104_Dr. David Nash on Leadership and Healthcare Evolution

What does it take to lead meaningful, system-wide transformation in healthcare—and why do even the best strategies often falter at the implementation stage? 

In an era defined by pandemics, rapid AI innovation, workforce volatility, and unprecedented organizational complexity, how can leaders cultivate resilience, trust, and sustainable excellence?

In this episode of the Excellence in Healthcare Podcast, Jarvis T. Gray sits down with Dr. David Nash—pioneering physician, healthcare executive, and founding dean of the nation’s first College of Population Health—to explore the essential leadership lessons behind some of the most significant shifts in American healthcare. Dr. Nash brings more than three decades of executive experience at Jefferson, an institution that grew from a single hospital to a $16-billion, 65,000-employee system under his watch—and he delivers an unfiltered look at the challenges and opportunities ahead for healthcare leaders.

Discover how Dr. Nash’s career has mirrored, and at times shaped, the nation’s journey from “To Err Is Human” to the age of AI—and why “knowing” isn’t enough if organizations can’t consistently “do.” This is a masterclass on navigating disruption, building high-performing teams, recalibrating strategy in turbulent times, and preparing for the unmistakable impacts of technology, trust, and the next generation of healthcare leaders.

Key Takeaways

• Proven insights for building high-performing healthcare leadership teams
• Why strategy execution is as important as vision—and where most organizations stumble
• The critical “know-do” gap: bridging the chasm between knowledge and consistent operational excellence
• Lessons from leading organizational transformation inside complex academic health systems
• The enduring importance of quality, safety, and patient-centered outcomes—even in times of crisis
• How the COVID pandemic exposed structural flaws—and the opportunity it provided for system-wide learning
• The impact of clinical training on team culture and leadership dynamics
• Future-defining trends: preparing your organization for the transformative influence of AI and the public’s evolving trust in healthcare

Notable Quote

"When leaders look in the mirror and can self-evaluate and when they're humble and when they're vulnerable—that's when healthcare excellence begins." — Dr. David Nash

Who Should Listen

This episode is especially valuable for:

• Hospital and health system CEOs
• Healthcare executives and C-suite leaders (COO, CNO, CMO, Chief Quality, Chief Strategy Officers)
• Healthcare entrepreneurs and organizational transformation leaders
• Quality and patient safety professionals
• Strategic planning and operational excellence leaders
• Rural and community healthcare executives
• Emerging leaders aiming to drive meaningful, measurable change

Connect and Follow Our Guest: David B. Nash, MD, MB

• Connection On Linkedin
• Celebratory Unveiling of the Portrait of David B. Nash, MD, MBA

About the Excellence in Healthcare Podcast

The Excellence in Healthcare Podcast features conversations with healthcare leaders, innovators, and industry experts who are helping organizations improve leadership, strategy execution, operational performance, and healthcare outcomes. Hosted by Jarvis T. Gray, each episode explores practical ideas, proven frameworks, and real-world lessons that help healthcare organizations achieve sustainable excellence.

Call to Action

If you are committed to driving transformation in your organization and want to stay ahead of the trends shaping the future of healthcare, make sure you follow the Excellence in Healthcare Podcast for more expert conversations. Share this episode with your leadership team, colleagues, and network on LinkedIn and beyond. Connect with Dr. David Nash and host Jarvis T. Gray for ongoing insights—and visit Healthcare Excellence Advisors to access resources that can accelerate your journey toward healthcare excellence.

Listen, engage, and lead your organization to new levels of performance and impact.

How does your healthcare organization measure up in leadership, strategy, operations, and more? 

Take the Healthcare Excellence Scorecard™ to benchmark your strengths and discover opportunities for growth: 

