This week’s episode features a conversation with Dr. Ken Anderson, a physician, health administrator, policy advisor, and author. Dr. Anderson served as a medical affairs advisor on President Clinton’s National Health Policy Team, and is currently the director of the Executive MHA program at the University of Iowa College of Public Health.

Alexis Clark:

Hello, everyone. Welcome back to From the Front row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark, and if this is your first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today, I am joined by Dr. Ken Anderson, who for the last 40 years has had a very active career in healthcare to say the least. In 2018, Dr. Anderson published his first book, Saving the Heart of American Healthcare, How Patients and Their Doctors Can Mend a Broken System. He currently serves as a clinical professor for the Health Management and Policy Department for the College of Public Health, and is the director for the Executive Master of Health Administration program at the University of Iowa. Welcome to the show, Dr. Anderson.

Ken Anderson:

Thank you Alexis. It’s great to be here.

Alexis Clark:

So honestly, we could spend a full episode discussing your career path and accomplishments from physician to medical administrator to author. Can you give us a brief overview of your career path and all of the various hats you’ve worn across your tenure?

Ken Anderson:

Sure. Happy to do so. At times I look back on my career, it’s as evolved, and sometimes I speak with people and they say, “Could you just never make up your mind what you wanted to do?” There really is something far different than that. I will go back to a very early moment in my life when I was that [inaudible 00:01:35] nagging kid, that my mother was probably ready to just pull her hair out because at every turn I would always ask the question, “Why? Why does it have to be this way?” Or I’d ask. “How? How does this work?” Because I had this children’s curiosity that was just driving me on. I wanted to know more about the world and how it worked. So I carried that forward in every step, along the way of where I was. So I had a good opportunity when I was in high school to be an exchange student.

Ken Anderson:

And I was in an opportune area where there weren’t really great medical resources available. It was in the rural country in Costa Rica and the rural outback area. And my cousin and my adoptive family at that time who became ill actually died over the course of that summer. And I believe that it made such an impact on me that I believe it was because I didn’t see having good access to healthcare was something that he was privileged to have. So of course, in my idealized, 16-year-old mind, what my thought was, “Oh, this is simple. What I’ll do is I’ll go back to the United States, finish high school, go to medical school, do my residency. And I’ll move back here to Costa Rica and I’ll deliver care for people just like my relatives there that perhaps didn’t have good access to it.” Well, the twists and turns of a person’s life certainly happened.

Ken Anderson:

And I went and had a really good opportunity, I think, to participate in many ways, but have not yet yielded myself to that dream of going back to Costa Rica and delivering health care in the rural settings. I’m happy to report that access to healthcare in Costa Rica is now much improved from when I was there as a high school student. But with this basic thought about delivering healthcare for people who were in need is what really drove me along my career path. So I began at the university while I was an undergraduate student and after a brief stint my freshman year of thinking that healthcare routes for [inaudible 00:03:45], I fell in love with writing. So I started into the English department and became on a path that I thought I was going to be the world’s greatest poet until one day I woke up and I realized, I don’t think I’m going to be the world’s greatest poet.

Ken Anderson:

So better go back to plan one and go through the medical experience. So I did that. I had a great opportunity through my medical school years to get familiar with not only the nuts and bolts of how healthcare works, the physiology, the pharmacology, and so forth, but also a little bit about how healthcare is organized. And the more I studied it, the more I realized that someone needed to be an active participant in how healthcare was going to be delivered in a very human fashion. So I chose family medicine. I did a family medicine residency program, hoping that I was eventually going to end up in small town, Iowa, and I’d be a valued member of the community and help out people would access health care in rural Iowa. Well, I had fallen in love with the study of nephrology, which was the thing that I most disliked in medical schools. So the kidney diseases.

