Designing for Health: Interview with Mark Townsend, MD [Podcast]

The innovation of technology and processes inherently requires not only trial and error but a non-negligible amount of risk. This presents a unique challenge for the healthcare industry, which both needs innovation and has very little room for risk or error. To move the industry into the future, leaders must adopt a nuanced approach that simultaneously appreciates governance and its goals and is willing to take calculated risks to fail fast and fail forward.

On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, chats with Bon Secours Mercy Health Executive in Residence Mark Townsend, MD. They discuss Dr. Townsend’s path from internal medicine and cardiology to his current role as a health system administrator, as well as his work with emerging healthcare startups, balancing cybersecurity and customization within the electronic health record, and what it means to “fail forward.”

Listen here:


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Want to hear more from Dr. Joseph? Order a copy of his book, Designing for Health.

Show Notes: 

[00:00] Intros

[00:53] Dr. Townsend’s background

[06:29] Working on Mobilizing a Million Hearts

[13:32] Challenging assumptions in product development

[16:29] Offering constructive feedback

[24:36] Innovating while respecting governance

[37:59] Things so well designed, they bring Dr. Townsend joy


Dr. Craig Joseph: Mark, welcome to the podcast. How are you today?

Dr. Mark Townsend: Doing great. Thanks for having me.

Dr. Craig Joseph: It is a pleasure to have you. A well-known, well-established physician leader to talk about some of the pitfalls and learnings with respect to design that you've had.

Dr. Mark Townsend: Yeah, mostly pitfalls.

Dr. Craig Joseph: Mostly pitfalls. Well, that's how we learn though, right?

Dr. Mark Townsend: That's right.

Dr. Craig Joseph: That's how we learn. So how did you get into doing some of this work? You're an internist by training and practice, I believe. Is that true?

Dr. Mark Townsend: Yes. Internal medicine, pediatrics, trained and then went on to cardiology, to adult congenital and pediatric cardiology. So I'm recovering from all of that, actually. So.

Dr. Craig Joseph: Fair enough. So I didn't realize that you did med pedes and then you did cardiology fellowships in both in both pedes and adult or focusing on one more than the other?

Dr. Mark Townsend: So dating myself, I'm grandfathered in through internal medicine or adult congenital. So I did have to do, there was training guidelines that helped me through that. So I did qualify for ABIM boards in adult congenital cardiology. When they finally came along and it was a great experience, I got to help write the boards and then take them. So that was good.

Dr. Craig Joseph: That is always, I think that's a tip that our listeners should really be focused on. If you help write the boards, your chances of successfully completing the boards have gone up significantly.

Dr. Mark Townsend: Absolutely.

Dr. Craig Joseph: That's great. It's funny, as a, I was a primary care pediatrician. I don't practice now, but I did for a while. And now when I deal with pediatric subspecialists like gastroenterologists or endocrinologists, you know, they tell me, Well, no, listen, what I need from my technology or other things to help me practice, they're very different than what the adults need because I'm a pediatric endocrinologist or pediatric gastroenterologist, and I always poopoo them and say, Well, it's really the same really, isn't it? You know, what an adult gastroenterologist does? But cardiology is actually very, very different. You take most adult cardiologists and ask them to look at it at a small, at a baby, and they get very, very diaphoretic anxious appearing. So hats off to you to be able to do both of those things.

Dr. Mark Townsend: Well, as I said, I'm recovering from all of that. And so I left clinical medicine behind to take a full administrative role three years ago. So here we have, here we have it.

Dr. Craig Joseph: So how did you get started? You know, you've done some fun things that we're going to talk about that are not traditional from either a leadership perspective or from a practice perspective. One thing that I would just like to kind of understand is how did you get to where you are? Where did you become interested in doing some of these things, working with startups and venture capital firms? How did that all happen?

Dr. Mark Townsend: Well, I became interested in working in the technology space by virtue of the fact that I needed technology, right? So as a congenital cardiologist, when no one knew what that was, I needed, for example, echo reading software. And then there was a couple of prototypes out there. I happen to know a couple of guys who were pretty good at hacking, if you will.

