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Lawrence R McEvoy II MD, Epidemic Leadership

An emergency physician, healthcare executive, and entrepreneur, Larry’s diverse perspective renders him an inspiring, design-oriented leader, strategist, advisor, facilitator, and speaker. His extensive track record of real-life strategic and operational results—and a unique facility with ecosystems, neuroscience, social intelligence, and human networks—helps you understand and capacitate entire systems, small and large, to optimize performance, adaptation, and vitality.  He has wide experience in shaping the challenges of our complex times into outstanding results, rapid learning, and energized professional cultures.

Larry’s mission is to deepen the vigor, resilience, and sustainability of leaders, the people they lead, and the organizations they create. Particularly focused on the shared work between executives, clinicians, and clinical leaders, Larry’s experience as both a CEO and a clinician deepens his skill in facilitating dynamic shifts in mindset, method, and performance. His background as a strategic innovator and “designer-in-chaos” has led him to increasing work outside of health care as organizations and corporations seek to create value via both stability andrapid reconfiguration in environments of velocity and volatility.

His career has comprised the renewal of multiple environments of distrust, stress, and dispirited dynamics.  He focuses on creating a practical approach to the acceleration of systemic shifts in results, adaptation, and professional vitality; the linkage between leadership evolution, stewardship ethic, and business value; and the activation of “positive epidemics” through the understanding and application of complexity principles, network science, and neuroscience.  As one of his clients puts it, “I learn more from him in an hour than I do from anyone else in a year.  His emotional intelligence is off the charts, and his strategic acumen is of the highest order.”

From 2008 to 2012, Larry served as the CEO of Memorial Health System in Colorado Springs, CO, facilitating a $100 million turnaround, the emergence of a culture of collaboration and commitment, and Memorial’s transformation from an at-risk and unfunded municipal hospital to the threshold of its merger with the University of Colorado Health system. Prior to that he was a senior executive and emergency physician at the Billings Clinic in Billings, MT, from 1995 to 2008. He completed his training in emergency medicine at Hennepin County Medical Center in Minneapolis, MN, in 1995. After earning a BA in English Writing from Carroll College (MT) in 1987, Larry graduated from Stanford University Medical School in 1992.

He serves as an Executive-in-Residence at the Center for Creative Leadership and as a Principal at Brenva Group. He is on the faculty of the American Association of Physician Leaders,The Governance Institute, and The Leadership Development Group, and has presented at the Conference Board, The Executive Development Roundtable, and the American Medical Group Association as well as at numerous health care organizations nationwide. He co-founded PracticingExcellence, a web-based professional collegial community which focuses on the clinician experience as the foundation of healthcare performance, patient experience, and meaning.   Most recently he has founded Epidemic Leadership, where he focuses on the executive work of creating organizations of exponential health and vigor—where performance, learning, and vitality rise in parallel and are abundant, infectious, sustained and sustaining.

As a life-long horseman, outdoorsman, and biologist at heart, he can be found—or not—taking in the beauty of his mountainous homeland in remote parts of Colorado and his boyhood haunts in Montana.

Larry is interviewed by Gary Gunderson.

Gunderson: We’re talking with Larry McEvoy here at the Governance Institute faculty on a different track. Extraordinary life as an emergency room doc, CEO, teacher of CEOs, and a student of complexity and emergence. So for all these reasons we’ve resonated on contact. I want to talk a little bit about the beginning, what you learned about life by building habitats in Montana as a kid.

McEvoy: Yeah. When I was real small I actually lived in the Twin Cities. My dad grew up in St. Paul, Minnesota and he was a internist, so for a time he worked at the Indian Health Services on the Cheyenne River Indian Reservation in South Dakota and then in a suburb of Minneapolis and St. Paul.

When I was real small what I remembered was that the suburb we were in was new and they kept building in it, so there were a lot of wetlands that would get road graded or turned into a road or a cul-de-sac or something. My brother and I would prowl in these things. We liked to find sunfish nests and salamander larvae and garter snakes and redwing nests and all these things that you find around wetlands. Then we’d show up one day and loud machines and a lot of mud and dust and all this life sort of scrambling to try to find another spot, so we used to fill ice cream buckets with turtles and salamanders and minnows and frogs and all this kind of thing. As little boys we would want to sort of find them a safe place. You know, if you put a frog in a bucket or a snake in a glass aquarium and all of a sudden you realize, boy, it doesn’t look right here. This won’t last for long, right?