Ken Anderson:

I couldn’t figure out in medical school why anybody would ever want to do this. But I ended up doing an internal medicine residency and a nephrology fellowship before I started my clinical practice in Des Moines where most of my work was in adult nephrology, involved a lot of caring for patients in critical care settings. And I was pleased that I was able to be a transplant physician and help people find new life as they receive new organs, heart and kidney transplant program immunology is what my clinical practice entailed. Well along that line, I continued to go back to how healthcare was organized and I was fortunate enough to serve on the Iowa State Board of health, and then during my career as a clinician, I helped with the CMS oversight of four states dialysis quality. How we manage and satisfied the goals of people who were on dialysis in this four state area. And was very humbled to be recognized by my peers to be elected as chief of staff of the MercyOne health system in Des Moines.

Ken Anderson:

Well, there, I realized that while I had a lot of interest and enthusiasm, I needed a little bit more competency, a little bit more education. So I could interact better with boards and senior executives and so forth. And I had more than just the clinical chops, but I could also understand how things were organized. So I went back to school, got a Master’s in Administrative Medicine. And from there started my administrative career. While I was in Des Moines, had the real privilege of doing things from a policy point of view that were exciting to me, aside from just the membership on the state board of health. One was I had a chance to work with Senator Tom Harkin and a gentleman by the name of Steve Gleason, who was a family physician in Des Moines at the time on helping to advise the early phases of the Clinton health plan, the present national health plan.

Ken Anderson:

One of the things I think that was interesting to me at that time was how could we get those receiving care and those providing care to be in more proximity and address it through issues tied to compensation. And I felt that there were a lot of rules of the road that had been put in place historically that created a paternalistic healthcare system rather than one that was joined, where those delivering care and those receiving care could really unite and accomplish great things together. So I helped to originate the secure care of Iowa, which was the state’s first providing our own health plan where our providers bore risks, but then had a lot more say in actually how the construction was of the healthcare system, allowing us to really focus on creating our own engagement rules rather than having them given to us politically.

Ken Anderson:

When that was discovered, Clintons were interested in looking at different models of healthcare too. And we had an opportunity to advise related what would happen if providers were more deeply engaged with how healthcare was organized and structured. So through the course of the next 10 or 15 years, had an opportunity to do some work with provider road health plans. I served as a chief medical officer of a health system in South Bend Indiana and became the first chief medical quality officer of a large multi-system health system in the greater Chicagoland area called North Shore University Health Systems before finally ending at the American Hospital Association, where I helped to oversee the health research and educational trust. That was an organization, which was the research and education arm for the American Hospital Association. And in that capacity had the opportunity to advise literally thousands of hospitals in improving the care for their patients in their communities.

Ken Anderson:

And it was just a very exciting time to be involved with healthcare where you felt you could really help make a change. During this time, I kept going back to this opportunity space that I saw as a kid where I wanted to bring people together. So I had an idea that I had a trilogy of books in me that I wanted it to be able to tell stories around us. And so the first is the one you mentioned that I first published about saving the heart of American healthcare. And this is about how patients and their providers can mend this broken system. The second, which is one that I’m writing right now, is called Healing Values. It’s the value system that people bring forward as they both give healthcare advice and receive healthcare advice. And then the final book in the trilogy is about my father and cousin who both suffered from polio and in the course of their journey.

Ken Anderson:

So one final thing, I ended up in Iowa City because I was going to come here and write the second and third of the two books. On my way here, I bumped into a fellow by the name of Larry Prybil who was instrumental in programming in the College of Public Health. He was a board member of the American Hospital Association. And his advice to me was you are not moving to Iowa City to write this book, unless you promise me that you’ll be involved through the College of Public Health. And that’s how I ended up here teaching and then serving as the executive director for the executive MHA track of our health care program.

Alexis Clark:

Wow. See, I’m telling you, we can talk a whole episode on all of those items that you’ve mentioned. Just tying back to what you had said at the beginning, your interest in healthcare first was brought about because you were always asking why? Why does this work this way? Or how does this happen? Going to your why in healthcare, many say find your why, because you are going to be advocating and working with patients every day. So is that your why in health care or what would you say your why in healthcare is? And has it changed as you have progressed throughout your career?

