Delivering Equitable Healthcare for All (ft. Dr. David Lubarsky)

Thanks for tuning to Digital Voices Podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Welcome to Digital Voices. What I like about what we get to do is we don't have to have any commercials, any sponsors, or any advertisements. It's just pure content. And thank you for listening. I know you have a lot of different choices in what you can listen to, and we appreciate you being part of our audience. And today we have the CEO of UC Davis Health, Dr. David Lubarsky. David, welcome to Digital Voices.

Thank you for inviting me. I'm looking forward to speaking with you.

And you're also Modern Healthcare 2022 Top 100 Most Influential People in Healthcare. That's pretty cool.

It is. It's really kind of peer recognition. And it does. It means a lot that people at least are thinking about what I'm saying. I'm not sure what I'm saying is always right, but at least it's getting people thinking.

Well, what I love about you, and, you know, we've never met previously, but I followed you for a couple of years now. And what I love is that you're very personal. I could tell through your interactions, and we have some common friends. That you're a very personal person and as a leader, and you're also a big evangelist for all things digital transformation, which, you know, is close to my heart. So, so I think that's awesome to have a CEO like yourself, you know, that's a major proponent of digital transformation. So David, one of, one of the first things we always ask all of our guests is songs on your playlist. So like when you listen to music, What do you like to listen to?

Well, you know, that was like the first digital transformation that occurred is I started to use Spotify thanks to my children, right? And I realized I was so caught in the past, right? And a lot of times, right, you learn from the younger generation. And that also goes to the playlist as well, right? Which is— and mine is kind of all over the place. It's really— and that's the advantage of having such a amazing panoply of choices in music is that depending on the time and the mood and your activity, you can choose whatever is best for you and that meets your needs.

Right.

And when I'm thinking, right, when I'm thinking about what I might say on a podcast like this, I'll probably have Chopin preludes playing in the background, right? And if I'm feeling in a soulful mood and trying to do some introspection, maybe Billie Eilish. In a convertible, right, with wind whistling across my bald head, or biking a road in one earpiece, you know, it's classic rock like the Rolling Stones or Aerosmith, or maybe something a little more modern like Beyoncé. And then at the gym, it's Doja Cat. Just really gets me going. So yeah.

That's awesome. No, I can appreciate a lot of that different type of music. And like you, you know, people often said, Ed, you know, where do you get your ideas for digital or transformation or whatever? or keeping up with the latest technology. It's all the kids. I have to give 100% credit to the kids, right? What about life message or mantra? Are there sort of words that you live by?

It is, which is— and I didn't really know what to call it until a couple of years ago when I read Think Like a Monk by Jay Shetty. And that was truly about finding your dharma, right? Doing what you love, something that you're great at, and something that gives your life meaning beyond just yourself and your daily existence. And if you can link all of those things together, and then your entire life is better, right? Your entire life has meaning and joy on a daily basis. And I'd like to say that the opportunity I've been given to work here at UC Davis is exactly that. All the skill sets, you know, And the, I don't know, 18, 20 years of education I have with all those degrees and all those professorships finally have come all together in a way to really amplify what a team of truly dedicated health professionals can accomplish.

Yeah, that's really cool. Whenever you can get that congruence in your life, you know, that alignment, that really is really important. Tell us a little bit about yourself personally or professionally, wherever you want to take it.

Sure. You know, a little while ago, I did a TEDx talk. And, you know, and it was the same thing. It was like, well, you have to introduce yourself to the audience. And, you know, one of the most personal things for any doc is talking about how did you decide to become a physician? And I knew I was going to become a physician at the age of 11. And it's kind of crazy, right? But, you know, I remember, I still remember this vividly where I was, You know, in bed suffering from GI flu, feeling as bad as you can possibly think an 11-year-old could feel, like the world was coming to an end. And I was lucky that my family doc was also a friend of the family. And, you know, he came over, you know, in the early evening with his little black bag, some flat Coca-Cola, a spoon, and a giant bag of compassion. And I realized that I wanted to be like that person. Now, I veered a little bit because I ended up becoming a cardiothoracic anesthesiologist, right? But very far from being a black bag toting primary care doc. And maybe I missed my calling because that's still, I think, the most important thing that a doctor metes out, which is compassion and empathy and understanding. The cures, they're hard to come by. But that inspiration has stuck with me for, I don't want to tell you how many decades now.