So I found myself without thinking about it until many years later always out in what was then the back yard trying to create a little weed patch in the corner where there wasn’t Scott’s Ortho-Turf, perfect monoculture green grass, some place where these animals could live and thrive. We think about building islands and wetlands and native vegetation. And I was too young to even comprehend kind of what the elements were.

But years later, when I was older and in the emergency department I sort of had flashbacks of this. As a kid I wanted to be an ornithologist and work in the Amazon. So I always had this fascination with life. Biodiversity wasn’t just amazing in its sort of multitudes and its variability, its constant surprises but also just the beauty of it, the beauty of it visually in terms of what bird songs sound like in the spring after you’ve been locked up all winter but also the beauty in how it functioned.

I remember as an emergency physician—young in my career, so well trained but having not been out a while—the odd dichotomy between the elegance of the physiology in front of me, the way that… Let’s face it, doctors and nurses don’t cure pneumonia. We introduce medication, one small little nuance in the system, and then a human body, which can also be described as a hundred trillion cells, manages to recalibrate itself, say thank you, breathe better, and walk out the door, which is kind of an amazing thing when you think about it. Right?

Gunderson: Most ER docs don’t talk about what they do that way.

McEvoy: No, we’re sort of trained in medicine I think in general, and I think it’s true in nursing, I think it’s true in healthcare, really kind of mechanistically. We’re very linear in our cause. Cause A or problem A and there’s fix it solution B, and when you put A plus B together you get result C, and that’s the way it goes. I think that’s not wrong, but I think there’s a trap in thinking that data explains everything, we can track everything, we can predict everything. I’m interested in predictive probabilities. If you set up the right environments, set the right conditions, you may not know exactly what will happen, but you can predict or expect that good things all of them surprising will happen.

What was interesting is I was taking care of patients and thinking about how do we get our team to do the same thing. How do we self-adapt, self-modulate, constantly renew ourselves, both in terms of our performance as well as what we’re learning as well as our vitality because it’s tough to work in chaotic situations, which everyone in healthcare knows these days, and to be honest, everyone outside of healthcare is feeling as well. We live in very chaotic, high stress, high squeezes times. What I became interested in was that the way we put our human environments together wasn’t the way the human body worked, it wasn’t the way ecosystems work.

You mentioned Montana. I moved there when I was small. After the frogs and snakes, out West we went. Initially, I thought along with my brother—I was actually the oldest of four and my sisters I think have this too, but my brother and I were sort of fixed at the hip. All of a sudden we were released under this bigger, wider landscape, fewer bulldozers, bigger mountains, more rugged country. We grew up sort of seeing this, and it was at first just amazing. Then the more we looked the more we realized this environment is pretty banged up as well. Everywhere we look human body or otherwise any biological environment, whether it’s human or what we call the outdoors, we’re in, it’s out, must be different than us are in a constant state of renewal and decay at the same time.

If you want to get really scary about this, the core of the whole universe is heading toward entropy. But biological systems whether they’re humans or an ecosystem or a human team can renew themselves, and that renewal can be described metrically. Is your blood pressure better? Are the team’s outputs better? Are you making more money? Can you create more board feet of timber per acre over time? We can also describe them in terms of adaptation. All biological systems, all organisms adapt. If they don’t adapt, they’re literally dead or going to be dead because the world around them will not stay the same. Some of those perturbations may be annoying. It’s windier now, and you don’t like wind in your eyes. Some of them may be lethal. It’s 30 below zero, you don’t have any clothes on, and the wind is blowing 30 miles an hour. If we don’t adapt, we don’t last very long. I think our vitality and our ability to adapt are clearly related to each other.

What I found interesting was that the way we built our organizations wasn’t really along those principles. That sort of makes sense to me if you’re building tires or running an account firm, you have to dig a little harder maybe to understand that even though you’re doing things that are not human or not alive, tires for example are not alive, you’re nonetheless a living system. You’re a team of people running a tire shop. In healthcare, I really thought it was odd that here we are, all of us focused on helping people get healthier, whether that’s reversing damage, delaying aging, getting back on your feet and on your own. Whatever way you wanted to look at that, we’re talking about renewal of biological system in one way. The biological system in that case being the person, the patient, or the people, this group of patients, this thing we call a population.

