What Surgical Patients Actually Want (And Why Systems Miss It)

Episode Contents

• 00:00 NovaNav Introduction
• 00:51 Guest Introduction: Fred Neis
• 02:16 What patients really want: service, predictability, and tailored interactions
• 07:35 The biggest disconnect after surgery: what happens once patients go home
• 11:41 High reliability, standardization, and reducing variation in care
• 16:20 Value-based care, risk-based contracts, and where AI can improve outcomes
• 20:49 Nurse coordinators, workforce strain, and using AI to extend clinical capacity
• 24:41 Why healthcare technology adoption fails and how to build trust
• 30:18 Fred's book: The Disciplined Leader
• 33:49 Referrals, reputation, and preventing network leakage
• 37:21 Where to find Fred and his book
• 38:25 Closing Remarks

Key Takeaways

Patients may not use those exact words, but they know when care feels predictable and when it does not. Neis explains why stronger follow-up, better coordination, and more consistent standard work are essential to perioperative operations. He also makes the case that high reliability requires leadership that is willing to reduce unnecessary variation across teams and build a more dependable experience for both patients and staff.

Transcript

Welcome to the Surgical Journey, a podcast about putting patients at the center of surgical care. From preoperative readiness to recovery at home, we talk about the real processes and data that shape outcomes. Each episode features conversations with health system leaders, surgical teams, and technology experts, who are changing how patients move through surgery and recovery. At NovoNav, we focus on making surgery easier for patients and their care teams.

That means clearer communication, reducing administrative burden, and smarter use of data. In this series, you'll hear how that work plays out in real clinical environments. Let's get into the conversation with our host, Lisa Miller. Welcome to the Surgical Journey, a podcast by NovoNav.

My name is Lisa Miller, I'm the host. And today I am welcoming Fred Meese. Fred, welcome to the Surgical Journey podcast. Hey, Lisa, thanks so much for having me.

I really appreciate it. Awesome. Just as a little background on you, Fred, and maybe you could share some things as well. You have a very interesting, you know, different, you hold different positions from being a registered nurse, a fellow of the American College of Healthcare Executives, a fellow of the Academy of Emergency Nursing.

You are a best-selling author. Although folks won't see this here on the podcast, I see the book behind you. You have held positions as a firefighter, a paramedic in Missouri. You've also led a very large team at the advisory board where you led a surgical services optimization practice, which is quite significant.

And you are also the founder of Advisor RN, where you advise systems on operational agility and leadership development. And you advise in a number of different places across the board. So I was looking very much forward to this conversation, just from your experience and your book. So welcome.

Oh, thank you. Those are fine. So thanks for having me. Great.

Okay. We're going to jump right in. So as I mentioned a little bit earlier in the intro, you've been on both sides of the bed rails, as a paramedic, as a nurse leader, you yourself as a trauma patient, I believe. Maybe you want to share a little bit more.

And how did that experience change the way you think about what patients actually need during recovery versus what they assume they need? Yeah, thank you. I think as clinicians and healthcare executives, can we operate on those assumptions that the person that we're caring for kind of really wants excellent clinical care and we build our programs and our services around that kind of clinical piece. It turns out, if we really dig into the research, what we believe as clinicians is like, oh, this is great clinical care is not really what the person wants, right?

Intuitively, they don't walk into a health system or a surgical clinic and think, oh man, I don't know if I'm going to get good clinical care. They intuitively believe they're going to get excellent clinical care. What they really want, as born out of the research, what they really want is a great service experience to feel like the experience is tailored around them. And it's really that consistency of product and brands around that service that they're really looking for.

So, you've got to have those tailored interactions. They want predictability. And it's that mandate, I think, for us as healthcare leaders and executives to create that kind of brand stickiness, regardless of where the setting is. So, it can be in the ambulatory space, it can be in the inpatient space and brand consistency is paramount to the success of really any of the health systems these days.

So, I love that. Once you started to say that, I'm like, oh wow, I didn't expect you to go there, but you are so right. I saw you smile involuntarily. Because you're right.

They want these, they want experience, they want communication, and which falls into, like you said, service experience, tailored interactions. I forget which company it was, I can't remember. And it's not the Ritz, it's actually a big brand, not like a higher end brand like Macy's, I forget who it is and it'll come to me. But basically, they empower their people to just make these really great service decisions.

