EP 8: Flight Into Chaos

In this episode, Dr. JB has an in-depth conversation with Mr. David Dibble on how the Law of Dissipative Structures, when applied to the healthcare system, clearly demonstrates the immense amount of stress within the system and the fast-approaching flight into chaos the system will experience if the stress is not alleviated.

Connect with our guest, Mr. David Dibble:
Email: david@thenewagreements.com
Website: https://thenewagreements.com/
LinkedIn: https://www.linkedin.com/in/davidbdibble/


Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Welcome to Hope 4 Med. This Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med. This Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med.

[00:00:38] Hi, everyone. Welcome back to Hope 4 Med. This is Dr. JB and on today’s show I am so happy to introduce you guys to Mr. David Dibble. Mr. Dibble is a serial entrepreneur, he has been in this field of entrepreneurship since graduating from college where one of his initial businesses grew to a value of over $10,000,000 and had over 100 employees. Since then, Mr. Dibble has been working in the healthcare arena with a focus on systems and system improvements. Lately, he has created a system-based transformational model for healthcare that we are going to be talking more about today. Welcome, Mr. Dibble.

[00:01:31]Mr. Dibble: Thank you so much, doctor. I appreciate it so much you having me on.

[00:01:38] Dr. JB: So Mr. Dibble, let us start from the very beginning. Walk me through what got you interested in health care.

[00:01:49] Mr. Dibble: Okay, well going back to the very beginning, I got out of college and I started a business in the back of an old warehouse with about $5,000 and over time we built it into about a $10,000,000 business. And I was still relatively young and somewhat successful, and I always thought that gosh, once you have all the stuff I would be happy, but I found out that isn’t necessarily the case. And so I started looking outside of myself a little bit at well, like what are the answers to the big questions? Like who am I? And what are we here to do? And what’s our purpose? Those sorts of things. And that took me into the arena of, uh, systems improvement. I started studying some of the great quality people, the pioneers at the time, and became an expert in systems-based quality improvement and then later in systems-based transformation. And I applied it in my own company and we benefited tremendously from that.

[00:02:59] And then after leaving the company, I started doing consulting and training using some of these models that have been created by some of the greats in the area of quality people like W. Edwards Deming and Joe Jorann and Peter Singhi at MIT, people like that. And in 2005, I got a call from a hospital and they were having a lot of problems and they asked if I might be able to help them, and I said I thought I could, and I made a kind of a deal with the CEO, I said, if we’re successful, I’d like to write a book about it. And so that was my first venture into healthcare, and we had a lot of success and I wrote a book called “The New Agreements in Healthcare,” this was in 2006, and for whatever reason, most of my work has been in healthcare ever since.

[00:03:57] Dr. JB: So I have a question for you. You hear a lot of talk about, “oh, healthcare is so broken, the system is broken.” What are your thoughts about that? Is it really broken?

[00:04:09]Mr. Dibble: Yes, it’s really broken, and particularly on the front lines where care is actually delivered. Almost all of my work is on the front lines, so we’re actually down in the trenches, working with the nurses and the doctors and the support staff, and it’s as broken as any industry that I’ve ever worked in and I’ve worked in a lot of them. And the thing about systems is for the people that work in them, they’re completely invisible. In other words, if you go in and you talk to, you talk to the physicians or you talk to the nurses that were working in these systems, they literally, they can’t see them. And so, it just becomes how we do things around here. And so you’ll see that healthcare in many ways has become one giant workaround. So you’ve got these systems that are really broken and so what are care providers doing? They’re basically working around those systems to try and deliver the best care possible for the patients. But that’s, of course, incredibly stressful and this is actually the primary root cause of the pandemic that we’re seeing of burnout in both providers and nurses. So, we’ve got a huge systems problem and it’s basically invisible to the people that work in it, in healthcare, but it’s there nonetheless.

[00:05:42] Dr. JB: It’s interesting that you say that it’s invisible because we definitely feel it, right? And, as an emergency room physician, I take care of these patients and I know the system is broken. I know that a lot of these patients that come in and see me for issues that really their primary care doctor could handle, they come to me because they’re not able to get in with their primary care doctor or get the follow up that they needed, et cetera, et cetera. So when you talk about the system being broken, can you elaborate a little bit more in terms of what you’re seeing from your end?

