Dr. Matt Sherrer (Host 1): Welcome to this edition of The Fresh Flow Podcast, Mitchell. What's shaking, brother?

Dr. Mitchell Tsai (Host 2): Not much. It's Friday.

Host 1: It Friday. That's right. Get hype! Well, anybody that listens to this show knows that at the beginning, I try to stump Mitchell up. But full transparency, I actually gave him a heads up this time, because this one's important to me. I've been reading from Strength to Strength by Arthur C. Brooks. It's about moving from striving in your career towards mentorship, right? Towards passing on all the knowledge that you've accumulated over the years.

And Mitch, you're one of my mentors, man, and I'm tremendously thankful for you. You've said numerous times your job as a mentor is to take me to the end of your capabilities and then throw me as far down the road as you possibly can. So, see? I did listen. But I know mentorship is important to you. Who are you mentoring now? What's your strategy at this point in time? Well, who is Mitch Tsai mentoring today and how are you doing it?

Host 2: That's a tough question. I think, for anybody that knows me, I try to mentor every day. And it could be a medical student, a resident, a colleague. You know, I have a colleague right now in my division who's going for promotion, right? So, how do you connect these individuals to the rest of our specialty and then maybe even the world?

But let's go backwards, right? Instead of looking forward, we're going to look backwards. And I just want to give a shout out to our guest today. And I can tell you without a doubt, the people that mentored me when I started my career in the specialty are the CRNAs and AAs that I worked with, right? They made sure I didn't get in trouble. And in a lot of ways, they taught me what the meaning of leadership really is. And that's just somebody willing to listen to you, and that's a two-way conversation. So, just a shout out to our guest, and I'll let you introduce her, but I'm excited about this podcast.

Host 1: Yeah, me too, man. When I talk about mentorship, I look at the CV of our guest today, Lynn Reede. And I say, my goodness gracious, I should aspire to mentor as many people as she has. So, Lynn Reede is with us today. Incredibly honored to have her with us. Lynn has been a titan in Anesthesia for years now. She's been involved in one of my favorite groups, the Anesthesia Patient Safety Foundation as a Board of Directors member. You've served in our military and the US Army Reserve Nurse Corps. You've been involved in Nurse Anesthesia education for a long time now, both in Ohio and now up in Boston at Northeastern University, even now serving as the Interim Assistant Dean for Graduate Program. So, the last dubious distinction is that you agreed to write a paper with me and Mitch, and that might show a lack of judgment, but we are incredibly honored to have you with us here today, Lynn.

Dr. Lynn Reede: Well, thank you so much to both of you. But regarding writing that paper, I always have to give a shout out to one of my heroes and mentors, that's Rick Dutton. I think he's the one that connected us. And in our profession in Anesthesia, he is just so inclusive. He sees the value in everyone, everybody being part of the solution, and just so much more power in that than one group or another.

Host 1: Well, to that end, my first question then, so in writing that paper, what we're talking about is paper we wrote called The Infinite Game. We applied Simon Sinek's Infinite Game premise to the Anesthesia-- I won't call it battle-- but just the way that we've done business over the last few decades, right? Where we kind of fight with one another. And we kind of tried to shift the attention towards collaboration. Because of that, I took some heat for writing that article, and I think Mitch probably did too. But at the same time, we had some people that said, "You know what? That needed to be said." And it really made me think and wasn't that really our whole point? Was to get people thinking, right? And so, on your side, did you take any grief for that article? Did you get any compliments? How was the reception?

Dr. Lynn Reede: On just one post on Facebook-- big criticism, "Who is she? She's just selling us out and this, that, and the other thing." And one of my colleagues stepped in and said, "You don't know her. You have no idea what she's done in the profession, how she is collaborative, believes in the strength of all Anesthesia providers to really bring the patient the best care possible."