• Take the Healthcare Excellence Scorecard

Transcript

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1:01

Hey, healthcare leaders. Welcome back to another exciting episode of the Excellence in Healthcare Podcast. And today, I'm here with a very special guest. We've taken a little bit of time to make this happen, but Dr. David Nash, I am so honored to have you on the show today. How are you doing? I'm doing great, Jarvis. Thanks again for the invite. Great, great to be together. All right, fantastic. Well, you know, Dr. Nash, we always like to jump into our conversations with leaders With, I'd love if you could just tell us a little bit about yourself and the journey that led you onto your healthcare leadership path. Boy. Okay. Well, first of all, again, thanks for the invite. I know you have a dedicated fan base out there, so great to be together. So look, I just retired 5 weeks ago. Holy mackerel. After 35 and a half years on the full-time faculty at Jefferson in Philadelphia. So for our listeners and viewers whose geography is a little bit challenged. So first of all, Philadelphia, right? Birthplace of our great country, home of the first medical school, first hospital in America. And Jefferson, when I got there in 1990, Jarvis, was a pretty parochial place, one hospital. 3 colleges, about 1,200 students. When I left on June 30th, we were a monster. 33 hospitals, 10 colleges, 9,000 students, 65,000 employees, and roughly a $16 billion enterprise. So I had a ringside seat at all of this, and so my career was Largely spent there 5 years at Penn and then getting recruited to come to Jefferson. So I started at Jefferson Medical College, which is one of the largest private medical schools in America. And I got recruited, uh, way back in 1990 because I was the only doctor on the faculty practice plan who had an MBA. Can you imagine that today? So the dean at that time, who's still alive at 95, God bless him, Dr. Joseph Gonella, needed some young guy who was ready to talk about the Clinton healthcare plan. So now I'm really dating myself, but that was the hook to get me out of Penn where I was an assistant professor of medicine and I had just finished the Wharton program. I was in this special national thing, the Robert Wood Johnson Clinical Scholars Program. Anyway, Dr. Gonnell thought it'd be important to have a young guy, a physician who could prepare the faculty for what we perceived at that point would be some pretty dramatic changes in healthcare. And I ended up over time just basically having 3 jobs. In 35 years, all at the same place. So I got recruited to build from scratch this Office of Health Policy. Nobody really knew what that meant, including me. There was no such thing. Uh, there was no resources, but basically my job for the first 13 years or so was to be an internal change agent and educate. What I mean by that is, you know, most medical schools were not in the business of talking about health policy or preparing for practice guidelines or a reduction in professional autonomy or improving quality and safety. This was all foreign language in 1990 for sure, because it wasn't until 1999, right, when Uncle Sam and the National Academy of Medicine published To Err Is Human. And 2 years later, crossing the quality chasm. So we didn't even have a vocabulary for any of this stuff. So my job was to jabber, influence, instigate, cause trouble, twist arms. You get the idea. So I did that for 13 years, and then we had a very progressive dean, Tom Nasca, who went on to become the president of the ACGME in Chicago. World-famous educator. And Tom saw the light and said, well, all this work's important. Why don't we create a department in Jefferson Medical College devoted to this stuff? So, you know, in the culture of academic medicine, if you don't have a department, you ain't got nothing. So I became the inaugural department chair of a Department of Health Policy Inside Jefferson. Now, you know, to some listeners, this might— doesn't sound like a lot, but trust me, this was a cultural paradigm shift. So I was about tenure at that same time doing research on quality and safety, writing a bunch of books. So basically you needed the coin of the realm, Jarvis, to have influence, right? If you weren't a scholar, no one was going to listen to you in medical school. So I had to have the same evidentiary basis as like the chief of medicine, the chief of surgery, and so on. So I did that for like 5 more years as the med school department chair. And then we got a new university president and I'll spare you the details, but Dr. Robert Barchi decided the university needs some more colleges. We started out with 3. And the board of trustees said, ah, well, we need at least a school of pharmacy and we gotta do something in public health, whatever that might be. Aha. So it was a strategic plan. I and another physician were chairing one of the subcommittees, and the long and the short of it is the board and the university president were innovative in 2008. It's a long time ago. And they said, okay, you know, this Department of Health Policy, we're gonna abolish it, take it out of the medical school, replant it, give it degree-granting authority. And you, Nash, are gonna be the founding dean. We're not sure what we're gonna call it. And so basically by 2009, we had agreed on calling it the first College of Population Health in America. And then something really big happened, of course, and all listeners know this, in March of 2010, which was, of course, the passage of Obamacare. Whatever your politics, I don't care. What was important is it put the term population health accountability on the front page of every newspaper in America. So we were off to the races. So basically 3 jobs. Uh, I was the dean for 11 years. That's one year longer than Peter Drucker recommends, as you know your leadership literature. And in that 11th year, I said, you know, I'm not having as much fun doing this as I used to. Maybe we'll talk about the reasons. So I stepped down from the deanship, rejoined the faculty. I was on an endowed chair doing my own research. This is pre-COVID. COVID hits, and this is June of 2019. By March of 2020, less than a year later, the country is locked down. Huge challenge. And something unbelievable happened to me. Um, the world, not an exaggeration, decided that all that population health stuff this Nash guy was talking about is like pretty damn important. So Jarvis, the floodgates opened and All kinds of companies and organizations. I became an internal Jefferson consultant working, raising money. All that money went to the university. So my final 5 or 6 years on campus was mostly outward focused. And then I retired 5 weeks ago and I'm operating now under my own LLC license. So basically I'm running a boutique healthcare