[00:00:00] Stacey Richter: Episode 432, "The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical ‘Waste’”. Today I speak with Kate Wolin.

American Healthcare Entrepreneurs and Executives You Want to Know, Talking. Relentlessly Seeking Value.  

Gratitude and Progress in Healthcare

[00:00:32] Stacey Richter: First of all, I just want to start out this pod and really thank everyone listening and for showing up for a show like this one. You do it and you are here because you care about patients/members.  

It's just so easy to feel like we'll never be able to do enough, and that's a rough, rough feeling. Please take a moment to truly hear how grateful I am for you being here and for doing all that you do and that you try to do. I saw on the interwebs the other day, a Marcus Aurelius quote, what he said was, "Be satisfied with even the smallest progress". 

And I think this is really important to remember because nobody working in the healthcare industry, especially today, is ever probably going to get anything close to a perfect solution. So instead, just aim for progress. Even the smallest amount and feel good about that, please.  

The Peril of Cutting 'Clinical Waste' in Healthcare

[00:01:25] Stacey Richter: This show is an important one for anybody either in the business of healthcare delivery or buying healthcare delivery services. 

It's an exploration of what works and what doesn't work and how what works can easily become what doesn't work in the face of the real world.  

This peril of cutting clinical and “waste” perilousness all starts with the whole, Hey, let's make some money. So we got to scale and be efficient. We got to do our thing at as low as possible a cost and maybe grow as fast as possible. We got to keep our investors happy or pay off our debt we got saddled with. Or pay that giant management fee we're being charged or compensate the C-suite at the level they've grown accustomed to. 

So again, the let's be efficient and get everything repeatable has entered the building. At the first point, my guest today, Kate Wolin, makes about all of this, and this is exactly the same point that Rik Renard made in episode 427. Efficient to what end game? Now, it turns out, surveys show, only a small, small percentage of healthcare delivery solution providers are measuring outcomes of pretty much any kind.  

So how do we even know if cutting so called waste is actually waste at all? I mean, in the absence of any actual measures, here's a hypothetical for you. 

If someone could look around. Hey, I see these nurses. They're all just sitting around chatting with patients. And I don't know, talking about throw rugs. What is this episode of HGTV? Who cares if a patient with diabetic neuropathy has throw rugs in their hallway? Let's tell these nurses, chop chop, get them on the computer using AI to be efficient, right? Like, let's get rid of that clinical waste. I just made a point in the most sarcastic way possible, but the bottom line is this. 

It's actually really efficient to not engage patients in these ways, right? Patients, they talk slow, they ask questions that seem irrelevant, and they're time consuming. It's very efficient to not build relationships or foster trust or, I don't know, assess fall risks. But whatever is going on is also going to fail in that model, from a patient outcome standpoint, at least. 

I'm going to quote Sergei Polevikov right now with some light edits. He wrote on LinkedIn, primary care is not scalable in the same way as Scrub Daddy or Bombus Socks. That's something not taught in MBA and CFA programs. Someone should have told Walgreens, CVS, Amazon, and Walmart. They also probably should tell a whole bunch of point solutions. And payers, also, some health system execs or pharmacy leaders might also want to get that memo.  

Kate Wolin's Optimism and Advice for Healthcare Entrepreneurs

[00:04:00] Stacey Richter: What I really liked about the conversation with Kate Wolin today is that she retains optimism in the face of all of this. 

She offers advice for how to navigate the balance between mission and margin in a way that's better for patients and also sustainable financially. She talks about three points. First, she talks about founders and investors being in alignment and the essential nature of that. Number two, the importance of having clinical leadership and a team dynamic that enables innovation, but in a clinically sound way. 

And number three, she talks about how you got to measure what matters and do it in a way that inspires a mission driven team, culture. If we're talking about relevant shows to listen to next after you listen to this one, please do not forget episode 331. This is where Al Lewis teaches us how to evaluate wellness vendors and health solutions, but it also teaches us how to be a good wellness vendor or health solution. 

