From Breakdown to Breakthrough: Transforming Your Healthcare from Clinic to Community, Tracy Gaudet, MD

[00:00:00] Dr. Tracy Gaudet: We've been starting from the wrong place when we start with the chief complaint or the disease body part and when we shift that dialogue to start with an exploration of what matters most to the person, their sense of meaning and purpose, magic can really happen

[00:00:17] Dr, Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level

[00:00:42] Dr. Melinda Ring: ​Today, we're diving into a topic that could redefine healthcare as we know it. How can we shift from a disease centered system to one that truly supports whole person well being? My guest today, Dr. Tracy Gaudet, has spent her career leading that transformation. A board certified OB GYN, She was the founding Executive Director of the University of Arizona's Program in Integrative Medicine and later served as Executive Director of Duke Integrative Medicine.But she's perhaps best known for her groundbreaking work at the Veterans Health Administration, where she led the development of the Whole Health Model, an approach that's fundamentally changing the way healthcare is delivered to veterans. Now, in her role as the Executive Director of the Doctor of Whole Health Leadership Program at Southern California University of Health Sciences, is training healthcare professionals to lead this transformation on a broader scale. Today we'll explore her journey, the impact of Whole Health, and why this moment is critical for the American healthcare system to embrace a more holistic, patient centered approach. Tracey, welcome to the show.Thank you so much, Melinda.

[00:01:59] Dr. Tracy Gaudet:  It's great to be on.

[00:02:03] Dr. Melinda Ring: ​You've just had this incredible career trajectory starting as an OB GYN to, right out of residency to jumping into new things and then leading major institutional transformations and integrative and whole health. So going back to the beginning, what first sparked your passion for that work and led you to take on leadership roles so early in your career?

[00:02:25] Dr. Tracy Gaudet: I would say that I was kind of not the typical medical track from the beginning, just so you know, like I was much more my background, my undergrad was psychology and sociology. I was always into the The humanized experience of medicine and science and wasn't pre med undergrad or anything, and then ultimately decided if I wanted to have an impact on trying to drive change in the medical paradigm, I'd be much more credible if I went through the MD route so that I went into that as kind of an odd duck. And I was an odd duck in med school. And then I was like, well, what residency do I do? Cause nothing really fit the paradigm that I was seeking. But I thought OBGYN was more of a holistic approach to not just disease care, but women's life. And transitions and stuff. So I went that route. And then I have one year out of, well, actually, while I was still in my residency, I heard about the concept that Andy Weil had for this integrated medicine. I never I'm putting the quotes on because I never even heard the term Melinda. I was like, what is that? And I read his description. And I was like, Oh, my gosh, that's what I that's like resonates. That's what I care about. So that started my trajectory. I wanted to do the fellowship and it was a long story, but I ended up being asked one year out of residency to lead the development of it. And I was really clear, like, do you guys know, like, I don't know anything about this. I don't know anything about this, but I know how to ask good questions. I know how to build teams. And so I dove into that. And that was the beginning of this trajectory.

[00:04:07] Dr. Melinda Ring: You create these wonderful, impactful things from just this little kernel of an idea. Because it's one thing to carry on the work of others and sort of evolve it, but I think it takes somebody with just this unique blend of courage and conviction and vision to see how something should be and then actually figure out how to get there and get, and, and get buY in along the

[00:04:35] Dr. Tracy Gaudet: Well, you know, just a quick comment on that. I appreciate you saying that because that's actually what I love. Like a lot of people think, Oh, Tracy's the vision has the vision and you need the vision. But what I love is what you described, which is how do you take a vision and bring that into reality? It never looks like you think it's going to. and, I, that's my passion is how do you really manifest something real change in the world in which we're living? And that's fun and exciting and hard and, and never dull,

[00:05:07] Dr. Melinda Ring: Along that theme, we had your successor at the VA, Dr. Benjamin Kligler, your good friend, my good

[00:05:13] Dr. Tracy Gaudet: yes.

