Transcript

In surgery, you become a lot of things overtime, lots of different dates mark your training trajectory. This is me, May 2014, when I graduated medical school. And that's my Mama. She's looking pretty cute, pretty proud. Then nearly a decade later I became a fully fledged transplant surgeon. Still not sure who let me do that, but pretty glad they did. Flash forward to over a decade later and I became something different, something that I'm not sure decades worth of training really trained me for. I became a mom. This is Gemma, and I might be a little biased, but I think she's pretty cute. As her mom, I love her to pieces, but she definitely has her personality. She's always down for an adventure, loves to get messy, and as a toddler, and maybe as my toddler, she has some very strong ideas and opinions. And one of those really firmly held beliefs is that shoes are quite literally the devil. Shoes aren't meant to be worn on your feet. No, no shoes after taking off your feet and. Throwing right back in Mom's face. Now, I think it's safe to say that everyone in this room is wearing shoes. And we would all think shoes are a pretty good idea. They help protect us from the environment. They support our back, our joints. They can make us look cool. Maybe even make us fly like Michael Jordan. The existence of a $400 billion shoe industry would argue that shoes aren't just a good idea. But a great idea. Now, I could get frustrated every day when I'm trying to get Gemma in her shoes and out the door. And don't get me wrong, as I'm sure every parent can attest, I definitely do. But me being frustrated isn't going to get us to a solution any faster. I need to take time. I need to understand why Gemma doesn't like the shoes. Do they not fit? Are they uncomfortable? Does she just want the sparkly ones today? Whenever you're working out of the new idea, and I realize shoes aren't new, but they're new to Gemma. And when you're working to present a new idea to anybody, be it a toddler or hospital administration, I promise administrators not calling you all toddlers, maybe just a few. I think it's really important to grasp three key concepts fuel the idea behind your why. Part of me the why behind your idea? Friction. The resistance to that idea. The roadblock? The what? That's in your way. And flexibility, your ability to bridge that gap, how you're going to make this happen. Now, this idea of fuel versus flexibility and friction is not my own fuel and friction. We're actually originally shared with me by one of my awesome mentors at Northwestern, Satish Nadig, and was originally crafted by Loren Nordgren in his book The Human Element, something I encourage you all to read if you have the time. When I was asked to give a talk about bringing innovation into the healthcare space and working in bureaucratic environments, this idea of fuel and friction really resonated with me and with my experience bringing perfusion. Technologies to our institution during this transformative time in transplantation. I'm not the innovator behind normal thermic regional perfusion. I didn't develop normothermic machine perfusion, but my decades long training did position me well to overcome some of those obstacles that I knew we would face as we started to adopt these technologies. And I think this framework of fuel friction and flexibility is the way you go about it. So let's dive in. Let's start with fuel. So fuel for Gemma and her shoes is understanding the purpose and the benefit of the shoe. So if we're at the playground and there's an annoying little pebbles bothering her feet, it's her learning that putting on shoes is gonna protect her feet from the environment. For me, with perfusion technology, the data are what really drove the understanding of the adoption of these technologies. The why was in the data. What we're seeing across all perfusion modalities is we're seeing improved organ utilization with remarkable patient outcomes. More patients are getting transplanted at a faster rate. They're having shorter ICU length of stays and hospital admissions. Fewer postoperative complications, and in the US a lot of this is happening with graphs that just a few years ago we were throwing in the garbage the same way Gemma throws shoes in my face. That's a huge win for our patients and for the transplant ecosystem. Everybody in this room knows that we have long had a huge gap between the number of organs that are available for transplant and those on the wait list, and these technologies are beginning to make a dent, beginning to make a difference in that gap. When we talk about these devices, let's spend a little bit time on the X Site 2 devices. They have some other perks to consider. With the XI 2 devices, we're able to take an organ from a donor and profuse it for multiple hours. Take the liver for example, even over a day to assess it for suitability and viability for transplantation. And that really helps give you a lot of options. It makes sure that this organ is right for your recipient. If your recipient isn't ready, you can have some time to optimize them before going into the operating room. You can even have your recipient at home while you're deciding if this organ is suitable for transplantation, and that's helpful in a congested hospital workflow system. We're also transplanting more organs more often during daytime hours, and that's a huge benefit for our patients. Everyone here knows Healthcare is a 24/7 365 ecosystem, but the reality is the best care is still delivered during the daytime and by optimizing transplantation more than the most demanding surgical fields to daytime hours. That's a clear clinical benefit to our patients. Something not talked about as much either is optimizing the well-being of our physicians, our surgeons, our staff. As I mentioned, transplants very demanding. We all worked a long time to be in this room, to be here. We want to encourage everybody's longevity in this field and well-being is a huge part of that. There's also a lot of well-being data that shows that a well physician, a well surgeon is going to provide more compassionate care for our patients and there's a lot of value in that. So these data are just the tip of the iceberg, but they're the fuel that ignited the fire to drive the broader adoption of these technologies here in the US and internationally. And when you begin to really dive into the data, the data is so