CHAPTER
6 Treating the Whole Person
THE GOOD DOCTOR
LAURA MONSON KNEW what she knew, but she couldn’t stop thinking about what she didn’t know. It was 2012, and she was 34 years old, starting her first “real job” after years of training to become a pediatric plastic surgeon focusing on craniofacial problems. She had come to Texas Children’s Hospital to operate on cleft lips and palates and other facial anomalies of young children. With many, if not most, of her patients, she would operate more than once, because staged approaches were demanded by their problems and the fact that they were growing.
She knew how to perform the operations, but as she interacted with patients and their parents over months and years, she found that she couldn’t answer the questions that were really on their mind. Sure, she could tell them exactly what she planned to do, how much discomfort they could expect, and what the cosmetic result was likely to be. “But they wanted to know what their child’s life was going to be like when they grew up,” Laura recalls. “They wanted to know how having a cleft palate was going to affect them socially. How was it going to affect them academically? What kind of jobs would they be able to get? Would they get married someday?
“I didn’t have good answers for them,” she said. “That was something I wanted to focus on.”
Laura had been attracted to Texas Children’s in part because the hospital’s surgical leaders had a track record in collecting patient-reported outcome measures (PROMs) for pediatric cardiac surgery. They had data not just on whether patients survived their operations, but also on how they really fared. These kinds of outcomes can only be assessed by asking patients questions like, “Can you run and play with your friends?”
Laura knew such issues were especially important for her patient population. The surgical mortality was close to zero for the kind of patients she saw. Hardly anyone had craniofacial surgery to avoid death; they came for surgery because they hoped for a better quality of life. But there were hardly any data on the outcomes that mattered to her patients.
Laura wanted to start collecting PROMs data on her patients so she could start giving numbers rather than platitudes when she was asked what patients and families should expect. Collecting those data would take resources, and the return on that investment would not be realized for many years. After all, the outcomes that mattered were long-term, not measurable in a month or three months.
Laura’s response to this concern was both pragmatic and audacious. “That’s why we should start right away,” she said.
Then she had an epiphany. Answering questions about what patients and families could expect was not going to be enough. Like any good surgeon, she wanted to change those outcomes for the better. She could improve and often completely correct the appearance of many children. Speech, singing, eating—these were more complex, but she had therapists who worked with her on those types of issues.
But having a normal social life? That meant trying to help her patients learn how much fun it is to act in a play or burst into song without feeling self-conscious. That meant helping them meet other children who had similar experiences, who after living in a cabin together, just might become their year-round friends and offer support beyond that provided by their family.
Laura realized that if she really wanted to help her patients she had to do more than perform surgery. So in 2014, she and her colleagues started Camp Keep Smiling for children ages 10 to 16 from the Texas Children’s Cleft Lip and Palate Clinic. It’s a camp like every other summer camp, with activities that include canoeing, fishing, archery, ropes courses, basketball, and arts and crafts. It also has chaperones (including Laura, her husband, and a host of volunteers from Texas Children’s) on the prowl to make sure the kids don’t have too much fun.
Unlike most camps, there is no charge, and there is an unusual purpose. As described on the website for the camp: “Children with cleft lip and palate tend to miss a lot of school for doctor and hospital visits. This can make it hard for them to make friends and fit in . . . Camp Keep Smiling provides a safe, fun environment for your child to engage in meaningful social interactions and gain self-confidence.”
Laura Monson arrived at Texas Children’s pretty sure she knew what she was doing with a scalpel in the operating room. A couple of years later she had realized that her therapeutic interventions should also include karaoke.
* * *
Laura grew up in Twin Lake, a western Michigan town of about 900 surrounded by farms. That rich farmland had attracted both sides of her family in the late 1800s. Laura, like almost all of her extended family—her parents, aunts, uncles, and cousins—went to Reeths-Puffer High School.
Her parents were high school sweethearts. Laura’s father worked at a sprawling Brunswick factory that made bowling balls, pins, and pin-setting equipment until it closed in 2006. Laura’s mother stayed at home with Laura and her older sister when they were young, and then went back to work as a librarian. Laura’s sister lives with her family in northern Michigan and works as a medical assistant.