Yet, when we looked at how we worked we were working more like machines, and we were wearing out. We weren’t adapting and changing very well. And I didn’t think we were performing very well either. Early on in my career, I got really interested in this question, “How do you help a biological system?” And that maybe was my bias initially. I looked at us less as a shift or a company or an organization or a series of org charts and more like an ecosystem just because of the way I was raised and embedded, if you will. Too much time outside maybe.

Why is it we’re thinking that way? Why is it all about spreadsheets and protocols and not about biological dynamics?

Gunderson: You were running the ED department in a tough town, became CEO.

McEvoy: Magic transition.

Gunderson: Magic transition.

McEvoy: Yeah, a rock turned into a bluebird.

Gunderson: Thinking this way. That’s a hard job in any case, but especially challenging when you think so radically different. Did these principles work? Did the organization work?

McEvoy: Well, what I found is they work floridly and they challenge radically. I learned early on in my career that my curiosity for how do we help things go better. How do we help learning become more accessible and spread easier? How do we help vitality come into these systems, the team? How is the team happier at 7:00 a.m. instead of 11:00 p.m.? It was a really valuable thing to think about and tinker with, but it was also an unnerving thing for people to talk about. Because they’re already moving under stress, and when you introduce an idea that’s different, that can create more stress.

I certainly enjoyed thinking about it and talking about it with other people, but I started to spend more and more of my time thinking about ways to design interaction. The way I thought of it is everything in an ecosystem, every cell in the human body, has some way of staying connected to the others. Either they bump into each other or things like hormones are running through your bloodstream that are sending certain signals or your body is subject to sunlight or wind or something. It occurred to me that a team was kind of the same way. They were bumping into each other, and every time they bumped into each other something would happen.

There were effects on the team. All of a sudden a busload of people came in at 11:00 p.m., and you were already busy. No one person/particle could control that. It’s like sunlight hit us all at once. I started thinking less about talking to people about that and how do we begin organizing the way people bump into each other. Just imagine marbles in a jar or sodium and chloride in a beaker. If you started bumping things together, why would we leave that to chance, that when they bumped into each other it was something that didn’t allow them to gain greater insight in how they might perform, the results metric thing, make it worthwhile, how they might learn something, and how they might feel more alive, not less alive.

It was a little shocking what happened. These are not unilateral things, Gary, so I don’t want to imply that I did this because that doesn’t work that way. In our ED when I started, I liked to say we were the third-rate ER in a two ED town. I mean, it really wasn’t a happy place. The nurses told us if we were good doctors we would leave, and if we were bad doctors, we would stay, which is an interesting kind of boundary function to lay down. Right?

Patients weren’t happy. The people who… Our numbers were low because the “marketplace” didn’t think we were that good. The physicians in the organization who were not emergency physicians didn’t think we were that good. We were a marginalized underperforming environment bluntly. We had a conversation one day early in my tenure in that era, not necessarily sponsored by me. But the organization had rifted about 10 percent of its people, and we were politically weak, and so we lost people. We were having a conversation one evening all of us, 85 or so, is this worth it or not. Should we just go? A few people did leave. They had had it in their long time, and this was the last straw for them, but most of us decided to stay not being because we were afraid we couldn’t get a job somewhere else. But for whatever reason that was our piece of ground that we wanted to turn into something worthwhile.

Three years later it was a place where the patient satisfaction was in the mid-90s percentile wise. There was a one-year waiting list for nurses to work down there. It wasn’t any more if you were a good doctor, you’ll leave, if you’re a bad doctor you’ll stay from the nurses, it was let’s make a bet you’ll all be gone within 15 years. I made that bet by the way, and I won it 15 years later when several people had stayed that long from the physician side. But it was interesting that you’ll go if you’re good, you’ll stay if you’re bad had turned to, “Well, you’ll stay 15 years and then you might go.”

