Jeff Ma
In today's episode, we talked to the CEO of Harris health system, Dr. Esmaeil Porsa. He shares about his incredible experience of being a new CEO of a hospital system at the beginning of a global pandemic. And he shares some incredibly vulnerable stories and insights that really highlight the impacts of culture in health care. Enjoy the show.

Hello, and welcome to love this business strategy, a podcast that brings humanity to the workplace. As you know, we're here to talk about business. But we want to tackle topics that most business leaders shy away from, we believe that humanity and love should be at the centre of every successful business. I'm your host, Jeff Ma. I'm a director at software which is a business to employee solutions company that creates products and offer services that help build resilience and high performance company cultures. I'm joined today by president ceo of soft way Mohammad Anwar. Hey, Mo how's it going today?

Mohammad Anwar
Good. Good. See you guys.

Jeff Ma
And our guest today, I will not waste any time. His name is Dr. Esmaeil Porsa. He has a very lengthy list of credentials that I that I wrote out to be honest for this podcast that I had to condense by like, like it's like a fourth of what is written. So go on LinkedIn. Check them out. He's got a lot of credentials. But he's had a unique experience in his storied career in the healthcare industry. He's working in Population Health Management and hospital system operations with a focus in quality and patient safety programme design and process improvement efforts. Dr. Porsa has served in a variety of leadership roles over the last 20 years including medical director VP of medical affairs chief medical officer and Chief Strategy Officer, but currently, he's the Chief Executive Officer for Harris health system. Welcome to the show. Dr. Porsa How are you?

Dr. Esmaeil Porsa
I guess I'm I chat. It's a pleasure to be here. And good morning, Mohammad.

Mohammad Anwar
Good morning.

Jeff Ma
So I don't know if you know this, but we do a pot we do an icebreaker before we get started on anything. We are going to dive deep, deep deep into your story and Harris health soon, but we have to get through this first. But I'll give Mohammad the question first, so you have time to think about it. The question today is Mohammad. Yes. What is what is a nickname? People have called you in your life and what's the story behind it? Oh my gosh, are you serious? This is okay, so I've been called curly. Well, in school, what is the case? I used to have curly hair. I mean, now I gel it to like keep it straight and short. But in school, my hair was like all over the place and it was curly and they weren't a lot of other kids in my class that had curly hair. I think I was the only one so my nickname was curly. Verily, I was strange. But yeah, that was my nickname. Most of my schooling.

That's incredible. Thank you for sharing that's, that's your best icebreaker answer ever.

Dr. Porsa what is the nickname that some people have called you in your life? And what is the story behind it?

Dr. Esmaeil Porsa
I gotta be honest, right? I can't I can just make things up. No, the . Yes, well, it's okay. in Dallas. They I was used to be called the Persian stallion. I know not not not for the reaction that Mohammad is showing right now. It really was not that it was the it for fun. There was a kind of a employee appreciation event and there was a Jeopardy game. And they were going around and asking people to kind of introduce themselves. But you know, the host started by introducing himself and given himself a nickname and that kind of went around that. When he came to me. I have no idea what happened. But you know, me being Iranian.

I introduced myself I didn't know Dr Esmaeil Porsa aka the Persian stallion, that kind of got stuck.

Jeff Ma
Got to be careful. It was

Dr. Esmaeil Porsa
Yes, sir. Yes. Actually, I used to have I used to have an orange stallion statue behind me. I removed it because I had to explain to everybody what that meant. Oh,

Jeff Ma
I love it. Thank you for sharing that. That's awesome. But what we're here to talk about, obviously, is called love as a business strategy. Before we dive in, though, I want the audience to understand a little bit more about Harris health if you don't mind if you're the CEO says Harris Health. Can you tell us a little bit about Harris health and what's unique about it?

Dr. Esmaeil Porsa
Sure. So Harris health system is the safety net hospital. system for the, for Harris County and the city of Houston. We are the fourth largest safety net hospital system in the country, actually largest in Texas. And what makes us different than other health systems is our safety net designation. What that means that, you know, imagine the if you've ever been to the circus, you see people, you know, walking on tight ropes underneath them, usually, there's a safety net, so that if they fall, the idea is that the safe net catches them and prevents them from getting harmed. The safety net hospital system is basically that we are here to catch people who fall through the cracks as far as their access to health care. So we provide care to everyone regardless of their ability to pay for it, regardless of their insurance status. And that's that that's our job. And that's our role be, our funding is a third and a third. And the third basically North comes from the federal government for a third from taxes, local tax support, property tax support. And the third is through collection from from patients who are able to pay. And I can tell by the system, you know, we have two hospitals Ben Taub which is our level one trauma centre, and LBJ hospital, which is a level three trauma centre. Interesting, you know, LBJ is half the size of n top. But their emergency room is actually as busy busier than Ben Taub hospital. And then in the community. We have 18 clinics scattered across the Harris County where we provide primary and specialty care services. That's Harris Health System in a nutshell.

Jeff Ma
Interesting.

Mohammad Anwar
So Dr. Porsa, can you share some of the challenges that you face as a safety net hospital that maybe traditional hospitals don't face?

Dr. Esmaeil Porsa
Yeah, I think, traditionally speaking, the biggest challenge is all this uncertainty about our funding status. If you can imagine, you know, moving from a republican government to a democratic government back to republican government, and what happens with regard to how provision of care is viewed in terms of human rights versus a privilege? It really, our finding is always in question, you know, from year to year. I don't know if you guys know about the waiver programme or the event 15 waiver district programme. It really came to exist for for the states that did not expand Medicaid almost 12 years ago at the beginning of the Affordable Care Act. So instead of Texas, the one of those states that did not expand Medicaid in order to encourage the states given time to think and finally expand Medicaid 1115 waiver was created where, you know, we are able to draw our federal money to pay for our uncompensated care. And it is a lot of money. And this year, that funding is supposed to end. And there's still a question mark exactly how that's going to be replaced. So that's unique to safety net hospitals, because we depend on that type of funding.