No one in Laura’s family had previously gone to college, but she thinks she was exposed to just the right influences at home to prepare her for her work. She spent a lot of time with her mother in the library, which was next to her elementary school and across the street from her home. “I read a ton when I was a kid, partly because we moved a little bit outside of town, so it was hard to get to friends’ houses,” she recalls. “I spent most of the summer reading, sprawled across my bed or lying around outside. I was always getting in trouble for reading under the covers with a flashlight.”
She traces her readiness to take on the mechanical challenges of surgery to time spent with her father. “In our family there was always a lot of emphasis on working with your hands,” she recalls. “There was a lot to do around the house. My dad actually built our second house. There weren’t any boys in the family, and I was always kind of a tomboy, so I helped him with that. There are photos of me putting the shingles on the roof when I was 13.”
She says, “I loved school from the start, but I wasn’t very good at actually going to it. I used to fake being sick a lot so I could stay home and read. I think I was a little bored.”
In third grade, however, she had a teacher who was in his very first year. He started a program for talented and gifted children at her elementary school. “He was just phenomenal, and he showed me just how much impact a great teacher can have on students,” she recalls. “The program was an after-school club for about 10 of us where we would build rockets and do various science experiments. It was 1986, the year the space shuttle Challenger exploded.”
That teacher was the first person to tell Laura that she should definitely plan on going to college. With that goal clear in her mind, some of Laura’s grown-up characteristics started to emerge. “I think my parents would say that I am stubborn,” she says. “And I realize now that I began to feel competitive. I wasn’t focused on beating other people, but if there was a spelling bee or a math contest, I really wanted to do my best. I was frustrated if I didn’t.”
* * *
If Laura had drive when she was a high school student, she wasn’t sure where she was going. “I didn’t see a clear path forward,” she says. “There wasn’t anybody around who made me think, ‘That’s how I see my life turning out.’
“I’ve always been very shy, and I didn’t feel like I fit in that well in any group,” she recalls. “I had some friends I’d go out with, but I didn’t like going to dances and parties that much. I played softball and tennis, and I was in the rifle line, part of the color guard of the marching band. I did a little bit of lots of things.
“But I had to work, too. I started babysitting full time in the summers when I was 13, and once I had my driver’s license I worked a couple of nights a week and on the weekends. They weren’t great jobs. I worked at a sandwich shop and at one of those kiosks in the mall that makes popcorn—that kind of thing.”
She did find time for the Science Olympiad, though, and took advanced placement classes in physics and calculus. She was near the top of her class.
Laura’s mother was diagnosed with breast cancer when she was 13. In that same period, she lost relatives to other common malignancies—lung, colon, and ovarian cancers. The family illnesses made her think that she wanted to become a cancer researcher.
After high school, she went to Western Michigan University in Kalamazoo for a simple reason—she could afford it. Without a lot of financial aid, she would have had to go to a community college while working and living at home. But she really wanted to go away, so she applied for “probably a million” scholarships and got one from Western Michigan. She still needed part-time jobs—she worked in the library and tended bar on nights and weekends. And in fact, she had not really gone that far away—Kalamazoo and Twin Lake are only 99 miles apart. But she had left home to go to college, and she was determined to make the most of it.
* * *
A pattern began to emerge in which Laura would work hard and get what she was seeking only to discover it was less than she had hoped for. She would then open herself up to possibilities that were related but different, find something she loved, and plunge in.
So it was shortly after starting her freshman year that Laura found herself thinking, “What am I doing here?” She felt unprepared for college and was stressed by living away from her home and her friends and working extra jobs to make ends meet.
More important, she was disappointed with what she anticipated as the first big step toward her goal of becoming a researcher. She wanted to work on cures for terrible diseases, so she signed up to work in a neurology research laboratory. Her role there was preparing specimens and killing leeches. There was probably a connection between that work and a big important scientific question, but if there was, it was not apparent to Laura.
“I really, really didn’t like it at all,” she recalls.
But in her sophomore year, one friend who was training to become an emergency medical technician (EMT) and another who was going to pharmacy school said, “Why don’t you come volunteer at this free health clinic? We could use help.” Laura went and found the first college extracurricular activity that she really loved.
Volunteering at the clinic appealed partly because it aligned with the values she had been raised with. “My parents were always very proud of how I did in school, but it was never the most important thing,” she says. “They put a lot of emphasis on being a good person, volunteering, and giving back. My mom was very involved in our church, and when someone was sick or in need, we would be making food and bringing it over.”
