Transcription of Podcast

Julie Soukup  0:01  
All right. Hi, my name is Julie. And I'm excited about our next episode of take one patient. I'm here with Louis stout, who is working with Providence Hospital System, and is a retired Army officer. And I think one of the really cool things that I have learned about his experience and in our conversation is how diverse his perspective is, with other communities with other cultures, and really brings a lot of insight of how the military sometimes faces the challenges that marketed hospitals do and how they perceive these things different. So I'm very excited to have him on on our episode today, loose if you want to kind of briefly introduce yourself, and then we'll kind of just dive in a little bit on on kind of these, these, this insight that you that you have.

Louis Stout  0:53  
Julie, Thanks, I appreciate it. I was in the military, I was in the army for 30 years, and retired last year, I now work for Providence healthcare system. As I was going through college, I was offered a scholarship, which I thought would be a good way to pay for school. And I thought, Hey, okay, sure. It's something I'll try for a couple years, I can do that. And I thought, oh, then I'll I'll go get a real job. Until my contract was for four years, and four became 10, and then became 20. And next thing I knew was 30 years, which is mandatory retirement for the military. And it was an amazing opportunity, and just so many different things that I had the opportunity to do, and just a great experience, to really, really build on and build a network and see healthcare from a lot of different perspectives.

Julie Soukup  1:52  
Yeah. And that's, I think one of the things that was very unique about our conversations and unique about you was really seeing kind of a lot of these different perspectives. If you're gonna kind of start by, by first of all, I mean, you were, you're forced to retire after 30 years, but I remember you saying, I felt like it's still so much to give, and that's when you went more into the private sector, public sector, I guess you'd say, what's some of the things that right off the bat that you that you saw, that from your experience in the mill that you could bring, to the hospital systems that you're working with now,

Louis Stout  2:29  
I think what was most intriguing to me is really to experience your nursing from a lot of different areas, different countries, and how they viewed it, you know, there's a lot of areas in the world where, you know, nurses is not really something that they have, you know, as we would define it, you know, there's a, there's a military agreement, uh, you know, like some of the some of the countries, Australia, Britain, Canada, US, New Zealand, you know, where we defined nurse in the same way and in the military, that we can exchange nurses doctors, because we've agreed that we have the same standard, same definition of it. But so it was really interesting to be in areas of the Middle East and Egypt and South Africa, and in working with them and just see how they approached nursing. Some is very similar. And then in a lot of areas, you know, they don't have what we would look at as a nurse, they have doctors, and then they have, you know, people that work in the hospital. And the family is used a lot as the kind of that nursing role. In some areas, they actually have to find their own medical supplies and bring them or do some of the procedures themselves, which is, which is obviously very interesting and very different from our western approach to to nursing, you know, as we've looked at it from Florence Nightingale through through the President and our approach to health care from a nursing perspective, it's just, it's so be very different in, in areas of the world.

Julie Soukup  4:06  
And that's interesting thing you, you know, I kind of mentioned, I had never thought about that, is that that role that we've defined isn't, isn't there? So how does how did you find that really changed the communication style of some of those providers to family members who weren't necessarily updating them, but sometimes really educating them about what they needed to do? I mean, did it become more of a teacher mindset as much as a doctor's mindset? Or how did these How would people know where to go to kind of help support their family member?

Louis Stout  4:39  
A lot of it is I think it's more of a probably more of a perspective that we had you know, in the US looking back you'll 100 years, you know, it was more the family was was more directly involved. You know, you had the you had the hometown physician and, you know, if you look back to before the US said, you know, nursing schools nursing programs before that was really established as a, an area of health care. It's it was more that there's traditional of, you know, working directly with the family. And you were the patient was discharged you they, they went home who and that's who continued to care, I think we just have a different health care system. In Western culture, that's some some pros and there's probably some downsides to it as well, you know, there's there's just probably less of a an approach of, you know, healthcare at home, which is now becoming more of a current trends, you know, it Providence, you know, we we've started a program of hospital at home. And I know, there's, there's a lot of different healthcare systems that have similar ones, some are more developed, where healthcare could actually be delivered at home, and, you know, a step beyond just the the home nurse, you know, coming in for a home visit, where now it's becoming more robust in in the clinical care that is provided it in, in the home setting. And certainly, there's, there's some very interesting perspectives to that. some opportunities there. So we'll have to see how it developed.