Again, that's episode 331. Also, do come back and listen to the encore with Jerry Durham next week about front desks and the total care experience. Lots of really bad, avoidable things happen if the front desk isn't considered, and it isn't often considered. For sure, also listen to the show with Dr. Kenny Cole. That's a must listen. That was a couple of weeks ago. Then again, the show with Rik Renard came up several times in this episode, 427, as I said before. The show with Jodilyn Owen also gets brought up, episode 421. That's a great cautionary tale there to keep in mind for mission driven entrepreneurs and investors. 

And then may, I also recommend J. Michael Connors, MD. He writes a lot of stuff in a newsletter along these lines, links in the show notes to all of these things. Last, last, last, please go to our website and subscribe to the weekly email. I am planning on doing a few invite only sessions for email subscribers. 

Plus, the weekly email is a really very convenient way to get the episode transcripts and stuff, and if you don't get it, you're making your life less efficient. So, go fix that.  

Exploring Effective Healthcare Interventions and Their Challenges

[00:05:56] Stacey Richter: Kate Wolin, my guest today, trained as a behavioral epidemiologist and has done research in chronic disease prevention and management. 

She launched and led a digital health startup and sold it to Anthem. She's been in the digital health startup space, largely at the intersection of science and product strategy ever since.  

My name is Stacy Richter. This podcast is sponsored by Aventria Health Group.  

Kate Wolin, thank you so much for being on Relentless Health Value today. 

[00:06:24] Kate Wolin: Thank you for having me.  

[00:06:26] Stacey Richter: If we're thinking about what works in healthcare and then how sometimes that might devolve when we start trying to make money at the same time, the whole conundrum of mission, margin. Maybe we start here. If we're just thinking about what works, irrespective of money.  

[00:06:47] Kate Wolin: Maybe everyone doesn't know, but as someone who spent a lot of her career living and breathing journals and articles and PubMed, there's a lot of information out there about things that work in clinical care, in population healthcare, things that have been around for decades in some cases. 

The challenge is that many of those things are human capital intensive. To plan, to train, to execute, and to maintain those programs that get tested in clinical trials that get published in the research base. They're built on relationships between people. They're built on time of people spent together. 

They're built on resources being deployed. And the unfortunate thing and one of the reasons that I ended up having my as good as it gets moments about academic research is those things are sometimes difficult to get paid for or difficult to scale.  

[00:07:42] Stacey Richter: So give me some examples. You said that there is a lot of information about what works relative to clinical care, relative to population health. 

And we've talked about this any number of times on the podcast, that it is at its core, at its seed about relationships. It's about trust. It's about spending time together because you got to spend time if you're going to have relationships and trust. But what are some maybe case studies of things that you have seen which inarguably work? 

[00:08:09] Kate Wolin: So these are things where we're deploying people into the community. To meet people where they are, and that's a phrase that we talk about using technology to personalize and hyper personalize to an end of one. We've been doing that for decades by putting someone in the community and having a conversation with them, having a conversation around the behaviors that they might be undertaking to take care of themselves. A barbershop or a beauty salon is a great place to have that conversation because you're talking about someone who is engaging in, to use a modern day phrase, an act of self care. And so to have a conversation about other things that they do to care for themselves in that moment is meeting someone where they are. 

Similarly, a laundromat is an act of care for yourself or your family. And so to have a conversation about the things that you do as a family caregiver in that moment, there are examples of that being an effective way to engage people. There are places that people go regularly, right? So one of the challenges that we often have in healthcare is how do we keep people engaged? 

And when you're meeting people in a place that they go on a regular basis, churches are another example of that, you're able to have an ongoing dialogue and an ongoing relationship because you're leveraging a place and a space where that happens naturally. And so you're able then to engage people in ongoing conversations around supporting preventive health behaviors and behavior change. 

Those have been effective ways to do that by using relationships of trust to your point that exist and building on them in the places that people already are.  

[00:09:52] Stacey Richter: And Dr. Carly Eckert did talk a bunch about this in the podcast, as have others. Just this idea that, you know, sometimes we talk about access, right? 

But if you start thinking about. Just cranking patients through a throughput machine, you might have access but you don't actually have engagement and therefore it would be questionable whether health outcomes actually improve. Is someone actually going to take their blood pressure medication as prescribed if they don't trust that prescription was given from a place of wholeheartedness? 

