In this conversation, Lee talks with Dr. Frist about his background as a surgeon, and how companies can create a culture of innovation. They also discuss how his work in the U.S. Senate helped change the government’s view of AIDS and AIDS treatment.

Speaker 1: Bringing you conversations with leaders within the operating room and healthcare community, this is Scrubbing In.

Todd Schlosser: Hello, and welcome to this episode of Scrubbing In, a podcast powered by SpecialtyCare. I’m Todd Schlosser, and today we have a very special treat for you. SpecialtyCare’s CMO Lee Pepper interviewing the former senator Bill Frist. In this conversation, Lee talks with Dr. Frist about his background as a surgeon, and how companies can create a culture of innovation. They also discuss how his work in the U.S. Senate helped change the government’s view of AIDS and AIDS treatment. Enjoy the conversation.

Lee Pepper: Senator Frist, thank you so much for joining us this morning on our Scrubbing In podcast.

Senator Dr. Bill Frist: Thank you.

Lee Pepper: It’s an honor, as we started Scrubbing In and our podcast title is Innovation in the OR, it’s a real honor to have a real surgeon in our presence this morning.

Senator Dr. Bill Frist: I’ve been there.

Lee Pepper: Exactly.

Senator Dr. Bill Frist: I’ve been there, years and years.

Lee Pepper: And that’s what I wanted to start our conversation this morning about, is how do you really look at surgery today, and especially heart surgery, because our company’s been so involved with cardiothoracic, with our profusion [inaudible]. So, how do you view, for young surgeons coming in, how can they be encouraged to innovate in that OR?

Senator Dr. Bill Frist: It is a great question, and I’ve been operating since 1979, literally since 1979. Did my last real operation about two-and-a-half years ago, operating around the world. So I’ve watched it change, and it really comes down to this culture of innovation, in the surgeon’s mind. It was very different in the eighties and the nineties, earlier on. Surgery was very regimented, there were five things that you did, you didn’t go outside of those boxes, you didn’t really address the efficiency, the productivity, the safety issues, in an engineering type way.

So today the culture is changing, and it’s changing in our residency programs, it’s training in the first early years when people are out on their own, to yes, let’s innovate, let’s figure out not how to change the steps, but how to make them safer, make them easier, make them more productive, make them simpler. And it comes back to that culture, what is that mindset, that openness?

So we went from 30 years ago, very rigid, don’t go outside the box, to today, yes, safety is number one, but to get to that endpoint of safety and productivity, meaning a great outcome, let’s think imaginatively of how to do that.

Lee Pepper: When you think about the area that we’re located in, in Nashville, and it’s kind of the Silicon Valley of healthcare, there’s a lot of articles, a lot of things coming out around the use of big data as it applies into healthcare. What are you seeing with companies around the Nashville area, or really in the U.S. in general, how they’re using that big data to help innovation?
Senator Dr. Bill Frist: The words artificial intelligence are way overused, but the whole concept of being able to collect data, and pick up trends of nuances, suggestions, that are generated data speaking to data, is to me explosively powerful. We have to be very careful, we have to look at what the assumptions are, but the fact that data can pick up something in a dimension that we cannot, our own minds cannot, to me, is very encouraging.

It means we need to look at the issues of privacy, of consent of use of that data, the identification of that data. But having that data put together in very systematic, with an engineering approach, to be able to look out the trends that are there, that suggest safety and outcome and better quality and higher standards, is hugely powerful.

So I’m an optimist, and when people ask me what’s different about the next five years than the past five, yes, it’s technology, but the most exciting thing is the information technology of good data, it has to be clean data, but data that you can make clean over time, that gives you a high [des] and helps you modify, improve in an iterative way going forward. So I’m very excited about using data.

Lee Pepper: It’s interesting to think about Moore’s Law, for many years ago, and the doubling of the speed of our chips, and how that could start to apply to healthcare today, and how everything is becoming so miniaturized. I wonder, what are you seeing from the operating room perspective, with some of the new advances in equipment?

Senator Dr. Bill Frist: It’s interesting, and people are always looking for disruption, and that was the Clay Christensens, thinking about innovation, nad I think that’s pretty good, but I think it’s about four to five years old, and it comes back to your data question. I think today with the amount of data, and the speed with which we can iterate that data, that you don’t need to have truly disruptive technology, but you can take technology and improve it much faster than in the past.

And I think too often we say, it has to be disruptive technology, it has to be a major change, it has to be a whole new piece of equipment coming in, or it’s not going to really change things. I don’t buy that anymore. I bought it two years ago, but I don’t buy it now. And I think this iterative, stepwise improvement of trying something, correcting it with data, correcting it, and not failing totally, but correcting it before failure, is something we could do today, that we couldn’t do in the past.

And I think it applies to instrumentation, it applies to the devices themselves in a way of constant, continuous improvement, rather than having total disruption, which has become the expectation around many of the young people today, that I just don’t agree with.

Lee Pepper: Absolutely. So you’re not advocating that we create the new Uber of heart surgery.