Julie Soukup  6:24  
Yeah, well, it's interesting too, because one of the pieces, even in our technology for medical memory that we're building out is a family, a family share app, where it makes it a lot easier for patients to download the videos onto their phone, with the focus of, I want to be able to share this information with my family, because there are a lot of times they're the ones that are starting to take care of me are going to help me heal or help me, you know, kind of get back to square one. And so it's interesting, like we've come a little full circle of although we have these pieces is a lot of family members, and patients are craving that information of well, I want to be a part of it. And I want to help and I want to make sure everything's, you know, good to that it's kind of necessitating the need for easier access to that information to be given, you know, to family members. So it's an interesting kind of perspective. What other things did you find kind of some in your way that that different cultures even perceived, perceive their role as a physician or how they went about, you know, healing, if you will? One of the one of the reasons I'm like, leading you really what is one of the things I remember you mentioning, was one of the communities that you were in having have a really had more of a perspective of sitting back and watching versus kind of diving right in where Western medicine really does, or, or some of those things that you started to see just their perspective on how they approached? That was different.

Louis Stout  7:56  
Yeah, I think, you know, one of the stories that I shared with you is you having taught for a little while, as, you know, trauma nursing in South Africa, they gave us some opportunities to go to some of the local facilities, and it was, it was interesting to see, you know, private hospital versus a public hospital in just, you know, having to be in that country. You know, I saw the same thing when I was sitting in Greece and working with the, the NATO countries that were there. Just, they have a different, you know, health care structure or different approaches to the delivery of health care. And one of the things that I observed in, you know, in the public facility, and this was, like, set happen to be in South Africa was, you know, they had over 40 traumas per day, you know, true traumas that were brought in it was, you know, a large facility over 1000 bed hospital, and they said, Oh, you know, we have one coming in now, do you want to observe and so yeah, absolutely, I, I really want to see their approach to it. And what, what I realized later, after I kind of reflected on it, watching them, it was, it was almost silent. The, the team approach to bed, you know, they all knew their roles. It was a small team, and they knew what each of their roles were. And they didn't, they didn't see the need to, you know, verbalize it as they were doing it, or really be louder demonstrative, which, as I got back to the US and started working with our teams, just it struck me as how robust it can be at times, and, in some ways disruptive in this case, where, you know, the the trauma of provider was assessing the patient. They were doing their head to toe assessment, and they were, they were talking it and speaking it and the transcriber, who was some distance away was able to just listen and hear exactly what the provider was saying, and take all the notes down and then at that time, and other trauma came in, and the other team approached and they were a few days down and doing their assessment and they were also just is having a quiet conversation and assessing the trauma patient. And they were just as you know, having been in the military and worked with different groups in the military, you know, there's there's groups that we refer to as the or the quiet professionals where, you know, they're just, they go about their job, they know what needs to be done, and there's not really a need to display it or talk about it. It's just they know their roles. And a writer reminded me of when I was writing on an ambulance years ago, when I was in nursing school. And that team that I happened to write with all the time, they did the exact same thing, they at the beginning of each shift, they said, Okay, if we get the big one, here, here's, here's the roles, okay, you're going to do this, you're going to do that. And if anytime, you know somebody is doing what is your job, you just, there was a word, it was actually really funny. I'll never forget it. It was quite some time ago, but they had a word, they said it was money. And okay, what is that like, to absolutely nothing, it means nothing. But if anybody is ever doing, what you see is your job, you say that, and we all know what it means. And we know to readjust it and get back in our role. It was, it was a great approach to it. Everybody knew what their role would be, even though you know, you had either to two medics or three medics. It didn't matter, you knew what what your job was going to be if you went into that trauma scenario, which is not the time to try to be figuring it out.