[00:10:26] Kate Wolin: Absolutely. I live in Chicago, so I heard about Oak Street in the very early days of them building that business. And one of the things that really stood out to me is quite different was the idea of building your facility to not look like a doctor's office, right? But to look like a place that the community would want to come and spend time. 

An older adult who is experiencing loneliness, their community, that sense of loss of community and loss of a sense of place as neighborhoods change. And to create a gathering place where people would want to be, then it's that same opportunity to have a conversation with Mrs. Jones about how she's feeling. 

If she's like, uh, I'm a little, uh, today, right? You can say, Oh, when was the last time you took your blood pressure? How are, is the medication working? You're building a relationship, you're building that trust, but it also loses some of the paternalism that people sometimes experience in the healthcare system. 

It loses some of that shame, and we often know that people will tell doctors what they think they're supposed to be doing versus what they're actually doing. And so if you're actually building a relationship by being part of the community and being a place that people want to be, I think you give yourself the opportunity to actually deliver care in a different way or a way that maybe look like how care used to be delivered many decades ago. 

It's not just about let's put some technology into a broken place.  

[00:12:01] Stacey Richter: Back to the point of you have to have trust. Social determinants is a great example. Unless a patient really trusts the one that they're talking to, if they're asked, are you hungry? They're not going to answer truthfully. So like just getting the, an accurate picture of the patient's health and then also having it come full circle in that that advice is actually taken really requires effort. As you said, it's very human capital and intensive. And this also really matters. This whole idea of going out into the community, because as we know, sometimes the individuals who have the biggest gaps in care are not the ones who are showing up in clinic, right? If they're showing up in clinic, they are in fact engaged at a certain level. 

[00:12:47] Kate Wolin: I think sometimes we make this about the clinical provider. It always makes me think about the rest of the people in an ecosystem that create trust and a positive experience. I was thinking of it recently, someone shared a clip from I think it was like a Golden Globes acceptance speech. And the person thanked the people who answer the phone at her agent's office, because those are the people she actually interacts with. 

Those are the people that make things happen. And that recognition that, yeah, like I might be paying the guy in charge all of this money, but I recognize that there's all these other people that make or break my experience. I think in healthcare, we forget the best experience in my doctor's office may be the person who's working the front desk and may not be my doctor that keeps me coming back. 

And so I think when we think about how we build relationships and how we build trust, It's not just about what the provider is doing, but the entire experience.  

[00:13:49] Stacey Richter: Again, there is a podcast with Jerry Durham and it's a really great show and this is what the entire show is about. Just the importance of the front desk and the patient experience and not just relative to are you going to get a good review on Google or whatever. 

It's actually important for clinical care. I encored that show and we'll link to it in the show notes. So if we start thinking about all the things we were just talking about, having community outreach and coaches and buildings and spaces that are welcoming and all the training and retraining and paying enough so that we can get quality, the quality and level of people that are needed. 

So margin is actually a required consideration here in the real world.  

The Impact of Money on Healthcare Mission and Margin

[00:14:33] Stacey Richter: So now let me introduce money into the conversation. The second that we introduce money and add margin to the no mission, no margin, or in order to have a mission, you have to have some margin equation. What starts to happen? Like, where does this go wrong? 

[00:14:50] Kate Wolin: It can go wrong in a number of places. The first one that kind of comes to mind is part of that margin is around how do we make this more efficient or how do we make it scale. And I think a lot of time we have a ton of unarticulated assumptions. about where we can create efficiency, where tech might be appropriate. 

A lot of times people actually don't do a whole lot of testing and evaluating of what is the one or two things that are key to the outcome I'm trying to drive, right? And maybe embedded within that is, are you clear on what the outcome you're trying to drive is? And then are you actually aligning to that? 

[00:15:32] Stacey Richter: So okay, what I'm hearing you say, someone thinks to themselves, okay, well, in order to make this profitable, I need efficiency and we need to be able to scale and maybe one begets the other. You can't scale unless you have efficiency. But then I just think to myself, all right, I want to make this process efficient. 

And I don't really, truly understand. What might wind up on the cutting room floor as being inefficient that actually was an ingredient in the secret sauce? So I wind up cutting stuff. Exactly. That is essential.  

[00:16:05] Kate Wolin: Exactly. Because we don't actually pay attention. We actually don't know what the secret sauce is, right? 