[00:05:14] Dr. Melinda Ring: on this show to talk about whole health and what's happening there. But I'd still love to hear your explanation of it. What is whole health and how did you lead that transformation at the VA?

[00:05:28] Dr. Tracy Gaudet: Those are great questions. And I appreciate asking about what is whole health because we're at a phase Melinda, which you know, as well as I do where the term is getting used a lot. And on one hand, that's a. Good thing, because it means people are buying into the concept. On the other hand, it's a tricky part of a transformation because people can start to use the term and mean entirely different things. So I, I'm, and I think one of the roles of leaders is to be kind of an advocate and carry the flag for. The real transformation and try to make sure people are in that dialogue. So I, I appreciate that question of what is Whole Health 'cause and, and for a lot of people I've been asked, well, is it just the new term for integrative medicine and I would say no. I would say it's certainly inclusive of integrative health and integrative medicine, but it is a broader construct of really I think there's. Three primary changes that happen in a whole health approach. One is the organizing principle is different. And what I mean by that is we shift from an orientation that starts with the disease. Or the body part and shifts to a focus on meaning and purpose. So it's not that we're not still addressing disease and, and, and medical treatment, but the whole construct of where do we start engaging with people and with ourselves when we want to address health and well being and saying. We've been starting from the wrong place when we start with the chief complaint or the disease body part and when we shift that dialogue to start with an exploration of what matters most to the person, their sense of meaning and purpose, magic can really happen and that is a whole paradigm shift that is. You know, and I think the other thing that's important to realize is that's not a trivial question. I mean, I have found in my clinical practice that the patients that are most poignant about explaining that moment in their life where they really stopped to consider. What matters deeply to them, not at a superficial level, but really deeply is if often if they have a health crisis, if they have a cancer diagnosis I had so many cancer patients tell me it was a blessing to have that diagnosis, even if it didn't, even if they were terminally ill, because it changed our life. And the, and so the question is how, let's not wait for the. Cancer diagnosis or the health crisis in this, in a whole health approach, we're inviting people to start with a deep exploration of what matters most to you in your life. And it can be something as grandiose as I share a story about a woman who wanted to climb Mount Kilimanjaro, or it can be as every day as I want to be able to hang out with my friends and drink beer. Because that brings me a sense of belonging and love and connection and joy. So it can be anything. But starting with that exploration is the foundation for intrinsic motivation. Because when somebody gets in touch with their sense of meaning and purpose, now they're actually intrinsically motivated to take on their health and their well being. So that's a really core distinction. And I realized I was practicing really good. I think integrative medicine prior to that insight. And it was holistic and it was integrating other therapies and it was certainly better than the biomedical model alone that I was trained in. But it wasn't this. This was this was the paradigm shift. So that's huge. And then the approach once people are engaged. And, and, and intrinsically motivated, the approach shifts from a, uh, uh, medicalized approach to what I would call a humanized approach. And what do I mean by that? It's like, well, yes, we're going to give our medical opinion and give priorities that we think the person might want to focus on given their medical situation, but really where they start is where they're drawn. There's, and you can see a very non linear path. So somebody that's morbidly obese, and we might say, start with diet, exercise, maybe medication. And when they look at their whole health, they want to start with addressing their relationships. Because they're toxic and hard and so honoring that and starting with where the person is drawn to is a very different approach than the medical approach and really what that all means is that the locus of control shifts from the medical expert model. To the person and in their community. So it's a different paradigm. We talk a lot about empowering people, equipping people. Ben probably talked about that. We need a system that is designed to empower people and help people get in touch with why they want their health. That's not our design right now. And in addition to that, we need to be able to help people once they're empowered and motivated to learn new skills and have support. To actually take on their health and well-being and that hopefully in my dream, the center of healthcare shifts from clinics to the community. So it's where people live and work and play. And yeah, they go to the clinic and they want their health system aligned with them, but really the center of health and well-being should be where we live and work and play because hopefully that's where you spend most of your time. That end game, like what is the purpose of healthcare that as a goal to help people live their most full and meaningful life is a very different end game than managing and treating diseases. And of course, you're going to manage and treat diseases along the way. But that when, when you're asking Melinda about, well, how do you drive change? I think being really clear that one of my favorite books is on systems thinking by a woman named Danella Meadows. And she defines how do you know a system is transformed? People use the term transformation all the time. And a lot of times they just mean incremental improvement and that's good, but it's not the same as transformation. And her point is. Yeah. The transformation is when the purpose of the system has changed. So what we're really, this is really, if we're doing it right, in my opinion, it is absolutely a transformation, because the purpose of the system is to help people live their most full and meaningful life.