Julie Soukup  11:25  
Yeah. And that's interesting, is really taking the opportunity to know that the few words that are spoken, or the person speaking at the time is with intention and purpose and feeling a lot of trust that, okay, that's where that that falls, and this is where I fall? And do you need perspective, do you feel like kind of as far as like, Is that consistent and in in more of a military approach versus in your experience, kind of being, you know, chief nursing officer in the army before kind of going into a private sector, what are other things that you see are really kind of different between the military and not

Louis Stout 12:07  
really realized that, you know, health care is, is essentially the same, no matter where you are. It's universal, you know, illness is the same, you know, trauma is all very similar. It really doesn't matter, you know, gender, race, whatever the country that you live in disease diseases, you know, as we see with the pandemic, in this particular case, you know, COVID-19, unlike other recent viruses, you know, for the past 1520 years that have, you know, kind of stayed in one area, this one has been able to go everywhere around the world from, you know, hot areas to cold areas, and regardless of gender, or religion, or whatever you want to look at, it's it's, you know, been, had an equal effect on everyone. And so, it to include the military, for the past couple of years of the pandemic, I was in a, you know, a military hospital, and it, it had nothing to do with the base we were on or, you know, we're a federal or and they were a civilian organization, it was, it was the same no matter what, and we really had to have have the same approach.

Julie Soukup  13:24  
Right. Well, and that, and that was that is kind of, you know, my perspective and I don't know much about much is, is kind of more of of, like the structure that sometimes happens, kind of consistently across the board versus more when you're seeing kind of, like, innovative hospitals or teaching hospitals versus more of that standardization or structure. You know, like, I'm not my perception. I mean, again, no, but would be that, that maybe the way that kind of you go about solving some of the challenges that are being addressed might be a little bit different, or is that kind of the false misconception of most, you know, civilians that have never really been in that world?

Louis Stout  14:14  
You know, definitely in the military, I think we spend a lot more time preparing for, you know, disaster management, disaster response, mass casualty situations, we, we spend a lot more of our time training for that, because that's those are the environments that we go into, and where it could occur, and has occurred much more frequently in those areas. So I think our approach from that perspective can be different. And we are more likely to put a lot more people towards a situation in the military. And it's just you have just been my impression of it. You know, as far as being in a remote area, I spent a lot of time doing burn care. And the Department of Defense has one Burn Center, which is in San Antonio. And looking back through their history, I was actually amazed to find out that in, you know, in the 1980s, they sent a burn team to Russia, because there was a large disaster that happened actually happen to be a train accident that occurred, you know, with a propane train, tank exploded, and a lot of burned casualties. And the military actually sent an entire burn team there into, you know, in the peak of the Cold War into for Russia as a response. And so, you know, we prepare to not only practice our crafts, you know, in a fixed facility, but then anywhere that we need to take it.

Julie Soukup  15:56  
That's probably what becomes key is because you're not in your space, like, that's your comfort space, you know, you're not in the same operating room where you have all your stuff, you have to rely more on well, how do we manage the chaos? You know?

Louis Stout 16:10  
Yeah, when the, you know, burn flight team, I spent years doing transports back and forth, you know, transoceanic long distance transports. And I, I did, you know, that was one of the things that I reflected on, I said, you know, now I know, I know what I know, you know, when you're in the back of an aircraft, somewhere over the Atlantic, and it's you and your team, it's either either you have it or you don't. So if you didn't bring it, you better figure it out. And what I realized was, the best piece of equipment was between your ears. And if you brought that with you, then that that's where it has to start. So whatever equipments in the in the box, you know, that's good that you have it, but it starts with, you know, your training, and the team that you have with you. That's, that's really the most important part of it. And being where you practice your craft. is, it can be somewhat irrelevant at times.