On the positive side, I did get a lot of personal notes. You know, that wasn't so much on social media. It was because, in Anesthesia, we practice in so many different kinds of settings, right? For nurse anesthetists in particular. And some of those, there isn't a physician anesthesiologist where we are. And in other places, there are. But we have to bring our best every day, and a lot of us have worked with anesthesiologists our entire career, and we like it. it's been a great relationship.

And that said, that relationship has really, for me, been-- I think I lived in a bubble. It was the 4:1 staffing, the high trust between us. If it wasn't that big complex case, the anesthetist started the case. If you needed help, an anesthetist came in, an anesthesiologist came in. But we invested in each other. Just as you said with Mitch, your mentorship, that collaborative collegial support over time. So, the call in that paper was really to develop leadership no matter your role, right? Whoever you are, wherever you are, bring it. So, I think that just resonated.

Host 1: Well, on the Facebook posts, I've learned you, you don't feed the trolls, right?

Dr. Lynn Reede: No.

Host 1: You keep on moving.

Dr. Lynn Reede: And I think the other thing about the Infinite Game was it's not win-lose. It's not lose-lose. It's how do we win-win, right? How do we continue to drive the excellence of the profession forward and provide the services that are necessary in the face of, you know, the complexities of our patients reimbursement, the technologies that are emerging. We have great opportunity.

Host 2: Matt, I don't have Facebook. And then, for Lynn, you know, Matt was the corresponding author on that paper. So, lesson learned, Matt. But, absolutely, right? Win-win. When I teach my residents on their OR management rotation, we have them deliver team-based care, 1:2, 1:3. And my lesson to them is that you want to develop a rapport, a relationship with our mid-level providers so that at 2:00 in the morning, that individual feels comfortable talking to you, right? I think that that's where you want to get to.

I think that, you know, you think about the recent stresses on the healthcare system, the pandemic's the closest one, right? Did the delivery of anesthesia change? Did we learn anything? Did we miss something? It's like, you know, you're looking at it in the rear view mirror and it's going to be blink in the eye at some point in time. But what can we take forward from the pandemic?

Dr. Lynn Reede: Well, I'm going to step back a second to something you said because I got scolded way back in the '80s, early in the Ohio State Association. We'd had someone present and they kept talking about mid-level providers, and I used that term. My senior anesthetist colleagues straightened me out and said, "You're not mid-level to anybody." And I think that's a really important framework to consider all of this from. I have moved from the Interim Assistant Dean to the Assistant Dean for grad programs at Northeastern.

Host 1: Congrats. That's fantastic.

Dr. Lynn Reede: Yes, yeah, that just happened. And in fact, I just got my rank promotion to Clinical Professor.

Host 1: Come on, let's go.

Dr. Lynn Reede: It's been a busy spring, so I'm so thrilled. I just talked to ASER, the American Society of Enhanced Recovery. Now, I'm talking to you. It's like our family. So, anyhow, advanced practice professionals are utilized at such a high level in care now. And so, I have the nurse practitioner programs, the Nurse Anesthesia. I have the Doctor of Nursing Practice and a number of different master's concentrations in nursing leadership.

And I think what's important to know, my experience in Anesthesia, I remember our chair saying to a patient once, "No, I'm not doing your anesthesia. We are going to do your anesthesia." It wasn't that separation of one better than another. It was absolutely that concept of bringing the best of nursing and bringing the best of medicine to the care of that patient in anesthesia. So, I'm glad you're encouraging your residents and your CRNAs and AAs, Mitch. I think we're still in the black fly season here in Vermont, when those no-see-ums are terrible. Mitch and I are about two hours apart in the state here.

I remember when graduates from the Cleveland Clinic program would come down to our hospital in Canton, Ohio, a community hospital, and they were blown away that they were going to staff CRNAs 4:1, whether it was cardiac. Now, granted, these are the older days, but that's how we worked. It didn't matter what service we were in, we all were prepared because the chair started the School of Nurse Anesthesia and felt that we should all know what he knew because he couldn't always be there. So, the morning meetings, the plans for the day, the quality improvement, all of that, everybody was part of that process. And I think that's why I lived in that bubble. I came out and started working at the American Association of Nurse Anesthetists, now Anesthesiology. And you think everybody practices like you do, and it's not the case. There's a lot of variability out there.

