Posts Tagged: Culture

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Full Circle

My inspiration to go into nursing was rooted in an idealistic view of Florence Nightingale, the ‘Lady with the Lamp’, as she carried her lantern and tended to the war’s sick and injured. My original perception of this career path was a melding of thoughts from my home health experience, TV, movies, and school. Through my first nursing job, I learned that nursing is not a glorified woman laying hands on the stricken, but rather really hard work. Work that I found that I loved.

My passion for helping others was founded in a leader I had at my first job as a home health aide before ultimately deciding to become a nurse. My director was an eloquent and skilled Registered Nurse, managing a large homebound elderly patient population, several RN’s, LPN’s and home health aides, like myself. She was directive but kind, making sure that all questions were answered and ensuring that we had everything we needed to care for our patients well. She was happy and patients loved her energy when she arrived at their home for supervisory visits. She encouraged and guided me through my decision to go to nursing school, with the added support of helping me balance both working and going to school full time. I admired her not just for her nursing skill, but for her compassion toward patients and me.

In my first few years of nursing, I noticed that RNs in traditional settings are often treated as the frontline information gatherers or the middleman; tasked with asking questions, placing orders, collecting specimens, starting IV’s, or performing one of the many other duties needed to care for a patient. Developing a relationship is an added bonus, but not part of the job description. After coming to this realization, I thought back to Florence Nightingale and my first director, asking myself, “do nurses ever get the time to really get to know a patient? Can a nurse uncover a problem without worrying about a meaningless 82-question admission assessment?” I got the answer I was looking for when I found Iora Health.

Iora is a place where I can collaboratively run a primary care practice with a physician, care for my patients in a kind and compassionate manner, and help others discover barriers to their own health. It’s a place where my opinion matters because people support one another. This environment cultivates the passion that drives me as nurse.


I am now refocused on the core reason I went into nursing 20-something years ago: transforming healthcare through nursing leadership. This is what nursing is supposed to be – lifting each other up with a culture of helping one another be better caregivers. It’s about meeting patients where they are, seeing the barriers they face and collaboratively figuring out ways to give them the type of care that the ‘Lady with the Lamp’ did 165-years ago or my home health aide director did 20-years ago. I have come full circle, back to my nurse heroes, and I get to be a part of this incredible change.

Gray, Sydney

Hiring for Character, Not Just Skill

Every Monday, social media is plagued with “I hate Monday” memes and jokes. I skim through these, thinking to myself, if only more people knew it doesn’t have to be that way!

I started on Iora Health’s Recruiting team about a year and a half ago, when we were a compact team of three. I remember opening an email invitation to join to a “speed interview” and thinking to myself, “What is this?” I honestly wasn’t quite sure if I was going to attend. I decided to go, and when I arrived, I was greeted by two members of the Iora team. When I got home, as one would expect, my family asked how the interview went, to which I answered, “I don’t really know, but everyone was so nice!” Over my subsequent interviews, I got to have much more in depth conversations with various members of Iora, and immediately fell in love, thinking THIS IS the way recruiting/hiring should be: talking to a candidate, looking them in the face (not just at their resume), and getting to know them as a person. I was sold!

Over that year and a half timespan a lot has changed; we’ve hired dynamic teams, we’ve instituted complex hiring processes, we’ve tested new things, and ultimately we’ve started to figure out what does and doesn’t work for this type of recruiting. But the one thing that has never, ever, changed is the desire to hire by character and not solely on skill alone. What a simple and refreshing concept – to just hire people who genuinely care about people. At Iora, it’s not enough to find employees that have the licensure you are looking for, with impressive looking resumes, but rather seeking out charismatic employees that believe in our mission and can be thoughtful cheerleaders for our patients.

