Stability and Adaptation: The Biology of Change, with Larry McEvoy and Kevin Kearns

David Shifrin: Larry, thank you for your time this afternoon. It’s a real pleasure to speak with you.

[00:01:51] Larry McEvoy: Yeah, thanks for having me. I appreciate it a ton.

[00:01:53] David Shifrin: So, I would love to start off with a little bit, just a brief overview of how you think about the world. And maybe that question is who you are or where you came from, but what led you to this point?

You are an accomplished healthcare executive, and you are now in a role with epidemic leadership. And so, you’ve spent so much of your career, from everything that I’ve seen, thinking about, and driving change within organizations and within healthcare. But give us a little bit of a sense of what that looked like, where you came from and where you are today.

[00:02:27] Larry McEvoy: Yeah, consistent with how a lot of people were raised, I grew up in a family that was oriented around community. My mom and dad were both scientists. My dad was a physician. My mom was a biochemist who went on to become a hospice worker, and then, of all things, a marriage and family system therapist.

I just grew up in an orientation that science counted, people counted, and we had to figure out a way to build community, whether that was at work or in the neighborhood or wherever else, that actually worked.

And I ended up becoming a physician. And so life is pretty simple, right? Be a good doctor, done. And what I figured out, particularly through the lens of the emergency department was that there were two things that were really interesting to me beyond the technical aspect of my field, which still compels me. It’s a great thing when someone needs help or needs a problem solved and that problem is their life and their body, and you can help them. It’s…there’s really nothing better than that. It lends itself to hubris pretty quickly. The whole doctor-God complex, “I fixed you.” It doesn’t really happen. If a physician or a nurse hangs a bag of antibiotics over someone’s bedside and they get better, really what happened is that person, all three hundred trillion cells of that person, really repaired themselves with a little help and a little nudge from the outside.

And I started getting really interested in that idea that in this chaotic environment where there are all these crazy things going on that you can’t predict, you wake up one day, you get chest pain, you clog a coronary artery, and all of a sudden instead of going to the office or going to work as a lineman for an electrical company or whatever it is you do, boom, you’re in an ER.

And in addition to that, I got interested in what about the people that do the work? How do they continually do a good job responding to what they know is going to happen? Might be Tuesday, might be Wednesday, but they know it’s coming. And the things they don’t know they’re coming because that’s stressful to people.

And then, if you can get folks to actually do that well, how can you get them to do it well again and again? That means how do you get them to learn constantly? Because they’re not going to see the same things every day, and they’re not going to be working with the same combination of people every day. And even if they were, they themselves are a little bit different every day. Sometimes they’re sleep deprived, sometimes they’re worried about their kids, whatever it is. So how do you get that stability of performance and adaptivity that you really need to run an ED was interesting to me early.

And so, I got really interested in how do you get the best of everybody any given day? And the best combination of everybody any given day? And then repeat that day after day. And after I thought about that for a while, I thought, there’s another piece I’m missing here, which is, you can be really good on Monday, Tuesday, Wednesday, and the next week be good again, and good again. And you can get that figured out. And then there’s this other problem you’ve got to think about called, what will make all these people want to keep showing up? How do you get performance learning or adaptation or innovation or whatever, and vitality? Humans really loving what they do, being energized by it and wanting to come back. How do you get that all together, all the time?

That’s a participatory, many hands on deck all the time kind of thing. And we weren’t really taught that, I realized we had kind of a language problem, and I realized it wasn’t just doctors, it wasn’t just nurses, it wasn’t just IT people, it wasn’t just accountants. We all had to come up with a language that actually made sense to the people we were working with, the people that came to our door. Whether they came to our door for a cut finger, or their aorta tearing in half, or their kid had cancer, or their mom and dad were aging and couldn’t live independently.

And that was the second part of the thing that I got really interested in solving, which is the challenge in front of health care is so vast. Make people healthy in any and all ways, in any and all combinations, while decreasing cost and making it easier for people to understand what’s going on and not just be a piece of our scientific thought, but actually participants in building healthier lives for themselves or families and others. You’re like, where do you start there? There’s no textbook that tells you how to do that.

And I think that’s where health care finds itself today, is we have a whole bunch of great people, we have great technology, we have great know-how about what makes a healthy person or a healthy population, or what builds a good doctor or a good nurse or a good team. And yet, when you put it all together, health care is still really hard to use, our populations really aren’t getting healthier, even though the technical level of our care is phenomenal, spotty, but phenomenal. And the people in the business are, and in the sector are just exhausted. It’s not that they don’t care, that they’re not committed, but they’re just, they’re tapped out.