Host 2: We talk about the global north and the global south around the world in terms of healthcare systems, right? And I think that's reflected even at the hospital level in the United States. And again, getting back to that, what is the appropriate practice model. It's got to go beyond the discussion of billing compliance ratios, concurrency or whatnot, but it's got to go with context, right? What does the institution in that environment need to be able to deliver the care, as you mentioned, so that we're not not giving care to the patients that need it, right? And so, I don't think that conversation has happened.

Dr. Lynn Reede: Well, it's happened for me. I mean, the standard of care is shared by all of us. It's not unique to one of the anesthesia professions or the other, right? The patient expects and deserves the same care wherever they are. Now, when they come to an academic medical center, the complexity of procedure and care for their comorbidities that they're going to experience could be quite different than a community hospital, than an ambulatory care center. But yet, those patients go to all those locations. I know we're going to get to Anesthesia Patient Safety Foundation, but how do we provide that framework, that scaffold for everyone, whether it's in a developing country, whether it's here in the United States, it's rural, it's in Burlington, Vermont, right? How does everybody get that level of care with the outcomes that they desire?

And I think that's where we really have missed opportunity to continue to focus on the patient. It's not about us. How do we the team bring the best to that patient? And when you keep that to your point, the North Star, we're going to get there. It would be wonderful to think there's one model of care that is the best and that's the way we should do it. But even in your own facilities, I suspect at any given hour of the day, you can't be everywhere. I used to tease one of my anesthesiologists, she was the only one that could personally perform in four operating rooms. But that's how she thought. And you can't. You know, that when seconds matter just concerns me because when seconds matter, CRNAs are already at the head of the bed. You know, if you have a CRNA or an AA practicing or your resident, or your students, you know, your trainees, we have a lot going on, and yet we keep this very safe, because we constantly look at our outcomes.

Host 1: So Lynn, I would say that your way of thinking is different, right? And I say that in a complimentary way, I learned in business school that the answer is always "It depends," right? Even though, as a physician, I was trained to know the answer and to be right. So, that was a very different way of thinking for me. And as I look at the three people here on this podcast today, we've all kind of further education to kind of get some sort of management or business degree. How did that journey for you-- your MBA, for example. Did it change the way you think? Did it change the way you see our professions?

Dr. Lynn Reede: Absolutely. Well, I don't know if it changed the way I see the profession, Matt. But I never wanted additional education unless it was useful. It was something that I needed. And I had moved into the operations manager role of a 500-bed hospital with some freestanding centers as well, $25 million business and, boy, about 90 anesthesia providers plus all the other things that go with that. And at that time, we had gone from an Anesthesia Department to becoming a department of the hospital. This was in the late '90s, early 2000s when reimbursement and partnerships in Anesthesia were becoming incredibly challenging.

But when I moved into that role, I had tremendous mentorship from my colleague, Faith Bestic, who was the Vice President for Surgical Services. She had soup to nuts from Same Day through Central Service. PACU did not have the ICUs. But she said her master's was by fire. Because she was a diploma grad like me, but she had done it for decades and decades. But I knew the more formalized understanding, when I was working with the finance department, when I was doing change management, quality improvement, gosh, I can think of so many different things that it allowed me to take my experience and speak and understand in the terms of the teams I was working with, right? When we were implementing the electronic health record, what's the most challenging thing to help the informaticists to understand what the workflow was and what needed to be done, not just billing, but how did it help me appreciate the profession?

I remember every January, I would publish the cost of our supplies and, you know, our trays, supplies, pharmaceuticals, all that, with no intent other than to inform the team. I never ask them to decrease cost of care. Never. Every year, they took about 20% out of the budget, just because when they looked at that cost, they said, "This isn't improving the outcome. This doesn't make sense." So, how did it change my perspective on Anesthesia? I think that, but the other one was the organizational design and development, the science of leadership, of how teams work and think, that was incredibly impactful and I use that today.

