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Join us for an inspiring conversation on transforming health care with Kim Downey, a physician advocate and physical therapist; Dawn Ellison, an emergency physician; and Denise Wiseman, a health care executive. Together, they discuss grassroots efforts, the power of collaboration, and their work with organizations like Medicine Forward and the Health Care Reinvention Collaborative to restore trust, compassion, and innovation in the system.
Kim Downey is a physician advocate and physical therapist. Dawn Ellison is an emergency physician. Denise Wiseman is a health care executive.
They discuss the KevinMD article, “Do you think the needle is moving in health care?”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey. She is a physician advocate, and as always, she brings together wonderful guests. Today, we have Dawn Ellison, who is an emergency physician, and we have Denise Wiseman, who is a health care executive. Today’s KevinMD article is “Do You Think the Needle Is Moving in Health Care?”
Everyone: Thank you, Kevin. Thanks for the opportunity. Happy New Year.
Kevin Pho: All right, so this is the first episode of 2025. It is an honor to spend it with all of you. Kim, as always, you are such a passionate physician advocate. I see you all the time on LinkedIn. How did you bring Dawn and Denise together?
Kim Downey: We want to make a difference, and we want things to change for doctors and patients. That is you, Kevin, me, Dawn, Denise, and a lot of other people. You have asked on your podcast, “Do you think we are moving the needle?” I think we have seen some small, positive changes, though we have a long way to go. Your asking that question inspired me to reach out to Dawn and Denise because they are both core members of the Medicine Forward and Health Care Reinvention Collaborative teams, and we wrote an excellent article speaking to this. I thought it would be important to introduce you to each other. One of the things they will talk about is impact networks, and later in the conversation I can share a specific example that is evolving, which I am particularly excited about.
Kevin Pho: Wonderful, and I think one of the things I always see is that physicians want to make change in our health care system, but sometimes there is a lack of organization. If you talk to a hundred physicians, you are going to have a hundred different ways of what they think should be done. Let us talk about two organizations making a difference: Medicine Forward and the Health Care Reinvention Collaborative. Dawn, talk to us a little about yourself, and then tell us what Medicine Forward is.
Dawn Ellison: Sure. The short version of my story is that, as you said, I am an emergency medicine physician, and I started coaching physicians as a side gig back in 2008. Not only have I experienced the challenges myself, but I have also been alongside many physicians over the years—people in all sorts of different specialties—who have been struggling. I had that perspective, and then I also had the opportunity to lead engagement and well-being for a health care organization. That is a different set of challenges because you are trying to move a whole organization rather than just working one-on-one with an individual.
I will tell you a little about Medicine Forward’s focus. They focus on the physician-patient relationship. Long ago, medicine was physician-focused, and then we kind of shifted to patient-focused, patient-centered care. We are all there to take care of patients, but the relationships—not only physician-patient relationships but all of our health care relationships—are important as well. Medicine Forward has focused on that physician-patient relationship and has asked, “How can we, together with patients and physicians, make it possible for that relationship to be sacred and to work the way it should?” It is a therapeutic relationship, right? When you have a therapeutic relationship as a physician with a patient, it also feeds you, and so it is part of the answer for burnout.
Kevin Pho: Dawn, as you know, I am a primary care physician, and like many physicians, I see all the things that detract from that doctor-patient relationship, whether it is health insurers or pharmacy benefit managers or electronic medical records. How does Medicine Forward work, or can you give an example of some of its initiatives to strengthen that physician-patient relationship?
Dawn Ellison: I can tell you about one big event we did this past year, which was an open space event in New York City, adjacent to the burnout symposium. We invited people to enter into conversations that they felt were meaningful to them around the idea of human connection in health care—so, “What can we do to restore and improve human connection in health care?” About thirty people joined that annex workshop the day before the burnout symposium, and they decided what was important to them about that question. Those people are now thinking more deeply about these problems that they had the opportunity to connect with others on. It is just the start of something that may build into other things, but it was really cool to see how people just jumped in. There was no pause after I said, “OK, the space is open—step forward. Which conversations do you want to have?” People stepped right forward. It was so exciting.
Kevin Pho: Dawn, what kind of stories did you hear? I know there were many. Give us a flavor of what it was like to be there and some things that you heard.
Dawn Ellison: One of the conversations people had was about the medical marriage. Another was, “How do we take care of physician well-being in this financially austere climate?” That is a real problem. Some of these participants were chief wellness officers or people in charge of well-being for caretakers in their organizations, so any kind of intersection or issue you can think of came up. Some people had solutions, and others had more problems, but they helped each other out.
Kevin Pho: Today, we are also going to talk about another organization, the Health Care Reinvention Collaborative. Denise, tell us a little about yourself, and then talk about the collaborative.