So anyway, I guess my world view, David, circling back to your, the question you asked is, that of, shouldn’t it be possible to get a bunch of really well-intended, highly committed people together? To do something that’s worthwhile to them, necessary to the people that come to us, and have it be something that works really well, can be constantly flexible to what’s really needed on the ground, and actually is energizing for people to go through?

[00:07:13] David Shifrin: Kevin, that, that feels like just the perfect softball for you, this idea of how do we get a bunch of mission-oriented, committed people who are just exhausted by the stress and the pressure of systemic challenges? Talk about that a little bit because organizations are trying to shift. They’re trying to survive with all these pressures, but we’re exhausted. So, what does that look like from your end as you’re thinking about bringing people together to sustainably create change and do that by building foundationally strong teams?

[00:07:45] Kevin Kearns: Hearing Larry share his kind of worldview and where it came from, for me, I just want to thank you, Larry. Mine started in healthcare, actually started at Memorial Health System with you as the CEO. And as I came with an organizational development change, change management background, and wanted to step in and be a part of the clinical benefits of health care.

And for me personally, it was my son got sick and went to Memorial. And I wanted to be a part of that. I got to come in and see a lot of people caring about doing great things. And at the time in that particular organization, it was a kind of a tough time, 2008, so financial turnaround, and that added more pressure.

So, you have the challenges of being a clinical provider, working with other clinicians to provide care in difficult times based off of what the presenting needs are, and then you have financial struggles of the organization layered on top of that. In that moment, what I found most inspirational was the whole reason it brought people to the organization is still there. People still want to care. It’s just a matter of what gets in the way and what can we do about it. How do we stop adding barriers to people working together effectively and allow them to do what they already want to do and build on that? That’s what I have found to be the most successful is get the bureaucracy away where you can.

Control the controllables. And then connect with the individuals and then help bring them together as a team.

As human beings, we want to collaborate. It’s actually part of our wiring. And how do we create the space for them to do that well? And again, I’ll give props to Larry because I learned a tremendous amount being able to watch him as an actual CEO in the midst of a turnaround do that, create an environment that helped people feel that it was possible, and then to be able to actually create change in real-time.

[00:09:41] David Shifrin: Kevin you talked about removing barriers. And I feel some of it, when we’re going through change or going through pressure, there is the element of just the sort of the steady push against a big barrier, whatever that might be. And then other times or at the same time, it may be multiple smaller barriers. And there’s just this constant drip of change.

And so, it’s almost like what we think about with adverse childhood events where, you could have one horrifically traumatic event that sort of scores really high or you could have multiple issues with your life, quote, unquote, “smaller events” that over time accumulate. And I feel like change is very much in that same vein. And so how do we how do leaders communicate through that? How do you help people work through that day-to-day? “Okay, this is difficult today, it’s a small thing, tomorrow, there’s going to be another thing, next week there may be a big thing.” But there’s this scaling up and down of the challenges that we’re facing.

[00:10:50] Larry McEvoy: I think the imperative for leaders here is to maybe take a deep breath and stop and back up a little bit. I have a friend named Nick Petrie – nickpetrie.com if you’re interested in what he does. And he works with individuals in corporate environments around the world on this idea of resilience.

So, resilience is both this ability to respond and this ability to sustain. And that doesn’t come by accident. The other things that sort of pop up in our business vocabulary are words like agility, adaptability, innovation, sustainability, viability.

These are all, by the way, biological words. When you watch biology at play in the human body, it blows anything else away as an operating system. If you want stability, you get stability. If you want adaptability and customization, you get adaptability and customization. And the four of us on this call right now having this conversation are examples, right? The consistency in biology is so profound that each of us had zero chance of turning into a chicken, or a hippopotamus, or a potted plant. There’s no way. Things could go wrong, but by and large, overwhelmingly, when biology decides to do something, create a person, it works. And at the same time, the four of us again in the call being a great example, there’s no way any of us are the same.

So, I like to look at biology from a leadership perspective as a, an operating system, if you will, that delivers unbelievable consistency and stability and constant adaptation and customization and responsiveness. So, if you’re a leader and said, in this team or this service line or this organization, would we want stability, replicability, reliability, the answer will always be yes. We want the team to perform well day in and day out. And yet at the same time, can we be rigid and do the same thing every single day, and never change? That’s not happening either. So how do you get both of those? To me, you look at biology.