Her work in the free clinic gave her a glimpse of the role that physicians could play in the lives of patients—and reinforced a positive impression from the past. “During my mom’s illness, our primary care doctor was a real resource, someone who was really involved with our family,” Laura recalls. “I realize now that, during college, I was trying to find something that really meant something—a job and a future that let me give back and do some good.”
Laura had not been interested in medicine up until that point, because she didn’t like many of the pre-med students she met. “They were so aggressive,” she says. “We were in a lot of the same classes, and I just thought, this isn’t what I want. I didn’t see myself as being like them.
“But when I went to that free clinic and actually did work for people who really needed help, that was different. I was just doing patient intake, measuring the vital signs, and so on, but I really enjoyed it.”
Halfway through her sophomore year, she decided that she wanted to be a doctor. College suddenly became much more enjoyable. She knew what she wanted to do, and she wasn’t afraid to do the hard work necessary to get there. In her junior year, feeling the urge to broaden her horizons, she went to London and studied English history and literature, living in a flat with six other students. She came home to complete her last year at Western Michigan University and graduated summa cum laude in 2000.
* * *
Laura had decided that she wanted to do primary care in an inner-city population. She wanted to give the kind of care that had meant so much to her mother during her breast cancer treatment, and give it to the kind of population she had seen in the free clinic.
She interviewed at the three medical schools in Michigan. Again, for financial reasons, she couldn’t look at schools all over the country. Wayne State University School of Medicine was the first to accept her, and because she was a Michigan resident, it was one of the least expensive. She immediately committed.
As had been true of college, the first year of medical school meant difficult adjustments. She was a country kid who had never lived outside western Michigan, and now she was living in one of the toughest urban areas in the country. “I was pretty sheltered,” she says. “We had made very few trips to the eastern side of the state. I can remember going to a baseball game when I was young, and asking my parents why these people were on the street. It was the first time I had ever seen homeless people.”
She describes living in Detroit as “eye-opening, and a little terrifying,” but came to really enjoy it. And over the course of that first year, she learned how to do the type of studying that learning medicine required. “I struggled a bit, and definitely wondered if I had done the right thing,” she says. “But I found a core group of friends who were very nerdy like I was. We studied in the basement of the library every night. Once I had that group, things got a lot better.”
* * *
Just as Laura found her research experience in college a disappointment, she was disillusioned during her third year of medical school by her clinical experiences in primary care. “I did all my primary care first, and it just wasn’t what I was looking for,” she recalls. “It didn’t feel like I was helping anybody. It didn’t seem like there were solutions to most of the problems that people actually came in with. So I was pretty worried.
“And then, at the very end of my third year, I did my surgery clerkship. I did trauma at Detroit Medical Center, and I loved it. I don’t know why, but I just loved it.”
Laura started thinking that she wanted to be a surgeon and was only mildly discouraged by well-intended advice that she should look for a less-demanding line of work. After all, she had received and ultimately ignored recommendations to avoid “the hard thing” before. When she was in high school, she told her guidance counselor she wanted to go to college and do research. The guidance counselor responded, “You can never go wrong with secretarial school.” In college, her advisor said, “Medical school is a really long road. It’s a hard life. It’s a demanding life. Why don’t you think about nursing?” Now in medical school, her friends and advisors were telling her that surgery was too hard and pediatrics was a better life.
Then during her fourth year, she watched a plastic surgeon do a breast reconstruction and thought, “That’s just amazing.” She had not even known what plastic surgery was. Someone told her, “If you really like children, and you really like plastic surgery, maybe you should check out pediatric plastic surgery at University of Michigan.” She signed up for an elective there and decided this was exactly what she wanted to do.
“I think it was the feeling that you are really fixing something each and every time,” she says. “But there is also a lot of counseling and clinic time with the families. There was this one surgeon I worked with, Haskell Newman, who was in his late sixties or early seventies at the time. He kept trying to retire, but the families were begging him, ‘No, please don’t.’
“That was because so many patients needed surgeries that were staged over many years, and there were always patients and families that needed him to stay on for one more year. He had watched these kids grow up and been with their families through all of it, through finding out that their baby had a cleft palate, through all the trouble of middle school, and so on. There was something about the continuity that really just clicked with me.”
Laura had discovered a field that blended what she liked from both primary care and surgery, and focused on a population of patients and families who were suffering deeply. It felt perfect.
