From War to Wellness (ft. Dr. George Kikano)

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 another edition of Digital Voices. This one's kind of a blast from the past because it's someone that's been super, super influential in my career. And I'm so glad to have Dr. George Kakano as a guest. George, welcome to Digital Voices.

Yeah, thank you, Ed, for having me.

Yeah, this is going to be so fun. So we had this chance encounter at a Becker's conference and we hadn't seen each other in many, many years. Of course, we still look the same as we did, you know, 20 years ago, back when we served at University Hospitals in Cleveland. But it was like, oh my gosh, wow. It was, it was so great to catch up with you and learn more about what you've done in your career since then. And you are the Executive Vice President for Health Affairs and Dean of the College of Medicine at Central Michigan University. So that's pretty cool. So we want to talk a little bit more about what all that means and unpack that a little bit and learn more about Central Michigan University as well. And so the most important question, George, that we have on Digital Voices is what songs are on your playlist? So what kind of music do you like to listen to?

I mean, for someone with an accent like, like mine, having been in the US for close to 40 years, have not lost my accent. So the singers and the artists I grew up with are mostly Lebanese. And one of my favorite ones actually is Fairouz, F-E-I-R-U-Z. She's probably in her 90s, one of the most famous Middle Eastern artists back in her days, and she's still alive.

Nice.

So unless you grew up in the Middle East, you would not know what these songs are.

Well, we're gonna, we're gonna grab them because we have a playlist on Spotify called Digital Voices, and we love adding new artists to that playlist. And so we will add her. That's awesome. I don't think anyone has, has mentioned her previously, so that's very cool. What about life message or mantra? Are there sort of words that you live by?

Absolutely. I mean, you have to live your life with purpose. You live once. You have, I mean, most of us have had great careers. All of us had opportunities. Just focus on the purpose and the mission. Really focus on what's important in your life. Do not sweat the small stuff. And most importantly, treat all people with respect. Everyone has a place somewhere. Just be respectful even when you disagree, difference in opinion, different SES or others. And learn from past experiences to help you shape your futures and move forward.

Yeah. Love it. We also have a playlist of everyone's favorite quotes and words to live by. So we will, we haven't published that yet, but we're going to, it's just full of great wisdom after having 250 guests or so, you know, we have a lot of, uh, could do a book on that for you. So you already revealed a little bit about yourself that you're, you have this accent and from, from the Middle East. Can you share a little bit about your story? Like, how did you? Where'd you grow up? How did you get into healthcare and, and all the way up to what you're doing today?

I don't know how much time you have there, but I mean, you grew up, I mean, obviously I was born in the early '60s. I was born in '61, so you have my age now. Life was good till it stopped being good. I mean, you live well, well-knit family, supportive parents, cousins, nephews, villagers, French schools. Life was good till it stopped being good. When I was 14, unfortunately, civil war started in Lebanon. And you don't wish this on your worst enemies where life is stable, you have security. All of a sudden you're dealing with the unknown. This is dealing, I mean, people who are living in wars now, whether it's Middle East, on the Eastern, Eastern European border or others. So life is good, then everything gets disrupted. And the fear of an unknown as a teenager, as a family, where you hear background, background bombing in the in the background. You'll know what it is. Lost a dear friend actually, who lived in the same building as we did in Beirut within the first 6 months of the war. So somebody you play with, you just go one floor down, you play. One day he's here, the other day he's gone. And from there on, civil war went between '75 and '90. This is through my high school, my undergraduate at the American University of Beirut. My medical school, lots of lessons learned. You live, I mean, with— you survive with both. I mean, I both have physical and emotional scars. So as many people who are my contemporary, my age, who lived in wars in Lebanon and many other places. During college, I mean, just fast forward during college as an undergrad, I was a senior in medical school when the bombing in the US Embassy happened. in Lebanon, I mean, with hundreds of Marines, many civilians. I mean, I was in class that day and the embassy, US Embassy was on the American University of Beirut edge of the campus. This is a big disaster. I mean, big disaster right there, right there. Hundreds of loss of lives in the flash of a second. You're in medical school, you have major infighting among different political parties, religious parties. You end up with having hundreds of casualties in the emergency room at the same time. Not to be dramatic about it, but these life experiences shape, shape who you are, shape how you approach decisions, build resilience for someone who, I mean, you know how to deal with adversity and leaves you with physical scars and emotional scars for the rest of your life, unfortunately. And this is the experience, not just of someone like who grew up in Lebanon, but experiences of anyone going through wars anywhere in the world at this point. And I mean, the humanitarian politics aside, the humanitarian tolls of wars on both sides, there's no winner in this. And unfortunately, I mean, the world's— this is the mantra that's happening in the world.

Yeah. Yeah. That's, I'm sorry you had that experience and yeah, it's, I'm sure it has impacted everything about your life for sure. And, and, and those around you.