I am extremely proud of some of the projects and planning that I have been a part of during my time at Iora. The biggest project I’ve been a part of thus far has been launching our newest clinics last winter where I helped to hire a brand new team. What I didn’t realize before this unique experience, is that there is so much mindfulness around who our future patients will be and the clinic locations we choose. These aspects play a huge role in determining how we go about building Iora’s dynamic teams. My team and I flew out to our new location week after week, doing interviews in cafes and coffee shops, because our sites were still under construction. All we could do was meet with candidates and share previous successes and Iora’s mission through anecdotal stories. The fact that people were willing to take a chance on a company’s story says a lot about the people we hired. In hindsight, this is probably the reason we have such incredible teams overall.

We all know that having a great experience at your doctor’s office is an amazing, and even life changing, feeling. To feel listened to, respected and cared for is all anyone wants when visiting their primary care team. What I love most about how Iora recruits is that our team understands that, because it truly makes the world of difference.

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The Iora Values Cube and My First Day

“What can we do to help?” asked a care team member at our Wicker Park office, as I stood thinking of next steps for my first patient on my first day in Chicago. Only two weeks prior, I had been finalizing work with my patients at Iora Primary Care in Seattle and here I was, feeling what true team-based care is….AGAIN. How is this even possible? One word sums it up: values. An organization that applies a set of values in every aspect of its operations is one where a unified culture is created, no matter what US time zone you’re working in.

I’ll start from the beginning; I joined Iora as a Fellow in Primary Care Leadership and Innovation two years ago. I had learned about what makes our health system so complex, but the remedies to these problems come down to designing a truly patient-centered experience. In starting from scratch, Iora Health has realized the role team happiness plays in the healing process for patients. An investment in people and culture permeates everything from our hiring process to the design of each of our practices.  

It’s fitting to talk about my patient Rachel’s* first visit through the lens of something that sits in each practice from Boston to Seattle: the Iora Values Cube, which is a concrete depiction of what we value most.

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Rachel walked in with lightheadedness and heavy bleeding. She hadn’t been seen by a doctor in over a year because the system was “too complicated”. Because of extenuating circumstances at home (child care and finances), Rachel made it clear that there was NO way she would go to the hospital, despite the heavy bleeding and dehydration. Conventional primary care (hearing her preferences, looking at her vitals and ultimately, sending her to the ER anyway), wasn’t going to cut it. Without even thinking, the Iora values came into play:

Bring Creativity

Though this was not a scenario we would normally come across, the team turned on support mode, in the same seamlessness I’d seen our Seattle team demonstrate. There were Health Coaches making Rachel feel supported, providers helping me get Rachel stabilized and finding the right medication at the lowest price possible.

Serve With Humility

No matter the task at hand, each teammate stepped up to get things done for Rachel and help me, a doctor that was new to the Chicago team.

Act With Passion

The unconditional way each teammate became a part of a process to help me and Rachel, speaks to Iora’s collective passion. The team manager coordinated with Rachel’s husband to get her clothes, locate her local pharmacy, and kept the clinic open late enough so he could make it to the center during rush hour.

Feel Empathy

Rachel’s story required a sincere human touch and compassion. An additional layer of empathy was the understanding the team had for me on my first day at a new practice.

Demonstrate Courage

Respecting Rachel’s wish to not go to the ER and coming up with an alternative plan required courage. I can’t imagine this scenario playing out smoothly in a conventional health care setting, especially on my first day.

When Rachel’s husband arrived with a fresh pair of clothes, she was no longer bleeding, dizzy or anxious and there was a prescription waiting for her at the pharmacy near her home. The team has been following up with Rachel ever since, ensuring that she continues to get the care and support she needs. Such is the norm here where a common set of values unify us no matter which clinic we work in under one culture: One Iora.  

*Name has been changed to protect patient privacy.

Health Coaches, Cori & Audra

Medicine Coupled with Compassion

Modern medicine is incredible. We can give you a pill and lower your cholesterol, give you a pill and lower your blood pressure. We can set a broken bone. We can save lives; we can extend lives. We can fix so many problems. It’s totally amazing.

