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Becker’s Healthcare Podcast
Courage, Value Based Care, and Leading Through Uncertainty with Dr. Ramin Davidoff
00:22:56
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the events tab in the upper right.
- [00:38]
B
Welcome to this episode of Leadership Unscripted at Becker's Healthcare Podcast. I'm Chris Sosa, your host and I'm very happy. Joined today by Dr. Ramin Davidoff. He of course, is co chief executive officer of the Permanenta Federation. Ramin, thank you for joining us today.
- [00:52]
C
My pleasure, Chris. Thank you for having me.
- [00:55]
B
Wonderful. Yeah, we always love when you're able to give us your time. Our conversation today is going to dive pretty deep into who you are as a health care leader and what has led you to make decisions you've made and, you know, just your, your overall journey. And before I do that though, I want to give you a chance to let our audience know a little bit more about yourself as well as your organization.
- [01:16]
C
Thank you so much. I appreciate that opportunity. My name is Ramin Davidoff. I'm the Executive medical director for the Southern California Permanente Medical Group, which is a very large, autonomous, independent and physician led medical group in Southern California. I'm also honored to be the co CEO of the Permanente Federation, which is a entity that conglomerates all of the Permanente medical groups under one umbrella. I'm a urologist. I practiced urology for 23 years before I took on the role as the executive medical director here in Southern California as well as the co CEO of the Permanente Federation.
- [01:59]
B
Thank you so much, Ramin. Obviously you wear a lot of hats and obviously keeps you very busy, but you know, you've had quite a career so far and I want to delve into that specifically. My first question for you is simply, what's something you've learned outside of health care that you've applied to your career?
- [02:17]
C
That's a great question. Lots of life lessons. But I will say that from the very beginning, I learned as a kid from my parents and family that there's no substitute for working hard and treating people with kindness and respect. I've definitely brought that into the work environment. I also learned that it was really important to make people around you feel that they are safe and that way they can be the best version of themselves in their personal and professional lives. These values have led me to truly believe in and champion the team based care approach that we have here in Kaiser Permanente, which essentially, in a team based model, we flatten the traditional hierarchies so that every team member can work to their fullest potential.
- [03:11]
B
I have no doubt that that's paying off in your organization. It's something that it's got to filter down from the top. Right. That's terrific. All right, so next question I have for you, Reen is, and this can be more than one thing, but I want to ask you, what accomplishment are you most proud of? It could be inside, you know, at the permanent federation or another entity. And why?
- [03:35]
C
Great question. There are multiple things that I'm incredibly proud of. I will say though, that they're all team accomplishments. They are not mine. One of the biggest ones is that the way we came together as a medical group and as an organization to manage through the pandemic, keeping our patients and our physicians and staff as safe as possible. The reason I'm very proud of that is because our organization was able to figure out a way to manage through the chaos, with all the uncertainty that was going on, figure out a way to continue to put the patients at the center of what we do and at the same time being able to protect our physicians and staff as well, because there was a lot of fear and uncertainty about their own personal safety and health. And so the way the organization came together, we all were learning as this thing was unfolding, and it was very difficult to keep everything together. And so many people came together to be able to manage and stay united, work through our fears, work through the uncertainty, and get the organization and the communities that we serve through the pandemic. That is one of the highlights of my professional career that makes me so proud of the healthcare industry in general. Another one is our laser focus on quality. We continue to have a very, very high view of quality care as one of our foundational guiding principles. We always have that as a very top priority for the organization. Just to give you an example of some of the things have been accomplished as a result of this laser focus and investment and making sure we have the right systems and protocols in place. In 2025, we led the country as the top performer in 71 HEDIs measures. This is most of any health plan and we ranked among the top rated Medicare plans in every state we served for seven consecutive years. Another thing that I'm very proud of is how We've been able to leverage technology and artificial, or what we call augmented intelligence, such as use of the integrated electronic health record, data analytics and also AI enabled tools to help enhance the value based care model that we have in our organization and at the same time improve the care for our patients, but also reduce the clinician administrative burdens that they've been experiencing. And it's increasing more and more year after year after year of practice. So those things are things that I think in my career have come about and the organization has really found a thoughtful way to work through them. And I'm really proud of the way we've managed through all these, what I would say, inflection points in the history of the health care industry and certainly of our organization.
- [06:49]
B
Romina, I want to follow up. So it's one, it's just hard to believe, I think for a lot of us that the pandemic was about a half a decade ago. You mentioned just sort of the fears and uncertainty that you know, can envelop really an entire country, entire planet. So but as a health care leader, when it comes time to say, you know what, this is how we're going to do that, how do you instill a sense of calm with those you're working with?
