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Embracing Digital Transformation
#354 Building a Remote Healthcare Team: Discipline, Accountability, and Telehealth
00:36:11
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Things that they need to deliver. We have very specific metrics that we have to adhere to and that we report on every single week. Right. And so basically everybody is very clear on what their job is for the quarter, what the deliverable is for the quarter. And we are measuring and tracking that process through. So that way there's no coming into the other side of it going, oh, but I didn't know that was.
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Welcome to Embracing Digital Transformation, where we explore how people process, policy and technology drive effective change. This is Dr. Darin, Chief Enterprise architect, educator, author, and most importantly, your host on this episode, Building a Remote Healthcare Team, Discipline, Accountability and telehealth with Dr. Gabriela Rosa, clinical director and founder of the Rosa Institute. Gabriela, welcome to the show.
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A
Thank you so much for having me.
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B
Hey, I'm really excited about what we're going to talk about because health care is really important and you've come up with a really incredible story around healthcare and technology and all that. So we'll dive into that. But before we do, everyone that listens to my show knows that I only have superheroes on the show. And every superhero has superpowers and an origin story. So, Gabriela, what is your origin story?
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A
Oh, geez, that really. That is a question that puts me on the spot. I told you.
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B
Yeah.
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A
All other fertility and technology related issues all day long.
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B
No, I want to know about Gabriella. That's what I want to know.
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A
Yeah, absolutely. You know, it's funny because I never really planned to be where I am today, certainly not in the way that I am. Like, when I first decided that I was going, you know, I. I'm still from that generation that had the idea that you're going to do one thing for life, you know, So I had the upbringing of, you know, like, what is it that I'm going to do for the rest of my life? And that was very much the question that I asked myself when I decided what it is that I was going to do. I didn't quite plan to have, you know, to be in 2026 and to have all of this amazing technology that we can leverage these days. But certainly for me was about, I asked myself the question, what is the conversation that I can see myself having for the next 20 years? You know, and to me, it was a question, a conversation about health and empowerment and taking charge of who you are in the world. And that ended up translating into women's health, which ended up translating into fertility treatment, which is what I've been doing for the last 25 years. So I think that if there was to be an origin story, it would have to be the fact that, you know, my boss at the time, he. I kind of mentioned that I wanted to do something in pediatrics. I was studying naturopathic medicine. And he said, that is the worst idea you've ever had. And he was such an encouraging man. He was like the loveliest, most encouraging person in my life, like, for many, many years still. I'm still in touch with him to this day. And, you know, and I looked at him and I said, oh, gosh, tell me what you really think. And he goes, yes, because, you know, in pediatrics, your patient's not your patient. Your patient is the parent of your patient, and your patient can't speak. And I'm like, okay, you make some excellent points.
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B
Yeah.
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A
You know, And I was like, okay, yeah, that's. I'm going to change what it is that I do. And so one day, I was. Got one. Went back to square zero with the question of, okay, what am I going to do for the rest of my life? And I'm walking into clinic, and I see this little A4 poster on the wall that says natural fertility. And I'm like, yeah, that's it. Fertility. That's what it is. And literally, it was any more than that. It was. It was the moment I remember so clearly, so vividly, exactly where I was where this fertility word just popped out of the page. And I'm like, all right, let's go. And so here we are.
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B
So it. You were like, instantly, you said, that's what I'm going to do. Or did it take some time for
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A
you to say I'm a crazy person? No, no, I. You know, especially back then, like, you know, being a young. I'm very decisive. I'm a very decisive person.
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B
Oh, that's awesome.
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A
So, you know, it's. For me, it's like the way that I think about decisions is make them see what happens as you're in it. You know, it's pretty much, you know, like, you weigh the pros and cons, and once you've done that to the best of your ability, I'm done. I'm like, let's go. You know, and so then I just. I just do. And, you know, whatever happens, I will deal with, you know, whatever happens while I'm doing so. This was no different. It was literally just like, okay, it's fertility, so let's go. And. And from there, I was very much. I. I went to postgraduate education even before I graduated in the topic of fertility, because I was just so clear that, that, that was just what I was going to do.
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B
So that's your calling. Your calling.
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A
That was it.
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B
I don't know.
