Brought to you by The Dartmouth Institute for Health Policy and Clinical Practice
and EBSCO Clinical Decisions, makers of DynaMed and DynaAI
Clinicians:
What would you do if you were unleashed?
Unleashed is the podcast that challenges every clinician listening to ask themselves…
What would I do if I were unleashed? What would I do if I could reinvent care from scratch?
The podcast also calls upon health care executives, thought leaders, and policy makers to do more to support innovation on the front lines.
Most episodes spotlight clinicians who have developed a new model of care. Occasionally, hosts Glyn Elwyn and Chris Trimble interview experts on innovation in health care delivery.
Follow Unleashed in Two Steps:
1) Choose Your Platform 2) Tap "Follow"
Our Sponsors
Unleashed: Redesigning Health Care is brought to you by the The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth and by EBSCO Clinical Decisions, producers of DynaMed and Dyna AI.
Episodes
EPISODE 19 - How do you care for a high-needs population when every patient is unique? Nancy Murphy, a pediatrician at the University of Utah, has been grappling with the challenge for decades.
“The system is like all or none. It's big and bold or it's nothing. Frustrating, disappointing, and sometimes even sad. And it makes me sad to think we're making it even harder for these families to get what they need, when it should just be more of a partnership.”
-
Nancy Murphy, MD is a Professor of Pediatrics, Adjunct Professor of PM&R, Vice Chair of Faculty Engagement, and Certified Physician Development Coach in the Department of Pediatrics. Dr. Murphy uniquely blends her expertise as a pediatrician, a pediatric physiatrist, executive coach and academic health leader to build and connect people and processes in team-based, interdependent systems. Dr. Murphy designs, implements, and sustains processes that enhance the interpersonal and professional experiences of pediatric faculty and staff.
Nancy Murphy
EPISODE 18 - What are the connections between the mind and, specifically, the heart? How should the health system respond? Roy Ziegelstein, cardiologist and editor-in-chief at DynaMed and DynaAI, offers a response to Episode 17.
“You know, as a cardiologist, it stands to reason that my patients come to see me because of heart issues, but when they walk into my office, it's not just that I'm a cardiologist, I'm a doctor. I can't ignore their biggest problem just because it's not in, quote unquote, my area or a service that I offer.”
-
Roy Ziegelstein, MD, is Editor-in-Chief of DynaMed, a leading evidence-based clinical decision support tool for health care professionals. He is the Sarah Miller Coulson and Frank L. Coulson, Jr., Professor of Medicine at Johns Hopkins University School of Medicine, and served as the Vice Dean for Education before joining DynaMed. Dr. Ziegelstein was Vice Chair for Humanism in the Department of Medicine at Johns Hopkins from 2014-2024 and is the current Director of Patient-Centered Medical Education.
Roy Ziegelstein
EPISODE 17 — The mind and the body are connected, but our system generally treats physical and mental health as two separate worlds. Sivan Rotenberg, a clinical psychologist at Dartmouth Health, is trying to change that, specialty by specialty.
“What we're all doing is really helping people navigate really complex medical conditions that all require an element of self-management and all also are kind of scary. That's psychology. That's behavior management. That's what we do every day.”
-
Dr. Rotenberg is an Assistant Professor at Geisel School of Medicine at Dartmouth, a clinical psychologist, and the Director of Embedded Psychiatry Services at Dartmouth Health. She has developed novel interdisciplinary programs to incorporate mental health care into over ten different specialties, to meet the psychosocial needs of their patients. Embedded Psychiatry Services are comprised of psychologists, psychiatrists, psychiatric nurse practitioners and licensed mental health clinicians.
Sivan Rotenberg
EPISODE 16 — What do elders really want and need? How must the health care system respond? Amber Barnato, director of The Dartmouth Institute for Health Policy and Clinical Practice, also a hospice and palliative care doctor, offers a response to Episode 15.
“It’s not just the issue of us having many, many elders to care for. That's a privilege. The issue is that we just don't have enough middle-aged and young people to care for them, while also carrying on all of the other economic and family care needs and community needs that they need to do. I think it's going to be an economic imperative. Like we actually have to take the risk and innovate.”
