Closing the Gap Between Potential and Performance in Healthcare

Why This Episode Matters

Healthcare organizations are rich with intelligence, talent, and commitment. Yet leaders across systems feel exhausted, constrained, and stuck solving the same problems year after year.

In this conversation, Dr. Laura Desveaux challenges the idea that improvement is primarily about adding more initiatives. Instead, she reframes leadership as the disciplined practice of learning, from everyday evidence, from diverse voices, and from the tensions we often try to resolve too quickly. This episode explores what it means to lead a true learning health system in operational reality.

Key Ideas Explored

• The gap between current performance and true system potential
• Learning health systems as a way of operating, not a series of projects
• De-implementation and “subtraction neglect” in healthcare
• Holding paradox: efficiency and humanity, population and individual care
• The role of co-design and implementation science in scaling improvement
• Asking better questions as a leadership intervention

Takeaways for Quality Leaders

• Start every initiative by clearly naming the problem you are trying to solve.
• Before adding a new project, ask what can be removed to create capacity.
• Integrate multiple forms of evidence: data, lived experience, front-line insight.
• Move beyond either/or thinking. Many leadership challenges are both/and.
• Build routines that embed learning into daily operations, not just pilot cycles.
• Revisit meeting structures, reporting formats, and governance processes with subtraction in mind.
• Anchor teams to shared outcomes while staying flexible on the path to get there.

Continue the Conversation

Connect with Dr. Laura Desveaux on LinkedIn or visit her website to follow her work in learning health systems and leadership development.
This episode is especially useful for senior leaders, quality executives, and clinicians navigating complex system change.
If this conversation resonated, share it with a colleague and consider leaving a review.

Resources & Frameworks Referenced

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

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Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

New episodes published every other Thursday at 7AM Eastern Time.

Transcript

Origin Of Women Who Lead

SPEAKER_01 0:00

They each sort of said, I'd love to continue the conversation. I bet there's other women that would want to as well. So I go home and at the time tweeted to see, you know, is anyone else interested in a conversation about career advancement and leadership in healthcare? I go to bed and I wake up to 150 emails and just as many direct messages on Twitter of women who are like, yes, when, where. I would love to have this conversation. And that's how Women Who Lead was born.

SPEAKER_00 0:26

Welcome to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the state street. I'm your host, Jason Meadows. Today's guest is Dr. Laura DeVaux. And if you spend any time in the worlds of implementation science, learning health systems, or leadership development and healthcare, her name might already be familiar to you. Laura is a behavioral scientist and implementation scientist by training with a career that sits right at the intersection of evidence, leadership, and real-world system change. She began her professional journey in clinical care, completing a master's degree in physical therapy, where early on she developed an interest in not just how clinicians care for patients, but in how the system enables, shapes, and sometimes constrains that care. That curiosity led her to pursue a PhD and a research career focused on understanding how we translate knowledge into practice. Over time, her work has centered on data-driven improvement, audit and feedback, clinician behavior change, and the conditions required for high performance in complex healthcare environments. She currently serves as the director of the Learning Health System Leadership Center at Trillium Health Partners Institute for Better Health, where she's helping to build global capability in what it actually means to lead within a learning health system, not just in theory, but in day-to-day operational reality. And that work is especially compelling because it's grounded in something very human. Laura has spent years studying how leaders learn, how systems evolve, and why the gap between potential and performance persists in healthcare. She brings together improvement science, implementation science, and leadership development into a practical model for helping organizations learn from everyday evidence and translate that learning into better care. She's also the founder of Women Who Lead, a not-for-profit leadership community that began as a small peer conversation and has grown into a large, sustained network supporting women across healthcare in developing their leadership voice and influence. What makes Laura's story so interesting to me, and why I wanted her on the podcast, is that she operates fluently at multiple levels of the system. She understands frontline clinical realities, she understands the science of behavior change, and she understands the leadership conditions required to unlock performance at scale. Our conversation explores everything from learning health systems to burnout and leadership capacity to the paradoxes leaders must hold as they try to improve care in an increasingly complex environment. So with that, I'm really excited to share this discussion.

unknown 3:15

Dr.

SPEAKER_00 3:15

Laura DeVaux, welcome to the Leading Quality Podcast.

SPEAKER_01 3:19

A pleasure to be here, Jason. Thanks for having me.

Laura’s Path From PT To PhD

SPEAKER_00 3:22

Yeah, you're very welcome. I'm looking forward to it. And I wonder if you could start us off with just a brief overview of your background and how your career has evolved to where you are today.