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A
You know, it's funny because it wasn't anything like the, the, the, the, the sky part, this ocean part of the sky opened and it was, it wasn't anything like that. It was just, it was a practical decision. Many of the biggest decisions in my life have been done very, made very practically. It's like, what is it that I want? Will this help me get there? And yes or no, do, don't do. Like, I don't spend a lot of time dwelling on decisions typically because of the reason that things change midway anyway.
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B
I really like that because, yeah, when things get tough, you've already said, I already made the decision.
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A
That's it.
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B
I don't need to make it again. Right. I just need. There's not exactly whatever's tough going on now. So let's talk, let's talk a little bit about your, your journey in fertility a little bit on, you know, you said 25 years you've been working in the space.
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A
Yeah, this year.
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B
It's changed a lot in 25 years.
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A
You know, it's changed somewhat and it hasn't changed enough, to be honest. Okay. Yes. So it, there has been, there has been some change. There has been some advancements. But I think that because medicine is such an institution and institutions by their own right move very slowly. Things in medicine, you know, yes, you will have technological advances and advancements and of course we've had many of those over time. And commercialization of medicine in a way that we haven't had, you know, in the early days of, of me doing my work. But, but in terms of real change, that's patient focused and that makes patients lives better. I think we're very much behind and there's, there's definitely a lot still of catching up to do for sure.
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B
Did you see any acceleration in that during COVID Did Covid accelerate that or decelerate it?
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A
No, I think that what we saw in Covid, which is something that for me wasn't new because I was already, you know, doing telehealth for six years before COVID was this idea that, you know, yes, okay, you can actually deliver excellent healthcare not having the patient right in front of you, you know, and so we saw telehealth become, you know, be embraced by medicine and even insurers in a way that had never been the case before. In fact, prior to Covid doctors were not allowed to bill for a phone consultation or a telehealth consultation. Hence why when you used to go to a doctor, they would not talk to you on the phone because that was no billable hour for them. So they would say, make an appointment, come into the office. Whereas after it's like, oh, no, make a 15 minute telehealth appointment. I'll charge it the same. All is good. And so that the change that we saw, and it has certainly had many benefits. I mean, I was, I was. I went to my defense for my doctor of Public health, like in March, and I developed a strep throat. Just before my defense, I'm like, I'm going to lose my voice. This is horrible. You know, what am I going to do? So I speak to my supervisor and she says to me, just, you know, get a telehealth consult, just get some antibiotics. And so, sure enough, literally that same day, I made an appointment, spoke to the doctor. He was a really lovely guy. He sent the prescription to my pharmacy, which was literally two minutes away. I got the antibiotics. I defended, you know, yay. And I had a voice. So, you know, so there are, there are benefits in that way that certainly we are seeing now as a result of COVID But I don't think Covid in terms of patient care and certainly in terms of reproductive medicine, I mean, IVF clinics were literally shutting down. They were literally. I was receiving. I'm a member of the major associations, you know, ESRA and Ezra, and I remember receiving emails about them talking about clinics and doctors going bankrupt during COVID and how they were going to support their community and all of these things. And I'm like thinking, am I in an alternate universe? Like, what is happening here? You know, obviously they figured that out pretty quickly and things moved quite, you know, quite smoothly after that initial shock and period of time. And I think that we've seen some benefits from that because patients at least have better access prior to it. You know, if you live seven hours away from a clinic and you have to go there to make even an initial appointment, it's going to be more difficult than if you can make a phone call and they can tell you, look, go and have these blood tests and then we'll make another appointment and have a further conversation.
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B
Yeah, that's a question I actually have for you. Especially with, like, fertility. There are a lot of things you can do without physically being with the patient 100%.
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A
And I mean, but there is a
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time where you have to be with the patient.
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A
Well, do you or not? And this is the question.
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B
That's my question. I have to.
