Episode Notes

Dr. Kevin Mailo welcomes Marlies van Dijk, founder of Alberta Health Services Design Lab and Lead of The Pivot Group, to the podcast to talk about human centered design and how to truly innovate for change in health care.

Marlies felt a restlessness in her nursing career that became the realization that she couldn’t influence the change she wanted in the places she was working. She moved jobs a lot, constantly innovating, and then came up on human centered design thinking and started the Alberta Health Services Design Lab. Marlies truly desires innovation that affects change in real ways.

In this episode, Dr. Kevin Mailo and guest Marlies van Dijk discuss what the three box solution to effective innovation looks like, why true change must prepare to bump up against organizational inertia, and how Marlies balances delivering results in her day job while pushing for new change on the side. She addresses how to safeguard time, why not joining committees that are the same old bureaucratic process is better for her, and shares very practical ways to communicate with immediacy between the members of your team. 

About Marlies van Dijk:

Marlies van Dijk currently leads The Pivot Group. Marlies is a registered nurse and has worked as an innovator and change agent in the health and care system. Her most recent experience was as founder and leader of the Alberta Health Services Design Lab. She led this to design new service models across all corners of the health care system. Prior to that she worked in British Columbia to improve care across 25 hospitals in 7 health authorities. She has worked with many national healthcare organizations to improve health care and services. Her passion is co-design as a way of working and hopes to apply her skills to the creation of a world class eating disorder treatment facility with clinicians, patients, community, and government. 

She loves the outdoors and feels most alive when she is on her bike (yes, she is Dutch too!)

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Physician Empowerment: website | facebook | linkedin

Marlies van Dijk, RN and Lead of The Pivot Group: the pivot group | the design lab | linkedin

Transcript

Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co hosts of the Physician Empowerment Podcast, and today I'm very excited to introduce to you Marlies van Dijk. And Marlies is... you know, Marlies, before I talk about you a little bit, I'm going to say it's a little hard to kind of describe what you do because you do so much and you've had such an incredible career and you've built so much. But Marlies is the founder of Alberta Health Services Design Lab, which is kind of an in-house console consultancy for the Alberta Health Services health care system, essentially for Alberta to help on leadership and direction. But then, as Marlies has grown as a leader in health care, she's now stepped out and formed the Pivot Group, which is nationwide. Super exciting. And every time I talk to Marlies, I'm learning something, I'm inspired, and I am so, so glad Marlies, to have you here today. So can I get you to just start with a little bit about yourself and your journey and how you got here?

Marlies van Dijk: [00:01:39] Yeah, for sure. Thanks for having me. So I started out in nursing and I realized very quickly that I was a cog in a wheel and that I could not influence the change that I wanted to make. And I started working in the nonprofit sector, working grassroots with marginalized communities. And I absolutely loved it. But I quickly felt that I wasn't growing there either. So I went back to the health system and I started leading large scale change initiatives with national organizations, things like, say, for health care now, etc.. And then I went to British Columbia for a while. So I change, you know, quote/unquote, jobs every five or six years. I'm not one of those lifers, which I'm very proud of.

Dr. Kevin Mailo: [00:02:24] I am inspired by the way. Inspired by the way. Keep going.

Marlies van Dijk: [00:02:29] Yeah. No, no pension is going to hold me down for life. There's no way.

Dr. Kevin Mailo: [00:02:32] Good. I love it.

Marlies van Dijk: [00:02:34] And I ended up in British Columbia working with surgeons across the entire province in 25 hospitals. And once I was finished that I came to Alberta and I was given a job because I was creative and I was like, What creative? I kind of know I'm creative, but not like in the traditional sense, like compared to really creative people, I'm pretty straight. But in the health care environment, I think I do stand out a bit that way. So I came to Alberta Health Services and I thought, Well, what am I going to do here? And then I realized there was a gap in the market inside the organization. There was a lot of improving best practice or implementing best practice, closing the gaps. But innovation was, per se, was no methodology for innovating. They talked about it, like I mean, thousands of people have the word innovation in their title, but actually doing it and how do you do it? So I stumbled upon a human centered design, design thinking, and I studied labs across the world and I said, Yeah, this is what we need to do. We need to create a design lab. So yeah, go ahead Kevin.

