The Balance of Acceleration & Stewardship within Tech Innovation

In this episode, Heather Gates and Daniel Carnegie explore the importance of balancing acceleration and stewardship in tech and data innovation. They discuss the critical role of listening, the challenges of implementing technology, and the need for humility and curiosity in fostering effective communication. Through personal anecdotes and insights, they highlight the lessons learned from past innovations and the importance of creating a culture that values inquiry and collaboration. They discuss the importance of defining success in tech solutions, the complexities of innovation, and the necessity of incorporating human elements into deployment. The dialogue emphasizes the need for open communication, judgment in decision-making, and the challenges of navigating complexity in a rapidly changing technological landscape.

Disclaimer: The views and opinions shared in this episode belong solely to the host and the guest and do not necessarily reflect those of their employer or affiliated organizations.

Host: Heather Gates, MPH, Owner & Strategy Partner, Human-Centered Strategy, LLC ()
Guest: Daniel Carnegie, MD, MPH, MBA Chief Data Officer, North Carolina Department of Health & Human Services 

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Transcript

Technical Note: Show notes are created with the help of Riverside.FM AI and thoughtfully reviewed by us. They’re meant to capture the spirit of the conversation, though they may not reflect every word exactly.

Heather
Hello this is Heather Gates and I welcome you to the stand in the and podcast where we have honest conversation about the messy complexity of the human experience, where we get stuck, and how we find forward in the and of it all where many things are true at once. 

This podcast is designed especially for those of us who want to make things more beautiful and better for everyone and sometimes need reminding that we are human too. I’m so glad you’re here. 

Heather
The views and opinions expressed by Daniel in this podcast are his own and do not represent the position of the North Carolina Department of Health and Human Services or the State of North Carolina. While Daniel is employed by NCDHHS, he is appearing solely in his personal capacity, drawing on 20+ years of experience across medicine, public health, health data, digital health, and health technology. Nothing discussed in this podcast should be construed as an official statement, policy position, or endorsement by NCDHHS or any North Carolina state agency.

Heather 
Welcome back to the podcast, y'all.

I'm Heather Gates, I'm joined today with fellow health systems thinker and heart forward leader, Daniel Carnegie. Daniel, thank you so much for standing in the and with me today.

Daniel 
Absolutely. It was something that was looking forward to, Heather. I really enjoy talking with you and just pontificating about life. Hopefully, we drop some gems for the audience.

Heather 
I love that. I just love, I think we're off to a great start by using the word pontificating. I just know that you, that we're in the right place. And you know, we're here to have some fun together and pontificate and we'll see what the benefit of that might be for other people. But before we start pontificating, I do want to give you an opportunity, Daniel, to introduce yourself in whatever way feels meaningful to you before we get started.

Daniel 
Sure. Thank you for that.

I will probably stay more career focused. think that might influence a lot of things that we talk about. But when I look back, my career probably seems very non-linear from the outside, but it doesn't feel that way to me. It feels like one long effort to understand where health really happens, where systems fail, and what it takes to build them better. I'll start off with general surgery.

In surgery, it taught me to be very disciplined. It taught me about preparation and what failure looks like when it's loud and immediate.

than transitioning into public health and research that widened my lens from individual patients to communities and systems.

Next, informatics and strategy taught me that even great people struggle inside poorly designed systems. And then preventive medicine deepened my commitment to thinking upstream about risk, prevention, and the structures that shape who gets care and who gets left behind. Now, as Chief Data Officer for North Carolina Department of Health and Human Services, I get to bring those lessons together in a different way.

Daniel 
My work is still about care, it's still about outcomes, it's still about service. The scale is just different. I didn't leave medicine, I widened the definition of what the patient is.

Heather 
How lovely for you to have a chance to reflect even your own story to yourself maybe in that way. I'm curious if even in preparation for doing that because it is, you know, I think a striking thing. You can't help but meet you and go, wow, what a diverse set of experiences you've had.

Daniel 
Yes. Yes. It's certainly the path less traveled, but I've learned a lot. I've talked to a lot of people and that helps guide decision-making to this day.

Heather 
Yeah, and I really, I I love just as we kind of get into content to have even within the health lane, such a diverse kind of pieces of the prism that you've looked through around this. Again, with this similar, you know, I tell people, you know, even for me, like the fire and the purpose has always been the same. I'm just kind of figuring out how I might

be in most service to that. yeah, I look forward to, and I hope you, and I know you will, bring all of those experiences to the conversation today. Before you tell me what we're going to be talking about today, which for everyone, I'm going to learn about when they learn about, apparently. Let's human together for a second. We call it the and stand, but it's like, what and are you standing in as you show up today?

And I can go first if you want me to, or you can go.

Daniel 
Why you go first?

Heather 
You know, I was on vacation for a couple of weeks. I don't know if everybody knows this because our release schedule is so scattered that you probably can't tell a difference. This is my first week back. My first week back, and as I think about where I sit, here we are on, you know, late, late at the end of the week. I feel, I'm going to pick feeling words, I think. I feel very humbled.

by the complexity and the tension of the challenges ahead and within right now. Related to the topic today and beyond, the tensions are so big. And I have a passion and a fire to try to be helpful. And I find myself often humbled. And I talk about this a lot, like humbled by the human experience. But in this case, just really humbled by the

magnitude of the, not only the challenge, but kind of the tensions in the and that are around that. And I feel so grateful. You know, I got to talk to you earlier this week in preparation and even after that call, just, I am so grateful. Not only to know that there are loving, brilliant people waking up every day.

try to figure out really challenging problems, but that I get to work with a bunch of them. Yes. And have podcasts with them. I feel just really grateful for the connection, for the knowing. I feel grateful to know that amidst challenge and the things we might hear about most on TV, like there are

just loving brilliant people, trying to figure out really hard problems. And that both inspires me and it feels comforting to me and it feels, it gives me buoyancy when, and makes me feel less alone in the mess of it all. So yeah, I think again, I don't really know how to give short answers. The and I'm standing in is that I feel humbled and grateful in the context of work.

Heather 
How about you?