That's cool. And, what about the flat Coke? Does that still play a role anywhere?

I will tell you that when my stomach is upset, a little bit of fizz, very little bit of fizz and some sugar water, it's a great placebo.

Yeah. Well, the reason I mentioned that, it saved me a few times in some long races. So, I like to run and in some long races, I feel like I'm about to quit. And then suddenly there's a flat Coke, and of all things, you know, much better than, at least for me, than Gatorade or anything like that.

I won't argue one bit for you. I've experienced the same thing in my bike races.

So UC Davis, that's an amazing organization and beautiful campus. What's the— I know it'd be hard to limit it to one, David, but what's one best thing that you love about UC Davis?

I actually really love the heart and the spirit of the people who come to work here. I've been lucky. I've gone to some great organizations and they had great doctors and they had great professionals, you know, across all the care design. But it's really rare for a CEO to get like 10 complimentary letters for every letter of complaint. And that is because I'm just shocked at how truly caring every single person is in this organization, A to Z, and how truly caring they are for each and every single member of our community, no matter who they are, advantage, disadvantage, particular, particular ethnographic background or socioeconomic background. They really go the extra mile to make people feel really comfortable. And, you know, that's maybe epitomized something we don't really think about very often. But old age, right? We're a geriatric-friendly health system and a geriatric-certified emergency department because we treat people the way they want to be treated, not the way we think we should just treat them. We really actually are truly inclusive. And it's great to work in an organization like that.

Yeah, that's very cool. That culture sounds pretty amazing. And I've heard similar things. outside of our discussion and relationship. How do you manage all the complexities? Because UC Davis Health is a pretty complex environment. So as a leader, how do you keep yourself focused? Right.

Well, so first of all, I'm going to hearken back to a book I read. I read a lot of books. I spend a lot of my time actually reading, which is another reason I really love my job because I love to put ideas into practice.

Yeah.

And Team of Teams was one of my favorite organizational design books. And I really model my modern C-suite on that and the way that they interact with one another, which is— and the whole concept of Team of Teams is that if things have to be run up the flagpole before you run them down the flagpole, you're neither nimble, the communication is indirect, problems fester. So, by having the C-suite really work by excluding me, which is kind of an odd thing for a CEO to say, but excluding me from the decision-making, except when I must be part of that decision-making. And it's not that common actually, because they're really competent people. So that's number one. And in Team of Teams, they describe a world of VUCA, which the military uses, right? Which is volatile, uncertain, complex, and ambiguous. And you have to manage through that. There are no right answers necessarily. There's not a, this is the right way and this is a wrong way. This is based on what I know today, the best way to go forward. And the team, having had input into that choice, lines up, goes down that pathway, and then we adjust and adapt and are resilient as we run into problems. And the other part is having the right team following, right? So, it's not only the people, but the responsibility. So, the New England Journal Catalyst wrote up, did a little thing on the fact that We've created a real modern C-suite, right? Having a Chief Digital Strategy Officer is— Chief Digital Health Officer, excuse me.

Yeah.

Is one of the most important things that we did, who really combined innovation and IT along with being the CIO and overseeing the nuts and bolts infrastructure that supports that innovation. But we have leaders in sustainability, in DEI, in marketing and communications, in experience. And wellness. And a lot of C-suites, you know, are traditional. We have the COO and the CFO. Everybody needs one of those, but they're just part of the team. And all these other areas, you know, if you have everybody there, like I said, they don't really need the CEO that much because they are getting all the high-level advice they need from each other.