leadership, strategic planning, and business development company after all this history at Jefferson. So it's a long-winded answer, I know, but that's a long time, 35 years, and a lot happened. But that's the summary. Well, no. Well, and I'll share just maybe my timeline on what you just shared there, Dr. Nash. So for me, I finished with my bachelor's in industrial engineering in 1999. I came into healthcare officially in 2007, working at Duke University Health System, but 100% of the work that I've done has always been around strategy, data and analytics, and process improvement work. So, I just wanted to kind of tip that in. So— Absolutely. Now, as we talk, you know, that stream, and I guess just the history that you've experienced through your, you know, robust career, I just, you know, now, just give you some context. It'd be like, all right, Jarvis, do you remember this? Um, well, uh, you, you came at the perfect time, right? You know, and we already talked about Tuareg's human. I mean, there's a great story associated with that. Why don't we start there? Because that's kind of consistent with your history too. So, you know, folks don't remember. Why would they? It's a long time ago. But it was the very first time that Newspapers across the country were saying, hey, hey, time out. Being a patient might be dangerous. And what we did in our training, you know, I got out of medical school 45 years ago. It's a whole different world, right? There was none of this vocabulary of patient-centeredness, process improvement, lean. High reliability. None of this vocabulary existed. And as a result, medical error was, uh, in 1999, the 3rd or 4th leading cause of death in America. And To Err Is Human, from then called the Institute of Medicine, was a watershed event. So I did an AP Wire interview. I wonder if our listeners even know what that is. So. In the old days, newspapers all collaborated and, uh, Associated Press shared material. Anyway, uh, in September of 1999, when the report came out, I did several of these wire interviews. And within days, in over 150 papers was my interview. And I foolishly said, because I was pretty brash in 1999, I said, it is true that we kill thousands of people every day. Uh, well, that didn't go over too well, uh, with the university president. I got called on the carpet, literally. And, uh, you know, I said, well, maybe it was an inopportune selection of words, but, you know, you and I know that that's the truth. And let's just say it was a career-defining moment, Jarvis. I thought, uh-oh, here comes the hatchet. But to their credit, they said, you know, tone it down, but keep going and you're doing a good job. So basically that was really important to me. And that is a key event. In 2001, just 2 years later, Crossing the Quality Chasm tried to answer the questions, you know, how do— what are we doing? How do we improve? And you and I know that if you lined up all the criteria from the book Crossing the Quality Chasm what we're doing today, we're making modest progress. Modest. And the good news is on the educational front, we've got textbooks now. I edited the American Journal of Medical Quality for 25 years. I mean, we have the scholarship pretty well established. Lean, high reliability, process improvement, crew resource management. I mean, we've done a good job. Now, you know what knowledge is. It's the doing. Right. The know-do barrier, which you're very familiar with given your training. So crossing the know-do barrier is something that we still need to be working on. Uh, but as I said selfishly, you know, I had a ringside seat in all of this and participated in it as appropriate, got into the ring. Got beat up pretty good and came back out of the ring. What most people don't realize, because I'm sitting down now, you know, when I got to Jefferson Jarvis, I was 6 feet, 2 and a half inches tall. You know, now I'm like 5'5. So attempting to change the status quo, we know from Machiavelli 5 centuries ago, it's pretty dangerous. And I just played a small role in that. But look, You know, when you tell experts that they could do a better job, you're making them vulnerable. And a vulnerable expert is like a cornered rat. You know, they're angry, they're hungry, they're going to lash out. And I saw that up close and personal for a long time, telling experts they could do a better job. They're going to attack the data, they're going to attack the system, and Eventually they're going to attack the messenger. So you have to learn to kind of overcome those barriers. But those 2 books, 9 years into my work at Jefferson, were formative. Uh, I think today we could spend 5 hours on how are we doing on the implementation, but to get back to your great question, that was my journey, uh, up until, you know, 5 weeks ago. All right. Well, and something else I'd love to get you to speak on. So just really quick. So both of those readings, when I came into healthcare, Those were required readings for my department specifically because that's all we did was performance improvement for the health system. So I just wanna highlight that for any of our listeners right now. If you have not read those documents, that is a must-read. As we sit here in 2026, the opportunity is still there. So it's still so very relevant. Um, I'm gonna interrupt you. Just let's also remember. I mean, how great. Required reading for you. Never was it required reading in any one of the now 150 allopathic medical schools in America. I'm not aware of a single one, including Jefferson. Right. Right. Very interesting. Fair enough. So let's just put that out there. Sure. Mandatory reading in your field, because in those days we thought, well, there's a quality problem. The quality guys and gals are going to solve it. So. We're good. Right. That's it. Right. But no, now I feel like it's required reading for all of our listeners. So outstanding. Let's put it there. You've already moved the needle here, Jarvis. That's great. There you go. But Dr. Nash, I would like to spotlight, and I'm kind of bouncing around, you know, I gave you some guiding questions, but I'd like to spotlight specifically, you popped up on my personal radar during the pandemic when I think I did come across some stuff on YouTube and some of your knowledge and thought leadership around the COVID pandemic. I'd love to ask just any of the experiences that really helped to continue to shape your leadership and your research, but take us maybe from the pandemic to current date. Like, what were— what was the moment? What was the learnings or the takeaways or the expressions of that time for you? Well, thank you for that. You know, who wants to talk about COVID You know, not me, but I get it. And certainly with, uh, uh, Dr. Fauci back in the news, this is still, the nation is