The Many Detours of the Yellow Brick Road with Dr. Abbey Vandersall || EP. 179

[00:00:00] It's ironic, actually, you asked that question in my head, goes right back to the two things that I said about being a hospitality brat. It's the dynamic natures of the day and it's the problem solving. I really love people asking me really complex, hard questions, getting smart on the content area, and it could be anything. My first case was a trucking case, so I could tell you all about the trucking industry in America, very bizarrely. But any industry, I just love learning the general landscape as fast as I possibly can. And then just taking a very systematic and kind of codified approach to solving the problem.

[00:00:29] Looking at all the potential solutions for the problem. Now, let's say, hypothetically, you have one, two, and three. Listing out the pros and cons of all those potential solutions and then just saying, okay, based on the pros and cons and tradeoffs, I'm going to proceed with solution B and then building a process to proceed with solution B. I really enjoy that. That's where I get a lot of energy.

[00:00:53] This is Inspiring Women, and I'm Laurie McGraw. And today I am speaking with Dr. Abbey Vandersall. And Dr. Vandersall likes to be called Abbey. She's made that very, very clear to me.

[00:01:04] Now, Abbey and I met each other when we were in New York City at one of an innovation summit where we are today is in Nashville, where Abbey lives as the VP of Vice President of Quality at AMSURG. We're going to talk about that. She is the only physician on the executive team of AMSURG. And we're going to talk about innovation. We're going to talk about what it means to be a physician leader today. And Abbey, thank you so much for being on Inspiring Women.

[00:01:33] Lori, thanks so much for having me. It's a pleasure to be here. I do feel like we need to set the stage a little bit for where we're at. This is a wonderful conference. And the podcast booth is located front and center in what can be described as a fishbowl.

[00:01:48] So apologies in advance if I get sidetracked. So we're just a lot of energy around us, a lot of enthusiasm for health care. So a lot going on today.

[00:01:54] There is a lot. And fishbowl is exactly the right word. We're in a glass booth and around us, no joke, there is Nashville country singers, sort of like live music playing. We've got a lot of people milling about. But that's okay. We've got a lot to talk about.

[00:02:09] So Abbey, let's just start a bit about, you know, you in your role at AMSURG. But before we even get to what you do in the area of quality and all that you've accomplished in that role already, maybe a little of the bio sketch.

[00:02:24] Sort of how did you get here? And as a physician, it's very hard to be a physician, but you are not just a physician. You're a physician executive leading an important company.

[00:02:33] Sure thing. So start at the beginning. I joke that I'm a hospitality brat instead of an army brat. So I was born and raised in a hospitality family, which I actually loved.

[00:02:41] I was hanging coats at weddings starting in fifth or sixth grade, and I was serving weddings in high school. Ended up actually my high school job is working as a front desk agent and ultimately a front desk supervisor for a luxury hotel.

[00:02:52] And I loved that. I loved it. If I stepped back and looked at it, I enjoyed it because it was very dynamic. No two days looked alike.

[00:02:58] And I got to help people with whatever their problems were. It might sound simple or cliche, but when I got to help somebody plan an anniversary dinner or plan a business party and they came back to me and they said, hey, it was wonderful.

[00:03:09] It was a big hit. Thanks so much for all your help. That gratitude made me feel valued and made me feel like I was adding value to society, which meant a lot.

[00:03:17] So when I went off to college, I kind of was like, hey, you're 18 years old. What do you want to major in?

[00:03:22] And for me, it was very logical because I took that and then I added my strengths in science and math and it was kind of a one plus one equals two situation.

[00:03:29] And that was health care. That was being a physician, just taking the dynamic nature, liking it to draw rewards by helping people and just math and science.

[00:03:38] All that together was health care. So went into college thinking that I was going to go to medical school, got about halfway or three fourths of the way through college and still was on the medical school path,

[00:03:47] but really found a passion and a love for preventative health and nutrition.

[00:03:51] So I actually got my master's in nutrition before I went on to medical school.

[00:03:55] And the reason I did that is I was fortunate enough to have someone pause and tell me, you want to do that in advance so that you can weave the threads of nutrition into medical school,

[00:04:03] because no one is going to weave those threads for you. Unfortunately, I had maybe one or two lectures on nutrition exclusively in all of my medical school education.

[00:04:13] There were threads here and there, but there was no theme. So I'm glad I was able to do the nutrition degree in advance and then weave those threads for myself.

[00:04:20] Then I got about halfway through medical school and decided that it wasn't the path for me.

[00:04:25] There was a myriad of reasons for that, but my kind of I really did have a light bulb moment.

[00:04:28] I was sitting in an auditorium and it was our first business of health care lecture that we had in all of health and all of medical school.

[00:04:36] And I'm listening to them talk and they flash up that graph that shows percent of GDP spent on the y-axis and health care outcomes on the x-axis.

[00:04:43] And I was just enthralled. I mean, the U.S. is, as you know, like falling off that graph.

[00:04:47] And I'm looking at it and I was like, this is what I want to solve. These are the types of problems I want to solve and I'm interested in.

[00:04:52] Go back to rotations later that day and I'm watching a resident essentially do kind of the CYA move of placing all the orders.

[00:04:59] And as she's going through and she's clicking, I'm just seeing dollar sign, dollar sign, dollar sign.

[00:05:04] And so for me, it was a moment where I stepped back and said, OK, this is a problem that actually will stay up till midnight reading about and really want to dive in.