[00:06:17] Mr. Dibble: Well, let’s start just a second about what’s going on with the primary care doctors. If you look at healthcare in general and you look at kind of how it has evolved over the last say 30 years or so, what we see is that in some ways it’s sort of cannibalizing itself. And I say that because all great changes, they take place or they start on the margins. And so if we look at healthcare, the margins of healthcare, and sort of like the first line of defense in healthcare are primary care providers and rural or community hospitals. And what we are seeing is that those providers, both primary care and either rural or community hospitals, independent hospitals, are basically either, either going out of business or being acquired. And so the system itself is starting to eat its own. And what’s happening is that sort of cannibalism is working its way toward the center now where you’re starting to see that only, it’s like survival of the fittest, and if we look at “why,” there’s this concentration of power. In other words, why people are showing up in the ED rather than going to their primary care providers.

[00:07:46] It’s part of this systems-based mess that is ongoing in healthcare, where the primary care providers they basically are not there to be able to handle sort of like that first touch of patients with healthcare. They’re, in many cases, they, they just aren’t able to stay in business anymore because the business model and the way things are set up makes it almost impossible for primary care providers to stay out there on the front lines. So what happens? People show up at the ED.

[00:08:23] Dr. JB: And that is exactly what’s happening now, these small, independent offices are becoming non-existent and they are being incorporated, I guess, into larger healthcare systems.

[00:08:40] Mr. Dibble: Yeah, and we see the same thing for the community or the independent hospitals. They’re being snapped up, of course, by the big hospitals and that sort of thing, but one thing that the big operators or the big hospitals and the healthcare centers don’t realize is that when they, when they acquire another entity which is highly stressed–and obviously whether we’re talking about independent primary care providers or community hospitals that have to be acquired in order to stay in business–those big healthcare centers are acquiring highly stressed systems. And those systems, that stress does not leave when they are acquired, they bring that stress with them to, to the acquiring entity and so that adds to the stress that, the stresses that are already there in the acquiring entity. And so now we, we see basically an additional, additional stresses which– one thing that’s not known that well in healthcare is that stressed systems produce a lot of adverse outcomes, mainly being that quality of care goes down, safety goes down, patient satisfaction goes down on, care provider morale goes down, and costs go up, and those are bad things as far as healthcare from an operating entity, from that respect, and yet that’s exactly what we see happening in healthcare.

[00:10:16] And they’ve been trying for 25 or 30 years to reverse those things, improve quality of care, improve safety, improve patient satisfaction, and care provider satisfaction, and reduce costs. And in the process of 25 years of doing whatever they were doing, the exact opposite has happened and so this is where, you know, I say, a new model was really needed, that would reverse those trends and at least give healthcare a chance to get out of this mess that it’s created for itself.

[00:10:54] Dr. JB: So I know when we talked before that you walked me through your model in the terms of how stress it gets, stress keeps building and building. In the current day, is there a place or a way for that stress to get released or not?

[00:11:14] Mr. Dibble: Yes. So I’ll go back a ways, actually back in 1980, I ran into the work of a very brilliant man named Ilya Prigogine, and Ilya Prigogine was chemist and he won a Nobel prize for his law of dissipative structures. And the law of dissipative structures basically describes how systems and subsystems in the physical universe evolve, grow, and transform. And so this is a universal law, all of the systems for the, for practical purposes, all the systems in the universe operate according to the law of dissipative structures. And so the law of dissipative structures is actually quite simple. If we take a system, what we see is that there’s a certain amount of energy that comes into a system and a certain amount of energy the system can dissipate. And as long as those two, the flow of energy both in and out are approximately the same, then what you have is a reasonably stable system, but when a system resists change in a changing environment, it requires more complexity and that complexity requires more energy coming into the system and the system can’t dissipate. And so now you have more energy coming in than can go out and this stresses the system.

[00:12:38] So this is, this is natural and this happens every time a system resists change in a changing environment, it become stressed. And what happens is unless the system transforms, these stresses continue to build until finally they get so great, the system can no longer tolerate the stresses and it flies into a state of chaos and then later reforms into a completely different system that operates at a higher level that can handle the increase of energy coming in because it can now dissipate that energy. So that’s exactly what’s happening in healthcare. It’s been resisting change for a long, long time in a more rapidly changing environment all the time and so the stresses have been building in the systems in healthcare from both the macro systems, this is up where we look at healthcare policy and things like that, all the way down to the micro systems where we’re looking at how healthcare is actually delivered on an individual basis. And so those systems are now just so stressed that they are getting closer to what Prigogine called reorder, and reorder is a flight into chaos.

