Taking Healthcare by Storm: Industry Insights with Dr. James A. Johnson Jr.

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with James Johnson Jr., PhD, MPA,  a Medical Social Scientist and a Professor of Health Administration and Policy in the School of Health Sciences at Central Michigan University.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-ARPA-120624-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

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Hello, everyone, and welcome to Taking Healthcare by Storm. I am Dr. Jean Storm, medical director at Quality Insights, and today I have the privilege of speaking with Dr. James Johnson, a distinguished medical social scientist and expert in international health systems and organizational development. Dr.

Johnson is a professor of health administration and policy at the I'm so excited to welcome him to the school of health sciences, where he teaches vital courses on comparative health systems and systems thinking. He is the founder of the first doctor of health administration program in the United States, and is authored over 100 journal articles and 15 books, including comparative health systems.

Global perspectives with extensive experience working with the World Health Organization's World Health Organization and various global health initiative. Dr. Johnson has traveled to 35 countries, engaging students in international service learning and research. His contributions to health administration have made a significant impact, and I am excited to hear his insights on healthcare quality improvement, organizational behavior, and the lessons learned from the COVID pandemic.

Dr. Johnson, thank you so much for joining us today. 

Well, thank you, uh, Dr. Storm for that, uh, very nice introduction. Um, I'm glad to be here. 

Great. So just first question jumping in, tell us how you came to do what you do. 

Yeah, appreciate that question. Um, Well, I went to, I did my graduate work, my PhD work at Florida State University, which has a very well known school of social sciences.

So I was housed in that school. So when you do that, when you do a PhD in social sciences at FSU, and there are others that have the, Berkeley has one, Northwestern University and so forth. But anyway, when you do that, then you. focus or specialize. You're taking courses, or I was taking courses, in economics and sociology and anthropology and on and on and on.

So what you do is carve out a, you know, a focus area. My focus that I chose is health policy and adjacent to that would be health administration and global health. So, uh, and by doing so, you know, Look, a lot of courses and these other other disciplines. Well, coincidentally systems thinking, which is something I have a level of expertise in systems.

Thinking is also interdisciplinary multidisciplinary. And, uh, so it aligned perfectly with my graduate level education without any serious anticipation that this is the kind of work that I would be doing. So I feel fortunate that all of that lined up, um, quite nicely. Um, and then after leaving there, I, uh, I was recruited over to the Medical University of South Carolina.

Um, worked there and was the chair of a department, health policy, founding chair actually, the health policy department. But my collateral appointment was, uh, in family medicine. So, uh, the nice part of that is family medicine is already well grounded within the whole field of systems thinking. As you know, they use the biopsychosocial model, they think of families as systems, the individual is embedded within that family system, which is embedded within a community, and so forth.

So once again, uh, without even anticipating or planning this, I was put in the kind of perfect place or the perfect, uh, setting to keep developing my understanding of systems thinking and how that interfaces with, uh, social science. It's in particular medical, social science. I, social science is so huge, but you know, my focus is in medicine and the application of medicine and in, uh, social settings like families and communities and countries and and so forth.

So then. After 15 years there, I was recruited to Central Michigan University, uh, to join the faculty, and, and I have remained since. I also have appointments at St. George's University down in Grenada, branching out more into the international or global community, and, uh, teach, actually, out of my book, comparative health systems.

teach a course, developed a course down there for them as well. Um, I, I think I'm leaving out some things, but that's, that's the, the basics, the basics of, of how I came into this. 

You are definitely a busy person. I have 

been. 

Yeah. You mentioned your book, comparative health systems, global perspectives. So what key insights did you discover about the strengths and weaknesses of health systems in different countries?

Well, all systems, all health systems in the world, everyone, there's no exclusion to this. Every one of them has strengths and weaknesses. So you may hear, you know, someone from Germany talking about they have the best health system or I have a son who lives in Norway. They talk about their best health system or my friends in Canada and so forth.

And yeah, in a way they're right, but in another big way, they're wrong. All health systems have deficits. All health systems have weaknesses. And I think this global, the global pandemic that we have all gone through recently exposed that. It exposed a lot of the weaknesses within health systems, big and small.

Small countries like Norway, large countries like the United States, um, underdeveloped, uh, countries, you know, say in Central Africa, uh, highly developed countries like Germany or whatever, um, they all had weaknesses exposed. you know, as a result of the pandemic. In some ways, that's because we as a, as a world, as a planet, we're not prepared for this.

