Lost in Translation: Bridging Communication Gaps

Do you ever find yourself struggling to communicate with colleagues on different teams as if you're speaking completely different languages? 

In this episode, we dive into the power of collaboration in the workplace. Our host, Jandel Allen-Davis, M.D., CEO and president of Craig Hospital, sits down with Dr. Andrew Park, a spinal cord injury physician and research scientist at Craig Hospital.

Leaders in many fields often deal with communication breakdown among experts from different disciplines who come together to solve a problem, build a widget or launch the latest software. Dr. Park understands the unique challenge of navigating two fields that often speak different languages - clinical work and research. These two specialties require collaboration between researchers, clinicians, patients and oftentimes funding sources. 

Tune in to this engaging and inspiring discussion to foster communication and productivity within the teams you lead. 

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Disclaimer: The content in this podcast is intended for general informational purposes only and is not a substitute for professional medical advice or treatment for specific medical conditions. No professional relationship is implied or otherwise established by reading this document. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Craig Hospital is not affiliated with resources that may be referenced in this podcast. Craig Hospital assumes no liability for any third-party material or for any action or inaction taken as a result of any content or any suggestions made in this podcast and should not be relied upon without independent investigation. The information on this page is a public service provided by Craig Hospital and in no way represents a recommendation or endorsement by Craig Hospital. Any use of this content by a corporation or other revenue-seeking or -generating organization is prohibited unless first approved by Craig Hospital. 

For more information, transcriptions and behind-the-scene photos, visit https://craighospital.org/unstoppable

Craig Hospital is a nationally recognized neurorehabilitation hospital and research center specialized in the care of individuals who have sustained a spinal cord injury (SCI) and/or a brain injury (BI). Located in Denver, Colorado, Craig Hospital is an independent, not-for-profit, 93-bed national center of excellence that has treated thousands of people with SCI and BI since 1956. Learn more: https://craighospital.org

Transcript

0:00:06.6Jandel Allen Davis: 0:00

Welcome to Unstoppable at Craig, where we pull back the curtain on what makes healthy workplace cultures click, and what happens when people are empowered to expand the boundaries of what is possible. We'll explore the perspectives of employees and leaders who have carte blanche to speak their truths, tell their stories and unlock uncommon ways of approaching challenges. I'm Dr. Jandel Allen Davis, CEO and President of Craig Hospital, a world renowned rehabilitation hospital that exclusively specializes in the neuro rehabilitation and research of patients with spinal cord and brain injury. Join me as we learn from people who love what they do,

and what happens when fear doesn't stifle innovation. 0:00: 0:42

50.9Jandel Allen

Davis: 0:49

Have you ever felt like you're speaking a different language to your teams? I could tell you so many stories, and thankfully I think there have been fewer of them as I've sort of had more experience and hopefully grown and learned from the teams, but I remember one of the best examples of this being, I was a young leader in the medical office that I was working in at Kaiser Permanente with all these, just brimming with ideas and things we could do or should do and could do. And it felt like I was working a little bit at cross purposes or certainly they weren't understanding much, and I remember thinking about the metaphor of white water rafting, which we've had a chance, and I've had a chance to do a little bit of in my life, and when you come to the rapids, you actually pull the raft out and you actually try to read the river, and you and your team, or whoever is in the boat you look at it, you figure out how you're gonna actually navigate your way through the rapid, which side of the rock, whatever it is that you're gonna

do. 0:01:47.8Jandel Allen Davis: 1:48

And I remember thinking about that as a great metaphor for this idea of speaking a different language and went on to write, I'll never forget that you... We start down this, we got... I think I got great sort of alignment, we know what we're gonna do, we know how we're gonna shoot this thing, we get back on the raft, then we take off and we hit the first part of the rapids and someone goes flipping out of the boat, all the gear is gone, luckily we didn't tip the raft, but by the time we get down, I'm one of the people who's fallen out and I got a big old gash across my head and we pull to the side of the river and I say, Wow, what happened? I thought that we really had clarity around what we're doing. And one of the more courageous team members speaks up and says, Well, you never actually asked us if we really understood. You just sort of said, This is what we're gonna do, and you said it with such some kind of way that we all just sort of went along

