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“The scenario is preset, and hence based on a lot of constraints, but when it is run, there is freedom for everyone to operate. This freedom to take part in the defined context is the same as the spirit of the rules.
The constraints and rules that we set define every problem. How we leverage scope determines how we can position ourselves for success. The prioritization becomes more critical as we engage with more complex and overarching challenges. The goal is to understand without running into infinite loops and endless rabbit holes.”
Carlo Mahfouz is a technology executive and author of Reality Check: In Pursuit of the Right Questions.
He shares his story and discusses his KevinMD article, “Chaos and order: the simulated context.”
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Transcript
Kevin Pho: Welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show we have Carlo Mahfouz. He’s a technology executive, and we’re going to talk about his book, Reality Check: In Pursuit of the Right Questions. Carlo, welcome to the show.
Carlo Mahfouz: Thank you so much, Kevin. It’s great to be here.
Kevin Pho: We’ll get into your book and an excerpt in a little bit. First off, briefly share your story and journey to where you are today.
Carlo Mahfouz: Absolutely. I’m originally from Lebanon. I immigrated to the States a couple of years back, and I’ve been in the health care tech industry now for over a decade. I work mostly on the technology side: simulation, debriefing software, all of that good stuff. Recently I went on the journey of writing a book. The book actually touches a little bit more outside just the tech side and involves a little bit more of a philosophical question of how we can improve and how we can tackle things much better. My experience has been predominantly in technology, but lately I’ve been shifting more toward leadership style and how we can do better: improving our decision-making, asking the right questions, things along those lines.
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Kevin Pho: So you’re approaching the health care field from the technology side. Looking at it through that lens, what are some surprising things about the health care field that you’ve experienced over the last few years?
Carlo Mahfouz: Yeah, a great question. I think technology has gone so far, but the health care industry has not caught on to what is even possible, and on the education side, that has definitely been true. We’ve seen so many advancements in what you can do in training styles and skills training, improving that, and yet I think because of the constraints that have been imposed on the health care sector in general, both in patient care and on the training and education side, it has been having difficulty catching up to it. We’ve been trying to push that limit even further.
Kevin Pho: So when you talk about those constraints, what would be an example of a health care constraint that would limit how far we can go from a technology standpoint?
Carlo Mahfouz: Absolutely. So let’s talk about EMRs, or the digital health records, for example. Most institutions today are at capacity or struggling with having the necessary capacity. You introduce a new technology, and you need to have the onboarding, the time, right? The doctors don’t necessarily have the time to either upskill and gain, or relearn that system. But at the same time, it is super valuable when it’s implemented. To get there, there is this gap, and there needs to be breathing room, usually, for that to happen. Change does not happen instantly.
I found that even on the education side it’s similar. Today we can do so many things with simulators. They’re pretty complex systems in general, but extremely helpful in changing the experience of what we can do, and how you can have a more tangible, hands-on experience when you are simulating any type of ailment, whether airway management, you name it. So the struggle usually ends up coming down to two things these days. I don’t see it as financial, because financial always is a constraint, for sure, but sometimes it’s capacity and having the time to onboard on that competency, and the willingness to do so. Those are real challenges, and it’s not necessarily a lack of willingness per se, but a lack of time, a lack of focus and energy to be going in that direction.
Kevin Pho: All right, let’s talk more about your book. It’s titled Reality Check: In Pursuit of the Right Questions, and it’s about exploring different tactics, mental models, and mindsets that improve our ability to identify ourselves and ask the right questions to solve complex problems. I know that whole mindset is very relevant to what we do in health care. So from a health care lens, tell my audience some of the main messages from your book that readers should come away with.
Carlo Mahfouz: Absolutely. So the book is targeting, as I said, a little bit of the prioritization: how we can be present, paying attention to the real problems and challenges. I think health care is one of the main keys. If anything, what we learned from COVID when that hit is there are so many things we could have done better, probably, or been more prepared for, and suddenly we weren’t. No one is to blame; it’s just a lot of circumstances. So in my book, what I try to approach is how we can leverage this reality check moment, which I consider a really clear read of the now, like a clear assessment of where we are today, to be able to prioritize and pay attention.
To me, I broke it down into a little bit of four lenses. Context plays a big part: What is the context? What is the environment? How are we managing it? I think in health care as well, if you are in an emergency, it’s one context. If you are in the clinic, it’s a different context. If you are at the hospital, it’s different. Different setups imply different ways of how you handle the situation, even if it’s the same problem.
Then second is time. We have this relationship, and I think even in health care, time is a huge key element: like four minutes to play, you go into hypoxia. One minute after, there are extreme constraints on the time. So it’s an important lens to look at when we’re looking at problems as well: How would you find what we’ve learned from the past, how can we manage that with our expectations for the future, and how can we really be present in that moment?