No, that's great. And David, you mentioned innovation. And so, As a CEO, how do you foster a culture of innovation? Because as I mentioned, UC Davis Health, you know, you're really known for a lot of great innovation and transformation. So how, as a leader, do you sort of make sure the culture is that way?

Well, I am going to actually put in one plug for the CEO actually having a part in how the organization runs, right? Which is that there are certain principles, right, that you have to espouse. Again and again and again. And I have a couple of mantras that people get really sort of tired of hearing, right? And one is about completing and not competing with other people who share our values, that we're not here to X out the ability of another hospital to do a commercially funded hernia. We're here to do liver transplants and have one of the best outcome programs in trauma in the United States.

Yeah.

That's what we're here to do. And when we have partners, it's easier for us to do what we do exceptionally well while letting them do things that they do exceptionally well, but probably at a lower cost. So one, completing and not competing, saying that over and over. And if you're thinking that way, you've got to rethink how you are working inside of your own community and that we're here to build up the communities around us who need us the most. And that's really, really important as well. The part that I'd like— and again, how we interact with our community requires innovating. Like, for instance, we say we want to hire people from underserved communities. And then we, you know, we put it out there and we, you know, 6% of our working workforce, non-licensed workforce, came from the most underserved zip codes in Sacramento. And I said, well, why? Why? There's all this unemployment. We know that. That's how we picked them. And we have all these empty jobs. Why are we failing? Well, we were failing because we didn't innovate our website to make it actually easy for someone who didn't have a 4-year college degree to navigate our website.

Right.

So, I know that sounds like a small innovation, but it's about not only looking forward and out, but looking inside and maybe even a little backwards saying, what were we doing right? But the real innovation, of course, is going to occur as we adapt to technology Not just to have another computer or another computer program kind of adding to what we do every day, but truly changing the work that we do, getting rid of all the work that we do not need to do, and allowing technology to do the— to free us to do the work we should be doing that only we can do. People worry that artificial intelligence will replace people. It won't. It's augmented intelligence. so that we can do more with our native intelligence on behalf of our patients. And when employing it, we can transcend the limitations of both time, geography, language, and socioeconomic background to deliver truly tailored ideas and effective communications to promote equitable healthcare. That's the message that I keep harping on, that AI is not something we're going to be doing to you. It's not something that will really aid you in doing the same rounding you've been doing your entire lives. It's to get at the point where you're treating the people who need your help before they get really sick, no matter where they are or how hard it is right now for them to come to clinic.

Yeah, that's well said. And that's a pretty awesome culture that you've developed to be able to do that. So I want to switch over now to digital transformation and UC Davis Health. How do you, as a CEO, how do you view digital transformation? Is it a strategic thing, a tactical thing? Just how do you look at it?

It's a survival thing for us. We are maybe the last of the dinosaurs in terms of our cost structure. And there's nothing I can do about that. I mean, we're a state institution. And we have certain rules around staffing ratios and rules around payment and rules around contracting out for cheaper labor. So I have to figure out how we're going to change the work that we do so that we can afford to continue supporting the career of everybody who works here.

Yeah.

And that won't work in the future, right, unless we're really doing the highest level of work. You know, we're the only academic medical center between San Francisco and Portland and the Pacific Ocean and Salt Lake City. That's a really big catchment area.

Yeah.

We're the level 1 trauma center for 33 of 58 California counties. Very large area, you know, about 8 million people are our catchment area. We don't need to treat a whole lot of them. We need to treat the people who really need us to treat them. and help local hospitals treat more of their patients closer to home. And so digital transformation for us— and again, I'll give an example because, you know, that's talk, right?

Right.

But there's a patient, you know, who comes in and maybe has had a stroke into a local emergency department, and they're evaluating the patient, and they figure out what's going on. And then they call us up if maybe they think a clot-busting operation might be beneficial. And by then, too much time.

has passed. Yeah.

