Clinical Changemakers

About Clinical Changemakers

Clinicians have trained in the art and science of medicine, and yet feel powerless to make a meaningful impact on the healthcare system. Clinical Changemakers is the podcast looking to bridge this gap by exploring inspiring stories of leadership, innovation and so much more. To learn more and join the conversation, visit: www.clinicalchangemakers.com www.clinicalchangemakers.com (https://www.clinicalchangemakers.com?utm_medium=podcast)

Publisher

Inspiring Clinicians to Thrive

Category

health & fitness · science

Language

en

Explicit

No

First episode

11 Sept 2023

Latest episode

24 Sept 2025

Latest episodes

30 episodes in the feed.

1. 

   24 Sept 2025

   The Ethics of AI in Healthcare: Beyond the Stochastic Parrot | Dr. Jessica Morley (Yale Digital Ethics Centre)

   "AI has the potential to re-ontologize healthcare—to completely redesign what we consider to be a disease, what we consider to be a disability, and how we organise care. But we need to decide what good healthcare actually means before we AI-ify everything." — Dr Jessica Morley In this episode of Clinical Changemakers, Dr Jessica Morley (https://dec.yale.edu/jess-morley), an AI ethics expert and researcher from Yale Digital Ethics Centre (https://dec.yale.edu/), challenges our understanding of what large language models actually are and what they mean for healthcare. Drawing from her work on data ethics and her involvement with OpenSafely during the pandemic, Dr Morley explains why viewing AI as "stochastic parrots" is crucial for healthcare implementation, explores the concept of re-ontologizing medicine, and argues why we need ethical frameworks before technological deployment rather than after. Key Takeaways Stochastic Parrots in Medicine: Large language models don't understand medical concepts—they predict the most likely next word based on probability from their training data. This means they can give you different answers to the same medical question and lack the contextual understanding crucial for patient care. Understanding this fundamental limitation is essential for safe healthcare implementation. The Re-ontologizing Power of AI: AI doesn't just replace existing tools like upgrading from a physical to digital stethoscope. It has the power to completely redesign healthcare by redefining what constitutes disease, changing how we organize care, and separating diagnosis from physical patient interaction. This transformation can be powerful and positive, but only if we're intentional about our goals. The Inverse Data Quality Law: Just as the inverse care law states that those who need healthcare most get it least, the inverse data quality law means those who need AI healthcare tools most will have the poorest quality data about themselves. This creates a two-tier system where marginalized populations get inferior AI-driven care. Social License Trumps Legal Permission: Technical feasibility and legal compliance aren't enough for successful AI implementation in healthcare. Projects like the UK's Care.data failed despite being legal because they lacked social acceptance. OpenSafely succeeded by building in privacy protections, transparency, and meaningful public engagement from the start. Where to Find Our Guest Dr Jessica Morley (LinkedIn (https://www.linkedin.com/in/jessicarosemorley/), Google Scholar (https://scholar.google.com/citations?user=hp-k6QwAAAAJ&hl=en)) In This Episode 01:27 - Stochastic parrots: Understanding what LLMs actually do 04:27 - Emergent properties: Why LLMs remain sophisticated probability machines 11:57 - Moral worth and parasocial relationships: When humans attach meaning to AI 14:33 - Re-ontologizing healthcare: How AI redesigns medicine itself 19:28 - The ethical traps: What happens when we AI-ify without thinking about outcomes 25:33 - Two-tier systems: How AI could worsen healthcare inequalities 28:44 - Ethics vs. law: Why we need both rules and values 32:31 - Learning from NHS failures: The importance of not making assumptions 47:43 - Global policy tensions: EU regulation vs. US "let it rip" approaches 54:33 - False dichotomies: Moving beyond "some care vs. no care" thinking 59:02 - Current global sentiment: From tech optimism to healthcare caution Referenced * Dr Morley’s Paper - The ethics of AI in health care: A mapping review (link) (https://www.sciencedirect.com/science/article/abs/pii/S0277953620303919?via%3Dihub) * Defining a Stochastic Parrot (link (https://en.wikipedia.org/wiki/Stochastic_parrot)) * OpenSafely platform and approach to health data research (link (https://www.opensafely.org/)) * Lessons from Care.data project and its failure in the UK (link (https://www.nature.com/articles/s41746-025-01928-0)) Contact If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com (mailto:jono@clinicalchangemakers.com) Hey there 🙌 As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it. Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com (http://www.clinicalchangemakers.com) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com (https://www.clinicalchangemakers.com?utm_medium=podcast&utm_campaign=CTA_1)

2. 