How much of this is people? How much of this is process? And if it's really people, are there ways to make the people better and more efficient without sacrificing the thing that makes people. Now, devil's in the details and how that gets implemented, but to me, it's a reflection of you build your business around what you believe is core to achieving the outcomes. 

[00:16:35] Stacey Richter: So I'm going to dig in on that for a sec because I am going to assume that you have some thoughts relative to how we make sure that actually the most essential ingredients don't wind up getting cast off. But I thought the other thing that you said was super interesting, especially in concert with the podcast that I did a couple of weeks ago with Rik Renard, in which there was this clinical operations survey that he did. 

They found only somewhere between 7 and 16 percent actually calculated patient outcomes, either PROMS, patient outcomes, or clinician assessed outcomes, such a small number. So sad. But to your point, can you even optimize a process and recognize what is essential if you kind of haven't figured out? What the goal is, or what you're even trying to do? 

[00:17:32] Kate Wolin: I think this is such a great question. The report that Rik put out was fantastic. To me, for exactly highlighting this idea, people are doing things without really being clear on why they're doing them or how they're doing them. It's actually not a well documented process. I think it makes me laugh as, laugh, cry. 

As a public health person who was like, oh my gosh, people go to school and they get a whole degree in management. And so they must be really great managing process and understanding it. And we have these books that are considered bibles of management around measuring what matters. And I think about Rik's report and I was like, if you aren't even clear that you have a process and you aren't documenting your process, you're certainly not then looking at that process and saying. What are the key metrics that tell me where the process is breaking down and where it isn't working, either in terms of efficiency or in delivering outcomes. Rik is really shining a light into this shadowy corner where we actually a lot of times don't articulate what the measures are along the way that indicate the process is working. 

We're not articulating what those intermediate endpoints are.  

[00:18:51] Stacey Richter: You got to figure out the ultimate key performance indicators KPIs that we're talking about here. Really what are we trying to do ultimately? Like what does improving patient outcomes mean? So if somebody's in our program for one year, they should have blah, that that happens at a minimum. 

[00:19:09] Kate Wolin: What I love about what you said there, Stacey, is You articulated a time frame, a lot of times in digital health we say things like, we need to get patients adherent to medication. We need patients to engage in this self monitoring behavior. And I'm like, every day? Yes, every day. Every day for the rest of their lives? 

Yes. Really? Like, really at no point in their clinical care can we decrease that to every other day. We're actually very unspecific in what we're trying to achieve a lot of times in these digital health programs.  

[00:19:45] Stacey Richter: I am a fan of the SMART goal, Kate, which is...  

[00:19:48] Kate Wolin: I love a SMART goal.  

[00:19:50] Stacey Richter: Specific, measurable, time constrained, and achievable. 

Great. So you have to have a SMART goal. That sits at the top of the flywheel. But then what I'm also hearing you say is along the way you need leading indicators or signals that the process is in fact working because if you don't and then you're continuously improving toward efficiency, ultimately what might wind up happening is you're like, I don't think we need that step. 

You cut the step. And ultimately, your outcomes go down because that was something that you're cutting into bone, but you don't know it. So like, this is how margin starts encroaching on mission and undermining mission. That's the theoretical nut of the whole thing.  

[00:20:38] Kate Wolin: Yeah, I applied example of this from my past life. 

We actually do a lot of protocolized things in healthcare and like the Diabetes Prevention Program, which is the gold standard, is this many week program. So week one, we're going to talk about topic X, week two, we're going to talk about topic Y, and people are going to progress through this program. 

There's really not a high level of personalization. People think of these things as like one on one, end of one tailoring, and in many cases, they're not. One of the things I learned early in, in working in this space of these like weight management interventions which are fairly protocolized is there's data that if people don't lose weight in the first two weeks, they are unlikely to achieve the weight loss goal, which in most of these programs is like three to six percent of your body weight. 

So I'm sitting there thinking, okay. If I'm got someone who has a connected scale and I can actually see that they have lost no weight in the first two weeks, why would I proceed with the protocol as written? That's insane. But the reality is that's how a lot of these care protocols work.  

[00:21:47] Stacey Richter: Okay, so now let's introduce confounding factors here when you start getting money in place. 

