 Hello everyone, my name is Lama Elzain and I'm here on our first episode of our agile series on the HMH YouTube channel. Let me first tell you a little bit about me. I'm in a mission to build a healthier, more efficient, integrated healthcare system for my kids and for all here in the US and beyond. I'm in a journey to answer my why, which is really straightforward. As a mom, as a daughter and a wife and also a physician leader, I want healthcare to be the safest experience where every family, including mine, receive excellent and personalized care. As an immigrant myself, I want this high quality care to be accessible to every person, here in the US and overseas in Lebanon where I'm from and beyond. I'm trying to use my skills to achieve this dream through science, innovation and empathy. I believe this is how I can be an agile conductor within the stiff, rigid and sometimes dehumanizing healthcare system. There's a pressing need for transformation, whether we call it innovation, redesign or something else. In our agile series, we will delve into how agile science, methodology, mindset, strategic development can propel progress forward and shake up the status quo. Today, we are honored to have with us for our inaugural episode, Dr. José Azar, our Executive Vice President and Chief Quality Officer at Hackensack Meridian Health. He leads quality across the continuum of care with passion and integrity. Welcome, José, to our episode today and we are excited to hear about your journey and especially with agile transformation. Thanks, Lama. I'm excited to be with you today. So first, tell us a little bit more about you. Well, just like you are passionate, I am very passionate about relieving suffering from the way healthcare is delivered. And I really want to transform healthcare to be more personalized and more humane. And that's the mission I'm on. You've been with Hackensack Meridian Health for about a little bit less than two years now, so tell us why you joined HMH and came all the way from Indiana. Yeah, I developed the agile transformation method at Indiana and it was a great experience that I had there. What really drew me to HMH are two main opportunities. The first one, HMH's mission and vision is to be transformative. Transformation is in our DNA and that really attracted me. That aligned with my mission on agile and then transforming healthcare to make it better and more personalized and more humane. The other thing is what's really unique and exciting about HMH and New Jersey specifically. New Jersey has a lot of diversity in healthcare settings, a lot of diversity in the way our physicians practice, whether employed or private. And it has a lot of diversity in the populations we serve and a lot of opportunities. And I think it's a microcosm of the country. And so if we are able to truly transform healthcare and make it the best here in New Jersey and at HMH, I think this can be a blueprint that we can build for the whole country and beyond. So that's what drew me here. And I have felt very welcomed and I have felt that the agile approach and the agile mindset is something our CEO, Bob Garrett, our chief physician executive Dan Varga and our chief HR person and many others in the organization like Linda McHugh and others have fully embraced. And that excites me. We know you wrote a couple of books about agile mindset and transformation. So can you tell us a little bit more about that? Let's go back about 15 years ago. I actually started in quality not because I ever thought about quality or safety or harm from the way healthcare is delivered. I started in quality, kind of stumbled on it. I actually initially set out as an oncologist and hematologist to work in the lab trying to discover treatments that would make chemotherapy obsolete so that no one has to suffer from chemotherapy. And unfortunately an error happened to one of my patients and that really opened my whole mind to the fact that more people suffer from the way we deliver chemotherapy and ultimately we deliver care than from chemotherapy itself. And so I thought I'm maybe on the wrong end of the equation and instead of being on the discovery end to create a new treatment, I needed to be innovating on the delivery end to create better systems that serve better our patients to deliver more personalized, high quality care, safe care to patients in a way that really meets the intent of healthcare which to me ultimately is about a human being taking care of another human being and I wanted to create systems that allow us to do that better. Tell us a little bit more about this concept of agile in healthcare. Many people have heard of agile in many other settings so tell us a little bit more where it comes from and how can it be applied to healthcare. Yes, so let me go back to my journey a little bit to build on that. When I started in quality and safety in oncology, Lean was a very hot topic and a very important tool. And I worked through Lean, I worked through Six Sigma, I used a lot of the IHI tools such as PDSA and others and they were great to improve processes. But then I quickly realized that I'm missing the most important element in the equation which is a human being taking care of another human being using processes and using standards. And so unless we really understand the human element, the beliefs, the attitudes, the norms, the habits that they have, their biases and unless we understand the system that they surround themselves in, whether it's the care provider in the healthcare system or it's the human being that's receiving care in the community, how they draw information, what networks they surround themselves in, what resources and structures they support themselves with, if we don't understand those dimensions, they're not going to use effectively the processes, they're not going to use the systems appropriately. And so I started exploring how do we impact the human element and how do we impact the complex adaptive systems. And the things that became very clear to me at that point once I started focusing on humans, when you're dealing with humans, you are dealing with uncertainty, you are dealing with unpredictability and you are