Dr. Adam Schiavi is a firm believer that practice improves performance and he brings that approach to his work as co-chair of the planning committee for The Alliance’s 2021 National Donor Management Summit. The event brings together professionals from organ procurement organizations, hospitals and transplant centers to discuss issues and share best practices on challenges facing the organ donation community. Schiavi, assistant professor of Neuroanesthesia/Neurocritical Care at Johns Hopkins Hospital, is an archetype ‘renaissance man’ with roots in art and science combined with a deep-thinking approach to life.

“Our committee is working in a very collaborative way to get a group of experts for the Summit who can come and speak about what’s relevant now,” says Schiavi. “We’re looking at what are we dealing with in the organ donation space now that needs to be talked about or that we need to disseminate information about at the national level. We want to build bridges in this meeting to get as many of the stakeholders in the same place to have these conversations.”

The 2021 summit, “Bold Goals, Bold Actions, Bold Impact” will be held virtually September 1-2, 2021 and Kelly Ranum, CEO of Louisiana Organ Procurement Organization, also serves as co-chair of the planning group. Topics that will be addressed at the Summit include the interface between death and organ donation, changes to the legal definition of death, and upcoming changes in the procurement and distribution of organs.

Schiavi was born in New Jersey and grew up in South Florida. His father is a professional musician which influenced him from an early age. He played and studied music in grade school and received a music scholarship in music performance studying woodwind instruments. He was the first in his family to attend college.

While at Florida State University, his path swerved from music to science and medicine after a talk with his father. “My Dad said, ‘You know, it’s really hard to be a professional musician. You can always be a doctor and still be a musician but not the other way around.’ I had enjoyed science and music in high school so I switched my major to science.“ However, he continued to play professionally for many years and still plays for enjoyment, including the ney, an end-blown flute that figures prominently in Middle Eastern music.

Schiavi prepares in the OR

Schiavi makes a song in the musical squares in a sound garden in NYC.

Schiavi shows off his sense of humor, mimicking a mannequin in the simulation lab.

Schiavi plays the ney for a NCCU patient from the Middle East.

After graduation, Schiavi spent eight years as a medical researcher and earned a doctorate in biochemistry and molecular biology from the University of Miami. The final leg in his journey to medical school came when his graduate advisor told him ‘You can always be a doctor and do research but not the other way around.’ He graduated from the University of Miami School of Medicine in 2004 where he decided to pursue anesthesiology. He fell in love with critical care during a rotation in medical intensive care and then did a two-year fellowship at Johns Hopkins in neurocritical care.

His interest in neurocritical care led him led to an interest in issues involving organ donation. “In neurocritical care, I felt like you were dealing with the essence of personhood itself because you’re dealing with broken brains. It didn’t matter that the person’s body is perfectly fine, if their brain was damaged to the point of never regaining consciousness. This led me to think about critical illness at a very different level. It’s a very philosophical space and led to my thinking about organ donation and getting involved with it.”

“I was also on the Ethics Committee at Johns Hopkins and we dealt with a lot of difficult organ donation cases that were difficult end-of-life situations,” he added. “I became interested in the interface between how we die and the definitions of death and how that relates to how do we allow people to be organ donors and to be good organ donors.”

Schiavi’s interest in ethics began while taking a biomedical ethics course at Barry University where his professor based part of the curriculum on “Star Trek, the Next Generation” episodes. “It was that experience in theclass and then linking it to something that you can actually think about and debate,” he says. “This very interesting and entertaining way of teaching got me interested in ethics.”

He went on to serve on the Ethics Council while in medical school where he helped rewrite the professional code of conduct and when he arrived at Hopkins for his residency, he volunteered as one of two residents for the same group. “From there I ended up doing work with the Johns Hopkins donor council and then Living Legacy. I’m one of the physician ethicists for The Living Legacy Foundation of Maryland and I teach ethics at Hopkins as it applies to medicine and critical care and anesthesia.”

Outside of his professional commitments, Schiavi is devoted to his two young adult daughters and loves to read—Meditations by Marcus Aurelius is on his nightstand, along with Carl Sagan’s Demon-Haunted World. Other interests include personal fitness, yoga, kayaking, and traditional archery, which he describes as using a stick with a string and a wooden arrow. “It’s instinctual archery. It’s an iterative process of targeting, letting it go, watching the angle and then correcting the course and doing this over and over and over again developing perfection of form and consistency of practice. I do the same thing in anesthesia that I do in archery. It’s the way I think about things.”