Mohammad Anwar
Got it. Interesting. And in terms of your staff, how are you staffed? Because it's a different type of hospital system? You have employment or are you partnered with university systems? Like how are you staffing your hospital system?

Dr. Esmaeil Porsa
Yeah, and I guess that's kind of also different as an academic medical centre. So all our provider staff, that's our physicians, nurse practitioners and physician assistants. They're actually contracted through either Baylor College of Medicine, or you can cover medical school. Now the rest of the staff, nurses, techs, everybody else.They are employees of Harris Health system. And right now we have close to 10,000 employees, and a little more than 2000 contracted providers through either UT or Baylor College of Medicine.

Mohammad Anwar
Got it? So does that mean it's also like use for teaching in addition to providing the services

Dr. Esmaeil Porsa
it is so as part of like actually part of our mission is to become a premier academic, medical centre and so you know, be in a safety net hospital, part of our mission was providing care to folks, especially those who need us the most those who don't have access to health care. But a very large part of our mission is also our training acting as a as a training centre. More than 50% of all physicians who practice across the city of Houston trained at Harris health system.

Mohammad Anwar
Wow. Okay, that's interesting. So with respect to other hospital systems in Houston, or Harris County, how is your relationship with them? Do you guys have like a kind of connection to the other hospital systems in the area? Do you guys collaborate? Or how does that work?

Dr. Esmaeil Porsa
Yeah, so that, you know, if you had asked the previous CEO, probably a couple years ago, you would have gotten a different answer. Okay. So we Harris health system, you know, Baylor College, Ben Taub hospital is actually smack in the middle of the Texas Medical Centre. So we are considered part of the Texas Medical Centre hospital system, which, if you don't know, it's the largest conglomerate of hospitals in the world, and nothing even comes close to it. But to answer your question, we do have a relationship is really, you know, I've had this conversation, different settings, we certainly do not compete. For volume to be our patient clientele are different than the normal patient clientele at, you know, Memorial, Hermann, or Methodist or St. Luke's. So it's really not a competition, there is collaboration, the collaboration was actually strengthened If you can imagine, for obvious reasons, during the COVID-19. I think it really, really forced the issue of collaboration where we had to rely on each other, not just in terms of sharing information, knowing exactly what was going on at each hospital. And we were completely transparent with regard to that, but also things that you don't normally think hospitals or collaborate on are PPEs or cloths and gowns and hats. And shoe covers. We were actually at a point where we became very close we collected became very close to running out of PPEs. So we were sharing, you know, we were to have extra gloves and maybe st Luke's extra accounts. So we would swap or maybe, you know, we had N 95 masks, and they have surgical masks and we swapped. So we do definitely collaborate. The collaboration had gotten a lot better as a direct results of COVID 19

Jeff Ma
You know, I believe, Dr. Porsche, you joined Harris health in January of 2020. Is that correct?

Dr. Esmaeil Porsa
March 2,

Jeff Ma
oh, march of 2020. But either basically, right? Like is like the worst? First day of work ever. Something I assume? What? I just want to talk a little bit, I mean, yes, about Harris health and COVID. But even you yourself, like Tell me about that experience of jumping into this job at that time? I can't even imagine.

Dr. Esmaeil Porsa
Yeah, well, nobody could imagine that. Right. I mean, nobody, nobody would have forecasted this. So yeah, so much. Second, I started on the job on a Monday. And I think that Friday, is when enough I attended my first meeting with the county officials talking about this new thing. That is called the novel Coronavirus. And a week later, we had the first case here in Houston the week after that the Bobby said event in Houston, the rodeo was shut down. So I mean, it was Bang, bang bang I before I knew it, I was in the thick of a global pandemic. So, you know, I've had this conversation actually several times and you know, people ask me, Oh, my God, you know, for you, as a new CEO, the first time as a CEO of a large hospital system in their large County, and COVID-19 heads. I know, it's true that there were there were times where things got hairy, you know, where we were actually running out of capacity at the hospitals. I remember having this conversation with my board members. You know, she was asking me, so Dr. Porsa what's the plan about phase one plan is this. So I guess Then why? So phase two, we're going to do X, Y and Z like Okay, great. What is phase three? So phase three, we're going to convert our pack used to ICU. So okay, what is phase four? So phase four, you know, we transfer model ours into ICU rows. Okay. And then if that happens, we get to that point, then what I said then we pray. There is nothing else. There's no face. You know, it's like You know, this is the this is, there is nothing else we can do. And luckily, we never got to that point. But you know, I say that, but also I have to qualify the experience. You know, COVID-19 has been terrible, terrible, terrible in terms of loss of lives and everything else that happened because of it. But it did a couple of things also. One was that he actually forced all of us to the previous conversation to really become collaborative and what they did. The other thing was that everybody, just all of a sudden, it's just like, the lightbulb went on, and everybody became innovative. I remember, you know, when I arrived here on the scene, March 2, you know, I'm very, very interested in virtual care. And I asked our community health leaders, you know, what is our virtual care platform, so Dr. Porsa So for the last month, we just beginning just transition last month, we had two virtual care visits, and we are very, very happy about it. Well, you know, since then, since March 2 of last year to this year, we now have at almost close to a million virtual visits. But it's not just us, right. So everybody had to really, really expedite their learnings and their their abilities. But really, really important to me personally, as a CEO, was that it forced me to develop relationships that otherwise could have taken me a very long time to develop my relationship with the county commissioners, my relationship with the county health department, with the county judge with the rest of the CEOs, I, I can't even imagine how long that would have taken me under quote unquote, normal situations, to develop those relationships, ever to develop those trusting relationships out of necessity. So yeah, there were a lot of bad COVID. But there were some some positives that happened just out of necessity.

Jeff Ma
Sure, yeah.