Daniel 
I love that. I took a different approach and this is probably a little bit of carryover from our conversation earlier. But the and that I want to kind of drive the conversation through was being in...

the position to be able to accelerate and be a stored stewardship. So acceleration and stewardship.

is the and that I'm functioning in today and throughout my job and how I've been living through many different career paths and journeys.

Heather 
And is that the and that we're going to talk about?

Daniel 
I'm hopeful that it is.

Heather 
Okay. Because I invite a what and are we standing in just kind of generally and then here's our topic and I think for you today those are the same is what you're saying to me. Yes, that's correct. Well then we won't make you explain your personal piece of it. So in your context you mentioned that you are the Chief Data Officer at DHHS. And when you say that you're standing in the and of

acceleration and stewardship. Let's just talk about in the context then of technology and innovation or kind of how would we kind of acceleration and stewardship right specifically in that context.

Daniel 
Sure, Yeah. For me.

Heather 
Yeah, tell us more.

Daniel 
I think acceleration is about not being complacent. There are real problems that need solving and I don't believe paralysis is leadership. But stewardship means remembering that not every intervention is wise just because it's possible. It means respecting readiness, listening to the other people closest to the work.

And being honest about unintended consequences. think healthcare has already taught us what happens when adoption outruns usability and human burden. So I'm interested in progress, but I'm equally interested in how we make the progress trustworthy and sustainable.

Heather 
I just feel like that was like a mini Ted talk and I just want to slow it all down. You said so much in there. Accelerate. kind of just to take these words separately and then maybe talk about how that shows up in a squeeze, especially when we think about tech, innovation, change. So acceleration being, not complete. I think of acceleration, right, this like momentum, this forward motion.

Like I have a belief about moving forward and that it's part of leadership is that forward motion. And I want to make sure I heard it. Not everything, what did you say? Not everything that's possible is wise.

Daniel 
Or do it that you should do it. And maybe we, maybe we start with that one. Yeah.

Heather 
Right, so it's almost this like go and caution, acceleration. And I just, love the word stewardship. And I bet that's what you're, we decided that I wasn't gonna know about this in advance. And I am always excited about your, the language and the words that you choose. So stewardship is such an interesting frame even, right? You could have called that caution or a lot of other things.

So when we think about stewardship and kind of the responsibility, it sounds like, right? Kind of the attentiveness, the mindfulness and the wisdom. How does that, do those, so if we hold those two things as true, that there is both for you a value on acceleration or we think about even acceleration in context and then stewardship, do they kind of

Is it a matter of let's be mindful that both of those are true and they're true or do they end up, do they bump into each other? Do you feel a kind of a squeeze when you try to hold both of those? Or do you see it squeezing kind of systems or structures in a way, or does it seem like we're seamlessly able to hold both of those truths?

Daniel 
I think through my journey. I've seen that those two. entities function, whether it's by design or not, in a very adversarial relationship. And what I find is that being able to hold those two entities in unison in harmony really is how we make progress in a responsible way. particularly when it comes to innovation and who their innovation is pointed towards.

Heather 
agree with you know, kind of however we think about those if it's, it can sometimes feel like, it stop or go? I mean, just to like dramatically simplify it. You know, it can feel a little bit like foot on the gas and the brakes at the same time. Or are we, do we have our foot on the gas or do we have a foot on the, you know, it can, the adversarial nature it can be. So when I think about those two, just in the in the framework of the and, I think what you're saying is often we can get stuck in the either or.

Daniel 
Yes, and it doesn't have to be that.

Heather 
I mean, maybe you're saying they can just be a conflict, but sometimes I think that that to me is like we're either kind of get stuck on one side or the other. What else that occurs to me in this play personally in this space is I can feel kind of I'm still trying to hold them both, but I can feel stuck.

by the magnitude of the complexity of all that comes with both of them at the same time. So there's like different types of being squeezed in the and. In this one, it seems like there's the, you're stuck in one or the other. For me, I can get stuck in like, this is true and this is true. How do I act if both of those things are true? It can feel kind of snow globy and crowded, which I think it points to a different tool.

And then one thing, Daniel, was I knew we were going to talk about technology today, not the specifics, but one other thing that in my experience, and I'm not a data scientist, but I've kind of worked on the periphery of lots of different strategy. That's how our paths cross, actually. I failed to mention that. think on statewide data modernization, if I remember correctly. And then we just have continued to find ways to pontificate together as our paths can cross.

But one of the places I think that we get tangled up in this space too is in this particular type of complexity. And when I say that, I mean, when you're working on tech and data, there are challenges and realities at what I would say like every level of complexity. It's technical, operational, strategic, cultural, political. It's all the layers.

And sometimes I think when we work in tech and data, we're just thinking about the tech and the data without contextualize it. Cause some of the places we get stuck in acceleration and stewardship maybe actually aren't about right. The minutia of like the numbers and how the tech works or whatever else. It's some other piece of it. And so I think just as we get started, want to, wanted to kind of honor that there's like the layer of onion complexity that is within.

Heather 
tech and data from my experience as a kind of systems thinking strategy partner. And that in the squeeze of this and there's like.

Maybe particularly when it's in teams, can get kind of what side of the and are you on? Are you on the foot on the gas side or foot on the brake side? And it feels like we're at odds. And then there's also the, I'm just overwhelmed by all of it. Where do you find if that, I mean, not that the framework has to make sense, but for you personally, it sounds like you're able to hold right now. think what you're saying is you're able to hold the tension of those. Yes.

Has that always been true for you or do you remember kind of a time where you felt the squeeze of it more?

Daniel 
I have gotten more comfortable holding that tension through a number of lessons learned along the way. And it hasn't always been very clear.

how to manage both of those truths at the same time. I'll give an example. Lessons learned from general surgery where you have the objective is to respond to a lot of alerts and making sure that patient is safe and you're very much moving as quickly as possible, but you have somebody's life in your hands. I think that

It's probably the earliest introduction of holding both of those positions together at the same time. However, that was a system that taught me how to be responsive when failure is very loud and in your face. And I think the study of acceleration and stewardship

became progressive in my career when I moved from the patient doctor interaction to health systems as my patient and then to the larger ecosystem of North Carolina Public Health in that the systems that I'm monitoring right now fail quietly or drift quietly. And you have to really be attentive to all the stakeholders or all your partners and finding out.

