As a part of my interview series with leaders in healthcare, I had the pleasure to interview Greg Irwin. Greg is the co-founder of Sagestone, a startup focused on improving healthcare by reducing clinician burnout through innovative data that positively influences leadership decisions. He has a track record of successfully implementing software in healthcare institutions to improve workflows, meet regulations, and improve overall clinician satisfaction. Greg has helped healthcare organizations secure more than $31 million in government incentives by developing key workflows to meet standard metrics.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
When I was 3 years old,my pediatrician told my parents I had an atrial septal defect (ASD). Basically, I had a hole in my heart that wasn’t supposed to be there and would require open heart surgery to repair. The next year included many visits to my pediatrician and cardiologist, and all sorts of tests including EKGs, echocardiograms, blood tests, etc.
By age 4, the ASD had not improved and it was time for surgery. In 1989, these procedures did not have the same outcomes and success percentages as they do today. I was in the hospital for days before the surgery ensuring I was healthy and ready for the procedure. I saw nurses, doctors, lab techs, and all sorts of healthcare providers every day. Everyone spent time with me and paid attention to the details. The surgery went very well and afterward, I saw more doctors, physical therapists, nurses, and others, again all spending quality time with me to help me recover.
Upon graduating college, I wanted to use my propensity for computers and combine it with my desire to give back to healthcare. I started in electronic medical records and thought I could help the field through optimization efforts. I quickly realized that the time and care that clinicians had given to me during my surgery was not happening anymore. I set out to determine how to give providers back their purpose in medicine and allow them to spend the time needed with their patients to help them heal the best way possible.
Can you share the most interesting story that happened to you since you began leading your company?
I was talking with a surgeon not long ago, gathering information about his work life and what his biggest dissatisfiers were. This doctor proceeded to explain that his healthcare system had set him up to perform surgeries in three different operating rooms at three different hospitals, sometimes in the same day. He loved the work, but the most frustrating part of his day…was remembering where he parked his car at each hospital. Since he moved around so much, all the parking garages started to look and feel the same to him, and he was spending more time trying to find his car than he spent driving. It was an ah-ha moment for me and the company. Healthcare workers are being put in suboptimal conditions, even with simple frustrations, that is adding to, if not creating their burnout. If this surgeon is worried about finding his car, how can his full mental focus be on the procedures he is performing? Something needed to be done to close the leadership loop in healthcare, and increase support of clinicians across the board.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I have worked in healthcare for 10+ years and have worked closely with all types of clinicians in numerous hospitals across the country such as Loma Linda Medical Center in California, Ohio State University Medical Center in Columbus, to the University of Rochester Medical Center in Rochester, New York. I have researched the industry and taken a deep dive for the past two years specifically into the topic of clinician burnout — now being termed moral injury by many.
What makes your company stand out? Can you share a story?
In 2014, the Mayo Clinic found that 54% of physicians in the U.S. showed at least one symptom of burnout. This leads to all sorts of financial and moral dilemmas. When a physician is burned out, he/she is 200% more likely to make a major medical error. That physician loses compassion, empathy, and this all circles around to patients not adhering to treatment plans because they do not feel connected to their doctors. In addition, burned out physicians create a 16.9% gap in patient satisfaction revenues for hospitals and a 24.3% gap in employee medical claims paid out, according to research from the University of Rochester Medical Center. All of this translates to a $12.8 billion problem in the U.S. alone!
Sagestone is a company that supports healthcare and leadership by providing a rock solid foundation on which to make supportive decisions for clinicians and prevent burnout from occurring. Research out of the Mayo Clinic found that leaders who support physicians on work most meaningful to them helps significantly reduce burnout. Sagestone provides a succinct roadmap for leaders to support meaningful clinician work.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Too many healthcare clinicians are burned out. They are suffering and most of us don’t understand this because they are the ones that make US better. How can they be suffering?
But that is exactly the point and part of why they are in such a precarious position. Clinicians are taught from the beginning of med school through their entire career that, ‘No matter how bad you are, the patient is always worse off.’ The mental health of our healthcare workers matters greatly to patient outcomes and there is real data behind these facts. 54% of physicians are burned out. This means that they cannot take care of us in the best way possible. Litigation, government regulations, and billing pressures are all major contributors to this rising percentage.
Our goal at Sagestone is to help decrease and prevent burnout from occurring. This is done by giving physicians back the right to be human, and not the expectation of being superhuman. Our technology helps leadership guide discussions and provides roadmaps to help change this culture in medicine and give clinicians back their purpose and meaning for going into healthcare.
