Right. We want our physicians to feel like they’re very much engaged. They are owners of the business and every which way, but you have to also nurture that relationship.

Anthony Viceroy (17m 29s):
So we do things like I have monthly dinners pre COVID, but will bring, you know, where a large multi-specialty practice or will bring 15 to 20 different physicians out once a month. Then we share ideas. I explain on a macro level of what is going on and the industry kind of what direction we’re going in as an organization. And then on a micro level, kind of what it is now, what’s really going on inside the clinics and you know, what’s working, what isn’t working? What, what they liked to see happen. And I think exchanging that type of information back to the trust and relationship goes a long way. It also really highlights what’s wrong in the company. How quickly can you fix it?

Anthony Viceroy (18m 10s):
Going back to the speed being so imperative. And then I think there’s other things that we do. We know that we’ve been having, a burnout series now where we were trying to create more wellness for our physicians and trying to balance, how do you deliver a high level of care with a large patient panel, but not get burnt out. And its interesting, you know what my experience has been surgeon’s never burn out, but primary care will tend to feel the pain. And this is, you know, as access is even more important, more patients want to get in that level of burnout starts to become even more important. So we’re very cognizant of that and we try to balance it out and work with our physicians, whether it’s on their panel size, but just some of their mental wellbeing.

Anthony Viceroy (18m 57s):
I mean we’ve offered even through COVID, you know, our behavioral health services internally to both physicians and employees to have a resource in order to kind of work through these issues. We do a lot around career planning and leadership training and things like that. So we, again, we don’t assume that everyone knows how to do things. And then, you know, on the other side of the day, so that’s one of the Physician in an employee side on the patient experience side. It’s just something that we work at every single day. I know there’s so many great programs out there, but if you really think about it, it really comes down to how do you wanna be treated? And if you treat your patients the way you wanna be treated, if you were going somewhere else, I mean, that’s really the basic success of a patient experience.

Anthony Viceroy (19m 45s):
We are at the 95th percentile overall, which were very proud of it. But I think what I’m even more proud of is our physicians who are at the 97 percentile. You know, so again, that relationship between physicians and patients, it’s just so vital and to affirm that our patients really see value in what our physicians are doing and truly appreciate the physician relationship is important. We want to celebrate them and we want to continue that. Then we moved over to This NPS now. So what we were using the press ganey for those in health care, in the press Ganey, but, but even our NPS four is 87, which for a net promoter score, it’s a very high numbers as well.

Anthony Viceroy (20m 25s):
So it was just something that we were always very cognizant of it and we appreciate, we have to continuously work to be the best that we can be. It’s not, I think a lot of organizations roll that out because it’s an imperative and you know, we kind of check the box that you did this, but then the following year, you’re onto another initiative and you’re not giving it the right level of love and maturity and looking to go to 2.0 or 3.0 every single year, how do we improve upon where we’re at? And you know, we’re mindful of that. So we very much are working to keep building upon the success that we’ve had and you know, we’ve gotten great national recognition because of it.

Anthony Viceroy (21m 7s):
We were presenters at the Cleveland clinic patient experience summit. So again, like I think that’s just a testament to the organization and everyone who worked so hard around building these programs and making sure that they, they stick and then we keep building it, you know, year over year to make it work.

Dr. Orsini (21m 22s):
I have a lot of physicians right now that are listening to this interview and I know exactly what they’re saying as your speaking, he gets us. That’s what they’re saying right now because you do get us the way to make a physician happy is to give him or her independence, give him a, her the autonomy, show them that they are appreciated. We all wanna help people. That’s what we went into medicine at the first place. I’m a firm believer that there is a very small percentage of people that went into the health care for the money. If you did, there’s better ways of making it to be honest with you, but you get it. And so what happens is it sounds like you understand what makes we as physicians and nurses and people tick.

Dr. Orsini (22m 4s):
What makes us happy. When we’re happy our patients are happy. What are our patients are happy? We have good patient satisfaction scores, and then you have great employees best workplaces have les turn over. So it doesn’t seem that hard Anthony but you have been able to nail it. And a lot of people have not. So I wanna thank you for that. To me, that’s clear that as you’re speaking, why are you Westmed has been so successful and so having said that, Anthony, Mr. Viceroy, let’s move in to Covid because that’s really what this is about. As I mentioned before and other episodes, when I’ve spoken to other leaders, the general public looks out on T V during the COVID crisis, especially March, April, May they see rightly so doctors and nurses who are just exhausted beyond the brink sadness everywhere.

Dr. Orsini (22m 53s):
And we hear about hospitals being full, but the reality is very different behind the scenes, right? I mean, we stopped elective surgeries, we’ve stopped elective procedures. And most of the time, although the hospitals may have had a big group of patients with Covid, many of them are empty. And as a primary care provider, you may have been swarmed with COVID patients, but the average routine checkup, people are staying away. Most hospitals have had to make some very difficult decisions, furloughing nurses, moving people around doctors, who’ve had to take big cuts in pay. I know, especially in the anesthesia group, but other primary care.

Dr. Orsini (23m 35s):
So now that you’re trying to navigate this as the CEO of Westmed tell us about the difficult decisions you have to make and the Difficult Conversations that you, you had to go through it for those.

Anthony Viceroy (23m 47s):
Sure. I mean, I think in hindsight, now you can start and you can appreciate all that went into it, but you know, candidly, I know we just went forward. I mean, it wasn’t even real a lot of time to think Tony, I mean, it was, we started planning for this, my executive team probably, but the very end of February, as they really started to see that, you know, it wasn’t just for a very bad shape. It was, it was coming, you know, we have all of our policies and our protocols around how to deal with disasters. No one had anything for this.

Anthony Viceroy (24m 28s):
And every day you’re hearing so much news that is just devastating and you’re trying to figure out how to handle this. So the first thing that I did very quickly on was I shore up our finance. And so I kind of felt like, you know, the capital markets or go to be a little crazy for the short term and maybe access to capital will be a bit of a challenge. And especially if patients who are, when I’m going to be receiving care and how would you keep the doors open? So I immediately leveraged us all to be able to secure enough cash flow to get through a year. We’ve been very fortunate and we were financially at a very disciplined organization. So my debt is virtually nothing, I was able to take advantage of very early on.

Anthony Viceroy (25m 11s):
And I talked to others in the industry and that kind of waited until April. And at that point it was much harder in order for these banks to kind of, of land and the amounts. So they would give out with just as much less. So we move very quickly to shore up our finances. And then what I realized very quickly is we had a, a, a PPP problem, a PPE problem by we couldn’t get the right information. I mean, every single day, what we heard from the department of health, when we heard from the CDC was conflicting. If it was changing every hour, you know, give a mask, don’t give a mask. As long as the doctors wear a mask the patients doesn’t have to wear a mask, not the doctor and this went on every single day,

Dr. Orsini (25m 53s):
Level one mask, level, two level one, the next day, level three. It was crazy.

Anthony Viceroy (25m 59s):
it was insane. And And after maybe two or three days of this team together and just said, we’re masking everyone. You know, we don’t know anything about this virus other than what we’ve been hearing people dying in Europe, its now here, there is a community spread and you have to assume that it’s going to be highly contagious. And even if wearing a mask, doesn’t stop this virus. There is a part of just confidence of having the mask. They do feel a little bit less, right? Whether it’s a patient or an employee who is on the frontlines.

Anthony Viceroy (26m 39s):
So we started asking everyone and when we did that, I realized that our PPE volume was going to be a matter of days out. So we were very fortunate. I think like many we have to navigate all of the back channels in order to get inventory. There was no water, no 3m N95 masks to be found anywhere. So we just took a large shipment of KN95 masks is probably enough for, you know, years worth of, of a mess. So that way I would insure that all of my staff, all of our patients would be master and try to protect them as much as we call it. We then move very quickly to set up protocol’s as far as visits, we, I think got about, we were already on tele-health, but not leveraging much of the utilization was still a relatively low or within 48 hours.

Anthony Viceroy (27m 32s):
Every one was up and trained on virtual visits. And you know, we tried to take car as many patients, you have some that had non COVID medical conditions that were afraid to go to the hospital and all those that just said, how do I think I was in touch with someone who has it? And how do I know if I have it? It just really just patient education. We were dealing with a lot to that virtually and you know, what we found to be the most effective form of getting through those dark days was over communication. And I can’t stress that. It, it seems so simple. And you don’t know if someone says now, how did you get through a pandemic?

Anthony Viceroy (28m 13s):
And they want this magic formula. There wasn’t one. But every day we would talk to the whole organization, whatever we heard, good or bad we shared. And I think that was important to build up credibility and to build up again that trust. And you know, whether it was a difficult conversation or today was a little bit better. We had a share it, right? Every one was in this together. Everyone needed to appreciate what was going on, what would be expected of them and how the plans will change. And we’re not going to be married to any specific plan. The virus will disrupt your strategy and that’s the message I kept giving them.

Anthony Viceroy (28m 56s):
So we have to try to anticipate what’s going to happen. So we’re playing both offense and defense at the same time. And I appreciate that because its complexities and ambiguity, but we have to manage that. And if we work together, we will get through it. And it was hard. I mean we had to furlough some staff to the patients weren’t coming in, governor Cuomo in New York, as well as the whole tri-state area. Governor sent me, they shut everything down, but we weathered through the storm. And I think having those conversations was just so important in making sure everyone was all painted, we would say on the phone. And so every question was answered even if some of the questions started to become repetitive because we go on the phone for so long, it was important for every single person at WESTMED to feel like they were heard.

Anthony Viceroy (29m 45s):
We heard them and we are going to give you the best answer that we can possibly give. And then in those times where we didn’t have an answer, we say, we don’t have an answer. And once we do, we will come back to you. And I think that really want a long way. I think the other thing too was when you had the level of media, that was your sharing, a tremendous amount of bad news every day. Number of body bags, outside of Manhattan, hospitals, and things like that. It’s very hard to get, to wake up and be motivated to say, I want to come to work in and do this. I mean, it, it was fear or there was just a complete exhaustion that it was, you know, so many different emotions.

Anthony Viceroy (30m 28s):
You know, we try not to tell everyone, you know, I understand how bad it seems like it’s going to get better. We have to believe that. You know, I, I think, although you can say hope is not a strategy when you’re in the middle of a global pandemic and everyday seems worse than the day before I think hope and having a reassuring message is so important because your mental outlook and how will you going to tackle this giant taskin front of you is very challenging. So as best as we were able to do without being too optimistic, but with being cautiously optimistic that we will be to get through this, it kind of worked out because once the middle of may came about things started to lighten up a little bit.

Anthony Viceroy (31m 14s):
And once we got into June and definitely into July, I mean our demand patient volume was probably a 140 plus percent. Yet we still we’re at a 95% capacity because we didn’t want to disrupt the protocols that we had put in place. You know, the virtual waiting rooms, things like that. It was still in the community, not as bad as it was in March and April, but we never want to let our guard down with this virus. That’s the message that you’ve been not as of last week when we were talking to our entire organization, you can’t be asleep at the wheel. So to speak with this virus because it gets out of control back with us,

Dr. Orsini (31m 54s):
It sounds like the immunization is coming soon. And then you’re gonna have a whole issue. You are going to have to deal with that on how to give out the immunizations. That will be good news. The important words that keep coming up, communication, trust relationships. And you know, it’s been said by many leaders, people will do things to help the organization and they will follow the rules. As long as you provide the Y you know, in my experience, the Y is what is missing often when people hand down rules, as I said it in other episodes. And especially when you’re dealing with doctors, you probably even dealing with doctors as long enough.

Dr. Orsini (32m 33s):
We don’t like to follow rules. We’re not rule followers we’re independent free minded thinking. But if you tell us something and then you’d give us the why, then we will certainly abide by those rules, you know, this podcast really came about because during COVID, you know, I’m teaching in 10 years now, I’m teaching doctors how to break bad news on teaching patient experience on teacher communication. And then all of a sudden in March or April, I get contacted through a friend two major in international companies had hundreds of employees die of COVID and asked me to train their HR people because its now for the first time ever an HR person has to call someone up and a different country to say, Tony, you know Jim, who you used to sit next to you in that cubicle for the last 20 years he died and they weren’t prepared to do that.

Dr. Orsini (33m 28s):
And this podcast came about because I started to realize more and more if you know how to communicate, if you know how to give bad news to a patient or a family member than having those difficult conversations with employees where you have to furlough where God forbid you are telling them about their workmates, who just died from COVID. So COVID is changing everything. And really, I would say if it weren’t for Covid it wouldn’t be doing this because of the whole concept of this podcast is it doesn’t matter whether you’re in business. Does it matter whether you are in health care? If you can learn to communicate my goodness, that’s it, it sounds like the reason why you have such a good employee there and you’ve navigated through this is that you provided the why as much as you knew.

Anthony Viceroy (34m 7s):
I mean, I think I’ve been fortunate enough to be a follower of a Simon Sinek so yeah. So understanding the why and where that fits in the overall communication strategy is a very important, but again, it’s the, over-communicating the why I realized a long time ago. Tony it’s not what you say is what someone hears. And a lot of time, when you asked a question and you’ll also get an answer and you say, you know, there are any questions or do you guys are great? How many times no one says anything. You know, most people say, Oh, okay. They all agree with what I’m saying. And that’s not.

Anthony Viceroy (34m 48s):
My experience has been, that is not the case. Silence does not necessarily equate to an agreement. It just means that I don’t want to be disruptive and an audience to tell you that I disagree with him. And so we try to figure out, especially during this COVID crisis, you know, what are the multiple ways in multiple channels so that we can try to get this message across, but also try to look for those signs where it is and then how do we have a level of comfort? So if there are questions or even a disagreement, you know, we can bring that to the forefront sooner. I said, I wish I had all the answers. I clearly do not. So if anyone has better suggestions, this is the right time, the right place to be able to have these types of conversations.

Anthony Viceroy (35m 31s):
But here’s what I think is the right thing. Here’s why I think it is right. And if it turns out tomorrow that it isn’t right, we’ll certainly now pivot accordingly. And I think that just builds a lot of trust in the system. Plus the truth as we were all in this for the first time it was a world. It wasn’t even as Westmed, it wasn’t even as the U S and it was, you know, it was a global pandemic. And so in many ways, no one had the answers. And I think that is allows us to kind of come together because it wasn’t, I disagree with you. It’s like, I don’t know. So we’ll follow you until we see that, you know, what’s not working. And the first wave of this virus, luckily it, as far as now, you know, being in New York where clearly into the second wave of this virus, and we’re starting to have these communications again with our employees, we’re doing a tremendous amount of patient outreach.

Anthony Viceroy (36m 25s):
So that way they will understand what to expect. I mean, it’s sad to say this after everything that everyone has been through, when there is so much COVID fatigue, as we enter the second wave of this virus, you know, there still isn’t enough testing. And you know, my ability to want to test every single patient who needs a test is very limited. So, you know, its not just the treatment of patient care, it’s going to be the communication of how, you know, when should you come in for the test I know that with the holidays coming up Thanksgiving next week, every one who wants to go to their aunt and uncle’s house for the holidays wants to come in and get a test.

Anthony Viceroy (37m 8s):
I don’t have enough tests on fortunately to be able to do that. So I can only really test symptomatic people who are like a rule out flu and strep throat and, and then sit down and say, okay, test for COVID now? So hopefully it will have more tests and in the near future, but I would have thought after this first wave, that would have been something that we wouldn’t be having this conversation about. But I think the hospital will be unfortunately overwhelmed as well. And it was just something that is unlike first wave that we didn’t have the experience of this with the second wave we kinda know what’s comming, I think all of us in the community, are you going to be much better prepared or not to say it’s going to be easy by any stretch, but its not going to be as foreign as the first wave was were literally minute by minute, you had no idea what to expect.

Dr. Orsini (37m 59s):
New York city took such a bit hit, I’m a New Jersey person and moved down to Orlando was six years ago. In Florida.

Anthony Viceroy (38m 7s):
It took a hit to hospitals and all that. I think what we did anticipate though, is people are asking for a test because they wanna go see Aunt Edna. we had assumed that people should go for a test or when they were exposed to or when they were feeling sick. We didn’t think that I’d like to go to see and Edna for Thanksgiving. So let me go for a test or even though the number of that unbelievable amount of testing, it’s still not enough at every day. I pray for the vaccine to to come out.

Dr. Orsini (38m 38s):
I think that’s the only way we are going to finish this and get back to normal. Is Westmed still having furloughs and issues. And what are you coming back?

Anthony Viceroy (38m 49s):
Again, very fortunate. I wish I could say that it was, you know, the great execution of the strategy, but our business bounced back very quickly, but it was just a tremendous demand. We probably had about six weeks that I would say were a bit rough. But as I mentioned earlier, I think financially we short everything up. We continued to have a virtual visits. My biggest concern was that there were many patients who needed treatment or which we were tooveafraid to come out. And if they didn’t get that treatment, their chronic illness they’re, you know, the complexities of what they had was going to get worse.

Anthony Viceroy (39m 30s):
So even in a pandemic, we have to think about how we deliver a care to those patients that need it. So we’re constantly thinking about how to reinvent our own model and disrupt the whole model because this is going to be the new norm that we’re facing. But after six weeks we were really kind of back to normal where I said I had to like limit the amount of appointments just to try to keep everything safe. So from that perspective, you know, economically it’s been very well. But again, it’s just something that I think when you go through this and every one who’s experienced this firsthand with I’m sure what it is great, it’s humbling, but it also, you don’t forget it easily and going into the second wave that it’s as if March was just yesterday, even though the differences between March and April felt like a year in between those, you know, a couple of weeks, the rest of the year has been so fast moving into November.

Anthony Viceroy (40m 26s):
But now that we’re in the second wave, I feel like it was just yesterday and most darkest hours. And that is still front and center on my mind.

Dr. Orsini (40m 34s):
Do you still got PTSD? You know the word you said before, cautiously optimistic, which I think is really important because we’re trying to go through this fine line of being optimistic, telling people that they need to be concerned about this. This was serious without panic. And I know that there is a bunch of people who have died at home from strokes and heart attacks. And just last month I got a call from a friend of mine saying, please speak to my dad. He’s having chest pain. I think he’s having a heart attack, but he refused to go to the hospital because he doesn’t want to get Covid. And so it’s a fine line to walk. And I think that’s where the media sometimes needs to maybe pull back a little bit on the panic. I know he sells newspapers, but its tough to say, Hey, you need to take this really seriously, but not so seriously that you’re willing to have a heart attack and die because you’re afraid to get on Covid in the hospital.

Dr. Orsini (41m 23s):
And I think that’s been the challenge and I hope that we can come together as a country and try to understand that if as I was taught a long time ago, if you think a problem has a simple solution, then you obviously don’t know what the hell is going on. And the solution is, Oh, well everybody will wear a mask and everything. It’s just going to have to be fine or let’s lock down and everything will be fine. That’s making a very complex problem. Very simplistic. So it sounds like Westmed has been able to do that. Anthony we were running towards the end that I know your time is very valuable, but I always ask my guests the same final question. Most of them hate it. So I’m going to, I’m going to ask you, so the name of this podcast is Difficult Conversations, you’ve been an executive, you’ve been a leader.

Dr. Orsini (42m 10s):
You’re a CEO you been in health care out of health care. What type of conversation do you think now for me it’s breaking bad news, telling a patient they were dying, but in your experience, what type of conversation is the most difficult conversation that you have to have? And can you give anybody advice on how to navigate through that?

Anthony Viceroy (42m 30s):
I would say for me, the most difficult conversation to have is when you have to let someone go out and shore, most of your prior guests probably had the same thing. So it’s extremely emotional. Especially when you work closely with someone for years, you may be built a personal relationship who made like them, but you just reached a point where may be that effective in their job or it’s just not the right job for them. It doesn’t mean the not a good person is just not the right job for them. Those are really hard. And I remember one in particular that unfortunately I had a like, Oh, and I felt so horrible ’cause his child was just about ready to go to college and he was trying to pay for college and he asked me, how am I supposed to pay for my daughter’s tuition?

Anthony Viceroy (43m 21s):
And you take that home, you get to the top and you look around and you realized you’re by yourself. You have no real support system. And every decision that you will ever make impacts everyone who was under your care. And I think maybe I was a bit un prepared for that in the beginning and it was harder. But I think the best advice I can give is know there is no silver bullet, but I think just again, like everything communicate honestly, you know, tell them where they went wrong. Try to help them land another job. I mean, in this particular case. So they said, no, no, this is not the right position for you. But I actually know someone who was looking for someone who has your skills and I’m going to put the two of you together.

Anthony Viceroy (44m 6s):
And, and I think if you treat people the way you wanna be treated and you make that aspect very personal, it’s not business. I think you can take a very difficult conversation and make it a little less difficult. It’s never been to be easy. And there is such a big human element to, with no different than what you must experience telling patients about end of life conversations. There is no easy way of doing it, but it’s so important and it has to be done. So I don’t think it’s so much at times what you say is it’s how you deliver the message, which I believe is also a a hundred at the title of your book is It’s All in the Delivery. And I, and I think that it is just really so important.

Anthony Viceroy (44m 49s):
It doesn’t take the pain out of it, but it helps get you through it. And I think that you also have to understand that when you’re dealing with people, it’s much more than just the situation that you have at hand. And I’m always mindful of the fact that people have families, people have health issues. People had other issues besides of their job. So, you know, you have to at least be aware of what goes on inside of people’s lives. Treat them the way you would wanna be treated, treat them with dignity, but always be clear and nothing should ever be a surprise. So in my example, we’ve had multiple conversations before there was a performance reviews.

Anthony Viceroy (45m 31s):
You never want to surprise anyone good or bad in my opinion, right? I think business relationships are no different than any other relationship. They need to be nurtured and they need to come a long over time. So again, that’s probably the best advice I can give you. So it was a very hard and gut wrenching experience, the look of that kind of news to someone.

Dr. Orsini (45m 52s):
Yeah. And you hit the nail right on the head. That should never be a surprise. When I teach breaking bad news, we use an acronym called Program. The G is for gradual. And what I teach physician’s all the time is that by the time you give that bad news, the patient should already know it’s coming in. We use different verbal non-verbal language. And even when I interviewed James Orsini from the Sasha Group I ask them the same question. He almost gave it the same answer. You said, first of all, I think as responsible is, first of all, I should never be a surprise, but how you deliver that news, it’s all on the delivery is so important in my business. And when you deliver a tragic news, if you do it wrong, it can affect somebody for 30 years and it should not be informational.

Dr. Orsini (46m 34s):
When you get bad news, it should be relational so that you were upset about that. And he probably noticed from the tone of your voice on the way he took that, that in the end, he would appreciate that, you know, the way doctors give out discuss medical errors, as you probably know, it makes a huge difference on whether you’re going to get sued for malpractice are not. And we’ve gotten that wrong. So many times the medical errors happen. You send out a lawyer, you send it to the CEO in the hospital or the administrator. And in the end they were looking at a whole bunch of guys in suits and the messages you’re just afraid of getting sued. You sending a physician who had been trained and we do a lot of Medical error training and says, He sorry, or is she sorry?

Dr. Orsini (47m 17s):
And discuss it with them. The American bar association said you are much less likely to get sued. If that doctor does it and does it in a compassionate manner and says, you, sorry, in fact, in, I think 14 States now the word I’m sorry, it wasn’t even admissible in court. Any more patients want to hear them? Sorry. So as you said, you care and how you’d deliver it makes all the difference. I think that’s fantastic advice and it’s amazing how consistent those answers get. But I appreciate that. Well, Anthony, this has been great. I think you’ve really shed some light on the amazing things you’re doing at Westmed again, being on top of patient satisfaction top and for accountability care organizations and best workplaces.

Dr. Orsini (48m 2s):
That is a trifecta. That is very impressive. And it’s all about relationships. And I think a lot of that has to do with people on the ground, but also you, so thanks so much for being on this podcast. I really appreciate it.

Anthony Viceroy (48m 12s):
And I know thank you. Tony it was so happy to be on it. And I think, you know, congratulations to you and to keep this up because I do think this matters, you’d be surprised. A lot of people do not know how to have difficult conversations and it makes the world of difference as you’re going through difficult situations. And I applaud you for what you’re doing here. And I think a lot of people are gonna learn a lot on it. That’s what’s most important. We have to share our knowledge, Nike

Dr. Orsini (48m 40s):
Yup. Steal from each other. I say we steal from each other. So Anthony, what’s the best way. If someone wants to get in touch with you, I’m going to put all your stuff on my notes, but what’s the best way to get in touch with you?

Anthony Viceroy (48m 50s):
Yes. Through my email contact is always the best way to get in touch with me. And as I said, I’m a professional workaholic, I work seven days a week and that’s because if it’s something that I’m very passionate about.

Dr. Orsini (49m 4s):
Thanks again. If you like this podcast, please go ahead and hit the subscribe button. Go ahead and download all the previous podcasts, especially the ones that we referred two today. If you want to find out more about what we do in the training positions, patient experience and communication training, you can contact me through my website. The Orsini Way.com. Thanks again, Anthony. And really appreciate your time. I know it’s a very valuable, thank you. All right. Wel before we leave, we want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician. I don’t want to thank the Finley project for being in such an amazing organization, please. Everyone who’s listening to this episode, go ahead.

Dr. Orsini (49m 44s):
Visit the Finley project.org. See the amazing things that are doing. I’ve seen this organization literally saved the lives of mothers who lost infant. So to find out more, go to the Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (50m 1s):
If you enjoyed this podcast, please hit the subscribe and leave a comment. To contact Dr. Orsini and his team or to suggest guests for a future podcast. Visit our site at TheOrsiniWay.com.

2020-We are in this together

Announcer (2s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author, Dr Orsini has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her
team members or someone who just wants to learn to communicate better This is the podcast for you.

Dr. Anthony Orsini (47s):
Well I’m honored today that The Orsini Way has partnered with the Finley project to bring you this episode of
Difficult Conversations Lessons I learned as an ICU Physician. The Finley project is a nonprofit organization
committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It
was created by their founder. Noelle Moore who’s sweet daughter Finley died in 2013. It was at that time that
Noelle realized that there was a large gap between leaving the hospital without your baby and the time when
you get home. That led her to start the Finley project. The Finley project is the nation’s only seven part
holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they
provide such things as mental health counseling, funeral arrangements, support, grocery gift cards,
professional house cleaning, professional massage therapy, and support group placement.

Dr. Anthony Orsini (1m 41s):
The Finley project has helped hundreds of women across the country. And I can tell you that I have seen
personally how the Finley project has literally saved the lives of mothers who lost their infant. If you’re
interested in learning more or referring a family or donating to this amazing cause, please go to the Finley
project.org. The Finley project believes that no family should walk out of a hospital without support. Well,
welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. I am Dr.
Anthony Orsini and I am delighted to be here with you again this week. This can be a very difficult time of
year for many, and I don’t believe that anyone would disagree with me when I say that 2020 has been a
particularly bad year for everyone.

Dr. Anthony Orsini (2m 26s):
There seems to be sadness everywhere. The COVID-19 crisis has affected everything. Almost 2 million
people have died worldwide. And then another 65 million people affected as of this month. Hospital workers
have been overworked, overwhelmed, and businesses shut down. People across our nation have lost their
jobs and can’t pay their bills. In an often overlooked aspect of the COVID-19 crisis is the number of people
who have died from cancer or heart disease, stroke, and other illnesses because routine health care
screenings were postponed. But for many who have lost loved ones in the past, this has been a sad season
year after year.

Dr. Anthony Orsini (3m 6s):

And that’s why on this episode, I chose not to have a guest, but rather spend just a few minutes talking
about this podcast and show my gratitude to the many guests that I’ve had on and the larger audience that
has been listening each and every week. I can’t believe that it’s already my 23rd Podcast Episode. We
launched our first three episodes on August 4th of this year with two amazing guests and my introductory
podcast. And here we are in a flash of the week before Christmas, when I started the podcast, I don’t mind
telling you that it was really nervous. I thought, what if no one listens? What if I can’t find guests, what if I fall
flat on my face and just sound ridiculous.

Dr. Anthony Orsini (3m 49s):
But to my pleasant surprise, in the first two weeks of the podcast at the Apple, top 100 in medicine going as
low as number seven and the top 200 for health and wellness. Week after week, I’ve been able to somehow
convince the most amazing people to come on to share their incredible stories, inspire my audience and
share their knowledge about various Difficult Conversations. For me, this has been an awesome experience.
I get to meet people that I thought I would never get to know. And now I call them friends. And just like those
of you are listening. I learn something each and every episode. You know when I first got the idea of having
this podcast, several of my friends said to me, why are you interviewing people who weren’t in the health
care field?

Dr. Anthony Orsini (4m 36s):
My answer was that this podcast is about effective and compassionate communication. And it doesn’t matter
if you’re a physician, a nurse, a business leader, or an HR professional, or just someone who wants to
communicate better with your spouse, your child, your teenager, and even your boss. Good communication
builds trusting relationships and is the keystone to everything that we do. And so I went on a search to find
the best guests that I can find to the best of my ability. Alternate, the weeks from healthcare to business. I
started with Kathy Caprino a Forbes writer, a top 100 Podcast to herself and author of the book The most
powerful You.

Dr. Anthony Orsini (5m 19s):
Kathy shared her wisdom and coaching tips for women who want to be more empowered in business and
gave incredible tips. Kathy’s Episode has been downloaded almost 1000 times and remains the most
downloaded episode. We also heard from Marcus Engle, who shared his incredible journey of his tragic car
accident that caused him to be instantly blind and how a nursing assistant held his hand and got him through
the trauma simply by saying the words “I am here”. And together, we heard more amazing and inspiring
stories. In episode four, Noelle Moore told her inspiring story of how she tragically lost her baby at birth.

Dr. Anthony Orsini (6m 2s):
And now Noelle runs a charity, helping mothers who lost a child get through the unimaginable sadness. And
then Episode 17 Debbie Haine shares or a story of stillbirth and how she turned that around to make a
difference in how hospitals around the country handle a stillbirth babies. These are incredible stories of

tragedy and triumph. And perhaps in my favorite episode, episode 11, I interview, my niece Lauren who tells
her story of how she went from a childhood cancer survivor to a registered nurse, treating kids with cancer
all by the age of 24. These are amazing people with incredible stories of strength, resilience, and hearts,
bigger than mountains.

Dr. Anthony Orsini (6m 47s):
People will make you feel better than knowing what they went through and pushing us to go forward no
matter what. As the Dalai Lama said, “tragedy should be utilized as a source of strength”. I also had some
incredible guests who have inspired us and made us believe that business leadership is not just about the
bottom line, but about people, guests such as Claude Silver from VaynerMedia James Orsini from The
Sasha Group showed us really how people should be treated. Holly O’Driscoll, Anne Bahr Thompson and
Stephen Covey talked about trust and relationships and how a true leaders lead and how the culture of the
business means everything.

Dr. Anthony Orsini (7m 27s):
These people made me feel really optimistic about the future of business. Now I’ve said before healthcare is
broken, we all know that, and I discussed their problems with health care and the solution’s in my book, It’s
all in the Delivery. But after interviewing people, such as Dr. Michelle Neier who treats pediatric cancer
patients, and Jason Wolf the President of the Beryl Institute who works tirelessly to improve the patient
experience I am optimistic about health care as well. I was also delighted to have Dr. Dike Drummond, who
was addressing the real crisis of physician and nurse burnout in medicine and Dr. Helen Riess who proves
to us in her book that empathy can be taught and is contagious.

Dr. Anthony Orsini (8m 11s):
And just a few weeks ago, I interviewed the incredible Quint Studer who was really an icon in health care
leadership and patient experience. So in closing, I understand that these are difficult times, and I hope that in
a small way, this podcast and the work that I do with The Orsini Way has inspired all of us to come to realize
how many incredible people are out there who have magnificent hearts. This podcast has made me believe
more than ever that the future is bright and the sky is the limit for all of us. In the coming months I will
continue to have inspiring guests and talk about how great things come from relationships and how our
relationships start with communication.

Dr. Anthony Orsini (8m 56s):
So in closing, I’d like to wish everyone who is listening a happy holiday season, and I hope you will continue
to listen as we all look forward to a much better 2021. Happy holidays. Well, before we leave, I wanna thank
you for listening to this episode of Difficult Conversations: Lessons I learned as an ICU Physician and I want
to thank the Finley project for being such an amazing organization. Please everyone who’s listening to this
episode, go ahead visit the Finley project.org, see the amazing things they are doing. I’ve seen this
organization literally saved the lives of others who lost infants. So to find out more, go to the Finley


Dr. Anthony Orsini (9m 37s):
Thank you. And I will see you again on Tuesday.

Announcer (9m 40s):
If you enjoyed this contest, please hit the subscribe button and leave a comment and review. To contact Dr.
Orsini and his team, or to suggest guests for a future podcast, visit us at The Orsini Way.Com.

Achieving Excellence in Healthcare with Quint Studer

Quint Studer (1s):
One of my messages for years in healthcare is learn how to say, thank you. Learn how to look what’s right,
because I think in health care, Tony, we filter out the positives. You take the patient home that you didn’t
work, you take the employee home, that you weren’t effective with, and you miss all of the positive things
that have been done. And so, you know, were a big believer that if you start off with meetings with the wins,
you end of the day with what are you here to be grateful for? Because I think health care or any leadership is
a great, great position, but I just think we just get worn down because we play defense instead of offense,
because we find out what’s wrong instead of focusing on what’s right.

Announcer (43s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author Dr Orsini, has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her
team members, or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 28s):
Well, I’m honored today that the Orsini Way has partnered with the Finley Project to bring you this episode of
Difficult Conversations: Lessons I learned as an ICU Physician. The Finley Project is a nonprofit organization
committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It
was created by their founder Noelle Moore who’s sweet daughter Finley died in 2013. It was at that time that
Noelle realized that there was a large gap between leaving the hospital without your baby and the time when
you get home that led her to start the Finley Project. The Finley Project is the nation’s only seven part holistic
program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 11s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards,
professional house cleaning, professional, and massage therapy and support group placement. The Finley
Project has helped hundreds of women across the country. And I can tell you that I have seen personally
how the Finley project has literally saved the lives of mother’s who lost their infant. If you are interested in
learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. The
Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another
episode of Difficult Conversations: Lessons I learned as an ICU Physician.

Dr. Anthony Orsini (2m 52s):
This is Dr. Anthony Orsini and I will be your host again this week as well. Okay. Everyone, each and every
week, I promise you, by the end of the episode, you’ll feel inspired and you will have learned a valuable
communication skills that will help you be more successful in your professional and your private life. Well get

ready because this week I have the incredible fortune and honor to interview one of the biggest experts in
the fields of leadership in health care and in business, whose name is frankly considered as synonymous
with a patient experience. And you’d be hard pressed to find anyone in health care that doesn’t know his
name. So you are tuned into this podcast will be inspired and to learn while there is so much a bolt in this
man that I can literally do 10 weeks of interviews, and you’ll still be learning something new every day.

Dr. Anthony Orsini (3m 40s):
Today I have the honor. And the pleasure to introduce to you Quint Studer. Quint is a businessman, a
visionary, and an entrepreneur, and a natural mentor to many. He has worked with individuals at all levels of
leadership and across a variety of industries to help them become better leaders and create high performing
organizations. As you will quickly realize during this interview, Quint has a gift for translating complex
leadership and business strategies, into simple behaviors that allow organizations to achieve long-term
success and profitability. He is a teacher at heart. In fact, he began his leadership journey working with
special needs children. And we’re going to talk to him about that today.

Dr. Anthony Orsini (4m 20s):
He entered the healthcare industry in 1984 as a community relations representative. He then went on to hold
leadership positions at mercy health system in Wisconsin and Holy cross hospital in Chicago, Illinois, where
their initiatives in patient care lead to their winning Hospitals Magazine’s greatest comeback award. In 1996,
he became president of Baptist Hospital in Pensacola Florida and lead that organization to the top 1% of
hospitals nationwide in patient and employee satisfaction. That’s quite a feat. In 2000, Quint formed the
Studer group to help hospitals achieve the same results as he brought to Baptist Hospital. He frankly put
patient experience on the map by connecting patient care and customer service.

Dr. Anthony Orsini (5m 4s):
Through his work at Studer group, he served as a role model for hundreds of CEOs and other administrative
leaders around the country. Studer Group became the go-to patient experience in hospital leadership
consultants. And during that time, he was honored to receive several accolades for his leadership. Quint has
authored nine books. In addition to the Busy Leaders Handbook, which reached number five on wall street
journal’s bestselling list. We want to talk about that a lot today. His book Results that Last also made the wall
street journal bestseller list and in the great employee handbook he shares insights from working with
thousands of employees during his career. Now, let me tell you every time I read one of his books, the first
thing that comes to mind is a list of friends and families that I want to purchase it for a present.

Dr. Anthony Orsini (5m 50s):
So if you want to be successful, these are books that are really on the mandatory reading list. Quint has
spoken to a variety of audiences across the United States, and it is nationally recognized expert regarding
leadership. He is often interviewed by radio and TV shows as well as magazines and newspapers across the
country. And I’m deeply humbled that he’s agreed to do this podcast. He and his wife are residents of

Pensacola Florida, they’re passionate about giving back to the community and they share their time and
resources with local and national nonprofit organizations. Well, thank you Quint this is quite an honor, and
that’s quite a lengthy introduction. How are you today?

Quint Studer (6m 28s):
I could have done the same thing and I want to thank you. You know, I’ve got your book. I keep it on my
desk. It’s all on the Delivery and I just will tell you a real quick, I love page 70. Tell me, I forget, show me, I
remember and involve me I understand. I also like your comparison with, if you’re a spikes in your program,
you hit the toughest issue in healthcare and leadership is that these difficult conversations. So thank you for
what you’re doing to make healthcare better.

Dr. Anthony Orsini (6m 55s):
Thank you so much coming from you that means a lot. And I’ve been in really forging forward with my
passion to teach communication. We’ll talk about that in a little bit. You know, at first I think is probably a
good idea. If you don’t mind, just to tell the audience, I kind of started this way all the time, who is Quint
Studer and how did you get here?

Quint Studer (7m 12s):
I got here with a winding road and I think I volunteer my time a lot in particularly in university settings,
teaching healthcare administration, sort of a, if you do have an hour and you want to have some of these
speak to your class, and I get this question quite a bit, and these are students that are great universities that,
you know, get their bachelor’s, their master’s. Mine was an interesting journey. My parents didn’t go to
college. I was lucky enough to go to college. I didn’t know what to major in. So my first two years, Tony was
like, what they call undecided major, and then 60 hours they call you in. And they say, you’ve got to pick a
major. Or courses you’re taking might not count toward graduation.

Quint Studer (7m 53s):
And I had like a four year deal. I didn’t have a four and a half or a five. I had to get out four. And so I thought
of people that had a huge impact on my life. And one of them was my high school soccer coach. And, and in
a study hall, he let me come into his classroom and work with his students, to work towards a special
education teacher. That’s what he was. So I became a special ed teacher and it, it was one of the great gift
I’ve ever had. ’cause I think what I’ve really done is taken what I have learned there into all of my jobs.
There’s no, I’m just been working on the same game plan in different fields, which is you diagnose, you start
off an assessment. You’re a physician.

Quint Studer (8m 33s):
And the challenge in leadership sometimes is we just don’t slow down to do an assessment. We read a good
book, or hear a consultant. When we rush into a treatment plan without doing an assessment, then you set a
lofty goal. Then you get everyone on the same page and then you take, and you break it down into steps,

just like you are. You know, I meet Tony so many doctors that they call me and they say, Quint, you know,
I’m now in administration. What should I do? I say, use the same skill sets you used as a physician, but
instead of a patient, you now have an organization. Frank Burn was probably the first Physician that when he
was a part of you ended up in a Madison, Wisconsin that I had this conversation with that.

Quint Studer (9m 14s):
So I did that. Then I ended up working in a behavioral medicine center, which I loved. It was 35 beds ended
up working in, in hospitals. You know, I got assigned patient satisfaction. I mean, I just happen to be the guy
who drew the short straw of that day at an administrative meetings. Our CEO, Mark Clemat was going to
divide us all up. We were sort of a new administration team and he gave our chief nurse officer quality,
clinical quality at the time. He gave our human resource person, employee engagement, employee turnover,
and he gave our CFO finance. And there’s this thing called patient sat, which was the fourth little thing.
Seeing they all had something, he turned to me and said you’re in charge of patient satisfaction.

Quint Studer (9m 58s):
And I did the same thing I had done everywhere. I did diagnosis. I was, I think the first hospital administrator
that I ever went to the press Ganey and sat on site to understand the tool and how it works. And then I came
back and started benchmarking places like Southwest airlines and other places and, and how you do it. And
then I came back and I was desperate enough that I actually started doing some of these things. And then
they sort of worked and then Tony what happened to me is I got discouraged in healthcare and I wasn’t
enjoying it like I used to because I’ve got into it. I like that. But then, you know, all we talked about at
meetings where FTEs and adjusted occupied beds and market share and should we take risk or not take
risks, should we be capitated or not be capitated?

Quint Studer (10m 44s):
And it wasn’t like a special ed or any of those things. And, and I got lost Tony and I don’t even know I got
lost. I just know it wasn’t fun anymore. And I don’t mean fun, just wasn’t feeling worthwhile. And then I’m
doing this patient sat stuff, which meant I had to go up on the units and ask a nurse’s what we should be
doing. And all of a sudden, after about six, seven months of it, I started getting the letters that people would
write to the hospital about their care started funneling to me because I’m now the patient sat guy, and some
of them were complaints. But one day I get this letter that just talks about their father dying in the hospital
and how this nurse held his father’s hand until he could get there.

Quint Studer (11m 27s):
And he said, I hope you appreciate that nurse. And because I had been gone up on units because I had
been doing behavior that was different than I have been. I rediscovered purpose worth while work on making
a difference. And that’s what changed my career. As a patient experience changed my career cause a nurse
made a huge impact. Like they do every single day.

Dr. Anthony Orsini (11m 48s):
That’s a great story. And I was when we were speaking, or I’m thinking about the issues that we have today
with physician burnout, with employee engagement in the healthcare system, and what you said, you were
going through about thinking more about FTEs than about the patient. I think today it’s worse than ever
where doctors and physicians are often forgetting why they went into medicine in the first place. So I do my
workshops about patient experience and communication I do a little thing and it’s in my book about physician
burnout. And we’ve been told for a, a a hundred years physicians that the best thing to do not to get burned
out is to just treat it like a business and not make those human connections.

Dr. Anthony Orsini (12m 32s):
It goes back to the 1912 believe it or not when Dr. Osler gave his speech to physicians who were graduating
John Hopkins and said, you can only be a good physician if you detached yourself. And so that’s exactly the
opposite because I think exactly what you said, once you started talking about the patient and you heard that
story about the nurse who held the patient’s hand, you got excited again. And I think that’s what I’m trying to
get doctors to get excited about again. Right?

Quint Studer (12m 60s):
I think you’re absolutely right. I think sometimes we hear things and because we hear it from people, me and
might respect with all good intentions, we think it’s accurate. And maybe it was at one time or maybe it
wasn’t. So here’s a couple of myths that I had to stop listening to. One of the myths was you balance your
positives and negatives. So if I compliment you, I also criticized you. I’m a one on one guy. Well, then I found
out I was completely wrong. One-on-one creates negative relationships at two to one creates neutral to
positive, to one criticism, three positive to one criticism creates positive relationships. So let’s go back to
Healthcare. We are trained you as a physician.

Quint Studer (13m 42s):
Other people are trained to notice what’s wrong. When I come to you, it’s not for a Well person checkup
probably. And in fact, I will tell you, and I like this about physicians. When I would go to my, one of my
doctors, I’d walk in, in the first thing they would say is what seems to be the problem or once a month. And
I’m glad they did that because that is why I am there. However, we have to be careful in our culture because
in our culture, it’s a little bit different. So I find that many of the things that I tried to create, where things to
play off the fence to find out what’s right. So when you look at a doctor, particularly by Dr is used to hearing
from anyone in health care or what pharmacy doesn’t call them with a compliment.

Quint Studer (14m 25s):
You, you know, the OR doesn’t call them to say, good news. Dr we’re running on time. I can’t wait to hear
what that patient is going to be ready for you. We normally only talked to the physicians when we have
something negative to say to them, and then we wonder why they get wore out. You know, I tell people when
you see a physician come down the hallway, if you say to them, can I talk to your doctor? There are already

coming up with an exit strategy to avoid that conversation because it’s not going to be positive. And some of
my greatest memories is when you start recognizing physician’s in a positive way and watch them flourish.

Quint Studer (15m 5s):
So I think healthcare has been built on a culture of what’s wrong. And I get that. We have to find out what’s
wrong, but we miss what’s right in my book, “healing physician burnout” I think I was ahead of the game. I
got a phone call from Dr. George Fort in San Antonio. He said, Quint, you’ve got to deal with burnout. She
sent me 72 pages of research. I wrote a book on it, but I think I was just not at the right time, but I had
moved from there. And I, and I go on a little bit here because I think it is so vital. Diana Handel wrote a book
recently is going to be coming out. In fact, I wrote the foreword and she is a CEO that decided that she
ended up being in post traumatic stress syndrome from her role as a CEO of a hospital and reading that
book, I came up with the new awakening.

Quint Studer (15m 51s):
That, you know, Tony, you know, we all know the pain scale. If I had come to you and I say your, a patient,
and I say on a one through 10 with a smiley face and the sad face, what are you? You are gonna say a six or
a four. I’m not gonna say to you what, you shouldn’t be a six. You should be an eight so that you have a
great pain threshold. Or I don’t say, well, you should be a two. You big wimp. I just acknowledge that your a
six, because you feel like you’re a six. Well, I think when you look at healthcare today, we’re so focused on
stress and resiliency. We might be misdiagnosing the organization because when I look at what’s happening,
we might actually be on the verge or in trauma.

Quint Studer (16m 37s):
And I think if we don’t treat it right, you know, if you treat stress and this is new stuff, so I’ve never talked
about this before on the air, because it’s just all new learnings for me. Fantastic. I got an exclusive. So what,
what happens is I was all about, I actually create, help create a stress tool kit. So that’s where I was two
months ago. And of course resiliency is. So if I treat you for stress and tell you meditate, eat right exercise,
it’s going to be healthy for you. But if you have trauma, it’s not enough. So if you look at this stress, I’m
creating a pain threshold for our organizations. And so I think if you want to be a leader, you always gotta be
looking around corners.

Quint Studer (17m 18s):
You’ve got to be figuring out what’s coming. And I think right now where health care is at, you mentioned, you
mentioned burnout, doctor suicide it’s because I think we are treating it as stress when really we’re really in
trauma. And let me quickly just to give a quick thumbnail definition, stress is usually something that, you
know, I’m stressful, but I’m going to go back to normal when it’s done. You know, you’re applying for medical
school, there’s a lot of stress, but why once you get accepted the stress changes. You have a talk, stress
changes. So there is stress we all go through it. But normally when we go through the situational stress, it
gets better. Or we go back to normal. Now the challenge is with trauma.

Quint Studer (17m 59s):
That’s a little bit different. With trauma, It can be one incidents or can be multiple. But if you look at trauma,
we know we’re not going to go back to the way it was. We feel powerless. We feel hopeless and we’re losing
trust for what’s going on in the situation. And our job is changing. Our role is changing. It’s now think of
COVID-19 you’re a physician or your role is different because now your a tele-health physician you’re using
different technology than you’ve ever used before. They’re still adjusting to electronic health record. They’re
changing your RV use. They’re changing the payment methodology.

Quint Studer (18m 40s):
You might even be asked right now to take a reduction in pay because COVID has hit the revenue streams
and you’re losing trust. And you’re feeling a little powerless and hopeless. So what are my hopes in 2021 is
to really start helping people call it what it is. I’m not saying that it’s trauma, it could be stress, but at least
we’ve got to help the organization diagnose themselves correctly. So I’m probably not the, maybe the topic
we all planned on, but I think you’re onto something when you mentioned burnout and what’s happening in
this year. So I’m very pleased that Diana Hendel who’s much smarter in this than me. He asked me, right,
the forward to her, a book on this, because I walked out of there saying there is a new light bulb that just
came on.

Quint Studer (19m 26s):
Its sort of like in patient experience, I had to move it from service excellence to If we do the right things we
will improve the clinical outcomes. ’cause when we start getting people to do difficult behavior or
uncomfortable behavior. When we connect it to the clinical outcomes with their values, your book is a perfect
example. I gave a talk two days ago on when we hit these crossroads, do we pick character or comfort?
Which way do we go? And I’d like to tell you that I always pick character, but I don’t at times I pick comfort,
but you know what you teach Tony, which has the most vital thing you teach is how to do those
uncomfortable things. But their the right things to do.

Quint Studer (20m 7s):
But when we do those uncomfortable things, eventually we’re more comfortable because we have done the
right thing. Your book is unbelievably great for people in health care. Cause the number one issue and all the
years I’ve done in healthcare is people struggle with difficult conversations, whether it’s with a patient, a
family member, a coworker, or their boss.

Dr. Anthony Orsini (20m 28s):
Exactly. And that’s something that Difficult Conversations is something that everyone has to do. Doesn’t
matter whether it’s in your professional, your personal lives. As you know, I started off with teaching the
Difficult Conversations to physicians on how to discuss tragic news. And then as time went by, I went into the
difficult conversations and how to communicate and build rapport and form relationships. And then right

before I did the podcast, it was really the basis of the podcast was that whether you’re in business for, in
medicine it’s really the same skill set. And I have to say, as we move into your book, your latest book The
Busy Leader is Handbook. I read that book and almost every paragraph of every sentence you were
speaking about how to be a good leader.

Dr. Anthony Orsini (21m 10s):
They realize that this book, you can easily take the word Leader put in Physician and you can easily take out
the word employee when you were talking about communication and put it in the word patients or nurses
that really it’s all about the relationships. And then how are you even say it on the it “leaders must be able to
build strong relationships. They are the foundation for everything else. And that communication is the basis
for that great communication from leaders. You say sets people to do their best work, helps them improve
and grow and connects them”. So that’s the parallel, right? Do you think that’s why you went from a business
person who taught leadership to a patient experience so smoothly because it’s really the same thing.

