293: Making Change Stick in Healthcare, with Teri Renfrow

We talk with Teri Renfrow about why strategy often breaks down at the point of execution in healthcare, and what it really takes to move from pilot to full-scale adoption.

Teri shares how frontline experience, not just technology, determines success, and why storytelling paired with measurement is the key to building trust, driving behavior change, and sustaining results across complex systems.  

• why well-designed initiatives fail once they reach the frontline
• the critical role of “why” in preventing backslide and resistance
• why negative feedback is not resistance, but data
• how storytelling translates data into meaningful action
• balancing metrics with real-world clinician experience
• the leadership habit of “going to Gemba” to understand reality
• scaling adoption while preserving human connection
• one practical way leaders can improve adoption this week

Connect with Teri Renfrow on LinkedIn: https://www.linkedin.com/in/terirenfrow/

Transcript

Scaling Beyond Pilot Projects

Dr. Pelè 0:58

Large-scale implementations across healthcare systems are helping organizations move from pilots to full-scale adoptions while improving clinical outcomes, operational performance and culture. Terry, that's a marvelous question. But I'm really glad to be here. How are you doing?

Teri Renfrow 1:14

Thank you. I'm excited to be here. So good today.

Terry’s Path Through Lean Healthcare

Dr. Pelè 1:18

Oh, awesome. That is so cool. Terry, you know, we talked a little bit before we began our conversation here today. And one of the things I've been really impressed with is your work is right at the sort of confluence of technology, people, strategy, all the things that really matter for success in organizations. And I would love to know how you first got into this area of interest in your work.

Teri Renfrow 1:44

I started out as a truly in healthcare as a lean coach, looking at workflow, looking at how lean management principles and lean thinking can drive an organization as a true management system. And in doing that, I actually started in healthcare shadowing physicians and their their staff as they engaged with patients. So truly watching and learning that workflow in clinics and coaching through how to better engage with the patients. From there, I went on to the larger system and looking at, well, what is what's the full picture? I got very frustrated by, okay, now I can work bottlenecks on just where that patient engagement is going, which is so critical. And I worked with so many fantastic physicians and APPs doing that work. But then I wanted to get rid of the rest of the bottlenecks and blockages. So I moved into a larger lean role. And from there I've done consulting and uh led different projects and different, and um, most recently, a really exciting digital health innovation. And all of it has to do with how you write what your strategy is, make sure everybody understands down the front lines, how you measure that, and then how it moves back up so that leadership knows what front lines are doing.

People First In Technology Change

Dr. Pelè 3:07

Powerful. Almost sounds like you're describing a factory where things have to work as design. And, you know, as you say, you had the lean thinking behind you. Um I wonder what when did you first realize that success in organizations, healthcare organizations, wasn't just about the technology, you know, but it was more about the people experiencing the technology in real moments. When did that sort of occur to you and push you in this direction?

Storytelling That Drives Adoption

Teri Renfrow 3:38

It's always about the people. And you know, the people that taught me what lean thinking is, how to coach to a lean management system, they came from factories, they came from other industries. But within healthcare, you know, it's not an assembly line. You meet every patient where they're at, I meet every physician or executive that I'm working with. I'm I'm meeting them where they're at and we're coaching through. And if the people aren't really understanding why they're doing what they're doing, what the larger picture, what the what the larger picture we're trying to gain is, then they're gonna go back to what they thought was correct before and they they backslide very quickly. But when you're trying to bring true change, people need to understand we're gonna give you this great new shiny object, this great new tool. Um, you can do great things with that, but if I don't really show you the why behind this is gonna be better for your patients, the why behind this is gonna help you get to what you need to be doing so you feel good about your work, because everybody got into healthcare, not to be able to run massive companies, but to truly work with patients. So if I can't express that, then we're not gonna go anywhere and backsliding happens. And my favorite thing is when I talk to people I had coached a couple of years back and they tell me, Oh, yeah, no, we're still that huddleboard, oh, still using that. That doesn't go away. No one's ever gonna take my huddle board away from me. Or though they really understood um and they'll hear themselves talk to things like, well, what problem are we trying to solve before we jump to solution? All of those things means your people got engaged correctly.

Dr. Pelè 5:21

So, you know, you you mentioned uh things like trust. Um uh and you you talk a lot about storytelling being a way of conveying meaning and and helping to move things forward from strategy to execution. How does that all work?