But at the end of the day, I mean, we've all heard it, what does not kill you makes you stronger. I mean, you build resilience. I mean, today, learned, you retool and move forward.

Tell us about how you made it to Cleveland, Ohio.

Actually, I came, I got a job as a postdoc right after medical school from American University of Beirut, got a job as a postdoc at the research lab at Case Western Reserve. In neurosciences, applied for residency program, matched in family medicine at University Hospitals, but I've done my residency and I had a great career in different roles, building a department, working with outstanding people in Cleveland for 25 and 26 years till the opportunity came up in Michigan to start a, to start a brand new medical school. And I've been there for 10 years. had an amazing experience. I work with excellent people, faculty and staff every day. And just these seeing students come in at that white coat ceremony, graduate 4 years later, having growing residency program. This is, this is absolutely has been the highlight of my career.

Yeah, no, that's amazing. And I want to, I want to jump into that in just a minute. But yeah, that's how I didn't really share at the top, But that's how we met. I was this young CIO at University Hospitals, and I don't recall if you became my family physician prior to that role or during that role. But I just realized I needed, you know, I was this young kid, I was pretty clueless, and I just needed someone who was a clinician who could sort of mentor me. And you did that. You provided this great input. to me and almost like, you know, a modern-day CMIO. And then, uh, I know we got you involved as a result into, uh, some of the tech side and helping us with governance and, and some of the decision-making. And we, and we had some big decisions to make back in the day, and you've been so helpful to my career. So when I look back on my career, I'm like, what, what are some of the major people and, and opportunities that I had? And you're definitely one of those people. So I'm so thankful. And excited about this conversation. So—

Thank you for the kind word, Ed, but there's something called HIPAA there, so I'm not going to answer you.

All right. So, when did you know you wanted to be a physician? So, you're growing up under very difficult circumstances, teenager, the Civil War starts. Is it then that you had an inkling about becoming a clinician?

At some point. I mean, growing up as a child, unfortunately, my father was older, suffered with chronic chronic illnesses, just the amount of kind of less than ideal care he was getting. I said, you know what, I'm going to grow up and make a difference, and I'm going to be different from the experience I've been seeing happening with a father who's older with chronic illnesses. And this is what led me to do family medicine, taking care of people on a continuity basis, taking care of families. And I mean, 2 or 3 generation families I take care of in the clinical part of my career. While having a big executive administrative job. I still see patients both in Michigan and Ohio, and this is the foundation of why I went to school, why I studied medicine. And even when I'm not in the office, I take care of people 7 days a week. And this is probably very— this is probably one of the best things I've done. Taking care of people, make a difference in people's life across generations and within the same families.

Yeah. Yeah. That, that's, that's pretty cool. How did you get into the administrative leadership track? So you're still seeing patients today, but obviously you're spending the bulk of your time now in the, on the administrative side. How did, what was there a catalyst or what was the thought process there?

I'm a strong believer. I mean, healthcare is so complicated. I'm a strong believer in physician leadership to make a difference in the life of patients and the communities. So getting this, I mean, getting in just any suit, going up the ladder, managing healthcare systems, managing academicians, researchers, and clinicians, you have less credibility and you're less, you're disconnected, even though you might have the skills, you might have the MBAs and the PhDs, all the degrees you need to make business decisions, which are absolutely important. But having physician and leaderships around healthcare who, at the same time, keep practicing to keep you grounded with the realities of what patients suffer from. What communities are going out, I mean, having interactions with family, dealing with patients' issues, health insurance. So I think the combination of a practicing clinician with executive functions leads to better health outcomes. As importantly, also leads to better, better business decisions and affects the bottom line too. So understanding both the business skills and clinical skills on someone who practices leads you to better— leads your healthcare. Most organizations, except for a few, are not-for-profit. You make better decisions while having a margin and keeping the lights on.

Yeah, that makes total sense. What drew you to Central Michigan University College of Medicine? I think you may have already foreshadowed part of the answer to this, but obviously you have a brilliant career already in Cleveland, Ohio. And then you take this role. What drew you up there?

I mean, as a country, I mean, we, I mean, I speak about it nationally. I mean, we are facing a major shortage of physicians. So existing medical schools have been established for years, increased their class size. But what other universities also came up to, came up to fill the gaps that, you know, there's shortages in rural Maine. Many medical schools are clustered in urban areas. I mean, Chicago, New York, Cleveland. LA and others have multiple medical schools. Living in small-sized communities, rural communities, there are few medical schools. So the leadership of Central Michigan University 14, 15 years ago said, we need to come, we need to come and fill the need for rural communities to start. And they started the medical school. So the opportunity to start a medical school, graduated all 7 classes myself, build it, shape the curriculum, recruit a great team. It's a, I mean, it's a medical, I mean, like every other medical school, it's a mission for us to provide physicians, both mostly rural, urban, focusing in primary care for health shortage areas. So the, it's a one-time opportunity, one-time in a lifetime opportunity to do so. Our graduates, I mean, we take a large majority of our graduates from underserved backgrounds. We're seeing a good 60% of our students go into primary care career. We have a large cadre of students going into psychiatry, which is a big shortage of, and our ranking with U.S. News and World Report reflect that we are investing in our mission. So seeing this coming to fruition, sitting on a stage graduating young minds to be future physicians, taking care of primary care needs and mental health needs of underserved communities, urban and rural. I mean, and if, and the best part of it, you get paid doing what you love.