We had had, you know, the 1918 influenza pandemic, uh, So severe it basically shut down World War II. I mean, so many deaths from that, maybe perhaps upwards of 50 million people worldwide during that pandemic and then the next, the next really significant and it's still occurring would have been the HIV AIDS pandemic.

It started in the early 80s and like I say, it's still with us and, uh, You know, that's a very long standing pandemic, uh, one of which, uh, you know, we're, we may be close to resolving or bring it to closure, but we haven't yet. Um, so, you know, coming out of that history, it's somewhat surprising to, no, it's not really surprising.

It was alarming to me as a social scientist that we weren't, you know, as prepared globally as, as I think we should have been, or perhaps could have been. We have global institutions like World Health Organization and World Bank and others, and they, they often work quite, you know, well, uh, clusters of countries working together.

But for whatever reason, despite some canaries in the coal mine, so to speak, whatever reason, even these big global agencies were not. Uh, prepared for this pandemic and having experienced HIV AIDS, you know, um, the large agencies could say, okay, well, with enough funding with prophylactic, uh, treatment and development and so forth, you know, we can kind of muddle through, work our way through this even in the absence of a vaccine.

So that was HIV AIDS pandemic, but that's not directly applicable. To something that's spread throughout the general population the way that, uh, COVID did. And we just weren't ready for that. Uh, we had not brought forward, I think I mentioned to you offline, um, sometimes USA is referred to as the United States of Amnesia.

And this is especially true in public health and global health. And the lessons that we needed to bring forward from the 1918 pandemic, we, we just did not do that. And, and hopefully in the future, we will bring the lessons of COVID forward. Um, and, and it's HIV AIDS and, and, and, uh, 1918 flu are not the only two examples.

And we've had others. We've had SARS and we've had, um, you know, well, we still have monkeypox ongoing and we have Ebola and some others, but they were more in the realm of COVID. Epidemics as opposed to pandemics. Pandemics ultimately spreading throughout the entire globe. 

Yeah, I would agree. And, and I, I, I want to kind of continue on this vein, um, with the COVID pandemic, if, if that's okay, so, you know, just reflecting on, you know, you've, you've talked, and I would agree with you about the United States of amnesia.

I think it's, It's pretty easy to try to forget things that, um, that are unpleasant as I maybe that's why. But, but reflecting on the COVID pandemic, what major lessons do you think health systems globally have learned about preparedness and response? 

Yeah. Globally, which implies a macro level of knowledge, uh, we, we learned that with pandemic, emerging pandemic, epidemics that are, have the likelihood of emerging into pandemics, we need to mitigate very quickly.

Uh, so, you know, that's one of the big lessons. Another big lesson is that we need to work together as a global community. no country in isolation can truly manage a pandemic, our borders are porous. Um, I have one of my students that was, that did a study of ports of entry in, uh, Ghana in particular, and, and ports of entry coming from Liberia and other places nearby, nations and so forth.

And, and they had seen this actually with, um, Ebola too, not just the more recent, uh, uh, pandemic, but, uh, borders are porous and disease, especially diseases such as, uh, uh, pathogenic diseases. Uh, they don't, they can't see or understand what a border is. They come. They come through ports of entry, and that was the point of his dissertation.

It's not just simply migration. It's not just simply people crossing borders illegally. He was looking at, his study was looking at airports and bus terminals and so forth, you know, kind of standard ports of entry, and each of which have been carriers, um, unknown. You know, and thus the disease finds its way in, as it does with the human body.

As you know, as a physician, um, we have many ports of entry for the human body as well, and, and disease, uh, finds its harbor. And, uh, so pathogenic disease does. Now, You know, at another, maybe in another podcast, we can talk about non communicables because that's a whole other, whole other topic, but the pathogenic things like COVID, um, you know, they find a way in, and so they cross borders, and they cross barriers, so, you know, we use masks, of course, uh, gloves, uh, and social distancing, and those kinds of things.

Well, in some ways, those are de facto borders. They're barriers, but the disease, the pathogen, finds its way, and, and thus, you know, the human, um, has a very receptive, in some case, a host, in some case, a, a victim, if you will, of the pathogen. Uh, and because the pathogen is crossed macro level country level borders as well as personal level borders, and it finds its way in and that that to me is one of the big lessons.

Now, there are ways to mitigate. One is that you. have enhanced barriers and understanding of barriers like mask and so forth. The other one is that you develop a treatment quickly, uh, because if you can treat, then you're going to reduce the spread. And then the other kind of the gold standard would be vaccine.

We have, we don't have that with HIV AIDS. We do have treatment. We do have barriers. And those are working quite well, but we still need a vaccine in that case. Now with COVID, we have the vaccines and we got them very quickly. It was really amazing how quickly those were developed outside of the norms of FDA.