[00:05:10] I want to have countless conversations about it. So that was my niche.

[00:05:13] And then in contrast, when I am up till midnight, what I'm studying is antibiotics.

[00:05:18] So I just kind of did a self-reflected moment and said where my areas of passion lie, where my areas of interest lie aren't clinical medicine, still health care.

[00:05:26] But it's more solving the pervasive problems of health care at large.

[00:05:30] So with that said, I took a very atypical path and I went into consulting afterwards.

[00:05:34] That required me to be very scrappy, to be honest with you.

[00:05:36] I remember clear as day when I told my medical school that I wasn't going to pursue residency.

[00:05:41] They lined me up in a meeting and they had four deans on one side of the table and they had me on the other.

[00:05:47] The inquisition.

[00:05:48] The inquisition. And it was essentially an hour of them asking me variations of the same question, which was, are you nuts?

[00:05:54] Like, why on earth are you doing this?

[00:05:57] And they ultimately kind of excused the meeting by saying, oh, well, you can always come back.

[00:06:01] Don't worry.

[00:06:01] Like, the door is still open for you.

[00:06:03] You can always come back.

[00:06:04] And I was like, all right.

[00:06:05] So the door is definitely open.

[00:06:07] But I just realized that I had to create my own path.

[00:06:11] I kind of felt, I'd say medicine is like falling in a yellow brick road.

[00:06:14] You know what's expected of you and you know what the next step is.

[00:06:17] The next steps are very well built if you are following that very traditional path.

[00:06:20] But if you want to take any sort of a typical step, there is no path.

[00:06:25] Not even a dirt path.

[00:06:26] You have to step off the yellow brick road and create the path for yourself.

[00:06:30] I think that's changing, which is wonderful.

[00:06:32] I was actually having coffee with someone just last week.

[00:06:34] And they told me there is a program that's being created just now at Vanderbilt for third-year medical students who find themselves in the position that I find myself in.

[00:06:41] And it's trying to help them get the resources to brainstorm.

[00:06:45] Hey, what can you do?

[00:06:46] What are you interested in?

[00:06:47] What problems do you want to solve?

[00:06:48] These are very talented, very smart individuals who can solve great problems in the world.

[00:06:53] And so it's just about supporting them on that next step.

[00:06:56] Well, in that time of sort of like yellow brick road, sort of like, you know, pathway navigation, a lot has changed in the world of medicine and physicians in particular.

[00:07:06] I will say, you know, the path from like being a hospitality brat, this is the first time that has led to becoming a physician to, you know, doing the business work that you've done.

[00:07:18] You didn't sort of like just start out in consulting.

[00:07:20] You started out at Bain Consulting, so sort of top brand in that space.

[00:07:25] Why don't you just like take us there?

[00:07:27] And what was interesting about that?

[00:07:28] Because that is so, you know, you're kind of like starting at the big boy school, if you will, of learning about consulting and business.

[00:07:34] Yeah, it was a deep dive.

[00:07:36] That's for sure.

[00:07:36] I mean, I jumped in with two feet.

[00:07:38] I joke that I got like an MBA in three months.

[00:07:40] Then I got a Bain degree in like three months.

[00:07:41] The first six months were just rapid fire, as you might imagine, really trying to get up to speed.

[00:07:45] Because even you go into health, you go into consulting and in the first day they're using terminology that I just don't even know what it means.

[00:07:52] So truly starting from this ground zero, so to speak.

[00:07:55] I was very fortunate.

[00:07:56] There's a partner in the Bain DC office who also had a PhD and she came from the PhD path.

[00:08:01] So she was very empathetic to my experience, but also saw the opportunities and me and the skill set that I brought to add to Bain and the culture and the contact knowledge at Bain.

[00:08:11] So she really helped develop me and kind of ease me into it as best as she could.

[00:08:15] But that's Bain's strength, in my opinion.

[00:08:18] I don't know that everybody would say that that's the case, but for me it was wonderful.

[00:08:22] It was six months of intensive, nonstop learning.

[00:08:26] And I thrived in that environment.

[00:08:28] So it's really analogous to being pushed into the deep end and just saying, are you going to sink or are you going to swim?

[00:08:32] And I realized different strokes for different folks.

[00:08:34] That's not going to work for everyone.

[00:08:35] But for me, it was wonderful.

[00:08:37] So what was exciting about it?

[00:08:39] So, you know, you're certainly learning a lot about business.

[00:08:41] But what about the businesses was interesting?

[00:08:44] Was it the sort of like, you know, how did they grow?

[00:08:47] Where was it?

[00:08:47] Was it the innovation path or was it just, you know, the math and science part of it?

[00:08:51] It's ironic.

[00:08:52] Actually, you asked that question in my head goes right back to the two things that I said about being a hospitality brat.

[00:08:56] That it's the dynamic natures of the day and it's the problem solving.

[00:08:59] I really love people asking me really complex, hard questions, getting smart on the content area.

[00:09:05] And it could be anything.

[00:09:06] My first case was a trucking case.

[00:09:07] So I can tell you all about the trucking industry in America very bizarrely.

[00:09:10] But any industry, I just love learning the general landscape as fast as I possibly can.

[00:09:16] And then just taking a very systematic and kind of codified approach to solving the problem.

[00:09:21] Looking at all the potential solutions for the problem.

[00:09:23] Now, let's say hypothetically you have one, two, and three.