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A
Yeah, exactly. And this is the thing. I think that what we need to turn from is a clinician that treats a patient as opposed to a clinical care team that works together to treat a patient. And so if we understand that, that it's not my speciality to do every single piece of that reproductive journey for a part for a patient. So, for example, I might need a urologist to examine the testicles of a man. I won't be able to do that myself, one, because I'm away from that person. And also it's not my speciality. Right. So what I'm going to do is, which is what happens in medicine in general. A doctor who specializes in stomach issues is going to send you to go and talk to a hematologist who specializes in blood issues. Right. And you're going to work as part of a clinical care team. So in the way that we work and, you know, this kind of. It was almost thrust upon me and that. That's another origin story we can dive into later. But, you know, basically the way that we work is that we actually access and we identify the clinical care team that we can work with or we help help the patient to make that decision. As to who's in area that you can see, here's a letter of referral explaining exactly what is happening for you, exactly what it is that you need. And so then the patient goes to see that specific person, have that specific test reports are produced, those are sent to us. We then analyze and interpret and treat accordingly and. Or make recommendations for treatment. You know, so ultimately, in my experience, and I have now been doing telehealth since 2013, in fact, I was doing telehealth in 2003 via the telephone. You know, like, I literally had. Yeah. So I had patients that had had babies through my clinic that I didn't know what they look like until after their third baby, you know. Yeah. And so, you know, so that was something that for me was just a normal thing. And then of course, in 2013, it became the only way that I treated patients. And the reason that that happened was because I had patients who were not already coming to me by referral, who already won coming into my clinic. 50% of my practice was actually referrals that were in other countries. And so I was treating people globally already. And when I had my son, my first son, he never slept a day in his life. And as a result, I never slept a day in my life. So I went from doing 60 patient hours a week to just like barely remembering my name about, by about four months into maternity leave. And then it was time for me to go back to work. And I was like, oh my, my dear Lord, just that I have to shower and get dressed to go to the clinic. That's already too much to ask, you know. And so I was really in a conundrum. I was like, okay, I can't. I just cannot. I don't have enough hours in the day to get my head around like even commuting 5 minutes because my clinic was literally a 10 minute walk from my house. And so I was like, okay, I can't do this. You know, the things that sleep deprivation does to a mother. And so I decided that if I was in my pajamas with breast milk all over me still, you know, kind of in between feeds, but somebody couldn't see me because back then, you know, Skype was still very early. And, you know, people don't even know what Skype is. Some of the people listening to this, it was the pre zoom, you know, and so that was early on. And so video wasn't great yet in terms of teleconferencing so you could do the whole voice thing. And I thought, you know, what, what, what a better way. I can be totally disheveled and just have a normal conversation. I can do that. And so soon after, a couple of years later, obviously video became better and it started to become a whole lot more, you know, kind of a visual process. But even so, you didn't have to dress up from the waist down. You know, that's, I think, one of the biggest developments that the world saw that I had already been used to for a very long time. It's like pajama pants and just, you know, look professional with a jacket on the top. You know, get your hair done, your makeup, always good. So that's really how that began. You know, it was necessity that drove me to go, okay, I need to find another way. And then I started hiring people in different cities and in different countries. And it just became a situation where now we have 29 staffing, seven time zones, you know, and so that's pretty much how we conduct business.
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B
So I want to, I want to touch on that a little bit because you mentioned that it's a team effort, fertility, right? Because there's a lot, there's a lot involved in fertility, a lot of different aspects. How do you, with, with a remote team that you have, how do you keep consistency how do you keep that. That patient? Because a lot, you know, what I'm trying to say. How do you get your team to act like a team when you never see each other? Right. And coordinating and how do you have quality in your business and processes are being followed and all that?
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A
Yeah, absolutely. Great questions. Really great questions. And here's what I'll say. Running a remote business is no different to running a physical business. And that, you know, I have been running a business since 2000, so I can tell. And I've run all sorts of variations of my business since 2001. I have been running this business for 25 years. And so I can tell you that it is absolutely no different to have a physical practice than to have a remote version of the same practice. Because ultimately, as a leader, I'm the same person. So that's the first thing that happens, is the culture is defined by what you will choose to accept. And so my team is very. And a lot of my team have been with me for a very long time. Like, you know, my core team, my executive team, have been with me between five and 15 years. So there is continuation in that process. We. They understand my expectations. They understand what it is that I want to see. They understand that patients come first, absolutely every single time. And it's not that the patient is always right. In fact, they are very often wrong. And we have to tell them that, you know, but the way in which we operate is patient care first, and we want the very best for our patients. And so that is a set of rules that are embedded in everything that we do, you know, and customer service. And you can. So the way in which to deliver something like that is by looking at, okay, if people can't see us. Like, if you had a physical premises, you would make sure that it's very beautiful, that it's nicely organized, that it's clean, that it's all of these things. So how do you translate that into a patient experience in a remote setting? It's by how quickly you answer messages. It's how. By. By how well you answer messages. It's by how well you actually take care of that person's concerned. Concern. So, you know, one of the simplest things you know, that translates so well in this kind of context is like this. My team knows that within 12 hours of receiving an email, they have to have an answer, or the person needs to know that they are on it with an update, right? So immediately upon sending a message, there is an email that goes out to say, we have received your Email. So the person at least knows, okay, there. There is something that's catching it. Yeah, exactly. And then the team is instructed and they are measured on this. So I don't. One thing that I have learned over time is that you don't believe what anybody says, including your team. You observe, so you measure trust, but verify.