What's their objective? Is their objective to move quickly or are they more in the stewardship lane? And you really have to kind of be responsive to multiple iterations of that duality at the same time.

Heather 
And in that last example, not even how am I situated within the and of this, but what are all the voices around, right? Where is everybody? know, I think a lot about our business name is human centered strategy. So I very much think about what humans are we, are we centering who decides, right? Back to the foot on the brakes and the gas. Where, where are all of us? So what is that?

How do you make that? I mean, I can, there's complexity in that, right? So there's how to manage. I'm sure every leader listening is like, both we know what it feels like to have a lot of competing, what do you call it? Like competing interests, competing experiences. And again, whether it's the tech or how to operationalize it or how it fits strategically or politically, who do I trust to move something forward or not? Right. There are lots of places that we have different. opinion. So when you're thinking about leading a team in the context where you are tasked with you know, the scope of what you are as far as advancement, right? I guess often kind of as a leader, maybe your task, does it feel like your task with advancing something and you have to figure out how to do that or how does that show up in leadership for you?

Daniel 
Sure, sure, I think about... those spheres where they overlap of what you can control and what you can't control. For example, if you have a grant that is time limited, sometimes you have to move very quickly with little information. I'd call that the acceleration part. However, depending on who's a recipient of the activities of this grant, that in

brings about the question of if we have to move quickly and that's out of our control, how do we do that in the best way as a steward or in the stewardship role?

And that shows up more often than you think. And many people who are thinking acceleration take the stewardship part, such as data governance or things that may have a obstructive stigma. They take it as adversarial versus an accelerant or a catalyst that can help make things easier in order for acceleration.

Heather 
This is such an important point. Because, so a couple things in there you said is, because I do, I think it's very important pretty early in this conversation to acknowledge the realities that we're all working in, right? Because I know that I'm somebody that can be so human centered in process, I can make it sound like I'm not aware that there are actual pressures and deadlines that are external to us that we have to respond to. So given the example that you just gave.

So we are under some external pressure. So acceleration, like fast, we have foot on the gas. And I think there's always some agency in the how, and you just laid it out. Right? It's like, yep, it's on the gas. And how can we do this, even though that is true, that honors stewardship? And then to say, you know, I do think some of these processes, like you said, have stigma.

have the stigma of like, oh, that's gonna get in the way, that's gonna slow it down. And when I think about what result we have in mind for this, then you realize it's the smart, right? It is the way. I think you said catalyst. Like there just are some steps and it's an interesting, the language that you use, like the stigma that's obstructive. I just, wonder how much of this kind of stewardship or thoughtful. work kind of does have a stigma of making the work slow, which is tricky for people who ready to make it happen.

Daniel 
Sure. think there are so many examples I want to pull from, but I'll start from humility because this is a very human-centered podcast. think being able to approach innovation with humility is very important. I was shaped early by humility. My mom is a retired nurse and she then, you

taught me to respect nurses and nurses are the reason why I got through surgery residency. time I learned that hierarchy does not have- me. Yes, yes, yes, yes. Go I learned that hierarchy does not have a monopoly on wisdom and that listening is the price of admission for learning. All those things kind of play a role in how I think about innovation in my role now. And that's the stewardship part is being able to make sure you have that human human part of humility, making sure that everybody has a voice in the room that you have. give the grace to stop and ask questions. If something doesn't make sense, those kinds of things are very critical. And as a leader, you should certainly make sure that space is protected for everybody, particularly those who are closest to the work.

Daniel 
I told you it was going to be one of those days Heather.

Heather 
I mean, I told you, I like, I made some notes, not really sure what we're gonna talk about, but just in case. I just, couple things, I mean, the exclamation point on listening. And again, I think often when we're in accelerated, things are important, there's urgency, either external or just the context demands it. It's one of those things, I think, that we kind of feel like we don't have time for. And I think that listening, you know, listening to who about what, it can't be everybody about everything.

You know, we can, we can, I want to maybe dig in a little bit to listening in this context to figure out how do you hold the tension even around what is, you know, when or who or enough are those sorts of things when you're thinking about it. And then you also mentioned question, both that I just think it's a critical piece of the human centered how of, of any innovation and change, but in particular, Daniel, I've found

When we're talking about technology in the context of complexity, we are often bringing many different people together around a shared goal, let's say. And if I'm a practitioner, like, I don't know what you're saying if you talk to me in like data science stuff or if you're the vendor. Like, there's so much detail in here.

And it can be so intimidating when you're in a room, probably on all sides, medical has jargon, public health has jargon, tech has jargon, data. We can't even really, we learned this in some of our statewide work when you say, let's talk about data. That means a thousand things. Are we talking about population? Are we talking about performance? What do you mean by data? There's so much nuance. do not, in my experience, we cannot get there.

without some like really courageous hand raising to say, some really basic questions. Like Daniel, when you say data, what does that mean to you? When you say interoperability, what exactly does that mean in this context? So the asking of questions so that we understand and can get on the same page and what you were saying about leaders making that okay. Yes.

Heather 
Right? Yeah. Because so often, I think in the context, especially of rapid change that you're trying to deploy, questions can feel like challenge.

Heather 
That's right. And so we can kind of get defensive about people not feeling supportive. I just, think there's so much progress that can come from just making a supported space to have curiosity.

Daniel 
And that's one of those things where depending on what role is speaking at the time, they could take that as a burden or as stewardship. And I think as leaders, we need to make sure that we give enough air to everybody involved to make sure that they feel empowered to stop and ask questions so that we can establish that common language.

We can all make sure that our objectives and goals are aligned and we don't take anything for granted. I mean, we see what happens when we move too quickly. one example, I think that, you know. When we talk about meaningful use, fantastic as far as getting health records digitized. But certainly we can't talk about meaningful use without talking about the burden of physician burnout.

And some people presume that the measure of success is by deployment, right? You plug something in and it's turned on that success. But while the hidden costs quietly accumulate underneath, that is what happens when we don't have the proper human parameters in place, asking questions, common language, thinking about who are we forgetting about in this situation. Those are things that I...feel like there's a certain nuance in learning that skill as a leader and making sure it's integrated in how you operate on a day to day.

Heather 
And just in case folks are less aware, give me a quick, when you say meaningful use, it's meaningful use in case listeners are not as oriented.