Quint Studer (21m 53s):
It’s my background and special ed, which was the same thing. Because when you go and keep going back to
this, but again, as a special ed teacher, you assess the situation, you set lofty goals. But the other thing you
have to do is build up trust. Then you build up trust by recognizing what’s right. And I think when I first got
into Healthcare people thought I was a nut job because I was so complimentary. But you know, when you’re
teaching special ed and I was in some schools with kids with lots of different, special, multiple needs, you
will learn how to recognize certain behaviors because you want that behavior to be repeated, recognized
behavior gets repeated.

Quint Studer (22m 34s):
And sometimes you recognize people for doing things such as sitting, when the class starts, putting stuff
away. We had a girl that would get so excited about popsicles, that she had put one in her mouth without
taking off the wrapper. And the first day she took off the wrapper, you had a thought she’d won an olympic
gold medal in. So I think my training in that was very helpful because I tend to notice what’s right. And I tend
to start with what’s right. It doesn’t mean you don’t have Difficult Conversations but you still build that
emotional bank account to noticing what’s right. So when you do have to take a withdrawal, you haven’t
bankrupt the relationship.

Quint Studer (23m 15s):
And I think that’s one of the great challenges in health care. We all get so busy. We don’t make those
deposits. And then the external environment, he starts making withdrawals on us. You know, I used to say to
the employees, you know, please, I’m not the one telling Medicare to not pay us this. I’m not the one that
there are certain things that the external environment drives that we’ve got to be able to manage. So I think
that was really helpful to me. I think again, when you are a special ed teacher, you also have be good at
Difficult Conversations because you’re sometimes telling parents that their child isn’t going to be as

independent as they would make their child to be there’s diagnosis that you wish you didn’t have to provide
to a, a family With that.

Quint Studer (24m 0s):
And there’s also some consequences. So one of the stories that I always tell is I taught at the high school
level for a while and we had, sadly, we had some kids that would be taken advantage of by other people in,
in the school system. Or you might have a girl that you have to tell her not to get into the car with anybody.
She doesn’t know not to take a drink. If she doesn’t know what’s in it or not to give money to people, these
are all students and in a, you wish the society wasn’t like that, but it was so we had to be very good about
consequences and accountability too. So I’ve just been really blessed. And you know, I remember years
ago, Tony, the hospital is that won a big award and a guy came up to me and he said it tongue in cheek.

Quint Studer (24m 46s):
He said, how does a guy who was a special ed teacher end up running a hospital? And I said, well, as a
special ed teacher here is what you did. And he looked at me and said, my gosh, I wish I had a degree in
special ed. It’s really good preparation for what we do.

Dr. Anthony Orsini (24m 60s):
Yeah, you talked about the characteristics of a good leader? One of the things that you talked about really
early on in the book is a good leader, has humility. And I call that genuine in my book as a good physician is
genuine and it’s a real person. And there is a lot of parallels between that again, wouldn’t you agree?

Quint Studer (25m 18s):
Well, I think the deal that anybody has to have is clarity and self awareness. So when I think of the word
humility, I don’t want to confuse it with false pride. So for example, if somebody comes up to you, Tony and
says, wow, that was a great presentation. You did a great workshop. I feel so much more comfortable now
going out and having these difficult conversations. And you say, Oh, it’s nothing. I’m just lucky. That’s false
pride. You’re pushing away a skillset. Humility is being able to see one as they are. It’s the clarity. And I think
that’s really vital because that means you see your strengths and you see what you’re not good in.

Quint Studer (25m 60s):
Periodically because I’m in Healthcare, you know, if you’re in a health care, people come to you just thinking,
you know, no more than, you know, so that we will come to me and they’ll say, well, Quint my doctor is
referring me to the specialist out of town. And I said, well, you should thank them because obviously they
feel that you can get treatment somewhere else beyond what they can offer you right now. I said the most
dangerous thing is somebody who doesn’t know their own boundaries and their own limitations. So that’s
that humility of seeing ourself clearly in my first chapter of my book, it’s self awareness. And I think that is
the key that opens the door to everything. So how, where am I? And sometimes I think of the older we get
Tony, the more self aware we get ourselves, but early on it, we need people around us to give us feedback.

Quint Studer (26m 48s):
I do that even today. I say, Hey, don’t let me go off grid. Don’t be afraid to push me when they have to tell all
the executives to do all the time, but their teams is throw out something they know is crazy and see who on
their team challenges them, because you need people that are going to challenge you and you surround you
with that. So, yeah, I think self-awareness on being genuine, being authentic. People ask me, what’s one of
the big skills every leader has that says to be authentic, to be themselves.

Dr. Anthony Orsini (27m 19s):
Yeah. And it’s really very important that you think of your boss as a real person who is not just your boss. It’s
also extremely important. I talk about it in my book that you think of your doctor as a real person. So I try to
teach doctors, don’t walk into the room and say, you know, what are you here for, walk into the room and sit
down and say, hi, how are you? Or if you’re really lucky, you can find some commonality with, Oh, are you
reading that book? Or I didn’t realize you’re a Tampa Bay fan. And then all of a sudden you become a real
person. And there’s this whole concept that I talked about called it’s hard to fire your best friend. Right? So if
your boss is your best friend, or do you feel that your boss is a trustworthy guy whose a real person or a
trustworthy girl, I think you’re going to give them more slack.

Dr. Anthony Orsini (28m 5s):
And that’s what makes a good leaders. Don’t you agree?

Quint Studer (28m 7s):
I think you’re going to share more. I think the reason people struggle when their physician retires or leaves or
they get referred to someone, is that idea of being vulnerable. You know, you have to have a story to start
Raphael Bueno is a doctor in Boston, who I have great respect for him as a lung cancer specialist at one of
the people who I admire greatly here, he got referred there for lung cancer. And by the time the fella got to
see Dr. Bueno, Dr. Bueno had actually look the guy up and knew something about him and talked to him and
sort of took interest in him. I think the, the issue always comes in to the fact Is are you interested or
interesting? And I think the big factors bring to the table is if I’m being interested in you, you’re going to be
more sharing.

Quint Studer (28m 53s):
You are going to be vulnerable. I mean, I’ve gone to mental health therapy on and off my whole life because
I’m a big believer in brain health. And I was going to a therapist named Martha Horton. And I used to tease
her. Cause I’d say on the way to her, my appointment, I’d wait till the last possible minute. Hoping she might
cancel, you know, something comes up, then I’d sit in before I would walk in, in, in case you want to cancel
the last minute, then I would sit here and say, here’s what, I’m not gonna tell Dr. Horton today. She’d come
meet me. At the time I had walked to her office. I’d already thrown out, but I wasn’t going to talk to her about.
She created that trust in that safe environment.

Quint Studer (29m 33s):
And that’s what doctors have such skill sets and doing because people have to feel safe than I can share
some embarrassing moments with you. I got a phone call from our friend maybe three months ago. And he
said, I got to tell you I’ve had suicidal thoughts. And I was so pleased he felt safe enough to tell me those
things right. And we can do something about it. So I think it’s that measure of feeling safe with yourself in a
safe environment and even what you teach Tony. And I’m a big fan of yours. When you do a workshop,
you’ve got to create the environment because you want people to practice it. You want people to
demonstrate it. Well, I’m not going to do it.

Quint Studer (30m 13s):
If I don’t feel I’m in a safe, safe environment. So one of the things that you do is you create that safe learning
lab environment for people to practice something that they feel it’s very difficult to do.

Dr. Anthony Orsini (30m 24s):
Okay. You really opened yourself up when you have to really start those show people how to communicate.
Cause its a skill. When I have been doing it for 10 years, With teaching the doctors individually, we’ve done
probably seven, 8,000 doctors by now teaching them how to communicate bad news. I have found it about
15% of the doctors that we train, no matter how young they are, knock it out of the park. They are just
natural communicators, compassionate people, 15% of them I have a real hard time and sometimes I feel
like I can’t teach them, but the other 70% are genuinely compassionate, great people who just want to learn
how to build that rapport. Get good communication. I suspect that in business it’s the same that most people
want to be good leaders and good communicators, but just need to be taught.

Dr. Anthony Orsini (31m 11s):
I guess my question for you is back to the business and where I’m trying to go back and forth and relating
business with health care and back and forth. The leader and the Physician. My question is, do you think if
you’re hiring a new manager or a new Leader I know you mentioned that in your book, how important
communication is . Do you pick the guy who could communicate or the girl who could communicate or do
you pick the smart person and the room and teach them how to communicate and be a leader? Can it be

Quint Studer (31m 36s):
It can be taught if the person who wants to be taught. Second chapter in my book, Busy Leader Handbook is
on once you’re self aware or are you coachable? Now, one of the challenges in healthcare Tony, you and I
both know is how we shortchanged training and development. We just short change people. And going back
to your research, as my research is about 34% of the leaders could probably learn this on their own it’s
natural, they’ll study it, but the rest of them need help. You don’t want to create an environment that they are
stoic people, health care people. So that they don’t want to raise their hand and say, why I need help on this

may be once in a while, I remember once again doing a training workshop years ago and a big health care
system, 75 doctors to this workshop I was doing.

Quint Studer (32m 24s):
And it was neat to see them over the day or two transform themselves from something that they thought they
could do. You know, sometimes we don’t know what we don’t know and the physicians truly are doing the
best job they can do based on what they know. And physicians that’s pretty challenging environment
because they don’t get to watch other people do it. Nobody says let’s double book physician’s in the ER
today. So they can learn from each other. Let’s watch this person. So, one of my favorite stories in the
emergency department, there was a healthcare system and they posted the patient satisfaction or a patient
experience scores by doctor.

Quint Studer (33m 3s):
And this doctor noticed that he was sort of at the bottom. No, he didn’t go to another doctor. He went to a
nurse and said, what are these guys are doing that I’m not doing. She said, well, here’s some things they do.
So I think you’ve got to almost create that training and the environment. So it’s not optional. It’s sort of
mandatory. And then when people get there, they get so much more out of it than they think you’re right,

Dr. Anthony Orsini (33m 31s):
I think a hundred percent. And when I give my workshops, you see a group of physicians or nurses or
anybody that I’m training with their arms folded in the back. And there are there because they were told they
had to be here. But I tell you, there is nothing more rewarding right then by the end of that workshop, that
person is writing stuff down and is excited. And I mean, that’s what gets me going. I love when that happens.
Cause they are like, Oh, I like that. I’m good. And I tell them, I’m going to talk to you about different things.
And I’m going to show you some communication techniques that I want you to steal from me. That’s the way
I call it a deal for me. And, but often I think what we do is we concentrate on people who are doing poorly.
And instead of concentrating on people who are doing poorly or just saying, gee, my satisfaction scores are
low or my employees aren’t listening.

Dr. Anthony Orsini (34m 15s):
Why don’t you just sit back and watch that doctor who’s having really good patient satisfaction scores. And
even without me and without you, you’ll probably say she does something a little different here. She sits
down and she talks about it. And I think that’s one of the things that I try to teach my kids now that they are
all almost adults is watch the guy who is good.

Quint Studer (34m 35s):
All right, well, you’ll hit something Tony. And this has been researched. Now the Heath brothers and their
book “switch change when change is hard” they say the same things, they don’t use medicine. They use
other examples. So they say that there’s been a study after study on a child who drops out of high school,

but they find the child that doesn’t drop out of high school that lives in poverty that is moving around from
foster home to foster home. And just trying to figure out what is different in that child. So I’m a huge believer
in what you said. And I fell into this by accident. So I am at Holy cross hospital. Our patient satisfaction is
crummy across the board, which was beautiful because then we could all blame the patient, the place where
consistently crummy and then all of a sudden, dang it.

Quint Studer (35m 24s):
If one nursing unit doesn’t pop way up. Now we start sitting here with our smart intelligence executive brain’s
we say those are the same patients that are in all the other units are probably the same payer mix, the same
shared rooms, the same community, the you know, the same intercom they’re hearing the same. gheel’s on
the cart. That’s to know. I see, because these are all the excuses we had for us not being Good. So the
challenge is Tony, because people don’t see other people do it. If you ask that person, what are you doing
differently? They are going to say nothing. I’m just doing what everybody else was doing.

Quint Studer (36m 6s):
And they think they are. So I released a fellow named Don Dean who worked for me. And he was like part of
our measurement team. He was in radiology. And I said, Don, Michelle doesn’t think he is doing anything
different, but something’s got to be different because those patients are so much feeling better about the
care than any place else. Go up there and I want you to just observe her for the next five days. And I know
you will probably be a pain to her. She’ll say nothing, but just watch everything she does. So about the third
day, he said, Michelle, I noticed that one of the first things you do in the morning, is you go visit every single
patient on a unit.

Quint Studer (36m 46s):
And she said, it isn’t everybody doing that? We said no, nobody is doing that. Well pretty soon. And
everyone was doing it and now we’ve got better at it. You know, you’d find recognition to come out reward
that I absolutely a a hundred percent agree with you. I had an ER in Texas, they put a camera up. They were
really clear about not doing the patient, but they then took all the physicians. And they basically, and I think
you’ll really, this is what you’re talking about. And then they created sort of a, like you would an athletic If
analyze the video. And what they did is they study the doctors that had the best patient experience.

Quint Studer (37m 25s):
That’s what they did. And then they took the physician in that didn’t have as good. And they showed the
physician, their video. And then they showed that video, the doctor with the best patient experience, within a
matter of months, everybody had a great patient experience. Because once they could just see, ahh, they
said, I don’t know, they offer a blanket. I don’t, they talk about it. I want to do everything I can to reduce your
pain. They narrate the care better than me. Doctors are smart people and what they saw it done. And they
were doing the best they could, but remember physicians and all health care people have a disadvantage
cause they don’t get to see the other people, the best practices where, you know, again, I own a minor

league baseball team.

Quint Studer (38m 11s):
The player’s watch the other people bat . That they watch other people’s pitch. They are constantly
observing what their peers are doing. And Healthcare the last time he got to see a peer or do anything. It
was your residency.

Dr. Anthony Orsini (38m 24s):
Yes. That’s a great point. So yeah. And so watch here at some of the take home messages, I have two
quickt more questions for you. I take our message to be positive reward. You mentioned about one to one
positive and negatives, but it actually should be three to five. In the previous episode that I did really have
the pleasure of interviewing Dr. Helen Reese. Who’s one of the big names for empathy and, and she brings
that up all so that when you’re bringing up children, that’s the same ratio, three to one, five to one positives,

Quint Studer (38m 54s):
Workplace. You’ve at least got to get three and outside of the workplace at home, you gotta hit five now. So
I’m sure if you can get five everywhere, I always teach people in health care where sometimes so unused to
hearing what’s right. We even get nervous when we hear what’s right. You know, what’s happening? I tell
people, Oh, it was my, when you start being more positive, you better tell people why you’re doing it. Are
there going to think somebody had changed your medication and they are going to be a little bit nervous
about it.

Dr. Anthony Orsini (39m 20s):
And the other thing that was really cool that you mentioned to me is that it is amazing. No matter how old
you are, how much do you like positive feedback? When I do my program from the book, it’s all in the
Delivery. When we go in and we do the workshops, we do communication training for everyone, the doctors,
the nurses, the final phase of that program is called. See something, say something. And we have little
stickers, tiny little stickers that go on your chest and little stickers that go on in your badge holder. And we
say to everyone who takes the class, the workshop that if you see something good, anytime you see a good
interaction, it doesn’t matter if you’re the housekeeper who sees an interaction with the director of medicine
or a director, a medicine that see’s a good interaction with the housekeeper, give them a sticker.

Dr. Anthony Orsini (40m 5s):
And at first people said to me, you know, directors, chief medical officers, directors of the NICU directors of
the programs, get these stickers and get this big smile on their face. They put it on their lab coat and some
of them even put it on their doors outside of their office. And there was a 60 year old man or a 60 year old
women. So everybody needs a little positive feedback.

Quint Studer (40m 30s):
I think too in healthcare sometimes we’d sort of joke about these things. We almost make fun of them at first.
Then you say the affect. Two little stories that I just love. We have this thing at the Hospital I was at Baptist
where you can give a wild card. So when somebody does something good, you right out and you give them
a wild card and it was cute. It was nice. You know, it, it was wonderful, but I underestimated the impact of
these wildcards. So I’m going up to see Dr. Troy tippett. He is a neurosurgeon and he’s a really spectacular
physician. And you know, I go out again in here, he’s got a wild card that somebody gave him a nursing
assistant had written him a wild card handed a to him.

Quint Studer (41m 12s):
And he had it next to his diploma from medical school, this wildcard. And it hit me how much of the impact
that it had. The other story is sometimes even when it’s not sincere at first, it has an impact and that we
joked and even insincere recognition works in health care time. So my story was, is this again, working a
hospital, there was a nurse. And she was very frustrated because she had always wanted her own children.
And adoption is wonderful, but you always wanted her own children and she could not conceive. And she
was in a busy ER in a inner city hospital and people are coming and either pregnant or maybe not taken care
of themselves.

Quint Studer (41m 55s):
And prenatal care may be very young. Pregnant may be sometimes beyond with two or three kids. So she
would get very judgmental. And this nurse manager got complaints about her treatment and it wasn’t just
them. It was, she treated people differently depending on different characteristics in it. She was very
judgmental. So the nurse manager brought her in and told her she’d have to be nice to everyone. And she
says, I know that’s hard on you. I don’t care. You know, she started made a joke. She said, I’ll give you a
smiley face teeth of plastic. He can put it in your mouth to look like you’re happy.

Quint Studer (42m 35s):
She said I don’t care if you’re a sincere and not sincere, or you have got to treat people better, no matter
what. So that next day she came in and almost went overboard. Well, hello, how are you going to get you
this? Let me do this for you. And then she would say, what’s the patient’s, that’s not me. It’s the patients. So
at the end of the day, the nurse manager called her in and said, well, how did the day go with, you know,
treating everybody night? And she said, today didn’t count because everybody was nice to me. So all of a
sudden it clicked on her at the message is you started to get what you reap. And I think the fact that you
talked about reward and recognition at first, these wild cards are sort of a joke or who, wow, Oh, here’s
something, Whoa, wow, you’re doing a good job.

Quint Studer (43m 24s):
But then all of a sudden it clicked up when I was again, president of Baptist people got little light bulbs so
that they made us better. So they got all these little light bulbs, right? Ideas and something. They look like

military people with all these little light bulbs. So USA today came to do a story on us. So what they were
walking around the hallways, they saw some of the staff with these light bulbs. And they said, tell me what
that is for it. Do you know, the staff member could go by every single light bulb and tell me why they have
that light bulb. And I think sometimes maybe we’re not comfortable with recognition. Cause in Healthcare,
you know, we are not used to getting it. And one of the things I used to always talk about and health care,
sometimes Tony, it’s even hard to compliment somebody.

Quint Studer (44m 8s):
You tell somebody, they do a good job. They start arguing with you. I could do better. I can do it better. And I
shared again, in one of my therapy stories, I went to Catholic social services years ago, Amy Storme was my
therapist. And she said, Quint, I’m going to give you some feedback. I went there because I was depressed.
And she said, you know, and I get some positive feedback. You rejected that you deflect. If you tell me why
it’s not true. And she said, I think one of the reasons you feel bad about yourself as you filter out the positive,
one of my messages for years in Healthcare is learn how to say, thank you. Learn how to look what’s right.
Because I think in health care, Tony, we filter out the positive. You take the patient home that you did help.

Dr. Anthony Orsini (44m 50s):
You take the employee at home you weren’t effective with. And you miss all of the positive things that have
been done. And so, you know, were a big believer that if we start off meetings with the wins, you end of the
day with what are you here to be grateful for? Because I think health care or any leadership is a great
position, but I just think we just get worn down. ’cause we play defense instead of offense, because we find
out what’s wrong instead of focusing on what’s right. And you’re one of those right. People in healthcare. I
mean, you know, you’re taken care of the most difficult topics in health care. I mean its easy to teach
rounding its easy to use key words at key times, its easy to talk about making a phone call.

Quint Studer (45m 30s):
It doesn’t mean it’s simple, but it’s easier than what you teach. You teach the most difficult thing. And
Healthcare my first grandchild was stillborn birth. Oh I’m sorry. My daughter-in-law was a full term maybe a
week before she was due. Her placenta released. And she didn’t know at the time that was going to be an
issue. She went to the hospital, she delivered a baby, they named her Ella and she was still born. Now when
she got to the ER, she sort of had that feeling something was wrong because of the blood, but she still has
held out hope that her baby was alive.

Quint Studer (46m 9s):
And somebody had to sit down with her and my son-in-law and tell him that the baby had died. Hard right?
Excellence of course of the book story at the end is Brian’s story was about my nephew who has killed at 19
in a car wreck. And somebody had to tell my sister-in-law and brother-in-law that your, you know, your son is
dead. I’m so sorry. But what I learned amazes me is how people have the skillset to do it in a way. So when
you, four years later, I go to speak at that hospital that Brian died on me and I call him his parents and tell

them I’m going to speak at Christ hospital in Chicago and immediately my sister-in-law Cathy said, tell them,
thank you.

Quint Studer (46m 49s):
They were so kind to us. So what you teach Tony is just how to do the most difficult thing in Healthcare and
they have to break bad news and have difficult conversations. So I want a thank you for the impact that you
make and thousands of thousands of lives.

Dr. Anthony Orsini (47m 4s):
Oh thank you. And it’s something that is so important. I don’t think most people know how important it is,
how you break bad news can affect somebody for up to 30 years of you don’t do it correctly. There’s not a
person in the world, a doctor, a nurse, a police officer at a first responder who wants to be bad at it. But we
are just never taught on how to do that. And when things don’t go well, we tend to get upset, but I’m going to
tell you what it brings me really. It makes me feel good is when and now it’s been 14 years, but I get letters
and Christmas cards from the mothers and fathers who’ve lost her baby that was in my care or a premature
baby had died for a variety of reasons.

Dr. Anthony Orsini (47m 48s):
And and I got a Christmas card from them 14 years later. If that doesn’t make you proud and be happy that
you went into medicine, then I don’t know what will because many people would to see that as I failed, but in
the end I was there for the family and they appreciate it. And it’s something that I think we just need the team
more and I’m trying Quint I mean, I’m trying to train every doctor out there on how to do that and build the
relationships and we’re doing it one at a time. Sometimes we’d do it in big groups, but I feel that is even
more important than what I’m doing as a physician, but it’s at least equally important.

Dr. Anthony Orsini (48m 27s):
And I thank you for your compliments, that’s really very nice of you to say.

Quint Studer (48m 30s):
I think I will tell you have to look at the physicians and yes, most physicians what they major in and it wasn’t
a sociology or psychology behavioral medicine per say it was usually science, biology, chemistry. If you take
the Myers-Briggs and you get most physicians, about 90% of them are going to be an I, which means they
like to think internally before externally. And that means some things are not going to be as natural to them.
And I think that’s why you’ve got to make it safe for them to be vulnerable, safe for them to say they don’t
know because they were sort of a program to know because they picked the major that they are really good

Quint Studer (49m 13s):
They’ve always been very successful. So I was talking to a person, a Harvard medical school, student

science major and the whole BIP or biology or chemistry. And I said, isn’t it amazing that most of your
training’s going to be scientific at your job’s going to be all about relationships.

Dr. Anthony Orsini (49m 30s):
Yeah. I love that a a a hundred percent. You’re exactly right.

Quint Studer (49m 34s):
And so I think the fact that you create a safe environment for clinicians or every one on how to have these
conversations, how to say they’re tough. And I know we are going way, way long, but you know, I love
doctors and I think doctors knew I liked them. And I think that makes a big difference. You can’t fake it
because their diagnosticians. One of the biggest impact I had from a physician who was my first week in
administrator on call, you know, that’s When in the old days, you got a beeper in you. Your role comes in to
the administrator on call. So it was a Saturday morning and be in a administrator and call. You have to walk
around the Hospital. My big skill was learning to say to the house supervisor, what do you think we should

Quint Studer (50m 15s):
And then I’ll tell you. So I had heard that a person I sort of knew not well, but knew of them. She’s mid
forties. Her husband had a severe stroke, couple of teenage children. I knew she was in the hospital and I
turn the corner and there she is with her kids and Dr. Ram Rao, who’s an internal medicine physician. And
he was sitting there with the family, going over the decisions that they have to make. The decision was when
you look at it, do we keep him alive per se, artificially, or let him die naturally.

Quint Studer (50m 55s):
And I watched him walk through the family with this and they made the decision to let sort of nature take its
course. There wasn’t any real other option, but you know, there is always another option, but they have
tools, all sorts of things, Andy. And then you said to them, now I am available. Here’s my number here’s my
beeper. This is beeper day. If you changed your mind or need to talk about it, I want you to call me. Now, I
think he knew that they probably wouldn’t call him. But the sense of understanding and comfort was really
quite remarkable. And I’m sitting there and I’m thinking I’ve never had to tell somebody that, and I’ve never,
you know, Dr.

Quint Studer (51m 37s):
Steve base and a good friend of mine tells about the fact when he’s telling a patient, a woman in her
husband that she’s got terminal cancer. She’s the same age as his wife and the kids are the same age. I
think physicians have to do some of the most difficult things of anybody. And what do physicians really want?
You know, treat me with respect to have things go on in time. They don’t have a lot of demands. So I’ve
always been a, a, a big fan of physicians. And that’s why I think in this environment, providing them the
support with training, because they’re not going to ask for it. I don’t think if the chief medical officer says,

Hey, raise your hand.

Quint Studer (52m 18s):
If you want some additional training on how to help be more effective talking to your patients, nobody is
going to raise their hand. Nope. Once you provide the training and the education, they’re so grateful for it. So
I think what you do is just a difference maker in Healthcare. And I’m very honored you have asked me to be
on your podcast.

Dr. Anthony Orsini (52m 37s):
Well, thank you Quint and what you have done for a patient experience really can not be underestimated.
You really made patient experience what it is today. We have a long way to go. There’s still, and I don’t have
time for the question, but we, we do know that most hospital executives place, patient experience in their top
three priorities and Yet many of them have not yet invested in patient experience, but thanks to you. It is now
put on the map

Quint Studer (53m 5s):
In 1999. It wasn’t even in the top 10, nor was employee engagement, I think two. And when you tie it in a
clinical outcomes, which I tried to do all the time, that’s where that all of a sudden it clicks just like an
employee engagement. You know, when the research came out and said, there’s a correlation between
employee turnover and your mortality, rate? So it’s no longer we’re lowering turnover at a lower, longer
turnover. We’re lowering turnover to save lives. So it’s really exciting for me to see there is an association
like the Beryl Institute that didn’t even exist. There’s a, job’s called patient experience. Chief patient
experience officer that didn’t exist. CEO is even having in their incentive comp that’s when you know, it’s real
when it’s, so we have a long way to go, but man have we’ve come a long way also.

Dr. Anthony Orsini (53m 54s):
And a lot of that has to do with you. You mentioned the Beryl Institute. Jason Wolf I interviewed just a couple
of weeks ago. His interview will probably drop early December, maybe right before yours. So Quint, this has
been amazing. I sent in the beginning of this introduction that we could probably do 10 of these. And I think
the audience now believes me because you have so much to offer what you’ve done for Healthcare or what
you’ve done for leadership and business is just amazing. When you agreed to come on in this podcast, I was
just elated. So thank you so much for coming. Thank you for spending your time. I’m going to put all the
references in our show notes about what’s the best way for someone to get in touch with you. And I’ll put that
in the show notes for those of you who are driving.

Quint Studer (54m 34s):
Sure. It’s my email is Quint@quintstuderstuder.com. I have one time, somebody sent me a note and I
responded right away. And the person’s husband said, yes, it’s not him. He has someone that does that for
him. So then she wrote me in another one and I confirm it really, it was me. So, you know, I pray every

morning just to be useful to people. So when people reach out and allow me to be useful, I feel I’m blessed
or a good friend of mine. And I went to thank him one day and he said, the one thing you and I will never
agree on us, who should be thinking who so, Tony, thank you. And anybody who reaches out, I’d be very
grateful to do whatever I can do to help them.

Quint Studer (55m 16s):
And I guarantee I’ll end up getting more from them than I’ll ever give them. Right.

Dr. Anthony Orsini (55m 20s):
Thank you. Quint this has been an amazing, if you like this podcast, please go ahead and hit subscribe and
download all of the previous episodes that we referred to during this podcast. If you want to know more
about the Orsini Way or about the book, you can go to the Orsini way.com. Thank you again, and thank you
again. Quint and I can’t. Thank you enough. It’s been great. So grateful. All right. Take care of well, before
we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an
ICU Physician. I want to thank the Finley projects for being in such an amazing organization, please.
Everyone who’s listening to this episode, go ahead. Visit the Finley project.org. See the amazing things that
are doing. I’ve seen this organization literally saved the lives of mothers who lost infants.

Dr. Anthony Orsini (56m 5s):
So to find out more, go to the Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (56m 11s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment in a review. You can
contact Dr. Orsini and his team, or to suggest guests for a future podcast? Visit us@theorsiniway.com.

Brand Citizenship with Anne Bahr Thompson

Anne Bahr Thompson (1s):
And Brand Citizenship is very much of the five step model is very much not just about communications in
that way of advertising, marketing campaigns, digital communities. It’s very much a conversation in terms of
full behavior of an organization, how a company behaves in every single action. And I think very much, I
know, as someone who goes to doctors periodically your responses very much, and based on the action of
the physician, not just his words.

Announcer (37s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of The Orsini Way. As a frequent keynote
speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to
navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in
their field who tell their story and provide practical advice on how to effectively communicate. Whether you
are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or
her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 22s):
Well, Welcome to Difficult Conversations Lessons I Learned as an ICU Physician. This is Dr. Anthony Orsini
and I will be your host again this week, today I’m very honored to have Anne Bahr Thompson as our guests
today, Anne is the author of the book “Do Good Embracing Brand Citizenship to Fuel Both Purpose and
Profit” a Trust Across America 2018 Top thought leader and a 2020 Superbrands Top 10 Branding Leader,
Anne Bahr Thompson has been using the Brand as a motivating force for change relationship building and
profitable growth for more than 25 years. A former executive director of strategy and planning and the head
of consulting at Interbrand, the world’s leading brand consultancy Anne is the founder of one sixty fourth, a
strategic and creative consultancy that helps integrate purpose and social responsibility into brands,
business strategy, and corporate culture.

Dr. Anthony Orsini (2m 15s):
Anne brings the knowledge and understanding that only comes from interacting with a lengthy list of the
world’s most prestigious brands. Anne is the author of Do Good. as I said before, Embracing Brand
Citizenship to Fuel Both Purpose and Profit. Her pioneering model of Brand Citizenship, which will be talking
about today is a win, win, win solution, mutually beneficial to people society and the bottom line. Anne’s
writings have been published in the top industry publications. She has been interviewed on numerous
podcasts, radio shows and Fox Business and spoken to the business schools, conferences internationally,
and the UN, but nothing as prestigious as this podcast .Anne holds an MBA from the Darden school of
business at UVA, and has been an adjunct professor at Stern NYU school of businesses, London campus.

Dr. Anthony Orsini (3m 3s):
Anne welcome, I know you’re incredibly busy and I’m very honored to have you take some time out to talk to
my audience today. How are you today?

Anne Bahr Thompson (3m 10s):
Well, and thank you. It’s a pleasure to be here.

Dr. Anthony Orsini (3m 13s):
So that’s quite an, an introduction and you’ve built up quite a resume. So I’m really excited that my audience
is going to get to learn all about Brand Citizenship and what you do, because I think it’s fascinating. I read
your book a few months ago and I thought it was incredible, I couldn’t put it down because I really like all the
kind of stuff that you talk about. So I want to get to the book, but first as I usually start off all my podcasts
with, I just would like my audience to get to know and Bahr Thompson and who you are. So please tell the
audience a little bit about yourself, about your book and how you came to found Onesixtyfourth consulting.

Anne Bahr Thompson (3m 48s):
Well, I’ll put myself in the context of my book since that’s why we’re here today. And I think what’s important
is I never set out to write a book or even create a model for Citizenship or Purpose or sustainability, whatever
you’d like to call it in today’s world. And what happened is very much exhibits who I am. I didn’t set out to do
this, as I said, but I actually followed the signs. I have a friend in the UK who calls it cosmic breadcrumbs,
and I followed the cosmic breadcrumbs over the course of a seven year period effectively, which culminated
in the book being published. The book is a result and my investigations into Brand Citizenship, which
actually didn’t start out as Brand Citizenship.

Anne Bahr Thompson (4m 32s):
It started out more as a business leadership, is a result of my being curious, my interest in understanding
how a cultural sentiment constantly shifts and moves forward, and my ability to connect the dots and relate
seemingly discreet things in ways other people haven’t related them.

Dr. Anthony Orsini (4m 51s):
A bit more about how you define Brand Citizenship because many people out there might not know what it is
and then we can move from there.

Anne Bahr Thompson (4m 57s):
So technically Brand Citizenship as a five Step Model that runs across something called the me too we
continuum. And I suspect will talk a little bit of more about both of those things.

Dr. Anthony Orsini (5m 6s):
Absolutely we will talk about the 5 steps.

Anne Bahr Thompson (5m 10s):
And I think what’s interesting is to deconstruct the phrase Brand Citizenship to actually understand what it is.

So technically, as I said, it’s a five-step model, but if you think of what a brand is and there’s definitions about
perceptions and how people view things, et cetera, but really the brand is a human face of a business. It’s
the thing that was, we relate to as people, as employees, as customers, as other stakeholders, the brand is
the human face. That’s the thing that causes you to have a relationship with the company in a certain
manner. So if you take brand as the human face of the business, and then you take the word Citizenship,
which is about being an active participant in society, Brand Citizenship beyond that five step model on a
technical level is very much about businesses being active participants in society and taking a role as a
citizen would.

Dr. Anthony Orsini (6m 8s):
So many of my audience. And I think when we spoke last month Anne you have that kind of the same
question, I looked at your face and I think you were asking the same question my audience is asking right
now, the name of this podcast is called Difficult Conversations. And I think when I was reading your face,
you were kind of had this little look like what is Brand Citizenship have to do with Podcast and how are we
gonna relate this? But the premise of this podcast is that all types of conversations that we have during our
time are really important, especially during those critical times in our lives. But the other part of the Difficult
Conversations is that there’s conversations that we have with ourselves there’s conversations that we have
with others, and that we’re not even aware of.

Dr. Anthony Orsini (6m 49s):
And if we can learn about these conversations and learn about how we communicate, that will be better off
than navigate through our professional lives and our personal lives. And as I read your book, I thought this
was really a type of conversation that companies and businesses are having with their consumers and the
public. Correct. And I think that’s how I think of this as you’re really trying to communicate with us. And that
isn’t, that what you’re teaching when you are discussing Brand Citizenship ?

Anne Bahr Thompson (7m 16s):
I would say it’s about communications and it’s about actions and aligning your words with your actions. So I
started out my life in the university, undergraduate as a biochemistry major. And one day I woke up and I
was looking at this book by Desmond Morris called man watching. And it was compelling me and it was
pulling me in and I actually started thinking, wow, this is more interesting to me. And I was in a special
molecular bio program at the time that there are a lot of people from China and India and their livelihoods
and their lives actually dependent on doing well in this program. And they would sabotage experiment
sometimes in the lab notes in the library. And I really was getting tired of all of that.

Anne Bahr Thompson (7m 56s):
And I wanted to learn more about people and the way people interact. And this book does by Desmond
Morris, man watching pulled me in, and that’s what drove me to go to communications. And in many ways,
the combination of biochemistry and communications makes me a natural anthropologist. And the first thing I

learned in communications in my very first lecture was things are not linear. You know, you say something,
you have a body movement, you have an action. It causes a reaction. You respond to how someone else is
behaving in the same way you were saying, you saw my face and say, Hey, you want it to answer that

Anne Bahr Thompson (8m 36s):
You are responding to an action, not necessarily a word. So I think what’s important to note is that
conversations are not only the words we have. They extend into the actions we have and whether your
physician having a conversation with a patient, or whether you’re a business, having a conversation with a
customer, with an employee, with a supplier, with an investor, with any range of stakeholders, what you say
and how you behave both creates that conversation. And brand Citizenship is very much, the five step model
is very much not just about communications in that way of advertising, marketing campaigns, digital

Anne Bahr Thompson (9m 24s):
It’s very much a conversation in terms of full behavior of an organization, how a company behaves in every
single action. And I think very much, I know as someone who goes to the doctor’s periodically your
responses very much, and based on the action of the physician, not just his words. And I think those two
things relate very much. I think the other thing that is very important to note, and I should’ve probably said
this before, is that I never set out to wrote a book, but I never set out to create this model either. What
happened was, is I was researching for, to come up with trends at the end of 2011.

Anne Bahr Thompson (10m 6s):
So five trends for 2012 to go out and market my business and have conversations with clients and potential
clients. And in the course of this research, two findings emerged that peaked my curiosity and led me down
this pathway to deconstruct Brand Leadership from Good Citizenship and favorite brands. So this Model
make so much sense. It resonated so much with you and others who read the book because it’s built from
the grassroots up. It wasn’t that I was in a corporate boardroom in a classroom, or even at home having a
glass of wine and saying, I want to come up with a model for Purpose or Citizenship because I think that’s
where the world is going.

Anne Bahr Thompson (10m 47s):
Actually, this was an advance of that being highlighted in spotlight it and people we’re calling for this. So the
model makes sense because it’s a five steps that will build from the grassroots up. And I think that’s very
important in relationships too, having empathy and listening to the people who are your audience, not
creating something, always in a vacuum.

Dr. Anthony Orsini (11m 10s):
And that will lead us beautifully to the five steps just this week where we’re recording this on November

fourth today’s date, November 4th, talking about just yesterday. We went live with my interview with Stephen
MR Covey, who wrote the famous book, the speed of trust. And we had a great conversation and I
encourage everyone to take a listen to that. And now this is like our 18th or 20th recorded episode may be
more. And one of the things that keeps coming up every single week, whether I’m speaking to people in
business, whether I’m speaking to patients or doctors or people in healthcare is the word trust and trust is at
the beginning of everything.

Dr. Anthony Orsini (11m 55s):
Whether it’s a marriage, a doctor, patient relationship, and how you establish that trust. And I really loved the
way you said it really is not what you said, but it’s how you say that because that’s my whole life. And that’s
what I teach. I go through hospitals and train doctors and nurses, and try to explain to them, it’s not that you
didn’t say the correct words. It’s that for some reason there was something on your face, something how you
said it’s something in your phrase, your tone inflection, that the patient looked at you and didn’t trust you.
And it doesn’t matter in medicine. I teach you one simple thing. Doctors should never use the word think,
they really don’t want a doctor that says, I think that you have that.

Dr. Anthony Orsini (12m 36s):
Now. That just means you’re stupid. And so we say, when I trained them, I say, of course you don’t always
know. We don’t always know everything, but if you find the mass or an abnormal picture on the x-ray, it, it
looks like cancer. Don’t say, I think it might be cancer. Say I’m concerned or I’m worried that this might be
cancer and that we need to work this up further. And by changing that one word you’ve really bought into
that trust. You went from a doctor who’s stupid. and doesn’t know anything to a doctor who really cares. And
so that leads us up into our five steps because here it is again, and the first step was trust, right? So can you
tell us more about that?

Anne Bahr Thompson (13m 16s):
And before I jump into that, I do want to say one thing in reaction or in response, I should say, not really in
response because they’re having a circular conversation here. Now I’m representing communication to what
you said is that it’s having a point of view. I think doesn’t represent a point of view, but I worry has a point of
view and people are looking for leadership everywhere and they are looking for guidance and having a point
of view is essential and trust begins with living up to your point of view. If you think of the word purpose,
which is a big loaded word at the moment in business, purpose is something that is the highest order reason
why your business exists is that plays on day at, in France.

Anne Bahr Thompson (14m 2s):
You know, it’s this highest order reason, but it has to be tied to what your business is about and your
industry. It’s not a social mission, but it’s a broad enough truths, a human truth. That’s broad enough and
deep enough that it fits the social mission. So once you have this point of view and this, purpose people
know how to benchmark you. And that’s the essential point of trust is knowing what to benchmark you from.

Prior to the global pandemic in the research, what happened was trust was based primarily on living up to
your product promises and commitments. So your product and services, you say, you’re going to do this. You
have to live up to it.

Anne Bahr Thompson (14m 42s):
And that’s how trust was based. In loyalty and retention work, which is a lot of my background from many
years ago. Trust used to be the end game for people in reputation management trust is the end game, but
actually, as you said, trust is the starting point for a meaningful relationship with the brand, with a business in
the same way it is for your wife or your friend, or for whomever. So you start with a living up to your product
and service promises, and then today’s world with COVID are actually living up to your claims, of your values
as a business what you say matters to you has been spotlighted and matters more. So the idea of what trust
means has grown deeper and wider in the course of the pandemic.

Anne Bahr Thompson (15m 26s):
So you move from trust, which is the me side of the equation, to enrichment, which has step two, which has
made my life better, more inspired, help me through your products and services, you know, make things just
feel more exciting. Then step three, which is the pivot point between being a me brand and a we brand is
responsibility. And it’s funny because when I was writing the book, I suddenly realized, Hey, at the middle
point, Step three is the pivot point between being a me brand and a we brand when the steps are emerged
from modeling and, and the research and the grassroots up, I didn’t even realize that the middle point was
actually a pivot point.

Anne Bahr Thompson (16m 7s):
So again, it wasn’t curated. It wasn’t contrived. It’s something that just emerged naturally through modeling
of what people told us. So responsibility is about the typical common things people associate with corporate
social responsibility, but, and this is a critical, but because it’s been highlighted more and more again with the
pandemic. Responsibility begins with treating your employees well and fairly. And what was happening is
because that started being a little bit of a given the environmental, treating the environment well was starting
to rise. And especially with climate change being highlighted, and so many people starting to acknowledge
and recognize it, and the UN SDG, sustainable development goals and companies signing on to deliver that
the environment started rising higher and higher as an important factor for people in being responsible.

Anne Bahr Thompson (16m 59s):
But then when employees health and employee’s safety started going to risk, what happens? Treating
employees fairly comes again with social justice issues. What happens treating employees equally and with
equity starts rising again. So responsibility to get credit for the good you’re doing in the world. You have to
first show people, your treating your employees well and fairly. So we have trust enrichment responsibility.
And then the We side of the equation, is community, connecting people through shared values, bringing
them together. And this is not just, you know, online communities, which is so easy to resort to, but actually

bringing people together and shared community program days in a variety of things, it’s businesses coming
together because they share our values and want to save forests or they want to save water.

Anne Bahr Thompson (17m 55s):
So it’s also business associations. So it’s multilevels of community bringing people together because you
share our values and you share our approaches to solving problems. And then contribution is make my world
better. And by my association with you, I am contributing to the world. So you are doing good and you’re
doing good on my behalf. So it’s making me feel bigger than I am when I stand on my own.

Dr. Anthony Orsini (18m 25s):
So, Anne in your research, and in your book, you mentioned a lot of different companies and one company
that you mentioned is my favorite company of all time. And that’s Apple and Apple was always at the top.
And it seems from your book, it’s a lot of people’s favorite company. And I was reading the book and I’m
trying to decide, looking at your book. Why is it that Apple is my favorite company? And I think I agree with
what you said in the book, but also a part of me was I remember that commercial many years ago, the first
Apple commercial, I think what the briefcases, you know, I was just graduating medical school. So I’m going
to say nineties ?

Anne Bahr Thompson (19m 7s):
The George Orwell commercial you mean?

Dr. Anthony Orsini (19m 12s):
Yes, yes where every day for people out there that don’t know, it was just a whole bunch of IBM like business
people in the same suits, walking like soldiers and the Apple message was be different. And I thought that
was cool and I became a big Apple fan. And there’s nothing, that’s not an Apple product in my house right
now. We don’t have any windows, any IBM. And so tell me a little bit about Apple and how are they able to
get to that point?

Anne Bahr Thompson (19m 32s):
the first thing that’s important to note is Apple actually is one of the reasons that I spent five years after the
first study investigating and deconstructing Brand Leadership from Good Citizenship and favorite brands. So
in that very first study in 2011, that was meant to come up with five easy trends to go talk to companies
about it for 2012, two interesting findings came about. We asked people which brands they thought would
exhibit leadership in the coming year, and which brands were good citizens. And within this, we also asked
why. And when you look at it, a lot of these studies that are published, what you often don’t know is many of
them don’t let you say whatever brands you want.

Anne Bahr Thompson (20m 18s):
Many of them are actually having you rank or rate or discuss a specific set of brands and that they don’t talk

to you about it. You have to have done a lot of this research to know that. So we had a completely
open-ended playing field and we had 2200 brands named as good corporate citizens, which means it was a
very fragmented market. It means that the definition of corporate citizenship was pretty vast for people.
There wasn’t a single definition that honed in on 10 great companies. And Apple came up as the number one
good corporate citizen, which normally I ask you to tell me which brand and 20 at the end of 2011, you might
think, but since you started with Apple you preempted that question.

Anne Bahr Thompson (21m 9s):
So it was curious to us at Apple was named as the number one good corporate citizen. We absolutely
expected it to be named as the number one Leadership Brand, but we never expected it to be named as the
number one good corporate citizen, especially at the end of 2011. Probably I think it was starting in 2010
Apple was in the middle of a bit of a scandal with activists and in the media because they had a chip that
was causing some problems and illnesses in China. And there was a whole lot of people on them because of
their supply chain and then not taking responsibility for the supplier’s they chose. So Apple was by no means
anyone we expected to come up in their, it didn’t even come up in conversation, but it was the number one
good corporate citizen.

Anne Bahr Thompson (21m 55s):
And why it was goes to the me to we continuum and goes to your question. So when you ask people, why
was Apple? Why did you say Apple? You know, it is number one it’s because Apple transformed the way I
communicate with other people across the globe because of the iPhone. Apple brought joy into my life by
bringing me music 24 seven, Apple changed so many things in the way we behave, communicate, and just
spend our time that’s in people’s mind that made it a good corporate citizen. So it was a very me proposition,
another brand that was a good corporate citizen that came up in the top three to five was Walmart.

Anne Bahr Thompson (22m 39s):
And this study was done in the U S and the UK, the UK, there was a comparable brand called Tesco to
Walmart that came up. And when you asked people why, because of their pricing policy, I’m afforded a better
lifestyle. Again, a me proposition, there was no way we expected this. And Ford came up because Ford had
been recovering. We are now great recession, 2008, end of 2011 Ford turned around and if Ford can turn
around that means America can turn around. And if America can turn it around, that means I can turn

Dr. Anthony Orsini (23m 17s):
And Ford didn’t take any of the money that the other companies did, so that kind of made them, I can do it
on my own kind of look at it. Yeah.

Anne Bahr Thompson (23m 26s):
That spirit of self-reliance that I can turn my life around, but all of these were me propositions and who

would’ve ever thought of good corporate citizenship as a me proposition. And each of these brands had
corporate citizenship initiatives that people didn’t know about. So it was sort of mind boggling two us. So
that’s one finding. And then the contradictory finding that came up this study was people were saying they
wanted business to step in and reform society and make things in society better because government was
unable to do so because politicians we’re so divided. And if you think back, and we are speaking to the day
after an election at the end of 2011 was a, another election year of 2012 election.

Anne Bahr Thompson (24m 7s):
So people then thought there was a huge range of partisanship and that politicians weren’t going to solve
anything. And so they were saying business faces no opposition in the way, if a politician does, although
What, they weren’t realizing. And I talk about this in the book is the business does have a bit of an opposition
and, and it has a board. It has to, to go to the shareholders. It has to go to and deliver it too, but it’s different
type of opposition then being a politician. So business needs to step in a reform society. We proposition
Apple that are in my life, me proposition. And this is what is the thing that really sort of made us step back
and pause and say, what’s going on here? This makes no sense Citizenship is supposed to be about We.

Anne Bahr Thompson (24m 49s):
But what we learned is that about me and we, and balancing those things out and Apple over time has really
bettered its performance on the We side. You know, you see Apple doing more and more to deliver on the
We side, as it delivers on the Me side. And why is Apple your favorite brand? Because it’s at step two, it’s at
enriching your life strategically. It just makes you feel better. It inspires every moment of your life, but it has
the other steps. It has elements of the other four steps. And so it slides back and forth along that continuum
of Brand Citizenship, it serves you as me and it serves you as we.

Dr. Anthony Orsini (25m 27s):
I’m going to draw some parallels to what I do at health care on everything you just said. First of all, what I
love about your model, as you said, it’s from the ground up. And when I teach physicians and other people
about communication, patient experience, as a big deal right now, where in medicine right now are finally
giving the patient a voice before they never had that voice before. And there’s very good physicians that are
struggling. They’re excellent physicians. They’re not trusted because they have that look in their eye, or
they’re just not good at communicating, or they just don’t know how to bond to their patients. And we are
often taught a look at people who are good at something and trying to learn from them. And I think that’s the
exact opposite.

Dr. Anthony Orsini (26m 10s):
And I think you’d agree because that’s what you did. When I speak to groups, I’ll say to them, you know a
physician or a nurse or a business leader, an administrator, who walks into the room, and everybody loves
him or her. And you know, that person who, when on their patient satisfaction scores as a doctor gets a 98
percentile. And he’s awesome. That’s the person that you should be looking at. We’ll look at her and say,

what is it that she’s doing that I’m not doing? And I don’t think society has really done that, but that’s
basically what your model was. Right? You looked at, you found that Apple and Walmart we’re up there. And
then you went back and said, why.

Dr. Anthony Orsini (26m 50s):
Right. And I think that’s a good parallel to what we do when it goes back again to the trust and the
leadership. And so there are so many parallels in every day, life and personal and private life. These are
conversations that companies are having with their employees.