SPEAKER_01 3:33

Yeah, I'd love to. Let me sort of jump in the DeLorean and go back in time. Maybe the reference dates me, uh, so apologies to the audience. Uh I'll take lands. Excellent. Uh love to be in good company. I'll sort of start the story with my sort of graduate training. So back many years ago now, I did a master's degree in physical therapy. And coming out of my undergrad, I did that because I was interested in healthcare, thought at the time that medical school would be too long. My eventual trajectory sort of made that point moot, but wanted to be in healthcare and wanted to find a way to help people function better. In that program, unbeknownst to me at the time, in terms of an early stage sort of career anchor, I was doing my clinical placements and noticed that a lot of the people I was working with had strong technical skills, were had strong sort of teaching and mentorship skills. Obviously, they were helping me develop as a clinician. But across the profession, I sort of noticed a lack of leadership skills. It was at the time when physical therapy as a service was being defunded publicly. And so there were lots of conversations about the value that we were providing as a profession and why physical therapists thought that that was the wrong decision to make. But what I noticed was the way that they were speaking about the value they generated was itself undervaluing the contribution they made. So again, at the time, didn't really think much of that beyond making the observation and sort of continued on in my career. From there, I went on to do a PhD, which is where the amusement happens about feeling like medical school would be too long. And that was really an extension of an innate curiosity that I have. I was always the kid that would ask why or how does this work or help me understand. And so I joke that after years of asking other people questions, I needed to develop the ability to ask them myself and find my own answers. And so I didn't know why I was doing a PhD other than in the health sector, given that I wasn't a physician and I wasn't a nurse. I looked around at people who I thought had interesting jobs who were helping to improve the system and improve the outcomes that patients got. And the people that weren't doctors or physicians had PhDs. So it really was, I wish I could tell you there was some highly strategic reason that I pursued those things, but it really was sort of a spark of interest and a curiosity. And take those two degrees together taught me to sort of think diagnostically. So start big and work small, and helped me to be very systematic in two very different but complementary ways.

SPEAKER_00 6:30

I have to say, it strikes me as I'm hearing the observation you had as a, I guess, a trainee in physical therapy, the observation that that the leadership language and the leadership behaviors were not there, that can't have been a common thing to notice amongst your peers. I feel like that's that's that's a rare insight.

Why Leadership Training Was Missing

SPEAKER_01 6:49

Well, so rare. Um, again, hindsight is 2020, that the research project I did as part of my master's was actually looking at leadership in the physical therapy profession. And it was, to my knowledge at the time, the first study to really do that in a systematic way. And what we were looking at was, you know, if you think about, no matter what your clinical sort of training or spaces that you occupy in healthcare, how physical therapists thought about the importance of business acumen and systems thinking, among other things, in their day-to-day clinical practice, uh, within their organization and within the system more broadly. And what really came out across that is sort of the importance of those two things weren't front and center. They didn't hit the top five. And over the course of my career, I've noticed that that's not unique to physical therapy as a profession. And across entry-level curricula, we see varying degrees of leadership training. But I'd be curious to get your perspective. Most people I speak to that are interested in leadership have learned it by experience, not because it was intentionally designed in their entry-level curricula.

Founding Women Who Lead

SPEAKER_00 8:09

Yeah, absolutely. And I think this is a common theme in uh physician discussions as well is that you become technically proficient in medicine and you develop those skills. And as in so many other industries, you can be promoted out of the thing you're you're most trained to do and into something that you uh have a lot less exposure to or training in. So I think very relatable to a lot of our listeners. And one of the next steps in this journey, as I understand it, is that you you founded Women Who Lead. What other or what problem were you seeing in healthcare leadership that made you feel like something like that needed to exist?

SPEAKER_01 8:49

What a great segue. I was sort of thinking to myself that um that was the natural next step in my journey. And I actually, to be honest, it was more about my personal experience rather than a systematic observation. And so my experience was at the time, I have I now have two very healthy, very high-energy boys at home. But when I was pregnant with my first, um I sat down with a really phenomenal mentor and great friend of mine who is a physician. And he said, This is so great. Like, how are you feeling? Tell me what you're thinking as you look ahead to Mattleave. And one of the things he said to me was, you know, I've supported a lot of patients who are pregnant, but I've not been through it myself. So you might want to think about finding, like adding a woman to your roster of mentors. And it hadn't occurred, funnily enough, hadn't occurred to me at the time because I had, you know, women who were within my network, but none that I was turning to to really help me think about how I balance who I am and who I wanted to become. And so fast forward through a healthy pregnancy and a um maternity leave, I found myself wanting to re-engage in professional development because I hadn't received leadership training to date. And I couldn't find anything, couldn't find anything that wasn't for a physician, that wasn't for a nurse, and I couldn't really find anything in Ontario. So I ended up going to a program that unfortunately no longer exists in Boston at Harvard Medical School. And it was just such an inflection point for me. And I thought to myself, I was active on social media for the first time because I was so excited about the content. I had a few colleagues reach out to me and say, Where are you? This sounds really interesting. And I'm giving you the long version because I think the sort of honest reality of it illustrates how sometimes the greatest things we do aren't intended to be great at the first spark, or we don't know where it's going to take us. So I return from that conference, I book a boardroom with three or four other women, I, you know, share all of these things that piqued my interest, these practical strategies I learned. And they said, they each sort of said, I'd love to continue the conversation. I bet there's other women that would want to as well. So I go home and at the time tweeted to see, you know, is anyone else interested in a conversation about career advancement and leadership in healthcare? I go to bed and I wake up to 150 emails and just as many direct messages on Twitter of women who are like, yes, when, where, I would love to have this conversation. And that's how Women Who Lead was born. And I think that the message I really want to leave with those who are listening is to trust that when you experience something and you see a gap that can be closed, you don't need to have the full vision to take the next step. Um, for me, it really was a series of, okay, I want to invest in myself. All right, let me find a place to do that. Wow, this is really great. Let me share that with others. They're just as energized as I am. Let me see how we can scale this beyond, you know, an extended lunch conversation. And eight years later, it's a not-for-profit that's still going strong and will continue to until people stop engaging.

SPEAKER_00 12:05

Wow, this is such interesting timing. I I just gave a talk earlier today on building communities of practice, framing the discussion around these small acts of courage. And what I hear from you, I don't know whether you'd frame it this way, but that sending that message, sending that tweet, having those replies back, like that's the kind of small act of courage that makes a big difference in in big complex systems. Is that how you would think about it? Was that a courage, courageous moment for you?