Or certainly more time than might be optimal. But if we're all on the same AI platform, and when a CT is done in the presenting ED right away, and our docs can view it simultaneously and say, this is a patient who might benefit. And we already have a transport system because they're almost always part of our level 1 trauma network, right? And we can helicopter that patient to our ED to get the type of comprehensive stroke care, right? And it's all aided by the computer doing the initial read of the MRI and really moving these patients, right, in almost real time into a system that will preserve maximum function. That's the key, right? It's making sure that the technology that we talk about is actually delivering superior outcomes. We think there are so many opportunities, whether it's real operational like that, or just simply early diagnosis, right? For people who are at risk of falling, right? And starting to use AI with our iPhone. I mean, my iPhone tells me exactly, you're a runner, you know this, right? It tells you what's your foot contact time, how even is your right and your left gait, and all this other stuff. Well, we can do all of this. We're just not applying it to healthcare to predict who might be at risk of falling. Who do we need to bring in? Because that's usually an early sign that unsteadiness of perhaps some dementia, right? And so do we need to bring them in, optimize their environment, inform their loved ones so they can be better caregivers and prevent that person from falling in the first place and ending up in the ED with a broken hip? Technology to improve wellspan is really another golden grail of mine, right? I don't want AI to help me treat that hip fracture, which it might be able to do.

Right.

I want AI to prevent me from ever having a hip fracture by identifying when I am unsteady on my feet from the first moment.

Yeah, those are some great examples. Not to put you on the spot, but do you have— is there one that you're most proud of that's come out of UC Davis Health, something that you're either doing now or maybe about to do?

Yes, so there is. So one of the things that you ask, what does leadership do? So we have some leadership training programs.

Yeah.

And Amit Lambda, who's my vice chair for radiology, went through that. And as a— one of the things they had to do was come up with an AI-driven way to improve the care that we're delivering. And another person in our leadership training program was the head of our thoracic surgery department division, who's very, very African American, very, very active in our local communities, especially around lung cancer screening. that interaction actually drove my vice chair for radiology to say, 60% or so of the patients who get X-rays in our emergency department have a request to follow— excuse me, who have something identified. They're being X-rayed for a broken rib or something, but they say, yeah, there may be a little spot in the lung that should be followed up. 60% of those people Never get a follow-up. They never get a follow-up, right? And they're just lost. And lung cancer is now a scourge, right? So if you could do directed lung cancer screening, which at least anybody who's come into your system who has a suggestion they might have a small lesion, not picked up necessarily by the radiologist, bring those people and then expand that to every X-ray being done in an emergency department, being screened by AI to say, hey, Maybe you want to arrange for this person to get follow-up. That will bring us to a new level of lung cancer screening. But what's great about that is that we can automate that and we're going to, right? So we're going to identify all these people who should have follow-up. We're going to set up a chatbot to reach out to every one of those people and get them scheduled with one click to get their follow-up CT that might be indicated. And then if they don't do that, we'll know who they are and then we can engage different types of communication strategies so that we get at all the people, at least that we know of. And we believe that we will be able to capture early on many lung cancers that would otherwise lead to death that will truly change the trajectory of those who are at risk that we've identified, and then start to use some of those learnings to change how we screen our local communities for lung cancer. So we think this is really an exciting thing that won't really cost us anything because, you know, there'll be some income related to doing some more CT scans that will cover the cost of the program, will affect the trajectory of the community, and we will be saving a lot of lives. And that's the type of promise of AI that we just can't do today. But we will be doing it and we will be implementing it shortly.

Yeah, no, that's super, super exciting. I love to see that sort of leadership, you know, and again, not surprising that it's coming out of UC Davis Health. And because I think then others follow, right? They see what you're doing, seeing that you're improving lives, saving lives, and follow that example. So I'm going to sort of merge a little bit, talk a little bit about digital transformation, but in sort of context of leadership. How do you learn? And, you know, we joked earlier, but there's a lot of truth to it about our kids helping us. How do you learn and stay ahead of the curve? So, you know, like AI is kind of an It's not new, but new in the way that it's applied today because we have greater computing power and things like that. But on a personal level, how do you stay in the know and kind of look over the edge a little bit what's coming up?