[00:11:52] Dr. Melinda Ring: In your opinion, in the current environment, why is now the time for American health care systems to embrace whole health?

[00:12:02] Dr. Tracy Gaudet: It's kind of a perfect storm. One of my mantras is we can't have breakthroughs without having breakdowns. And when you look around and see the degree of breakdown across so many parts of a system that impact health and well being, you We, it is totally unsustainable and, and way back in the dark ages when I was starting the University of Arizona program with Andy and we were all at that startup phase, there was still a lot of debate. That was the late 1990s. There was still a lot of debate about why do we need to change? Well, the good news is that debate is not happening anymore. Everyone across the nation is saying. This, what we're currently doing is unsustainable financially, clear data and outcome wise too. Like when you think about, well, if we're spending so much more than every other country in the world, you'd think we're getting better outcomes and there's tons of data that says we're not. So I think the good news is there's no argument anymore that doing more of the same and just trying to do it better or more efficiently is not going to solve the problem. It is not. So there's a call for a big transformation. The value of the VA work, I think we could do in the VA, what we couldn't have done, I can't, I went from Duke to the VA and I think in the private sector, you just don't have the ability to explore and research real transformation. That's for the betterment of veteran healthcare, but also the nation like we did in the VA. So that's a piece that I think the timing of that is great. As you know, with the National Academies report with the surgeon, former Surgeon General, people are saying, Hey, not only do we need to change, we have some sense of how to change. And it's not, it's not like we can just cut and paste and, or flip a switch and Oh, we have it all figured out. And now we just have to implement it in the, in the private sector. It's not that easy. It's hard. It's going to look different, but we learn, we have learned and are still learning a lot about what can work and what will work and how are we going to take that on as a nation you know, the current administration change just adds more chaos and adds more uncertainty. And I try to frame that in the positive, some days I can do that, some days I can't, but that the sense that now is a great time for radical change. And so let's seize that moment and try to do that for the betterment of health and outcomes and humanity and our financial situation as well.

[00:14:36] Dr. Melinda Ring: Loss of funding is really impacting all of the institutions across the country in terms of what? What? Well, okay, we want to change, but now we can't because we don't we no

[00:14:47] Dr. Tracy Gaudet: Yeah,

[00:14:48] Dr. Melinda Ring: to do so.

[00:14:49] Dr. Tracy Gaudet: yeah, it is a, I don't begin to have. Insight or any expertise into how we will navigate this. Yeah. It's, it's going to be, it's, it's very, very challenging time.

[00:15:05] Dr. Melinda Ring: From there, maybe we can talk about. What you're doing because your current role at Southern California, uh, at the health sciences. You've been there, I think, about a year now. You created this first of its kind doctorate program in health leadership, who's the program intended for? What are your hopes for the graduates? What are the skills they're learning?

[00:15:29] Dr. Tracy Gaudet: Yeah, it,

[00:15:30] Dr. Melinda Ring: I'd love to learn more about this.