Dr. Mark Townsend: And next thing you know, we found ourselves content and this can go on the podcast, but necessity is the mother of invention. But building tools for the job that that we needed to perform clinically was how I had my start. So, you know, whether or not it was reading an echocardiogram, whether or not it was an electronic health record, I essentially had to build my own. So that's how I had my start.

Dr. Craig Joseph: Well, that sounds all kosher. Nothing secret.

Dr. Mark Townsend: Mostly kosher. Yeah, exactly. And the guys I partnered with went on to be CMIOs. I'll leave them nameless and blameless.

Dr. Craig Joseph: All right, that's fair. If you just tell me after the show, we'll make sure to put that secretly in the show notes. And for small feel, I'll make it more clear for people so that they can actually find out who you're talking about. So the, so necessity was the mother of invention, and that's kind of how you got forced into it. Obviously, though, once you were there, in some way you enjoyed yourself, you were working with and I assume still are occasionally working with startups. Is that true?

Dr. Mark Townsend: Yes, absolutely. So, you know, the design journey that I was on was create a tool that I need to do my job that I can't afford. And that doesn't exist. Right? And then that leads to, well, you know, if I could do it for that use case, could I not apply, you know, the same concept to an additional use case and then the creative juices start to flow and next thing you know, you know, you find yourself in over your head. And so I, I got involved in, in mobile health and, you know, conceptually helped design a couple mobile apps that led to then some additional content development and Mobilizing a Million Hearts that led to additional development. And then at some point, you start to realize that it's a lot of work doing it on the front end, and it's more fun to criticize other people as they're doing the work. And so there's a local incubator called Lighthouse Labs, I’m based in Richmond, Virginia, so shout out to Lighthouse Labs. And so I, I work with them to help distribute venture capital that helps select the healthcare cohort that that is funded, that then turns into helping startups access health systems. And it gives me the advantage of being able to constructively critique the work as it is being developed. So yeah, neat space to be in. It's a creative outlet, right?

Dr. Craig Joseph: Yeah. Well that's, you know, that's very helpful. And a big differentiator between you and me is you're giving constructive criticism. I generally do destructive criticism as folks that work with me know. Well, let's talk about Mobilizing a Million Hearts. You had talked about that as a project that you worked on. What was that? How did that come about and how did it turn out?

Dr. Mark Townsend: Yeah, so as a practicing cardiologist and trying to get your patients to buy in to improving their healthcare outcomes is the heavy lift, right? So that's healthcare. And so if you say “how might we” statement, you know, how might we help my patient achieve better health outcomes, that that conceptually leads to patient education. And so we as cardiologists, when we're predicting the risk of a ten year cardiovascular event, a heart attack or stroke, and this is relevant for adult congenital, right? You're born with a heart problem and now you're acquiring heart disease by virtue of the fact that you're an American. So and we've got the, you know, the oh so healthy lifestyle, trying to engage those patients in minimizing their risk was the heavy lift. And so I found myself trying to gamify their cardiovascular risk for them to say, for example, you've got a 50% chance of having a heart attack or a stroke within the next ten years using, you know, that's a cardiovascular risk prediction tool. And then you say, you pick one variable and say, but if you stop smoking, I guarantee you your risk will decrease. Right? And so then the patient's like, well, by how much? And so that led to the concept of, okay, well, let's gamify this thing. Right? And so taking that show on the road ended up then allowing us to engage the American College of Cardiology that went on to gamify the mobile health app, which became the teaching tool, by the way, of Mobilizing a Million Hearts, the nationwide initiative to curtail heart disease. That then led to the concept of, well, we could do that as a SMART on FHIR app because it's pretty darn clunky in the middle of the patient care episode to pull out your phone and to start plugging in data points and trying to convince the patient, Hang on with me, you know, hang in there. We're going to have a really cool outcome here for you and I won't be able to print this and you'll have no record of this. So taking that concept, we developed a SMART on FHIR app and that turned into an ONC Leap Grant, Office of the National Coordinator Leap Grant 2018 to 2020, which by the way, was designed to demonstrate that we could kind of kick open the door of development in the third party open API space to develop content for electronic health records without begging for permission. So that's what we did.

