Datica Podcast

February 11, 2020

Consumerism, Patient Experience and Population Health

In this episode of 4x4 Health, we talk with Royal Tuthill, Co-founder and President of Docent Health. Royal’s work at Docent has taken him to the intersection of consumerism, patient experience and population health and the cutting edge of leveraging healthcare technology to enable better customer relationships that achieve great outcomes for patients and providers. He also shares insights from the venture studio at Oxeon Partners where he first conceptualized and then led the development of Docent Health.


Transcript

Dr. Dave Levin: Welcome to 4 x 4 Health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I'm your host, Dr. Dave Levin. Today, I'm talking with Royal Tuthill, co-founder and president of Docent Health. Prior to launching Docent Health, Royal worked extensively in healthcare with a focus on innovative solutions to large problems. For example, at Aetna, he helped build new population health products. At Deloitte he worked with health systems to design and optimize revenue cycle management. He's also worked with not-for-profits in Africa and Southeast Asia to improve access to life saving HIV AIDS treatments. Most recently, Royal was recruited to help stand up the venture studio at Oxyon partner, where he conceptualized and led the development of Docent Health. He currently lives in New York with his wife and four young children. Welcome to 4 x 4 Health Royal.

Royal Tuthill: Dave, thanks for having me. 

Dr. Dave Levin: Let's jump right in here. I'm going to ask you a series of four questions and knowing me some follow ups as well. You have up to about four minutes to answer each one, if you would. So to get us started, tell us about yourself and your organization. 

Royal Tuthill: Great. Well I originally started my career coming out of a degree in biology and always interested in healthcare but wasn't quite sure where I wanted to take it. Started in clinical research. And as you mentioned, moved through a couple of different parts of the healthcare industry initially non-for-profits and did grad school and also realized I was going to have to pay for grad school and went into consulting. And part of that process for me was just really being interested in solving problems and always connected to sort of the higher level of mission of healthcare and improving lives. And spent a lot of time helping health systems to manage revenue cycle, which was a real sort of interesting perspective of the patient journey as they're navigating through health systems and how do we help them get access and how do we help them understand their billing. And ultimately went from there over to a boutique strategy firm that I thought would be a little bit sexier, but it turns out being away from solving the problems and getting your hands dirty, felt like I was handing over recommendations and I wanted to be more accountable for the ideas and the concepts that I was putting forward. So had a chance to come into Aetna at a time where they were standing up a division called healthy gym, it was part of an innovation team that was really focused on how do we solve new problems in healthcare and how do we leverage some of the best things for Aetna and the payer side to support health care delivery systems as they're taking on risk, and really got to sort of bring in design thinking and work with engineers and work with designers and bring new products and new businesses to the market. And it's a really sort of exciting opportunity. Just an amazing access to the healthcare ecosystem through the relationships they had on the recruiting side. And got to talk to a lot of people in the industry and ultimately led to working on a business plan around how do we help health systems to understand who their customers are and engage their customers, and ultimately compete in the market and build really sticky, engaged relationships with people as opposed to just a patient going through an episode of care. And so that's been a really exciting journey for me. We started Docent Health about five years ago and had the opportunity to get that off the ground and sign up our initial partners and bringing in some great investors. And yeah, it's been an exciting journey for the last couple of years as we've done that. 

Dr. Dave Levin: What a great story. And I want to go deeper on what you're up to a Docent, but before we do what is a venture studio? 

Royal Tuthill: Yeah. Great question. There's a lot of different sort of models out there for incubators or venture studios. I think in general venture studios are a little bit different than a traditional VC model where you're just investing in entrepreneurs who have a business plan or maybe an MVP. But you're actually saying, can we bring together some set of assets and capabilities to help support the development of new businesses? And usually that includes some level of funding and then in support of providing, a home, a place to get started access to engineering resources or sales channels, they're getting equity in those companies as they start to scale. Oxyon was a little bit unique in that they started as an executive search firm. And they wanted to find ways that they could start businesses, leveraging the relationships that they had. And so and they could own early equity in those companies and then leverage that and support those new startups to know what are the biggest problems that are emerging today. And then how do we get connected to the right people who are trying to solve those problems in the market. And then ultimately, how do we recruit great teams to scale those teams up. So there's a little bit of a unique model for a venture studio. 