Dr. Kevin Mailo: [00:03:45] Tell us what human centered design is. Because, you know, the first place I kind of go is patient centered, But we realize that we're ignoring another part of that equation, which is health care providers and frontline staff. So tell us what human centered design means within our health care systems and talk to us at everything from the clinic level in private practice all the way up to large subnational health care organizations.

Marlies van Dijk: [00:04:12] Yeah, I can give you some examples that makes it more tangible. Human centered design is essentially a methodology that's pretty high level that looks at collaboratively making decisions about a product or service that would meet the need of the user. And usually it's out of the box. It is something that hasn't been thought about. We use a lot of analogies from other industries to gain inspiration, but the method is really that walks you through testing, building prototypes, and creating something that which you can feel fast with. So that's human centered design. Examples of, for example, I just came from Vancouver and we led a two day skunkworks project and we called it Hacking Wounds - the year before, Hacking Pain - where we essentially take 75 to 100 people, clinicians, diverse teams who tackle a problem from a different angle and try to come up with unique solutions and test them right then and there. You know, failing in health care is difficult to do because of the stakes, but we also put way too much time into our work six months, 18 months before we actually test it with our users or patients. And so failing is not an option because we've put this much money and time into things, like it's cost us.

Dr. Kevin Mailo: [00:05:36] The cycle is so long.

Marlies van Dijk: [00:05:39] It's so long. Yeah.

Dr. Kevin Mailo: [00:05:40] When I think about starting my companies, it's like, Oh, try something. And if it doesn't work, try something else. But that happens very quickly and at low cost, right? Because as you said, the stakes are high in health care because we deal with patient care.

Marlies van Dijk: [00:05:54] Yeah. And I think human centered design is a method that that is a - well, it's well known to be the innovation method - but we haven't created a lot of space for people to work in that way, in part because we're all about evidence based practice, return on investment, you know, show me the impact.

Dr. Kevin Mailo: [00:06:12] Productivity, output, volume, measurable. Quantifiable.

Marlies van Dijk: [00:06:17] Yeah.

Dr. Kevin Mailo: [00:06:19] Values.

Marlies van Dijk: [00:06:21] Exactly. And I mean, if you look at the three box solution, which I'm a big fan of, which tells you that future customer base is future models or delivering service, you have weak signals telling you something might be doable, but you're not 100% sure. Like, you know, virtual care. Before COVID, we were like trying to ignore it at all costs, right? The US had embraced it long before us, but now we're actually finding that, oh wow, we can actually provide the care virtually in many circumstances. But why did we not look at that sooner? We know it's more cost effective. People don't have to travel. But it's, in essence, we haven't cultivated the space for us to innovate because it's a different skill set than implementing, you know, evidence based practice where you know, what needs to be done. You have a list, right? It's proven and future work and delivery models are not proven yet.

Dr. Kevin Mailo: [00:07:21] And talk to us about the three box approach just in brief. I mean, I just love new ideas out there and get people to look at the world differently. Not in any great depth. Tell us, give us an overview.

Marlies van Dijk: [00:07:34] So three box solution, which I'm in love with, is incredibly simple. So if you Google it, you'll find some great videos. The author talks about we have box one, that's day to day operations. It's what, you know how to operate a hospital. You know how to deliver services at scale. You know your business. We're very good at that. Box two is what is it that you can let go of to create the space to actually look at new service models and new potential future customers? So that's the letting go of phase. You know how we have trouble letting go of things? Everyone does. So you actually have to take some time to figure out what you can scrap so you can create space. And that third box is really about - and he says it should be between 10 to 20% of any organization - should have dedicated resources and people that look at weak signals. There is no recipe, there is no proven methods for how we're going to move forward, because most of our problems are very complex, right? We're not dealing with just taking out an appendix for most of our health issues. We're talking about chronic disease management, delivering care to rural communities. Those are complex problems that it all depends on the local resources to know how you're going to navigate that. So that's a quick summary of the three box solution.

