Open Source Health with Tripp Johnson

From Spain to Strategy: How Intentional Leadership Fuels Healthcare Innovation

• Season 5 • Episode 12

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This week on Open Source Health, Tripp checks in from Valencia, Spain, reflecting on what it means to lead with intentionality while managing complexity back home. Marcus and Tripp unpack the personal and organizational shifts that made this kind of work-from-anywhere leadership possible, from data infrastructure to performance management systems. They dive into how deliberate leadership transitions—like Dr. Book stepping into the Chief Medical Officer role—reflect a broader organizational commitment to aligning personal growth with company strategy.

They also announce a major next step for Advaita Health: launching a Mental Health PHP/IOP (Partial Hospitalization and Intensive Outpatient Program). The conversation explores how building a closed-loop behavioral health system requires both patience and long-term vision, resisting the urge to chase short-term wins in favor of sustainable impact.

Key Topics:

  • What slow productivity looks like for a CEO working abroad
  • The leadership development philosophy behind Advaita’s recent medical leadership changes
  • How data and management infrastructure support strategic decision-making
  • Why Advaita is moving toward a true integrated outpatient behavioral health system
  • The internal debate: When is the right time to launch new services?

Chapters:
00:00 – Checking in from Valencia
02:00 – Slow Productivity and CEO Mindset Shift
05:30 – Why Tripp Took the Trip: Professional Development and Leadership Evolution
07:45 – Building Internal Capacity: Data, Dashboards, and Leadership Systems
11:00 – The Infinite Game and Designing for Flourishing
15:00 – Mental Health PHP/IOP: The Next Strategic Move
20:00 – How Data-Driven Decision-Making is Changing the Way We Work
25:00 – Cultural Shifts: Clarity, Calm, and Team Development
30:00 – Organizational Announcements: New Roles and Career Pathing
35:00 – Wrapping Up: A Scalable, Developmentally Intentional Future

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Tripp Johnson

  • LinkedIn: https://www.linkedin.com/in/trippjohnson
  • Instagram: https://www.instagram.com/trippjohnson
  • Website: https://www.trippj.com/

Hey from Spain, open source health international. Live from España! that's funny. Did pretty, pretty cool. This is really surreal. How's uh, how's it how's it been so far to toddlers born country traveling with a one-year-old and a three-year-old is brutal. And especially, like, I mean, my wife had to deal with, like, the leeches. They just, you know, need to be on top of her all the time. But, yeah, I mean, didn't sleep, you know, lost an entire night of sleep, slept last night. So today was the first full day in Valencia. Got to go do a little istanga with a group here in the morning and been walking around the city just having fun with the family and getting a little work uh in this evening. Yeah, I think this is so cool. I love that you're doing this. I think it's like one of the coolest things. It feels very surreal to think like what we've seen over the years and like to be in a place where you're able to like just go hit it in Valencia for a month. Yeah, has me like, especially thinking about this idea of the slow productivity. What does it mean to be a CEO? How do we lead? How do we want to show up? And one of the things that I think is going to be very interesting and impossible to prove is whether taking this kind of space would have been better all along. I think I've always glorified the discipline, nose to the grindstone kind of. leadership and just output mentality. But now I like I know for a fact it's not what helps our team the most and us like our organization and patients. uh But it's still it's weird because you know, uh truly leaning into being like an ideas guy is I feel like that's like a average white guy. Like, I just want to be an ideas guy. Like everybody wants to be an ideas guy. Maybe, maybe they don't. Yeah, yeah, yeah. Everybody wants media media like I started Yeah We're the CEO of our own company. And we borrowed family money. Yeah, yeah, exactly. Oh man, that's awesome. man, just been kind of hunkered down. Nothing like, nothing super interesting. I'm delightfully boring right now. I, the slow productivity stuff is kind of, maybe we're all sinking up or something, but the last couple of weeks have been this really nice, slow productivity, able to like take time and think. And, and I think for me, one of the things that's always been really difficult is it is like, yeah, I think grew up pretty lower working class sort of mentality of always be busy, always be busy grind. That's where. And that's always been anchored to like my own sense of well-being or emotional stability in a way that I have to be really, really intentional about. And it's, I frequently have to like find these ways of puncturing through that to get to the reality of it. And last couple of weeks have been really, I think I've been kind of abiding in that space a little bit better. And it's funny, I feel more productive. I feel more clear-headed, better. So I... Need to find my Valencia or something, guess, dude, want to, I want to kind of shift a little bit because I, you talked about this whole trip as a forcing function. And I think we have a lot of really cool stuff and. Did this Valencia trip in some weird ways