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Episode Synopsis:

Welcome to Episode #78 of Habitual Excellence, presented by Value Capture.

lander-timothy-1548264435Our guest today is Timothy Lander, MD, Chief of Surgery at Children's Minnesota

He is an Associate Professor of Pediatric Otolaryngology in the Department of Otolaryngology-Head and Neck Surgery at the University of Minnesota. His interests and background include Health Information Management, software/web design, and medical education. He is particularly interested in advancing quality improvement initiatives throughout Children's and specifically within the Surgical Division.

In today's episode, Dr. Lander talks with Ken Segel about his leadership journey and how this journey, along with an organizational transformation, brought him from considering leaving the profession to feeling engaged in his work again. 

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Automated Transcript:

Ken Segel (18s): 
Alright, listeners. Welcome to this episode of habitual excellence. Where healthcare leaders talk about transformation in American healthcare and what that's taking, and the transformation of themselves. That's a big part of that.

Ken Segel (31s):
I'm Ken Segel. I have the privilege of leading Value Capture, and we have the privilege of supporting great leaders, and we have one today. Dr. Tim Lander, Tim is the chief of surgery at Children's Minnesota, and he is much more than that. He'll tell you more in a second. But he's an incredible informaticist. And according to his bio, he is also a spectacular chef.

Ken Segel (1m):
We'll let Tim introduce himself in a second. But Tim is here to talk to us today about learning to define great leadership differently, and really the journey of one chief of surgery, his own journey, and doing that together with a true north journey in his institution. And we really want this to be a conversation that's very real about sort of leadership and continuous improvement and coaching at this sort of fraught moment in American healthcare history, and we're really glad to have Tim, a true Renaissance leader. Do that with us. So, Tim. Welcome, thank you, Dr. Lander, and tell us a little bit more about your biography and you at this moment.

Tim Lander (1m 34s): 
Well, thanks, Ken. It's a pleasure to be with you today and share some of my thoughts. It's sort of an honor that I would even be asked to speak to your audience about being a leader. I still feel like I'm very early in my arc as a leader. I've come to leadership. I guess you'd call it relatively late in my career.

Tim Lander (1m 57s): 
I by training, am a pediatric Otolaryngologist, and facial plastic surgeon, and I grew up in the Twin Cities in Minnesota, Minneapolis and Saint Paul

Tim Lander (2m 11s): 
After I completed my training in general ENT in San Diego, California and returned to the Twin Cities. I trained and did a fellowship in pediatric ENT and facial plastic surgery, and then I joined a very small, other pediatric Otolaryngologist in private practice here in the Twin cities based primarily in Minneapolis, back in the early 2000s.

Tim Lander (2m 39s): 
And so I was basically a private, you know, private practice pediatric surgeon for the first 10 years of my post training career.

Tim Lander (2m 51s): 
And then we as a group. At that time we had ballooned to all of 3 people in the group, and we had decided to just to become employees of Children's Hospital.

Tim Lander (3m 3s): 
Some of the first employed surgeons at the hospital had, and that decision was primarily driven by 

Tim Lander (3m 10s): 
Trying to make it easier to deliver patient care in a tertiary quaternary hospital. And since then, we went to a group of about 8 or 9 physicians, and we've gotten a multiple advanced practice providers and audiologists, etc. So suffice it to say, the first 10 years of my career was as a private practitioner frontline surgeon.

Tim Lander (3m 32s): 
The next 10 years, I’m an employed frontline surgeon, and it was only towards the end of that that second decade that I became the medical director of the pediatric ENT program here at Children's, and then, surprisingly, quite shortly after that became the chief of surgery after the  previous chief of surgery, who'd been in that position for 20 years, had announced his retirement from practice.

Ken Segel (4m 2s):
Thanks, Dr. Lander. So some of you may have caught it. But Tim said, surprisingly moved into that leadership slot. And I think that's gonna form a background. And what I think a lot of the

Ken Segel (4m 15s): 
C-suite physician and clinical leaders and other leaders may respond to in Tim's journey here because you shared with me, and we'll talk about it a little bit later that that you really were not picked as a leader originally, and yet through this sort of recent journey have really powerfully overcome that and maximized your sort of powers as a leader and on children's behalf and really dramatic ways. So I think we're all excited to hear a little bit about that

Ken Segel (4m 53s): 
But frame us up if you could. So, about 2 years ago, the Institution, Children's Minnesota decided to change. And what was that change? If you just had to describe it. What did you all set out to do as a leadership team? That was different than how you've been going to give us a frame for this work.

Tim Lander (5m 19s): 
Well, interestingly enough, Children’s had decided to make this transition to being a continuous improvement organization or start that journey, if you will

Tim Lander (5m 30s): 
To become a high, reliable organization. Which is I would describe it as a somewhat fashionable trend, and you're starting to see a lot of health care organizations sort of adopt that. Like many things in healthcare, we seem to be about 5 to 10, maybe even 15 years behind many other industries in this regard. But Children's made that decision almost coincident with my

Tim Lander (5m 57s): 
Taking on the role as chief of surgery. We really became serious about it, like within my second or third month, quote unquote on the job, chief of surgery. So that was interesting. I believe it was primarily in response to what we learned through the pandemic of the 2020 covid pandemic.

Tim Lander (6m 17s):  
My insight that I've gained over the last 2 or 3 years on that score is that

Tim Lander (6m 26s): Children's Minnesota as a pediatric hospital or children's Hospital system. Was actually very well resourced, was blessed with a lot of human capital, and was able to function very effectively as long as all those people were in place. But what we all learned in the pandemic is when you have to downsize, or you hit a financial situation where you, where you no longer have nearly as many people as you once had, and then I don't think it's a secret to anybody

Tim Lander (6m 56s): 
That may be listening that there's been a significant

Tim Lander (7m 0s): 
Amount of retirement from the healthcare industry. People are reassessing what type of what type of careers they want to seek in the future. And healthcare is really struggling with the workforce problem. And that persists even now that we're pulling out of the pandemic. And so what I think, what children's finally realized is like Whoa, we don't have very good. Our systems are not highly reliable.

Tim Lander (7m 25s): 
We do not have fool proof systems. They're highly dependent on a very skilled and experienced workforce that knows our systems and is primarily built around relationships. And if you want to become a highly reliable organization

Tim Lander (7m 41s): 
You can't base your system on single individuals who happen to know how the system works. And so that that I think that was one of the things that really spurned the organization to, to, to adapt this change and to take this, take this bit and basically say, we need to get our house in order and learn how to build a much more resilient and functional health system because of all the headwinds that we see in the world.

Ken Segel (8m 12s): 
So you set out to sort of change in that way, to build systems based on values that you held and sort of head toward true north and sort of goals, and some ways that may be resonant for those that have been on similar journeys.

