Time Stamps

• 00:00 What are “baby alligators” in medicine?
• 02:24 Rifaximin & Workflow Fixes 
• 14:17 Verbal Orders Policy
• 18:39 Micro Skills for Change
• 25:12 Key Takeaways

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Show Notes

• Reframe Before You React
  • Shift from venting → systems thinking
  • Microskills
    • Treat inefficiency as a workflow problem, not a people problem
    • Assume good intent; name it out loud
    • Use “I was surprised…” instead of blame
  • Example
    • Rifaximin delays framed as a processing issue, not a pharmacy failure
      
• Open Conversations Without Triggering Defensiveness
  • Lead with curiosity
  • Microskills
    • Ask for the policy before arguing
    • Ask how the decision was made
    • Acknowledge the original goal (name what the intent is for – cost, safety)
  • Example
    • Verbal orders: requesting the policy be reconsidered, rather than ranting
• Make It a Win-Win
  • Solve their problem too
  • Microskills
    • Show how the change reduces their workload
      
    • Offer to do the downstream work (education, rollout)
  • Example
    • Offer to help educate clinicians on a new change
      
• Persist Without Burning Bridges
  • Follow up kindly, not forcefully
  • Microskills
    • Brief check-ins that assume busyness
    • Offer help in follow-ups
    • Gentle reminders to yourself (Post-it system)
  • Example
    • Polite follow up emails + offers to attend meetings
• Persuade in the Room
  • Let others convince themselves
  • Microskills
    • Watch what lands (nods, posture shifts)
    • Lean into shared pain points
    • Use short stories, not arguments
  • Example
    • Focus on losing note progress that affects doctors and nurses
    • Communicate With Credibility
• Facts Over Rants
  • Microskills
    • Avoid “I feel” when issues are objective
    • Use measurable data + brief stories
      
    • Be aware that rants are received differently based on role, gender, and race
  • Example
    • Stating how long patients are waiting for echos without “I feel”
    • Use Presence as a Tool
• How you Speak Matters
  • Microskills
    • Slow cadence to emphasize key points
    • Open posture; visible listening
    • Pause intentionally
• The Meta-Skill: Capacity Comes First
  • “People can only give what they have.”
    • Small wins build confidence
    • Emotional regulation enables change
    • Depletion makes even good instincts fail
• Bottom Line
  • You don’t necessarily need authority to fix broken systems.
  • You need:
    • Regulated curiosity
    • Strategic empathy
    • Small, well-chosen moves…
      • …and change that is big enough to matter and small enough to win!

Transcript

Dr. Eileen Barrett: There can be 10,000 baby alligators on you in a day and that those baby alligators are those little betrayals of purpose and that you can just take off one little baby alligator at a time. I do recognize I have never actually seen a baby alligator, but then I finally did and I was like, wow, they’re huge and they look fierce. But just the idea that it’s something that is your betrayal of purpose that’s sort of latched on and how can you just get rid of one at a time? Because once you get rid of one, then you often learn how to get rid of others. 

Dr. Shreya Trivedi: So today we’re talking about baby alligators. Those little betrayals of purpose, those death by thousand paper cuts, whatever you call it, it’s those silly workarounds, those many phone calls it takes to get radiology to push over images. Oftentimes it leaves us feeling so angry at the system and these inefficient workflows, maybe you’ll vent to the person sitting next to you or you’ll utter some curse words under your breath, or you try to go home and you don’t want to think about it, you doomscroll until you feel some type of dopamine. But either way, I think all of us have been there and I’m so excited for Headspace to think about this a bit more. I’m Dr. Shreya Trivedi.

Dr. Marissa LoCastro: And I’m Dr. Marissa LoCastro. And honestly, I’ve definitely been there. But what do you think, Shreya? What if we could actually change some of these baby alligators? 