Host 2: So, Lynn, we've talked about anesthesia team's Infinite Game, right? And now, we've been talking about institutions, places, perioperative services, which we've managed in the lessons learned. You've been involved for over 25 years with American Association of Nurse Anesthesiologists. How do you take the lessons at a personal level, professional level, institutional level, and now you're at the national level? So, what's different? What's better? Is it easier? Is it harder?

Dr. Lynn Reede: Well, I've been blessed to move from being the student in the profession and part of a very active state association in Ohio also coming from a program where my program director, he made sure-- and so did the chair I keep talking about-- he felt anesthesiologists, CRNAs need to be part of their professional organizations. That is just a critical activity, that ability to understand what's best practice, advocate for that practice network. So, that was really ingrained in me both for my diploma Nursing and my Certificate Anesthesia program. Isn't that hard to believe? That's that long ago.

But then, I also had opportunity to serve on the various committees. I served president twice in Ohio, lived through the supervision battles, the scope of practice battles at the State House, the testimony, the smiling CRNA and the anesthesiologist. And they're like, "Can we ever crack her?" It's like, "No. I really like you guys. That's the problem you don't get." And then, I had the opportunity to serve on the Board of Directors for the AANA, the American Association of Nurse Anesthesiology. And then, I had several names for the same role, the Senior Director for Professional Practice, and it became the Chief Clinical Officer for the AANA.

And all of that journey, what I really appreciated was the opportunity to experience other people's practices, where the challenges were, where the hiccups were, where we could eliminate the noise that you were talking about, the politics. Because at the end of the day, the battle for the marketplace, the battle for reimbursement is important to many. But to me, I've always been well-compensated. I've been able to always practice at the top of my education, licensure, and experience. I have lived a charmed life.

And now, for the AANA specifically, the opportunity to come back together as educators, as researchers, as clinicians, and as administrators. Because those are the four roles that CNA can continue to certify in, and to be representative of all of that. That to me is important. The leadership of the professional organization has really focused on that independent provider where there's still a large number of us who collaborate, we're in collaborative practice, some are in team practice, there's all kinds of practice models. So, that's why I stay very busy at APSF, the Anesthesia Patient Safety Foundation or the Patient Safety Movement Foundation. I just had served with the Council on Surgical and Perioperative Safety. But when you focus in safety and with the perioperative team, the perianesthesia team, now you're in business.

Host 1: You're preaching to the choir right here. I'm just sitting here. I want to stand up and give you a round of applause.

Dr. Lynn Reede: Well, that's why I'm really glad we're getting to have this conversation. Because when we were working on Infinite Anesthesia or Infinite Game, you and I had extensive email exchanges. And we really wrote that article for the audience that was going to read it. But I'm glad I'm getting to say these things out loud, because the same things we hoped for the anesthesiologists, we wish for the anesthetists, for the AAs, for anyone in Anesthesia who we all need to be at the table. Anytime my anesthesiologist, my chairs would be out in the hospital, because I served on all the medical staff committees, I served on the hospital committees, we were together because it informed best solution. What my anesthesiologist did every day was not the same as what the nurse anesthetist did every day. Yes, we did anesthesia, but the workflow's different, if that makes any sense.

Host 1: Yeah. No, it does. You mentioned those extensive emails. In my opinion, that was the best part of writing that article, was going back and forth on a lot of this stuff. It was so fun and I felt like I had known you for years by the end of it, even though it was probably done over the course of a few months.

You mentioned advocacy, right? It's something that we should do because our professions have given us amazing lives, right? So, I should advocate for my specialty. However, I ask my question in yours is, can we do it a little different? And I will say, just got back from a meeting, advocated at the state level in DC to our representatives at a national meeting. And I was incredibly proud and actually said this at our dinner, after our time on the hill, so proud of my group that we advocated for our specialty in a way that was respectful to our nurse anesthesia colleagues. I did not hear a single negative word said. And if that could become the standard and maybe we could even begin to collaborate together, how powerful could Team Anesthesia be?