[00:13:57] And so I feel it’s absolutely critical that we intervene and create transformation at some level in these care delivery systems prior to them following their natural trajectory, which is to get to reorder, a flight into chaos. If that happens, the problems we see in healthcare today are going to look like the good old days. So that’s what the new model that we’ve created is really designed to do, is to create an intervention and actually create transformation in those systems before they happen naturally, before it happens naturally, and we don’t have to go through what will be a very traumatic and dramatic time for healthcare, if we have to go through that natural transformation process.

[00:14:48] Dr. JB: And as part of this system, you know, we always hear a lot of people complain about, “oh, it’s my manager” or “it’s my boss” or whatnot. So what role does your supervisor play in the stress in the system?

[00:15:07] Mr. Dibble: It’s interesting, from the outside, if you weren’t looking at it in a systems-based way, it would appear that our leadership and management in healthcare leaves a lot to be desired. And in some cases, people will point to their supervisors, their manager, even their leadership, and they’ll say, “oh my God, I can’t stand it, I’m going crazy, this, these people are driving me crazy, they don’t know what they’re doing,” we hear that all the time. However, when we look at it from a systems-based standpoint, what you see is it’s highly unlikely that these people are actually doing any of this on purpose.

[00:15:52] We know that 94% of the outcomes we get in healthcare, good and bad, are a function of the systems in which people work, not the upper people. And this is not well understood by people in healthcare but it’s a fact. So, what we have is these, I will call them, these poor managers and supervisors are working in those systems where they absolutely have no chance of being successful in managing and leading and doing that sort of thing because the systems are broken. And so, there’s no way to create the outcomes that they are being held accountable for creating. And so what do they do? They end up cracking the whip or telling people what to do or micromanaging or doing all of that sort of thing when in the vast majority of cases, the things that they are, you know, trying to do are really a function of the systems as well. So now we have stressed out care providers, stressed out supervisors, stressed out managers, stressed out leaders. And in most cases, these people are in the same boat as the people that they’re leading and managing. They just can’t win.

[00:17:09] Dr. JB: Sounds like it’s a pretty tough position to be in, and so how do we change it?

[00:17:16] Mr. Dibble: The only thing that will really work is to go in and intervene and create genuine transformation in the care delivery systems. See when we create that transformation in the systems, what happens is we reduce the stress on the systems, and of course, now we reverse, I talked about what stress does in systems as far as creating the worst possible outcomes for healthcare, including for providers and for leaders and managers. So we basically take the stress out of the systems. We get the systems so they’re working better, and so now we’re getting the outcomes that we want. And now all of a sudden, you find out that, you know, you’ve got leadership and management that appears much better, much more competent, much more able to support the people that they’re working with and so forth, and so it’s, we get the best of all worlds.

[00:18:21] And that, I think, is what’s really going to be necessary because there’s so much stress in the systems now that the systems themselves are burning up the people that have to work in them, including the physicians, including the, the nursing staff and support staff, and that’s where this pandemic of burnout is coming from. It’s from the stress, both long-term and short-term, that has built up in the systems for care delivery.

[00:18:50] Dr. JB: Yeah. I agree with you 100%. With Hope4Med, you know, it was created to provide wellness solutions for healthcare professionals working in this system and this environment, and with the creation of this company, I came into it eyes wide open. Right? I, I know that there is a room for self-care in terms of improving your experience in your day to day, that’s not a huge percentage. If I had to just put a number on it, I would say really truthfully, it’s maybe 20% of the problem. But the rest of the problem, the 80%, really is the system and the environment in which healthcare professionals find themselves working in. And so what we’re talking about today is extremely important.

[00:19:37] Mr. Dibble: Yes, I think it is. If we lose, or continue to lose at the rate we are losing, our best and brightest in healthcare, I’m not sure that the system can survive intact for an extended period of time. One thing about the law of dissipative structures is that it sort of predicts when we might see sort of this flight into chaos and with COVID, of course that added tremendous stress to the systems. And what that did is it reduced the time that we have to do this intervention. And so I feel a really significant sense of urgency to get to work on doing this intervention in healthcare, so that possibly we can avoid the worst of what may be coming down the pike in what I would call the natural intervention of the law dissipative structures.

[00:20:41] Dr. JB: So I’m sure my listener is very anxious to find out about, you know, a little bit more details in terms of what your model looks like.