Dr. Shreya Trivedi: I can’t. It’s always going to stick now. Yeah. And so we talked to someone who’s actually made those changes and tried to take off some of those baby alligators one at a time. Dr. Eileen Barrett, she is someone who is so humble and gracious. And until you really probe her and ask her, you wouldn’t know that she’s made all these changes to the system she’s been in. She’s not someone out there trying to get credit. And she just has this superpower when it comes to quote unquote fixing broken systems and not in the way where she’s trying to overhaul a whole healthcare system, but in a very tactical, how can I make Monday less terrible way?

Dr. Marissa LoCastro: And in addition to being an internist, Dr. Barrett is also the chair Emirata of ACP Board of Regents and president of AMWA, the American Medical Women’s Association.

Dr. Shreya Trivedi: Yes. And I really like Dr. Barrett’s philosophy where she often thinks about it as, what are the things that are big enough to matter and small enough to win? The baby alligators. And so let’s go through some of Dr. Eileen Barrett’s wins. And throughout the episode, we’ll try to really highlight what are the micro skills that she needed to make changes happen. And along the way, I’ll also share one of my failure stories that I think might resonate with a lot of you.

Dr. Eileen Barrett: One sort of baby alligator that we got to speak about before that I felt like was very rewarding was we had a system where if you wanted to order rifaximin for a patient, then you had to first call the pharmacist because the pharmacist had to check to see if the patient would be able to pay for it after they left the hospital. We can have a respectful conversation about if that step is necessary. Because even short courses of a medication with a mortality advantage, one would argue, should be given in the hospital, right? Anyway, but they have it that you have to call the pharmacy first to see if you could get it approved to make sure that they could get it, even if they were on it at home, and just make sure they could have it after discharge. And that seems on its face value, possibly something really reasonable.

Dr. Shreya Trivedi: Classic well intention policy to make sure that patients can actually pay for this expensive medication, but not so smooth of an execution, right? Because what ended up happening often was a game of phone tag.

Dr. Eileen Barrett: What ended up happening is say you’re a medicine attending or a resident and you’re admitting someone in the ER, you’re calling the inpatient pharmacy, which is what’s listed in the chart, is who you’re supposed to call when you try to order rifaximin or to reorder it from the home meds. And you would call that person and they say, “Oh, they’re not actually in the hospital, so you need to call the pharmacist in the ER.” But the only thing is that the pharmacist in the ER, they need to know what bed the patient’s in. And oftentimes you don’t know which one they’re in because you’ve already seen so many patients, you sort of got rid of that or they’ve been moved, so then you don’t know where they are. So then you have to go and you have to either log out and go into a different system to find out what room they’re in, or you have to go walking around trying to find them. And it absolutely has been the case that in the interim, the person actually was in the elevator on the way up to the room. And then you find that person and then that person says, “Oh yeah, that sounds reasonable.” And then you still can’t order it and you have to wait for them to order it and hope that they remember. And in my experience, I never had that they forgot, but it didn’t feel very good to have it out there in the ether. So what I ended up upon finding what the idea was, again, we have to check, I’m doing air quotes, we have to check to see if they can get it after discharge, was what we just did was ask, well, can we just flip the process, which is, can we order it and you check, you’re going to check anyway, and you’re going to check to see if they can get it after discharge. And if they can’t get it after discharge, just let us know and then we’ll figure out another plan. And so we switched that. And then we tracked it over the course of just a year. I mean, actually it was less than a year. And it was over 500 phone calls that we had saved just from that. And I’m not going to say that saving 500 phone calls in under a year is going to change the world, but it was just one example of something that we can do by just switching something in the workflow that can decrease the frustration of the thing that feels like it’s getting in the way of you taking good care of the patient.

Dr. Shreya Trivedi: Yeah. And again, I could see someone just being so frustrated being like, “Oh my gosh, what is this workaround on work around on workaround?” And mentally, how did you get yourself to write that email or have that conversation and then what was that conversation and/or email about?