Dr. Craig Joseph: So how did that work? So now you're with a patient, you've got the electronic health record open because it's omnipresent and you tell them that, hey, you've got a 50% chance of having a stroke and in the next ten years. But if you do some things, we can decrease that. And so right from your screen, you're able to kind of say, well, if you do stop smoking, it's going to go down to this percent. But if you continue smoking. But if you lower your cholesterol, it's going to go down by this percent. But if you do both of those, that, is that the idea?

Dr. Mark Townsend: Exactly right. And the whole point was to embed that content within the electronic health record. So it looks and feel like the EHR, right? And so you also don't have to go and pull in the data points, the age and, you know, the medications and whether or not they’re on an antihypertensive, etc.. So you can pull in discrete data points which fuel the application and then you make a FHIR call and then next thing you know you've got real live data to work with and then you can use sliders to gamify risk. So you engage your patient and say, well, so if you only took that blood pressure medication that I've been asking you to take for years, this is what it would do to your cardiovascular risk. And then next thing you know, you can visually display that in the electronic health record. You can print that and then send the patient home with it.

Dr. Craig Joseph: And by visually display, are you saying, here's a hundred little icons of people and you know, you're going to go from this many people who are going to have a stroke to that many? Is that the kind of thing you're talking about?

Dr. Mark Townsend: Yeah, I like that. And maybe that should be the next iteration of it. It's more of a red, yellow, green construct with sliders and more of a bar graph presentation. And so, you know, your risk goes from red to green, you know, if you make an intervention. So that's how we displayed it.

Dr. Craig Joseph: Awesome. Well that's that was some free suggestions that I just gave you. I've seen others do similar type risk explanations for patients and that was the way it was kind of expressed. And what I thought was quite effective again, is like showing a 100 little people or ten little people and, you know, showing three of them as being red, which those are the ones that are going to be affected negatively. And having, I've seen a kind of physician go, which one are you? Pointing at the, here's the good one, here's the bad one, which one do you want to be in? And boy, look, if you do that, take that blood pressure medicine. There's a lot more of the good guys and a fewer of the bad guys. And that seem to be much more effective than kind of just numbers, which are a little bit more kind of difficult to make into the real life a percentage.

Dr. Mark Townsend: Yeah.

Dr. Craig Joseph: So when you were working with this, was this at MedStar? Was this at the, at that time, with the Center for Human Factors in Healthcare?

Dr. Mark Townsend: Yeah. So, you know, it's been said a prophet has no honor in their own country. I'm no prophet and I have no honor in my own country. So that made it perfectly tenable that this wasn't going to work in my former healthcare institution. And I needed a partner. So I went to Ken Mendell, who's the father of Smart on FHIR, and I was in grad school at the time, and he gave me a lecture. So I chase him down after the lecture and said, Hey, so this is what I want to do. And he's like, that'd be a great grant. You ought to apply for a grant. So a classmate of mine named Terry Fairbanks started the Human Factors Institute at MedStar. I'm based in in Virginia. I was reconnected with Terry's institute and the MedStar Center for Human Factors in Healthcare helped us partner. So Chris Miller was really the one that the heavy lifting with Mobilizing a Million Hearts. And so we were able to use the Human Factors Institute to really help with the design of the application. So, you know, finding extreme users and putting them to work to punch holes in your concept, is where we started.

Dr. Craig Joseph: Were there other kind of learnings that you might have stumbled in to yourself, but that they were able to identify quickly and say, okay, this is completely wrong? Or have you even thought about this perspective? You had mentioned kind of extreme users, the folks that are going to be on the periphery of the of the use cases. Was there, were there other things?

Dr. Mark Townsend: Yeah. You know, so once you get into content development, we all fall in love with the solution and not the problem. Right? And so design thinking and challenges us to fall in love with the problem, not the solution. So, you know, it's one thing for me to, to use my experience and say, okay, this is how it works in my clinic and this is how we should do it right? Then you get that in front of expert users, you get that in front of novice users. And what we were able to do using human factors was set users down in front of the screen, an electronic health record, and have them start engaging with our content. And one of the cool things that MedStar does, they use a technology that essentially attracts the user's visual cues with the user interface with the screen. So you can see where they're looking and then where they're engaging. And so you put content on an electronic health record where we think it's intuitive. Well, and guess what? It's not necessarily intuitive. And then, you know, through this process you start to refine, okay, so if I'm in the middle of a patient interaction and I need to access content, where am I going to put it? And that's how we embed it within the electronic health record. That's how then we started to engage users and how did they interacted with that technology and using those rapid cycles of continuous improvement, you know, those short quick cycles. All right, let's tweak this, try again. Right? And keep the user pool fresh. That that's how the design aspect really worked. And that's what MedStar does very well.