Anne Bahr Thompson (27m 6s):
You have to look at great examples, whether you’re a business or you’re a person, but you can’t necessarily
do what they do in the same way they do it. And so the notion of purpose or being, you know, authenticity is
a trendy word. And I’ll in a moment tell you why I actually am not so fond of the word anymore, but you have
to do it in a way that’s true to who you are, because if you completely mimic them and that doesn’t sit in your
center and it doesn’t reflect who you are or how you look or what people know as your values, it comes off
as insincere and people won’t believe it. So you have to take cues and notions from leaders, but then follows
through in a way that’s true to who you are, make it true to your purpose.

Anne Bahr Thompson (27m 54s):
So what I like to think of it as is actually, how do you feel comfortable and confident to go out there every day
and be your best self? And to me, whether you’re a business or an individual physician working with a
patient, that’s the true thing. Sit in your center, be grounded in yourself, in your true purpose and be your
best self. Yes. Learn from others, but do it in a way that’s true to who you are.

Dr. Anthony Orsini (28m 21s):
Agree. 100% in the fact that the word that we use is be genuine and you have to be genuine. And you’ll see
the best people that are able to build rapport. They have good conversations, create loyalty. Whether there
are a leader in business or their are a doctor, they are genuine people. And so, yeah, correct. You can’t copy
somebody, but you can look at them and say, what is that they’re doing? You know, wow, this person’s being
himself. He commented on baseball. Or he sat down with his patient. He wasn’t typing on the computer while
the patient was speaking and he looked in his eyes and so on, but you’re absolutely right, people will identify
fakeness if you will, in a heartbeat.

Anne Bahr Thompson (28m 58s):
Yeah. I think that’s the problem with authenticity in the social media world. Back in 2007, we have millennials
telling us that authenticity in today’s world was curated at best and contrived. The more typically and how
they spoke about that had to do with their playlists. And they would talk about how they knew their friends
weren’t listening to a lot of these things on their playlist and they couldn’t figure out why they have certain
songs pop up. And then they realized that was because they would make sure that they pick that song. So it

would come up to the top. So people wouldn’t actually know what was on their playlist and you have to go
back and remember iPods to go back to remember that was 2006, 2007.

Anne Bahr Thompson (29m 40s):
So authenticity is very much curated on social media. It is your true story, but it’s the parts of your story
you’re choosing to let people know. And with businesses, and I’m sure there’s elements of this that relate to
physicians with businesses, telling their authentic story is how they reframe who they are often. And so you
used the word genuine, which has a word I debated on using. And I ended up using the word sincere
because sincerity is speaking from the heart and people know when you speak from the heart. And that’s
how you tell when someone is quote unquote authentic in the truest manner or not in the new social media
version of authenticity,

Dr. Anthony Orsini (30m 23s):
Let’s switch that over to one of my other favorite topics is Leadership. And you have to have conversations,
companies call you in to help you with their branding, their brand Citizenship, et cetera. Do you have to have
some difficult conversations with leaders? And maybe I know when I give workshops, you can see the
people that have bought into this and the people that haven’t bought into that. And sometimes they’re in the
same room. And sometimes the bosses, you know, when I give some big workshops, you can see the doctor
in the back with his arms folded, who really doesn’t want to listen. And I get some credibility because I’m a
physician. And I usually I’m able to use my communication skills to bring them around. But how do those
conversations go?

Dr. Anthony Orsini (31m 3s):
When you have somebody who was really just not buying into this and they are asking for help, but not
everybody’s on board. Is that something that you run into a lot ?

Anne Bahr Thompson (31m 6s):
Everyone not being on board? Absolutely. But why are you brought in often is because they know there’s
something wrong now to your point. And I think it’s indirectly hidden underneath. What you’re saying is
people resist change. People think they want change until it means they as an individual have to change.
And when you go in and whether it was way back when doing traditional corporate identity to moving now
into how you integrate citizenship and, and diversity and inclusion and belongingness all of these things into
an organization, which are all elements of your brand all elements of brand citizenship, it’s hard for a lot of
people to grasp on, to change.

Anne Bahr Thompson (31m 52s):
So you have to do things, not in a way. That’s what I always call pulling off the white sheet. It’s not like, Oh,
here’s the answer. It’s more that you have to get people to work with a material and then understand it. And
absolutely your listeners can’t see this, but I’m smiling because I can think of so many client engagements

where someone in the room really didn’t buy in or decided that the business was going in the direction that’s
different for them. And I have an exercise that I do that has to do with the first 100 days. And people
confidentially reveal things of what they’re gonna change in their behavior. And then 100 days later, we send
them a reminder to see if they have actually lived up to what their commitment was.

Anne Bahr Thompson (32m 40s):
And undoubtedly, even in the room of executives, or, you know, if you even have 10 people that are board
level or, you know, have a C-suite on doubtedly one, person’s always has decided the direction of the
company’s moving is, not a place that they want to go. So, yes, it’s a difficult conversation. If you were to
make it just a simple, this is how you have to behave. But if you get people to interact and come and
internalize these things to themselves and start thinking about it, they usually get their, you know,
businesses are run by people and most people don’t wake up saying, I wanna be a bad person today. You
have to believe that most people wake up saying, I want to do good today.

Anne Bahr Thompson (33m 25s):
I want to get through today in a way that makes me feel good about myself. And it’s just a matter of the
things they have to balance that directs them. And you know, many ways your job is to hold their hand and
insure they don’t lose their way. Yes. And that they feel comfortable. As I said before, it’s being comfortable
and confident to be the best version of yourself, whether you’re a person or a business, that’s really what
being a good brand citizen is about. That’s what really, you know, gaining the greatest social and financial
value from your brand is about being the best version of who you are.

Dr. Anthony Orsini (34m 4s):
Convincing that person in the room that they should change is often difficult. I do this thing with conflict
resolution when we do this exercise and we, I have four pillars of conflict resolution, but the fourth one is
making them think it’s their idea. And if you lead them correctly, to the water, and they’ll say, gee, maybe I
should have a drink. And I think that’s the biggest problem. You know, in my business, that’s usually the
patient is unhappy, the medical error, the other things that are a big deal. But if you sit with them, you build
that trust and they start to trust you in the end, they’ll say, you know, Anne this brand citizenship thing, that
was really a good thing, you know? And you know, like, yeah, that’s really insightful. So I think that’s really
important to get the person who is at least buying into it to get on your side.

Dr. Anthony Orsini (34m 49s):
And I’m sure that you’ve had trouble doing that and any advice to anybody to get to do that. And when that
happens to them.

Anne Bahr Thompson (34m 56s):
Yeah. And I think it’s probably the same in what you do is that this is a journey. We are not going to step out
of the box and do everything right. And as a matter of fact, you’re probably going to do a lot of things wrong

because we’re developing new models. And then any moment you are developing a new framework and
new way of doing things, you’re going to make mistakes. But the idea is let’s commit to doing this. Let’s
commit to doing this in the best way we can in the most sincere way we can. Let’s also recognize that we
can’t make everything perfect at once. And I think one of the challenges, so many businesses face that is so
hard for them is once they do one thing right, activists are in there trying to suss out what their doing wrong.

Anne Bahr Thompson (35m 44s):
You can’t change the business models we’ve been living with for decades. If not longer overnight, it’s going
to take some time. And if they changed everything at once and made everything all about 100% sustainable
supply chains, you know, 100% raising salaries for everybody, you can’t do it all at once because you lose
your profit. And if you don’t have profit, you can’t maintain yourself as a business. And that’s why it’s about
balancing. It’s a balancing act in how you slowly gracefully make your way along this pathway in the thing
that’s, good about the five steps is it gives you small steps So you don’t get overwhelmed with this big thing.

Anne Bahr Thompson (36m 28s):
I have to go live with purpose because that’s overwhelming. You know, and how do you start? And it’s about
taking small steps, taking step one, committing to doing things better and getting on the pathway. And if you
look at the way, the five steps span out, it helps companies sort of categorize how to make changes, where
they can make changes, where they can do things better. What’s easier to do. What’s harder, what’s longer,
but you have to be committed for the long haul and not just do a check the box exercise, and then go out
there and say, we’re great. We’ve just done this. It’s about committing to changing behavior over time for the
long run and aligning yourself and keeping yourself in balance.

Anne Bahr Thompson (37m 9s):
Even us, as individuals, you know, how many people say they’re going on a diet. And after you know, two
days a week, it’s about aligning with your commitments and following through on them. You have to keep
yourself in check all the time. So you have to also have measurable benchmarks, you know, and business,
that’s what it is not measured doesn’t happen? So you need to create a new set of benchmarks, a new set of
performance management to match this up, which is why ESG on the investment side and how investment
managers evaluate companies from environment, social and governance now is going to help change the
way businesses behave.

Dr. Anthony Orsini (37m 45s):
Because it’ll be their bottom line with a patient experience. It was always considered a soft thing to have it.
It’s kind of nice, but hospital administrators, 90% of them said it was an important thing, but they weren’t
doing anything about it. And then Obamacare came along and Medicaid and Medicare started thinking, you
know what, if you have a poor patient experience score, I’m going to pay you less. All of a sudden now
patient experience is a big deal. And so that’s why people hire me now to say, you know, you need to help
me with the doctors and the communication because our patient experience scores need to get better. For

my audience this is just audio. So you can’t see Anne’s face.

Dr. Anthony Orsini (38m 26s):
But one of the things that I noticed about you when we’re speaking, which I think really helps when you’re
doing your workshops in your brand citizenship to companies, it really helps when someone’s passionate
about this. And you can see my face. When I talk about what I’m doing, people go, wow, you just light up
because this communication training and this patient experience stuff, and the stuff that I do is, and I’m
training human resources people. Now, I think the guy who’s standing in the back with his arms folded sees
the excitement on your face. And I can tell from your face that you really believe in this and you think this is
really cool. And I’m just going to make a commentary here that I believe that helps because when someone’s
up there going through the motions, it’s like a teacher or an elementary school, right?

Dr. Anthony Orsini (39m 9s):
If their just here’s the problem lists, but if you are up there and going, Hey, this was the coolest thing ever.
The students really respond to that. So I can see your face. When you talk about it, you love this so much.
So that’s really cool. I just want to tell everybody that

Anne Bahr Thompson (39m 22s):
One thing to build on that is that my intent in writing the book was actually to provoke more meaningful
discussion and spotlight and accelerate the changes that were happening. And the book was published in
2017, the end of 2017. And then the research started in 2011. And now you see how this stuff is out there
and important for businesses. And, and it’s essential with a global pandemic that so many of these principles
are lived up to. So I mean, people would say to me, after I published the book, why aren’t you working more
and more with social enterprises? And I do work with some social enterprises, but the reason my focus is
corporate is because if a corporation changes something, the impact it can have because of the scale is

Anne Bahr Thompson (40m 4s):
The impact it can have on people and how they behave, you know, on supply chains, in the developing
world, its huge that’s important. Social enterprise is essential also, but we can’t just assume we can replace
business with social enterprise. We need to bring the two of those things closer together and have each of
them embrace principles of the other.

Dr. Anthony Orsini (40m 27s):
And that was so cool about your book. I mean I’m reading your book and I’m going companies or having
conversations with me. This is what this is. And I thought it was a really cool thing. And that’s why I thought
this podcast is perfect. One final question that I ask everybody, that’s a very difficult question. So get ready. I
don’t know if I put this on to your list. What is the most difficult conversation that you have on a regular
basis? We don’t have to get too specific, but you know, for doctors is telling somebody that their child died or

that they are or have cancer etcetera, in what you do. What do you think is the most difficult conversation?

Anne Bahr Thompson (40m 59s):
I wouldn’t say it’s difficult in the sense of getting people to believe you. It’s difficult in the sense of finding the
way of approaching it and telling this story. But you know, you’re typically not brought in because a company
is doing great. You do have some amazing companies that do call you because they want to keep getting
better and better. And I love those people. I love going in there and watching transformation happen. And to
me, that’s what excites me in finding the right steps to create transformation. But to get to that, you have to
make people aware of the things they’re doing wrong. And the way back when I worked in B2B banking and I
started realizing what a lot of my job at the time I was in strategic planning and research and retention and
satisfaction and all this stuff and its B2B bank.

Anne Bahr Thompson (41m 48s):
And you know, this is big money stuff is consumed not to undermine consumer banking, but you know,
having conversations to tell them you are doing the wrong products and services is really hard. And what I
realized is my job was to dispel corporate myths and most anecdotal wisdom that runs across an
organization is rooted in some truth. And you have to surface that truth and show why it’s no longer true.

Dr. Anthony Orsini (42m 15s):
And there is a great advice right there in the

Anne Bahr Thompson (42m 18s):
First thing that you do. And when you are doing management and interviews or when you’re talking in a
briefing meeting, whatever it is, where you’re getting your bit of insight, and I’m sure you do this too, with
people with individuals, what are the sacred cows? Because if you don’t identify the sacred cows, you don’t
know how to communicate, to maneuver around those landmines because usually the sacred cows need to
be dispelled. They’re usually corporate mythology are based on anecdotal wisdom and that’s, what’s holding
you back. And, you know, fear is what prevents us from moving forward. Someone once said to me, fear is
false evidence appearing real.

Anne Bahr Thompson (42m 58s):
And I remind myself about all the time. So as you step on this pathway of doing good, you have to remember
that maybe making the mistake is not bad. And that’s your biggest fear factor. Usually

Dr. Anthony Orsini (43m 10s):
I love it. That’s fantastic advice and a great way to finish. Anne this has been amazing. I, this has been great
again, the name of her book is Do Good, it’s available on Amazon and I’m sure everywhere else. Anne
what’s the best way for people to get in touch with you?

Anne Bahr Thompson (43m 26s):
Well, my Twitter is @AnneBT and then my easy to remember email address is ABT. So Anne Bahr
Thompson @ one 64th and it’s the fraction spelled it out, which may not be the easiest thing for people.com.
It’s one S I X T Y F O U R T H.com. I’m on LinkedIn. I’m on Twitter. I am on Facebook, but I don’t use it
really anymore. So there’s multiple ways of getting at me and my website’s. They all have a way to contact

Dr. Anthony Orsini (43m 58s):
Yeah, we will put all of that on our show notes. So you don’t have to remember that if you are listening in the
car or they’ll write it down and we’ll have it all in the show notes, and you’ll be able to go ahead and click on
it. This podcast is available on just about every podcast format. If you enjoyed the podcast, please go to your
favorite podcast format and hit subscribe in, download all of the previous episodes. But if you want to find out
more about the Orsini Way please go to the Orsini way.com and you can also get the podcast episodes from
there too. Anne thank you. This was a lot of fun and it’s really great to get to know you. And I hope that we
can talk to you. And again, thank you.

Dr. Anthony Orsini (44m 43s):
If you have enjoyed this podcast, please hit the subscribe button and leave a comment or review. To contact
Dr. Orsini and his team or to suggest guests for a future podcast visit us@theorsiniway.com.

Elevating the Patient Experience with Jason Wolf of The Beryl Insitute

Jason Wolf (1s):
When you look at what consumers say and we look at the data again, and again, back to the things we
talked about it. Listen to me, communicate to me in a way that I can understand, treat me with dignity and
respect. Those are the things that are at the top on the lowest level of the scale for them is the best food
ever parking is easy, all of these things. Yet, we spend all our money on the side that matters the least to
patients. And we call that patient experience in investment. And therefore we leave ourselves unbalanced.
Instead of working at the fundamentals where a leader can model the kinds of behavior they can suggest not
only just suggest but demand that that’s the way in an organization operates. And you’re creating an
experience with little to no resources, except having very smart people, guide that process and having the
right people involved in your organization execute on that every day in every interaction .

Announcer (51s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author, Dr Orsini has been training healthcare professionals and business leaders, how to navigate
through the most difficult dialogues. Each week, you’ll hear inspiring interviews with experts in their field who
tells her story and provide practical advice on how to effectively communicate. Whether you are a doctor are
faced with giving a patient bad news, a business leader who wants to get the most out of his or her team
member’s or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 35s):
Well, I am honored today that the Orsini Way has partnered with the Finley project to bring you this episode
of Difficult Conversations Lessons I learned as an ICU Physician. The Finley project is a non profit
organization committed to providing care for mothers who have experienced the unimaginable, the loss of an
infant. It was created by the founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that
time that Noelle realized that there was a large gap between leaving the hospital without your baby and the
time, when you get home, that led her to start the Finley project. The Finley project is the nation’s only seven
part holistic program that helps mother’s after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 19s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards,
professional house cleaning, professional massage therapy, and support group placement. The Finley
project has helped hundreds of women across the country. And I can tell you that I have seen personally
how the Finley project has literally saved the lives of mother’s who lost their infant. If you are interested in
learning more or referring a family or donating to this amazing cause please go to the Finley project.org.The
Finley project believes that no family should walk out of the hospital without support. Well welcome to
another episode of Difficult Conversations: Lessons I learned as an ICU Physician.

Dr. Anthony Orsini (2m 59s):
This is Anthony Orsini and I will be your host again today, you know, before we start, one of the best

decisions that I really made is to do this podcast. I really do believe that it provides a unique opportunity for
healthcare professionals and business leaders, to learn more about communication, about leadership,
culture change, then how we can really do better. In our professional and in our personal lives, just by
understanding the human to human interaction. But really one of the best things about hosting this podcast
is I get to meet people and connect that I thought I otherwise would never get to meet. I’ve been really
fortunate to actually to keep in touch with many of the guests that has been on this podcast. So I would feel
really blessed.

Dr. Anthony Orsini (3m 39s):
Now at one person I’d been trying to meet is, our guests today and Jason, and I’ll introduce him in a second.
Jason is a very busy man. He’s very approachable. He’s a great guy, but boy, when I meet him, there are
thousands of people around him. And so I shook his hand, but I’m sure he doesn’t remember, but thanks to
Diane Rogers and some mutual friends. I was, if you ask me a few months ago, will I be interviewing Jason
right now? I probably would have said no way, but last month we did it, hit it off. We spoke on the phone and
he’s been kind enough to come on to this. Now, before I introduce Jason, I want to tell everybody out there
that if you are in the health care industry and you’re listening to this and the majority of our audience is , I
just want you to tell your friends about this, please go ahead and share with your, whether their hospital,
administrators, nurses, or doctors, anybody who has anything to do with patients, because we’re really going
to talk about something that’s near and dear to my heart and something that’s really important.

Dr. Anthony Orsini (4m 31s):
And that’s the patient experience. So it just pick up the phone and call your friends and tell them that you
have to listen to this. Today I have, the distinct honor of speaking with Jason Wolf. Jason Wolf is a
passionate champion and recognized expert on patient experience. As President of the Beryl Institute, Jason
has led the growth of the organization into the leading global community of practice and thought leadership
on improving the patient experience. A central leader in expanding the patient experience movement, Jason
is also the founding editor of the Patient Experience Journal and serves as president of the patient
experience Institute, which is a non-profit committed to continuing education and professional certification
prior to leaving the Institute Jason designed and led the organizational change service and leadership
development strategies with HCA health care working with over a 45 facilities on improving and changing

Dr. Anthony Orsini (5m 23s):
We also conducted groundbreaking research to identify the characteristics of high performance health care
organizations, which I hope we we’ll get to speak about. Jason is a sought after speaker provocative
commentator and respected author of numerous publications, including two books on organizational
development in healthcare and over 25 white papers on Patient Experience Improvement. Jason lives in
Nashville, Tennessee. And in his spare time, I’m told he likes to watch the Nashville MLS team and a run to
his kid soccer. Welcome Jason!

Jason Wolf (5m 54s):
Thanks for that. I really appreciate the chance to be with you and really humbled to be asked to be a part of

Dr. Anthony Orsini (5m 57s):
Thank you so much. Please call me Tony. I’m just Tony to everybody. Only my mother calls me Anthony and I
can’t get her to stop.

Jason Wolf (6m 4s):
It’s our Jersey roots I got you, you know what I mean? You know,

Dr. Anthony Orsini (6m 7s):
Let’s talk about that. I want to tell your story, but you know, this was actually a question down the line when
you and I spoke up and it turns out that we grew up, I checked it on Google today. We grew up about nine
miles from each other. So that’s pretty amazing and we’ll talk about that later on, but I really want to get into
patient experience. So I want to get into the communication, but I always usually like to just start about just
the letting the audience get to know you. So if you don’t mind just telling us your journey, how did Jason Wolf
get here?

Jason Wolf (6m 35s):
Actually, you mentioned your mom and I think I got to thank my mom first, right? I mean, it’s not growing up
in a household that was run by my mom with my brother and I, and her, she instilled a real sense of purpose
in me from the beginning. And this is not just because I hope she’ll listen to this one day, but because it’s
true. I think that the, you know, I mean, when you are supported and, and believing yourself and have the
privilege to have that, and I will acknowledge that and then are challenged to be your best. And to know that
there is greater good that you can do in the world and caring for other people, you know, that inspires you to
really think big, there are roots there that I have to acknowledge those seeds for any journey like this, that
we’re on,

Dr. Anthony Orsini (7m 13s):
That we are where we come from.

Jason Wolf (7m 15s):
And, you know, so for me, I’ve been fortunate. You now have a background in, I believe it or not. And in
international relations, So trained in being a diplomat, but found myself in the organizational world and
ultimately in healthcare. And I think like many that kind of an interesting and winding youthful journey that
really found my way into focusing on an organization Improvement and in particular, doing that within health
care. And as you noted within that in particular in the HCA healthcare system was my last stop on that

journey. During that time, they are really discovered there was a huge opportunities. You know, we were in
the living in the core measures era, and also at the beginning of sort of in the United States, the caps
evolution, an application at that in practice, but being a student of culture and being really a student of
diplomacy in life at the edges of relationships realized how important that was, and also acknowledged and
seeing not only our system, but looking at health care as a macro system, we were struggling with
collaboration, with connection, with the sharing of ideas, with the rising of the tide, for all that participate in
health care and really was an inspiration for what it was to become the Beryl Institute in its form today in that
reality was that if we could create a place that wasn’t trying to sell anybody, anything wasn’t associated with
a vendor or a product wasn’t associated with one provider institution or another, but it really became a safe
place for people to come together, to share ideas, to support one another with purpose, and to acknowledge
that the knowledge that people share is so vital and important to do that we could create something that
potentially had an opportunity to the way we looked at health care, the way we thought about what health
care could do, and ultimately the impacts that healthcare could have.

Jason Wolf (9m 2s):
And so it was kind of a, if you build it, will they come? question 10 years ago, just a little bit over 10 years
ago now to the fact that people have shown up and this journey for me of realizing that when you can hold
the space kind of grounded to those initial seeds, I was talking about around think, finding your purpose,
being clear on what potential is and acknowledging the power in others, and then supporting kindling,
fostering, and, and bringing it together. You can accomplish great things. And, you know, in this last 10 years
have now grounding the Beryl Institute with this idea and growing it into this global organization that you
noted has been incredibly significant to me personally, because, and it’s never been about me, you know,
that in our conversation, not even about the Beryl Institute, but it’s about the potential that we all have to get
at the essence of this work to elevate the human experience in healthcare.

Jason Wolf (9m 56s):
And so to see these tens of thousands of people from around the world contribute knowledge, ideas,
thoughts, but also compassion. And shoulder’s at times of need. And, and in particular, Elevating, they’re
support for one another in times of crisis like we’re in right now has been incredibly moving, an overwhelming
to see. And so the kind of impact that we’ve seen this global community of practice as a global network, be
able to have as a result of the passionate work, such as the work that you are doing, being filtered through
this entire global infrastructure has been incredibly powerful and moving. And so that’s the way I see my
journey. It’s not so much all these milestones along the way, but one driven from seeds of purpose that has
really enabled me to do everything I was taught back in those days from my mom.

Dr. Anthony Orsini (10m 40s):
I think that’s a beautiful way of thinking about it because we all are whoever we come from, the patient
experience is, you know, its come a long way from being this, saw it kind of soft skill that, yeah, that’s kind of
nice. And you know, my journey as you know, is from Physician and I started out really being interested in

communication and how the doctors break bad news. And so I was always kind of into that communication. I
find it really fascinating, but as time went by, it went from, yeah, yeah. That’s kind of nice too. And I think the
Beryl Institute, has a lot to do with that. I mean, right now the patient experience is in the front of medicine
right now.

Dr. Anthony Orsini (11m 23s):
And, and what I really love about just to put aside, what I really love about the Beryl Institute is that is it, it is
independent. And you said, you’re not looking, trying to make money. And I’ve been to several of your
conferences. I even spoke at one of them and it is really kind of like a family. And I think you’ve done that.
And when you are walking around, everybody wants to hear about what you’re doing and what I’m doing.
And so do you think it’s a generational thing? Or why do you think that all of a sudden the patient is totally
different than they were 20 years ago? Now the patient is understanding that my experience is really
important in that I do deserve to be treated better.

Dr. Anthony Orsini (12m 3s):
Why do you think that’s changed over the last 10 years or even more?

Jason Wolf (12m 6s):
Yeah, I think it’s definitely been quite an, an arc of evolution. I think in the way that health care has operated
and in the way that health care consumers react it to their engagement in health care. My grandfather was a
pediatrician. He was a pediatrician in Patterson, New Jersey. I remember watching him, he would literally put
on his fedora and his suit in his little black bag and walk across the street. Cause he literally live across the
street from his hospital. He’d spend time, you know, doing his rounds, he’d meet with his residents. He
actually stop and had lunch with this nurse’s and they would come home across the street that afternoon.
And in the afternoon, open his one room practice and see children and their family.

Jason Wolf (12m 47s):
And you know what I saw it, you know, in watching my grandfather do that was even though as a
grandfather, he was actually a little scary to me was this compassionate guy, almost this Norman Rockwell
picture of a black and white checkered waiting room with a wooden panels walls. But these toys and books
were, he would get them on a knee when he came out to bring the next child back and talk to the child and
acknowledge the parents and walk everybody back together. And you know, even in the moments like that,
where I know the system that he was operating, one is one of hierarchy. Right? Do what the doctor says, go
to your appointments, go and do what you’re told the potential for that connection always existed. But I think
what we’ve found has evolved over time is the realization of the power of that as part of really the
prescription for health and wellbeing became more and more evident.

Jason Wolf (13m 36s):
That it wasn’t simply the science of medicine that mattered. But the research has evolved dramatically from

the aspects of care. To, a rapidly evolving consumer population that has access to more information is driven
to make different choices. And so I think it’s the kind of this inflection point of a shift in the way people realize
they could deliver on medicine that expanded their own capacity. That really drove them back to their
purpose. Right? My grandfather was a McGill graduate raised in the Ostler methods. He was taught that
person centeredness. It is that connection to people as important, but yet it in practice, we started wiped that
out. But I think what happened is all the purpose that drove.

Jason Wolf (14m 16s):
I’m sure you, in so many others to choose the clinical world is a profession wasn’t because I, you know, I am
a science whiz, even though you need to be incredibly smart at that it’s because you have a bigger purpose
for caring for the person in front of you. And I think we created a space for that to come out. I think the
consumers asked for that to come out and they started making choices as a result of that. And so that
evolution of the reality of moving beyond just the mechanisms and science of healthcare, I think was this arc
of life we’ve been on now, it’s been inspired yes. By things like surveys and other things in particular in
United States, like the CAHPS survey that made measurements of experience have a financial priorities
while for organizations.

Jason Wolf (14m 59s):
But I think that when you look at what people do, it’s beyond simply the fact that they are reacting to a
survey. And in fact, the places that succeed at this are the ones that worry least about the survey and more
about the overall experience they wanna provide. But I do think it’s been an evolution of how we practiced.
It’s been an evolution of the demands that have been placed on us by the typical health care consumer. And
those continue to evolve at a place where we are finding this incredible opportunity for mutual partnership to
drive the best outcomes overall. And then I think that’s been an exciting evolution to see.

Dr. Anthony Orsini (15m 31s):
And for people who may not know this, and I find that a lot of people don’t know, this is not a soft skill. As
you said, it really affects clinical outcomes. That’s really clear how it affects your net profits. I talk about it on
my book, how that affects physician burnout, right? And if none of that gets you, that it’s just the right thing to
do. So I had was really fortunate to talk about your grandfather and I have a role model too. Of course my
parents who are amazing people and they raise me amazing and I’m so indebted to them, but there was
somebody in my life who was a Physician, I’m the only non non-cop in my family, you know, but I was a very
close to Dr. Merk and Dr. Merk was a family doctor in Newark, New Jersey, and he did everything.

Dr. Anthony Orsini (16m 13s):
He delivered babies. He was a pediatrician and Dr. Merk practice for so long that he delivered me. And he
was one of the first people I rotated through medical school with it was at his office. And the reasons why
this is so important to talk about him in my book is Dr. Merk. And when I watched him, his patients lit up
when they came into his office and Dr. Merk had a way and you know, and the more I learned about patient

experience, the more I understood that why Dr. Merk was so successful, he practiced 50 years. He never
got sued. Jason, that’s amazing. And his patient’s loved them so much. And he could taken off the wrong
finger and they wouldn’t have sued him.

Dr. Anthony Orsini (16m 53s):
But r. Merk had this way of connecting with people and we talked about burnout, why it’s related to burnout
Dr. Merk, He loved his job so much. He practiced for 50 years because he was happy. He was relating to
patients. And I really do believe that this is all about patient experience, so that it gets to my next question.
Patient experience is really about the ability of the provider to form a relationship with their patients. And I
want you to comment a little bit more about that and, you know, there’s so many different aspects of the
patient experience, but that’s the most important thing is how do you describe patient experience? I know the
Beryl Institute if you want to give people that definition, but what do you think communication falls in the
importance of all this?

Jason Wolf (17m 37s):
Yeah. Well, I would say to answer that question first at the top, that’s an unquestionable data point, not just
an idea. And I think exactly to your point, it was actually one of the very first papers. We every wrote at the
Institute we spoke to are exactly the point you raised. That when we have open honest, transparent
communication between providers, physicians, and patients and family members, we have better outcomes,
but we also to your point, see little to no legal recourse are all of the mechanisms that get in our way of
building stronger relationships and better outcomes. And in fact, they, it creates that positive feedback loop
that you were speaking about, right? I mean, if I’m there and present as a physician like you are for your
patients and they give you that feedback, they re-energize you.

Jason Wolf (18m 20s):
And to what that purpose was that brought you into that cycle in the first place. And all of that comes down to
this communication component that you speak about. I mean, I think when you know, our data over the
years and in particular, even just as recently as are most recent PX polls that we do in conjunction with
Ipsos, once a quarter, we reinforce that people are saying, you know, what matters most of my experiences
that might health, you know, ultimately improves, that it’s safe. So safety and outcomes are up at the top.
And if they are parallel by not above or below, but paralleled by, you listened to me and communicate to me
in a way that I can understand. And so what a general consumer is saying that if you can show me that
you’re caring for me in a safe quality way, and you’re communicating to me and listening to me and in a way
that I can understand we’re getting it all right.

Jason Wolf (19m 9s):
And in fact, I think when you invert that and say, well, from a provider, I could almost turn this around a new
it’s like, you know, from a provider standpoint, if you feel like you have a healthy, vibrant, engaging
conversations with your patients and, you know, you’re providing them the best in outcomes, that’s an

enlivening outcome for you was a doc. And so we create this kind of positive, outward swirl that really
generates the best of health care can be all around that ability to communicate that does drive the best in
outcomes. So I think it’s not even a question of whether it’s a thing that should be considered. It is essential
and fundamental to the experience overall.

Dr. Anthony Orsini (19m 44s):
As the Beryl institute would tell you in their definition, that is really, it’s the continuum of the patient
experience from the moment they walk into the door. And so that’s why it’s so important to you and I are
talking about patients and doctors right now, but it’s how you are greeted by the receptionist and how you
greeted by the security it’s the signs in the hospital. The room, you know, in the name of the book is all the
Delivery. It’s how you say it makes a big difference, but you know, talk about communication. We did an
informal study. We asked the mother, a father in a pediatric setting. What makes you feel more comfortable?
Someone walked in and say, I am one of the doctors whose taking care of your child, one of the senior
doctors, or I’m the intern responsible for your baby’s care?

Dr. Anthony Orsini (20m 30s):
And Jason 60% of them said, I’d rather have the intern. And we looked at them and I said, you know what an
intern is, right? they just got out of school. And the response that we got very often was, but that’s my intern.
She’s taken responsibility for my baby and its all about that connection and building rapport. And that’s what
I think Dr. Merk did so well. And that’s what I think the best Dr do. They take the time to sit down and build
the rapport and find a commonality and example of when you and I spoke it, didn’t take us very long in to
find commonality within three minutes, we knew that we grew up next to each other. So you are younger
than I am, but communication has been an issue with this, but I think we’re getting better at it.

Dr. Anthony Orsini (21m 14s):
I think that we are starting to teach it in medical school a little bit, but I want to move on to difficult
conversations with hospital administrations and leaders. I think there was a study. I believe it was in Beryl
that said that 64% of hospital, executive leaders named patient experience in the top three priorities for the
year. And that was back. I think the 2011, I believe. And yet I speak to the patient experience managers all
over the country. And I know you do a lot more who asked me questions, asked for help and say, I’m on an
Island here, Tony. They give me no budget. You know, it’s a 300 bed hospital and I’m told just to go around
and fix the patient experience, why do you think executives keep putting it in a top priority?

Dr. Anthony Orsini (22m 3s):
But it still hasn’t put their money where their mouth is in many cases. And how should that conversation go
with them?

Jason Wolf (22m 8s):
It’s a great question. And that, you know, I think it almost comes back to your mentioned of the definition of

patient experience itself. So as we define patient experience, as a sum of all interactions shaped by an
organization’s culture, that influence patient perceptions across the continuum of care. So every touch point
and it is even well beyond anyone ever enters any clinical setting to well after they leave. That’s a part of the
experience that they have. It’s the stories they tell it’s the lasting impact of those efforts. And so if you think
that every interaction, every touch point makes a difference and the experience and ultimately the story that
people will tell about your institution is that it is grounded in and the evidence continues to prove it’s
grounded in the kind of organization you build, the kind of organization you say you will be the behaviors you
espouse and require of people that are part of that organization.

Jason Wolf (22m 57s):
The story is that you tell us about yourself in your own communities. It is an interesting disconnect. And I
think here’s where, and at least in my observation it happens. I don’t think anyone out there from a
leadership standpoint will tell you that the experience they provide people in their care, isn’t important? And I
think that if they say that it isn’t true than they are definitively in the, you know, the wrong business or if you
got to have their priorities upside down, or the challenge with it is that we have operated at least from my
perspective of health care. So much as sort of tactical operationalizing of so many buckets that we have
made for some where some have chosen to make a patient experience or experience overall a thing to do.
And when it becomes a thing to do, you have to prioritize it among other things to do, you have to budget it
against other things to do.

Jason Wolf (23m 44s):
And here’s the reality, whether you have the most beautiful patient experience strategy in the world, or none
at all, the next person that engages in your organization. Like I said, whether it’s on the streets, talking to a
friend at Walmart or they’re sitting in the discharge area of waiting for their instructions, they are having an
experience and whether we plan for it or not they are having an experience. That Experience builds is the
stories that they will tell. And those stories will be told. So you can either choose to have it, be part of the
strategic framework of how you operate your organization and then support that in a way that matters or you
leave at all to risk. And here’s where I think we have a huge opportunity to stop seeing patients experience
as a thing to do it is who organizations are, the experiences that the organizations provide, reflect everything
about all they do clinically, operationally, financially priority-wise strategically, we’ll get every l word in there.

Jason Wolf (24m 38s):
Right? And it’s part of what an organization espouses to do. It’s the disconnect with making it a thing that we
have to put in the list that it then gets deprioritized or are underfunded or those kinds of things. Yes, there are
tactics and tools and resources that we need to invest in to ensure even greater levels of experience
excellence, but it doesn’t require us to do huge amount of things. When you look at what consumers say,
and we look at the data again and again, back to the things we talked about, listen to me, communicate to
me in a way that I can understand, treat me with dignity and respect. Those are the things that are at the top
on the lowest level of the scale for them is the best food ever parking is easy. All of these things yet we spent

all our money on this side that matters the least to patients, and we call that patient experience investment.

Jason Wolf (25m 25s):
And therefore we leave ourselves imbalanced instead of working at the fundamentals where a leader can
model the kinds of behavior they can suggest not only just suggest but demand, that’s the way in an
organization operates. And you are creating an experience with little to no resources, except having a very
smart people, guide that process and having the right people involved in your organization, executes on that
every day in every interaction. So to bring this all back to the sum of all interactions shaped by an
organization’s culture, if we can get that part, right, this doesn’t have to be an issue of prioritization are
missing. It shouldn’t be a fundamental fabric of any organization. If they’re looking to drive the outcomes that

Dr. Anthony Orsini (26m 4s):
Absolutely. I just spoke to someone last week whose head of patient experience at a 200 bed hospital. And
she said to me, I said, well, what kind of resources do you have? And she said, it was just me and the CEO
is on board yet. And I have her support. But every time I try to do some kind of training for the nurses or, or
work with them and talk to them about communication skills. I got an HR guy who’s not so convinced that
this is how we want to spend our resources. And so she was very frustrated. I get this all the time, but I don’t
know what to say to her. What would you say to her, how we can approach that? Because I feel helpless to
help her.

Jason Wolf (26m 41s):
It has to come back to me. The conversations that have worked have been in the, t that you have to be very
clear that it’s just not another thing to do, but if you work from the end back in, we want our patients to feel
cared for her, to be heard, to get the best outcomes in order to do that, we need to provide an experience
that enables all of those things to happen. And we have to ensure that our people in our organization have
the resources necessary to enable that to happen at every moment in every interaction. And if we can make
that argument and build backwards from there, it’s not just a, we’re going to go do patient experience
training, but we are actually building the fundamental fibers of the kind of institution kind of organization kind
of care provider’s we wanna be. For everybody in this organization, ’cause you never know where that
experience can go right or wrong.

Jason Wolf (27m 25s):
Right. As you said, it could be the person changing out the garbage. It could be the person parking. It could
be the person that literally wearing your badge in the supermarket that you run into. That’s rude to you.
Right? And so all of those moments matter. And so providing the core skills to ensure that those moments
matter and they matter well in each encounter is so significant. So that’s the way I would approach it. And it
usually advice. I give people, you can’t approach it as just a okay. It’s a thing in my strategy that I need to do,
but it’s really driven towards our broader organizational intent.

Dr. Anthony Orsini (27m 55s):
Absolutely. Where The Orsini Way has been most successful. It, I think the reasons why we do a program on
communication is the cultural change is almost permanent. Yes, because what I try to do is explain to them
while we give them a really cool communication techniques on how to build a rapport. But in the end, they go
home happier with her job, which we have business leaders on this podcast all the time. And employee
engagement is so important. And in the hospital, your nurses and your doctors are in your employees. And
so they’ve left a meaningful relationships with their patients, even if they just met them for four or five
minutes, and everybody loves their job, they go home and it’s infectious, right? It’s just it’s infectious, but we
are still struggling.

Dr. Anthony Orsini (28m 37s):
We’re getting better. I’ll tell you a quick story. We were going to do a communication training program at a
hospital. It won’t tell you what it is, but I got a call right before were ready to do it. And so we have to put it on
hold. And I said, why? And they said, well, one of the nurses, she put a complaint in with the union that she
didn’t want to be forced to take Dr. Orsini’s workshop and her quote was, she said, it wasn’t in her job
description to be nice. And so we’re fighting this, but overall what’s so amazing is that when people start to
understand that it’s not only benefiting the patient, it’s benefiting, your hospital has benefiting you. You are
going to go home happier. And it’s not that hard, right?

Dr. Anthony Orsini (29m 17s):
Jason it’s, it’s not that hard.

Jason Wolf (29m 19s):
Right? Well, the argument is right. It is in your job description to provide the best outcomes for everyone that
walks in this institution. And so therefor, this helps you do that. I mean, and that’s the point that we have to
continue to reinforce, right that, you know, the, you know, if anything that people take away from these kinds
of conversations I have is that if we continue to think of Experience or patient experience, as a phrase is a
thing to do, we’re going to always miss because it’s going to be something that we can prioritize. And then
something, we can also draw the line through and until we realized that we have to make it fundamentally
part of what we want health care to be, and then invest in the right resources to do that. We’re not going to
necessarily be there. And our patients and our families, the general consumer is saying, that’s exactly where
they want us to be.

Jason Wolf (29m 59s):
And so until we can do what we need to do to match that disconnect, then you know, we’re going to
consistently be at risk in the health care of not meeting the ultimate needs of our patients and families.

Dr. Anthony Orsini (30m 9s):

And the patient experience. People need to be involved with everything, including how you design the office.
You know why it was at the hospital the other day where the, the new office is literally had the computer, you
know, in order for the physician to look a lab value up, she literally had to turn her back to the patient. And so
we need to be their from the ground up and say, let’s imagine your the patient. I think we got along way to
go. But I think thanks to the Beryl Institute, I’d been so excited because this turns me on, I love this stuff. I
think it’s because it’s so nice when you leave work and you’re happy. Yeah. I just have to figure out the best
way to have the conversation. And I’m sure you do this all the time with that. CEO saying you don’t need a
bigger TV.

Dr. Anthony Orsini (30m 51s):
Let’s invest in a little training for you and lets talk about patient experience because in the end like you listed,
what was so important to me is that TVs didn’t even come up. Its not, it doesn’t matter how big the TV is.

Jason Wolf (31m 2s):
You mean the lowest number thing on of our rankings. This is in this last study and it was even in 2018 was
a healthcare facility that provides amenities. It’s extremely important to less than 10% of the US consumer
base, less than 10% is extremely important. It’s not even very or extremely important to just 20% of people.
So one or two out of five people, that’s it? That your amenities matter to the other four are looking to you for
the things that really matter to them. That is the point in all of this, right? I think, you know, we have the
evidence, we have the practice and we have the purpose altogether in a way that should drive people in the
right direction.

Dr. Anthony Orsini (31m 40s):
How many resources out there for a hospital administrators who want to improve this through the Beryl
Institute and you have so many training programs for patient experience people that I really do believe that
this is a ripple effect, then I think we can kind of get away from that. Let’s just make the waiting room prettier
and everybody will be happy. And I think that, you know, well back when I’m sure when you started, there
were a lot of people who are treating the hospital’s like hotels, let’s make the lobby nice And in a hotel a big
TV is probably much more important than it is in the hospital because what’s important in a hospital is that I
relate and form a relationship with the doctors and nurses. And so I think we’ve come a long way.

Dr. Anthony Orsini (32m 20s):
I want to ask you before we leave about two more questions. So yeah, you can’t get it from an interview right
now without talking about COVID right. And I know that I was doing a lot of speaking about patient
engagement, patient experience, and then COVID came and everybody, and I don’t blame anybody, but
every hospital administrator was running around with their hair on fire and all of a sudden Patient Experience
was pushed way down and employee engagement was pushed way down, but in some ways it’s really been
more important. So how did COVID effect us in the last seven months or eight months?

Jason Wolf (32m 54s):
You know, there’s so many layers to that question and you know, seriously, it’s like, you know, in general it
made healthcare consumers more cautious. I mean I think, you know, again, back to our PX pulse and
watching the data, less people were participating in direct care. So first of all, you know, at the same time, it
reinforced and really heightened the importance of the relationships we built with people because you know,
in the majority of cases out there and still to this day, if not that they came back and are now going there
again because of the surge in cases. So many places around the world is that the only relationship that our
patients have and a lot of our facilities right now is the staff around them.

Jason Wolf (33m 37s):
Their family member isn’t with them, their loved ones or care partners cannot be at the bedside necessarily.
And this level of strain, I mean the weight that puts on our care teams, the delivery side of our care teams is
so significant. I say that only because I see care teams as involving patients and families as well. But I think
that the reality is that we’ve had to really fine tune and hone the ways in which we build that connection. And
even the most simplest of ways to be there for someone to listen when we can get health care has done
more in innovation. I think in the last six months where they said, Oh, it’s going to take us another year and a
half to implement tablets in our hospital to do with it in three weeks, write all of a sudden magically, we found
budget an the capacity to implement hundreds of tablets in places to give people access to information or
communication with their loved one’s.

Jason Wolf (34m 28s):
It’s showed us that we can be agile in the moment when we need to do it, probably helped to see we can be
agile in any moment, not just a moment of crisis, an elevated the realities that we have to build stronger
relationships with our patients and family members and find a stronger way’s in fact, to connect with an
engaged family members in care partners, because their absence is clearly felt. And I believe their absence
is actually having an impact on safety and outcomes overall, I would wager and I’ve had other folks say this
to me that they believe people have not made it because their loved one couldn’t be there with them or that
they didn’t have the information they needed to care best for those patients because someone wasn’t there
to help inform them. So it has shown us what is possible in a moment of dire need.

Jason Wolf (35m 11s):
And at the same time, it has made us stronger in the face of what I can only say. And I’m sure you are
experiencing and you have to walk into a hospital every day anymore. The highest level of exhaustion. I
have seen it in a health care workforce ever. Yeah, because you’re not only just carrying the clinical burden,
you’re carrying the emotional burden of having to do everything we just talked about. So in all of that and all
of that chaos, I guess it’s the optimist in me. I see the reality is that everything we just spent all of our time
talking as important to have only been elevated as critical to the overall outcomes that we provide an
healthcare. We’ve had to find two in and sharpen our focus, but I don’t think it’s meant we’ve diminished
focus on experience and unless people see it as the thing to do, like we talked about before, and we’ve done

a lot of work to try to care for our employees, but we were acknowledged a stress.

Jason Wolf (35m 59s):
You know, we have set up a food banks and we have set up the respite rooms and all of the things that
we’ve done, that, you know, it probably a care provider team actually would’ve liked all along the way to care
for them in their busy lives. So we have discovered things in it. So I’m gonna be the optimist to this and say,
we’ve reinforced the important things. We have established practices that shouldn’t go away as a result of
this crisis, eventually hopefully are receding. It also really elevates the importance of why this focus is so
essential and it’s going to be challenging. I mean, we’re in our, what do they say are the four darkest months
in particular you’re in the United States, right? We’re going to have to rely on each other and a lot more in
significant ways than we have. So all of the principles that you have, and I believe in all of the things we’ve
talked about over the last 10 years on our journey of the Beryl Institute are essential and central to a
conversation of literally survival with this moment.

Jason Wolf (36m 49s):
And I think we have to realize that and not just throw it out because right now we’re just caught in a churn of

Dr. Anthony Orsini (36m 55s):
So to emphasize and follow up with what you said before is a patient experience. Shouldn’t be a thing it
should just be yes. And what I’ve seen during COVID is amazing, beautiful, compassionate motions and
things that I have a personal friend whose mother died in the hospital from COVID he couldn’t visit in. So I’m
seeing this around the hospital, the nurse, or the Dr is, you know, got the N95 mask covered from head to
toe, that is holding the iPad so that the son or daughter can say goodbye right. Easily get choked up. So I’m
getting choked up right now, but how beautiful that is and when I see that I go, there’s the patient experience
right there. And he didn’t even know you were doing.

Dr. Anthony Orsini (37m 36s):
And it was, you know, I do this thing in the way. I talk about this book about being a friend in the business,
you know, you want a friend in the business. And when I look at those beautiful moments in health care,
people are really, I still believe are heroes who get caught up in tasks sometimes, but let’s say, and look at
that, you look at that beautiful thing and, you know, let me tell you something, those N95 masks are not easy
to breathe through right. There is sitting there with those patients for hours and holding the iPad. So
grandma can say goodbye. And I just look at that and I’m really proud to do what I do and say, nobody’s
saying I’m doing this because I’m improving the patient experience. It just is. And I loved that when we
stopped thinking about it as a thing, it will just happen.

Dr. Anthony Orsini (38m 18s):
And I love that. So

Jason Wolf (38m 19s):
That’s a, a a hundred percent, but it takes me back to the image of my grandfather who was as tough as a
nail. Physician getting done in his knee and saying hello to the child. That was so scared because they have
to go to the doctor and instantaneously easing his pain because he was willing to be there, not as Dr. Wolf,
but simply as this gentleman who cares about you as who you are, and that’s what we’re doing right now in
this moment, that is the, you know, if we are looking for that glimmer of hope, that moment right now is that
humanity. That’s so essential to medicine. It’s so essential to the health care is so prevalent and it’s
exhausting, but it’s there. And I think that at the end of this, when we look back, that will be the proudest
moment that Healthcare was able to contribute that not only the, you know, clearly the clinical outcomes and
all that we will do for people, but the fact that we, whether someone made it or not brought such dignity and
compassion, connection, and communication in a way that literally impacted people’s lives and will have a
ripple effect, like you said earlier for years to come.

Dr. Anthony Orsini (39m 22s):
Yeah. And those health care workers left exhausted. Yes. As you said, but they left with a sense of pride that
they did something that is, as I say, consistent with their core beliefs and values, as opposed to just seeing
25 patients, because someone told you needed to, it adds purpose. When we add purpose to medicine and
we add relationships to the patient experience just follows in so many thanks to you, and the Beryl Institute,
we’re snowballing here. What do you think ?

Jason Wolf (39m 48s):
We’re trying? I mean, I think, you know, like I said, from the beginning, it’s never going to be about me are
the, Institute so much as it is the contribution of so many in the conversation. And if we can ensure exactly to
your point, if that conversation snowballs that we create, you know, not just a small but significant ripples
around the world and what really matters. And we’re going to end up with the best outcomes we can and
really raising this tide in a way that hopefully we will have a profound and lasting impact. And that’s what
we’re all in this for, I think at the end of the day.

Dr. Anthony Orsini (40m 16s):
Okay. And I know you say it’s not about you, but you are the one who is bringing this up and, and helping
Beryl really be what it is. I mean, what’s the average number of people that are at a conference last time I
was at a conference, it’s a huge conference

Jason Wolf (40m 29s):
A thousand plus people at the conference, you know, we’ve got, you know, close to 60,000 people around
the world that are participating. I mean, just this week alone, we did our first webinar in Portuguese for those
folks in Brazil, you should have heard me trying to speak Portuguese. And you know, we’re going to do a
session here in just a couple hours for folks in Asia and Australia. I mean, this is a universal, or let me say

global. I don’t know that people are on other planets or doing this yet, but it is a global conversation that
really matters. And you have to be able to see so many committed people from so many walks of life, from
all segments of healthcare, like you said, this is not just hospitals. It’s a long-term care home health hospice.