Influence, Authenticity, And Values

SPEAKER_01 12:37

Yeah, I think that that's accurate framing. And I would add to that that it's a small act of courage that's sparked by curiosity. Um, I remember saying at the time that if there are five other women who are interested in having this conversation, that's time well spent. Um, and you know, maybe at the moment that was a, you know, courage and like fear and courage mixed together of what if no one cares about the thing I care about. But it it really is, it makes me think of entrepreneurship and the messages we often hear about, you know, just start doing and iterate and figure it out as you go. And that takes a lot of courage because people will critique you along the way, they'll critique the idea, they'll overlay their own experiences and suggest you may want to pivot, expand. Um, and so discipline and focus over time is also a small act of courage to keep the magic of that community of practice um going so that it sustains over time.

SPEAKER_00 13:40

It sounds like that community building women who lead uh probably taught you a lot about leadership and influence. What stands up?

SPEAKER_01 13:49

I it's interesting. I think to oversimplify, it taught me more about influence because I routinely get asked, how did you start this? And how how is it still growing? And how do you still fill the room at capacity with 160 women and have a wait list of others? And when I talk to small groups, large rooms about influence, you can't manufacture authenticity, and you can't manufacture a deep connection to what it is you're doing. Women who lead for me, I'm an introvert. I leave those events, I leave any speaking event taking a solid 60 to 90 minutes to just decompress. I love creating, connecting, and sharing expertise. But influence lands when people can connect to not only the message, but the person who's delivering it in some way, shape, or form. Maybe it's the way it's delivered. Maybe it's the person themselves and some aspect of who they are or how they identify. And I think how I would connect that to leadership, and I'm so grateful to have had that experience when I did in my career, is that the leadership is at its best when it feels effortless and true to who you are. And I don't mean that it doesn't take work. I just mean you don't need to put on a mask. You don't need to be someone different than you are. You understand, you have the self-awareness of who you are, what you bring, what matters deeply to you. And as you develop as a leader, you build the muscle of harnessing those the right parts of you in the right context and surrounding yourselves with people who bring diversity to the group dynamic. And I think that's the second piece that Women Who Lead has taught me is seeing in a collective and at scale how powerful it is to bring people together and how much diversity you can get in the room when it's around a shared set of core values.

Creating A Leadership Center

SPEAKER_00 16:14

It's exciting to hear this values aligned story and the growth that you had in this whole journey. And it's led you, uh, among other things, while you continue to lead women who lead, to be the uh the director. Is that sorry, is that your title? Yes, it is. Um you're the the director of Learning Health System Leadership Center out of Trillium Health. And I understand you're more or less building that from scratch, I'm sure, with some some help. But I I'd be curious to know what is that center trying to do um that wasn't being done well before.

What A Learning Health System Is

SPEAKER_01 16:50

Let me test my memory to get to what it's doing that hasn't been done before. And for the benefit of uh your audience, be really clear that that center and the idea for it was born out of a rejection or a failure, however people frame it. And I think it's important because if we create the bridge to values, um, I had pitched what feels like four or five years ago now, um, as part of an international fellowship where one Canadian is selected. Um, it's called the Harkness Fellowship Program. It's run by the Commonwealth Fund. I pitched that we needed to develop the leadership maturity model in healthcare and that the conditions in which health leaders were operating have shifted dramatically and the capabilities they need has have also evolved given the context of the world. I made it to the interview stage. I think there were three people that made it to that stage. And when I got the call that I didn't get the fellowship, I wasn't devastated. Um, but it really caused me to reflect on what about this matters deeply to me, such that I need to take it forward. Um, and so that's sort of that that exact concept I just explained to you. You know, we went through a pandemic where globally we realized things are a lot harder. And we aren't, we sort of saw the cracks in different systems. Sometimes they're the same cracks, sometimes they're a little bit different depending on context. Um so those were the observations. And what really fueled me, because I wouldn't generally describe myself as a patient person, was the leaders I met one-on-one or in small groups who genuinely believe in the potential of our health systems to deliver more equitable care at a population level, but who were so inundated by and overwhelmed with the day-to-day responsibilities they had that they could never think about what different would look like or the skills they would need to get there. So it was those sort of observations and those conversations and the inspiration of the people working in the system that was the impetus for the Learning Health System Leadership Center. And really what that center aims to do is to provide sort of a center of excellence to support health leaders, organizations, and systems around the globe in developing the capabilities they need to lead in the current context and to also create a sort of global community of practice over time where innovations or new models that work in one jurisdiction have a network through which they can be spread and scaled so that we can learn from one another more rapidly. Because although there are differences in how systems are structured, funded, organized, um, we're much more similar than we often allow ourselves to believe at first blush. So I really hope that, you know, if we do a Where Are They Now episode in five years, that we can really celebrate, you know, those leaders shaping the future of that center and it being responsive to what they need and what the systems they work within need those people to bring so that we can celebrate better outcomes five, 10 years from now.

SPEAKER_00 20:29

And I'm thinking that our audience at this point has got this clear picture of you with a career that emphasizes leadership and leadership development and all of the key skills. They may not be as familiar with a learning health system. And I wonder if we can dive into that a bit.