Senator Dr. Bill Frist: It doesn’t have to, it doesn’t have to. And if it appears it’s fine, but if we wait, and use that as the excuse not to continually focus with a disciplined, the accumulation of data, the assimilation of that data, and putting it forward, in an iterative way, testing it, that’s where the real progress is gonna be. It’s not gonna be sitting around, waiting, as a lot of companies do … well, we’ll wait until the next disruptive thing comes in and we’ll hop on board. We need to start … I think we can start today with that process, much, much earlier with the access to data and information technology.

Lee Pepper: Going back to your … the first question you touched on, culture and innovation, what can private companies and even the public sector do to create that culture that will attract the innovation?

Senator Dr. Bill Frist: You’ve gotta talk at every meeting, and you’ve gotta open with it. It used to be that place is too soft, or we’ve got to be a lot more aggressive and more disciplined and hardcore, and … I think you need to begin every conversation with the importance of culture and a culture of innovation, of openness, of safety and talking about it. Put your mission statement out there, put your strategy out there, and let people react to it.

Really interesting, in 1983, I was chief resident at Massachusetts General Hospital, that was a long time ago. But it doesn’t change, and I think about it all the time, and I thought about it in the United States Senate, I thought about it being majority leader, I thought about it in HIV/AIDS legislation, and it went back in 1983, an article was written in the New England Journal of Medicine, saying that Boston should not do heart transplants. I’d gone from Nashville, Tennessee, up to Boston to Harvard, to Mass General, because it was, I thought, one of the greatest places of innovation in health and in surgery.

And I got there, and after five years, they said, we’re not gonna do heart transplants. Why? Because it’s not the greatest good for the greatest number of people. So, they said no to innovation, they said no to creativity, they said no to advancing science. Harvard. So I picked up and left. Literally, I said, I’m not staying in Boston, I’m going to California. I began to work with a different culture there, with a fellow Norman Shumway, who was open to transplantation and the future, and giving hope to people who had no hope, and do it in a systematic, scientific way.

And then over the next 10 years, Stanford and the West Coast exploded in a productive way on transplantation and innovation and immunology, leading into treatment of HIV/AIDS, and Boston saying no to that innovation, basically for the next five to 10 years, in the field of immunology and transplantation, fell behind most other centers, or many other centers in America today.

And it all started with this culture, this openness, this willingness to innovate, and not say no, even if your intent is good from a public policy standpoint. Public policy can kill innovation. If a hospital doesn’t want to innovate, if a surgeon operating room doesn’t want to innovate, it can kill that culture, ultimately hurting the whole purpose, and that is lifting patients up to better lives and a higher quality of life in curing disease.

Lee Pepper: That’s an interesting segue, that you were a young man, leaving Boston, going out to the West Coast. And earlier this morning, in another conversation that you had, you were discussing how we have to embrace the Gen X, the Gen Y. We cannot … we have to embrace this youth, because they have a lot of vitality, and they have a lot of great ideas.

Senator Dr. Bill Frist: It’s fascinating, and I bring it up a lot, and now, 1983 was a long time ago. And that was the peak of much of the energy and the openness, and the clear thinking about innovation. So when I’m innovating, I like, in my teams of people … and I’m spending a lot of time establishing innovative companies, solving problems that are seemingly insurmountable … I make sure, from a diversity standpoint, by age, and gender, and race, that it is all in the room.

And much of that energy, and much of that freedom to innovate, comes from the 20-year-old, the 25-year-old, the 30- and the 35-year-old. I still have the wisdom and the experience in the room of people who are my generation, and together, as a team, that diversity allows us innovation and this creativity, and this dynamism just to explode.

Lee Pepper: Excellent. Is there anything you’d like to share with us that we can look forward to what Senator Frist is going to be doing in 2019? What can we look forward to from you?

Senator Dr. Bill Frist: It’s been a fascinating ride, and I tend to integrate my life, and it’s all centered around health and hope and healing, and I spent the first 15, 20, years as a surgeon figuring out this creative field of heart transplantation and lung transplantation, and heart-lung transplantation. And then I lost my mind and went into politics, started at the bottom, and again applied this creative, innovative approach to United States Senate. It sounds so strange today with where we are.

But out of that innovation came HIV/AIDS and treatment around the world, and openness to get Republicans to think about HIV/AIDS as much as Democrats. And that creativity of innovating means that there are 20 million people alive today because innovation in our government allowed people, Democrat, Republican, to come together around ideas that people thought, you couldn’t treat HIV/AIDS, it’s too expensive to treat it around the world, and there are 20 million people alive today because they came together.

And the last 12 years have been starting companies, whether it’s palliative healthcare or end-of-life, or treatment for opiod and substance abuse, the innovative and the creativity is what bring those together. My life has really taken that health, hope and healing concept, which in my mind is all the same. But mixing it with innovation and the creativity and the openness, with an engineering type approach, and out of that, good things seem to happen.

So most of my focus over the next year will be just on that. It will be looking at nature, broadly, around the world, as part of the global board of the Nature Conservancy, and looking at the intersection of nature, with health, in a way that will improve the health and wellbeing of populations in America and Appalachia, but indeed in India and in Haiti and in Cuba and around the world.

Lee Pepper: Great. Well, Senator Frist, thank you so much for your time this morning, we really appreciate it. Honor to have you.

Senator Dr. Bill Frist: Right there with you, thank you very much. Appreciate it.

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