And, um, you know, so. And then the whole world benefited from that because as a planet, as a globe, as something bigger than a country, we're all very interdependent. And this goes to my work in systems thinking is an acknowledgement, recognition, and vigilance about that interdependence and interdependence on the, on the receptive, meaning the, um, the disease spread side, but interdependence also on the mitigation and treatment side as well.

And, and I think, I don't know how if, you know, I'm a professor and if I was going to give the world a grade, it wouldn't be an F, it wouldn't, probably not a D, it would, but it wouldn't be any higher than a C. I, you know, I don't think we, uh, perform to the level that we need to. The next time and believe me and you know this, there will be a next time and it could be some variant of a coronavirus just like COVID is just like SARS was.

I mean, I, I don't know. I don't, I don't, you know, as a social scientist, I don't like to do predictions, but I do, you know, in a kind of general conversational, uh, statement, I will say there will someday be another, another pandemic, maybe already emerging. 

Yeah, I would definitely agree with you. And I love to think about, you know, thinking about every, everything is a system and, you know, all interded all, you know, depending, um, yeah.

So, you know, a little bit on that vein, thinking about organizational behaviors, how do organizational behaviors within healthcare institutions impact the quality of care delivered to patients? 

Right. Well, as you just indicated, organizations themselves are systems. Everything from the human body all the way out to the organization all the way out to the country and these different levels of systems, all interfacing.

So the organization as a system is interfacing with the world. It's interfacing through patients, through staff, through community leaders, through politicians, through policy, all of these kinds of things. So the organization never sits in isolation. It's not an island. Uh, it's interactive. It's In some ways, organic is forever changing.

So the organization, because of its interface and because of its systems nature is going to always be, um, an opportunity, if you will, uh, for more effective management to manage that system more effectively. Now, when one seeks to manage systems, there are a few fundamentals that are needed. One fundamental would be leadership.

Another fundamental would be information, accurate, timely information. And then another fundamental would be the ability to work as units, as teams. Um, and so if you have leadership, the teams and the information, all as inputs into the organization, you're more likely to have better outcomes, more improved outcomes for that organization.

Now with COVID with that particular pandemic. And also with HIV, AIDS and 1918 flu and all these other examples as well, um, there were information deficits. So the organization is trying to adapt. But it's not always, it's not adapting to timely and accurate data. It's, it's adapt, it's a lot of guesswork.

And so that's where the leadership becomes even more important because the leader at best would take the organization in a direction. The leader could not No leader in the world would be capable of making all the decisions. The leader has to build a team and preferably multidisciplinary has to build a team that can, can broaden that leader's scope and ability.

And so with that in place, the organization is more likely to adapt. Secondly, or thirdly, uh, in that adaptation process, the organization, uh, needs to recognize itself as a system. Uh, it's not that organizations have consciousness, but who knows? I mean, with new physics and, and co locality and some of the things that we're looking at now about intelligence and especially artificial intelligence, you know, maybe the organization itself does have some By some definition does have an intelligence and therefore because of that, you know, it can be, uh, empowered and enlisted to be part of this vigilance process, uh, so that it's dealing, you know, from a higher state of awareness.

That all might sound kind of strange, but, uh, organizations are indeed kind of strange. You know, there's no calculus, there's no trigonometry, there's not a lot of precision with organizations, uh, their social phenomena. And, you know, so therefore, because of that, um, the leader has to be willing to suspend their embrace of precision and do what one can.

And that's where, you know, systems thinking and systems tools that we've developed, uh, are quite useful. We use causal loop diagrams, uh, BOT analysis behavior over time. And, and we use these tools and they, they kind of help, they augment the more natural judgment of a, of a leader and their team. Uh, so it all interplays, uh, effectively when we take that systems thinking approach.

I will just say, I think that idea of an organizational consciousness, I think that's fascinating. I mean, you know, That you think about like a beehive like it really does function almost as a single consciousness, but there's obviously individual, many individual parts. So yeah, it's fascinating to think about.

Well, even the 

cell, the cells in your body or the bacteria or the biome and you're within your own body is there, it's all coordinating. So there's a consciousness there. And, uh, even though there might be a trillion cells or thereabouts or something, 800 billion, whatever it is, um, they, they, They're communicating.

And if they're communicating, they're going to coordinate. If they're coordinating, they're interdependent. So it all just, you know, ties together. That's why I use the phrase loosely, the new physics, our quantum level understanding of physics is not simply for spaceships. It's not simply for exploring, uh, Venus.