with it. 0:02:41.0Jandel Allen Davis: 2:39

Well, you know the interesting thing about that as a metaphor for leading teams, whether they're clinical or administrative, is very much akin to that. And at Craig, we have doctors, therapists, nurses, psychiatrists, social workers who come together on one team, each of them having a different level of expertise, different perspectives and approaches to how we're gonna treat that one patient. And in an effort to make sure that our patient can interpret what we're saying and have an active role in their own rehabilitation, it becomes essential that our team of experts are speaking with one language, that they know how we're gonna shoot those rapids as it were. You know, experts on one interdisciplinary team often have a challenge of learning the team's language and making sure that we're creating the space for them to put that language into the room to get the highest quality product. And it's not specific to healthcare settings by any means. We see it in the software industry where you can have developers, managers, designers, and IT specialists all coming together to hopefully create great products that help all of us sort of navigate and make our way through the world.

0:03:43.8Jandel Allen Davis: 3:43

Well, I'll tell you that as leaders, it's our obligation to understand the nuances of that kind of language to foster communication and to alleviate the tensions that can come up as a natural part of working in teams, all at the benefit of the team,

but ultimately our patients or our customers. 0:04:02.8Jandel Allen Davis: 4:02

Well, we're gonna talk to Dr. Andrew Park today, who has a one of a kind role at Craig. He spends about a day a week, actually, caring for patients as a spinal cord injury physician, and then the other four days as a research scientist, and if ever there were two languages that you think would be hand in glove and are not at all, it would be these two. So he splits his time between Craig's dual focuses on neuro rehabilitation and research, and he's able to provide some important insights, I believe, into both areas of care, which he describes as often speaking different languages. The way he thinks about problems and the way he approaches solutions to these problems in research and clinical work are often very different, and this can be both a benefit and a challenge while collaborating on an interdisciplinary team. Andrew understands the opportunities and the challenges of what happens when we bring together those who are the best in their field to treat a patient. So welcome, Andrew. It's so nice to have you here. Thank you, Jandel. Really appreciate you having me on

today. 0:05:03.7Jandel Allen Davis: 5:03

So when we think about sort of this beauty of navigating two roles, I could imagine that there's some real cool moments, but also it can create some challenges. Why don't you just sort of riff a little bit on what those are like for you? Yeah, absolutely. I think I have one of the best jobs in the world. You know, becoming a physician was such a life long goal, and as I kind of traverse the process and training, as you're aware of, to become a physician, I found that in some ways, the position would bottleneck you into certain roles within the healthcare system. And so an opportunity to also be able to kind of flex this different muscle and become a researcher, it's really quite dichotomous and contradicting to each other a lot of the time, but what I find just so much fun about my role is that when I'm providing clinical care and I'm frustrated with whatever, the healthcare system or whatever I'm seeing from a clinical perspective, I can take and channel that energy into something creative on the research side to say, And now I have a goal, I have something that I can try to solve using research. But then sometimes research can feel very far away from helping anybody. And so the ability to take that context of saying, Well, I'm doing this daily grind of research, which oftentimes is a pretty obscure and a hard thing to define, and I can take it back into the clinic and say, Well, this is why I'm going through these steps that sometimes feel monotonous or are far from actually helping anybody with the hope that it'll actually help people one day. And really the beauty of it is, is that being able to do both roles, they really serve each other. That way my clinical questions that I'm asking in my clinics, in my practice, I have the process to turn into a research question, which then I can apply with a scientific method to actually answer a fundamental question that helps me in the clinic and vice versa, where sometimes the research world gives you something interesting. But sometimes it's hard to understand the context of whether that's gonna help somebody. So again, being able to bring that information back to the clinic and say, Well, this is where this might be applicable, or the ability to pivot and say, This is super interesting, but actually I just don't see a path for this to actually help anybody. So being able to make that quick switch and say, Interesting but not relevant, let's move on. That's the benefit of being in both worlds that I enjoy so much about my job.