He’s also a voracious consumer of the performing arts. “I attend concerts, theater and anything where you have people displaying themselves and performing at a high level,” he says. “I look for unique insight and virtuosity. You can find it in many places you just have to look for it. My Ph.D. adviser told me that I always took an artistic approach to science and that I did the same thing–seek out unique insight and virtuosity, not only in performance art, but in the ability to do science and to think.”

That lifelong interest in performance led Schiavi to direct simulation education for his department at the Johns Hopkins Medicine Simulation Center.” We create a simulated environment such that people can perform and act instinctually in a crisis situation. And then we are able to take that, have them reflect upon it, and then actually fine-tune their instinct so that when they see the situation again, they can act a little quicker or act a little more accurately. It’s a process where you develop mastery through iterative practice to become more focused and precise in dealing with a crisis or an emergency in real time.”

Circling back to The Alliance’s upcoming National Donor Management Summit, Schiavi says “The good thing about The Alliance is that it’s there for the common good of organ donation in general. We can look at how we promote the best of what’s out there and bring the best of people together to have conversations and disseminate information and ideas. People come to The Alliance and then go back to their organizations with new ideas, with new connections, and with new friends.”

To spur innovative thinking, The Alliance is helping selected conference presenters to create TED (Technology, Entertainment, Design) style presentations to share critical ideas about the ever-changing healthcare environment. These presentations, dubbed TAD (Transplantation and Donation) Talks, are available online and include presentations recorded at The Alliance’s 2022 National Critical Issues Forum and The Alliance’s 2023 National Pediatric Donation and Transplantation Summit.

The Alliance’s TAD Talk collection includes eight presentations so far on such topics as, “Adopting a Beginner’s Mindset: Embracing Uncertainty with Certainty” by Paul Myoung of Massachusetts General Hospital and “Bringing Real-time Data Insights to Transplantation: A Ready Frontier for Precision Medicine” by Dr. Rowland Pettit of Baylor College of Medicine.

The presentations are modeled on the TED Talk format of public speaking which are carefully crafted short talks that share a big idea and are known for telling a singular coherent story and using strong visuals and props. Since the first TED Conference in 1984, TED Talks have set the standard for short-format talks. The talks are now viewed or listened to online more than three billion times annually.

In a 2016 article in the Journal of Business and Technical Communication, authors  April A. Kedrowicz of North Carolina State University and Julie L. Taylor of the University of California, San Bernardino, note that, “Advances in digital media have made an impact on traditional rhetorical culture, thus shifting expectations and norms associated with orality and public presentation. Technology, entertainment, and design (TED) talks represent a new genre of presentation characteristic of Jamieson’s notion of electronic eloquence in that presenters weave together an engaging narrative complete with a strong visual presence.“

They go on to say, “In particular, Jamieson (1998) explained a new form of eloquence characterized by narrative, self-disclosure, and visual modes of persuasion—electronic eloquence, in which the eloquent speaker engages the audience and speaks comfortably. Thus, an eloquent message is defined by the clarity of the story, the passion with which it is told, and its relevance to the audience.”

The Alliance has engaged professional speaking coach Stephanie Weaver of Experienceology to help presenters prepare their TAD talks. She has coached over 200 speakers, including Richard Dreyfuss, Billie Jean King, and Ken Blanchard.  She works with The Alliance presenters for approximately three months prior to their presentations to craft their talk theme and ‘Big Idea’ and assists with the script and visuals for the presentation.

In his book, Talk Like TED: The 9 Public-Speaking Secrets of the World’s Top Mind, Author Carmine Gallo says that the most popular TED presentations share three basic principles that inspire people:

Emotion: Ideas that spread touch our hearts.

Novelty: Ideas that spread teach us something new.

Memorable: Ideas that spread are easy to recall.

“Based on feedback, people truly enjoy our TAD talk presentation and leaders across the continuum are volunteering to develop them for our upcoming conferences,” said Karri Hobson-Pape, executive director of the Alliance. “It’s a unique approach to delivering content at a healthcare conference.  The talks pique peoples’ interest and imagination and inspire them to think differently and approach work in our field in a new way.”

Going forward, new TAD Talks will be produced for The Alliance’s signature events.

Richard K. Gilroy, MD, hepatologist and medical director of the Liver Transplant Program at Intermountain Medical Center says that facilitating opportunities in others and appreciating their success is the guiding philosophy for him as a leader.