Dr. Dave Levin: That's really interesting. This is what I think my venture colleagues would refer to as smart money, but in some ways smart money on steroids, because you're bringing more than just the investment. You're bringing other expertise on other resources. And I presume from the investor standpoint, you're getting a close up look at these companies and to some degree de-risking your investment. Do I understand that correctly? 

Royal Tuthill: Yeah, I think that's spot on. And we've been hugely fortunate at Docent Health to have a great investor that all bring some strategic value in different ways to the partnership. And so Oxyon partners obviously has a great network that we can leverage to help, get insights in the market to identify people who are working on the solutions that we're building and also recruiting talent, but we've got a Maverick Capitol, NEA and Bessemer partners. And they're all really sort of forward-looking VCs that have brought a tremendous amount of value in different ways as well. So we're always looking for Value add when we're looking at around. 

Dr. Dave Levin: So, you were there at Oxyon, this idea was developed and then Docent Health was formed, is that right?

Royal Tuthill: Yeah. So started as the original business plan and went out and talked to executives around the country around what are some of the biggest problems that they had. And I had a hypothesis that I was kind of working on as we were conducting these interviews and market testing. And it really played out that as we were talking to executives and some of the biggest problems that people were talking about at the time was shift from fee for service to value-based care. There is sort of this cross-chat trend across wave of discussion around what is consumerism and how do we meet consumerism in a fee for service world. But what does consumerism mean when we get more into a value-based care environment as well? And how should that translate? And so there's a really interesting component because as you think about consumerism, it's not just the better digital app. It's about how do you really understand who people are? How do you engage them on their terms? How do you build products and services that are going to keep them engaged and loyal and the services that you're offering? And ultimately an either model what you're trying to do is influence behavior change and a fee for service model, just like any other industry, you're trying to get them to like your products and use them more and recommend them, in a value-based care model it's even more important. Because you ultimately want to get them on the best path to being healthy and keeping your costs down. And so, we spent a lot of time at Docent Health, doing technology and a services perspective, trying to figure out how do we influence behavior change and whether we're supporting clients in fee for service or value-based care, that's sort of the core of consumerism for us. And a key part, and the fun part about sort of thinking about how do we engage people, how do we create relationships? How do we build a sense of trust and influence through the technology and the services we offer? 

Dr. Dave Levin: So it's a kind of a tech enabled service. 

Royal Tuthill: Yeah, exactly. Docent's a tech enabled services company. And we put a lot into the technology to help health systems understand who their customers are, who their patients are as people. But also ultimately, we're very grounded on the belief that healthcare is very human and the opportunities to make meaningful change are really accelerated when you have interpersonal moments. And so we have a services team as well, and some of our partners only licensed our technology, some work with our services and our technology, but in either case, the technology is designed to create to automate and scale and digitize the transactional interactions and leave space for people to connect with people and have meaningful moments that are going to help to build that relationship and help to increase stickiness and trust and loyalty and influence their behavior in positive ways.

Dr. Dave Levin: Can you give us a couple of specific examples of where this has been applied and what kind of results you've seen? 

Royal Tuthill: So a couple of different models. Typically what we'll do is, we'll put the technology platform into place. And then the capabilities on top, which is the services teams and then the digital engagement platform, which is an embedded text messaging. So we don't have an app or a portal. We didn't want to create any other barriers for patients to have to access the Docent program. So we've invested a lot in text messaging and AI driven chat communications that can help scale the interpersonal communications. And then we'll work with our partners to identify strategic populations that are important to them and say, from a customer success perspective, where are the programs that you need to engage. And what does success look like for that population and success for a mother of three on Medicaid in an urban food desert looks very different than what does success look like for a commercially insured working mother who's going through her second IVF treatment in Silicon Valley and for a health system, you've got to be able to manage both of those types of populations. Both those individuals. We'll deploy programs that are designed to be able to have that level of personalization, to get individuals connected to the services that are appropriate for them, really convenient, empathetic, human oriented way. That's going to help to drive better health outcomes and also help to drive engagement and retention of services. And so we've seen some pretty tremendous results. If you just take both of those examples in terms of vulnerable populations, the ability to drive down things like lack of stay and ED readmissions. In the maternity space, we've had extremely high rates of improvement in reducing NICU utilization and increasing or decreasing preterm births, which is a really exciting program that we've been working on with Dignity Health and now Common Spirit. And on some of the other programs, whether it's a primary care engagement, or we just started to do some work in health plans to manage member engagement and member retention or customer engagement within that ambulatory care environment, the same sort of principles and mechanisms applied. And so we've been able to show increased share of wallet capture, increased retention of patients within those services, and then within those networks that they're building. So, yeah, it's the same sort of underlying mechanisms and principles that we deploy, but supporting different programs depending on the strategic priorities of the partners we're working with. 