Dr. Lynn Reede: In my role at the AANA, Beverly Philip, Rick Dutton and I, we had the opportunity to collaborate on some issues with Joint Commission. We went together, you know, and presented. Labeling on the sterile field may not sound important to people, but those of us in the profession understand how important that is. And we still need to be safe, pay attention to the patient, place the block, do all that kind of thing.

And so, for all my life, has looked for those places to collaborate. And that's frankly from the Americans Association of Nurse Anesthesiology, the AANA. What we're always told when we go to advocate is don't-- do not --badmouth our colleagues, the other part of our profession, because the legislators don't want to hear it. They don't want to hear the negative stuff. They want to hear what can be done to move forward with affordable care, access to care, preparing our students, our trainees for practice. We got a lot to do.

Host 1: To that end, what role does a society like the Anesthesia Patient Safety Foundation play? That's a collaborative group, right? What's new at APSF? What's going on there and what are the ways that we can collaborate in the future?

Dr. Lynn Reede: It is a family, it is our colleagues or they're not even healthcare providers, they're involved. We have our industry at the table. You know, we're not talking about products per se, the things you're not allowed to talk about, but they're there to hear from what's going on in practice, what's being developed, how can we collaborate to bring these things to market, to optimize outcomes. Our patient safety priorities, we look at those every few years. A little different than ECRI. I think ECRI's topping out at 19 or 20 priorities. This year, we have 10 or 11.

And as we sort through that, we have a wonderful process, I guess you'd call it a Delphi process. It makes you keep responding and comparing the different priorities that are being considered. And you would think airway would still be number one, but it's really fallen down with video laryngoscopy and other tools that we have, like the superglottic devices. And the things that are most important, we've collapsed a few of them together because teamwork, well-being, and we have Patient Safety Priority Advisory groups where we bring in anyone who has interest in the different topics, whether it's brain health, medication safety, airway, this huge team, group one. And it's intended to take those priorities and move to action. You've seen a lot of articles published in the APSF newsletter, which is read in every country around the world. I think we're up to nine languages now and continuing to grow that.

The impact of that is so important, but these patient safety priority groups are now in their fourth year. I am co-chairing that with Steve Greenberg, an anesthesiologist from Northshore and Stacey Maxwell, who is our admin for APSF. And the opportunity for all these groups, we meet quarterly as the entire PSPAG group. And for them to hear from each other, it's like kind of like a sourdough starter. They feed each other what's happening out in practice and evidence, "Have you thought about this question?" But our Stoelting Conference that happens annually, we can't possibly tackle all the issues at once. So, this gives us opportunity to do that. We hope to become more of a hive where we collaborate, whether it's ASA and AANA, it doesn't matter, AORN, anyone, what do they have? An excellence that we can link to their website. So when you search our website, it just takes you wherever for the information you have interested.

APSF is obviously a we're focused in research as well, patient safety research. And there's many different entry points there. Mentoring people in patient safety research. Anyone's welcome, anyone. There's no dues. The dues are what can we do that no patient and no provider be harmed by anesthesia.

Host 1: I use that mission as the ultimate mission statement. It should be big, bold, and forever beyond reach. That is a wonderful, wonderful mission statement. So, thankful for the work you guys do.

Dr. Lynn Reede: Well, it's the work for the profession and the patients, right? We're just grateful to be able to do the work. It's awesome.

Host 1: We get to do it.

Dr. Lynn Reede: Yeah.

Host 2: You mentioned teaming and--

Dr. Lynn Reede: Oh yeah. Amy. Amy Edmondson, let's team.

Host 2: I love Amy Edmondson. This is a existential question, I think some places do and some places don't, but you know, how do we teach nurses, physicians, surgeons, anesthesiologists, everybody that's in the operating room, how do you teach them how to build better teams, right? The good teams practice together.