would have represents like where this maturational place as a, as a company. Um, but I'd be curious before we kind of kick off with that, like. What was this really, really, really about, right? Like just anchor into that for a minute. Well, ask more directly. In what sense, coming to Valencia? I mean, that as part of this professional development piece? Yeah Yeah i would say that uh... the primary reason is that my wife loves to travel i like to travel i don't even know if love is the right word i you know because i can do my routine and be really uh... pleased as can be anywhere in the world uh... but from a from a work perspective you know it's really hard to continue to upgrade my own skills and the way I lead as we develop as an organization and as we grow, what's needed from me and how I can be the most helpful just changes. And that's often why as companies mature, they get to a certain size and then you bring in professional management or private equity because they know how to take a business to the next level. Right. And since that's not something I'm interested in, ah I have to stay kind of ahead of the curve. And it's hard to do because we have these well-worn grooves of how we show up for our team and what we think we should be doing. And even if we're reading a lot and pouring a lot into our own development, it can be really difficult to actually change the way you're showing up and to get the insight you need. um if you're just going about the normal course of business. And so, you know, for in a lot of ways this trip represents, you know, the real shift from being in the weeds and in, I'll call it an internal CEO, to being more of an external CEO who, you know, plays a more consultative role with our current operations as opposed to like driving what we're supposed to be doing. Yeah. I think it's, it's interesting to me when I, when I think about what this trip sort of represents is it. It's everything you just said, but it represents the culmination of a lot of hard work, right? Like we've laid all of these. We didn't hire out. didn't bring in outside experts. didn't do all of this other stuff to sort of, it would require taking on P money and that sort of thing where we could have fast tracked it, but we decided to build all of this. internally, it was part of our commitment to being a developmentally intentional organization and focused on that. I, man, in the last couple of months, it really feels like we're seeing the fruits and the benefits of that and our ability to sort of as a leadership at the leadership level, manage so much more because we took the time and the sweat equity and invested in building these data structures, these data hierarchies. our dashboards and to be able to observe and see this stuff and build what we need to be able to feel comfortable like stepping away and clearing out space to be able to be more thoughtful. And I think that's a, to me, this like, that's what's really cool right now. We've our, you know, our chief medical officer with Dr. Books chilling in Spain and you're there and you know, most significant portion of our leadership is working abroad right now, but we've taking the time to set that up and do it intentionally. That's really cool, right? Yeah. What's the thesis behind that? Why? Why is it so important for you to build a company where that is the case? How does that tie into the organizing thesis of this whole thing? ah I think the original, early, early on, just like I want to build things and I want to build things that help other people. And as I matured and became, my philosophical orientation had more depth. At first, originally it was kind of about the patients, then it very quickly became about the team and supporting their growth. ah And then, you know, more recently, I've taken a step back too to just ask, what are some of, my real goals as just an entrepreneur? ah And certainly there's, like, certain financial, you know, metrics that I want to establish for my own income level ah that we're not anywhere close to. But we're getting there, slowly but surely. But then beyond that, it's like I do, there are a lot of things that I enjoy uh if I give myself the space outside of work. I think one of my kind of blind spots personally has always been like not having hobbies, not having a huge like community that I lean on um in the course of my normal life. And that goes back to like when I was a kid, like I played tennis, I was very individually driven. I've always kind of gone against the grain. And so I haven't had that like long-term friend group that a lot of people have. And if the goal is to flourish, then I need to understand like how do I do that the best too? And everyone's gonna be different on that, but I'd rather run an organization where there's no, uh I wanna play the infinite game. I want to keep wanting to show up and keep playing the game, not feeling like there's some finish line that I need to get to. And I hope that for a lot of people, that's kind of how work is. Like, yeah, we want to get paid more. want to, you know, we want our lives to evolve. But this like, I am working so that I can retire. You know, it's just a, you know, I mean, capitalism is pretty fucked in so many ways. And uh And I want to have some little reprieve from business as usual. Yeah, it is interesting, right? We tend to think in this very linear sort of way, right? Like I work and I have a career so that I can earn money, save money, build money, and then