[00:20:53] Mr. Dibble: Well, thank you for that question. I started studying, I started studying the greats in quality in 1980. And this was when I was, I started with W. Edwards Deming who is probably the number one quality guru ever and credited with turning Japan around after World War II and the Ford Motor Company and many others. But Deming was, he was an amazing individual, and so I studied him in some depth and implemented his work in my own companies. And when I went out to start consulting, I was primarily using Deming’s model. Now Deming’s model is brilliant, but what I found is that when I tried to take that model into, into, I’ll call it Western business culture, it was incredibly difficult.

[00:21:55] Now I was successful, but it was exhausting because we were always fighting the culture of the companies that we were working in, trying to get into that company what in essence is not a quality improvement model, it is a management model. If you read some of the books that were written about Deming, it’s Deming management method, Deming management at work, it was not, Deming quality. And so what happened, I found out very quickly, is that these management models that people had developed, such as Deming, were, they were being jammed into what I would call the Western management model as a quality program. And it doesn’t fit, it’s like a, square peg in a round hole. So I started looking at some of these quality programs that have basically come down the line, sort of one after another.

[00:23:02] So starting with Deming, and then went to total quality management, and then there was reengineering, and then it moved on to six sigma and lean, and lean sigma, and you can probably think of a few other ones. But for practical purposes, none of those programs have worked in health. They, very few of them worked in any industry in Western, in Western culture, but in healthcare in particular, they have all completely failed. And so I started looking at “why?” Because there are, there’s nothing wrong with them, why don’t they work?

[00:23:38] And it took me about a year and a half of looking at it, trying to figure it out and finally I sort of figured it out. And so I looked at what changes could we make in those models to create a new model that would work in Western business cultures, in particular in healthcare. And the big thing that I found out in looking at these, these previous models which had not worked was that they only looked at one side of the transformation equation. They looked at the systems side. So, it turns out, I think it was Einstein that said, you can’t solve problems with the same thinking used to create them. And so it turns out in order for these perfectly good principles to stick, there also has to be a change in culture. Or there has to be a change in thinking, particularly at the level of leadership and management.

[00:24:38] And so this new model has been created in such a way that we address both sides of the equation at the same time. We do systems improvement work,  and at the same time we also look at expanding people’s thinking so that it will become supportive of the system’s change as opposed to, as we see, if we don’t do that work, even good systems work will be undone by people who basically fall back into their comfort zones and undo any good systems work that’s been done. So this model takes both into account and we do both at the same time, and luckily, the law of dissipative structures is on our side. So we use the stresses in the systems to speed transformation at both the systems level and at the level of thinking, as it turns out that the mind too is also systematic and responds very, very well to some of these systems tools, systems improvement tools that we’ve created.

[00:25:58] Dr. JB:  So it doesn’t sound to me like this is a one size fits all model.

[00:26:04] Mr. Dibble: Actually, it does. Yeah, this model is universal. It’ll work pretty much in any industry, it’ll work in any culture. It’s really, I think because it’s based on the law of dissipative structures it, it is a universal model. Now, the one thing I will say is it will not necessarily work in any business culture if there is a huge amount of fear and control in a specific business or a business culture, then this model won’t work. But other than that, it’s pretty much universal.

[00:26:48] Dr. JB:  So has this model been tested or applied to any hospital or institution?

[00:26:56] Mr. Dibble: Actually, thank you so much for that question, yes. I mentioned that I started off with the first hospital in 2005 and, of course, ended up writing a book about that. That was in a regional medical center, but since then we’ve gone to a number of hospitals, both large and small, and collected lots and lots of data about the successes that the hospitals were able to create, and so that data is certainly available. However, there has been a case study that’s been going on at a major medical center for about three years now and they are just crushing it. That’s the best way I can describe it. But their chief transformation officer who has been leading in this particular case study is now at the point where the hospital itself is going to begin publishing results and outcomes, and these are outcomes and results that have been going both into the medical journals and also into the journals that are more around admin and stuff like that. But they should begin publishing a little later this year. And I think that will really open up some of the doors to mainstream healthcare for this model.

[00:28:15] Dr. JB: That’s so exciting!

[00:28:18] Mr. Dibble: It is. I know, I’m going “wow, what do you know.”

[00:28:25] Dr. JB: Yeah, it seems like it’s been a long time coming and it’s so, it’s amazing to see the model being applied and it being successful. That’s wonderful.

[00:28:36] Mr. Dibble: Yeah, I’m feeling like there’s an opportunity to really make a difference in healthcare and a sense of urgency to do that if we can. And I believe it is in training a large number of, I’m just going to call it what I think it is, a large number of kindred spirits who want to take this model into healthcare and in some way, whether it’s internally as an internal consultant or facilitator or externally as a coach or facilitator/consultant, but I really believe that if we had a few thousand people teaching this in healthcare around the world, we could really make a difference.