Ken Segel (8m 30s)
And you're a new leader, you intersect with this intention.

Ken Segel (8m 34s):
And you describe some pretty catalytic moments early, and some of us sort of framing exercises in which you shifted others, perceptions of you. And actually, you saw some things for the first time that spoke very deeply to you as a person and a leader. And I wonder if you could describe a couple of those early catalytic moments for us?

Tim Lander (8m 59s): 
Yeah. So I think it might be helpful to understand where I was coming into this. So imagine you are the new chief of surgery. You've been on the job for less than 2 months. It, believe it or not, the job description for chief of surgery was not very clearly defined. The previous chief of surgery was primarily just a professional staff leadership position would basically about a 30% administrative component and 70% clinical.

Tim Lander (9m 31s): 
But when I became the chief of surgery, there was. The organization was very intentional to bring the chief of surgery into alignment with the other clinical chiefs within the organization, critical care, pediatrics, etc. and massively expanding the

Tim Lander (9m 48s): 
The administrative role as it pertain to the hospital system. So you know, I'm basically 60 of my time is focused on hospital operation clinical operations. The other 30% of the time, maybe on professional staff concerns credentialing and you know, pro professional staff management and then a small, a small component of clinical work.

Tim Lander (10m 12s): 
So I didn't really even know what the job was. I was just getting my feet wet and they throw me into what I call the “indoctrination.” Where Value Capture, whatever you want to call it, so, basically, it was a 5 day, pretty intensive, 8 hours a day from Monday through Friday, with 40 of the quote unquote top leaders in the organization, some of whom have been in their roles for many years.

Tim Lander (10m 47s): 
And a few had actually been in their roles even less than me. We had some had one individual who had been there like that was their first day on the job was like boom. It's value capture day and week. So so there and then I definitely so I didn't really even have a good idea what my job was. And I, sort of came into this whole enterprise, thinking like, I don't even really belong here, and part of part of the reason. I say that is because

Tim Lander (11m 11s): 
About 5, 6, 7 years ago. Now I was at a pretty significant crossroads in my life. I had reached a level of like disgruntlements, disengagement, and I was frankly despondent about being a part of the healthcare system. I felt like I had lost control of my clinical practice. I was sort of working for a healthcare system that wanted to tell me how it was supposed to do my job.

Tim Lander (11m 38s): 
And yet every place I looked around. I would see things that like boy this, this is not a great way of doing things. This doesn't really apply to me. This seems like, why are we doing it this way. And so I kinda developed this reputation as a bit of a squeaky wheel. Someone who doesn't really, who's not really a team player who's complaining all the time. Who doesn't, who actually would just out, not refuse to do certain things as a member of the professional staff, because they just didn't make sense to me, and so I was a bit of an outcast and I get for better or worse.

Tim Lander (12m 11s): 
When the when the job of medical director of my ENT group was vacated because of retirement of one of my senior partners,

Tim Lander (12m 23s): 
My group wanted me to be the next medical director. They actually saw me as someone who got a lot of good ideas and could be a very strong leader for the group.

Tim Lander (12m 31s): 
This view was not shared by the greater hospital leadership, as you can probably imagine. They thought I would be the worst selection for that role, and for better I can. Ken Segel: I can. And I hope that the leaders listening are resonating as much as I think many will be right. This kind of tension and differing views.

Ken Segel (12m 54s): 
In the C-suite and across the physician leadership. So yeah, so keep going, Tim, please. This is great nobody. 

Tim Lander (12m 56s): 
Nobody likes the rabble rouser, I guess, and honestly, the culture Children's was not one that was very embracive, embracing towards alternative points of view, different ways of looking at things. Could we do things different? Could we do things better? No? This is just how we do it at Children's. This is the Children's way. Get in line or get out. Basically, it was kind of the message at that time.

Tim Lander (13m 24s): 
And so I, one of my partners described. One of the reasons why my partners wanted in this role as their medical director was because was specifically because I didn't want the job. They're like, this is exactly the type of leader we want the reluctant leader, someone who doesn't not seeking leadership for their own, a self aggrandizement who's not interested in titles,

Tim Lander (13m 47s): 
Who's not interested in putting themselves on a different level, But someone who's actually interested in making our lives as surgeons better.

Tim Lander (13m 58s): 
And so I kinda went into the enterprise with that and there was a bit of a turning point when it became clear to the Hospital Administration at that time that that my group wasn't going to accept anybody as our medical director other than me

Tim Lander (14m 13s): 
And I had to work through that conversation with the leadership of Children's. And they're basically like, I don't. We don't see how you could possibly be successful in this role. You're someone who doesn't like to follow rules. You're someone who thinks everything we do here is stupid. How do you see yourself functioning in this role?

Tim Lander (14m 31s): 
And my response? I hadn't really planned the response. But I but my authentic response was. look, I understand that when you're

Tim Lander (14m 44s): 
An employed physician and you're unhappy about things, you have a lot of choices. You can complain about things. You can decide to take yourself out of the conversation. You can play a lot. You can do whatever you want. You have a lot of agency and autonomy. But when you become a leader and you're the medical director of the group. You have a different role, and you have different responsibilities, not only to your group but to the organization for, and I understand that.

Tim Lander (15m 9s): 
And I will do, even though I don't want this job. I promise that I will do the best I can to be the best ENT medical director I can possibly be. And that was a pretty good answer. Because ultimately I ended up getting the job

Ken Segel (15m 30s): 
So there, that amount of alignment had happened right and but maybe you know I as a listener, and hearing it's kind of a detente, we'll see, right. But you know, recognizing the larger role has already happened. You then come into this room.

Ken Segel (15m 50s)
You know it sounds like some discoveries happened that really resonated with you and allowed you to reach some others right there.

Tim Lander (16m 3s): 
So I would say that at that point in it, so interestingly enough, and maybe the listeners can jump to the conclusion, that okay, so that was 4 years ago, roughly or 3 and a half years ago. And then they offered me the job of chief of surgery again, a role that I did not seek and did not want. In fact, I specifically said.

Tim Lander (16m 23s): 
If there's anybody else in the organization that you would consider giving this job to, please, give it to them because I do not want it. And the response came back, was like, Yeah, we're not really looking at anybody else for this role. We want you to do it. So within that year and a half of me being the ENT Medical director. Not only had I demonstrated that I was actually a good medical director, but that was exactly the type of leader that they actually wanted to promote into a higher level of leadership in the organization.

Tim Lander (16m 50s): 
So then, coming into this shortly after becoming the chief of surgery, and then coming into this Value Capture event, where our CEO had basically said, and he was very clear at the time, he basically said,
“I don't know that I'm entirely sold on everything about continuous improvement and HRO, but I know for a fact that we need to do something different as an organization in order

Tim Lander (17m 20s): 
To create a sense of resiliency. And we're a nonprofit Children's Hospital and one of the tenets of our existence is that we need to be here for the community, and I think most of us kind of felt at the time. It wasn't clear that we would be able to survive as an institution if we didn't make some significant structural changes, and how we do things at Children's.