In biology, performance is life, and lack of performance is death. If you don’t breathe for a few minutes, you’ll die. And so, your ability to breathe well and to ventilate well is something that your body pays a lot of attention to and gets really good at.

Predators like cheetahs and mountain lions are very good at being predators, and if they’re not, they die. So, this performance thing is throughout biology and it’s requisite. And so is learning because you’re existing in an environment that doesn’t stay the same. It never does.

So, in biology, performance is not just essential. If you don’t do it, you die. And learning is the same way. And so, I mentioned my buddy, Nick Petrie. He’s been talking to people, leaders around the world saying, “Hey, before the pandemic was there a big push toward performance?” And the answer was yes. And then there was this push toward growth and increasing your capacity and growing your capabilities in the way that you think and the way you process things so that you can perform better.

And he was thinking that this may be helpful to people, right? And maybe give them a template for how to respond to this pressure and perform well and help their teams and corporations perform well. But when he asked them after the pandemic, are you guys focused on performance now or more on growth and development? And he said, what he heard back from people was yes, everything. Right now, there’s a pressure to perform and there’s oppression, a pressure to grow, learn, develop, evolve.

And I think you see that in healthcare. And so, if you look at how biology handles that pressure to constantly innovate and adapt to constantly perform, it’s really about vitality. You can’t ask the body to perform, or you can’t you know, if you’re that mountain lion or that cheetah, you can’t really perform and learn and adapt in your environment unless you have vitality.

So, you were talking earlier about this like this big change idea and how do you get people to focus iteratively. To me, the step back that leaders would do well to take is to ask ourselves, “How do you actually design and facilitate and cultivate performance and learning and vitality all together?”

And so, if you were to sit down with a group of healthcare people today and say, hey, tell me a little bit about the best team experience you’ve ever been part of. And, if they gave you the time, and they do, it’s a fun conversation to have, what did performance look like in your best team performance ever? Or your best team experience ever? And what did you learn during that experience? Either after or during? And what was your energy like? They will actually describe, universally, through very specific different stories, but the universal themes pop out, a reality where they performed very well. And it might have been a mess they started with, right? Like a mistake with a patient or a bad thing. But the way that they performed in response was something that was, that something they take with them, and something they remember, and something they now believe can happen again.

And they’ll also describe an event, an experience, where things changed in real time, and changed how they think going forward. They learned something and they learned from each other. And they’ll describe something that was not exhausting, they’ll describe something that was, even though it may have been difficult, it was actually energizing. And it made them excited and want to try it again.

Interestingly, I’ve not heard anybody talk about a best team experience yet and say it was pre-cooked from the beginning, it was easy, and the outcome was never in doubt. It’s actually always some sort of thing, when they start it, they’re like, really? Can we actually do this? We didn’t even plan on this. Here it is in our face, and we’re going to do this, right?

I think, across healthcare, there is a gigantic reservoir of memory, often not real well evoked, about what a best team experience is, and what value there is in helping people go from hoping to get lucky at a best team experience to actually designing it.

You can flip the card, the coin over, by the way, and ask people about their worst team experience, which is interesting to watch from the front of the room because the room gets pretty dark in a hurry. So, Kevin’s laughing here because he’s seen this, right? People actually… their mood will darken as they talk about their worst team experience because these things stay with us too. And they’ll describe a reality where performance degraded right in front of them, despite the fact that no one wanted to, where learning stopped, people went to their corners and vitality just went out the window. These are the kind of things nurses say, after that, I wanted to go run a flower shop. I wanted to leave the ED and go work on outpatient surgery, right?

And these things stack up. And so, if you think about healthcare as this pile and pile of best team experiences and worst team experiences, best team experiences have these seminal elements that are interoperable. They work across teams. They work across personnel and across professional disciplines. They’re universal in that sense.

And so, I think it’s worth asking from a leadership perspective, what’s really sticky for humans? Not one human or one person who thinks this way, but any given human, because that’s what’s really the essential ingredient in healthcare. What’s essential for any human and every human and all combinations of humans to perform well together, to learn well together, and to be vital together?