Daniel 
very high level, there was a national push to make sure that medical records went to electronic health records. And they were used in a meaningful way. There was a lot of funding that came from the federal government for that.

Heather 
to get us to more digitized documents. Okay, go ahead, sorry.

Daniel 
That's right. That's right. And similarly, I feel that same acceleration when it comes to innovative tools like AI and how we're thinking about it. But we certainly do need to learn from lessons of the past and make sure that we're thinking about there are harms done to the consequences that came from it. And how do we try to think through or diagnose those problems before they come back and haunt us again?

Heather 
So what else might you say if part of what we're listening to here is your suggestion based on lessons that we stand in the and of acceleration and stewardship and that listening to voices involved, we could talk more about kind of how you figure out the voices to be involved in listening.

know, making space for questions. What else stands out to you as tool? Like, I'm just thinking about tools to help not even navigate the tension, but some of this for me, it's more like how to just exist in it, how to even see, it's like, how do you open it up and say, what is the wholeness of this? of this picture because if you are kind of in one side or the other, because I guess we could get stuck on either side. We're kind of talking about, let's make sure we're not too accelerating and we slow down for stewardship. I imagine sometimes we could be like, well, we got to be good stewards or we're just going to kind of study it forever and we don't move forward. So maybe you can get stuck on either side. But either way, kind of understanding when I think about listening, it's where is everybody? Where's the team?

Where's the team or the system or the community depending on what the project is on their thinking about various things? So part of that is is opening it up to see The whole picture, know zooming out a little bit To see the whole picture. What other what other kind of tools or thoughts or lessons? Do you think that we have learned that we could be thinking about when it comes to? Tech innovation and the complexities within that

Daniel 
I do want to kind of pause and really circle around listening for a second. Because I think some people take it as, I've heard what you said and I'm going to move on. just, I stated earlier, I think listening is the price of admission for learning. And so the ultimate goal of learning is being able to listen well and actively. And an example from my previous career in consulting.

When I was doing a lot of the large electronic health record transformations, some of the most quote unquote resistant to change positions were considered, you know, folks that nobody wanted to go talk to. And a lot of them were surgeons, right? Very, very upset that change was, change is hard. We'll start with that. Change is very hard. And more often than not in my role, I was assigned to those… those physically challenging, right? And so what do you do? You have to stop and understand that sometimes that anger are unaddressed issues that need to be addressed. And building that rapport, being honest, and really listening to understand what are the reservations. And then not just listening, but coming up with solutions to what their concerns are.

and communicating the way that says you did listen and closing that loop. I learned very early how to do that pretty well. And I was known for, you know, go send Daniel, this person is having a difficult time. And I think that once you have somebody on your team and you've addressed their issues, they become your strongest physician champions. And so I think that listening is not just I've heard what you said, but being able to be active and really address those things that they're concerned about and making sure that you guys are moving on. If not, you know, amicably, at least in a progressive way. I think that that's one of those human.

Daniel 
parts of the puzzle that we kind of gloss over.

Heather 
Yeah, I mean, even you put listening on the table for us as an important thing, but even getting into really digging into what do we mean by listening, right? And how do I feel listened to is what I hear in this is, and it's not even, let's do active listening so that I'm saying, Daniel, this is what I hear you saying. It's, I'm going to go handle something. Right? It's active in as a thing is now going to happen. And I'm gonna communicate back to you that the thing that you wanted to happen happened. So I think we often miss, this is listening of all sorts, right? There's the, heard what you said. And then there's a subtle kind of validate. You just said, and some of these needs need to be addressed. And so then we address them and then we do the circle back and close that loop.

Daniel 
Yes.

Heather 
I think too, kind of an unspoken piece of what you said too is so often, I think, in change initiatives where, I mean, we'll take your resistant surgeons maybe in this example, who get kind of labeled as that, right? You said there's some stigma in that sometimes it's like, Heather doesn't, you know, and so to even from a leadership perspective then, like the curiosity and the...

Again, thinking about this as stewardship, you we think of it as like concerns or cautions or fears. And how do we turn toward those and understand them better? How do we turn toward them with curiosity and not, you know, either as something that's slowing down the process or perceived as being resistant to the vision?

I think there's, yeah, like you said, probably a lot of missed, opportunity in there. That's a really helpful nuance in the and, because you said listening, as then leads to learning. So this value on, I guess then first you have to say, I value learning as much as I can. mean, I guess if we approached it from, I want to learn as much as I can about how to make this successful.

then all of that fits a little bit differently. Again, and I'm always get curious about who gets to define what success looks like. So not just how do I achieve this thing, right? How I achieve the goal, but what listening could be involved in? What goal for who? know, sometimes in tech, like we implemented a tech solution.

Daniel 
Mm-hmm.

Heather 
Just like you said, change is hard, guess, just to state the obvious that tech for the sake of tech is just activity, right? That's just we're doing something. Tech is a tool, tool to solve a problem. Like what is the problem that we're solving? Even there I could imagine that there's listening to be done. It's do we all see the problem the same way? And can we all imagine this, right?

Because otherwise if it's like, we're pushing this thing, we're like, I don't even understand the problem that we're trying to solve. There's so many opportunities for us to miss each other, I guess, in this.

Daniel 
Yes, absolutely. And even understanding, you really got my brain percolating here. I have another lesson learned from my life in surgery in that there was this back and forth between the surgical tech and the surgeon where the surgeon would say, me what I need, not what I ask for. Through decades of consulting,

I've learned to listen to my clients, tell me what they think they need, and then do that due diligence of disciplined sequencing, right? You do your assessment, you do a good design, you do a good build, you test it well, you train it well, implement well, and then that builds a sustainable model that you can scale. But I think there's a level of discernment that's required on top of the listening where you go beyond.

I hear you, I'm going to do what you say into, that really what you're looking for? And you'll find that a lot of the, want translates into old problems that were not really addressed properly or that are ongoing. And instead of bringing that bright and shiny, let's investigate how you can improve your circumstance right now.