Tim Lander (17m 41s): 
So that was kind of the setting for it. And that I think that was great. It for me. It I don't know, didn't think about the time, but in reflecting that created a very nice sense of psychological safety. Even the head of this organization isn't necessarily convinced that this is the right path, but he's willing to take a leap of faith and say, Let's just roll with this for a while, and see and see what it can offer.

Tim Lander (18m 6s): 
So that may have been the first transition, and that was like within the first 10 min of day, one on Monday power, psychological safety from the lead. So you know. And at that point, and at that point, remember, I'm a guy who like I didn't want this job. I honestly didn't think II didn't know how long I was gonna be in this role, or whether or not I would want to continue in this role, because I really strongly felt. I got a lot of ideas

Tim Lander (18m 31s): 
And a lot of ways. I think we should. We should change our  approach to running the hospital. But again. I'm super naive. I'm like a new leader. I don't really know how the system works. I don't know all the players, and I wasn't really sure that I was gonna be able to be to to be okay. I'm like, you know, if

Tim Lander (18m 50s): 
It's just more of the same. And like it takes you're hitting your head against the wall every time you turn around to get something done around here. It's like I'm out. So my psychological space at that time was, I don't have a lot to lose, and so I was very. I was very Tim at those meetings for the first couple of days I would speak my mind. I had a reputation of just saying what was on my mind, even if it was controversial.

Tim Lander (19m 14s): 
And anyways, I was pretty open with my thoughts and ideas in a respectful manner, but, like, you know, not just going along with the party line on everything, and then one of my colleagues and I and I'm I maybe it's good. I don't remember who it was. Oh, no, I actually do remember who it was. She's no longer with the organization. But she. She was in a role at the organization.

Tim Lander (19m 36s): 
That was basically a leader of change management, and she's she kind of stopped. It was either down to the first day or second day, and she said, Tim, I gotta tell you

Tim Lander (19m 48s): 
You are completely changing the way that I see old white surgeons she's she couldn't believe that I was like open to different ways of thinking, really like understood the need to change, and was basically willing to, at least engage in those conversations and potentially do the hard work that was required. So that was very encouraging.

Tim Lander (20m 11s): 
And then I would say, the turning, the really big turning point for me during that Value Capture week. And I think this was on Thursday. So the fourth day, Lego, Lego Day.

Ken Segel (20s 23s): 
And I, and so I. And so the tagline here is I cried at Legos, I cried at Legos Ken Segel: and Legos, for those who aren't familiar with it is, it is a systems thinking, doing exercise.

Ken Segel (20m 38s): 
That came originally from the Toyota supplier support center that we've evolved to include some very powerful elements on the leadership role. And Tim, let's hand it back to you for you. You cried at Legos. What did you cry out? Why? And sort of where did you take it from there? 

Tim Lander (20m 56s): Yeah. Okay, so just super brief. Set up at the beginning of the Lego exercise. You're basically a cog in the wheels of the factory.

Tim Lander (21m 4s): 
And you're basically putting together widgets. And at the beginning of the exercise, it's sort of. It's utter chaos. You know the materials that you have to put your widgets together, or all jumbled up in one box, and you can't start doing your work until someone else has completed their work.

Tim Lander (21m 22s): 
And you're not making any money. And you're not getting a bonus. And you're super stressed out. And it's just like, It's horrible. Okay, I can totally see the peril between the Lego Widget factory and a day on the front lines in healthcare

Tim Lander (21m 39s): 
But then, as you go through the exercise, there's a series of role playing, and one of the things that happens is after each, round of the Lego exercise, where you're trying to improve the process.

Tim Lander (21 m 53s): 
There's facilitators at this point. It was people from value capture that were role playing the goal, the role of the sort of frontline supervisor who's like, they're responding to the needs of their workforce, and is kind of responsible for delivering the widgets and like making the money and delivering the product. And he's not having a lot of success

Tim Lander (22m 18s): 
And his supervisor. Comes in. They at the end of each round to kind of do a little check in, and they have a series of standard work and a series of questions that they go through to kind of evaluate. You know. How did the day go?

Tim Lander (22m 23s): 
What went well? What didn’t go so well, and what are you going to do? And it was during the interaction. It was probably the second or third round of this interaction.

Tim Lander (22m 45s): 
But I was just watching these two people from Value Capture. It's a very artificial, you know situation, They're playing roles. So it's like. It's sort of the kind of thing that I would generally sort of scoff at, like, yeah, role playing small groups hate that stuff.

Tim Lander (22m 59s): 
But as I sat there watching this interaction between the two.

Tim Lander (23m 3s): 
I was overcome by a sense of emotion that is like rarely experienced in my lifetime I can think of maybe 2 or 3 times that this has happened to me in my life.

Tim Lander (23m 16s): 
And I became like I started. I started kind of becoming tearful. And then I began to like, actually, quietly sob.

Tim Lander (23m 28s): 
And at some point I couldn't control myself anymore, and actually had to like, get up and move to the wall like I had to take myself away from the table and move away, because I was kind of embarrassed that I was having this this reaction and was basically crying at the legos exercise. 

Ken Segel (23m 49s): 
And what was it? What were you feeling? What did you respond to? 

Tim Lander (23m 52s): 
So when one of the Value Capture facilitators came over to me. As they started the next round, she said, is everything okay? And I said, I said, Yeah, everything's fine. she said, what's the matter? You know. Why are you crying? 

00:24:08.290 --> 00:24:09.710
Tim Lander: I said this and again, remember we'd had 3 days of Value Capture like indoctrination leading up to this. And then on day 4, it all kind of crystallized for me, and what I realized is, it was the first time that I had ever witnessed.

Tim Lander (24m 22s): 
How a interaction between two human beings, in the work situation could be respectful.

Tim Lander (24m 34s):  
Not demeaning, constructive, a true give and take, and it's like a true coaching moment that results in sequential improvement of the of the workplace.

Tim Lander (24m 51s): 
And that was when I realized at the time. That is what I had been craving
ever since I became a physician.

Tim Lander (25m 2s): 
Was like the ability for you to have an impact on your daily work and for your ability to design a better system that not only works well for you, but works well for everybody in the organization, and like that to me. That's what

Tim Lander(25m 18s): 
That was like the epiphany moment for me. And I realized at that time I was like, Well, if Children's is serious about embracing this.

Tim Lander (25m 26s): 
This methodology, and this almost the culture of continuous improvement. I can stick with this for a little while longer.

