Listen:
Check out all episodes on the My Favorite Mistake main page.
My guest for Episode #323 of the My Favorite Mistake podcast is Grace Bourke, Consulting Director of the Performance Excellence Practice at Baker Tilly. With nearly 40 years of experience in healthcare quality improvement and industrial engineering, Grace has worked in clinical care, biotech, global public health, and senior leadership roles at organizations including Kaiser Permanente and Sutter Health.
Grace shares a very personal favorite mistake — the challenges of building a new home that turned into a nightmare of mold, leaks, and structural flaws. What began as a house problem quickly became a more profound lesson in trust, verification, and speaking up — themes that resonate far beyond construction and directly into the world of healthcare.
“Trust and verify becomes trust and vigilant, educated verification.” – Grace Bourke
She reflects on how her tendency to trust inspections and processes, while ignoring her own instincts, parallels what often happens in healthcare systems when leaders or staff don’t feel psychologically safe to raise concerns. Grace connects her experience to the importance of leadership accountability, patient safety, and continuous improvement, noting that healthcare still struggles to admit mistakes and act decisively to prevent harm.
We also talk about the role of psychological safety, second opinions, and lifelong learning, both in our personal lives and in healthcare. Grace shares how hobbies like glass fusing remind her that safe spaces for experimentation and “planned mistakes” can strengthen resilience, creativity, and growth.
“We can’t fix the whole world, but we can fix our small piece — and that makes a difference.” – Grace Bourke
Questions and Topics:
- What’s your favorite mistake?
- Was the mistake choosing this builder, or not verifying inspections before closing?
- Why do you think you didn’t speak up more during the building process?
- How does this experience connect to psychological safety in healthcare?
- What have you learned about yourself from going through this?
- How do you put the house problems into perspective?
- Has the builder taken responsibility or apologized?
- What parallels do you see between this home-building experience and healthcare improvement?
- Why is it so hard for healthcare organizations to admit mistakes?
- What role does leadership play in creating safer systems?
- How do hobbies like glass fusing help you practice learning from mistakes?
- What do you mean by “the mistake you’re planning”?
- What gives you hope for improvement in healthcare, despite the challenges?
Scroll down to find:
- Video version of the episode
- How to subscribe
- Quotes
- Full transcript
Find Grace on social media:
Video of the Episode:
Quotes:
Click on an image for a larger view
Subscribe, Follow, Support, Rate, and Review!
Please follow, rate, and review via Apple Podcasts, Podchaser, or your favorite app—that helps others find this content, and you'll be sure to get future episodes as they are released.
Don't miss an episode! You can sign up to receive new episodes via email.
This podcast is part of the Lean Communicators network.
Other Ways to Subscribe or Follow — Apps & Email
Automated Transcript (May Contain Mistakes)
Mark Graban: Hi, welcome to My Favorite Mistake. I'm your host, Mark Graban. Our guest today is Grace Bourke. She is consulting director of the performance excellence practice at Baker Tilly. Grace has nearly 40 years of experience in healthcare quality improvement and industrial engineering.
Mark Graban: She started her career in direct patient care and went to work internationally in biotech, supporting clinical research and global public health initiatives. Grace also played a key role in major technology implementations, including Kaiser Permanente's EPIC rollout. And later, she held leadership roles at Sutter Health. For the last eight years, she's been an external quality improvement coach specializing in tech-enabled improvement efforts. On a more personal front, Grace also serves on the board of Corvallis Housing First and partners with organizations focused on expanding access to care, including Tribal Health and PACE programs.
Mark Graban: She has an MBA, has taught at UC Berkeley, and brings a deep commitment to systems thinking and practical improvement. So, Grace, thank you so much for being here. How are you today?
Grace Bourke: Good. Thank you, Mark, for inviting me here. I'm looking forward to our conversation.
Mark Graban: Yeah, me too. We've, you know, there are a lot of similarities in our backgrounds. They're not exactly the same, but we've done, I think, some similar work related to healthcare improvement. So, we'll talk about that in the middle of the episode. But I'm not gonna let you off the hook, as you're expecting here, the first question: what's your favorite mistake?
Grace Bourke: I think it's the one I'm going through right now. We had a house built starting in June of 2023, and it finished in May of 2024. But in March of this year, we found mold. And as we looked into it, yeah, we had a leak in our foundation into my walkout basement. That's also my office.