[00:15:31] Dr. Tracy Gaudet: integrative medicine. And they asked to talk with me just to brainstorm and I said, you know, I might be missing something, but I'm not really sure why we need a doctorate degree in integrative health or integrative medicine. But I do believe we need a whole cadre of leaders to help drive this transformation. Just like we're talking about, right? Like everybody's calling for it now and there's not much debate that we need it, but who's going to lead it. Right. That was the question, right? And, and, and who's going to have the depth of knowledge of what whole health really is and really means, and who's going to have the skill, because I think as I think there's all kinds of leadership, and I believe that leading system transformation is a unique kind of leadership. It takes a different skill set than leading, for example, even a very complex established organization. So, so I thought, I think there's a real need for this. We just need. A lot of people in different sectors of this world in this nation to understand this and say, we're taking this on and we're going to lead. So, so we had the fun of creating the, the, the doctorate and the curriculum. And I was having a ball because I'm like, I needed to take this. Where was this when I was coming up, you know? And, and it's just been a real interesting experience. And then we honestly, to your point, I was like, okay, if we build it, will they come? Like. I mean, it's a doctorate degree in a field that doesn't exist yet. It made me think of when we started the fellowship and integrated medicine. Andy was the first Andy Weil was the first to name integrated medicine. And it's like, okay, come leave your career. That was full time on in person. And do this fellowship, so it's very parallel in that kind of cutting edge way. And we have, we just started the 1st cohort this fall. Amazing people who are passionate coming from. I'm really excited because they're coming from different professional paths, which is great and different parts of the country and different. There's just a tremendous amount of diversity in that way. And they are on fire to apply, learn and apply this in their world when they go back. I think the other really cool thing about the doctorate is we're calling on our network of like all of all of us that have been doing this work like you and really have said, who is going to take this over like who's who is the next wave of leaders who are really going to drive, not co op, not get co-opted by the dominant paradigm, but really drive change. And so it's really cool to connect. More of the senior leaders in the nation with these folks who are often mid to late career themselves, but who are learning whole health and learning about the transformation. So it's been a blast and I'm super excited about it and we have a new class entering twice a year. So, yeah, help spread the word if there's anyone, if you know, anyone that might be interested. Just to have people check it out at Southern SCU. Um, It's a, it's a very interesting, exciting group and um, hopefully we'll help lead the movement. It's two years and a quarter. It's designed to be. The core lectures and courses are online asynchronous. So for a dinosaur like me, Was like, really, like, how is this going to be meaningful? Meanwhile, my son who's in college just last night, he's talking about canvas and how he loves asynchronous classes. And I'm like, okay, so this is designed for people who are in their full time career, so nobody has to leave their work. No one has to relocate. It's not like in the old days. So the core courses are online asynchronous. We have a lot of opportunity to connect human to human because this is such an important piece of it. The last. The last quarter of it is a capstone project. So people are already beginning to envision and work with and apply what would, what could I do to make this practical? So not a dissertation, it's not an academic, it's not a PhD with a dissertation, it's a professional doctorate with a capstone. So that allows people to really decide how can this apply to their world or their vision. And then we support them in making that happen. And then the coolest part from my perspective, because I'm. Very, very, very much believe that we can't drive transformation in the outside world if we're not doing that on the inside world. So I really strongly believe that this is a personal transformation as well as a professional one. And so the question was, well, how are we going to do that in this asynchronous online thing? And I brought that up to SCU and said, I don't think you could be successful in what we're promising around really preparing people to lead transformational change. If we don't have in person time. So across the 2 years, we come together 4 times. So twice a year for a long weekend, intensive Thursday to Sunday, which is entirely experiential. So people are having that experience of whole health and then learning to lead that. In person together, and we're also visiting differently. We're doing that across the country and visiting different places. So we can also learn different from different leadership styles across the nation.

[00:21:03] Dr. Melinda Ring: nice.

[00:21:04] Dr. Tracy Gaudet: It's really exciting. I'm hoping everybody will spread the woRd.

[00:21:03] Dr. Melinda Ring: What are some of the lessons that, and takeaways you have for being an effective leader in transformation?