Ken Segel (25m 36s): 
And that is such a powerful story of vulnerability, and thank you for sharing it. And we also know that if that had stayed in the leadership classroom

Ken Segel (25m 51s): 
It could have been a powerful moment remembered. You know, a year and a half later, and not much else. So the real task for you and for Children's was taking that realization that you and other and you helped others have. And by the way, breaking through their stereotypes, too, about surgeons, which is something that's very important to do, or physicians, or whatever we carry with each other.

Ken Segel (26m 13s): 
And you decided to start making change with this evolved framework and so talk about that a little bit. Where did you go with it? How did your leadership style change? Give us some examples, you know, as you help lead the organization on, if you will. That Aha!

Tim Lander (26m 39s):  
Well, I guess the first thing to say is that it was a little bit of an unknown as to whether or not we would actually, you know, follow through on this like adoption of continuous improvement. And there was a lot of skepticism with the organization. You know, we had tried. We had kind of tried this multiple times in the past, and there's always failed. And I think a lot of. That's another concept that'll probably resonate well with a lot of people in healthcare is like, we do try many things, many things that we think are gonna work

Tim Lander (27m 8s): 
And they just don't ever. They don't quite stick.

Tim Lander (27m 13s): 
And they may have some very short term results. But there's no long, long term endurance to them. And so I was, you know, been pretty skeptical for the last, you know, for the first 6 to 12 months. But I actually do think it is sticking with the organization and part of the, I think part of the thing that makes it stick is what we were sort of taught is like.

Tim Lander (27m 32s): 
Look for quick wins, look for things that you can do that. Make a significant impact in a very short period of time. And sometimes they come out of this real time problem solving exercise where you basically, you know, kinda someone comes to you with the problem and you drop everything, and then you work on it. So one example from very early in this exercise. It probably happened within the first month after value capture, that after the Value Capture, indoctrination events

Tim Lander (28m 6s): 
Was I was walking through the department late one afternoon, and just happened to stop to chat to one of the nurses that I I've known for years, and we were just chit chatting and she was talking about how excited she was that I was, you know, had moved into this role, she for surgery, cause you know, jeez, maybe you'll be able to help, you know, solve some things which is kind of that's sort of a classic.

Tim Lander (28m 32s): 
That's a classic thing. People are like, well, leaders are supposed to solve our problem. We can talk about that. We can talk about that in a little bit. But I was like, Okay, and I was very early in the journey. And I'm still kind of thinking that that was my role was like, okay, I'm chief problem solver.

Tim Lander (28m 48s): 
So when I was trying to learn how to do real time problem solving and see and like test out, to see how it would work. So anyway, she was talking to me about this problem that that they had with discharge prescriptions and when the surgeons would write prescriptions they weren't getting there. There's a problem with getting them

Tim Lander (29m 4s): 
Transmitted to the out patient pharmacy, and you know it creates all kinds of downstream problems, and the families

Tim Lander (29m 11s): 
Don't get their medications on time and this, that and the other thing, and then she happened to be a nurse that worked on the weekends, and it was even more of a difficult problem on the weekends with discharge medications on Saturdays and Sundays. Blah blah blah. So listen to all the things that she had to say is that oh, this is really interesting. This is really interesting problem. And so I was like, well, I'm gonna real time problem solve this, even though it wasn't like a specific, real time thing that just had happened to her. She gave me enough details

Tim Lander (29m 36s): 
About the problem. Okay, I'm gonna treat this like a real time problem. So I went, you know. So, I went to the pre-OP desk and interviewed 

Tim Lander (29m 46s): 
The unit coordinator, who like checks in the patients and  logs in their preferred pharmacy information in the computer when they check in for surgery. And then I was like, Okay, there's a problem here. And then I went down to the I went to the outpatient pharmacy and stood in line until I got up to the front of the window, and this is like chief of surgery. I like, you know, my Id waiting in line with all the patients

Tim Lander (30m 8s): 
I got to the front, and I said, Hey, you know, is your manager here, can I ask them some questions about the discharge pharmacy? Well, she's not here today, but you could go check down to the inpatient pharmacy. So I ran down to the inpatient pharmacy and knocked on the door and said, Hey, I'm Dr. Lander. I wanna do some as and like, There was no supportive culture at children's for real time problem solving most people like, Who is this joker, you know, running around the hospital trying to ask all these questions. Anyway, long story short.

Tim Lander (30m 32s): 
I gathered enough information and was able to figure out that the root cause of this problem was

Tim Lander (30m 40s): 
When we transitioned to E prescribing, so what used to happen after surgery, and this worked for 20 years without any problem.
Tim Lander (30m 50s): Is, the surgeon would either write out a prescription or eventually would print out a prescription from the electronic medical records, sign it.

Tim Lander (30m 58s): 
The nurses would tube it to the pharmacy. They would get the paper copy, they would fill it at the pharmacy, and then they would provide the patient with their medications, but when we went to E prescribe

Tim Lander (31m 9s): 
Now, all of a sudden, when the surgeons would go to fill up prescription, they would oftentimes, default to the pharmacy that the patient had chosen, which could be like a like a pharmacy like close to their house, that may not even have the pediatric medications we're prescribing. And most families after they've had surgery, they just wanna go home with the medications. They don't have to stop at their local pharmacy to pick them up. But some do because their insurance, blah blah blah, and

Tim Lander (31m 34s): 
Anyway, logs for a short, huge problem that was introduced by what everybody thought was going to be great, which was the E prescribing thing.

Tim Lander (31m 40s): 
So once we figured that that was the root cause problem, we were able to work it backwards and basically say, Okay, how do we modify the E prescribing process and create standard work around it, so that all the prescriptions actually do still go to the

Tim Lander (31m 57s): 
The hospital pharmacy and the hospital pharmacists were already actually interested in helping to route the prescriptions appropriately, either fill them locally, or contact the patients preferred pharmacy, if that's what the family wanted, but they were in a much better position to avoid all of the downstream problems. And so that  was a huge success, because unbeknownst to me.

Tim Lander (32m 22s): 
This has been a problem since we went with you prescribed for like a year and a half. It was, and you know, within the matter of a couple of weeks we solved the problem, and it's no longer an issue. And people and like people don't even remember that now that that was a problem cause it's been so long since we fixed it. Well, that's a great example. And I, you know, and I think about our listeners. And some may be saying, Okay, well, the chief of surgery can't chase every problem, etc.,

Ken Segel (32m 48s): 
And you know, but also heard you say, lack of support, or really infrastructure for solving problems in real time. And what I hear. Is you modeling learning, right, what it would take to do that around a concrete example.

Ken Segel (33m 3s):
And then, knowing you and knowing what happened, you as a leader took that in which is part of the design to say, Okay.

