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- [00:02]
A
Thanks for tuning to Digital Voices podcast where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now your host, Ed Marx. Welcome to another edition of Digital Voices. This one's kind of a blast from the past because it's someone that's been super, super influential in my career, and I'm so glad to have Dr. George Kakano as a guest. George, welcome to Digital Voices.
- [00:34]
B
Yeah, thank you for having me.
- [00:36]
A
Yeah, this is going to be so fun. So we had this chance encounter at a Becker's conference, and we hadn't seen each other in many, many years. Of course, we still look the same as we did, you know, 20 years ago back when we served at University Hospitals in Cleveland. But it was like, oh, my gosh. Wow. It was so great to catch up with you and learn more about what you've done in your career since then. And you are the executive vice President for Health affairs and dean of the College of Medicine at Central Michigan University. So that's pretty cool. So we want to talk a little bit more about what all that means and unpack that a little bit and learn more about Central Michigan University as well. And so the most important question, George, that we have on Digital Voices is what songs are on your playlist? So what kind of music do you like to listen to?
- [01:23]
B
I mean, for someone with an accent like mine, having been in the US for close to 40 years, have not lost my accent. So these singers and the artists I grew up with are mostly Lebanese. And one of my favorite one actually is Feyroz F E I R U Z. She's probably in her 90s. One of the most famous Middle Eastern artists back in her days, and she's still alive.
- [01:46]
A
Nice.
- [01:46]
B
So unless you grew up in the Middle east, you would not know what these songs are.
- [01:49]
A
Well, we're going to. We're going to grab them because we have a playlist on Spotify called Digital Voices and we love adding new artists to that playlist. And so we will add her. That's awesome. I don't think anyone has. Has mentioned her previously, so that's very cool. What about life Message or mantra? Are there sort of words that you live by?
- [02:08]
B
Absolutely. I mean, you have to live your life in purpose. You live once, you mean. Most of us have had great careers. All of us had opportunities. Just focus on the purpose and the mission. Really focus on what's important in your life. Do not sweat the small stuff. And most importantly, treat all people with respect. Everyone has a place somewhere. Just be respectful even when you disagree Difference in opinion, different any SES or others. And learn from past experiences to help you shape your futures and move forward.
- [02:43]
A
Yeah. Love it. We also have a playlist of everyone's favorite quotes and words to live by. So we will. We haven't published that yet, but we're going to. It's just full of great wisdom. After having 250 guests or so, you know, we have a lot of. Could do a book on that for you. So you already revealed a little bit about yourself, that you're. You have this accent and from, from the Middle East. Can you share a little bit about your story? Like how did you, where'd you grow up? How did you get into healthcare? And all the way up to what you're doing today.
- [03:13]
B
I don't know how much time you have there, but I mean, you grew up. I mean, obviously I was burned in the early 60s. I was born in 61, so you have my age now. Life was good till it stopped being good. I mean, you live well, knit family, supportive parents, cousins, nephews, villagers, French schools. Life was good till the list stopped being good. When I was 14, unfortunately, civil war started in Lebanon. And you don't wish this on your worst enemies. Where life is stable, you have security. All of a sudden you're dealing with the unknown. This is dealing. I mean, people are living in wars now, whether it's Middle east on the eastern, Eastern European border or others. So life is good and everything gets disrupted. And the fear of an unknown as a teenager, as a family worried, your background, bombing in the. In the background, you'll need what it is. Lost and lost. A dear friend actually lived in the same building as we did in Beirut within the first six months of the war. So somebody you play with, you just go one floor down, you play. One day he's here, the other day is gone. And from there on, civil war went between 75 and 90. This is through my high school, my undergraduate at American University of Beirut, my medical school. Lots of lessons learned. You live, I mean, with. You survive with both. I mean, I both have physical and emotional scars. So as many people who are my contemporary, my age, who lived in wars in Lebanon and many other places during college, I mean, just fast forward during college. As an undergrad, I was a senior in medical school when the bombing in the US Embassy happened in Lebanon, I mean, with hundreds of marines, many civilians, I mean, I was in class that day and the US Embassy was on the American University of Beirut, edge of the campus. This is a big disaster, big disaster right there. Right there. Hundreds of plus of lives in the flash of a second year in medical school. You have major infighting among different political parties, religious parties. You end up with having hundreds of casualties in the emergency room at the same time. Not to be dramatic about it, but these life experiences shape who you are, shape how you approach decisions, build resilience for someone who, I mean, you know how to deal with adversity and leaves you with physical scars and emotional scars for the rest of your life, unfortunately. And this is the experience not just of someone like, who grew up in Lebanon, but experiences of anyone going through walls, any wars anywhere in the world at this point. And I mean, the humanitarian politics aside, the humanitarian tolls of wars on both sides, there's no winner in this. And unfortunately, I mean the words.