still struggling with the issues. So we'll put politics aside. I'll give you my experience. So Jarvis, like everybody else in March of 2020, I came home sitting in this second bedroom in our home, which was my sort of immediate office. I thought, what are we going to do now? On a personal note, uh, my wife's a doctor also with 3 children. One of our 3 children is a hospitalist. She was on the front lines. Uh, her hospital at that moment was ill-prepared. She wore a trash bag over her white coat. She threw her then fiancé out of the house and sent him packing back to his parents until things calmed down. I mean, and there are stories like this across the nation, of course. So a couple of reflections for me. I had never heard of the term social distancing. Now I'm the dean, had just been the dean of a college of population health. And I'm like, what is all this? This can't be happening. And I'll remind our listeners, the Cambridge Group in the UK predicted globally At 25 million deaths, right? So I was, wow, what are we going to do? This is unbelievable. And I can't say that I had any super great insights, but here's what happened. Part 1, we already talked about. Folks were writing to me from all over, hey, you know, post-COVID, what is care going to look like? And are we going to learn from these issues? That was a big part of what was happening. And then a real breakthrough for me was Charles Wohlforth, my co-author of our book that we wrote during COVID a science writer who lives in Princeton. I'm in Philadelphia. We were pals before the pandemic. He reached out and said, we need to write a book right now. And the last thing I wanted to do, Jarvis, was write another book. But I had time and we certainly had a compelling platform. And what Charles said was, look, we need to create the historical record right now. Wow, was he smart. And he said, we would be a great team. Uh, you'll get all your, you'll, you'll gather all the research data. You, you'll organize everything, get a med student to help you. And then I, Charles, I'm gonna record a Zoom conversation every other week, and then I'll create prose and I'm gonna channel what you tell me. And I thought, how can he really do that? And that's exactly what happened. And so over almost 18 months, every other week for 90 minutes, uh, we organized it. And here was the thesis very quickly. You know, we didn't just wanna write a book, here's COVID. Here was our thesis. We, the title of the book is How COVID Crashed the System. And we were NTSB federal investigators, the guys with the black baseball hats crawling over the crash site looking for the black box. But we all knew what was in the black box. And here's the, you know, the jiu-jitsu of the story, right? Because we know what's in that damn black box. Structural racism, underfunding of the public health infrastructure, terrible incentives in private practice fee-for-care medicine, or poverty, lack of access. I mean, you name it, it's in that black box. So what COVID did is it shined giant bright lights on stuff that guys like you and me, knew was there, but now it was front page news and it helped explain why America had over a million deaths, now 1.5 million generally attributed to COVID, why COVID was the leading cause of death for 4 years in America. So nobody wants to talk about it, but my catharsis and my therapy was writing the book with Charles. And it had, it's in 2 parts. Part one is a Kind of a downer, you know, how'd we get here? Here's all the issues, some of which I just illustrated. And part 2 is much more uplifting. What are we going to do about it? Let me give you some concrete examples, right? Our listeners, you know, again, it's hard to even conjure all the fear that we had. At least I did. I'm sure some of our listeners did too. So every hospital in America had an incident command center. Remember those? I wasn't in ours, but I studied this nationally in our research for the book. And the typical incident command center was a place— now we're going to use our language, you and me, Jarvis— was a place for daily self-evaluation, measurement, and closure of the feedback loop clinically. Because doctors, nurses were gathered around a table in every single place. And they said, hey, what are you doing? What'd I do? What are they doing at Northwell? What are they doing at Mount Sinai? What are they doing at UCSF? Let's find out. Should we give steroids? Should they be prone? Should— you get the idea. So every day we were practicing the tenets of improving the quality and safety of care. Now, it's true we took our eye off the ball on all those measures. Buddy, Clabsy, all of that was at the wayside because people were dying in the street. So that incident command culture gave us a unique opportunity to self-reflect, measure, and close the feedback loop. So part of what we talk about in the book is, could we try to continue aspects of that culture? Turns out to be too high a goal. By 2024,'25, certainly we realized all the CMS quality measures were a disaster and we had to get back to what Uncle Sam wanted. And so we sort of, I'm not sure we missed the opportunity, but it fell by the wayside because the cultural imperative to do it no longer exists. I mean, on the one hand, great. You know, vaccines, social distancing, it all actually worked. On the other hand, we had a great opportunity, but we had to get back to sort of what was considered to be the core issue. So, but out of that time period, Charles and I were able to write this book. It came out in September of '22. So it's hard to believe the book's going to be 4 years old, but here's the punchline. The second half of the book, recommendations for the future. It's as timely as though it came out today. Kicking in now. I mean, unbelievable. And, you know, we could go through the issues, realigning economic incentives, still critically important, coming up with better measures, putting the patient at the center. So patient-related outcomes. Totally amazing. Again, what the book did for me was a couple of things. One, as I already alluded to, it was sort of a cathartic opportunity. I was really nervous about our daughter, about our city, about our hospital. Jefferson had the highest number of COVID cases of any place in Philadelphia. And that's saying a lot, Jarvis, because we got 5 med schools. So that was pretty scary. Um, it gave me an opportunity to really sit back and study, and then I had a formative experience, the Philadelphia Convention Center Bureau. So we have the second largest number of scientific conventions of any city in America. So Boston, then Philly. than in California. And the convention bureau was basically shut down by COVID. They had never had a physician spokesperson, and they needed somebody who was a good communicator to explain to