I mean, it's, it's for here, the here and now. The up close and immediate biological, sociological experience that we're having as human beings. 

Yeah, I agree. You touched briefly on leadership. Yeah. And so you're a professor in health administration and policy. So what do you feel are the most pressing topics that future healthcare leaders should be aware of and focusing on?

I think, uh, number one, the leader, everything kind of cascades from what I'm about to say. The leader needs self awareness. A leader needs insight, self awareness. They need to know who they are before they can start building a team or organization. So, so the first, principle, if you will, is also the most challenging.

None of us are fully self aware. I mean, I, I don't know, maybe, maybe there's somebody out there. I know I'm not. Um, but we can work toward that and build that, build our self awareness. So we would appreciate Input and feedback interaction. We don't want we as a leader, we would not want to dissuade that we would want to encourage that because those provide back to systems thinking that provides feedback loops into us as a micro system, an individual who is a human being and a leader concurrently, but also into the more macro systems like organizations.

Um, so that's 1st and foremost awareness, self awareness. Secondly, and that includes receptivity to information, ability to change, and so forth. So that does lead to the next thing, and that is, uh, the leader has to Embrace, foster, encourage, support, change. Um, as Albert Einstein once said, so often other people quoted, uh, change is the only constant.

Change is constant. And the leader needs to be aware of that. That means people, his people, or her people, her budgets, her, um, staffing, the policies coming out of Washington or state capitals or wherever they may be coming from. All of that is just an amalgam of change. And the leader, if the leader's uncomfortable with change, the leader becomes static.

And if a leader becomes static, they can't grow. So there's not a lot of stasis in the world. You know, even a brick is not truly static. So anyway, a leader has to embrace change and foster it, encourage it, support it. As part of that or an extension of that would be the leader embracing and supporting teams because health care may be more or as much as any other field, certainly more than say, banking or or some other field.

Health care is truly interdisciplinary and. You know, the leader would need to build, help build, uh, interdisciplinary teams and defer to those teams to do the necessary work to, to, to be fully empowered in their, from their interdisciplinary perspectives. Uh, I think leaders also need courage because a leader is going to often have to say no, or the courage to say yes.

You know, sometimes the hardest thing to say is yes, not that no, but the leader has to be willing to do that. And the leader has to, as a result of that, sometimes, um, question hierarchy that currently exists because the hierarchy that exists in 2020. wouldn't serve an organization immersed in pandemic in 2021.

So questioning these hierarchies, being willing to, to, um, facilitate their change and responsiveness would also be an important attribute. Uh, as well, I, you know, as one who comes out of health policy and health administration, I do advocate that leaders have grounded educational grounding and health administration or business administration, organizational behavior in particular.

I think that's very important that that allows for the leader to have a foundational understanding of that, which they're involved in and working with. Um, I'm sure there's more, um, Those were 

really wonderful. Perfect. So, can you, um, share with us a specific international health project? I'm really interested in international health.

Any, yeah, that you've been involved in that has, that had a significant impact on a community? 

Yeah, so one that I started, I was the founding, founder of it, uh, is a project in Belize in Central America. And it's overarching purpose is a diabetes mitigation. But it also serves as a platform for students to come to Belize and engage in service learning.

in rural and remote villages. So we set up free clinics and this is close to Guatemala. We don't, we don't, when, when patients come into our clinics, we don't have any questions about insurance status or which country they're from or any of that. They're totally open clinics. who wants to can come. And we do health assessments and, and diabetes education.

Why diabetes? Because Belize and much of Central America, uh, diabetes is, uh, anywhere from number one to number three cause of death. Um, so, uh, that's the added risk. Why the focus there? We could have also chose HIV AIDS, or we could have done little spot micro clinics on dengue or whatever, but we chose diabetes to be the primary focus.

And we had to get that approved by the ministry of ministry of health. And they have partnered with us from the very beginning. So they provide, for example, physicians that I don't, I don't take physicians down. I take students and a couple of other faculty members, but the physicians are staffed by Ministry of Health.

And that's very good because the patient comes in. They're curious about their general health status. They, you know, get feedback, counsel from us about things like diabetes or hypertension or whatever. Sometimes. They need to see a physician then and so with these MOH, uh, physicians within our clinics and sometimes it's only one, um, then, you know, we're able to refer them and then sometimes even help transport the patient to hospital or clinic, not clinic, but laboratory.