SPEAKER_01 20:48

Yeah, what a great moment to pause. So for me, at least that sort of first act of my career really clarified what learning means in a complex system. Because a lot of what I sort of came to be doing, I didn't know that's what it was going to be at the outset. So it was really about identifying or observing what was happening, identifying a gap, and then learning more about it through practice. So the simple definition of a learning health system is that it is a system that learns from everyday evidence to inform how decisions get made and how care is provided. And so it moves beyond individual projects or pilots or tools and is really embedded in day-to-day operations. And the two things I hear often in response to that are well, you know, don't we do that with quality improvement approaches now? And, you know, doesn't that exist in places and spaces today? And my answer to both of those would be. It's not a, they're not mutually exclusive concepts. If we take the science of quality improvement and scale it up to a system level where we're thinking about co-designing the solutions across organizational boundaries, across sectors, across jurisdictional boundaries, it's the scale at which that improvement happens and those plan-do study act cycles come to life. And the recognition that it's not just learning and doing new things. It's sometimes sustaining what we're doing really well. It's sometimes de-implementing or letting go of what isn't working so well. And then sometimes it's about building something new or innovative entirely.

The Five Gears Action Framework

SPEAKER_00 22:50

So learning from the everyday evidence, is there also a component of this that is bringing in evidence in the more traditional medical sense? So how we incorporate that more rapidly as well as the everyday operational evidence?

SPEAKER_01 23:06

Yeah, there's um the team that I work with a few years ago published what we call the Learning Health System Action Framework. And at the core of that action framework are five gears. And we're sort of getting to the point where we've, I think, made explicit most of them. The first is population health analytics or data. What do you understand about the people you serve or the patients in your practice and the people you don't? From there, we also want to incorporate evidence. And what we mean by evidence isn't just what we traditionally think about, scientific evidence, clinical evidence, but again, that evidence in everyday care. What can we learn from how we make decisions currently, the patient experience data we get, the rounding we've done with our staff? It's taking the lived experience of our patients, our workforce, what have you. It's taking all of that as evidence. And then those feed into a co-design cycle, a co-design cycle that includes anyone involved in reimagining how we work or organize care. That includes patients, caregivers, people with lived experience, clinicians, perhaps leaders, managers, anyone involved in ensuring something we do differently becomes the new way of doing things. From there, we want to use implementation science to wrap an evidence base around the new thing we're trying to do. Implementation science, for those that aren't familiar, is about the science of understanding how we implement something new in practice, ideally something that's already been shown to be effective, but sometimes you can assess that effectiveness in real time as you're implementing something new. And then the last gear in that framework is about evaluating and adapting. So it assumes that as you are rolling something out, you are going to need to sort of loop back to that initial data or collect new data or augment what you already have to understand how well this new model or new program is working, for who it's working, how well, where the equity gaps are and who might be missing. And then it's an iterative cycle from there. And what strikes me is that if I tie us back to the example of women who lead earlier, there is an underlying similarity of observe, you know, gather data or insights, and co-design with others what might be useful and start to act and iterate. One of the common critiques of embedding science or evidence within systems or policy and practice is that it takes too long. And so it also requires scientists, clinicians, leaders to sort of stretch the ways they work and realize that there will be thoughtful tensions to navigate in terms of responsiveness and rigor, prioritizing scientific advancement or practical relevance, system relevance. And so there's a sort of openness and ongoing appreciation for the fact that it's a journey and a way of working rather than a destination.

Paradoxes And Mindset Shifts

SPEAKER_00 26:40

And that leads nicely into my next question, where it's clear there's a lot of rich information that you and your team have to impart when it comes to leadership development and learning health systems. What kind of ideas, preconceptions do you need to help people work through or work around that are typically coming to you? And where and how are they coming to you?

SPEAKER_01 27:10

One of the most common things that I see, um, and I should sort of preface this by saying I'm a behavioral scientist and an implementation scientist. I study how and why things work with a particular interest in human behavior. One of the things I see the most is that individuals will come to me and say, you know, we're having this problem. You know, there's a real pull between efficiency and comprehensive care. Or there's a pull between the humanity in medicine and the advancement of technology or the adoption of AI. And so these things are often presented as sort of two opposing tensions. And sometimes the things we experience are in fact opposing tensions. Um, it is an either or. If we think about things like antimicrobial resistance, that's a population-level challenge that manifests patient by patient. And it's just the aggregate effect of those individual interactions that create a population-level problem. So I was intentionally descriptive there to help people try to lean back and say, where might there be something that I am where I am trying to resolve or prioritize which of these I need to choose. And what I ought to be doing is shifting the frame to it's not an either or what does it look like to hold both? And in what places or spaces might I be holding, you know, the patient as the priority? And and where might I need to hold sort of population health as the priority to continue with that example? So that's the number one place. It I spend a lot of my time thinking about mindset. I think in our system, whether you're a clinician, a leader, sort of an enabling staff and quality improvement strategy, what have you, I actually think a lot of the innate capability to solve our complex problems exist. We just don't stand on the right real estate in order to be able to access that in a collective way. So, to bottom line the answer to your question, people come to us because there is some complex, persistent, we haven't been able to figure it out over time problem. Um, and and they're hoping that by engaging with us and with the learning health system concept, that it will help them find a new way forward.

SPEAKER_00 31:20

Where are these people coming from? And and how do you uh maybe uh if there's a a specific example without naming names that that might illustrate this this whole process further?