retire. And so we sacrifice the quality of the present moment so that we can get to some sort of hypothetical promised land. And we end up missing so much as a result of that. And what I dig about this and what we're doing is we're like, that didn't have to be that way. We're sort of restructuring and redoing some different, doing some different stuff. And I think that's a, it's pretty cool, you know? Why work until we're dead? Yeah, and I think the final kind of reflection on all of that is, uh does go back to the Dr. Book story that I shared on LinkedIn, was he took a trip to Spain last year, loved it, and wanted to go back for a month this year. And so for me, wanting to run a deliberately developmental organization, I want to figure out how do I help Dr. Book reach his goals so he helps the organization reach our goals. And I also think that there is something like If I'm encouraging everyone else to have a fulfilling life, but I'm seen as the guy who just wants to work and doesn't do other stuff outside of my contemplative practices and reading, then people are going to be like, well, is that actually what he wants to see? Or am I going to be judged by not being in the office or working remotely? And I don't want there to be any doubt that that's the type of organization we want. We want to have autonomy. obviously autonomy needs to be met with responsibility but you we need to show that those can coexist Yeah. And I think maybe this is shifting topic a little bit. I don't, I see it all as connected and related, but I think we took the time to build, like I was alluding to earlier, we took the time and intentionality to build data, right? Like to build the ability to gather data, to make decisions, to and to empower each other and our team to use that as a tool to make informed decisions. Um, And I, again, I think that's a little bass ackwards. Like I don't think most people do that, right? Like they start, they build, and then they start trying to graph this stuff on versus build the apparatus first. And now you have the tool you need to be able to make the best decision so that you're not stuck in this constant whirlwind of always trying to play catch up or fix what you broke. Yeah. Yeah. Like you mentioned the data, which we've obviously invested pretty heavily in both kind of the data and technology infrastructure that we haven't really seen it. I mean, we've seen definitely some rewards of it, but I think we're just kind of at the inflection point of actually there's one thing about collecting data and trying to use it. And then there's a totally different world when you're actually making data-driven decisions. And the other piece I want to highlight that I think we've invested in that is much more qualitative is the leadership and management infrastructure. And I would say we're 1 % of where I want to be, but I would also say we are leaps and bounds probably ahead of most organizations of a comparable size. And we have a manager's handbook. We're updating that. We take the performance management and career development piece really seriously. And I think the combination of the The soft skills plus the hard analytic skills really positions us well for the future. I agree. And I think as we, you know, ultimately the organ, the idea for us is to become something like a self-contained system. And that's always been, we've talked about that in different ways, but ideally the best healthcare is something that's integrated where your primary care, your therapy, your psychiatry, your behavioral health, your on and on and on your physical therapy, everything would be within a system so that it's all communicating and speaking with each other. But it takes a lot of work to do something as complex as that. think there's other organization, maybe this is more of a tortoise in the hare situation. I think there's probably a lot of like standard PHP, IOP for substance use or outpatient practices or various entities that it'd be easy for us to get really distracted by and say, man, these people are killing it. Why aren't we? And then if you go chase that shiny object or whatever, like how we have to do what they're doing. But I think it takes a lot of clarity and vision to say, we're trying to build something different and it's going to take a little bit more time and we're seeing it pay off in some really interesting and cool ways. Yeah, one of my advisors over the years, Alan Hughes, always makes the statement that variation drives cost. And the point of that is you want to specialize in a niche and you want to have a process that doesn't, all of your processes shouldn't have a ton of variability to them so you can appropriately measure them and improve them. And this becomes immensely complex when part of your core strategy is integration, to be a closed loop healthcare system that really promotes flourishing for our team and for our patients. We are talking about a lot of variability, and so we need the equivalent data and analytics infrastructure and the management infrastructure in order to handle that complexity and not. trip over ourselves as we continue to grow and try and fulfill this vision of like that closed loop healthcare system. Yeah. And I know it like, it's never fun podcast water for, for other people, but it's, know, we can only reference what we can reference. Right. But for me, we had a, again, like another sort of seminal sort of moment, right? We're in the process of we've done this precursory sort of analysis