Dr. Eileen Barrett: Yeah. So when I was asking the pharmacist, I was speaking about it and I said, “I just feel so bad. You get all these calls from me all the time for this medication that this person is on at home and the patients are on at home.” And I know that they’re always like, “Oh, I don’t mind.” And I’m like, “I know. I also, you have a lot of work to do also too. I wonder if, who do you think I could talk to about this if maybe we could just switch the order because you’re going to be checking anyway.” And the person said like, “Well, yeah, that’s a good idea. Why don’t you email our supervisor?” Or, “This is their name.” And I emailed them and wrote, “Hi, insert name here.” And we recently have been having conversations about the benefit of this medication, rifaximin, as you know, and I appreciate that the pharmacy is so sensitive to the patients, their ability to pay for it after discharge. And I believe that the process is, and I said what it was, one of the things that has ended up happening at times or that I’m hearing about, and I know has happened to me, is that we end up having to make multiple phone calls because the patient isn’t actually physically in the hospital and often it’s a continuation of a home medication and I’m concerned about delays to the patient care. And I said, “So I wonder if this is something that we could talk about or to consider. I hope we’re able to get in touch. Thanks very much. Take good care. Sincerely, Eileen Barrett, hospital medicine.” The person did write back to say something like, “Well, internal process,” something about their internal processes. And I said, “Oh, I trust your internal processes and don’t wish to have any involvement in any of those with the exception of how it interfaces with the physician. Could we just switch the order because I know you’re checking anyway?” So it was a little bit of a kind back and forth acknowledgement. We may have had one phone call. What the person said was they wanted to better understand the scope of the problem. So they asked that one of the pharmacy residents did a little chart review. They did find that some significant number of the patients were on it at home. And so that was very persuasive to them because then it decreased the workload of their pharmacists. And then they said, “Yeah, we can roll it out. “

Dr. Shreya Trivedi: So much to unpack here. I think one of my favorite parts is that she started off with, “I just feel so bad. You get all these phone calls from me all the time for a medication that a patient’s already on at home.”

Dr. Marissa LoCastro: Yeah, no, for sure. I have definitely called the same person many times, but I also really like that she calls out the good intention behind the policy. She even wrote, “I appreciate that pharmacy is sensitive to patient’s ability to pay.”

Dr. Shreya Trivedi: Definitely. And one of the things that I think is so powerful to point out too is that this wasn’t like a massive effort to save 500 plus phone calls. Right? It was she had one phone call with the frontline pharmacist, an email to the supervisor, and then a few back and forth. Maybe total time of 30 minutes to an hour tops, right? Small amount of time, but a whole lot of emotional intelligence and persistence.

Dr. Eileen Barrett: And I left a post-it note on my computer at work that would say follow up on rifaximin. So if I didn’t hear back after a couple weeks, I would like circle back with a brief, “Hey, I hope that all is well. Just wondering, I know that everybody’s super busy. Is it something that anybody’s been able to discuss yet or is there any way – if it would be helpful, I’d be happy to come to an upcoming meeting” because you want to offer something, not just ask something in a follow-up. And then when they finally said they were going to roll it out, what they said was, “But please make sure that you educate the physicians that they are being careful that this is a really expensive medication, that you’re only giving it to people who absolutely need it. ” So, I said, “Of course, I would love to. If you feel like someone on your team wanted to come to one of our meetings to talk about it, you’d be welcome to. ” And they said, “No, they didn’t have time.” And I was like, “That’s okay. I’ll talk to them about it. ” And then that was it.

Dr. Shreya Trivedi: Yeah. I appreciate her also offering something to come to a meeting to make it easier for the person on the other end, acknowledging how busy they are and really finding that win-win for everyone.

Dr. Marissa LoCastro: Yeah. And I also really love the post-it note reminders, but I do want to pause here because listening to Dr. Barrett, this all sounds so easy, right? Be curious, show empathy, but in reality, it’s really, really hard in the moment, especially when you’re advocating for patients. 

Dr. Shreya Trivedi: Yeah. I have been there, and I wish I had Eileen’s level of emotional intelligence. I actually remember a time when I was a resident and the hospital has switched over the long acting insulin that was on formulary. And there was this middle aged patient of mine, non-English speaking, who was doing really well on insulin for many years. And suddenly she had multiple ED visits, her sugars were in the 360s, she had blurry vision. Thankfully, no other complications, but still, my God.