Dr. Dave Levin: This was a topic where I know enough to be dangerous. So I want to go a little bit deeper. In a former life I was responsible for care management in an integrated health system, and actually was involved in a project where we went quite deep on maternal outcomes and with a specific outcome measure of reducing NICU admissions. The thing that I left that experience with was impressed that, there was a lot of focus on data and it turned out that it actually wasn't that hard to figure out who you need to be concerned about, who the high-risk patients were. The challenges were more, at least at that time in organizing a process to interact with them that was consistent and scalable and affordable. And the other frankly, was finding and connecting to specific patients. It's no surprise that a lot of times this tract with other socioeconomic problems and challenges. So I'm curious, and by the way, you can call BS on me anytime during this podcast. It's a hard and fast rule within 4 x 4 Health. Have you encountered those challenges? Do they still exist or am I out of date and if not, what are some things that you've learned in terms of how to address those issues?

Royal Tuthill: Yeah, well, it sounds like you're plenty more informed than dangerous. But no, I agree. I think that's still true. And I think a lot of the care management programs we look out today, you can do the pop health analytics and you can see who are the patients that are the highest risk and highest cost and develop some programs to engage them. I think there's a couple challenges in that model that we're, that we see as gaps in the market and Docent is starting to address. Which is, you only see what you can see, right? So you only have the data for the patients that you have the data for, but how do you identify the rising risk patients? How do you identify the patients who might have social determinants of health that haven't led to those high cost issues, but you want to start to engage earlier? And so, and then also you bring up just the challenge in creating a longitudinal engagement and trust in, in some of those populations. And there's a lot of factors that go into that. So two things that Docent has been doing, one is deploying our tech enabled services across the whole population. And so typically this is sort of counterintuitive to how we thought about it, because it's always been seen as so expensive to have this services model. We're only going to focus on the highest risk, highest cost. And we've really invested in a technology that enables us to scale across the whole population. And if we scale across the whole population and we can do it cost effectively, we ended up identifying a lot of patients earlier before they have those critical issues. And if you do that, you can offset a lot of the downstream interactions, but you also create other opportunities and other value drivers that you might not have had before, because you've never engaged the sort of 80, 90% of the population that's in that middle bucket. And then the way that we, and then you have to be relevant, you have to be convenient and you have to be relevant to have a longitudinal channel of communication that stays open. And so we've worked at this really hard. It's one of the reasons we don't have an app. And a lot of our communications, 70% or more through texting. Live texting, and then AI automation to handle some of the more transactional things. But it's really convenient. It's in people's pockets today and that's been hugely successful for us. So for the populations that we serve, our engagement rates are about in the high 80's, 88%, 89%, 90% of the population are engaged in our services, which is significantly higher than what you see in a lot of digital programs alone, which maybe 20, 30%. And then the patients who aren't engaged on texting, we're following up with the phone. And the last component saying that engagement that's really important on our services teams that we've discovered is, you need to be able to relate to the patients to start to build trust. And we have a distributed workforce on our Docent team, our navigator team, and we'll often hire from the communities in which we serve. And I know there's a big trend now in sort of community health work or other models. And this has been something that over the last five years has proven really valuable to us. If you're hiring someone who we're screening for the highest standards of EQ and personalization and communication skills and empathy, but we can do it from within the community of patients that we're trying to support. And you can have people that have cultural relevancy, they have language skills that relate to that community. And on the same time zones that they understand the unique geographic dynamics of that market. The ability to connect and relate goes up significantly. And so all of that plays into trust. All of that plays into the ability to stay engaged and influence behavior. And so that's a couple of different ways that we've had success at managing sort of the other part of the population that's kind of been left out in the more traditional care management models.

