At BrilliantRead Media, we always strive to bring meaningful and powerful stories from India and around the world to empower and motivate our growing community. This week we invited Dr. Lara Goitein for an exclusive interview with us. Dr Lara is a Physician (Pulmonary & Critical Care), Healthcare Consultant, Author, Leader, Advisor and Change Enabler. Let’s read more about her incredible journey so far and her advice for our growing community!
Excerpts from our exclusive interview with Dr. Lara:
Tell us about your background and your journey, please.
I’m a pulmonary and critical care physician, which means I specialize in lung and ICU medicine. I grew up in Boston and trained at Massachusetts General Hospital, and later at the University of Washington, Seattle, and I was headed single-mindedly toward a career in academic medicine. But during my training, two things happened.
First, I started river rafting, and enjoyed it so much that I became a river guide in the Grand Canyon, rowing trips during all my vacations and a “gap year.” Second, I had children.
Both of these things made me look up from my very narrow, fixed path and rethink how I wanted to live. We ended up in Santa Fe, New Mexico, where I’ve been able to combine my career in medicine with time with family and enjoy the desert southwest and its rivers.”
In the last few years, I’ve transitioned to doing primarily administrative work, running a hospital quality program from 2015-2019, and serving as vice president of medical staff from 2020-2021.
Last year I wrote a book that I’ve been meaning to write for 15 years, The ICU Guide for Families: Understanding Intensive Care and How You Can Support Your Loved One (Rowman & Littlefield, December 1, 2021). In it, I walk family members through a loved one’s ICU admission, providing explanations and practical suggestions for how they can support their loved one at every step of the way.
What led you to found a quality improvement program at a hospital in Santa Fe, and what contribution has it made?
By and large, physicians and nurses are idealistic, and most entered the profession because they wanted to help people. But often, problems in the underlying systems in health care make it difficult for physicians and nurses to provide the quality of care they want to provide. This causes “moral injury” — the damage that comes from being part of an environment that fails to align with their own moral compass. I suppose my interest in quality improvement was driven by my own moral injury and that of my colleagues.
Unfortunately, most people in health care don’t really listen to front line physicians and nurses and their ideas for improving systems. Quality improvement is largely driven by regulatory requirements and reporting on metrics tied to reimbursement from large insurers, and in practice often centres around documentation rather than actually improving care.”
Also, practising clinicians are generally too busy at the bedside to do the hard work of improving systems. I wanted to try something different: to create a program that would provide doctors and nurses the protected time, support, and training to fix the real day-to-day problems that worried them. We called the program Clinician-Directed Performance Improvement (CDPI).
The doctors and nurses knocked it out of the park, completing more than 10 initiatives per year, and dramatically moving clinical outcomes for the patients. The hospital’s performance during the first three years of the program corresponds to a shift from a 1-star CMS Hospital Rating to 5 stars. At the same time, we also saw a tremendous increase in physician engagement — 14-fold as a percentile ranking on the Advisory Board national survey.
It’s a simple but underused concept: harness the deep motivation and insight of your front line to improve how your organization works. Give them the tools and the authority to be effective.
What are some of the strategies that have helped you grow as a person and a professional?
The move away from major urban academic medical centres to a community hospital in Santa Fe was important to my growth. At the time, I was seriously anxious about going off my career track and damaging my resume. But in a certain way, it freed me from all the “shoulds” that had been in the back of my mind. I was suddenly able to think about what I wanted to do, not what should go on my resume to get to the next rung of the ladder. And it turns out that what I wanted to do was improve the quality of care at my community hospital.
Ironically, I probably wouldn’t have had the flexibility to do the kind of work I wanted to do at a larger academic medical centre. I think people always do their best, most creative work when they’re driven internally rather than by a path created by someone else. What has helped me grow as a professional is to pay less attention to the “shoulds.”
What drives you to keep going despite the challenges?
I’ve been lucky in my life. The only real challenge for me has been to balance the time and energy I give to my work and to my family.
This balance has shifted over time, and it’s a constant juggling act to get it right. What drives me to keep going is how much I love both parts of my life.”
Professionally, I thrive on the feeling of having an impact and making a difference to patients and to my colleagues, and the opportunity to work with such smart and dedicated people.
What do you believe has been the biggest source of motivation in your life?
Professionally, the biggest source of motivation is to have an impact and help people. Initially, I thought of this as helping patients. I also came to think of this as helping family members, which is why I wrote my book for family members of ICU patients. Increasingly, I also think of this as helping doctors, nurses, and other clinicians.”
More and more physicians are employed by large corporations and have less control over their work environments. Many feel unable to provide the quality of care they would like. They’re increasingly regulated, required to see higher numbers of patients faster, and burdened by documentation and regulatory requirements.
Many are demoralized and disengaged. I see my efforts to support clinicians in improving care in their organizations as a way to reconnect them to a sense of purpose and professional identity. Observing the improvement in clinician engagement that accompanied the quality improvement program I directed was probably the most rewarding professional experience of my life.
What advice would you give to students and young medical professionals who want to have a successful career and meaningful life?
The medical profession is under siege, but at its heart, helping sick people remains one of the most rewarding, important things you can do with your life.
Study hard and get the best training you can so that you have a solid base of credentials that no one can question and that will continue to propel your career. But once you’re done with marching in lock-step through those years of training, step off the track a minute and think. Put the “shoulds” and planning for the future aside.
What do you want to do today? How will you make things tangibly, concretely better for the world and the people around you? If there’s no clear track to your goal, you can make one.
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