Ken Segel (33m 10s):
What are the implications of this for the systems we're running? And we need to structure, right? And you then went into that systems building mode around some of those insights right to support more agile problem solving across the organization, is that fair?

Tim Lander (33m 31s):

Ken Segel (33m 34s):
Tell us, though, from that, and from that story, and I'm sure there are many others.

Ken Segel (33m 40s):
You very consciously started to change your leadership style, and if you had to describe your sort of before and after as you evolved it, and you know and you've described it has been a gradual revolution, but as it started to accelerate what was the before? What is it now? What you know? What have you gone to? What have you could come from? And where are you now? In terms of how you lead? Sort of around coaching and things like that?

Tim Lander (34m 8s): 
Yeah. So. This has been a very. This is actually been a, I think, a source of very significant personal growth and like exploration, and something that I've had a lot of help along the way with from Value Capture, but also through

Tim Lander (34m 25s): 
There’s what's called the Leadership Academy. So there's essentially a cascade of cohorts of leaders within children's that are, they're basically going through a 12 session over the course of a year. About once a month, our cohort, would get together and explore topics and leadership. And this is facilitated by a local group. Here in the Twin Cities. And again, one of these things where you're like.

Tim Lander (34m 52s): 
And most of us are pretty skeptical about this kind of thing. Oh, bring in the consultants, and let's all sit around and like talk about what it's like to be a leader, and I will say, During the first couple of sessions there was an incredible amount of skepticism about like, Oh, this really gonna be effective? And I remember some of the comments people making about that would be like. Well, this isn't as good as the leadership thing we did 10 years ago, where it was through the Carlson School of Management, and they had very like

Tim Lander (35m 20s): 
I would call it a much more curriculum driven sort of structure. The Leadership Academy was a little bit more focused on concepts. And you know, reflection and and like thinking a little bit, I don't know more broadly but less specifically, about what you do in healthcare and

Tim Lander (35m 39s): 
So there's a lot of skepticism about that kind of thing. And it's funny because from the beginning of that to the end of that. And I can say the same thing with our experience of Value Capture is that skepticism at the beginning was really high. Skepticism at the end very low, and people really felt like, Oh, my God! This was a transformational experience. So any case. So as part of that leadership Academy thinking about

Tim Lander (36m 5s): 
What it means to be the like the chief. I'll just say the chief, like what is my role as the chief of surgery? I alluded to it earlier. I think the conventional role of a clinical chief was. Yeah, I'm here to solve people's problems for them.

Tim Lander (36m 20s): 
And someone that can actually quote unquote, get stuff done, or has the power, or is at the table, whatever you know idiom you want to apply, I think that's a conventional understanding of leadership. And then the other. The corollary to that is, the leaders are the ones that come up with the ideas, and then make all the worker bees do like do the work. You know, they design the work, and then the worker bees just do what they're told.

Tim Lander (36m 50s): 
Yeah, that's like, not remotely close to the way it should work or the way that it does work, but that, I will say that that top down command and control

Tim Lander (37m 2s): 
Method of thinking is highly entrenched in healthcare. Just reinforce it every time you turn around. It's like, Well, I gotta, you know, I report to so and so, and they've got to sign off on this, and I have to get them to make the decision and did it, and everybody's passing the buck everywhere.

Tim Lander (37m 22s): 
So that's really started to change. And it's changed quite a bit. And I would say that I'm probably at the bleeding edge of that effort at children's. Yeah, redefining what it means to be a clinical chief.

Tim Lander (37m 38s): 
And it's been a little bit of a struggle, although it's getting easier and easier day by day, as people realize that the benefit of

Tim Lander (37m 45s): 
The benefit of me, not taking ownership of everybody else's problems is they can take ownership of the solutions themselves. Yeah.

Tim Lander (37m 53s): 
So I would say, that is the biggest change. And the mantra that we've adopted is, look, my job is the chief of surgery is to remove barriers and provide resources. I'm not designing your work for you. I'm not telling you how to do your work. I'm not telling you when to do your work. I'm not telling you. Who do you have to work with?

Tim Lander (38m 16s): 
I'm just removing barriers and supplying resources. And it really focuses. It focuses me to think more about what it is that we have to accomplish rather than thinking about how we're accomplishing it.

Tim Lander (38m 31s): 
And That's been a that's been a significant change. And I and it's interesting. II see this thinking all the time. Like, you know, I'm still in. Even in our continuous improvement meetings, people tend to lapse into that. Let's focus on the process and forgetting what it is we're actually trying to accomplish or trying to do so, keeping constantly going back to what's the problem we're trying to solve.

Tim Lander (38m 57s): 
And what's interesting about that process is a lot of times we realize that the problem that we're quote unquote thought we were working on isn't really the problem or this, even a problem that's worth solving. Or we have to solve this other problem before we even talk about solving this problem.

Tim Lander (39m 12s): 
So it really cuts down on the spin and the churn and the waste of effort. That a lot of people are sort of used to experiencing, and that that leads to a lot of frustration. Because people spend, they put their heart in their soul into quote unquote, solving a problem or coming up with the system or boy, if everybody just did it this way, wouldn't life be great?

Tim Lander (39m 35s): 
And you're like, yeah. But you kind of solved the problem that we weren't even looking

Tim Lander (39m 39s): 
For a solution for, So that's been interesting. I think that what I've what I've

Tim Lander (39m 49s): 
So what I've realized is like my job is to stop doing the work. My job is help coach people

Tim Lander (39m 56s): 
How to develop and design their systems better.

Tim Lander (40m 1s): 
It's more rewarding. But it's a lot harder. Ken Segel: It's a different set of questions, a different framework that you come to them with in those moments, and a different set of questions, right?

Ken Segel (40m 14s): 
And what? So you describe it as rewarding and harder all at the same time. So just share a little bit more about that, emotionally or otherwise.

Tim Lander (40m 22s): 
Well, I think it's a lot like the old the saw about, you know. Give a man a fish. You've got him for day. Teach him how to fish,

Tim Lander (40m 32s): 
You've fed them for a lifetime. Takes a lot longer to teach someone to fish than it does to just hand them a fish you've already caught, cause you're an expert. Right? So that's the frustration. Is that, it's just much more time consuming to coach, and you will

Tim Lander (40m 51s): 
Have slower progress at the beginning, but then it becomes exponential. As people as people adopt the tools they get their own successes, it tends to inspire them.

Tim Lander (41m 1s): 
And makes them realize that the results of their like, they're much more. They have much more ownership. They're much more proud of the results.

Tim Lander (41m 8s): 
And they're much more excited to teach other people

Tim Lander (41m 11s): 
And bring for other people. So it's sort of like, you know, he told two  friends, and they told your friends, and so on, and so on, and so on. So, definitely an exponential effect of it, I think, where a lot of leaders can sometimes get tripped up is

Tim Lander (41m 28s): 
You have to let go of the recognition.