[00:29:23] Dr. JB: No, I definitely agree that something needs to be done because the way that things are, again, it’s not sustainable. We are going to implode, you know? And that’s not okay. It’s not okay for our patients, which is why we’re doing this in the first place, right? And so it’s really important and it, and it is urgently needed. You know, COVID did nothing to help the situation. I think the best thing that COVID did for us was, you know, shed light on issues that were there but were buried under the surface and people didn’t talk about it. I think as a result of COVID, just because the stress was so great that the cup runneth over, and, you know, people started talking about the stressors of working in healthcare and what they’re seeing and experiencing and how it’s affecting them. Things that we would have never seen prior to COVID.

[00:30:26] Mr. Dibble: Yes. You know, doctor, I heard the most amazing thing, this is actually from my friend who is this chief transformation officer. Prior to taking that job, he had been, in my opinion, one of the best international healthcare consultants on the planet, and so he’s in contact with some of the best healthcare consulting people anywhere. And he was sharing with me the other day, he said, you won’t believe this, but I was talking to a friend of mine who’s still on the consulting side of the business, and he said the calls that they are getting now from CEOs and from just healthcare facilities and centers and hospitals is not about consulting for cost reduction or the normal stuff that healthcare had been looking to consultants to help them with, they are now calling about, about employee wellbeing.

[00:31:32] And they are now waking up to the fact that if they don’t get their arms around this burnout issue, they’re really going to be in deep trouble. So I think that probably may be a huge opening for this transformational work. Not only on the coping side, which is where most of the work has been, looking at how to reduce stress and how to self-care, and I’m all for that 100%, but actually looking at going to the source and removing the stress from some of the systems that is being passed on to the people that have to work in those systems as emotional stress.

[00:32:12] Dr. JB: I agree 100%. I don’t know if it was a conversation with you, when we talk about when you go on these retreats, they’re wonderful, you end the retreat and you’re so pumped, right? Like “yeah, I love this, I can do this!” And then two hours into your shift, you’re feeling the same exact way you were before your retreat ever happened.

[00:32:35] Mr. Dibble: Yeah, you know I used to, I was talking to people about why transformation is it’s two, two halves and they’re both equally important. One half is systems and one half is people. In other words, working at the level of thinking, and they both have to transform. But the two examples that I use of why there is an integrated whole, one of them is that of course, that you’ve got to, you’ve got to do the systems work because 94% of the outcomes are in the systems, if you don’t do the systems work you can’t change outcomes, but the other half is on the people side. When we look at retreats and team building and EQ and servant leadership and all those sorts of things, which I love and support, but what you see is that when people go on these retreats and they feel great and they get to know people at deeper levels and they come back. If you haven’t done the systems work, the outcomes are still the same, the stresses are still the same, and so very quickly, those good feelings wear off.

[00:34:39] And so this is the reason, and this is not well-known either, but leadership training, according to Deloitte, only has a 2% return on investment. And so the reason is because there’s no systems work, if you don’t do the systems work, you can’t change outcomes. So now what we see is these two halves of the whole that they must be integrated. We have to do that work around making people better and expanding their thinking and that sort of thing, but we also have to do the systems work and vice versa. So yeah, that’s where we could really get an ROI for doing leadership training, we just have the systems piece.

[00:34:43] Dr. JB: But it’s interesting how you say that the systems it’s invisible. So how do you make it visible? How do you fix something that’s invisible?

[00:34:52] Mr. Dibble: That’s where the tools come in. We developed a set of seven tools and actually, the first three tools are I think, we call it 3D, 3D PS, which is 3D problem solving, but the first three tools basically make the systems visible. And it’s not only that they make them visible, but it’s the way that they make them visible. It’s basically a transformative process for the people that are involved in it. And so we make the systems visible and we also identify the critical 20% of the systems which are creating 80% of the outcomes we want to change. And so that means that we are now working on the important stuff and not on the trivial many. And so, we get huge returns for our time and investment by working on basically the critical 20% of the systems. But that process of bringing basically multidisciplinary teams together to do the work is where we actually do the transformational work at the level of thinking, where we get people to now start to interact and to understand that it wasn’t the people down the hall that were creating their problems, and there’s no reason for the night shift to hate the day shift, it was systems issues, and we resolved those issues together. And in the process, we are able to address that part that says that we’ve got also expand people’s thinking. And so we do the systems and we do the expansion in thinking at the same time, while we are using the tools which have all been designed to do specifically that.

