The Power of a Shared Vision, Part 2

Sofia Ramirez

Alright, welcome back to "It’s Time," where we, ah, take on big questions about health systems, and occasionally tackle tongue-twisters. I’m Sofia, and joining me again is the endlessly curious and always entertaining, David. How’s it going, David?

David Caldwell

Doing great! Although endlessly curious makes me sound like a two-year-old who just learned the word "why," but I’ll take it. Hi everyone!

Sofia Ramirez

And before we dive in, quick disclaimer—yes, we’re using AI voices to host this podcast, but behind all the tech wizardry, there is a real person, Dr. Chad Swanson.

David Caldwell

Oh, absolutely. And speaking of real people, Sofia, last episode we had what I’d say is a pretty fascinating conversation about the power of a shared vision in health: equity, efficiency, and making it all work better for everyone. Sounds simple enough, right?

Sofia Ramirez

Simple in theory, complicated in practice, but, yes. Last week set the stage—big ideas, big challenges. Though I’ll admit, I kept saying "healthcare system" when I really meant "health system." Words matter, and that nuance? Well, it’s kind of a pet peeve of mine.

David Caldwell

Wait, really? That bugged you?

Sofia Ramirez

It did! "Healthcare system" makes it sound like we’re just talking about hospitals and clinics, when really, we’re talking about something bigger—the whole ecosystem of influences on health. See? Nuance.

David Caldwell

I think I’m learning more about your pet peeves than I ever signed up for. But I’m here for it. Okay, so before we get too far into today’s deep dive, let’s do a quick check-in. What’s been on your radar? Any good books, scandals, or... podcast-worthy rabbit holes?

Sofia Ramirez

Funny you ask. Lately, I’ve been glued to the discourse around RFK Jr.—his whole stance on public health and, let’s say, creative interpretation of science. It’s like watching a car crash you can't look away from. Also, I’ve been reading this book called "Blind Spots," which highlights some times when the medical establishment really got things wrong.

David Caldwell

Ooh, noted. I’ve got "Blind Spots" somewhere in my growing pile of shame—uh, I mean my reading list. For me, I’ve been keeping an eye on Erik Bricker over at ahealthcarez. His videos are so good at breaking down the business side of health. Also, they're like ten minutes long, so, win-win.

Sofia Ramirez

Oh, I love his stuff! He’s so quick but so sharp. Alright, we should probably get back on track. Today’s focus builds on last week’s, but before we dive into theory and systems, David, let’s make one thing clear—

David Caldwell

Stuff matters. Got it.

Sofia Ramirez

Exactly. We’re not just spinning ideas for fun here, folks. This is about the real people impacted by the health system—people who could avoid suffering, avoid unnecessary pain, if the system worked better.

David Caldwell

You’re absolutely right, Sofia. It’s about the people at the heart of all this, not just theory or abstract systems. Honestly, it hits close to home for me. Like, okay, have I ever told you about my uncle’s little misadventure with his health insurance? It’s a perfect example of what we’re talking about.

Sofia Ramirez

You haven’t, but it sounds like I’m gonna need popcorn for this.

David Caldwell

Oh, totally. So, my uncle, great guy, right? He’s in his seventies, retired, pretty healthy overall. But he gets this weird pain in his side, ends up in the ER. They run some tests—nothing life-threatening, thankfully—but here’s the kicker. Turns out the hospital was out-of-network for his insurance. He got slapped with an insane bill for, like, a few hours of care. The stress of the bill made the pain seem like a vacation spot in comparison. I mean, come on, the guy paid into insurance his whole life, and that’s the reward?

Sofia Ramirez

That’s the kind of thing that really gets to me. No one should have to deal with medical debt on top of being unwell—it’s absurd. And it’s everywhere. You know, my parents came to the U.S. with very little. I remember, as a kid, my mom avoided going to the doctor for years because she worried she couldn’t afford it. Even when she clearly needed help, she just... couldn’t justify the cost. It wasn’t until I got into med school that she even had regular check-ups. I mean, how many people are walking around with something totally preventable, just because getting care feels out of reach?

David Caldwell

Too many. It’s heartbreaking. And it’s stuff like that where you sit back and think, "How is the system okay with this?" So, what finally got your mom to trust that she could get care?

Sofia Ramirez

Honestly, it wasn’t just me. It was about finding a community clinic that worked on a sliding scale. They treated her like a person, not just a number. There’s a psychological toll that comes with navigating healthcare. When the system feels hostile or indifferent, you opt out. It’s safer to avoid it, even though, you know, it’s not actually safe at all.

David Caldwell

Right, right—and it’s not just adults, either. I remember talking to a friend whose kid developed asthma. They couldn’t afford the proper medication, so they rationed it. They had to decide if breathing or grocery bills were the priority that week. That’s not a choice anyone should have to make. It’s, um, it’s infuriating, honestly.