“You should do this,” Newman said to her. “You should definitely do this.”
Laura was encouraged but worried that what she wanted was just out of reach. She knew that the odds of her getting into one of the premier surgery programs in the country (University of Michigan) from Wayne State were not good. (Wayne State’s medical school is ranked slightly below the middle of the pack of the 141 US schools, while the University of Michigan’s is near the top.) In fact, while she was on her elective at the University of Michigan, one of the leaders of the program said to her, “We’re really glad to have you, and I hope you learn something while you are here. But we don’t take students from Wayne State.”
“Great,” Laura thought to herself.
But the University of Michigan did in fact select her for its training program. Asked why, Laura says, “Because I worked my butt off. Hard work is hard work, and not everyone is willing to put in the time. They could tell how much I wanted it, and that I was never going to be a problem. I was always going to be super grateful that I had the opportunity. They had spent a month with me, and they knew what they would be getting. And they took me.”
* * *
And so by July 2004, Laura—the first person in her family to go to college—had made her way from a small university an hour from home to a gritty state medical school to one of the top surgical training programs in the country (where another trainee was Mike Englesbe, from Chapter 2). She would work hard as a surgical resident from 2004 to 2011, including one year doing research. During that year, spanning 2008 and 2009, she operated on rat mandibles, making little devices that would go under their jaws and stretch them. “It was terrible,” she says.
When it came time to apply for a fellowship in craniofacial surgery, she felt like the best fit for her was at University of Pittsburgh Medical Center (UPMC). It wasn’t one of the top few programs in the country in terms of prestige, but during her interviews, those top few programs felt like old boys’ clubs. She couldn’t help but notice that she was usually the only female among about 30 applicants on interview day for surgical fellowships, and when she looked around for female professors in those departments, she wasn’t finding any.
At UPMC, though, the feeling was different, more welcoming. The surgeon who would become her main mentor was gay, and there was a female faculty member already. The program seemed to be on the upswing, and there were close ties between the surgery departments at UPMC and the University of Michigan, with several faculty having worked at both. She signed on for one year at UPMC and immediately began looking for the “real” job that she would have after her fellowship.
* * *
Laura’s resilience would be tested during that year at UPMC.
During the fall, she interviewed at several places that anticipated funding a position, but weren’t able to make an offer when budgets were finalized in the spring. She interviewed at the University of Michigan, the institution at which she had trained, and accepted a position. She thought she was going home and was delighted.
But late in the spring, just a couple of months before her fellowship at UPMC was to end, she got a call on her cell phone while she was scrubbing for surgery. A nurse held her phone in front of her, and she could see the call was coming from a phone at the hospital at the University of Michigan. She ignored it, but then her phone rang again. It was the same number, and Laura decided she had better answer it. She was operating with her mentor, who said, “Yeah, absolutely, go take it.”
She broke scrub and went out in the hallway to take the call. She learned that the funding for her position had been pulled back by the department of surgery. The person making the call had been her mentor at the University of Michigan for seven years, and he felt terrible about it. Laura just said, “OK, thanks for letting me know. I’ll call you back when I know what I’m going to do.”
And then she went back into the operating room and resumed the rest of her day.
“When I get news like that, I tend not to have a very large emotional reaction,” she says. “It takes me a while to process things. I need to focus on getting my work done, and then I can let my mind race later.”
Laura was in limbo, highly trained but without the job she would need in another eight weeks. She was also out of money. “You make very little as a fellow, and you’re traveling everywhere to interview, paying out of pocket,” she recalls. “I started to look at doing locum tenens work, anything. I started applying for privileges at hospitals in the Pittsburgh area. I was going to be doing wound care and staffing low-level ICUs and emergency departments. It wasn’t the kind of work I had trained to do, but I needed to do something to keep the lights on.
“And then I heard that a position had opened up in Houston. My mentor in Pittsburgh said, ‘You have to go interview.’ And then he called Larry and said, ‘You have to interview her.’”
* * *
“Larry” was Larry Hollier, MD, one of the country’s leading plastic surgeons—someone with special focuses on craniofacial and cleft surgery as well as pediatric hand surgery. Larry is a meticulous surgeon, a highly respected expert on difficult problems like gunshot wounds of the face. He is high energy and intense. He has written hundreds of articles and book chapters, and given countless presentations. He has broad interests—and trouble saying no. As a result, he has been pulled into more and more activities outside and inside his institution, such as surgical training trips in Haiti, Africa, Central America, and Southeast Asia, and increasingly important roles leading care improvement at Texas Children’s.
