What Else but ELSO?

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. And I'm very pleased to have with me today, Christine Stead. Christine, welcome to Studies in Empathy.

Christine Stead: Thank you so much, Steph. Thanks for thinking to include me.

Steph Bayer: I'm thrilled you're here. Christine's the CEO of the Extracorporeal Life Support Organization, ELSO. This is a global nonprofit for life support. ELSO aids those delivering life support through continuing education, guidelines, original research, publications, and the world's largest registry of ECMO patient data. Christine's also an adjunct instructor at the University of Michigan's School of Public Health in the Department of Health Management and Policy. And we're so excited to have you here today. Are you ready to do this?

Christine Stead: I'm ready.

Steph Bayer: Well, let's start at the beginning. Could you start by telling us a little bit about your background, about ELSO and how you came to be the CEO there?

Christine Stead: Oh, that's a great starting question. And I say ELSO just to try to make it easier.

Steph Bayer: I love that. Thank you. ELSO.

Christine Stead: My background is that I've got a couple of degrees from the University of Michigan. And while I was getting my undergraduate degree in cell molecular biology, I started working at the ECMO lab under Dr. Bob Bartlett, who is largely seen as the inventor of ECMO. That stands for Extracorporeal Membrane Oxygenation.

So, it's a little bit more than the cardiac pulmonary bypass, just the pump function that has long been in existence to help patients get through bypass procedures, doing the work of your heart while your heart's being worked on. What Bartlett did and many others, but what really made happen, was adding the oxygenator part, which does the work of your lungs.

And so really what we can do with ECMO is do the work of your heart and your lungs outside of your body for patients that are really sick and need that kind of support. But I started working in that lab as an undergrad in 1990. I worked with Bob and his team there, which has now about a hundred medical students in it, and they're voracious producers of research and advancing the field quite a bit.

And from there I went to graduate school in Michigan as well in health management and policy and spent about 20 years working with academic medicine around the US and Canada and some other places. But lo and behold, the CEO of MC3, who used to be back in the day, a PhD student in my same little OR where we were working on ECMO stuff together. We were both walking out of a conference where we were talking and he said, "You know, ELSO really needs a little bit of help and maybe you could help them."

And so that conversation led to me becoming CEO and kind of coming back home. That's how I think about it. Starting there as an undergrad when I didn't know what the heck I was going to be doing and getting a chance to come back to kind of where I started at Michigan. And I'm still in Ann Arbor, Michigan and really happy to be here now as the CEO of ELSO. So that's the circuitous path of how I became the CEO at ELSO.

Steph Bayer: That's great. Thanks for sharing that.

Christine Stead: Yeah.

Steph Bayer: And you mentioned that ECMO is essentially the heart and lungs for a patient as we're waiting for a bridge treatment to what's next. Can you talk about what ELSO does?

Christine Stead: Yeah.

Steph Bayer: What the organization does for these patients that are in ECMO?

Christine Stead: I have to give credit where credit's due, and this again goes to Dr. Bartlett. While he was inventing ECMO, he also gathered a group of people together back in 1989 because these people really were pioneers. ECMO was this pioneering thing that was a chance for people to really have a chance to survive that otherwise weren't being offered that chance. And so, while he was working on that, he also established ELSO as an organization. And part of his thinking was, "Let's learn from each other."

So, he developed this as a global nonprofit, and we now have around 800 centers around the world that are ELSO member centers that are providing this kind of life support. We know there are more centers than what are members of our society, but what that looks like is wherever Dr. Bartlett goes around the world, and I've been with him in Peru just recently, India. He was in South Africa right before the pandemic started.

He's literally all over the world. And seen as friend and family wherever he goes because it's his work that's allowed ECMO to take off around the world. And that's something we're enormously proud of. But the other important ways that ELSO helps bring that global community together is through contributing their data, having meetings, creating guidelines, creating a standard for how we hope every ECMO team is educated and trained and what they know.