Jason Wolf (41m 10s):
It’s an ambulatory settings. It’s in an EMT. It’s just the places that you see people committed to the human
connection and healthcare is boundless and our capacity to impact that is as well.

Dr. Anthony Orsini (41m 21s):
Well, I promise my audience every week that they’ll be inspired. And if you aren’t inspired by this episode,
then I don’t know what to tell you because I’m inspired. And this is, you know, what I love, but it really does
lift up my heart. And it makes me feel really optimistic about health care. We talk about money and funds
and whether what kind of medicine we are going to have where there’s going to be socialized or private. But
in the end, it comes down to the human to human interaction. And no matter what we do that is going to
have to be there. And I think if we’re getting there, so Jason, this has been awesome. I learned so much
from you and the Beryl Institute conference is coming up, but that will be a virtual?

Jason Wolf (41m 59s):
Yeah. Elevate PX. Now, is there a new name. so it’s going to be a global event, bringing people together
from all of the continents and conversation, and Elevating the patient experience. So we were really excited
about that.

Dr. Anthony Orsini (42m 12s):
They can go on the Beryl institute.com

Jason Wolf (42m 15s):
BerylInstitute.org. The, with the BerylInstitute.org, you can find information on that as well as all of our
resources, as, as you talked about it, you know, pretty much half of what we do is open to the world. Our
Journal is open access. We really want this information in people’s hands to make a difference. That’s our
primary purpose.

Dr. Anthony Orsini (42m 28s):
That’s the right thing to do. And I will put that for everybody listening in their car, I will write all that down and
put it in the show notes. So please don’t pull over and, and write it down. We want you to be safe. Jason
thanks again so much. This has been awesome. And I really appreciate taking the time of your busy
schedule. I hope that we’ll be speaking many times, just like I’m doing with my other guests now.

Jason Wolf (42m 47s):
Of course we will. And I just am again and humbled and honored to be able to talk to you, you, your

listeners, and, and really appreciate the invitation. So thanks for all you do.

Dr. Anthony Orsini (42m 55s):
Thanks Jason. If you liked this podcast, please go ahead and hit subscribe. Please tell your friends about
this. If you want to find more about the Orsini Way you can go to the Orsini way.com and he could also
contact me through that website. Thanks again Jason! Well, before we leave, I want to thank you for
listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician and I want to thank
the Finley project for being such an amazing organization, please, everyone who’s listening to this episode,
go ahead. Visit the Finley project.org see the amazing things they are doing. I’ve seen this organization
literally saved the lives of mothers who lost infants. So to find out more, go to the Finley project.org.

Dr. Anthony Orsini (43m 37s):
Thank you. And I will see you again on Tuesday.

Announcer (43m 41s):
If you enjoyed this contest, please hit the subscribe button and leave a comment and review to contact Dr.
Orsini and his team, or to suggest guests for a future podcast visit us@theorsiniway.com.

Difficult Conversations with your Teenager with Joshua Wayne

Joshua Wayne (1s):
And a metaphor that I use that parents tend to find helpful is this idea of a board of directors, right? So think
about every major corporation or major organization in the world that has a board of directors. It guides their
strategizing and their decision making, just like that organization, your kid has their own board of directors,
but for your kid, it’s like a virtual round table of the people who they are listening to and paying attention to as
they figure out what it means to be an adult. So I think about who is on that, it’s, you know, hopefully a
teacher or two it’s their friends’ for sure. It’s celebrities their following on social media, it sports figures they
idolize and musicians whose music they love.

Joshua Wayne (47s):
My core premise to parents Is that your number one goal is you want to have a seat on their board of

Announcer (55s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of The Orsini Way. As a frequent keynote
speaker and author Dr Orsini has been training healthcare professionals and business leaders. How to
navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in
their field who tell their story and provide practical advice on how to effectively communicate. Whether you
are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or
her team member’s or someone who just wants to learn to communicate better this is the podcast for you .

Dr. Anthony Orsini (1m 40s):
Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. This is Dr.
Anthony Orsini and I will be your host again today. You know, as parents, teachers, and caring adults in the
lives of kids, we all want the same thing and that’s to see them happy, self confident and ready for the adult
world. For over 25 years, Joshua Wayne has worked with kids in just about every setting imaginable,
including drug and alcohol treatment., With at risk foster youth community, mental health, private practice,
and as a director of special education at district of Columbia public A former struggling teen himself, Joshua
understands deeply what teens are going through. Joshua speaks across the country to schools and youth
organizations on how to help kids today become successful young adults.

Dr. Anthony Orsini (2m 25s):
Tomorrow. He is the author of the “Simple Parenting Guide to Technology”. Josh helps youth face the
challenges in front of them and make smart, empowered decisions as they navigate toward adulthood. He
also instructs parents, teachers, and other caring adults, how to best love and support them through this
process. He has trained as a consultant across the country for police department’s school districts, state,
and local governments and youth organizations on how to work effectively with teens and their family.
Joshua holds a master’s degree in counselor education from Northeastern Illinois university in Chicago. And
is a nationally certified counselor. Has been featured as a life coach on the Style network. And is the

co-creator with Josh Shipp of the one caring adult online community.

Dr. Anthony Orsini (3m 8s):
He currently lives with his wife, the Tina and son Hunter in Washington, DC. I’d like to introduce you to
Joshua Wayne. How are you Josh?

Joshua Wayne (3m 16s):
All right. Great. Thanks for having me happy to be here, chatting with you.

Dr. Anthony Orsini (3m 20s):
I’m so happy to have you today, you know, tha each and every episode I promise my audience is two things
and that’s to be inspired and to learn some practical communication techniques that will help them in their
life. And I think something that we all struggle with, I have three children now all passed their teenage years.
We all struggle with those conversations that we have with teenagers, especially the ones who are going
through some difficult times. So this is a great episode. I can’t wait to air this and have my audience hear
what you have to say. You know, as coaches and counselors and trainers is so much of what we do depends
on our credibility, right? So I know what I’m asked to coach physicians, who are struggling with their
communication skills or to train doctors, how to deliver a tragic news.

Dr. Anthony Orsini (4m 2s):
The fact that I’m a physician and I work at one of the busiest neonatal intensive care units, and the country
gets me at least in the door with some credibility. So I think it’s probably best if we just start out by you telling
everybody your story and your journey on how you got here.

Joshua Wayne (4m 18s):
Yeah. It’s a part of my bio. As you read, I consider myself to having been a struggling teen. There was a lot
of questioning I did about myself. Teenager my self confidence was just very low as a kid. My self-worth was
really low or, you know, experimented with the drugs and alcohol in high school. And we were not for a
couple of significant adults that came in to my life at critical times. My life could have very easily gone down
a different track and into, into a self-destructive path. You know, you can go back a little bit further because
it’s funny how sometimes these things work out. But I grew up in a family, very, you know, comfortable
middle class upbringing, where I had everything I needed and most of what I wanted, but there was this
underlying discord in my parents relationship.

Joshua Wayne (5m 7s):
It’s kind of a classic. They stayed together for the kids kind of scenario. And there was a lot of fighting and,
and discord, even though it was, you know, we we’re loved. And they came to all my sporting events and all
of that sort of stuff, that there was an underlying thing that as a sensitive kid, really effected me. And it just
never having this feeling of like families should be a different experience. And a, when I saw my parents with

their marriage was Anyway, when I say, it’s funny that how have you seen this play out as it is incidentally,
then it became a family therapist, right? That it became the path that I followed. I didn’t intentionally map it
out. There was no equation in my head because my parents had these problems. I want to go be a family
therapist, but I think sometimes we’re instinctively drawn to work out our own issues.

Joshua Wayne (5m 52s):
There was something in me that I was still probably trying to figure out at a certain level and really learning to
work with at risk youth kids. They could have been me, you know, some years before operating on a similar
path that I could have gone down and then seeing their families, and then the problems that their families are
having. It just became this natural thing for me to want to really help them and apply myself there. And it was
just almost like an intuitive thing that just to get gradually, but definitely lead me to want to be working with at
risk youth and their families and helping the kids have the tools they need to feel better about themselves
and more competent about themselves and ready for the adult world. And then also, if I can’t connect with
the kid in my private practice scenario, then I found that I can also have to work with the parents and really
guide them to strengthen their relationship with their kid.

Joshua Wayne (6m 41s):
You know, if, if for whatever reason, I couldn’t make a connection with a kid, I could still help the parents
change their dynamic with a kid and get a totally different results in their relationship. And that really became
my mission was to help families thrive in it and improve their communication and, and build stronger

Dr. Anthony Orsini (6m 55s):
Well, there is something that you said during the last few paragraphs is that if it weren’t for a couple of adults
that changed it, and I heard you say once that it was in an interview, every kid is one adult away from a
success story. If we, can you elaborate on that? Because I love that.

Joshua Wayne (7m 10s):
Yeah. It’s actually where every kid is one caring adult away is the, the actual phrase. And that’s actually, you
know, I borrowed it from my a, a colleague and friend of mine Josh Shipp who has been a mentor and friend
of mine. I feel that you may have heard of him. The idea is that that every kid needs at least one caring adult
in their life to help guide the way, right? It’s like, it doesn’t mean some kids that can’t, or won’t figured it out
by themselves. But if there is at least one caring adult that shows up to provide guidance, to provide an ear,
to provide support, that can make all the difference in the world, but it’s really a relationship at the end of the
day that changes a kid’s life and helps them work through whatever obstacles are in their way.

Joshua Wayne (7m 55s):
Now, sometimes that is going to be the parent or the parent may be one of those caring adults. And
sometimes it’s going to be somebody else is going to be a therapist, It’s going to be a coach, it is going to be

a teacher. It’s going to be an uncle. It’s going to be a neighbor. It doesn’t really matter where it comes from,
but having those caring adults to, help show the way to help guide us, because someone’s got to show us
what it means to be an adult in the world. You know, we’re going to figure it out regardless. But I think one
key thing is who are those role models. We are the people that we’re looking at and adopting our values
from, as we are trying to figure that out. So, you know, for me, that was helpful because I had a couple of
really significant caring adults that came along. And, you know, as they said at critical times, but also really
put a certain focus on my work because now I am that caring adult for a lot of particularly young men.

Joshua Wayne (8m 44s):
But a lot of young people to show up in their life is that person where they can just, hey, this is just, I, I just
had this fight with my girlfriend or this disagreement with my parents, or I’m applying for this job interview, or
I screwed up this job interview, what should I do better next time, just having a sounding board to say, Hey,
like, I don’t really know what to do. What would you do? Because there’s that trusting and caring foundation
and the relationship that they can rely on.

Dr. Anthony Orsini (9m 8s):
You know, as you know, I’m in healthcare and I teach doctors how to improve the patient experience and like
teach communication to nurses the single most important thing in healthcare right now is trusting relationship
between the health care giver and the patient. And that is often difficult to maintain in today’s society. But I
started this podcast back in August, we’d been wildly successful. I’ve interviewed people in business and in
healthcare. And those two words, trusting relationship comes up almost every single week when we were
discussing on how to be a true leader in business. When we are discussing how to be an effective doctor or
a nurse.

Dr. Anthony Orsini (9m 51s):
And now we are discussing how to bring up a teenager, that trusting relationship is really what it’s all about.
And it’s amazing. What I love about communication is that once you can learn how to build trusting
relationships with anyone, it will help you in your personal life. It will help you in your private life. And I think
you’ve said that it’s the single most important thing that parents have in favor is a trusting relationship. What
advice can you give to parents to help them build that trusting relationship, but not necessarily with the
troubled teen, but hey, I had three children. It was not easy, you know, and thank God they’re the youngest
one is 21 now, and he’s in college. The other two are working and you know, they’re, they’re doing well,
they’re successful adults, but my goodness, Josh there’s times when it’s not easy, you know, and my wife
and I have to different parenting kind of styles.

Dr. Anthony Orsini (10m 43s):
I think that they really helped because, you know, I was brought up more strict than she was, but speak to
that parent out there that’s going my 16 year old child, is just driving me crazy. How do I get her to speak or
him to speak to me

Joshua Wayne (10m 56s):
Right now? The metaphor that I use that parents tend to find helpful is this idea of a board of directors. So
think about every major corporation or major organization in the world that has a board of directors. It guides
their strategizing and their decision-making just like that organization. Your kid has their own board of
directors, but for your kid, it’s like a virtual round table of the people who they are listening to and paying
attention to as they figure out what it means to be an adult in the world. So think about who’s on that, you
know, hopefully a teacher or two, it’s their friends’ for sure. It’s celebrities their following on social media, it’s
sports figures.

Joshua Wayne (11m 39s):
They idolize as musicians whose music they love. My core premise to parents is that your number one goal
is that you want to have a seat on their board of directors, right? You don’t need to be the chairman, but you
need a seat at the table because that’s the only way you are going to be one of the people that are coming to
and seeking advice from when the big things hit and they always hit. Right? They’re not going to tell you
everything because we are talking about kids and teens in particular after all. But when those big things
come up, if you successfully get yourself on their board of directors, you can be one of the people that
they’re talking to you. Now, the only way to get in and stay there is to have back to your original question is
to have a relationship that they perceive as valuable.

Joshua Wayne (12m 22s):
Okay? Right. If they don’t, they can talk to you. And more importantly, that you’ll listen without judgment,
without lecturing. Then they’ll put you on their board of directors, but it is a relationship that we have to
constantly manage and constantly nurture and tend to, to stay on their board of directors in to keep that
connection strong. Now, in terms of just some practical advice, if my hypothesis is right, that getting in on
their board of directors is the most important thing. And that’s the strength of your relationships that will get
you there. One of the most sure-fire way to get yourself ex-communicated from their board of directors is to
be, is to be fighting the wrong battle.

Joshua Wayne (13m 4s):
Because if you think about it, what does Parenting, in some ways its the series of the decisions you have to
make around is this a battle I am going to fight with. My kid was about to close on the floor in their room,
right? About putting your phone away at the dinner table or is it something that I’m just gonna let go? And the
reality is as that parenting, it’s a balancing act between those two things between, Hey, like as a parent, of
course I have to have boundaries and structure and accountability. Like that’s a core function of parenting,
but we also know as parents that we need to give them room to figure things out and to fall down and learn
to pick themselves back up again. So really learning to navigate that and to walk that tight rope, if you will,
around what battles you’re going to fight really, really becomes one of the main things.

Joshua Wayne (13m 50s):
So we can talk about where some of the things too, that are probably the, the better battles to fight in some
of the things we’re letting go of it. But that really becomes it because if you are fighting the wrong battles with
your kid, you are going to waste all of your relationship capital. If you’re constantly fighting about school and
homework, for example, or about their room or about the people that are hanging out with you. Now, I’m not
saying that sometimes you shouldn’t fight those battles, but if you’re always in conflict with your kid, it is
going to weaken your relationship and they will increasingly tune you out. And you would the last thing we
want to have happen as quickly as their teenagers in the stakes get higher and they start to have to make
more sophisticated decisions around their behavior online and pornography in drugs and alcohol and sex, all
of these more high stakes decisions that they are making.

Joshua Wayne (14m 37s):
The last thing that you want them to do is to feel alienated from us because we can’t even be part of that

Dr. Anthony Orsini (14m 44s):
Agree with you. Totally. So you, you really want them to come to you when they have an issue. And the only
way to do that is to establish trust with them. Is there a way that you recommend that, you know, this is my
practical episode, I’m getting practical advice from you right now. What’s the best way to let your kids know
that, you know, it’s okay to come to me when things get really, really bad. Is it just picking your battles?

Joshua Wayne (15m 6s):
Well, I mean, its it’s also the other, the flip side of the coin is, is that you have to keep the relationship vital
and energized and active and currant. You know, you’ve got to find some way to be doing stuff with them, to
whether it is throwing the ball around it, it doesn’t have to be super fancy or sophisticated, but you also, you
have to have a relationship where they can relax around you and let their guard down. They can’t just do
simple things. Would you like throwing a ball around, you know, geeking out on some scifi show on Netflix or
just hanging out riding bikes, if they can’t just do some simple stuff with you is going to be really hard to get
to the deeper subtexts of what’s really going on in their life. Kids need to be able to relax around you, they
need to feel that you’re not on their guard, that you are accepting them.

Joshua Wayne (15m 51s):
And so the other piece of that is, is that you have to find some way to keep the relationship active. You have
to find some way to keep the Just a sense of having fun together .

Dr. Anthony Orsini (16m 1s):
And to be positive. We had Dr. Helen Riess on an episode a couple months ago in she’s an expert on
empathy and Helen Riess spoke about a study of children who are brought up and the ratio of positive and
negative comments. If I remember correctly, she said three, two, one to five to one was the perfect ratio. You

don’t want to give them compliments all the time. You know, while you walk really well, you know when
they’re 15 years old, but giving them some positive comments for three or five of them for every one
negative thing. And there are some households, would you agree that the household is so negative all the
time? And I think the kids pull away, correct?

Joshua Wayne (16m 40s):
Yeah, totally. Totally. And I listen as a parent myself, it’s hard because there’s this quote, I’ll botch it a little bit,
but you get the, the intent when you have a child it’s to know what it’s like to have your heart go walking
around outside of your body, you know, and, and, and it is almost excruciating, but the love you feel and the
concern and the care and the desire to protect. And I get that. And the trick then is to not letting our own
anxiety, just overflow and everything, but we’re constantly correcting them, constantly telling them what to do
because the more we do that, the more we’re fighting against their natural need for autonomy. And they are
wanting to be able to spread their wings and take flight. And in some ways it, it, it requires a fair amount of
self control from us as parents too, the slow down to relax and take some deep breaths, you know, going
back to the whole thing around, you know, what battles to fight.

Joshua Wayne (17m 29s):
One question that I find really helpful fast to myself as a parent, but also is a piece of advice to parents is to
ask themselves this question. Can I let go of this? Look at all of the areas of conflict you have in your life
with your kid, their room being messy, not cleaning up after themselves, issues around curfew, issues
around just being respectful in the home school, all these areas where there are they take can, I let go of it?
You know, certain things that you probably can’t and you shouldn’t have like basic issue is around safety in
respect and knowing where they are following curfew, using the car only with permission. Those are always
non-negotiable, but there’s a lot of other things that we might get uptight around.

Joshua Wayne (18m 10s):
Like I keep going back to the room, cause this is a low hanging fruit that someone who is better off for
parents to let go of, you know, if they’re just, even their clothes are all over the floor, stop doing their laundry
for them. They have to figure it out sooner or later.

Dr. Anthony Orsini (18m 21s):
I think what really helped me is having a spouse to help me bring up my child who has a different way of
looking at things. I happened to be a worrier. So it was a lot harder for me to let things go. I’m the type A
personality overachiever became a Physician just by pure hard work. And my wife is also a very successful,
but she was brought up a very different, my father was on the SWAT team in Newark, New Jersey. So you
can tell how we’d been raised a totally different, and they really resonated what you said. ’cause I had a lot
harder time letting things go than my wife. My wife grabbed me sometimes and said, you know, you need to
let this go a little bit. And without her, I don’t think the kids would have had that balance.

Dr. Anthony Orsini (19m 4s):
And so let’s pivot over to Difficult Conversations because that’s what, this is all about. One of the things,
well, many things scare me to death as a parent and to all parents. But one of the things that really want to
talk about is suicide and suicide in teenagers, I think, I heard you give some, some statistics about a study
that you did with suicide ideation, but that is something that I think for all the topics haunted me the most, not
that there’s any depression or suicidal my family, or it’s totally irrational, but I can’t imagine there being
anything worse for a parent and the kids go through difficult times and many of the people that are children
or commit suicide.

Dr. Anthony Orsini (19m 46s):
Don’t tell anybody, tell me about suicide and some advice on how we can maybe pick this up earlier, that
conversation specifically that you have with your child to say, how do you approach the conversation? If you
ever have these thoughts, please come to me.

Joshua Wayne (20m 2s):
He will just have to first talk about the statistics in 2014 suicide became the second leading cause of death
amongst adolescents, only behind accidents. And it’s a real issue. It’s a real serious issue. It’s, you know,
we’re also having this conversation in the midst of the prolonged COVID experience and the CDC put out a
statistic. I think it was one in four young adults, seriously considered suicide in the last 60 days or something
like that. And it’s a major issue. You know, it was also interesting just by way of just current events in 2011,
2012, the adolescent anxiety and depression rates started to really spike.

Joshua Wayne (20m 44s):
That was the same point in time. And for those of you who, who can’t see me, it says I’m holding up my cell
phone. That was the exact point in time where we crossed the threshold where more than 50% of Americans
who were in possession of a Smartphones. So, you know, if you can’t say the cause is there, but the
correlation’s unmistakable. So all along that trajectory, that’s around in 2011, 2012, 2014, suicide becomes
the second leading cause of death amongst adolescents by 2017, three out of four teenagers have an
iPhone. So it’s an unmistakable correlation between device use and increased mental health concerns with

Dr. Anthony Orsini (21m 23s):
And they discuss that on a recent movie that I just saw called the Social Dilemma. I just actually watched the
movie last night with my wife and those exact statistics were brought up about the, really the relationship
between I-phones or social media and suicide. So how did we have that conversation with our child to let
them know that please tell me if things are getting bad because most parents don’t have a clue. Right?

Joshua Wayne (21m 46s):
I think it was a couple of things. One is that I go back to my board of directors metaphor. This is still the first

and foremost thing you have to work at. Because if you’re on their board of directors, of course there’s no
guarantees, right? But your chances of them coming to you when something serious is going on or are so
much higher, that’s why I say this idea of at least having a seat at that table is the most important thing is
more important than their grades is more important than their choice of friends. That’s more important than
what college they go to. It is a thing that matters most. I think they’re going to be okay if you have a good
relationship with you and they have a, a, a general sense of have decent values in life, they are going to be
OK. You know? So I think we have to just really do that inventory. Like, am I freaking out about my kid’s
grades and my kids school and worrying about what college or going to go to and, and bringing that anxiety
to my relationship with them, because that’s gonna chase them away.

Joshua Wayne (22m 35s):
Alright. So again, you have to go back to that inventory, of all the things that you have conflict with and your
relationship with them and find a way to reduce it. What can you let go of? So you can strengthen the
relationship and work on having a strong relationship. So that’s the first thing. The second thing is I think if
you have to have an explicit conversation with them, and I think with kids in general, with teenagers, very
often the way to have the conversation, it it’s just a call up the elephant in the room. Hey, I want to chat with
you about something for just a few minutes. That may be a little, a bit weird, but it’s really been on my mind. I
just need to talk to you about it. You know, I heard this statistic about suicide as a second leading cause of
deaths amongst kids and not trying to, you know, make you feel like they have to talk to you about whatever
is going on in your life right now.

Joshua Wayne (23m 17s):
But I just, I need you to know. And if you ever find yourself in that situation, that I am here, and if you don’t
think you can talk to me and there are other adults in your life, and you have to think about who they are, you
can talk to you and maybe it is it’s grandma or grandpa, or maybe it’s uncle John May be, it’s your teacher
there, our other adults, if he can talk to me for whatever reason, there are other adults out there who care
about you and love you, and you can talk and you just have to plant that seed and let them know that I’m
here for you. And for whatever reason, why I’m not the person for you to talk to you about it, please find
another person.

Dr. Anthony Orsini (23m 46s):
And is that the same angle that we would take when we’re concerned that are child is doing illegal drugs, or
maybe he be getting mixed up in the wrong, you know, how do you have that conversation? We are pivoting
off to the next topic, but how do you have that conversation? You know, I think my child might be in a, in a
bad crowd. He was having those conversations. Don’t go easy. Because how does it usually end dad leave
me alone. I’m fine. Nobody says, yeah, you’re right. That I am experimenting. Is that all about the
relationship again? And how do you have that conversation?

Joshua Wayne (24m 16s):

Yes. It’s about the relationship because of the stronger your relationship with them is, the more A. They’ll talk
to you about stuff, but B the more they’re likely to behave in accordance with your values when you’re not
around, right. You know, you don’t want to upset or disappoint mom and dad, they are less likely to behave in
a way, you know, you wouldn’t want. Drugs and alcohol is tricky. There’s no simple sugar coating. I don’t
think it’s just a matter of having some conversations with them. But, you know, I don’t think it’s a matter of
talking to them about how their brain is not fully developed until they’re 25. And if they smoke, like all of
those things are true, but you have been hearing that since their in sixth grade or whatever it is now that if
they just wait until they’re 22 to do it, and they’re out of college before they have a drink or experiment with
marijuana, for example, then their chances of becoming an addict are 80% less.

Joshua Wayne (25m 8s):
Again, all these things are true, but it doesn’t really address, I think how most kids are making decisions
these days. So I think the first thing we have to do is also just check her own values on this. You know, I
mean, I have worked with parents who are literally range from, you know, talking about lets just say
marijuana is a common and, and obvious example. You know, I worked with parents who felt that their kids
smoking pot would be the absolute worst thing that could possibly happen. It would be a surefire, a predictor
that their life is going to go off the rails. And I worked with parents who were upset that their kid found their
own stash and took it without asking in it and everything in between. So I do think that there is some level of
just checking our own values around it in having, you know, just honest conversations about it.

Joshua Wayne (25m 52s):
I mean the reality is unless you lock your kids in the house and in their room, there’s no way to absolutely
completely prevent it. So I think the better play is to try to keep the relationship strong, try to see the world
through their eyes and just have honest conversations with them about it. If, if you found out they’re
experimenting instead of freaking out and yelling at them and getting punitive, I think the more generally
speaking in a better conversation is, okay, so what did you think of it? Or did you like it? What did you like
about it? What didn’t you like about it? That’s a tough one. They were requires us to be in an uncomfortable
position, but if you’re having that conversation, there’s at least a conversation.

Joshua Wayne (26m 34s):
If a reaction is, if I catch you doing this again, you’re going to be grounded for six months. You’re not leaving
the house. I’m taking the car away. I mean, the reality is is for some kids you might scare them out of doing it
for a period of time. But for a lot of kids that they’re just going to become craftier at hiding it from you. And
then again, it’s back to my original point is when your out of the conversation, you have no ability to influence
them because they had made a decision that this was something I want to do or my friends are doing and it’s
okay. And by the way, there’s this whole other thing with, you know, marijuana, which has been, you know,
besides alcohol, the most common drug kids are using today and it’s now being legalized all over the
country. So there’s this whole other conversation. Whether we want to acknowledge it are not going on in
their head around whether it’s actually a harmful thing or it’s really just a plant in an urban and all that.

Joshua Wayne (27m 19s):
So there’s this whole other conversation going on in their head, our job is to try and be a part of the
conversation so we can love them, support them, help guide them, help them think critically about the
decisions their making. And in particular, if they do find themselves in a tough spot or is it becoming
problematic so that we can be one of those caring adults in their lives, that’s there to help them. You know,
they get the train back on the track. If things are starting to slide off

Dr. Anthony Orsini (27m 44s):
In going back to the Technology, you’re also fighting a lot of stuff on the internet. That’s not necessarily true.
In my case, I’m a physician, so I’m having talks with my kids when they were a younger about
neuro-transmitters in a real science about why it’s not great to do drugs. And then I get an iPhone little thing
on Twitter that goes, see dad, that’s not true. And I’m showing them real medical studies and they are
looking at me going, I don’t know what you’re talking about. I just read this on Twitter. So you’re fighting the
technology too, right?

Joshua Wayne (28m 15s):
For sure. For sure. You know, like, and again, with some of these things, you’re fighting a whole kind of
cultural momentum, the movies they are watching, glamorize it, all of these stoner comedies and stuff that
they are watching them make it seem funny and cool. And again, there’s this whole legalization
conversation. So again, like that’s the conversation that they are in with their friends and internally, if we want
to be able to influence it and we have to be a part of that conversation,

Dr. Anthony Orsini (28m 40s):
Part of the board of directors, love that.

Joshua Wayne (28m 43s):
A conversation that we think we should be having around them. But the conversation that they’re really
having around that this is the conversation we need to find a way to be a part of it. And it’s not always easy.

Dr. Anthony Orsini (28m 52s):
Okay. Now you work with a lot of troubled teens and I want to get your opinion on this because one of the
things that’s really in the news right now in really front and center is the role that fatherlessness plays in
troubled teenagers. And I really like your comments about that. How much has important is that, and there
are a lot of young teens that are growing up without fathers is either a divorce or have never had a father
that was in the house. How do we best help those troubled teens?

Joshua Wayne (29m 21s):
It comes back to be, to be the caring adult in their life,

Dr. Anthony Orsini (29m 24s):
Right? They need a male Adult somewhere. You know, I know mothers are doing a great job, but they
cannot do everything. So they need somebody else in their lives to help out with it. Right?

Joshua Wayne (29m 33s):
Yeah. And in my opinion, I agree with that a hundred percent. I think that, you know, it was, again, this is not
in any way undervalued the importance of mothers or, or the, women in the lives of young men, but at a
certain point, from my experience, they need a man to show them what it is to be a man in the world. You
know? And it’s, it’s the things that, that man says it to them. It’s just watching how that man behaves in his
own life, how he conducts himself, whether its, you know, it in a restaurant and how you interact with the
server, to showing up for work to, how you relate to and take care of your own family. They just need those
role models to see on a day in day out basis, to see how men Adult healthy, strong men behave in the world,
they are absolutely essential a need that I’m not going to get those statistics, right.

Joshua Wayne (30m 18s):
I’ve read about them and seeing them. But I would say the, the recall what it will be tough, but if you start to
look into the literature around it as a father in the home is one of the greatest predictors of success, just from
a sheer statistical standpoint, you know, a child without a father in a home is something like nine times more
likely to wind up in jail, you know, 8 times more likely to be poor and to be on some kind of public assistance.
There’s a whole litany of statistics like that. The number one predictor is a father in a year in the home.

Dr. Anthony Orsini (30m 46s):
Well, I read a statistic about 30 years ago. It was a study that said, if you have a father in the home that
actually played, but we were talking about sons that does, for lack of a better word, rough housing play, play
wrestling. I used to wrestle with my sons. We pretend to roll around and the way that those children were
much less likely to be violent when they were adult males. Because during that rough housing, the father
actually says, okay, that’s a little too far. Right. You know? And they learned that. And I thought that was a
fascinating thing. And my two boys would love to play wrestling with their dad when I got home. And, but I
welcomed it. It was fun. And first of all of it, but I also welcome it because they knew about that statistic.

Dr. Anthony Orsini (31m 27s):
And I think that’s really emphasized as how important it is, but there are so many young kid’s not growing up
with fathers, but there’s also a great organizations like big brother And and other organizations like that, that
I think we really all could help. And I don’t think there’s enough for them where they’re funded enough are

Joshua Wayne (31m 44s):
That’s probably not. But I agree with you back to your point. I think the rough housing, there’s a very healthy

aggression that men have, you know, but it needs to be tamed that needs to be channeled in the right
direction. I mean that can also be in an enormous attribute towards a being successful in life. If you have that
sense of assertiveness, let’s call it. And I think a lot of times you can you learn that from your father. And I
think you can learn that from wrestling and in the thing that you mentioned, I’ve seen similar studies where
that is where they learn healthy boundaries, right? You learn that you can be forceful and assertive, but there
is an appropriate time and place for it. And you learn that from your dad, rough-housing with you when to
turn it on when to turn it off, what’s going too far or what’s appropriate.

Joshua Wayne (32m 25s):
And that teaches young boys, these very, very important boundaries that they can later translate into other
relationships and, and to work life and then to all kinds of stuff. But they have a healthy outlet for that natural
assertiveness or a regression. However you want to call that healthy aggression. And

Dr. Anthony Orsini (32m 41s):
That’s why I always think boys and girls, it’s so important for them to get involved in sports or get involved
with something because now they have somebody else in their life as a coach and how many children, and
we’ll tell you that the Coach turn their life around. We’re a family that we are all my sons and myself, we all
played football. And whether you’re a football fan or do you want your kid to play football? I’m not going to
get into that. But if you think about it, football is a very violent sport, but what happens? The whistle blows
and every one on the field freezes, they just stop. And so it teaches these boundaries and it teaches just like
the father rough housing. There’s another example of, okay, we can get our aggressiveness out. And then
what happened at the end of a football game? Do you know, what’s the only sport we’re at the end of the
game, both teams shake hands except for the Stanley cup in the NHL, but that’s only during the Stanley cup.

Dr. Anthony Orsini (33m 29s):
So, you know, I think you’re right. So this is, you know, having that person who can teach you those
boundaries is really, really important. We’re running out of time and you brought up COVID earlier before, but
I want to get your opinion on this right now we have these lockdowns and we have many children and
teenagers living at home and doing remote schooling. How have you seen any ill effects of this as far as
suicide or drugs or depression or anything with the children who aren’t getting that social interaction with that
person to person way .

Joshua Wayne (34m 5s):
Anecdotally, yes. There’s that one study that the CDC published that was talking about young adults. And so
they may be talking about more, you know, 18 to 24 year-olds type of thing. But I see it and I want to see,
my son is six. We’re on lockdown in doing distance learning and he is struggling. You know, he is craving to
go run around on the playground and tackle his buddies and exhaust themselves and then come home and
sleep good. You know, he’s definitely missing that. I think a lot of kids are missing that. Some kids
interestingly, and I don’t know what the percentage breakdown is, seem to actually respond well to distance

learning or in the region. I think it was a personality thing. And I think certain kids, it actually helps them
focus. There’s less distractions in the classroom and just sort of being one-on-one with the computer helps
them. So I am hearing some anecdotes that for some kids is working really well, but I know for a lot of kids is
really, really difficult.

Dr. Anthony Orsini (34m 49s):
Okay. I’ve read that it’s really affecting adversely the lower socioeconomic kids because you know, maybe
they have it as a single parent, right? The mother’s got to go to work the teenagers home by himself. Maybe
they don’t have the technology that they need to do all the online learning. And if they do, there’s no one in
the house, you know, if you’re fortunate enough to be able to stay home with your teenager and say, you
know, please, you know that you have, you have a class go in front of the computer. My wife works at home.
It takes a lot of discipline. And as you know, to really at home, there’s so many distractions and for a
teenager, that’s a lot worse. And then while you’re online, you know, you got the tweets that pop up and that
the instant messaging it’s so easy to get distracted.

Dr. Anthony Orsini (35m 30s):
And so, yeah, I really worry about what, you know, the social interactions, you know, I spent my life teaching
them how to form a human connection between two different people. And, and there’s so many good people
out there that don’t know how to build that rapport. And I’m a big person on body language and non verbal
language, trying to build a rapport. And I can teach somebody how to build a relationship with somebody in
less than a minute. That’s really hard to do on the internet. You know, it’s so much better to do it in person
and have a big smile. So I worry about our kids who are already having trouble communicating in-person
because they’re growing up with the iPhone and now we’re in the era now of homeschooling.

Dr. Anthony Orsini (36m 10s):
So I’m praying that we get through this COVID and we can get back to normal as soon as possible.

Joshua Wayne (36m 15s):
I agree with you completely, I think kids need to be in school and around other kids. And you know, if your
doing distance learning and, you know, remember when you’re in class, when I was a student, if you fall
behind on something that you’re in a math lesson or something, and you have to get distracted and you
follow the behind, if you don’t find a way to get yourself back on track, you can lose the whole lesson, you
know? And it’s hard enough in class. There’s a raised your hand and ask a question, but online it’s such as
another again at a totally different dynamic.

Dr. Anthony Orsini (36m 40s):
Yeah, I agree. So we’re running out of time, but I want to ask one final and Difficult question that some
people have trouble answering. Now, I’m going to ask you because it’s only fair. What do you think is the
most difficult conversation that any parent or an adult would have to have with their child? And what advice

can you give them? We kind of touched upon that, but what do you think is the most difficult one?

Joshua Wayne (37m 3s):
Okay, so I’ll answer, but with a bit of nuance, I think Difficult one is the one that is most difficult for you. Okay.
You know, for some parents is going to be the drugs and alcohol thing, because that’s something that gets
them very anxious and uptight, but maybe sex is not an uncomfortable conversation with that parent or vice
versa. So I think just depending on who you are and what is your personality is in what your values are. It
can vary. I mean, I think it’s going to be, is definitely going to be about choice of friends, behavior, online sex
slash porn, drugs, and alcohol may be mental health. I think I am, again, my biggest advice is just to lean
into it, just to say, hey, look, I want to talk to you about something that might be uncomfortable for both of us,
but it’s on my mind.

Joshua Wayne (37m 43s):
I’ve got to talk to you about it because I love you.

Dr. Anthony Orsini (37m 45s):
I love that. Well, great. Advice funny story. My father was not a very verbal person. You know, the typical
stereotype cop. And I remember it was 13 years old. He came into my room and said, mom says, I have to
have the sex talk with you. And of course I turned bright red and he turns, even redder. And he said, do you
have any questions? And I said, I looked down, I got no Dad. He goes, okay, tell Mom we spoke. So I don’t
recommend that, but that’s just, as you said, it was a difficult conversation for him. So it was just funny.

Joshua Wayne (38m 19s):
I want to just a little pro quick, quick practical tips, that also would be helpful. A lot of times when you sit a kid
down, particularly an adolescent, do you want to have that face to face conversation? It’s going to feel more
like an interrogation than the conversation. So sometimes the more nonchalant it is, your driving in the car
when They don’t have to face you when you are facing, if you’re out on a bike ride or you’re walking or you’re
throwing the ball around, there’s something else that it doesn’t have to be this eye contact, awkward, all your
chips on the table, right? In this moment, Conversation sometimes it can work better when you just diffuse it
a little bit with some other environment or some other activities.

Dr. Anthony Orsini (38m 56s):
That’s great advice. And I think it makes us as parents and we are comfortable too. Cause we don’t have to
look at the kid. And as my father turned really red and also we’re playing basketball in between shots. Yeah.
So, you know, tell me about what’s going on. Josh this has been really, really informative and it’s been
inspiring and you’re just an amazing person. The name of Josh’s book is “A simple Parenting Guide to
Technology”. Josh, what’s the best way for people. I mean, they can visit you on Joshua wayne.com or the
best way for people to get in touch with you because they could do so many great things. And I’m sure that
you and I can speak for hours and hours and hours about teenagers. Cause there’s no book and it’s not

easy. What is the best way for people to get in touch with you if they want you to speak at their event or just
need some advice.

Joshua Wayne (39m 42s):
Joshua Wayne.com Is the place to get in touch with me. I’ve got some free resources for parents there or
information about my speaking in counseling it’s all right there.

Dr. Anthony Orsini (39m 50s):
Thank you Josh. This has been great. If you enjoy this podcast episode, please go ahead and hit subscribe.
Where on Apple, Spotify, Amazon, and many other formats and Google podcast. Please go ahead and
download all the previous episodes. If you want more information about the Orsini Way you can contact
me@theorsiniway.com. Josh thanks again. This has been amazing and I can’t wait for my audience to go
ahead and hear this episode.

Joshua Wayne (40m 16s):
Thanks for having me.

Announcer (40m 18s):
If you enjoy this podcast, please hit the subscribe and leave a comment for me to contact dr. Orsini and his
team. Or do you suggest guests for a future podcast? Visit us@theorsiniway.com.

Human Centered Approach to Leadership with Holly O'Driscoll

Holly O’Driscoll (1s):
The leaders have been rewarded for a certain set of behaviors. And so part of what I’ve come to believe is
that the condition’s inside of the organization direct that the reward systems inside the organization promote
a certain way of working as a way of getting results. And you might be the smartest person in the room, but it
doesn’t for a moment, really make a difference. When, you know, you may be you’ve left a trail of bodies
behind you because you have trampled over, you know, the rest of the team or you’ve taken all the credit or
are you throwing people under the bus and they continue to get rewarded. So until that reward system
pauses and says, hold on a second, right?

Holly O’Driscoll (44s):
What kind of leader we building here? What kinds of organizational climate are we creating and, are we
intentional about who we want to be as an organization? How do we want to show up what kind of employee
experience do we want to deliver? What kind of, you know, end user or patient experience do you want to
deliver? And what is that narrative that we want them to carry with them throughout the course of their

Announcer (1m 8s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way, As a frequent keynote speaker
and author Dr Orsini has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor are faced with giving a patient bad news, a business leader who wants to get the most out of his or
her team member’s or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 53s):
Well Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician This is
Dr. Anthony Orsini and I, will be your host again this week. You know, every single week I am more and
more blessed, I get better and better guests. And they’ve all been amazing. When I first started out with this
podcast, I thought, Oh my goodness, nobody’s going to come on. Nobody is going to want to come on as my
guest. But each and every week, I’ve got some guests that help me with my promise, and that is to inspire
and to teach communication and make people want to be better. And this week is no exception. So this
week my guest is Holly O’Driscoll. Holly is an industry expert in the field of design thinking in human
centered innovation.

Dr. Anthony Orsini (2m 36s):
As a global design thinking Leader at Procter and Gamble. Holly partnered with teams across the company
to lead more than 250 design thinking experiences. Often at the request of C suite executives. Through her
20 plus year career, Holly has built a reputation as a master of human centered innovation strategists,
trainer, and facilitator. Her passions include problem solving, problem framing. The organizational strategy

unleashing the diversity of people, leadership philosophy and creating conditions that allow human creativity
and curiosity to thrive. She is the founder and CEO of Ampersand Innovation, which I love that name. And
you’ll find out why a design thinking and human centered innovation strategy consulting agency.

Dr. Anthony Orsini (3m 20s):
Holly is the former chairperson in lead instructor of the Rutgers University design thinking executive
education program, which she may not know this, but that’s my Alma mater. She has lectured at the Parsons
school of design Harvard business school, Stanford university’s graduate school of business, and many
more prestigious schools. In addition, Holly has contributed to several books and is working on her own
book, which I’m waiting to hear about. And Holly is a globally sought after conference keynote speaker. She
has a BA in chemistry and an MBA at Thomas Moore college. She lives in Cincinnati with their husband and
four children. Holly Welcome!

Holly O’Driscoll (3m 57s):
Hi, thanks so much, Dr. Orsini really excited to join you today.

Dr. Anthony Orsini (4m 1s):
So this is a really been looking forward to it is we met by phone from a mutual friend I guess about a month
ago, we spoke on the phone. Things were so great I thought, well, all I had to do is hit record and I just, we
had our interview it just without even preparing for it. So I’m sure it’s going to go well, my audience is
growing every week. I’m really very blessed that way. And it’s right now it’s about 75% Healthcare and 25%
business. Although getting more and more amazing guests like, you know, I had Ann Barr Thompson that I
had just interviewed this morning. We’ve had Claude Silver. My cousin James Orsini from the Sasha group.
My business part is growing more and more. And I think that’s because it’s becoming evident to people that
communication is communication, and that if you want to be successful in healthcare, you’d better learn how
to communicate with your co-workers your team members and especially your patients.

Dr. Anthony Orsini (4m 53s):
And if you want to be a successful leader, you’d better learn how to communicate all that turns into this
culture, which we are going to talk about. So I really am dying for, because I think my audience right now is
asking two questions. Oh my goodness. What is design thinking? And how does this have to do with difficult
conversations that I promise you, we are going to answer both of those, so it stay on it. But before I ask you
that question, I always start off the same way. Tell us who Holly O’Driscoll is. And by the way, this is what I’m
told. This is the toughest conversation of all the interviews. So it was Holly O’Driscoll. And tell me about your

Holly O’Driscoll (5m 26s):
Well, thanks for that. So I’m, Holly, O’Driscoll and I live in Cincinnati, Ohio, and I’ve actually been in this
region in my entire life, but I’m going to start with the early part of my life, where for me, I got kicked out of

kindergarten. So I went to kindergarten for two weeks and I got kicked out for doing other people’s work,
telling the teacher how long she had to teach and it wasn’t going so well. And so I remember the walk out to
my mother’s car, and, you know, she said, get in, you’re not going back to kindergarten. And I said, well,
what am I going to do? And she said, I don’t know. I was like The oldest, right. We had to wait a couple of
weeks until the governor of Kentucky decided it was okay for me to go on to first grade.

Holly O’Driscoll (6m 9s):
So, you know, looking back, I think there were early signs that I had a natural propensity to kind of push the
boundaries and challenge assumptions. I just didn’t have language for that, you know, at age five, for sure.
And then I’ll fast forward a little bit to middle-school. So when I was in middle school, I had one of those
really nice zipper pouches for my pens and pencils, and still have this thing for a stationary items. Right. And
I would loan them out to classmates and I wouldn’t always get them back. And so I thought first that would
be a better way. And so I launched a pen and pencil rental business, and it was 2 cents a minute for a pencil
and 5 cents a minute for a pen. And so I came home

2 (6m 44s):
Some accountability in the world us good you know. So I came up with this bag of money

Holly O’Driscoll (6m 49s):
And, you know, my Mom said what are you doing and I said I’m running a business. She goes, Oh my
goodness, Holy cow. But you know, it didn’t, you learn, don’t rock the boat in kindergarten, you know, what’s
going on and go with the flow. And I think that we learn these messages and these ways of living and
working and communicating really early on in our life. And I don’t think they are serving as well. So, you
know, fast-forward to them in, to my kind of University ending day’s and I went and interviewed with P and G
and joining in the engineering organization in 1996. So I spent six years their in engineering, the for moving
on to the commercial side of the business. And so I have this depth of technical expertise that when
slammed together with kind of the business side of things really unlocked this kind of hybrid model of
thinking and working inside of the organization.

Holly O’Driscoll (7m 35s):
There weren’t a lot of people that kind of cross that chasm between the technical and the commercial. So I
moved to the Design organization where I was brought in to really be able to translate from the technical and
commercial and vice-versa, and then round about 2007 design thinking came to P and G. And so this really
was born out of a combination of efforts from the Stanford university D school IIT in Chicago, the University
of Toronto, in Canada, and really trying to apply the mindset’s and methods of designers, to business and
business strategy and user experience and holistic design. And at that time, that was all pretty new to the
world. But for me, I had a baby in 2007, as soon as I came back, I got trained and in design thinking.

Holly O’Driscoll (8m 19s):

So for me, it changed my life because for the first time, and I was able to fully practice this idea that I help
people matter more than anything else that we can do. And that’s what I feel like I was really missing in my
engineering role and trying to really put people at the heart of that. And so I stayed in that part of the
organization, practicing design thinking for about another, you know, 11 or so years, I left a little more than
two years ago because the outside world kept calling. Right. How might we just want to say this? That was a
really great pattern and to kind of unlock, but also practicing that method and mindset of design thinking and
prototyping is this going to work? Can I run a small experiment?

Holly O’Driscoll (8m 59s):
Can I try it on, can I try to figure it out? So, yeah, so that’s been really great. I’ve done quite a bit of
consulting both in the private sector and in the public sector, working on civic innovation challenges to, you
know, re-imagining, what is an in store experience might look like for a brand training in this space as well
has been a really important part of the portfolio. And then also this academic lens. So for me, that’s when I
launched my company Ampersand Innovation and then you mentioned the title and, you know, for me, the
title was really intentional and important because in design thinking, we talked about the power of, and when
I think about unleashing that and doing that and telling that story Ampersand represents that.

Holly O’Driscoll (9m 40s):
And when you say, and do you know, what really is it connecting? Its connecting people and ideas and how
do we really get intentional about bringing that forward in all of that we do, right? The signal’s that we send,
the words that we use, the way that we communicate, the way that we show up and behave as leaders.
Setting the stage for this to really take root and stick. So for me, Ampersand is not just a name, it’s really
deep connection to really unleashing the potential of people and ideas. So, so that’s what I’ve been doing.
And you mentioned my family and my husband and four kids and two horses and two bunnies and a dog.
And, you know, we’d get the whole thing going on with that.

Dr. Anthony Orsini (10m 16s):
Wow, my God, I don’t know how you are. So you have that much energy. You answered the question. So
now we talking about human centered and again, I was asked to do this as a video way back when, and I
decided to just do audio for many reasons, but one of the things that’s missing, what it can do a video is for
my audience. Holly gets so excited when she talks about this, you’ve got this big smile. And when you talk
about people, that’s what really comes through. I can see it in your face. I mean, this is what I do, I, the
communication and the body language. So there’s your answer to your second question audience about
what does this have to do with communication? It has everything to do with communication. Just design
thinking that term. Can you just define that for us a little bit?

Holly O’Driscoll (10m 56s):
Absolutely. So, and I’m going to give you my definition. There’s many out there. And so the one that I’ve
been sticking with is this human centered approach to really anything that you want to go after. I focus on

with clients quite a bit solving problems, solving challenges, and I think communication may, you know, fit
under some of those constraints as well. But this human centered approach, focusing on five principles that
were made famous by the Stanford University D school, the first is empathy. The second is problem
definition. Third is Ideation forth is Prototyping and fifth is Testing. And so this focus on empathy, empathy is
first for a reason, the idea that you need to understand what it looks and feels like to be someone else and to
experience their reality and recognize that their reality is their truth.

Holly O’Driscoll (11m 44s):
And even if it’s not yours, it’s theirs and we need to go down and go. Wow. Yeah. Can you tell me more
about that? Right. So often I feel we’d been socialized or educated and then corporatized to say, Oh, I’m not
sure. I agree. Let me lean back and cross my arms and you walk away or say, yeah, I don’t agree.
Therefore, something must be wrong with you. And there’s a different way. If we lean in and say, hold on a
second, can you tell me more? I’m not sure I agree and leaning in you. No, you can’t see that on the
podcast. Right? But you can start to imagine what it looks and feels like to lean in instead of kind of cross in
the arms and bring that to life.