   8 Sept 2025

   How Systems Thinking Can Fix Healthcare's Organizational Chaos | Dr Sharen Paine

   "We want a two-way flow of communication so that we have a better understanding through the levels of an organisation up through those levels of what's actually happening and we can make decisions closer to the ground." — Dr. Sharen Paine In this episode of Clinical Changemakers, Dr. Sharen Paine (https://www.linkedin.com/in/dr-sharen-paine-47170b7?lipi=urn%3Ali%3Apage%3Ad_flagship3_profile_view_base_contact_details%3BS9cKbRQQQUSneEWjqYYp5A%3D%3D), a systems thinking expert with a doctorate in business administration focusing on cybernetics, explores why healthcare organisations repeatedly struggle with the same problems despite constant restructures. Drawing from her hands-on work with ophthalmology services, Dr. Paine introduces the Viable System Model (https://en.wikipedia.org/wiki/Viable_system_model) (VSM) as a framework for creating truly functional healthcare organisations that can adapt and thrive rather than merely survive. Key Takeaways Cybernetics vs. Command-and-Control: Healthcare systems fail because they rely on one-way, top-down commands rather than cybernetic feedback loops. True organisational health requires continuous information flow between all levels, like an aircraft's autopilot system that constantly adjusts based on environmental feedback, not rigid directives from a distant control tower. The Black Hole of Management Chaos: Service managers and clinical directors get consumed by day-to-day firefighting because healthcare systems lack proper coordination functions. Without clear coordination mechanisms, everything collapses into the management layer, creating a "tumble dryer" of urgent tasks that prevents strategic thinking and long-term planning. The Five Functions of Viable Systems: Every healthcare organisation needs five continuously operating subsystems: (1) Operations that deliver patient care, (2) Coordination that orchestrates daily activities, (3) Management that sets conditions for success, (4) Intelligence/Planning that looks ahead strategically, and (5) Governance that defines purpose and values. Most healthcare systems conflate these functions, leading to dysfunction. Recursive Autonomy Creates Efficiency: The VSM applies at every level—from national health systems down to individual departments. Each level requires all five functions to operate with appropriate autonomy. A $150 equipment purchase shouldn't require Wellington approval, just as an ophthalmology clinic shouldn't decide national hospital placement. Right-sized autonomy eliminates bureaucratic bottlenecks. Coordination is the Missing Function: Healthcare systems fail to recognise coordination as a distinct, critical function requiring dedicated resources and IT systems. Coordination includes prioritised wait lists, rosters, schedules, skills matrices, and training—currently done manually or through spreadsheets, creating errors and inefficiency. Proper coordination would prevent most day-to-day chaos. Where to Find Our Guest Dr. Sharen Paine (LinkedIn (https://www.linkedin.com/in/dr-sharen-paine-47170b7?lipi=urn%3Ali%3Apage%3Ad_flagship3_profile_view_base_contact_details%3BS9cKbRQQQUSneEWjqYYp5A%3D%3D)) In This Episode 00:00 - Introduction: Dr. Sharen Paine's background in cybernetics and systems thinking 07:37 - Sharen's journey: From mental health services to ophthalmology system challenges 15:05 - Production planning struggles: Why system changes fail without organizational support 18:16 - The governance-management-operations disconnect in healthcare hierarchies 25:04 - Introduction to the Viable System Model: Five essential organizational functions 26:59 - Defining viability: How organizations persist and adapt over time 28:05 - The five subsystems explained: From governance to operations 36:05 - Applying VSM to ophthalmology: What it looks like in practice 46:33 - Functions vs. roles: VSM describes what needs to happen, not organization charts 55:29 - Building collaborative understanding: Clinicians learning constraints, managers understanding frontlines 59:48 - Bottom-up implementation: Practical steps toward VSM adoption 1:05:12 - The VSM perspective: Seeing cybernetic patterns everywhere Referenced * Utilising insights from cybernetics and the Viable System Model to address health system disconnects (Doctoral Thesis (https://ourarchive.otago.ac.nz/esploro/outputs/doctoral/Utilising-insights-from-cybernetics-and-the/9926478625801891)) * Principles for embedding learning and adaptation into the New Zealand health system functioning: the example of the Viable System Model (paper (https://nzmj.org.nz/media/pages/journal/vol-138-no-1608/principles-for-embedding-learning-and-adaptation-into-new-zealand-health-system-functioning-the-example-of-the-viable-system-mod/d820d4b584-1737579526/6770.pdf)) * Utilising VSM insights to address health system disconnects: introducing three novel organisational pathologies (paper (https://www.emerald.com/k/article-abstract/doi/10.1108/K-11-2023-2450/1259806/Utilising-VSM-insights-to-address-health-system?redirectedFrom=fulltext)) * Mapping clinical governance to practitioner roles and responsibilities (paper (https://www.emerald.com/jhom/article/35/9/18/511336/Mapping-clinical-governance-to-practitioner-roles)) Contact If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com (mailto:jono@clinicalchangemakers.com) Music Attribution: Music by AudioCoffee from Pixabay. Before you go! 🙌 As a small independent podcast, every rating and share makes a real difference in helping us reach more healthcare leaders. If you found value here, please rate us and pass this along to a colleague who needs to hear it. Clinical Changemakers is a podcast that explores inspiring stories of leadership and innovation in healthcare. To learn more and join the conversation, visit: www.clinicalchangemakers.com (http://www.clinicalchangemakers.com) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com (https://www.clinicalchangemakers.com?utm_medium=podcast&utm_campaign=CTA_1)

3. 