Julie Soukup  17:07  
Yeah. Hmm. That's really interesting. That's really interesting, in the perspective of, of, I never really thought that that Yeah, I mean, you're kind of you're, you're relying really on what you have with you and the team that's around you. And I think that's where that that communication element, or that team communication element becomes so much more thoughtful, because you don't have the luxury of access any extra space, or things or time or equipment, or, you know, you have to kind of be focused on what you're doing, especially in a trauma type situation. Yeah. Do you miss that part of you? Like, do you miss kind of the, the time you spent over there and or, like, time you spent doing that now that you are in one local place? Or are you kind of leaning more into taking kind of some of that experience into what you're doing now?

Louis Stout 17:58  
I do. Do I miss it? Yes, I, you know, I enjoyed obviously doing it for years, but it, it builds up over time, you know, after years of doing, you know, back to back deployments and missions, and even even teaching, you know, as I was teaching, you know, all around the United States, and then, you know, we went to other countries as well. Which, which was fantastic. But you can only do that, you know, for so long as well. So there's, there's some positivity to be in, in one place, you know, for myself, for my family. There's, there's some goodness to that, but it also being able to share those experiences, you know, not necessarily to sit and tell stories, you know, a deal there. I was it, but it's, it's still have a different perspective. So as, as a discussion comes up, you say, Well, you know, here's, here's something to consider. And you just, you know, kind of a different thought process, or a different approach towards it might give you a different solution that you would not necessarily have considered and I'm certainly I learned from all those that I work with, as well of, you know, things that work or more importantly, think things that don't work and like, okay, you know, here we try that, you know, five years ago, it was not successful. Let's not let's not go down that that path again. Good, good to know. Got it. Let's move on. Take that one off the table. Let's let's see, you know, what, what might be, you know, successful,

Julie Soukup  19:39  
right? No, absolutely. And really, I mean, definitely leaning and learning on that on a different perspective of how its approached and all of that. Absolutely. Well, that's and so that being said, is is what what, what do you find are kind of some of the things that when you are giving a different perspective or wanting to think about it A friend or even giving advice that people that are starting to say, hey, we want to kind of think about this problem different or how we're going to approach even trauma normal spaces, what are what are some of the things that you really leverage or have learned in your experience that would be useful for someone else? Kind of facing i Something overwhelming, forgetting their toll, but seeing their brains, I guess, as you said, or that

Louis Stout  20:26  
I think there was, you know, I loved opportunities. And certainly going through some of the senior, you know, healthcare executive courses that the military has was, was really, to force you to think and actually, I had one instructor who this was, you know, very purposeful he and it was the approach was what else? So, you know, the military, I think, for many years, always, was fighting the last war. So, you know, they, they looked back and said, Okay, here's, here's what we learned, going through that experience, and here's how we can avoid that. And that's that, that's okay. That's, that's good on one level, and then there's a lot of time spent saying, Okay, what's going on? So looking at what's what's currently going on, but I had some really good coursework, where they said, Okay, well, what else is happening? What do you mean? So let's, let's talk about we got it, we know what has happened, we know what's currently going on, everybody's looking at that everybody's engaged in it, but what else is going on? That might be the next thing. And that really helped, you know, frame the mindset of being more of a thoughtful thinker, to you know, for other considerations, and I found that, that has really helped when looking for solutions. You're like, Okay, that's good. You know, we have what we have, we have what, what has worked or what hasn't worked? And then what else can we consider? And so there's been, you know, a few things, just, you know, recently in my new role, I can say, Okay, well, got it. But you know, what else? Who else could we bring to the team, that might give us the support that could offer a little bit better solution or make us more efficient. And it's not, it's not limited to, you know, being a nurse and looking at your nursing assets. That's obviously one thing, but it's your external support, and every the ancillary services that help relieve the pressure for the nurses to work function at their highest scope of their practice. So when you don't have your ancillary support, when you don't have the other areas covered as also, then that means that your nurses are doing their job, and as well as other jobs as well. So as a healthcare executive, a lot of times, you know, I just spent a lot of time doing is saying, Okay, I got it, we, we need nurses, always, you know, it's, we're always looking for more, but maybe we need to put more of our organizational resources into another area, that would actually relieve a lot of the pressure that the nurses have also taken on a lot of the additional duties that they've taken on so that they can focus on on their craft. And then and those people also can, can focus on their craft. Because, you know, I used to talk to, you know, a lot of my counterparts in the military, and they're like, Well, you know, we need to reduce the healthcare number. So we're just gonna, you know, cut the numbers as well, you, could you drive a tank with only half of a tank crew? And like, no, no, no, you could never do that. I said, exactly. So you can't, you can't just put one person or two people in a tank and say, you know, go, it takes an entire tank crew. And they have, they have an entire process that they need to go through to be certified. And they understand that. So when you say that, it's like in our team, I can't go in there with just a surgeon and just an anesthesiologist, that's great, but that's only part of the team. If I don't have the nurses, if I don't have the circulators if I don't have housekeeping if I don't have everyone else, it's part of that team, then one, we're not going to be efficient. And two, we probably can't do the surgical case if we don't have a complete team. So our hospital teams are very diverse and and it takes it takes everyone to be part of that process.