How did that happen? I can’t say there was a grand plan. We were young. We just knew we wanted a better environment, and we wanted to feel good about what we did, and we somehow pulled it off. Now looking back, I can see sort of the elements that made it work as well as a lot of mistakes and things we could’ve done differently. For me in this whole arch toward, if you will, CEO’ness or executive leadership or maybe beyond that, what does transformation to leadership look like these days, it really sort of lit my fire that, hey, you actually can create environments. You can design the conditions. You can design how people interact, and you can design how those patterns diffuse. If you’re really good, you don’t design them, they are designed by people who are doing the work.

That probably sounds good to people in an HR kind of sense. That’d be good for engagement. It was good for engagement, but really this idea of collective intelligence, I think, is finally emerging as the currency of the 21st Century. We’ve got big problems right now. With the social platforms that we have, social media platforms and the ability to move knowledge and ideas quickly, we see a lot of banal stupid stuff flying around those things. One of the things that cloud computing and big data and social media platforms I think have helped us understand if you’re thinking that way is this isn’t about influencing or gathering a bunch of observations in a big spreadsheet and building pivot tables that can have predictive or analytical power beyond what one person could with a pencil and a couple of Excel workbooks, this is really now about realizing that hive intelligence, collective intelligence, can be designed. If it’s designed on the right ethic, stewardship and creativity and generativity, doing good, you can get a lot more done a lot sooner, a lot easier than you can by yourself.

By the time I had been in this work awhile and I was the chair of the department for a while, and then I was a physician executive in the organization where I was, it became clear to me that we’re still going to keep doing mechanical things. Some of that’s just the basics. You’re going to keep your numbers as a healthcare system on spreadsheets and certain accounting principles, and that’s great. But the thinking, if the thinking can be more biological, how do we do what biology does every day, which is create amazing things that start very small? I don’t care if it’s an acorn or a human embryo. I always like to describe sex this way, and it’s probably a racy version of this podcast for people.

Gunderson: Cool. Let’s go there.

McEvoy: If you think about fertilization, there’s one meeting. Mom and dad got together. We don’t know much of that meeting. It was theirs, right? They didn’t take meeting notes generally. All of a sudden there’s a habitat called a uterus and two half complements of DNA are now one integrated brand new never been there combination, never will be again by the way, and yet shockingly similar to all the other half DNA pairings that have been with all these other meetings we don’t know about. And really all that happens in this rich environment it supplies oxygen and blood and the right temperature control. Temperature control by the way really important for biological systems. All of a sudden multiplication begins, and it goes and it goes and it goes. When it goes long enough, then multiplication and differentiation begins.

It’s not just a cell, it’s one of three germ layer types of cells. Those cells begin to stream and move around. As they stream and move around and get organized, the way that they bump into each other, the way they interact with all sorts of factors we know and don’t understand, they begin to differentiate even further. Some turn into muscle and some turn into skin and some skin cells turn into fingernails. All of this sort of florid differentiation takes place, and this is baffling to describe, but it’s so common it’s boring. Thirty-nine weeks later, out comes a human. This has not happened occasionally. This does not happen with sort of a fifty-fifty, “Well sometimes it’s a human, sometimes a frog, sometimes it’s just like an old dead log,” every single time out comes a human being.

You’re like, “How does that happen?” I mean, look at the replicability. Now someone’s going to say, “Well, you got birth defects.” Of course you do. For the Six Sigma people out there, the level of deviation from healthy human to something else is very, very small. Do we actually lead that way? Do we actually say, “We trust how things self-organize, and we know how to facilitate self-organization both by being intentional and by being out of the way enough and not trying to control it, that we trust this is how you can lead radical evolutions of performance, variation, innovation, consistency, fidelity, reliability at the same time in an organization”? I think we’re seeing that’s possible, and I think it’s a challenge to people.

Gunderson: You call this epidemic leadership?

McEvoy: I do. Right. My colleague Laura Quinn from the Center for Creative Leadership had a chance to watch this happen during my CEO tenure where frankly we got a lot more done. When I say “we” I don’t mean Laura and me, I meant 5,000 people who were used to sort of being boxed in and then learned, wow, we can be not only better than we thought and prove it and start learning more easier everywhere than we thought, we can enjoy it. If we link those things together and link them together not just to the level of intention, we want to perform better, we like to learn more, we’re curious, and we want to feel better, but actually say how do we design our environment so that that happens. We’re not exactly sure what will happen, but we’re going to focus on how we design, how we interact, how we design context and how we multiply, something amazing will happen. That’s really what epidemics do.