Dr. Dave Levin: Yeah, this resonates really deeply with me and like you, one of our insights at the time was that we needed people from those communities as our partners and had great success, pairing community lay workers with skilled nurses and others. And as you said, they're there and they know the communities and often they're trusted there. And so if there's a knock on the door, people are more willing to answer the door because they know who's on the other side. It sounds like you've had a similar experience.

Royal Tuthill: Yeah, we have, it's been great to see that level of engagement. All of our teams are virtual, they're remote. So they're engaging primarily over the phone and text, but they'll come into community events and work with the health systems to help promote certain programs. I think another key part of this, and you just touched on a little bit is that layering of the team of that workforce. And so we provide, the outsourced nonclinical care extenders to engage that population, and most of our partners have care teams in place already with RNS. And what we found is a lot of the work that the RNS were doing doesn't necessarily require an RN. So we can take some of that and we can distribute it across a lower cross workforce, but ultimately, we're building a ton of new information about that population, that health systems haven't had before, and whether it's personal preferences or behavioral attributes or social determinants of health, that's all coming into our underlying platform on our CRM layer. And a key thing for us that we've been working really hard on is how do we make sure those insights aren't just siloed within Docent Health and our teams. How do we make sure we sort of democratize that so that downstream teams have more access and not just the nurses that are in that program, but the physicians as well, and so that they can relate with more empathy? And as you sort of democratize that across the health system and other teams, patients really feel like they're known and they're valued, and they're heard as they move through that ecosystem. And that's been one of the biggest challenges that health systems have had, is the experience of navigating through a health system is so fragmented. You feel like you're introducing yourself for the first time, every time you interact with someone. And if you look at best practices from other industries, you build a brand relationship with like a hotel chain. You don't really build a brand relationship with the health system because you don't have a consistent relationship. You have one off interpersonal relationships with maybe a great nurse or a great physician, but we haven't really managed the relationship across all of this staff very well. And so we're doing a lot on the technology side to help use human interactions, capture information, and then bring that back into the core workforce of the health system.

Dr. Dave Levin: Well, hopefully this next question may be a challenge for you because you're doing a lot of important and interesting things, but what's the most important or interesting thing that you're working on right now? 

Royal Tuthill: Yeah, there's a lot going on. We were pretty excited about everything. I think basically what we've talked about is one of the, it's just the biggest thing that we're focusing on. How do we continue to scale this model of human services across a broad population and making sure that we can really scale personalization? So it's one thing to have the human services across the population, but how do we increasingly make sure that when a navigator or the technology is sending a text out to that individual, that those recommendations are personalized. And so we're doing a lot to map out with our health system partner. What are all the services or products that you have available in your ecosystem today? Anything from digital apps to your portal, to your education system, to education classes, to mental health services to services that are in the community like a food bank or and then understanding the attributes that we can tag to the customers. And so, as we engage with those customers and we learn more about them, we can understand what the right services are to get you connected to at the right time. And so we're doing that in a much more granular and granular level, which is really exciting. And then, so the Docents are enabled, or the navigators are enabled with information about who this person is. And our rules engine underneath is surfacing. Okay, here's the best interaction for this individual at this time via this channel. And so that's an ongoing process that, yeah, it's been probably the top priority for us.

Dr. Dave Levin: Well, that's really terrific. I'm sitting here kind of bounce it in my chair almost because, what you described, I think of as kind of a mass customization which has been mastered in some industries, but I think we haven't quite figured this out on healthcare. And the other thing is I personally believe this has potentially huge implications for clinical outcome. On a good day we'll talk about a population and we'll refer to them as diabetics, or if we're really fancy, we'll talk about, you know, type one or type two. And I think what you're describing is something that that's far more granular, that really looks at someone who has diabetes, but is looking at that as a whole person, looking at their behavior, looking at other characteristics that are predictive of what will they respond to, what will be most effective in engaging them and motivating them to change to healthier behaviors. Again, if I'm over the top, call me out on this. And I'm talking about something that's probably more aspirational than what we're doing now, but I see a lot of promise in this approach.