Heather 
Do you know as I hear us and like zoom out, I'm like, wow, we just made this all really more messy and complicated from a process perspective when you think about, I don't know, there's something sometimes that could feel kind of clean and shiny to me about tech innovation and data systems. So often in our work, right? Otherwise we're talking about these big kind of macro population health. When I think of like, we're gonna adopt a new EHR. That feels like a contained thing. You know, there's a product.

It'll be clear when it's done. But I'm again, just humbled by the complexity even as you talk about this, about the layers of need and nuance that are involved really and kind of how we're in this dance all the time about acceleration and stewardship to use your language and then discernment. Like.

Probably across all ends, I mean, that's really what we're wrestling with. So if we say yes, we'll honor that both of these things are true and we want to hold them at the same time, then it's a constantly.

Reflexing the muscle and the tool that's just tricky and hard is discernment So I don't know that's just an observation of like It's it's a lot It's a lot to do and I and I can see

Heather 
Come on, you got something ready to come out.

Daniel 
going to make that muddy a little bit less muddy in that when we think tech and AI, know, for somebody that is looking at something for face value, it's plugging in something and it goes. But the stewardship really is pulling the human aspect that's less often in the room that needs to be more of the process. And that we need to translate everything into human stakes. What does that mean?

We need to talk about what trust looks like. We need to talk about the burden of those frontline staff who are closest to the work. And are we causing more burden through the tech and enablement? We need to talk about fear. I think fear is a great motivator for resistance. My toddler, you know, there was a switch that turned on and she all of sudden was scared of the dark. The day before, no issue. And we really need to work on demystifying.

those things that scare us or that we're fearful for. We'll talk about AI. It is scary for a lot of people, but it's certainly one of the causes I think leads back to a lack of education and what it's capable of doing and how to be safe when we use it. We need to talk about dignity, right? And respect. Those are simple terms, but when it comes to doing the work and what it affects,

You'd be surprised in multiple rooms, how often those things are left out. Workflow friction, right? Are the decision makers in the room that are working through the workflow. You'd be surprised how many times we go through an electronic health record transformation implementation, and we find out all of the, the workflow we thought is not the one that's actually being done and there lies a problem. It's already turned on. How do we go back and make re-engineer decisions? All those things are.

human aspects that are, that comprise that stewardship part of the equation. Acceleration is you do, you do your, your build and you plug things in and you turn off and now technology is working. There's so much more than that. And I think that really highlights that duality of acceleration versus stewardship. And I just wanted to try to clarify my point of view is we need to bring in the human part, the human aspects.

Daniel 
back into those conversations so that we try to reduce the harm and unintended consequences when they're left out.

Heather 
Amen. I'm like, stop it right there. I just, I agree so much and I, it's hard to have this conversation for me and not talk even more about the context of AI acceleration and the pace of change there. And I just, I worry that the pace just doesn't allow for enough of the human.

conversations sometimes. So it's just this is such a timely conversation, I think. So I appreciate you being here and surfacing this because, you know, I think what it's reminding me of is where a lot of the technology that we're facing right now and the capabilities are much more advanced than we have seen before when it comes to technology and adoption. We've learned things already.

We've learned things already about the importance of bringing the human aspects into this. And certainly as capabilities get greater, the need is greater, not less.

Daniel 
Yes.

Heather 
you know, even as we think about technology that can replace some of what humans are doing, that keeping humans in this conversation on the development, right, on the technical strategic, technical operational strategic, cultural, all of that is so important. So I just, feel really passionate about that right now. And I mean, you said fear a minute ago that some of this feels scary and is lack of education, but I'll be honest, Daniel, some of it, I mean, especially when we start thinking about really advanced capabilities, like the more I learn, the more it feels scary. So I think it depends, right? Back to common language, right? Back to common language. And I think AI is a great example of that. AI means a lot of things. That's not a one size, you know, there's very narrow use case examples and specific technologies to solve specific problems. And then there's very big, powerful general other things that also can be talked about in that space. So yeah, I think a lot of what we've talked about though feels relevant even just more so not less as we're increasingly having conversations around tech. And I would say for a long time, it just wonders mainly like, those are people that work on tech and data science kind of are over here doing their tech and their data science thing. Certainly healthcare has gotten more and more tech enabled. But now like this conversation is with all of us. You know, we're everybody trying to figure out even in your own house, like, do I want another Alexa or so like the the decisions and the discernment that all of us, think, are making about acceleration and stewardship, individually and collectively, just feels like there's... I'm curious, I could think about this in my own house. Like, I wonder what everybody's perspective is on some of the tech that even we have in our household and how we are using it together and how that impacts not only the Plug It In, but how that impacts, you know, relationships and other things in our house.

Heather 
again to like what result do we have in mind and who are the humans to get to chime in on that and listen along the way. It's just an important, I think a really important point that you make about we think technology and we think a plug-in and it goes.

Daniel 
There's so much more to it than that.

So much more. And I have a really fun thing that I need to repeat, like a mantra when it comes to innovation and AI. And it really does kind of hold those two dualities, again, simultaneously in that I think we need to make sure that we clean our room before we go outside and play. What does that mean? We know that an AI use case is dependent on good data quality.

So we need to focus our efforts on making sure data is clean that leads into the AI use case. We need to make sure that there is, that we address readiness, right? Digital capacity, digital capability. Do we have all the pieces in place to ensure the greatest success for this effort? Are we ready as a system? Are workflows in order?

Are we thinking about all the things that can have those, those quiet, or can contribute to that quiet drift that causes systems to fail? That's, you know, I mean, every day acceleration and stewardship, the stewardship is so important. Acceleration is easy. AI is very enticing. We know that there are some things that can do really, really well.

Daniel 
Let's have the conversation of making sure that we give it the best success of being as impactful as possible for as many people as possible in a very safe and thoughtful way.

Heather 
Yeah, I agree. You said the word safe. I think that's so much of what I'm thinking about is what are the conversations needed to help make sure that we have done the thoughtful work needed to optimize the benefit and mitigate the risk.

Daniel 
Absolutely.

Heather 
And back to your earlier point, you know, I mean, I guess just my, again, as somebody kind of process person on the outside, but doing that type of listening and including voices, bringing people together, just, it seems like how else can we see all that we need to see to accelerate benefit and be good stewards by tending to know, safety and risk in the way that we need to. And I'm humbled by the scale of this challenge right now, globally.