Dr. Kevin Mailo: [00:08:56] I love that. And let's shift gears a little bit. And one of the things, so Physician Empowerment, we host a lot of educational events. We've got monthly small groups with a small group of physicians where we tackle aspects of practice or health care or finance. We also have our national conferences and other events like that. And, you know, whether it's in the formal discussions or a hallway conversation, you know, somebody next to the coffee urn is talking about the culture of large organizations. And specifically what I'm getting at is the struggle to overcome organizational inertia. Right. Like an object at rest wants to stay at rest. And so, you know, and it's a source of burnout. It is because I've heard many physicians, especially kind of mid-career, you know, 10 to 20 years in where they came into the profession, they came into health care - and this applies across the board, it's not specific to physicians - they've come in with a certain energy, a certain zeal, a desire to go beyond patient care, to build better systems, to improve delivery, and being people centered is part of it. And they come up against organizational inertia. And I've heard this from doctors coast to coast. I hear it from American physicians as well. And so what does a physician in that position do when she or he is in a leadership role and they're trying to say, okay, how do we break past this organizational resistance to change? Even thinking about new ideas, it's not, you know, it's not even a case of like getting to change and taking steps and trying something new. It's like even having the discussion of could we do things differently? It's like we're going to shut that down.

Marlies van Dijk: [00:10:54] Yeah, well, I've lived it my whole life up until very recently. I've survived in the health authorities across Canada until now, and I decided to leave on my own fruition, believe it or not. But a couple of things. And I of course, I'm super passionate about this, but the first thing to know is you need to find some others who are like you, which sounds easy, but it's not, right? You need to find some fellow, and I call them rebels. I know for some people that might be too much, but you need some people who are innately dissatisfied with the status quo. But they are hopeful because if you're dissatisfied with the status quo and you are miserable and don't see any hope, then you know that's not fun to work with. So you need people who have not given up the spirit. I also have learned over time that you have to avoid the formal structure of a health organization. You have to do it on the edge. This is not something that's going to be in an operational plan. This is not going to be approved by the CEO with the multi year implementation plan. Real change happens on the edge where you start small with a group of people and see if it has some legs before you start talking about it. And that is hard to get your head around in the way that you feel like you're manipulating the system, which is exactly what you're trying to do. You also need to really embrace the fact that you're not going to be super popular. I knew from day one that people thought I was a loose cannon, wildcat, tornado. You know.

Dr. Kevin Mailo: [00:12:34] All compliments, by the way, as far as I'm concerned. All compliments. I love it. Just keep rolling them off.

Marlies van Dijk: [00:12:39] I remember talking to a leader and I said, hey, I want to do this. And she said, Walk to the elevator. She goes, Marlies, two suggestions for you. Watch your back, first of all. And second, you need to learn how to walk before you fly. She opens the elevator, steps in, and goes up. And, you know, I stood there and I said, No way in hell am I not going to fly. So you have to really believe in yourself in the sense that you can, that you're not going to back down to keep the job, to keep the pay. Although I have to say, I have really focused and I've told you this earlier, people said, how come you haven't gotten fired? Like, how is this possible?

Dr. Kevin Mailo: [00:13:19] Love that. Love you.

Marlies van Dijk: [00:13:20] And it's an interesting question. I, I think I really, the reason I've survived is I'm quite a doer. I'm action oriented, so I deliver. So I've always made sure that I'm focusing on something that people know, Oh, Marlies does that. Oh, she delivered that. Yet on the side, I do my innovative stuff and I change stuff. So I make sure that I'm not just all about innovation and trying new things. I actually have a day job. And on the side is where you try these new things. And then the very last thing that is really worth mentioning is accepting this fact that people might not like you, they might think you're likable, like I think people think I'm friendly and they can laugh with me, but they know it's, you know, they're not quite sure what to make of me.

Dr. Kevin Mailo: [00:14:09] It's coming.