Grace Bourke: So that was all quarantined. And we started to look into it, and then we had an inspector come out and found more issues.
Mark Graban: More mold or different?
Grace Bourke: Then we had a civil engineer, more problems, code violations, like no smoke detector. I'm trying to think of some of the other ones, just a lot. It was actually a 64-page report with pictures.
Mark Graban: Yikes.
Grace Bourke: And the inspector was shocked. He recommended engineers. So we got a civil engineer and a structural engineer. And I got to learn a lot about engineers: very focused, very specific.
Grace Bourke: They found significant defects in the foundation. Water is leaking in under almost all of the foundation because we're on a little bit of a slope to have a basement. And in fact, the geotech engineer and the structural engineer came out yesterday to do some testing, and I'm waiting for the reports on how bad is it? Because every time somebody comes out, they find something else wrong with the house. So it's been quite an adventure.
Mark Graban: So, I want to dig more into that. I'm sorry to hear all of that. Hopefully… I mean, that just sounds like an awful thing to go through.
Mark Graban: Would you say the mistake was choosing this particular builder? Or, I'm curious why all that inspection wasn't done before you took possession and closed and moved in. I'm not trying to blame you for that, but I'm wondering why.
Grace Bourke: Yeah, well, so you know the expression we use: trust but verify.
Mark Graban: Yeah.
Grace Bourke: Yeah. I'm very high on trust, and I did not do enough verifying. I trusted the bank's inspections, I trusted the city's inspections, I trusted what the builder was saying. And I didn't show up.
Grace Bourke: Of course, we built it long distance, so that added to some of it. And the other part, in full transparency, is that I didn't listen to myself enough. Working in healthcare and process improvement,
Grace Bourke: I know enough about how things should work. And I kept saying, “We need to be up there more. We need to be up there more.” And I got vetoed. And I regret that I didn't speak up more for what I knew was right.
Mark Graban: Yeah.
Grace Bourke: And I think that happens a lot in healthcare. We don't feel safe. It's not psychologically safe to speak up. And it's not just at work, it's in our lives. And I didn't speak up enough.
Grace Bourke: Sorry, go ahead.
Mark Graban: So you're still working through this. I mean, I hope there's… you know, we always try to look for the positive. What makes this a favorite mistake is that it's a favorite because it's caused you to reflect on these different things. Or what would you say?
Grace Bourke: I think it helped me learn a little bit about myself and to have a little bit more backbone. It's one thing when I go into work and I know I'm the expert, but again, it's the imposter syndrome. It's like, “Oh, I don't really know that much, I shouldn't speak up,” things like that. So I'm addressing the feelings of imposter syndrome, and I'm also putting things in perspective. One of the vendors that came out reminded us, “It's just stuff, and stuff can be fixed.”
Grace Bourke: So I'm just breaking it down into the process steps and working through it, asking for help and doing more thinking. So, we're actually going to make some improvements while we're tearing things apart.
Mark Graban: Yeah.
Grace Bourke: The structural engineer found out our stairs are not safe, and they're going to have to be torn out. It's like, “Okay, well, if we're tearing down the outside stairs that block my picture window, we're going to move them to the other side.”
Mark Graban: Yeah.
Grace Bourke: Find the silver lining. That's what I'm doing.
Mark Graban: Yeah. And I imagine that can be hard to do. I mean, you say the house is just stuff, and it contains our stuff. I mean, a house is the most expensive stuff we ever buy or build.
Grace Bourke: Yes.
Mark Graban: Right. I mean, I might get upset if somebody said that. It's one thing to say, “Oh, you know, someday I'm going to drop an iPhone and shatter the screen.” I have dropped my iPhone a lot over 15 years.
Mark Graban: I have never cracked or shattered a screen. And again, it's a matter of when. I'm surprised it hasn't happened yet. But you know, I have AppleCare and a house has insurance, and I might be more likely to say, “Well, the phone is just stuff,” but it's only mildly expensive, not “house expensive.”
Grace Bourke: That is a really good point that I'm probably a little bit in denial about. It is a big-ticket item.
Mark Graban: I'm not trying to make you upset about it.