Mohammad Anwar
I think

Jeff Ma
this is not a there's not a question. So you have the stage. I just want to add context for the for the listeners who are not familiar with Texas, or whose scenario are these things that just you hear Harris County, I just want to be clear, it's the largest county in Texas, I think, the third largest in the nation. So we're talking like for four and a half million people plus, in one counties, I think sometimes people don't get that context of what we're dealing with here and the Harris health system. So I just want to add that go ahead.

Mohammad Anwar
I was just gonna say like, I think the whole aspect you brought up about innovation and building relationships, and, you know, having that collaboration, you know, we refer to that as vulnerability based trust, because you just talked about trust. And usually that comes into existence, and you have a high risks, emotional exposure, and uncertain the a field like COVID-19 presented all of that in the situation and in our lives. And I think like your your statement of earlier, it accelerated everything that could have taken you probably months or even years to build such relationships and getting that collaboration level going. In fact, some of the highest performing teams operate, you know, at the highest level, under situations of high risk emotional exposure and uncertainty and, and I think we saw the whole globe do that all at the same time. It is very uncommon, and something that was really real for us last year. So that makes complete sense how you witnessed it in your own surroundings and the hospital systems as is really crazy. So Dr. Porsa, it's, you know, obviously, you landed in your new position as a CEO, right in the middle of COVID-19. But for you personally, what were some of the challenges that you faced as a leader as a CEO of a 10,000 employee organisation?

Dr. Esmaeil Porsa
Sure. You know, I have spent all my professional life working and in safety net hospital systems, you know, either originally hearing Harris health then Parkland in Dallas and then back to Harris Health. So it was really not a struggle understanding the mission that was very clear. And you know, yes, I've had you know, different leadership roles, but never as a CEO and definitely not a CEO of a such a large hospital system. So of course, you know, you have you have some doubts, you have some Questioning in the back of your mind, are you ready for this? And you know, you do your best you read about how to spend your first 90 days and this and that. And I did all those things that of course, you know, you start and then no COVID-19 hits and everything goes out the door. The the main challenges, just, if I could name a few of them, one being being in charge being the final voice being the ultimate decision maker, I don't think I don't think you can prepare yourself for that. Until it actually happens. I did that was that was two things, it was very, very scary. But also very gratifying. To be able to, to, to have an impact and feel empowered, to have to have an impact on the lives of not just the people that you serve. But to your point, you know, the 9000 plus employees. That was one. Really, really interesting. And I think that's part of being the first time CEO is that I didn't quite appreciate that. But when I said something, I it didn't occur to me that everybody around me heard it as the CEO saying something. It literally took me a few months to get used to that. So when I would when I would say something, I would always have to kind of check with myself in my head, okay. Be careful what you're saying, because people are going to react to it. Even though you may just be expressing an opinion, you may be thinking out loud, be careful, qualify it as thinking out loud, because otherwise people actually react and then the follow through. So it took me a couple of times and couple of missteps and misfires you know, but it would say something and all of a sudden, the following day, I will have an extensive report on my not my intention. But it took me a while It took me a while to understand that. I think the biggest challenge. And this is something that's really interesting that stays with me even today. Because I felt so terrible about it. You know, he was at the peak of COVID-19. And I remember it was like it was bad news after bad news after bad news so that the hospital was getting inundated.We were running out of supplies and just likeit was really any one of the things that we get as a CEO.It becomes 24 /7, right, you know, just like you can't disconnect, especially at the heat of a pandemic. I rememberit was I think the middle of the week had you know, we had, you know, every morning we were meeting as a CEOs at seven o'clock typically Saturdays and Sundays, all the Texas Medical Centre CEOs were getting a call to check out. And then at 10 o'clock in the morning, every day, including Saturdays and Sundays, we Harris Health system would have our own incident command centre meetings, you remember, just everybody's checking in and finding out what's going on in the hospital. I was going into clinics. And I remembered that I was that one day I was overwhelmed with everything coming at me and I did not react well. I wasn't I wasn't aggressive, but I was I was very flat and I was very it you know, instead of you know, I see my I see my role. One of my roles as a cheerleader as the the as the motivator and that day I I completely failed as a CEO. I was flat. I was dejected. I was defeated. It was just a terrible meeting. And then you spend the rest of the day just really feeling bad about it. And you know I tell the following day when I you know when we had the incident command centre and I had to apologise to everywhere and they call us the guys I know are failed yesterday at promise I will never do that, again, I don't care what is going on. I know that I have a great team and I do have a great team. And regardless of what is happening, I know we can, we can find solutions, and you know, we can move forward. So that was, you know, talking about the big challenge, that was a huge challenge realising that. And I don't know, I have not read a textbook about what the CEO is supposed to be like, but I can tell you in my mind, as the CEO, I cannot let my team down by not being the the additional shot of energy that that they needed at that time. Yeah, so that that was that was a huge lesson. So, you know, it's really interesting, because I've always prided myself in the fact that it's really difficult to catch me without a smile on my face. But that day, I'd really don't know what was going on. But yeah, that was not me. And it was, and I still remember that feeling.

Mohammad Anwar
Wow, well, thank you for sharing that doctor Porsa. Like, I think that takes a lot of courage for anybody in a position like yours to be able to share that we just did. But um, but I'm witnessing just by you sharing that, that that, that ability to take ownership ability to realise and have that self awareness that you did, in almost real time and feels like, is actually one of the, you know, needed traits of a leader. And the fact that I feel like you were able to even go on the call the next day and apologise to your team is not common. And most of the times leaders may not even recognise that they've done that, right, because they may not even have realisation of how they came across. So I'm looking at that as your superpower To be honest, the ability to recognise that you may have, you know, Let down your team, you may have made a mistake, but also your ability to go and confess and apologise. I think that's quite inspiring and motivating this for me to hear, to be honest. Uh, Jeff, I don't know what your thoughts are. But that's not commonly seen.