Ken Anderson:

I think that that core part of my mission remains the same, and that is my belief that engaging in one of the most personal and intimate professions in the world, delivering health care. We have not great responsibility, but we have great privilege and opportunity to do something for the good of those visa. And so that began when I saw healthcare or lack thereof from my time as an exchange student. And as I move forward, that core part of my personal mission has remained the same. It’s still about interactions between one person who is in a very vulnerable state who might be worried about injury or illness, or how to stay healthy and stay well. And another person who’s designed with the information that he or she has to provide help and assistance. So that part of my core mission has remained the same. I will say this, that as I move forward in my career, I would say that instead of one to one relationships that I’m trying to spread this to, I’m trying to through a circle of influence, reached out to literally thousands of people to try to help them out.

Ken Anderson:

I have done that in the form of the work at the American Hospital Association, working with literally thousands of hospitals, trying to improve the care for millions of patients that they serve to providing whatever information, impetus, knowledge, stimulation I can to the students that I’ve worked with over the years to through kind of a second messenger. To encourage them, to get involved, to really understand the personal nature of what healthcare is all about and to carry that forward. So I would say that the why has changed a bit, but at the very core, it’s still the why of why is healthcare such a tricky and difficult profession and how can we do better to organize it and to bring the human side as our best foot forward every single time we have a healthcare.

Alexis Clark:

That makes sense. I just think people originally get into healthcare for reason X and then as doors open. And I think people evolve, maybe people’s why they get up and go to work every morning changes as well. So since you have had the privilege of working in multiple capacities with at the state level and the national level implementing more effective healthcare policies, did you notice differences in ideals or motivations when working with these different governing bodies?

Ken Anderson:

Yeah. You know, I will just tell a humorous story about myself when I had gone back to get my master’s. I did an internship with [Dr. Fitz C Woolen 00:13:44], who was a deputy HHS chief, and he was just a very kind and open sharing individual. And so he was interested in getting me involved with care policy. He had known I’d done some work with Senator Harkin. He’d known I’d some work with setting up this first provider on a kind of a health plan and so forth. He said, “So you really should be involved with policy, help change at the policy level.” So in my time working with him in HHS, he would drag me off to meetings and we’d come out of the meetings. Then Fitz would say to me, “So let’s debrief. I’d like you to tell me what it is you learned today. What was really going on in the meeting.”

Ken Anderson:

So proudly, I would tell him everything that I heard and all the great ideas that were really coming forward and Fitz would say to me, “This is really interesting, but I think you and I must have been attending different meetings because none of what you told me that you thought you heard actually happened in there.” And I realized that policy in fact, was a unique experience. There were words used and sentences constructed and nonverbal communication used that I clearly just didn’t have the experience with it and did not understand. So I think that I realized early on that perhaps my best way of influencing healthcare was to really go out and try to help the people who were delivering and organizing healthcare at a local regional level, how they might best organism themselves. I will say this, I did have a great opportunity throughout my training to work with people from a variety of countries.

Ken Anderson:

And going back to my early childhood days when I told you that I was just a curious little kid, that curiosity never left. So I never missed an opportunity when I was working in a research lab, for example, with colleagues from Egypt and Italy and France and Great Britain and New Zealand to ask them about how healthcare works in their countries. Or as a resident, when one of my best friends was from Canada and ask about the Canadian healthcare system, how it was organized and so forth. Or later on, as I served as chief medical quality officer with a researcher who was from England had worked with the National Health Service to ask questions about that. And if there’s a few things that I think I’ve been able to glean, and that is we truly do in the United States have a healthcare system. A couple of words about it.

Ken Anderson:

Number one, it’s not very much of a system. It’s kind of a disorganized healthcare approach, but it can deliver the best of the best while at the same point in time, leaving behind some people who need it the most. And so this egalitarian approach to healthcare that we sometimes find in other countries like Canada is at times lacking. And I think that’s one of the lessons that I’ve taken away from this in looking at trying to influence healthcare I’ve taken, what are some of the best aspects of healthcare as practiced in other countries around the world and try to use those to embed in how we are trying to reconstruct ourselves here in the United States.