And by doing so, again, it's a luxury brand, I can't think of the name, but they have such a reputation for that experience. And I think, you talk, I think a lot about culture, but I think it is this tailored interactions. And that's why I thought about that example where this big brand realtor, luxury realtor says, listen, up until X dollars or you're allowed to make your own decisions, which is tailored. And I wonder what would happen in healthcare if we kind of gave some of that opportunities to clinicians and frontline workers.

I think that's actually, I think that's a really great point too, around how can we look outside of healthcare and look at successful businesses and what they do to be successful. And I don't think we would suggest that we could be completely wild and reckless and say every employee has $10,000 to play with every year. However, I think the point is right on, which is, how do we take what we can learn from other industries and bring it into the body of healthcare and actually do this stuff differently and get a different result? Yeah, I love it.

I love the tailored interactions. It's the first time I've actually heard that in healthcare. I'm gonna mention one more thing. Years ago, my daughter was in the hospital overnight and she was in a Peds department and they were just great.

And they had all different ways. It was very tailored to her. And I remember that. I remember more the tailored experience for her than even the high quality clinical care she received.

It's really a great point. Yeah, that you generally expected. Yeah, yeah, yeah. I remember the woman who came to the environmental services who came in to clean the room and she had a bunch of Disney pins and my daughter loves Disney, that's what Kim does it.

She gave her one of her pins. You know what I mean? And I think that speaks to the heart of people, but I agree, how do we think about those tailored interactions differently? I think it really does make a difference.

And if something does go not perfectly, I think people will be also more forgiving. If there were these more customized approaches, I think people would be more willing to just say, oh, okay, that's no problem. You know what I mean? If the person has had a consistent experience in the brand and then there's this random hiccup, we tend to be a little bit more tolerant of that random hiccup.

That's right, yeah, I agree. I love the story about the pin. It's that one little moment, right? It wasn't an expensive thing.

It was just that moment. And that's what you remember. Yeah. Out of a pretty like, you know, she's fine and everything and we were kind of stressed at the moment and she had to get like a CAT scan, all these other things that happened, but remembered the pin.

Like, isn't that? And that she's obviously done, she's doing great. So you built your career at the intersection of clinical care and operations. When you look at the surgical patient journey today, what do you think, or what do you see really as the biggest disconnect between what the clinical teams know should happen and what actually happens once a patient goes home?

So that's like a, that is a big conversation. Right, that takes the rest of this podcast. Ready, go. As you mentioned at the outset too, I was a trauma patient.

And so I had multiple surgeries as a trauma patient, as well as multiple surgeries following that, or the years following that on my legs. And so I had the experience of what an emergency surgery felt like and then the discharge as well as not elective necessarily, but, you know, given some time and distance, a little bit more of a scheduled tempo for surgeries as well. I, you know, I gotta say, there tends to be this kind of precipitous drop-off once the door kind of closes behind me and then I'm free range again. And, you know, I get that pile of discharge instructions.

And even for someone like me, who has read probably hundreds, if not, you know, a thousand of these in my career, like there can be very overwhelming. And like, what do I need to pick out of this that I really have to make sure that I do besides the answer is all of it. And then it's, you know, then there's this request for follow-up. It normally will say in the discharge instructions, like follow up with, in my case, ortho in six weeks.

Why can't we have that experience where that ortho visit is actually scheduled while I'm still in even pre-op? It's not like we don't know when that surgery is scheduled and it's not like we don't know when I need to be seen again for follow-up. So why wouldn't all of this be front-loaded as best as possible to create that tailoring, to create the predictability in the entire process, not just for the consumer, also for the clinicians and operators who are working in this space too. Can I ask you a question about that?

Sure. Why don't you think it's front-loaded? Because it's really a great point. Like, is it just too much?

Is it just too much? And I don't mean this negatively. Like, is it just too much work for now a hospital to have to do even more so versus, yeah. It's the same amount of work, just depends on when it happens, right?

You still gotta schedule it at some point. So it depends on where you wanna put it into the process for that. Yeah, I think, you know, and I put a post out a few weeks ago about this random musing. You know, I find it interesting as well that we will schedule appointments so for me a couple of weeks ago, there was a scheduled appointment with my primary care physician at 1030 in the morning.