[00:36:43] Dr. JB: So at this institution where your model has been implemented, how long did it take for you to start seeing effects?

[00:36:54] Mr. Dibble: I think there’s already, as they say, some quite significant wins or victories in the pipeline, but they were seeing significant changes within six months in some of these departments, for instance, that had issues for decades. And yeah, they did tremendous work, for instance, you’re very familiar with the ED, and they had tremendous problems with wait times and discharges and people not knowing where people, where they were and stacks, stack ups. It’s the ED, they would, you never knew exactly what was going to be showing up at the front door, but they had very few ways of dealing with all of the issues that were coming in through the ED because basically everything was a workaround and everything was a firefight.

[00:37:54] And so you would see them, these amazing ER docs and nurses, they would be just doing heroic work, but the problem is that it’s, we wear people out doing that stuff all the time. And they worked on all sorts of things in the ED and of course they had all sorts of victories. They were also working in, in heme and I’m actually currently working there right now in their regional neonatal intensive care unit, which is, is a class four unit we’d been working for about six months, we’re already starting to see huge changes there as well. So I think a lot of those things, they’re all going to be sort of pieces of the publishing work that’s actually in the process right now. So yeah it’s kind of all over the hospital at this point.

[00:38:54] Dr. JB: That’s so amazing. And I’m so excited to see this study when it gets published with the results, because I definitely think that this, the study could potentially be transformational, especially, when we see in black and white the effects, like the before and the after.

[00:39:10] Mr. Dibble: I am too, like I said I am feeling like the big, the key to all of this is if we can, if we can create leverage. And that means many, many people teaching this in healthcare, both internally and externally, because it’s simple, it’s fast. We can teach anybody how to, you know, facilitate this model, and that’s really the key. Can we get enough people out teaching this model in healthcare to really make the difference?

[00:39:45] Dr. JB: And how long is the training?

[00:39:49] Mr. Dibble: Well right now, I’ve just completed two beta tests of the online Train the Trainer program, and we’ll be going live with the polished version probably in a couple months. But it’s been taking the beta groups about two months, anywhere between six weeks and probably two months, to go through the training and actually get to the point where they could begin to practice facilitating this model on small projects in health care.

[00:40:19] Dr. JB: Okay. So this is all online I take it?

[00:40:22] Mr. Dibble: It’s all online. Yeah, cause it’s the only way. Almost all of my training prior to COVID had been live and I realized right away when we were looking at taking this out to the world in a more meaningful way that it had to be online because there’s no way to reach probably many of the people that might be interested in becoming facilitators of this work.

[00:40:46] Dr. JB: And is there some kind of like certificate or something that they acquire once they finish the training?

[00:40:54] Mr. Dibble: Yeah. They’re certified. They can, you know, they can go out, they can use it in whatever way that they want. They can, my hope is that they’ll, they’ll take it into healthcare, doing something that really makes their heart sing. Particularly I’m thinking of like the burnout side of things, what are all these people–I mean there’s so many people looking for what’s next and I’m saying, this is it. You know, take this, take it in and be part of the solution for the problem that drove you out of healthcare.

[00:41:26] Dr. JB: Yeah, exactly. I mean, there’s a lot of people that are exiting healthcare and again, healthcare, the healthcare system in America cannot afford to lose all these people, right? Because it’s not a job really. I mean yes, we get paid for it, so yes, and we use the money to live our life and pay our bills, but what we do on a day to day, there’s no money that can really truly make up for what we experience and what we do and the care we provide. There isn’t [an amount of money].

[00:42:02 ]Mr. Dibble: Yeah. I mean, I look at what physicians, for instance, have to go through in order just to become a physician and, you know, it’s a, it’s a calling. It’s the only thing I can say is, it almost has to be because no one would do that just for the money. Nobody.

[00:42:25] Dr. JB: Yeah. You can start, you could start in college. “Ooh, yeah, when I graduate from medical school and become a doctor, I’ll make so much money, yeah.” And then you go and you start as a pre-med, and then you, there starts those little, those hurdles you have to jump through, like off the bat half of them are gone, and then it continues from there.

[00:42:51] Mr. Dibble: Yes. And I look at, and then of course when you get to where you are, where you’ve been there and you’ve been practicing for a while, and now you are in that system and somehow you stay with it, you know it’s just, it’s not easy. I don’t even know how you guys do it.