[00:17:57] Kevin Kearns: Larry, I’ll jump in there and I’ll say that what’s interesting to me is looking at the best case/worst case as far as your team experiences is how much everybody does have in common and then when you explore the worst team experience ever, how it’s difficult for people to admit that they opted in to doing the very things that made it the worst team experience, right?

Their values, not to say that they went out the window, but let’s say that being respectful to other people is an important value for them, but in their worst team experience ever, if they’re truly being reflective, they can see moments where they were doing things that didn’t line up with their values, right? If there was a camera watching them in that moment, they may capture some things that don’t line up with the self-identity of the individual telling the story. And I’m social science background, so I don’t have the biology piece, but I’m curious. Where does the biology come into play there, where you’re intentionally opting into behavior that goes against and is incongruent with who you are and how you’re viewing the situation?

[00:19:06] Larry McEvoy: I like this question because it goes to the mutability and the fallibility of all of us, right? I could say as I try to raise… as the dad in our household, raise our sons as a, quote, “good dad,” right? I try to be a good parent. Am I the same good parent every minute of every day? Heck no! All of us have good and bad moments as humans, right? Whether it’s as a teammate, as a leader. As a, in our job, in our families, in our neighborhood, it doesn’t matter.

So, I think one of the interesting things about the situation you pose, Kevin, that leaders have to think about is, how do you win the math, right? How do you get the best of people most of the time, and how do you create a social system, which is what work is, right? So that the social system – the individual, the two people talking, nurse to nurse giving a report or discharge instructions to a patient, or getting someone ready for their chemo, or team to team – that in any combination, you optimize the probability that you get the best of everybody, individually and together.

And, you optimize the ability that people can self-modulate. Because in that best team experience, what I hear people describe… they’ll say, “You know what, it wasn’t that we were perfect. But if someone got a little bit out of line, either they said, you know what, my bad, sorry. I just, was thinking of something else. Let me take a deep breath. And they’ll handle it themselves. Or someone else will say, Kevin, whoa, this is not the you we know. Do you need to, do you need to take a deep breath? Do you need five minutes off?” “No, I’m good.” Or maybe I will take my five minutes, right?

I had a, one of our exec team members once in the tour of duty that Kevin’s mentioning, was having a bad day and he was blowing up our executive meeting. And we asked him a couple of times if he could self-modulate, and he couldn’t. We kicked him out. And he looked at us like, “am I being exiled?” We’re like, no. And I told him, because I was his boss, I’m like, I’m not firing you. Just right now, you’re not functioning well. Don’t waste your time, don’t waste ours. Just get out, right? Come back when you’re ready. So, he did. It turned out to be a really healthy experience.

And to one degree it’s okay, and then if you’re really bad, I mean if you literally start throwing rocks at people’s heads or start to blow up the team, at some point it’s not okay. But I think that building that mechanism of modulation of behavior early and often into teams and into work relationships is not about pampering people, it’s not about pandering, enabling, being codependent. It’s just acknowledging that people, we swing around a certain range of behaviors, hopefully acceptable ones, and you got to do everything you can to optimize the best behavior. Some of which is with the individual, period. But you put any of us under enough squeeze and enough stress, take enough sleep away and enough support away, and we start to crack.

[00:21:52] Kevin Kearns: You know, actually, I’ll add on to that. It’s interesting that when you have different situations, different environments, you end up having different rules for what’s acceptable and what’s forgivable. When do you offer grace, right? And the best team experience ever, you have things that don’t go well, as you mentioned, but you actually sometimes just let it go. It’s not even something that like lands and lasts with you. It’s not even a forgive the person. You literally just ignore it because it doesn’t, it’s such an outlier that it’s not beneficial and you move on.

Whereas in the not so great environment, they almost can do the same exact behaviors as in the positive environment, but you process it differently and you end up looking like, “Oh, so Larry said good morning to me.” “Oh, like he cares that I’m having a good morning,” right? Like it, it almost works against you as a leader. If you’re not creating the environment that can build the positive aspect of team experience. You’re just fascinated about human behavior.

[00:22:49] Larry McEvoy: Yeah, it’s like that old thing we all saw in grade school, right? Where they’d show you a blue dot on a white background versus a blue dot on a dark gray background and a blue dot looked differently because of the context it was against.