Well, as I've said, I spent a lot of my time, and I learned this from really smart CEOs, right? I didn't invent this myself, not having meetings. When we need to have meetings, when it sends some impetus around, Prioritization, central direction. That's one thing. But I try not to have too many standing meetings. Instead, I'm constantly reading the literature of all sorts, whether it's JAMA and the New England Journal or digital health publications or recently published books. You name it, I'm consuming it. I'm a pretty fast reader. And then I'm sending out like Missives to all my leadership team saying, "Well, what do you think about this? Should be considering this idea. Should be considering that idea." And and then I do a fair number of roundtables. I'm on a couple of roundtables. One's Leadership Institute. The other is CCI Health Management Academy. And I learn from my fellow executives. I listen to them, and which they probably don't realize because maybe they think I'm just there to talk because I. I talk a lot, but I talk a lot to be provocative and challenge people about what they're doing. And then when I hear something that I say, wow, that could really be applicable in my environment, I take it right back and challenge the team to say, hey, should we be doing this? And there's none— no one ever comes to work here for a week without getting an article or a question from me saying, Should we be rethinking how we're approaching this? Or how do we prove to ourselves that what we're doing is right and this person is doing something maybe differently and is it better? And I think that keeps us moving forward.

Yeah.

And listening to other people, reading what other people write and have to say, and an occasional big meeting, but I find the big meetings are a little harder to get something out of. Because the real knowledge is when you start trading ideas with people and refining them.

Yeah, those are some great suggestions. The only one, David, you may have missed is, you know, to listen to Digital Voices podcast.

Well, and talking to smart podcast generators like you. You see, the questions you ask me, they make me think more. Have I got this right?

That's funny. What about CEOs that may be listening right now, or maybe they're sort of working their way up the ranks and they want to be CEO? And they find themselves a little bit behind, right? UC Davis Health, you're definitely ahead of the pack. And so a lot of people listening, they'll be like, wow, I wish we were there. What are maybe one or two practical steps you might share with a younger in their career CEO in terms of what they should do if they find themselves in that situation?

Well, first of all, I think that you have to look at digital transformation and the investment in that. In the same way you look at building a new clinic or putting in a new MRI, you don't expense it day one. You actually have a plan, right? And you need to make sure that that plan is realistic about implementing the technology, spending the time and energy to do the change management to elicit the improvement in either outcomes or efficiency that you're seeking, logging that, and then in classic change management technique. going back and saying, hey, this worked, let's move on to the next thing. There's no, in my opinion, in technology, right? It's almost guaranteed you're going to have both efficiency and improved outcomes if the technology is good. But a lot of people think, I can't invest in this, I can't afford it. And you need to come at it from a different perspective, which is what does 5 years look like from now? Can you not afford it? If you have to afford it, what else can you give up? Because this is what will generate income into the future that will sustain the constant improvement in your health system. And I think it's a mindset around innovation and information technology and innovation technology about what it means, because no one ever says, oh, we don't need another hospital bed or we don't need another MRI. But a lot of times they say, but we can, we can We cannot invest in this IT part. But that really is the building block of the future more so than another brick.

Yeah, that's really great advice. Well, I have one more question around advice. So a lot of our audience are CIOs or chief digital officers, and I think they're always wondering what's the best way to work with a CEO. So from a CEO perspective, what would you say to those individuals on how to best, you collaborate with their CEO?