“Success is moving the needle. Success is not recognition,” says Gilroy. “For our collective, we measure our success by what our organization achieves, and recently it has been a lot. I believe measuring to manage is a philosophy for everyone in my position and everyone claiming to be a leader. It’s not that a leader makes the changes. It’s that changes are made and that these are made by a collective and not one person. The greater good is always best for everyone.”

Involvement with The Alliance

Gilroy serves on the Organ Donation and Transplantation Alliance (The Alliance) board of directors. He became involved with The Alliance about eight years ago when he was invited to speak at a National Critical Issues Forum. He then joined the board of directors and served as secretary from 2020-2022.

“When I step back and look at recent issues with organ donation and organ allocation, I wonder what I should be doing to enhance the opportunity of donation,” says Gilroy. “And what followed was my involvement with The Alliance. I realized that not only do we need to share more opportunities amongst ourselves, but we also needed to find more opportunities within what we already have. So every day it is a question of whether and how we improve our performance to make us better stewards of the resource, how do we better design the process to get and maintain people on waitlists over our enormous four-state geography and how to make them optimal when the transplant opportunity comes. Essentially my entire mission centers on this.”

“And with the operational performance changes we have made over the last six years, we are on track for around 180 liver transplants in 2023 and with this growth we continue to maintain excellent patient and economic outcomes. Each team redesigned its operational activities, and one critical change was with surgical operations where a redesign of perioperative and organ selection activities drove growth. We have quadrupled our living donor program activities as well over the last five years. Change involves so many people at Intermountain and beyond Intermountain. We are aligned, and all our actions maintain a team focus as imperative. And we  live with the vision of  “every potential donor, to any waitlist candidate, every time.”

“I understand the importance of relationships and synergy and The Alliance is a body that is all about synergy and alignment. The vision for The Alliance is to create a world in transplant that sees the greatest number of opportunities in organ donation realized by a community in need,” says Gilroy. “The Alliance has become one of my most important and valued relationships and being a member of The Alliance, taught us at Intermountain how to be optimal in transplant service delivery.”

“Most critical for creating change is identifying and aligning passionate and effective people around a meaningful message and goal. After this and more importantly, having these people able to tell the story and their message in such a way that other people can hear it and choose to make the teller’s mission theirs. The great thing about The Alliance’s team, the Board, and The Alliance members is that we are collectively moving the needle.”

Growing up in Australia

Gilroy was born in England and then moved to Australia. Both of his parents are physicians, one an OBGYN and the other pediatrically trained and ultimately in family practice. He describes his parents as workers and his father ultimately retiring at 78. He has an older sister and a younger brother and younger sister and they, in Gilroy’s words, wisely listened to his parents and did not do medicine. “My father was a prolific obstetrician and at his peak in one year personally delivered 625 kids,” says Gilroy. “My mother was one of the top students in her medical school year and raised the four of us while working full time and gave us everything including a 5.15 AM start most every day for swimming training eight months a year.”

Gilroy says he became a doctor because he was enamored by M*A*S*H, the 1970 movie, and later by the medical television dramas of MASH, St. Elsewhere, and ER. He enrolled in the University of Queensland in 1986 and received his MBBS in 1991. He became involved with organ transplantation when he was a medical student at Princess Alexandra Hospital where he followed doctors Stephen Lynch and Russell Strong who performed the world’s first successful living donor liver transplant in 1989. Then followed a start to a surgical residency which switched to a medical residency when he became aware that diabetes and a transplant surgical career might not be an ideal match, then gastroenterology and hepatology under Darrell Crawford and Charles Steadman and later an interview in Seattle in 1997 and then plans for training in the U.S.A in 1999.

“But the plan was to come to the United States for only a year at the University of Nebraska and then to return home to do a mixture of gastroenterology, hepatology, and transplant in a mixed private and public environment,” he says. However, one year quickly turned into 10 and then 20 and along the way returning to Australia was for never more than eight days and over time, he adapted to the U.S, ‘mostly.’

He had several mentors at Nebraska who helped him acclimatize. ”Doctors Byers Shaw and Michael Sorrell taught me tenacity, responsibility, clinical care and they taught me that your relationship with your patients is the most important key to success. And Doctor Alan Langnas taught me another critical and important lesson, and that is that you are very much responsible for your actions, and these actions lead to our success as no-one will just give it to you. He also taught me the concepts of competition driving performance and “Frienemies.” Finally, and importantly, Doctor Tim McCashland taught me humility, self-reflection and that one shouldn’t demand recognition, people can only give it to you if they choose to.”