Jeff Ma
Yeah. And I think I think there's a blind spot for leaders in this in this, I think the higher up we go. You mentioned earlier, like, how it took you time to even realise that everything you're you say, and do is being watched and kind of meticulously picked apart. That's magnified, right? Think as the higher up you go, the less you're allowed to have a human moment or a bad day, because there's a reaction every time. And it's really unfair, right, honestly. But I think it's really powerful too. I don't think the goal is to find a way to never have a bad day, I think the goal is to find and build an environment that allows you to have a bad day and still come out of it stronger and better for it. So I think you demonstrate that there. I think that's a great story. I really liked it.

Dr. Esmaeil Porsa
So I appreciate that.

Jeff Ma
Yeah,

Mohammad Anwar
no, amazing, and I think I think, you know, I, I hold the position, you know, similar to yours, except I don't manage 10,000 people, but you know, I strive to always be my best, but the days that, you know, I cannot be positive and optimistic and a cheerleader, I've had moments where I will have, you know, showing my face I'm very, I wear my emotions on my sleeve. And people automatically recognise that, okay, there's something wrong, and he's not motivated, or something's really behind the scenes, something's going on. And the more I've recognised and openly shared that hate, I'm sorry, guys, today, I'm not having a great day. And apologies, if, you know, I'm able to share my emotional state, so that they don't go into the meeting. You know, assuming things I've noticed that my team actually becomes much more supportive of me. They are there to be be my cheerleader, because at the end of the day, I think they're able to see me as human and not invincible like this flawless leader, but someone who is flawed, who does have ups and downs who, so I've noticed that it's actually opened up these doors of relationships with my team around me where I actually feel supported and not lonely at the top, you know? And so I think you may have Have a, you know, unintentionally opened up those doors of care and support by your team because you showed to them that you're human, and you had a bad day and then coming out and apologising, probably changed their whole perspective of you as a CEO. And, you know, it took me a while to recognise that fact that at times, it's okay to be human, it's okay to, you know, have a moment. And in fact, over here, they have a name for it, they call it the moment with my name, like Moe had a moment. It's actually humanised me and given me this incredible support system that I never thought a CEO or the leader that could have because I always used to have this philosophy or belief that it's lonely at the top, the higher you go up, the lonelier it gets. But I think it's a myth. And there are opportunities for leaders to have a team that corrals around you to help support you in times of you being human. And I think it's it's really important that leaders recognise that but obviously, just hearing your story, you know, makes me confident that it's probably already happened and happening at Harris Health for you as well.

Hope so.

Jeff Ma
I want I think we've broached the topic of culture now. So I actually I'm curious, Dr. Forster, like, how would you describe the culture of Harris health right now?

Dr. Esmaeil Porsa
I can not not ideal. And I'm going to qualify that. And but what I mean by that is that this is not where I'd like for us to be. But I believe, you know, we havecompleted a journey. That there are things that are lacking. And it's really interesting, you know, because you're asking me about the culture oh Harris Health system. I'm telling you through the lens of Esmaeil Porsa. What I see that right, or are ideal right now. What is ideal? Is the spirit of the being truly mission driven. You're there, it's perfect. It really is this great. The ability to forge trust, the ability to make decisions, you know, decisions are made every day all day, obviously, because otherwise we will not be able to function. But but to be able to make decisions without the not fear, but but concern, concern about how it might be evaluated. We are not there, you're not there yet. You know, this is something that I should have brought with me because I am talking I'm going to tell you a story of so many, many years ago, in my role as a chief strategy officer. Something caught my attention, you know, no, we had we had an employee evaluation, satisfaction survey one year. And there were three items that are directly related to the score for employee satisfaction. That had score very low. It was respect recognition and trust, very interesting. The following year, the same three items, the following year, the same three items. And just like you know, in we were always struggling as assistant trying to you know, figure out, you know, what are we going to do? What are we going to address so guys screaming at us, that that be our employees are not happy with the respect that they're receiving, they're not happy with the way they're recognising them, and they don't trust the top leadership. That's what we need to fix. So it's actually not become part of our value statement that respect recognition and trust at Harris health system. I really believe that it is the that really the foundational values that we must address and you know, I speak every couple of weeks at our new employee orientation, I feel it is important enough for them to hear from the CEO about this three pillars of respect recognition and trust and I tell them you know, respecting yes our patients as as active participant the care that we're providing them, but also respecting each other respecting doses service, respecting those that we serve. Recognition you know, we are in the journey to higher reliability organisation Part of that this preoccupation with failure, identifying errors is in rest, teaching moments and all of that great. Really, really important to balance it is recognition, there's a lot of excellence that happens around us and be need to spend the time and resources and energy to recognise that and trust. Without it, nothing else really matters. It is not nothing impossible becomes really challenging to do anything, if there's not a trusting relationship, again, at all levels among ourselves, those we serve those who serve us that but also tell our employees to trust your training. I find those three things respect recognition and trust. as fundamental, let me know, ask me about the culture and hairstyle system. I don't think you'd be there yet. With regard to the respect recognition and trust that that's what we're working on.

Mohammad Anwar
What do you think is the obstacle in the way of building up these three values, according to you,