And I'd had it on the calendar for 1030 in the morning for months. And yet three or four days before I get a text message that says, hey, show up 15 minutes early to your appointment. Why would you do that to the consumer, right? Like I'm already planning to be there at 1030.

Not to mention it marginalizes the team who's working for that first front end 15 minutes as if I kind of just show up about 15 minutes early, we've got some stuff for you to do and somebody is gonna do it with you. So why wouldn't we create more concreteness and predictability? Yeah, I think it's a really interesting thinking exercise for hospitals, you know, because I think those things can be done without putting too much overwhelm and I think it would add to the experience for sure. There's a lot for patients to think about, like you said, when they leave those doors of the hospital, now they're home.

And, you know, I think a lot of things happen differently, even in the best case scenarios, you being a clinician, just things that are unexpected. So be more thoughtful about, we have to be more thoughtful about what happens when patients go home. Yep, absolutely, absolutely. So you talk about high reliability organizations and reducing variability in care.

Most surgical programs have protocols on paper, execution is inconsistent. So in your opinion or what you've seen over your career, what does it take to close that gap and does technology play a role in that, making reliability more of a default rather than exception? Yeah, I think in the first part of that question, it's the answer, like we gotta get this stuff off paper or it's a checklist still embedded in the medical record or the electronic tracking system some way, somehow. And number two, I think the other piece is, it takes strong leadership that has a commitment to absolute reduction, if not as best elimination of variation as possible.

Because I think today, and I would imagine you see it as well in your practice, you know, we could have multiple surgeons and multiple anesthesiologists and they all have kind of different ways that they wanna operate on the same procedure or do the same processes based on clinical conditions. And we've gotta reduce that variation, if not eliminate it. It's really essential to do that. And that's what forms a high reliability organization.

I think I use a couple of different analogies in a lot of my practice. Number one, and I'm not a pilot, so I say this with limited knowledge. I've been on thousands of airplanes. You know, the pilot with 12,000 hours of flight experience who's flying a commercial plane with 150 passengers on board.

If that pilot chooses not to use that checklist to take off and land the plane, they can get fired. Like there's zero tolerance for that kind of variation. And in my space, I still do work as a paramedic firefighter a couple of shifts a month. Even if I'm the officer in charge that day on the shift, I'm not allowed to go in and start moving things around in the ambulance or moving equipment on the fire truck just because of personal preference.

In order to create that high reliability, we all have to have an early agreement as a team where the equipment is, what it does, how it does it, and who is going to use it when an emergency occurs. So why aren't we doing that in a surgical suite today? I agree. I mean, even in the, you have a lot of experience in the OR and just the different, you know, amount of supplies or implants or, you know, there's variation.

There's some good reasons why, right? Some physicians are trained differently and there's some, there's definitely some exceptions, but I think overall, I think there's a lot of room for standardization or reliability or just keeping things little more uniformed. I don't know what this is called, but you might, and I'm putting you on the spot off script a little bit. When physicians, I know there's, so when physicians hand off patients, so I have a floor, there's a name for it.

Isn't there a name when they hand off, like, so they're going through the notes from one patient to the next? I think there's a term for it. I can't think of it. Rounding?

Is that what you're talking about? It could be rounding. I think there's another, yeah, we'll call it rounding, right? But that's a- Rounding or a clinical handoff?

A clinical handoff, yeah, yeah. Sure. I thought there was another name, but maybe it's something else. But that's another example, right?

Isn't that like also another example where it's terrible for the most part? I mean, you know, like, because I was talking to somebody who was, I think they're looking to develop some technology on that handoff to make it, you know, more precise. Yeah, there are some existing technologies out there, and even the EMRs of today are, you know, are mechanized to do those types of things. I think where sometimes as clinicians, we get lost is the differentiation between what we need to know versus what we want to know.

And then we're like, oh, I need to know the I's and O's for this patient. It doesn't necessarily clinically change anything or operationally what I'm going to do. I just wanted to know it. And so I still have, you know, I still have flashbacks of giving a report to nurses in the ICU who are like, well, what are the I's and O's?