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B
Right.
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A
If you absolutely, 100% verify, if they tell you that they're doing 100 dials a day, you go and you check the system to see, yes, that's 101 calls. You don't believe that they're doing 100 calls. Because I have been caught in that situation before, you know, and so ultimately, they know that they're being audited. Everybody knows that they're being audited in terms of their performance. There are very specific things that they need to deliver. We have very specific metrics that we have to adhere to and that we report on every single week. Right. And so basically, everybody is very clear on what their job is for the quarter, what the deliverable is for the quarter. And we are measuring and tracking that. That process through. So that way there's no coming into the other side of it going, oh, but I didn't know that was early on in my business. Now it's different.
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B
You know, I like what you've done because you've put discipline in. That surround your culture.
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A
Absolutely. And everybody.
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B
And a lot of. A lot of organizations never do that. They say, we want our culture to be this. And. But there's no verification. There's no feedback for people. Because if I'm doing things right, it would be great to know that I'm doing them right. And you've put that in there and that someone is there watching over me, holding me accountable. Accountability is extremely valuable.
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A
Yeah. And it's a 360 situation. Like, in the same way, I don't. I cannot expect one of my team to deliver on something that I myself don't deliver on. Right. And I think that this is one of the biggest errors that leaders make. They think that it's one rule for everybody else and one rule for them. And what I have learned, and this was, again, a hard lesson, you know, like, I didn't train in business. I had to learn business, you know? And so basically, for me, it was literally a lesson of what is it that I want? What is it that I am doing that is stopping me from getting it? Because I am demonstrating something that my team, they're hearing what I'm saying, but they're seeing me do something else. You See, so the one thing that I like, and this is very much what I learned in terms of this, has actually translated into every other aspect of my life. My teenage son, I have a 13 year old. The one thing I say to him when he leaves the house is be a good example.
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B
I love that.
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A
Be a good example. Because people are looking at you at all times and how you show up and what you do is going to determine how they show up and what they do. And it's amazing to see and I see this in my own team because I have high standards and I operate within those standards. I don't expect that people are going to just, you know, essentially show up when I'm not. So I, I show up, I don't even have to tell them that they're not showing up. They self analyze, they self assess. So when I ask the question, what is it that you need to do differently? They already know the answer. Like I'm not having to, you know, point my finger and say, you know, and sometimes when I do, it's like, okay, what is it? What, Tell me what's happening here. Tell me how you're going to address this in a different way. Because it's not my job to baby people, right? I'm an employer. I want results, I want ultimate outcomes. You're holding people, they have to hold themselves accountable. I'm just holding the mirror.
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B
I love that. All right, so here's my next question with you have people over seven time zones. Must be hard to have a meeting where everyone.
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A
Not really.
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B
Not really.
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A
Again, it's, you see, it's the agreements that you make that you make at the outset. Okay, so you see, the agreements that we make is that we work like the, the Clinic hours are 7 to 7am Sydney Standard Time. So that means that when you're employed in my clinic, I don't care where you are and I don't care where you go to work from. Like literally, you can be in Vietnam today and tomorrow in China, whatever, I don't care. As long as one, you deliver the outcome that you are employed to deliver. And the second thing is that you understand very clearly that you work within Australian business standard hours, which is 9 to 5. There is flexibility 100%. Like there are people who basically say to me, I don't want to start at 6am My local time, I want to start instead of starting at 9am Sydney time, I want to start at 1pm Sydney time and I'm going to work until 8. They understand that once a week at 10am we have a meeting. So I don't care what else they do. One, you deliver on your outcomes, which is very clear for everybody to see. So either you're on or you're off. And you know, then you need to figure out what you're going to do about that. And the second is that we make agreements and you show up to meetings. That's it. The rest. And we have so few meetings, you know.