Holly O’Driscoll (12m 26s):
And so if you think about Empathy as that first principle, it really is the foundation of everything else. Solving
challenges with the person at the center, this whole concept of human centeredness, nothing else matters if
the human needs aren’t met. And so say you’ve got a terrific technology or you’ve got a cost structure or all
of these things that were often asked to deliver on. If it’s not adding value and meaning to the human
experience, I would argue it’s not useful. And how do we really prioritize the human needs first?

Dr. Anthony Orsini (12m 56s):
So it goes into culture of the place. And as you speak and really thinking about what happens in healthcare
and when I’m asked to train physicians on how to communicate, it’s all about, you said, Empathy I used the
word compassion, very similar. It’s all about empathy, compassion. And in fact, a few months ago we had
Helen Riess. Dr. Helen Riess was a guest on my show and that’s what she does. She teaches Empathy,
she’s a Harvard psychologist. Then she does that to businesses as well. But I think what happens in
medicine, I think it was also what happens in business. If we get really caught up in the number’s, the bottom
line, physicians tell me all the time that I forgot.

Dr. Anthony Orsini (13m 38s):
That why did this in the first place? And physician burnout is almost 60% right now physicians have the
number one profession for suicides. And it’s because you’re taking that excitement out of what your doing.
And so when I’m able to speak to physicians and you know, your five principles or almost the same five, I
use a different acronym, but I’m like, Oh my God, this is exactly have a plan, be empathetic, build a
relationship to be a genuine person. And what’s really nice about when I do personal coaching with
physicians or when I do it on a large scale is when you remind people like you leaned over, that’s exactly

what I teach.

Dr. Anthony Orsini (14m 21s):
When I tell a doctor, how do you connect with a patient? But one of the things is don’t look over at a
computer lean over and look them in the eyes and smile and give them that active listening look where you
are really concentrating on in their eyes. Helen Riess used to say, make sure that when you say hello to
somebody, you remember what color their eyes are, because it just forces you to look at them. But what’s
great about my job is that after I’m able to meet with them, even on a large scale, I get people come back to
me and say, I remembered why I went into the medicine in the first place. And you know, you’re giving me a
few techniques that I can bond with my patient and still not go home at nine or 10 o’clock at night.

Dr. Anthony Orsini (15m 2s):
’cause there you go to Ampersand you could have, and you can have a job satisfaction and you can go
home at five o’clock and you can bond with your patient and still see 25 patients a day. It’s exactly right. And
so getting a long winded question here, but that leads into my biggest issues are how many people are being
put in leadership that have no business being in leadership because they’re the smartest person in the
group, but they can’t communicate. They can’t build loyalty. And again, I’m paralleling back to the healthcare
there’s physicians that I know that are brilliant. But their bedside manner is so bad and they’re not trusted by
their patients.

Dr. Anthony Orsini (15m 45s):
And because they don’t have the communication skills, which by the way, as you know, it’s not that hard to
teach, you know, lean forward and looking in your eyes, its not that hard, but you can be the smartest person
in the group and also be the worst leader. And that leads me into my question about what you do with
leadership and culture. And the last time we spoke, you were discussing how these companies just had this
horrible culture that you are asked to fix. So tell me about a poor leader, how that works, how do you fix the
culture? How do you get people to get excited about their job again. Long question.

Holly O’Driscoll (16m 21s):
I love it because it happens all the time and you know what they think so many organizations are struggling
with. You know, how might we build a leader that really does inspire and promotes trust and creates a
climate of candor and you know, psychological safety, which we’ll talk about it in a moment. But when you
think about that, core leaders, the leaders have been rewarded for a certain set of behaviors. And so part of
what I’ve come to believe is that the conditions inside of the organization direct that the reward systems
inside the organization promote a certain way of working as a way of getting results.

Holly O’Driscoll (17m 3s):
And you might be the smartest person in the room, but it doesn’t for a moment, really make a difference.
When, you know, you may be you’ve left a trail of bodies behind you because you have trampled over, you

know, the rest of the team or you’ve taken all the credit or are you throwing people under the bus and they
continue to get rewarded. So until that reward system pauses and says, hold on a second, what kind of
leader we are building here? What kinds of organizational climate or are we creating and are intentional
about who we want to be as an organization. How do we want to show up what kind of employee experience
do we want to deliver? What kind of end user or patient experience do you want to deliver? And what is that
narrative that we want them to carry with them throughout the course of their journey, whether that is, you
know, you’re coming in as a new or coming in as a new patient.

Holly O’Driscoll (17m 52s):
When you think about, you know, when people are coming to healthcare providers, maybe it’s when things
are going well, we hope that they’re going for well visits, but often that’s not necessarily the case. And so
how do you really step into that space and say, Oh, you know what narrative, or are we going after? What
kinds of experiences are we aiming for it? And so when I think about the leader, I think the leader is one kind
of cog and that entire organization’s machine and the leader is just as much as I would say, an artifact of that
culture as they are a contributor to that culture. And so when you think about, you know, they’re building on
this platform for which they’ve been rewarded, and until that reward system changes, it’s really hard to
change the leadership and the mindset and the way that leaders show up.

Dr. Anthony Orsini (18m 39s):
So you kinda answered my next question, but I am not sure. So my next question was going to be do
companies, hire poor leader’s or can you take a smart person and make them a leader. If you were giving
advice to a new company, would you say I can train most of your smart people that would be good leaders or
don’t pick that person. I’ve trained thousands of thousands of doctors. And I can tell you when it comes to
the communication skills and I call it compassionate communication out of a hundred doctors, we’ve found
that 15% of them, I can put them in an, you would love for them as a new patient. They are wonderful.

Dr. Anthony Orsini (19m 19s):
You’ll walk through the fire for them. And by the way, if you trust your doctor, you are a very unlikely to sue
them. Even if something goes wrong, that’s how much trust is important. You know, 15% of ’em I can train
every day. They are never going to get it every day, but the other 70% are teach me. I want to know this was
awesome. So if you are starting a new company, which way do you go do you hire the good communicators
or do you hire the smart people and teach them?

Holly O’Driscoll (19m 45s):
I would back up or even one step further and I would choose to hire for integrity. And I don’t believe integrity
is something that you can teach, but I absolutely believe leadership is something that you can teach. And if
there’s a willingness to kind of go there and grow tthere it’s a whole lot easier. So, you know, inspired by the
work of Carol Dweck out of Stanford, she wrote a book called mindset and she talks about growth mindset
versus fixed mindset. And if you have been exposed to climates may be in your educational experiences

where it wasn’t okay for you to be wrong. We are getting something wrong, meant there’s something wrong
with you. Its a lot harder to step into that growth mindset than it is to kinda stay in that fixed mindset where,
you know, there’s one right answer.

Holly O’Driscoll (20m 29s):
There’s only one right answer. You know, how can I figure out how to not look bad in this situation versus
really saying, wow, what did we learn and how can I grow and deliver on these experiences and
expectations that not only do the organization has, but the end users or the patients are the consumers
clients or you know, whoever that is, what do they have? And so I would choose to hire for integrity and train
leadership. What comes with training Leadership is also a training. This, I would argue a human centered
mindset on it’s in service of others, this idea of servant leadership and coming with empathy coming with
curiosity, you know, as we mentioned earlier, kinda that leaning in versus crossing your arms and walking
away there’s ways to do it.

Holly O’Driscoll (21m 14s):
And often I find organizations just fly right by it on, Oh, because you pass the screening process, we assume
that you are going to be able to lead this team. In fact, you know, if you think back to the first time that you
managed a team were you are well-trained two, go and do that to lead that group of people? And most of the
time they have people respond to that question with no Holly and they weren’t right. They weren’t trained to
do that. And so they learned by fire and they learned from some really tough experiences and there’s an
opportunity to step in and feel more supported and to get really intentional about the skill set that you wanna
build every step of the way. And I think at that point around getting intentional is just as important as the
integrity piece on, you know, how do you hire for integrity and then get really crystal clear and intentional
around the skills that you want to build such that you are cultivating great leaders, not just now in the
moment in the organization, but great leadership that will carry you into the next 50 years, hundred years.

Holly O’Driscoll (22m 10s):
You know, whatever that horizon looks like in your organization, you know that this idea of now and for
generations to come, how do you establish those standards of leadership and high expectations to set the
stage for what’s important here? What gets rewarded here? What’s valued. What are those stories that we
tell each other, when, you know, maybe you run into your neighbor, walking the dog around the block, what
would you say to them about the leader you have in your organization or what the climate of the place is, or
kind of the idea that the CEO talks about? You know, what do you stand for in the hearts and minds of

Dr. Anthony Orsini (22m 43s):
One of the words that I use all the time is genuine and you spoke about leaders is their only one answer. I’ll
make an observation that I noticed when I was training, is that the smartest people in the room had several
correct answers for some one question because they were so confident in their ability that I think that when

you truly understand something that you understand those more than one way of doing it, but the word I’m
thinking of, I use all the time is insecurity, right? So the leaders’ who are insecure, they just, it has to be done
this way and will, why can it be done in that way? Just because it has to be done this way. And I think I’ve
had some bosses who are so smart, like, OK, well that’s not the way I would do it, but go ahead.

Dr. Anthony Orsini (23m 24s):
And it makes you engaged and it makes you exciting. And I don’t understand, I guess my audience is getting
tired of me saying this before. I don’t understand how certain people advance to these leadership and then
tear down the culture, which is the next question. I’m going to ask you that you tear down a culture of a place
where I guess I’m trying to remember the exact quote, but it’s something to the affect of the worst thing that
can happen is when your employees go silent, your best employees. And I’ve seen that before, I’ve worked
with bosses that I would kill for. And I’ve worked with the bosses that I didn’t trust. Stephen Covey is on this
week, his podcast dropped this week the speed of trust and I don’t get it.

Dr. Anthony Orsini (24m 7s):
Holly, why do we let these people lead when we can find somebody? And I guess people like you are
helping, but now let’s go into the next step. So now you’ve got these poor leaders, your culture’s terrible, the
employees are leaving, your employee engagement is so bad, you got this turnover, leader it doesn’t trust
the workers, workers don’t trust the leader, there are walking the dog and they are talking about what is it an
ass their boss is, and then they call you. And how do you fix that monumental problem? What goes through

Holly O’Driscoll (24m 40s):
Well, you know, it’s a really interesting scenario. And for me, I don’t think of it as fixing. I think of it as guiding
on, you know, when you think about wow, really understanding what do those drivers, one of those
behaviors and using a lot of the tools that we use and the innovation space to really unlock what’s going on.
So one of the one’s that we use quite often we call an empathy map and it was really focused on sketching
out what are people thinking, feeling saying, and doing, and you know, what’s happening on kind of the
inside, which is the thinking and the mind and the feeling of the heart, and then what’s happening on the
outside. What are people saying? What are the words that are coming out of their mouth and what are they
doing? What are those behaviors that show up and really sketching out What does that look like?

Holly O’Driscoll (25m 23s):
What does it look like for a specific leader? What does it look like if you were to do an analysis across the
core leadership team and how is that impacting your group? So the idea that certainly the leader sets the
tone for the rest of the organization is absolutely true because everybody’s watching.

Dr. Anthony Orsini (25m 40s):
So I’ll share, not to interrupt you, I’ll share an old Italian quote that my grandfather used to say, the fish rots

from the head down is what he used to say. I don’t know that you’ve ever heard of that, which by the way is
not true fish. Fish don’t rot from the head down but I used that all the time sorry to interrupt you. But I just
had to say,

Holly O’Driscoll (25m 59s):
What’s the plan that says the same quote. And I think it’s really genius. Interesting to know the physiology is
actually not true or are they wrong? And organizationally, I would say absolutely it’s happening in that way.
And so we have to do some work to really map out what’s going on. How are people feeling? What are those
stories that are coming in with you? And I do a lot of work with images as well and have people choose an
image that represents what it feels like to come in to work every day. And sometimes, you know, I’ve had
people pictures in the image that is a radar shot, have a cyclone or a hurricane. And then they’re like, this is
what it looks and feels like. Okay. Tell me about that. And so evoking those stories, those human centered
stories are so much more impactful because I’ve seen other organizations that say, Oh, well look at the
employee’s of engagement or employee opinions or employee feedback.

Holly O’Driscoll (26m 47s):
And I’ll say, fair enough, but I’m not really interested in the survey. And they say, what do you mean? And
they say, my goodness, you know, if your spreadsheet has, I don’t know how many employees do you have
to have 5,000 employees, or you want me to look at the 5,000 rows spreadsheet and tell me that overall,
your average of the 4.4, the metrics are really lopsided in a lot of organizations as well, because if you’re
high fiving, because you get to a 4.4 and you know, out of five, why, what does that matter? And what those
moments for your employees look like every day and the impact that those leaders are having on them. And
the running joke that I often share is, you know, nobody’s ever looked at a spreadsheet that size and said,
Oh, 4.4, On brought to tears as a result of the 4.4 but for every story that everyone shares You know, there is
something you can take away.

Holly O’Driscoll (27m 36s):
That’s going to stay with you for a really long time. And sometimes it does result in tears for them and for
me. Right. And do you feel like, wow, you know, these are the stories that need to surface. And I think that is
so linked to our collective humanity. We, you know, for generations, humans should have sat around
campfires and listen to the stories and learned about life in that way and learn lessons that way. And wow,
the survey doesn’t do it justice, and yet it happens all the time. And so I would prefer a dozen or so really
great deep conversations to get a snapshot versus the survey. And I know its quick and easy and that’s our
mindset and there are a busy western world, but I would argue there’s such limited effectiveness and
usefulness there.

Holly O’Driscoll (28m 16s):
And frankly it’s dehumanizing the depth of relationship and connection that could be happening inside of our
organizations. Imagine if you got some stories early on versus waiting for the survey to kick in, you know,

what was it like today? Or if you can choose a path that through the Paris airport used to travel, and that was
a thing to do. And it was gone and the past couple of years, and it passed through the Charles de Gaulle and
you know, you went to the restroom in there, they had this little stand and you’d hit, you know, how was the
condition of the restroom today? And you could have a frown or a straight face or a smile and then one that’s
joyful, right? And then you can get this emotional data in ways that, you know, don’t rely on, hey, your score
is a 4.4.

Holly O’Driscoll (28m 57s):
So starting there and understanding what’s going on with the people is always the richest place. You know,
when I’m taking on one of those situations, because it’s rooted in the Empathy,

Dr. Anthony Orsini (29m 6s):
It’s in our DNA from the caveman days to relationship, to form a human connection with people. And that’s, I
brought up genuine before if your leader or your coworker, if you happen to know that they have, how many
of you say you have four dogs and a rabbit,

Holly O’Driscoll (29m 22s):
The kids and a dog. Yeah,

Dr. Anthony Orsini (29m 27s):
There you go. So if you share, and I say that the physicians all the time share personal information with your
patients, you become a real person. It’s that human to human interaction. It’s in our DNA. And if you really
want to be happy at work, I’m astounded of how many companies do these employee engagement surveys
get poor scores and then do nothing about it.

Holly O’Driscoll (29m 49s):
Right? That’s the worst because not only could you tell them how you felt, but nobody cared enough to do
anything about it. Are you kidding?

Dr. Anthony Orsini (29m 55s):
Their response is their crazy, I don’t believe that.

Holly O’Driscoll (29m 59s):
And you know, I love the point you are hitting on, which I would describe as a vulnerability. How do you have
a snapshot into someone’s personal reality? What does it look and feel like for them and as leaders, the
leaders that show up with a sense of vulnerability connect, with their organizations so much better. And if
you’re sharing stories of hey, you know, hey, this is a vision for that we have for the future. Here’s an
example of what that could look like. And, Oh, by the way, let me tell you a story about a time when, you
know, I tried to do something really hard and I didn’t go so well. I used to have shame with my kindergarten

story. And then about 10 years ago, I was on maternity leave and doing some reflection and thought, wow,
there was a pattern here.

Holly O’Driscoll (30m 40s):
And instead of feeling badly about that moment in my life, I need to connect the dots and be really explicit,
such that other people can start to connect the dots in their own journeys and to figure out what does that
mean for their gifts and their energy and the impact they can have in the world. And I used to not feel great
about that. When you think about being vulnerable and setting the stage for sharing stories and sharing this
idea of, you know, we’re humans and we’re complex and we’re emotional and, what better way to connect
with others then to bring that forward on yourself,

Dr. Anthony Orsini (31m 14s):
Especially you brought up a new leader and you know, I’ll tell you something funny about medicine.It’s the
only job that as you’re training that you only have two choices. You either get promoted or you get fired. So,
you know, you start over you’re training in medical school and then you became a resident. You’re a
first-year resident. You have to really screw up very badly. Otherwise you’re going to get promoted, you going
to get promoted, but now you find yourself in a new job, in a new leader, there’s nurse’s around you or
maybe your a seasoned, physician and you’ve just taken a director job. The best thing that you can do is to
be genuine, to be humble and to say, how do we do things here instead of coming in and saying that nurses
and your worker’s, especially if you’re a brand new or they know you don’t know what you are doing, they’re
not stupid.

Dr. Anthony Orsini (31m 59s):
So don’t fake it

Holly O’Driscoll (32m 0s):
Right, as they think, Oh my gosh, I’ve got to train them such that they can get up and shine.

Dr. Anthony Orsini (32m 5s):
So say help me be vulnerable. I love that there are so many parallels between what you do in medicine. And
the last time I spoke to you, I’m going to, I need to get Holly to fix medicine.

Holly O’Driscoll (32m 16s):
I don’t know if I have those kinds of super powers, but I’m up for the fight.

Dr. Anthony Orsini (32m 19s):
Well, the medicine culture, and we’ll get to the next question is shortly, but in the culture of medicine right
now. And I think we talked about this last time. It’s not the insurance companies, that’s killing medicine right
now. It’s the inability of the hospital, administrations, the leaders to speak to the nurses and doctors and the

people on the ground floor. And that’s no different to business, and if I went and told the CEO how to do their
P and L he looked at me like, what the hell do you know and so that’s what happens with the physicians?
When you have the administrators to say, do this, and the doctor is look at them and go, what are you talking
about? Like this has nothing to do. And that caused job dissatisfaction, employee turnover, all that kind of

Dr. Anthony Orsini (33m 3s):
So I think I’m talking too much. So I want you to talk more, but a couple more questions. The next one is, I
know you give some training sessions, which are in a day, right? Some of them are two to three days long or
even longer. And you’re training a large number of people. And I know this happens to you cause it happens
to me all the time. There’s always the guy or girl that sits in the back and you can tell from her body
language or his body language that they think you are full of crap. Right. And why do I have to sit here? This
is so stupid. Just let me do my job and I’ll get outta here. You know, I’ve been pretty fortunate for the most
part through the workshops and the little humor and kind of engaging in that most of them come along.

Dr. Anthony Orsini (33m 46s):
What do you do with that person? Because they have to be on board too.

Holly O’Driscoll (33m 50s):
Boy, they absolutely have to be on board too. I love that. And I would say name it. So I called them the
skeptics. And so if you name the skeptics in the room and you’ll see, you know, who they are, the energy is
different. The eye contact is different or the stance, whether they are standing or whether they’re sitting, you
know, that you can go, Oh, okay. You’re exactly right. And someone either sit you here, or if this was better
than going into your day job today. So one of those two, which is usually the case, right? You might be a
tourist or you might be kind of hear because someone said, no, you need to go and you get to get it fixed or
learn how to work on this way and I’ll make it visible. And so you say, hold on a second, right?

Holly O’Driscoll (34m 30s):
What’s going on, you know, what are you thinking about? Can you bring us a story that will contribute to
vulnerability or, you know, an empathy for your patient, for example, and tapping into them and making it
really visible has been super effective. Right? So if it’s a group that is, I would say 50 people or less one of
the first things I do when I walk in is to go through introductions and I want to know who’s in the room and it
takes some time for sure, but it’s super intentional around creating a space for human centeredness. And
what’s more human centered than knowing the names of the people that you’re sharing space with. And I am
astonished by the number of leaders in organizations who don’t know the names of kind of, their two down,

Holly O’Driscoll (35m 12s):
And think if they don’t know the names of the people that are a second level down, they don’t know the

names of their direct report’s children are their pets or their significant other, or whoever, but connecting at a
human level. So, so important. And so once I know their names, we’ve done the round of introductions. I
play it back to them and I’m like, okay, you know, Dr. Orsini hi, really glad that you’re here. And I’ll say, let me
make sure I get it straight. I’ll do the circle. And people are kind of astonished at that point. I was, please
learning the names really matters. So when I can say, you know, hey Sarah, I notice that your body language
is a little different. You have something to add to this, or what’s going on.

Holly O’Driscoll (35m 55s):
You know, I called someone out in a session once and she said, I really have a toothache. And I said, okay,
hold on, let me go get some ibuprofen out of my bag. Let me help you. And so I called it a break and said,
you know, Hey, here’s what we’re going to do. Will come back. And 10 minutes, I’m gonna help her and get
her what she needs you to go grab a coffee. It will be back in 10 minutes. And she said, I was so afraid to
speak up and say something. I have some ibuprofen in my bag, but I didn’t want to interrupt. And I’m like, no,
right. This is about human centeredness. Go do what you need to do for you. Let me go get a bottle of stuff
and I’ll get you a glass of water or you stay put, but modeling that for the group, sent such as a signal on,
hey, it’s perfectly fine. You know, if a new person enters the conversation, or enters the room, if somebody
comes in late in their, like, I’ll invite them in and say, welcome.

Holly O’Driscoll (36m 41s):
Hi, I’m Holly who are you? And they’ll say, you know, Oh, well, I’m Tom. Okay. Hi Tom. Welcome what do you
guys think Tom needs to know? And I said to her or Tom, I’m not calling you out because maybe he had a
perfectly good reason or you had something going on. I’m not coming from a place of judgment. I want you
to feel included and a part of the conversation. So let’s pause for a moment and say what we think Thom
needs to know and will spend a couple of minutes doing that. So what happens Their the group says, O all
right. We are going to bring them along. We’re not going to make them feel badly and sit in the back or, you
know, make them feel like I need to sneak it. And I need to be really quiet and pretend I’m invisible when
everybody knows your not, we have these really weird behaviors for these moments that could be handled in
much more human centered ways.

Holly O’Driscoll (37m 24s):
And so one of those with a skeptic is calling them out. This is Sara, and what’s going on for you and really
bringing them into that conversation and inviting them into the story. When I kick off a session, usually we
started in a circle in the in person days and now that we do it on zoom, right? And we do it with a screen
share off, and you can see all the faces. I ask everybody, just turn their cameras on that. It’s intended to be
in an analogous circle. And we start it in a circle for a reason, because that’s where the stories come from.
That’s the campfire. Sometimes I’ll turn on a YouTube clip of a fireplace as well to really set the tone. If I think
people are going to get stuck. And it’s such a great signal to say, Hey, we’re here to support each other. I
used to do a lot of workshops in a space that was a loft space and had a hardwood floor.

Holly O’Driscoll (38m 9s):
And in the middle of the hardwood floor, we had a green carpet. When we caught up the green carpet of
candor, where you can safely share your truth. And the expectation is that everyone else supports you and
you can count on me to support you as well. So whatever that difficult conversation is that spirit of candor
and openness, and I’m not here to judge what you’re saying. I’m here to support you, to find and reveal your
truth is so, so important. And we can do it. We have just been socialized to operate in other ways that maybe
are more comfortable until you get comfortable trying on something new

Dr. Anthony Orsini (38m 41s):
And you are walking the walk. You are not just to be because you’re including those people. And many
people want to just be included. I’ll tell you a funny story. When I was in college, I made some money by
being a substitute teacher and the inner city in Newark, New Jersey. And there was a tough school. Like they
paid me $45 for the whole day, but I would go there and I’d sit there. And I was terrified because the kids
wouldn’t be, they run around, they wouldn’t be listening. And I learned after about three days, find the kid,
really the worst kid there, the, what is causing all the trouble. And, you know, Tommy today, you are in
charge of keeping everybody quiet. And I was like, Oh, I came home. And I said, this awesome, like the bully
is now telling everybody to be quiet, you know, what all he was doing was making them mad.

Dr. Anthony Orsini (39m 29s):
And, and that’s all he really wanted to do was be, he didn’t want to be the bully. He wanted it to be the
teacher’s helper. And once I learned that trick it was the easiest money I ever made. It just, it was great.

Holly O’Driscoll (39m 39s):
I know, but the insight there holds, whether it’s, you know, a kids’ in third grade or a grownups and
professionals and physician’s, and everybody wants to feel like they matter. And if you can bring the energy
and the eye contact and the ability to demonstrate that they are the only person in the room that matters in
that moment, you can tell them anything. Right. We have the ability to do that because it’s rooted in trust. So
I love that your talk about Stephen Covey and the speed of trust. That was actually a course that was put on
internally when I was working at Procter and gamble. So that core to the culture is, you know, the importance
of trust and everything else kind of stems from there, and absolutely the bedrock of leadership and

Holly O’Driscoll (40m 22s):
And I find it really interesting that the Gallup organization says, you know, I think at 16% of our employees
are actively engaged every day. And you feel like it’s a 16%, are you kidding? But I would argue the
remaining 84%, maybe don’t have that level of trust with their leader, with their manager and trying to set the
stage for something that is so much so important as trust is really hard. If your one, when we talked about it
earlier, right? Rooted in integrity, we need to be routed in integrity. We need to be really intentional and
intentional on your behaviors. What you say, what you do, how you show up, are you consistent? What

signals are you sending? Because if we can situationally kind of shift our tolerance for behaviors on, Oh,
Because, it was the leader of that said that I’m just going to keep nodding, right?

Holly O’Driscoll (41m 12s):
You’ve probably see it a million times where, you know, behind closed doors, you’d be saying, what in the
world is that? And you would never put up with that from your team. How might the organization create a
climate? And you starting with the leader where the leader can say, Hey, if I’m not congruent and consistent
with the principles I say are so important, I need you to hold me accountable. That only comes from a place
of trust.

Dr. Anthony Orsini (41m 33s):
We can go on forever and ever. And you know, the program that I do in the name of my book, It’s all in the
delivery, one of the key components of the program after we train everyone, how to communicate, how to
build relationships with each other and the entire hospital that are building relationships with the patients are
telling them that it’s not what you say is how you say it. It just says, we’ve been talking by the way, audience.
There’s been a lot of communications skills here that we discussed. So I’m meeting my promise. We do
something to go see something, say something. And so we have these little stickers that say, it’s all in the
delivery. And any one in the hospital, you can be the housekeeper, is allowed to give to the doctor, the
nurse, anyone in the hospital. If they’ve had a good communication, they bonded a little sticker.

Dr. Anthony Orsini (42m 16s):
I was shocked when I did this the first time in four years ago, you can be a 65 year old director or CEO and
you get a sticker, you get a big smile on your face. It’s amazing, right? Like you were 65 years old or you get
a sticker. But the other thing we do is that we also empower everyone to also say, I noticed, so sometimes I
get really busy. Maybe I don’t have a good conversation with an employee. Maybe I didn’t smile and say,
hello. The housekeeper can say to me, Dr. Orsini it’s on the delivery. And my response is that we get
everybody in a promise to do this. My response is, well, thank you, Sandy. I forgot. Or I got caught up and
this is why it works. So you need that positive reinforcement.

Dr. Anthony Orsini (42m 57s):
You need that negative reinforcement for the audience out there. Holly and I can talk forever because I can
see your face. You get so excited about this stuff. You know, how excited I get about the staff, that it’s cool to
be able to learn communication and to learn about your DNA and how people feel and it’s frustrating a little
bit for me, because I don’t think it’s that hard.

Holly O’Driscoll (43m 15s):
Well, I so agree, right? This is part of how we’re wired as humans we’ve been brought up in systems that
don’t allow us to practice this in a thoughtful and intentional way, or we’ve been so conditioned to be a zero
sum thinkers, and it doesn’t have to be that way. How can we lean in and say, Hey, why am I think this is

going to be tough, but we’re going to get through it together and let’s talk about it. And even those most
challenging conversations can be handled and thoughtful and human centered in compassionate ways when
they are rooted in relationship and trust.

Dr. Anthony Orsini (43m 49s):
Absolutely. So last question. I asked everybody the same question. That’s the toughest one, next to, tell me
about yourself. What’s the most difficult conversation that you’ve had that you don’t have to get personal, or
you can just call it a type of conversation that you find the most challenging?

Holly O’Driscoll (44m 6s):
Yeah. You know, I think type of conversation is a really great way to put it because when I think about what
makes it challenging, I think it’s kind of wrapping up a lot of what we’ve talked about and the conversations
that are tough As are the ones that are not rooted in trust. So if you feel like you need to not tell the full story
or sugarcoat some things, one of the things I find is so important, you know, that the more experiences I
have and the older I get, the more intentional I want to be for setting the tone for my kids is this important
piece of congruence. And then when you talked about kind of walking the talk and having a stated way of
thinking and doing, and, you know, wanting to serve up to the world and bringing that to life are so important
and more important to me now than ever.

Holly O’Driscoll (44m 57s):
You know, you think about it. I have 45 And wow. You know, you get older, you get the more important that
congruence comes to be. And the toughest conversations are when the trust isn’t there. And when you think
about the absence of trust, that makes everything harder. Because I could say, you know, I talk about it often
as the spinach in the teeth test. So if you, and I didn’t know each other, and you know, I noticed that, you
know, your sitting in the cafeteria and I think, Oh my goodness, he’s got spinach in his teeth or is it okay for
me to approach you as a stranger and say, hold on, you’ve got spinach in your teeth, or are you going to be
mortified or embarrassed? Or how could she be and how rude that is. But you would tell your partner, you
would tell your child, you would tell your friend you’ve got spinach in your teeth.

Holly O’Driscoll (45m 41s):
They would say, thank you, thank, you know, you’re coming from a good place versus, you know, places
where you don’t have that trust established, they might say, huh, alright. That was really uncomfortable. And
that was weird. And what are they doing? Looking at my teeth anyway, it, all of these narratives that are not
helpful when it was coming from a place of help. And when you have an absence of trust is what makes that

Dr. Anthony Orsini (46m 5s):
That word comes up every week. Holly every week that we’re in, it comes up and I’m going to keep pounding
it home till everybody gets it. So

Holly O’Driscoll (46m 14s):
I think that’s really the biggest barrier to handling conversations, whether they are great conversations or
whether the really challenging conversations, because even the great ones are improved by trust. And that
don’t, you want to share great news with people that you feel a depth of connection and relationship with an
even more satisfying than it is for us as people to be able to share those great moments in addition to
navigating the challenges ones.

Dr. Anthony Orsini (46m 35s):
And I’ll finish it up by saying, and People trust people who are real people and not fake people. And so I
teach physicians and nurses how to build trust in less than a minute. And so you can be genuine, as I say,
be real, build the trust. Be humble. Boy, you taught us a lot of stuff today, Holly, this is awesome.

Holly O’Driscoll (46m 53s):
So fun. And boy, you are spot on that we could talk for hours because I am deeply committed to the belief
that this is something the world needs more of, you know, people often ask me, what’s next for design
thinking. You know, it’s been in business for awhile, and now it’s starting to show up in University education.
And in some schools as well, kinda K through 12, we want to say, wow, you know, I would like for this to be
the way that work gets done to the way that people live in to bring that congruence to life on, you know,
human centerness and curiosity and empathy and candor and trust, all of those are so important. And, you
know, arguably this might be something our country needs more than ever, right.

Dr. Anthony Orsini (47m 34s):
Definitely. And were filming. This is the day after the fact of the audience, the day of the election. And we
don’t know who the president is, but we need to communicate better. And I think, again, there’s so much
cross-reactivity here between health care or your personal life, your professional lives. And that’s why I’m,
I’m working with businesses. They’re saying what’s an ICU physician working with business leaders. But it’s
the same thing. If we can build that trust you, it doesn’t really matter. What is

Holly O’Driscoll (47m 59s):
Common humanity for sure.

Dr. Anthony Orsini (48m 1s):
You got it. This has been really a lot of fun. Holly finishing up real quickly. You know, a book coming along,

Holly O’Driscoll (48m 7s):
I’m working on it. My goodness,

Dr. Anthony Orsini (48m 9s):

It’s hard. I finished my in May.

Holly O’Driscoll (48m 12s):
It is right. I am trained to crank out corporate memos, no problems. And you know, translating a lot of that
into a book format is harder, but I’m writing about how do you really humanize leadership and bring these
concepts and ways of working to life in a way that they are not, I would love it to be a place when they are no
longer special where we can look around the organizations that we work in, that we connect with, that we
kind of contribute to our customers and patronize, how do we look around those organizations and say, wow,
you know this sense of human centeredness, this is the way, and that’s, what’s normal instead of a lot of
these stories that are often we get caught up in that we hear all the time that aren’t so positive.

Holly O’Driscoll (48m 52s):
So that’s my greatest wish

Dr. Anthony Orsini (48m 54s):
I can’t wait to read it. How would anybody get in touch with you? What’s the best way for them to get in touch
with you?

Holly O’Driscoll (48m 59s):
I know I would say LinkdIn is absolutely the best way I’m under Holly N O’Driscoll there is another Holly
O’Driscoll I came to know about. And so I had to add the middle initial into the mix, but on LinkedIn
absolutely is the best way. You know, people often ask me, Oh, do you have a website? And I’m like, well,
I’m working on it, but I got to tell you, I’ve managed to, you know, go on for a couple of years without it’s
going okay. And so LinkedIn really does seem to be the catchall for all of that. It looks like. So I have chosen
to really focus on making a difference for our clients and for projects versus building my website.

Dr. Anthony Orsini (49m 33s):
Well, we are going to put all of that in the show notes. So if your driving, you don’t need to remember it. We
are going to put all Holly’s links in to our show notes. If you enjoyed this podcast, please go ahead and hit
subscribe and tell your friends downloaded all the previous podcasts. If you want to hear more about the
Orsini Way in what we do, you can reach me through any LinkedIn, but also through my website, the Orsini
way.com. My email is dr. orsini@theorsiniway.com. Thank you so much. Holly I cannot wait for this to air and
thanks so much for coming on. This was just so much fun

Holly O’Driscoll (50m 6s):
And what a great way to spend some time this afternoon and super inspired. Yeah. We’ll have to figure out a
time where we can go on for a longer and continue to share stories. Cause I talked about Conversations is
making you feel taller or shorter. And this one certainly made me feel taller. So in a fight and to contribute.
Thanks so much for the invitation.

Dr. Anthony Orsini (50m 23s):
Thank you so much.

Announcer (50m 26s):
If you enjoyed this podcast please hit the subscribe and leave a comment. And to contact Dr. Orsini and his
team, or to suggest guests for a future podcast, visit us at the Orsini Way.com

3 (50m 39s):

My journey with stillbirth with Debbie Haine

Debbie Haine Vijayvergiya (1s):
I found losing Autumn to stillbirth one of the most isolating experiences because people don’t know about it
and they don’t talk about it. And that’s what made me, I felt like I almost was wearing a scarlet, A, I didn’t feel
comfortable talking about it. I didn’t feel comfortable with what cards I’ve been dealt because no one knew it.
It wasn’t something that people talked about.

Announcer (33s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author Dr Orsini has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her
team members or someone who just wants to learn to communicate better.

Announcer (1m 16s):
This is the podcast for you.

Dr. Anthony Orsini (1m 19s):
And I’m honored today that the Orsini Way has partnered with the Finley project to bring you this episode of
Difficult Conversations Lessons I learned as an ICU Physician. The Finley project is a non profit organization
committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. If it
was created by their founder, Noelle Moore whose sweet daughter Finley died in 2013, if it was at that time,
that Noelle realize that there was a large gap between leaving the hospital without your baby. And the time
when you get home, that letter to start the Finley project, that Finley project is the nation’s only seven part
holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they
provide such things as mental health counseling, funeral arrangements, support, grocery gift cards,
professional house cleaning, professional massage therapy, and support group placement.

Dr. Anthony Orsini (2m 13s):
The Finley project has helped hundreds of women across the country. And I can tell you that I have seen
personally how the Finley project has literally saved the lives of mothers who lost their infant. If you are
interested in learning more or referring a family or donating to this amazing cause please go to the Finley
project.org. The Finley project believes that no families should walk out of the hospital without support. Well
welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician and this is
back there Anthony Orsini and I will be your host today in every week moving forward. Although I only
started this podcast back in early August, I’ve been very fortunate to have some great guests, and today is
no exception.

Dr. Anthony Orsini (2m 54s):

As with every episode of my promise to each and every listener is to leave feeling inspired, learn a little more
about communication, especially during those times of our lives that are most critical. This week is no
exception. Today I have the honor to have a conversation with Debbie Haine. Debbie is a good friend.
Someone who I worked with before and someone who I admire a great deal. On July 8th, 2011, Debbie’s
daughter Autumn Joy was born still ans as expected, her life would never be the same. Debbie experienced
the loss that a few people could ever imagine. That Somehow out of the tragedy she made it to the other
side. Since that horrible day in 2011 Debbie has been a dedicated and tireless advocate of stillbirth rights
and research at both the state and national level.

Dr. Anthony Orsini (3m 38s):
She’s been working tirelessly towards improving stillbirth outcomes and to raise stillbirth awareness.
Debbie’s horrific experience regarding the care that she received when her daughter autumn was born still,
led her to push for state and national reform. In 2013, Debbie assisted in drafting new Jersey’s first ever
Stillbirth legislation. And in June of 2014, Governor Chris Christie passed the Autumn Joy Stillborn Research
and Dignity Act. Later that year, the Debbie founded the 2 Degrees Foundation. A New Jersey based
organization, dedicated to giving her a family in the state, a fighting chance against stillbirth. Most recently
she has been working with health care professionals, key opinion leaders in the Senate Majorities office to
bring her a vision for the first ever stillbirth focus Center in the country, in her home state of New Jersey.

Dr. Anthony Orsini (4m 23s):
Then after much hard work in March 5th, 2020 Senate Majority Leader to Loretta Weinberg introduced the
Stillbirth Resource Center. The Stillbirth Resource Center would help fill many of the gaps we played at the
stillbirth, especially with regards to data collection. It’s hope that the research conducted by the Stillbirth
Resource Center, will result in real solutions that we’ll one day to prevent or greatly reduce the incidence of
stillbirth at births. Debbie is also a member of this stillbirth advocacy working group co-chaired by the
international Stillbirth Alliance and London school of Hygiene and Tropical Medicine. Debbie resides in New
Jersey with her husband and two children. Well welcome, Debbie.

Debbie Haine Vijayvergiya (5m 3s):
Well, thank you for having me Tony, happy to be here.

Dr. Anthony Orsini (5m 6s):
And first of all, thank you so much for taking the time to be. I know your schedule is very busy. You work
tirelessly towards stillbirth advocacy and I’m really happy and I think my audience is in for a real treat today.
To me, you are really the epitome of someone who experiences a tragedy and then takes that tragedy to use
it towards making the world a better place. My mother-in-law he used to tell me, as we were growing up,
always leave a place better than you found it. And I think that you’re the epitome of someone who is
experienced something horrible, but then wants to do everything possible to make sure that this doesn’t
happen again to someone else. So I’m really honored that you are here.

Dr. Anthony Orsini (5m 46s):
And I know your story with you and I have known each other, I think probably about four years now, we’ve
worked together. You were an instructor for a breaking bad news, and you’ve always had some really great
advice for the people that we train the young doctors, but if you would just take a moment and tell the
audience about the day that Autumn was born and what happened subsequently after that. And so maybe,
perhaps we’ll talk a little bit later about the communications, if that happened before and after.

Debbie Haine Vijayvergiya (6m 15s):
Sure,actually my story starts on July 7th during my routine, second trimester checkup. The doctor told me
that she couldn’t detect Autumn’s heartbeat. It was the most innocent of moments that took a horrifically
tragic turn. And on July 8th is when I gave birth to Autumn and nothing can prepare you for the moment that
you deliver your dead baby. For me, it was like a switch had flipped. My life irrevocably changed the second
that I brought Autumn into this world. I was devastated and mad beyond words. You know, for me, I couldn’t
wrap my head around how something like this could happen to me, bad things like this happen to other

Debbie Haine Vijayvergiya (6m 58s):
And here I was my daughter dead, stillborn and I didn’t know why. I thought at this point, you know, I’ve
written about this a lot. I’ve said that, you know, I thought I’d paid my dues to the fertility gods, I had almost
died due to a late presentation of group B strep after the birth of my first daughter and had then
subsequently the following two years suffered two miscarriages. I always believe that after my first trimester,
I was good to go. I didn’t think that much more could possibly go wrong up until the point that I lost Autumn I
honestly really didn’t even know what the true definition of stillbirth was.

Debbie Haine Vijayvergiya (7m 43s):
No one could explain to me at that time why she died or promise me that it wouldn’t happen again. I really
truly was at a loss. I’d at that point had 3 failed pregnancies in a row after a seamlessly easy first pregnancy.
And I guess the best answer about all of why I do what I do is because I couldn’t sit by and not do anything. I
was compelled to give Autumn a voice. I couldn’t let her life be lost in vain. I wanted to do more for my living
daughter, Maya, because we also still don’t understand if stillbirth is hereditary.

Debbie Haine Vijayvergiya (8m 26s):
And I really wanted to raise stillbirth awareness so that other families weren’t caught in the same situation as
I was and are learning what stillbirth was the moment that it happened to them.

Dr. Anthony Orsini (8m 41s):
And it was nine years ago. So I totally understand this is not something that anyone ever can get over and I
could still hear your voice quivering, as you tell it. I’m sure this is story that you’ve told hundreds of times.

Correct? And we had a good friend of mine here in Florida who runs a 501C3 called the Finley Project. And
Noelle Moore also had a loss. And I know her story just as well as I know yours. And one thing in common is
she still gets choked up whenever she tells that story. So I can’t even imagine what it must be like for you.

Dr. Anthony Orsini (9m 24s):
You told me the story of what happened after Autumn was born still. There were some things that happened
in the hospital. We won’t name the hospital, but there were some things that happened in the hospital that
did not go very well. And we talk about Difficult Conversations and difficult situations and how we as human
beings can handle that can either help somebody or hurt them. And it sounds like from your story, I’m
convinced from your story is that there wasn’t much that they did to make it better. In fact, they probably, I
know they did a lot of things to make it worse than that really fueled you moving forward. So tell us about

Debbie Haine Vijayvergiya (10m 5s):
So, from the minute that I walked onto the labor and delivery floor, they put me into a room and left me alone
to change. And I’ll never forget that they ask my husband to leave me alone. And I was standing there and
I’m starting to get undressed. And I hear the cry of a newborn baby from the room next door. And it stopped
me in my tracks. And apparently the nurse must’ve been standing outside the door and she rushed in to get
me to bring me to a room all the way in the opposite end of the hallway, where no one was around.

Debbie Haine Vijayvergiya (10m 46s):
And no one never even said, I’m so sorry. She just said, Oh, this was the wrong room. And brought me there
and left me to, to continue what I was doing. And from the moment that I was changed in, in my bed, you
know, I was bombarded with questions where all I was was hoping that they were going to find out that they
were wrong. I would get more testing. And they were going to say, this was a huge mistake where so sorry.
So I was really in denial. What was going on at that moment. and I’ll never forget the social worker came in
and started asking me about all these questions about what I wanted to do and hold the baby, take pictures
of the baby, take pictures with the baby, all these things that I couldn’t wrap my head around.

Debbie Haine Vijayvergiya (11m 38s):
And, you know, I will regret it for the rest of my life, but I said, no, because I could not, I wanted it to stop. I
wanted her to ask, stop asking me questions. I wanted her to go away. And she never once came back to
ask me if I changed my mind and things progressively got worse at that point, you know, after I delivered
Autumn, as I mentioned earlier, I had gotten very, very sick after the birth of my first daughter. And one of the
biggest concerns after delivering her was that I could always possibly get Strep B again. And what would we
do if it happens?

Debbie Haine Vijayvergiya (12m 20s):
And so after I delivered autumn, I was in a ton of pain. I was feeling really awful. And one of the things that

the hospital mandates is that you talk to a hospital psychiatrist after you have lost a child. And so the doctor
came in to see me. And in that particular moment, I was in a ton of pain and he looks at me and sits down
and asked me to look him in the eyes and says, I think that the pain that you’re feeling is psychosomatic. I
want you to calm down. I think this is a psychosomatic, its not real. And I basically kicked him out of my
room and you know, I was furious and he left.

Debbie Haine Vijayvergiya (13m 2s):
What happened following that I was discharged few days later with nothing more than a hand-out on the 10
stages of grief and a pat on the back. And they bid me farewell. And it just so happened that I was still
continuing to be in a ton of pain. And I was readmitted the next day to the hospital and realized as I was
trapped in a room by myself, not on a labor and delivery floor, no one was checking on me that I was super
anxious and really unhappy. And wasn’t quite sure how to manage. And so I asked the nurse for some
anxiety medication and I had to speak with a hospital psychiatrist ,to, for them in order to fill my requests.

Debbie Haine Vijayvergiya (13m 44s):
So the same doctor came to see me. And then without even looking at my chart, sits down and says, I see
that you’re looking for anxiety, medications, aren’t you breastfeeding?

Dr. Anthony Orsini (13m 56s):
Oh my God.

Debbie Haine Vijayvergiya (13m 57s):
I had a few choice words for him. And he left and within two minutes I had some, I think Xanax sitting on in
my hand. And so I left there angry and really mad at how I was treated. And it, it didn’t help matters that after
I came home, all I did was try to search for answers. I wanted to understand what had happened. And I was
calling a number of different organizations. There aren’t that many that, that you can find that focus on
stillbirth and I’ll never forget. I called one and I was crying and it was said, explain what happened. And I
said, you know, I see you know, I’ve been told I had a fetal demise, but I also see that there is this stillbirth
and are they the same thing?

Debbie Haine Vijayvergiya (14m 47s):
And the woman on the other end of the line said I don’t know, let me call you back. And she never called me
back. And from that moment on I, I had it. What, what can I say? I’m a Jersey girl. I was done. I was like, I’m
going to fix this for others. It’s unacceptable. It’s inexcusable. How I was treated? It’s unacceptable that
people who supposedly even work in organizations that seem to be focused on stillbirth don’t know the
definition of what one is let alone don’t call someone back. Who was just hysterical on the phone. So yeah,
unfortunately I don’t have a positive story or a conversation that propelled me down this path of advocacy.

Debbie Haine Vijayvergiya (15m 31s):

It was all really bad and I just was not okay with it

Dr. Anthony Orsini (15m 38s):
But there were opportunities along the way that the hospital and during your grieving period, and during your
tragic loss, that there were opportunities for people to have a conversation with you that might’ve made it a
little less worse, or at least not made it worse because it, it correct me if I’m wrong. It sounds like there were
people who said things that made things even worse.

Debbie Haine Vijayvergiya (16m 3s):
Absolutely. And there is a huge opportunity to at, I mean, and it, and it’s true. It is nothing can make it better,
but there is an opportunity to there to not make someone feel worse about the situation that they are in and
to support them. And it, at least to give them a platform to jump off of when they’re ready, I was basically
thrown into a deep dark ditch and then left to find my way out .On my own .

Dr. Anthony Orsini (16m 34s):
For the audience out there. And for you, I’d say you and I have had to this conversation before, and there’s
two things going on right now that we’re trying to fix. In medicine, 1. is that things to people who see
something every day, sometimes become routine. And in medicine, I do a lot of teaching of a patient
experience. And one of the things that I stress I call imagination and what happens in medicine is that this
may have been the fifth stillbirth of the week for the very large hospital. I know what hospital. It was, but it’s
you’re still birth, that’s the only one that you will ever have.

Dr. Anthony Orsini (17m 15s):
And, in order for the people who are entering that room to genuinely feel the empathy. And actually it’s not an
empathy, it’s compassion. And I’ll tell you what the differences in a second, you need to take a moment to
imagine what it’s like. And so things become routine. And it sounds like that was the first error that everyone
did at that hospital. And we talk about empathy and compassion. During my lectures, empathy is
understanding someone’s pain and people can be empathetic. That’s great. Compassion takes it to a whole
new level. Compassion in Latin means With pain. And so it means that you’re actually feeling that person’s
pain in the only way to get from empathy to compassion is through imagination.

Dr. Anthony Orsini (17m 60s):
There were a lot of opportunities for those nurses and that psychiatrist, just to take a moment and remind
themselves that this is what’s going on with Debbie and imagine what it would be like to be her. None of us
can really, truly imagine that, but at least try in the conversation would go better. So we talk about learning
how to communicate it. And there’s a lot of do’s and don’ts and you and I worked with breaking bad news
and I trained physicians all over the country on how to do that. But a major step is just take the time and
imagine what it would be like in most people’s compassion will flow, it really does surprise me that this
psychiatrist was the conversation that you remember as being the worst.

Dr. Anthony Orsini (18m 44s):
’cause one would think that the psychiatrists would be the best at it right?

Debbie Haine Vijayvergiya (18m 47s):
Okay. One would think and hope that it’s not the case. And I will note that I did write a letter to the hospital
because I was so floored, but they seem to just say, thank you for your time. We will make sure to speak
with him.

Dr. Anthony Orsini (19m 0s):
And the second thing that’s happening here. So you have number one what’s going on is that we felt that
take a moment to imagine that this is the only stillbirth that Debbie is having at this particular moment. And
secondly, no one wants to give bad news. No one wants to be around tragedy because it reminds all of us
have what can happen to us. And so we’re uncomfortable. Then you’d take nursing school, a medical school
that totally ignore this topic. They don’t teach you what to say. They don’t tell you how to say it. And so now
you’re asking someone who is stressed out, or this is no excuse. I’m just trying to explain it to the audience.
They’re stressed out. They were never taught to take the moment to imagine they were never taught what to

Dr. Anthony Orsini (19m 45s):
And all of a sudden, we end up making a horrible, horrible nightmare, worst, which is hard to do. It’s hard to
take something like that would make it worse, what they did,

Debbie Haine Vijayvergiya (19m 57s):
They did.

Dr. Anthony Orsini (19m 59s):
So even the people that you reached out didn’t have great conversations with you, they put you on hold and
told you, they’d call you back. And instead of going downward in a downward spiral, you, this was what I
really, really respect you for you said your Jersey came out and you said, I’m going to fix this. Right? And,
and tell me what you did after that.