Dr. Craig Joseph: Yeah. Well, so it sounds like there's some serious technology there with the eye tracking. And were you shocked at the fact that there were people who did the same kinds of jobs as you? There are other cardiologists or internists and who were not ready to interact with the technology that you created? I know I have been, I'm like, of course, this is the most obvious way of doing it, and I've been wrong. I mean, it's only been once, but it did happen to me and.

Dr. Mark Townsend: Yeah, yeah, No great minds think alike, right? So you, you assume that everyone's going to be great like you and I was going to think just like you. But who knew? Some people don't get the memo. Like I got the white shirt memo today, and you didn't even have to tell me because we're great minds. But, you know, other people get the memo and but they get it from someone else apparently. They don't get it from me.

Dr. Craig Joseph: Wow. Yeah. Well, I think we both agree that we are some of the smartest people in the room.

Dr. Mark Townsend: Yeah, for sure.

Dr. Craig Joseph: It's just everyone else that just disagrees with that.

Dr. Mark Townsend: Poor souls.

Dr. Craig Joseph: I know. I feel sorry for all those people. Let's talk about some of the work that's ongoing now. So you've worked with and you had just mentioned that you're in the enviable position of giving constructive criticism to startups and folks that are looking to create either apps or other technology. How does that, how do you interact with them? How do you make constructive feedback and not the kind of destructive feedback that I give? What are some examples of things that you've seen people do that made sense to them as they're developing their apps or creating their technology that that you're like, Yeah, that's not going to work for most of us.

Dr. Mark Townsend: Yeah, it's interesting. So I think the first call out is that maybe 5% of the technology that I review at some point has some significant compliant, you know, compliance related concern. You know, in other words, something that they're trying to do is a little bit illegal. And, you know, if you're a young developer and you're not in healthcare, you wouldn't know that, you know, for example, enhancing documentation, using automation to improve your reimbursement in a capitated environment, Why not, right? I mean, if you can get a computer to be smarter than a human being. So I think first things first, you know, trying to keep people out of orange jumpsuits is a start. But moving past that, you know, having been there, done that and falling in love with my creation as opposed to, you know, really being in love with the problem, not the solution, I think, you know, as you extract yourself emotionally and you're interacting with start ups, you commonly see that, you see people just so infatuated and so down in the weeds, so far down the rabbit hole with their own technology that there’s not much oxygen down in the rabbit hole anymore. They're a little hypoxic and they need to zoom out, get out of the rabbit hole, take a big breath of fresh air and say, hang on a second. So if you can gently mentor them. An example of that is a startup couple of cohorts ago, so this is couple of cycles ago, had developed this great tool, but it was a free standing user interface. It was, you know, it was mobile health, it was as a mobile app and you just have another sign into another portal and you're going to have another user interface and another screen out there, right? And why not? Because it's easier to design it that way and then challenging these people. Well, you know what? It's going to be really hard to get traction from someone who's actually living the life of a physician or a clinician. It's going to be really hard to get traction because they're not going to log into your interface. They're not going to have another floating window in the midst of a busy patient interaction. So you've got to embed that in the electronic health record. Here's how you can do that, right? Introduction to HL7. Smart on FHIR. You can do that. And so that's where, you know, I'm able to intervene in some cases and help out. It's gratifying then to see them come full circle and that happened recently where a startup I'd worked with had had actually listened to the advice, which was kind of gratifying.

Dr. Craig Joseph: Shocking, really.

Dr. Mark Townsend: And they should have known better. But now and this in this case, they came back and they had actually done it. It was so gratifying because they now have a tool that is fully integrated into an electronic health record that actually is very cool, very useful. And we're trying to bring that full circle and get that plugged back into our health system.