Grace Bourke: Fortunately, I have a brother who's in project management for construction, and he keeps saying, “Oh, this is something the builder is responsible for.” On the other hand, I have my husband saying he's not going to pay for this, but the builder has acted with integrity and says that he will fix it. I'm going to be honest: the problem is he does bad patches on top of shoddy workmanship. So I guess I'm feeling like, “Okay, this is a challenge.”
Grace Bourke: “I'm going to make this right. I can do this.”
Mark Graban: Yeah.
Mark Graban: And you know, you're making me think about different situations I've been in. My wife and I have moved a lot in the last 25 years. And you know, when buying a home, there's always an inspection, and you hire a specialist, and there's a report. I don't know enough to know if the inspection is good. I don't know what, if anything, I should be second-guessing.
Mark Graban: And there's almost always something that got missed, or something that was deemed okay turned out to not be okay. So, to your idea of trust but verify, it can be hard to verify whether it's a home or, you know, we're going to maybe move back and forth to the parallels to healthcare. If a surgeon is proposing surgery, which I've had happen before, let's say, related to a back issue, I could trust or I could verify, which means maybe getting a second opinion. It's hard to evaluate these technical things, whether it's electrical work or potential back surgery.
Grace Bourke: surgery, you know, and I'm going to be honest, in healthcare, in my experience, getting a second opinion is not easy. Docs don't want to second-guess another doc, et cetera. And my husband's facing back surgery, and his doc said, “You know, feel free to get a second opinion.” And I'm thinking, It took a year to get in to see you.
Mark Graban: Yeah.
Mark Graban: And what's the tone of voice that was used? It could sound like a sincere, “Oh, no, you know, get a second opinion,” or, “Well, if you have to, I mean, you'll delay your surgery to get a second opinion.”
Grace Bourke: I think part of it is… I do a lot of technology implementations because I love that. I'll be honest, I do love adventures and a challenge. That's probably what got me into the mess with building a house from scratch. You have to get educated, and that can be a challenge in this day and age.
Grace Bourke: But life is so complicated. This is not the old days with the country doc that you paid with a chicken or eggs. This is bigger risk, bigger financial impact, especially with some of the surgical…
Grace Bourke: …some of the health plans that are out there now, where we're on the hook for a significant amount of money.
Mark Graban: Might be the second most expensive thing you buy other than a house.
Grace Bourke: It's been ages, decades, but a statistic or a saying that stuck in my head was from IHI and Brent James of Intermountain Healthcare.
Mark Graban: Sorry to interrupt, but for those who don't know, IHI is the Institute for Healthcare Improvement, which is a great non-profit.
Grace Bourke: organization with a big mission to help healthcare. And they have some big data sets and they do a lot of research. The number that stuck with me is that we're one of the few first-world countries, for lack of a better word, that bankrupts their citizens over healthcare.
Mark Graban: Right. That is a uniquely American phenomenon. Other countries have other problems with their health systems, but you're right.
Grace Bourke: Yes. So, to your point, you're absolutely right. Healthcare, especially back surgery—which is high risk, expensive, and involves neurosurgeons, recuperation, and rehabilitation—is a big investment, and it's hard to get educated. Just healthcare literacy.
Grace Bourke: I find myself translating for my family members on healthcare literacy because doctors and healthcare use a lot of technical terms that have very specific definitions, and the average person doesn't know what they're talking about.
Mark Graban: Well, there are Latin terms. You know, I ran across that as an engineer getting into healthcare 20 years ago, like, “You know that patient's NPO?”
Grace Bourke: I remember that. Yeah.
Mark Graban: What does NPO mean? It means “nothing by mouth.” I'm like, “Nothing by mouth doesn't have an ‘mp' in it.” “Oh, well, it's based on the Latin.”
Mark Graban: “Well, okay, but why?”
Grace Bourke: You know, when I was in high school, I actually took two years of Latin because I knew I wanted to go into healthcare. And I figured two years of Latin would help me with all the terminology in medicine because it is very, very Latin.
Mark Graban: Yeah.
Grace Bourke: So back to the whole thing about how we get educated: trust and verify. How do we verify? We have to get educated. And in healthcare, even in construction, we kept having arguments with the builder because he said, “You're not using the right term.” It's like, “Well, you're not using the same term.”