Debbie Haine Vijayvergiya (20m 24s):
I started writing. I wrote a lot, I was fortunate enough to write a piece that got picked up by the New Jersey
Star Ledger, which is the largest paper here in New Jersey. And I got the cover of the opinion page on a
Sunday. And somehow it landed on the desk of the Senate Majority Leader here in New Jersey, Senator
Loretta Weinberg and she showed compassion and empathy for what I had been through. She agreed with
what I had to say and thought that it would make perfect sense to work on legislation that would improve
policies and protocols for hospitals, for what when stillbirth occurs.

Debbie Haine Vijayvergiya (21m 8s):
And I was able to see that Improving data collection, would be like she really valuable. That helped me with
that part of the beginning of my advocacy journey as far as the writing and getting everything off my chest, it
was very cathartic. I also felt like I was doing my part where I could in raising awareness and then to try to
make a real difference and create change in 2014 Governor Chris Christie passed the Autumn Joy Stillborn
Research and Dignity act, which is the first stillbirth legislation here in the state. And it’s been, it hasn’t done
as much as I would have liked to think that it would, but that’s politics for you.

Debbie Haine Vijayvergiya (21m 55s):
And I’m learning that. But between that soon after the bill got passed, I established the two degrees
Foundation, which really has allowed me to connect with the number of different women who have been
impacted by stillbirth and other forms of pregnancy loss, and to empower them and help them as best as I
could, because at the end of the day, I just want to help to make things better where I can, whether it’s
through policy, whether it’s through communicating with them and giving them a place to share their feelings
with no judgment. So that’s been, that’s been exciting for me.

Dr. Anthony Orsini (22m 37s):
And I want to hear more about the 2degrees Foundation but if you want to go back to the Autumn Joy
Stillbirth with Research and Dignity Act first of all, I would imagine that it is not easy getting legislation
through anything, but what does the Autumn Joy Stillbirth Research and Dignity Act do at It’s finest. Is that
the politics I didn’t get into the problem? What should it do

Debbie Haine Vijayvergiya (23m 3s):
In its most simplest, basic form the purpose behind it is to improve data capture around stillbirth events,
establish a more consistent protocols for when a stillbirth occurs in a hospital and increased sensitivity
around those protocols for suffering families.

Dr. Anthony Orsini (23m 21s):
Clearly there were no protocols at the hospital that Autumn was born.

Debbie Haine Vijayvergiya (23m 26s):
Clearly there were none. No

Dr. Anthony Orsini (23m 28s):
And now hopefully that hospital does have policies? Yes I hope?

Debbie Haine Vijayvergiya (23m 33s):
Unfortunately, I’ve spoken to other women who’ve delivered there over the past two years and they have not

really improved much of what they had going on. So

Dr. Anthony Orsini (23m 44s):
A lot of work to do. I know that your not going to stop doing that. Was there any conversation because we
always wanted to inspire and give advice. Was there any conversation or any opportunity to have a
conversation along your journey that someone could have said to you? What advice would you give to
someone who said I am in this situation, this woman just had a stillbirth and I need to go in the room,
whether I’m a doctor, a nurse, a social worker, what would you say Debbie to them? This is what I would
have needed. This would’ve been a good way to approach this. A tough question. I know

Debbie Haine Vijayvergiya (24m 23s):
That’s a really a tough question. I truthfully don’t think there is a lot to say. I found losing Autumn to stillbirth
one of the most isolating experiences. because people don’t know about it and they don’t talk about it. And
that’s what made me, I felt like I almost was wearing a Scarlet A, I didn’t feel comfortable talking about it. I
didn’t feel comfortable with what cards I’ve been dealt. It wasn’t something that people talked about. And so I
think if there was a way to which I’ve one of the many things I’ve been working towards to break the stigma
associated with stillbirth and make it a conversation.

Debbie Haine Vijayvergiya (25m 16s):
I think that women would feel more comfortable at the same way that miscarriages, I mean, you say, I’m
sorry, I’m sorry for your loss. And you know, I wish there was more that I could do. I think just having
someone say, I’m going to sit here with you and if you have a feeling, you can share it with me. And if not, I
just don’t want you to be alone. But I think it’s a much bigger picture where if we can find a way to make it a
safe conversation so that women are aware that these things do happen, do they happen to everyone? No,
but are they happening? Yes. Are they happening too much? Absolutely.

Debbie Haine Vijayvergiya (25m 56s):
And I think that if women are aware of it and it happens and you’re not dealing with all those other emotions
on top of finding out that you’ve lost your baby, the guilt that you feel that maybe you did something wrong or
everyone else is having babies, but you didn’t. I think that that would just help soften the blow of this news of
that. You get, when you find out that your baby has died.

Dr. Anthony Orsini (26m 25s):
That’s a conversation, a difficult conversation that people don’t want to have because they feel
uncomfortable. I’m surprised in the 25 years have been practicing medicine. For instance, how many times
people have twins, mother had twins and one is stillbirth. And the baby that survived is with the mother and
doctors and nurses will come in and say, congratulations and pretend that the other baby didn’t really exist.
And its not that their not good people. They’re all good people. It’s just uncomfortable. It’s uncomfortable.
And what I do is I make it a point to say, I’m sorry for your loss.

Dr. Anthony Orsini (27m 8s):
And you can see the parents really do appreciate that. That there’s a reason why this baby has a B after
their name. Okay. And that we know that that baby has to be after their name because it’s a twin and the
other twin was born stillbirth but we’re going to be almost pretend that that baby wasn’t here. And just, as
you said before, just may be sitting. There may be the best advice we can give to the audience to sit there
and say, I’m here. If you want to talk, I’m here or whatever you need. I’m here. One of the big mistakes that
your hospital made is that they should have taken pictures. They should have encourage you to hold your
Autumn. If you didn’t want to, that’s perfectly your choice.

Dr. Anthony Orsini (27m 50s):
We have babies and the NICU and in OB that pass away and I’ll ask the mother, she wants pictures. And
many times they’ll say no, but usually I’ll follow that up with, well, how about I take some pictures? I hold
them. And if you want them, you can always call me. And our hospital does do that. And I’ve been very
fortunate to work in hospitals that have done that. And statistically 90% of mothers do as pick up the phone
later on and say, do you have those pictures. Sometimes it’s up to several months. In fact, if I’m not
mistaken, most hospitals keep those pictures for one year.

Debbie Haine Vijayvergiya (28m 24s):
They do. They do. They do. And, and trust me, I called and they didn’t.

Dr. Anthony Orsini (28m 29s):
Because you don’t know, then that’s when I want physicians out there and nurse’s to know that you are
acting the way you are acting in one of the things that we know that 90% of mothers are going to want those
pictures later, but you didn’t know that at the time. The He mother, this is, I don’t want the picture’s. They
didn’t know that at the time. So its an opportunity for you to say, I’ll take the pictures. I’ll just hold them for
you. ’cause you know that they’re going to call back and if they don’t, that’s fine. But I think the best lesson
that you taught us is there’s really not much that you can say what to say, but just be there.

Debbie Haine Vijayvergiya (29m 0s):
Yeah. To your actions it’s being there. And I will, I will just add that. I think it would be fair to also ask if they
have a name for their baby and then you can call their baby by their name because they were alive at one
point they are still their baby and will always be their baby.

Dr. Anthony Orsini (29m 20s):
That’s great advice. Yeah. And it’s something that we sometimes forget, but you do have to do that. And I
really, I think that’s really fantastic advice. Tell me about the 2 Degrees Foundation and how we can help and
what you’re doing with it and all of the exciting things on how the audience out there can get involved.

Debbie Haine Vijayvergiya (29m 38s):
Well, our mission and vision is pretty simple. We wanna provide every family in Jersey, have a fighting
chance against stillbirth. You know, where Jersey, you know, in New Jersey stillbirth rate has been holding
steady at approximately 700 Stillbirth a year. And those are only the ones that are recorded. And as with
most adverse health outcomes, there are long standing and persistent racial disparities with regards to
stillbirth here in the state. African-American women experienced stillbirth at more than three times the rate
than Caucasian women. And it’s simple more needs to be done. Everyone deserves the opportunity to have
a healthy baby.

Debbie Haine Vijayvergiya (30m 19s):
So right now our goal is to raise money. There’s not a lot of education in training going on right now because
of the COVID situation. We were planning on having our first huge fundraiser, which is very sad to say that
will not be happening this fall because of the current climate with everything going on. And I think that right
now we would love money. They would definitely help with the Center if we were able to get the bill passed,
but that’s a tall order. So I know that that’s probably not as realistic as it is to have support. Please become a
member, join us and follow us on social media so that you can learn about what we’re trying to do.

Debbie Haine Vijayvergiya (31m 2s):
And if, and when the opportunity presents for them to help, whether they ask to volunteer or, or whether they
ask, if they can donate, they know how to find us. Because as you said before, I am not going anywhere.
Two degrees is not going anywhere and we have some big plans. So hopefully we can make them all
happen. At some point in the future,

Dr. Anthony Orsini (31m 24s):
The world needs more Debbie Haines or that’s for sure. And you, because you are not going anywhere. And
I like that and you are not going to stop until you get what you need. And I think you should, because it, is it
something that is wasn’t being talked about enough? I think thanks to you and other organizations that were
changing, that if they want to donate or get involved, what’s the website that they should go

Debbie Haine Vijayvergiya (31m 50s):
Well, it’s www dot the, two the number two degrees.org.

Dr. Anthony Orsini (31m 57s):
And then I’ve been on the website and it’s a fantastic organization. Debbie and I have worked together on
different, breaking bad news projects. I hope that we can work together again. Debbie in closing before I’d
say thank you and goodbye. Any words of wisdom to two people out there one way or the wisdom to the
healthcare professionals on what they can do to help and words of wisdom to mothers who have just had a

Debbie Haine Vijayvergiya (32m 23s):
My words of wisdom to the healthcare professionals is to be respectful, compassionate, and empathetic.
Even if you’re having the worst day ever. You’re not having as bad a day as that family, that couple, that
mother is having. My words of wisdom to mothers are simple. Be kind to yourself. There is no rule book as to
what this looks like or what you’re supposed to do. Follow your gut, believe in yourself. And know that if you
find that you want to advocate for yourself in the future pregnancies or any other time, do it.

Debbie Haine Vijayvergiya (33m 11s):
I want to empower women more than anything to speak up for themselves and never doubt themselves.

Dr. Anthony Orsini (33m 19s):
That’s great advice. If you are a health care professional or if you are a mother whose experienced the
stillbirth or someone out there who just wants to help this cause please go to the two Degrees Foundation
donate your time, donate your money. If you can, whatever you can do, because it is something that we
really need help with and we need more Debbie Haine out there. I just want to say thank you again. Debbie if
you enjoyed this podcast, please go ahead and hit the subscribe button, download and leave a review. If you
need to find out more about what we do @theorsiniway you can go to theorsiniway.com website and you can
email me or contact us through that.

Dr. Anthony Orsini (34m 1s):
Debbie thank you again so much. Thank you for being you. You certainly were inspiring and you certainly
gave some great advice to people that I think I accomplished my tasks to the audience today. so thank you
very much.

Debbie Haine Vijayvergiya (34m 13s):
Thank you for having me. It was a truly was an honor.

Dr. Anthony Orsini (34m 17s):
Well before we leave it, I want to thank you for listening to this episode of Difficult Conversations: Lessons I
learned as an ICU Physician and I want to thank the Findley project for being in such an amazing
organization. Please, everyone who’s listening to this episode, go ahead. Visit the Finley project.org. See the
amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who have lost
infants. So to find out more, go to the Finley project.org. Thank you. And I we’ll see you again on Tuesday.

Announcer (34m 47s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment at the reviews to contact
Dr. Orsini or his team or to suggest guests for a future podcast, visit us@theorsiniway.com.

Difficult Conversations in Leadership with James Orsini

James Orsini (1s):
Delegation really comes from something that you should be doing, that you bestow on somebody else to get
done for you. And facilitation is really looking at a much broader landscape and taking the time to really
understand what it is that people do well. And then how connecting the dots between two folks whose paths
normally wouldn’t cross and how they bring value when united together on a particular project.

Announcer (27s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate.

Announcer (1m 3s):
Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most
out of his or her team members, or someone who just wants to learn to communicate better this is the
podcast for you.

Dr. Anthony Orsini (1m 12s):
Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr.
Anthony Orsini I’ll be your host today and every Tuesday moving forward. Today I’m especially excited
because I have my cousin as a guest James Orsini. James Is the President of The Sasha Group, which is a
VaynerX Company. Working alongside Gary Vaynerchuk it’s CEO in a serial entrepreneur, james leads The
Sasha Group to help small businesses reach explosive growth, potential.

Dr. Anthony Orsini (1m 43s):
The Sasha group provides educational consulting and marketing services for companies from 1 million to
200 million in revenue, James previously held key high level positions, four VaynerMedia, including Chief
Operating Officer and Chief Integration Officer. Before coming to VaynerMedia, James held prior positions
as chief executive officer and member of the board of directors of site to Mobile. He has more than 35 years
of experience and operations experience across a broad range of marketing and communication disciplines.
James was the executive vice president and director of finance and operations for Saatchi and Saatchi in
New York, where he worked closely with the CEO to provide strategic and day to day direction for all
financial and operational functions.

Dr. Anthony Orsini (2m 21s):
His impressive resume continues prior to joining Saatchi and Saatchi, James held the key leadership
positions that they had brand North America, KPMG and Goldman Sachs. James graduated, Magna c*m
laude from Seton Hall University in New Jersey with a bachelor of science in business administration. He
received at universities, presidential academic scholarship is still served the university today. He is a

licensed New York state certified public accountant. On a personal level, James is a board member of
renovation house in New Jersey, New York a residential substance abuse rehabilitation program.

Dr. Anthony Orsini (2m 53s):
He served as a member of the board of regions for Seton hall university, but perhaps his best
accomplishment was winning that third and fourth grade little league championship with his cousin. Yours
truly wouldn’t you agree that’s your highest accomplishment of life?

James Orsini (3m 8s):
Absolutely. I take every occasion to mention it to where they allow me to do so,

Dr. Anthony Orsini (3m 13s):
You know, I think you and I were the two worst player’s on the team. You played center field, I was a second
base man, but somehow I think both of us or the championship went three for three.

James Orsini (3m 23s):
Yeah. Yeah. And I gave birth to an athlete. So I make it All level off now

Dr. Anthony Orsini (3m 28s):
That’s right after you’re a stellar career in third grade, you’re son went off to play college baseball. It must’ve
been Joanne’s genes, I guess,

James Orsini (3m 35s):
Absolutely Joann who we met when she tripped and I picked her up. So we do not have any kind of finesse
when it comes to sports.

Dr. Anthony Orsini (3m 44s):
All kidding aside, your career has been an incredible story of one success after another. And I really enjoyed
watching your accomplishments pile up. As I read your bio in the position that you’ve had I thought anybody
would be it happy just to have one of those positions, but each career defining step that you made, you just
took on more and more and had more and more success. I think that’s incredible. I just want to say, I’ve
personally enjoyed watching your career just give better and better. .

James Orsini (4m 11s):
It was unplanned, but the, but it unfolded really in a, in a nice way.

Dr. Anthony Orsini (4m 16s):
So the topic of this podcast that has always difficult conversations and particularly we are going to talk about
Difficult Conversations in Leadership, you’ve held so many positions in leadership, but before we get into

that, I just want the audience to know that James Orsini that I know. So tell us about James Orsini. How
would you describe yourself? What drives you and what is your leadership philosophy?

James Orsini (4m 37s):
Well, I’m a family man. I love every aspect of my family and look to spending as much time as I can with
them. I actually see business as my hobby, which most people find strange and unusual. So it wouldn’t be
crazy for me to be on a vacation, still reading the wall street journal where a, a, a business book and hand.
So that’s why it, my passion has actually become my profession. And I don’t feel like I really work. I just
show up and do what it is that I like to do.

James Orsini (5m 7s):
So, you know, my leadership style is one a servant leadership. You know, I actually serve out of this to get
the best out of them. I am a facilitator rather than the delegator. So a that means you gotta do to really take
the time to understand what it is that people do well, and then how your needs plug into their talents. You

Dr. Anthony Orsini (5m 26s):
It’s interesting. You bring that up. I read a piece that you actually wrote, I think in 2017, right? Don’t Delegate,
Facilitate, So just expand upon that. Could you just mentioned that a little bit? What did you mean by that?

James Orsini (5m 37s):
Yeah. You know, delegation really comes from something that you should be doing that you bestow on
somebody else to get done for you. And facilitation is really looking at a much broader landscape and taking
the time to really understand what it is that people do well. And then how connecting the dots between two
folks whose paths normally wouldn’t cross and how they bring value when united together on a particular
project. I kinda see things from 30,000 feet.

James Orsini (6m 6s):
So things look small to me, but as a result of that, if you think about it, right, when you’re up in an airplane
and you see these little puddles that you realize there’s, somebody’s swimming pool, but you were at 30,000
feet. So they don’t look grand in any way, shape or form. And that’s the way I see problems. I just don’t see
them big. I have a different vantage point and I help people navigate through them.

Dr. Anthony Orsini (6m 27s):
That’s great. So you had some great positions and then tell us the story, because you know, you can get
through an interview without somebody asking you about GaryV right? So he’s just bigger than life. And you
work with him, and I have a couple of questions about Gary V how did you end up at VaynerMedia? If you
could tell us the story and then tell is how the soccer group started it and why you started that.

James Orsini (6m 47s):
So it wasn’t interesting that I went to Seton Hall, University basketball game. I was invited by another board
member at the time, and he brought his son and his son brought a friend and their friend was AJ Vaynerchuk
Gary’s younger brother. At that time, I was Chief Operating, Officer it Saatchi and Saatchi. And, you know,
we’ve got to talking and I just invited him down to Saatchi to see what it was like when he gets big. And it
took me up in the offer, but most importantly, he knew enough to stay in touch with me and use me as a
mentor, you know, oftentimes ask, have you ever done this?

James Orsini (7m 19s):
You know, somebody who does that, how would you handle this? So we kind of stay in touch over the years.
And I left Saatchi. I went out to become the CEO of Sito Mobile and then I stood, there are three and a half
years. I had a three year employment contract. I spent three and a half years, and now I was leaving to
come back into big advertising. So I just called AJ to just say, Hey, man, I’m going to see you again. You
know, I’m going to be back in big advertising. And he’s like, you know, did you ever meet my brother Gary.?

James Orsini (7m 50s):
And I said no, and he said, you ever hear of him? And I said, no not really. And he’s like, all right, well, do a
quick Google search. He’s not going to be harder to find. I spent some time with him that long, maybe 15
minutes, I got a call back from AJ and said, Listen he likes you, he want’s to have dinner with you. You know,
don’t take that too lightly. His times is pretty valuable and we had dinner and he said that James, I want to
create a $500 million independent integrated international communications company. Can you help me do it?
And I said, yeah, I actually think I can. So he was like, all right, well, don’t take one of those other jobs.

James Orsini (8m 21s):
You’ve already had that step on a cloud and do this with me. And I did. And, you know, he has certainly been
successful Before since, and it continues to be, I like to think I had played a small role and help a piece of his
vision come to life.

Dr. Anthony Orsini (8m 37s):
And that’s an important point. You mentioned in one of your interviews, the Gary asked you one simple
question. So what is it that you do tell us about that?

James Orsini (8m 45s):
He said, could you describe what you do in one sentence? And I said, yeah, I take dreams and visions and
put them into action plans. And he was like, you’re hired. So I got a lot of dreams. So it does good.

Dr. Anthony Orsini (8m 55s):
Well everybody needs someone to see the big picture and then somebody who facilitates. So I think that is
certainly you, it sounds like its a perfect match.

James Orsini (9m 3s):
Yeah, yeah. Has been, we’ve got an absolute blast and I’ve had several positions and is running the VaynerX
world and the newest of them right now.

Dr. Anthony Orsini (9m 10s):
So lets start moving towards difficult conversations and I asked Claude Silver the chief heart officer at
VaynerMedia the same question I’m gonna ask you. Of all the years you have been in leadership and all the
types of conversations that you’ve had with board members, CEOs, workers, employees, what do you think
is the most difficult conversation that you have had and that you continue to have to have that you really
thought that you needed to master?

James Orsini (9m 36s):
Well, its so many people unfortunately define who they are by their work it’s said definition, but it is factual
and removing someone’s work while not removing their soul has always been a difficult situation for me. And
as you read from that bio, I have had a lot of senior roles with those senior roles come, a senior
responsibilities, many of which was unfortunate in all different times, right?

James Orsini (10m 7s):
Or removing people who are simply out a position and I’ve had to do that around the world. I’ve done that
with bodyguards. I’ve done that with translators. I’ve done that in different cultures and it’s always difficult
when you’re removing the people who was used to removing to people. So I’m talking about CEOs,
founders, businesses that I bought and then remove leaders really, really difficult situations. And you know,
we need to do it because you know, the needs of the many outweigh the needs a few and what you are
trying to accomplish.

Dr. Anthony Orsini (10m 41s):
Any advice that you have to the young executive out there who needs to remove somebody’s or separate.
We had Dr. Larry Barton on a few weeks ago, Dr. Barton is the world’s leading expert on workplace violence.
He has a brand new book that talks about the way you separate someone from employment can really
predict whether they’re gonna come back and shoot the place up. Or, you know, I mean, those are rare
instances, but they do happen. So what advice do you have that for that manager whose got to remove
somebody’s that you could help him do it in the kindest most compassionate manner?

James Orsini (11m 14s):
Well, one, it shouldn’t be a surprise. So make sure you’re taking the time to properly communicate, to
evaluate over a period of time to, you know, having an ongoing dialogue. I believe Claude calls it “radical
candor”, you know? So by the time you get to that closed door office, nobody should be sitting on the other
end of that desk, thinking that it was a surprise. To, you know, be as fair and reasonable as you possibly can.

This is not the time. You know, at that moment to try and save an extra week, salary are pay or whenever,
you know, try and be as fair as you possibly can within the policies of your company and as reasonable as
you can in a, you know, not making it a choking situation.

James Orsini (11m 56s):
You know, as a global CFO, I was the guy that used to have to remove global CEOs. The CEO didn’t do it,
he put me on a plane and say, you know, you’ve go to Mexico city or your going to Tokyo, you know? So that
was always hard and difficult. They kind of knew when I was flying in this sort of grim reaper type of analogy,
I’ve removed people who was companies’ I bought, we then absorbed a company and there was no need for
the founder anymore. That was difficult. But you know, I’ve done it in such a way, in one particular example
where I called years later in a different company.

James Orsini (12m 30s):
And I said, listen, I know I’m not the voice you want to hear on the other end of the phone, but I had the right
opportunity for you now I’m in a different place and I know what it is that you do well. And if you’re willing to
trust me, come and join me here in this new role. You know, I made lifelong friends that way. Obviously when
you do something like that in the Sito Mobile situation, I was brought on as the CEO, the founder was moved
to a chairman role. We worked for a couple of years together and then the board told me, listen, you have to
remove him.

James Orsini (13m 4s):
It was his, yeah. It was really, really, really difficult. Two grown men crying on each side on the phone, you
know, their thinking about it. It, it was his baby birthed that company. Now, if he was removed from it. So that
is a really hard,

Dr. Anthony Orsini (13m 17s):
Yeah. You know, it’s interesting that your first thing you said was they should already know it’s coming and
I’ve been training doctor’s as you know how to break bad news, how to give tragic news. You have cancer,
your baby is passing away. Your child’s gonna have neurological deficits. And what I teach and I use this
acronym called program PROGRAM and the G is for gradual and its the number one rule of breaking bad
news in healthcare and business. There’s so many parallels. That’s why I’m having you on also that there’s
so many parallels that when someone hears the bad news, that their husband just died in the emergency
room, et cetera, I always tell the doctors, they have family members should already know what’s coming.

Dr. Anthony Orsini (13m 56s):
So you want to plead your case first. And this is what happened. There is a heart attack was worse than we
thought it was by the time he got to the emergency room in his heart was a very low, his blood pressure was
low. We had to give him an adrenaline, etc, etc, etc. And this is neuroscience based just allows people to
brace themselves for that news. That’s coming in your case, you’re talking about over a period of time where

your giving them feedback, et cetera. But it’s interesting that the parallels, that was a first thing that you said
and that’s number one rule in medicine too.

James Orsini (14m 26s):
Yeah, no surprises. I mean, but at a time some of this difficult and hard conversation is coming. It’s horrific
when it’s cold water in the face, you know, it’s never easy, but it’s a little more acceptable. When this is the
third time you’re talking about this particular topic and this is going to be the last time.

Dr. Anthony Orsini (14m 44s):
In a small way. They appreciate that you took the time that you gave them the chance and that you did in a
compassionate manner. And so that whether you’re a separating someone from a appointment or you are
doing it in medicine, it’s really, really the same thing. There’s so many parallels. And as you know, I’m a big
student of communication. Well, I know you very well, but knowing each other, since, since we were
children, I know you have a very even temperament. And in medicine I had a mentor when I was very young
training, I think he was doing a neonatology fellowship and he told me this thing, he said, the higher you are
up on the ladder or the softer you speak.

Dr. Anthony Orsini (15m 21s):
And that was probably the best advice that I ever got. And I routinely get thrown into situations where there’s
a child or a baby who has no heart rate and the team whose very, very good and their very well trained. They
are trying to resuscitate. Then they called me and I can get in there. And although they are very good,
there’s panic in the air or there’s and I’ve seen Physician to start barking. You see it on TV, right. They
started barking orders, right. That doesn’t happen. Not real. And I learned very early on from this mentor that
when everybody is screaming and yelling and get this and grab the oxygen and do that, And I walk in and I
just say, okay, what are we have here?

Dr. Anthony Orsini (15m 58s):
That’s what’s going on. The level of tension in the room goes down. So you mentioned how you’re even
temperament helps. Can you expand upon that? Just again, to join another parallel?

James Orsini (16m 6s):
You know, that’s been both a blessing and a curse for me because for some high strung people, it was like,
Listen, James, you’re not sensing the urgency that I’m trying to relay to you. And I said, I am sensing the
urgency, but if we’re all running around, like our hair is on fire, you know, nobody’s gonna have to see
through it and understand how important it is. Right. I’ve wrote a great book called the six fundamentals of
success by Stuart Levine, who is the ex CEO of Dale Carnegie. Now, if you know anything about Dale
Carnegie in business, it’s they train CEOs and it was about knowing what’s on your bosses dashboard.

James Orsini (16m 41s):

Some meaning like know what’s important to your boss and make sure that’s important to you. You know, for
a lot of what it was that I did with Gary in the earlier years, I was more like a decoder ring to him because
you know, the people that were around him were he used to Gary barks and out in an order and they run
100 miles an hour. Sometimes they smashed into a wall. And I was like, Listen I heard what he said, I think
this is what he means. You can go in a direction like this. Where do you know what let’s put some, we didn’t
necessarily call it process. We called it is scalable organization because when you are in hyper growth
mode, like most of his companies are, you know, process by nature sounds lethargic and slow.

James Orsini (17m 21s):
So we were just trying to organize enough to be able to scale. And a lot of times it gets tense in those rooms.
He’s just such a passionate individual that it comes out with a sense of urgency. And I just have a way of
seeing the dots in the room and understanding how they connect and come together. So I’m a much better
and a crisis situation. And I am a, it’s so funny. Because anytime I get very emotional in happy situations,
you want me as your pallbearers, but you know, because I’m gonna be no problem, but like they give a toast
at your wedding.

James Orsini (17m 55s):
I’m crying. So, You know, that’s a familial. And in fact, I just interviewed, I have a niece she’s gonna be on in
a couple of weeks, probably before this even airs. She was a premature baby survive that then, when she
was 16 years old, she got lymphoma, went through chemotherapy. She survived that. And now she’s a
pediatric oncology nurse and she takes care of kids with cancer. So I’m so proud of her. And I thought she
was going to be perfect. So I had her on, she was really a great interview.

James Orsini (18m 25s):
And during the interview or the introduction to my niece’s interview, I said in that introduction that please
forgive me because I think it’s familial that I might cry outt of pride and your gonna hear my voice quiver.

Dr. Anthony Orsini (18m 43s):
And my father is the same way. I think your father was the same way. Sadness, stone cold. But when their
kids graduating high school, they’re bawling their eyes out.

James Orsini (18m 54s):
Yeah, absolutely. Absolutely. That’s it. That’s the way it is.

Dr. Anthony Orsini (18m 58s):
So I don’t know if this is an Orsini thing anything or an Italian thing or what, but we were all the same and
let’s move on. So you, once said, were talking about More Difficult Conversations and sometimes you have
to have difficult conversations with clients, in the Sasha Group and I want you to tell us a little bit about that.
You’re really into mentoring and consulting and people are coming to you to help, but you once said a big

idea is not a business Hope is not a strategy and expand upon that. And I would think that sometimes you
have to have those difficult conversations with clients, with the Sasha group were people that come to you.

James Orsini (19m 28s):
Yeah. And that’s all, it was interesting when Gary pivoted and said, Hey you ready to start something new?
And I said, yeah, would you have a mind? He said, well, come on the cover of entrepreneur magazine, I got
14 million followers and we built a company to service Fortune 500, I don’t have a company for the smaller
and medium sized businesses. So he said, I want to start a new company. I want to name it after my dad for
legacy purposes his Dad was from Belarus, a Russian immigrant, who came to the United States worked his
way up. Bought his own liquor store? I, you know, the story there are, Gary helped out with that to help to
grow or whatever.

James Orsini (19m 59s):
It was 3 million in sales to 60 million in sales. So servicing the small businesses and is why we kind of
positioned ourself more like a consultancy on the front end in an advertising agency on the back end, you
know, fortune 500 has a brand manager’s from Wharton MBAs and, you know, understanding the real side
of marketing. And the folks that I serve are founders and owners and entrepreneurs, you know, who has a
passion for something and saw an opportunity could have been as a family owned business that they are
now taking to another level.

James Orsini (20m 30s):
You know, it could have been something that they saw on the marketplace and saw a way to pivot and they
be learned something new and they need guidance, not only marketing guidance, but business guidance,
but I was fortunate at this week to be included in a campaign, the magazine’s 40 over 40, it celebrates
wisdom and experience. Really, if you think about it, there’s no substitute for that. And in this space, I
happen to have that.

James Orsini (20m 60s):
So there are, are difficult conversations there. Like I know you’re birthed in this business in you and you
loved it, but the pivot the has to be here, or I know this guy has been along side of you for umpteen years,
but he’s not doing you any favors in the role that he’s in. And he’s simply not a chief operating officer or is it
not financially savvy? So there are difficult conversations with people who, you know, are passionate about
what is that they birth in a business, but don’t necessarily have a plan, but I spent a lot of time giving them
outlines to a business plan.

James Orsini (21m 35s):
Here’s how your idea becomes a business. Now remember the four pillars that Gary gave me, I wanted to be
integrated international independent communications company. Those four pillars, help guide the decisions
that we were making. They did two things. One, they enabled us to hit the gas and directions that aligned

with that. But more importantly, they enabled me to push back and challenge him.

James Orsini (22m 5s):
When, it didn’t align. Why are we doing this? I don’t understand how this fits. Remember the pillars that you
gave me. You know what I mean? So and Gary, by his own admission, says that he’s a moldable dictator,
right? So their buddies, a moldable, a dictator, meaning that you can have a conversation with him. And you
know, he’s going to make the ultimate decision as he should, but you can reason with him to understand why
things should be the way they are.

Dr. Anthony Orsini (22m 30s):
So you have to approach that conversation with at CEO because as you said, it’s his, baby, its her baby.
Then you need to tell them I have to train a bunch of physicians sometimes who are referred to me from their
hospitals saying that this guy’s is a great surgeon. He’s the great obstetrician. We were getting so many
complaints about his bedside manner. His, we call them H cap scores. Our patient satisfaction scores are
really low and it’s my job to coach them. Sometimes I put them through improvisational role playing with

Dr. Anthony Orsini (23m 1s):
I’m getting someone already. Who’s got an attitude like he or she does not want to be there. They’ve been
sent by daddy down there to get trained. And I can say, Because, I’m a physician. I mean, doctors have egos
and that I’m sure CEO’s have egos. And I’ve learned through my coaching that you do have to spend a lot of
time stroking that ego. And as they say, lead the horse to water in, when I teach conflict resolution, you kind
of steer them until they go, you know what James I think we should do this way. And that’s exactly what you
wanted them to do with it.

Dr. Anthony Orsini (23m 33s):
Is that a problem with CEO’s too? Stroking the egos a little bit?

James Orsini (23m 36s):
Well, I, you know what, the interesting thing, when I was going to Sito Mobile to become a CEO, you know, I
had never been a CEO. I was never been in a publicly traded company. And at the time I didn’t know
anything about technology and a, I resigned from Saatchi and the then global CEO, Kevin Roberts said to
me, so your going to be the CEO of a small, publicly traded company. He said three things. He says one
lonely job. He said two-hard job because when it gets to your desk, as this stuff that nobody else can figure

James Orsini (24m 7s):
And he says three, where is it trading now? And I said, it’s trading on the bulletin board and were going to
bring it up to the NASDAQ. And he said, you are going to be asked to compromise your morals and integrity

on a daily basis. You know? And I shook his hand, it sounds like a Hallmark card. And six months later I went
back and I said, wow, those words were so deafening because it is exactly what I was feeling. So the
interesting part is in any room, there are so few people who even, you know, I’m sure as publicly traded
companies CEO is I’m honored to have held that title.

James Orsini (24m 40s):
I know what I don’t want to be ever again. And its a publicly traded CEO but once you have the badge, you
have the bage. So while Gary has 900 people in VaynerX, I don’t know anybody other than me, who’s been
in a publicly traded company CEO. So there are decisions he makes that you no, in the earlier times when I
was able to send him a text and so I know how to difficult, that is how you handled it eloquently I’ve been in
that situation. Well done.

James Orsini (25m 11s):
And that’s what happened with some of the CEOs, nobody want’s to come in and you know, and then they
were like, James, what do you know? What, what do you know about retail furniture? What do you know
about insurance? What do you know about law firms? And I said, absolutely nothing. I said, but I will never
know as much as you know about your practice, but you’ll never know as much as I know about the people
who are purchasing your services. Now that’s where the two of us come together. So that’s what I have. And
I don’t profess to know what it is that you have, but what you have becomes better when you mix it with what
I have,

Dr. Anthony Orsini (25m 45s):
It’s all about credibility. I have the same issue when I’m coaching physicians or when I’m doing workshops
and big hospitals about improving patient experience. We do exercises about how you sit down. When you
speak to a patient, how to be a genuine person, et cetera. Many of the other companies that do what I do,
they are taught by masters in education. Maybe they are taught by a nurse and as a physician, I know this to
be true. So even when I started my workshops, they are sitting in the back with their arms crossed, going. I
don’t really want to be here, but once I say to them, listen, I work in the world’s largest neonatal intensive
care unit.

Dr. Anthony Orsini (26m 22s):
We’ve adopted these practices. Our patient experience scores have gone up and I still go home at four or
five o’clock then all of a sudden, everybody sits up a little bit straighter. So when you were alluding to is it’s
all about the credibility. And I think that’s really important, but you still have to be careful with egos, right?

James Orsini (26m 38s):
That’s right. You, you definitely have to play with egos and it can get to your head. Just you read in bio. You
know, I was kind of cringing and looking around and I couldn’t even look at you reading it. I mean, if not done
properly, it will go to your head. You know? And now we had a 40 over 40 accolades somewhere in the

bottom of that, my wife does a good job of helping ground me. You know, they say Einstein’s wife thought he
was an idiot. Right,

Dr. Anthony Orsini (27m 6s):
Exactly. Right. I know you. well, your very grounded, your genuine people wouldn’t even know you do what
you do. Because you just loved to laugh. You enjoy life. And so I think that really goes a long way. Tomorrow,
“I’m going to be interviewing Stephen Covey, the speed of trust author. And he talks about building trust and
building loyalty, the best bosses I’ve ever had in my life. I walked through a fire for them. And that if you said
something poorly about them, I’d be very angry at you. No matter what. And some bosses I’m not happy

James Orsini (27m 37s):
Yeah. That’s really, really important. You know, when I left the Sito Mobile I read a book called “Consigliere
ruling from the Shadows” and it was about being a great number two. When I read that book, I’m like, Listen,
that’s who I am. I don’t need to be the guy on the stage. I don’t need to be the number one. God, I think I
would of been a better CEO if I had a number two, like me behind me, I know most people have a number
two who is trying to shoot them to be number one. And that’s kinda, you know, what the realities of the
business world are.

James Orsini (28m 9s):
But I think that’s kinda where even when the, and this is, this is a funny one, Gary was like, alright, so you’re
going to be the CEO of the Sasha Group. I said, nah I think I would like to be the president. And they said,
you should be the CEO it’s, you know, you should be the CEO of VaynerMedia. You should be a CEO of The
Sasha group. And he’s like, wow. I never really had somebody get back a title. No, but it was like, that’s
kinda what was, I knew what was going to be doing. I didn’t really need any bigger title than the one that I
had to do, what it is that I knew I can do. And there’s a lot of trust there you know, there’s a lot of trust there.

James Orsini (28m 40s):
The thing as his father, his name on it, you know, he doesn’t want to screw it up in any way, shape or form.
He was involved in the vision. And then I sat the strategy for how to execute the vision.

Dr. Anthony Orsini (28m 49s):
And the trust has to go also downwards. So there are so many managers and leaders in bosses that I’ve had
where, I know the way that the way they stay up top, they believe in a way to stay up top is to keep
everybody down. And the best bosses I’ve had were ones that, you know, would hire Anthony Orsini and
then say, when I have another accomplishment, I’m going to take the credit because I hired him and there’s a
big difference. And as the audience knows my daughter Summer, she also works for VaynerMedia.

Dr. Anthony Orsini (29m 21s):

We had the episode with Claude on that atmosphere that Gary has started in that you are able to do that
people wanna work there. Right? I mean, how do you build that trust and loyalty for, with the people that
work for you?

James Orsini (29m 34s):
The interesting part about the Sasha group, is that we over index on senior people. So when I came to the
Sasha, I mean, I took me six VPs and SVPs is over to recognize people that I took over at each one of them
were running a portfolio of a business bigger than the Sasha Group. And I had a half a dozen and most were
like, Hey, how are you going to make any money? I, you know, all of these people making all of this, you
know, big salaries and, but I knew what it was that we were trying to build. And you know, the people that we
were servicing wanted to hear from senior people on the other end, a, a, a consultancy by it’s nature, you
know, Gary gave me the, the, the creative Liberty.

James Orsini (30m 12s):
They take the cream of what I saw at KPMG , Goldman Sachs, interbrand or Saatchi and pull kinda those
things together to form what it was that the Sasha group is and does for its clients, I’m big believer in a
succession planning. And you should have that or not feel threatened by it. You know, if I were to hit by a
bus and you know, one of those leaders is going to run this company. That’s important and you have to be
really comfortable in your own ability to do that.

Dr. Anthony Orsini (30m 41s):
That’s exactly right. The bosses that are worried about keeping people down are often insecure and worrying
about it, but I know you, and I think the reason why people stay loyal to you and you build so much trust, is
that even at work, I know this from my daughter, you’re just a genuine person, your James right? I mean,
everybody knows you, if you have to tell everybody you’re the boss, then you probably not doing a good job,
right? How do you build that loyalty with your employees?

James Orsini (31m 7s):
I tell people that I lead mostly because people choose to follow not because I get on the desk and say, Hey,
I’m the CEO or I’m the COO, and you need to listen to me. So that happens. I’m in touch with every boss I’ve
ever had. Listen to that statement. I am in touch with Every boss. I had ever had, and I left, although you
went through a line of Company. So obviously I resigned, left a lot on all of them, but it, my cell phone, I can
call even the first guy who hired me out of college, Larry Jansen from KPMG, you know, because I left on
great terms.

James Orsini (31m 44s):
And that is a lot of the advice I would give to people, even when there were resigning or looking to resign, I
would like, you know, I understand that the notice is two weeks, as Gary says, and I’ve really hung on to this
doing the right thing is always the right thing.

Dr. Anthony Orsini (31m 58s):
That’s what I tell my kids all the time, right? Is that right or wrong? As always, while you, you can rationalize
away from it,

James Orsini (32m 3s):
You know? And I can tell them from experience. I understand they want you over there. They will never want
you more than the first day that they want you. So just so you know that I’ll tell them that, you know,
everybody wants you today. There’s always the need today. And you need to tell him that you are going to
start there next month. The good news is you’re coming. The bad news is, is it’s the next month. And if they
want you that bad, they’re going to accept that. And I’ve done that time and time and time again, when I left
into a brand to go to Saatchi and I gave three months notice, and, you know, I left Saatchi to go to Sito
Mobile I gave three months notice, you know, three months was a long time, know your kind of leaving and
walking out the door, but it was the right thing.

James Orsini (32m 43s):
And they said, James why are you doing this? I said, because you would want me to do it to you. If it was
different, you would want the same thing. You know, I also think that giving them people or helping people,
and this is why get along so well, I think with Gary because he genuinely loves to help people as do I even
doing it, even when there’s nothing in it for you seemingly at that moment, there’s no quid pro quo, right? It’s
I happen to be in a position to help. And therefore I am, you know, now, is there an expectation if I were to
call you fourd months from now, you should be taking my call.

James Orsini (33m 18s):
Absolutely. But we don’t do it with that notion of a favor bank per se.

Dr. Anthony Orsini (33m 23s):
That’s a great answer. Or two more questions. Because I know you gotta go. So one of the questions that I
teach, communication skills, especially a conflict resolution, et cetera, we talk about active listening and I
saw quote that you wrote that somewhere. Listen more than you speak. Just expand on that. Just briefly.

James Orsini (33m 41s):
When I went to VaynerMedia as the oldest guy in the building, I think at the time, the average age was 26. I
didn’t really know anything about social media. Gary gave me great advice. He was like, I want you to just
kinda breathe. I don’t need you in every room or making a decision or telling us how to do it. I want you to
breathe my company is just take a few months and taken all in. I would learn a lot. You know what I mean?
That’s the other thing, like its just not too old to learn. Do you have this wisdom and experience?

James Orsini (34m 11s):

Yes, but I certainly became relevant in my kids’ lives because they’re all the sudden I was telling them what’s
coming up next on Snapchat. You know what you know, there is times to learn. So I do listen more than I
speak just so I could, you know, help connect those dots that we talked about earlier. I just wanted to see
how it comes together. And then I’d like to think that my input is a thoughful.

Dr. Anthony Orsini (34m 37s):
Speaking of they have 26 year old average age or the millennial and generation Z this leads, me to my last
question. And I asked Claude the same question. So there are a little different than we are. The millennials
generation Z is our kids are both. And most of those are little, in my opinion, in a little bit more impatient than
we are. Some of them may be more used to texting. Then they are speaking in communication. At least
when I’m training young physicians, I find that their communication skills or not what they should be.

Dr. Anthony Orsini (35m 9s):
I ask Claude this question. What advice do you have to the young person who really wants to do more for
the company who wants to speak to their manager or somewhat higher up and say, Hey, I’d like to do more. I
would like to move up, but not necessarily a raise, but you know, I want to advance a little bit. What advice
can you give them about that conversation? How should that go?

James Orsini (35m 30s):
Two things. One, I want to reverse it and the speak to the people who are getting those requests and
recognize my observations. I dispell alot of notions about millennials. Okay. I did not see them as lazy and
self centered. I mean they’re smart, they’re inquisitive, they’re collaborative, they’re hungry. So why not
harness that difference from our generation, right? Or rather, rather than stifle it. So one embracing the
differences and you know, not to get off on a tangent, but certainly we as a country or not doing that really

James Orsini (36m 6s):
Like if you’re not like me that’s a really bad, bad, bad problem. Right? So embracing the differences two we
encourage an open door policy, you know, I probably spent more time with people putting in 15 minutes on
my calendar simply to try and figure out what it was that a chief integration officer did or what does chief
operating officer was there to do? Do you, you know, and in most other company’s those senior levels are
kept in a corner office. You don’t get access to them.

James Orsini (36m 37s):
Okay. You just, you just don’t, you don’t even go to The when I was at Saatchi, most people didn’t come to
the 17th where I sat next to the chief executive officer and chief creative officer or chief strategy officer and
me, and we had this glass off areas and you didn’t come there, you know, unless you’re summoned to be
there. Not here at VaynerMedia they had like scheduled 15 minutes. So like, I am just, you have to introduce
myself, find out what is it you do James you know, what do you do here to do so gathering that information is


James Orsini (37m 8s):
Recognizing I asked them to do an SSP matrix, strength, skills, and passions. Okay. So it’s a reflective mirror
where you could look at yourself and you’re going to tell me honestly, with your strengths, skills and passions
are, and then I will tell you where that fits in our company as opposed to okay. James yeah, I think I’m ready
to be a creative today. And I said, aren’t you going to be in the strategy department? And they said, yeah,
yeah, I’m ready to try being a creative.

James Orsini (37m 39s):
I said, well usually you’re either born creative or you know you went to Miami school design or something.
You don’t just kind of flip a switch and say today’s today I become creative, right? This is where using your
strengths, skills and passions. If you are strength, skills and passions, don’t align with a creative director. I
don’t see a lot of hope for you finding your way there. So the NSSP matrix has really opened the eyes to
many of these younger people that say, Hey, you know what?

James Orsini (38m 9s):
I am passionate about that. And now, now I can find my way there because I have a skill in it. And I’m getting
stronger in that.

Dr. Anthony Orsini (38m 18s):
Let’s go with that. So now you are a young millennial. You want to talk to your boss, you look at your
strengths, your skills, your passion. If you think you’re in line and now you need to get up enough energy to
go into your boss. And you say, how do you think that conversation should go as the boss? If you said, well,
if he or did it really well

James Orsini (38m 37s):
In the SSP matrix, I just kind of lead them from themselves. I then help them position the conversation,
right? So there’s another form of advice. If your one of these millennials don’t go, you know, boldly in where I
would know, man has gone before, find yourself a mentor to help you are going to flesh this out. Now your
going to be like Listen I did my strength, skills and passions. I think I could align nicely with that position over
there. That’s open. And can you help me maybe even role play that you look your whole profession right now
is on role playing, right?

James Orsini (39m 12s):
So you know the importance of that and how much you could learn from that, would you mind role playing or
if I know, I know you’re not the one that I’m supposed to ask when I’m gonna run this by you and this way,
can you Q and a, this with me, I do this with my wife to, you know, hen she’s a looking to do something at
work, let her do a little role play and being honest, you know what? I don’t see it. I don’t see you. haven’t

made us strong enough compelling case for why this should be.

Dr. Anthony Orsini (39m 37s):
Great. That’s great advice that a young person, so James was, this was a lot of fun. And I want to thank you
so much for taking time out of your crazy crazy schedule, but it’s always fun talking to you. Can’t wait for this
to air because, you know, I promise my audience two things, every single episode in that’s to inspire, which
you certainly did because your career is inspiring. And you gave a lot of advice about communicating both as
a boss and as a young millennial who was trying to go to increase their career.

Dr. Anthony Orsini (40m 7s):
And I just want to say thank you. I think my audiences in a real treat when this airs, so thank you so much.

James Orsini (40m 13s):
It was great being on. I hope that they do find some value with it. You know, they can follow me or find a lot
of what we talked about. I wrote about in medium, whether it’s to delegation stuff or how to work with
millennials, it’s all on James Orsini in media, and James Orsinion LinkedIn and Instagram. And I am
@Jimmy the pencil on Twitter. Yeah. I wanted to ask you about the Jimmie the pencil thing. That’s it. We
have a story for another day or you actually do remember me with the pencil thin Clark Gable mustache.
When I combine with the fact that I started in accounting in the pencil.

Dr. Anthony Orsini (41m 12s):
Fantastic. All right. Great. Well, thank you so much. If you enjoyed this podcast, please go ahead and hit.
Subscribe to podcast is now available on Apple, Spotify, Amazon now, and Google podcast. If you like to get
in touch with me or find out more about the Orsini Way I can go through the Orsini way.com and you can
reach me through that. James thank you again. It was an absolute pleasure and I will see you hopefully

James Orsini (-):
Hopefully a Florida.

Dr. Anthony Orsini (41m 14s):
Yes, that would be great.

Announcer (41m 17s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and to contact Dr Orsini
and his team, or to suggest guests for a future podcast visit Orsini way.com. <inaudible>.

The Speed of Trust with Stephen M.R. Covey

Stephen Covey (1s):
And my point is, if you start with trust, where you yourself are trustworthy and trusting, and you build a
relationship of trust, a high trust team, a high trust culture, and your ability to do every other one of those
things, you know, lead through change, built a team, be able to build a culture of inclusivity, you know, where
we value our differences. Because we trust each other, where you can truly collaborate where you can
engage your people, where you can innovate, create new solutions. All of those other dimensions of
leadership go up. They are multiplied by the high trust trust dividend, just like they are diminished and
diluted, are taxed by a low trust dividend.

Announcer (48s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her
team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 33s):
Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. This is Dr.
Anthony Orsini and I’ll be your host again this week, you know, every week I am just amazed about how
many wonderful guests that I get to have and how many people that I get the meet. And I really had been
truly blessed to have so many guests. And today is no exception. Today we have Stephen M.R. Covey as
our guest today. Stephen is the New York times number one wall street journal bestselling author of the
speed of trust. It’s a ground-breaking and paradigm shifting book that challenges our age old assumption
that trust is merely a soft social virtue. And instead demonstrates they trust is a hard age economic driver.