Alexis Clark:

If you go into a room and you have physicians, health policy analysts, and administrators, sometimes there can be a clash there. Whether it’s personality or drivers and making decisions. And you’ve had a taste of as of all three. So do you think you being able to relate at all three levels has served you well? Or do you think it’s made being in roles different because you could relate to all three?

Ken Anderson:

I’d say it’s a little of both. I know that when I went back to get my master’s after having been in clinical practice for about 12 years, the program director, where I was, gave us a role from day one. And he said, “The charge I want to give to you is that you are going to be facing a challenge of being”, what he called, “the bridge over people.” And he always in somewhat of a function of being a translator, how do you help people who are aligned in the very necessary business aspects of healthcare with those who are really directly at the sharp end of the care experience, delivering health care one-on-one with people and focused on things like how do I help Mrs. Smith get better from a hypertensive crisis or high blood pressure crisis, for example? But how do you, how do you span those conversations so that you can actually bring the best out in both and create what I have called third alternatives?

Ken Anderson:

It’s not this or that, but a combination of the both which enriches the depth of what are the solutions that are found. So I did find, I think, from having been a healthcare provider, it’s still in my heart. It’s still something that I see, I understand. And I hear back from my transplant patients with some regularity, even to this day that I still do find myself dropping back into that clinician’s role. When I think about the clinician’s role, it has to operate within a structure or a system, and it takes administrative people to be able to do that 24/7. A lot of people involved with provision of care and want to do that in the larger system.

Ken Anderson:

So they can perhaps focus on delivering care and not focus so much about organizing care. So a real necessary role for people who administer the healthcare systems. And so the complexities of the United States healthcare system mean that there has to be somebody who can run the thread along and unite people. And that’s how, I guess, I try to use is some of these lessons learned from the different position that I’ve been in national state policy, administrative work, provision of work and administrative care on an academic setting. I really think that’s given me a great opportunity to be that listening and understanding ear for people who come into a highly complex system that sometimes not necessarily hear each other very well.

Alexis Clark:

That is very true. I think active listening and understanding and growing as a professional, I think is crucial when making decisions that involve multiple entities. So as we briefly talked about earlier, you’re in the process of writing this trilogy of books. In 2018, the first one was published. You’ve been involved, I’m sure, in different research publications in the past, but how has writing this trilogy of books different? Does it mean more? Is it impacting you on a more personal level?

Ken Anderson:

That’s a great question. And I think that we have an opportunity to ask all kinds of questions in our lives. And some of them are very narrow and very focused. Some of them are very broad and some have the most hazy of possible answers that are there that just need to be clarified and some need to just have those answers clarified and captured in the form of stories to tell so that people understand and they get it. They get the idea and some exist fundamentally an unknown area where we don’t know even remotely where we’re going. But it’s science carries this in that direction. So I was really privileged to be involved with doing bench research where the area of my work was somewhat humorously, an area that only seven people in the entire world were really working on at that time. But technically it was called bioenergetics research.

Ken Anderson:

And it was looking at the models of how different molecules behave to generate energy within the organs of the body and how you’d modify those based on dietary factors and so forth. So a very narrow area, which was highly scientific in nature. The questions that I asked had to be very detailed questions. I had to be able to prove beyond a shadow of a doubt that this was the central factor that produced the results that we were seeing. I had to be able to graphically display the data so that people could understand. So that was one aspect of my career, where I would say that I was highly technical and very narrow in scope. And sort of you go all the way now to what my role is now in writing this trilogy. I am reconnecting now back to my time when I was at the University of Iowa an undergraduate where storytelling became really important way of communicating.

Ken Anderson:

So I’ve tried in the form of this first book to try to tell stories about how healthcare providers and those who received healthcare interact. In my second book that I mentioned called Healing Values, it’s all about the stories. About what people bring to the care experience and how their values drive them to act in certain ways and so forth. So that is all about telling a broad series of stories where we can actually illustrate the values that are at play at the bedside. How does this work and why does this work in this way? And then finally, the last book is really all about the story of my father and my cousin, both of whom had polio. And I wanted to tell that story to honor them, but also to show that folks who have been traditionally seen as having disabilities are incredibly strong people who have incredibly deep reserves, are resilient beyond belief. And I wanted to just be able to tell the story and to honor all people who have those kinds of perceived limitations, but really have such incredible strength below the surface.