-
Amber E. Barnato, MD, MPH, MS is the director of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth. She is trained in two medical specialties, public health and preventive medicine, and hospice and palliative medicine. Her research focuses on end-of-life care, life-sustaining treatment, and patient-provider communication.
Amber Barnato
EPISODE 15 — When Si France heard about the PACE program, a care model for nursing-home-eligible seniors, he thought it was the most amazing care model that he’d ever heard of in the United States. He went on to launch WelbeHealth, which serves seniors in thirteen locations in California … and growing.
“Usually when people first hear of PACE, they don't believe it. They think it sounds too good to be true. Because when someone enrolls, it's at no cost to the patient or family. And they get, twenty-four seven, all the medical and social services that they need to stay in their home, live healthy, and avoid a nursing home.”
-
Si France, MD, is a physician-entrepreneur and mission-driven leader dedicated to transforming healthcare for vulnerable populations. As the Founder/CEO of WelbeHealth, he is expanding access to high-quality senior care through the Program of All-Inclusive Care for the Elderly (PACE), a Medicare/Medicaid program that provides comprehensive care for nursing home-eligible seniors. He earned his MD and MBA at the Geisel School of Medicine at Dartmouth and MBA at the Tuck School of Business at Dartmouth.
Si France
EPISODE 14 — We are introducing a new kind of episode, a response episode. Guests will offer reactions to the prior episode. Our first respondent, Roy Ziegelstein, comments on our story in Episode 13 about caring for people with serious mental illness.
“That is a classic cognitive bias called anchoring bias. And anchoring bias has a close cousin that's called premature closure. And so, what they did was they anchored on her schizophrenia, and they closed the case. Done.”
-
Roy Ziegelstein, MD, is Editor-in-Chief of DynaMed, a leading evidence-based clinical decision support tool for health care professionals. He is the Sarah Miller Coulson and Frank L. Coulson, Jr., Professor of Medicine at Johns Hopkins University School of Medicine, and served as the Vice Dean for Education before joining DynaMed. Dr. Ziegelstein was Vice Chair for Humanism in the Department of Medicine at Johns Hopkins from 2014-2024 and is the current Director of Patient-Centered Medical Education.
Roy Ziegelstein
EPISODE 13 — Joe McDonough has a straightforward goal: Keep people with serious mental illness healthy and out of the hospital. He’s doing it with home visits.
“They may see a primary care physician every six months and have a fifteen-minute visit. And so for them, it's a constant revolving door of ED visits, hospitalizations, and really struggling at home.”
-
Joseph P. McDonough, MSN, MHCDS, is a visionary entrepreneur, innovator, and healthcare leader who has transformed home health care for 30 years. A Yale University Master of Science in Nursing graduate, Joe founded Innovive Health in 2004 to serve one of the most underserved populations: individuals with complex behavioral health needs and co-occurring medical conditions. Innovive is Massachusetts’ largest home health agency specializing in this group. The company has expanded to Colorado and Iowa.
Joe McDonough
EPISODE 12 — Our final episode in a four-episode series on primary care. Today: Artificial Intelligence. Is it possible that technology could actually restore humanity in health care? What other doors might AI open?
“AI tools are only as good as the corpus of information that they're drawing from. If you take, for example, Google, Gemini AI, it's drawing from the whole body of information that's out there, much of which, you know, is junk. So, its answer may be right, sometimes, but it may be completely off base.” - Roy Ziegelstein
-
Annuradha Bhandari is an internal medicine physician and Medical Director of Clinical Informatics and Perioperative Medicine at Reid Health. With expertise in primary care, perioperative medicine, informatics, and quality improvement, she leads initiatives that enhance provider efficiency and elevate the EHR experience. Dr. Bhandari is deeply committed to using technology to deliver clinical excellence and empower clinicians to use digital tools effectively, advancing evidence-based care and personalized patient engagement across the organization.