Denise Wiseman: Thank you, Kevin. About me: I have been in health care for decades now—I will just say it that way. I started as a registered dietitian on the front lines, working as a clinical dietitian. When I left that health system, I was on the executive team for the patient experience department at a large health care system in the Pacific Northwest. Over the years, I have worked in health care IT, I have worked with third parties outside of health care, and I have worked all across the nation, so I have seen a lot of different elements of our health care system.
When COVID gave me the opportunity, as I like to say, to redefine my career, I decided I needed to do something different. I was working as a solopreneur, trying to do my own thing, and I quickly identified that there are thousands of us attempting to reinvent this health care system from our own perspectives—the lived experiences we have had as part of the system or as patients affected by the system. What I realized was that many of us are in competition with each other rather than collaborating. We are not coming together, and we are not recognizing that many of the symptoms we are trying to address share root causes. If we could come together, we could solve those root causes in a way that would lessen the efforts we each have to make on the other side. That is where the Health Care Reinvention Collaborative, or HRC, comes from.
We are seeking to identify, connect, support, and illuminate changemakers. Kevin, you and Kim are changemakers. I like to call them ruckus makers. Now I call myself a health care ruckus maker. Our focus is on bringing those changemakers together, using a model called Two Loops, using impact networks, and leveraging the collaborative experiences Dawn brings to our team—open space technology and other ways of connecting with a low hierarchy. We are all in this together. How do we unite and make this happen?
At the beginning, Kevin, you mentioned the lack of organization among physicians and others trying to make change, and that sense of “I am alone; this is a heavy weight.” We are trying to help lighten that through connection. Now, the November 20 event that Dawn spoke of—HRC actually took that to the next step. On December 16, we invited those who joined us in November, plus some others, to come back around the same topics that were raised in November. We started to challenge them: “What could we do, and what should we do?” We are trying to move from conversation—there is a lot of conversation about problems in health care—to action. That is the other piece HRC wants to foster: uniting collaborators toward action.
Kevin Pho: Denise, tell me who you are bringing together. What are some examples of these groups you are convening to effect change?
Denise Wiseman: We started with people, because there are a lot of individual ruckus makers out there: physicians, nurses, pharmacists, patients, health care marketers—the entire spectrum. Most of these individuals are solopreneurs or part of connected networks. For instance, there is Kim with Stand Up for Doctors; we have members of Medicine Forward—Gabe, Todd, Jeff, and others. They are all part of HRC because our work is so aligned and connected. We have people from organizations like Humanitara—so many. We have an Excel sheet listing them, and one of the things we want to do, Kevin, is make that list visible. How do we see these people, and how do we see the organizations they are associated with so we can all come to one place?
We want everyone to recognize these are trusted individuals and groups. There is a vetting process—are they purpose-driven rather than profit-driven? Profit exists, of course, to support the purpose, but the focus is purpose. It is a trusted network. Now people can come in, see a visualization of the many elements, filter down to where their special interests are, find their people, and start collaborating.
Kevin Pho: Kim, you are very well connected in the physician advocate community. Tell us how you see Dawn and Denise moving the needle through their organizations. What differences are they making from your perspective?
Kim Downey: Sure. I will share a trail from the open space event. Both Dawn and Denise were there, and I am in the “troika” for Medicine Forward with them, and I am also heavily involved in HRC. So when Dawn really led that event—she has a lot of experience—Denise and I were more like “bumblebees,” floating around, supporting Dawn. We called the question at that open space event: “How do we restore and nurture human connection in health care?” Then the people who attended that day drove the additional questions. Under older technology, they would have used Post-its, but we had a more current platform. They raised their questions, and then we split into groups. Whoever wanted to talk about that question got to join that group, and we had a couple of different sessions.
As Denise mentioned, we had another event on December 16, where we revisited the same questions. Some who attended in November came back, and some were new. We broke out into rooms. In my room, we talked about patient empathy and clinician well-being. That was raised in November by a doctor who asked, “How can we foster empathy in patients for doctors?” Obviously that is my focus, so I facilitated that one. We had two breakout sessions—”What could we do?” and “What should we do?”—and people were really excited. I followed up with them, and now we will have another meeting to keep it going, so we can actually start doing things. One idea I have is something really big for doctors, just to let them know how much support they have, but I cannot do it alone. Now I have other people, and that is just one example. The other breakout sessions might have been about AI or other topics. Each session can keep going in that manner, and that is how I think we really start to make a difference.
Kevin Pho: Dawn and Denise, I will ask each of you essentially the same question: how do we translate these meetings, the getting-people-together part, into action? Dawn, can you give an example or a story about how Medicine Forward has taken action and moved the needle in redefining and strengthening that doctor-patient relationship?