0:07:30.1Jandel Allen Davis: 7:29

Yeah, I could also... Though it's interesting and it's funny that I thought about that navigating a river and white water rafting metaphor, because I could also imagine that there are things you see clinically that, Boy, this would be exciting and interesting to think about taking back to a research team and having them go, Huh, or the other way, the challenge of, We really do have an opportunity to answer a significant and important clinical question. And you take it to clinicians and it's met the same way. And do people candidly say, Huh, or do they just sort of nod? And that's how we get the crazy, everybody's out of the raft by the end of it, or on a serious note, you come up with great research questions, great research findings, and we have a heck of a time both translating, and let alone using them in clinical practice, 'cause that feels like the challenge the other side of this. 100%, Jandel. I would say that that is the biggest struggle. And the real defining moment of translational medicine versus not. Is that I see that every single day. Is where a great question is just not appreciated. And this is true in both directions and in every facet of what it takes to do good research or provide good clinical care. So this is not just researchers and clinicians that are working together or sometimes not working together, but also funding sources. Whether it's an insurance provider on the clinical side or a funding agency for research projects, they can't see the potential, oftentimes, when you're trying to describe why this is important. And those things influence how we end up practicing in both ways. So in clinical practice, we make decisions that are driven by not always for best patient care, but because of payer sources and those kind of things. And vice versa, that happens in research where often times our end points is about getting more funding, not necessarily when will this translate? How do I get this in the hands of people who can actually take care of patients with this? The dissemination piece that we oftentimes forget. And so, yes, 100%. I think that's the underlying messaging that is so important and the theme of our talk today, which is the ability to talk multiple languages, because that's where that translation stops. And if you're able to communicate with multiple different parties in ways that they can understand the benefit, I think that's the real legitimate way of getting past that barrier to make researchers go, aha, I see the importance, and for clinicians to say, aha, I see how that research can end

up helping my patients one day. 0:10:09.5Jandel Allen Davis: 10:07

So how... When you think about this notion of different languages, when I think about

what we do here, and as I said, therapists of all sorts: 10:18

Psychologist, nursing. There's all sorts of folks who rally around and wrap themselves around patients when they come in. How do we respect or do we respect the different languages and the different voices in that room? Yeah, that's a great point. I can summarize that in one major concept, which is kind of the gray zones and the tension that exists within interdisciplinary teams, and how critical that is to a successful team. The trust portion really comes with, especially, people in leadership roles, is to really just be genuine and vulnerable. And so I just think it's just human nature that if you're kind of set in an environment where everyone is really targeting one specific goal, like we do at a hospital, which is to help the patient, that's what we fundamentally wanna do every day, and then you bring a team member into your team, the best way to integrate them into your team is to give them something worthwhile to do, to contribute to the team. And sometimes team members have a hard time knowing how they're gonna contribute unless they find gaps or problems or something that the team isn't good at that they are good at, or maybe they're best at. Maybe there's a lot of people who are good at something, but they're really the best person, how can we set them up to take on that role? As leaders I find that many leaders who tend to be more extroverted individuals, who like to talk and people who fill the room, sometimes it's hard to vulnerably say, This is... I'm really bad at this. I'm really bad at this, and I need my team members to rally around me and help me with this portion, 'cause I'm surely not an expert in this. So whether it's self deprecating humor or whatever it may be, your team needs to feel like they have space to contribute in every single day. And so there are some natural obvious components to that, which is that... Obviously, I'm not a physical therapist or an occupational therapist or any member of our interdisciplinary team. I couldn't do their job. And so there's naturally expertise on the team. But then there are

like the non measurable components. 0:12:26.4Jandel Allen Davis: 12:24

The intangibles. The intangibles, yes. They are the, who's the most organized person in the group, or who is the most tactful person? Sometimes you need the stern parent in the group for a certain type of patient, while other times you need a much more softer hand with other types of patients. It's the psychologist's job to deal with the patient's

feelings. That was with the question mark in quotes. Okay? 0:12: 12:50

54.2Jandel

Allen Davis: 12:54

Right. So, no, it's not because they may be able to help influence our thought process and how to work with a certain patient, but we all have a role to play in making the patient feel comfortable, confident and progressing both through the grieving process and understanding of the new injury, but then to get the most out of them every single day to set them up for success. And I'll tell you, being part of Craig Hospital, what I love is we have these very highly integrated teams on the clinical side and the research side that allow individuals and the team themselves to figure out these roles, and over time through knowing each other and trusting each other. So without saying names, there are certain physicians in the group who by delegated authority are the leaders of the group and are not the most organized human beings. Great human beings, but there are members of

their team that keep that team organized. 0:13:49.0Jandel Allen Davis: 13:47

That's so cool. And they serve a different role. Like context and big picture. While there are other teams where the physician is the driver of the organization and the dictator of the agenda, but that allows the team to work in different ways and have other types of strengths that they bring to the table and are able to provide to the patient.