Dr. Anthony Orsini (2m 16s):
And the speed of trust has been published and has been translated in 22 languages and has sold over 2
million copies worldwide. He’s also the coauthor of the number one, Amazon bestseller “Smart Trust” the
defining skill that transforms managers into leaders. Stephen asserts that trust has become the new
currency of the world and that having the ability to develop the extent and restore trust with all stakeholders
is the number one competency of leadership needed today. He passionately delivers this message that is
dedicated to enabling individuals and organizations to reap the dividends of high trust throughout the world.
Stephen brings to his writings, the perspective of a practitioner as he is the former president and CEO of the
Covey Leadership Center, where he increased shareholder value buy 67 times.

Dr. Anthony Orsini (3m 7s):
And it grew the company to become the largest leadership development firm in the world. A Harvard MBA
Stephen co founded and currently leads the Franklin Covey global speed of trust practice. He serves on

numerous boards, including the government leadership advisory counsel, and has been recognized with the
lifetime Achievement Award for Top Thought Leaders in Trust. Stephen is a highly sought after international
speaker who has taught Trust and Leadership in 54 countries. He resides with his wife and children in the
shadows of the Rocky mountains. Well, thank you Stephen for coming. This is awesome to meet you.

Stephen Covey (3m 43s):
Wonderful. Thank you, Tony. I’m thrilled to be on your podcast.

Dr. Anthony Orsini (3m 47s):
That’s the short version of your resume. It’s a very impressive, I hope one that I had one third of that. That’s
pretty impressive. So thank you so much for coming. I’m so excited. I have way too many questions for you
to do this in 45 minutes, but I want to get to your book and I want to get to this whole topic of trust because it
ties into so much of what I do as a physician and what I teach to business and physicians. But before we
jump into the book, I just want to know a little bit about you, what I want my own eyes to get to know you. So
who is Steven Covey and how do you think of yourself and what are your goals in life and how do you want
to be remembered all that kind of stuff?

Stephen Covey (4m 27s):
So I’m often known for who my father is. And my father is Dr. Steven R. Covey who wrote the seven Habits
of Highly Effective People. He passed away about eight years ago, but his legacy lives on through his work
and through his books in the like, and so I feel a great sense of stewardship and responsibility being his son.
I see it as a blessing and rather than feeling like I need to carve out my own identity, I feel like I am standing
on the shoulder, have a giant and am so grateful for what I have been gifted and given by having him as my
father. So I’m very proud of that. And so I’m partly known for that.

Stephen Covey (5m 8s):
And then I think I’ve tried to carve out my own niche really around this idea of trust and how trust is really not
just some soft, warm, and fuzzy social value only, although it is a social value, but kind of making the case
that Trust is an economic driver. It affects the speed at which if we can move, it affects the cost of
everything. And there’s a compelling business case for trust. There’s a compelling leadership case for trust.
When you have trust in relationships, teams and organizations, it changes everything. And so it kind of
making that case for trust.

Stephen Covey (5m 48s):
And then also talking about how trust is learnable as a skill, as a competency that is so important. And I feel
like what my mission is and who I am about is really about trying to increase trust in the world, because if
we’re going to take on and solve these challenges and problems that we have, we can only do that If we’re
able to understand each other and collaborate and ultimately innovate. And we can’t do any of that, if we
don’t start with trust. And so trust is foundational to the kind of collaboration and innovation to move forward

in society. And as you know, with your work on communication and Difficult Conversations best
communication happens when there is trust in relationships and trust between people and someone could be
a great communicator in terms of just skills.

Stephen Covey (6m 44s):
But if they’re not trusted, when the communicate people don’t believe at their hearing, even though they may
be very skilled. And so I see my kind of calling to try to help increase trust in our world largely, and then
specifically to try to help leaders and people increase trust in their lives, in, in their leadership. And so that’s
my work. The speed of trust is about, is trying to kind of make the case for why trust matters and then to
show people a practical tools and skills of how they can build trust on purpose intentionally. And that’s what I
feel like is my life’s mission.

Dr. Anthony Orsini (7m 19s):
Well, just as you were talking three or four more questions popped in my head, cause I’m so excited to talk
about this and you talk about dividends and taxes, and I want to get into that later on, because what you’ve
just said that really rang a bell is that people think trust is just, it’s just something nice to have its a soft skill.
And then later we’ll talk about the dividends and taxes because I really truly believe in that. I want to just
jump back to your father real quickly. I’m a firm believer that we just don’t pop up and be who we are that
there’s genetics involved, but there’s also a stewardship and we have role models in our lives. And I’d like to
think that I’m who I am because of role models and you just had great parents you talk about your parents in
your book and your father wrote your forward in the first book correct?

Stephen Covey (8m 3s):
Yes he did.

Dr. Anthony Orsini (8m 4s):
And you can tell how proud he is.

Stephen Covey (8m 6s):
Well, thank you.

Dr. Anthony Orsini (8m 7s):
You really think that he had a big influence on you and how much do you think that made you, who you are?

Stephen Covey (8m 14s):
Yeah, I think it’s a measurable, it’s hard for me to imagine a different world than without the kind of the
thinking the guidance, the mindset my father gave me. So I think what my father did for me was kind of two
things. One obviously as a parent, just feeling loved, appreciated, valued for who I was as a person
regardless. And you know, it was a great parent. It also what he did for me professionally, he gave me a

framework through which the, you know, look at the world through his work on Leadership seven Habits and,
and that whole mindset has become kind of the software of my mind, of how I look at things. And so it clearly
influenced me that way, but also he believed in me in affirmed me and help me see how I might contribute
and create value.

Stephen Covey (9m 2s):
And he believed in me maybe more than I believed in myself. And that’s a gift. And hopefully for most of us,
if not all, we all have maybe somebody in our lives and may be more than one person who believed in us,
who had confidence in us. Who took a chance on us, whether it be a parent or a friend or a leader or a
coach or a clergy person or someone at work, but someone that believed in us and had more faith in
confidence in us, then maybe we had an ourselves in, in many ways my father was that for me. And so it
enabled me to kind of gain that in myself. And it really flows from my father’s definition of leadership, which I
think is quite beautiful.

Stephen Covey (9m 49s):
He said, leadership is communicating people’s worth and potential so clearly that they come to see it in
themselves. And that’s what my father did for me to communicate to my worth and potential so clearly that I
began to see it in myself. And that’s a great gift. And I’m so blessed and grateful for that.

Dr. Anthony Orsini (10m 5s):
Both of you and your father tell the story of clean and green. And I think that’s a, what you’re alluding to. I
can just tell people a little bit about that story. That’s a great story.

Stephen Covey (10m 13s):
Yes it’s a great story. And a long story made short is I was just a young boy, seven years old. My dad was
trying to teach the kids responsibility. So he asked me to take care of the yard. And this is in the days before
automatic sprinklers. So this is a big deal. We’d go around and try on the sprinklers and like. And he trains
me for like two weeks and he says, all I care about is two things, green and clean. We want our yard to be
green and want it to be clean. And so he trained me on how to do this take responsibility and how to turn on
the sprinklers. And it had to do it so often and paying off, et cetera, sounds so simple, but I was seven. And
he trains me and then he turns it over to me. He asked me, how are you ready? And I said, I’m ready.

Stephen Covey (10m 55s):
He turns it over to me. And when I did nothing, I did nothing for like five days in a row during the height of the
summer with scorching heat and the water and the lawn is shriveling up yellowing all around us. And we had
neighborhood, you know, barbecues over at our house and there’s a garbage everywhere, and it was
anything but green and clean. And my dad was just about to kinda just take it back, the job, thinking these
two young, but he stayed with it. And he said that, you know, how’s it going on in the yard sign? Because we
agreed that we’d talk about how it’s going walk around once a week on how things were going. And when we

walked around, I looked around and I was so embarrassed, cause the yard was yellow and it was messy, not
green and clean.

Stephen Covey (11m 37s):
And I remember saying to my dad, this is just so hard. And I began to break down and cry and Dad said, but
what’s hard? You haven’t done one thing yet, but what was hard was me learning to take responsibility. He
said to me, I’d be willing to help you if you’d like help. And I said, would you help? He said, yeah, I’ve got
time. So then I said, well, Dad, will you go around and pick up that garbage? Because it makes me kind of
want to vomit. I was kind of telling him what to do. And when I saw him doing that, it was at that moment. I
realized, this is my job. I’m responsible. I’m directing him not he directing me to. And from that moment, the
green and clean became written in my heart. And I kind of rose to the occasion and took over that

Stephen Covey (12m 20s):
And the rest of the summer, the lawn was green and it was clean. Now my father will, sometimes teach this.
We use to teach the story to talk about win-win agreements and stewardship delegation. And it was those
things, but I was a seven year old boy. I didn’t know what those words meant, but here’s what I knew as a
seven year old, I felt trusted. I felt my father trusted me. I didn’t want to let him down. You see, I was too
young to be worried about money or status at the time, but I didn’t want to let my dad down. And he trusted
me in and I ultimately responded to that trust rose to the occasion, developed some skills, took responsibility.
And so it was really my first learning on trust.

Stephen Covey (13m 1s):
I didn’t label it that at the time, but I realized later that I felt the trust and what it did for me, how it inspired me
and made me want to rise to the occasion. And that’s what trust does to people. And to be trusted is the
most inspiring form of human motivation. It brings out the best in all of us, whether we’re seven or 70, we all
want to be trusted. It makes such a profound difference on how we view the world.

Dr. Anthony Orsini (13m 25s):
There’s such a great story. And so let’s go back to your book in the first thing is if you want people to trust
you, you just think going along that line, you first have to have self trust. Right? You talk about that when you
first need to have self trust before you can have other people trust you, can you just expand upon that?

Stephen Covey (13m 40s):
Yeah. You know, I’m going to sustain trust with others. If you don’t trust yourself, number one. So self-trust
means trust in yourself. But also it means that you give to others, a person who can be trusted. So it it’s
smart to trust you. In other words, you’re a credible you’re trust worthy and you know, it’s hard to have trust
without trustworthiness. And so you are trustworthy. I call that credibility and that is that your a person of
character and a person of competence and really to have self trust, to be credible when needed to have both

character and competence.

Stephen Covey (14m 20s):
I mean you come from medecine, you wouldn’t go to a, you know, a surgeon, you want a surgeon to have
both the character and the competence. You want to make sure that if they cut that are good at it, they’ve got
the competence, but you also want him to have character and to really recommend, do you really need the
surgery? And you wouldn’t want someone without either one you want both and same with any work project.
Do you want people to have character and competence to sustain the trust? And that’s being credible. That’s
been trustworthy. So when you start with self interest, that becomes a foundation for building then trust in
relationships, trust on teams, trust and organizations. But too often, we kind of skip that step and just kind of
move right to the relationship without looking in the mirror and focusing on ourselves and asking the

Stephen Covey (15m 6s):
Do I trust myself? And do I give to my teammates, to my partners, to the people that I lead or serve a person
who they can trust because of who I am as a leader, my credibility, my trustworthiness, my character and my

Dr. Anthony Orsini (15m 22s):
My next question, you talked about trust and trusting yourself. I’d like to have you give me some advice. So
what I do as a physician, as you mentioned, when I teach workshops, I’ve really dedicated my career to
training physicians how to build relationships. And because that’s what medicine’s all about. It’s about that
human to human connection. Physicians generally are not great communicators, patient satisfaction. And
the patient experience is a big topic right now. And we know that when patients have a trusting relationship
with their doctor, they are actually more likely to take their medicine. They are more likely to be compliant
with their therapeutics. They are more likely to follow up.

Dr. Anthony Orsini (16m 2s):
And 100% they do have better outcomes period, and a discussion. One of the things that I have to teach is
how to build that trust in a five minute interaction. You can say that there’s a lot emergency room physicians.
You’d come in to the emergency room, I’m meeting you for the very first time. I have three to five minutes to
build that trust. And I teach certain techniques. I’m really big on body language and showing competency. I
call it being the expert in the room, but also being a genuine person. I’m sure you’ve had the same issues in,
in a boardroom or what you’re doing business. Any advice you can give to people to say, this is how you
build trust quickly. You just meet somebody. We talked a little bit about how quickly people build either trust
you or they don’t.

Dr. Anthony Orsini (16m 44s):
And I thought about that book, blink and slices. When people walk in the room, they even instantly trust you

or any advice you can give to a physician or a business person. So you’re just meeting somebody or how do
you start off on a good note?

Stephen Covey (16m 57s):
Yeah, it’s a great question. Cause we all face every day in our word and the like, so here’s a couple of
thoughts. What you can show perhaps in just quick interactions, is that you’re real, your genuine, you’re
authentic, you’re not trying to put on airs or try to pretend. And so coming in and just right out of the gate or
whether you’re a Physician or a business person I have learned, if you will kind of up front to declare your
intent and declare yourself, here’s who I am. And I like to build a relationship of trust. If we can trust each
other, everything works better.

Stephen Covey (17m 38s):
So I’ll try to model it. I’ll try to go first and hold me accountable if I don’t, but I will do my best that I can
because if we can trust each other, it’s better for all of us. And if you’re a doctor, you kind of already come in
with the idea that there are some competence there by your training in your profession and for a doctor,
maybe the greatest need is to show that you have character that you care. And so coming in and say, and I
really liked to help you and be a value to you and serve you. So let me listen to you, let me understand, try to
hear you out. Cause my goal has to be a value of help to you of service. That matters to me.

Stephen Covey (18m 18s):
See, I’m declaring my intent and in the process to clarify who I am, that I’m here to serve, to lead, to make a
difference, stat value versus you know, trying to self aggrandize myself. It’s all about me and narcissistic
view. I’m just trying to show him a real person I’m genuine and authentic. And the best way to do that is to
declare yourself, declare your intent, open yourself up, be transparent, be authentic, be real and trying to
listen, trying to understand someone who has a great way of kind of taking a next step on that. Let me hear
you first to it shows that I am who I say I am, that I care about you. And those are sometimes things you
have a chance to do.

Stephen Covey (18m 59s):
It might be a better setting where maybe your expertise, your competence is not as known. Like it might be
in medicine. And so coming in and you don’t wanna come in and be braggadocio, but you might come in and
say, I’ve got experience in the background of this at my whole goal again is to, you know, create value and to
serve and add value and base upon my training. And in my experience, I hope that it can be able to do that.
But if my main point is, if you will, to declare your intent to another and even declare yourself, I learned that
from Doug Conant. I’ll tell you about that in a moment of who you are and what’s important to you and why
that way there is no mystery in a relationship and it also shows kind of a vulnerability that you’re not trying to
pretend, you are trying to be real and authentic.

Stephen Covey (19m 50s):

And that kind of is disarming for people. And they realized that this is a good person that is just trying to get
to know me and help me in my problem, help me in my situation to help me succeed and just being
disarming by being authentic and real is a great way to do that. So it was Doug Conant. He was the former
CEO of Campbell soup company and they had a massive turnaround. They went from the bottom 10% in
engagement of their people to the top 10% during his tenure in not only in engagement, but also in a
performance, you know, dramatic turn around. And he told me that in any new relationship, when he would
come in and meet someone for the first time, he would try to declare himself saying, here’s who I am.

Stephen Covey (20m 39s):
Here’s what I’m trying to do is to just be genuine, to just be real, to be authentic, and to lead out with it and to
take the mystery out of the relationship. And it was always about trying to again serve and because we
would all be kind of embarrassed to declare self-serving intent. But if our intent is to serve, to create value, to
build a relationship, to give back. That’s a natural thing to want to declare. And then it just invites authenticity
back and it helps accelerate the relationship of press. So it’s not easy stuff because if you feel vulnerable,
but it’s in that vulnerability that helps you build trust faster than if people are wondering, this person has kind
of still playing their cards close to the vest, who are they?

Stephen Covey (21m 29s):
What’s their agenda here instead you’re just open. Here’s my agenda. I want to serve. I want to help. I want
to build a relationship of trust.

Dr. Anthony Orsini (21m 34s):
You don’t know how happy I am that you said that you actually use the word genuine for those people who
read my book and have gone through my workshops. I used an acronym called program and the G is
actually for genuine it be a genuine person with the acronym is a discusses communication. And if you’re a
genuine person, people tend to trust you, especially if you’re a Physician, as you said, Physician to come in
with a certain level of competency, we want them to number one, show that they care. So if you’re typing on
the computer while the patients’ speaking, that’s not bringing the patient first. So you are losing trust right
there, but by being in a genuine person. But I will tell you a quick story in my mother-in-law, who was in a
hospital in New York, a very well known hospital.

Dr. Anthony Orsini (22m 18s):
The cardiologist told her that she had a clot, that it was inoperable. And my wife came home and she started
to cry and a cardiologist told her, and she would just go home and she’s going to have a stroke because it
surgeon won’t, operate on her. So I made a couple of phone calls and we agreed to meet the, a head of
surgery at the hospital, thoracic surgery. He came in and he started talking about how he avoids the traffic
with his motorcycle in New York city. And he sat down with us and he spent no more than two minutes just
being a genuine person. And then he said, well, we’ll operate on your mother-in-law tomorrow. And that’s
being a physician said to him, well, the cardiologist said it was an operable.

Dr. Anthony Orsini (22m 59s):
And his response was well, it is to most people, but for me, I’ll be able to take care of it. No problem. And I
think he wasn’t braggadocious. So we didn’t think that he was cocky. We thought he was competent. And
because he was first a genuine person. And I think that’s what you were talking about, but don’t you agree,

Stephen Covey (23m 15s):
Tony, this is a beautiful illustration have exactly what I’m talking about. That by coming in and being genuine,
real, authentic, rather than an out of the gates versus pretending or trying to seem or trying to just be kind of
narcissistic it’s about me, but rather here’s who I am. I’m genuine. That builds a little bit of trust right out of
the gates people to reciprocate back then, when you say I can do this, I can help you. Your discussion of
your capabilities, your competence is in the context of a genuine relationship that you are building and a
desire you have to help.

Stephen Covey (23m 55s):
So it seen differently. It’s not seen as I’m bragging as seen as yeah, they really can help me like he says he
wants two or she wants to.

Dr. Anthony Orsini (24m 3s):
Yeah. If he came in on his phone and didn’t make eye contact and didn’t spend time and just said, bring your
mother-in-law to the, OR tomorrow we would have said, wait, hold on a second, I’m not sure I trust you. But
he talks about his motorcycle and how he loves to scoot in and out of the traffic in New York city, and he
became a real person and that took one to two minutes. So when he said I’ll operate on your mother-in-law
tomorrow no problem, I’ll take care of it. We can totally believe them. And I guess what, he did an amazing
job. And she did really well. So let’s shift over to business and I’ve had several bosses in my life. And I
mentioned this in a previous podcast. Some of them I’d walk through fire for. And if you’re in a room and
someone said something bad about them, I would be ready to fight you.

Dr. Anthony Orsini (24m 47s):
I’d be really mad. I’d defend them to death and others, not so much. And I think that when I was reading your
book, that’s what I was thinking about it as the one’s that I’d walked through, fire for had my back. I trust with
them. They trusted me. I knew that if I did something well, they would brag about me and say, look at Tony is
doing a great job. And they wouldn’t throw me under the bus if something went wrong. So you talk about
taxes and dividends. How important it is that, that we teach these leaders how to do this because otherwise
they’re going to get complete turnover over and over again.

Stephen Covey (25m 28s):
It is absolutely critical because just the example you gave, when you build a relationship of trust with
somebody, oras a leader, then it literally impacts how people interpret everything else that you’re doing. That

if you get through that lens and when you are both trustworthy, but also trusting to the example you gave is
that you trusted them and they trusted you. So we’re really inspired by leaders who are not only trust-worthy,
but who are trusting. They were willing to extend trust to us. That really brings out the best in us. We want to
rise to the occasion.

Stephen Covey (26m 9s):
We want to prove that trust justified and we gave it back to them. And when you have a leader like that,
you’re loyal to that person. You want to stay with them and they engage you. You want to contribute. You
want to make a difference. Whereas when you have a bad boss and the very definition of a bad relationship
is low trust, or you can’t trust the person either because they’re not trustworthy or because they don’t trust
me or anybody else hardly, then that’s something you want to avoid. It is, it just sucks the energy and the joy.
It slows things down. It takes longer. Cause you have to compensate for that lack of trust.

Stephen Covey (26m 48s):
It is a tax and everything takes longer, everything costs more when there’s low trust and relationship,
because you now have to check and verify and question and wonder and take all of these steps to
compensate for low trust. Whereas when there’s high, trust it as a dividend, you moved fast, low costs
because there is a speed to trust. Nothing is as fast as the speed of trust. When in a relationship on a team,
in a company and you can put a value on it. In fact, there is overwhelming data that shows that high trust
organizations outperform low trust organizations by about three times.

Stephen Covey (27m 29s):
Well in economic performance, total return to shareholders because they get greater speed, lower costs,
greater creativity, greater innovation, better engagement. When there is trust and when there’s distrust,
everything takes longer, costs you more, but also you will see less engagement and people far more
turnover. People far less collaboration, far less innovation. And all of those things are taxes and we can’t
afford to pay those taxes. And when you view trust as an economic driver, not just a social virtue, suddenly it
moves up on the hierarchy of why it matters that it’s not just, that is nice to have, like you said, at the outset,
it’s a better way to lead.

Stephen Covey (28m 19s):
We get better results, better outcomes, better performance. And it’s, there’s more energy to enjoy and the
relationship. So its kind of both the, the quantitative and the qualitative are higher.

Dr. Anthony Orsini (28m 28s):
You know more about this than I do, but employee turnover cost a lot of money and not every job that I have
left, but most jobs that I’ve left it’s because I thought the manager was untrustworthy or that there wasn’t a
good relationship there. So that’s what I love about this dividends and trust that you can get away with it for a
short period of time. Right. But sooner or later the rooster’s are coming home. Right? A what’s that saying? I


Stephen Covey (28m 56s):
The hens have come home to roost.

Dr. Anthony Orsini (28m 57s):
Right, but you’ll get away with it over a short period of time, but not long.

Stephen Covey (29m 3s):
Yeah. You won’t sustain it. Especially in today’s environment where it’s a new world. We got all this change
hitting us, technology changes work has changed it’s more collaborative and interdependent and has also
being done increasingly more remote as well as in person, the work force has changed. We have multiple
generations, including millennials and gen Z. They have a whole kind of a different expectation and they
want to be trusted. And then they’re so many options in choices that if there is a low trust culture, its kind of
characterized by command and control kind of the old style of leadership command and control based upon
low trust that’s not going to attract, retain, engage or inspire the best people.

Stephen Covey (29m 50s):
The best people want to be part of a culture, have a team where they feel trusted and that brings out the
best in them. And then it not only engages them, it inspires them and they perform better because of it. And
they want to become a part of something new and great and they tell their friends about it and they tell
others and they become your greatest champions and advocates. Whereas yo had a bad boss or a low trust
relationship. You go find a better boss. You’ll leave. Half of us have left companies because of a bad boss
and that’s all based upon trust. And so the data is just overwhelming. High trust is a dividend.

Stephen Covey (30m 30s):
It gets played out in multiple ways, low trust as a tax. And you start in our discussion, Tony with this in
medicine, when there’s high Trust with a Dr you’re more active follow their directions and instructions. All of
the things you’ll get better. Medical outcomes is also a happier relationship where there’s low trust. If you get
lesser medical outcomes and also a probably is more stressful, painful, exhausting, no fun. So that’s true in
medicine is true in business. That’s true in life and is just a matter of kind of putting the, I call them the trust
glasses where you look at the world through the lens of rust and see how trust is impacting everything.

Stephen Covey (31m 11s):
Not in small ways in profound ways. And it’s always been this way, but we’ve often never seen it. And I’m
trying to get people a lens through which the view, the world who ends with trust.

Dr. Anthony Orsini (31m 20s):
Yeah. And from my point of view, when I trained physicians and nurses, almost all of them are very

compassionate people. They want that trust they haven’t just learned how to communicate that trust and
they haven’t learned that to make that relationship with their patients quickly. And it doesn’t take long for me
to teach them that three hour workshop, a couple of sessions and they get so excited when they see the
difference when they see the patient’s eyes light up when they walk into a room because they’re so happy to
see them. So it can be taught. It’s all tied into this communication. And when you come in as a consultant to
a business, so I guess there’s two ways of looking at this now, do we have to be careful about who we make

Dr. Anthony Orsini (32m 2s):
Because sometimes as I always say, a lot of companies make the mistake, it’s just finding the smartest guy
in the group or the smartest women in the group and make them as a manager or do we take the manager
and teach them how to build trust? Or do we just pick the manager that already exudes the trust. I guess this
is what I’m asking.

Stephen Covey (32m 21s):
Well, it can be both, you know, obviously sometimes there are some people that are just natural leaders that
know how to build trust, build relationships, and that’s wonderful. And hopefully they are also good at getting
outcomes and results. So we want both, we want the results. We want the relationship with the outcomes we
want the culture. It’s not either or it’s both. And your point is also a valid. Sometimes we tend to just promote
the top producer that may or may not be really a good leader. They might technically know how to do it, but
they might not understand really how to lead people and relationships in. Sometimes they try to manage
people is if they were things in the learning is how you manage things and you lead people in the moment,
you start to try to manage people as if they were things and be efficient with people and manage them like
things you lose trust.

Stephen Covey (33m 15s):
And then we to lose trust with them and everything will get bogged down. You’ll start paying the taxes and
I’ve learned with People fastest, slow and slow is fast. So taking the time to build the relationship and yeah, it
takes you have some time up front, but then you build that relationship of trust. Suddenly, you move faster
when you don’t take that time up front and try to just be efficient, not listen, not, you know, be genuine not
kind of build that relationship. It all in the name of efficiency. I don’t have time for any of this. Well guess what
everything you try to do is take you longer to do because I was wondering, can I trust this person? So with
People fast is slow and slow is fast.

Stephen Covey (33m 55s):
So, but I think it’s learnable, I think these are the things that you can learn to do as a leader. Some might be
natural at it, but others can learn to do, you know, to model, how to trust and to inspire. And those are kind of
the three key dimensions that I see at modeling that you model the behavior, trusting you, trust your people
because of what that does is a great way to lead and then inspiring, which was all about connecting them to

why it matters to meaning, the purpose of the contribution as well as just connecting in the relationship alone
can be inspiring that you care enough to do that. And I think that’s learnable that you can learn how to do
that and become better at it.

Stephen Covey (34m 37s):
And so when people ask are leaders made or are they born? My answer is that they are reborn through their
choices or they made them and they can learn that and get good at that.

Dr. Anthony Orsini (34m 50s):
I have trained individually over 5,000 doctors and we use improvisational roleplaying and different ways. And
then I can’t even count how many workshops in other ways, but with the improvisational role-playing we take
doctors, we put them in difficult situations. We videotape them. We talk about their communication skills.
What I have found is about 15%, just what you were saying before, about 50% of the people that go through
these exercises, just knock it out of the park. I mean, they walk into a room, they light it up. If they’re giving
tragic news to a patient in this case, there are actors, they do it in the most empathetic way and they’re just
naturals. And some of them are right out of medical school and some of them are older. There’s about 10 to

Dr. Anthony Orsini (35m 30s):
And I want your opinion on this too tha maybe I could train forever and they’re just not going to get it. But the
other 70% really want to learn and are teachable and get excited when you tell them, do this and do that and
try this and try that. And then they try and in a work, is that your experience to that? There are some that just
can’t be trained, but most of them can be,

Stephen Covey (35m 54s):
Yes, it is absolutely that most people can get there because it’s a character first. It’s who you are, that
genuineness. And if people have that, your intent matters more than your technique. Now the technique
does matter as well. You can kind of learn how to do it better, but your intent matters more. And when you
start with that and if people say I care and I have good desirous to do this, they can get there. They can
learn better practices, better skills, better ways to communicate when their intent is good to begin with. There
may be a few that just don’t quite get it. Their mindset is so oriented around either just doing the task that
they don’t think about their relationship, or just maybe there are two ego centered narcissistic.

Stephen Covey (36m 41s):
They’re not worried about other people as much. And this all feels like a foreign language to them almost,
but that most people can get there if they are willing. So intent comes first and the techniques, but you can
get good at this. And I’ll say, let me just give one illustration of this in medicine. I know that it’s a big part of
this audience, not exclusively. You got other people that are heavy in medicine. The good news is the
medical professions come in already with the highest levels of trust of any profession, the highest trusted

professions tend to be nurses and doctors at, and even pharmacists, a medical or a higher trust professions.
It’s not a given it will happen, but that’s a good starting point.

Stephen Covey (37m 24s):
And I think it is because it’s so important. It’s your life and your coming in. And most people are most nurses
and doctors are good people trying to help. And so that’s a good thing. I think if you could get really good at
that genuineness and declare an intent, but also two key behaviors in medicine, but also in all the
businesses and in life that are really good. If you can focus on empathizing and showing compassion. So
that’s listening and then showing that you care than those two things of, I am willing to listen and to
understand and to empathize, which is I understand somebody.

Stephen Covey (38m 7s):
And then I showed that I care about that person that really moves you to the front of the line of saying that
person, I liked this doctor, I liked this nurse. I liked this leader because they listened to me and they care
about me. And this is all back to the genuine-ness that will help you. If you establish that trust, then all your
communication skills will just be enhanced because they trust you. Whereas you could not be trusted and be
really skillful and smooth and in articulating. But if you’re not trusted, people are diminishing diluting taxing.
What you’re saying.

Dr. Anthony Orsini (38m 44s):
There are so many parallels between medicine and business. And you were talking about intent before. It’s
well known the American bar association in one of their conferences, many years ago I don’t remember what
year was, put out a statement to the fellow attorney’s and said, if a patient who has a trusting relationship
with their doctor, they are unlikely to file for malpractice lawsuit, even if prompted to do so. And that’s the
intent that’s right there. If you trust your doctor, something might’ve gone wrong, but the intent was good.
And you, well, Dr. Orsini he’s a good guy and he didn’t do that on purpose. And there are less likely to sue.
So there’s that tax and dividend Again right? So there’s, it’s palpable.

Stephen Covey (39m 24s):
It is a tangible, you could put an economic value on it. I’ve seen similar studies, university of Michigan, sorry,
works where, you know, doctors who have build the relationship and who apologize or sued about two and a
half times less than those who don’t. It Is because that people, why do they sue? They sue when they’re
they’ve been wronged. And when they’re mad, they tend to stay mad when they’re owed an apology and
don’t get one. And so then as the apology takes the story to get out of their hands and the look I’m not giving
legal advice, my insurance companies don’t want you to do it. But the whole point is if you build a
relationship of trust, that dividend is a dividend and every dimension and aspects of that relationship, I’ll have
a team of a culture and you can put an economic value on it.

Stephen Covey (40m 10s):

You can put a qualitative value on it. It’s a happier way to live the best relationships. The happiest, the most
enduring are those which people can trust each other.

Dr. Anthony Orsini (40m 19s):
And in business. We have some HR people, a lot of HR, people in the audience. And we had Dr. Larry
Barton on a few months ago, I guess. And he is one of the leading experts in a workplace violence. And he
talks about the manner in which the HR people separate someone from employment and when things aren’t
working out. And if you can communicate that trust and communicate that you’re a genuine person and
things didn’t work out, that person is less likely to come back and shoot the place up. And so there’s trust in
this relationship. I mean, we can go on and on it. It’s just amazing. What are my favorite sayings as people
follow not because they are told to people follow because they want to. And I think that really goes well with
your whole trust thing.

Dr. Anthony Orsini (41m 1s):
My best bosses as I said, I would follow them through fire. So it really is intangible. So this has been great. I
know you’re a very busy man. I can talk to you all day long. You’re so easy to speak to this whole concept of
trust. I think you said it in the beginning of your book, it’s every aspect of our life. There is no aspect where
trust isn’t important, right?

Stephen Covey (41m 21s):
But it applies everywhere. So if you call it the one thing, right, I call it the one thing that changes everything.
And it’s not that you don’t have to do other things. Leaders today. We have so much that a lead through
change that to build teams, you need to build cultures, inclusion, and equity. You need to collaborate. You
need to engage. You need to innovate all of these things for asking of leaders. And my point is, if you start
with trust, where you yourself are trustworthy and trusting. And you build a relationship of trust, a high trust
team, a high-trust culture, and your ability to do every other.

Stephen Covey (42m 7s):
One of those things lead through change, build a team to be able to build a culture of inclusivity, where we
value our differences. ’cause we trust each other where you can truly collaborate, where you can engage
your people, where you can innovate, create new solutions. All of those other dimensions of leadership go
up. They are multiplied by the high trust dividend just like they’re diminished or diluted or taxed by a low trust
dividend. So it’s the one thing that changes everything, trust when it’s right in front of us. At one level, we all
know this from our own experience. Just the example you gave Tony of. when you think of a leader who you
trust that you’d go to war for them, and you have their back compared to someone you don’t trust and who
doesn’t trust you, how they are very forgetful.

Stephen Covey (42m 54s):
He’ll move on. We’re all that way. We all know this. It’s just the message that I’m trying to give is that not only

does trust matter because of high trust dividends compared to low trust taxes is also that trust is learnable
from the inside out. Meaning we look in the mirror, we start with ourselves, we work on our credibility, our
trustworthiness. We work on our behavior, including the behavior of trusting other people. And we model the
others, a high-trust leader, and we build a high-trust relationship and you can do it with one. You can do it
with many, and you begin to build that kind of team and culture. And it’s learnable as a scale, as a
competency, as a team, as a culture, as a company, you go from good to great in trust and suddenly you get
all these dividends.

Stephen Covey (43m 41s):
And that’s kind of the big idea that trust is learnable as a scale, as a competency, through our credibility and
through our behavior and getting good at this matters for all the reasons we’ve discussed. That’s the big

Dr. Anthony Orsini (43m 52s):
That’s why so many people in so many companies need your help. So how do people get in touch with you?
Stephen, if they need your services, what’s next on a horizon for it? You tell us a little bit about how they can
get in touch with you and get some help from other companies, for the corporation, for their individuals. How
do they get in touch with you and what services that you offer now.

Stephen Covey (44m 13s):
I see the best place is just go to our website, which is speed of trust.com, the variety of tools there, and
videos and things you can look at, including there are some places where you can ask, how do I bring me in
to give a speech, or what have you? We have training. We have consulting, we have tools, measurement
tools, products, or services. I’ve spoken to a lot of organizations all around the world, including healthcare,
as well as government and education and the businesses NGOs. So kind of a whole gamut. And if we have
others that do the same. So I’d say the website’s speed of trust.com was probably the best place. Plus there
are some good tools, some videos there that you might find useful, and it’d be a good place to start.

Stephen Covey (44m 57s):
And then we just say this in conclusion, we are living in a world of declining trust and the trust is going down
because of all around us, in our society, in our politics and a media. In most institutions, we are seeing the
trust go down in the U S and in most parts of the world with some exceptions. And so the danger of a low
trust world is that it tends to perpetuate itself and create more of the same, where we all become a little bit
more careful, more cautious, more guarded. Now we can find ourselves perpetuating a vicious downward
cycle of distrust and suspicion, creating more distrust and suspicion.

Stephen Covey (45m 41s):
And everybody feeling justified in this process. Distress is contagious. Here’s the good news. Trust is also
contagious and trust and confidence can create more trust and confidence, and you can build it one person

at a time, one relationship at a time, one a leader at a time, and each of us can kind of look in the mirror and
start with ourselves. We don’t have to wait on others, we can get that person, a leader that they can trust.
You can be that kind of person for another, by your credibility, your trustworthiness, and by your willingness
to behave your way into a trust, including being trusting. And so ultimately, while it takes two, to have trust, it
only takes one to start.

Dr. Anthony Orsini (46m 19s):
I love that. That’s fantastic. I love that. And so thank you so much, Steven. This has been a true honor to
have you. It’s been great. Oh, a lot of fun. I hope we’ll get to speak again sometime soon. I’ll put all of those
links on my show notes. Thank you again for being here.

Stephen Covey (46m 34s):
It’s been a lot of fun. Thank you for me to as well, Tony and I really admire you and the great work that you’re
doing with this podcast in the other thought leadership that you’re providing,

Dr. Anthony Orsini (46m 45s):
You enjoyed this episode, please go ahead and hit subscribe and download all the previous episodes. If you
want to know more about the Orsini Way, you can contact me @theorsiniway.com my the book is available.
“It’s all on the Delivery” on Amazon, and you can contact me through the website as well. So thank you,
Steven. That was incredible. And I will be in touch really soon.

Stephen Covey (47m 7s):
Wonderful. Hey, thank you so much, Tony wonderful to talk to you.

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Learning how to human better with Beth Weissenberger of The Handel Group

Beth Weissenberger (1s):
Your chicken and brat and weather reporter are not on your team, their entire life is about getting in your way.
Their entire life is about you not having what you want. Their job is to mess you up and they are not going
away. They are your board members. They are yours. You should meet them and have fun with them
because they talk constantly.

Announcer (27s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author Dr Orsini has been training healthcare professionals and business leaders how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their story and provide practical advice on how to effectively communicate. Whether you are a
doctor are faced with giving a patient bad news, a business leader who wants to get the most out of his or
her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 13s):
Well, Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is
Dr. Anthony Orsini and I’ll be your host. Again, today, today you are in for a special treat. I am very excited to
have, as my guest Beth Weissenberger. Beth is the co-founder and President of the Handel group. The
Handel group is a renowned corporate consulting and life coaching company dedicated to teaching people
how to realize their personal and professional visions. Their straightforward and innovative method has
changed the lives of thousands of private and corporate clients, and has been taught in over 50 educational
programs and institutes of learning, including MIT and Stanford graduate school of business.

Dr. Anthony Orsini (1m 53s):
Beth has developed the Handel group into a multi-platform company, comprised of a corporate, private
coaching ,education sport and product divisions. They Handel Group not only offers live coaching, but a
digital platform interview for a professional athletes, individuals and students. With her 20 years of
experience, coaching thousands of the most senior executives that is not only a masterful coach, but it also
leads corporate seminars in her signature mince no words style on a variety of topics that are fused with
energy, transparency and inspiring personal stories. Beth, thanks for being here today.

Dr. Anthony Orsini (2m 34s):
Really looking forward to this, you and I have met, I guess, about a month ago, we met through Claude
Silver of VaynerMedia and spoke to you for about five minutes. We had instant rapport. I knew this was
going to be an awesome interview. So I immediately booked you and I know you’re busy. So thanks again for
being here. So I really wanted to get into your coaching and your method. I’m just find it so fascinating that
I’ve done my homework, that I want my audience to about it. So let’s just start off slowly by just telling us
about the Handel group, what you do and how it started.

Beth Weissenberger (3m 8s):
For sure. 16 years ago, my youngest sister and I, so there’s four children in the Handel family. We named
the company after my dad he’s our lawyer, but he has been for 16 years and you know, we paid them
nothing, but we gave him the name of the company. So 16 years ago, my youngest sister Lauren and I had
decided we were both coaches and she is a genius who invented our Handel Method and then I’m a builder.
And we said, all right, why don’t we do this? Your genius, let me build you and let’s give it a shot. We gave it
a year. Cause we, at the time, 16 years ago, executive life coaching was not like a thing. The first comment
it was, are you a doctor or are you a therapist?

Beth Weissenberger (3m 48s):
And we’re like, no we’re coaches, but we hit it out of the park. And now 16 years later we’re the largest
executive life-coaching company and we have about 70 people who work for us and we have a ball. So that
is how it started. Lauren is my boss, even though she’s 11 years younger, she really is that genius. She is
the chairman. She’s now working in Handel group inventing two new divisions to new pieces of work and I’m
running the company, but that girl is still my boss.

Dr. Anthony Orsini (4m 19s):
And Lauren wrote a book recently, which I read. It’s an awesome book.

Beth Weissenberger (4m 23s):
So my other sister morning, Marnie Nir is an executive at Handel Group. She is our Chief Content Officer
and our writer. And so she and Lauren wrote the book “Maybe it’s you”.

Dr. Anthony Orsini (4m 33s):
I love that topic. And I read it. It’s an easy read and we will reference it on the show notes. So that’s great.
Now, one of the things I do a lot of coaching, as you know, I do a lot of seminars myself, all in the health
care area, although we are doing some work on business and HR, one of the things that I think really helps
me when I teach physicians is that I speak from experience. And I’ve seen some of your seminars. I’ve seen
you on the internet. You can tell some great stories about yourself, but this is not stuff that you can’t relate to
because when Lauren contacted you, you were at a point in your life also that made you want to change?

Beth Weissenberger (5m 8s):
Yeah, I actually called Lauren, so Lauren remember is 11 years younger. So yeah, I was out of the house
when she was growing up. And so I’m now living in Laguna beach, I’m married to my second husband. So
you can hear yes, jerky genius in business jerky in love the story. It took me to divorces and I live with the
third man who then cheated on me. So it took all of that until I was 59 years old to finally get Love. Both
sisters have to coach me. I’m 61 now in madly in love with the final man, amen. But yes. So I called her
because at the time I was married and I was in a job where I was the head of sales of a management
consulting firm had just had the best year they’d ever had an 18 years.

Beth Weissenberger (5m 52s):
And this is my second year there I was bored out of my mind was not it wasn’t turning me on. I didn’t love
living and sorry those of you who are in California, I didn’t Love Laguna beach. I’m a new Yorker. And max,
our daughter who’s now 19 was about two and I’m like, Oh, Lauren help and I have never called her as like a
coach right? Because you know, I was the coach and in two 20 minute conversations, she literally altered my
life. And that’s when I got, who are you? How much do you charge? My boss charges is 600. And isn’t even
close to who you are charging a hundred dollars? And I was like, Oh, okay. And so I left New York. She had
got me a job that didn’t turn out.

Beth Weissenberger (6m 33s):
I turned her and said, let’s go. And that’s how it started. 16 years ago, August, 2004.

Dr. Anthony Orsini (6m 38s):
And it just gets better and better and better. Let’s get into the Handel method. But one of the things that I
wanted to ask you first is, you know, the premise of this whole podcast is that how we communicate
effectively and with compassion that if we can learn to do that, it will not only help us in medicine and
business, but also in our personal lives. And what I found throughout the years is that it’s the same
communication techniques that I use for telling someone, sadly, that their baby died. It’s the same
communication techniques that can help someone else in business, but also help us in our lives. And so
there’s so much overlap. And one of the great things about doing this podcast is that one week I have
business one week I have health care and you see the overlap is just, people are seeing the same thing,
building trust, building loyalty.

Dr. Anthony Orsini (7m 26s):
I noticed that the Handel group does a lot of different areas. So you do corporate, you do individual, you do
athletes. Is there a common thread that, that works? And is there a special kind of approach that you have to
take with each person?

Beth Weissenberger (7m 40s):
And the Handel Method is the Method no matter what. So Whether, you know, you’re a, Chicken, whether
you’re an NFL player or your a CEO, you’re a brat, whether your, a student or whether your, a mother
staying home with your kids. So our method of Chicken Brat, weather reporter for instance, which I’m sure
we’ll get into or how to have a hard conversation. It’s the same method. Whether I’m teaching a student at,
Stanford or NYU or a Fordham, or you are listening to InnerU student or InnerU love the method is the
method. And as a coach, all of our coaches have to be responsible for. Okay. In fact, we just got off a
recording with Nolan Carol who played for the NFL.

Beth Weissenberger (8m 25s):

His last team was the Dallas Cowboys for eight years. And I coached him and he has built himself. What I
like to call into who he is now and his empire and created himself and took them from hell because they
retired him. But they took on there. But knowing as an NFL player, there’s things you have to know about
that that are different than if I’m speaking with, you know, the CMO of a public company. Right. But I’ll use
the Method, but just frame it for the athlete or the student or the CEO hard conversations are hard
conversations. Whether I’m about to have a hard conversation with my boss or I’m about to have one with
my boyfriend.

Dr. Anthony Orsini (9m 7s):
Yep. And that’s exactly right. And it’s amazing once you learn how to have those hard conversations, it really
doesn’t matter. What do you approach them differently? I find that when I’m coaching physicians and I can
say it because I’m a physician that, you know, sometimes we have egos and a, if you’re coaching CEO’s
they have egos. Now, if you have a different coaching method, you are very no-nonsense, but you still
probably need to approach that differently. I would imagine correct? when you’re doing an athlete or a CEO?

Beth Weissenberger (9m 39s):
There’s the need being accountable for who I’m sitting in front of whether a zoom session or back before the
pandemic with them. Right. So there’s, and there’s industry’s, there are different. So one of our large clients
that we’re on hold with right now, we have a joint venture with live nation. That’s the music industry, the
music industry is different than the insurance industry, right? So there’s industries, there’s humans, there’s,
you know, your age and where you’re at in your, you know, development is a human. So everything has to
be taken into account, but I’m going to still call you a Chicken Brat or weather reporter with you’re in your
way of your own dream. You’re dream at this time. in your life Dr is probably different than if I’m speaking to
obviously a 30 year old and their dreams.

Beth Weissenberger (10m 23s):
But your dream is just as important to you as the 30 year old. And then what’s in your way could be any one
of the 10 things that are in an NFL player’s way.

Dr. Anthony Orsini (10m 34s):
Right. I get it.

Beth Weissenberger (10m 35s):
To teach someone to human better, which is, you know, we call it a burden to human better. Our method is
the same. We just are responsible for who were speaking with.

Dr. Anthony Orsini (10m 45s):
Yeah. And things interlay so well, the audience right now is going, what’s the chicken. And what’s the Brat I
know because I know you, so there we are going to get to that. But before I have one more question, can

you talk about being the author of your life? Because I think that leads into chicken and Brat very nicely.
What do you mean by that? Because I think it’s really impactful.

Beth Weissenberger (11m 2s):
For sure. When you take a look at your life, any area of your life, where you are happy, you are proud and
you’re effective. You can say your being the author, you’re in charge. You have the pen in your hand or the
iPad. Your saying, here’s what I want. Here’s how it’s going to go. And you authored that result. So when
you’re an author, how do you know you’re an author in the area of your body or your health or your marriage
are your children? How, you know, you’re an author, you’re happy, you’re proud. And you’re effective. If you
are not happy with your body, you are not being an author. If you are not happy with where you are in your
career, you are not being an author.

Beth Weissenberger (11m 45s):
So there are areas of your life where you are absolutely being an author. We don’t touch those because
you’re living inside of your dream, what you want, you know, what you want. And you’re out to it. I know
matter what the universe gives you. You are going to figure out a way to stay the author and make it happen.
That we identify. Because then it’s so funny because then I go, all right, Tony, you’re an author here. Why
aren’t you being an author over here? Right. So it’s, it becomes real evident like, OK, you’re in charge here.
And they’re not here. Who is really running the show here. Because author means your running the show.

Dr. Anthony Orsini (12m 21s):
And I think that one of the most difficult conversations we all have is with ourselves. And that’s basically what
you do. You facilitate the conversations that we have with ourselves, correct. That’s really what it’s all about.

Beth Weissenberger (12m 33s):
Who do you have to speak to? You know, Nolan was recording and he was speaking about his NFL coaches
and he’s like, they always say, get out of your, Way get out of your way. He said, for years, I was like, I am
out of my way. What are they talking about? But when he started to get coached by me, he got that what
was in his way was himself in his own head.

Dr. Anthony Orsini (12m 53s):
And that’s where we lean into the chicken and the Brat. So tell us about that. What I really liked about
learning about what you do with the Handel method is that you simplify things so much, that you’re exactly
right. You get out of your own way. I did it myself. I did the Chicken and the Brat myself. And it makes you
think Clearly, it really does. Tell us more about the chicken and the Brat.

Beth Weissenberger (13m 14s):
Let me give a little context and then I’ll back into it. So the question becomes what’s the source of results.
And most people will answer that the source of any result that you have in your life or don’t have is because

you’re either taking the actions or you’re not, you’re taking the right actions, your being effective with your
actions, it’s all action based. So if you say, OK, what’s the source of results. You’re going to go, Oh, I made
an action and people really do think it’s action. But if you’re dealing with an area where let’s just say in
COVID you gain 15 pounds, right. With as many people have, you know, you’re sitting at home today and
you’ve gained the 15, you will then say, so if I go alright stop it stop eating those french fries, stop snacking
all day he’ll be like, yeah, yeah, that’s right.

Beth Weissenberger (14m 0s):
That’s right. That will not stop you for eating just because you know, to stop. So actions are not the source of
results. The source of all your results is your inner dialog, your thoughts are, and you might have just said to
yourself what inner dialog. Yeah. That voice that just said that, that your inner dialog and Dr. David Hawkins
years ago, did a study of human beings inner dialog. And what he discovered is that 80% of a human being’s
inner dialogue is negative, not surprising at all. So 80% of your thoughts are negative, which gives you your
actions and gives you your results. And then wait, one more statistic.

Beth Weissenberger (14m 43s):
95% of the 80%. That’s negative is the same crap you thought the day before. That, when I was looking in
the mirror, I’m like, Oh my God, I’m falling down. Do you think that I have a different thought tomorrow, look
in the mirror tomorrow, it’s falling. Right? So it’s the same, Crap 80% negative. So what we do at Handel is
you having that information will do nothing. So now we break it down to, all right, let me introduce you to the
80% negative that talks to you constantly. And we broke it down to three Inner Dialogues, three Voices. One
is the Chicken voice and the Chicken voice. And we’ll hear yours in a moment. Your chicken voice is the

Beth Weissenberger (15m 25s):
Like you avoid anything hard, confrontational. You don’t want to hurt their feelings. You were a nice guy. Oh
my God, do you want to put it off? That’s the harder phone call. I didn’t want to deal with them for 20
minutes. I don’t have the time to listen to their products. So you would avoid. And so a Chicken might say to
you, Ooh, I should talk to Tony. Today about that thing that happened, you know, it’s his podcast today. He’s
really busy. He doesn’t have time for me. You know, Fridays are usually good because it’s the weekend and
he’ll be happy. So I’ll wait till Friday to tell him. And you’ll think that’s the greatest business strategy. And then
I’ll laugh at you and go no no , you’re a Chicken. So Tony, why don’t you tell them your chicken that you had
done that?

