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Stop Talking, Start Listening


Doctors give advice, but sometimes the smartest way to improve the health of a community isn't prescriptive, it's more about listening. Aaron Byzak, M.B.A., with University of California San Diego Health says his system decided to stop talking and start listening. What they learned changed the way they do business. 

Host: We're broadcasting live at the AAMC in Baltimore 2015, and this year's conversation is about change. What needs to change in health care? I know there's a ton of things, but we're asking each person what specific thing is on their mind right now.

Announcer: Asking questions, seeking solutions. Algorithms for Innovation. Live from Baltimore at the AAMC 2015.

Host: We're looking for stories of change at your institution. What needed to be changed, how did you do it, what barriers did you have to overcome. We're talking to Aaron Byzak. He's with the University of California San Diego Health.

What was the thing in your organization that had to change?

Byzak: The thing that in our organization had to change was receiving community input. We had really failed to do that to the extent that we should have in the past, and that had a really negative impact on our projects and the way the community perceived us. So what we did was we started listening to the community.

We started actually going out and talking to the leaders in the community, the thought leaders, and we did comprehensive needs assessments, started asking them how we might be able to help them achieve their goals rather than them achieving our goals, and ironically, when you find out what their goals are they end up aligning with what you want to do. So we put together a comprehensive initiative. We call it the HERE Initiative, Health plus Education plus Research equals Empowerment, and we implemented it.

It has nine programs and it covers health care, clinical care delivery, education and workforce development, and research, particularly focused on health and education disparities.

Host: And how do you decide what the community needs to weigh in on and what it doesn't need to weigh in on when it comes to what you're doing? You're not asking about everything?

Byzak: No, we're not asking about everything, but we developed a fairly straightforward survey, and the survey really came down to, "What do you know about us? What do you think of us? What are the needs of your constituents? How might we help you meet those needs, and who else should we talk to?"

Our group of 12 that we started with grew to 150 over the course of 6 months. From that, we gathered quite a bit of qualitative information mixed in with quantitative data that we had from research and whatnot, and mixed it with our tripartite mission as an academic medical center and everything aligned and it worked out pretty well.

Host: Was there some barrier to implementing this change, or was everybody pretty much on board?

Byzak: Oh, no, there are always barriers. I think bureaucracy is always a barrier, the silos are a barrier in academic medicine and academia in general. But we were able to overcome that by effective communication and really reaching out to our folks, internally and externally, and really getting them bought into the vision of what we're doing, and it's worked out very well for us.

Host: So explaining to them why it matters, was that a big part of it?

Byzak: That's right. And what we tapped into was that most of the people there at the organization wanted to do it anyway. They just didn't know what vehicle they could utilize to do that.

Host: So if you could do it all over again, what would be the thing you would differently to make this process a little bit easier?

Byzak: I think that some of the bureaucratic barriers could have been overcome, particularly with things like human resources and bringing our team up to speed in time, and getting budgets approved and things like that. We could have actually been four years into it instead of three years if we had done that more effectively, and that was just me not really knowing the system as well as I could have. It really was on me to learn it better before I got involved. So now I think if I did it over with I'd be much more prepared.

Host: Yeah. Would you mind if somebody had any questions that they contacted you?

Byzak: Not a problem.

Host: And what would be a way they could do that?

Byzak: The best way to contact me is through my email. It's

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