0:14:10.0Jandel Allen Davis: 14:09

So I heard trust, I heard vulnerability, I heard humility, and this notion of leveraging the team strengths, those intangible strengths, that actually aren't that intangible if we're paying attention and really getting to know our team members well. We sort of know who we need to have fly in at a given point, and making sure that all the team members know that there is their sort of content knowledge that they bring and expertise. But they also bring their humanity, they bring their human ness. That is important too. How does this look on the research side? Same sorts of... Yeah. Yeah, yeah. I think the research side is... It's been a learning experience for me as well. But overall, it's really the same themes and the same concepts, but applied in a very different way. I think the context and the timelines and the urgency is different on the research side. And that would be my criticism. But also... But at the same time, there's a thoughtfulness and a rigorousness to research that sometimes is lacking on the clinical side. And so bringing that marriage is... It creates a lot of tension, and I bet there are clinicians who think maybe a little too slow and methodical when it comes to some clinical things or maybe too abstract, and there's probably some researchers who think I'm just a little too much pedal on the metal, I'd say. Slow your role a little bit. But that's because living in both worlds, you try to find the middle

place and provide that attention. 0:15:41.7Jandel Allen Davis: 15:39

So say a little bit more then how you navigate that 'cause you are between two worlds. Right? And actually within those worlds, there are multiple languages.

100%. 0:15:49.0Jandel Allen Davis: 15:48

Statisticians, bio statisticians talking

to research scientists. Absolutely. 0:15:55.8Jandel Allen Davis: 15:52

Talking to the people who really understand the technology and the databases.

Yeah, absolutely. 0:16:02.0Jandel Allen Davis: 15:59

There are clinicians and there are people who've never touched patients who are also doing the same work? Right, right, 100%. So I think it starts by saying it out loud and providing that context to everyone you talk to. So I have a same spiel, it doesn't matter if I'm talking to clinicians or researchers or patients and their family members, I start by saying, It is contradictory to do research and be a clinician. It is contradictory. As a healthcare, as a physician, my job is to do no harm. That is what I vowed to do. And under that mandate, providing solid concrete evidence and trying to minimize risk to my patient is priority number one. But as a researcher, it's the exact opposite actually. We're trying to push the science and innovate, and that inherently has harm and potential risks. And so my job as a researcher is to inform about the harm

and the contention... 0:16:55.3Jandel Allen Davis: 16:53

The potential harm you mean. The potential harm? Right, right, exactly. So the potential risks that we're taking push the science. And that role can be really difficult to navigate if your participant in a research project also happens to be your patient in the clinic. So those lines can be really blurred really most importantly for the patient and their family members. So when I'm consenting a patient for one of my studies, I talk about putting on my researcher hat. This is a different person you're talking to right now. I have biases now as a researcher that I don't have as your physician. And so that's how I talk about it. I need you to participate in this study because you participating equals me finishing the study, which will mean me getting funding for a different study, and I have to... There's this incentive bias that I have. So I lay it out for my patients who are now my participants. And I ask the same of my colleagues. When I come into a room and I talk to a group of researchers, I give them that context and say, Listen, the battle that we have in front of us is that clinicians do not want to put their patients in any higher risk of harm than they absolutely need to. And every day we come in here and ask them to put their patients in more potential harm than them not participating in the study. So that's the context. So we gotta be really sure we're gonna do something meaningful for these participants. That we're gonna push the science in a meaningful direction. And I would argue we can't do that without the clinicians. And vice versa though, 'cause clinicians, just as you mentioned, statistics, research methodology, funding language to bureaucracy, all the things that operationalize research is not necessarily taught very... Not very high language in medical training necessarily. Just because you're a clinician doesn't necessarily mean you really understand what it takes to do research. Is a clinical question really a research question? Is this something that research can answer right now with what we have and feasibility and all the components that's necessary for research? So that gets lost to clinicians relatively frequently because you can't see the end game of how this little tiny study may improve things in the future, but vice versa without that knowledge and that potential then we may choose to throw the baby out of the bath water every time. So that was a really long way of saying, you first point that out and give that kind of perspective. And then the rest of it is, again, that humility piece. You have to ride that line of knowing just enough to be dangerous. I'm not a statistician but I know enough statistics so I can start talking to a statistician. The basis of how they're thinking through the process, and realizing that if I try to do this by myself, I'd make a mess of statistics and do some bad things, but to be able to start that conversation with them