- [07:19]
C
Really great question, Chris. And I was very new to my role. In fact, the pandemic happened in my first year on the job and there was so much fear and uncertainty and we were seeing the pandemic unfold on the other side of the world and we always felt that eventually it will get here, but, but we didn't know for sure and certainly it came to the United States and the way we were able to manage through that as leaders, uncertainty, fear, lots of things that we didn't know. We didn't know how to test for the virus, we didn't know how to prevent the virus, we didn't know how to vaccinate for the virus, we didn't know how to care for all the patients that would need to come into our medical centers and the medical office buildings. And it's a brand new disease essentially. So the disease process was also unknown. So the things that evolved and we learned and we implemented were very important to be real with our people. Don't sugarcoat things, be realistic, state the issues and the realities and the facts that we have, the knowledge that we have about the information that we have, have a regular communication mechanism with as wide an audience in the organization as possible because the communication really does alleviate to some extent the fears and the anxieties and allows for people to want to be a part of the solution. Delegating appropriately so that not not to feel that all of the burden is on one person or three people, but finding the leaders in the organization that you can delegate to and trust to be able to execute on what we've decided upon and then just make decisions and you have no idea if the decisions are going to work or not. But you have to make timely decisions. After evaluating all the available information and if the decisions were the wrong ones, pivot quickly, accept the error, own the error, and move on to the next thing that you have to do. Lots and lots of learnings about the pandemic and how we manage through it. None of that comes innately for any leader. A lot of it is learned and I had to learn quite a bit of that in my first year on the job.
- [09:43]
B
That's very well said, Ramin. And certainly there's a lot to be said in situations especially similar to those that are that communication and transparency are very important. I like what you said about how just if you make a mistake, own it, because that's going to happen in any leadership space. Right? I mean you love to be right all the time, but unfortunately that's just not not realistic. So yeah, I think as you said, just being transparent and communicative can be very, very good strategies. I want to pivot now. Speaking of pivoting, for me I want to go to what issue or aspect of healthcare do you think deserves a brighter spotlight and who should be shining that spotlight?
- [10:25]
C
Really great question. I will tell you that I genuinely believe in value based care and I think that aspect of healthcare absolutely deserves much brighter spotlight as probably the answer to the issues that we have around healthcare in our country. Much of the care in this country is not based and focused on value. Value based care, the way we define it, it rewards positive health outcomes rather than volume of services that are provided. It focuses on prevention and early detection of disease, in keeping people healthy, proactively in managing chronic diseases very well to prevent complications and hospitalizations, and also focusing on truly on greater health outcomes for our patients and communities and not solely on revenue generation. That's our definition of value based care. It absolutely needs a greater focus in our country. I believe that there is a way to align all of the incentives that are needed for the different aspects of healthcare system to come together to deliver on value to our patients, including the providers, including the payers, including the hospital systems. The aligned incentives on providing outstanding patient outcomes have to be front and center for our country to be successful because the current model is frankly, absolutely unsustainable and we do need to do something different. Another area that I believe needs a much higher focus is workplace safety. And violence in the healthcare setting is a problem. It's a major problem. There's violence against physicians and care teams and we are seeing an increase, a significant increase in the past five years. The American College of Emergency Physicians reported about three years ago that up to 85% of emergency room physicians believe that violence in their workplace has risen. So I've experienced that in my department. When I was practicing urology in my medical center, there was a clear act of violence in the department and it was very traumatic and it took a long time for the department to recover. I do believe that deserves a much larger focus in our country through legislation, through the different organizations that are involved with assuring that violence does not impact the workplace. Workplace violence in a healthcare setting first and foremost impacts safety and the quality of the care that is provided for the patients. And it certainly, of course, impacts the safety of our physicians and staff and nurses. So value based care front and center, by far top of my list. And the next one, I would say, is workplace safety.
- [13:36]
B
Thank you for sharing that, Ramin. It's certainly when you're in a situation that can be scary in a hospital setting where there's violence involved. Yeah. It's hard to say how that's going to affect your, your staff. So as someone who's in the position you're in, what are some of the steps that you've taken to assure first your staff. Well, not first, but assure your staff and your patients that, hey, this is something that's on our mind, this is something we're working on.
- [14:07]
C
Absolutely. So clear communication to our physicians and staff that this is a priority for our organization and not just say it, but in acts and actions to demonstrate it. Some of the things that we've done to demonstrate this is, for example, workplace violence seminars and training sessions for our physicians and staff to be able to recognize the early signs and signals and of potential violence happening in the work setting. Lastly, improving the safety mechanisms in the medical center, the hospital as well as the medical office buildings, including visibility of protective services, of guards that are looking at making sure that there is safety in our organization. Also, frankly, there are times where you need actually metal detection mechanisms at our emergency room entrances. So those are all things that we've taken action on and put into place. And it has required significant investment. It has required a revamping of our workplace violence and safety and security protocols and strategy, both in the short term and in the long term for the organization. But we've communicated it and we've done our best to deliver on what's needed to help people feel safe in the workplace environment.