[00:21:31] Dr. Tracy Gaudet: That's what's been interesting. Yes, that is, that has been very interesting for me to reflect on that. And so I, I am conscious of the fact that I got really obsessed when I started the VA job in particular, they had the title of the office, which was patient centered care and cultural transformation. And I love that that was in the title. And because it meant big, bold, like go for it. This isn't like tweaking around the edges. This is. cultural transformation. So I became obsessed a bit with, well, how do you define culture? Because if we're going to transform it, it would be helpful to understand. And so there's a definition that I have adopted and I, the reason I've adopted it and the reason I'm sharing it is it's very practical in my opinion. So the concept that culture is really evident by behaviors, but the behaviors are driven by. Primarily 2 things. One is experience and one is incentives. And so it's interesting if you think about that's true. I think for any kind of behavior, right? If you, if you have an experience of what it is, you want it to be like, you have that. Like a lot of people come to this because they've had a healthcare experience or some other experience in their life where. Yeah. A, they were either really disappointed and they now know what they would wish it could be, or they had an experience of what was amazing and they want that to be available to everyone. So having the experience. Of the future state or a part of the future state, I think is essential and the incentives part is, is you can have the experience and you can be incredibly motivated. But if the system you're in, the incentives are not aligned with that future state that you're trying to transform to, it's not going to be sustainable. So either one will not. Work without the other, you can try to incentivize behavior change and if people or the system isn't, doesn't want it and isn't intrinsically motivated, it won't work. So what does that look like practically? And I think what I love about this is that I think this is applicable to somebody that's in a leadership position of a whole system as it is to somebody who's in solo practice. Okay, so I think that what I, what I think about all the time is how do you provide an experience of whole health for your team or for your patients. So they get a little taste of that and now they want more. That's the seed of a movement. That's the seed of the change because change is only going to happen from the grassroots. How do you engage the grassroots, the frontline? Well, give them an experience. And a lot will change. So we did as much as we could in the VA to offer whole health, intro to whole health experiences for an hour and a half and take charge of my life and health courses for in groups that anybody wAnted to have. Another way to share an experience is through storytelling. So if you feel like, Oh, I don't have the ability to offer those kinds of experiences, have people share their stories. Of that future state of that really help people go. Oh, that's what we're talking about. It's not just the words. Oh, empower equip. It's like somebody's life story and it becomes real. So that so I think strategies around how do I bring the experience to my world again? Whether that's a clinic team, patients, whether you're running a system. I, we tried to do that in the VA from all levels of employees, including senior executive leadership. So experience is a key. That's the bottom up. And the incentives top down are sometimes the harder part. So if you, if you can't align the incentives and the rewards, however, that is with that future transformed state, it's also not going to be sustainable. So the, the example in the VA, we had when I first got on board, the question to me was, well, aren't you just gonna like mandate that people do that. You're in central office. That's what we do. Like, you can just like tell them you have, I was like. You can't drive a cultural transformation from the top down like you can't just tell people it will never work. So I was, I was good that I wasn't from I didn't know any better. I didn't know I wasn't supposed to be doing it. So we took a systems approach and we said, okay, we've got to evolve the model. We don't know what it looks like. We don't know how to operationalize that. And so we empowered the front lines, bottom up, we gave grassroots innovators some grant funding to say, try it, we'll see what we'll learn what we can. We had centers of innovation. We had places that said, we don't know what it looks like, but we're going to help try from the bottom up. And then we took on one of the best things that, not one of the best things, but a great thing that Ben did when he was still on my team before he took over was he helped get the alignment of funding for the health systems to cover these services. That's the example of the incentives, right? We made sure that part of how leadership was evaluated on their performance evaluations included. Are you doing whole health? And I could go on and on. There's a whole list of things that we did, but they basically fell into the categories of how do we empower the front line? The grassroots give people experience. And how do we address the alignment of the incentives and removing barriers and while that. Not everybody is in a situation like we were in the VA to take that on. I think that construct, that way of thinking can be a value to people wherever they are in the system.