Dr. Craig Joseph: I'm genuinely shocked that that is the most common example that that you came up with, because it's exactly my experience, and we were talking about it, again, your constructive ways and my destructive ways. I've told many developers that that's great what you just proposed. Are you curing cancer? Because if you are curing cancer, I am willing to go and log in to that system and to have a floating screen and to do all those other things that are good for you but bad for me. But if you're not curing cancer, and almost no one is, then I'm not going to do it. And then you hit that kind of 80% mark where, you know, this is where I live and it's 80% of the way there. And it's good enough. And your new technology is offering me a boost up to 20%, you know, up 20%, up to 100. It's amazing. But that 20% differential is not enough. And so hence, to really get traction, it needs to be in the, you know, it needs to be connected or at least appear to be in the tool where I'm spending all day. I'm not going to be flipping even to even ask someone to who's living in the electronic health record to email is, can be a big deal. Because that's not where they live. Have you found any other kind of trends, are there colors, are there sizes of fonts? Are there particular affordances in software that you've seen where people are like, No, this is great, and then you have to point out not everyone's 24 years old?

Dr. Mark Townsend: Well, the older I get, the font size is more helpful, right? So it's hard to read something that is in small print anymore. But no, you know, that aside, another fun application is wearables. You know, there's a lot of interest in wearables and you see in the design cohorts some pretty cool creative ideas come through. And then to be able to redirect and shape that, particularly how you take a wearable and then you ingest the data that you've curated from that. Right? And that's where it can be a little bit disheartening. Back to again, the electronic health record. It is again such a great limiting step to be able to say, okay, well, I've created all this fantastic data. Now you're a smart doc, you figure out what to do with it, right? And you can get halfway there, right? You've created this fantastic new technology that's going to be really helpful in a movement disorder, for example. And then but we have no idea what to do with that. And now with that data that we've created, can we turn it into cognitive assistants? Can we turn it into something that makes the life of the clinician better rather than one more annoying pop up that that obstructs my workflow in the midst of a clinical scenario? Can we turn it into cognitive assistance that is somehow embedded into a workflow that I as a human being have to suffer through or excuse me, I live through every day that I'm clinically active, right?

Dr. Craig Joseph: You know, as the, as you may know, I am the inventor of the pop up and I am offended. I am offended by your—

Dr. Mark Townsend: The accursed pop up, yes.

Dr. Craig Joseph: By your, by your bad attitude towards my invention of the pop up. And I've encouraged software developers around the world to pop things more, to pop up more things, Mark. So you need to tone down your pop up attitude and get with the program. But seriously, your point is well taken. Boy, it's much better to prevent me if I'm entering a medication order or interacting somehow with the technology, it’s much better to guide me in the right direction than to yell at me after I make a mistake. Right? And those are some of the things that I think we who study design, at least even superficially, kind of get, and humans appreciate, although they don't know why. This it just you know, this technology seems to be easier to use than that. And they couldn't tell you why. And it's because this one kind of guided you. So it's unlikely you're going to make a mistake. And this one just let you make the mistake and then yelled at you after you made the mistake. And it would have been nice to have some advice, some gentle in-line advice to kind of point me in the direction.

Dr. Mark Townsend: Cognitive assistance.

Dr. Craig Joseph: Absolutely.

Dr. Mark Townsend: Yeah.

Dr. Craig Joseph: So as you've kind of given up most of your practicing career and now you're focused on leadership, I'm assuming that governance of I.T programs and other kind of technologies come across your way. How much fun is it telling people that they can have what they want or they can't have what they want or how they get what they want?

Dr. Mark Townsend: Yeah, God help us. All right. That's synonymous with governance. Yeah. You know, there's this whole little thing about, you know, how we're going to pay for our great idea and that factors into governance. And then the other little problem is, you know, how we create vulnerabilities with our own technology. And so, you know, it's a sinister world out there. And there are people that want to do us harm even in healthcare. Right? That's the thing that that kind of stifles innovation. Having been there on the front end of that, where you come up with a technology and you say, you know, all I got to do is just plug this in and we're going to be great. We're going to save lives, stamp out disease, It's going to be amazing. And then someone tells you, well, you've just created significant vulnerabilities in our system. Na na na na na. Well, well, even if I did, you know, no one is going to take advantage of those vulnerabilities. Well, apparently some people out there are. So, you know, in this governance construct, it's yeah, you do have to sometimes be the naysayer. I still find myself on the other side of the argument more often than not, and more recently trying to integrate the technology into our health system. That's an AI driven algorithm, just like every other algorithm these days, right? And that does super cool things in terms of mining data and then turning that into actionable, you know, clinical interventions that was supposed to be like a two month project that turned into a nine month compliance centric project just to get it through governance, right? So I was very patient. The older I've gotten, I've gotten a little bit more patient. So working on that, I'm impatient with my progress and trying to become more patient. But with that whole project, I then was able to use that as an example of how we need to blow up our whole governance construct and redesign it. So in an environment where the time to market is how you protect intellectual property, that you know, you can't, you can't delay, you can't wait nine months to get something approved. So that's the constant paradigm that that we're all living in. It's, you know, it's a bit of a innovation paradox. Time is money and how do we capitalize on technology if we're stuck in that time warp, which is compliance and governance?