Dr. Esmaeil Porsa
it's I think it's human nature is, is self doubt more than anything else, you know, I struggled with it. You know, it wasn't easy for me, you know, I told you a story about, you know, coming back the next day, I apologise did he was not, it was not easy. It was not, you know, I lost sleep over it. And, you know, I know that, you know, when you're talking about 10,000, people, they all bring a little something to the mix, a lot of lot of positive, but you know, we all have our experiences, and you know, and baggage is that, you know, we carry with us, but ourselves that that prevents us, until prevents us to achieve those ideals until we actually become intentional about that, right. You know, you you, you become intentional, you identify that, yes, I'm struggling with respect because of X, Y, and Z. And, you know, we should do better with recognition. Because if this and that, and, you know, why is it that there's a trust issue with mid level managers, directors and vice presidents and above? And how do we go about addressing them? You know, it's really interesting, this is actually kind of eye opening for me as well. I'm having a bit of a lightbulb moment. You know, on Sundays, I go to the hospitals and visit folks at the hospital, you know, people always ask me, Why do you do that? You know, it you know, you can you can become facetious about it, then say, you know, yeah, I get it, you know, you're trying to improve patients that, you know, employee satisfaction or are, or whatever. You know, and I've always felt that, you know, I go because it, it actually energises me really, really does. You know, whenever I go in and flat, when I come out at the end of the day, I am full of energy and ready for another week. But that, as I'm having this conversation occurred to me that it's really creating a relationship of trust. Yesterday, I was at the hospital. No, this actually happened I witnessed when instead of one of the units, and there was like, there was a lot of commotion, and there was security officers and different doctors and nurses. And we had a patient who was suffering from acute psychosis and you know, she was just irate. She was just using every slur, every curse of he, really, she was just like, all over the place that it was, people were trying to manage her medicate her, counselled her. I didn't do anything. I really did it. I was just standing there just watching it happen. And you know, really, really impressed with the level of competence and professionalism. But before I left, one of the nurses you shouldn't miss anything. She kind of like just made a gesture. It's like, like, like she saw me. You can't put a price on that. I don't say that to self promote. I say that, that note, what does it take to to to create a trusting relationship, you know, whatever it takes, you know, you become visible, you become vulnerable, like you said. So that's really interesting. It just, it just occurred to me that and I'm actually addressing one of the pillars

Mohammad Anwar
Awesome. No, I, I totally appreciate that. And Jeff, I don't know I, I follow Harris health social media handle and they post pictures of you visiting even through last year during the pic and Taylor COVID-19, you are at the front lines, supporting your staff being there with them. And they used to put up pictures of you with the staff. And you could see how happy the staff was just to have you in the front lines with them. And you were giving them all of the respect the recognition. And even some of the I've noticed like Houston Chronicle and the ads, and some of the promotions that you're putting up that you've put up in the press, all through 2020. It wasn't a promotion of Harris out if the promotion of the people of Harris Health. And you recognise them and you recognise them for their sacrifices and the hero heroism and everything. And it's very uncommon, like they were full page ads, not on how yourself but the people of Harris health for many, many times over the course of last year. And you know, it's a very different coverage of price versus before 2020 for Harris health. So it was really incredible to see, you know, it wasn't the self promotion, it wasn't like promoting your services for money, it was really genuinely promoting the people of how you felt. And I was very inspiring for me to witness because I fall I've been following it. And I follow your social media handles with Harris health. And I think with discipline, you've shown up to the hospitals at the front lines every weekend, just to go show your support. And that's it. And that's really unheard of very uncommon. So kudos to you for being able to do that and being there with the frontline staff and, and showing your support and just just your presence, probably uplifts them just as much as you're having to realise it uplifts you. So really amazing. Thank you for sharing that. I wanted to ask, How do you feel? You know, you mentioned high reliability and patient safety and outcomes is one of the big drivers of any hospital system? How do you actually beat that to the culture of the hospital system and an organisation? What are your thoughts on that?

Dr. Esmaeil Porsa
So, you know, many types of a high reliability organisation in the health system, you know, bottom line, you're trying to arrive at a zero patient harm situation. You know, you can be a part of where, you know, you become very draconian, right, zero patient harm mean that every time there's patient harm, somebody's head gets chopped. And that actually happens, there are systems that's that's how they try to achieve high reliability organisation. So that's one approach and the other approach is, you know, when we're talking about respect to the condition and trust Now, we also talk about adjust and accountable culture, realising as a system that and I don't know how I do, or Jeff, how much you guys are familiar with the the construct of error, especially when it's in health care system and patients is that I'm going to ask you all to kind of use your, your imagination or the way a drive is like, you know, a rectangle or better pizza slice, you know, laying on the side, there's always a point at which the error reaches the patient. And usually at that point, there's a person present a tech and nurse a doctor. But but the systems usually miss is the rest of the pizza, the rest of the triangle, everything that lined up to get to that point, or to actually when the error reach the patient. So how does how does that interrelate with with their culture is that as a system that really believes and kind of adjust an accountable culture is that you you embrace that? You realise that majority of the time, far majority of the time? Yes, there was a person at the point of the error that could have potentially prevented it or recognise it. But that person usually is not at fault, is the system that created the opportunity for that error to reach the patient is the system That put that person at risk of being at the point where the error occurred. So yes, it requires that culture change, to really, really embrace that understanding to get and I really believe that's the only way you're going to get to a high reliability organisation that don't take your organisation do it being draconian, and chop heads off every time there's an error. That's not sustainable. You can get there for a year, you can get there for a year and a half, that will not sustain itself. You pretty soon gonna run out of heads to chop. So it's going to require a a new culture, a new way of doing things and looking at things to get there and sustain it. Yeah.

Mohammad Anwar
So talking about near misses, I think is where maybe the correlation is. So if we're going to go with that the draconian culture, I would imagine that people would be afraid to speak up when they see errors or issues that could be avoidable, because of that fear, correct.

Dr. Esmaeil Porsa
That's exactly what happens, right? I mean, so there's the code and both red roles in hospitals, we have to have the the Harris health system, we have two have them and it has to do you know, patient identification, making sure that we are treating the right patient. And then the other one said timeouts, before procedures and surgeries. The have identified those two things that no matter what happens, no matter what else is going on, no matter how bad of a day you're having, no matter how understaffed you are, how overcrowded you are. Those two things we will meet 100% of the time, every time with every patient. There are hospitals that have a book full of red rules. And the idea is that every time you you break a red rule, chances are you're going to get terminated. And again, I have been part of systems where that happens. Nurses of 10-15 years of experience, commit an error and are escorted out of the building. You're exactly right. But guess what happens to the rest of the nurses? First of all, they're they're really operating with under a lot of stress. And secondly, if they commit that same error, you really think they got to report it out, chances are they're not going to. So you know, so you don't want that you want to create a culture where you know, there's understanding there's trust, and there's the ability to self report. I say that all I'll say no, I told you about our to write rules. But you know, there are things that are really, really important enough. where, you know, it seems minor. So what if, you know, I thought Jeff was Mohammad, Mohammad was Jeff. Doesn't seem like, Yeah, but if you guys are one of y'all is going in there to get an eye surgery and get out of sticking your appendix out. It is very important. Yeah.