He goes on to note that when he moved to the University of Kansas, his influencers and guides were Radiologist Phillip Johnson, Infectious Disease specialist Stephen Waller and Chief Nursing Officer Rachel Pepper. “I wish I could be as good any of these three as a person, a steward, a clinician, and a citizen. They are truly remarkable.”. However, he says he has found many remarkable individuals since moving to Intermountain, including Derek Ginos, Jean Botha, and Joanna Stephens, who are not only active Alliance participants, but also the most amazing opportunity creators and leaders one could ever know. “And the truest measure supporting this fact is our growth, our outcomes and the access to an actual organ that we have created for people in remote locations.”

Wide range of Interests

Gilroy lives in Park City, UT and has a wide range of interests. He swam and played rugby when he lived in Australia. He has run the Boston and Chicago marathons and now that he’s living in Utah, he skies (55,000 vertical feet on a Saturday in February and 700,000 vertical for the year).  He has an interest in wine (“I used to trade it but now I simply drink it with friends and family’), has a wood-fired pizza oven, an elaborate kitchen, and says his favorite pizza is a basil pesto base topped with smoked salmon, capers, asparagus, and red onion on an extremely thin and firm crust.

He plays chess online and says, “The great thing about chess is that it’s a game where the most important thing is the objective. In chess, one occasionally may make an intentional sacrifice, and this is always, if you are awake and attentive, done with a specific purpose. It is sometimes necessary to sacrifice to create a better position. And this is what we all do in transplantation every day.” He likes to cycle and travel and is just back from Croatia where he traveled with a group of friends. There is another group of 14 friends that travel together every year and these events occur in a different location as the friends live all over the world (Singapore, Hong Kong, Australia, and France). This year the group plans to visit Utah.

PDSA Leadership style

Gilroy is a proponent of PDSA (Plan-Do-Study-Act), an iterative, four-stage problem-solving model used for improving processes or carrying out change. “No matter what you’ve done, or you’ve chosen to do, there’s an opportunity to improve,” says Gilroy. “You plan, do, study, and act and continue to repeat that cycle to refine and optimize. It’s also critical to develop relationships with effective people around you so you have partners in any new endeavors, know who you need to keep informed and do not change processes alone.  Teams move mountains not people. And work with teams and remember everyone is equal. Maintain a shared understanding and investment in the objective. Doing this also builds capacitance should someone need to leave the team. It also brings the greatest number of people to the challenge or opportunity you seek to address.”

“At the same time, the other part essential to development is the opportunity analysis. Everyone should have a gap analysis done, and everyone should do their SWOT analysis. Then have someone else or a few people do the same and then compare. This way you don’t get blindsided. Always understand the measurable benefit before you start and measure this against the investment in time and personnel required to make the change. And then consider asking someone else to do the same analysis and see if they agree and see if they would invest in the idea. Above all, do not anchor to your first idea as it is very unlikely to be your best. People sometimes do and they lose out on true potential. And then when all of this is done which takes a week or two …… get going on the project as time is the only real commodity we ever lose, and we should never waste time when you have a valuable action to complete.”

He also loves market analysis. “If you look at the Idaho market, there was a deficiency in liver transplants per million population. We use a number of 30 transplants per million and Idaho has a population of around 1.95 million people and did 23 adult transplants in the calendar year before we entered the market. These data are easy to find, and this deficiency illustrated an important opportunity to correct inequity and to enhance access for a community in need.”

“We entered the market in 2018 after some local resistance and now Idaho has enjoyed a substantial increase in the number of people being transplanted and along the way the growth had little impact upon the other five programs transplanting out of that market,” he says. “For our program, we went from transplanting three people four years ago out of the state of Idaho to 27 people out of the state in 2022. For the state the number of adult liver transplants went from 23 to 54 and this year there will be at least 60 and with this, disparity in access to an organ was corrected.”

“And we addressed disparity in Idaho by placing transplantation services within the community and the ability to manage the patients we serve within the community. And the patients appreciated this as the drive is six hours, flight one hour, and many were not seeing transplant opportunities before as a function of distance. We succeed by developing alliances and high-value networks. And every program has access problems which they can address by saying, ’Let’s analyze, let’s identify where the best opportunities exist, and let’s design a change to effect a meaningful change.’

Gilroy is an active member in multiple societies and participates in guideline developments in hepatology and transplantation. At Intermountain, he oversees multiple clinical and investigator-initiated research studies and was responsible for overseeing the initiation of a process leading to Intermountain undertaking the many of the world’s earliest hepatitis C positive organ transplants into hepatitis C negative patients.