Alexis Clark:

That’s great. I definitely need to grab a copy of the first book and stay up to date when you release the second and third. Because it sounds like a great story, especially coming from your lens, because I feel like you have a very unique lens that very few people in the healthcare world have with all of your different experiences. So looking at, as we reflect back, if you had to pick one aspect or accomplishment during your tenure, what has been the most rewarding?

Ken Anderson:

There are so many different ways of looking at so many parts of my career that I have found rewarding, but if I had to trace it back to that very first core principle that we’ve talked about today, and that is this human exchange. This very personal and intimate profession, that I was privileged enough to be able to be involved in. I think that helping someone who is scared and has so many questions about where to turn, that to me is a place where I always felt such an incredible privilege and reward. As I mentioned to you before, I still hear from patients of mine.

Ken Anderson:

And when I do, it’s like family. I draw back and I reconnect still easily with where we were and how we are. Catching up and realizing that we really were sharing something that was so unique. And so I guess I would say that’s probably the most rewarding part is that clinical care experience. Now, all the other things that I’ve had privilege also to do have brought me great joy, I have really enjoyed every aspect of what I’ve done. I’d say that is at the very core, the one that I’ve found the most rewarding.

Alexis Clark:

So on the flip side of that, what aspect or item has been the most challenging throughout your career?

Ken Anderson:

I think when you see an arc of what you’d like something to become, and if you find through a variety of interactions with people, a less than desirable interaction of wanting to get involved, wanting to be a part of this, that’s probably been the most challenging. So I have been a giant reader of people and love this idea about what makes folks tick, particularly as enough to change. Changing one’s mind and so forth, and trying to find ways of helping people to realize what’s the best that’s inside of them, of getting a unity of purpose. That has been a goal. And probably most challenging has been when I find people who are just not willing to participate. I’ve oftentimes separated people in a variety of ways. But two groups I’d like to just briefly talk to you about. One is a group that I call skeptics.

Ken Anderson:

These are people who they might want to come and listen to what we have going on. They may be skeptical about where we’re going and why we’re going to go there. But when given enough information, they become just absolutely deeply engaged. And I love working with those skeptics. On the other hand, I have had an opportunity to work with some cynics and cynics are folks that no matter what the justification is, the value that you’re trying to portray, they just have a very difficult time getting over their resistance to change in any fashion whatsoever. So that’s probably the most challenging is working with folks who are cynical.

Alexis Clark:

So moving into some advice, do you have advice that you’d like to give to the upcoming workforce in healthcare?

Ken Anderson:

I do. If I could give only one small piece of advice, and that is never forget that we are engaged, whether we are clinicians, whether we are administrators, whether we are policymakers, we are engaged in the most personal and intimate profession with such high stakes impact involved. That when people who are in need of our services, come to us, they’re looking for someone not only who has expertise, technical skills, but they’re looking for someone who brings the heart of their human experience with them when they come forward. I would say that if we could do one thing and then is unify around the care experience that we have had the privilege of experiencing all of this. Whether in delivering it or receiving it, we understand it at such a visceral level. At such a heart level. And if we could just remember to keep bringing that heart forward to me, that’s why I wrote this book, Saving the Heart of American Healthcare, because I really believe that it’s very core the best of what we have is when it becomes the best of human experiences.

Alexis Clark:

Yeah. I’ve read… Well, I honestly don’t remember who said this, but I really liked it. It stuck with me. We’re working to put the health back into healthcare, and I think that goes back to what you said greatly. But I should really figure out who said that first. I’m not taking the credit.

Ken Anderson:

In my book, I call out care with caring. And it’s sort of similar to what you said. And I think the idea is we can all come and deliver technically appropriate care. But when you experience care with caring, there’s a little extra feeling that you get from that. That you’re willing to engage. You’re willing to be a part of something greater than just yourself. And again, I’m talking about those delivery and those receiving care. And when we’re unified in that area where we experience care with caring, it just feels like it’s the right thing to be a part of.