Grace Bourke: “I don't know what your term means.” And then my brother uses different terms. And so, it can be quite challenging to get educated, but I think it's worth the time investment upfront. And I missed that step.
Mark Graban: Yeah.
Mark Graban: And I think there are a lot of mistakes people hopefully don't repeat. So, like, we've moved into a number of condo buildings, and there's always a condo association, an HOA. And the first time we moved into one, we didn't know anything about the questions we should have asked about HOA finances. And it was still developer-controlled because it was a new building. And we “shoulda, coulda” done that research in advance. But we're both busy professionals, and we do our best to understand how mortgages work.
Mark Graban: We'd already bought other previous homes, and thankfully, we've avoided a really bad decision. But somebody out there listening has a story like, “Oh, yeah, we bought a place, and the HOA was a disaster. And we ended up getting stuck with a big bill the first year we were there.” And now we've learned, and my wife and I do this: we ask, “Let us see the financial report. How much cash is on hand? Have there been special assessments?”
Mark Graban: And sometimes we learn those mistakes the hard way. Sometimes people, I guess, learn from someone else or do that research. But there are so many things we might not know.
Grace Bourke: Yeah. And, you know, it's a really good point: how do we get educated? Because we don't know what we don't know. So how do we educate ourselves?
Grace Bourke: We helped our daughter buy a condo, and three years into it, there's a $3 to $6 million HOA encumbrance. They're near the waterfront, and they have to do a massive pier support to prevent the land from sliding into the river.
Mark Graban: And people in Florida are faced with a lot of big bills either because of hurricanes. There was that one awful collapse… tragic, yes.
Mark Graban: …with the structural issues that everybody's now having to inspect for, and it's hard to get insurance. But, you know, I'm thinking back to the medical side of things. I brought up the lower back issue because that was very much mine. At the beginning of the year 2020, I was in the emergency room New Year's Day with awful back pain.
Mark Graban: I had a badly herniated disc and all of this pain, and was in the ER. And I wrongly thought on January 2, “This year's only going to get better from here.” And then COVID… there's that optimism. I was being optimistic, but the first spine specialist I went to recommended surgery and kind of scared me into it, like, “If you don't have surgery right away, your foot's going to be numb the rest of your life.” And you know how this is.
Mark Graban: As a traveling consultant, though, he said, “Well, if you have surgery, you won't be able to fly for six weeks.” I'm like, “Okay, well, then I need to have the surgery in Orlando, because I need to be there where my wife's working if I can't travel for six weeks.” So I went to a doctor in Orlando, not looking to get a different second opinion, but it was a practical matter of needing a surgeon in Orlando. And wouldn't you know, that surgeon independently said—and he gave me the journal articles—that the medical evidence actually shows recovery and outcomes are better not having surgery than having surgery. He was a younger doc with, I think, some more recent training.
Mark Graban: And then that kind of… I wasn't about to go follow up with the doctor back in Dallas and say, “Hey, by the way, a young punk doctor has this journal article. Do you want me to send it to you?” Like, I wasn't mad at that surgeon, but his truth was that surgery was a good idea.
Mark Graban: And this other doctor's truth was that no, you should let the body heal itself. And he could have gotten paid for doing surgery, I bet.
Grace Bourke: Yep. And that's one of the things… I'll tell you, I've run into that too. I fractured my spine, and it turned out I had osteoporosis secondary to a healthcare treatment.
Grace Bourke: And so my primary care doc did this certain protocol, and I'm saying, “This is not working, this is not working.” So there was a website I used when I was an RN case manager—even though it wasn't an RN, I could do the work because my background is more technical, just no bedside manner. So I went to a specific website for healthcare providers: “What's the latest on the research?”
Grace Bourke: And it's like, “Oh my gosh, we're doing a 15-year-old protocol. I want the new protocol.” So I went to him and I said, “Hey, this is what we need to be doing.” And he goes, “Well, I can't order that.” I said, “Well, get me to who can order it.”
Grace Bourke: And so I ended up going to an endocrinologist, who I didn't know was the specialist for osteoporosis. And so, not even the docs know all the information they need to know. And it's evolving so fast.
Mark Graban: That's the thing.
Mark Graban: Yeah.
Grace Bourke: How do you stay up with the latest? And I'll tell you, looking up YouTube videos—like you can do to fix your phone or the Keurig when it gets broken—is not something you can do for healthcare. My husband did a bunch of YouTube videos, but you can't do that for healthcare. So that is a really big challenge.