All of this became relevant in the spring of 2012 because it was very clear that Larry needed help. Laura’s position at University of Michigan fell through at just the right time—just as Texas Children’s started spreading the word that it was looking for someone to join Larry. Laura flew down to meet him in late May.
Laura and Larry were both decisive. Larry knew he wanted her, and Laura knew she wanted to come within a week. She signed her contract on June 23, 2012.
“It was just an amazing opportunity, and I couldn’t believe my good luck,” she said. “Texas Children’s was the best-kept secret in the world of craniofacial surgery, and it was because they were so busy, they didn’t have time to present their data at meetings very often.” But now they really needed help. And Laura was ready.
* * *
When Laura joined the staff at Texas Children’s Hospital, it was already nationally known as the largest pediatric hospital in the nation with top-rated programs in several areas. A Harvard Business School case study on its program for care of congenital heart disease describes how Texas Children’s has organized terrific multidisciplinary teams to meet the full range of needs of children with these conditions. Part of that effort has been measuring PROMs and creating a culture of relentless work to improve them.
But that was cardiac surgery, not craniofacial surgery. Laura and Larry Hollier wanted to do for their patients what the surgeon-in-chief (a cardiac surgeon) had done for his. They wanted to measure the outcomes that mattered to their patients, and they wanted to organize great teams to improve those outcomes.
“The problem was that the outcomes that matter for our kids are different,” Laura said. “For example, with adults with cardiac disease, the most important outcomes play out in 30 days—mortality, myocardial infarctions, strokes. But for our kids it could take 5 to 10 years to really get any handle on what’s happening. And there are so few major clinical complications that you can measure, which makes it harder to demonstrate that you are improving.
“And the teams we need to care for patients must deal with so many issues,” she continues. “We have to ask, do they have a good dentist? Are they getting the right speech therapy? Is the family as engaged as we want them to be?”
Laura looked at the number of patients with cleft lips and palates receiving care at Texas Children’s—large by almost any other institution’s standards, but small compared to the number of cardiac surgery patients. “You need large numbers to answer these questions,” she says. “I thought to myself, my gosh, if they had just started collecting this information 10 years ago, we’d already have the answers to so many questions.”
It was frustrating to her. That was when she made her comment during her job interviews about the long-term work of PROMs data collection, “We need to start this right away.”
Laura made that comment to the surgeon (Charles Fraser) and nursing leader (Kathleen Carberry) who had led the congenital heart disease program development that was the focus of the Harvard Business School case study, so she had a receptive audience. “I was trying to sell them on why they needed me,” she said. “And I wanted them to know I was enthusiastic to get started right away.”
* * *
It worked out. Laura moved to Houston and immediately had plenty of patients. At first, most were overflow from the many patients seeking care from Larry Hollier or the other established pediatric plastic and reconstructive surgeons, but now she has plenty of patients who come to Texas Children’s specifically seeking her. The majority of her patients have cleft palate or lip, or other craniofacial anomalies. “Basically, I take care of anything that a child can be born with that makes them look different from their peers,” she says.
By the time Laura arrived at Texas Children’s, she knew that she was different from the big names in craniofacial surgery. They had established themselves by doing basic science research, studying how bones and other tissues developed, trying to get at the root causes of the diseases that affected their patients. Laura respected that work and is glad that she spent her time in the laboratory as a college student and surgical resident. Those experiences enable her to read papers and listen to presentations, and understand the questions that her laboratory-oriented colleagues are trying to answer. Such research may benefit patients who are not even born yet.
But Laura knows that what’s right for her is taking care of the patients who are in front of her right now. Like her colleagues who are doing more traditional research, she has the long view, but it’s a different kind of long view. She is looking way down the road for her patients and trying to figure out what will make their lives better a decade or so from now.
* * *
Here is how Laura got the idea of Camp Keep Smiling.
“One week in clinic, I was struck by two conversations I had with a couple of my teenaged patients,” she said. “They were talking about some of the challenges they faced at school. They said they didn’t have anybody to talk with about what it meant to have a cleft, and how they were treated.