Who Engages And How Work Starts

SPEAKER_01 31:32

Yeah, I to be honest, because the center is sort of still painting and decorating as we're hosting parties, to use a bit of a metaphor, um, there isn't a centralized intake yet. It's it's for for both the Institute for Better Health as a whole and the expertise around the learning health system, it's very much organic in terms of how people come to connect with us. They've either read about the Learning Health System Action Framework, they have heard myself or my colleagues, Walter Woechis, Laura Rosella, Carrie Kaluski, Ibakin Abigerinde, all of these great scientists, they've heard them speak in different places and were intrigued by the lens they bring to solving complex problems. And any one of those individuals can be an entry point. So candidly, as of right now, there is no go to the website and sort of answer the contact form. So I'm happy if anyone is sitting there curious to contact and or to connect with anyone rather directly. The types of people that come to us, it's quite varied. There are regional authorities. Sometimes it's an individual and it could be a chief of staff, it could be a chief human resource officer. We've had many CEOs reach out and say, How do I even start thinking about um helping my organization become a learning health system? So who it is actually varies quite a bit, and where the space they occupy in the system also varies quite a bit. We have people reach out from the United States because we're an Ontario-based organization in Canada. We have people reach out internationally from the UK and say, how is this working where you are and what have you learned? So there really is no one single archetype. Um, and I think that's part of it reflects the vision of a learning health system in its maturity because when we reach that level of maturity, it becomes the fabric of how we operate. And so learning becomes everyone's job. Sometimes it's an individual who just wants to upskill themselves. And sometimes it's those individuals I mentioned before who are in positions where their accountability is to set strategy, to advance the organization on a five or 10-year timeframe. And they're looking for support to do that in a more evidence-based way that will help unlock the capacity and capability of their workforce against the backdrop of a system where resources are stagnant at best and constricting at worst.

SPEAKER_00 34:19

And then you have on top of that something that you and I talked a little bit about in an earlier conversation, which is this phenomenon of burnouts exacerbated by the pandemic. Um I don't get the sense, although maybe we've we've breathed kind of a few sighs after the uh after the pandemic finished. You know, burnout levels remain high among frontline clinicians. I imagine that is consistently so amongst leaders as well. I'm curious what your experience is there and how that's influencing this landscape, maybe even holding us back from more effective leadership and making that transition to learning health systems.

Practical De-Implementation Moves

SPEAKER_01 35:05

I have definitely noticed the same. Um, I was having a conversation just the other day where I was standing across from someone saying, I remember during the pandemic when they were banging pots for us, and then all of a sudden that just um went away. And there was a phrase around that time, um, because everyone was calling people who worked in healthcare heroes, that I read that I might misquote, but it was heroes are what you call somebody when you ask them to betray themselves. And that really stuck with me and has sort of fueled a bifocal lens to not only thinking about how we build programs that support leadership development and frontline development, but also how we can systematically understand what it is about how we structure care, how we govern, how decisions get made, how things get prioritized, how we incentivize leaders and clinicians to learn, innovate, or improve. Because the leaders I have spoken to, and again, I can't remember if I started this question by saying I've had the same observation you do, are exhausted but still have hope. Um they never really got time to decompress when we emerge from the pandemic, however, we define that, or if we feel like we've done it fully. They are so deeply motivated to provide care today while also advancing the system tomorrow, which is another paradox that people feel. We can't choose between one or the other. They're both necessary. And part of how leaders can help others is by identifying where they can de-implement things or strip away some of the whether it's bureaucracy, ambiguity, where they can create operational transparency or clarity for others, um, where they can, you know, send something in an email rather than have a meeting, um, so that it frees up the time to think differently and creatively. The concept I want to put in people's mind as it relates to this is one that's called um subtraction neglect. So if it applies across healthcare as a human um phenomenon, if you give, for example, I put in front of you, here's a little Lego structure, and it was off balance. And I said to you, Jason, can you balance this Lego structure for me? Can you make it stable? The human tendency is to add something to that structure so that it balances rather than say, oh, well, let's take away the leg that puts it off tilt. And we do the same in life and in systems. We say, oh, there's a problem here. What do we need to add? What do we need to do differently? What do we layer on to our processes, our models, what have you? What new committee do we need to strike? What new initiative do we need to embed alongside the, you know, 40 others we've said are high priority for the year ahead? And what we need to deliberately develop the muscle for is first saying, what isn't creating value anymore? What's getting in our way and what can we let go of? Because it was a great idea at the time, but it's no longer serving us. And for a whole host of reasons, we haven't hardwired that mindset. Those conversations don't happen. And so leaders and clinicians alike, in year over year, just feel like we're piling more and more onto them. And at a certain point, people will break. Many have. Um they'll leave the system, they'll leave clinical care. Uh, and we can't afford for that to happen. And so we need to decide, or rather, be honest with ourselves, that we actually have agency to do something about that and figure out the sort of first step we can take. Again, um I didn't map it out this way in my head, but going back to the women who lead example, I didn't set out to build a not-for-profit. I just started with a conversation. And then, you know, things incrementally built from there. And I think if we take the pressure off of ourselves to deliver something world-class as a first step, that's how we're gonna find our way to better.

SPEAKER_00 39:44

The idea of de-implementation is I think gonna resonate really strongly with anyone listening who has practiced in healthcare. Whether you're leading quality teams and you suffer from project IDIS because it's easy to add more projects and they they tend to stick around, whether it's you know, administrative rules that hang on a long time or policies that get created and never get sunset.