Grace Bourke: I don't think I have an answer for how you get yourself educated.
Mark Graban: And you know, there's this phrase, and it's politically loaded, but especially over the last five years, people say, “Do your own research.” Well, if I'm researching a washing machine that's on the fritz, just to pick an example that's not directly happening, I might find different opinions about whether you should repair or replace the washer. But I'm probably not going to run across misinformation or disinformation.
Grace Bourke: Yes.
Mark Graban: And that happens in the realm of healthcare.
Grace Bourke: There is. And one of my pet peeves—it's funny because I'm running into it with friends and family—is when one friend said, “Oh, I had a back injury and they did a cortisone shot and it didn't work for me, so don't do it.” I was like, “It's just one data point.”
Mark Graban: That's true.
Mark Graban: Yeah.
Grace Bourke: “And you don't know what your back injury is compared to my husband's back injury. You have no expertise. And you think that just because you did one, you're an expert.”
Mark Graban: Right.
Grace Bourke: I took a machining class once, and the teacher said, “If you want to learn a new skill, go out, look at YouTube, find three videos, and find the middle ground because they're not going to agree.” But how do you do that with three docs, right? “Find three docs, get three opinions, and pick the one that you think is the most… you know, the two that agree.”
Mark Graban: Two out of three? Vote. I mean, yeah, take a vote. And you know, this goes back to your trust-but-verify question.
Mark Graban: I think of one other case of mine. This is going back 20 years ago, thanks to heredity, I have some pretty bad varicose veins in my legs. Thanks, Mom.
Mark Graban: So did she. And it wasn't just kind of unsightly, but really achy. My legs were really heavy. It was a medical issue, not just a cosmetic issue. And so I went to a vascular specialist, and he proposed a particular procedure.
Mark Graban: And thankfully, we had a friend we knew—she's a nurse in a vascular clinic in Nebraska, in a different state. And we called and asked and got her on the phone, and I was explaining what this doctor was proposing: that there would be a big incision in each leg from groin to ankle. And you're making… for those listening to the audio podcast, they can't see Grace's eyes getting wide.
Grace Bourke: Our friend, because it was on the phone, shrieked. She yelped out loud, “That's an archaic procedure! Don't let them!” And if we hadn't had that person in our life, you know… I found another doctor that was like, “No, actually, no, no, no, no. We can do a much more minimally invasive procedure, like four little incisions, and the healing will be better.”
Mark Graban: And the pain and… yeah. And I'm not trying to… I don't think anyone's accusing me of being ageist, but that thought popped into my head. I don't think it's just a function of age, but I think it's back to your point, Grace, about how it's hard to keep up with everything.
Mark Graban: And if you're a surgeon who is good at a procedure, why jump to the new learning curve of a different procedure? There's that question too, right? These are tough questions.
Grace Bourke: So years ago, I was implementing electronic ICU at Sutter, and we decided to tackle, or align with, the Surviving Sepsis Campaign, which is a campaign to prevent unnecessary deaths from unrecognized and untreated sepsis from two particular sources: hospital-acquired infections, but also 50% of them were community-acquired. But as we were writing up our research paper for publication, we found a statistic: it takes 17 years from when something has been fully researched and validated to be the best practice in healthcare… 17 years before it becomes routine practice.
Mark Graban: And that number goes back a very long time, and it seems to also hold true today.
Grace Bourke: Oh my gosh. So, how does a doc… I mean, first of all, it's not even filtering into the providers. There's so much change. There's another quote about how many hours a doc would have to spend reading journals to stay up. And I think it's more hours than a human being can stay awake.
Mark Graban: So maybe AI can help.
Grace Bourke: You know, that's an interesting…
Mark Graban: …here's what you should be reading or summarizing. I mean, I don't know, I'm brainstorming.
Grace Bourke: I'm jumping into a solution. I expect you to scold me for that.
Grace Bourke: No, yeah, you're right. Yes, it's somewhat of a solution, but it's more of an approach. So that is actually something I did on the construction. As I mentioned, our foundation leaks, and it's a huge foundation because it's a walkout basement. So I did an AI search and said, “Okay, what are the things that you do for sealing basements?”