I once had a nurse say… a nurse did something, we were taking care of patients together and came back and said this is done and I said “thanks, strong work,” I was being appreciative. He thought I was being patronizing. He’s like, “Don’t say that to me.” What did I say? He said, “Don’t be patronizing is it’s my job.” I said of course, it’s your job. I’m just glad it’s done I’m glad it got done. And I appreciate you doing it. He’s like, “That’s condescending.” So, we ended up having a series of conversations over this where I tried to understand where he was coming from, and he tried to understand where I was coming from. He had been in an environment where nurses were not respected, and so anything I said was going to come out of and through that filter. And until I realized that I couldn’t do much about it. And until he realized that we couldn’t do much about it either.

[00:23:59] David Shifrin: So I want to sort of bring this home. And let’s say that you guys are on stage facilitating a workshop. What do you then go to your metaphorical tables of workshop participants and say, okay, as you go back to your office, as you go back to your team this afternoon, here’s what’s next to start rethinking how you manage change and activating and supporting your team in the way that’s necessary to help everyone be at their best.

[00:24:27] Larry McEvoy: Sure, I think one is, if you’re really trying to drive change, participation works better than proclamation. And sometimes leaders think we’re so busy, there’s change on Monday, change on Tuesday, change on Wednesday, we don’t have time to slow down. And I think that’s really a tragic miscalculation.

I think if you can frame for people, here’s where we’re going and why, and here’s what’s negotiable and not. Humans get that. And then after that, asking people, how do you want to get there, what’s most important to you, and what are your ideas about what will work and what won’t work.

At this point a lot of leaders are like, no, I don’t have time to handle all that scrum. Now I’ve got a big long list. You don’t have to handle the big long lists, right? If people can generate ideas and they can generate boundaries about what they won’t tolerate and what they will, then you can simply ask the question, what’s the first thing we’re going to try here? It’ll actually make things better for us as a team, and better for the people that we interface with, which is patients and families, obviously, but it’s also other teams. Try the first one or two ideas, and then all you need to do is build a feedback loop. Alright, fine, we’ll try it Monday and Tuesday. We’ll check in on Wednesday. What happened when we tried that? Did we like it? Did we not? What do we observe? What do we learn? Should we lose it? Should we refine it? Should we try another thing?

And if you can get that going, and Kevin’s seen this before in real-time, you’ll get a few people piling in early. Okay, great, we got an opening. The opening is, sincerely framed and welcome, so let’s go. You’ll see some people fold their arms like it’s a trick. “I don’t know, I don’t believe this.” Whatever, let them keep watching. And you’ll see some people roll their eyes and say, this will never work. This is just population dynamics, so don’t worry about that.

Just start moving with some of these simple little things that allow people to participate. Try something. See if it worked. And then accept it or reject it. And be ready for a lot of things that don’t work, that’s okay. That’s the nature, the inner nature of change, and innovation, and mutation in biology.

But you’ll start to find people realizing, hey, we’re going to try stuff, and if it works, then we won, we got something. And if it doesn’t work, it’s not like a policy that we need to do for the next 500 years that’ll kill us. We’ll lose it, we’ll get rid of it.

And that plasticity, that sort of relational fluidity that you can put in a team if you’re a leader willing to do that, becomes awfully effective and allows you to ask some sort of bigger questions as a subtext. What do we need to unlearn to get better? What approaches do we need to start trying that maybe would help us get through this? And how do we start thinking and interacting in a way that actually optimizes our chance for, again, performing better, for learning better, and for actually being healthier together.

And if you can start framing that conversation, science says it starts to roll. But I think experience shows that people come in. No one wants to go to work and be miserable. They’d like to be part of something, and if they get a chance, they’re fully capable of realizing that there are no 100 percent guarantees.

[00:27:16] Kevin Kearns: So with the idea of sharing to a workshop, I would say everything you said is true. But I would start off with a more simple statement of, hey, leadership 101, there’s no algorithm that’s going to save you. There’s nothing you can learn that’s going to work all the time. Sometimes it’ll work great, and then you do the same thing in a different context or even potentially on a different day, and you’ll learn and find out it didn’t work.

And the openness to be able to process that out loud with people that are depending on you for leadership is going to go a whole lot further. and be more effective than being right. being right isn’t always going to work. And so having that in mind is going to set you up for longer term success when context change, people change. And as Larry mentioned earlier, you’re just having a bad day or somebody else is. Because that happens to all of us.

[00:28:11] David Shifrin: I love it. Larry and Kevin, thanks for your time. This has been a blast.

[00:28:15] Larry McEvoy: Glad to be part of it. Thanks for having me.