Heather 
Truly. Yeah, truly. With the paces, you know, I just, think this is one of this, this how do we hold acceleration and stewardship at the same time is going to be one of the big and challenges and tensions of our careers.

Daniel 
Yes. Yes. And like everything else, there's going to be some, there's going to be some things that don't work and there'll be some things that work really well. And we need to make sure that we are learning from our mistakes learning from our mistakes.

Heather 
Yeah, some of which we've already, right? There's lessons we've learned from other deployments. And one of the things, know, I think just to kind of pick up on that from a process perspective, because sometimes I think tech can be in this mindset of, you know, move fast and break things and like learn and then fix it and go along the way. And I think I've said on a prior podcast, like it makes me itchy to think about that approach in complex systems of community.

You know, in large system where trust is so important to hold. you know, I think it's another and of that's why we said, you know, move fast is the acceleration side and also stewardship is the thoughtfulness in advance, right? Like what can we do with the how and the listening in advance of a deployment? And obviously we're going to learn things along the way. But yeah, it just, I mean, I guess the word that stands out to me, Daniel, from hearing you is just being intentional. I mean,

being intentional about, what did you say, human aspects, bringing the human aspects and human stakes.

Daniel 
Yes. Those simple things like trust, burden, dignity, access, burnout, those things that are not necessarily part of the playbook of implementation. certainly I'd make the argument that they should be.

Heather 
So what if somebody is listening and they're like, oof, sounds good. Maybe we should be doing that more than we are. What does it look like in real life to say, we're thinking about some technology of whatever it is. People are looking at a project, some adoption that they're considering from idea to neck, like what is, how do you make that real in real life?

Daniel 
I'd give a life example first and kind of talk about how that translates into reality right now. One of the biggest lessons I learned in surgery is knowing when to cut and when not to cut. Just because you can intervene does not mean you should. Sometimes the real skill is not action, but judgment. Knowing when the conditions are right, when the diagnosis is clear, intervention is more likely to help than harm. And now you can translate that into AI.

Same question, just because a use case is technically possible does not mean it's ready to be deployed. If the data is poor, if the is weak, the governance is immature, or users are unprepared, then layering AI on top of that operation before we're ready, it may look decisive, but it's going to make problems down the road. that's the reality that we're, know, such a simple concept is giving us space to ask questions. And we've seen it many times, you know, things are highlighted, early as problems and we kind of gloss over them because of, the need to go fast. This, this, this grant money is going to run out or we need to have a decision by XYZ. Sometimes the safer action is not to do anything because moving in a way that that project in jeopardy is not the right thing to do. I'd query everybody listening, think about that situation where the problems were called out earlier.

And in that sphere of things that we can't control, there's a timeline where money needs to be spent or there's a chance that it will go away. Sometimes we've made the decision to do in lieu of the problems that were highlighted. It is no surprise that things did not work out as we anticipated. And now we end up paying a higher expense to try to mitigate that than the original cost of the project. That's a very common reality.

Daniel 
So judgment, I'll circle back to judgment.

Heather 
just wonder, know, because part of that, you know, when you said that there are systems that we need to get in place or things are moving forward too fast, I just, I wonder, I'm still, I think I'm still sitting and maybe I'm self-conscious about it because I'm often the person maybe doing it is, is the listening feeling slow?

Right? The, don't have time. We don't have time. And I just, I wonder if that, it just makes me wonder how we're listening. Like, I think we can learn a lot in an hour, you know? Like, I don't know if it's that we don't have time. I don't know if it's, you know, that we're not sure how to, how to do it. I don't, I mean, sometimes yes, it takes time, but I feel like some listening is better. Like,

Surely there are some cases where we can at least add a little bit. I guess I just am curious if people are like, oh, we don't have time for that, if they imagine it's a much bigger thing than it has to be. Right? Because they're like, oh, if we have to do that, if I need an all staff listening and a survey of stakeholders, all these things. Because sometimes we do do all those things.

We do listening in a way that is big and it does take a long time. And I just, think I want to invite us to stay curious about little listening. know, human centered design probably has a lot of tools to offer in this space, but some observation even. Back to workflow, you gave an interesting workflow example. Like what would some just observing in real time workflow look like? I mean, that's an observation, not a listening, but.

Like what are the ways that we can understand or get information that feel a little lighter and more possible so that we can do them even in things that are in excess? Because I mean, I feel the sense that the pace of change is on a further accelerated momentum right now, not less. And so if we have felt like that is slow before, I just am concerned that we're going to feel like we don't have

Heather 
time for it when things get even faster. So it's just a curiosity. know, existing meetings, existing gatherings, other processes, right? Asynchronous processes. I think, you now that we talk about it, I think of things like Mural, which are virtual, you know, how do we use some tech tools? But it's a virtual whiteboard space where you can have people contributing content and ideas and questions all the time.

That could be happening all behind the scenes. Such that maybe there are some some AI tools that can help us consolidate. Because sometimes I think it's not about the listening, it's about consolidating diverse perspectives. And so, you know, what are other ideas that, you know, we can play with so that the listening and understanding, that's not the same as high touch listening, like you're doing your one-on-one listening that you.

With the surgeon and you're moving forward to take an action and you're circling back. But I think we can to some degree do that in groups. Like, hey, we heard this from staff and we've addressed the following things that we can and here's where we are with this. it, it just, the realities are sometimes it can't be that one-on-one and that close up depending on what's happening. So I guess just to open up that it can look a lot of ways.

Daniel 
Yes.

Heather 
Let's keep trying. Which is back to the point I guess you're making about stewardship is we have to keep it. We have to keep it on here. Like there's not a just foot on accelerate.

Daniel 
That's right.

Heather 
that doesn't also hold the stewardship that is human involvement in the process.

Daniel 
And in a lot of it, I think you mentioned it, but just to kind of reiterate the point of listening is not one thing, it's a variety of things. And then with listening comes accountability, right? Are we listening just to listen? Does that person feel empowered to speak up and ask questions? You know, there's a lot of nuance that goes into the dynamics of communication that I think are at play when it comes to those decision points that we're talking about but I think that the overarching theme is. circling back to the greater point of stewardship and what we are responsible for if and when we have a seat at the table.