Alexis Clark:

I really like that. So the last question we ask all of our guests on From the Front Row, and this can be in regards to any aspect of your life. What is one thing you thought you knew, but were later wrong about?

Ken Anderson:

Oh, if we have the next six hours, I will go through the litany of all things that I thought I knew something about and later able to find that I didn’t. But just tying it to healthcare, if I could, for a second. When I was a younger and more naive resident and fellow, I had a great opportunity to work in areas where I really provided outreach to people of all walks of life. Perhaps the best place that I could think of that I had a chance to experience that was at LA county USC Medical Center, which is located in east Los Angeles. And it’s a part of Los Angeles that’s very rich in its traditions and it has a lot of need. And so one of the things we did, I felt we were all reaching out and helping to fulfill the needs of individuals in these communities that I felt, this is what happens across all of the United States.

Ken Anderson:

This is what US healthcare is. We’re all lining up and we’re all helping people who need it the most. And I think that as I moved on in my career, and then in some of the policy aspects and so forth, I realized that that isn’t probably true. That we are probably working in less than a systematic approach to healthcare delivery. And then I think good health outcomes are probably equally distributed and not quite as available to all people. And so I went from being naive thinking that US healthcare workers are organized around all 330 million of us that are sharing this set of goals and ideals. And yet we have, as I mentioned earlier, the best of the best. And yet there are many people who are being left behind.

Ken Anderson:

So I think that’s one of the unfortunate lessons that I learned along the way, among many lessons that I thought I probably had the answers to, that I was wrong about. But this is one as it ties to healthcare. And that’s what’s caused me, I think, to keep fighting so hard, to help people who don’t have good access to healthcare or the available options in healthcare that others do that. That it isn’t really about the privilege of gaining access to healthcare, but it really is something that we should all have the ability to enjoy. And it is really a right of all of us as Americans to expect that we should have equal availability to healthcare. And I think I was incorrect about that from a very early on time.

Alexis Clark:

I completely agree with you. And I don’t know if naive is the right word, but yeah. I think almost that should be an expectation out of modern medicine, but unfortunately that’s not the case.

Ken Anderson:

I think you’re right. And I thank goodness that we’re seeing now a lot of people pulling along those lines. One of the great parts of my time when I was at the American Hospital Association, there was an association of community health improvement. It’s doing a lot of study on aspects of healthcare, as it ties to things like diversity and equity and inclusion, and beginning looking at populations who perhaps weren’t doing as well in interacting and having an interface with health care and a lot of publications now that are coming out about differences based on zip code in lifespan or access to care or overall health or overall satisfaction. I think now we’re really looking at this straight in the eye and we’re having to say, we’re going to have to face that really we are in a health quote unquote system that is unequal and that there are people that are being left behind.

Ken Anderson:

And I think all of our responsibilities is to try to do what we can to make healthcare just a little bit more available and accessible every day that we’re on this planet. So when I say naive, I think as somebody going through a healthcare experience in training and just not necessarily seeing that. I was clearly blinded by what I was seeing and just imagining the best of what’s in US healthcare. And we have the best in so many ways. And if we could just elevate what we have on the back end, where people are being left behind, it would do wonders for how I would feel we’re helping to solve the healthcare crisis in America.

Alexis Clark:

Yeah. That makes sense. Well, Dr. Anderson, I want to thank you again for coming on From the Front Row. This has been an excellent opportunity for me to learn, and I know all of the listeners I’m sure have enjoyed.

Ken Anderson:

Well, it has certainly been a pleasure. And I think that if we can all pull together a program such as this, where we almost sort of and unify around a thought is all of what I’ve been hoping for ever since I was about 20 years of age. So thank you for bringing me to this environment as well, Alexis.

Alexis Clark:

That’s it for episode this week, a big thanks to Dr. Anderson for coming on with us. This episode was hosted, written, edited, and produced by Alexis Clark. You can learn more about the University of Iowa, College of Public Health on Facebook. Our podcast is available on Spotify, Apple podcasts, and SoundCloud. If you enjoyed this episode, and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy, and keep learning.