Teri Renfrow 5:39

There are there's there's two ways people learn. It's that some people can hear the data and and glom on and understand it and make sure that they get, oh now that's why I'm changing. Most of us need the story behind it. So, what story are I needing to connect so that people understand the data and the new change in the workflow or the new technology you're going to be adopting? What story tells that best? So, when I was working with uh MedParl when I was with Providence and we were standing up that new innovation fantastic clinical decision support system, we we looked out um high and low for our users, our physicians, our APPs to be able to tell us how they were using it in the work uh in the wild, as it were. So we had favorite stories. My one of my favorite people that we worked with, she was an urgent care doc and she tells this fantastic story. May I share this story? Absolutely. We talked a lot about how you use this tool, how this tool can um improve work RBUs and we're total cost of care and all of those right metrics. Well, this was one story. She was at the end of a very long shift and was tired, and in comes a police officer who had fallen asleep on a boat on a shuttle. And as he was waking up, he realized he'd lost his hearing in one ear. That's an unusually unusual thing to happen, very scary. So gets off and uh goes, ends up actually think at a couple of different urgent cares before he finds one that doesn't have a super long line, gets in front of this person that I just adore, this doctor, and she went, okay, I'm exhausted. This is important. I think I need a tuning fork. What do I need to do for this guy? And she pulls up MedParl, our clinical decision support system that is to give you within a couple of minutes the right actions. She walked through that algorithm, she asked him what happened, she went through what she needs to do. She was able to get him the right referral to an ENT with the right wording that would catch the ENT's understanding of what was happening. So that the next morning, because she dedicated, followed up with the ENT's office, that cop was able to get in with that ENT and have his hearing restored to the point where that ENT said, no urgent care doctor he's worked with caught it so effectively. Saved not just this man's hearing, but obviously his career and what he could do with his life. And that is a story to explain. Look, this is going to help you in your practice. You're going to be able to use this and get to the answer faster. Uh, medical knowledge is doubling every 73 days, and that's an old statistic. That statistic is pre-COVID. So, how fast is it? Post AI everywhere. Yeah. How do you keep up with it? We had MedParl as an answer. And that story is just one of many.

Dr. Pelè 8:53

Wow.

Teri Renfrow 8:54

I had another physician that was able to, in an ambulatory care setting, realize that without, I believe, without even any international travel, that he was looking at a family that was going through sepsis. There was no hospitalization. There, he just was able to diagnose it from what he was, and he pulled up Med Pearl and said, Okay, I got this. Now that's a catch you don't normally get. That's a story that is going to capture the attention of the people we talk to about this product. That is how technology changes. I'm going to capture your mind on what this can do for you. By the way, this also is going to here's a pajama time stop stat that's going to help you think through how what those will save you. Here really is what the bottom line is for your CFO. Whatever that looks like, the stories must go with.

AI Trust And Faster Clinician Uptake

Dr. Pelè 9:43

You know, I have to tell you, I am a fan of storytelling and of you know the power of narrative. And even just now, what you shared gave me the real picture of what you were talking about in a way that regular words would not have. You put me in a place and time. And I really appreciate that power. You know, what's something that you believe about change? Because you mentioned change earlier as being central uh to what you're doing sure. Technology is the vehicle, but uh what's something that you used to believe about scaling change in healthcare? That you no longer believe today, as you said, in the world of AI and speed to market and trust and all kinds of things going on at the same time. What what's new?

Teri Renfrow 10:26

What's new? Um how how quickly physicians and APPs are willing to try technology. You know, uh I can I can admit to being old enough that there were some physicians that were saying, I don't want an EMR. And I was saying it's coming, and you need to get faster at typing. This is what you need to do. You need to figure out how to do better with the keyboard. And now obviously we have AI where they can stop doing as well with the keyboard because they can use ambient listening to be able to get their notes moving better and faster. But that that idea of um what how quickly they're willing to try technology when AI first hit, you know, how many doctors did you hear say, I can't trust that? I would never have that anywhere near me. Yeah. And with enough safeguards in place, with enough testing, with enough of uh true scientific testing, can we trust this? Yes, they're more and more willing to trust. That I would say is new.

Why Initiatives Fail At The Frontline

Dr. Pelè 11:33

And it's absolutely yes, it's absolutely new and still evolving. We're right in the middle of this huge change right now. Right. Let me ask you, let's zoom out for a second. Let me ask you a question that's a little larger, and that is why do well-designed initiatives with strong leadership support still fail once they hit the front line? Why?