I also take nurse practitioners and they, you know, they see the patients. We do home visits as well because so many patients, and you know this, you know, with diabetes, there can be impairment, walking impairment or limb, loss of limb and other kinds of things. So there's limited limits on mobility. And so we, we go to the homes and I take small teams of students and clinician, nurse clinicians, and we do.

on visits as well. We keep track of all the data that we're collecting and we feed that back into Ministry of Health. And, and as a result of this project, other universities have been taking students down and all of their data also goes back to, um, Ministry of Health. And, and the projects have expanded beyond, um, you know, just primary care.

And also there, there's a couple of universities that take dental students, a university that takes optometry and ophthalmology students and, you know, focus on eye care, um, and or dental care. Uh, so it's expanded clearly, but it's been running for 20 years. And. That fits well with my nature. I mean, I could, I could share a couple of projects I've done.

Uh, collaterally with the WHO, but that's the big policy level kind of things, and that is exciting to me. Don't, don't, please don't misread, but when I'm really animated and elevated by what I'm doing, that would be the projects like the one in Belize. Very community based, very on the ground, and, and just seeing true benefits.

And of course, documenting that. So that would be, uh, that's the one I'm most proud of. 

I mean, you should be, just to find this tremendous meaning. I mean, finding meaning in your work is what, you know, is basic, basic, you know, human happiness. So, I mean, and that is amazing to have that big of an impact. 

We were there just this year and, uh, in March of this Oh, yeah.

2024. So, uh, amazing. Yeah. 

So I could talk to you, uh, for hours and hours, but we don't, we don't have hours and hours, but hopefully I would, I'd love to bring you back on the podcast. Um, if you would come back, but I have one last question that I would love to hear your input on. So if you were in charge of healthcare in the United States, what is the first thing that you would do?

Well, having a certain level of maturity, I've learned to experience the very first thing I would do is to build a team. I, you know, we're all so limited, um, in, in our knowledge and our capabilities. And I would, I would build a team. I would bring together a team and whether I was working for a a prime minister or president, um, almost irrelevant.

Either way, I'm gonna need, I'm gonna need a team. And that team would include, in addition to social scientists like me, that, that, including epidemiologists and biostatisticians and physicians and other clinicians and Currently what we're advocating through WHO, um, teams that involve people with expertise in animal health, like veterinarians and so forth, um, because we see so much zoonotic, um, disease.

And so it would be a multidisciplinary team. That would be the very first thing, and, and I would have to tell the Prime Minister or the president. You know, I, I need time to build my team. I can't go to work immediately. If you want, someone is just going to jump in immediately and start to work, you know, probably better find somebody else.

I need my team. I know my limitations. And so that would be first and foremost. Um, then I would shift into a. An incredible 24 7 data consumption mode to try to better understand the population or populations that I would be working with or that my team and I would be working with and that data consumption would be shared amongst our, our group, kind of, you know, the working group, so to speak, and.

Using that as a basis or a foundation, we would begin to develop some strategies. Um, and strategies are often vague. They're not really, they often lack precision because they're, they're emergent. And so we would have these strategies and they probably because the prime minister or president, they would probably want, want us to have some goals and that's fine.

And goals are things you work. For, toward, and moving forward. And, uh, so those are, you know, that's what I would do. And that's, you know, that doesn't come, that's not a response you would get necessarily from a hospital CEO or executive director of, uh, FDA or whatever. I mean, they come from a different perspective.

So, as a social scientist who's taught health administration for nearly 30 years, uh, And has written books on the topic, quite a few, um, that's how, that would be my response. And, you know, some prime ministers, you know, they'd say, yeah, that's what we want. And others would say, no, no, that's going to take too much time.

We need you to jump on this right now, which I just wouldn't do. I don't, there's a real good older Harvard Business Review article titled Set Up to Fail. I would not set my team up to fail. We have to have a little bit of time to understand that which we're about to jump into and that which we're about to develop strategies and ultimately policies for mitigation.

Yeah, I would, I would agree with you. Give team and time and assessment. There you go. Yeah, very basic, but very important. Dr. Johnson, thank you so much for joining us today. It was, it was a delight. I mean, I, I just, I mean, I was thinking about, we had a little conversation, um, offline talking about organizational consciousness, and maybe we can talk about that on the next podcast.

I would love to. 

Yeah, sure. I would be interested in that and it's been a great pleasure. Glad to know you. We have a friend and a mutual friend, Richard Greenhill. Yes. Yeah. 

Yeah. Rich is our Chief Transformation Officer and we're very happy to have him. Transformation. 

There we go. 

Yes. Yes. Thank you again.

And um. Okay. All right. Dr. 

Storm. It was a pleasure. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.