I'm like, I don't know. I don't know off the top of my head. You don't need to know that right now. You can find that out later, right?

So it's part of that. How do we create that standardization and agreement amongst the team that this is what we need to know to move forward? This is the package of information I absolutely have to have. Yeah, and I think technology takes the noise out of a lot of it.

That's right. Yeah. Agreed, right? Because then it does what you just said.

It narrows what is necessary. Yeah. So you've spent a number of years in value-based care where outcomes, done mostly everything. So how should surgical programs be thinking about the connection between what happens in the pre-op and post-op window and the outcomes that are being measured on?

So this whole question, of course, is about, you know, teams, right? Like managing, like we have a new funnel payment in teams and we're required to like have five episodes managing the whole episode in 30 days post-surgical. So I guess that's the context. Yeah.

I think, you know, I have struggled with the term value-based care now for a couple of years. I used it a lot. I've worked for value-based care companies and I've been entrenched in it a lot. And for the last couple of years, I've kind of stepped back and I struggled with the term because if we call it value-based care, is that what, then are we suggesting to the consumer and their families and their loved ones, like we haven't been delivering value for years but look at us now.

That's a really good point. Yeah, I think, you know, I think about it as kind of, there's the fee-for-service space and then there's the risk-based contracting space. And at the end of the day, the operational nuances, you know, minus the things that maybe have to be tracked for a risk-based contract, for additional payment through the risk corridors that are created or something like that, at the end of the day, the procedures are still the same, exactly the same, regardless of the payment model. And the outcome should still be the same, regardless of payment model.

And I think part of the promise of integration of technology is, and especially within the, you know, really acceleration of adoption of AI, the promise there is we may very well be able to do what we've said we needed to do for decades, which is improve outcomes, improve experience and drive down costs. I was thinking about this a couple of months ago. I was having a conversation with a friend of mine and we realized, like, I'll use the radiologic space as the example. We now have enough AI capabilities that AI can do a lot of the reads.

They can do them 24-7, 365. They can do them with some high degrees of accuracy. Periodically, they're actually picking up things that human radiologists will miss. And I'm not suggesting we're gonna get radiologists.

What I am suggesting, however, is we may need less radiologists and we can do it at faster speed and at lower cost. So if you're a health system and a radiology group and you have to think through this, what happens when you actually do drive down the cost and improve outcomes? Are we gonna end up having to go to payers and have a really interesting and tough conversation of we probably could get paid less and still maintain, you know, our revenue profile because we've actually done what we said we were gonna do. And for the payer, that may mean maybe they get to drop rates for the consumer, right?

I mean, that's the math that's looking like it's mathing out if we keep going at this pace. Yeah, no, the radiology example's perfect. And I think the other idea too behind that is, you know, we can do more with the radiologists that we do need, right? So rural health care, I mean, they get to cover more.

So I think that's a great example, but you're right, if the cost of reviewing a radiology, you know, exam is less, how does that really go down to the consumer patient? Does it follow through? That would be really interesting. Yeah, well, and I use radiologists because in my head, it is the math that I do regularly.

We could do the same with like a nurse coordinator in the surgical suites. Now all of a sudden I can help very crisply clarify what the nurse coordinator should be doing and as well help spread them out a little bit more because AI technology can kind of take over and do seven different things for that nurse coordinator that right now the nurse coordinator is trying to do one at a time with a lot of interruption and variation. Now technology can help. To me, that's a perfect example of an AI application.

And I think that's precisely it. So nursing teams are carrying more than ever with fewer resources. We just talked about that. So it goes right in line with what we were sharing before.

When it comes to managing surgical patients before and after procedure, what should a surgical, a nurse coordinator be spending time on and what should be taken off their plate? So that's actually that you gave a great lead in. So I'll let you continue on. Thanks.

I kind of also go the other way on this one too in terms of, I think we have the resources. So I think while we would say like nursing teams carry more, which is correct in a number of different ways, it is a correct statement with fewer resources. I would say the resources exist. I think we just don't optimize them and take advantage of them as much as we really should.

In an indictment personally, my iPhone, for example, I probably optimize or use 20% of it, right? Like I should be a better student of what my iPhone can do for me to save me time and make me more efficient. And I think the same is true within, you know, like the space of nursing teams, all encompassing. I think there is a lot of opportunity for us to actually better incorporate existing technologies and use them to our advantage.