[00:09:26] Listing out the pros and cons of all those potential solutions.

[00:09:28] And then just saying, okay, based on the pros and cons and tradeoffs, I'm going to proceed with solution B.

[00:09:33] And then building a process to proceed with solution B.

[00:09:36] I really enjoy that.

[00:09:37] That's where I get a lot of energy.

[00:09:38] Okay.

[00:09:39] You then came back to healthcare.

[00:09:40] And so this is Envision Healthcare.

[00:09:43] And you moved into quality.

[00:09:45] You also were the chief of staff for the organization and had responsibility for, I think it was 25,000 clinicians in terms of their quality.

[00:09:57] So tell us about that.

[00:09:58] That's a pretty big responsibility and an enormous jump of professionalism.

[00:10:03] Yep.

[00:10:03] So I actually pivoted back into healthcare on the heels of COVID.

[00:10:06] I pivoted back in September of 2020.

[00:10:08] And I think that's because as much as I loved solving the problems, and honestly, I loved the culture and the environment of Bain, I would have been there forever if I could.

[00:10:16] And I could work those hours, honestly.

[00:10:20] I learned a lot.

[00:10:20] But then I saw healthcare playing out in a crisis mode right in front of me.

[00:10:24] And I was just drawn to going back into it and seeing how I could be, again, part of the solution instead of just contributing and snowballing with some of the healthcare challenges that we have today.

[00:10:32] Yep.

[00:10:32] So took that pivot.

[00:10:34] Honestly, I joined.

[00:10:35] I reported to the president and CMO.

[00:10:37] And his name is Dr. Chan Chuang.

[00:10:38] And he's out and born and raised in the California system.

[00:10:41] So he really grew up in the value-based care system.

[00:10:44] And I know value-based care is a word that's thrown around a lot.

[00:10:47] And everybody has a different definition for it.

[00:10:50] So I use it as a quite literal phrase, meaning how can you optimize a numerator, which is quality of care delivered, while minimizing the denominator.

[00:10:58] Are we doing a math lesson right now?

[00:10:59] A little math lesson?

[00:11:00] And just like FYI, audience.

[00:11:02] Like Abby's actually drawing this out for me.

[00:11:05] I talk with my hands.

[00:11:05] Pointing to the chalkboard.

[00:11:08] Miss my calling.

[00:11:09] That's my next career move.

[00:11:10] I'm going to be a math teacher.

[00:11:11] I do love math.

[00:11:12] Math has to do.

[00:11:13] I'll do that all day long.

[00:11:15] So he kind of sold me on it.

[00:11:17] And he said, hey, as you said, we have 25,000 physicians.

[00:11:20] At the time, it was about 20% of all emergency physicians nationwide.

[00:11:23] We had a massive footprint.

[00:11:24] We had seven service lines or seven areas of care that we provided.

[00:11:27] And he said, if we can change this company from the inside out, we have fundamentally changed health care from the inside out.

[00:11:33] And that was really attractive to me.

[00:11:35] I was like, here is an incredibly talented, incredibly hardworking individual with a true vision and wants to put health care into a more positive direction, really optimizing that quality for cost.

[00:11:45] And I would love to get on this roller coaster ride with him.

[00:11:47] So I did.

[00:11:48] And we made tremendous strides in the years before we filed for bankruptcy.

[00:11:51] I joined in September of 2020, as many of your listeners probably know, and Vision filed in May of 2023.

[00:11:57] So it was about a three and a half year journey.

[00:11:59] And we did make tremendous strides.

[00:12:00] At one point, we had a $10 million grant, essentially, from the board of directors to drive innovative care pilots.

[00:12:08] So we've got about four or five pilots off the ground and saw some great success with those.

[00:12:12] But then ultimately, just the headwinds of the health care industry is what put everything on pause.

[00:12:16] And then, as I mentioned, Vision filed in May of 2023.

[00:12:19] Tell me about the quality aspect of what you were doing there, because that is such an important area.

[00:12:25] And that has a lot to do with costs and cost measures.

[00:12:29] So how did that work show up at Envision?

[00:12:32] And because then I want to get to AmSurg, what you're doing there.

[00:12:36] I focus a lot more on quality at AmSurg than I did at Envision.

[00:12:40] So at Envision, I served more.

[00:12:42] I was initially chief of staff.

[00:12:43] And then I was senior vice president of clinical operations, which is like a clinical field team.

[00:12:47] And then I wrapped as vice president of clinical strategy and also head of the Clinician Value Institute,

[00:12:52] which is really trying to drive support for those 25,000 physicians.

[00:12:56] We've heard that a ton this week about the labor shortage and the number of physicians who are feeling burnt out,

[00:13:01] just exacerbating that labor shortage.

[00:13:03] So that was my task was how do I support those 25,000 physicians and make sure that they can feel empowered and supported

[00:13:09] just to care for patients day in and day out and not worry about all the other things going around them.

[00:13:13] So that was what I did at Envision.

[00:13:15] Now I focus a lot more on quality at AmSurg.

[00:13:17] Yep.

[00:13:18] Okay.

[00:13:18] So like bring us now to the next phase of so like AmSurg, which is, you know, came out of the Envision Health bankruptcy.

[00:13:25] That's correct.

[00:13:26] So when Envision Health Care Company filed for bankruptcy, it's the company essentially split into two.

[00:13:30] So Envision Medical Group went one way and AmSurg, which is the company I'm now with, went the other.