Dr. Marissa LoCastro: And you couldn’t explain why any of this was happening?

Dr. Shreya Trivedi: Yeah. Nothing was really adding up. We ruled out things. We had her come back multiple times, try different doses, and she just kept saying, “Look, I really need to go back to the other insulin that I was on. ” And I mean, I’m humble. I couldn’t physiologically explain why her body was not responding to this type of long acting versus the other type. But I said, “Look, I’ll do what I can.” I filled out the non-formulary forms that I needed to. I think I was on my CCU rotation, and so on my day off, she was sending me so many patient portal messages. She was so distressed about this. I was like, “Okay, sure, I will take care of this. ” I went and delivered it to the pharmacy and hoping that this was going to be it. Unfortunately, the pharmacist just straight up looked at the paper and said, “No.” I remember that no. And I lost it, Marissa. I literally blew up at him. I was so angry. I was like, “Gosh, these people are just following protocols. They don’t know how patients are suffering.” And then I think most of all, I was like, “You guys don’t understand, you’re not seeing the patient and you guys are not the face of the system. We are. ” And it just did not go well.

Dr. Marissa LoCastro: Shreya, that sounds so tough. I’m honestly angry for you listening to this story. I can only imagine the frustration.

Dr. Shreya Trivedi: Yeah. I mean, well, don’t be, right? I was not my best self. I walked out of those doors. I actually started crying and someone who cries, but I was so upset at myself for raising my voice and probably one of my lowest moments in residency. And I think after listening to Dr. Barrett’s stories and the micro skills that she uses, I do wonder, would the narrative have been different had I recruited this pharmacist to actually problem solve with me? Could I have said, “Hey, okay, if it’s a no here, then can you help me think about other hospital clinics where the insulin she needs is on formulary?” Instead, I just took that “no” at face value, I shut down, and I made that pharmacist the bad guy in my head. And honestly, to step back and something that Dr. Barrett does so well, she really recognizes that that person answering the phone or collecting the non-formulary forms are just a messenger. They’re just following a protocol that they didn’t create, and who knows, they might be just as frustrated.

Dr. Marissa LoCastro: Right. And with all of that being said, I think that’s why Dr. Barrett’s approach sometimes feels almost radical. She sees an inefficient process and taps into problem solving skills and does not lose her cool.

Dr. Shreya Trivedi: Yeah. So I had to ask her, how does she get from being enraged to actually being effective?

Dr. Eileen Barrett: I think for the first part of how do we overcome our emotions, that’s hard. I do, and that can be incredibly difficult. And at times I have done that with more and less grace. I think that in general, if I try to think of something as a systems story or as part of a system story, then it becomes easier to consider addressing it. True story. I think one of the reasons why I have an easy time thinking of things as part of a system is because when I was in college, I had a job where I worked on an assembly line. Truly, when people say like, “Oh, this medicine is like an assembly line.” I’m like, “No, I worked in a factory on an assembly line.” And it made me think about what can be automated and what wasn’t and also just how things can be done a little bit differently because it’s safer when there’s some degree of standardization. So I think I might have that disposition. I do think that it’s harder now than it was. I do think that also because I’ve been able to get some of these successes over the years, then it becomes easier to see how getting these changes. So I think anyone who wants to think, how do I first get over my emotions? I do think I strongly believe people can only give what they have. I think that that should be on a billboard in general. People can only give what they have. So they have to ideally have a mindfulness practice, be getting their sleep, that they feel cherished, that they feel valued.

Dr. Marissa LoCastro: People can only give what they have. And that makes me think about your story, Shreya. I wonder what your interaction might have been like if you weren’t on Q3 call rotation in the CCU.

Dr. Shreya Trivedi: Yeah, fair, fair. I think I’ve got to say, I’ve matured a ton since then, but I really also appreciate Eileen calling out that these small wins beget other small wins. So each time you can draw upon those skills in a better way with each rep you go through.