We don’t like epidemics because they threaten us. Every year we plan for the flu, the CDC cooks up its best, they do a marvelous job. We look at all this DNA sequencing and epidemiological data, and every single year the flu comes and it hits us. It basically says, “You’ve got your way of doing things. We’ve got ours.” Ebola does the same thing. It comes out of the African jungle from a reservoir we think we understand, but we’re not really sure. It picks its time and place. It’s highly impactful, lethal. It jumps easily into you and then from you again as it multiples in your body. It crosses oceans without passports, and it starts national or global media campaigns without so much as a marketing expert, not one FTE.

You think about that. What is our response to things like the epidemic of depression, of opioid addiction, of domestic violence, of diabetes, of cardiovascular disease, political dysfunction, warfare on this planet? I’m not saying we have a cure-all, but it seems to me if you want to take these things that can really root into our population and spread under our radar, we need to start thinking that way in a positive sense. What does a positive epidemic look like? I think leadership in this, if you will, cloud era is really understanding biological systems, not just at the level of metaphor. When you take a bunch of humans and put them on a football field or an orchestra pit or a school or healthcare organization, they are not like a biological system, they are a biological system.

What makes this interesting to me is that if you throw technology in the mix, it can be tremendously un-biological. It can take what’s going on in healthcare with sort of a psychic, cognitive, and neural wear and tear it puts on it to be lined up in this mechanized clicking that we do all day long. Technology nonetheless is more and more being built on ecological principles. The app store is an ecology. Cloud computing is hive intelligence. In a way if we’re thoughtful about it, I think there’s the opportunity for leaders to start thinking about mobilizing social intelligence in a way that has unbelievable impactful power, and that means really your job as a leader is to foster social contagion.

Gunderson: Jonas Salk at this time would both burst out laughing and applause.

McEvoy: Other people laugh at me often too and applaud.

Gunderson: He would burst out laughing because of the way that the intelligence of the universe is expressing itself in your findings. He had the idea of “epidemic health,” which is perfectly synchronous. One of our leading cause of life fellows, Dr. Heather Wood Ion, worked with him for years around much of this concept, and so you’re expressing another outbreak of the positive contagion of thought.

One of the other ones I didn’t realize we had in common, but we do, is Dr. Arvind Singhal-

McEvoy: Oh, yeah. Arvind’s a great guy.

Gunderson: … in liberating structures, positive deviance. Connect that dot for me because a number of our folks have heard that podcast.

McEvoy: I have not listened to that podcast. Arvind is a friend of mine-

Gunderson: You pretty much know.

McEvoy: Yeah. Arvind’s thing is about really I would say… Arvind’s idea of an infectious particle is the story, and he’s right. There’s a reason why cultures without written history nonetheless have very strong DNA that goes across lots of generations and defines their identity. That’s because they tell stories, and stories are sticky. Any good infection is sticky. When I run into it, it sticks into me very easily. Influenza is a great example. You breathe a few of those particles in, and it sticks to your respiratory epithelium, and, boom, it’s easy. A good story is very sticky. A good story is very spreadable. You think about it, you’re like, “Oh, that’s a great story,” and before you know it you’re telling it to someone else, “I heard this great story today.” It leaps as well.

I think what Arvind and I share is an idea that if you can get everyone in the mix listening to stories, telling stories, seeking stories, things begin to travel, and a story changes as you tell it, and yet it stays the same. One of the qualities of biological systems is that they’re enormously stable and they’re enormously adaptive, both, but they’re not rigid, and they’re not flimsy willy-nilly. Frogs don’t turn into snakes overnight. There’s this identity function that happens. That’s really what we need in our organizations. You need identity. You need to stay who you are, and you need to be constantly changing if you’re going to get that grocery list of things done at the utilitarian level. People need that too. If we’re too stable, we’re bored. When things are too wacky, we’re stressed. We’re sort of cognitive refugees on the run all the time from all the stress.

Arvind just does a wonderful job, I think, in his work around the world and his work at UTEP helping people think about how do you build community by involving and inviting everyone with their story and bringing a story to them that, again, isn’t so much a one way thing but is “What’s your story?” Right?

Gunderson: I wouldn’t be surprised the intersection between positive deviance, liberating structures, leading cause of life, stakeholder health, I think we need to throw in an epidemic and gather on the border next winter.

