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Becker’s Healthcare Podcast
Dr. William Cooper, Cornelius Vanderbilt Professor of Pediatrics and Health Policy and President of the Vanderbilt Health Center for Patient and Professional Advocacy (CPPA)
00:12:43
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- [00:01]
A
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a gentleman, Dr. William Cooper, Dr. Bill Cooper. Dr. Cooper has had this magnificent career largely at Vanderbilt University Medical Center. He currently has several different roles. One of those roles is president of the Vanderbilt Health center for Patients and Professional Advocacy. He's going to talk to us about that, about trends he's watching about his career and a lot more. First of all, Dr. Cooper, congratulations. I see 28 to 30 years at Vanderbilt. What an amazing career. Congratulations. Can you tell us a little bit about yourself and about the Vanderbilt University Medical Center?
- [00:45]
B
Thanks, Scott. You know, it has been a great place for my career. I'm a pediatrician, so I take care of children here at the Monroe Carroll Jr. Children's Hospital at Vanderbilt. And that sort of platform as a clinician has given me insight into a lot of the leadership roles I've had at Vanderbilt, including my current role serving as president of the Vanderbilt Health center for Patient and Professional Advocacy.
- [01:07]
A
Fantastic. Talk about when you talk about what you do at the center for Patient Advocacy and so forth, what is it? What is the core mission there? Tell us a little bit about that, Dr. Cooper.
- [01:20]
B
So, Scott, we have a group who comes to work every day to make medicine kinder, safer and more reliable. We started as a medical malpractice shop, trying to understand why some doctors get sued more than others. And what we found is that 1 to 3% of healthcare professionals account for about 50% of the challenges that healthcare organizations face priority, particularly in the domain of unprofessional behaviors, either towards patients or coworkers. Those same individuals account for a lot of an organization's malpractice risk. For physicians, it's about 50 to 70%, accounted for by 2 to 3% of docs who behave unprofessionally towards patients or coworkers. We've been able to do research showing the connection between individuals who have these unprofessional behaviors and surgical complications. Cognitive impairment, well being concerns, burnout. And what we've done is developed an intervention model that really is relying on peer feedback to help those individuals understand how they sit relative to their peers. Either physicians, advanced practice professionals, nurses, trainees, we even do surgical techs and medical assistants. When we provide those comparisons, those individuals who are healthcare professionals can self regulate and about 85 to 90% of the time we, we can turn them around and drop their risk of subsequent unprofessional behaviors. And it's just a great thing to be able to do to Help individuals be the best version of themselves.
- [02:55]
A
Thank you very much. That's an amazing stat. That 1 to 2% create 50% of the challenges. Like I remember, in one practice we had worked with, one physician, had been sued 18 times in a group where no one was ever sued. And that stat rang exactly true. And at some point, the CEO of that group had to get rid of that. You got to find a way to move that physician out because there's too much risk to the group as a whole. How do these people get better that are in that spot? Is it, is it a. Is it a changeable behavior? And it sounds like it is. But how do you get to those people that are causing a disproportionate amount of the trouble that a practice or health system or group has?
- [03:34]
B
So here at the center for Patient Professional Advocacy, we have about 300 hospitals in our national collaborative. They send all their data to us around professionalism concerns and, and we use our approach to identify their high risk docs. And then we train peers and leaders at the local organizations on how to address it. And what's really striking, and I've done this for years, I've been one of those peers who shared conversations with my colleagues. All it takes is to say, gosh, Scott, for some reason, your practice seems to have a lot more of these concerns about how you interact with your coworkers and that other clinicians here at our organization and actually nationally for those who practice in your specialty. Scott, I just wanted to let you know about that. What happens is the self regulation that follows is very similar to self regulation that occurs for clinicians. When I'm practicing as a pediatrician and new antibiotic prescribing guidelines come out, I look at my practice and I say, wow, I'm seen to be prescribing these, this stronger antibiotic when something like amoxicillin, a penicillin would do just fine. So I adjust my practice, and that's what we think is operating here.
- [04:47]
A
Thank you. And when you talk to physicians about this or text or anybody, can you tell right away their level of responsiveness? Can you get a sense right away, is this person changeable or not? Are they willing to change or not? And how often do they get very defensive versus willing to listen and hear it?
- [05:07]
B
You know, I'll tell you what, it's hard sometimes to get feedback in this way. And so people are often naturally defensive. And we train those individuals across our organizations how to address that and how just to redirect that, to acknowledge and say, I get it. Maybe it does feel to you like it's someone else's fault or it's the broken systems, or you didn't think it was that big a deal. And all I want you to do is to think, is there any way those behaviors could go differently? So our training is designed to sort of redirect those. And oftentimes I can't really necessarily predict how someone's going to respond because the work they're doing in improving their professionalism occurs the next time they're in that clinical environment.
- [05:53]
A
Yes. And. But in one of the characteristics of people that can help people improve or people that choose to improve. What do you see when you have good coaches, good mentors? What does that look like?