Yeah, no, that, that's super exciting. It's always fun to pioneer something new. So when you're already passionate about something and you get to help start something new and it's filling a need for the country, uh, I think it's awesome. I, I, I love that. Tell us a little bit about the role of the dean. Like, wow, that's a big deal. So a little bit about what you do.

It's just managing, managing people and keeping them aligned for the vision and mission. The best thing to do is just hire the right people, get them the right seats on the bus. And my job is not to get in the way. My job is to manage politics, external worlds, and provide resources for my team who's outstanding. I mean, my faculty as well as my staff, they are the engine that run the medical school. My job is to protect them from politics, make sure they have the right resources to do, and as importantly for me, get out of their way.

Yeah, that's good leadership stuff right there. Uh, very important, uh, what you just articulated. Tell us about the role of digital or tech. You know, how, how do you, I have, uh, several questions on that, so you can take it a couple different ways, but how do you incorporate tech in the training? Right? Because the training's different than, than when you went through medical school when it was maybe, you know, less, less technology.

Uh, and.

You know, how do you view it? So I'm super interested in your thoughts here.

I mean, it goes throughout the curriculum. It goes from first-year medical student to residency program. As simple as the classroom where we don't have lectures, we don't have PowerPoints at this point. It's all interactive, all the technology. If I'm teaching someone about heart failure, about physiology of X and Y disease, these kids are more res— I mean, I call them kids, they're younger than my kids. They're more resourceful than you and I. I mean, they know where to go, which sites to go. So all what we have are digital libraries. We have no books, we have no PowerPoint at this point. The other tech piece of it, which is very exciting, is the simulation center. We have a state-of-the-art simulation center based in Saginaw, and we have one in Mount Pleasant. The tools you do, for example, I mean, if you were to have surgery, I mean, as if, I mean, as a patient that you go through robotics, Da Vinci, we have an actual Da Vinci robot build our sim centers. We have 3D simulation. We have built-in tools where you can practice anything as real life as possible. And we introduced digital simulation from the first year of medical school. We build in it as our students progress through their third and fourth year. And obviously you take it at a much higher level in the residency program. So the tech piece of it, I mean, there are no textbooks, we have no libraries, is core to what we do.

I love that. I'm definitely going to come and visit next time I'm with you.

You'd love the sim center. I mean, I can have you do an appendectomy or deliver twins sitting in a sim room. And we have simulated patients. The other thing we do, we disseminate our cases to other communities. So this is not just a resource for medical students. This is a resource for other professionals. I mean, Being nursing, EMS, rural hospitals. We take our sim mannequins, we simulate the cardiac arrest in the communities and how the community responds to it. So part of it is just not teaching students and residents, but meeting a community need through multiple programs we build throughout the community in Mid-Michigan and Northern Michigan.

Yeah. No, I get excited hearing about that. And I'm so glad, and I'm not surprised that how progressive your organization is. And I think it probably was a benefit to have just started 10 years ago. So you didn't have a legacy, right, of doing it, you know, any differently. So that's pretty cool. What about your role as EVP of Health Affairs? What's different about that than what you do as a dean?

Obviously, I mean, like one of our mutual friends in Cleveland back in the days quoted the term that Healthcare is a team sport, obviously. I mean, as a university, we have other allied health programs. You have master's in public health, you have a PA school, we're starting nursing schools. We have many other programs, so the ability to coordinate work with other professions and disciplines. I mean, this is psychology, this is social workers. I mean, ability to coordinate these efforts while holding a dean's title helps other programs, other students, other disciplines. And one of the other things I'm proud of, for example, is started, I mean, started an interprofessional programs the first year I came to Central Michigan University that evolved into something called Rural Health Equity Institute, where communities, I mean, north of Ann Arbor or Lansing in Michigan, I mean, this is actually 70-some counties out of 72 out of 83 counties in Michigan. Are considered health professional shortage areas. So the ability to impact healthcare communities, resources in rural Michigan through the Rural Health Equity Institute, it has been an amazing experience and one of the most rewarding I've had in the past 10 years.

Wow. That's pretty cool. I, yeah, I'm really, I was just up in Michigan not too long ago and I, I wish I would've reconnected prior to that, but I'm definitely gonna make a trip.