Grace Bourke: “And give me the references.” And then I go back to the original ones, and if that reference is a vendor, I might give it a little bit more weight than I do a contractor who just says, “Hey, this is the way I think you should do it.” And then the other thing is, if there are any institutions that have information, that type of thing… and frankly, I talk to experts. Oh my gosh, I've gotten to know so many engineers. But how do you get an expert equivalent to an engineer for healthcare?
Grace Bourke: I mean, these people come in and they spend hours, and they come with a big price tag. I think part of it is, I guess I'd love to see us… healthcare does it a little bit. If you have cancer, they will give you an RN case manager who is an expert who can help you navigate. They are specialists in that field.
Grace Bourke: There are doulas for when women are delivering babies during the pregnancy and delivery. But how do we get… so it's starting to get advocates, and then AI can be a way to get informed.
Mark Graban: Yeah.
Mark Graban: And this is in aspects of life that are more important than “just stuff.” This is our lives. This is the lives of others. And so, as I'm thinking through this, maybe the amount of research we should do depends on the stakes and what happens if something goes wrong.
Mark Graban: So I wanted to ask you, to the house before we bounce back into healthcare, what outcome are you hoping for? Things can be repaired, things can be made right, as opposed to some medical errors that have debilitated or killed somebody.
Grace Bourke: Yeah, let's start with the easy one, the stuff that can be fixed. So, I'm hoping… I'm building a very specific list for a statement of work. These are the things that need to be fixed.
Grace Bourke: I have to go through all the engineering reports and the inspector reports and pull out the very specific things. So I think that for me, that phrase of “trust but verify” becomes “trust and vigilant educated verification.”
Mark Graban: Sure.
Grace Bourke: Because that has increased. It's like a video game. We've got to keep leveling up in life because it's getting so much more complicated.
Grace Bourke: So ask me that question again for healthcare.
Mark Graban: So, I'm thinking about healthcare. There are some situations we might get ourselves into, let's say, a surgery that wouldn't generally be indicated or some approach to prenatal care or delivery that led to a catastrophic problem that could not be made right. But people are busy, and these things are complicated.
Mark Graban: I'll leave some space for you to share your thoughts. But as I'm thinking through this, if the stakes are high, but it's also super complicated, that's still a big challenge.
Grace Bourke: So that goes back to the Institute for Healthcare Improvement, the “100,000 Lives” campaign. I didn't realize that's 20 years old.
Mark Graban: The campaign.
Grace Bourke: Yeah, that campaign. I don't think we've done that much better. So for folks, the “100,000 Lives” campaign was a study that found that each year, healthcare killed—not just injured—killed 100,000 people. Healthcare mistakes, not things that we couldn't treat or we didn't know how to treat or they couldn't get access to care.
Grace Bourke: But actual healthcare mistakes. And this is always a challenge in healthcare because we tend to have big egos. We've been highly educated. We're an elite group. We're “prima donnas.”
Grace Bourke: Healthcare has major snobbery. They didn't want to admit that they make mistakes.
Mark Graban: And…
Grace Bourke: And that's 100,000 people that died unnecessarily. And in two decades, we might not have done any better. So there is no obvious, easy answer. I think the first step is we have to admit that there is a problem. We have to admit we're a part of it.
Grace Bourke: And we have to commit that we want to be a part of the solution. And I'm going to be honest, Mark, I work in healthcare consulting—first within Sutter, and then externally. We're having trouble getting executives and leadership to admit that it's not okay to make a patient wait six months for an appointment. You've got to fix your processes.
Grace Bourke: It's not okay to harm people, and it's not okay to kill people unnecessarily, because mistakes happen. And nobody wants to go to work to make a mistake.
Mark Graban: Right.
Grace Bourke: But the systems are broken and people are doing their best. Look at all the people we had “check out” of healthcare because they just got burned out by bad systems, right?
Mark Graban: And overburden and stresses.
Grace Bourke: Stress.
Mark Graban: Solvable stresses.
Grace Bourke: You know, think about it. You make a mistake at work or it's just been bad communication, right? You go home and you have a bad day. You don't get over it just because you left the office or the hospital or the clinic or whatever. And you go back and you do your very best again, and the same things break, and you get that same heart-weariness. You know, it just wears on you.