Annuradha Bhandari
-
Roy Ziegelstein, MD, is Editor-in-Chief of DynaMed, a leading evidence-based clinical decision support tool for health care professionals. He is the Sarah Miller Coulson and Frank L. Coulson, Jr., Professor of Medicine at Johns Hopkins University School of Medicine, and served as the Vice Dean for Education before joining DynaMed. Dr. Ziegelstein was Vice Chair for Humanism in the Department of Medicine at Johns Hopkins from 2014-2024 and is the current Director of Patient-Centered Medical Education.
Roy Ziegelstein
EPISODE 11 — Our third episode in a four-episode series on primary care. Today: Advanced Primary Care, sometimes called team-based primary care. What happens when you combine the advantages of Direct Primary Care with bigger clinical teams that include advanced practice providers, health coaches, behavioral health professionals, pharmacists, nutritionists, and more? What gets better for patients? What gets harder for clinicians?
“I was just on the phone with a primary care doctor. He's asked to see 32 patients a day, which is all well and good if they're young and healthy, but he's 62. And he has a panel who's aged with him who are older and sicker. And there's no chance you could see an old sick person with 18 meds and chart the size of a phone directory in 15 minutes, right? Zero chance you could do that well. It's an unwinnable game.”-Rushika Fernandopulle
-
Mack Hinson is a physician and the President and CEO of Kinwell Health, an integrated primary care collaboration with Premera Blue Cross. Mack joined Kinwell because of his conviction that an integrated and aligned approach between a clinical group and a health plan offered the best path to improving how health care works for patients. He is passionate about the role of independent advanced primary care in partnering with patients to help them reach their best health potential.
Mack Hinson
-
Rushika Fernandopulle is a practicing physician who is the CEO of Liza Health, a startup building a new AI-enabled platform for Primary Care. He was the co-founder and CEO of Iora Health, an early innovator in Primary Care redesign which was acquired by Amazon in 2023. He earned his A.B., M.D., and M.P.P. from Harvard University, and completed his clinical training at the University of Pennsylvania and the Massachusetts General Hospital.
Rushika Fernandopulle
EPISODE 10 — Our second episode in a four-episode series on primary care. Today: Direct primary care. What happens when you take the middle man … the health plan … out of primary care? What happens when primary care clinicians no longer have to worry about billing and coding? What new services do they offer? What else do they do differently?
“It's remarkable how hard primary care is in a more traditional practice. And I think providers get to the point where they're like, you know what? I can't do it anymore. I can't do this. I'm losing the joy.” - Beth Wilson
-
Clint Flanagan is a physician, entrepreneur, and founder and CMO of KerixHealth (previously Nextera Healthcare), an award-winning Colorado-based healthcare company that provides advanced Direct Primary Care services to individuals and employers. A pioneer in DPC, Flanagan has influenced DPC legislation at the state and federal level and has attracted numerous awards such as Top “Fierce15” Healthcare Companies in the US (Fierce Healthcare), and Top 50 Value Based Healthcare Thinkers in the US (Pearl Health).
Clint Flanagan
-
Beth Wilson, MD, is Chair of Community and Family Medicine at Dartmouth Health and Geisel School of Medicine. Her areas of focus include workforce diversity, health equity, community engagement and health professions education. Prior to this role, Beth served as Chair of Family Medicine at Maine Medical Center and Vice Chair of Education in Family and Community Medicine at the University of California San Francisco (UCSF).
Elisabeth Wilson
EPISODE 9 — Our first in a four episode series on primary care. Today: Full scope family medicine. Is it an unfortunate necessity in remote areas, or a model for primary care everywhere?
“A well-trained, full-spectrum family physician can care for 80 percent or more of a patient's needs, of a family's needs. And so the reliance on high-priced specialists is lower, and so that's just far more efficient.” - Ben Anderson
-
Dr. Sarah Moore, MD, is a full spectrum family medicine physician at the Sterling Regional Medical Center in Sterling, CO, where she serves as the site director for the North Colorado Family Medicine Residency Program.