Teaming is a big part of how we do our work. So, unlike other medical societies that have a certain physician specialty that they'd focus on, we have a whole team of people that are part of our work. Respiratory therapists, perfusionists, nurses, all of the specialties on the physician side involved in ECMO, which are quite a few, that's our family of people that we work with. And then the data we have available to us to do research on is over 200,000 ECMO patient runs now. So that's an enormous asset where people can advance knowledge.

Steph Bayer: I'm curious, just to pull on the thread that you just mentioned, 800 members. Did you see a growth in ECMO and the data that came from the pandemic? I know ECMO was certainly a treatment that was crucial for many of our patients during the pandemic to help get them well again, how has that impacted the organization?

Christine Stead: We played a lot of roles differently than we did before during the pandemic. So, Steph, I appreciate that question because early on in the pandemic, there were nine out of 10 patients in Wuhan, China, the original site for COVID-19 patients that were put on ECMO and those nine of 10 died. And so, some of the early thinking of COVID-19 and whether they'd benefit from ECMO or not didn't look that promising.

What we did as an organization changed everything. So instead of collecting data once a patient's left the hospital, we thought we better start learning about this in real time. So please enter your data when you put someone on. And back in the early days, it took days to even run tests to figure out if someone's positive for COVID-19 or not. But that thinking started changing policy at the global level and country level about whether this was an effective treatment or not.

There was a lot of interest, but there was also a threshold we saw hospitals reach. There was so much demand for patients, and you had to think carefully then about how you were going to spend very precious resources. That's not just ECMO equipment, it was the staff that were available and PPE available. So, I think if sky was the limit and we had limitless resources during the pandemic, we would've seen enormous growth in ECMO.

What we saw instead was realizing our patients, that our COVID-19 patients on ECMO took two months on average at some points during the pandemic. That's a lot of resources to dedicate to one patient when you have a lot of demand. And so, people had to make trade-offs. And we as an organization then created guidelines to help people make really hard choices. And so, we used our data to say, "These are the patients that we're seeing have the best chance for survival on ECMO. And as your resources get more constrained, we'd recommend you consider some of these factors."

And that did constrain some access to ECMO, but I think it also helped practitioners in the field try to make good decisions at the bedside when they had enormous demand for every bit of resources that were available. So that was something we saw as kind of this upper limit and also a trade-off where we usually saw some cardiac related ECMO cases. Those procedures were being shut down or not as accessible to try to emphasize providing as much access as we could for lung, a respiratory based demand. And so, we just kind of saw that flip.

Steph Bayer: That's a really interesting perspective, and it also speaks to why a group like ELSO is so important to help set guidelines because these are really tough ethical questions.

Christine Stead: Yes.

Steph Bayer: And to be nimble with your real time data, that's so important. So, thank you for doing that during that time and beyond. So, the topic of the podcast is empathy. And as a leader of a nonprofit for life support, I have to imagine that empathy is the forefront of many of your conversations. Is that true?

Christine Stead: Really, it guides everything that we do.

Steph Bayer: Yeah.

Christine Stead: And empathy with a patient kind of focus is a primary thing, but also a team focus became part of a real area for us to consider during the pandemic as well. Because patients really are why we do everything. We're trying to improve access to ECMO and improve outcomes for patients that are on ECMO.

ECMO is not easy to go through. You're really sick if you need it. And there are some things that people struggle with too just because of ECMO. But also, our providers are another thing we need to think about. We need to think about their work, how they're experiencing their work, and what we could do to help them do better in the field.

Steph Bayer: Oh, I love that perspective of not just empathy for the patients, but also for the providers. So how does ELSO apply empathy? How do you make room for it and ensure that it's part of your guiding approaches?

Christine Stead: Well, you probably spend a lot of time on this given the role that you have at the Cleveland Clinic. And a big part of empathy is listening and creating opportunities for people to share their experience, how they're feeling about something in their own words.

And we take a lot of time and effort to have a vast group of people that we can listen to and have a vast group of people that we can check back in with about how we're shaping something that they said would be helpful, but we want to see that it's actually helpful.