Royal Tuthill: Yeah. I think that's one of the things that we've gotten really excited about as we started the company, we talked about sort of clinical and nonclinical as if there was this stark line in between the two and as we've progressed, I think what we've learned is that there isn't and we have largely nonclinical services teams that are out there, but being able to take in a clinical protocol or a clinical pathway, and then layering on top of that, what are the interactions that we want to have from a relationship perspective, or what's the information or data that we want to capture from a patient that can help inform a variation of that clinical pathway? And so we can really help to enable a much more personalized clinical approach, as well as, what's the right sort of relationship approach as well. So I think we're, yeah, I really think we're just starting to scratch the surface on that. And we've already seen some pretty amazing outcomes results in terms of reductions in length of stay, ED remissions, utilization of the right care sites at the right time. We talked a little bit about preterm deliveries. And I think we'll continue to get more granular in that with the clinical pathways.

Dr. Dave Levin: Yeah. My last thought about this is I think a lot of this is also about putting the caring back into healthcare as well and had a very powerful years ago with one of our high-risk OB patients enrolled in that program. She was coming from a tough socioeconomic background. It was clearly a high-risk pregnancy, and I’ll never forget when we were interviewing her. She said that she didn't care about herself until she realized other people cared about her. And it was the interaction of the care managers and the community lay workers that gave her that message and she responded in kind. And my guess is that you guys have seen similar kinds of things. 

Royal Tuthill: Yeah, it's amazing. The personal side, the best parts of my day are when I have a chance to talk to our navigators and hear some of these personal stories. And maybe some of them are terribly sad, but some of them are the most sort of uplifting moments as well. This is actually a few years ago, we had a patient who was going through a maternity journey and we had a navigator who was supporting her through that. Not high risk, no major concerns, pretty normal first-time mother. And she reached out to Docent and told, and sort of late in the conversation that they were having, that her house had recently had a fire and they'd lost the nursery. And she was really nervous about making sure that the home, she was going through the unit, the nesting process and thinking about what it is going to be to be a first-time parent and all the anxiety that comes with that. And so her and her husband were trying to figure out what do we do. We just lost the nursery. And so that the Docent just, in a very sort of human way, supported her in that conversation. But afterwards thought about what can we do to support that individual and send a ticket into the hospital system that we have to alert the nursing team that when this mother came to deliver ticket popped up, there was a little note about the fact that they'd had a fire and they'd lost their nursery. And the nurses went together. They raided the stock closet and they brought her a basket as she was getting ready to be discharged. And this mother was crying. The father was crying. It was just, and the nurses were crying. It was really magical moment. But it took kind of almost in passing, having that conversation. And you think about that family going home and knowing that that health system like knew who they were and cared about them and in a way that we don't typically, and I think especially for mothers, we've had cases where we're following up with them, well post discharge and making sure that they're acclimating to home life. And, after all that sort of flowers of diet and the balloons have popped and suddenly all the, everyone who dropped off food isn't coming to your door anymore, it's a really hard transition. And following up with the mothers and just starting with that, how are you doing? And it's amazing. I mean, we've had really meaningful moments where, especially as we're sort of evaluating and these sort of screening questions, and it's not an overt screening question, like are you feeling like you have postpartum depression? Just how are you doing? Nobody asks me, they always ask you about the child. And I think that bringing caring back into healthcare is, I mean, some of these stories come out, we have sheets and sheets of them are so moving and it's really what motivates our company. And I think, it is what keeps everybody sort of driven to keep doing what we're doing.

Dr. Dave Levin: Yeah. I think there's something else really, really important buried in that story. And it speaks to the challenge we've got a healthcare right now with caregiver burnout. And we really got to get more focused on creating resiliency on the workforce. And the story you told about the nurses in the hospital and their reaction, I got to believe that they felt really great about what they were doing. It created more meaning in their work and that in turn creates resiliency within that workforce. And I hear this time and time again from my physician colleagues, that that's a piece that's really missing for them. And it's interesting if you look at the statistics about satisfaction, some of the most satisfied providers are in the field of palliative care and hospice, now that might seem contradictory or counterintuitive given what they're dealing with, but what they will tell you is they have the time to spend with patients and really connect. And that's what they went into healthcare for in the first place. So in addition to the sort of obvious financial and clinical outcome benefits of what you're doing, I suspect that it also has benefit in terms of creating a more resilient workforce, greater satisfaction for the folks working in healthcare.