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B
Yeah, yeah, yeah. Well, that, that's the key is if you have fewer meetings. I mean, in some organizations it's just meeting after meeting after meeting.
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A
I have avoid meetings. Like I use technology as much as we possibly can to avoid.
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B
Well, let's talk, let's talk about the technology. Because a lot of times you have meetings for coordination or for reporting out or for making decisions, whatever. If you're using technology, what technology are you using and what is that technology being used for to manage your team?
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A
So there are a few pieces of technology that are absolutely like, I could not run a business without Slack. Right. And this is not a plug. This is not a plug. Yeah, it's literally just, you know, like, I think it's expensive Slack, if you're hearing me, I don't like it anyway. It's an expensive tool, but it's a very necessary tool for my business. Things like Slack Zapier, we couldn't run a business without those these days, honestly just makes everything that we need to have organized and done. And the automation, I think as much as possible we've improved the quality of our team by not having to have quantity because of automation patients. And so that has been another thing that has completely transformed the business in the last six months is AI note takers for clinical appointments. Like, who writes notes anymore? Sure, we write little kind of things that we need to add to the notes, but it really has transformed. It has saved the amount of hours in my day and also the presence in the consultation because now I don't have to be, you know, oh, hang on a second, you're not sitting there,
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B
write this down, typing while trying to listen.
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A
You're literally having a conversation and it's just being so, so great. So, you know, transcriptions and, you know, recording of video meetings and, you know, things where it just has made such a much easier process to be able to actually, you know, get that understanding. And this is another reason as to why meanings have become more and more obsolete is because by the time we have the agreement about who's going to work on what and how, it's Going to actually unfold and when it will be delivered by what has happened is that if somebody hasn't been able to make it to a meeting, there is a transcription that comes up straight away so that they can quickly catch up. Or we don't have to have a meeting at all because we've done a screen capture of demonstrating exactly on screen. Hey, look at this. Check out this. This is what you need to fix, like feedback. These days when I give feedback on materials that my team is producing, whether it's my research assistant or you know, my marketing team, it's a two. Like before you used to have to get into a meeting. Let me share my screen, let me show you this. Now I literally pull up bloom, I go check this out, blah, blah, blah. They do it comes back done, approved, let's go. So there's lots of these kind of like pieces of technology. And mind you, there are certain things that are meant to help that don't really work all that well, but then obviously they get replaced pretty quickly because they're not doing the job. But those kind of basic things that, you know, we have, that we have being able to actually put into the business for productivity and also for just making sure that things work well has made a huge amount of difference. The other thing of course is our political notes. You know, political notes. Now EMRs are the best. Honestly, like going from paper files to an emr, it's like, you know, no EMR is perfect. You know, you have to know that. And we had an experience last year where we wanted to change in ema that that essentially wasn't serving us to the full capacity of what we needed because we needed to integrate lots of other tools to be able to make it work. And it wasn't, it wasn't working as well. But then we, we hired a company who was supposedly going to, had a solution, who then was supposedly going to customize, you know, more for what it is that we needed. It went totally pear shaped, like it was not a good experience at all. It made me learn a lot about, you know, what people say they can do versus what the reality of what they can actually do. And in the end, you know, a year later we pulled the plug, you know, a hundred thousand dollars down the drain and learned a great lesson about how this is never going to happen again. You know, so there are things that work and there are things that you learn. Huh?
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B
So, so that brings up an interesting question I have for you. You work with other doctors outside of your clinic as well, correct?
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A
Yeah, we do, because we have to either make a referral or ask them to do certain things that, you know. Exactly. And so, you know, we will be getting back, you know, information and feedback based on.
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B
How do you get that information back? Because I have a functional medicine doctor, and he refers me out to specialists to do certain things, you know, whatever. But I wish there was a centralized electronic health record. How do you handle that now? Are you taking faxes? Oh, heaven forbid. Faxes. Oh, my goodness.