Mohammad Anwar
Totally , no that, that that makes sense. So tying back to the trust conversation, and how trust could play a role in patient safety and outcomes. Do you feel that if the employees do not trust their leadership, to give them a fair chance or a fair assessment of, you know, What mistake happened? or adjust assessment? that that could be maybe what is coming mean, you know, the trust between the leadership out of the management and the employees?

Dr. Esmaeil Porsa
Yeah, I mean, that's, that's part of it. You know, it's not it's not just that it's not just the related to errors and patient harm and high reliability. I think it's even more fundamental than that. Trusting in fairness, trusting in hearing, the employees trusting and being open. To sharing to understanding to listening, is really this more fundamental. Yes, absolutely. There's regard to harm and surf report and all of that, but I think it's so much more fundamental than that. And is really the fundamental things that once you address, the bigger things the self reporting, it becomes, it becomes automatic, almost it becomes it a logical continuation of that relationship. So yeah,

Mohammad Anwar
Awesome. Yeah, I think, you know, we we internally, were having some situation I'll share a quick story. So we had these Monday morning stand ups, where we bought leaders and directors together project managers to report problems to their projects that we could solve them blocks or issues. And more and more every Monday that I showed up to the meetings, and I was present in the meeting with the CEO. And my behaviours are obviously, probably not the best at the time. And every meeting, our project managers and leaders were like, no problems, no issues. No, no, no problems with their projects at all. It's on time, everything's on track. We're doing good. Only to find out a few weeks later, I'll get a call from a customer saying, hey, our project, Mr. deadline, it's over budget. Like we're not hitting our goal that's got lots of bugs. It's got lots of software issues. And every Monday I went into those meetings and like, Why are Why is my team not being honest with me? Why is my team not sharing these issues and problems. And I came across this study by Amy Edmondson around psychological safety, where she had done research of organisations that had more near misses reported, had a better patient quality score, versus organisations that reported less near misses had higher patient safety incidences. And believe it or not, like we learned from that study, that our team was not psychologically safe to report issues with me on the call. Because I would become lit, lit. Like, like a litigator, I'd start or, you know, what is it? You know, the police go and interrogate like, I started like, so what did you do? How did you handle it? What did you do? Why did you let this happen? Why didn't you turn into the report. And ultimately, I created this environment of fear, where everybody only showed up to the meeting, to let me hear what I wanted to hear, not what I needed to hear. And it impacted the safety of a project safety or for delivery. And a quality of a project review or budget behind schedule, patient of our study, our customer satisfaction was low. It was all because we never created an opportunity for them to be honest, and feel comfortable to give up the information we need to hear. And know we're there. I'm like, I'm like, I'm the servant leader, coming to help you to move your blocks and issues. But inherently I created an environment of fear, unintentionally, and I had to learn from the hospital cultures and psychological safety, and borrow that in our technology business to try and create this environment where people felt comfortable to share. So that was my exposure to psychological safety and patient safety, and how we could borrow it in our industry. So I completely hear you when you're saying, you know, how do you create an environment where people can report those near misses and not have fear of repercussion and so forth? So, , yeah,

Dr. Esmaeil Porsa
thank you for sharing that. And, you know, this is this is really mind boggling to me, because, you know, you've seen me, I mean, just like, I can't stop smiling. And it's really interesting. When I get frustrated, I smile more. For people who don't know me that they find that sometime. I don't know I that they find it difficult to understand it as if I actually was in a meeting one time, I was going to tell you something else. But I want to tell you this quick story before I get there. This is that I was actually reporting to a new leader. This is many years ago. We had been there for maybe just a couple of months. And it was a big meeting. And we were talking about something and he noticed like it was something that I really thought within five minutes we could solve and it was like an hour and 20 minutes into it. We're talking about the same thing. And you know, it was getting to a point I was really really frustrated with everybody, all the discussions that were happening. We're all leaders at my level, having this conversation. It and you know, people get frustrating it can get angry or flustered or whatever I smile. So I started smiling. My leader actually got very upset. She She stood up. She you know, she hit the table. I said obviously some of you think this is a joke, and she left the room. So I had to go and explain that actually follows her and said you know, this is who I am. So you don't know me right now. But I promise you this is Um, and you will see that you know, truly this is just a this is just how I react and you know, she she got that what I was gonna tell you about how much your story is that as much as I like to think that because of the fact that I smile because of the fact that I not only try to show but actually talk about openness and trust and servant leadership and this and that I'm still being told that people find me intimidating. And I honestly, I struggle with that I don't want to be intimidating. That's the last thing I want to be. So it's something about my actions or the way I relay information or, or the way people are receiving this not everybody but enough people for me to, to try to analyse a step, analyse, analyse, and identify that. Hi, can I still change? Because I'm not there? Obviously, I'm not there if if people are reacting that way. So

Jeff Ma
I, having worked, having worked with Mohammad for almost a decade now, I'll tell you the turning point for me when Mohammad went from intimidating to, let's say less than today, just joking. But it's because I work closely, very closely monitor over the 10 years, even back in the days when he was much more almost in you know, abrasive almost all the time, sorry, Mohammad. But, but there's a period of time when he was really trying to change for a long period of time, he was really, really working hard. You could tell everything he was doing was like this brute force kind of like, I'm going to be positive, I'm going to smile, I'm going to be as nice as I possibly can. And it was like, it was this really this this facade, like if you if you knew him? Well, he's just gritting his teeth. And being as sweet as possible, even when he's really upset. He's just like, Okay, well, that's good news here, I get like, he's just finding every little silver lining trying to force it out. And I just remember, you know, there's a point when Mohammad you kind of came to peace with, with kind of what you really wanted to be, we found more of a mission behind what we're trying to do. And we kind of learn more about ourselves, through writing the book and all this stuff, you know, as we were working on this stuff.