Sofia Ramirez

Exactly. And these stories—they’re not exceptions. They’re the rule for so many. That’s why we talk about systems. The system should make it easier to access care, not harder. It feels so backwards sometimes—

David Caldwell

And yet here we are.

Sofia Ramirez

Here we are. And it’s why I think reframing the conversation is so important. When we talk about change, we’re not just talking abstract ideas. We’re talking about helping people like my mom, your friend, your uncle—

David Caldwell

Oh, and everyone they love, too. The ripple effects are massive—it’s not just about one person, right?

Sofia Ramirez

Exactly. You fix one part of the system, and the impact spreads. That’s what makes this so challenging and so worth it.

Sofia Ramirez

It’s clear that these ripple effects we’ve been talking about don’t come out of nowhere—they’re rooted in a larger history of how the system developed. If we think about where a lot of this started, the 1890s were, well, kind of a turning point. Medicine, and health systems in general, began to focus much more on reductionism and mechanism—this idea that you could break things down into parts to understand the whole. Frederick Taylor and his principles of scientific management were shaping not just industries, but also healthcare.

David Caldwell

Wait, Frederick Taylor like, "Taylorism" Taylor? The guy whose idea of efficiency was timing people with a stopwatch? That’s the guy we let influence healthcare?

Sofia Ramirez

Exactly. Taylorism prioritized efficiency and standardization, which, sure, can be good... but it came with this intense focus on the parts instead of the whole. In health systems, that meant looking at diseases, symptoms, and processes individually, rather than understanding how it all works together in the context of the patient’s life or community.

David Caldwell

Okay, but doesn’t that sound completely opposite to what health should be about? I mean, people aren’t some, I don’t know, assembly line where you just tweak this or fix that and call it a day.

Sofia Ramirez

Exactly, and yet that’s where the tide was moving. Medicine and healthcare started adopting this mechanical view. You treat the symptom, not the system. Now, to be fair, it did push incredible medical advancements—seeing diseases as distinct entities led to vaccines, antibiotics, surgical innovations. But it also set the stage for some of the fragmented, siloed care we see today.

David Caldwell

Right, like pulling a single thread in a sweater but forgetting, oh, it’s all connected. So, when did we realize this reductionist view wasn’t cutting it?

Sofia Ramirez

That’s complicated because, in some ways, we’re still there. The shift away from reductionism has been slow, though ideas like systems thinking have gained traction. What’s interesting is that this reductionist period also coincided with growing roles for public health and, paradoxically, community organizing. But we’ll get into that more in another episode. For now, just know that—

David Caldwell

We leaned really hard into "parts over the whole."

Sofia Ramirez

Exactly. And it’s that emphasis—breaking things down into isolated pieces—that still echoes in today’s challenges. It’s deeply ingrained in how we approach care, research, and even policy.

Sofia Ramirez

And that brings me to this thought—if we’ve known for so long that focusing on isolated parts can create these issues, why hasn’t the health system’s ultimate goal shifted more fully to, say, health for all, delivered efficiently and holistically? Isn’t that what it should’ve been about all along?

David Caldwell

I mean, yeah. Isn’t that—uh—like the reason it even exists?

Sofia Ramirez

You’d hope so, but in reality, it’s often not the case. In clinical medicine, for instance, there’s this hyperfocus on episodes of care, treating each visit, each problem, as a separate task. Then you’ve got hospital systems, pharmaceutical companies, insurance corporations—

David Caldwell

Classic trio.

Sofia Ramirez

Right? And their primary concern? Profits. It’s not even hidden. It’s built into how they operate.

David Caldwell

Okay, but let me play devil’s advocate. Doesn’t every industry aim for profits? Like, I get the frustration, but, isn’t that just how the world works?

Sofia Ramirez

Fair point, but the stakes are different here. We’re not talking about making shoes or selling phones—we’re talking about people’s health. There’s an ethical dimension that shouldn’t take a back seat to profit margins. And then we have academic institutions—university health faculty? They seem more concerned with publications, grants, and tenure than, you know, systemic change for better health.

David Caldwell

Right—publish or perish. What’s the saying? "Innovative theory, but make it profitable, or it doesn’t matter."

Sofia Ramirez

Exactly. None of these priorities are inherently bad—innovation, funding, efficiency—they’re important. But when they become the only focus? That’s where the real disconnect happens. We lose sight of what we really want.

David Caldwell

So, what should we really want? Give me your big-picture answer.

Sofia Ramirez

A system that puts the idea of "health for all" front and center. Not as a footnote, not as marketing but as a genuine mission. And that shift—it starts with us, with the courage to raise the priority of the ultimate goal.

Sofia Ramirez

Thinking about it, if we really prioritized "health for all" like we talked about earlier—relentlessly focused on that—imagine the kind of system we’d create. It’d be, I think, unmatched in human history.