Back out there and, uh, we'd love to have you.

Yeah. I love what you're all doing in your mission and vision. Let's shift a little bit to leadership because you've already dropped a lot of golden nuggets, I call them, on, on leadership. But I know not everything is always, uh, perfect. So can you share a time that, uh, something wasn't perfect and how did it shape you?

Anytime you have a title, you have a position, you're, or just managing a small business. If you haven't failed in life, if you haven't made mistakes, something is wrong. You've been hiding under a rock and you have not grown. So we've all made our shares of mistakes. You just learn from them, lessons learned, and put, put the pieces back together and move on.

Yeah.

And that's life. If someone tells you I haven't made mistakes, please tell me how.

If, yeah, if someone says that they never made a mistake, then you definitely wanna avoid that person for sure. What about advice that you've received? Are there one or two things that someone shared with you along the way in your journey that have really helped you become a better leader?

One thing that helped me get centered, I mean, you need to find the balance between personal, personal and professional. You can be successful in one unless you have peace, unless, unless you're balancing the other part of your life, whether you have family, whether you have relationships, whether you have a social community. So the balance between personal and professional. is key to success. You cannot succeed on one unless you have the other piece well handled. So you need to find the right balance.

Right.

On the business side of it, one thing I learned in business school early in my career, so I'm obviously, I'm usually, I mean, my North Star keeps me focused about mission, vision. We're here for T students. We're here for that mission. One thing I learned actually at the Weatherhead School back in Cleveland in the days, if you're climbing the ladder of success and you reach the top, The last thing you want to do is find yourself that your ladder was in the wrong wall. So as you're climbing, as you're going up, make sure, I mean, this is your North Star. You're not putting work for things you're not passionate about, you don't believe in.

Yeah, that's good. Uh, I like that a lot. Yeah, it's, it's sad, right? You could be climbing this ladder and working so hard and then, yeah, you don't wanna be 10, 20, 30 years down the road. down that journey and realize, wow, this is not what I want to do, or it has no meaning for me. What about, what advice would you have for non-clinicians working in healthcare? So the example would be like, like me, and when I first met you and you provided a lot of great guidance, and I think as a result, I learned from you and other clinicians along the way, and it helped, it helped me a great deal to be successful working in healthcare. As a non-clinician, what, what do you wish more CXOs or vice presidents, you know, sort of leaders knew about working with clinicians?

I mean, healthcare is so complicated and unfortunately, I mean, as a country, we don't have the best healthcare system for what we pay for, for what we pay for and what we get in terms of outcomes at the macro level. It's very, I mean, it's very unfortunate. On, on one hand, we have some of the best technologies, some of the best, best training, best physician in the world, but our system is so broken to be fixed at this point. I mean, and I'm not gonna get political or others there. So people working, focus on what matters, don't get frustrated. And what matters is making a difference in people's life. So the IT piece of it is the backbone of what, what we do at this point. Don't get me, system don't work, systems break. you're dealing with your CMIO, CIO about technology, about softwares, about plugs in or others. At the end of the day, your North Star should be patients and communities.

Yeah.

That's what matters.

Yeah, I love that. Well, George, this has been amazing just to catch up and also just to learn more from you. And we covered a lot of different things. We covered Lebanese music for the first time ever on Digital Voices. And then we learned some of the philosophies that have helped shape you, like living with purpose. And you've mentioned the North Star several times. And, you know, you shared with us a very personal story about growing up during Civil War, and I, and I'm thankful for you to share, for sharing that. And we also talked a lot about your heart for patient care and why you got into healthcare to begin with. And then going to Central Michigan University and starting a new med school. And I love all the tech things that you talked about and that you, you were able to start, right? It's, it is great that you didn't have a legacy.

Yeah.

You know, sort of old school foundation, if you will. So you're able to start from scratch and your focus, you really embrace technology and digital. You talked about the simulation centers and then no PowerPoints, library books, things like that. And then you sort of talked about leadership and that personal professional balance. And again, the North Star and climbing the right wall as you, as we all work so hard in our lives. So is there anything we missed or is there anything you wanted to double down on? I'll give you the last word.

Uh, just trust, trust your team, treat people with respect. I mean, you're as good as your weakest link there. Your staff is as important to you. I mean, there are, I mean, culture, culture. I mean, if you're a leader, culture is as important as anything else. You can be the smartest in the pack. You can have the resources. You might not have to worry about your budgets. Unless you have a good culture, unless you have people who are engaged in your team, this is bottom-up, top-down. I mean, you're not going to be successful.

Yeah, that's, that's well said. Again, Dr. Kakano, thank you so much for being a guest on Digital Voices. You're just amazing human and clinician.

Thank you, Ed, for having me. Wishing you the best, and you have an open invitation to come and visit Michigan.

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