Tim Lander (41m 31s): 
You know my job isn't to make myself look good. My job is to make the people that report to me and look good, and then their job is to make the people that report to them look good. And 

Tim Lander (41m 42s): 
That's also a pretty significant culture shift where you just have to get people to focus less on taking personal credit

Tim Lander (41m 51s): 
For successes and accomplishments and sharing the credit, or just celebrating that we're all doing a better job together as a collective team. And I think that's really really hard for people, cause I think a lot of people are definitely motivated by

Tim Lander (42m 9s): 
By reward and recognition. But I think, as a leader, you just have to. You just like I'm not here. I'm not here for kudos.

Tim Lander (42m 19s): 
And I'll be. I'll be honest with you and your audience. It's something I have to remind myself of, almost daily.

Tim Lander (42m 27s): 
Like I can think of myself, telling myself, I'm like, Oh, you know, like we at the beginning of every huddle there's celebrations right? We celebrate things. We celebrate different people sub recently

Tim Lander (42m 27s): 
And I feel like I do a lot of really cool things every day. And I have a lot of really cool interactions and a lot of things that, like people like that might be celebratory, worthy, and I get sometimes get a little disappointed like, why isn't anybody celebrating me or celebrate my work. And I have to remind myself, I'm like, Yeah, that's not what you're in this for. This is not about you, dude. This is about your contribution to the betterment of the whole.

Tim Lander (43m 2s): 
And I'm truly fine with that. But it's amazing how our brain works. That stuff is just ingrained, and you just have to work at it every day to remind your yourself of the different things that you need to change your thinking about.

Ken Segel (43m 32s): 
Absolutely. Sort of attack those saboteurs and stay on it. I’m glad you highlighted that, cause our audience won’t necessary know the beautiful partnership you have with your nurse leader, pairing, and some of the other leaders. In your humility, you know, while leading and doing that

Ken Segel (43m 42s):
I will say just I do know that the regard held for you is extremely high. And for your being willingness to do that so. But it is interesting, right, because some of the things we used to get rewarded for regularly, we hear about less and yet hopefully, the satisfaction

Ken Segel (43m 58s): 
Of leading this way gradually outweighs that and leads forward. 

Ken Segel (44m 4s):
Tim. You know we could talk for a long time. About these ideas, because you've continued to

Ken Segel (44m 12s): 
Think about at the deepest level, like all the way up to the President of the United States, you know, but also to a parent you shared with me

Ken Segel (44m 20s): 
What a leader is, and what a leader's most essential task is.

Ken Segel (44m 26s): 
And I wanted to sort of ask you. You know, some core thoughts as you've re. You know you’ve been evolving on these questions with a lot of talent and a lot of skill and a lot of intelligence. And then you're building new habits, some overview thoughts of what a leader is. And we'll go from there.

Tim Lander(44m 48s): 
Yeah. So you know, I thought about that. I was like, if anybody came to me and said, Like, Tim's a really great leader

Tim Lander (44m 57s):
What does that mean? And if I was to say, like, I think so and so is a really good leader. And such and such is not, like, what does it really? So I really started to reflect on that 

Tim Lander (45m 9s):  
How would I define a good leader? And then I thought, like you said, it's not good enough just to define a good chief of surgery or a good chief medical officer, or CEO of a hospital.

Tim Lander (45m 20s): 
But I wanted to come up with a definition that would apply to almost anybody who's in leadership. So someone who leads

Tim Lander (45m 28s): 
Like a family or a demographic group, or the city or State mayor, President, United States, etc. So to me, I think good leaders are people who recognize and understand the common purpose

Tim Lander (45m 47s): 
Of the of whatever collective that they're leading. Everybody kind of has a con. If you're a leader, you have a constituency.

Tim Lander (45m 55s): 
But, generally speaking, that constituency and that leader are part of a larger enterprise. So if you're the President, United States, you're part of the, you know group of nation. You're Governor of Minnesota. You're part of this collective of states and part of this nation, and I would say that as a chief of surgery, I lead a department of people who are tight, tightly

Tim Lander (46m 19s): 
Associated with the period services. But we're all a part of Children's, and we all interact with the medical surgical units, the people that work in the emergency department. All the support systems so like that's the greater collective is really the larger organization.

Tim Lander (46m 33s): 
And so we all have a common purpose.

Tim Lander (46m 36s): 
And so then what's the goal? Is the goal just to like, go. And then this is the conventional thinking of leadership, I think, is as a leader. Well, your job is to just make everybody row in the same direction as the organization

Tim Lander (46m 49s): 
Like we all need to be aligned

Tim Lander (46m 51s): 
You'll hear that all the time, and I'm like that's only part of it. The piece that's missing, and I think the piece that most

Tim Lander (47m 2s): 
Frontline workers, if you will feel, is missing is that you need to be as a leader, you have to find a way to maximize the well being and the personal satisfaction among your constituency

Tim Lander (47m 15s): 
While maintaining allegiance or alignment with that common purpose of the larger organization, and that is to me, that is the job of a good leader, is

Tim Lander (47m 27s): 
Keeping everybody more or less happy in what they're doing and keeping them motivated and having them feel like they're part of the larger enterprise, but then you're able to meet the goals of the enterprise by that. And so, to me, that's what it's all about.

Ken Segel (47m 45s): 
It's a very powerful thought for me because it takes it beyond sort of the simplistic, We've got to get everybody aligned. And I love how you in other conversations you've sort of

Ken Segel (47m 58s): 
Framed it, as you know, allowing people to continue to feel agency and and vibrant themselves. Well, maybe

Ken Segel (48, 5s): 
You know a tweak on the shoulder to just make sure they're still in the river with everybody else, you know. But that's focus on the people and what they need to be feeling

Ken Segel (48m 16s):
While being enough in line with everyone else. Tim Lander: So if I think of the framework, If I was to say, How does your constituency feel like you are a good leader?

Tim Lander (48m 28s): 
Me, I feel that it's all about being a good coach to what learned, and the coaches that I’ve ever had in my lifetime have been very impactful for me. So what makes a good coach then, right? I think a really good coach has an ability to encourage.

Tim Lander (48m 44s):
To inspire. to teach and educate. and also to provide perspective.

Tim Lander (48m 51s): 
Sometimes this involves telling very difficult truths, you know, you kind of have to be honest with people. You can't just make everything all sunshines and rainbows all the time.

Tim Lander (49m 2s): 
But you have to do it in a way that doesn't punish them or demean them. but really

Tim Lander (49m 8s): 
Prompt them to do some self-reflection and to support them in order for them to kind of be nudged in the

Tim Lander (49m 17s): 
Proper directions, so that they're successful as a member of the collective that supports the goal, the shared goals of the enterprise. And I think it's important to recognize that the goals have to be shared.