So let's say that I am a venture funded digital health RPM, remote patient monitoring software. I've got a program and I'm getting paid PMPM per member per month, or maybe I'm getting paid only for patients in the program, or at a minimum, someone is tracking my patient engagement and giving me reports on how many patients are engaged. 

There is a really good reason why I'm going to continue the protocol after two weeks, even though I know it won't work, especially if nobody's, I mean, because measurement, let's just say has two different sides to it. One is the vendor's measurement, the digital health company or the RPM company, are they actually measuring their results? 

But then on the other side, does the customer even know what to do with the results as measured? Correct. If you are a digital health vendor, you've got your private equity investors squawking at you to get your ARR up or whatever the acronym of the moment is that all have dollar signs in front of them. 

I could very much see that all of a sudden the protocol starts to change and not in a way that is going to drive better patient outcomes because the metric that we're striving for there is not outcomes.  

[00:23:03] Kate Wolin: It's a growth outcome of the business, right? It's more patients, you know, in the case of cerebral, right? 

The thing they measured was scripts. That was the metric that they wanted to report on. And when that's the thing you're measuring and not a clinical outcome. That tells you what's important to that business.  

[00:23:21] Stacey Richter: And just to remind everybody who might be like, what was the cerebral example? That was the company. They got in a lot of trouble. They're allegedly almost became a pill mill for ADHD drugs.  

[00:23:32] Kate Wolin: Right. Lots of things happen behind closed doors and lots of speculation has been made about what drove that. But I think enough times that you start to think there's something to it. There's often this sense of the business measures and the business growth measures put pressure on the business to do things in their product and in their clinical that are not in the best interest of the patient outcome. 

It's easy to villainize the finance folks, but to me, it's a reflection of are you aligned at the founder as a business with your investors on the pace of growth and what is feasible and what is reasonable and what is required to get there. There may be places in healthcare where the growth comes at a slower pace in order to unpack these questions around what is really driving the clinical outcome. 

And can we do it in a way that scales faster or is more efficient to drive a better margin without sacrificing the clinical outcome? I think what I worry about is that conversation isn't happening, that there may be tradeoffs in clinical outcomes that don't have to be made if we're willing to grow a little slower. 

[00:24:48] Stacey Richter: So that's actually probably a pretty optimistic picture that I just heard you say there, because what I'm hearing is scalability and growth is in fact possible. You just have to do it in a very considered way and in a slow enough way that enables the entrepreneur, the digital health solution to try some things, see if it impacts outcomes. 

Rework it if it does try something else, right? Like that there is in fact a path forward to profitability and maybe even to some kind of multiple, but you can't do it super fast because then you're probably going to make a big mistake that ultimately is going to impact patient care.  

[00:25:31] Kate Wolin: I think I'm optimistic that we can achieve growth. 

We can achieve profitability, not for every business, but for many and still deliver outcomes and still deliver value. Like I do fundamentally believe that or I think I would bang my head against the wall one too many times in frustration. Mike Pykosz spoke at the Kellogg Healthcare Conference a couple weeks ago. 

[00:25:58] Stacey Richter: Mike is the co-founder and CEO of Oak Street Health, by the way.  

[00:26:02] Kate Wolin: What really stood out to me in the Q&A with some of the Kellogg students was this question of like, why didn't you do X to grow faster? Why didn't you do X to add more revenue? And what stood out to me as a part of being a leader is what you say no to. 

Mike said, yeah, we looked at a lot of these things, but we had to say no because they weren't core to our business and how we were going to grow and how we were going to deliver clinical outcomes. Those are really hard things to do in my experience as the CEO when people throw ideas of how you can get more revenue, more customers, is to think about does that come at a cost and do I really understand the cost? 

We're talking about here as a cost of clinical outcome or clinical quality that may be sacrificed in the process.  

Advice for Healthcare Entrepreneurs and Investors

[00:26:51] Stacey Richter: I'm going to ask you for some pieces of advice, both for private equity, as well as CEOs. And I'm going to put words in your mouth here and assume that your first piece of advice is gonna be exactly what you just said. 

You gotta level set together and have alignment between the investors and the CEO relative to what does good look like? What are we doing here? And what is the pace of growth, which we're going to accept?  