and vice versa with other fields. 0:19:51.6Jandel Allen Davis: 19:50

Talk a little bit about what does it take to be that kind of high performing interdisciplinary team, whether we're talking clinical or research, or frankly even administratively? Yeah, thank you. That's a great set up. I think back to my medical training and something I noticed immediately when I entered the rehabilitation world as a good starting place, which is back when I was in medical school, the idea of Interdisciplinary Rounds with the patient in front of the ICU bed, that was kind of a hot topic. Still is. We still try to perfect it. So the idea that every member of this interdisciplinary team stands around and talks about the patient together. And what a great idea. What a great concept. And then I came into the rehabilitation world and said, Man, we've been doing this forever. This has been just how we function for the longest time. But it's not that... There's something different that I couldn't quite put onto it until later into my career, which is that an interdisciplinary team that are standing and talking about their specific discipline, pharmacists talking about medications, physician talking about some sort of management plan, the case manager talking about a disposition program, these are all good things. It's good for us. I'll hear what each of us are doing. But that's not truly the power of a true interdisciplinary team. The power is when as a physician, I know something about your job as a physical therapist or as a case manager through osmosis, through mutual discussions and education and the team being the same team for a long period of time. I can become a case manager light and understand their world a little bit better, have really a scope of what they're doing when they're not with me on a daily basis. Oh yeah, I know that my case manager is gonna go and meet with the patient, and within the first two to three days, 'cause they really love to do that, and then I know they're going to talk about this component and the payer source and do all of these things. There's an entire meeting or the focus meeting here at Craig that doctors are not invited to on purpose, because it's very important for them to stay focussed and that

might be hard with a physician in the room. 0:22:03.7Jandel Allen Davis: 22:04

It's funny. So there are all these pieces that are happening outside of my realm that I know they're going to be doing because I understand that case manager and how they function and how a physical therapist functions, and the nuances of what their evaluation and care are doing. And this is really hard to do after your training has ended,'cause now we got a job to do. You gotta do your job as a physician, and so that's a full time thing, but if you're with the same team with long enough, you can get this osmosis and learn about what their roles are beyond these very superficial content points. And then if you can start predicting what your team is going to do and start communicating that with your patient and their family members, just again, full loop back to just setting up your team for success every time. You know that if so and so therapist on my team is definitely going to talk to you about bathroom equipment on day two. So if something about the bowel program comes up, you can say, So and so is gonna talk to you about this tomorrow. And then guess what? They come in and then they say

it. 0:23:10.7Jandel Allen Davis: 23:11

They come in and then they do it. And they're like, Oh yeah. Everybody's on the same page here. Everybody's getting it. Everybody... There's a process of that. And again, I can only say it long windedly because I still have a great name for what that is, but it's a level of interdisciplinary ness that

really crosses disciplines. 0:23:31.8Jandel Allen Davis: 23:28

How do you, as a physician, as a research scientist, as a leader, sort of deal with the mythical part of Dr. Park, when you know darn well, and we know it, even as the good clinicians, you don't get that stuff done by yourself. 100%. Oh, that's a great segue. What a great topic. The most important thing is when there are situations where you are deemed the expert or the person in charge by the system and not by reality or actual how things work in real life, you point that out to your team. You point out the ridiculousness of some of our roles. And I've given this example before of there are many cases in interdisciplinary teams where the physician's signature is the end game of the process.

0:24:19.0Jandel Allen Davis: 24:19

Oh, gosh. I just had a therapists work on this extremely complicated wheelchair prescription involving every nut and bolt and chair and cushion, and every delivery system, and then at the end of the day, they need my signature for this to be prescribed.