Yeah, I'm just gonna quote Tom Cruise, show me the money. I mean, at the end of the day, right, I could be the best CEO in the world. And when my budget flatlines, or God forbid goes negative, the best CEO in the world is no longer the best CEO in the world, right? So, you know, within reason, advocating for a reasonable share of surpluses, but understanding that most health systems don't have a lot of surpluses. They do have some investment funds. So that's, of course, key. But the ROI needs to be done from a true business development perspective. You're putting this in. It's not simple, right? I mean, just today I was having a discussion with Dr. Chija, who is my chief digital health officer. And we were talking about putting in an extension of our Epic programming. And it was like expensive, but then I was like, okay, well, and then it's gonna cost a licensing fee, and then it's gonna cost 5 more FTEs. And I said, what are we actually getting for it? Is there really a tremendous improvement in patient safety? Is there a tremendous improvement in efficiency? And if there's neither of those 2, then maybe that's not the right— Right. Technology to be investing in, or maybe it is, right? But, and having really strong strategic advisory and financial advisory subcommittees that prioritize these projects. So when you come to the CEO, you know that there's support in the administrative or the clinical realm, that it has been deemed to be of very, very high value, and that the analysis of the delivery in terms of patient outcomes or finances slash labor productivity have been clearly defined, can be measured, will be measured, and that people will be held accountable. That's what I want to hear as a CEO.

Yeah, yeah, that's, that's great advice and very clear. What about the hardest decision you ever had to make? So I'm sure along your career journey you've had to make a lot of tough decisions. I'm curious as to the, uh, the most difficult one.

Ooh, most difficult decision along my career journey. Well, I'm gonna talk about one of my earliest difficult decisions. So, you know, I've actually been a fan about a couple years into my career at Duke. My first boss, Jerry Reeves, was an early adopter of a perioperative information system. And I got really revved up and we were early adopters. And as part of that, with another colleague, who is another MBA graduate from Duke, we created a perioperative information system in Lotus Notes. How many people still use Lotus Notes, right? So after 32,000 patients were emptied, were entered, and we were starting to really gather data, it crashed. And I had to decide to walk away from it rather than continue to spend my life trying to resuscitate a failed decision. And I think that that is a critical element in teaching me some things that have prevented me from having similar meltdowns. Because you can imagine, you know, as a young academic professor thinking they're going to publish all this great data and it's gone.

Yeah.

First of all, don't homegrow anything. Okay? If you're going to homegrow something, get professionals. Number 2, you know, it's really hard for any one place, right, to create software of the future. Because it requires constant upkeep. You've got to have a real commitment to it, right? And that if you're going to fail, fail fast and move on. I did not fail fast. I knew that the program wasn't what it should be, but I couldn't give it up, right? Because of either hubris or pride or ownership or whatever. And that was an important lesson to learn, right? Fail fast, fail forward, move on. And especially when it comes to technology, you can't be in love with your own idea.

Yeah, that's good counsel based on experience. Yeah, I think we're all a little slow, most people, to say when something's over, that it's over and just start with something new. Wow, we covered a lot of different areas and I would just like to leave you with the last word. Is there something we missed or anything, David, that you want to double down on?

I'm gonna say that, you know, my favorite CEO compatriots are those who have not retired in their job. People are, you know, they can be a little annoying part of my own leadership style, which is I'm just never satisfied. I am not satisfied that we are doing the best job that we can do every day for our patients if we're not seeking out new ideas, new improvements, new programs that alleviate the suffering and the burden that our patients have, And don't maximize wellspan for every single patient that comes in the door. And I think that if you're a chief innovation officer, chief digital health officer, when you're looking for a job, you should be interviewing your CEO. Do they feel that way or not? Because there are a lot of people, they've spent their whole careers climbing that ladder. By the time they get to that top of the ladder, they're tired.

Yeah.

Right? Yeah, some of my C-suite would wish I was— I biked a little less and was a little more tired, but I'm not. I'm never tired of great ideas that help other people. So, you know, definitely if you've got a digital health group listening, you need to interview the team that you're joining.

Sage, sage, sage advice. Thank you, David, for being our guest on Digital Voices, and thank you to all of our audience for joining us.

Thank you. Thank you for listening to Digital Voices Podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.

Thank you.