Tim Lander (49m 30s): 
And another component that may be missing from some people's conventional thinking. And when you hire people into the workforce. I do think it's important that people understand

Tim Lander (49m 43s): 
What the goals of the enterprise are like. Why are we here, and honestly, if you don't share the mission or the goals of the enterprise.

00:49:52.050 --> 00:49:55.410
Tim Lander: then maybe you should, you know, take yourself out of the family, or move to a different state, or emigrate to a different country, or in in this case, maybe find a different department or a different healthcare organization to work for

Ken Segel (50m 13s): 
Yeah, no, I love it, and bringing that coaching metaphor back to that sort of inspiration and guidance combined as part of a larger, very important purpose, which those of us in medicine.

Ken Segel(50m 22s): 
And in healthcare, obviously should have centrally driving us. But in but any human in any organization.

Ken Segel (50m 28s):
So, Tim, if we're if we're circling back a little bit. And you were so generous and vulnerable to describe that sort of like a lot of leaders in medicine, etc. At one point, not too many years ago you were thinking of getting out, and you are feeling disgruntled. And recently you've said I love my job, and I love how we're changing at Children’s. So if that's still accurate, share a little bit more about that, why, you know why. Why this now alignments right in your own journey, and what you're excited about for the future.

Ken Segel (50m 58s):
And then I'll ask one more question after, and we'll let you go back to leading your team and to support the children and families in Minnesota.

Tim Lander (51m 7s): 
Yeah, it's funny. I'm almost embarrassed to tell people that when people say like, How are you doing?, How do you like the chief of surgery job? 

Tim Lander (51m 15s): 
I'm kind of embarrassed to say it, cause I know a lot of people don't love their job right now. I love my job. I can confidently say
that I do. I’m probably the happiest I've ever been in my life.

Tim Lander (51m 31s): 
Maybe save like a couple of specific events in my life. But, like I would say, if you look at the period of time, we're most consistently happy. I don't think I've ever been happier.

Ken Segel (51m 44s):

Tim Lander (51m 46s): 
Yeah, why!

Tim Lander (51m 48s): 
I think a lot of things have fallen into place for me. Personally.

Tim Lander (51m 52s): 

Tim Lander (51m 54s): 
And a lot of them are specific to me, but could potentially apply to other people in leadership. I think that.

Tim Lander (52m 5s): 
And I think people might be surprised by that, because, like, you gotta be crazy, healthcare has so many headwinds, and you know it's a terrible industry to be involved in right now. We have so many pressures on us from payers and patience and regulation, and it's just hard. Delivering healthcare today is really hard. But, so, why am I so happy?

Tim Lander (52m 31s): 
I'm happy because, for me personally, every day is full of some new challenge, that’s interesting.

Tim Lander (52m 44s): 
It's challenging, but it's fun to work through the problem, the exercising different skill set. I feel like, though, over the past year to year and a half, as I've gone through this sort of, you know. Once again calling it the “indoctrination.” We actually started calling it drinking the Kool aid so much that we had packets of Kool-aid, on the last day, because I had clearly talked to Kool-aid by the end of the week.

Tim Lander (53m 13s): 
And then, in addition to the leadership development that we've had at Children's over this past year. As part of the Leadership Academy. I feel like I have so many tools in my toolbox now. So like when I'm faced with things that would have been incredibly uncomfortable for me in the past, like having difficult conversations with surgeons, is like double the thing that I was most afraid of.

Tim Lander (53m 35s): 
I have so many. I have so many tools in my toolbox so that I can pull out and use to help me solve those problems. I feel like I've been

Tim Lander (53m 47s): 
Been very well educated and resourced in those mental tools. And I'm not one of these people who like keeps copious notes, and has like notebooks full of like different spreadsheets and worksheets like that. I mean, I kinda read through them. II get the concept. And then I usually just kinda like make them my own. And so

Tim Lander (54m 11s): 
That's been very. That's been very rewarding because you feel like Oh, my gosh! No matter! Quote unquote, no matter how bad things get, 

Tim Lander (54m 19s): 
You can always find some type of path forward. And that's the real trick. That's the real challenge. And that's the real fun of being a leader is, how do I find myself out of this mess? And then, being able to succeed because you've been adequately prepared for it.

Tim Lander (54m 36s): 
I will say that parenthetically, I kind of alluded to this earlier in the conversation is like I had. I had resources and the plans to leave medicine like one of the things I think this made me a very successful leader is I don't need the job. I don't do this because I need the job. I don't need the paycheck.

Tim Lander (54m 59s): 
So the only thing that keeps me in this role is that I want to do it. 

Tim Lander (55m 7s): 
And weirdly, that's very freeing. It allows you to look at things differently. It allows you to limit well, a lot of times. It's fear of losing our job or fear of being judged for a bad decision, or how many get fired. If I do that, or you know people are gonna think that I'm a bad leader. If I make a mistake, I don't have that baggage

Tim Lander (55m 32s): 
To follow me, and I think that that's probably one of my secret weapons.

Ken Segel (55m 39s): 

Tim Lander (55m 45s): 
Makes you a much more courageous leader. Because you can go out on a limb without too much fear of failure.

Ken Segel (55m 50s):
What a what a powerful weapon it is! And you know, and it reminds me of polynomial. One of our co-founders and inspiration, who, you know, talked a lot about leading from purpose and supporting people to do great things instead of leading from fear and other potentials. 

Ken Segel (56m 7s): 
And you know, Tim, I hear you talking about the fun you're now having in the support for you. And is it fair to say you're also doing it with other leaders in an organization that's doing the same thing at the same time. And you're building those systems that are built on that way of

Ken Segel (56m 26s):
Thinking and working together and collaborating, and that that must have sort of a leveraged effect on your sense of well being right absolutely. And I think the building of psychological safety is a really interesting topic.

Tim Lander (56m 40s): 
How do you do that? I think that people feel cause that. And again, psychological safety. Holy smokes! If there was. Well, if there was a scoff, worthy phrase that I was exposed to during my first week of Value Capture that was it. Like, I mean, you gotta be kidding me. Talking about psychological thing. I mean, it's really important. It's probably the most powerful

Tim Lander (57m 5s): 
Concept that I have been exposed to and embraced in the last two years. But, the problem is, you can't just declare it. And that's the other people are like, well, we wanna create a psychologically safe space. This is a psychologically, sorry you can’t declare it, you have to create it.

Tim Lander (57m 28s): 
And that's really hard. The only way that I've observed people creating true psychological safety is over the course of time with shared experience.