Royal Tuthill: Yeah. I, thank you for bringing that up. I couldn't agree more. It's one of the biggest issues I think in healthcare today for nursing and for physicians, and we're asking them to do more and more, we're asking them to document more and more and more, and now we're also asking them to be more empathetic and to spend more time. They don't have the time. And they do get burnout out. And it's frustrating because I think most people who are drawn to that field, have a sort of a philanthropic and mission driven approach to wanting to support and connect with people. So we've been really working to try to find ways that we can help support that. We have a large partnership with Northwell Health, and their chief experience officer is a really visionary guy. And this was one of his main focuses for helping to sponsor the partnership was how do we ensure that these sort of like golden nuggets, these relationship bits and pieces are then surfaced to teams so they can connect with more empathy and they can connect because they don't have as much time and can we share insights that'll help them sort of jump start a relationship and get connected. And then as they're having conversations, can they capture that and quickly put that into the platform as well through the tools that they're already using that helps to build that support for the next person downstream? Yeah, it is a challenge. And if we can find ways to help makes more space, make more time for those clinicians who are doing amazing work to have more meaningful moments. I think that's a great secondary benefit. We haven't found a way to quantify that on our ROI models yet. So if you have any thoughts on that, I'd be happy to hear it, but it's definitely one of those halo effects that we feel really great about.

Dr. Dave Levin: That's just terrific. If you just joined us, you're listening to 4 x 4 Health, and we're talking with Royal Tuthill, co-founder and president of Docent Health. What's your favorite pet peeve or rant these days?

Royal Tuthill: I think pet peeve, and maybe within the context of what we're talking about in healthcare? Well, two things. I think the first thing would be this, some of the buzz terms that come out and that catch on very quickly. I think the biggest one for me right now is, I’ve already used it. So I think it has a place, but it's like the notion of AI. And especially in the sort of startup community and the investor community, there's so much buzz about AI and what the opportunities are. And I think some people use it in the appropriate way and some people don't, but in general, for us, I think that the pet peeve for me, especially in healthcare, is that AI is going to solve everything. And I'm firmly passionate that I believe AI has the opportunity to help improve and increase that level of personalization but should be used in the way to create space for people to have those meaningful moments and not to displace people. And a lot of times you'll see that the opposite of, we'll just digitize everything, and AI will drive it and we'll push more the opportunity for the patient to take control of this. I don't know that patients want to take control of it. And I don't know that we want to digitize everything. And so how can we use AI and machine learning and other really, really amazing technical capabilities to ensure that empathy still exists in healthcare today.

Dr. Dave Levin: Regular listeners to this podcast have heard this theme before. A number of my guests have advocated for us referring to AI as augmented intelligence, not artificial intelligence. I think there's something to of it. One of the more skeptical guests said, my whole career, the AI has been coming in the next five years. And I agree with a lot of what you're saying. And I think the other theme there is, and you've said this quite clearly, you got to meet people where they are. And so there may be some who are like, yeah, I don't want to talk to people. I just want to interact with the system. And I'm fine with that. And then I think they're are going to be others who are at the other extreme. And so sort of recognizing that and then being able to adapt to what works best for them. And in the particular setting to me is, again, an example of sort of mass customization. That's really personalizing healthcare.

Royal Tuthill: Yeah. I agree. And at different points in time, you were going to be happy to have a convenient technical solution for one thing and want a human interaction for something else. And your neighbor might have a completely different perspective on when he wants to utilize technology or speak to a human. And so we have to realize that those are personal preferences and people are different and adapt to how we serve our customers. And I think in healthcare reviews some pretty blunt force tools in the past and getting better at personalizing those interactions and providing consumers with the right capabilities at the right time via the right modality is really the path that we're on.

Dr. Dave Levin: That's a pretty good pet peeve. And I think one that's widely shared these days. I'll add to it, concerns about the validity of the underlying data sets. So, what we're training AI on. Are we training it with the right things? Are we training it on the old biases and that sort of thing? And then I think there are some interesting moral problems that I’ve not seen aired out deeply in healthcare. I see it talked about when people talk about autonomous vehicles. But I think those are sort of hints of things that will arise on healthcare and will have to be sorted thoughtfully. 

Royal Tuthill: Yeah, that's a really good point. 

Dr. Dave Levin: So for my last question today, what's your most Sage advice?