But then there are all these health problems that biomedicine doesn’t have a quick-fix pill for. There’s no pill for loneliness, and it’s a common problem that definitely affects your wellbeing. There’s no quick answer for losing weight, or getting fit. Balance is a really important issue at our clinic. So many of our patients are afraid of falling and feel unsteady. There’s often not a quick fix for improving balance. I think that most of the time, when it comes to health problems like these, patients are kind of left to go it alone. Part of the health coach role is to support patients with problems that take more time. No doubt they have to put in the legwork, but they don’t have to do it alone.

Sometimes the role of the health coach is just to hear the patient and understand what they’re going through. At the Shoreline clinic we have two patients named Dan and Mary Ann. They have been married for a long time. And it is really obvious when you meet them that there’s a lot of love. They just have a very kind way of interacting with one another.

Dan was diagnosed with Alzheimer’s disease at a fairly young age: in his mid-sixties, which was devastating for Mary Ann. And this last year was particularly hard because Dan’s condition worsened quite rapidly. And as it worsened Mary Ann had to take on more and more caregiving responsibilities.

Audra is a health coach who works in Shoreline with me: Mary Ann and Dan are on her patient panel. For any of you that have been caregivers, you know it can be really taxing work. At one point Mary Ann was sending emails to her health coach, Audra, nearly every day. Often Audra would have really solid advice for her, or something tangible to offer. With the support of Dr. Levine and Debbie Yoro, our clinical social worker, the team provided care that was so far above and beyond the status quo. But sometimes Mary Ann would come to Audra with problems that didn’t have a clear answer. When this happened Audra would just hear her out and be there with her. What resulted was really special. Mary Ann developed a very trusting relationship with Audra and the care team as a whole. It was clear that Mary Ann felt like we were on her side: that we were a team. She knew we had her best interests at heart.

There’s no cure for Alzheimer’s disease. But what is so great about the Iora model is that it recognizes that, yes there is value in fixing people’s problems, but there is also so much value in helping them cope when their problems can’t be fixed. Mary Ann sent us a note recently and it included a quote from the poem ‘Kindness’ by Naomi Shihab Nye. It read, “Then it is only kindness that makes any sense anymore; only kindness that ties your shoes and sends you out into the day.” What I love about Iora is that it’s not just medicine. It’s medicine coupled with compassion. It’s difficult to measure the value of human compassion in medicine. But when you hear stories of real human experiences, it just intuitively makes sense. The care that is provided at Iora is so exceptional partly because we recognize the value of the healing relationship and actively work to foster meaningful connections.

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A part of something bigger

What led me here to Iora? That’s an interesting question. Healthcare was never interesting to me. I went to school for filmmaking and the only real thoughts I had of the health system was that it was expensive. I avoided doctors and hospitals like the plague. Being healthy, I could get away with that.

Then, life changed. I met my husband, a type 1 diabetic, and about nine months later, my video editing job came to an end. After several months of hard thought I realized that while I was pretty good at filmmaking, it wasn’t the right place for me. Not knowing what was, I took a job doing accounts receivable at a Skilled Nursing Facility.

Work was disheartening. I watched families struggle to try and figure out how to pay for rehab and long term care. I called 85 year old widows on social security to tell them they owed money for their time with us while they were trying to figure out how they were going to pay to heat their house that winter. And the worst was the sad realization that the work wasn’t about what was right for the patients, but rather what was best for the facility.

And it was just as disheartening on the personal side. There was a lack of communication between my husband’s doctors. We had little to no support in general, especially when we had to figure out how to do what the doctors prescribed. While his primary care doctor was better than most, she didn’t have the time to spend with him or with his specialists that would have been truly beneficial. We felt like numbers, not names and certainly not people.

We are told from a young age that we can do anything we put our minds to; that we can change the world. But on so many levels, at work and at home, it felt like I was constantly swimming upstream, with someone telling me why we couldn’t do something, why some change or another wouldn’t work. Just three years out of school and I had stopped believing that change was possible.