[00:13:35] For those listening who aren't familiar, AmSurg is the largest independent ambulatory surgery center management company in the nation.

[00:13:41] We have over 250 centers in over 35 states, including the District of Columbia.

[00:13:46] And very stereotypically, we just partner with physicians to run a surgery center.

[00:13:51] So for example, Dr. Smith and his three colleagues are gastroenterologists and they want a surgery center to do their colonoscopies.

[00:13:58] That we help partner with them to make sure that that surgery center where they're doing their colonoscopies is a well-oiled, well-run, very safe, optimal clinical care and quality machine.

[00:14:06] I am, as you mentioned, the executive leader overall of clinical.

[00:14:09] So we have four institutes of clinical.

[00:14:11] One is quality, as you mentioned.

[00:14:13] One is risk and safety, which is exactly what it sounds like.

[00:14:17] The phrasal here in health care, which we all have to just accept, is to err as human.

[00:14:20] So unfortunately, occurrences will happen in health care.

[00:14:23] And it's not about being punitive or pointing fingers when they do.

[00:14:26] It's about learning from them.

[00:14:27] So doing a really deep dive analysis to figure out what occurred, what went wrong, and how can we learn from them and then push out education to mitigate any sort of future occurrence in that vein.

[00:14:36] The second institute is, or the third institute is a clinical field team, clinical operations.

[00:14:42] And then the fourth is accreditation and regulatory.

[00:14:45] So just making sure that we are compliant with all of our accreditation and regulatory standards.

[00:14:49] What's happening there?

[00:14:51] Are the regulations actually increasing?

[00:14:53] Are they burdensome?

[00:14:54] Are they helpful?

[00:14:55] How do you, like, you know, on that fourth pillar there, which is a must do, have to do, you know, no matter what you're doing, you've got to be compliant.

[00:15:05] Is it helpful to you in terms of, like, figuring out the programs that you need to do?

[00:15:10] Is it becoming harder, you know, over time?

[00:15:13] And people want to, when they're going into the health care system, they want to feel safe.

[00:15:17] They want to feel secure.

[00:15:19] They want to expect excellent outcomes.

[00:15:22] That is not what always happens.

[00:15:23] And so these areas of quality and all the different components that you're putting in.

[00:15:27] But I'm wondering how the regulatory aspects of this are changing.

[00:15:31] They aren't changing very rapidly, as you might imagine, with anything in terms of regulatory.

[00:15:36] And both the accreditation and regulatory standards, honestly, I just see as a stamp of approval on the end of work that we already should be doing and already are doing.

[00:15:43] Okay.

[00:15:43] So what I mean by that, and I think those four institutes are very well intertwined.

[00:15:47] So what happens, as you said, patients want to ensure, feel that they have optimal clinical care being provided to them and optimal patient safety.

[00:15:54] And the way that I ensure that is, it's a circle.

[00:15:57] Like I said, they're all intertwined.

[00:15:58] So I'll just start at a particular location.

[00:16:00] So we provide care.

[00:16:01] We need to measure the quality outcomes of those care.

[00:16:04] So that's that whole clinical institute, making sure that we are measuring, tracking, and trending, and responding to all of our clinical care delivery metrics and also all of our clinical operations metrics.

[00:16:14] If we find that there are any trends where there are areas of opportunity, that's where the field team comes in.

[00:16:19] So we can deploy the field team in a SWAT manner, so to speak, and go out to these centers and train boots on the ground.

[00:16:25] They're very highly educated.

[00:16:26] Many of them have been in health care for decades.

[00:16:28] And just train the staff there and say, hey, this might be a slightly better way to do this.

[00:16:32] Or, hey, do you have those files organized over here?

[00:16:34] Just making sure that everything is buttoned up.

[00:16:37] Then, as I mentioned, to err as human, something inevitably will go awry here or there.

[00:16:42] Hopefully it's extremely infrequent.

[00:16:44] But just learning from those opportunities and pushing out education to respond to it.

[00:16:47] But all accreditation and regulatory does is come in at the end to say, you're doing all of those things.

[00:16:51] So regardless of whether accreditation and regulatory were there or not, I don't think our ways of working, honestly, would change.

[00:16:57] I hope they wouldn't change.

[00:16:58] We almost have like a mock accreditation team.

[00:17:02] And they go out and they do what we call center assessments.

[00:17:04] And they spend two days on a site turning over every stone they possibly can.

[00:17:09] And, again, it's not in a punitive nature.

[00:17:11] The individuals who run our centers are called center administrators.

[00:17:14] And they work in and hand with those center administrators to say, hey, Sarah Smith, are you totally familiar with X, Y, and Z?

[00:17:20] Is there any sort of education I can provide you to make you more comfortable with it?

[00:17:24] Or they make sure that the facility is in good condition.

[00:17:27] Or they make sure that the fire exit is not blocked.

[00:17:29] I mean, truly, they turn over every stone they possibly can think of in those two days.

[00:17:34] And they do it in a collaborative educational manner with the mini CEO that's center administrator of the center just to make sure the center is completely buttoned up.

[00:17:43] So we are doing those far more frequently than even Triple HC, for example, is doing it.

[00:17:48] So by the time Triple HC comes along, we already know what to expect.

[00:17:51] Abby, what are the hard problems you're trying to solve for today in that space?

[00:17:56] Because I have to imagine, I mean, you're busy.