the thousands of people out of work— hotel workers, food workers, transportation people, These are people who, you know, was incredible when we would say, well, isolated home. Oh, really? Well, I'm in a multi-generational house. You know, stay home from work. Oh, really? Well, I have no money to pay for food. And I'm an essential worker because I'm driving the bus that's taking the hospital workers to work. You get the idea. So I had an amazing opportunity to communicate both internally to the folks at the ecosystem running the convention center and much more challenging to the outside world. And no one had ever done this before. There was no precedent. So that was an incredible 3-year experience, just trying to distill all the science and the non-science that was flying around, give good advice. When could we reopen? What would testing look like? So that was a tremendous experience for me as well. And we put a lot of that kind of learning in, if you would, into the book. But the book is still enduring because as I said, sure, part 1, you know, all the details about COVID may be not as relevant day to day today, but where we're going and what we need to do, still sadly very relevant. Right. Well, and again, thank you for sharing that, you know, experience. Um, thank you for the leadership during that experience. And, you know, one of the interesting things that you just shared that I picked up on is, you know, the thing that helped you kind of get through that was the book writing process. So I'll share with you, Dr. Nash, um, you know, right now we're in the era of healthcare transformation. Indeed. In so many areas. I'm actually working on my second book now, which I'm titling Mastering Healthcare Transformation because— Outstanding. Yeah, I'm a huge advocate that it's not the money that's gonna transform the system, but there's a lot of other things that need to take place. But that's been my experience. So, I just kind of feel like I'm taking my version of what you just shared to kind of help leaders get through this era and hopefully come out better on the back end. So, I do wanna encourage— Outstanding. Well, I hope it's therapeutic for you as well. It actually has been. The way that I'm writing this compared to my first book, I'm having fun with it, but I think it's going to be very powerful when it's done. We're about 6 chapters in right now. That's great. I feel your pain. Yes, I do. But now let me take you down to one of my first pillars. So, Dr. Nash, I share with you I work kind of in 3 very specific pillars when I think of healthcare excellence is leadership, strategy, and operational. And I, I love to talk leadership first. And so, my first question I'd love to throw at you is, what leadership practices have you used just throughout your amazing career that have helped you to build high-performing teams? Wow. Well, I guess first is I am a student of leadership literature. Nice. Uh, I found, uh, going to business school. So just to review, so I did college, medical school, internal medicine residency. The day residency ended on a Friday in June in 1984, and the following Monday I was in class at the Wharton Business School during the summer session. So, uh, and I got a full academic ride to Wharton. Of course, I was a Robert Wood Johnson clinical scholar. And Wharton was, uh, life-changing because I finally got the vocabulary to help explain what I had just seen. Let me give you an example. So as an internal medicine intern and resident in a lock 'em sock 'em busy urban hospital, the Graduate Hospital at the University of Pennsylvania at the time. We were seeing all the terrible side effects of poverty and racism and gun violence and admitting people and we discharging them and they would be right back 2 days, 3 days later, right? There's no food at home. There's violence. doctors can't afford the meds. I mean, and I, there was no vocabulary for any of this. And it was at the height of the AIDS epidemic in Philadelphia. So we were running scared from that. Anyway, Wharton gave me the vocabulary and I had, I don't want to call it an epiphany, but it pretty much was. It gave me a construct, a model, a paradigm to help better understand what I had just spent 3 years of sleepless nights doing. By the way, Jarvis, just on the personal front, my wife and I were already married. We were interns and residents together in the same place. That's another conversation for another time. But that training, and then juxtapose that, you know, 2 days when it's all over, I'm back in business school and it was mind-blowing. And I thought, okay, great. Now I had the vocabulary to help me understand what I had just been through. And I got exposed as a result of being at Wharton to famous people, many of whom are still not around. Sam Morton, Bill Kissick, Sandy Schwartz, John Eisenberg, who were leaders in the beginning of the transformation. So my leadership learning started from reading and being in the classroom. And I thought, I gotta be able to put these tools to work. And I practiced what I learned as best as I could through the 3 jobs. So by the time I was a med school department chair, I had my own, you know, leadership tools and style pretty well established. So the components for me Some of them anyway, were try to be a great listener, try to keep the message on track, and people are only going to follow you if you have enthusiasm for the vision and you are open and most important, you're vulnerable. So those were the things I tried to do. Was I successful? You know, mostly. Uh, I had my moments. I think where I missed, based on what I read, was, uh, I didn't fire people fast enough. And that's a classic leadership failure. Uh, I tried to patch over things that probably were not fixable. I probably trusted a little bit too much, and I probably was a little bit too much outside focused. Uh, so those were my shortcomings. But the central tenets that I tried to follow were right there, mostly Drucker and others who I read a lot about. And the vision, I certainly had the vision. We were in the business to train leaders for the future. That sounds great. It worked for me. It's a very complicated thing inside academic medicine. Everybody there is a leader. At least they believe that they are. Uh, and, and it wasn't until decades later that I learned of Simone's maxims and, you know, you realize, how do people get promoted in that specific culture? Well, they're great researchers, so they must be a great leader. Not true. Uh, and then I attacked very vigorously one of the most tightly held shibboleths in academic medicine, which is what we called at the time the triple threat. Maybe you've heard this so far, listeners. So in the late 1990s, early 2000s, the triple threat was still extant, which was a doctor, mostly a guy,