Tim Lander (57m 42s): 
Dipping your toe into the water, you know, maybe getting a negative reaction, reflecting on that, talking through it, being bold and telling your colleagues, boy,

Tim Lander (57m 56s): 
That didn't really feel good, or I didn't feel safe when you said that. Like, I feel like I'm being personally attacked, or you're not blah blah blah! So that's been super powerful. And I will say that, that comes with

Tim Lander (58m 10s): 
So, as you said, what's so great? Now this is, it's so rewarding to have been through again with Value Capture. Been through Leadership Academy with 40 of my closest friends at the hospital, my co-leaders and what I've started to notice, and it's just within the last couple of months. Honestly, Ken, I'll be in a meeting

Tim Lander (58m 34s): 
And it'll be a meeting with, say, 5 or 6 other people, and maybe only two of us are a member of this, like secret Society of Psychological Safety, and those numbers are continuing to grow in the organization as more people have these experiences. But right no,w we're still very early in the process. So there's a really a small cohort of us that really understand what that means to be psychologically safe, what it means to rumble effectively.

Tim Lander (58m 56s): 
And now I'm in meetings like that, with my colleagues, where they'll actually tell me what they're really thinking.

Tim Lander (59m 5m): 
Shaving 20 min off of this meeting, and we probably can cancel the next two, because we've actually gotten to the heart of the matter

Tim Lander (59m 19s): 
In a very short period of time, because my colleague can say, Look, Tim, I don't know what this is, it’s the dumbest thing I've ever seen. I don't know why we're even bringing this up, I'll go along with your question, But you gotta understand, that I’m coming from this from a completely skeptical lens.

Tim Lander (59m 36s): 
We never see that at Children's like, and I don't know that I've ever seen that anywhere where people will be that authentic and truthful with you, because they know, that I'll receive that information and be grateful.

Tim Lander (59m 49s): 
That's like, oh, my God, thank you for just calling it out. So now I know where you're coming from. And now I can understand that everything that you tell me is gonna be filtered through that lens. It can be much harder to see where you're coming from and share your point of view to the degree. And what was interesting about this particular case that I'm thinking about is at the end of the meeting. We realized that we completely agreed.

Tim Lander (60m 15s): 
We were just seeing the problem from two different angles. But in the end it was like, Yeah, we so yeah, we're all we're both on board. Let's move on. And so I felt like we really accomplished a lot in a very short period of time. That is fun.

Tim Lander (60m 28s): 
That's not just reporting, but that's fun, and it goes from tense or frustrated, to just something that is whatever the opposite of that is right. And it's you just feel like you can leverage that to the moon to do great things together with all of the talent that you all have right cause. I realize there was 4 people on that meeting that had no idea what was going on.

Tim Lander (60m 51s): 
I couldn't believe how we were talking to each other, and so I, at the end of the meeting, before everybody got up, I said, I just want to call it out. I want to thank so and so for embracing the moment just cutting to the chase, we have a relationship that allows us to be psychologically safe. I hope none of you felt that you weren't. But this is the type of environment and type of meeting that we hope to have.

Tim Lander (61m 13s): 
And then that was followed up by a very nice note from one of the other participants, and they're like, I always feel psychologically safe in meetings with you, Tim. Thanks for calling it out. Thanks for being such a strong leader and such a strong advocate for just basically getting stuff done. So I think it's changing. And I think it's through those types of interactions, and that intentionality as a leader to just call it out. And basically saying, this is how we function better as an organization. Just try it. You'll like it.

Ken Segel (61m 44s):
Right? That combining of the living, the example courageously, and then drawing attention to the framework around it, back and forth. That's the power of great leaders and great organizations that teach and systematize all of that. So what a great example! And you know, a couple of things are clear to me.

Ken Segel (62m 5s):
One is, we need to find more ways. And I'm sure audience members watching this will want to find more ways to learn from the incredible work that Children's is doing that you are doing as chief of surgery, and your colleagues are doing, I think, at this time that is fraught in American healthcare, and you have been so generous and sort of sharing how you felt and what position you are at, because we know so many other leaders feel that way, and so many other people more in the trenches feel that way.

Ken Segel (62m 34s):
And you've offered us a vision of sort of putting the key pieces together. The human, real.

Ken Segel (62m 41s):
Practical level, all at the same time, that can sort of chart a better path, forward. So I know we're all very grateful to you for the work you've already done, but also your generosity and sharing, and for those that are interested, we’ll have Dr. Lander’s, bio and the show notes. We know that you guys listening are passionate about improving things on American healthcare for your teams and yourselves.

Ken Segel (63m 9s):
Look for things on sort of deploying strategy and this human supporting, effective way, coming from Value Capture shortly, including an upcoming webinar in early November.

Ken Segel (63m 21s):
Join with us on LinkedIn. Come to our website for resources on all these things. But you know, Dr. Lander we'll turn it back to you for any last words for your peers and colleagues before we wrap up this chapter. And what else would you like to share here? Thank you for your generosity.

Tim Lander (63m 44s): 
You know, this has been a really interesting conversation. I think the thing that I would reflect most upon is I would never have pictured myself in this position. You know, 4 years ago.

Tim Lander (64m 1s): 
One of the concepts that I've been trying to work into is like some type of conversation, or whatever is like, I'm not a logo guy, and like you can see, I'm wearing a Children's Minnesota shirt. I'm wearing a children's Minnesota vest, but for the my entire life and career, I have not considered myself to be a logo guy, and I think most people understand. What I mean by that is,

Tim Lander(64m 31s): 
I've always been someone who's been a very independent thinker always. I don't really want to be seen as part of like a bigger collective, or some, you know, some other endure. Like I've been kind of staunchly independent in my thinking and my approach to my life in general. 

Tim Lander (64m 50s):
But I've definitely changed, and I don't know why I'm I don't know why I've become a logo guy, but I wear Children's logos, and I would say, proudly, and I think it's because of the way that I've changed and grown as a person has allowed me to see.

Tim Lander (65m 17s): 
The value in embracing that part of who I am. That is part of a larger organization and a larger whole. And it represents something more to me than it ever did.

Tim Lander (65m 31s): 
I haven't really figured out exactly what that means, but I know that's been a big change for me in the last couple of years.

Ken Segel (65m 48s):
What another powerful leans, thank you for offering that. You know, what that means, I think it will resonate with a lot of folks, and my own hypothesis on hearing it for the first time. As you are helping an organization change in ways that are very resonant with your values, and the organization is changing with you, and that makes it a lot easier to

Ken Segel (66m 6s):
Feel that sense of pride and possibility. Right?

Tim Lander (66m 11s): I think you nailed it!

Ken Segel (66m 13s):
Terrific, all right. Well, Dr. Tim Lander, thank you so much. You've been an incredible teaching guest here for us on habitual excellence, and we'll look forward to the next chance to learn with you. We're very grateful.

Tim Lander (66m 26s): 
Thanks, Ken. It's been a pleasure.


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