- [06:06]
A
This.
- [06:06]
B
Is the mantra that's happening in the world.
- [06:08]
A
Yeah, yeah, that's. I'm sorry you had that experience and yeah, I'm sure it has impacted everything about your life for sure and those around you.
- [06:19]
B
But at the end of the day, I mean, we've all heard it. What does not kill you makes. Makes you stronger. Mean you builder. Is it mean today? Learned you. You retool and move forward.
- [06:33]
A
Tell us about how you made it to Cleveland, Ohio.
- [06:37]
B
Actually, I came, I got a job as a postdoc right after medical school from American University of Beirut. Got a job as a postdoc at the research lab at Case Western Reserve in neurosciences, applied for residency program managed in family medicine at university hospitals. But I've done my residency and I had a great career in different roles, building a department, working with outstanding people in Cleveland for 25 and 26 years till the opportunity came up in Michigan to start a brand new medical school. And I've been there for 10 years, had an amazing experience. I work with excellent people, faculty and staff every day and just these. Seeing students come in at the white coat ceremony, graduate four years later, having growing residency program. This is, this is absolutely. Has been the highlight of my career.
- [07:31]
A
Yeah, no, that's amazing. And I want to, I want to jump into that in just a minute. But yeah, that's how I didn't really share at the top, but, but that's how we met. I was this young CIO at University Hospitals and I, I don't recall if you became my family physician prior to that role or during that role, but I just realized I needed, you know, I was this young kid, I, I was pretty clueless and I just needed someone who was a clinician who could sort of mentor me and, and you did that. You provided this great input to me and almost like, you know, a modern day cmio. And then I know we got you involved as a result into some of the tech side and helping us with governance and some of the decision making. And we had some big decisions to make back in the day. And you've been so helpful to my career. So when I look back on my career, I'm like, what are some of the major people and opportunities that I had? And you're definitely one of those people. So I'm so thankful and excited about this conversation.
- [08:37]
B
So thank you for the kind word, Ed, but there's something called HIPAA there, so I'm not going to answer you.
- [08:43]
A
All right, so when did you know you wanted to be a physician? So you're growing up under very difficult circumstances. Teenager, the civil war starts. Is it then that you had an inkling about becoming a clinician at some point?
- [08:58]
B
I mean, growing up as a child? Unfortunately, my father was older, suffered with chronic cancer, chronic illnesses. Just the amount of kind of less than ideal care he was getting. He said, you know what, I'm going to grow up and make a difference and I'm going to be different from the experience I've been seeing happening with a father who's older, with chronic illnesses. And this is what led me to do family medicine, taking care of people on a continuity basis, taking care of families, and I mean, two or three generation families I take care of in the clinical part of my career while having a big executive administrative job. I still see patients both in Michigan and Ohio. And this is the foundation of why I went to school, why I studied medicine, and even what, even when I'm not in the office, I take care of people seven days a week. And this is probably very me. This is probably one of the best things I've done, taking care of people, make a difference in people's life across generations and within the same families.