who did all 3 things fantastically well: 35:13

patient care, research, and teaching. And Jarvis There's no such thing as the triple threat. Well, there might be one or two, but to promulgate that as the leadership model. Yeah. Failure, failure, failure. So going upstream against this was not easy. So tackling the triple threat, that was a problem. Uh, and then, you know, building a big enough tent so that nurses and pharmacists Could legitimately be at the leadership table. We tried hard to do that. A lot of barriers to getting that done. And when you boil it all away, here's the secret. Why is leadership so hard in our world? Well, clinical training, traditional clinical training on the medical side. So Medical school training creates a block to understanding, adopting, and internalizing the tenets of quality. There's no question about this. And I've written extensively and spoken about this all over the country and the world. Here's why. If you believe the way we're trained, see one, do one, teach one, that's part of it. But much more fundamental is if you are taught that the solar system rotates about you and you are the sole critical link and you are the sole critical, best-informed decision maker, and we teach you this in the guild model of training down, you know, in a super hierarchical expert-driven culture, and then you become an attending. And you have to be on an interprofessional team. Well, you know, folks, I don't have to spell it out. So the leadership challenge, when you boil it all away, that I faced with mostly clinicians is the fact that clinical training created barriers to their ability to embrace the team-based model. And we also assume that all doctors, and again, I'm focused on doctors here. There's plenty of blame to go around, but if you made it through all this, you were assumed to be a great teacher, a great researcher, a role model, and a great clinician. And having that overhang and the prejudice that that created, that you The triple threat. Well, terrible thing. That's one. The autonomy model, that's 2. And let's get into COVID on this one more jar. It's very controversial, but we'll do it. I didn't think this up. It's out there in the literature. So let's go back to 2020, 2021, and we're banging pots, right? And we're Hanging out at apartment buildings in Italy, in Philly, California, and we're celebrating caregivers. And every hospital I've ever been to said, heroes work here. Well, 2 years later, Jefferson interns and residents could not get on the subway with their scrubs because they were going to be assaulted. Why is that? Well, pretty clear. People turn on heroes. Part one. Part two, labeling it as heroism totally demonstrated the lack of understanding that it was systems that were caring for people. Let's go back to incident command culture, right? Sure, there was heroic behavior. I get it. I'm not disparaging. I'm just pointing out as a scholarship observer of what happened and to explain explain why people turned on Fauci, on doctors, on the system. It's complicated, but a lot of it has to do with we held them up as heroes. And then when people got tired of wearing the damn masks, then they became targets. So instead of heroism, we should have been talking about humanism. Easy to say in 2026. I get it. But that's a big part of what we wrote about in the book, and it contributed to the challenge. So let's summarize, you know, here, here's the punchline for me. And again, you know, I've been talking about this for a long time. Clinical training is the culprit. That's the answer. Yeah. And it, it hasn't changed all that much since Esther and I trained 45 years ago and our daughter trained, you know, 20 years ago. And I see it now. The good news now is, and what kept me going at Jefferson when caught, was medical students, law students, nursing students coming to me on their own volition saying, hey, I find this stuff very interesting. And now there's a career trajectory for these young people. That is super satisfying for me. That did not exist one generation ago. So when young people come and say, hey, I'm interested. I want to be the chief quality officer. Holy mackerel. Well, that role did not exist, right? So, you know, that's awesome. And what's also awesome for me in retrospect is to go to a place like Jefferson. Well, guess what? We have 2 endowed chair Leaders in the quality arena in our enterprise, 2 endowed chair professors of quality. Well, for an old guy like me, this is awesome. You know, so Trish Henwood, Oren Gutmann, I mean, these guys and gals are amazing. And there's lots of them all over the country now. And Jarvis, there's 17 master's degrees in quality and safety in America. We were number one, right? There's 8 of them overseas. I mean, this is amazing. So, um, none of this existed when we opened the doors to our school in September of 2009. Wow. You know, 17, 18 years ago. So it's, it's incredible. So we've made progress on the educational front, but back to where we were, the knowledge, we're seeing Versus the doing, hmm, we still have a lot of work to do, which is great for guys like you and me. Yeah. It keeps us busy if nothing else. Indeed. Indeed. Which is why I still have some gas left in the tank. Exactly. Well, and I, I'm familiar with Jefferson's, uh, Master's in Quality program. Um, I have a couple of colleagues that are instructors with the program and I've heard nothing but amazing things, but— Yes. Well, let's get Let's give a shout out to Dean Billy Oglesby and Professor Dr. Mary Cooper and all the leaders. I mean, these folks are still at it and it is pretty incredible. It's very gratifying when I'm out and about still. Last week I had the privilege of giving an endowed lecture at Geisinger Medical Center in Danville, of course, world famous place. And in the audience are 2 docs, probably 15 years younger than me, both of whom had been in my American Association of Physician Leadership classes. And Jarvis, just one moment. So guys, my heroes, right? Don Berwick, Brent James, Atul Gawande, the giants who helped create this field. But I own the record of the largest number of physicians having been taught