Dr. Marissa LoCastro: Exactly. And speaking of reps with the small wins, let’s internalize these skills even more with our last story, when all of a sudden nursing said they can no longer take verbal orders.

Dr. Eileen Barrett: Yeah. I worked at a hospital where one day there was the decision and without anybody knowing, it was just suddenly one day someone wouldn’t take the hospitalist’s verbal orders. When I heard about that, I was like chief of a hospitalist program, but that I just asked for the policy. Right? And one always says, “I was surprised. This happened last night. I was surprised to hear this. ” No, “someone was wrong,” but I was surprised to hear this. I wonder if I could, this is news to us when I’ve checked with other colleagues, is there a policy? Has such policy recently been changed? In most cases, what you find out to that email is the policy didn’t change and that one random person was just wrong, right? They’re a contractor from another hospital. And in this case said, “Oh yeah, that is the policy.” I went, “Oh, just so I can best understand, how did we arrive on that? I’m a little bit surprised.” And they said, “Oh, well, because it is a requirement,” they said through the federal government, but also because we do know that there should be computers everywhere, so no matter where you are, you should be able to put in an order, plus it’s for patient safety.

Dr. Marissa LoCastro: A small but key step of being curious, asking for the policy, and then how did we arrive to this?

Dr. Shreya Trivedi: Right. Yeah. And she didn’t just jump into, “No, that’s wrong,” or going into rant about how defeating it feels that so much of our cognitive space is taken up by orders that interprofessional colleagues can take full ownership of, like heparin flushes, de-accessing ports, that’s really their territory, right? Or putting in wound consults or nutrition consults. Yes, of course. If the patient needs wound or nutrition, I wouldn’t say no. Or say pharmacy needs the medication change because we don’t have it in our formulary. It just feels so defeating to be an order monkey for everyone sometimes!

Dr. Marissa LoCastro: Oh, it does for sure. And I think another thing to call out is that Dr. Barrett always communicates with generosity. She doesn’t put people on the defensive.

Dr. Eileen Barrett: So it was like, “Hi, I’m so glad that we were able to talk about this. I wondered if we can follow up.” It looks as though that the federal requirements on CPOE, maybe it has recently changed. You give somebody the out, right? And I wonder if we’re able to achieve that, and I wonder if we could talk about these other issues. And the person said, “Well, what you would have to do is have to come before the nursing council.” And I said, “Okay.” And in my case, then I presented there. And what was interesting about being able to present to them was that I talked about what mattered to them. So as I started to say things and I just noticed who was started to involuntarily nod their head when I mentioned, say, for example, the part about you lose your progress note because you have to go in to write an order and you’ve lost all of your work.And I saw half the room did this. 

Dr. Shreya Trivedi: Even from the nurses? 

Dr. Eileen Barrett: Yes. Yes. And then I thought, okay, that’s the thing I’m going to lean into more here to talk about that. And then when we should very heavily talk about the thing that seemed to matter with them. And then when we talked about patient safety and I talked about like, “Oh, I can see that people couldn’t have known.” You don’t want to say, “You didn’t know,” but “you couldn’t have known” that what we have the experience of when someone is at the bedside and they can’t leave because a person is critical.” And then you have two people in the back of the room going, “It creates conflict and it leaves the nurses in the lurch because you have to leave to go put in an order and it leaves the patient in the lurch.” So you’re not overplaying that you’re hanging your colleague out to dry, but you are acknowledging that this introduces conflict and you’re like, “I have to leave to go enter the Metamucil order, even though we’re starting pressors here” and talked in more story form, and what are the questions and what are the concerns that you have? And then it helps people see without you having to disagree with them, because you try not to disagree. What you try to do is be more persuasive because as you know, people, we don’t persuade each other of things, people persuade themselves. So you make them the hero and let them persuade themselves. So in that case, what they did was that they changed the rule and they said, “Okay, we can absolutely allow,” And the nurses were really happy about this too. “We can allow verbal orders, but it has to be because it’s important.”