Dr. Craig Joseph: So where do we put that line, that safety line? You know, in terms of cybersecurity, I used to joke with some of the chief information security officers and lawyer type people when I was on the provider side to say, hey, you know, I hear what you're saying about security. What we're going to do is we're just going to have one terminal and we're going to put it in the middle of the hospital on the fifth floor of ten floors, and we'll have two guards outside it and then we'll be 100% secure, but we won't be able to treat patients. And so there's got to be some kind of give and take. Have you, have you, what is the secret? If you could just tell us what the secret is, Mark, that would be awesome.

Dr. Mark Townsend: Yeah. Yeah. No, I got all the secrets. You know, secrets aside, one thing that I am advocating for currently is the creation of an innovation sandbox. And give me an epic environment where I can sit down. It's a non-prod environment where I can sit down and with a team of developers and we can just have fun, right? Epic does that, by the way. So I hear. But I'm taking that one step further and then saying, All right, so if we do develop a technology using a sandbox internally or using ethics tool, sure. Let's, let's then create the vehicle for us to actually get into the production environment in a secure construct. And let's have all of our compliance team in the room with us when we do it. But then let's actually create this innovation space as incubator or this little igloo, you know, borrowing from Google terminology, how can we do that internally as a system? So that's turned into a conversation of, okay, well, we're going to have to pick a specific location. And so, you know, I'm based in the Richmond market, so of course it's going to be Richmond, right? If we get this right. And then if we can do that, can we pick a specific hospital and a specific physical space that is clinically active and turn it into our innovation hub? So that's where we're going with it, is let's create a sandbox, let's create an environment where we can actually get our hands dirty, roll up our sleeves and not hurt anybody and not heard anything in the process and not jeopardize the security of our entire health system by virtue of the fact that we want to be innovative. So that's where we're going with it. I don't know if that's the right answer. Ask me in a few months and if the compliance people get a hold of this concept, ask me in a couple of years.

Dr. Craig Joseph: Yeah. And I'll, I'll also if I see any pictures of you wearing orange, I will. Well, I'm not going to rescue you, no, but I'll.

Dr. Mark Townsend: Have you send in your people.

Dr. Craig Joseph: Yeah. No you're stuck there at that point. But I just want to know that's where you stand with me. I will not be breaking you out of jail. Hopefully, though, you're not going to be in there. Well, let's pivot a little bit from that kind of trying to be innovative. As you may know, I worked for two, three, actually almost four years in Silicon Valley area for a hospital system out there. And I certainly encountered a lot of startups that were saying some of the things that you just mentioned, which is, well, come on, it's unlikely that they'll be a problem or come on, it's pretty close. And one of the things I heard from the Valley, as the cool people call it, is that that concept of, well, if we're let's just try this and if we're going to fail, we'll try and fail fast and fail cheaply. Now, is this something, I understand, like, you've taken this concept of kind of failing fast and talk about failing forward. And I'm not I'm not sure exactly what that means. How do you fail forward?