Marlies van Dijk: [00:14:10] Right. They're like, Oh, God, what's she going to say? Yeah, but managing the discomfort and being really, like, comfortable with getting the answer no. Like, I didn't care. Like, I would get ten no's, I didn't care. I'm like, Yeah, okay, I knew that was coming. All right, go around this person. Go talk to so-and-so. I'm going to manipulate so-and-so and I'm going to talk to so-and-so. And I was continually navigating.

Dr. Kevin Mailo: [00:14:35] It's a hustle, It's a hustle. I love it. It's a hustle.

Marlies van Dijk: [00:14:41] Right. It's a huge hustle. And some people aren't hustlers. I am a natural hustler, like I am an extrovert.

Dr. Kevin Mailo: [00:14:50] I am totally a hustler. Love it. Yeah. You and I are very much on the same wavelength.

Marlies van Dijk: [00:14:56] Yeah.

Dr. Kevin Mailo: [00:14:56] Yeah.

Marlies van Dijk: [00:14:58] And so, I mean, I think I also knew that I would get down, like there was times where I was completely deflated, demoralized, burnt out. But I took those those times to recharge and to forgive myself for not succeeding and to lay low for a little while. And then I knew my energy would always come back. And it did again and again. So I just was sort of watching my cadences. And I also knew with my supervisors, because I did have them, believe it or not, that I would need to make them happy too, and make them look good. And I, I focus on that quite a bit. But then, you know, I would time my jabs or time my challenges so that I wasn't burning out my supervisors with me as a nutbar employee. But actually, you know, she's delivering. Oh, and it's worth listening to her at times when the message isn't what they wanted to hear.

Dr. Kevin Mailo: [00:15:55] I love that. And I think it's also important, as we're trying to invoke change, is to focus on core values. Right? Like this is about making things better for patients and frontline staff. I feel like that's always a centering, that's always a great centering point. It's like, listen, I know we're disagreeing here and I know you didn't want to hear it, but I'm just trying to tell you that this, from my perspective, is a step forward in patient care or a step forward in caring for our burnt out frontline staff.

Marlies van Dijk: [00:16:30] Right. And just even to build on that, doing a 'Yes and', is people quickly realized I wasn't a climber. They knew, once they realized that I was not there to try to climb the the bureaucracy which is what most people are into, let's just be honest.

Dr. Kevin Mailo: [00:16:46] I'm not. But yes I get that.

Marlies van Dijk: [00:16:53] Yeah. Yeah. Yeah, exactly. So once people realized I wasn't in that game, that's a whole other game, you know, that's a Game of thrones. Like, you know that, like it's like, it's cutthroat, killer. I wasn't part of that. So, for example, if I did a project and I wasn't acknowledged or I wasn't thanked, I didn't care and I honestly didn't care.

Dr. Kevin Mailo: [00:17:18] You know what, though? Clearly you're making waves because here you are on the podcast, right? Right. But I mean that, I mean that, right? Because actions speak louder than the words of an email or some little placard or whatever have you.

Marlies van Dijk: [00:17:33] Well, and I think too, I started to realize you could influence without being high up in the hierarchy, even more influential potentially. And they talk about the 3% influences 80% of the organization. You can be an influencer without that position. And so I when I first came to Alberta Health Services, I started tweeting, and I was like, Why is no one talking outside of the formal email process? And that was fairly new in 2015 and comms just talking about we can do better. And health care suffers from X, Y, Z. I have been told by the communications team that I walk the line just right, just a fine line. I say enough about generally speaking and health care. I don't point fingers. But I learned how to be critical yet hopeful and not pointing fingers. So just that wasn't a role navigator. And so my voice mostly came to me through social media. I didn't wait for a committee meeting or something, you know.

Dr. Kevin Mailo: [00:18:42] Oh, exactly. Right? And I think the other thing is, is focusing on actions, not individuals when we're directing criticism. Right? Or focusing on the process, not on the individuals that set it up or run it, because that gets very emotional when we personalize like that. And there really isn't any role for that. Do you know what I mean? Like.

Marlies van Dijk: [00:19:03] No. Absolutely.