and we know that there's a lot of things lacking in terms of, uh, mental health care in Eastern North Carolina and Raleigh kind of further east, just like PHP, IOP for just pure mental health, just plenty for substance use, but there's not a lot for mental health and our clinical director and team, all of us really as part like that, we've all sort of decided that this is a thing that we want to build, right? Like that's the next iteration or the next add-on or the next portion of the closed system. And how do we do that? And I think from my purview, I feel more confident than I've ever felt in my ability and my, in our ability to make the decision for in the strategy for how to proceed with that. Then we ever have like some of the conversations we've been able to have about this. just so much better because we took the time to build the right systems and data collection and be able to go and orient ourselves towards that to make the decisions. And that's huge. That's key. And again, I think a lot of organizations miss that or skip that or they think they have that, but they've not, you know, probably not in all reality. They don't actually have what they need. Yeah, so I think to make this real tangible, when we look at the triangle market being Raleigh, Durham, and Chapel Hill, we've probably got 10 to 15 substance use treatment, PHB IOPs, and there probably less than five mental health PHB IOPs that accept commercial insurance. Couple with that, our clinical director really comes from, and who's being promoted to executive director, maybe we'll go over some announcements at the end, but there's a little teaser. uh Quite frankly, her background is more like pure mental health, and co-occurring for sure, but a lot of her team was working in assertive community treatment teams, uh working with uh the SPMI population. So a mental health PHP IOP is something that a lot of our team actually has more familiar with, except for the people who are in the substance use side of things. uh two weeks ago when our COO, Nick, was on vacation, Corey called me and said, hey, I know we're not supposed to talk about this now, but I really want to float us starting a PHP IOP. There are some people we could hire, and I'd just like to hear your thoughts on it. And I said, well, Step one for me is like we we know we want to do it. We want to be this closed-loop Health care system and the first thing we need to do is fill out all of our outpatient behavioral health lines of service and the immediate You know next step for that is a mental health phbi Now we're not always performing where we want from a census on our substance use treatment, so maybe we should just focus on that. But then again, if our core strategy involves integration, we want to be able to offer all of this. So is now the time to do it? then we, again, operating at a much higher level, it's like, OK, well, let's just do some analysis. Let's not jump to, hey, should we answer the question, like let's say what's the opportunity for us? And you know, if we have eight people in uh PHP and 10 people in IOP six months in, you know, because of all of our infrastructure that we've already developed, that's going to be a highly profitable line of service, which means that we can invest a significant amount of uh financial capital in order to get great human capital in order to build a great PHP IOP. And so now all of a sudden we're walking down the path of uh we want to start this. It is on the list. uh And now it's just really up for debate. Are we trying to open September 1 or January 1 or somewhere in between? And that's, to me, that's kind of where we've landed on it uh based on the conversation yesterday at our leadership meeting. Is that kind of what you heard? Yeah, yeah, absolutely. That's where my head went. So I think digging into this and maybe rehashing a little bit is, we have a pretty complex system because there's a lot of different lines of service, which means for some people it's like, you're just starting a PHP IOP. You've already done that before. Is it really that hard? just go get the state license, build the team, and start providing the service. But again, there's a lot of complexity and we haven't optimized every line of service and not everything is built to the level at which we want. um But for us to add the mental health, PHP/IOP, I don't quote me on this, but I would say we would be the only people in North Carolina that had this true kind of behavioral health system of care at the outpatient level to have mental health and substance use PHP/IOP plus the ability to work with therapists and med providers long term. And I think that's a really unique value proposition. And I don't know that the market will see it that way. But I like to think it is. Yeah. I mean, and even if it's right, like even if the market doesn't see that it's a, I think we get there where the market sees it, but either way, like you build a good enough product and all of these things sink together, right? Like building an organization where we can attract the best talent, the best people, because they see, you know, like this emphasis on this work-life balance. And I hate that because it sounds so trite or whatever. Like all of these things are like flowing together, right? Like we can attract those sort of people. We can create a lot of upward mobility for people, a really robust management system and supervision system where people can all just get better. That's a cool thing. Yeah. You