Learning From Other Industries

SPEAKER_01 40:09

You know, it it happens to everybody. But if you're listening to this and you hear, yes, 100%, say it louder for the people in the back. I wish everyone that I could you say this to everyone I work with, my message to you is yes, we will happily say it to everyone you work with, send them this podcast as a start. But you have there, there is a way we all contribute to this. And so a bottom-up way of shifting our day-to-day reality is to stop doing some of the things that irritate us in and of themselves. Ask, you know, is this a meeting everybody needs to be at? Or can we tell some people it's optional and that they can reclaim the time? Have you checked that everybody feels like they're adding value or the format in which you're engaging provides the most value to people? Are you asking people to read, you know, a 75-page PDF in advance, or can you just clarify that we know your time is valuable? We will spend the first 10 minutes of the meeting highlighting the key things you need to know. Um, I think one of the things that has led to some of the best and most rewarding experiences in my career, it was born out of me realizing that I didn't have to create the same experiences that were driving me crazy. And sometimes it feels like our influence is really small, but that influence will ripple out to everyone who benefits from your approach to de-implementation. I mean, it is January 2026. What a great time to leverage the fresh start of a new year to say to your teams and the people you engage with, is this cadence and this format of coming together still working for everybody? Is there something different we could try? Do we switch from monthly to bi-monthly? And if we don't like it, we'll switch back. Do we scale down from 60 minutes to 45 because we find ourselves just, you know, catching up on the weekend? And we have other places and spaces where we can do that. So it really is about leading yourself before you expect others to lead, and sort of those small acts of courage and taking the first step in making things different.

SPEAKER_00 42:38

Yeah. Another thing that I imagine you've encountered when working with healthcare people is this idea that we are unique, uniquely complex, that we are special in the QI world. We hear this that, you know, for example, you know, a lot of QI originated from Toyota, and surely the tech the techniques that evolved in the automotive industry, you know, aren't sophisticated or complex enough, don't account for enough nuance to be used in healthcare. When does this belief help us and when does it hold us back from learning?

Potential Versus Performance

SPEAKER_01 43:15

Great question. I think it helps us when we are looking to understand more fulsely understand the problem. What's at play here? What are what's everybody's perspectives? No one else can add texture the way the people who are living the day-to-day can. You know, what I want to say to everybody working in healthcare is yes, you are special, but you can be so much more than what you are today. And one of the easiest ways to do that is to look outside of the sector, to look outside of your Profession and ask yourself, what can I learn from how others might tackle similar problems differently? And you're looking at the 40,000-foot level. You're not looking on the ground. The contexts aren't the same. But what you can learn is, you know, where are their other highly skilled professionals that have to consume a lot of information and make, you know, highly complex judgments and decisions based on their understanding of an issue? Where are their high-risk environments such that, you know, they similarly have never events or, you know, one mistake can have a catastrophic consequence? It's why healthcare learns from aviation. Where are there other industries that have really figured out how to get the most out of their people? Where are there other industries that have standardized processes and ways of working that they have either learned to automate or create efficiencies or scale in some way? And especially in the current context of AI, I've had a lot of conversations where people are worried about job stability and the future of their role. And I just want to layer on for a moment that AI requires a human interface. It requires judgment and decision making. And that is the sort of cognitive capacity to invest in and allow to be differentiated. And I can't think of a conversation I've had where somebody wouldn't be thrilled if I said, let's take the repetitive, monotonous administrative work out of your day-to-day so that you can use your brain and your strengths to think about something different. And there's another, I mean, maybe it feels like more than a small act of courage for all of us to believe in our potential so much that we can let go of the things that we don't really love that much, to be honest, and the things that often drain us. And instead of protecting against the loss, we walk towards the gain of something better, something more meaningful, a better use of our skills and intelligence than some of the things we're spending our time on today.

SPEAKER_00 46:31

Well said. I've similarly found it hard to hard to imagine a time where even just the complete needs of the population to have healthcare taken care of are met, let alone exceeded, and it feels like pretty good job security for everyone for a long time. Appreciate that perspective. You also kind of touched on there something that I think is a is a pretty big passion of yours, and maybe you can elaborate a little more on this gap between potential and I guess potential and actual uh performance or yeah, potential performance and actual performance. Can you tell me a little more about that and how that kind of intersects with with your interest in your work?

SPEAKER_01 47:17

Yeah, I would actually say um it doesn't just intersect with, like it is the the foundation that drives me. I, in all aspects of my life, much to some people's um displeasure, perhaps, cared deeply about closing the gap between current performance and potential. And I'll give you a really small example just so you know how widespread it is. I went to a basketball game earlier this week with my eight-year-old son. Uh, for anyone else who is a Raptors fan, uh, they were playing the Philadelphia 76ers. It was a Sunday, 6 p.m. game, so great game to take my son to. It went down to the wire and went into overtime. And so there was five minutes of overtime, and Toronto ended up winning the game by one. Multiple times during that overtime period in the last sort of two minutes of regulation time, I would lean forward and put my head in my hands, or I would, you know, hold my fists together in frustration. And my eight-year-old at one point, I looked over and he looked a little alarmed and he said, Mom, are you okay? And I said, Yes, buddy, I'm fine. They're just capable of so much more than they're doing right now. And it is hard to watch somebody who has put so much time and effort and attention into something not realize their full potential. And we all have bad days. So I'm not suggesting that I expect everyone to show up at 100% every day. But I care deeply about the conditions, understanding the conditions within which we can perform at our best, the capabilities we need to perform at our best, and what it looks like to move beyond performing, you know, as out as um my own best, as Laura's best, and performing collectively as part of a team is the best, because the this um the sum is greater than its parts, or the whole is more than the sum of its parts. Is that the you got it that time?