Sarah Moore
-
Benjamin Anderson is the President and CEO of Hutchinson Regional Healthcare System in Hutchinson, Kansas. He is a recognized leader in transforming rural health care who has been featured on CBS Sunday Morning, NPR, Politico, and Sports Illustrated. In prior posts, Anderson led the Colorado Hospital Association’s rural health strategies and served as the CEO of the Kearny County Hospital in Lakin, Kansas, where he expanded access to coordinated primary care and specialty services.
Ben Anderson
EPISODE 8 — Göran Henriks has spent decades leading innovation in the Swedish health system, and he’s gained an international reputation for his work. He shared three patient stories with us, each offering a conceptual building block for clinician-innovators.
“Design thinking starts with imagination. So you have to practice imagination. And in care, the best way to do that is to help people to go outside and harvest from others.”
-
Göran Henriks is Chief Executive of Learning and Innovation at Qulturum in Region Jönköping County, Sweden. He has more than thirty years’ experience of management in the Swedish healthcare system. Mr. Henriks’s academic background is in Psychology from the University of Lund, and he has worked as a child psychologist. He holds a Master’s degree in Business Administration from University of Gothenburg. Göran is also appointed as a Senior Fellow at the Institute of Health Care Improvement.
Göran Henriks
EPISODE 7 — Winnie Henderson, a surgeon who focuses on breast cancer treatment at Oregon Surgical Wellness, describes how she deepens her connections with patients through empathy, education, and collaborative decision making. She also describes the benefits, for both patients and doctors.
“When we started this practice, we said, you know, the most powerful touch that I do as a breast surgical oncologist to the patient is that first phone call.”
-
Winnie Henderson MD, PhD, FACS, CGRA is a private practice surgeon specialized in general & breast surgery. She participates in several quality registries & national committees to improve surgical outcomes. Dr. Henderson completed her PhD, medical, surgical & fellowship training at Oregon Health & Science University. She is certified by City of Hope and the National Consortium of Breast Centers to provide Cancer Genetic Risk Assessment and management.
Winnie Henderson
EPISODE 6 — JoAnna Leyenaar, a pediatric hospitalist at Dartmouth Health, is developing mental health skill-building programs for teens who are boarding at the hospital, sometimes for several days, after a mental health crisis.
“It's rare that we have the time to step back and think, holistically, how can we fix this? I feel like this is one example of so many that if we had the time, the space, and the infrastructure to be able to collaborate, we could transform healthcare.”
-
JoAnna Leyenaar, MD, PhD, MPH, works as a pediatric hospitalist and Vice Chair of Research for the Department of Pediatrics at Dartmouth-Hitchcock Medical Center. She focuses on improving the quality of healthcare provided to children, particularly those who are vulnerable and underserved, with particular interest in the integration of mental and behavioral healthcare. Dr. Leyenaar received her MD from McMaster University (Canada), her MPH from Harvard University, and her PhD from Tufts University
Papers in the Journal of Pediatrics, the Journal of Adolescent Health and Hospital Pediatrics.
JoAnna Leyenaar
EPISODE 5 — Lara Goitein shares her experience building and leading a program for clinician led innovation and continuous improvement at a community hospital in Santa Fe, New Mexico.
“We changed the paradigm of physicians engaging in the hospital's quality agenda to the hospital engaging in physician’s quality agenda.”
-
Dr. Lara Goitein is a pulmonary and critical care physician and Medical Director of Clinician-Directed Performance Improvement for Dartmouth Health. She trained at Harvard Medical School, did her residency in Internal Medicine at Massachusetts General Hospital, and did her Pulmonary and Critical Care Fellowship at University of Washington, Seattle. She is author of the book, “The ICU Guide for Families: Understanding Intensive Care and How You Can Support Your Loved One” (Rowman & Littlefield, Dec 2021).
Paper in Health Affairs
Lara Goitein
EPISODE 4 — David de Gijsel is building community partnerships and advancing innovative methods for testing for and treating Hepatitis C.
“What's become very clear is that you have to step out of your office.”
-
David de Gijsel, MD, MSc, MPH works on the intersection of social justice and health. As the Chief Health Officer at Better Life Partners, he designs community-embedded, whole-person care for people with substance use disorders. As an infectious disease physician at Dartmouth Health, he focuses on the infectious complications of injection drug use, specifically on new care models for the treatment of hepatitis C in people who inject drugs.