Dr. Mark Townsend: Sure. Yeah. One of my favorite expressions, fail fast, fail forward, fail frequently, but, too many Fs there. But, you know, the notion is: let's not be afraid to fail. And so many times whether or not we're in management, whether or not there's capital at risk, whether or not sometimes there's maybe careers at risk, if we're afraid of failure, we get paralyzed. Right? And you can apply that to so many different environments, in which case not being afraid to fail means that, listen, we're going to screw things up. That's why we have a team. Let's be accountable to each other and let's have the environment fully established whereby when Townsend is screw things up, my people tell me that I'm screw things up, in which case I'll nod, smile. Thank them tomorrow. Maybe not today, but I'll thank them. And then there'll be a group hug and then we'll move on and then we'll pivot. But. But the pivot is the real time feature that makes it, that makes this thing work. So. So that's my interpretation of fail fast, fail forward. When we create that environment, it becomes a safe space to try new things. Right? And you don't, you know, nothing stifles innovation as quickly as saying, well, that's not the best practice. You know who defines the best practice? I want to find that whoever the best practice person is and I want to see them in orange. I don't want to be the guy in orange, don't see the best practice people in orange. But nothing kills innovation as quickly as saying, you know what? Someone already figured that out. They're much smarter than you are. And so you really have to go home and just think about that. So let's try it, even if it means we fail. And, you know, the most costly failure of my career today, it was maybe an issue of maybe about $1.3 million. I didn't get fired for it. We failed miserably. I learned a lot. I was accountable for my failure. And guess what? The value that we created through that failure turned into a much more enhanced value proposition by virtue of the fact that we had to learn from our mistakes. And we went on to do very, very well. That $1.3 million was a small investment compared to the eventual return.

Dr. Craig Joseph: So the failing forward is taking one step back and then trying to go two steps forward with that concept. Okay. And how do you explain to healthcare executives, because I struggle with this regularly, who are saying, who say, well, we're in healthcare. And so failure is not an option. We can't have any problems. It has to all work perfectly and it has to work perfectly the first time. Do you give, how do you deal with that kind of mindset, which again, I totally respect. I get it, but it doesn't it's not accurate. Of course, no one's, one would assume that we're not trying to kill patients here, that failure simply means that we're going to be spending money unnecessarily or things that we thought were going to make some minor improvement actually didn't make an improvement at all. That's what we're talking about generally with failure. How do how do you kind of get that message across to executives?

Dr. Mark Townsend: Yeah, it's a great place to start, as you just pointed out, is there's no death and dying involved in the failure that we're talking about. So this is not getting into patient safety and trying things out at the expense of potential harm, obviously. Right? But the freeing thing, as you get into healthcare administration, as a physician leader, is yes, I've been to many codes and I've been the physician responsible for patient outcomes for my entire career. Using that mindset creates a willingness to tolerate risk in a business environment. However, that gives us a little bit of an advantage, because I know that if I go and try something with a revenue cycle innovation, nobody's going to die, right, and there's not going to be a code. And at the end of the day, yeah, we might be a little bit further behind in our budget and we might miss budget for the month. But again, fail fast and fail forward. We'll figure it out next month that we're going to do better next month because we've just learned from what we did. And so applying that concept really does differentiate, I think, clinical leaders in many cases in healthcare administration, many people have never been on the front lines of assuming risk in a patient care environment. And that's the weight that we bear is as clinicians, I will tell you, leaving that behind, as I say, I retired from clinical medicine to turn into a healthcare administrator. There's nobody going to get hurt if my project doesn't end on time. And there's going to be no patient safety episode, you know, by virtue of the fact that the budget cycle is a little bit altered by virtue of the, you know, a project that have got underway.

Dr. Craig Joseph: I think it's really insightful what you said about kind of clinicians, people who treat patients are used to taking risks, not like let's see what happens, but hey, I only see, there's only three options and all of them are bad. And we have to deal with that or I can't wait until I get all of the information to the best decision, I have to make a decision now in an emergency situation. And I'm going to make the best decision I can with the information that's available now, because I can't wait. And for a lot of folks who don't deal with that on a regular basis, that's crazy. It is crazy. It's why, you know, you don't want to make a decision to have all the information. But oftentimes in healthcare, there's no option. You have to do that.

Dr. Mark Townsend: As long as you're measuring your outcomes as well, right? And so one of the epiphanies in my career was the introduction to the notion of a control chart or the Shewhart chart where time is on the horizontal axis and you've got an upper control limit, a lower control limit, and you intervene, you make an intervention and then you measure your outcome. So let's try something and then let's see what happens. And then if it was a good intervention, then guess what? You get to compress your control limit and you get to reset your ground zero or your starting point in your control chart and then you measure going forward again. So that really factors into that fail fast and fail forward concept where if time is on your side, let's try it. Rapid cycles of continuous improvement, right? That's what makes the world better.