We can't just blow past, we can't just blow past problems. And we also have to encourage and support everybody in the room having a voice at the table so that if systems are at risk of breaking, somebody feels empowered to speak up and call that out and that we address it before we move on. Because we know it, we know it, missing that step looks like we know that.

Heather 
Daniel, what do you think it takes from a... when you just said, like, when people see something they're concerned about, that it's okay to call it out.

Right, to me that takes, and we said this a little bit in the beginning on the listening side, that takes both courage from the speaker, courage by the person that's raising their hand, and there's something culturally that's created by leadership or team or teams that help make that possible.

Daniel 
Yeah.

Heather 
What do you have any tips for us about how to make it feel okay to raise your hand and go, I hear you Daniel and I don't think your idea is going to work for the following reasons.

Daniel 
Mm-hmm. Mm-hmm. I think, let's assume that everybody's not going to agree, right? I think that being able to... Look at options, weigh them and make a decision based off of best judgment is safe for leadership perspective, knowing that when they make a decision, they're accountable for the output of decision. The bigger picture I think that I'd like to bring up is do the leaders think that they can learn from everybody at the table? I'll tell you that I have mentors ranging from.

toddlers to CEOs of Fortune 500 companies. The point of that is you can learn from anybody. And I want to make sure that our point of view is not to listen and pretend like we're listening. That is active listening and we are taking into account people's opinions that are trying to contribute something valuable. That's that human aspect of listening in a way that's active.

Daniel 
accountability.

Heather 
And a mindset. mean, when you just said, I mean, it sounds like your approach is I as a leader have the mindset that I can learn something from everyone. And if that's your MO, then it does seem like you're just approaching the world differently. And more that I am here so that I can hear that and that we are, yeah, that's what I'm making space for.

So in this so far, we've talked about making sure that we're stewardship along with acceleration, a lot of that having to do with listening and engagement and these kind of qualities around human-centered approaches, to hearing a lot of perspectives on a potential change, opening up the range of where do we have our foot on the brakes and the gas? Who's concerned about what's coming, both technical, operational, strategic, and beyond relationally and otherwise?

I think I want to come back to the piece of, and this is probably selfish one, like, great, we sorted all that out. Let's sort me out now, okay? Let's just take a minute before we wrap up and sort me out. No big task. I see all the sides, right? I am somebody who is, I mean, naturally as a facilitator, I am taking in all the perspectives and all the opinions.

And sometimes can feel overwhelmed by the diversity and scale of all of that. Right? The like, now what? Or given that just the very varied, let's go, go faster, let's stop, let's never go. The sort of whiplash of kind of feeling pulled between those.

Daniel 
It's

Heather 
It's just an interesting place to and to be, maybe just to honor that there's in that process of I'm taking it all in to kind of figure out what to do and what's next.

There is a phase of I don't know. When we're still consuming information and you still feel like I thought I knew this and now I don't and I just maybe I want to normalize how disorienting sometimes information gathering can be.

Daniel 
Yes.

Heather 
Like it's probably easier just to be like, pull the thing off the shelf, let's just plug it in and go. But when we say we're gonna open this up, we're gonna learn more, we're gonna now learn things that feel conflicting. I thought I understood and I don't. These people feel this way, these feel this way, what's true. That it can feel like a pretty disorienting place to through all that until you get to the other side of pieces of clarity. And I think given the pace of change right now that there are so many different things moving at once that we're kind of always be in some version of clear and cloudy.

And to just normalize what that feels like and then figure out like what's good enough. What is the acronym? Gitmo? Good enough to move on?

Daniel 
Yes.

Heather 
Like what's enough listening? When am I clear enough? I don't have answers to this. I just wanna acknowledge that it is for me, feels like a normal part of the process. sometimes like listening, sometimes it brings tremendous clarity quickly. You're like, well now that we've opened it up, it seems really clear this is what we need to do and this is the actual problem. And it's like click, click, click. And sometimes it can create like, ooh.

you know, what do I do with all of this? So I just wanted to name that. I don't know that, like, just to be honest about the tension and often in leadership, you know, we are having to kind of make some decisions where things aren't fully like clicked in and alignment or everybody's like not all 100 % agreed or we haven't had every one of our questions answered. I don't know if that... turns anything up for you, but I guess just for me knowing how I'm feeling about some probably some AI context in particular that it can feel pretty swirly as you're kind of newly taking in lots of different inputs and information

Daniel 
Yeah, I absolutely want to state that my life, my career journey has been full of missteps and I've learned a lot along the way. There's a lot of teachers along the way and I've developed this ability to have some introspection and knowing what my limitations are. I think that's important. It's necessary for meaningful leadership is having introspection, learning from those mistakes so that you can grow.

And have judgment, but also having a system in place that calls out your perspective racing, right? Who's responsible, who's accountable, who are the decision makers, who needs to be consulted, right? Like that's important. And so to pretend like you're going to have all the answers, for everything that you face or every pro program that you try and lift off the ground. That's, that's far beyond reality. And being able to be comfortable in that and knowing that there is a, have a decision tree on the if then that there's going to be a point where you need to make a decision with the best information that you have and go with that decision.

I don't know if I can identify a listening enough point, but I'm saying make sure you give space to listening for sure.

Heather 
And that's what came up for me, you know, back when you said,

I mean, often leadership every day all the time, we're having to act with the best information we have. And I think what this conversation has done is perhaps made us question, what does it mean to have the best information? And if the best information ideally includes this sort of listening and understanding.

Daniel 
Yes.

Heather 
right, that, you know, at least we're eyes wide open as far as they can be. And we're doing the best we can with the information we have. And often I think we have to sit with that. So often, whether complexity or tech or, you know, any of it, there's no, don't we wish, right? Can there just be the test that has the answer key and we take it and we check it off?

Daniel 
Good

Heather 
And we got an A and we get the star and we know we did a good job. And we celebrate it and we hang it on the fridge. Unfortunately, I think many of us on and listening to this podcast work in right, volatility, uncertainty, complexity, ambiguity systems that are so complex and complicated. And the work is such that it's just not that way.