[00:17:58] 250 centers is a lot of different locations, a lot of different people, dynamics, geography issues, staffing issues, all of those things.

[00:18:07] What are the hard problems that sort of come across your desk that you're just trying to solve for?

[00:18:12] The first and foremost is the labor shortage.

[00:18:14] We've heard that, like I said, a lot this week.

[00:18:15] We do have a lot of turnover.

[00:18:16] We're seeing far less of it now that we get further and further out from COVID than we were seeing at COVID.

[00:18:21] But it does have a snowball, unfortunately, into clinical.

[00:18:24] So just to use a specific example, a hypothetical example, if somebody has been trained and working in the health care space for 20 years, it just becomes muscle memory.

[00:18:34] You know, they know exactly how to speak to a patient.

[00:18:36] They smile.

[00:18:37] They do it with ease.

[00:18:38] They're very comfortable.

[00:18:39] They make sure that they're supporting that individual while they're getting dressed after their procedure, all of things.

[00:18:44] It is ingrained in them.

[00:18:46] On the contrast, if we have somebody who comes into a center and they only have a year or two experience, perhaps none in the ASC setting, we're trying to train them.

[00:18:54] And I have no doubt that they're putting their best effort forward every single day, but it's just not ingrained with them.

[00:18:59] So one thing that we have seen, we have a whole portfolio of clinical metrics, as you might imagine.

[00:19:04] And I monitor with heavy scrutiny, especially the ones that we as a management company can control.

[00:19:09] And one of the ones that I focus on is falls and fall prevention.

[00:19:12] Yep.

[00:19:12] So a big part of fall prevention is just making sure that after a procedure has occurred, that we are assisting patients while they're dressing.

[00:19:20] And this is a challenge because many of our patients are otherwise pretty healthy.

[00:19:23] So as you can imagine, if you think you're an otherwise healthy 45-year-old, you just had a little anesthesia, no big deal.

[00:19:29] Hey, I can get dressed.

[00:19:29] Not a problem.

[00:19:30] You don't realize until you're going to put your leg in your pants and all of a sudden you're falling over.

[00:19:34] Well, and the spaces, I mean, the spaces in surgery centers are odd.

[00:19:38] You know, I mean, you've got maybe a curtain, you know, you're having to deal with some wires or something.

[00:19:43] Maybe you've got tape around your arm from an IV.

[00:19:46] I mean, there's a million different things that are, I'm assuming, unpredictable in terms of there.

[00:19:51] So like, you know, I've always been so interested that, you know, we have to worry about falls.

[00:19:56] And it just seems like the simplest of things.

[00:19:58] But once you're in those environments, those acute environments, like my goodness, there's a million different ways that, you know, regardless of whether you're under anesthesia, just walking around, you can fall as like a visitor, you know.

[00:20:11] And that's our job is making sure we can mitigate all those weird things as much as possible, but also just making sure we can educate.

[00:20:16] We had one patient, unfortunately, that had a fall just because his clothing was set near him in the room.

[00:20:21] And again, he otherwise perceived himself to be fine.

[00:20:23] So he took it upon himself to get out of bed and try to get dressed.

[00:20:26] Right.

[00:20:26] And those are the very little but very impactful things that a lot of people don't think about.

[00:20:31] If you've been practicing and if you have been in the health care setting for 40 years, you've learned perhaps even the hard way.

[00:20:37] Don't set the patient's clothes near the patient because they might take it upon themselves to try to get dressed.

[00:20:41] Or you have communicated four times by that point.

[00:20:44] Mr. Smith, please don't try to get your dressed on your own.

[00:20:46] I will help you in a minute.

[00:20:47] Please, please take a pause.

[00:20:48] And so that's what we're seeing is there has been a labor shortage.

[00:20:52] And that is, to some extent, rippling into clinical quality performance very lightly.

[00:20:57] But it's just something that I'm keeping my eye on.

[00:20:59] And I'm pressing the education pedal a lot more this year than I anticipated to try to mitigate that as much as possible.

[00:21:05] So that's one area.

[00:21:06] The second, I would say, is innovation.

[00:21:07] And this is something that just honestly makes me excited and something I really have passion for.

[00:21:12] But I want to make sure that we are delivering optimal clinical care to patients when and where they need it most.

[00:21:19] So we're actually working right now on launching a pilot with Exact Sciences who are the makers of Coligard.

[00:21:24] And I don't know if you're familiar.

[00:21:26] Coligard, many of your listeners are probably familiar because they advertise a lot.

[00:21:29] They're on the TV.

[00:21:30] They're on the TV all the time.

[00:21:31] They got the dancing box.

[00:21:32] It's an at-home colon cancer screening solution.

[00:21:35] Most people don't realize, though, it's actually a two-step test.

[00:21:37] So you do the at-home portion.

[00:21:39] If you get a positive result, you still need what's called a confirmatory colonoscopy.

[00:21:44] The compliance rate with the first step is actually very high.

[00:21:47] It's about 80%.

[00:21:48] And that's for numerous reasons.

[00:21:49] But one being Exact has wonderful care navigators that will call patients and remind them and make sure they're following up on this ask to get the Coligard done.

[00:21:57] The compliance rate with that second step, that confirmatory colonoscopy, is only about, they tell us, 20% to 50%.

[00:22:03] That's a wide range, so let's just call it 40%.