Teri Renfrow 11:56

There's a uh there's a couple of reasons that are that I typically see. Um, a lot of it is it's just it's not communicated well. So there are people in the system that will just wait it out. I don't have to change because this is a shiny object, leadership's excited about it, it's going to go away. That's poorly communicated. You weren't explaining the problem you're trying to solve and how this will help the people that need it the most. Or you didn't look at the full workflow and see where that new technology fit into the workflow. You don't understand what the person's doing with their entire day and if this helps or hurts. So it can't be adopted if it breaks my workflow in a way that puts my patients in harm's way or keeps me from going home, right? That's that's what we want to make sure that our clinicians are able to do. So that is a big piece of failure. Um would say another is where you you've missed explaining the why. So connect what this new technology, what this new digital health product does to the mission of the company. What are you saying that I need to do with this workflow change? That I need to get better, smarter leap buildings, faster, whatever it might look like. How does that help me make my mission? And so you get leaders who will explain the how, they might understand the what. They might not actually have been uh for one of my favorite words we use within lean coaching, you might not have gone to Gamba, you might not have gone to where the work is being done to really understand what it is. You've just, I've been an ER doc in the past. I know exactly how this is gonna help the ER. I haven't actually worked a shift in 20 years, but I know exactly how this is gonna help the ER. So if you haven't gone to Gamba and you haven't explained where the why is, people are are gonna be resistant and they'll wait to help.

Dr. Pelè 13:58

Yep.

Teri Renfrow 13:59

So you make sure that why is what I worked with one group now, it's a fantastic um ABA firm in the Midwest, and they've been doing amazing work. I've watched them scale beautifully over the last four or five years, and we are always talking about the why. How do you explain to the folks that are at the front lines of this company? And they're typically fairly new in their career when they come into ABA. They might have had some experience somewhere else, they've been through some schooling, but they want to help these autistic kids. These are younger kiddos. How do we do that? You only get them for a certain amount of time. And how do you make sure those people that are doing the work don't think you're trying to get them to work faster or that you're trying to crack a whip because you're trying to make them do better, faster, because they want you want to make more money. You're really trying to explain the why. You have these kiddos for only a couple of years, and in those couple of years, we need to have them in the clinic. We need to have them working in our centers. And if we are not able to get them there every time and have the right program set up for them, then we're missing opportunities and we're not going to meet our mission. It's we only meet our mission by keeping our doors open. So, all of what we're talking about I talk with them about as we stand up their strategy and we go through what communication is is how does that message stay centered? Because it is truly at the center of the hearts of these leaders. They know they need to make help as many kids as possible. And to do that, they need to be running their business as efficiently as possible. It's all connected, it's how you communicate it.

Negative Feedback As Useful Data

Dr. Pelè 15:38

Yep. No, I I hear you about being able to explain the why of things and not just talk about what to do and how to do it, but really get that purpose component in there because that's what inspires versus you know anything else. You know, I wonder you you made a really good uh uh uh uh sentence that I love in one of your articles that I've read. You say that negative feedback is not resistance, it's data. And and of course, you know, when when you're trying to push things from strategy to uh technologies or implementations of any kind from strategy to actual results, uh you're gonna get resistance. So from your experience, is resistance really resistance, or is it something else happening beneath the surface?

Teri Renfrow 16:23

Any kind of we'll call it negative feedback, it could come from just a genuine place of I want to help you do better so you can help us do better. Build this product better. Let me give you that. That's a gift that you need to be grateful for and show the show the gratitude. So um I would say what uh what what you need to hone in on is how that negative feedback gives you data points to go back to look at your roadmap, to go back to look at, well, why did we do what we did that created this feedback for us? And how do we undo it? How do we move to that next level that we wanted to? Within MedPurl, it led us to be able to go from some tables of or tabs of knowledge to full algorithms that they were able to walk and be able to build as they worked with their patients to what the what the final diagnosis and treatment plan should be. We got that by talking with our users and them saying, okay, but these tabs aren't really helping me. And really many focused groups and and hundreds of physicians and APPs giving us their input got us to a better place. And it started by getting and listening to something that was more negative than not. It's a gift.

Dr. Pelè 17:46

Yeah.

Teri Renfrow 17:47

Thank you, thank people for the gift.

Gemba Leadership And Better Metrics

Dr. Pelè 17:49

Absolutely. And one of the things I talk about is that leadership shows up in moments, not just in strategy presentations and things like that. You emphasize things like listening in the moment, shadowing, feedback loops, as you just mentioned. Why don't those things happen consistently, even when leaders know they should?

Teri Renfrow 18:11

It's I I think I've I found executives get very wrapped up in their extremely important day-to-day world, and they forget that they haven't gone to Gamba. Again, my fave, one of my favorite words from lean coaching. A Japanese word that it's a perfect one word in in the Japanese language where we have to explain. This is where you go and watch where the work is done. And when executives get very busy and realize that, oh, it's been a couple of months since I've been on a hospital floor or since I've been in one of my clinics, they they just time goes by and they forget, but they assume that they remember. They assume they know what's happening, they assume that memory is key and that's all they need. And it takes them stopping and having good moments of reflection to remember. I need to go and watch, I need to go to Gamba.

Dr. Pelè 19:07

Yeah.

Teri Renfrow 19:08

And it's it's it's a very much a forced mental activity. They must keep it at the forefront of their brains, the best leaders do.