Julie Soukup  24:32  
Yeah. When I love even when you just said that like there and it kind of goes back to your experience when you're saying hey, like the nurses really been defined here. And a lot of times is you are relying on family or people outside of that but even when you're just saying okay for this surgery be successful. everyone's mind I was like, okay, the doctor and the anesthesiologist, but no, it sounds so the you know, housekeeping and every every piece that's a part of like, that whole part that's making this whole thing, you know, run efficiently and I that's I've never really heard someone kind of allude to that. But the whole piece and not only just that medical part of it, because even with some of the nurses we work with, they love the patient care of it. Sometimes it's more the administrative tasks and start to really wear on them. So the solution always, isn't it, let's get more or less he wants to get more it, as you said, take a step back, what else? What else? Can we? How can we just look at this difference? It's interesting, it's very, it's a very, that's a very interesting experience. So great, well, um, that being said, Is there anything else I've stolen your time for 25 minutes, you're so intelligent and have so much experience in this space, I could learn from your stories, as I'm sure most of your team and, and network really liked. But is there anything else you kind of want to add, that you think might be useful for anyone really starting to kind of take this perspective of, of yours and how they're addressing patient communication and their their own teams?

Louis Stout  26:03  
I think I'm smart enough to know, that I've been, had been blessed to work with very smart people, you know, through through the years. And you know, a lot of what I've been able to share, they're like, Where'd you come up with that, like, actually, I can come up with it. I had some brilliant solutions. And, you know, I've had the opportunity to see a lot of a lot of what works, and be able to just be able to pass that on, and share that with others. And it makes a difference. And we know, you know, staff satisfaction is, is directly tied to patient satisfaction. So, you know, being a healthcare executive, you know, the role is to look at resources and say, Okay, what else can I do to bring resources to you, so that you can be more efficient at your job. And that we can all strive for the best patient outcomes because that's, that's ultimately, is our goal. And that's not it's not always easy to find those resources, or to find those solutions, but we keep looking. And in the military, what we say is you're always trying to improve your foxhole. So wherever you are, wherever you're you, you're dug in, you're always just trying to make it better, you know, whatever that is, you just keep working. Keep working on it. There's, there's sometimes you know, feels there's never an end to it, but but that's good, because you always want to be growing in your craft and growing in your practice.

Julie Soukup  27:39  
Absolutely. Awesome. Well, thank you so much for your time today. And and for your service and everything that you've kind of done there. Um, yeah. And I just thanks again for having us. All right. Thank you. Thank you.

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