Are you working on any exciting new projects now? How do you think that will help people?
The current trend in healthcare leadership is to deal with problems, fix issues, and only talk to physicians and other clinicians when there is a problem. Ask any clinician that works in a healthcare organization what their first thought is when they hear that their supervisor/chief/manager wants to see them. Their typical first thought is, ‘What did I do wrong?’
Leaders need to come out from behind their desks, out from their closed door offices and do what we call ‘Leadership Rounds.’ Leaders need to interact in a positive way with those they oversee and creating at least a 5:1 ratio of positive to negative interactions. This ratio comes from a study done by the Gottman Institute. These interactions do not have to be complex, just positive in nature. A joke, laughing together, a quick check in, or asking about something that matters to the clinician all go a long way to building up a positive relationship.
We are currently working on a way to help organically track these types of interactions in our technology so that we can help show leaders who they are supporting well and how they are doing it, as well as who might need a little more help, interaction, and support. It’s a way to get healthcare back to being human again.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
- Research — Do as much research as you can on whatever topic you want to get into. Do it on the side while you have another job, but don’t let research kill your idea or product. When you feel you have 80% of the knowledge, push ‘Go.’ Finish the last 20% as you are working on your idea.
- Take your time with customer discovery — When you have a solid product fit, customers and revenue will still not come easy. But they may come a little easier than forcing a product that sort of fits.
- Don’t lose your network — A lot of times when you start working hard on a project, you become siloed and only interact with your fellow coworkers. Work hard to keep those outside of your company in your life as sounding boards and a support network. You’ll be glad you did.
- Surround yourself with those who make you better — This goes along with networking. Ensure you are spending 70–80% of your time with people who you want to emulate. You likely have heard that you are a combination of the 5 people you spend the most time with. So find those 5 people who have skills, personalities, and ideas that you don’t, or that you want to improve upon, and spend time with them.
- Never…Stop…Learning! — Through successes, work, and failures, make sure you build in time to learn from what you have done. Success is great and should be celebrated. But make sure to identify why it went well and try to replicate that in the future. Even in success, there are things that could have been done better. So find those areas as well and determine how you’d do them differently next time. Doing this with your failures is just as important. Never stop reading, listening to podcasts, and listening to others. This will help in your assessments and will only improve your ability to do the right things at the right times.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Medicine has been created as a business in the US. There are three sides to this business triangle:
3. Payer (insurance and Medicare/Medicaid)
The patient is in the worst position because he/she is sick. Often this is one of the hardest times the patient and loved ones go through in life and it is scary. However, most, if not all, of the control of what is available and happens to the patient is held by the other two arms of the healthcare triangle. The patient ends up feeling frustrated and helpless.
The Provider is the one caring for the patient and making decisions of how to approach the medical issue at hand. The provider wants what is best for the patient, to make him or her whole again and give them their quality of life back. This is why physicians and clinicians went into practice. However, they also understand and are being pulled in a seemingly opposite direction by the business of medicine. The hospital has to get paid for the work completed. And not only paid for this patient, but they need to get paid for a certain number of patients each day to make it worthwhile. So instead of taking their time, fully engaging with patients, and dealing with the underlying and whole problem of the patient, they often deal with symptoms because the business says they have to move on to the next patient within 15 minutes. Why must they see so many patients? The Payer.
The Payer, typically an insurance company (which includes Medicare and Medicaid), typically pays the hospitals and doctors for their services. This is the group that holds a majority of the power in healthcare because they hold the money! The Payer can make up their own rules that physicians must follow or else not get paid for a patient visit. Things like checking off certain boxes in the EMRs, writing notes with detailed and very specific information, and coding patient visits with exceedingly detailed ICD-10 diagnosis codes (a favorite ICD-10 code of mine is V97.33XD: Sucked into jet engine, subsequent encounter). In addition to making these rules, Payers also negotiate their pricing with the healthcare providers. The Payer typically has the upper hand of, ‘If you want to see our patients and get paid by us, we will only give you X amount for that type of medical issue visit.’ Hence the need for each physician to see a certain number of patients to meet a financial quota.