Dr. Kevin Mailo: [00:19:04] I don't think it moves anywhere when we start getting into finger pointing.

Marlies van Dijk: [00:19:09] Exactly. And I also think, to build on that, is I was invited to many committees and I actually have a rule that I don't join committees on a regular basis, like I'm not a member.

Dr. Kevin Mailo: [00:19:22] You'll come in, you'll speak.

Marlies van Dijk: [00:19:23] A committee land for me is like, no, no. But I got invited to an innovation committee and I was like, Oh geez, I'm innovation. I guess that makes a lot of sense. And oh, there's a there's some VP's there. Oh my God, VP's this is Whoa. I went to the first meeting and I realized this is nothing about innovation. This is just another bureaucratic process of committee meetings. And I knew that the end game, there was nothing there. I could sense it. And so I actually resigned from the committee after the first meeting. I wrote a nice note. I apologized, but I'm --

Dr. Kevin Mailo: [00:19:59] Yeah, powerful. You know, you're your most important resource.

Marlies van Dijk: [00:20:02] Yes. My time is really important.

Dr. Kevin Mailo: [00:20:03] Where are you gonna spend your time?

Marlies van Dijk: [00:20:04] Yeah, yeah.

Dr. Kevin Mailo: [00:20:06] I love it. I mean, it's wisdom for all of us in health care. We're the rate limiting step. If I'm busy translating the Bible into Klingon, I'm probably not doing something else more important.

Marlies van Dijk: [00:20:20] Yeah, it's easy to get sucked into the way things, the way they design change. And I, somebody in the hallway saw me shortly after that, and they said, How did you get out of that committee? I want to do that too, but I can't. And I said, well--

Dr. Kevin Mailo: [00:20:36] You run a course on that.

Marlies van Dijk: [00:20:38] -- why can't you? Like, let's get real here. It's all a figment of our imagination. What's happening there? Like, it's just fluff. And I just made really careful calls on that without, you know, offending anyone.

Dr. Kevin Mailo: [00:20:52] I just say I think I'm more effective not being on the committee. Right. Like, politely declining. I like that.

Marlies van Dijk: [00:20:59] Yeah. And call me, call me when you need me. I'm here.

Dr. Kevin Mailo: [00:21:02] So talk to us about practical ways to communicate. And let me just send my big gripe. I hate email. I think it's a giant step backwards in human communication. Like I feel like spoken language, written language, the printing press, really great developments in human evolution. Email was like a step back because how do you address a complex issue going back and forth over an email string with like five other people on it? Right? So for those of you that email me personally, you'll find that I have on my signature line a little thing that says, I never check this, I'm real hard to get a hold of. And so I'm old fashioned. I want to pick up the phone or go meet with somebody because if it's something complex, it's probably best addressed that way. But that's just one example, and that's my own personal perspective on it. I mean, in the end, yes, emails have to go back and forth and in the end there has to be some kind of formal written summary of what was said, what was decided at meetings or whatnot. But in the end, I think we're just so much more effective when we communicate verbally or face to face.

Marlies van Dijk: [00:22:08] Right.

Dr. Kevin Mailo: [00:22:08] So talk to us about some very practical approaches. I mean, we covered some of them, but I want to hear more because this is, these are the things that that courageous health care leader listening to this podcast who wants to do more, wants to get out there, wants to begin hustling to improve their health care system, but what does she or he need to really hear on the how? You know. What do they need for tools?

Marlies van Dijk: [00:22:31] Well, I always, you know, made it my mission to get, to have a relationship with the highest person in the organization. And you can imagine that wasn't going to happen through email. So I would use Twitter or LinkedIn. So DM people directly. And ultimately texting is of course, my love. But I, you know, my teammates at Pivot, we communicate through Discord. You're probably wondering why, we just picked Discord because some people are on it. And actually I love it. It's instant. But of course I'm not in a health organization. But when we were in a health organization we used, of course, Slack, and methods to communicate quicker about logistics. Like you don't want to email logistics. That's just painful. Right? But I did have one of my teammates say, You know what? I got a text from you, I got a tweet, I got a...