[00:27:15] Dr. Melinda Ring: I was thinking about as you were first talking with the executives who got their compensations tied to whole health. I you know, in the non VA setting, to me, that's the biggest challenge because spending time talking to somebody, spending time talking about it. Yeah. Really, what I think are the most important things to get to the root causes of disease takes time and time is not compensated in our insurance model. Uh, somebody who sees four to six patients in an hour, a clinician makes a lot more money than somebody who spends an hour with a patient, even though that's, possibly a more long term, impactful investment of time. And that's a real challenge, and I think it's why, unfortunately, we're seeing so many people in the lifestyle medicine, integrative medicine, leaving the insurance model to do cash, which then creates a whole. Different issues in terms of access to this care, which I think everybody needs, uh, not just people who can pay out of pocket. So that incentivizing is, is, is a real challenge as I think about how do we grow our cadre of clinicians who can practice in this way without saying, but you need to sacrifice your income to do that,

[00:28:42] Dr. Tracy Gaudet: 1000%. Yes. That is such a major obstacle. And I do think also that when we look for places where incentives are aligned, I think employers have a huge alignment with it. These kinds of an approach approaches, right? They are when you look at the cost that most employers, even if they're not self insured, but for sure, self insured employers, the cost of medical insurance for them is huge. Not and let alone, they want people to be present in their work and efficient and effective. So these non clinical approaches, like the empowering and the peer groups and the equipping the well being centers with skill building and support. There is no reason that can't be done. In, in, in, in a workplace environment and supported and paid for by a workplace environment when they see, and this is where some of the data from the VA is helpful when they see that's actually going to save them not even 20 years. People like to say, well, it's going to be 20 or 30 years. Do you see the benefit? Not not? Yes, you'll see a benefit in 23 years, but in the real time the reduction in opioid use, the reduction in hypertension and diabetes control, et cetera, et cetera, et cetera. So I feel as though maybe we as we're trying to drive change to shift and engage employers in a more proactive way because their incentives are aligned.

[00:30:07] Dr. Melinda Ring: Right. And yeah, Dr. Mike Roizen was another one of my guests and Cleveland Clinic has really done a lot of that in terms of employee well being and showing the immense savings that have, I can't, he reeled off so many numbers, the immense cost savings to the employer, less sick days all of that kind of stuff. Really dramatic. So I agree. Like we need to, it. get all of that data together to share with the health system leaders. This has been rich. It's been inspiring. I've learned. I'm inspired. I hope listeners will walk away with. A whole new perspective on what's possible for health care. And before we go, I always like to ask a final question. That is, what is one piece of personal wisdom that you would share to help our listeners reach their own next level of health?

[00:31:01] Dr. Tracy Gaudet: Wow. Well, I think what I would recommend is often the hardest when we're in busy lives and just trying to get through the day, but it is to engage. Invite yourself to have the conversation we were talking about to reflect on what really matters most to you. What do you want your health for? Don't wait till you have the cancer diagnosis to reflect on that and give yourself the gift of peeling back the layers on that. So the first thing that comes up is You know, my, my family through, what about that and really allow yourself to go deeply into that and share that with somebody that matters to you in your life. And then just pay attention to choices you might make that are more grounded in that clarity of your own sense of meaning and purpose. I would invite everyone to do that.

[00:31:55] Dr. Melinda Ring: So Tracy, thank you for all you've done to transform health care. And for those listening, if you want to learn more about Tracy's work, the whole health model. Or the Doctor of Whole Health Leadership Program will link all the details in the show notes. If you enjoyed the episode, don't forget to subscribe, share it with a friend, and leave a review. I personally would love to hear what resonated most with you. You can find me on Instagram and LinkedIn at Dr.Melinda Ring. And let's keep the conversation going.

[00:32:26] Dr. Tracy Gaudet: Thanks so much for having me, Melinda. I really loved the conversation.

[00:32:30] Dr. Melinda Ring: Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.