can see the light. my phone so you can see me a little bit better because I know everyone on YouTube wants to look at my face. Yeah, and then on top of all, like you said, to make this a place that people want to work long term is really, really exciting to me. people have goals of providing these services and I want to be able to provide that opportunity. um Yeah, I mean, I'm really cool. think there was a lot like, I don't know, where do you want to go from here? There was a lot I think we've talked about the last few weeks in terms of the conversations really being elevated on our leadership team. And yesterday, like it was so funny because I was like, should I even go to the leadership meeting? Haven't slept in 40 hours. But I just had like a great afternoon with the family. There is nothing I want to do more than just like see what's going on at work and talk to people for a little bit and then catch up on some sleep. And especially when I'm sleep deprived, I don't know if some of my kind of ranting lands. And I think one of the things for me in trying to be a more strategic leader is really like just at a baseline letting other people talk because a lot of people have great ideas that I... have in the past tended to stifle to some extent. And they need more time to flesh them out than I give them in the moment. So I've been trying to take a step back and kind of let the conversation unfold a little bit and take notes by hand and then say, OK, this has been a great conversation. Here are my thoughts. ah And I mean, that certainly happened some yesterday. But everyone brought a ton of great. I mean, the thing for me is it's a lot easier to sit back. when there's a very intelligent conversation going on. Yeah, yeah, Right. It's easy to sit on your hands on that cicade. Yeah. I mean, again, I think this is, I, yeah, I think this, you know, I'm biased, but this is the way to do it to me. Right. Like if you want to build a sustainable healthcare system, it starts with how do you, how do you give people the tools to elevate themselves and elevate their team and everybody develop to be able to have that level of conversation. And I think that's a cool thing to build. And I think patients get better care and I think if everything sinks. what what to you like really stands out like if we want to kind of make it and like what what specifically is changing and i think there are a lot of places we could go with that but i i'd say like let's take a couple minutes talk about like what's changing whether it's the way you're showing up the way i'm showing up the way other people are showing up and i'd like to make a few announcements Yeah, I think um I think for me, I'll speak for me, and I think this is probably mirrored throughout the organization and everybody's respective silos. think for me, what I'm noticing is proof of concept. And so there's less, there's less pressure to get it, to necessarily get it perfect, right? Like we're, we're seeing the fruits, we're seeing the stuff bear out. We can look at it. We have the ability to, the tools to discern what's happening and, and, ah And I think as a result, I'm able to start settling into a more specific role where I can gain some degree of mastery. think other people are starting to have their role sort of carved out as we've scaled and at the level that we're at now, we're not having to wear as many different hats. And so we're able to develop a greater degree of competency. um And I think not living in some sort of like fear of catastrophic failure. at least for me, allows me to show up in a way that's more regulated, more calm. um And I'll say really over the last, since January or so, I think for you, you're the kind of figure out of that, right? Like in a lot of ways you've mirrored this stuff in a way that I think is trickling down and we're kind of seeing it across the board from everyone. I think the... The emphasis on oh clarity and kindness and delivering that allows everyone to take the time to think and reflect slowly and thoughtfully. ah I know that's not necessarily super specific, there is something like, there's a lot of intentionality in that that I think has shifted and changed culturally for us. And I think it's important, right? Like you can't. Cause all of that stuff trickles down, right? Like if I'm having a bad day, if I'm not showing up well, people on my team aren't going to show up well. They're not going to execute well, you know, and for patients, they're going to be experiencing providers that are front like burned out, that are stressed, that aren't feeling well or whatever. um so I think there's this sort of collective calm and confidence is taking root, um, would be my 10,000 foot. observation of it and my personal experience with it. Yeah, and I'd say, you know, from the listening to the discussion mainly for the first half yesterday, you know, the thing for me was like everyone was asking, hey, what is the data say? So how many patients are we referring out to PHP, mental health, PHP IOP? how many people are calling in admissions and us kind of screening them out thinking that it's mental health primary ah what are the financial metrics we need to hit everyone was having a very data-driven discussion without turning into just like how do we make more money or and it was just really cool and then i think like for me again what what's interesting taking that kind of step back and not trying to solve a problem, but just lay out the path on what