The last aspect is observer. In simulation, we do a lot of debriefing. Usually we record and have these debriefing elements, where you doing the action is one thing, and you observing it and learning from it is another. So there is this element of, when we’re observing what’s happening and have removed our biases and removed our actual involvement, understanding all of these dimensions, how we can learn better and how that can improve where we go. So these are the three kind of pillars I built the book around. I think they touch on my experience in health care and technology, and I try to bring all of these dimensions into it to give us a better structure to work with.
Kevin Pho: So I’m a primary care physician. Give us an example or a scenario of a problem, and how you can utilize the framework that you just mentioned and apply it to a problem that a primary care physician would typically see.
Carlo Mahfouz: So I was recently at a conference where we were doing airway management training, and it was really interesting to observe. We had a whole simulation set up, and then we had the mannequin, and we had the debriefing capabilities on everyone going through. One of the interesting aspects is you could see, and the training was for surgeons, so this is someone who already has the experience and has been involved, but sometimes the rigor of actually doing the action under a certain context changes. For example, when you are under pressure, you behave one way; when you are at ease, you behave another way, right? And sometimes the subtleties, those things which we don’t necessarily always pay attention to, make the biggest difference in whether you’re able to accomplish what you need to do or not.
So when I look at those kinds of problems, I would say you can either eliminate these elements or you introduce them, and once you introduce them, you can stimulate a certain type of thinking about what might be happening. Usually we’re emotional beings. As much as we say we’re objective, and I think in health care we try to be, there is always a bias, which exists; you cannot escape it. And that’s OK, as long as we recognize it. As soon as you recognize it, you’re able to redefine the problem, reframe it and how you see it, and probably get a better, different solution.
So in that context, usually what ends up happening is you start to see, “Oh, OK, this is not the problem I was facing.” In that context specifically, it is someone bagging: the pressure on the mask, the hand position. You start to notice things you thought you already knew, because the technique, and I’m not, I don’t have a health fan, but the technique looks simple. Then when you try to implement it, it’s actually more complicated than it feels. And then there’s the deterioration: You’re sitting there with this for four minutes. So this is the time element. “Yeah, I can do this for one minute.” Do that for four minutes and you’re stressed out, and it’s a whole different way of what ends up happening. This is where usually the errors happen, or the problems start surfacing.
Once you start introducing these elements and your thinking into the problem you’re facing, then suddenly you realize, “Oh, it’s a different type of issue that I have. The technique is not the problem. It’s probably the duration, or my stamina, or my posture that I’m taking.” So the framework, the structure, is a little bit abstract; it’s high level. When you bring it down, it comes to these elements, like context, environment, the time, and elements of what we already know as well, because usually we have these three assumptions that we already know, and as soon as those kick in, we are no longer open to seeing something new. And then, of course, on the observing part, observing even our thoughts, in addition to just what’s happening, gives us a different reflection on them, whether we’re able to see it differently.
Kevin Pho: We’re talking to Carlo Mahfouz. He’s a technology executive, and we’re talking about his book, Reality Check: In Pursuit of the Right Questions. In the description of your book, it says that your book will help identify ourselves and ask the right questions to solve complex problems. Now, from that framework, what kind of specific advice do you have for physicians? Any actionable tips that you can offer them?
Carlo Mahfouz: Yeah, on the action side, I think, especially for physicians, today we should be looking for only new opportunities and keep a window for opportunities. I think one of the biggest things I advocate for is that we do all of these things to be present, to leave a window for opportunity, to see the things we’ve never even known as a solution or possible outcome. That’s sometimes hard, especially for a physician with years of training, years of experience. After years of trying to encapsulate, that window to the unknown is very difficult. I think if we can leave even a little bit of that open, it allows for so much potential in how we can solve problems in health care, whether that’s by introducing technology elements, like in sim, and understanding that it’s not that easy. I know it’s not as simple as saying, “OK, now use this, and it will work.” But leaving that window of opportunity can accelerate things and can allow for much better questions to be asked, a whole different dimension which we might not have explored.
Kevin Pho: And my final question: What are some of the take-home messages that you want to leave with the KevinMD audience?
Carlo Mahfouz: I would say, in health care especially, embracing ambiguity in a world which is so uncertain is a really big thing. But I think we do have so many tools in our hands, and it’s a matter of giving them a chance. Even if you look at Zoom and what it brought as technology, we didn’t really give it a chance, then COVID hit, and we leveraged it. I think in health care it’s similar, from simulation, the different types of simulators, different types of new methodologies. I think that can allow us and help us to leap forward.
Kevin Pho: Carlo, thank you so much for sharing your time and insight, and thanks again for being on the show.
Carlo Mahfouz: Thank you so much, Kevin. It was great to be here.
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