SPEAKER_00 49:18

Yep.

Questions Leaders Should Ask

SPEAKER_01 49:18

There we excellent, thank you. Um I was like, I know there's something that isn't rolling up my time the right way. And so, you know, this it's I'm so driven by this that after many years of the research I was telling you earlier about using data to improve feedback, I actually went to get my certification as a coach because I said it's not enough for me to advance the science. There's something I'm missing about the practice of helping people see and believe in what they are capable of and develop the courage to take a step towards the person that they want to be. And that isn't about asking individuals to work harder or do more. It's about helping people understand where their learning efforts belong and where it doesn't, who they can learn from or the or the sectors they can learn from. And the there are things that will stay hard. We're still going to be navigating ambiguity, we're still going to see slower progress than we want in some domains, but it really is um similar to compound interest. You know, if we start today, um, humans underestimate what they can accomplish in a year and overestimate what they can accomplish in a day. Um, and so I'd really encourage people to think, you know, if I just deposit a little bit each day, each week, whatever feels feasible, and then you revisit sort of a note to yourself in January 2027, you will be astounded by what you can accomplish in one year if you are deliberate about understanding where you need to double down, where your energy isn't creating the value it could, and what really matters to you such that you're willing to keep pursuing it when someone says no, or when a door shuts, or when you don't immediately see the path to better. Um, because we need more of those people in healthcare who, you know, I think that that coalition of change makers is growing. Um, but it really does take people who are values-driven, willing to accept that there are things we cannot choose between, and rather, you know, polarities that we need to hold together, um, and who are sort of relentless in their pursuit to understand what the best version of themselves looks like.

SPEAKER_00 51:49

If a leader wanted to start behaving more like a learning system tomorrow, what's one small but meaningful shift they could make?

Co-Design For Lasting Change

SPEAKER_01 52:00

I think it's all about the questions you ask. And I'll list off a couple. Um, in that learning health system action framework paper I referenced, we actually put the questions and um operating units, you know, who you might partner with in the hospital to help answer those questions. So if anyone's looking for a little bit more, you can find some of that specificity there. But asking questions like, who are we serving now and who aren't we serving? What is the problem we're trying to solve for? What would it look like for us to achieve better? What are we doing today? Um, who needs to do what differently to get to better? And why are things the way they currently are? I think there's a the number of meetings I'm in where I say, I'm sorry, I just need to pause this for a second. What is the problem we are trying to solve? And nobody can answer the question. And it's not because they're not brilliant people, it's because nobody stopped to ask it. And it wasn't framed at the outset. And that question, you know, I think that's the number one thing you can do as a leader is say, what is the problem we're trying to solve for? And every time you come together around that, re-anchor to it, you know, as we kick things off, just anchoring us to the problem we're trying to solve for is X. It gives you focus and discipline. It helps protect against scope creep because you can say, yes, Jason, that's a great point. It's out of scope for this question, but let's make note of it and come back to it sort of once we see this through to completion. If I simplified it even further, I would say in every meeting that you're in, just ask one what or how question. What do we hope is different? How would we know we're successful? What matters most to us about this? Those types of really simple short questions are so powerful. But when you ask them, don't take the silence that follows as a negative signal. Take it as a positive signal that you are reorienting people and refocusing their attention in a way that hadn't been done previously. And it will help get the most out of the people in that conversation or around the table.

SPEAKER_00 54:30

Yeah, I'd love I'd love to lean into that because what you've what you've said is is part of your answer there was a really great application and maybe slight rewording of the model for improvement out of IHI. Um so what are we trying to accomplish? How will we know that a change is an improvement? And what change can we make that will result in improvement? That's that's such a tangible piece that that any C XO, you know, CEO, et cetera, could bring to their system. And I guess importantly, because this podcast is largely about building influence, building uh you know, creating improvement um among people at all levels, frontline and and otherwise, that sounds like a framework that would be pretty easy to apply if you're in any nurse huddle, any meeting, any problem that we're looking to tackle with the most authority in the room or the least.

SPEAKER_01 55:30

The one I'm gonna knit together that great comment with one of the questions I said. If we're asking what change do we need to make to improve, we need to follow that up with how do we know that that's the right change? And if we think back to the learning health system model, it's the co-design piece that's often missing in at least the quality improvement initiatives that I've seen. We're making assumptions about what the right change is. And it can be as simple as stating the change and having a few quick conversations to validate. You know, if you need the unit clerk to do something different, well, then ask them what you might be missing about that change. Is it incomplete? Is there something you need to support implementation of it? Getting buy-in for that change and allowing a diverse set of voices, including patients, families, communities, um, to inform that sets you up for the improvement at scale that you're hoping to have. Too often in healthcare, I think we sacrifice, you know, comprehensiveness. And by that I don't mean let's take three years, but we we sacrifice the sort of systematic approach to engaging multiple voices to understand what we've got right and what we were blind to for speed. But the result of that is that we end up having to try to save this, solve the same problems year after year after year after year. Uh, and so it really is, you know, if you want to go fast, go alone. And if you want to go far, go together.