   12 Aug 2025

   AI's Jagged Frontier and Why Human Judgement Still Matters | Dr Graham Walker (Kaiser Permanente)

   "I think judgment, I've been honing in on that word more frequently recently because I feel like the judgment piece is the piece that feels particularly like human in this decision." — Dr Graham Walker In this episode of Clinical Changemakers, Dr Graham Walker (https://www.linkedin.com/in/graham-walker-md/), an ER doctor and AI healthcare leader, discusses his role at Kaiser Permanente and the challenges and successes of integrating AI into healthcare. He emphasizes the importance of communication, leadership, and the need for alignment in large healthcare systems. Dr. Walker shares insights on predictive AI tools, the operationalisation of AI in patient care, and the ethical considerations surrounding AI's explainability. He also highlights the rapid adoption of AI scribes across 4.6 million members and the balance between AI benefits and risks in clinical practice. Key Takeaways Leadership through servant mentality: Successful healthcare innovation requires leaders who ask "How can I help you?" rather than directing from above. Clear communication, removing blockers, and building relationships are essential for large-scale change. The 85% capacity rule: Healthcare systems running at 100% capacity fail due to variance in patient complexity and unpredictable demand. Queuing theory suggests keeping 10-15% flexibility to handle the inherent unpredictability of medical care. Predictive AI has staying power: Kaiser's Advanced Alert Monitoring system, running live since 2018, successfully predicts ICU transfers and rapid responses across all inpatients. The operational challenge isn't building the model—it's fine-tuning sensitivity/specificity and creating sustainable workflows. AI scribes: Healthcare's fastest adoption: The rapid rollout of AI scribes represents perhaps the fastest technology adoption in healthcare history, driven by ease of use (just install an app and hit record) and immediate physician benefit in reducing "pyjama time" documentation. Judgment remains human: While AI excels at pattern recognition and data synthesis, clinical judgment—weighing risks, understanding context, and making treatment decisions—remains distinctly human. The scraped knee doesn't need septic workup; that's judgment, not diagnosis. Where to Find Our Guest * Dr. Graham Walker (LinkedIn (https://www.linkedin.com/in/graham-walker-md/)) In This Episode 00:00 - Introduction: Graham Walker's role at Kaiser Permanente Northern California 04:36 - Innovation framework: Value-based care vs. fee-for-service and finding ideas with potential 07:08 - Commercialisation strategy: Building internal tools for external deployment 11:00 - Leadership lessons: Coalition building and relationship management in large institutions 16:34 - Queuing theory in healthcare: Why running at 100% capacity breaks systems 19:48 - Predictive AI success story: Advanced Alert Monitoring system in production 26:00 - The human element: Why unexplainable AI might force better clinical thinking 32:33 - AI scribes rollout: Fastest healthcare technology adoption in history 39:30 - Information fidelity challenges: Note bloat, omissions, and human nature 45:02 - The judgment frontier: What remains uniquely human in clinical decision-making 50:20 - Advice for healthcare leaders: Use AI tools daily to understand capabilities and limits 53:57 - Off-call introduction: Building transparency in physician work and workload data Referenced * Dr Walker’s company website Offcall (https://www.offcall.com/) * Dr Walker’s Medical Calculation Website MedCalc (https://www.mdcalc.com/) * Paper: Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration (Link (https://www.nejm.org/doi/full/10.1056/NEJMsa2001090)) * Paper: Ambient Artificial Intelligence Scribes to Alleviate the Burden of Clinical Documentation (Link (https://catalyst.nejm.org/doi/full/10.1056/CAT.23.0404)) * Queueing Theory (Wikipedia (https://en.wikipedia.org/wiki/Queueing_theory)) * Servant Leadership (Link (https://www.inc.com/guides/2010/08/how-to-become-a-servant-leader.html)) Contact If you have any feedback, questions or if you'd like to get in touch, reach out at jono@clinicalchangemakers.com Music Attribution: Music by AudioCoffee from Pixabay. Before you go! 🙏 If you enjoyed the podcast, please share the love by rating us and sharing it with a friend or colleague. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.clinicalchangemakers.com (https://www.clinicalchangemakers.com?utm_medium=podcast&utm_campaign=CTA_1)

Who has been a guest on Clinical Changemakers

Names identified in recent episode analyses. Showing up to five guests.

• Dr Richard Lehman
• Dr Raj Mehta
• Dr Raj Srivastava
• Dr Amandeep Hansra
• Dr Vikas Saini

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Public platform figures. Ratings count people who left a rating, not total listeners.

Apple Podcasts (US)

5.0 / 5

1 ratings

Podcast Authority Score: 46 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

65

Social presence

0

YouTube

0

Engagement

71

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