Dr. Craig Joseph: That that is what makes the world, I was going to say, I was going to start singing a song about making the world go round, but that is rapid cycles of continuous improvement, small little iterations. And sometimes you're right, sometimes you're wrong. But as long as you're moving forward, you're making progress. Well. Well, Dr. Townsend, it's been a great conversation. We're getting near the end of our time. I wanted to ask you a question that we ask all the folks our on our podcast, which is, are there things in your life that are so well designed that that they bring you happiness and joy, and oftentimes these are not in the healthcare sphere. So is there something in your life that is so well designed, you're thankful for it on a regular basis?

Dr. Mark Townsend: Absolutely. Absolutely. So, joy, in my world, I'm six foot seven. Joy is defined as the absence of pain. Right? So a joyful experience for me walking through a door is that I fit and I don't hit my head and there's no pain. So apply that to now sitting in the driver's seat of the vehicle. I haven't fit in a vehicle since I was 14 years of age. And then Ford had this design challenge, and I was not a Ford fan, let me just say, because my first car was a Ford Escort and I had to fold origami to get into it with the seat recline and my head hitting the ceiling and me driving from the back seat, I would cruise through town and it would look super cool in my Ford Escort. But then you fast forward a few years. Ford apparently got the memo that people my size don't fit in a Ford and they had a design challenge which led to the Ford Maverick, which was to say, let's identify extreme users. Apparently I'm an extreme user and they came up with a driver seat that I actually fit in. They installed that in Ford Broncos. And for the first time since the age of 14, I actually fit in a vehicle and I'm not in pain. So that brings me joy.

Dr. Craig Joseph: How, what how does this work? I'm fascinated by this. What design, what did they do to make it easy for you to fit in there? Now, again, I am almost as tall as you. It's just about one and a half feet or so different. So I feel the pain.

Dr. Mark Townsend: I look up to you. I look up to you.

Dr. Craig Joseph: Yeah. When you're sitting down, maybe. What's the magic there, or can you put your finger on it? Is it a bunch of things or one major thing?

Dr. Mark Townsend: Yeah. No, it's interesting. So if I sit in a Ford F-150, I don't fit. But if I sit in a Ford Bronco, they had this innovative concept which was, what if we allow the front seat, allow the user to push the front seat all the way into the back seat, Right. So you move your seat back, and guess what? There's no one, no one can sit behind you anymore because you're all the way in the back seat instead of having to recline your seat like I did in the Ford Escort, you can now you move your seat back and accommodate your leg length, even if you're six foot seven. That's a novel concept, right? So take that and then and the other novel concept was we don't need to have a super fancy driver's seat. In fact, it actually looks pretty basic, but it doesn't create this forward leaning posture where you're hugging your steering wheel and therefore you don't hurt. And so hats off to these people at Ford. I'd love to meet people who design this thing, but thanks to them, I can get out of a car and I'm not in pain. That brings me joy. It's a joyful day every day I get in the car.

Dr. Craig Joseph: All right. I am now dedicated to finding that person at Ford and connecting you two and putting it on video and going viral. And as the kids tell me, if we do that, we're all going to be gazillionaires.

Dr. Mark Townsend: That's it. That's it. Yeah. And I want to a Maverick out of it. If I get a Maverick out of it, I’ll be happy.

Dr. Craig Joseph: No, you're going to take fame and you'll be happy with the fame. And I'll get the Maverick and.

Dr. Mark Townsend: Oh dude, dude.

Dr. Craig Joseph: Or the cash equivalent, because it's my brilliant idea. Thank you again. This is great. And I'm glad that you fit in a car and that you fit in the car without pain. And I hope other aspects of your life. I'm not. I'm afraid to even ask you about airplanes because.

Dr. Mark Townsend: Yeah, let's not have that conversation.

Dr. Craig Joseph: No. We're not going to go there now. All right. Well, be well. Thank you again for kind of educating us and look forward to that, that Ford reunion that I'm going to be planning in the next year or two.

Dr. Mark Townsend: Thank you so much. Thanks for having me on.



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