[00:43:15] Dr. JB: You know, because, because it’s those wins that you have that remind you of why it is that you’re doing this. It’s that connection you have with that patient, even if it’s just one throughout your day, that you really feel like you had a, an impact on their life, it’s that family that you’re able to explain things to where they really get it, or it’s just being that person that’s listening. At least for me, and I guess I can’t talk for everybody, I can’t talk for all my, my listeners, but for me, it’s those little wins that really give me the strength to continue.

[00:43:49] Mr. Dibble: Yes. And I just, I would just say, you know, the people that actually deliver care, in my estimation, you guys are amazing. So I’m talking about, really, I just, I’ve got to the point where I have such a big place in my heart, even for the people that make up the beds and the people that you know, that are doing the support work. It’s just this really amazing work, and it’s so wanted and needed and probably the most satisfaction that I get out of the work that I do is seeing the people in healthcare light up, when their light goes back on, the nurses and the physicians and the support staff suddenly realizing, “oh my God, I really can make a difference, I really can make a change, I really– my voice, I’m being heard, maybe, for the first time in a while.” It is, it, I actually describe it in one of my books like popcorn, you’ll watch people when they’re doing this work, here we are, we’re just doing the work, and all of a sudden you’ll see them pop into a little bit of expanded thinking and all of a sudden they realize, “oh my gosh, I’m actually going to be able to do this, I’m going to be able to make a difference, and I see things a little differently, maybe with a, a little more optimism.” So I don’t know, I love that, it’s part of what brings me to the work every day.

[00:45:32] Dr. JB: Yeah. And the population that you’re targeting really is the population that can actually be effective in terms of making the change, because they’re living it, they’re experiencing it, and they know their pain points.

[00:45:48] Mr. Dibble: Yes. And you look at the failed, all of these failed programs and so forth that have been going on for 30 years, they’re all top down. They’re all top down. Admin brings them in and there’s a big fanfare and everybody’s all excited, and then they bring in the experts and the consultants come in and they go down and they start trying to tell the people where the work is actually supposed to be done what to do.

[00:46:15] Dr. JB: Exactly.

[00:46:15] Mr. Dibble: And the people down there wait it out, they go, “hey, here’s the next flavor of the month and this too shall pass.” And it always does. So the work, that’s one of our tenants, is that the work has to be done bottom up. Now you need the support of top management, but you don’t need the kind of support that you need for the top-down type stuff. You just need them not to be barriers to change.

[00:46:41] Dr. JB: Exactly. Sit back and let us handle it.

[00:46:47] Mr. Dibble: Yeah. Don’t do your natural thing, which is to try and control everything, and you know, anyway… it’s yeah, it’s got to be bottom up. And so that’s part of the model too, is we work bottom up

[00:47:03] Dr. JB: And that’s exactly it because yeah, the people that are working boots on the ground, experiencing the reality of the situation day in and day out. They’re extremely intelligent, they think outside the box, they’re the problem solvers, we’re used to doing workarounds, and passionate. We’re the ones that are seeing the expressions on our patients’ faces. We’re the ones that are interacting with both the patient and the families. And we’re doing this work because we want to make a difference. And because we actually do, we love the patient experience. We want our patients to have a good experience in the hospital. We’re not at odds with that, of course we want them to be happy and want them to be satisfied with their care, et cetera, et cetera, but part of that satisfaction doesn’t mean providing them services that they don’t necessarily need or giving them medications that they don’t necessarily need. And we need to have that space to be able to make those decisions ourselves also.

[00:48:06] Mr. Dibble: Yes. Well, you can see, I mean those issues, you see those probably more clearly than I do, is baked into the system. In other words, the fact that when we look at well why would someone, in general, why would someone overmedicate or why would someone do something that was not in the patient’s interest? And you’ll see it’s in the system. And you start with the physician maybe having to protect themselves based on policy and stuff like that, that you run every single task and somebody could make the argument “yeah, that’s great because it generates more revenue for the hospital,” but you start looking at policy and the system itself, and you start looking at, if you don’t do that stuff, you put yourself and the organization at risk.

[00:49:03] Dr. JB: Exactly. It’s called C Y A.

[00:49:07] Mr. Dibble: Yes! But look, it’s in the system.

[00:49:14] Dr. JB: Yeah, exactly. We have an acronym for it.

[00:49:20] Mr. Dibble: Yeah. You can see there are very few bad people in healthcare, there really are. There’s just an awful lot of really poor systems. When you go against the system, the system always wins. And that’s the thing people don’t understand. I mean, if you put the best people on the planet in a bad system and the system will win.