- [09:58]
A
Yeah, yeah, that's, that's pretty cool. How did you get into the administrative leadership track? So you're still seeing patients today, but obviously you're spending the bulk of your time now in the, on the administrative side. How did, what was there a catalyst or what was the thought process there?
- [10:14]
B
I'm a strong believer, I mean, healthcare is so complicated. I'm strong believer in physician leaderships to make a difference in the life of patients and the communities. So getting this, I mean, getting in just any suit, go up the ladder, managing healthcare systems, managing academicians, researchers and clinicians, you have less Credibility and you're less, you're disconnected. Even though you might have the skills, you might have the MBAs and the PhDs, all the degrees you need to make business decisions which are absolutely important but having physician and leaderships around healthcare who at the same time keep practicing to keep you grounded with the realities of what patients suffer from, what communities are going out, I mean having interactions with family, dealing with patients issues, health insurance. So I think the combination of a practicing clinician with executive functions leads to better health outcomes as importantly also leads to better better business decisions and affects the bottom line too. So understanding both the business skills and clinical skills on someone who practices leads you to better leads your healthcare. Most organization except for few are not for profit. You make better decisions while having a margin and keeping the lights on.
- [11:30]
A
Yeah that makes, makes total sense. What drew you to Central Michigan University College of Medicine? I think you may have already foreshadowed part of the answer to this but obviously you have a brilliant career already in Cleveland, Ohio and then you take this role. What drew you up there?
- [11:48]
B
I mean as a country I mean we do mean I speak about it nationally I mean we are facing a major shortage of physicians. So existing medical schools have been established for years increased their class size by what other universities also came up to came up to fill the gap said you know there's shortages in rural Maine. Many medical schools are clustered in urban areas. I mean Chicago, New York, Cleveland, LA and others have multiple medical schools living in a small sized communities, rural communities there are few medical schools. So the leadership of Central Michigan University 14, 15 years ago said we need to come, we need to come and fill the need for rural communities to start and I started the medical school so the opportunity to start a medical school graduated all seven classes myself build it, shape the curriculum, recruit a great team. It's a mean, it's a medical mean like every other medical school. It's a mission for us to provide physicians both mostly rural urban focusing in primary care for health shortage areas. So the let's see one time opportunity, one time lifetime opportunity to do so. Our graduates I mean we take large majority of our graduates from underserved backgrounds. We're seeing a good 60% of our students go into primary care career. We have a large cadre of students going into psychiatry which is a big shortage of and our ranking with us in news report reflect that we are investing in our mission. So seeing this coming to fruition, sitting on stage, graduating young mind to be future physicians taking care of primary care needs and mental Health needs of underserved communities, urban and rural. I mean, and the best part of it, you get paid doing what you love.
- [13:34]
A
Yeah, no, that, that's super exciting. It's always fun to pioneer something new. So when you're already passionate about something and you get to help start something new and it's a filling need for the country, I think it's awesome. I love that. Tell us a little bit about the role of the Dean. Like, wow, that's a big deal. So a little bit about what you do.
- [13:55]
B
It's just managing, managing people and keeping them aligned for division and mission. The best thing to do is just hire the right people, get them the right seats on the bus. And my job is not to get in the way. My job is to manage politics, external worlds and provide resources for my team who is outstanding. I mean, my faculty as well as my staff, they are the engine that run the medical school. My job is to protect them from politics, make sure they have the right resources to do and as importantly for me, get out of their way.
- [14:26]
A
Yeah, that's good leadership stuff right there. Very important what you just articulated. Tell us about the role of digital or tech. You know, how, how do you. I have several questions on that. So you can take it a couple different ways, but how do you incorporate tech in the training? Right, because the training is different than, than when you went through medical school when it was maybe, you know, less, less technology and, you know, how do you view it? So I'm super interested in your, your thoughts here.