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A
I know, right?
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B
But that still exists in the medical world.
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A
Oh, my God. But it's you. It's. And see, this is the problem. It's not that they still exist. They still use it daily.
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B
Yeah, yeah.
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A
You know, in the clinic that I used to manage, I used to manage the. The obstetrician gynecologist clinic. That was my. My first mentor. That was one thing that I actually instituted because I. I've always been very pro technology, and so I've always been very focused on, okay, what are the advancements that we can add in here that are going to really support. The first thing that I did was get rid of that fax machine. And this was like 2000s, and it was. Now we can actually receive fax on email. That is what we're doing. You know, so the. The facts.
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B
Yeah. How are you coordinating with these other.
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A
So this is the part that the pa. Okay, so this is one thing. And I think that this is important information for people in general. So anybody listening to this is actually going to benefit from this piece of information. Your health is your responsibility. And what that means is that you take every single blood test, MRI report from surgery, and you have your own file, and you have your own file that's digitalized and a physical file. Because unless you just want to have a digital file, which is fine. Like, for me, what I do, whatever test I have, whatever, if it's a blood test, if it's an mri, if it's a surgery report, whatever it is, I have a file in my own EMR in the clinic, and basically every single report that I have had for my health, for anything, like for every other patient, gets uploaded into the emr. And I have a separate file on my Google Drive that literally has all of my reports. Why is this important? Because. And you might think, why would you want to keep a report from 1998? Right, exactly. The reason you're keeping those is because you want to understand how is your health trending over time? At what point did this issue become an issue? And how far from reversing it, are you? Given the fact that, okay, this actually was first flagged two years ago, so it's early. So it means that, okay, there's still something I can do about it, et cetera. If you don't get your physical reports, your doctor will simply tell you if you have a population, broad population range of results, most of the people who go and have blood tests are people who are sicker than the general population.
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B
Right.
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A
And so the population trends are not favorable. Right. They're not ideal. And so if your doctor just tells you, oh, it's normal, oh, it's a little bit low, that means it's not ideal. It means that it's not optimal. And you better make sure that you make it your business to understand what that number means and how to address it. And if you don't have those physical reports, you will hear it's normal. And what, what do you do with that information? Like, my patients come to me all the time with, you know, the doctor said the semen analysis is normal, and I'm like, okay, where's your baby
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B
proof? Proof is in the pudding, right?
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A
Normal is you have sex, you get pregnant, you have a baby, we're done, we're no longer having this conversation. That's normal. Everything else we need to figure out, what are we dealing with here? Because there are levels, right? And for one person, what is considered normal might not be normal for that other person. And so one person might be quote, unquote, normal. And yes, they have their baby, the other person is normal and they don't have a baby. So where is.
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B
You got to find out discrepancy, preventing it from happening.
- [34:01]
A
Yeah, exactly. What is it that that normal for that person needs to be in order for them to have the result that they want. You see? And so this is one thing that is not perfect. It will not be perfect because different healthcare systems, different parts of the healthcare system, in and out of healthcare system. So I don't think we will ever have. Unless, of course, you know, we move completely into the whole blockchain for healthcare where everything gets put in, which I think we're still many, many, many years, you know, away from that personal. Now it's. You have to take personal responsibility, you have to get the reports you need to bring it to us and then we, you know, do what we need to do with it.
- [34:44]
B
There's a great business right there. Personal, erm.
- [34:47]
A
Personal, that would be.
- [34:49]
B
You know what, Gabriella? We're going to start a company.
- [34:52]
A
Personal, erm, that could be good
- [34:57]
B
idea. Yeah. There you go.
- [34:59]
A
Absolutely.
- [35:00]
B
I love it. I love it. Hey, Gabrielle, we are out of time. What a great story. Thank you for coming on my show. When I first saw this fertility. What does fertility have to do with digital transformation? A lot, it turns out.
- [35:13]
A
A lot. A lot. Especially we have only scratched the surface.
- [35:18]
B
Yeah, especially a pioneer like yourself who is right on the forefront of a new way of working and running a business. This way. Pretty incredible story. Thanks, Gabriella for coming on.
- [35:30]
A
Thank you for having me. Wonderful to be here.
- [35:37]
B
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