I think healthcare is a human touch business. It's not going to not be a human touch business. And, you know, AI, for example, really uses the inputs from humans to help them make determinations and help with, say, clinical decision-making. AI can't actually reach out and touch the patient and say, oh my gosh, you're actually sweaty and clammy, and then input that into AI.

It's relying on a clinician to have good clinical skills to identify that and translate it for AI and say, okay, AI, here's what I'm finding. Help me make some clinical decisions. You don't look, something looks off, something doesn't look right. Yeah.

Of course, that's a nursing experience, or just piecing it together, and then using AI to find a rapid solution based on what that environment is showing. I agree. I heard somebody say, which is true, it's AI is not, you know, everyone's not polite, replacing humans and everything, but it's those who can really coordinate AI, right, to use it, like orchestrate, and you've said it a number of times, those people who know how to be an AI operator are really going to do well. You know, and I think this speaks to what you've said before, so if the nursing or whoever teams are embracing AI, they will actually be the ones who have, in my opinion, will do really well, you know, because like you said, it just, it's going to make them be able to do more.

AI can do what AI does, and nursing can do, or, you know, clinicians can do what they do best, but I agree with you. Yeah, I think if we want to believe that there's a nursing shortage and that there will be a perennial nursing shortage, you know, for the foreseeable future, this is a great opportunity for us to embrace AI, embrace technologies, regardless of whether or not it's an AI, they have an AI component or not, and actually leverage it to do our jobs more efficiently and effectively, and kind of spread out that existing workforce that's there. And I just think it's a matter of creativity, where at good point, it could be technology, it may not seem to be AI. Like I met somebody who he's younger, and his job, he's like a, it's not telehealth, but basically he's got a couple of rooms, three or just a couple of rooms, so almost like a 24-hour sitter, but virtual, right?

And so again, what a great use of technology, right, as having a sitter and, you know, using cameras and not having to be right in the room, and maybe not spending as much money that they would be having someone sitting in the room. I think there's all these great applications. Okay, so healthcare has no shortage of technology, we know that, but adoption's a different story. And this is, I wanted to bring it up sooner because I think there's a threat in there, right?

Because adoption is really key, and there's probably some challenges there. So from a clinical perspective, what does technology need to do for a surgical team or even really in a hospital to actually trust it and use it every day? Yeah, I think, you know, to get anything, like whether it's technology or processes or people embedded into those activities of daily living, there's gotta be that right culture in the organization. You know, it's a culture that has folks feeling safe and confident to test and innovate, and kind of pushing or leaning into your clinical feature of the question, like the clinical team has to be part of the design process from the very beginning.

Like, this is the problem that we're trying to solve, how are we going to solve it and incorporate that technology or technologies and the process, and rethink it, right? Like, kind of going back to, why do we schedule an appointment with a primary care physician, and then three days before, tell them to show up 15 minutes early? Like, how do we do this so markedly differently than we had before? And then what is it gonna be to impact their role in a positive way?

I think, at least in my experience, some of us walk away sometimes with this is just additional work. So hopefully it's a zero-sum game at a good case, and a best case scenario, it starts to lift that individual, and some of the kind of noise and mundane tasks that they shouldn't be doing anyway that aren't value-add, takes it away from them. So there's gotta be that value proposition incorporated into this, so it's like, how is it going to make my job much more efficient and effective, not easier? And I wanna delineate that, because I think sometimes we get confused, and we're like, oh, I want my job to be easier.

Well, I do too. However, that's not the, I should stop going to work if I want easy. Right, it's promises made, but not delivered with technology, right? I think that people get exhausted, like, oh, okay, this is gonna be something else that's gonna do everything.

But I agree, it's not meant to make it easier. It's meant to bring efficiency, and just drive that value. But I have a question for you, right? So sometimes, like you talked about, you know, culture's key, 100%.

That's number one. Number two is, clinicians need to be part of this design. Absolutely, and I was recently on a call, in fact, with Omrit, and the hospital was so excited because they were part of this design. And they were like, you're bringing this in now, and it was so awesome, and they were very, you could just see them light up and feel differently about the engagement.