[00:22:06] So despite telling people that they have a positive result and there is something of concern there, there are markers of concern, and we might believe they are at high risk potentially of having colon cancer, there's a 40% drop off.

[00:22:17] So to do any sort of action in life, right, your motivation has to be higher than your barriers.

[00:22:23] And that, to me, is just stunning because I step back and I look at it, and the motivation has to be inherently pretty high at that point.

[00:22:29] Someone has warned you that you're at high risk of having colon cancer, which tells me the barriers are also pretty high.

[00:22:34] So we are partnering with Exact to try to learn a lot more about those barriers and provide high-touch care navigation to those patients that have been identified with a positive test.

[00:22:43] So we're doing this for about 10,000 patients.

[00:22:45] Yep.

[00:22:45] And just trying to figure out what we can learn from them and how we can support them to get that confirmatory colonoscopy done.

[00:22:50] Are you thinking that the sort of, I'll just call them at-home diagnostics are, I mean, Cologuard is one of what are other tests that are out there for, you know, at-home diagnostics that you would otherwise have to do with blood draws or things of that nature.

[00:23:08] You can even do some of those finger pricks, not full blood draws at home.

[00:23:12] But what are you seeing there that you're excited about?

[00:23:15] Clearly this pilot has a lot of promise.

[00:23:18] Are there others that you're looking at?

[00:23:19] It's going to snowball, that's for sure.

[00:23:21] We actually, we had an investor call a couple of weeks ago and this ended up being a point of discussion for about half of it, which nobody expected, as you might imagine, an investor call.

[00:23:29] But I think individuals on the call were just genuinely curious because for those who aren't familiar, the blood-based colon cancer test was recently FDA approved.

[00:23:37] The sensitivity and specificity of it does not compare, unfortunately, to Cologuard, for example, or other at-home colon cancer screening tests.

[00:23:45] So it's something to monitor.

[00:23:47] But if I had to put a stake in the ground, I would say yes, 20 years out from now, whether you have a finger prick or blood draw and whether it's done at your home or it's done at a physician's office when you're either having your preventative care visit or you're having other medical care delivered.

[00:24:02] I think those, it's going to be a mass screening panel.

[00:24:06] There are companies out there, Gallery, for example, being others.

[00:24:08] I know Exact is starting to get in the space as well of just looking at these early cancer identification markers.

[00:24:14] So I think we're probably a couple decades away from that, but I do see that's where it's going.

[00:24:18] The caveat with that is we just need to ensure appropriate safeguards.

[00:24:22] Just imagine the average American, Sarah Smith, receives this result and she's got all of these markers.

[00:24:27] Well, how do we support her in letting her know what that means and what to do with it?

[00:24:31] There's going to be a lot of markers that turn positive, but they might be a 2% increased risk.

[00:24:37] Would we actually want somebody taking action when it's only a 2% increased risk versus the average population?

[00:24:42] That's something around public health.

[00:24:44] Yeah, and it's also like, you know, arming patients with education or, you know, just people.

[00:24:49] Like you have, and once you start to get these tests and then, you know, Google is your medical diagnostic,

[00:24:54] I mean, that is just a morass of just, you know, the worst things in the world are going to happen to you,

[00:25:01] which is not the case.

[00:25:02] You need clinical guidance and that clinical guidance needs to come from, you know, trusted sources.

[00:25:08] And so that sounds like the direction that you're going in.

[00:25:11] And we need to also not burden the healthcare system.

[00:25:13] So like you said, if somebody gets a report, they themselves need to know how to interpret it

[00:25:17] and what the best next steps are.

[00:25:19] And we need to also proactively prevent all of these patients who have tested

[00:25:23] from just sprinting towards a healthcare system because as of now,

[00:25:27] we can't support all of them in an appropriate manner.

[00:25:29] So just making sure they're armed with the information about best next steps.

[00:25:32] Yep.

[00:25:33] So Abby, how long have you been doing this work at Amsurge now?

[00:25:37] A little over a year.

[00:25:38] A little over a year.

[00:25:39] So, okay, so that's sort of like at the early stage and the beginning.

[00:25:42] So, and you've got lots of challenges that you're thinking about, innovation that you're excited about.

[00:25:47] What, as a physician leader, again, the one physician executive as part of the leadership team there,

[00:25:53] what's been surprising to you in terms of that you've been better at

[00:25:56] than perhaps you thought when you started this journey?

[00:26:00] Making impacts in patient experience.

[00:26:02] So we, like many companies, measure our patient experience.

[00:26:05] And for those of you who aren't familiar, if you haven't had a medical experience,

[00:26:10] you go through the care and after your care episode, you get a survey on the back end

[00:26:12] and ask you about things that are really positive and also areas of opportunity.

[00:26:17] And I have been stunned.

[00:26:18] I launched at the top of this year a program that was directed at really,

[00:26:23] I'm very passionate about making sure that care is patient-centric.

[00:26:26] And I actually go so far as to say patients should be the consumers that we continuously make sure are supported.

[00:26:34] And I know some people push back on me in using the word consumers.

[00:26:36] But I want to make sure the patients are at the center of the care.

[00:26:38] I'm here for it.

[00:26:39] I'm here for it.

[00:26:40] Honestly, I feel like our expectations need to be so high, you know, of the entire healthcare system, ecosystem.

[00:26:48] And patients need to be more demanding.

[00:26:51] And that will help.

[00:26:52] The additional pressure will help.

[00:26:54] It will.