Dr. Kevin Mailo: [00:23:26] There we go.

Marlies van Dijk: [00:23:27] And I was like, Yeah, this is yeah, I am a little bit intense at times. Answer me, no. So I think just also what I've learned is just having fun with your teammates like at the design lab, we were like family, like it was crazy. We fought like cats and dogs and and still loved each other. So being able to create a relationship in your team where you actually really like each other and appreciate each other for who you are allows you to work much faster because you can say, Oh my God, I'm sorry, but this PowerPoint needs some help. People don't want to give negative feedback very easily. And we talked about radical candor on my team and we would have to detox people when they joined the lab because they were, the bureaucratic detox, right. Like, and the first time someone, you need to be able to challenge the boss. If you're not challenging the boss and your team, you do not have a psychologically safe team and your products are probably crap. Because no one wants to say, Hmm, I want to--

Dr. Kevin Mailo: [00:24:34] -- throw this one in the trash. Let's start over.

Marlies van Dijk: [00:24:36] Yeah, Yeah. And so I have, I think people, I've been told have never worked for someone who gives this kind of feedback, like, ever. And I'm like, Wow. Like, do we just go along and say, good job? Good job, employees, you're awesome. And yet the work is shit and you know it. So intervening early to create that iterative feedback about what about this and what about this and how can we make this better? I think it's a culture of where you can, everyone can improve the products you produce because I've seen in formal systems people can work for eight months on something and it's not good, but it's too late to comment because you've spent that much time.

Dr. Kevin Mailo: [00:25:19] Yeah. It's like a rocket that's never going to launch. I'm never going to launch properly.

Marlies van Dijk: [00:25:25] Right. And I think the Gantt chart and the project management planning for complex problems is an absolute joke. It's like it's a human system. You think you're going to map out for six months what you're going to do? Like what planet are you from? Like, that's never going to happen. So I have a joke on my team, like if a leader is really into Gantt charts and project management, go to Google. There's tons of templates. I want you to spend half hour on a Gantt chart, make it look good with colors. They love red, blue and yellow for some reason. Do a dashboard, put it in front of their faces and they'll come right down, like they see order. They see a plan. Because that's what we're trained, we're trained to think, you know, and good business etiquette is a plan. And so, I mean, I'm sounding horribly manipulative, but that's how we kind of work. We feed the the top, you know, a really canned project management plan. And then underneath you work more in an agile way where you're not living to that Gantt chart because you know you're going to get information within two weeks that's going to throw your whole plan into the garbage. So we play the game. You have to play the game on the outside and have another game on the side.

Dr. Kevin Mailo: [00:26:41] Love it. Now, here's one more one that I'm going to put you. And I think we can just keep going because I absolutely love this. Absolutely love it because I'm passionate about seeing health care done better. You know what I mean?

Marlies van Dijk: [00:26:54] No, I get it. Yeah.

Dr. Kevin Mailo: [00:26:56] Let me be blunt. Let me let me follow your path. When we talk about closing down beds because we don't have adequate staff, that's kind of like the airliner that you're about to board, that you're boarding, it's about to go for a transatlantic flight, and they're like, oh, by the way, three out of four engines are working and we're down a few crew members, but we're pretty confident we're going to get through our transatlantic flight, you know? So I'm passionate about seeing things done better. And yet the issue is that I feel like health care is always in crisis. I mean, you know, there's no margin within the system. And I hear this coast to coast from Canadian physicians who are like, yeah, I want to do change, but as a leader, I'm putting out fires all the time, right? As an organization, we're putting out fires all the time.

Marlies van Dijk: [00:27:47] We're designed. Yeah, we're designed to not be in the news. That's what we're, that's how we operate. How can we not have a headline that makes us look bad?

Dr. Kevin Mailo: [00:27:56] Yeah. So how do you get past that? That crisis in front of us a week, a month ahead from now, and really make space mentally, emotionally and in our calendars for real change? Do you have any ideas?