But what happens in that process where, you know, maybe there's feedback to the clinicians, like, you know, when it gets a little rough, like, not rough, but, you know, they're trying to give feedback on maybe the solution, and the feedback is, well, you know, this does need to be this way, even though we're working together. I mean, you know, sometimes having those tough conversations are bad, but we avoid them. You know what I mean? Like, it's, so you've been in that world, right?

I mean. Yeah, yeah, I've lived it more than once. I, you know, I think underpinning that is the communication, right? Part of that, though, is the culture of the organization.

And as, and I'll use another, I'll use a different example than technology. However, I was involved in a construction project years ago in a health system. And we had the clinical staff as part of the construction design team. And then we had them walking through the construction site periodically with hard hats on, like, hey, where do you think this desk should go?

Hey, how do you think this cabinetry should be arranged? All of those things. And then I think along with the contributions of having that team there to be the voice for the rest of the clinical team, when someone said, hey, I don't like where this cabinet went, well, your peers were the ones who actually made that determination. It kind of helped, you know, bring the temperature down a little bit.

I love that story. Yeah, yeah, and it helped me as the director to take a little weight off of me. It wasn't me making the decisions. We had a group that made these decisions.

And at the end of the day, it wasn't my decision. I wasn't gonna use the cabinet. And then the other thing is this regular feedback loop. So if there were those questions that came up, you'd post them, like, hey, this was the question.

I don't have to attribute it to anybody. Somebody else has probably got the same question. So it's, you know, here's the question. Here's the response.

Yeah. Yeah, that's a great- And post it. Yeah, I think that's great. Thank you.

I was a little bit, again, off the cuff there. Yeah, we can go off road. Let's go. Funny story, the same hospital.

My daughter, it's her, because she had to be, you know, they wanted her to stay in the wheelchair, but her wheelchair didn't fit into the bathroom. And then every time the nurse was like, let's see what happens. They don't talk to us. The doorway was, she was smaller.

And it was relatively like a new, you know, design. It was just so interesting. So I agree, though. Clinicians need to be part of the process and everywhere.

And I love the hard hats. They wonder how frequently that does happen. You know, having them walk a new, you know, new area. So I wanna spend a little bit of time here because I love this for many reasons.

So you have a new book called The Discipline Leader. So what inspired you to write it? What is the one lesson from the book you think healthcare leaders need the most right now? And I got a couple other questions afterwards.

Yeah, sure, let's do it. You know, I've actually been wanting to write the book for a few years now. So part of kind of the work that I've done over the years, there's been a lot of workshops and seminars and opportunities to be a conference speaker and then be an advisor and a consultant to, you know, a lot of health systems around the country and learn from them. And then I've been part of other industries as well.

So I've been in public safety for 35 years. I've been part of health systems for 30 years. I've been in business and publicly traded companies and not-for-profit organizations, and I've been on boards. And what I came to decide and realize was kind of going back to one of our earlier parts of this conversation, as leaders, I think the best leaders are the ones that take from other parts of other industries as well and bring them into healthcare.

I think sometimes we don't do a great job within the healthcare space, looking outside and bringing those practices in. And as I step back a little bit, I kind of encourage myself to step out and write a little bit more about what I've learned working in a business and working in a very corporate setting that is not directly, you know, in the direct patient care space. And how can we use some of those tactics and practices in our work as leaders within health systems and within the healthcare delivery space to really be the high performer we wanna be every day, number one, and number two, help bring the rest of the team into that high performance space as well. So that's kind of how I thought about it over the years.

And I was really excited to be able to have the opportunity to do it and publish it a couple of months ago. And it's, you know, it's been good. And I always hope people will certainly buy it and read it and take a couple of nuggets out of it. It's designed not just for kind of a newer, early career leader, it's designed for all of us.

So, and oh, and one lesson. Yeah, don't let me off the hook. That's right. Yeah, it's all right.

Don't let me off the hook. One lesson, I think really kind of based on our conversation today. So if I'm kind of keep it to what we're having fun talking about, is it's about relentlessly driving towards reduction and variation in the consumer experience. I think that will harden a brand of a health system or a clinic or a practice.