“I thought back to some of the most challenging things I’ve been through in my life. I remembered how important it was at those times to have a friend who was either going through the same thing or who’d been through something similar. It helped just to be able to talk with them and feel like somebody understood what I was going through.
“Both of those patients had said they didn’t know anybody else with a cleft. Now cleft is fairly common, affecting 1 in 700 kids. But if you’re from a small town or from a small school, you may not know anybody else who has one.
“So I thought, ‘Both of these girls feel like they are alone. But I know so many kids who are going through the same thing. What if I could just connect them?’ So that was how the idea of the camp came to be.”
* * *
Part of Laura’s vision for the camp was that finances would not be a barrier for children or their families, so the first step was raising funds. Larry Hollier stepped right in and found the resources for his young protégé to get the project off the ground. It continues to get funded through philanthropy for at least one session a year, sometimes two. For a few years, Laura had a grant from the state to study interventions that might improve quality of life in these patients. Finding the funds is a perpetual part of the adventure, as are the three-day sessions themselves.
The camp is in Burton, Texas—about 90 miles from Texas Children’s Houston location. About 50 or 60 children come every year. The staff are all volunteers from Texas Children’s. There are nurses from the clinic, hospital floors, and operating rooms. There are doctors, surgical technicians, physician assistants, schedulers, and receptionists. The hospital allows employees to use a few days a year for volunteer work, so that institutional policy has helped make the camp viable.
Laura’s physician assistant, Michelle Roy, coordinates everything—and there is a lot to coordinate—contracts for the buses that transport the children to and from the hospital and the camp, insurance forms, and other endless paperwork. The detail work is offset for Michelle by the fun of the theme planning.
“This year we are having a rodeo theme, but other years we’ve done a Halloween camp with a haunted trail and trick-or-treating,” Laura says. The kids get a swag bag full of stuff that fits with the theme. We have a dance party on Saturday night that is probably overdecorated, but we really enjoy it. The staff is into it, too.”
Read the blog posts by campers, and you can’t miss the evidence that Laura’s sense of what her patients needed was correct. There is plenty of text about camp features, like “free ice cream,” and descriptions of how it felt to use a zip line for the first time. But buried among these paragraphs are sentences like, “Soon after arriving at camp, I met all of the people in my cabin and made tons of friends. It was cool to attend camp with other kids who have cleft lip and palate. I knew that every other camper (and some counselors) had similar experiences as me.”
* * *
As for Laura herself, the outcomes that matter are good and getting better. Laura recently was asked to become chief quality and safety officer for the department of surgery. That has meant cutting her clinical time back to 50 percent and concentrating her care on patients with cleft lip and palate.
Her family life outside work is as intense as life inside Texas Children’s. She has a daughter born in 2014 and a son born in the spring of 2019. When he isn’t helping out at Camp Keep Smiling, her husband is a researcher, studying alternative energy sources. “We have a crazy work-life balance, and somehow we make it all work,” she says.
* * *
I met Laura for the first time in 2015, not long after she had gotten the camp off the ground. I asked if she had to worry about the kids sneaking off in the woods and doing what teenagers do at other camps. She laughed and said, “Not so far. But many of these children have only been kissed by their parents. In a way, what you are talking about would be a good problem to have.”
Three years later, she emailed me to tell me that she now had the problem. “I mean, we’ve got 16-year-olds, and they have been coming back year after year, and staying in touch in between,” she says. “We make sure that the oldest boys’ and the oldest girls’ cabins are very far away from each other. The counselors are always sleeping by the door.
“We have a lot of ingenious ways of making sure that nobody leaves their cabins at night. Part of the decorations in their cabins include some kind of noisemaker that’s attached to the door, so we know if the door gets opened.
“We’ve never had any real issues. Our kids are very respectful. Everyone signs a code of conduct that they know they have to follow.
“But we do have three couples now from the camp. They are dating. Their families have met. They’ve been to prom together and to homecoming.
“It’s really very sweet.”
* * *
How many surgeons bring up prom dates when they talk about their patients’ outcomes? It couldn’t have happened if Texas Children’s had not already been interested in measuring PROMs, and if they hadn’t hired a young surgeon who really wanted to take care of her patients. She not only wanted to capture data on the measures that mattered to her patients—she wanted to change them for the better, even before the data started coming in.
She understood that there was a long game that mattered to her patients, and she was determined to be a player in it.