quality face-to-face is yours truly through the AAPL from 1991 to 2023. Well, that's, that's my, I still got that, right? So that's pretty cool. That's awesome. So wherever I go, guys and gals of a certain age, they've had the quality course. Not true anymore, but it was from that time period. So 30 years of being out in the front. Teaching this stuff, what an amazing experience, right? Because I got my energy from these folks and I learned a ton from what was going on across the country. And then I could pressure test the pedagogic tools a couple of times a year all around the country. I learned a lot and it helped me to focus on coming back to where we were 10 minutes ago, clinical training. That's the, uh, that's the crucible. And that's what is also how awesome in America and creates these intellectual barriers. Well, some, some great takeaways, Dr. Nash, on everything you shared there. I'm over here taking notes. So just, so, you know, I, I, I brag on this podcast that I get to be the first to learn from you, but eventually I'll let others in the audience learn too. But— Well, you're a, you're a good guy. Yes, you are. No, but, um, but so be a student of leadership is a takeaway that I heard. Um, having proximity to the thought leaders and the mentors that are pushing the industry, we have to put it into practice. So learning is not good enough. We have to do. Having a vision is key. Um, you've mentioned this. I don't know. I'm curious to maybe ask Dr. Nash if this was intentional on your side, but it sounds like being a disruptor is a part of your style. Now, is that intentional or are you just, you know, you just kind of found the opportunities and say, you know what, triple threat? Nah, not really. But yes. But I heard disruption in there as well as building a big tent for others. So. Yeah. Well, thank you. You know, I don't look like a radical, but I was, I was an internal, an internal disruptor. That was part of my toolkit, right? And the only way I could be a bona fide disruptor was to have all of the currency of the realm in a culture that celebrated that currency. Meaning, you know, I wrote and edited 25 books, had 200 publications, given 10 commencement addresses, 15 endowed Lectures. I've been in 10 countries. Well, that gave me, in our crazy world, the moral authority to talk about what we're talking about today. You could only be a disruptor if you were in the club. I was clearly a member of the club. Yeah, on the edges, but you could only be inside the tent. As one of my favorite presidents, LBJ, always said, Jarvis, much better to be inside the tent Pissing out than outside the tent pissing in. I was inside the tent pissing out always. Um, let me move you into strategy really quickly. Strategy. Yeah. Wow. And would love to. Yeah. So any insights around just processes or strategies that you've used to help leaders align around their top strategic priorities? Yeah. You know, um, strategy is great till you, you know, till you get punched in the mouth of But I, what I mean by that is great to have a plan. I think a couple of observations in our industry, people who are talking about a 5-year time horizon, unrealistic. You know, listen, I think we're much better off talking about where do you want to be in a year? That's what I've always said to people. I couldn't think further than that. Too complicated, too many unknowns. You had your Known knowns, you know, and your unknowns. You know, Don Rumsfeld, say what you will, but he was pretty smart about stuff like that. And I, we always had an annual strategy session at least once a year. I would bring in outsiders to help us facilitate people who are really experts in the tools necessary to create a strategic plan. The university always asks for an annual report. That's different from strategy. So I guess summary, I relied on a lot of outside help to give me the bandwidth to really focus on what we're trying to do and then manage the process. Talked to a ton of people. I tried to read as much as I could, you know, in the day-to-day. I was a very, the term is a very Catholic reader, very varied outside my field. I was influenced by Malcolm Gladwell also. I would put him up there as, because especially, especially The Tipping Point in there, and this book is now, you know, 15 years old at least. In The Tipping Point, I had 2 takeaways early on. One was I was a Malcolm Gladwell connector, specifically where he says working inside and outside of your sphere of influence. So I nurtured relationships in the private sector, pharmaceutical companies, biotech. We raised money for the college from places that most universities didn't even have relationships with. And that was because of nurturing these non-traditional relationships. And that was based in part on my reading of the leadership and management literature. So I guess I sought a lot of help. I read as much as I could. I tried to distill it and then it was not easy, but I always said, okay, what did I forget? What did we leave out? You better be prepared. And let's circle back, Jarvis, to your question. You know, um, by year 10 and 11 of my deanship, I, I wasn't as good anymore, uh, at asking those difficult self-reflective questions. And it's, you know, understandable, I think, up to a point, which is why the leadership literature was all about a decade and then get out of there. And I always sort of, you know, knew about that, but didn't pay much attention to it until I was in it myself. And, you know, it's hard work and I didn't expect people to follow me just because I said so. I had to create the compelling, burning platform to do so. I think we had that with the college, especially in the beginning. People felt that they were doing something cool and they were part of something unique that was mostly above me at Jefferson. We got to thank the innovative board, the presidents, the leaders who said, yeah, we're going to do this. Would I have liked more support, more money? Sure. But they paved the way and put me in the position to be able to, you know, succeed or fail with the team. Not everybody wanted to be on the team, you know, in retrospect, I get it. Not everybody