The one that I think of is jazz musicians. Jazz musicians, they're an expert at their instrument, maybe several. But they understand the underlying construct of what needs to happen during a set. And you would think that everybody in an operating room that works in an operating room knows that there's an underlying construct of how to get a patient safely from point A to point B, right? So, how do we do that? And I think the broader discussion is it's not just nurse anesthesiologist and anesthesiologist. It's the AORN. It's the surgeons, you know, American College of Surgeons. How do we get everybody at the same table? Just a shout out to David Etzioni, who was the keynote speaker at the Association of Anesthesia Clinical Directors meeting this past March, but he gave the keynote address, and the bigger question is, "How are we going to make this safe across the world?" And the APSF Newsletter is published in nine languages. One of the things that I've noticed is that there's definitely a discrepancy between the care that we deliver here in the United States and the global south. And how do you bring everybody up to a level that's considered safe, maybe where we were a hundred years ago?

Dr. Lynn Reede: Well, first, if you just level set each day in the operating room or the anesthetizing location, I think that's really important. But you need leadership who's at the table and talking about these systems of care and making sure that we have good pathways. We have the equipment, we have systems that we don't need hemostats, tape to make work better. I mean, my scissors, my hemostats, my tape, that's like everything I ever needed in Nursing. I had the hemostats when I went into Anesthesia.

And you know, Mitch, I was thinking about this when I was pondering what we would discuss today. And every morning, I would just stop when everybody's setting up the operating room before we ever brought a patient in. I said, "Okay, who's transporting today? Who's doing this? Who's doing that?" And you know, that worked until the first break, I mean, the team changes constantly during the day.

And as anesthesia professionals, it is critical. It is critical that we lead the operating room, the anesthetizing location. Because we are the one and only person whose only focus is the patient. We're not focused on all the supplies it takes to do the procedure or that procedural list. Yeah, we're going to have to cope with it and deal with it and do the dance, but that ability to understand what's going on, and in the first hour, the first day of my nurse anesthesia program, I was told, "Don't let them see you sweat." And it wasn't because of ego, it was because your confidence and your presence in that role lets the whole room stay calm. When someone's losing their mind in an anesthetizing location. When you can bring them back down and help them focus on what we're doing at the moment, that's a huge win. It's avoiding danger, right? It's stopping the line.

And the other thing, I think, the challenge that we have is there's still a lot of agency and locums and from the COVID days, there's still big money to be had. And as people retire, facilities got used to paying for that. And I think that's another issue to be conquered. I was tickled up here in Vermont. A couple of the facilities don't have any more locum CRNAs. Everybody is staff. And I thought that's awesome, because now you can create a culture.

Host 2: That would not be my institution. We'll just leave it there, because I came up with a study idea. I want to do a monthly trend since the pandemic of first case on-time starts.

Dr. Lynn Reede: Oh, we did that always.

Host 2: Oh. Oh no. But I want to correlate it with the percentage of non-regular staff operating room nurses. And I think there's an inverse correlation.

Dr. Lynn Reede: That should be a report that could be built in a second.

Host 1: Gosh, we could talk about staffing and shortages forever. I actually want to take us in a different direction, Lynn. You recently spoke on the intersection of AI and patient safety at an APSF Conference. Where is Anesthesia going? What should we be excited about, but also what should we be leery of as technology advances in the perioperative space?

Dr. Lynn Reede: So, I'm going to put on our business hat first. So, the first place I'd be really excited, because I've been dabbling in AI for a couple years, and what I appreciate is the hiccups have diminished tremendously and having been someone responsible for practice considerations, position statements, all of that work, to be able as a department manager or a department educator to really be able to create great documents that are informed and now referenced well. I was surprised the reference-- I'm working with several other folks, APSF family as well as folks from Virginia Commonwealth, an AI workshop in the afternoon at AANA Congress in August. And we're still in our developmental phase for our APSF section, but we want to use AI. How can we utilize the tools available, and I'll say more about that in just a moment, to make care safer, to look at our patient safety priorities and how could we impact several of them, but actually help the attendees to figure out how to do that in their own practice, right? Some people are a 10-99, they move everywhere. So, how can they do even look at their own data, their own outcomes and start to consider practice? So, I think that's one place.