Unknown Speaker
You know, you turn a corner where I think, you we talked about this a little bit earlier was less about trying to cover up how you how you felt, or anybody felt we this is when we would start having meetings, and you just be like, you know, I just want to share something openly. And I know this might come off, you know, XYZ, but I have to just say it, and I'll put it out there and stuff that would make the whole room really awkward for like, you know, a good 30 seconds, like nobody knew what to say it just quiet. Everyone's just on the call, just waiting to see who would say something next, but then you look at the end of those meetings, and we would all leave, kind of like we just rip the band aid off, you know, address an elephant in the room. And then, you know, meet it wasn't one meeting, it was like that. And then the next one, the next one, you get used to Mohammad kind of being this person who is not going to hold back who he is, he's not going to keep switching from talking about Mohammad third person, first person, sorry, Moh, I know you're right here. But I just wanted to share that because I, I have this perspective, always I'm the only non I'm the I'm the minority here on the non CEO on this on this on this conversation. But as someone who is someone who looks up to Mohammad, but also I know today, like I'm not intimidated by Mohammad, I it's it's what's left is respect and like a true following. But you know, before that, there was always an element of fear still driving it, because you're kind of like, you know, that you don't want to be the one to tip Mohammad over into the space into a bad place. And today, you know, I know how to move into a bad space. And we'll just talk about Mohammad. Last week, we had a call where we had a meeting, he and I disagreed on something at about 3pm. We got off both of us pretty upset. And he texted me at 6pm. We talked at 6-6.30 that day. And we're like, Look, man, here's here's what I was feeling. He's like, here's what I was, like, cool. Are we cool? Like, we solved it? And then that would never have happened, you know, a long time ago and stuff. So that's just how I feel about that topic just for perspective of you know, non CEO this.

Dr. Esmaeil Porsa
Yeah, yeah, that's a really good perspective. Actually, you you know what I'm actually you gave me an idea. But I'm going to actually do in my next meeting. So thank you for that.

Mohammad Anwar
Yeah, I think the last thing to say I think what changed was when I went to those meetings, and started to share my failures, or my near misses. And I give, that's when I felt like I give permission for everyone else to be comfortable to say, you know what, if Mohammad can mess up, so can I. But as long as it's not intentional, as long as there is no mal intent, I think we create, I was able to inadvertently create an environment where people felt comfortable to say, Hey, you know what I messed up, I forgot to send the report, I forgot to do proper testing, before the project was deployed. This is where we screwed up. But this is how we will avoid going forward. What I realised was that I had this immense amount of power or influence, where if I was to be the first one to say, I messed up, I screwed up, I made a mistake. It all of a sudden opened up the permission and gave everyone else the permission to also come and say, You know what, I messed up, my CEO can mess up that I can mess up. And that's how we started to see our projects become more, you know, on time we got issues reported, our customers started to feel like we were able to come proactively with problems to them versus hiding it till the end. And that's what I saw was a big turning point was when I was able to be vulnerable, then the rest of the team did that as Okay, I have permission to also make mistakes.

Jeff Ma
And we're still working on it, right? We're trying to work that way, like I'm still working to personally as we work our way down the leadership, because if you had to compare it to like just an accountable culture, we got better at reporting mistakes, but we can still get better reporting near misses and learnings and things like that along the way, and that you can't do it alone, you know, as Mohammad as the person like we're working? Actually, that leads me to a question for you Dr. Porsa. Like, how are you kind of trying to, I hear a lot of good things coming from really, really great to hear that there's someone at the top of the leadership chain that has this mindset, but from what I've seen, you know, it doesn't always just automatically just transfer downward, or outward to others, how are you kind of actively spreading this culture, you know, through your leadership?

Dr. Esmaeil Porsa
it? Well, that's, that's a good that you gave me it for my next meeting. But you know, it honestly, it's, for lack of a better word is the, during the meeting, showing the humility, that. And it's really interesting, because I want to be careful with what I'm about to say, I don't want to come across as like ambivalence. You know, I know I'm the CEO of this system. But when I enter a meeting, I don't want to be how can I say this, I was gonna say that I don't want to be seen as a CEO is not that yes, I do want to be seen as the CEO, but the freedom that I want to create in the meetings, that's really important for people to what I don't want to happen is, you know, it's a journey, it's gonna take a while. My people say things, it can be like, every time they say something, they stop looking at me. It's It's way more than just me, this is not about me. I think that message is really important. And I keep trying to emphasise that this is not about Dr. Porsa, this is not about the COO, or the CMO, or whatever. This is about Harris Health System. This is about our patiets at the end of the day. And we are all here we all have a part to play. We all have a part of the answer. None of us have to hold the whole answer. We all have to be a part of it. And I think that's what I'm trying to answer your question, Jeff. This is what I'm trying to instil in our leadership group that it's got to take all of us and it's interesting. It, it keeps happening, right. It's just like, I observe one leader acting a little out of alignment that just like, you know, you just have to bring that leader and you know, bring it to his or her attention that you know, what, when you did this, this is how it could have been interpreted. And, you know, nine out of 10 times they really were not aware and they can they can self correct and you know, you see the results and it's very, obviously very fulfilling. I want to be the CEO where others can tell me Dr. Porsa, what you said, Could have been misconstrued for whatever, you're not there yet, but we're working on that.

Mohammad Anwar
Awesome.

Jeff Ma
Awesome. I love it.

Mohammad Anwar
Thank you for sharing So sure, what would you like Dr. purses legacy to be with herself, this is your first time as a CEO, you know, a CEO of a hospital system. And, you know, I read articles and data that the average tenure of a CEO is less than four years at our hospital system. And so what is important to you, for her your legacy, as a CEO of herself, or any future health system that you might work at?