The spring after we got married, I started looking for a new job. I stumbled across an administrative/finance position at Iora Health. While I had no interest in continuing in healthcare, I needed to pay my bills. Honestly, I didn’t expect much, but when I read the company description, I felt an immediate connection. You could feel the honesty in it. These people believed they could change things.

I applied for the job knowing that I could do about half of what they were looking for, and that I could learn the rest if someone was willing to teach me. I never expected that I would actually get a call, but the next day I received an email asking for a phone screen. After talking to Paul Dufault for a half hour, I was hooked. I dug up everything I could on Iora (which wasn’t much beyond the The New Yorker’s “The Hot Spotters” article), and the more I read, the more excited I got. As the interview process progressed, I realized that I wanted this job more than I’d ever wanted any job. What they were doing made so much sense to me. I never thought about the fact that it was a start up or that in six months I may not have a job, or that they could fail. It didn’t matter to me; I wanted to be a part of this.

When Iora’s Chief Operating Officer, Zander Packard, told me that they wanted to hire me but they weren’t sure when they could bring me on, I told him I would wait. We set up a time to check in in a few weeks. That was in March of 2012 and I started in May and haven’t looked back since.

The past three years have been an incredible journey. I’ve watched the company grow from 30 people with two practices in two states, to 150+ people with 12 practices in seven states. I’ve grow in leaps and bounds as my role evolves. I’ve done everything from ordering lunch and scheduling meetings, to writing company policies and creating processes. I found a company that believes that if you do the right thing, the rest of the pieces will fall into place. The bottom line is important, but it’s not the first thing.

Margaret Mead once said “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” I never felt that this was a truer statement than I have working with this amazing group of people at Iora Health.

Scott Jacobson

One Coffee at a Time

The work we do is challenging and sometimes it is easy to succumb to feelings of doubt, thinking that all our hard work is in vain. However, there are examples that highlight the difference we make. One such example is one of our Health Coaches, Vero’s, most challenging patients.

She is a 23 year old patient. When she came to us it was clear that she was suffering. She has type 1 diabetes, difficult enough for a young adult to handle yet she also suffers from ulcerative colitis. After an extended hospital stay and major bowel surgery, she was left with an ostomy, a difficult situation for anyone and particularly debilitating for a 23 year old.

Her surgeon told her she would have to get her sugars under controlled before they would reverse the ostomy. Dealing with an ostomy bag was not only a hindrance on her social life, it limited her job opportunities.

Not surprisingly, she also suffered from major depression which became a compounding factor in managing her multiple medical problems. She tried talk therapy but never really felt comfortable opening up. Antidepressants didn’t make a dent. She was mired in despair and despite our efforts to engage her in managing her blood sugars, Vero’s texts often went unanswered. We knew she would spend days in her room, crying and isolating herself. She would frequently break down while at work. We begged her to come in to talk to us.

Finally, one day without prompting, she did. We could tell she was on the edge and didn’t know where to turn. She had decided to put her trust in us as a last resort. She opened up to us and all her emotional and physical traumas began to trickle out. It was a very emotional meeting and it was only the beginning. We offered more therapy from a professional, but she really just wanted to talk to her Health Coach. We decided that coffee with Vero every other week would be a start. She left that meeting only a step back from the edge but she was moving in the right direction.

And then, Vero received a gift of beautiful flowers.

One Coffee at a Time Vero

The note reads:

I HONESTLY WANT TO THANK YOU FOR EVERYTHING THAT YOU HAVE DONE FOR ME EVEN THOUGH I AM A PAIN IN THE BUTT I’M SO GRATEFUL THAT YOU HAVEN’T GIVEN UP ON ME YOU TRULY ARE A GODSEND

Over the past couple of months Vero’s coffee meetings have been a huge success. She has shared some of her deepest secrets that have clearly been weighing her down and blocking her from moving forward. She has felt comfortable enough to establish care with Nina, our social worker, so she can get the trained help she needs in dealing with her significant past traumas. From a medical standpoint we are still working on her sugars with the goal of reversing her ostomy. She is by no means a picture of health, but we are taking baby steps, in the right direction.