Because you might have an idea about how that works and if it's not actually helpful to the people you're trying to help, it's not that helpful. So that's part of our approach to everything that we're doing. We want to make sure it's responsive and effective in a way that's meaningful for people that are trying to use that.

Steph Bayer: Listening is so important in how we design around empathy.

Christine Stead: Yeah.

Steph Bayer: I have an opportunity this summer to work with one of your students in the University of Michigan, and she was telling me what an empathetic leader you are, that as a CEO and as a professor, that empathy is a real value that you live. Why is it important for a CEO to build up that skillset?

Christine Stead: Well, it's a good question. And the way I think about my job as CEO and the way I teach at Michigan about the students who will soon have jobs and be thinking about their own work is whatever you're responsible for, those are the people that you serve. Those are the people you serve.

And that's how you need to think about how you approach all of your work all day long, how you talk to people, how you prioritize things, why are you here and what are you doing. So, our mission helps us, but I really try to think about the patients that we're taking care of.

And when I'm teaching, I try to help our students think about their possible future roles. And some of them will become CEOs of big health systems or an organization, and all of those people that you work with and for are people you're responsible for, advancing their career, having the impact they want to have in the field that you're working in. And in healthcare specifically, how are we doing for the health of our communities and the patients we serve? That really ought to be number one or two every day when you wake up in the morning.

Steph Bayer: I'm so glad to hear of a professor who believes in servant leadership and believes in teaching that to the next generation of leaders because that is the path forward. Thank you for doing that.

Christine Stead: Yeah, it's a pleasure. I mean, it's some of my lived experience in just being a person going through things and how things have felt for me. But also, when you think about people that have inspired you or made you feel good or made you feel like something's possible, that's also I think part of our work in leadership.

And you have to embrace the reality of other people's lived experience a little bit more to do that well. And so, everyone's coming from a different perspective with a different journey to get to this point in time where we're all together in the same spot. And the more you think about that and how you're doing the work, the more likely you are to have the kind of impact that you're hoping to have.

Steph Bayer: Well, building on that, everyone's coming from a different lived experience. I'm also told that you're a huge champion for diversity.

Christine Stead: Yes.

Steph Bayer: That is so important, especially as a leader. Do you see a link between empathy and diversity and what are some ways that you promote.

Christine Stead: Almost by definition, I think.

Steph Bayer: Right?

Christine Stead: Yes.

Steph Bayer: Right? How do you promote it?

Christine Stead: It's an important question to ask, and I'm really glad you asked that, Steph, because I'll tell you about, it's not something with ELSO, but another thing where a couple colleagues of mine at ELSO, we were paying attention to a conference being held at the AAMC. This was two years ago at their conference. It was virtual, and there was an African American woman who was on a panel of otherwise older white men, and they were talking about healthcare and how it's going for them.

And they started, the men started, and they were saying, "Pretty good actually, things are going pretty well. I've got access to what I need. I don't see any big changes or issues." And thank God she was there because for her, she could talk about a very different experience. And had she not been there, the finding from that podcast or conference session would've been like, "We're doing pretty good. Things work. Generally, they work."

And had she not been there, we wouldn't have heard what her experience was and the challenges of even going on them, so now she's got some success in her career, and now she's a private consultant. That means she doesn't have healthcare benefits, that means she has to go on the Obamacare circuit to get access to care, which means she had to abandon her OB-GYN and other providers that have been part of her life so far that knew her well, but they're not in that network. And that isn't working very well.

She shows up to appointments to physicians dressed up because she feels like she needs to, to have the kind of credibility that other people can just walk in the room and get. Thank God that she was there because had she not been, we would've thought very differently about how well we're doing. So, diversity is almost an equitable thing with empathy. If you don't have people in the room that are diverse, you're just going to get a very narrow view of how things are actually working, and it doesn't allow for empathy to exist the way we need it to.

Steph Bayer: It's a very powerful firsthand story of why diversity matters. Are there ways ELSO or other organizations can actively promote a diverse workforce or diverse presence in the room?