- [14:54]
B
I mean, it goes throughout the curriculum. It goes from first year medical student to residency program. As simple as the classroom where we don't have lectures, we don't have PowerPoints at this point. It's all interactive, all the technology. If I'm teaching someone about heart failure, about physiology of X and Y disease, these kids are more, I call them kids that are younger than my kids. They're more resourceful that you and I. I mean, they know where to go which, which sides to go. So all what we have are digital libraries. We have no books, we have no PowerPoint at this point. The other tech piece of it, which is very exciting is the simulation center. We have a state of the art simulation center based in Saginaw and we have one in Mount Pleasant. The tools you do, for example, I mean, if you were to have surgery, I mean as if, I mean as a patient, that you go through robotics, DaVinci, we have an actual Da Vinci robot build, our sim centers, we have 3D simulation, we have Built in tools where you can practice anything as real life as possible. And we introduced digital simulation from the first year of medical school. We build in it as our students progress to their third and fourth year. And obviously you take it at a much higher level in the residency program. So the tech piece of it, I mean there are no textbooks, we have no libraries, is quite core to what we do.
- [16:18]
A
I, I love that. I'm definitely going to come and visit next time I'm with me.
- [16:22]
B
You'd love the SIM center. I mean I can have you do a appendectomy or deliver twins sitting in, sit, sitting, sitting in the sim room. And we have simulated patients. The other thing we do, we disseminate our cases to other communities. So this is not just a resource for medical student, medical student, this is a resource for other professionals. I mean being nursing ems, rural hospitals, we take our SIM mannequins, we simulate the cardiac arrest in the communities and how the community responds to it. So part of it is just not teaching students and residents, but meeting a community need through multiple programs we build throughout the community in mid Michigan and Northern Michigan.
- [17:03]
A
Yeah, I get excited hearing about that and I'm so glad and I'm not surprised that how progressive your organization is. And I think it probably was a benefit to have just started 10 years ago. So you didn't have a legacy right, of doing it any differently. So that's pretty cool. What about your role as EVP of Health Affairs? What's different about that than what you do as a dean?
- [17:29]
B
Obviously, I mean like one of our mutual friends in Cleveland back in the days quoted the term that healthcare is a team sport, obviously. I mean as a university we have other allied health programs. You have Masters in Public health, you have a BA school, we're starting nursing schools. We have many other programs or the ability to coordinate work with other profession and disciplines. I mean this is psychology. This is psychology. This is social workers. I mean ability to coordinate, to coordinate these efforts while holding a dean's title helps other programs, other students, other disciplines. And one of the other things I'm proud of, for example is started me started in interprofessional programs the first year I came to Central Michigan University. That evolved into something called Rural Health Equity Institute where communities, I mean north of Ann Arbor or Lansing in Michigan, I mean this is actually 70 some counties out of 72 out of 83 counties in Michigan are considered health professional shortage areas. So the ability to impact healthcare communities resources in rural Michigan through the Rural Health Equity Institute has been an amazing experience and one of the most rewarding I've had in the past 10 years.
- [18:47]
A
Wow, that's pretty cool. Yeah, I'm really, I was just up in Michigan not too long ago and I, I wish I would have reconnected prior to that. But I'm definitely going to make a trip back out there and would love to have you. Yeah, I love what you're all doing in your mission and vision. Let's shift a little bit to leadership because you've already dropped a lot of golden nuggets. I call them on, on leadership. But I know not everything is always perfect. So can you share a time that something wasn't perfect and how did it shape you?
- [19:16]
B
Anytime you have a title, you have a position, you're or just managing your small business. If you haven't failed in life, if you haven't made mistakes, something is wrong. You've been hiding on the rock and you have not grown. So we've all made our shares of mistakes. You just learn from them, lessons learned and put the pieces back together and move on and that's life. If someone tells you I've made mistakes, please tell me how.
- [19:41]
A
Yeah, if someone says that they never made a mistake, then you definitely want to avoid that person for sure. What about advice that you've received? Are there one or two things that someone shared with you along the way in your journey that have really helped you become a better leader?