Marlies van Dijk: [00:28:14] Yeah, it's a really tough one. If you are a full time clinician, it's going to be hard to carve out space because the mountain of work and the mountain of people is just growing of who needs to see you. So maybe going back to that three box solution, finding out what you can let go of and actually creating time and space to be, to bring bring people together to look at different ways of skinning this cat. We're holding on to old models, right? Old models of delivering service. It's clear we cannot ensure that every Canadian has a family physician. I know that might be like a gas for some people listening, but with chronic disease rise the age, the cost of the system--

Dr. Kevin Mailo: [00:28:59] Oh if you've seen what I've seen in the ten years that I've been in practice or so, I say, Wow, it really, really changes. I mean, sorry, I'm just going to interrupt because--

Marlies van Dijk: [00:29:08] Yeah, yeah.

Dr. Kevin Mailo: [00:29:09] Like you get a young person, like in the emergency department where I work, you know, a young person, 25 years old, has a fall. I mean, you may, they may dust themselves off and you may examine them, they may not require an x ray. Right? And yet, if that same person was an 85 year old on a blood thinner that has a fall, like they're getting a lot done in the emergency room. Yeah, a lot of time there. And then they're getting admitted. Right? And so, you are absolutely right when you talk about like, how are we going to, how are we going to service an aging population with a growing list of chronic diseases?

Marlies van Dijk: [00:29:46] Yeah, it's going to like, you know, I'm from Europe myself. I grew up there and I go there a lot. And, you know, when we're spending 85% in the last year of life, we need to start asking ourselves is, is that what we should be doing? And what about, what could we not potentially do and how do we navigate that? Why are people dying in the ICU? I've heard numbers up to 84, 85% of non reversible deaths are happening in the ICU of acute care facility. And it's like, that's $4 / $5,000 a day when it was not reversible. We know these things, right? So, I mean, there's, this is a huge conversation, but...

Dr. Kevin Mailo: [00:30:28] These are big conversations. But it starts by having the conversation for change.

Marlies van Dijk: [00:30:35] And to challenge people. But I think in the end, making sure that you don't burn out is number one. Tackling something that you can make your project that you get some satisfaction from because you say to me, oh, you've done so many great things and I feel like I've barely done anything. Like I'm hard on myself. And most innovators and entrepreneurs and change agents are. They're like this is pathetic. What have I done? And that is the part about being a change agent. Like, I remember seeing one of my VP's in the cafeteria one day and I was talking to him and I was like, on fire. I was in a great mood and all of a sudden he goes, Wow, are you not happy in your job? And I said, What? What are you talking about? And then I realized, Oh, no, this is, I'm wired this way. I'm dissatisfied with the status quo, but I'm willing to tackle it. But he wasn't used to it, like he he thought, you know, he was surprised that I sounded the way I did. So that is, that is definitely a criteria for being a change agent, that you're not happy.

Dr. Kevin Mailo: [00:31:47] I love it. I absolutely love it. Marlies, I want to just keep going. But I know we have to wrap this up, which just means we'll have to get you on again to talk about these issues because there is such a hunger out there with physicians who, you know, physicians and other health care providers who are passionate about what they do and the system they work in. And they want change. They want tools. And you often feel alone in this, but you realize you're not. And the wisdom that I'm going to, I'm going to take away is, find those allies, find those people that are like minded as yourself, and begin to connect with them and see what you can do to start the conversation.

Marlies van Dijk: [00:32:28] Yeah. Find your wolfpack.

Dr. Kevin Mailo: [00:32:30] Yeah, I love that. Love it. So again, Marlies, I really want to thank you. And for those of you that are interested, again, it's The Pivot Group that Marlies founded, which is her national consultancy, and it's really incredible.

Marlies van Dijk: [00:32:44] Thanks for having me, Kevin.

Dr. Kevin Mailo: [00:32:45] Thank you so much.

Marlies van Dijk: [00:32:46] Bye.

Dr. Kevin Mailo: [00:32:47] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal wellbeing, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo at PhysEmpowerment dot ca. Thank you again for listening. Bye.