Christine Stead: Yes. We think about that all the time. And so, when I started here as CEO, I was the only woman in the room and including on my board. And so, in my first year, I was able to help us get a female added to the board. And we now have two, which are phenomenal. I think about that with our leadership when we have our own steering committee and opportunities for women to advance, but also ethnic diversity. We're global. We are everywhere in the world, and we need to start reflecting on that.

So, we now have our first non-US based president of the board. He's based in Singapore. And that's important for us to not be so US-centric and have more diversity there. But we are planning our next conference right now, so that'll happen in September in Seattle. And we also want to make sure there's diversity of who's up at the podium talking, and who are the patients that we're profiling, who are the families we're profiling, and what's their story that they're sharing to our gathered audience of practitioners.

So, women need to be there, we need people from different countries and ethnicities and sharing their work, the challenges they have so that we can learn and grow. And so that's some of our more visible commitments to diversity, but it needs to be fostered a little bit more robustly so that we're also helping to advance the workforce. And who feels acceptable? Who feels included? That's me. When I see that organization, I want to think that that's me, I fit here.

Steph Bayer: It's so important. Thank you for also thinking about that and being active in it. So, this next question is a little painful for me because I am an Ohio State grad, and I'm going to ask you about teaching at the University of Michigan. But can you tell me about that? Did you always want to teach?

Christine Stead: I love teaching. I'm really passionate about it. And I have to say, your Ohio State program and health management policy, you have some amazing people there that are just incredible, and they really help shape the future of where that field is going. So, I'm proud of that, and you should be proud of that too. You've just got some amazing people there that we're so lucky to get to work with.

But teaching is, to me, part of your responsibility is you get a little experience to help shape people and share and create opportunity for them. So, for me it's, I see it more as a responsibility than a nice to have. I do get a lot of energy and enthusiasm from the students I'm lucky to get to work with and watch them advance and grow.

But part of my commitment to them is to try to bring in what I'm learning in real time outside of the faculty role, but in the real world clinical and leadership role I serve to help them think about what's happening in healthcare now. And I hope that has a positive impact on them and helps create more possibilities for them. But mostly I'm hoping they feel confident by the time they're done with our program to at least know how to approach some things, and that they see and hear ways that we're trying to model servant leadership.

Because that responsibility in healthcare in particular is enormous. You're dealing with people's lives, the thing they're most passionate about, a family member's life. Emotions are quick to get involved. So how can you use data to help you with really difficult conversations? How can you integrate empathy in everything you're doing so when you're working with people or helping whole teams of people work with people, you're doing that with the end goal in mind? And at the end of the day, it's the community we serve and patients in their most difficult moment of need.

Steph Bayer: That's so true.

Christine Stead: Yeah.

Steph Bayer: So what words of advice do you have for those who want to be leaders in healthcare next?

Christine Stead: Oh, gosh. Leader is a big responsibility. And I would think about it that way, that that's not something you take, it's something you're given. So how do you position yourself to earn the trust of your colleagues and your peers and do the work so that one day you might be provided with an opportunity to lead?

Steph Bayer: Do the work, yeah.

Christine Stead: Yeah.

Steph Bayer: Is there anything that we missed today that we should have talked about?

Christine Stead: Oh, gosh. We could spend a couple years talking I'm sure, Steph.

Steph Bayer: I think we could, I really enjoy speaking with you.

Christine Stead: I think the patient experience whole area and department that the Cleveland Clinic has set up is just an incredible asset and reflects that commitment to patients, the Cleveland Clinic does. I'm so glad you have that part of your organization.

I know more people are trying to do that, but to the extent that this work, this conversation, and your work in general, just to help keep patient centered for everybody, it's an inspiration. And just thank you for being part of that work too, Steph. I think you probably don't hear all the ways that go a long way every day, but I can tell it goes a long way every day. So, congratulations on being part of that.

Steph Bayer: Oh, thank you. And thank you for working in a field that is also advancing patient needs and the needs of clinicians. ELSO is an important group, thank you for leading it.

Christine Stead: Well, it's a team effort, and we're all part of the same team in some ways. So, thank you so much.

Steph Bayer: This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.