SPEAKER_00 57:11

Well said. And in the spirit of what you you thought earlier, I couldn't resist adding with this language of what change can we make. I I wonder if we almost substitute the word change with what can we add or remove, something like that to to kind of further codify this de-implementation idea. Because I I've been struggling to think of how I could how I could coach people or how I could kind of nudge people in the right direction of how do we make this project about either adding, which which can be valuable, or removing. Um but I love I love this framework. It feels really concrete for somebody to be able to take back to their system right away and make impact. What does your center look like in five years if things are going the best they could be?

A Five-Year Vision For The Center

SPEAKER_01 57:57

What a great question. Um I also can't resist the urge to say, I think I want to edit your question even further and say, I think I would challenge us all to say, what do we need to remove before we have the space to make something better? Because sometimes we might be adding something to remove administrative work, but it will go a long way for the workforce, um, no matter what your role is, to be clear that you're making something easier. You're taking away effort before you're adding net new. Back to your question of what the center looks like in five years. I often, in coaching conversations, will, you know, coach people to get at the answer to that question by saying, What are you seeing, hearing, and feeling? And I, so I'm going to take that same approach in answering your question. Uh, in five years, the center is a global network. And what I'm seeing is an exponential growth in the number of people who have developed the capacity and capability to connect across systems, to connect across departments or organizations who are sharing things sort of in near real time. I think we would see a shift in mindset in two concrete ways, three concrete ways. One is moving beyond describing things as tensions and embracing that this is just the messy reality of healthcare and we need to pursue sometimes dual objectives together. It's about both. The second is a more routine integration of evidence. So the things we might see are people talking about the scientific evidence or talking about the patient and family stories or experiences that are relevant to the problem at hand, or engaging with community organizations or groups that, you know, have the day-to-day experiences of what is missing in the system that lands people in the emergency department, for example. Um, so seeing evidence as part of routine conversations. Um and the third is is really about shifting from a workforce that feels exhausted, feels unsupported, doesn't know where to turn to, to one that feels like they are on a concrete path to better. They're less exhausted than they were five years ago. They're energized because there are clear pathways to plug into clear places to learn, clear ways for them to contribute. And the types of things the center will be doing to support that, you know, will probably evolve a lot based on the iterative feedback we get from participants. But it'll be workshops, it'll be supporting organizations with coaching, it'll be helping, coming in to support people and lifting those learning networks, um, giving them the support they need to get off the ground, and then letting them be great independently. You know, I really hope in 10 years the center sort of puts itself out of a job and adapts to what the system needs in 2036. And I really hope that's different than what it needs in 2026.

SPEAKER_00 1:01:21

Yeah, what a what a hopeful picture to uh to paint. And uh, you know, you you've assigned yourself uh a really important and uh no doubt very challenging task. What gives you the most hope right now?

SPEAKER_01 1:01:35

The people. What gives me hope is that there's no ambiguity around what matters most. Um, what matters most is providing better care. What matters most is helping people receive care when they need it, age in place at home. You know, it it's we could talk about all the different ways that better care can look in a person-centered way. But what energizes me is the people I connect with have so much potential. We don't need to reskill the entire workforce. We have so much uncapped intelligence and capability now. And what excites me and energizes me is finding the ways to unlock that, both one person at a time and at scale. And it doesn't matter, you know, I'm fine if we're wrong. Like I'm fine if we try something and it doesn't work. It's not the product that I see clearly, like the services the center offers. I have ideas of where we start. We've got a pretty clear plan there, but it really is the outcome we're driving towards. And I believe as leaders, we don't get to control or prescribe the path we take to get somewhere and the outcome it produces. You can again have thoughts about both, but if you're holding the outcome true, you have to be flexible and adapt with how you get there and responsive to the data you see, what we're learning in evidence and what you're hearing, because to continue to do the same thing over and over and expect the outcome to be different is the definition of insanity. And so year to year, I think how I'll know we're at least operating the way we should is because no two years look the same. We're constantly tweaking, adapting, um, scaling the things that seem to be working well and iterating on what can be improved, and you know, possibly de-implementing or leaving behind the things that people don't really want or aren't really useful.

SPEAKER_00 1:03:48

I think that's just such a great place to leave the conversation. And we've gotten a really rich, concrete, and very hopeful view of where this is going, where this can go. For listeners who'd like to follow your work or connect, what's the best place? Uh LinkedIn or a website or somewhere else?

SPEAKER_01 1:04:07

Yeah, they can find me on LinkedIn. Um, it's they can just search my name. I'm the first person that comes up, or you can reach out to me uh at Laura.devot, so firstname.lastname at thp.ca, and I'd be happy to connect.

SPEAKER_00 1:04:20

That's great. And uh any uh we'll we'll link to those as well as any of the uh resources we've talked about in this uh in this recording today. Laura, I really appreciate this conversation. You've you've clearly painted a picture for us as to what this what healthcare can really look like in the future, how we can help our our healthcare workers and especially our leaders um go from from potential to performance. Thank you so much for your time today.

SPEAKER_01 1:04:45

It's been an absolute pleasure. Looking forward to the next time.

SPEAKER_00 1:04:50

Thanks so much for listening to today's episode of Leading Quality. If you enjoyed the show, please take a moment to like, subscribe, and share it with someone who might find it useful. You can find all our episodes at leadingquality.bugspoke.com or in your favorite podcast app. The show is written and hosted by me, Jason Mell, edited by Milan Milo Savievic, and produced by Thrive Healthcare Improvement. See you next time.