Mark Graban: Yeah.
Grace Bourke: And we don't respect people enough in healthcare. We don't respect the workers, and we don't respect the patients, and we don't fix the systems. Healthcare's really broken. And now the financial impact is gonna be even worse. And we've gotta get leadership to realize this is their responsibility, the system is their responsibility.
Grace Bourke: And how do they support people and coach them and invest that time and yet get out of the way?
Mark Graban: I totally agree with everything you said there. And you make me think of the idea… we talk about that on this podcast a lot. You have to first be able to admit a mistake and feel safe to admit a mistake if we're going to go into learning and prevention and improvement mode.
Mark Graban: Admitting a problem is often the first step. And in hearing you use that language about how “this many people are killed” or that “healthcare problems kill this many patients,” I got scolded once, 15-plus years ago, for saying some of those exact same things by one of my bosses—not by somebody at a hospital client. But I got scolded about, “Oh, you can't talk that way.” And my engineer brain says, “But this is true.”
Mark Graban: It's an accurate thing to say. If we're going to dance around being so afraid to state the problem clearly, what hope do we have of solving it?
Grace Bourke: So I think I have the advantage because I started in healthcare and then went into industrial engineering and technology and all of that. So I recognize that culture. But I'm with you. You've got to say, “I want things to be better.” And if you're not willing to do that… but I think it takes three things, and this is my personal approach to change.
Grace Bourke: “Connect with the head, engage the heart, and enable the hands.”
Mark Graban: Wow.
Grace Bourke: So the head is all about the facts, the numbers. “100,000 Lives”—that's the numbers. Or, “It takes six months for a new patient to get in to see a primary care provider.” You also have to tell the stories and connect with the heart. “Why is this bad?”
Grace Bourke: Because this is somebody's grandmother who didn't come home, who didn't see her grandchild graduate from high school. That's why we need to fix the “100,000 Lives” campaign.
Mark Graban: Right.
Grace Bourke: Then you need to enable the hands. What are we going to do to fix this? How can we fix it? What is our role? Let's be clear, healthcare is a mega-machine right now, and it is not something that can be fixed by one person trying to do better in their clinic.
Grace Bourke: Yes, they should do that. But we need some bigger systems thinking and advocates and work done and connections. We need to have collaboration between policy setting from the government, which includes funding policies, and the insurance companies and healthcare providers. And I don't quite know, maybe we need the AMA to step up. I don't know right now.
Grace Bourke: I don't see a solution. But I know it needs to be better, and I have hope that things could be better, but sometimes I think I'm overly optimistic about where healthcare is going.
Mark Graban: Yeah.
Grace Bourke: But I show up every day doing my best.
Mark Graban: I know. I mean, this is powerful what you're saying there, but now I'm going to bounce back and forth again. We're making these parallels, I think, between, let's say, home building and a surgical procedure. Did the home builder apologize? Were they super defensive?
Mark Graban: Because the way we respond after a mistake matters a lot in either setting. What happened? What's happening with your home?
Grace Bourke: So the builder has a lot of hubris. So some of it he just brushed off. And he… he would deny some of it. But for the most part, he, in writing, has taken responsibility for it.
Mark Graban: But it's hard to make him accountable for it in a way that, like… “Well, I'll fix it, but I'll do a shoddy job of fixing it.” Right? That's not really accountability.
Grace Bourke: Yeah. And that's where I need to come in and verify with the engineers, “Is what he is proposing going to fix the problem?” Or is it just going to cover up the problem so that it comes back later? And I guess that's the big difference between, let's say, my home being built and, God forbid, me having back surgery.
Mark Graban: Yeah.
Grace Bourke: I want a fix that's going to fix it for the long term. And in healthcare, when you look at it, a lot of the fixes that we've put in place—some of them are great, but some of them have not. And they've had unintended consequences, right? We have all these electronic medical records, and we can pull out all of this data, but we don't have enough data literacy in the healthcare community to know how to use it.
Mark Graban: Well, it's garbage in, garbage out, and then you just get faster garbage, and a lot of times it's not even garbage. It's just noise.
Grace Bourke: Or we use it to punish people.
Mark Graban: Yeah.
Grace Bourke: Right? “You're not filling out the form fast enough.”
Mark Graban: Yeah.
Grace Bourke: “You're not getting in enough patients.”