Now if you’ve stayed with me this long, here is where it all comes together. Because the providers are worried about the business and keeping their job, seeing enough patients in a day, and documenting the correct things, they often don’t have the mental capacity left to take as good of care of their patients through no fault of their own. So patient care suffers. And when patient care suffers, medical issues are bandaged, not healed and fixed. Therefore, the same and often more severe problems come up with patients again and again. This makes the cost to treat a single patient go up significantly. So our healthcare outcomes stay low and our healthcare costs skyrocket. It’s a very dangerous slippery slope that we have embarked on and the dynamic needs to shift back towards the Patient, Provder, and Payer having equal control over healthcare.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Patients need to care for themselves (and be given time and space to do so by employers) — If everybody in the U.S. did one additional health conscious thing, we could decrease our healthcare reliance significantly and therefore costs. Exercising one more day a week, quitting smoking/vaping, eating a healthier meal each day, and meditating are all ways that we can improve our individual health and become less reliant on medications and the healthcare system. This will save resources for the extreme health issues and save money.
- Medications are great for extreme situations — Patients need to be OK with changing their lifestyle instead of taking the quick fix of popping another pill. There was a woman who started going to the YMCA Silver Sneakers program. At the beginning of the program, she was on upwards of 10 different medication a day. After a year of consistently attending the program of movement and light exercise for seniors, she had been able to get rid of 8 of her 10 medications completely! Our bodies are resilient and can take care of themselves so let’s give them the opportunities to do so instead of overburdening the healthcare system.
- Give autonomy back to clinicians — Physicians and clinicians need to be able to practice medicine with meaning and purpose. Being able to do this results in a higher cognitive ability to perform medical interventions and better patient outcomes. When a physician or other healthcare worker does not feel related to their work, they lose their motivation and cannot operate at their highest level of mental problem-solving ability.
- Support hospitals as a service, not a business — We need to develop a way that healthcare can be a service offered, not a business to run. We need active participation by patients and we need providers, patients, and payers to work together for the benefit of the whole, not solely the payer, shareholders, or BOD.
- Decrease administrative burden — Meaningful use was a program where government incentives were paid to hospitals for implementing electronic health records in a very specific way. There were three separate organizations within the government all trying to do the same thing, each having their own program with different names and different monetary incentives. Not only was this a waste of government money and resources, it was a pain for hospitals and physicians to have three different programs to keep track of with tasks and reporting requirements for each. Providers need to be responsible to the patient first and work with each patient to help provide the best support and outcomes. When healthcare workers are bogged down by additional tasks, clicks, and paperwork, they are not able to provide optimal care.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
The first step is creating awareness of the imbalance in healthcare. Bringing to light the intense burden this has on our economy as well as each individual is key. We need to revamp Medicaid. It is a great program that is needed but too many take advantage of it and it is a drain on the system.
Corporations need to understand that working their employees to death is unsustainable for them as well as the economy. It’s time to do what’s right for the greater good, not just their bottom line. Companies should offer employees mental health days, encourage healthy practices while at work, and understand that life happens. Decreasing stress is the single best thing corporations can do to help the healthcare crisis in America. Decreasing burnout isn’t only only good for healthcare reason though. Less burnout means fewer sick days that employees have to take and ultimately more working hours by employees.
One major step that I believe healthcare needs to take is adding a primary mental health counselor to everybody’s health plan, just the same as having a primary care physician. Seeing a mental health professional on a regular basis would go a long way to achieving two goals.
- It would help everybody get through tough times. Every person goes through periods of mental low points during their life. Having a professional on hand to talk through and provide advice and suggestions would help counteract and actually prevent these downturns. Once a month meetings would be a great place to start for everyone.
- It would help destigmatize mental health. Seeing a mental health professional does not mean anything is wrong. It is a simple check in and can be of great help to be able to talk about anything going on in your life in confidence. Realizing that seeing these professionals is not an indication of a problem would help the culture around mental health.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Patients Come Second — Patients are the reason for the healthcare system. However, we have lost sight of how best to care for them. Clinicians are human and we cannot expect them to be superhuman for the purposes of patient care.
Redhot Healthcare podcast — It is an engaging update on a wide range of healthcare topics. Everything from EMRs to bedside manner are within the limits of this podcast. You can easily pick and choose topics, but it’s worth listening to them all because he connects ideas you wouldn’t think are related and you can easily start to see how the whole healthcare system is put together. He breaks down complex topics in a way that can be understood both by those who work in healthcare and those that don’t.
How can our readers follow you on social media?
Twitter — @gregscottirwin
LinkedIn — https://www.linkedin.com/in/gregscottirwin/
Instagram — greg.scott.irwin
Thank you so much for these insights! This was so inspiring!