- [15:41]
B
Got it. Thank you so much again for sharing. Ramin, next question I have for you relates to just how managing people is part of your job. Right. And not only that, just what traits you like to see in any leader. And that can be someone who's a CEO, Co CEO all the way on down. Right. I mean, you mentioned how important it is to be a hard worker. That's one thing. That's a wonderful thing to have, no matter what kind of leadership position you're in. But I also want to ask you what isn't. Do you consider to be an underrated leadership trait and whose have you seen embody it? It can be one person, one role in any way you see fit to answer that question.
- [16:20]
C
Excellent question. I really appreciate that. I often think about leadership qualities that are so critically important. And the underrated ones, in my opinion, are. I have four, but I will put focus on one of them in particular.
- [16:35]
B
Well, you can mention four. Let's start with one, though.
- [16:38]
C
Okay. I think about courage. Very important and underrated leadership trait. Humility is another one. Empathy is critical. That I believe is underrated in leadership. And last one is clarity. Being very clear in the communications, in the thoughts, being transparent and very focused so that people can understand complex issues and make it simple for them to be able to understand it. Why we'll focus a little bit on courage, because in my five years on the job, I have found that courage is really a critical aspect and it's at the top of the list for me. All those four are really important, but the courage to stand for the right principles and doing the difficult things that leaders sometimes shy away from, but are very important to do because of the message that it sends to everyone in the organization, making those hard decisions that are in the best interest of the people in the organization, but also of the communities that we serve. I will tell you that throughout history, there are many courageous leaders that I admire in the historical sense. Winston Churchill, Abraham Lincoln, Martin Luther King. These are courageous leaders that come to my mind. But in the healthcare setting, I don't have to look too much farther than our ICU leaders during the pandemic, our emergency department leaders, our hospitalists who were admitting critically ill patients without knowing how to treat it, whether they were going to get sick themselves or Not I've seen it over and over again in health care and also historically, courage I would put at the very top of that list. But certainly humility, clarity and empathy are also very underrated.
- [18:41]
B
I'm seeing a lot of important through lines in our conversation, Amin, and they all come back to, well, courage is part of it, but I think it also melds into what you mentioned before, just about how it's important to own your mistakes and, you know, be forthright about any decision that you're making and being able to move on and always be doing it in the best interest of not only your, your staff, but your patients as well. And that's a really good segue actually into my last question for you. I mean, and that is speaking of courage, what is one risk you've taken that has paid off?
- [19:16]
C
Great question. That one risk. I have to tell you, I practiced full time clinically for 23 years. So it was a big leap of faith to go from clinical practice into leadership and administrative role. So that transition was a big risk for me. And the reason I say that, Chris, is because I really had a purpose in clinical practice. I was purpose driven. I'm still purpose driven, but I had a purpose and that was to help impact the life of the patient in front of me and their family members that were in the exam room with us as we were having conversations and to heal and to educate to the best of my ability. I had purpose and I didn't know if I would find that same purpose in administrative work. And I can tell you I have found that purpose. I really have, because in this role I am now able to, with the help of an incredible team and a phenomenal medical group and of course of the Permanente Federation, to be able to have a broader impact on our organization, on the care delivery model, on what I truly believe in is value based care and implementing that consistently and in a standardized fashion across our organization and also creating the systems and processes that that will allow for every member of the team to be able to be the best version of themselves, including team based approach, flattening systems and hierarchies that I believe are an impediment to value based care and eventually and ultimately absolutely help improve patient care more broadly. So I will tell you that that was a big risk. I didn't know I would enjoy doing this work the way I do. I really miss clinical practice in a big way. In fact, I once in a while go back into the operating room and in the exam room because that's part of my DNA. But I have found a purpose in administrative work and I'm very grateful for the opportunity to be able to have such an impact on a broader organization and ideally also in the healthcare industry in the future, because I do believe in spreading the tenets of value based care.
- [21:45]
B
Remain. Not that I think that you should be pushed back into clinical care, but I'm curious, do you ever see yourself doing more of that since clearly it's something that's very important to you?
- [21:55]
C
I do. I actually do. I think once my tenure as Executive Medical Director is over, I actually very much look forward to going back into clinical practice. I really do miss those conversations with my patients, with the staff in the department, in the operating room, with my colleagues, anesthesiologists and the other staff. So, yes, after the tenure has ended in this role, which I love, I very much look forward to getting back into clinical practice.
- [22:28]
B
Got it. Well, it seems like a great gift to have found such purpose in both roles and it's led you to hear. And thank you again so much, Ramin, for being on this podcast. I mean, we're going to love sharing all these insights with our audience and we cannot wait until the next time our paths cross.
- [22:44]
C
I look forward to it. Chris, thank you so much.