goes to work saying, hey, I love to innovate. I get it. You know, and it is a time-limited activity because leaders, you need leadership support above you to implement a change. And this is true in world politics and it's true in any, you know, complex organization. What I've learned since in the last few months and through my retirement, you know, if you want an organization to love you, you're in a jam. So 2 reflections on that. By the late'25, '26, and I'm, you know, still on campus here and there doing my thing. I had the realization that none of the current senior-most leaders of our very complex organization had any idea who I was. And that took some getting used to, speaking very personally now. Like, you know, I did a lot for this place. You don't know who I am? How'd that happen? So, you know, that was one. thing you had to get your grip on. But if you want an organization to love you, you know, get a dog. The dog will love you no matter what. Organizations are not a living, breathing thing. Cultures change, times change, generations are different. At the end of my tenure, faculty wanted to have a vote on every principal change and every issue as though it were a democracy. And, you know, you can't run a school as a democracy. So that was a challenge for me. And I get it, you know, young people, millennial generation. I have 3 grown successful children in their late 30s. They come from a different world than I came from. The authority gradient, respect for decision-making, it's a totally different environment. I'm not labeling it good or bad, but from a leadership perspective, very challenging. And I would say, you know, we're not having a vote on this. I value what you're going to say and I'm listening carefully, but I've got to go across the street and tell the university president what the hell we're do with you. You want to do that? Then we'll have a vote. And that did not go over well. So I knew it was time to step down. That was part of it. Yeah. But, you know, look, it's not easy. I'm, I'm not making light of it. Certainly not. Uh, deciding to step down in our culture, academic medicine, the surrendering power is not a typical behavior. Uh, and I'll spare our listeners the details, but I'll just summarize. The provost at the time said, you, you can't be telling it, number one. And the second comment was, what did I ever do to you? So I'll let our listeners just sort of ponder that. Right. But I mean, that says, that says volumes about leadership. Yeah. Well, and I was gonna say that reflection to even make that decision or to know That your time is up. Yes. Um, that's powerful by itself. You bet. From a strategy point of view, I mean, highlighting, you know, the need to bring in outsiders to allow you and your teams to kind of focus on the, the priorities versus trying to do it all. I think that is worth noting. Um, Dr. Nash, in the work that I do when I facilitate workshops for clients, so I run on what I call the 24/12 plan. Which is essentially, you know, what's the wishlist 24 months from now? What do we wish? And then to your point, we focus on the next 12 months because— Well, I didn't know, I didn't know about 24/12, but I certainly would embrace that. Yeah. Yeah. That, that's, that's the mindset we facilitate with, you know, with, uh, my company and my clients. But I just, again, wanted to, to highlight those. And, uh, if it's okay, let me do a time check. Are you okay? Can I, can I get 2 or 3 more questions in for you? Do you have— Uh, I think we got time for maybe one more. Yes. One more? Yes, sir. All right. I will make this the best of all. Dr. Nash, all right, let me go with this one. I'm picking between 2. And first, again, I do want to thank you for your time and just these amazing reflections. Let me ask, what trends do you personally think will just have the greatest impact on healthcare over the next maybe 3 to 5 years? What's coming? And what's your crystal ball predictions? So it won't be a surprise to our audience, but I'm tracking as much as I can about the influence of AI in medicine. Over here, certainly just very quickly, we have open evidence and up-to-date, all AI infused. That's amazing. So I see the confluence of a couple of streams. One is agentic AI, which is super powerful, and I'm trying to keep up with anybody who's half my age there. The other is the improvements in the electronic medical record, and then the clinical decision support tools that are blasting off using the AI infrastructure. So that's got to be the greatest influence. Bob Wachter is probably our most eloquent spokesperson in this field. He's a good pal of mine. He was my medical students once upon a time when I was an intern. And I mean, so I follow his work very closely. I think he's the best guy to explain this, but that is the most important trend we're facing. And then the second is sadly the lack of trust in science and what doctors do. And we've lost the public's trust. So AI, lack of trust, it could be combustible. And I'm paying close attention to both of these issues. Perfect. Any takeaways, anything that our listeners should be planning on as they think about the impact of AI themselves? Yes. Well, you know, make friends with people who are way younger than you and keep up with the Claude code and all the rest. I'm trying my best. It's not easy, uh, but learn these skills. And even if you don't practice it, learn about it and have pals who are doing it, because that's where the world is going. Fantastic. Well, Dr. Nash, before we wrap up, I always kind of like to ask just this final thought. If you could complete this sentence for me, healthcare excellence begins when leaders— Ah, that's for me. That's great. When leaders look in the mirror And can self-evaluate and when they're humble and when they're vulnerable. Fantastic. Well, Dr. David Nash, first again, thank you for your time. Thank you for letting me catch you right at the beginning of a new phase of your career path. Yes. Wow. It's David Nash 2.0. Here we go. 2.0. Now, to all of our listeners, thank you so much for your time and plugging in with today's conversation. Until next time, this is