In education, what's been amazing is to develop standardized patients. So, imagine if you're doing a morning meeting and you want to mock up a grand rounds or whatever, and you create that standardized patient and the audience starts to ask questions and talk about treatment and management.

Then, of course, we have the clinical decision support. APSF just did a conference. Was this last year or year before? Just on this topic. Was this just last year? I don't know. We're working on maternal morbidity and risk this year. So, I'm on that planning committee too, so my brain's a little short on that. But what I'm appreciating right now is the academic medical centers, at a minimum are developing their own platforms, their own ChatGPT, so that it's encrypted. But I was pondering the question, you see how fast the LLMs are learning? Are those going to learn at the same rate? Because they might not have access to all of the external data. I don't know. I'm not in that space. But I think AI in whatever format is here to stay because the machine learning related to patient data, the algorithms to identify risk early, it's just so important. And then, you add in what we all know from our experience to keep that care personalized. I think at Northeastern, we call that the intersection of humanics.

Host 2: Really looking forward to what happens in the AI front. And. I just saw a video, I think, yesterday or the day before about physicians that don't think AI is going to impact their profession. We already live and work with it. I think our responsibility as nurses and as physicians is to understand the technology and sort of like what Jennifer Doudna said about CRISPR technology, you got to set up the guardrails, right?

But the other piece is that, you know, computers, they do burn a lot of electricity, right? I think Elon Musk's facility in Memphis, Tennessee is polluting the local environment. But it doesn't sleep, so it can work more than humans can, and that's good. But the longer piece is AI will continually learn. The old joke about when does physician practice change? About every 30 years, because you need the physician to retire. But AI is going to be the opposite, it's going to keep learning. And I think that's a wonderful opportunity that we need to figure out how to embrace.

The other thing that we had a grand rounds with the chair at Cleveland Clinic and he talked about how do you take AI to sort of develop an Opticon. And Kheterpal's come out with the paper showing that concurrency may affect the delivery of care. Intuitively, as clinical directors, we make sure that the skillset and the people at the task, you know, they have the cognitive bandwidth to manage the patient safely. But what if AI was able to inform us to say, "Hey, you know, you'd really look into this patient." Alert Watch tried to do that with AM-PAC. But this would be sort of an active surveillance for everybody and, most importantly, for the patient.

Dr. Lynn Reede: It would take the place of what we did every morning of looking at our cases as we met every morning as a department and looked at what cases we had, did we have everything we needed, the complexity so that everybody knew that this particular room or whatever was going to have, you know, these challenges. But if AI couldn't look at the patient, look at the procedure, look at everybody's engagement, it's just another level. But you reminded me of one thing we didn't say, and that is patients are getting a lot of information from the chat bots, from AI. So, how do we improve patient healthcare competency as well? Is there a tool that we can harness and how do we make sure that they understand what they're reading? And is it framed in questions for the providers? There's things we've done on paper, how are we going to make this move into the more virtual space? Another opportunity.

Host 2: Or even extend the perioperative period, right? And it doesn't end in PACU. How do you continuously monitor them when they leave the four walls of the hospital.

Dr. Lynn Reede: No. And having worked heavily in enhanced recovery for so long, and as you have too, the opportunity that we never have to optimize a patient. because we're just optimized. We live that life. Would that make the perioperative perianesthesia space fabulous? That's my dream.

Host 1: So Lynn, I want to talk about well-being. One of the things we kind of posited in the Infinite Game paper was that we need to create a workspace, a work environment, that not only maximizes patient care, but maximizes provider well-being. I noticed that you also spoke recently on fostering a successful learning culture, and I think that certainly plays into it. What pearls do you want to share with us about that, creating a learning culture? And then, what does that mean for us as on the well-being front?