McEvoy: I would love to do that. In our other conversations before this podcast you heard me say that I think that the 20th Century maybe was the industrial era’s crowning century of industrialization and mechanization. It’s how we propagated our wars. It’s how we build companies. We had mass marketing for a while. Now we’re realizing that the operating system on this planet is fundamentally biological. That operating system isn’t something that’s an option for us, it’s the way we are. We are biological. A hundred billions neurons in our brain, a hundred trillion cells in our body, we are an ecology of biologically interacting parts.

By the way, there are more bacteria in our gut by far than they are cells in our body, so we’re really not even one entity. We’re these collections of ecologies. We know in our wider world if we disrupt the biological dynamics, we’re going to pay a price for that. Some people are apparently still arguing about that, but they argue about the world being flat too. We’ll see in this century how well we collectively, and how well leaders, I think, respond to this idea that really our job is to sponsor an epidemic of participation of insight, of stewardship, of connection. Will we use that map, if you will, to “get things done”?

Gunderson: Help us finish on an encouraging note, which is the 3,000 acres in Montana. What can that tell us about hanging in our work?

McEvoy: I’ll go back again to the way I was trained as a physician, and I’m not knocking the way I was trained at all. I think it’s more paradigmatic. It certainly wasn’t personal because I like great mentors. I was trained to be an expert. You have a problem, I have a solution. The problem by the way you have is complex, it’s difficult, it’s scary, and I have studied a long time, and I’ve had my times where I’ve had people around me help me through this. I have an unbelievable set of technical skills that can help you. It’s an enormously gratifying feeling to help someone. It’s also an ego trap to think that where there’s a problem, you’re the answer. It’s also a heavy burden.

As a lover of habitats, my family and I bought some land in Montana about 25 years ago that was I suppose like the ER I started in, discarded ranch land. It had been leased grazed, meaning the person who grazed it thought more about now than tomorrow. It was eroded and overgrazed and had trash dumps on it. You could putt on its surface. It was supposed to be prairie, but it was so overgrazed it was just like flat dirt. We bought quite a chunk of it, about 3,000 acres. I was interested in what did it look like before. What did it look like when it was really healthy, which is I suppose every doctor’s goal. What does this patient look like really healthy, not kind of patched together? If you could give them their life back, if they could find their way back to life at its best, what does it look like?

I had sort of a similar idea about the ground. It was interesting. There were some people that thought we were nuts. Just after we bought it, we had 10 years of crippling drought. Four of those years we didn’t even get 10 inches of rain. That part of Montana is semi-arid anyway, it doesn’t get 30, 40, 50 inches of rain. On a normal year it gets 13 or 14, and really wet year it will get 17 or 18. Twenty-five years later there are streams on that land, and the biodiversity, the number of bird species has doubled. The elk came back, prairie elk, not mountain elk, but elk the way they used to be at the time of Lewis and Clark came back within 36 months. Turkeys came back. All these things came back that we didn’t have on a schedule. We didn’t have a 322-page business plan and a schedule for these things.

I think what I really appreciated over the past 25 years is how life will surprise you. If you give room for it, it will come back. We have riparian birds there. This may or may not mean anything to your listeners, but Bullock’s Orioles and Yellow Warblers and Solitary Sandpipers and things that never would’ve been there before. I mean, it’d be like seeing an elephant in Manhattan or a giraffe in Manhattan, or something just walking around as if it belonged there. These things do belong there, and they were gone. I suppose if I were… We didn’t go out and plant every bit of grass again. We didn’t go fix it. It’s too much.

It’s just like ceftriaxone for pneumonia. We tried to give it space and tried to interact with it in a way that would allow things to return, and I think the inspiring thing for me, and I’ve seen this in teams, I’ve seen it in organizations, I see it in land. And I really see sort of a common phenomenon everywhere. If we think about what it takes to create regeneration, and we’re thoughtful about that, it will happen in spades and frankly will not be stopped. It will keep coming. That’s kind of what I trust these days. It’s a long way from expert solution problem solver.

Gunderson: Larry, I’m thrilled for our first conversation. Thank you for this time.

McEvoy: Thank you. I immensely enjoyed it. Thanks a lot, Gary.

Gunderson: Thanks.