First and foremost, this assumes mission is measured by an actual KPI by which work is evaluated. 

And secondly, that frankly, both are sophisticated enough in the healthcare industry to understand actually what that means. In fact, I just had lunch with a doctor recently who had quit a startup because she said, and this is pretty much a quote. She said, I just couldn't with the working with a bunch of cowboys, her term. Who just were running around breaking things with no clinical knowledge or really understanding of what they were doing or the impact that they were having. And she said this is really frightening and especially so because a lot of their clients were Medicaid.  

[00:28:02] Kate Wolin: Absolutely. Part of what makes that a two way street is if you're an investor. And you're investing in a digital health company that doesn't have someone with a scientific or clinical background in a key position of influence. Like why? It's healthcare. I think as someone who trained as a population health scientist, I also get it that it's very hard in these settings to engage with someone who has a clinical background and they're like, that's not how it's done. 

And the whole point is, yes, because we're trying to do something different. You know, I've been in that position, advising a clinical team, implementing a new workflow that is traditionally done face to face, and we're trying to bring it virtual. And they're like, this is how it's done. And I was like, is it done that way because there's a regulatory requirement? 

Is it done that way because that's just how it's always been done? And what are the risks if we were to do it differently? There are ways that those things go well. And there are ways where people really don't feel heard between your clinical scientific folks and everyone else. And this is one of those things that blows up my inbox and LinkedIn from clinicians a lot or scientists a lot is feeling disrespected, not heard. 

And I think sometimes like I always say to them, a great lawyer will say to me These are the 3,000 risks in the contract you asked me to review, because that's their job is to find all the risks. That's technically why I'm paying them. And my job is to say back to them, okay, help me understand which of these are likely to happen and destroy me, which of these are highly unlikely to happen, but if they do will destroy me. And which of these are like, You know, like the impact of this is not that big, right? And I think there's a lesson to be learned there in how clinical folks interact. But the bottom line point is the same, which is you have to have a clinical or scientific person on the team. And that's a responsibility of both leadership and in my view, investors. 

[00:30:09] Stacey Richter: Okay, so we've got two pieces of advice so far. Let me recap. Number one, there has to be alignment between private equity or investors, maybe I would say, and the healthcare entrepreneurs themselves. And maybe it's just a real also understanding that if you want to invest in private equity, or build an enterprise mostly for a huge exit, like that's the primary driver. 

Maybe do something else that isn't going to involve grandmas getting suboptimal care as a necessary part of the business model. And I just do want to do a callback to the show with Jodilyn Owen who runs a maternity clinic in a zip code rife with social determinants of health. A digital tech maternity startup came in with lights flashing on a magic carpet. 

Ultimately failed. And for all the probably reasons that you were just talking about, but it wasn't just that digital health entity failed. It actually diminished the quality of care in the entire community because they disrupted a bunch of things in their arrival that had been stable before. So like this isn't just the self inflicted wounds, but actually we're talking about people here. 

We're talking about patients. We're talking about communities. So what I think I'm doing is I'm understanding your advice in the sense that if you're actually going to succeed with the mission margin thing, or maybe even just with the margin thing, you got to do what you said, that you have to have alignment between the private equity and the, and the entrepreneur themselves. 

[00:31:39] Kate Wolin: Particularly in the venture space, right? People will say all the time that you want the right investor, not just a check. And I understand, you know, in a tough funding environment, particularly like the one that we're in can become a harder thing to stomach. You just need capital to survive as a CEO or a founder. 

If you're not having that conversation as part of your process to really understand this and to be clear about the assumptions. Then it's really, really hard later when you hit the struggle point. And you're in a board meeting and saying, we didn't hit our growth metric and being able to say, and here's why, but this is something we talked about right before you invested that this was a risk. 

If you're not having that conversation before the check is written. I've seen it with founders where they're reluctant to give that transparency, right? Because they're afraid that the board is not going to reinvest. Things are going to get difficult and complicated. And so I think it's just, it's something that can't wait until after someone is invested to talk about. 

[00:32:48] Stacey Richter: Yeah, and I think, you know, if I was gonna just throw something out into the universe, I really feel like if there's private equity or there's a venture capitalist out there who's listening to this show, and probably if you feel this way, you're not listening to the show, but all that is cared about is money. 