Dr. Pelè 19:17

Wow. So healthcare organizations track a lot of metrics. What do leaders measure well and and what are they missing in terms of tracking metrics?

Teri Renfrow 19:29

Well, in healthcare, I think the phrase is that we're data rich and information poor. And I'm hoping AI can help us with that. Who knows? Um, but we get we get to where these are the data points that I know my leaders are looking for. So my board is most focused on this one. And sometimes we don't really remember what the other process metrics are that are gonna help us meet that outcome. So they forget is the flywheel going the right direction? Is it going at the right speed that I'm gonna get to that outcome? Or am I just beating my people over the head with you're not at the outcome yet? And I don't see what the process metric is to get me there. And it's not trending how I need, so I need to beat you over the head again with did you not see the dashboard? It's right there. You're not where you need to be. It I think that that can happen when uh we're not as cognizant of the full picture. Most leaders um more and more are figuring out they they need to be information rich and they need to figure out how all of the numbers connect and how that connects to what the bigger picture is.

Dr. Pelè 20:45

It's almost like you're saying uh wisdom is the outcome we're looking for, not just these numbers. Um, in in in high pressure environments like healthcare, what causes leaders to default to pushing compliance and all these different outcomes instead of, as you say, leveraging wisdom and uh maybe building belief amongst their team members?

Teri Renfrow 21:10

It has to be a bit of both. I mean, you're teaching your people, and um so you you are accountable to the quality. And if your folks, if your team doesn't understand, um because maybe they've not done it yet, or they have their own knowledge gap on what that is, you do, it's your it's on you. So for leaders to really get the ex to get both sides of that, they need to know where each person is and make sure that plan is in place for them to get to where they can replace. You want your team to be able to replace you because you want to be able to go on to your next challenge. So it's the the best leaders figure out that balance.

Keeping The Human Element While Scaling

Dr. Pelè 21:54

It's a little bit of both. How do you retain the human element as you scale things? So you've got a great Idea, great technology, a great new process. Sounds good in the pilot phase. Everything works out when you first introduce it. And then it's in practice. It's scaling, and you're like, ah, how do you maintain that human connection that makes things work?

Teri Renfrow 22:16

Well, any kind of engagement work is it's a constant effort of what's my what feedback should I be hearing? What story, what new stories do I get? Some of my most favorite meetings have been to go to either my engineering team or my clinical team, these beautiful humans I got to work with with MedPearl, and take them the latest user story. And they looked for it. A couple of them were like, Terry, where's my story? And I had to make sure that one because they knew that helped them understand how these products that product is being used and how we were building it. So I think it's that. I think it's it's making certain that it is a conscious effort because the scaling never stops. What you there is no, oh, we've scaled, now we're done. That's not a thing. You're always scaling.

Dr. Pelè 23:08

Yep. I love that. So, what is one thing a healthcare leader can take away from our conversation this week, for example, to improve some new process uh or new technology adoption on their team? What is one thing they can put into practice?

Teri Renfrow 23:25

I would love for someone to let us know from here they remembered I need to next know my stories match up to what my data is telling me, and that I am sharing both of them correctly and as loudly and as effectively as I can because that that gets a change.

Dr. Pelè 23:46

Wow. So, Terry, what what's next for you? What are you excited about? Any new projects, something coming up soon?

One Practical Takeaway And Closing

Teri Renfrow 23:53

I am I am working with um and looking for a chance to join a larger team. I've been doing my own consulting work for a while and I work with some really amazing organizations. And one of those two things will continue more consulting work, or I'm gonna go back and join a team. I'm not sure which yet.

Dr. Pelè 24:12

Yeah. How can people how can people reach you and read those articles that that I enjoyed reading?

Teri Renfrow 24:19

LinkedIn is the best place, and we'll have that for them, right?

Dr. Pelè 24:22

Yep, absolutely. Well, you know, Terry, I just want to say that Execution. I think it was in there's a book called Execution by uh I think Ram Ram Charan and and Larry Bossity, and they say that strategy is less than 15% of the equation, right? Everything is our people actually taking action. Yeah. Um, it seems to me like you would agree with that, correct? Yes, 100%. And and in your world, what what you've seen moves the action needle more than anything else is storytelling, believe it or not, correct?

Teri Renfrow 24:57

I think it is. It's making sure that everybody understands why we're going in the direction we're going and what how are we getting there? And the stories tell you how you're getting there. The story tells you that pop is still out there, keeping his career going because he was able to get his hearing back.

Dr. Pelè 25:14

And then and then the leader continues as a motivator along the way, right? Right, exactly it. Love that. Well, Terry, thank you so much for for talking with me. I've learned a lot, and I can't wait to go tell some stories now.

Teri Renfrow 25:29

Thank you very much for inviting me on.

Dr. Pelè 25:31

All right, thank you.