dealing with irrational but beautiful behavior. Rationally, we would never create beautiful cities like New York City and high-sized skyscrapers. Rationally, we would never fall in love. Rationally, we would never go to the moon, right? Rationally, we would not have art. But we do and that's beautiful. But we also have to understand the other side of it is that that type of biased behavior can lead to unreliability. And so you have to understand the irrational mindset of humans to be able to influence behavioral change. And that's where the agile transformation agile methods came in, by understanding better behavioral economics, by understanding better complex adaptive systems and managing the unexpected, and by understanding better networks and how people interact with each other. So it seems a big difference for the agile transformation and the agile mindset is the human aspect and the complexity of the network. How do you think these concepts and this transformation can help us here at Hackensack Meridian Health? I think HMH has already been doing agile without knowing, right? The fact that we want to innovate, the fact that we want to adapt, the fact that we look at transformation and change as the way to the future and innovation as the way to really achieve that better excellence that we strive for is a great foundation. And so we already had that. I think what agile is bringing in addition to this is a little bit more of a framework mindset and set of tools that allow us to achieve that a little bit faster. I'll give a couple examples that we've been doing with the agile approach. So a lot of the agile approach is about co-design because that creates demand. And we've launched a lot of the clinical sprints where we've defined a lot of our capabilities and identified a lot of our gaps. We are creating specialty collaboratives where we have many physicians contributing. Ultimately, I'm striving towards about 400 physicians involved in defining the way clinical care is delivered. Right now, we have more than 100 involved. So these are really exciting aspects to me. I think what I'd like to take it next and where I feel it would really make a true difference is when we start taking it to actually co-design with patients and engage patients in designing the way our systems work and designing the way we optimize our systems and designing the way they can use our systems most effectively to help improve their health and improve the way they receive care. So other than those clinical sprints that you mentioned that seems have been very good success at HMH, is there any other successes or benefit that you and your team has experienced whether in the quality departments or beyond so far while embracing the agile transformation and agile practices? Yes, so the sprints focused a lot on co-design and on engagement and creating demand for transformation. I think two other aspects that I'd like to maybe highlight, one of them is localization. So I'm very passionate about localizing while we're standardizing. So that's the concept of minimal viable specifications because when you have minimum standards, meaning you define why are we doing something and what are we going to do then you can allow localization in terms of how is it done by whom. And that creates a partnership. It allows us to really localize solutions at every hospital based on their capabilities, based on their environment, the communities that they serve, based on their ambitions, based on the nature of the hospital, a tertiary care hospital is different than a community hospital, is different than a destination or a center of excellence and they need to be able to meet the standards with different solutions and different resources. But the standard needs to be the same. What is patient receiving needs to be the same? How we deliver it could differ. And so that's the minimal viable solutions or minimal viable standard concept that we have been leading a lot of our solutions and problem solving through that lens, which allows that partnership effective partnership. The other or another example of that is the way we've set our goals. So everybody has the same framework to the goals, but it's not the same goal that's cascaded down and broken down to hospitals. It's basically the objective is the same, the framework is the same, but each hospital can specify goals that they have opportunities in that basically advance them towards the ultimate objective. So that's the ultimate objective is the why and the what and the localization is how each hospital finds specific goals that matter to them that will advance them further towards the ultimate objective. And that's that's another example of localization and minimal viable specifications. Thank you, Jose. Thank you for your time today. I mean, I hope during this we were able to entice them curiosity with our audience. This is, as I mentioned, our first episode for our team for the Agile series. We're hoping to have you back soon with more and more information and more success with the Agile transformation. I want to just give you the final say if you have anything to say for us as we start embarking this journey and any other message you have for the institution. Yeah, I do. I thank you for for doing this. I'm really excited to be on the inaugural session. I do have a preview maybe for a future session, but I'm really excited that we're launching on the road towards an Agile Institute that basically will create a setting by which everybody can have access to this approach. And we could train people and develop their skills. We can give them a lab for them to experiment with some support and consultation. We can give them a place to basically do research publish and really bring HMH at the forefront at a national level to be a leader in the Agile transformation approach across the whole country and beyond. So more to come on that, but I'm really excited to share that that's a vision that's happening. And I think this is the first step towards it. So thanks for launching it. Thank you for your time and we're really looking forward for this collaboration and this journey with Agile and HMH and beyond. Thank you. Thanks.