[00:26:54] And patients need to have agency over their own health journey.

[00:26:57] I don't think we're going to make any sort of notable change in healthcare just by continuously top-down directive telling people what they need.

[00:27:05] Patients and therefore consumers need to be demanding it of us.

[00:27:08] And we need to be responding to them back to the customer-centric, in a customer-centric way that supports them on their journey.

[00:27:15] So that's an area of interest and passion for mine.

[00:27:18] So I launched this program at the top of the year that was just about little changes, behavioral changes.

[00:27:23] I'm actually playing this in my head in real time, realizing this probably goes all the way back to the hotel world again.

[00:27:28] But it's just little things like saying, hey, good morning, Mrs. Smith.

[00:27:31] Welcome to X Center.

[00:27:33] Really glad to have you.

[00:27:34] Do you have any questions this morning?

[00:27:35] Yep.

[00:27:35] Smiling, using their name, making eye contact with them, greeting their friends and family members who are also in the room, not just ignoring them as if they're not part of the care journey.

[00:27:44] Little things like that.

[00:27:45] We just launched at the top of this year.

[00:27:46] We saw the highest patient experience score in AMSURG's history ever in June and the third highest monthly score ever in August.

[00:27:53] And year to date, and I'm really pushing towards the end of the year and hoping this stays the case.

[00:27:57] Year to date, we have the highest average patient experience score.

[00:28:00] Congratulations.

[00:28:01] Thank you.

[00:28:02] That's been the – and that's truly a team effort.

[00:28:03] I can't do it for sure without my team.

[00:28:05] But that's been the biggest win and the biggest thing that I'm shocked at how effective it is, which is eye-opening, right?

[00:28:11] And it matters.

[00:28:11] And it matters a lot in terms of like how people are going to actually do, what the outcomes will actually be in terms of their health.

[00:28:18] And look, let's face it, like any procedure, no matter how minor, is scary.

[00:28:22] Like I'm – like I just like flat out, like we have to remember how human it is and how vulnerable you are when you're having any procedure done.

[00:28:32] I say this as somebody who's had, you know, multiple, the smallest of things with the one little stitch and a piece of blood or just little drip, and I am out.

[00:28:42] I'm just like, you know, I have to like go to bed.

[00:28:44] I can't do a thing.

[00:28:46] It's a disaster.

[00:28:47] I didn't want to interrupt you, but I want to hammer this point home.

[00:28:50] This is all too real.

[00:28:52] I think people – there's almost like a bit of shame or fear of their shame of the health care system.

[00:28:56] I, as a physician, am petrified of the health care system.

[00:28:59] I just personally have an overactive nervous system, and I gratefully have not had a lot of procedures, but I fully have white coat syndrome.

[00:29:06] I remember I got in a car accident 10 years ago or so, and my blood pressure and heart rate was through the roof.

[00:29:12] And the EMS team was like, oh, you are certainly going to the hospital.

[00:29:15] I'm grateful I had learned enough about myself and my body at that time just to say, give me a moment.

[00:29:19] I will calm down.

[00:29:20] Just let me sit here for 10 minutes.

[00:29:22] My body just swings.

[00:29:23] It swings very high, and then it can also swing very low.

[00:29:25] It's just who I am.

[00:29:27] But all that to say, like, I go to my primary care physician, and I'm petrified.

[00:29:30] My heart rate is like 108.

[00:29:32] Yep.

[00:29:33] So it's totally normal.

[00:29:34] It's totally acceptable.

[00:29:35] And that's, again, I want to empower patients to speak up for themselves and how they're feeling and also to empower themselves to find a physician where they potentially only have a heart rate that goes to 98.

[00:29:45] I'm not sure we're going to get it down to 60, but just someone that makes you feel a little bit more comfortable, someone you can relate to, someone who hears you out.

[00:29:51] You have every right as a patient to demand that, and I encourage patients to demand that and seek that.

[00:29:57] I'm just going to double click on that even further.

[00:29:59] I mean, literally this morning, I was on the phone with a friend who is a physician.

[00:30:05] She is in a different city than her home.

[00:30:08] She needed to go to the emergency room.

[00:30:11] And she is a physician, and she knows all the things, but she's nervous, and she's out there.

[00:30:17] And, you know, I've talked to her multiple times this morning, and she's fine.

[00:30:22] And some of the things that made a difference to her, it's like, you know, are you getting good care?

[00:30:26] Are you asking the right questions?

[00:30:28] Are they treating you the right way?

[00:30:29] Are they respecting you?

[00:30:30] All of those types of things.

[00:30:32] The physician sat down and spoke to me.

[00:30:35] And that one little thing, the way she said it, you could tell it just was a calming moment for her to be spoken to as an adult, as a, you know, human, as a whatever it is.

[00:30:48] That was a calming moment for her.

[00:30:50] So I just think that those little things that you're focused on, the hospitality beginning that you talked about is an important thing to be bringing and will have dramatic impact on quality outcomes and all of the important things that people need.

[00:31:05] So, okay, so that's my, like, story supporting you, Abby.

[00:31:08] I mean, this is all about you.

[00:31:09] Well, no, you're totally accurate.

[00:31:11] And like you said, it's the little things that add up and matter.

[00:31:13] I think we see that in our data.

[00:31:14] And like I said, that was the thing I was most surprised by this year.

[00:31:17] I was surprised by how rapidly it was effective.

[00:31:19] But I think we all should take that as a health care learning.