Dr. Shreya Trivedi: Right. So she spoke about what mattered to them and helped people convince themselves that yes, purple orders are still needed.

Dr. Eileen Barrett: And with the caveat that sometimes that it . I’ve had a lot of successes with it. Sometimes I’ve had failures also too, right? I feel like some of the ways how – ooh, one of them is I try not to use the word I feel. It is an objective scientific fact that the patients are waiting four days for an echo. That is not about my feel. That is not about my feeling. I personally try very hard to not have a rant in a meeting and I usually encourage people to try not to. There can be a real role in it. What’s hard about rants is that they are received very differently based on the ranter, and particularly that it is gendered and racialized and it is received through an age prism as well. And this ridiculous belief that somehow our early career colleagues are less dedicated than people who trained some time ago, is just so patently false. And so I’m very sensitive to that those dynamics. Some people can have those implicit biases, right? I think it’s really important to consider short storytelling. I try to be pretty dispassionate so that the story tells itself and that could include quotes from a patient, or even paraphrase from a patient, and ideally if you have one paraphrase from a nurse. So like one example that I had when I was talking about something that was going on was I said, and “it was incredibly difficult that when I let the nurse know that the patient wanted a bath and that I didn’t want to put the pressure on the nurse because I know their day is really difficult,” but that when I just said, “I just want to let you know that they let me know that they wanted a bath and that the nurse just deeply sighed and their shoulders slumped forward and they said “what I would do to have time to be able to give my patients a bath.” And I did the same thing with my body language because I cared about her expressing that problem. And I showed that care without it being, “I feel, I think, I want, ” is allowed the anecdote to tell the story. Sometimes an anecdote more clearly tells a story than otherwise. So sometimes it’s nice to have afterward, “so I’m really concerned about our staffing levels and how our nurses are doing and how we can look to see to decrease what we’re asking of them. I know that this doesn’t fix it, but these are some of the things that I think could be opportunities to do so.”

Dr. Shreya Trivedi: Yeah. And you offer solutions.

Dr. Eileen Barrett: And then offer solutions!

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Dr. Eileen Barrett: I always have meetings before the meeting, so I try to find out what will a successful meeting look like and what do I want to see to come result from that meeting? And that often is … And to not be wedded to my way, but just to know that having some degree of strategy is going to be more successful than none, because I want to always be open to that someone could go in there with a much bigger problem than I’ve identified and with a much better solution than one that I’ve identified. So try to think about like, what is the North Star? What am I looking to get out of it? Who are my allies? Who can we speak to about how can we have the pre-meeting essentially? What is the tenor of the room? I write down bullet points about what I think I want to say. And also, if someone has said something that lands with me or that supports a case for something that I think we need, give them credit for it in the room. So I’ll say, just like I heard, Dr. Trivedi’s point was a really good one that I wanted to amplify and then just choose seven words from that because I don’t want to give someone some big long soliloquy. But try to find the common themes that we’ve already heard as I’m presenting what is the idea of what a solution could be. I also try to think about when I am speaking about trying to create some sort of a change, then I think about what is the skills that we get to be above a public speaker. And one of them is how we create presence and just like how when we’re talking with patients, how we just pause. And then just go slower because when you start to go slower, people often, they notice the change in your cadence and they know usually something important is coming. And so I’ll often do that. I try to be mindful of how I’m sitting. We’re speaking right now and I’ve just crossed my arms, but I actually very deliberately try to keep my arms open often. And when the person who is speaking is listening, you almost want to be their safe harbor so that they see that you are their ally. So when they’re talking about what they did to nod and to thank them, because they’re people also too, right? So it treats them like a human being. It also helps them see that you are their ally and that we’re all on the same side, which is like, we want a healthcare system that works for the patients and also for the physicians.