Dr. Esmaeil Porsa
Yeah, thank you for asking that question. You know, actually, a once in a while, I write a letter communication. Two, to all my system, you know, I have I have recurring communications about the business of Harris Health system, you know, I endocarp, those go out once a week, almost. But every couple of months, I send a personal statement to the herself, employees across the system. And really, there is no, there's no timing. It's not like every couple of months, I send one. Sometimes in one month, I'll send two and sometimes three months I can send any. I think it's on purpose, you know, I really only do it when I'm moved to do it, something happens. And I feel the need to express it to the rest of the system. And so the question that you're asking, was actually asked of me. You know, I think I said it at the beginning of this conversation at epic. every other Monday, I speak at our new employee orientation. And you know, at the end of my talk with them, I just open it up to questions and they ask questions, and I answer them to the best of my ability. And it's usually about the business of healthcare. But one time, one of the new employees asked me Dr. Porsa, what do you want your legacy to be? And I honestly did not have a good answer. I did not. I kind of gave the textbook response, you know, I want to be the CEO who helped Harris Health achieve its mission or I don't know, some some not very inspiring response to that question. But, you know, almost a week later, over the weekend, when I was visiting, one of the hospitals, one of the nursing staff, I one of the units came and gave me a hug and said, Dr. Porsa, I love it that you love us that you show us that you love us. And again, a lightbulb moment. That's what I want my legacy to be I want to be this the guy who loved his employees and was not afraid of showing that he loved his employees ever since then. And it's really interesting. This almost like I got a permission slip to start telling people that I love them. Including this last Friday, I was at the pharmacy graduation programme. And I told our senior vice president pharmacy operations His name is Michael Nigel. I just said it, you know, at the end of my speeches I love you Michael. You know, there was no reason for it. But I just felt like I had to sit because I was so proud of the programme that he had put together. So yeah, so that's what I want my legacy to be the CEO love his employees. I was not afraid to show it. Wow.

Mohammad Anwar
amazing.

Jeff Ma
Yeah.

Mohammad Anwar
So So Dr. Porsa, that is unheard of, you know, CEOs using that type of language at a workplace. And so did you hesitate? How did you feel initially and how are you feeling now?

Dr. Esmaeil Porsa
Like I was there I'm not I was absolutely hesitant. You know, because you're right you know, you know, it's not it's not that every day recurrence is not like I had seen others you Oakwood did it. I love my previous CEO, in Dallas, great guy. I think it comes the closest to a saint that ever was. But that was not that was not part of our vocabulary that was not part of our everyday thing about going around that you know, telling folks that we love them. So yes, I was very hesitant about it. But you know, a couple of things happened. One, it was that reaction from from the employee. And I think the other thing was that it is one of those things, right? It's not like you wake up, and all of a sudden you feel comfortable telling people that you love them, right? It's, you build, you build that moment. And I think why that happened previous to this statement was another statement that had set out. You know, it was at the it was after the, or maybe during the presidential election, and they know their hostility toward the Asian communities. But was escalating and that it just again, one of those moments that I just had, I felt like I needed to say something as a CEO of the Harris health system. And I remember with the state man talking about different things that there was a sentence in there, where I said, You know, I always just write free hand and then I'll start going over it and think through it. I wrote it. And this sentence that I wrote was that I am ashamed to say that I am part of the problem I was talking about, you know, systemic racism and biases and all of that. That's what I wrote. And then I finished, I went back and read it, it's a shame, do I really want to say I am ashamed? Maybe I'll change it. I said, hated to think that I'm part of the problem, or I really like to be part of the solution. He I don't know how many times I changed it. You know, the whole thing took me like 30 minutes to write. I spent two weeks agonising over that one sentence. But it finally occurred to me that if that is how I felt, to say it, otherwise would be so dishonest. And it will be the opposite of the message I was trying to send. So I sent it exactly the way it was. And the reaction was extremely positive, as you can imagine, now, when people see statements like that, they know that, you know, you're not you're not faking it like nobody, nobody's going to fake being ashamed publicly. So yeah, it takes several incidents, to get you to a point where you really feel empowered by the reaction that you receive. That is not only Okay, it's actually well received. That, you know, that's, that's what, that's what they want. And, you know, why not? Why not? You know, we keep talking about, we keep talking about culture, and we're talking about leadership, and we talk about how, you know, true leaders, quote, unquote, true leaders, lead not by power or title, but lead by influence, right? What is more influential than love? There is nothing else. I mean, it's just like, what a wonderful way to lead by loving those who are trying to lead and if you're fortunate enough to have the capacity to show that to the folks that you're trying to lead. What a great influencer.

Jeff Ma
Wow, and what a wonderful way to close our show out. That was amazing. Thank you. You know, Dr. Porsa, it's been it's been really inspirational talking to you today, I can't thank you enough. Because we obviously are these types of messages and these things that we're always breaking them apart, strategizing around them, trying to pick them apart. But it's not, it's not often enough that we get to talk to it at a practical level and apply it to the real world with real situations, real people. And you coming here and sharing with us, you know, very honestly, and vulnerably. Really appreciate it because we're hearing the realities of the struggle is the mindset that you have. And it took a lot for you to share that. And I want to acknowledge that. And thank you for joining us here today to do that. Thank you so much.

Dr. Esmaeil Porsa
Thank you guys. I really appreciate I enjoyed it.

Mohammad Anwar
Yes, thank you. I got goosebumps for the end. As you were sharing your story. It was really inspiring.

Jeff Ma
Yep, absolutely. And we will. We will talk to you hopefully soon and hopefully have more opportunities to hear how your story goes. And good luck with your, your legacy that I know you're on the right track to leave.

Dr. Esmaeil Porsa
Thank you, Jeff. Appreciate it.

Jeff Ma
Here at love as a business strategy. We are posting new episodes every Wednesday. And you can read more about our story and our mission to bring humanity back to the workplace by checking out our book on Amazon or any book retailer and you can also visit loveasabusinessstrategy.com for more information, if you liked what you heard today, please do leave us a review, subscribe at apple and Spotify, all that good stuff. And be sure to always share love. See you all next week.