Right? It's not like there is a right answer. I just need to find it and I find it and I'm going to get a, and it's fine. It's, all this messy kind of navigating. in, and often picking like, what's the least bad path? Like there's no perfect one, which one does the most good and the least harm. And if, you know, do it kind of doing our due diligence to get to that point. So it's.

It's another, a bit of an attention for me too. It's not a matter of being like, well, there's no answer. Let's just like pick something and we got to figure it out and move on.

Daniel 
Yes.

Heather 
It's how do I make sure I've learned what I can and considered kind of the broader impacts and implications of this and now we're gonna move forward. But when you do that, I guess what I'm saying so often for me, it's like, gosh, was that right or was this the right decision? And be like, well, what is the metric that we're gonna hold up to say that we did the best we could, right?

Daniel 
Yes.

Heather 
whether it's success, it'll be some version of successful and not successful usually, right? There's really anything that's like completely sideways or otherwise, but to go, well, whatever it is, we listened to our team. We made the best decision. We cleaned up, what was yours? Like we cleaned up our room so we know we put good information in. We were attentive. It's like these, it's almost like, guiding principles or values or processes that you can stand in and with throughout so that other at the other end we can hold up and say we did the best we could with the best information we have defined by these things. maybe that's part of it that just kind of helps anchor what enough means. So I deal with this all the time, like, I doing enough in the world? Am I making a big enough impact? Or did I serve that client well enough or whatever? And I'm like, well, I showed up in my integrity. I was authentic. I did my homework. Like these things that I've decided

Because I can't control the outcome, I can control, I have agency over my approach. Right? I do think we have a lot of agency back to acceleration and stewardship. So much of stewardship is the how we're going to do it. Right? It's not like we're going, it's how are we going to go? And we do have agency over that. And so, however, if we can say we were stewards of this opportunity, which to us means this, maybe we are almost creating kind of operational definitions for what enough means to us that does give you some buoyancy in the tension of it.

Daniel 
Or at least be defensible in your actions, right? And you're talking about my world of data now, right? You want to make sure you limit how much noise is coming through, get some signal, look at your data and make a determination of an early intervention. And it's very oversimplified point of what does the data say and what do we make in our actions and our decisions based off of. Is it decision driven?

Is it data driven? it for fear of not doing something that we're doing something? What drives you? What's that engine that's driving this mechanism? And have the courage to call it out. If the decision is we need to make a decision that means go, regardless of what the data says, that is what you state be transparent and move on from it. It's not always going to be, you have the best data, you have the cleanest data, you have all the things that give you a checklist and your checklist is complete. There are situations where you're not going to have all that support that you're making the right decision. And sometimes it's just about going, measuring, improving, and building that cycle.

Heather 
It strikes me that one of, I think, in the category of what is stewardship, part of what is serving, and this is true, I think, for anything, especially when we're talking about collaborative efforts, is not only the result we have in mind, what does success look like for this?

There's some, guess it's almost like the decision filters or criteria are these kind of driving principles before we even get started. What is driving? What are we going to have drive us? What are our drivers for this?

Daniel 
Mm-hmm.

Heather
I think there's so much that we could clarify on the front end. It does actually say, feels like, back to it feels like it's slow. It feels like it's slower, but what we've seen is how much kind of side effect mass can be created in the long run. So if we take a little bit longer range view and say, let's get good and organized. What problem are we solving? What result do we have in mind for this? You know, are the kind of values or drivers that we're going to lean on when we're making decisions that just kind of give you something to stand on to navigate the complexity of all this.

Daniel
And that's the point of everything, right? That's where we started is have stewardship, have some stewardship. It's not about just accelerating. It's being able to say, have listened, we have done data, we have done governance, right? There's a decision matrix at play and have those things that you could defend your decision-making. even if you've done all the things, you can still be wrong. That's fine. That's fine, but that stewardship is so important.

Heather
think we have to leave it there. You and I can talk for approximately 27 more hours. And I think the tie there of we have to have some stewardship alongside our acceleration is both your experience and your lesson learned. And it feels like your call to action and invitation for the rest of us.

Is there anything as you think about this before we wrap up that feels really important to leave us with as folks think about holding this tension, how to move forward in it that feels kind of unspoken? We'll be rumbling around in your brain tonight if you don't tell us about it before we wrap up.

Daniel 
Nothing new. just really want to emphasize that it's so important to understand and lean into the excitement of going outside and playing with AI. It's so important. We need to test it out. We need to expose ourselves to it because it's not going away. let's clean our rooms before we go outside and play. I want to leave with that. I think that's such a simple concept.

But it certainly does pay dividends when you kind of put things, sequencing, put things in order, right?

Heather 
Let's make sure we're doing things.

Heather 
You said we put things in order.

Daniel 
That's right, sequencing is so important.

Heather 
All right. So everybody go clean your room. That's right. And then go have fun. Daniel says we got to get ready and go have fun. Yeah. And there's a lot in there. think anybody who knows me close up knows that I have so much swirling in me about this AI conversation. And I anticipate that we'll have more discussions about it because I do think it is an area that we all really need to be

paying attention to both from excitement and a challenge and risk perspective that does have really important implications for all of us. So more on that maybe from me another time, but I really, Daniel, appreciate you leaning into the and of this complexity, know, kind of deal with the complexity of human systems and change in the context of tech is just a lot to kind of lean in and wrap your head around.

So I appreciate, always enjoy talking and pontificating with you. So thank you for being here.

Daniel 
It was a pleasure. It was a pleasure. Thank you so much Heather for the invitation.

Heather 
I hope we can do it again. And for everybody else, thanks for hanging in for Heather and Daniel's pontification and pondering podcast. If something in here resonated, yeah, I hope you'll share it with somebody. You know, I'm always curious about how our conversations prompt other conversations. You know, maybe this is an opportunity to, you know, share the podcast with somebody on your team and say, hey, how are we holding stewardship along with acceleration?

What does that mean to us when we say, you know, I just continue to invite y'all to stay curious, invite others into your curiosity. And I'm hopeful that this podcast can help you do that. So thank y'all for being here and we'll see you next time. 

The Stand on the And podcast is supported by Human-Centered Strategy, where we help leaders and teams build connection and strategy and complexity so that everyone can flourish. To learn more or to work with us, please visit us online at humancenteredstrategy.com or message me on LinkedIn.