Dr. Shreya Trivedi: So much good stuff here. I love these stories. And maybe Marissa, you and I can summarize. The next time we find ourselves frustrated on our fifth phone call, our fifth form for something, when you’re short on time, maybe instead of just venting the person next to us, maybe our first move before we send off an email with a rant or saying something out loud that we might regret to reframe, right? And Dr. Barrett does this very deliberately. She shifts from a venting mode to a systems mode.

Dr. Marissa LoCastro: Exactly. This isn’t a people problem. It’s a workflow problem.

Dr. Shreya Trivedi: Yeah. Yeah. She doesn’t think about, oh, pharmacy is blocking me or nursing won’t help. It becomes, okay, where is the process missequence? And she assumes good intent, right? And she acknowledges that out loud.

Dr. Marissa LoCastro: Yeah. And that part really does matter. The, “I appreciate that this policy was meant to protect patients” naming that, that one sentence alone can change the temperature of a whole conversation.

Dr. Shreya Trivedi: Right. And then she notices her language, right? She doesn’t lead with blame. She leads with, “Oh, I was surprised to hear that. ” So it’s a flag, not an accusation.

Dr. Marissa LoCastro: And once she’s regulated herself, the next step is how she opens a conversation. And this is where a lot of us do go wrong. She continues to lead with curiosity. She says, “Can you help me understand the policy? Has it changed?” And then acknowledges the original goal, which is often cost, safety, compliance before talking about the unintended consequences. And honestly, that keeps people from getting defensive.

Dr. Shreya Trivedi: Yeah. And then it comes to her real superpower, right? She thinks about the smallest change that actually matters, right? The big enough to matter is small enough to win.

Dr. Marissa LoCastro: She’s not trying to overhaul pharmacy policy. She’s just trying to flip one step in a workflow. 

Dr. Shreya P. Trivedi: Yeah and with rifaximin, she did the simplest one. She let the clinician order at first and the pharmacy check affordability afterwards. Same goal, different sequence.

Dr. Marissa LoCastro: And with that one flip, she saved over 500 phone calls. That’s huge leverage for a tiny change. And she even offers to downstream – work, education, rollout, explaining the change to others so the burden doesn’t fall on the other team.

Dr. Shreya Trivedi: So now let’s talk about persistence because most good ideas don’t die from opposition, but die from silence. Dr. Barrett follows up, right? And she does so gently, short check-ins, assuming people are busy and offering help instead of pressure.

Dr. Marissa LoCastro: And I love the Post-it note system, nothing fancy, just a way to remind herself to circle back without stewing.

Dr. Shreya Trivedi: And then she does the prep work before she enters the room and really is thoughtful about what is happening in the room. She notices who nods, she notices what stories land and what pain points are shared. And another big one that I’m definitely going to take away is facts over rants, right? Avoiding those I feel statements and keeping things objective and leading with objective stories.

Dr. Marissa LoCastro: And finally, a point on presence. Dr. Barrett slows down before key points, open posturing, pausing. She’s regulating the emotional climate of the room and not just making an argument.

Dr. Shreya Trivedi: Yeah. And underneath all of that is a meta skill that Dr. Barrett named so clearly. People can only give what they have. 

Dr. Marissa LoCastro: Exactly. You cannot do this work when you’re completely depleted. 

Dr. Shreya Trivedi: So it’s these small wins that can help build confidence and confidence can build capacity and capacity makes the next change possible. So maybe one of the things that resonates with me is you don’t need a lot of authority to make change or maybe even a lot of time, which sometimes is what gets me. What you need is regulated curiosity, strategic empathy, and small, well chosen moves.

Dr. Marissa LoCastro: Exactly. And things that are big enough to matter and small enough to win.

Dr. Shreya Trivedi: Awesome! Thanks so much for joining us. Let us know if this resonated, if you have any small wins that you’d love to share, any other micro skills that you used, they all kind of help all of us, especially in this day and age where it feels like there’s so much going on in the world, nothing matters. It’s hard to know even sometimes where to start, but the everyday workflows are still kind of very real and I’m sure there’s a lot of work in progress that we all can do. Thank you so much. Take care!