Mark Graban: And it's so frustrating. It's so frustrating to think, to me, of, you know, we're talking about health and safety and human life. And, you know, it reminds me of that famous quote from W. Edwards Deming, where he said, “If you can't measure it, you can't manage it.” I always love to point out that he also said, “The most important things cannot be measured.” And I think about respect for people, and empathy, and trust.
Mark Graban: The ability to be compassionate. These are things that are so important, but are very difficult, if not impossible, to measure. And I think that's sometimes where things break down. We focus on what's easily measured, which is the electronic medical record, the number of clicks, the number of patients seen, and that misses a lot of the important stuff.
Grace Bourke: I'll be honest, the electronic medical record has probably been one of the biggest disasters for process improvement in my lifetime in healthcare. It's created so much frustration and, in fact, has decreased quality.
Mark Graban: Yeah, and led to burnout.
Grace Bourke: Led to burnout. And it took away, I think, a lot of the trust because you're sitting there looking at the screen instead of looking at the patient.
Mark Graban: Yeah.
Grace Bourke: And that can't be good for the healing relationship. I think in healthcare, the most important relationship is that between the patient and the care provider. And anything that gets in the way of that needs to be questioned. And I feel like the EHRs, electronic health records, have gotten in the way of that.
Mark Graban: I've heard somebody once describe it as “EHRs are like a new employee that comes in, who's very demanding, takes up a lot of time, doesn't really know how to do the job, but, by golly, they are very proud of themselves.”
Grace Bourke: Yeah, they're the new prima donna.
Mark Graban: Yeah, and that's not a healthy relationship. It's not a healthy system.
Grace Bourke: No, and it frustrates me when people say, “Oh, but now we've got all this data, and we can track this and we can track that.” It's like, “Yeah, but what about the trust relationship?” It's like, “What are we doing here? Who are we doing this for? Why are we doing this?” And I don't feel like the focus is on the patient and the worker. The focus is on the system, and the system is so big that it's just becoming this thing that's running away from us.
Mark Graban: Yeah, and there's also the problem that if we think about that phrase, “If you can't measure it, you can't manage it,” sometimes people are over-managing what they can measure. For example, a doctor's work, a physician's work in particular, has become so highly scheduled, right? Every 15 minutes, there's a new patient.
Mark Graban: What if that patient has a complicated issue that really requires 20 or 25 minutes? The system is telling the doctor, “Well, you need to work faster,” instead of, “The system needs to accommodate that variation.” And the doctor knows, “No, I'm doing the right thing for the patient, but the system is telling me I'm wrong and that I'm being inefficient.”
Grace Bourke: That's right. And it's not the patient's fault, right? Because they waited six months to get in, they've got their list of questions, and they've got their stories to tell, and they're not going to be rushed. So you're either going to have to do a shoddy job, or you're going to have to take the time that you need to take and then get dinged for it. And it's a no-win situation.
Mark Graban: It reminds me of the story of a cardiologist I was talking to, and he said, “Oh, I've seen it all.” And I said, “What do you mean by that?” He said, “I have seen a patient in the emergency department for a heart attack, where their blood vessels are literally closing right now, and the nurse is standing at the door and says, ‘Dr. Jones, you've got to sign off on their chart.'” He said, “I've seen it all.”
Grace Bourke: So true. And I'm sorry, I'm getting a little emotional about it because it's so frustrating to see these brilliant people who are so committed to doing good work, and the system is getting in the way. It's heartbreaking.
Mark Graban: Yeah. And that's why, you know, to your point, “engage the heart.” That story is one of those that gets to the heart of the matter. It's not just some abstract thing. It's real people and real lives.
Mark Graban: Well, Grace, this has been an incredibly powerful conversation. Thank you for being so vulnerable and open about your personal mistake and your journey through that. I appreciate it. And I'm sorry, of course, that you're going through that. But thank you for drawing the parallels to healthcare and the importance of things like speaking up. We've talked about that before, but also trust but verify, and the importance of educating yourself, and how hard that can be.
Grace Bourke: Yeah, it's been an adventure, and it is a gift to be able to talk about it and be open about it. Thank you.
Mark Graban: Grace Bourke, thank you so much for being a guest today. It's been a real pleasure.
Grace Bourke: Thank you.