- [19:58]
B
One thing that helped me get centered, I mean, you need to find the balance between personal, personal and professional. You can be successful in one unless you have peace, unless you're balancing the other part of your life, whether you have family, whether you have relationships, whether you have a social communities or the balance between personal and professional is key to success. You cannot succeed on one unless you have the other piece well handled. So you need to find the right balance on the business side of it. One thing I learned in business school early in my career, so obviously I'm usually, I mean my North Star keeps me focused about mission vision. We're here for these students, we're here for that mission. One thing I learned actually at the Weatherhead School back in Cleveland in the days if you're climbing the ladder of success and you reach the top, the last thing you want to do is find yourself that your ladder was in the wrong wall. So as you're climbing, as you're going up, make sure, I mean, this is your North Star. You're not putting work for things you're not passionate about. You don't believe in, yeah, that's good.
- [21:00]
A
I like that a lot. Yeah, it's sad, right? You could be climbing this ladder and working so hard and then, yeah, you don't want to be 10, 20, 30 years down the road, down that journey and realize, wow, this is not what I want to do or it has no meaning for me. What advice would you have for non clinicians working in healthcare? So the example would be like me and when I first met you and you provided a lot of great guidance and I think as a result I learned from you and other clinicians along the way and it helped me a great deal to be successful working in healthcare as a non clinician. What do you wish more CXOs or Vice President, you know, sort of leaders knew about working with clinicians?
- [21:48]
B
I mean, health care is so complicated and unfortunately, I mean as a country we don't have the best health care system for what we pay for, what we pay for and what we get in terms of outcomes at the macro level. It's very mean, it's very unfortunate. On, on one hand we have some of the best technologies, some of the best, best training, best physician in the world, but our system is so broken to be fixed at this point. I mean, I'm not gonna get political or others there. So people working, focus on what matters, don't get frustrated. And what matters is making a difference in people's life. So the IT piece of it is the backbone of what we do at this point. Don't get the means, system don't work, systems break. You're dealing with your CMIO CIO about technology, about software, about plugs in or others. At the end of the day, your North Star should be patients and communities. Yeah, that's what matters.
- [22:42]
A
Yeah, I love that. Well, George, this has been amazing just to catch up and also just to learn more from you. And we covered a lot of different things. We covered Lebanese music for the first time ever on Digital Voices and, and then we learned some of the philosophies that, that have helped shaped you like living with purpose. And you've mentioned the North Star and you know, you shared with us a very personal story about growing up during civil war. And I, and I'm thankful for you to share, for sharing that. And we also talked a lot about your heart for patient care and why you got into healthcare to begin with and then going to Central Michigan University and starting a new med school. And I love all the tech things that you talked about and that you, you were able to start. Right? It's, it is great that you didn't have a legacy, you know, sort of old school foundation if you will, so you're able to start from scratch and, and your focus, you really embrace technology and digital. You talked about the simulation centers and then no PowerPoints, library books, things like that. And then you sort of talked about leadership and that personal professional balance. And again the North Star and climbing the right wall as you. As we all work so hard in our, in our lives. So is there anything we missed or is there anything you wanted to double down on? I'll give you the last word.
- [24:00]
B
Just trust. Trust your team. Treat people with respect. I mean you're as good as your weakest link there years time as important to you. I mean there are culture. I mean if you're a leader, culture is as important as anything else. You can be the smartest in the pack. You can have the resources. You might not have worried about your budgets unless you have a good culture. Unless you have people who are engaged in your team. This is bottom up, top down. I mean, you're not going to be successful.
- [24:28]
A
Yeah, that's well said. Again, Dr. Cacano, thank you so much for being a guest on Digital Voices. Just amazing human and clinician.
- [24:37]
B
Thank you, Ed, for having me. Wishing you the best. And you have an open invitation to come and visit Michigan.
- [24:43]
A
Thank you for listening to Digital Voices podcast with Ed Martin. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.