This patient has been a huge reminder to me that despite the monumental task we have in front of us, we do make a difference in people’s lives, everyday. Because of the unconventional resources we have to help us connect with our patients, we are able to continue to find creative ways to make breakthroughs and put our most challenging patients on the track to leading healthier and more fulfilling lives. I know that there are times we feel like no matter how much we try to help our most challenging patients, that they can’t or won’t change. It is so wonderful to be reminded that by showing our patients that we truly care about them and that we won’t give up on them, our positive attitude can have an impact. Great job Vero!

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Building a Company on Culture

At Iora Health, we wake up every day with one purpose—to restore humanity to health care. Through our ever-evolving model of delivering health care, we are able to build meaningful relationships with our patients that allow us to support them on their journey toward health. Every day, in practices across the country, our teams of providers, Health Coaches, nurses, behavioral health specialists and administrative support come together to solve the unique, complex medical and social concerns of our populations in ways we never thought possible. Whether we are caring for casino workers in Las Vegas, Carpenters in Boston or seniors in Seattle, anyone who walks into an Iora practice will experience the same something remarkable—true relationship-based primary care. How is this possible? Culture.

Many of us have come from ‘typical’ health care. We left a culture that we knew could not become what it needed to to care for modern patients. We had to select the best that modern health care culture has to offer—a deep sense of responsibility toward patients, incredible technical competence and knowledge, a tremendous work ethic but leave the rest behind. We created a culture around a core set of values not often found in health care: to feel Empathy, to bring Creativity, to act with Passion, to demonstrate Courage, and to serve with Humility. And then we found people that already embody these values, regardless of their background, and brought them together to form amazing teams.

We define culture as a common set of values that allows every member of the team—clinical, operational, technical, to know how to approach any problem regardless of its novelty. Rather than operating our business from a set of top down policies and procedures, drilled into our teams to create uniformity, we have focused on creating a culture first. Our core values inform every aspect of our work. Embedded in every act, whether it’s how we greet you at our practices, how we build our software, how we treat diabetes, or how we raise funds for the business, is the Iora culture. From this culture spring our strategies, policies and process that make it easier to do what we do best—help our patients solve their problems.

Building a culture-based series of radical primary care practices is not easy — and not for the faint of heart. We are used to falling back on the rules of big health care which are comfortable, but false. However, we know where the old way will get us—to the old place. No perfectly crafted set of rules, no brilliantly designed provider incentives, no amount of quality committee oversight will get us to where we need to be.

Imagine you are the primary care provider on call for your practice. It is 1am and your well-known patient with advanced lung cancer on chemotherapy is calling with fevers. What do you do? Typically, you would gruffly mumble “go to the ER,” if you even received the call. Not at Iora. First, you calm the patient and his wife. You then tell them to sit tight and you will call them back. You call the oncologist (thankfully it is 10pm local time) that you have selected for that patient because of the amazing service that oncologist provides, consistent with our values, to see if this can be managed with antibiotics and an office visit in the morning. When you decide together that it cannot, you call the ER nearest the patient, speak with an attending to prepare them for the patient’s arrival, send what records you can through the antiquated fax system plaguing modern medicine. You call the patient back, (who is shocked to actually get a call back) and let them know the ER is waiting. You also let them know that their Health Coach will call and check up on them in the morning. And at 8:15am they receive a call from their Health Coach who is able to find out exactly what is happening and work with you to plan the next move. Why do you do all of this? Because you love your patients, your work and don’t really need sleep? On the best of days. Because you are paid for every middle of the night well-facilitated ER visit? Hardly. You do it because that is what you do, why you signed up, and because your team would tolerate nothing less from you but excellence. That is the power of culture.

Culture means that even when the way forward is unclear, you can count on each other to build the map to get where you need to go. It means that whether you build software, market Iora Health, or decide where to open new practices, that you work off of the same standards, the same criteria, and seek to optimize the same things. When we think of it, we couldn’t imagine how to build a company on anything but culture.