David Caldwell

Wait, unmatched? Like, better than the systems we see in countries with universal healthcare models? Or something even beyond that concept?

Sofia Ramirez

Even beyond that. We’re talking about a system that wouldn’t just ensure basic access or check the boxes easily quantifiable by policy makers. It’s about creating a system that fundamentally prioritizes health and equity—not just healthcare efficiency, though that’s part of it—health is the focus. And it’s not about copying or tweaking an existing model, but truly rethinking how we deliver health in all its forms.

David Caldwell

Okay, so basically this utopia-level system where we’re doing more than treating colds and broken legs—what, like, solving root causes on a systemic scale?

Sofia Ramirez

Exactly. We’re talking about making systemic changes so profound that we address health-related socioeconomic barriers upfront. Imagine a world where no one has to delay seeking care because of cost, or where your postal code doesn’t determine your life expectancy.

David Caldwell

Wow. Big stuff.

Sofia Ramirez

Yeah. And think how far that ripple effect could go. If the collective vision shifted—relentlessly—every decision a health leader, a doctor, a policymaker, or even a community member made would ladder up to this shared goal. But here’s the tricky part: the system needs everyone—patients, clinicians, administrators, regulators—to buy into that vision and work towards it every day. Relentlessly, like I said earlier.

David Caldwell

Okay, I hear that and I’m impressed. I am. But let’s, um, pump the brakes for a second. What would focusing “relentlessly” actually, you know, look like, on the ground, in practice?

Sofia Ramirez

For starters, it’d mean questioning every norm that exists today. Every decision—every hiring choice, clinical guideline, policy, research grant—you name it—would need to be evaluated against that vision. If it doesn’t align, it shouldn’t proceed, simple as that. It’s about clarity. And the courage to say no to things that don’t fit the bigger picture.

David Caldwell

So, like, dismantling the status quo? For some people, that’s gonna sound terrifying.

Sofia Ramirez

Oh, absolutely. Comfort with the status quo is part of what’s holding us back, even though so much of it isn’t serving us. Transformation isn’t comfortable. But it is necessary. It’s about moving beyond just tolerating dysfunction into reshaping the entire landscape, for good.

Sofia Ramirez

Alright, so following from what we talked about—questioning norms and reshaping the system—it’s critical to drill into specifics. Every conversation we have, every hiring decision, clinical encounter, health course, policy decision, licensing requirement—everything must align with this shared vision of health, equity, and yes, efficiency. It’s a tall order, but that’s the relentless commitment we’re talking about, right?

David Caldwell

Yeah, kind of massive. But at the same time, it feels so... obvious? Like, of course, that's what we should aim for, but clearly, we’re not even close yet. So where do we start, then?

Sofia Ramirez

We start where we are. If you're a nurse, you start there. If you're a concerned citizen, you start there. If you're, I don’t know, a podcast host with endless questions—

David Caldwell

Hey, I resemble that remark!

Sofia Ramirez

You know what I mean! The change doesn’t have to start with sweeping overhauls. It begins with individual choices made by all of us in our daily roles—however small or large those might seem. You know, the system isn’t gonna fix itself. People fix systems.

David Caldwell

Right, and that's where this shared vision comes alive, huh? Like, if enough people keep calling for it, working for it—relentlessly, as you said before—it’s kinda like... collective momentum builds. Okay, so help me out here—this shared vision is just one piece of the puzzle though, isn’t it?

Sofia Ramirez

Exactly. It's the foundation, but it’s just the first of the three principles that we will talk about in the next couple episodes of this podcast. The second is becoming what we call "systems stewards"—people who understand the complexity of the system they're part of and can navigate it toward better outcomes. And the third? That’s connecting and converging around those all-important leverage points—the places where a well-placed effort can spark real, system-wide change.

David Caldwell

Okay, that sounds powerful. Maybe even doable? But it’s definitely a shift in how most people think right now, right? I mean, this isn’t just about one person marching into a hospital and flipping a switch.

Sofia Ramirez

No, not at all. It’s about creating and sustaining momentum at every level. And the thing is—we can do this. With enough people holding onto this vision and contributing in their roles, transformation becomes not just possible, but inevitable.

David Caldwell

I like that. "Not just possible, but inevitable." Alright, I’m sold. So, what’s next?

Sofia Ramirez

Next, David, we all take what we’ve talked about here—this shared vision, systems stewardship, and strategic convergence—and we bring it into action. But for now, how about we let our listeners reflect on all of this? It’s a lot to take in, and maybe, just maybe, they’ll feel inspired to start wherever they are.

David Caldwell

I hope they do. Alright, folks, that's all we’ve got for today. Thanks for tuning in and exploring this vision for health systems with us.

Sofia Ramirez

Yes, thank you all. And remember, transformation starts with a shared vision. We can do this. On that note, take care, and we’ll see you next time.