deafening, it makes it hard to imagine that in some not so distant future, some combination of these perfusion technologies are going to become the standard of care for many donor and recipient scenarios. The hard thing with fuel is that when you believe so much in your fuel. You kind of get lost in it. You relish it, you're really excited by it, but you don't spend that much time dissecting the roadblocks that are in your way. You don't spend much time understanding the friction. And just like Gemma with her inexperience around shoes, most people in hospital leadership or administration don't have the same experience in transplantation that everybody here does. And they might globally believe in transplantation and it's in its goals. But when they hear innovation or a new device. They're not going to appreciate the fuel to the same degree as they see the friction. They're going to see barriers. Red tape. New cost, staffing changes, policy, procedure, all things that can get in your way. So friction. Friction. Here's your resistance to your idea. The roadblock. The what? That's in your way. It's the reason for the no no no. I get what I'm trying to put on Gemma's shoes and have this frustrated look on my face. When you're engaging in hospital leadership and administration, you really have to take the time to listen to their friction. Understand where they see issues with your idea. It might not be the same ones that you thought you're going to bring to the table. So let's talk broadly about machine perfusion. There's lots of different issues that have been raised, ethical, legal concerns, financial constraints, technical issues, staffing. Listen to their friction points. Dissect the friction. And then once you dissect the friction. Once. So let's hone in on one dissection 1 friction point. Let's pick cost. I'm gonna pick on normal thermic machine perfusion that's really carbon. I'm sure this will come up today. That cost is a common friction point. So when you think about the cost of 1 device. And one transplant. The cost of normothermic machine perfusion can seem insurmountable. But break that cost down. What does routine use of machine perfusion mean for your patients? Your prayers and your transplant center. Are you able to transplant patients more quickly with fewer pre transplant admissions before they need a transplant? Are you able to tackle more complex patients? Do you have fewer peri transplant and post operative complications? Last returns to the OR, shorter ICU, length of stay and hospital admissions post transplant. All things that the data are demonstrating. When you see these benefits, you're able to use these benefits and take that data to your payers. And then you can renegotiate your contracts to help you mitigate some of these costs. Similarly, when hospital administration here's these data, they're hearing that you're providing higher quality care at a faster throughput in the ICU and the hospital and a very congested hospital system. Everyone here knows that the ICU and the ER has been really impacted since COVID. Anything that we can do to provide higher quality care that helps minimize those strains on those resources is crucial. Once you understand the friction points that your institution with whatever technology you're trying to bring to your institution, you can take a quick no. And start to work on it and make it be a maybe and then a yes. And this is where I think the last key point comes in flexibility. We all have ideas, and I think a lot of us has tried to incorporate a new idea into a new system in the past. And what we find is that path is not a straight arrow. There's lots of twists and turns. It doesn't happen exactly as we envisioned it or in the time frame that we anticipated. Don't get frustrated by those changes. Don't get frustrated by the friction. Get flexible. We all know that change is very difficult. It means to alter or to modify, and by definition any any modicum of change you have to overcome inertia. And that inertia is hard. It's much easier for people to say no than to do the work associated with yes. With Gem in her shoes, it's been no no no for a really long time. But now that we've taken time to explain to her the fuel, the purpose, the benefit of the shoe, and listened to her friction, I get a lot more yeses. If the ground is hot, I show Gemma the ground is hot. She understands the purpose, the benefit of the shoe, and we put the shoe on. Sometimes the shoes are uncomfortable or she does just want those damn sparkly ones. I understand that and I get a new pair of shoes. Easy fix. Sometimes we're just going to the beach and she doesn't want to put her shoes on for the car ride. Why fight it? We're just going to take the shoes off when we get in the sand. I adapted and got flexible. Once you understand the barriers, the points of friction at your program, you can figure out how to use your programmatic strengths to overcome some of those, compromise on others, and then what few are you going to leave to tackle as innovation involves knowing that innovation and Healthcare is never static. I would argue that taking time to understand friction and craft flexibility in your response is the key way we can really begin to move forward as a transplant community. I think that any idea can really be transformative. Maybe wearing your shoes on the wrong feet or mom's shoes on the wrong feet is the next innovation in footwear. But to make transformative change really happen, you have to take time to dissect the friction and craft flexibility in your response. And it's how when we're in this room today, I want us to all begin to think about these critical issues in transplantation. And as we engage in the phenomenal conversations that we're going to have the next 48 hours at the Critical Issues Forum, I want us to get excited about the idea. Relish in the fuel. That's good. Learn the data. But take time to understand the friction, Be mindful of it. Understanding it is key to overcoming it. And then how are you going to adapt? How are you going to get flexible? I challenge everyone here today to take one idea, one concept, something you learn here, and bring it back to your own transplant center ecosystem. How are you going to adapt that idea to overcome the barriers for our patients? I know we can all do it. Anyone who's ever convinced the toddler to put on a pair of shoes has the power to do the same. Thank you.