successfully solving a problem looks like, it does really turn down the temperature. We already think, I'll say, I know we have a world-class team. And if that's the case, then we should be able to make world-class decisions and execute uh great patient care and have a great culture. And so then it's really just like, uh how can we follow a somewhat deliberate process? uh so instead of, you in the past, what we've done is like pin a project in the success or failure on one person, right? Like you're in charge, you're accountable. As we're evolving, like our CTO Butler, you know, introduced me to a framework that I love, like called a RASC model, which is R-A-S-C-I. So. uh responsible, who's the responsible party, who's the accountable party, who's in a supporting role, who's in a consultative role, and who just needs to be informed. And a lot of times, like, I was taking the, you know, responsible or accountable party kind of seat for a lot of projects, and now I think that's shifting into a consultative or a lot of times just an informed role. Like, I need to know what's going on. But that's about it. And if we can kind of put a team together and then start a working group to follow our planning guide, then I think we can execute this. We can figure out what timeline works for us to keep us not feeling like we're treading water or we make some progress on the mental health, PHB, IOP, but then our existing services or metrics start to suffer. And that's just really exciting to me. we're, you know, we're walking and chewing gum at the same time. And for me to say that means that we are managing a lot of complexity well, because quite frankly, like I don't give enough, uh I don't lend enough credence to how difficult it is to just pull off what we're already, you know, doing and trying to do it really well. So I'm really just stoked about the how this mental health PHP IOP is going to roll out over the coming months. Yeah, same. It feels like a good litmus test for all of this stuff too. oh Yeah. is a real proof of concept on how we manage projects, how we lead. yeah, mean, it's genuinely very exciting. And it's exciting that we have a goal. There's a loose timeline right now. But it doesn't feel chaotic. Yeah. man. God, that feels good. So a couple quick announcements before we hop. uh In light of this idea of this being deliberately developmental and how this has become a core strategy for us. So we talked about Dr. taking some time off and being able to spend a month in Spain later this year. He's here in Europe for two weeks right now. uh That's something that he really values is taking time to travel with his family. So he's able to do that. He's also moving into the role of Chief Medical Officer, which is probably long overdue, but seems kind of silly when you only got five medical providers to have a CMO. ah So he's moving into that role, largely also in part because now we have Dr. Alexandra Spessett joining the team, who Dr. Book actually trained her when she was doing her residency at And she worked with our Executive Director, Corey. um at Carolina Outreach where they uh started a walk-in clinic and really innovated on the behavioral health side. She's coming in to be the medical director of the triangle, so in some ways I think that evolves into like a regional VP or vice president of medical services. She's going to be really focused on uh developing our clinical treatment guidelines and putting little more kind of structure and process into what we're doing in the medical side of things. uh And then Dr. O'Connor uh is uh going to be focusing more on patient care as opposed to some of the administrative responsibilities he's had and be doing a lot of psychodynamic training uh in order to kind of bring some of that back and also train our PAs and nurse practitioners on in-depth psychotherapy practices. uh again, just to close the loop on the deliberately developmental piece. You know, Dr. O'Connor moved into a medical director role about six months ago, and over the, maybe a year ago, and over the last quarter or so, a lot of conversations have been had. like, is this aligned with what I want to be doing right now in my career? And he said, you know what? I'd rather not be in this administrative kind of role. as much really focus on developing certain clinical skills and bringing that back into my supervision with our team. for him to be able to say that, for Dr. Book to say, hey, I think I should be the CMO, Dr. Special should take over. That means a lot of people are having conversations about their careers that is aligning their work with what they actually want to do work-wise and build the lifestyle that they you know want to have and and to me like that is the most rewarding thing possible and it is so cool to see people step outside their egos and just be able to say hey this is kinda what I wanna do is this possible and for us to figure it out Yeah, I think this is, as we're wrapping up, the thing that's really cool to me, right? This is the benefit of having something at scale, right? You've got room and a place for everyone to find, find themselves and find what it is that they're uniquely skilled at. That's a really, really cool thing. Totally. All right. Well, yeah, I'm going to go. It's 10 o'clock. I got lead practice in the morning. So I'm going go get a little rest. And hopefully the kids sleep through the night, because if not, it's going to be brutal. All right. I'll see you, man. see you man, bye.