Don't invest in healthcare, go level up dry cleaning or something. You know what I'm saying? This is just, there are downsides that exceed anybody's wallet here. The second piece of advice you offered up is really think about the composition of the team and also the team dynamics. Make sure that there is clinical people, experts, epidemiologists, pop health, like you've got the right clinical and epidemiology expertise, behavior, behavioral health expertise that are on the team. But beyond that, ensure that there are efficient and effective ways of working together such that clinical fields heard, but at the same time there can be forward progress, right? Like there has to be a good culture.  

[00:33:51] Kate Wolin: I get it when you're a, you know, seed stage startup. You may not have the need or the resources to have a massive clinical team and that's totally fine, right? Like to have someone who is in an advisory role, but what drives me absolutely bonkers is a face on a slide that you're never talking to. You end up with the inclination from those folks to swoop and poop and that's not, that doesn't work for anyone. 

You have to engage your clinical and scientific people. In a way that you build trust between the team members so that they can be heard and they're not just being asked to rubber stamp things.  

[00:34:29] Stacey Richter: Okay, we've covered two pieces of advice that you have for those with money and those who need money. Is there a third? 

[00:34:36] Kate Wolin: The third thing I would say is we talked a lot in the beginning of the show around how people matter, right? The front desk person matters, the clinical staff matters, and we're in an era of a lot of burnout and a lot of turnover from the workforce. Yes, it's the clinicians, but it's also the staff who are cleaning the dialysis center are turning over as well, and that puts strains on businesses. 

What I would say, whether you're an early stage startup or a late stage business, is humans are fundamentally motivated by the mission to be in healthcare in so many cases. But they are also motivated to be successful in their own journey in life. They want to know that the work they are doing aligns with the success of the company. 

If they're not clear on what success for the company looks like, they don't see how their work align to that success. And so to me, it does come back to this idea of are you measuring what matters? And do people know how their success contributes to the success of a business? For early stage companies, it's easier to see how your work aligns to those clinical outcome measures, but also to the success of the business's growth. 

Perhaps it's just me and my end of one experience, but working at a fortune five company. I did not feel connected to the mission. And to be honest, I wasn't clear how my work connected to the stock price. It's really hard to sort of feel like you're moving the healthcare business as a business or moving healthcare forward when those things don't connect. 

And the more I think you can help people. Understand what is success for your business or business unit and how their work connects to that. You have to be clear on what the success looks like to our conversation around measuring what matters. It also helps people see how their work connects to that. 

[00:36:29] Stacey Richter: Well, I would reframe that because I can really see exactly the point that you're making. So I had asked you, the original question was, what's your advice to ensure that margin doesn't start to trump mission? And what I'm hearing you say, if everybody in an organization understands what the goal is, and if that goal has a mission focus, then you wind up creating a culture. 

Which can serve you very well downstream. But what it also does at every step along the way is now you have an entire organization pointed in the right direction. And if it starts to go off course, margin starts to eat mission. You have an entire company of people who potentially could be the one to raise their hand and say hi, like we're going off course. 

And just also be accountable to one another and keep each other in check. I think what you're saying is super important, which is probably why they say culture eats strategy for breakfast, lunch, and dinner, or whatever that latest iteration of that is. If what we're trying to do here is hard and we need to stay on the path, then it would be great to have everybody aligned and accountable to one another. 

Kate Wolin, is there any place that you would direct people to go if they would like to learn more about your work?  

[00:37:44] Kate Wolin: LinkedIn.  

[00:37:45] Stacey Richter: They will find you on LinkedIn. Kate Wolin, thank you so much for being on Relentless Health Value today.  

[00:37:50] Kate Wolin: Thanks, Stacey.  

Closing Thoughts and Invitation to Subscribe

[00:37:51] Stacey Richter: So let's talk about going over to our website and type in your email address in the box to get the weekly email about the show that has come out. 

Sometimes people don't do that because they have subscribed on iTunes or Spotify and or we're friends on LinkedIn. What you get in that email is the whole introduction of the show transcribed. There's also show notes with timestamps just apprising you of the options that are available. Thanks so much for listening.