Royal Tuthill: That's a deep question. I don't know that I'm qualified to give Sage advice to anyone, but I don't know, I think with our company at least and the employees, one of the things that I’ve really tried to push for and in my own life, is perspective, I think, and it's really easy, especially probably at any point in your life, but especially in sort of that sort of an entrepreneurial setting to get just very caught up in what you're doing. And it's exciting, there's pressure, you feel like your contribution is having a direct impact to the company on any given day, which is exciting and terrifying. But and that can be fully consuming. And I think for me, I’ve really worked over the last five years, especially having four young kids under the age of eight and growing a family and a wife who works in early stage companies as well. It's like, how do we figure out how to be parents? How do we figure out how to maintain some semblance of a relationship with each other and with brands and still be successful professionals? And it's hard but figuring out ways to sort of integrate work and life is really important. And that to me has been really helpful to have some perspective on what are we trying to do as a business? What are we trying to do as a company, why is our mission meaningful? And if you don't step back and sort of see the humanity around you, I think it's easy to get caught up in sort of the near-term wins and lose the forest through the trees.

Dr. Dave Levin: Well, that's really Sage advice. I've got a pressure a little bit on that. What are you specifically doing to help you figure out this integration of work and life and maintaining this balance between the broad perspective and the need to get things done in a startup environment, it's a huge challenge?

Royal Tuthill: Yeah, it is. And so on two different fronts, I think perspective on just like the human side of what we're doing carving out time to sit down and talk to our navigators and our Docents and hear the stories that they're hearing firsthand. It's just extremely important for me as I think about the vision and the strategy of the company and just staying connected to what matters from an altruistic perspective. And if we can keep that balance, I think it's one of our best attributes in terms of building and hiring and recruiting a great team and really understanding what people need. And so sometimes it feels like, Oh, no, I’ve got to get this latest like sales deck out, or the investors are requesting something. And carving out time in our schedule that to have those conversations is just really important. And on the life side, we've actually shifted our workforce to a more flexible model where teams can work from home two to three days a week. It can be in the office two to three days a week. And we have unlimited PTO. And I think what we've built is a culture where people feel really bought in, they're extremely driven. And we want to give them the autonomy to be able to say, yeah, as long as you're doing good work, I don't care where you work from necessarily, or how many days you're taking off. And that, actually it's kind of quite the opposite. We have to tell people to make sure they take enough vacation days sometimes. But letting people work from home and giving them opportunities to come in and collaborate to be separate so that they can run to the bank in the middle of the day, if they need to, I think helps create a lot more balance. And so for me, I started coaching my son's lacrosse team, which was really fun, and I never thought I'd have time for, but on Friday afternoons, I’ll leave at 4.30 and for the last couple of years I’ve been coaching five and six-year olds to play lacrosse, which is hilarious. Cause the helmets are so big and they barely make it out from underneath. They're just running around chasing a ball, but it's been an absolute blast. And yeah, so it's hard sometimes to justify those things, but we've been trying to put policies in place to make sure that everyone in the company has more ability to have a life in addition to the work they're doing.

Dr. Dave Levin: Well. I think there's a lot of wisdom in what you're saying and good on you and the leadership of your company for thinking about these things. And I suspect like me, you believe these are actually really good investments in our people and they pay huge dividends. And so it's not taking away from our productivity. It's actually an investment in that. And likewise, I feel really strongly we're in business of healthcare, we're supposed to care about people. It's supposed to be a part of this as well. So, good on you. My personal experience is heavily involved, particularly in technology and healthcare. The last 10 years was there's a great opportunity to connect my technical colleagues with the mission of healthcare and have tried to routinely bring clinical scenarios and stories and those things to my IT colleagues, to remind them of the importance of the work they're doing, how they next for it directly to the frontline. It gives more meaning to their own work. And I think it also reminds them of the importance of doing it well and safely and correctly as well. And some might argue that that's a waste of time, but I don't think so at all. I think it's been not only the right thing to do. I think it's been a really meaningful and productive thing to do. Well this has really been terrific. And I want to thank you. We've been talking with Royal Tuthill today, co-founder and president of Docent Health. Royal, thanks again for joining us today. 

Royal Tuthill: Yeah, Dave thanks for having me. This is great. 

Dr. Dave Levin: You've been listening to 4 x 4 Health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I hope you'll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I'm your host, Dr. Dave Levin. Thanks for listening.