[00:49:43] Dr. JB: It’s powerful

[00:49:46] Mr. Dibble: Mhmm, well 94% powerful.

[00:49:48] Dr. JB: Yeah. You know, that’s an amazing statistic. And I, and it’s true, many people in healthcare don’t realize that.

[00:49:57] Mr. Dibble: No. A matter of fact, the vast majority don’t realize it and they really think that people are the cause of both whatever comes out, good or bad. And you find that no, it’s the system, but again, we’re dealing with something that’s invisible so it just becomes, you know, it just becomes the way we do things.

[00:50:22]Dr. JB: Ever since “To Err Is Human,” that book came out, then we started, you know, really shedding light on the adverse events that happen and whatnot. I know there was a change in, in language in healthcare system where it has transitioned from, ” oh, it’s the doctor’s fault” or whatever, anytime something happens it’s always blamed on the system. It’s the system, you know? And then they go ahead and do this analysis to try to find the root cause, a root cause analysis, and try to find what is wrong with the system that can be adjusted to prevent similar errors from occurring.

[00:51:08] Mr. Dibble: Yes, but, you know doctor, that the big problem is that the systems don’t change. They say, “okay, we’re going to do a root cause analysis and we’re going to—” you know, “evidence-based” you hear it all the time in healthcare, and yeah, it doesn’t matter. You can have all the evidence, in the world and you can practically, you know, bring in all the tools, do lean, do six sigma, do whatever it is you’re going to do, but the systems don’t change because the culture of healthcare is no change. It’s so difficult to actually get to the point where you can change anything unless you work at the level of culture of thinking too. And so you just see it, you know? You’ve got, 2 million injuries a year in healthcare, you’ve got 300,000 deaths or some number, like it was ridiculous, and that number has been the same, approximately, for decades. And all of that root cause analysis and all that sort of thing hasn’t changed a thing. And so, that’s when you have to start looking at what is the model by which we are trying to change these things, because it certainly is not working.

[00:52:36] Dr. JB: That’s true. That’s so true. And the people that are on the ground are feeling those effects.

[00:52:46] Mr. Dibble: Yes. Well, you see it because of what’s happening now with burnout, wellness, and all those things for, for the health care providers themselves.

[00:52:58] Dr. JB: And again, if the system that the healthcare professionals find themselves working in does not change, this is not going to work. We’re going to continue having this burnout epidemic that’s going to continue to worsen.

[00:53:15] Mr. Dibble: Yes. And the thing is see, there was, I had a sort of a mentor early in my career, a guy named Buckminster Fuller, and Buckminster Fuller was a great genius and just probably one of the greatest humanitarians who ever lived, but he called it accelerating acceleration. And that’s exactly what we are seeing in the levels of stress in healthcare with the burnout of care providers. See when they are the workaround artist and without them there to work around the systems, that puts more stress into the systems. So that’s accelerating the already acceleration levels of stress into the systems in healthcare. And of course, as we continue to add stress at an accelerating level to those systems, we move ever closer to a reordering.

[00:54:19] Dr. JB: Yep. So true. So, with that being said, Mr. Dibble, if my listener wanted to get in touch with you, wanted to find out more about this model that we’ve been talking about, how can they reach you?

[00:54:39] Mr. Dibble: Probably the best way is just send me an email, it’s david@thenewagreements.com and that’s also our website, thenewagreements.com, and then also connect with me on LinkedIn. I’m real active on LinkedIn and I, for whatever reason, I seem to be connecting right and left with people from healthcare these days, but yeah. And I’d love to hear from you, particularly with the launch of the Train the Trainer certification program in a couple or three months. I really believe that if we get lucky and this gets out there in a, in a big way in the world, we’re really going to make a difference in healthcare

[00:55:25] Dr. JB: And in closing, because we are reaching the end of our time together, do you have any final words of wisdom that you would like to share with my listener?

[00:55:39] Mr. Dibble: Yeah, I think I would just say that I know there’s an awful lot of things going on in the world right now which are daunting to say the least, but I would also say that I think we’re all here for a reason and that in some ways this may be the most exciting time to be alive in the history of humanity, and that we’re here really to do I think our real work in the world. And this is it, it’s our opportunity to step up and to really make a difference in the world. And yeah, let’s get to work.

[00:56:20] Dr. JB: I love it. Because getting to work, making a difference, making a change,  not only will improve things for us and our colleagues, but also the future generations to come.

[00:56:35] Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.


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