- [06:08]
B
Most commonly, we really try to select. We call them peer messengers because they're peers who are having challenging conversations, who are models of professionalism themselves respected, can practice in a clinical environment similar enough that that person says, okay, yeah, maybe you do get what it's like to be a surgeon in our busy ORs, or a pulmonologist in our busy bronchoscopy suites, but whatever that setting is. But those characteristics are really key. They also have to have a really strong base of empathy. I can't walk in and say, Scott, you are the reason we have such bad turnover here because you keep misbehaving. If you would just mind your business and behave better, Scott, we wouldn't have all this problem because you are the source of our problem. If I come in and sort of attack you in that way, you're not going to self regulate, you're going to be mad at me. What we're after is to give them a chance to hear the message and, and then to reflect. And what's really striking is it happened. It's so effective. Like sometimes I leave a conversation, I'm like, wow, I'm not really sure I did such a good job as a messenger. And still they're one of those individuals who are at the 90% response rate.
- [07:20]
A
And talk about your involvement in this because you've done so many different things and held so many different roles at Vanderbilt, including currently, I think, interim chairman of the Department of Pediatrics. What drove you to find so much interest here and be engaged in this effort?
- [07:40]
B
You know, as I, as I came up through the ranks taking on various leadership roles here at Vanderbilt, I found I needed these skills because there's always opportunities to help people improve their performance. And so taking that on, I was then identified as one of those peer messengers. I got Training and I engaged in that and continued to use those skills. And even today, I mean in my, my various leadership roles at Vanderbilt, I use the same skills I teach our peer messengers applied in different settings where someone just may not be the best version of themselves that day or on repeated days.
- [08:16]
A
Thank you. And isn't this the truth that some of us are better on some days than others, depending on sleep, mood, relationships, exercise, a million different, different things. How do you keep yourself motivated and excited? How do you keep yourself after the work that you've been doing for nearly 30 years at Vanderbilt? I always say about people that doing the same thing 30 years, not the same thing, but at the same place, they must be good at what they do and they must be relatively likable. So if you're someplace for 30 years and you've not been gotten so sideways as somebody to leave, then you must be fairly likable and competent. Talk about how you keep yourself excited and motivated after 28, 30 years to Vanderbilt.
- [08:51]
B
It's got to tell you one of the things that really helps me and I do a fair amount of career development support in my role with our, with our faculty in my associate dean title. One of the things that's really key is it's so crucial to identify what you're passionate about. I'm passionate about people helping vulnerable people be the best version of themselves. And sometimes that's the children that I serve clinically, sometimes that these individuals that identify. Sometimes it's helping other leaders here at Vanderbilt and across our national collaborative sort of understand how they can navigate these really complex circumstances in a way that will make a difference. And when I look at my to do list every day I look and I say what's one thing I'm going to do that's going to help a vulnerable person? And I try to do that first. What that does is reduces the number of days when I go home at the end of the day and I say what the heck did I do all day?
- [09:43]
A
But that's an amazing framing. What is one thing I could do today that will help a vulnerable person? That's an amazing framing. Not what's one thing I could do this day that's going to help me, that's more for my fitness or my self aggrandizement or my this or my that. But what's one thing I could do each day to help somebody who's vulnerable? I love that. I mean that is just a fantastic concept and I love that. Talk about Dr. Cooper, what advice would you give to Emerging leaders. What advice do you give to emerging leaders?
- [10:18]
B
Everybody has their own passion. Mine happens to be because as a pediatrician, children are so vulnerable so early. My research career, my clinical career, really focus on vulnerable children, and I expanded to other vulnerable populations of my. Of my colleagues. But it's really helpful to say, what are my best days? What am I passionate about? And how can I, to the greatest extent possible, align my portfolio of activities in support of that central passion?
- [10:50]
A
Thank you. And that's fantastic. You keep a notebook. How do you keep yourself aligned on this? Because if you can keep yourself aligned each day with what your core passion is, you're way ahead of the game. How do you do that? And how do you keep yourself focused? When I know you wear a few different hats at Vanderbilt, how do you make that happen? Because so many of us struggle with the fact that we're so many different hats that staying intentional and centered about what we're trying to accomplish becomes harder than it should. How do you sort of manage that?
- [11:22]
B
Actually, I have it in my cabinet right behind me where I'm sitting here, Vanderbilt. And in that, I've got my passion statement, and I've got what can I do clinically, what can I do as a teacher, what can I do as a leader? And what can I do with my research and scholarship today to support that when I get to work? And there's some days, Scott, I'm not going to kid you. I may have 45, 50 things on my to do list, and it's kind of daunting. But if I pause and I either open my cabinet and look at that, or at least I remind myself mentally. And all it takes is to just say, I've got to do some of these other really necessary administrative tasks. But if I can make sure that at least one of those, and I try to put it up on my sort of priority list aligns with that, it just sort of helps the rest of it feel less mundane.
- [12:09]
A
No, I think that just is a wonderful, wonderful way of looking at things. I've learned a lot talking to you. What a pleasure, Dr. Cooper. What a great education and inspiration for me. I'm sure it will be for our audience as well. Again, Dr. William Cooper for Vanderbilt University Medical Center. Remarkable career. Thank you for taking the time with us today.
- [12:28]
B
It was a pleasure to talk with you, Scott. Thanks so much. I hope you have a great day.