Dawn Ellison: Sure. I am not the best person for that question, Kevin, because I am the newest among the three of us at Medicine Forward. But I know they have a program in which they provide some kind of training for medical students and residents. They focus on ensuring that those coming through training appreciate the value of that physician-patient relationship. I am probably older than anyone else on this call, and I remember when the only thing we used a CT scan for was a head scan, right? Now we are scanning everything, and MRIs were not around during my residency. Our dependence on technology has skyrocketed from when I went through training. You lose something when you depend too heavily on technology: you lose that observation, the history taking, the relationship building with a patient. I am kind of an odd emergency medicine doctor in that I highly value the relationship with my patients. Primary care definitely is more attuned to that because the relationship continues. In emergency medicine, the folks I see most often are often not the ones I want to see back so frequently, because I would rather they address some lifestyle factors that might prevent multiple returns. But relationships have always been important to me, and I think by adopting this program for students and residents, Medicine Forward is improving the way we do things. How we do things can affect solutions.
Kevin Pho: Dawn, just to follow up in an emergency department setting, what are a few ways or tips you can share to maintain and build those relationships in such fleeting moments?
Dawn Ellison: It comes back to sitting down. We are all pressured for productivity—emergency medicine, primary care, everywhere. Just the act of sitting down, bringing yourself to the patient’s level, is really important. It is funny, because I think it might be easier for me as a woman physician to establish that relationship, perhaps due to patients’ expectations. Once, another redheaded doc was chiding me about how long I spent in the exam room. I asked him how often patients commented on his red hair, and he said, “Never.” I told him, “Every day, multiple times a day, patients comment on my red, curly hair.” That might reflect different expectations, but I think it may be easier for me. Ultimately, it is about being present, genuinely asking how they are doing, and listening when they tell you why they are there.
Kevin Pho: Denise, tell us a story or an example of how you have translated these initiatives into action that is moving the needle in our health care system.
Denise Wiseman: Sure. Even before HRC was fully formed, I was putting together cohorts—small, sprint-like gatherings where groups would coalesce around a topic they were passionate about. From the start to the end of six weeks, we created something. Maybe it was not monumental, but as James Clear says, if you get 1 percent better each day, you will ultimately reach a tipping point. We are doing the same thing with HRC. In 2025, we plan to start hosting cohort-like, sprint-like projects where people can come together—like what Kim is doing—in a structured format. They can ideate, realize they do not have to solve everything, and contribute that first 1 percent. Then someone else can pick it up, move it forward, and together we get to that tipping point.
Already, three people have told us about connections they made through HRC that are making a real difference. We often say that HRC is not going to reinvent health care; we are the convener, the conduit, for these ruckus makers who will. We are proud to celebrate what Kim is doing—continuing that energy forward—and that is exactly what HRC wants to do.
Kevin Pho: We are here with three guests: Kim Downey, Dawn Ellison, and Denise Wiseman. Today’s KevinMD article is “Do You Think the Needle Is Moving in Health Care?” I am going to end by asking each of you to share some take-home messages with the KevinMD audience. Kim, why don’t you go first?
Kim Downey: Sure. We all need to care, even if it is for self-preservation. Everyone has a story about themselves or someone else waiting months to see a doctor, sometimes with deleterious consequences. Doctors, too, are suffering in the current system. They are leaving, and they are dying, for many reasons, including those deep systemic flaws you mentioned, Kevin—loss of autonomy, monstrous administrative burdens, moral injury, and so on. If we want doctors to be there when we need them—for ourselves, our parents, our children, and even for doctors themselves, because doctors need doctors, too—we need action. That is my word of the year. Just this week, I registered Stand Up for Doctors as a business. My mission is to build connection and create advocacy for healthy doctors. So please reach out to Dawn, Denise, or me, and we will help you find your people.
Kevin Pho: Dawn, what are some of your take-home messages?
Dawn Ellison: Frontline workers hold crucial insights for transforming health care, but they need spaces where their voices can truly be heard. Through the various roles I have held in my career—coaching, organizational work, and now with Medicine Forward and HRC—I have seen how collaborative approaches can reveal solutions that traditional hierarchies might miss. I invite people to join us, whether via Medicine Forward or HRC, because we can do this better together than alone.
Kevin Pho: And Denise, we will end with you. Your take-home messages for the KevinMD audience?
Denise Wiseman: My take-home message is that the purpose every changemaker carries is critically important, but when you try to do it alone, you can feel isolated and ineffective. We can only do this together. Building the better health care future we want is possible through connection, trust, collaboration, building your network, and leaning in together.
Kevin Pho: Kim, Dawn, and Denise, thank you so much for sharing your perspectives and insights, and thanks again for coming on the show.
All: Very much appreciated, Kevin. Thank you.