Dr. Lynn Reede: I think that culture translates into just the practice culture, right? I mean, we're putting people into a learning cauldron, if you would, that they feel like they're on display, right? That they're at risk, that they make a mistake if they're being seen, that type of thing. I know every semester while I was still teaching, I talked about growth mindset, Carol Dweck's mindset. And to move critical care nurses from that setting as an expert now into a novice and anesthesia study, right?

What I've appreciated different than where I came from critical care decades ago, is that it's become very protocolized and they are not the decision-makers I was. They're running a pathway, a protocol, and not necessarily making as many decisions to manage that patient. So to become a critical decision-maker in a safe environment, simulation and lab is a huge value, no question. Simulation wasn't available to me. Maybe some low fidelity back in the '80s. But that, for our students that are getting ready to go into clinical this fall, that's a huge element of their comfort when they do that first induction.

Remember the slalom skier? You thought you had it all lined up. All those things you're going to do, you push the propofol. And all of a sudden now, the masks on that face, I'm supposed to squeeze the bag, all those things that you have to think about. But to create the environment and my students of color or different ethnicities, their sensitivities to how people respond to them and talk to them is something I never had to experience. Sometimes being female, but I guess my core strength is pretty good and I could brush off those instructors, I just didn't care. I was there to learn. But if you can make it safe, no microaggressions perceived or real, and the ability to question to have conversations with your faculty back from the field, right? What if this, that? Could I? Did I? Should I? It may seem intuitive to us because that's what we've done as clinical faculty, but some people were never treated that way. They didn't translate it well into their own practices. They're mentoring other providers.

So whether you're working with a medical student, a respiratory therapist, anybody rotating with us, it's all the same. What they need to learn is important and we need them to learn it. So, how can we create that instant trust like we do with our patients, with our students? And the other thing is faculty is infamous for talking about a student not in the room. When we take out of each other's buckets, if it's not constructive, it can be just damning, just devastating.

Host 2: I just want to echo the sentiment about protocols and checklists. Checklists are great. It's going to help you identify the problems that happened in the past. I try to teach my residents that there's a difference between following a recipe and understanding why you're doing what you're doing right, and the ladder's going to make you an expert in what you do. And how do you get people to that place. And that means, you know, giving them freedom when the freedom is due and they can go and explore the edges safely. But we've all made mistakes., And it's how you respond to them and then how you learn from them.

Dr. Lynn Reede: This is the other thing I wanted to share with you guys, and I tell my students this still to this day. What did I do today that I liked? What did I do today that I didn't like? What will I do differently tomorrow? And what will I never do again? And we were told somewhere in your drive home, 30 seconds to a minute, don't make it long. Go through those questions and that way you've appreciated something that really, you really did okay, and then something that didn't feel quite right, and what am I going to do differently tomorrow? So that you can kind of take it out of your head and get some rest on that wellness point, Matt, because students will ruminate if things haven't gone right, and you've got to let yourself off the hook or you can't come back and be successful the next day. There's a responsibility on the student side. And there's a responsibility on the faculty side too. There's an investment in both.

Host 2: I'm going to quote Kung Fu Panda here, "The past is history. The future is a mystery. and today is a gift, and that's why it's called the present."

Host 1: Let's end there? That's incredible, the wisdom of Kung Fu Panda. And Lynn, this has been awesome. I wish that we had Jocko Willink's budget and we can go for like three hours on our podcast, but we don't. So, we're running out of time, but thank you. This has been incredible. I wish the people could actually see my face and how I've kind of beamed a few times as some of the things you've said.

I appreciate your friendship. I've appreciated getting to know you more. And I certainly hope this is not the last time we get to pick each other's brains. So, thank you so much for being here with us today.

Dr. Lynn Reede: Thank you for the invitation. This was just a gift to spend time with both of you. Thank you.

Host 1: Oh, you're too kind. This has been a blast. Appreciate you guys tuning into the Fresh Flow Podcast. We will see you soon on the next one. Thanks.