And that's gonna be really, really important moving forward because consumers like that, you know, consistency of a brand. And that's what makes them good users of the service and repeat users of the service, as well as they're the ones that are our best marketing. They're the ones who tell their friends where to go. I agree.

Like, I'm not done with the book yet, so we have to... Oh, okay. I've got a couple more things, but I agree. I do, you know, you as a clinician in hospitals, maybe were you speaking about that more?

Were readers talking about referrals? Because the best work business are other patients. Maybe would that be a topic? Like, how do we get more of our patients to talk?

You don't prefer to share. Was that a conversation? I think the conversation could be around two things. So in healthcare, it's a bit different depending on the types of referrals.

So yes, it could be your neighbors. We're at parties, we're at our block party, we're at our kid's sporting event, and somebody says, man, I'm gonna have to, you know, I'm gonna need a primary care physician. Who do you recommend? That's a fun conversation potentially amongst friends.

Oh, I have a friend or I know somebody or I really love my physician. The other one though, and I think this is really important on the surgical space is those are typically referrals from another physician. Right? And so if we think about it, it's the networks that are developed by those surgeons to get those referrals.

So are they buddies? Do the referring physicians believe that those surgeons are of high quality? Are they buddies in conferences? Do their kids have some kind of association with sports or something?

So they're all in the same place. But what are the reasons that drive referral patterns? And then if you're a health system or an ambulatory clinic setting, like how do you prevent what we typically have called leakage, but the network is not where you want it and you've not fenced your network properly. So yeah, I think there's probably a huge opportunity to have a podcast all around kind of the referral patterns and the practices and what would make it best for a surgeon to build that network.

Because all too often I've heard, well, that's the guy I've always referred to for 20 years. Or I don't wanna refer to that surgeon because they don't have good quality or good bedside manner. But no one's ever said anything to this surgeon or measured it for that matter. Maybe that surgeon actually is the best clinically and it's a perception problem that they never thought about or tried to overcome.

It's a great point. I'm gonna mention one last thing and then we'll talk a little about where people can buy your book and have you speak and have you come consult. So I was at about six, seven months ago, I was at UC San Diego. And yes, I'm calling out this hospital because they're amazing.

They actually walked in the door. They had a greeter. This woman was the most beautiful woman, literally come right up, good morning, where can I help you? But like, she was just remarkable.

Everybody that came in, earnest, genuine. So I was waiting for colleagues. I just sat in the area and I was watching her, watching her file. I got up and I said, I've never seen anything like this.

I've been in healthcare over 30 years. I've never seen anything like this. Just tell me about yourself. And she's like, oh, I've been with the system for years.

I've been, you know, she was in a number of different places. I know this hospital, I love it. And it's one of my favorite jobs. I'm here for the morning.

She's like, I get in, I think she's up like 3.45 a.m. for something crazy. And then, and remarkable. And I think that's what you were speaking to.

It just has always stood out to me, you know, just having that experience. Patients love that. And she was genuine. It wasn't a job.

It was really a heartfelt mission, which is really outstanding. So I think that's what you're talking about, Fred. I was gonna say, sorry to interrupt you. As you're pointing out though, it had nothing to do with the clinical experience.

Nothing. Nothing to do with the clinical experience. What you remember is the service. That's what made you feel.

Mm-hmm. How that made you feel. That's right. The service, yep.

100%. So the discipline leader is on Amazon, I'm sure. Is it on Amazon? Yes.

It's on sale on Amazon, yep. What's your website? Can you guys tell everybody what your website is, please? So I'm the managing partner for Advisor RN.

So it's advisorrn.com. We are a really fun firm of about four of us that really are truly committed to doing things in a much more innovative way in healthcare. We've been doing it for a number of years inside and outside of the direct delivery space. So we are always interested to have conversations and work with organizations that are really ready to level up.

I would hope everyone would go to advisorrn.com and to buy your book, The Discipline Leader, and to bring you in to executive meetings, to conferences. You are an amazing speaker and just you have a lot of experience. So Fred, thank you very much for being on the Surgical Journey podcast. I hope you come back, but thank you for today.

Absolutely. Lisa, thanks for having me. It was really fun. Absolutely.

Thanks for listening to The Surgical Journey. Join us next time as we continue examining smarter, more connected approaches to perioperative care.