I couldn't tell you from front and back... 0:24:40.7Jandel Allen Davis: 24:39

It's like a hyperbole, isn't it? Everything I know about wheelchairs is from my team, and so... But there's that ridiculousness where I need to sign that for the insurance company to authorize this wheelchair. And so you gotta point that out to your team and say, This is ridiculous. We both know this is ridiculous, but we're gonna go through the motions

because that's gonna help the patient. 0:24:56.5Jandel Allen Davis: 24:54

That's gonna help the patient. Yeah. At the end of the day, that's what we're here for, right? So sometimes we have to be okay with some ridiculous things and deal with the realities of a system, if we know that the end goal is this, but I'm right there with you. I'm never gonna question you on your decision regarding some piece of equipment that I have no expertise really on. So that's how you move from that delegated authority, someone told you, your boss, to legitimate authority, from being vulnerable, pointing out your flaws and looking for answers. Another way is to just... Again, if you really know your team and why the expertise lies, use that. Nothing more valuable than going to a team member with a problem and saying, I don't have a solution for this, and I think you're really good at this. What do you think? Every chance try to get feedback, get out of your own head, even if you have an answer that you think is excellent, to go to your members of the team that are truly experts, and that placation. And within the team they know, this person is really good at talking through these tough situations, or, This person's really level headed and could handle this really well, or, This is our expert on a very specific topic like. That might be... Feel specific. No one in the team questions that if you say, I went to this member of the team to talk about that, and I'm gonna come to you for this type of topic. And there isn't any hurt feelings when you didn't talk to everyone every time about every problem, because everyone on the team knows, Yeah, if I had that problem, I would go to that person too.

Yeah. 0:26:25.3Jandel Allen Davis: 26:25

That's so true. It's a... Just a... I had a, I don't know if you've heard the phrase, a bust your buttons proud moment last week at the hospital board meeting, and I think it was actually one of the best board meetings we've had when we had not people with big titles, directors or vice presidents, but we had some folks who were truly the experts present on different topics, and I wouldn't have done that anywhere close to as well, anywhere close. And I would even challenge my other executive team members to say, And we couldn't have done it that way either. So I think what you're speaking to is that the way we get out of this notion of the mythical or the charismatic leader of teams or of research projects and research work, let alone the chair that I get to occupy right now, is to let them speak. Give them the spotlight from time to time and let them do it. And you also have no idea where it'll take them in their career. So another great way to think about it. Thanks though for spending time with us today to talk about this notion of... Well, we talked about a lot of notions, but this notion of really the languages that we speak and how translating them, which is not a technical exercise, it's all. It's not head, it's heart and gut, it's how we pull

those two together. Absolutely. Absolutely. Comes down to people. 0:27: 27:41

44.8Jandel

Allen Davis: 27:43

Comes down to just people and caring about them. And you do it beautifully. So thank you. It was my honor. I appreciate it. I love these conversations. I look to have some more

in the future. 0:27:58.0Jandel Allen Davis: 27:51

It's a real privilege and honor to have the opportunity to talk to a physician colleague, and, interestingly, one who is relatively early in his career relative to my age and where I am, and to think that a guy who's figured out and has channeled this sort of wisdom so early in his career is going to continue to provide lots of great learnings over the decades that he continues to practice. But what are those essential ingredients, those pre conditions to creating the environment for teams to flourish? It's about providing as a leader, real clarity around what it is that we seek to do. And it can be hard. In all honesty, that level, the kind of clarity that people will need, especially as we take on audacious and big work in our organizations,

requires that we slow down enough to do two things: 28:49

One, to figure out what's the language that is gonna speak to the hearts and the minds of people who have to do the work, but also take time to make sure that people are committed, going back to my rafting, my white water rafting analogy, that they're really committed to making sure that we're gonna get through that set of Class 4, Class 3, Class 5 rapid safely, because we are all in. And I mean, we are all in. So I think that's another

important one. 0:29:20.7Jandel Allen Davis: 29:18

The other thing I heard from Andrew that I think is really, really important, and I spoke to it at the beginning of this, at the top of the time together, is this notion of being I would say culturally versatile. That is the ability to speak multiple languages, to speak multiple dialects, which means, back to what I said at first, it's about people and you must know them through and through. So that's it. I hope that you picked up some great nuggets today in our Unstoppable at Craig, and here's to continuing the journey of building great teams. Thank you.