[00:31:22] Back to the point about accreditation regulatory.

[00:31:24] Most health care systems or care settings have phenomenal policies and process in place and wonderful clinicians providing care day in and day out.

[00:31:33] It's the little things that change the experience.

[00:31:36] So if we can take that learning, whether it be sitting down, smiling, being more empathetic, all of that would start to snowball into a much more positive experience.

[00:31:44] Because right now, if you ask people about their relationship with the health care system, you're going to get adjectives like fear, cost, dread, anxiety.

[00:31:54] I mean, all negative adjectives.

[00:31:56] And we're never going to be able to empower people to be proactive about their health care journey and take agency of their health care journey and seek some of this preventative medicine until they say, hey, it's a system that listens to me.

[00:32:08] Right.

[00:32:08] It's a system that, you know, it might be uncomfortable, unfortunate because that's an answer of health care.

[00:32:12] But coming out of it, I feel educated.

[00:32:15] I feel empowered.

[00:32:16] I feel heard.

[00:32:17] I feel good about myself because I took action on taking care of something that I needed to take care of, both for myself and then also potentially for friends or family.

[00:32:25] So until we can turn it into a more rewarding and appropriate experience, I think we're just always going to be coming up against that battle.

[00:32:32] Yeah, I think I'd stay focused on that word consumer.

[00:32:36] I think it's a good one.

[00:32:37] And I think you're really bringing it in terms of your outlook there.

[00:32:40] Abby, as we close out on this Inspiring Woman conversation, we started with hospitality, moving to nutrition, moving to being a physician and now a business executive that you are.

[00:32:51] You're all of these things.

[00:32:53] As you look ahead these next couple of years, is there anything else you're going to add to that exceptional portfolio of what you've already done?

[00:33:01] Well, first and foremost, the thing, honestly, that's most important to me.

[00:33:04] And it's not adding to.

[00:33:05] It's already there.

[00:33:05] But the thing and most important to me, I hope people just describe me as a daughter, a family member and a friend.

[00:33:10] I always try to keep that as my I'll use a Bain phrase.

[00:33:13] That's my true north.

[00:33:14] That's what gets me out of bed in the morning is making sure that I'm a supportive, loving, caring daughter, family member and friend.

[00:33:20] So I always just try to keep that as my number one descriptor, if you don't mind.

[00:33:24] And then honestly, I hope to be a founder.

[00:33:27] That's the one area of opportunity that's on my radar.

[00:33:29] I know that's how we got connected.

[00:33:35] Now, I don't know that I will be founder and CEO.

[00:33:37] I don't know that I am necessarily I even had a conversation with an incubator last week and I was honest with them.

[00:33:42] If you know me, you know I'm a straight shooter.

[00:33:44] And I said, I don't know that I am the best CEO to take a company from zero to one.

[00:33:47] Just knowing me and my skillset, I might be better to go from one to five or three to six or whatever it might be.

[00:33:52] But I see a lot of areas of opportunity in health care.

[00:33:57] And I'm very fortunate to have had a myriad of experiences.

[00:34:00] I think one of the things that holds health care back from innovation is that most innovation in most industries comes from boots on the ground individuals.

[00:34:07] You have individuals doing a process day in and day out and saying to themselves, there's got to be a better way.

[00:34:13] And they create that better way.

[00:34:14] Unfortunately, health care and fortunately or unfortunately, unfortunately, in this context, health care demands almost perfection.

[00:34:21] And so you really get physicians and care leaders doing the same thing day in and day out and just trying to strive for perfection, which inhibits creativity or innovation sometimes.

[00:34:32] And so I think we've got to break through that a little bit.

[00:34:35] And I am fortunate, I think, because I've jumped around so much, I have seen health care from multiple lenses.

[00:34:41] And I've gotten a lot more comfortable with pushing the limits in some areas and arenas.

[00:34:45] So I hope to take advantage of that kind of 360 atypical view and drive health care to a more positive direction.

[00:34:51] I don't think it's just a little bit, though, Abby.

[00:34:53] I think it's a lot.

[00:34:54] I mean, we're in Nashville.

[00:34:55] And so Nashville is one of these very, very interesting locations.

[00:34:59] There's so much innovation going on.

[00:35:02] But there's also so much of just staying the same.

[00:35:05] You know, like, you know, health care was built here in Nashville in many ways.

[00:35:09] And so this, like, grounding in just status quo is quite pervasive here in Nashville.

[00:35:17] Yet there are just, there's just, like, innovator after innovator after innovator who keeps coming back or is already here like you are.

[00:35:24] So I think the opportunity is really available.

[00:35:26] But it's going to take a lot of energy, a lot of smarts, a lot of, you know, chops, if you will, that you certainly have.

[00:35:33] And I'll be looking forward to seeing what's happening for you, Abby.

[00:35:35] So I just want to thank you for being on this Inspiring Women episode.

[00:35:39] And I've been talking to Dr. Abby Vandersall.

[00:35:42] And Abby, thank you so much.

[00:35:43] Lori, thank you so much.

[00:35:44] It's been such a pleasure.

[00:35:46] This has been an episode of Inspiring Women with Lori McGraw.

[00:35:49] Please subscribe, rate, and review.

[00:35:51] We are produced at Executive Podcast Solutions.

[00:35:55] More episodes can be found on inspiringwomen.show.

[00:35:58] I am Lori McGraw, and thank you for listening.