Resources:
Publication in the Journal of Participatory Medicine
David de Gijsel
EPISODE 3 — Jessica Salwen-Deremer, a gastro-psychologist and an innovation leader at Dartmouth Health, is building new care models for patients with irritable bowel syndrome.
“And it starts with pain, but long-term, of course you become anxious. Who wouldn't become anxious if they got pain every other time they ate and they didn't know when they would need to use the bathroom?”
-
Jessiy Salwen-Deremer, PhD, DBSM, is the Director of Behavioral Medicine for Digestive Health at Dartmouth-Hitchcock Medical Center and Assistant Professor of Psychiatry & Medicine at the Geisel School of Medicine at Dartmouth. Dr. Salwen-Deremer earned her PhD in clinical psychology at Stony Brook University and completed her fellowship in behavioral medicine at the Johns Hopkins School of Medicine. Her areas of expertise include behavioral sleep medicine and GastroPsychology, with a particular focus on improving access to care through the use of novel technologies and care pathways.
Resources:
Jessica Salwen-Deremer
EPISODE 2 — Dick Levy is a philanthropist with deep interest in … and deep knowledge of … innovation in health care delivery.
“Philanthropists understand a new device or a new drug. They don't really understand the weaknesses of healthcare.” — Dick Levy
-
Richard “Dick” Levy is a philanthropist with deep interest in innovation in health care delivery. The Susan & Richard Levy Health Care Delivery Incubator is a joint initiative between Dartmouth College and Dartmouth Health that brings together multidisciplinary teams of researchers and frontline healthcare providers to improve patient care. Dick served as the CEO of Varian Medical Systems from 1999 to 2006 and Chairman from 2002 to 2014. He holds a bachelor’s degree from Dartmouth and a PhD in nuclear chemistry from the University of California Berkeley.
Dick Levy
EPISODE 1 — Tyler Hartman and Kate Richards have a goal: Get pre-term babies home sooner. A pioneering innovation effort at Dartmouth Health.
“If you've ever been in a NICU … it's a pretty beepy and loud environment. The room structure, the lighting, the noise, the smells. It doesn't scream bonding … let’s put it that way.” — Tyler Hartman
-
Dr. Tyler Hartman, MD, is a neonatologist and director of Dartmouth’s Neonatal High-Risk Follow-Up Clinic and Pediatric Hospital at Home program. He has a particular interest in developing new models of care that enable children to be home with their family instead of being in a hospital. He is the director of the New England Follow-Up Network (NE FUN), the first multistate regional high-risk neonatal follow-up collaborative consisting of 14 tertiary referral NICUs in New England.
Resources:
Paper in BMJ Open Quality
Tyler Hartman
-
Kathryn Richards, APRN, is a pediatric nurse practitioner at Dartmouth Health Children’s in the Neonatal High-Risk Follow-Up Clinic. Kathryn’s clinical work focuses on care of the high-risk and medically complex neonate in the home environment. She is the co-investigator for the Hope Grows at Home program, designed to transition the care of the stable neonate from the NICU to the home environment with nasogastric feeding.
Kate Richards
The Hosts
Glyn Elwyn, BA, MD, MSc, PhD, FRCGP, is a clinician and researcher. He is a tenured professor at The Dartmouth Institute for Health Policy and Clinical Practice in the USA. He has visiting chairs at Radboud University, Nijmegen, University College London, and the University of Lausanne. His work focuses on implementing change in how healthcare is delivered: whether it be about critical decisions or a better way of getting effective things done as well as possible.
Glyn Elwyn
Chris Trimble founded Treehouse Audio Productions in 2021, intent on helping clients share their expertise, with impact, through the medium of recorded audio. Prior to founding Treehouse, Chris was a professor at the Tuck School of Business at Dartmouth for 17 years. He has written six books on innovation, the last of which focused on innovation in health care delivery. Chris holds a master’s degree in business and bachelor’s degrees in engineering and music.
Chris Trimble