Dr. Anthony Orsini (16m 3s):
Yeah, I was afraid of you were going to ask me, this is so I know I wasn’t going to get out of this. I think you
can even heard you ask Gary Vaynerchuk, what his cavity was. I think that my chicken is an inability to step
back, to move forward to where I want to be. I think that’s probably the best way that I could answer it. That I
have so many projects going on, that what I really need to do is stop doing them all at, or some of them. I

don’t want to see I’m being in a physician at 90%. But other things that I wanted to do with my life. I’m doing
it at 80% because I don’t want to step back. And I think that’s my Chicken.

Beth Weissenberger (16m 39s):
So your Chicken is avoiding taking certain actions on things that your higher self that keeps telling you to do.

Dr. Anthony Orsini (16m 45s):
Yeah, my Chicken is to, to not step back,

Beth Weissenberger (16m 47s):
Step back from what what’s the Chicken say.

Dr. Anthony Orsini (16m 49s):
So I have so many different projects, right? I’m a full-time Physician, but eventually I want to teach more. I
love teaching and in doing my workshops and doing my communication and doing these learning modules, I
would need to step back from being a physician a little bit, but that would hurt me because I like doing that.
But also financially, that would hurt me temporarily too. So I think that’s my chicken it’s, you know, time to, as
they say, poop or get off the pot sometimes, you know, in Brooklyn words.

Beth Weissenberger (17m 15s):
So yeah, you are being Chicken about, Oh, no, the money. Oh, this rather than create something that could
actually make you money doing something else you loved to do. Yes. Be a chicken. All right. So that’s one
voice, everyone. The other voice that makes up the 80% is the brat, the brat and the defiant voice. It’s like
my 19 year old daughter. And I know that those of you who have teens, for sure, you know, the Brat voice,
but the funny part is Is Oh, you’re a Brat too. So the brat, the defiant voice goes like that, but I don’t want to.
You can’t make me. You’re not the boss of me. Leave me alone, drop dead and get away from me go away.
So the brat is like the one in the morning where you’re supposed to get up. You have the alarm set. You had
said to your wife the night before honey, I’m going to get up and meditate.

Beth Weissenberger (17m 57s):
So when my eyes are closed, no I’m meditating for 20 minutes. You wake up the next morning to go meditate
in your voice goes, Nah go back to sleep. And you like to go, thank you, God, like God just talked too. And
you go back to sleep. That would be the Brat just ran in your life. So do you have a Brat one Tony to tell

Dr. Anthony Orsini (18m 17s):
I think my Brat one is that I am so busy at work and doing so many different projects that I keep saying to
myself, you know, you’re having trouble sleeping, you know, you’re not exercising and you quit golf. Totally
because you took on too much. And then I go, well, but I really can’t help that because I got all this to do and

some day. So I think that would be my Brat.

Beth Weissenberger (18m 39s):
Yeah. You’ve got your Brat and a bit of weather reporter in there, which I am going to explain. So it’s so far
everyone, you got your Chicken, so you want to identify your chicken. So and then if you identify your
chicken, it’s really your higher self that just identified your lower self. That’s a good thing because the
moment your higher self met, your lower self, we can now do something about it rather than you walk around
in life thinking that your chicken is real. So the last one, so we got the chicken, we’ve got the Brat and the
third one is the subtlest of the three, but just as deadly, it’s called the weather reporter. So what’s a weather
reporter. So I’m sitting in New York city. Let me look up the weather. It is sunny and 70 degrees.

Beth Weissenberger (19m 20s):
There’s nothing I can do about that. Those are the facts, sunny. Yup. 70 degrees. So now when you are
being a weather reporter in your life, you swear, the excuse, the reason and justification as to how come you
can’t do something is as real as it, 70 degrees and sunny. So you might say to me, Beth I don’t have time to
do what I want. I don’t have time to work out. I don’t have time to meditate. And you think I don’t have time is
as real, as 70 degrees and sunny, like it’s not malleable. It’s a fact. So the reporting is all of the excuses,
justifications, and reasons you use to not be accountable for something.

Dr. Anthony Orsini (20m 3s):
I love that.

Beth Weissenberger (20m 3s):
you blame it on the reasons like you’re a victim. And you could hear the difference between the author
whose in charge. And then the weather reporter, who is like, Oh, I know I don’t have time COVID. You know,
I can’t have any fun in my life until COVID is over it. That’s a weather reporter. So then the question
becomes, all right, so you’ve now identified them. So we then don’t leave people in their Chicken Brat or
weather reporter. So with your Chicken Tony about like all, I have so many things in so many projects at all
of that, right? You need three things, everyone, before I give you the three things, let me say this, your
chicken, brat, and weather reporter are not on your team, their entire life is about getting in your way.

Beth Weissenberger (20m 44s):
Their entire life is about you not having, what you want their job is to mess you up. And they are not going
away. They are your board members. They are yours. You should meet them and have fun with them
because they talk constantly. You know, one of mine is when I have to do something scary. It reminds me
that I had ADHD and I had to take fifth grade again. So it says something like Beth Don’t forget, you were an
idiot. Beth, don’t forget you’re stupid Beth don’t forget, right? It will say that. Got it. Like in the middle of
wherever, I’m like really thank you. Yeah. So you have to be able to hear it so you can tell it to shush up,
right and back off.

Beth Weissenberger (21m 25s):
It’s not you, it’s not God. It is not you, not you. That has nothing to do with your higher self, but your higher
self must hear it. So we are now clear the Chicken, Brat weather reporter are not on your team. So then the
question becomes, how do you move from being the Chicken ,Brat, weather reporter to being an author,
because remember wherever you are an author, your happy, proud, and affective, wherever you’re a chicken
brat, weather reporter, you’re not living true to your dreams and what you want in life. So there’s three things
you need. And its like, Tony says, this is simple. This is not hard. There’s three things. You do these three
things and you will alter every chicken, brat and weather reporter.

Beth Weissenberger (22m 7s):
So the three things you need is I’ll say it and then explain them. You need a specific, measurable promise.
You need a consequence and you need someone to hold you to account. So let’s start backwards to the
person to hold you to account has to be someone who doesn’t take your crap. So like if you don’t keep the
promise and you go, honey, come on. Like with my love of my life, Steve, right? If I break a promise and I’m
like, honey, and he was like, eh it’s okay. That is not who I ever have hold me to account for my promise. All I
do is just text me my sister, my new promise or consequence and that’s the end because I’m not messing
with her. So you need someone who doesn’t do the double or nothing.

Beth Weissenberger (22m 50s):
Crap. Okay. All right. So then specific measurable promise. Why is it must be measurable is because you’re
Brat we’ll find loopholes. I’ll share one with you. So I had another NFL player whose came up with his
promise and his consequence was, he says Beth I love my wine. If you take my wine away from me, that will
kill me. And I’m like, perfect. So we made the promise and if you broke it there’d be no wine. All right. Well, if
he gets in his next session with me and he’s giggling and he, you know, I know him and I’m like, what are
you giggling about? He goes, you didn’t tell me I couldn’t have vodka. Well, you didn’t tell me you liked the

Beth Weissenberger (23m 32s):
So you will find a loophole. So it’s got to, your promises has gotta be specific and measurable. Can not just
be, I will work out because you’ll sit at your desk and lift your arms 10 times ago. I worked out right. So
specific measurable. Okay. So like with Toni, you would need a specific measurable promise with regards to,
you know, when are you starting a project, right? You would need that. All right. So then now the most
important part. So you got the promise, you got someone holding you to count is the consequence. The
consequence is the way in which you manipulate the chicken, brat and weather reporter from not running the
show because they need a manipulation because there are good.

Beth Weissenberger (24m 14s):
And they’ve been running in your life for some of you for 40 years. Right? So it needs something. So as a

consequence is going to feel like a punishment, but it’s, you’re the one that’s inventing, right? So you’re the
judge. You are the criminal, you are inventing your own. So it’s got to be something that if you don’t keep the
promise, you have to pay, that would so annoy the crap out of you, that it forces you to keep the promise.
Cause over your dead body are you paying for that? So I’ll give you an example and I’ll give you some of
mine. So one example, I have a client who at the time was 61 years old, billionaire owned a company, very
successful, except the one area.

Beth Weissenberger (24m 54s):
There were a few, but one of the areas that sucked in his life is he never worked out and his doctors were
furious with him. Like you’re going to die. Like he was overweight, his heart wasn’t good. Now watch, he had
three homes. He had gyms in each home and he had a trainer in each home. He would just pay them to do
nothing. All right, well you got the brat you hear are the brat right? and so his promise, which worked was for
every workout he did not do. And all he had to do is three a week. With the specific measurable three a week
for any one he missed he had to pay Trump $10,000. and this for a year to go when and Trump was first
running, right?

Beth Weissenberger (25m 37s):
Ask me how that man’s health is fabulous. Great, lost the weight he works out. He never had to pay Trump
the $10,000. Now that’s obviously being a billionaire. So then what do you do inside if not right. So money.
$10 bills out your car window, throwing them to the street, not to the homeless, not to make you feel better
drop it. That would be annoying. You know, anyone of your vices like my sister or one of my sisters loves her
TV shows. And so if she breaks a promise, whatever current TV show she’s in, she loses the next episode
and never gets to watch it. Right? Take your liquor away, take your weed away.

Beth Weissenberger (26m 17s):
You’re coming up with something, your golf or anything that would annoy you. That’s what you got to do. And
then you have to have someone to hold you to count. And I promise you, if you do that today, you will alter
your life in that area done.

Dr. Anthony Orsini (26m 28s):
love that. Now you got to find somebody in your life is willing to be tough. I got a beautiful, very sweet wife.
She’s not going to be my,

Beth Weissenberger (26m 36s):
You pick out one of your nurses who would like to talk with you. You pick another doctor who would enjoy the
giddiness of taking your money, right? Like try to find someone who will do it.

Dr. Anthony Orsini (26m 46s):
It sounds like a college roommate. Who’s very quick to tell me I’m flawed in every way. So that’s, that’s what

guys do to each other. So that sounds great. Yes. So that’s fantastic. But you know, for that person who’s
listening right now, there is going, Oh my God, this speaks to me. Beth then I need to do this right away. This
is where the inner U comes to. Like, how do they say I need help? Beth

Beth Weissenberger (27m 11s):
Yeah. So one of the things that we have, so about two years ago, when we were in, remember I’m the
president of the corporate division. So we go into corporations and we’re expensive. So, you know, you get
the top, let’s call it like the 50 people, right? Who are going to get the one-on-one coaching, get the
workshop’s, you know, at the top C-suite. So then the question became, what are you doing for my other 300
people in my other 500 people? How come, you know, I don’t want to spend that kind of money on them.
And so that’s when we went, we should have an online coaching program. We could do that. We could
charge, we could give it out in bulk. And so that’s where we invented. We have innerU student where
students do that.

Beth Weissenberger (27m 52s):
We have innerU Love to handle your love life. We have IinnerU Life for your whole life. And we have innerU
Career that’s for inside of us. We sell them in bulk, inside a corporation’s or individual. My sister does the
principal. Chicken, Brat weather reporter has someone giving an example. Whether one of our clients. And
one of our coaches gives you the homework gives you answers to questions, the most common questions.
And you’ve got 12 modules. That’ll take you about six months, which is a coaching program to do it on your
own in your home. You get one free coaching session that you get one private coaching call that comes with
it. And then you have access to any one of our masterclasses.

Beth Weissenberger (28m 35s):
And you have that. It’s a lifetime subscription.

Dr. Anthony Orsini (28m 38s):
Yeah. So it’s really bringing in that corporate service that you give to the individual who said, I need help.
And I don’t have that much money. And it can’t be that bad because you are, you’re offering it to the

Beth Weissenberger (28m 49s):
Fordham just dropped it to I think a hundred students. Yes. So colleges are now going to start doing that. It
just makes the difference right for you too. What I mean? Hi, we’re in the middle of COVID and you’re
working from home. When this is to take care of you. And if you do, there’s two ways to do it because it’s a
beast. You can just listen to it. Don’t do any of the homework, just listen to it. And it will change your life. If
you do the homework, which is a beast, because it’s about 30 minutes of listening and then it could be, you
know, an hour and a half of homework plus, right? If you do the homework, you’re life will be radically
different in six months, like altered, life altered those of you listening.

Beth Weissenberger (29m 29s):
We have a coupon so you can get innerU career? That’s usually $650. You can get it for half off use Difficult
Conversations. If you go on to our website, you’ll see innerU Career put in Difficult Conversations get it for
half off.

Dr. Anthony Orsini (29m 44s):
Fantastic. See if it does pay to listen to this podcast. So that’s amazing that you were able to do this Your I
can tell you. I know, I see your face in the audience. Doesn’t see your face. You loved this stuff. You breathe
it. This is, this is fun for you. And people say that about me. I just know I heard you interview. I think you ask
Gary Vaynerchuk what his cavity was. And he said I wanted it to avoid conflict. I think that was what his was.
And then I thought to myself boy, and how different people are ’cause I would say that was one of my strong
points because that’s what I teach. I teach her to go through conflict resolution. And so everybody’s different,
but everybody, there was no one in the world. It, it doesn’t have a chicken and a brat.

Beth Weissenberger (30m 24s):
Well, I’m more bratty than I am chicken. Some people are more chicken than they are Brat so you’ll find out
where you land in it. But we all have what sucks about us, right? We all have our dark side. We all have our
bad traits. We all have what doesn’t work about us. And one of my favorite things that I have people do is to
ask two questions to your spouses and partners too, your children. And I did this with my daughter when
max was six and a half years old, the two questions are what sucks about me. And when I do that, how does
it make you feel? So I’ll never forget. You know, I know what sucks about me when Arman and I got divorced
and we have a lovely divorce.

Beth Weissenberger (31m 7s):
We’re dear friends. This is my daughter’s daddy. I knew when he left, he was the fun one. I was, I am not fun
back then. So this is now a year. I know this is why we got divorced. So this is like 8 plus years ago, almost
10 years ago. And Max was nine years old and I sit with her and I’m like, Maxi, is mommy any fun? I knew
the answer. He was like, mommy, you are not fun. And she laughed. And I laughed. Now, if that’s all the
conversation was that would have done nothing about it was, I then said, Maxi, how does that make you feel
when mommy is not any fun?

Beth Weissenberger (31m 49s):
And she burst out hysterical, crying. So, and when she could breathe again, she said that you never want to
play with me. That struck my heart, like a sword through my heart. And that was the end. I made a promise
and a consequence. I kept the promise. I didn’t ever have to pay the consequences. And I altered my
fun-ness for my daughter because I was not going down, having her think that I didn’t want to play with her.

Dr. Anthony Orsini (32m 15s):

And that’s a great example, right?

Beth Weissenberger (32m 17s):
So it, it, it behooves all of us are the people that work for you or your loved ones, your children, your spouse.
I know you’re not gonna want to, but go ask them, listen, we have three more months left in the year. I want
to be a better leader, a better mother, a better wife, a better girlfriend, whatever it is. And I want to know from
you, what sucks about me and you’re not in trouble. I won’t defend. I won’t answer you. Write it down. What
sucked. And when you tell me what sucks, tell me how it makes you feel that I do that. That’s the most
important thing is how it makes them feel. Because they make stuff up. You have no idea. And then after
they tell you to make a promise and a consequences, cut it out, right?

Beth Weissenberger (32m 58s):
’cause you’re not proud of that behavior. You don’t want to be that human. You think I really want to be mean
to the love of my life. I know, Oh my God. But from time to time, I had that bad trait. I got hurt. I’ll go like that.
And then in a matter of five minutes or less, it’s like, Oh my God, I was just all, let’s not, you know, like fix it
because that’s not who I want to be. That’s not who any of us want to be, but we all have our bad traits. And
so we teach you how to human better.

Dr. Anthony Orsini (33m 28s):
Fantastic. And you know, this podcast is about learning how to navigate through those difficult conversations
in your life. And you certainly inspired us to be better people. That’s my first promise to the audience. And
boy, we learned how to navigate those difficult conversations with ourselves and with each other. And I think
one of the most important thing is ourselves. We need to have more of those conversations and stop
avoiding them. So I must say I was worried that you would be asking me, I didn’t expect to be revealing stuff
about myself. So now my audience knows about my chicken and a hopefully a we’ll see what happens is
about that. I think that was really very informative. I’ve loved this episode. And I think that Handel Group is
doing amazing things that are just getting bigger and bigger and bigger.

Dr. Anthony Orsini (34m 9s):
And I’m just so happy to get to know you. And so honored that you were on this podcast. Thank you so

Beth Weissenberger (34m 16s):
Absolutely. And everyone just go on to our website. If you don’t want to buy anything, just get the newsletter.
We ou, blogs are hysterical because we just keep telling on ourselves, write to make it easier for you to own
your dark side.

Dr. Anthony Orsini (34m 28s):
Yeah. So that’s the Handel group.com, right?

Beth Weissenberger (34m 29s):
Well, Group H a N D E L. It’s our maiden name. Handel group.com. Go enjoy it. There’s some fun stuff on
there. I’m and we would love to have you join our newsletter.

Dr. Anthony Orsini (34m 41s):
That’s fantastic. And so contact Beth. We’ll put this all in the show notes. If you enjoyed this podcast, please
go ahead and hit subscribe. It’s available on every platform. And if you want to reach me it’s
drorsini@theorsiniway.com that’s Dr Orsini at the Orsini Way.com. Then we’ll put that all in the show notes.
So thanks again so much. I really appreciate it.

Beth Weissenberger (35m 4s):
Thank you everybody for listening.

Announcer (35m 5s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr.
Orsini and his team, or to suggest guests for a future podcast, visit us@theorsiniway.com.

Discovering the best in others with Diane Rogers

Diane Rogers (2s):
When we see that we are doing and being what we wanted to in the first place. And that is to make a
difference in other peoples lives than that will help to fuel and nourish our heart’s in what it is that we do each
and everyday. So if you want to work 24 plus hours a day making a difference and you can be well in doing
so then let’s create the environment that supports that for you

Announcer (32s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician With Dr. Anthony Orsini. Dr
Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker
and author Dr Orsini has been training healthcare professionals and business leaders, how to navigate
through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field
who tell their stories and provide practical advice on how to effectively communicate. Whether you are a
doctor faced with giving a patient bad news or a business leader who wants to get the most out of his or her
team members, or someone who just wants to learn to communicate better,This is the podcast for you.

0 (1m 18s):

Dr. Anthony Orsini (1m 18s):
Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr.
Anthony Orsini and I will be your host today. Before we started the episodes today, I wanted to go ahead and
thank my audience because, you know, I started this podcast a few months ago and I was hoping that one
person would at least listen, but the audience has been amazing. My subscribers are going up every week
and it’s getting more and more popular. And I want to say, thank you now, I’d like to take credit for that, but
actually the credit goes to all my amazing guests and I’ve had some great guests and we have some more
guests that are lined up and today is no exception. So today we are lucky enough to have Diane Rogers.

Dr. Anthony Orsini (1m 59s):
Diane Rogers has a diverse background that a big heart, both of which power, a simple and focused
mission. And that is to inspire individuals and organization to harness the strengths and magnificence of
people. She is the Founder and President of Contagious Change LLC Diane is best known for her Breakthru
programs for health care organizations, where she has long been a trusted coach. Sought after for her ability
to inspire strength based leadership behaviors among medical professionals who want to optimize
performance, experience and engagement, I guess the best word to describe Diane’s approach to leading
and inspiring others is the word collaborative in everything she does.

Dr. Anthony Orsini (2m 39s):
She endeavors to leave her stakeholders feeling like their best selves. Diane is frequently called upon by
leadership teams across the various industries, including health care technology, finance, and professional
services to do the important work of developing and coaching leaders, improving quality and performance,

implementing organizational change and transforming workplace cultures. DIane holds a PCC level
certification from the international coaching Federation, as well as several certificates in positive psychology.
She is a dynamic energetic speaker, as you will see, who offers keynotes in presentations of all kinds, and
she is an author and her first book, Leading, hArtfully the art of leading through your heart to discover the
best in Others is scheduled to be out in publication on October 21st.

Dr. Anthony Orsini (3m 28s):
And depending on when this airs may already be out. And I’m sure Diane will tell you how to get that at the
end, but we are very, very happy to have Diane. Then I think that if this is gonna be an incredible episode,
I’m really looking forward to it. And thank you. Diane for agreeing to come on. I know you’re so busy.

Diane Rogers (3m 43s):
Well, Tony, I am absolutely thrilled to be here. I can’t even tell you. I remember when we first met at the Beryl
conference and it was like, you and I were magnets together. There was an energy and a passion that we
both shared around how to best create the most exceptional human experience. And also I hear your
passion come out in the Podcast. I’ve listened to, I think all of ’em at this point, right? And hearing Larry and
Nicole and Claude. And what I loved so much about the podcast is Tony you have such a way of just making
them real and inviting for people.

Diane Rogers (4m 27s):
I think that your mission is to inspire and have somebody take something away each time, an honest to God,
every time I listened to one of your podcast, I am inspired and taking away something new. So I’ve really
enjoyed them.

Dr. Anthony Orsini (4m 43s):
Fantastic. I make that promise every week, and I know I’m going to keep it this week, cause I know all about
you. And I know my audience is gonna get both promises fulfilled. So thank you so much.

Diane Rogers (4m 52s):
Your welcome. Thanks for letting me be here today.

Dr. Anthony Orsini (4m 55s):
And so, yeah, so we met at The Beryl Institute I think it was three or four years ago. We are going to talk
about The Beryl Institute later on and you and I had just met and the audience will find out by the end of this
podcast about your dynamic personality. You’re a very Contagious. I think that’s a great title for your
company. Contagious change because you have a Contagious personality. And I showed up at The Beryl
Institute first time ever, didn’t know what to expect. I loved it. I’ve been teaching patient experience for four or
five years. You and I met it. I think a physician break out. And as you say, it was just instant rapport.
Although I have a feeling you don’t really have much of a problem getting rapport with everybody. So, but it

was great. And we’ve kept in touch.

Dr. Anthony Orsini (5m 36s):
You become friends with Liz, our director of operations. So it’s really just great to have you here, I know
about you and I know your background and I know you you’ve had some great thoughts, but I think I would
like the audience that first get to know who Diane Rodgers is. And a little bit of your background. I have a
whole bunch of questions ready to go, but I really want you to tell your story that I can tell everybody about
yourself and how you got to this moment at this time.

Diane Rogers (6m 1s):
It is a really great question because it requires it oddly enough, each time I’m asked that to actually reflect on
that journey because it kind of shifts and changes, but I have a very diverse background. I started out years
ago in nuclear power as an engineer, and then moved into aerospace. And I worked for what is now Boeing
on the Apache helicopter. That’s cool. While it is called, let me tell ya. It is the coolest they’re playing in the
whole wide world. Right? And I was good at what I did and I had various leadership positions, but for a very
long time, I was searching for purpose.

Diane Rogers (6m 44s):
I wanted a gazillion kids and that just didn’t work out. And so there was like this hole in what I was doing and
how I could find meaningfulness in it in one day, John Rogers and I John Rogers and my husband were
playing golf. Then we came upon this house were a friend of ours, had just up and left his house to go
beyond the senior tour. And I turned to John Rogers that I asked them, I said, how does somebody just
leave their house and go play golf? And John Rogers looked at me, he’s a very smart man. And he looked at
me and he said, you know, I suppose that if that’s what your dream is, that’s what you would do.

Diane Rogers (7m 27s):
And that struck me. And I turned to Jon and I said, what would my dream be? And he said, your dream
would be to help people. And that quick moment was very inspiring for me because I had really never
thought about it. And honest to God, the next day I went back to work. I was working in semiconductors at
the time I went to work and I called a colleague who worked for our local hospital system here, which is now
called banner health. And I called up our colleague and he said, you need to talk to this woman. And I talked
to her, she worked in performance improvement at banner health and a long story short.

Diane Rogers (8m 12s):
I ended up working for banner health for many years, working with them to help improve and reduce their
liability claims. And Tony, it was there that I found purpose. It was that I could connect back to what was real
and healthcare professionals were real and they were doing amazing, magnificent things. And they did these
very scientific and incredible clinically profound things. But at the same time, they were just showing up and
taking care of people.

Diane Rogers (8m 52s):
And what I realized all across the many years is that if I could help others to see the magnificence they had,
simply in being who they are, what an amazing purpose I might have. And so that’s really kind of where it all
started is really around how is it that I can be my best self in an endeavor to help others discovered the best
in themselves.

Dr. Anthony Orsini (9m 19s):
That’s a great story. And so you’re made this change and now you spend most of your time coaching
physicians, correct?

Diane Rogers (9m 27s):
Yes. I work with physicians holding up the mirror if you will, to their magnificence, but in a way that brings
clarity and specificity to what it is that they’re doing and who it is that they’re being. And most importantly, the
impact that they make in doing that. And I also work with organizations to kind of create a culture where
we’re actually leveraging the best in others.

Dr. Anthony Orsini (9m 53s):
And that is going to dovetail into a question later. I’m gonna ask you about something in your book, on a
character, in your book, as a person called Bob, and then we’ll talk about Bob. But in the meantime, we’ll get
to the book. One of the things you and I had talked about, I wanted to ask you, so my audience, a lot of them
are physicians. A lot of them are in Healthcare. I also have a lot of business. People physician’s are tough
people, and I can get away with saying that because I’m one and Dike Drummond was on our Podcast
previously, he does physician burnout and he talks about how physicians are a perfectionists and physician’s
are told from a very early on, you need to work harder. And if you’re working 24 hours a day, then you should
be able to work 24 hours a day in one minute, and you should never complain.

Dr. Anthony Orsini (10m 40s):
And it makes them a little bit hard around the edges. But when I give lectures and I do a lot of lecturing, as
you know, to physicians and to health care professionals about how does it remind themselves of how they
are, why they went into medicine for the first place, and that leads into a good patient experience. And I’m in
a room and I read body language. You, as you know, I loved that kind of stuck when you see the physician
sitting in the room, not all of them, but some of them, and you see them in their arms are folded. And they
are like, I can’t believe I have to be here. Many of the classes that I’m forced to take from a hospital and from
the administration are given by nonmedical people that are not physicians. And I’ll be honest with you. Many
times, a lot of physicians come out of they’re going, Oh my God, what does she know.

Dr. Anthony Orsini (11m 25s):
She doesn’t know what it’s like that to see 30 patients in a day. She doesn’t know what it’s like, got

administration on my back. She doesn’t know what it’s like to be forced to work more and more for less and
less money. And to spend all of my off time doing paperwork. And on the electronic medical record. I have an
advantage because I can say, Hey, I’m one of you and I have a little bit of an in. And so I get some credibility
with them. You’ve been very successful as a lay person, being able to coach physicians and get through that.
And I think part of its your personality is so I kind of know the answer to this, but you have a certain
technique that allows the physicians to put the, the wall down and say, Hey, I know she’s not a physician, but
I’m gonna learn something from her.

Dr. Anthony Orsini (12m 11s):
So how do you approach that?

Diane Rogers (12m 13s):
So, I love how you captured kinda of the environment that we do step into right? The one thing that you keep
on saying Tony was, she doesn’t know what it’s like. Right. And that’s exactly true. And I don’t pretend to. So
how do I connect with a physician or really anyone else in the coaching relationship is first is to appreciate
that I am not the expert in their lives. The second thing is to believe, and as coaches, we are trained to do
this as well, but to believe that each individual holds within themselves their own ability to do and be their

Diane Rogers (13m 2s):
And so, you know, I thought about this a lot actually. And the word that kept coming up in my head was this
notion of collegiality, right? That part of how you can stand up in front of a bunch of physicians as a physician
is the relationship that you’ve established and collegiality is grounded in trust, right? So they know that you’re
not going to stand up there and really throw them under the bus if you will. But, and I know you, but to come
forward in an empathic way, understanding them, right in an endeavor to partner with them together, right?
And so foundational to how you relate to them is trust. And if I can appreciate it.

Diane Rogers (13m 42s):
So when I enter into a relationship with some physicians, with some people they do have their arms crossed,
there are like, why am I here? Right? So the most important thing for me is a couple of things. One is to
know I’m not the expert, two, I always create an intention. I created an intention before our conversation
today, what experience do I want to create? And I think that’s really important. What intention do I want to
make in an, an endeavor to have an experience that is meaningful, productive, and positive.

Diane Rogers (14m 23s):
So I try and to actually think about this. So if I go into a physician relationship and I want them to change
their behavior so that they have a better patient experience and that I’m going to be auditing them to ensure
that they do what I think is best for them to create the patient experience, that will never work. But if I enter
into the relationship and I ask you Tony, I know that you went into medicine for a reason. Tell me about that

and tell me what it is that you want to create with your patient interactions. And I value that. And I trust that
that is a way in your interview with Claude Claude talks about what she does as hold the space and see you
as a coach.

Diane Rogers (15m 9s):
What we are doing is we’re creating the space for you to discover again and again and again, what is grand
about you and where your strengths lie? And then I also have the trust that I’m this’ll sound really weird, but
that I’m also really good at what I do, because if I come in, not confident, just like when you see a patient
and you have to tell them something, you talked about this, I forget with Nicole bout how you have to go in
with confidence, right? Even if you’re going to share bad news, you have to bring confidence, right? So I
have to be confident and trust that I know how to bring out the best in each individual.

Diane Rogers (15m 55s):
Because if, if I go in going, Oh my God, they’re going to hate me. I don’t know what to do. I’ll just crumble. So
the whole idea of how I show up as my best self to leverage the best in others becomes really important in
our ability to create trust and build a relationship where that is therapeutic and pathic and where you see the
magnificence in who you are each and every moment.

Dr. Anthony Orsini (16m 24s):
And I think that’s beautifully said, Diane thank you. And I think as, whether you’re a physician are a business
leader and you’re being coached. I think that’s the key. You are able to get trust because you’re saying I’m
not coming from you at a different angle, and I’m not going to tell you what to do. And I think you talk about
that in your book, when you were a leader that you realize that telling people what to do is not the best way
to get the best out of them. As Claude Silver said, you want to bring the best out of each person. And I think
those are the words that you use. Also, what it’s really important that we put people in positions, but I do
some lecturers for business leaders, the different between a basic manager and a real leader is bringing out
the best in everybody.

Dr. Anthony Orsini (17m 7s):
Right? And so your bringing the best out of the physician and the example I’ll use at my workshop is I will
say, listen, if I take Peyton Manning or Tom Brady two phenomenal hall of fame quarterbacks, then I put
them at linebacker are going to be lousy football players. You’re not putting them in a position to succeed.
And so what you just said, there was beautiful because that was the answer. It that’s how you break down
the arms folding and Oh, she’s not telling me what to do. She is bringing out the best of me. And I think that’s
beautifully said, so thank you for that. Let’s get to your book. I’ve read it. It’s not out yet. Or you were nice
enough to give me an advanced copy. So I looked through it. I really enjoyed it.

Dr. Anthony Orsini (17m 47s):
I love it. One of the great things about doing podcasts is that I get the read so many books and years was

really incredible in your book. You give us story of yourself, how you were a leader. You are a perfectionist.
You are really, if you thought you were a great and you thought you knew everything. And then you had this
aha moment of which your boss, you are giving a presentation that said he’s going to give you some
constructive criticism. You saw all the bad things you saw in your boss, you saw it in yourself. And that was
really your AHA moment that changed your life. Right? Tell us about that.

Diane Rogers (18m 24s):
Well, first off, Tony, thank you for reading my book. Great, great. I mean that, so sincerely when I set it to you
and you wrote me back and you said, you know, I’ll make sure to read it. I was like running downstairs, going
to John Rogers, Dr. Orsini is goiead my book. I was so excited. Right. So I really do appreciate that. You
took the time to read it. My defining moment. Yeah. That mirror that was held up in front of me. Do you
describe it quite well? I had prepared and prepared for a presentation thinking that I had mastered it. And,
you know, I had spent my whole life growing up in the leadership world, really trying to be perfect and trying
to be the best.

Diane Rogers (19m 10s):
So then boy, when do you do that? At least for me, lots of things. Just get in the way of being able to create
meaningful relationships. Right. And I had a boss who was very much, although it took me years to realize
very much about driving perfection and everything I did. There was always something wrong. And I
remember the presentation that you’re talking about specifically, because at the end of that, not only did he
tell me, well, here’s the things that you missed. I got very defensive and he then went on to tell me how now,
it was time for us to have a teachable moment.

Diane Rogers (19m 57s):
And I felt so demoralized and so invisible and that I didn’t matter at all. And I realized that that moment, Tony,
that my way of being in my leadership approach, I was doing all of that to all of the people that work for me,
even though what I thought we were doing was hitting the mark on our organizational objectives, write that I
was driving this team of people to be there best. The reality is, is that I was driving them to be my best and
the organizational best. And I think that we grow up in leadership.

Diane Rogers (20m 39s):
You asked this question, I forget who I think it might’ve been to Claude as well, but you know, how is it that
we undo? Or how is it that we got, where are right now in terms of how we lead? And I think that, you know,
we continue to do what has been successful. So if we’re climbing the ladder because of our
micromanagement techniques, because of our command and control philosophies, right? And we continue to
get promoted in that way and acknowledge in the way we are going to continue those behaviors. So you
really have to, you know, I mean, my defining moment was a horrible for me to look at in the mirror, but I will
tell you that in seeing that and really coming and choosing to shift everything about the way I did it, Today,
I’m a better leader today.

Diane Rogers (21m 38s):
I can help others be a better leader. What we achieve in terms of potential is far beyond that when I ever
imagined is possible, because when I’m in charge of, we can only be as good as what I think. Right? And so
when, when we can leverage the best in others and we’ve heard this, this is not new science. This has been
the mantra forever. But until we want to step into a space where we are choosing to discover reflect act
differently, be differently. All of this takes work. I tell my clients all the time, the burden of change lies in
leader’s burden of change doesn’t lie in our employees’ at all.

Diane Rogers (22m 22s):
It lies in how we choose to show up in order for them to show up, to be their best.

Dr. Anthony Orsini (22m 29s):
You wrote in your book, you shifted from it’s all about me, too. It’s all about them. And that’s a concept that
Claude Silver so eloquently spoke about. And that’s what leadership is all about. Now this all ties in to the
patient experience because, and you’re work with being a physician because in many ways we have the
audience might be going, OK, we’re going off topic here. But in many ways, the physician is the leader. And
there is no way around that can be walks into a room. The pressure’s on my shoulders, I’m in a code
situation. Everybody is looking towards me. It’s part of a team. And when you look at the best physicians and
they get the best patient experience scores, I learned a long time ago, stop looking at the people who were
failing, and start looking at the people who are succeeding.

Dr. Anthony Orsini (23m 18s):
You learn so much more than say, why does that? Dr get 95% from all of this patient. And if you sit back and
watch, you will see that the true leader, the very effective physician is one that has relationships. That’s the
word that I use all the time. That can form a relationship. He or she walks into the room. Every nurse lights
up, every therapist, lights up, he walks into a patient’s room he introduces themselves. She introduces
themselves. I use an acronym called program in my book. The G is for genuine, they’re are a genuine
person. They spend a few minutes and they’re being leaders, but what they’re doing is when they enter the
room, everyone is better.

Dr. Anthony Orsini (23m 59s):
Yeah everyone is a better version of themselves, as opposed to just kind of being grumpy or just going
through the motions. So this all ties into a patient’s experience. And that’s what you and I really care about,
right? Because we are trying to make a horrible situation. And I don’t care if you’re in the hospital for an
appendectomy or you’re in a hospital for cancer. Of course I’m not equating them, but it’s a horrible situation.
As I say, my book, nobody says, you know, I would like to go to the hospital today. Wouldn’t that be fun?
Nobody wants to be there, so you talk about how you can bring the doctors or the leaders to be the best of
themselves. And one of the things you talk about in your book is being in an understanding that you are

good at what you do, because whether you’re in business or your nurse or your doctor, you are kind of
always just told what to do.

Dr. Anthony Orsini (24m 51s):
One of the people that you speak about that you’ve coached was a guy named Bob. You speak so highly
about him. Not going to take it away from you. I want you to tell the story about Bob was great, except for
one problem. What was Bob is a problem?

Diane Rogers (25m 4s):
Bob is great. Bob is a fine fine human being. And I have known Bob for her 25 years and Bob approached
the Patient Experience when I first met him very intellectually. He had read every book. He knew every
communication technique. He was very good at telling his team of docs, you know, use this technique.
Although we sit down and he, by the book, man, he could do it. But what Bob didn’t connect to initially was
the impact of how he showed up. I remember he and I had this huge argument. One night I was standing
outside of a restaurant.

Diane Rogers (25m 46s):
I literally had to get up from the table. We were talking on the phone. I said, Bob in fact, he is how I kind of
started coaching positions. I said, fine, I’m gonna come. We’re going to do this together. And I’m going to
help you to see how incredible you are. Don’t get me wrong. Bob knew. He was a good doc and Bob new
that he was good at communication, but taking this deeper level. And we went into see this one woman who
was her kid’s had sent her to the ER, he’s an ED doc. He had sent her to the ED for some chest pain, and,
Oh my God. The way in which he immediately connects, just as you described.

Diane Rogers (26m 27s):
And as I imagine you would as well, Tony, you walk into the room and you see the person and you
understand that they’re, there, and they’re scared. And Bob had this most incredible way of reassuring the
patient instantly. And he was very clear in explanations and could go through all of the things that he did so
wonderfully. I still can see it in my head. And I was kind of standing off into the corner. And I just watch the
relationship as you describe. And also Your G Tony, his genuineness coming out. And at the end of the
interaction, I asked the woman and I don’t do this today because I’m not a part of the interaction at all.

Diane Rogers (27m 15s):
But at the time I had asked the woman, I said, Bob, do you mind if I ask her a question? And I asked her a
question. I said, if you could describe the interaction that you had with Bob, how would you describe it? You
know. Was it good? Or was it just OK, or would you not even bring your dog here? All right. And she looks at
me and she said, well, I wouldn’t give him a good, and I think Bob was startled by that. And I had said, well,
please tell me more. And she said, I would give this man an excellent, because I could tell that he truly cared
about me.

Diane Rogers (27m 59s):
And I even still I’m can be right in that moment. You know, doc’s are kind of funny sometimes, right? So he
wasn’t going to say anything to me, you know, but as we both kind of walked out of the room, I could see in
his head, in his eyes and in his heart that he got it, he knew exactly what I was talking about is, you know,
my phrase, Tony is turn your observer on and notice the impact that you make. Because when you can see
the impact that you make, I call those change a world moments. When you can see your own capacity to
change a world that going to reconnect you to the, what is meaningful.

Diane Rogers (28m 41s):
And that is part of how we are being Well. In other words, that’s part of our strategy toward wellbeing. And its
also how we are going to reduce burnout is that when we see that we are doing and being what we wanted
to in the first place, and that is to make a difference in other people’s lives than that will help to fuel and
nourish our heart’s in what it does that we do each and everyday. So if you want to work 24 plus hours a day,
making a difference and you can be well in doing so then let’s create the environment that supports that for
you .

Dr. Anthony Orsini (29m 21s):
And the audience can’t seek because this is audio only, but, but Diane can see that I have been nodding my
head up and down. Yes. And it all ties together. So I’m gonna say to the audience out there, if you’re a nurse
or a doctor, or even if you’re in business tomorrow, that when Covid is over and go back into the office, go in
to the hospital, sit there and watch people. There are some people and I know, you know, already who they
are, there are some people that walk in and the room becomes a better place. Immediately. The nurses light
up the therapist light up. You, as you said, Bob made the patient feel excellent. It improved the patient

Dr. Anthony Orsini (30m 2s):
We know beyond a doubt that when the patient experiences better, it improves clinical outcomes,
malpractice, losses, everything is better and burn out goes down, it’s all about enjoying what you’re do and
not getting caught up in the weeds. That’s exactly right. And so next time you go to work, sit there and watch
someone whose good at that. Coaching is great. And if you need coaching, Diane is the person to call, call
her right now. But to get to the point where even know that you’re need coaching, ask yourself, wow. I mean
there were people and I grew up, I did a rotation with a doctor in my goodness when he walked into that
hospital, every single person was happy to see him.

Dr. Anthony Orsini (30m 42s):
And you know why? Because he was happy to be there. He enjoyed what he did. It showed. He was a family
doctor that actually I’ve mentioned this one of the other podcasts. He practiced 50 years. He delivered me,
and then I did a rotation with him. But I was in his office. It was the Italian section of Newark New Jersey

where I grew up and I was doing my family practice rotation. I would say at least no exaggeration Diane,
eight out of 10 patients who came in, brought him food. They loved him so much that they felt weird, not
bringing him a gift. And so I was lucky enough to have that role model.

Dr. Anthony Orsini (31m 26s):
And I think understanding your importance and as you bring out the best in people, when you bring out the
best in people, it brings up the best in everybody else. And yeah, Helen Reiss was on our podcast also that
she wrote the book of the Empathy Effect. Yeah. And one of her things taking care of yourself first, be happy
first and it’s contagious what a great title of your company. Contagious change. Because that’s what you’re
all about. Your very contagious.

Diane Rogers (31m 52s):
Okay. Well thanks. And you know, Tony, just add to that. Right when you walk in and you see those people
creating that environment, right. Then just the, I invite you just to say to yourself, I want some of that. And
then to take the next step to, create an intention or ask yourself, I wonder what it would look like. If I walked
in to that room where everyone was thrilled to see me, what would I have to do? What strengths within me,
what intrinsically about me would I want to bring forward? And what is it that I wanted to look for to notice to
where, I can say, OM G and a half their thrilled to see me because then each and every day you will be
motivated, inspired to do it again and again and again.

Diane Rogers (32m 46s):
Right? So everyone has the capacity to be that way. And the other thing that you were saying, like the doc
that you were talking about, right? Imagine that I’m just ever so curious, what would be like for him to know
that Today, you’re still talking about the impact that he made years ago. Right? And so the invitation is also
there to say, as you’re entering into the room, consider that 10 years from now 15 years from now, people
will still be talking about how you made them feel. In my book, I use Access your superpower to make
people feel un-invisible And so what is it that you want to do to make people un-invisible and then notice how
you are happier.

Diane Rogers (33m 40s):
You are more joyful and you appreciate your own capacity to make a difference.

Dr. Anthony Orsini (33m 46s):
Now there’s people listening right now and Because this is, I hear this all the time. Well, in fact, when I first
gave one of my first workshops, it was in my own hospital and my own boss said to me, are you sure you
want to give this workshop because not everyone can be you. And there’s a common misconception that
some people either have an outgoing personality or they have an ingoing personality. I’m gonna share with
my audience. And I’m going to share with you that you’re probably going to say no way, but the truth is I am
very shy by nature. I worked at it. I know it doesn’t look that way, but I was very shy by nature my whole life.

But I learned that I watched and you make everyone better.

Dr. Anthony Orsini (34m 27s):
And so you don’t have to be a natural extrovert and you don’t have to be the life of the party, but you can
learn communication techniques like smiling with your eyes, looking in people’s eyes, being genuine, sharing
something about yourself, all of those things, you can be that person. And if everybody was like that, what a
great work environment and how much that would improve the patient experience. You know, every doctor
that I train, you know, This statistically, you will have between 200 and 250,000 patient interactions in their
lifetime. So what an impact to train one doctor, how many patients you are helping.

Dr. Anthony Orsini (35m 7s):
And that’s an amazing thing before we close. And then, because I don’t wanna take much more of your time
at want people to hear more about the Beryl Institute and your work. There how you got involved with that.
Just what its all about because what you’re talking patient experience, The Beryl Institute is the go to place
and it’s all about patient experience. So I’ll just tell me a little bit how you got involved with that and a little bit
about The Patient Experience

Diane Rogers (35m 32s):
Absolutely. So The Beryl Institute is and I’m just gonna read the who we are, right? It is a global community
of practice committed to elevating the human experience in health care. And I loved this notion of human
experience. It has 20,000 members in 36 countries. So that notion of global in every state and the
membership varies in roles across health care, right? So it’s not just physicians or nurses in the patient
experience experts, but anyone interested in elevating the human experience. Right? So what I love about
The Beryl Institute is the community Tony, you and I are connecting because of that community.

Diane Rogers (36m 20s):
It’s not an organization of experts that are telling 30,000 people what they need to be doing. Everything
developed within the Beryl comes from the community itself. So it is extremely inclusive for me. I can’
actually remember the year that I first connected with them. It was either 2011, 2012 kind of timeframe. I
walked into that room, walked into the key note speaker room. And I don’t use this word very often, but I
have found my tribe, these where people who are passionately connected to the purpose of making a
difference in the lives of others in the field of health care.

Diane Rogers (37m 3s):
I work with them as a faculty member, we have 15 domains of knowledge around the things that are
important in being a patient experience professional. And while I’m the facilitator of their virtual classes as a
faculty member, I’m telling you, I learned from these experts in the community of patient experience all the
time, they are welcoming and they are open. And I would be remiss in not mentioning Jason Wolf, who is the
president of The Beryl Institute, who is one of the most incredible visionaries.

Diane Rogers (37m 47s):
He is very focused on data and information and brings that forward. He shares everything that The Beryl
Institute uncovers and just guides us in what I think he would call a movement toward creating Experience
excellence by enabling others to create a human experience that is exceptional.

Dr. Anthony Orsini (38m 15s):
I’ve met him one time. He’s an amazing guy. If your listening, Jason, I have emailed you a few times and try
to get you out of the podcasts. Diane time you see ’em tell ’em what a great experience it was. But yeah,
The, Beryl Institute is wonderful because it’s inspiring because you have so many people who are dedicated
to making the patient experience better. I think this Podcast was an amazing episode because I kept
promise Diane. I think people out there are inspired to be the best themselves. If I can be the best me that I
can help other people, whether I’m the doctor, a nurse in business, we have given some really good tips
about how to lighten up a room. So I think everybody learns some really great communication techniques.

Dr. Anthony Orsini (38m 56s):
Your book might be out by the time this episode airs. I’m not sure of the date, but it is certainly gonna be
available on Amazon. Is that correct? Yes. So please everybody, if you need Diane, what’s the best way to
contact you Diane

Diane Rogers (39m 9s):
You can just get me a diane@contagiouschange.com

Dr. Anthony Orsini (39m 13s):
And the book is called Leading hArtfully the art of leading through your heart to discover the best in others.
And that should be out any day now. So Diane thank you so much. You’ve been an excellent host and
another podcast that I’m gonna get credit for, but I had nothing to do with me. It’s just all about you . So
thank you so much.

Diane Rogers (39m 33s):
Oh, Tony. It was my absolute pleasure as it, you know, it is disappointing that people can’t see the video
because I’m smiling so much, Tony, you’re a gracious host. You have the ability to make people laugh.
There’s a fluidness in all of this. My intention, I will tell you was to create a conversation with you that people
would listen to and go, Oh my God, they must be the best buds. There are just dancing in the moment. And I
think Tony, that we did that wonderfully together. So thank you for the invitation. Right?

Dr. Anthony Orsini (40m 9s):
And thank you for the kind words. If you liked this podcast, please go ahead and hit subscribe. If you haven’t
already, please go ahead and download this podcast and all the other previous episodes, you can find it on

Apple and Spotify and Google podcast. If you want to find out more information about the Orsini way, you
can go to www.theorsiniway.com. Then you can contact me through that website. Thanks again, Dianne.
This has been amazing and I can’t wait for your book to come out and to find out how many people bought it.
I’m sure it’s going to be a big best seller. So thanks so much. Thank you.

Announcer (40m 46s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr.
Orsini and his team, or to suggest guests for a future podcast, visit us at The Orsini Way.Com.

3 (40m 56s):

Caring For Our Veterans With Dr. David Shulkin

Dr. David Shulkin (1s):
Well, I think this single most difficult conversations that I had were when I had to speak to family members,
wives, mothers, and fathers of Veterans that either sacrificed their life or had taken their own lives through
suicide and sitting down with people that clearly are not only deeply missing their loved one’s, but continuing
to replay in their own mind if they could have done anything differently.

Dr. David Shulkin (38s):
And knowing that this was the many ways of failure of a system that I had responsibility for. Clearly were the
most difficult conversations that I ever had.

Announcer (50s):
Welcome to Difficult Conversations Lessons I learned as an ICU Physician with Dr. Anthony Orsini. Dr Orsini
is a practicing physician and the president and CEO of the Orsini Way. As a frequent keynote speaker and
author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through
the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell
their story and provide practical advice on how to effectively communicate.

Announcer (1m 22s):
Whether you are a doctor or faced with giving a patient bad news or a business leader who wants to get the
most out of his or her team members’ or someone who just wants to learn to communicate better. This is the
podcast for you.

Dr. Anthony Orsini (1m 34s):
Well, welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. This is
Dr. Anthony Orsini and I will be your host today and every Tuesday moving forward. I know I say we have an
extra special guests every single week, but this time it is really incredible. Today I am so honored to have
with us the Honorable Dr. David J Shulkin. The honorable Dr. David Shulkin was the night Secretary of the
us department of veterans affairs.

Dr. Anthony Orsini (2m 4s):
Nominated by President Trump to serve his cabinet, Secretary Shulkin was confirmed by the US Senate by a
vote of 100 to zero. He was the only Trump’s cabinet member to receive a unanimous confirmation. Prior to
serving as secretary of the VA , Dr. Shulkin served as the under secretary of health under President Obama,
for which he was also confirmed unanimously by the U S Senate. As Secretary Dr. Shulkin represented the
21 million American veterans and was responsible for the nation is the largest integrated health care system
with over 1200 sites of care, serving over 9 million veterans.

Dr. Anthony Orsini (2m 37s):
The VA is also the nation’s largest provider of graduate medical education and major contributor of medical
research. It provides Veterans with disability payments, education through the GI bill, home loans, and even

runs a national cemetery system. Prior to coming to VA, Secretary Shulkin was a widely respected health
care executives having served as chief executives of leading hospitals and health systems, including Beth
Israel in New York city and Morristown medical center in Northern New Jersey.

Dr. Anthony Orsini (3m 7s):
And that’s where I first met him. Secretary Shulkin has also held numerous physician leadership roles,
including the Chief Medical Officer at the University of Pennsylvania h